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What if: President Obama abandons the ‘public option’?
What if: The Progressive Caucus puts up a fight for the ‘public option’, but eventually gets outnumbered, outmaneuvered, and outvoted?
What if: All of the various Democratic HCR bills stall out, get watered down, and we end up with practically nothing: A law that says everyone must purchase health insurance, a wholly inadequate fund to assist the poorest Americans in complying with that law, and a couple of mild ‘suggestions’ to the insurance industry about cost control.
What if?
We still win, eventually.
Think about it. It’s the day after President Obama signs the new law.
The Federal bureaucracy is now charged with implementing that law. Here are some scenarios:
Either 1) Everyone who doesn’t have health insurance now, because (a) They can’t afford it; and/or (b) The insurance companies kept turning them down because of their pre-existing conditions, rushes out to comply with the law;
or 2) They don’t.
Let’s start with 1), shall we? I happen to be one of the uninsured, and, funnily enough, it’s not because I prefer to squander my meager self-employment income on flat-screen teevees, trips to Jamaica, and booze. It’s because the only private insurer who would consider signing me up for a plan at all wanted $700 a month for a premium, with a $2500 deductible and a ‘lifetime cap’ of $100,000 in payout, and no prescription coverage. And (this is great, I love this--) any and all charges related to my ‘pre-existing conditions’ of asthma and seasonal depression, are not covered. However, all of this is academic since my self-employed self doesn’t make enough to pay $700 a month anyway. And no one else will cover me at all.
But hey, I’m a law-abiding citizen, so I’ll go straight along to whatever bureaucracy is in charge of figuring out exactly how much it is ‘reasonable’ for me to pay, and paying the rest of it. And I’ll fill out forms and I’ll provide my tax returns or whatever and we’ll work it out…
Or will we? Because I’m not at all sure that coverage as shitty as that would qualify under whatever definition of “insurance” they mandate, especially since virtually any health care services I might need will be disallowed based on those “pre-existing conditions” anyway. Except maybe splinting up a broken leg, and even then they might decide that if I wasn’t depressed or coughing because of my asthma I wouldn’t have tripped and busted the leg anyway, so no claim, sorry—but that’s by the way.
But let’s continue to suppose the worst case. The bureaucrats say, “Well, if that’s the only insurer who will take you, the law says, you have to be insured, so, let’s get you insured.”
Now, see, I have worked in and with various government programs most of my life, and I know how eligibility tends to be calculated and what income thresholds usually mean in terms of benefits and so forth, and I can tell you with reasonable confidence that based on all the data, they’d have a very, very, very difficult time indeed rationalizing a payment (on my part) of more than, say, $200 a month. Even that would be a stretch. I’m thinking more like $120, based on what I know about how eligibility and benefits are calculated for other programs, which would be a burden but a barely manageable one, but let’s stick with the worst case scenario. They tell me, “Two hundred bucks a month, or you’re in violation of the law, Toots.”
And like a good citizen, I meekly acquiesce. And walk out, with a $200 a month burden added to my budget, and essentially still no health care.
I’m going to assume –again, based on the worst etc.— that in order to remain a law-abiding citizen, I will now have to write a check for $200 a month to the insurance company who shall remain nameless, or, better yet, let’s give it an alias: Folksy Cobra Insurance, or FCI.
Here are three ways this can go from here:
1) I continue making my $200 a month payments to FCI for the remaining time until I am Medicare-eligible, and I do not get sick (much,) do not need to file a claim. In which case, the $2400 a year is, essentially a TAX that I am paying, because the US Government demands that I make this payment. And my money goes to FCI, PLUS an additional (let’s assume the Feds muscle themselves a discount so my total monthly premium is six hundred a month instead of seven hundred) $4800 a year that is coming out of all the other taxpayers’ pockets, PLUS the costs of administering those payments and making sure I am complying with the law, for those remaining years until I get Medicare.
2) I get sick. Very sick. And, because my illness might conceivably be related to my “pre-existing condition,” FCI tells me, ‘sorry, not covered.’ So I end up with a big fat hospital bill and have to file for bankruptcy. Plus, of course, being as how I’m self-employed I have no sick benefits and if I’m sick I can’t go out and rustle up business, so I essentially end up indigent and sick. My contingency plan, should this happen, is to stick up a bank and get sent to the Federal Pen, so the taxpayers are still on the hook—in fact, even more so, since I’ll probably still be sick or even sicker, and the corrections system will be on the hook for my medicines and doctor visits and stuff. I’ll be miserable, of course, but it will be my own fault for getting sick and having a pre-existing condition and all.
3) I try hard, but I just can’t keep up the payments to FCI. My check stops arriving. FCI, naturally, reports me to the Feds, who… what? Issue a warrant for my arrest? Put a lien on my mortgaged house? Make me sell my books and my cat and my 1993 Plymouth Duster? (That’ll get me another coupla months’ payments to FCI, sure…) So, do I have to go to court? How much does THAT cost the taxpayers? Do I get put on probation? Who pays the probation officer monitoring scofflaws like me? Ultimately, who pays the sheriff to come out and boot me out of my home and/or drag my ass off to jail? And of course, if this goes far enough, I implement my contingency plan, the bank stickup, and we’re back to the taxpayers paying my room and board and medical expenses at the Federal pen.
And these are only the costs to all the taxpayers from scenario 1): The one where me, and about FORTY MILLION OTHER AMERICANS, attempt to be good, law-abiding citizens and buy our Federally-mandated private health insurance.
Try to imagine the costs from scenario 2): The one where me, and about 40 million other Americans, decide that hell no, we are NOT gonna meekly pay what amounts to a TAX, and not even a tax that goes into the general revenue fund, but a tax that goes straight from me, the taxpayer, to a private, for-profit corporation, do not pass go, do not earn interest for the public coffers. Imagine it. Forty million of us, breaking the law.
How many empty prison beds do we have right now? How much money do we have to contract with CCA and Wackenhut to build more, and to pay local law enforcement and the courts to sentence 40 million or so of us to assemble cheap plastic crap in the prison workshop?
It’s not going to get that far.
If Congress is stupid enough to do the worst-case thing, I think it’s a foregone conclusion that within a couple of years they are going to have to do something to fix the chaos that results.
Now, they may try to twist and whine and continue rimjobbing their corporate insurance company bankrollers, but at some point, they will HAVE to do one of these things:
A: Make the insurance companies limit premiums
B: Not allow the insurance companies to deny claims based on pre-existing conditions
C: Not allow the insurance companies to deny coverage based on pre-existing conditions
D: Not allow the insurance companies to cap benefits and/or charge outrageous deductibles
And here’s the kicker, my friends: If they impose ANY of those rules on the insurance companies—ANY of them—not even all of them—
The insurance companies start to collapse like wet paper.
Seriously.
America’s insurance companies have worked themselves into a situation where their VERY EXISTENCE depends on an unsustainable business model. They can NOT continue to pay dividends to shareholders, pay inflated executive salaries, and pay the staggering administrative and marketing overhead their business model requires, if ANY of the rules change.
It may take three years, it may take ten years, but they WILL abandon the attempt to pretend they are providing any benefits at all. Many will go under altogether.
But if I can follow this worst case scenario, I am willing to bet that there are people in Congress and the Senate and the Administration who can follow it, too. And who know exactly how untenable it is.
So I am betting that we end up with something less than the worst case.
Not what we want—probably not by a long shot—but definitely better than the worst case. Some form of public option. Some form of restrictions on the insurance companies. Some attempt to preserve the status quo, but it won’t work.
It can’t. Because the core of the problem is the simple reality that what we have now is unsustainable. It is reaching its limits, both socially and economically.
What we end up with— less than the worst case, but not yet affordable, accessible health care for everyone— might make the transition to the ultimate end a little less horrific than the worst case scenario. But it, too, will only be a way station.
Because the rest of the world’s industrialized nations have already figured out all the ways of doing it better, and at some point, dragging the troglodytes and the plutocrats kicking and screaming and suicide bombing the economy to the limits of their capability, we will pick one or more of those better options and, finally, and probably not very efficiently (but more efficiently than what we have now) implement it.
What you are witnessing now is the death throes of big, for-profit health care. They are fighting for their lives, and they will take as many of us with them as they possibly can.
But ultimately, we WILL win.
confidently,
Bright
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