Wednesday, August 19, 2009

Avoiding Whiplash

If you're following the whole "healthcare reform" process, you're at serious risk for whiplash (which is why I've kept my distance). Both the political debate and the public debate have sunk into street theater, instead of movement toward a goal.
On the political side, the "public option" is back and forth like a tennis ball at Wimbledon. It's in, it's out, it's back in, or maybe it's out. It's going to be "bi-partisan", but one party will oppose anything at all. So the Dems will go it alone. Except if they don't. Even if you're paying close attention to the process, the picture is about as clear as mud.
The public debate is even more absurd. People with guns screaming about "death panels" get TV airtime as if they were credible. People on Medicare decrying "government run healthcare", proving we really need a better mental health system, seemingly have zero sense of irony. Never mind the "facts" (which are rather dull), let's focus on the absurd. The lobbyists are having a field day. It would be really entertaining if it weren't so tragic.
Somewhere in reality there is the main actual proposal, H.R. 3200. While it's certainly going to go through changes in the reconciliation process, this is what is actually currently "on the table". Good friend badtux the snarky penguin has put together the best summary analysis that I've read so far:

Well, basically, HR3200 is a strange amalgation of the German system -- which has publically owned nonprofit sickness funds and for-profit insurers largely funded by employer contributions with all citizens required to purchase insurance if not provided by employer (and all employers required to provide insurance for their employees) -- and the Swiss system, where individuals purchase insurance in a heavily regulated must-issue must-have individual insurance market (that is, insurers are required to issue insurance that meets minimum standards w/no pre-existing conditions exclusions, and individuals are required to purchase insurance). Subsidies are provided in both systems so that people who cannot afford to buy insurance on their own can afford to buy insurance, and HR3200 includes similar subsidies. One thing HR3200 does *not* do is force employers to provide insurers -- if employers refuse to provide insurance, instead HR3200 taxes them 8% of payroll
in order to fund subsidies so the employees themselves can afford to buy individual insurance.

There's no reason why HR3200 should not work as designed -- the public option in the German system keeps costs low, the 8% tax encourages employers to provide employer-provided insurance, while the various mandates and subsidies insure that all Americans can afford and obtain insurance that will cover all common health costs -- but of course it is nowhere near the most efficient way to provide health care. The system HR3200 sets up will provide universal healthcare, but at a cost much higher than a single-payer system. Still, it's a whole lot better than the current system, which is "let them eat cake" filled with rescissions, refusals to insure due to pre-existing conditions, discrimination against women, older Americans, and against families with young children, and far too many people who cannot afford to purchase health insurance and cannot obtain any subsidy for doing so.

"What HR3200 really is"

So, it's not "bad", but it's also not all that good. It may be the best bill we can get passed in the current climate, but it's not a solution to the healthcare crisis.
Like most "liberals" ("socialists" in the current lexicon), I would really like a "single-payer" system. It's not even "on the table", but Thom Hartmann has a really simple, good proposal:

Dear President Obama,

I understand you're thinking of dumping your "public option" because of all the demagoguery by Sarah Palin and Dick Armey and Newt Gingrich and their crowd on right-wing radio and Fox. Fine. Good idea, in fact.

Instead, let's make it simple. Please let us buy into Medicare.

It would be so easy. You don't have to reinvent the wheel with this so-called "public option" that's a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won't - just like the Post Office versus FedEx analogy you're so comfortable with.

Just pass a simple bill - it could probably be just a few lines, like when Medicare was expanded to include disabled people - that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it's revenue neutral!

To make it available to people of low income, raise the rates slightly for all currently non-eligible people (like me - under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

Most of us will do damn near anything to get out from under the thumbs of the multi-millionaire CEOs who are running our current insurance programs. Sign me up!

This lets you blow up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with Blue Cross. Those who like it can buy into it. Simplicity itself.

Of course, we'd like a few fixes, like letting Medicare negotiate drug prices and filling some of the holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don't. Easy message. Even Max Baucus and Chuck Grassley can understand it. Sarah Palin can buy into it, or ignore it. No death panels, no granny plugs, nothing. Just a few sentences.

Replace the "you must be disabled or 65" with "here's what it'll cost if you want to buy in, and here's the sliding scale of subsidies we'll give you if you're poor, paid for by everybody else who's buying in." (You could roll back the Reagan tax cuts and make it all free, but that's another rant.)

We elected you because we expected you to have the courage of your convictions. Here's how. Not the "single payer Medicare for all" that many of us would prefer, but a simple, "Medicare for anybody who wants to buy in."


Thom Hartmann

Of course, this has a snowball's chance in Turlock of ever passing. Good ideas aren't allowed in the current dialogue. There is no army of lobbyists for "common sense".

My own personal healthcare is paid for by the state of Arizona. Because I was unemployed when I broke my shoulder, I'm enrolled in "AHCCCS", the "Arizona Health Care Cost Containment System" (the name makes clear their motivation), and as long as I remain below the poverty level I'll continue to receive basic health services on the taxpayers dime. I can't complain; the service has been adequate and my Dr.'s have been top-notch. The problem for me is that if I ever rise above the poverty level, I'm screwed. I'm uninsurable thanks to pre-existing conditions, and unless I got really, really rich there's no way I could afford the treatment I need out of pocket. And a lot of Americans are in even worse shape.

So that's where we stand: A huge problem, a number of vested interests in the status quo, weak political leaders without real solutions, a largely ignorant populace inflamed with rhetoric, and a dysfunctional legislative system determined to avoid real action. And I only say this because I'm trying to remain optimistic. Because if you watch too closely, you're likely to suffer whiplash.

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