My family is comfortable and healthy; my country is angry, uncomfortable and unhealthy. Constant Healthcare reform gyrations and capitulations left a bad taste. The Senate Bill has good and bad features- is it a blessing, a curse or a Pyrrhic victory predicting defeat? Consider it in the context of the recent Copenhagen meeting ("partial success...Britain and other countries imposed a weak agreement ‘at the peril of the millions of common masses’") and the tragicomedy of California state government, where four different ballot initiatives are gathering signatures hoping for an easy out, to legalize and tax marijuana.
Healthcare reform (HCR) can bring better and more affordable healthcare to almost all Americans and reduce business costs. Obama and the Dems didn’t stress our system's many deaths and bankruptcies (many of the medically bankrupt had insurance). There are no French or Swiss medical bankruptcies. A national one-payer solution was never feasible, because of corporate and right wing opposition and because the Obama plan was/is basically the old RomneyCare plan, see surprising history of healthcare reform Medicare expansion was a good idea, but nothing was done to frighten Congress. A one payer plan should be tried at the state level- if successful, maybe later at a national level.
Obama’s election was a small step forward, aided by disgust with the Bush/Cheney policies and by McCain’s erratic behavior during the fall economic crisis. Annise Parker’s election as mayor of Houston is another small step. There was no conservative option and turnout was low. Parker is a cautious person, perhaps even more financially cautious than Obama. Young people will see that an openly gay executive does not make the skyscrapers fall. On the other hand, Houstonians will not embrace gay marriage. Acceptance of openly gay politicians will not end the religion-stoked fear of gays and gay marriage among older Americans, especially rural Americans. This will take years.
Palin-NRA enthusiasts are predominantly rural and older. Gay politicians are city folks. America is divided between two groups, based primarily on life style. Read The Big Sort. There is a middle group, but few Americans are truly independent today. Most Americans can’t sustain enthusiasm for either the Democratic or Republican Party, with reason. They aren’t indifferent or uncertain about big life style issues such as gay marriage, family structure, religiosity, taxes for public education, obligations to the poor, military might, etc. The rural-urban divide is stronger than the religious divide. Many urban Americans are very religious. Although European religious interest has declined greatly in the last 75 years, US church attendance has increased.
Most Senators and House Blue Dogs dance to rural tunes. They supported the Iraq War because they always vote for patriotism and military solutions. Some ask why Obama could not manipulate Congress like Bush did. Complex question- 1. Presidents have great power to launch military actions, but much less power in the domestic realm. 2. Obama considers costs and deficits, Bush/Cheney did not. 3. Obama is a great compromiser, like Henry Clay. It’s not in his nature to fight corporate America. Although median personal income for the communitarian left is significantly higher than that of the Palin rural right, the right knows how to intimidate the media.
Nate Silver, Paul Krugman and many others say that any increase in the number of people insured and cost reduction for poor Americans is good; I respect them. See Krugman’s http://www.nytimes.com/... Silver says "the individual mandate penalty is not very harsh, especially for lower-income people". I disagree. The mandate activates the individual rights trump card. It's a poison pill, the Gallipoli strategy. Winston Churchill insisted on repeated frontal assaults on the Dardanelles in 1915; it was a total failure. See Failure at Gallipoli
Churchill was also in command at Dunkirk, where the allies salvaged a desperate situation in 1940. The critical difference: salvation came from thousands of British people who crossed the channel in small and ancient boats to retrieve British fighters, a bottom up solution. Had the entire British force been destroyed at Dunkirk, parliament might have forced Churchill to surrender.
Consider three problems: 1. The House & Senate bills are very different- what happens in conference? - will anti-abortion provisions be increased? Will the House provisions be scuttled?
- What about the sweetheart deals? $100 million for Landrieu, $100 million for Dodd and his "UCon", which guarantees his defeat next fall, and many more. Nelson was bought off by money for Nebraska Medicaid. This payment continues indefinitely. All legislation involves compromise and bribes, which are usually concealed. These widely publicized buyouts will stimulate letters and phone calls to Congress, saying NO. Optimists say that there will be more calls saying, preserve and expand the gains for the uninsured. Color me pessimistic. Remember that the USA originated in a middle class tax revolt.
- will regulation of the insurance companies be any more effective than California’s current Potemkin regulation?
Robert Reich says, "We are slouching toward health-care reform that's better than nothing but far worse than we had imagined it would be ". Dems will lose Congressional seats in 2010. The top-down route can’t give us sustainable American HCR. Obama and Axelrod took a brilliant top-down strategy to the White House. Switzerland and Taiwan used top-down strategies for successful HCR in the 1990s. They don’t have our peculiar political system or our bloated military. I agree with the California nurse’s criticism, California nurses say no. It will be difficult to sustain the present bill against popular outrage/tax revolt because nobody understands it and its benefits and cost controls are mostly delayed. If it fails, there is no way to start over in the 111th or 112th Congress.
What is my bottom up HCR solution?
Preserve what we can (especially community rating rather than underwriting) and fight again at the state level.
Section 1332 of the Senate bill permits waivers for state innovation, starting in 2017. States may apply for a waiver to replace the new health care system created by the bill with something else. 2017 is far off; three elections away.
Why so sure that only a bottom up solution will work in today’s America? Because HCR will collapse without shared sacrifice – the current bill lacks realistic financing or cost control, Medicare commissions have again been hamstrung until at least 2014, and will be watered down in conference to conceal disagreements. A millionaire’s tax won’t do it: Congress will undo any millionaires’ tax with the support of many poor people. They supported cutting "death taxes" which provided money for safety net services, and second, a millionaire’s tax doesn't bring enough revenue. We must tax everybody (a graduated tax). Yes, some smart people like Atul Gawande, how the feds enhanced agriculture believe that cost control will come in gradually from the bottom up: I’d like to believe him, but I can’t. California has advanced something for nothing disease. Attempts to legalize marijuana at the state level can keep lawyers busy, but will be a Pyrrhic victory. What about Copenhagen? Almost all states accepted the climate problem as real, but wanted others to pay for its control. The Guardian has part of the complicated story copenhagen jousting
The promises made are not enforceable. Former IGCC chairman Martin Parry says that they would meet at most half the likely costs.
Why do I say that a state one-payer plan would be properly financed? It will fail if it isn’t- the feds won't bail them out. I've called my representative and Senators and asked them to save the bill without further cutting cost control. Maybe I’m wrong. I call no names. We have the Gruber-Romney Care plan, without sound financing, and two elections before most people start to benefit from it. The Republican derived plan transfers money from blue to red states, as pointed out by avenging angel, red states are health care pits. I don’t believe that Congress will go through with the planned 20% reduction in Medicare physician payments for 2011. Sounds good to the CBO, but doesn't pass a reality test.