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Here's the post I was thinking about writing last night. I'm going to write it now because there are enough posts out here saying that this health care reform (HCR) bill is still worth passing that I figure maybe I don't have the facts right. If any of you out there can disprove my reasoning, nobody would be happier than I. Here goes...
The Senate is proposing an HCR bill without a public option or any other means of cost control, such as caps on premiums. It will mandate that individuals have health insurance, but in turn will prevent insurers from being able to turn down anybody with a preexisting condition. It will, however, as noted by Howard Dean last night in Rachael Maddow, allow insurers to charge those with a preexisting condition three times more. Furthermore, there is a provision saying that insurers cannot turn anybody down except in cases of "fraud". As another poster here suggested, this means that insurers will probably wind up taking a lot of people to court accusing them of fraud just to tie them up in a legal swamp which individuals will not be able to navigate without the help of a costly attorney. Let's just say I wouldn't put that past our insurance industry.
Of course, not everyone will be able to afford what it may cost for them to procure insurance. To help, the bill contains generous subsidies for low and middle-income individuals and families. This seems like a bitter pill we would have to swallow. I mean, who among us wants to see hundreds of billions of dollars shoveled at private health insurance firms? Especially if they're the same firms that have been gouging us for years, denying coverage to those who need it and fighting real reform. It kind of seems like we're rewarding atrocious behavior, no? But okay... if we're committed (perhaps in both senses of the word) to making this reform strictly through the private market, that's how we're going to have to go. So we have subsidies in place to help those who need them. What about people who make just a little too much to qualify? Then they are expected to shell 15% out-of-pocket for insurance, I hear. What's the difference between doing that and just raising their taxes by 15%?
Furthermore, and here's the real problem, I think, there are no ways to staunch the fast rise of costs. So while whatever subsidies we set aside today might be sufficient, the continually rising cost of insurance will eventually make them inadequate. But, because of mandates, everybody will still have to be insured. So they will either need to make up the difference that emerges over the next several years out-of-pocket, or we will have to increase our subsidies to those who need them to allow them to afford the mandate coverage. Essentially, the private insurers will be able to get whatever price they ask for, whether they get their money from us individually or as taxpayers. All this, and the Senate also removed the provision against lifetime limits on coverage, so we don't even get that benefit anymore.
I might be able to put up with all this if there were some kind of precedent-setting public option that could be continually expanded to cover more people until it covered everyone. At least with the mandate in place, if we had a public option we might be able to avoid forking our money over to private firms if we didn't want to. Even the Medicare expansion would have made this palatable, because it would set a precedent for making Medicare available to more people until maybe someday we could have made it available to all. Of course, this is why Joe Lieberman says he's now against it after he was for it. But we get neither of those things. People who defend the Senate bill say that this bill will still set a positive precedent because it will make health insurance into a right, not a privilege. Maybe so. But look at the other precedents it will set:
1) It will make us totally committed on the federal level to our inefficient private health insurance system. It will essentially merge the public mandate for universal coverage and the private system which has been ripping us off for so long. It will not restrain rising costs of care. So essentially, it sets us off on the road of being forced to perpetually prop up the likes of Wellpoint and Aetna now and forever, because they will be the only type of delivery system in this country. That will further empower them to block future reform, and there will be nowhere for individuals to turn.
2) It rewards bad behavior. We are at this juncture today because enough people have finally once again become fed up with the practices of the insurance industry. I don't need to describe them to you, we know what they are. This Senate bill will reward the insurance industry for this past behavior. It will guarantee them an endless income from yet more subscribers in what is essentially a government-backed promise of money in the form of subsidies. It will require people making about 89k for a family of four (I think that's what I read) to pay 15% of their income to a private insurer whether they like it or not. That sounds like a big, wet kiss for everything the insurance industry has done previously.
3) It leaves us in a terrible position. What are our alternatives as of this morning? We are told to either pass this bill or be stuck with the system as it is. So we have the choice of shoveling more money than God has at the insurance industry through subsidies and mandated premiums (with no cost controls, remember) or maintaining our decrepit system that everybody hates for however long it will take to generate momentum for new reform. This is like hearing from the insurance industry, "Give us billions in subsidies and mandated premiums or we will continue to kill 44k people a year". I hate to put too fine a point on it, but that sounds like something from a bad western movie, and we're tied to the tracks.
Those of us who still favor this bill say that "something is better than nothing". It is true this bill will cover many of those who currently have no care. But at what cost? At the cost of enshrining the private system with NO alternatives and no cost controls? How will we pay for this new coverage ten years from now? Twenty years from now? This seems unsustainable to me. Furthermore, how is it a positive thing to force people to pay for something they can barely afford, especially if they don't get subsidies? While universal coverage is a necessary goal, it seems to me that achieving it by putting further financial stress on the middle class is not the practical or just means of achieving this. We are also warned that this is a "once-in-a-lifetime opportunity" that won't recur for decades if we pass this up now. Maybe it won't.
But I put it to you: Is this the kind of system we want to enshrine in law for the same number of decades? I maintain it is not.
Prove me wrong.
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