The health care reform drum beat in Congress moves forward at the pace and feel of a dirge. Now Senator Majority Leader Harry Reid says there may not be a vote on the Senate bill until 2010. House Leader Nancy Pelosi expects a vote on the merged House bill this week or next weekend or sometime, depending the source you read. But until the Senate votes, there can be no work on a final bill for the entire Congress.
As the bills now stand, here are some key points from one or another or both. None of this is guaranteed as there is no way to tell what the final bill will contain:
In the Senate version, the public option would apply only to people whose employers do not provide coverage and who cannot buy private coverage for whatever reason. States would be allowed to opt out of the public option.
In the House version, according to reports prior to the vote, the public option is stronger and does not allow states to opt out. It also forbids the federal government from bailing out the private option.
That last item represents doom for any public option because in either the House or Senate version, the pool of public option participants too small to successfully spread the risk. Is it possible that among all 535 members of Congress, their thousands of aides and me, I am the only one who has noticed that failure of the public option is built in? Or am I naïve to think it isn't being planned that way?
There had been a provision in the House bill that would allow individual states to create single-payer systems if they chose to, but it was stripped out.
The House bill expands Medicaid to more people, and provides for a 5.4 percent income tax surcharge for singles earning $500,000 or more and couples earning $1 million and above to help pay for the bill.
The House bill also provides more generous subsidies to families buying coverage from exchanges and – good news for elders - it lowers the cost of prescription drugs for Medicare beneficiaries by authorizing CMS to negotiate drug prices with pharmaceutical companies. The Senate bill only reduces the doughnut hole a bit.
There are hints this week that the execrable trigger option, the brainchild of Maine Senator Olympia Snowe may be back on the table. If it is passed in place of any version of a public option, a public option will never go into effect.
These items don't begin to explain the bills in any detail which, anyway, seems a waste of good brain cells to try to do since there is no way to know what the final bill from the two houses of Congress will contain.
What is evident overall, as we have discussed, is that aside from preventing private insurers from rejecting insurance applicants for most pre-existing conditions, the bills generously preserve the status quo for private insurers, even guaranteeing tens of millions of new customers, in one of the bills, by mandating purchase of insurance and limiting the number of people eligible for a public option.
That's what millions of lobbying dollars buys; billions for private companies and minimal help for everyone else.
Having spent the entire summer deeply embedded in following the progress of health care reform, I am terribly disappointed in what we now have before us. The only thing that could improve my mood about health care reform would be a knight in shining armor riding in with a single-payer system and magically persuading Congress and the president to see the light.
However, since that will not happen...
There is no choice but to support what we've got. If some kind of health care reform is not passed by this 111th Congress, there won't be another chance for 15 or 20 years. And in the interim, health care costs will skyrocket leaving millions more than now unable to afford coverage or treatment.
It is better to pass even as weak a bill as we will apparently get and have something to work with – to amend, tweak, change and fix (even the best bill would need some of that) – than to face the collapse of Medicare in a few years and perhaps the entire health care system.
What worries me most about Senator Reid's retreat on a Senate vote before early 2010 (remember that the Senate already missed a promised August vote) is that the mid-term election campaign will be gearing up and senators facing voters next year will be a volatile bunch as they try to please all the people in their states all the time.
So keep writing and calling your representatives in Congress. Tell them what parts of the bills you like and what you don't like. Let them know that their vote will affect your vote in the mid-term election next year.
The PBS series Life (Part 2), hosted by my friend Bob Lipstyte, is continuing on television and online. This week it's about dating - the second time around. Here's a clip:
You can watch the full episode here.
At The Elder Storytelling Place today, Johna Ferguson: Looking Backwards