Monday, April 27, 2009

A Dream Realized

It's too early to open the champagne or to even assess the package, but we've taken a big step as a nation:
Late last week President Barack Obama and Democratic congressional leaders agreed to use "budget reconciliation" if necessary to jam a massive health-care bill through Congress.

Most Americans probably greeted this news with the glazed eyes and yawns that should rightfully accompany any discussion of "the federal budget process" longer than 30 seconds. But this decision is a deeply troublesome attempt to circumvent the normal and customary workings of American democracy.

It's a radical departure from congressional precedent, in which budget rules have been designed and used to reduce deficits, not expand the size of government. And it promises bitter divisiveness under an administration that has made repeated promises to reach across the partisan divide.

If we can ignore Sununu's posturing and calling for a whaaaaaaaaaaaaaaaambulance, on balance what this means is that some form of national health coverage will be in place within the next few weeks.

Undoubtedly, it will piss everyone off, which means either it is stellar piece of legislation or a complete bonehead bill.

National health care is long overdue in this nation. For too long, health insurance and healthcare has been both overpriced and underservicing the needs of the people of this country, unless you were rich enough (or worked for or with a large enough organization, which is diametrically opposed to American capitalism) to afford premium coverage.

Health insurers knew they have a captive audience and treated us all monopolistically. You went to work for an employer: take it or leave it.

Healthcare decisions effectively became the domain of your employer, who picked and chose coverage not based on what was best for you, but for his or her bottom line. By extension, your health care plan was next determined by the actuaries and bean counters at the insurer, not the doctor you saw. Their decisions guided not only his courses of treatments, but in some cases even forced him to tailor his diagnosis to get you out of his office faster, not necessarily healthier.

Doctors are not innocent in this scam, to be sure, although their guilt is not one of conspirator but of expeditor. The doctor or hospital must look to their own bottom line, knowing that their revenue stream is determined by two factors: limited time (who can work 25 hours a day?) and limited reimbursements.

Therefore, the faster they can churn patients out, the more money they can earn. This is not conducive to good healthcare, much less preventive healthcare. What doctor is going to waste precious revenue-earning time with you, discussing diet alternatives or recommending a good heart monitor? "You're fat, lose weight, next?"

Sununu's problem is two-fold: one, he sees national healthcare as socialized medicine (as if somehow our free enterprise model is helping anybody), and two, he's watching a parliamentarian trick used against his party.

Here's how that works: normally in the Senate, a bill must pull a supermajority. Sounds stupid and it is, but because of the filibuster rule, a simple majority is no longer sufficient to determine the will of the people.

The filibuster is the subject of a very long post in its own right, and I can't do justice to it here. Suffice it to say I feel it is necessary when something as controversial as committing the resources of this nation to a foreign objective is at stake, but quite unnecessary when 51 Senators determine, after 218 Representatives, that something as fundamental to the "life, liberty and pursuit of happiness" of the American people is at stake.

And there's the rub. Rather than letting health insurance stand or fall on its own merits, in the conference to resolve discrepancies in the annual budget Democrats can slip it in as a budget resolution, and it passes with a simple majority.

Tricky, to be sure, but whatever it takes, this is necessary. To delay this vital need of the nation a year longer or more until even the most hard-headed conservative "gets it" is both deadly and economically dangerous.

So John?

Shut up.