My interest in the filibuster, as manifest by my 2010 summer blog project on it, wasn’t idle curiosity. Legislative function, or dysfunction, is directly related to making progress on major problems, including health care costs. I connect the dots in a Kaiser Health News column that appears today. Here’s a choppy summary:
[T]he Senate has reached such a level of dysfunction that it requires 60 votes under normal procedure to pass any significant bill or amendment. … The new health law that promises just a dozen more years of Medicare solvency only passed the Senate because Democrats had those 60 votes last December. They no longer do and likely won’t for the foreseeable future. Under these legislative conditions, can more health cost control legislation pass? …
If not, this leaves a vacuum for private-sector approaches. Employers and individuals are not going to stand for double-digit percentage premium increases for much longer. Gradually, they will begin to demand that something be done. …
The hottest trend in health plan design is the consumer-directed health plan, higher deductible plans sometimes coupled with a health savings account. …
Will [such plans reduce costs] … and, if so, for whom and for how long? To date the evidence is encouraging but not conclusive. …
Equally important, however, is whether these consumer-directed plans (or whatever private-sector innovations that fill the cost control policy void) will enjoy a long-term embrace by Americans. Remember, managed care worked too, until it became intolerably rigid for many people. …
So, when it comes to the thorny problem of health care costs and with the Senate in seemingly endless deliberation, do we, must we, say, “In the private sector we trust?” If you find that unappealing, good luck trying to fix the Senate.
See the rest at KHN.
I left a few things out of the column. One is that though the private sector can and will come up with possible solutions to the health care cost problem that doesn’t make the private sector a replacement for a functioning government. Some problems, even in health care, require some government involvement. A good example, not in health care, is global warming. The private sector can’t solve that on its own. In fact, our government alone can’t either, but it can play a major role. Without it, we’re toast (burnt, boiled, or even deep fried).
Second, if the federal government doesn’t seriously address health care costs, private firms aren’t the only actors that could fill the vacuum. State governments could act. But the problem isn’t necessarily a whole lot easier at the state level. Massachusetts is still struggling with cost control, for instance. Maryland’s all-payer system seems to have kept costs down there. Your results may vary.
Third, I ignored the fact that legislation can pass the Senate without influence of filibuster via the budget reconciliation process. But that process has constraints so not everything can be done that way. In general, the Senate has important work to do that requires a filibuster-busting 60 votes.
Finally, I want to make one thing very clear. My column neither advocates for private-sector solutions, like consumer directed health plans, nor for government-dominated solutions, like single-payer. I may (or, actually, may not) have strong opinions on such things but they are not relevant to the column. My point, my only point, is that if the Senate cannot pass significant legislation to solve a problem like health care costs, the private sector will act. Like it or not, that’s just a fact.
