Why I Still Believe In This Bill: Jacob Hacker on the Senate health care reform bill

[salvorhardin]

Now that the core demand of progressives has been removed from the Senate health care bill--namely, the public health insurance option--should progressives continue to support the effort?

For me, the question is particularly difficult. I have been the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control. I was devastated when it was killed at the hands of Senator Joe Lieberman, not least because of what it said about our democracy -- that a policy consistently supported by a strong majority of Americans could be brought down by a recalcitrant Senate minority. ...

As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans. ...

To be sure, the bill also contains a requirement on individuals to have coverage, which has become the main target of criticism from the left. Without the public option, this mandate amounts to forcing people to buy private insurance without creating an affordable public alternative with which insurers must compete.

But the correct response to this critique is to make the requirement less necessary by providing greater assistance with the cost of premiums and by facilitating enrollment in the exchange--in other words, by making coverage more attractive and easier to obtain.
More: http://www.tnr.com/blog/the-treatment/why-i-still-believe-bill

[ixion]

1. make all the excuses you want. The Bottom Line is that this bill is crap

and nothing more than the Insurance Industry Profit Protection Act.

[salvorhardin]

3. Did you read Hacker's essay? eom

[ixion]

4. yes

I see alot of folly and excuse-making and speculation of things that will never happen.

[salvorhardin]

5. Can you provide specific examples of where you think Hacker is making excuses? eom

[ixion]

6. sure

* As weak as it is in numerous areas, the Senate bill contains three vital reforms.
*
* Second, it makes available hundreds of billions in federal help
*
* But the correct response to this critique is to make the requirement less necessary by providing greater assistance

And so on.

[HuckleB]

9. Those aren't excuses.

You want perfection. We all want perfection. But we all need improvement. We don't need to repeat history on this matter.

[ixion]

10. The "it's better than nothing" meme is an excuse, too

This has nothing to do with healthcare, and everything to do with providing insurance companies with a massive new revenue stream.

[salvorhardin]

11. You're avoiding the big question

No one here is disputing that this is a big gift for the insurance companies. Does it give us enough of a start though that we can use it to get further reform down the road and can we risk torpedoing it?

[ixion]

12. that's the thing: it doesn't

all that talk of "we'll make it better down the line" is just BS day dreaming.

The said the same thing about the unPATRIOTic Act, and here, nearly a decade later, that bill still lives in tact, for the most part.

[salvorhardin]

13. So you'd be fine with giving up the small good this bill does?

If so, then where do we go from here?

[ixion]

14. yes, the small may do (read: neglible, at best) does not outweigh the massive bad

I would scrap it and start from scratch with the idea being real reform, and I wouldn't let insurance lobbyists anywhere near it.

[salvorhardin]

15. Do you think that's realistic?

Given the rather lackluster support Obama gave to real reform and the general resemblance of the House and Senate to jellyfish, at least when it comes to having a back bone?

[HuckleB]

16. You haven't read the bill.

You haven't read history.

You are living in an ivory, and that's nothing but an excuse. The real world awaits your assistance.

[salvorhardin]

2. People are unrecommending this?

Jacob Hacker is generally considered the father of the public option. His opinion here is important. Further, he's far from an unabashed supporter of the bill.

Progressives have good reason to be angry. Yet we should harness our anger to fix the bill--now and every year from now. The current bills in Congress do too little to help Americans immediately; their main actions are delayed for years. If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.

So a bill must pass. Yet it must be a better bill that passes. And it must be understood by the President, the Congress and every American as only a step--an important but ultimately incomplete step--toward the vital goal that the campaign for the public option embodied: good affordable health care for every American.

He's saying the bill is better than nothing, does contain a scant few real reforms but we need to demand better. Passing the bill gives us a starting point to get closer to what we want in the future. If you're unrec'ing this because you think this is my opinion, well, I just don't know. I know I wanted Medicare buy-in for all, but it's very clear we're getting the bill Obama wanted all along. So this is what we have. If this goes down now, I fear it'll be another sixteen years at least before we can get another chance to make any kind of reform. If this bill passes, then despite all its inadequacies, it gives us a lever and a place to stand to get more meaningful reforms enacted down the road. Granted, that lever isn't as big as we'd like but it's at least something. For now. Maybe.

[HuckleB]

7. Too many do not want to look at history, or the good that is in the bill.

They'd rather throw a tantrum. It feels like they're still addicted to being angry, after eight years of Bush.

[salvorhardin]

8. Apparently

I'm not at all happy with this bill, and I generally agree it's a giant gift for the insurance companies. But this is what we have to work with. So, the question is, does this bill do enough good that we can afford torpedoing it and risking another generation, another 15-20 years, of things continuing as they have since 1992-1993 -- the last time we tried to do anything about health care reform in this country.

Frankly, I'm not sure. That's why I posted this in the hopes that we could have a real conversation about this bill without all the hand-waving, histrionics, and frothing-at-the-mouth.

[HuckleB]

17. Kick.