Couple of questions for the "kill the bill" folks

[liberalpragmatist]

I see a couple of major arguments about why we should kill the bill and what we should do now which I find holes in. And I'm curious to see if we can get a good discussion going on this.

First, people keep arguing that with the public option and then the Medicare buy-in removed, insurance under the mandate is going to be unaffordable. However neither the public plan in its more recent incarnations, nor the Medicare buy-in, would have done anything to solve this. The weak public plan offered in the House bill, and the opt-out public plan offered in the initial Senate bill, were estimated to only cover a few million people in ten years and would enjoy comparable prices - possibly even slightly higher premiums - than the private insurance companies. Depending on how it was structured, the Medicare buy-in might have offered significantly lower premiums for those 55 and older, but that depended on whether it would be regular Medicare they received or a separate component with its own negotiated rates. And even if it enjoyed regular Medicare rates, everyone under 55 was still going to face a competition mainly between private insurers. So the question is, why "kill the bill" citing cost containment, if the provisions you withdrew your support over, didn't provide cost containment?

Second, I don't understand how people can be so cynical that we'll never fix or expand the bill, while proclaiming in the same breath that we can start all over and redo this either after the midterms or this spring. If Congress is too incompetent to make additions and tweaks to existing legislation, then how confident are you that they'll start over from scratch and magically come up with something vastly better?

UPDATE: Also, on update, I have a third question: what exactly is so onerous about the fine for non-compliance with the individual mandate. It really is more of a "pay-or-play" mechanism on a small scale, similar to the House bill's provisions for employers who either have to cover their workers or pay a special tax.

Basically, on your tax form you would be asked if you have health insurance, then depending on your income bracket you may or may not have to pay a $750 per year tax. Which, btw, is cheaper than many health insurance policies. Nobody is going to jail for refusing to buy health insurance.

[PBS Poll-435]

1. The Internal Revenue Code (IRC) of 1986 is considered the largest tax-reform bill ever

And it is modified every single year.

[NJmaverick]

2. Some excellent and well thought out points pragmatic one

:thumbsup: :thumbsup:

[Armstead]

3. A couple of answers

First of all we donlt see it as "kill the bill." The goal is to start towards real reform, either by improving this bill or taking a time out and then doing it right.


1)Many of us were not enthusiastic about the public option for the reasons you mentioned. It was an effort to compromise from what we reallyy believe should be done, which is opening up Medicare for everyone. But it was at least a possible start to something better. But the leaders in Congress and the White House kept whittling even that away to appease the other side (representatives of Big Insurance) and throwinjg us out in the cold.

2)As it is written, this bill makes it more difficult to fix or expand the bill later on because it forces people to buy private insurance with no options. That further embeds gthe worst of the current system instead of beginning to fix it. This will also turn the public against healthcare reform in the future. All gthey will see is the giovernment intruding into their lives without the compensating benefits.

[Armstead]

5. And on your update

There should be nothing that requires people to buy private insurance. If people don't buy it because they can't afford it, then it is morally wrong to make them pay a fine -- that;s what it is -- because they are not making enough money.

The ONLY justification for a mandate is as part of a public health program with payments based on income.

[SpartanDem]

18. Going by your standard many health care systems are immoral

in Belgium, the Netherlands, Switzerland to name few most people don't get their health care directly form the government, but mandatory regulated private insurance.

[eridani]

20. So, why the hell is a root canal $25 American in the Netherlands?

(That was in 1996--it's probably more now.) Because the government DICTATES the prices of health care and basic insurance packages. Our government is forcing us to buy a really shitty and mostly unregulated product.

[liberalpragmatist]

6. OK, thanks

Here are my responses:

1) If the public option still needed to be "fixed" in the future for it to be effective, then why blow up the bill over its removal right now? There's nothing impossible about passing a public option in the future, since almost everyone expects this will have to be revisited. And yes, you could simply pass a public option, or expand Medicare through reconciliation.

2) The bill establishes that everyone requires health insurance. Yes, it's true that health insurance and health care are not one-to-one correlated, but in general, access to health insurance IS access to health care. Also, there's the example of Massachusetts. MassCare is far from perfect, and its too expensive. But polls show few people want to repeal it - instead the public support is for fixing the cost structure, and Massachusetts is poised now to overhaul their cost structure to shift away from fee-for-service medicine. In other words, enacting MassCare hasn't killed future reform efforts - it is getting people looking towards fixing it more in the future.

[Armstead]

9. I live in Massachusetts

Mandates (imposed under Mitt Romney) have put many people in very financially difficult positions, and rates have not been brought into line. Maybe it'll get fixed, but why impose a similar half-baked plan on the nation?

As for the public option. It could have been expanded later, and I would have been able to accept its loss now IF there were no mandates for private insurance being imposed without one.

[grantcart]

4. below

First - Public Option offered price competition in a monopolistic market place and would have an impact or price, not cost control.

Second - The fundamental problem is that this is a major expansion of government function - expanding health care - but the actual operation of that function is going to be done 100% by private companies. Private companies do not care about public policy they only care about bonuses and return on profit. Further expansion will not help because you will simply be expanding private company malfeasance.

If there had been even a limited public option then your argument would have been valid there would have been a window or portal to expand on, here there is not.

This is not adding a government program this is a marriage. The private companies get the strength of government law to enforce participation in private companies. This administration will get all of the negative actions of private companies as a part of its record. Look at TARP initated under Bush people are pissed off at bonuses that he had nothing to do with. Now the Obama administration will be responsible for the turn down rate of every private company, their premiums and most painful of all their $ 50,000,000 CEO bonuses.

[Armstead]

7. Spot-on answer. You nailed it.

[liberalpragmatist]

8. But again, why not just add Medicare or public option later?

If you concede that even an initial public option would not have done much at the outset and would have needed additional legislation to actually be significant, then what's stopping you from including that as part of the next effort in the first place?

[grantcart]

11. Exactly my point kill this bill and expand Medicare in reconciliation

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=433x64169

Expand medicare - think of the US post office - now think of Medicare offering individual, family and employer options.


Leave private carriers alone - let two completely different systems compete against each other. One supported by the Repbulicans spends 65 cents of every dollar on care and the Democrat plan spends 97% on care.

Let the people choose in the market. The idea is explained in more detail above.

[liberalpragmatist]

13. But why kill the bill then?

Given that most people already have private insurance, why not pass the regulations, the exchanges etc.? How does expanding Medicare through reconciliation require killing everything that's on the table right now?

[grantcart]

17. Because it ties us with an unpopular mandate with no upside

We become the enforcers in forcing the public to purchase product and there is no political benefit.


Why not do the one thing that private insurers fear the most - go into direct competition. Give them all of the freedom to discriminate and give themselves huge bonuses.


If we pass this bill then we will be held politically accountable for every action of the private companies.



Imagine a future press conference:

"Mr. Obama last year CIGNA medical loss ratio was only 67%, 30 points lower than medicare or what Canadian residents pay, and yet Mr. Joseph P Fuckoff was paid over $ 50 million in bonuses and stock options this year alone. Complaints against CIGNA denial of basic coverage is an astonishing 15% of its clients. Exactly how, Mr. President is it reform when industry profits go up, bonuses go up while prices continue to go up and client satisfaction go down?"

[styersc]

10. You are either stoned or a lobbyist for the health insurance co's.

You think that its no big deal that the gov't can require insurance without providing an affordable alternative to leverage the private providers into keeping rates affordable? You don't see that this is a license to allow them to charge us anything they want, under duress?!?!?!?

Additionally, you think that a $750 fine is no big deal. Now it's not enough that I do not have the money to buy insurance and when I do get sick I have to compete with insured people to pay for services out of my pocket that they are getting corporate help to pay for (causing increases in the cost), but now I get to pay a $750 fee for being poor?

Incredible.

[liberalpragmatist]

12. Yes, I'm an insurance company lobbyist

:eyes:

My point is quite simple: why, if every independent estimate did not have a public plan offering lower rates than private insurance does its removal make a difference in insurance company rates?

(And for the record, yes, I did favor a public plan and think Obama erred in not fighting for one, given that it had 56-57 votes - but in its weakened form it really just functioned as one extra regulatory tool and as a place for useful payment reforms, etc., not a huge cost control measure like a Medicare-rates public plan open to everyone would have been.)

Second, if you earn up to 300% of poverty level (Senate bill) or 400% of poverty level (House bill) you will receive subsidies. If you earn more than that but still don't get insurance through work, then depending on how much you earn you are eligible for an exemption.

[Armstead]

14. I'm going to be totally honest about the public option

It was -- in its proposed form -- totally symbolic.

But the symbolism was extremely important because what was originally a "compromise" from advocates of medicare for All (optional or universal) was taken away. That basically said to anyone who was not an insurance lacky "You don't matter." Instead we were told to accept crumbs while the insurance lackeys were given the moon. Kinda made people understandably angry.

But beyond the symbolism, it could have at least been the start of something that could have been built on.

[liberalpragmatist]

19. I agree

And, frankly, that's why I wanted the public plan too and, yes, why I think Obama screwed up by not pushing for it.

But the point I'm trying to make is if it was purely symbolism at that point, and not substantive, and if it needed additional legislation in order to become something significant, then what difference does it make to the CURRENT bill? What's stopping from pushing for a public option later, through reconciliation? Why does establishing a public option require a symbolic, somewhat useless, "beachhead" public option as a prerequisite?

[TheKentuckian]

15. Why would you want to be forced to buy a product

with ZERO price controls and ZERO choice in that for profit product?

At some point the 31 million mantra falls flat.

[WeDidIt]

16. I will refuse to pay for health insurance and I will refuse to pay the $750

So I will go to prison for failing to pay for health insurance.

[Aramchek]

22. no, but you will certainly demonstrate the thickness of your skull

why should you get Healthcare if you are unwilling to pay for Insurance?

would you rather pay the massive taxrates that come with European Health Coverage?

either way, you have to contribute something to get coverage.

[FrenchieCat]

21. The first year, the penalty will be $95.00 for the year.

and yes, you are exactly right....
that at the end of the day,
one would be paying into the system,
so that when they get sick,
the rest of us aren't left with that bill.

There will also be subsidies,
for lower income,
so that in essence, a policy will be less expensive,
than the fine.