I get that there is no panacea for healthcare reform. I get that there is no political will in Congress for a strong public option, much less Medicare for all. I get that you have to play with the cards that you are dealt, and President Obama does not have the cards to outbluff some senators.
I don't get how "something is always better than nothing." If there was a bill that gave Medicare for all but outlawed abortion, would that something be better than nothing? The bill that is being unveiled in the morning doesn't have Medicare for all, a public option, and (if Senator Nelson gets his way) no expansion in Medicaid spending. It does have mandates to buy health insurance and subsidies to fund them, but the subsidies are being paid for by taxes on already existing insurance plans. It will also negatively impact women's rights if Senator Nelson has his way.
There will be federal guidelines that set for the MINIMUM that an insurance has to cover. I guarantee that the minimum is going to be the status quo from now on. It is in the best interest of the insurance company to only provide as much care as it absolutely has to provide.
Insurances will start negotiating from the MINIMUM requirements. The "cadillac" plans that are being taxed for the subsidies will get outpriced or cost shifted to the patient. After all, why should an employer offer MORE than the federal minimum? If the employees want more, they can pay for it. "But companies can't do that!" you say. Why not? There is no law saying an employer SHOULD provide insurance; it's just been a convention that insurance was a part of the compensation package. Already some small businesses are worried because they are already being priced out of the insurance market.
So? The system is working! Now employers don't have to worry about providing coverage! Then where do the subsidies come from? What are we going to tax to take their place?
As employers drop insurance, they COULD up the wages of their workers. After all, they aren't paying those pesky premiums any more! Somehow I doubt that is the route they will take. Oh, the workers might get a dollar or two here and there, but the bulk will go into the business. Especially since the Fed views increasing wages and inflationary, and it will do anything to control inflation that it can.
So, people will have minimum coverage that is going to become more expensive, and we can only hope the minimum coverage is similar to what they have now. If not, you can be sure to see ads about the "good old days before healthcare reform" everywhere.
Well, we'll fix that over the next few years. An amendment (like to an appropriations bill that has to be passed) can fix that!
Right now President Obama and this Congress have the most political capital to spend. Going by historic trends (which may not occur next year), democrats will lose seats in Congress. Even if they don't lose their majorities, this will weaken the power the administration has to get its agenda through Congress. After the midterms the Presidential race of 2012 will be underway, and no sitting president is going to push through anything controversial. Even to "fix the bill" there will be compromises and we've seen how well those work out.
Still this could be the only time to pass healthcare reform before the system is completely gone! It may be. Maybe it is "pass anything." Without passing a bill the President and Congress look weak and ineffectual, and the mushy middle don't like voting for the weak and ineffectual.
But where is the line? If we simply call a bill "The Healthcare Reform Act of 2009" without it actually reforming healthcare, is that enough? Do we think that the voters are so oblivious that as long as it SAYS it's healthcare reform that they will BELIEVE it is healthcare reeform?
I don't have answers. If I thought that it would help, I would call my senators and congressmen, but they are Republicans and the bluest of Blue Dog DINO's you can get. The White House at least SEEMS to think that anything is better than nothing, so I have written them with my opinions.