The strategy I outlined in my last post may not work out. There may be no HCR bill resulting from it. In that case, progressives ought to introduce a back-up plan offered just yesterday by Scarecrow at Firedog Lake, based in part on an analysis of Dean Baker’s.
Scarecrow’s proposal has the following steps. First, use reconciliation in the Senate to get by the filibuster and to expand eligibility for Medicare/Medicaid, which would be paid for by increasing progressive taxes and ending Medicare Advantage subsidies. Second, move as many of the uninsured as politically feasible into these programs. Third, fully fund Medicaid and give Medicaid recipients the same basic coverage as Medicare recipients. Fourth, fill in the gaps and doughnut holes in Medicare. Fifth, “reform Medicare provider payment practices, including adequate funding for rural areas, better allocations to primary care etc, and reforms of provider payment incentives using a stronger MedPAC.” Scarecrow points out that all of these can be part of reconciliation which requires only 50 votes, plus Joe Biden’s for passage.
After the reconciliation bill is passed, Scarecrow proposes that progressives could then introduce a separate bill, which would require 60 votes to shut off a filibuster, to end the private insurance industry’s most unconscionable and unfair practices. My version of this bill would include five provisions. Make it illegal for insurance companies to: 1) deny coverage based on pre-existing conditions, 2) charge people with pre-existing conditions more than others are charged, 3) rescind anyone’s policy because they failed to report a pre-existing condition, or because they got sick while insured, 4) raise anyone’s premiums because they’ve gotten sick while insured: and 5) price individual insurance rates at greater than 20% above an insurance company’s rates per person to its best group customers.
If progressives passed a bill like this one and made it effective immediately, it would stop a lot of the bleeding going on due to the private insurance system; and next year (in an election year) progressives could come back and push for Medicare for All, which would either pass, or alternatively it would be possible to negotiate a Jacob Hacker type of PO system in return for mandating health insurance coverage.
This sequence of doing things would be harder for “Blue Dogs” to oppose than the current one. That is, how could any Democrat object to the above 5 requirements without explicitly aligning themselves with the insurance companies and jeopardizing their re-election? They couldn’t excuse their behavior by hiding behind their concern for fiscal responsibility, or their concern for not having “socialized medicine.” They’d have to admit that they just don’t want to require the insurance companies to play fair, and that they are favor of letting insurance companies continue their systematic extraction of excessive profits from their customers.
Further, if such a bill passed, it would immediately impose heavy costs on the insurance companies and begin to wipe out their profits; putting them in a much more favorable frame of mind for negotiating either a worthwhile public plan in 2010, or even Medicare for All.