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A Day Of Uneasy Hope
Mar 21st, 2010 | 26 responses
Now that the passage of the package seems assured I am pondering my own feelings about it.
For many the vote on Health Care Reform today is an easy one to react to. My good friends on the left will watch the vote with varying levels of celebration, a feeling of triumph and optimism for the future. My equally good friends on the right will watch the results with varying levels of dismay, ranging from disappointment to outrage over what they see as a major mistake.
For me, the reaction is not as easily defined. This is not an uncommon situation for me, since I do not strongly fit in either the left or the right and frequently the issues are sharply defined for most.
As most of you already know I do strongly support reforming our health care system. It is clearly broken and if we do not do something to fix it then we are simply heading towards the cliff with our eyes closed. That is not an option.
I like many of the provisions of the package being passed through Congress today. Things like restricting the ability of insurance companies to deny coverage for pre-existing conditions, limiting their ability to cancel when you become ill, placing limits on things like lifetime maximums or annual copayments. I think these are important reforms
I also am pleased to see some effort being made towards fixing the doughnut hole in Medicare as well as improve the system of payments to providers under the program.
I am even supportive of the mandate for individual coverage. I take this position not because I think the government should be in the business of telling people what to do but rather because those without coverage will inevitably fall back on the public system for treatment and it is not fair for them to do so.
So on that level I am hopeful that these elements of the bill will work to improve the current situation.
At the same time there are some serious questions that continue to plague me.
For one, during the discussions with the GOP one of the proposals that the President was increasing funding to investigate fraud. But this was dropped from the final bill. There is also no medical malpractice and/or tort reform contained in the bill. I think if we are truly going to control costs that we need to address all sides of the problem and that includes controlling the cost of malpractice insurance for doctors and hospitals.
As I previously wrote, I am also concerned about some of the specifics of the mandate. For me the basic mandate should be just that, basic. You should be required to have coverage to insure that if you get sick or have an accident that the public system won’t be burdened with your treatment. At the same time, if you want a slightly lower premium in exchange for slightly higher copayment or deductibles that should also be your choice.
But looking at the current plan it seems quite possible that people who currently have basic plans could be forced to upgrade to plans they really do not need. If we are looking to control costs and reform things, it hardly seems fair to make a middle class individual or a family pay higher premiums.
To be fair we don’t know for sure what the costs will be, but as I discussed in an earlier post, the estimates from the CBO suggest that many of us could see our costs rise. It is possible that these costs could be offset by the proposed subsidies, but I have to wonder if it would be less expensive to simply skip the subsidy part and allow the more basic plans.
I’m also concerned about the impact of the Cadillac tax, which would be a tax on high end insurance plans. On the one hand the law seems to require people to purchase more extensive (and more expensive) plans while on the other hand it is placing taxes on some of those plans.
Even worse, as I also discussed in a prior post, there seems to be a two tiered system where a plan offered through a union employer is exempted until 2018 while one offered through a non union employer would seem to be subject to the tax. This does not seem fair to me. If the general argument is those with more expensive plans should have to pay then everyone should have to pay, or they need to find a new option.
Finally there is the general issue of cost. I know that the CBO says it will save money in the long term and I certainly hope that they are correct. But for all the ‘non partisan’ labels you apply, we all know that the CBO is going to lean a little to the party in power and that like any employee they are going to tend to give the boss the answer he or she wants.
This is not to suggest fraud or any outright dishonesty, simply that there is no way to be sure what will happen in the future and that it would be foolish to think that given several possible options as to how to run the numbers that the CBO is going to side with the party in power (and would do the same if the GOP were in charge).
Indeed if you look at most of the prior cost estimates on things ranging from Medicare to prescription drugs, tax cuts, etc the costs were often badly underestimated.
Of course we may not know for some time how these proposals will pan out since many of them do not take effect for years (mostly either in 2014 or 2018). I believe most of the things I like go into effect more or less immediately and so that may leave us time to look at the things I am worried about.
In addition we have no idea how the various court challenges will pan out (it seems probable that at least the mandate portion will be challenged by several states and there is also talk of a challenge on the delay in the Cadillac tax).
So I like the general outlines of the package being passed today but I have serious concerns about unintended consequences as well as the lack of what I see as some key elements. Obviously we can try to fix those problems in the future, but that does not entirely assuage my concerns.
So I am hopeful that the good aspects of the bill will work to have the desired effects. At the same time I maintain a level of unease about those I am not sure about. Nobody will be happier than me if those concerns are unwarranted, but I suspect this will be far from the end of the legislation.
26 Responses to “A Day Of Uneasy Hope”
It will be a fight to fix the bill after it is passed. Reps won't stop trying to kill anything Dems attempt to fix…and then use it against them come Nov.
We might not see any real fixes until after Nov.
We won't see any changes until after November. But we will likely see changes following that, as problems emerge.
Well-said, by the way Patrick. I'm obviously more sanguine about the bill than you but I certainly have my concerns. The first step was the biggest, however. It's the principle that sets in motion everything else.
I have been paying med insurance for 20 years, then all of a sudden unicare says Illinois is not profitable and pulled out leaveing us to bluecross. Then bluecross says we need temporary insurance, and please send 300 dollars to start this temporary stuff leaving me to conclude they are going to increase premiums at their discretion. Whatever, we need reform and right or wrong I am glad this bill passed.
“I like many of the provisions of the package being passed through Congress today. Things like restricting the ability of insurance companies to deny coverage for pre-existing conditions, limiting their ability to cancel when you become ill, placing limits on things like lifetime maximums or annual copayments. I think these are important reforms”
What I don't think most people realize is that this is the cause of your other concerns. I was at a party last week talking to a woman who was on chemotherapy. Often, we hear about a particular drug costing $100,000 a year, what we don't hear is that these people are on several.
In her case, the drugs she was taking cost $5,000 a week. She said she was one of the cheap ones and that other people she saw at the cancer center drugs were costing $50,000 a week!
Well, who's going to pay for that? A bunch of people with $10,000 deductibles? And the worst part of it is that longevity rates for people that have cancer are not much better than they were when only surgery and radiation therapy was available. Often, one type of cancer is put into remission, but a different one arrives to kill the patient.
This is only a first step, anyway. Ending the insurance model for comprehensive care is the final goal.
There is plenty of uncertainty about this, not limited to fiscal problems that are denied by proponents (and believed by fools). This is going to unleash all kinds of Change [tm] in state-federal relations (making them more testy) as well as in the insurance market (rates are going to keep rising and employers can now dump their plans if they wish). The individual markets and high risk pools likely will make Anthem benign.
You are right about that. This country was built on cheap labor, just like China is building now. The fellows that worked on the Hoover Dam and had their legs crushed were out of luck, tragedy, what a shame, but we didn't have Worker's Comp then, same as the Chinese don't pay the workers or family members of the coal miners that are maimed or killed in one of the regular collapses.
It's going to be interesting to see how this shakes out.
The enemy of my enemy is my friend. I like this bill exactly as much as my insurance company, Anthem (spit, stomp, retch, curse) hates the bill. They lavishly fertilized the astroturf teabaggers and put that pathetic whining woman on TV fretting in her oh so afraid, sad sack voice about the bill “America can't afford to pay”. This bill won't kill them now, but I hope it does eventually. You think it's freedom to give money every month to a company you totally despise?
“This country was built on cheap labor …”
I grew up in California, where the idea of a “safety net” [gasp] on the Golden Gate Bridge was some kind of Commie radical stunt. (Accounts of the ironworkers on the classic skyscrapers such as the Empire State Building in NYC had them out in all kinds of weather, with the unemployed lined from the building on the streets below; when a worker fell, the line advanced by one.) I've also thought about the railroads when traveling between the West Coast and the East where I lived for the recent decade or so.
The Chinese? [chuckle] The Chinese are probably responsible for some of the immigration we are getting from Latin America, because their jobs south of us were outsourced, too, to China.
Green Dreams, you are a militant advocate and defender of “single-payer” (to the point of irrationality as well as ugly behavior sometimes), and all I can say is that you have to try to see it not only as Dennis Kucinich (hold nose, vote “aye”) sees it, but Bernie Sanders* as well. It's a turn of the incrementalist ratchet toward federal health care for everyone, no doubt about it. It's a win, even if you hate the details.
You're like Melvin Konner, back in the 1990s. “Shoveling money into the furnaces of corporate greed.”
You'll have to settle for reading his criticism of ClintonCare and arguing for “single-payer” as he did then.
http://www.amazon.com/Dear-America-Concerned-Do…
“Incidentally, I did not choose the title of this book, the publisher did, and I have never liked it. My preferred title was 'Real Health Reform: The Single-Payer Solution to America's Health Care Crisis.'”
http://www.melvinkonner.com/index.php?option=co…
* Sanders is onto something with getting health clinics in this legislation. These can be set up in not only rural areas, but also in inner cities, the “pincer” laying the groundwork for advance into the suburbs later.
Well, I'm mostly on the left, but I don't feel celebratory or victorious. I think the people in Washington should be ashamed and sobered by just how difficult it's been to pass even this meager bit of HCR, which of course is something most of them have nothing at stake in – barring politics alone. And it should serve as a reality check for those in the ideologically obsessed portion of the electorate who still look at it as only another horse race. Our enemies continue to be greed, ignorance, and apathy. This passage will change none of that. We need to set our sights higher. Hopefully more changes will be made in this HCR package as time goes on… and not too much time either. I watched my own health insurance premiums go steadily into the stratosphere over the last few years, until I had to switch to a fairly useless (on a practical level) very high deductible policy that seems more like extortion than it does insurance.
Well J Spencer it seems we aren't that far apart at least in our hopes that things improve for the average guy. I'm not quite as angry at the health insurance industry but I'm certainly no fan.
As I've said before, my concern is that this reform may increase those premiums for many of us and with the subsides not going into effect until 2014 that could leave us in a lurch. I would have liked to at least see most or all of the bill go into effect now, rather than in parts.
Once again, we see a unwanted and unfunded mandate from Washington, promising to deliver the impossible for nothing, while actually laying a huge burden at the feet of our children and grandchildren.
Well, I take part of that back, It is at our feet, too.
The CBO score is just political hookem, a false number created by playing financial and budgetary tricks that if done in the private sector would be called by their rightful name – fraud.
Todays for profit health care insurance is the very face and definition of fraud.
I also have mixed feelings about this bill. I would have preferred a far cheaper bill, but the only way to get there was with single-payer and there are far too few people who could stomach that path. I also would have preferred a bill that was implemented more quickly. I have other provisions I cannot support. But this bill does begin to ensure that our citizens have access to health care, even in a convoluted fashion. By now, however, I am convinced that not passing this bill would mean another 20 years with no change, and no political will to tackle the problem. Not passing the bill would also mean that the centrists lost and the extreme wings of both parties stopped progress. We cannot afford that to happen, so we must hold our noses and vote aye.
“you are a militant advocate and defender of “single-payer” (to the point of irrationality as well as ugly behavior sometimes), “
No more militant than women are hysterical, bud. I'm not taking up arms, and have no need to “defend” single payer. The rest of the world uses that system, it makes perfect sense, and it costs way less. About half. It's not irrational at all and I know more about it than you. As for “ugly behavior,” I got a really good laugh at that one. From you. Good one.
My hope is that as unforeseen problems arise, fixes can be done. To do nothing was not an option.We are a society of fluidity of our laws. That things got so overheated in this discussion can be laid on the shoulders of the Republicans and Faux News who both tossed rationality out the window between Obama's election and his Inauguration. It is unforgivable what the Repubs have encouraged in this debate. Healing will take a long time and the sad thing is, it never had to be like this.
And I have some confidence in the American people that they are not all out in right field like the Tea Partiers, Palin and Bachman. The fearmongering will be falling on deaf ears as I truly hope the bulk of Americans have more sense than that. I think we are a nation of middle of the road people and that will show itself in the November elections. And the Dems better start to sell themselves much better than in the last year!!
I am no left-winger, and I have a horrible sense of dread about this bill. That being said, I am pleased at least that some attempt at change, however abysmal, has been made. That being said, until the federal government stops every last cent to clinics and insurance plans that cover the slaughter of unborn babies, I shall not be comfortable. The Stupak Amendment goes nowhere near far enough to make me comfortable.
“No more militant than women are hysterical, bud.”
You're wrong again.
“It's not irrational at all and I know more about it than you.”
You've demonstrated the opposite numerous times, including making false and misleading claims.
Even before I qualified for Medicare I knew more than you (the truth, at least; there's no limit to what others can substitute) and with additional experience, all I can do is scoff. You go on believing it's wonderful while those of us who have to live it talk to our doctors about having to find someone else, if we can. Just try to keep a lid on tantrums whenever anyone [gasp] criticizes it.
“Once again, we see a unwanted and unfunded mandate from Washington, promising to deliver the impossible for nothing, while actually laying a huge burden at the feet of our children and grandchildren.”
Lost in the jubilation, unfortunately. Not so much about the bill, though there's a great deal of superficial elation about that right now. It's about the Dems finally managing to get off the ground and get moving again, past the GOP opposition. Were the celebrants honest, they'd admit to more relief about recovery and restarting “progress” than joy about this greatly-shrunken health care legislation.
(Never mind that shrinking this federal takeover incrementalist legislation was the only way to recover and go on.)
Lots of good feedback gang.
As I said there are lots of things I like about this bill but I also have concerns.
I'm not in too different a boat from 'Bob' (as discussed in my post on the Bronze Plan).
While I do not expect it to happen I could find myself in a position where on the one hand I was paying higher taxes to help those who could not purchase health care right now and on the other hand find myself unable to afford coverage because of increasing premiums (since the subsidies don't go into effect until 2014).
Indeed even then I might not qualify, since the subsidies are based (I think) on gross income and so I could in theory make too much for subsidies but between taxes and higher premiums that I'd be w/o coverage for the first time ever.
Of course this is the doomsday scenario and I doubt it will happen. But at the same time there is a much better chance of it happening to someone in my (or Bob's) position than for someone who works for an employer or doesn't have to pay income taxes for whatever reason (income level, type of income, etc)
Patrick, the media are confident enough they have already issued post-mortem and related stories, and as I was looking over various stories I saw this, which may address some of the questions or fears you have.
“some clarity”
http://www.nytimes.com/2010/03/22/your-money/he…
Thanks for the link DLS
As I said, I don't really expect the worst case scenario to pan out, but I can see where this is going to be an issue of concern for people like me.
I am quite sure there will be fixes in the future
A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largess from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship. The average age of the world's greatest civilizations has been 200 years.
Great nations rise and fall. The people go from bondage to spiritual truth, to great courage, from courage to liberty, from liberty to abundance, from abundance to selfishness, from selfishness to complacency, from complacency to apathy, from apathy to dependence, from dependence back again to bondage.
No problem, Patrick.
I have my own concerns — on an individual plan currently out of state (waiting for underwriting to complete in the state I'm currently in, to be laughed at officially and be referred to the high-risk plan, which is how the game works here) while also waiting for details of the legislation to come through, in case I get dumped on Medicare (if the insurers can get away with this, as employers have done when their retirees qualify), and lose access and quality of care due to that. (It's a common problem nation-wide and especially bad here where access is notoriously poor due to low compensation to begin with. My doctors have been frank with me already about trading decent insurance for Medicare and what it means with them as well as finding other providers as needed.)
Everyone who doesn't have a special health care insurance or access story of their own to tell no doubt knows somebody who does have one to tell.
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