Health Care

Shutdowns and Filibusters

~ R. Stanton Scott ~ Leave a comment

I see a lot of social media posts from the right blaming the Democrats for the shutdown, including a comment on a LinkedIn post claiming that Democrats forced a shutdown because they wanted to cut federal funding for rural hospitals and redirect it toward health care for non-citizens.

If this LinkedIn account is genuine, you must respect this guy’s background. But if he really believes this is true, he pays little attention to how government works and even less to politics. This is easily the most egregious disinformation, if not outright lie, I’ve seen on LinkedIn – and that’s a high bar.

Yes, Republicans want you to blame Democrats for their failure to pass a continuing resolution (CR) funding the government and the resulting shutdown. They also want you to think Democrats did this because the CR does not include money to provide health care for illegal immigrants.

This is not what happened. Democrats refused to pass a cloture resolution (more on that later) that would allow a vote on the CR because the “Big Beautiful Bill” cuts funding for Affordable Care Act (ACA) subsidies and Medicaid. Democrats want this funding restored so that working Americans who get health care through the ACA won’t see their health care costs rise to unsustainable levels, and so that poor Americans, mostly Seniors in nursing homes and children in poor families or with disabilities, would not lose coverage. Cuts to Medicaid have already caused rural hospitals and clinics to close, but Democrats want to stop this, not use it to pay for immigrant health care.

Should Republicans agree to restore this funding, Democrats would vote for cloture, end the filibuster, and allow passage of the CR in the Senate (Republicans in the House have already passed it). A filibuster is a somewhat complicated Senate rule that allows 41 Senators to block legislation, including budget votes, simply by filing that intent. Once upon a time Senators had to hold the floor to continue a filibuster, but they got lazy and made it easy on themselves by changing the rules. Today, simply announcing the intent does the trick.

The key thing to know about the filibuster, besides the 60-vote requirement, is that the Constitution does not require it, nor does Federal law. This is a simple Senate rule, which 51 Senators could change at any time. It was originally designed to require different factions to compromise and write legislation that 60 Senators could support, rather than a simple majority. It had that effect, when segregationists used it to block voting and equal rights laws they saw as extremist, and it has that effect today when budget hawks want to cut social infrastructure spending.

In any event, this means that if Republicans, who hold a 51-49 majority in the Senate, wished to end the shutdown they could make this happen simply by changing the rules so that budget or continuing resolution votes cannot be blocked in this way. They have already done this to make it easier for them to approve Cabinet and Court nominations over the objections of Democrats, so ending the filibuster for budget votes would not set a new precedent.

Why they don’t is a good question. Could be that conservatives just hate government so much that closing it looks to them like good policy (except for ICE and the military, I guess). Perhaps they want to use the shutdown to achieve other goals, such as making workforce cuts DOGE didn’t get to, before they end it. Some have speculated that if they brought Congress back to Washington to vote on the shutdown they would have to seat Adelita Grijalva (D-AZ) who just won a special election in Arizona. Seating her would create a majority in support of releasing the Epstein Files.

In any event, Democrats have indeed refused to vote for the Republican budget in its current form. They did this because they want health care funding restored. But this does not mean they are to blame for the shutdown. Republicans could end it whenever they want, and it’s time they – and their supporters – own that.

James Bacon Hasn’t Heard About Medicare for All

~ R. Stanton Scott ~ Leave a comment

James Bacon writes at The Bull Elephant that he doesn’t think Virginians should have health care if that means taxing the wealthy and regulating providers.

“The healthcare system is so immensely complicated, with so many moving parts, so many feedback loops, and so many hairy ethical questions of life, death, and well being, that it is exceedingly difficult for politicians or the public to understand.”

These “hairy questions of life, death, and well being” are what makes allocating health care as a commodity through market forces so immoral – and impossible, Mr. Bacon.

Also, too:

“Here’s the problem with subsidies: They’re never enough. Never ever. The political class always wants more. There’s always someone who falls between the cracks. There’s always some unmet need. There’s always a new, higher standard of care to be insisted upon. Unlike taxpayer’s pocketbooks, the demands are endless.”

Too long, don’t read James Bacon: We cannot improve health care access through regulation because it’s just too complicated, and subsidies are never enough. No program will ever meet every need, so we should do nothing at all. And by the way, some taxpayer’s pocketbooks are, in many practical ways, more or less endless.

Bacon thinks “price transparency, competition, and innovation with the goal of enhancing productivity and improving outcomes” (that is, markets), will solve the problem. And I guess that if you’re a conservative who thinks access to life-saving treatment should depend on ability to pay instead of a shared moral obligation to our fellow man (as expressed, for example, in the “red letter” Bible verses) you might be right. Only, of course, if you’re OK with the “some people will die because they cannot afford to buy insulin” part.

At the end of the day, no amount of price transparency, competition, innovation, or enhanced productivity will change this one fundamental fact: every consumer’s demand for health care will eventually become so inelastic that none of these things will matter in any way. Everyone will pay any price demanded because it keeps them alive.

Bacon thinks this is the fix because his only tool is a market, so he believes every problem is a price transparency and competition failure. In fact, we have a better chance to make our health care system more efficient by honoring our commitment to each other, accepting health care access as the human right it is, and working together to ration according to need rather than resources. In the end we all benefit because in the end we’ll all have the same need: life-saving medical care we won’t be able to pay for without help.

He has apparently not heard of Medicare for All – the best expression of this shared commitment to the common good we have today. I’ve read this legislation from cover to cover. Everyone pays in, and they do so the minute they start working. And everyone takes out, and the do so the minute they get sick. This system also costs less – and the people who oppose it do so because they generally have something to lose because it does.

Medicaid expansion has improved the lives of almost half a million Virginians, but that alone cannot save everyone. McAuliffe’s reinsurance plan won’t, and neither will Medicare for All.

The one idea Bacon doesn’t mention can get us closer. It’s time.

Federal Judge Rules ACA Unconstitutional

~ R. Stanton Scott ~ Leave a comment

A Federal District Court judge for the Northern District of Texasruled the Affordable Care Act(ACA) unconstitutional on Friday night.  Judge Reed O’Connor, a George W. Bushappointee, wrote that “[the] Individual Mandate can no longer be fairly read as an exercise of Congress’s Tax Power and is still impermissible under the Interstate Commerce Clause—meaning the Individual Mandate is unconstitutional.”   

Because the Supreme Court in 2010 allowed the individual coverage mandate to stand as a tax, and Congress reduced the tax to zero in 2017, Reed argues, the entire law violates the Constitution since Congress has no power to require coverage except as a tax.  Democrats will of course appeal this decision and may have the stronger argument.  The ruling ignores the fact that Congress simply changed the tax rate – the tax itself remains in place.  Until outright repeal, the law still rests on exercise on the power to tax even as Congress exercises its discretion by applying a zero rate.  It’s also not clear that the entire law fails without the mandate.  The US Supreme Court will of course adjudicate this question – and when it does all eyes will turn to Gorsuchand Kavanaugh.

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