In watching the President talk about healthcare on Meet the Press yesterday, I had an observation that puzzled me. Why is it that Congress always feels the need to pass cobbled-together bills for major change? My observation was about healthcare, but it seems to be true with many issues. Yesterday, President Obama talked about many parts of the Baucus healthcare bill, which he seems to support. One of the first parts that he talked about was allowing small business owners and individuals to create their own pools to bargain with insurance agencies. This has been promoted by right-wing think tanks for years, and if presented in a stand-alone bill tomorrow, would probably pass with bipartisan support. And it would probably dramatically lower costs for many small business owners and individuals. If it's tied to mandates or a public option, it probably wouldn't pass. And there's no reason why it wouldn't help by itself. Why not make the reforms that can be passed now, then work on the more contentious issues? Is it purely political, with Democrats wanting to draw up a bill that Republicans would vote against to paint them as "voting against healthcare"? (That wouldn't be an indictment of Democrats, it'd be an indictment of partisans, Republicans would do it if they were in charge.) Is it because many of the provisions that Congressional leadership really wants is unpopular, and they have to tie to something more meaningful to get it passed? Or does Congress just not want to "piecemeal" anything? To me, I'd think piecemealing smaller popular change would not only be more popular than trying to push through a cobbled-together compromise, if it worked, it would give Congress some additional credibility to do more in the future.
I think there are a few reasons here: 1. Some of the things are woven under the surface together. For example, most people seem to be OK with getting rid of pre-existing conditions. But you can't do that without a mandate for coverage. And you can't mandate coverage without giving support for the poor, etc. 2. Passing bills is harder in general with piecemeal legislation - you see this in the earmark garbage that goes on. None of those earmarks would go through as individual bills - but by adding them all together, everyone votes for them. Not saying this is a good reason, but it happens. 3. If you pass some smaller reform legislation, there's a decent chance that people will lose the nerve to pass the bigger, more important, and more controversial stuff. 4. There's some possibility that putting together a bunch of individual reforms is inefficient. This goes back to #1, but if there might be popular solutions that don't work as well with other bigger reforms, and then if you get the popular ones, you might make the bigger stuff more difficult.
glynch, I agree that much of our current problem owes itself to a piecemeal approach to healthcare, but generally, it has been a problem of additional mandates and regulation adding to cost and limiting choice. Just this year, Congress mandated mental health drugs be covered by insurance. Now that may have merit, but it adds cost, and with the additive effect of all of these mandates that are added every year, can add significant cost. For the first time, we are looking at reforms that can increase competition and reduce cost. I don't think that collective bargaining for healthcare costs will make a huge difference for anyone that works for a corporation or gets healthcare from the government, so the overall savings wouldn't be enormous. But for the millions that are in small pools or buy individual plans, it would make a huge difference. Although I certainly disagree with the Baucus bill, my purpose for asking the question is not to wonder how to defeat parts of it. Right now, with the schism between moderate and Progressive Democrats, I don't think a comprehensive healthcare bill can pass. But tied up in the comprehensive bills are popular, bipartisan reforms that could make a significant difference for many people. It would be a shame to let those die because Congress demanded something comprehensive.
first of all I have to admit that I wondered why they couldn't just try to pass individual legislation instead of having this enormous with or against type of legislation. secondly, I think the coops is a great start. no one is truly worried about people who get their healtcare through corps, its still relatively cheap. at least you're covered, you're trying to get people covered. the coops i think can go a long way in helping people in the cracks from small business owners to people temporarily out of work. that and the exchanges.
I agree - there are lots of things like the insurance exchanges and buying across state lines and streamlining information that are fairly non-controversial. It will really suck if those things die in the process. Hopefully, if the big bill does die (I don't think it will), they will come back and at least pass all the small stuff. Right now, my guess is that the small, non-controversial stuff helps keep the whole package a little bit more popular.
