A Very, Very, Very Fine House Bill

This perhaps tells you more than anything about the roller coaster week in Congress:  when the House of Representatives released their bill today, it looked more or less like we thought it would.  It didn’t exceed expectations, but it clearly met them.  And yet that was enough to prompt a huge sigh of relief from the ranks of health care activists.

The week started with a bang in the form of the President’s speech to the AMA.  But then it descended into the chaos of the Senate Health, Education, Labor and Pensions Committee’s mishaps with the Congressional Budget Office and the stall tactics of Sen. Tom “Amendment Generating Machine” Coburn and entrenched conservative opposition reminiscent of Groucho Marx’s song, “Whatever it is, I’m against it!”  The past two days have been filled with the Senate Finance Committee lopping off an arm off their health care bill rather than face a score from the CBO ($1.6 trillion over 10 years) that’s not appreciably different from the estimate of Hillary Clinton’s campaign health care plan ($1.3 trillion over ten years) for more or less the same plan.  So we can perhaps be forgiven from something going well for a change!

First, there’s the simple fact that three mega-stars of the Democratic party and three of the most powerful committee chairs are stifling the kneejerk reaction to fight over territory and are working in unanimity on a single bill.  But that’s exactly what Rep. Henry Waxman of Energy & Commerce, Charles Rangel of Ways & Means, and George Miller of Education & Labor are doing – and with none of the backbiting and anonymous-quote drama that the media thrives on.  Second, there’s the simple fact that this is the health care bill we’ve been waiting for.  It’s not appreciably different from what is in Kennedy’s bill, or what we originally thought would be in Baucus’s (these days, who the hell knows).  Heck, throw in the Obama, Clinton, Edwards campaign plans and the Commonwealth Fund proposal, and you’ll scarcely notice the differences.  But unlike the Kennedy bill – which left out the most contentious parts in the hopes of some future leap of bipartisan faith – or the Baucus bill, which is going through a heavy attempt to water it down revision, the House bill seems immune to the panic in the Beltway.   As a result, the House version of the common provisions is quite strong.

Come on, sing along – you know the words by now:

• Expansion of Medicaid eligibility to everyone at or under 133% of the poverty line (this while Baucus is floating only covering pregnant women and children at 133% of poverty to save money)
• A national Health Exchange for individuals and families to buy comprehensive plans with a standard minimum set of benefits set by an Advisory Committee chaired by the Surgeon General (no, not Sanjay Gupta).  A unique feature – over time, all employers, not just small businesses, would be allowed to purchase a plan from the Exchange rather than negotiate directly with insurers.
• No pre-existing conditions, no rescissions, no lifetime benefits, no variable rates based on gender, and premiums can only vary by age and geography to the tune of 2:1.  That may seem weak – making people who are older pay twice as much as the young? – until you realize the same proposal in the Senate Finance Committee caps variance at 7.5:1.
• Subsidies based on income, up to 400% of the poverty line – they’re sticking to it even knowing how expensive that was in the HELP Committee score.
• Actual detailed plans for employee pay-or-play and the individual mandate.
• A robust public health insurance option – important, since Speaker Pelosi has gone on record as saying the package won’t have the votes in the House without it.  In structure, it’s similar to Sen. Rockefeller’s proposal – the plan would start with Medicare rates just to get it up and going, but would ultimately transition to a “level playing field” where it’s negotiating rates with providers.  The plan is financed only by premiums – no matter what John Boehner tells you.
• A whole raft of proposals on improving Medicare, Medicaid, quality of care throughout the country, recalibrating our system towards primary care and prevention, and developing the health care work force.

I’ll be delving more into the 852 pages worth of details this weekend.  But it’s worth noting the language in the summary documents.  Simply put, they’re not backing down.  Ezra Klein suspects this is because the House is more responsive to populist concerns than the Senate – something our founding fathers made much of in designing the House, but of which I’m skeptical.  I live in New York City – the only way Charlie Rangel’s not getting re-elected next year is if he sets half of Manhattan on fire.  On purpose.  But whatever the reason, it’s nice to see the people in power actually ask for what they want, and what they promised they’d deliver this year, rather than start compromising before the plan has hit the desk.

So here’s to our House.  It’s a very, very, very fine house.  With two cats and a yard, life used to be so hard… now everything may not be easy, but at least it’s got a fighting chance, ‘cause of you.