Healthcare Reform: Now Messier Than Ever

MOTHER JONES

December 18, 2009

Mother Jones

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THIS WEEK IN THE BLOGOSPHERE

Healthcare Reform: Now Messier Than Ever

Last week I said that the Senate version of healthcare reform was messy, inadequate, infuriating, and still worth passing. Well, guess what? This week it's even messier and more infuriating.

The infuriating part, of course, is Sen. Joe Lieberman (I—CT). After stringing everyone along for months with suggestions that he was on board with a weak public option and a Medicare buy-in for 55-64 year olds, a few days ago he suddenly changed course and decided he wasn't. Majority Leader Harry Reid's delicate compromise fell apart at the last minute, and it was back to the drawing board.

The messy part is political. If Lieberman had been actively trying to split apart the liberal coalition supporting healthcare reform, he could hardly have done a better job. The public option, which provides a bit of government competition to keep private health insurers honest, had already been watered down so far that liberal activists were barely on board with the deal even before this week. Lieberman's last minute defection, which removed even that, caused all hell to break loose.

So now there's a bizarre alliance of conservatives, who want nothing of any kind to pass, and furious liberals, who aren't willing to support reform unless it includes some kind of public component, all actively opposing the bill. And the liberals have a pretty strong case: the Senate bill includes an "individual mandate," which makes it a federal requirement to buy health insurance. This is a huge boon to private insurance companies, who will receive tens of millions of new customers, and without a public insurance option it means the only competition they have is each other. So millions of people are going to be forced to buy insurance from one of the most hated industries in America, and they'll be able to set prices without any pesky public competition.

But it turns out there's less here than meets the eye. The public option that was in the Senate bill had already been compromised so heavily that only a small percentage of people would even have qualified to purchase it, and the Congressional Budget Office estimated that its effect on premium prices would have been minimal. So in practical terms, not much has changed. For better or worse, private insurers were always going to get about 98 percent of the business anyway. Now they'll get 100 percent.

That's infuriating and messy, but in the cold light of day it's not worth killing reform over it. The Swiss and the Dutch have universal healthcare based around private insurance carriers and they manage to make it work, after all. What's more, the basics of reform are still intact: the Senate bill brings down insurance rates, expands Medicaid, offers the prospect of moderately priced insurance to tens of millions of the uninsured, forces insurers to take you on even if you have a chronic pre-existing condition, mandates minimum levels of coverage, and takes several small but important steps toward reducing the future growth of healthcare costs. That's an enormous advance for the progressive agenda. It's a bill that's still well worth passing.