First of all, I want to get one thing out of the way: I'm a policy guy. I care first and foremost about getting good public policy out there. As such, I distrust politicians, despite the fact that I know their motives quite well.
So I cringe when I hear about this new plan to break up the HCR bill. How do you know that all of the important parts are going to get through? How do you get cost control and expanded access? Also, how do you know you can manage all of the politics and line up all the votes in the Senate, let alone the House? Until I hear a coherent answer to all of those questions I'm going to continue to think that the House Progressives are lunatics.
For example, if we pass a ban on denials and rescissions, that's great. But how will we get cost control if people have the ability to simply get coverage any time? Adverse selection would drive costs up astronomically.
No one likes mandates. How the hell will you get the votes for a mandate separate from a ban on denials?
It just doesn't add up. We need the whole bill for a real reform of the system. Piecemeal, even if it's done all at once, still won't cut it.
That being said, I think I can see what the House Dems are doing here. They don't support the Senate bill, and I can understand why. The Senate bill really has a lot of aspects that are very undesirable: no public option, lifetime caps, crap community rating, no antitrust exemption, no full benefits til 2014 (exposing it to repeal), and so on.
However, I think this plan, if they can get the votes for it WELL IN ADVANCE, could really be a game changer in terms of the ugly politics of health care. I certainly think that cost-free health care reform is an oxymoron, and that trimming Medicare is going to have to happen either way, but I can see what they're doing.
If they can get the votes in the Senate for obvious and useful reforms on a piecemeal basis, they can likely divide the GOP opposition. Who wants to vote for rescissions and denials based on pre-existing conditions, for example? Only someone who is politically suicidal.
And even more importantly, it truly gets the GOP ON THE RECORD in a serious way against the popular component parts of health care reform. This would be a fabulous way of getting them on defense for 2010 and could actually put some GOP seats in play, especially in the House.
The GOP has been able to coast this whole time on a wave of popular misunderstanding and anger that they created, and did so without taking much political risk.
The path of breaking up the bill will make certain that they cannot remain paragons of fiscal virtue without looking like heartless monsters that oppose commonsense reforms to a broken health care system.
As such, if they can make it work, if they can frame it right and twist enough arms, this is actually not a bad play.
Just something to think about.