How Will Health Care Get Screwed Up?

You know what? The House Democrats' Health Care reform bill is... pretty ok! We have no serious problems with it, besides its not just being goddamn single-payer. But there are so many ways for things to still go seriously wrong!

Because, you know, congress is dysfunctional. The system is broken. Democracy doesn't work. Etc. Let us count the ways we will end up with no health care reform, shitty health care reform, or decent health care reform followed by a backlash that leads to the collapse of the state apparatus, anarchy, a military coup, and internment camps, or whatever.

Bipartisanship In Roll Call today we learn that the Senate Finance Chairman Max Baucus is still working around the clock to reach consensus... not with moderate and liberal Democrats, but with the four Republicans negotiating on behalf of their colleagues. Those negotiators are led by noted sexter Chuck Grassley, and the "consensus" they are looking to reach is no health care reform. The Republican party is opposed to fixing health care. Including them in negotiations is not only useless—most of them will vote against it, no matter what it looks like, and they have said as much—it is destructive, as it makes it a worse bill that does less and it could lead to Democrats (who, remember, are in the majority) voting against it. Ahem:

Minority Leader Mitch McConnell (R-Ky.) alluded to the Republicans' unity on Tuesday when asked what guidance he has given the GOP negotiators.

"Well, I think everyone understands the direction Republicans would like to take," he said. "No government plan, no tax on small business and a genuine bipartisan effort. As long as we are simply being called upon to take 60 or 70 percent of something we don't like, we don't really think that's meeting in the middle."

Right. The thing is, you guys are only 40% of the Senate, and that 40% represents an even smaller portion of the national populace, because the Senate is an undemocratic institution, so you should probably be happy with whatever portion of what you don't like that you get. But Max Baucus and Harry Reid will probably still find ways to try to "meet in the middle," because being collegial and politically nice is more important than implementing good policy.

Taking Too Much Time Right now, with the House bill having been released, and Obama finally beginning a major push, the momentum is for reformers. It's looking almost inevitable that something will happen by the end of the year. But! In three weeks, the Senate goes on recess, halting all the work. Meanwhile, the economy continues to suck, and it will only get worse, and that economy is very gradually dragging down Obama's poll numbers. Obama remains pretty damn popular, but if things continue to get worse, Obama will look weaker, and congress will not feel quite so empowered to actually do anything. Delaying shit is actually part of the Republican strategy, too—pretend to be almost willing to compromise, then retreat, then repeat. They hope to derail the process until they see if maybe 2010 looks a little better for them. And if it does, we're all fucked.

Centrists Oh no, the top marginal tax rate for people making more than a million dollars a year might inch up a couple points under the House plan! Won't someone please think of how that will hurt regular Americans? You know, hurt them spiritually, because in actual terms it will help them, in that people much richer than they are will be helping these regular Americans afford quality health care? Oh, Democratic Centrist Senator Ben Nelson, you wanna try?

"Tax is a four-letter word" with voters, said Sen. Ben Nelson (D-Neb.). Even families not ranking in the top 1 percent of earners "hope they're going to be there someday," he said. "So they don't necessarily think it's fair."

No, Ben, millionaires don't think it's necessarily fair, and it ought to be the job of actual Democrats to make the argument that families not in the top 1 percent would be better off with protection from catastrophic health care emergencies bankrupting them than they would be with imaginary low taxes on their imaginary future hypothetical millions.

But "centrists" are very powerful in the Senate! And their bitching could either derail the process or dilute the reforms. In the House, meanwhile, the "Blue Dog" Democrats are still bitching about how they haven't gotten their requisite pound of flesh from the bill. It uses taxes to pay for things! That is what Blue Dog Democrats hate, more than anything.

Industry How will the health insurance, biotech, and pharmaceutical companies help destroy the bill? The usual way: advertising, scare campaigns, money, and lobbying. Hey, a targeted "ad blitz" by biotech and pharma got "several key Democrats" in the Senate to sign on to their pitch for 12 years of exclusivity—and price gouging!—for "their most lucrative biotech drugs."

A coalition of seniors, consumer groups, pharmacy benefit managers and health insurers support language that would provide fewer years of exclusivity before competing generic biologics could enter the marketplace - and presumably drive down costs. An amendment by Sen. Sherrod Brown (D-Ohio) would have granted about five to seven years of monopoly.

On Monday night, the HELP Committee approved an amendment that would grant the products 12 years of market monopoly. Sens. Kay Hagan (D-N.C.) and Barbara Mikulski (D-Md.) championed the effort, and nearly all of the Democratic Senators on the committee who were targeted by the Biotechnology Industry Organization and its allies voted for the amendment.

"We are definitely pleased with the outcome," said BIO spokesman Jeff Joseph, who noted that in the past week alone his group spent about $500,000 on advertising in selected states. It used the Harbour Group for communications and advertising strategy. "It is the result of a lot of hard work, a lot of footwork, lobbying and communications strategy over the past couple of years."

One of the things about health care is that costs are out of control, because of these people, basically. Reform needs to drive down those costs in order to be affordable, but driving down costs by going after the massive profits of powerful corporations is less easy, politically, than doing it by, say, selling the organs of poor people to Monsanto for genetically engineered corn-livers or whatever.

Obama not doing enough, or doing too much This one, who knows. The president is going to sell health care, on the road, for the rest of the summer. And that is good! But a lot of his efforts—the White House has actually been doing a hell of a lot on the Hill for this—have been behind-the-scenes, so far. One of the president's best skills is educating people. He needs to be publicly convincing people that a) we need health care reform and b) it will actually cost money, but it will be worth it. He should probably drop his fucking objection to ending the tax break for employer benefits, but whatever. He needs to sell it.

It Will Just Be a Shitty Bill The most likely bad scenario is simple: something that does not come close to universal coverage and that, despite that, still costs an obscene about of money will end up passing, and actual fixing of our many problems will once again just be punted down the road. But we will probably all be dead from the global warming before our future descendants have to worry too much about how only Jared Kushner III and Moon Unit William Gates can afford their space-health space-insurance, in the future.