It’s the centrepiece of Obama’s domestic agenda, and there have been months of haggling, deal-cutting and sausage-making in order to push it through. The prospect of a Democratic loss in the Massachusetts special election has further injected a sense of urgency. Given the unwieldy, dysfunctional nature of the Senate, with its seemingly interminable succession of committee discussions, procedural motions and amendment deliberations, and the messy negotiations required to reconcile the differing House and the Senate bills into one, it’s a frustrating and sapping process. It’s perhaps no surprise that, as Howard Dean said in December, the end of the process can result in a mentality in which “passing any bill is a victory, and that’s the problem”.

The loud voices of disappointed progressives such as Dean have drowned out the fact that the healthcare bill has real and significant benefits. Even though neither the House nor the Senate bill would rein in insurance costs to the extent that progressives would like, the average family would still be considerably better off with reform legislation than without. Both bills would curb the insurance company practice of denying coverage for pre-existing conditions, a notorious practice which eight states have even used to deny coverage to victims of domestic violence. Both bills also include measures which would allow dependent children to remain on their parents’ policies until their 26th birthday (in the Senate bill) or their 27th (in the House bill); this would be a significant boon for young adults, a third of whom are estimated to be uninsured.

Nevertheless, it remains true that the bill does not go as far as it ought to. Many of the factors which have been causing healthcare costs to skyrocket are untouched by this legislation, such as the lack of competition between insurance companies, many of which have regional monopolies, and the fee-for-service model, which gives doctors an incentive to perform unnecessary procedures. Several praiseworthy measures were watered down or dropped due to the bargaining necessary to acquire 60 votes; see, for example, conservative Democrats’ rejection of the public option and Lieberman’s killing off of the “great compromise” of expanding Medicare to those aged between 55 and 64. Furthermore, the Congressional Budget Office also projects that, even with the bill, 24 million people will remain uninsured by 2019 - 24 million people too many.

Considering the difficulties of the process so far - the effort required to shepherd the legislation through byzantine congressional procedures, the intensity and hysteria of the right-wing opposition - there’s a high risk that, should the bill pass and the President sign it into law, exhausted lawmakers will act as if the matter of healthcare reform is over and done with. There is certainly much to be commended in the House and Senate bills and the final bill will still be the biggest expansion of the USA’s social safety net since 1965. However, given the shortcomings of the bill, its purpose should be to set in motion a legislative trajectory which will lead to additional expansion and improvement of the healthcare system, rather than to settle the matter once and for all.

Filed under: health, uspolitics on January 19th, 2010