Saturday, March 06, 2010

Lies, Damn Lies, and Reconciliation in Health Care Reform

Yeah, I know I’ve been quiet for a while. I’m having a different sort of Lent. But, more about that later.

I’ve been stewing over the efforts to accomplish access to health care for all residents of the United States (and, yes, I do mean residents; but that’s me). There has been so much rhetoric, much of it moronic (not only in Umberto Eco’s sense of moronic, but also uninformed) – and some of it simply dishonest.

Of course, since power struggles in the Democratic Party have wasted the initial opportunity to provide this service and security, much of the rhetoric has been about the technique of “reconciliation.” We’ve all heard about this legislative tool. Basically, by setting the budget consequences of a particular law, it allows the law to be included in the budget legislation, even if its intent isn’t really a fiscal change.

Now, those who want to prevent health care and health insurance reform (and don’t you believe this nonsense, “Let’s get health care reform, but let’s start over and do it right.”) have been saying that “reconciliation has never been used for such a non-fiscal purpose,” or “reconciliation has never been used to affect something with as large an impact on the economy as health care.” I wouldn’t find that compelling, of course: since I believe it’s the right thing to do, the thought that we haven’t done it that way before doesn’t convince me that we shouldn’t do it that way now. But I certainly can’t find it compelling when I realize it’s blatantly false, and that the people who spout this are among those who know how false it is.

This is what brought me to this: I realized where I had heard that word, “reconciliation,” in relation to health care. It has come up – it has come up again and again – as part of the title, “Omnibus Reconciliation Act.” When I realized that, I suddenly began to realize just how important reconciliation has been in health care.

It’s never been used for health care? What about the Balanced Budget Act of 1997? It put into place Medicare reductions so severe that in 1998 and 1999 hospitals across the country reduced their budgets and long term plans by literally millions of dollars. And I don’t mean millions of dollars nationwide. I mean $60,000,000 just from my own small regional system, and comparable cuts from every hospital in town – and that’s just in my own middle-sized, Middle America metropolitan area. In my system alone, we lost 4% of our positions; in my own, then very new, very small hospital, 30%. No, reconciliation has certainly been used to affect health care before, and with huge fiscal consequences.

It hasn’t been used for such non-fiscal purposes? What about the Omnibus Budget Reconciliation Act of 1990? It had one of those non-fiscal amendments: the Patient Self-Determination Act. That is the Federal law that establishes the right of patient to make his or her own health care decisions. It is the law underlying Living Wills, Health Care Treatment Directives, and Durable Powers of Attorney for Health Care. It wasn’t introduced for fiscal purposes, but to accomplish a social good in health care. (And it was sponsored, by the way, by Jack Danforth, Republican Senator from Missouri, and an Episcopal priest.)

And then there was that more famous reconciliation act that was, really, one of the most important efforts at health care reform. Many of us (including me) have lost jobs but have been able to keep our insurance for a period of time because of COBRA. Under that law, an employee who leaves a position can continue insurance for up to 18 months (it has recently been extended) if the employee can pay the full cost (both the contribution the employee has been paying, and the employer’s contribution). While it isn’t cheap, it has saved many a family from major medical expenses between positions. And what does COBRA stand for? The Consolidated Omnibus Reconciliation Act of 1985. And few laws have had a more widespread and pervasive effect on the security of employer-based health insurance.

So, when you hear conservatives claiming, “reconciliation hasn’t been used that way before,” you’ll know the truth. They’re not simply uninformed or confused. They’re lying through their teeth, and they know it. The fact is that Mitch McConnell, Senior Senator from Kentucky and Senate Minority Leader, was elected to the Senate in 1984, and would have voted on all three of these acts. Whether he was for or against each law, he was in the Senate when each was passed. So, he of all people should know not only that reconciliation has been used this way, but that it has been used this way fairly often.

We Americans have a tendency to forget even recent history. That can keep us trying to reinvent the wheel, as it were, when it’s not really necessary. It can lead us to try to create a new tool when we already have a usable tool sufficient to the task. Worst, it can make us vulnerable to demagogues who make false assertions, secure in the hope that most folks won’t realize the falsehood. Let’s not make that mistake this time. Reconciliation has been used again and again, and used successfully, to make changes affecting access to health care for Americans in big and important ways. It is absolutely an apt tool to reform health care and health insurance now.

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