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The big honking flaw in the health care reform bill

So I read all 1018 pages of the health care bill (the July 24 version). I’ll summarize it in another post, but here’s a summary of the summary:

  • There’s a lot to like in it. Most of the bill seems to have been written with care and thought by very knowledgeable people who genuinely want to reform the health system in the country. It’s not single-payer, but it’s okay.
  • Which is too bad, because we’re not likely to ever see most of the reforms in the bill, even if it’s enacted in its current form.

See, the key idea of the bill is that health insurance plans have to insure everyone and meet a bunch of requirements (like, no denying claims for no reason), with a public option to keep them honest. But as currently written, the important reforms don’t go into effect until 2013 (section 100(c)25, 101(b), and 221(a)). And then, existing group health insurance plans have a five-year grace period to get up to code (section 102(b)1(a)). And then, the health insurance company can choose to “grandfather” an existing plan, which means that it can keep offering the same crappy old terms but can’t enroll new people.

What this means is that if reform were enacted tomorrow, people with no health insurance could hope to get it in 2013, while people with today’s junk insurance could expect their coverage to improve in 2018, unless their plan was grandfathered.

The 2013 date has received almost no mainstream media attention—the most popular hits on a Google search on “health reform 2013” are mostly diaries and blog posts. The 2018 date has attracted even less attention (here’s an exception).

It’s not that fixing a health insurance plan really takes that long—nine years (2009-2018) was enough time to create a military from scratch, fight World War II, dismantle the military, and rebuild it for the Korean War. Back in the thirties, nine years was enough time to create important programs like the Works Progress Administration, the Public Works Administration, and the Civilian Conservation Corps, have them do their work, and dismantle them.

On the other hand, the long delay gives the forces against reform time to undermine it, and an entire freaking presidential election campaign to replace pro-reform politicians with ones more amenable to their interests. One doesn’t have to be paranoid to think that maybe this is the point.

The left is mobilizing against delaying the public option for this reason. Here’s Robert Reich:

[A]ny controversial proposal with some powerful support behind it that gets delayed — for five years or three years or whenever — is politically dead. Supporters lose interest. Public attention wanders. The media are on to other issues. Right now the public option is very much alive because so many Democrats care deeply about it, with good reason. But put it off for years, and assign it to the lawyers and lobbyists I just mentioned, and you can kiss it goodbye forever.

Reich has it right, but what’s true of the public option is also true of health care reform in general. Waiting so long to implement reform nearly guarantees that it will be whittled down to nothing, or killed outright, before we ever see it.

I’m planning another post summarizing the whole bill, if only because I read the whole damn thing and other people should suffer too, but I’ll wait to watch Obama’s speech tonight before starting.

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