natowelch

Cross-posted from n8o.r30.net:

Mandating that people buy private health insurance is the wrong thing, but I don't think it's so bad that it overrides the counteroffers of a rescission ban and an expansion of Medicaid subsidies.

I don't buy the argument that allowing the Senate bill to pass into law will somehow diffuse people's dissatisfaction with the health care system. This bill is garbage, and I don't seriously see active progressives or significant numbers of polled voters satisfied with it. A public option was a clear majority priority, and there isn't one. Even the House version's public option wasn't one.

It seems the first thing you have to learn about politics is that the fight for justice never, ever stops. It doesn't matter whether that stop is based on winning or losing. Satisfaction and discouragement both accomplish nothing.

I think the effort that would go into opposing this bill would be better spent improving it, and pushing the next bill. Because there will be another one. We might have to replace some conservative Democrats to get the votes first, but there are elections with which that can be done.

Cross-posted from n8o.r30.net:

There's been considerable debate on the Senate health care bill where it belongs: among democrats.

Some progressives want to scrap the bill - and start over, I guess. There's a sense that it reall is worse than nothing, since the mandate in the absence of some form of public option or other cost controls amounts to rewarding the industry's bad behavior, not only with taxpayer subsidies, but with citizens' own earnings.

I'm starting to get the idea that people simply can't get anything they actually want without carving it out as a compromise from the plutarchy. And really, once I look at it in that light, I become less concerned about whether the health insurance industry is getting something it doesn't deserve. It's (mostly) not my money, after all.

But I have to admit that we are getting something in return. It's not WORTH it, and it's not just, but it's something.

The more interesting discussions have to do with the political tactics involved in the debate of whether to reject the bill. How are voters going to react? If progressives kill this bill, and nothing passes in its place, will progressive voters really stay home rather than voting in the midterms, scuttling the (non-) majority they barely held together to pass this turd of a bill?

I have to admit this claim sounds absurd. Reid has been whining about not having 60 votes for years, bringing into sharp focus that the quality of legislation turns on the number of good legislators you can get in the Senate. If it's becoming apparent that we can't get what we want with as many votes as we have (and it sure as hell isn't 60), why in the world would people not continue voting for more and better Democrats? Wouldn't the first thing to cross people's minds in explaining such a failure be the same thing we've been told for years?

Maybe it has something to do with the fact that conventional wisdom holds that Reid has his magical 60 votes when he obviously DOES NOT. Despite the fact that Lieberman and Nelson are "in the caucus" (ever seen a liberal Republican?), they are clearly not constituting your hallowed 60 vote majority if you strip out the entire centerpiece of meaningful legislation just to get them to ALLOW A VOTE on the bill. Nonetheless, voters have been hearing this magical "we finally have a filibuster-proof majority", and still wonder why the fuck nothing worth a damn can get done.

Regardless, everybody is pretty much coming to terms that nobody is going to get what they want, and the debate has moved to the consequences for "fixing it in post". The discussion is about which outcome will get more left-wing voters to the polls in the next election, because the Senators we have are obviously not enough. One must compare estimates of base voters demoralized away from voting by the Senate's paralysis against estimates of those energized by the fact that, well, we got a bill, which is more than we've had in decades, even if it's worse than nothing.

Will more voters be demoralized if the current bill passes, or if it doesn't? THEN, compare to how many voters will be ENERGIZED by the argument (presuming this message, "more and BETTER Democrats", is pushed competently) that we still need more votes in the Senate, if the current bill passes, or not.

It's a complicated calculation. I have no damn idea.

Cross-posted from n8o.r30.net:

Dear Senator,

I would like to eat at the cafeteria during my lunch break every day, but all they have on the menu are shit sandwiches. I could go for a plain hamburger or even a BLT, if I could. Can you guys do anything about this? I know it's a stretch, and I don't expect much, but I figured I'd at least ask.

Thanks,
Joe Constituent

--

Dear Joe,

Yeah, I brought up the lunch menu issue at the last staff meeting. Turns out we got a smokin' deal out of the bargain! As part of a sweeping new lunch program, we got the cafeteria to drop their prices on shit sandwiches by 50%! They're going to call them "Freedom Burgers", now. We made the program mandatory for everyone, so we'll be taking the meal costs out of your paycheck from now on. You won't notice a thing.

Bon Appetit!

Your Senator

--

Dear Senator,

Thanks...
/deadpan

The next time I have a problem, I'll be sure to keep it a secret from you.

Joe Constituent

Cross-posted from n8o.r30.net:

The public option is out.
Medicare Buy-in is out.

All we have left is a Medicaid subsidy expansion, and an alleged ban on rescission (except in cases of "fraud" and "willful misrepresentation", which is what most rescissions are based on currently),

in exchange for:

A personal mandate that people buy crappy private insurance, without any regulation to control costs or pricing.

Tough choice. It seems socialism is perfectly acceptable, as long as we are not just subsidizing, but mandating the purchase of a lobbyist's client's services.

The Singularity has already happened. Now we are merely discovering the consequences.

We are surviving serial crises in the growing shadows of slowly falling giants.

Cross-posted from n8o.r30.net:

The Senate bill is no better.

Only in America can you turn a push for a social safety net into mandatory corporate welfare.

Cross-posted from n8o.r30.net:

Canada is a better place to be uninsured than the US.

Cross-posted from n8o.r30.net:

The House health care is looking more and more plutocratically compromised the more I hear about it.

I keep reading that the public insurance option in it is only really available to around 6 million people - the rest don't qualify, including more than a hundred million people currently uninsured. So the public option isn't any kind of option for most people. It's a public option in name only (hereafter: "POINO").

That being the case, it is almost as bad as the personal mandate to purchase insurance without a PO of any kind, as I've said before. It's one thing to subsidize insurance industry profits by spending tax dollars through Medicaid; it's another to force people to do it themselves. That's disgraceful. It's equivalent to raising taxes on the poor and middle classes, something President Obama has most clearly promised against. But if the "tax" is levied by insurance companies, and not government, he can get away with it on a semantic technicality.

Now, with that said, this particular bill might be better for me specifically, because I'm likely to be one of the few who can qualify both for the public insurance option and the expanded Medicaid subsidies. I won't know until I can see what's on offer.

Cross-posted from n8o.r30.net:

Well, well. Something passed the House, finally, barely.

Here's the inventory:
* Insurers are banned from rescission of customers with pre-existing conditions, as predicted. I don't know if they're banned from refusing new subscribers based on pre-existing conditions, however. They also lose their anti-trust immunity (which, frankly, I didn't even know they had to begin with).
* There's a public option! So this makes the preceding question moot, since the PO isn't going to turn anyone away on that basis - it's a federally-instituted health insurance co-op, in essence.
* There are subsidies for people with low incomes, paid for with what appears to be a tax increase on households making more than half a million dollars a year. And really, who cares about their taxes?

On the other hand:
* There's a personal and employer mandate. Everyone is required to buy some insurance. Given the existence of the PO, I can live with this. I won't have to give my money to for-profit thugs. I look forward to seeing what kind of plans the exchange will have when it gets off the ground.
* There was an amendment tacked on that prohibits the funding of abortions by PO plans or government-subsidized private plans except in the cases of rape, incest, or maternal endangerment. That's a bummer, but it's not a bad bone to throw conservatives. It was also obviously not a show-stopper.

Of course, we're not there yet. There is still the much more difficult Senate to pass, and the inevitable House/Sentate conference compromise process.

But it appears the cube has rolled onto a brand new side. It's progress. It's history. I approve.

Jiminy Jester Christ - Did I just say that about an act of Congress?

Cross-posted from n8o.r30.net:

Hm.

There is a difference between prohibiting rescission (insurers dumping customers for pre-existing conditions only when they get sick, AFTER they have been paying premiums for months or years) and banning the practice of denying enrollment on the basis of pre-existing conditions entirely. So the idea, previously floated, that I could "game the system" by not buying insurance until I needed it, may not be as viable as I thought.

But what is clear is that any public option - even any co-op - needs to be playing by the same rules as private insurers. But it seems to be the case that, by their very definition of their natures, that can't happen.

The ability for an insurer to deny enrollment alone, never mind coverage after enrollment, tilts the playing field in their favor. A public insurer, be it government or a co-op, is in the business of insuring people, not making a profit. Thus, all those with pre-existing conditions will invariably be forced to enroll in public insurance plans while private insurers cherry-pick healthy customers. Private insurers thus get the better end of the deal, because the costs to insure healthy people are less than the costs borne by public insurers who won't turn sick people away.

Now, on the other hand, public insurers save costs by not having pay for profits or marketing. It's hard to say, however, how this will balance out. It's like trying to weigh the amount of money you lose to file sharers who won't buy copies of your work when you release it for free distributions against the amount lost to those who won't buy it because they hate DRM, or don't even hear about it in the first place because you're too paranoid about piracy. Who will come out on top in terms of fiscal feasibility is hard to say without data - and there is none, because it hasn't been done yet.

Businesses often oppose competition by government on the basis that government has an "unfair" advantage in the marketplace. But this is a textbook case of exactly the opposite.

So, in order to truly level the playing field, either private insurers are going to have to be prohibited from denying enrollments of patients with pre-existing conditions, or we can leave it at prohibiting pre-existing rescission only. While prohibiting pre-existing rescissions is certainly called for, I somehow doubt that any public option or co-op plan will really succeed if it remains disadvantaged by a lopsided ratio of sick customers.

Cross-posted from n8o.r30.net:

Talking to a friend, I realized a few more things about my health care realizations.

It isn't quite true, as I have been suspecting, that the likeliest contested outcomes of the current health care & insurance reform fights now ongoing in congress would have absolutely no affect on me. I found something that matters to me, and, thankfully, it's not even something that's hotly contested among the party that matters: the Democrats. It's not even specifically contested by Republicans - although they certainly want to block it as part and parcel of sending anything even spoken of politely by the Democratic majorities down in flames.

Surprisingly, it isn't the public option.

As I mentioned in my last post on this subject, it seems that health insurance is less about protecting health as it is in protecting financial assets. But it isn't just catastrophic emergency care that bankrupts people - it's slow, creeping diseases. Parkinson's, Alzheimers, Cancer. None of these will send you to the emergency room to get the kind of care they can't refuse to the indigent. It WILL cost your ass an arm and a leg. For emergency care, insurance doesn't mean the difference between getting or not getting care. But for some illnesses, it does. In those situations, insurance means more than mountains of debt that don't matter anyway - it means the difference between persistent suffering and living a livable life.

So I'll be very happy to see provisions in most of the bills being debated - provisions that aren't really being debated themselves - that would prohibit private insurance companies from denying coverage or claims on the basis of pre-existing conditions.

So this will mean that, so long as I'm healthy, I have the freedom to "game the system" and not buy insurance until I really need it.

Now, insurance companies will say (and I understand where they're coming from) that it's not really fair to allow people to do that. That would be like being able to buy home insurance after your house burned down. But really, I don't have much sympathy for this argument, because those who make it just happen to be the very same assholes who refuse to tolerate the really quite modest tax increases that would be needed to fund what every other developed country in the world has taken for granted for decades: single payer health care.

So suck it up, fat cats: You're lucky enough you don't have to pay for my prescriptions, check-ups and flu shots. I think you can help pay for some of the costs of chemotherapy for the destitute and indigent if they happen to need it.

Now, granted, they still have the balls to wedge in a personal mandate, requiring all Americans to fork out for some form of insurance. Without a public option, this amounts to a despicable handout to an insurance industry that doesn't deserve it. I know I'm sure as hell not going to give these fuckers my money, even if it means having to pay penalties to the government instead. But at least I know I'll be able to get some kind of actual insurance when I know I'll need it.

I went out shopping for health insurance, just to see.

For a single, non-smoking male resident of Snohomish county, WA, monthly health insurance premiums start at $71, with deductibles starting at $1000. If I limit my premiums to no more than $150/mo, I can get a deductible of $1000 or $2000 or so.

I had some unexpected reactions to this, and it really brings out the contrast between my liberal/progressive politics and my libertarian personal attitudes.

First off: That's it? I think I could afford health insurance for $100/mo or less.

So what was stopping me? What was I getting for that $1000+/year that was so worth having?

I've been lucky, so far in life. I have been uninsured since I got out of school, and haven't had many health problems. I've spent more on dentistry and glasses than other health care. I've needed to see a doctor once since 2003, for what might have been a kidney stone, and it dissipated untreated while I was at the clinic.

In other words, I'm one of those guys who would lose a TON of money paying health insurance premiums for nothing.

Now, don't get me wrong. I know that I'm going to get hit by the bus someday. I'm not going to live young forever (though, honestly, I had more bumps, bruises, stitches and scrapes as a kid than I have since). I also know that there is a lot of preventative care that I just don't bother with because I can't afford it, that I would get were I insured.

But then, I look at the deductibles. Am I really going to spend more than $1000 on preventive care in a year, just because I'm insured? No. A few hundred dollars, maybe. The point of preventive maintenance is that it's cheap, right? So if insurance isn't going to cover that, what the hell am I paying for?

The answer, is, of course, bus insurance. The point is that if you are overtaken by catastrophic medical bills, you can avoid going bankrupt.

Here's where my logic gets even more unusual. I don't really have any property or investments. What do I have to lose from bankruptcy? I'm poor. And I'm just not well motivated to acquire any. I'm judgement-proof. What threat would a medical bankruptcy really pose?

It seems that health insurance doesn't protect your health - it protects your money. And I have neither money to protect, nor any intentions of acquiring any. The system does not apply to me.

I'd be more worried about the injuries or illnesses I'd have to deal with than the costs of treatment. Once you get past a certain point into the negative, money is no object; it's all just stuff you'll never pay off anyway.

And conservatives worry that giving people money destroys incentives to work.

I have actually learned something new in the US health care reform debate. When I first Robert Reich explain it, I was bewildered:

"The public plan would not be subsidized by the government, or have the government set the rules for anyone."

So, the public option, as proposed, would be funded like any other health insurance company: from premiums. The difference would be that, being a non-profit enterprise, it would be "unfairly competitive" because it would not have to make so much profit, or blow so much on, say, marketing, because everyone would know about the public plan, in the same way they know about Medicare.

Then I heard it again in Obama's speech before Congress on the subject.

Now, my understanding of conservative and/or libertarian objections to the public option revolve around using forcefully coerced (dare I say "stolen") tax dollars to subsidize the health care of others. But to hear these guys tell it, the public option doesn't even use tax dollars. So if no one who has health insurance already is going to be forced to endure a "government takeover" of health care, AND no one is being coercively forced (through taxation) to pay for someone else's coverage, what exactly is the substance of the libertarian objection, again? Is it just the same plain old ideological principle that says "You can do whatever you want, unless you want to do it together"?

Now we've heard mutterings in the background about health insurance cooperatives being proposed as an alternative to the public option. The primary criticism of this is that coops - plural - wouldn't have the requisite size needed to have the necessary negotiating leverage to strike competitive pricing deals with drug vendors and doctors.

But, as I see it, the public option effectively is a co-op; one that has the requisite national size and scope. The only difference, which seems rather minor to me, is that it's incorporated statutorily instead on entirely "private" initiative (I imagine this is what Canadians would call a "crown corporation"). Big deal. At that rate, it might be just as effective to attempt to incorporate a national-level health insurance cooperative entirely on "private" initiative, instead of pushing Congress to legislate it into existence.

But then again, this has always been the case. So why don't we already have a national-level health insurance cooperative, that can save money by being unbeholden to Wall Street profit expectations? If it's so much more competitive, why isn't it already making for-profit insurance companies cry uncle? Is it really easier to get this by pushing for the proverbial Act of Congress?

I find it interesting to note that Obama and Frank's so-called "Nazi policy" of public health insurance is implemented by such Nazi countries as the UK, France, and, lest we forget, Israel.

Every so often, John Robb at Global Guerillas describes the difference between guerilla warfare and terrorism. The purpose of a revolutionary guerilla force is to overthrow and replace existing government. In contrast, terrorists are only out to hollow out existing governments, and have no intention of replacing it with something that can effectively provide the services governments provide. The idea is merely to disrupt the functioning of society until society meets its demands, rather than to dismantle regimes that oppose them, and replace them with institutions that can fulfill them. It's a kind of cheap cheat, an attitude that says "If I can't get my way, nobody else can, either". It also costs far less resources by focusing on disabling one's opponents, instead of making one's own case.

Remember that when you watch this.



Some defend this as the citizenry's protected first amendment expression; I see it more as the abridgement of the protected first amendment expression - you know, that of those who couldn't be heard above all the chaos. What about them? Shouting someone down isn't freedom of speech - it's censorship.

I'll give them this much: Nobody died. Yet.

You know, we have more people who are uninsured in this country than the entire population of Canada.

--Wendell Potter, recently retired PR executive for CIGNA, one of America's largest health insurance providers.

It IS a bipartisan bill; it appeals to Democrats - and conservative Democrats!

Don't let plutocratic capitalists stop it because they're afraid to compete with "socialism".

Granted, I still have no idea if I would be able to afford anything the bill offers yet. But I'm getting the idea that if public health insurance is actually allowed to compete in the "marketplace", it will indeed be "unfair" how popular it will become.

Of course, the health insurance lobby could be about as wrong as the copyright cartel. I mean, market fundamentalists like these are always the ones saying that government is incompetent. So what are they afraid of?

I just got through watching Michael Moore's Sicko.

It was so pointed, I had to pause for an intermission. I still cried. Twice.

Moore's not exactly the most accurate, as journalists go. He uses tactics. He bends truths. But how far do you have to go before the preponderance of evidence that the US is run by so few for their own benefit becomes too much to just wave away?

Transhumanism? What possible relevance could the bounties of prospective emerging technologies of years hence have, when we have so very badly screwed up securing the benefits of industrial societies - benefits that are now at least 30 or 40 years old? If we can't properly distribute those, what possible hope can the "transhumanist project" really offer?

For many years, future studies and emerging technologies may have well just served as an escape for me, from the present that was a consistent and repeated disappointment. These days, the escape has really lost its shine, and the present has worsened to such an acute state of nightmare that I am forced to notice - and I'm horribly, horribly demoralized.