Monday, December 21, 2009

Healthcare: random thoughts and questions

The Senate healthcare bill will probably squeak through sometime in the next seventy two hours. Count Clever Wife and I among the very disappointed. I'm inclined towards a position of hold your nose and vote for the damn thing and she inclines toward throw the game board in the air and start a violent revolution. I have a lot of questions to ask and a few observations to make.


The supporters of the bill keep saying we should support the bill because it will give coverage to thirty one million people who are currently not covered by the for profit insurance industry. The pundits, politicians, and activists who chant this line speak from a perspective of a "we" who have secure coverage and who are doing a good deed for those people who need coverage. I have news for them, many of the "we" whom they are talking to are among the uninsured or insecurely insured. This is not an abstract question of doing a good deed for others; "we" need to know if the bill will improve our dire situation.


If thirty one million will gain coverage, who are the twenty million who will not gain coverage? Which group am I in? If I'm in the lucky thirty one million, when does it kick in and how does it work?


Those same pundits, politicians, and activists keep telling us we shouldn't let the perfect be the enemy of the good. I don't know of anyone who is doing that. We gave up on the perfect at the beginning of this process when the Democrats decided to start the negotiations by making a big concession in keeping single payer off the table. A robust public option was the good. The weaker public options that the Senate eventually bargained away were only okay. At this point, those who have given up on the bill are letting the okay get in the way of the only marginally better than nothing.

More questions:

Clever wife and I have a wildly fluctuating income. This year it will be zero. Our COBRA coverage will end in a few months. We're in our fifties and we each have chronic conditions. Joe Lieberman made sure we can't move into Medicare, so what are our options?

The individual mandate means we will be forced to buy insurance from a for profit insurance like the one that is about to terminate our COBRA. When will we be forced to make that purchase. They tell us there will be subsidies to help pay for the over priced limited coverage that the for profit insurance offers. When will the subsidies kick in? We're not a typical four in their thirties. How much help will the subsidies give to people like us?

Another observation:

Right now, we're all focused on blaming Joe Lieberman and Ben Nelson for the constant erosion of the Senate bill. Let's not forget that it was Max Baucus who delayed the process for two months, allowing the Lieberman and the conservative Democrats time to sabotage the bill.


How miserable can we make their lives without forcing them to change parties?


I think it's fairly clear that after the next election, Lieberman is going to openly declare himself a Republican for his 2012 run. If he runs as an independent, he will probably lose in a three way fight. If he runs as a Democrat, he will face a bloody primary challenge and little support from the Democratic establishment. That leaves running as a Republican. Any hope of improving the bill is dependent on getting rid of Lieberman.


Is there any reasonable chance that we can gain a seat in the Senate next year to give us a Lieberman proof majority?

Final observations:

It took thirty years to get from Social Security to Medicare. It took forty five years to get from Medicare to whatever this mess is going to be called. I probably not going to live to see the next major improvement in this country's healthcare system.

This disappointing business has completely destroyed the morale and enthusiasm of the people who elected Obama and the Democratic majority. Many of the people who became first time voters last year, because of that enthusiasm, are probably going to stay home next year.

Final questions:

Can Obama and the congressional Democrats regain our trust and support? Will they even try?

Can the bill be improved in committee and still make it through another vote in the Senate? Is it realistic to hope for improvements to come through later legislation or will those attempts be blocked by the same saboteurs that created the need for improving the bill in the first place?

What next?

PS: Rahm Emanuel can kiss my red, furry ass.

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