UPDATE #2: The substance of the bill is now coming out and seems similar to the leaks from last weekend. I’m still not sure this is going to pass this year as it seems very sketchy in details. Public opinion may not be more receptive in spite of rhetoric to the contrary. Obama has a political event scheduled today in Wisconsin to support his health care bill but an inadvertent truth slipped into the Washington Post article about the trip.
States such as Wisconsin have lower medical costs because they are predominantly white and middle class, he said. The notable exception is Milwaukee, with its “poverty corridor,” he said. “Nobody wants to talk about the fact that if you want to deal with health care you have to deal with poverty.”
Nobody wants to talk about the real drivers of high healthcare costs. Of course, they also do not mention how many of the Green Bay elderly move to warmer states as they age.
UPDATE: Obama seems to be making a serious effort at a single payer health care bill this year. The details were secret but now seem to be leaking out and the bills, themselves, may be reported out soon. Whether this will actually pass is still in doubt but there are several sites doing a good job of analyzing the two versions of the legislation, for the House and the Senate.
Here is one analysis. The mandatory rule is one that Obama opposed in the primary debates but seems to have adopted. The free rider is a serious problem that needs to be addressed but, as always, the devil is on the details.
The Kennedy-Dodd bill would create an individual mandate requiring you to buy a “qualified” health insurance plan, as defined by the government. If you don’t have “qualified” health insurance for a given month, you will pay a new Federal tax. Incredibly, the amount and structure of this new tax is left to the discretion of the Secretaries of Treasury and Health and Human Services (HHS), whose only guidance is “to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).”
This should be unconstitutional as the taxing power resides with Congress. Of course, COngress can delegate but this is extreme, even for Democrats. My concern is with the type of insurance to be mandated. If this is a basic catastrophic plan, I’m for it, but I doubt they can leave well enough alone.
The Kennedy-Dodd bill would also create an employer mandate. Employers would have to offer insurance to their employees.
Once again, the idea has merit but it will no doubt increase unemployment just as the French have created high unemployment by onerous rules for discharging employees. I thought the idea was to get employer-related insurance ended to free up the job market and reduce the anxiety that losing a job meant losing health insurance. McCain tried to suggest this in the campaign but could never explain it.
In the Kennedy-Dodd bill, the government would define a qualified plan:
All health insurance would be required to have guaranteed issue and renewal, modified community rating, no exclusions for pre-existing conditions, no lifetime or annual limits on benefits, and family policies would have to cover “children” up to age 26.
The House bill outline is consistent with but less specific than the Kennedy-Dodd legislative language. The House bill outline would “prohibit insurers from excluding pre-existing conditions or engaging in other discriminatory practices.” I will keep my eye on what “other discriminatory practices” means in the legislative language. Does that mean that a health plan cannot charge higher premiums to smokers?
Here is the camel’s nose under the tent. Other sections of the bill will ban insurance rating for risky behavior.
A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.” The MAC would have to include items and services in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.
This appears parallel but is less specific for now: “Independent public/private advisory committee recommends benefit packages based on standards set in statute.” I find the “standards set in statute” interesting. It suggests that provider and disease interest groups will have two fora in which to lobby for their benefits to be mandated: Congress, and the advisory committee.
Here comes the politics. I spent years on the California Medical Association’s Commission on Legislation. We lost most of those battles because every provider group, from inhalation therapy to alternative medicine freaks, was in there promising contributions if the legislator would only vote for this one little item that was crucial to their group. I might add that the Republicans were the worst in voting for the weirdo alternative health bills.
Health insurance plans could not charge higher premiums for risky behaviors: “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.
The House bill outline says it would “prohibit plans [from] rating (charging higher premiums) based on gender, health status, or occupation and strictly limits premium variation based on age.” If the bill were to provide nothing more, this would appear to parallel the Senate bill and preclude plans from charging higher premiums for risky behaviors.
More politics. This is what kills health care cost control. Eventually, you end up with conventional care being rationed and the alternative stuff approved because it is “cheaper” and people want it.
Tags: health reform, rationing
It appears to be a case of “to save the village, we had to burn it down.” Our politicians are too eager to “pencil in” a flat rate for health insurance, so what we’ll have is essentially a health tax.
I don’t think it matters what the legislation provides. Congress will start with something extreme so it will be easier for Obama to step in with his trademarked above-the-fray compromise. I don’t think he cares about the details as long as they move America closer to single-payer, nationalized health care. Why? Because at some point it will be too late to go back, so all Obama wants is get things moving in the direction of socialized medicine. But he needs to do something fast while Americans are still swayed by his oratory and personal popularity, especially in the first 6-12 months.
Off-topic FYI re: P’s comments: The SuperCache is on to keep the website from melting down but that really slows down comments.