Making the case for the compromise

by: Chris Bowers

Wed Dec 09, 2009 at 13:51


In the wake of the tentative Senate health care compromise, I am going to reiterate the case I made last night that the public option campaign was actually a real success.  While it looks like we didn't get a new public option program, we have received at least:

  • 4 million more people covered by Medicaid, which is a public option, than the July version of the House bill
  • 1-2 million covered by a Medicare buy-in, which is also a public option, and which was entirely absent in the July version of the House bill
  • An increase, from 85% in the July House bill to 90% now, in the percentage of money companies receive on health insurance premiums that must be spent on health care.
These are all concessions directly made to progressives in return for dropping a Medicare +5% public option that would have covered 10 million people.  Not bad.

The Progressive Caucus spent five weeks in September and October trying to round up support for health care reform with a Medicare +5% public option in the House.  While they came up about 10 votes short, they knew they were doomed to fail from the start.  A public option tied to Medicare rates had no chance of passing the Senate, and the CPC knew it.  As near as I could tell, the point of passing a Medicare +5% public option in the House bill was improve the bargaining position for the public option in the conference committee.  The hoped-for end point was a negotiated rats public option (which would have covered about six million people, but not as well as Medicare), plus concessions like the ones listed above.

At its fundamental core, the goal of the public option campaign was to get more people onto public health insurance plans.  The Senate compromise will result in 16-17 million more people entering public health insurance plans than current law.  This is down from 21 million in the bill that passed House committees in July, but it isn't zero.  How can a campaign that was designed entirely to get more people on public health insurance be a failure if it resulted in 16-17 million more people receiving public health insurance?

Assuming for a moment that the Stupak language is defeated, the major objection I am still seeing to this bill from the left is that some people will be facing a mandate without the choice of a public option.  Specifically, that means people between the age of 27 and 54 (inclusive) who do not have insurance from their employer and whose income is above 133% of poverty level.  That is certainly a substantial group of people, numbering somewhere between 20 and 22 million.

That group, however, will still receive substantial subsidies to purchase insurance, and several thousand lives will be saved every year as a result.  Further, now 90% of the money they spend will go to health care, up from the current national average of around 70%.

Covering 16-17 million more people on public health insurance than current law, among an overall decline in the uninsured population by 30-35 million, with a cut in health insurance industry waste and profits from 30% to 10%, is, in my estimation, much better than the status quo.  Public insurance rolls will be increased, lives will be saved, and industry profit margins will take a real hit.  If a $95 per annum mandate penalty in 2014, and a $750 per annum mandate penalty in 2019, makes all of that too much to swallow for you, I am not going to argue with you.  But there is a strong case to be made for this compromise.

Chris Bowers :: Making the case for the compromise

Tags: , , , (All Tags)
Print Friendly View Send As Email

When people finally realize what the Democrats have done (4.00 / 4)
by requiring mandates, they will punish the party for it. No amount of spin is going to change that.  

Getting health insurance isn't spin (4.00 / 2)
Having or not having health insurance isn't spin. It is an objective reality that people face.

And far, far more people will get health insurance because of this--at least half of it low cost, public run health insurance--than will ever pay a mandate penalty.

The political results will be based on the degree to which this improves people's lives or not. And it will improve people's lives.


[ Parent ]
Possibly a short-term political bludgeon... (0.00 / 0)
Since even the Medicare option doesn't seem to be put into place until 2011, it probably will be used as a talking point going into the 2010 elections.  Democrats will need an answer.

On the other hand, I keep seeing analysis suggesting that we'll still be at more than 10% unemployment even with another jobs package, which probably means that 2010 is going to be extremely ugly and there's not really much Dems can do about it.


[ Parent ]
I don't think it will (4.00 / 8)
improve many people's lives--no more than the 1996 HIPAA did.

People with pre-existing conditions will now have the privilege of paying into high-risk pools so that insurance companies profit even more from their new healthy customers.

Given the way this bill has come together, I assume that pretty much every good provision is written with loopholes.  

Join the Iowa progressive community at Bleeding Heartland.


[ Parent ]
Yeap- your assumption is probably correct (4.00 / 2)
From the read of it that I have as well. The key element that Chris glosses over time and again is the junk insurance issue. Any insurance is not better than no insurance if it  

[ Parent ]
Job losses, too (0.00 / 0)
Personally, the Senate bill is a disaster.  My long time girl friend runs a surgical practice in Manhattan with four surgeons and fifty employees.  The practice lives off a relatively small number of Cadillac cases plus very wealthy foreigners.  These may be less than 20% of cases, but they provide most of the doctor's income. The Baucus bill might cut revenue by 50% and that will probably mean substantial layoffs to fund insurance company greed.  My guess is that the doctors would push for 20 people to be laid off.

And that means poorer service.  Longer waits between calls.  Maybe robo-calls replacing people to remind about appointments.  Coordination for testing, prescriptions, and other services would go out the window.  Ancillary services like physician assistants would be scaled back a lot.  Billing, not so much.

I suspect, she would survive the purge but many would not.  Obama said he would not touch the insurance companies because of the economy.  Well, he is making a bigger mistake.  Add in the mandatory payments for crappy service and it is third world here we come.


[ Parent ]
Why are you assuming (4.00 / 3)
that the community rating rules will not apply? Under every version of the bill I have seen people with pre-existing conditions will be in the same risk-pool with everyone else once the bill fully kicks in. And in the final House version that provision starts right away.

Plus I find it endlessly amusing that most of the people complaining about the mandate are pushing a Single Payer plan that will cost them more than the penalty every would. There is good reason to despise insurance companies but that doesn't mean blinding yourselves to reality about what the comparative costs would be. Under Single Payer everyone is forced to pay for insurance for everyone. Which is okay by me, I am a Social Democrat. But somehow certain progressives have managed to convince themselves that Single Payer is cheaper than the mandate penalty would be.


[ Parent ]
Of course... (4.00 / 2)
...the mandate penalty get you exactly nothing.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
A ticket for not having proof of insurance (0.00 / 0)
on my car gets me exactly nothing.

People are getting tangled up with semantics. There are hundreds of occupations that require you to be licensed and often bonded. If you cannot produce a copy of that license and proof of insurance then you can get fined (or depending on the profession jailed). Among other things these licensing and bonding requirements are designed to prevent you from externalizing your risk and negligence. The fine for not having proof of acceptable health care coverage is no different.

The fee for not bonding to cover your risk for a catastrophic injury or illness is as much as $750. Why this is some huge injustice while requiring a general contractor to bond simply so that he can do a remodel is not is beyond me. I mean I get the glibertarian argument, but not the progressive one. Congress has decided that in order to promote the general welfare it is necessary to get every American to put up a bond in the form of health insurance. What is the big deal?

Western Washington was a pioneer in the area of establishing Medic One service. And one way or another everyone here has to pay a mandatory fee to support an enhanced ambulance system. The lucky ones get exactly nothing for that particular health insurance mandate.


[ Parent ]
As I've said below, there's a world of difference (4.00 / 3)
between a government levying a tax to provide a service directly vs. a government using the force of law to compel people to buy a private sector product, which is nothing more than naked corporate welfare.

Fees to do business or requirements to buy auto insurance are completely different, because people choose to go or not go into that business, or to drive or not to drive.  However, there is almost no escape from a health insurance mandate because it applies to everyone who lives.  Yes, people can choose to die, but for most people that's not an acceptable choice, and furthermore the right to die in the USA is not airtight.

And yes, I believe that government should directly sell/provide auto insurance, as well as any other service that would fulfill a legal mandate.


[ Parent ]
Optics and political viability (4.00 / 3)
Liberalmaverick addresses the voluntary nature of your examples vs. a penalty requirement for citizenship in the country. I want to address what you call (dismiss as?) semantics, which I see as optics and the political viability of a mandate penalty.

I have no problem with a 'penalty,' tax, assessment -- whatever semantics you prefer -- for those who choose not to purchase health insurance. They're transferring their risk to the rest of the body politic and ought to charged accordingly. The problem I have is there's nothing in the design of the penalty to demonstrate a) that they're being charged for the public cost of their risk or b) that their penalty payment gets them something specific and tangible in return. They're going to see it as a $750 penalty that gets them nothing. You and I know that's not true, but they don't. That's a real, political problem.

What I would prefer is the smallest possible 'penalty' that enrolls them a 'safety net' type program. Give them an ID card that entitles them to triage in an Emergency Room or Urgent Care and Medicaid catastrophic coverage when their financial resources are gone. This is, in fact, what they are getting, so make it explicit. To put it in semantics, call it a 'mandatory safety net enrollment fee,' not a 'penalty.' Codify the 'safety net' benefits. Give them a 'safety net' ID card. They still may not like it, but at least there's some identifiable connection between the money they're paying and the benefits the government is providing.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans


[ Parent ]
Wholeheartedly agree (0.00 / 0)
That "penalty" money the government takes away from people has to go towards something. (Does the legislation even specify where that money is supposed to go?)

[ Parent ]
Good question (0.00 / 0)
I assume CBO scores it as a credit against the overall cost of the bill, so money being fungible I guess you can say it's going for health care. Of course, low information citizens forced to write the penalty checks won't see it that way. They'll just be pissed at Democrats...

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
If that money is just going into the general treasury (0.00 / 0)
what's to keep it from going to, say, the war in Afghanistan, or a bailout for big banks?

I know money is fungible but the increase in revenue as a result of the penalty is a tangible amount that could be directed into the budget of something that has nothing to do with health care.


[ Parent ]
what I find funny about you Bruce is that on (4.00 / 3)
mydd you were attacking me for the attitude that you are putting off over here. But, then as I suspected at the time, it was disagreement rather than the tone of what I said that truly bothered you.

For the record, I am not a single payer advocate. I am, however, an advocate of functioning healthy markets. Something that the insurance markets are guaranteed now not to be.  


[ Parent ]
You could be more specific (1.33 / 3)
Because generally I don't stop to count the people I smack down.

But if you think I am impressed by your guarantees then think again. Some insurance markets function well, others not, a blanket assertion like yours is pretty much worthless and based on an authority you have not demonstrated.

A fully sufficient response here would be "Who says?"


[ Parent ]
You are just wrong, and won't see it for some time (0.00 / 0)
The truth is there is a simple solution to this- fight to end the mandate for those 27-54 or only require the mandate when the public option or some other public insurance is offered. Tie one to the other.  

[ Parent ]
You have a narrow vision (4.00 / 1)
I agree that the mandate needs to be removed or weakened.

However, to think that the mandate is the only provision of this bill with any political consequence is simply taking a far too narrow vision of the overall bill.


[ Parent ]
I am focused on junk insurance amongst other issues (0.00 / 0)


[ Parent ]
The Junk insurance argument is itself junk (4.00 / 4)
Where are the loopholes in the 'Acceptable Benefits Package' language? What part of open enrollment, guaranteed renewal and prohibition of rescissions allows the kind of cherry picking people assume will continue?

Opponents of the mandate seem to be working from the assumption that the lead authors of the original forms of these bills, i.e. Kennedy, Dodd, Dingell, Waxman, Brown, and Rangel and their staffs were either in cahoots with the insurance industry or simply blind to their past history and so willing to deliver millions of Americans into the bloody maws of private insurance providers.

The question progressives need to be asking themselves is "How did Kennedy and Dingell, each with decades of experience in this, propose to address this or that form of gaming?" and then examine the bill language to see how well or poorly they did so. Instead the level of analysis for critics rarely seems to rise above the level of "Oh man, we are so fucked!"

There is reason to be suspicious of the Senate Bill, because SFC openly scrapped the more progressive HELP Bill in favor of a Conservadem alternative, but both the orginal House Tri-Committee Bill and Pelosi's ultimate version are pretty tightly written. Dingell didn't devote his entire career to this issue just to sell you out at the end. Yet people continually work from a model that would have the insurance companies perfectly free to operate in the future as they did in the past only this times with millions more customers mandated to buy "junk insurance". Well they can't, even under the worst versions of this bill the benefits package and limits on out of pocket expenses are a hell of a lot better than current industry standards.


[ Parent ]
My sister lives in a state with junk insurance (4.00 / 2)
I know from personal experience that the concept is not b.s.

I am working from the assumption that like you and others who post here that in the zeal to get a "deal" they were willing to compromise. Those compromises will later be used by the insurance industry to create regulatory loopholes. This is why they hire very good lawyers in regulated industries because no regulation can be perfect regarding an enterprising lawyer trying to get around it.

I am also working from the assumption that having observed the behavior of the Congressional Democrats thus far- it leaves a lot to be desired. I look at things like the financial industry regulatory reform effort, and I see exactly how the loop holes form.


[ Parent ]
He didn't say the concept of junk insurance was BS. (4.00 / 1)
He clearly said the "junk insurance argument" was incorrectly applied here.

It starts by assuming what needs to be proven: that all politicians, Dem as well as GOP are by definition corrupt sellouts (or they wouldn't have made it as far as they have) and that corporations can get around any regulation.

Now of course, there's more than a little truth to those ideas.  But if you really believed all that, that strongly, then you wouldn't be messing around with any laws, you'd be out there organizing the revolution right this minute.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


[ Parent ]
I responded to the rest of what he said (0.00 / 0)
Which begs the question of did you read my response because it refutes the assumption he makes about how loopholes happen.  

[ Parent ]
Regulatory capture is a problem (0.00 / 0)
Yes.  But it's also an argument for never trusting the government to do anything right - a two edged sword.  I could use that argument to oppose any law you might want passed.

(And if that wasn't enough, we now have the Supreme Court ready to overturn the laws that convicted Jeff Skilling and Conrad Black.)

Loopholes happen because corporations are more powerful than we are.  At this point in time, short of single payer (maybe), there's no Health Care bill you could write that couldn't be screwed with the private insurers and Big Pharma.  Certainly the Public Option that was on the table wouldn't have helped against this problem.  Your idea of making mandates contingent on a Public Option is not a bad one, but we couldn't even get the crap Public Option through, so what chance did this have?

The mandate issue is important but perhaps not as important as you think it is.  They don't have mandates in other countries - they have another mechanism for funding Health Care.  It's called "taxes".  But that's a bigger issue than Health Care.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


[ Parent ]
You make the argument for my position better than I do (4.00 / 2)
"Loopholes happen because corporations are more powerful than we are.  At this point in time, short of single payer (maybe), there's no Health Care bill you could write that couldn't be screwed with the private insurers and Big Pharma. "

The purpose of the public option to use market mechanisms to do what regulations could not. Competing by giving a better product, and thus, producing an elegant solution to the flaws of regulation. If you can not get the crap public option in the bill, then don't include the mandates. That's the solution because then you don't have to worry about loopholes that trap voters with purchasing junk insurance or paying  a fine for not doing so.

Other countries are not applicable because we refuse to go where other dcountries go. Even the Franken amendment is a half ass attempted at price controls, but it is not truly price controls.

Part of the issue here is that many do not seem to appreciate that my arguments are trying to balance off different variables in a complex system to get them to work together. One without the other leads to a break down. What we were attempting with the PO was  a first time experiment. The idea was that all the moving parts needed to be there to work. Once you take the PO off the table, the other moving parts cease to have their function, and like with the mandates and junk insurance take on a more malicious relationship to the system.

Finally, you make an absolute statement that reflects the truth of why CHris, you and others are so willing to capitulate. It is summed up here:

"Loopholes happen because corporations are more powerful than we are.  At this point in time, short of single payer (maybe), there's no Health Care bill you could write that couldn't be screwed with the private insurers and Big Pharma. "

THis mindset in a nutshell sums up DC and apparently a great bulk of bloggers of the A-list variety.

The options are limited, but they are not limited to just single payer.  This is why when the robotic thinkers post assuming I am a "single payer" supporter I sometimes laugh. It just demonstrates how captured the thinking is on these issues.  Single payer would have been the best for pricing, but it was never the only choice. The other choices, however, required a far more complicated process that required multiple moving parts. If any part of that system breaks down- the system is not going to work properly.

THere are other models in the world that work. The problem is that we have chosen none of the above with people claiming to be progressive once again rationalizing poor policy that will come back to bite us in the ass years from now.


[ Parent ]
I couldn't agree more (0.00 / 0)
Especially about the fact that there are multiple options.  I tell people this all the time. It isn't that we had to have one particular solution.  If I was emperor for a day I could come up with a dozen different ways of meeting the twin goals of universal coverage and cost reduction.

[ Parent ]
I won't reply in this tiny space. (0.00 / 0)
Instead, I reply here.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
"reasonable and customary" (0.00 / 0)
Recall that a large percentage of all bankruptcies result from people whose insurance decided not to cover parts of their treatments that were deemed medically necessary by the physician or otherwise pre-approved by the insurer.  Reasonable and customary is a loophole you could drive a truck through.

[ Parent ]
It is not up to the insurer (4.00 / 1)
Under the bill the decision is the physicians as long as it falls under accepted clinical standards, the insurers have no discretion.

[ Parent ]
check out the relationship between (0.00 / 0)
Big phrama and doctors to understand why I laughed a little bit reading your post.

[ Parent ]
I don't see your point (4.00 / 1)
Big Pharma is a provider, doctors are providers. They collude to over deliver care. Insurers are out to deny care.

Now over delivery of care is a societal problem that drives up costs for everyone and so needs to be addressed collectively. Denial or under provision of care effect the individual and so can lead to individual bankruptcy in a way that a systematic societal overcharge doesn't. Which was the issue that marxmarv raised.

You raised yourself a strawman, lit it on fire and are trying to have a chuckle at my expense because it is burning. Dude it is not my scarecrow, and you are burning it in somebody else's field.

Sorry I hurt your feelings, but really you need to sharpen your analytical tools. Try not operating on the principle of 'Ready, fire, aim'.


[ Parent ]
See my reply to Bowers just below (0.00 / 0)


[ Parent ]
Right (4.00 / 1)
People will grouse at the mandate - I certainly will - but if it turns out that the required insurance is affordable, the grousing won't become an electoral issue.

However, if the mandate is expensive, inadequate, and complex, then it will become an electoral issue.


[ Parent ]
Why would it be affordable? Where (4.00 / 1)
are the mechanisms that would force such a thing?  

[ Parent ]
In the bill language. (4.00 / 1)
Which most people seem not to have bothered to read, instead relying on Kip Sullivan's opinions (hint, that JD after his name means he is by training an advocate and not an analyst).

The bills have limits on premiums as a percentage of income and hard limits on total out of pocket expenses. They also have premium and cost-sharing affordability credits for families making up to 40% more than the median family income. Yet every time I see a number cited it seems to take the premium dollar paid from a family making $90,000 and which also maxes out its annual cost-sharing cap and presents that as typical.

Now obviously there are differences between a bill that kicks in affordability credits at 133% of FPL and tops them at 300% and a bill that raises Medicaid eligibility to 150% and then tops credits at 400% of FPL (which is the range within which all these bills are operating) but the assertion that such mechanisms simply don't exist at all just doesn't survive encounter with the bill language. Are they inadequate? Well make a case. Are they non-existent? No they are not.


[ Parent ]
I can make a case for that... (4.00 / 5)
The subsidies are indexed to inflation, like CoLAs at some people's place of employment.

In just the last decade, Medical costs and insurance premiums have risen much faster than inflation.  Eventually, the subsidies will not be enough to cover the costs, since the best mechanism for cost control was watered down to nothing, then traded away for who knows what.


[ Parent ]
Sssshhh , you are not suppose to think (0.00 / 0)
down the road:

"
"According to "Paying the Price: How Health Insurance Premiums Are Eating Up Middle-Class Incomes," employer-sponsored family plans will rise from an average cost of $12,298 in 2008 to $23,842 in 2020 (the same coverage would have cost close to $9,200 in 2003) if health-care costs continue to rise at the current rate.

The study found that:

The rapid rise in health insurance premiums has severely strained U.S. families and employers in recent years. This analysis of federal data finds that if premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020--a 94 percent increase.

However, if health system reforms were able to slow premium growth by 1 percentage point in all states, by 2020 employers and families together would save $2,571 per premium for family coverage, compared with projected trends. If growth could be slowed by 1.5 percentage points--a target recently agreed to by a major industry coalition--yearly savings would equal $3,759. The analysis presents state-by-state data on premium costs for 2003 and 2008, as well as projections, using various assumptions, for costs in 2015 and 2020."

http://www.huffingtonpost.com/... without-reform-health-ins_n_266589.html

Healthcare data from 50 states:

http://www.dailykos.com/storyo...

Certainly, don't point this out as to why inadequate subsidies will be a problem:

""From 1999 to 2007, average insurance premiums have risen 120%, while US wages (on average) have risen only 29%.  Moreover, in that same time, the profits of health insurers have risen 428%!"

http://online.wsj.com/article/... 6304052223.html

Better to declare victory and call anyone who disagrees with you a purist.


[ Parent ]
This isn't a cost control bill (0.00 / 0)
If is an affordability and access bill for people primarily aimed at the 50 million people who don't have insurance. And it does have measures to control premiums by setting limits on the share of each dollar that can be collared by the insurance company.

But the overall issue of medical cost control needs to be addressed separately in order to ensure that people who do have adequate coverage don't lose it going forward. Frankly the demand that this bill do everything all at once and finance itself within existing medical care spending was an exercise in cowardice by Obama and Reid. That the overall trend of medical spending is unsustainable is not an argument that the proposed mechanism for interim funding for 50 million people simply does not exist.

You asked a question. I answered it. Then you changed the subject. Which is the oldest and cheapest debating trick in the toolbox.


[ Parent ]
Being forced to buy health insurance that you can't (4.00 / 2)
afford or face the hammer of the government isn't reform.

Unless we believe triggers work now. I heard they didn't.  


[ Parent ]
Why would you not (4.00 / 1)
be able to afford it? Given the actual provisions of the bill? At exactly what level of income and family composition would this burden be too much? How many Americans are in that income band? And where does this "face the hammer" come from? There are stories floating around that the Pelosi Bill would subject you to $250,000 fines and/or five years in jail for non-compliance. Well all of that is in origin bullshit coming out of Republican Dave Camps office that relies on a total misreading of a Joint Committee on Taxation letter directly solicited by Camps to support a particular wingnut talking point. Yet too many progressives seem to have internalized every right wing talking point against these bills in a misguided attempt to sell Single Payer.

Well we are not going to get anywhere by adopting the techniques of Faux news over actual analysis of what is actually in the bill and what is not. "Face the hammer" has as much real world credibility as "death panels'.


[ Parent ]
Is there a table or a graph somewhere... (4.00 / 1)
... that might show some of the variables you mentioned (income levels that "trigger" subsidies vs population at those levels for example) within these different versions of the bills?  I'll google it too, but if you have some handy I'd love to see them.

[ Parent ]
There is a matrix (4.00 / 2)
That shows premium limits for various ranges of income between 133% and 300% or 400% of FPL in the various bills in the Affordability sections. But you would have to go else where to actually see current FPL for singles and families and then consult census information to figure out how many households were in each range. And then control that for differing cost of living figures within any given SMA or state. So getting a detailed breakdown would be difficult.

The short version is that there is a sliding linear scale of premium limits that starts at 1.5% of income at the bottom and tops out at either 11 or 12% at 300% or 400% of FPL at the top of the subsidy range. Meaning that all families earning under around $88,000 get some level of subsidy. Which is a huge slice of the population given that median household income is something like $50,000. Given that most people making more than $88k are likely to be covered under some sort or group coverage and mostly employer paid/subsidized the number of people simply left unsubsidized would seem to be pretty small. And for people earning under say 250% of FPL the subsidies are pretty damn good. And 250% is pretty close to median household where that household is actually a family, and even for a single person it is certainly a living wage most places (top of my head calculation around $12.50 per hour)


[ Parent ]
$12.50 as a living wage? (0.00 / 0)
Not in any relatively densely populated area of the country.  But I guess what's good for Kansas is good for California.  Somehow.

[ Parent ]
Thanks (0.00 / 0)
This helps me wrap my mind around it.

[ Parent ]
Low cost for some, not for others (0.00 / 0)
Those who are not subsidized are going to pay for everyone else's coverage.

Nothing in the bill gets insurance companies to lower their prices -- or even to stop raising them at ridiculous rates.

Even that 90% ratio is deceiving. Sure, insurers have to put 90% of earnings into medical care, but look at how that plays out, using big round numbers to make a point:

- 90% of $100 million for medical care leaves $10 million in profit.

- 90% of $100 BILLION for medical care leaves $10 Billion in profit.

Which do you think Wall Street and insurance execs prefer? The higher revenue number with the higher profits.

One of the big questions not answered is how much more will the average wage-earner pay for health insurance now than before?

Also, are there any loopholes that will allow insurers to continue to deny coverage or cap benefits?

Also, thank you for all your hard work on this.

   


[ Parent ]
Numbers (0.00 / 0)
If the numbers change from 70% to 90%, then they would need an increase of 30% in their insurance base to make up the difference.

That isn't going to happen in this bill. It will be more like a 10% increase.

I appreciate your point, though.  It isn't as straightforward as it seem.


[ Parent ]
Sigh (4.00 / 1)
First the 90% MLR is for payments to providers. All administrative expenses  and marketing costs have to come out of the 10%, it is not all executive compensation and profit.

Second with a little work you can answer the question of whether the average wage earner will pay more or less. It does take scoring different family compositions at different income levels and then comparing existing benefits packages to that of the minimum Acceptable Benefits Packages of the various bills. The honest answer is that some will pay more and some will pay less. But that is equally true for Single Payer. The key factor in this bill is that it prohibits annual or lifetime limits and establishes hard caps on out of pocket expenses in a way that will eliminate medical bankruptcy. A bad medical year might wipe out your savings, but it won't leave you bankrupt and homeless. Not to mention that the phrase "medically not-insureable" will pass from our collective vocabularies.

Third all of the bills are pretty tightly written in ways that prevent insurers from denying coverage or capping benefits. By year five even existing insurance plans will with certain voluntary exceptions by the insuree have to be up to QHBP (Qualified Health Benefit Plan) standards which mandates coverage for a broad range of treatments (established externally to the insurance companies) and without annual caps. Basically it works like Medicare, if your doctor prescribes normal and necessary care it is not at the discretion of the company to deny that care based on their own internal guidelines or formularies.

Fourth the subsidies continue, at admittedly lower rates, right up to the point that singles or families are enjoying pretty comfortable incomes, at least outside places like Manhatten or San Francisco. If you are making more than $44k as a single or $88 as a family under the House Bill or $33k or $66k under the Senate Bill you will be paying to subsidize others care. But this would be equally true at those income levels if we were going Single Payer, and for that matter that is true of Medicare today.


[ Parent ]
Hate to be a dittohead (0.00 / 0)
But, these are really great points. I think this comment should be "featured" on the front page with Chris's original post.  

[ Parent ]
But this would be equally true at those income levels if we were going Single Payer (0.00 / 0)
The difference being that we would, you know, be getting single payer. Rather than the increases going to line the pockets of insurance CEOs.

[ Parent ]
To respond to both Bruce and Spitball (0.00 / 0)
Single-payer wouldn't necessarily mean a flat tax for all Americans to cover the cost of health care, would it?  

My understanding of single-payer is that the idea would be that instead of placing the burden on the healthiest to pay for the sickest which is what this current bill seems to be indicating it will do, single-payer says that the richest pay for the poorest (and we all pay some of the bill).

In other words, right now if Medicare starts at 55 and up, and subsidies kick in at 133% and down then then people who are young and outside of poverty will pay the bulk of either the insurance industry who will dump the higher risk old folks on Medicare OR the mandate penalties.  It won't matter if those young people have the income to afford it or not, they are the ones who will pay.  Correct?

To make a broad and over-simplified analogy that would be like saying the military will be paid for by the people who need protection the least.  OF COURSE we should all pay for military protection, but as a moral principal we should ask people to pay what they can afford and not base the payment on who needs the military more or less (you know, we all need a military AND we all need health care).

I'm really just trying to figure this out, so tell me your thoughts.


[ Parent ]
What's a little socialism, just between citizens? (4.00 / 1)
Those who are not subsidized are going to pay for everyone else's coverage.

That is the definition of subsidy when the people are the government, no?


"It sounds wrong...
     ...but its right."


[ Parent ]
This has not been the case (4.00 / 1)
in Massachusetts, where essentially this plan was implemented.

[ Parent ]
No matter how many times this bill changes, someone says (0.00 / 0)
"this was tried in Massachusetts"  

There have been, and still are about seven hundred versions of Reform wending its ugly corrupting way through Republicans and conservadems, but everyone has been tried in Massachusetts.  

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
What I am referring to (0.00 / 0)
is the mandate to buy private insurance.

[ Parent ]
Ah yes, good point (0.00 / 0)
And almost all versions of reform since the primary has had the mandate.

Although I chuckled, you are correct.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
CBO scoring (4.00 / 2)
I may be wrong, but I think that getting rid of the mandate would make the overall cost of the package higher, creating another problem to negotiate with conservadems.

I agree that a mandate is a messaging problem for Dems (maybe not as big a one as bruhrabbit, but maybe bigger than Chris thinks), but nearly all the economic analysis I've read says that a mandate is a pretty significant way to cut overall costs. Maybe my impression is wrong, but I think getting rid of the mandate would necessitate cutting other costs or increasing revenue to make the CBO scoring come out the way the conservadems want it.


[ Parent ]
Mandates are necessary, morally and fiscally. (4.00 / 3)
The whole slogan "everybody in" implies everybody chips in, and you can only do that with a mandate. I don't want mandated private insurance, so it is important that we have AT LEAST the public option.

But, Chris makes an important point that a mandate will increase the number of people covered. Whatever other problems Massachussetts has, coverage has increased dramatically.:

Assuming for a moment that the Stupak language is defeated, the major objection I am still seeing to this bill from the left is that some people will be facing a mandate without the choice of a public option.  Specifically, that means people between the age of 27 and 54 (inclusive) who do not have insurance from their employer and whose income is above 133% of poverty level.  That is certainly a substantial group of people, somewhere between 20 and 22 million.

That group, however, will still receive substantial subsidies to purchase insurance, and several thousand lives will be saved every year as a result.

From a moral standpoint. Mandates will save lives.

From a fiscal standpoint. Mandates remove free riders.

Again, I hate the idea of subsidizing insurance companies, their profits and their waste, but...


[ Parent ]
Next up, Obama solves the problem of Food Insecurity (4.00 / 2)
by simply mandating that we all eat at Denny's.

The week after that, he will solve poverty by mandating that we all bank at Check Into Cash&trade.


[ Parent ]
Single Payer is a Mandate (4.00 / 2)
I get the Red State argument against mandates, God forbid we take an ounce of freedom away from a glibertarian simply to achieve some social justice end. But I find the argument odd from OL commenters.

No one is forced to enroll in Medicare. On the other hand everyone in wage or self-employment is MANDATED to pay in. Would it help if we called the new fine a 'Universal Coverage Health Care Tax' and then gave everyone who could prove they had 'Acceptable Coverage' a tax credit? Which operationally is exactly the same thing. People seem to be hung up on the semantics.


[ Parent ]
Yes, we're in agreement. (4.00 / 1)
I would also prefer Single Payer Insurance as a guaranteed entitlement (if that's not redundant). And, taxes would be a more progressive way of paying for it than by user fees.

Generally I would prefer the more progressive mechanism, but I think it is important for everyone to have both the benefit and the contribution...at least with subsidies.

It is interesting that the dreaded mandate was one of the biggest arguments against the Massachusetts plan, but in practice that hasn't been the issue. Access and delivery apparently have been harder than concerns about the mandate itself.


[ Parent ]
It's not the same (4.00 / 3)
People paying a fine will getting nothing tangible for their money.  As far as they're concerned their money is just disappearing down a dark government rabbit hole.  It might go towards subsidizing their care eventually but that will be in no way apparent to them now. (Does the legislation even specify where fine money will go?)

Also, as a civil/personal liberties libertarian myself, I draw a big line between government levying taxes for a social service (like Medicare for All) and government telling people what to do with their money (like buying insurance).  It's like the difference between government trying to control health care costs by extending Medicare for All vs. government trying to control health care costs by legally mandating that everyone goes to the gym five times a week.


[ Parent ]
I detest the idea of being mandated to buy insurance from ass------ (4.00 / 1)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
How much does Medicare actually cost? (4.00 / 6)
Brad DeLong seconds Robert Waldmann seconding Ezra Klein that one really good thing this will do is make people really see what a good deal Medicare is compared with private insurance.

http://feedproxy.google.com/~r...

The cost of a Medicare premium will start becoming common knowledge - that's really a big deal in terms of political messaging in the future.


And will rachet up the pressure... (4.00 / 3)
...to open the Medicare buy-in to more people. A foot in the door toward Medicare for all is better than the weak public options.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
How does that work, exactly? (0.00 / 0)
The theory is that people will say:

"Hey! I didn't know they could lower the age of eligibility for Medicare! I will now grouse and grumble until they lower it some more!"

But there's no proof that this is how it's going to work out. I would be more inclined to think that voters feel their millionaire representatives have set an arbitrary age limit on medicare, in their arbitrary way, and recent events have shown that the American people are in a poor position to affect the arbitrary whims of their millionaire elected representatives.


[ Parent ]
Well Medicare age was not set arbitrarily (4.00 / 1)
Instead it was tied to Social Security and standard retirement age. I don't know when 65 began being the normal age for full retirement or whether Social Security was the chicken or the egg in establishing it but legally and practically Medicare has always been bound at the hip to Social Security. You reach full retirement age and file for Social Security and your Medicare card.

So to the degree that extending Medicare to age 55 breaks that mental tie I think it could well open Steve's door.

Speaking solely and selfishly for me, I am just about to turn 53, am uninsured and uninsurable on the individual market, and if this provision passes will immediately start counting the days to my own eligibility while openly whining "Why not me? Right now!"


[ Parent ]
Like this (4.00 / 2)
Meanwhile, the Medicare buy-in lets people in the broader insurance market see what national bargaining power can do for individual premiums. Right now, Medicare's rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare's superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we'll see how long it is before representatives begin getting calls from 50-year-olds who'd like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.


Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
We'll see how long it is... (0.00 / 0)
But if the premiums become visible, and Medicare's superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we'll see how long it is before representatives begin getting calls from 50-year-olds who'd like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.

They can call all they want. 75% of Americans wanted a public option, what did they get?

But let's say you're right, so in, what, fifteen or twenty years maybe they drop the eligibility age to 50, then another fifteen or twenty years to get it to forty.

At that rate - Hey presto! We'll have medicare for everyone in just sixty or seventy years!

Feel the power of the progressives.


[ Parent ]
Cost of Medicare premiums. (0.00 / 0)
Unsubsidized: approximately $600.  If anyone's got better information or a better source, I'm all eyes.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.


[ Parent ]
Counting Eggs Before They've Hatched (4.00 / 1)
"These are all concessions directly made to progressives in return for dropping a Medicare +5% public option that would have covered 10 million people.  Not bad."

We didn't gain any 'concessions'.  All the Dems did was unilaterally state that we were willing to abandon the public option without securing any commitment from so-called centrists.  These "concessions" you claim that we have won are merely the left-most starting point in a new round of negotiations and compromises where they too will be whittled away into something toothless and ineffective by centrist Dems like Lieberman (who won't even say whether or not he supports the compromise).  We haven't won anything and we just gave away one of the largest guns in our arsenal.  


No, they are the right-most point (4.00 / 1)
This deal was forged with all of the problem Senators, save Lieberman.  And Lieberman sounds open to it--his major objection is the trigger, which I could care less about.

This isn't a proposal floated by the leadership to try and win over Lincoln, Landrieu and Nelson.  This is an agreement forged with Lincoln, Landrieu and Nelson.  That is why it is a right-most starting point, not a left-most.


[ Parent ]
Not sure the trigger is that bad... (4.00 / 7)
Even so, maybe Olympia Snowe votes for this trigger and we can dump Lieberman.

God I wish that CT had gotten rid of this lying asshole in 2006.


[ Parent ]
How much flesh will Lieberman extract? (4.00 / 2)
If the deal included everybody except Lieberman, then I suppose Lieberman will be the only person abusing his status as the 60th Senator to mandate that the bill adequately cater to the Insurance industry.  I don't know why you think that guy is trustworthy at all.  Every chance he has had, he has stuck the knife in the backs of progressives and the Democratic party.  He ferociously backed the war in Iraq.  He ran against his own party's nominee for Senate.  He endorsed McCain.  And now he's going to fuck us over on Healthcare just like he's reliably done so many times before.  

If Lieberman didn't commit, then all of those 'concessions' that 'we won' are Candyland fantasies made to make progressives feel better.  


[ Parent ]
Shylock reference distasteful and unnecessary (0.00 / 0)
How would you have felt in October if someone had described Obama with an Othello reference ...

[ Parent ]
What Shylock reference? (0.00 / 0)


sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
you gotta be kidding, right? (0.00 / 0)
Google "a pound of flesh"

[ Parent ]
what reference to "pound of flesh"? (0.00 / 0)


sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
If I hadn't seen your handle around here before ... (0.00 / 0)
... I'd assume, from this willful stupidity, that you're a troll.  A Jewish senator betraying the party is described as extracting flesh.  I'm gonna bet that your trigger was a little more sensitive when it was Obama and racist innuendo .......

[ Parent ]
Well excuse me for living (4.00 / 3)
and for not having made a study of Shakespeare.  But I'm a Jew myself and in my 57 years I've never associated "pound of flesh" with antisemitism.  Just as there are many who say "knock on wood" without realizing that the phrase was originally a reference to the cross.

I'm sure that there are many who throw that phrase around without meaning anything antisemitic by it.

In this case I took it to mean that Lieberman would still insist on extracting more concessions, a possibility I can't dismiss out of hand.

Traitor Joe may be a member of my tribe but he has to lie in the bed he's made.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


[ Parent ]
LOL (4.00 / 2)
Well said. Its always good to avoid the phrases that are used as "dog whistles" to the racist crowds. I would prefer if we assume goodwill, and I do assume Stivo's goodwill, when highlighting 'dog whistles' you can always pour disgust on later when you realize the goodwill was ill-founded.

In fact lets try and assume a little more goodwill generally, it makes the medicine go down.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
What Jew mean by that? (4.00 / 2)
Which is what Woody Allen famously 'heard' in one of his movies from "What'd you mean by that?"

In the offending post we saw:
"Every chance he has had, he has stuck the knife in the backs of progressives and the Democratic party."

Which you somehow read as "extracting flesh". Well typically when someone gets shivved either the stabber leaves the shiv in or pulls it out, in either case there is rarely any carving involved. Moreover as I recall the Merchant of Venice the pound of flesh was supposed to be extracted from the chest and not the back. And nobody suggests that Shylock was being treacherous in doing so. Somebody is being a little hyper-sensitive here.

Besides our language is cluttered with phrases from Shakespeare whose original provenance are totally unknown to that large majority of Americans whose last exposure to Shakespeare was reading Romeo and Juliet in H.S. freshman English.

If I had to think up a Shakespearean reference for 'stab in the back' I would be more likely to think 'Julius Caesar' than 'Merchant of Venice' (though of course in the former it was a bunch of Senators doing the stabbing rather than one Senator stabbing the rest, but certainly the treachery motif is there: 'Et tu Brute'.)


[ Parent ]
I made the same mistake as you Bruce (4.00 / 1)
The "pound of flesh" reference was in the title of the original piece, not in the text.

But we were both right anyway.  Greg's reference was completely innocent as we originally suspected.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


[ Parent ]
Look at the title of his post (0.00 / 0)
"How much flesh will Lieberman extract?"

[ Parent ]
No "Shylock" reference (4.00 / 1)
Call me uneducated, but I never read Shakespeare and never even heard of Shylock until right now.  I sincerely apologize for the Shakespearean reference.  

Regardless, I am still convinced that Joe is a fucking vampire and that he's reveling in this opportunity to fuck us all over.  


[ Parent ]
As a vampire (4.00 / 1)
I object to your undeadist hate speech.

[ Parent ]
This is political correctness running amok (0.00 / 0)
Really, folks, do you believe that everybody knows Shakespeare's works by heart, and memorizes all possible discriminatory meanings? Ridiculous. Stop this shit, pls, it only makes you look like the stereotypical elitist liberal everybody loves to hate.

[ Parent ]
Well, someone tell the Senate, then. (4.00 / 1)
Because according to Jon Walker at FDL, the Kent Conrad and others are pushing to make sure the medicare buy-in won't be real medicare.

Also, this is the second blythe dissmisal of the trigger I have seen from you in less than 24 hours. Do you remember HIPAA? That had a trigger, which never got pulled. Same for the prescription drug provisions of medicare part D.

They should call them "trigger locks" since the triggers are designed to never get tripped.


[ Parent ]
The trigger worries me, no, worries isnt strong enough, I detest it. (0.00 / 0)
Unless soemone gives the right to pull the trigger to a  random group of unemployed uninsured Americans.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Trading the trigger (0.00 / 0)
We should be thanking Lieberman. Now we can insist on greater access to the exchanges and/or full access to the Medicare buy-in for 55-64 year olds as the price for giving up the worthless trigger that will never trigger.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
insurance regulation (4.00 / 2)
what is the status in the compromise of the issue of undermining individual state's ability to regulate their insurance industry?

unless you're ok with insurance regulation becoming as bad as credit card regulation (just set up shop in the state with the least regulation and go to business in all 50 states regardless of their own regulations), i'd think this would be a nonstarter for any progressive.


Not sure about explicit regulation provisions... (0.00 / 0)
...but if one of the options offered in the exchanges is essentially the choice that Congress has, then at least one option will be well regulated. I would think it would be hard for other plans to compete using a race-for-the-bottom strategy.

In any case, I hope that state's regulatory ability isn't touched.


[ Parent ]
well regulated? (0.00 / 0)
you mean by the economic team led by mr. larry "no regulation" summers? or the administration that doesn't believe in adequate regulation for the FIRE industries? (reminder the "I" stands for insurance). or by some future R administration?

in a weakly regulated health insurance market, price competition is by denying care and adverse selection. without very strong risk adjustment regulation and enforcement, competition WILL lead to a race to the bottom. this has been a major flaw of the proposed reform all along (typical for neoliberal "solutions" based on market competition where competition does not work as advertised).

in any event, i want individual state regulations to remain intact and not be undermined by states with even worse regulation (see CA). if fed regulations are better that's great. if they are worse, then state regs should apply.


[ Parent ]
no (0.00 / 0)
I mean regulated by Congress's self-interest. Members of congress presumably won't suddenly see the enormous benefit of bottom-of-the-barrel insurance just because the plan they have is offered to the public - they'll still want a plan that actually serves them well.

That's not to say that this should be expected to take the place of actual insurance regulation, just pointing out one place that will keep pressure on insurance companies to provide a quality product.


[ Parent ]
90%. Does that apply to all insurance plans or (0.00 / 0)
just the non-existent non-profits? How does any of this control costs?  

All insurance plans (4.00 / 1)
I believe it is nationwide.

[ Parent ]
Not sure how that lowers costs (0.00 / 0)
other than trying remove the greed factor. But if they simply stop negotiating with docs to lower the costs of procedures then they can charge more and make more.  

[ Parent ]
That's true of any industry (0.00 / 0)
Price-setting can happen through collusion in any industry. It's illegal in most industries, so you're right that the legislation has to be checked to make sure it's not granting immunity to the insurance industry.

But this is one of the minimal requirements that pretty much everyone agrees is necessary for the market to cut costs: if competition gives way to collusion, then the market increases the price to consumers rather than decreasing it.


[ Parent ]
Well (4.00 / 1)
I'm not even sure it's price collusion. The docs charge X for a procedure and the ins. cos. say they'll only pay Y and they agree on a price. Y is lower than X right now but if the ins. co. stop negotiating and just pay X because they have no incentive to negotiate anymore then they'll make more profit than if they keep negotiating down.  

And I don't see any competition present in this proposed plan.  


[ Parent ]
But... (0.00 / 0)
that assumes that the insurance companies are colluding to pay what the docs ask for. That's where it's the same as any industry. If you assume that the insurance companies are competing with eachother to offer cheaper insurance plans and win more customers, then they're going to be looking to cut costs and one of the places they'll look is in doctors fees, same as they always have.

Overall medical costs may go up with doctors being able to negotiate higher fees, but overall insurance costs should go down unless there's collusion instead of competition among the insurance companies.


[ Parent ]
Actually... remember the $10 aspirin? (4.00 / 2)
There is a lot of this going on already, in particular with powerful negotiators on the provider side like big hospitals. Sometimes on price collusion, also on renegotiated (incorrect) billing codes and differential pricing. We have almost zero transparency on what costs really are.

Federally Qualified Health Clinics are interesting because they are transparent by regulation. Surprise! Costs are much, much lower for equivalent services than big hospitals.

If you think Insurance companies are sweating healthcare reform, wait for big hospitals to shit bricks if we see any real reforms on transparency!!!

Fundamentally, we have 20-30% savings on getting rid of insurance companies. Another 20-30% from delivery-side reforms. Another X% from access to primary care.


[ Parent ]
Sure (4.00 / 1)
Absolutely, the negotiations in the medical industry are often more than just a little corrupt. But the other provisions in this bill will make it harder to be corrupt rather than easier.

The 90% limit probably won't recoup a full 10-20% in insurance savings, but I see no reason to think it will lead to an increase in overall health insurance costs.

I'm not sure whether the hospitals or pharmaceuticals are benefitting more from corrupt negotiations.


[ Parent ]
This is cogent and on the money. (0.00 / 0)
Accurate, progressive, ethical and fiscally sound. No republ;ican can argue these down. Of course Republicans lie to cover ignorance and their lack of any counter argument.

"The water is wet." Focks Nues says this means "Liberals want everyone to be soaked in blood by death panels."

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Good point! The higher the 90%, the higher the 10%. (0.00 / 0)
So, this is hardly an incentive to reduce costs. Quite the opposite.

[ Parent ]
Maybe I'm being too cynical... (4.00 / 1)
But is there a chance that conservatives  submitted to expanding Medicaid and Medicare because they want to eliminate it in the future? Seems counterintuitive but if they can make the case that it is too expensive, which it will undoubtedly be with mostly high risk groups in both... I guess I'm just really cynical of progressives' agency in real legislation. I think they are damn capable of getting in on media portrayals of congressional fights but in the end... the corporatists always win.

I have a feeling we're going to be running into this dynamic on future legislation too. Democrats propose weak legislation, we threaten to kill it, if it dies democrats lose seats, if it wins we get stuck in a stagnating half-way measure that probably does more harm by preserving most of the status quo...

Agitate.Liberate.Create.


Perhaps (4.00 / 2)
but the one thing we should have learned from the past five years is how hard it is to remove government programs that people like.  Hell, they don't even view them as "government programs" any more, they view them as "mine".

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
Very good point, and it needs to be remembered. (0.00 / 0)
The mandate sucks, we need new good ways to kill it. Kill it next year even before it gets approved.

Maybe we need to start organizing the election of "Kill the Mandate" dems. (!)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
If there were a nationwide single payer plan (4.00 / 1)
run by the federal government, would you consider it a "mandate" that every citizen be included in the pool?


"It sounds wrong...
     ...but its right."


[ Parent ]
No. (0.00 / 0)
Signing everyone up for the program is not the same as forcing everyone to join and then penalizing the ones that don't. We don't force people to buy 401ks, we just sign them up for social security.

And for the sake of fuck, this bill is nothing like single payer. Stop it with the false equivalences.


[ Parent ]
If you are self-employed (4.00 / 1)
And don't pay your Social Security contribution?

The IRS pursues you and charges a penalty on top of collecting back taxes. Under the exact same provisions of the tax code that apply to the mandate.

The requirement that everyone meet the Individual Responsibility requirement under the bill  to prove you have Acceptable Coverage is EXACTLY parallel to the requirement that people in self-employment pay into Social Security or pay civil and potentially criminal penalties for failure to do so.

Similarly you are FORCED to contribute to Medicare Part A even if your long term plan is to retire to your Countess Wife's schloss in Germany prior to your 65th birthday. And while nobody can force you to buy a car, in most parts of this country you need at least one household care and the government will fine you if you can't show proof of acceptable insurance, insurance that overwhelmingly comes from the private sector.

That is all the mandate is, a fine for failure to provide proof of insurance. It doesn't surprise me that people on the Right find some sort of huge Constitutional issue here, they often work from a text out of their own imagination, but for progressives to object to this as some sort of a matter of principle baffles me.


[ Parent ]
Not trying to make them equivalent (0.00 / 0)
Just get a handle on what mandate means. More exploring the concept that Bruce has been pushing, than agreeing with him.

Folks see single payer as an entitlement, rather than a compulsory program. But, could individuals pay a fee to get out of a single payer plan?

No way around the fact that mandates are compulsory.

It comes down to the penalties for non-compliance, as far as I can see.

So, I can get behind Bruce in an intellectual way, but the political framing is pretty different.


"It sounds wrong...
     ...but its right."


[ Parent ]
I'm not against mandates per se (0.00 / 0)
what I'm against is

1. That for many the only recourse is to go to a blood-sucking for-profit business.  This has been expounded on countless times.

2. That there is a "penalty" rather than something like an MSA or auto-enrollment.  Dealing with people not having insurance by taking away their money is the most counterproductive thing I ever heard of.  Imagine if the government tried to deal with malnourishment by legally mandating everyone to eat three square meals a day, and those not in compliance had to pay a fine that could've otherwise gone to food.


[ Parent ]
Indeed (0.00 / 0)
If the corporocrats insist on private insurers, they should have to be non-profit and subject to anti-trust. Only seems fair.

Already on record about the penalties. That what makes mandates unpalatable. The uninsured are inherently penalized by not having insurance, why pile it on?

Between non-profit, de-monopolized, private insurance with "suitable" regulation and expanded entitlement programs administered by the feds, the ratchet might be working from two directions. How long until the expanding Medicare swallows the non-profits and mends into single payer?


"It sounds wrong...
     ...but its right."


[ Parent ]
no doubt in my mind about this (4.00 / 4)
without the significant "noise" generated by netroots activism there is no way the Senate bill would include this much "reform."

But we should still keep "kill the bill" on the table until the very end.


Netroots powerful in more ways than one (4.00 / 2)
For me the success of netroots activism includes the accurate and breaking information available from sources that are not necessarily as left as OL like Ezra, 538 and TPM. Including Bowers, they are all a godsend in keeping me informed on the issues and policies that I care about--stuff like this that has never been available before. There is no mainstream media filter to wade through in order to figure out what is going on with the issues (and sub-issues) that are important to me. This allows me to participate more directly in my government and hold them accountable for progressive ideals. Pretty cool.  

[ Parent ]
Ezra is good for informations, but all in all he's hurting progressives. (0.00 / 0)
He was unsupportive of the public option from the very start, and that has hurt the progressive efforts tremendously. Yes, he had good reasons to be sceptical of the chances to push this through, but it would have been much better if he kept those for himself. And actually with stomping for Baucus his stance as something of a self fulfilling prophecy. Not to speak off that his misguided focus on regulation misses the point that historical evidence shows that changing the system trumps manipulating the symptoms every single time.

No, really, for a smart guy, he can be horribly naive sometimes, and he hasn't learned yet when to keep his mouth shut. Well, Ezra has sank a lot in my esteem in the last months.


[ Parent ]
yep (4.00 / 2)
The opposition should believe that you could vote "no" right up until the moment you vote "yes".


"It sounds wrong...
     ...but its right."


[ Parent ]
eh (4.00 / 1)
i haven't felt this apathetic to government since I was 15.

I was married two months ago and filed the paperwork to get my wife covered under my plan (she's a student). We're still waiting from the insurers to cover her. There is no reason why she should be uninsured to begin with.

I was without insurance for 2 months after my school plan ran out in August. I was waiting for my employer (small business) to offer me a full-time position. Once that happened, I had to wait another month before being covered...

Am I supposed to feel something for this current plan? No! It doesn't do anything for too many people.


reform the House of Lords (4.00 / 4)
whatever the actual final bill turns out to be, it seems pretty clear that as long as we have to get 60 Senators to agree to not block passage, we're stuck. the same shenanigans are going to go on for any kind of jobs bill, for climate change legislation, for financial reform - anything.

i'd like to see, for instance, the Progressive Caucus in the House make common cause with some liberal Senators about bringing majority rule to the US. make noise about it, make it an issue that people know about.

while the rule is still there, it would be nice to have a few people from the left be willing to block cloture too, and not only always just the right-wingers. instead of always going along to get along. but that seems less likely. just go right for the main thing. yes, it's dangerous, but so is an ungovernable superpower.

(this is why the campaign by Grayson and others to move from 60 to 55 seems like just a gimmick to me. if your forecast is right, we could change cloture to require 55 votes and we'd be right back where we are now after the election. a majority is 50% plus one. works for baseball, works for elections, works for me.)

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


I am happy to say I support abolishing the House of Lords (0.00 / 0)
Abolish the House of Lords!

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
You're a brave man, Chris (4.00 / 4)
I salute you for trying to look lucidly at this (with the caveat that the details are still not really known - and there may be less here than meets the eye).

I must say at this point that I am amazed at the level of passion still evident in many fine folks here and on other lefty sites for the Public Option, even though there was no version of the Public Option left on the table any more that would have provided much in the way of remedying what is still lacking in the compromise.

"Without the price competition of Public Option there will be no way to force the private insurers to keep rates down"

to which I regretfully say

"The price competition offered by the watered-down Public Option currently on the table will do nothing significant in the way of forcing the private insurers to keep rates down."

The "Public Option" and the campaign built around it proved to be an effective means of extracting as much as possible in this corporate-dominated environment.  Whatever the symbolic value of achieving a public option, it has no talismanic powers.  Just because you call it the Public Option doesn't mean it does anything.  And if it's a symbolic victory you're after, I don't see why expanding the existing "public option" - medicare - to a wider swath of population isn't as potent a symbol.  

Sorry, folks, I guess I'm too much of an old Labor guy.  At some point it's not just about keeping the troops revved up.  You don't lie about how good the contract is, but neither do you piss all over the settlement with statements that aren't true.  Things are bad enough without making them worse than they are.

I applaud Chris Bowers for trying to be objective here.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


Back to creeping socialism. (4.00 / 3)
Not like that's a bad thing.

Medicare Expansion has some real advantages.

First, Medicare is already set up so expansion is super-easy. National rates and benefits are already in place so you don't need to make any new structures or bureacracies. Secondly, it is single payer (not just "public option") on a national scale , meaning that it comes without that 20-30% insurance profit and bureaucracy hit.

Finally, Medicare is very understandable, visible and popular, so the politics of expanding Medicare will sell extremely well. So well, that it is a good push onto the slippery slope to medicare for everyone. The mere act of changing the age to 55 wakes the public up to the possibility that 65 is not a magic age. Why not 45? Why not 0 - 18?

Watch what happens when the public gets its mind around the idea that "everybody over 55 now gets medicare". They won't want anything to do with those little restrictions, which will that work in favor of popular pressure.  


Exactly, and a movement to include groups into medicare needs to start forming now. (4.00 / 5)
Cover Children with Medicare!

Cover Students with medicare!

Cover Mothers with Medicare!

Workering parents deserve meidcare

Dont exclude me from medicare!


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Medicare and Medicaid (4.00 / 1)
Why not 0 - 18?

That's a nice vision - I hope to live to see the day when Congress is debating how Medicaid and CHIP should be subsumed into Medicare....


[ Parent ]
Next Year! In five weeks, is time to start. (0.00 / 0)
"I hope to live to see the day ....." Damn this is THE way forward. Right now is the time to start the demand for inclusion!

Support the demand for inclusion!

"No one in America deserves to be excluded!"

This fight has win written all over it.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
For R's this has 'fail' written all over it (0.00 / 0)
Are all Republicans evil, blood sucking vampires intent on keeping 50 million people uninsured SIMPLY to profit ONE sector of their corporate masters?

Well no. In fact the only two Senators that are wholly owned creatures of private insurance are Lieberman and ex-insurance man Nelson who are technically not Republicans at all.

What Republicans fear beyond all else is a Big Government program that DOES become the Solution. The New Deal was a huge fricking disaster for the Republican Party, its success buried them politically, particularly on the House side, for two full generations after 1936. And Medicare didn't do them any favors either. Now after 1968 they were able to use race and class to poach away the South and the burbs and gradually rebuild their brand as the party of Normal 'Mericans but that could be shattered by effective and efficient government delivery of health care to more and more segments of the country.

Republicans really liked that 12 years in control of the House and were licking their lips at the prospect of using perma-war to create a Permanent Majority to rival that came out of the New Deal. Any chance of reversing 2006 and restoring that dream rests on a continuing ability to demonstrate that Big Government is the Problem. On the other hand Progressive Democrats have an opportunity to show that steps towards Social Democracy can pay off in the forms of better outcomes and so restart progress that mostly stalled in 1980.

So HoP has exactly the right idea. As long as people realize that it is possible that only one Party will walk out of the death cage. Because the Republicans can't afford to lose New Deal II. And they have no intent or desire to fight fair.


[ Parent ]
This excusing of rthuglicans is exactly what I expect from you, Bruce. (0.00 / 0)
Not that it is wrong to analyze the position of the other sid of the aisle, but you're cutting them much too much slack: "In fact the only two Senators that are wholly owned creatures of private insurance are Lieberman and ex-insurance man Nelson who are technically not Republicans at all."

Ridiculous. Really ridiculous. You wanna make us believe those two fools are worse than total nutcases like Inhoffe? Now, come on...


[ Parent ]
Nice (0.00 / 0)
I like your perspective on this, Chris. I would love single-payer as much as the next progressive, or at least Medicare+5% as part of a robust public option, but at some point I do believe we have to compromise to win the required votes or risk having zero progress whatsoever on the matter, much less any 'progressive' ideas being included.

At the end of the day, it's politics. Not everyone is going to have what they want. But this is a good start, I think, and if the Medicare expansion becomes popular, I could see Democrats expanding it to other age groups. It may be even done for political gain, but then, who cares? As long as Medicare is offered to more and more Americans as an alternative to private health insurance.


I support this compromise. (4.00 / 1)
I have read the arguments, I have read Chris. I suppor the compromise, details following intent of course. We still need lots of fighting doen to make it actually help enough people, but that can continue and follow on to win in the future. This a compromise that delineates the path to fight for Americans, with American values.

I vote go for it. And hurrah to the Dems that crafted it.

If I can't win, I want to keep my tools for fighting. This feels more like extra innings, while banking the win if I can mix a metaphor.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


This compromise is awful. (0.00 / 0)
I can't support it. We must have a better bill than this, or we are right to try and kill it.  

I'm not there yet, Chris (4.00 / 3)
I hear you. You make some sound points. Yes, objectively, cost and details aside, getting a large number of people health insurance and care -- including some small number of them under Medicare (maybe) -- is a good thing. However, I remain concerned:

* That the Medicare option isn't going to be real Medicare (and that alone should be a deal breaker).

* That in limiting access to the Medicare option and the exchanges all we've really done is create a public/private dumping ground for the high risk pools, they'll therefore be expensive and will thereby have the appearance of Fail.

* That a mandate penalty that gets the payer nothing in return will be a political disaster.

* That the 2013/2014 start date is a political disaster.

* That if the House is forced to accept this without any significant changes we'll be essentially ratifying a unicameral legislature run (at best) by Conservadems.

* That this renders the House progressive caucus irrelevant and moot.

I'm just not ready to buy all of this as "a win." And frankly, if this had been described to you as the outcome back when you (and others) were developing the public option campaign I don't think you would have viewed it as "a win."

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans


Plus, as a negotiation stance, the hard line position of FDL... (4.00 / 1)
..is much more reasonable than Chris stomping for support of the compromise now. Firstly, it's much too early, we don't know about the details, but we can be sure there are some devils in it that are unaccptable. And then, if the obstructionists notice that the progressive base supports the compromise, this wil only show them there is still some room for manoevering the progressive block into more concessions. That's bad negotiation tactics. Bad bad bad.

[ Parent ]
Moving in the right (or is it left?) direction (0.00 / 0)
the correct direction, anyway.

Now that the progressives have apparently overcome their initial inertia, or at least laid a few more cards on the table, the issue becomes how to garner further improvements.

What will "we" ask for next time the "moderates" come looking to negotiate? We compromised on the PO, now its their turn to give up something that they value.

"It sounds wrong...
     ...but its right."


Now that the progressives have apparently overcome their initial inertia (0.00 / 0)
When did they do this?

What will "we" ask for next time the "moderates" come looking to negotiate? We compromised on the PO, now its their turn to give up something that they value.

I'm sorry, have you been watching a different senate then the rest of us?

Because what I see is that progressives gave up all their bargaining chips, and now have to stand by and watch this POS bill get worse and worse.


[ Parent ]
It seems apparent to Chris (0.00 / 0)


"It sounds wrong...
     ...but its right."


[ Parent ]
I still have my same two concerns (0.00 / 0)
that I've had since this compromise started floating up.

One, is that the Medicare buy-in is being offered to all 55-64 year olds, even those with insurance, instead of all uninsured Americans of any age.  This means that 27?-54 year olds will still be at the mercy of an individual mandate with fines but no public option.  It seems like a huge misdirection of priorities to offer the Medicare buy-in to 55-64 year olds who already have insurance rather than those of any age who don't have insurance and will be feeling the brunt of the individual mandate.

Two, that we liberals/progressives are ceding ideological and rhetorical ground by ditching the public option, whose government-run status is well known, in favor of Medicare, which is kinda like a stealth government program.  It's not a reason to oppose the compromise, but it does mean that after the legislation is passed we need to do a serious PR tour explaining that yes, Medicare is a government program; no, that's not a reason to panic; and yes, government can do good.


Reply to bruhrabbit, I refuse to be shoved any further over to the right margin (0.00 / 0)
The post I'm replying to is this one.  Click this link and you'll see why I didn't reply there.

"Loopholes happen because corporations are more powerful than we are.  At this point in time, short of single payer (maybe), there's no Health Care bill you could write that couldn't be screwed with the private insurers and Big Pharma. "

THis mindset in a nutshell sums up DC and apparently a great bulk of bloggers of the A-list variety.

The options are limited, but they are not limited to just single payer.  This is why when the robotic thinkers post assuming I am a "single payer" supporter I sometimes laugh. It just demonstrates how captured the thinking is on these issues.  Single payer would have been the best for pricing, but it was never the only choice. The other choices, however, required a far more complicated process that required multiple moving parts. If any part of that system breaks down- the system is not going to work properly.

THere are other models in the world that work. The problem is that we have chosen none of the above with people claiming to be progressive once again rationalizing poor policy that will come back to bite us in the ass years from now.

You've somehow turned my remarks into a single-payer-or-bust diatribe.  That's not me and that's not what I was saying.  What I was saying though was that single-payer would, however, prevent private insurers from capturing the regulators because there then wouldn't be any more private insurers.  (Good luck getting it passed.)

So, then we have the public option.

You have (correctly) made a point that tying mandates to a PO would have made a lot of sense and would have been a good talking point.  But no one made that talking point (present company excepted).  And that might have been a good hardball move, had anyone made it.  But they didn't.  (Good luck getting it passed).

And more importantly, it still would have left the private insurers free to try to capture the regulators.

So it's not that you're wrong, in my opinion, but that you're focusing on one particular mechanism and avoiding the overall issue of power.

That issue was obviously not settled on 11/4/2008.  It was always going to be a long-haul effort.  I think we all have to get used to it.  

How many Civil Rights bills were passed in the fifties and sixties?  They passed one in '57, in '64 and then again in '65.  There was a movement that wouldn't quit.  All I hear now is "I'm so disillusioned, I'll never do this again."  That isn't helpful.

And while it's quite right to put a spotlight on the Democratic cretins who blackmailed us into this corner, we should not give Republicans a free pass.  That hard block they put on should not just be assumed for all time.  Besides primarying the Blanche Lincolns of the world, which I support, we need to be asking ourselves which Republicans are most vulnerable to being knocked off for their implacable opposition to health care for their constituents.  If there's no essential difference between Blanche Lincoln and a Republican, both should be our targets.



sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


You couldn't opt out of single payer... (4.00 / 1)
Only supplement it. The slogan goes "everybody in, nobody out" for a reason. The whole idea is to spread the risk over an entire population as a matter of citizenship in a wealthy democracy. Private Insurance plans would be illegal and reduced to covering the luxury items, or at least those items which couldn't be provided for everyone.  

Agitate.Liberate.Create.

Pay no attention to the man behind the curtain (4.00 / 2)
The insurance industry bleeds this country.

We pay twice as much as the next closest industrialized nation and we get worse care in return. The US ranks at the bottom of similar countries life expectancy.

We've done nothing to stem the systemic errors which poison the provision of health services in this country. This was our moment to bring them to light and to offer a real alternative and we've failed.

You can pat the dems on the back all you want for this debacle, but it is still just rearranging deck chairs on the Titanic.


USER MENU

Open Left Campaigns

SEARCH

   

Advanced Search

QUICK HITS
STATE BLOGS
Powered by: SoapBlox