Simple Question: Why do you want to be forced to be a customer of an abusive industry?

[Armstead]

That's my simple question for those who believe this version of health care reform is a good thing.

Can you give an honest answer, aside from the fact that it's a Democratic party "reform" and we all want reform?

Is not the REAL thrust of the brand of "reform" that is being drawn up to force everyone into the private insurance market and to perpetuate the employer-based system (which is hard on employers as well as employees)?

Health coverage is important, and we all want it. However, because of the inherent nature and the shameless greed of the insurance industry many people do not have it because they cannot afford the high rates. Many others have it but are being sent to the poorhouse trying to make the payments. Many others have it, but only if they stay in their jobs. Many businesses provide it, but it is a drain on their bottom line.

Congress wants to force people to buy the product of insurance companies that can only make a profit by doing everything possible to deny you care and charging you as much as they can get away with.

Congress is afraid to -- at the very least -- offer a real public alternative to back up this mandate. Yes there is a public option, but they are doing everything possible to make it non-available and non-competitive -- and so convoluted that no one really knows if they will be eligible.

And Congress doesn't even have the 'nads to regulate prices of private insurance. They are relying on "competition" to encourage insurance companies to "be nice."

Forcing people to buy a private product while only setting minimum standards for the providers of that product (pre-existing conditions, can't cancel people for wrong reasons) without really forcing that industry to clean up its act seems like a step backward to me.

Can someone explain why I am wrong without using words and phrases like "ideological purist" or "perfect is enemy of good" or "freeper" or the other cliches that avoid the central question of why we are supposed to settle for a law that will enslave us to a private industry that is the source of the problem to begin with?

[MNDemNY]

1. You must support this bill.

We(Democrats) sorely need a "WIN" and the fancy Rose Garden Signing Ceremony is the shot in the arm we need. Get with the program.

[TZ]

3. Why don't you try having a pre-existing condition

and living at the insurance industries mercy before you start saying shit? Fuck anybody who doesn't understand that getting rid of lifetime caps and pre-existing conditions is a VERY good thing.
But hey, just like to the Republicans people like me don't matter I suppose.

[MNDemNY]

7. Bullshit, WE DO NEED REFORM! This bill is TOO little.

[Armstead]

8. The pre existing clause is a good thing. But why not stick with that instead of...

...adding what is a poison pill to many people living on the margins financially? (Not just the poor but working people who are struggling with ever-increasing rates)?

[MNDemNY]

11. 'Cause we need the "WIN" nothing else matters.

This is as GOOD as the bill will get, it's DOWNHILL from here as more compromise will be needed to get it through the Senate. This shit bill will only get worse.

[Armstead]

33. Regulation of insurers that almost everyone wants would be a win

[timeforpeace]

61. Look, it could mandate daily whippings and if it was labeled healthcare reform, we would love it.

[phleshdef]

22. Exactly. Some want to change what healthcare reform was SUPPOSE to be about.

Its suppose to be about getting people reliably covered at a price they can afford. But some want to hijack the debate and make it about punishing corporations. As much as I think they probably deserve some punishment, this reform bill should never be about that.

[MNDemNY]

35. WOW.

[Armstead]

38. It's not about punishing them. It's about either...

forcing them to be socially responsible corporate citizens and/or providing the public with a form of coverage that is not profit driven and that is designed to be affordable and useful for everyone.

[urgk]

42. You don't even have to have a pre-existing condition to be at risk...

Wait until these people with decent coverage switch plans because of a job or moving to a new state, to find out years later that retro-actively something is being labelled pre-existing.

[Cronus Protagonist]

29. Count me OUT

I'll go Green before I'll support a tax on living.

[MNDemNY]

36. .

:evilgrin:

[TZ]

2. We all are forced to be anyway to get decent care.

This actually does put some limits on that abusive industry. Since there is NO FUCKING WAY that insurance industries are going away anytime soon ANYTHING that does put SOME regulation on the abusive practices is a good thing. Better this than the unchecked bullying tactics the insurance industry gets away with now. Anyone who doesn't realize that NOTHING could be worse than the status quo isn't living in reality!

[Armstead]

4. Why the gifts to this industry? Why not just put in the limits in a way that....

deals witn the problems, without making that same problematic system more entrenched by giving insurers the force of law as a sales tool?

Why did Congress not put in price controls? Why do they not at least makes these "reforms" neutral, without giving undue weight to the bottom line of insurers while accepting republican notions of the "free market" ?

[Mass]

9. I dont know. As I said a few days ago, it is very bittersweet, but it is better than nothing.

Sadly, this is what will pass and we need something that passes.

[Armstead]

15. I appreciate the honest answer....But why should we always settle for the bittersweet?

That's what gets my goat. I am reasonable, and realize that often we need to settle for half a loaf, etc.

But I can't see why so many of us accept things that actually makes things worse to get some things that are helpful.

I'd rather they would have done this honestly from the beginning and proposed modest, straightforward reforms as a starting point without making a bad plan the "be all and end all" that is going to put a lot of peopel behind the 8-ball, leaves insurance companies in the driver's seat and rewards them for bad behavior...,.And which is likely to pre-empt further reform in the future.

[GreenArrow]

21. "Why the gifts to this industry"?

Because the industry has effectively written the bill?

[Armstead]

34. That's the right answer....My question is why people support that

[subterranean]

46. The bill does provide indirect price controls.

Insurance companies would be required to use at least 85% of premiums to pay health care costs. Theoretically, this will limit premium increases because in order to raise premiums they would also have to pay out more for health care.

[Armstead]

49. The key word is theoretical...

Companies havde entire departments whose aim is to keep such indirect good intentions as theoretical goals rather than operating realities. They will find plenty of loopholes.

[subterranean]

52. I fully expect them to find and exploit every loophole. n/t

[Mass]

5. Because the votes are not there for more. How long are we supposed to wait to help these people

who could be helped by the House law, as imperfect as it is? How many people who could get help will not or will get it too late because we are waiting for a perfect bill.

So, what do you propose? That we wait 30 more years so that the morons who do not get it get it. It is about getting people help and this bill starts to do exactly that.

[Armstead]

10. Maybe not for some sweepingf change -- but why not just focus on fixing the present system?

If there are not tghe votes for more, what's wrong with some good old-fashioned regulation for a start?

Limit price hikes, deal with pre-existing conditions, denial of service, etc through regulation. That would be popular with a majority of Americans (except insurers and wingnuts).

Why keep kissing the butt of the industry that is causing the problems?

[stray cat]

6. I think you should be able to sign a do not treat order and avoid insurance

Thats freedom - if you don't want insurance you can opt out and be required to pay up front for any medical care or not get treated. You could have money in a fund and if you are to injured to speak they can check your account and see if you can be treated or not.

[mopinko]

31. +1

don't want to be insured, fine. don't get sick, and if you do die quickly. at home. otherwise, i pay for you.

[Armstead]

37. Why not solve the problem instead?

What you're talking about now is basically a more Darwinian version of what we have already.

I don't know if it is a serious answer or not. In either case, your answer seems to be to avoid dealing with the problem, and continue to throw people to the wolves?

[Nederland]

41. You'd have to repeal existing laws...

...that say inability to pay cannot be grounds for refusing service. I would add that those laws were passed by Democrats.

[uponit7771]

12. I'm not ALREADY forced to be one of their customers?!!??!

[Autumn]

13. Good luck with

getting an explanation that doesn't use the words "ideological purist" or "perfect is the enemy of good" or "freeper". You know it's coming. I agree with all of the points you make, they happen to be true, so I can't say you are wrong. I guess all that matters is that we get a victory, no matter how crappy most of it is.:shrug: They should have just passed legislation baring the insurance companies from turning down people for existing conditions. To me , that seems to be the only thing we won on.

[Armstead]

18. Bingo....If they only planned modest reforms, why not just sell it that way?

It seems to me that if they had said "We are not ready to make widespread change, but we know people are struggling so we are going to pass some reguklations of insurers that address specific problems as the first step in a process of overall reform."

Not ideal, but better than this nonsense we've gotten.

[Jamastiene]

19. Actually,

they didn't need over a thousand pages for this bill at all. They only needed one sentence: "Congress' solution to help the uninsured is to force them to buy health insurance from the insurance companies we own stock in."

[Autumn]

25. Good post

:rofl: and it's so fucking sad that it has so much truth to it. :thumbsup: :hi:

[kath]

50. +1

sad but true, as the other poster said.

[Jennicut]

14. Would any reform work without a mandate? That is the question.

I am torn about it. I think is is partly unfair but wonder if the exchange would work without everyone having insurance. The subsidies seem to cover people 400 times the poverty level in the House bill. If there were no subsidies, I would see the argument clearly for no mandate.

[Jamastiene]

23. But do you know, yet, what percentage of coverage

these subsidies will cover for poor people? That's my worry. I'm concerned that I may end up with health insurance but be homeless because I won't be able to pay the rent any more. That money to cover what the subsidies do not cover has to come from somewhere. Where? You can't get blood from a turnip. That's MY problem with it.

[Jennicut]

26. I am have a post out there about the subsidies.

It is $43,320 for an individual, $88,200 for a family of four.

[Armstead]

27. The problem is they are using right-wing free market principles rather than the public benefit

Mandates are based on protection the profitability of insurance companies based on actuarial factors. Insurers want a large number of healthy people paying premiums to offset the ones who use services.

Government mandates are essentially protecting the position of the insurance companies as the first priority, in exchange for asking insurers not to do tghings like deny coverage for pre-existing positions.

The problem is that this places a higher priority on the needs of insurance companies, and forces the public to be a part of that.

Unless the government is willing to provide a real public coverage plan as a backup -- with no strings attached for eligibility -- mandates are essentially forcing peopel to become customers of that industry.

Subsidies are basically using the public treasury to funnel money into the private hands of insurers. That money could be used to support a public system instead.

[Jamastiene]

16. I don't.

I wonder what would happen if our Congress decided to "reform" homelessness in America by forcing every American, regardless of income, to buy brick two story houses 3,000 sq. ft. or larger in gated communities...or face the consequences of huge fines and hard prison time.

Would that make any sense? Of course not.

The mandate that forces poor people, who cannot afford health insurance to begin with*, especially not health insurance from profiteering insurance companies, is ridiculous.


*And don't even start with me about Medicaid. The erroneous belief by many on DU, as evidenced in another thread I saw in the Poverty Forum, that the only requirement to get Medicaid is that you are poor is startling. I cannot believe how out of touch people are to actually believe that. If that were the case, there would be no reason for this health care reform bill in the first place. Give me a break.

I'm going to dust off my harmonica, that is, if they'll let me have it in prison, because I am going to pay my current rent and utility bills as normal. Fuck this mandated bullshit. Congress can take care of my health care costs by providing me with health care in prison when they send me there for refusing to inflate their fat, rich insurance company stocks. What good will health insurance be if it makes me homeless?

[phleshdef]

17. If I can afford coverage that I can't be dropped from, I don't give 2 shits who provides it.

Thats what the healthcare reform is about. Its not about punishing the insurance companies. Its not about sticking it to the corporations. Its about getting people covered and making sure they can rely on that coverage for the rest of their lives.

[Armstead]

28. Then why not just stick with that goal?

Congress has it in their power to set the terms for insurance companies through basic regulation. They can require insurance companies to provide affordable coverage to everyone.

That is not about "punishing" the insurance companies. They already have a cash cow. All it is doing it setting rules for the road that they have to abide by.

[kath]

51. but have you seen what they consider "affordable"??

it's absofreakinlutely ridiculous.

[TexasObserver]

20. The health insurance industry is reprehensible and oppressive.

Of all the various areas of insurance, the one that is most oppressive and least responsible is the health care industry. While they use media to put seniors in fear of "death panels," they routinely allow some lower level cubicle dweller to decided those real life and death matters regarding health care. They use a big manual from the company, and the manual's guidelines are based mainly upon helping the insurer's bottom line, not providing the care paid for by the insured.

[Xipe Totec]

24. Answer: When did you stop beating your wife?

There is no way to answer a question that begins by asserting a lie.

[Armstead]

32. Do better than that and tell me why it isa lie.

It mandates everyone to buy insurance coverage. It might provide some alternative in a public plan, but it is convoluted -- and the public plan is essentially being forced to be non-competitive.

Subsidies are basically diverting public money to fill the private coffers of the insurers. Why could that money not go into a public program?

[Cronus Protagonist]

30. Obama should threaten a VETO

And carry it out if out. However, that would get in the way of his legacy of changiness, so I doubt he'll have the nads to do it.

[Nederland]

40. Why would he do that?

Mandating insurance coverage for everyone was his idea.

[Nederland]

39. You don't get it

You have a CHOICE of who you want to get abused by (except when you don't). That completely changes things... :eyes:

[Armstead]

43. A familiar refrain between me and thee.....It's been awhile

It's like a choice of being hit over the head with a baseball bat or having a mallet smash your hand I guess.

Personally, if we're going to get abused anyway, I'd prefer to at least see people also have the option of being mildly abused by public servants at an affordable cost, who are not protecting the ability of an insurance executive or investors to buy their fourth summer home.



:hi:

[Nederland]

45. Actually I was being sarcastic

I would love to get rid of the health insurance model completely--they add no value to the equation and only exist as an accident of history.

[Armstead]

48. I agree.

What bugs me about this is that it is making that more entrenched, not less.

Seems to me that reform....even modest reform...ought to be aimed at lessening a problem, not making the cause even worse.

[high density]

44. I consider myself to already be a forced customer

My options are private insurance or no insurance. I don't consider going without insurance an acceptable choice. I buy insurance through my employer, selecting from the options they offer. My employer absorbs about 75% of the cost.

[Armstead]

47. Not everyone can make that choice

For many people who are working but making a modest income, when the basic bills are toted up at the end of the month there isn't anything left to cover exorbitant insurance prices. It's not a choice...Unless you count food and heat as optional expenses.

And not everyone has the option of employer supplied insurance.

[treestar]

53. Because you can't be covered by insurance except by an insurance company

How else would you be covered? The only way not to be covered by an insurance company is not to be covered at all. What's 'abusive' about it? There are remedies for failure to pay claims if the claims should be paid. Any industry can be 'abusive' if they don't agree with their customers. If you had a bad experience with an insurance company, why does that mean every does all the time? Why do people want to be covered then?

The idea is to cover everybody by insurance. Insurance policies are sold by insurance companies.

:banghead:

This is just insane. Really crazy. If you want Medicare for all or single payer, why not just say so? This is not in the bill, but at least complain that it's not in the bill, rather than, hinting around that everyone must be covered by insurance, it just shouldn't be by insurance companies.

[Armstead]

57. I havew always been very clear that I favor either a single payer or voluntary Medicare for all

Insurance companies have become monsters. Healthcare reform should fprce them to behave and give the public an alternative that is not a for-profit driven private enterprise.

yes insurers provide insurance. But when they have the whole system held hostage (as is currently the case) there ought to be a remedy.

Forcing peo-pe to become their customers without providing a clear and string public alternative is wrong.

I would not object to the mandate so much if that benefit of a public and universally available were offered too. But it is wrng to make mandates as step one and then "maybe we'll see if there's a way we can allow some people to maybe sign up for a sort of public option that charges the same as insurance companies."

[TheKentuckian]

54. Probably in the end because the alternative is worse aka have my ass flapping in the wind

I've never objected to maintaining coverage not even when I was 20 but I do object to the structure of the mandate that gives the employers all the real choices and decesion making ability but only puts them on the hook for a tiny portion of their existing contribution while the comparative responsibility for coverage is on the individual.

The lynchpin that is making reform unsatisfactory is maintaining the employer based system. This is why none of it can go as far as needed and why many aren't happy because it is creating a grabbag effect on the whole process.
I've yet to see an acceptable explaination of why we need an individual mandate on an employer based system, especially one that is many times more vigorous than the one for the people's system we are sacrificing the greater good to maintain.

[dionysus]

55. if it's subsidized for poor people they won't care.

[quiet.american]

56. Here's my take:

(I'll say up front I don't expect to change anyone's mind one wit on this, but I write this more as a "why" I'm in support of the bill) :)

"Congress wants to force people to buy the product of insurance companies that can only make a profit by doing everything possible to deny you care and charging you as much as they can get away with" -- this ignores the many restrictions on insurance companies introduced in this legislation. These are exactly the things this bill addresses through:

Anti-trust exemption -- repealed

Price-gouging -- halted: Sec 104 -- "Establishes an annual review process for increases in health insurance premiums by the Secretary of HHS in conjunction with the States that requires insurers to submit a justification for any premium increases prior to implementation. Effective for plan years beginning January 1,2010."

Denial of coverage based on 'pre-existing conditions' -- banned

Being dropped from coverage based on filing a claim -- banned

Lifetime limits on coverage -- banned

Amends the Public Health Service Act to require health insurance issuers in the small and large group market to meet a medical loss ratio of not less than 85%, effective for plan years beginning January 1, 2010. Directs the Secretary to require that plans in the individual market also meet a medical loss ratio of not less than 85% so long as it does not destabilize the existing individual market. If plans exceed that limit, rebates to enrollees are required. -- in plain English, this means 85% of what an insurance company takes in in premiums must go to providing services for its customers -- not into the CEO's pocket ("administrative costs"). As a side note, I came across this tidbit while researching what in the world a "medical loss ratio" is: "For Aetna, <its medical loss ratio> increased last quarter from 74.6 to 79.4, causing a 20 percent plunge in its share price when it was announced.(Apr 2006)" http://www.washingtonpost.com/wp-dyn/content/article/2006/04/29/AR2006042900256.html">Link

(All of the above cuts off at the knees the most despicable ways insurance companies currently turn a buck, so to simply state -- "And Congress doesn't even have the 'nads to regulate prices of private insurance. They are relying on "competition" to encourage insurance companies to "be nice." -- is just not accurate.)

Turning to Sec. 221 of the bill -- the Essential Benefits Package: "Sec. 221. Coverage of essential benefits package. Requires qualified plans to meet the benefit standards recommended by the Benefits Advisory Committee and adopted by the Secretary of HHS. Plans outside the Exchange must offer at least the essential benefits and others as they choose. Plans within the Exchange must meet the specified benefit packages, including being able to offer additional benefits in a specified tier. Allows for the continued offering of separate excepted benefits packages, as in current law, outside of the Exchange."

Through the Essential Benefits Package, at a MINIMUM, insurance companies will be required to cover:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services, including behavioral health treatments.
(8) Preventive services, including those services recommended with a grade of A or B by the Task
Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the
Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well-baby and well-child care and oral health, vision, and hearing services, equipment, and supplies for children under 21 years of age.
(11) Durable medical equipment, prosthetics, orthotics and related supplies.

(Just reading the essential benefits package alone is why I would support this bill -- when I had knee surgery, and was insured, crutches for me to hobble out of the hospital were not covered by my insurance company. Small thing, but so unbelievably petty of the insurance company. Under this bill, that would not even be an issue.)

To state that everyone is going to be forced to buy private insurance is also not quite accurate --

The actual language is that everyone will be required to have coverage -- this can be obtained either through their employer, the Exchange, Medicare, Medicaid, VA, or TRICARE. Now, I imagine you will say, well, why not Medicare for All, then? Let's just say it upfront: politics. Yes, plain and simple. The political will, and not only in the WH, for Medicare for All was not there. Shutting down the insurance companies, putting their employees out in the street, and adding 46 million new clients to Medicare simply wasn't what was deemed the best thing to do going into an election year. Was it the right call? I don't know, but we've passed that exit.

Lastly, the OP sees this as "enslavement," but I actually see it as a chance for more freedom. Hear me out. There have been times in my life when I've taken a job more often than not to have the health insurance. Now, if I can have insurance through an option other than an employer, it really frees me up to look at making choices regarding my livelihood that have more to do with my actual livelihood than what kind of benefits the employer is offering.

I suppose I could go on and on and on and on -- but lastly, I would like to say, even though it seems to be dismissed out of hand by those against this bill, that all these agonizing stories out there of peoples' lives being destroyed by lack of access to health insurance -- selfishly, I don't want that to happen to me, *and* I want those who need help NOW to get it. And they will through this bill. This bill was meant to bring access to health insurance to more people and to do away with the most hideous practices of insurance companies, and it accomplishes that. I also understand this was never meant to be the "Abolish Insurance Companies Act." I'm willing to forego re-inventing the wheel at the moment so that, bottom line, people who need help can get it now, and those whom the insurance companies are abusing will see a stop to it, now.

[Armstead]

58. A good post...Thank you

To be honest -- as I have said in posts in the past -- I hope i am proven to be totally wrong in my worries about what the Congress and Obama are going to do. I'm not going to stay on my haunches just for the sake of being "right." I will happily eat crow if the end result is a bill that actually helps people.

There are some undeniably good things in the versions of reform that have been bandied about. The pre-existing, denial of benefits clauses, etc.

Having said that, I fear that the positive provisions are not strong enough to offset or justify making Americans pay big insurance companies just because they are born. That is corporate socialism, and it does enslave us to them. The only justification is if there really is a STRONG PUBLIC OPTION AVAILABLE...Not just subsidies, which are basically welfare paid to private entities.

Personally,I would have preferred that they focus on the specific positive changes rather than make big promises or do half-assed systemic changes, if Congress and Obama didn't have the moxie to actually lead on the issue and push for single payer or universally available medicarw.

As for the anti-price gouging provisions....Well, they are sending out a lot of mixed messages. What they usually say is that a public option would keep prices down through competition. I fear that any real price controls will either be removed or watered down and/or not really enforced in any meaningful way.

True, it aint over til its over, and the fat lady is still warminbg up her vocal chords.

I honestly hope your optimistic assessment wins out over my more cynical one in the final product. As I said, I will happily eat crow if that turns out to be the case....In the meantime, I think it is important that we be skeptical and critical and not simply accept whatever is foisted upon us because it is called "reform."

[quiet.american]

59. Fair enough. :)

:hi:

[Vidar]

60. K&R