The House of Representatives has passed a measure to reform the US healthcare and insurance industries. The strictly partisan vote was 219-212.
Although I am generally pleased with the measure, I have a few concerns.
First, even though the Congressional Budget Office predicts that the measure will save money during the next ten years, the CBO cannot project too far into the future. Thus, the ultimate costs are not known. Congress must combine this with cost-saving features. Repealing some aspects of the Bush tax cuts and winding down the two wars will help some, but other cuts probably must take place.
Second, the abortion executive order is quite disturbing. It is one thing to deny coverage of abortion services for persons in public health plans. It is a completely different proposition to mandate that everyone have health insurance or face legal sanctions, provide subsidies for poor people (which is the equitable thing to do), but then restrict the availability of abortion services for poor women who buy the mandated coverage. Although I doubt that the Supreme Court would find this unconstitutional, it is a highly disturbing aspect of the reform package.
Third, I am upset with the lack of a public plan. The public plan would have provided the strongest path for health insurance cost containment. The Republicans favored simply handing people money (tax credits) to purchase insurance, which would have probably driven up costs. The Democrats promised not to do this, but this essentially what they have done with their version of a market solution.
Finally, the so-called healthcare debates have been awful. The White House was mercurial and evasive on the subject at times, which lengthened the process and led to uncertainty among supporters. The rightwing distorted reality and fomented loud, angry and often wrongheaded opposition. It has been quite unpleasant.
Nevertheless, this is historic legislation. Having anxiety about the process and the future does not mean that this is the wrong decision. Many great moments are filled with uncertainty. I believe that this is one of those moments.