Jonathan Cohn of The New Republic:
The three House committees writing health care legislation have just released the full text of their bill. And my immediate, admittedly tentative reaction is strongly positive. Once fully implemented, this reform plan will accomplish most of the goals on my mental checklist:
- Generous subisidies, available to people making up to 400 percent of the poverty line
- Expansion of Medicaid to cover people making less than 133 percent of the poverty line
- Guarantees of solid benefits for everybody, with limits on out-of-pocket spending
- Strong regulation of insurers, including requirements that insurers provide insurance to people with pre-existing conditions without higher rates
- An individual mandate, so that everybody (or what passes for everybody in these discussions) gets into the system and assumes some financial responsibility
- A public plan, one that appears to be strong, although I'll reserve judgment on that until I hear from the experts
- Choice of public and private plan, at first just for individuals and small businesses, but later for larger businesses and--possibly--eventually for everybody
Efforts at payment reform, if not necessarily as strong as they could be
- Investment in primary care and prevention, which is not sexy but potentially important for general health .
The House of Representatives is now prepared to unveil their health reform legislation with markup taking place tomorrow and Thursday. It’s a good bill (more on that later) but it’s worth also giving a tip of the cap in the direction of the House process. The chairs and members of the three relevant committees did a great mitzvah by putting egos aside, forming a unified “tri-committee” bill writing process, largely shutting up about their internal negotiations, and getting down to the job of writing a bill that fits the parameters Americans voted for in November. I appreciate that the Senate has its own idiotic self-imposed supermajority requirement to deal with, but it would be nice to see the same discipline and seriousness of purpose from Senators at the committee stage.
OK, so the CBO score for the 3-committee House health care plan is in: $1 trillion over the next decade for 97 percent coverage of legal residents.
That’s a bargain: the catastrophe of being ill without insurance, the fear of losing insurance, all ended — for much less than the Bush administration’s useless $1.35 trillion first tax cut, quickly followed by another $350 billion.
And that’s just the budget cost, which the House proposes covering partly with savings elsewhere, partly with higher taxes on very high incomes. As Jon Cohn points out, the overall effect of expanded coverage will probably be lower health care costs for America as a whole.
There is now absolutely no excuse for Congress to balk at doing the right thing.
The Process Is the Message: Three separate committees -- Energy and Commerce, Ways and Means, and Education and Labor -- have come together on one bill. This is an incredible achievement. If you read histories of the 1994 health-care reform fight, all of them have a substantial section on the committee crack-up: One passed a version of single-payer, another a variant of Bill Clinton's reform, another went further to the right. There was no unity.
There is unity now. And if it holds -- if the House of Representatives manages to pass this plan with a substantial majority of enthusiastic Democrats -- that significantly strengthens the House's hand in its eventual negotiations with the more fractious Senate. That's a big "if." But so too would have been the idea that three separate committees could cooperate on a bill of this size.
Pretty positive reaction on this House bill thus far. While the bill may not be the single-payer option that most Americans want to see, it looks like this bill is a fairly decent consolation prize. Now we will have to wait and see what the Senate brings to the table and I am trying to not be pessimistic, but something tells me that the bill they put forward isn't going to sit as well as the House version.