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July 21, 2009

Key House Panel Scuttles Health Care Vote Due to Revolt of the Moderates

"Revolt" may be overstated. But they refused their support.

A key House committee on Tuesday indefinitely postponed voting on health care reform legislation after Democratic leaders were unable to line up enough votes from moderate members of their own party.

The House Energy and Commerce Committee canceled the session as it faced serious concerns about the legislation from fiscally conservative Blue Dog Democrats, who hold a large number of seats on the panel. The Energy and Commerce Committee is the only House panel with jurisdiction over health care that has not completed writing its version of the reform bill.

President Obama plans to meet with those Democrats Tuesday.


But he and his congressional allies still have a lot of Democrats to convince.


The two other House committees with jurisdiction over health care legislation -- Ways and Means and Education and Labor -- approved their versions of the package last week.

But the Energy and Commerce Committee was considered the toughest lift for advocates of the bill on the table, which could carry a price tag of up to $1.5 trillion over 10 years. The Blue Dog Democrats on the committee say they are worried about the cost of the bill, tax increases that could be attached to it and the speed at which the House is trying to adopt it.

The legislative process really begins, normally, when there is a consensus about the basic mechanism by which the law will operate. That basic consensus doesn't exist yet, partly because Obama hasn't clearly spelled out his "plan," and in any event, the public hasn't been convinced by his plan. (I don't think they would be convinced if he honestly shared his plan with them, but, whether I'm right or wrong about that, it seems clear there is no national consensus for a single payer plan.)

So these guys are trying to work out the details when the Big Picture is still in flux.

Ed has a post on a subject I wanted to write about -- rationing. The dirty little secret is that, yes, of course there is rationing now.

However, the most significant rationing that goes on now involves the difference in treatment of those who have health care insurance, or can pay for their care out of pocket, and those who don't. Those who can pay get better health care. Period. Those who can't pay are not, in fact, allowed to die in the street as in Victorian London, but they are not getting the standard of care that people who can pay do.

For one thing, they have to wait for everything.

A single-payer scheme would obliterate this distinction. Health care would be rationed in other ways -- Obama's plan calls for "bending" the health cost curve so that it doesn't become so expensive, but he mostly calls for that so that covering everyone becomes a non-bankrupting proposition -- but no longer would doctors make distinctions between those paying and the indigents they care for pro bono.

That's the entire point of "covering everyone." Obama and the Democrats think it's unfair that those who pay for health care get a better standard of care, and prompter service, and so forth, than those who don't, and wish to end this "Tyranny of Paying Customers."

This is a good deal for those currently getting that lesser standard of care. (But not all that good -- any country that does this immediately lowers its overall standard of care and the health care system becomes even more dysfunctional.)

It's a terrible deal for those who are currently "privileged" due to the fact they're actually paying for the services they seek.

The standard for those who pay will be reduced to a gray British-style medium-crappy standard of care, because it's only fair that we all have the same level of treatment, after all, and the standard off care will then have to fall for all the current payers, because there is only so many "units" of health care in the system, and if you're spreading them more equitably, that means you're moving some from the payers to those subsidized by those who pay.

I don't know if this is a good message for the Republican Party. It's "selfish" (as if the other side's position isn't similarly "selfish.")

But it is important that, before anyone sign up for this system, he correctly categorizes himself as someone currently "privileged" due to the fact he actually pays for what he's getting, either out of pocket or through his insurance, or someone unpriviledged due to the fact he's not paying and his coverage is paid for largely through excessive charges to those who pay.

For the latter, single payer is a step up. (Although, again, not as great a step up as hoped, because the system as a whole will inevitably become mediocre or worse, as it has everywhere else it has been tried.)

For everyone else -- for the 275+ million Americans who do have health care coverage -- your health care standard will become poorer, by necessity.

And, by the way: You'll have to pay a lot more for that privilege. Obama can't do this only by reducing the standard of care for everyone; money has to be injected into the system as well. So you'll be getting a worse standard of care and paying more for it to boot.

Again, I don't know if this is a winning message for the party itself, but it seems an important one. Maybe one that Tellers of Unkind Truths like Rush Limbaugh should get out there.

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posted by Ace at 01:17 PM

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