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The Dynamics of Health Reform - Part 1
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Chants at a rally in support of health care insurance reform in Washington, Thursday, Oct. 22, 2009.
(AP Photo/Alex Brandon)
A chess match:
Health reform, H.R. 3962, about to be debated in Congress, can be compared to a championship chess match. The majorities in Congress will ultimately pass a change package. The health care industrial complex will attempt to circumvent the changes so as to maintain and/or improve their individual bottom lines. Success for the American people will ultimately devolve into a game of move and countermove.
The stakes are enormous:
The stakes are huge. This year, health spending will balloon to $2.5 trillion or 17 percent of the total of a GDP totaling $14.2 trillion. Whatever changes are made will result in massive shifts in spending. There will inevitably be winners and losers.
It is important to acknowledge that while there are differences in opinion about methods to achieve health care reform, there are no villains in this process. The system developed as the result of free market forces. Each business component acted honestly in their enlightened best interest. Those interests do not necessarily intersect with the interests of the nation as a whole. Regulations so far resisted since 1945 have delivered us to the edge of a cliff.
Fixing a broken system will be expensive
There will be costs involved with repairing the broken system. According to Congressional Budget Office’s preliminary report, the proposal as submitted will not expand the budget deficit. More important to ordinary Americans is whether or not the entire cost of health care recedes as a result of the process to a lower percent of GDP and whether or not reasonable care is available to all.
Protection against getting "rooked"
Pursuing the chess analogy to a tortuous conclusion (checkmate), Congress must protect its kings (all of you voters out there) from being out-maneuvered and “rook-ed” (a technical term) by all those entrenched interests (the health care industry).
Congressional argument really the side show:
The argument ongoing in Congress centers around three basic questions. What changes are going to be made? Whose profits are going to decline because of those changes? How do the changes affect the national budget and deficit?
The results (for Americans) of all this move and countermove have become a side show to the wrangling between the political parties and within the Democrat caucus. While rich the health industrial complex has extremely well paid representatives pushing, cajoling, and spinning their agendas, patients and the populace at large are limited to a few less well heeled advocates and (oh yes) the fidelity of their elected representatives.
Don't judge the product by its page count:
The result is a proposed piece of legislation that required some 1990 odd pages. Many members of Congress are already clamoring to amend what has been presented. According to a statement by the Kaiser Family Foundation, an additional 800 pages could be added in the amendment process before a vote and passage in the lower chamber.
The Senate has yet to release their amalgamation of two bills passed out of committee on their side of the Capitol rotunda. Senate Majority Leader Harry Reid has announced that the Senate will debate a public option to compete with insurers as part of that proposal. The Senate version will face a likely attempt at a filibuster (an attempt to talk the measure to death). If 60 affirmative votes can be found to end the filibuster, then the measure will likely pass to a conference committee.
In conference, the real lawmaking begins. Behind close doors, representatives of both houses agree to a version of the reform which will then be passed by both houses for the President’s signature.
Sausage making:
This is the modern process of American lawmaking, frequently compared to the making of sausage. This is going to be one, long hot dog with a huge bun and lots of relish and a little mustard. How many pages this will take would only be a guess at this stage of the process. Compare it to the original Social Security act which had only 64 pages.
The majority House proposal is so humongous that it cannot be described in minute detail here before the vote. The size of the package results from an effort to somewhat satisfy all those external forces who want to protect their own interests. Democrats should not be blamed on the basis of size alone. It is wise, however, to remember Ross Perot’s admonition that the “devil is in the details.” And also to keep in mind that there is a law of unintended consequences that acts to derail every well intended initiative.
Looking at the pieces parts:
The summary breaks down the whole into parts. Each of the parts will be covered in articles to quickly follow this one. They are Insurance Reform, Shared Responsibility, Affordability, Medicare, Reducing Fraud and Abuse, Prevention and Wellness, Medicaid, Workforce Development, and Controlling Costs.
Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” He can be reached at alanportner@gmail.com
For more info:
Health and Labor Committee Summaries
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