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The Senate HELP Committee Releases (Most of) Its Health Reform Bill


This is it.This is what health reform looks like. Embedded in that link is actual legislative language. More than 600 pages of it, in fact. It's the preliminary first draft of the Health, Education, Labor, and Pension Committee's bill (there are still some holes that will be filled in Friday or Monday). It's the work of Chris Dodd, but more properly understood, the product of his mentor, Ted Kennedy (and his staff), who has been grinding away at this issue for decades. The dream, it turns out, will never die: it will just be modified and re-released into each new Congress.

In the lower chamber, the Ways and Means Committee has released an outline of their coming health reform bill. And the Senate Finance Committee, of course, is looking to unveil its bill next week.

It's worth taking a step back for a second to consider the weight of the moment. It's been 15 years since Congress last tried, and failed, to reform the American health care system. Fifteen years in which everything has gotten worse. In which health care costs have risen and insurance coverage has contracted. In which individuals have lost their protection and businesses have lost their competitiveness.

It's easy, in the daily jockeying between committees and factions and caucuses, to forget that something pretty big is happening here: Congress is trying to solve, or at least improve, one of the most severe and enduring public policy problems confronting the country. A problem that has resisted the efforts of Franklin Delano Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon, Jimmy Carter, and Bill Clinton, but is pressing enough that for all its difficulty, it has never dropped from the agenda.

And here we are again. The bills are being written. The committees are holding their mark-ups. The president is laying down his markers. The industry is calling for consideration. It's worth remembering that the history of this issue is filled with moments of false optimism and dashed hopes. And maybe this time will be no different. Maybe we'll all be picking through the wreckage of the strategy and showing why it was really quite inevitable that health reform failed.

Or, maybe not.

(Photo credit: Marvin Joseph -- The Washington Post Photo )

By Ezra Klein  |  June 9, 2009; 4:19 PM ET
Categories:  Health Reform  
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Health care reform might pass, but in 10 years we'll still be talking about how to fix the health care problem.

Posted by: SteveCA1 | June 9, 2009 4:56 PM | Report abuse

Ezra, have you noticed that there's no way to get to your blog from the Post's front page? The Politics heading opens a drop-down menu that includes "politics blogs" - but no Ezra. And the Opinions heading doesn't even have a drop-down for blogs.

Posted by: Bloix | June 9, 2009 6:38 PM | Report abuse

I'm actually in the business and finance section, though I see how that's not intuitive.

Posted by: Ezra Klein | June 9, 2009 6:44 PM | Report abuse

It'll happen.
Health Care is only a BIG THING in the US. Elsewhere (in the developed world) has long since adopted a largely single payer system.
The bigger (systemic) problem the US faces is the ideological ethic that seems to pervade almost every aspect of your social debate.

In most parts of the world the humans have decided that businesses etc are there to serve the needs of the employees of those businesses. PEOPLE.
All the crap that has rained down on the world recently stems from some weird belief that businesses employ people to serve the needs of CAPITAL.

Fr'crissakes it just don't matter if the columns don't add up. There should be no transgenerational transfer of wealth. There have to be salary caps. There have to be caps on consumption. The financial market is BS. Shuffling paper and money does not make anything except for disafection. And when do I get to vote on whether or not we have to buy goods produced by Chinese slave labour or from stolen third world resources?
The health care debate reflects this strange idea that the money market is in control of the populace instead of the other way around.
It is a mythology that provides cover for aggregations of privileged individuals to collectively undtertake criminal activities on a worldwide scale (including conspiring in the oppression of hundreds of thousands of third-world residents).

Posted by: jamesmmoylan | June 9, 2009 8:54 PM | Report abuse

Stop acting like we don't know how to provide healthcare for all. I pay a ridiculous amount of money for healthcare....just in case. I see a doctor once a year, but my employer takes money from my paycheck every two weeks. It's an extreme amount of money for .....just in case.

Let's get real, the CEOs and other big management moneygrubbers don't want to give up the 14 million dollar per year paycheck. FYI: If we can feed one child in Africa for a YEAR for one cup of coffee a day, what can we do in America. C'mon, people. Stand up!

Posted by: gamble2000 | June 9, 2009 9:02 PM | Report abuse

We need to do something about the affordability of healthcare, but I wonder if government can handle the task without messing it all up. OsiSpeaks[dot]com

Posted by: KYJurisDoctor | June 9, 2009 9:07 PM | Report abuse

Trouble is, health care reform is being treated only as insurance reform. What will this do to bring down the actual costs of health care?

My son recently had three stitches in a finger. Cost? $999 dollars. Insurance covered about $600+ of that so more than $300 dollars for three stitches?

How will insurance reform help the inflation of actual medical expenses?

Posted by: haroldb1 | June 9, 2009 9:20 PM | Report abuse

Our biggest Healthcare problem is the high US cost per individual.
Highest quality healthcare providers have below average costs.
To find out why read Atul Gawande's article "The Cost Conundrum" in the June 1 issue of The New Yorker. All of our legislators would be well served to read this article.

Posted by: howacow | June 9, 2009 9:24 PM | Report abuse

Health care reform is like AIG: it is too big to fail. But whatever emerges may not look very pretty

Posted by: stewartconnell | June 9, 2009 9:42 PM | Report abuse

I would like to report that several articles concerning health care reform have been posted in various sites concerning the Blue Dog Democrats opposition to a public plan option an requiring a trigger option if a public plan is approved. I have talked directly to my representative who is a member of the Blue Dog Democratic caucus and he states that he supports the public plan option and does not support a trigger. Unfortunately there have been several articles that have misrepresented the positions of our Congressional Representatives. I suggest that everyone concerned about this issue contact their Representative and Senators and find out where they really stand, and express your opinion. They are listening right now, even though many people think they are not. Call them, email them, etc. Find out where they stand and express your opinion.

Posted by: Screenname05 | June 9, 2009 9:45 PM | Report abuse

I still don't get it. Why would you want the government to manage your health insurance? They are really really bad at managing everything. They will waste tons of money and it won't work well.

Why don't we just have the Government produce everything for us at lower costs? Would you eat a tasty Government burger for lunch? Only 5 cents! If Nationalization is the cure for poverty then why don't we nationalize everything?

The reason politicians don't ever solve problems effectively is that good solutions don't involve increasing political power and politicians are not interested in poliicies that make them less powerful.

Half of our health care system is already nationalized. Which half do you think is screwing the whole of it up most?

Posted by: fallsmeadjc | June 10, 2009 12:05 AM | Report abuse

Anything less than single payer health insurance is NOT "reform."

But as always, Obushma is more concerned about lining the pockets of rich executives than he is about helping the vulnerable.

He's all about screwing over the middle and working class in favor of his cronies.

Just like Bush.

Posted by: solsticebelle | June 10, 2009 12:08 AM | Report abuse

"Getting people to reduce their use of medical services is the spinach of health care reform. Expanding insurance coverage is the dessert. The Democrats want to enact dessert now, and worry about spinach later. For the dessert part, they want no Republicans involved. Down the road, when they are ready to tackle the spinach part, they will press for bipartisan cooperation and statesmanship from Republicans.

My suggestion in the talk is that the Republicans not fall on their swords to defend private health insurance. Yes, many people like their insurance. But many of us hate the claims process. In our household, the phrase "going postal" has been replaced by "going health insurance." My guess is that sticking up for private health insurance is a political loser. Moreover, real health care reform would require radical innovation in health insurance, so it is counterproductive to try to entrench for the existing system.

If I were a Republican, I would support a public health insurance plan that provides real health insurance. That is, it would have low premiums, but extremely high deductibles and co-payments--beyond anything we see today. People on the plan would, on average, pay more than 50 percent of their health expenses out of pocket. Only people at the very high end of expenses would get insurance payments. Even their co-oayments would not drop to zero.

There are various reasons why such plans do not exist today. Many of these reasons are regulatory. I am not sure how such a plan would fare in a free market. But that is the kind of public plan I could get behind."

Posted by: staticvars | June 10, 2009 12:09 AM | Report abuse

To fallsmeadjc,
I'd love a 5 cent "veggie" burger. While we're at it, the post office runs really well. We have public schools. not perfect, but we have them - and every child can go!

Why do I want the government to run healthcare? Because the government is... us! I don't want CEOs taking my money (who get paid absurd salaries up to 28 million A YEAR.) Put that 28 million back into the government to run the health care in this country, give it back to ME.

Posted by: ps89 | June 10, 2009 12:20 AM | Report abuse

I live in the US and in Canada. have 3 kids in Canada never had a bill come to my home.
just did my physical did all types of blood test & EKG.did not pay anything out of my pocket. I can walk into any doctors office or Hospital and get health care. all i do is show my health card. My employer covers my dental prescription and glasses. One thing I know, in Canada I will not go bankrupt or have to sell my house to pay for health care. American need to stop listening to republican propaganda and do research for themselves.
Just drive across the border and as some questions they're no perfect health care system,but i would never give up the Canadian system for the American.

Posted by: mcintyreerrol | June 10, 2009 12:30 AM | Report abuse

Dear Senators et-al,
On health care our "e pluribus unum" principle has failed, our runaway health care problem resembles our "greed is good" wall street problem. Why are so many foreign insurance companies like AXA and Allianz operating in the US? Because there is so much profit to be made, I can't blame them, but if we continue bailing out the likes of AIG we might as well nationalize the health insurance industry and run it as a non-profit national health care fund regulating the health care service providers.
The only way to ensure quality and availability is some form of government sponsored umbrella empowered to regulate the private sector. Stop for a minute and look beyond CONUS -- France is give or take #1 in health care quality and availability whereas we are in the double digit doldrums (WHO puts us at #37), but France is also leader in productivity among developed nations so let us avoid the "socialist" scarecrow that that is used to shy us away from understanding a better model that works, as an expat I know, I live in it.
Please, we must not let the insurers and their lobbyists hijack the reform in the name of sacrosanct profit

Posted by: seanseamour | June 10, 2009 12:56 AM | Report abuse

"I still don't get it. Why would you want the government to manage your health insurance? I still don't get it. Why would you want the government to manage your health insurance? They are really really bad at managing everything."

Maybe we can get the laid off folks from Wall St. to run it. The private sector sure seems to know how to provide health care.

Posted by: SteveCA1 | June 10, 2009 12:56 AM | Report abuse

Health care reform might pass, but in 10 years we'll still be talking about how to fix the health care problem.

Posted by: SteveCA1

Assuming arguendo that you are right, I think the odds are strong that if a true public option is part of any health care reform legislation, whatever needs to be fixed in 10 years will pale in comparison to the magnitude of the fix that is required now.

Posted by: newjersey_lawyer | June 10, 2009 1:04 AM | Report abuse

It's time for journalists, advocates, bloggers and progressive media to name names in the Senate for those representatives not firmly in favor of a public option for government sponsored health insurance. For our country to advance, we need letters, e-mails, calls and organizing in every county and state of senators who wish to water down the prospects for true reform.

Posted by: mcrcareer | June 10, 2009 1:42 AM | Report abuse

Let's hope something good FINALLY comes from this. America's health situation is abominable. USA is a first rate country???

Posted by: taid | June 10, 2009 1:58 AM | Report abuse

We also now have widespread unemployment, closed businesses, a contracted economy, and the only viable and lucrative business industry seems to be the private insurance business. Yet, what I have read is nothing but a bail out for insurance companies and nothing that meets what people are needing. It is not healthcare reform that meets the access to care issue that keeps people covered in all circumstances if all you do is create another product line for private insurers that is modeled after the federal plan and call it a "public plan". The only real solution is Universal Health Care Plan and no one even discussed it. They don't even want to talk about Single Payor Plan or Public Plan until people raised hell so then they just hung that label of the federal plan. This is going to be another sham and rip off like the Medicare Part D plan, the prescription plan for Seniors. It just makes me, an RN for over 40 years, and now retired, take the attitude of not caring, no one will turn me away to die on the curb and if they do, I am better off dead than living in a country who would do that to me. This is very disappointing. We will be fixing it in another 10 years when there is no choice because NO ONE will be able to support the insurance CEOs in their lifestyles they have become accustomed to and it will be the only way hospitals and physicians can be reimbursed....from the gov't.

Posted by: nana4 | June 10, 2009 2:14 AM | Report abuse

Your Republican plan prohibits people from seeking care. Low premiums and "extremely high deductibles and co pays"....what does that accomplish other than keep people who pay the premiums away from seeking health care until they are too sick and then it costs everyone more. A plan that is low in costs that stresses preventive health and access to care other than ERs for simple things will save money. Management of outcome based care will eliminate using every intervention available just because it is available but only when statistics and methodology indicates it has a high probability of being effective. Universal Health Care with excellent case management, disease management, claim administration, is the answer but it is not even being discussed because it would put insurance companies out of business.

Posted by: nana4 | June 10, 2009 2:23 AM | Report abuse

fallsmeadjc asked:
"Half of our health care system is already nationalized. Which half do you think is screwing the whole of it up most?"

Well, from where I sit it looks like the private health denier.. I mean insurance companies are the biggest problem. Their 32% administrative overhead consists largely of hiring people to deny coverage as long as they can. If they are forced to actually pay somebody's medical costs, they then deny insurance to that party.

I don't understand who the people are who deny that private companies, whose fiduciary responsibility is to their stockholders (and their CEO's) are better than a government bureaucracy. Do they have huge health benefit schemes paid for by their employers? Or are they just in the top 10% of earners (i.e., more than $130,000 a year)?

Posted by: Acharn | June 10, 2009 2:44 AM | Report abuse

Whoops! I meant, "who claim that private companies, whose fiduciary responsibility is to their stockholders (and their CEO's) are better than a government bureaucracy."

Posted by: Acharn | June 10, 2009 2:50 AM | Report abuse

You really have no idea, do you?
you say "Half of our health care system is already nationalized. Which half do you think is screwing the whole of it up most?"
It's absolutely and unequivocally the private part. Medicare runs at a 3% overhead, with private at over 35% (see: waste). Medicare covers everyone, granted not everything, but still provides rather good coverage for the cost. Private, on the other hand, picks and chooses who to cover, and when they develop a serious illness, can cite a "pre-existing condition" and deny anything, to anyone.
As far as costs, price setting and reimbursement rates are some of the problem, but the whole pricing and hospital charging system needs serious reworking.
Either way, the bottom line for fairness in access and care is a single payer system, with options for private on top, no pre-existing conditions. Cap insurance and pharm profits, reward primary care and preventive medicine (this alone would save hundreds of billions) given to EVERY person. The vast majority of our health care costs come from chronic disease and the underserved, who are more likely to suffer from these. Allow them to get free preventive care and just watch costs fall, health rise, and the well-being of all communities in this country rise.

But wait, this requires morality and justice, and a system that's based on HEALTH AND HUMAN RIGHTS, and not money. We live in America, so forget it.

Posted by: akoreishi | June 10, 2009 2:56 AM | Report abuse

Health care is a basic human right, not a commodity. It can't be a commodity because people don't CHOOSE whether or not to buy health care. Everyone must, at some point in their lives, obtain health care, so it cannot be a commodity like soda pop or music players. It should be provided to our citizens out of our tax money, just like our allies do.

Posted by: HyperInfluential | June 10, 2009 4:20 AM | Report abuse

Our current unregulated capitalistic healthcare system has to be reformed to a universal care system. Otherwise we'll continue to fail millions more patients like this:

Posted by: rxvette | June 10, 2009 6:39 AM | Report abuse

So why is no one asking about the pay scale of doctors who work privately. Half a million bucks or more a year is not uncommon. Why do these folks, who run their patients thru the exam rooms like cattle, often times just handing out drug samples with out looking deeply into causes rather than symptoms, sit at the top of the income bracket. I know there is the arguement of costly and arduous education, but it seems their income is far outsized compared to their actual work. I'm not suggesting that they take enormous cuts, but a 10% reduction would hardly send most doctors to the poorhouse.

Posted by: ksmom | June 10, 2009 7:32 AM | Report abuse

"why do these folks who run their patients thru the exam rooms like cattle, oftentimes just handing out drug samples..."

that is a sweepingly pejorative, insulting statement to make about doctors.
most of the doctors that i have come into contact with, are incredibly hardworking and devoted working long hours, with sick and scared people, sacrificing family time and social time, for the care of their patients.
having a very ill parent, i have had to spend much time in hospitals and emergency rooms, under very difficult circumstances...and the level of dedication and hard work of the doctors who have been caring for him has been nothing short of heroic.
i have seen this throughout my life.
i cant think of work that carries more emotional demands and responsibility than that of being a doctor.
have you ever called a pediatrician at three in the morning, frantic?
have you ever had someone perform open heart surgery on a loved one?
have you ever been in an emergency room at four in the morning?
if you thought about this, maybe you would say such sweepingly unkind things about doctors.

Posted by: jkaren | June 10, 2009 7:59 AM | Report abuse

last line is to read,
"maybe you wouldnt say such sweepingly unkind things about doctors."

Posted by: jkaren | June 10, 2009 8:02 AM | Report abuse

From jamesmmoylan:

In most parts of the world the humans have decided that businesses etc are there to serve the needs of the employees of those businesses. PEOPLE.
All the crap that has rained down on the world recently stems from some weird belief that businesses employ people to serve the needs of CAPITAL.


If you truly believe that businesses are there to serve the needs of their employees rather than their stockholders via income from selling services/products that consumers want/need, then I don't see how you can possibly expect anyone to take any of your comments regarding health care reform seriously.

As for me, I have no desire to have the federal government control my health care. Nor do I believe that insurance companies should be forced to take anyone, regardless of pre-existing conditions, without charging commensurately higher premiums. To do otherwise is to raise everyone's rates to cover the increased costs of high risk, high use patients.

Posted by: dbjmtaylor | June 10, 2009 9:10 AM | Report abuse

Thanks, dbjmtaylor, for saying openly what all opponents of health care reform actually believe. You are, of course, a selfish bastard, but an honest one.

Posted by: henderstock | June 10, 2009 11:00 AM | Report abuse

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