Lieberman is not on board.

Yeah, I'm trusting a Democratic Strategist. They tell the same lies you all doe

"This ends rescission" unless they are willing to pay a 5000 dollar fine.

"No denile of coverage!" unless they are willing to pay a 5000 dollar fine.

"No Lifetime Caps" but low annual caps!

"Premium control!" but copays that can go through the roof.

All of this from the man who's idea of helping people keep their homes is allowing bankers to reject their applications for modification and begin auctioning the property without ever telling the homeowners it intends to do either.

Real trustworthy, those Democratic insiders. Aren't they the folks that promised us EFCA and card check if we delivered 60 votes?

Get ready for the outrage to be dialed up to 20.

So... what did Nelson get in the end?

And doesn't the 80/85 thing just encourage insurers to encourage inefficiency. With 10% unemployment right now, it's easy to see insurers concentrating on the subsidized users. "See a doctor about anything at all, and we'll include a standard diagnostic that includes an MRI, DNA profile, and fifteen different blood and urine tests." Healthcare costs triple, so so does the insurer's margins. Yay for unrestrained insurance costs!

"Insurance companies who jack up their rates will be barred from competing in the exchange."

This is critical.

Just vote on the damn thing.... Pass something. 20 years from now, when the country eventually has medicare buy-in for all, we'll look back and wonder what the fuss was about.

What soullite said. As said over at FDL:
Better yet, all of those lower-income lucky duckies who get subsidized insurance premiums will find their co-pays and deductibles to be so high that they can’t afford to actually use the insurance they were forced to buy, making them even more of a (taxpayer-sponsored) windfall for the insurance industry.

And how many Republicans are supporting this hideous unpopular corporate giveaway? Not a one. If it becomes law, the Democrats will own it in its entirety on election day.

Nothing in there about more restrictive abortion language? C'mon, Nelson got something for his vote. How bad is it?

Ten years from now, when we've built on this thing, covered the overwhelming majority of Americans, and reined in healthcare costs, I wonder if the shitheads at FDL and Kos who are running around spreading fear and distortions about this bill will apologize and admit they were wrong.

Jeremy, sure it is

Just like universality was critical.

Just like price controls were critical.

Just like Health Care Reform was critical before Health Insurance Reform was critical before any Healthcare bill became critical.

Nothing is actually "critical" to you people. You're not wonks. You're not ideologues. You're hacks who don't give a shit what you actually pass.

Jeremy - it's not going to make any difference. Right now, non-corporately negotiated insurance really does cost more than most people can afford which is a central reason why there are so many uninsured in the country. Rates generally start at $250 per month for the basic "Barely covers you" single people plans. Insurers can enter the exchanges with prices unchanged, and the end result may well be people actually deciding that the end of year fines (up to 2.5% of income - ie anyone earning less than $120,000 per year will find the fines lower than the premiums) are better value for money.

Toast, even Ezra Klein says no alterations will be made to this bill for at least 10 years. So it's if someone told you this was going to be "built upon" by then, they lied.

When these people say "this isn't over" they don't mean they plan to do anything else about it. They mean they are leaving it for another generation to actually do real reform. They aren't going to do jack shit, as they have already proven.

Page 39 has the amended abortion wording:

http://democrats.senate.gov/reform/managers-amendment.pdf

It pleases me to no end to see you pub trolls screaming in defeat!

Greg - there's no Medicare buy-in in this bill, and it's improbable that one will be passed if this bill is (because this is likely to be the one that fails so badly it "proves" universal healthcare is highly unpopular to the politicians/MSM/etc.) Can we wait to vote on that one, and skip the "Health Insurer's Shareholder Bail-out Bill" that this article is about?

Pub... Except were were democrats. You're not watching Republicans scream in defeat. You're watching the moderate wing of the party purge the left.

Good luck trying to win elections with 10% of your base on holiday. In the middle of 10% unemployment. After the baillouts. Good luck wi

Something tells me your ass has never been outside in October knocking on doors and that you've never likely spent an entire day driving other people to the polls to vote.

Well, there's still reconciliation, so it's possible--even likely--that there will be some alterations to this bill.

I just still can't believe that there -is- a bill. I won't, until Lieberman votes.

As Steve and others have pointed out, this bill does more and does it more aggressively than Howard Dean's 2004 reform plan proposed. So all this crap about this not being "real" reform is just shameless goalpost relocation.

Just pass the damn thing. There looks to be a few changes in it that will be beneficial. The sad fact is that most Americans, even though they whined and moaned and groaned for several years over the growing health care crisis, sat back on their bums and let this go when they should have been hitting Congress hard for massive change. They either believed lies or didn't care enough to stay on it. I don't know how many calls I made to Washington, how many emails I sent out--I even called senators and representatives who are not mine--I talked in person to my own Rep., but too many people were disengaged and apathetic and I don't know WHY.

soullite,

I don't remember you campaigning for Spector or Leiberman. Down to 58. How about Baucus, Bayh, Conrad, Lincoln, or Landeiu. Down to 53. Lets not forget about everybody's favorite the honorable senator from Nebraska, Down to 52. Then lets add some of the semi-liberal(most of the time "deficit hawks"*) of McCaskill, Webb and Warner and were down to 49. Your poutrage is obvious to everyone and it is what keeps you and the people like you from ever being taken serious.

Toast,

Of course they wont. They will pretend that they were "holding his feet to the fire", "pushing the Overton Window to the left" and blah blah blah. There are some who will still say that Gore and Bush II are the exact same and that their stupid rhetoric had nothing to do with the outcome. They feed on venom and hate progress. It is the becoming very clear to a lot of liberals that they are not on the side of the American people.

Nelson got something for his vote. How bad is it?

They promised Senator Ugly Face a bunch of virgins in heaven if he pulled the trigger...

I just still can't believe that there -is- a bill. I won't, until Lieberman votes.

Josh is reporting many heroic senators are "braving" a DC snow storm. And that many of our noble 100 slept on "cots" last night in their offices. Joe however is in Conn. He will begin the pilgrimage to DC shortly. This will be an epic journey. He might even do it barefoot with a cross on his shoulders. Such suffering by so many deprived senators is enough to bring tears to my eyes...

Toast - nobody's denying it's not "real" reform. It's just most us wanted a reform bill that helped people get insured, rather than one that sets up a dynamic that ends up forcing people to pay for excessively priced health care.

That's the problem with the bill, it contains many good things, but they're all undermined by the central dynamic where there are no proper cost controls.

There's also what it does to abortion coverage, essentially enforcing the Stupak amendment in "red states" - states will be able to ban access to insurance policies that cover abortion, even as an optional, premium raising, bolt-on, and the evidence is many, many, states will go for that. So we have a backdoor (backstreet?) way of undermining existing abortion rights in a way unprecedented since Roe vs Wade.

This is a bill designed to fail. It's designed to set up a dynamic which will be very, very, unpopular, and discredit the entire concept of universal health coverage for decades, possibly centuries. It is designed to give the appearance of giving everyone what they "want", but designed to make it expensive.

The first act by the incoming Republican administration in 2012, and mark my words, if this bill passes unchanged, that's what we'll get, will be to repeal this law. Were a sane, rational, bill that actually controls prices directly or indirectly to pass, then the chances are the Republicans wouldn't win in 2012, and if and when they do, they'd be too frightened to do more than tweak with what could be a very popular reform.

As it is, this one's shot. It's a bad bill, it's destined to be repealed, and to set back the cause of healthcare reform with it. Mandatory subscriptions to unaffordable plans, with an effective partial rollback of Roe vs Wade for a large part of the country. How can anyone seriously support it, just because it happens to ban some of the more senseless insurer practices?

The professionally aggrieved will never be satisfied so ignore them, like the republicans should have their own 29%-ers. We aren't a center right country, but we aren't leftist, either. We are pretty damned centrist, overall.

Anyway, pass the fucking thing already.

Ezra is wrong to say it won't be addressed again for a decade. There will be another bite at the healthcare apple before the 2012 reelection. Dems will campaign on it, and they will win on it. The r's are terrified because they know this dooms them. It will be as popular as Social Security and their opposition won't be forgotten. Not in the internet/YouTube age.

All well and good soullite, but you if don't play the game because you don't like the rules, you forfeit. Given the rules we've got (electoral college, stupidly engineered filibuster rules) and the opposition that we've got (crazy people, voting in a block), this is what you've got. Results matter. Your approach gets us nothing.

The only way that "take my ball and go home" has a prayer of working, is if enough of the skilled young people in the country (and we've got them, my kids are pretty sharp, and so are their friends) look at all this, declare that it simply will not get fixed, and take themselves to another country to live. Biggest, multinational business might not care, but everything smaller (what ought to be the members of the Chamber of Commerce) ought to be worried. Even then, given world-scale problems (climate, overfishing), a poorly run USA has the ability to ruin it for everyone.

Keep a level head, think about how you convince people on the margin, and keep your eye on the ball. And yes, sometimes acting a little crazy can motivate people on the margin, who are gaming to get as much as they can from a bill that will nonetheless pass. I hate that sort of behavior, but I don't think you fix it in public. It's a long, multiturn game, if we need Leiberman later for some other bill, we can't push him off a cliff yet.

I will say, I am contemplating ways that I might harm his future chances for employment, not sure what they are, but a consumer boycott of anyone he works for might be a good start -- in fact, looking at his future employers, and writing them letters NOW, might even be productive. If word comes back to him that the Hartford Insurance company has been getting letters from senators and customers about how they'll never get a foot in the door if they hire Leiberman, that might matter, and it matters a heckuva lot more than punishing Connecticut by closing bases, etc (if he retires, it's not teaching those voters "a lesson" will be good for anything).

The state to consider applying pressure to is Maine. Snowe and Collins are both allegedly sane, they ought to be willing to deal, yet they've dragged their feet. They're also both R's, so there's no problem with hurting Dodd to teach Leiberman a lesson. I wouldn't consider death-from-above scale cuts, but a little paring and foot-dragging, might be enough to make them wonder if it's really worth sticking up for the crazies.

What soullite said. As said over at FDL:
Better yet, all of those lower-income lucky duckies who get subsidized insurance premiums will find their co-pays and deductibles to be so high that they can�t afford to actually use the insurance they were forced to buy, making them even more of a (taxpayer-sponsored) windfall for the insurance industry.

******************************************

AND IF THEY CAN'T AFFORD ANY OF THIS, INCLUDING THE FINES, GUESS WHAT HAPPENS: THEY GO TO JAIL ! So we end up putting poor people who do not have any extra money for any of this in jail because they CAN'T AFFORD 'universal' health care..it's as fucking insane as it is sadistic ........

Well, I guess you just took credit for the fuck-up, soullite, cuz you never "delivered 60 votes". You let that shithead Lieberman run and win as an independent. Apparently this is all your fault.

The hyperbolic fears of the FDL crowd are exactly why Ezra is wrong and the issue won't take ten years to come back around. Nobody is going to jail over it. Get real. The instant a case comes to light and someone is threatened, they will swing into action and fix it.

I seriously doubt anyone will go to jail, and I recall Obama saying something recently about assistance for those who really, absolutely can't afford it. We have a populace too apathetic to take action to secure their own interests, so I guess that's the way they want it.

For all those who think that nothing else will be added "in 10 years or more": Medicare buy-in can be done through budget reconciliation, which only needs a simple majority. Why wouldn't that happen?

Converse, I don't think it will happen that way because, if I understand correctly, reconciliation items, by definition, have a sunset.

I just downloaded the whole pile of crap, and did a search. There is _nothing_ in it about rescission. Even searching for "fraud", which is the allowed justification for rescission in the House bill, turns up nothing about rescission. there is text about establishing a database for "denial of care", but nothing limiting cases where DOC is allowed. I call BullSh1t

In my experience thus far, the world continues to turn and sunsets lead fairly quickly to sunrises. If the Medicare buy-in is popular, which it certainly could be among age 55-65 voters, I'm not sure the Reps would be willing to let it die, assuming they were able to gain a majority at some point in the future.

Did Ben Nelson and Harry Reid punk Joe Lieberman? The ease with which Nelson caved suggest yes. Here's the scenario I have in mind:
Nelson lets Lieberman know that under no circumstance will he support a bill with abortion funding in it. Lieberman, confident the the bill will be spiked, lays his cards on the table; he won't support any bill with a public option or a medicare buy-in. He figures Reid is desperate to pass a bill and will go along with his demands, which he does. This allows him to talk about his support for the emasculated bill, which he describes as progressive, and play good guy,secure in the knowledge that Nelson will kill the bill for him. But Nelson betrays him and caves.

That's pure speculation. Take it for what it's worth.
ps. Lieberman has always opposed health care reform , so his frustration of progressive goals this time around may have only been icing on his bitter cake.

No argument with it's popularity, converse. And yes, it is much easier for the state to give than to take away. But my hunch is that they will try to get it by 2014 without going that route. Of course, that is all it is: a hunch.

@soullite et al

Right now you, the so called progressive / liberal / netroots wing shouting outrage is making me feal ill frankly. Why? Not because I disagree with one single iota of actual policy. You guys want single payer, i want single payer. Else, you want the strong public option, I want the strong public option, etc.

The problem with the outrage on the left is that it is so fucking stupid and counterproductive. Who bamboozled you guys, soullite etc, into believing that the way to get your agenda accepted is pissing into the tent and wining endlessly. These threats of taking "revenge" on the democratic party in 2010 is nothing but a powerplay b/o longing to feel relevant. Guess what? It wont make you relevant.

The ability to get your policy agenda commonly accepted by the general public makes you relevant. The repubs knows how to frame the debate because they know how to be good public advocates for their prefered policy. The netroots seem to only know how to pin all their hope on one hero, then expect said hero to pull all of their dreams out of his ass as if buy magic, and in addition at the same time convince the rest of the country that they should go along.

Why whine instead of work? Apparently because you are to just to fucking lazy to be out there advocating and helping advance the agenda yourselves. You make your wishlist and then you try to get as fucking much as possible. The rest goes on the backlog and then you work your ass off for that in the future.

Your fucking pride is not important, the policy is important. This was as much as we could get this time, because we didn't manage to sell more.

Some confused souls (traitors) on the left will bitch at Obama and the dems. But once this HCR bill is finally passed, in the years to come, will they keep talking up single payer and/or the public option every chance they get? I doubt it. These same loosers are too fucking stupid to know that the latter strategy would eventually help make all their wishes come true while the former strategy will only make their nightmares come true. Just like it did in 2000. Memory is short, apparently.

Danny - it's quite simple: A bill that will fail and discredit health reform for generations is a bad bill. Period.

Pretending that critics are complaining because of "policy agendas" and other horseshit just blinds yourself to the reality. From what I can figure out, those promoting this bill are the ones who are letting "policy agendas" get the better of them. It's a bill that says it's about healthcare reform, so you're supporting it, even though the end result will be people forced to buy unaffordable health plans.

The bill doesn't have a price control mechanism, and has huge incentives - from uncapped subsidies to encouraging inefficiencies by relating profits to health care expenditure - to make premiums astronomical.

Come back when it has a price control machanism, be it a PO, effective (and non-politically controlled) price capping with enforcement, or else an end to the uninsured tax penalty and caps on subsidies for the less well off.

I'd rather have the former than the latter, but you know what, I'd be able to live with the latter and consider it a real compromise, a bill that moves things forward, if not as far as I'd like, without making things worse.

This is stupid bill. It can only fail in practice. The end result will be Republicans getting back in power, and the bill's repeal, and healthcare reform off the table for generations. The only reason to support it is if you actually don't want useful reform.

I have a question for all of those who claim we should pass it anyway, regardless of whether it'll work or not:

If you supported a free market approach to electricity (put yourself in those shoes, regardless of whether you do or not), would you have considered California's electricity deregulation bill a bill that helped your cause?

It had the EXACT same problem: a group (in that case the utilities, in this case the government and people who don't work for corporations) were forced to buy something, regardless of cost. The bill then, as with this, paid lipservice to cost controls, but in practice these were unenforcable (as with HCR. Indeed, with HCR the "enforcement" is spread amongst the fifty states, making enforcement both difficult and, in many cases, unlikely to even be bothered with.)

Do you think Californian deregulation actually made states think that deregulation was a good idea? Or have you noticed it discredited the concept, which has not been seriously attempted again since?

Let me understand: LIEberman is more than willing to hold things up so that Senators who are Christians perhaps might not be able to celebrate Christmas with their families, yet he's taking the day off to celebrate Hanukkah with his?

What a jackass. (But we already knew that).

And Ben Nelson isn't much better.

@squiggleslash

First, I think you are slightly confused, or else I was not being clear about what I mean by a "policy agenda". I mean what I / you / we want to see made into law. I.e. the public option, single payer. I consider our policy agenda to be full of good things that I want to see happen.

Secondly, as you may have read already, the bill does in fact - in direct contradiction to your assertions - have price control mechanisms & incentives. It legislates a percentage of the premium that has to go to providing health care, and in addition misbehaving insurance companies can be kicked out of the insurance exchanges - a pretty good incentive I'd say since they would be excluded from reaping the benefits of the so called "giveaway" that I assume you are angry about.

So, there's a difference between no control mechanism, no incentives on the one hand and the best incentive and price controls on the other hand. Personally, I think we should have the best price control, single payer.

When this bill is passed it will increase coverage to 95% of the population. That means millions of good americans that will get good care when they are sick. Because of generous subsidies insurance will be affordable for middle and lower class americans and therefore it will not be an unpopular bill.

But if and when, in the future, it turns out that the incentives and mechanisms included in the bill were not enough to force insurance companies to cap price hikes, then all of us on the left should already have advocated ceaselessly for the superiority of the public option in doing just that. So that the bill, at that point can be perfected.

Because the reality is that we had a great policy for the american people, but because conservatives had other ideas we had to compromise to get halfway. We knew that the public option would be superior in providing value and security to americans and we tried to get it done but we were stopped by a misguided and misinformed conservative ideology and it's proponents. Time will prove our case, and if we don't allow people to forget that we had the ideal solution all along then eventually we will get it done.

That's how I see it, and incidently I happen to think that that's a productive way of seeing it - while shooting yourself in the foot while committing fratricide is not.

@Danny

I misunderstood your comments on policy agendas, sorry about that.

As far as your other comments go: I already covered, above, several of the things you mention. The 80/85% thing is not a price control, it's encouragement of inefficiency. It gives insurance companies a very big incentive to persuade doctors and hospitals to spend more on treatments than they need, as this pushes up premiums and reduces the ratios between ordinary medical treatment and the more expensive extremes. The logical consequence of 80/85% is not lower premiums, but higher premiums and the undoing of a lot of the work that's being done to keep medical costs under control. Without higher expenditure on healthcare, however silly, there's no way to raise salaries for the insurer's workforce or pay higher share dividends. Growth cannot happen without intentional inefficiency.

Misbehaving insurance companies can be kicked out of insurance exchanges, but as I've also said before, non-corporate rates for insurance are already excessive, so excessive indeed that the vast majority of people currently uninsured will find the 2.5% penalty makes better financial sense if they have no serious medical expenses. Insurance rates generally start at around $250pm for a basic, single person, premium, for a plan that's generally at the bottom end of the scale (and arguably not one anyone would want.) That aint cheap, and it's particularly bad when compared to corporate rates, that are generally much, much, lower than that.

(Interestingly, that also means the 2.5% penalty is lower than the monthly premium for every single person on an income lower than $120,000 (and the situation gets even worse for families.) Anyone currently avoiding insurance because they can't afford it, who isn't going to receive a subsidy, and earns less than a six digit salary, is likely going to continue to opt out and pay the penalty.)

But back to the point: no insurer currently offering policies from $250pm and up has any reason to reduce that amount, despite the apparent cost savings they'll get from having more policy holders, who, supposedly, constitute a group "so healthy" they don't want insurance. (In fact, I doubt this rationale. But anyway...) They're not "misbehaving" if that's what they offer upon entrance to the exchanges. It's also questionable how enforceable it is in practice.

When the bill's passed it will increase taxes for around 30 million Americans, who'll perceive the penalty better value than the policies available from the Exchanges, and provide free healthcare to around 10 million. It probably will not reduce health care costs, it'll almost certainly make health care more expensive, even for those already covered, because of the bail-out it gives the insurers. And that damages the possibility of fixing it in future, because people don't like paying more taxes with nothing in return, or being forced to buy overpriced policies from an industry whose reputation is somewhere between a rat's behind and a snake's stomach. It'll be very easy for conservatives to take advantage of the dynamic the bill introduces.

I agree we /should/ have single payer, but here's the thing: YES, I'm prepared to compromise. I'm very prepared to compromise. I'm prepared to compromise on a lot of things, as long as (a) the bill goes in the right general direction (and I don't question that here) and (b) the mechanisms the bill introduces aren't going to fail. Unfortunately, this bill cannot work, and therefore it's a bad bill, however much I may like the fact that it slowly moves us towards universal healthcare. Without, at the very least, oversight of premium prices, it would be better to have a bill that goes slightly less far in the same direction, as it's less likely to discredit the concept, and less likely to cause us to reverse direction in the near future.

I accept that we can't get the cost controls we want, Lieberman seems to be firm on that. There's still time to fix it. The next best thing right now to adding controls would be some reorganization of the mandate. We can't force people to buy something at any cost, we just can't. That's not right or fair, and it'll never be popular.

Agreed 100% with Danny. We know what we wanted,and we're seeing what we're probably going to get.

And yet, we still have our ultimate goals. Any talk about spiking the bill and starting over is delusional. The question IS NOT, will we get to complete what we've started late. The question IS, will a political @oalition survive this stage of the proceedings that it can get done.

My prediction is medicare buy-in via reconciliation well before '12. Once effective, no way it gets repealed by any congress.

I too second Danny's comments. I find my fellow lefties pitching a hysterical fit over this to be incredibly counterproductive. It's as if they're so used to being strongly opposed and deeply offended (a la Bush years) that it's their default position. We *are* on the same side, folks, everyone needs to keep that in mind. We're fighting about process and not the end goal. Don't become so committed to your oppositional position that it becomes something you can't change.

HCR needs to pass and then those of us who support single-payer need to keep pushing for it. As Senator Harkin said this morning, this isn't the end of health care reform, it's only the beginning. We just need to let it begin.

Zoe and other Bill supporters: you have a needlessly uncharitable view of your fellow lefties who oppose this questionable Bill. I'm not even sure at this point who is right, so I'll say: they have a rational case, backed by some major players, that a Bill will certain features could be worse than trying other things (like separate regulatory bills etc.) They have made logical arguments here about details, and I see more generalized emotional hype from you and other supporters than I do from the best of them like squiggleslash. That is a logically possible way for a product to be, you shouldn't pretend it can't be so. And just knock off asinine ad-hominem, motivation-mongering shit talk about "whining" and people not being happy enough with reality and all that.

The only thing I truly agree with "realists" here is: don't take it out on Election Day. Keep voting for Dems. The more there are, the easier it is to get good bills. Going Nader was a massive mistake.

Yeah, keep shitting on the left, you liberals. After all, without the left, we wouldn't even have this sell-out of a bill; you go-along-to-get-along liberals did squat to fight for single-payer or any other version of health care reform. You afraid-to-offend liberals were too busy giving Michael Moore shit for having the poor taste to release a film like Sicko to actually campaign for single-payer, which was taken off the table before any negotiation had even been opened. Now you want to cave in and sign off on a bill that really will punish the poor (read about the fate of Disproportionate Share Hospital funds in the proposed bill, and find out how that affects urban ERs, where poor people receive a great deal of their care). Go ahead, vote Dem and convince yourself you've actually done something, but stay the hell out of the way of those of us who are actually fighting for change. If you aren't going to help, at least don't hinder.

This bill is horrific. I am a progressive for a public option, medicaid buy in and at least a trigger. This is only making the insurance companies a utility with no protection from them.To get a bill just for a bill's sake is not a bill at all. The democrats are in for a rude awakening in the next cycles of elections. Their base will not be their. They will have to deal with that reality.

This bill is horrific. I am a progressive for a public option, medicaid buy in and at least a trigger. This is only making the insurance companies a utility with no protection from them.

@squiggleslash

I misunderstood your comments on policy agendas, sorry about that.

No problem :)

The 80/85% thing is not a price control, it's encouragement of inefficiency. It gives insurance companies a very big incentive to persuade doctors and hospitals to spend more on treatments than they need, as this pushes up premiums and reduces the ratios between ordinary medical treatment and the more expensive extremes. The logical consequence of 80/85% is not lower premiums, but higher premiums and the undoing of a lot of the work that's being done to keep medical costs under control.

All this assumes that the 80/85% cap - as an incentive - rather exists in a vacuum, where insurance company executives have perfect freedom from any other factors to set premium levels by dictate - but in reality they do not.

Insurance companies when they set premiums will make a bit more holistic cost benefit analysis on where they stand to profit the most. Raising premiums f.e. have the side effect of making premiums more unaffordable, even with subsidies and in relation to mandate penalties, so you lose customers. And again, you risk getting kicked out of the exchanges, thereby losing business. Raising premiums thereby screwing the consumer in order to try to screw the law to get to pay management higher salaries is unpopular and would be made an order of magnitude more visible than it is today. You then increase the probability of new legislation, i.e. the public option.

Without higher expenditure on healthcare, however silly, there's no way to raise salaries for the insurer's workforce or pay higher share dividends. Growth cannot happen without intentional inefficiency.

Like I said, this may seem reasonable to a market libertarian, but to the american public this kind of behaviour by insurance companies would appear uncounscionable, wouldn't you think. Now it is still actually a fact that the american public are the customers of the insurance industry, and while it unfortunately doesn't have the impact it should have I think you're rather trivializing the ease with which the insurance industry and the health care providers would conspire to artificially up HC costs in order to pay off management, all while never taking the possibility of a publick backlash or new legislation into account. I'm not saying it's impossible but I don't agree with you on it being extremely likely, and find your analysis a tad bit simplistic.

Misbehaving insurance companies can be kicked out of insurance exchanges but as I've also said before, non-corporate rates for insurance are already excessive [..]

So you concede then that the possibility of getting kicked off the exchange is a real incentive for insurance companies to behave and avoid future frivolous premium hikes?

so excessive indeed that the vast majority of people currently uninsured will find the 2.5% penalty makes better financial sense if they have no serious medical expenses.

Insurance rates generally start at around $250pm for a basic, single person, premium, for a plan that's generally at the bottom end of the scale (and arguably not one anyone would want.)

That aint cheap, and it's particularly bad when compared to corporate rates, that are generally much, much, lower than that.

But arent you forgetting all about the existence of new subsidies in the bill? That actually turns your entire speculation on it's head because with subsidies, it will for most people be both affordable and wise to pay for insurance rather than take the penalty (and get nothing).

Furthermore, while the subsidies sure will change the game for the individual health insurance buyer (making it affordable to have health insurance), that state of affairs that the insurance industry get to charge more in the individual market more may stay the same (therefore a.k.a "the handout" i guess). But this is the exact same market that they will get kicked out of if they do not restrict future frivolous premium hikes. So I'd say that's a pretty good reason to wan't to stay in that market then, no?

Anyone currently avoiding insurance because they can't afford it, who isn't going to receive a subsidy, and earns less than a six digit salary, is likely going to continue to opt out and pay the penalty.)

Well, yeah. Anyone above making above 400% of the poverty line who are currently avoiding insurance because they can't afford it may continue doing so. But, presumably those people are included in the 5% estimated to stay uninsured. So there's still millions of new customers, plenty in the exchanges, and a big fat reason for insurance companies not to want to kicked out. And we were talking incentives here, remember? In other words, your point is valid to some extent, but it is ultimately irrelevant.

But back to the point: no insurer currently offering policies from $250pm and up has any reason to reduce that amount, despite the apparent cost savings they'll get from having more policy holders, who, supposedly, constitute a group "so healthy" they don't want insurance. (In fact, I doubt this rationale. But anyway...) They're not "misbehaving" if that's what they offer upon entrance to the exchanges. It's also questionable how enforceable it is in practice.

Maybe, but remember - subsidies makes the premiums affordable today (for those that qualify) and for them to stay affordable we are only interested in the insurance business to be restrained from future frivolous premium hikes. Wanting to stay in the exchanges is one incentive that motivates just that. So I frankly don't see your point here.

When the bill's passed it will increase taxes for around 30 million Americans, who'll perceive the penalty better value than the policies available from the Exchanges, and provide free healthcare to around 10 million.

You're not an undercover teabagger / operation kaoser i hope :) A penalty is not the same thing as a tax. Thats a FoxNews talking point, my friend.

And you also manage to get it completely backwards. The 30 million people estimated to get insured are quite trivially (it should be bleeding obvious really) not going to be paying the penalty. You take some time and think about it some more, okay?

(In case that you by "30 million" meant the 5% estimated to stay uninsured - we're not really a 600 million people country yet, right? Furtheremore, concerning those 5% and them having to pay the penalty - see below!)

It probably will not reduce health care costs, it'll almost certainly make health care more expensive, even for those already covered, because of the bail-out it gives the insurers.

It will most certainly make insurance more affordable for everyone who gets subsidies, which is most americans. The CBO has analyzed this already, did you read up on that, because you seem misinformed.

Incidently the so called "bail out" is exactly what will make it less expensive for the individual so you are just way off mark here.

Health care costs in general (in society) may or may not rise as fast as they do today. I think the new regulations and incentives we have discussed above may give a somewhat better long term development, but I don't know for sure. Here, the public option would be invaluable. That is why we should keep pushing it!

And that damages the possibility of fixing it in future, because people don't like paying more taxes with nothing in return

Well most americans will see no new nor higher taxes, but instead subsidized premiums, and a set of new consumer protections, so there's no problem mate. You haven't thought it through, is all.

or being forced to buy overpriced policies from an industry whose reputation is somewhere between a rat's behind and a snake's stomach.

If you are trying to solve a problem the problem of having a hell of a lot of citizens that don't have health insurance and then get sick and fill up ER rooms for expensive and inappropriate care and goes into personal bancrupcy because they can't pay the doctors bill, you really only have two options:

- You can give them free healthcare and finance it by taxes or borrowing. (Thats what we arguably do now though extremely poorly)

- You can legislate that they have to have health insurance.

Those are the only two freaking options, digg? The first option is politicly impossible. It sucks, but it is. So there we are. There are subsidies to sweeten the deal, and it will make it an ok deal for everyone who did not have insurance because they couldn't afford it.

For people who actually could afford it, but were young and healthy f.e., yes they will se penalties or be forced to pay for insurance. And we wan't them to! They were betting iresponsibly on themselves not getting sick, while assuming that the rest of us would pick up the tab (through tax financed ER care) if they did get sick.

So in summation:

Taking subsidies into account and assuming (which i think I have shown is reasonable) that the incentives inherent in the bill is not terribly likely to make the cost curve worse than it is today, most people will actually get HI cheaper or at the same price as today, and a lot of new consumer protection.

Unnecessary ER care is likely to go down by 30 million which in itself will lower costs, and for the government and taxpayer in particular. So this picture you were painting of the bill as a cyanide pill in disguise, I think it's based on a set of flawed assumptions, frankly.

Apart from that, I see we basically agree on most actual policy which is nice. And that's also my point, that Obama, Harry Reid et al quite obviously does as well. Lieberman, not so sure, Ben Nelson, not so sure.

So if any progressive should hate on anyone and spend energy, spend it on getting senator assholes from progressive states away from the senate (Lieberman) and advocating progressive ideas in red states so we can some time in the future have a real progressive senator from Nebraska (Nelson). And spend it on advancing senate and filibuster reform.

I don't support the Senate bill, and if the legislation passes without real alterations, there won't be many Democrats left in Congress. The mandates and crap coverage are my big sticking points--we'll see companies start to bail on providing decent coverage. This is a disaster. I would support higher taxes to pay for true universal coverage. Most Americans would. But this is a tax for and by the insurance companies. They control the ball and will game the system. It is a stupid mistake and worse policy.

Unnecessary ER care is likely to go down by 30 million

If you genuinely believe that, you don't know much about health care. I work (among other places) in an ER: insured people use them, too. Barely-affordable insurance with high co-pays isn't going to make a huge difference in primary care compliance or preventative care.

Whatever you're smoking, please share.

I read over at Blue Girl's place that the current plan eliminates copays on preventive care for those who buy their insurance from the exchange.

I love preventive care. But most of the poor cannot get off from work to take advantage of it--if they are working. It will help the indigent. But Americans are royally screwed in the workplace. We need to make health care more broadly accessible outside of banker's hours. The system in place is not reformable, and is really a non-starter. That is why this bill is so truly bogus. It takes a terrible system and makes it worse. And democrats will be rightly blamed for it.

@DocAmazing

If you genuinely believe that, you don't know much about health care. I work (among other places) in an ER: insured people use them, too. Barely-affordable insurance with high co-pays isn't going to make a huge difference in primary care compliance or preventative care.

Whether insurance will be "barely affordable" or not is, as already established, completely irrelevant. The 30 million figure is (if I'm not mistaken) the number of additional people estimated by the CBO to get insured given the current bill, afordable premiums or not. (presumably they will be somewhat affordable, with subsidies, since 30 million new people will now prefer them over paying the penalty)

But, I expressed myself sloppily - I did not mean to assert that not one of those 30 million wont ever go to an ER to get anything else than emergency care ever again. I'm sure you're right that some will. However, if you mean to say that there will not be a substantial reduction, then what you're actually claiming is that 30 million people will pay for insurance that they will never use. Then it's me who'll have to ask you to share the smokes :)

Also, see Realists post above.

Insurance companies when they set premiums will make a bit more holistic cost benefit analysis on where they stand to profit the most. Raising premiums f.e. have the side effect of making premiums more unaffordable, even with subsidies and in relation to mandate penalties, so you lose customers.

And that's what happens in an open market where people get to chose whether they buy a product or not, and where there's no entity that will also buy massive amounts of that product irrespective or whether they do.

But this isn't that bill. This is a bill where people are going to be forced to buy insurance, at whatever price is demanded. And even if - as seems likely - a significant, probably a clear majority - of those people say "Screw it, I'll pay the fine, I'm not paying $250, $350, $500, $1000 a month on insurance, I only earn $25,000 a year, that's 10-40% of my income, I just can't afford it", the government is going to buy those same overpriced plans for those at the bottom of the income scale.

Again, you need to go back to California and the Energy market, and look at the dynamic being set up here. Companies can charge what they want, are encouraged indeed to increase their prices to match the increase in their overheads and shareholder dividends. There's little incentive for them not to, they're not going to lose any customers, because with rates already much higher than the penalty, realistically the vast majority of exchange subscribers will be those receiving government subsidies.

So you concede then that the possibility of getting kicked off the exchange is a real incentive for insurance companies to behave and avoid future frivolous premium hikes?

No, I said the opposite. I said the definition of "misbehave" here is such that it'll have no effect on prices, because it assumes prices are low today, whereas in fact they're so high as to be unaffordable. So to argue that a price control exists because companies may be kicked off the exchange for "misbehaving" is, in practice, nonsense.

Well, yeah. Anyone above making above 400% of the poverty line who are currently avoiding insurance because they can't afford it may continue doing so. But, presumably those people are included in the 5% estimated to stay uninsured. So there's still millions of new customers, plenty in the exchanges, and a big fat reason for insurance companies not to want to kicked out. And we were talking incentives here, remember? In other words, your point is valid to some extent, but it is ultimately irrelevant.

Maybe I didn't make my point clear enough, as I really don't understand what you're claiming here as it relates to my comment. I said above that anyone not earning a six digit salary (as in, anyone earning between $0 and $99,999 per year) who is not receiving a subsidy is going to find that the penalty is considerably lower than the lowest cost insurance option. Given that, today, they generally don't buy insurance because it's too expensive, can you give a single reason why they will not continue to opt for no insurance?

The only people currently avoiding insurance who will find themselves immediately better off buying it even if they believe it to be unnecessary are those earning $120,000+, using the assumption (which is reasonable) that a typical low-end insurance policy available via the exchanges will cost around $250. $250 is a reasonable estimate, because that's what they cost today, because there are no price controls to bring that down to a level comparable with corporate plans, and because the laughable "You get kicked out of an exchange if you charge more than you were" rule doesn't apply.

Now, tell me what benefit you're bringing to people who don't get subsidized insurance with this little scheme?

You're not an undercover teabagger / operation kaoser i hope :) A penalty is not the same thing as a tax. Thats a FoxNews talking point, my friend.

Insults don't help, and the penalty is implemented as a 2.5% income tax, so yes, in this case it's reasonable to argue that the 30Mish people who find that the penalty makes better sense to them than unsubsidized healthcare plans will be paying more in taxes. And sure, we can sit here and argue semantics, but it's a sin tax in every realistic way that will be seen as one by the poor bastards that have to pay it, especially as it's just another line on your 1040.

And you also manage to get it completely backwards. The 30 million people estimated to get insured are quite trivially (it should be bleeding obvious really) not going to be paying the penalty. You take some time and think about it some more, okay?

*sigh* 40M people are currently uninsured (article says 31M, which may be a source of confusion here, I was going on what I've read elsewhere.) The mandate will require that all 40M get insurance or pay a penalty. 10M of them will get the insurance subsidized (according to what I've read, that is 10M of them are presently uninsured and are on low incomes.) The rest will choose between the penalty or getting insurance. As I've explained above, given the vast majority of those left have incomes of less than $120,000 a year, and given insurance plan prices are unlikely to be any lower than they are now, and given most of them have decided that they don't need or can't afford healthcare, the likelihood of anything like the majority of that 30M getting health insurance just to avoid the less expensive penalty is close to nil.

That's why this is a problem. If you could demonstrate that prices will drop compared to existing prices, then that would be one thing, but there's no incentives whatsoever for that to happen, indeed the exact opposite applies: insurers have every reason to keep prices as high as possible.

It will most certainly make insurance more affordable for everyone who gets subsidies, which is most americans. The CBO has analyzed this already, did you read up on that, because you seem misinformed.

Obviously, because I was under the impression that subsidized policies would only be available to those on low incomes, with tax credits (which are not the same thing) for small businesses, and everything else I've read says much the same thing. I've not read anywhere that "most americans" will get subsidies, and I'd love to know where that's coming from.

Incidently the so called "bail out" is exactly what will make it less expensive for the individual so you are just way off mark here.

The "Bail out" consists of letting insurers charge whatever they want, and the government paying it to cover those on low incomes. I don't see any mechanism in which that can result in making it "less expensive for the individual". I see the opposite, again, it means Health Insurance prices rising as regardless of what the price is, the government will pay it. There's no way of looking at that and saying that it's less expensive for the individual.

Those are the only two freaking options, digg? The first option is politicly impossible. It sucks, but it is. So there we are. There are subsidies to sweeten the deal, and it will make it an ok deal for everyone who did not have insurance because they couldn't afford it.

You're missing the point, trying to come up with a justification for a situation when I was pointing out that the situation would be unpopular and cause resentment. The correct response would have been to either agree with it, or argue that somehow a situation where 10/30/31/40 million people (take your pick) have to choose between insurance they can't afford or a 2.5% regressive supplementary income tax would be wildly popular.

Before you pick apart the above, let's get back to basics a little. I'm getting the impression there are two opposing views that can be summarized (in extreme) as the following:

1. Happy citizens will eagerly purchase shiny new insurance plans from exchanges. The plans will be cheap, because OF THE SUPREME POWER OF MARKET FORCES and because of efficiencies that will be realized by new government rules. Everyone will be happy and vote for President Obama in 2012.

2. Unhappy citizens will be stuck between buying overpriced insurance plans from exchanges, or paying more in taxes. The plans will be expensive, because the citizens will be FORCED to buy them and so THE SUPREME POWER OF MARKET FORCES will keep prices high. Everyone will be unhappy, and will vote against President Obama in 2012.

I really think we need some real cost controls for (1) to be a reality. As it is, there aren't any. Those you've mentioned really aren't cost controls and may have the opposite affect to what you believe - namely the 80/85% thing might work without subsidies (because then market forces really would work to keep them under control) but with subsidies, well, then there's really nothing at all here. And the "Insurance companies get kicked out of the exchange" thing just guarantees initial prices will be as high, or a little higher, than they are today, which is already ridiculous.

There are modifications that can be made that would not raise the hackles of Lieberman et al. The most obvious would be to water down the insurance mandate. If there's no reasonable plan at the exchange that costs 2.5% of your income or less, you shouldn't be required to buy a plan, and shouldn't have to pay a penalty for not doing so. No, I don't like it much, and you may have a better idea, but as stated, right now, we're forcing people to buy something without controlling the costs. You can't argue with that, that's what this bill does. You buy. They charge whatever they want. You better hope they charge something reasonable, because otherwise you're going to be stuck paying a-la-carte and a 2.5% penalty at the same time. It's not fair, and everyone's going to hate it.

@Sparko

But that's exactly it! See where that line of thought gets you. The system is (according to you) so fucked up that incremental change for the better is impossible - only a revolution will deliver us. But the political reality is such that only incremental change is possible - if that was not the case, you would not be here bitching right now.

So what you have established is in fact nothing but an excuse to do nothing but bitch.

In fact this bill will make a fucked up system a bit better. It will make health insurance more affordable for people of limited means. It will prevent insurance companies from dropping you because you get sick and they don't want to pay. It's a start.

For those who still comment on the "outrage on the left", please remember to amend your remarks to read the "outrage on the right, left, and center".

The little, feeble left that Rahm continues to ignore is not the source of outrage, any more than the teabaggers are a source of outrage. We're just out here reporting it. The people are paying attention and can easily see that HCR is ANOTHER US taxpayer handout to a failing big business that's screwed America (and itself) into the ground.

The Democratic DC villagers, especially the WH, have their heads pretty far up their asses on this whole issue, and are going to get horse walloped in 2010 and 2012.

I think one Democratic Congressman reporting on the public's mood for the 2010 mid-terms summed it up nicely: we're screwed.

Wow. This argument is nauseating. Let's just be like the right for once: our side proposed this, then we should hold our noses and support it. You say that this bill will hurt the Dems in future elections. But the pain is nothing compared to what would happen if it fails. The public doesn't know or care about the details. All they know is the race to pass it, because that is what they're fed. If we fail to pass anything, no matter how odorous, we will lose to people who will do far more harm.

Save your idealism for something else. Here it is a luxury we can't afford.

Save your idealism for something else. Here it is a luxury we can't afford.

Agreed. I believe the solution is called: politics - throw them a big enough bone.

Idealism has very little to do with it.

And that's what happens in an open market where people get to chose whether they buy a product or not, and where there's no entity that will also buy massive amounts of that product irrespective or whether they do.

Let me just say that you're kind of an unconventional kind of progressive, what with your apparent willingness to trust free market forces over government regulations.

But this isn't that bill. This is a bill where people are going to be forced to buy insurance, at whatever price is demanded.

This is incorrect. They will get new incentives (penalty, and subsidies) to get insurance. If the premiums go up to much, the incentives to get insurance will disappear.

And even if - as seems likely - a significant, probably a clear majority - of those people say "Screw it, I'll pay the fine, I'm not paying $250, $350, $500, $1000 a month on insurance, I only earn $25,000 a year, that's 10-40% of my income, I just can't afford it", the government is going to buy those same overpriced plans for those at the bottom of the income scale.

If the government "buys" that plan (in reality they will pay subsidies to make it cheaper to buy and that incentive is as pointed out above sensitive to premium hikes) then the cost is, i'm sure you'll agree, not very hard to bear for the indivual consumer in that particular case. Therefore it would not be a problem for the consumer, but for the government and in the end for high earners, since they would pick up the tab with the progressive financing of the bill.

But all that is irrelevant. Your argument was and is based on assertions about what incentives will be at work in setting insurance company premium policy. Those assertions were proven dubious (above). Subsidies and penalties does in fact not remove the impact of premium hikes on affordability and therefore the risk of losing customers is still an incentive for insurance companies. Public outrage, getting kicked out of the exchanges and the general impracticality and risks of conspiring to circumvent the law in order to pay off management are other incentives.

Again, you need to go back to California and the Energy market, and look at the dynamic being set up here. Companies can charge what they want, are encouraged indeed to increase their prices to match the increase in their overheads and shareholder dividends.

Like I already said, this is boiilerplate economic libertarian thinking about incentives. I am more used to hearing it from people wanting to argue that all attempts at government regulating business are in vain because it screws up incentives which is said to always be counterproductive. The preferred conclusion is usually that private companies should be left unregulated and everything will be hunky dory.

But as we have already established, there are multiple incentives to take into account. The 85% requirement may be an incentive for premium hikes, but then you risk getting kicked out of that juicy insurance exchange market etc, see above & below.

There's little incentive for them not to, they're not going to lose any customers, because with rates already much higher than the penalty, realistically the vast majority of exchange subscribers will be those receiving government subsidies.

I really don't get your point here. If they get kicked out of the exchange, they lose the customers - if those customers are subsidized, penalized or whatever.

No, I said the opposite. I said the definition of "misbehave" here is such that it'll have no effect on prices, because it assumes prices are low today, whereas in fact they're so high as to be unaffordable.

This sounds confused to me. There are two issues, one is if prices are too high today, and the other is at what rate they will increase. If the price is made to grow at the level of general inflation f.e. then it is preferable to the current situation where it grows much faster than the general inflation.

So, once again: Do you agree that the risk of getting kicked out of the exchanges is a real incentive towards preventing the price level of premiums from growing faster than other goods and services in society? Do you agree that this is a good thing that the bill does, since premiums currently grows much faster?

Maybe I didn't make my point clear enough, as I really don't understand what you're claiming here as it relates to my comment. I said above that anyone not earning a six digit salary (as in, anyone earning between $0 and $99,999 per year) who is not receiving a subsidy is going to find that the penalty is considerably lower than the lowest cost insurance option.

What I'm claiming is:

1) That anyone making under 44k$/year will recieve a subsidy as per the bill.

2) Most people making > 44k$/year already can and do afford insurance (or are insured through their work), and will keep doing it at the same price as they used to pay.

Given that, today, they generally don't buy insurance because it's too expensive, can you give a single reason why they will not continue to opt for no insurance?

You're confusing the issue. Are you trying to prove that there won't be any people in the exchanges, that 30 million additional people won't get insurance, that the CBO estimate is wrong? Because that is what it sounds like.

Sure, there may be some people who make more than 400% of the poverty line (44k$/y&p), who presently are uninsured and who will stay that way, but now pay the penalty.

That's their choice. I can see how they might prefer to have no bill. But those people are in the vast minority and the fact is that as the current system works, in not using part of those >44k$ to buy insurance, they are taking a risk - for themselves and for society. That's how it is.

Now, tell me what benefit you're bringing to people who don't get subsidized insurance with this little scheme?

You still get consumer protection; you won't get dropped because of a preexisting condition.

But you tell me - you're making over 44 thousand dollars a year, why should you get to go around without an insurance when you will have to get poor care if you get sick, that will also be extremely and unecessarilly expensive and will in the end end up on my tax bill?

You're not an undercover teabagger / operation kaoser i hope :) A penalty is not the same thing as a tax. Thats a FoxNews talking point, my friend.

Insults don't help, and the penalty is implemented as a 2.5% income tax, so yes, in this case it's reasonable to argue that the 30Mish people who find that the penalty makes better sense to them than unsubsidized healthcare plans will be paying more in taxes.

It is implemented as a tax for purely technical reasons. But it is in reality a penalty for not being insured when you are considered (rightly or wrongly) to be able to afford insurance at 44k/year. But, yes, I agree that it would be preferable with a public option to provide a cost effective, affordable alternative for you.

*sigh* 40M people are currently uninsured (article says 31M, which may be a source of confusion here, I was going on what I've read elsewhere.) The mandate will require that all 40M get insurance or pay a penalty. 10M of them will get the insurance subsidized (according to what I've read, that is 10M of them are presently uninsured and are on low incomes.) The rest will choose between the penalty or getting insurance. As I've explained above, given the vast majority of those left have incomes of less than $120,000 a year, and given insurance plan prices are unlikely to be any lower than they are now, and given most of them have decided that they don't need or can't afford healthcare, the likelihood of anything like the majority of that 30M getting health insurance just to avoid the less expensive penalty is close to nil.

So what your saying is basically that thinking about it and with your current knowledge of whats in the bill and it's impact you are sure that you are right and the CBO is wrong. The bill will in fact not cover 31M more americans, it will actually only cover 10M more. I'm going to make a blatant appeal to authority here and say that maybe the fact that those guys with the fancy degrees that actually get paid to make estimates of these things come to a wildly different conclusion than you means that you misunderstood something.

That's why this is a problem. If you could demonstrate that prices will drop compared to existing prices, then that would be one thing, but there's no incentives whatsoever for that to happen, indeed the exact opposite applies: insurers have every reason to keep prices as high as possible.

As we covered at some length there are incentives. Maybe they are not optimal, but continuing to blatantly assert that there are not just because you have deemed them insufficient is not convincing.

Obviously, because I was under the impression that subsidized policies would only be available to those on low incomes, with tax credits (which are not the same thing) for small businesses, and everything else I've read says much the same thing. I've not read anywhere that "most americans" will get subsidies, and I'd love to know where that's coming from.

You're right, everyone under 400% of the poverty line will get subsidies. I assumed that most uninsured people would fall into that category, but according to you that is not the case. I don't have the time to read up on that so I'll take your word for it.

The "Bail out" consists of letting insurers charge whatever they want, and the government paying it to cover those on low incomes. I don't see any mechanism in which that can result in making it "less expensive for the individual".

The insurance companies will charge "as much as they want" no more than they already do. The government subsidizing people with low income trivially makes insurance less expensive (for those individuals). Isn't that obvious?

I see the opposite, again, it means Health Insurance prices rising as regardless of what the price is, the government will pay it.

The subsidy does not cover the whole cost of the premium so it's still quite possible to price yourself out of the market. Furthermore if you hike premiums unreasonably you get thrown out from the market exchange so I still don't see how you arrive at that conclusion.

You're missing the point, trying to come up with a justification for a situation when I was pointing out that the situation would be unpopular and cause resentment. The correct response would have been to either agree with it, or argue that somehow a situation where 10/30/31/40 million people (take your pick) have to choose between insurance they can't afford or a 2.5% regressive supplementary income tax would be wildly popular.

I don't agree with your claim that all people who make (at least) 4 times more than someone who we as a nation define to be living in poverty cant afford to get health insurance.

Furthermore, your description of facts don't add up in the aggregate, since if the (individual) incentives are as you claim then the estimate that 31 million would get insurance does indeed become untenable. It does indeed sound more likely that the (claimed) 10 million who'll receive subsidies would get insured and no one else. To me, at least, that is an indication that you got some basic fact wrong from somewhere. But I'll openly admit that I don't have the time right now to read up on it, unfortunately.

Before you pick apart the above, let's get back to basics a little. I'm getting the impression there are two opposing views that can be summarized (in extreme) as the following:

1. Happy citizens will eagerly purchase shiny new insurance plans from exchanges. The plans will be cheap, because OF THE SUPREME POWER OF MARKET FORCES and because of efficiencies that will be realized by new government rules. Everyone will be happy and vote for President Obama in 2012.

2. Unhappy citizens will be stuck between buying overpriced insurance plans from exchanges, or paying more in taxes. The plans will be expensive, because the citizens will be FORCED to buy them and so THE SUPREME POWER OF MARKET FORCES will keep prices high. Everyone will be unhappy, and will vote against President Obama in 2012.

I really think we need some real cost controls for (1) to be a reality. As it is, there aren't any. Those you've mentioned really aren't cost controls and may have the opposite affect to what you believe - namely the 80/85% thing might work without subsidies (because then market forces really would work to keep them under control) but with subsidies, well, then there's really nothing at all here. And the "Insurance companies get kicked out of the exchange" thing just guarantees initial prices will be as high, or a little higher, than they are today, which is already ridiculous.

I agree with your general point of there not being a totally clear cut case of either (1) or (2). In the end we're left with estimates and educated guesses.

But I do think you are being overly pessimistic and not really correct about discounting the mechanisms that are put in the bill to achieve some level of price control. Subsidies does f.e. in no way negate market mechanisms of price control. A good that gets more expensive still gets more expensive, subsidized or not (granted depending on how the subsidy is implemented).

For all the reasons I outlined above several times I think that what your pushing is a worst case scenario and not extremely likely. I think it's more likely that the 85% cap in combination with market incentives, the risk of backlash on attempts to game the system and the risk of getting thrown out of the exchange will keep the insurance business somewhat in line.

Once again, the rate of price increase and what price level you start at are two different things. If we can keep the level of price increase lower than without the bill, starting at the same - albeit high - level, then that's (trivially) a good thing in itself.

There are modifications that can be made that would not raise the hackles of Lieberman et al. The most obvious would be to water down the insurance mandate.

I'm not sure this is certain. The mandate - apart from other aspects - is I gather a big reason why the health care providers are on board. Lieberman and many other senators certainly seem willing to listening to the opinion of wealthy businesses.

If there's no reasonable plan at the exchange that costs 2.5% of your income or less, you shouldn't be required to buy a plan, and shouldn't have to pay a penalty for not doing so.

I generally sympathize, but can't see how this will not erode getting to 95% insured given the rest of the bill. That's one of the major goals of health care reform. But I do hope they will make some tweaks in conference, make more people eligable for subsidies...

No, I don't like it much, and you may have a better idea, but as stated, right now, we're forcing people to buy something without controlling the costs. You can't argue with that, that's what this bill does. You buy. They charge whatever they want. You better hope they charge something reasonable, because otherwise you're going to be stuck paying a-la-carte and a 2.5% penalty at the same time.

Above you stated that the 2,5% penalty is presently cheaper than any plan available for most people. That's a major premise of your argument, and i'll take your word for it. But it can then not also be the case that the insurance industry will "get to charge whatever they want" and "people will have to buy it" because you are already claiming that the penalty that would make people buy insurance is already lower than the price of the insurance (if you don't get subsidies). So, taken by themselves your assertions sound reasonable but as a whole the argument is not consistent.

Once again, I think this bill will excert some level of price control through the 85% cap and the threat of being thrown out of the exchanges. Time will tell.

ETA:

I think we're also forgetting about the employer mandate (which AFAIK is still in the bill). Maybe this is the reason why the numbers don't seem to add up about how many more people will be covered. Since the employer mandate establishes strong incentives for employers to cover their employees presumably a lot more people would get covered by their employers with the bill than without - which i guess would account for a lot of the additional 31 M estimated covered.

This is also quite obviously a group of people who stand to gain a lot from the bill, since they will get paid health insurance from their employer while today they have none. And that makes your assertion that after subtracting people making less than 44k (who will be subsidized) and the people who gets covered through their employers (they get it paid) there will still be 30 Million pissed off people without insurance, paying the penalty very dubious.

ETA2: Read up and there does not seem to be a clear employer mandate in the senate bill, here's hoping that gets fixed in conference.

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