The Facade of Reform (Health Reform Part 2 of 4)

[Political Heretic]

(NOTE: - the original source contains hyperlinked text linking to additional resources and references. Please click on the link below for full review.)

Previous Parts:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7956377">Part 1: The Trillion Dollar Wealth Transfer

LINK:http://practical-vision.blogspot.com/2010/03/facade-of-reform-health-reform-2-of-4.html">The Facade of Reform (Health Reform 2 of 4)

By Political Heretic
March 20, 2010

National Nurses United, the largest Nurse’s Union in the United States, issued a statement following the passage of the Senate insurance (health care) reform bill in December, opposing the bill and explaining in meticulous detail the critical flaws in the legislation. They called it an insurance give away, and they were right. Using the NNU’s detailed analysis as reference, with updates and additions relevant to the current state of the legislation, the breakdown of critical failures in current legislation are as follows:

One: An individual mandate, forcing everyone to buy private insurance, can only work effectively when there are strong cost-protection mechanisms to contain high premiums, deductibles and out of pocket costs. This bill contains no such mechanism. It quite literally says next to nothing about cost control.

Yesterday, an amendment that Senator Dianne Feinstein (D-CA) hoped to introduce in to the Senate reconciliation process which would have granted the federal government the power to review and regular premium increases was ruled out of bounds for the reconciliation process by the Senate parliamentarian. Translation: yet another cost containment mechanism was defeated and thus absent from insurance reform.

Two: While insurance reform claims to provide affordability, for millions of American families it does nothing of the sort (will be discussed further in part 3 of this blog series.) Insurance reform does not address overall cost-of-care proving neither regulatory oversight of increases to health services nor sufficient relief for out-of-pocket expense.

Choosing only to focus on reductions in premium costs for families, insurance reform practically guarantees that millions of families may carry an insurance plan, but will not be able to afford to access substantive critical care in a crisis due to stifling costs. For millions of families, the choice after insurance reform will be the same as the choice prior to insurance reform if ever faced with a prolonged medical crisis: Bankruptcy.

Four: The excise tax on so-called “Cadillac plans” – a euphemism for comprehensive quality health care plans – starting at $24,000 (up from $23,000 after a deal cut on January 14, 2010) encourages families to reduce their health benefits while encouraging providers to trash their most comprehensive coverage plans.

Far from targeting only elite coverage options such as $40,000 plans held by top CEOs, this tax cuts into the middle-class. The NNU cites a a Towers-Perrin survey from September 2009 which found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.

Five: Major loopholes exist in the legislation that allow insurance companies to continue many of their most offensive practices. One of the major talking points of insurance reform has been that it would finally ban denial of coverage based on a pre-existing medical condition. Unfortunately, rarely has the full truth of what the insurance reform bill would actually do been told.

For example, few know that the ban on denial based on pre-existing conditions would not take effect until at least 2014. In the meantime, people that private insurers refuse to cover would be shunted into a low-end “catch-all” insurance group and be weakly covered (definition of “weakly” unspecified) in the interim. This gives insurance lobbyists at least four years to work their magic on congressional representatives hungry for their cash.

Six: While the insurance industry may not be able to outright deny coverage to persons with pre-existing conditions after 2014, they can charge you double if they decide you are high risk. Quoting the NNU directly, “Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.” It gets worse. Insurers are allowed to charge up to four times normal pricing based on age and certain conditions that are excluded from the “pre-existing” category. And it gets even worse.

Seven: The main tool the insurance industry currently uses to illegitimately deny claims is by accusing the policy holder of “intentional misrepresentation or fraud.” By now most people have heard the horror stories of people denied coverage for life saving medical treatment because their insurance provider claimed that they failed to disclose something like having acne as a teenager, and that constituted “intentional fraud.” As soon as a person or family files a major claim, Insurance companies immediately investigate for any technicality they can find to claim “misrepresentation” and then cancel the policy. There is nothing in this bill that even addresses this most common exploitative practice of the insurance industry.

Eight: In perhaps one of the most stunning features of insurance reform is that oversight of denial of claims by the insurance industry is minimal – next to zero. Denying claims is the normal business-as-usual practice of the insurance industry. Every claim denied means more profit for the corporation. No one I have encountered seems able to explain how an industry predicated on looking for every opportunity to deny health coverage to people who need it translates into quality health care.

The California Nurses Association conducted analysis which showed that one in five claims were rejected by the the state’s six largest insurance providers. One in five. You can bet that picture is little different across the entire country. Current insurance reform legislation does little to address this nightmare.

Nine: One of this most crippling costs to families related to health care is the price of prescription drugs. Yet thanks to backroom deal-making between the White House and the pharmaceutical lobby, promising to strip any legislation that let the federal government negotiate for lower drug prices. In fact, the Senate was considering an amendment that would have allowed precisely that. But it was eventually killed after pressure from the Obama administration.

Ten: Current legislation establishes a tiered system of health care, in which poor families receive meager coverage while wealthy families able to afford top-tier options receive the highest quality coverage. These insurance tiers in the propose exchange are even offensively named “Gold, Silver and Bronze” tiers. What class of citizen will you be when it comes to health care? Second Class? Third Class?

Worse still, the Senate version of insurance reform contains little federal oversight of exchanges, instead allowing states to create and oversee their own exchanges with minimum federal regulation. This means the quality and effectiveness of the exchange will vary widely and depend exclusively on each individual state’s commitment to social investment programs. Arch-conservative states that seek always to sabotage such programs will not doubt establish exchanges which punish working families while allowing private insurers to reap exponential profits.

Oh, how things have changed since so many of us cheered on Election night 2008. While it is true that some Americans will benefit from this insurance legislation given their current situation, millions more American families will continue to face costs of care beyond their ability to pay, denials of claims when they need coverage the most, wrongful policy terminations due to corrupt practices of insurance companies, third rate standards of coverage because “Bronze” is all they can afford, and on and on and on.

Anyone who claims that this current insurance reform legislation looks anything like the health reform we were promised back when now President Obama was just candidate Obama is simply lying. Worse still, this legislation does long term harm by entrenching a failed and corrupt system of private exploitation of the health needs of ordinary Americans, doubling down on our collective health nightmare, and virtually guaranteeing that our children will be faced with twice the health care crisis we face today.

That is not change anyone should believe in.

“Desperation to pass a bill, regardless of its flaws, has made the White House and Congress subject to the worst political extortion and new, crippling concessions every day.” - Deborah Burger, Co-President, National Nurses United

Coming Soon:

Part 3 – The High Cost of Reform
Part 4 – Is Something Really Better than Nothing?

[OhioChick]

1. Bookmarked for later..

Thanks for posting.

[Lydia Leftcoast]

2. Most of the people I've talked to who are FOR this bill

don't actually know what's in it.

They THINK it sets up a Canadian or European system in the U.S. They THINK it will immediately enable people with pre-existing conditions to buy affordable insurance. They THINK that it applies to existing policies as well as to new ones.

[Political Heretic]

7. I think the lack of transparency is deliberate

Perhaps that's the wrong way to put it.

But it is entirely possible for politicians to explain this bill to Americans is crystal clear terms, but they don't. And I can only assume that's because they're afraid if they did it would become even more unpopular than it already is.

[LibDemAlways]

20. The media is doing an excellent job of not telling Americans what's

in the bill. Suspect they are waiting to spring it on the public after it's signed in order to bolster the R's in the fall. My take, anyway.

[Political Heretic]

22. Agreed. Well at least on the first part.

I don't know if their political agenda is that specific or not.

[LibDemAlways]

26. I can't think of any other reason for not offering the public the

information in advance. They are deliberately laying low and waiting for Obama's signature before they start running headlines like : Unpopular Mandate Angers Voters - Will Be Overturned, Republicans Promise.

[Political Heretic]

33. Yeah, well - I'm sure that's true. They do that as much for the ratings and to

"manufacture" drama as they do because all journalists are secretly plotting for republicans to win. I'd say the media was phenomenally favorable to Obama in the election because it was a great story and great for ratings. I think ratings and $ drive them even more than political ideology.

[LibDemAlways]

40. No doubt. During the Bush years I mentioned the pro-Bush bias

in the media to a friend who works for CBS news, He said the same thing - it's ratings driven. Whatever sells. Although I do think there's some self-interest that filters down from the rich guys at the top.

[Name removed]

56. Deleted message

Message removed by moderator. Click here to review the message board rules.

[LibDemAlways]

60. That sums it up. They sell us out to a bunch of criminals behind

closed doors and leave a furious America with its pockets picked who will punish them by electing a bunch of Repukes, who will further sell us down the river. It's a fuck-up of major proportions.

[ProSense]

3. Points one and two

The country's largest nursing organization, representing 3.1 million nurses, supports this bill:

ANA Urges Passage of Health Reform Legislation

03/19/10
The American Nurses Association (ANA), the largest nursing organization in the United States, urges lawmakers to vote ‘yes’ on health care reform this weekend. This historic vote represents a rare chance to effect change that will positively impact people’s lives. This legislation will enact very real and much-needed insurance reforms, placing a new focus on wellness and prevention, improving access to primary care and expanding coverage to over 30 million people.

Single payer is mandated, and for a reason:

Mandatory Insurance Enrollment
Single-payer insurance systems in industrial countries typically have mandatory enrollment that include the entire population. Low- and middle-income countries, with a higher share of rural and agricultural workers and other workers outside the formal economy, may have difficulty assuring compliance with an insurance mandate for the entire population.

Adverse Selection
Adverse selection presents a long-term threat to the viability of microinsurance pools and any other multiple-payer insurance system without adequate safeguards. The health insurance system presents low- and middle-income countries with a difficult dilemma. There are two feasibility concerns to balance: insufficient financial and administrative capacity to establish a single insurance pool, and adverse selection concerns with multiple insurance pools. One general compromise that has been advanced is the formation of multiple insurance pools with an eye toward building the capacity needed for a future single-payer system (WHO 2000). For example, an insurance pool covering only public sector employees could later be expanded to include the entire population. This, however, could encounter practical difficulties. For example, the public sector benefits may have to be reduced in the future to make health insurance affordable for the entire population.

PDF

[Edweird]

5. This isn't single payer. If it was, I would support it. This is a RW screwjob.

It's 2 steps away from single payer, not a step towards.

[ProSense]

10. "This is a RW screwjob."

That's BS hyperbole.

[defendandprotect]

13. That's exactly what Howard Dean said of it: "A Romney-type bill" . . "NOT HCR" . . .

[ProSense]

14. Howard Dean: "A lot of important things in this bill that will make it worth passing."

Howard Dean: "A lot of important things in this bill that will make it worth passing."

[defendandprotect]

42. Evidently everyone has been told they need to save Obama's ass . . .

"Can't allow the president to be delegitimized" . . .

Wow! and most of us thought this was about getting health care to all American

citizens -- equally!!

[Edweird]

53. If he wasn't pushing far right policy, he wouldn't be in deep shit.

[Edweird]

35. No, it's not 'BS'. Where did 'individual mandate' and 'benefits tax' come from? Republicans.

They've been FOR that long before they suddenly decided to be against it. That's why Obama clearly and articulately OPPOSED it during his campaign.

[area51]

63. +1

The first person I ever heard say that we needed a law to force people to buy private, for-profit, unregulated health insurance was Newt Gingrich. This bill is Gingrich's, and the idea should be called GingrichCare; this is a republican wet dream.

[Edweird]

67. I got your 'hyperbole' right here:

http://healthca.newamerica.net/blogposts/2008/reform_newt_gingrich_on_free_riders_and_the_individual_mandate-18127

"Gingrich appears to get this, as did fellow Republicans Arnold Schwarzenegger in California, and Mitt Romney in Massachusetts. Romney made the individual mandate central to his state reform proposal while he was governor of Massachusetts, and confronted this issue head on in a Wall Street Journal op-ed, during the heat of the health reform conversations in his state. "Some of my libertarian friends balk at what looks like an individual mandate," he wrote. "But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian."

The reality of an individual mandate (when coupled with subsidies so that insurance is affordable and market reforms so that coverage is accessible), is that it would not only address the "free rider" problem, but also serve as a tool to enhance insurance market competition. When combined with market reforms and subsidies, the mandate would help move insurers away from a business model that relies on marketing and underwriting and towards a strategy that involves competing for customers based on performance and price. This is a good thing...and something those in favor of market competition could get behind."

[Oregone]

19. Why do you talk about single-payer being mandated? Its so moronic

You want to point out the intersections, but never the differences. Single-payer is an entirely different egalitarian solution. This is a private, for-profit, multi-tiered system, in which the care you get depends on your wealth (yes, even after this reform).

So what...yes, there exists a fair system where everyone gets equal state insurance, and your contribution is proportional to your income. Yes...but so what? Thats not this system, and you damn well know it.

Moronic.

[ProSense]

21. Moronic is believing that universal coverage can be achieved without a mandate. n/t

[Oregone]

23. Who believes that? Thats a straw man (again)

Perhaps some believe that it isn't worth a fancy title "universal" (which it wont be anway) if you are forcing people into an unfair, unethical, bloated, inefficient, for-profit, multi-tiered system thats designed to cause economic rationing among the lower classes.

You pro-mandate people want to run around and pat yourselves on the back for getting to label something "universal", and thats what this is all about for some of you. Others care about social justice and good policy.

[ProSense]

25. "some believe...if you are forcing people"

Of the nearly 300 million people in this country, nearly 177 million of them are in this system. They are not going to be forced into it. The nearly 50 million people who are uninsured and not going to be outraged because they gain access to a reformed system.

[Oregone]

28. When yo utake away an alternative, you are forcing.

[ProSense]

31. The status quo includes an alternative? n/t

[girl gone mad]

32. The status quo includes many alternatives.

Millions of uninsured people have access to health care. This bill makes no distinction between them and those with no care. It simply pushes everyone into the wreck of a system.

I can promise you that a lot of uninsured people are going to be upset about being pushed into the system against their will.

[Oregone]

37. Parallel

Imagine committing yourself to an insane asylum (this one probably hits real close to home for you).

Then, lets say after a year, you want to leave and go about your life in a different manner. If the doctor does not allow you to leave, you are being forced to stay there despite your wishes otherwise.

A mandate forces people into a single option and strips them of the ability to decide (which subsequently, augments the demand curve in a market scenario). To do this into an unfair system is irresponsible and unforgivable.

You know it and I know it. You weren't so hot on mandates either last summer too when you thought they'd be dropped from the plan and no one cared about them. Well, apparently, you care now that you need to toe the party line.

[Oregone]

38. BTW, nice deflection from the original point: the dishonest comparison of for-profit to single-payer

Deflect, obfuscate, and misconstrue...its about all I see anymore from you

[defendandprotect]

43. Nice post -- thanks!

[suffragette]

27. This bill is not single payer

But then, you already knew that.

[defendandprotect]

44. ...it's not even Health Care Reform . . .

[suffragette]

50. It should really be called HIA

Health Insurance Act

[bread_and_roses]

51. How about "Insurance Profits Protection Act?"

I think that's even more accurate.

[Mithreal]

65. +1 The fabulously wealthy weren't going to subsidize themselves.

Insurance Industrial Congressional Complex profits were unsustainable. Cheers to Obama for once again protecting the welfare kings, he's a free market sorta guy, you know, one of them.

That's why - as soon as Hillary left the race - he went on CNBC and assured big business: "Look: I am a pro-growth, free-market guy. I love the market."

That's why he declared to the New York Times last March that his economic policies were absolutely not socialist, but rather "entirely consistent with free market principles."

That's why during his 2008 "I love the market" interview on CNBC, he shunned the "populist" label.

http://www.commondreams.org/view/2009/09/24

Take a look at all the proposed free trade agreements. Obama just took a deal for access to 7 military bases in Columbia for support of the FTA there, but the Obama folks have been busy in Asia too. Find out for yourself, before you lose your job.

[suffragette]

68. Agree, IPPA is more accurate.

[defendandprotect]

75. Sadly, yes . . .

:)

[enlightenment]

4. Thank you for posting, Political Heretic. nt

[Edweird]

6. Imma buy you a rec.

[defendandprotect]

8. America wants MEDICARE FOR ALL -- public, doctors, nurses -- even Catholics, even Republicans!!

Meanwhile, what we're getting according to Howard Dean is "NOT health care reform" --

but "a Romney-type bill."


Further, how are DU'ers glossing over the news that Obama sold America and its citizens

out long ago in private deals with insurance companies and Big Pharma --

How is this being ignored?

And now we're supposed to protect Obama's ass against a GOP assault as a reward to Obama?

Humorous!!

Remember when Cheney made private deals at the White House with the energy companies --

disgusting -- everyone at DU could get it .

Evidently if there's a "D" after your name -- or if you're a "chess playing" president! --

it's all quite different!!

Still smells like betrayal to me!!

[defendandprotect]

9. Thanks Political Heretic . . . these reports should be "sticky's" . . ..

[defendandprotect]

11. Why don't we just get together and buy some doctors and hospitals . . .I mean the public!!

This is such extreme farce and BS that there has to be a way around it!!

[sixmile]

15. Buy a Doctor?

That is probably a better idea than many I've heard coming out of congress.
Municipalities could pool money together for community health centers and actually own their own health care.
Intricate surgeries and complex health problems could be sorted out at teaching hospitals or universities.

[snot]

17. That is exactly right. Like a credit union, only it's a healthcare union. Until WE own it,

THEY own us.

[Political Heretic]

30. Agreed.

[defendandprotect]

47. I've also been suggesting that we get Erin Brockovich to represent us . . .

I mean ALL of us -- the whole lot of us/the public!!

Let's start paying for lobbyists to bang on the heads of Congress on our behalf!!

The real difference between the elites/corporates and us is that they're organized

and we're not -- MOBILIZE!!


:evilgrin:



Meanwhile, Obama is making back room deals with insurance/big pharma

much as Cheney made with energy industry -- and we're not pissed????

Evidently, if there's a "D" after your name, you're on sacred ground????

Overall, it raises the question of why we're even bothering to elect a Congress

when everything is being taken out of their hands . . . they're essentially Mafia run.

[sixmile]

12. K&R

Ready the defenders!

[Starry Messenger]

16. Excellent series, thank you PH.

[Hannah Bell]

18. kr

[LibDemAlways]

24. Thanks for these posts. It's laughable how so many on DU

have their rose colored glasses firmly affixed and are convinced Americans are going to be effusive with praise for Obama and the Dems once this is signed. Suspect by fall the Dems will be desperately trying ass covering maneuvers as the R's score political points bashing them with the mandate. They had a chance to make a difference and give the American public affordable healthcare, but they chose to enrich the coffers of the corporations.

[Political Heretic]

29. Will-to-believe is powerful.

[defendandprotect]

48. Evidently the theme "save Obama's ass" has been being played ....

Kuchinich seems to be echoing that line of play . . .

"We can't let the president be delegitimized!" . . . !!! hmmmm

and here we thought it was supposed to be about health care for Americans!!!

[LibDemAlways]

55. Dems who think they are saving Obama or themselves by voting for this POS

are clueless. They are inflicting major damage on their political futures and are apparently too blind to see it.

[defendandprotect]

74. Agree -- + had Obama/Dems gone for Medicare for ALL . . . they'd be set next 40 years!!

Obviously, that had to be overlooked for something more important!!!

Making insurance and Big Pharma wealthier!!

[ipaint]

34. Thanks for these posts, looking forward to the next two.

Too many of the gatekeeper class and most politicians are heavily invested in the for profit companies that will make a mint on this legislation. The idea of health care for all would hit them too hard in the pocketbook.

In the end it is always about the money and any plan that even begins to include all Americans regardless of class would require a massive redistribution of wealth from the top to the lower classes. That is impossible given the corporate control of the government, all media and the elections.

[LWolf]

36. This is not change that I believe in, to be sure. nt

[goclark]

59. It sure is change I can believe it and millions of others are with me!

Give it a break!

[LWolf]

64. No, I won't be "giving it a break," but thanks for your warmly meant suggestion. nt

[Better Believe It]

39. Passing this health insurance industry bill will guarantee a Republican landslide in 2010 & 2012

That along with the unwillingness of the Obama administration and Democratic leadership in Congress to advance a bold public works program to put America back to work will put Republicans back in control.

Of course, did the Republicans ever lose their control of Congress?

The Republicans will spend the next several years campaigning to repeal a bill that "forces people to buy expensive private insurance" that provide few benefits, as they will present it, and that will tax high quality insurance plans.

[LibDemAlways]

54. You said it. Expect to hear the word "mandate" repeated hundreds of

thousands of times in the months to come. It's already on Republican lips as witnessed yesterday at a press conference. I'm amazed that so many here are so short-sighted that they are touting this POS bill for no other reason than to give Obama a political "victory" - one which will prove incredibly hollow. The posts on here the day after the November midterm will be interesting - no doubt a lot of hand-wringing and clueless wondering what went wrong.

[Better Believe It]

77. Bookmark this!

[glitch]

61. They'll certainly talk about it, but they'll have no intention of repealing it.

Why would they repeal something they've wanted since before 1970?

[merkins]

41. K&R!

Quite an opus you have going...

[New Dawn]

45. Kick for truth.

[defendandprotect]

46. K&R ----

[leftstreet]

49. K&R

[stillwaiting]

52. k & r

[robinblue]

57. National Nurses United has done an excellant job of keeping us informed

during the last year but unfortunately, the media has, for the most part completely ignored them.

[paulk]

58. k and r

looking forward to parts 3 and 4.

[SlingBlade]

62. K & R

[Name removed]

66. Deleted message

Message removed by moderator. Click here to review the message board rules.

[unapatriciated]

69. “intentional misrepresentation or fraud.”

This is the one the Insurance Industry uses often in California, where it is illegal to deny coverage for pre-existing conditions.
You can fight them but they will keep you tied up with reviews and denials until you are bankrupt, crippled or dead.
Been there done that, experienced two out of three. Went bankrupt and my son was unnecessarily crippled because of these practices.

[avaistheone1]

70. kick

[Uncle Joe]

71. I've been out most all of yesterday, too late to recommend.

Thanks for the thread, Political Heretic.:thumbsup:

[Political Heretic]

72. Not a Problem. Finishing up Part 4 today even though its too late.

Just for the sense of completion.

[Skittles]

73. a win for Obama, a loss for America

[defendandprotect]

76. Sad but true summation . . .

[midnight]

78. The process they "claim" will be via transparent appeals.....

Eight: In perhaps one of the most stunning features of insurance reform is that oversight of denial of claims by the insurance industry is minimal – next to zero. Denying claims is the normal business-as-usual practice of the insurance industry. Every claim denied means more profit for the corporation. No one I have encountered seems able to explain how an industry predicated on looking for every opportunity to deny health coverage to people who need it translates into quality health care.

The California Nurses Association conducted analysis which showed that one in five claims were rejected by the the state’s six largest insurance providers. One in five. You can bet that picture is little different across the entire country. Current insurance reform legislation does little to address this nightmare.

This insurance giveaway has an appeal process that provides no teeth for consumers.

[defendandprotect]

79. Agree . . . lotta PR here, but little regulation ...same insurance industry Obama called "evil" --

They should be being sued for criminal conspiracy vs the sick --

rather they're being rewarded with hundreds of billions of dollars and the

whole structure of corrupt corporate monopoly of health insurance strengthened with

our tax dollars!!