Sunday, November 8, 2009

Health Care Reform?

Well, the House of Representatives has passed a health reform bill (HR 3962) by a slim vote of 220-215. At this point, I don't know whether it's real reform, or just the culmination of political grandstanding by both parties and President Obama.

The Vote
The Democrats voted 219-39 while the Republicans were 1-176, with Rep. Joe Cao of Louisiana casting the lone “yeah” vote. Not exactly a resounding vote. Nearly 1/5 of Democrats voted against the bill. And it seems a lot of the moderate "pro-life" Democrat votes were "bought" by allowing them to vote "yeah" on an amendment prohibiting paying for abortions in the public option or in the insurance exchange pools. In all, it seems to me that everyone was voting with one eye on the 2010 midterm elections.

The Democrats want to report they gave the people health care reform. The moderate to conservative Democrats get a favorable "pro-life" check mark on their scorecard so the remain elegible for the litmus-test voters.

And the Republicans can say they did all they can to oppose socialist healthcare.

What's Still Baffling about the Republican Position
I'm still baffled about Republican mantra that this is a "government take-over" of health care. There is a public option, but that remains an option.

Clearly, the words "government take-over" are fighting words for conservatives. Clearly, politicians favor slogans and getting the base energized by charged slogans over a fare discussion of the pros and cons.

Between this tactic and the screaming opponents at the town hall meetings, it seems to me the Republicans don't like the essence of democracy: a fair and open discussion of the issues!

We also need to call out the Republicans on this: if government-run healthcare is so bad, why do the Republican representatives and senators accept it?

I don't think any bill the Democrats have proposed has been anything near perfect. Still, I think we have to call out the Republicans as being obstructionists in the public debate.

Republican Proposals
The Republican proposals, to counter the Democrat's bill, have read like the pile of scrap wood from the RNC party planks. Start with tort reform (limit those rare, but big settlements), throw in some enhanced competition among insurance companies, but leave the reality of many remaining uninsured. (After all, being uninsured is something you should be free to be.)

A Couple of Good Things to Say
It does appear that the new proposal will increase the number of people insured. And it does address the issue of denial of coverage to those with "pre-existing conditions." As someone with a "pre-existing condition" that precludes me from getting certain insurance coverage, I feel strongly about this aspect of reform.

The Mess We're In
The more I look at it, the best we can expect is to tack on a few modifications to the existing healthcare system. Perhaps, system is too kind a word. Some people have employee-provided insurance, some have government-provided insurance (Medicare, Medicaid), a few buy it, and many are uninsured.

Just as the "system" is so complex, the solutions only add to the complexity. There is no clear vission of a simpler, more understandable system. Instead, we're adding some additions to a structure built on a shaky foundation and with a questionable structural integrity. As an engineer, it doesn't appear to be a sound proposal.

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