Starting Over
I don't want to blog endlessly about healthcare reform today because, really, there's not all that much to say. I think the Senate bill in its present state is well worth passing, other people don't, and that's that.
But there's one argument that I find perplexing. Here's Howard Dean:
This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.
Here's what I want to know: which one of us is living in dreamland? If you don't like the Senate bill, fine. Don't support it. But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014?
I usually don't say much about legislative tactics because I figure you need some serious ground level knowledge before you mouth off about what's possible and what's not on Capitol Hill. But the fate of failed major initiatives is so obvious that I can't believe anyone is taking this seriously. When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon — and that's especially true when big healthcare bills fail. It didn't happen in 1936, it didn't happen in 1949, it didn't happen in 1974, and it didn't happen in 1995. What makes anyone think it will happen in 2010?
If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.) But if it passes, here's what we get:
- Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.
- Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
- Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
- A significant expansion of Medicaid.
- Subsidies for low and middle income workers that keeps premium costs under 10% of income.
- Limits on ER charges to low-income uninsured emergency patients.
- Caps on out-of-pocket expenses.
- A broad range of cost-containment measures.
- A dedicated revenue stream to support all this.
What's more, for the first time we get a national commitment to providing healthcare coverage for everyone. It won't be universal to start, unfortunately, but it's going to be a lot easier to get there once the marker is laid down. That's how every other country has done it, and that's how we did it with Social Security and Medicare, both of which had big gaps in coverage when they were first passed.
But if we don't pass it, we don't get any of this. Not now, and not for a long time. Instead of being actual liberals, we'll just be playing ones on TV.
Comments
"Insurers have to take all
"Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick."
Of course they will. The insurance companies doubtlessly already have the paperwork in place to let them deny coverage to anyone they like. They won't call it "pre-existing condition" maybe they'll call it "unforseen complications" but regardless they'll do the exact same thing and it'll be perfectly legal.
"Community rating. Within a few broad classes, everyone gets charged the same amount for insurance."
Again it's ridiculously naive to think the companies won't have a work around before the bill is ever signed. Of course they will.
"Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down."
Individual mandate without a public or non-profit option is practically criminal. It means that a bill that was supposed to stake the insurance company parasites will instead be a HUGE handout to them. Mandates are necessary but only moral in conjunction with a non-profit insurance option.
"A significant expansion of Medicaid."
Didn't that just get killed by lieberman? If not are you really sure it still won't be?
"Subsidies for low and middle income workers that keeps premium costs under 10% of income."
Assumes insurance rates don;t go up which they absolutely will since there's no alternative. This bill gives complete and total license to insurance companies to bleed america dry.
"# Limits on ER charges to low-income uninsured emergency patients.
# Caps on out-of-pocket expenses."
Nice but we could get that easily without all the bad stuff. Make that its own separate bill.
"A broad range of cost-containment measures."
none of which will work without a public option. There is no way to reduce costs or expand coverage without a public or non-profit option. It just isn't possible when the people providing the insurance do it for money and make money by charging more and doing less. They will always find a way.
"A dedicated revenue stream to support all this."
Great a tax for the right to rally against. If we were getting much of anything in return I'd say great but as it is all we do is help the very industry we should be killing.
Barring reconciliation to get the still lame but much better house bill this fight is lost. There's not going to be any meaningful HCR in my lifetime. The only question is whether we pass an abomination and call it HCR and thus taint the name.
If at first you don't succeed, redefine success.
If at first you don't succeed, redefine success.
Yea! We all win!
This is also what the climate change debate will look like.
Here's how I see the first
Here's how I see the first three points Kevin makes playing out with the insurance companies, and it's really very simple:
"Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick."
Sure...we won't turn you down. We'll just charge you as much as monthly mortgage payment in order to get it.
"Community rating. Within a few broad classes, everyone gets charged the same amount for insurance."
Awesome! We'll raise the price for you neighbors too. You don't think this is going to make the price go DOWN, do you?
"Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down."
Yyyyyeah.....we promise that if you force everyone to buy insurance that we'll make the price lower. In fact, we pinky swear. (snicker). I mean, it's not like there's anything there to actually MAKE us lower prices.
Boy, I couldn't agree more.
Boy, I couldn't agree more. We should be killing the industry, or at least regulating it so closely that it can't realize a profit.
Agree 100%
Nice post Kevin. I would also point out what Ezra said in November. Every time HCR reform has failed, it has gotten more conservative, not more liberal. If your legislative instincts are correct, and I think they are, Dean is advocating for killing substantial progressive reform for something 10+ years down the line that will be profoundly worse.
Not true. This bill is more
Not true. This bill is more liberal than what the Clintons were proposing 15-plus years ago.
But, this even without the public option/Medicare buy-in is a game changer. For the first time, The Federal Govt will be held accountable for all people having coverage.
No, the government will not
No, the government will not be held accountable for coverage, we will be, via our steadily shrinking household budgets.
It's a lousy post. By not
It's a lousy post. By not having set goals and targets with objective criteria for the bill at the beginning, we have no idea on when it's in our interest to walk away. So instead we constantly yield to the trump card of "it will take another two decades", "best we can get", "camel's nose", and "insure more people than yesterday."
We think we're King Arthur, it turns out not only are we the Black Knight, we're Monty Python's Black Knight.
The Healthcare bill has only suffered a flesh wound.
The problem with that
The problem with that analysis is that we keep NOT getting our stepping stone. We didn't get Clinton's reforms. We didn't get Kennedy/Nixon. Every attempt for more than a generation, we've ended up with nothing but the political fallout.
Get this much. Then come back to it, sooner rather than later.
No, It Will Not Keep Insurance Costs Down
There is NOTHING in this bill that will do that. They will continue to stick it to consumers because there is nothing in this bill that amounts to any kind of protection for affordability. Maybe in your world it is affordable to pay almost $14,000 a year for insurance plus co-pays on the order of 30% until you've spent $10K out of pocket. In my world, and the world of the people I know, this is not in any way affordable. Who's living in a dream world, Kevin?
As for losing a chance that may not come again for 40 years, if the Right gets back in charge down the road, there is nothing to stop them from gutting or rescinding any bill that passes anyway, so why not try for something worth fighting for? This bill as Lieberman wants it amounts to the government holding us for ransom on behalf of corporate profit.
It's fine to be a critic, but
It's fine to be a critic, but what do you propose to do instead? Keep millions of people uninsured for decades?
"what do you propose to do
"what do you propose to do instead? Keep millions of people uninsured for decades?"
So your solution is to force the poor to buy insurance from the insurance industry?
My God. Thank you for solving the problem!
I have a solution for people living in shacks, too. Force them to buy mansions.
Come on!
Your comment shows an absolute misunderstanding of the bill at hand.
Is it perfect? Absolutely not.
However, it's hysterical and ridiculous to say that poor people will be required to buy health insurance. First, if you look at the bill, there will be a huge expansion of state government run healthcare programs and medicaid. The bill calls for making the process of enrolling in these programs much easier and standardized. It will even be able to be done online! If Cantwell's basic health compromise made it into the legislative compromise Reid is holding against his chest, we are looking at the possibility of people whose income exceeds 400 percent of the poverty level to enroll in Basic Health Programs WITH government funding.
Finally, the way the bill works is that nobody will ever be forced to buy health insurance if the amount of your out of pocket expense for the premiums exceeds 8%. Those who are in this situation will be granted a hardship waver.
This bill is an excellent start! I'm sure i'm about to get spit on for saying that by people who haven't even looked at the thing.
How would keeping those
How would keeping those millions uninsured for decades be different than what already exists ? If people are mandated to feed the coffers of the insurance cartel, what makes you thing there won't be millions more ?
Millions WILL Remain Uninsured
The report just out from HHS, Centers for Medicare and Medicaid Services Office of the Actuary predicts that this dog of a bill will only insure half of the currently uninsured population by the end of the next decade (2019). That is hardly a lif-saver that must be passed at all costs.
cost containment
Folks who complain that the Senate bill does nothing to control costs should have a look at Atul Gawande's article in the December 12 New Yorker.
Health Care
Kevin,
I agree with you 100%. If this passes with the components you cite, it will be the greatest piece of social engineering legislation since the Civil Rights Act of 1964. There will be no turning back from universal health care, and that's a signal accomplishment.
But Kevin's components are mythical
There is nothing workable to prevent insurance companies dumping anyone who gets sick. They just yell "fraud", call out their lawyers and you can die before you prove they are making it up.
Reid took out the caps.
Affordability has been defined as expecting middle class people to be able to shell out $25,000 a year on a combination of insurance, co-pays, and uncovered this-and-that anytime they get sick. How fast does anyone with a real problem become medically indigent? One year or two?
But you do have to pay a private company because there's a mandate, so they can pay their lawyers to screw you. Great deal!
Just curiously,
how old are you? I find it hard to believe anyone over the age of, say, 30 could possibly say such a thing with a straight face.
Read my lips: I Don't Trust
Read my lips: I Don't Trust Rahm.
Eh, if everyone who Lieberman
Eh, if everyone who Lieberman thinks is a hippy stays angry, maybe he won't filibuster it...
Christ what a sorry state our government is in...
Remember BEFORE we bailed GM
Remember BEFORE we bailed GM out, what we were saying about the competitive disadvantages of Employer Based Healthcare?
If you want healthcare reform that's fair and of the people and for the people and can be applied universally, and that helps business too, we have to get rid of employer based healthcare.
This is Simply a LIE
"If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well."
If the current bill doesn't get 60 votes in the Senate and 218 votes in the House, we'd move immediately towards reconciliation.
Kevin knows this.
And Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well.
If Kevin wants to pimp for the Baucus Bill, fine. But don't lie about what would come next if it can't get the votes.
Source? It's good news if
Source? It's good news if it's true, but I haven't heard anybody saying this (and I'm not trying to pick a fight -- for all I know you're a Hill staffer who knows what he's talking about, but again, I haven't heard anybody mention a move to reconciliation is automatic, or will definitely succeed if it's tried).
They insurance industry would rather let the bill die
So Obama won't let Reid to go to reconciliation. Obama would rather have no reform than annoy his "base" - the insurance and pharma industries. They were the ones that got to negotiate the plan in secret and it will be either their plan or no plan.
To which I reply, once again:
To which I reply, once again: Who cares ? Would you support getting something, any something, passed if say, taxes on the middle class were raised 400% to pay for their own private mandated health care ? Where is the line in the sand for you ? I absolutely do not trust Rahm Emanuel to do anything other than what advances Obama's chances in the next election cycle, and at this point, I don't trust any of these other holders of free government tax-paid-for health care, either.
There comes a point where making these rich assholes feel better is not worth our increased burden. If these suits want to give us the same health care as they have, then I would say OK. But just to get something passed ??? You've got to be kidding me. The insurance cartel is just like the computer hackers. Make some new rules to constrain them, and they'll have them broken and working to their advantage in no time. It's call individual initiative and free enterprise, you see. Do you, see ?
How I wish that were true!
"If the current bill doesn't get 60 votes in the Senate and 218 votes in the House, we'd move immediately towards reconciliation."
In your pony Democratic majority (and mine too!), that would absolutely be true.
Back here in the real world, I wouldn't bet on it. The Dems are still a bunch of scared rabbits at heart, unwilling to play hardball to achieve their goals. Part of the reason for that may be that for many of them, their commitment to many of the things that you'd think Democrats would automatically be for is somewhere between lukewarm and suspect. That's certainly the case here.
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Individual Mandates only keep rates down in theory.
In reality, what reason do insurance companies have to keep rates down once everyone is mandated to buy their product? Without a mandate, they have an incentive to keep rates down because if they were too high people could drop their insurance. Now, that risk is gone. People become a captive market, forced to pay for a product no matter what it costs.
A few reasons...
Well, for one thing: the possibility that consumers will decide that the $750 penalty (with the option of buying insurance only when they get sick, something which isn't possible under our current system but which would be under this bill) is a better deal than paying the current rates. An awful lot of people here seem to be concerned (obviously, not without reason) about the insurance companies gaming the system, but in reality that's a two way street: consumers can game the system too!
For another: the exchanges themselves are government programs, and access to them is conditional based upon compliance with the new insurance regulations... insurers that failed to meet these requirements wouldn't even have access to the consumers affected by the mandate.
For another: market entry and competition. Just because there are a lot of insurers who currently have large market shares doesn't mean that they don't have to worry about competition at all. If the insurance industry was offering massive profits to anyone who could offer a plan just a little bit better and a little bit cheaper than the nightmare scenario envisioned by many above, than you can rest assured that one of those other greedy businessmen in another business or industry would find a way to make it happen. That's how this stuff works... is in fact entirely consistent with the "profit profit profit" mentality that everyone seems so afraid of.
For another: community rating means that any such increases are going to effect sizable political constituencies, which is a pretty quick road to ending any sweet heart deal.
You actually believe in
You actually believe in competition ? Unbelievable !
Yeah
Well I certainly don't believe that all the other profit-hungry business types out there are going to look at the insurance industry racking up huge margins and think "Good for them, they deserve it." I think they're going to want a part of that action. And, to steal from the sentiment of most of these other comments, I think it's pretty naive to think otherwise.
Just wait till next year
Of course, if health care passes this year,wouldn't we be able to add a Medicare buy-in next year through reconciliation? And add public option the same way?
Honest, I don't know the fine points, but I think once the framework is in place, the changes can be added more easily.
Like a lot of people I think Lieberman sucks and honestly don't think any rock would allow him to emerge from beneath it. But it feels a little like fourth and one in the red zone. I'd rather put some points on the board and get more next time we get the ball, which on my calendar is January 2010..
How is the individual mandate
How is the individual mandate different from a tax?
A sales tax would be paid by everyone, people, businesses, every time a transaction took place. It would cumulatively turn over more money than mandated premiums ever will, especially if it's progressive, with giant corporate transactions paying more.
(second try)
Mandate
Why should I be required to pay an exorbitant price for inadequate coverage to a private corporation I loathe merely because I exist and live in the United States? Existing isn't a privilege. Talk about taxation without representation. Let me vote at stockholders meetings and I'll think about it.
You're looking at someone who
You're looking at someone who will be burning my 'individual mandate' card and probably never voting democratic again. There is nothing in this bill that guarantees coverage or restricts the ability for insurers to drop you. In fact the provision as written almost completely matches the current language in most policies that allows most insurers to deny coverage!
Beyond that, wait until 2010 when the democrats get electorally slaughtered because they ignored their base and their constituencies, and watch the Republicans kill the subsidies as well.
Thanks but no thanks. We're better off without.
Perhaps more importantly, why
Perhaps more importantly,
why does anyone think a personal mandate will survive the first Supreme Court challenge?
The Supreme Court is filled Republican yahoos who will jump at the chance to fuck with this on any pretext whatever.
Never mind an argument over whether it is or isn't Constitutional. They'll simply overturn it within a few months of its passing and then, if the whole financing scheme depends on a personal mandate what are they going to do?
The whole thing turns into a pile of junk.
Perhaps more importantly, why
Perhaps more importantly,
why does anyone think a personal mandate will survive the first Supreme Court challenge?
The Supreme Court is filled Republican yahoos who will jump at the chance to fuck with this on any pretext whatever.
Never mind an argument over whether it is or isn't Constitutional. They'll simply overturn it within a few months of its passing and then, if the whole financing scheme depends on a personal mandate what are they going to do?
The whole thing turns into a pile of junk.
(second try)
I don't see what mechanisms keep premiums down.
If insurance companies have to take all comers, and charge everyone the same amount (community rating), what's to stop insurance companies from raising premiums?
Maybe Medicaid and low-income people will get some support, but what about the middle class? They could be facing much larger premiums.
Politically, the current (Lieberman-approved) bill will be very bad politics.
The insurance company
The insurance company executives have been chastened by what happened to the banksters.
Starting Over
This may be a dumb question, but what is the big rush to get this thing done by Christmas? Obama will still be president next June and the Democrats will still have a majority in both houses. Why not stick a boot up Lieberman's ass and keep working at it till they get it right? It's not as if all the members of the House and Senate are tied up with Health Care Reform. That's why they have the various committees. Nothing to stop the rest of them from doing something useful in the meantime.
It's to force Harry Reid to deal with Lieberman.
The "deadline" of Christmas is meaningless. It's not the final bill, only the Senate version. I believe that White House pressure to get the Senate bill passed by Christmas is to put the squeeze on Reid, preventing him from looking at alternatives to the current (Lieberman-approved) bill.
The White House didn't show much urgency for this bill until this week. If they really wanted a finished bill by Christmas, they would not have been absent throughout August (when the Tea Parties were wasting everybody's time) and would have been more engaged in the process in autumn.
Basically, I see the White House on the same side as Lieberman.
Either give me my public
Either give me my public option, or take out the individual mandate, or fuck you, I'm never voting for a Democrat again.
Counterquestion
You ask:
"But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? "
But:
I get to be forced to give insurance companies money for garbage. And don't forget the GOP will run against it for a generation.
How soon will that get fixed?
A guess
My honest guess is that Howard Dean does not believe what he said. I really think his calculation is that if Howard Dean supports the bill, the Joe Lieberman will vote against cloture. I don't know if this is his calculation but it does make sense. Many people think Lieberman is determined to make liberals squeal. If he can't make us squeal now by blocking Medicare buy in and the triggered public option, then he will make us squeal by damaging the bill further.
So, it's a dirty rotten job but some prominent liberal has to squeal against a very bad bill.
I say Dr Dean is taking one for the team. He sounds crazy, but I'm sure he is warming the cockles of Joe Lieberman's heartlessness.
Is that typical of Howard
Is that typical of Howard Dean's behavior? To be disingenuous like that?
Remember Waldmann, he's not a professor or economist, so he probably isn't as sophisticated as you and your elite buddies about rationalizing lying....
?? sophisticated ?? reverse
?? sophisticated ?? reverse psychology is sophisticated?
Oh, please
Spare us your cleverness. Howard Dean, thank goodness, isn't even capable of thinking like that. What nonsense.
Jeez Kevin, this bill is a
Jeez Kevin, this bill is a dog. Call it what you like, but minimum 60% of Americans are going to call it another trillion dollar gift to Obama's financial sector fat cat friends. And the individual mandate? Are we deliberately dreaming up the best way to lose elections?
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