It Begins

July 14, 2009 1:51 PM

Three committees of the United States House of Representatives have released the House's version of healthcare reform--the America's Affordable Health Choices Act. The bill [1000 page pdf] [summary] introduces a Health Insurance Exchange, minimum standards for benefit packages, protections for consumers, and a "level playing field" public insurance option with the right to use Medicare rates for the first three years. Initial reactions are positive.
posted by nasreddin (112 comments total)

It seems to be an interesting start and covers several of the main points of concern that people on both sides have about coverage. Let's see how much of it survives sausage-making.
posted by Blazecock Pileon at 1:54 PM on July 14, 2009

I posted this over at TPM, but you guys talk more so here is my take

Skimming so far -

Details on insurance plan standards

Page 27
Breakdown of covered services. This looks good.

Page 28
Seems like there's no cost sharing on preventative care. That's also good

Page 29
This is a zinger. Basically, out of pocket can't exceed 5k for an individual or 10k for a family, increasing by CPI every year. That's a huge gotcha.

There's something about either covering up to 70% of the value of the benefits, but I'm not sure if that sets a copay maximum on non-preventative stuff.

Page 30
Private/Public board determines covered benefits and essential enhanced and premium plans.
Surgeon General.
9 members not from the government appointed by the prez.
9 Members appointed by the comptroller general (like Medicare)

Page 33
Cost sharing breakdown on the plans.
Enhanced Plan - covers 85% of costs
Premium Plan - 95% coverage

Seems like there's a lot of places to rack up the copays/charges, especially with the costs where they are.

Page 37
Consumer Protection stuff
Limiting recisision to cases of Fraud only

Page 72
Health Insurance exchange program

Page 80
3 years until large employers are eligible for the exchange program? (20+employees)

Page 84
the only required offering is a Basic plan. Seems to be a high copay plan.

Once they offer Basic, they can offer the Enhanced and Premium mentioned above.

I'll be honest, the exchange program is sort of gobbledygook to me.

Page 116
Public Option
Covers the Basic, Enhanced and Premium plans with the option for a Premium Plus plan

page 119
Premium Costs must be high enough to fully cover all benefits provided.

They need to get the costs under control to make that one work...

Page 122
Payment rate for prescription drugs are either derived from Medicare A/B payment schedules, or rates negotiated by the secretary.

Negotiated prescription costs from the government is something new to the US system.. We'll see how that goes.


I'm posting this as is, even though there's another 800 pages left.

I'm not sure why they're doing the exchange and the public plan, nor am I familiar enough with the specifics of the costs, but at first glance, it's interesting and MIGHT be a step in the right direction..


Anyone with a better eye for legalese able to add more?
posted by Lord_Pall at 1:57 PM on July 14, 2009 [19 favorites]

Preventing insurance companies from using pre-existing conditions is huge. I've known lots of people (myself included) that didn't seek treatment for medical issues because a diagnosis would make it a pre-existing condition.
posted by electroboy at 2:07 PM on July 14, 2009 [20 favorites]

I have the utmost confidence that our leadership in the Congress will read every page of that 1000+ page bill before signing and subjecting the entire country to it.

I'm also extremely confident that the same Congress members will use the system for their own families, since it's the best solution for all of America.
posted by TheFlamingoKing at 2:12 PM on July 14, 2009 [4 favorites]

Let's see how much of it survives sausage-making.
-Blazecock Pileon

I'm interested to see how the hungry/crazy and ravenous members of Senate will take to this.
posted by glaucon at 2:12 PM on July 14, 2009

Ezra Klein has more.
posted by emjaybee at 2:16 PM on July 14, 2009 [1 favorite]

Hallelujah on the end of pre-existing conditions and lifetime maximum clauses. Not all of us are fortunate enough to be healthy and wealthy, insurance company assholes.

This whole thing where the public option isn't actually an option for people with existing health insurance strikes me as simply a gimme for the insurance companies. There is insinuation it will phase in, and maybe gradual growth of the public plan is the best way to do it from a logistics stand point, but it's not really fair to have public insurance that most of the public can't use.
posted by hydropsyche at 2:17 PM on July 14, 2009

Quick! vote on it before anybody has a chance to read it!
posted by LakesideOrion at 2:20 PM on July 14, 2009

If I'm reading this correctly, about half is paid for through $500 billion or so in savings from Medicare and Medicaid. The rest comes from a surtax on the richest 1.5 percent. The surtax is 1 percent on income between $350,000 and $500,000; 1.5 percent on income between $500,000 and $1,000,000; and 5.4 percent in income above $1,000,000.

How long before we start hearing about those poor people who have incomes of more than a million dollars annually?
posted by grouse at 2:21 PM on July 14, 2009 [3 favorites]

Employers with fewer than 25 employees get a tax credit proportional to their health insurance benefit costs. The credit starts at 50% of the cost if the employees make an average of $20k/year from the employer. There is a proportional phaseout such that by the time the employees make an average of $40k/year from the employer, there is no credit.

There is also a phaseout based on the number of employees. The phaseout starts at 15 employees and ends at...well, I'm not sure where, that section is really hard to understand.

You can't use averaging tricks to take advantage of the credit for highly paid employees (i.e., those earning more than $80k/year from the compan). The employees have to make at least $5k/year from the employer.

All of these amounts are tied inflation beginning in 2014.

Surcharge on the very wealthy. Individual taxpayers making more than $350k will pay a 1% tax on income from 350-500, 1.5% on 500k-1000k, and 5.4 on income over $1000k. This will go up to 2%, 3%, and 5.4% in 2013. That increase won't apply if this program manages to save between 150 and 175 billion dollars. If it saves more than 175 billion, the surcharge goes away entirely. These numbers are also pegged to inflation. This is a politically smart way to pay for it and brings much needed progressiveness to the top tax brackets, but it'll probably be fought hard by Republicans, unfortunately.
posted by jedicus at 2:22 PM on July 14, 2009 [6 favorites]

Saying initial response is positive and having a link to Mother Jones is like saying all Americans support the Iraq war and citing Free Republic as your source.
posted by Catholicgauze at 2:26 PM on July 14, 2009 [4 favorites]

I read the whole thing last week. The plot is a bit weak, and there's numerous spelling mistakes. I definitely think they need a better editor.

Wait, you mean it's NOT fiction?
posted by blue_beetle at 2:27 PM on July 14, 2009 [1 favorite]

Hallelujah on the end of pre-existing conditions and lifetime maximum clauses. Not all of us are fortunate enough to be healthy and wealthy, insurance company assholes.

This whole thing where the public option isn't actually an option for people with existing health insurance strikes me as simply a gimme for the insurance companies. There is insinuation it will phase in, and maybe gradual growth of the public plan is the best way to do it from a logistics stand point, but it's not really fair to have public insurance that most of the public can't use.

Agreed. Part of what I'm hoping will happen is that the existence of a federal plan without exclusions for pre-existing conditions (which is one of the cruelest and most unreasonable elements of most health care plans) will make Americans covered under private plans see just how reprehensible these clauses are, and perhaps increase demand for the public program and/or demand for a ban against such exclusions.
posted by foxy_hedgehog at 2:28 PM on July 14, 2009 [1 favorite]

I read this to mean that no-one gets excluded from any plan, public or private, for pre-existing conditions.
posted by electroboy at 2:30 PM on July 14, 2009

Ah, jeez. I just put a comment in the last open health reform thread about this, and the status of all the other pieces of health reform traveling through the Senate.

Interestingly, the CBO has costed the House bill out at about a billion dollars over ten years, which was the same score given to the Senate HELP committee legislation about a month ago. The HELP committee thought that was such a negative result they actually asked CBO to re-score, with slightly changed assumptions (and they did get it to about half as expensive).

I guess reporters and the political chattering class are less shocked when the House proposes expensive legislation, because of the perception that of course the Senate will knock it down to a more reasonable level.
posted by iminurmefi at 2:33 PM on July 14, 2009

Wow! Thanks, didn't get to that PDF.
posted by foxy_hedgehog at 2:33 PM on July 14, 2009

Saying initial response is positive and having a link to Mother Jones is like saying all Americans support the Iraq war and citing Free Republic as your source.

Be fair now, there was a link to WaPo too and I interpreted the Mother Jones link as a way to confirm that, yes, the left wing of the Democratic Party is also happy with this. Which there was some question as to whether or not progressives would be satisfied with what came out of the Congress.
posted by IvoShandor at 2:38 PM on July 14, 2009

Seems like a decent starting point.

To me, and I realize this is a bit contentious, I think this issue is worthy enough to threaten and follow though on the "nuclear option" if there is a significant filibuster threat in the Senate. The long term consequences may be dubious, but frankly looking at 6 years of Bush and Republican congress I can't see that the democrats use the filibuster all that often anyways. So ditching it may be just fine. Do that and climate change, DOMA, DADT, and a bunch of other things just well could all get that 50 votes needed to pass.
posted by edgeways at 2:39 PM on July 14, 2009

the CBO has costed the House bill out at about a billion dollars over ten years

I think you meant a trillion.
posted by jedicus at 2:40 PM on July 14, 2009

Interestingly, the CBO has costed the House bill out at about a billion dollars over ten years, which was the same score given to the Senate HELP committee legislation about a month ago. The HELP committee thought that was such a negative result they actually asked CBO to re-score, with slightly changed assumptions (and they did get it to about half as expensive).

That should be "trillion," of course.
posted by nasreddin at 2:41 PM on July 14, 2009

I'm not sure yet which will be more infuriating -- the Republicans' populist spin on surcharges for the wealthy, or poor schlubs' buying into it.
posted by HumuloneRanger at 2:41 PM on July 14, 2009 [10 favorites]

jedicus, yes, of course. Duh. My zeros are getting away from me!
posted by iminurmefi at 2:42 PM on July 14, 2009

I think the better approach to filibuster reform is to do away with procedural filibusters and require senators to actually stand up and talk for hours on end. Let their faces be plastered all over the news as they hold up vital reform efforts.
posted by jedicus at 2:44 PM on July 14, 2009 [4 favorites]

Incidentally, I linked to both Klein and Drum because they're healthcare wonks. What the Republicans think doesn't really matter, since they're all going to vote against the bill anyway.
posted by nasreddin at 2:44 PM on July 14, 2009 [1 favorite]

Employers with fewer than 25 employees get a tax credit proportional to their health insurance benefit costs. The credit starts at 50% of the cost if the employees make an average of $20k/year from the employer. There is a proportional phaseout such that by the time the employees make an average of $40k/year from the employer, there is no credit.

I'm still reading, but I hope there's some sort of adjustment for this: otherwise, a huge number of companies, of all sizes, that are based in high-cost-of-living areas like the San Francisco Bay Area, Seattle, or New York City are going to never even get a shot at the credit.
posted by scrump at 2:45 PM on July 14, 2009

Wait.. a billion dollars over 10 years is expensive? Who actually thinks this? That is literally about $3.30 cents per person in the USA, over ten years. Even if it was 100 billion dollars over ten years that is friggen cheap when spread out over the population. A billion a year, ten billion a year, all those are reasonable, nay pathetically cheap. there is no excuse not to pass something like this if this is the price tag.

A trillion dollars every ten years? Oh noes $3300 over a decade for medical insurance?
posted by edgeways at 2:47 PM on July 14, 2009 [14 favorites]

On the surface, this seems like a decent plan designed to bring us into line with the rest of the industrialized world.

Of course, this is the beginning plan. You never know what this will mutate into when it finally reaches the Senate.
posted by reenum at 2:49 PM on July 14, 2009 [1 favorite]

ah.. others have corrected it, even so a trillion for ten years seems pretty reasonable.
posted by edgeways at 2:49 PM on July 14, 2009

Interestingly, the CBO has costed the House bill out at about a billion dollars over ten years, which was the same score given to the Senate HELP committee legislation about a month ago. The HELP committee thought that was such a negative result they actually asked CBO to re-score, with slightly changed assumptions (and they did get it to about half as expensive).

That's for the non-revenue parts of the bill. The cost should be covered by the entitlement savings and the surtax, but we haven't seen the CBO's report on those sections yet.
posted by mikedouglas at 2:53 PM on July 14, 2009 [1 favorite]

scrump: I'm pretty sure it ends at $40k. The phaseout language is phrased in a way that is almost intentionally difficult to understand, like a word problem from hell. I mean, I have a bachelor's degree in mathematics, and while I thought I understood it, maybe I didn't:

"In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the [50%] specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000."
posted by jedicus at 2:53 PM on July 14, 2009

"In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the [50%] specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000."

Seems straightforward to me. Bob pays his employees $20k a year and gets a 50% reduction. Jane pays her employees $25k a year and gets a (25 - 20)/20=25% reduction in the reduction, i.e., a 37.5% reduction. Steve pays his employees 40k a year and gets a (40-20)/20=100% reduction in the reduction, i.e., a 0% reduction.
posted by nasreddin at 3:03 PM on July 14, 2009

The standardized benefit package is a fantastic idea (and the requirement that any plan offering addition services must cost out the price of each additional service individually), but I'm really not liking the method for implementing it. Setting up an independent board, then only giving them the power to "recommend" the standard benefit package (Congress presumably retains the ultimate power to monkey around with the benefits package itself)? Bad idea. I really hope there's push back from consumer advocacy and other progressive groups to give the advisory committee some teeth.

Congress is neither qualified nor particularly good at figuring out benefit packages, and this is just ripe for abuse in terms of medical device makers and pharmaceutical companies dumping tons of money into lobbying for specific procedures or devices to be covered. Bad, bad, bad.



SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans...

(b) DUTIES.—
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
posted by iminurmefi at 3:12 PM on July 14, 2009

nasreddin: Yeah, that's how I worked it out, but after scrump pointed out that it would leave small businesses in expensive metro areas out in the cold I started to doubt my result.
posted by jedicus at 3:17 PM on July 14, 2009

shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000

Who the hell wrote this? Who is supposed to understand this kind of phraseology without a big handful of amphetamines and a pot of coffee?
posted by crapmatic at 3:17 PM on July 14, 2009 [1 favorite]

Nice start, and I'd be satisfied with this as a final bill - but I was never too worried about the House version. The senate is where the screw-over's going to happen, because heaven forfend we just pass an insanely important bill with 51 votes instead of playing 'bipartisanship' games.
posted by Tomorrowful at 3:22 PM on July 14, 2009

The Benefit Packages: This is why I say there could be three, even four, public plans. Within the Health Insurance Exchange, the basic plan that everyone needs to offer is, well, the "basic plan." On first glance, it's pretty comprehensive: It has to be equal in value to the prevailing employer-based insurance in the area. Cost-sharing cannot exceed $5,000 for individuals or $10,000 for families in the first year (it can then grow by the rate of inflation each year after that). It is heavily regulated. And then there is an "enhanced" plan above it, with less cost-sharing, and then a "premium" plan above that, with even less cost sharing, and then a "premium-plus" plan above that. Of these, only the "premium-plus" plan can vary in benefits, as opposed to vary in cost-sharing. The public plan can offer all levels of plan.

Uh, really, I like absolutely everything I've read except this graf (From Ezra). As a single parent with one kid, I could expect to pay $10,000 a year? Is that what is meant by cost-sharing in this instance? Is that right? That's COBRA rates. Thank you.
posted by etaoin at 3:51 PM on July 14, 2009

Uh, really, I like absolutely everything I've read except this graf (From Ezra). As a single parent with one kid, I could expect to pay $10,000 a year? Is that what is meant by cost-sharing in this instance? Is that right? That's COBRA rates. Thank you.

If I understand correctly, that $10,000 would be your maximum total annual payment. That is, no matter what happened to you or what medical services you received, you would be liable for no more that $10,000 in a single calendar year. In a country where a staggering number of personal bankruptcies result from uninsured medical expenses, that's a pretty good safety net.

I don't think it implies that your base rate would be $10,000 p/a.
posted by yoink at 3:54 PM on July 14, 2009 [3 favorites]

> I think the better approach to filibuster reform is to do away with procedural filibusters and require senators to actually stand up and talk for hours on end. Let their faces be plastered all over the news as they hold up vital reform efforts.

The point of the procedural filibuster is to avoid locking up the Senate while someone reads recipes into the Congressional Register.

The end you're trying to achieve has actually been reasonably well met by outfits like Talking Points Memo: When there's an anonymous hold placed on a bill, they organize their readership to start calling Congressional/Senate offices to ask their representative "are YOU the one filibustering?" In at least a couple cases, they've found out who it was, and that person pretty quickly removed their hold once they were exposed.
posted by fatbird at 3:55 PM on July 14, 2009 [1 favorite]

I understand correctly, that $10,000 would be your maximum total annual payment. That is, no matter what happened to you or what medical services you received, you would be liable for no more that $10,000 in a single calendar year. In a country where a staggering number of personal bankruptcies result from uninsured medical expenses, that's a pretty good safety net.

I don't think it implies that your base rate would be $10,000 p/a.
posted by yoink at 6:54 PM on July 14 [+] [!]

Ah, thank you, Yoink. I'm so stuck on the monthly rate issue that I haven't even gotten around to actual medical expenses. Thanks again; your answer makes a lot of sense.
posted by etaoin at 4:01 PM on July 14, 2009

No, etaoin, cost-sharing is a different beast from premiums. That sentence means that your copayments (the flat dollar amount you pay every time you go to the doctor or visit a hospital) and coinsurance (the portion of the medical bills you're responsible for, usually something like 10% or 20% of the total cost) are capped at $5,000 per person, or $10,000 for everyone in the family.

For instance, a hypothetical person could pay $100 in premiums every month, no matter whether they visited the doctor or not. When they visited a doctor, they had to pay an additional $20 per visit in copays, as well as a percentage of any lab tests or other costs, until they hit the ceiling every year. Premiums don't count as cost-sharing, so the total amount any one person would spend on health care every year would be somewhere between the cost of all their premiums for the year, and the premiums + $5,000.
posted by iminurmefi at 4:01 PM on July 14, 2009 [1 favorite]

Interestingly, the CBO has costed the House bill out at about a billion dollars over ten years

A billion dollars over ten years is a hundred million dollars a year. That's about thirty-three cents per American per year.

That seems utterly unbelievable. Am I misunderstanding something?

Ah, no, I'm not. Checking your link, it's a trillion dollars over ten years, not a billion.
posted by Flunkie at 4:01 PM on July 14, 2009

You, too, Iminurmefi, thanks. We were writing at the same time--I"ve been hung up on premiums rather than real medical payments. The answers from you and Yoink reminds me of why I love Metafilter.
posted by etaoin at 4:02 PM on July 14, 2009

This is better than I expected. As a person with a pre-existing condition who has paid out the nose for shitty insurance to the only vultures who would accept me, I like it. Liability caps, a public option, negotiated prescription prices - this is definitely aimed in the right direction.

As to the cost, late last week The New Republic reported the Congressional Budget Office had scored the newest version of a public option (this one?) and said that it could incur savings of $150 billion over ten years. I wonder if the 1 trillion takes that into account.

It is time for voters to put heavy pressure on their senators not to fuck this up or slow it down. Call and write, call and write, call and write.
posted by Benny Andajetz at 4:19 PM on July 14, 2009 [1 favorite]

It is time for voters to put heavy pressure on their senators not to fuck this up or slow it down. Call and write, call and write, call and write.

My senators are McConnell and Bunning. I'll just write a letter to the neighbor's fox terrier.
posted by dilettante at 4:27 PM on July 14, 2009 [14 favorites]

I understand correctly, that $10,000 would be your maximum total annual payment.

This is where I am now with the insurance I have. Which means I still don't get my allergy shots, my asthma meds, or any of the other care I need. I can't afford to get through a 2000 dollar deductible before I get to my coverage, so I may as well not have coverage. Fantastic if I get in a car accident, but for maintenance care, this doesn't seem to be an improvement.
posted by headspace at 4:38 PM on July 14, 2009 [2 favorites]

Initial reactions are positive.

Fair AND balanced...
posted by ZenMasterThis at 4:44 PM on July 14, 2009

This is where I am now with the insurance I have. Which means I still don't get my allergy shots, my asthma meds, or any of the other care I need.

I'm sure someone will correct me if I'm wrong, but I believe the $10,000 isn't the deductible. It's the maximum annual payment if you have a plan where you have to pay, say, 10% of your surgery fees etc. So, if you get leukemia, need a heart-lung transplant, and end up in a body cast all in the same year, you can't ever be required to pay an amount exceeding $10,000.

(See: yoink's reply to etaoin above)
posted by Blue Jello Elf at 4:45 PM on July 14, 2009 [1 favorite]

I'm sure someone will correct me if I'm wrong, but I believe the $10,000 isn't the deductible.

You're right. It's not, but a lot of us have employer-provided high deductible plans right now. Mine is $3600. That means I have to spend $3600 out of pocket before my insurance will pay for anything. Unless I get cancer or hit by a car, it's the same as having no insurance at all. I still have to skip my meds, cut pills in half, etc. For people like me and headspace, this doesn't help.
posted by ValkoSipuliSuola at 4:53 PM on July 14, 2009 [1 favorite]

But this plan still doesn't seem to address a bigger issue: those who cannot afford the premiums, even if they make over $43,000/year.

I'm in that category. I make over $43,000/year, am single, have no kids and therefore qualify for absolutely no credits under this plan. Yet, if I don't get health insurance, then the government will tax me an additional 2.5 percent on my income. What? I still won't have insurance b'c I can't afford the premiums but I'll be on the hook for an additional 2.5 percent tax and still not have health care.

I'm not alone in this: I work with a ton of folks who have student loans that are so crippling we can't afford health insurance and other needful things. One person I know has a monthly student loan payment in the $1,500-$1,800 range and is in the hole for a total amount of $125,000.

This plan doesn't help people like us.
posted by LOLAttorney2009 at 5:57 PM on July 14, 2009 [2 favorites]

Unless I get cancer or hit by a car, it's the same as having no insurance at all.

That's like saying 'unless my house burns down, it's like having no home owners insurance at all'

The point of having health insurance is exactly for when you get cancer or get hit by a car.

If your insurance covered all those easily predictable expenses, it would just cost $3600 more a year to make up for it.
posted by empath at 5:58 PM on July 14, 2009

I want to know how much the premiums for the public plan...
posted by Lord_Pall at 5:59 PM on July 14, 2009

That's like saying 'unless my house burns down, it's like having no home owners insurance at all'

Yes, it's exactly like that. Homeowners insurance also covers replacing your roof after a hail storm, water damage due to broken pipes or flooding, someone injuring himself on your property, theft, small fires from kitchen mishaps or faulty wiring, and any number of other things. It's not just for total catastrophic losses.

The issue here is that we, meaning the American public, keep using health insurance and health care interchangeably, and they are two completely different things.

I have health insurance. What I don't have is affordable health care.
posted by ValkoSipuliSuola at 6:12 PM on July 14, 2009 [13 favorites]

I linked to both Klein and Drum because they're healthcare wonks

Kevin Drum has a BA in journalism and is a blogger. This does not equal "wonk."
posted by raysmj at 6:15 PM on July 14, 2009

Debating a lot of these specifics is moot, since this is only a jumping off point, not an actual about-to-be-signed-into-law bill.

Also, it's very depressing how poor the Left is at negotiating. They are too fair-minded and empathetic (!). Don't come to the table with a compromise below which you will not go. Come to the table with a list of demands (i.e. single-payer). Then allow yourself to be talked down to a public option.
posted by DU at 6:16 PM on July 14, 2009 [4 favorites]

I'm very glad that this is getting discussed in congress. It strikes me as ironic, through, that the Republicans are opposing this plan out of ideological fealty to capitalism, while the Democrats are supporting it mightily to save capitalism from itself.
posted by Avenger at 6:35 PM on July 14, 2009

Healthcare is not on the table. Health insurance might be.
posted by Kadin2048 at 6:45 PM on July 14, 2009

...the Republicans are opposing this plan out of ideological fealty to capitalismts...
posted by DU at 6:46 PM on July 14, 2009

Oy vey. The goal of this bill seems to be to establish national coverage while changing our health care system as little as possible. Politically smart, but the system we're going to end up with will be an expensive mess.
posted by miyabo at 7:14 PM on July 14, 2009 [1 favorite]

Kevin Drum has a BA in journalism and is a blogger. This does not equal "wonk."

Huh? Have you read his blog? He's posted on a pretty regular basis about the intricacies of health reform, and he's generally lucid and well-informed. You don't need a master's degree to be a wonk.

What? I still won't have insurance b'c I can't afford the premiums but I'll be on the hook for an additional 2.5 percent tax and still not have health care.

It says the penalty won't exceed the cost of the basic plan, and that affordability waivers will be available. Presumably it won't be just a raw income calculation for those, though it may be for the credits.
posted by nasreddin at 7:15 PM on July 14, 2009

It also just occurred me that once we get the 40+ million American people insured, we are going to have a serious case of "OMG NEED MOAR DOCTORS".
posted by Avenger at 7:23 PM on July 14, 2009

All the Congressional Budget Office publications on national health care.
posted by miyabo at 7:26 PM on July 14, 2009

Kevin Drum is a blogging pundit, not a wonk. He repeatedly echoes what others are saying in his biz, or at least he always did when over at the Washington Monthly. He has to spend much of his work time pontificating about what everyone else is pontificating about, the Supreme Court judicial hearings, Sarah Palin, etc., etc. This is not an insult. It's the nature of his job. I'd rather read what someone who has looked at this who actually knows something more about government finance and statistics (I've seen nothing to prove that on his blog, ever) and dedicates his or her time almost solely to this issue and/or has worked on this issue in either government or with nonprofits or in the private sector--and that means either having a degree or being something other than a blogging pundit.
posted by raysmj at 7:26 PM on July 14, 2009

Enhanced Plan - covers 85% of costs
Premium Plan - 95% coverage

I smell something here.
posted by Brian B. at 7:33 PM on July 14, 2009

I'd rather read what someone who has looked at this who actually knows something more about government finance and statistics (I've seen nothing to prove that on his blog, ever) and dedicates his or her time almost solely to this issue and/or has worked on this issue in either government or with nonprofits or in the private sector--and that means either having a degree or being something other than a blogging pundit.

OK. Find a link, take it to MeTa, or FIAMO.
posted by nasreddin at 7:38 PM on July 14, 2009 [1 favorite]

It also just occurred me that once we get the 40+ million American people insured, we are going to have a serious case of "OMG NEED MOAR DOCTORS".

We already have that in lots of places.
posted by dilettante at 7:47 PM on July 14, 2009

Ok, somebody explain for me, please, what does it do about my pre-existing condition? Will it be covered, or am I still out of fucking luck?
posted by orthogonality at 8:00 PM on July 14, 2009

nasreddin: You pretty much asked for a response/clarification. Cool down.
posted by raysmj at 8:01 PM on July 14, 2009

Orthogonality: You will be covered. Current private insurers are going to be banned, apparently, from playing pre-existing condition games (or, more likely, they'll be sorta-banned and have to come up with whole new games, but then I'm a pessimist), and the public option would take anybody no questions asked.
posted by Tomorrowful at 8:05 PM on July 14, 2009

Clarification for orthogonality & others: This is just the House bill. Nothing is law yet. We still have to see what comes out of the Senate, and then they get merged and we get some combination of them, and the Senate has always been much more reluctant to do absurd things like "help people stop dying of preventable diseases."
posted by Tomorrowful at 8:06 PM on July 14, 2009 [2 favorites]

Yeah, I know it's just the House Bill. In other words, the best we're going to see, before it gets whittled down in committee and in conference.

And I actually got excited and hopeful, for a minute, until I remembered what Nancy and Harry have accomplished since 2006 -- precisely nothing --, and recalled how Obama has kept disappointingly few of his promises on torture and civil liberties.

But I'll consider my contributions and volunteering well spent if we can get what's in this House Bill.

I finally do have insurance, though after a gap because of which it's essentially useless to me until I've had it for a year's "elimination period" -- and even then I don't know if my pre-existing will be covered. And so, I still spend too much of every day monitoring myself, cataloging my various pains, and hoping it's just a bad back or acid reflux, and not another heart attack. Every day, I wonder if today's the day the ticking time-bomb in my chest goes off.

Despite a six figure income and an easy job, I literally fear for my life, every day, and so do far too many other Americans here in "the greatest country on the Earth". The poorest Canadian or Frenchman leads a more secure life than I and 49 million other Americans. I guess that's why we call America "the home of the brave" -- with our current healthcare system, bravery is all we've got.
posted by orthogonality at 8:19 PM on July 14, 2009 [12 favorites]

I think community rating--which means no exclusions for preexisting conditions--is a bedrock that the Congress cannot go below if they're going to pass anything at all. Nothing's written in stone, but at the moment, the hrumphing I see online is all about how taxes/premiums will go to pay for abortions instead of slut-punishing; this is the wedge that's gotten lots of airplay today. Probably because paying for abortin' sluts is easier to yell about than paying for Uncle Ted's diabetes. Although I fully expect to see some fat-shaming go down before we get through this too.

I work in the evil healthcare empire right now (long story), and I can tell you, they're not sanguine that it's all going to be cream gravy. The current spin I heard today is this:

1. We must kill the public option because
2. It will unfairly compete and drive us out of business and then
3. The govt. owns your healthcare and your records and horrible undefined things might happen to you. I think they want you to imagine Uncle Sam blackmailing you with details of the surgery to remove that wayward butt plug, but this was unclear.
3 (b). Also, taxes will go up for some "of us" (he conveniently didn't mention which "us" since most of us at this company aren't in that high of an income bracket) to pay for "others." Meaning, I suppose, abortin' sluts or brown people or fill in whatever group fills you with hate.

Meanwhile our CEO constantly sends out emails urging us to call Congress and tell them to strike a public plan.

But that's all they got, aside from threatening officals with no campaign funding. They pretty much acknowledge that a public plan will be cheaper and very popular, and are struggling mightily to convince America that this makes it bad.

I'm supposed to agree because I want to keep my job, but most of the reason for my job is to give my family healthcare. Otherwise, I'd do something more flexible.
posted by emjaybee at 9:33 PM on July 14, 2009 [10 favorites]

It'll pass.
posted by Ironmouth at 9:48 PM on July 14, 2009

emjaybee, I for one am glad to hear a firsthand account of a health insurance CEO quaking in his boots. The writing has been on the wall for years now, that healthcare had to change how it did business or somebody else was going to change it for them. Looks like they chose option B.

This is a good day, America :)
posted by contessa at 10:00 PM on July 14, 2009 [1 favorite]

I'm in that category. I make over $43,000/year, am single, have no kids and therefore qualify for absolutely no credits under this plan. Yet, if I don't get health insurance, then the government will tax me an additional 2.5 percent on my income.--LOLAttorney2009

Presumably healthy people could just avoid insurance altogether, which would make insurance more expensive for everyone else. It is a public health plan, and it only makes economic sense (especially the 'can not refuse' clauses) if everyone is part of it. If you insist on the right to not have health insurance, then you aren't paying your part. It is like saying "why should I pay taxes for the police? I can't afford it and there's never any crime where I live."
posted by eye of newt at 10:32 PM on July 14, 2009

The Ezra Klein link says the CBO estimates the plan would cost 1 trillion over 10 years. That's $100 billion a year or ( very roughly ) $1000 per year per taxpayer. Show me the private insurance plan that costs $100 a month.

Anyway, based on what I've seen, the plan seems great. Too bad it'll be obliterated in the senate. I'll happily eat my hat if it passes in anything close to the current form.
posted by heathkit at 11:28 PM on July 14, 2009

It doesn't make any sense to have a public plan AND many private plans. If the public plan doesn't get subsidies, as the administration is currently proposing...then it should perform exactly like an independent nonprofit provider, many of which already exist. If it does get subsidies, then it will provide cheaper care than private plans, so everyone will use it. The only explanation for having both public and private plans is that the Democrats want public, the Republicans want private, and neither is willing to cave.

Lobbyists for private health insurers believe the public plan will get subsidies, and will thus take customers away from them. Boo hoo, you say? Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?
posted by miyabo at 1:16 AM on July 15, 2009

Boo hoo, you say?

Yes, if it stands in the way of the country getting decent healthcare for everyone.
posted by Brandon Blatcher at 3:44 AM on July 15, 2009 [3 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?

As do hospitals. I met a women who travels the country, from hospital to hospital, just to do the hospitals' insurance "coding" (the classification of patients' cases into insurance reimbursement categories). When I met her -- we were both staying at the same extended-stay hotel -- she'd been at her current hospital, staying at that hotel, for eight months.

And she wasn't directly employed or contracted by the hospital, she was an employee of a firm that existed to do insurance reimbursement.

So the hospital pays enough money to her employer the the firm, for it to take a cut, and in turn pays her salary and her insurance, and to put her up at a hotel for eight months -- that's got to be a substantial sum -- just so that the hospital can bill the insurer! And of course that's a lot of money that doesn't go to patient care.

So yeah, under a public option system, we won't be paying insurance companies to employ professional health care deniers, and we won't be paying hospitals to employ professional claims-makers, and we won't be paying doctors to waste their time battling with deniers or conferring with claims makers, and insurance companies won't be paying those doctors incentives to give less patient care (yes, that's legal in many states!) , and third parties like the firm that employs this woman or the extended-stay hotel won't be getting their cut.

And yes, they'll lose jobs, jobs that do nothing to add to our prosperity or to accumulate our national wealth, because they're all engaged in a zero-sum game over who gets how much of the pie, rather than in baking more pies. I won't even compare them to the buggy-whip makers made obsolete by the advent of the motor car; buggy-whip makers, even if they made a product no longer needed, at least made something. Kabuki theatre is at least entertaining; but we employs thousands to play Kabuki games in secret, all over how to profit from delaying and denying healthcare to millions.

Now all those silent players of cynical games will -- hooray! -- be able to get real jobs that really contribute value to the economy. That's good -- that's much healthier -- for them, for us, for the national economy.
posted by orthogonality at 3:59 AM on July 15, 2009 [22 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?

Yes.

Next question?
posted by caddis at 4:45 AM on July 15, 2009 [5 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?
posted by miyabo at 1:16 AM on July 15

yes please
posted by Optimus Chyme at 5:19 AM on July 15, 2009 [1 favorite]

I can't find it right now, but there was a WSJ article about 2 years ago about a Florida corp that provides software to hospitals to strategize their claims. Same company sells similar package to insurors to strategize their denials. Selling arms to both sides of this war was estimated to be a 40 billion/year market. 40 billion. Another WSJ article about a month latr said that total costs for indigent care in the U.S. are 30 billion/year.

So yeah, I'm not gonna cry over job losses in the insurance claims field.
posted by yesster at 5:40 AM on July 15, 2009 [4 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?

That might be the first time in my life I ever heard someone oppose the creation of a massive government bureaucracy because of all the pointless jobs it would eliminate. Bravo.
posted by XQUZYPHYR at 5:55 AM on July 15, 2009 [8 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?

If I don't keep throwing rocks through these windows, Larry the Window Fixer* will be out of a job!

*Not related to Joe the Plumber
posted by dirigibleman at 6:14 AM on July 15, 2009 [5 favorites]

Eye of Newt, somehow you completely misread my comment. I didn't say that I would *refuse* to buy insurance. I stated that I doubt I'd be able to afford it, considering that a large portion of my income (and that of my coworkers') goes to other things that can't be avoided. Nice goin', taking that out of context, EoN.
posted by LOLAttorney2009 at 7:06 AM on July 15, 2009

I don't really see massive numbers of jobs being eliminated, since people will be able to retain their current insurers. Hospitals will still need to bill those insurers, and the government plan, and the new government plan will need people to process (and deny) claims. If anything, it seems like it's going to create lots of admin jobs.
posted by electroboy at 7:17 AM on July 15, 2009

Sen. Kennedy's committee passes health care bill
posted by ryoshu at 7:31 AM on July 15, 2009 [1 favorite]

GO TEAM
posted by saysthis at 8:25 AM on July 15, 2009

Regardless of which side you take in this debate, you should watch this video. Bill Moyers recently made an episode on the healthcare issue, and had on his program Wendell Potter, former VP for Public Relations at Cigna Healthcare.

It will be painful for the Free Marketeers out there, but watch it anyway. We'll be here for you.
posted by spirit72 at 9:04 AM on July 15, 2009 [1 favorite]

From Ezra Klein:

Under a Republican amendment approved Tuesday in the HELP bill, every member of Congress and their staffs would be required to enroll in the public insurance option. Sen. Tom Coburn (R-Okla.) authored the measure, which has become a rallying point for conservatives opposed to the public option. Sen. Ted Kennedy (D-Mass.), who voted by proxy, and Sen. Chris Dodd (D-Conn.) called their bluff and voted with Republicans to pass the amendment -- effectively neutralizing the issue for now. It seems unlikely that it would survive the many stages of the legislative process. Then again, Kennedy apparently likes it, according to his spokesman: "Sen. Kennedy believes strongly in the public option and its ability to provide quality and affordable healthcare while keeping the insurance companies honest. This was a no-brainer."

Good job, Ted. If there's a public option, it shouldn't be just for poor people. All federal employees should have to participate.
posted by electroboy at 9:39 AM on July 15, 2009 [8 favorites]

I don't really see massive numbers of jobs being eliminated

Well, in the long term we'd better all hope that they are. One of the major ways of reducing costs in the US health system must be to dramatically shrink the amazingly top-heavy bureaucracy that characterizes it.

I always find it hilarious when Republicans go on about the Public Option "putting a bureaucrat between you and your doctor." What tiny, tiny percentage of Americans DON'T have whole teams of bureaucrats "between them and their doctor"? If you're one of the lucky ones in America who actually has health insurance, then every piece of medical care dispensed to you other than meeting with and talking to your PPP gets vetted by various levels of bureaucracy. I have great health insurance, but I still will often find that the drugs my doctor prescribed have to be substituted for something else because those drugs aren't covered by my HMO's drug plan, or the doctor will recommend that I see a particular specialist and I'll have to have several back-and-forth negotiations with the insurers before they approve the referral. Who the hell are these people who simply get whatever treatment they want whenever they want it?
posted by yoink at 10:08 AM on July 15, 2009 [3 favorites]

Private insurers employ tens of thousands of people to review cases, and much of that work won't be necessary under a public plan. Do we really want all of them to lose their jobs?

The fact that these jobs have to exist at all is a sign of huge inefficiencies in that sector of the economy.

Most of the people who make this argument were perfectly happy to remove inefficiencies from another sector of our economy by allowing GM and Chrysler to fail.
posted by oaf at 10:13 AM on July 15, 2009 [2 favorites]

This made me laugh this morning, but I can't say I don't see the truth in it:

[C]ongress would definitely find a way to pay for healthcare if everyone was insured by AIG.
posted by fiercecupcake at 10:27 AM on July 15, 2009

electroboy: "From Ezra Klein:
Under a Republican amendment approved Tuesday in the HELP bill, every member of Congress and their staffs would be required to enroll in the public insurance option."

Good job, Ted. If there's a public option, it shouldn't be just for poor people. All federal employees should have to participate."
---

Isn't that a bit like saying "hey, we have public education, all politicians should make their kids go to public schools"?

Bluff, indeed! But yes, I agree... if you're gonna be for a good public plan, you'd best be willing to be on it, yourself.

Personally? I still wish we just had a single payer plan. But, as politics is compromise, and this would restrict pre-existing conditionals, and other things... well I guess I can live with it.

I have too many loved ones who are without insurance, or are fighting to get on some sort of assistance. My 45 year old sister has been fighting for years, all the while, my mom and dad are helping to support her with their (miniscule) life savings. And my mom continues to buy the Reagan/AMA/Socialized Medicine bit. I hope this passes, my sister gets on, and my mom sees first hand how it is beneficial. But it'd DAMN be cheap enough for people to afford.
posted by symbioid at 11:00 AM on July 15, 2009

Isn't that a bit like saying "hey, we have public education, all politicians should make their kids go to public schools"?

Bluff, indeed!

Yeah!

And by the way, Congresscritters, we have this public, volunteer military....
posted by spirit72 at 11:42 AM on July 15, 2009

Well, in the long term we'd better all hope that they are. One of the major ways of reducing costs in the US health system must be to dramatically shrink the amazingly top-heavy bureaucracy that characterizes it.

Oh, of course. I can see this going one of several ways:

1. Public option becomes much cheaper than private insurance, leading to a mass migration to the public option over time. Private insurance sector massively downsizes and becomes gap insurance that allows people to insure against high out of pocket expenses.

2. Public option is poorly managed and doesn't compete with private insurance, making it the insurer of last resort for the poor and otherwise uninsurable, which in turn makes it massively expensive since it can't balance out the premiums from the old and sick with young healthy people who don't need as much care.

3. Public option becomes cheaper which puts pressure on private insurers to operate more efficiently, lowering costs all around.

4. Some other scenario in which we all get fucked.
posted by electroboy at 12:04 PM on July 15, 2009

Isn't that a bit like saying "hey, we have public education, all politicians should make their kids go to public schools"?

Sure, but lets face it, wealthy people will always have better stuff than the average person in one way or another. Public health insurance is about providing a minimum level of care for everyone who needs it, rather than making sure everyone gets to take a ride in the diamond encrusted MRI machine.
posted by electroboy at 12:13 PM on July 15, 2009

This is a pretty awful bill when you consider that this is the Democrats' opening offer. I doubt very much that the public option or the ban on pre-existing conditions will survive in any form that will be useful to ordinary Americans.
posted by dirigibleman at 12:18 PM on July 15, 2009

This is a pretty awful bill when you consider that this is the Democrats' opening offer. I doubt very much that the public option or the ban on pre-existing conditions will survive in any form that will be useful to ordinary Americans.

It's not clear that the political process actually functions like a bazaar. Making the House bill too radical might have prevented it from getting any traction at all, so that instead of gradually amending it down the Republicans and center-righters would effectively have been allowed to write their own bill. This is a bit better.
posted by nasreddin at 12:55 PM on July 15, 2009

Love the idea of a "minimum." It's just a safety net, so you'll still have to pay out the wazoo for the non-catastrophic stuff? That would suck, just as high deductible policies do now. You gotta think of health care as a right, not hard to do when you consider that you may one day suffer from a disease that you didn't know was a result of genetics. You might get cancer from an unknown source, skin cancer tied not to your adult behavior as much the amount of sun exposure you had as a child, etc. And I do think that the only way to get wealthy people to care, ultimately, is to have the system benefit them, in however small but significant a way (hopefully through positive effects on business and industry, as well as an impact on their own health care costs).

Meanwhile, here's an interesting article from Peter Singer on what hardly anyone has mentioned in this whole debate--the crazy costs associated with end-of-life health care in the U.S. That, sensible prevention, control of technology costs, etc., all have to ultimately be addressed to straight our health care system out. I hope that the public option bit (a single payer system with tight, but reasonable and well-researched cost controls would likely be more cost effective than this safety net idea, ultimately, at least is accompanied with prevention--and note that too many Americans still eat horribly, abuse drugs, shoot one another more than in most, if not all, industrialized nations, so "prevention" should mean more than regular doctor visits) is just a start.
posted by raysmj at 1:03 PM on July 15, 2009

What I fear most is a California-style health care reform---expensive and rah-rah progressive, but not paid for or paid for only via deficits.
posted by raysmj at 1:11 PM on July 15, 2009

Meanwhile, here's an interesting article from Peter Singer on what hardly anyone has mentioned in this whole debate--the crazy costs associated with end-of-life health care in the U.S.

Actually, President Obama has, rather bravely, spoken directly to this issue (see p 5-6):

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question.

posted by yoink at 1:28 PM on July 15, 2009

Love the idea of a "minimum." It's just a safety net, so you'll still have to pay out the wazoo for the non-catastrophic stuff?

Depends on the details. It looks like they're proposing a pretty comprehensive plan. I'd like to see them lower the out of pocket maximum, but it's not clear if that's scaled to your income.
posted by electroboy at 2:00 PM on July 15, 2009

Who the hell are these people who simply get whatever treatment they want whenever they want it?

Members of Congress!
posted by Blue Jello Elf at 4:08 PM on July 15, 2009

It's admittedly a little more complicated than that, but the simplified answer is that members of Congress get the same health benefits as any other full-time federal employee.

The little more complicated than that is that there's also a clinic in/near the Capitol itself that's funded by a mix (roughly 50/50 from what I can tell offhand) of deductions from member pay and an appropriation.
posted by ROU_Xenophobe at 4:31 PM on July 15, 2009

I'm for reform, but I am extremely dubious about any of the financial claims for income or costs of the program. The reality is that the tab is going to be much bigger than anyone thought since we all have unlimited healthcare wants.

Don't take that as my pooh-poohing the idea outright. Yes, something needs to be done, but in general I am dubious about government coming in to save the day. The law of unintended consequences can be a real bitch.
posted by tgrundke at 8:26 PM on July 15, 2009

The Bill Moyers interview with Wendall Potter is well worth it. Thanks, Spirit72.

-It is the insurance companies job to minimize the percentage of premiums that get paid for actual health care. They look at the medical loss ratio. When Clinton was trying to pass a plan about 90% of the premium dollar went to pay for healthcare. Now they have it down to 80%. Wall Street likes this.

-The insurance companies rather like the statis quo. They wouldn't mind if insurance coverage was mandatory but same old same old is just fine.
posted by pointilist at 9:03 PM on July 15, 2009

Yes, something needs to be done, but in general I am dubious about government coming in to save the day. The law of unintended consequences can be a real bitch.

As against that, we have the fact that the US spends far more per capita on healthcare than all the other Western nations in which the government picks up (most of) the tab.
posted by yoink at 9:13 PM on July 15, 2009

I think we'd get a good jump on a national pool as well as on the funding if we did start by migrating all federal employees to the public option. And yes, with something as huge as a national health care plan -- of any variety -- we're going to need to do some phasing in. I think this is a good start to that, although I don't like the fact that opening the pool to the currently insured who work for employers with more than 20 employees is discretionary, rather than a mandatory step in phasing in.

Still, this is leaps and bounds better than we have now, if anything remotely approaching this current version passes. Annual caps and killing the ability to legally exclude based on pre-existing conditions will go a long way toward making things right for most of the underinsured and many of the uninsured in this country. I am concerned that I saw nothing specific about laboratory services (which I have a complex partial rembursement scheme to negotiate with my current plan), and that it appears the cost of prescription drugs won't apply to the caps. I could be reading it wrong, but that, coupled with the fact that the premiums are excluded from the caps, could easily more than double the maximum amount a family spends on health care per annum.

I hope that, more than just providing broader access to care for millions of Americans, this will also result in more effective disbursement of services -- shorter wait times at the ER because the uninsured can take their flu to the clinic or can see their URI taken care of before they develop pneumonia.

I'm amazed at the stories of others in the various threads on this topic who are in countries with national plans of one sort or another and how efficiently their needs are met and at what low costs to them (both in taxation and out-of-pocket expenses). I have insurance for my family through my employer (though costs have increased and coverage decreased, I am thankful to have it), but still have run into some of the ludicrousness of our system as it is. Three years ago my older daughter was attacked by a fox on the street in front of the woods next to our house. I immediately took her to the ER, of course. Fortunately her actual injuries were minimal -- she fought back and had one small bite that broke the skin as well as a few bloody scratch marks -- but she had to have the rabies shot series. This required seven more trips to the ER for the shots, as there was nowhere else for her to get them, at $100 a visit. For a shot. No lab tests, no exam, nothing but a shot. As I'm a single mom, $800 in medical bills in a 2 month period was a considerable burden, and as a health-care consumer, I think it's a waste of resources not to have a non-emergency clinic where I could have taken her and avoided the ER, which should be for emergencies.
posted by notashroom at 8:15 AM on July 16, 2009

Why We Must Ration Healthcare by Peter Singer. It's a good read and explores some of the sticky issues with public healthcare.
posted by electroboy at 9:49 AM on July 16, 2009 [1 favorite]

I think we'd get a good jump on a national pool as well as on the funding if we did start by migrating all federal employees to the public option.

Heck yes. That's 1.8 million civilians. Not all of them are necessarily enrolled on any of the health insurance plans currently offered but I am willing to bet that the majority are. Add in Congress and all the staff associated with them. Offer it as an option to postal employees, too.

I wish I had the chance to buy into the public option. It would be worlds better and vastly cheaper than the cruddy, expensive coverage I have now.
posted by contessa at 10:01 AM on July 16, 2009

From reading several articles, it looks like they have no way to contain costs that satisfies centrists, who are in the position to extort their vote. Opponents will buy time to lobby and run their scare ads against Canadian-style health care, so I think proponents need to get rough and make public health care a fairness issue, everyone or nobody, because right now public options favor those who can't work as a class (the very young and old), which is just another industrial form of cherry picking the field and minimizing costs, and splitting the votes. Americans are so used to being unfair that they don't even notice when it kills them out of their own pocket.
posted by Brian B. at 8:10 AM on July 18, 2009 [1 favorite]

If they fail to contain costs than it is an overall failure. Obama understands this but he has taken perhaps too much of a backseat role. He needs to get over his fear of what happened to Clinton and step up to the plate an twist some arms, right to the breaking point if necessary. Rahm is the perfect hitman for this job.
posted by caddis at 2:17 AM on July 19, 2009 [1 favorite]