1/10/08 - "He wants to lower health costs first, and is willing to consider a mandate ..."

[Clio the Leo]

Obviously he said he was opposed to mandates ... but the issue was always about costs .... not that he thought the idea was inherently wrong or unconstitutional (as some here are arguing.) The very fact that he made no bones about requiring a mandate for children is proof of that.

Hillary Clinton says she favors mandates, but isn't sure there should be a penalty for noncompliance. Barack Obama favors an immediate mandate for children, but doesn't include one for adults. He says he's willing to revisit the issue after making health insurance more affordable and enrollment easier, and is also considering an automatic enrollment with an opt-out for those who don't want to be included.

As a practical matter, the difference between Sen. Clinton's and Sen. Obama's approaches come down to timing and sequencing. Mrs. Clinton wants a mandate first, believing that enrolling the younger and healthier will help reduce costs for everyone else. Mr. Obama thinks forcing people to buy health insurance before it's affordable isn't realistic. He wants to lower health costs first, and is willing to consider a mandate only if necessary.

http://www.prospect.org/cs/articles?article=the_road_to_universal_coverage

When taken together with this....

Comparing the House and the Senate Health Care Proposals
"Require that most Americans have a minimum level of health insurance or else pay a penalty."

Senate version
"Penalty: $95 a year or 0.5 percent of a household’s income, whichever is greater, in 2014; $495 or 1 percent of income in 2015; $750 or 2 percent of income in 2016 (with a maximum of $2,250 for a family). The penalty would be adjusted for inflation after 2016. No penalty if the cost of cheapest available plan exceeds 8 percent of household income."

http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html?hp

Considering the fact that the average middle-income family is paying as much as 22% of their income (with that number continuing to rise) I'm afraid this "broken promise" outrage seems to be much ado about nothing.

[OHdem10]

1. Just curious what is considered average-income???

[napi21]

4. Another question is what is the avg. AGI? People who are fighting the mandate

consistently ignore that all things in the new HC bills are based on AGI (Adjusted Gross Income!)

[Born_A_Truman]

9. Wiki only has Nationwide AGI listed up to 2006

Nationwide AGI
Average AGI per Tax Return for the USA:

Year 2006
Amount $55,019

http://en.wikipedia.org/wiki/Adjusted_Gross_Income

[napi21]

14. You have to be careful taking Nationwide AGI numbers.

It's like the old story about 9 guys in a bar who had an avg income of $40,000 but suddenly Bill Gates walks in and their avg. just increased by several million! Those numbers have to exist somewhere because there is a breakdown by % of people in each earnings level, the top 1/2% the highest, and on down from there.

[rapturedbyrobots]

27. that's why you never

listen to anyone making an argument with average income numbers. its all about median income. not really a novel observation...that's what our bank used to determine if we qualified as low-income for our mortgage.

[Born_A_Truman]

37. You asked what the average AGI was...

Yes, the numbers I provided were nationwide. How will the bill break it down? Regionally? States? Cities? Counties? Neighborhoods?

Obviously the average AGI in one locality will be different than another.

I found household incomes broken down but not by AGI.

http://en.wikipedia.org/wiki/Household_income_in_the_United_States

ETA: If it's based on our individual AGI, then we all have to do the math and no amount of average income, average AGI will matter.

[Cha]

2. Thanks Clio~ It must

give people comfort to always think the worst in people and cast themselves as the victim.

[napi21]

3. If the costs can't exceed 8% of your adj. gross income (I think that's what I heard)

then I'm all for a mandate. I believe there is also a minimum where you will get almost a full subsidy to pay for it.

When you say the avg midd.e income fmily is paying as much as 22% of their income, something is wrong with your stats. Think about what you said. What is the average AGI of a middle income family? Even at $50,000 or $60,000 their mtg. interest is deducted, several thousand $$ per family member is deducted, and I won't even go into other deductions that many people take.

The majority of middle income families have employer sponsored ins, and their share isn't anywhere close to 22%! The lower income individuals & families who have to buy ins. on their own will get subsidies to do so.

[Clio the Leo]

7. They aren't my stats....

The drain on finances is even more concerning for low and middle income Americans. Thirty-seven percent of low-income people and 22 percent of middle income people with private coverage spend more than 10 percent of their household income on health care, compared with 8 percent of high-income people.17
The burden is even greater in the individual market. A middle-income family with individual coverage spends on average 22 percent of household income on health care – and some spend up to 50%.
(Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2006.)

http://www.healthreform.gov/reports/hiddencosts/index.html


As for, "The majority of middle income families (who) have employer sponsored ins..." this bill has never been about those who had decent, existing health care plans. This bill/s have been about improving the situation for people who either didn't have it or couldn't afford it because they weren't able to get it through their employer and were paying HUGE premiums because they were buying private plans. Eventually, everyone's premiums will go down because this is a free-market economy and that's how it works ... but the overriding goal of this was to use everyone's resources to help the lot of those less fortunate.

We're Democrats ... it's what we do. :)

[Hello_Kitty]

28. No, mortgage interest is not deducted from AGI

AGI is gross income minus IRA or HSA contributions, student loan interest, some business or moving expenses, and a few other things but none of your itemized deductions.

[Clio the Leo]

5. And because I've been here long enough to know you have to spell it out for folks....

That is a genuine difference between myself and Senator Clinton.
And the last point I would make is, the insurance companiesactually are happy to have a mandate. The insurance companies don't mind making sure that everybody has to purchase their product. That's not something they're objecting to.

The question is, are we going to make sure that it is affordable for everybody? And that's my goal when I'm president of the United States.
http://www.msnbc.msn.com/id/23354734/page/3/

"The only difference between Senator Clinton's health care plan and mine is that she thinks the problem for people without health care is that nobody has mandated -- forced -- them to get health care." He added, "That's not what I'm seeing. ... What I see are people who would love to have health care. They desperately want it. But the problem is they can't afford it."
http://www.medicalnewstoday.com/articles/89192.php

(and I could go on, his message was always the same .... cost .... cost ... cost.....)

[Skittles]

6. a mandate will not lower premiums

it will just increase corporate profits

[Clio the Leo]

8. Not by itself....

..... but regulating medical loss ratios and good old fashioned American free-market competition will.

[Skittles]

10. if there was a public option, yes

without it - dream the fuck on

[Oregone]

12. Not exactly

Regulating medical loss ratios provides some incentive to actually increase negotiated billing rates with care providers (and therefore increase premiums), especially when there is an anti-trust exemption int place that rules out free-market competition will ever take place. Shareholders are expecting the same returns per share, and the only way to ensure that with regulated loss ratios is to up the ante across the entire board. Common sense and a little math dictates this.

Why race to the bottom when your cut is a guarenteed percentage of your gross revenue? Why race to the bottom when you can continue to price fix with your "competition"?

[Phoebe Loosinhouse]

24. I've tried to make that point many times. People are not getting it.

Lower medical loss ratios provide a perverse incentive for the insurance industry see base costs RISE in order to maintain their profits at the abusive levels they are used to.

The medical loss ratios actually guarantee continued profit for a private industry. There is no competition as we now do not have a federally funded option as an alternative - THAT would have driven down costs as the insurers for the very first time would have had to make an effort to be competitive in order to stay alive.

[Hello_Kitty]

31. Except that the insurance cos. got to keep their anti-trust exemption

So there goes that free market competition. They will continue to collude to raise rates as they've been doing. And the MLR, which got set at 85% because the CBO whinged that it would be a gov't program at 90% (so?), basically functions as a cost-plus contract. They are guaranteed a profit of %15 no matter what. So where's the incentive for lowering costs? 15% on a $200 aspirin is a lot more than 15% on 20 cent aspirin.

[Clio the Leo]

32. Which may be why we have HB 1583. NT

[Cleobulus]

38. Uhm, where the hell is the "free market" Health Insurance companies cannot exist in one of those....

and hence it will not lower costs one iota.

[grantcart]

40. Actually OPM has the authority to set prices, coverage and profits under the plan

in addition to MLRs. But this critical point has been lost in the discussion.

[TheKentuckian]

43. There is no plan for any free market competition

A) The vast majority of Americans will not have access to any market or even a sembalance of choice.
B) The industry's anti-trust exemption was specially demanded by insurance toadie Nelso to be removed which means that price fixing and other anti-competitive systems will not only remain in place but be further codified by specific language in this bill.

Also, consider that medical loss ratio doesn't control the flow of money that goes into the industry's hands just what percentage they are supposed to spend on care. In a situation where they have a mandated market and anti-competive practices are permitted they have zero incentive to do anything other than to increase the amount of dollars that flow through their hands.

Actual price controls would undo the damage from insurers and help drastically to correct excessive costs in other parts of health care like hospitals and general treatment but I reckon that would make us too Euro even if not Socialist.

[napi21]

13. Yes they will. You're ignoring that one of the highest costs

anyu hospital has are the people they must treat by law, but don't pay a penny to anyone for their care. Who or what do you think pays for the costs that have to be written off because of bankruptcies? All those costs have to be covered somehow, and they are added to the costs all the others pay, no matter if they are insured through an employer or as an individual. If those costs are covered by ins. the provider costs will go down, as will the rates charged to the ins. co's and whatever is now being paid for by the govt.

[Lorien]

15. I believed that Bush changed that law. "patient dumping" is common in many cities

in my State the uninsured literally wait DAYS in an ER waiting room to see a doctor. Most give up before anyone admits them. Hell, I've waited over eight hours and never got admitted into our Regional ER, and I have insurance.

[napi21]

16. The "MUST TREAT" laws have not been changed! I guarantee that!

My close friend is the VP of Finance at the largest hosp system in a lage city in the NE corridor. We recently had a discussion about covering the costs of the must treat can't pay patients in all their ER's. That's the reason an asprin is billed out at $10-$15 per pill!

It is very common if you have to go to an ER at a very busy time, you will have to wait a long time if you are not in a very critical state. ER's in large urban areas are busier than suburban or rural ones, and even the urban ones are not as busy in the weird hours of the morning and sometimes even 9-10 in the mornings.

Don't you realize that even the wait times will go down if more people are insured? They won't HAVE to go to the ER, they can go to their local Dr. or clinic.

[Oregone]

19. How'd that work out in Massachusetts?

Can you explain to me how their per capita costs dropped dramatically once the uninsured stopped ripping off the hospitals?

http://www.mass.gov/Ihqcc/docs/meetings/2009_06_03_Cost_Containment_estimated_savings.ppt

Was there any savings? Were they passed on to the consumer?

[Skittles]

21. fuck no

same as when they forced everyone to get car insurance - I've always had car insurance but did my premiums go down? fuck no

[Oregone]

11. So did he lower health costs?

What is the expected drop in per capita health expenditures due to this?

[napi21]

17. I honestly think you have to wait and see how much the drop

will be. A lot depends on participation in the new programs and how much ER usage drops, and how many critical health conditions are caught early enough to treat rather and too far advanced. Anything you might hear now is speculation at best, and you can bet the budget office who is currently rating the diff. p;rograns is giving it their best guess, though prrobably on the low side, and they will tell you that.

[Oregone]

18. So you claim there will be a drop?

This will be history?



How much did per capita costs drop in Massachusetts from the mandate? What do you gleem from this link:

http://www.mass.gov/Ihqcc/docs/meetings/2009_06_03_Cost_Containment_estimated_savings.ppt

Yeah, doesn't look too peachy

[napi21]

25. I don't know a LOT about the Mass programs...I'll have to look

into it more. At first glance, I would think they do not have the mandate that ins. co's spend at least 85% of their revenues on patient care is one of the reasons. That IS in the Fed. HC bill AFAIK. That would prevent additional profits from the mandates gong to the ins. co's bottom line!

[levander]

20. The CMS report said health care costs under the bill would go up faster...

All the cost cutting is just like, "yeah, we're gonna create some bureaucracies, they'll be able to figure it out". Forget about it...

And, I love the MLR thing. One of there most prominent ideas to reduce costs, and if you think about it for 5 seconds, you can figure out how it's nonsense.

To me, the reason health care is not just a problem that strikes the uninsured, but everybody in this country, is the costs. Those charts comparing how much we spend on health care vs. how much other countries spend are astonishing. The size of our health care industry is like 16% of our GDP and it's only spiraling upwards. It's got to already be sapping productivity from other areas, and only getting worse.

This bill helps with the 2nd most important problem, it insures 30 of the 40 million uninsured. But, it exacerbates the most important problem, the cost. And that my friend, is why this bill is a piece of horse shit. It makes the problem worse.

[Clio the Leo]

33. Yeah! Screw all those folks who dont have any insurance....

.... or who pay 20% of their income on premiums .... if MY already cheap insurance wont get any cheaper then the loaf is half baked!

[Oregone]

42. If the per capita cost of health care doesn't get cheaper, the US is a dead boat in the water

The big picture isn't about me or you. Its about the competitiveness of US industry (as well as the health of the workers). The current costs are sinking the boat and putting the US at a major disadvantage internationally, and no matter how you feel about the moral & ethical arguments, if the US cannot compete, everything else falls to the wayside (and the nation will be living in paper boxes).

Yes, the reform should have expanding coverage as a component, but lowering costs (actually lowering them), should of been in the forefront being that the US is paying a massive amount for very little right now (compared internationally). Part of expanding access includes lowering premium costs and costs at point of use (co-pays).

You are essentially scoffing at the notion of lowering costs (and thereby helping the US economy). Its absurd

[Laelth]

22. Dismiss people's sense of betrayal at the Party's peril.

Precise parsing of the language will do nothing but further enrage those who feel betrayed. Showing some sympathy might be a better strategy.

:dem:

-Laelth

[Bluenorthwest]

23. Let your yes be yes, your no be no

The fact is that Obama equated mandating Insurance purchase with trying to solve homelessness by making a law requiring people to buy houses.
So the parsing and redefinition games, the hair splitting and the denials of what was actually said might be acceptable, if it were not for the fact that many including Obama claim to follow Christian rules and laws to the point that they insist that others must follow those laws, and they think the secular law should not treat us equally, because of that faith. So listen up. All such people need to either practice the basics of their faith, or shut the fuck up about how others do not live up to your expectations. That simple.

[rug]

26. I'm dizzy.

[Armstead]

29. from one of those quotes....."AFTER making health insurance more affordable and enrollment easier,"

Have health insurance premiums gone down lately? Are they likely to go down anytime in the foreseeable future?

[Clintonista2]

34. Shhh your logic isn't welcome here!

Don't shatter their alternate reality.

[P. Dexter]

30. Did he run any campaign ads in favor of the mandate?

Or was it anywhere in his campaign website that a mandate was to be considered?

[Clio the Leo]

35. .....

Welcome back to the Texas Democratic debate. Let's get right to it. Jorge Ramos with the next question.

RAMOS: Senator Clinton, yesterday you said, and I'm quoting, "One of us is ready to be commander in chief."

Are you saying that Senator Obama is not ready and not qualified to be commander in chief?

CLINTON: Well, I believe that I am ready and I am prepared. And I will leave that to the voters to decide.

But I want to get back to health care, because I didn't get a chance to respond after Senator Obama finished. No, let me finish, Jorge...

RAMOS: But I would like to come back...

CLINTON: This is a significant difference. You know, Senator Obama has said it's a philosophical difference. I think it's a substantive difference.

He has a mandate for parents to be sure to ensure their children. I agree with that. I just know that if we don't go and require everyone to have health insurance, the health insurance industry will still game the system. Everyone of us with insurance will pay the hidden tax of approximately $900 a year to make up for the lack of insurance.

(APPLAUSE)

And you know, in one of our earlier debates, John Edwards made a great point. It would be as though Social Security were voluntary. Medicare, one of the great accomplishments of President Johnson, was voluntary.

(APPLAUSE)

I do not believe that is going to work. So it's not just a philosophical difference.

CLINTON: You look at what will work and what will not work. If you do not have a plan that starts out attempting to achieve universal health care, you will be nibbled to death, and we will be back here with more and more people uninsured and rising costs.

(APPLAUSE)

BROWN: All right. We appreciate that you want to make a point, Senator Obama. We have limited time, so I would like Jorge to move on to another subject or we're going to be out of time.

(CROSSTALK)

OBAMA: Well, I understand. But I think that Senator Clinton made a...

(LAUGHTER)

You know, she's making a point, and I think I should have the opportunity to respond very briefly. And I'll try to make...

BROWN: Very briefly, absolutely.

OBAMA: Number one, understand that when Senator Clinton says a mandate, it's not a mandate on government to provide health insurance, it's a mandate on individuals to purchase it. And Senator Clinton is right; we have to find out what works.

OBAMA: Now, Massachusetts has a mandate right now. They have exempted 20 percent of the uninsured because they have concluded that that 20 percent can't afford it.

In some cases, there are people who are paying fines and still can't afford it, so now they're worse off than they were. They don't have health insurance and they're paying a fine.

(APPLAUSE)

In order for you to force people to get health insurance, you've got to have a very harsh penalty, and Senator Clinton has said that we won't go after their wages. Now, this is a substantive difference. But understand that both of us seek to get universal health care. I have a substantive difference with Senator Clinton on how to get there.

BROWN: All right, Senator Clinton?

CLINTON: Wait a minute, no, this is too important. This is the number one issue that people talk to me about. You know, when a mother grabs my arm and says, "I can't get the operation my son needs because I don't have health insurance," it is personal for me.

CLINTON: And I just fundamentally disagree.

You know, Senator Obama's plan has a mandate on parents and a fine if parents do not...

OBAMA: That's right.

CLINTON: ... insure their children.

OBAMA: That's right.

CLINTON: Because he recognizes that unless we have some kind of restriction, we will not get there.

OBAMA: There's a reason.

CLINTON: He's also said that if people show up at a hospital sick, without health insurance, well, maybe at that point you can fine them.

We would not have a social compact with Social Security and Medicare if everyone did not have to participate. I want a universal health care plan.

(APPLAUSE)

OBAMA: Now, that's -- that mother -- that mother who is desperate to get health care for her child, will be able to get that health care under my plan. Point number one.

Point number two, the reason a mandate for children can be effective is we've got an ability to make affordable health care available to that child, right now.

OBAMA: There are no excuses. If a parent is not providing health care for that child, it's because the parent's not being responsible, under my plan. And those children don't have a choice. But I think that adults are going to be able to see that they can afford it, under my plan; they will get it, under my plan.

And it is true that, if it turns out that some are gaming the system, then we can impose, potentially, some penalties on them for gaming the system.

But the notion that, somehow, I am interested in leaving out 15 million people, without health insurance, is simply not true.

http://www.cnn.com/2008/POLITICS/02/21/debate.transcript/

[Armstead]

36. The difference -- Clinton also tied a mandate to a public plan

Clinton's platform did explicitly call for a government coverage plan (expanded Medicare or public option), among other things.

(I did not support her in the election)

[AllentownJake]

39. Can we move on from this failure

I pray the Supreme Court does the right thing on the mandates.

[Bodhi BloodWave]

41. minor caveat: Just because you and some others sees it as a failure, does not mean it is one n/t

[AllentownJake]

44. Can we move on from the obvious failure to anyone who wanted a public option or any other thing

that might look like reform.