There is a huge difference between PROVIDING coverage and MANDATING you BUY private, for profit, corporate coverage.
You are not mandated to buy for-profit coverage. Medicaid and Medicare will still exist, and the rating/issue regulations will allow non-profits to survive and thrive, something that is presently possible in only a handful of states. Having everyone in the same pool, and making it illegal for insurers to deny people based on their medical history, prevents insurance companies from carving up the risk pool and taking all the "profitable" customers (young and healthy). After Vermont passed community rating and guaranteed issue back in the early 90s, their non-profits went from being on life support to financially sustainable.
The mandate exists so that people will not be able to purchase coverage only when they get sick, and dumping it after they get treated, without some sort of cost attached to it. And the cost is pretty light.
It is a lie to call it health care reform when failure to buy the for profit insurance (that will not be sufficiently regulated) will result in FINES or PRISON.
The government is forbidden by statute to issue any liens or criminal penalties for not complying with the mandate. Section 5000A(g)(2), on the question of failure to comply with the mandate:
(A) WAIVER OF CRIMINAL PENALTIES.
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(B) LIMITATIONS ON LIENS AND LEVIES.—The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.
It's $750 a year or 2% additional income withholdings, whichever is greater, if you don't get even the minimal, basic, catastrophic coverage. This is subject to change pending reconciliation. The Senate version is less than the House version, but the House version is on a sliding scale so if you make less, you get a lower rate. Obama's proposal (which I believe is safe to say will be the reconciliation version) will be a bit of both. Lower overall than the House, but progressive.
So, no, the IRS won't send men with guns to your house if you refuse to get insurance. Unless you don't pay your taxes at all. Then yeah, they'll send the men with guns. But they still won't penalize you extra for evading the mandate.
It is a lie when they say we can pass this bill and fix the issues later. IT WON'T HAPPEN. Look at NAFTA.
The NAFTA comparison has always been apples and oranges. It's an enforcement issue, particularly within Mexico, not an issue with the text of the agreement itself. This is why the vast majority of the complaints about NAFTA deal with the U.S./Mexico trade relationship and not the U.S./Canada trade relationship. The same is not true with respect to the content of the HCR Bill.
And even if it was, there is a growing consensus within both House and Senate caucuses that the best way forward is for the House to pass the Senate bill and for the Senate to pass a reconciliation bill that implements changes that House Democrats want. The only roadblock are nervous House Blue Dogs and how much can be done under reconciliation that doesn't violate the Byrd Rule. The process is there for "fixing" the Bill, and its far less Sisyphean than renegotiating a trade agreement between three counties.
The very corporations that have created the need for health care reform will be rewarded immensely for their bad past behavior.
Every insurance company will have to abide by new rules on rating, issue, and pricing that are vastly superior to the regulations in all but a few states. Anthem's recent rate hike among individual policy holders, for example, would simply not be possible within the exchanges. Rescission would be limited to issues not related to medical history (like if you lie on your application saying you have two dependents who will be covered under the policy but actually have six, and stuff like that). All insurers would have to abide by medical loss ratios (minimal % of revenue spent on care). Clearly defined benefits and price controls within the exchanges, and expanded to the large-group market within a few years.
The only bad actors that are rewarded, in any respect, are the drug companies via the 12-year exclusivity on brand name drugs.
Health care reform must include a strong public option that allows ALL Americans that want to participate access. It's key to controlling costs, expanding coverage, and forcing big insurance corporations to compete.
A "strong" public option can certainly help control costs and foster competition, but it is by no means the only thing. Which isn't to say that I'm against a public option. I'd like one. I'd like several, actually. It's just that it isn't the real prize: a more responsive marketplace.
Without the necessary regulation, health insurance is fundamentally a broken market. Yes, even with a public option. Companies don't compete to offer the best and least expensive services. In fact, they hardly compete at all. They carve up the risk pool, weed out anyone who will be a major liability, and dump those people onto public programs or non-profits. Without community rating or guaranteed issue, even the strongest public option would become financially insecure eventually. Companies like Aetna and Wellpoint would simply leave it all the people who cost more than they put in, which is exactly what they did to all those BCBSs around the country that use to be non-profit.
The puzzling thing about the "no cost controls" argument is that there is usually nested within that a complaint about the mandate and/or the excise tax. Here's the thing: both of those are cost controls. The mandate makes sure people who don't think they need to be insured (younger/healthier) actually pay into the system, offsetting the costs of older and sicker people. And the excise tax gives a major disincentive to insurance companies to offer benefits packages that are grossly inflated and drive up premium/OoP costs up for everyone else. This bill has no cost controls... except the cost controls we don't like for reasons unrelated to cost. Which is perfectly fine. There are legitimate objections to the mandate and the excise tax. But that they aren't cost controls isn't one of them.
Anyway, the legislation also has some other cost control measures. One is payment bundling (Medicare/Medicaid/Tricare paying hospitals for total care over a period of time, not breaking up payments for diagnostics, treatment, medication, etc) so that doctors no longer get paid more for simply doing more, especially when the "more" is just stuff they add on that has no relation to care but gets them more money. Another is that regulators have the legal authority to ban insurance companies from the exchanges if they inflate premiums. There's also the Medicare Commission, which has the power to take local pilot programs, such as those that save costs, and institute them nationwide as well as forcing a vote on spending-related issues without the possibility of filibuster or amendments.
So cost controls are there. They may not be ones you like, but that's a different issue.
This legislation as currently stands is totally dysfunctional
and I cannot support it.
Nor should any thinking person, especially progressives.
I've long been of the opinion that the root of "progressive" is "progress". Whether or not that makes me a thinking person is a matter of perspective, I suppose.
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
