To answer my question...hell no!!!!
As many of us have said, getting this health care reform package passed was a FIRST step. The Democrats got what they could get out of the current legislative process with this particular bill. It was an ugly process and leaves much work to be done. So here's my take on what's next.
The first is in the recent promise by Majority Leader Reid to bring up the public option for a separate vote in the next few months.
The big question there remains...which public option? During the recent clash over that, many of us lost heart in fighting for the PO when it was watered down from its "robust" version in order to pass the House. One of the major sticking points was whether to use Medicare rates as the basis for calculating payments to providers (which would make the PO more affordable to the uninsured) or to allow the administrators of the PO to negotiate rates. The House chose the later, much to the consternation of many progressives.
But as we all know, the controversy over provider payments in Medicare (and Medicaid) is a long-term problem that existed both before and after the discussion about the PO.
Lawmakers and medical providers have made much ado about the "doc fix" that’s needed to remedy the long-standing flaw in the Medicare payment system. As Ezra and others have pointed out, this has been a problem that’s dogged Congress for over a decade, long predating the health reform debate. Hopefully, the Democrats will make good on their promise to pass a permanent fix, after year after year of temporary patches.
So it seems to me that if we want a "robust" public option to provide competition to private insurers in the exchanges, the first thing that needs to be done is to resolve the provider payment problem with Medicare rates...and to make that a permanent fix. Then a fight to tie the PO to Medicare rates will make sense. Its likely to increase the cost of the public option, but would make the program sustainable over time and ensure that those who choose it as an option are able to receive quality care.
Of course the other option is to support Grayson and his bill to lower the age of eligibility for Medicare. But either way, we're still faced with needing to fix the payment issue in order to make that a realistic option.
The second area for involvement is in the current plan's implementation. Since many of its features roll out over the years, this will certainly be a long-term process.
Many people are already weighing in on this in relation to the items of the bill that are set to take effect immediately or shortly. On this issue, I found a recent report by NPR to be instructive.
The health care bill President Obama signed this week is more than 2,400 pages long. Still, it doesn't contain many of the details about how it will work and how it will be enforced. The responsibility for explaining the bill falls to workers in the trenches at government agencies.<...>
It's an approach to lawmaking that William Galston, a senior fellow at the Brookings Institution, has seen for decades.
"Since the New Deal, the legislative style has been to leave a fair amount of actual detail undetermined by the text of the legislation itself," Galston says.<...>
But the scope of this measure is extremely broad, and coordinating regulations across government agencies will be challenging. Miller says don't be surprised if the number of pages of the regulations dwarf the more than 2,400 pages that were needed to spell out the act.
This report put the recent issues about insurance for children with pre-existing conditions and the implementation of the high-risk pools into perspective. It is not surprising that Secretary Sebelius is working hard to fill in the gaps of regulation that were left for her department to develop and enforce.
I suspect that as one provision after another of this law rolls out - we'll see these battles over the development of the specific procedures and regulations. And yes, we'll have to fight every time against those who would distort the meaning of the law to develop loopholes through which they can affirm the status quo.
This is likely to be a very different kind of battle from the one we recently won to get the bill passed. Folks like Secretary Sebelius will be front and center in that fight in the way that legislators were in the last round. Keeping those lines of communication open will be important. As we see, this administration has developed some tools to help us do that. I hope we all take advantage of them and let our voices be heard.