Saturday's debate on the House floor was at various turns entertaining, depressing, amusing, and even enraging. But, strictly speaking, it was not particularly dramatic.
Yes, the final vote was close. A bill needs 218 votes to pass. This one got 220, including one not entirely expected Republican. And at least according to one Capitol Hill source, the leadership didn't have a bunch of extra votes in its pocket. (If they had, the source noted, they would not have made the deal on abortion funding.) But whatever the margin, Speaker Nancy Pelosi was saying all day long the bill would pass--a verdict operatives on the Hill were echoing. While nobody was guaranteeing victory, everybody was expecting it.
Of course, that's often the way these votes go: The outcome is all but certain beforehand. If you want appreciate the significance of what happened on Saturday, you really have to take a step back. Or maybe a few steps back.
Consider:
The last time the House of Representatives tried to pass health care reform was at the beginning of the Clinton administration. That effort failed miserably, as committees squabbled over jurisdiction. This time, three committees produced nearly identical versions of legislation, putting those turf battles (mostly) aside. They got their work done quickly--well in advance of a self-imposed August deadline. And, most important, the legislation they produced was good.
Do not be fooled by the Beltway conventional wisdom, which has repeatedly treated House legislation as inferior to its counterpart in the Senate. If anything, the opposite is true. Should the House bill or something like it become law, the vast majority of Americans would have health insurance--protecting them from financial calamity and giving them access to medical care when they need it.
Republicans have repeatedly mocked the House bill because of its length. But there is a reason the bill needs so many pages: It's the product of thinking carefully about how best to design a health care system. The legislation has its problems; all legislation does. But at the level of detail--like, for example, the all-important question of how to design insurance exchanges--the House bill holds up extremely well.
And the bill pays for itself--not just in the first ten years, as the original version did, but in the future, as well. It may not do as much to reduce the overall cost of health care as the Senate bill would; in the view of most experts, that's the House bill's chief weakness. But it at least makes moves in the direction of cost-control.
Speaking of the Senate, that is where attention now turns--and where the process is unlikely to go forward as smoothly. It's the nature of the institution and the people who presently inhabit it. It'd be nice to think health legislation would blend the best of both approaches, rather than the worst. Alas, that's not a given.
But that's a matter for another day. Or at least later in the day. Now is a moment to appreciate what has taken place. The House has passed what is arguably the most significant piece of domestic policy legislation in a generation. Dramatic or not, it qualifies as history.
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COMMENTS (9)
I would appreciate a preview of the differences in the House and Senate versions. In particular, those differences that are attributable to insurance reform vs. health care reform, by the latter meaning universal coverage and funding to achieve it. Some provisions are difficult to characterize, such as the maximum premium differences that can be made based on age (2:1 in the House but 5:1 in the Senate). Is that an insurance reform or a funding necessity; the greater ratio in the Senate means the subsidies for lower income young and healthy insureds would be lower, but it also contradicts one central aspect of reform, namely spreading health care risks (the Senate version places more risk ... view full comment
I would appreciate a preview of the differences in the House and Senate versions. In particular, those differences that are attributable to insurance reform vs. health care reform, by the latter meaning universal coverage and funding to achieve it. Some provisions are difficult to characterize, such as the maximum premium differences that can be made based on age (2:1 in the House but 5:1 in the Senate). Is that an insurance reform or a funding necessity; the greater ratio in the Senate means the subsidies for lower income young and healthy insureds would be lower, but it also contradicts one central aspect of reform, namely spreading health care risks (the Senate version places more risk (i.e., cost) on older insureds as compared to the House). Your coverage has been outstanding but I expect rapid-fire events over the coming weeks, so it would be nice to have the preview so we can keep score.
Anyone understand the substance of what was done with respect to access to abortion?
Anyone understand the substance of what was done with respect to access to abortion?
I think health care reform has tremendous potential from improving our economy to improving our human resource to improving the lives of individuals and their families, but that is probably beside the point; a critical portion of the voting public, as a matter of identity, will probably focus on winners and losers and align itself with the perceived winner. If true, next year's elections start in the Senate.
I think health care reform has tremendous potential from improving our economy to improving our human resource to improving the lives of individuals and their families, but that is probably beside the point; a critical portion of the voting public, as a matter of identity, will probably focus on winners and losers and align itself with the perceived winner. If true, next year's elections start in the Senate.
purcellneil, my understanding of the abortion language is this:
1. The Amtrak/USPS-like public health insurance program created by the law will not cover abortion procedures.
2. Private insurance purchased by individuals receiving federal subsidies to aid in the purchase of coverage also may not cover abortion procedures.
Item 1 was always going to be in any bill passed by Congress containing any form of publicly established health insurance plan. Item 2 was a concession to the anti-abortion folks, and almost certainly necessary to get the last 30 or so votes for a bill that ultimately had only 2 votes to spare.
I'm not hugely concerned about the effects that the above will have on abortion ava ... view full comment
purcellneil, my understanding of the abortion language is this:
1. The Amtrak/USPS-like public health insurance program created by the law will not cover abortion procedures.
2. Private insurance purchased by individuals receiving federal subsidies to aid in the purchase of coverage also may not cover abortion procedures.
Item 1 was always going to be in any bill passed by Congress containing any form of publicly established health insurance plan. Item 2 was a concession to the anti-abortion folks, and almost certainly necessary to get the last 30 or so votes for a bill that ultimately had only 2 votes to spare.
I'm not hugely concerned about the effects that the above will have on abortion availability, since on the one hand they apply to what will, at least for the time being, be a tiny minority of all health coverage in the country, and on the other hand abortion is not so common or expensive a procedure that access to it is determined significantly by the extent to which it is covered by health insurance. While I understand and agree with the principled arguments against this kind of measure that really just amounts to gender discrimination against women, the practical effects would seem to me to be acceptably minor given the positive effect of the bill on achieving other important goods.
"Do not be fooled by the Beltway conventional wisdom, which has repeatedly treated House legislation as inferior to its counterpart in the Senate. If anything, the opposite is true. Should the House bill or something like it become law, the vast majority of Americans would have health insurance--protecting them from financial calamity and giving them access to medical care when they need it."
Now that's some great writing.
Thank you Rhubarb. I'm very pro-choice, but I think CW has changed since Reagan first stopped fed govt funding for abortions. We just plain lost that one awhile ago and the structural issues (bombed clinics, harrassed doctors) are a much bigger issue than cost. Abortion f ... view full comment
"Do not be fooled by the Beltway conventional wisdom, which has repeatedly treated House legislation as inferior to its counterpart in the Senate. If anything, the opposite is true. Should the House bill or something like it become law, the vast majority of Americans would have health insurance--protecting them from financial calamity and giving them access to medical care when they need it."
Now that's some great writing.
Thank you Rhubarb. I'm very pro-choice, but I think CW has changed since Reagan first stopped fed govt funding for abortions. We just plain lost that one awhile ago and the structural issues (bombed clinics, harrassed doctors) are a much bigger issue than cost. Abortion funding does not belong in the final bill (doesn't this seem like a crafty plant? I mean does anyone really think that was ever going to pass? I wish, but this ain't 1978).
When I saw that there was one Republican I immediately expected to to be Cao from La. (maybe that was a misprint when you meant "one not entirely unexpected Republican" He represents and overwhelmingly Democratic district who got elected simply because he wasn't the corrupt ass clown who preceded him. It would have been unforgiveable for him to vote against the clear wishes of his district. If he is voted out next year then he will always be liked and respected by the people of his district. And with this vote he actually has a slim chance to be re-elected.
I found the speeches generally terrible on both sides, and Boehner nearly put me to sleep (they are going to set up a commission to study ... view full comment
When I saw that there was one Republican I immediately expected to to be Cao from La. (maybe that was a misprint when you meant "one not entirely unexpected Republican" He represents and overwhelmingly Democratic district who got elected simply because he wasn't the corrupt ass clown who preceded him. It would have been unforgiveable for him to vote against the clear wishes of his district. If he is voted out next year then he will always be liked and respected by the people of his district. And with this vote he actually has a slim chance to be re-elected.
I found the speeches generally terrible on both sides, and Boehner nearly put me to sleep (they are going to set up a commission to study the health of native Americans, the horror!)
"I found the speeches generally terrible on both sides, and Boehner nearly put me to sleep..."
I liked the speech by my congressman Ed Markey. His scathing attack on Republican hypocrisy was short and to the point.
Too bad he is not running for Ted Kennedy's Senate seat. He would get my vote in the blink of an eye.
"I found the speeches generally terrible on both sides, and Boehner nearly put me to sleep..."
I liked the speech by my congressman Ed Markey. His scathing attack on Republican hypocrisy was short and to the point.
Too bad he is not running for Ted Kennedy's Senate seat. He would get my vote in the blink of an eye.
Yes, if the House bill passes, everyone (more or less) will have health insurance - like it or not. Increasing coverage is the one thing the bill most assuredly would do, and this is not nothing.
However, the bill does next to nothing to control costs (aka, change fee for service), and does little about insuring quality. The MA experiment along thes lines is instructive - 97% coverage and costs through the roof.
The POTUS started out by intimating that we could cover 45 million people at no cost to the system. When it became obvious that this was arrant nonsense, he stopped saying it. Good for him, but the House bill is predicated on cutting Medicare reimbursements by a huge amount. Funny ... view full comment
Yes, if the House bill passes, everyone (more or less) will have health insurance - like it or not. Increasing coverage is the one thing the bill most assuredly would do, and this is not nothing.
However, the bill does next to nothing to control costs (aka, change fee for service), and does little about insuring quality. The MA experiment along thes lines is instructive - 97% coverage and costs through the roof.
The POTUS started out by intimating that we could cover 45 million people at no cost to the system. When it became obvious that this was arrant nonsense, he stopped saying it. Good for him, but the House bill is predicated on cutting Medicare reimbursements by a huge amount. Funny - when Newt tried that in 1995, Dems went batshit. I suspect those cuts will never happen, and this bill will be paid for in the least. It is a chimera.
That should be "not be paid for..."
That should be "not be paid for..."