Next Steps on Healthcare

Next Steps on Healthcare November 9, 2009

We are now in a position where the House has passed a healthcare bill that is pretty much as good as it gets at this point. Aside from adopting the Stupak amendment, which provides ironclad protection against the subsidization of abortion, this bill is better than its Senate alternative in terms of subsidies, in terms of coverage, in terms of the public option, in terms of the employer mandate. While both bills pay for themselves, reducing the deficit, the House bill does it in the fairest way – by adding a surtax on those making more than a million dollars a year. This is in line with the principle of solidarity and is especially appropriate at a time when income inequality has returned to the levels of the gilded age.

For sure, this bill is not perfect. But look at the advantages. It will cover the vast majority of people. It will prevent the insurance companies from excluding people, dropping people, denying claims, and pricing people out of the market based on pre-existing conditions.  It will end the scandal of people dying from lack of healthcare, not seeking treatment because it is too costly, and going bankrupt because of healthcare costs. It is comparatively weak on overall cost control, but that would mean tackling ingrained special interests such as the medical industry, the drug companies, and the AARP. It is no surprise that these groups are all on board, but it will not come without cost. While I believe this bill will reduce the trajectory of healthcare costs from the do-nothing baseline, US healthcare will still be dramatically more expensive than among comparator countries.  But at this point, it is hard to see how a better bill can come out of this tortured political process.

So, where do we go from here? I think the pro-choice groups were in shock after Sunday’s vote, but they are rapidly regrouping. This is not over. There is, however, one way that a bill like this that includes the Stupak amendment can pass – if enough principled Republicans step up to support it. Can it be that Joseph Cao is the only principled Republican on this issue? The pro-life Democrats have proved their mettle. They stood up on principle and faced down the House leadership. Now it is the Republicans’ turn. Can at least some of them stand up for universal healthcare that excludes all abortion funding? Can they not follow the lead of the USCCB? Or will they stick to their meaningless and wholly inaccurate slogans like “socialized” medicine and the “government takeover” of healthcare?

It is true that the Republicans have had little input in this debate. But they have only themselves to blame. If they had delved into the substance from the beginning, instead of resorting to slogans, perhaps they would have had a better opportunity to influence the outcome. Many of our friends on the Catholic right claim that the Republicans are motivated more by social issues than economic ideology – here is a perfect chance to show that.

And what about Obama? I think Obama should encourage all to maintain the Stupak amendment. After all, it fits with what he has said previously, and this has drawn the ire of the pro-choice groups:

In 1993, Hillary Clinton explicitly told Congress that she expected pregnancy and abortion to be treated in health reform like any other medical service. This year, though, Obama sent a different message, telling Katie Couric in July, “I think we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care”.

Oh, but isn’t he supposed to be the most pro-abortion president ever….or is that yet again an example of sloganeering over substance?

"Your mention of John Courtney Murray is apt, though I suspect he has already laid ..."

Four Episodes from a Consistent Life ..."
"It does make things more complicated and suggests that there's more to be done with ..."

Four Episodes from a Consistent Life ..."
"Joe,thanks for this detailed comment. I appreciate your sentiments about ensoulment though the very uncertainty ..."

Four Episodes from a Consistent Life ..."
"David, I likewise applaud your series on how you came to believe in a consistent ..."

Four Episodes from a Consistent Life ..."

Browse Our Archives

Follow Us!


TRENDING AT PATHEOS Catholic
What Are Your Thoughts?leave a comment
  • I was hoping this would be a list of concrete steps we can take to ensure that the health care bill with the Stupak amednment passes. Specific Seanators we can contact, etc.

    Of course if it passes, then we won’t have anything to blame on Republicans, and that’s not fun.

    So instead, it was just another jab at Republicans and defense of Obama.

    One day, you are going to look back at these posts and weep. We have a great opportunity to have a profound impact on the future of this country, and instead you’re just talking about how bad the other guys are.

  • Kurt

    Democratic Leader Harry Reid’s office has said that it would be allowed for a senator to move to strike all in the Senate bill and replace it with the House bill. If the Senate passes this, there is no conference committee and the Stupak language stays.

    However, I can’t imagine the Republicans allowing that to happen.

  • wj

    MM,

    Since you know more about the details of all this than I do, and since I (more or less 🙂 ) trust your account of things, I was hoping that you might clarify for your readers: (1) how the Stupak amendment might be removed after conciliation with the Senate and whether this removal would have anything to do Republican Senators being willing to vote for the pro-life health-care reform; (2) whether Stupak represents a continuation of the status quo or an actual *advance* in pro-life legislation (I’ve seen both descriptions given); and (3) why people like Deal Hudson, Thomas Peters, etc. continue to use the canard of “death panels”–a quote from Hudson’s recent piece–and rationing to claim that this bill does not meet the USCCB’s criteria for an acceptable version of reform.

  • Precisely what percentage of each branch of government must the Democrats control before any failure can not be blamed on Republican obstructionism?

  • Zak

    Specific Democratic senators to contact:

    Bob Casey (PA), Ben Nelson (NE), Kent Conrad (ND) (on the record supporting the Hatch Amendment, the Senate equivalent of Stupak).

    Mark Pryor (AR) (moderately pro-life)

    Byron Dorgan (ND), Tim Johnson (SD), Harry Reid (NV), Evan Bayh (IN) (some pro-life votes in the past, particularly related to funding; local politics favors pro-life vote)

    Mark Begich (AK) (Unknown position)

    Longer bets: Bill Nelson (FL), Mary Landrieu (LA), John Tester (MT), Mark Warner (VA) (pro-choice, but somewhat moderate, might think it’s good politics – I think we might pick up one person from this group).

    On the other hand, Snowe (R-ME) opposed it in committee, and Collins presumably will too. I don’t think we’ll lose any other Republicans.

  • Zak: why only Democrats? What about the pro-life Republicans in the Senate? Who are the Catholics in that group for a start?

  • WJ:

    (1) I defer to commentors like Kurt who are well versed in procedure – I am not!

    (2) That’s a good question. The pro-choicers actually think its a step backwards. Michael Sean Winters has a good post on that at America.

    (3) Don’t know what Hudson’s argument is, but Peters cannot be taken seriously. His “American Principles Project” is an ugly neocon Palinist outfit.

  • Kurt

    (1) how the Stupak amendment might be removed after [conference] with the Senate and whether this removal would have anything to do Republican Senators being willing to vote for the pro-life health-care reform;

    The Catholic position should be for a senator to move to strike all in the Senate bill and replace it with the exact text of the House bill. Reid would allow it, but the question is would any Republicans vote for it. If this did happen, there would be no conference and the bill would go straight to the President’s desk with no chance of changing anything in the House bill including the Stupak amendment.

    If you can find me only 10 pro-life Senate Republicans who would support this as a way of absolutely preserving the Stupak language, I can get the Democrats needed to go along.

    Otherwise, this issue will be fought out on the Senate floor. It will be in order to offer a pro-life amendment (most likely by Hatch) and there will be a vote. There might be an attempt at compromise like the Ellsworth Amendment.

    If the Senate passes abortion language the same as the House, but there are other differences, the rules don’t allow the Conference Committee to drop the abortion language. If there are differences, they have to agree to the House language, the Senate language or something in the middle (whatever the Senate does will become the floor in Conference).

    The Conference Committee members tend not to push their personal views as much as working for something that will be adopted by their respective chambers. The Conference Report needs to be adopted by both the House and Senate and if they vote it down, it is considered an embarrassment to the Committee.

    No one can guarantee what will happen in Conference,. That is why the Boehner-Rangel exchange on the floor was just a stunt.

    (2) whether Stupak represents a continuation of the status quo or an actual *advance* in pro-life legislation (I’ve seen both descriptions given);

    Absolutely an advance. It writes into permanent law the Hyde restrictions and makes a dramatically larger share of the private insurance market pro-life.

    (3) why people like Deal Hudson, Thomas Peters, etc. continue to use the canard of “death panels”–a quote from Hudson’s recent piece–and rationing to claim that this bill does not meet the USCCB’s criteria for an acceptable version of reform.

    I give them credit for saying something. The stark silence from most conservative pro-lifers is stunning. A tremendous victory for the anti-abortion movement and most have clammed up in horror as they face the possibility of national health care without having abortion as a tool to defeat it. Hudson and Peters are looking for some reason to still oppose it but their arguments are less than thin.

  • Thanks for that, Kurt. And I agree with you – the silence from those who claim to be animated by pro-life instincts is deafening. I’ve put people like this on the spot from the beginning, asking if if they would support the propsed reform with abortion off the table. Not a single one answered in the affirmative, and the response to this question sometimes drew an angry response (one person de-friended me on facebook!). I think it hits a real nerve.

  • the silence from those who claim to be animated by pro-life instincts is deafening. I’ve put people like this on the spot from the beginning, asking if if they would support the propsed reform with abortion off the table. Not a single one answered in the affirmative,

    Hello??? I don’t know if you consider me a conservative, but I think I’ve been anything but silent on this question.

    But do go on talking about how awful conservatives are. Clearly, that’s what’s needed at this moment.

    I swear, if the Senate was unanimously Democratic, and there was just a single Republican in the House, you guys would still be blaming (even before we know if this will pass!) about Republican obstructionism.

    You guys have the ball. The pro-life Democrats in the House did something with it. You and the Senate can either do something with it, or complain about the defenders still on the field.

  • I guess I’m not sure why you’ve always been convinced that question is so telling, MM. I can’t speak for other conservatives, but the reason why I oppose the health care bill whether it contains the Stupak ammendment or not is because I think it will mostly result in increasing the cost of health insurance, while doing very little to actually get more people more care. Further, I think experience with mandatory cost savings rules in Medicare leads one very strongly to suspect that rather than being “deficit neutral” this will end up vastly increasing the deficit 5-10 years down the line, and will thus reduce the government’s ability to devote dollars to projects which might actually do someone some good.

    Why should I support a bill which I think will do far more harm than good simply because it promises not to fund immoral activities as well?

    Think of it this way: Say that Pelosi has just pushed through the “Affordable America Act” which was designed to set up a government price control board to cap prices on consumer goods in order to make things more affordable for “the little guy”. Now, I would expect that to be a horrible idea, which would end up hurting “the little guy” in the long run through shortages and decreased production of much needed goods and services. So I would oppose the bill. But if there was an ammendment proposed to exclude pornography from the list of products to be made “affordable” (and perhaps even be subsidized for the truly indigent) through the program, I’d support the ammendment on the theory that in that case even if I lost at least the government wouldn’t be trying to help people buy porn. The success of the ammendment, however, would make me no more supportive of the bill.

  • Matt Bowman

    Pro-lifers are silent? What are you talking about? They are loudly praising the Stupak amendment and gearing up for the same fight in the Senate.

  • John,

    First, I have no beef with conservatives. However, most of those in the US who consider themselves conservatives are not. They are laissez-faire individualists.

    Second, you seem to impute some power to me that I do not possess. I am a nobody. My views don’t really matter. Yes, I desperately want the Senate to pass this bill with Stupak attached. But here’s the problem: the so-called conservatives in the Senate seem more concerned with the public option than with abortion. Why is that?

  • Matt: the amendment makes no sense without the bill. I want the Senate to vote for the entire bill, including the Stupak amendment.

  • Darwin,

    I really don’t know where you get your analysis, but the CBO scoring is regarded as the most objective analysis we have. And you know what that says. You can quibble over costs, but how can you say the combination of the individual mandate, the employer mandate, and some form of community rating won’t increase coverage?

    As for costs, are you talking about overall healthcare costs or the budget. You know where the budget savings lie. The bill is paid for. You ight argue that these saving won’t materialize, but at least they are trying. The biggest spending items under Bush – tax cuts and war – were not paid for at all and are actually the largest contributors to the current debt stock aside from the economic slowdown.

    I also think overall healthcare costs will decrease relative to a no baseline scenerio – by improving the risk pool, by exploiting economies of scale, by inducing competition from the public option, and by not subsidizing those who rely on the ER.

    But at the end of the day, the cost argument is secondary. The moral argument is primary. By doing nothing, you are allowing the status quo to continue, a status quo where people are rationed by cost from accessing needed healthcare, even to the point of death. A status quo where medical bills drives people to bankruptcy. A status quo whereby insurance companies make money by minimizing what they call “medical losses”, or what we call paying for healthcare. This is a scandal.

  • MM,

    You have a forum here. I’m not sure how large a forum it is, but a larger one than most of us have access to.

    This is a critical time in for an issue, health care, you care deeply about. Over the weekend, it also became a great opportunity for an issue we all claim to care deeply about — our society’s tolerance for abortion.

    There are many politicians making very brave stands and can use some support. There is a hard battle in the Senate to be one.

    At the same time, your party has a wonderful opportunity to shake itself from an issue that has turned off many Catholic voters. If the Democrats can deliver a health care reform bill that also seriously undercuts society’s acceptance of abortion, who could claim that Republicans are the party of life?

    Yet you spend your time and your forum kicking the people who currently have little or no power. And by doing so publicly, you are encouraging others to do the same.

    This is, to put it mildly, disappointing.

    At some point, we have to stand up and do the work that needs to be done, not just bitch about how awful the other guys are. In the context of the election campaign, I can understand your type of behavior.

    But not now. There isn’t an election coming up. Let’s work to get this thing passed rather than worrying about whose fault it is if it’s not.

    But here’s the problem: the so-called conservatives in the Senate seem more concerned with the public option than with abortion. Why is that?

    Probably because of a temperamental opposition to government involvement in commercial activity.

    But I don’t really give a damn. They don’t have power.

  • Matt Bowman

    MM–you think Obama should support Stupak–you think the amendment shows he isn’t the abortion radical he has always shown himself to be?

    Maybe you should wait before you speak. Your beloved abortion reducing President took his very first opportunity to to slam the Stupak Amendment as taking away women’s insurance choices. http://www.mediaite.com/online/obama-this-is-a-health-care-bill-not-an-abortion-bill/ So when he says we can all keep our same insurance which in the House bill means no one can, what he really means is that we must make sure, and go out of our way to guarantee, that people with abortion coverage get to keep that.

    Yep, Obama is showing himself to be a stealth pro-lifer once again.

  • David Nickol

    MM–you think Obama should support Stupak–you think the amendment shows he isn’t the abortion radical he has always shown himself to be?

    Obama says: “So, you know, this is going to be a complex set of negotiations. I’m confident that we can actually arrive at this place where neither side feels that it’s being betrayed. But it’s going to take some time.”

    This does not sound radical to me.

  • Zak

    I only emphasized Democrats because I believe the only Republicans who might not support the Hatch Amendment are Snowe (who has already opposed it) and Collins.

    Maybe there are some Republicans who would agree to vote to end cloture if it were guaranteed that the amendment would get a vote, although Hatch and Brownback are the only ones I can think of for whom pro-life issues are important enough that they would let Democrats pass a bill they think very bad for the country.

    I’m torn on the legislation as a whole – I think it does little to control overall healthcare costs, I think its budgeting is a sham (pretending Medicare reimbursement rates won’t rise) and I wonder if there are more efficient ways to expand coverage. I’ve been intrigued by the German system, but I understand there isn’t the will for that here.

  • Cathy

    MM:

    You tell Darwin that the cost of this bill is secondary. If our country goes broke with this new entitlement package, who will it help?

  • grega

    JohnMcG,

    a Senator Lieberman does give a damn for your concerns – business interest really run the show on both sides – as MM pointed out so elegantly certainly the ‘conservative’ side is far more invested in the ‘public option’ than anything else.
    Unfortunately this sad affair along with the too close for comfort bank bailouts will cost our in my opinion great President dearly next fall.
    But why point fingers – as long as a majority of Americans is rather comfortable with having Abortion around – this will not change anytime soon.

  • MM,

    My argument that the bill will probably result in very little increase in coverage is very simple:

    1) Every state which has tried similar provisions has seen the cost of individual insurance rise to more than twice the current national average. (As I pointed out on your post referencing Mass., the only reason their insurance costs went down a little in 2006 is that they had originally passed guaranteed issue and community rating back in the 90s _without_ and individual mandate — which needless to say is idiotic from an ecnomic perspective.)

    2) The subsidies in the House bill kick in to help you pay for insurance once you’ve already payed 8% of your pre-tax income for health insurance. However, the fine for not getting health insurance is only 2.5% of your pre-tax income. Obviously, if you’re currently unable to afford insurance, you may well not be able to afford to shell out 8% of your income for health insurance, so you’ll get stuck paying the 2.5% fine instead. People in the lower-middle class who feel the can’t afford health insurance and are being fined several thousand dollars a year for not having it are obviously going to absolutely hate this bill. This is not an imaginary scenario, there are already plenty of people in Mass. who are similarly stuck paying fines because they can’t afford the massively inflated cost of insurance there. Anyone who hasn’t been reading those stories over the last few months hasn’t been paying attention. The CBO analysis basically confirms this idea, in that it estimates a constant rate of penalty payments from the uninsured to the tune of 5-6 billion per year. In a dark irony, this is one of the elements that funds the bill. (Though based on states that have tried similar schemes, I think the CBO estimates for the number of people who would actually become insured under the bill are way too optimistic.)

    3) The bill is likely to be horrific for the deficit because it “pays for itself” in two ways: mandatory cuts in medicare payouts and extra taxes on “the rich”. The latter the CBO estimates are pretty good on: taxing the rich leads to excessive variance in tax revenues (obviously, anything funded by taxing millionaires is suffering a lot right now) but at least that’s predictable. (Though if your theory is this is a way to reduce inequality, that means you’re theorizing the income stream will dry up.) But the former is a big problem in that we can look at all the existing mandatory payout cuts already passed by congress to reduce Medicare spending, and we see that every year they vote not to let the automatic cuts go through. So this claim is kind of like an alcoholic constantly insisting he’ll save lots of money if he stops buying booze next week. And yet, the CBO rules don’t allow them to say, “BS, you’ve never gone through with cutting payouts before, why should we believe you now.” However, those who take an unblinkered view of it are forced to conclude that this bill will be mainly unfunded. And while you can say that “Bush did the same thing” the fact remains that the financial situation of the country is far worse now, and it was a bad idea when Bush chose to run up some deficits in the first place. Doing so even more so now is a worse idea, and should be called such.

  • Kurt

    Maybe there are some Republicans who would agree to vote to end cloture if it were guaranteed that the amendment would get a vote, although Hatch and Brownback are the only ones I can think of for whom pro-life issues are important enough that they would let Democrats pass a bill they think very bad for the country.

    The amendment already has been guaranteed a vote.

    If the Senate were to simply take up the House bill and pass it, there would be no conference and no possibility of dropping or modifying the Stupak amendment.

    Hatch and Brownback would be honorable men to suggest this course. Most Democrats would jump at the agreement.

  • One thing I would like to see done is confront all the rhetoric about how the Stupak amendment represents a return to the back alleys and coat hangers with vigilance equal to that with which you confronted the “death panel” rhetoric.

  • Kurt

    John,

    I have.