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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Shape of the Real Deal on Health Care Reform

If you’re interested in the broad outlines of what House and Senate conferees will be grappling with in reconciling their health care reform bills, take a look at Paul Waldman’s American Prospect piece on the top ten conference issues.
What’s most interesting about the less-visible but important issues at stake is that several have big implications for the future shape of health care in this country. One is pretty much settled: the bill if enacted will almost definitely put a final stake in the heart of Medicaid’s vast inequalities between states in eligibility (unless, of course, some sort of general state opt-out is authorized). Another is the collateral attack on the employer-based system of private health insurance via the Senate’s excise tax on high-cost plans, and its small opening to Sen. Ron Wyden’s proposal to let some employees covered by particularly bad employer plans to join the new health insurance exchanges. And still another is the principle, all but gutted in the Senate bill but still maintained by the House, that the health care system, beginning with Medicare, should finally begin separating the sheep from the goats in terms of effective and ineffective treatments.
It’s very likely that media coverage and public controversy over the conference will continue to focus on total public costs, new taxes, subsidy levels, the individual mandate, and the ghost of the public option. But in the long run, other deals may represent the real deal on health care reform.

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