The Big Fights and the Big Benefits in the Bill

03/18/2010 05:12 am ET | Updated May 25, 2011

I thought it might be useful to summarize the big battles ahead, as well as the list of things that are good policy changes that seem likely to be in the final legislation. The battles still ahead include:

1. The shape of the public option. The House public option, while not everything we had hoped for, is still pretty solid. It is national in scope so that it can compete with the big insurers, will cover more people over time, and can be a platform to build on and expand in the future. The Senate version is worse because of the state opt-out, but still has some strong features. Most of the other alternatives -- Snowe's trigger, Conrad's co-ops, Carper's opt-in -- are extremely weak and completely unacceptable.

2. Affordability. The House bill is far better than what is rumored will be in the merged Senate bill on middle-class affordability. This is an absolutely critical issue for middle-class families mandated to buy insurance.

3. Who pays, middle-class workers or millionaires? The House bill pays for much of health care reform with a surtax on wealthy Americans, while Senate Finance taxes middle-class workers who have better than average health benefits. The Senate Finance version is a terrible way to go.

4. Do businesses have any responsibility? The House bill makes most business (exempting the smallest businesses) pay a fair share for covering their employees, while the Senate Finance bill exempts businesses from responsibility. Everyone needs to take responsibility for health care.

5. Are immigrants totally screwed over? There is still a fight over how immigrants, both legal and undocumented, will be treated in the final health care bill, with various amendments constructing terrible ways to treat them -- such as immigrants being mandated to have insurance but not being allowed into the new health insurance pools. The Senate Finance language in this area is much worse than the House language. Any good bill has to treat immigrants fairly.

6. Abortion. The Stupak amendment is designed to decimate abortion coverage in the country. It is completely unacceptable and has to be taken out of the bill in conference committee.

7. The individual mandate. This is one place where I think the Senate Finance committee actually got it better than the House, with much lighter penalties if you don't get insurance. There are downsides to that, but given the cheapness of the subsidies for the middle class, and the weakening of the public option in even the House bill, I think having too harsh penalties on the individual mandate would be wrong.

Some pretty big stuff, huh? Lots of intense work to do. The good news is that under all the hullabaloo of the public option fight and the horrendous Stupak amendment, there is actually a lot of good things that are pretty well-settled assuming a bill gets passed. These items don't have the drama of some of the other fights, but none of them are insignificant policy changes, all will improve a lot of people's lives. Included in this list are:

1. The ability of insurers to destroy people's lives over pre-existing condition clauses, recissions, and lifetime caps on their coverage will end.

2. Everyone will finally be covered, with subsidies for low and middle income people. That is a very big deal, something that a lot of us have been fighting for our entire lives.

3. The "doughnut hole" screwing over senior citizens on their prescription coverage will be fixed.

4. Community rating is incredibly important, means older and sicker people, and women, won't face the same kinds of discrimination.

5. Creating the insurance exchange will provide lower prices and more choices for many people.

6. It does provide immediate help for the un-insured, even before the public option and insurance exchanges are in place.

7. It extends coverage for young people wanting to stay under their parents' coverage up to 27 years old.

8. Strengthens Medicare in several modest but important ways- no co-pays for prevention services, more help for low-income seniors, stops Medicare Advantage from screwing seniors.

9. Provides more disclosure of insurance rate increases.

10. Allows people to keep their COBRA until the exchange is in place.

11. Creates a new long term care insurance program.

12. Makes it easier for early retirees (55-64 years old) to get health care coverage.

13. Doubles the number of patients Community Health Services can treat.

14. More money for education/training of primary care providers.

I do think these kinds of modest less visible things really do matter in people's lives, and we should be proud if we can get them done. The big fights left, though, are incredibly important to whether this is a good bill overall.