So, where are we at on health care reform

[TayTay]

Friday, July 10, 2009

http://voices.washingtonpost.com/ezra-klein/2009/07/an_inside_look_at_the_senate_f.html?hpid=news-col-blog">Ezra Klein at the WaPo has a very good article on ways the Senate Finance Committee is looking for pay for health care reform:

The biggest-ticket item under consideration on the health side is an increase of 0.3 percent on the employer and employee Medicare tax. That would raise $275 billion over 10 years. Another option would be to apply the Medicare tax to investment income above the Social Security tax cap. (That seems like a really good idea.) There's also a potential flat tax on insurance companies tied to their number of members or premium payments. That could bring in $75 billion to $100 billion over 10 years. Then there are a couple much smaller revenue options relating to fees on pharmaceutical companies and the medical itemized deduction cap.

http://online.wsj.com/article/BT-CO-20090709-716694.html">Wall Street Journal reports that Sens Reid and Schumer have made progress on health co-ops as a "publicly funded" option

WASHINGTON (Dow Jones)--Senate Democratic leaders Thursday claimed progress in talks on forming a public competitor to private health insurers, though senators appeared to make little headway on finding a way to pay for health-care legislation.

Senate Majority Leader Harry Reid, D-Nev., and Sen. Charles Schumer, D-N.Y., said they're amenable to making a non-government health cooperative part of health-care legislation, perhaps in lieu of a controversial proposal to form a government-run health insurance plan.

Schumer, who has led efforts to find a middle ground between opponents and supporters of a public plan, said it is most important for the public competitor "to keep the companies honest, to be available right at the beginning to everybody, and have the strength to borrow."

"If it can do those things in a co-op form, I think we're open to it," he said.

Reid told reporters that "we're going to have some type of public option - you can call it cooperative or whatever you want."

An article from July 7 in the http://www.nytimes.com/2009/07/08/health/policy/08health.html?_r=2&hp">NYTimes detailed what concessions the White House is making for health care:

As part of their deal with the White House, pharmaceutical companies say they won an agreement from Mr. Baucus to oppose efforts by House Democrats to sharply reduce what the government pays for drugs for some Medicare recipients previously covered by Medicaid.

The deal with doctors could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements. The American Medical Association and other doctors’ groups have sought to change or repeal the provision, and they are likely to try to extract that as their price for boarding the Obama train, people tracking the negotiations said.

Wal-Mart, the nation’s largest private-sector employer, agreed recently to support requiring all big companies to insure their workers. In exchange, Wal-Mart said it wanted a guarantee that the bill would not “create barriers to hiring entry-level employees” — in effect, code words to insist that lawmakers abandon the idea of requiring employers to pay part of the cost for workers covered by Medicaid, the government insurance plan for the poor.

“It’s kind of a give-and-take, quid pro quo kind of environment,” said Tom Daschle, President Obama’s first choice for health secretary, who remains in touch with the White House on health care issues. “I think that the stakeholders wouldn’t do this if they didn’t think there was something in it for them.”

http://www.mcclatchydc.com/homepage/story/71584.html">McClatchey has an article that takes the Dems to task for doing health care reform deals in secret (and notes that Sens. Kerry and Snowe are meeting in private over financing issues)

The private sessions continue, however.

Four Senate Republicans met for an hour and a half Wednesday to discuss health care with Senate Majority Leader Harry Reid, D-Nev. Separately, Sens. Olympia Snowe, R-Maine, and John Kerry, D-Mass., have been in intense discussions. White House Chief of Staff Rahm Emanuel and Office of Health Reform director Nancy-Ann DeParle are in constant, private contact with key players.

The House of Representatives could vote on a plan before the August recess. The Senate is poised for a longer debate. Assuming they pass differing plans, any final product would emerge from a conference committee, whose negotiations typically offer even less public scrutiny.

Lawmakers, health care interests and public policy experts acknowledge that Obama's campaign vision hasn't exactly come to pass.

"Sometimes for people to say what's really on their mind, it helps to do it outside the public eye," said Senate Finance Committee member Thomas Carper, D-Del. "Could the process be more transparent? I suppose it could be."

http://firstread.msnbc.msn.com/archive/2009/07/06/1987433.aspx">MSNBC had a pretty good timeline of what is supposed to happen in the Senate this month. I seriously wonder if this timeline will hold however:

THE SENATE
Starting this week, the Senate meets for five weeks before summer recess. The leadership is planning to spend the fifth week (Aug. 3rd) on Sotomayor floor debate and vote. And it hopes to spend the two previous weeks on Sotomayor (July 20 & 27), as well as debating and voting on the health-care reform bill.

This essentially gives the two committees (Health and Finance) two weeks to finish their bills and merge them into one bill before taking it to the floor.

The Finance Committee is THE committee to watch. If the committee gives up its efforts for a bipartisan bill, it will likely trigger Dem leaders to use a procedural tool called "reconciliation." That would prevent a GOP filibuster and allow Dems to push a bill through with a simple 51 majority vote. (That said, reconciliation involves a complex set of rules that could still make for an perilous road to final passage.)

[TayTay]

1. I am actually more concerned with who is paying for this than

I am on the public option. There, I said it and I am now an official liberal blog apostate. (Sorry, I will try not to get apostate dust on anyone.)

I am very concerned with efforts by companies like Walmart to weasel out of paying in substantial money to a reform system and my alarm bells are going off like crazy at the thought of Walmart agreeing to a public option. What is in it for them? (Okay, I'm paranoid as hell, but this is Walmart and they never do anything for the public good ever.)

Walmart moves into an area and depresses wages to at or near the poverty level. They run seminars on how their employees can sign up for Medicaid and food stamps and stuff like that. (They also suck municipalities dry for tax money for roads and services and then don't do their part by really paying much into the tax system. Walmart takes money out of the system and contributes a net negative to the bottom line of most municipalities. They are a drain on resources.)

So, why would Walmart agree to a public option? Because they are looking for a concession that says that Walmart will not have to pay into the cost of providing Medicaid services for employees. They don't give a rat's ass about the public option or who is paying for it as long as it's not them.

I wish we were having this debate instead of a debate over the inclusion of the public option. So what if we get a public option that goes bankrupt in a few years. Ask California what it's like to have no money for public health. We could have this option and no corporate money or concessions to fund it. I think it's a toothless debate right now with the wrong emphasis on the wrong things.

Again, yeah, I'm apostate on this. I think it's about the money not the purity of who supports what option the most. I want to know how this is going to be paid for and how much corporate America is going to pay. Is there a GM in the future dumping it's health care obligations on the public? Is the money all going to come from taxpayers or is there a corporate component?

[beachmom]

2. Okay, I'll join you. I saw this report on the BBC about the healthcare system

in Holland:

http://news.bbc.co.uk/2/hi/programmes/world_news_america/8141383.stm

There is NO public option there. All insurance is private, but heavily regulated.

There are really two issues about our health care problems:

1. Universal coverage (for some, it is impossible to get insurance at any price)
2. Cost (many people simply cannot afford the premiums, and even if they had the insurance, could not afford to pay the percentage of the care they are obligated to pay under the plans)

Massachusetts set out to fix #1, and #2 bit them in the a**. It is pretty clear that both need to be fixed in order for this to work. I find too many commenters to be too ideological -- it HAS to be government doing it. Well, I have to agree what is most important is the goal: universal coverage (REAL coverage, not junk insurance) and keeping costs down. That's it.

[TayTay]

3. Mass got some right and some of it is still a work in progress

The Mass plan suffers from not having a national component. (OTOH, MA got a lot of federal money to see how this program can operate and IF it can be a national model. The results are good/mixed.)

97% of MA residents are covered. This is a remarkable achievement by any standard. It was done with mandates and without the strictest of employer mandates. (Employers in MA pay $275 a year as a penalty if they don't pay into a health insurance program.) There has NOT been a big dumping of employees onto the State systems, as was feared.

BUT, the recession has hit this program as it has hit everywhere else. The loss of money to cover people is going to hurt and cause permiums to go up or services to be cut back. Or both.

On the whole the MA program was pretty good. I say this even though my own daughter was one of the folks who, for several odd reasons, fell through the cracks and hasn't had health insurance for a while.

BTW, I am four-square FOR mandates. I think that is an essential part of the program.

Excellent find on the Holland model. Germany has a public/private system as well that seems to work pretty well. Thanks for this!

[karynnj]

4. If you throw in also the design of the subsidies to people

to purchase health insurance, I am 100% with you. By that I mean how will they actually help people who are above the medicaid level, but still too poor to pay the full cost of insurance. It seems they need a sliding scale like SCHIP has. It makes no sense that you go from Medicaid being free to no help at all.

I know the theory is that a government plan is thought to be cheaper as they do not have to make a profit, but it likely still will be too expensive for many slightly above the Medicaid level to support. Many people on GDP to not seem to get that even if the plan is designed to be like Medicare, they still have to pay premiums.

I also wonder if creating an industry standards board that could create standard forms, paper or electronic, that minimized the paperwork would not cut costs significantly.

Your comments on WallMart are interesting - if they are allowed not to pay for all their entry level people, they may pay for only a small fraction of their workforce.

[wisteria]

5. Who is going to end up paying bothers me too. Along with quality.

The costs for good care is so expensive and I just don't know why. Is it greed on the part of doctors? Or, is it because so many people sue for what they consider substandard care, that insurance premiums are so high for doctors- or is this a myth. I have had dealings with several types of medical insurance carriers for nearly 25 years because of one of my children and I can tell you, the more control and less flexibility that is placed on coverage by those who control the money end of it, the worse it has gotten. I now pay a little more- luckily we can- and I have options I did not have with many other types of insurance like HMO'S. I am free to take my daughter wherever "I" think it is appropriate without referrals or BS about limited coverage and arguments over unnecessary tests. I just pay a bit more for those doctors who are out of network. However, I have taken notice that I pay more deductible all around and more co-pays than I have in the past since the beginning of this year because my husband's employer has turned over the increases to their employees to pay. Frankly, it bothers me that not everyone has access to good care and those who have better care have to pay so much for it. Remaining healthy in America should not be based on income. And, good healthcare is not a privilege but a necessity and everyone including employers should pay into it. It benefits them as much as it benefits everyone else to have a healthy American population. So, I suppose what I am saying is I would like to see a cap on insurance costs, higher quality of healthcare for all Americans and have it available so that all people can obtain the insurance they need. I do not however, as a taxpayer, want to shoulder the entire cost of changing and running the system.

[sandnsea]

6. Walmart is taking too much heat

for being a bad employer and they know they are going to have to start providing health insurance. What better way to level the competition then support a mandate on all businesses. In addition, they're opening those little instant clinics so they will stand to gain from the business end too. Win win all the way around for Walmart.

It is so nice to see such a rational health care debate. Should have known it would happen in here.

The problem Blanche Lincoln has with the public option is cost too. As some in this thread have said, what good is a public option if it isn't financially self-sustaining. Just because a premium might be set at an affordable rate, if it's being propped up by taxes then that doesn't mean it's cheaper at all. It's also important to make sure there is an honest accounting system in place that really measures equal service, not limited public care against the full care that the wealthiest expect and pay for.

I think there's a kind of shifting reasoning when people quote numbers proving single payer costs less, single payer countries spend less; and then when shortages are acknowledged they say the funding isn't adequate. Well if the funding isn't adequate, then how do we know if it's really cheaper if we are comparing it to so many people who fully fund their own health care here. It's not as if the health care of low income people isn't calculated into the costs because low income people do get emergency care and often get treatment as well. The cost is billed and included in health care statistics, it's just not paid for.

It's nice to hear Mass is at 97% coverage. Oregon is going to hit 95% of children covered with a new bill, and an additional 60,000 on the OHP. We passed some new taxes including a hospital tax which most hospitals thinking they will get more money by getting more people insured than they will lose with the tax. I think that's it anyway. We also passed a tax on premiums. http://www.oregonsenatedemocrats.com/press-releases/senate-votes-to-dramatically-expand-health-care-coverage-for-oregonian%E2%80%99s-children-and-most-vulnerable Health coverage here is basically OHP which is Medicaid, SCHIP, and then the Insurance Assistance which are subsidies that pay up to 95% of premiums. The Insurance Assistance has a waiting list, OHP and SCHIP don't. I have insurance assistance, there was an open enrollment a few years ago. It's fine, I have Blue Cross. Opening the federal employee insurance to everyone, with a subsidy, would probably be a huge step forward in itself.

One thing Oregon does that I haven't heard discussed at all - insist non-profits take all patients. I am so fortunate that the local Catholic hospital does real outreach and practically demands that you use their assistance program. Almost everybody qualifies for some kind of help and quite often it's 100%. They just built a huge new facility in Eugene so it doesn't seem to be hurting them any. It would be helpful to see why this group can do this, and other Catholic providers sometimes turn people away.

[beachmom]

7. I waded in. And now I am out. I threw it in, put in a link, and now

I shall become an apostate on DailyKos:

http://www.dailykos.com/comments/2009/7/15/9544/35631/89#c89

I guarantee you no one will rec my comment. DailyKos is too rigidly ideological for my taste. But there ARE moderates (or just less partisan extremists) on the site, just less so than before.

[TayTay]

8. Aaarrrrrgggh, I am on my way out the door.

I have another engagement and just stopped in here for a second to get any updates on JK.

I agree with you and will wade in later.

Damn. Just when it was getting extra interesting. I will probably be too late. Sorry.

[beachmom]

9. I finally looked back at the thread and it was really ugly.

I realize the Left is as capable of extremism as the Right. Some went after me in a personal way. I am going to stay away from the health care debate. I mean look at this diary:

http://www.dailykos.com/story/2009/7/17/754562/-ABCs-Tapper-Slams-Obama-on-Health-Care-Choice

Now I can't stand Jake Tapper, but there actually was relevant information in the article that is being ridiculed in the diary:

But last month, as the president acknowledged during a press conference, he doesn't literally mean that you are guaranteed to be able to keep your health care plan, and your doctor, if and when health care reform passes.

"When I say 'If you have your plan and you like it,... or you have a doctor and you like your doctor, that you don't have to change plans,'" the president said after we asked him about this, "what I'm saying is the government is not going to make you change plans under health reform."

Importantly, the government might create circumstances - say, a public health care option that is less expensive since profit is not a concern and overhead is lower - where you might find your business forcing you into that public plan.

The diarist pokes fun of Tapper, and then says that employers are already dropping health plans, etc. That is all well and good, but the fact is many people are on an employer health care plan, and I tend to think those people vote. Based on what I have seen in Germany, employers don't usually offer the public option; that is for state/federal employees and those unemployed or on welfare. Public is not as good, but it is a Godsend for those who would otherwise be left with nothing. However, I had never considered that employers would switch to a public plan if health care reform passed. Or it would be only an alternative to the private plan they offered.

Now, ABC could have been taking this all too far, and, of course, we are "forced" onto a health care plan already (believe me United Health Care would NOT be my first choice, yet I am stuck with it), but this is relevant for discussion. Not over at Daily Kos, though. A negative piece on their beloved public option must be immediately shot down, ridiculed, and marginalized as boneheadedly stupid. Echo chamber, anyone?

[karynnj]

11. I agree with you on Daily Kos and on the need to really have a discussion

as to what the proposed system will be. So far, the choice is to read the over 1000 page bill, with language that I really have trouble following or to read 2 paragraph summaries. Part of this is maybe the complexity of the insurance plans themselves, but there should be something - maybe from the administration explaining clearly what the overall system will be and what the public plan covers and how it works. Some information is not even available now - such as which doctors and hospitals will sign on.

Now in fairness, my husband and I found it really really hard to compare the plan his company offers and the use I can get as a retiree to see which we should pay the co-pays for. With the public option, the devil will be in the details - and we don't have them yet.

[sandnsea]

12. Medicaid is the gold standard

I've been on just about every kind of insurance there is, and helped my heart-transplant mother wade through Medicare. Unless you're in some kind of dumb-ass Clinton state where they limit prescriptions, which are few, it's the best health insurance you can get. If people were ever on Medicaid, especially 10-20 years ago, they would be pissed at what they're paying for.

Honestly, this is the dumbest excuse to oppose the public plan I've heard yet. Employers force you into a plan now. They force you to choose a doctor in the plan they forced you into. They force you to pay whatever they decide. They force you to pay office and drug co-pays. They force the whole thing on you. But OMG, don't let them "force" you into a public plan like Medicaid that pays almost 100% of everything. The Horror!!

Geez. Come on.

[beachmom]

13. Thanks, that is a nice rebuttal. That is not what happened on that diary, though.

I think it could have sparked a good discussion, but instead it was just a collection of insults.

[sandnsea]

14. My oldest was born in a military hospital

He had a birth defect that caused his heart to stop and was life-flighted to an area children's hospital. Champus, the old Champus, covered that 100%. He had routine care for several years, plus he was sent to Travis for check-ups with the cardiologist there, who always said to keep seeing the children's cardiologist. All paid. My other two kids were born on regular old insurance which paid fairly well too, no emergencies though. We had to go on Medicaid when my husband's legs were burned and he was between jobs. So when I say I've been on just about every kind of insurance there is, that's what I mean. I'll take Medicaid every single time, even over military hospitals and Champus or Tricare or whatever they're doing these days. I hate military hospital care. Nothing like going through a pregnancy in a 50 year old puke green military clinic along with 50 other women at every appointment. There is no way I would call that quality care. For the troops needing specialty surgical care, it seems pretty good. For the families, not so much.

Regardless, emloyers will choose the quality of health insurance they offer using the same criteria they do now. If they can attract better employees with better private insurance, that's what they'll offer. If their employees don't want to be on a public plan and have a snitfit, then they won't switch, just like they don't always switch to HSA's or cheaper plans now. Just one more option, that's all.

[karynnj]

10. I somehow missed this 2 days ago

I would have recommended because I agree. To me the three biggest things are the subsidies, the elimination of pre-existing conditions and anything that adds to efficiencies - like standard forms. I do see that a public option, if run well, could put pressure on the private companies. I also like the fact that the overall plan, whether a public option is there or not, would likely provide better options than COBRA for people losing company paid insurance.

I actually found some company on Dennis Kuchinich's diary. There were rational people arguing against him. So many are very ideological and unable to see that things proposed will really help a large number of people.