According to The Hill (so take it with a grain of salt), Howard Dean says that passing the Senate health care reform bill as is will destroy Dems in upcoming elections:
"The plan, as it comes from the Senate, hangs out every Democrat who's running for office to dry -- including the president, in 2012, because it makes him defend a plan that isn't in effect essentially yet," Dean said during an appearance on the liberal Bill Press Radio Show....
"It's easy to campaign on repealing something if no one knows what the something is," Dean said. "And fundamentally people don't understand what the president's healthcare plan is."
Now I'm as much in favor of including a buy-in to Medicare in health care reform as Dr. Dean is, but how sound is what he's saying? Is it true that Dems can't defend themselves because the benefits of reform won't be apparent for years, while the opponents of reform will have years to demagogue and churn out their propaganda and be believed before anyone gets to experience any benefits?
So what exactly does come into effect immediately if/when the (presumably Senate version of the) health care bill becomes law?
You would think the Senate backers of the bill, and the WH, would be all over this and pushing the immediate benefits for all they're worth. But no. In fact, it's amazingly difficult to try to corral what the immediate benefits of the bill would be.
Even in the worst case scenario, where the Senate reneges on passing the fixes the House wants, there are many improvements to Americans' health care coverage situation that will come into effect within months after health care reform is signed into law:
Seniors will see the Medicare "donut hole" start to shrink. [i.e., the need for seniors to pay the full cost of their prescriptions out of their own pocket when their prescription costs are between $2,700 and $4,350 in out-of-pocket expenses in a year; the bill cuts this by $500 immediately, adds a 50 percent discount on brand-name drugs, and will get rid of the donut hole entirely, eventually]
Families will get to keep kids on their policies past high school, until the kids are 26.
Preventative services will have "first-dollar" coverage, meaning you'll pay nothing out-of-pocket--that's right, nada, zilch--when you get a regular checkup.
People who are uninsurable because of high medical risks will get access to catastrophic policies, as a stopgap until full coverage becomes available in a few years.
The government will set up a website with information about different insurance plans, letting people compare benefits in standardized, plain English terms.
It will also make investments in the health care workforce--spending money to train or hire new primary care doctors, nurses, and direct care workers.
Insurers will have to fess up about how much money they divert from patient care to overhead and profits--and to set up systems for appealing coverage denials.
People will have the right to go to the emergency room--and women the right to see an obstetrician/gynecologist--without prior approval.
More features that immediately go into effect:
- starting immediately, children can't be denied health coverage due to a pre-existing condition
- small business tax credits for health coverage are expanded in 2010 (small businesses are eligible for up to six years and the wage levels for the tax credits are increased)
- immediately bans annual and lifetime caps on coverage
- immediately bans rescission (rescinding a patient’s policy when they file a claim)
-
immediately lets unemployed workers keep their COBRA coverage, until the exchanges are set up (UPDATE: I think this is incorrect, and that this particular provision is just in the House bill, not the Senate bill, the one the WH and leadership are pushing to pass. See this comment below for more info.)
- immediately sets up an insurance program to provide long-term care coverage
- immediately prevents Medicare Advantage from charging higher cost-sharing than Medicare does
The Senate bill bars insurers who excessively hike their premiums from participating in the exchanges, but since the exchanges don't come into play for a few years yet, the interim measure included in Obama's own compromise plan gives the power to control premium hikes to the HHS Secretary in the interim, a fix to the Senate bill that presumably will be included even if the House's fixes aren't:
The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, potentially superseding state insurance regulators. The bill would create a new Health Insurance Rate Authority, made up of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.
Officials said they envisioned the provision taking effect immediately after the health care bill is signed into law.
The legislation would call on the secretary of health and human services to work with state regulators to develop an annual review of rate increases, and if increases are deemed "unjustified" the secretary or the state could block the increase, order the insurer to change it, or even issue a rebate to beneficiaries.
These changes are technocratic and don't have the emotional sweep that the true radical change the country's health care system needs, but I think it would be hard to argue that these changes won't provide immediate benefit to potentially millions of people.
Like many people who supported President Obama, I expected more in the way of transformative change than the centrist fixes to the status quo that he's delivered so far. I haven't been happy with his approach, because I thought, considering his political skills, he would be more willing and able to seize the moment, with the shambles Bush and the Republicans left the country in, and work in a dramatically transformative way.
But I wonder if there may be some transformation taking place that will need the larger perspective of history to appreciate.
Up until now, the terms of the debate over health care were limited by a refusal to accept that health care should be universal, a basic human right.
I think that comprehensive reform, if it is passed, will change that. Passing comprehensive reform, even if it's private coverage, still too expensive, a giveaway to the insurance companies, etc etc - and all the other sadly true complaints about the legislation that was the best the US lobbyist-corrupted congress could produce - still will achieve major transformation.
What it will do is change the terms of the discussion from should everyone have access to health care to establishing universal access to health care as a right, and the responsibility of government to ensure that right, leaving the only questions to still wrangle over how to make sure everyone is covered and how to pay for it.
This is what the Republicans fear. If they truly believed that Dems would suffer from passing comprehensive health care reform, they'd simply step out of the way, stop blocking a vote on it, just happily vote against it themselves, and let the Democrats hurtle to their own destruction. The fact that they're not letting that happen says volumes.