Wednesday, December 23, 2009

PLEASE READ & RT—from the WHY HC REFORM WILL STILL EVOLVE DEPT.: Harkin—P.O. to be revisited next year; Sanders's sneaky path to Single Payer

For everyone who's been running around with their hair on fire because this bill is far from perfect, here are some reminders that there's still plenty of work to be done -- and the energy being poorly spent to "kill this bill" should be going into doing it. THIS IS JUST SQUARE ONE

The uncomfortable truth: Those who are attacking the bill because it's flawed from the get-go are acting like, well, creationists. (Or at least "intelligent designists.") They're maintaining that ideal legislation should spring into being wholly formed, in the image of Divine Perfection, 

That's just not how legislation of this scale works, given our broken political system. Like Civil Rights, like Medicare, like Social Securitymajor, game-changing legislative initiatives in our nation almost always begin with incomplete bills that get enhanced substantially as time goes on -- it's an evolutionary process.

And we on the Left should be putting the pressure for reform to keep evolving -- not trying to cut it off at the knees when we're on the verge of taking a truly historic first step. Fortunately, there's evidence that there are, indeed, smart, progressive legislators who are already looking ahead to that future evolution:
  • Sen. Tom Harkin says: Public Option will be "revisited" next year as separate legislation. This is what Intelleftual supporters of the bill have been saying all along: Pass this meh bill, and take the stuff we want and put it into future bills -- potentially passed through reconciliation (which requires just 50 votes plus Biden); the P.O. and Medicare expansion are ideal candidates for reconciliation passage, while all the other important change in this bill (eliminating denial for pre-existing conditions! stopping the practice of rescission! huge, huge, huge progressive subsidies for those who can't afford insurance!) is completely locked out from the reconciliation process, due to Byrd guidelines to that effect. 
  • Meanwhile, anti-bill progressives are overlooking the major stocking-stuffer that Sen. Bernie Sanders slipped into the Senate bill: $10 billion in additional funding for Community Health Centers (there's already $14 billion in the House bill). The additional CHCs will provide quality, nonprofit pay-what-you-can-afford dental, mental and primary care services AND low-cost prescription drugs to 10,000 more communities, or up to 25 million more Americans. It's what they have in Vermont (the state Sanders represents, and that Howard Dean used to govern) -- and people in Vermont love them
They're not just used by poor and working class individuals, either; CHCs have become the mainstream day-to-day healthcare solution for nearly all Vermonters outside of major city centers. They're amazingly cost effective: Per Dan Hawkins, SVP for Public Policy and Research at the National Association of Community Health Centers, in 2008, CHCs "pulled down $3 billion from the Medicaid program and sent back more than $6.5 billion to the government for care provided to Medicaid beneficiaries." They also put a major focus on prevention: Since checkups are so cheap (and free to those on Medicaid), chronic illnesses and treated before they become major health problems, while acute ones are caught early before they become life-threatening; meanwhile, the healthy are encouraged to drop in for wellness visits (it's much cheaper to keep people healthy than to treat the sick). But the real reason why people should be excited about any additional funding to CHCs? 

One word: Saskatchewan. That's the Canadian province that turned a similar program into such a success that patients in the rest of Canada demanded it be expanded to their regions as well. 

And guess what? Bernie Sanders also slipped into the Senate bill language that allows states to obtain waivers from participating in the national health care infrastructure if they can create an alternative that meets the same goals and benchmarks for care and cost savings. 

Now, the Republicans couldn't possibly hate that, right? It's essentially an opt-out for the states (assuming they can figure out other, better ways to provide universal care). But the reality is, very few alternatives to what's in the current bill could ever meet the bill's benchmarks -- other than more progressive, say, single payer

Sanders has not hidden the fact that he's pushed the waivers so that single-payer could be put back on the table at the state level. His language is now in the Senate bill and Sanders is working with Sen. Ron Wyden to strengthen it (Wyden is also pushing for an expansion of his employee choice language, allowing a bigger percentage of working Americans to participate in the health insurance exchanges -- another significant advance). It's not currently in the House bill. And my guess is that Sanders and Wyden will demand that it be put into the combined end product. 

Which would give rise to the very real possibility that Vermont, with its preexisting CHC infrastructure, could rapidly evolve into America's Saskatchewan. And we'll just see what neighboring Maine, land of Snowe and Collins, thinks of that.

Bottom lineWe need to come together to pass this bill. And then we need to stay together to pass further reforms. We'll get there -- but only if we stand united and move forward...not back. Isn't that, after all, what "progressive" means?

Posted via email from OriginalSpin


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