If Reform Fails

[babylonsister]

http://www.nytimes.com/2010/03/07/opinion/07sun1.html?hp

If Reform Fails

Published: March 6, 2010


As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation.

Are they really satisfied with the status quo? And is the status quo really sustainable?

Here are some basic facts Americans need to know as Congress decides whether to approve comprehensive reform or continue with what we have:

HOW REFORM WOULD WORK: Let’s be clear, the changes Mr. Obama and Democratic leaders in Congress are proposing are significant. But, despite what the critics charge, this is not a government takeover. And the program is not only fully paid for, it should actually reduce the deficit over the next two decades.

Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.

The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.

46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.

The Congressional Budget Office projects 54 million uninsured people in 2019; the actuary for the federal government’s Centers for Medicare and Medicaid Services projects 57 million.

It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.

The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.

snip//

Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

[Clio the Leo]

1. The question is a simple one....

.... would one of the smartest Presidential campaigns in our nation's history STILL be HEAVILY and PUBLICLY pushing something like this, 9 months away from a mid-term elections if 1. they didn't think they could get it done or 2. it wouldn't benefit them politically.

I suspect the President DOES know if this is the right thing to do politically. ;)

And the fact that the GOP is STILL fighting us tooth and nail is also very telling.

This thing passes by Easter and by the time November rolls around, no one will remember this winter. All you'll have will be a bunch of happy senior Medicare recipients, no longer having to deal with that dreaded donut, hopping into their cars and going to the polls.

[demodonkey]

2. The fools unreccing this should know that donut hole is NOT funny. My mother was in it last fall...

...even WITH supplemental insurance covering some of the donut hole costs, what she had to pay for some of her prescriptions almost doubled. Without the extra coverage should would probably have had to cut back, at great risk to her health.

Sure I want single payer, and I think that's where we'll end up someday, but HOW MANY WILL DIE in the meantime with NO coverage at all under the status quo?

[babylonsister]

4. I love the way you phrased this:

Sure I want single payer, and I think that's where we'll end up someday, but HOW MANY WILL DIE in the meantime with NO coverage at all under the status quo?

I feel the same way. :toast:

[Bluenorthwest]

5. But that leads to the question

how many will die because of the half measures and the avoidance of the real solution, single payer? If the first question is how many will die if we don't, then the next is how many will die if we do this instead of what is really right?
How many deaths are you bargaining with to settle for that which helps some but not all? If you ask that one question, refusing the next is simply avoidance of the very can of worms you opened.

[Mimosa]

17. The underinsured die too and will later if this treacherous 'reform' happens

Why didn't Obama and Congress work hard to help us? WHY?

[demodonkey]

23. Less will die with "reform" than will die waiting for all-or-nothing single payer...

As one of the uninsured myself who is at risk DAILY, I say we need to get SOME kind of coverage for as many as possible now, and keep working for single payer beyond that.

BUT THAT SAID, we need to make sure that whatever is done at the federal level, Dennis K's amendment is included so that state-by-state we are free to adopt single payer (like Canada did.) THAT'S how single payer is most likely to happen and it will take a long time.

But in the meantime almost 50 million of us face having NO healthcare on a daily basis, and that's plain wrong. In my case, ANY coverage would be better than what I have right now.

[AllentownJake]

26. The political operation has been a disaster since January 21, 2009

The only people they can beat right now in elections are outright Tea Baggers.

[Kber]

3. And Bart Stupak is trying to torpedo the whole thing

to accommodate his personal religious views

[47of74]

18. I wish someone would primary challenge that son of a bitch

[Puglover]

6. I am highly critical of Obama's admin

but this MUST pass. For my blood pressure if nothing else. I firmly believe that it's a start and would dearly love to see the idiot Republicans try to repeal it. They would be out of power for a century.

[angelicwoman]

7. 85% of us will pay $100-300 less a year than we would have paid under the status quo

in premiums.

Yippie.

(source: CBO, regarding employee-sponsored insurance.

[tridim]

8. I assume by your statement that you would rather pay 39% more..

every year for declining coverage?

Why?

[eridani]

13. The bill flat out guarantees declining coverage

It just says you must purchase a worthless shitty product (the only subsidised tier is the basement, with only 60% of actual costs covered)--it says nothing at all about what has to be included in the "coverage." Nor does it say that they actually have to pay up.

[Mimosa]

16. ^ TRUE!!! ^

Wake up, people.

[babylonsister]

9. Well aren't you the lucky one-you have insurance. nt

[ProSense]

10. "The CBO says premiums will go down for the vast majority of Americans"

First, the bottom line of the report is simple: The CBO says premiums will go down for the vast majority of Americans, and that the same insurance policy will cost less under reform.

The confusion comes in the CBO's analysis of the individual market, which serves about a tenth of the population. CBO expects prices in the individual market to rise by 10 or 12 percent, an expectation driven entirely by predictions that individuals will purchase policies that are much more comprehensive, and thus somewhat more expensive, then the insurance they can afford now. Then the CBO turns to look at the impact of the subsidies, which will cut premium costs by a bit over 50 percent for a bit over 50 percent of the market.

But as the CBO explains on page five, part of the increase in the type of insurance being purchased is the result of "people’s decisions to purchase more extensive coverage in response to the structure of subsidies." In other words, the change is driven by the subsidies, not offset by them.

To see this more clearly, imagine that the University of Florida decided to give incoming students who receive financial aid an $800 credit to purchase a laptop computer. You'd expect that the average computer purchased by students on financial aid would become a bit more expensive. But that wouldn't be because computers had become more expensive. It would be because people now had money to buy better computers.

So too for health-care reform. Premiums for the same policy in the individual market fall by 14 to 20 percent. But people in the individual market, who are largely low-income, will now have the opportunity to purchase better policies that cover more expenses and provide more security. That's a good thing. It's one of the reasons for health-care reform, in fact. And it is not analogous to health-care insurance becoming more expensive, any more than the fact that I could buy a nicer car after getting a better job suggests that cars are becoming more expensive.

link

link

[eridani]

14. Yes, because you get shittier and shittier coverage n/t

[depakid]

15. LOL- premiums aren't going down nationally any more than they have in Massachusetts

but people WILL have worse and worse coverage.

And little effective recourse for denial of care or claims.

[DailyGrind51]

11. They will get it passed, but it will not be everything we were told it should be.

[eridani]

12. Where in this over-complex abortion of a bill does it say--

--anything at all about insurance companies actually being required to PAY FOR CARE?

[damonm]

20. RTFB.

Your answers are there.

[eridani]

21. I have read it. Insurance companies remain completely free to refuse claims

Some folks, it would seem, only read talking points from Dr. Pangloss.

[eridani]

22. I have read it. Insurance companies remain completely free to refuse claims

Some folks, it would seem, only read talking points from Dr. Pangloss.

[damonm]

24. Well, perhaps I'm missing something...

...but the end of recission, the end of "Pre-existing conditions", and a requirement that 85% of the premium dollar be spent on the actual medical care you say they're free to deny, doesn't seem to me to be a recipe for denial of claims.
Pray elucidate as to how they'll be able to do so, because I don't find this anywhere.

[eridani]

25. CA has anti-recission laws now. They just aren't enforcing them

--because they can't afford to. The legislation as written does not end recission anyway. What it does say is that recissions will be eliminated except in the case of fraud. Can somebody please explain why the insurance companies will not be able to drive a whole fleet of very large trucks through that loophole? And there is no mention of what happens when you get dropped because you are unable to afford the premium one month.

15 states have tried regulating insurance companies by MLR specifications, and they have utterly failed. http://www.familiesusa.org/assets/pdfs/medical-loss-ratio.pdf

Locking the barn door after the horse gets away is not regulation in any sense of the word, as demonstrated by the following real life example.

Dear Mr. and Mrs. Sarkisian:

We were sorry to hear that your daughter Nataline died because CIGNA denied your claim for her liver transplant. However, you will be glad to know that we have analyzed CIGNA’s medical loss ratio and that all of their customers are entitled to premium refunds. Isn’t that wonderful?

Yours truly,
Dr. Pangloss

[jeanpalmer]

19. "the program is not only fully paid for..."

It's paid for only through an accounting gimmick. On a yearly basis starting in 2013, it is underfunded by about $33 billion a year. The Senate couldn't come up with the money to fund it on an annual basis, so what it did was let the revenue raisers start immediately, but have the spending on benefits not start til 2013. That way, "over ten years" the program is funded. But starting in 2013, it is not fully funded on an annual basis.

Also, $30+ billion a year in funding comes from "Medicare savings." That gimmick has also been exposed. If Medicare experiences savings, those savings should be used to shore up Medicare which is going into the red. The savings shouldn't be used to fund an unrelated general budget item. If savings are available in Medicare, they ought to be used within Medicare.

The whole effort has used sleight of hand accounting tricks and has been dishonest from the beginning.

As an indication of the dishonesty, the Democrats tried to double count the "Medicare savings," saying the Medicare savings would shore up Medicare, and at the same time decrease the deficit. They got called on it by Jeff Sessions. And the CBO at that point admitted that the savings were being double counted.