Senate Health bill

[psychictv]

in many cases it's worse to create a bad bill on an important issue rather than do nothing.

Agreed.

I am opposed to lots of new taxes but I think it is inevitable that we will need a small VAT tax

Oops, perfect example of worse than doing nothing. A regressive VAT is exactly what we don't need.

 

[Puppycow]

I think that is the "big lie" going on here. This bill, is probably, worse than doing nothing. It reforms little, does little, and seems like the insurance companies wrote it.

Look at this way:
1. insurance companies still won't have interstate competition (also known as the DUH reform that has been buried by both chambers)
2. insurance companies won't have to compete with a government option
3. insurance companies will have a flood of new people coerced into buying insurance by the government

This bill is worse than nothing at all. Its corporatism in disguise.

And who should we blame for that? Did republicans and Leiberman try to make it better or did they try to make it worse? I looks like the latter to me. They wanted to either kill it or, failing that, make it as bad as possible. A lot like the stimulus.

The only way to really, truly save money is to gore the ox of some powerful lobbies.

 

[WildCat]

I think I was responding to the claim that there's nothing in the bill to encourage competition.
ETA: Here it is: "I haven't seen anything in the bills that introduces actual competition."

Key word bolded by me. There is no actual competition.

So long as the states can regulate health insurance companies we won't have competition. We will only get rising costs.

Consider that the Federal bills mandate coverage, and the Federal government subsidizes them to be affordable. But it's the states who determine what this coverage entails, above and beyond what is sure to be a basic Federal requirement. Do you see the problem here? Now the states can mandate all kinds of "cadillac plans", and the Federal government is on the hook for the bill! Neat, isn't it? You can be damned sure that the only competition in this bill is between the states to mandate the most comprehensive health insurance imagineable, and why not? They get to send the bill to Uncle Sam.

Did the CBO consider this when they determined that these bills would reduce the deficit?

There's so much stupid in these bills it sets a new standard for Congressional stupidity.

 

[jdp]

Is there anything still in the health care bill that the Republicans generally oppose on principle? Aside from the higher taxes for upper income brackets. Most of the liberal provisions have been stripped out. I mean an exchange comprised of health insurance companies is the way I would think they might go anyway.

 

[JoeTheJuggler]

The problem with them doing that (collecting taxes for 4 years before anything goes into effect) is that it only helps the bill in being neutral or saving money for that period of time. Past the next decade the price will continue to increase and they can't be stopping service every 4 out of 10 years just to keep it deficit neutral.

Except the estimate is that it will continue to reduce the deficit even for the second 5 year period. So that isn't what's going on.

ETA: From the CBO estimate, the following are the net changes on the deficit for the years/periods specified (in billions of dollars):
2010 +5
2011 -8
2012 -20
2013 -54
2014 -35
2015 -12
2016 +10
2017 +3
2018 -7
2019 -16
2010-2014: -111
2015-2019: -21 (my calculation based on the other numbers you see here)
2010-2019: -132

Linky.

I take your point about the CBO but my main argument is that their numbers should not be taken as gospel no matter if you are for or against any bill in question but especially health related bills such as this one.

I don't know what you mean by taking as gospel, but if you're going to make a case that the bill will increase the deficit, you've got to prove that.

I see no reason why we can't have a nonpartisan panel (that includes plenty of people in the health care industry from the US and other countries) to pick and choose the best of all other UHC programs around the world and shape a US UHC system, come up with a way to implement it, estimate how much it will cost, the best way to pay for it (new taxes, a VAT, etc), and how long it will take to put in place instead of relying on politicians which as this bill has shown can and will screw up just about every aspect of it.

I see a reason why that won't happen: Congress would never pass it. Even this, the best Congress we're likely to have for healthcare reform wouldn't pass a true UHC. Opponents are already claiming insurance reform is "socialism" or the "government take over of healthcare".

Unfortunately, the only way to do this is through legislation, and all our legislators are politicians. There is simply no way we can avoid "relying on politicians".

FWIW, even though not having an autocracy means it's very difficult to implement even really good ideas, I'm still glad we don't have an autocracy! (To make it difficult to implement really bad ideas.)

 

[JoeTheJuggler]

Key word bolded by me. There is no actual competition.

Yes, and I pointed out couple of measures in the bills that do just that.

So long as the states can regulate health insurance companies we won't have competition. We will only get rising costs.

The House bill would end the insurance companies' anti-trust exemptions.

Again, you originally said there was nothing. You then amended it to "a bit but not far enough" (something I agree with), and I pointed out that I was refuting the claim that there is nothing in the bills that would introduce actual competition. Your emphasizing the word "actual" doesn't change anything. (What kind of competition is not-actual competition? Sounds like a Zen koän.)

Consider that the Federal bills mandate coverage, and the Federal government subsidizes them to be affordable. But it's the states who determine what this coverage entails, above and beyond what is sure to be a basic Federal requirement. Do you see the problem here?

Yes, I think it's a mischaracterization of the bill. The bill specifies in some detail what minimum coverage is. To say it's left entirely to the states isn't accurate.

Now the states can mandate all kinds of "cadillac plans", and the Federal government is on the hook for the bill! Neat, isn't it?

If the states mandate plans that result in premiums that few people can afford, I hope those state legislators will be voted out of office. Remember, there isn't a true public option, so your explanation of how the subsidies work isn't at all accurate.

You can be damned sure that the only competition in this bill is between the states to mandate the most comprehensive health insurance imagineable, and why not? They get to send the bill to Uncle Sam.

That's not how it works. I think you realize that too.

Did the CBO consider this when they determined that these bills would reduce the deficit?

 

[WildCat]

Yes, and I pointed out couple of measures in the bills that do just that.

None allow insurance companies to sell across state lines, state regs be damned.

The House bill would end the insurance companies' anti-trust exemptions.

Do you even know what these exemptions are? AFAIK it relates only to allowing them to share actuarial stats.

Again, you originally said there was nothing. You then amended it to "a bit but not far enough" (something I agree with), and I pointed out that I was refuting the claim that there is nothing in the bills that would introduce actual competition. Your emphasizing the word "actual" doesn't change anything. (What kind of competition is not-actual competition? Sounds like a Zen koän.)

You're being pedantic. It's like you complaining that I paid you nothing to juggle at my nephew's birthday party, and me saying "I sure did! I gave you a shiny new penny".

Yes, I think it's a mischaracterization of the bill. The bill specifies in some detail what minimum coverage is. To say it's left entirely to the states isn't accurate.

The states are free to regulate all they want. They can mandate as much coverage as they want, without having to pay for any of it. You don't see a problem there?

If the states mandate plans that result in premiums that few people can afford, I hope those state legislators will be voted out of office.

Quite the opposite. They'll get voted out if they don't mandate cadillac plans. It costs the people in the state nothing, because Uncle Sam picks up the tab and as everyone knows Uncle Sam gets the money from magical pixies.

Remember, there isn't a true public option, so your explanation of how the subsidies work isn't at all accurate.

What's not accurate about it? Suppose the federal formula decides that a single person earning $30,000 a year can afford to pay only $100/month in health insurance. Then Uncle Sam pays the premiums in excess of that amount. Whether the coverage mandated by the states costs $101 or $1,001 it doesn't matter to the guy making $30,000 a year, he pays $100 regardless. He'll be demanding the cadillac plan, and his state legislators will be happy to comply, after all they won't have to pay for it.

That's not how it works. I think you realize that too.

Then how does it work Joe?

 

[Dr Adequate]

The provision is that people on government assistance will pay for their abortions separately. As people who are on government assistance are unlikely to be able to pay for that, if a doctor recommends one for any reason, patients in this situation will be reluctant to comply.

So not paying for something is interference? If the government won't pay for my car, are they "interfering in the car-dealer - driver relationship"?

 

[JoeTheJuggler]

Then how does it work Joe?

http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

I suggest you start with the short summary, then the detailed summary, then the section-by-section analysis.

 

[JoeTheJuggler]

So not paying for something is interference? If the government won't pay for my car, are they "interfering in the car-dealer - driver relationship"?

I think the point is the inconsistency in the way this "government interfering" with healthcare idea is applied.

The people who oppose this bill because it is the government takeover of healthcare, or government coming between patients and doctors (or even government death-panels) are the same ones who want to prohibit insurers from covering abortion (and, if they could achieve it, would prohibit abortion altogether).

 

[WildCat]

http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

I suggest you start with the short summary, then the detailed summary, then the section-by-section analysis.

Can you link to or paraphrase the specific parts preventing the states from doing what I described?

 

[Cynic]

So not paying for something is interference? If the government won't pay for my car, are they "interfering in the car-dealer - driver relationship"?

When someone is dependent on you, denial of that which they depend on you for is a means of interference, yes. A silly example: say I'm dependent on you for air. Normally I breathe just fine, but not if I walk into Room A. If I do that, you refuse air until I leave it. That would be an example of you interfering with my free movement by action of failing to provide the air I require.

If someone is dependent on the government to pay for their healthcare, and their doctors are recommending an abortion, but the government is unwilling to pay for that because they feel the doctor's recommendation isn't justified, then the government is interfering with the healthcare by withholding the money required for it to be provided. It's not a perfect analogy, but it's close. The abortion is Room A here. The money is the air. And healthcare is free movement.

Dependency is fundamentally distinct kind of relationship.

 

[Dr Adequate]

When someone is dependent on you, denial of that which they depend on you for is a means of interference, yes. A silly example: say I'm dependent on you for air. Normally I breathe just fine, but not if I walk into Room A. If I do that, you refuse air until I leave it. That would be an example of you interfering with my free movement by action of failing to provide the air I require.

If someone is dependent on the government to pay for their healthcare, and their doctors are recommending an abortion, but the government is unwilling to pay for that because they feel the doctor's recommendation isn't justified, then the government is interfering with the healthcare by withholding the money required for it to be provided. It's not a perfect analogy, but it's close. The abortion is Room A here. The money is the air. And healthcare is free movement.

Dependency is fundamentally distinct kind of relationship.

I find your analogies strained and your reasoning rococo.

The government has been not paying for abortions since ... uh, 1776 ... and it appears that up 'til now this has not been interference with the doctor-patient relationship. But now if the government starts paying to have broken legs set and inflamed appendices removed, then the act of not paying for abortions suddenly becomes interference? ... this seems a very odd way of looking at it.

You might as well complain that food stamps interfere with people's rights to acquire caviar. After all, the people who use food stamps are presumably dependent on them, and presumably you can't get caviar with food stamps.

By your logic, then, then, not buying people caviar is a way in which the government interferes in people's lives --- so long as they provide them with any form of food. Whereas if the government gave people no assistance with buying food, then the government would not be interfering. Of course, the people affected would still not be getting any caviar, but at least they'd be not getting caviar because they weren't buying it for themselves, rather than because the government wasn't buying it for them. And that is the difference between liberty and oppression.

As for those guys who take away my garbage but won't sweep my yard or clean my house ... don't even get me started.

 

[SezMe]

60-40. The bill is now likely to become law.

There is A LOT to not like about this bill but if I was a senator I'd hold my nose and vote yea.

Joe, you keep saying that future improvements are impossible. The fact that this gets the health care reform process started is one of the few points in favor of this bill. What precludes future tweaks? And even a gradual shift to single-payer?

 

[Undesired Walrus]

What was the vote on last night (I thought I heard something about it being a vote to end debate?)? What votes are left before Obama's pen slides across the legislation in the rose garden?

 

[jdp]

What was the vote on last night (I thought I heard something about it being a vote to end debate?)? What votes are left before Obama's pen slides across the legislation in the rose garden?

I believe that the vote last night were to accept the Manager's Amendment, the compromise worked out between Lieberman, Nelson, and the rest. There are I think one or two procedural votes left (one on cloture for the debate on the compromise language and then cloture on the whole bill itself) and then an up and down vote whether to pass the bill, only 50% is required for that.

Next the Bill is merged with the House bill and then both chambers must debate and vote on the exact same bill then it's ready for Obama's pen. So we have some time to go. There are still some sticky points like Stupack in the House doesn't like the abortion language, he thinks it's too soft.

 

[Cynic]

I find your analogies strained and your reasoning rococo.

I find your use of the word rococo old fashioned.

The government has been not paying for abortions since ... uh, 1776 ... and it appears that up 'til now this has not been interference with the doctor-patient relationship. But now if the government starts paying to have broken legs set and inflamed appendices removed, then the act of not paying for abortions suddenly becomes interference? ... this seems a very odd way of looking at it.

First, I never said "suddenly" -- that's you misrepresenting my argument. A situation in which a person is 100% dependent on the government to pay for medical care in which the government refuses to pay for a procedure recommended by her doctor would be interference regardless of the timeframe involved, and I never said otherwise.

Second, military (i.e. government) insurance pays for abortions when the mother is put at risk if the pregnancy goes to term. So you're wrong there too.

You might as well complain that food stamps interfere with people's rights to acquire caviar. After all, the people who use food stamps are presumably dependent on them, and presumably you can't get caviar with food stamps.

Comparing a doctor-recommended procedure to using food stamps to acquire caviar is beneath you, Dr. Adequate. Or at least I think it is -- perhaps I have you confused with someone else. You are conflating two distinct types of dependence here and ignoring the distinction between endangering health and a preference for a certain type of food.

The issue is with the government deciding what is and isn't necessary for a mother's health -- making decisions that should be in the doctor's realm. Given that all pregnancy is inherently dangerous to the mother, it could easily be argued that this sort of decision is entirely in the patient's realm. Rococo or not, my argument works and yours is fallacious.

 

[Undesired Walrus]

I believe that the vote last night were to accept the Manager's Amendment, the compromise worked out between Lieberman, Nelson, and the rest. There are I think one or two procedural votes left (one on cloture for the debate on the compromise language and then cloture on the whole bill itself) and then an up and down vote whether to pass the bill, only 50% is required for that.

Next the Bill is merged with the House bill and then both chambers must debate and vote on the exact same bill then it's ready for Obama's pen. So we have some time to go. There are still some sticky points like Stupack in the House doesn't like the abortion language, he thinks it's too soft.

Thankyou. Why was last nights (well, this mornings) vote so pivotal then? Shouldn't the Christmas eve be the pivotal one?

When is it likely to get the signature then?

 

[Random]

Key word bolded by me. There is no actual competition.

So long as the states can regulate health insurance companies we won't have competition. We will only get rising costs.

It is counter-intuitive, but increased competition between insurance companies can lead to higher prices for insurance.

The issue is how health insurance companies negotiate payment rates with hospitals. The insurance company goes to the hospital and says that they want a reduced rate on heathcare or they will send their customer to another hospital.

If there are only two health insurance companies in town and each represents half of the hospitals insured patients, then each company has some serious leverage. If there are ten insurance companies in town and each represents ten percent of the hospitals insured patients, then the individual companies have a lot less leverage and the hospital is in a better position to set the rates that it wants. Not surprisingly, hospitals want rates set high.

This is why Aetna dropped a bunch of customers in 2001 to save money. Yeah, some of them were dumped because they were sick, couldn't pay increased premiums, etc., but a lot of them were dropped because they happened to live in an area where Aetna didn't have strong market representation and couldn't haggle for lower rates.

 

[leftysergeant]

It totally sucks that there is no public option. But then, the best way to have implimented that would have been to offer Medicare for All.

This is, of course, to ask the Republican vampires whether they would like a nice plate of raw garlic.

It would accomplish something that the GOP, or at least the neocon hard-core, does NOT want to do. It would ensure the solvency of Medicare for generations, because it would have a large pool of healthy young people putting into the system and drawing out little.

Guess that just makes too much sense to fly with anyone who still thinks that supply-side ecconomics ever had a snowball's chance of working.