HELP Bill Progress: Lower CBO Score w/ Public Option, Pressure on Hagan Continues

Is Dodd a health care reformer? (0.00 / 0)

"The single most expensive option is to build on the existing system," says the health care costs expert John Sheils of the Lewin Group.  

Sadly, Dodd still appears devoted to that doomed course of action.  That candidate Obama's campaign commitment to "universal health care for everyone" has been reduced to this insurance-industry salve is truly sad. (And, BTW, MORE evidence that we will we never get real health care reform - or ANY reform - until we have sweeping campaign finance reform).

Is it really a "Public" option if it is hamstrung by so many limitations, regulations, and "Sorry, you can't cut costs THAT way" rules?  I'd call it just another private plan (same rising premiums and disappearing benefits)--  with the word "Public" stamped on the cover.  And BTW, what ARE the premiums on this "public" plan - I mean, for the comprehensive coverage tier that you and I would want for our children?

A $750 annual fee on employers for each full-time worker not offered coverage through their job?  What is that - a tenth of what the employer would pay to actually provide an employee with decent insurance?   Big Business says "Thanks, Mr. Dodd!"

AND we would end up with an even MORE complex, fragmented health care system.  One more set of forms for doctors to fill out ("Time to bring on some extra admin. staff, Dr. Welby?")

Bottom line: If this mess -- labeled "reform" -- is all that can be passed by the people now representing us in DC, and if DC will then moves on to other issues, I'd say "let it die."  We can return when we have the courage and leadership for real reform: quality, affordable health care for everyone.    

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by: iBlog @ Thu Jul 02, 2009 at 11:59:49 AM CDT

It's a Distressing Pattern (0.00 / 0)

Energy Reform seems like an industry salve - Financial Services Regulation is heading the same way - and now Health Care Reform?

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by: Jon Kantrowitz @ Thu Jul 02, 2009 at 13:33:38 PM CDT

[ Parent ]

Political Realities (0.00 / 0)

"The single most expensive option is to build on the existing system," says the health care costs expert John Sheils of the Lewin Group.

But not building on the existing system — which is to say, summarily dismantling the existing system — is a political nonstarter: While the public support for healthcare reform, and for a public plan, is broad and deep, it's also true that the vast majority of people who have healthcare coverage like what they have, and don't want to have to change. It's useless go complain about how frustratingly self-contradictory it is for people to want the system to change but not want their own piece of the system to change; it is what it is.

So do you want imperfect reform, or no reform at all? Recognizing political realities isn't always cowardice or craveness.

A $750 annual fee on employers for each full-time worker not offered coverage through their job?  What is that - a tenth of what the employer would pay to actually provide an employee with decent insurance?   Big Business says "Thanks, Mr. Dodd!"

It hadn't occurred to me before, but maybe there's some interesting political kung fu in this: As long as there's a public plan for folks to migrate to, "tricking" employers into opting out of employer-provided healthcare might be the only way we could get to single-payer (my preferred end-state) in my lifetime.

I truly believe people wouldn't stand for having the government take away their existing employer-provided plans (yes, I know none of the plans currently under consideration do that, but a direct move to single-payer would)... but if their employers dump their existing plans and the government's there with an alternative, they'll be grateful instead of hateful. And once we've got >50% on some sort of public plan, the move to full single-payer will be much more plausible, and politically possible.

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by: dauphinb @ Thu Jul 02, 2009 at 16:15:31 PM CDT

[ Parent ]

All true (0.00 / 0)

... but the reason why most people like the plan they have is because most people have not depended on it with their life.

I used to have this car that went haywire when it was on the highway. If you were just driving it on local roads, then you'd think it was great. Once it really started pushing 60mph, you'd think it was crap. Now, was the car actually great, or actually crap? Depends on whether or not you have a realistic expectation about what it was meant to do.

Likewise, I don't think most people have a great idea of what it is they actually have in their healthcare coverage. If you walk in and out of a routine checkup without having to pay anything, you're probably going to feel pretty good about your insurance -- but someone trying to fight cancer and Aetna at the same time might have a different outlook, and there's no way for a consumer to know what kind of crap awaits them when the big bills start coming in.

And you're right that if an employer unplugged from the private plan they used previously to switch over to the public option, that would be a good deal for the company. Whether or not the employee enjoys that change would be a question of a) what their newly-visible payment for insurance is, and b) how much of the cost difference to the company becomes higher wages for the worker. If the company dumps the worker off their previous insurance plan and pockets the difference, then workers would be furious. Whether they'd be furious at their boss or at the federal government is a political question, one for which neither side of the debate has begun to position themselves.  

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...

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by: mattw @ Thu Jul 02, 2009 at 17:16:32 PM CDT

[ Parent ]

You're Selling People Short (0.00 / 0)

... but the reason why most people like the plan they have is because most people have not depended on it with their life.

...

I don't think most people have a great idea of what it is they actually have in their healthcare coverage.

Really? How many families do you know that have gotten the kids through childhood and into college without any serious injuries, or major illnesses, or surgeries (or scares related to same)? These are the things that exercise an insurance policy beyond routine office visits... and I don't know many families that have managed to avoid all of them.

someone trying to fight cancer and Aetna at the same time might have a different outlook

When my family was fighting cancer, our insurance company (CIGNA rather than Aetna, in our case) was one of our strongest allies. In fact, our company is at its best when helping us through the big crises (not that it's bad on the routine stuff, either).

I think people who have good insurance (see my reply to iBlog; there really is such a thing as good insurance) know it's good. Don't write off every instance of satisfaction to ignorance or complacency.

People who have bad insurance, or none at all all, know that, too, so...

was the car [that rides like crap when you hit 60 mph] actually great, or actually crap?

...to somebody with no car at all, or one that can't make it above 30, actually great, probably. Are we more concerned with optimizing the system, or with covering the uninsured and underinsured who are just one surgery away from bankruptcy? My long-term goal is a universal single-payer system, but my short-term goal is to get everyone covered, and in that regard, it may be that the perfect is the enemy of the good.

Of course, the real goal is to achieve the short-term goal in the way that best enables achieving the long-term goal eventually. In that light, the new version of the HELP bill looks to me like a good step. But, as always, YMMV. I just want us to at least try to avoid the typical liberal circular firing squad on this one.

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by: dauphinb @ Fri Jul 03, 2009 at 00:22:22 AM CDT

[ Parent ]

. (0.00 / 0)

Of course, the real goal is to achieve the short-term goal in the way that best enables achieving the long-term goal eventually. In that light, the new version of the HELP bill looks to me like a good step. But, as always, YMMV. I just want us to at least try to avoid the typical liberal circular firing squad on this one.

And I'd like to avoid letting conservatives get 95% of what they want with 42% of the votes. Though I agree about the modified HELP bill.

It's good that your healthcare provider has done right by you -- my point is that nobody knows until it's crunch time whether they will or won't. There are a number of points in the system (rescissions, denial of care as elective or experimental, preapproval, etc) where people can get their coverage revoked or individual claims denied, and what I'm getting at is that the industry as a whole fundamentally depends on consumers being at an informational disadvantage when it comes to the workings of their insurers. That leads to some good side effects (older adults are subsidized to a certain extent by the not-as-statistically-necessary employer-provided benefits of young workers), and a lot of bad ones.

I'm also suggesting that while it seems that your claim "that the vast majority of people who have healthcare coverage like what they have" is correct, it seems likely to me that a poll of those who have submitted enough bills to trigger an examination by a medical loss expert would reveal some other currents. I saw someplace (should look it up) that around 80% of the insured like their insurance -- do you think anything would characterize the other 20%?

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...

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by: mattw @ Fri Jul 03, 2009 at 00:55:26 AM CDT

[ Parent ]

Maybe I'm Just Kidding Myself... (0.00 / 0)

...but I've always assumed that other folks in similar jobs to mine at comparable companies got pretty much the same kind of benefits I get. Maybe UTC is a uniquely shining star and I just don't know it? While your points about denial of care are well taken, we get an awful lot (some would say too much) information about limits, coverage, etc., and I'm not aware of anyone being taken by surprise by the noncoverage of anything (or anyone).

Still, I buy the notion that some arbitrarily large percentage of the people who're happy with their insurance probably shouldn't be. Even so, though...

I saw someplace (should look it up) that around 80% of the insured like their insurance

...that's the number I recall, as well, and the existence of such a large group of people who are happy with their personal status quo (even if perhaps they ought not be) represents a not-inconsiderable obstacle to "change" I'm not saying anyone should abandon the goal; I'm just saying everyone should factor that speed bump into their approaches.

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by: dauphinb @ Fri Jul 03, 2009 at 01:29:55 AM CDT

[ Parent ]

interesting (0.00 / 0)

Still looking for the 2009 poll I'd seen, but found this to be an interesting read:

http://www.harrisi.org/news/al...

The international bits are kind of fun to see, but I was surprised to see that many people in the U.S. basically in favor of totally demolishing the current system.

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...

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by: mattw @ Fri Jul 03, 2009 at 01:06:12 AM CDT

[ Parent ]

Thanks... (0.00 / 0)

...for all the links, though I'm on my way to bed and won't be able to study them 'til tomorrow.

many people in the U.S. basically in favor of totally demolishing the current system

Hey, me too! But it's often (always?) true that you get significantly different answers when you poll people about "the system" than when you ask how they feel about specific, personal issues. It's like the polls that show most people refuse to describe themselves as "liberal," yet polls of those same samples show most specific liberal policy ideas winning by big margins... or the oft-repeated finding that most Americans hate Congress... but most also love their own Congresscritters.

This sort of collective cognitive dissonance between global issues and personal particulars will always, I'm afraid, be a thorn in our leaders' sides; the question (which I am neither clever enough nor sufficiently wakeful to tackle at the moment) is how to deal with it politically.

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by: dauphinb @ Fri Jul 03, 2009 at 01:44:11 AM CDT

[ Parent ]

one more (0.00 / 0)

Here's the poll I had seen. It doesn't probe the experiences of those who are satisfied or dissatisfied.  

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...

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by: mattw @ Fri Jul 03, 2009 at 01:15:18 AM CDT

[ Parent ]

yet more polling (0.00 / 0)

Gallup:

According to combined data from Gallup's 2007 and 2008 healthcare surveys, the vast majority of people who say they or a family member put off medical treatment -- 77% -- have health insurance, either in the form of Medicare or Medicaid, or private insurance. Only about a quarter -- 23% -- have no health insurance.

However, these statistics largely reflect the fact that there are far more insured than uninsured Americans (89% vs. 11%). They also mask the important reality that delaying medical care is the norm for the uninsured.

Among the 11% of Americans with no health insurance, 61% tell Gallup they put off seeking medical treatment in the past year. This contrasts with 29% of those with private health insurance, and only 18% of those with Medicaid or Medicare coverage.

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...

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by: mattw @ Fri Jul 03, 2009 at 01:23:22 AM CDT

[ Parent ]

False promises (0.00 / 0)

"But not building on the existing system - which is to say, summarily dismantling the existing system - is a political nonstarter."

Yes, yes, we were all told that, over and over.  Better to ignore the truth that, according to the best research, the ONLY way to make universal health care affordable is to rebuild the system.  Settle for a lot less - then learn that the LESS you change, the MORE unaffordable your small changes becomes.

But here we are in July. Most of us settled for compromise after compromise, and I'll say this: We are further from a "strong public option" than we are from "single-payer."  Because the insurance industry and their paid congressmen know they can (accurately) brand any decent public option as unaffordable, then neuter and/or kill it.  Not so with single payer models - which ARE actually affordable, which HAVE the support of more than half the doctors in the US, etc. etc.

Of course, ending slavery was once a non-starter.  

Getting women the vote was once a non-starter.

But somebody started them.

.

"It's also true that the vast majority of people who have healthcare coverage like what they have, and don't want to have to change."

Drill deep into those surveys. Or find the ones that ask the follow-up questions, the smarter questions.

And think of, like, every person in America that you know.

ARE they happy with their coverage?  With their premiums that are rising eight times faster than their wages?  With the need to switch all their doctors whenever a new job means a new health plan or whenever their employer switches carriers?  With exclusions for pre-existing conditions?

Of course not.  Health insurance sucks.

But people certainly "like" their coverage IF the alternative that is described to them sucks even more. If they're told they can't keep seeing their current doctors and specialists.  If they're told they will have fewer choices of doctors and treatments.

Explain it right and you'll learn what people REALLY want (Hint: It's NOT the status quo!)

I haven't met a single person who says he likes his current plan because of the wonderful people at the claims department or the charming premiums or the exciting denials-of service.

Nor have I met anyone who will fight to the death for the chance to choose at work between two 99%-identical, equally unaffordable insurance companies' plans.

People have just been scared into believing that the alternative to private insurance must be horribly worse.  Score one for AHIP.

Ask better questions - get the honest answers.  

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by: iBlog @ Thu Jul 02, 2009 at 20:07:42 PM CDT

Meet One (0.00 / 0)

I haven't met a single person who says he likes his current plan because of the wonderful people at the claims department or the charming premiums or the exciting denials-of service.

Well, meet me. My employer-provided health insurance has been uniformly excellent throughout my 20-year career with my current company. I've never had a claim denied nor has needed care or procedures ever been refused. Roughly 8 years ago, the worry-free access to care afforded by this coverage played an important role in saving my daughter's life from a cancer that might have gone undiagnosed for much longer had I had to fret over the cost of each office visit. And throughout our ordeal (and on every other occasion, too), representatives of my insurance company have been kind, efficient, and effective... routinely easier to deal with that the actual healthcare providers.

And this is not some one-in-a-million goldplated plan; it's the same plan (or, actually, one of the same menu of available plans) on offer to every employee of United Technologies (the union-represented workers have a slightly different slate of plans, but they're equivalent or better in terms of cost and coverage). While my cost (my share of the premiums, plus deductibles and copays) has gone up some over the years, it's still quite affordable and the coverage has remained excellent. With out-of-pocket limits, my family can't possibly get into serious financial trouble due to medical costs, no matter how much care we need in any given year.

You say...

Health insurance sucks.

...but you're wrong. Plenty of people have health insurance that sucks, and plenty more have no insurance at all, which really sucks... but lots of folks (and esp. lots of middle-class voters) have health insurance that really doesn't suck, and if you ignore that fact, you're not looking at the whole political/tactical picture.

Personally, I would be willing to take a modest step backward in the quality of my own personal coverage, in exchange for a universal, publicly funded, single-payer system, because I think that's what would be good for the whole society. But it would be foolish to pretend there isn't a big chunk of the electorate that feels differently on that score.

BTW...

Of course, ending slavery was once a non-starter.  

Getting women the vote was once a non-starter.

Nice! Because you and I disagree about political tactics (even though we seem to agree about ultimate goals), you're going to lump me in with slavers and anti-suffragists? Well, you did stop short of calling me a Nazi, so I guess I can't invoke Godwin's Law, but even so, that's some pretty offensive bullshit, right there.

Happy Independence Day to you, too!

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by: dauphinb @ Fri Jul 03, 2009 at 00:00:58 AM CDT

[ Parent ]

To an outlier - (0.00 / 0)

From the Washington Post-ABC News Poll, June 24, 2009

Among those with health insurance:

--------------------------------
42% are "Very Satisfied" with their health care coverage

39% are "Somewhat Satisfied"

11% are "Somewhat Dissatisfied"

8% are "Very Dissatisfied"

1% have "No Opinion"
---------------------------------

So, well over half of Americans who have health insurance are either dissatisfied with their insurance, or only somewhat satisfied with it.

Not such a ringing endorsement...

.
at: http://www.washingtonpost.com/...

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by: iBlog @ Fri Jul 03, 2009 at 07:57:30 AM CDT

[ Parent ]

The Way I Look At It... (0.00 / 0)

...your numbers say that 81% are at least somewhat satisfied, and the largest percentage are very satisfied.

Look, I think for-profit healthcare coverage is bad public policy, and tying it to employment is really bad public policy. If I could magically replace it with a not-for-profit, publicly funded system, I would do so in a heartbeat. But if you ignore the fact that the current system works for a large number of individuals and families, you're just not looking at the whole political dynamic.

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by: dauphinb @ Sat Jul 04, 2009 at 00:36:42 AM CDT

[ Parent ]

Past the numbers . . . (0.00 / 0)

Good points!  No sense entering this political minefield with any blinders on.

What I do find disturbing is the way people of various persuasions have been quick to jump on studies like this to say, quite unequivocally: "See, our system works" and "People are happy with their insurance."  That just is not shown in the numbers.

Perhaps we can agree that a study like this shows some happy people and some unhappy people.  (Personally, if I owned a car that I was "somewhat satisfied" with, I would never buy that model again.  And I wouldn't stay long with a girlfriend with whom I was "somewhat satisfied.")

Of course, our current system leaves 50 million Americans (think of ten Minnesotas) with no coverage to BE satisfied or dissatisfied with.  I'm guessing they're not exactly thrilled with said system . . .

And if the premiums of those "satisfied" folk keep rising eight times faster than their salaries (as they are now), how much longer can we imagine them still "gettin' satisfaction?"

For me, what this means is: We need public policy that gives EVERYBODY quality, affordable, SATISFYING coverage.

Have a great holiday!

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by: iBlog @ Sat Jul 04, 2009 at 08:45:22 AM CDT

[ Parent ]