For anyone other than the insurance companies, that is.
I caught an article on Yahoo today about Howard Dean urging defeat of the health care billthat is currently being proposed in the Senate. It’s interesting that Dean would be against the bill, but this thread isn’t really about Howard Dean or his opposition to the bill, per se.
My concern (and question, leading most likely to debate,) is: just what exactly does the bill DO (as it currently stands in the Senate)? How does it reform our broken health-care system?
From the linked article:
WTF? When did that happen? I’ve been pretty pissed-off about how the bill has been steadily watered down but I figured if nothing else, at least the current emasculated version would still prohibit insurance companies from denying coverage based on pre-existing conditions or from charging more to certain risky groups of policy-holders (e.g. the elderly and the infirm/sick).
Now, according to Dean, this bill doesn’t do any of that; he asserts that it actually BENEFITS insurance companies at the cost of consumers:
I have been supportive of mandating all Americans to have insurance, but that was only because I thought that people who couldn’t afford insurance would get help through the public option, and that no one could be over-charged or turned down because of pre-exiting conditions. But if you take all those protections away, aren’t you merely forcing people to buy the over-priced, under-effective snake-oil that the insurance companies are peddling?
At this point, just what in the hell does the proposed health-care “reform” actually do? Nothing? Or even WORSE than nothing? Is Howard Dean right about this?
When will we finally join the civilized-nations club?
Well, from the White House blog it appears as if a few of the things Dean is stating aren’t true.
• Among the many provisions to end insurer abuses, lower premiums, and hold insurance companies accountable:
• Insurance market reforms will prohibit abuses such as denying coverage for pre-existing conditions, charging exorbitant premiums based on gender, age, or health status, dropping coverage when people are sick, and imposing lifetime limits on benefits.
• Consumer rights will be enhanced by requiring all insurers to provide effective appeals procedures including outside, independent review of appeals
• New insurance exchanges will reduce premium increases by lowering administrative costs and increasing the leverage of individuals and small businesses in this insurance market.
• Competition will also be enhanced by providing consumers comparative information on available insurance options giving them the tools to make more informed decisions and drive competition based on value and service.
• Insurers will be held accountable for excessive overhead costs fueled by unreasonable executive compensation and profits.
• Insurers will also be required to compete against cost-effective national plans selected by the federal Office of Personnel Management.
• Wasteful taxpayer overpayments to insurance companies through private Medicare Advantage plans will be eliminated.
• A new $6.7 billion annual fee will be levied on insurance companies to ensure that they pay their fair share of coverage costs.*
So who knows, is this going to be a game of he said/she said?
Can’t we just pass something that at least DOES something useful?
Slate seemed to have a good roundup of the implications
Page 2 seems to have most of the meat. Page 1 of the article is mainly the politics of it. From the roundup, it doesn’t look like things change much if you have a job that provides insurance.
And in case anyone forgot, Howard Dean is batshit insane, and Nate calls people like him out on it here.
The Public Option/Buy-in provision has always been a sliver of the bill that had more symbolic importance than actual effect. And really, what’s Howard Dean proposing instead of passing this bill in Congress? Starting over and hoping to convince Lieberman to play nice this time? Going with a brand new reconciliation bill that won’t get passed until next year, if at all? Wait until Democrats lose tons of seats in 2010?
Bottom Line: The Senate Bill does a great deal for the people who need healthcare reform the most: the 20,000 odd people who die every year from lack of coverage. And there’s absolutely nothing stopping Democrats from passing this version now, and tacking on a public option or Medicare buy-in through reconciliation before 2014. The best method for never ever having a public option is letting this bill die.
Both Dean and Greenwald are pretending that the bill revolves around nothing but insurance mandates and public options. That is a horrible simplification of a 2,000+ page bill. Yes the insurance mandate helps insurance companies. Who cares? There are lots of other things in the bill that protect people from insurance companies (see post #2) and lower costs for poor people (see post #9). 1,000+ pages of the bill are also devoted to pilot programs (a program for nearly every major cost cutting solution proposed by experts in the field), and a new agency to monitor them and adopt any that start to work. That is not reflected in CBO estimates because no one knows if any of the programs will work or not. Yet it’s pretty cynical to assume that out of the 1,000 pages of experimental programs, none of them will cut costs.
No one is forcing people who can’t afford insurance to buy into a plan to help the greedy insurance fat cats. If that’s the whole story then where is the $900 billion dollars going to go? If you read Greenwald’s story (that I linked to above) it makes a pretty good case that Obama never wanted a public option from the beginning. That he worked out a deal with drug and insurance companies for an individual mandate and no public option in exchange for their support for the bill. That seems like a perfectly reasonable compromise. Progressives like Greenwald seem to want a Bill that will tar and feather everyone that works for an insurance company. Like it or not, insurance companies are part of the negotiating process, and an individual mandate seems like a reasonable offering to get them their support.
The lack of a public option does not bother me either. Medicaid and Medicare have both done horrible jobs to keep costs down by negotiating prices, so why should we expect another government run insurance company to do any better?
In short, Dean needs to stop pretending that the Bill is nothing more than an insurance mandate. It’s a lot more than that and it would be insane for anyone who supports UHC to vote against it.
That’s why it helps that there’s an individual mandate – it forces healthy people into the system to counterbalance the sick people. Something which mandate haters on the left never seem to acknowledge is that you can’t have guaranteed issue (i.e. no denying coverage due to preexisting conditions) without a mandate to purchase insurance. Not only for the reason I just mentioned, but also because to do otherwise encourages gaming the system by not buying insurance until you get sick.
Problem is, an individual mandate isn’t something you can count on due to constitutional issues. seems awfully strange to make insurance reforms dependent on something that might not survive court scrutiny. What do you do then, just scrap the whole thing?
I realize many here think that the mandate is likely to stand. But no one can say that with 100% certainty. Do Democrats have a backup plan?
(my bolding)
Could one end up buying insurance on the way to the hospital and after you’re healthy again, cancel until you get sick again? It also would mean that the healthier you are, the less convenient this plan is.
I still think it would’ve been simpler to simply change my US “medical coverage” pet peeve, which is tying it to your employer.
I think a better approach is to allow insurance companies to deny specific coverage for preexisting conditions, but tighten up the process considerably.
In other words, an insurance company could have you paying premiums and then deny you coverage for cancer because a test 20 years ago revealed a hereditary likelihood of getting cancer. But if you have no insurance and then you get cancer and try to buy insurance for it, then they shuld be able to deny you coverage for it(although they’d still have to pay for other conditions that you didn’t already have).
To me, the individual mandate is an affront to our liberties. Plus it opens the door to Congress making you buy anything they think you should have. Don’t think health insurance will be the first and last thing you’re forced to buy.
This is exactly why I disagree with this legislation.
I do not approve of the government granting itself unreasonable power to close a loophole that only exists because the government is granting itself unreasonable power.
And that’s why I (of the left) have been supportive of the ‘everyone-must-have-insurance’ mandate. But at some point, if the health care bill gets so watered down that it offers consumers almost no protections against sky-high premiums, denial of payments for procedures, and denial of affordable coverage for those with pre-existing conditions, then still requiring everyone to buy insurance only games the system in favor of the insurance companies.
Except for this: AFAICT the fine for not carrying coverage is going to be a lot less than the cost of buying a private policy – I heard a figure of a $750 cap on the fine. If true, that’s less than many people pay to buy a policy through an employer.
Unless the penalties are truly harsh – strict enforcement and heavy penalties – guaranteed issue is pretty much an invitation for people to not buy insurance until they get sick.
ETA: Which, of course, means insurers will have to jack up premuims to stay in business. Which in turn will 1) create a negative feedback loop and 2) enable people to keep screaming about “greedy insurance companies.”
