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News & ArtsTuesday, June 9, 2009
Health / Politics Health Care Reform Bill Draft Released
Posted by Jonathan Golob on Tue, Jun 9, 2009 at 6:39 PM
Jonathan Cohn, over at TNR and an expert on healthcare reform in the US, has the scoop:
The Senate Help, Education, Labor, and Pensions (HELP) Committee just released its proposed health care legislation for markup next week. That's right—it's the actual bill. Not conceptual language. Not leaked drafts. This is actual legislative language that the committee is making public.... You can read it online here, in all of its PDF glory.
.....Insurance would be available to everybody, regardless of pre-existing conditions; insurers would have to charge everybody the same rate, with only a few exceptions. (One of them would be age, but the variation could only be two-to-one, rather than the seven-to-one ration contemplated in the Senate Finance Guidelines.)
Everybody would have to get insurance, except for hardship cases. Not clear what the penalty would be.
On two of the most contentious points—employer responsibility and the public plan—there's a blank. Well, not a blank, just a phrase: "Policy under discussion." So stay tuned there.
Other elements of the bill have more specificity. And here we start to get really wonky.
There are subsidies available to people making up to 500 percent of the poverty line, plus an across-the-board increase in Medicaid eligibility up to 150 percent of the poverty line.
(Emphasis added by me.)
I've written about the need of a public plan before. The negotiations in the congress are coming to a head: Now is the time to fight for your right to opt out of private health care insurance, and demand a public heath insurance plan be a part of this reform.
The insurance industry is lobbying hard against such a public plan. Have your voice heard, even as a short message saying "I support a public health insurance option as a part of health care reform," by contacting the Senate HELP committee members:
For the Democrats / Independents:
Chairman Edward Kennedy (MA): (202) 224-4543.
Chris Dodd (CT): (202) 224-2823.
Tom Harkin (IA): 202-224-3254
Barbara A. Mikulski (MD): (202) 224-4654.
Jeff Bingaman (NM): (202) 224-5521
Patty Murray (WA): (202) 224-2621, (206) 553-5545
Jack Reed (RI): (401) 943-3100
Bernard Sanders (I) (VT): 202-224-5141
Sherrod Brown (OH): (202) 224-2315
Robert P. Casey, Jr. (PA): (202) 228-0604
Kay Hagan (NC): 202-224-6342
Jeff Merkley (OR): (202) 224-3753
For the Republicans:
Ranking Member Michael B. Enzi (WY):
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
John McCain (AZ)
Orrin G. Hatch (UT)
Lisa Murkowski (AK)
Tom Coburn, M.D. (OK)
Pat Roberts (KS)
4
A public option would be fine if the legislation included a rule that mandated equal income-indexed funding for public and private plans.
E.g. - if someone making $50,000 a year qualifies for a public plan with total costs that equal $10,000 per year (individual pays $2000 and the government pays the remaining $8,000), then the government would have to give everyone else making $50,000 a year $8,000 to buy private insurance.
Failure to do so would make for unfair competition between the government and private insurance and would unfairly favor people enrolled in public plans over those enrolled in private plans. If the choice is between paying $2,000 a year and getting access to benefits worth $10,000 a year, and paying $2,000 a year and getting access to benefits worth...$2,000 a year it's not terribly difficult to predict which plan the public will want to join under such lopsided "competition."
Rules that mandated this kind of fiscal neutrality would also force the government plans to compete in terms of value and quality, since they'd have no advantage in terms of out-of-pocket price.
However, I expect that pretty much everyone who favors a public option to compete with a private plan would object to such conditions. Why - because rigging the game to drive private insurers out of business and bring about a single-payer regime has been the objective all along. It's a feature of the game, not a bug.
E.g. - if someone making $50,000 a year qualifies for a public plan with total costs that equal $10,000 per year (individual pays $2000 and the government pays the remaining $8,000), then the government would have to give everyone else making $50,000 a year $8,000 to buy private insurance.
Failure to do so would make for unfair competition between the government and private insurance and would unfairly favor people enrolled in public plans over those enrolled in private plans. If the choice is between paying $2,000 a year and getting access to benefits worth $10,000 a year, and paying $2,000 a year and getting access to benefits worth...$2,000 a year it's not terribly difficult to predict which plan the public will want to join under such lopsided "competition."
Rules that mandated this kind of fiscal neutrality would also force the government plans to compete in terms of value and quality, since they'd have no advantage in terms of out-of-pocket price.
However, I expect that pretty much everyone who favors a public option to compete with a private plan would object to such conditions. Why - because rigging the game to drive private insurers out of business and bring about a single-payer regime has been the objective all along. It's a feature of the game, not a bug.
5
Goddamnit, I wish we could just get this shit over with already. For-profit insurance cannot and should not fulfill the role of a social safety net. Who the fuck cares if it's "socialism" or whatever the fuck, single payer will save money and lives and only hurt those stupid tiger-repellant rock peddlers.
My health should not be a profit center.
My health should not be a profit center.
6
The wacky right thinks Obama is a Socialist.
The wacky left wishes Obama is a Socialist.
The middle? We laugh at you both.
The wacky left wishes Obama is a Socialist.
The middle? We laugh at you both.
7
where's the vaunted Obama 11 million strong e mail organizing effort on this? What in hell is he saving it for?
8
"Insurance would be available to everybody, regardless of pre-existing conditions; insurers would have to charge everybody the same rate,"
then it will not be "insurance".
it will be a government funded subsidy program.
then it will not be "insurance".
it will be a government funded subsidy program.
9
That committee list looks pretty good for getting a bill out of committee.
But ifthere's no indication as to which ones are actually on the fence about the public option...it's a totally untargeted effort.
And the real challenge will be the 8 most conservative Democrats from the Seante, in general; the news today was that the reconciliation process is NOT going to be used.
So we need every Democratic senator's vote plus probably 1-2 from the GOP.
Cuz we won't get every Dem Senator's vote.
o it would be helpful to have a list of those 8-9 conservaDems in the general Senate, plus say a few GOPsters like the two from Maine, and maybe one more, say from a state that went for Obama and where the GOP senator is up for reelection next year.
You know a little direction here would go a long way and really, Obama should be coordinating this stuff instead of leaving alt media bloggers to post generic lists with no coordinated strategy as to hwho exactly needs to be persuaded.
But ifthere's no indication as to which ones are actually on the fence about the public option...it's a totally untargeted effort.
And the real challenge will be the 8 most conservative Democrats from the Seante, in general; the news today was that the reconciliation process is NOT going to be used.
So we need every Democratic senator's vote plus probably 1-2 from the GOP.
Cuz we won't get every Dem Senator's vote.
o it would be helpful to have a list of those 8-9 conservaDems in the general Senate, plus say a few GOPsters like the two from Maine, and maybe one more, say from a state that went for Obama and where the GOP senator is up for reelection next year.
You know a little direction here would go a long way and really, Obama should be coordinating this stuff instead of leaving alt media bloggers to post generic lists with no coordinated strategy as to hwho exactly needs to be persuaded.
10
Jonathan: Thanks for this. You should repost this, or post a reminder to call, during the hours those offices are open. I want to call, but I have a short attention span.
ooh look, a birdie!
ooh look, a birdie!
11
Yaj: Oh shit, you mean those insurance companies that caused the greatest humanitarian crisis in our country's history will have to start respecting human rights or go out of business? That sucks for the nineteen or so people getting filthy rich off that scam. *quietly weeps*
12
Jonathan, thanks for the heads up, but can you also post the Republicans' contact info? They're the ones that need a bigger kick in the ass on this issue, I think.
13
"greatest humanitarian crisis" - lizzie, you are an ignorant slut.
The system sucks the way it is now. It will be worse when everyone, regardless of conditions, gets the "same" insurance. Effectively, this means that you're paying the same rate as someone with terminal, end-stage cancer, to the tune of millions.
Be prepared, is all.
The system sucks the way it is now. It will be worse when everyone, regardless of conditions, gets the "same" insurance. Effectively, this means that you're paying the same rate as someone with terminal, end-stage cancer, to the tune of millions.
Be prepared, is all.
14
Be prepared for the patriotic backlash against Barack Hussein Mohammed Obama and his march towards totalitarian fascistic socialism.
Socialized medicine killed the Democrat Party in 1994 and led to the rise of Patriot Newt Gingrich, and it will do so again in '10.
Liberals can never see the forest for the trees.
Socialized medicine killed the Democrat Party in 1994 and led to the rise of Patriot Newt Gingrich, and it will do so again in '10.
Liberals can never see the forest for the trees.
15
And thanks for posting the GOP numbers for those of us against.
Another glaring example of how dishonest and conniving liberals are.
Another glaring example of how dishonest and conniving liberals are.
16
Oooo look, the triumphant return of Lord Bozo!
Nothing like a conversation about helping sick people to bring you in from the wilderness.
Nothing like a conversation about helping sick people to bring you in from the wilderness.
17
@16 Socialism never helps anyone, the sick or otherwise.
It only helps bureaucrats and arrogant and angry politicians like Barack Hussein Mohammed Obama and his angriest of wives, Michelle,
She's first "lady" and se still hates America!
It only helps bureaucrats and arrogant and angry politicians like Barack Hussein Mohammed Obama and his angriest of wives, Michelle,
She's first "lady" and se still hates America!
18
I can't wait for the hard traditionalists to unseat these ungrateful Anti-American bastards from their usurped perches.
19
The reason American Health Care cost have spiraled out of reach is that the basic free market price resistance pressure has been broken.
If a consumer himself pays for a product he cares how much it costs and will consider price when making his purchase decision.
The providers of the service know that and try to deliver the best price/value. The competition among providers to do so keeps prices down.
When many/most Americans had their health care paid for by an insurance plan they did not pay for (thru work, etc) or provided by the government that feedback mechanism was broken and the inevitable result was that prices skyrocketed.
Consumers (patients) didn't care (or even know) how much anything costs because insurance would cover it. At the end of the year if they have unused benefit left they will even choose to have tests etc to avoid 'losing' that unused benefit.
Providers (hospitals, physicians etc) know that consumers don't know/care how much things cost and prices rise (rapidly).
The participants may not be aware of how they are acting but human nature drives the process.
Any economist could have predicted it would happen.
Some say health care is unique and economic models don't apply but they are wrong.
Consider LASIK eye surgery, a recent procedure not usually covered by insurance. From the time it started prices have dropped greatly as providers compete for patients who are paying out of pocket and are price concious.
And if you look at utilization rates of insurance and compared individuals who buy their own insurance coverage (small business, etc) vs individuals whose insurance is provided as a benefit by their employer you will find that, given identical plans and benefit levels, individuals paying for their own insurance utilize it much more prudently than those who do not pay for it, because they realize there actually is no free lunch and excess utilization is going to drive their premiums up.
Any health care reform must address this problem or it will financially fail.
There is currently little reward to those who make prudent lifestyle and health care utilization choices and little penalty to those who do not.
By provioding coverage to the 50 million uninsured; especially if that coverage ignores fundamental economic realities like pre-existing conditions, Obama just throws 50 million more hungry hogs into the system to gourge at the 'free lunch' health care trough and have taxpayers pick up the tab.
Financially it will be ruinous.
More...
If a consumer himself pays for a product he cares how much it costs and will consider price when making his purchase decision.
The providers of the service know that and try to deliver the best price/value. The competition among providers to do so keeps prices down.
When many/most Americans had their health care paid for by an insurance plan they did not pay for (thru work, etc) or provided by the government that feedback mechanism was broken and the inevitable result was that prices skyrocketed.
Consumers (patients) didn't care (or even know) how much anything costs because insurance would cover it. At the end of the year if they have unused benefit left they will even choose to have tests etc to avoid 'losing' that unused benefit.
Providers (hospitals, physicians etc) know that consumers don't know/care how much things cost and prices rise (rapidly).
The participants may not be aware of how they are acting but human nature drives the process.
Any economist could have predicted it would happen.
Some say health care is unique and economic models don't apply but they are wrong.
Consider LASIK eye surgery, a recent procedure not usually covered by insurance. From the time it started prices have dropped greatly as providers compete for patients who are paying out of pocket and are price concious.
And if you look at utilization rates of insurance and compared individuals who buy their own insurance coverage (small business, etc) vs individuals whose insurance is provided as a benefit by their employer you will find that, given identical plans and benefit levels, individuals paying for their own insurance utilize it much more prudently than those who do not pay for it, because they realize there actually is no free lunch and excess utilization is going to drive their premiums up.
Any health care reform must address this problem or it will financially fail.
There is currently little reward to those who make prudent lifestyle and health care utilization choices and little penalty to those who do not.
By provioding coverage to the 50 million uninsured; especially if that coverage ignores fundamental economic realities like pre-existing conditions, Obama just throws 50 million more hungry hogs into the system to gourge at the 'free lunch' health care trough and have taxpayers pick up the tab.
Financially it will be ruinous.
20
#19: Bingo.
We should be careful what we ask for, especially if these underlying issues are not addressed.
Here is a fairly short and very specific tale of the kind of things we should get ready for...
http://www.theatlantic.com/doc/200903/po…
http://www.theatlantic.com/doc/200903u/p…
My favorite quote from the second piece:
"But acknowledging that the current system has problems and might be improved is a long way from believing that those problems can be solved simply—or that Americans can have, as many readers seem to believe, health care that is simultaneously cheaper, less likely to escalate in cost, more widely available, technologically innovative, and fully responsive to the desires of patients and physicians."
We should be careful what we ask for, especially if these underlying issues are not addressed.
Here is a fairly short and very specific tale of the kind of things we should get ready for...
http://www.theatlantic.com/doc/200903/po…
http://www.theatlantic.com/doc/200903u/p…
My favorite quote from the second piece:
"But acknowledging that the current system has problems and might be improved is a long way from believing that those problems can be solved simply—or that Americans can have, as many readers seem to believe, health care that is simultaneously cheaper, less likely to escalate in cost, more widely available, technologically innovative, and fully responsive to the desires of patients and physicians."
21
@11 - "greatest humanitarian crisis"?
The african american slaves, native americans, and non-voting women of the past would like a word with you.
The african american slaves, native americans, and non-voting women of the past would like a word with you.
22
"the greatest humanitarian crisis in our country's history"
Geez, if you're gonna be a laughable hysteric, why not at last call it a 'holocaust'.
Geez, if you're gonna be a laughable hysteric, why not at last call it a 'holocaust'.
23
"...insurers would have to charge everybody the same rate, with only a few exceptions. (One of them would be age, but the variation could only be two-to-one, rather than the seven-to-one ration contemplated in the Senate Finance Guidelines.)"
I think that Jonathan Cohn in the original article surely must mean "ratio" rather than "ration", which is a truly unfortunate Freudian typo when discussing progressive healthcare reform.
I think that Jonathan Cohn in the original article surely must mean "ratio" rather than "ration", which is a truly unfortunate Freudian typo when discussing progressive healthcare reform.
24
@17 - Yeah, you totally hear about those high-rollers at the norwegian ministry of health all the time, with their caviar and champagne, those funkin' pigs.
@19 - Did you know that medical bills are the cause of over 60% of bankruptcies? Making people pay for health care out of pocket will only multiply that.
The thing about a single-payer system is that the payer (government) is in a central position to bargain with providers to set prices.
@19 - Did you know that medical bills are the cause of over 60% of bankruptcies? Making people pay for health care out of pocket will only multiply that.
The thing about a single-payer system is that the payer (government) is in a central position to bargain with providers to set prices.
26
Well there's "gonna" be a lot more Americans die unless we do a lot of things -- how about banning motorcycles?
@24: yeah, because using price controls has always worked out so well...that will only create even more acute shortages. In the long run, people have to go to the doctor less and get less care if you are going to see any sort of drop in costs.
@24: yeah, because using price controls has always worked out so well...that will only create even more acute shortages. In the long run, people have to go to the doctor less and get less care if you are going to see any sort of drop in costs.
27
@24:
It's not easy to determine what percentage of people driven into bankruptcy by medical bills, and what percentage of these people put under by the loss of income associated with a prolonged illness - but the data suggests that most people driven into bankruptcy by illness had health insurance.
Ill health and the loss of income from the associated disability are two separate problems. Even with the best health coverage in the world that costs you zero out of pocket dollars, if your ability to generate an income is compromised - you're toast.
The only way to protect yourself against that risk is with a disability insurance policy that will cover your bills if you're too laid up to work.
http://www.msnbc.msn.com/id/6895896/
It's not easy to determine what percentage of people driven into bankruptcy by medical bills, and what percentage of these people put under by the loss of income associated with a prolonged illness - but the data suggests that most people driven into bankruptcy by illness had health insurance.
Ill health and the loss of income from the associated disability are two separate problems. Even with the best health coverage in the world that costs you zero out of pocket dollars, if your ability to generate an income is compromised - you're toast.
The only way to protect yourself against that risk is with a disability insurance policy that will cover your bills if you're too laid up to work.
http://www.msnbc.msn.com/id/6895896/
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