by Sam Smith
I ended up supporting the health care bill. Not because it was a historic measure, or the most important piece of legislation in four decades or as an icon of Obama's greatness, but for the same reason one hands over a wallet to a robber. There are times when principle takes the back seat. But when it's all over, the robber is not your hero, but still a thug.
Obama essentially said that if you want 16 million poor people covered, you have to agree to heavily subsidize the insurance industry either through your taxes or through the individual mandate. Remember that about a third of that money will go for marketing and other superfluous industry spending that might have been avoided under a public plan.
The Maine Owl put it well: "The health bill neither is the Armageddon that the Republicans claim, nor the greatest social legislation since Civil Rights and Medicare in the 1960s. Rather, it's a warmed over version of Republican Bob Dole's individual private insurance mandate proposal from 1994. It is what Barack Obama campaigned against versus Hillary Clinton and later John McCain in 2008."
I can't recall a major piece of Democratic legislation that was so coated with corruption, intellectual dishonesty, cynicism and political disloyalty by those pushing it. Obama and the Democrats have offered us a quack cure - full of corrupt, ineffective and even unconstitutional provisions - neatly moderated by some good provisions. And we'll be years straightening it all out.
The liberal groupies at Move On and the like didn't notice or weren't bothered by all this, but much of America was, and because neither side was being honest, the public predictably floundered. The irony is that the Tea Party that the liberals love to hate built itself in no small part on the indefensible way in which the Democrats have behaved on health care. Thus, we are not only getting a badly designed bill but a future in which the right will thrive even more than it already has.
WHAT'S GOOD
Center On Budget Policy Priorities: The plan would expand Medicaid up to 133 percent of the poverty line for all children and adults younger than 65 who are lawfully residing in the United States and not eligible for Medicare. This would mean that millions of low-income parents, as well non-disabled low-income adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states with waivers), would become newly eligible for health coverage through Medicaid. Medicaid is the most cost-effective way to provide comprehensive and affordable coverage to people with very low incomes and thereby ensure that the low-income uninsured gain coverage.
Reuters - Within the first year of enactment Insurance companies will be barred from dropping people from coverage when they get sick.
Lifetime coverage limits will be eliminated and annual limits are to be restricted.
Insurers will be barred from excluding children for coverage because of pre-existing conditions.
Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
A tax credit becomes available for some small businesses to help provide coverage for workers.
In 2011, Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
In 2011, Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
In 2012, The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
In 2012, The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
In 2014, State health insurance exchanges for small businesses and individuals open.
In 2014, Health plans no longer can exclude people from coverage due to pre-existing conditions.
In 2014, Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
Crooks & Liars: Authorizes early funding of community health centers in all 50 states. Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
WHAT'S BAD
There is a huge subsidy for health insurers, paid for out of either taxes or required purchase of health insurance.
The bill doesn't take insurance and medical cost inflation into adequate account. For example, between 2000 and 2007, health insurance went up 100%. Under such a rise, the policy subsidies would become less valuable. Congress tends to lag badly in correcting such situations.
Major provisions of the bill don't got into effect for four to nine years. This is a considerable con, because it allows politicians to say they've passed something that may not go into effect until they are either out of office or, as with the president, safely in his second term. As a result they don't have to take responsibility for any failure or unanticipated cost.
The individual mandate is unconstitutional. If the Supreme Court doesn't strike it down, it will open the door to major new intrusions by the federal government into individual freedom of choice.
Many healthy people may prefer to pay fines than to purchase health insurance. Others would have no choice. Just because you're making a middle class wage doesn't mean you can afford all your expenses. What effect this will have - including on health insurance costs - is unclear but it's not good
Medicare will be hurt one way or another, probably most deeply by cuts recommended by an appointed budget commission with unconstitutionally broad powers.
Because of the delay in programs, the election of a Republican Congress or Senate could drastically change things. As the LA Times pointed out: "Insurance industry experts say there is no way to fully gauge the effect because of its extended time frame. Four years from now, they say, Congress and the White House could have new occupants who may try again to reshape the healthcare landscape."
There will be cuts to the Medicare Advantage plans that could reduce enrollment by as much as one third.
The bill does not deal with state actions. For example, budget cuts in Arizona may slash $385 from the state's Medicaid program and end Kids Care for 39,000 poor children. Writes Casey Newton in Arizona Central: "Programs benefiting low income individuals and families, such as Medicaid and CHIP, are politically vulnerable to the whims of conservatives wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us with a prime example of that. Yet popular programs benefiting everyone, such as Medicare, are relatively impenetrable to the weapons of the conservatives. Suppose Congress had included single payer in their deliberations and eventually decided that the benefits were too great to pass up ,and so enacted an improved Medicare program that covered everyone. Gov. Brewer and her ilk on the state level would be powerless to stop it. "
One of the big sleepers in the bill is the plan to "institute efficiencies" in Medicare programs. In fact, Medicare is far more efficient than any private insurance plan in the country. Consider this snippet from CBPP: "The legislation would reduce annual payment updates to hospitals, skilled nursing facilities, hospices, ambulatory surgical centers, and certain other providers to account for improvements in economy-wide productivity. It would also reduce payments to home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities." And just what will happen to service and its availability? Remember: one person's efficiency is another's lack of service.
MEDIA GROSSLY EXAGGERATING BILL'S IMPORTANCE
Sam Smith
IT'S PROBABLY to be expected of people who spend all day quoting disingenuous public officials, but the media is grossly exaggerating the importance of the health care bill. The comparisons to Medicare and Medicaid are not only wrong, they're insulting.
There are presently about 137 million people on Medicare and Medicaid. Although the Democrats claim to be providing health care to 32 million, half that number are being order to provide themselves with health care, which the government will partially subsidize. Those to be added to Medicaid represent only 12% of those currently enrolled in these programs and even if you add those ordered to buy insurance the number is only a quarter of those benefiting from earlier programs.
Further, Ezra Klein of the Washington Post has pointed out that, "the bill wouldn't really kick in until 2014. To get a more accurate annual figure, look at a year in which the bill is fully operational. In, say, 2016, the bill's spending will be about $160 billion. According to the Center for Medicare and Medicaid Services, total health-care spending that year will be about $3.7 trillion. In other words, the bill's spending is equivalent to about 4 percent of what we'll spend in health care in a year."
