Here’s a video (hat tip: Firedoglake.com) of House Speaker Nancy Pelosi (D-CA) announcing the Affordable Health Care for America Act. Click here to read a copy of the 1990-page bill. We’re still waiting for the CBO analysis, but Pelosi says the bill will extend coverage to 36 million more Americans at a cost of under $900 billion over 10 years; about 4% of Americans would remain uninsured. The bill would extend Medicaid eligibility to 150% of the federal poverty level, add a public option-lite (i.e., provider rates would be negotiated rather than set at Medicare levels or slightly higher), provide subsidies to people up to 400% of FPL, and close the Medicare drug donut hole.
All of which is more or less what we’d expected. Still, I have to admit it was pretty exciting to watch the announcement, even despite the bill’s shortcomings. As Pelosi noted, it really is an “historic moment.”
But what I want to talk about for a minute is that last detail — closing the Medicare Part D donut hole. In an opinion piece back in 2006, I’d pointed out that the convoluted benefit design resulting in the donut hole was an absurdity that wouldn’t last. (I also predicted the government would eventually start to use its bargaining power to negotiate drug prices, another big failing of Part D that we haven’t yet addressed; although I still think we will — secret back door agreements or not; Addition: Nov. 10, Sorry, failed to note the House bill gets at this as well).
What’s my point? There is, as Paul Krugman has noted, an irreversibility to healthcare reform. “The really important thing, for reformers, is to get the principle of universality established. Once that happens, there’s no going back,” he wrote.
I have put it a different way in this blog. The U.S. is making incremental progress toward a highly regulated public-private health insurance market or single-payer healthcare. The only question is how soon before we get there. The merged bill from Senate Majority Leader Harry Reid (D-NV) goes further than the Baucus bill, and the House bill goes further than both. But they all get us a little closer to where I think we’re eventually heading, and there’s no going back.
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