Healthcare Compromise

[bascule]

I think I can conclude that this is not a healthcare compromise, it is a compromised (in the military sense) healthcare bill. It may still be better than nothing

 

This is worse than nothing. They dropped the public option but retained a mandatory insurance requirement for all Americans. The public option is the one thing that would make mandatory insurance actually make sense.

 

Is it even Constitutional for the federal government to force you to buy something from the private sector? WTF...

[Phi for All]

This is worse than nothing. They dropped the public option but retained a mandatory insurance requirement for all Americans. The public option is the one thing that would make mandatory insurance actually make sense.

 

Is it even Constitutional for the federal government to force you to buy something from the private sector? WTF...

My neck is starting to hurt from shaking my head. What happened to all the lofty visions and messages of hope? This isn't what the Democrats are supposed to be about, it's not even what the Republicans are supposed to be about. This is pure corporate society machinations.

 

Who do you think will win the Rollerball match tonight?

[iNow]

We all lose with this suboptimal approach. We as a country are broken.

[doG]

Why? I assume you're conjecturing that any tax-funded entitlement will be abused by its recipients until it becomes unsustainable. Can you actually demonstrate that's the case with any kind of evidence, or is this more of a "gut feeling" sort of thing?

 

It's a democracy thing. As more and more of the public vote themselves gifts from the public treasury, fewer and fewer of them fund it and it eventually leads to their downfall.

 

IMO, Healthcare reform as it currently appears will not really decrease the cost of the quality healthcare delivered in the U.S. now. That means that those that can currently afford their own healthcare are just going to end up having to pick up the cost of someone's else's as well in order to provide healthcare for everyone regardless of who's paying for it. A percentage of them will not be able to afford the burden of paying for others. They're barely covering their own now. This will end up kicking them over to the dependents side of the equation further increasing the load on the providers side causing more of them to not be able to afford the extra burden either.

 

I would also add that the very concept is discriminatory in the same way affirmative action is. Any time one class of people is favored over another then those that are not in the favored class are effectively discriminated against. In this case those that will end up receiving free care are being favored over the workers giving up their earnings to pay for it. It is discrimination against the workers.

 

Make whatever arguments you wish but you will never convince me it is OK or morally right to take what one man has earned and give it to someone else that's done nothing for it. What ever any man earns should be his to use as he wishes.

[iNow]

Make whatever arguments you wish but you will never convince me it is OK or morally right to take what one man has earned and give it to someone else that's done nothing for it. What ever any man earns should be his to use as he wishes.

By logical extension, then, you are against public roadways, public water treatment, libraries, public schools, universities, and countless other similar services. Such a position is untenable, and seems to ignore how you personally benefit from those exact same services paid for by all of us collectively, even though some people cannot contribute.

[bascule]

It's a democracy thing. As more and more of the public vote themselves gifts from the public treasury, fewer and fewer of them fund it and it eventually leads to their downfall.

 

No, it's a tired conservative cliche. Someone is robbing the public treasury here. That someone is the insurance industry.

[Pangloss]

They dropped the public option but retained a mandatory insurance requirement for all Americans. The public option is the one thing that would make mandatory insurance actually make sense.

 

It is rather stunning that we could actually end up with health care reform that does nothing about the tens of millions of people without health care except to declare them to be breaking the law. The situation is analogous to Democrats putting forth a plan that closes the border and then gives all current illegal immigrants citizenship, and then removing the citizenship part just before passage "just so we can have some kind of reform".

 

Even more bizarre is the fact that Democrats will then have to *sell* this as both beneficial and progressive in order to capitalize on it in next year's election. It'd be practically writing the GOP's recovery strategy for it. And the short deadline they're forcing on the situation -- completely artificially -- may actually be contributing to the lack of recognition for what they're about to do (e.g. refusing Lieberman a few moments to finish speaking today, ostensibly because of the overwhelming need for speed).

 

All in all a very strange state of affairs.

[bascule]

It is rather stunning that we could actually end up with health care reform that does nothing about the tens of millions of people without health care except to declare them to be breaking the law. The situation is analogous to Democrats putting forth a plan that closes the border and then gives all current illegal immigrants citizenship, and then removing the citizenship part just before passage "just so we can have some kind of reform".

 

As far as I'm concerned such a bill is unconstitutional. What in the Constitution gives the federal government the power to do this?

[Pangloss]

You mean the legality of being non-insured? That's an interesting question. I don't know much about the rule, though.

[Phi for All]

You mean the legality of being non-insured? That's an interesting question. I don't know much about the rule, though.

I think bascule is talking about the federal government forcing us to buy something from insurance companies. States can make us buy car insurance and safety seats for kids. Isn't it a federal law that makes us pay for air bags in cars? I guess there is something in the Constitution that could force us to buy insurance from the private sector.

[ydoaPs]

I think bascule is talking about the federal government forcing us to buy something from insurance companies. States can make us buy car insurance and safety seats for kids. Isn't it a federal law that makes us pay for air bags in cars? I guess there is something in the Constitution that could force us to buy insurance from the private sector.

 

They're not forcing you to buy cars or drive.

[Phi for All]

They're not forcing you to buy cars or drive.

But there are plenty of alternatives to driving a car for transportation, and it can be argued that there are national safety concerns involved. The alternatives to healthcare are much more limited and unsound. And being forced to purchase insurance from a private company doesn't carry the same national safety concerns as seat belts and air bags on a car.

 

I suppose you could argue that sick people could put others at risk, but I don't think there are even any state laws that make inoculations or medical care mandatory.

[iNow]

Howard Dean says: kill it and start over in the House.

 

I agree.

 

Another perspective from the NYTimes today.

 

 

 

http://www.nytimes.com/2009/12/18/opinion/18krugman.html

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

 

But meanwhile, pass the health care bill.

 

Yes, the filibuster-imposed need to get votes from “centrist” senators has led to a bill that falls a long way short of ideal. Worse, some of those senators seem motivated largely by a desire to protect the interests of insurance companies — with the possible exception of Mr. Lieberman, who seems motivated by sheer spite.

 

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

 

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

 

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

 

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That’s an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

 

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

 

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

 

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

 

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

[ydoaPs]

But there are plenty of alternatives to driving a car for transportation, and it can be argued that there are national safety concerns involved.

The situations aren't analogous since the laws requiring seatbelts/airbags and car insurance are conditional; they only apply if you decide to purchase/operate a motor vehicle. One could walk or ride a bicycle and avoid such things. However, the proposed law has no such opt-out sans suicide.

[bascule]

Another perspective from the NYTimes today.

 

This article brought to you by Anthem Blue Cross and Blue Shield.

 

Just kidding. But while this bill has some pros, they are heavily outweighed by the cons. The mandatory insurance requirement, with no plan for having the government pick up the slack, is absolutely appalling to me. Worse, removing the public option increases the cost of the bill.

 

Our government isn't exactly in the black here. If we're going to create a huge new entitlement right now, it better damn well be a good one. Instead the Democrats are trying to plunge us further into debt and for what? To make the insurance companies even richer?

 

...it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick.

 

I agree this is great! Why not pull this little bit out of this horrible monstrosity of a bill and pass it separately? Oh wait, the insurance lobby won't capitulate on that unless they're getting something big in return.

 

I am adamantly opposed to the government taking out a huge loan just to hand the money over to the insurance companies, especially when the country is up to its eyeballs in debt already. And worse, they want to spend more money for the sole purpose of not having a public option. WTF.

 

Watching this bill evolve is proof to me that corporate America has the majority of our politicians in their pocket.

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Let me offer yet another perspective:

 

http://voices.washingtonpost.com/ezra-klein/2009/12/what_lieberman_has_wrought.html

 

Joe Lieberman's reckless decision to blow up last week's compromise has had exactly the impact many of us predicted. Much of the left has flipped into vicious, angry opposition to the bill. Is that because the Medicare buy-in, a good but limited policy, has disappeared from the bill? Ostensibly. But not really. If you don't believe the bill has cost controls, Medicare buy-in was not an answer to your concerns. If you believe the mandate is bad policy, letting the small slice of exchange-users between 55 and 64 choose public insurance did not answer your fears.

 

But progressives had compromised plenty already. Single payer became a strong public option, a strong public option became a weak public option, a weak public option became Medicare buy-in, and Medicare buy-in became Joe Lieberman's revenge. Progressive ends are submitting to conservative means, and industry is laughing all the way to the bank. All this amid the first year of a president they elected, a Democratic majority they built.

 

And it's not just the policy that galls. It's the precedent they fear. Continual compromise with swing senators who are willing to kill good legislation for bad reasons is not a path they want to continue down. They saw the results in the stimulus, a too-small bill that was made yet smaller by, among others, Joe Lieberman, Ben Nelson and Susan Collins. And now, health-care reform is being weakened too, with the subsidies coming in beneath what experts believe we need and the public option erased from the bill.

 

Worse, it all feels divorced from detectable policy principles. Medicare buy-in was a policy Lieberman supported. It was a compromise that had been communicated to him directly. It emerged from meetings that he was invited to attend. He didn't bother to wait for the Congressional Budget Office's report, or even to offer a coherent argument against the policy. He had the power, he knew it, and he used it. Now he's giving happy, triumphant interviews to any camera and reporter he can find. My personal favorite was his comment to the New York Times. “My wife said to me, 'Why do you always end up being the point person here?’ ” Did Lieberman say this somberly? Did he seem weighed down by the responsibility? No. He was "flashing a broad grin."

 

A lot of people have made a lot of compromises to protect this process. Ask Rockefeller and Schumer and Brown and Wyden how fun this has been for them. But they grit their teeth because it's important. There are no pearly whites on display as they sit for interviews for front-page profiles in the New York Times.

 

Lieberman has tossed the process into chaos. But the short-term satisfactions won't overwhelm the long-term judgments. Lieberman is "point person" because he has appointed himself the 60th senator. Every other member of the Democratic caucus could have done the same, but most all have judged the underlying bill more important than their disagreements with it. Lieberman did the opposite, and there's little evidence that he actually had disagreements with the bill so much as dislike for some of its supporters.

 

And Lieberman, let's remember, is not a lefty blogger. He isn't a pundit or an op-ed columnist. He is the "point man," and by choice. He bears a special responsibility. Atop the shoulders of another man, it would make for a heavy load. But not his. His recklessness has endangered the bill, and through it, many, many lives. He may not be ashamed. But he should be.

Edited December 19, 2009 by bascule

[Pangloss]

Well regardless of the outcome, I have to praise the discussions here.

 

This is why I follow politics as a hobby. It doesn't get any more interesting than this health care thing.

[JohnB]

Guys, I'm really, really sorry. I thought for a while you had a chance.

 

It makes me think that "Big Oil" and "Big Coal" who are supposedly obstructing the AGW thing are mere beginners when compared to the "Health Insurance" lobby in the US.

 

Right now would be a good time for "the people" to be asking very hard questions of their Senators.

 

Edit to add.

 

Anyone who is active in the Democrat party should be particularly upset over all this. It's handing the next election to the Republicans who can run with the slogan "Even when they control the Upper House, the Lower House and the Presidency, the Democrats can't do squat!"

 

I would add that such activities as practiced by Congressman Billy Tauzin would lead to a full scale investigation down here, with probable charges. We have prosecuted before and had Ministerial decisions overturned (with the Minister convicted). Joining a lobby automatically means that any decision regarding that lobbies industry is investigated.

Edited December 20, 2009 by JohnB

[iNow]

This is worse than nothing. They dropped the public option but retained a mandatory insurance requirement for all Americans. The public option is the one thing that would make mandatory insurance actually make sense.

 

Is it even Constitutional for the federal government to force you to buy something from the private sector?..

While my leanings are definitely similar to yours in this arena, I just wanted to share some extra information for context...

 

According to David Axelrod who appeared on both Meet the Press and This Week with George Stephanopoulos this morning, citizens will not be forced to buy a policy which costs more than 8% of their income as per the hardship exemption in the legislation, and they will receive significant assistance from tax credits to assist them in purchasing these policies.

 

He also noted that directly written into the bill are limitations on CEO pay and bonuses at insurance companies, and restrictions on the amount of money they are allowed to take away from claims payments for things like compensation. He also stated that the bill has written into it that the tax payers will receive rebates from the insurance companies if they exceed those limits (basically, they will have to pay money back to the people if they do not operate within the mandates and limits of the bill).

 

Also, from what I heard from others on the shows, the bill will provide coverage to 30 million more Americans (including those small businesses who simply cannot afford to provide coverage for their employees right now), and according to the CBO it will decrease the federal deficit by $132 billion over ten years, and in the 10 years following that deficit reduction could reach $1.3 trillion.

 

http://cboblog.cbo.gov/?p=446

 

 

So... not perfect... still needs work... pretty far short of what we all want and know will work better... but still a pretty good improvement over the existing system (although, I concede, that's not exactly saying much considering how bad it is right now).

 

 

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Right now would be a good time for "the people" to be asking very hard questions of their Senators.

Except, in our populace a hard question is "are you for or against abortion," and "how do you feel about gays in the military?" The priorities in our nation have been profoundly disoriented for far too long.

 

 

As for your edit... Have you heard the term, "Preaching to the choir?"

Edited December 20, 2009 by iNow
Consecutive posts merged.

[bascule]

Also, from what I heard from others on the shows, the bill will provide coverage to 30 million more Americans (including those small businesses who simply cannot afford to provide coverage for their employees right now), and according to the CBO it will decrease the federal deficit by $132 billion over ten years, and in the 10 years following that deficit reduction could reach $1.3 trillion.

 

http://cboblog.cbo.gov/?p=446

 

This is news to me. I'm confused as to how an expansion of coverage saves money, though, although that seems to be exactly what the CBO is saying. Where would those costs otherwise come from? Medicare?

[iNow]

That's an excellent question, and I must stipulate that I'm really unsure. Either way, though, despite the feelings we might have for the private health insurance industry, the bill still does some significant good.

 

I'd rather we had universal single payer healthcare myself, though. It just makes the most sense, no matter how I've dissected the various pieces or criticisms leveled at it.

[npts2020]

iNow; This 8% of your income represents one of the largest tax increases ever for someone who does not have health insurance. Why should anyone be required to give any money to entities whose sole purpose is to make money as opposed to helping people and how can the government mandate that they do so? It is nothing like car insurance where I don't have to own and drive a car (how do you get out of living wherever you live?). Somebody will make tons of money off of this in the same way that farming out tasks that were formerly the domain of the DoD and Bureau of Prisons has.

[iNow]

Which is why I favor a single payer universal healthcare system, and also the removal of the profit motive from healthcare insurance. Profit = waste in this domain, and all money should be focused on care outcomes and success (IMO).

 

As for the 8% limit and how this will impact people, bear in mind that it comes with tax rebates. Those people will get help to minimize the impact as much as possible. With that said, I tend to agree that the current legislation is a steaming pile of shit, but it's also better than what we have now, so I'm not exactly against it. I AM one of those people who has been turned down for a pre-existing, and who has had to pay the insane costs of Cobra while out of work so my coverage didn't lapse (if I'd let it lapse, there was a real chance I'd never get it back again). I can't speak to the concept that we are punishing people who would not otherwise carry health insurance, because frankly I think those people are irresponsible and have been gaming the system and have been mooching off the rest of us for far too long already.

[padren]

iNow; This 8% of your income represents one of the largest tax increases ever for someone who does not have health insurance. Why should anyone be required to give any money to entities whose sole purpose is to make money as opposed to helping people and how can the government mandate that they do so? It is nothing like car insurance where I don't have to own and drive a car (how do you get out of living wherever you live?). Somebody will make tons of money off of this in the same way that farming out tasks that were formerly the domain of the DoD and Bureau of Prisons has.

 

You can go your whole life without driving a car, and your entry costs at age 50 don't have any real impact vs if you started getting car insurance at 20.

 

With health insurance: It's illegal to let someone die in the street outside a hospital. If you don't have insurance while you are healthy, you may save yourself some money but it is at the expense of a society that will have to try to help you when you do get sick. It's a huge cost increase for these people yes - 8% is not small. It's already being paid though, just not in any sensible way.

[jackson33]

I'm confused as to how an expansion of coverage saves money, though, although that seems to be exactly what the CBO is saying. Where would those costs otherwise come from? Medicare? [/Quote]

 

bascule; As I understand something not meant to be understood, the bulk of the savings take effect on signing of the bill, added taxes and so on, while the programs that cost will not until 2013. I'm sure you have heard the analogy, buying a car, making payments for three years, before driving it off the lot.

 

Trying to keep from being cynical, the 20% pay cut for Doctors involved with Medicare, is not going to happen. There was another House bill that covers this (cutting off the allowed cuts and since 2008 never imposed), not included in the CBO's figures and if passed after the HC Bill passes, that will wipe out the savings, but under a different program, not the HC program, think over 200B$ alone, over ten years.

 

Another serious problem MAY be the legality of fining/taxing a person for not buying a product. Most legal experts are saying this would no doubt be found unconstitutional, or unenforceable under the program. I am not sure how they could determine how many their figuring will pay the fine, rather than sign up with an insurance company, but surely this will be more than the proposed 'Government Option'. Remember, disqualification for pre-existing cause will take effect on day one, meaning while a person can sign up after a condition develops at the SAME price.

 

There are many other factors which IMO are not being considered, one; To process the new system, enforce and prosecute is going to take a good many people, possibly a new Department adding a great deal of cost not considered or if so someplace will be under estimated. As the CBO suggest, cost are not going to remain the same, inflation alone will add 2-3% each year compounded and over 20 years would be 22-23% in not mentioned expenses. Another bill heading through the House involves 'Immigration Reform', which if passed would instantly add -x- number of eligible to participate in the program, if ever disallowed in the first place (this is basically a State option).

 

These longer-term calculations assume that the provisions are enacted and remain unchanged throughout the next two decades. However, the legislation would maintain and put into effect a number of procedures that might be difficult to sustain over a long period of time. Under current law and under the proposal, payment rates for physicians’ services in Medicare would be reduced by about 21 percent in 2010 and then decline further in subsequent years. At the same time, the legislation includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation. The projected longer-term savings for the legislation also assume that the Independent Payment Advisory Board is fairly effective in reducing costs beyond the reductions that would be achieved by other aspects of the legislation.[/Quote]

 

offered by iNow; http://cboblog.cbo.gov/?p=446

[Pangloss]

ABC News ran a piece tonight saying that the health care insurance companies are already reaping a windfall from the hobbled health care bill in the form of stock values, which are way up since November, in some cases as much as 33%. With the loss of the public option and the addition of 30 million new customers subsidized by almost half a trillion dollars in government money it's not hard to see why.

 

(Kinda makes complaints from Democrats about increased spending in Afghanistan look a little silly, doesn't it?)