Health Care Politics Thread

[magerette]

@dte: You're not telling me anything that surprises me. For every attempt to write something meaningful into this legislation, a lobbyist's pet rabbit had to die. You wouldn't want all those families deprived of their bunnies, now would you, you heartless fiend? Compromises just had to be made.

IOW, yes, people tried to do a health bill, but it was written by and paid for by insurance people for insurance companies, and every idea in it has been watered down to nothing. If there had been a public option, there would have been something salvageable for everyone imo, but without it, all the compromising has produced the most over-rated and under-producing Big F-in Deal ever seen. For which I'm sorry, but not surprised.

 

[Prime Junta]

@mags, no, it hasn't. It's still a big improvement over what went before, both in terms of coverage and in terms of long-term cost control. It's far short of what it could have been, but calling it "watered down to nothing" just isn't accurate.

 

[dteowner]

@mags, no, it hasn't. It's still a big improvement over what went before, both in terms of coverage and in terms of long-term cost control. It's far short of what it could have been, but calling it "watered down to nothing" just isn't accurate.

That part, at least, is just undeniably false. The numbers have shown clearly and indisputably that this bill will cost the nation overall, not save anything. They might save a pittance in the first decade (particularly if you start the "accounting decade" 3 years before the meat of the bill kicks in, like Barack did), although there's a fair bit of debate about even that pittance (see most recent evaluation from the CBO that I linked a few posts back), but pretty much everyone agrees that the finances completely go to shit in the second decade unless the program gets modified between now and then. Really, the only thing of honest value coming out of this entire turd is eliminating the pre-existing condition scam.

 

[magerette]

Respectfully, Prime J, my basic understanding of a bill that I've followed since inception through it's convoluted, months-long path through the sausage grinder is that far from being serious reform, the best that can be said of it is that it lays a base for future improvement. It does regulate insurance companies in their exclusionary provisions, which of course is important and beneficial, and introduces a mandate that everyone buy insurance, but it doesn't do much to make insurance any cheaper. It remains to be seen how well or how poorly the insurance exchanges will work in providing competition and coverage options. Without a public option forcing lower prices, I think the cost control provided that way will be minimal, as all the companies can get together and rig their prices—which afaik there is nothing in the law to prevent.

Premium costs are expected to rise, perhaps not as much as without the bill, perhaps more, no one knows, but insurance cost control is not part of this bill. Also, without a public option, this bill redirects the government subsidies for lower income coverage directly to insurance companies through the mandate.

If you think the left is happy with this bill as written, you need to cast your eyes over the analysis in the table of Myth v Fact here at Firedoglake:
http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/

I'm very glad the bill passed, because had it failed, the whole topic of healthcare reform would have been politically radioactive and there would be nothing to build on for future needed reform, but 'watered down to nothing' is pretty much how I feel about what we got this time around.

EDIT: And if you can talk me down with some facts I've missed, I'll be very happy to change my mind about it.

 

[Ubereil]

Without a public option forcing lower prices, I think the cost control provided that way will be minimal, as all the companies can get together and rig their prices—which afaik there is nothing in the law to prevent.

Wait... cartels are legal in the states?

Übereil

 

[Prime Junta]

EDIT: And if you can talk me down with some facts I've missed, I'll be very happy to change my mind about it.

I don't think you've missed any facts, Mags—your reading of the situation looks relatively accurate to me. I think we differ a bit about the implications, and perhaps perspective.

From where I'm at, the new bill does two very important things: it expands coverage by a quite a lot, and it's structured in a way that breaks the "good risks drive out bad" cycle that, basically, makes a pure market solution to healthcare unworkable. It also realigns the incentives a bit to make relatively cheap preventative care and earlier interventions workable (that's a consequence of the expanded coverage), while creating some incentives for insurers to put brakes on expensive and unnecessary procedures. That makes me a bit more optimistic about cost control as well.

I do agree that it's nowhere near as good as it could have been, from both perspectives. But it is probably the best you can do with what you have—any public options that would have passed would, in itself, have been watered down enough to be pretty ineffective.

I guess my point is that even with its imperfections, the bill is a major victory for, for want of a better word, Rooseveltian ideas. That's cause for celebration, not hand-wringing. Just IMO, as always, and it's always easy to talk from a safe distance etc.

 

[magerette]

My objections with the bill come mainly out of frustration with how much could have been done and still needs to be done. It seems like the more you delve into how the bill will actually work when fully implemented, the more flaws and limitations get exposed.

But it truly is a major achievement in terms of how many times HCR has died stillborn or been the victim of a late term legislative abortion in all its previour incarnations.

I'll hold a good thought that the worst of the bill will be tweaked and fussed with a bit more once the money starts coming out of peoples' pockets for the mandate and the public and press refocus on its shortcomings.

@Ubereil: There is some anti-price-fixing power re: insurance companies, but it's vested in state insurance boards, which work like utility commissions to regulate statewide rates. The federal bill doesn't make it clear how much authority these boards will have over the exchanges—everything about this bill has been all vague and contradictory since the first day, and passage hasn't done a lot to really paint a picture of what we're going to end up with.

 

[magerette]

Some actual good news from the Healthcare Bill:
http://thehill.com/blogs/healthwatc...-funding-allocation-for-healthcare-work-force

note to dte: reading the comments here affect me like the ones over at TPM affect you—terror is not too strong a word..

 

[Thrasher]

Thanks.

What are "nurse managed health centers"? Sounds kind of like health clinics without doctors? Worrisome....

 

[magerette]

I imagine they're primary care centers that just do obvious and easily diagnosed stuff and refer you off to a real doctor or specialist if it's something major. I actually have had better care from a PA in terms of diagnosis and treatment than I have from some of my MD's. Back when I had Pacificare as an HMO plan, I always saw my doctor's PA—she rocked. I only saw the doctor for major physicals and so forth. The PA diagnosed my gall bladder disease and the clinic referred me to a surgeon. It worked fine.

 

[dteowner]

There's nothing wrong with using nurse practitioners. They get a fair bit of training. And really, 75% (totally unsupported statistic ) of doctor visits boil down to basic stuff that can practically be self-diagnosed if you've progressed beyond cave painting: coughs and colds, basic infections (ala sinus issues, strep), sprains and strains. Hell, I was practically the team doctor for my wrestling team when I was in high school-- it just doesn't take 12 years of med school to check range of motion, feel for structural damage, and tell the guy 48 hours of ice and 24 hours of heat and here's a maxipad for yer aching pussy now get back out on the mat. There's just no reason to pay a $100/hr MD for simple stuff.

Some of the comments there are just plain stupid, but the questions about funding seem pretty legit to me. It's just a shame that people go so far around the bend on this thing. There's enough genuine problems (fiscal suicide, the "keep your insurance/nothing will change" lielieLIE, fiscal suicide, reduced availability of care, fiscal suicide) with the turd of a bill that there's just no need to roll out conspiracy-theory grade accusations like VAT and 2011 tax forms. It just weakens the entire argument and makes it easier for the left to ignore the genuine problems.

 

[Thrasher]

True. Just wonder if it is yet another expensive step in the lengthy process to get proper diagnosis and treatment when you've got a serious problem.

 

[magerette]

T… Hell, I was practically the team doctor for my wrestling team when I was in high school— it just doesn't take 12 years of med school to check range of motion, feel for structural damage, and tell the guy 48 hours of ice and 24 hours of heat and here's a maxipad for yer aching pussy now get back out on the mat. There's just no reason to pay a $100/hr MD for simple stuff.

As long as you weren't performing brain surgery…(an engineering degree might help there, though, in installing some artificial intelligence.)

Some of the comments there are just plain stupid, but the questions about funding seem pretty legit to me. It's just a shame that people go so far around the bend on this thing. There's enough genuine problems (fiscal suicide, the "keep your insurance/nothing will change" lielieLIE, fiscal suicide, reduced availability of care, fiscal suicide) with the turd of a bill that there's just no need to roll out conspiracy-theory grade accusations like VAT and 2011 tax forms. It just weakens the entire argument and makes it easier for the left to ignore the genuine problems.

And vice versa. Lots of red flags in front of bulls any more when people discuss almost any kind of politics. AFA funding, I imagine that $250 mil is relative peanuts compared to other aspects of getting the ball rolling—you know I've followed this bill since it was a gleam in daddy O's eye, and I haven't STILL the faintest clue where the money's coming from other than the slashing and dashing in medicare part d subsidies. I've been saying all along we're going to see some kind of tax disguised as a fee wrapped up in a mandate somewhere.

 

[dteowner]

As long as you weren't performing brain surgery…(an engineering degree might help there, though, in installing some artificial intelligence.)

It was the wrestling team. It's not like I had much opportunity to work on brains. Not to be overly arrogant, but give me a roll of medical tape, 2 popsicle sticks, and a bag of ice, and I could cure cancer (back in the day, at least).

And vice versa. Lots of red flags in front of bulls any more when people discuss almost any kind of politics. AFA funding, I imagine that $250 mil is relative peanuts compared to other aspects of getting the ball rolling—you know I've followed this bill since it was a gleam in daddy O's eye, and I haven't STILL the faintest clue where the money's coming from other than the slashing and dashing in medicare part d subsidies. I've been saying all along we're going to see some kind of tax disguised as a fee wrapped up in a mandate somewhere.

We'll just run the national debt up another trillion or two while nobody's looking and then either ObamaCare will get gutted or you'll get camoflaged taxation just as you say, depending on how functional ObamaCare turns out to be and which party is in charge when the debt can't be ignored any longer. You're seeing some genuine public awareness that the spending parade has eventually got to stop (the recent almost-depression might have finally awakened the masses to the concept of money in / money out) and some day that will filter thru to Congress. Probably not this decade, though.

 

[magerette]

It was the wrestling team. It's not like I had much opportunity to work on brains. Not to be overly arrogant, but give me a roll of medical tape, 2 popsicle sticks, and a bag of ice, and I could cure cancer (back in the day, at least).

See, you don't even need insurance. The garage or family room can double as an ER, and everyone can take two aspirin and call you in the morning.

RE: the Bill—The funny thing is, I don't think many people would object—I wouldn't anyway—to an upfront tax for an upfront service, if the service was sound. FICA and Medicare taxes already come out of everyone's paychecks; nobody expects those programs to be without cost. They should simply be cost effective. Why not expand Medicare and pay for it with scaled premiums and give everybody, not just people 65 and older, what they actually need? Instead we have a bill that gives nobody anything they need except insurance companies a guaranteed profit in mandated coverage…I don't get it.

 

[dteowner]

Well, we finally know the real story. Thanks to a government funded study, we've determined that anyone that doesn't support Obamacare is a racist. Nice. And I helped pay for this crap. And then y'all wonder why I give the ivory tower such scorn.

http://dailycaller.com/2010/06/17/n...-report-calling-health-care-opponents-racist/

 

[magerette]

That's a weird one. Too bad no links to anything except other stuff. There are people that are like that though in the lefty world, who are extremely defensive about the history of oppression of blacks by whites and see it everywhere, and feel, presumably, some deep level of guilt about it that makes them want to demonize the opposition. Plenty of that going around in various forms on both sides, of course. Race is an issue that nobody seems able to deal with very well.

 

[Thrasher]

Definitely a suspect funding procedure.

 

[dteowner]

http://dailycaller.com/2010/06/18/j...s-legal-challenge-to-federal-health-overhaul/

In its defense of the law, the Justice Department invoked the Commerce Clause and claimed penalties for Americans without health-care coverage were consistent with the federal government’s powers to regulate interstate commerce and impose taxes.

The Justice Department filing describes the penalty as a tax, stating that the law “imposes a tax on the choice of a method to finance the future costs of one’s health care.”

Well, either the Justice Department is lying to a federal judge in trying to support the turd of a bill, or Barack has been caught in yet another lie about ObamaCare. Imagine that. Seems like a trend, doesn't it.

 

[magerette]

Apples and oranges. This is a legal argument about where the federal government draws its authority to impose the mandate. It draws the authority from the constitutional provision to regulate commerce and impose taxes(which is why everyone said these lawsuits were frivolous and would be dismissed.)

From what I'm getting out of this reporting, the Court has said the penalty is a tax. The mandate isn't. So if you buy insurance you won't be 'taxed' you'll receive a service. I'm not seeing a big breach of promise on that, despite how I hate the bill, just the usual legal parsing and hair-splitting. I may not be grasping which particular alleged lie you're referring to, though.