Where Health Care Reform Stands Now: Who�s Selling Out Whom For What

By John Ballard

"Without objection..." (as they say in Congress) I'm stealing Ian Welsh's headline.
He gets today's extra points for squeezing the most content into the smallest space with this latest step in health care reform's laborious, turgid, messy, bruised and stained trudge through Washington politics, hopefully on the way to the president's desk.

Guaranteed Issue: The best thing about the bill is unquestionably the fact that insurers have to issue policies to anyone who can pay. No one can be denied coverage, no matter what pre-existing conditions they have. This is a big deal....

Individual Mandates and cost sharing: An individual mandate force people to buy insurance whether they want to or not. Insurance works better when everyone is covered and in the same risk pool. It also shares costs throughout the population....

People who don�t have insurance right now are primarily younger people or those who feel they can�t afford it. What individual mandates will do, then, is subsidize older people�s insurance costs and the price of guaranteed issue, which is very costly since it forces insurers to cover people who are very likely to get sick. [And those who can least afford it are unfortunately the ones burdened with bearing the price.]

No Robust Public Option: A robust public option is one that is large enough and with enough pricing power to force down costs, and one which is available to everyone...

Reduces Practical Access to Abortion: The Stupak amendment, passed Saturday evening, makes it illegal for any plan offered on the exchanges to finance abortions. Any woman who wants abortion access, after being forced to buy insurance that doesn�t include it, will have to buy it elsewhere...

The Bottom Line: Who�s Getting What, and Who�s Paying

This bill does not contain a robust public option which will contain costs. It will give guaranteed issue and force cost sharing through an individual mandate. Older people will disproportionately benefit, and the people who will disproportionately pay are younger poorer people, and especially younger women, the poorer ones of whom will lose practical access to abortions.
[...]

This health care �reform�, if passed in this form or worse, which it will be if it is passed at all, will blow apart eventually, because it will not contain costs or �bend the cost curve� and the US economy simply cannot indefinitely afford health care costs wich rise faster than inflation or wages. But for as long as it lasts, it will help some people at the cost of other, generally younger and poorer people.

More remarks and links at the source.

His final comments, with which I agree...

If progressives really meant that a robust public option was their minimum requirement, when Medicare +5 failed they would have gone into opposition. They didn�t, therefore it wasn�t their minimum requirement. It remains to be seen if enough progressives really will vote against a final bill which still contains the Stupak amendment. Given progressives failure to live up to their threats to pull support if no robust public option was in the bill, I am forced to suspect that if Stupak is in the final bill, the final bill will pass.

The last couple weeks have been very revealing as to what various people, including politicians, progressive bloggers and activists, are really willing to fight for, and what their bottom line really is.

I would suggest that if progressives ever want their threats to be taken seriously by anyone again they go into opposition against this bill until such a time as it both has a robust public option and the Stupak amendment is out. Failure to do so will show that their threats were always hollow, that they are willing to sell out child-bearing age women, and that they prioritize the interests of older people over younger and poorer people.

In negotiation against a good negotiator, you get the minimum you are willing to settle for. Progressives have shown that their minimum is not a robust public option. It may not even be practical abortion access. They will not get a robust public option if they will not oppose the bill over it, and if they won�t oppose the final bill over the Stupak amendment, that too will most likely remain.

This is neither the time nor the place for the abortion debate.
The right to abortion, last I checked, is a legal right at the federal level. State restrictions are a mixed bag, but single-issue anti-abortion forces wish to federalize their agenda.

If that discussion is to have room for negotiation the abortion issue must be saved for arguing over the Freedom of Choice Act.

The Stupak amendment is a legislative land mine set to blow up during that debate.