The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

House Health Care Reform Bill: Some Varied Perspectives

Posted by Alan on October 29, 2009

One person’s socialism is another’s sellout. At least that’s the way it seems to go when it comes to health care reform. And it certainly must appear that way to House Speaker Nancy Pelosi who today unveiled the Affordable Health Care for America Act. HR 3926 blends together provisions from the three House Committees that have produced health care reform legislation: the Ways & Means Committee; the Education & Labor Committee; and the Energy & Commerce Committee. The result is not as liberal as some on the left called for and is too radical for those on the right.

As CBS News reported, those on the left are upset that the bill would create a government-run insurance plan that would be required to negotiate rates with providers much as private carriers do. This angers liberals who want the public health plan to set rates that providers would have to accept, much as is done with Medicare and Medicaid.

Meanwhile, back on the Hill, conservatives attacked the House health care reform bill in no uncertain terms. “It will raise the cost of Americans’ health insurance premiums; it will kill jobs with tax hikes and new mandates, and it will cut seniors’ Medicare benefits,” proclaimed House Minority Leader John Boehner.

Is it socialism? A sellout? A good idea or a bad idea? Most readers of this blog can guess my answers (for those interested, my view of it is at the end of this post). Here’s how others are discussing the legislation:

The National Underwriter does a great job of identifying where some of the controversial provisions in the bill can be found. While the publication is a bit too fixated with the number of pages in the House health care reform bill (1,990), it’s still a good starting point for understanding the legislation. And it points out that the bill does nothing to prevent brokers to sell products within the Exchange, so it offers a bit of a reassuring start, too.

The Congressional Budget Office is highly regarded by lawmakers on both side of the partisan divide for its objective analysis of the budget impact of legislation– unless, of course, they don’t like the analysis. The CBO’s analysis of HR 3926 indicates it will reduce the deficit over the next 10 years by $104 billion, insure 96 percent of non-elderly legal residents in the country (18 million people).  The CBO’s director, Douglas Elmendorf, maintains a blog and summarizes the analysis in his post today. he notes that the findings of the CBO are “subject to substantial uncertainty.”

The Christian Science Monitor’s story reports on the how the liberals may call for a floor vote on a more robust public option than is in the bill in order to put Democratic and Republican members on record as to where they stand on a government-run health plan.

The Associated Press focuses on the CBO’s conclusion that the public option might actually cost consumers more than private coverage. It also notes that while Speaker Pelosi compromised on the powers of the government-run health plan to appease the more moderate members of her caucus, many of those moderates remain concerned about the overall cost.

A BusinessWeek article zeroes in on some of the taxes the House health care reform legislation would impose and how they differ from the taxes likely to be in the Senate reform bill.

Reimbursing doctors for providing end-of-life counseling remains in the House health care reform bill. Given that some conservatives described this provision as creating “death panels,” preserving this element of the bill can be viewed as an act of political courage. As I’ve posted before, the death panel claim was more of a cruel hoax on the American people than an insightful read of the legislation. But the passions and paranoia surrounding the provision was so vociferous, the easy course would have been to simply drop it from the bill – as was done in the Senate. The Oregon Congressman, Earl Blumeauer, who championed inclusion of the counseling provision in the health care reform package, says he was motivated by a talk with a Southern Minister who told him ‘It’s very important for those of us in the clergy that this provision be kept, cos’ we see situations where families don’t get the help they need, and we have to try to counsel them through.”

For those interested in reading the bill, here’s a link to HR 3926 – the Affordable Health Care for America Act. As noted, it’s 1990 pages, but there’s a lot of white space on most of the pages.

My take on the House health care reform bill is that it’s not socialism nor a sellout. It is a politically necessary step down a long road. As regular blog reader Alison noted in her comment on an earlier post concerning Senate Majority Leader Harry Reid’s efforts to forge health care reform legislation that can muster 60 votes in the Senate, “… if you start off extreme then there is more room for negotiation to where he (Senator Reid) most likely anticipates its going anyway. If you give away the farm at first you have nothing left in your hand to negotiate with. I do not believe he anticipated this to fly at all but rather offers it as a calculated starting point.”

Alison’s point applies equally as well to Speaker Pelosi’s health care reform bill.

Health care reform is a process. First there was the pre-legislation discussion of what health care reform should do. Then there were the debates in various committees in which those intentions were put into bill form. Now the leadership of each chamber are blending the work of their committees into single bills. Next will come a conference committee tasked with combining the two bills that emerge from the Senate and the House of Representatives into a single bill. At each step along the way positions harden, the rhetoric (hard to believe it’s possible) becomes even more shrill, and the compromises more plentiful. But at each stage, the final legislation becomes more clear. After all, if the House Leadership is going to push moderate Democrats to vote for a public option of any kind, a vote those moderates will need to defend at election time, they must believe it is going to be a part of the final reform package. (At least those moderate Democrats hope so).

The Affordable Health Care for America Act will look more like whatever finally emerges from Congress than the bills passed by the three House Committees. But it’s not the last word. The blended Senate bill has been described, but not seen. Both the House and Senate proposals will be evolve. We’re several weeks away from seeing the legislation that will emerge from the conference committee.

The worthiness of the result, as always, will be in the eye of the beholder.


10 Responses to “House Health Care Reform Bill: Some Varied Perspectives”

  1. The reform bill is meant to blow up. That means their goal of single payer is one-step-closer to reality. Premiums will increase even more than they are now, and the left will say, we’ve tried to work with the insurance companies, but they are not willing to flexible, so our only alternative at this time is to offer Medicare for all.

  2. MARY GRIBBIN said


  3. don said

    There is no way insuring an additional 30 million people will save money in the long run. Let’s be honest. I have yet to see anyone explain what the bill provides. Likely because it is so complicated. A real discussion needs to take place on what truthfully is driving health care increases. And what is driving the cost is a fat unhealthy society of people getting older who are propped up to live or shall I say exist via modern medical advances. Give folks pills nursing support and when necessary cut off a limb to eliminate a catastrophic hemorrhage and continue on with a near life support quality of life. But what the heck you’re not dead..

  4. daniel lane said

    who really understands this one thousand page bill ? health care is a serious issue but the way this economy is going,i think its going to continue to be business first . its going to take decades to get the system how it should be. We all kno one things for sure HEALTH CARE = EXPENSIVE

  5. Dave Wood said

    Why Obama, Hillary, and John Edwards ALL went down the Massachusetts reform model road is a mystery to me. The Mass. reforms have done nothing to reduce costs, but have done excellent at expanding the insured.

    The main problem with our system is that there is no major authority to handle important issues such as obesity reduction. In our system we have 532 members of congress running Medicare and Medicaid, the President as well, and then 50 states all involved in health care.

    Notice that when there is a SINGLE chief, like Wellpoint Blue Cross, they seem to get exactly what serves their needs. For big drug companys as well.

    The reason these corporations get what they want is because there is real ACCOUNTABILITY for them. Whereas for the states we have governors elected on a myriad of issues, medicaid fraud not very high on the list, thus it gets no attention in any election. Lax accountability results in lax results…EVERY TIME

    So we get a very slow process for change, with poor results, complex compromises, and no accountablity for those poor results. Contrast that with Pfizer or Merck where the CEO is in charge and if he does not get results, he gets the boot- FAST.

    Sadly Obama care is the same old song and dance from big govt. and we will undoubtedly get poor results and no accountability.

    Who is taking the fall for the trillion$ plus costs of this phony war in Iraq? Who is taking the fall for the fact that Congress voted to ALLOW fannie and freddy to EXPAND risky home loan purchases when some were screaming that fannie and freddy should be reined in? Who is taking the fall for the fact that Medicare has at least 10% of its claims are fraudulent? That is $40 billion per year folks.

    Do you trust that this Congress will run Obama care with any efficiency?

  6. We will have to wait and see what comes out as the final bill. I think the important thing is that we now have a starting point for continued reform. The next step after this has to be addressing the cost of health care or this country is going to go bankrupt.

    • Doug said

      I would not call anything currently running through Congress a “good starting point”. The proposed laws will do NOTHING to curve the cost of health care. Consumers will pay an indirect tax on medical devices and on “premium” insurance plans. Second, there is a menagerie of insurance regulations where the federal government will mandate expensive coverage and quell any possibility of low cost plans. Third, there is a series of individual and payroll penalties for not owning or offering the “correct” insurance coverage. That is like penalizing a homeless person not getting a mansion.
      There are alternatives to putting a velvet cover on the sledge hammer of the current “reform”. Allow insurance to be purchased across state lines, increase transparency in cost and incentives for consumers to lower cost themselves, expand health care savings accounts, equalize the tax treatment for health insurance cost, and improve management of Medicare.
      These items would be a good start. The Hippocratic Oath states “Do no harm”, well I would say the current “reform” bill will do a lot more harm than good.

  7. JimK said

    You have made several comments on the length of the healthcare reform proposals, most of which were of the nature that the length of the Bill is irrelevant and is just more of a distraction. I too agree that the length of the proposed legislation is irrelevant but only to a degree. Most Washington observers would probably agree that Paulson’s original 3 1/2-page TARP proposal showed either intellectual laziness or worse an ambiguous Bill, which would provide Regulators more leeway on how to interpret provisions in the TARP legislation in a manner consistent with what would be good for Wall Street and particularly, Goldman Sachs, Secretary Paulson’s former firm. Unfortunately, the additional 1000 or so pages did nothing to change the direction of the TARP bailout.
    This brings me to the point of the current legislation; it is not the number of pages the Bill includes, but the clarity of the written provisions. As most observers of Washington know the current Bill if passed will be assigned to an Executive Agency and it will be the Agency’s mission to interpret Congressional intent when the final regulations are drafted and added to the Code of Federal Regulations. Congressional interpretation becomes the overriding factor when the final regulations are passed and this is an area of law that draws intense judicial scrutiny. It becomes a very time consuming and litigious process to determine the intent of Congress and the Courts routinely rule in favor of the Agency’s interpretation under a legal doctrine known as “Chevron Deference.” In essence it is up to the moving party to articulate a position, which will demonstrate how the agency’s interpretation is at odds with the intent of Congress.
    Determining the intent of Congress was instrumental in deterring the outcome of Riegel v Medtronics where the Supreme Court decision believed Congressional intent favored the Medical devices industry and essentially eliminated the right of patients to bring State Tort actions against Medical Device manufacturers. The same holds true for various actions brought under the American’s with Disabilities Act and to a lesser degree the Family Medical Leave Act. The number of Supreme Court decisions on the ADA is legion, while the Family Leave Act has brought only a handful of Supreme Court cases. The most significant Family Leave Court case (Ragsdale v Wolverine) focuses on the number of weeks an individual is entitled to the protections of the Family Medical Leave Act. The moving party believed that an employee’s Family Medical Leave protection did not begin until the employee received official notification that their current leave was protected under the Family Medical Leave Act. This position was consistent with the rules promulgated by the Department of Labor. The Supreme Court ruled that Congressional intent called for a maximum of 12 weeks or protected Family Medical Leave regardless of the employer notification procedures. However, the Court did not fully address the regulations leaving room for future litigation.
    I raise these issues because while the proposal is quite lengthy, less specific Congressional language would lead to an explosion in litigation. Under the 2000 page proposal there will still be cases where it will be deemed that the Director overstepped his or her bounds in interpreting Congressional intent but if the Bill provides the necessary language the approved Public law will translate easily into the Code of Federal Regulations. However, given the scope of the proposal and the assumed ambiguity of the language of many of its proposals, if passed, I am sure that new legal strategies will be devised to challenge the Director’s interpretation of the new law. I doubt very much if the Congressional Budget Office gave this matter much consideration.

    • Dan said

      If you read any of these bills that are all an obnoxious length, none of them are specific. They are impossible to understand. The length is a mirage. People think if it is that long then it must be very specific and cut out and loop holes. In fact, it is the opposite, it leaves so many loop holes for people to game the system it is incredible. There are many times inside of the bills that they actually contradict themselves. This whole process is a mess. Anything that comes out of these committees will be a mess.

  8. Tom Degan said

    I don’t know what kind of health care reform will come out of this session, but I strongly suspect it won’t be much. There is, however a silver lining behind this very dark cloud. I am reminded of the Civil Rights Act of 1957. Don’t be embarrassed if you’ve never heard of it, there really isn’t a hell of a lot to remember about it; a mere pittance, really – a scrap of leftovers tossed out to “American Negros” (in the parlance of the age) in order to appease them. But it made the passing of the Civil Rights Act of 1964 – the one we remember – all-the-more easier seven years later.

    We’ll live to fight another day.
    Tom Degan

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