Some Health Care Observations

I've mostly refrained from commentary and analysis about the big health-care reform legislation battle, mostly because there's just been so much light and heat I didn't feel it necessary to add to the din. But nevertheless, here are a few things rattling around my brain of late on the topic:

--Is the health-care exchange system a big-time boon to insurance companies (especially with no public option)? You betcha. It was insurers who helped come up with the idea here in Massachusetts (as I wrote way back when) to make sure they got their take, and without their self-interested buy-in it's unlikely the state would have passed anything, and we wouldn't have nearly-universal coverage today. Ted Kennedy, and Barack Obama, got that, and chose the same path for the national model so that the insurance industry wouldn't kill the legislation the way it did in 1993. Looks like it worked. Buying off your obstacles ain't pretty, but it works.

--Speaking of buying off your obstacles, yeah some Senators held up the legislation for something they wanted. Welcome to the freakin' real world, people. BTW, a word of caution to Sens. DeMint and Graham of South Carolina, who are leading a charge to find something unconstitutional in Congress making a law that sends money unequally to one state (in this case, Nebraska): be careful what you wish for. Your state receives $1.35 in federal spending for every $1.00 it contributes to the federal budget. We up here in Massachusetts have been subsidizing you for decades -- largely because of the disproportionate voting power Southern Senators have held.

--And while I'm thinking of the seven state attorney generals reportedly considering bringing a constitutional challenge (although none have indicated a possible basis), not only are all seven Republicans, but three are actively running in contested GOP primaries in 2010 (Henry McMaster for SC Gov, Troy King for re-elect in AL, and Mike Cox for MI Gov), and three others are reportedly looking at similar situations (Greg Abbott for TX LG, Rob McKenna for WA Gov 2012, and John Suthers for various CO possibilities). The 7th, Wayne Stenehjem of ND, always needs to play to the conservative base.

--As for the other Constitutional complaint -- the individual mandate -- I think it's a legitimate policy concern, but I don't see the constitutional problem. (At least, from my understanding of the arguments, concerning the commerce and taking clauses.) And as policy goes, it's an absolutely necessary part of the reform, and not just because it buys off the insurance companies. I wrote about this back when Massachusetts adopted a mandate, and in addition to the reasons I mention in that article, there is the problem of what happens if you don't mandate, while at the same time forcing insurers to take on everyone, regardless of their pre-existing conditions (one of the most popular pieces of the whole reform package). What happens? Just that everyone is incentivized to remain uninsured up until the moment they get in a horrible accident or receive a terrible diagnosis. Nobody would ever be insured while they're healthy -- which defeats the whole purpose of the system.

--And, for totally failing to understand that, Keith Olbermann deserves singling out for mockery. Olbermann gave a special comment about a week or two ago, all pissy about all the public-option options losing out in the Senate negotiations. Olbermann, who says he is already self-insured, proclaimed that if the final legislation includes a mandate but no public option, he would refuse to obey the mandate -- even in the face of fines or imprisonment. That's idiocy -- not on the level of what many on the right have been saying, but idiocy that deserves insult nonetheless.

--By the way, supposedly sane Olympia Snowe of Maine voted with the rest of the Senate Republicans on two moronic last-minute attempts to declare the legislation unconstitutional. She didn't have to do that, and she should be made to answer for those votes; just what exactly does she think is unconstitutional about the bill, that she didn't notice was unconstitutional up until yesterday?

--As for the political consequences of passing this health care bill (assuming, as I do, that it will eventually get passed, in largely the form of the Senate version).... As I have written all along, I believe that not passing a health care reform bill would have been extremely damaging for the Democrats, so passing it, regardless of the fallout, is better than the alternative. I do think it will be a big positive for the Democrats, and Obama, although I do think the length of time it took probably eroded some of that benefit. But the bottom line is that, other than the core conservatives, everybody in the country wanted either this or more aggressive reform, and gaining the confidence of the nation's center is (politically) well worth the disappointment of the left.

--And, as for the issue helping the right's motivation in November 2010, let me make a little prediction here. By November, conservatives will need to be reminded that the health care bill even happened. They've been fired up about the issue because it's been the single big issue going on -- but in the grand scheme, it's not even close to being one of their biggies. And those biggies are on their way: climate legislation is in the queue, and Obama has said he'll push for immigration reform in 2010. Those are issues that will have the right screaming at Town Hall meetings and such in the coming year; health care will be long forgotten.

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