Howard Dean Wrong to Urge Killing the Health Reform Bill

By Robert Schlesinger, Thomas Jefferson Street blog

Howard Dean wants to make like Dr. Kevorkian on the current version of the senate healthcare bill. Telling Vermont Public Radio that the bill's current form--no public option, no Medicare buy-in--is "essentially the collapse of healthcare reform in the United States," Dean argues that it's time to scrap the whole thing and start over. "Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill," he said.

It would be much simpler. There would, for example, be no ban on excluding people from coverage based on pre-existing conditions. That's because reconciliation is a budget short-cut, meant to avoid filibusters on revenue raising and spending. So a lot of the regulatory guts of the bill--the ones that have the broadest public support no less--would disappear.

And there's a larger issue here, as Kevin Drum points out: If you kill healthcare this year, there's no bringing it back. Not in 2010 with momentum dead and congressional elections impending; not in 2011 with more Republicans in the House and Senate (as seems likely right now given the makeup of competitive House and Senate seats), not in 2012, and so forth.

Drum goes on, listing the good parts of the healthcare bill as it stands: 

• Insurers have to take all comers.  They can't turn you down for a preexisting condition or cut you off after you get sick.
• Community rating.  Within a few broad classes, everyone gets charged the same amount for insurance.
• Individual mandate.  I know a lot of liberals hate this, but how is it different from a tax?  And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
• A significant expansion of Medicaid.
• Subsidies for low and middle income workers that keeps premium costs under 10% of income.
• Limits on ER charges to low-income uninsured emergency patients.
• Caps on out-of-pocket expenses.
• A broad range of cost-containment measures.
• A dedicated revenue stream to support all this.

Does that make for a perfect health reform bill? No. But a perfect bill isn't coming. I'd rather bank what's gettable now rather than waste it away on a fool's quest for perfection.

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