Reid's Health Reform Bill: A Blizzard of Compromises

Around the time people were finishing off Turkey Day leftovers, Senate Majority Leader Harry Reid promised he’d gift-wrap and deliver a present to the Big O before Christmas. It’s been a tumultuous few weeks since then, but it now looks like the Nevada Senator will keep his promise: a Senate-approved health reform bill.

Unfazed by the death of the public option in his chamber, the stratospheric rise and precipitous fall of a Medicare expansion plan designed to replace it, untold Republican shenanigans and a historic blizzard at the worst possible time, the intrepid Democrat cobbled together a plan for the Big Do-Over, and sealed the deal by buying off Nebraska Senator Ben Nelson who had been holding out on the abortion issue.

With Nelson in the fold, Reid had his 60-vote filibuster proof majority, which is essential because his cut-and-paste job will receive not one single vote from the GOP.

Ironically, the deal closed on Saturday—the Winter Solstice—when there is less light in the sky than on any other day.

The news cheered The Regal One, who despite looking a bit out of sorts after a taxing week in Copenhagen, reminded the C-Span Watching, Non-Sleigh-Riding few that, “after nearly a century-long struggle, we are on the cusp of making health care reform a reality in the United States of America.”

What’s in , What’s out
Reid’s mash-up would provide health insurance to 30+ million uninsured Americans by expanding Medicaid and subsidizing the purchase of private insurance by middle-income people. It would require most people to buy insurance and penalize those who don’t.

Gone from the deal is the public option lefties everywhere wanted so desperately. In its place are 2 national insurance plans similar to those provided to federal workers (including Congress) and a spiffy Federal long-term-care insurance plan. Reid’s Christmas present also prevents the Privates from denying coverage to those with pre-existing medical conditions and limits their ability to bump premiums based on age.

The Congressional Budget Office said Reid’s deal would cost $871 billion over the next decade, and that new tax revenues and Medicare cuts would cover these cost and then some: in fact the deal would reduce the deficit by $132 billion in the next decade, the CBO said, and perhaps by 10 times that amount in the subsequent decade.

Reid’s deal with the hold-out Senator from Nebraska was classic Beltway politics, laced as it was with both artificial sweeteners and reverse Bo Bo Brazil head-locks.

Nelson got a few extra bucks for his state’s Medicaid program, and on abortion, well, at least one federally subsidized health plan in each state won’t be able to offer them, and all those that do have to keep separate books to prove taxpayer dollars aren’t being used to pay for them.

This ridiculously transparent compromise was excoriated by both the Pro-Lifers and the Right-to-Choosers with the tie going to the Democrats: abortion didn’t sink the ship after all.

The Cadillac tax and an employer mandate also made the cut, while the Bo-Tax was dropped in favor of a—can you believe this?—tax on “indoor tanning services.” There were hat tips in several directions, including those to police officers, firefighters, miners and construction workers, who have high premiums because they work in high-risk occupations, and who happen to vote Democratic in droves.

“All Senate Democrats stand shoulder to shoulder with President Obama and the American people, who know that inaction is not an option,” said Reid.

Republicans, meanwhile, are sure The Big Do-Over is a wasteful boondoggle that might sink Medicare and take the entire nation’s economy down with it. They think Dems cooked the books on the cost of the overhaul, and warned in particular that things would get seriously bad if those Medicare cuts get axed before the bill winds up on the Big O’s desk.

Or, as Kentucky Senator Mitch McConnell spluttered, “this bill is a legislative train wreck of historic proportions.”

“The lines are drawn,” Senator Richard Burr, a Republican from North Carolina, added in an interview with the New York Times. “(Reid) has to get 60 votes. If he doesn’t, the American people win. If he does, America’s payback will come in the form of the 2010 elections.”

Those are fightin’ words, but right now all he and his GOP buddies can do is talk smack. The Senate passed the first of 3 procedural votes on the matter last night by a 60-40 vote, as expected. Barring unforeseen circumstances, the Senate will pass Reid's opus before Christmas as he had promised. Negotiations with the House will begin shortly thereafter.

Glenn Laffel MD, PhD
Sr. Vice President, Clinical Affairs, Practice Fusion