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March 21, 2010
The House of Representatives in the US is expected to cast its final votes on health care reform in the next few days. It is considered to be the most important piece of domestic health legislation since the enactment of Medicare in 1965, and it is really needed.
Michael Tomasky has an interesting article on the impediments to health reform in the US in the New York Review of Books entitled The Money Fighting Health Care Reform. It makes for depressing reading as it shows how big money has increasingly dominated politics from the 1980s on. The result is that Congress has not passed a piece of major progressive social legislation for many years and a question mark is placed over whether Congress is capable of passing major, progressive domestic legislation anymore.
Tomasky says that on the big health reform question, the private health insurers won: if a health care bill is passed, it would contain no public option, no federal alternative that might compete with them.
The bill is still progressive in that it is fundamentally, an effort to address the the plight of the nation's 50 million uninsured. Ezra Klein says:
Once it's up and running, it spends $200 billion a year to help low-income and working-class Americans afford health-care coverage. About 15 million of those people will become eligible for Medicaid, which is public insurance. Another 15 or so million will get private insurance.
Tomasky does qualify his judgment that the institutional pressures of big money have effectively and quietly deformed central parts of the bill and continue to loom over any attempt by Congress to write and pass major domestic legislation. He says:
In fairness, the bill's many positive features should be recognized. It ends discrimination based on preexisting conditions and development of catastrophic illnesses. It eliminates price discrimination based on health status and offers subsidies for up to 30 million currently uninsured people. It establishes a host of other precedents concerning cost control and new services that would, taken together, still be a major, even astonishing, step forward. As big a victory as that would be, it will remain the case that it could have been a considerably better bill, in both providing medical care and controlling costs.
The bill would significantly change the way healthcare is paid for and delivered in the United States, and it would represent an enormous expansion of access to medical care for those who are uninsured or under-insured.
Update
It does look as if the Democrats will have the votes they need to pass the health reform bill. Obama has spent political capital, trading popularity for health care reform, and has succeeded by the narrowest of margins. Obama is now one of the handful of presidents who found a way to reshape the nation’s social welfare system.
The Republicans strategy was to throw everything into killing the bill instead of working with it, and to hope that this would result in the bill's defeat. The entire strategy was predicated on killing the bill by arguing that big government was intruding into the lives of citizens.The bill is now passed, and it means that the US health care system has been fundamentally changed, and there will not be the votes to repeal it. The Republicans echo chamber is now talking about the healthcare wars.
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One of my son's American Facebook friends keeps posting exhortations for the world to pray for America. Apparently Obama's healthcare policy is so dire the country is on the brink of civil war. People never cease to amaze.