Sunday, November 01, 2009

Back to the real world, Part 4

Updated All the recent attention on health care issues has been given to the Senate, where the argument centered almost exclusively on whether or not a "public option" - some kind of public option, any kind of public option - would be part of the bill to be brought to the floor. The idea was, as I said myself just the other day, having the provision in there
sharply increases the chances of it being in what the Senate ultimately passes, which in turn clearly increases the chances of a decent public option being part of whatever final bill comes out of a Senate-House conference.
Underlying that idea was another one, that the House bill would be clearly better than the Senate bill.

Well, that last idea still holds true - but the gap is shrinking as the House bill worsens.

First, the House Democratic leadership stripped out of the bill a provision that said that rates for insurance obtained through the public option would be based on Medicare plus 5%, and replaced it with one where the government would negotiate rates with doctors and hospitals, as private companies do - thus guaranteeing that premiums will be higher than they otherwise would. That gives away one of the advantages for consumers in the whole plan while propping up the health care industry and particularly the insurance companies, who will not face any actual competition.

Even beyond that, it will likely make public option insurance more expensive than private insurance. As Miles Mogulescu, writing at Huffington Post, explains, big insurance companies can get volume discounts from providers because of the size of their subscriber base.
But without the ability to tie pricing to Medicare rates, the public option will have no ability to negotiate volume discounts. It will start out with no subscribers. ... [P]roviders will have no incentive to give volume discounts to the public option, which will end up paying more than large private insurers. This in turn will make the public option more expensive than private insurance. As a result, it will sign up few subscribers. With few subscribers, it will be continue to be unable to negotiate volume discounts.
And so on.
As a result, when the Congressional Budget Office first evaluated the Senate negotiated-rate public option plan, the CBO concluded that it would end up with no subscribers. ... [T]he CBO is now projecting that by 2019, approximately 6 million Americans would be enrolled in the negotiated-rate House public plan. The CBO also projects that "a public plan paying negotiated rates would ... typically have premiums that are somewhat higher than the average premiums for private plans."
Mogulescu describes it as being like "a brand new Mom and Pop store trying to compete with WalMart" and charges, as others have, that it is "a public option designed to fail." Considering that 10 years from now it would reach only a little over 10% of the currently uninsured and that it is intended to be unavailable to those who can get insurance through an employer (no matter how sucky that coverage is) and provide zilch in the way of competition, while still leaving, by CBO projections, 18 million uninsured (plus who knows how many underinsured), it's hard to argue with that conclusion.

And it seems to confirm what I said nearly five months ago, that the public option
increasingly looks like it will be consciously designed to be no better than existing private plans - in which case, exactly what is the point?
But remember, that was just the first. The second tells you just who is running things:
House Democratic leaders quietly stripped a single-payer provision from the House version of the healthcare overhaul Thursday. The measure would have allowed states to set up their own state-run healthcare systems, where local governments would have become de facto health insurers for residents.
That is, it specifically empowered states to set up their own single-payer plans. It was proposed by Rep. Dennis Kucinich and was added to the bill by a bipartisan 27-19 vote in the Education and Labor Committee. The majority was a combination of progressives who support single-payer and conservatives who support states' rights.

Significantly, according to Consortium News (via Corrente),
President Obama told the committee chairman, George Miller, to oppose Kucinich's amendment, and he did so, leading off the voting with a resounding "No." But the Democrats voted 14 to 14 with one member passing and two failing to vote. And the Republicans voted 13 to 5 with one member failing to vote.
And now it's gone. Because somebody - gee, I wonder who that could be - is so against single-payer that they want to, ahem, insure that it can't even be tried, even voluntarily, even by a single state.

According to News Junkie Post, as quoted by Raw Story, Kucinich was "livid" when he learned the amendment had been removed.
Kucinich’s amendment passed the House Labor and Education Committee in July. "No one gave me any rational reason," Kucinich said. "I can only assume the insurance company interests brought pressure to take it out. Otherwise I would have heard from someone."
Appearing on MSNBC's The Ed Show on Friday, Kucinich basically called the bill a sham and "a bailout for insurance companies." He pointed to section of the bill which says, quoting the bill as read on the show by Kucinich, "that rates shall be set at a level that does not exceed 125 percent of the prevailing standard rate for comparable coverage in the individual market." That is, it allows for an immediate 25% rate increase in premiums.

Referring to his amendment, Kucinich said in a statement:
If a state wants better health care than can be provided by the federal government in the health care bill we are seeing today, the federal government should not stand in their way. ... The removal of the Kucinich amendment constitutes yet another capitulation to the health insurance and pharmaceutical industries who are already reaping billions of dollars from the bill.
Third and finally (for now), the Progressive Caucus, obviously unhappy with what's happening, is staking out some positions it wants adopted via Manager's Amendments. In what TPM called a "curt, terse letter," caucus co-chair Raul Grijalva laid them out:

- The public option must be available without triggers or opt-outs.
- If rates are to be negotiated, a ceiling will be set.
- The health and medical malpractice insurance industries must lose their antitrust exemption.

He also said he wanted an up-or-down vote on tying reimbursement rates to Medicare plus 5% - but Nancy "I gotta please the Blue Dogs but stomp on progressives" Pelosi has made it pretty clear she doesn't want that to come up. If she really doesn't have the votes for it, then I don't see what the problem with an up-or-down vote is - unless the brave, bold, Dimcrats are just afraid of being seen voting no. Or wait - maybe it's that some of them, enough of them, are afraid of being compelled by logic and back home support to vote yes even as their insurance industry overlords look on. Yes, that could be it.

Footnote: House GOPpers, at the last minute, say they intend to offer their own plan.
John Boehner, the House's top Republican, said his party hoped to introduce one single bill with a "step-by-step approach" that would include allowing the purchase of health insurance across state lines, letting people group together to buy it at lower prices and ending "junk lawsuits."

The bill will include eight or nine healthcare ideas that have already been introduced separately, he said on CNN's "State of the Nation."
So it's just an amalgamation of the same old crap of undermining the ability of states to require more than lowest-common denominator coverage, ineffectual co-ops, and "tort reform" to protect corporations and the powerful against responsibility for the damage they cause to individuals.

Boehner, whose name I still give the more fitting pronunciation, said the GOPper plan wouldn't try to cover all the uninsured but said "We will cover millions more" while refusing to give an exact number. Well, now, either they ran the numbers or they didn't. If they did, he should have been able to offer something better than the incredibly vague "millions." If they didn't, then he was just freaking making it up.

Updated to add my quote from five months ago.

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