The Fact of My Ignorance

Today the Senate Finance Committe (made up of both republicans and democrats) released their long-awaited “compromise” healthcare bill.  Since Obama’s healthcare speech last week (Read or watch the speech here) this seems to be the bill everyone’s been looking to as the hope for the future.  Some of that may be warrented but there’s still a long road ahead.  I’ve provided details and links after the jump

Links

For the full text of the bill (which seems to be formatted in an odd paragraph format) see here:

http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

For a brief but thorough official 18 page summary see here:

http://finance.senate.gov/press/Bpress/2009press/prb091609.pdf

For the Congressional Budget Office’s always excellent and always non-partisan analysis see here:

http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16-Proposal_SFC_Chairman.pdf

For a summary of the CBO analysis, from their blog see here:

http://cboblog.cbo.gov/?p=354

And for CNN’s description of the bill, which seemed to me to be the most balenced and informative of the major news outlets articles see here:

http://www.cnn.com/2009/POLITICS/09/16/health.care/index.html

Summary

So what does it contain?  Well it’s similar to many of the bills completed in the last few months in that it contains subsidies for those who can’t afford insurance, a mandate for individuals to purchase insurance, new regulations preventing insurance companies from dropping patients mid coverage or denying them insurance due to pre-existing conditions, mechanisms for eliminating waste from medicaid, and it creates a health insurance exchange.  But it’s also clearly designed to appeal to republicans and thus has some important differences from previous bills, specifically:

-It does away with the “public plan” (read more about the public plan) and replaces it with a series of co-ops (read more about healthcare co-ops)

-It includes more detailed provisions against providing funding for illegal immigration, adding stronger enforcement mechanisms

-It discusses abortion explicitly, reinforcing the old capp’s amendment, making clear that no tax dollars would be used to pay for abortions, except in cases of rape, incest, or immediate threat to the life of the mother, as it has always been in medicare and medicaid.  It also allows all state abortion regulations to stay in place

-Encourages tort reform, the details of which are to be decided by individual states

It’s also important to note that the CBO analysis was also released today and on the two big statistics everyone’s looking for the bill does decently well.  Ten years out the CBO predicts that the projected number of uninsured will be reduced from 54 million, to 25 million (pg 16), and the federal deficit will be REDUCED by 49 billion (pg 3)! That second number is significant because while Obama has always maintained that he would not sign a bill that wasn’t at least deficit neutral, this is the first completed bill I’m aware of that actually is.

Reception

The bill was received with optimism by the president, and by democratic leaders of the senate, but some democrats there have expressed concerns, namely Jay Rockefeller, who has come out in open opposition to it, and fellow finance committee member Ron Wyden.  In fact, as of right now, nobody on the Senate Finance committee aside from Baucus has endorsed the bill, and no republicans are committed to support it.  Not even the moderate Republican Olympia Snow who the white house has been working with extensively.  But the markup process will proceed for the next several weeks and it’s quite likely that a few republicans will be on board by that time.  Acquiring the support of at least a few senate republicans is a necessity since democrats do not have the majority necessary there to pass the bill on their own.  But moderating the bill wasn’t motivated purely by a desire to attract republicans, several moderate democrats were also somewhat uncomfortable with some of the provisions of the house bill and their support should also be more reliable with the Baucus Bill.

Unfortunately, widespread republican support on this, or any bill, cannot be expected.  Upon the Senate Finance Committee Bill’s release today, Mitch McConnel (R-Kentucky) released a statement saying “This partisan proposal cuts Medicare by nearly a half-trillion dollars and puts massive new tax burdens on families and small businesses to create yet another thousand-page, trillion-dollar government program.”  With all due respect to Mr McConnell, the first concern about cuts to medicare has already been widely debunked, there are new taxes for very few Americans but I think anyone looking at the numbers would say massive is a gross overstatement, the bill is not a thousand pages but is only 223 pages (almost half of which is just describing existing policies) and the CBO clearly predicts a gross cost of a bit over 800 billion dollars over ten years and a net cost of -49 billion.

But this kind of response was to be expected.  I tend to agree with Obama’s assessment in his speech last week that there are

“those who have made the calculation that it’s better politics to kill this plan than improve it”.

Back in July, Sen. Jim DeMint (R-SC) said in a conference call, “If we’re able to stop Obama on this it will be his Waterloo. It will break him”.  And since that time, I think, many republicans have committed themselves firmly to the idea that killing reform in the hopes that it will destroy Obama and get them more congressional power in 2010 is the best course of action.  The fact that republicans have yet to submit a proposal that is even halfway serious seems to support this theory.  Not that this is new behavior for congress.  It’s unfortunately common for one party to oppose good, moderate proposals simply for strategical reasons, especially when that party is the party out of power.  But I guess I had just hoped that with a healthcare crisis immediately looming, and with this being a subject that deals with the very life and death of American citizens, everyone would be putting forth a good-faith effort.

Anyway, this is important because it means that Democrats can really only hope to pick off a handful of republicans to support this bill, and they risk losing a corresponding number of liberals at the same time.  It’s a difficult task to balance.  And it’s beginning to upset liberals, Like Rockefeller and Wyden, who feel that Democrats “are being asked to support a bipartisan bill that doesn’t have bipartisan support.”  The compromise without the cover.  This same concern was present back in Stimulus days when extensive bipartisan talks resulted in a strikingly conservative final bill (with the final product being 42% tax cuts and 58% spending, nearly equaling Rush Limbaugh’s stimulus proposal in the WSJ of 48% tax cuts and 52% spending), but it still passed on a nearly party-line vote.

In the end will liberals say, “enough is enough” and push through a bill using a public plan with no republican support?  Will they use the controversial budget reconciliation method to do it?  Or will they stay on board with a compromise bill as it continues to be modified to meet republican needs to draw those precious few to their side?  Time will tell.  Personally, as much as I think a public plan would be a better choice, I think budget reconciliation is the wrong way to go at this point.  I think Americans prefer a bi-partisan bill, even if that bi-partisanship amounts to 57 democrats and 3 republicans.  And while I’ll reserve my final judgement for when mark-ups are finished, I think baucus’s bill looks decent so far.  Frankly, if it weren’t for the possibility of securing something “better” I think democrats would be thrilled with it.  I hope the liberal democrats realize that it would be silly if we took 0 steps forward because people were upset about taking 3 steps forward instead of 4.

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