Healthcare Update

Okay, here's the deal. House bill is complete. A separate vote in the house on HR 676, Single Payer is also supposed to happen. Senate does not have a bill. When the Senate has a bill, the two bills get voted on, then they go to reconciliation committee. Then I think that bill gets voted on, then the President signs.

House Bill (2260?)
-Insurance Reform
1. No more lifetime limits
2. Cannot non renew a policy unless there's fraud
3. Annual caps on out of pocket expenses
4. Cannot discriminate based on gender or preexisting conditions (but can discriminate on age in terms of premium)
5. Individual mandate - meaning if you don't have insurance you pay a tax penalty
6. No employer mandate - meaning employers who don't offer insurance don't pay a tax penalty
7. Funding is unclear at this point, but some would come from Medicare "savings" which is a point of contention, and the rest might be funded by taxes on those making $250,000+.
8. Government panels that recommend treatments and end-of-life counseling. The panel's recommendations would be unbinding. This piece of the bill has a lot of misinformation around it, critics compare it to something Hitler did, although it's really not like that at all. Seriously, I just want to go to the doctor when I'm sick, and these schmucks at the Town Halls are carrying around pics of Obama with a Hitler mustache. Arrrggh! So anyway, the panels might get wiped out.

-Public Option
1. An "exchange" (read Web site) would be created where consumers could choose from government-negotiated private plans, or they could choose a government-run public plan, presumably cheaper because it doesn't include profits, marketing, or underwriting costs.
2. Government plan will have to negotiate reimbursement rates with doctors, won't use Medicare rates
3. Subsidies for low-income
4. Financed by premiums only, no new taxes
5. Not in place until 2013

Senate (what we will probably see)
I expect the Senate to widdle down the already watered down bill to include non-profit "co-ops" instead of the government run public plan. "Co-ops" could be seen as more politically popular, as they would be managed by non-government organizations (who would actually manage these things is unclear). Presumably, there would be several co-ops in the exchange, vs. the one public option in the House Bill.

Now, co-ops in my opinion are not a good solution for a very simple reason. The Law of Large Numbers. Insurance is about spreading risk. The more risks in your pool, the fewer relative losses, the cheaper the premium. Hence, big groups can negotiate better plans than small groups. One federally administrated government plan would probably attract a lot of consumers, hence allowing lower premium. Not to mention, Uncle Sam is much sturdier negotiater than any Tom, Dick or Harry that would be managing these co-ops. The Feds can basically dictate the terms of most contracts, incl. reimbursement rates for doctors and pharmaceuticals. Unfortunately, they are loathe to flex that muscle currently, preferring large campaign contributions to consumer-friendly policy.

Frankly, I am very upset about the way this is going. I am not convinced the consumer will see savings from this, in the short term or in the long term, esp. if we lose the public option.

Not to mention, it is so fucking clear that the Republican mantra of tax cuts, unregulated markets, and small government DOESN'T FUCKING WORK!!! Bush tax cuts created 0 jobs. ZERO!!!! We've lost jobs even as population has grown. It's like we just keep letting the chimpanzee drive the car. Chimpanzees can't drive! They don't even believe in driving. They just get distracted by shiny objects until the inevitable crash.

It's time for Democrats to do the job we elected them to do, but instead they seem prepared to sell us out to corporate interests again.

The fight will never end. Keep the pressure on. See below to contact your Senators. Tell them you want a public option that will keep costs low, NOT CO-OPS!

Town Hall Meeting, starring me (sort of)

http://link.brightcove.com/services/player/bcpid13105315001?bclid=1612721902&bctid=33425062001

Heathcare!!!!

http://www.pbs.org/moyers/journal/07312009/watch.html

First off, I love Bill Moyers. Yes, I am a nerd who would rather watch PBS on a Friday night than go to a bar.

One thing I've noticed is how every argument against a public healthcare option can be countered with, "That's what's happening now!"

The rich will subsidize the poor
That's what's happening now!

There will be a bureaucrat between you and your doctor
That's what's happening now!

Competition will be stifled
That's what's happening now!

It will be inefficient
That's what's happeing now!

It will be too expensive
That's what's happening now!

It will kill old people.
That's what's happ - oh wait, old people have access to Medicare, a publicly run healthcare provider which is very efficient and has higher rates of satisfaction. Old people would not see much of a change if a new public Medicare-like option was available to all. Admittedly, they will continue to die from time to time.

So I guess not every argument...

It breaks my heart that a few "blue dogs" can almost kill a public option and employer mandates. When the Republicans were in charge, moderates like Chuck Hagel didn't have this kind of power. Many very conservative policies were enacted, killing regulation and civil liberties. We all know how that ended up...

(Update: just learned that Nancy Pelosi has promised to have a vote on Single Payer Healthcare on the house floor. Yea! The House's final bill maintains a public option, but requires them to negotiate rates rather than tie rates to Medicare. The Senate will be trickier, and they don't really have a bill nailed down. The Senate Finance Committee chaired by Max Baucus is the real bear. Write to him and tell him what's what: http://baucus.senate.gov/contact/index.cfm)

Fact is, Republicans do not support responsible policy, they support corporate lobbyists. They've proven it. America voted for CHANGE, we want Democrats to exercise as much disregard for conservative interests as they did for our interests when they were in power. I don't want to build a bridge to a rich thief that wants to continue to give my money to other rich thieves. What I want is to go to the doctor when I'm sick, and not get a damn bill in the mail that I have to dispute every single time. I want drug addicts to be able to get counseling so that they have a chance of getting clean, rather than committing crimes. I want to know that even if I lose my job, I can still get treated for unexpected illness. I want to know that our kids are going to school with healthy kids.

It's time for our party to get real about healthcare, and we need to demand it. I would rather pay taxes than these exorbitant premiums. The private market can continue to operate competitively along side a public, not for profit model. They have this thing in the Senate bill, "co-ops". It's like a community-run insurance option. Basically, they took a public model and cloaked it in complexity and inefficiency. So they could "get the votes." They also removed employer mandates, but maintain individual mandates. So if you don't have insurance, you pay an exorbitant tax penalty, like we do in Mass. But in Mass, employers w/ more than 8 employees also pay a fine if they don't offer insurance. So the burden is shared, and we're still operating at a deficit. Uninsured Americans cannot afford the whole burden of funding this system.

And while I'm on the matter of funding, can I just reiterate, I don't mind paying more in taxes if it means my overall, out-of-pocket healthcare expenditures go down. Next time you get anxious about higher taxes, imagine a life without premiums, deductibles, copays, scheduled benefits, lifetime limits, shared percentages, and out-of-network fees.

The reason Commonwealth Cares is operating at a deficit isn't because penalties aren't high enough. It is because MA is operating as an agent to insurance companies. The state goes out and negotiates plans with Blue Cross, etc. So we are still paying corporate profits, marketing, underwriting, advertising. All that would go away with a publicly administrated, not for profit alternative. Let the insurance companies live in a profit-driven vacuum, keep them out of any public option. The co-ops are trying to fill that void, but I'm skeptical...

These things always go longer than I intend them to...

Even though I don't want to perpetuate this thing...

... how fucking disgusting is Mark Sanford? I was actually worried for this pervert's safety not too long ago. It honestly didn't bother me that much that he had an affair, it's more that he couldn't fuck an Argentinian and govern at the same time. Now he's talking about some "ultimate line" that he may or may not have crossed with a handful of other women, and the nausea begins. Is this seriously the shit I gotta hear about? But the thing that really pissed me off was when he started referring to his mistress as his soulmate and describing some cheesy love story. Can you imagine how that must make his wife feel? What an asshole. The only silver lining will come when that wise Latina rips his beating heart out of his chest and eats it for breakfast. She might make off with some of his money, too. It's just a matter of time...

Write to this jerk like I did, and tell him America has more important things to worry about than his indiscretions.
http://www.scgovernor.com/contact/email/

The Community Health Insurance Option

So, the Senators put a plan together. Here's the link to their little marketing byte:

The Community Health Insurance Option

This plan would be federally administrated. On the surface, it appears to be a centralized, simple enough plan. Of course it is just in its infant stages. And the golden question, how much will it cost? I think what we all want to know is, how much will it cost me. Will my taxes go up, how much, will I be eligible, what's the premium? If the Community Health Insurance Option really is a centrally administrated, more affordable, all-inclusive (or almost all-inclusive) plan, than glory, glory! Time to read the fine print. Watch out for those naysayers in Congress that want to water this thing down!

Stop Bitching...

...Do something! Call/email your senators & representatives! It's easy and it really makes a difference.

Find them here:
White House: 202-456-1111 http://www.whitehouse.gov/CONTACT/
House of Reps: (202) 224-3121 https://writerep.house.gov/writerep/welcome.shtml
Senate: (202) 224-3121 http://www.senate.gov/pagelayout/general/one_item_and_teasers/contacting.htm

I just emailed them all urging them not to support health care legislation without a public option. Contacting them really makes a difference, but only if a lot of us do it.

Unless of course you want to keep letting those blowhards on Capitol Hill sell you out. Remember, we pay their salary, and that includes their sweet health insurance coverage. They work for us!!!! Let them know who's boss.

Thanks ~

Rethinking Iran

My last post was very pessimistic about the situation in Iran. I guess I still doubt we will see the election nullified or even recounted. But today I heard an Iranian diplomat speaking on the radio, who suggested that the UN could get involved in demanding a recount. I hope that international diplomatic efforts and national civic action are strong enough to initiate a recount. The more the Iranians demand accountabililty, and the more pressure we all apply through media and diplomacy, the more likely there are to be results. Maybe it's not impossible. And if not this time, next time for sure;)

Health Care

Okay, here's my two cents. Yes I am a progressive. Yes I want a public option. Yes I think single-payer is the best model. I do think there is room for a private competitive market, but ultimately I think all Americans should have a public option.

I work in Property Casualty Insurance. Insurance has a very specific role, to finance risk. We make money by insuring a lot of relatively safe exposures, and only paying out for the occasional accidental loss. Health insurance isn't like this. Health insurance funds wear & tear. It's more like an auto warranty, but that of course runs out after the car ages a bit. The point is, insurance is not a wise business model to fund healthcare, because we need it to pay for wear and tear and accidental loss. (Especially wear and tear because often medical costs associated with accidents are covered under property/casualty policies). Since there is also a profit motive, we end up paying exorbitant premiums, as if we were paying for wear & tear and accident insurance on our automobiles throughout the life of the car. We all feel this play out in our day to day lives. I am a healthy person, and I still see how my premiums are not enough to fund my basic care and why health insurance companies need deductibles, copays, higher premiums, limits and other mechanisms to limit their exposure; they simply cannot run their business otherwise. And that's to say nothing of exorbitant executive pay, marketing costs, administrative overhead, etc, many of which are eliminated or reduced in a public/not-for-profit model.

Of course, the average individual does not have the resources to cover medical costs anymore, nor do employers, nor does government. So we are in quite a pickle then. This is why politicians focus on cost reduction. It's an obvious first step, and one that seems like it would be generally less susceptible to political backlashes. The insurance companies like reform plans that focus on cost-reduction, because it's not a public competitor, and they can keep promising to cut costs, buy some time. The rest of us like cost-reduction because we can't afford this stuff anymore.

The insurance companies won't cut costs though, unless government forces them to. And I do mean force, as in Uncle Sam says to Blue Cross, "You must charge $x for y services." I'm not here to be a class warrior. As I've already stated, profit-driven health insurance business models are not sustainable nor lucrative. Also the profit model subverts public policy, because the field makes money off sick people, so the more sick people, the better. It's all about turnover, people. We can't expect businesspeople to be philanthropists. There is a time and a place to be profit driven, and that place just is not healthcare. It never was.

So here's my idea. Being that I am not at all qualified to evaluate responsible health policy in this country, I think I have as good a shot as most politicians.

I recently went to a little meet and greet breakfast at Worcester Temple Beth Am to meet my local candidates for state senate. I ran into an old fellow, Gerard, and we got to chatting politics. Gerard told me that Taiwan recently moved to a public health care model. According to my new friend, the Taiwanese travelled around the world to find the most efficient model of administrating health care. And they chose Medicaid. In the interest of full disclosure, I have not confirmed this fact.

Medicaid, as I understand, is a state-administrated health care provider for low-income people. It differs from Medicare, as Medicare is federally administrated, and available to the elderly. Hence, low income elderly people sometimes get stuck in the middle.

A state administrated program seems like a better approach to me than a federally adminstrated program. Many states already have some kind of public health, and the states could try different things and learn from each other. Also, state policies are closer to the consumer, and tend to be less bureaucratic and more accessible. I do believe the public health program should be federally subsidized, but I believe the states would be more effective administrators. According to Gerard, the Taiwanese agree.

Now, as progressives, we have to fight the urge to demonize private industry. These companies provide jobs and reasonable benefits and income to many Americans, and right now is not the time to be abruptly robbing the health insurance companies of market share. We need to acknowledge that a sudden shift in the economy can be extremely disruptive, and develop a long view to a single payer system. A lot of progressives disagree with me on this, and they can go pound sand. Nothing happens overnight. The suffragists worked for over a century!

So, my idea is annually raise the cap of income eligibility for Medicaid. Year one, kids under 12. Year two, income eligibility ceiling goes up $10,000. Or the next 1% of incomes. And on until everyone is covered. Each increase should be coupled with tax increases on the newly eligible classes. The idea is that you take your health insurance costs and pay them in income tax instead as you move away from your private company to a public provider. I'm sure the GAO would have a field day with these numbers, but you get the idea.

And that brings me to a little diatribe about one current plan. Robert Reich, whom I respect immensely, has suggested that we should tax employer benefits to fund a public model. Correct me if I'm wrong, but isn't that self defeating? The more people move away from a private to a public market, the more money you need for the public market, the less money you have. Am I missing something?

Would love to continue discussion with anyone who cares.

Iranian Election Fallout

Ok, I'm throwing my hat in the ring here. Mostly because I want to discuss this stuff, but nobody in my life seems to care. Not that anyone will ever read this thing. 

I've read up a bit on this whole election debacle in Iran. I think the American inclination is to identify with the reformist, whom we have identified as Moussavi. And just look at all those Moussavi supporting Iranians in the streets protesting the election results. They obviously have a fire in their bellies, one that clearly trumps whatever suspicions Americans had in 2000 & 2004 elections. I feel a sort of patriotic identification with their rallies; if they were American, they'd be exercising their First Amendment freedom.

But they aren't American. I am seeing them through an opaque American lens. And I realize that. While I won't be traveling to Iran in the near future to get the insider's perspective, I do feel that the sheer level of political upheaval is indicative of election malfeasance. But there's not a damn thing I can do about it. Nor is there a damn thing I should do about it. The Iranians are working it out, and frankly, I think they're going to fail. It's good that there are rumblings of election recounts, but does any of us seriously thing that Ahmedinijad is going to be dethroned at this point? And would it really be appropriate for the US to get involved?  

But God bless them anyway for fighting for what they believe in, and may we all be inspired by it. They are facing far more violent government retaliation than we ever did in this country. And they are out there fighting nonetheless. These aren't Iranian leftist yuppies, as some bloggers have insinuated. They are patriots with conviction. And they are being murdered. 

Despite that, and despite weird accusations that the US is somehow inappropriately participating in this, I see no indication that our foreign policy is seeking involvement in this crisis. Obama has acknowledged the US's inappropriate meddlings in Iranian leadership in 1953. Obama has stated that he doesn't believe the outcome of the election matters much in terms of US foreign policy. While I find that statement highly debatable, the point is that we aren't involved in this thing. We can blog about it and cover it and watch footage on the news. But we are not getting involved politically. And as much as my heart goes out to the Iranian protesters, and especially to Iranian women, I don't see that any official involvement by the US at this point would be useful. But we do have the right to discuss it in our media, just as Iranians have the right to protest in the street.

And while I think we are all stuck with Ahmedinijad for the next four years, I pray that this uproar serves a more long term goal. Perhaps as in America, they will iron out some of the holes in their election system, and elect a reformist next time around.

Or maybe that's just my naive American lens again.