Starting Over

| Tue Dec. 15, 2009 7:10 PM EST

I don't want to blog endlessly about healthcare reform today because, really, there's not all that much to say.  I think the Senate bill in its present state is well worth passing, other people don't, and that's that.

But there's one argument that I find perplexing.  Here's Howard Dean:

This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.

Here's what I want to know: which one of us is living in dreamland?  If you don't like the Senate bill, fine.  Don't support it.  But in what universe will healthcare reform get revived anytime soon if it dies this year?  2010?  With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up?  2011?  After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray?  2012?  A presidential election year?  2013?  2014?

I usually don't say much about legislative tactics because I figure you need some serious ground level knowledge before you mouth off about what's possible and what's not on Capitol Hill.  But the fate of failed major initiatives is so obvious that I can't believe anyone is taking this seriously.  When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon — and that's especially true when big healthcare bills fail.  It didn't happen in 1936, it didn't happen in 1949, it didn't happen in 1974, and it didn't happen in 1995.  What makes anyone think it will happen in 2010?

If healthcare reform dies this year, it dies for a good long time.  Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well.  So do John Boehner and Mitch McConnell.  (Boy do they know it.)  But if it passes, here's what we get:

  • Insurers have to take all comers.  They can't turn you down for a preexisting condition or cut you off after you get sick.
  • Community rating.  Within a few broad classes, everyone gets charged the same amount for insurance.
  • Individual mandate.  I know a lot of liberals hate this, but how is it different from a tax?  And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
  • A significant expansion of Medicaid.
  • Subsidies for low and middle income workers that keeps premium costs under 10% of income.
  • Limits on ER charges to low-income uninsured emergency patients.
  • Caps on out-of-pocket expenses.
  • A broad range of cost-containment measures.
  • A dedicated revenue stream to support all this.

What's more, for the first time we get a national commitment to providing healthcare coverage for everyone.  It won't be universal to start, unfortunately, but it's going to be a lot easier to get there once the marker is laid down.  That's how every other country has done it, and that's how we did it with Social Security and Medicare, both of which had big gaps in coverage when they were first passed.

But if we don't pass it, we don't get any of this.  Not now, and not for a long time.  Instead of being actual liberals, we'll just be playing ones on TV.

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