Senate Health bill

[Thunder]

Republicans think there is nothing wrong with middle class Americans not having health care.

 

[JoeTheJuggler]

It makes a lot of questionable assumptions, about the rate of health care cost inflation, the numbers who will remain uninsured, the subsidies which will be required.

Again, --it's a simple question: Where are these assumptions made?
ETA: And in a related question: why do you think the CBO would do skew their estimates? Is this skewing enough to change the net effect of an approximately $130 billion deficit reduction over 10 years into a net increase of the deficit?

Also, are you giving up on your assertion that it's some kind of trick or gimmick to do a 10 year estimate on the effect on the federal deficit?

 

[WildCat]

Again, --it's a simple question: Where are these assumptions made?
ETA: And in a related question: why do you think the CBO would do skew their estimates? Is this skewing enough to change the net effect of an approximately $130 billion deficit reduction over 10 years into a net increase of the deficit?

Also, are you giving up on your assertion that it's some kind of trick or gimmick to do a 10 year estimate on the effect on the federal deficit?

Joe, I am in no position to speculate as to their motives or competence.

I do know that a $750 penalty for not buying a policy costing a minimum of $3,600 is unlikely to sway many people, especially given the requirement to cover pre-existing conditions.

Once again, no other country has taken such a foolish, mindless, and stupid route to UHC as the US Congress is determined to do.

 

[JoeTheJuggler]

Joe, I am in no position to speculate as to their motives or competence.

But you've done just that. You claimed they used trickery or gimmickry to misrepresent the effect of the healthcare bill. When I call you on it, you just change the subject.

I do know that a $750 penalty for not buying a policy costing a minimum of $3,600 is unlikely to sway many people, especially given the requirement to cover pre-existing conditions.

Again, you're being evasive. Where does the CBO make the assumption that people will choose a $3600 premium over a $750 penalty?

FWIW, I don't think those numbers reflect a choice that many people would face. Even if they did, just comparing $750 and $3600 isn't the whole story. The fine doesn't get you insurance, so the comparison would be $750 plus the pay-as-you-go costs of healthcare compared to $3600 plus any co-pays you might incur. (Last I checked, the reform bill would limit those co-pays, while the sky's the limit on the pay-as-you-go approach.)

Once again, no other country has taken such a foolish, mindless, and stupid route to UHC as the US Congress is determined to do.

I agree.

A true single payer system makes a lot more sense than health insurance reform. I've said that many times.

However, I find your implied support here for the UHC systems of other countries to be disingenuous.

 

[WildCat]

But you've done just that. You claimed they used trickery or gimmickry to misrepresent the effect of the healthcare bill. When I call you on it, you just change the subject.

Let's just call it questionable then, like their worst-case scenario last February of unemployment peaking at 8.5% under the stimulus.

Again, you're being evasive. Where does the CBO make the assumption that people will choose a $3600 premium over a $750 penalty?

When they claim the mandates will cause the ranks of the insured top go from 83% to 94% (bottom of page 8).

FWIW, I don't think those numbers reflect a choice that many people would face. Even if they did, just comparing $750 and $3600 isn't the whole story. The fine doesn't get you insurance, so the comparison would be $750 plus the pay-as-you-go costs of healthcare compared to $3600 plus any co-pays you might incur. (Last I checked, the reform bill would limit those co-pays, while the sky's the limit on the pay-as-you-go approach.)

No, the fine doesn't get you health care. What does get you health care is paying for one month of health insurance coverage, even after you get sick.

Suppose I decide to not buy health insurance, which I can get for $300/month (a low estimnate actually), and simply pay the $750 tax penalty instead. I can budget $100 for an annual checkup, so my maximum out-of-pocket expense is $850, quite a deal compared to $3,600. Let's suppose I have my annual checkup in June, and the doctor discovers I have a condition requiring surgery, which will cost $7,500. Now all I need to do is sign up for the insurance, pay my $300, and get my surgery. After my surgery I can simply cancel my coverage. And guess what? The $750 tax penalty is pro-rated, so my tax penalty goes down to $687.50, reflecting the one month I purchased health insurance. My total expenses for the year are $987.50, I'm still much better off than if I had paid the $3,600 for the entire years worth of insurance.

This is a rational choice Joe. To anyone who can do 3rd grade math it would be irrational to buy a years worth on insurance, because I would have spent an extra $2,612.50 for no benefit to me at all.

Do you see the problem here? Assuming people are rational, this will cause premiums to skyrocket because insurance companies can't survive selling a $7,500 operation for $300.

I agree.

A true single payer system makes a lot more sense than health insurance reform. I've said that many times.

It makes more sense than the idiocy coming from Congress, but I hardly think single payer is the way to go. If we go to single payer, to whom do you turn if you're unhappy with the only provider you have? What incentive is there to keep costs down, to innovate, to keep the bureaucracy in check?

However, I find your implied support here for the UHC systems of other countries to be disingenuous.

It's not disingenuous at all. While I don't support single-payer, I do support the following:

1. Tax health insurance benefits offered by employers. The goal is to untie health insurance from employment, which in a company of 100 people means you have 100 people shopping around for health insurance instead of one person buying ot for 99 others. This will help spurn actual competition amongst insurance providers. A side benefit of this is employers would be gretly pressured to increase employee pay to make up for the loss of benefit.

2. Get the states out of the insurance regulation business. Let the Federal government be the sole regulator of health insurance, far easier to comply with one national standard rather than 50, which will cut down on overhead costs and thus allow for lower premiums. There won't be any constitutional issues because...

3. Insurance companies are then allowed to sell insurance across state lines - interstate commerce! Again, this increases competition because instead of having only a few (in some states as few as 2) insurance companies to choose from the consumer now has dozens. All of which have to offer plans meeting the minimum standards set by the Federal government.

4. While the Federal government won't set the price of any insurance plan, they will require that everyone buying that particular plan pay the same premium as everyone else buying that particular plan. Joe won't be paying $500/month while Harry pays just $250.

5. Insurance companies won't be able to deny coverage for any reason, including pre-existing conditions. This will be made possible because the penalty for not buying health insurance will be set slightly higher than the national average for a plan meeting the minimum requirements. No financial incentives to game the system as I described above.

6. Of course, not everyone will be able to afford insurance. So the Federal government will subsidize your premium on a sliding scale according to income. The poor get nearly 100% subsidized, the rich get no subsidy at all. Everyone else gets a subsidy somewhere in between those extremes.

7. With all the above in place, there would no longer be a need for Medicaid, S-CHIP, and the myriad other federal, state, and local health care initiatives offered nationwide. Overnight, billions and billions of dollars in unnecessary administrative costs are excised from budgets at all levels of government. The entire health care system just got radically more efficient, with a much higher percentage of health care dollars going towards patient care rather than to administering thousands of pages of complex and overlapping rules and regulations.

This is actually very similar to what many UHC countries already have today. In fact, it's a more common model than the single-payer systems in Canada and the UK and one in which the United States already has the bulk of infrastructure (private health insurance companies) in place.

And it is far, far simpler than the *************** coming out of the US Congress currently.

 

[JoeTheJuggler]

Let's just call it questionable then, like their worst-case scenario last February of unemployment peaking at 8.5% under the stimulus.

Estimating the cost of legislation over 10 years is the normal procedure. What's questionable about it?

It's a non-partisan cost estimate. It might be wrong, but it's a fair assessment of what we can expect.

Do you think it would be more accurate for the CBO to ignore the first 5 years? Do you think it would be more accurate to use the Cato Institute's outrageous figures? (See the recent BaC thread.)

And the CBO reports do provide breakdowns of 2010-2014 and 2015-2019, besides estimates for each of the 10 years. The net deficit reduction of ~$138 billion is the total over those ten years.

 

[JoeTheJuggler]

Looks like it's about to pass.

http://www.cnn.com/2009/POLITICS/12/15/health.care.lieberman/index.html

 

[Random]

Blech. No public option, no medicare buy-in, just a mandate for everyone to buy insurance and government subsidies if they can't afford it. Heads the insurance companies make money, tails, the insurance companies make money.

Unless there are price controls in place (fat chance), the subsidies will be worse than useless. There will be nothing stopping the health insurance companies from simply raising their rates to suck up the subsidies indirectly. (Well, there will be the miracle of the free market, but since that hasn't worked in 40 years, I'm pretty sure it won't work now.)

It's Medicare D all over again, only HMOs get the cash instead of big Pharma.

 

[Undesired Walrus]

I suppose Obama overlearned the problems of Clinton's health reforms by leaving everything up to Congress.

 

[JoeTheJuggler]

As they say, politics is the art of the possible. Do you think something significantly better was possible (given the need to placate Lieberman and the Blue Dogs in order to get cloture in the face of a Republican filibuster)?

And also, is what we're likely to get better than nothing (the status quo)?

 

[Peephole]

And also, is what we're likely to get better than nothing (the status quo)?

Is it? The subsidies are nice. But forcing people to buy into private companies is just reinforcing all that is dysfunctional about health care in the U.S.

And I wouldn't be surprised if those subsidies dissapear once President Palin gets into power.

Also, Obama was terrible throughout this whole process. Brownbeating Democrats is apparantly worth it when it comes to his wars, but not when it comes to healh care. Obama seems to have never really had much interest in reforming the system, the most important point on his agenda was solidifying the relationship between the Democrats and the health care industry.

 

[JoeTheJuggler]

The subsidies are nice. But forcing people to buy into private companies is just reinforcing all that is dysfunctional about health care in the U.S.

That's right about where I'm torn. It will provide access to healthcare for a lot of people who currently have little to no access to it. (And I admit a bias--I'm one of them.) But it pretty much puts real reform (like a single payer system or real UHC system) forever out of reach. On the other hand, a lot of people claim that that sort of reform was never even on the table to begin with.

And I wouldn't be surprised if those subsidies dissapear once President Palin gets into power.

That won't happen. For all the resistance to government benefits like this, once they're passed, they become sacrosanct-- even the Republicans will scare voters with even the threat of their removal. (For example, the very people opposed to this sort of thing have been running ads saying that this reform bill will cut Medicare benefits.)

Also, Obama was terrible throughout this whole process. Brownbeating Democrats is apparantly worth it when it comes to his wars. . .

Your freudian slip is showing! You get the ESL exemption, though.

ETA: I agree with you wholeheartedly, though, that Obama spent his political capital extremely unwisely.

 

[Cynic]

But what good is browbeating the democrats about healthcare reform when then the people holding it back aren't the democrats?

 

[Random]

Is it? The subsidies are nice. But forcing people to buy into private companies is just reinforcing all that is dysfunctional about health care in the U.S.

Exactly. Health care costs have been rising faster than wages for a while now, and nothing in this bill addresses that problem. Having the federal government provide subsidies to help make up the difference buys us some breathing room, but the law of exponential growth will eventually swamp even the federal governments ability to print money and we will be right back here again.

 

[JoeTheJuggler]

Exactly. Health care costs have been rising faster than wages for a while now, and nothing in this bill addresses that problem.

You might disagree with the measures that have that aim, but it's not true that nothing in the bill addresses the problem of cost. The universal mandate for one is an attempt at lowering the per-capita costs. If low-risk people have to pay premiums, it will reduce the per capita cost as whole, for example. Other examples are the market reforms and insurance Exchange the bill proposes.

Having the federal government provide subsidies to help make up the difference buys us some breathing room, but the law of exponential growth will eventually swamp even the federal governments ability to print money and we will be right back here again.

But that's not at all how the bill is meant to work or how the CBO estimates it would work. I haven't seen the estimate for the revised version yet (I thought it was expected yesterday), but the estimate on the previous version was a net reduction of the deficit of $138 billion over the first 10 years.

I'm not sure where "the federal governments [sic] ability to print money" comes in at all. Again, you might disagree with what the bill is doing, but claiming it's borrowing or printing money to pay for healthcare insurance isn't accurate.

 

[Peephole]

That won't happen. For all the resistance to government benefits like this, once they're passed, they become sacrosanct-- even the Republicans will scare voters with even the threat of their removal. (For example, the very people opposed to this sort of thing have been running ads saying that this reform bill will cut Medicare benefits.)

I don't see any overhaul of big systems as likely either, but I wouldn't underestimate the possibility that in the deficit hysteria, an overturning of subsidies might occur over the years. A new entrenched structure like a public option would be able to survive a lot better.

 

[JoeTheJuggler]

I don't see any overhaul of big systems as likely either, but I wouldn't underestimate the possibility that in the deficit hysteria, an overturning of subsidies might occur over the years. A new entrenched structure like a public option would be able to survive a lot better.

I still don't see cutting the subsidies (once passed) happening. Look at all the "death panel" and "they want to euthanize grandma" and "they want to cut your Medicare benefits" rhetoric going on now.

Also, the net effect of the bill is likely to reduce the deficit over the next several years, so I don't see anyone going after this. (If they did, I assume you'd have to remove the revenue streams that pay for the subsidies, and the net effect of "overturning the subsidies" might be to increase the deficit.)

I think a bill with the public option would have been better, but for reasons other than the likely longevity of the law once passed.

At any rate, given Lieberman's position and the need for a cloture vote, I don't think a real public option is possible.

 

[jdp]

So I guess the only question I have is is there anything in the bill worth the effort anymore? Will the proposed exchanges provide the compitition and cost control?

 

[Peephole]

And of course, in the irony of ironies, the White House suddenly decides to knock some heads:

On Wednesday, White House Press Secretary Robert Gibbs strongly hit back at former DNC Chairman Howard Dean for criticizing the Senate health care bill, suggesting, at one point, that Dean was being irrational and didn't understand the contents of the legislation.

"I don't know what piece of legislation he is reading," said Gibbs.

"How better do you address those who don't have insurance... passing a bill that will cover 30 million uninsured or killing a bill?" he added. "I don't think any rational person would say killing a bill makes any sense at this point."

Asked if Dean was acting irrationally, Gibbs replied: "I can't tell what his motives are, to be honest with you."

...

"If this is an insurance companies' dream, I think the insurance companies have yet to get the memo," he summarized.

In actuality, the insurance companies do seem to have considered the recent round of negotiations a victory, with one executive telling Ben Smith of Politico: "We win."

...

Asked if they are worried that Dean's criticism of the bill will sway progressives in the Senate, Gibbs replied: "No."

Asked if Dean was an irritant, Gibbs replied: "That is not a question for me to answer. I think if you look at what Sen. Tom Harkin (D-Iowa) and Sherrod Brown (D-Ohio) and others have said, I think they can point out the benefits of the legislation."

http://www.huffingtonpost.com/2009/12/16/gibbs-lashes-back-at-dean_n_394596.html

 

[JoeTheJuggler]

So I guess the only question I have is is there anything in the bill worth the effort anymore? Will the proposed exchanges provide the compitition [sic] and cost control?

The insurance reforms (removing at least lifetime caps and "unreasonable" annual caps, doing away with rescission and pre-existing condition exclusions) are worth the effort. (That rescission business was getting really crazy.)

Removing effective monopolies in some states will certainly improve competition competition. As I mentioned above, mandating low-risk people to pay something rather than nothing should help lower per-capita costs.