Let's just take grantcart's journal summary for the sake of space:
The reason that all progressive Senators are signing on is that it is going to save lives and reduce costs but beyond that it puts the federal government in charge of approving the price, coverage, profit of plans that will be in every state exchange. Every state will have plans that must include a non profit plan and multi state plans negotiated by OPM.
First of all, after being praised for sticking with "just the facts" giving opinion about the reason Senators finally voted to pass something, after having it eviscerated to the point of irrelevance isn't a fact. It's a guess, and one that contradicts what some senators have publicly said. Take Bernie Sanders for instance, who stated publicly on the Thom Hartman program that he thought this bill was a tremendous disappointment and as it stands runs the risk of doing more harm than good to middle class families. He went on to say that value of passing this bill, since it is the only thing with a chance, lies totally on the ability of congress to quickly build on it and essentially "fix it later."
That's a big risk, in my opinion. And history is very mixed as to whether such an idea actually works or does more harm. So we should acknowledge it as such - opinion - just like we should acknowledge that its certainly not a "fact" that all senators voted for the bill because it would "save lives."
In fact, it doesn't take much critical reasoning to look at the situation and surmise that senators voted for the bill primarily because it was absolutely essential that they pass anything for the same of avoiding a perceived political/electoral disaster in Democratic politics. And why is it easy to surmise this? Well for one thing since Rahm Emmanuel said exactly that to John Conyers during a meeting back in July, according to Conyers himself in an interview on the Ed Shultz show.
If saving lives was driving decisions on health care reform, we wouldn't have this bill at all. We would have something very different. Passing this bill is about saying you passed a bill that "saves lives" without having to pass a bill that saves lives but does concede to the wants and whims of the financial elite.
I'm going to go on to explain and defend that last statement, not just say it as dogma.
This bill gives a floor of federal government control for health care and allows states to improve on that, creating an opportunity to improve upon that. Reading this act and the pages cited above there is nothing preventing a state, like Vermont for example, from incorporating its own Public Option alternative to negotiate with OPM as an alternative plan in their state. Vermont State government would also have the opportunity to pass legislation increasing the MLR of the public plans.
There was nothing preventing this from happening
before we took up so called health care reform. And yet we still
needed health care reform at the national level. States already had the power to incorporate its own public option alternatives and to negotiate. It also had the opportunity to pass regulatory legislation to govern insurance business in its states.
Funny how we still had a health care crisis in our country, isn't it?
Oregon, for example, has a public plan for low income individuals and families that supplants and expands on medicaid. States can do this. But guess what? Most states don't. So millions upon millions of Americans living it either conservative states, or states that are the center for insurance corporations are not going to be able to place their hopes in state government to improve on a health care foundation that is insufficient to effectively meet their needs.
This is why we needed national health care reform. Because, our system in which we point out that states "could do more" if they wanted to
does not work.
I need to return to something before moving on:
This bill gives a floor of federal government control for health care
And
this is where the debate rests. And guess one no one is going to conclusively "prove" someone else right or wrong. Because we're all trying to predict how this legislation is going to impact Americans in the future, and that's not an exact science. But there's a lot of people gravely concerned that this bill does not in fact give an acceptable floor for anything.
For example, here are some of the concerns as described by the NNU:
1. The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.
2. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.
3. An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.
4. The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.
5. Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:
* Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
* Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
* Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
* Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage.
6. Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002.
7. Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.
8. New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want.
9. Reduced reproductive rights for women.
10. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.
http://www.calnurses.org/media-center/in-the-news/2009/december/nation-s-largest-rn-organization-says-healthcare-bill-cedes-too-much-to-insurance-industry.html
Are their concerns the final word on the subject? Nope. For example in talking about cost-to-families, they do not discuss the subsidy options within those bullet points. They do elsewhere, and other analysts have as well, with different opinions on how effective and generous the subsidies might be. For example, the Center on Budget and Policy Priorities, concludes that middle-income families gain greater affordability from changes in the Senate Bill which still remain, but that poor families do worse.
http://www.cbpp.org/cms/index.cfm?fa=view&id=3004CBPP concludes that the bill overall is worth supporting. I'm not trying to hide that fact. But it only underscores the ways in which our entire society completely marginalizes poor families. I don't care as much about the comfortably middle-class as I care about low income or working class individuals and families, and I care less about the wealthy investor class, and even less about multi-billion dollar corporations and the executives that represent them.
That part about poor families doing worse is crucial for me. Combined with the loopholes and giveaways to corporate insurance giants and pharmaceutical companies, combined with insufficient benefits to poor and working class families - makes me severely disappointed with what is coming out of the Senate.
Not to mention the fact that those who support passing this bill under the something is better than nothing philosophy have a core disagreement with those of us who believe that profit-driven health care is immoral, and a contradiction in terms.
Pay attention please: I said profit
driven. That does not mean there is zero place for a private company in health care.
Single payer is one way to go, but as others have described in great detail (even over my initial fact mistakes and objections) there are systems out there such as the Netherlands with exceptional quality health care, high consumer satisfaction, low rates and a mixture of non-profit health providers and for-profit providers limited to a 5% profit margin and under heavy, thorough, no-loophole regulation.
The problem is, this bill does neither.
We should agree to pass this bill and then immediately turn around (just like Teddy would do on minimum wage) and start pressuring for public options and increases in medicare.
Of course, this is not what happens. Congress is already tabling environmental legislation because their so burned from the year long health care battle that they don't want the issue. No one in Washington is going to want to touch the health care issue again for another decade or more. There's a reason why substantial health reform of any kind (even bad reform) has only happened once every generation or so. It seems very naive and without any sort of evidence-base to believe that somehow this time it will be different.
In states that have large progressive voters, especially that are located closer to the Canadian border we should agitate for higher MLR and state government run "non profits" that would operate as a public option, in the same way Canada expanded public health care from a single province to all provinces.
But that's just the problem. Hundreds of millions of our 300+ million Americans
don't live in Progressive states. Most Americans live in centrist blue-dogish states or flaming conservative states.
I said this was the second easiest rebuttal I've ever made. And here's why:
The entire argument basically boils down to, this bill sucks but its ok because states can fix it.
In rebuttal:
(1)Historically we have an overwhelming trend of evidence to suggest that bills that are bad for poor and working class individuals and families don't magically get "better" when states get their hands on it.
(2)Leaving it up to states to fill the gaps in a weak and bad bill leaves millions of Americans not living in "progressive" states screwed.
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
