About The Most Sweeping Piece of Social Legislation in Decades

Ken AshfordHealth CareLeave a Comment

Obama_health_care_victory_shirt_from_Zazzle.com-20100322-130448 New dawn.

And yet, somehow, we're still a democracy.  The iron fist of Stalin is nowhere to be found.  People got up today and went to work, just like last week.  Only this time, they go to work knowing a few things have changed.  Here is what is coming online immediately or within the first six months:

  1. Adult children may remain as dependents on their parents’ policy until their 27th birthday
  2. Children under age 19 may not be excluded for pre-existing conditions
  3. No more lifetime or annual caps on coverage
  4. Free preventative care for all
  5. Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
  6. Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
  7. The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
  8. Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
  9. Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
  10. AND no more rescissions. Effective immediately, you can't lose your insurance because you get sick.

The New York Times gives a more thorough but easy-to-understand breakdown of what health care reform will mean for you.  For most of us, not a lot has changed.  (By the way, mainstream media, maybe you should have reported this before, instead of the he-said-she-said back-and-forth demagoguery that went on for months).

It's not socialized medicine (although I wish it was).  It just forbids a lot of the abuses of the insurance industry.  It is, as many have said, a good first step.

It is rather astounding that we got this far.  As late as Thanksgiving, health care reform was dead in the water.  And then when Scott Brown was elected from Massachusetts to replace the dead Ted Kennedy, here's what Fred Barnes wrote (January 20 of this year):

Oh, yes. The health care bill, ObamaCare, is dead with not the slightest prospect of resurrection. Brown ran to be the 41st vote for filibuster and now he is just that. Democrats have talked up clever strategies to pass the bill in the Senate despite Brown, but they won’t fly.What changed?  I think a couple of things. 

Uhhhh… not so much.  But why was Fred and others so wrong?

First of all, House Speaker Nancy Pelosi (who, I must say, grates on me) did the yeoman's job of getting the votes.  The Obama White House was just about to offer small little mini-health care bills, but Nancy persuaded them to go for comprehensive reform, and she delivered the votes.

Second of all, the insurance companies shot themselves in the foot the past few months.  A 39% rate increase?  What a stupid time to announce something like that — in the middle of a national debate on health care.

And finally, Obama stepped out from the Oval Office and actually began pushing health care reform, demonizing the demonizable insurance industry.  He became, in a word, partisan instead of Mr. Kum-by-ya.  And that helped carry the day.

It should be noted that Republicans were never interested in health care reform.  There have been many votes on various proposals.  There have been four votes taken in the House regarding various proposals.  Two in the Senate.  And about seven votes from various proposals floated by House and Senate committees.  Of all those proposals put forward, only ONE time did a Republican vote for health care reform.  ONCE, by ONE Republican.  Every other time Republicans have had a chance to vote for any version of health care reform, they have always voted NO.  Every single one of them.

[UPDATE:  I find it funny that Republicans are now going on teevee lamenting the lack of bipartisanship and transparency in the process.  For well over a year, Obama extended his hand to Republicans and they batted it away.  Ridiculous.  UPDATE UPDATE:  And now, McCain is saying not to expect any Republican cooperation on any legislation for the rest of the year.  Uh, and that's different from GOP obstructionism how?]

I think one of the nicest things about health care reform passage is this: at the end of the day, fear lost.  That was, of course, the GOP tactic from day one.  Paul Krugman writes about this:

The emotional core of opposition to reform was blatant fear-mongering, unconstrained either by the facts or by any sense of decency.

It wasn’t just the death panel smear. It was racial hate-mongering, like a piece in Investor’s Business Daily declaring that health reform is “affirmative action on steroids, deciding everything from who becomes a doctor to who gets treatment on the basis of skin color.” It was wild claims about abortion funding. It was the insistence that there is something tyrannical about giving young working Americans the assurance that health care will be available when they need it, an assurance that older Americans have enjoyed ever since Lyndon Johnson — whom Mr. Gingrich considers a failed president — pushed Medicare through over the howls of conservatives.

And let’s be clear: the campaign of fear hasn’t been carried out by a radical fringe, unconnected to the Republican establishment. On the contrary, that establishment has been involved and approving all the way. Politicians like Sarah Palin — who was, let us remember, the G.O.P.’s vice-presidential candidate — eagerly spread the death panel lie, and supposedly reasonable, moderate politicians like Senator Chuck Grassley refused to say that it was untrue. On the eve of the big vote, Republican members of Congress warned that “freedom dies a little bit today” and accused Democrats of “totalitarian tactics,” which I believe means the process known as “voting.”

Without question, the campaign of fear was effective: health reform went from being highly popular to wide disapproval, although the numbers have been improving lately. But the question was, would it actually be enough to block reform?

And the answer is no. The Democrats have done it. The House has passed the Senate version of health reform, and an improved version will be achieved through reconciliation.

This is, of course, a political victory for President Obama, and a triumph for Nancy Pelosi, the House speaker. But it is also a victory for America’s soul. In the end, a vicious, unprincipled fear offensive failed to block reform. This time, fear struck out.

Hear hear.

The unhinged-ness of the right was never more apparent than last night when Rep. Bart Stupak (D-Mich.) got up to speak and a Republican representative — not someone from the gallery, but an actual elected representative — called him a "baby killer".  Watch:

That is simply remarkable.  Listen, I am pro-choice and strongly disagree with the pro-life Stupak, who singlehandedly almost succeeded in killing health care reform because he feared (wrongly) that federal assistance would go toward paying for abortions.  Once he was reassured that this would not happen, including the assurance from Obama through an executive order forbidding such practices, he voted for health care reform.

And this makes him a "babykiller"?

[UPDATE: Rep. Randy Neugebauer (R-TX) has stepped forward and admitted he was the one….although he's saying that he shouted out "it's a babykiller", in reference to the law, and not Stupak.]

That's the funny thing about conservatives and their stance on health care: they think Congress ought to protect unborn children; but once you are born, you are on your own and/or a freeloader.

Anyway, one thing about which all can agree.  The Democrats "own" health care now.  If it is better, they will be painted favorably by history and a whole new generation.  If it is worse, the opposite will be true.  Of course, the same thing was said almost 50 years ago when Democrats were largely responsible for the passage of Medicare.  And guess what happened?  People came to LOVE it.  In fact, the teabaggers were livid that Medicare might come to an end.  I expect the same will hold true for today's new health care reform initiatives.

Conservatives are convinced that health care reform went against the overwhelming will of the people, which is true if one defines "the people" as Republican Fox News watchers.  Ultimately though, about half of the country was always in favor of health care reform.  Still, most Republicans think this means huge victories in the 2010 midterm elections.  Maybe they're right about that, but I find conservative speechwriter David Frum to be reassuring when he writes that yesterday was the Republican's Waterloo:

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

So far, I think a lot of conservatives will agree with me. Now comes the hard lesson:

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.


This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.


We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.

That's a pretty strong condemnation of his own party.  Guess he's a babykiller, too.

Still, I think the Republicans will enjoy a short-term gain in November, and probably control both houses of Congress.  But their long-term legacy of stonewalling what is sure to be a popular package will hurt them in the long run.


Okay.  What's next?