Wednesday, December 30, 2009

Whose Interests Is the White House Representing in the Senate-House Health Reform Conference?

By FireDogLake's Scarecrow FDL

After the Senate passed its version of the health reform bill, the White House was quick to announce that the President and his aides will be actively involved in helping to guide the process of reconciling the Senate and House bills.

Nothing wrong with that; it’s what we’d expect from any White House in pursuit if its own agenda and legislation affecting the public interest. But something’s missing, something important.

What the announcement left out is any statement about whose interests and what positions the White House would represent. While I realize that criticizing the White House in dealing with Congressional realities is something that, in civilized Villages at least, is just not done, I seem to recall instances in the past when Presidents actually took public positions on matters important to them by, uh, you know, telling us what they wanted Congress to do or not do on specific issues.

Even completely despicable Administrations, which shall go unnamed, usually let us know what was really important in their perspective on the public/private interest; we always knew what they were demanding be included or taken out as legislation moved along. Why, some even said they’d veto a bill that didn’t have something they thought important.

We now have two different bills, with lots of overlap/common features but also dozens of important differences that affect the public interest, some profoundly so. Does this President have a view on any of these? And if so, would it be too much to ask, Your Majesty, that your Ministers give us a hint, this being a democracy premised on governmental accountability and all? I mean, you don’t have to put it on C-SPAN (though what’s wrong with that?), but maybe your COS could leak it to Jake Tapper, or someplace safe like Meet the Press? For example, consider this list from yesterday’s Times editorial:

AFFORDABILITY Under the more generous House bill, low-income people would pay substantially less and get better benefits than under the Senate bill. The House bill has far better subsidies to help lower-income Americans with premiums and cost-sharing. The Senate bill offers better subsidies for middle-income people. House staffers calculate that a family of four earning $33,000 a year would pay $1,521 in premiums under the Senate bill, which is $530 more than under the House bill. The same family would be exposed to as much as $4,100 in cost-sharing under the Senate bill, which is $3,100 more than under the House bill. Affordability is probably the most critical issue in winning popular support. The Senate needs to agree to more subsidies.

MEDICAID The House bill would expand Medicaid coverage to higher-earning people than the Senate bill does. It would raise Medicaid’s low payments to doctors in one crucial respect — paying primary-care doctors the same that Medicare pays. That would make it more likely that poor patients could find a doctor willing to serve them. The Senate should follow the House lead.

EMPLOYER MANDATES The House bill imposes higher penalties on employers who fail to offer coverage, a prod estimated to increase the number of covered workers by six million in 2019. The Senate bill has weaker penalties that would allow more employers to opt out, reducing by four million the number of workers covered. Under the House bill, employers would have to pay most of the premium and meet minimum benefit levels; the Senate has weaker requirements. The House bill is superior.

INDIVIDUAL MANDATE The House has stronger penalties on individuals who decline to buy insurance and would exempt fewer individuals on grounds they could not afford to buy coverage. Given that the reforms would work best with the greatest number of people insured, the House provisions should prevail.

I make this humble request, because there seems to be confusion among your subjects the citizens about whose interests your aides will be representing. Will it be big PhRMA, or AHIP/insurers and the hospitals with whom you reportedly cut secret special deals to protect their interests? Or will you side in protecting the public interest in controlling the prices and market power and limiting the public money these groups receive with no safety valve/alternative to continue corrupting Congress and, uh, forgive me, your own Administration?