Nate Silver's Postscript - Reiterates benefits of health reform bill which have not been rebutted.

[jefferson_dem]

Let me, however, recapitulate three particular sets of arguments that I believe have not been adequately rebutted.

Firstly, I don't think you can make a credible argument that the bill will leave poor people worse off. The bill provides very impressive subsidies to working-class people, in some cases providing them with in excess of $10,000 worth of assistance per year. Perhaps more importantly, as Jonathan Cohn and Jonathan Gruber have outlined, it radically reduces the downside risk to lower-income families because of annual caps on out-of-pocket expenses. And -- something that hasn't gotten enough attention -- the bill increases the Medicaid threshold from 100 percent to 133 percent of poverty; about half of the assistance in the program is devoted to that Medicaid expansion.

Now, you can certainly argue that the bill is not quite generous enough -- I wholeheartedly agree with that position, and hope that the subsidy levels can be improved, particularly in the 133-250 percent of poverty range. There have been some efforts, however, to conflate the maximum amount that people might have to pay under the bill with the amount they will usually pay. In a typical year, a family of four making $50,000 will have to pay about $300 per month in premiums to cover the entire family. That compares with a retail cost, before subsidies, of about $1,000 per month. They'll probably also bear some out-of-pocket expenses. But no matter how bad things get, a family's exposure is limited to about 20 percent of its annual income. That compares with the status quo, in which even an insured family can bear downside risk of as much as 68 percent of its income, and in which an uninsured family has essentially unlimited downside risk. I don't mean to suggest that 20 percent of one's income is pocket change -- especially given how little savings the typical American family has -- but it's potentially the difference between having to cut back on vacations, entertainment and meals out versus filing for bankruptcy or losing one's home.

Secondly, I don't think you can make a credible argument that reconciliation is a smart strategy. You can certainly argue that reconciliation is possible -- meaning, that you might be able to pass something that you call a health care bill via reconciliation. But I've not seen a persuasive case -- or even really an unpersuasive case -- to rebut the argument that what reconciliation would take out of the bill (most notably the exchanges and the protection for people with pre-existing conditions) is better than what it might be able to put back in (a middling public option or Medicare buy-in). Nor have any of the structural problems I've pointed out with the more "creative" versions of reconciliation really been addressed; people have just dropped the argument when I've pointed out these problems. Although, with the Senate's passage of the bill this morning, this has probably become a moot point.

Thirdly, I don't think you can credibly argue that the bill would be improved -- policywise -- by dropping the individual mandate. You can argue that dropping the mandate makes political sense. You can argue that we can add the mandate later. You can argue that the mandate should be restructured. You can even argue that it's morally unacceptable. I'd disagree with most of those arguments, but you can make them in good faith. But fundamentally, you can only get (at most) two out of the following three things: a bill without an individual mandate; affordable health insurance; coverage for people with pre-existing conditions. This is Health Care Economics 101. (In the status quo, we sacrifice coverage for people with pre-existing conditions and arguably affordability, especially for those on the individual market.)

If you want to argue that the Senate's bill is worse than the status quo, or otherwise an unwise choice, without resorting to any of these three arguments, then more power to you; we're in disagreement, but we're having a logically coherent discussion based on different preferences and priors. And if you want to argue that the appropriate progressive reaction to the bill is a lukewarm one, and that it would be premature to celebrate while the bill can and should still be improved, I certainly don't have a problem with that. Implicitly, in fact, that's what a lot of people -- particularly Markos, Howard Dean, the unions, and Darcy Burner but also many others -- have been saying all along. The differences I have with those folks are more semantic than substantive, and I apologize to anyone to whom I've conveyed the wrong impression. There's More...

http://www.fivethirtyeight.com/2009/12/postscript.html#comments

[HughMoran]

1. Nate Silver is now a pariah

This is stunning to me. I recced it at +1 and it went to 0. Amazing.

[depakid]

10. No, he simply doesn't know the first thing about health policy

Not his field- so why should he?

[WeDidIt]

2. Silver is being rational which, of course, means he should be denounced.

And he didn't even mention that every time the Congress works on a budget, progressives can push to have them insert a public option into the insurance exchange and that simple item goes into reconciliation like the rest of the budget.

[BlooInBloo]

15. Confirmed: There is no place on DU for people like Silver...

I.e., mathematically knowledgeable, and concerned with facts.

[mzmolly]

3. K and R.

"it would be premature to celebrate while the bill can and should still be improved, I certainly don't have a problem with that. Implicitly, in fact, that's what a lot of people -- particularly Markos, Howard Dean, the unions, and Darcy Burner but also many others -- have been saying all along."

I appreciate, those advocating for a better bill. I think in the end, we'll all thank them. I do agree with Silver that it's incorrect to assert that the poor will be better off with no bill. That doesn't mean we should not work now to improve it as the bills are merged.

[girl gone mad]

4. Nate Silver believes they haven't been adequately rebutted..

I believe they have.

Note how now he is attempting to redefine the terms of the debate.

[pscot]

6. Yes. He's using reasoned arguments

That's so unfair. :P

[Cha]

5. Thanks Jefferson and

thank you, Nate Silver.

[cliffordu]

7. I like Nate. He and I and grantcart can talk numbers under the bus.

Actually, those two can talk numbers I can listen in bovine wonderment.

[Vinnie From Indy]

8. To be fair, Nate and other supporters simply IGNORE the strongest argument against the bill

Truly, I do understand how much easier it is to debate when you have the luxury of simply ignoring arguments that fundamentally rip your position to shreds. Nate's arguments and those of DU'ers for supporting this bill ALWAYS shy away from the fact that there is ABSOLUTELY NO MECHANISMS IN THIS BILL TO KEEP INSURANCE COMPANIES HONEST. The bill's success rests squarely on the ASSUMPTION that health insurers will not game the system.

You folks are truly deluded and sadly wrong about trusting Wellpoint and the rest to play fair and implement the so-called "good" aspects of this bill. You can throw around phrases like "30 million people will now have insurance" and "no denial for pre-existing conditions" until the cows come home and we are still left with big insurance being ASKED to play fair. They won't!!!!

I will also add that it is not just me that understands that insurance companies are STILL free to continue to rape and pillage Americans, Wall Street knows it as well. It is THE reason that health care insurance stocks are on fire right now.

As always, feel free to ignore this central fundamental flaw in the HCR bill and keep repeating your phrases about 30 million people and pre-existing conditions.

[GreenPartyVoter]

9. +1

[frazzled]

11. There are 400 pages of regulations on insurers in the bill

I, myself, have not read every provision in those 400 pages of regulations (and probably wouldn't understand a lot of it if I did), but the LA Times recaps some of the more common ones we will see:

Democrats in the House and Senate have filled their bills with a dizzying array of rules and regulations on insurers. The insurance market provisions in the Senate bill alone run nearly 400 pages.

For example, the Senate legislation would require all insurers to fully cover federally recommended preventive health services, such as immunizations, colonoscopies and HIV testing.

Insurance companies would be prohibited almost immediately from rescinding policies for people who get sick and imposing lifetime limits on how much they pay for customers' healthcare.

And state and federal regulators would be required to set up procedures for reviewing how much insurers charge customers and whether premium increases were justified.

A more intense round of regulation would begin in 2014, when states set up marketplaces, or exchanges, where insurers could sell plans to millions of people who do not get coverage through work.

Companies in the exchanges would have to offer policies to all customers, regardless of their health status. Insurers could not charge older people more than three times what they charge their youngest customers, an unprecedented national restriction on what is known as age-rating.

Every insurance company that offers a plan in these exchanges would have to provide a minimum set of benefits determined by the Department of Health and Human Services.

http://www.latimes.com/news/nation-and-world/la-na-health-assess18-2009dec18,0,5056746.story

I often see this argument against the bill--that "now insurers will be able to take your money and do whatever they want! You'll have to pay and you'll get nothing!" Um, no. They will have to cover a set of benefits required by the government. They won't be able to get from you more than annual or lifetime caps allow. They won't be able to jack up prices beyond what a government panel allows.

Those kinds of protests against the bill are as meritless as the ones that cite the mandate to purchase insurance without taking into account the masssive subsidies that will allow people to fulfill their obligation to cover themselves.

[ibegurpard]

12. required by the government...

the same government lobbied relentlessly by the industry to dump a public option to compete with them and write this steaming pile of shit.
sorry, not much faith there

[frazzled]

13. Peace be with you

There is clearly no rationality that could convince your seething, paranoiac, antigovernment views. I give you evidence that there are massive new regulations to be had in this bill where now--and without it--there are absolutely none.

I believe you oppose this because you fear you won't have anything to oppose if it passes.

But boy, you are gonna make the baby jesus cry with that kind of attitude. Go chew some pine needles.

[johnaries]

18. Yes, the same government that would run the Public Option.

Next, you'll be yelling "keep your government hands off my Medicare!"

[Vinnie From Indy]

14. I think your rebuttal is a bit naive

You, and other supporters, perpetually confuse having a piece of paper from an insurance company with actual treatment or medical care. They are not the same thing by a long shot. Insurance companies will game the system AND stay within the letter of the law. One need only look at Wall Street's excesses over the last decade to see how easily this is done.

In addition, I believe that the reason this bill is so large is precisely in order to provide loopholes. Our tax code is a masterpiece in that regard and I fear HCR legislation was created in the same spirit.

[SpartanDem]

16. Then what is the point of regulating anything ever?

if regulation doesn't work. If you believe government is so ineffective why do want to get your health care from it? If the insurance companies the circumventing the regulations, then get better regulations.

[Vinnie From Indy]

17. I believe that federal regulations have steadily become less effective

as our legislators and political process has become more influenced by corporate money. Your question about why we should regulate anything if regulations will be circumvented or ignored is too extreme. Some regulations have worked well to make our society better and others have failed miserably.

Regulations alone will never restrain the health care industry just as financial regulation has not restrained Wall Street or the credit card industry or oil companies or media companies. Regulations coupled with a REAL public option would, in fact, go a long way to achieving the broad goals of meaningful health care reform. Without real competition the health insurers will work as a group to keep their pieces of the pie. Think of it as the five mafia families in NY forsaking war for mutual gain.

In short, without a public option in this bill health insurers are not worried in the least about it's passage.

[bornskeptic]

19. When regulations aren't enforced it's because

violations are easily concealed. Denial of enrollment and rescission are impossible to conceal, so enforcing those regulations will be trivial. Companies won't even try to violate them, as violations will be promptly reported by the victims. Other regulations may be somewhat more difficult to enforce, but that is not a reason for not making the effort.

[Vinnie From Indy]

20. Is "effort" actually a good thing if it takes you farther from where you want to be?

But, my central point is still valid. Health insurers WILL implement policies that effectively deny coverage without violating the letter of the law. The ONLY way ANY of the regulations will work is with a public option that would provide REAL competition. I would even go further and offer that the MAIN strategy of the health insurers was to kill any public option. Everything else in the bill would be manageable if they could kill real competition. This legislation has simply bought them at least a decade of time to continue to soak the system and trade lives for profit. Remember this post in five years when it is being reported that many tens of thousands of Americans are STILL dying because of lack of treatment and that aspects of the bill like pre-existing conditions are a dismal failure because insurers have found new ways to avoid paying for sick people.

[Hello_Kitty]

22. They can drop you for "fraud and misrepresentation"

Forgot to report that case of acne you had 5 years ago? Oh well...

[Hello_Kitty]

21. Ah, but they can rescind you for "fraud or misrepresentation"

That's in the bill, with no specific definition of what that entails. So it's possible you could be unceremoniously dumped from your insurance because you forgot to disclose you had a kidney infection back in 1987.

[SpartanDem]

23. Which why their is a ban pre existing conditions

your past health can't be used to kick you off.


SEC. 2705. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.

`(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
`(1) Health status.
`(2) Medical condition (including both physical and mental illnesses).
`(3) Claims experience.
`(4) Receipt of health care.
`(5) Medical history.
`(6) Genetic information.
`(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
`(8) Disability.
`(9) Any other health status-related factor determined appropriate by the Secretary.

[Hello_Kitty]

25. BUT they can still rate you for a preexisting condition

And since I don't see anything in the bill (there might be, I just haven't seen it) specifically laying out what is allowable to be considered to be a preexisting condition, that means they could conceivably drop you because you signed up for the plan not disclosing your prior medical issue and got the regular premium instead of the preexisting one which is 1.5X higher. You "misrepresented" your health history to get a lower rate.

[SpartanDem]

24. I don't think you can compare health care and wall st.

health care is a much, much more personal issue you have to look at the non existent public reaction to Gramm Leach Bliley vs the attempts to privatize Social Security and Medicare. The public will demand much more accountability from the government in keeping the health care industry in line.