GUEST COMMENTARY
By Bob Gelfand
Pass the damn bill. So say a growing collection of Internet pundits and political activists regarding the Senate's version of healthcare reform.
The context is unfortunately simple. If the House of Representatives
passes the Senate's bill unchanged, it will go to the President for
signature and it will become law. If the House changes so much as a
comma, then it has to go back to the Senate for final ratification, and
there it will probably die.
With the election of Republican Scott Brown to the open Massachusetts Senate seat, the ability of Democrats to put together a 60 vote, filibuster-proof margin has gone up in smoke. With that loss, the usual process that would lead to passage of a final bill has all but disappeared. That now-unlikely process requires that a House-Senate conference committee tweak the differences between the House bill and the Senate bill, and then the product of that tweaking, one unified bill, is ceremonially passed by both houses.
In a year that broke new ground, both the House and the Senate passed their own versions of health care reform bills. The House bill is certainly more far-reaching than the Senate bill, but lacks support in the Senate. Getting a bill passed in the Senate took months of negotiations and a couple of major giveaways (to Louisiana and Nebraska). With the loss of the crucial 60th vote, the ability of Senate Democrats to repeat the process and pass an amended bill coming back from the House has probably died.
House Democrats have been floundering around, trying to figure out how to rescue something of their own bill and repair some defects they see in the Senate bill. One option that has been discussed is to try to pass a collection of smaller, more focused bills. This would essentially be to go back to square one, and would likely signal defeat for hopes of healthcare reform for another generation.
Another possibility that has been floated is for the Senate to pass a second bill to complement and repair its original bill. The idea is that the second bill would get passed using a process called reconciliation, a parliamentary maneuver which would only require a simple majority in the Senate. The rules are a bit tricky -- reconciliation is generally limited to a specific set of topics including appropriations and budgeting. Some members of the House have been calling for the passage of that second bill by the Senate before they would be willing to take up the original bill. This also is a recipe for defeat.
The final scenario is simple: The House could pass the Senate bill and thereby deliver it intact to the President to be signed into law. The advantage in this is that it requires only a simple majority in the House for passage, and the Democrats have that majority if the leadership is capable of delivering it.
Internet columnist Kevin Drum may have been the first to make the point in this simple, dramatic fashion: "Pass the damn bill." Andrew Sullivan and others have adopted the Internet's method of pounding on the table by headlining it as "Pass.The.Damn.Bill."
The downside to passing the bill intact is that it contains provisions that are anathema to liberals (constraints on abortion funding, low levels of subsidy for the poor) and lacks the "public option" health insurance plan that was considered terribly important by liberals throughout the summer and fall.
The upside to passing the bill is that it fixes some very serious problems in the American healthcare system. The most important fix is removing the ability of insurance companies to deny coverage to anybody who has any one of hundreds of preexisting conditions, or anyone who had some illness in the past that is on the exclusion list.
Some people object to a provision in the Senate bill which makes insurance coverage mandatory.
There is an inescapable logic behind this provision though. Without it, the requirement that insurance companies cover those currently excluded by preexisting conditions becomes unworkable: Without the mandate, people would be free to go without health insurance until they got some serious illness, at which time they would apply. The mandate supplies the large pool of insured, both healthy and sick, that is required to make any large health insurance system work.
It should be noted that every modern, industrialized country that currently guarantees universal health coverage also requires that everyone participate. Interestingly, the United States pays a far higher proportion of its national income to health coverage than any other advanced nation, even though a substantial fraction of our people are without health insurance. In this sense, we have the worst system in the industrial world, being far more expensive and far less inclusive than any other.
There has been some chatter of late that the healthcare reform process should be put on the back burner and possibly taken up some time in the indefinite future. That future might be a month and it might be never. The alternative is to take Kevin Drum's advice and pass the damn bill. One pundit added an additional word: "Now."
This is pretty much a unique opportunity that could die if the Democrats in the House of Representatives continue to act stubbornly. On the other hand, if they pass the bill, then millions of people will finally be eligible to buy insurance, millions more will receive subsidies, and an ugly set of insurance industry practices (such as rescinding coverage for sick people on the flimsiest excuses) will be abolished.
Equally important, the existence of the new law will create incentives for its continual improvement, as the worst parts of the Senate bill get sanded down by subsequent legislation, and as the scope of reform is expanded. This may take ten or fifteen years to complete, but absent the passage of this bill, imperfect though it may be, we would probably have to wait that same fifteen years before the subject is considered anew by some future congress.
It's important to call your congressman and share the message that it's time to pass the bill and to do so right now. We lost the chance for healthcare reform in the early 1990s, and we could lose it again for another couple of decades if the congress fails to act.
(Bob Gelfand is a member of the Coastal San Pedro Neighborhood Council and is vice chair of the Los Angeles Neighborhood Council Coalition.) -cw
CityWatch
Vol 8 Issue 9
Pub: Feb 2, 2010
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