Reasons Not To Kill The Senate Bill

Over at Firedoglake, Jane Hamsher outlines 10 reasons to kill the Senate health care bill. The comprehensive list relies on the competent work of FDL’s team of health care bloggers and some of the critique is not without merit; other points are overstated. For instance, the claim that “many will be forced to buy poor-quality insurance they can’t afford to use,” is a bit baffling. The newly uninsured would have access to a minimum benefits package that is far more comprehensive than the available options in the individual market. Two-thirds of these “forced” Americans would pay less for more substantive coverage, not more. And the poorest Americans would have their out-of-pocket costs capped.

Hamsher claims that the bill “allows insurance companies to charge people who are older 300% more than others.” This is true, but it’s a massive improvement from the status quo, which allows insurers to charge older people as much a 11 times more for equivalent coverage. The 3:1 ratio may be excessive but it also recognizes that older people use more care than younger people and permits insurers to attract younger applicants with lower rates. Finally, the argument that “the cost of medical care will continue to rise,” also misses the point. National health expenditures will naturally increase, but under the Senate bill, they will raise at a slower rate.

On the whole, Hamsher is right to argue that the Senate bill is a deeply flawed piece of legislation which, as Paul Krugman observes, “we’ll spend years if not decades fixing it.” In fact, “with few exceptions, sweeping initiatives in the U.S. system start small, are often flawed, and then are expanded, sometimes improved, sometimes not.” Medicare began as smaller program that was expanded to cover “hospice benefits, mammograms and pap smears to detect cancer, and most recently, under the Republicans, prescription drugs.”

Fixing something that’s broken is better than not having anything to fix. Buying a fixer-up home is more appealing than remaining homeless for the next 10 to 20 years. In time, you’ll be able afford to change the tile in the bathroom or fix the leaky roof patch, but for the time being you’ll have a place to sleep, eat, and keep warm. A newer house would have caused less problems, but it — like the Senate health care bill — was simply out of reach.


The top 10 list isn’t reason to kill the bill, it’s reason to improve it in the years to come. After all, the choice isn’t between passing this bill or a better bill — it’s between passing this bill or nothing at all. Seen in this context, the Senate health care bill provides an adequate foundation for transforming the system in the years to come.

Here is a graphic representation of the choice lawmakers face: