The incredible disappearing health reform plan

Today’s revelation that Joe Lieberman is once again flexing his political muscle to force the Senate Dems to remove the Medicare for 55-64 provision is just the latest evidence of the evisceration of the Senate Health Reform bill.
Here’s a few of the items that were considered for inclusion that have somehow not made it this far (this isn’t to imply or deny an endorsement).
– a meaningful mandate penalty instead of the paltry $750/individual $2250/family in the current Senate plan (the income-indexed penalty in the House plan is better but still not enough…)
– a public plan with reimbursement based on Medicare (if this was mandatory it would definitely have reduced costs – a lot)
– some form of tax on high-value/high benefit plans, aka ‘cadillac’ plans
– a plan that would actually cover the vast majority of Americans (the current plan still leaves 15 million uninsured)
– a clause enabling the Feds to negotiate drug prices for brand medications purchased for Medicare patients
– a non-fungible ban on lifetime caps on medical expenses
– a ‘budget neutral’ plan; although the current Senate plan is indeed budget neutral, it doesn’t include the quarter trillion accumulated deficit in Medicare physician costs. Notably the coming cut to physician reimbursement is addressed in the House bill, where it is eliminated.
What’s next? As Lieberman et al get more and more of the power and influence they so obviously crave, their appetites grow ever more insatiable. Liberals and centrists are getting increasingly desperate to pass something, anything, to deliver on the promise of health reform, and the longer Lieberman et al can put this off, the more press they get and the more their swelling egos demand.
(I’m wondering exactly how far the Senate Dems are going to let Lieberman push them before they decide enough is enough and smack the political crap out of him. He’s become the schoolyard bully to the Democratic weaklings, taking ever more of their lunch money in hope he’ll be nicer next time.)
The current mishmash of giveaways and concessions can only be called ‘reform’ by those willing to hope we can do much over the next decade to rein in costs before they kill our economy. I’m not among those optimists.
It is time to trash the whole thing and start over – preferably with the Wyden-Bennett Healthy Americans Act. (for a comparison of WB HAA to the current mishmash see the Kaiser Family Foundation’s excellent web tool.
But that won’t happen; We’ll likely get something passed in Congress, and President Obama will sign it, and they’ll all declare victory and move on to energy, Afghanistan, and other critical issues. Meanwhile, health care costs will continue to escalate, and in ten years the average family will be paying north of thirty grand for their health insurance and deductibles, and we’ll be reading books about how and why we missed this golden opportunity.
And this from the worst kind of government in existence, except for all the others.

2 thoughts on “The incredible disappearing health reform plan

  1. Some readings have deepened my conviction that (meaningful) health care reform is impossible in the present conditions.
    1) The Broken Branch by Mann and Ornstein dissect the extreme failure that Congress has become. Facts speaks for themselves but understanding the whys helps.
    2)http://www.healthbeatblog.com/2009/02/uwe-reinhardt-the-us-is-not-a-democracy-its-an-aristocracy-.html
    http://www.healthbeatblog.com/2009/02/uwe-reinhardt-the-us-is-not-a-democracy-its-an-aristocracy-part-2-.html

  2. Joe:
    Comments on the bullet points:
    – a meaningful mandate penalty instead of the paltry $750/individual $2250/family in the current Senate plan (the income-indexed penalty in the House plan is better but still not enough…)
    – Where does the Federal Government derive the power to force citizens to purchase something? I don’t believe this would stand up to Judicial review. Sure, States mandate Auto insurance, but you can escape by not driving. You cannot escape a Federal “penalty” by not purchasing health insurance becuase it would require you to die in order to escape.
    – a public plan with reimbursement based on Medicare (if this was mandatory it would definitely have reduced costs – a lot)
    – What would happen if more & more Dr.s said “thanks, but no thanks” to reimbursements that were continually (and increasingly) below market value and elected not to treat? If reimbursements were made at true “market” value, by definition, there would be no savings; 1=1.
    – some form of tax on high-value/high benefit plans, aka ‘cadillac’ plans.
    – This is specific taxation targeting a specific group and I don’t believe would stand up to Judicial review.
    – a plan that would actually cover the vast majority of Americans (the current plan still leaves 15 million uninsured).
    – No comment here. I have no beef with a plan that everyone could buy into, I just don’t want to subsidize it with my $. Plans already exist today that everyone could buy into, they’ve just made choices (present or past) that have resulted in their own non-coverage. Where is the sense of personal responsibility here? Now, carriers that drop subscribers because of catastophic illnesses is something completely different and ought to be addressed via existing avenues for contract performance disputes. If you signed a contract that allowed the other party to opt out under certain circumstances, and you shout disbelief when they do, then shame on you, not them. While more expensive obviously, because of the greater risk, plans exist that cover pre-existing conditions. Anyone can buy one. If you’ve made financial choices that preclude you from said purchase, when needed, then the responsibility for those choices lay upon on you. Look to family and friends for assistance. The Federal Government does not exist to protect you from yourself; it exists to protect you from others. If they’ve done something illegal then prosecute.
    – a clause enabling the Feds to negotiate drug prices for brand medications purchased for Medicare patients
    – Why are they prohibited from doing this today? If there is legislation/regulation that probibits this, the Federal Government put it there. It should be removed.
    – a non-fungible ban on lifetime caps on medical expenses.
    – Will cause everyone’s premiums to go up. Holding everything else constant, if we legislated/regulated it illegal to place a lifetime cap on medical expenses (which commonly exist today), would there be upward or downward price pressure on premiums?
    – a ‘budget neutral’ plan; although the current Senate plan is indeed budget neutral, it doesn’t include the quarter trillion accumulated deficit in Medicare physician costs. Notably the coming cut to physician reimbursement is addressed in the House bill, where it is eliminated.
    – “Budget neutral” for any new program (entitlement, beautification, whatever) is only possible one (or combination of) two ways: 1) increased revenue (most commonly in the form of taxes), or 2) cuts from other programs to free up necessary capital. We pay enough taxes.
    There is a difference between positive and normative statements, although most people cannot recognize the difference. Most of the above are normative (even mine!); “this is the way it should be …” I support everyone’s right to voice and pursue their visions, just not their belief in their right to project onto me. To all who say health insurance is too expensive, the first step you should take to help someone out who needs it, not look to ways to force someone else to help.