It's time to get out there and save HCR.
The public option is gone? Okay, the it's time to cut all of the cost management portions out of the bill -- that includes the Individual Mandate (which is intended to drive down prices by increasing the pool of the healthy insured) and the excise tax on "cadilac" plans.
This would leave us with a bill that moderately reforms the rules by which Insurance companies play, provides subsidies to the poor, and creates some form of state-level exchange.
Not a great bill, but it will not do a great evil.
The current bill, as the Senate has altered it -- has created a preposterous position where folks who are older, or folks with high blood pressure and other pre-existing conditions (hey, I thought those were supposed to go away) end up paying up to three times as much as their peers -- how many of those plans will wind up subject to the excise tax because of their high price-line?
If on the other hand, you are a healthy person, the gov't will give you a stiff tax penalty if you fail to pay for excessively expensive insurance.
Both of those look like taxes that hit people earning less than $200,000 a year.
What's left if the Senate actually strikes the Mandate and the Excise tax from the bill?
Enacted:
- A weak tea regulatory bill.
- No taxes on families earning less than $200,000.00 a year -- an oft-repeated campaign promise for Mr. Obama.
- An end to recision (if the enforcement mechanism functions, which is unclear at this time).
- Subsidies for the poor (which may go away before they are implemented).
Not Enacted:
- Individual Mandate to reign in cost.
- Excise tax to pay for subsidies.
- Medicare expansion to bring fresh cashflow into medicare, and to save on subsidies (since medicare expansion is targeted at early retirees and the unemployed, those individuals would otherwise have low enough income to qualify for subsidies -- ergo, moving them into medicare early lowers the government's liability profile).
- potentially a public option engineered to maintain an upper-limit on insurance premiums -- the public option wouldn't be the cheapest plan -- in an ideal world it would offer a fair deal to those who would otherwise be suffering trippled premiums in order to scare them out of the private insurance pool (the old-but-not-retired set, and those with pre-existing conditions). This isn't a public option that you or I would want to sign up for, because it will be expensive, but it will be as cheap as it can be, given its risk exposure and liability profile, because the public option will be explicitly designed to reject profits that would come at the cost of higher premiums or lower quality of service (the private insurer's bread and butter).
Where does that leave us?
With a bag full of budgetary items necessary to achieve the President's fiscal plan for HCR.
Hmm -- that sure sounds like the kind of thing that falls into the traditional framework of Reconciliation procedures doesn't it? We'll retain the individual mandate as a carrot for the insurance lobby, and we can pull out the medicare expansion and public option sticks to bring on the liberal senators. I'm not sure who really likes the excise tax, but if it becomes a necessary evil, it is available in their bag of tricks during negotiations.
So, that's what I think we should do -- enact the reforms we can -- come back with reconciliation to save the bill later.
Update: edited intro for clarity.