Thursday, October 29, 2009
Back to the Same Old Question. Is the Public Option In or Out?
It seems really difficult to tell what will become of the so called public option. One day it's out, then it's in , then it's back out again. Will a filibuster succeed or will it fail? Express an opinion it you like, but be prepared to change it an hour later.
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I am disgusted with the whole healt care reform debate. A pox on both their houses. I need to start looking for a new third party.
ReplyDeleteHaven't you ever heard the expression that there are two things you never want to see being made: (1)Legislation in Congress and (2) Sausage. The reason we are getting mixed signals on the public option is because the real dealmaking is being done behind closed doors and no one except the people in that room know what is in the bill. Everything we hear is spin from all the Congressmen at their press conferences -- spin that is designed to send the right message to their constituencies. Meanwhile, we the American people are being sold a bill of goods -- over 1900 pages worth! Is there anyone who really believes this is a good thing? Let's be serious. I'm with Patrick, time to find another party.
ReplyDeleteWhat happened to all that transparency that Barack promised us?
Perhaps the problem is that there is too much transparency. With cable TV looking to fill 24/7 hours, every little thing becomes something to talk about. I put my trust in Nancy Peloci. She knows how to bring down the hammer and get this health care reform passed. Actually, this is not health care reform. It is health care insurance reform.
ReplyDeleteAlthough I am somewhat of a political junkie, I find it is good to sometimes get busy with other things and let the sausage making take place without close scrutiny.
ReplyDeleteYes indeed - this IS insurance reform! Do we even need a public option?
ReplyDeleteIf you read the House bill, notice how closely it approximates socialized medicine even without the public option. The bill is classic national socialist legislation, in that it takes ostensibly private entities, the health insurance companies, and perverts them into instruments of the state, run top-down and barred from competing among themselves.
Under the House bill private health insurance companies will still exist, but to what end? They will be legally prohibited from competing in any meaningful sense. They will be required to issue substantially the same coverages at substantially the same rates, changes in which must be justified to the government. They will be prohibited from underwriting insurance risks in any rational way: they must pay all bills resulting from preexisting conditions, and they will be prohibited from charging lower-risk customers lower rates.
You can force insurance companies to "cover" preexisting conditions, but the resulting product is NOT insurance. You cannot insure against something that has already happened. It is merely a bill-paying mechanism. Likewise, the House bill prohibits insurance companies from charging premiums on any rational basis. Section 213, titled "Insurance Rating Rules," provides:
The premium rate charged for a qualified health benefits plan that is health insurance coverage may not vary except as follows:
(1) LIMITED AGE VARIATION PERMITTED.--By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
So young people--who, remember, will now be forced to buy health insurance--will subsidize older people.
(2) BY AREA.--By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT.--By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.
That's it. A lower premium for non-smokers or the non-obese? Forget about it. It's illegal.
Under the House bill, it is scarcely an exaggeration to say that health insurance companies are no longer in the insurance business. They can't rate and underwrite risks, which is the essence of insurance. That's illegal. They can't decide to whom they will issue policies; that's illegal, too. They can't offer novel or innovative coverages; their coverages are dictated by law. To a limited extent they can make decisions on paying claims, but under the watchful eye of government regulators. Meaningful competition among insurance companies will be, in effect, illegal. (In that context, it is a joke that the Pelosi bill also subjects health insurance companies to the antitrust laws, from which they had been exempted in consideration of their regulation by state, not federal, authorities.)
In the world that the House bill would create, the money we will pay to insurance companies won't really be insurance premiums. Insurance premiums are contractual payments which the parties voluntarily agree upon and which are based on a mutual assessment of risk. Rather, the checks we write to insurance companies will be taxes--legally compelled, at rates set by the federal government that are designed to punish some and subsidize others.
Isn't this socialized medicine in all but name? So why worry about the public option? Maybe it isn't necessary after all.
Hey Anonymous:
ReplyDeleteYou sound like you either are a Republican or you work for a health insurance company or both.
Hi Victor:
ReplyDeleteI suggest that you focus on the substance of what Anonymous has to say rather than any of his or her perceived affiliations.
Point taken. The only system that will really work is single payor government run Medicare for all. It may be socialism, but it would be good socialism.
ReplyDeleteThe Pelosi bill creates 111 new boards, commissions, councils, and other such bureaucracies. Is THIS what Victor thinks is "good socialism".
ReplyDeleteHere is the Top 40. The limit on comments being less than 4096 characters prevents me from listing the rest. I suggest everyone read up on this bill and contact your elected representatives with your opinions.
1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
2. Grant program for wellness programs to small employers (Section 112, p. 62)
3. Grant program for State health access programs (Section 114, p. 72)
4. Program of administrative simplification (Section 115, p. 76)
5. Health Benefits Advisory Committee (Section 223, p. 111)
6. Health Choices Administration (Section 241, p. 131)
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
14. "Public Health Insurance Option" (Section 321, p. 211)
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213)
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
23. Independence at home demonstration program (Section 1312, p. 718)
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191)