Forgive the obscenity. You’ll recognize that I’m quoting the Vice President. Yesterday (March 23, 2010),  at the White House signing ceremony for the healthcare legislation (officially H.R.3590: Patient Protection and Affordable Care Act).  Vice President Biden, introducing President Obama shook the President’s hand and observed, “This is a big f***ing deal.” Robert Gibbs, White House Press Secretary tweeted, “And yes Mr. Vice President, you’re right…”  

News media have jumped on the comment, and made quite a to-do about it. I’d almost say he said it on purpose, to divert attention from what really matters. Because what really matters is the content and constitutionality of the legislation — not the inadvertent exposure of yet another politician’s potty mouth. Several things have to my mind as I’ve been mulling over H.R. 3590. 

1. Are the healthcare provisions good or bad?
2. How do I feel about special deals in the legislation?
3. What about the “extra” provisions in the bill?
4. Do I really know if this bill is a “big deal” or not?
5. Was the way this legislation passed “proper” (whatever that means)?

I don’t honestly know if the overall healthcare content of the legislation is good or bad. A summary of the provisions runs into 66 pages (see http://dpc.senate.gov/healthreformbill/healthbill53.pdf) and some of the language is, to say the least, unclear! 

• My quick impression is that is DOES extend coverage to many who could not othewise obtain it — which is a good thing.
• On the other hand, it adds an extra burden of costs to employers and middle class families (especially by enforcing a requirement to maintain “minimal healthcare coverage) — not so good.
• It increases entitlement for some who could fend for themselves (“Children” up to age 26!) — not so good.
• It provides support for wellness programs — obesity management and tobacco cessation. Seems like a good thing.
• On Abortion, it permits states to prohibit abortion coverage in qualified health plans offered through an exchange in the state. It prohibits federal funds from being used for abortion services and requires separate accounts for payments for such services. I’m not sure about the overall impact — many of those who have essentially the same views on faith and government as I do assure me that the bill adds funding for abortion, through indirect application of its provisions. The fact that the President felt it necessary to issue an Executive Order setting out “Following the recent enactment of the Patient Protection and Affordable Care Act (the “Act”), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment.” seems to suggest that they are correct. Executive orders, of course, persist as long as the then President wishes — and no longer. This appears to leave a substantial threat that federal funding for abortions will one day be freely available. At the very least, the lack of clarity is a bad thing … 
• It adds substantial administrative and data processing burdens. I know about the implications of the data processing provisions and I’m willing to stake my small reputation that the costs will be much greater than anticipated
• … and so on.

I’m bothered by special deals for American Indians, Alaska, Louisiana, and the “frontier” states of  Montana, Wyoming, North Dakota, South Dakota and Utah.  

The healthcare aspects of the legislation are one thing … but there’s something else that really bugs me: The other items that have been included, portmanteau style, in this massive legislation. The “Health Care and Education Reconciliation Act” contains provisions which provide 2 billion dollars to allow community colleges to develop and improve educational or career training programs and adds about 40 billion dollars in support of student loan programs. I’m not (necessarily) against such provisions, but I don’t see why they belong in healthcare legislation! I’m sure that most people, if asked, have no idea these provisions are included when they express themselves as being for or against “Healthcare”.  

As I tried to decide if the Patient Protection and Affordable Care Act was a big deal or not, I had three questions in mind: 

1. Will the proportion of my wealth and income that I have to spend on healthcare increase?
2. Will the proportion of my tax dollar spent on healthcare increase (affecting the other services I receive)?
3. Will the quality of mine (and Myra’s) healthcare improve?

I can’t prove it, but I fear the answers are “yes, yes, and no” – but I’m sure the legislation doesn’t fix the fundamental issues of healthcare. The fundamental issues are about the incentives for healthcare professionals to provide the best possible service as affordable as possible, and for consumers to be best able to stay healthy. That involves more focus on helping people stay healthy, better control of “real” costs (payroll, drugs, equipment, etc.) and better control of administrative costs. What I have seen in this new legislation has only minimal impact on these issues, at best … which makes it not such a big deal. 

This brings me to the last issue that has been occupying my mind as I consider  H.R. 3590. Is the way this legislation passed proper? It has been argued that there is, at best, no clear public majority in favor of the legislation. Does that mean that that Congress and the President have acted improperly in passing it? 

These United States are, by the grace of God, a unique federal constitutional republic. Senators and members of the House of Representatives are elected to speak for their constituents in the legislature. This is more complicated than it sounds, since “speaking” cannot mean “giving the opinion of every constituent”, and does not even, necessarily, mean “giving the opinion of the majority of constituents on every issue”. I believe (somewhat naively) that it should mean, “expressing what is, in the best understanding of the representative, the best interests of all constituents”.  In practice, of course, it means something more like, “doing what is most likely to advance a political career”. Interestingly, the constitution is silent on how representation is to work. It follows that any discussion as to whether representatives “should” express themselves becomes a matter of opinion … Mine is that making law on such a fundamental issue as healthcare needs to be an open process, and that passing it should not depend on fancy mechanisms to garner the necessary representative votes. The process used to pass H.R. 3590 fails … and to me, that is a big deal. 

In the end, the passing of the Patient Protection and Affordable Care Act is a big deal for President Obama and Vice President Biden, because had their administration failed to pass its first major legislation its effectiveness would, immediately, have been mortally undermined. For the rest of us, it’s a wasted opportunity foisted upon us by partisan political sleight of hand. Shame. 

One last thing … isn’t it sad, and typical, that the media chose to jump on the Vice President’s foul mouthed comment and made so much of it. What a waste of time that could, and should, have been spent discussing the real issues. News as entertainment is a sickness all of its own …