Health Care Reform - the morning after

[nathan28]

The infrastructure has to be paid for somehow, this is, among other things, a first step in reducing the portion of paid money being wasted on overhead. If you're absolutely adamant that you don't want to pay for health insurance or receive the subsidy to do so, there are ways to opt-out, I think the "fine" (which is the only form the mandatory-ness takes I think) is only $345 a year added to your taxes. I believe there is religious exemptions to avoid even paying that fine.

The infrastructure is paid for, though, every day. It's called Medicaid. I don't see where the "overhead" disappears, though, or how this necessarily does anything about it.

medicaid patients don't bring in remotely enough on their own to keep all the hospitals and clinics open and equipped.

the overhead I'm talking about reducing is the difference between an insurance companies in-takes and it's health-care payouts, medicare is like 95% efficient in this sense, private companies are now going to have to reveal their list of "expenses" publicly. If I were shopping around, I'd be sure to find one with the lowest overhead. So much of the 'what-they-pay-for' details are going toward standardization, and they'll be carrying a lot more expensive customers they can deny care to or cancel, the primary point for insurers to compete on now will be overhead efficiency. It could really work out well. Now if they ignore that and fail to get more efficient, they'll find a public option will surely be introduced.

Nah, fuck it. I don't like this "compromise" bill--more like "regulatory bill" than anything else, which leads me to think it's going to turn into the SOX of the ins. co. world (and I don't think private or non-profit ins. are going to lose money over expensive customers so much as shift cost-burdens)--but I want to take the opportunity to laugh at the Sarah Palins, Bettie McCaughneys and Glenn Becks of the world, who should be crying somewhere right now, probably at my "representatives'" offices.*** "Hey dude, thanks for voting against ins. reform, I was gonna write you to tell you to vote for single-payer , but here's a picture of my cat's asshole instead. See you in 2010, when I vote for your opponent!" "It's raining because our founders are weeping"--why, did some Indians steal Thomas Jefferson's wig powder, or something?

***Why are there "two hundred republican amendments" in a bill that they didn't vote for? Why are the Democrats such chumps?

[Simulist]

It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other."

I don't either, SanDiegoBuffGuy.

The kind of language JustDrew used there is the kind of guilt-laden rhetoric used by both political parties whenever they want to cram something the people don't want down their collective throats.

Complying with someone's demand to buy a defective product is neither "the right thing to do" nor is it "part of fulfilling our obligations to each other."

It's bullshit — that's what it is.

let me ask you this:
would you shove peace and justice down their throats?
would you shove repeal of the patriot act down their throats?

Comparing "peace and justice" and the "repeal of the Patriot Act" to this unjust boondoggle — which benefits rich corporations disproportionately at the expense of real people — is a piss poor comparison.

This isn't the "first step" to anything — it's just another step along the road to indentured servitude at the hands of corporations and the rich men who run them.

And that's exactly where the "two party" dialectic lie has been leading us all along! — supported, of course, by fervent partisans on both "sides" of the political duopoly who don't know their asses from holes in the ground.

[§ê¢rꆧ]

C'mon, this is RI. Let's not believe the hype. This is just as crappy as you fear it to be... and probably worse. From afterdowningstreet...(links and footnotes in original)

I'm trying to be upbeat, and will make the best of it no matter what. I mean, what choice do I have, right?

§§§

Fact Sheet: The Truth About the Health Care Bill

By Jane Hamsher, FireDogLake

...

Myth 1: This is a universal health care bill.

Fact: The bill is neither universal health care nor universal health insurance. According to the Congressional Budget Office:

* Total uninsured in 2019 with no bill: 54 million

* Total uninsured in 2019 with Senate bill: 24 million

Myth 2: Insurance companies hate this bill.

Fact: This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009.
The original Senate Finance Committee bill was authored by a former Wellpoint vice president. Since Congress released the first of its health care bills on October 30, 2009, health care stocks have risen 28.35%.

Myth 3: The bill will significantly bring down insurance premiums for most Americans.

Fact: The bill will not bring down premiums significantly, and certainly not the $2,500/year that President Obama promised during his campaign.

Annual premiums in 2016: status quo / with bill:
Small group market, single: $7,800 / $7,800
Small group market, family: $19,3oo / $19,200
Large Group market, single: $7,400 / $7,300
Large group market, family: $21,100 / $21,300
Individual market, single: $5,500 / $5,800
Individual market, family: $13,100 / $15,200

(The cost of premiums in the individual market goes up somewhat due to subsidies and mandates of better coverage. The CBO assumes that cost of individual policies goes down 7-10%, and that people will buy more generous policies.)

Myth 4: The bill will make health care affordable for middle class Americans.

Fact: The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can't afford to use.

A family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income -- out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible.

Myth 5: This plan is similar to the Massachusetts plan, which makes health care affordable.

Fact: Many Massachusetts residents forgo health care because they can't afford it. A 2009 study by the state of Massachusetts found that:

* 21% of residents forgo medical treatment because they can't afford it, including 12% of children

* 18% have health insurance but can't afford to use it

Myth 6: This bill provides health care to 31 million people who are currently uninsured.

Fact: This bill will mandate that millions of people who are currently uninsured purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties. Some will be assisted with government subsidies.

Myth 7: You can keep the insurance you have if you like it.

Fact: The excise tax will result in employers switching to plans with higher co-pays and fewer covered services.
Older, less healthy employees with employer-based health care will be forced to pay much more in out-of-pocket expenses than they do now.

Myth 8: The "excise tax" will encourage employers to reduce the scope of health care benefits, and they will pass the savings on to employees in the form of higher wages.

Fact: There is insufficient evidence that employers pass savings from reduced benefits on to employees.

Myth 9: This bill employs nearly every cost control idea available to bring down costs.

Fact: This bill does not bring down costs and leaves out nearly every key cost control measure, including:

* Public Option ($25-$110 billion)

* Medicare buy-in

* Drug re-importation ($19 billion)

* Medicare drug price negotiation ($300 billion)

* Shorter pathway to generic biologics ($71 billion)

Myth 10: The bill will require big companies like Wal-Mart to provide insurance for their employees.

Fact: The bill was written so that most Wal-Mart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage.

Myth 11: The bill "bends the cost curve" on health care.

Fact: "Bends the cost curve" is a misleading and trivial claim, as the U.S. would still spend far more for care than other advanced countries.

* In 2009, health care costs were 17.3% of GDP.

* Annual cost of health care in 2019, status quo: $4,670.6 billion (20.8% of GDP)

* Annual cost of health care in 2019, Senate bill: $4,693.5 billion (20.9% of GDP)

Myth 12: The bill will provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition.

Fact: Access to the "high risk pool" is limited and the pool is underfunded. Only those who have been uninsured for more than six months will qualify for the high-risk pool. Only 0.7% of those without insurance now will get coverage, and the Centers for Medicare and Medicaid Services report estimates it will run out of funding by 2011 or 2012.

Myth 13: The bill prohibits dropping people in individual plans from coverage when they get sick.

Fact: The bill does not empower a regulatory body to keep people from being dropped when they're sick. There are already many states that have laws on the books prohibiting people from being dropped when they're sick, but without an enforcement mechanism, there is little to hold the insurance companies in check.

Myth 14: The bill ensures consumers have access to an effective internal and external appeals process to challenge new insurance plan decisions.

Fact: The "internal appeals process" is in the hands of the insurance companies themselves, and the "external" one is up to each state.

Ensuring that consumers have access to "internal appeals" simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an "external appeals process," as there is neither funding nor a regulatory mechanism for enforcement at the federal level.

Myth 15: This bill will stop insurance companies from hiking rates 30%-40% per year.

Fact: This bill does not limit insurance company rate hikes. Private insurers continue to be exempt from anti-trust laws, and are free to raise rates without fear of competition in many areas of the country.

Myth 16: When the bill passes, people will begin receiving benefits under this bill immediately

Fact: Most provisions in this bill, such as an end to the ban on pre-existing conditions for adults, do not take effect until 2014.

Six months from the date of passage, children could not be excluded from coverage due to pre-existing conditions, though insurance companies could charge more to cover them. Children would also be allowed to stay on their parents' plans until age 26. There will be an elimination of lifetime coverage limits, a high risk pool for those who have been uninsured for more than 6 months, and community health centers will start receiving money.

Myth 17: The bill creates a pathway for single payer.

Fact: Bernie Sanders' provision in the Senate bill does not start until 2017, and does not cover the Department of Labor, so no, it doesn't create a pathway for single payer.

Obama told Dennis Kucinich that the Ohio Representative's amendment is similar to Bernie Sanders' provision in the Senate bill, and creates a pathway to single payer. Since the waiver does not start until 2017, and does not cover the Department of Labor, it is nearly impossible to see how it gets around the ERISA laws that stand in the way of any practical state single payer system.

Myth 18: The bill will end medical bankruptcy and provide all Americans with peace of mind.

Fact: Most people with medical bankruptcies already have insurance, and out-of-pocket expenses will continue to be a burden on the middle class.

* In 2009, 1.5 million Americans declared bankruptcy

* Of those, 62% were medically related

* Three-quarters of those had health insurance

* The Obama bill leaves 24 million without insurance

* The maximum yearly out-of-pocket limit for a family will be $11,900 (PDF) on top of premiums

* A family with serious medical problems that last for a few years could easily be financially crushed by medical costs

[23]

Thanks for that informative link, one-eyed one.

I don't trust anyone who tries to regulate my behavior by using financial punitive measures as a cattle prod.

Cattle prods may work on cattle.

But I refuse to (re)act like cattle.

The sad thing about this scenario is most folks will (re)act as expected: like cattle.

Which will only reaffirm to the herders that... cattle prods work.

And so the herding will continue.

Until we have enough balls to inform the herders that... cattle prods no longer have any effect on us.

[ninakat]

Just to throw some REALITY in here: I'm self-employed and have to pay about $350 per MONTH for health insurance (Blue Advantage). There really aren't any alternative insurance companies worth switching to either. And that's why the public option is so important. Without it, insurance premiums are going to skyrocket out of control. They already have for me -- I started at about $175 per month just 6 years ago, and the rate just keeps climbing. Bottom line: it won't matter how many "good" crumbs of "reform" this bill contains if there's no competition to keep insurance costs down. That's what the public option would have done (in theory, at least -- we'll never know).

And here's a little more evidence that insurance is way out of control. My elderly mother has had long-term care insurance for over 20 years. She paid about $2000 a year when she started in about 1990, and that gradually increased to about $2900 a year and stayed there until about 2007. Every year since then, it has gone up exponentially.

This year, her premium jumped from $4700/year to $6600/year -- a FORTY-PERCENT increase. Unfuckingbelievable. And she can't change to a new policy with a different company without having to start from square one. In 2003, when we inquired with State Farm about a new policy with them, they quoted us $22,000 a year. That is not a typo.

She'll be 91 in May, and she's still in very good health. And she's one of the lucky ones who can still afford insurance even at those rates. But what's going to happen next year and the year after? It's probably going to become too expensive, and she'll just have to take her chances and hope she doesn't need some sub-standard hell-hole nursing home that even Mother Teresa wouldn't have been willing to practice in.

[justdrew]

It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other."

I don't either, SanDiegoBuffGuy.

The kind of language JustDrew used there is the kind of guilt-laden rhetoric used by both political parties whenever they want to cram something the people don't want down their collective throats.

Complying with someone's demand to buy a defective product is neither "the right thing to do" nor is it "part of fulfilling our obligations to each other."

It's bullshit — that's what it is.

let me ask you this:
would you shove peace and justice down their throats?
would you shove repeal of the patriot act down their throats?

Comparing "peace and justice" and the "repeal of the Patriot Act" to this unjust boondoggle — which benefits rich corporations disproportionately at the expense of real people — is a piss poor comparison.

This isn't the "first step" to anything — it's just another step along the road to indentured servitude at the hands of corporations and the rich men who run them.

And that's exactly where the "two party" dialectic lie has been leading us all along! — supported, of course, by fervent partisans on both "sides" of the political duopoly who don't know their asses from holes in the ground.

so what's it going to be then... Rampage or Standoff?

Look, I really don't think it "benefits rich corporations" at the expense of "real" people, I can see why anyone would say that, but I really think it'll be a wash, more likely a great cost to those companies. If it turns out that it does enrich them at people's expense, it'll have to be fixed. I'm just done bellyaching about it for now. While emotionally I totally would love to see all the private for profit insurers put out of business, realistically, we'd be talking about dumping tens if not over a hundred thousand people out of jobs, and screwing up how many pension plans that contain insurance company stock?
IF private for-profit plans can be forced to be at least very nearly as efficient as a centrally-run single-payer-plan, it's not necessarily such a bad thing that there be multiple providers instead of a single monolithic plan. I'm sick of seeing the leadership of these companies so grossly and unfairly overcompensated, it's outrageous, this can be a start to ending that. We MAY even see all the for-profit insurers go out of business by selling out to non-profit operators.

===

Simulist - I agree with a lot of your ideas but I do reject this idea that there is no two-sided conflict and that both the major parties are the same. One is flawed but changeable and semi-responsive and has sometimes served good, even though they don't always do the right things, for a variety of reasons... While the other is completely bat-shit crazy, evil, and honestly, I think, dangerous.

in any large scale human situation where there is multi-polar conflict, it's inevitable that two alliances will form. That said, the totally simplified/stupefied version of the two-party conflict pumped out by some partisans and the mainstream media is ill informed and harmful. So I guess I kinda agree and disagree?

[justdrew]

a few links to informative roundups on the HCR law:

The five most promising cost controls in the health-care bill

Ten immediate benefits of HCR

[chiggerbit]

A two‐year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatement of diseases.

I'd sure like to see which Congressperson inserted this little goody. I have a feeling it was Harkin and his "prayer therapy", or maybe to do with his bee pollen buddy.

[SanDiegoBuffGuy]

justdrew wrote:

Look, I really don't think it "benefits rich corporations" at the expense of "real" people, I can see why anyone would say that, but I really think it'll be a wash, more likely a great cost to those companies. If it turns out that it does enrich them at people's expense, it'll have to be fixed.

You can't seriously believe this.

[norton ash]

justdrew wrote:

Look, I really don't think it "benefits rich corporations" at the expense of "real" people, I can see why anyone would say that, but I really think it'll be a wash, more likely a great cost to those companies. If it turns out that it does enrich them at people's expense, it'll have to be fixed.

You can't seriously believe this.

Yeah... this is truly audacious hope, justdrew. I mean I understand the feelings in these dark times, and the HCR bill is a small improvement, but it's DESIGNED to enrich the insurance industry at people's expense.

[redsock]

Anyway, even if the system were "free" care for all citizens, taxes would just go up, things have to be paid for somehow.

No. I pay roughly the same money in taxes in Ontario (2005-now) as I did in Manhattan (1987-2005). But more of my money goes to help the general public as opposed to blowing apart brown people on the other side of the globe (though Canada is certainly not perfect in that regard).

Have corporations actually pay taxes (since they are people, right?) and cut the bejeesus out of the military budget and presto! Gobs and gobs of money for everyone's health care! And taxes would not have to go up a penny.

[23]

Have corporations actually pay taxes (since they are people, right?) and cut the bejeesus out of the military budget and presto! Gobs and gobs of money for everyone's health care! And taxes would not have to go up a penny.

[17breezes]

[barracuda]

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

So far, I think a lot of conservatives will agree with me. Now comes the hard lesson:

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.

[barracuda]

^^ What the hell? How did Ronnie Wood get in that picture??