What is bad about the Senate health care bill?

[murdoch]

I'm asking more out of not knowing what is in the latest bill than in not knowing what the different proposals in general are.

I also don't mean things like that it's not single payer, it's not universal, there's no public option etc. I mean what is bad that is in it, not what is bad that is not in it.

The individual mandates to buy insurance from private HMOs is one bad thing. Are there other bad things in it (inclusive, not exclusive)?

[TheKentuckian]

1. State rather than national exchanges, anti-trust exemption upheld and further enshrined, funded by

the Max Tax from the Finance bill off the backs of the middle class and union workers, perpetuates the employer based system by locking tens and hundreds of millions into their employer provided plans without any choices despite mandating coveragge to start.

[levander]

2. Costs is the main issue.

They're are a lot of details, everywhere there are various ways to do it. But, if they could at least do it in a way that controls costs, I'd be sympathetic towards it, regardless of my personal prejudices toward how I'd like to see it done.

And, I'm not just talking about the effect of the bill on the federal budget. That whole thing Obama is running around saying about, "Reduces the deficit in the 1st decade, and the 2nd!" is a bunch of nonsense. Half of how they're paying for the bill is with them saying they're cutting Medicare by half a trillion dollars. But, the Center for Medicare Services came out with a report that basically said cutting Medicare that drastically is simply not possible. Then, there's the other trick they've got in there where they're only providing 5 1/2 years of services, but taking in 10 years of revenues and cost cutting so they can make their claim about how much they're saving. But, that's not even the main issue.

You've seen those charts that compare how much Americans spend on health care vs. what other countries spend? Those charts are astonishing. Those charts don't just measure how much each country's government spends on health care. It's a reflection of how much government, businesses, and individuals together all spend on health care. And, the problem is only getting worse. Our health care costs are growing much faster than other countries. And to me, that's why the problem with health care in America doesn't just hurt the uninsured, it hurts everybody. Because we as a nation have to spend way too much on health care. Money that could be spent on other issues, and still get great health care if our system worked as good as those in other countries.

This bill helps with the 2nd most important problem in US health care. It gets 30 of the 40 million uninsured insurance.

But, that Center for Medicare Services report says that health care costs in the US will grow even faster under this bill than it would under the current system. So, this bill make the main problem with US health care, costs, exacerbated. It makes the problem worse.

That said, there are some subsidies in there that will help make health insurance more affordable for lower incomes. How affordable is something you'll hear a lot of debate about. Even if they dont help enough, that we at least have some subsidies is a good thing.

But, those subsidies don't make health care cost less. They just shift the cost to rich people. So, this country is still sinking a lot more money into health care than it should have to. And, it will be sinking even more money into health care with this bill than it would be without it.

Now, I don't want you to think that it's necessary to increase health care costs in order to obtain (near, with the current bill) universal coverage. The Healthy Americans Act is an example of a bill that would get ~39 of the 40 million uninsured insurance. And, it would lower the amount America spends on health care. And, it actually had broad bipartisan support in the Senate. Why in the world the Senate went the way they did instead of the Healthy Americans Act, I've never seen a good answer for. If you want to read about the Healthy Americans Act, there are some good, simple articles here:

http://www.huffingtonpost.com/lanny-davis/the-healthy-americans-act_b_301962.html
http://www.huffingtonpost.com/lanny-davis/the-wyden---bennett-healt_b_293117.html
http://www.huffingtonpost.com/lanny-davis/a-plan-for-universal-cove_b_309513.html

[Eric J in MN]

3. Cadillac Plan Tax and Free-Rider Provision

"Cadillac Plans" tax - insurance companies have to pay a 40% excise tax on top part of high premium plans.

That would make those plans less profitable or unprofitable for the insurance companies, and cause them to discontinue those products.

The tax on so-called "Cadillac Plans" would mean that union workers, including teachers, who have good, high-premium insurance, with low out-of-pocket would get bad, low-premium insurance, with high out-of-pocket.

Free-Rider Provision - Companies have to pay when a full-time employee buys subsidized insurance. But not for part-time employees who work under 30 hours/week. And not for full-time employees who qualify for Medicaid.

So companies are incentivized to hire people part-time and/or at low wages.

[Juche]

4. It cements the hold and power of private industry over the country

The only way we could get a bill is if the health insurance industry and pharma industry agreed to one. The democrats are not able to stand up to these groups or piss them off excessively. So whatever reforms that helped the American people but hurt those industries were stripped.

As examples we have no strong public option, no reimportation of medications and no medicare negotiations of prescription drug prices.

Those 3 reforms sound small (reimporting drugs, medicare negotiations, a public option) but they will cost tens of billions a year in higher prices.

A strong public option would save $200 billion over 10 years.

http://www.smirkingchimp.com/thread/23578

Drug reimportation would save $120 billion over 10 years. Possibly more

http://news.firedoglake.com/2009/12/09/fda-letter-warns-of-safety-concerns-with-re-importation-of-prescription-drugs/

Negotiations in medicare part D would save $24 billion a year.

http://www.medicalnewstoday.com/articles/169218.php

And the savings could be higher due to downward pressure to lower costs due to more competition and negotiation.


So that is what is, in my view, wrong with the bill. It will cost the public and the federal government hundreds of billions of extra dollars over the next decade (and trillions past that) to protect the influence and power of private industry by shielding them from competition and negotiations. The only way we could get a bill is if we threw in a half a trillion in corporate welfare over the next decade.

The problem is when we need more reform in 10 years, these private groups will have even more money and influence to block negotiations, regulation and competition.

[gateley]

5. Thanks for asking this question - I'm learning a lot from the responses. nt

[deaniac83]

6. As someone who have defended the senate bill

and the Congressional Democrats' health care reform efforts at length, I have no problem admitting a few faults with the Senate bill:

1. The 1:3 gap in premiums that is allowed based on age is way too much. Insurance companies should not be able to charge an older person 3 times as much as they charge a younger person.

2. Medicaid expansion is too little, it needs to be to 200% of FPL, IMHO.

3. The subsidies need to be extended to people up to at least 600% of poverty, or at least provide for regional variations. You cannot get for $40K in California what you can get for it in Vermont.