\n“4. ENDS RESCISSIONS \u2014 Prohibits insurers from nullifying or rescinding a patient\u2019s policy when they file a claim for benefits, except in the case of fraud.”<\/font><\/font><\/p>\n<\/blockquote>\nAn unambiguously good provision that eliminates one of the worst injustices in the present system and does so immediately.<\/font><\/font><\/p>\n\n\u201d5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS\u2019 INSURANCE \u2014 Requires health plans to allow young people through age 26 to remain on their parents\u2019 insurance policy, at the parents\u2019 choice.\u201d<\/font><\/font><\/p>\n<\/blockquote>\nThis one should prevent increases in the number of uninsured, since fewer young people in school will be swelling the ranks of the uninsured before they get jobs and have employer-based insurance available.<\/font><\/font><\/p>\n\n\u201d9. IMMEDIATE SUNSHINE ON PRICE GOUGING \u2014 Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.\u201d<\/font><\/font><\/p>\n<\/blockquote>\nNow, why is it that whenever Congress deals with large corporations, it seems incapable of just mandating behavior, specifying criminal penalties, and subjecting corporate executives to the penalties of the law? What’s this nonsense about discouraging \u201cexcessive price increases\u201d through sunshine. A lot of good that’s done in persuading the credit card companies who have had plenty of sunshine lately, from raising interest rates way beyond the levels of usury, and into loan shark territory. If we don’t want \u201cexcessive price increases,\u201d by the insurance companies in the band-aid period, why not just define them, prohibit them, and specify criminal penalties for individuals working for corporations who violate the law, and enormous fines for the corporations themselves? The fact that the House won’t do that sort of thing to corporations and their employees who have been \u201cmurdering people by spreadsheet\u201d by the thousands, and also driving a million others into bankruptcy and foreclosure each year, is the kind of thing that convinces people that Congress and the Democratic Party are just playing games, and really have no interest in protecting working people from rapacious corporations. To stop stealing we make it illegal, and prosecute the criminals doing it. To stop the corporate protection and extortion racket called private health insurance, we also need to make the extortion illegal and to prosecute and imprison the executives who are dictating price increases that exceed inflation.<\/font><\/font><\/p>\nMedicare-related \u201cGoodies\u201d <\/font><\/font><\/strong><\/p>\n\n\u201d1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE \u2014 Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.\u201d<\/font><\/font><\/p>\n\u201d6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE \u2014 Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.\u201d<\/font><\/font><\/p>\n\u201d7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES \u2014 Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.\u201d<\/font><\/font><\/p>\n\u201d8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE \u2014 Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.\u201d<\/font><\/font><\/p>\n<\/blockquote>\nIt’s clear that these provisions are there to give something to people over 65, so that they will have more positive feelings about the \u201creform bill,\u201d and to be able to claim that it strengthens Medicare. Having said that, it’s hard to understand, from the perspective wanting to do right by Seniors, why the doughnut hole is not just completely eliminated immediately. Of course, the answer to this question, is the need to keep the bill deficit neutral. To progressives who either 1) don’t believe that deficits are anything to worry about during near depressions, or 2) think that the current income tax system is much too regressive and that wealthy people pay far less than their fair share, this reason for keeping the doughnut hole, and only gradually reducing it between 2010 and 2019 is far less than compelling. To speak plainly, this half-hearted attempt to close the doughnut hole, will seem like another decision Congress has made which is over-solicitous of the interests of well-off people at the expense of people over 65.<\/font><\/font><\/p>\nMiscellaneous \u201cGoody Bag\u201d Provisions<\/font><\/font><\/strong><\/p>\nThese together constitute a \u201cgoody bag\u201d that eases various aspects of the health care reform problem. None of them is particularly momentous, but together they could help a substantial number of people. This \u201cgoody bag\u201d makes it harder for progressives to oppose this bill. It includes the following items.<\/font><\/font><\/p>\n\n\u201d10. CONTINUITY FOR DISPLACED WORKERS \u2014 Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.\u201d<\/font><\/font><\/p>\n\u201d11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM \u2014 Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.\u201d<\/font><\/font><\/p>\n\u201d12. HELP FOR EARLY RETIREES \u2014 Creates a $10 billion fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.<\/font><\/font><\/p>\n\u201d13. COMMUNITY HEALTH CENTERS \u2014 Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.\u201d<\/font><\/font><\/p>\n\u201d14. INCREASING NUMBER OF PRIMARY CARE DOCTORS \u2014 Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.\u201d<\/font><\/font><\/p>\n<\/blockquote>\nItems 11 and 14 are certainly good features of the bill, but they don’t address immediate health insurance problems. Items 10, 12, and 13 help to alleviate current hardships. But it’s fair to say that they are band-aids that won’t have a substantial effect on the number needing insurance. So rather than being key elements in a solution to the problems of universal coverage, or insurance and pharma costs, they are expedients that are there to alleviate the hardships of some during the band-aid period.<\/font><\/font><\/p>\nIn evaluating the band-aid period aspect of the House bill, there are a few key points that really stand out. First, the very fact that there is a \u201cband-aid\u201d period is a grievous problem with this bill. It does two things. First, it ensures that there will still be roughly 31,000 fatalities per year during the band-aid period, a total of 108,000 dead throughout the period, still 2\/3 of the present number of fatalities forecast without a bill. To the people who have no insurance and who will die because they don’t have it, the House is saying: \u201chelp is on the way: just hang on until 2013, or alternatively you can pay the enormous cost of individual health insurance in the high-risk pool \u2013 if you can afford it before the subsidies kick in.\u201d<\/font><\/font><\/p>\nSecond, the \u201csunshine provision\u201d in the band-aid period, rather than persuading us that it will be effective in meeting the problem of insurance cost increases, is so weak that it tells us the opposite: namely, that Congress is just giving lip service to the idea that insurance cost increases must be regulated and minimized during this period, and that we can probably expect insurance cost increases of between 40% and 50 % over the band-aid period. So, during the band-aid period, this bill does almost nothing to address the problem of rising insurance costs. There’s also a further effect on the people going into the high-risk pool who choose to, or are forced to, buy insurance at 125% of the going rate for individuals. Because, as individual rates go up by 40 \u2013 50% over rates today, their rates, already 25% more expensive than scale, will increase proportionately, so that their rates are 75% above today’s rates. Will they be able to afford that insurance, even if it is finally available to them? Many of them won’t; and to the extent that occurs, fatalities due to lack of insurance will increase beyond the 31,000 per year level during the \u201cband-aid\u201d period.<\/font><\/font><\/p>\nWhile the \u201cSenior buy-off\u201d Medicare provisions in this bill are certainly an improvement that progressives can get behind, and while the miscellaneous \u201cgoody bag\u201d provisions are also hard for progressives to turn down. It’s hard to see how anyone could mistake the band-aid period for a substantial improvement over the present system except in the case of eliminating rescissions. This reform should prevent further growth in the ranks of the uninsured, but, not necessarily, because the bill may not control pricing of policies tightly enough to protect those who are seriously ill from exorbitant price increases, which effectively prevent them from taking advantage of the no rescissions aspect of the bill. This is a point to watch closely in the final bill.<\/font><\/font><\/p>\nSo, what should we think of this bill, evaluating it from the perspective of what it provides in the band-aid period. Does it improve things in that period or not? Is it better than nothing at all? Is it an immoral and an intolerable bill, in some ways like Alan Grayson’s “Republican plan” saying to thousands of people each year, \u201cIf you get sick then die quickly.\u201d <\/font><\/font><\/p>\nThe truth is that the bill does improve things immediately in 2010. It prohibits rescission. It provides a way, through the high risk pool, for people with preconditions to get insurance, even if it is at a high price. It also does some good things for Medicare recipients, and a number of good things that are part of the \u201cgoody bag.\u201d Yet even though this bill is an improvement compared to the status quo, I think that both putting it forward, and voting for it, are immoral acts, if the bill, in any way, creates a dynamic that prevents us from, or weakens our efforts to, take up the health insurance reform problem in the next session, and thereafter, for as long as it takes to get a bill that will end fatalities, bankruptcies, and home foreclosures, due to lack of insurance.<\/font><\/font><\/p>\nThe overriding problem with the bill is that it prioritizes deficit neutrality over the deaths of many thousands of Americans per year. Yes, I said earlier that the bill will reduce the 45,000 annual deaths by some substantial amount, but in the \u201cband-aid\u201d period before the exchange takes effect in 2013, we\u2019re still looking at 31,000 or so deaths per year from lack of insurance. And, even after that at current death rates due to lack of insurance we\u2019re still looking at 11,000 annual deaths. These likely forecasts suggest that the current bill is a great moral failure of Nancy Pelosi, the Democratic Party, and progressives who support it.<\/font><\/font><\/p>\nWe can, if we like, look at the bill from the perspective of how it compares to no bill at all. And compared to no bill at all, and, if we assume that we will have no other reform bill over the next ten years, this bill is certainly an improvement.<\/font><\/font><\/p>\nHowever, whether or not we have other bills, whether now, or next year, or any year in the future, is our choice, the choice of Democrats, progressives, and the American people. So, the comparison of this bill with no bill at all is a false framing<\/em><\/strong>, narrowly circumscribing our choices. and relieving us of responsibility to look at what we ought to have, or what we might have had, or what we may yet have, if we fight harder right now.<\/font><\/font><\/p>\nThere are bills we should have formulated, and bills already formulated, like HR 676, that we can pass<\/em><\/strong>, that will not leave 31,000 annual deaths due to lack of insurance, and nearly as many health-related bankruptcies and foreclosures, if progressives \u201cjust say no\u201d to Pelosi. There are bills that can virtually eliminate fatalities due to lack of insurance, and also bills that reduce the levels of these much more, if progressives \u201cjust say no\u201d to Pelosi. So, why isn\u2019t the House bill like those?<\/font><\/font><\/p>\nThe answer is that the bill\u2019s number one priority is not <\/em><\/strong>solving America\u2019s health insurance problem. It is, instead, to pass a bill that legislators can say is deficit neutral.<\/em><\/strong> That is \u201cdeficit hawkism,\u201d adhering to the ideology that prioritizes bringing tax revenues and Government expenditures into balance ahead of other far more essential national needs and priorities. In the case of health insurance and health care reforms, adhering to that ideology is not only mistaken, or stingy, or an instance of false economy, but given that it accepts the inevitability of hundreds of thousands of American deaths over the next decade, it is immoral. <\/em><\/strong>And its application in this legislation is also immoral.<\/font><\/font><\/p>\nWhy isn\u2019t health insurance reform in the House bill made fully operative until 2013, since, if it were operative within a year, along with subsidies that ensured that nearly everyone would get insurance, it would save more than 70,000 additional lives in the first 3.5 years compared to the current bill? The answer is that it is Congress and the President placing the false standard of deficit neutrality over the next decade, above the moral imperative of ending fatalities due to lack of insurance. <\/font><\/font><\/p>\nThe extent of immorality accompanying this choice is even more apparent, when everyone sees that we have not employed that standard to the bank and wall street bailouts, or to the Wars in Afghanistan, and Iraq. We prioritize some things above \u201cdeficit hawkism,\u201d just not the lives of more than 108,000 Americans over the next 3.5 years, and about 72,000 more over the next ten. In addition, passing this bill, with its \u201cband-aid\u201d period, brings with it the near certainty, if we try to revisit health insurance reform, of having to face a propaganda campaign emphasizing the idea that we just got through legislating reform, and that we therefore, ought to wait until the \u201cband-aid\u201d period is over, and the legislation with its public option plan, has had a chance to work without considering more reform. Looking at things from the perspective of these considerations, and the possibility of other and better alternatives, and not from the perspective of whether it is better than no bill at all; the House bill, because of its enactment of a \u201cband-aid\u201d period of more than 3 years, and its provisions that don\u2019t end substantial lack of coverage after that, is both immoral and intolerable. It needs to be defeated ,and another bill needs to be quickly put in its place.<\/font><\/font><\/p>\n(Also posted at firedoglake.com<\/a> where there may be more comments)<\/font><\/font><\/p>\n","protected":false},"excerpt":{"rendered":"We’ll see many policy analyses and evaluations of Nancy Pelosi’s compromise health care reform bill as it gets closer to a final vote. This one won’t be thorough, since the bill is one of daunting length (1990 pages) and complexity, and I haven’t had the time to do a really detailed analysis. But I’ll do […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[693],"tags":[2515,2505,2511,2504,2325,2500,2501,2503,2509,2507,1693,2508,990,1553,2502,2510,2506],"class_list":["post-301","post","type-post","status-publish","format-standard","hentry","category-politics","tag-2515","tag-000-deaths-annually","tag-14-provisions","tag-2504","tag-alan-grayson","tag-band-aid-period","tag-deaths-due-to-lack-of-insurance","tag-deficit-hawkism","tag-doughnut-hole","tag-goody-bag","tag-health-care-reform","tag-high-risk-pool","tag-medicare","tag-nancy-pelosi","tag-operaive-2013","tag-price-gouging","tag-rescissions"],"_links":{"self":[{"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/posts\/301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/comments?post=301"}],"version-history":[{"count":0,"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/posts\/301\/revisions"}],"wp:attachment":[{"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/media?parent=301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/categories?post=301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kmci.org\/alllifeisproblemsolving\/wp-json\/wp\/v2\/tags?post=301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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