Democrats squabbling and buying votes for the Health Care Reform Bill

Here is a fascinating article on the battles that are brewing among Democrats over the Health Care Reform bill, now that a delicately compromised Senate bill will have to be reconciled with a delicately–but differently–compromised House bill. The story contains this tidbit, the price Senator Ben Nelson (D-Neb) extorted in order to compromise his pro-life convictions:

Nelson, who got the federal government to pick up the cost of any Medicaid expansion under the health reform bill in the state of Nebraska forever. Republicans said Democrats have refused to say which state would get about $100 million inserted into the bill on behalf of a still unidentified university hospital.

“This process is not legislation. This process is corruption,” said Sen. Tom Coburn (R-Okla.). “And it’s a shame that that’s the only way we can come to consensus in this country is to buy votes.”

Nebraska would get its Medicaid bills picked up by the rest of the nation’s taxpayers FOREVER! What a deal.

Health Care bill negotiations

Senators are negotiating what kind of health care bill will be put up for a vote. As things stand right now, the government-run public option is out, but abortion funding is back in. Anything the Senate passes, though, will have to be further negotiated with the House of Representatives, whose bill has both.

Incoherent health care

Charles Krauthammer is not against coming up with health insurance for those who do not have it, but he points out that the current bills are utterly incoherent, making a system that is already inefficient even more so:

The United States has the best health care in the world — but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

– You'll find mandates with financial penalties — the amounts picked out of a hat.

– You'll find insurance companies (which live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third — numbers picked out of a hat.

– You'll find sliding scales for health-insurance subsidies — percentages picked out of a hat — that will radically raise marginal income tax rates for middle-class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

Then do health care the right way — one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

He goes on to recommend malpractice reform (which the current bills do not address, out of respect for trial lawyers, one of the Democrats’ biggest sources of donations, even though fear of malpractice suits causes doctors to run countless unnecessary and expensive extra tests); then allowing insurance companies to compete across state lines (which the current bills do not address, even though this would cut insurance premiums); then taxing benefits to raise money to help the uninsured (which I’m not sold on).

But still. . .His point is that this bill is a bloated monster that won’t accomplish what it claims to. A better solution would be to take one reform at a time with the goal of making health care less expensive and less complicated.

The young picking up the tab for their parents

Economics columnist Robert J. Samuelson finds another quirk in the Health Care bill. Already, our system of entitlements is forcing the young to subsidize the old, what with Social Security imbalances.

Now comes the House-passed health-care "reform" bill that, amazingly, would extract more subsidies from the young. It mandates that health insurance premiums for older Americans be no more than twice the level of that for younger Americans. That's much less than the actual health spending gap between young and old. Spending for those age 60 to 64 is four to five times greater than those 18 to 24. So, the young would overpay for insurance that — under the House bill — people must buy: Twenty- and thirtysomethings would subsidize premiums for fifty-and sixtysomethings. (Those 65 and over receive Medicare.)

Dictating how much something is allowed to cost is always disastrous, since market mechanisms work whether one wants them to or not. (When I was in Estonia under the Soviet Union, the communist government kindly mandated that bread be sold for a price that was less than what it cost to produce it, which meant that bread was reasonably priced but that there was no bread in the shops!) For the bill to presume to set these kinds of prices–as well as others, such as not allowing insurance companies to charge extra for pre-existing conditions–is a dire sign.

But now to force young adults just starting out–who already have a hard time making it, thanks to housing prices and the rest of our high cost of living–seems especially unfair. This is not a matter of the young helping out the venerable old. Retirees are under Medicare. This is paying for their parents, who are at a stage where they make far more than their 20-something kids.

Spiritual healing in the health care bill?

Christian Science practitioners are trying to get spiritual healing to be paid for in the Health Care Reform bill:

The calls come in at all hours: patients reporting broken bones, violent coughs, deep depression.

Prue Lewis listens as they explain their symptoms. Then Lewis — a thin, frail-looking woman from Columbia Heights — simply says, "I'll go to work right away." She hangs up, organizes her thoughts and begins treating her clients' ailments the best way she knows how: She prays.

This is health care in the world of Christian Science, where the sick eschew conventional medicine and turn to God for healing. Christian Scientists call it "spiritual health care," and it is a practice they are battling to insert into the health-care legislation being hammered out in Congress.

Leaders of the Church of Christ, Scientist, are pushing a proposal that would help patients pay someone like Lewis for prayer by having insurers reimburse the $20 to $40 cost.

The provision was stripped from the bill the House passed this month, and church leaders are trying to get it inserted into the Senate version. And the church has powerful allies there, including Sens. John F. Kerry (D-Mass.), who represents the state where the church is based, and Orrin G. Hatch (R-Utah), who said the provision would "ensure that health-care reform law does not discriminate against any religion."

What do you think of that? Would you be OK with acupuncture? macrobiotics? “natural healing” techniques? (I don’t know if the bill would cover those treatments or not. Does anyone know? Do most insurance companies? Do any insurance companies cover “alternative medicine”?)

The Louisiana Purchase

The Health Care Reform Bill passed a key procedural vote in the Senate, shutting down the possibility of a filibuster, when Democratic leaders promised a moderate Democratic holdout $300 million for her state in return for her vote. Here is how the Washington Post describes this and other shenanigans:

Staffers on Capitol Hill were calling it the Louisiana Purchase.

On the eve of Saturday's showdown in the Senate over health-care reform, Democratic leaders still hadn't secured the support of Sen. Mary Landrieu (D-La.), one of the 60 votes needed to keep the legislation alive. The wavering lawmaker was offered a sweetener: at least $100 million in extra federal money for her home state.

And so it came to pass that Landrieu walked onto the Senate floor midafternoon Saturday to announce her aye vote — and to trumpet the financial "fix" she had arranged for Louisiana. "I am not going to be defensive," she declared. "And it's not a $100 million fix. It's a $300 million fix."

It was an awkward moment (not least because her figure is 20 times the original Louisiana Purchase price). But it was fairly representative of a Senate debate that seems to be scripted in the Southern Gothic style. The plot was gripping — the bill survived Saturday's procedural test without a single vote to spare — and it brought out the rank partisanship, the self-absorption and all the other pathologies of modern politics.

I am aware that “horse trading” is how things get done in the Senate, but Sen. Landrieu is so brazen about it–bragging about the money she got on the Senate floor–that this strike me as particularly shameful. I wonder if that $300 million will be calculated into the costs of this bill. At any rate, if we get a new health care system, whether for good or for bad, we can look back years later and thank Sen. Landrieu and the Democratic leadership for this Louisiana purchase.