How bad is the healthcare reform bill?
I’m compiling the post I promised here (the online working session on general feminist/leftist strategy), but in the meantime, I’m wondering if the healthcare bill on the table is so bad we need to kill it. Even without Stupak, I mean — of course we need to get rid of that. But the rest of it: is it actually going to make things worse?
This is not a new question, of course. Healthcare activists have been trying to make this calculus all year. Anything less than single-payer (Medicare for All) is bound to be some flavor of dog’s breakfast; the issue is whether the resulting mess will nevertheless constitute a net contribution to The Good. Looking at the truly remarkable sludge that has been pumped out of the House’s bilge hole, I’m not so sure.
Ezra Klein addresses this in Is a flawed health-care bill better than no bill at all? Not surprisingly, if you’ve been following Ezra, he says yes. This is his argument in a nutshell:
Failure does not breed success. Obama’s defeat will not mean that more ambitious reforms have “a better chance of trying again.” It will mean that less ambitious reformers have a better chance of trying next time.
Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn’t cover prescription drugs, or individuals with disabilities, or home health services.
But once the programs were passed into law, they were slowly and continually improved…
…As any scientist will tell you, it’s much easier to encourage something to evolve in a certain direction than it is to create it anew.
Corrente, on the other hand, is one of the many leftist voices sounding the alarm. In Strategery, lambert lists some of the worst aspects of the bill, including forcing people to buy junk insurance, imposing fines for not buying it, and creating a class of working poor who become healthcare refugees: can’t afford the insurance, can’t afford the fines, and can’t afford to risk getting caught by going to the emergency room. Cannonfire paints the picture:
She should go to the ER right away. But will she?
Under today’s system of socialized emergency medicine for the poor, she probably would go to the hospital within 24 hours. But under Pelosi’s plan, she knows that stepping into that hospital mean paying an unpayable fine, because she can’t afford to be on a health plan. And she’s terrified to fill out any forms giving out her personal information, because the last year she filled out a tax form was the year she “fell off the grid.”
So she stays home, spitting out her saliva every minute, unable to sleep, feeling ready to die. Maybe she ends up doing just that.
Lordy, lordy, lordy.
Also, read Bruce Dixon’s analysis from last week (all of which still holds):
Most alarmingly, the Democratic version of the public option will be rigidly means-tested to ensure that only the poorest get in, and financed with a John McCain style tax on those who receive nearly adequate benefits from their employers. This is a patented recipe for ghettoizing and socially stigmatizing those who do avail themselves of the public option, setting one segment of society against another poorer one, the exact reverse of the everybody in, nobody out spirit of social security and Medicare.
And though we are told that insurers will not be able to deny policies on the basis of pre-existing conditions, there is mounting evidence that insurers intend to enforce the same discriminatory requirements by claiming that conditions such as diabetes, overweight, smoking and more are the result of patient behaviors and “lifestyle choices” for which the insurance company cannot be liable unless it is able to charge more. The president has even deceitfully lowered the number of uninsured referred to in all the Democrats’ pronouncements by subtracting the 12 or 15 million undocumented from all its numbers, as though they are expected to live in our midst as an underclass with no access to health services.
Finally, take a look at this conversation at Democracy Now with Amy Goodman, Jane Hamsher, and Dennis Kucinich.
Thoughts?
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By the way, the “Don’t Ask, Don’t Give” boycott of the DNC is killing me. When I saw it come over the wire, at first I thought it was a response to Stupak. “Cool!” I said. “Daily Kos and Crooks & Liars are going PUMA!” But no, it’s about gay rights. Fine to boycott the Dems for gay rights; not fine for women’s rights. Everybody clear?
53 Responses to “How bad is the healthcare reform bill?”
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myiq2xu says:
Arthur Silber nailed it:
If you listened carefully to what almost every politician said during the last election campaign — and I emphatically include what Obama and all leading Democrats said — and if you understood what they were saying, you realized that they told you over and over again that they would fuck you in an endless variety of ways, until almost every last drop of your blood and almost every dollar you possess were gone. In their infinite kindness, they won’t kill you, for they hope to extract still more from you, as your life and hope slowly ebb away.
They’ve kept their promise. They’ve fucked you yet again, just as they said they would.
http://powerofnarrative.blogsp.....u-act.html
November 10th, 2009 at 3:52 pm EST -
anna says:
Does the healthcare reform bill ban charging women higher costs for insurance than men, and ban preexisting conditions (often including pregnancy, domestic violence, previous c-section, etc) from being used as a reason to deny insurance?
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madaha says:
it’s price gouging, pure and simple. More people may have (forced) coverage, but they are going to go broke trying to pay for it. It’s scandalous.
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Nadai says:
Fine to boycott the Dems for gay rights; not fine for women’s rights. Everybody clear?
Well, sure. Some of those gay people are men. We can’t stand by while men are mistreated.
Which is not to say, of course, that boycotting the Dems for gay rights is a bad idea (nor, of ocurse, that that’s whay you’re saying). I’m just curious as to why it took these idiots this long to realize the Dems might have just the teensiest problem with gay rights.
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Topper Harley says:
If I may be so crass as to correlate health care and gay rights, I’d note that a government that has the moral authority not to put a donut in your mouth also has the moral authority to tell you not to put a dick in your mouth.
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angie says:
I believe I’ve made my position pretty clear in my thread-jack of the Rachel Maddow thread, and I will not bore everyone with a repeat of why this bill (even without the Stupak amendment) is worse than what we have now other than to say it is my firm belief that this bill will increase costs & decrease services.
I will also point out what I see as the fallacy of Ezra Klein’s argument: We have a Dem. president & Congress, we should be able to do this thing right the first time. Furthermore, this “less than perfect” bill is going to cost us (depending on what numbers you use) from $894 billion to $1.3 trillion. Call me crazy, but for that kind of money I don’t expect a “fixer upper.” Finally, remember that $787 billion dollar stimulus bill that the Ezra Kleins of the world told us wasn’t perfect, but was better than nothing? How it was going to keep unemployment at 8% etc? Yeah. I’m not falling for that again.
DIRFT
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Northwest rain says:
Just so we know who the villain is — the one who killed the Public option — from Violet’s link to DemocracyNow interview:
REP. DENNIS KUCINICH: Well, my amendment passed in the Education and Labor Committee, and it would have protected the right of states to pursue single payer by granting states a waiver from what is known as the Employment Retirement Income Security Act, which is currently being used in court by the insurance company to attack single-payer initiatives. My amendment passed the committee. It was taken out of the bill at the behest of the administration.
I added the bold to the last sentence. This is the “administration” taking of the corporations making sure that they get their “welfare” payments.
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SarahG says:
This crapfest was completely predicatable, which is why lots of reasonable people don’t want government-run healthcare.
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janicen says:
Among the things I cannot understand about this bill is, how can the government force me to buy a product from a private business? Here in VA, we are required to buy car insurance, with the amount of coverage we choose to have, or we can pay for uninsured motorists coverage. The healthcare bill seems to be forcing people to buy particular products, not of their choosing, from particular vendors. Can the government force me to buy a car from GM or pay a fine if I don’t?
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janicen says:
I think my comment disappeared. I apologize in advance if it pops up as a duplicate comment. I was asking, how can the government force me to buy a particular product from a particular vendor? Here in VA, auto insurance is required by law, but we can choose our vendor and the amount of coverage we want, or we can pay for uninsured motorist coverage. The healthcare bill seems to be requiring people to buy predetermined coverage from predetermined vendors. Can the government also force me to buy a car from GM or pay a fine if I don’t?
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janicen says:
Well, there it is. Sorry all.
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Violet says:
Yeah, I have caching enabled to cope with traffic. It might take a moment for a comment to show up.
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angie says:
janicen — it is actually worse than that because (legally) driving is a “privilege” in that you don’t have to drive but if you choose too the state is allowed to put requirements on you (like buying a minimum amount of liability insurance). Requiring people to buy health care is based on nothing other than the fact that you are alive & breathing — no “choice” at all, other than killing yourself (and that kind of interferes with the whole right to life, liberty & the pursuit of happiness thing). If this was single payer where everyone, including the members of Congress, all had the same coverage, it would be different because everyone would be covered automatically & no private vendors would be involved.
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At least he can still give a great speech (plus open thread) | Reclusive Leftist says:
[...] is a also an open thread if you want to talk about anything other than healthcare reform, which is here.) Share [...]
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merciless says:
Help me out here. I can’t see the endgame, and I’ve been trying my best. One guess is that somehow, Obama really believes what he said the other day about this being the greatest thing since Medicare and Social Security (which puts him in company I don’t really think he deserves). If so, he’s going to be sadly disappointed when right and left alike use this debacle to hoist him on his own petard.
Another guess is that Obama has accomplished his goals (enriching his corporate donors) and is trying everything to sell this pig at any cost. In this case, only the corporate donors count, and he believes that they are enough to ensure his continued rule.
So is he dangerously naive, or utterly corrupt?
Or am I missing something?
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janicen says:
Thanks, angie. I forgot to add that to my comment. We can choose not to drive, but we can’t choose not to participate in healthcare.
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quixote says:
merciless: That would be “utterly corrupt.”
(btw, Ian Welsh has a good rundown of the main points in the House bill.)
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Gayle says:
Merciless,
There’s a reason this thing doesn’t kick in until 2013.
No real public option means we’re all forced to buy ever more expensive insurance policies. There will be no cost controls.
I’m also sure the insurance companies will opt to pay a fine of $5000.00 or so instead of insuring a person with a potentially expensive pre-existing condition. Why not pay 5 grand up front if it allows you to avoid paying 50 or 100 grand on expensive treatments later on?
I’d rather have no bill than this bill and the thing hasn’t even gone to the Senate yet where even the puniest of Public Options will almost certainly be dropped.
The only way we’re going to have real reform in this country is if corporations, small and large alike, demand it. I expected more vocal support for single payer or a robust Public Option from businesses during this debate. Where where they? They’ve been complaining about spiraling costs for years.
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yttik says:
I believe this bill in it’s current form is worse then no reform at all. I’d be quite happy to kill it. Forcing people to purchase insurance and punishing them if they don’t is not reform, it’s a windfall for the insurance companies. Like our current system, we’ll be spending about 46 million on people’s health care and the rest of the 89 billion will go to new bureaucracy and insurance companies.
The tax credits are a joke too. They begin for a family of four making less then 33,000. A family of four making 34,000 can’t afford much, let alone 12 grand in insurance premiums. They’ll either have to go on welfare, live in their car so they can spend all their money on insurance, or simply bite the bullet and pay the fines. Regardless, nothing in the bill helps them out.
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Violet says:
Quixote, Ian Welsh’s post is excellent. I recommend it.
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merciless says:
I expected more vocal support for single payer or a robust Public Option from businesses during this debate…
Gayle, I did too. I was shocked to see NO business organizations backing serious reform. I mean, it’s winner winner chicken dinner for them; lower costs, pay employees a pittance more and keep the rest as profit, get rid of half of your human resource dept., what the hell?
This whole thing smells to high heaven.
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madaha says:
kill. the. bill! kill. the. bill! kill. the. bill!
That’s a catchy chant for demonstrations, what say you?
and @15 merciless:
perhaps Obama doesn’t care if he’s a one-termer, because after this deal, he will undoubtedly be walking away a very very very rich man. That’s probably endgame enough for him.
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lambert strether says:
merciless asks:
So is he dangerously naive, or utterly corrupt?
Simple answers to simple questions:
Yes.
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Thanks for the link on Strategery, Violet. And that reminds me, there’s another point:8. No Sasketchewans. HR 3962 in effect outlaws single payer experiments in the states by permitting continued successful court challenges under ERISA, which was what the Kucinich Amendment was designed to prevent.
Remember how the “progressive” access bloggers kept telling us that [a|the] [strong|robust]? [Federalist?] public [health insurance]? [option|plan] would permit a glide path to single payer? (Even though Kathleen Sibelius let the cat out of the bag?) Well, the access bloggers turned out to be full of shit. Quelle surprise.
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Violet says:
I was shocked to see NO business organizations backing serious reform.
Maybe they figured it would be a waste of time. Obama took single payer off the table — no, actually, he never allowed it to get to the table in the first place. Obamacare was always going to be some insurance industry bailout.
I admire the people who worked all year long on single-payer (like Corrente — hi, lambert) in the face of that kind of opposition. Most of the year I felt too discouraged to even mention it on the blog. Brief ray of hope (or self-delusion) before the August recess, but then things turned clusterfucky.
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RKMK says:
There’s a reason this thing doesn’t kick in until 2013.
I thought it was because he and the Dems need to hold Americans hostage for the 2012 elections?
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madamab says:
I cannot understand why every single big business in America is not begging for single-payer/Medicare for All (well, except for the insurance companies, chortle). I never have been able to fathom why my employer should have to pay for my health care. Right there, that whole paradigm is wrong, because that means that people under working age and people who aren’t working by chance or choice, are immediately at a disadvantage.
It’s extremely uncivilized of us to run our country this way.
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TA says:
Of course a bad bill is worse than no bill at all. If all we do is transfer YET MORE money to the health insurance companies, that’s worse. They’re not going to get weaker over the next few years.
madamab, me too! Why aren’t the big employers on this? For that matter, how much money do Citibank, Bank of America, and the rest lose to personal bankruptcies (caused by medical bills)?
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lambert strether says:
Violet #24 — Lambert waves back, and remarks that DCBlogger and hipparchia played a bigger role than he did. DCBlogger was relentless, and hipparchia’s analysis is deeper. But thanks!
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Our rulers (and their rulers, the corporations) view all of us as human resources from which profit is to be extracted. Period. That’s what health insurance reform is about — making that model explicit and rationalized. Thanks, “progressives”!
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merciless says:
Lambert, as always, hits the nail on the head. It makes sense if you think of this as a business decision. In businesses, there are profit centers and loss centers. All-war-all-the-time is a profit center, while health care is a loss center (think of the personnel department). This bill will extract as much profit as possible out of an ultimately money-losing venture. But hey! if they’re lucky, my menopausal, asthma-riddled, uninsured body will succumb to H1N1 and rid them of the cost of me. We can only hope.
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Sameol says:
Ezra seems unable to grasp the basic point that while programs which help people and improve their lives can be expanded and perfected, a disaster which makes the situation worse and negatively impacts millions of lives in an extreme way will set back any possibility of any real reform for 50 years. Good luck explaining that yes, you’re the ones who created this monster, but this time you know what you’re doing.
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Sasha, CA says:
Actually the fictional Ellen in Cannonfire’s example would be eligible for Medicaid under the health care reform bill that the House just passed. Not only would her emergency care be paid for, she would be able to obtain preventive care with absolutely no cost sharing. A significant part of this bill consists of expanding Medicaid to cover childless adults with incomes at or below 150% of the FPL. That would certainly cover Ellen. There’s so much misinformation here, you guys may actually want to read the bill before you condemn it. A family making 34k being forced to spend 12k on insurance premiums?!? Where do people get this stuff?
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angie says:
Quixote — I also want to thank you for recommending Ian Welsh’s post. It is excellent & so are the comments (well not the ones by mandos).
I’m making this quote from Ian my new status on facebook:
The stupid is tiresome, but apparently stupid done wrong is what most Americans, including far too many liberals, want.
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Sameol says:
Um–fictional Ellen is a prostituted woman. That’s the point of the example. Her income may entitle her to expanded Medicaid coverage in theory–but she’s not going to sign up for a plan, and she’s not going to the hospital.
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Kookaburra says:
I work at a job slightly over the minimum wage and were I still working full time (I’m a student) I would make well over 150% FPL for a single person. ($11,000 x 1.5 = $16,500) I have asthma, and my medications cost about $500 every 2 months. Buying them full price is cheaper than any premium I’ve ever been offered.
With this bill, I would have to pay the premiums, or face fines.
My taxes are already about $800/yr, I don’t have any more to give Uncle Sam.
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Violet says:
Sasha, if you have links or sources you can share, please do. We’re all trying to sort out what the deal is. I would like to have as full and accurate an understanding as possible.
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janicen says:
madamab @ 26, I suspect one of the reasons employers are not backing a Medicare for All type plan is because employees would then have the luxury of mobility. If they weren’t tethered to their jobs because of fear of loss of insurance coverage or potential pre-existing conditions denials, they would have more freedom to shop around for better paying jobs and better working conditions. Greater attrition costs employers money. That’s the only reason I can think of for why employers are not supporting a Medicare for All type plan.
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RKMK says:
If they weren’t tethered to their jobs because of fear of loss of insurance coverage or potential pre-existing conditions denials, they would have more freedom to shop around for better paying jobs and better working conditions. Greater attrition costs employers money.
Yeah, Ceiling Cat forbid you just provide a positive work environment and loyalty incentives so that people don’t want to leave.
You guys need single-payer so hard. For a smart person, I have a lot of problems understanding the details of this because buying health insurance, what is and what isn’t covered, etc, is so foreign to me. Single-payer, paid for on a progressive tax basis (i.e. if you’re un- or under-employed, or on minimum wage, you pay nothing or a little off your paycheque, and get the same uninterrupted necessary coverage as millionaires.)
And, I’ll repeat myself here, since Stupak has made it so timely: abortion is covered by (federally-mandated, provincially-run) health care up here in Canuckistan.
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yttik says:
“That’s the only reason I can think of for why employers are not supporting a Medicare for All type plan.”
Well some are probably concerned about the increase in payroll taxes they will have to pay. And the increased paper work. Employers are already mandated to jump thru so many government hoops. With the economy bad, they’re probably reluctant to get on a bandwagon that would require them to collect and pay more taxes and fund the labor required to do so.
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DancingOpossum says:
“…lots of reasonable people don’t want government-run healthcare.”
Wrong. Most reasonable people, including more than half the world, have AND LOVE government-run healthcare.
Where do you get that idea that this bill is government-run healthcare? From your Republican friends? This is health-insurance-company-run healthcare (using the term “care” in its loosest sense), strong-armed and forced upon us by the government, but not run by the government.
Government-run healthcare works extremely well, and saves lives and money. Insurance-company run healthcare does neither, and hurts a lot of people. That’s what this bill is.
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fortherecord says:
No, employers actually should be saving money with Medicare For All.
In 2005, without reform, the average employer that offers coverage was contributing $2,600 to healthcare per employee (for much skimpier benefits), or 217.00 per month. Under HR 676, the average costs to employers for an employee making $30,000 per year will be reduced to $1,425 per year; or about $119.00 per month.
“Should be saving,” because obviously not everyone will save. Those employers who offer their employees no health insurance, or crappy health benefits, would have to pay more.
Since those employers are currently free-riding on our public health care systems, they SHOULD pay more. Because right now the rest of us are paying their share.
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lambert strether says:
Sasha writes:
Actually the fictional Ellen in Cannonfire’s example would be eligible for Medicaid under the health care reform bill…
This again is the key sentence that makes Ellen’s situation untenable, regardless of how income limits are calculated:
[S]he’s terrified to fill out any forms giving out her personal information, because the last year she filled out a tax form was the year she “fell off the grid.”
Is it too much to ask that Sasha read the post before lecturing others on what they haven’t read? Of course, serious people, and especially women, never fall off the grid….
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Sasha, CA says:
Sasha, if you have links or sources you can share, please do. We’re all trying to sort out what the deal is. I would like to have as full and accurate an understanding as possible.
Violet, here you go: http://edlabor.house.gov/blog/.....care.shtml. At this link you’ll find a ton of PDFs you can download, including the complete text of the bill as well as a ten page summary.
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SarahG says:
@39: You don’t need to be rude. I didn’t say this bill was government-run health care, I said it was crap. And I suppose you can say that most reasonable people agree with you, if you define “reasonable” as “people who agree with me.” The fact remains that nobody should be surprized when the boys on the Hill manage to screw things up.
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Sasha, CA says:
Lambert, fair enough but that’s potentially a problem with any government-run program, not just Medicaid. There will be forms to fill out, and some people will be reluctant to do so for a variety of reasons. Does that mean we scrap government-run programs? Also, Cannonfire stated that Ellen would be forced to buy coverage and that she would be financially unable to do so. He made no mention of her being eligible for Medicaid. I felt that needed to be corrected. Finally, let me add that I’ve known quite a few people in Ellen’s situation, many of whom have already tried to apply for Medicaid in the past only to be told that, not having children, they are not eligible. They would absolutely jump at the chance to get covered by Medicaid, their years “off the grid” be damned.
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Sameol says:
Actually, he stated that Ellen would not be able to buy coverage, and that, for obvious reasons, she would not apply for a hardship exemption.
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lambert strether says:
Sasha: So, we’ve cleaned up the issue of getting you to read the post. Good. For the rest of it, sure — with the caveat that if health care is a right, bringing the off-the-grids into the system would be a heck of a lot easier. Naturally, there’s not a hint of such a right on offer.
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As far as the links to house.gov, it’s fine to have the full text of the bill to read, but as far as interpretation, a dime and the Dem talking points will get you a cup of coffee. I’d really like to see enrollee figures based on some analysis that doesn’t come from the Dems or K Street, and I haven’t (so far). For example, the current talking point seems to be “36 million!!!” with pearls clutched that anybody wouldn’t be for that, but IIRC, that figure will happen only by 2019, and that’s a long, long way away, with an administration that’s dedicated to “entitlement reform.” So there’s no way to tell what it means in practice at all. And that’s before we get to the GENIUS move by the Dems, framing putatively universal health care as Medicid expansion (i.e., welfare (i.e., a constant target for attacks and cuts)).
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Violet says:
“That’s the only reason I can think of for why employers are not supporting a Medicare for All type plan.”
Well some are probably concerned about the increase in payroll taxes they will have to pay. And the increased paper work.
No. Medicare for All would involve lower costs to employers and reduced paperwork. It would be a tremendous boon for employers.
If you’re talking about higher employer costs and more paperwork, then you are not talking about Medicare for All.
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yttik says:
You don’t have to believe me if you don’t want to, I just thought you’d like to hear what many small businesses are saying about medicare for all, since someone asked why employers were not advocating for it. Many businesses are currently struggling and they aren’t too happy about all the taxes and paperwork they already have to do. I know businesses who are already laying people off because they are concerned about the health care bill in general and the burden it’s going to place on them.
But it doesn’t really matter anyway because medicare for all is certainly not what we’re getting.
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Sasha, CA says:
I believe this bill (at least in its present form minus Stupak; who knows what it’ll look like when the Senate is done with it) will help millions of the poorest Americans obtain coverage by expanding Medicaid which is a big deal, but my concern is for people living within 150-400% of the FPL. A big part of the problem is that the FPL doesn’t take into account regional differences in the cost of living. Currently there’s a separate FPL only for Hawaii and Alaska, but I think we all know that there’s a huge difference between making 38k in the SF Bay Area, Los Angeles, NYC, etc. and making 38k in rural North Dakota, Mississippi, etc. The cost of living in some of the large urban areas is so outrageously high that it’s quite possible for someone to be within 300-350% of the FPL and still barely scraping by. In which case they can’t afford to spend 10-11% of their income on health insurance premiums with a whopping 28% cost-sharing limit (annual out-of-pocket cap for an individual in that income range would be $4,500)!
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Violet says:
And the ban on pre-existing conditions is undercut by provisions in the law that encourage insurance companies to institute “wellness” incentives, a backdoor means of achieving the same kind of segmentation that discrimination on the basis of pre-existing conditions served.
Insurance companies are not only prohibited to offer abortion services in any policy paid for in part with government funds, they are not even required to offer pelvic examinations or family planning services of any kinds. Doubtless then, some will not.
Medicare will be slashed, depending on which version you prefer, from $300 to $500 billion and the medical benefits of those who have them now taxed to fund the “public option” and low-end private insurance offerings, enabling racist Republicans a peg to tell their constituencies that their hard working tax dollars are paying for the meds of undeserving, lazy black people and so-called “illegals.”
And although millions more will receive some kind of health insurance, just about all those who do so between now and 2013 will do so through the expansion of Medicaid, rather than the private insurance exchanges, which are not scheduled to be fully operational till 2013 at the earliest.
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Kookaburra says:
I’m very concerned about all the talk of “people who can afford it will have to buy insurance.”
I know I don’t trust lawmakers who eat $1,000 lunches out of the lobbyists’ pocket to have any concept of what I can and cannot afford.
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DancingOpossum says:
SarahG, sorry if I came across as rude. But your post did characterize this as a government-run system.
And by reasonable people, no I don’t mean people who agree with me — I mean the citizens of every European and Scandinavian country, Canada, Brazil, Japan, Thailand, and dozens of other places where they have government-run health care and love it.
Of course we all knew that Congress would screw this up.
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Stephanie Hunter says:
What’s even worse is that the success stories and history of the public option haven’t found the light of day in this debate. http://cli.gs/23yYaM/
