Twice last week I was on panels with Republicans who expressed surprise about the “unseemly” tactics employed by Democrats in passing health care reform. The horsetrading was so “venal!” The process so “hyperpartisan!” Noble Americans, we should all be so very shocked!
Well, not really.
Those decrying the “hyperpartisanship” may have forgotten Republican Senator Jim DeMint’s rallying cry to the tea partiers and their GOP allies, in which he boasted that if they could “stop” the President on health care reform it would be his “Waterloo.” Indeed, according to Senator DeMint, it would “break him.”
“Break him?” What sort of Charles Bronson wannabe is that Jim DeMint? All this talk about “breaking people” is mildly reminiscent of what the bad guys wanted to do to the blue people inAvatar. And now those who wanted to do the “breaking” are whining about a lack of bipartisanship?
But even more curious are the complaints about the “horsetrading.” Yes, Senator Ben Nelson, in addition to acquiring for himself the dubious honor of making abortion coverage more onerous for women receiving federal subsidies, did manage to collect a number of special goodies for Nebraska.
Perhaps Republican Senate Minority leader Mitch McConnell could weigh in on that whole special goodie thing, since he managed to pull in around $51 million in special favors for the state of Kentucky in an omnibus spending bill earlier this year.
Obviously this process has been as ugly as that which attends most significant legislation. To suggest it is any uglier is nothing but a passive-aggressive attack against reform.
Lost in the hubbub over dead public options and the deals Senators like to cut for themselves is any meaningful discussion of what is actually in the bill, some of which does respond to many of the public complaints about the health insurance industry. I am not going to attempt to summarize here the entire Senate bill (or its counterpart in the House) — the Kaiser Family Foundation, however, has put together a very good summary — but here are a few of the key provisions, with their effective dates in parentheses:
- Insurers will no longer be able to increase premiums with impunity (2010) and will be banned from excluding from coverage those with preexisting conditions (2014). They will have to use least 80% (and in some cases, 85%) of premium-derived revenues for the provision of clinical services (2010) and if they don’t, they will have to provide their insureds a rebate for the difference (2011).
- Lower-income consumers will be eligible for subsidies to help them pay the costs of insurance (2014) and insurers will be required to cover certain essential services — with limits on consumers’ out-of-pocket costs (2014).
- Insurers will no longer be able to place lifetime limits on the dollar value of coverage (6 months after enactment) and ultimately will be prohibited from imposing annual limits as well (2014).
- The bill will also prohibit insurers from rescinding coverage except in cases of fraud (6 months after enactment) – a prohibition that hopefully will put to rest the insurance company practice of retroactively rescinding coverage because an insured had a “preexisting condition” of which she was unaware.
This is not to say, however, that the bill comes without its own costs: everyone will be required to obtain coverage, new taxes will be imposed on higher income Americans (the House version), high value insurance plans (the Senate version), and, among others, indoor tanning salons. Businesses may be penalized for not providing coverage but some may receive tax credits to help cover costs.
You can oppose these items because you think that the government has no business in this business (I would beg to differ) or because you think them too costly (the Congressional Budget Office has reported that the bill would cost $871 billion over the next 10 years and would reduce the deficit by $132 billion during the same period), but to suggest that the process that begat these reforms is uglier than any other bit of legislative dealing is to ignore the way that Congress has done business for as long as most of us can remember. At least this time the ugly frog that was the legislative process turned into, if not a swan, at least an edible egg-laying chicken.