House Health Reform Plan

by: DaveJ

Wed Jul 15, 2009 at 15:00

I'm looking over the House's "Affordable Health Choices Act."  Like so many families, my wife and I need a good health insurance plan when COBRA runs out in a few months, so let's see what this plan offers us.  (Of course like most people here I would prefer just one Medicare-like plan for everyone, but this would be unfair to insurance company profits so it is off the table.)

You can read the House health care bill here.  Think Progress' Wonk Room post on this is here.  

The proposed legislation includes a "mandate" requiring everyone in the country to purchase health insurance or pay 2.5% of their income as a penalty.  Employers are required to pay for health insurance for all full-time workers or pay an 8% payroll tax instead.  (That means that they pay the government 8% on top of all the wages they pay out.)  I haven't figured out yet what happens with part-time workers.

The supporting materials say that "public plans" have to be on a "level playing field' with private insurance, including holding rates higher to cover "startup costs and contingency funds".

People making up to 133% of poverty level will be covered by Medicaid.  Then the plan has a subsidy to help people pay for the mandated insurance, but only for individuals who make $43,320 or less and a family of 4 making $88,200 or less.  People just above that 133% will have their payments limited to 1.5% of income by the subsidy.  That slides up to the "high" end where people will have payments capped at 11% of income, which is $4765.20 per year, $9702 for a family of four.  Above that income level, people apparently just have to buy health insurance without subsidies - currently as much as $4-500 a month per person if they want just a basic plan.  


DaveJ :: House Health Reform Plan
Good: Everyone will be covered so those with insurance won't be paying for those without.  And everyone GETS covered - no pre-existings, etc.  Costs will be lower because people will have access to care instead of being forced to wait until desperate then heading to an emergency room.  It will reduce the future health care burden on the economy.

Best: No one will ever be forced into bankruptcy again.  (What about nursing homes and home care ?)  No one will be forced to stay at a job just to be covered anymore.  Age discrimination based on health coverage costs will end.(Assuming older people don't have to pay higher rates.)  

Bad: Mandates without meaningful subsidies.  People and businesses are required to cough up huge amounts of money.  The people and businesses most affected by this are those who don't have insurance now - often because they can't afford to.

Worst: Republicans will be able to savage Democrats for this bill because they didn't choose to subsidize the mandated costs in a meaningful way.

Summary: This is an excellent plan within the context of preserving insurance company profits, trying to appease Republicans who won't vote for it anyway and not spending more over ten years than we spent on big financial corporation bailouts in about ten minutes.  It makes some extremely important changes that we all need.  But overall I think the restrictions they are operating under might make the plan unworkable because needed public support could erode before the plan takes effect.

This plan has a mandate requiring everyone to buy insurance.  A mandate is the only way that health care reform can work because of the cost savings that come from universal coverage, but a mandate without meaningful subsidies is political dynamite that Republicans will use to try to destroy the plan - and Democrats - for decades.  If you don't think they will call the mandate a "big government ordering you to pay a huge tax" and do everything they can to destroy Democrats who vote for this, then you don't know Republicans.

My wife and I currently pay about $850 a month for the minimal plan in this area under our COBRA, and under this House bill that becomes a mandate.  So the House bill will require us to cough up about $10K per year if we make a dime more than whatever the married maximum is going to be, and quite a bit even if we don't because the subsidy is minimal.  The fact is we wouldn't have health insurance today if COBRA were not subsidized, and certainly can't afford anything approaching $10K, public option or not.

Businesses will have to cough up 8% of payroll.  Ian wrote about this earlier.

The plan doesn't appear to take effect until 2013, giving Republicans a lot of time to campaign on "stopping this massive tax" and spread lots of lies about it after it passes.  So we could lose both Democratic control of Congress AND health care reform.  I wonder how much of this plan is the result of political calculations by many Democrats who worry about directly taking on the Republicans and the insurance companies -- even though I expect both will work to kill this bill no matter what is in it.  On the other hand maybe this plan is just a step in a strategy involving introducing increased subsidies later.

I think the political cost of mandates, combined with keeping private insurance, demonstrates why Medicare-For-All (insiders call this "single-payer," apparently to confuse ordinary people) really is the only workable plan.  But, as I said, meaningful subsidies could make this plan politically workable.  As I said above it could be that this is a strategy to introduce a plan that "pays for itself" and gets that out of the way, but increasing subsidies later as the public reacts to the amounts they will have to pay.

At least there is a "public option." Without it this mandate would be the final straw in the complete corporatization of the government - just passing a law requiring everyone to give the rest of their money to big companies.  If the public option gets removed I'm not sure how requiring everyone to buy health insurance from private insurers is supposed to be different from requiring everyone to buy a cell phone (but only from ATT with a data plan) or cable TV, except health insurance costs a lot more.  If the public option is removed a mandate must not pass.

I ran a business for a number of years and provided health coverage until I couldn't afford to.  I understand the effect that a new 8% payroll tax will have.  (Of course businesses that don't provide health insurance aren't going to do so under this plan either, and will have to pay this tax instead.)  But this may be worth it to help everyone get health insurance.  I might think so, but most business owners are going to howl and scream about this.  Remember, health care costs are a big reason companies like GM moved plants to Canada.

Final word: Increase the subsidies so no one making less than $100K has to pay very much and this will breeze through and be loved.  Republicans and insurance companies are going to try to kill this no matter what you do so get the public behind you with meaningful subsidies.

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I am not sure I understand your math (0.00 / 0)
How do you get to 10k per year? Just paying the 2.5% of 100,000k is $2500. If you make 400k a year, you should be able to afford your own health insurance.

The 2.5% is a penalty... (0.00 / 0)
...for those who don't buy health insurance. I think DaveJ was calculating $10,000 as the price for health insurance, based on the unsubsidized maximum of 11% of income. So DaveJ and his wife make what, $90k? In which case $10k for insurance is a lot, but that's what he's already paying to COBRA ($850 x 12 = $10,200).

I'm curious to know if these income levels are pretax or after-tax. Because there is a big difference between somebody making $90k before taxes vs. $90k in take home pay.

[ Parent ]
I think 11% is only if you are in the range (0.00 / 0)
I think I read it that you pay a max of 11% if you are IN the subsidy range.  In other words, they subsidize it so you don't have to pay more than that.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
I paid about $600 per month (0.00 / 0)
for a family of 4, about 10 years ago, when my husband was without a job. We earned about $35,000 to $40,000 (taxable income, before taxes). It was excrutiatingly difficult, but with two very young children, we felt we could not afford to be without coverage.

Compared with our predicament back then, the House plan seems quite generous.

[ Parent ]
Right but (0.00 / 0)
Wages haven't gone up much in that ten years, while health insurance costs have become unbearable. So more and more people just can not afford it now even if they could back then.  This plan at least stops that escalation but with this mandate and insufficient subsidies it requires people who can't afford it to buy it anyway.  That has to change.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
What we pay now (0.00 / 0)
We pay $850 per month, about $10K a year.  If we make more than the max for subsidies we will be required under the mandate to pay for our health care without subsidies.

I wrote we will pay $10K "if we make a dime more than whatever the married maximum is going to be" because we won't qualify for that subsidy.  For a single person that maximum income for receiving a subsidy is $43,320.  So it appears that a single person making $43,321 is on their own, unsubsidized.  A 50 year old will have to shell out $4-500 a month or so if rates in 2013 are only what they are now.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Questions for Pelosi (4.00 / 2)
As part of the HR3200 rollout in the blogosphere, Speaker Pelosi appeared on C&L. Nice get! These are the questions I asked her. I think they have application here:

I understand that Speaker Pelosi will answer some questions submitted, even from those of us prevented by RL from attending. (And John: Nice get!)

1. Why does the implementation of the public option need to wait until 2013? Even the moderate HCAN has established a principle that the public option should be available on Day One, and there was large-scale campaign in the progressive blogosphere based on that principle. Why did you reject it, and them?

2. How many people do you expect to enroll in the public option? Reuters has indicated that Congressional staffers believe that there will be 9 million by 2019. Do you agree with that number, and, if so, do you regard it as high enough to "keep the insurance companies honest"?

3. How many people do you expect not to be covered by the bill? Reuters has indicated that 10 million will not be covered. Do you regard that coverage as "universal"?

4. There are three ombudsman in the bill. First, why is there not a single ombudsman to cover the whole program? Second, do the ombudsmen have conflict resolution authority, and do they have the confidentiality, neutrality, and independence that ombudsmen typically have? Specifically, will they be able to offer whistleblowers protection?

5. The bill is both complex and unproven. HR 3200 is over a thousand pages long; by contract, HR 676 (single payer) is only 27 pages long. Since single payer has been proven to work in other countries, and so save both a great deal of money (France's per capita spending is half ours) and lives (we lose 18,000 people a year in our system), it is clearly the science-based solution, based on the evidence. Do you feel comfortable advocating health care policies that are complex, experimental, and not science-based? If so, why?

Thanks for your attention!

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

HR 3200 vs HR 676 (0.00 / 0)
Can we compare HR 3200 to HR 676?  Because HR 3200 looks awfully complicated as opposed to just expanding and improving an EXISTING SYSTEM to provide single payer health care coverage starting right now rather than 2013.

I keep hearing these arguments that we need to transition to a better system, well, the easiest way would be to offer Medicare to anybody that wants it.  It already exists (no exchanges or co-ops to set up by 2013), it's already much more efficient than the insurance industry (i.e. provides real competition), and would only improve if we were able to expand the system to have a larger pool of people.

Quite frankly, HR 3200 is going to cost the Dems the Congress and the WH in 2010 and 2012.  This bill is too easy to attack by Repubs, too late to implement in 2013, and we've all watched the Congress give Wall St trillions in just months while we have a prolonged major recession followed by a jobless recovery.  The Repubs have been praying that the Dems will f&*k up, well, this is it.

[ Parent ]
Good points (4.00 / 4)
I too think the mandate is an enormous problem, especially the lack of subsidies.

What it will do is piss off the middle-class, which will feel they're getting the short end of the bargain. 11% of income is way, WAY too high for the middle-class, squeezed as it is between debt, wage stagnation, and facing a jobless recovery.

They will become ripe for Republican claims that their suffering is the cause of the tax increases to provide health care to the "undeserving" - i.e. the poor and the previously uninsured. Sure, the taxes won't get anywhere near the middle-class, but that has never stopped right-wing populism based on cutting taxes for the wealthy from finding support among the middle-class.

The reason the subsidies are so weak as to be a sick joke is that the House reasoned that there would not be support in the Senate, the White House, or even among some in the House, for higher taxes on the wealthy.

Because as we all know, the #1 overriding policy imperative in the US is to ensure that money keeps flowing to the rich with as little imposition as possible.

Worse than that (0.00 / 0)
As I wrote about, I think that 11% is WITH the subsidies, if you are in the subsidized range.  Above the subsidized range it is open season on the buyers, if I read it correctly).


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Looked at the bill itself (0.00 / 0)
OK I just looked at the text of the bill itself and it seems clear that the 11% is with the "affordability" subsidy and that goes away once you pass 400% of the poverty level.

So it seems clear they mean you have to pay for insurance at market rates entirely on your own, not limited to 11%, if you make more than 400% of poverty.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Market rates (4.00 / 2)
The one thing you seem to miss is that "market rates" are determined by large buying pools you get to join.  So you aren't really on your own as you would be today, you'll get to pay the same sorts of rates large corporations pay.  That is still expensive, of course, but not as expensive as you seem to be thinking.

[ Parent ]
No limit (4.00 / 1)
I see nothing at all in this bill that ensures market rates will be affordable. That's kind of a problem, don't you think?

Massachusetts assumed your scenario would come to pass, and it hasn't.

[ Parent ]
this is what i have worried about from the start (0.00 / 0)
it looks to me like the net effect of this legislation for me personally is going to be a) a 2.5% surtax and b) no health insurance. $500/month would be cheap compared to the plans that i have looked at (not that i'm eligible for any of them anyway), and it's still more than i can afford. for me that would be more than 11% of my income, but if i am understanding this correctly, that's just too bad so sad for me.

i have never been able to understand why they don't just use the income tax to cover the cost of insurance for people who enroll in the public plan. you could exclude some initial portion of income, and then add some fixed percentage surtax for income over that amount. with maybe an absolute cap, so that the most that you pay is X thousand or %N of your income, whichever is lower.

the very first thing that gets cut, always, are subsidies for poor people. either explicitly cut, or stealthily by just letting them fall behind rising costs. benefits have to go to everyone or they're toast.

ah well. good job Democrats.

not everything worth doing is profitable. not everything profitable is worth doing.

I can't imagine this staying (0.00 / 0)
It seems to me that it is important at the introduction to have it be minimal cost.  So they only help people pay for this up to 400% of income.  And even at 400% of income you still pay 11%!!!  And above that there appears to be no subsidy so you could pay even more than 11%.

And with this plan it comes out to adding nothing to the deficit, etc. In fact it will save more than it costs. (Overall, but not for the people who have to cough up for this mandate.)

BUT I can't imagine this staying like it is.  I just can't imagine this getting through without changing this so people up to maybe $100K don't have to pay ANYthing.  I just can't imagine them imposing this huge tax on people!

So I am imagining that this is part of a grand strategy to get a good plan in place.  


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Free insurance to those making $100,000 a year? (4.00 / 2)
Seriously?  Even Medicare for all would raise everyone's taxes much more than this.  I don't get where you are coming from at all.

[ Parent ]
That makes perfect sense to me (4.00 / 2)
If you're talking about a household income, 2 kids, $100,000 is really not very much. For people squeezed by debt, stagnant wages and poor job prospects, free insurance would be a HUGE economic boost.

Plus it makes political sense. Show me the government spending program benefiting the middle class that they have not fought to defend. Show me the government spending program NOT benefiting the middle class that they have fought to defend.

You're wrong on the policy and wrong on the politics.

[ Parent ]
That's why no bill is better than a bad bill (4.00 / 1)
Through the mandate, I'm forced to buy junk insurance. Going naked now, I pay nothing, and get nothing.

Under the bill, I'm going to end up paying, and then being denied care anyhow, because that's the way that insurance companies make a profit, and because the subsidies are already being framed as welfare, so they'll be cut.

That's an improvement why? Except, I mean, that it keeps the campaign contributions to the Dems flowing for another decade or so?

If this thing was any good, they wouldn't be implementing it in 2013. It's so transparent: Obama runs on solving health care in 2012, but he kicks the can down the road on doing anything 'til after he's re-elected. What does that tell you?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Well... (0.00 / 0)
Well I don't see it passing without meaningful subsidies.  And we have to make sure it doesn't pass without a good public option that is not junk insurance.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Public Plan, etc. (4.00 / 1)
Anyone who qualifies for the individual mandate (you aren't covered at work, for example) by a also eligible for the public plan.  No one is required to purchase private insurance.

Also, insurers are no longer allowed to drop customers for previous conditions or similar reasons, so the risk there is also far less than today.  (I don't trust them either and suspect they will find loopholes like late payments, so better to go with the public plan just to be safe.)

The 2013 date is a stupid little trick they use to get a smaller number from the CBO, who only looks 10 years into the future.

[ Parent ]
Oh, really? (4.00 / 1)
You mean the 2013 date isn't a stupid little trick to let the Democrats run on solving the health care crisis in 2012 before the reality of what they've done kicks in starting 2013?

Incidentally, 18,000 people die each year for lack of health care in our system, and that's going to keep happening until the system is fixed. So that stupid little trick is going to kill several thousand people.  Not a real confidence builder!!!

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Starting later reduces the 10 year cost on paper (4.00 / 1)
Ezra Klein (don't have the link handy) points out that the 2013 date appears to be so the CBO 10-year costings would come in under $1 trillion.

[ Parent ]
And you find that acceptable? (0.00 / 0)
Surely you don't find it acceptable that thousands die so a number on a piece of paper looks good in Versailles?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Of course not (4.00 / 1)
Unless, of course, the alternative is to not pass anything at all.

Washington politics is dumb-ass stupid.  

If you have any practical ideas of how to make it less dumb-ass stupid please share.  But simply pretending we can get what we want out of sure will power puts us into neocon territory.

The good news is many of the laws kick in before this.  Double check me on this, but I believe, for example, that community rating kicks in almost right away.

[ Parent ]
No bill is better than a bad bill (0.00 / 0)
Pelosi admits that public option is "next best" after single payer.

Don't the American people deserve the best? And with the Dems controlling the Presidency, the House, and the Senate (with 60 votes), why shouldn't they get it?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Subsidies (0.00 / 0)
I'm not getting why people who make more than the median wage should be subsidized.  We should be pushing subsides to the poor who needed it.

Everyone gets to purchase health care from national pool (only a state level pool in the Senate bill), giving you the buying power of a very large corporation, so you won't have to pay the same price a single person would be required to pay today.

Because (4.00 / 2)
Because the government is mandating that people buy insurance.  People do not like "unfunded mandates."  

Insurance is very expensive.   Many of the people who do not have insurance today can't afford it.  Simply ordering them to get insurance isn't the solution to that problem.

Even people earning the median wage can't afford to be socked with something like this.  Even if rates are lowered by the plan it is still a huge, huge amount of money per month.

But if the government subsidized this up to a fairly high income level it would cost us much less than what we paid to bail out the big financial companies, or the Iraq War, or the amounts in the bush tax cuts, or the amounts that we let corporations escape paying by pretending they have an address in the Cayman Islands, etc.  

It is just a matter of choosing priorities.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Hillary (0.00 / 0)
Back when I supported Obama over Hillary I made some similar points for a while, but eventually decided I was wrong.  The mandates really are better than not having them.  It is the mandates that get health care costs manageable.  The worst case scenario is your taxes go up 2.5% until you get health care.

[ Parent ]
No, the worst case scenario... (0.00 / 0)
... is that I'm forced to buy junk insurance, and then don't get care.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
No (4.00 / 1)
That can't happen due to the public plan option.

[ Parent ]
You are wrong (4.00 / 1)
Had you paused to consider lambert's point, you might have realized that if someone has to buy junk insurance - and there is no guarantee the public option will not be junk - then they are still not guaranteed care.

I don't see anything in the bill that ensures someone with insurance, public or private, will have certainty that they will get the health care they need when they need it. People will still be stuck in an insurance system.

[ Parent ]
That's why I was hoping that the ombudsman... (0.00 / 0)
... would have conflict resolution powers. But they don't. They're a lot more like a call center -- information, or advice.

If Mark wants to argue that the market power of the exchanges, which include public option, will drive out bad products, he needs evidence of that power. Unfortunately, Congressional staffers only expect 9 million to be in the public option by 2019 -- hardly enough to keep the insurance companies honest, even if such a thing were possible.

Alternatively, Mark might argue that minimum standards might ensure that no insurance is junk. But then he needs to show the standards are enforceable (see comment on ombudsman above). What happens when the insurance companies deny care? And he also needs to show that the insurance companies won't both write the legislation and then game it.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
I agree (0.00 / 0)
I agree that you can't reform health care without universal mandates (or just providing it to everyone), but without serious subsidies you can't impose this kind of burden on regular people and businesses.  It isn't fair, and it is political dynamite.

So you have two choices.  Either do it like this but put in meaningful subsidies to reduce the financial burden or just give everyone Medicare. (A start at paying for this is to look to companies that currently provide health insurance but won't have to anymore.)


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Tax (0.00 / 0)
At first I thought you believed a Medicare for all tax is better than a mandate, even if it cost the same.  Now I see you believe that companies that do the right thing today should be penalized for that and subsidize health care for everyone else.

At one level I guess I agree with you.  I certainly wouldn't mind the tax hike on the rich increased in order to subsidize others more.  But even in that case I disagree the subsidies should go as high as you are suggesting.  A family making twice the median household income (currently at about $50,000) need not be subsidized.

I will say this expense should be before taxes, though.  Employers right this off, so it is only fair for everyone else.  I'm not sure what the plan says on this account.

[ Parent ]
Penalize? (0.00 / 0)
Companies doing the right thing?  Penalize?  

My point was that companies now paying for health insurance would no longer be paying, so we could collect a portion of that savings, and come out ahead while the companies also come out ahead of where they are not.  That is a pool of funds that could be the starting point for extending Medicare to the rest of us.

Companies don't "do the right thing" they are companies -- bundles of contracts.  Chairs and hammers don't do "right" things either.  PEOPLE do.

And FYI taxes are not "punishments."  


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Now (0.00 / 0)
Where they are NOW, not where they are NOT.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Penalize (0.00 / 0)
Say you have two companies that compete against each other.  CompA pays health care and CompB does not.  Under your suggestion CompA would have some of that money transfered to CompB.  So now both companies enjoy the advantages of providing health insurance but only the company that was doing it before has to pay for it.  So yes, I think penalize is the correct term.

[ Parent ]
Misunderstanding (0.00 / 0)
Under my plan CompA would STOP paying $100 for health insurance and instead pay maybe $80 toward Medicare-for-All, netting a $20 gain over the current system.

But I grant your point.  Currently companies that provide health care are at a competitive disadvantage to companies that do not and what I suggested just extends that (while making it a little bit better for the ones providing insurance today.)  I was pointing out that this is a pool of money that gets freed up by a Medicare-for-All plan.  But you are correct in the bigger picture.  So what DO we do?

As with all things about our current economic paradigm the companies that can better externalize costs gain competitive advantage and pass those savings on to a few at the expense of the rest of us.  So we need to rethink the overall role of companies in our economy.  We need to better understand and deal with the concept of externalization of costs.  


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
What we DO (0.00 / 0)
Personally, I have no problem with the employer mandate.  Make the companies suck up the cost and pass it on however they may.  Since all companies must do this there is no competitive disadvantage.

Yes, anytime there is a change like this some companies will fail to adjust and go under, just as there will be other winners.  That's fine.  Rolling this in somewhat slowly helps with that adjustment as well.

[ Parent ]
Competitive (0.00 / 0)
Ah, but there is still a competitive disadvantage for companies competing with companies in countries that provide health care for their citizens.  Which is every other country but ours, I think.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
Perhaps (0.00 / 0)
The reason this isn't automatically true depends on how it is paid for.  If a company pays a higher tax instead of health care, then it cancels out, money being fungible and all that.

Small businesses and startups, though, are much better off with true single payer for a variety of reasons.

[ Parent ]
thing is (0.00 / 0)
overall per capita/gdp costs for single payor countries are about 1/3 less than US costs.  Single payor would probably save most companies which currently have healthcare plans quite a bit of money, probably even more than that, given how little tax so many companies actually paid (saving tax when you pay no tax = meaningless).  Of course, it depends on the details, but odds are pretty strong.  Full effect would take time to phase in, based on Canada's experience, call it 10 years or so.

[ Parent ]
Definitely (0.00 / 0)
I didn't mean to argue against single payer, it does a great job holding down costs.  Did you know the U.S. Government already spends the amount per capita other countries spend on health care, only they get universal coverage out of that and we only get piecemeal coverage.

But some of that is Americans, especially the upper class like doctors, etc., just make more than people in other countries.  But some of that very much related to single payer.

None of my arguments at this site should be interpreted as against single payer.  What I am against is rejecting some very important improvements to our current system just because something better is out there; something we just aren't going to get this time around.

[ Parent ]
You have to be kidding (0.00 / 0)
People making more than the median wage are suffering economically, particularly from high health care costs.

You're assuming this is still 1997 where making more than the median wage actually meant you had a shot at financial security.

[ Parent ]
It is all relative (0.00 / 0)
Those making more than the median may be suffering, but nothing compared to those making less than that.  And Dave is suggesting those making twice the median should be 100% covered.

[ Parent ]
Subsidies are a FAIL in the making (4.00 / 1)
The Dems have already set up the framing so that HR 3200 fails. For whatever reason, they can't frame health care as a right that all citizens should have (as they do, in civilized countries). What they did instead was create a system of means testing and subsidies for people who can't afford the service.

Means testing + subsidy == welfare.

Politically, framing public option as welfare is a total loser. They've set up Blue Dogs and Republicans to hack away at "entitlements" for the next few decades.  So what's going to happen on the minimum standards side is that the insurance companies are going to constantly try to cheapen what they claim to provide in their policies (and that's before we even get to denial of care). And what happens on the political side is that the right and the Blue Dogs constantly chip away at the subsidies. So, we end up paying more and more for less and less. Of course, if you want to keep the campaign contributions flowing from the insurance companies, it's not a FAIL, but a win. There's that.

The real solution is to abolish for-profit insurance entirely. Single payer would do that, of course.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
How is 19% of family income "affordable" (0.00 / 0)
Let's go through the numbers again. Average health care costs for a family of four with an employer-sponsored PPO are now $16,771. That is the average cost for a relatively healthy sector of society. Many with greater needs pay more than that. That is the average health care spending under the best of conditions in our current multi-payer system, and it doesn't even include insurer administrative costs.

Under this legislation, no subsidies are provided for individuals or families over 400 percent of the federal poverty level. For a family of four, that threshold is an income of $88,200. Thus average costs would be 19 percent of family income, and more for those with greater needs. By no stretch could that be considered affordable.

It's great that the concept of income transfer has been accepted by the policymakers in Congress, but they need to go back to the drawing board to craft a plan that would actually work. (Hint: Provide all necessary services for everyone, and pay for those services through a single universal risk pool that is funded equitably using progressive tax policies.)

Why not go for a solution that's proven to work, instead of a complex, untested, and experimental proposal?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

Maths (0.00 / 0)
Hey David, not to nitpick, but I don't understand your maths:

My wife and I currently pay about $850 a month for the minimal plan in this area under our COBRA... and certainly can't afford anything approaching $10K, public option or not.

Are you including the subsidized part of COBRA in what you're "paying" (e.g your out of pocket cost is less than $850 a month)? Because $850 x 12 = $10,200. As written, you're already affording 10k a year in health care costs.

Me | My Work | Future Majority

Yes (0.00 / 0)
The cost of our health insurance policy is about $10K.  It happens that the government is subsidizing that right now, which is the only reason we have it.


Seeing The Forest -- Who is our economy FOR, anyway? Twitter: dcjohnson

[ Parent ]
I don't get it (0.00 / 0)
Can anyone explain why the public plan isn't operational and open to people until 2013? I've heard they have to get the machinery up and running, and also they need to get funding in hand. Maybe. It seems, though, that it's fundamentally an accounting trick, so as to make it seem like they are under their target budget of $1 trillion over 10 years. What kind of significant reform is it that costs only $100 billion a year, anyway? The Iraq War costs about that.

Second, if the Reuter's report is correct that congressional staff expect only nine million people to be enrolled in the public plan by 2019, that's less than 9 percent of the 194 million people expected to have health insurance. I thought the main point of the public plan regarding cost containment and keeping the health insurance companies honest was that it would have enough enrolled that it would have the weight to drive down health care costs. How is less than 9 percent in a public plan going to do that? Yes, thsoe numbers would be added to Medicare's ability to bring down costs, but what kind of significant reform is that?

I don't have health insurance. I was expecting to be able to get on the public plan next year, 2010. Foolish and naive, that. This is crap.

And it seems like it comes down to an unwillingness to tax rich people more. Doubling the proposed surtax on the rich would raise the rates on those earning more than a million dollars to about 40 percent (far less than the top rate of 70 percent they paid under President Nixon). Doubling the surtax would allow greater subsidies for a wider range of income and it would allow the plan to kick in next year. We should demand no less.      

Correction on math (0.00 / 0)
Nine million of 194 million people with health insurance is less than 5 percent.

Worse than that (0.00 / 0)
As I wrote about, I think that 11% is WITH the subsidies, if you are in the subsidized range.  Above the subsidized range it is open season on the buyers, if I read it correctly).

zoft breast gum

Sounds like just another pile of Democratic crap. (0.00 / 0)
Day by day, I grow more and more convinced that this party has to go. This isn't health care reform, it is another give away to corporations.  

When I saw the sign behind Pelosi... (0.00 / 0)
"Health Reform for the Middle Class", I knew that, once again , the Dems were going to do nothing (or worse, ala the credit card bill) for the poor (many formerly middle class). I will remain on crappy Medicaid, BUT, they will actually CUT it (!) while adding more eligibility!! (But, you can always put it on the backs of the poor---we're all stupid and dont vote, or at least, we're not  big enough bloc, huh? Moral cowards...)

The best I began to expect of Dems is that they might not make things worse. After Clinton and Obama,I can no longer say that.

Nothing will change for me and I still will not be able to return to work (I need a surgery to use my hands enough to work) and my health caRE  may actually become worse...thanks again Dems.

I'll never vote for one again.

Why is there no consideration for those under the poverty level? Medicaid was supposed to be for poor AND disabled, but expanded when so ,many lost care. Now, it is just a dumping ground. HR 676 is the only way...maybe I'll just stop my meds and die, if all I'm ever going to be able to do is sit here, with a Masters degree....


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