Health Care Reform: Short term "gains" vs. long term cataclysmic failures

[Political Heretic]

From posting elsewhere:

...where it falls apart for this administration is that now that they've played that hand well, and exposed republicans for the obstructionist contrarians they are, there's no reason not to use this opportunity to push through real reform. Not the half-assed, rife with problems Senate Health Care Bill, but a fully expanded health care solution, that seriously regulates industry from a federal level and establishes a medicare part e alternative to private insurance.

Instead what we're getting is a bill so full of long term problems that is poised to do more harm than good to regular Americans in the long run. We're getting a bill that is already chalked full of capitulations and compromises. It includes insufficient subsidies and does nothing to address the overall cost of care, which extends far beyond premiums. The out of pocket expense cap at 10,000 is enough to bankrupt any working class family that ever finds itself in need of serious long term medical care. There is no regulation of insurance industries pattern of denying claims or cancelling coverage for bogus reasons, and little to protect against the continued explosive raising of premiums the insurance company is engaged in to this very day. There's little safeguard against monopolies, and no clear structure of regulatory oversight, with many things just being punted to the states to "sort out."

All of those things are long term problems, and most people here refuse to see anything other than the short term political win. In the short term, more people have access to Medicare and Medicaid. In the short term, people receive subsidies to help them purchases insurance. In the short term, noone can be denied coverage (up front) based on preexisting medical conditions. In the short term, we use this bill as the vehicle to provide funding to build many new medical clinics.

That's great. But the long term problems completely, utterly overshadow all the short term benefits. In the long run premiums still soar. In the long run, claims are still denied illegitimately and policies are still cancelled illegitimately (by claiming the purchaser was "fraudulent" by not disclosing that he/she had zits at at 13.) In the long run subsidies remain insufficient to generate affordability for millions of people. In the long run the out of pocket cost of care still bankrupts families.

And yet here we are, ready to ram through a bill that 65% of Americans say they don't want (while at the same time 60-65% of Americans say they do want a public option). This is not something that I can celebrate. 65% don't hate this bill because they don't want health care. The very fact that the same majority wants a public option is testament to that fact. They don't want the corporation-first, working families last horse shit being pushed through Washington right now in the name of reform.

And neither should we.

Now we don't even get to know what would be passed via reconciliation before the Bill passes into law. We don't know what, if anything, will be fixed. This morning I read that House Representatives are saying they will have to pass the bill first and just take the Senate's "word" that it will fix stuff later. Reid says he "thinks" he "may" have the votes. Wow. How comforting to know before we thrust this fucking nightmare onto working families.... :eyes:

http://fdlaction.firedoglake.com/2010/02/26/george-miller-says-house-democrats-will-pass-senate-bill-first-on-mere-promise-of-future-fixes/
(Link to the House Reps saying this)

This whole process has been about people looking at short term political victories or short term public gains over the long term general welfare and public good. It's quite the tragedy, hardly a triumph.

[Political Heretic]

1. It's not going away just because its inconvenient.

[AllentownJake]

2. Let me see

For the past 10 years most activist in this country have been focused on the middle man, the insurance industry. At least when a doctor or a drug company gouges me I get some sort of service. Now, the solution is to mandate everyone to use the middleman. Yes, that seems like a brilliant plan. Lol, who do these politicos think they are fooling.

[laughingliberal]

14. Well, from reading here on DU on a regular basis, I would guess they have managed to fool a

whole bunch of otherwise intelligent people. Is it the emotion of the issue (scads of uninsured people without access to health care) that is clouding people's judgement on this?

edited punctuation

[BzaDem]

3. I support passing the Senate bill + fixes because it is good policy, not just because of the victory

In other words, I believe the long term affects are not only NOT a "cataclysmic failure," but are actually a great success for our country. Directly and indirectly.

Directly, it is good policy. Mandating premiums only be 2.5-9.5% of one's income from 133% FPL-400% FPL (and huge Medicaid expansion for 133% FPL and below) is good policy. The corresponding out of pocket/deductible/coinsurance caps for those up to 300% FPL is also good policy. Helping the millions of poor and middle class people who are uninsurable from pre-existing conditions ranging from Cancer to Acne is good policy.

While a lot of people here like criticizing the mandate (not realizing that it is required under any system that covers pre-existing conditions), the way it is structured in the bill isn't actually that bad. Those who are uninsured will essentially be paying $700 dollars / year or 2.5% of their income to buy the right to buy insurance at any later time for the price normally charged to a healthy person. Whereas right now, the uninsured have the "right" to buy insurance at prices anywhere from 1 to 20 times the price (or more) of insurance for a healthy person, depending on their condition. If the mandate penalty were much higher (without a proportional increase in subsidies), then it would probably be a bad policy. But not the way it is structured in this bill.


Indirectly, it is also a good policy, because it makes Single Payer and/or a Public Option MUCH more likely in the future. Right now, most of the burden of our healthcare system is on the sick, who have to pay 101-2000% (or more) of what a healthy person does for their healthcare. Since there are always going to be far more healthy people than sick people, there isn't the political will to enact a huge change to our system and there WON'T be under the status quo in the future. (That's why you see 80+% being satisfied with their own insurance.) However, if we enact community rating, everyone will be charged the same price for healthcare, and this means everyone will have a political stake in keeping costs low. Your argument that insurers will just deny claims based on "zits" at the age of 13 doesn't hold water. Insurers won't be able to deny claims based upon medical history because they won't be able to use medical history AT ALL in coming up with the price for insurance.

Most of your criticisms fail because you are essentially comparing the Senate bill to HR676/Single Payer that (despite your great want for it) doesn't have a chance of becoming law now or ever under the status quo. If you instead compared the Senate bill to nothing, you would find different results. (Are insufficient subsidies worse than no subsidies? Are out of pocket caps worse than no out of pocket caps? Is the regulation in the Senate bill worse than the status quo level of regulation?)

[AllentownJake]

4. Most of the good in the senate bill

Doesn't kick in until 2013 and the accounting on how it is paid for is shady.
I'm not worried, I doubt this is really going anywhere.

Insurance is the problem. It is about the worst product for the solution. Insurance generally only works well in low claim environments. This is really silly policy an entreaches a 50 year old mistake.

[BzaDem]

5. The "shady accounting" bullshit is a false right-wing talking point.

The bill saves not only 100+ billion in the first decade but over 600 billion in the second decade. Accounting gimmickry can make the first 10 years cost more than it appears but not the second 10 yeras.

Ironically, the "insurance is the problem" stance is also very similar to a right-wing position. Right-wingers want to get rid of insurance and have everyone pay for all routine medical appointments/procedures out of their own pocket (with either no or completely inadequate subsidies). The only insurance that would remain would be non-community-rated catastrophic insurance, which would be (by definition) a "low-claim environment." Be very careful what you wish for, because this right-wing utopia is FAR more likely than single payer is if the status quo remains (because the insurance-less right-wing-utopia can occur without legislation).

[AllentownJake]

7. I agree with the routine cost

Most insurance is used for non-routine occurences like accidents, death, and annuity payments which is one computer transaction and review generally. I guess you have never worked in the insurance industry.

[BzaDem]

10. How routine expenses are paid for (through insurance or cash subsidies) is BESIDES THE POINT

that is an INSIGNIFICANT ISSUE compared to whether we

a) Have community rating for non-routine medical expenses

and

b) Provide subsidies for the uninsured, regardless of the form they take

The Senate bill does both. Your favored approach (the status quo) does neither. That is all there is to it.

[eridani]

23. The subsidies are only for the really really SHITTY level of coverage

It is even worse than the coverage that has driven so many into bankruptcy.

[dflprincess]

25. Exactly

the subsidies are nothing but a cover for the transfer of more public money into the pockets of private industry.

Nothing in the bill guarantees that a person will have access to to care as they will still need cash (or plastic) to cover the hefty out of pocket costs that will still be allowed.

[AllentownJake]

11. I looked over the numbers btw

It doesn't make sense. If it doesn't make sense I generally call foul, and am usually right. Government accounting and estimates over the year has been slightly more honest than the shit you read after the financial statements labled projections. It is a best case estimate

[BzaDem]

Forgive me if I don't buy your "I'm usually right so I'm right now" argument

You have been wrong on almost everything relating to the Senate bill I have seen, so your past history of accuracy would weigh in favor of you being wrong here, not right here.

And not only that, but the estimates actually do make sense. Many of the taxes don't start until later, but neither do most of the subsidies. The savings we get from Medicare Advantage cuts and the Cadillac tax grow much faster in the second decade, hence the higher savings.

[AllentownJake]

15. Overly optiMistic

And political poison. No thanks, as for the personal attack, in the immortal words of Cher, whatever. The party fucked this up don't blame me in November.

[slipslidingaway]

16. The savings we get from Medicare Advantage or any other improvements

in Medicare should stay in Medicare, they will be needed.

Medicare enrollment - from 46 million to 79 million starting in 2010, but somehow we'll be able to cut Medicare costs to partially fund a public option???

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7804861&mesg_id=7805051

[laughingliberal]

17. And that should be perfectly obvious to anyone

Which means we need to ask ourselves why they would be taking this kind of money out of a program which is going to really, really need it. Could it be they have a plan? Should we, perhaps, be asking ourselves if they have a plan and, if so, what that plan might be?

[slipslidingaway]

18. It should be obvious, but I have never heard anyone question this

when they talk about using Medicare savings to partially find this bill.

Yes, the question should be how do you plan to fund the anticipated shortfall, but the question never comes ...what is the plan.

:(

[laughingliberal]

19. What they tell us is they will save that amount of money by

stopping the waste, fraud, and abuse. I do not buy that, at all. My suspicion is that, as Medicare, becomes more and more insolvent, we will see a huge push for privatization of Medicare. I fully expect this to be the recommendation of the deficit commission. I believe it is the precise reason for this cut to Medicare-to set the stage for this.

[Political Heretic]

21. I think that's the chief plan of the elites behind both democrats and republicans.

Setup the privatization of medicare.

[slipslidingaway]

24. We should be suspicious, here is a program that everyone agrees is

in trouble in the coming years and any saving will be transferred to pay for subsidies. Maybe another little push will do it.

:shrug:

[slipslidingaway]

13. "...reduce budget deficits by $104 billion over ten years..." Here is 72 billion ....

Generating revenue to cover the plan's cost over the 10 year period...bottom of page 7 in the CBO report. While the program itself sounds good, notice how this new piece reduces the deficit by 72 billion in the 10 year window.

Nice way to reduce the cost for Now.

Links...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6915576&mesg_id=6916406

[eridani]

22. It saves the GOVERNMENT $100 billion

--accomplishing this by fucking over consumers of health care, especially those over 50.

[AllentownJake]

6. If they weren't going single payer

They'd be better off with an out of pocket subsidy for the uninsured for doctor visits and generic prescription plan and a catastrophic coverage plan for everything else. Eliminate half the payment back office in the doctor offices and clinics and get people out of the emergency room. Kids have the schip option.

[BzaDem]

9. You would still need community rating for the catastrohpic coverage

and the only way to get that at all within the next decade or two is to enact the Senate bill.

The main point of the Senate bill is to

a) provide community-rating so that those with pre-existing conditions can get healthcare
b) provide subsidies so that the uninsured (with and without conditions) can afford healthcare

Whether this is done through insurance for everyone or catastrophic insurance + cash subsidies for routine matters is really besides the point. The main benefits of the Senate bill are a) and b). Just because having insurance for high-claim expenses (such as doctors appointments) isn't necessarily the optimal solution doesn't mean that we shouldn't enact the Senate bill.

[AllentownJake]

12. Yeah, I'm not going to support it

Which means nothing this isn't perfect being the enemy of good. Bad or fucking awful, I'll stay with awful because I know once the parties change power I'm going to really fucking awful when they attack the subsidies.

[slipslidingaway]

8. As mentioned in the OP a 10K max on out of pocket sounds good

until you start paying it every year in addition to the premiums you mention.

Medicare for All does not have a chance because the Democrats continue to take it off the table.

This bill to bail out the insurance companies who are losing and stand to lose more customers as the boomers move to Medicare will do more harm than good. In addition this bill transfers any savings from improved efficiencies to pay subsidies which benefit the private companies.

We need to stop comparing this bill to the status quo and look at other HC systems to see what we could have.

[dflprincess]

26. And remember, that 10K max out of pocket only applies to covered expenses

You'll still need money for (adult) dental and vision and anything else not included in your "coverage".

[slipslidingaway]

27. Yes, if people are looking for these bills to give them some financial relief

when they need care, I think they will be in for a surprise.

[Political Heretic]

20. What are the fixes? Can you name them?

[dflprincess]

28. Probably similar to the "fixes" that were going to be made to NAFTA after it passed -

imaginary.

[Political Heretic]

29. Yeah I'm still waiting.

[BzaDem]

30. The ones in Obama's plan.

Excise tax delayed until 2018, increased subsidies, elimination of Nelson's deal, federal rate regulation authority, etc.

Though I don't want to emphasize the fixes, because the Senate bill by itself would be a huge, positive achievement that would help tens of millions of people (your comparisons to an imaginary, impossible single payer plan notwithstanding). The fixes just make it better.

[Political Heretic]

31. I actually made no comparisons to a single payer plan.

You just keep repeating the same bullshit line over and over, ignoring facts, and lying about other people's positions.

The Senate Bill would not be a huge, positive achievement, nor would it help tens of millions of people in the long run. This just it - health care isn't about the short term. It's about the long term. Health care remains unaffordable under the Senate bill.

You keep thinking affordable means "able to purchase." No, it means "able to use."

Millions of Americans who don't have insurance right now will go to bed praying the exact same prayer under the Senate Bill than that prayed before the Senate bill: Dear God, please help no one in my family to ever get seriously sick. Because the cost of care is bankrupting to working class families. It was bankrupting before this Bill. It will be bankrupting after this bill. So your "it makes it better" meme is a steaming pile of shit.

Insufficient subsidies to buy shitty corporate insurance doesn't do anything to address to costs of accessing health care, especially when you really need it. A 10,000 out of pocket cap, means that any family every facing serious illness or emergency requiring hospitalization, tests, rehabilitation, or any other sort of serious by common treatment will first be on the hook for 10,000 dollars, plus premiums. That would bankrupt me. That would bankrupt my family. That would bankrupt most of my friends and my neighbors and leave us on the street.

So we'll go to bed praying the same prayer we prayed before the Senate Bill: Dear god, please don't let us ever get really sick, because it will ruin our lives. It still ruins our lives under the Senate Bill.

Part of the problem with people talking about health care is so many people are talking about what it will do for "other people" when they have no clue what they are talking about, and don't really care. They just want a political victory. If you already have insurance, of you've never been on food stamps or had to access social services to avoid homelessness - then FUCK OFF. I'm sick if upper-middle class white people telling me how great things will be, when they aren't the ones that have to lives with the system.

How about you let me tell you, as an uninsured poor person, that the bill isn't great. That buying corporate insurance wasn't what was critically needed in health reform. They quality of care for working class Americans, and addressing the comprehensive costs of care for working class families was critically needed and was not delivered. Subsidies for premiums totally misses the point, and fails to address the most glaring problems with health care for working class families.

Not to mention all of the other problems I've identified, such as the failure to substantially regulate insurance companies, or stop them from their old dirty tricks of denial of claims or policy cancellations.

Of course, you'll have nothing substantive to say in response to any of this. You'll just say "this bill makes things better for millions of Americans" even though its shown - clearly - to be an empty, meaningless political slogan and bullshit.

I don't want a single payer plan. I want health reform that makes accessing health care affordable. Simply making premiums cheaper doesn't accomplish that.