Kevin Drum on health care reform and the legislative sausage-grinder

Bismarck is quoted as having said, more or less, that you probably shouldn't watch how either laws or sausages are made if you want to be able to stomach them afterward. On Wednesday Kevin Drum cogently explained how this sausage-making process has been working itself out in the health care reform marathon.

Glenn Greenwald had argued that the whole process of compromises, concessions, backroom dealmaking, sellouts to powerful interests, and other policy distortions by which the current bill has emerged "reinforces all of the worst dynamics of Washington." Kevin responded:

This is pretty much correct. The individual mandate was a way of getting support from the insurance industry.

[JW: Actually, as Kevin must realize, by itself this is misleadingly one-sided. The individual mandate is also essential for substantive policy reasons. But an insurance mandate without a public option could turn into a form of corporate welfare for the insurance industry.]

The backroom deal with Big Pharma was a way of getting support from the drug industry. The change in Medicare reimbursement rates was a way of getting support from doctors. The gutting of the Medicare commission was a way of getting support from hospitals. Provisions related to biologics, home healthcare, and the prescription drug doughnut hole were a way of getting the support of AARP.

Any honest observer has to concede that all this makes it hard to defend the final product. Except for one thing: in 1994 Bill Clinton failed to get the support of these groups and healthcare reform died. If Obama had done the same, it would have died this year too. There's really just no question about this. It's ugly, but that's the real world.

So is the bill worth passing in the end, despite everything? Kevin's conclusion:

From any kind of progressive point of view it's hard to see how you could seriously argue that the current bill is a net harm. Sure, it makes compromises to powerful interests that are hard to swallow. But that's why they're called powerful interests: because they can kill your legislative priorities if you don't assuage them. In return, though, the Senate bill brings down insurance rates, expands Medicaid, offers the prospect of moderately priced insurance to tens of millions of the uninsured, forces insurers to take you on even if you have a chronic pre-existing condition, mandates minimum levels of coverage, and takes several small but important steps toward reducing the future growth of healthcare costs. That's an enormous advance for the progressive agenda.

And, if this works at all the way it's supposed to, for basic human decency.

=> It's not an easy call, but all in all I'm inclined to agree with the main thrust of this analysis. The bill emerging at the end of this process, for all its flaws, looks like a real and significant step in the right direction, certainly better than no bill at all (and, with luck, its more glaring faults and gaps and unfortunate side-effects can be fixed in the not-impossibly-distant future before they do more harm than good). We'll see.

Meanwhile, read the rest (below).

--Jeff Weintraub
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Kevin Drum
Wednesday, Dec. 16, 2009 (5:02 PM PST)
Sleazy Sewers and Healthcare Reform

Glenn Greenwald has this to say about the Senate healthcare bill now that the public option and the Medicare buy-in have been stripped out:

In essence, this reinforces all of the worst dynamics of Washington. The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls. Progressive opinion-makers, as always, signaled that they can and should be ignored [...] Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress. And highly unpopular, industry-serving legislation is passed off as "centrist," the noblest Beltway value.

This is pretty much correct. The individual mandate was a way of getting support from the insurance industry. The backroom deal with Big Pharma was a way of getting support from the drug industry. The change in Medicare reimbursement rates was a way of getting support from doctors. The gutting of the Medicare commission was a way of getting support from hospitals. Provisions related to biologics, home healthcare, and the prescription drug doughnut hole were a way of getting the support of AARP.

Any honest observer has to concede that all this makes it hard to defend the final product. Except for one thing: in 1994 Bill Clinton failed to get the support of these groups and healthcare reform died. If Obama had done the same, it would have died this year too. There's really just no question about this. It's ugly, but that's the real world. Which brings me to the place where I think Glenn is wrong:

Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm.

From any kind of progressive point of view it's hard to see how you could seriously argue that the current bill is a net harm. Sure, it makes compromises to powerful interests that are hard to swallow. But that's why they're called powerful interests: because they can kill your legislative priorities if you don't assuage them. In return, though, the Senate bill brings down insurance rates, expands Medicaid, offers the prospect of moderately priced insurance to tens of millions of the uninsured, forces insurers to take you on even if you have a chronic pre-existing condition, mandates minimum levels of coverage, and takes several small but important steps toward reducing the future growth of healthcare costs. That's an enormous advance for the progressive agenda.

There's an alternate universe out there in which you could get all this stuff without compromise based on the sheer force of progressive arguments. Sadly, it's not this universe. I sure hope we don't have to learn this the hard way yet again.