Open the champagne? Health reform passes the Senate

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After months of the most brutal, and perhaps at times cynical, Washington horse-trading, (congratulations Nebraska, on your $100 million Medicaid payoff), a historic health reform bill finally made its way through the Senate. Passed on a straight party line, 60 to 39, Christmas Eve vote, the Senate health reform package was something of a poorly wrapped Christmas present for the nation, stripped of those measures liberals believe were essential to a meaningful reform, the public option and even the Medicare buy-in for folks older than 55, and retaining language that the U.S. Catholic bishops feel comes too close to public financing for abortion.

The package now moves to a conference committee which will attempt to reconcile the House and Senate reform bills in a process that could drag on through February. It's likely that the House bill's public option for health insurance will similarly be stripped away from the bill that eventually finds its way onto President Obama's desk, and its stronger effort to separate public monies from abortion may be watered down somewhat.

The bishops have emerged as effective players in the reform debate primarily because their long record of advocating for the uninsured and comprehensive health reform legitimized their interest in the final reform package. They are not attempting to use abortion funding simply as a handy rhetorical weapon meant to monkey-wrench or terminate reform.

Without their involvement the House bill would not have included the Stupak Amendment, and Senator Nelson's efforts to pull together language aimed at keeping public money out of abortion would not have succeeded. It's likely the final bill will include Nelson's compromise and dump the Stupak language. The bishops will be dissatisfied, although it's not clear what the practical effect of more tinkering would have on absolutely preventing public monies from being used to pay for abortions.

A split has already emerged within the Catholic community over this issue as the Catholic Health Association and other Catholic groups including the Sisters of Mercy have already offered a tentative endorsement of the Nelson/Casey rewrites, despite the bishops' quick pronouncement of the Nelson compromise as morally deficient. (The bishops also continue to express concern about the plan's failure to address health insurance affordability, extending coverage to all immigrants regardless of status, and lack of clear conscience protections.)

Advocates along both sides of the abortion debate are howling about the Senate compromise, which suggests that it may be just about right in a pluralistic democracy. In truth Nelson's gambit may be the best this Congress is capable of in terms of separating public money from abortion. Trying to grasp the practical implications of the reform's language about abortion and public money can make a fella's head hurt after a while. What we may be learning from the current debate on reform, public financing, and abortion is the real-world limitations of the Hyde Amendment.

As for the actual business that reform was meant to address, moving toward comprehensive coverage, reducing costs, and preventing misfortune or illness from driving U.S. families to bankruptcy court, the current package represents a partial success.

Lifetime coverage limits and exceptions for pre-existing conditions will be prohibited, so people who actually get health insurance can anticipate that major illness will not mean bankruptcy. Millions of Americans who currently are without health insurance will be able to find what currently passes for affordable coverage, but the real short-term winners under this reform may be the for-profit insurers who can anticipate millions of new federally subsidized customers.

If the current reform does not produce significant cost savings and merely safety-valves a system that continues to burden middle class subscribers with onerous co-pays and ridiculously overpriced group plans that workers may finally begin to perceive as significant diversions of their compensation, the nation may eventually see the wisdom of more radical adjustments to its over-priced, under-achieving system.

The current proposal's absurd 2,000 page complexity alone is a strong case for a single payer approach to health care. The Canadian system managed to summarize its plan in 14 pages, in BOTH English and French. "Medicare for all" would similarly require fewer pages to get its point across.

One day the 53 percent of Americans who are not already covered by a single payer system that clearly prevents public financing for abortion may be ready for a real reform package (yes, 47 percent of all Americans already receive health coverage financed via the federal government in the form of Medicare, Medicaid, VA, and other government pension and employee plans, including the Cadillac health care enjoyed by members of Congress).

Until then, this fractured reform may be the best we can hope for, though it is a far cry from what decency and common sense demand.