Of course, I thought we already had our big historic health care reform day when the Senate passed their bill on Christmas Eve. So, things happen, you never know. But it looks like we will get a vote today to determine once and for all the fate of health care reform. Keep your eye on C-Span if you don't want to just wake up to the news tomorrow. There will be a handful of votes. The House has to vote on the Senate bill and also on the fixes that will go to the Senate for a reconciliation vote. The final up or down tally won't come until probably 9 or 10 tonight, Eastern time. But we will know where this is going when they vote on the rule for debate, which should happen around 6.
I've tried pretty hard to understand as much as I can about the content of the bill, to help especially with convincing friends. It's tough though - complex language, conflicting reports. Some elements I'm still really unclear about. But a few sobering truths about what we've got are worth remembering, regardless of the details: 1) This reform will change reality for a minority of Americans. If you get insurance through your employer, you probably won't notice much. 2) The bulk of the substance won't go into effect for what's going to seem like a really long time. The exchanges won't be up and running until 2014. 3) One of the most powerful things this bill does will thankfully go unnoticed, helping us avert serious catastrophe, by trying to begin tackling the insane elevation in health care costs which would drive ever more Americans into bankruptcy and threaten the fiscal solvency of the government itself, if left unchecked and on its current path. Once your premium goes up 10%, it may be tough to be thankful that it didn't rise 25% instead, but this legislation may have helped save you that crisis.
Some things will happen fairly quickly after the President signs the bill. One of my favorites says that insurers will be required to allow children to stay on their parents' policies until age 26. That will go into effect 6 months after the legislation is enacted. Also, while pre-existing condition discrimination will not be ended until 2014, it will be immediately ended for coverage of children, and some provision - this is one thing I'm not clear on - will allow anyone denied coverage or kicked off for pre-existing condition in the interim to be able to buy into a pool of coverage. [UDPATE: Here's a list of things that will go into effect immediately. I had read somewhere that the age 26 provision comes 6 months later, but either way, pretty quickly.]
But at the end of the day, the details don't help in debates until we agree on an important starting point: health insurance is not just any "product." And health care is not just one more consumption category. It's an extension of nothing less than our own mortality, a human necessity almost as surely as food and water, if much less predictable in need. And as far as the fair chance to have equal opportunity in life, health care can be every bit as essential as education. Listening to Republicans and especially tea-party protesters, it sounds like they view health insurance as just another perk of life. You would think subsidies were going to help people buy a sports car or a cellphone; or that treatment for injury or illness was about the equivalent of getting your car fixed.
My view is much different. Because health care is different, it's wrong to think of it as a luxury for just some, or a mere contingency everyone should be able to address with just a little planning, saving and personal responsibility. If only it were that inexpensive to face a serious health crisis, or insurance companies were that dependable when one comes along!
In fact, of all the things government should help ensure all Americans can access equally and fairly, health care should be right near the top, alongside education as a guarantee, and something we shouldn't hesitate to fund as well as is required to get it right. This bill doesn't go that far. But if we are going to leave private insurers in place as the only avenue most Americans have to health care, we need mechanisms in place to fix the injustices in the system. And there are plenty. This reform package goes a long way toward - eventually - doing just that.