The Sciences


Cosmic VarianceBy Sean CarrollMar 22, 2010 2:03 PM


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Good news and bad news last night, as the House passed health care reform. The good news is: the House passed health care reform. The work isn't completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn't it; last night they passed the Senate's version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life's goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?) So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only "majority vote," a quaint notion in this highly baroque age. It's not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:

  • Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.

  • Guarantee insurance for people with pre-existing conditions, and eliminate "rescissions" that take away insurance from people who get sick.

  • Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.

  • Close the "donut hole" in the existing Medicare payout structure.

  • Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.

Overall, it's a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago. Still, a tremendous political accomplishment -- maybe not from the perspective of what we were hoping for when Democrats took control of both houses of Congress and the Presidency in 2008, but certainly from the perspective of the last couple of months, when it often seemed like we weren't going to get anything at all. More than anyone, credit for the accomplishment goes to Nancy Pelosi, who didn't give up when things looked grim. From now on she won't simply be known as the first female Speaker of the House, but one of the most effective leaders in its history. Here she is marching to the Capitol yesterday, arms linked with civil-rights pioneer Representative John Lewis from Georgia, carrying the gavel that was used when Medicare was passed in 1965. An historic moment. Which brings us to the bad news. One of the reasons why Pelosi was marching with Lewis was to demonstrate support a day after this man who had marched at Selma was repeatedly called "nigger" by protesters outside the Capitol. Ugly by itself, but worse in context: it's becoming harder and harder to have a meaningful debate in this country without participating in a race to the rhetorical bottom. There exist reasonable arguments against health-care reform; not arguments I agree with, but ones that at least make superficial sense. It costs money to provide insurance for the uninsured, and someone will have to pay. Asking healthy people to buy insurance will be a burden to them. There will be less extra money floating around if we cut down on unnecessary costs, which might impede the pace of medical innovation. (I didn't say they were great arguments, just that they made superficial sense.) But these aren't the arguments that are actually made most frequently. Instead we hear that the Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won't stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny. Right-wing bloggers nod with approval at the idea that people are stocking up on guns, preparing for fighting in the streets. The race to find the most scary and overheated characterization of a pretty benign state of affairs is a fierce one. The most depressing aspect of the situation is not the existence of crazy fringe elements -- those will always be with us, on both sides of any issue -- but of the reinforcing dynamic between the fringe and the supposedly respectable parts of the Republican party. It's been clear for a while to most people (outside the White House, anyway) that Republicans in Congress made a clear choice that their own self-interests are served by preventing Democrats from passing any meaningful legislation, whatever that might mean for the good of the country. Speeches during House "debate" last night consistently played to the worst aspects of the protesting mob. One Congressman shouted "baby killer!" at Democrat Bart Stupak, who is staunchly anti-abortion, as he spoke to support the bill. [Update: it was Randy Neugebauer (R-Tex.).] Two protesters inside the House chamber were arrested for being disruptive -- and "several Republican lawmakers stood up and cheered during the interruption." Lest you think this is simply concern-trolling from a liberal telling conservatives to be less intrusive, note that conservative commentators like David Frum are making the same point: the rhetoric has gotten out of hand, and it's not good for anybody, except maybe the "conservative entertainment industry."

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

I'm not sure what the end game is -- whether it's possible to step back to a more reasonable dialogue. Disagreement is good, and it's important to have an active and engaged opposition party, no matter who the majority party might be. But whipping up hysteria at the cost of working together constructively isn't in anyone's interests. Obama campaigned on a message of hope and change and bipartisan togetherness, and I think that was a sincere message on his part; but it certainly hasn't come to pass, and there doesn't seem to be any indication that it will.

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