... let me explain at fuller length, because this is one of the great misunderstood keys to the whole health care debate.posted by russilwvong at 2:20 PM on February 16, 2010 [1 favorite]
Start with the proposition that we don’t want our fellow citizens denied coverage because of preexisting conditions — which is a very popular position, so much so that even conservatives generally share it, or at least pretend to.
So why not just impose community rating — no discrimination based on medical history?
Well, the answer, backed up by lots of real-world experience, is that this leads to an adverse-selection death spiral: healthy people choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out.
So you have to back community rating up with an individual mandate: people must be required to purchase insurance even if they don’t currently think they need it.
But what if they can’t afford insurance? Well, you have to have subsidies that cover part of premiums for lower-income Americans.
In short, you end up with the health care bill that’s about to get enacted. There’s hardly anything arbitrary about the structure: once the decision was made to rely on private insurers rather than a single-payer system — and look, single-payer wasn’t going to happen — it had to be more or less what we’re getting. It wasn’t about ideology, or greediness, it was about making the thing work.
About 800,000 people in California who buy insurance on the individual market — as opposed to getting it through their employers — are covered by Anthem Blue Cross, a WellPoint subsidiary. These are the people who were recently told to expect dramatic rate increases, in some cases as high as 39 percent.posted by russilwvong at 8:01 AM on February 19, 2010 [1 favorite]
Why the huge increase? It’s not profiteering, says WellPoint, which claims instead (without using the term) that it’s facing a classic insurance death spiral.
Bear in mind that private health insurance only works if insurers can sell policies to both sick and healthy customers. If too many healthy people decide that they’d rather take their chances and remain uninsured, the risk pool deteriorates, forcing insurers to raise premiums. This, in turn, leads more healthy people to drop coverage, worsening the risk pool even further, and so on.
Now, what WellPoint claims is that it has been forced to raise premiums because of “challenging economic times”: cash-strapped Californians have been dropping their policies or shifting into less-comprehensive plans. Those retaining coverage tend to be people with high current medical expenses. And the result, says the company, is a drastically worsening risk pool: in effect, a death spiral. ...
What would work? By all means, let’s ban discrimination on the basis of medical history — but we also have to keep healthy people in the risk pool, which means requiring that people purchase insurance. This, in turn, requires substantial aid to lower-income Americans so that they can afford coverage.
And if you put all of that together, you end up with something very much like the health reform bills that have already passed both the House and the Senate.
What about claims that these bills would force Americans into the clutches of greedy insurance companies? Well, the main answer is stronger regulation; but it would also be a very good idea, politically as well as substantively, for the Senate to use reconciliation to put the public option back into its bill.
But the main point is this: California’s death spiral is a reminder that our health care system is unraveling, and that inaction isn’t an option. Congress and the president need to make reform happen — now.
Democrats should pass health-care reform because it's the right thing to do. They should pass health-care reform because between 18,000 and 45,000 people die each year because they don't have health-care insurance, and this bill will save many of those lives. They should pass health-care reform because it will prevent countless medical bankruptcies and an enormous amount of needless chronic pain and infirmity. They should pass it because it will take important steps towards cost control. They should pass health-care reform, as my friend Chris Hayes says, because it's important for the American people to see their government doing more than starting wars and bailing out banks. They should pass health-care reform because it's the right thing to do, both for the millions of people whom it will directly affect and for the country as a whole.We'll see what happens today.
The more substantive objection to the use of reconciliation for passing health care reform derives from the fact that, according to polls, more Americans oppose than support what they think is in the reform bills. It is hardly surprising that people are nervous about health care reform. Most Americans are insured and are reasonably satisfied with their coverage. In principle, large-scale reform could upset current arrangements.Why is it that every other industrialized nation in the world has affordable health care, but the US doesn't?
If public perceptions of the intended and expected effects of the current bills were accurate, democratically elected representatives might be bound to heed the concerns. Because the perceptions are inaccurate, reform supporters have a duty to do a better job of explaining what health care reform will do. When participants in focus groups are informed about the bills’ actual provisions, their views become much more positive. The prevailing views have clearly been shaped by opponents’ misrepresentations of the reform plans, which supporters have done little to rebut. ...
Meanwhile, supporters have spent most of their time on seemingly endless debates with one another about specific legislative provisions ....
President Barack Obama has announced a bipartisan meeting on moving the reform process forward. It is an opportunity for all sides to present ideas for improving the bills that already have been passed by both houses of Congress. If modifications are identified that will command the support of simple majorities in both houses, they should be adopted through reconciliation. Then the House should pass the Senate bill.
Other strategies, in my view, have no prospect of success. Abandoning the reform effort is the worst strategy of all — not only for reform advocates, but for the nation. Reform advocates are already on record as supporting reform. Voters who oppose reform will not forget that fact come November, and those who support it will find little reason to make campaign contributions to or turn out to vote for lawmakers who were afraid to use large congressional majorities to implement legislation that would begin long-overdue efforts to extend coverage, slow the growth of spending, and improve the quality of care.
Ever since Scott Brown beat Martha Coakley, conservatives, with very few exceptions, have been convinced that health care reform is dead.posted by russilwvong at 8:32 PM on February 24, 2010
... there was no rational reason that the Massachusetts election had to kill health care reform. Fundamentally, the main barrier -- getting sixty votes in the Senate -- had already been crossed. The remaining obstacles are puny. All the Democrats needed to do was have the House pass the Senate bill. If they insisted on changes, most of those could easily be made through reconciliation, which only requires a majority vote in the Senate. Most conservatives paid no attention to this basic reality, though they did indulge in some gloating mockery of those of us who pointed it out.
... the mustache-twirling bonhomie has started to give way to the realization that the legislative door to health care reform is wide open, and Democrats simply need to walk through it. By no means is it clear that they'll succeed. But I've been waiting for conservatives, filled with hubris at having swept liberalism into the dustbin of history, to wake up to the fact that health care reform is very far from dead, and start to freak out.
The big story out of the summit is not that Republicans and Democrats extended their hands in friendship, but that the White House has dug its heels into the dirt. The Democrats are not taking reconciliation off the table, they are not paring back the bill, and they are not extricating themselves from the issue. They think they're right on this one, and they're going to try and pass this legislation.The Health Care Blog has a more diverse range of views.
Today was a boost for that effort. The Democrats got hours to make their case, at an event they planned, with one of their own controlling the discussion. For that reason, I imagine that this will be the last bipartisan summit we see for awhile. The format is simply too kind to the president, and he takes advantage of it ruthlessly. When the camera panned, you could almost see Republicans wondering why they'd accepted the invitation.
It's not our Puritanism and it's not the Senate. We have expensive health care because of wage controls during World War II. The only way to compete for workers was to offer benefits like free health insurance, housing, and education, and the health insurance part of that system was entrenched by both corporations, unions, and tax advantages after the war. As a result, it exacerbated conflicts between those with good jobs and those without. In this, organized labor is as much to blame as health insurance companies: constantly fighting to preserve benefits for their members at the expense of the lumpenproletariat.I don't think that these are mutually exclusive explanations. Indeed, both Trattner and, with more nuance, Skocpol, argue that providing benefits to people who are worthy because they belong to particular classes (veterans, mothers, workers) while refusing them to others, is precisely why we're in this particular mess. Theirs is a higher level critique, insofar as it explains not just why businesses might offer insurance, but also why this would be a well-received solution from a social perspective. Certainly social mores need to be translated into policy in some fashion.
“You have now explained to me why the Democratic Party is called the party of tax and spend, because we are financing all the things that are affected by the cost disease and Republicans want to short-change them.”I think we could interestingly complicate that with reference to prisons and the military: I suspect both parties have caught to cost disease at this point.
« Older "And maybe this is the time to share a secret... | Music For Real Airports... Newer »
This thread has been archived and is closed to new comments
Well, you know, they might lose out in the Midterm Musical Chairs game.
posted by Halloween Jack at 8:16 AM on February 16, 2010 [1 favorite]