Friday, March 19, 2010

My Final Decision: I'm Against the Reform Bill

As the title says: I'm against what's likely to be passed in the next week or so. Oh, I grant you it'll be disastrous for the Democrats if it fails, and their only hope of avoiding a Republican takeover of at least the House if not the Senate as well. On that ground- and on that ground ALONE- I hope it passes.

But, in and of itself, not as a political move but as a simple law, it's a bad idea. It won't work. And here's why.

Today somewhere or other I found a link to this extremely simplified explanation of what the health insurance reform plan does. It's a good summary. Let's start with this:

If you already have coverage through your employer... you keep it. And the government would offer small business incentives to provide coverage to their workers.

This insurance is strengthened by:

  • Banning exclusions for pre-existing conditions
  • Banning lifetime and annual caps on how much insurers will pay out for care
  • Capping consumers' annual out-of-pocket expenses
  • Requiring full coverage for preventive care
  • Allowing young adults to stay on the family's plan until they turn 26 years old

All well and good... but there's something utterly vital missing there.

There is absolutely no provision to cap how high insurance premiums can go, or how much they can be raised each year or due to changes in medical condition.

Insurance corporations can go to the limit- and well beyond.

Moving on:

Medicaid will be expanded to cover an additional 16 million Americans.

Which would be all well and good, if Medicaid were solely a federal program. It's not. The bulk of funding for Medicaid comes from the states, nearly half of which have governments whose governors or attorney generals have pledge to sue to have this bill declared unconstitutional. Even now these states want Medicaid killed; my state, Texas, has driven up the requirements to qualify for Medicaid to such an extreme, and driven so many off its rolls, that they no longer meet the minimum qualifications to receive ANY federal matching funds for Medicaid at all. In short: what this bill promises on Medicaid, the federal government is powerless to deliver.

Onward again:

State-based health insurance exchanges will enable these individuals, families, and small businesses to join together in larger risk pools to purchase private health insurance coverage at affordable prices.

Except the bill only empowers states to create these exchanges- it doesn't force them to. Again, nearly half the states want this bill struck down; they certainly will NOT cooperate with it in any way.

The new system will cost about $100 billion each year. Much of these new funds will be used to provide tax credits to offset costs for those individuals, families, and small businesses that still cannot afford to buy insurance and other improvements to the health care system.

Except, well, this cost estimate, and the ability of the federal government to provide these subsidies (which don't kick in for five years at least), rely on the overall cost of health insurance either remaining stable or coming down. As I mentioned above, there is absolutely no guarantee of this whatever. Indeed, in half the country the insurance exchanges which are supposed to provide competition among corporate insurance plans won't even happen because of Republican opposition to any sort of aid to the poor whatever.

And the subsidies come in the form of tax credits- which means you have to have the money for the insurance plans up front for a year before you can hope to get any money back at all.

And there is absolutely no guarantee that these tax credits will be anything like enough to offset the uncontrolled rise of health insurance costs. The only help here is that the penalty we would pay for not having health insurance would be waived if- in the opinion of the IRS- the minimum health policy available to you would cost more than 15% of your gross (not net) annual income.


We will save money by:

  • Eliminating waste, fraud, and abuse, as well as subsidies for health insurance and pharmaceutical companies
  • Better coordinating care to eliminate unnecessary hospitalizations and duplicate tests
  • Better utilizing electronic medical records
  • Paying for quality and not just quantity

Obama already introduced subsidies for electronic record-keeping systems. In fact, some doctors' offices have tried implementing such systems, at their own expense. The results: HIGHER expenses and SLOWER performance, because current laws- which this bill does not, to my knowledge, address- PROHIBIT the sharing of medical information without the patient's express permission, and thus the systems aren't talking to each other... and it's faster to write things on paper than to enter them into a computer.

The other items, to be blunt, are empty Washington talking points, with no substance.

And finally, let's look at what this plan doesn't even address:

  • It does absolutely NOTHING to stop health provider corporations, such as hospitals and chain/franchise clinics, from raising their charges astronomically to take advantage of the requirement that insurance companies cover services- which has happened in Massachusetts where a virtually identical program has been in force for years;
  • It does absolutely NOTHING to address the sky-high price of prescription drugs and the non-competitive market practices pharmaceutical companies engage in;
  • It only offers "support to state governments to find solutions" to frivolous malpractice lawsuits, tort reforms, and malpractice insurance premiums; and
  • It does nothing to address the practice, common at all levels of health care, of padding bills with unnecessary tests, outrageously marked-up supplies and over-the-counter medicines, and other additional charges and services included not to avoid lawsuit but simply to maximize profit.

So, in summary: this bill provides no, absolutely no guarantee that we will be able to afford health insurance, or that health care costs will go down or even level off... but it requires everyone in America but the truly indigent to buy it, at full cost, cash up front, in the hopes that whatever tax credits they get the following year will make them whole. It addresses absolutely none of the basic problems which have caused health care to become so expensive in the first place. The one good thing it does is that it requires health insurance corporations to take all comers and provide the coverage they promise... provided you, the customer, have infinitely deep pockets. (And if you do, what do you need with insurance anyway?)

This bill is a disaster waiting to happen. The only argument in its favor, from where I sit, is that if the Democrats spend all this time and effort and fail to pass it, the Republicans will regain power- and they are currently ruled by the most nakedly racist, bigoted, intolerant, evil and corrupt politicians to be found in our country.

But once this bill takes effect, and health insurance costs skyrocket, and other health care costs continue to rise without any foreseeable end in sight... won't the Republicans get back in power anyway?

The Democrats did this to themselves- pushing forward a program without first, in advance, making sure that their own party was united on what to do. By compromising, and compromising, and compromising just to keep their own party together- plus Obama's idiotic pre-compromises in an obviously futile effort at "bipartisanship"- they've destroyed everything good that might have been in this bill... and gained, in its place, a dog of a bill that they either kill (in which case it will be said Democrats are incapable of running the government) or pass (in which case I expect the results to be so horrible as to give Republicans another decade or more of absolute power).

We're damned if they do, and damned if they don't.

Damn them.

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