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 The filthy rich involved in Enron, World Com, Tyco and plenty of other dot coms earlier this decade have been replaced by the filthy rich from AIG, Citigroup, Goldman Sachs, Morgan Stanley, B of A, among the survivors; and, Countrywide, Wachovia, Washington Mutual, Bear Sterns and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.

No Public Option is NO REFORM

At the same time I'm blogging for a saner middle in our discourse, I'm extremely disappointed in the apparent fall back. A pretend competition between multi-billion dollar insurance companies and the authorization for medical cooperatives is a serious blow to health reform. The government is the only entity strong enough to provide a serious competitor to the for-profit insurance companies. I'm all for coops as another option in the exchanges, but they are not a substitute for a public option to provide competition. Without another option for people to CHOOSE, this bill will FORCE 50 million people onto the rolls of United Health, Cigna, etc. Why isn't this a meme in the media. No one seems to question the individual mandate and yet, the mandate was supposed to be accompanied by providing a public option which the uninsured could CHOOSE. Instead, without the public option, we are providing the insurance companies with 50 million new customers to gouge.

Because of a few improvements envisioned by this bill, in the system we now have, I don't want to see a bill go down to complete defeat even without a public option but I strongly disagree that this is only a sliver of the reform we were promised and therefore not all that important. Congress failed to give single payer even a minimal hearing and instead dispensed with the argument with this proposal in favor of a limited public option. Now they pretend that compromise between a limited public option and no change is the only way to get "reform". This compromise may represent a small improvement over the status quo, but it in NO way represents reform.

Sebelius: Public Health Care Option "Not The Essential Element"

I wanted a real public option, but the limited public option available to the uninsured and some small business, is unlikely to make much of a difference anyway. At yesterday's town hall, it was clear Obama is signalling that the public option is expendable - the deal has probably already been struck behind closed doors. This was to give the people who wanted a publc option time to rant and rave until October when the tiny sliver gets thrown under a bus to be renamed coop. We will get modified insurance reform, where the government will pretend that insurance companies cannot discriminate and cannot rescind, we will have an individual but not an employer mandate. we will have some subsidies to make it more affordable and that's it.

Health care reform isn't coming anytime soon. Are baby steps better than none? I don't know, but probably. I did read an intriguing article in Atlantic called health care killed my father that made some really interesting points about the employer based insurance system and the idea that comprehensive, unlimited care can ever be affordable. Frankly, with the moderate changes likely to be the end result, I don't see why I should get excited trying to get my representatives to pass something that barely resembles reform. I have to remind myself that this is administration is better than the alternative but was never going to be revolutionary or truly progressive. And I also have to remind myself that the President isn't able to make these changes uniliaterally and having to work with this Congress which may be Democratic in name but in reality milk toast, moderate change is all you can probably hope for. As Donald Rumsfeld might have said, you go with the Congress you have not the Congress you want.
Read the Article at HuffingtonPost

Public Option vs Non Profit Coops

Well, the insurance industry has come up with a new clean way to shut down the public option. We are not against robust competition, we just don't want it to come from the government. Therefore, we will support non-profit coops as an alternative that you, chicken hearted Democrats can vote for.

Why would the insurance industrial complex support coops. Because they know they would be toothless weak shells that could be run over by the insurance industry. They also know that it sounds so democratic to support coops as viable competition. These coops will take years if not decades to even organize and begin to service people. They do not resolve any of the overhead issues [where most savings might lie] costing health care so much money in the current situation - rather they will be saddled with as much or more because they will lack economy of scale that either most major insurance companies or govenrment health plans would have. They will be denied financing by the same industry that they are supposed to compete against and they will either eventually do ok and then become for profit insurance companies ala Blue Cross, or they will go out of business like so many coops do. The insurance companies will be no worse the wear.

Furthermore, as part of their support, they have succeeded in obtaining an individual mandate [but not an employer mandate] in the bill. This means that the insurance companies can expect another 40 million lambs for them to slaughter. What's not to love?

Thirty to fourty percent of our health care dollar is paid for administrative overhead. This includes profit, marketing, huge salaries and other benefits for the executive class, denial of coverage specialists, state and federal lobbying expenses, underwriting to reduce claims, along with some necessary expenses such as salaries, benefits, rent, and supplies. One of the main goals of a public option is to save money by getting rid of the first five items. By being able to streamline the claims process because only one entity will be processing the claims, further savings will occur. Medicare for example has only a 3% overhead. This is not money for medical care, this is money for conserving and promoting the insurance industrial complex. On the other hand, this is also the best reason for single payer because all this fat is sliced from the budget [estimated at 400 Billion dollars]. However, since a mini public option is viciously attacked by so many as socialized medicine, there is not hope that a single payer program could be passed. However, a public option would provide much of this benefit for the people receiving the coverage, thus allowing an affordable insurance program for the currently uninsured and perhaps demonstrating where the waste is in the system we now have. That demonstration is what the insurance companies so fear that they and their allies will say anything, do anything to ensure that it does not pass. Unfortunately, with their lies and distortions, they seem to be able to scare enough uninformed, low information voters about the program that the weak-kneed well greased Blue Dog Democrats and others in the Senate seem prepared to scuttle the public option so that nothing will change, except our premiums, which will of course go up.

This is what will pass as health reform, until the country either goes broke or wakes up to its puppet masters.