Universal Healthcare

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This issue has been rearing it's ugly head again in the media, so I was looking through information on the healthcare debate today and I found this, this, and this. The first is a review of what the House Dems are trying to do to sneak the legislation through (i.e. pass it without a standard floor vote on it), the second is a review of what the Senate bill would do (from Dec 2009), and the third is a discussion of what the differences between the Senate and House bills are (also Dec 2009). All in all, they seem to provide a decent coverage of the current debate.

Now, this whole debate has gone through a lot of permutations and evolutions since it started, some good, some bad, and some just plain messy.
Among the bad:

The Dem's plan for passing healthcare reform. It stinks of shortcutting the intention of Congress. From the article, it sounds like it's not illegal and will probably work, but I think that, if the Dems actually try this, they'll pay for it come election time. It may be legal, it may even be good, but it will stink of forcing something on an unwilling public, through an unwilling Congress. The Reps will play this up to their full advantage, of course.

The Senate's abortion coverage. It's messy and complicated and needlessly so. On the one hand, it allows plans that cover abortions to be bought through the federal funding, but the buyer will have to make seperate payments. I think that means they can buy the basic coverage with federal funds, but the abortion portion would be entirely on them. On the other hand, it allows states to ban plans offered at their Exchanges because they cover abortion. I think this is a very bad idea. The precedent of state politicians being able to decide what heathcare plans can and can't be offered in their states is dangerous, especially based on a completely political issue. What happens if a state legislature shifts policies and wants to ban all plans that don't advise hospices after age X? What if they want to ban all plans that will cover alternative procedures? I'd rather let buyers decide on that. Banning federal funding for something is one thing, but banning the very option of it is something else entirely.

The Senate's alternative to a public option. The Senate bill will establish two private national health plans overseen by the Office of Personnel Management, but provided by private companies. So, we're turning your health care over to government contractors? I'm sorry, but that seems pretty reckless to me. I'd honestly prefer a real public option. If there's one thing worse than the Government doing it for you, it's the Government hiring someone else to do it for you.

Both Senate and House plans to offer subsidies. They're very generous, offering help for families making up to $88,000 a year, or individuals making about $40,000 a year. That's not exactly wealthy, but it's quite comfortable. If I'm making that kind of dough, at least as an individual (I've never had a family of four I needed to pay for), I'd like to think I can afford things independantly.

Among the Messy:

Funding. The House and Senate plans differ on who will be paying for this. The House wants to raise taxes on the rich, while the Senate wants to place a tax on the very expensive health care plans. Honestly, I think they both come up to about the same thing, since only the rich (and corporations) can afford the super-deluxe plans. I think it's a good idea, but I'm affraid it's going to be sticky to impliment. I think the flat tax increase on the rich is the better of the two, but I'm not sure.

Exchanges. Both bills establish state exchanges where health care plans are offered on a state-by-state basis. I don't think the state-by-state basis is a good idea. Why should residents of Utah be allowed to buy X plan, but not residents of Virginia? Furthermore, it just begs for the states to take control of these things and use them to limit what is offered, creating an even more piecemeal thing than we have now. On the other hand, the idea of a single market place for purchasers to go to is a good one, and I'd like to see it implimented in some way.

The cost. It's going to be expensive. $1 trillion over the next decade. And taxes won't pay for it all. They're talking about cutting spending on Medicare. Now, the plan is that that cut will be on administrative waste, that by streamlining things they'll save money. However, the best laid plans of mice and men... I have a terrible feeling that this won't live up to expectations and they'll either have to cut Medicare coverage or raise taxes again to pay for this. Of course, there aren't a whole lot of options.

Employer penalty for employees using federal subsidies. From everything I've heard, these penalties are woefully insufficient to the task, but it's good they're there at least. And I also like than they're penalties for employees using federal funding, not just not having employer insurance. On the flip side, I think this only strengthens the tie between health care and employers, and I don't like that tie. I'm honestly not sure how I feel about this.

Restrictions on health care premium conditions. The Senate bill at least (and I think the House bill as well) will restrict health insurance companies from raising premium costs based off of gender, health history, and occupation. This is another sticky issue. On the one hand, those at highest risk are most in need of insurance, and the companies can and have used this to milk them for all they had. On the other hand, those at highest risk will cost the insurance companies the most, and I beleive these companies have the right to manage the risks they take on. Again, I'm uncertain on this one.

Among the good:

Mandated acceptance of pre-existing conditions. This is one of the biggest problems with the current system, all too often tying people to their current insurance, and thus employers, because they know they'll never be able to get a replacement. Along with this, the ban on dropping people because they got sick is a great idea. The two together have produced a health care system that simply drops anyone who get's too sick. Stabbing that square in the heart is the single best thing Congress could have done with this bill, and they have. In both houses.

Mandated coverage. Ok, so I'm not such a big fan of this on it's own, but if you have the above mandated acceptance of pre-existing conditions, this absolutely has to come with it. Without this, the above would produce a system that is as bad for the health insurance industry as the current system is for everyone else. I may not like it by itself, but in conjunction with the above, it's mandatory, and again, both houses have done it.

No federal funding for abortions. The two bills achieve this different ways, and I think the House way is the much better way, but it's good that both made a stab at it. I'm not going to say that we should ban insurance coverage for abortions, not for a second, but I will say we shouldn't force every taxpayer in America to pay for it, especially considering how many of us are so strongly against it.

Federal subsidies for small business health care plans. This may well end up being a big boost to small businesses. At the moment, few if any can afford to provide health care for their employees, and that's one of the big hits in working for one. Sure, the owner may be your best friend, but health care is expensive on your own! Especially for a family or the elderly.

The Dem's plan for passing healthcare reform. I know, I called it 'the bad' previously, and I stand by this decision, but the behavior of Congressional Republicans has, quite frankly, been appauling. We need some kind of health care reform, but no Republican wants to be seen as supporting a Democrat plan, so instead of working with the Dems and actually trying to improve the bills put forth, they're attacking them on any basis they can. Basically, the Reps have refused to play ball, so the Dems need to write some new rules where they can play by themselves. They're trying to do just that.


All in all, I'm still disappointed. I like the House bill a lot more than the Senate bill, and surprisingly, I actually like the House bill. Unfortunately, I think the Senate bill is the only thing that has any real chance of passing, thanks to this 'deem and pass' approach.

 

As a resident of MA, we are seeing first hand all of the problems of univerasl health care. The costs are way more than anticipated and doctors are starting to refuse patients who are covered under "Romneycare". I read this in today's letters to the editor

 

A wonderful link showing just how stupid the teabaggers are and how many lies about the healthcare reform that floats around http://www.youtube.com/watch?v=pilG7PCV448

 

So, how do you feel about what is in the bill?

 

The insurers are the problem right now.

 

They can be "a" problem, but they are not "the" problem.

 

Sorry, they are THE problem. Yes, there are other problems, but the reform movement is largely about how these "gentlemen" do business.

 

Straight out of the Dem Playbook. Villify, marginalize, and belittle the opposition. Is Equester really Rahm?

 

Maybe if it's good enough for Scott Brown, it's good enough for you too, Snook (and the rest of us).

http://www.newsweek.com/id/235246

 

An "IMO" would have worked better in that statement. It really is your opinion (and I can respect that) but others have different opinions. Health care is too complex to blame just one part of the equation.

 

I'm sorry, but the companies, while a real problem, are far from the only one. Another big problem is the medical industry's passion for over-testing and over-prescribing. In the past decade or so, the health care industry has massively expanded costs without much benefit by doing more tests, more expensive tests, and more unnecessary procedures. Something like 1 in every 4 children are born through C-sections now, and the mortality rate in mothers and children hasn't benefitted from it. Why do it, then? Simple, anything short of everying doable could be seen as malpractice (if anything anywhere goes wrong) and someone could sue. That's the third problem: the sue-happy American public and the idea that doctors can (or at least should be able to) do anything and, thus, that if anything goes wrong, it's their fault. This leads to higher malpractise insurance, higher costs (both in procedures and fees), and fewer doctors (especially in OBGYN).

So, what do people think of the bill that has been passed by the House now?

 

No, really, it's not [just my opninion]. Why does Nancy keep referring to the health care bill as "insurance reform?" And how many times did Obama mention the insurance companies is his short speech after the House bill was passed last night? The abuse of insurance companies is what is driving this movement and the health care reform bill that is in Congress.

As I commented there are more problems in health care than just the insurance companies, but they are what is driving the debate at the moment.

 

They are driving the debate because the bill isn't a health care bill, but a health care insurance bill. Nothing in the bill discusses anything other than insurance, there is no issue of what procedures may be done. The closest it comes to that is what the government will pay for through insurance and what it won't pay for through insurance (either as subsidy or as a public option). I believe there is a seperate bill being discussed somewhere about limitations on malpractice suits, and the cost of prescription drugs is yet another debate. They're all part of the overall 'Health Care' problem, though.

 

Well, the bill is very similar to the one passed by the Senate, so there is no "public option". This bill will cover a lot more people than before, but those people will be covered by the same insurance companies that are already out there - not by the government via a public option.

The other thing that I find annoying is the constant bleating by the Republicans that this bill "costs too much" and represents a "government takeover of healthcare".

By the CBO estimates, over a 10-year span, it will cause a deficit reduction of $138 billion. Even if they are way off it certainly looks like it will be no worse than a break-even scenario.

The "government takeover of healthcare" is what truly baffles me. We are not turning into Britain where the doctors are federal employees. The government is also not getting into the insurance business - as I said, there's no public option, and the new enrollees will be covered by insurance companies that are already in existance. I do not see how placing regulations on insurance companies can be construed as a "government takeover".

 

Yes, maybe someone here can explain to me exactly how government is taking over healthcare. Regulating it perhaps, trying to make it more competitive, but "takeover"? Another lie intended to scare the public?

 

See? Even NOG agrees with me. When the planets and moons are lined up this closely we can't be wrong.

 

OK, I've missed a lot of what's gone on in the US about this, but wouldn't it be ok for there to be a law (or series of laws) that freaking regulates the insurance industries, thereby restraining them from really underhanded practices? That wouldn't end the free market forever, would it?

 

NOG correctly pointed out, that it is what the major portion of the House Bill consits of as it is crafted at the moment. In return, the insurance companies will get a whole lot of new customers because health insurance well be mandated, much like auto insurance is in most places. There will be an exchange, in place of a public option, to allow for some free market competition, which does not exist in the current system.

As for the issue of "tort reform." We had tort reform in Texas several years back; my insurance premiums did not go down .01. Of course the insurance companies want to cap compensation paid to victims. It's just more money that they get to keep. So why wouldn't they want it?

 

One of the problems with the health care bill is several powerful politicians are ignoring all the aspects of the problem of health care and only focusing on "insurance reform."

Insurance reform is an easy target -- everyone hates the insurance companies.