A courageous vote

Our view: For once, political consequences mattered less than doing the right thing when Democrats in Congress approved the president's health care reform legislation

March 23, 2010

Not so long ago, America's elderly routinely died in abject poverty, with no means to support themselves and no way to pay their crippling medical bills. Social Security and Medicare changed that, and as controversial as both were in their day, it is now nearly impossible to imagine this country without them. Likewise, it will be hard one day to imagine that tens of millions of Americans once lacked health insurance, that people were denied coverage because of pre-existing conditions, that insurance companies dropped them when they became sick and applied lifetime caps on benefits, or that people lost their insurance when they lost their jobs.

What will be even harder to believe is that an entire political party denounced the legislation to reverse these injustices as the ruination of America.

For all the Republican insistence that the nation is deeply opposed to the health care overhaul that Democrats in the House of Representatives voted late Sunday to send to President Barack Obama's desk, it has become increasingly clear that the GOP's greater fear is that what they derisively call "Obamacare" will become just as popular, just as embedded in the fabric of our nation as Social Security and Medicare. After all, if they really believed their rhetoric about this vote presaging an electoral drubbing for the Democrats in November, why would they be so upset? They could simply seek to reverse this legislation when they recaptured the majority in Congress. And if they really objected to the bill for substantive reasons, not political ones, wouldn't they line up to support the reconciliation bill headed to the Senate, which strips out the special deals many found so objectionable in the original legislation?

The health care reform legislation President Obama will sign is probably nobody's idea of perfection. But it will help provide access to health care for those who now lack it, and it will help make millions more Americans who already have insurance more secure. The bill could certainly do much more to contain costs, but it does include elements that will encourage experimentation to move the nation away from the current fee-for-service model that provides incentives for people to get more health care, not necessarily better outcomes.

And at least in Maryland, a reduction in the number of uninsured patients will help hold down costs for everyone else. Unique among the states, Maryland spreads the costs of uncompensated care among all paying customers in the form of higher hospital rates. By some estimates, covering the hospital visits of the uninsured under Maryland's all-payer system adds hundreds of dollars a year to the average family's insurance premium. Significantly reducing the number of uninsured Marylanders would, over time, drive down that cost.

Perhaps the most important thing about Sunday night's vote, beyond the merits of any one element of the legislation, is that it showed that the government can overcome all the nasty rhetoric, fear-mongering and obstructionism in Washington and actually tackle the nation's big problems. Not only would the failure of this push for health care reform have doomed us to another decade or more of no progress on that issue, it would have seriously dampened the prospects for handling anything else of substance.

Republicans are probably right that some Democrats will lose in November because of their vote on health care, but some of them almost certainly would have lost anyway. As they move from health care to financial reform, climate change, immigration or the deficit, Democrats should be emboldened by their vote on health care to worry not about whether they're strengthening their prospects for re-election but about whether they're strengthening this country.

Readers respond
But who pays for all of this? Make no mistake, this will turn out less effective and more costly in the long run than what we have now.


A great day for America. An incremental bill that will have to be revised going forward, but for now, it's nice to know that in a few years there will be no denying coverage for pre-existing conditions, no annual or lifetime limits on coverage, no need to worry about losing your insurance when you lose your job, exchanges to encourage competition and choice, and your children can stay on your plan until they are 26. Not a bad year's work!


Keep drinking the Kool-Aid. The polls show that the American people do not want this bill. At least a trillion in new spending, half a trillion in new taxes, a takeover of the health care system by the government and to top it off, shady backroom bribes. Oh, and the talking point that it will reduce spending? It belies common sense that adding 30 million people to the public dole reduces spending.

Mike D

Certainly this is a step forward, but I agree that it's just incremental change. A single payer system is the answer, or at least something like what Japan has, where the price of all health care procedures are set by the government. Either way, we need MORE change. If the anti-government loons don't like it, they can move to China!


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