I was reading through the "disgusted with DailyKos" diaries above and I wanted to respond. My response is long enough that it doesn't really fit well within the comments so I'm posting a diary to cover it. But the short version is that the bill doesn't change anything and it needs to be killed. Read on for why I think this.
There's the argument being made that there's a lot of progressive values contained in the bill and that we should be happy with them. Sure we aren't getting single payer or even a horribly mangled public option, but at least it's something, right?
There are two problems with this line of thinking. The first is that I don't believe the bill as currently constructed will fix anything. The second is a matter of how the politics of this plays out. Politics should always come second to policy, but it's still important in the long run.
Why it's a bad bill
Yes, it's actually a bad bill right now. The bill as constructed has essentially three core elements:
- Coverage mandates
- New rules for insurers
- Government subsidies
Now that all sounds good, but the question we need to consider is whether this fundamentally changes the health care environment in a positive way. That's what "reform" is, non? I would argue that it doesn't really fix anything. What it's actually doing is throwing money at the problem in hopes that it will magically go away. It won't.
Solving the right problem
The fundamental problem with our health care system is that the profit motive of health insurance providers and pharmaceutical companies is fundamentally in opposition to helping people get better. The less you spend on taking care of people, the more profit you make, and that's the fundamental motivator of any corporation. This bill does nothing to address that.
To illustrate why, let's consider recision. The bill outlaws the practice, which is great, but does that actually fix the problem? Recision is the practice of kicking people off insurance for the least little reason rather than paying for their expensive care. So what we do is eliminate one tool in the insurance company arsenal, but it does not, in any way change their motivations. They will still not want to pay for these people and will do anything they can to avoid it.
So what the private insurers will now do is find other ways to get these people off their rolls. They'll simply deny coverage for certain procedures. They'll make it hard to get approvals. They'll create a customer service nightmare. There's a million ways they can make it impossible to get the care you need that doesn't involve kicking you off outright. Their profit motive necessitates it.
Coverage mandates and throwing money at the problem
The bill doesn't address the right problem but it will help dump billions of dollars into the laps of private health insurance companies. Requiring people to get private insurance and providing subsidies for that insurance is just a giant transfer of tax payer money to these insurers. We'll end up with those 40+ million people mostly being covered, but what kind of coverage are they really getting?
Do you remember the Michael Moore movie, Sicko? In the beginning of it, he shows these people who do not have insurance. He talks about their plight and then says the movie isn't about them. Then spends the rest of the movie talking about how screwed people are that have insurance. My concern is that we're going to end up papering over the problem with dollar bills while we still have the same fundamentally broken system.
What I imagine is a future where you go to the hospital and you have insurance, thanks to the government, but then when you get there you have all manner of hurdles to actually getting what the government is paying for. Sure if you need basic services, no problem, and that is a positive thing, but if anything serious comes up you're still going to hit hurdles put in your way for the sake of profitability.
The politics
The politics of this is just terrible. The threats of progressives look weak because they were. By refusing to hold the line on some kind of public option, we've made it clear that future bills need not consider our interests. We'll sign on no matter what because it's "better than nothing" while conservatives will freely water down bills and make the reforms worthless.
Health care reform need not die with this bill, but this bill, in it's current form, doesn't actually reform anything. They need to go back to the drawing board or find another way to do this. My concern is that if this passes as is, we will lose the battle in the long run.
What the future looks like is a world where the motivation to fix things is weaker because, day to day, more people will have insurance and feel safer. But the quality of that insurance will deteriorate and the costs of that insurance will go up because that's what's been happening and nothing in the bill stops that. If anything it makes the problem worse because we'd be subsidizing the whole system.
Why we need at least a weak sauce public option
The establishment of a public option, even the weak sauce version that was in the bill previously, would have been a fundamental change. The reason is that it would have set up the ground work for creating government competition. Initially the costs would probably be no better, but it would allow for later expansion. It would also establish the precedent that the government can provide quality health care. Even in a limited form it would provide competition and a proof of concept.
Conclusion
The fundamental problem with this bill is that it does nothing to address the way we pay for health care and the cost of that care. We are just subsidizing the existing system with tax dollars. Furthermore it puts real reform at risk in the long term. They'll say, "see everything is fine," because most people are covered while the cost for that coverage will climb unabated. It is unsustainable in the long run, and the sooner we address that fundamental problem, the better off we'll be.
This bill must be killed because it will not make things better. We can go back to the drawing board and try a different approach. We can take the bill with a public option and run it through reconciliation. We can use parliamentary tricks to change how the filibuster works. We have many many options here other than passing a bad bill and we need to use them.