Editore"s Note
Tilting at Windmills

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November 8, 2009

THE NEED FOR AN OCCASIONAL REFRESHER.... Reader C.G. emails over night: "Hooray! The House passed reform! Remind me: what's in it?"

I suspect that's not an uncommon question this morning.

It's tough to summarize the entire policy, but the House bill does what reform has set out to do all year -- if you have insurance, you'll have better, more stable coverage with consumer protections. If you don't have insurance, you'll get subsidies to help you purchase coverage from an exchange.

The House is expensive, but it's fully paid for, and would lower the federal budget deficit over the next couple of decades. It includes a public option for eligible consumers, an individual mandate, and an employer mandate. It would cover about 96% of the population, and does not raise taxes on the middle class.

I found Harold Meyerson's recent description of the plan quite useful.

The health-care reform bills emerging from the House and Senate, when melded and enacted, will constitute an epochal achievement: the near-universal provision of medical care to the American people. But the House version is clearly the more epochal, as the health coverage it provides is more universal, chiefly because it's more affordable.

For families who buy their insurance on the exchanges that both bills establish, for instance, the House bill includes more generous subsidies -- on average, $1,000 more, according to the Congressional Budget Office. The House bill also offers a lot more assistance to Medicare recipients by reducing the cost of their prescriptions. While the bill that emerged from the Senate Finance Committee renews the Bush administration's mega-bucks gift to the drug companies by continuing to prohibit Medicare from negotiating drug prices with them, the House bill authorizes those negotiations. The Senate bill reduces by half the payments that Medicare recipients must make for prescription drugs that fall into the "doughnut hole" (annual drug expenses are covered up to $2,700, and coverage kicks in again at $6,100, but for all purchases in between, Medicarians are on their own). The House bill would cover all prescription purchases by 2019.

The Center on Budget and Policy Priorities also had a helpful report on the strengths of the House bill, as did HCAN. Both are worth reading for additional analysis.

At its core, this is a reform bill that would extend quality, affordable care to the country, with a fiscally responsible plan. It's long overdue, and it's poised to become the landmark legislation of this generation.

Steve Benen 10:45 AM Permalink | Trackbacks | Comments (25)
 
Comments

...oh, yeah, and all this real neat stuff in 'healthcare reform' over the bodies of all the poor women in america.

Posted by: neill on November 8, 2009 at 10:44 AM | PERMALINK

So Stupaking the 'healthcare' reform bill is the Dims' version of domestic shock and awe?

So glad to see the laser accuracy of the legislation, to only wage war on, you know, the weakest and most powerless among us -- poor women.

Posted by: neill on November 8, 2009 at 10:52 AM | PERMALINK

Can somebody explain to me how the govt can fine people for not having insurance if this plan is not going to cover 100% of Americans?

Posted by: Speed on November 8, 2009 at 10:59 AM | PERMALINK

I feel exactly as Gay Californians on Election Day. There's no way I can be happy.

Posted by: MissMudd on November 8, 2009 at 11:01 AM | PERMALINK

It's tough to summarize

Especially without reading it. All we have are the talking points of the proponents and opponents.


according to the Congressional Budget Office

Even CBO warned that they had not read the final language and had to make some interpretations and debatable assumptions.

Speed: Can somebody explain to me how the govt can fine people for not having insurance if this plan is not going to cover 100% of Americans?

No. That will have to wait for court decisions.

A note of praise for Rep. Pelosi. It looks like she accomplished what she set out to accomplish and what she said she could accomplish. And a note of prais for Pres. Obama.

Posted by: MatthewRMarler on November 8, 2009 at 11:23 AM | PERMALINK

This bill was a TARP to the insurance and pharmaceutical industries.

Posted by: Brian on November 8, 2009 at 11:29 AM | PERMALINK

Wow, imagine that. Elected officials (Democrats, mostly) getting together, working hard, and actually accomplishing what they were elected to do - passing laws that improve the lives of average Americans. If I were Rush or Beck or Rove or Fox, I'd be more than a little worried. Their anti-government narrative, which is their very reason for existence, is being turned on its head. And as we look back on this in the years to come, all those hysterical teabaggers are going to look pretty f#cking stupid.

Posted by: Patrick Starr on November 8, 2009 at 11:38 AM | PERMALINK

Health Care Reform?
Illinois Democrat Jan Schakowsky:
This [Stupak] amendment goes far beyond current law which already bans the use of federal funding for abortions. It goes far beyond the language already in this bill that guarantees no federal dollars are used for abortion. This amendment says that a woman CANNOT purchase coverage that includes abortion services using her own dollars; middle class women, using exclusively their own money will be prohibited from purchasing a plan including abortion coverage in every single public OR PRIVATE INSURANCE PLAN in the new health care exchange. Her only option is to buy a separate insurance policy that covers only abortion - a ridiculous and unworkable approach since no woman anticipates needing an abortion. This amendment is a radical departure from current law and will result in millions of women losing coverage they already have.

This health reform bill is about improving access to care, not further restricting a woman's right to choose. Our bill is about lowering health care costs for millions of women and their families, not further marginalizing women by forcing them to pay more for their care. This amendment is a back door way of overturning Roe v. Wade; it is a disservice and insult to millions of women throughout our country.

Posted by: neill on November 8, 2009 at 11:42 AM | PERMALINK

Is the public option in the house bill limited to people who can't afford to contribute to Healthcare and Humana stockholders and executives? If so, it's a mess.

Posted by: Danp on November 8, 2009 at 11:53 AM | PERMALINK

If we saw the original Social Security bill from FDR, we would be REALLY disgusted. The coverage was disgraceful, mostly white guys if I recall. I believe Medicare was somewhat spotty also.

The foot is in the door.

If we can keep the Dems in the majority for a few years (or more!) I will bet there will be some low key improvements, not enough to set off the wingnuts, just a few gentle pushes here and there. And the House version fixes the doughnut hole while keeping the deficit reduction going. The 'r's passed that POS with NO funding. This is a huge improvement, it's just not going to happen yesterday.

There has been little mention of the improvements of SS and Medicare over the years, which is probably just as well, as the wingnuts would see a conspiracy of us libs to SOCIALIZE medicine. Gasp! So what else is new?

Posted by: jean on November 8, 2009 at 12:42 PM | PERMALINK

This bill won't be perfect...not even close. But, as I see it, it will be FAR better than the system we have now. And like others have already noted, it is a foot in the door. The fact that nearly all Americans will have coverage that cannot be denied because of age or pre-existing condition is HUGE. That point cannot be overstated here. Even the far-left liberals who complain this plan doesn't go nearly far enough need to step back, take a breath and see the bigger picture. This will be a monumental step in the right direction.

Posted by: independent thinker on November 8, 2009 at 1:01 PM | PERMALINK

neill: middle class women, using exclusively their own money will be prohibited from purchasing a plan including abortion coverage in every single public OR PRIVATE INSURANCE PLAN in the new health care exchange.

Rightly or wrongly, that is to ensure that the public and private plans all compete on the same terms.

I oppose restrictions on abortion (except possibly late-term abortions, sometimes), but if the supporters of the reform bill are going to assert that both a) no federal funding for abortions and b) private and public plans have to operate according to the same rules, then the Stupak ammendment is necessary.

The bill, as described in the Democratic talking points, has irreconcilable provisions, and some of them will have to be sacrificed in the execution of the law (put differently, it has some "false promises".) The Stupak ammendment merely removed one of the irreconcilable provisions.

Posted by: MatthewRMarler on November 8, 2009 at 1:26 PM | PERMALINK

55% of people covered by employer-provided health care have a lifetime benefit maximum on their plans. Generally, it is around $1M. Mine has one imposed this year for the first time.

All it takes is one bad traffic day on I-75 to become a spinal injury patient, for which the lifetime cost of care is around $3M. It isn't the only type of catastrophic injury that fits in that category.

So it is possible for me to have employer provided health care and yet have no benefits under it. Where do I go then? Am I allowed to be on the public plan? Medicaid?

I've heard a lot of blather about how if you love your current plan, you can keep it. Trouble is if you hate your current plan, too damn bad. You HAVE to keep it. And it appears to not matter whether the plan actually does anything for you or not.

Posted by: Paul Camp on November 8, 2009 at 2:26 PM | PERMALINK

Another item that is being looked over in the bill is the fact that employers will be REQUIRED to pay at least 72% of a single employee's coverage and at least 65% of a family employee's coverage. I can tell you from personal experience that most companies currently pay less than that, especially on family coverage. If the employer does not offer any coverage at all, they have to pay a tax equal to 8% of their payroll.
Sorry to tell you, but most companies are already paying 10-15% of their payroll for health insurance. And now you are asking them to pay an even larger share of each employee's insurance...
So if a CEO has the option of paying 15-20% of payroll for health insurance or not offering insurance and only paying 8% of payroll, which option do you think the average CEO will choose?

Posted by: Gridlock on November 8, 2009 at 2:36 PM | PERMALINK

Actually, the bill allows for abortions in rape, incest or where the mother's life is in danger - on any plan. It then restricts it that no other abortions can occur under any government sold plan, or any plan paid for with government subsidies. This doesn't deny someone the use of their own money to buy their own plan which does allow abortions outside those three circumstances.

Posted by: coren on November 8, 2009 at 3:41 PM | PERMALINK

If you don't have insurance, you'll get subsidies to help you purchase coverage from an exchange.

I still don't understand what someone who has no money at all is supposed to do.

Get sent to jail?

The plan is basically ridiculous because it's about insurance.

Insurance is what we need to eliminate.

It's like a school voucher program or volunteer firefighters. They simply don't work better than a public school or real firefighters.

Posted by: cld on November 8, 2009 at 3:58 PM | PERMALINK

It is as if to criminalize unemployment.

Posted by: cld on November 8, 2009 at 4:02 PM | PERMALINK

What Brian said... Or Kucinich

And, Jean... SS and Medicare/Medicaine (other than taking the old and poor off private insurer hands) had not giveaways.

Posted by: SocraticGadfly on November 8, 2009 at 4:05 PM | PERMALINK

Everything created as a public good in the US must be made as cheap and as harsh and punitive as possible to gratify Republicans.

Is this not corruption?

Posted by: cld on November 8, 2009 at 4:10 PM | PERMALINK

Geez I can't type. To Jean: Medicare/Medicaid, as well as Soc Sec, had no giveaways to insurers, or anybody else. Tis true it took 20 years ot get farmers and some others in the system, so, it wasn't great. But, there was no private sector incentive to keep farmers out of Soc Sec, either. Per other commenters, should a bill like this pass, the private sector has an incentive to either dump health ins. coverage or else trim it back further. It was NOT given an incentive to force insurers to lean on doctors and hospitals.

Of course, as Ron Wyden notes, other cost-containment factors are slim in this bill too.

Yes, it's a start. But, at some point, whether as part of this bill or later, the government is simply going to have to face the cost control issues.

Posted by: SocraticGadfly on November 8, 2009 at 4:20 PM | PERMALINK

@cld: This will not eliminate Medicaid; in fact, it's supposed to raise the ceiling income to qualify, so more people with low incomes will be on Medicaid. (The fact that essentially no doctors, outside of teaching institutions, take Medicaid, because it doesn't pay enough to turn on the lights is another matter altogether.)

Posted by: Randy on November 8, 2009 at 4:51 PM | PERMALINK

Medicaid eligibility is organized by individual states and virtually no one outside pregnant women and children qualify anywhere.

It's simply absurd to arrange a program like this as insurance. Why? What is the point, beyond vindictiveness?

Posted by: cld on November 8, 2009 at 5:01 PM | PERMALINK

So if a CEO has the option of paying 15-20% of payroll for health insurance or not offering health insurance and only paying 8% of payroll, which option do you think the average CEO will choose?" Gridlock @ 2:36 PM.

The employees will be eligible to then participate in the insurance exchange which, of course, includes the public option. If I understand the bill correctly, the fine the company pays in lieu of providing insurance will be used to defray the costs of that company's employees' insurance choices from the insurance exchange.
Great way to get started on funding single payer, though. And I rather think that's what the health insurance industry is so worried about.

Posted by: Doug on November 8, 2009 at 5:26 PM | PERMALINK

But...this bill will basically continue the bastard system we have where insurance companies can screw patients as hard as they want..until we have true regulation, all the written law in the world will not stop Big Insurance from fucking everyone they can, as hard as they can. Because unless you get a GOOD lawyer, and sue their asses for abusing you, they'll keep right on doing it.

We need single-payer. Period. No co-pays. No paperwork. No arguing with insurance companies. We want what Congress and the President have: some of the best health-care in the world, with no bullshit when it comes to being covered for it.

I swear, I cannot figure out why there has not been a huge backlash against our ruling elite for fucking us so badly, for so long, in this area.

Posted by: LL on November 8, 2009 at 6:04 PM | PERMALINK

Cheers! America fucked women over yet again for rancid putrid dead asses.


Posted by: Silver Owl on November 8, 2009 at 8:02 PM | PERMALINK
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