Next month, America’s health insurance plans may lose $1 trillion in revenue.
It won’t have anything to do with a business deal gone awry, or Americans dropping health coverage during the recession. Instead, $1 trillion is the amount of revenue that health insurance plans can expect to lose if the Supreme Court overturns the Affordable Care Act. The Court is expected to issue its opinion in late June.
The figure comes from Bloomberg Government, where number crunchers have taken a look at what happens if the Supreme Court strikes down the Affordable Care Act and its expected expansion of health care coverage to 32 million Americans. They find that, should the Affordable Care Act be found unconstititional, insurance companies will lose $1 trillion in revenue between 2013 and 2020.
To put that in perspective, $1 trillion accounts for about 9 percent of all revenue that health insurers are expected to earn in the same period. It’s one-half of a percent of the country’s Gross Domestic Product. Add up the annual revenues of America’s five largest banks - Bank of America, J.P. Morgan, Wells Fargo, Wachovia and U.S. Bancorp- and you’re still about $500 billion short of what health plans can expect to lose if the Supreme Court decides against Obamacare.
“It’s the sheer size of the number that was startling,” says Bloomberg Government health care analyst Matt Barry. “I don’t know if people fully appreciate the stakes involved here. It’s not just politics - there’s a lot of money, and a lot to lose.”
Showing posts with label Insurance. Show all posts
Showing posts with label Insurance. Show all posts
Tuesday, May 15, 2012
C'mon, Scalito, Roberts, do it. DO IT! I dare ya...
I hope they spend more intellectual firepower on Obamacare, than they did on Citizens United:
Wednesday, January 19, 2011
Jonathan Cohn: "Why Today's vote matters"
A very nice article from a guy who's been watching this fight for the last couple of years. But the killer paragraph(s) were these:
Today's House vote to repeal the Affordable Care Act is merely symbolic. The Senate will almost certainly not pass it and, even if it did, the president surely would not sign it.
But symbolism matters. It sends a message about values. And so it's worth considering what values this generation of Republicans has decided to embrace.
Over the last year, the Republicans have spent a lot of time arguing that the Affordable Care Act will cost too much, that it will micromanage care, that it will burden business with taxes and bureaucracy. The most outrageous claims, like the notion of government-run "death panels," have zero basis in fact. And even the less explosive arguments frequently rely on flimsy evidence. But the most remarkable thing about the Republican campaign against health care reform is what the advocates of repeal haven't said.
They never bothered to engage with the fundamental moral logic behind the Affordable Care Act--that a modern society guarantees everybody access to doctors, hospitals, and the treatments they provide; that it's wrong to sit by and watch people give up their savings, or their lives, just because they happened to get sick. They have some ideas, yes, but nothing that would come remotely close to insuring 30 million people or bolstering coverage for the people who have it.
As recently as the last debate over health care reform, in the 1990s, prominent Republicans showed sincere interest in finding common ground in order to achieve similar goals. And there are, I know, honest, caring conservatives who still feel the same way. But the Republicans in the House? If they too are committed to helping the un- and under-insured, they haven't shown it.
Thursday, September 2, 2010
More workers at small businesses will get Health Care under that no-good Law which MUST be repealed...
From Jonathan Cohn, and the Los Angeles Times:
Yes Republicans, please stop all this nasty, nasty growth and stabilization.
An economist and two health policy researchers at the nonprofit Rand Corp. conducted a simulation to predict what is likely to happen once employers are able to offer coverage through these exchanges. Overall, they estimate that the proportion of U.S. workers who will have access to health insurance through their jobs will jump from 84.6% to 94.6%. That works out to 13.6 million additional workers having the option to buy affordable health plans.
Most of that bump is likely to come from smaller businesses with 50 or fewer employees. Today, only 60.4% of these employees can get health insurance through their jobs. Once the exchanges are functioning, the Rand researchers forecast that 85.9% of small business employees will have the option of buying health plans at work--an increase of 10.5 million workers.
Part of the reason for that growth is that the policies that will be offered through the exchanges will be less expensive, the researchers said. Small companies will be able to band together to pool their risk, which will give them more leverage to bargain with insurance companies. It also means their premiums should be more stable from year to year.
Yes Republicans, please stop all this nasty, nasty growth and stabilization.
Wednesday, September 1, 2010
Remember what I said about Tim Pawlenty?
Never mind:
Do as I say, not as I said to get a couple of headlines a couple days ago in the interests of my faltering Presidential ambitions.
And yes, I know I just ripped Huffington Post and quoted something from Huffington Post in the space of two postings. I am just Mr. Consistency!
Although Minnesota Gov. Tim Pawlenty (R) on Tuesday signed an executive order aimed at keeping the Patient Protection and Affordable Health Care Act out of the state, he has also approved a budget that encourages state agencies to apply for grants funded by that very same health care law.
Pawlenty's executive order explicitly states, "All executive branch departments and agencies are directed that no application shall be submitted to the federal government in connection with requests for grant funding for programs and demonstration projects deriving from the Patient Protection and Affordable Care Act ("PPACA" or "the Act") (Pub.L. 111-148) unless otherwise required by law, or approved by the office of the Governor."
But in Minnesota's Special Session Budget, signed by Pawlenty on May 21, the state health commissioner is directed to apply for grants from this exact law:
Do as I say, not as I said to get a couple of headlines a couple days ago in the interests of my faltering Presidential ambitions.
And yes, I know I just ripped Huffington Post and quoted something from Huffington Post in the space of two postings. I am just Mr. Consistency!
The Republican Con-job on Health Care
As expected a number of states are suing the Federal Government over the “Individual Mandate” in the Affordable Care Act (aka Health Care Reform), all while they work very hard to collect the money they're suing to...keep from...having to take??
Anybody get all that?
The Conservative position is simple. The Individual Mandate makes people buy Health Insurance, and people shouldn’t have to be forced to buy Health Insurance if they don’t want to.
Here’s the problem with that notion. One of the most popular aspects of Health Care Reform is the provision that forbids Insurance Companies denying you coverage based on Pre-Existing Conditions. This provision is so popular that even Conservobots who voted against the bill say that this is the one thing they agreed with. If the Democrats had just gotten rid of the Individual Mandate, we could have voted for Health Care Reform.
Of course, that’s bull@#$%. One of the hard lessons people learned in the last few years is you cannot have one without the other.
Paul Krugman from back in March:
Of course, as you remember, the reform was passed, and Republicans are campaigning to repeal it.
It’s very simple. Health Care is a complicated machine. Piecemeal reform isn't going to cut it (as Dr. Krugman said). If you wanna do X, then you have to do Y. If you don’t, costs spiral out of control and soon nobody will have Health Insurance (see, Insurance Death Spiral).
Which brings me to Tim Pawlenty, Governor of Minnesota, and potential Republican Candidate for President in 2012, doing his damnest to make it impossible to carry his own state.
From Steve Benen:
Let’s call it what it is. Tim Pawlenty is screwing over the uninsured in his state to burnish his Conservative Credintials in advance of the 2012 race.
What a guy!
Needless to say Doctors in Minnesota are pissed off:
But not all Doctors are pissed off, according to Jonathan Chait. Actually, they are pissed off, but for them, not for you:
This is all real simple.
Republicans don’t give a rats ass about deficits or future costs. Period. All they care about is representing the Corporate Master who has given them a lot of campaign cash. They don’t care about the Health of the Health Care System. It’s broken (but starting to mend thanks to HCR), a fifth of our Citizens can’t access it, but screw ‘em. They should have been born to richer, whiter households. We don’t like President Obama anyway, and this seems as good an excuse as any to rail against him, even if it means lying through our teeth to get the job done.
If you fall for this, America, you'll fall for anything.
We’re about to learn a lot about America in the coming months. I maintain my position that the problem with the country isn’t its Polticans, but its people.
Anybody get all that?
The Conservative position is simple. The Individual Mandate makes people buy Health Insurance, and people shouldn’t have to be forced to buy Health Insurance if they don’t want to.
Here’s the problem with that notion. One of the most popular aspects of Health Care Reform is the provision that forbids Insurance Companies denying you coverage based on Pre-Existing Conditions. This provision is so popular that even Conservobots who voted against the bill say that this is the one thing they agreed with. If the Democrats had just gotten rid of the Individual Mandate, we could have voted for Health Care Reform.
Of course, that’s bull@#$%. One of the hard lessons people learned in the last few years is you cannot have one without the other.
Paul Krugman from back in March:
So what’s the answer? Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies.
Or to put it another way, you end up with something like the health care plan Mitt Romney introduced in Massachusetts in 2006, and the very similar plan the House either will or won’t pass in the next few days. Comprehensive reform is the only way forward.
Of course, as you remember, the reform was passed, and Republicans are campaigning to repeal it.
It’s very simple. Health Care is a complicated machine. Piecemeal reform isn't going to cut it (as Dr. Krugman said). If you wanna do X, then you have to do Y. If you don’t, costs spiral out of control and soon nobody will have Health Insurance (see, Insurance Death Spiral).
Which brings me to Tim Pawlenty, Governor of Minnesota, and potential Republican Candidate for President in 2012, doing his damnest to make it impossible to carry his own state.
From Steve Benen:
As implementation of the Affordable Care Act proceeds, the law extends subsidies to states to help early retirees -- folks who leave the workforce before they're eligible for Medicare, but who still want to maintain their coverage. States led by Republicans may claim to hate the new law, but they're nevertheless seeking the funds -- even many of the states trying to kill the ACA in court.
In Minnesota, Gov. Tim Pawlenty (R) is taking a different route. The increasingly right-wing governor, desperate to pander to the party's base in advance of his presidential campaign, issued an order to state officials yesterday, demanding that they not seek grants through the new law, even if the funding would help the people of his state.
Keep in mind, this isn't some kind of opt-out scheme -- the law still applies to Minnesota, just like every other state. This is a scheme whereby funds are made available to states, and Pawlenty is demanding that Minnesota not seek those resources, at least for now.
Let’s call it what it is. Tim Pawlenty is screwing over the uninsured in his state to burnish his Conservative Credintials in advance of the 2012 race.
What a guy!
Needless to say Doctors in Minnesota are pissed off:
The heads of Minnesota's most influential medical associations -- which nearly always keep political matters at arms' length -- issued a sharp rebuke. "The governor's decision just doesn't make sense for Minnesotans," the Minnesota Council of Health Plans, the Minnesota Hospital Association and the Minnesota Medical Association said in a joint statement late Tuesday.
But not all Doctors are pissed off, according to Jonathan Chait. Actually, they are pissed off, but for them, not for you:
Hal Scherz, a doctor and president of the right-wing lobby "Docs4PatientCare" writes in today's Wall Street Journal that he and members of his group are posting letters in their waiting rooms warning patients of the horrors of the Affordable Care Act and urging repeal.
This is all real simple.
Republicans don’t give a rats ass about deficits or future costs. Period. All they care about is representing the Corporate Master who has given them a lot of campaign cash. They don’t care about the Health of the Health Care System. It’s broken (but starting to mend thanks to HCR), a fifth of our Citizens can’t access it, but screw ‘em. They should have been born to richer, whiter households. We don’t like President Obama anyway, and this seems as good an excuse as any to rail against him, even if it means lying through our teeth to get the job done.
If you fall for this, America, you'll fall for anything.
We’re about to learn a lot about America in the coming months. I maintain my position that the problem with the country isn’t its Polticans, but its people.
Saturday, March 6, 2010
Saturday, February 27, 2010
The Fireside chat for February 27, 2010 (VIDEO)
The President takes a moment to congratulate our Olympic athletes. Discussing the unity and pride Americans feel in cheering them on, the President relates that sentiment to his own desire for bipartisanship in Washington. He praises the recent bipartisan meeting and talks about moving forward on health reform.
Saturday, February 20, 2010
The Fireside chat for February 20, 2010 (VIDEO)
The President points to outrageous premium hikes from health insurance companies, especially those already making massive profits, as further proof of the need for reform. Looking ahead to the coming bipartisan meeting on reform, the President urges members of Congress to come to the table in good faith to address the issue.
Or as Paul Krugman put it, game on.
Or as Paul Krugman put it, game on.
The Public Option isn't alive, but it sure isn't dead either (VIDEO)...
Ezra was on Keith last night, basically saying that the Public Option isn't as alive as a lot of my fellow Liberals would hope, because of various Hill Aides fearing that its inclusion will seem too partisan, at a time when the Democrats seem to be bending over backwards to seem bipartisan.
Laurence O'Donnell agreed.
I respectfully disagree.
Visit msnbc.com for breaking news, world news, and news about the economy
Laurence O'Donnell agreed.
Visit msnbc.com for breaking news, world news, and news about the economy
I respectfully disagree.
The Public Option isn't as alive as people think.
Nor, is it as dead as people think (hope) either.
I remember, right as the Senate Bill was being debate Jay Rockefeller (D-WV) coming on MSNBC, and saying that its passage means that Health Care goes from being a every 20 year debate, to an every year debate.
I think this analysis still holds. Once the House passes the Senate Bill (Plan B - which I think they're going to do at the end of the month), the fixes they want will be passed through Reconciliation.
In fact, their fixes and a whole bunch of others will be passed through Reconciliation.
Why couldn't one of those fixes be the Public Option?
Odds are, it will...but the question is when. And that's another area where I disagree with Erza and Laurence. I don't think this is the White House trying to pawn it off on Harry Reid, and vice versa. Part of this is them keeping the issue alive for the February 25th Conference, so that the Senate Bill isn't the most leftward idea in the room. But a lot of this wanting the Public Option fight later. Pass Health Care Reform for signing. Pass a Jobs Bill. Have the fights for Progressive stuff in time for Campaign Season.
I'm one of those people who believe that Politicians always tell the truth when they speak, a very parsed and precise (lawyerly) truth.
When Harry says he'll fight for the Public Option through Senate procedures, I believe him. Of course, he doesn't say he'll succeed or that he has the votes. When the White House says they'll fight for it if the Senate Leadership is for it, that's true also. Of course, they didn't say when they'll fight for it. That's the trick.
I think that before President Obama's first term is up, the Public Option will be passed into law...somehow. I guess the question I have for my fellow Liberals is, does it have to be now in order to be valued by our side. What if it's 2011 or 2012? This President believes in timing. I think he wants to have certain fights at certain times. I think he likes to go public with certain fights at certain times. I think the Public Option fight is scheduled, it's just not when you think its gonna happen...
Friday, January 29, 2010
Answering the Beige One...
This deals with another blog (the Savvy, The Extreme, the Idealist) I occasionally post on. It might sound repetitive to my three regular readers.
There was a quote in the beige one’s recent post that got my attention and I wanted to answer:
I must call up a post I made on here earlier today:
Reforming Health Care is more complicated than what the beige one is making it out to be in his statement. This is why the Democratic solution doesn't fit on an effing bumper sticker. Short of ripping everything up and installing a Single Payer Plan (which is my preferred choice – but good luck getting the votes for that in either chamber), you’re going to be surprised at what choices you have to do reform the system.
And by the way, I’ll get to the beige one’s unemployed dude in a minute. But to debate his point, I have to go to the beginning.
First, you start off with the concept of Universal Coverage. At its core, this is what we all want. Of course, since you want everyone to have access to the system, you have start with ending the ban on pre-existing conditions. This is just basic. Everyone loves this. It polls great.
But, if you end the ban of pre-existing conditions, what happens? Well, sick people who couldn’t previously get insurance will jump into the system, and healthy people will leave figuring (at this point correctly) that they can just buy insurance when they need it (i.e. when they're sick). If that happens, Insurance rates don't just rise, they skyrocket. (Krugman referred to this as an Insurance Death Spiral). If everyone in the Insurance Pool is pulling money out of the system, the Industry can't cover all the costs.
Not won’t, can’t.
So, to keep the healthy people in the system, thus keeping costs low, you have to force the Healthy People to buy insurance (yes, force). This is called a mandate, which everyone hates, and polls terrible.
The mandate is not Insurance putting a gun to our heads, and demanding our healthy citizens. This is just how Insurance works (Auto, Home, what have you). It’s all about managing risk. You have multiple Healthy people putting money into the system covering the one Sick person who takes money out. Doing that keeps our rates lower (though not non-existent). One day, those Healthy People will get sick themselves, but there will be other Healthy people covering them, so the cycle goes on.
Now, if people are made to by insurance, well...some of those people aren't going to be able to afford it (like The beige one’s unemployed guy), so you need to have subsidies to help those who can't pay for this crap, or increased access to Medicaid to do the same. Once you've taken that step, you pretty much have the bills that are wandering their way through Congress.
The lack of a Public Option is a loss, but there are parts of Europe (I think the Netherlands, hardly a bastion of Conservative thought) that have similar systems but don't have Public Plans. It's not a disaster if Health Care Reform doesn't have one. It's just infinitely better with one. It’s not pretty. It’s nowhere in the same good neighborhood of Single Payer (the best and truly cheapest way to fix Health Care), but given the fact that Health Care Costs will double in ten years, it’s our best shot.
And might I remind the beige one a little something about his unemployed guy. Sickness cannot tell, nor does not care when someone don’t have a paying job. If he or his family gets sick while he’s unemployed, he’s screwed, and the rest of us are going to have to cover him. At least with even the crappier Senate plan, he has options, like Medicaid.
This is also a basic sketch of the Massachusetts Plan, which also wasn’t popular when it passed, but try taking it away from them now.
All that mess...was just for one issue: Health Care Reform. Imagine that, multiplied a thousand times (given the thousand problems we have) where every Federal dollar spent has a lobby attached to it.
If I have a complaint about my fellow progressives, it is that they’re spending a lot of time with their heads up their arses, thinking everything is simple. “If he just did this, everything would work…”
No it won’t.
Leadership is never simple. Certainly not as simple as Liberals make it out to be.
And comparing everything to the New Deal?
My fellow Liberals may be many things, but experts on Roosevelt they ain’t (particularly at the Huffington Post where they quote the New Deal like it was the tablets Moses brought down from the mountain. Too bad none of them seem to have...you know...read a book on the the New Deal.)
I’ve been working on a project set in the Depression so I’ve been reading nothing but Depression stuff for the last year and a half. And let me tell you, the New Deal was horribly, horribly compromised from jump. In fact Norman Thomas (Socialist Party leader and Dennis Kucinich of his day, once compared the New Deal “cough drop for a case of pneumonia.” African-Americans were suspiciously left out of a lot of New Deal Programs. Farm Workers were cut out of the National Labor Relations Act just as sharecroppers were going on strike. FDR had a more favorable Congress (with an even bigger majority), but even then they bickered and guffawed about every little damn thing. The Supreme Court struck down a lot of the initiatives from the 100 Days, being about as ethical as the current Roberts Court. There were fears of open armed rebellion, not in the south, but in fuckin’ Iowa. And oh yeah, unemployment was at 25%, almost triple what it is now.
Roosevelt got some things he wanted, some things he didn’t. (He was, it is often forgotten against the creation of the FDIC). You have to look at the whole picture, and not just your imagined corner of it. It is the overall metric of FDR's Presidency that we judge him on, and judge him rightly. It has to be the same standard for Obama, or otherwise the Progressive movement is more full of shit than I feared.
There was a quote in the beige one’s recent post that got my attention and I wanted to answer:
Mr. President, during the State of the Union address, you said that you didn’t choose to tackle the health care reform issue just to get a legislative victory under your belt. I believe you, but can you tell me how taking someone that is unemployed, or maybe is employed, but still can’t afford decent health insurance and making them buy some kind of policy from the very insurance companies that have screwed us in the past; how is this not capitulation? How do you go from the Public Option (and you did campaign on the Public Option) to trigger plans and not see that as dispiriting for the people who voted for you?
I must call up a post I made on here earlier today:
Reforming Health Care is more complicated than what the beige one is making it out to be in his statement. This is why the Democratic solution doesn't fit on an effing bumper sticker. Short of ripping everything up and installing a Single Payer Plan (which is my preferred choice – but good luck getting the votes for that in either chamber), you’re going to be surprised at what choices you have to do reform the system.
And by the way, I’ll get to the beige one’s unemployed dude in a minute. But to debate his point, I have to go to the beginning.
First, you start off with the concept of Universal Coverage. At its core, this is what we all want. Of course, since you want everyone to have access to the system, you have start with ending the ban on pre-existing conditions. This is just basic. Everyone loves this. It polls great.
But, if you end the ban of pre-existing conditions, what happens? Well, sick people who couldn’t previously get insurance will jump into the system, and healthy people will leave figuring (at this point correctly) that they can just buy insurance when they need it (i.e. when they're sick). If that happens, Insurance rates don't just rise, they skyrocket. (Krugman referred to this as an Insurance Death Spiral). If everyone in the Insurance Pool is pulling money out of the system, the Industry can't cover all the costs.
Not won’t, can’t.
So, to keep the healthy people in the system, thus keeping costs low, you have to force the Healthy People to buy insurance (yes, force). This is called a mandate, which everyone hates, and polls terrible.
The mandate is not Insurance putting a gun to our heads, and demanding our healthy citizens. This is just how Insurance works (Auto, Home, what have you). It’s all about managing risk. You have multiple Healthy people putting money into the system covering the one Sick person who takes money out. Doing that keeps our rates lower (though not non-existent). One day, those Healthy People will get sick themselves, but there will be other Healthy people covering them, so the cycle goes on.
Now, if people are made to by insurance, well...some of those people aren't going to be able to afford it (like The beige one’s unemployed guy), so you need to have subsidies to help those who can't pay for this crap, or increased access to Medicaid to do the same. Once you've taken that step, you pretty much have the bills that are wandering their way through Congress.
The lack of a Public Option is a loss, but there are parts of Europe (I think the Netherlands, hardly a bastion of Conservative thought) that have similar systems but don't have Public Plans. It's not a disaster if Health Care Reform doesn't have one. It's just infinitely better with one. It’s not pretty. It’s nowhere in the same good neighborhood of Single Payer (the best and truly cheapest way to fix Health Care), but given the fact that Health Care Costs will double in ten years, it’s our best shot.
And might I remind the beige one a little something about his unemployed guy. Sickness cannot tell, nor does not care when someone don’t have a paying job. If he or his family gets sick while he’s unemployed, he’s screwed, and the rest of us are going to have to cover him. At least with even the crappier Senate plan, he has options, like Medicaid.
This is also a basic sketch of the Massachusetts Plan, which also wasn’t popular when it passed, but try taking it away from them now.
All that mess...was just for one issue: Health Care Reform. Imagine that, multiplied a thousand times (given the thousand problems we have) where every Federal dollar spent has a lobby attached to it.
If I have a complaint about my fellow progressives, it is that they’re spending a lot of time with their heads up their arses, thinking everything is simple. “If he just did this, everything would work…”
No it won’t.
Leadership is never simple. Certainly not as simple as Liberals make it out to be.
And comparing everything to the New Deal?
My fellow Liberals may be many things, but experts on Roosevelt they ain’t (particularly at the Huffington Post where they quote the New Deal like it was the tablets Moses brought down from the mountain. Too bad none of them seem to have...you know...read a book on the the New Deal.)
I’ve been working on a project set in the Depression so I’ve been reading nothing but Depression stuff for the last year and a half. And let me tell you, the New Deal was horribly, horribly compromised from jump. In fact Norman Thomas (Socialist Party leader and Dennis Kucinich of his day, once compared the New Deal “cough drop for a case of pneumonia.” African-Americans were suspiciously left out of a lot of New Deal Programs. Farm Workers were cut out of the National Labor Relations Act just as sharecroppers were going on strike. FDR had a more favorable Congress (with an even bigger majority), but even then they bickered and guffawed about every little damn thing. The Supreme Court struck down a lot of the initiatives from the 100 Days, being about as ethical as the current Roberts Court. There were fears of open armed rebellion, not in the south, but in fuckin’ Iowa. And oh yeah, unemployment was at 25%, almost triple what it is now.
Roosevelt got some things he wanted, some things he didn’t. (He was, it is often forgotten against the creation of the FDIC). You have to look at the whole picture, and not just your imagined corner of it. It is the overall metric of FDR's Presidency that we judge him on, and judge him rightly. It has to be the same standard for Obama, or otherwise the Progressive movement is more full of shit than I feared.
Thursday, January 28, 2010
This helps...Part 3
This has been a freakin' busy day, mostly because the State of the Union tends to produce a lot of news around it.
Screw Mary Landrieu, Al Franken has got it goin' on:
Statement's like Mary Landrieu's are why she's going to lose in November, and frankly...won't be missed.
Screw Mary Landrieu, Al Franken has got it goin' on:
"I think we all thought this gathering today would be a celebration," he said. "Well, it may not be a celebration, but it's not a funeral either," he said.
From that moment, Franken called for those present to keep fighting for the cause and not to give up so close to victory.
"The opponents of reform have found their bumper sticker, their slogan, their rallying cry, it's one word: No. You can read that on a bumper," Franken told the members of Families USA, drawing laughs. "Our bumper sticker has — it's just way too many words. And it says, "'Continued on next bumper sticker.'"
While Franken acknowledged there were some parts of the Senate bill he does not agree with, he said that called for the House to pass it, with the understanding that Congress would then "fix" the bill through the process of budget reconciliation which only needs a simple majority.
"We have to stop letting perfect be the enemy of the merely very good. And I believe that the bill we passed in the Senate is a very good foundation on which to build," he said. He highlighted several "very good" aspects of the Senate bill, including his medical-loss ratio provisions, which would require that 85 percent of premiums be spent on actual health care costs, not profits and overhead.
Franken acknowledged that the Democratic loss in the U.S Senate race in Massachusetts was a setback, but reiterated Obama's words in the State of the Union speech Wednesday night that this is not the time to give up.
"If they did anything, it helped remind us of why we're doing this in the first place. They reminded us of how hard it is, how truly hard it is, to bring about big change in America. And they reminded us of what we're up against. And they reminded us about how close we are to the biggest health care victory in half a century."
Statement's like Mary Landrieu's are why she's going to lose in November, and frankly...won't be missed.
This helps...Part 2
House Speaker Nancy Pelosi (D-DA, talkin' willpower:
I've said to my colleagues, go in the door. The door's locked? Go to the gate. The gate's locked? Climb over the fence. It's too high? Pole vault in. That doesn't work? Parachute in. We have to get this done for the American people one way or another.
This helps...Part 1
Sen. Ben Nelson (D-NB), talkin' reconcilliation:
“If Republican colleagues are serious about fixing our health care system and want to avoid using the reconciliation process, then I will go to the negotiating table with them,” Senator Nelson said. “If Republican senators join me at the table, we can use bipartisanship for health reform rather than use reconciliation, which needs only 50 votes to approve legislation.
“All it takes is one Republican to come forward, put partisanship aside, and work on behalf of those that do not have or cannot afford health insurance,” Nelson added. “Working together, we can fight to ensure health reform relies on our private market system, rather than the government to reduce the cost of health care and deliver better care for millions of Americans.
“Reconciliation has never been my preference for moving legislation. Instead, I always prefer the regular order process that allows full and open debate, many amendments and an opportunity for broad bipartisanship. That can be achieved, if Republican colleagues come to the negotiating table with their ideas and proposals,” Nelson said.
Wednesday, December 16, 2009
Ezra Klein explains the Individual Mandate...
Ezra Klein wrote a brilliant post today, pushing back on one of my fellow progressive's more popular claims: that the Senate Health Care Reform would be okay if they just got rid of the individual mandate.
One of the many things that drew me to Barack Obama during the 2008 Campaign was his opposition to an individual mandate. (Hilliary if you remember, supported one). All that meant to me was that Heidi was gonna be made to buy Health Insurance, and I wasn't down with that.
Now, I've since learned...since watching the Health Care debate is that then-Senator Obama was wrong about the Individual Mandate, and so was I:
Erza, thus, presents the reasons:
One of the many things that drew me to Barack Obama during the 2008 Campaign was his opposition to an individual mandate. (Hilliary if you remember, supported one). All that meant to me was that Heidi was gonna be made to buy Health Insurance, and I wasn't down with that.
Now, I've since learned...since watching the Health Care debate is that then-Senator Obama was wrong about the Individual Mandate, and so was I:
Erza, thus, presents the reasons:
The importance of the individual mandate
Markos Moulitsas explains his opposition to the Senate bill, and says it all comes down to the individual mandate. "Strip out the mandate," he says, "and the rest of the bill is palatable. It's not reform, but it's progress in the right direction. And you can still go back and tinker with it at a later time."
I'm sympathetic to his thinking. This was, of course, Barack Obama's position during the 2008 campaign, and it led toarguably the most bitter policy dispute in the race. But after winning the presidency, the Obama administration flipped on it, and they were right to do so. Here's why.
Pick your favorite system. Socialized medicine in Britain. Single-payer in Canada. Multi-payer with a government floor in France. Private plans with heavy public regulation in Sweden, Germany and elsewhere. None of these plans are "voluntary." In some, there's an individual mandate forcing you to pay premiums to insurance companies. In some, there's a system of taxation forcing you to pay premiums to the government. In all of them, at least so far as I know, participation is required except in very limited and uncommon circumstances. And there's a reason for that: No universal system can work without it.
Holding the price of insurance equal, insurance is gamble on both sides. From the insurer's perspective, it's a better deal to insure people who won't need to use their insurance. From the customer's perspective, it's precisely the reverse.
Right now, the insurer sets the rules. It collects background information on applicants and then varies the price and availability of insurance to discriminate against those who are likely to use it. Health-care reform is going to render those practices illegal. An insurer will have to offer insurance at the same price to a diabetic and a triathlete.
But if you remove the individual mandate, you're caught in the reverse of our current problem: The triathlete doesn't buy insurance. Fine, you might say. Let the insurer get gamed. They deserve it.
The insurers, however, are not the ones who will be gamed. The sick are. Imagine the triathlete's expected medical cost for a year is $200 and the diabetic's cost is $20,000. And imagine we have three more people who are normal risks, and their expected cost in $6,000. If they all purchase coverage, the cost of insurance is $7,640. Let the triathlete walk away and the cost is $9,500. Now, one of the younger folks at normal cost just can't afford that. He drops out. Now the average cost is $10,600. This prices out the diabetic, so now she's uninsured. Or maybe it prices out the next normal-cost person, so costs jump to $13,000.
This is called an insurance death spiral. If the people who think they're healthy now decide to wait until they need insurance to purchase it, the cost increases, which means the next healthiest group leaves, which jacks up costs again, and so forth.
Kill the individual mandate and you're probably killing the bill, too. The mandate is what keeps average premium costs low, because it keeps healthy people in the insurance pool. It's why costs have dropped in Massachusetts, not jumped. It's why every other country with a universal health-care system -- be it public or private -- uses either a mandate or the tax code. It's why the Obama administration flip-flopped.
But maybe you're willing to ditch universality. Add some subsidies, leave the mandate, and it's a step forward, right? At least until the project is consumed by an insurance death spiral? And Congress will surely do something to stop that, right? Well, maybe.
Kill the individual mandate and you make it easy for Congress to let the country backslide to its current condition. In a world with an individual mandate, insurance has to be affordable. If it's not, there's a huge political backlash. That gives Congress a direct incentive to focus on cost. Remove the individual mandate and ... eh. If insurance isn't affordable, people simply go uninsured. It's exactly what happens now. Same incentives, or lack thereof, to make the system better.
In his post, Markos says the bill lacks "mechanisms to control costs." I'd disagree with that, pointing to the bundling, MedPAC, the excise tax, the possibilities of a competitive insurance market, and more. The bill doesn't do enough, but it does more than anything we have ever done before. But put that aside for a moment. As Atul Gawande argues, there's no Big Bang of cost control. The public option wouldn't have done it, and nor would Medicare buy-in. It's a process. And this bill, in large part through the individual mandate, creates that process.
The key to cost control is a politics that forces Congress to make the hard decisions that lead to cost control. Right now, the ranks of the uninsured grow, the cost of insurance rises, and Congress can pretty much ignore the whole thing. The individual mandate controls average premium costs, but more than that, it is the political mechanism for cost control. Kill it, and you've killed our best hope of making the next reform better than this one.
Nate: 20 Questions for Bill Killers...
Wow. Nate's just as pissed as I am...at my fellow progressives.
1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?
2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?
3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?
4. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?
5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?
6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: "forcing you to buy government-run insurance?"
7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill?
8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?
9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?
10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?
11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?
12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?
13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?
14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?
15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?
16. What are the chances that improvements can be made around the margins of the plan -- possibly including a public option -- between 2011 and the bill's implementation in 2014?
17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a 'mandate' for a public option that could be inserted via reconciliation?
18. Was the public option ever an attainable near-term political goal?
19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?
20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?
Friday, December 4, 2009
This week in Liberal pushback...
There's a been a fair bit of Liberal pushback over the last couple of days, as in pushback against Liberals who are bashing the living hell out of the Obama Administration. Today's latest comes from Ezra Klein:
(Of course, I'm going to cut right to good stuff. Click on the above link if you want to read the three paragraphs worth on the Public Option analysis.)
Let me put an exclamation point on this posting by saying, categorically, that my personal preference is for a Medicare for all System. There are people who oppose this. Those people, frankly, are idiots.
Failing that (because, I know how to count), my next level of preference is for the Current Health Care Reform Package with a robust Public Option.
There are people who say that it is better to tank the whole bill, rather than let the Public Option slide away. As before, those people, frankly, are idiots.
Losing the Public Option will be a tragedy. Losing Health Care Reform itself will be criminal.
(Of course, I'm going to cut right to good stuff. Click on the above link if you want to read the three paragraphs worth on the Public Option analysis.)
It might have been a necessary thing from an activism point of view, but convincing liberals that this bill was worthless in the absence of the public option was a terrible decision, wrong on the merits and unfair to the base. The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won't be sent. Parents won't have to fret because they can't take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.
But bills like this one have failed before, even in my (admittedly brief) lifetime. Indeed, pretty much the only thing that bills like this one have ever done is fail. But somewhere along the way, a fair swath of people convinced themselves either that this legislation was pretty much a done deal, and the argument could move toward its margins, or that the legislation wasn't worth passing without the public option. Neither was true, and a lot of the difference between me and some of my progressive friends came because I placed a higher probability on, and had more of an aversion to, the failure of the underlying bill.
Basic passage here is a liberal win, and evidence that liberals are running the country. Channeling $900 billion towards the un- and underinsured is Jay Rockefeller's addition to the agenda, not Ben Nelson's. But structurally, liberals only have what power and influence they actually have. And that's not 60 votes' worth. The incredible organizing that's been done on the public option was, on some level, an effort to suspend that reality, and it worked a whole lot better than I thought it would. But it wasn't enough -- couldn't have been enough, really -- to overcome the math of the Senate.
Some will take that as a criticism of the folks organizing on the public option. It's not. There's no chance to win if you don't play the game. But constructing liberal influence and power is a project with a longer time horizon than health-care reform. It's not going to happen before this bill is passed, and I disagree, strongly, with those who think it will profit from this bill's failure. This was something of a test case. Democrats had their 60 votes. They had a majority unknown in modern times. A majority that isn't going to get bigger. And what we learned is that, in this game, that majority simply is not big enough.
The U.S. Congress is hostile not only to liberal power, but also to conservative power, and for that matter, to majority governance. The rules trump the election, trump the organizing, trump the 50-plus senators in support of the public option, trump all of it. Liberals will never have 70 votes in the Senate, and, in a useful symmetry for the purposes of coalition building, nor will conservatives, and nor, it seems, will people who want to make hard decisions to solve pressing problems. The story of the public option -- and of the preservation of employer-based health care, and the insufficient cost controls, and the protection of providers, and all the rest -- isn't just a story for liberals. It's a story about our system of governance and its inability to respond to problems even when you stack the deck in change's favor.
That's why the focus of this blog has shifted somewhat. The first problem for people who care about policy outcomes -- regardless of which direction they care about those outcomes from -- is that the Congress has developed an overwhelming bias toward inaction and the status quo. It is much stronger now than it has been in the past, and it's exacerbated because we are much more divided now than we have been in the past. The answer to the systemic dysfunction on display in the health-care reform debate does not lie elsewhere in the health-care reform debate. For now, you get the best bill you can given the constraints we have. But seeing those constraints clearly is, I think, a step forward, because it's a useful guide to where we need to go next.
Let me put an exclamation point on this posting by saying, categorically, that my personal preference is for a Medicare for all System. There are people who oppose this. Those people, frankly, are idiots.
Failing that (because, I know how to count), my next level of preference is for the Current Health Care Reform Package with a robust Public Option.
There are people who say that it is better to tank the whole bill, rather than let the Public Option slide away. As before, those people, frankly, are idiots.
Losing the Public Option will be a tragedy. Losing Health Care Reform itself will be criminal.
Monday, June 29, 2009
The cream rising to the top...
This is from a longer piece on Talking Points Memo. One of the things that I liked about the Public Option was that it was a method by which the Insurance Companies would die a slow death, and we'd transition over time to full on Single Payer.
But there's another side of this, a danger where the Insurance Companies prolong their hold over us, and keep prices high, wherein they "cream" their pools.
Simply put, they insure only healthy people, and dump the unhealthy onto the Public Option, keeping prices high as a result. Josh and Zack have more on their in their highly wonky article, but the key part (and the good news) was this from the Later Update section:
But there's another side of this, a danger where the Insurance Companies prolong their hold over us, and keep prices high, wherein they "cream" their pools.
Simply put, they insure only healthy people, and dump the unhealthy onto the Public Option, keeping prices high as a result. Josh and Zack have more on their in their highly wonky article, but the key part (and the good news) was this from the Later Update section:
The current health care reforms drafts, at least in the Senate, would create regional risk pools that drive out the incentive to "cream." In short, if Insurance Company A insured only the lowest-risk half of a given pool, it would have to pay a subsidy that goes to the company (or public plan) insuring the highest-risk members of the pool. In other words, we would drive out the incentive to cream, while also making it illegal to deny coverage on the basis of a pre-existing condition. CMS would manage that risk-balancing process, and has apparently become quite good at it. The Netherlands does something similar, so successfully that insurers actually seek out diabetics to insure.
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