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Hollow reconciliation threats

According to ABC's “The Note,” "Senate Republicans say they can get the whole package of reconciliation fixes – the fix-its that make the Senate plan palatable to House Democrats – thrown out with a trump card procedural motion." That trump card? The dreaded 310(g) point of order.

The less you know about this, the more impressive it sounds. Budget point of order 310(g) "prohibits consideration of reconciliation legislation that contains recommendations with respect to Social Security." In particular, it bars changes to the Social Security trust fund. As points of order go, this is a pretty easy one to avoid: All you have to do is refrain from mucking with the Social Security trust fund. Which this reconciliation bill, like all reconciliation bills, does. Both sides in this debate have read the rules governing reconciliation, so you're not likely to see major errors of that sort.

But my sense is that there's some confusion about what happens if the parliamentarian rules against the Democrats on this or that provision. So let me be clear on this: Reconciliation isn't all or nothing. The parliamentarian isn't ruling whether you can do a reconciliation rider. He's ruling over what you can do with it. An adverse ruling is more annoying for the Democrats than it is disastrous.

If the parliamentarian strikes a provision or two, Senate Democrats will either pass the reconciliation act with that provision deleted from the package or they'll rewrite the package to try and achieve the same thing in a way that survives parliamentary challenge. Either way, if the package Senate Democrats pass is changed from the package the House considered, then it will have to go back to the House to be passed again. But since House Democrats clearly have the votes to pass reconciliation fixes, that shouldn't be much of a problem.

The key decision that made reconciliation problems an irritant rather than a roadblock was to treat tonight's expected passage of the Senate bill as the victory and to sign the bill immediately. Back when Republicans thought they could stop the Senate bill by stopping the reconciliation fixes, any problems in that package posed considerably more danger to the Democrats. Now, passing that package is a bonus.

Plus, if anything popular gets struck from reconciliation and left out of the final fixes, Democrats can bring it back through the normal order and let Republicans spend their time filibustering something they've repeatedly said they think Democrats need to do for the good of the country. Insofar as Democrats want to hit Republicans for being obstructionist above and beyond actual policy disagreements, that will be the perfect example.

By Ezra Klein  |  March 21, 2010; 8:38 PM ET
Categories:  Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: Another programming note
Next: A bill becomes a law

Comments

my biggest thought about parlementarian challenges is on the excise tax. I don't think there's any way you can make the excise tax pushback work under budget reconcilation rules, no?

If so I'd be very happy that we'd get an early fix to the lack of cost controls to the system.

Posted by: visionbrkr | March 21, 2010 8:47 PM | Report abuse

That assumes the Democrats have enough backbone to let the Republicans hang themselves. The usual Democratic response to the GOP saying "Boo" is "We surrender!".

Posted by: lmb02 | March 21, 2010 9:32 PM | Report abuse

No, let me be clear. You have no idea what you're talking about.

Posted by: ii00 | March 21, 2010 9:41 PM | Report abuse

Budget point of order 301(g) applies primarily due to the manager's amendments introduced earlier today. See footnote #3 on page 3 of CBO analysis of 20-Mar-2010, which reads "As originally introduced, the reconciliation proposal would require transfers from on-budget general funds to the off-budget Social Security trust funds to offset any reduction in the balances of those trust funds resulting from other provisions of the proposal. The effects of that provision were reflected in CBO’s preliminary estimate. However, the manager’s amendment to the reconciliation proposal strikes that provision, so its effects are not included in this estimate."

Posted by: rmgregory | March 21, 2010 9:55 PM | Report abuse

The URL for the CBO report referenced above is http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf

Posted by: rmgregory | March 21, 2010 9:56 PM | Report abuse

http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf

That's a nice fun fact. It would be more salient though, if this were a proper use of reconciliation in the first place though, huh?

Posted by: ii00 | March 21, 2010 11:00 PM | Report abuse

It passed. Thank you for your work over the years Ezra, you've had a share in bringing this about. It's a breathtaking accomplishment.

Posted by: opinionpieces | March 21, 2010 11:10 PM | Report abuse

I'd like to thank President Bush.

For without all his monumental screw-ups, the Democrats would not have taken control of both houses, a woman would not have become speaker of the house, health reform would not have happened, and a black man would not have become president.

Perhaps people like me will be able to get insurance now.

Posted by: Lomillialor | March 21, 2010 11:18 PM | Report abuse

I am anticipating the Constitutional challenges to this bill. For one, the “mandate” that govt forces you to purchase a commodity is clearly unconstitutional. When the individual mandate is ruled unconstitutional, the whole plan collapses.
Don’t belittle the idea of this type of challenge. Remember, FDR’s NRA was thrown out over a challenge by four jewish butchers in NY. (Schecter v. US, 1936). Oh, and don’t try that weak Obama argument about how “..we force people to buy auto insurance…” Big difference. Driving a car is a choice. Every person alive today had no choice in the decision to bring them into this world. I can’t find anywhere in the Constitution where govt can force you to purchase a good because you can fog a mirror with your breath. Also, does anyone see the absurdity of the entire notion of the use of “force” as a some sort of moral argument? It’s so nice to realize that the kleptocracy in Washington has so little respect for the idea of freedom that they revel in their ability to “force” people to do their bidding. What an utterly disgusting group of representatives we have in DC.

Posted by: markcarbon | March 21, 2010 11:20 PM | Report abuse

"I'd like to thank President Bush.

For without all his monumental screw-ups, the Democrats would not have taken control of both houses, a woman would not have become speaker of the house, health reform would not have happened, and a black man would not have become president.

Perhaps people like me will be able to get insurance now."


:-)

Posted by: jkaren | March 21, 2010 11:25 PM | Report abuse

The Supreme Court threw out small portions of the Military Commissions Act, not the entire bill.

Even if they threw out the mandate, the remainder will remain, and then the Dems and Repubs would have no choice but to drastically increase taxes on the wealthy to make up the loss of revenues. For that reason, the Republican justices would never vote to increase their own taxes by throwing out the mandate. That's my prediction.

Posted by: Lomillialor | March 21, 2010 11:27 PM | Report abuse

Thanks Ezra for all the coverage over the last year plus.

Posted by: Hopeful9 | March 21, 2010 11:32 PM | Report abuse

Thanks and congratulations Ezra, you rock, totally. You were great on MSNBC.....

Posted by: LiberalForReal | March 21, 2010 11:37 PM | Report abuse

Or maybe you are still on.......

Posted by: LiberalForReal | March 21, 2010 11:37 PM | Report abuse

Lomillalor,

I am honestly happy for you and for the jkaren's of the world who have been trying to get to this day.


I hope they sooner rather than later get to the drivers of cost.

Posted by: visionbrkr | March 21, 2010 11:41 PM | Report abuse

tks vision

What cost controls, besides tort reform, do you believe the GOP will actually support?

Do you think the GOP would ever vote to reduce profits of Drs and hospitals, or unneeded medical testing (which many drs do to increase profits)? I don't. And because the GOP is likely to gain seats this year, I do not anticipate any more major health reform changes any time soon.

Posted by: Lomillialor | March 21, 2010 11:49 PM | Report abuse

G-d bless our wonderful and amazing president.
he is a magnificent, beloved leader and a beautiful and wise human being.

Posted by: jkaren | March 21, 2010 11:52 PM | Report abuse

thank you visionbrkr.
we have all been a part of this journey together.

Posted by: jkaren | March 21, 2010 11:54 PM | Report abuse

markcarbon, although I commend you for endorsing the sale of bad chicken, NIRA has very little in common with HR3590. So back to your point - it's unconstitutional for the gov't to force me to purchase goods. So.... can I decline to pay my share of those new F-35 figher jets rolling off the assembly line? Can I decline to pay a licensed contractor $10k to fix my ailing septic system and do it myself instead?

Your argument would hold if the gov't was forcing me to purchase a policy from Blue Cross, or Cigna. But the gov't isn't forcing me to purchase a "good". Rather, it is forcing me to participate in a program. That program costs money. Certainly there is precedent for that. Individual mandate is the corollary to guaranteed issue. Do you argue against guaranteed issue?

And your argument that "Driving a car is a choice. Every person alive today had no choice in the decision to bring them into this world." Are you kidding? What does the act of being born have to do with this? One could argue that health insurance is more important and more necessary than driving a car. If I elect not to drive a car, that will have an economic impact on me. If I elect not to have health insurance, that will have an economic impact on everyone who purchases insurance, and everyone who pays taxes.

Posted by: highland2 | March 21, 2010 11:55 PM | Report abuse

"Drivers of cost," LOL

There's no money for any of this nonsense.

Can't you people count?

Posted by: ii00 | March 21, 2010 11:57 PM | Report abuse

Ezra is nothing but a mouthpiece of the the Obama agenda....Thanks for all your bias coverage in this healthcare debacle, we all now have to pay for it

Posted by: johnrick | March 21, 2010 11:58 PM | Report abuse

Lomillalor,

I hope that they do stand up to them but I don't know that they will. They'd do well to show some fiscal conservatism and push that ideal. I'd also add Pharma to that list. The crisis 5 years from now will be the crushing cost of biologics because this reform gave too long a period to generics (12 years).

A good place to look is MA because they basically did the same reform several years ago and now their costs are unsustainable and they're being forced to make changes to it. unfortunately the federal government can run deficits so this may get a whole lot worse before it gets better with no mechanisms in place to rein in costs.

I only pray that the upcoming fiscal commission President Obama convenes has some teeth to it.

Posted by: visionbrkr | March 22, 2010 12:00 AM | Report abuse

Yes, if only healthcare were in the hands of virtuous insurance agents, and not provided by greedy doctors to dumb patients.

Posted by: pseudonymousinnc | March 22, 2010 12:03 AM | Report abuse

After months of watching tea-baggers trying to subvert the system, I'm very happy to see the system worked. Americans voted decisively for health care reform on Nov. 4 2009. All this noise about Republican concerns for health care cost is empty rhetoric - they had 12 years. They chose instead to spend trillions on building a better future for Iraq.

Posted by: highland2 | March 22, 2010 12:06 AM | Report abuse

pseudo,

I know how to make you go away.

What is it you do?

Didn't you hear? There's no more pre-ex. I'm no longer the devil.


You're right, doctors aren't greedy? Ever seen one driving a car more than 3 years old? Patients aren't dumb, except no one understands the HCR debate, a simple insurance contract etc.

You've been proven wrong and wrong again.

Posted by: visionbrkr | March 22, 2010 12:08 AM | Report abuse

HCR will be a disaster!!!

Posted by: bmull | March 22, 2010 12:08 AM | Report abuse

ii00, when we were heading into a $3T nation-building exercise in Iraq, were you saying "There's no money for any of this nonsense"? If so, then your point is well-taken.

Posted by: highland2 | March 22, 2010 12:11 AM | Report abuse

highland2: Swing and a miss. The bill requires you to enter into a contract with an independent third party. Whether it is a "good", a "service", or a "program" is irrelevant. The fact is that, when this provision is enacted, you are required as a matter of law to enter into a "contract of health insurance" as mandated in the bill. There is a realistic potential for this to fail Constitutional muster.

The argument that, as you put it, "Individual mandate is the corollary to guaranteed issue." There is no guaranteed issue in the bill. An insurance company still has the prerogative to underwrite and decline your application for insurance, at least in the individual market. The only entity that may be required to accept any comer is the government funded high-risk pool, and later perhaps the exchange. Consequently, there is a significant probability these will become the point of adverse selection, increasing the premium requirement necessary to offset the cost of claims. The costs of adverse selection are nowhere contemplated in the bill.

Some will want to blame the President. Not his fault, since he doesn't cast a vote. I will hold my Senators and Representatives accountable, however, especially those who felt the party line was more important than their own conscience.

Posted by: riskexcellence | March 22, 2010 12:20 AM | Report abuse

pseudo,

if you haven't gone off to take your meds can you answer me one question:

Are people that work for the federal government that deny claims for medicare recipients evil? You know considering Medicare denies more of a percentage of claims than any single insurance company?

Posted by: visionbrkr | March 22, 2010 12:24 AM | Report abuse

hurray hurray hurray for john dingell!
what a joyful night this must be for him.
i think this must be one of the happiest nights
of his life.

Posted by: jkaren | March 22, 2010 12:26 AM | Report abuse

"I'm no longer the devil."

You really do think so very highly of yourself, don't you?

You're more of a low-end demon, efficiently shovelling coal for the fires and keeping the lakes of excrement topped up.

Posted by: pseudonymousinnc | March 22, 2010 12:42 AM | Report abuse

you conveniently didn't answer EITHER of my questions?

Does that make the federal employee denying claims via medicare a "low end demon" as well?

Oh and there's one "L" in shoveling.


Where does the "evil" stop in your warped mind? The claims processor? a software engineer who works on systems integration? An old secretary who answers phones in her spare time?

I figured that now that healthcare reform is here you'd share with me what it is you do for a living, no? What really could you be hiding??? hmmm.

Posted by: visionbrkr | March 22, 2010 12:47 AM | Report abuse

here is a thought. Let's say the individual mandate provision gets stroked down in courts. The other parts of the bill such as no annual or lifetime caps, no denial for preexisting conditions... will still be there, right? This will cause insurance companies to go bankrupt. Can we have the single, government payer system then?

Posted by: thor2 | March 22, 2010 1:01 AM | Report abuse

A couple observations visionbrkr,

I was talking with a pediatrician today who drives a minivan much older than 3 years. Pretty typical of GPs and pediatricians. i asked about his biggest nightmare with new law and he quickly said uncertain insurance reimbursement has always been his problem. Note NONE of his patients are on Medicare, they're just kids.

Meanwhile, we're paying huge bucks for cardiac catheterizaions that have low medical efficacy. And buying da Vinci surgical robots at $1.7 million a piece, plus consumable arms that get trashed after a handful of procedures, yet have marginal medical efficacy. And dropping $40K for herceptin and $70K for avastin therapeutics that cost about ten cents to produce based upon research paid for by taxpayer funded National Cancer Institute.

The difference is that those are predominantly used by people the age, and often the gender, of our elected officials, which is why those technologies are reimbursed by Medicare

Posted by: boscobobb | March 22, 2010 1:09 AM | Report abuse

democrats are TRAITORS

Posted by: Imarkex | March 22, 2010 1:16 AM | Report abuse

boscobobb,

I'll readily admit that PCP's are paid much less than specialists but in my part of the country (NJ/Northeast) they still do very, very well. I know some as well who easily make $200k per year in private practice and that's after expenses while specialists make a whole lot more (especially if they own a stake in a surgery center they refer to).

And I'm 100% with you on the need to negotiate better drug prices. Its a shame that's nowhere in this reform though. Rep. Eshoo made sure of that.

And at that price I fear there's a time when Medicare will either have to negotiate better with Pharma or we'll really start seeing some rationing.

That day will come but not soon enough for me.

Posted by: visionbrkr | March 22, 2010 1:26 AM | Report abuse

Can't Biden overrule the parliamentarian?

Posted by: ElrodinTennessee | March 22, 2010 2:02 AM | Report abuse

What do you mean there is no money for this? The vast sums health insurance companies have been collecting for years in premiums has not been used to provide much health care. It has been used to jack up the stock price, "compensate" executives, build an impressive balance sheet, and fund an expensive department in charge of finding ways to slough off medical losses without running afoul of the law. It is pretty easy to deny coverage to anybody who once had a hangnail. It is pretty easy to rescind coverage to somebody who gets seriously ill -- just find a misplaced comma in the insurance application. It has been estimated that Americans spend twice as much for health care than people who live in rationally run nation states that provide excellent health care services without trying to make big money at the same time. Did Bush do anything at all about stamping out Medicare fraud?

Posted by: BlueTwo1 | March 22, 2010 2:17 AM | Report abuse

This whole thing is BEAUTIFUL!!! It's about time we passed some kind of health care/health-insurance reform in this country and tonight's historic passage of the bill did just that.

The rest is gravy and it will all be taken care of.

This is historic; this is as good as it gets; this is BEAUTIFUL.

Excellent!!!

Posted by: TheWizard1 | March 22, 2010 2:28 AM | Report abuse

Something my dad told me a long time ago seems particularly relevant.

"You know you're looking at a true compromise when both sides are unhappy."

It's a bit cynical, but it describes what compromise has become in a politically polarized system. Liberals think the bill doesn't go far enough, and conservatives think the bill will cripple the country. Nobody's happy.

Ah, compromise...

Posted by: damascuspride04 | March 22, 2010 2:33 AM | Report abuse

damascus - this wasn't compromise. liberals wanted to drive us over the cliff at 100 mph, Obama is just taking us over at 60 mph. Most of this country didn't want to go anywhere near that cliff.

Posted by: termiteavenger | March 22, 2010 3:21 AM | Report abuse

This waters my eyes. Another entitlement thrown atop the heap, in a spiral of spending that never ends with big government. Do any of you know that there are $50 trillion dollars in unfunded mandates from Social Security, Medicare, and Medicaid alone? Our country is going into bankruptcy, and all anyone can cry for is more entitlements! Our Federal Government was initially designed to maintain a military and build roads, among very few other things.
Isn't it interesting that we didn't start running a huge national deficit until we created these massive entitlements? We're spending away the future of our children and grandchildren so we can have security today, while they will never enjoy such liberty as we have enjoyed during our lifetimes. They will be forced to pay our debts, and they will hate us.

Posted by: OfConservativeMind | March 22, 2010 3:27 AM | Report abuse

"Even if they threw out the mandate, the remainder will remain, and then the Dems and Repubs would have no choice but to drastically increase taxes on the wealthy to make up the loss of revenues."

Actually, they wouldn't have to do anything, just let the fund go bankrupt.

Additionally, you realize because this was brought in via reconciliation, it expires in 5 years unless congress re-passes the law? It's why the Bush tax cuts are going away.

Enjoy.

Posted by: Ombudsman1 | March 22, 2010 3:58 AM | Report abuse

There are two Ls in shovelling, breaker, but I'm billing you for fifteen of them and three Qs.

You already know that your job wouldn't exist if the US had an actual healthcare system, but you've spent the past however long here portraying yourself as a model of virtue between the ignorant and the greedy. At least that kind of sanctimony's cheaper than Ambien.

Posted by: pseudonymousinnc | March 22, 2010 4:23 AM | Report abuse

'The usual Democratic response to the GOP saying "Boo" is "We surrender!".'

No wonder they were so ready to quit in Iraq.

It is about time for them to show some resolve. That is why we send them to Washington.


Posted by: GaryEMasters | March 22, 2010 5:45 AM | Report abuse

There's no such thing as a free lunch; wait'll all the unintended consequences kick in.

Posted by: ronjaboy | March 22, 2010 6:29 AM | Report abuse

pseudo,

well that's where you're wrong yet again.

if my job was ended due to single payer there'd need to be some overpaid, underworked government bureaucrat who'd have to explain to dolts like you how the system worked.

Won't in your warped little world everyone work for the government eventually?

Exactly what again do you do in that world?? hmmm.

Posted by: visionbrkr | March 22, 2010 6:38 AM | Report abuse

Can the Post get any more partisan liberals to comment on this disaster of a bill?

Posted by: bobmoses | March 22, 2010 7:08 AM | Report abuse

They are selling the mandate all wrong. If it is tossed out due to constitutionality, they can levy a health care tax on everyone that can be offset by credits to anyone that has a policy.

Posted by: brent_b | March 22, 2010 7:12 AM | Report abuse

"Actually, they wouldn't have to do anything, just let the fund go bankrupt."

The GOP may indeed, if foolhardy Americans again give them the chance, bankrupt the country AGAIN. No law, no matter how well designed it is to reduce the debt or mitigate predatory medical insurers, can hold up to saboteurs.

"Additionally, you realize because this was brought in via reconciliation, it expires in 5 years unless congress re-passes the law?"

Yes indeed. And in that five years time (or is it 10?), as we see all the people the bill helps (it helps almost everyone whether they know it or not) start supporting the reform, political pressure will be brought upon elected officials to support permanent renewal of reform. I predict this will help the Dems at that time, even if it doesn't help them this year.

Still, I agree this reform represents a huge risk to Dems. Dems now have to exhibit fortitude on these issues for years to come and have to find a way to keep the GOP from sabotaging reform. They now have to carefully watch the insurers to make sure they don't intentionally try to increase rates and pin blame on the reform passage. They have to keep costs under control, etc..

The GOP does NOT want to reduce costs or deficits--they never have and now never will because they will gleefully blame entitlements and reform, if any of these problems manifest worse.

If the GOP were willing to make this reform work, make it bend costs downward, make sure all Americans were insured and had the kind of quality insurance that would keep them healthy and financially solvent, then all would be good and the task easy.

American voters have a clear choice now: recognize that medical costs are out of control and insurers have become predatory, and therefore embrace reform and vote for people who will make it work; or surrender to fear and sabotage and elect people who will embrace the status quo.

This reform clearly shows that the Dems alone stand against the status quo. The divide could not be more distinct. And now we will find out if this generation of Americans have the courage to embrace change or whether they will surrender to the status quo.

It is their choice, and no matter which one they make, we will deserve what we get, and how can we ask for more than that.

Posted by: Lomillialor | March 22, 2010 7:25 AM | Report abuse

Why would Republicans want to stop the reconciliation bill? These are the fixes that take away some bad parts of the bill. Do Republicans really want to be known for blocking the repeal of the Cornhusker Kickback and other bad provisions? Democrats will have a field day running on those votes.

Posted by: lswonder | March 22, 2010 7:26 AM | Report abuse

Hey Erza - bite me you liberal b*ast*rd

Posted by: fxfemail | March 22, 2010 7:28 AM | Report abuse

Whew! With Holder and Obama on the ropes with regards to fighting terrorism, we now have a domestic policy to rail against Democrats. Feeling sick? Join our suit! Liberals have manufactured rights by way of the courts for years. When a major right has been loss for real, Americans will be challenging this for years. Don't repeal too quickly, make sure we hang this around the Democrats for a few election cycles to ramp up to a 65% majority.

Posted by: JohnnyGee | March 22, 2010 7:33 AM | Report abuse

some people aren't paying attention.

The law wasn't brought in with reconciliation, just the fixes. Its the fixes that can expire (assuming they pass through reconciliation). That means the only challenge to the mandate would be a constitutional one and many scholars say that it is absolutely constitutional.

The excise tax is what I want Ezra to focus on. To me pushing it back adds to the deficit so that could and should be stricken out of the reconciliation package.

Lomillalor,

The problem with your argument is that insurers (while you may call them predatory) do not determine costs. Doctors, hospitals, pharmaceutical manufacturers determine cost.

Posted by: visionbrkr | March 22, 2010 7:35 AM | Report abuse

Was it worth it? Boosters laud passage of the health care bill as an historic event. Yes, it is – and so was the Charge of the Light Brigade.

Posted by: Micholina1 | March 22, 2010 7:53 AM | Report abuse

"The problem with your argument is that insurers (while you may call them predatory) do not determine costs. Doctors, hospitals, pharmaceutical manufacturers determine cost."

I did not make the argument that insurers determine medical costs.

Posted by: Lomillialor | March 22, 2010 8:01 AM | Report abuse

Iswonder

I agree. If the GOP votes against the changes, then it will AGAIN prove their hypocrisy, because they gleefully and specifically attacked those aspects of the Senate bill, and now the House Dems want to make those changes.

Posted by: Lomillialor | March 22, 2010 8:03 AM | Report abuse

Welcome to tyranny, American style, mother f...s, brought to you by King Obama and his merry band of abject life-cowards otherwise known as Democrats - the most craven flock of sheep people ever to have populated a once free country. Now get you out there to report to the federal government that you have insurance for your family. And while you're at it, take along some pictures of your fridge's contents to prove you're feeding them adequately as well. Of their closets to show they're properly clothed.

And before you accuse me of overstating the case, read up on the rise of Nazi Germany. It all started with innocuous measures that established federal control over individual decision making.

One of two things will happen now, and which one occurs will display what we are as a people. Either the citizens of this country will throw Democrats out and reject their collectivist flock mentality, in which case being an American will still mean living freely, associating freely, speaking freely or we will collapse into the kind of human jellyfish the Dems like to see in their subjects.

As for me and mine: we will honor in deed the spirit of our immigrant fore bearers who took their chances and counted on nothing but themselves to build new lives away from the oppression of totalitarian government rule.

Choose now. Roar or bleat.

Posted by: grohlik | March 22, 2010 8:09 AM | Report abuse

Lomillalor,

your post only mentions insurers as predatory. It makes no mentions of doctors, hospitals, pharma. How else should anyone take it?

You're also still assuming by the below part of your post that premiums (charged by insurers) drive costs.

"They now have to carefully watch the insurers to make sure they don't intentionally try to increase rates and pin blame on the reform passage. They have to keep costs under control, etc.."


Premiums don't drive costs, costs drive premium. That was the facts before reform and they're still the facts now.

Posted by: visionbrkr | March 22, 2010 8:14 AM | Report abuse

A few thoughts: it will not be a free insurance system, people may be "forced" to buy insurance, but then someone needs to check to ensure they do (more IRS agents) and of course eat, drink, and be merry for others will now pay for your failure to take care of yourself. The tragedy is that people who really need assistance will noice little change. The day I have the same access as Nancy Pelosi or Harry Reid medical benefit plan, I will become a believer. That ain't going to happen....

Posted by: djudge1 | March 22, 2010 8:14 AM | Report abuse

vision

Note the period between the two concepts. I put them in two sentences to show separation. If I was unclear, fine, please forgive me. But now that I am responding to your confusion, and clarifying my comment, I hope you are happy.

Posted by: Lomillialor | March 22, 2010 8:16 AM | Report abuse

This was a slam dunk Win in the face of the American people! Enjoy it while you can...

Posted by: LongTimeSkinsFan | March 22, 2010 8:18 AM | Report abuse

It is clearly evident that this show of unity by the Republican Party reflects how far they are willing to go to stop any kind of Health care reform in America. This lemming-like unity in favor of the status quo should be reason enough for them to drop their taxpayer-subsidized Government Health coverage-because it is part of the huge Public Plan that covers more than half the population of America. Its the honorable thing to do.

Posted by: lionelroger | March 22, 2010 8:19 AM | Report abuse

Lomillalor,

thanks for the clarification. I hope you can understand my reasoning for misunderstanding your post.

djudge1,

there won't be more IRS agents. MA has the same reforms and all that's required there (and i assume what they'll do here) is for people to file a MA-1099 form with their annual tax returns. MA residents are required to get that from their insurer so it'll be more work on their end but nowhere else.

Posted by: visionbrkr | March 22, 2010 8:22 AM | Report abuse

vision,

By the way, I also used the word "etc" to show that my list was not complete. I assumed everyone knows what "etc" means. So, though I did not mention Pharma by name, I was hoping everyone would know that's the kind of thing I meant by using the word "etc".

Also, look at this earlier question I directed to YOU: "Do you think the GOP would ever vote to reduce profits of Drs and hospitals, or unneeded medical testing (which many drs do to increase profits)?"

Do you see the words "Drs and hospitals"?

Clearly, I have not made a point to assume that premiums drive costs. In fact, over and over again I have separated the issues of "costs" (to imply medical costs) and "insurance rates".

But again, since we are just talking off the cuff, I apologize if I was unclear. Now, if you have any substantive observations on my earlier comments or questions (to you), I would be interested.

Posted by: Lomillialor | March 22, 2010 8:26 AM | Report abuse

Lomillalor,

Thank you. I hope everyone can distinguish that difference so that we can get to what really drives costs because many out there don't understand.

As far as your question I did answer it but I will gladly bring it up again. Republicans can in my opinion gain traction in this discussion if they truly become fiscally conservative and address the issues of costs. Will they, I don't know. Boehner for all his warts made comments very recently how he'll run a very fiscally conservative house when he becomes speaker so maybe that means they will although recent past is not on their side in that argument.

I still hold out hope that the fiscal commission can address these issues but again they can only recommend and we're left with legislators too worried about re-election and not worried enough about helping people (this healthcare vote notwithstanding.)

I truly feel we're going to be rationing care (and now that reform is here and done I can say it without being accused of fear-mongering). At some point, even with subsidies we'll need to feel the impact of costs whether it be in higher taxes, less services or some combination of both.

Posted by: visionbrkr | March 22, 2010 8:35 AM | Report abuse

Wah wah wah wah!!!! Repubs - this is the bygolliest, you betcha, best thing to happen to this country since Sarah Palin saw Russia. Keep up your fillibustering. We see it for what it is. Hollow hatred of the citizens you purport to represent...

Posted by: DontGetIt | March 22, 2010 8:50 AM | Report abuse

the literary irony here is rich. What is left is "reconciliation" to be conducted in the Senate where Republicans march like a Stalinist congress voting for a five year plan.

Posted by: medogsbstfrnd | March 22, 2010 8:58 AM | Report abuse

We are rationing care now. 30+ million can't get care because of money reasons. That's rationing.

We will have less rationing if the goals of this reform are achieved.

Because of health exchanges, insurance premiums will go down, and that will induce insurers to fight back against out of control medical costs. Until now, the insurers found it easier to just raise rates instead of fighting costs or filing lawsuits against Drs and hospitals or hiring billing advocates. That will change now.

If the mandate holds, insurers will also get more profitable as more insurance is sold and people will start buying better policies as the bang for the buck increases.

Drs, hospitals, Pharma, etc, have been price gouging us. I know this from personal experience. I've seen the way they hide charges during ER visits or even with scheduled surgeries. I've seen the way they order unneeded tests and drugs. I have relatives involved with outrageous and deceitful hospital billing practices.

Many more changes are needed. But this first step is essential. Otherwise, go back and read Ezra's posts where he outlines what happens if we DON'T reform. And no, I don't believe Boehner or Ryan's promises are worth the paper they are written on. People like them intentionally inflated deficits over the years in the hope of someday killing entitlements completely in their pursuit of a libertarian society. We are the richest nation in the world, and after we stop sending all that money to executive bonuses and pay packages, we will discover that we can both afford a reasonable health care system as well as a string national defense.

So you go ahead and put your faith in the idiots who created this fiasco (people like Boehner). I'm sticking with change.

Posted by: Lomillialor | March 22, 2010 8:59 AM | Report abuse

"The usual Democratic response to the GOP saying "Boo" is "We surrender!"."

Apparently, that didn't happen this time, did it?

Posted by: kemp13 | March 22, 2010 9:05 AM | Report abuse

kemp

Nope. Not this time. And not in 1994 either.

Posted by: Lomillialor | March 22, 2010 9:19 AM | Report abuse

"Most of this country didn't want to go anywhere near that cliff."

Err, termitesurrender -- do you recall that Obama made Health Care Reform his biggest campaign issue -- and that Obama won the election fairly decisively?

So, I think the country is OK with this. And they will even be more OK with it once they realize how many of the scare stories ("death panels") were lies. And they will even start to get happy about it, when they find they can insure their children who have pre-existing conditions, or start new small businesses without worrying whether they can get insurance.

Posted by: ADCWonk | March 22, 2010 9:30 AM | Report abuse

Lomillalor,

I hope that they do stand up to them but I don't know that they will. They'd do well to show some fiscal conservatism and push that ideal. I'd also add Pharma to that list. The crisis 5 years from now will be the crushing cost of biologics because this reform gave too long a period to generics (12 years).

A good place to look is MA because they basically did the same reform several years ago and now their costs are unsustainable and they're being forced to make changes to it. unfortunately the federal government can run deficits so this may get a whole lot worse before it gets better with no mechanisms in place to rein in costs.

I only pray that the upcoming fiscal commission President Obama convenes has some teeth to it.

Posted by: visionbrkr
---------
While it is true that President Obama convened the fiscal commission, however like the previous Commission (BRAC for an example) it requires a up and down vote from Congress to approve the package and that also means the usual jocking for leverage from all sides because they can not make the hard choices needed.

The problem comes from the political arena where you have dogmatic groups intent to do things their way or it is nothing. The recent vote by the Senate failed because only 53 voted for it instead the required 60+ votes under the rule set by the Senate.

Even Judd Gregg was disappointed by its failure.

Posted by: beeker25 | March 22, 2010 9:41 AM | Report abuse

@VB: Your gratuitous slamming of government employees may play well, but it has very little to do with the vast majority of federal workers that do a great job. Having actually worked with federal employees for 12 years, I have always found them dedicated and more than competent. I can only think of 1 person who, because of illness, was not keeping up with the rest of the staff. Personally I am tired of it because it feeds people'e prejudice and does not reflect reality. Complain about you NJ employees all you want, I have no experience with them, but leave the feds alone, unless you are citing specific instances that you personally have experienced.

"Republicans can in my opinion gain traction in this discussion if they truly become fiscally conservative and address the issues of costs."

Right, republicans as fiscal conservatives. Exactly what is your evidence for that over the last 30 years. Deficits exploded when republicans were in the white house, mostly because they cut taxes without cutting spending. One the issue of costs, lets look at the last major health policy initiative, medicare part d. Huge program with no funding mechanism, just added to the debt. Say what you want about HCR, but at least Obama was willing to propose some ways to pay for the program (whether they will actually pay for the bill is something that will become clear in time), unlike the last 30 years of republican tax cuts and programs.

Posted by: srw3 | March 22, 2010 9:46 AM | Report abuse

I just used the Post's interactive "how will this affect you" device and learned that under this proposal my premiums will be capped at about $9,500 ... of course, since I currently pay roughly $5,000 in premiums (my employer pays the rest buit will now have a strong incentive to dump my coverage over to the 'exchanges') that means I will potentially have to pay an additional $4,000+ in premiums annually ... there goes the possibility fop saving for my kids' college fund!

Posted by: ToughChoices | March 22, 2010 9:49 AM | Report abuse

Swing and a miss. The bill requires you to enter into a contract with an independent third party. Whether it is a "good", a "service", or a "program" is irrelevant. The fact is that, when this provision is enacted, you are required as a matter of law to enter into a "contract of health insurance" as mandated in the bill. There is a realistic potential for this to fail Constitutional muster.
-----------------------------

There is no "requirement" to purchase health insurance. The mandate says if you do not purchase health insurance and you are otherwise able to purchase health insurance and you chose not to purchase health insuarnce then you will pay a fee of ($X) for not having insurance. The choice exits; buy insurance or pay a fee the two are not equal, all this guarantees is that people who opt not to buy health insurance would have paid something into the system that would guarantee that they receive health care if and when they need it. No one rides for free. You would think that Republicans would be happy about this part of the legislation.

Posted by: justonevoice | March 22, 2010 9:50 AM | Report abuse

Lomillalor,

I'm not standing with Boehner. I'm standing with whoever will take this reform to the next level and address the drivers of cost. If that's Republicans fine, if that's Democrats fine.


srw3,

I'll gladly explain a personal experience. I don't assume that its all federal workers because that's ludicrous. My father's employer has 5 employees. he's 71 and still working full time. His primary insurance should be medicare based upon law but I can't convince anyone from Medicare that they should be paying his claims primarily.

I also have countless clients that are told by Medicare (when their employer is under 20 employees) that if they are still working after age 65 that they don't need to take Medicare Part B. That's absolutely 100% FALSE. Most insurers assume that you have Part B coverage and pay your claims accordingly. Because of this people get their premiums reduced but don't get their claims paid in full because they're given wrong information from social security. Over the past year I've had to have had at least 20 clients call me on this and its always after the fact and its always a mess to clean up and get them Part B coverage.


I don't have any evidence that Republicans will finally act like fiscal conservatives. Just a hope that they will, that someone will, that anyone will. I don't care if they're Dems, Reps, or little green men from Mars. Just do something, anything and then I'll judge and then vote accordingly.

Posted by: visionbrkr | March 22, 2010 10:00 AM | Report abuse

Just to be super clear on this, although the Republicans in the house voted against the reconciliation package, it contains what they claim they wanted fixed in the Senate bill that is now law. Likewise, the Republicans in the Senate used to be for these changes before they were against them.
So, the Republicans in the Senate are going to drag this out and prevent Democrats from voting for fixes that the Republicans wanted until they didn't want them. Meanwhile, the Republicans will delay the Senate from taking up debate on economic issues, jobs bills, and other important legislation to prevent the passage of the changes the Republicans wanted.
Bottom line, the Senate Republicans are for the Cornhusker Kickback and the Louisiana Purchase and against small business tax credits.

Posted by: Prosperity2008 | March 22, 2010 10:00 AM | Report abuse


On a semi-related note, I've got a hunch that there are people out there who apply for Social Security Disability Insurance only so that they can eventually get Medicare. Truth be told, they'd rather keep working (which you really can't on SSDI) and they might take a job under the table, but the cost of insurance is their biggest financial obstacle.

Once pre-existing condition restrictions are lifted, I think it is possible you'll see SSDI claims go DOWN, and, about 15% of those on Medicare are on it because they're disabled. Once it becomes obvious they can have a job AND (affordable) insurance, we might even see a decrease in Medicare utilization.

Of course, maybe I'm just feeling optimistic this morning...

Posted by: ThomasEN | March 22, 2010 10:37 AM | Report abuse

Here's some ideas to help reduce the deficit.

All of you who are worried about Social Security, Medicaid, Medicare, and the new HR3590 Bill or any other entitlements adding to the deficit DON"T take any benefits from any of these programs.

While you're at it check out the subsidies given to farmers so you can afford bread, and sugar. Perhaps you could mount your next protest against the farm subsidies.

The war on Iraq and Afghanistan and Bush tax cuts added to the deficit. Let's end the war and eliminate those tax cuts.

Posted by: BlueDiva | March 22, 2010 11:06 AM | Report abuse

To ThomasEN:

I like your thinking. I believe many people on SSI and even Medicaid would be willing to work if their healthcare was protected.

People will no longer be slaves to an employer just because of the health care benefits.

Posted by: BlueDiva | March 22, 2010 11:31 AM | Report abuse

To All the Conservatives on Ezra's post that talk about the loss of their liberty and their freedom I ask only one question - In order for you to live by deed what you say you live by in word are you willing now to sign a letter to the government rejecting your access to the entitlements (social security, unemployment insurance and Medicare)that you say you are against your vision of America so that you can live and support your families on the sheer strength and will of your free-market, pull yourself up by your boot straps mentality?

Posted by: Concerned28 | March 22, 2010 12:27 PM | Report abuse

ThomasEN and BlueDiva,

I heard a while back that about two thirds of those that apply for SSDI are denied. I'm wondering if that will blunt any affects to that?

BlueDiva,

I'm thinking the last line of your post is why many large employers were against it. Now they can get rid of "bad" or non-productive employees but good ones could potentially be job locked. This would resolve that issue for them to an extent but remember I don't know anyone that thinks that costs in the small group markets will approach what many large employers pay. I've got a client now who left his job at a company he started and sold and his COBRA premium was $900 a month for basically cadillac coverage ($10 copay, $10/20rx) and he's greatly reducing benefit but its guaranteed issue and his premium's going to $1600+

Just remember too there are all sides to this. Pluses and minuses.

Posted by: visionbrkr | March 22, 2010 12:53 PM | Report abuse

concerned28,

I'll gladly forgo social security if you give me back what I've put into it. Same goes for unemployment insurance.

Medicare, well that's another story. That's never been a good deal for the one putting the money in which is why its in financial trouble.

Posted by: visionbrkr | March 22, 2010 1:00 PM | Report abuse

"A good place to look is MA because they basically did the same reform several years ago and now their costs are unsustainable and they're being forced to make changes to it"

I agree, look at MASS.

The initial goal of MASS coverage was not to control costs, it was to provide universal coverage. With that done, they are now focusing on costs. Same will happen with Obamacare, and in fact, if you read Ezra's posts you will find the new bill actually starts us on the path to cost control as well as increased coverage.

http://www.nytimes.com/2009/03/16/health/policy/16mass.html

"....To make it happen, Democratic lawmakers and Gov. Mitt Romney, a Republican, made an expedient choice, deferring until another day any serious effort to control the state’s runaway health costs....Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls."

Posted by: Lomillialor | March 22, 2010 1:13 PM | Report abuse

visionbkr:

Glad to refund you that money as long as you pay your per capita share of the national debt that you are also responsible for.

Posted by: Concerned28 | March 22, 2010 1:13 PM | Report abuse

vision : "Just do something, anything and then I'll judge and then vote accordingly."

Were you awake last night?

The Dems passed a bill that will save over a trillion dollars in costs over the next two decades. So yes, in your words, the Dems did "something, anything".

It's only a start, but the good news is, it is indeed an abrupt departure from past policies.

Posted by: Lomillialor | March 22, 2010 1:15 PM | Report abuse

bmull posted March 22, 2010 12:08 AM
"HCR will be a disaster!!!"

Hey bmull,
Did republicans introduce a bill eliminating congresses gold plated life time health and pension benefits they gave themselves and "We The People" have to pay for?

Posted by: knjincvc | March 22, 2010 2:39 PM | Report abuse

You are such a liberal journalist..don't bend over.your little white ass will ge prentated by a bug black ni.....! Oh hell, you are probably a "homo" that would like to get it in the as.

Posted by: rsmith5588 | March 22, 2010 2:53 PM | Report abuse

concerned28,


whoa whoa whoa I didn't contribute to this monstrosity of a debt. I was against the wars AND I'm not well off enough to have received Bush's tax cuts.

And I'm 39, its not as if I'm going to see Social security at this rate anyway so why not just let me off the hook OK?

Lomillalor,

Come on now, you still don't believe that it'll cut the deficit do you??

I'll see you back here in 9 years. I'll be the one saying I told you so.

Posted by: visionbrkr | March 22, 2010 10:26 PM | Report abuse

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