Challenge to the health insurance bill supporters. (WARNING: No politics thread)

•The excise tax, (which is not in the House bill) which the CBO itself says will affect 19% of people with employer-provided insurance in 2016. In 2019, six years after this bill takes effect, the excise tax will affect one in five taxpayers making $50-$75,000 per year, and the average tax impact on this bracket will rise to $1,100 a year in 2019.

In addition, the Centers for Medicare and Medicaid Services (CMS, another CBO-like organization) predicts that the excise tax will actually make coverage worse for very little return in savings.

In reaction to the tax, many employers would reduce the scope of their health benefits. The resulting reductions in covered services and/or increases in employee cost-sharing requirements would induce workers to use fewer services.

Because plan benefit values would generally increase faster than the threshold amounts for defining high-cost plans (which are indexed by the CPI plus 1 percent), over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage.

The savings?

This excise tax, which would reduce the quality of millions of Americans’ health insurance coverage, will technically "bend the cost curve" by just barely 0.3% in 2019. All that for a measly 0.3% reduction in national health expenditures.

To give you a comparison, CBO projects that Dorgan’s drug re-importation would reduce spending on prescription drugs roughly $100 billion over the next decade (I think the savings could easily end up 4-5 times that amount). A $10 billion reduction in prescription drug spending compared to the total NHE spending last year, which was roughly $2.4 trillion in 2008, would be a 0.4% reduction in NHE.

•The mandate remains, with a larger fine for those who don't purchase coverage attached. Perhaps that's in response to the calculations done showing that it would be cheaper for people to pay the fine than to maintain coverage under the junk insurance plans that are still going to be allowed in the newly "reformed" system. The exemption for those who can prove they can't afford coverage is maintained.

•There is no public option of any kind in the Senate bill, no opt-out, no Medicare buy-in. Just the two national private plans, one of which would be non-profit, that would be overseen by the Office of Personnel Management.

The CBO says it's questionable whether "insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult." Note, even should a national non-profit be set up by an insurer, it is not the equivalent of the public option.

effective they will be:

California recently dropped an attempt to enforce its anti-rescission law against a major insurer, saying that it was financially outgunned by the insurer's legal team.

The rescission law, according to the legislation, "shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage."

Insurers today routinely claim that patients engaged in "fraud" or "intentional misrepresentation" when dropping them from coverage. Much depends on who defines the terms in the bill.

It won't be the federal government. There will be no federal agency tasked with overseeing the enforcement of the bill's rules. Rather, a Senate leadership aide told reporters in a briefing Saturday, individual states will police the new system.

That's a task the California Department of Managed Health Care was unable to perform when battling Anthem Blue Cross, which has rescinded 1,770 policies since 2004.

"In each and every one of those rescissions, the right to contest each, and that could tie us up in court forever," the department's director, Cindy Ehnes, told The Associated Press. A million-dollar fine was announced in March 2007, but has not been enforced.

If the enforcement for these regulations falls on the individual states, and the individual states will have to litigate them, which could take a very long time in each case. The regulations are unlikely to be uniformly enforced state to state--some of them have extremely proactive insurance commissioners and strong regulatory structures in place, others don't. And in the states that don't, don't expect insurers to end some of these practices out of the goodness of their hearts.

Bottom line, Americans are still going to be forced to buy insurance that for too many people will be unaffordable. As long as that's the case, and until there's a true alternative public option that provides people real choice, the insurance companies shouldn't get that one thing in the legislation they want: the mandate.

This odd juxtaposition of "suffer now, benefit later" is the byproduct of the administration's sleight of hand in specifying 10 years' worth of cuts and taxes in the legislation, but deferring its benefits for the first four years. By comparing six years of spending with 10 years of taxing, it managed to appear deficit-neutral under the rules of the Congressional Budget Office. In fact, the annual revenues fall far short of covering any single year's worth of spending, adding to the deficit for each of the last six years over the next 10 ---- but, viewing the decade as a whole, it appears deficit-neutral.

Yet the political price is hardly neutral. Democrats who misguidedly vote for this monstrosity will face immediate political repercussions.

The harshest of these backlashes will come from the elderly, who will face the rationing immediately.

The first "no" will hit the 10 million elderly who now rely on Medicare Advantage to pay for the care Medicare itself does not cover. In a payoff to AARP, Obama gutted this program in his bill, ending over $100 billion in federal premium subsidies.

These 10 million voters will get the grim news that their premiums are going up and their benefits dropping early in 2010. The goal, of course, is to force them to drop Medicare Advantage and sign up, instead, for Medi-gap insurance ---- offered, not coincidentally, by the AARP ---- which provides less coverage at higher cost.

Young people without health insurance can expect to start writing $750 annual checks to Washington to pay the fines written into the bill. (And, after the Conference Committee finishes its work, the fines may be higher.)

All Americans will soon find their insurance premiums rising as a result of the bill. The young uninsured will not buy policies. Why should they? Why not just pay the $750 fine each year? Why pay between 2 percent and 10 percent of their household income before subsidies kick in? It makes no financial sense for anyone making more than $30,000 to pay for coverage. (And most of those under that threshold will be covered by Medicaid, not by private insurance.)

There is no reason for the young to buy private insurance. The legislation requires that health insurers take all comers and not raise rates based on pre-existing conditions. So the young can get coverage when they need it, having only paid $750 per year beforehand.

The difference in cost will, of course, be borne by families throughout America, who will see their health insurance premiums increase. President Obama and his Democratic rubber stamps may appreciate that they are not raising taxes on the middle class, just raising mandatory health insurance premiums, but the distinction is likely to be lost on swing voters.

Reform In The Modern Era
After World War II, President Henry Truman launched another effort advocating sweeping political and social reform which he called the “Fair Deal.” President Truman went so far as to make universal health care coverage part of the Democratic Party’s Platform. Although Truman was, in the end, forced to settle for a modest expansion of Social Security coverage, his platform was to be a direct influence over Lyndon Johnson’s proposals, outlined in his “Great Society” policy.



Read more at Suite101: U.S. Presidents And Health Care Reform: The History Of Public Health Politics In America http://modern-us-history.suite101.com/article.cfm/us_presidents_and_healthcare_reform#ixzz0as5Js5NZ

Now you're on the way down the aisle with an abusive person who is about to make your life hell. How is that a good thing?

And walking down the aisle with the wrong kind of health INSURANCE bill because you really would like single payer but haven't ever gotten it is just as destructive.