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Stewart Shaw: Sausage-making in action

Stewart Shaw: Sausage-making in action

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Stewart Shaw
Community columnist Stewart Shaw

If nothing else about the health care reform legislation pending before Congress is clear, the complexity and messiness of the legislative process is.

Special interests have spent hundreds of millions of dollars influencing legislators. They have promised to help finance future election campaigns of incumbent senators who do their bidding. They are represented by hundreds of lobbyists. The willingness of individual senators to hold out for attachment of provisions of questionable relevance and special favors for the states they represent before offering the votes that are needed to break a filibuster threatened by all of the senators of the minority party indicate the extent to which they would be willing to sacrifice the common good.

It has been said before: The making of laws in a representative democracy is not pretty. It's like making sausage. The more you know about what goes into it and how it's done, the less you like it.

As a passionate advocate of health care reform, I face the dilemma of deciding whether to support what has become a very flawed proposal or join the disappointed progressives who are calling for halting the present effort and starting over.

How many concessions to the greedy self-interests of the power brokers can be made before the bill is no longer worthy of my support? How far am I willing to accept abandonment of the common good?

When the health care reform debate was joined, progressives had two general goals: Improve access to health care for all Americans, especially those of us who are uninsured, and slow down inflation of costs. The legislation currently before Congress moves us in the direction of both goals, but not nearly as far as it could have and should have.

Most significantly it will eventually lead to the coverage of another 31 million Americans. It requires insurance companies to insure you even if you have a "pre-existing" condition. It prohibits them from canceling your coverage if you get sick. If you are considered a "high risk" for making large claims in the future, it prevents them from charging you rates so exorbitant that you will not purchase insurance. If you change jobs, it guarantees continuing coverage. If you are self-employed or otherwise not qualified to be covered by "group" insurance, it guarantees you access to affordable coverage. And if you cannot afford to purchase health insurance, it subsidizes your participation.

It requires private insurance companies to spend at least

85 percent of their premium revenues on health care. It eliminates some wasteful Medicare spending. It reduces government spending on health care by requiring those of us who don't think we need health insurance to help fund the costs of those who need care. And to the extent that care becomes affordable, it reduces the incentive to delay treatment until more expensive treatment is necessary.

Some people will claim that they like the insurance that they presently have, see no need for changing the system and are afraid that reform will destroy their present benefits. They do not see the possibility that future changes in their health might render them uninsurable. They consider their present premiums, deductibles and co-insurances reasonable, given the accelerating charges of health care providers.

These are people I consider "morally challenged." They are thinking only of themselves and of their present circumstances. They are not allowing compassion for those who are sick or have pre-existing conditions to influence their thinking. Their thinking does not incorporate the most basic and widely known moral rule: "Do unto others as you would have them do unto you." And they are not thinking about how their circumstances might change.

I've included all of the achievements of the proposed legislation listed above in my "plus column." But the entries in the minus column are also numerous. The Senate proposal would leave

15 million people uninsured. It perpetuates a system in which health care is falsely regarded as a commodity that consumers can purchase when they consider it a "good deal" but leave on the shelf or in the lot when the price is too high. It continues to compensate health care providers for "procedures" performed and diagnostic tests administered, regardless of whether they have been proven to be effective in improving health or lengthening the life of patients, instead of compensating providers for positive outcomes achieved by their care. It does not sufficiently restrict malpractice litigation so the incentive to practice "defensive medicine" is diminished.

Where is the balance between the positives and the negatives?

The benefits of the Senate proposal still outweigh its deficits, while acknowledging that the balance is getting closer to even. As President Barack Obama frequently says, we should not allow the perfect to be the enemy of the good. Although far from perfect, the pending Senate legislation is still good, a step forward, supportive of the common good and our country. And I hope that some good features of the better House of Representatives-approved legislation are included in the conference committee's report and ultimately approved by the Senate as well as the House.


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