Premiums Will Go Up. But You'll Probably Pay Less

As we edge (creep, crawl, inch, take baby steps - insert your own word for mollases like progress) closer and closer to passing comprehensive health insurance reform, those of us who support the bills have been hoping that one effect they would have would be to lower the out of pocket costs of buying healthcare.

Well it turns out that most people's day to day costs WILL in fact be lower (phew), but that premiums themselves are likely to go up slightly. How can this be so?

According to CBO, average premiums in the individual market would increase 10 to 13 percent because of provisions in the Senate health care bill, but, crucially, most people (about 57 percent) would actually find themselves paying significantly less money for insurance, thanks to federal subsidies for low- and middle-class consumers, than they would under current law.

Furthermore:

Separately, for those who have high-end employer-provided insurance, CBO finds that a new excise tax on high-end policies will have disparate effects on premiums. Those who keep their "cadillac" insurance would end up paying higher premiums than they do today, and those who choose instead to choose less luxurious policies would pay lower premiums.

"[P]eople who remained in high-premium plans would pay higher premiums under the excise tax than under current law, and people who shifted to lower-premium plans would pay lower premiums under the excise tax than under current law," the report reads.

But CBO also finds that on average, people who have plans susceptible to the 40-percent tax will ultimately be paying less in premiums than they would without health care reform: "On net, CBO and JCT estimate that the excise tax and the resulting behavioral changes...would reduce average premiums among the 19 percent of policies affected by the tax by about 9 percent to 12 percent in 2016."

Senator Evan Bayh, who had requested the CBO report in the first place out of concern that healthcare costs might go up under the proposed Senate legislation, was encouraged by the findings:

This report alleviates a major concern that has been raised--that insurance costs will go up across the board as a result of this legislation.

"This study indicates that for most Americans, the bill will have a modestly positive impact on their premium costs. For the remainder, more will see their costs go down than up. Hopefully, we can continue to focus the Senate debate on additional ways to make health insurance even more affordable for all Americans."

Yet another non-failure... Asia trip success

While we're on the subject of things that are working better than people say, it's worth pointing out that apparently Barack Obama's trip to Asia- though a miserable failure in the "not generating stories critical of Presidential bowing" competition - seems to have been rather successful in the lesser known "winning important concessions and agreement with major world powers" stakes.

James Fallows points out that following Obama's trip, China has now agreed to:

• Reduce greenhouse gases
• Criticising the Iranian weapons program
• Considering removal of weapons that threaten Taiwan
• Preparing to end the rigid currency control that has been harmful to the US

Fallows has lots more fascinating details of the trip on his blog. He concludes:

To sum it up: the Administration may or may not end up getting what it hoped for from this trip to Asia, especially China. But its members had a clearer idea of what they were after, how they could get it, and how to represent American interests and values than most coverage gave them credit for. The words that stick with me through this whole episode are those in the subtitle of Tish Durkin's piece last week: "Even through a veil of censorship and propaganda, the Chinese people managed a clearer view of Obama's visit than the US media did."

Experts Agree: "Without the Stimulus It Would Have Been Worse"

One of the really hard things about governing during a time of economic downturn is that people are understandably uninterested in being told taht things are bad, but they could have been so much worse.

Heck, it's an argument I hate making. People that I love are hurting, badly, in this economy - people that I love are worse off financially than they have ever been in their lives. So it's not very comforting to know that, while bad, things were very nearly much, much worse.

Uncomforting though this truth may be, however... it is true.

Mark Zandi, chief economist of Moody's Economy.com and an occasional adviser to lawmakers from both parties, said, "[T]he stimulus is doing what it was supposed to do -- it is contributing to ending the recession." Zandi added that without the recovery bill, the "G.D.P. would still be negative and unemployment would be firmly over 11 percent. And there are a little over 1.1 million more jobs out there as of October than would have been out there without the stimulus."

For example, remember that a great deal of the stimulus money went directly to states to fund programs that they would have otherwise had to cut because of the downturn in their tax revenues.

"Programs" sound clinical, though - the types of things states were need to cut back on were teachers, firefighters and police. Let's say your small town loses one firefighter, one teacher, and one police officer. OK, now you've got three peopele out of work - that's three people who won't be buying much stuff in your town now. Direct effect = bad.

But the loss of that teacher means slightly larger class sizes for all the other kids. There's a proven correlation between class sizes and student performance - that means an entire school's worth of kids are slightly worse off in ways that will harm their future.

One fewer police officer on the street means the PD needs to reorganise their shifts - slightly more of each officer's time is now focussed on emergency callouts, for instance, and slightly less on patroling. Areas that aren't patrolled can become more welcoming for a small number of criminal elements.

Let's not even talk about what happens if the fire department is down one many (possible consequences = detroyed property and lost lives).

Long term indirect effects = even worse.

A LOT of money was spent by the government trying to forestall the worst effects of the recession. But in the long run, in my view, this was all DEFICIT busting expenditure. It costs a lot more to fix a community once it's broken than it does to keep it from breaking in the first place. The President wasn't free to spend as much money as he would have liked in the stimulus package. But there simply is NOT ARGUMENT whatsoever based on fact that says the stimulus didn't save jobs - it paid salaries of people who would otherwise have been fired.

Unfortunately, an awful lot of people who deserve a hell of a lot better got badly burned anyway. It's heartbreaking.

Things I'm Thankful For...

In no particular order.

1) My health.
2) Speaking of which, the NHS. Not only do they keep me healthy, they have transformed my life.
3) My family. Most of whom are across an ocean. Miss you!
4) Feeling proud to be an American.
5)Pret a Manger lattes. One of life's daily pleasures.
6) My husband. Another of life's daily pleasures
7) You Know Who.
8) You Know Who's sense of humor. On turkey pardoning: "There are days when I remember why I ran for this office. And then there are days like today, when I pardon a turkey and send it to Disneyland."
9) Michelle. Just because. You've gotta love Michelle.
10) Democrats Abroad. Registering overseas voters, lobbying for American's abroad, getting out the vote, allowing us to be politically active though far from home. They are a lifesaver. Speaking of which...
11) Being Vice Chair of Democrats Abroad, UK. Although some folks felt more inclined to offer me sympathy than congratulations when I was elected, I still consider it a great honor to represent the wonderful people in our membership.
12) Matthew Yglesias.
13) Andrew Sullivan.
14) Josh Marshall. Without these three men, my life would be so much duller and less informed!
15) New Media. I blog, I tweet, I Facebook. And I never thought I would love it... but I do. Thanks for reading.
16) Moving Past 9/11. It felt like the world would end that day. It didn't.
17) Discovering New Places. This year, Asturias in Northern Spain was a revelation.
18) Work. Difficult, interesting, challenging, inspiring projects - that they pay me for! My first year of self employment is turning out to be profitable in all sorts of ways. (Knock on wood.)
19) The London 2012 Olympic Games. Providing much of the afformentioned interesting work. And transforming my neighborhood - hurray for East London!
20) The New Yorker. Still the best magazine in the world, and the only one that can make me read about subject I am otherwise not at all interested in.
21) London.
22) Lovefilm. A constant supply of fresh DVDs has saved us from the rubbish TV options.
23) Comprehensive Healthcare Reform being passed out of all 3 House Committees.
24) Comprehensive Healthcare Reform being passed out of both Senate Committees.
25) Comprehensive Healthcare Reform being passed by the full House.
26) Comprehensive Healthcare Reform arriving on the floor of the Senate.
27) The possibility that comprehensive Healthcare Reform might pass the Senate by Christmas.
28) The most progressive Presidential budget in generations.
29) The Stimulus.
30) The stimulus starting to work.
31) Live chat on Facebook. And how it let's me keep in touch with folks.
32) Hope. I've still got it.

Don't Ask Don't Tell to be repealled next year?

Congressman Barney Frank has stated that the repeal (at long last) of the military's Don't Ask Don't Tell policy will be included in next year's Military Authorization Act.

This is excellent news. Frank is not known for beating around the bush, so when he says something he believes it.

But the bit that made me really believe this would happen was these lovely words:

Anecdotally, Frank recalled an incident earlier this year when Defense secretary Robert Gates made a statement to reporters suggesting that repeal was still an open question.

“There was a point where Gates said, ‘If we repeal don’t ask, don’t tell,’ and the next day he said, 'When we repeal don’t ask, don’t tell,’” said Frank. “That’s because Rahm called him up. The White House has been consistently committed.”

Every soldier who serves with honor deserve the right to live his or her life with honor - asking our men and women in uniform to sneak around and hide the most basic facts about themselves is just... tawdry. It's not worthy of the dignity that should come with service.

My First Blog Post EVER! Those were the days...

Wow. On a whim, I thought I would check to see if my short-lived first blog - the one I started way back in 2003 and used for a combination of political and personal perspectives for a very short period of time until... like most blogs... I trailed off.

Well it IS still up there, and reading it again it's funny to see how much my perspective has remained pretty consistent across time.

My very first blog post ever was inspired by W's visit to Britain at the time, when he was give the Royal treatment (literally) but kept far away from the many thousands of protestors.

So here's how I got started, on day one of My Life as Blogger:

So I live here in London, and I have a lot of friends back home in Washington who have been asking me whether I was at the demonstrations against Bush's state visit. I wasn't. But here's what I think of the visit itself and the protest.

The visit was a stupid idea - no American President has ever before been honoured with a state visit, hosted by the queen, and the time to do this would be when there was a genuine spirit of togetherness and pride in the "special relationship" that these two countries have. From what I have seen back home, Americans are feeling especially warm towards Britain at the moment and Tony Blair is becoming a sort of national hero. That's great - I'm glad that Americans are warming up to a leader who is anti-death penalty, staunchly pro-national health care, willing to invest huge amount of money in education (and not just create an unfunded mandate) and public services. I'm a little surprised, but I'm glad...

Deep thought

These guys don't seem real respectful of the members of the Women's Caucus.

Weird.



On a totally unrelated point, they had a lot of fun on the same day denying abortion rigths to an awful lot of women.

Coincidence, I'm sure, and not at all reflective of any innate misogyny. These guys are famous for their sensitivity to women, after all.

The Abortion Compromise

When I was at college in Washington, DC one of the biggest moments there happened in late January each year. That was the annual anniversary of the Supreme Court’s Roe Versus Wade decision, and for a few days my city would be overtaken by tens of thousands of Right to Life protestors.

My friends and I would always avoid the National Mall during these days – the posters of aborted foetuses were annoying, but even more so the confused mobs of Midwesterners in their matching t-shirts who would block the escalators with their out-of-towner refusals to “stand right, walk left.”

But I DID go every year to the local Women’s Health Clinic on the day before the march, to link arms with fellow students from our local Students for Choice chapter and form a human barrier as pro-lifers made a concerted effort to enter and shut down the building.

It was ritualistic rather than violent, and fortunately our organisers were experienced and professional – they knew how to keep temperatures cool even in a pretty heated environment, and they made sure all stayed focussed on our core mission: keep the clinic open.

The Women’s Health Clinic was not an abortion factory – the vast majority of their services were related to birth control, STD testing and prenatal care. In reality, the clinic would routinely encourage patients not to make appointments on the protest days – it was traumatic enough for women who were dealing with a pregnancy (wanted or unwanted) without having to wade past an angry army calling them murderers. So the very few patients who did come in on the day were typically drop-ins – women who had not phoned ahead, but made a spur of the moment decision to get tested or seek family planning. But keeping the clinic open was a point of principle and pride for us.

The pro-life people I faced off with, even when they were doing their best to push through our linked arms, didn’t strike me as bad people. They were Christians mostly, and when not shouting names at me, they seemed pleasant enough to each other. I watched them serving each other coffee from thermoses, sharing a joke. Once an older woman fell ill and her friend politely chastised her for not taking her pills. Then the both lay down on the pavement until the police arrested them and carried them away.

But there were one or two unpleasant incidents. One time, a middle aged woman who had been face to face with me on the line for some time, started shouting, “Are you Jewish? Are you Jewish?” right in my face. We’d been instructed not to engage with the protesters, but in this case I was shocked into a response. “No, actually. I’m Episcopalian.”
“Because the Jewish faith permits the murder of babies!” she shouted, apparently unwilling to let go of her script. Or perhaps she just felt strongly that the situation could be improved with some arbitrary, out of context anti-Semitism.

Whatever.

Why Am I Telling You All of This?

This is all by way of somewhat proving my pro-choice bona fides. Because the pro-choice movement just faced in some its biggest setback for decades. And it’s something I’m going to reluctantly support.

I am referring, of course, to the compromise that was agreed in the House’s Health Insurance Reform bill. Faced with a rebellion from pro-life Democrats in her own caucus, Nancy Pelosi agreed to allow an amendment to the bill that would ban abortion provision under the publicly managed health care plan. So far this was pretty much what I was expecting, and an agreement that for political expediency (the ugliest but most unavoidable of excuses) I was prepared to live with.

What came as a shock to me – and apparently also to a large number people in the pro-choice part of Pelosi’s caucus – was the additional provision that would also forbid those who receive health care subsidies from purchasing any plan that also covers abortion.

This is worse than it sounds. Of course, the intention here is to avoid using government money in any way to directly pay for abortion services. I fundamentally disagree with this judgement (if a woman needs a medical service, she needs it regardless of who pays) but I CAN understand the logic of it, and on a subject where so many people so passionately disagree – where they not only disagree but think those who think otherwise are condoning murder – it’s not insane to say that there’s something inappropriate about asking those folks to spend their tax dollars on a service the consider morally abhorrent.

(As an aside, I can’t help but wish these people had been equally respectful of my pretty similar beliefs about the Iraq war – but... well...)

However, the compromise agreed doesn’t just affect the specific use of federal tax dollars – the ban on use of Abortion-inclusive services for all plans made available to women who receive subsidies is likely to have the obvious consequence that most private sector plans will stop including the service altogether. After all, the insurance companies – for all their kicking and screaming – are perfectly aware that this bill represents a significant new customer base for them. If the government says they need to cut abortion from their plans to get these new customers, I’m sure they’ll be happy to oblige – and it’s easiest just to trim it from all the basic packages.

So why am I still supporting the bill even after choking down this bitter pill?

Simple – women’s health includes more than the rare and declining cases where she might need an abortion.

I am lucky enough never to have had an unwanted pregnancy. But I sure do need a regular cervical exam, I’ll be needing breast cancer screenings pretty soon, I’ve got chronic trouble with my lower back (much better at the moment, thanks for asking) and if I break a leg tomorrow I sure don’t want to worry whether my insurance will cover me. Fortunately, I live in England. But somehow I don’t think that’s going to be a workable solution for the 40 odd million uninsured right now.
Most women will never need an abortion in their lifetimes. With good family planning services we can bring down this number even further – and we should. But every woman needs, and deserves quality, affordable health care.

If necessary I will stand with linked arms one more time to stop the right from shutting us down.

The Berlin Wall and Health Insurance Reform

This weekend I was in Berlin for a Democrats Abroad regional meeting which was held (only semi-coincidentally) on the same weekend that the city is celebrating the 20 year anniversary of the fall of the wall.

Meanwhile, in the US Congress, the House narrowly passed its version of Health Insurance reform – after an uncomfortable compromise with the Anti-Abortion faction with the Party.

Both events, the historic and the contemporary, are likely to profoundly shape the respective countries for years to come.

Watching again on video the images – so often repeated, but never stale – of East Germans streaming through the Brandenburg Gate, climbing over the wall, taking pickaxes and hammers to the 10 feet high concrete... who could fail to be moved.

Meanwhile, only a couple of days ago in the US Congress, furious right wingers took over the halls of Congress bearing despicable images of Dachau victims, with text explicitly comparing President Obama’s desire to provide minimal health protections to all America’s citizens with the Nazi’s determined effort to slaughter a large number of theirs. The juxtaposition of these images with those from Berlin made me wonder if these radical right wingers even understand the meaning of the Freedom that they claim to be fighting for. The freedom that those ecstatic Germans peaceful won for themselves 20 years ago.

After all, ugly propaganda and politically expedient lies were more or less exactly what they were fleeing. And of course they were not fleeing the hell of a totalitarian state for the right to go bankrupt for lack of sufficient health insurance.

It may sound absurd to say that - but that is, quite literally, the argument that the right has always made about any attempt to improve the availability of health care for Americans. Listen to Ronald Reagan telling us how Medicare expansion will mean the end of a free America.

But the people who peacefully revolted in Germany 20 years ago didn’t see it that way.

Reunification for them didn’t mean the right to be “free” of all government attempts to improve their lives. Indeed, East Germany and its citizens received mass quantities of direct subsidies from the West for decades – and until this day. The citizens of the West made a collective decision that they were willing to make a massive investment of their taxes in support of their strongly held value that the people of the East should be offered a higher standard of living.

And of course, West Germany did also have high quality, near universal health care for all its citizens. If this had not been the case, I doubt very much if the newly liberated East Germans would have very excited to be congratulated by the Right for entering a country in which they would be free of the totalitarian free health care they had been burdened with all these years. To the extent that people in the former Soviet bloc had objections to nationalised health care it was because they wanted MORE OF IT – a better managed system that would provide more drugs and services. Not because they wanted to pay twice as much on the private market as what they would theoretically be paying in taxes.

Would they have chosen free health care over a free Democracy? Who knows. I wouldn’t. But fortunately, that is not the choice we are presented with here.

In a free society, free citizens can decide to improve the way that important things such as health care are run. They can chose to spend more in taxation, or to spend the same amount overall but reallocate how it is spent, or to intervene in the free market when it fails the public good. Free citizens in a free society can choose to punish their leaders if they don’t like how they manage this.

With health insurance reform passed through the House, all eyes will now be on the Senate to see if they can pass a similarly strong package. If they do, we’ll still need to await reconciliation of the two approved bills, and passage of the final package before the President can sign something into law.

But when he does, that will be a great day. For freedom.

Consider Faster

You can tell a lot about a man from his Facebook Feed.

Give em Hell, Harry!

I've just had an e-mail from Move On reminding me that Senate Majority Leader Harry Reid:

has been under intense pressure to drop the public health insurance option.

But on Monday he defied insurance lobbyists, political pundits, and conservatives of both parties by announcing that he'll include a public option in the Senate floor bill.

That's the kind of courageous leadership we need for victory on health care. But the fight's not over yet: Sen. Reid is still under fire from conservatives, including some in his own party, who will stop at nothing to kill the public option.

Move On is asking people to sign a petition in support of Harry's efforts - I've just done so myself. So should you.

But - there is a bigger issue here. Harry Reid is facing a brutal re-election fight in Nevada, and if it were held today... he would lose.

President Obama asked him to make health care a number one priority, and to negotiate an incredibly difficult legislative process, putting him at the center of a political firestorm, just when he is most threatened. You may remember that the Democrats' last Leader in the Senate, Tom Daschle, lost a brutal election fight after Republicans put him on a hit list - they knew that taking down our leader would weaken the Party, and it did.

We can't let it happen again. Harry Reid has put his neck on the line to deliver the President's Health Care Reform - those of us who support it should back him in his Nevada fight as well. I'll talk to you soon about some ways we can all help, but in the meantime - here's a link to Harry's campaign donation page. Chip in what you can (I'm thinking $51 would be a good amount for Americans abroad as the unofficial 51st state).

Presidential Basketball

Personally I don't care a fig whether or not women are to be found on the President's basketball court.

Well, actually - I do a little bit. President Obama is, by all accounts, a really good basketball player. As a non-sporty person myself, I would hate to see, for example, Christina Romer taking time out from her important work saving the US economy to learn how to serve as Presidential point guard. Or, do we imagine that the country might be better off in some inexplicable way if the President would recruit in some WNBA stars to play with?

Obama has signed legislation to guarantee women the right to sue for equal pay. He has doubled the number of women on the Supreme Court (by adding 1. Sigh). He has appointed a strong female Secretary of State. And he is agressively pursuing health care reform that would hugely benefit woman and families. The female Speaker of the House is one of his closest Congressional allies, and he happens to be married to a whip-smart, successful woman and to be raising two confident girls.

Let the guy play b-ball with some friends, for heaven sake. Watching Melody Barnes panting for breath as she darts around after an orange rubber ball wouldn't really seem like much a victory for feminism, to me.

Harry Reid, The Opt Out Public Option, and Joe Lieberman

Senate Majority Leader Harry Reid - who by the way has just about the toughest job in Washington right now, and is facing a vicious re-election battle at the same time, poor guy - has announced that he will bring to the floor of the Senate a health reform bill that will include a version of the "public option." Specifically the opt out public option. Any questions?

Opt out what?

The public option, as you probably know already, refers to the opportunity of choosing to purchase health insurance that is government managed. Under most versions of the bill, including the one Reid is likely to propose, the public option would only be made available to a small number of people - specifically those who do not have or who lose their employer provided health insurance.

It would be not for profit, but is not intended to lose money - in face most estimates say it would reduce the government's health care expenditure. These consumers will have the option of chosing from a range of health insurance options across a national exchange, most of which would be privately managed for-profit alternatives, but one of which would be public.

The what public option?

Opt out. The opt out version of the public option means that all states will be automatically enrolled, allowing them to offer the public option in their exchange. But some people (Republicans, mainly, but some nervous Democrats as well) are making a big fuss about their preference for removing the public option as a choice.

Under the plan now proposed, any state that for whatever reason doesn't want to offer this option can choose not to offer it. States will be automatically IN the program, in other words, but if they don't want to offer people in their state the alternative of purchasing health care in this way, then they can choose to prevent people from doing buying it.

Why would they do this?

Beats the heck out of me. But then I'm not the one who's going around complaining about the supposed budget busting effects of this privision, which the CBO and almost all experts agree would actually REDUCE the cost of health care and the Federal Government's liabilities in this area.

Who is doing that?

Well, for a start - Joe Lieberman.

What's Joe saying?

Tonight he came out with a statement that he would would support a Republican filibuster of the bill as it currently stands.

And that's bad?

Well, it's certainly frustrating considering that:

1) The reasons he says he won't support the public option are not actually factually true.
2) Voting to support the filibuster is not the same thing as voting against the bill. Leaving aside the stupidity of his opposition, he could easily choose to vote against the final bill without endangering its passage. But voting with the Republicans in support of a filibuster prevents the bill from even being voted on - this is a far higher standard.
3) Democrats are barely in control of the requisite number to end a filibuster, so it's unclear whether any bill could be passed if Joe and his ilk really dig in their heels on this procedural issue.

Why would Joe Lieberman do this?

Dunno? Cuz he's kind of a schmuck?

Are you fired up?

Barack is.



Health reform IS going to happen. We'll make it happen.

It has to - today a study was released revealing that nearly 48,000 Americans die each year due to lack of insurance. That's just not good enough. Period.

Attention Southerners: I'm Glad You Lost. You Should Be Too.

Heckling right-winger Joe Wilson has become quite the cause celebre on both sides of the debate. In the course of this heated discussion, one of the things that has been discussed is Wilson's status as one of only 7 legislators to vote in favor of keeping the Confederate flag flying over the South Carolina capitol building.

In defending his new BFF, Rep. Steve King had this to say:

Being a son of the South puts you in a different position when it comes to the Confederate flag. It means something entirely different to the people who have ancestors who fought in the Civil War on the south side of the Mason-Dixon line.

Ya know, that's true. For sure, those who fought in favour of slavery and oppression of black people come from a differnt point of view when it comes to this flag.

But I would think that this would be something you would be decently ashamed of, rather than using as, ya know, an argument in favour of continuing to be disrespectful of black people.

Ew.