Health care under the tree
Ho, ho, ho. The Senate will most likely stuff a health care bill down the chimney by Christmas. Is it a gift to the American people? Or a bag of coal?
Of course, the opinions are wide-ranging, and we’ll get to those shortly. But first, the facts.
The public health insurance option that’s in the House bill is out of the Senate bill. The individual mandate is in both, meaning for the first time in US history, every American would be required to purchase health insurance. Those who don’t would be financially penalized. Other elements of the Senate bill:
Insurers cannot deny coverage based on pre-existing medical conditions.
People who don’t get coverage through work can buy insurance through “exchanges.”
Tax credits for lower income people who get their insurance through an exchange.
Employers that offer health benefits must pay 60% of the cost. The employee portion of the premium cannot exceed 9.8%.
Paying for the plan: Taxes on “Cadillac” health insurance, fees on drug companies and insurers and an increase in the Medicare payroll tax for individuals making more than $200,000 and couples making more than $250,000. Those taxes would start next year, while most of the benefits of the plan wouldn’t take effect until 2014.
Ezra Klein writes for the Washington Post that if you go back and look at President Obama’s campaign promise, this bill is pretty close to the mark:
… there are, to be sure, some differences. The public option did not survive the Senate. The individual mandate, which Obama campaigned against, was added after key members of Congress and the administration realized that the plan wouldn’t function in its absence. Drug reimportation was defeated, and a vague effort to have government pick up some catastrophic costs was never really mentioned.
But the basic structure of the proposal is remarkably similar.
But the Wall Street Journal would like to see the bill shredded into a million tiny pieces:
The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that “reform” has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later…
This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.
New York Times’ liberal economist Paul Krugman says this:
It’s a seriously flawed bill, we’ll spend years if not decades fixing it, but it’s nonetheless a huge step forward.
In other words, doing something is better than doing nothing. You agree or disagree?
See also:
Comparing the House and Senate bills (LA Times)
What does the Senate health care bill do? (Reuters)
Profiles: How might health reform affect you from PBS NewsHour.
Why I still believe in this bill (from an ardent support of the now-vanquished public option).
Ten reasons to kill the Senate bill.
Why the Supreme Court should strike down the individual mandate from Business Insider.
Health care winners and losers (Washington Post).
- Dec 21, 2009 11:12 AM — Scott Jagow
- 12 comments
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Comments (12)
December 21, 2009 11:37 AM PT
Dear Santa Congress, I would like health care reform for Christmas. I don’t like the current system of private insurers. We would like a public system we can turn to if we don’t like the private options. It would be great if you could also do something to keep costs from rising so fast. Thanks!
Signed, Good Voter.Dear Good Voter, My elves and I looked at healthcare. We don’t think a public option is, well, an option. But, what we can do is pass a law that forces you all to buy that private insurance you don’t like. Make sure you buy it because if you don’t the IRS will fine you. Oh, and about keeping costs down? Ho! ho! ho! that’s funny, you’re a hoot!
Merry Christmas!
Sincerely, Santa Congress.
December 21, 2009 2:48 PM PT
Would a mandate on buying health insurance not be a breach of separation of church and state?
December 21, 2009 3:21 PM PT
Not sure exactly what you mean by this. Please explain. What I’m thinking about is how “Individual Mandate” was accepted but “Raising Taxes” is out of the question. In the end, they probably mean the same thing and both will happen!
Scott Jagow: responding to joey | RespondDecember 21, 2009 4:14 PM PT
Joey and Kevin, read the business insider story linked in my post. It talks about how the president has said the individual mandate is not a tax, but in fact, that argument might make it more difficult to defend at the Supreme Court level. It’s pretty interesting.
December 22, 2009 6:58 AM PT
Obama’s done that before - saying something isn’t a tax that actually is. Maybe it wasn’t on taxes, but he did it on something similar.
And then there was the whole “it wasn’t a bow” deal. So he’s not exactly a reputable source in the arena.
On my separation of church and state statement - if my religion doesn’t believe in using modern medicine, then I’m being forced to go against my religion.
December 22, 2009 2:34 PM PT
I’d say no conflict. The mandate is for the insurance, not the actual visit. And I might get off my area of expertise here, but I think other legislation has impeded on religious values in the past. Defense of Marriage Act certainly impedes on religions that endorse polygamy.
December 21, 2009 7:12 PM PT
Thanks for providing the useful links, are all the key details addressed? The Ten Reasons to Kill the Senate Bill seem compelling. Others include:
Prohibiting denial of coverage based on pre-existing conditions does not prevent such conditions from affecting premiums. Nor does it preclude claims from being denied, reduced or factored into your overall costs. The business model of medical insurers has not changed. As Krugman once noted, paying for your health care is a “medical cost” for an insurer. http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/
State based exchanges will continue wide variations in health care as with Medicaid, greater regulatory capture, and greater asymmetries of information than if there were a federal exchange. State insurance commissions protect insurers not consumers. Hospitals and physicians are not compelled to release quality and error data. The complexity is designed to defeat market efficiency not enhance it, just like Medicare part D.
The bill does not comprehensively address the causes of system cost or its lousy performance.
On the other hand, the WSJ editorial is so rabid that perhaps there is something in the detail that makes it worthy of passage?
December 22, 2009 5:04 AM PT
It really isn’t a present if your broke parents have to go buy it. Government! Gimme! Gimme! Gimme!
December 22, 2009 5:40 AM PT
This health care bill may be a bag of coal, but the system we are replacing is also a bag of coal. When the Clinton’s tried to redo it everyone was against it. The difference this time is that a president and a congress were elected by the voters on a platform of reforming it, due to things that have gone terribly wrong with the system.
Those who oppose the reform do not have a plan that fixes all the bad things that caused the nation to vote for reform. Oh, they do offer tort reform as a fix, but we already have tort reform for health care in Texas and it did NOT cut the cost of insurance. What it did do is make hospitals no longer responsible for their mistakes. Like a friend of mine who got a blood clot from her surgery, and got a staph infection from the fix of the clot. The hospital says this is a risk you take with surgery and the insurance should pay. Her insurance refuses to cover the expense of fixing the mistakes, saying the hospital should cover it. Now she, with full health health insurance, owes $150,000 on her surgery.
The issue of health care reform will be with us forever unless the two sides can fix everything that is wrong with the old system in a way that satisfies everyone, but people needing care, providers, and insurers have conflicting interests and the issue can never be resolved in a way that pleases both sides. And both political parties will be doomed to be screaming at each other forever while we the people get more disgusted than ever at our politicians of both parties. This screamfest is proving the Watchtower people to be correct in their teaching about who really runs the political system and both parties.
December 22, 2009 7:45 AM PT
It’s common Christmas occurrence. You asked for that remote control car but instead you got the sweater with the reindeer on it that you can’t wear again until after Thanksgiving next year.
The healthcare bill is kinda like the sweater. It’s a nice gift that will make you feel warm and fuzzy for a few weeks but it’s not really all that useful in the big picture.
December 22, 2009 12:22 PM PT
I suggest everyone in the country, and particularly in Congress and the White House, read David Goldhill’s piece in The Atltantic. The last section “A Way Forward” is in the URL below. I suggest reading the entire article.
http://www.theatlantic.com/doc/200909/health-care/6
Give consumers the ability, financial stability, and motivational structure to make rationale decisions about what care is in their best interest and at what price and we will go a long ways toward solving our problem. Unfortuantely nothing in the current plan is targeted at empowering the consumer.
December 22, 2009 1:47 PM PT
I can’t decide if the healthcare legislation we are going to get is the biggest regressive taxation bill ever passed or the biggest corporate giveaway ever. It’s almost patterned after farm subsidies - except here we are going to pay healthcare companies to not provide better healthcare. As Will Rogers said almost a century ago, America has the best government money can buy!