After a resounding Democratic Presidential election win, a terrible recession, and a bruising year of politics, it would be just like America that a crazy election result torpedoes the health care reform bill. It would be the first Republican Senator win in 43 years in Massachusetts, a state that’s bluer than blue, and the actual seat being elected on Tuesday hasn’t been won by a Republican since 1947!
But it’s becoming more and more possible, and the latest polls are all over the map.
Let’s play out what happens if we go back to a 59–41 Senate. The current Senate rules basically allow the minority to shut down proceedings. Harry Reid has in fact performed miracles to keep Lieberman, Nelson and some of the rest on board. Obama, Reid & Pelosi are now working the deal out with the unions and all the rest to make sure that what’s a pretty slim majority in the House will essentially accept the Senate bill—with some sop to the unions on the “Excise tax”. There are some other technicalities about the Exchange et al, but in the end we have a fair idea of what’s going to be the result.
Now the right just don’t care about the uninsured—or least not as much as they believe in protecting the health care industry’s ability to do what it’s been doing for 50 years, combined with their desire to hand Obama a defeat.
Much of the left and a plurality of Americans (polling data bears this out) believe that what’s in the bill is not enough—and because the Senate is not a democratic body, they’re angry enough to sit this out.
Almost inconceivably, but not surprisingly given their records of veracity, via AHIP the major health plans (with the very vocal exception of Kaiser Permanente) have been playing both sides of the street and have given money to the US Chamber of Commerce to oppose reform, while Karen Ignagni has always maintained that AHIP was in favor of reform. And of course several sensible commentators on THCB disagree with me and think that the current bill doesn’t do enough to fix America’s health care delivery crisis to be worth the cost of fixing (some of) its uninsurance crisis.
So there are lots of people who think that the current mealy-mouthed compromise is bad for one reason or another. But if the vote happened right now it’ll pass the Senate with 60 votes.
If, and only if, the 60th is the new Democratic Senator from Massachusetts. If the Republican wins I cannot see a way for a compromise bill that will get Snowe or Collins (the two most liberal Republicans) to be the 60th vote, while keeping the mainstream Democrats in the House on board.
And remember what this means for the health of the health care system and of America.
No bill means we’re not coming back here again until we are forced back. It means that the number of uninsured will go up—way up as states run out of stimulus money and start cutting back on Medicaid (as has been happening in California). And more and more people will continue to lose insurance at work.
There won’t even be any of the pilot programs buried in the Senate bill for reforming the delivery system payment mechanism. I know I’ve derided them, but they’re better than nothing. And of course if the 2010 elections are as bad for the Democrats as many predict, the ability of the Feds to muster the will to change even Medicare alone will be gone.
To sum up: no bill means in 5–10 years a huge rise in uninsurance, no reform of the delivery system, and no prospect for a rationalization of health care spending. That will mean the collapse of large parts of the health care system in a spasmodic unplanned fashion.
After the next serious downturn the health system will crash rather than soft land. The bubble will truly burst and the most likely result will be an austere single payer system.
I’m not sure that’s what the opponents of reform want, but it’s pretty much out of their hands. Unless of course the voters of Massachusetts—who ironically already have a health system much like the Senate bill promises the rest of us—decide that they’re angry enough about, well, everything and nothing to do something crazy.
Categories: Matthew Holt