After the Future

December 16, 2009

Healthcare Boondoggle (Updated)

Somebody explain to me why this bill as it stands is worth passing. I haven't read a thing yet that's convinced me. Sure there are a few improvements here and…

Somebody explain to me why this bill as it stands is worth passing. I haven't read a thing yet that's convinced me. Sure there are a few improvements here and there, but are they worth the price? I recognize that the game isn't over, and substantive improvements can be added–and it starts with dumping the individual mandate–but it just seems that the Democrats have been played and beaten by the insurance industry, and all they are trying to do now is save face and their political asses by getting something, anything passed no matter how bad it is as policy.

If I hear one more person say, "Don't let the perfect be the enemy of the good," I don't know what I might do. This bill with the individual mandate is not good; it's bad. It's worse than nothing. It's a huge gift to the insurance companies, and will be a huge burden to many, many Americans. This bill if it is passed with the individual mandate will be in large part what the teabaggers have been saying it is: Big Government forcing many people to do what is not in their best interest.

UPDATE: Nate Silver , in arguing that the bill should be passed because of what will be lost if it isn't has twenty questions for opponents. Among them are these on the individual mandate, which is for me the biggest obstacle:

5. Why are some of the same people who are criticizing the bill's lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: "forcing you to buy government-run insurance?"

Silver certainly knows more about this bill than I ever will, but why is the individual mandate necessary for controlling premiums in the individual market? Because individuals might game the market and wait until they're sick before buying the insurance? Are there other factors? Will the minuscule number of people who do that really push costs up that significantly?

Just asking, because abuse concerns by themselves don'tt seem a good enough reason to insist on coercion. Some people will game the system. So what? Is the price that will be paid in resentment regarding Big Government forcing people to buy insurance worth it? And as to point six, the problem is not what the Republican talking points will be, it's what the person shopping for insurance will feel when confronted with bad choices he will be forced to make–buying bad insurance at exorbitant prices from a monopoly. He won't need the Republicans to tell him that.

This is where wonks like Silver don't get it.

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5 responses

Bobby C.

December 17, 2009

If we pass this politically suicidal, corporate-Communist insurance-company giveaway, we deserve the electoral beating we are going to take. We will have confirmed the baggers’ worst nightmares about big government without any of the upside.
Again, if we are stupid enough to pass this bill, then we aren’t smart enough to govern.

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Mike Houser

December 17, 2009

Where do the people who will be able to have heath insurance under this bill fit in? I realize that we could all craft very excellent bill that could do this much in a much cheaper way. Could any of them pass in the current environment? Really? It seems to me that we are in a position of putting a dollar figure on peoples lives. I’m willing to pay a lot to save peoples lives. Is it political suicide? Was the Civil Rights Act political suicide? Would you do it again given the chance? Pass it and then work to prove it was a good idea by fighting to make it better.

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jack Whelan

December 17, 2009

Mike–I’m not sure the analogy to the civil rights legislation is apt because I’m not sure that what we have here is a foundation on which to build. This is a bill that is crafted by the insurance industry to benefit the insurance industry. The civil rights legislation of the sixties was not crafted by segregationists to benefit segregationists. Segregationists hated the civil rights legislation; insurance companies love this legislation, and they should because it costs them very little and benefits them tremendously.
I think there’s little possibility that there will be any improvements to this legislation because the insurance companies have got everything they want with this group of Democrats. If the Dems can’t win now, they will not do any better in the next decade. So our only hope is that they find some way to restore some of the elements that are real reform in the next couple of weeks. If they don’t then they should probably kill it. They won’t, of course, so this is all academic, but let us see as clearly as we can what’s happening here.

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Jason

December 18, 2009

Jack, without an individual mandate, insurers cannot be assured an adequate risk-pool to keep down premium costs for everybody. You talk about the “minuscule” number of people who will game the system, but how do you make that assumption? If the law says that you have to be sold insurance regardless of age or medical condition, why wouldn’t EVERYBODY game the system? The individual mandate really is the sine qua non of meaningful reform.
“And as to point six, the problem is not what the Republican talking points will be…”
Well, in fairness to Nate, point six is directed to those raising “concerns about the political downside.”
Also, I’m really interested to know why these elements are suddenly a concern. Everything that is being complained about was present all along, and if these provisions are really so odious, I really don’t see why a weak public option or a very minor Medicare expansion makes them any better, other than making progressives feel like they are symbolically sticking it to insurance companies.

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Jack Whelan

December 18, 2009

Jason–
I understand the liberal wonk logic of the individual mandate, but this is where I side with conservatives against that kind of thinking. Conservatives are right about resisting the intrusive state forcing people to do what may or may not be in their best interest. Insisting on the individual mandate was never good and only palatable if people were given the choice to go outside the private insurance system.
Candidate Obama understood that, and I recall posting in support of Obama against Clinton when it came up as an issue during the campaign. I think I wrote about it as the more subsidiarist position. The public option or the medicare buy-in are not intrusive or coercive in this way–they are subsidiarist.
So for me the individual mandate was always bad, but now without even a weak public option or Medicare buy in, it pushes this bill across the line where it’s worse than nothing, even though it would still be bad with those other counterbalancing features.
I’m not saying I’m at the point where I think the bill needs to be killed (as if my opinion matters), but try to understand why I’m leaning in that direction: The bill is fundamentally flawed at its foundation in terms of its basic concept of what universal coverage means, which is even though you are now free to buy insurance and choose not to, probably because you can’t afford it, we are now going to force you to buy what you probably can’t afford and call that universal coverage. Why will you probably be unable to afford it? Because the insurance industry is a monopoly that can raise rates at its whim and will push those rates as far as it can get away with, and it will be able to get away with a lot more with the government telling you to pay or else. They are simply not going to pass savings from the larger pool of premium payers to the rest of us as lower premiums. What incentives have they to do that?
What are the benefits of this plan, and do they justify the costs? Ok. A lot of people will get help from the subsidies, but what will those subsidies buy? Where’s the quality and cost control? Will oversight there be left solely to the state exchanges? That’ll be great for Mississippians.
I thought Bush’s medicare prescription bill was worse than nothing because it’s simply a way to transfer vast amounts of taxpayer money to corporations while incidentally giving people some help with their pharma bills. This bill is the same concept. It is primarily designed to benefit the insurance companies, and only incidentally to benefit the taxpayers who are funding it.
That’s its flaw at the foundation that makes it unacceptable and in all liklihood unsustainable, and as such worse than nothing. It’s completely out of balance in that respect. And if it’s the only way so-called reform is possible, then I agree with the principled conservatives that Big Government should stay out of it. This is a wasteful, terribly expensive boondoggle. There are benefits, but they don’t justify the costs. Same logic as for Afghanistan.
As far as the gaming problem goes, there are better ways to handle what I still think is relatively a non problem. Just off the top of my head: If a thirty year old, for instance, gets appendicitis and decides to buy insurance only then, he should be billed for some percentage (90%/100%/110%, whatever) of the premiums he hasn’t paid since he was 21 or whatever age one becomes responsible to self-insure. He can do the math, and decide if it’s better to pay out of pocket for his operation. Maybe there are better ways, we can go back and forth on that and look at any number of scenarios, but what they’re proposing now is the product of liberal thinking that IMO is rightly held in contempt and will be politically disastrous for Dems, especially with twenty-somethings, who will all become Libertarians.

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Healthcare Boondoggle (Updated)

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