The Other Health Care Fires

The public option vote was expected, and we'll see a lot more wrangling and floor amendments and other votes before that's done. Supporters picked up Tom Carper and Bill Nelson, so progress was made, actually. I'd like to look at some of the other aspects of the bills moving through Congress, which also have important implications, and what the progress looks like on those fronts:

• Byron Dorgan, Kent Conrad's colleague from North Dakota, will fight to stop the White House/Big Pharma deal from getting implemented. He's going to offer amendments to the final bill to allow reimportation of prescription drugs from Canada, at a savings of $50 billion dollars over 10 years. Surely the free-traders won't have a problem with that, and if they do, they can put a pool together and find the $50 billion that we're otherwise wasting by restricting such a common-sense measure.

• Jay Rockefeller is looking to extend the bill protections to "self-insured" health plans. I just found out about this a couple weeks ago. Apparently, 70 million people in America work for large corporations which self-insure. They have health insurance companies to administer the billing, but the corporation is taking on all the risk themselves. And, they reap the profits, too. These corporations have essentially turned their employee health care into a small profit center. And none of the regulations in the bill would impact these 70 million, simply based on who their employer is. Those employees should have the same protections, regardless of how "well" the self-insured market is working currently.

• In terms of pernicious amendments, anti-abortion activists want to block the exchanges from providing reproductive choice as part of their health care coverage. That would include private companies, and would represent the government telling private insurers what they cannot cover. That's fine to free marketeers because it would restrict legal medical services like reproductive choice. It's complicated, but the anti-abortion types want to use the Hyde Amendment to say that anyone getting subsidies to use the exchange couldn't buy a plan which covers abortion. Thing is, Jon Cohn writes that taxpayers already subsidize plans that offer reproductive choice:

Remember, the single largest tax subsidy in health care today is the tax break for employer-sponsored insurance. If you have insurance through your job, then you're getting government assistance just as surely as if Washington wrote you a check. And if your policy happens to cover abortion services--which about half of you do, according to the Kaiser Family Foundation's annual benefits survey--then the taxpayers are helping to subsidize it.

I'm not trying to accuse abortion rights opponents of hypocrisy or inconsistency. I'm sure they'd eliminate everybody's subsidy if they could. By trying to keep funding out of the exchanges, they're trying to hold the line--to keep more abortions from happening. I don't agree with their position, but there's nothing illogical about it.

But I suspect a lot of voters think the distinction makes sense for a different reason. They have mixed feelings about abortion, so they like the idea of supporting choice in principle while opposing taxpayer funding. The trouble is, it's not a meaningful distinction because of the employer tax subsidy, which (much to my regret, for unrelated policy reasons) is here to stay.

This is a larger attempt to overturn Roe v. Wade without going to court, basically.

• House Democrats will probably add the tax on high-dollar insurance plans into their funding mechanism for health care. Unions hate it, because they've given up wage increases for high-quality health care. But the employer deduction, as Cohn says above, is very pernicious and inefficient, and taxing insurance plans is a way to get at it. I would think that companies would welcome cash payouts over maintaining such high-price health care benefits. Hijacking health care reform to save parochial interests, when we should be moving away from employer-based health care entirely, doesn't make sense.