Tuesday, March 16, 2010

The Health Care Follies Continue

I think today's the big day for the health care reform bill.  I haven't seen the CBO estimate yet, but it's got be coming soon in order to enable a House vote before the end of the week.  The President has made his last public pitch.  And if Pelosi doesn't schedule a vote by tomorrow, then doubt starts to kick in as to whether she can actually get the votes.

Speaking of the President's last health care pitch, this is too funny...
Natoma Canfield, the cancer-stricken woman who has become a centerpiece of President Obama's push for health care reform, will not lose her home over her medical bills and will probably qualify for financial aid, a top official at the Cleveland medical center treating her told FoxNews.com.
Though Canfield's sister Connie Anderson said her sibling is afraid she'll lose her house and Obama warned at an Ohio rally Monday that the patient is "racked with worry" about the cost of tests and treatment, she is already being screened for financial help.
Lyman Sornberger, executive director of patient financial services at the Cleveland Clinic, said "all indications" at the outset are that she will be considered for assistance.
"She may be eligible for state Medicaid ... and/or she will be eligible for charity (care) of some form or type. ... In my personal opinion, she will be eligible for something," he said, adding that Canfield should not be worried about losing her home.
"Cleveland Clinic will not put a lien on her home," he said.
Cleveland Clinic offers personal guides to patients like Canfield who are concerned about payment to try to match them up with programs that can provide full or partial assistance. One option is state Medicaid coverage, which Canfield did not have when she was admitted. Another is charity care that is routinely provided by the hospital, which is a nonprofit. Cleveland Clinic reported providing $99 million in charity care in 2008.
...Anderson said her sister expects to spend at least 28 days in the hospital. She said Canfield has her own cleaning business but does not have any kind of health coverage, adding that for now nobody is paying for her stay at the Cleveland Clinic.
But Sornberger said that even if Canfield doesn't qualify for charity care or Medicaid, "there's probably eight to 10 options that a patient has" to find payment.
What I'm reading here is that Natoma Canfield seems to be a good argument for keeping the current system. Or that while she has problems, they're probably not worth blowing up the current system. And keep in mind, someone at the ever-competent White House thought this would be a good way to make the final sales pitch on health care. If the government runs health care the way the Obama campaign team has run the White House, I'm going to start investing the funeral home business. Heck, Obama even got some opposition among his pre-selected crowdRobert Samuelson also did a nice job of tearing down some of the substantive arguments in favor of the bill in his column, which is well worth a read.

Meanwhile, back in the alternate world of Capitol Hill, where Pelosi continues to try and pull in votes, Ramesh Ponnoru makes a good point about the Slaughter Solution, which makes less sense by the day (in addition to being sleazy and borderline unconstitutional)...
Any House Democrat who votes for the rule that allows the Senate bill to be deemed passed will be voting for the Senate bill. A foreseeable consequence of that vote is that the Senate bill may become law while some of the fixes the House votes for do not. It is entirely fair for Republican opponents of any House Democrat who votes for the Slaughter rule to tie him to the Senate bill. Republicans will be able to say, fairly, that such a House Democrat has voted for the Senate bill — kickbacks and all — and tried to hide the fact. Republicans may as well point out now that that's exactly what they're going to do.
That's about right -- and as much as I think former Judge Michael McConnell is right about the issue, I doubt the Supreme Court would invalidate healthcare reform because of Pelosi's gambit (although the awesomeness of such a moment in creating spectacular constitutional chaos almost makes me wish for it).  The real problem for the Democrats is that this looks awful politically -- they're racing to pass the bill, and using every technique possible to justify it.  Even Ezra Klein, who's the left wing blogger version of the Energizer Bunny on healthcare reform, thinks the Slaughter Solution is politically idiotic.  Other liberals are coming up with really bad analogies, like this one from Tim Noah...
As Slate's John Dickerson explained March 10, this would be achieved by a "self-executing rule" that would allow the House to "deem" the Senate bill already passed as it considers the clean-up reconciliation bill containing various corrections demanded by the House and the Obama White House. A sort of virgin birth, if you will, with the Senate cast as Mary, the House cast as Joseph, and health care reform cast as the baby Jesus.
...If this is what it takes to pass health care reform, maybe it's best to avert your gaze as you might do while attending certain rituals of far-flung premodern civilizations. Even better: Do as the Three Wise Men did. Skip labor and delivery and arrive two weeks later to appraise the newborn babe.
Since I'm not Christian, I can avoid being offended at the comparison of healthcare reform to that religion's savior (and even many Democrats should find this formulation problemaic, based on the deification of the President during his campaign... although maybe the bill is now the Son of Obama, which makes the President... my head hurts). As Jim Geraghty notes, the headline to the left isn't exactly what a supporter of the health care reform bill would like to read.  The GOP figured out how bad this looks and is trying to force the Democrats to vote on the gambit, as reported by Michelle Malkin, who also points out that Democrats have another problem -- they're losing support from normally reliable newspaper editorial boards.  That means Obamacare may be losing votes in the moderate-left of center, which is where they need support to pass the bill.

I'd rehash whip counts, but The Hill's running tab is fine for that. FireDogLake is here, and Jay Cost is here. Of course, whip counts don't matter when Dems seemingly flip for no reason at all, like Dan Maffei, although I'm guessing the "pro-village burning" line will find a way into a campaign ad this fall.  As to what's going on now with Pelosi's persuasion, Yuval Levin has a good point...
In their Politico piece noting that Pelosi has declared the reconciliation bill closed, Patrick O’Connor and Jonathan Allen suggest that Pelosi’s announcement means the wheeling and dealing for votes is over, and all that remains is an ideological appeal for votes. But members who were open to such appeals would have been on board with this bill long ago. In fact, what remains are deals outside of the health-care bill. What Pelosi is doing now is offering wavering members a variety of gifts and goodies that will be included in other bills (or in administration actions) between now and the November elections — and especially in this year’s appropriations bills. These deals will be much harder to discern than the crude buy-offs that Ben Nelson, Mary Landrieu, and others obtained for their states in the Senate health-care negotiations. They will no-doubt involve money and other favors for members’ districts or powerful constituents in unrelated bills — from transportation funds to Medicare payment decisions to an assortment of pet projects. And they will need to be delivered regardless of whether Pelosi gets enough members to switch their votes this way to actually pass the bill.
These special dispensations will present themselves in the course of the coming months, but we will probably never have a full picture of what they involve, and what it really took to get “no” votes from last time to switch (assuming any actually do so, of course.) We won’t know, that is, unless political reporters stop covering this week as though it involves a wonky substantive debate among House Democrats and started asking the Speaker and any members who change their votes about just what the “persuasion” process has involved.
I think the process for this bill will end up exposing a lot of those deals, whether the Speaker intended that or not. And the public will be even more offended by Congress' conduct, which should serve everyone well heading into the fall elections.  I'll give the last word to Megan McArdle...
So now I'm thinking about another political problem. Assume this passes; what happens afterward? I don't think that many people believe that the answer is "Nothing: the bill becomes law, and we sing happy smurf songs all the way to the longest life expectancy in the Western world!" Even the bill's proponents expect it will need some follow-up work. But what will that follow-up work look like?
Worst case scenario for Democrats: a wave of public outrage like the one that followed Cat Care, aka The Medicare Catastrophic Coverage Act of 1988 (and its step-child, the Medicare Catastrophic Coverage Repeal Act of 1989). This strikes me as quite likely, actually. If this passes, yes, you will have AARP support and a wave of positive coverage from 90% liberal media. These things did not save Cat Care from a wave of angry public protest. I mean, really angry.
...My nightmare is that they repeal everything except the really popular thing, which is to say the ban on rescission and exclusions for pre-existing conditions. These are basically free, and they're by far the most popular part of the legislation, as far as I can tell.
I'm not exactly a fan of rescission, and to the extent that it is being abused by insurance companies, they deserve whatever regulatory penalties they get. But without rescission, the natural thing to do is to wait until you get sick, and then lie on your insurance application. Like bans on pre-existing conditions, this leads to the classic "insurance death spiral" where the only people who want to buy the insurance are the people who expect to need more care than the cost of the premiums, causing the pool to shrink and the prices to rise.
...Would Obama dare veto it? When there's no longer an unpopular Democratic Congress to hide behind? One hopes, for the good of the country. But while so far the president has been enthusiastically urging members to lean into the strike zone and take one for the team, I've seen little indication that he's willing to risk his own job.
So what she's saying is... we're all screwed. Woo-hoo!

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