Coming from New Zealand where we have a public health system (with problems, but it exists), my reaction to a lot of the proposals has been: “Huh” or “that’s so fucked up” or “that’s making things better than they are now?”
I’m not an incrementalist, But I thought I understood why people did support the bill. I thought that the trade-off was about ensuring that people could get coverage. I thought the mandate (which seems to me like a rort for the insurance companies) was part of the policy because of the requirement that insurance companies cover people with pre-existing conditions. I thought the ability of people
But then I discovered that that although insurance companies have to cover people with pre-existing conditions, there will be no limit on how much extra they charge because of those pre-existing conditions.
If insurance companies can charge what they like for people with pre-existing conditions, and people have to buy health insurance. Isn’t that basically an penalty payment on having an impairment, a body, or a life, that the insurance company deems non-standard?
This entire “debate” has been nothing but Kabuki theater.
The insurance companies love this bill.
Yes, it requires that the insurance companies cover anyone, but it also requires that everyone buy insurance. And it doesn’t set any limits on prices.
And as we’ve seen in recent weeks, the ins companies have no shame when it comes to high rates.
This bill sucks.
I think the imperfect solution being offered to that is the tax credit for premiums over a certain percentage of income. I haven’t had a chance to read up on what the recent amendments have done to the subsidy plan, though.
It still needs a lot of work.
Yep. This bill is essentially an enormous blow job to the insurance industry.
It’s better than the even larger penalty of not being able to buy insurance at all, at any price.
Let me illustrate:
I’m a math person, so I’d only pay up to $1 to get a 1/1000 chance of winning $1,000. It would be even odds at that point. nobody should pay more.
But what about the reverse? What if I was forced into a choice between paying you money or risking a 1/1000 chance to LOSE $1,000? It’s still even odds, right? How much money would I pay to avoid that?
Well, I don’t have a spare $1,000. Let’s say that if I lost I’d be forced into bankruptcy. So I’d happily pay you more than $1, in order to minimize the risk. I’d even give you all $5. That’s because the cost of losing money I don’t have is much greater.
I’m using that example to illustrate a point: Plenty of people need insurance because it is impractical for anyone to plan for a low-percentage high-expense catastrophic loss. The simple ability to get insurance, replacing their risk with a known loss can have a huge effect on their security. That is true even if the insurance is expensive (in my example, it’s 5 times the risk basis.)
Absolutely, Sailorman. That’s why people should be allowed to buy insurance when they want to – and even a good justification for government intervention and regulation of the insurance industry, to ensure that terms are fair, policies actually get paid, etc.
Nobody thinks insurance is a bad thing. Many people believe that the decision to insure, and the type of insurance to buy, however, should be up to the individual. If I held a gun to your head and MADE you pay $5 for your 1-in-1000-loss scenario, then I would be the villain of the piece.
i think once the forced coverage for pre-existing conditions goes into effect insurance companies will simultaneously be prevented from charging more for individuals with those conditions– which technically means there is no limit to how much they can charge–but if they decide to charge thru the roof they have to do it for everyone…so they risk losing all their customers.
so the market in effect limits them
Manju is correct. When the mandate comes into effect in 2014, insurance companies will not be able to charge more for pre-existing conditions. Right now, insurance companies have been banned from refusing coverage due to pre-existing conditions for children, no one is required to buy health insurance, and insurance companies can still charge more for pre-existing conditions.
Interestingly, this temporal donut hole will probably lead to more short-term rescissions and treatment denials, as companies try to kill off their prospective future money sinks.
Manju and Charles S. got it covered. And even so, this is still a victory, even before 2014. Consider me, for example. I’m now a cancer survivor who suffers from ADHD and major depression. I could not buy coverage on the open market prior to this bill; no insurance company would take a chance on me. And in the unlikely event someone did, the odds of the policy being rescinded once I actually tried to use it approached one.
Now, I can get insurance. It may be really expensive, but I can get it. Once I have it, they can’t take it away from me because I technically missed something on the form. And by 2014, when the mandate kicks in, my insurance won’t be any more expensive than anyone else’s.
In short, it’s a victory in the short- and medium-term. Indeed, anyone who thinks being able to buy insurance is not a victory has never been told they can’t.
Oh, and Robert — the cynic in me agrees with you.
Cultivate your cynic. He sees with the eyes of truth.
And be leery of any medical advice your insurance company sends your way over the next four years.
i understand there is a temporary subsidized high-risk pool/ fund set up to bridge those who can’t get insurance or can only get the high cost type until 2014.
not sure if you qualify but if you do it should reduce costs significantly right off the bat for you. good luck.
Robert, do you think that insurance companies ought to be able to be able to refuse to sell insurance to people with preexisting conditions?
If so, how do you think those people ought to go about not dying?
If not, how, other than an individual mandate, do you plan on avoiding the insurance death spiral?
—Myca
Thanks for the responses. I was basing my respone on this from Jezebel: “There is no cap on what insurance companies can charge people with so-called pre-existing conditions, including being a victim of domestic violence or sexual assault — insurance companies just can’t refuse to cover you, but they can charge what they like and, worse yet, you’ll be required to buy it or pay a fine.”
I’ve been doing som searching since then, and I’ve only found references to that they’ll have to cover you. Nothing about whether they’ll be able to charge higher premiums or not. Is it because I don’t understand how the insurance exchanges will work. Do people have a link?
And this seems to imply that it’s increasing the limits of the penalities employers can put on non-standard bodies (which is obviously a different issue from pre-existing conditions, but still a pretty important issue)
Sailorman – I understand that. I still think it’s a really fucked up way to get everyone access to healthcare. But I understand the argument. What I think is messed up is that if one group of people (who tend to be advantaged in society) pay a dollar, while another group (who tend to be disadvantage) pay five. If that’s not the case then this particular objection doesn’t stand.
Jeff – See I don’t understand your mindset at all. I don’t see politics as sport, and I don’t identify with either of the teams. So I don’t care whether or not it’s ‘a victory’.
Instead I think the two things that are important are the effects it’s going to have on people’s lives (and this has to include the ways the legislation is going to make things worse as well as make things better). But also the structural affects of the legislation. As far as I can tell it’s going to entrench the profit motive in the American healthcare system, and give insurance companies more power.
See Myca I agree with the first (in as much as I agree with health insurance companies exisiting, which is obviously not at all) part. But my response to the second part is “Why should I care if Health insurance companies go into a death spiral?”
I don’t understand why any activist or commentator is accepting making abortion more inaccessible as an acceptable trade-off (which I understand the Nelson ammendment will do). But even leaving that aside – I don’t understand why activists and commentators from the left who surely list the financial health of insurance companies are using that as a defence. Why not just say “fuck insurance companies”. You’re not Obama, or in Congress, you’re not actually doing hte bargaining, so there’s no need for you to conceed anything.
Robert
I wasn’t a fan of the individual mandate when it was proposed by the Heritage Foundation and championed by Romney and Grassley as a recipe for personal responsibility in health care, and I’m not in favour now that it’s being implemented under a different rhetoric by a party of the centre-left. In fact, one of the main reasons I preferred Obama over Clinton in presidential race was that he was open to other ways of structuring health reform.
But I am somewhat comforted to learn that the mandate in this legislation is not “a gun to your head” – it doesn’t work through coercion.
If you can afford health insurance but choose not to buy it, you will be charged a penalty (one that’s usually much cheaper than insurance). But if you choose not to pay the penalty, the law explicitly states that you cannot be charged with a crime, and you won’t have any liens imposed on you to recover the money.
The idea seems to be to create a very strong set of norms around buying health insurance without using the coercive power of the state to impose anything. If you can afford health insurance but don’t buy any, then you’re not living up to your legal responsibility to take care of yourself, and there’s a penalty for that (just not a very big one). And if you don’t pay the penalty, then you’re in breach of the law and you’ve got a debt – both of which are morally weighty facts, but no substantial harm will come to you.
Oh, hey, I agree 1000%, but I assume Robert doesn’t.
I’m all for single payer. Fuck the insurance companies. But if you’re talking to someone who:
1) Doesn’t want the insurance companies to go out of business.
2) Wants pre-existing conditions covered.
and
3) Opposes the individual mandate,
Then I think it’s worth explaining that that’s incoherent.
—Myca
Robert, #8:
They do that as much as they possibly can already. What difference will it make?
Myca – I don’t disagree with that – there is definately a reason for exposing people’s hypocrisy. But I don’t think there’s a progressive justification for the mandate.
I think this is a particularly a problem becaues if progressives spend all their time defending non-progressive policies, that limits the discourse donut.
Maia,
Jezebel is simply wrong. Insurance policies in the exchanges will be allowed to be priced based on age (with older people being charged a max of 3 times as much as younger people), but not on anything else (except family size and tobacco use.
Basically, the exchanges work like large companies buying insurance for their employees. A company negotiates a fixed rate per employee for insurance, employees with pre-existing conditions any the same rate as any other employee. The exchanges will work the same way. The government organization that runs the exchange will negotiate insurance rates for participants in the exchange with insurance companies, and any person participating in the exchange will buy insurance at that rate (except that, unlike employers, the exchange will actually negotiate different rates for different age groups).
It isn’t a matter of winning a political game that makes it a victory. It is a matter of winning huge subsidies for tens of millions of people who don’t currently have insurance to be able to buy insurance, and adding tens of millions more to the medicaid rolls. Also, rather than enshrining profit in the insurance system (it is already enshrined there in the US), it is controlling and restricting profit in the insurance system. Currently, there are lots of scam insurance policies that basically never pay out anything and rake in huge profits. Under the new law, insurance companies will be required to pay out at least 80% of their income on medical expenses. That may seem ridiculously low (and it is), but it is much better than many policies currently do.
Basically, our current system is so horrible that something that looks like absolute crap can still be a major improvement, and nothing that doesn’t look like absolute crap was ever on offer. This law plus a public option would still have been absolute crap, and would still have been better than what we have. Obviously, this law wasn’t what any of us advocated for. We advocated for single payer, and then for a public option (stupidly, we should have advocated for better subsidies instead), and then we advocated for better subsidies, and then we advocated against Stupak’s ban on insurance policies in the exchanges covering abortion. And then we celebrated the fact that while we didn’t get a quarter what we wanted, we got a hundred billion dollars a year more support for people getting health care than we had last week. Next week we can start advocating for improving the law that just passed.
Part of the incremental gain of this law is that it sets the stage for further gains. We have now set in law that the government can set insurance industry profit rates, pushing insurance companies towards a public utility model. We have now set up an exchange system to which a public option is a reasonable addition. We have now set a precedent for expanding medicaid beyond the poverty line. We have now established that the government will help people pay for insurance based on their income in a progressive fashion rather than a regressive fashion. None of these are revolutionary changes, but all of them are steps towards something better.
There are plenty of countries that include private insurance companies in their health care payment systems and get much more egalitarian health care results than the US does. This new law doesn’t move us away from the private insurance model (although it does move us away from the private insurance as scam model), but it should be a step towards more egalitarian health care outcomes. People who need medical treatment but couldn’t afford it or insurance will now be able to afford the insurance that will make them able to afford medical treatment.
Here’s CNN’s bit on the pre-existing conditions part of the bill:
I don’t know what “unrealistic” means, or even whether we’re dealing with an actual equity standard or if CNN is just simplifying a more concrete test, but it does seem pretty clear that the bill doesn’t allow infinite rate-discrimination against those with pre-existing conditions.
Right now, insurance companies have been banned from refusing coverage due to pre-existing conditions for children
Well, no, not really.
But don’t let reality conflict with your hope and change / ponies and rainbows demotard incrapmentalist fuckery.
Or that’s what I would have written, except I’ve been banned from “Alas” for writing stuff exactly like that. Also, I’m the sort of lying asshole who uses out-of-context quoting to create false impressions, because my own personal views are so stupid and unsupported by reality that I have no choice but to lie. If I didn’t lie, then I couldn’t retain the illusion that I’m superior to everyone, when actually I’m boringly ordinary.
So those quotes above sure make it seem like the administration pulled a fast one on all you naive dipshits, and there was never actually an intention to cover sick children. Kids with pre-existing conditions can’t be covered! Ha! Ha! Ha!
The truth is, more context would let people know that the impression I want to give here, is false. Let’s bring in some different quotes from the same article:
So a “potential” legal loophole in the bill has been discovered, which the administration is already working on fixing; the question is whether the protection for kids begins this year or in 2014, not whether it exists at all; and with or without the fix, there’s no doubt that previously uninsurable children with pre-existing conditions will be able to get insurance this year.
Gee, that’s not exactly the impression the quotes I chose gave, was it?
From MSNBC:
You know the worse thing about me? I’m so committed to my I’m-so-much-leftier-than-thou views that I’m actually delighted at the prospect of sick children not getting the care they need. My first thought on reading about this was not “oh, shit — I hope they are able to close that loophole” but “oh, goody — now I have a chance to gloat at the stupid liberals!” What’s wrong with me? Am I really that much of a moral monster? Am I so completely lacking in decency and in perspective? I guess so. Oh, well.
It’s probable that some of the words in this comment have been altered by Amp, because I’ve been banned from posting on Alas. And also because Amp is so incredibly handsome and well-dressed.
Maia,
I just wanted to flag that for a moment.
Go back to the “how much would you pay to avoid a 1/1000 chance of losing $1,000?” example.
The law doesn’t specifically cap the amount for an individual at $1.25. But it does–through the payout requirement of 80%–mean that on average, people in similar situations will pay no more than a 25% premium to cover their risks.
For most of us, the cost premium for “losing what we can’t afford to lose” is well over 25%, so it is actually a fairly small premium.
Manju:
That risk, however, is significantly lessened by the fact that those customers can no longer say “fuck it” and forgo insurance entirely. An insurance company that jacks up premiums only risks losing customers to other insurers doing the same thing.
At one stage the bill discouraged this by requiring insurers to put a certain percentage of premiums into benefits, but I’ve heard almost nothing about that survivng into the final bill.
Now, Robert, you seem above all-right-jackism, which one to eight of these do you disagree with:
1. The healthcare system as it existed on January 19th, 2009, was failing many Americans for various reasons, at least some of which were circumstantial or otherwise not primarily due to unjustifiable choices on the part of the affected individuals.
2. 1 is fixable.
3. Access to healthcare should be universal; anyone who legitimately wants or needs medical treatment, preventitive care, or other medical attention should be able to get it regardless of financial status or other involuntary factors, if this can be achieved without violating the Constitution or harming individual liberty.
4. Access to health insurance should be universal; anyone who wants or needs health insurance should be able to get it regardless of health, financial status, employment status or other involuntary factors, if this can be achieved without violating the Constitution or harming individual liberty.
5. 3 and/or 4 is within the government’s authority.
6. 3 and/or 4 is within the government’s ability.
7. Obamacare as passed fixes 1, in whole or in part.
8. Obamacare as passed accomplishes 3, in whole or in part.
Maia:
True, it’s not a criminal matter. But what it means is that the Federal government can penalize you for not entering into a contract with a private party. That to me is a violation of the proper role of government. I grant that’s a philosophical point, not a legal one. I do not know right now how to define this in terms of legalities. Perhaps the much-vaunted right to privacy that was used to justify abortion? It’s certainly an invasion of individual liberty. I’m sure that the the court briefs that will be filed to challenge this will be very educational.
I wonder how much it will matter that the Supreme Court has numerous justices on it that are not particulary happy with the President having criticized them to their face at the last State of the Union address for what appears to be a perfectly Constitutional decision. At least the President seems to think so, since at no point that I can see did he criticize the decision on Constitutional grounds. He just didn’t like it. I don’t recall a President ever having done that before in his SOTU speech.
Without using the coercive power of the State? Try not paying the penalty and see what happens. Be self-employed and keep your money in your mattress so that the Government can’t simply make your bank or your employer give them the money. How much do you want to bet against the circumstance that at some point men with guns will show up at your doorstep to collect the money?
Robert, do you think that insurance companies ought to be able to be able to refuse to sell insurance to people with preexisting conditions?
Yes. Similarly, I think that casinos ought to be able to refuse admission to (self-proclaimed, proven) psychics and telekineticists, that colleges should be able to refuse admission to stupid people, and that senior living centers should be able to decline the applications of 23-year old metalhead party animals.
Private companies and organizations are not always set up as public accommodations open to all; most of them, in fact, are designed to serve a certain set of the population, and should be allowed to decline to do business with people who don’t fit their model.
In the case of insurance companies, insurers are essentially a gambling house. They are willing to gamble with you that the total health care costs (including the costs of running the insurance company and its return on invested capital) you incur will come out to be less than the total premiums you pay. Like a casino, they may lose some bets – whoops, Jeff got cancer, that’ll be $300,000, way more than his premiums, damn – but the total among all their customers has to meet this requirement, or the company goes out of business.
Someone with a pre-existing condition is exactly like a precognitive psychic coming in to play roulette. It isn’t a bet anymore; it’s someone coming in KNOWING that they will take the house for more than they bring in.
So obviously, a private insurance company, which exists to provide a hedge to healthy people against future risk, not a guaranteed benefit to sick people against current problems, needs to be able to lock out the latter category of customer.
If so, how do you think those people ought to go about not dying?
All kinds of ways.
First, they can spend their own money and resources, if they have them. Secondly, they can ask for help from family and friends. Third, they can ask for resources from private charities and religious organizations, whether this is cash money to pay for a private hospital course of care or simply access to a free or reduced-cost charitably-motivated facility (like the Shriners’ children’s hospitals, which are completely free).
Those sources of resources will adequately help a lot of people, but there will be a remnant, possibly a large one. If the people in a country want to help the remnant, and I think that here in the USA most of us do, then it is entirely appropriate for them to vote to use tax dollars to provide further support. Currently this is done via Medicaid; if you are poor, or become poor as a result of your health care expenses taking all your money, then the government steps up and provides a baseline level of care. I would arrange the funding somewhat differently – we could get more bang for the buck with a revolving loan fund (which would lose money in buckets, but provide more control to individual patients) – but the basic principle is OK – the taxpayer can pick up the bill as a last resort.
If not, how, other than an individual mandate, do you plan on avoiding the insurance death spiral?
Like Maia, but for ideologically opposite reason, I have no interest in avoiding an insurance death spiral. I don’t think we should CREATE one by requiring insurance companies to make water flow uphill, but if they happen to die off because they don’t offer a product or service that people are willing to buy at greater than its cost of production, who gives a shit? I don’t care if casinos go out of business, and private insurers have exactly the same moral role in society as casinos.
1) Doesn’t want the insurance companies to go out of business.
2) Wants pre-existing conditions covered.
and
3) Opposes the individual mandate
I’m saved from incoherency, because I don’t believe in (1) or (2).
Funding health care through insurance is a fundamentally stupid practice. It is on exactly the same level of rationality as funding your children’s education by setting aside $1000 every year to take to Vegas to play roulette, hoping for a 30:1 payoff. Over 18 years, that actually has a decent chance of successfully producing at least one “win” (43.5% chance you’ll hit once or more) , but the typical consumer would be far better off simply saving the $1000 annually in a college fund.
I don’t believe in stopping people from throwing their money away in this fashion, whether they do it at Vegas or at Aetna. (For some people the psychic benefit of security is greater than the psychic cost of money poured down the premium rathole.) But I’m not obliged to join them in their folly, either.
That is why I am not concerned (other than from personal sympathy) when someone “can’t get insurance”; the ability to get insurance should have little to do with whether someone can get health care. Insisting that insurance companies cover everyone and that everyone has “insurance” is like insisting that casinos always pay out 105% of their intake in winnings; it can’t work because the basic model doesn’t work that way, even if you try to boost the casino’s profits by requiring that people who previously didn’t gamble start going to Vegas every year.
We should totally take steps to ensure that every single American who gets sick can get medical care at a basic level. We are more than wealthy enough to make that happen, and humanitarian reasons (let alone the economic and social cohesion reasons) are sufficient to justify a large effort by both the private and public sectors.
But doing it through insurance is stupid. A government network of free hospitals for people with uninsurable conditions is not stupid. A government loan program for people with medical expenses they can’t pay from current income is not stupid. A government single-payer system is not stupid (not the best idea for other reasons, but not stupid.)
I’m in favor of non-stupid health care reform. This is stupid health care reform.
Long post in moderation. Pretty sure I didn’t mention Capitalis, the new penis pill, but who knows.
Now, Robert, you seem above all-right-jackism, which one to eight of these do you disagree with:
1. The healthcare system as it existed on January 19th, 2009, was failing many Americans for various reasons, at least some of which were circumstantial or otherwise not primarily due to unjustifiable choices on the part of the affected individuals.
2. 1 is fixable.
3. Access to healthcare should be universal; anyone who legitimately wants or needs medical treatment, preventitive care, or other medical attention should be able to get it regardless of financial status or other involuntary factors, if this can be achieved without violating the Constitution or harming individual liberty.
4. Access to health insurance should be universal; anyone who wants or needs health insurance should be able to get it regardless of health, financial status, employment status or other involuntary factors, if this can be achieved without violating the Constitution or harming individual liberty.
5. 3 and/or 4 is within the government’s authority.
6. 3 and/or 4 is within the government’s ability.
7. Obamacare as passed fixes 1, in whole or in part.
8. Obamacare as passed accomplishes 3, in whole or in part.
Hershele, I agree with 1, 2, 3 (with your final caveat bolded and italicized and starred and with a dagger next to it, and with the replacement of “anyone” with “legal US residents”), but none of the rest; 5 I could endorse if it was “#3 is something the government can play a major role in facilitating”.
This is an impossible bet, because “at some point” could always in theory be in the future, no longer how long we wait (until the sun explodes, anyway).
To be a bet, you need to propose something can be measured or tested objectively at some specific time in the future.
And also because Amp is so incredibly handsome and well-dressed.
And funny.
Not sure I’m following this.
Lots of people who emphasize the role of “individual liberty” favor voucher systems – that is, replacing services provided by government organizations with services provided by private ones. You seem to be making the opposite argument: “Government could tax me and use the funds to create a state-run health system, but instead they’re letting people contract with the provider of their own choosing. How dare they? Where’s the state-takeover-of-health-care that I was promised?”
People make much of this fact. I don’t get it.
Certainly critiquing a Supreme Court decision is nothing unusual. Plenty of Republican officials, from the President on down, have make careers out of criticizing Roe v. Wade at every opportunity.
Do we imagine that professional jurists are unacquainted with the idea that people hold contrary views on the issues they rule on? Or that jurists wilt when disagreement is stated face to face? Heck, compared to Alito’s dissenting opinions, Obama’s remark was a love letter to the court.
The issue there, nobody, is that the political tradition (a strong one) is that SCOTUS members who come to the SOTU sit politely and are nonpartisan. They don’t cheer, they don’t stand for ovations other than the traditional respectful ovation at the beginning, they don’t boo…they are there to hear the president but not to oppose or support him.
It’s rude to take someone who has those social constraints on them and start ripping them a new one. If you invite your mother-in-law, whom you hate but whom you are civil with to keep peace in the family, to the big family dinner and have an expectation that the old battle-axe is not going to stand up and suddenly start talking about your inadequacies as a man, then in turn you have an obligation not to stand up and start picking a fight with her.
[response edited to make cite correct; should be “RonF” and not “Robert.”]
Actually, I can see RonF’s point on this. RonF’s making the “process” argument, in which the government must act only in certain limited ways. That is how it should be, at least in my opinion.
If you look at process, you’ll see that the government can usually only compel you to do a very very small number of things: pay taxes, mostly, or fight in the army sometimes.
Almost everything the government does is in the form of restrictions, not compulsions; laws are generally about what you CAN’T do. (There’s a subcategory of “if you do A then you must also B” laws. But the laws don’t require doing A, so those don’t count as compulsions.) Not incidentally, Constitutional rights are the same; they’re about what the government can’t do, not what the government must do.
The end result may seem silly but is pretty damn important to the process geeks. I’ll give some examples:
From a theoretical perspective, the government can’t compel you to buy private insurance, or more accurately it can’t fine or imprison you for a failure to do so. That is because “buying insurance” doesn’t fall into the category of things that the government can compel you to do.
But it can do a lot of other things. For example:
The government can give you a 100% tax rebate for any private insurance you buy, and (if needed) can raise taxes across the board so that pretty much everyone has minimum taxes which match their insurance payments.
The government can tax everyone and can provide single payer insurance.
The government can (provided that it can find a rational basis for doing so, which is pretty darn easy) make other government benefits contingent on purchase of insurance, just as it makes federal student loans contingent on registration for SSI.
The government can tax everyone and can provide vouchers through which you can buy your own insurance, or waste the voucher if you so choose.
Those options accomplish pretty much the same thing as compulsion. It’s just a difference in process. But is it an irrelevant distinction? [shrug] I certainly don’t think so.
I have no doubt but that the Supremes will uphold it, though. Yet I’m not so sure that they should.
(edited slightly for clarity)
1. not sure if its true that “those customers can no longer say “fuck it”” especially in the scenario outlined (all companies raising premiums). I’m not up on the details, but I understand the tax is only triggered if the person can afford insurance (which is defined by the cheapest premium as a % of your income) so the raising premiums scenario would likely trigger the tax exemption
2. insurance companies jacking up rates in union would trigger an anti-trust investigation
3. even if it doesn’t trigger an antitrust lawsuit (after all prices do often go up in unison for reasons other than collusion) its such a nightmare scenario that it would trigger a single-payer legislation.
regarding any of these nightmare scenarios particularly the one this post is about, i think it helps to default on the assumption that if something something sounds too bad to be true its probably false. do we really think obama is so stupid he’d have these glaring loopholes in the bill? he’s not that dumb. quite the opposite, actually.
I won’t gainsay the value you place on procedural concerns. But I did not understand RonF to express concerns about process; I understood him to express concerns about individual liberty. I’m just not seeing how the new health care act — letting people choose among insurers or pay a fee — represents a greater intrusion on individual liberty than creating a single-payer insurance program in which the buyer would have NO choice of what to pay or who to pay it to, and NO choice in who provide the insurance services.
And this is the irony. In essence, the litigation says, “Gee, Obama, thanks for designing health care reform in a manner that imposes the least restrictions on my choices rather than pursuing the simpler path of command and control; I’m now going to exploit that fact to attack the bill.”
Health care insurance issues are riddled with Moral Hazard problems; this is just one more….
Thx. I fixed it.
I’m obviously not RonF and I won’t speak for him.
But at heart, process concerns frequently are about individual liberty, or more accurately a perceived future threat to liberty. The idea is that government is pretty much a heartless blob which will constantly seek to expand its powers. And if you let it expand its powers–because you don’t think that particular power is a problem–then you are going to have a bitch of a time putting the genie back in the bottle.
So if you let the government do this, then you’ll be SOL when a Republican-controlled Congress has voted that you must pay for something you don’t want to do.
Or, to put it more generally: If you give up a set of rights because the current enforcement benefits you, you’ll be fucked if the enforcers change sides. And history shows that the enforcers always change sides eventually. People like me are more concerned about the dangers of that issue than we are about the short term benefits.
It doesn’t, practically speaking. But it does, theoretically speaking, as discussed above.
Or: Gee, Obama, thanks for passing a health care bill which seems like a serious expansion of the role of the federal government. Thanks but no thanks for trying to phrase it as a favor; here’s hoping that your administration (and all future administrations) don’t use the expanded role of the feds to screw us over.
(Wouldn’t it be nice if the feds ran the school system, so kids could get a good education? We could fill it with liberal academics and then Texas’ rewriting wouldn’t be an issue. Great, right? Well… how about if the federal school standards committee was run only by conservative Texans? Do you see the problem?)
Unfortunately, a lot of people share my views for other reason (aka a hatred of Obama, dislike of health care in general, etc.) I’m not like that; I’m OK with the bill but just wished it used a different process. But the fact that those people have federalism issues is pretty obvious.
At the risk of belaboring the point: Yes, I do see that problem. And a voucher system helps to ameliorate that problem by giving people more power to exercise their own choices. A voucher system does not free people from PAYING; the vouchers must be paid for somehow, presumably by taxes, and government doesn’t give you any choice in that. But a voucher system frees people in making their purchasing decision.
WHICH IS WHAT HEALTH CARE REFORM DOES. Just as in a voucher system, you don’t get to evade the duty to pay: Government compels you to bear costs for health care insurance purchases or to pay a fee (subject to some support for people with low income). And just as in a voucher system, you get to choose who provides your insurance and (with some minimum limits) what insurance to buy.
In short, I can understand that people don’t like the bill. But I really don’t understand how anyone would object on procedural grounds while acknowledging that there are no procedural problems with a voucher system — let alone a single payer system.
Maia, if you want this moved elsewhere, say the word.
That’s wrong, though I’m not sure how to explain beyond what is in comment #33 above. I’ll try:
Your claim appears to be that:
(a) there are no valid procedural objections to the bill; or
(b) if there are valid procedural objections to the bill, the same objections would also apply to single payer and vouchers.
and in support of that claim you are saying
(A) The results of these procedures are equivalent;
(b) Therefore the procedures (and challenges to them) are equivalent.
The problem is that focusing on the results as proof of equivalency of process is simply using the wrong language. I think you would see the reverse fairly easily. To use an example, there are plenty of situations which use a neutral process (“Nobody can sell crack”) but which have a decidedly non-neutral result.
Here’s another way to look at it: You start with Input > Process > Result. The distinguishing factor is answered by the question “if you change inputs, what else changes?”
Let’s say that Amp chooses Alas moderators from a pool, and that the applicant pool is related to their SAT score.
If Amp is driven by PROCESS, then a change in inputs leads to a change in results. I.e. if eligibility to be an Alas moderator is based on scoring 1500 on the SATs, then some years he will have more (or fewer) applicants eligible to moderate. Focusing on process means that you lose control of results.
If he’s driven by RESULTS, then he has to change the process in light of changing inputs. If he wants exactly 10,000 applicants to be eligible to moderate, then he may need to set the SAT cutoff higher or lower in any given year, depending on that years’ scores and the total population of text takers.
Or, look at it in reverse, from the political angle:
There are two basic ways that Prop. 8 could be repealed: constitutional majority vote, and judicial ruling.
Those are not equivalent. The repeal (result) is equivalent, but what happens if the people of California change their minds later (change in inputs) is not equivalent at all.
Sorry for spacing out on this. I do actually want to know the answer. But I have super limited internet access (changing tomorrow when I get a computer that works woo-hoo).
I’ll admit I’m still confused. Because David Schraub’s quote is quite different from what Charles is explaining (and thanks Charles – I’m beginning to see the point of an insurance exchange). If the deal is people with pre-existing conditions can only be charged a reasonable amount more – then my previous point stands. But if hte protection is the exchanges where the only way that insurance companies can discriminate is on age, then it doesn’t (although the point about the changes to the way health insurance costs are past on to employees who deemed ‘not healthy’ still stands).
I’d still be interested if there is a progressive, as opposed to a pragmatic defence of the mandate.
But I still don’t think I really understand. Because when I worked as a union organiser the first rule was avoid concession bargaining (and giving up abortion access for more people insured under a model that includes penalties for having bodies that are not deemed normal (which this does even besides my original point) is concession bargaining). But most people here aren’t even in a position to concession bargain. So why defend things like the mandate, which are I think indefensible from any solid left viewpoint, rather than saying – actually it’s not enough, I want more.
I’m not sure what you mean by concession bargaining.
But yes, none of us here were involved in negotiating any of this law, so we don’t have to defend our action as negotiators or the deal that we didn’t negotiate. And I won’t say a single word in defense of the abortion coverage restrictions that ended up in the law (although I think that the new law is better than no new law, which appears to have been the final option). I am more than happy to advocate for repealing the abortion restrictions and the Hyde amendment in any way I can. The abortion restrictions aren’t progressive, they aren’t good, and they aren’t defensible.
On the other hand, a mandate in conjunction with a minimum cutoff income and an income-based progressive penalty (and no enforcement mechanism) doesn’t seem horribly unprogressive to me. I’d like a different system that didn’t use insurance companies as the means of payment, but the system I’d like instead would also be mandated, with universal coverage paid for by progressive taxati0n. The mandate in the new law is pretty much exactly equivalent to a somewhat progressive tax plus an equivalent tax credit for buying insurance, not the best system in the world, but this isn’t the aspect of the new law that I expect will, to my mind, determine whether this law is successful or whether it needs lots of further improvements. It is sort of like the question of a national exchange or state level exchanges. I wouldn’t have chosen state level exchanges, and I can make a possible pragmatic argument against them, but I don’t have a strong progressive argument for or against them. Regulatory capture can happen at any level of government, some states will probably run crappy, insurance company captured exchanges, but at least other states will be somewhat insulated from capture by the insurance industry once a Republican is elected president again and appoints an insurance company CEO as head of HHS. And since states can join together, small states can gain bargaining power by joining with larger states to form regional exchanges.
Basically, if I have to defend this law as being better than the previous condition and as being better than any sort of less strong reform, then I’m happy to argue for the mandate as a probably necessary component. I’m also happy to point out that the stronger, better method of ensuring health care for all would not have a mandate to buy insurance (although it would require absolutely everyone to pay in, it would do so based purely on income, not on family size or age).
If I’m going to involve myself in advocating for further health insurance/ care reform (I’m in favor of it certainly), the mandate is not going to be one of the main fronts I’m going to fight on (but I wouldn’t refuse to join an effective movement just because they made it one of their fronts). Repealing the mandate wouldn’t be on my own list of goals, although my dream objective would make the mandate to buy health insurance a non-issue (no insurance companies, no mandate). Whether I would choose to advocate for my dream position or whether I would be advocating for gradual change would depend on my mood and the context.
In relation to preexisting conditions and what I wrote and what David quoted, there is a difference between what will happen in the individual insurance market (where people currently go to buy a health insurance policy for themselves or their family) and what will happen on the exchanges. Nothing in the law bans the existence of an individual insurance market, so the individual insurance market will continue to exist along side the insurance exchanges. If you don’t have insurance through an employer, you will get to choose to buy insurance on the exchange or you can go directly to an insurance company and buy insurance. Why you’d want to do the later, I don’t know, maybe you hate the idea of government mediated health insurance purchases, maybe you are the ideal purchaser and can actually get a better deal than the negotiators for the exchange were able to negotiate for the general population, maybe you want some non-standard policy (the exchanges will have a suite of standard policies).
The quote that David found on CNN refers to a restriction the law places on the individual insurance market. The law adds new regulations to the individual market (such as reasonable rates for pre-existing conditions, with reasonable presumably to be defined later by the department of Health and Human Services), although those don’t give as strong of protection for pre-existing conditions as the common pool approach that the exchanges will provide.
In addition to this, I’m also happy to say outright … this is worse than single payer. This is worse than a public option.
But we fought for those, and we lost. It sucks, but we did.
This is clearly a compromise measure, and as much as it’s not what I would have chosen, 1) it’s way better than the previous status quo, and 2) what was on the table was this or nothing. Something better wasn’t an available option.
—Myca
It’s also worse than if it had better subsidies and worse than if it had a better minimum standard plan (the deductible and out of pocket in the Silver Grade plan is obscene, and the subsidies are based around setting the percentage of income people have to pay for Silver Grade plans, as far as I can tell). It is also way worse than if it didn’t have absurd and vile anti-abortion provisions. It is also worse than it could be because it still has an employer mandate rather than putting everyone into the exchanges.
I guess it is possibly worse for having a mandate, unless the mandate is necessary to make it work, in which case it is much better for having a mandate. If not having a mandate meant that the thing collapses in a decade or so, that doesn’t mean we get a better system. Anyway, we can fight for a better system without needing to heighten the contradictions first.
Can you talk more on this? i find it fascinating.
I do a lot of mediation, and I also do a lot of litigation–almost all of which ends in a negotiated settlement.
From my perspective, it is always preferable to ‘expand the pie’ so that neither party has to make any concessions. But in many situations, a successful agreement depends on concessions from both sides. In fact, going into a settlement discussions with a preexisting refusal to make any concessions at all, would arguably be an example of bad faith.
So how can “no concessions” be an acceptable negotiation tactic, for progressives or conservatives? Do you think it’s an acceptable tactic when used by your opponents?
Sailorman,
Concession bargaining is a union negotiating term of art. It is not equivalent to going into a negotiation unwilling to make any compromises in your position.
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