The Endless National Health-Care Discussion
September 16, 2009 12:26 PM   Subscribe

Senate Finance Chair Max Baucus has released the "chairman's mark" (his draft) of health-care legislation, America's Healthy Future Act.

Candidate John Edwards laid out the foundations of the health-care reform debate during the 2008 Presidential Campaign. These ideas were debated throughout the primaries and general election. After the election, key ideas were selected and organized by the Obama administration into a number of guiding principals which were presented to the legislature as direction regarding the kind of reform he'd be interested in passing.

The House of Representatives tasked three committees to draft and pass the detailed language by which the principals would be made into a program (Energy/Commerce, Ways/Means, Education/Labor). Working together, all three committees basically agreed on the same language earlier this summer...HR3200 (aka America's Affordable Health Choices Act of 2009).

On the Senate side, two committees were tasked with drafting and passing the relevant language. The Senate Committee on Health, Education, Labor, and Pensions had drafted and passed their own version of health care reform. Four committees wrote, debated and passed health-care reform language. Today, the Chair of the Senate Finance Committee released its first draft. This document will be debated by the Finance Committee, changed (if needed), then voted upon by the whole committee.

Then the party begins.

Each house will need to debate the legislation passed by their respective committees. 23 Democrats in the House have voiced some opposition to the House bills. A few Democratic Senators have expressed doubts about certain aspects of reform as well, most notably the so-called public option. If/when both houses pass their versions of the legislation, the bills would be debated by a select group of Senators and Representatives in conference committee, who would then need to re-write (probably) and pass the final bill to be signed by the President (or not).

This Youtube clip is an informative take on the back-and-forth that successful legislative efforts must undergo. The current health-care reform effort is at about 1:10 on the timer.
posted by Hypnotic Chick (81 comments total) 31 users marked this as a favorite
 


I am embarrassed to say I would not have known where to find all this info and having it all together in one place makes this a Good Post. Thanks!
posted by kittyprecious at 12:46 PM on September 16, 2009


The Medical Insurance Industry America's Healthy Future Act

FTFY, Baucus.
posted by you just lost the game at 12:47 PM on September 16, 2009 [2 favorites]


I'm aghast. This draft is unbelievably bad.

I'll say this one more time, Democrats: KNOCK IT OFF WITH THE ATTEMPTS AT BIPARTISANSHIP - the Republicans ARE NOT INTERESTED UNDER ANY CIRCUMSTANCES. Any health care bill the Democrats seek their support on will come up empty, even if it includes a provision to resurrect Reagan, fit him armor, treads and cannons and unleash him on Iran. There could be an amendment in there to put Barry Goldwater on the one dollar bill and it STILL won't get any GOP votes.

Know why? ALL they're looking for here is a replay of 93-94. Obstruct at all costs, then run against a "do-nothing" Congress in the mid-terms. That's all that's going on here. QUIT TAKING THE FUCKING BAIT. And for fuck's sake, knock it off with these Frankenstein's monster bills that manage to screw the pooch from every direction. There will NEVER BE ANY REPUBLICAN VOTES for health care reform, no matter what. Stop tilting at that windmill, draft a proper bill with a robust public option and ram that shit through. I dare any Republican to actually filibuster universal health care should it come to the floor.

Here's Baucus's DC office number - (202) 224-2651 - you'll get a lot of busy signals, but keep trying. Right now, he's gotta be told that he ain't trying hard enough.
posted by EatTheWeek at 12:59 PM on September 16, 2009 [56 favorites]


To be precise, this is the Baucus/Fowler plan. When you examine the properties of the plan document, the author is listed as Liz Fowler who - by an extraordinary coincidence - was Vice-President for Public Policy and External Affairs at WellPoint.

WellPoint's stock chart for the last 6 months - if you can stomach it.
posted by Joe Beese at 1:01 PM on September 16, 2009 [12 favorites]


I posted months ago that any bill Baucus puts out there will be worse than doing nothing at all. It's all there in blue and white. Completely and utterly unsurprising and yet still I am aghast.

Bend over, America. Max is Back!
posted by Justinian at 1:02 PM on September 16, 2009


FiveThirtyEight: The Baucus Bill's Bad Math
(a few months old, but it looks like the language discussed is largely unchanged)
Baucus's bill will not contain an employer mandate -- a requirement that employers provide health insurance to their employees -- even though it does contain an individual mandate.

Does this look familiar to anyone?
-- No employer mandate
-- No public option
-- But yes, an individual mandate

It should -- because this particular permutation on health care reform looks an awful lot like the incomplete draft of the HELP Committee's bill that the CBO scored last month, which also lacked an employer mandate and a public option but contained an individual mandate. That bill, the CBO estimated, would cost about $1.0 trillion -- but would only cover a net of about 16 million people. In contrast, the revised version of the HELP Committee's bill, which did include both a public option and an employer mandate, would cost about the same amount but cover a net of 37 million people.

[...]

The AP may be right that Baucus's bill will cost less than $1 trillion, but it accomplishes that by shifting the burden to middle-income families, some of whom have poor balance sheets and will face a really tough choice between paying for health insurance they can't quite afford and facing some kind of penalty. Odds are that many of them will take the penalty, which is why coverage probably won't expand very much. Or, the enforcement mechanisms could be more stringent, in which case they'll have to buy health care, at the cost of reducing their spending in other areas -- and in probably being very teed off at the Democrats who passed the bill.

[...]

Just to underscore this point: when it scored a similar bill, the CBO estimated that 15 million people would lose their employer-provided coverage. Most of these people are likely to be lower-to-middle income persons with somewhat tenuous employment situations, a group that tends classically to be swing voters.

Now, how are those 15 million people going to feel about health care reform when they find out that:

a) Although the bill was supposed to guarantee access to health insurance, they've in fact lost theirs;
b) They're required to buy an expensive, private plan on their own, or to pay a fine;
c) They're probably not getting any government assistance;
d) They certainly don't have any Medicare-like alternative to fall back upon;
e) All of this cost the country about $1 trillion dollars.

You think those 15 million people are going to vote for the Democrats again, like, ever?
posted by Rhaomi at 1:02 PM on September 16, 2009 [7 favorites]


As I understood this bill when I read about it this morning: for someone like me, who is currently covered through my job, I will pay more in income taxes because the cost of my insurance will be tacked onto my annual income on my w-2. Also, for those who use a pre-tax medical spending account, those will be capped at $2000 instead of the $3000 (?) that they are now.
Those who are uninsured can be fined between $750 and $900 a year for failing to comply. People making 133% - 300% above poverty level can get tax subsidies, but I did not see numbers on those.

I'm discouraged.
posted by 8dot3 at 1:04 PM on September 16, 2009


Thanks for your very solid first post Hypnotic Chick. You've waded into the deep end.
posted by netbros at 1:11 PM on September 16, 2009


I would say "I told you so", but this smells even worse than I ever feared.
posted by Thorzdad at 1:17 PM on September 16, 2009


kittyprecious,
You're welcome!

8dot3,
I'd be interested in seeing the analysis you describe, namely the addition of insurance costs as income. Do you have a link?

netbros,
Thank you for your kind words.
posted by Hypnotic Chick at 1:23 PM on September 16, 2009




I love the idea of fining the uninsured. That will definitely solve the health care crisis. But this doesn't go nearly far enough. A law should be passed so that people caught outside their homes without proof of employment would be punished by being whipped through the streets. For a second offence, the unemployed and the homeless would lose part of an ear. If a vagabond was caught a third time he or she would be executed. Call me a traditionalist. Or a Tudor.
posted by It's Raining Florence Henderson at 1:30 PM on September 16, 2009 [3 favorites]


Does this look familiar to anyone?
-- No employer mandate


Why would you want an employer mandate? Why do people insist on tying your health insurance, something you need under any circumstances to a job that you can lose at your employer's will without notice. Does anyone read the newspapers? 10% unemployment. So you mandate employers provide insurance to workers. You can't mandate that they keep employing those workers.

If you want to fix the system, ban employers from providing insurance. Force insurance companies to compete in an national market for consumer's premiums. Employer mandate reinforces the most idiotic aspect of the current system, one that ensures the market for health insurance remains grossly inefficient and increasingly more costly.

An individual mandate without correct the current distortion is a close second on stupid aspects of this bill. It forces people to buy over-inflated private insurance which mirrors the grossly over-inflated insurance sold to companies for their employees.

There is absolutely no logical reason for health insurance to be tied to a job, and there are a myriad of reasons why it is economically and socially bad. I can buy $100 million of life insurance today, and as long as I keep paying the premiums, I can get cancer, the superflu, and the hantavirus all at once and they can't cancel me. The open market for insurance is very well understood. It is very efficient. It works for auto, life, and home. How about we try it for health?
posted by Pastabagel at 1:31 PM on September 16, 2009 [5 favorites]


This is all you need to know about the contents of the bill that was announced today:
Humana - HUM up 4.87%
Aetna - AET up 3.97%
Cigna - CI up 3.66%
UnitedHealth - UNH up 5.74%

If a bill is passed without public option, I will be so fucking pissed. It's a straight-up giveaway to these companies. Demanding everyone sign up for health insurance with accepting all pre-existing conditions is going to increase premiums ridiculously high. These companies are going to make out like bandits. I may need to buy stock in these companies if it's announced to pay for my future health insurance bills.
posted by amuseDetachment at 1:32 PM on September 16, 2009 [15 favorites]


for someone like me, who is currently covered through my job, I will pay more in income taxes because the cost of my insurance will be tacked onto my annual income on my w-2.

I'm fairly sure this is not the case: what will be required is that your employers *report* how much they're paying on your behalf for health insurance. Nothing in the bill that I've seen changes the status of those fringe benefits to be taxable, though.

I imagine that forcing employers to give their employees this info (the W-2 really is the place that makes the most sense) is a way to build support for further reform, particularly on the delivery side. One of the big reasons why you're not seeing Obama be more aggressive or expansive in what he's proposing is because polls stubbornly show that 80-85% of people are pretty satisfied with their insurance. A lot of policy wonks believe that's because people pretty much have no idea how much in potential wages they're losing through the employer payment for health insurance. If people knew that their health insurance actually cost $12,000 per year, not the $4,000 per year that they've been paying, they'll be more open to further reforms down the road.

Also, for those who use a pre-tax medical spending account, those will be capped at $2000 instead of the $3000 (?) that they are now.

Yup, looks like. On the other hand, it looks like the minimum benefit package that will be mandated--and which big employers will eventually be forced to meet--is pretty damn comprehensive. So it may be that you don't need as much in a pre-tax account because more is actually being picked up by your insurance. Probably depends on what, exactly, you're using those benefits for now.
posted by iminurmefi at 1:33 PM on September 16, 2009


if it's announced passed to pay for my future health insurance bills.
posted by amuseDetachment at 1:33 PM on September 16, 2009


8dot3,
I'd be interested in seeing the analysis you describe, namely the addition of insurance costs as income. Do you have a link?


In the pdf link in the fpp, page 202, under "Chairman's Mark". But this is just a reporting requirement, I don't think this means that it becomes additional taxable income.
posted by Pastabagel at 1:34 PM on September 16, 2009


HC - It was an ap wire story, here's a link. The pieces I noted are about 3/4 down the page. If I misread that, I'd be embarrassed but delighted.
posted by 8dot3 at 1:35 PM on September 16, 2009


Ack, should've previewed. If the cost of the insurance is simply noted on the w-2, not added as taxable income, cool.
posted by 8dot3 at 1:39 PM on September 16, 2009


And still, people hooting about death panels. Here, I wrote this. Use it whenever people talk about obama killing people, it's free for you. I am so dispirited that this shit keeps happening.
Ethical "end of life counseling" is hospice care. When my dad became terminally ill, his normal GP dropped him. He was referred to a doctor who cared for terminally ill patients.
My father broke down crying when he talked with his new doctor. It was the first time anyone directly addressed his fears. As a result, dad was put on strong painkillers that allowed him to finally sleep through the night; to eat regular food again; to have some respite from the pain.
He was tended to by a hospice nurse at home. She was able to look after him while my mother wrestled with the situation. She fed him, made him comfortable and kept him clean and free from bed sores. That is end of life care means from a family who’s dealt with it.
Regardless of what else might be said about this bill, support for end-of-life counseling is a moral and just imperative. I ask you to please reasses your opinion based on my story.
posted by boo_radley at 1:39 PM on September 16, 2009 [16 favorites]


Fuck Max Baucus. Goddamned sellout, disgrace of a Dem, and lifelong whore of the insurance industry.
posted by shiu mai baby at 1:43 PM on September 16, 2009 [8 favorites]


I'm not exactly a fan of the bill, but "according to the CBO, the bill covers 94 percent of legal residents and actually reduces the deficit.". Should be a strong selling point to joe q public.
posted by dig_duggler at 1:51 PM on September 16, 2009


I imagine that forcing employers to give their employees this info (the W-2 really is the place that makes the most sense) is a way to build support for further reform, particularly on the delivery side. One of the big reasons why you're not seeing Obama be more aggressive or expansive in what he's proposing is because polls stubbornly show that 80-85% of people are pretty satisfied with their insurance. A lot of policy wonks believe that's because people pretty much have no idea how much in potential wages they're losing through the employer payment for health insurance. If people knew that their health insurance actually cost $12,000 per year, not the $4,000 per year that they've been paying, they'll be more open to further reforms down the road.

Someone said this in a previous thread and I'm still not convinced.

If I am not paying the price for my coverage, why should I care how much the company is spending? It is not like if they suddenly got to stop paying that amount they would give it to me. Instead, it would be a big fat bonus check to the highest levels of management.

I think this whole idea is predicated on people being a lot less cynical about employers than is the case.
posted by winna at 1:57 PM on September 16, 2009 [1 favorite]


the bill covers 94 percent of legal residents

Assuming that by "covers," you actually mean, "insists that you get yourself covered, somehow."
posted by It's Raining Florence Henderson at 1:57 PM on September 16, 2009 [4 favorites]


Ah, how crafty ...

Would appear that someone's caught wise and re-uploaded a new edit. The author is now listed as "SAA" -- last modified this morning at 9:00:47 AM.
posted by grabbingsand at 1:59 PM on September 16, 2009 [4 favorites]


I haven't trusted this guy since he played the millionaire on Gilligan's Island.
posted by Marisa Stole the Precious Thing at 2:03 PM on September 16, 2009 [3 favorites]


Why do people insist on tying your health insurance, something you need under any circumstances to a job that you can lose at your employer's will without notice.

Because, despite all that, getting insurance through an employer is the only realistic way many, many, many, many middle-class Americans have to get affordable, relatively comprehensive coverage.

Private coverage is simply bankruptably expensive for families. High premiums. High deductibles. Most things beyond a simple office visit is regularly "applied to deductible", meaning large out-of-pocket costs. Add, too, really weak prescription coverage and NO dental or vision. That's what's out there for everyone not covered by an employer's group plan.

So, yeah, I hear you about the ridiculous aspect of tying insurance to employment. But, as I said, it makes healthcare affordable for the average family.
posted by Thorzdad at 2:07 PM on September 16, 2009 [2 favorites]


I heard about this on my way in to work this morning and it made me want to vomit. Every month I become more bitter and cynical about this country. I wish to God it weren't so, but it's the democrats that are making it so hard to be optimistic. Why do we keep fucking up? If it weren't for Sarah Palin we'd probably have fucked up the election too.
posted by desjardins at 2:07 PM on September 16, 2009 [1 favorite]


Private coverage is simply bankruptably expensive for families.

It ain't just families. I'm a single guy in my early 30s and my insurance costs like $650 a month. And that's with a $45 copay for office visits and such.
posted by Justinian at 2:14 PM on September 16, 2009


Max Baucus: Shitty Senator.

I've been "serving" the great state of Montana in the U.S. Senate since 1978.

You'll notice I put "serving" in quotes, because, let's face it, I suck. My wife has been pleading with me not to say this publicly, insisting that it's not true, that I'm a capable and dedicated public servant, blah, blah, blah. Bless her dear heart, but she's just being nice. Because, folks, I am telling you, I am hands-down the shittiest senator in the history of the Senate. The worst.

posted by ignignokt at 2:17 PM on September 16, 2009 [1 favorite]


This bill is just ridiculous. I emailed my congressman a while back encouraging single-payer ... as if.

I would also like to relate an anecdote of my own recent experience in health care. I have very good plan (Blue Cross) and recently my son had a tympanostomy (ear tubes). Very routine outpatient surgery that takes 5-10 minutes and is recommended all the time when kids have more than a few ear infections. So far I've only paid $590 to the hospital, which frankly seems like a reasonable price for the whole procedure. But I still (1 month later) don't understand how much I will owe in the end - here are some fun facts:

* the full bill from the hospital (just a clinic building) was $8,477.55
* a few weeks later I got a separate anesthesiology bill for $555.00 (for the anesthesiologist - the anesthesia was on the main bill and was $564.00)
* After calling the hospital they let me know that I would probably also get a bill from the physician (insert shocked silence). They gave me his number and I called to find I had another pending bill for $1,330.00. They haven't billed me yet because they are waiting for the insurance company's analysis.
* Among the items on the main bill is $544.00 for "recovery room". Let me translate that for you - my kid lay on a little bed in a generic little room for about 30 minutes and ate some crackers.

Frankly, I'm lucky. I'll get out for under $1000 total probably, plus a few hours my boss loses while I make all these calls at work. The I can't grasp are:

* How can the hospital not manage the billing? When I get my car fixed I don't get separate bills from each guy in the shop who helped out.
* How can a 5 minute surgery cost over $10,000? They did a good job, but it sure as hell isn't open heart surgery.
* The insurance company can't be actually paying the other $9,000, can they? Is this just a pretend bill so that my out of pocket charge gets jacked up?

And last but not least, if I'm paying the anesthesiologist and doctor separately, then what service did the hospital provide that is worth $8500? Nothing beyond an operating table and machines that go "ping" from what I can see, and close access to a crash cart and other resources in a "worst case" botched surgery.

It's outrageous, and the whole system needs to be scrapped and started over.
posted by freecellwizard at 2:19 PM on September 16, 2009 [16 favorites]


It ain't just families. I'm a single guy in my early 30s and my insurance costs like $650 a month. And that's with a $45 copay for office visits and such.

But hey, the fine for not having insurance is only gonna be like, 900 bucks! Which kind of just makes this a $900 tax on the uninsured! Great!
posted by graventy at 2:22 PM on September 16, 2009 [1 favorite]


A law should be passed so that people caught outside their homes without proof of employment would be punished by being whipped through the streets.

Enforcement of this measure would be much too complex. A more elegant situation would be to mandate that employees live in their workspaces. Then anyone found outside without striped pants and a top hat would automatically be in violation.
posted by Kirth Gerson at 2:22 PM on September 16, 2009 [1 favorite]


How can the hospital not manage the billing? When I get my car fixed I don't get separate bills from each guy in the shop who helped out.

The doctors and specialists are independent contractors. They do not work for the hospital. They belong to separate corporations. About the only people the hospital actually employs are the nurses.

I went to the hospital emergency room a few months back to get my finger stitched back together. I think I got 3 individual bills from that brief visit.
posted by Thorzdad at 2:28 PM on September 16, 2009


But hey, the fine for not having insurance is only gonna be like, 900 bucks! Which kind of just makes this a $900 tax on the uninsured! Great!

ding ding ding ding ding! Since the fine is monumentally less than the cost of insurance it isn't actually an incentive to buy insurance. It's just a way to squeeze money out of the uninsured. Unless we massively subsidize the insurance, of course. In which case instead of a way to squeeze money out of the uninsured it is a way to funnel tax dollars from taxpayers to insurance companies.

Neither thought makes me very happy.
posted by Justinian at 2:31 PM on September 16, 2009 [1 favorite]


How can a 5 minute surgery cost over $10,000?

That sounds outrageous. I had a 3-day hospital stay at Northwestern Memorial in Chicago (no surgery), and it was around $20,000. My insurance did indeed pay $18,000 of that, though.
posted by desjardins at 2:34 PM on September 16, 2009


It saddens me that these damned legislators refuse to consider the needs of the people over building their political capital. I realize that this is the way it's always been, but for such an important issue, it really sucks.

I saw a story about the People's Plan in Mexico and the success it's been. Mexican citizens now spend less of their income on health care than we do.
posted by reenum at 2:35 PM on September 16, 2009


This is a hopeless bill being brought forth by one of the Dems who don't want to be put in the spot of voting on a viable health bill.

What America needs to fix health care is simple. Cease Medicare immediately. Cease Medicaid immediately. Explicitly forbid health insurance, by way of commerce regulation.

That's right. No health insurance for anyone, whatsoever. Pay full price for doctor's visits, prescriptions, and surgeries. Much less paperwork, much less inefficiency, and the added bonus of people dying left and right from inadequate medical care. We'll replace the loss of the health care industry with morticians and estate lawyers. The rest will simply be covered by dead people who usually don't need jobs. Doctors will rejoice at the simplicity of payment, patients will know that they have no worries about pre-existing conditions and can get treated without any hesitation so long as they have the money. We'll even save untold billions on Social Security. Think of the joy Republicans would find over that, getting to take a huge chunk out of the budget in an area that's almost impossible to touch.

Of course, then people would clamor for some sort of health plan so loudly that the most forceful and influential group in Congress would push forth an emergency bill, passing 100-0 in the Senate and 434-1 in the House.
posted by Saydur at 2:41 PM on September 16, 2009 [1 favorite]


How can a 5 minute surgery cost over $10,000?
Have you seen the homes and cars those specialists own?
posted by Thorzdad at 2:44 PM on September 16, 2009 [4 favorites]


I just left a message with Senator Baucus's office to inform them that there is apparently a page missing from the bill, since it offers no public option and appears to be nothing but a massive cash giveaway to the existing health insurance industry.
posted by Faint of Butt at 2:54 PM on September 16, 2009 [3 favorites]


I think the mistake many of you are making is assuming that the Democrats actually want a public option. Actions speak much louder than lip service.
posted by Stonewall Jackson at 3:06 PM on September 16, 2009 [2 favorites]


No wonder the GOP calls Democrats cowards and pussies when the Dems cave into the Republicans every fucking time.
posted by Pope Guilty at 3:07 PM on September 16, 2009 [6 favorites]


In my tortured little fever-dream, I imagine that this all subterfuge on the Dems part. Slap together an utter abortion of a health bill that is so horrifically bad, that Obama ups and vetoes the thing outright. Following that, he issues a presidential proclamation declaring all tax-paying citizens of the US, and their dependents, members of the nation's single largest group, and that the government would begin soliciting group plans from the private sector immediately.

And then I wake up and cry.
posted by Thorzdad at 3:17 PM on September 16, 2009



Have you seen the homes and cars those specialists own?


Which are toys compared to the homes and cars the CEOs of the insurance companies and hospital conglomerates.
posted by eriko at 3:34 PM on September 16, 2009 [2 favorites]


* The insurance company can't be actually paying the other $9,000, can they? Is this just a pretend bill so that my out of pocket charge gets jacked up?
Why yes! That's actually how that works. The "charges" bear no relation to what your insurance pays. The only people that pay "charges" are the uninsured. Actually, this varies depending on the hospital. Some hospitals discount charges for self-pay, some don't.

And last but not least, if I'm paying the anesthesiologist and doctor separately, then what service did the hospital provide that is worth $8500? Nothing beyond an operating table and machines that go "ping" from what I can see, and close access to a crash cart and other resources in a "worst case" botched surgery.
And nurses, technicians, all supplies and drugs used in the case, the actual facility, electricity and other utilities, staff to direct, supervise, educate, and monitor the nurses and technicians, staff to deal with the physicians, staff to handle purchasing, billing and to fight with your insurance company for payment.

Is that worth $8500? Probably not, but your insurance company won't pay that much for it.
posted by jeoc at 4:36 PM on September 16, 2009 [2 favorites]


And I also hate this bill.
posted by jeoc at 4:36 PM on September 16, 2009


Between 2003 and 2008, Baucus received $4 million from the health care industry. How is this not corruption?
posted by parudox at 5:05 PM on September 16, 2009 [7 favorites]


It is corruption. It's disgusting.

Don't forget that he represents less than a million people.
posted by kathrineg at 5:09 PM on September 16, 2009 [4 favorites]


Okay, guys. Enough clowning around. The role of those in power is to do what is right, not what is popular. I'll admit, some issues have a grey area and require intelligent discussion, but this should be pretty cut and dried.
posted by Eideteker at 5:34 PM on September 16, 2009


freecellwizard: Those are made up bills. If you, as an experiment, call up one of those doctors and tell them that the insurance isn't involved and you'll be paying their bill directly, but that it seems a little high, they'll cut it in half as an opener. From there you can negotiate. If you end up paying more than 25% of the original bill, you're a pretty lousy bargainer. The insurance company will pay about 10% of it, and charge you most of that through your deductable.

Yes, it's a giant scam. There is no other word for it. If more people knew, we wouldn't have all this stupidity about fixing it.
posted by rusty at 5:41 PM on September 16, 2009 [4 favorites]


How come I always end up paying the made-up bills, then?

No, scratch that. How can we make a health care system where everybody's not trying to scam everybody else?
posted by vibrotronica at 6:23 PM on September 16, 2009 [1 favorite]


How can we make a health care system where everybody's not trying to scam everybody else?

Start by removing the profit motive. Note: this is tricky.
posted by JohnFredra at 6:28 PM on September 16, 2009 [8 favorites]


The corporate media isn't likely to mention this any time soon. But some of you have heard perhaps that the Roberts Supreme Court is about to remove the ban on direct corporate contributions to political campaigns.

This is a Big Deal. In oilman terms: politicians are about to tap the gusher of the century.

If the Democrats deliver us on a platter with an apple in our mouths to Big Insurance - which you may have noticed they're already well under way with - the lion's share of that money goes to them.

If they don't deliver, that money goes to the Republicans. Who already had an escalated war in Afghanistan and a jobless recovery to run against in 2010. And now a de facto middle class tax hike as well.

It's not even just the Democrats' natural tendency to sell us out at work here now. Now they can't afford not to screw us.
posted by Joe Beese at 6:30 PM on September 16, 2009 [5 favorites]


The final bills I receive always list the cost first and then another line for the substantially lower cost for my insurance company. One of the things I'd love to see would be a law stating it's illegal to charge different people different health care costs depending on which group they belong to. And we're not talking a 5 or 10% discount here, it really is an all out scam pricing scheme. A procedure is listed as 10k, but the cost billed to the insurance is 1400? How is that not designed to force people to buy insurance just to avoid paying ridiculous, made-up costs?
posted by ShadowCrash at 6:44 PM on September 16, 2009 [3 favorites]


The Final Option
posted by brain_drain at 6:47 PM on September 16, 2009 [2 favorites]


excellent post!
posted by brandz at 7:22 PM on September 16, 2009


You know, "senile" and "senate" ultimately come from the same Latin word.

I used to find more humor in that.
posted by oaf at 8:20 PM on September 16, 2009 [2 favorites]


This bill is just ridiculous. I emailed my congressman a while back encouraging single-payer ... as if.

Just a reminder to everyone: emailing your elected representatve is a worthless action. It does nothing, other than let you vent. You might as well post it to reddit instead. It's easy to send off an "OMG this bill is teh suXX0r!!!", so plenty of folks do so thinking their voice has been heard. It hasn't.

You have to call someone. Get a real, live human on the other line and succinctly give your opinion. Even this is just a drop in a very large and loud bucket, but it's at least something.
posted by zardoz at 8:50 PM on September 16, 2009 [1 favorite]


Just a reminder to everyone: emailing your elected representatve is a worthless action.

While what you say fits easily into my pessimistic view of politicians, do you have some personal experience working with reps that led you to this insight?
posted by voltairemodern at 9:50 PM on September 16, 2009


The open market for insurance is very well understood. It is very efficient. It works for auto, life, and home.

My parents live in a fairly safe area that saw a rash of burglaries a few years ago. They were hit more than once. The last time, their agent advised: Don't make a claim. If you do, we won't let you renew your policy when it expires.

My parents were about to become too expensive.

Yes, the open market for insurance would work great for health care.

Seriously, I do not get why it's so hard for fans of the free market to get that these companies are motivatived by profit. That's what drives the market, isn't it? They do not want customers likely to cost them money. Duh. It's not like selling computers, when it doesn't matter who's buying.

Also: fuck the individual mandate. "Tax subsidies"? What does that even mean for a person like me, who has never seen a health insurance quote for lower than half her monthly income?

I am so, so angry that this bill has turned into this mess. I had honestly, really hoped that meaningful health care reform would happen, and now it looks like I'm just going to be fined for the crime of being a young, poor woman with health problems. But hey, at least I'm not a battered woman - which is another pre-existing condition, you know.

Fuck all you goddamn idiots crying "free market" and "socialism." You don't understand anything.
posted by Kutsuwamushi at 10:04 PM on September 16, 2009 [4 favorites]


The open market for insurance is very well understood. It is very efficient. It works for auto, life, and home. How about we try it for health?

Automobile insurance hasn't worked so well in Philadelphia and New Jersey. Uninsured motorists drove up local prices for those who are insured, which created a positive feedback loop.

It seems like a poor idea, to the extent that applying this model to healthcare — with the current proposal where we legally mandate coverage without providing a public option — leads to uninsured who, if they are lucky, end up getting very expensive intensive care that the public still ends up paying more for, than if we were to all have a nationalized insurance option.

The failure of HR 3200 was not to forgo the public option, but to eliminate single payer from the start. There seems no way to regulate private health insurance companies into genuine competition and efficiency, nor has a half-century of right-wing governing having forgone regulation encouraged health insurance companies into genuine competition and efficiency.

A public alternative that forces private companies to make fundamental changes would be the best way to reboot the situation.
posted by Blazecock Pileon at 10:25 PM on September 16, 2009


It seems like a poor idea, to the extent that applying this model to healthcare — with the current proposal where we legally mandate coverage without providing a public option — leads to uninsured who, if they are lucky, end up getting very expensive intensive care that the public still ends up paying more for, than if we were to all have a nationalized insurance option.

I'll amend this to clarify the point: Following the auto insurance model, people in high-risk areas would be mandated to pay artificially high insurance rates on behalf of those who cannot afford insurance, who require government-funded health care services that cost insured taxpayers just as much as they were paying before, except that now they have a higher total bill overall because they are paying private insurance companies higher premiums, which is now is mandated by law. Issues of collusion aside, that's why this model fails for health care.
posted by Blazecock Pileon at 10:37 PM on September 16, 2009


Popping in to disagree with zardoz. Every office is a little different, but generally speaking a Member's staff tracks constituent* phone calls, emails, and letters in the same database, which one can refer to if the Member asks for a count of how many pros and cons are coming in on an issue. Some offices have a set policy on giving the Member x constituent letters to read personally every week, other Members never read their mail personally. My boss does from time to time - when he does, I often include printouts of emails. So, having something in writing might actually be more valuable. Yes, you are a drop in the bucket either way - as much as we would desperately love to treat each and every contact from a constituent as the specialest snowflake in the world (I'm not being sarcastic here - I really take pride in the quality of responses our office sends to the constituents who write or call in, and it kills me when we send out a response that isn't an absolute work of art), congressional offices (especially throughout the healthcare debate) receive literally thousands of calls and letters every day, and managing them is a somewhat Sisyphean task, but hey, it's democracy in action, so keep your calls and letters coming!
Like I said though, every office does things a little differently.

*Key word constituent. If you don't live in the state/district represented by the Member you're calling, we almost certainly don't care. Sorry.
posted by naoko at 10:43 PM on September 16, 2009 [2 favorites]


The open market for insurance is very well understood. It is very efficient. It works for auto, life, and home.

I'm going to lose my renter's insurance because State Farm is leaving Florida as we're too expensive to insure, this despite the fact that I live in North-Cental Florida, which has seen a whopping 1 hurricane in the last decade*.

BTW, ask the people of Louisiana and Mississippi who were denied claims for wind damage because the winds from Katrina drove rain drops and thus any structural damage at all technically constituted flooding. This would be the equivalent of your dropping coverage for cancer because you had a broken arm at 13.

Private insurance sucks. Any industry that has billions vested in not honoring their end of the bargain necessarily becomes a scam. Health insurance is just the extreme end of that scam.

*Yes, I know the typical Conservative line: "No one should ever live in any part of the world that ever gets natural disasters ever, for any reason." Have fun with that.
posted by dirigibleman at 10:59 PM on September 16, 2009


Really interesting, thanks for commenting naoko!

Do you check to see if the people who are sending in emails/letters are actually constituents before including them in the tally?
posted by voltairemodern at 11:14 PM on September 16, 2009


They do not want customers likely to cost them money.

True. That would be sick people. Does an insurance company write life insurance policies on dead people? Would one write a homeowner policy on a burning house? Auto insurance on a car that's been totaled in an accident?

Health insurance should protect people when they are sick or injured. The for-profit model militates against that. Comparisons with auto insurance are heartless and stupid.
posted by Kirth Gerson at 3:35 AM on September 17, 2009 [2 favorites]


Insurance works because it amortizes the cost of rare, costly events. Fire insurance for your house works because houses burn down infrequently. If you suffered two house fires in your lifetime you'd be an extremely unlucky person. Health care, as you may have noticed, is not a rare event. It may not have happened to you, but I've heard there are people who have to visit a health care provider as often as twice in a single year.

Insurance as a solution to the healthcare problem is like bailing out a flooded basement with a shovel. Even if the shovel has a rusty blade and a bad handle, fixing the shovel is not the solution.
posted by srt19170 at 7:50 AM on September 17, 2009 [5 favorites]


hey, it's democracy in action, so keep your calls and letters coming!
Like I said though, every office does things a little differently.

*Key word constituent. If you don't live in the state/district represented by the Member you're calling, we almost certainly don't care. Sorry.


You realize that your boss votes on things that affect the entire nation, right?

This is such a shitty attitude and it's not democracy.

Maybe I'm just bitter because my the 19+ million people in my state get as many senate votes as the <1 million people in Montana. And the <600,000 people in Wyoming.

That's right, 20 to 40 times as many people and the exact same number of votes.
posted by kathrineg at 8:15 AM on September 17, 2009


If this (or a similarly shitty) bill passes the house and the senate our best hope is that Obama vetoes it...so I will be contacting his office.
posted by kathrineg at 8:20 AM on September 17, 2009


You realize that your boss votes on things that affect the entire nation, right?

Yes, but he/she is an elected representative of his/her district. He/she is responsible to the people who she has been elected to represent.

Your voice still matters, you just have to channel it the right way -- through your representatives. By the way, the President is your representative too, you voted for him (or, er, for the other guy/girl, but technically he is listed as your representative).

Bill sucks. You'd hope MSM would say "Woah now, that's a lot of campaign contributions for the people you are pretending to regulate", but then, well, their advertising and news divisions are so close together...

Here's hoping the Daily Show catches it? :P
posted by cavalier at 9:17 AM on September 17, 2009


Yes, but he/she is an elected representative of his/her district. He/she is responsible to the people who she has been elected to represent.

I suppose we'll just have to agree to disagree.
posted by kathrineg at 9:20 AM on September 17, 2009


Denial is not just a river in Egypt.
posted by cavalier at 9:26 AM on September 17, 2009


You think they are responsible to the people that they were elected to represent, I think that they have a responsibility that goes beyond that--both as human beings and as people with power over the outcome of legislation that affects the entire country.

If you don't think so, fine, but there's no reason to get all third-grade retort about it.
posted by kathrineg at 9:35 AM on September 17, 2009




Maybe I'm just bitter because my the 19+ million people in my state get as many senate votes as the <1>

This is precisely why we have a bicameral legislature. You can be that the folks in Montana aren't too thrilled that New York has 29 representatives in the House to their measly one.

posted by JohnFredra at 10:50 AM on September 17, 2009


Err... didn't quite close the italics tag there. Only the first sentence is a quote.
posted by JohnFredra at 10:51 AM on September 17, 2009


Well, unfortunately, the folks in Montana have proportional representation in the House, and if they're upset about that then I can't say I'm too sympathetic.
posted by kathrineg at 1:16 PM on September 17, 2009


brandz,

Thank you.

To all,

I wanted to link to this Matt Yglesias post that speaks to the differences between the House and Baucus bills and spends some time dealing with the conference committee.
posted by Hypnotic Chick at 1:29 PM on September 17, 2009


You know, I really agree with you both - constitutionally, a Representative is responsible to his or her district, but obviously it's true that those votes affect everyone, and that morally at least you have a responsibility to the nation. My snark about not caring about out-of-state/district calls and letters was pragmatic as much as anything else: a Member truly has only enough staff and resources available to deal with the concerns of a few hundred thousand people, not a few hundred million.

As to voltairemodern's question: we ask callers if they'd like to leave a name and address. If so and if it's in our district, their comments get entered in our database. If not, we basically just say "thanks and have a nice day." Letters from outside of our district generally get forwarded to the appropriate office.

Also, I hope I didn't give the impression that we entirely discount phone calls - in the office I worked in previously, we would occasionally (generally if we were in the midst of a difficult vote) collect quotes from phone calls to give to the boss - which he could then use in floor speeches, etc.

I am very mindful that my job only exists because taxpayers provide my salary, and they deserve nothing but the best constituent service in return. However, I ask that if you're calling your representatives, please remember that you're likely speaking to some 22-year-old who makes a not-enormous amount of money to get screamed at by teabaggers all day - share your opinions as civilly as possible when you're angry, and if you're happy with something your rep has done, let them know - it can really brighten up a staffer's day to get the occasional positive feedback.

As far as the fairness of the bicameral legislature goes: think how the District of Columbia (which has more people than all of Wyoming!) feels. Now that's just fucked up.
posted by naoko at 8:03 PM on September 17, 2009




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