The Realities Of Passing Health Care & The Risks Of Not

The Realities Of Passing Health Care & The Risks Of Not


Time and time again during this grand debate, I’ve said that compromise was not only appropriate, but also absolutely necessary if we wanted anything passed. Yes, this legislation is flawed. But all important legislation is. Eventually, we’ll build on this and create something that works for every single American, but for now we’ve got a good start.

Still, what did we hear from the left throughout this process? “You’re not doing enough! This isn’t reform! Give us a public option or give us nothing! Obama is breaking promises!” Perhaps they forgot this during the Bush years, but politics is the art of the possible and a public option wasn’t possible with this Senate. Neither was not having a mandate. Sorry folks. Thems the breaks. And it’s not like the Dems will have a better chance to pass this because it’s likely that Dems will lose their 60 votes next year.

Thankfully, liberals like Ezra Klein get it…

Passing legislation, it turns out, is a long and ugly process. God, is it ugly. The compromises, both with powerful special interests and decisive senators. The trimming of ambitions and the budget gimmicks and the worship of Congressional Budget Office scores. By the end, you’re passing a compromise of a deal of a negotiation of a concession.

But bad a system as it might be, it’s the only one we’ve got. At least for now, this is what victory looks like. The slow, grinding, ineluctable advance of legislation that is quite similar, albeit not identical, to what you began with. It’s not pretty, and it doesn’t necessarily feel like winning is supposed to feel. But this bill will do most of the things supporters hoped it would do: cover about 95 percent of all legal residents, regulate insurers, set up competitive exchanges, pretty much end risk selection, institute a universal structure that we can improve and enhance as the years go on, and vastly reduce both medical and financial risk for families.

It’s been a long time since the legislative system did anything this big, and people have forgotten how awful the victories are. But these are the victories, and if they feel bad to many, they will do good for more. As that comes clearer and clearer, this bill will come to feel more and more like the historic advance it actually is.

And from the right, well, there was basically a consensus early on that defeating the health care bill was more important than being involved in the process. I thought that was foolish, and still do. Sure, they’ll pick up some seats next year, but they weren’t involved in the most important legislation they’ll ever vote on. And all because they wanted to pick up some seats? Not smart.

Let’s see what they voted against:

  • Removing lifetime caps on how much care you can get.
  • No more denying people insurance based on pre-existing conditions, which has the net effect of making health care a right, not a privilege.
  • Insurance companies can’t charge higher premiums based on gender or medical history.
  • Subsidization of private health insurance for Americans who make up to 400% of the poverty level.
  • Medicaid will be extended to those who make 133% of the poverty level.
  • Health insurance exchanges (co-ops) will be established in all 50 states that give people and businesses the opportunity to pool together and force down premiums.
  • Antitrust exemptions for health insurance companies are now gone. That means the monopolies that exist all across the country will eventually go away.

That’s a hell of list to oppose. Think that won’t hurt Republicans down the road? I can’t help but think it’ll seriously hamstring them, especially after 2014 when a lot of the reforms kick in.

So, those are some of the realities and the risks. And, at least to me, Americans got one hell of a gift this holiday season with this legislation. Tell me what you think.

  • Alistair


    Like Ezra Klien Chris Mathews is another person who get it too. He argue that President Obama needed to compromise with Democratic Senators from Red States like Nebraska, Montana, Arkansas, North Dakota, South Dakota and Louisana.

  • Justin Gardner


    Exactly. Compromise was key for this legislation and Dems didn’t have any other options. That may seem crazy to a lot of liberals, but that’s the reality…and welcome to it. :-)

  • SpkTruth2Pwr

    You are very right. Good policy should be about the measures that will work best, but no policy is effective without looking at the tradeoffs, and looking at FEASIBILITY.

    It was clear that public option was not going to last once it hit the Senate – and I wanted a public option badly – but I do think it is important not to become disillusioned and take this progress we have seen in both the House and Senate for granted.

    So I say this is a big Christmas gift for America that will pay dividends down the road!

  • William Crider

    I agree that this bill does accomplish some reform that is admirable.

    Such as extending benefits to many lower income individuals. Not allowing denial for preexisting conditions.

    What is missing that is an easy fix is allowing nationwide competition by plans. Alo no mention of the need tort reform.

    The major flaws, taxes start immeciately, benefits in 2013, 2014. Requiring states to expand Medicaid (unfunded mandates). Government oversight agencies with unfettered powers.

    The method of back room deals and not transparency or public input makes me believe it can not stand up to honest debate.

    I am personally discusted with our political represenatives, I will work against the reelection campaigns of all incumbents. I live in Nevada and Harry Reid, snuck into town in August and would meet with no voters. His telephone town halls were nothing but vey controlled campaign speaches.

    Health care reform is needed urgently. I am positive that if we took a group of honest citizens we could craft a bill that would meet the needs of the citizens.

    I personallly worked for 30 years in behavioral healtcare field, have been a patient (victim) of both insurance denials, and Veterans Administration Care. It makes no difference who is in charge of the show they have their own agenda and that is not what patients need.

  • CJ

    Until the title of a bill reflects 100% of it’s content there will be no significant change. Until congressional representatives do not have the option of hiding legislation within legislation no significant change will come. Until they represent the people who elected them instead of special intrests and do the right thing instead of what is politically safe we have no democracy. And stating that you are either a conservative or liberal before you’ve even heard the question or proposal is a sign that deadlock and stalemates will be the nature of legislation for a long time to come.
    Get rid of the isle. Seat representatives alphabetically. Call them out for voting their campaign wallets instead of their conscience, and remind them who they represent, (really). Just a start but it’s gotta start somewhere. Don’t you agree??