The Health Care Reform Law (yes, the one that will destroy America as we know it and make the Founding Fathers cry) has provisions that take effect today. The National Conference of State Legislatures has put out a handy grid that itemizes the changes that will kill your grandma and whatnot. The fiendish measures destroying America today:
#No annual or lifetime limits on insurance policies for essential health benefits.
# Limiting rescission (the practice of canceling policies only after the insured gets sick) to cases of actual fraud or an intentional misrepresentation of material fact. (In other words, you have to pay to fix the broken leg even if the insured lied about having a bad cough 5 years ago.)
#For plans beginning after 9/23/10, coverage for preventive health services with no copayments and the service being exempt from deductibles.
#Extending coverage to adult children until they are 26 years old.
#No exclusion based on pre-existing conditions for children under the age of 19.
#Group plans can’t discriminate on eligibility in favor of higher paid employees.
Frankly, I don’t know how the Republic can survive.
This needs to be printed on a biz card and handed out to all the people screaming about repealing Obamacare. Then ask them ok, which ones do you think we should cut.
Come on Dems. We MUST get out and vote, or a lot of this could go away…
I think the 2014 thing where the government forces you to buy a product is where the Republic starts to crumble.
Certainly mandatory auto insurance and taxing me for National Parks whether I use them or not and wars whether I agree with them or not has ruined us.
I am teaching Constitutional law next term and we will look at the commerce clause arguments against the healthcare plan. I am not a commerce clause expert, but Congress’s power to regulate interstate commerce combined with the neccessary and proper clause makes Congress’ power almost plenary. And I have also seen analyses that say that challenges to the mandate based upon taxing provisions are also weak.
I agree that the mandate will be unpopular, but without a mandate guaranteed issue cannot work. Adverse selection will swamp guaranteed issue health plans. And opponents to this very modest proposal in this bill understand that. Ironically, the Republican Plan that is supposed to be put forward today would repeal the healthcare bill, but retain guaranteed issue. No mention, of course, of how that can coexist without an individual manadate. And no other explanation of how guaranteed issue will be actuarially supportable. But this is an election year and who can expect rational explanations of policy rationale.
Odd that the comments for Stampede Blue are closed. Did they bring their girl fight over to your fine blog?
Weird. Fixed that. Thanks for the heads up on the comments.
Taxes are taxes, they are paid to the Government. That’s where the National Parks are paid from. In theory, I don’t make someone rich through taxes.
I can choose to be car-free, and live without car insurance. Many people in large cities do just that.
This is a product made by private companies that I must buy just because I live here. That just isn’t right to me.
I honestly have less of a problem with government-provided health care than I do with government forced health care. The difference is where the dollars are going and how they are spent, and how much control I have over watching and shaping that process.
Also, to be clear, just like the 16-year old naked breast debate, I have no personal stake in this. I’m not stupid enough to go without health insurance.
It is just that we’re passing laws to force people to be less stupid. Laws against running with scissors are soon to follow. I really have a hard time accepting that as the role of government.
Agree with Jason wholeheartedly.
An additional concern of mine is the timing (worst timing ever?). Three of our biggest domestic issues currently are: (1) taxes are scheduled to raise because the Bush tax cuts expire at the end of the year (right or wrong); (2) we have record deficits and a national debt at approximately $13 trillion; and (3) the economy. If we want to raise taxes even more (which generally inhibits economic growth), our #1 priority should be to lower the national debt, not the creation of a whole new entitlement that will be impossible to remove.
It burns my butt quite a bit that we have the following to thank for the passing of health care: (1) a Senate race where Al Franken beat Norm Coleman by something like 18 votes (and had lost on the first counting); (2) Massachusetts changing election law (again) with the sole purpose of making sure they had Ted Kennedy’s seat to pass health care; and (3) the utilization of a budget reconciliation maneuver to get health care finally passed without requiring a final vote.
Franken won.
And didn’t Mass elect a Republicans?
#1 helps counteract #2, and there are efforts afoot to mitigate #3 by limiting the tax increases to those portions of peoples’ income that exceed $250,000. I’ve seen reference to studies that suggest tax cuts on those upper parts of people’s income don’t do much to encourage economic activity.
Government provided healthcare would be more cheaper and more efficient option. But the lobbying influence of the health insurance industry is insurmountable. Medicare operates with a 2-3% administrative overheard. Most private insurers cannot beat 15%. The individual market comes in at about 40%.
And the multiplier effect of high income tax cuts are minimal. The lost revenue swamps the imagined economic growth. But tax cuts on high income earners are very effcient at redistributing income upwards.
It does not matter. The gutless democrats are running like hell away from health care and other Obama programs. Instead of working together, which they seldom if ever do, they are now turning on each other and the result will be a republicant win in the house and perhaps the senate-and they will not hesitate to ban together to speak and vote with one voice. Corporations are destroying America and the republicants are trying to help them. And democrats are just standing with their head up their fjd ! pence and boehner are empty shirts with no plan-see todays pledge to America, and yet they are killing the democrats. I prepare today to bow to beck/palin/mitch. We are doomed.
T: I didn’t count the votes, but the Minn Supreme Court says he did. Either way, it was REALLY close.
And yes, Mass did elect a Republican (actually a RINO, but he was against health care). Still, I believe the RINO (Scott Brown) never got to vote on health care though. Dems in Congress never gave him that opportunity by using a budget procedure to avoid his vote.
Doug: Agreed that #1 does partially mitigate #2, but the fact is, we have interest on $13 trillion to pay now, and I doubt the repeal of the Bush tax cuts will stop the national debt from increasing. More will need to be done if we want to stay solvent as a country.
Regarding 3), yes, we limited the tax increase to a tax on the “rich” (for the most part) to pay for health care (we also tax people with cadillac tax plans and people that like to be tan, possibly others). Ok. Are we going to tax the rich again to pay down some of our huge national debt? You can only hit the rich with so many special taxes, right? Are we going to go back to 70% again like we did in the quagmire 1970’s?
Todd: More people will use health-care for more reasons in the new system. So, even if you’re right about lower overhead, health-care costs will rise because individuals will pay a smaller portion of health-care’s cost. If Uncle Same (or whoever) is paying the bill, why would people care about how much health care costs?
This need for increased transparency is one of the reasons I think Flex Spending Accounts were a great idea, and the decision to reduce their benefits (in the health-care bill) was absurd.
HSAs have a surface appeal, but on closer analysis, have little ability to reduce spending. First, most spending on healthcare is not discretionary. Second, individuals have no bargaining power vis a healthcare provider. Finally, the high deductible policies that back HSAs are indemnity policies that have not agressively bargained for prices.
Expanded care will have some marginal increase in elective services. But the increase in these services, I believe will be more than offset by broader coverage for all individuals in lower cost, primary care settings.
I have always believed, based upon proximity to the legilative process and the lobbying efforts by Patrick Rooney of Golden Rule, that HSAs were nothing more than a gimmick to sell high dediciblet individual policies that were being edged out of the market place by managed care plans.
Quagmire 70s? Let’s just go back to the rates during the golden age of Ike or even Nixon. (See, e.g.)
Again anecdoctal history ,but Im remembering back to the 50s and 60s when my father earned less than $5,000 to support a family of 6. I dont know how much that would be in today’s money. But I cannot remember health insurance being an issue. We just went to hospital or clinic if we needed to and it wasnt to an ER as I remember.We mostly saw a family doctor.I do remember we had to scratch around for stuff to eat by Wednesdays with paydays every Friday.But it wasn’t an issue, because so did everyone else we knew.
Memory is deceptive because our mind can go back and re-invent the past. Nevertheless, times seem to have really changed.It was OK to be poor then as long as you had a job.Now it’s better to live off government,unless you have a relatively good-paying job.
But I dont know whose point of view Im supporting,liberal or conservative.
Paul,
One last point. You are completely correct that pricing transparency would be invaluable for making rational economic choices. However, transparency in pricing is actively discouraged or not permitted among healthcare entities.
When I represented managed care companies the managed care companies purchased payment data from companies that specialized in developing pricing date. The payment information was proprietary. The managed care companies could not provide the data to the providers! As a workaround, we would give providers the prices we would pay for their top ten procedures. This would give them an idea of what they would get paid for the bulk of the procedures.
Also, many providers, especially large successful tax-exempt hospital systems, do not even have a good handle on what their costs for a certain procedure are. They just charge an amount they establish and expect people to pay it. And good luck trying to bargain with them for a lower price.
I used to have a saying when I worked in healthcare law: Economics is the study of the allocation of scarce resources. Healthcare economics is the study of the misallocation of scarce resources.
Paul– my memory of it is that the gutless Dems refused to use budgetary procedures/reconciliation/etc., and that it actually passed a 60-vote hurdle in the Senate. The same 60-vote hurdle that everything has required since 1-20-09.
Doug: Was Nixon not President in the quagmire 70’s? :-)
Todd: Your point was unknown to me, but I think it reinforces the idea of price transparency. If hospitals charge an arbitrary amount that is not based in reality, than there should be significant discrepancy between the prices hospitals charge. If this pricing information was provided to patients, rational patients may want to have their procedures performed at hospitals that are the best value, no?
Lou: your recollection matches everything I have heard. Health care costs have spiraled in the past 50 years. There are multiple reasons for this, I’ll share a couple: (1) health care has improved greatly, but these improvements have come at a cost; (2) we use health care for so many more problems now than we used to (Example: a guy in the 1950’s that had frequent indigestion or heartburn used to just tolerate it, now we have all sorts of pills to make the issue go away); and (3) we are more overweight and unhealthy than we were in the 1950’s. The health care cost of our unhealthy habits is enormous (look up the prevalence of diabetes and how much we spend on that one illness alone). Of course, unhealthy people don’t have to pay this financial cost (but do experience decreased health and lifespan) since most of the cost of health care is usually picked up by employers (who can’t discriminate based on health).
Lou,
In those days you’re recalling, there were many diseases where the only option was to die. Now, we can cure almost anything, but we can’t cure “almost anything” cheaply. Regardless, it is assumed to be everyone’s right to have the best health care that money can buy.
The logic can be taken to other things as well. It was easier to live on a smaller income before because there were less common monthly bills. Sure, you can do without a telephone, cell phone, cable TV, Internet, etc. However, most people don’t.
T: A bill like this would normally have two votes. The first vote is to approve the legislation. The Senate did have this vote before Scott Brown was elected in Mass., and health care passed a filibuster 60-40.
The next part is the bill would go through a reconciliation committee to reconcile differences between the House Bill and the Senate Bill. After that, the bill is normally voted on again. Since Scott Brown was elected, the Senate didn’t have enough votes to pass, and the House passed the Senate Bill. The Senate never received the opportunity to vote again on Health Care Reform.
Why should the Senate have to vote on it twice? They broke an active filibuster, and then passed it by a majority vote. The House then passed the Senate version. I don’t see anywhere in the Constitution where you have to have a re-vote if someone named Scott from Massachusetts gets elected after the bill passes.
That legislation passed over higher hurdles than most, and the fight was fairly won.
This is such a scam. I hope the turnover in November repeals the whole bill. The talk of only repealing parts of it make me ill.
Think about it… 1 person coverage w/ no deductible has shot up since passage about $200 a month. Its now as expensive for healthcare in my state as it is for property taxes (and more expensive in more reasonable states). 6K a year. That’s 60K in 10 years and approx. 360K over one’s lifetime *just for coverage*. This doesn’t include out of pocket costs or deductibles. Its LUDICROUS. I think I’d feel a little better if there was indeed *interstate commerce* and I could buy insurance from some podunk town in some other state, but *I can’t*. It’s so bullshit. I’m thinking of pulling out all of my money from the banking system, buying gold, quitting my job, going on welfare, and letting you suckers pay for my healthcare. Fuck this government.
Where’s the land of the free again, I can’t seem to find it.
Costs of coverage were shooting up quite nicely before the health care law was passed. So, color me skeptical when health insurers blame the continuing rise in costs on the health care bill.
I could probably buy into interstate sale of policies if the applicable consumer protection rules were set by the State where the insured lived and not the state where the insurance company is domiciled. That would prevent a race to the bottom like we’ve seen with, say, credit card companies. But, that’s not what was on the table.
Jimmy,
By all means, by gold. My GLD ETF is probably near a peak and a little more demand provides downside protection.
And whether you are on welfare or elect not to purchase health benefits coverage, the taxpayers will get stuck with the extraordinary costs of your care.
BTW, in the 1990s, if I recall, there were some interstate insurance purchasing pools. I researched for my LLM Healthcare Law thesis, but that was a few years ago. They turned out to be sham organizations sucking up premiums for duped and otherwise ignorant employers. But hey, I have a healthcare background, maybe these promised (but never to be delivered) purchasing pools will be a good way to make some money and screw over healthcare reform opponents at the same time.
Have more than my share of the pie and eat it too. No good idea goes unscrewed-over by the well-healed lobbyists.