Thursday, 17 December 2009

Accentuating the Positive

Following on from our discussion below, John Podesta does a really good job here of setting out what's IN the Senate Health Care bill for progressives. Refreshing after all the talk about what's not in!
1. Largest Expansion Of Coverage Since Medicare’s Creation: Thirty-one million previously uninsured Americans will have insurance.

2. Low/Middle Income Americans Will Not Go Without Coverage: For low-income Americans struggling near the poverty line, the bill represents the largest single expansion of Medicaid since its inception. Combined with subsidies for middle income families, the bill’s provisions will ensure that working class Americans will no longer go without basic health care coverage.

3. Insurance Companies Will Never Be Able to Drop or Deny You Coverage Because You Are Sick: Insurers can no longer deny coverage because of a pre-existing condition. They can’t rescind coverage or impose lifetime or annual limits on care. Significantly, the bill also ends insurer discrimination against women — who currently pay as much as 48% more for coverage than men — and gives them access preventive services with no cost sharing.

4. Lowers Premiums For Families: The Senate bill could lower premiums for the overall population by 8.4%. For the subsidized population, premiums would decrease even more dramatically. According to the CBO, “the amount that subsidized enrollees would pay for non-group coverage would be roughly 56 percent to 59 percent lower, on average than the nongroup premiums charged under current law.”

5. Invests in Keeping People Healthy: The bill creates a Prevention and Public Health Fund to expand and sustain funding for public prevention programs that prevent disease and promote wellness.

6. Insurers Can’t Offer Subprime Health Care: Insurers operating in the individual and small group markets will no longer sell subprime policies that deny coverage when illness strikes and you need it most. Everyone will be offered an essential benefits package of comprehensive benefits.

7. Helps Businesses Afford Coverage: Small employers can take advantage of large risk pools by purchasing coverage through the bill’s state-based exchanges. Employers with no more than 25 employees would receive a tax credit to help them provide coverage to their employees. The bill also establishes a temporary reinsurance program for employers providing coverage to retirees over the age of 55 who are not eligible for Medicare.

8. Improves Medicare: The bill eliminates the waste and fraud in the Medicare system, gets rid of the special subsidy to private insurers participating in Medicare Advantage and extends the life of the Medicare trust fund by 9 years. It also closes the doughnut hole that affected 3.4 seniors enrolled in Medicare Part D in 2008.

9. Reduces The Deficit: Not only would the bill expand coverage to 30 million Americans without adding to the nation debt, it would also reduce the deficit by up to $409 billion over 10 years.

10. Reduces National Health Spending: A CAP-Commonwealth Fund analysis concludes the bill could reduce overall spending by close to $683 billion over 10 years – with the potential to save families $2,500. Even the most conservative government estimates conclude that the bill would reduce national health care expenditures by at least 0.3% by 2019.
If enacted, this would be the most profound structural reform in my lifetime.

If not enacted, I fear we may not see this problem solved in my lifetime.


KathyF said...

If someone announced that Congress were considering a bill to add millions to the Medicaid rolls, liberals would salivate at the opportunity.

And that is exactly what this bill does. Yet the only salivating over at DKos seems to be from anger over the bill.

Confused here.

Taylor_Democrat said...

My thoughts on these points.

1. Most of the 31 million people will have insurance only if they pay for it. With only a $95 penalty for not buying insurance (less that one month's premium), do we really think they will? My guess is that many will still just close their eyes and hope for the best.

2. This is a great change.

3. Insurance companies my not be able to deny/drop people, but they can make it so expensive that you cannot afford it and we are back to the situation in #1. People will choose not to purchase it.

4. Key word is "could". I hope the CBO estimates are correct, but they are just estimates.

5. Fantastic. Like the NHS here trying to get people to quit smoking. We need more of this. We also need to totally change our food/farm policy so we are not forced to eat such unhealthy foods (See the movie Food Inc. if you really want a shock)

6. But what will it cost. Will people (primarily the currently uninsured) be able to afford it? This is the key question on all of the insurance industry regulations. There is little in the legislation to limit what companies can charge.

7. Good stuff. Wish there were more of it.

8. Long overdue. Too bad we could not revoke Medicare Part D and allow Medicare to negotiate drug prices with PHARMA. Now that would have saved billions more.

9. 30 million? (see #1). I hope this will reduce the deficit but all we can do is hope. This is based on CBO estimates, and they cannot see the future.

10. The key word is "could". I hope it does lower spending. The US spends as much at six times what other western countries spend per person on health care. A 0.3% reduction in 10 years will not do much to change this.

See next post for more.

Taylor_Democrat said...

Continued from 1st post.

With these points made, let me turn to the general question of whether this bill represents a fundamental change.

This bill has not changed the basic way that health care is delivered in the US. It will undoubtedly bring more people into the system, but the system has not changed. It still relies on private (profit driven) insurance delivered through employers.

To use a sporting analogy, we have changed the rules a bit and we have brought more people on to the field, but we are still playing the same basic game.

I think many progressives were hoping that President Obama would be a game-changer. I know I did (and still do I would add), but I have not been impressed with his coaching on the health care issue.

I think the reason why progressives became fixated on the public option was because we saw it as a small tear in the playbook -- something that could ultimately lead to a wholesale shredding of the current playbook and the invention of a completely different game.

I know we were correct to see the PO this way because the insurance companies also saw it as such and that is why they fought so hard against it.

In some respects I do think that we are stuck with this crappy Bill and we just have to hold our nose and support it. But, I will not tout this Bill as a great achievement in health care reform. I think we are all just trying to convince ourselves that we did something great (or even good) when we did not.

We did not lay the foundation for health care as a right. Passing a law forcing 30 million people buy private insurance (or face a fine) is not the same as saying “because you were born in this country you have a guaranteed right to health care.” This is not universal health care, not even close.

I know that the watered-down Public Option was no where near universal coverage either, but even on a small scale, it would have fundamentally altered the system, just like Medicare and Social Security did. These were both GOVERNMENT alternatives to their private sector counterparts and they came to be “entitlements” that came with citizenship. An entitlement is much closer to a right than a mandate.

If Roosevelt had followed the current Senate health care logic, he would have pushed for a law mandating that everyone buy a private pension plan from the corrupt banks that were responsible for causing the Great Depression. Had he taken this approach, I do not think Roosevelt would have sat back at the end of it all with a smile on his face and said “We have achieved universal pension coverage.”

Again, this bill does not establish a principal right of health care. What it does do is solidify our reliance on a flawed system of private insurance delivered primarily through employers. Without even the smallest kernel of a government insurance alternative that we could nurture and grow until it actually became a counter balance to private insurance, we will never break out of this flawed system.

So should we now to talk about going back to the drawing board? As I said above, it may in fact be too late. I will just have to hold my nose, cover my eyes and ears, turn my head in the opposite direction and reluctantly support this Bill.

We will all then have to look ourselves in the mirror and know that we failed to do for health care what FDR did for wealth care.

Still waiting...

Taylor Kunkle