Matthew Holt

Modest step in the reform journey shows the idiocy of our political system

It does seem to take a health care bill to remind us all how incredibly screwed up the political process is in these here United States. The Medicare Modernization Act was railroaded through by Tom Delay and friends using all their charm and finesse. And last night the House passed its version of the health reform bill. It includes employer mandates, exchanges, subsidies, public option and taxes on those earning more than $500,000 to close the cost gap. And CBO in its wisdom says that it doesn’t increase the deficit.But it didn’t pass by much. 40 Democrats opposed it. These were the Blue Doggers who needed some political cover to be able to say in 2010 that they were against the bill before they were for it. Their expected course of action is that a less liberal bill comes back from final conference with the Senate which they can support. Apparently out there in purple state land uninsurance and egregious health plan behavior are not a problem—at least not compared to the desire of the people to protect the incomes of those earning over $500,000 a year.

But in order to stop even more Democrats opposing it at the last moment Pelosi had to let some previously unheard of Congressman called Stupak become the mouthpiece of the Catholic Bishops who decided that they needed to impose their views about reproductive medical care into the debate. Cynics like me may wonder about the validity of views on that issue from a bunch of old men who’ve allegedly never been married or had sex with a woman, and whose main contribution to child welfare over the past few decades has been to ignore and assist in flagrant abuses of it by their colleagues. But no matter, over recent days they started putting pressure on various Democrats to tighten restriction on Federal funding of abortion.

Someone with greater interest and attention to detail than me will surely figure out which Democrats were against the bill for “deficit reduction” reasons and which were against it because they feared that a mob of frenzied newly pregnant women were awaiting their federal subsidies so that they could expressly sign up via the exchange for health plans that offered abortions. But Pelosi obviously decided that to get the latter groups votes was easier than the formers, and allowed a completely non-sensical abortion of an amendment about abortion that seems to be completely unworkable. So as part of the final bill the Stupak amendment (which is only 2 letters away from describing itself accurately) will prevent insurers offering plans that cover abortions to people buying them through the exchange with subsidies.

This presumably means that insurers would have to offer two plans in each exchange, one with abortion in it and one without, and then track who was eligible for each one, and then make sure that people transferred appropriately between them when they go in and out of subsidy coverage, and then communicate that information clearly to the providers at the point of care, and then check that they paid them or not appropriately. Lucky there are no complications or potential pitfalls there. On the other hand maybe because the government is paying for the exchange no insurer offering any plan in the exchange can pay for any abortion through any of its exchange plans? Or maybe no insurer receiving any Federal Funds for anything can pay for any abortion anywhere? But at least those crusty old Catholic bishops are happy. In any event it’s clear that Stupak is as Stupak does.Nonetheless, for now mission has been accomplished. The “radical” house bill has passed. The Senate will now introduce a bill with a seriously toned down set of mandates and public options. (That had looked in doubt before the House bill). And Harry Reid will show his vast political acumen by somehow rounding up 60 votes in favor of it. Oh, where is Tom Delay when you need him.Then whatever comes out of the Senate will make it to a brutal and bloody conference committee with the House where all the Stupaks, anti-stupaks and everyone else will be trying to make sure their interests are heard. Then that goes back to the House and Senate, and we’ll then go through this all again and see what emerges for Obama to sign.It makes me amazed that anything works in this country.