Sunday, November 8, 2009

Health Reform-Trade-Off and HR-3962

November 8, 2009 - Last night 219 Democrats and one lone Republican in the House of Representatives passed a “historic” health reform bill, HR 3962 by name. Just how “historic” depends on whether the Senate can pass its own bill, which will require 60 votes, and whether the House and Senate bills can be reconciled. The House bill is a liberal bill written by liberals: the Senate bill will be much more conservative.

President Obama will sign whatever emerges from the sausage-making legislative process. He has to. The credibility of his presidency, perhaps even a second term, rides on a successful outcome.

When word reached me this morning of successful passage of H.R. 3962, the word “trade-offs” sprang to mind. The bill is an amalgam, forged by various “special interests “of both the public and private kind, and lobbyists of every political stripe. It squeaked through by a razor-thin margin of 220-215, and is laughably bipartisan since only one solitary Republican voted for it. There is something in this bill for everyone, both positive and negative, for everyone and for every economic sector of American society.

On the positive side, I would list these things - new-found access to health coverage for 36 million previously insured Americans; coverage for nearly 96% of Americans, allowing us to hold our moral head up high among “civilized” nations; more freedom from fear of medical bankruptcies, giving more of us new economic security; and guaranteed coverage for those with pre-existing illnesses; cessation of cancellation, “rescission, ” of health care policies for those with high-cost illnesses, and a general sense that government is protecting citizens from commercial excesses by health plans, drug firms, and other prioft-making health care enterprises.

As for the negatives, I would mention these factors - no real cost controls, no credible means of paying for the $1.3 trillion ten year cost, a likely increase in the federal debt, now estimated by the Office of Management and Budget at $9 trillion by 2019, a probable doubling of health care premiums for the middle class, federal mandates on individuals, employers, and health plan benefits limiting flexibilities. freedoms, and innovations in our capitalistic system, and various penalties, fines, and taxes that will result in higher taxes and costs for all of us.
In general, HR3962 gets an A on “increased accessibility” and a D on “greater affordability.” For ignoring, downplaying, and discouriagin such fundamental issues at tort reform. shopping for the plan of one’s choice across state lines, Medicare Advantage benefits, and health saving accounts it gets an F.

Where the Washington Merry-Go-Round on health reform goes from here and where it stops no one knows. How one interprets the effect of current legislation depends on where one sits or stands ideologically. Liberals and moderates will welcome HR3962 as a triumph for progressive government. Independents and conservatives will regard it as unwarranted government intrusion.

Which side is right only history will tell. Only one thing is certain – health care and how we perceive it will never be the same again.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.


Unknown said...

Given your interest, you might want to check out the piece on the healthcare debate : Bigger Than Healthcare

Michael Kirsch, M.D. said...

Richard, Another one of your excellent posts. It will be quite interesting to watch the process in the Senate. It will be a struggle for Reid to keep 60 votes together. I don't think that the public option devotees should pop the cork yet.

Richard L. Reece, MD said...

The House is composed of liberals,

The Senate contains more wafflers.

The Senate requires 60 to pull the cork,

Lieberman and Snore have the torque.

The two think the public option has consequences terriblers