Trust Us!

The more I read about the health insurance reform going on in Congress the more confused and worried I get. This isn't supposed to be the way it works -- like in the public service annoucement, its supposed to be The More You Know.
This process is so complex its no wonder nothing has ever passed. In addition, in the current environment, there is no trust that the people's interest is what is driving the compromises. Incremental progress is now a Republican concept to derail health reform. I'm really concerned that whatever comes out of Congress is going to make things worse rather than better, both politically and about health care. As I read the bills in both the Senate and House, there seems to be some good things in them. And after reading them, or summaries, I generally thought this would work. But then upon reading criiques of them and the Massachusetts bill and seeing the cost to a middle class American family, I'm astonished that some of this is being proposed. I'm talking especially about the individual mandate coupled with the skimpy subsidies.

The Congress seems to be unwilling to take back the windfalls to the rich from the tax breaks earlier in the decade to help pay for this. These windfalls resulted in some of the most revolting excess of conspicuous consumption witnessed since the Gilded Age and by some of the same types of people who were called Robber Barons in the late 19th Century. The filthy rich involved in Enron, World Com, Tyco and plenty of other dot coms earlier this decade have been replaced by the filthy rich from AIG, Citigroup, Goldman Sachs, Morgan Stanley, B of A, among the survivors; and, Countrywide, Wachovia, Washington Mutual, Bear Sterns and Lehman Brothers among those who did not. Whether the people who reaped the benefits from the demise of any these organizations landed on their feet hasn't bee analyzed in any depth as far as I know, but in their heydays, they walked away with billions.

Because of this unwillingness to tax any of this "wealth", the individual mandate may end up costing a family of four $9K or more for a health insurance policy. And given that it costs over $13K for many policies one wonders if they will get even minimal protection for that price. If one cannot or does not wish to pay this amount [unless the government agrees with a hardship exemption] the family will be fined up to $3800 for not having insurance. There is also no employer mandate and this may result in either poor quality choices from an employer or incentives to dump employees into the Excange Market. These provisions are in the Baucus bill which is currently the media favorite for passing the Senate. A question was posed on the Sunday talk shows to Obama about whether this was a tax. He denied that it was because we know "tax" is a four letter word in politics. However, it is hard to see how someone with a family making $66000 would refuse to pay for insurance if it was what they considered affordable. They likely uninsured because they consider the premiums unaffordable given the many demands on a family budget. Many people just don't have that much available for something they can do without if they are lucky. Yet, this bill will require they pay these sums to private companies who have been denigrated in this battle for being anti-patient and greedy, uncaring behemoths who owe their allegiance to the bottom line and their stockholders. It is unlikely that these companies will lower their premiums without some outside force. Yet that outside force, if available is about as capable of exercising any pressure as an ant facing an anteater. This bill would also set up a mechanism for enforcing this mandate, further siphoning off government dollars that would be better spent for health care or deficit reduction.

The Massachusetts experiment provides a picture of just how difficult this process is. While the program has dropped the level of uninsured to less than 3%, it has substantially smaller penalties and higher subsidies than the Baucus bill. And yet, there are many anomalies of coverage such as a 40% dropout rate on some policies after 5 months. Enforcement has not been easy and premiums and penalties are increasing as costs balloon out of control. Can the federal government do any better? Are the enforcement mechanisms against the insurance companies for keeping their part of the bargain as good as those against individuals through the tax code.

This is also just one example of why the bills are so long and complex. Each item they take up brings forth all kinds of permutations that have to be addressed less they create loopholes which imperil the bill's purposes. Reading the bills seldom explains anything in clear language because so much is an amendment of an existing law or a change to a procedure or regulation in another Title or section.

All of this is being done in an atmosphere of severe distrust of our leaders that has seldom been so evident. It is also being done without the transparency that was promised in the campaign. Every "deal" behind the scenes with the medical industry raised scepticism as to who's benefit these are done, since medical industry contributions and lobbyists are at an all time high. People who have been burned by other government reform efforts are feeling very unsure about this one as well. With 80% of the people insured through their employer and only uneasy about its potential loss, any bill that does not make things better could be viewed as a disaster for those who are insured.

All these concerns I have are juxtaposed against a personal desire to finally see us commit to making health care a basic right in this country. Do we throw the baby out with the bathwater or do we wake up to find the baby was poisoned to death by the bath water? I know legislating is ugly and difficult. I know compromise is the only way to pass something, but I fear the Democrats is their efforts to compromise the heart of the effort away may be setting themselves up for a terrible backlash. And the Republicans who have opposed any reform may end up being the winners because their names won't be on any legislation when the bills for premiums or penalties, and the complaints about problems with the bills start rolling in.