The House Passed the Health Bill

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/07/AR2009110701504.html?hpid=topnews

by raintrees • 17 years ago

54 163 17 years ago

washingtonpost.com

raintrees2• 17 years ago

Now if we can only reform medical insurance...

old-gregg5• 17 years ago

Medical insurance? What a barbaric concept.

I paid $30K in taxes last year. I don't quite understand why would I even have to think about terms like "insurance" and "money" when/if I get sick. I'm not an American, although I've been living here for 11 years, yet the thought of PAYING for medical care still feels shameful and medieval.

If there isn't enough money in the budget to pay doctors then start cutting: on "defense", on bureaucrats, I don't care. Medical care must be absolutely the highest priority federal expense: not a single government employee should be paid until the last US citizen who needs medical attention gets help.

Dilpil• 17 years ago

Why should medical care be a higher priority than food?

natrius6• 17 years ago

I don't understand how paying for medical care can possibly seem strange. Single-payer systems are merely an arrangement for paying for medical care. In my opinion, it's not a very good arrangement.

Everyone who needs health care should be able to obtain it. Most people in developed countries can already obtain health care. Why insert the government into the situation where it isn't needed? Any time you disconnect the amount paid for goods and services from the receipt of those things, the market (i.e. mass human psychology) will work less efficiently. Perhaps the price the government decides to pay will be less than is needed to convince enough people to provide the services in question, resulting in a shortage.

Subsidize health care for those who can't afford it. Everyone else should pay their own way privately. Similar changes should be made to the other non-public goods we subsidize, like roads, transit and education.

ryanwaggoner2• 17 years ago

This kind of over-the-top rhetoric is great for rallying the masses, but it breaks down under the lightest of logical scrutiny. Here are three of my favorite issues with your position:

1. Why is medical care the highest priority? What about food? Shelter? Safety from rape, murder, and other forms of violence? What about electricity, water, and other infrastructure? While most people don't get very sick, pretty much everyone needs the things above. Why should medical care be the highest priority federal expense?

2. You think it's barbaric to think about paying for medical care, but guess what: you do pay for it. Everyone does. Your "right" to healthcare is not free; someone has to pay for it. And because you think you're entitled to that free of charge, someone else out there is having money taken from them under the threat of force so that you don't have to worry about healthcare. The right to private property far outweighs the right to healthcare, according to the US Constitution, but your system reverses this relationship.

3. The decoupling of supply and demand in the type of system we're about to pass is likely to result in dramatically higher costs and lower quality care over the long run, not to mention the fact that we have no way of paying for it. Granted, our current system is screwed up, but this is far from a fix. This is just moving further in a bad direction.

EDIT: Added a third item :)

pmorici5• 17 years ago

If you want to know where your money goes just look at this list...

http://washingtontechnology.com/toplists/top-100-lists/2009....

raintrees2• 17 years ago

Medical care is a service. I keep myself very healthy, so I pay very little for medical service. I am willing to pay for Medical Insurance, because like automobile insurance, I may find it difficult to pay for drastically large bills that arise, and may be quite large due to the reimbursement system for emergency services.

In car collisions, pain and suffering is a scary demand. In emergency medical care, all those fancy machines to figure out what is going on with my body right now is likewise rather expensive.

A long term plan to adopt a good diet, exercise, stretch, brush my teeth, etc. is a relatively easy way to avoid paying for large amounts of medical care. And, I am fortunate enough not to have any major body/mind disability.

vaksel2• 17 years ago

So the Dems gutted the bill(from single payer), just to gain a single Republican vote?

spamizbad• 17 years ago

The bill didn't start from single payer - it started as offering a public option, which would co-exist with existing private plans, which would theoretically be available to all citizens as an option.

The United States attempted implementing a single-payer system during the FDR Administration, which fizzled before it left the white house, and then again during the LBJ Administration, which was cut down to what we now call Medicare/Medicaid via the Social Security Act of 1965.

vaksel2• 17 years ago

which just goes to show you that dems don't know how to negotiate. You never start off with a compromise, you start off with something you have no hope of getting and slowly get down to the compromise position.

btilly• 17 years ago

Single payer was never on the table. Despite having majority support in public surveys, even thinking about it would galvanize all aspects of the health care system to fight tooth and nail against the bill. Big pharm would fight because they'd expect to see the price of drugs drop. Insurance companies would fight because they would no longer have a business. The AMA would fight because they have too many connections with the other two not to unify.

In fact even the massively watered down version called "the public option" is marginal. Which is why you keep on hearing about how it is in this version, out of that one, in the next, and so on.

trominos• 17 years ago

If you have no idea what you're talking about, please don't use incendiary language.

davidw4• 17 years ago

Incendiary language is basically what you're likely to wind up with when you discuss politics on the internet. Yes, even on sites like this one; vaksel isn't just some random guy who joined the site yesterday.

Which is why I keep harping about keeping these types of articles off this site.

Zak8• 17 years ago

Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income.

This seems like a horrible violation of property rights, perhaps to the point of being a violation of the fifth amendment.

mattmcknight• 17 years ago

The challenge comes in the definition of a minimal insurance plan. What exactly does it have to cover to count as insurance? Am I going to have to put my policy number on my 1040 next year? Many things to worry about given the sordid history of bureaucratic implementation.

protomyth6• 17 years ago

part of the requirement is the deductible. So, people who have the $2,000 deductible (because you have other means to deal with the smaller stuff) would be out of compliance.

jpcx01• 17 years ago

I'm pretty happy with my high deductible plan. I'm guessing this bill will put the kibosh on that, though I'm not totally sure. I'll add reading the 1,900 page bill to my todo list.

pg2• 17 years ago

I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insurer. I ended up getting health insurance eventually, because I found the system won't treat you without it; you can't simply offer to pay doctors with a credit card, the way you can with dentists. But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently, or we could end up with a string of Ruby Ridges.

Zak8• 17 years ago

I found the system won't treat you without it

Now there is something that could use some reform. I have a hard time picturing a good solution coming from a government though; something that looks like more like a union than an insurance company might be effective.

jerf3• 17 years ago

It's going to be difficult for them not to enforce it, if something like this actually goes into effect. Getting those who think they can go without insurance to pay into the system is one of the major ways it is going to get paid for.

(It is, objectively, a wealth transfer from young people to old people. I find myself wondering if youth support for the bill would drop somewhat if youth realized what was being done to them. I'm not "old" but I'm past the age where I feel I can go without now, so I guess I'm out of this "youth", but I still don't like it. I am young enough that I don't foresee a single penny of this ever being around when I'm actually old enough to need it, since there's just no way in hell either the current system or this new one if it passes will hold up until 2045.)

One interesting scenario I saw (don't recall where, sorry) pointed out that the entire idea of forcing purchase of coverage like this is very Constitutionally dubious. (Where "dubious" means that I actually can't even come up with an argument I disagree with that the Federal government can do this based on the Constitution.) So it is possible this provision could be struck down, but leave the rest of the bill intact, committing to massive outlays with no way to pay for it.

davidw4• 17 years ago

Leaving aside whether people like the government to do things for them or not (there are many internet libertarians here who obviously do not), is requiring you to purchase something really that different from just taxing you and purchasing it for you? For instance, I am not happy about having purchased a share of a war in Iraq or numerous other things the government spends my money on.

Also, a point for consideration: you're pretty much required to own car insurance if you want to drive.

radu_floricica3• 17 years ago

I live in a country with universal health care (Romania). Being forced to pay insurance is annoying, in theory. What happens in practice is if you don't pay it and need insured medical care you have to pay for the last 6 years, with penalty (about double, in the worst case). That would be the "fine". Not being employed I was able to delay paying for about a year, without penalty and being insured in the meantime.

What you get for it is the knowledge that you'll never have to budget for medical expenses. I did have to pay occasionally, like when I wanted a better yearly checkup, but it's never been an amount I couldn't just take out of my pocket.

Anyways, I always felt that if there's something worth paying for it's a healthy society. At least as much as all the other givens: police, military or emergency services.

Calamitous4• 17 years ago

I found the system won't treat you without it

I find this assertion strange... my wife and I lived for several years on a cash-only basis with little trouble. Granted, there were no catastrophic expenses, but we never had any trouble paying cash for ordinary doctor's visits and the occasional minor emergency.

Create• 17 years ago

the reason behind this is simple. A basic task of the state (a framework for society) is to insure[sic] that its people can live (even at the eventual price of others' lives, albeit in other states). This is why the state would (normally :) not kill you, and to the contrary, has to do everything to keep you alive (think euthanasia controversy, obesity, tobacco and alcohol price in healthcare). Therefore, when you fall ill, in most normal[!] societies, people would have to help you -- even before validating your PIN code, or even if you are not holder of a visa or mastercard (are there any other credit cards left?). Like the neighboring lady looking after the kids you were alluding to once. And this inevitably has monetary costs to the society: this is why the compulsory health insurance.

The downside is, that it is wide open to abuse by those who only wish to profit themselves from society. Many countries in Europe introduced universal healthcare after the World Wars, because they learned the hard way, that health and lives and peace are the most important in [to] the world (and ie. not getting rich from online pr0n trade). A great wealth has been amassed, and it has become too tempting to chip off bits and pieces (as always with any huge value) hoping it will go unnoticed. This has happened in most countries (.de, .uk) along with the pension funds (think Enron: the millions who lost their pension savings). Currently there are little safeguards against these white collar crimes (no coincidence either, the politicians don't really make laws against their own interests).

jules2• 17 years ago

What happens now if you don't have insurance and you need medical treatment? For example what happens if you're in a car accident, do they first ask you whether you have insurance? What do they do if you don't have health insurance & don't have enough money to pay for the treatment?

1) You die? 2) They take you to the hospital and treat you

If it's (2), who pays for you? If the answer is the taxpayers then that's a reason for making not having insurance illegal.

It's the same reason why car insurance isn't optional.

DanielBMarkham10• 17 years ago

...But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently...

I'm still trying to wrap my head around that sentence.

Are you saying it's bad for government to take away all those freedoms? Or are you saying that it's a little bad for government to come strip you of your property, but hopefully they won't do it too much?

It sounds like you are equivocating. Either it's more bad than good or not. Right? And -- assuming you reply -- if it's just a little bad, where is the line where you know the government is overstepping where it should go? If your party does a little bad this year, and the other guy's party does a little bad next year, after 100 years we're not going to be in such a good spot, are we? (Made even worse by having nobody to actually blame for our predicament) But hopefully nobody will enforce all those laws too much? (scratches head)

tptacek7• 17 years ago

Wait wait wait wait wait wait.

You had 7-8 figures in your brokerage account, and that was when you decided you didn't need health insurance?

adammichaelc• 17 years ago

Luckily it likely won't get to that: http://news.google.com/nwshp?hl=en&tab=wn

pmorici5• 17 years ago

So does this mean we can all quit our jobs, live off our savings and get free health insurance from the government? Because I find that prospect exciting, if not morally dubious.

natmaster4• 17 years ago

Nope. Quite the opposite. If you quit your job, you'll be required to buy the government health care.

Who needs to add value to the economy and satisfy your customers when you can just point a gun to someone's head and say, "buy my product or I'll just take your money anyway, and then strip you of your other rights."

c3o• 17 years ago

So health insurance was the only thing keeping you from doing that so far?

miles• 17 years ago

This seems like a horrible violation of property rights

I couldn't agree with you more. On a related note, there is apparently a religious conscience exemption:

http://www.pajamahadin.com/?p=1376

Reminds me of the Amish exemption from Social Security:

http://www.amishnews.com/amisharticles/amishss.htm

And so it came to pass that in 1965, the Medicare bill was passed by Congress. As Wayne Fisher writes in The Amish in Court, "Tucked into the 138 page bill was a clause exempting the Old Order Amish, and any other religious sect who conscientiously objected to insurance, from paying Social Security payments, providing that sect had been in existence since December 31, 1950. After Senate approval in July, the signing of the bill by President Lyndon B. Johnson on August 13, 1965, made it official and canceled tax accounts of some 15,000 Amish people amounting to nearly $250,000."

seldo• 17 years ago

Why is this more of a violation of property rights than any other form of taxation?

djcapelis• 17 years ago

Taxation takes a portion of what you make while this imposes a burden to buy something even if you don't have anything. I don't see the argument for how any of this violates property rights, but it's different from taxation.

With taxation if you wanted to exclude yourself from a world of currency and live a "simpler life" without any form of modern money (and somehow found land to do it on, which I acknowledge is a tricky aspect) you could. With this new bill, for the first time ever, this way of life is closed for all Americans.

Or not really, since the penalty simply appears to be (I'm getting all my information third-hand.) that if you don't buy the mandated insurance you won't get care, which seems semi-reasonable enough to me. Not optimal, but hardly the violation of rights I was worried about.

Zak8• 17 years ago

In a strict sense, it may not be, but how a government might fund itself without taxation is a subject for another discussion. It took a constitutional amendment to legalize a Federal income tax. Regardless of any moral objections, the income tax is about as legal as it gets[0]. I'm not sure what legal theory would justify mandatory health insurance under the Constitution.

[0]I'm aware of various claims that the income tax really isn't legal, but I don't think any of them attack its constitutional authority.

rabidgnat2• 17 years ago

Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill.

Worth it!

I also don't think suggesting that this violates the Fifth Amendment is very convincing. 2.5% of the average American income isn't very much, if you do the math! Even a family making 100k per year (well above average) would be penalized $2500, which is fairly light when you compare fines for other crimes.

Zak8• 17 years ago

The point is that making it a crime to refuse to buy something is what violates the Constitution. It doesn't matter if it costs 2.5% of your income or 25 cents.

bokonist4• 17 years ago

The worst part of the mandate is that every health care interest in country will start lobbying Congress to ensure that their procedure is covered by the mandate. Thus we will be forced to pay for care we don't want, didn't need, and doesn't work. This is exactly what has happened in Massachusetts since the mandate passed, and costs have continued to rise even faster than before. The dirty secret of medicine is that most we spend a huge amount of money on stuff that just doesn't work ( http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medi... ). The mandate will make this even worse. Recently I got a letter from my health insurance provider that by law they must cover mental health drugs now. This is despite the fact that these drugs do not work ( http://www.overcomingbias.com/2008/06/anti-depressant.html ).

DanielBMarkham10• 17 years ago

I believe this is by design.

The underlying philosophy is that health care is such a basic part of human life politicians must be in control of it. So from now on (assuming passage) when you have a health care problem, you'll be going to your Congressman to fix it. Insurance not covering something? Go to your congressman. Public plan not covering something? Go to your Congressman. More people need coverage? Go to your Congressman. Rich folks getting really cool benefits while poor folks don't have them available? Go to your Congressman.

Trying to balance the budget? Thought Social Security was impossible to change? You haven't seen anything yet. Try touching national health care once it's rolled out.

It's not "solving the problem" that sucks. We all know there are problems with the free market when it comes to paying for health care and we all know insurance pooling isn't optimum. The problem is the side-effects a huge national solution is going to have.

And those side effects sure look like they make Congressmen even more powerful than they are now.

jamesbritt6• 17 years ago

"This is despite the fact that these drugs do not work "

You go from a report on SSRI anti-depressant medication not working to claiming no anti-depressant medication works?

GHFigs• 17 years ago

SSRIs are not the only kind of "mental health drugs". They aren't even the only kind of anti-depressant drugs. Nor does the single meta-analysis cited even claim that they "do not work".

natrius6• 17 years ago

This seems like it will be a rare political discussion on HN that won't be flagged, so I'd like to take the opportunity to copy/paste a comment I made on reddit a while back about how the public option is a bad idea, and see if intelligent discussion follows this time around.

A government run plan will be able to easily attract customers because it gets free advertising, making it more attractive than even private, non-profit insurers. Once the government plan has enough customers, it will be able to demand lower prices while still getting the same quality of care for its customers. If doctors refuse to accept it, they'll be turning down a huge chunk of potential customers. The government's even lower prices will draw more customers, thereby intensifying the effect until we get to the point where the government dominates the insurance industry and can set whatever price it wants.

In a functioning market with several players, prices stabilize at a level that customers are willing to pay for the goods or services in question. Healthcare costs have been rising so much because we've always valued healthcare greatly, and lower costs of food and other necessities leave more money for us to spend on it. As a result, advances in medicine come fairly quickly. If the government uses its power as the dominant insurer to drive down prices, advances in medicine will come more slowly because less money will be available. Most of the arguments I've seen for the public option seem to assume that cost reductions will come solely from eliminating non-medical expenses, like advertising. If you think that's the case, can you explain how that will happen? When the government tells doctors what its willing to pay for certain services, are they going to pay no less than private insurers are paying? That's not what happens today with Medicare, and that's not what a private insurer would do if it became the dominant insurer. This isn't about hating government; it's about how markets don't function properly when few players rule them. A public option will almost guarantee that outcome.

The public option is undoubtedly the best way to lower the cost of healthcare. However, I don't think that should be our goal. Our goal should be to maximize the quality of care for everyone, not minimize the price. We should ensure that everyone can afford healthcare by subsidizing it for those who can't, but trying to create dominant government insurer so we can provide healthcare for everyone isn't necessary. Let's get rid of silly things like preexisting conditions and the antitrust exemption, then pay what it costs to ensure everyone is insured and maintain the progress in healthcare technology that we enjoy today.

WesleyJohnson2• 17 years ago

I'm genuinely interested in the debate on Health Care Reform, but I will be the first to admit I have neither the political chops or core knowledge of the bill to really back up that interest with a solid argument. So instead, I'll try some questions.

1) I've read somewhere that there are some states, Alabama I believe was one, where there is basically a single dominant health insurance provider. As your post suggests, when few players rule, the market doesn't function properly. How is this scenario any different than what you proposed will happen under the HCR bill? If it does indeed exist already in the private sector, how do we go about putting end to these monopolies (I know that's the wrong word here, but it's the best I could come up with), without government regulation?

2) My brother works at a very small game studio based out of Florida. The company has maybe 20 people, at best, and because of this it has been impossible for the company to procure any decent rates on insurance for their employees because they do not have the leverage that a larger company would have. Why should he have to pay amounts in excess of several hundred percent more for insurance than he would have to pay at a larger company, for the same coverage? How can that be fixed without regulation?

3) You mention that without the high costs of private health care, there will not be enough funding to assist with advances in medicine. You suggest that cures and treatments will come at a slower pace as more people switch to the public option or as more and more private insurers fold up shop because they can't compete at the new, lower costs of health insurance. And yet, on the opposite hand, I continually run into, what I consider to be intelligent conversations, that would suggest that advances in medicine are actually held back by these large organizations. That it is more lucrative to treat diseases than it is to cure them. Is your stance that these discussions are merely brought on by conspiracy theorists and have little to no merit, or do you believe that there is some validity to them?

I realize the position I hold is probably apparent, but I really am interested in hearing your (or anyone else's) opinions on these items.

Calamitous4• 17 years ago

The three counter-arguments that make the most sense to me:

1) One proposal was to allow insurance companies to compete across state lines. This would allow smaller contenders to make their offerings on a larger scale, and sidestep the Alabama issue you mention.

2) The point here, I think, is that your brother shouldn't "have" to pay for insurance at all. Allowing individuals to receive the same tax breaks on insurance as businesses do would allow people to choose their own plans, open up the market more, and allow more consumer choice.

3) This is the first I've heard of this one. I find it hard to imagine not wanting to cure a disease... even in the nastiest, greed-driven environment, I think the byline "We cured colon cancer!" is worth more money any amount of incremental profit from treatments. So yeah, going to go with the conspiracy kook option on this one. :)

natrius6• 17 years ago

To clarify, my position is far from the Republican party line on the issue. I agree with most of the new regulations in the bill that I'm aware of, but I would vastly prefer a bill without a public option.

1) The scenario you described isn't as damaging because it's just a single state. If doctors are underpaid by the dominant insurer in Alabama, they can move elsewhere. Even if they don't, losing money from just Alabama isn't going to set progress that much. Losing money from the whole nation will.

2) They shouldn't, and regulation is necessary to fix that.

3) I don't think insurers and pharmaceutical companies hold back cures for diseases, but they definitely do push forward treatments that will lead to long-term revenue. This is why non-profit research funding is an important part of the system.

rdtsc2• 17 years ago

> ... without the high costs of private health care, there will not be enough funding to assist with advances in medicine.

I think that is the token defense phrase used by the big pharma companies. In fact they spend more on marketing and advertising than on research. A lot of research is actually done by the public universities.

jamesbritt6• 17 years ago

"The public option would effectively be just another insurance plan offered on the open market. It would likely be administered by a private insurance provider, charging premiums and copayments like any other policy. In an early estimate of the House bill, the Congressional Budget Office forecast that fewer than 12 million people would buy insurance through the government plan."

http://www.washingtonpost.com/wp-dyn/content/article/2009/10...

natrius6• 17 years ago

"Any public plan is likely to have a relatively narrow scope, as it would be offered only to people who don't have access to coverage through an employer."

If that is what ended up in the bill, then I agree that it will be mostly harmless. I was under the impression that anyone would be able to enroll in the public plan.

protomyth6• 17 years ago

I just cannot understand how we can keep looking at medicaid, medicare, and social security projections and think that this will save us money. I find the rhetoric and fiscal foolishness of this bill to be beyond the pale.

Also, how is this the top priority. Perhaps some of the congressmen need to check the unemployment rate and economic numbers.

elblanco8• 17 years ago

It's pretty simple math. The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care.

The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance. The only exception are measures where simply paying unlimited amounts of money into your care will get you something.

If we can move cost down from 20% of GDP (or whatever the figure is), to a level that everybody else enjoys, like 10% of GDP, we'll have realized a very large savings at a national level. Even if the cost of the program grows north of all estimates.

lionhearted6• 17 years ago

> The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care.

The United States also has only 5% of the world's population (304M/6,700M), but produces a heck of a lot more than 5% of the world's medical innovation. Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down.

> The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance.

With an incredibly unhealthy lifestyle, it's pretty incredible how long American longevity is. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen.

protomyth6• 17 years ago

Why can I buy car insurance across state lines, but not health insurance? The funny part is that the "public option" crosses state lines, but current insurance companies can't.

ars• 17 years ago

You can't. Your car insurer needs to be licensed in your home state.

And especially Massachusetts where car insurance is completely run by the government, and few regular insurance companies operate there. (Every plan by all companies costs exactly the same amount - AAA has a 5% discount for members, so the other companies are allowed to offer a discount too if you ask for it.)

protomyth6• 17 years ago

You are correct in the "McCarran Ferguson Act" leaves health, auto, homeowners to the state regulators, but it sure seems to be easier to buy my car insurance from a national company then any attempt at health.

Good to know about Massachusetts, I had never heard of a state pulling that.

vlad• 17 years ago

This is no longer true as of a year and a half ago.

Another change in Massachusetts is that everybody must submit proof of health insurance with their tax return, or else pay a penalty.

natmaster4• 17 years ago

Strange, I get full coverage anywhere I go (including other countries).

natmaster4• 17 years ago

Great, now I have buy into the screwed up healthcare system or become a felony and goto prison and lose all my rights. What kind of country do I live in now?

gojomo• 17 years ago

The most sensible package of market- and technology-friendly health reforms I've seen proposed:

http://www.willwilkinson.net/flybottle/2006/03/19/health-car...

In particular, it doesn't call things 'insurance' that are not insurance, and faces the reality that some people are going to be charity cases, and that society will (one way or another) ration the care that goes to charity cases.

The house bill hides difficult choices in mandates that turn 'insurance' into something else entirely -- a compulsory social service, run by 'companies' that have essentially become federal agencies collecting taxes. Nationalizing the industry outright would be more honest.

physcab• 17 years ago

What the bill provides:

>>Required coverage for preventative care

>>Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill

>>Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies.

>>the House package would immediately offer discounts on prescription drugs and reduce a gap in Medicare prescription drug coverage, closing it entirely by 2019.

>>Uninsured people who cannot get coverage could join temporary high-risk insurance pools, and unemployed workers would be permitted to keep their COBRA benefits until the public plan and insurance exchanges started in 2013.

>>Tax-free benefits for domestic partners just like health benefits provided to the family of an employee married to a person of the opposite sex.

>>Provide grants to states for home visitation programs in which nurses and social workers counsel pregnant women and new mothers in low-income families.

>>Nutrition labeling requirements for snack food sold in vending machines and many restaurants.

DanielBMarkham10• 17 years ago

I'm going to step out on a limb and predict that if this passes both houses and is signed, the Supreme Court will strike it down.

You just can't have a law that requires people to buy something. There's nothing in the Constitution that can be remotely construed to allow the government forcing people to purchase things.

Now at the state level it's a different matter entirely. Congress could have easily come up with some kind of reward-punishment system that required states to find some solution. And then you'd have 50 states each trying different ideas. They could harvest the best from each other. But it does not appear (to me) that the goal here is iterative, incremental solutions to a pressing problem. It appears that the goal is Big Design Up Front, Top-Down control, and over-engineering every possibility.<sarcasm>An obvious recipe for success</sarcasm>

In the last decade, and with this bill especially, I think we've finally reached the end-game of the American federalist experiment. It's become obvious that we can't meet our current obligations, and it's also become obvious that politicians get elected making promises for even more obligations, not fixing the ones we currently have. So the goal isn't to "fix the system" The goal is to gin up new and various ways to keep making more promises while blaming all problems on the other party. The party's over, but it might be another 20 years before the cops show up, so let's have fun while we can!

Mz• 17 years ago

My issue with this is that it presumes "healthcare" and "medical care" are the same thing. Study after study after study indicates that diet and lifestyle are major factors in health outcomes and greatly influence your odds of suffering the deadliest conditions. But getting a prescription for a pill is a lot easier than making dietary and lifestyle changes, so a great many people will go that route and then complain about the high cost of medicine when they wouldn't need medication and frequent doctor's visits if they just took care of themselves. If you really want to bring down medical costs, people will have to start taking better care of themselves. Restructuring how we pay for it won't do a heckuva lot towards lowering costs if people continue to pursue self-destructive lifestyles. To the degree that it adds regulation and bureaucracy, the odds are good it will increase costs.

tptacek7• 17 years ago

It's interesting to see people who supported Obama, or even paid attention to the '08 election at all, acting surprised about the health insurance mandate. Obama was pummeled over the concept during the race, most notably by Clinton during the primary. This was a long time coming.

As for the concept of a mandate, it's simply the flip side of guaranteed issue. Without a mandate, guaranteed issue screws insurers: it creates --- as a matter of law --- an incentive for people not to get insurance until they get sick. Adverse selection is the enemy of insurance.

It seems to me that you can't argue about whether an insurance mandate is confiscatory or overreaching without at the same time arguing about whether people with preexisting or chronic conditions (or some statistical disposition to same) should be excluded from the health care system. And yet: all I see here is arguments about whether politicians should run the health care system.

Finally, I'll just note that the dollar amounts being discussed for the fine accompanying the mandate are a fraction of what someone would pay for actual health insurance, and probably lower that one would pay even for low-deductable coverage. I think lots of people don't realize that, because right now, the cost of coverage is very stealthily deducted from their income at the fiat of HR directors and the health insurance reps that instruct them.

DanielBMarkham10• 17 years ago

Couldn't you just allow cross-state insurance pools, insurance portability, require direct payment and encourage the states to have their own pooling solutions, much like some states currently do with automotive insurance?

I don't think it's an either-or question -- pooling/mandate or not -- at the national level. Sure, I think lots of folks would like it to be that way, but it doesn't have to be. It doesn't have to have a centralized answer for it to have a solution. Co-ops, for instance, have been left on the floor so far.

tptacek7• 17 years ago

Cross-state insurance seems like such an obvious proxy for insurance de-regulation that I'm surprised its advocates don't just come out and say it: "we should work with the minimum possible regulation on insurance companies".

I'm wholly ambivalent about whether states or the federal government should operate the government-sponsored risk pool.

You already know where this discussion is going to go with me, so think about whether you want to wade into it. Pick your poison: government by the Government, or government by the insurance companies. I'm not wild about what the federal government is coming up with (though not because of the mandate, which seems sensible), but the major insurance companies are both inept and actively evil, and the system we have today is rigged to favor them decisively whether we regulate or not.

jamesbritt6• 17 years ago

Nicely done on a Saturday night.

Dems must be proud of their work.

sachinag• 17 years ago

The best thing about my new gig at oneforty is that I'm in Massachusetts and I can get health insurance via the Massachusetts exchange. I seriously, seriously believe that if health insurance doesn't pass that startups who aren't looking to raise money locate in Massachusetts for this reason alone (and there are a ton of other good things about the community here).

The House Passed the Health Bill

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