Saturday, December 19, 2009

Health Care Reform: Are We There Yet?

It seems to have taken nearly forever, but at last the Senate
seems ready to move on Health Care Reform.

After thirteen straight hours of negotiation with holdout
Democratic Senator Ben Nelson of Nebraska, it appears the
Senate's version of Health Care Reform is ready for a final vote.

After reconciliation with the House version, the plan is to
present this to President Obama for signature immediately
after the Holiday recess.

But, after considering the final product of all this effort,
I'm beginning to wonder if this whole exercise was
really worthwhile.

To be sure, there are some nominal reforms in the bill.
Health care coverage will be extended to some thirty million
people now uninsured. Health Insurance companies will no
longer be able to deny coverage for pre-existing conditions.
Nor will they be allowed to deny claims for illnesses contracted
while covered. Annual and lifetime caps on coverage will
be eliminated, caps and ceilings will be put on premiums,
and premium subsidies will be made available for lower-income
workers to afford coverage.

Well, on the surface it does sound like an improvement.
But, as usual, the devil is in the details. And, after studying the
details of this bill, in my opinion it would be better if it did not pass.

Let's take a look at the first so-called "reform" - the extension
of coverage to the thirty million currently uninsured.
This will be accomplished by "mandating" that these individuals
purchase coverage, or pay a fine.

Now, when it comes to a mandate, I'm all in favor of
"mandating" that people be covered by such things as
social security. Social security is a universal coverage
government benefit program, and the premiums for it are
handled through the tax system.

But I have a real problem forcing people people to spend
after-tax dollars on private health insurance that is subject
to no meaningful cost controls or competitive constraints.
That provision, however desirable it might be, may not survive
the legal challenges it will undoubtedly attract from conservatives.

But wait - aren't there other provisions in the bill that we might
consider reform? How about the ban on denying coverage for
pre-existing conditions?

Well, let's see. As written, the bill contains no fines,
penalties, or enforcement mechanisms to punish insurance
companies wrongfully denying coverage. That means that the
insurers will "handle" pre-existing conditions by raising
premiums so high that no one would sign up unless one
consented to "exclude" the pre-existing condition.
To my mind,that's not reform.

The same situation applies to lifetime and annual "caps"
on coverage. No enforcement mechanisms - only vague
statements of intent. You don't have to be a rocket scientist
to figure out how the insurance companies will get around
that one. The same thing applies to the ban on dropping
coverage once you get sick.

Without enforcement - and the regulatory and
administrative apparatus to support it - nothing will
happen except the Health Care Cartel will gain thirty
million additional customers at whatever prices it
chooses to charge.

Now, let's look at what's not in the bill. First of all,
No Public Option. Without a universally available Public Option,
the Health Cartel will face no competitive pressure and no
restrictions on its profitability.

And no "early eligibility" for Medicare either. This modest
reform, first proposed in these pages three months ago,
would have dropped the eligibility age for Medicare from
65 to 55 under certain circumstances.

This reform I felt made a lot of sense. It would have removed
many of the chronically ill (and those likely to fall ill), from
insurance company rolls and thus actually helped insurance
company profitability. In my proposal, I would have dropped
eligibility immediately to age 59-1/2, and gradually extended
eligibility downward to 50 over a period of years.

This could have been done, championed as a major reform,
and set the stage for the eventual adoption of the only reform
that makes sense for an advanced country - single payer,
universal coverage. But what happened? It was floated up
only long enough to get rid of the public option -and then
it disappeared.

And cost controls on pharmaceuticals? That didn't even
make it to Congress - it was killed in a private,
campaign-contribution laden agreement between the
White House and the Pharmaceutical

To sum up, then, about the only thing in this bill is
thirty million new customers for the Health Care Cartel - and
nothing else that can't either be bargained away in the
House-Senate conference or dropped later.

No wonder Wall Street - that other great bastion of the
people's well-being - sent the stocks of the Health Insurance
and Pharmaceutical companies to 52-week highs.

And that seals it for me. If Wall Street thinks that this is a
great idea, it almost certainly isn't good for the country.

Sometimes, no deal is better than a bad one.

And this is a bad deal for the American Public. It contains
no meaningful coverage or cost reforms. What we'll wind up
with is less care, more costs, and more profit and bonus dollars
in the hands of an undeserving CEO class, wrung out of an
impoverished and increasingly destitute and desperate

Mr. President, on Health Care Reform, We Aren't There Yet.

Scrap this bill - and start over.

1 comment:

  1. The House hopefully will prevail in keeping the public option over the Senate's corruption, especially Lieberman's. Doesn't mean the House will. I want the public option because the cartel of insurance companies stink. In this reconciliation hopefully Alan Grayson, the bold speaker that he is, tells it like it is and gives a good deal that 51 Senators can accept.

    Senator Nelson got a good deal for Nebraska, too bad Senators Boxer and Feinstein couldn't take say $10 billion in pork and give it to California, it would help us with our deficit. Take the pork and run, excellent political skullduggery. Hah! Hah!

    Moving Medicare to 55+ is an excellent idea it should have quickly passed unanimously but everything has to be slow and political which is absurd.

    We can't start over. Tea Bag Republicans will use that to their advantage and the next time health care comes up it will become even more privatized, financialized, and ruined.

    so more people will die.