Sunday, November 15, 2009
Editorial: The health care nitty-gritty
Boucher's dissent raises the kind of questions that can move reform forward, rather than simply mire debate in fear and confusion.
From the RoundTable blog
Read the latest entries
Rep. Rick Boucher voted "no" the night of Nov. 7 when the House passed its health care reform bill, but he staunchly supports health care reform.
Rep. Tom Perriello voted "yes" -- though, like Boucher, he represents a largely rural Virginia district, and he initially shared his colleague's concern that the House bill did not do enough to protect health care delivery in rural areas.
That both Democrats are committed to reform yet came down on different sides on a critical vote is an indication of just how complex the policymaking task is, leaving politics aside.
Boucher explained his vote Monday at a news conference back home in far Southwest. At his side were the heads of the region's two major hospital chains, both nonprofits.
He had several concerns about the House measure, but principle among them, he made clear in a later telephone conversation, is a public option to compete against private health insurance plans. He fears it would put the hospitals in his region out of business.
"Eighty percent of their total income is a combination of Medicare and Medicaid," Boucher said, neither of which fully reimburses hospitals for the cost of patient care. "The way the hospitals break even is with the small number of privately insured patients."
A public option, he said, would attract lots of those patients, pay providers less for their services and force hospitals already operating on razor-thin margins to close.
"The CEOs were very clear. If this legislation becomes law, the survival of these hospitals is very much at risk."
So, for him, the choice was between the House bill or the hospitals -- nonprofits that operate for the benefit of the community and are essential to the people of his part of Appalachia. He voted with the hospitals.
This is the kind of legislative sausage-making critical to a functioning system.
Contrast Boucher's objections, driven by the specific needs and realities of his district, with the blanket objections of partisan opponents. Republicans, well-versed in opposition talking points, have been strewing the path toward health care reform with misdirection and misinformation that has not furthered serious debate but mired it in fear and confusion.
Perriello -- like Boucher, a progressive on most social issues and, like Boucher, an early opponent of the House bill -- switched from "no" to "yes" after it was revised more to his liking, for instance by narrowing the disparity in Medicare and Medicaid reimbursements for urban and rural hospitals, which get much lower payments.
Perriello, too, said he remains dissatisfied with parts of the House bill and expects the Senate to pass a much different version. His gutsy vote with a narrow House majority, though, helped keep up the momentum for reform.
Both Democrats think reconciliation of the two bills will produce health care reform they can support, that Congress will pass and that President Obama will sign.
It will satisfy no one completely. If it delivers near-universal, affordable coverage, though, it will be a big win for the American people.
