| Finally.
Health care reform is entering the final stretch in Congress. All sorts of stories will be written in the next few days, but the bottom line is that the Congress is about to pass the most significant economic justice legislation in 40 years and the most fundamental rewrite of our social contract since the New Deal and Social Security.
Like Social Security, Medicare, and, well, everything, this bill is a process, not an end-point. But the expansions of Medicaid, the creation of health insurance exchanges paired with meaningful regulation to make insurance function more like a regulated utility than the ferocious beast it has become, and the subsidies to make insurance affordable are all huge immediate gains for low- and middle-income Americans.
Combine all of those moves with the strong attempts to control costs -- bundling of prices, comparative effectiveness research, etc. -- and we've got something that just may keep people insured for the long term while also being the single biggest piece of deficit reduction legislation passed in the history of this country.
Damn. I know there are a lot of complaints out there, but we stand at a major turning point of American history. The future will build upon this point in a few ways:
- Creation of a public option. Count me skeptical that we'll get it in this bill. But the public option is an easier thing to pass in the future than the framework in which it would live and, over the long-term, it is important, but nearly as important as the insurance market regulations and subsidies that will make insurance fair and affordable. We can get back to this and probably in better form than the compromised version we'd get today.
- State experimentation. One of the amendments that both Ron Wyden and Bernie Sanders helped insert allows states to take the revenue streams under the bill and implement alternate models of reform, so, yes, California, New York, or even Montana could pass, for example, a single-payer plan and use the federal funds to make it happen.
- Implementation of further cost control. This last piece will be the hardest, but it may prove the best. Focusing especially on bundling and comparative effectiveness research, which both create the opportunity to cut costs while increasing quality, we may be able to significantly restrain health care spending while improving health outcomes.
The wonderful people at Families USA, a progressive outfit that has been working on health reform for something like 25 years, put out a report on the effect of health reform on Montana. Over 100,000 Montanans will get insurance. Pre-existing condition discrimination will be a thing of the past. |
