The House of Representatives, by a vote of 220-215, passed a landmark health care reform bill last night. The tight margin follows a Saturday morning Capitol Hill appearance by President Obama and a major concession by Democrats on abortion rights.
The approved House version includes a public option, individual and business mandates, subsidies for insurance premiums, bans private insurers from discriminating against those with pre-existing conditions, and lowers the federal deficit in the out years by over $100B.
The president and Speaker Pelosi deserve some major props. They've accomplished what no other administration, Republican or Democratic, was able to; a comprehensive reform of the nations health care system. But, along the way, Democrats made some significant concessions that may or may not have been actually required. Ezra Klein had written recently:
For the real liberals, the public option was already a compromise from single-payer. For the slightly less radical folks, the public option that's barred from partnering with Medicare to maximize the government's buying power was a compromise down from a Medicare-like insurance plan. For the folks even less radical than that, the public option that states can reject is a compromise from the public option that would be available to Mississippi's residents and Vermont's residents alike. A liberal person in a conservative state will not be allowed to choose the insurance option they prefer, nor will an apolitical person who simply doesn't trust private insurers.
Speaking of compromises, also adopted yesterday was the Stupak/Pitts amendment. The amendment, passed with a 240-194 margin, prohibits the public option insurance function from paying for abortions (except to save the life of the mother, or in cases of rape or incest) and prohibiting the use of federal subsidy money to purchase private insurance to cover an abortion.
The Stupak Amendment may be the perfect metaphor for this very long health care debate and the amount of compromise. In an effort to woo conservative House members who had argued a public option was nothing more than a government takeover of insurance and would lead to faceless federal bureaucrats making the insured's private health care decisions, Democrats added an amendment that mandates faceless federal bureaucrats make private health care decisions.
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