Tracking Health Care Reform

by Pejman Yousefzadeh on July 10, 2009

Let’s take a look at a grab-bag of links that are useful in keeping abreast of the health care reform process.

1. I recommend to everyone Keith Hennessey’s examination of how a health care reform bill is likely to become law. Interestingly enough, Hennessey details plausible reasons for why Senate Democrats may prefer not to use reconciliation in order to pass health care reform. This is all very wonkish, process-oriented writing, but it is exceedingly valuable, and lot of fun to wade through if, like me, you are a political junkie.

2. As always, Jennifer Rubin is excellent:

There are, of course, ways to bring down health-care costs. Shifting from an employer-based to individually-purchased insurance and allowing interstate insurance sales will help. (Look at the car insurance market.) Real malpractice reform will help reduce unneeded tests and procedures that are the product of “defensive medicine.”

Reducing government mandates on health insurers (so that lower cost, basic-coverage plans can be more readily purchased by younger, healthier people) would also be a positive step. But these are antithetical to the Democrats’ vision of a one-size fits all, government-run health-care system. Thus [the New York Times's David] Brooks is right on the big picture: if we want to reduce health-care costs, we should scrap everything coming out of Congress and start over again. Isn’t it about time to hit the reset button?

3. The health care bill has been delayed in the House because of the ongoing negotiations between the House Democratic leadership and Blue Dog Democrats who–unlike the leadership, or the rest of the Democratic caucus–are concerned about health care costs. More found in this story:

The “Blue Dog Democrats” group released a list of demands on the eve of House Democratic leaders’ planned unveiling of their final bill Friday. The bill release was pushed back to next week and Democratic leaders spent part of Friday meeting with the fiscally conservative Blue Dogs to work through their concerns.

“The message that was sent was heard loud and clear,” Rep. Jason Altmire, D-Pa., a member of the group, said Friday. The group’s concerns were the need for more cost containment measures, protections for small businesses and a focus on rural health care.

“We cannot support a final product that fails to” address these issues, members of the group wrote to House Speaker Nancy Pelosi and Majority Leader Steny Hoyer. Opposition from the 52-member group could imperil House passage of a bill.

Before Thursday, delays and internal Democratic disputes over taxes and the role of government had seemed mostly confined to the Senate. A bipartisan deal emerging in the Senate Finance Committee was threatened this week when Senate Majority Leader Harry Reid, D-Nev., and other top Democrats indicated displeasure with the likely payment method, a new tax on health care benefits.

That has left Finance Committee members scrambling for alternative taxes to replace the $320 billion the benefits tax would have raised over a decade. Democrats are considering raising taxes on wealthy investors instead, along with other options, according to officials who spoke on condition of anonymity to discuss private negotiations. The proposal to extend the current 1.45 percent Medicare payroll tax to capital gains earned by high-income taxpayers would bring in an estimated $100 billion over 10 years.

In the House, Democratic leaders had hoped to release an ambitious bill Friday that would achieve Obama’s goals of holding down health care costs and extending insurance to the 50 million people who lack it. Insurers would have to cover all comers, employers would be required to offer insurance and individuals would be required to purchase it, with subsidies for the poor. The tax-writing Ways and Means Committee met throughout the day Thursday to try to finalize plans on how to pay for the plan, with an income surcharge on high-earners of some 3 percent or more emerging as the leading option.

But the move by the Blue Dogs scrambled the equation. It was unclear whether Democratic leaders would be able to satisfy the group’s demands since in some cases they’re far apart from draft language produced by the three House committees writing health legislation.

As Hennessey (link supra) points out, in the House, Nancy Pelosi has more discretion to pass a bill without the support of conservative Democrats than Harry Reid does in the Senate. But because Senate Democrats will be able to use their weakness as a strength in conference, the Blue Dogs will be able to wield a lot of power in getting their policy objectives into a final bill.

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