If anyone is still interested in facts, here is why you cannot pass a PO with reconciliation.

[BzaDem]

Nominally, a PO can probably pass reconciliation. It would have to reduce the debt, and with the ban on discrimination on pre-existing conditions, the CBO believes it will. This is why some people are saying that it is possible.

However, the only PO that even qualifies for reconciliation is one that reduces the deficit (and therefore sustains itself on premiums alone). This means it would have to keep premiums just as high as necessary to pay providers for healthcare.

With the ban on discrimination on pre-existing conditions, this could be done. Private insurers won't be able to discriminate, which means they won't be able to just dump sick people into the public option. The public option will probably have a healthy mix of healthy and sick individuals, and could therefore afford to keep premiums reasonable.

However, EVERYONE conceeds that you can NOT pass the ban on pre-existing condition discrimination through reconciliation.

That changes everything.

Without the ban, the private insurers will deny insurance to sick people freely, at will. These people will all go to the public option. This will force the public option to raise premiums so it can afford to cover a much sicker pool of people.

What will these higher premiums do? They will force any remaining healthy people in the pool out of the public option, and back to private plans (which for healthy people will be MUCH cheaper).

So at this point, the ONLY people in the public option will be those who are very sick. I don't think people understand just how much this will increase premiums. Premiums will literally have to cover all the care of everyone in the plan, with no healthy people paying in. If the average person in the public plan requires $3,000 of healthcare per month, premiums will be $3000 per month. If the average person in the public plan requires $5,000 of healthcare per month, premiums will be $5000 per month. There is literally no limit, as more and more healthy people leave to go to the MUCH cheaper private plans that don't have to cover sick people (which makes the public option pool sicker and sicker, and more expensive).

Would you like a public option that charges several thousand dollars per month? One that costs MULTIPLE TIMES what the next most expensive private plan costs? I don't think so.

The situation is EXACTLY the same with the Medicare buy-in. The Medicare buy-in will have to sustain itself off premiums, just like the public option would. For the above reasons, the premiums of Medicare for those that have to buy-in will be thousands of dollars per month (at LEAST). In fact, the situation would be even WORSE for the Medicare buy-in, because such a buy-in would be limited to older people.


In short, the ONLY way to have a sustainable public option and/or Medicare buy-in is to ban discrimination on the basis of pre-existing conditions. That prevents the above death spiral. And EVERYONE concedes that reconciliation will not allow such a ban.

[grantcart]

1. Not true. An expansion of Medicare could happen easily under reconciliation

It coud be done without mandates.

The way to avoid the problem of adverse selection that you are attempting to describe is by qualifying the gateway.


For example start with a limited open season - say 6 months. Everyone who wanted to buy in could do so but would not get another opportunity for 2 years (except if they were transferring from another plan in which case adverse selection would not be an issue).

Then have an extended enrollment period, the time from application until benefits start, for example 3 months.

On top of that have a waiting period. During the waiting period, lets say the first year, only a percentage of the costs would be underwritten.

These are some examples of how Medicare could be expanded, kept voluntary and not suffer from the "adverse selection" that you try to illustrate.

[BzaDem]

4. I don't see how that solves the problem.

People with pre-existing conditions will literally have no where else to go than the Medicare buy-in. If they have to wait 3 months, they will wait 3 months. If they have to wait 6 months, they will wait 6 months. If there is a waiting period, they will wait (and pay what they have to). The end result is a MUCH sicker pool than any private insurer.

The point is, what you are describing won't stop the adverse selection problem. Healthy people aren't going to buy into Medicare now because they are afraid of the waiting period. They are instead going to buy into private insurance now, since that will be much cheaper.

In fact, the waiting period would make things worse for the most part, because the people it is meant to deter will simply buy private insurance (meaning the consequences of the waiting period will fall almost entirely on people who need and want insurance but are too sick to afford it).

The only way I can think of that would make the public option work without community rating would be to have the public option itself deny people based upon pre-existing conditions. But what is the point of a public option if it has to act the way a private insurance company does just in order to stay alive?

[grantcart]

38. The problem is not people with pre existing conditions

The problem is adverse selection, which you try to describe.


The answer is that you have an initial open season that everyone can join with no waiting period and no enrollment period. Join today see a Doctor next month.

After that initial period anyone reaching the age of 18 would have a 60 day open season.

For the people that want to "game the system" and only sign up when they get sick there are ways to handle it, and these are common every day practices that work very well and solve the problem that you try to describe which is known in the industry as "Adverse Selection" http://en.wikipedia.org/wiki/Adverse_selection

People that held out because they wanted not to pay any money to join the plan would face limited open seasons, enrollment periods, and waiting periods so as to disincentivize the practice.

So the premise of your OP is incorrect. It is possible to use reconciliation to expand Medicare and make a buy in available. It is possible to avoid the problem of adverse selection by having an initial generous open season and then make future enrollments defer any immediate benefit so that people join a plan for a long term risk spreading contract and not simply to take care of the thing that is troubling them today.

Unlikely to pass expanded Medicare through reconciliation is our last best hope for anything decent.

[laughingliberal]

2. Reconciliation can be used to levy taxes also. HR 676 could pass under reconciliation

And I still believe there is a way to do pass public option under reconciliation. It would need to reduce the deficit but there is nothing to say a combination of taxes and premiums would not do that. Bush passed his tax cuts under reconciliation and we all know it did not reduce the deficit. It did reduce a surplus we had at the time. The only reason either of the plans you mention would have to sustain themselves on premiums they don't raise taxes. There are already plans to raise some taxes in the bills. Shuffle some of that revenue into the PO and there you have it. In fact, impose a windfall profit tax on the insurance cartels to fund it. Make the PO available to anyone who wants it. I would need a good number's cruncher for this but I'm willing to see taxes go up if we actually get health care out of it.

[BzaDem]

3. Raising taxes wouldn't fix the problem.

The adverse selection premium death spiral would cause the expenses of the public option to rise each and every year.

That means a tax increase meant to fund the bill would have to automatically increase every year. In other words, the income tax required to fund it would have to go up (as a percentage) each year. I don't think any income tax has ever been passed this way in the history of the US.

As for HR676, that might very well pass under reconciliation. The problem is that it doesn't have close to a majority in either house that supports it. I wouldn't be surprised if fewer than 25% of each house voted for it. In fact, if it got more than 20 votes in the Senate, I would be very surprised.

And for the public option, on top of the unusual tax it would require, I don't think a taxpayer subsidized public option would get a majority vote in either house. This would come a lot closer than single payer. But keep in mind that even the extremely watered down, premium-sustained market-limited public option only got 220 votes in the House. A taxpayer subsidized public option might get 150 at most.

[laughingliberal]

10. Private insurance premiums rise each and every year, too.

Tax the private insurance companies to pay for it.. They get 30 million new customers. They can afford it. Lift the cap on payroll taxes.

Basically, it's obvious we can't pass any bill which will help the American people with our bribed legislators but it does not mean there is not a way the bill could be done. The will to do the right thing is lacking.

[BzaDem]

12. The insurance companies will pass every penny of that tax onto consumers.

So the ever-increasing tax on insurance companies will become an ever-increasing tax on people's health premiums.

Lifting the cap on payroll taxes will indeed bring in revenue, but not nearly enough to support the adverse-selection-induced premium death spiral required for a public option or Medicare buy-in without community rating. You would literally have to lift the cap AND increase the payroll tax every single year for it to balance out.

[ChangeYouCanBelieve]

5. Pre-Existing condition Ban

> However, EVERYONE concedes that you can NOT pass the ban on pre-existing condition discrimination through reconciliation.

Why can't that issue be passed in a separate bill?

Also, the Bush tax cuts exploded the deficit, yet were passed via reconciliation.

Another point that I don't understand is the CBO calculation that only a very small percentage would take the public option. I don't see how they can estimate that number (without taking a poll) because many would sign up on principle if they could afford it.

[BzaDem]

7. That tax cut is going to expire now because of reconciliation.

In fact, a healthcare bill would have to expire within 5 years if it were to get around that rule like the tax cuts did. (This is because Kent Conrad refused to allow such a reconciliation rule in the budget unless the time window was reduced to 5 years. This cannot be changed now, since the budget was already passed.)

The CBO says a very small percentage would take the public option because no one who had employer insurance offered to them would be eligible for the public option. It was only open on the exchanges (to people in the individual market).

And the reason the pre-existing condition issue can't be passed in a separate bill is because it would be subject to 60 votes, and would be filibustered. Republicans would salivate at killing it, and Lieberman probably would too. Just because Lieberman supports such a ban doesn't mean he would vote to allow Democrats to pass a public option through reconciliation and then pass the remaining parts with his vote. Lieberman, as bad as he is, isn't that stupid.

[Hippo_Tron]

11. That's an unenforceable agreement, though

Reid can't just make an agreement with Lieberman that he won't later try to get a public option through reconciliation after they get all of the other stuff through the regular bill. Especially if Reid doesn't make that commitment public. Reid has no incentive not to re-neg on any such agreement and try to do a public option through reconciliation later on. If Lieberman entered into such an agreement then he's a fucking idiot. Although as you suggest, he probably isn't. They could pass a public option through reconciliation later on. And IMO given that 70% of the country supports one I think they ought to do that as soon as this bill passes.

[BzaDem]

14. It is somewhat enforcable.

Lieberman could demand a shell bill be passed that satisfies the reconciliation instruction. That would foreclose reconciliation for the current budget.

They might be able to pass a public option with next year's budget. The problem with this is that it would have to be passed a few weeks before an election for the timing to work. So technically possible, but probably not.

[ChangeYouCanBelieve]

18. The CBO says a very small percentage would take the public option

But aren't there many small companies/self-employed/industries that don't provide health care in the US? And isn't the list growing larger?

[BzaDem]

19. Yes, but the percentage is still very small. The large group market is MUCH bigger than the

individual market.

[laughingliberal]

13. I think if you have a public option that is in competition with the insurance companies

everything the insurance companies do is tied to the budget. It's a stretch but the justification is there.

[BzaDem]

15. I really wish you were right (and that we could somehow get community rating passed through recon).

Unfortunately, every single expert who knows far more than I do about Senate procedure says that it can't be done. In other words, that the Senate parliamentarian will say no. The parliamentarian has said no to lots of Republican initiatives (tort reform, ANWR, non-expiring tax cuts) so he won't be afraid to say no here.

[laughingliberal]

20. I do believe it is possible to replace the Senate parlimentarian

There would be no way to show an effect on the budget with tort reform or ANWR. And non-expiring tax cuts increase the deficit. I know it's a stretch and it, likely, wouldn't fly. But wouldn't you like to see someone stand up for it? Would not some sort of fight from the left be a refreshing change? I'm stressed and in no shape to research the ins and outs, right now and you're probably right. But a fight now would be helpful. It would be good if the White House found that selling us down the river comes at a price. Could be a deterrent in the future when mugging their base looks like a great idea, if nothing else..

[BzaDem]

23. If I thought it was a fight we could win, I would be the first one calling for such a fight.

The big difference between me and a lot of other people here (not necessarily you, I don't know your view on this) is that I am much more concerned with the outcome than the battle. Some people here would rather go down fighting for the optimal policy than accept a much less optimal one.

I totally disagree. On an issue this important, I care much more about getting the best policy that can pass enacted than I am about a fight for a better policy that cannot be won. (And to answer your question, yes, the parliamentarian can be replaced, but that takes a long time and the current parliamentarian's decision on the matter would not be reversed just because there was a new one much later. Republicans tried this in 2001 -- they got a new parliamentarian eventually, but the decisions of the old one could not be reversed and were used as precedent. So this is a fight we cannot win.)

I understand the benefits of fighting for what's right. But honestly, this fight has been going along for longer than you and I both have probably been alive. There was a huge fight in the Truman administration. There was a huge fight to enact Medicare. There was a huge fight in 1993-1994. There was a huge fight this year. There have been campaigns and fights over healthcare for decades, if not a century. If the choice is to prolong the fight and fail to pass anything, or end the fight now and pass the best possible bill that can pass, I totally am in the latter camp. We cannot wait another decade or two to insure 30 million people.

I am heartbroken that the 30 million people will have no public choice to pick. I really am; I am not kidding. I want the choice of a public option and I want everyone to have that choice. But I would be more heartbroken if the 30 million people had NO choice because they could afford it due to a lack of subsidies (of which the bill has 900 billion for them).

As much as I hate it, the structural properties of the Senate indicate that this is the absolute, best possible bill that can pass this Congress (and given the political realities of midterm elections, probably this presidency at the very least). If the structual properties of the Senate allowed more, I would guarantee you that Obama would demand and receive more. The bill's proponents in the Senate aren't stupid -- they are fighting for and getting as much as they possibly can. I am angry that this is the limit, but I am not going to let my anger about the system cloud my judgment about healthcare reform and insuring 30 million people.

[burning rain]

6. They could pass the Senate bill that's taking shape now by the regular procedure...

and then take up a public option under reconciliation. And another thing they really need to do, if they care to pass solid legislation, is abolish the 60-vote cloture rule in favor of simple majority.

[BzaDem]

8. They could very well do that, if they had 50 votes to do that.

They would have to wait until the 2010 budget resolution, but they could definitely do that. That's why we should pass this bill now -- because it is absolutely possible to add the public option later. And if there aren't enough votes for that at that point, at least we ended pre-existing discrimination and helped 30 million people get insurance (while we had 60 votes). The public option could also be taken up in future Congresses with reconciliation.

[laughingliberal]

16. I'm am not in favor of passing this bill in its current fomr at all

Promises to fix it later are a sucker's game. I think we've seen where trusting our leaders to live up to there promises gets us. Fool me once, you know.

[BzaDem]

17. What if it were this bill or GUARANTEED no bill for the next two decades.

I'm not asking you if you think there would be no other tries for the next two decades. I'm asking you to ASSUME for a moment that it is this bill or no bill for the next two decades. Given this assumption, would you really say no to insuring 30 million people through subsidies and banning pre-existing condition discrimination?

[Selatius]

21. I think the issue is the left is not seeing a "show of good faith" on the side of the right.

The left is being asked to accept an incomplete bill on the premise that it will be completed later. However, in any negotiation reaching a deal, both sides need to demonstrate concrete actions to show good faith in negotiations. OK, so the left conceded everything from single-payer to a robust public option to apparently no public option or even a Medicare buy-in in the Senate bill on the idea that a public option or something that is viewed as being better will be passed later on down the road.

What is the right wing willing to concede now, on the spot, to the left to demonstrate that they are negotiating in good faith and that they will allow a return to the issue soon after the bill is passed? The fear is the left accepts this bill now, and, like NAFTA, the "side agreements" are never implemented as promised. What people want is concrete actions, not promises. Words are too cheap. People want it backed up with something solid.

[BzaDem]

22. Oh you are absolutely right in that the right is not acitng in good faith.

They are acting in incredibly bad faith.

The problem is that the dynamics of this are not similar to a negotiation between two parties who want to get something done.

The dynamics are more like a hostage negotiation.

The right (in which I include Lieberman/Nelson/etc) really couldn't care less if a bill passes. They would have NO problem voting no. Therefore, they can demand the moon and the stars. Progressives, on the other hand, really want a bill to pass. This is because progressives are fundamentally people who want to help their fellow neighbors in need.

When one side really wants a bill and the other side could really care less whether or not there is a bill, the other side can demand anything it wants without compromising.

This is completely different than a normal negotiation. For example, in a normal negotiation for a labor contract, both the union and management want to reach agreement. The union doesn't want to have to strike, and the management doesn't want a strike. Therefore, both have incentives NOT to walk away, and this means that both have incentives to comporomise.

Here, one side has no incentive not to walk away.

These dynamics are dynamics that we cannot changed. They are ingrained into our political system. The question is, given these dynamics, do we want to foreclose the opportunity to insure 30 million people because we would otherwise have to agree to every one of Lieberman's demands? I don't think so. I can't stand Lieberman as much as anyone here, but I want to help 30 million people more than I want to politically hurt Lieberman.

[laughingliberal]

24. I think passing this bill is tantamount to killing off what shreds of a working or middle class are

left in this country. So, sadly, if it were this bill or nothing for the next 20 years kill it. I, truly, believe this bill is nothing less than the transfer of the last shreds of money held by workers and middle class Americans to the top. They're just cleaning up any scraps they might have left behind during the theft of our money over the last 3 decades. Even if this bill would do what you think it will do, and I do not think it will, it is too high a price. And I am one of the people (the few) who, actually, would be helped by it. Yes, I would have health care under this bill due to the expansion of Medicaid. I am 54 years old, sick, and without health insurance now. And it is still the wrong bill for the majority of the country.

I don't believe 30 million more people will be covered. 30 miilion more might be eligible to be covered but I don't think the reality is that we will actually see 30 million more people with health insurance. The cost of the premiums will be too high for most people. Well off people who have a preexisting condition will be helped. That is, those people who can afford it but are shut out due to a preexisting condition. I don't think there are many of them. I have some friends who are well off, in their 50's, with some health problems. Their premiums are $2000. Those who are, currently, falling just outside the guidelines for Medicaid will be helped. Those people who fall around around the 400% of FPL may be able to swing it, with some difficulty, with the subsidy. Some of the ones near the bottom of the income range for subsidies may or may not be able to lay out 10% of their AGI for health care without cutting back on essentials. The government's idea of what constitutes poverty is desperately low. There are people who are not in poverty, by the government's definition, who are homeless and hungry. But the real hit is coming to those who fall just outside the guidelines to receive a subsidy. Let's look at a couple. That's easiest for me cause I'm part of a couple with no children. When I lost my job we practically starved to get the premium for COBRA paid because my husband had just been diagnosed with prostate cancer and had not been treated yet. Our premium was $1200. A couple making $58, 280 AGI is at 400% of FPL. If they make $58,281 a year, no subsidy. So, assume that couple has a $1200 a month premium. That premium is 25% of their income. If you think about the fact that a workable household budget is one which allows 25% of your income for housing, that premium is tantamount to buying a second home. How many people do you know at those income levels who own 2 homes? In my part of the country, $1200 is a fairly typical mortgage payment. How would a couple, even at $70,000, be able to pay 2 mortgages of that magnitude? What of those who have premiums of $2000 and are above 400% of FPL? We haven't even talked about the fact that these policies will still have out of pocket costs, some as high as $10,000 per year. These people are screwed if they get sick. We are still looking at medical bankruptcies. As for coverage, it is criminal that, somehow, the ability of insurance companies to place annual caps on treatments for certain illnesses is allowed in this bill is criminal. Don't even think about getting cancer. Not only that but that horrible Republican idea of letting these crooks sell across state lines made it in there.

This bill may lower costs to the government. But it is not going to lower costs for most people or businesses. And it will increase costs for younger people. More and more businesses are dropping health care benefits for their workers. This will continue. The fines they will pay for not covering their employees are not going to be enough deterrent, at some, point to keep paying the rising costs. Assuming that many businesses do continue to cover their employees, wages will continue to stagnate, just as they are now, just as they have been for a couple of decades or more due, largely, to the rising costs of health care benefits. There was an opportunity here to pass a bill which would have solved not only our health care crisis but would have improved the overall economy for workers and businesses who provide benefits. It could have boosted our businesses competitiveness in the world and put our workers back on the road to financial stability. It's not what happened and I do believe we will see negative ramifications of this bill throughout our economy. It will hurt more than it will help. Yes, that light you see at the end of the tunnel is a train heading straight for you.

[BzaDem]

25. First of all

Under this bill, people at the bottom of the income range for the subsidy will NOT have to pay 10% of their AGI. They will have to pay 3% of their AGI. The percentage of one's AGI that goes to healthcare ranges from 3% to 9.8% linearly from 133% of poverty (below which you have Medicaid) to 300% of poverty, and then the limit is a constant 9.8% of AGI for 300% to 400% of poverty.

You are correct that those above 400% of poverty will not be helped (at least in terms of subsidies). Those with pre-existing conditions will be tremendously be helped (their premiums will probably be reduced by a factor of 5 or more), but those without pre-existing conditions at 400% or more of the poverty level won't be helped.

But how is this possibly a justification for not helping people from 133% of poverty to 400% of poverty (and the expansion of Medicaid from 20% of poverty in some states to 133% of poverty in all states)?

No one saying this bill is perfect and helps everyone. But why deny help to a HUGE segment of the population just because it doesn't help the rest?

Honestly, 900 billion is pretty cheap to cover 30 million people. How are the costs too high?

Even the mandate is not that onerous. If you don't buy health insurance, you get taxed up to 700 dollars a year. This 700 dollars gives you the right to sign up for health insurance on a moments notice the minute you get sick, even if you went without insurance for years. As opposed to right now, where if you wait to buy insurance for any reason, you either get no insurance or go bankrupt trying to get it. You really think that this tax (and associated benefit for allowing late signups when you are sick) is so bad that all the help for all the millions of people should be thrown out?

Your arguments are very persuasive if you are arguing that we should do a lot more. But I don't think apply very well to my question, which was if it was this or NOTHING, why kill this? I think your arguments still assume that we could actually do something better, and my question specifically foreclosed that possibility for the sake of the question.

[laughingliberal]

26. I really do believe it is worse than nothing

I do not think HUGE numbers of people will be helped. And why would I believe anyone will see a reduction in their premiums? Our tax dollars will go to help some cover their premiums but the premiums will remain high and will go up every year. There is absolutely nothing to force the insurance companies to lower their premiums in it. They will keep the high premiums they have now for their older policy holders and divide by 3 to get the lowest rate. We are not dealing with an industry known for dealing in good faith. They are thieves and murderers and we have people here who seem to think it's a great idea to turn our money and our lives over to them. They still get to cap benefits annually. And you are quick to dismiss those above 400% of the FPL who will not be able to afford coverage. That is a lot of people. Who are these people? They are the sole proprietors of a locally owned business that employees two people. They are the independent contractors who work on commission. These are the people who are left in the working and middle classes. This is the money they would spend on something which might create a job down the road. These are the people who can, every few years get a car. They might go out to dinner once a week. They buy and dry clean clothes for work. What happens when even that dries up? If money does not get in the hands of the workers and the middle class and get spent this country is dead. How in the name of all that's holy is an economy that is on life support ever going to come back when the working and middle classes will never be able to spend anything again? What will drive our economy? Are we really prepared to give the last of the money anyone has to the insurance industry? Really? And that's not going to tank the economy? And talking about people being able to sign up for health care at the drop of a hat still assumes they will have the money to buy it. We have people who will, perhaps, just be getting employed again, at the point this mandate kicks in. And this is what we burden them with?

We already have a huge disparity of wealth in this country, higher than the levels we saw just before the depression. Transferring what's left of the pittance that is still circulating out here to another greedy, for-profit industry is economic insanity. Another huge transfer of the money out of our hands to an industry that provides no value? And they put nothing in there to attempt to assure anyone gets anything for their money? Is there even anything in there about mental health parity? For a population that is enduring economic catastrophe in their lives. Is there any help for them for the depression and PTSD we are seeing all around us? Are we to just keep watching the suicide rates climb? We are going to force people just crawling out of a hole to spend that amount of money on a crap policy that will still limit their benefits for serious illness? Have they lost their minds in the Senate? I know I'm ranting but this is a disaster with more unintended consequences than I think anyone realizes at this point.

Another nightmare scenario is this one: you're a couple. You're making $58,280 dollars a year. You have a subsidy and your premium is around $5800 a year. It's tight but you're making it working your ass off, hoping for a better future. You would like to put money into your 401K but there's really not any there to save since you started paying for health insurance. Your annual evaluation comes up. You are, for the first time in a long time, getting a raise, not much but the first one in a while. You get 5%. Not a lot. A little over 200 per month. Great, I got a raise! Uh oh! Subsidy gone. You're on the hook for the whole shebang, now. Your premium is $14,400 per year. You're worse off. You won't see another raise for a while. How many years will it take you just to get back where you were before that raise? It is a working and middle class destroying bill. I can't believe they can't see it. I'm not sure they don't see it, actually. There are times I think it may be the point of the whole thing.

[BzaDem]

27. It depends on whether you think 30 million will be huge.

I am quick to dismiss those above 400% of FPL because it does not hurt these people. It helps other people. I am arguing that the bill is better than nothing, not that it helps everyone.

I just don't buy your transfer of wealth argument is a justification for killing the bill. The bill will most likely have a 15% cap on profits for insurance companies, and in reality their profit margin is lower than that. So only a small portion of all this money will go to insurance companies. Most will go to providers (hospitals, doctors, etc). Honestly, that is the real problem. Insurance companies are disgusting and they take their cut off the top (unfairly), but most of the money goes to providers and provider gouging is really what is driving up costs.

Your 401K argument is a valid argument, but that is going to be true with ANY system with sliding scale subsidies (even with a public option). There is always going to be a line (400% FPL in this bill, higher or lower in any other bill) like that.

I don't think we are going to agree. But thank you for having a civilized discussion about substance (which seems to be getting rarer and rarer here).

[laughingliberal]

37. I think the 30 million number is an overly optimistic calculation by an administration which wants

desperately to say they reformed health care and people who have no idea what kind of money people in the real world actually have and how far that money goes. For God's sake, our government sets the federal poverty level at $10,830 for a single person. Someone living on 11,000 a year is not in poverty? Where do they live? Under a bush?

I think the fact that we are looking at widespread impoverishment in this country as the result of the premiums people will be forced to pay is alarming. We are already seeing the destruction of the middle and working classes. As for that cap on profits, we all know they play fast and loose with those numbers. Regulate them? That's working out so well with the financial sector. Provider gouging is an issue and they did diddly to address it. I hate the for-profit hospital corporations about as much as the insurance companies. We, the people who have been working harder every year for less money are now looking at another chunk out of our limited resources to buy, under penalty of law, a product which will give us little return. With the scrapping of the ban on annual limits to coverage, this coverage will be little help with a serious illness. I worked as an RN for 25 years. One good heart attack or a serious cancer and you're out of the game in short order with an annual cap. The people who need the most help will still be left in the cold. And, with the out of pocket expenses, bankrupt to boot. This bill is, at the very best, a bandaid. Is it better than nothing? Maybe, but the far reaching implications to the economic structure has more far reaching ramifications than the amount of help it provides would seem to warrant. I know we disagree. I, actually, hope I am wrong because they are going to stick us with this monster and there is nothing we can do about it. And, I'll be able to have Medicaid and have nothing now. Guess it's just the nurse in me. It's never been all about me.

Thank you, also for the civil discussion. I also have found it in short supply, here.

[burning rain]

41. Other than blind faith, there is no reason to believe they'll pass public option later,....

if they don't now. And the fact that they aren't now, shades against belief that they will in future. Also, a significant part of the rationale--certainly, it seems, the administration's--for public option was that it was viewed as a concession to liberals to keep them on board, not one's own preference. If the current bill passes first, why make the concession to liberals later? And, if the current bill passes first with an individual mandate, private insurance companies will have all the more incentive to fight public option later so as to preserve their stranglehold on captive market, not that they lack incentive and determination now. What might be smart, is for Senate liberals to postpone passing the current bill until public option's been passed via reconciliation. That, or ditch the individual mandate and pass the current bill, expecting that the administration and senators in the middle will withdraw their weak support for public option, killing its chances for passing later.

[SeattleGirl]

9. Never thought I'd see the day when facts were as anathema to DU

as they are to FreeRepublic.

Guess I was wrong.

[H2O Man]

28. Or what if

the sky were falling? Would DUers REALLY like to pay millions of dollars a day, because the sky was falling? Do DUers even HAVE a few million dollars to pay each and every day? I think it is much safer to trust Joe Lieberman. We can't afford not to.

[MadHound]

29. Or we could simply have Obama, Reid and/or Pelosi provide strong political leadership

Then we could get this legislation, including a strong public option, passed the old fashioned way. Gee, what a novel concept:eyes:

But that's not happening, so we're going to be saddled with a POS bill that's going to impoverish the middle and working class in this country and continue the upward transfer of wealth.

[BzaDem]

30. This "political leadership" argument is bullshit and most people know it.

There is nothing Obama, Reid, or Pelosi could do to get Lieberman on board. Lieberman would be happy pissing on all of them. Passing legislation is always a hostage negotiation with the last few votes. It always has been, and it always will be.

[MadHound]

36. No, actually it isn't

You don't need Lieberman on board, you don't need sixty votes, you don't need reconciliation or the nuclear option. You need fifty one, count them, fifty one votes in the Senate to pass this bill.

So the 'Pugs are threatening a filibuster, let them, bring it on. Use this opportunity to blast them for being obstructionist know nothings, do nothings. Let Obama use the bully pulpit of the presidency to show American how utterly bankrupt the Republicans are morally and intellectually. LBJ did this during the debate on the Civil Rights bill, and guess what, it worked.

Let us stop being scared little mice, jumping at our own shadow. We've got a large majority in both houses of Congress, along with control of the White House. Let's start acting like it, take the fight to them instead of meekly going along with whatever stupid shit the 'Pugs come up with.

[walldude]

39. No shit! You never heard the goddamn Republicans

whining that they needed 60 votes. This is pathetic.

[lonestarnot]

31. Fuck their ban on pre-existing wouldn't have to be bothered with their crap.

[sendero]

32. You are an idiot or a paid shill..

... Medicare delivers care with a 3% overhead, private insurance with 25-27% depending on who you believe.

Basic math says that what you are saying is COMPLETE BULLSHIT or more likely PAID LIES.

[BzaDem]

33. The bill will most likely not allow overhead to exceed 15%.

But you likely don't care about facts, since you instead decide to question my motives. Good day to you.

[sendero]

34. Oh wow..

... than you kind sir only 5 times what Medicare costs rather than 9.

You must be some kind of idiot if you think anyone is buying what you are selling.

[mainer]

35. You actually make sense. But I'm so confused about it all.

I trust Howard Dean, but I think you raise some really good points. I agree that having a PO would only encourage private insurers to dump the sick -- and it will push Medicare into a truly expensive realm.

In the end, it looks like we need either all-PO or it won't work.

[Nikki Stone1]

40. Bza Dem: You're right about the math. This is why the mandates are the cornerstone of this bill.

Of course, we are assuming a mostly ethical insurance industry that will go by the numbers. And the truth is that you have to get the healthy people to pay for health insurance when they don't need it to subsidize the the older or sicker people who need their health care paid for. No question about that. That's why there are mandates in the bill, and why every single American is required to buy in.

The problem comes NOT in the numbers (they will work out) but in trusting the health insurance industry, which has already demonstrated that it won't cooperate unless a new law actually makes them far better off than they are now. They DON'T want to take sick people with pre-existing conditions, and even though the bill says they'll have to, they can still charge more under certain circumstances. They DON'T want price controls of any kind or any kind of oversight or any kind of competition. You need one of those three to keep this lying industry honest. You either limit the increase in premiums by a fixed percentage, which the government has the right to do because it is mandating a customer base, thereby interfering with the free market; or you have intense oversight, which will require a new bureaucracy of accountants, statisticians and the like, and a special IG for the health insurance industry; or you have to provide a public option which will force a competitive situation. Without any of these options. the insurance industry gets the benefits of a free market without actually having to struggle in the free market; they are being fed customers who can be fined or possible jailed for not buying their product. (And yes, jail is possibility. Not paying IRS fines can also land you in jail.)

Finally, the insurance industry is already proving that it is completely ungrateful for its government sugar daddy. Wellpoint is suing the state of Maine because it's not making enough profit.

http://seminal.firedoglake.com/diary/8735

Just wait until they sue the US government to increase premiums way beyond the public's ability to pay. Which side will Congress be on in that battle?

This plan is flawed not because of the numbers, but because of the sheer greed and immorality of the health insurance industry. As it stands now, the private sector is not the solution to healthcare for ALL.