Health Care Reform: A Refresher, Part Two

While the politics of health care reform had been brewing for decades, the new incarnation of the beast came in early March 2009.  At the President’s summit on health care, the stakeholders and power brokers came together in a series of meetings designed to bring about bipartisan legislation. The ensuing 13 months were filled with a number of good ideas, all unfortunately drowned out by an avalanche of political shenanigans and outright lies. This article will highlight (or lowlight) that process.

Coming out of the summit, even the health insurance industry was on board the reform bandwagon. They saw the benefits of changing the way doctors billed for services, and hoped for reasonable reforms in the pharmaceutical industry. Several Republican senators were signed on as cosponsors of the Healthy Americans Act, introduced first in 2007 and then again in February of 2009. The bill was an ambitious attempt to decouple insurance from the prevailing employer-based system. Its architects, Senator Wyden of Oregon and Senator Bennett of Utah argued that the fluid nature of the U.S. labor market made employer-based plans unsustainable. They were also able to point to a rough study by the CBO that concluded the measure would be “budget-neutral” in 2014.

The HAA (known as S. 391) was paired in the early going with a bill being tossed around the House and designated HR 676. HR 676 was the so-called “single-payer” bill that would replace the insurance industry with a government agency. Different from a purely socialized structure, single-payer would essentially be Medicare for all. No more bills, co-pays, or premiums; just a hefty tax increase. These two bills both provided relief to the nation’s small business community and those individuals who wanted to start ventures of their own. But neither of these two bills were destined to see the Sun; most Republicans were prepared to defeat them, the President thought both too radical, and powerful Senate committee chairs Max Baucus and Ted Kennedy had personal agendas.

The President told supporters of both bills that the Administration would not be supporting either. In July, the House moved onto the path that would eventually lead to the law we have today. The so-called liberal media was quick to point out the size of the bill…both in terms of price and, ridiculously, page length. Starting a theme that Republicans eagerly adopted, the media decided that a bill with 1,000 pages must be problematic. The idea blended well with the GOP mantra of health care reform as “government takeover’. The entire Tea Party movement was built on the anger of the population of the perceived takeover over elements of the marketplace by the “socialist” government of Barack Obama. A bill with that many pages, some felt, must include protocols that would facilitate takeover.

The multiple bills, large cost, bill length, and scale of change gave opponents many opportunities to muddy the water. The opposition to health care reform would become expert at the art of straw-man construction; whereby a non-existent element in the bill is identified, attacked, and refuted. The strategy has the novel benefit of allowing politicians and pundits to debate an issue without facts getting in the way. Early Senate estimates of a $1.6 trillion bill were used for every incarnation of reform throughout the duration of the process. The American people spent 9 months or more hearing Republicans in the House and Senate, individuals who knew better, calling various proposals “$2 trillion takeovers of the U.S. health care market”.

By August, the debate reached a tipping point and public opinion for passage began a long, slow decline. Democrats eager to explain their proposals to constituents at town halls were met be organized “shout-down” teams who bullied and browbeat the legislators into silence. A clause in the public option section of the most prominent House bill existed to provide funds that facilitated counseling for patients and doctors regarding living wills, medical powers of attorney, and do not resuscitate orders. The clause was derived from the Medicare Act of 2004, an act passed by the Republican Congress and signed by the Republican President. In the hands of Fred Thompson, Sarah Palin, and Chuck Grassley, it became the Death Panel controversy of 2009. It is instructive that death panels led to an ongoing theme of opposition by Republicans; that Democrats were trying to save money by hurting seniors and attacking Medicare.

“The government better keep its hands off my Medicare”, was a pivotal moment in our democracy; a moment of profound ignorance that let Republicans know that it was open season, with no restrictions. If seniors didn’t realize that Medicare was single-payer medicine, the military was socialized medicine, and Republicans had spent 40 years trying to beat and then repeal Medicare, then the GOP and its allies could say and do whatever they wanted to defeat the legislation. But the problems with health care reform weren’t all sourced from the party of Limbaugh. The Democrats, as is their habit, were in a hurry to cut their own throats.

Mr. Obama, in his haste to clear the way for health reform, blunted a critical avenue for cost containment when he dealt with  Big Pharma. The patent monopolies and protectionist policies afforded to drug companies, on the false premise that they are necessary to generate innovation, were and are principle drivers of cost in the market. Far more damaging to the process however, was the needless shenanigans of the Max Baucus-led finance committee. In a bad attempt at window-dressing, Baucus delegated a six senator sub-committee, with three Democrats and three Republicans, to come up with legislation. The idea was bipartisanship, the result was gridlock and a bad bill. Majority Leader Reid cut and pasted elements from that bill, and another stinker from the Health Committee, to form a Senate bill that could be voted on.

The House passed a reform bill in October, then waited for weeks while Reid tried to assemble a bill that could get 60 votes. The bill needed 60 votes because Republicans were using procedural maneuvering to keep the bill from coming to an up or down vote. Matters were further complicated by several Democrats who used the opportunity to leverage changes to the bill. Ben Nelson, Blanche Lincoln, Mary Landrieu, and Independent Republicrat Joe Lieberman refused to allow the bill to come up for vote until their requests were met. Most of the challenges revolved around the now legendary “Public Option”.

The art and science of polling, the battle over the public option, and the 4 month roller-coaster ride for health care reform are the subject for part three of Pigeon Post exclusive,  Health Care Reform: A Refresher.

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