Health Care Reform

[Primula Baggins]

[Note: I split this off from the President Obama thread - VtF]

I wasn't able to watch it either (sleeping puppy), but from what I read online he did well, by my lights. He did support having a public option in healthcare, for example, and apparently he pointed out the little flaw in the private insurance companies' main arguments against it: that (1) private health insurance is the best healthcare system in the world and we are all happy with it and it shouldn't be changed at all; and (2) if a public option is available it will be better and cost less so people will swarm onto it en masse and the private health insurance industry will go down in flames. "That's not logical," Obama said helpfully.

His remarks that the healthcare bill will have to be fiscally responsible lead me to hope that a public option will have to be included, as it's the only proposal that's capable of reducing costs while covering more people. The CBO markup of the Senate Finance Committee bill did not include a public option in its calculations, which is why the price tag came out so high and the number of uninsured who would end up getting covered came out so low.

[Voronwë the Faithful]

We may need a separate thread on the health care debate. I'll just say that as much as I hope that there is a public option, I don't see it happening. The liklihood is that all of the Republican senators will oppose the public option, and I think enough "moderate" Democrats will as well. That will result in a situation where either both sides dig their heels in and nothing gets done, or we end up with a compromise that doesn't include a public option.

I hope I'm wrong.

[Primula Baggins]

Two major polls indicate that more than 70% of Americans want a public option, and that's after having it either largely ignored or badmouthed all over the media for weeks. (Link to one of the polls) The support among Republicans is 50%. Those are numbers that elected officials are bound to notice soon if they haven't already.

And Obama is only starting to use his platform to support it. So, all in all, I'm more hopeful than you. I have to be: Only a public option is going to make any difference at all to my own situation. If Mr. Prim is ever laid off, and I ever get sick again, it will ruin us.

[yovargas]

If Mr. Prim is ever laid off, and I ever get sick again, it will ruin us.

Even if private single-person policies somehow become affordable/reasonable?

[Primula Baggins]

They won't. Not for people who have ever been seriously ill. They will either exclude the "preexisting condition" forever, or they will cost more than I can afford to pay (and still might be canceled without warning if I ever got sick; there's no accountability, you see; insurance providers are not obliged to deliver what I've paid them for).

[Frelga]

If Mr. Prim is ever laid off, and I ever get sick again, it will ruin us.

Even if private single-person policies somehow become affordable/reasonable?

Most private single-person policies exclude pre-existing conditions.

Obame expressed his intention to require that the insurance companies accept all comers instead of "insuring only the healthy people" (his words).

One of the things I liked about Obama's speech today is the constant emphasis that choosing to do nothing is as big a choice as an attempt to change something. If things continue as they are, more and more people will not be able to afford medical care, or will experience the drop in quality accompanied by rising costs.

[River]

They won't. Not for people who have ever been seriously ill. They will either exclude the "preexisting condition" forever, or they will cost more than I can afford to pay (and still might be canceled without warning if I ever got sick; there's no accountability, you see; insurance providers are not obliged to deliver what I've paid them for).

They'll cover your pre-existing condition if you've never let your insurance lapse, but you pay through the nose. L's been doing this dance. It sux.

[Primula Baggins]

But if we lost the chance to get group insurance, if say Mr. Prim started a consulting business so we were both self-employed, my understanding is that I would lose that continuing eligibility. That's really my point, that my insurance situation removes all possibility of Mr. Prim ever being allowed to decide his own career path. Unless things change.

[Frelga]

Prim, I think River is right. There is a law where if you get new insurance withing X time of losing your group plan, they have to take you. Doesn't say anything about the price, though.

[Voronwë the Faithful]

I assume you are referring to COBRA, which provides that you have an opportunity to continue on your health plan for up to 18 months (at a fairly high cost) after your employment is terminated.

Prim, one of the things that is on the table is eliminating the ability of insurance companies to discriminate against people with pre-existing conditions. Wouldn't it be a shame if we end up not even getting that, and other things that would significantly reduce the cost of private insurance for all and ensure that continued coverage is guaranteed for individuals like you and me, because of a stubborn "public option or nothing" position? I've seen those polls that you refer to as well, but they don't convince me that it will make much difference. Unfortunately, just because a majority of the people or in favor of something doesn't mean that it will happen. I will be terribly disappointed if we don't end up with any meaningful health care reforms at all.

[Primula Baggins]

See, I think if there is no public option, what is left will not be meaningful reform. Insurance companies can be required to insure me, maybe, but they can charge whatever they want or impose Draconian requirements for health records I have no way to provide, and turn me down for that reason. Or, as many do currently, wait to investigate until I file a claim related to the pre-existing condition, then find a hoop I failed to jump through and terminate me after I've been paying premiums for years.

I think health insurance will pass, and I think there will be at least a semi-satisfactory public option. The numbers won't work if there isn't one.

And the polls do matter. There is a lot of passion about this. Obama's former campaign website emailed his supporters to ask for their personal healthcare stories and got hundreds of thousands of responses in a little over a week. The webpage is going live today and will probably continue to grow as people find out about it. It's searchable by state and within states, so people can easily collect anecdotes from within a particular Congressional district, say, to use in ads. And that's only one tool that's being set in place.

I don't think the fight has really begun yet. But we'll see.

[Voronwë the Faithful]

See, I think if there is no public option, what is left will not be meaningful reform. Insurance companies can be required to insure me, maybe, but they can charge whatever they want or impose Draconian requirements for health records I have no way to provide, and turn me down for that reason. Or, as many do currently, wait to investigate until I file a claim related to the pre-existing condition, then find a hoop I failed to jump through and terminate me after I've been paying premiums for years.

All of those things could be prohibited.

Of course, it would be better to eliminate the insurance companies altogether, but that's not going to happen. And I tend to agree with those that say that that would the logical result of including a public option. I think the public option really would be so much better than the private options than not enough people would stay with the private options to allow the insurance companies to survive. And the insurance companies are too powerful of a lobby for that to happen.

Ergo, I don't think there will be a public option. But if there isn't, I still want to see meaningful health care reform. Meaningful enough that it would make a difference for you and me. And I do think that is possible.

[Dave_LF]

Having health insurance tied to employment is a really bad idea. It makes it difficult for workers to change jobs, it makes it difficult for employers to hire new workers, and it prevents people who are so inclined from working multiple part-time jobs instead of one full-time one. And the day you lose your job is about the worst possible time to have your premiums increase.

[Primula Baggins]

But the kinds of rules you're talking about would hurt the insurance companies' bottom line. Won't they lobby against that just as hard? If they do end up determining what is passed, I'm dead certain there will be enough loopholes and exceptions and "voluntary pledges to be nice" involved that nothing significant will change. We'll be just as trapped, and with all the impetus for reform spent, and ten years from now we will be spending 20% of our GDP on healthcare.

Edit: Crossposted with Dave_LF.

[Voronwë the Faithful]

But the kinds of rules you're talking about would hurt the insurance companies' bottom line. Won't they lobby against that just as hard? If they do end up determining what is passed, I'm dead certain there will be enough loopholes and exceptions and "voluntary pledges to be nice" involved that nothing significant will change. We'll be just as trapped, and with all the impetus for reform spent, and ten years from now we will be spending 20% of our GDP on healthcare.

Yes, those rules would hurt their bottom line, but not threaten their very existence. In my opinion, the only hope for meaningful reform is that in the end the public option gets traded for meaningful reforms that don't have enough loopholes and exceptions and "voluntary pledges to be nice" involved that nothing significant will change. And I suspect that is exactly what Obama is planning to try to negotiate. Because he knows that the alternative is not to not to anything, and that is not a viable option.

[Frelga]

Who was it that said that we don't have a demonstracy, we have an auction?

Obama clearly recognizes the obstacles. I suppose this is why he is approaching this by organizing the grass-roots effort that served so well in his campaign. If the voter opinions are united and strong enough, it is just possible that the politicians will opt for keeping votes instead of campaign contribution money.

I do think it's a sign of progress that at the moment one of the best things the opponents to the reform can come up with is, "But it will hurt the insurance companies!"

[Voronwë the Faithful]

Very view people (or organizations) actually oppose health care reform this time around. That's one of the big differences between now and the mid-90s. The argument this time around is over what form reform should take, not whether we need some kind of reform.

[Primula Baggins]

And, there's a good possibility that Sen. Franken will be seated before the vote, giving the Democratic caucus 60 votes in the Senate. Yes, a lot of Democrats are taking money from the insurance companies, but I wonder when it comes down to decision time how many will choose to vote against what something like 86% of their Democratic constituents want, and without any way to shelter behind Republican votes. They'll have to vote very publicly against the wishes and interests of the people who elected them, and for no better reason than to protect and subsidize an industry that is widely and deeply resented.

[Voronwë the Faithful]

There is almost no way that they will be able to get 60 votes, even if Franken in seated. There is almost no way that Nelson will support a public plan, and I doubt that Specter will either. Conrad would probably support some version of a public plan, so long as it isn't called a public plan. Then there is Bayh, Landrieu, and 12 or 13 other moderate Democrats that all would need to be convinced to support a public option. I don't believe that will happen. The only way that a package with a public option will be passed will be if the Democrats use the reconciliation process (which avoids the possibility of a filibuster), if they actually get away with that.

[Primula Baggins]

As the Republicans did to pass Bush's $1.3 trillion tax cut package? Yes, I think they can and will get away with that, if Obama's got the political will. In which case they need 51 votes, not 60.

Obama would obviously like to pass decent healthcare without going to that "nuclear option," with some support from the other side of the aisle. But it's increasingly clear that the Republicans are solid, determined "no" votes. They aren't even supporting Sen. Conrad's "health care co-op" proposal, which (it appears to me) is designed to be ineffective and leave the insurance companies in charge.