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The Health Bill, The Price of Everything, and What to Do Next

The new bill has more breaks for business, but harsher punishment for the uninsured, it eliminates the public option, it pays doctors less -- and it costs the Federal government $23 billion more.
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The CBO finally scored the redrafted Senate health care bill, saying it will cost $871 billion over the next ten years. Not that anybody waited for the numbers before cutting a deal. This was never really about the numbers. It was about coming in below an arbitrary figure and passing the bill by an arbitrary date. It looks like both goals will be met.

The CBO Director's Blog writes that "(t)he changes with the largest budgetary effects
include expanding eligibility for a small business tax credit;
increasing penalties on certain uninsured people; replacing the 'public
plan' ... with 'multi-state' plans ... deleting provisions that
would increase payment rates for physicians under Medicare; and
increasing the payroll tax on higher-income individuals and families."

In other words, the bill now has more breaks for business but harsher punishment for uninsured individuals, it eliminates the already-weakened public option, it pays doctors less - and it costs the Federal government $23 billion more.

Hey, what's not to love?

The idea of raising payroll taxes on higher earners is a good one. But if you take that new revenue, add the unfair tax on higher-cost benefit plans (studies demonstrate its unfairness), throw in the pay cut for doctors, and toss the higher individual penalties on top of that, it still doesn't offset the fiscal recklessness behind killing the public option.

Why would the public plan have saved the government money? Because, as the CBO puts it, "it was expected to exert some downward pressure on the premiums of the lower-cost plans to which those subsidies would be tied. " In other words, it would have made other insurance cheaper by creating real competition. If it's costing the government this much money to lose the public option, can you imagine what it's costing the rest of us as individuals?

Remember: the CBO score doesn't include the personal value of these policies for each of us. The Senate's new bill won't just increase the Federal budget.We'll also pay higher premiums because we lost the public option, and face more out-of-pocket payments because the excise tax stayed in. Wasn't it Oscar Wilde who said a cynic is someone
who "knows the price of everything and the value of nothing"? One issue dividing progressives now is that some see pragmatism in this bill and others see cynicism.

If Joe Lieberman can single-handedly be credited with most of these changes, is it fair to call him the Twenty Billion Dollar Man? Maybe. But remember, it's easy to hate Joe Lieberman - and it's a distraction. The Administration and the Senate leadership made a series of choices that give him this power. In fact, some say that the public option was always doomed - that the Administration cut a deal in which they'd make a half-heated attempt to fight for it and would then let it die, placating the always-compliant liberal wing with another mantric repetition of the phrase "we didn't get everything we wanted, but ..." In that scenario Joe's the Bad Cop to the President's (and Harry Reid's) Good Cop. If Joe Lieberman didn't exist it would be necessary to invent him. "Hey, I wanted to help you out - here's a cup of coffee - but my partner here ..."

So progressives are torn between the Good Cop/Bad Cop Scenario and the String (of Blunders) Theory. The reality's probably somewhere in the middle: mismanagement and a back-room deal or two. (We know there was a deal with Big Pharma.) There's an easy way for the President and Sen. Reid to disprove the Good Cop/Bad Cop Scenario, of course: They can fight like hell to win concessions in the House/Senate conference, bringing final bill more in line with the House version. That would mean, at the very least, a public option and no excise tax.

Think they will? Me neither - but I think they should be pressed to do so. I expect that the House will be put under enormous pressure to cave and accept the bill as it is. I think the President and other party leaders assume the left can always be counted on to cave in for the good of the country. I also think that anyone who points out the flaws in this bill will be subjected to another round of scoldings from party leaders and their supporters, charged with not understanding how the world works. Wouldn't it be better to debate the tactics on their merits instead?

Because that last charge is the biggest miscalculation of them all. Many of the people being lectured over this bill are the same people who have been right about matters of both policy and politics for most of the last decade. (And about the politics - the Democrats are going to get killed if they pass this bill.) So it was particularly satisfying to see Markos Moulitsas respond forcefully to Chris Matthews for his wave-of-the-hand dismissal to those who saw the last decade's events more clearly than he did.

That doesn't necessarily make them right today, of course, but I think they are. Debates over motives don't even matter in the end, since the tactics should be the same either way. And speaking personally, I'm not talking about "killing the bill" here - I'm talking about getting a better bill. I believe it will take a credible threat from the left - a "fear factor" - to get that done. Sure, we'll be told this is the best we can expect, that it's this bill or nothing, but it's too soon for that. When it really is take-it-or-leave-it time, I and many others will agonize over the decision. But most of all, I think now is the time to press the case against the Senate draft. The odds may be long but the struggle for a better bill is still worth pursuing.

The battle is lost but the war isn't over.

(UPDATE: I talk about the bill with Cenk Uygur on The Young Turks; video here.)


RJ Eskow blogs when he can at:

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