Getting to Yes
| Mon Aug. 3, 2009 1:20 PM PDT
I missed this a couple of days ago, but Robert Pear and David Herszenhorn write in the New York Times that for all the turbulence surrounding healthcare reform right now, there's actually a surprising amount of bipartisan consensus about certain parts of it:
Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person’s medical history or current illness. All insurers would have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans would be required to have insurance.
....Lawmakers also agree on the need to provide federal subsidies to help make insurance affordable for people with modest incomes. For poor people, Medicaid eligibility would be expanded.
The chaos on Capitol Hill, combined with bitter disagreements over how to pay for the legislation and the role of a public plan, has obscured the areas of potential consensus. “There is wide agreement on the two elements of the legislation that the public cares about most: insurance market reforms and the expansion of coverage, with subsidies,” said Drew E. Altman, the president of the Kaiser Family Foundation, which focuses on health policy.
In other words: community rating plus subsidies for low-income families. That's nice to hear. I'd like a lot more than that, of course, but if we manage to pass a bill that contains reasonably strong forms of both these things, it will be a huge step forward.
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Comments
Higher for all
Submitted by James2 (not verified) on Mon Aug. 3, 2009 1:49 PM PDT.
You do realize that by forcing insurance companies to accept the sick, while prohibiting those companies from charging the sick more than the healthy, will drive everyone's premiums much, much higher, right? This doesn't sound like a step forward to me.
"You do realize that by
Submitted by Anonymous (not verified) on Mon Aug. 3, 2009 2:58 PM PDT.
"You do realize that by forcing insurance companies to accept the sick, while prohibiting those companies from charging the sick more than the healthy, will drive everyone's premiums much, much higher, right?"
No, not for everyone. Sick people will have lower premiums.
In any event, this is what cost spreading is supposed to do. Whether you become sick or not is (partly) a function of chance, so instead of some people shouldering a heavy burden and others no burden, we pool resources so that everyone shares a part of the burden. That's what insurance is.
I agree these will be a huge
Submitted by urban legend on Mon Aug. 3, 2009 1:58 PM PDT.
I agree these will be a huge step forward. Ending the waste due solely to the provider's worries about not getting paid, and the massive administration required by insurance companies to avoid insuring unhealthy applicants and to avoid payment of big claims (i.e., big bills from providers) will provide significant benefits for Americans, and will have a significant moderating effect on the costs of providing services and insurance to pay for those services. We would save even more of aggregate healthcare costs if we socialized the highest risks -- i.e., took the profit out of covering the risk for people who get really, really sick -- and maybe eventually everyone will see that.
In the meantime, how about if we get some working definition of a "public option"? Does it mean a government-issued policy funded in part by tax dollars as well as by presumably low-cost premiums, or could it mean a policy issued by a government-created entity which (other than tax-based assisted purchase for lower income purchasers just as with any available plan, including the private plans) must be funded by premiums only just like any other non-profit plan? The latter should go a long way towards what liberals want (it is a "public option," which has acquired symbolic significance for progressives), and it should address any legitimate objections of foot-draggers. It is not unreasonable for private insurers to think they can't compete against a plan that can turn on the Federal funding spigot anytime it wants -- that is, anytime when the Democrats are in the majority -- but it is unreasonable to say they can't compete against a non-profit plan that must fund itself by premiums and cannot draw on tax dollars for its operations.
Which Republicans have agreed to these principles? I haven't heard of any. And the first commenter is right: without some cost containment built in, premiums will just go sky-high and the whole project could get discredited, with the middle class being open to propaganda that they're being screwed on behalf of the previously uninsured.
James 2, we are already
Submitted by urban legend on Mon Aug. 3, 2009 2:08 PM PDT.
James 2, we are already paying for that now in higher provider costs (for hospitals in particular) that generates higher premiums and profit on the excess. One of the benefits of universal coverage is that it will improve lower-cost preventive care for tens of millions, and massively reduce inappropriate use of frigtfully-expensive emergency rooms as if they are community clinics.
What do you think accounts for the difference between 15% of GDP -- what the U.S. is spending -- and 8% for other advanced countries. Doctors do very well financially in most of those systems, too, as they should. As someone said, I want my pilots and my doctors to be very well paid.
Wealth, of course
Submitted by James2 (not verified) on Mon Aug. 3, 2009 2:19 PM PDT.
The abundance of wealth is why we spend twice what others spend. We can afford to get our tits and faces done. We can afford LASIC instead of glasses. We can afford that MRI when we feel something pop while we're playing hoops. How many people got MRI's 20 years ago? Nobody. Now, it's routine. Is this bad? I don't think so, but it's certainly more expensive.
You may be right that we're paying for the sick in the form of higher provider costs, but these are invisible to most people, as they are paid for by taxes, 90% of which the top 5% pay. So, if you're argument is to help the poorest people, making everyone's premium (which is out of pocket) more expensive hurts the middle class and certainly the poor the most.
Dr. Pay
Submitted by James2 (not verified) on Mon Aug. 3, 2009 3:29 PM PDT.
BTW, my uncle is a doctor in France and he makes a touch over $100k a year (in USD). I would not call that doing well financially.
Every doctor I know in this country advises their children to do anything but medical school, because the payoff for all of the schooling just isn't their anymore, unless you want to be a plastic surgeon or a LASIC doctor. Out of all of them, only one still went to med school, and realizes his standard of living will be well below that of his parents because of it.
*****You do realize that by
Submitted by Anonymous (not verified) on Mon Aug. 3, 2009 2:10 PM PDT.
*****You do realize that by forcing insurance companies to accept the sick, while prohibiting those companies from charging the sick more than the healthy, will drive everyone's premiums much, much higher, right?*****
I've seen estimates all over the board on this score, but the net/net is it's doubtful insurance companies will need to charge "much much" more because an individual mandate will mean that millions of young, healthy people will also be entering the insurance pool. Of course, no doubt insurance companies will TRY to use community rating as a reason to jack up premiums, so that's why a strong public option is desirable.
If insurance companies only
Submitted by James2 (not verified) on Mon Aug. 3, 2009 2:14 PM PDT.
If insurance companies only had to charge a little bit more, they would already be doing so, and collecting the premiums of all those sick folks. There's a reason they don't want to insure the sick: they cost a lot of money.
A mandate? Doesn't liberty
Submitted by Another Brad (not verified) on Mon Aug. 3, 2009 3:49 PM PDT.
A mandate? Doesn't liberty count for anything anymore? Why should I be forced to buy something I don't want or need? Because some a-hole president thinks it's in my best interest? I can make decisions for myself thanks. Besides, if you think you can wave a magic wand and get insurers to cover everyone for anything and everything without jacking up premiums, I've got a bridge you should really take a look at.
Because you are relying on
Submitted by AngusM (not verified) on Tue Aug. 4, 2009 12:12 AM PDT.
Because you are relying on the government (and the rest of us) to bail your ass out anyways if you get injured or a catastrophic illness. You'd demand and get treated through emergency rooms and government assistance, but without paying anything into the system to fund it.
Community
Submitted by Anonymous (not verified) on Tue Aug. 4, 2009 4:06 AM PDT.
It's called living in a community. Someone's "liberty" to engage in risk (e.g., not vaccinate their kids, not fix a damaged septic system, not follow pesticide guidelines, not match loans with sufficient reserves) often times causes problems for the rest of us. It's perfectly reasonable, even rational, for the rest of us to place demands on such behavior (i.e., demand that you pay the _real_ average costs of your decision). But do you really want to be charged with an extra x thousand in taxes per year because you chose not to be insured? Those taxes, by the way, would almost certainly be higher than the cost of placing everyone into a single insurance pool.
Universal coverage by its
Submitted by urban legend on Mon Aug. 3, 2009 2:17 PM PDT.
Universal coverage by its very nature has massive cost containment built in. How much bureaucratic waste do you think there is in providers needing to make sure they are going to be paid and how and by whom? (The Duke University Hospital example: 800 beds, 800 billing administrators.) And how much waste is built into insurance companies trying their damnedest to deny coverage or payment of claims due to so-called pre-existing conditions? These changes alone will dwarf any half-baked attempts (other than the commons-sense ones that are built into the current bills) to eliminate unnecessary charges. For what some are wishing for, the bureaucracy needed for a cure will be worse than the disease.
It's all about the revenue
Submitted by g. powell on Mon Aug. 3, 2009 3:01 PM PDT.
I don't think it's really all that encouraging that there is agreement on community rating and subsidies lower-income insurance. That's the easy part, the hard part is how to pay for it. And so far, the Blue Dogs have rejected a tax surcharge on the wealthy, and scrapping the deduction on employer-provided benefits looks dead, so I don't I know what's suppose to happen next. It looks like a dead-end to me.
Screwed Unto Death
Submitted by Mellors2 (not verified) on Mon Aug. 3, 2009 3:33 PM PDT.
We family of four with me on Medicare as primary now paying Calif BS/HMO $18,500 a year plus $1116 for Medicare plus co-pays and endless fights for prescribed meds; bastards at BS raise premiums through employer every year $1500 to 1850 a year and the top execs get bonuses for screwing us out of service. We won't get one cent of help as premiums from the shits eat us up more and more every year. The whole reform hustle utterly irrelevant and meaningless scam & rotten joke for us.
Every discussion of health insurance in midst of our moral depravity should begin with body count of those who have died since AMA first shot down Truman's efforts at reform in 48 at about time Britain went NHS. The suffering and moral bankruptcy is staggering but kept too far to the margin of the endless wonkish neurotic discussion while people die.
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