Is the present HCR bill better than nothing?

>> Tuesday, December 15, 2009

On the one hand:

(1) No single payer

(2) No public option

(3) No expansion of Medicare

(4) People will be forced to buy insurance they don't want (btw about 17% of drivers on any given day have no car insurance although it's legally mandated).

On the other:

(1) In theory, insurers will be barred rescinding coverage when people need to actually use their insurance, and denying coverage because of pre-existing conditions. I say in theory because a crucial aspect of the final bill (and exactly the kind of thing that gets decided in the most disingenuous and confusing way at the last moment during conference committee negotiations) will be exactly what sort of legal mechanisms will be created to enforce these "rights." Absent a vigorous administrative process, federal legal mandates on giant insurers aren't likely to mean much.

(2) There will be, for now, subsidies for purchasing insurance.

In sum, while it would be an exaggeration to say this bill is *no* improvement on the status quo, the improvement appears quite minimal, the political costs of enacting it are likely to be considerable (requiring people to buy health insurance sounds almost like a parody of what Rush and Co. claim the Democrat Party is all about), and the good stuff in the bill will be the easiest to strip out (the subsidies) or simply ignore (the new legal requirements on insurers) the second the Republicans are back in power.

On yet a third hand something is generally better than nothing. For me, the ultimate question is whether a weak bill will destroy the momementum for further reform, or will (like the 1957 Civil Rights bill) serve as a starting point -- or at least a cautionary tale -- for future efforts.

Update: Howard Dean says no sale.


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