Think what those billions of dollars in subsidies could do towards a real Social Insurance program

[Armstead]

Look at all of the money that is going to be spent on Medicaid expansion and subsidies for private insurance.

Think of what could be done with that money if instead it were channeled into either an expansion of Medicare access or as the basis of some other real public social insurance program.

We're going to spend vast amounts of money in this new bill.

The problem is that it is going to be spent for a mix of charity and for propping up the profits of insurance companies, instead of allocating it to real social insurance that would allow access to coverage at income-based rates and more allow the same people to get healthcare and keep their dignity, while also providing an opportunity to choose much more affordable coverage for everyone else.

But I guess that's off the table because it is not conservative enough.

[Armstead]

1. This post has nothing to do with political personalities

Anyone want to reply or criticize on the content?

[eridani]

2. This bill will be stripping a lot of the middle class of disposable income

Which may very well contribute to re-sinking the economy.

[frazzled]

5. Disposable?

Whatcha wanna spend it on: an X-box and a new iPhone?

Disposable income is what you have left over after you pay the health insurance, car insurance, rent and mortage, etc.

In my family (and I've been married for 35+ years), there's never even been a question of using disposable income before health insurance. Health insurance has always been mandatory. Granted, we have always been lucky enough to have at least one member of the household employed. Some of it has been good over the years and some shitty: but we always get it in case the "big one" comes along that would wipe us out. But I see lots of people on this board every day who say they don't take their employer's insurance because they can't "afford" it. It's just not a mindset I can understand.

[Armstead]

6. Not everyone has that choice

After the rent, food, heat and other essentials -- not an XBox -- many hard-working people do not have hundreds of dollars left over for insurance. It just aint there.

[frazzled]

8. But the poster was saying people shld not have to buy insurance, but rather

be able to use their disposable income elsewhere.

Disposable doesn't include food, heat, rent, etc. Those are necessities. I totally agree with you that it is very difficult for some people: that is why this bill must be passed: it will provide subsidies to precisely those people so that they can at long last get it. And it will prevent insurance companies from disallowing people from getting it because of pre-existing conditions. And for older Americans, the insurance will only be 3x greater, not 11x greater as it is now (presuming they would let you get it anyway). It would be nice if it were not more expensive at all, but it's still a hell of a lot better.

I think what this poster was betraying was that they just don't want to get insurance. I've been kind of shocked at the number of people who don't want to get it. You know, I used to agree with Obama during the campaign that mandates (which I knew would be politically difficult to sell) might not be necessary ... because almost everyone would WANT to get it. I guess he saw the light on that, and I do too: there are a lot of people who just don't want to "waste" any of the precious money they could be spending on cell phones and bars and video games on something they don't think they need--while the rest of us pay for them when they get hit by the bus.

[Armstead]

10. That is one reason for real Social Insurance

You are correct about some people. However most people really do believe they are stretched by insurance costs (and it doesn't do much good for employers either). Even in the middle income brackets, what if it becomes a choice between college for the kids or health insurance? A Hobson's Choice.

Social Security mandates you to save for a rainy day, which is something many people would not do voluntarily. However, it is a public pool of money and payments are based on income (to a point).

Social insurance would accomplish the same for health coverage, but with payments also based on a share of income, and without the added layers of profit. Once peope got used to it, it'd just be an accepted part of the income and pay-outs, like taxes and SS.

[frazzled]

14. Well, we all would have liked that

But this is where we are now. So the question is, do you believe there is a universe in which we can kill this bill and get real social insurance instead? My strong belief is that the answer is a big fat obvious no. So our choice at the moment is to make it more affordable and available to those who cannot get it now in the individual market, stanch the unsustainable increases in premiums that are killing both employers and employed who get it in groups currently, get some cost controls in, and start up the regulation machine ... or take nothing. Nothing, to me, is crazy.

There's a certain extent to which the mandates in this bill are "public" as well (though clearly not to the degree of SS): requiring that everyone become insured (with exceptions, of course) is the only way to drive the prices for everyone else down. Most of all, by making sure that insurance is not only bought by the older and less healthy (the young folk can pay their premiums and help us older folk get more affordable deals; when they are old, they won't bitch about it as much, because they'll need it more, too).

We do have other mandates to buy private insurance: car insurance is most often cited, but there is homeowner's insurance as well: if you buy a property, you are required by law to carry a certain amount of insurance on it. Now the argument is often made that, yes, but you don't HAVE to buy a car or own a home. This is very true. So these are limited mandates. But the common good is not affected by whether or not you own a car (except in terms of emissions, ... but that's another story) or whether or not you own a home. But the common good is very much affected by whether or not you choose to be insured for medical costs. You cannot NOT have a body. And when you don't insure your own body, and you get sick or hurt ... you put a strain on the common good. We have to pay for it. And eventually, as fewer and fewer people are insured, it is an unsustainable burden.

So I take great umbrage at all these libertarian (whether left or right) mandate opposers. It is highly illiberal to oppose the mandates, because they are a contribution to your fellow citizens. We are in this together, not separately.

Everyone we've trusted--from Jacob Hacker and Paul Krugman--to senators like Jay Rockefeller, Sheldon Whitehouse, and Bernie Sanders, says we have to do this. So we do it. It's a start. If we don't do it now, nothing will every get done. And I believe that is a certainty.

[Armstead]

18. I wouold prefer we stem the bleeding now, and do the surgery correctly

Abnd I'd follow that physician's motto of "First do no harm."

Deal with the most egregious problems and accepted solutions right away. Provide some emergency subsidies for coverage with sunset clauses without embedding them.

No mandate for private coverage, but do prohibit denial for pre-existing conditions. If necessary provide temporary payments to insurers to subsidize that -- temporarily.

Many other stopgap possibilities.

Do whatever is necessary that does not further entrench the role of private insurance.

Meanwhile, also put on the fast-but-not frantic track a real base for social insurance. And really sell to the public it based on the practical merits (of which there are many) and appeal to the sense of common decency. (I know that it often seems hard to find, but it is there.) Don;t just sell it as a liberal solution but as a real solution.

It could be modest, like expansion of Medicare access at lower age, or a new "public option" program. Whatever gets the foot in the door.

The point would be to immediately provide relief to people and get more people insured in the present system. But also get rear ends in gear to generate support for a real public program, and give a demonstration so people realize that it is good for them rather than being the boogieman.

Once in place, the GOP would not be able to take it away (witness medicare and SS).

[bluethruandthru]

40. It's too bad the half the country - or more - just doesn't understand

what social insurance is. I really wish the Democrats had gotten behind this 100 percent and explained it concisely to the public. If people really understood what it is...they would be in favor of it. Problem is, there's been such a disinformation campaign by the right..and the Dems have been all over the place with their 2000 page bill that no one is quite sure what's eventually going to be passed or how it will work.

[KrR]

30. If they are poor they will receive subisidies...

If they are not poor they need to get insurance regardless.

[eridani]

11. Health insurance mandates wipes out my disposable income

$125/month for single payer would not.

[frazzled]

15. Where'd you get the $125 number?

That's crazy. That might be your amount for supplemental premiums paid to the government, but your taxes would have to go way up.

Plus, single-payer is not nor has it ever been--nor will it be in the foreseeable future (and I'm talking 50 years)--in the picture. So it's useless to discuss it with respect to the current debate.

[eridani]

17. Right from HR 676

http://www.healthcareforallwa.org/health-security-trust/
Also, WA State single payer legislation proposes $100/month. That this is doable should be obvious from a comparison to the tightly regulated private insurance of the Netherlands, which costs 100 euros/month.

[frazzled]

19. Pshaw

Run that one past the CBO.

You can propose anything you want in a bill. As a Congressperson, I could propose a bill that said everyone should get a free iPod with a $100 iTunes giftcard.

[eridani]

27. Our state single payer bill recommends $100/month

The Netherlands has 100 euros/month.

[KrR]

31. The premium is $100... not the cost...

Its 2 entirely different things.

[eridani]

32. So what? The rest of the cost is paid by a payroll tax

Are you actually advocating that more and more costs should be transferred to individuals? That is totally fucked.

[KrR]

33. No im for single payer also... but i dont want to "kill the bill' either n/t

[eridani]

34. This bill is going to kill the Democratic Party

--unless the Repukes keep ramping up the assholery. I don't think we should be relying on that.

[KrR]

35. Not true...

even tho i am for a PO i believe this PPP Poll is accurate.

http://publicpolicypolling.blogspot.com/2009/12/democratic-dissension.html

On our last poll 27% of Democrats expressed disapproval of the party's Congressional leadership. Out of that group 49% said they were opposed to the health care bill with only 44% in support, and 85% of those opposed said it was because the bill created too much government involvement in health care.

[eridani]

36. The actual fucking over of the public has not yet commenced

Are you telling me people are going to be happy to be forced to buy useless garbage that only pays for 60-70% of actual health care expenses? Are they going to be happy to see their rates skyrocket over the next four years, with even more copays and deductibles?

[KrR]

37. You are uninformed.

The bill requires that 85% of premiums go to healthcare. Their rates will go DOWN, not UP. You are trusting reports published by the insurance companies you hate over the CBO? I really do not understand that.

[eridani]

44. Regulation after the fact isn't regulation that does anybody any good.

Dear Mr and Mrs Sarkisian:

It's really too bad your daughter died when CIGNA wouldn't cover her liver transplant, but things will be ever so much better when we make requiring specific Medical Loss Ratios into law. After this reform, if the government determined that CIGNA's MLR was too low at the end of their fiscal year, you would get a premium refund! Isn't that WONDERFUL!

Yours truly,
Dr. Pangloss

If our government is forcing this shitty giveaway to insurance companies, what makes you think they'll bother to regulate those parasites in our interests

[quakerboy]

51. And you didnt read what he wrote

He didn't say only 60% went to pay for health care. He said the coverage will only cover 60-70% of the cost. The remainder we get to pay out of pocket

[bornskeptic]

38. How is a payroll tax so progressive?

If every working person pays the same percentage of his or her income in payroll tax and everyone pays the same amount for a premium, then a person making $20,000 ends up paying a higher percentage of income for health insurance than a person making $60,000. Under the currently considered bill, the person making $20,000 would pay a lower percentage of income than the person making $60,000, because of the subsidies, which are paid from funds collected through the progressive income tax.

[eridani]

46. The payroll tax is on the EMPLOYER n/t

[eridani]

48. So? Employers pay a payroll tax to cover the rest.

The cost to the individual is $100, and the math all works out.

[eridani]

47. We've already done that in WA State

Our single payer bill would require $100/month.

[bornskeptic]

23. The 100 euros is only about half the cost of coverage,

the rest being provided by emplyers and government. Thus it costs about $285(200 euros) per month to insure an adult in the Netherlands, but the cost of the healthcare itself, apart from insurance, is much higher in the US than in the Netherlands.

[eridani]

28. So? Single payer has a payroll tax in addition to an individual premium

The reason that health care costs less in the Netherlands is that the government controls those costs too.

[quakerboy]

50. A retirement plan

that's the first thing that this mandate will cost me personally, from what I would call disposable income.

Also buying new clothing before it is absolutely necessary. IE before I get complaints, rather than after.
Any chance of visiting my more distant(a couple states over) friends and family more than a few times a decade.
Any chance of saving money to eventually buy a home.
Any chance of paying my student loans off before 2034.

These are a few of the things my "disposable income" tends to go toward that would instantly disappear if I were to buy health care under this system, or the best case new one. The only benefit that I can see is that I will likely be able to buy the insurance, where now I do not even have the option even if I could squeeze the money from my budget.

[AllyCat]

3. I'm envisioning all those out of work insurance execs in line at the soup kitchen

If only...

[Armstead]

4. They could be hired to manage the social insurance program

They're smart folks and know how to squeeze a dime for efficiency.

Only difference is they'd be mandated to make it efficient to make ot work better for people....and they'd have to live on a measly couple hundred thousand or so a year plus federal benefits.

[AllyCat]

26. That's for their underlings. It would be better for the execs to be in jail I suppose.

[Gregorian]

7. The same could be said about military spending.

What we could have had for the trillions spent in (I almost typed 'Nam.) Iraq.

edit- Sorry, should have acknowledged your post. I agree with it.

[Armstead]

12. True -- But Sadaam had WMD and we needed to protect ourselves

er Nevermind

[MisterP]

9. apologist excuse 1: it would never pass; excuse 2: the President has spoken!

of course, they're shielding the fact that subsidies only feed the sparrows through the horse, which is far more efficient

LBJ pinned Senators to the wall to get his way; Obama wouldn't even need to do that with the current batch of Senators

[Armstead]

13. Intersting anology -- Not sure I want to picture that

[boppers]

16. Its not "off the table", it's already part of the plans.

This plan (or plans, they have to be combined) isn't as simple as the daily talking points are trying to portray it.

There's huge investment in non-profits, in health centers for the poor, community prevention programs, community research programs, more training for free community doctors with the National Health Service.

[Armstead]

20. Charity is a good thing -- but not the ultimate answer.

IN a nutshell, (IMO of course) we should not be buolding a system in which basic health coverage is unaffordable while expecting charity and government hand-outs to take up the slack.

Those may be necessary in the short term, but the emphasis should have been oriented to creating the foundation (even if just a foot in door) of a real social insurance system -- based on the notion of pooled resources and shared responsibility based on ability to pay to benefit all.

[boppers]

21. Just saw this on another thread... (where you might have just seen it, too...)

http://www.dailykos.com/story/2009/12/22/818060/-This-HCR-Bill:-45,000,000-Get-Single-Payer-Vermont-Health-Care

Whaddya think?

[Armstead]

22. The way it is written confuses my feeble brain

But here's what I think.

Added support for things like community clinics, etc. is a very good thing and will hekp many people -- to an extent.

However, I would prefer to see a reorientation towards a system where such things are less necessary because public coverage is more widely available and affordable to as many people as possible. That's what i was referring to in the billions of dollars in my OP.

Although he bargained and got support for comunity health centers, Bernie has the same position. He got what he could to help as much as possible with this sub-par bill, but he also believes Single Payer social insurance is far preferable.

[boppers]

24. It looks like a huge toe-hold of single-payer+sliding scale.

Clinics and doctors everywhere: That's step one.

Step two? Point out that single payer *and* sliding scale through a government health system is a better use of dollars, and transition people from crappy private insurance, private facility, private doctor system to public+supplemental systems.

It's a dream, at least.

[Armstead]

25. A worthy dream

[jeanpalmer]

39. Those things were included to get people

to go along with mandates. They could have been enacted into law at any time on their own without the mandate. But they were linked up with the mandate to ensure passage of the mandate. That's why you hear, "wow, this bill is great, it has all kinds of extra goodies in it that are wonderful." That's exactly the response the bill's sponsors were calculating and hoping for. These extra goodies take people's focus off the mandates and get them to saying how wonderful the bill is.

The touted Medicare "savings" have a very similar purpose. They're designed to give the impression that there will be a pile of cash saved from Medicare that can be used to fund mandated insurance premiums and other parts of the bill. However, Medicare will not work that way.

Medicare currently has an operating deficit of $4 billion -- that means it spends $4 billion more for care and expenses than it receives from current payroll taxes. And this deficit is projected to greatly increase in future years. Normally, if sources of waste, fraud or inneficiency can be identified in the course of business, they are eliminated to reduce current operating expenditures and bring the budget back into balance. For example, if $4 billion of waste could be found in Medicare this year and eliminated, the $4 billion operating deficit would be eliminated. If those sources can't be found and liminated, then the $4 billion deficit remains.

The point is that elimination of $4 billion in waste etc. in Medicare does not create a separate $4 billion fund that can be raided to fund programs outside Medicare, such as insurance mandates. If the $4 billion saved are siphoned off to pay for mandates or other parts of the plan, then Medicare will go back to having a $4 billion operating deficit.

But this is exactly what Obama is doing. He is taking $400 billion out of Medicare, under the guise of savings, and using it to fund his mandates. This will leave Medicare seriously underfunded. It's a sleight-of-hand approach that we see throughout his plan. Some people refer to it as an "accounting gimmick" and that's about right.

[Armstead]

42. It seems to me that bringing in more younger people would help Medicare

IF younger people who need fewer services were allowed to buy into Medicare, it seems to me this would be one way to help reduce its deficits.

One would really have to get out the green eyeshades and crunch numbers to know but on the surface it seems that would at least bring in revues without as many costs and would make more sense than siphoning off money to into the hands of private insurers.

[KrR]

29. What is wrong with money going to Medicaid expansion???

WTF this is like the 10th post today i have seen bashing Medicaid today.

[Armstead]

43. You and I have altready had this discussion and this thread is from yesterday

You are welcome to disagree -- but at least make an effort to understand what hyou are disagreeing with.

[txaslftist]

41. Until we drastically cut our military budget, this debate isn't that

relevant. We are spending beyond our conceivable means year after year. The only way this is at all sustainable is through massive inflation. Our military expenditures are about half of our annual government budget, and these expenses alone are more than we can pay annually.

And since the government is firmly in the hands of the military industrial complex, don't look for any change soon.

[jeanpalmer]

45. That's THE issue

and all these Congress people act as if it doesn't exist. Every Congress person knows we could fund great health care if we reined in defense spending. And yet very few of them mention it (Dennis Kucinich being a notable exception). That's why this debate, and this bill, is a complete fraud on the American people.

[quakerboy]

49. Here's my question

If we took the money allotted to subsidies and instead paid it directly to the Canadian health system, how many people could we get covered for the price, vs what we plan to cover?

[dflprincess]

52. It's not off the table because it's not conservative enough

it's off the table because Congress & Obama want to keep those big campaign "contributions" rolling in. Not to mention those lucrative lobbying jobs members of Congress and their staffs may have waiting for them when they leave "public" service.