Monday, March 22, 2010


Sam Smith
I ended up supporting the health care bill. Not because it was a historic
measure, or the most important piece of legislation in four decades or as
an icon of Obama's greatness, but for the same reason one hands over a
wallet to a robber. There are times when principle takes the back seat.
But when it's all over, the robber is not your hero, but still a thug.
Obama essentially said that if you want 16 million poor people covered,
you have to agree to heavily subsidize the insurance industry either
through your taxes or through the individual mandate. Remember that about
a third of that money will go for marketing and other superfluous industry
spending that might have been avoided under a public plan.
The Maine Owl put it well: "The health bill neither is the Armageddon that
the Republicans claim, nor the greatest social legislation since Civil
Rights and Medicare in the 1960s. Rather, it's a warmed over version of
Republican Bob Dole's individual private insurance mandate proposal from
1994. It is what Barack Obama campaigned against versus Hillary Clinton
and later John McCain in 2008."
I can't recall a major piece of Democratic legislation that was so coated
with corruption, intellectual dishonesty, cynicism and political
disloyalty by those pushing it. Obama and the Democrats have offered us a
quack cure - full of corrupt, ineffective and even unconstitutional
provisions - neatly moderated by some good provisions. And we'll be years
straightening it all out.
The liberal groupies at Move On and the like didn't notice or weren't
bothered by all this, but much of America was, and because neither side
was being honest, the public predictably floundered. The irony is that the
Tea Party that the liberals love to hate built itself in no small part on
the indefensible way in which the Democrats have behaved on health care.
Thus, we are not only getting a badly designed bill but a future in which
the right will thrive even more than it already has.
Center On Budget Policy Priorities: The plan would expand Medicaid up to
133 percent of the poverty line for all children and adults younger than
65 who are lawfully residing in the United States and not eligible for
Medicare. This would mean that millions of low-income parents, as well
non-disabled low-income adults who do not have dependent children (and who
are generally ineligible for Medicaid today except in a small number of
states with waivers), would become newly eligible for health coverage
through Medicaid. Medicaid is the most cost-effective way to provide
comprehensive and affordable coverage to people with very low incomes and
thereby ensure that the low-income uninsured gain coverage.
Reuters - Within the first year of enactment Insurance companies will be
barred from dropping people from coverage when they get sick.
Lifetime coverage limits will be eliminated and annual limits are to be
Insurers will be barred from excluding children for coverage because of
pre-existing conditions.
Young adults will be able to stay on their parents' health plans until the
age of 26. Many health plans currently drop dependents from coverage when
they turn 19 or finish college.
Uninsured adults with a pre-existing conditions will be able to obtain
health coverage through a new program that will expire once new insurance
exchanges begin operating in 2014.
A tax credit becomes available for some small businesses to help provide
coverage for workers.
In 2011, Medicare provides 10 percent bonus payments to primary care
physicians and general surgeons.
In 2011, Medicare beneficiaries will be able to get a free annual wellness
visit and personalized prevention plan service. New health plans will be
required to cover preventive services with little or no cost to patients.
In 2012, The threshold for claiming medical expenses on itemized tax
returns is raised to 10 percent from 7.5 percent of income. The threshold
remains at 7.5 percent for the elderly through 2016.
In 2012, The Medicare payroll tax is raised to 2.35 percent from 1.45
percent for individuals earning more than $200,000 and married couples
with incomes over $250,000. The tax is imposed on some investment income
for that income group.
In 2014, State health insurance exchanges for small businesses and
individuals open.
In 2014, Health plans no longer can exclude people from coverage due to
pre-existing conditions.
In 2014, Employers with 50 or more workers who do not offer coverage face
a fine of $2,000 for each employee if any worker receives subsidized
insurance on the exchange. The first 30 employees aren't counted for the
Crooks & Liars: Authorizes early funding of community health centers in
all 50 states. Community health centers provide primary, dental and vision
services to people in the community, based on a sliding scale for payment
according to ability to pay.
There is a huge subsidy for health insurers, paid for out of either taxes
or required purchase of health insurance.
The bill doesn't take insurance and medical cost inflation into adequate
account. For example, between 2000 and 2007, health insurance went up
100%. Under such a rise, the policy subsidies would become less valuable.
Congress tends to lag badly in correcting such situations.
Major provisions of the bill don't got into effect for four to nine years.
This is a considerable con, because it allows politicians to say they've
passed something that may not go into effect until they are either out of
office or, as with the president, safely in his second term. As a result
they don't have to take responsibility for any failure or unanticipated
The individual mandate is unconstitutional. If the Supreme Court doesn't
strike it down, it will open the door to major new intrusions by the
federal government into individual freedom of choice.
Many healthy people may prefer to pay fines than to purchase health
insurance. Others would have no choice. Just because you're making a
middle class wage doesn't mean you can afford all your expenses. What
effect this will have - including on health insurance costs - is unclear
but it's not good
Medicare will be hurt one way or another, probably most deeply by cuts
recommended by an appointed budget commission with unconstitutionally
broad powers.
Because of the delay in programs, the election of a Republican Congress or
Senate could drastically change things. As the LA Times pointed out:
"Insurance industry experts say there is no way to fully gauge the effect
because of its extended time frame. Four years from now, they say,
Congress and the White House could have new occupants who may try again to
reshape the healthcare landscape."
There will be cuts to the Medicare Advantage plans that could reduce
enrollment by as much as one third.
The bill does not deal with state actions. For example, budget cuts in
Arizona may slash $385 from the state's Medicaid program and end Kids Care
for 39,000 poor children. Writes Casey Newton in Arizona Central:
"Programs benefiting low income individuals and families, such as Medicaid
and CHIP, are politically vulnerable to the whims of conservatives
wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us
with a prime example of that. Yet popular programs benefiting everyone,
such as Medicare, are relatively impenetrable to the weapons of the
conservatives. Suppose Congress had included single payer in their
deliberations and eventually decided that the benefits were too great to
pass up ,and so enacted an improved Medicare program that covered
everyone. Gov. Brewer and her ilk on the state level would be powerless to
stop it. "
One of the big sleepers in the bill is the plan to "institute
efficiencies" in Medicare programs. In fact, Medicare is far more
efficient than any private insurance plan in the country. Consider this
snippet from CBPP: "The legislation would reduce annual payment updates to
hospitals, skilled nursing facilities, hospices, ambulatory surgical
centers, and certain other providers to account for improvements in
economy-wide productivity. It would also reduce payments to home health
agencies, skilled nursing facilities, and inpatient rehabilitation
facilities." And just what will happen to service and its availability?
Remember: one person's efficiency is another's lack of service.
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