Lefties Against ReformA taxonomy of left-liberal opposition to the health care bill.

Click here for a guide to following the health care reform story online.

(Continued from page 1)

PRINTDISCUSSE-MAILRSSRECOMMEND...SINGLE PAGE

FacebookMySpace Mixx Digg Reddit del.icio.us Furl Ma.gnolia SphereStumbleUponCLOSE

Most of health care reform doesn't kick in until 2013 (Reich is off by one year), but some important parts take effect sooner. Under both the House and Senate finance committee timelines, for instance, the prohibition against insurance companies excluding applicants with pre-existing conditions starts phasing in next year. In the House bill, so does a ban on insurers' lifetime payout caps and a requirement that insurers spend at least 85 percent of the money they collect in premiums on medical benefits.

Over the long term, the unemployment rate will come down with or without government intervention. But failing government action, the percentage of uninsured people will probably, after a small post-recession drop, resume this past decade's upward climb. That's a pretty good argument for making health care reform a priority.

The this-is-a-gift-to-insurers faction. A troubling aspect of health care reform that I've noted before ("The Paradox of Health Reform") is that it may end up rescuing employer-based health insurance, an inefficient and inegalitarian system of delivering health care that is already in the process of dying off. Shoveling half a trillion dollars to private insurers over 10 years does seem a strange way to reward them for their spotty record helping sick people get the medical care they need.

Rep. Dennis Kucinich, D-Ohio, was thinking along these same lines when he voted against the health care bill on the House floor Nov. 7. "We have been led to believe," Kucinich said in a prepared statement afterward, "that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care." The health reform bill, Kucinich continued, "incentivizes the perpetuation—indeed, the strengthening, of the for-profit health insurance industry, the very source of the problem." Better, Kucinich says, to hold out for a "not-for-profit, single-payer health care system."

Similarly, Marcia Angell, a former editor of the New England Journal of Medicine (and wife of Arnold Relman, another former editor of the New England Journal, whose views on health reform I've written about) concludes, in a Nov. 8 column for the Huffington Post ("Is the House Health Care Bill Better Than Nothing?") that the health care bill "simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and … augments the central role of the investor-owned insurance industry." Angell proposes that instead we gradually drop the eligibility cutoff for Medicare, "decade by decade, until everyone is covered."

Both Kucinich and Angell argue that the public option, which conservatives have labeled (with some justification) as a potential bridge to single-payer, has been watered down to the point of ineffectiveness—a point the Congressional Budget Office largely concedes. But if conservative health reform critics like the Washington Post's Fred Hiatt can doubt "whether Congress will truly cut hundreds of billions of dollars from Medicare programs in coming years, as the House bill assumes," then it seems to me that liberal health reform advocates can doubt whether Congress will long allow a public option to drain the treasury when the simple corrective of aligning its hospital and doctor fees with Medicare lies within reach. (Psst! Don't tell Sen. Kent Conrad!)

"We don't pass perfect laws in the U.S.," notes the New Republic's Jonathan Cohn in a blog post about Angell's column. "We pass imperfect ones and then do our very best to improve them over time." The eventual result might or might not be single-payer, but even it were merely that a government insurance program, made available to ever-greater numbers of people, really did keep private insurers honest, as Obama predicts, then perhaps Kucinich and Angell might reconsider their views. In the meantime, I tend to agree with Kucinich's fellow single-payer advocate, John Conyers, D-Mich., who swallowed hard and voted for health care reform "because the cost of inaction is too high."

Much of this logic, I'll concede, may not apply if the public option disappears from the bill altogether.

The abortion-rights-are-more-important faction. Forty-one House members are pledging not to support any health reform bill emerging from House-Senate conference that contains the anti-abortion language that Bart Stupak, D-Mich., inserted into the bill prior to its passage. We don't know who these 41 members are, but the ringleader, Rep. Diana DeGette, D-Colo., voted for final passage Nov. 7 (after voting against the amendment itself). So did Rep. Jan Schakowsky, D-Ill., who co-authored an op-ed with DeGette threatening not to support a conference bill containing the Stupak language.* So I think probably it's an empty threat. Indeed, Nate Silver reports on his blog that 17 of the House's 20 most pro-choice Democrats voted for the Stupak amendment itself.

I don't mean to belittle the rottenness of the Stupak amendment, which I've elaborated on here, here, and here. It's a genuine affront that anti-abortion groups might prove able to leverage language borrowed from the 1976 Hyde amendment to prohibit effectively coverage for abortion in private-health insurance policies offered to previously uninsured people through the newly established exchange (or exchanges, since the Senate finance committee bill has one for each state). It's also exasperating to consider that the Stupak amendment would complicate any effort to repeal the Hyde amendment, a plausible medium-term goal in a Democratic Congress.

But the Stupak amendment is not a good enough reason to sink the most ambitious piece of social legislation in decades. DeGette and Schakowsky showed in their votes Saturday that they don't think it is, and neither do I.

E-mail Timothy Noah at .

Correction, Nov. 11, 2009: This article originally misspelled Rep. Jan Schakowsky's last name. (Return to the corrected sentence.)

PRINTE-MAILRECOMMEND...RSS

FacebookMySpace Mixx Digg Reddit del.icio.us Furl Ma.gnolia SphereStumbleUponCLOSE

Timothy Noah is a senior writer at Slate.

Photograph of Dennis Kucinich by Paul J. Richards/AFP/Getty Images.

SPONSORED CONTENT

• Barack Obama's Facebook Feed
  Thanksgiving, Afghanistan, and the Salahis' next big stunt.
  Christopher Beam | Dec. 4, 2009
• This Week's Bidenisms
  Collecting the vice president's gaffes and head-slappers.
  Jeremy Stahl | Dec. 4, 2009
• The Twitter Holdouts
  Why is more than half of Congress still not on Twitter?
  Christopher Beam | Dec. 3, 2009
• Search for more Politics articles
• Subscribe to the Politics RSS feed
• View our complete Politics archive