Alright, here's the score. The Senate, barring some unforeseen circumstance, is going to pass a health care bill. Yes, it sucks. No public option, no Medicare buy-in. It's a steaming turd.
So we have a choice here. We can freak out and run around in circles, or we can push our Congresscritters, who'll soon be negotiating in conference committee, to get some final improvements in the last revisions to the bill.
So what can we accomplish? Where is there room for us to work?
I love the idea of the public option, and of single-payer, and think the Medicare buy-in was a great idea for a compromise. But Joe Lieberman and Ben Nelson cockblocked those ideas. They're not gonna happen. It sucks, but we want to redirect our energy to somewhere where we can get results.
Where is that direction?
Think about it.
Who here likes dealing with their health insurance company? (Assuming you have the means to get health insurance...) Nobody.
Health insurance companies in America are HATED!!!
That's why there's so much of a backlash over the dropping of the public option - they were the means to check the price-gouging and the abusive behavior of the insurers. That's why there's so much hate for mandates - it's basic emotion - we're being required by law to fork over our hard-earned cash to these organizations which we HATE, and that pisses us off!
Because we hate those fuckers and are tired of being scalped by them.
This means that regulation is POPULAR.
Any new provisions that put checks on the ability of insurers to screw us will be greeted with cheers from the voters. Anything that will force them to pay out more, get us more health care, and keep them from screwing us will be hard to resist. Any resistance to tightened regulation this late in the game will result in immediate backlash. That gives us power. Regulate 'em!
And regulation is still in the final bill. At least some form of ban on pre-existing conditions clauses is still in the bill, as is the ban on rescission of sick people, as is the ban on lifetime and annual benefit caps.
They can be strengthened. And they have been strengthened. Because we made a huge amount of noise in the backlash to the stripping of the public option, Reid did put some things like the annual cap ban back in the bill. There's room here for us to demand more improvements.
We can demand that the age-based pricing cap (currently old people would pay 3 times more than young people) be tightened up. We can demand removal of the loopholes in the community rating provisions. We can demand more oversight of insurers and more penalties for insurers that behave badly. We can demand that the out-of-pocket maximums be reduced. We can demand that insurers pay 85+% of the bills instead of 60%.
While we're at it, demand some sunshine laws - regulatory actions need to be public, and out of the smoke-filled rooms. That includes appeals of denials, actions to fine misbehaving insurers, etc. We've got a lot of regulatory capture, and transparency can make it harder for regulators to turn a blind eye to abuses. Make some rules where insurance industry executives and employees are not allowed to be employed as regulators, and vice versa - lock the revolving door!
While we're at it, try to get the anti-trust exemption revocation back in the bill - it has a chance of making it, since it has a lower profile than the public option or the coathanger amendments, and Ben Nelson might not be able to make slick-sounding excuses for cockblocking the bill over anti-trust like he could for abortion or public-option.
There's where we've got to focus our political pressure - to tighten up the regulations on price-increases, on discrimination against sick people, on all the bad behavior of the insurers. There's still room to regulate the fuckers, and that's what we need to do.
The bill sucks, but there's still room left to make the bill less sucky.