So, health care reform.

92 thoughts on So, health care reform.

1. It’s terrible that this is the best we can do. I’m still not completely convinced that this bill does more harm than good. I think the fact that we’ll have a mandate, but it is very unlikely that we’ll have a public option, to be one of the worst possible outcomes. I do not think the corporate takeover of our government is going to be significantly reduced unless we can pass some meaningful campaign finance reform and no one even talks about that much anymore. Too many democrat politicians and staff personally benefit corporate interests that I think they fail to see that it might not be good for the country, even when some miniscule amount of social progress is thrown in to go with our tithes. I’m not anti-business. I work in business. I enjoy beating the competition. I do not pretend that our interests are the interests of people in general.

   It’s enough to make a person want to move to France. Too bad for me that’s not an option.

   This whole mess depresses the hell out of me, but I’m not angry at Obama over it. It’s a problem bigger than him. I am angry over his actions on telecom immunity, state secrets and 3-tiered justice for ‘terrorists’, all of which I think he could have done better.

2. Agreed, Jill. And you’re right, this isn’t the “perfect” as the enemy of the “good”. This is far less than we’ve wanted and worked for, and there is much about to be ambivalent. “Public option” was, after all, a compromise — not the single-payer plan most progressives really hoped for.

   If I look down the road a decade, with the pendulum having swung back again and a conservative in the White House, I ask — given how wretchedly broken so much of our system is, is there a reasonable chance of getting something better in the next decade? Does any rational progressive think we’re gonna have an even bigger majority in the House and Senate after the midterms? History says we take a hit. The election cycle draws near.

   This isn’t quite the last best hope for health care reform, but it’s not far off. And if we pass this, we can say that we’ve reached the end of the beginning, the end of the phase of trying to get a a bill passed that at least moves in the direction of declaring health care to be a right.

   If we pass this, we establish a beachhead, however tentative. And then we push and push and push and push to expand that initial landing point into something bigger and better.

3. The grown-up table welcomes you, as we can definitely use someone who articulates their thoughts, arguments and emotions on the issues in a realistic manner.

   Tactically, yeah, you aren’t going to see much better until the younger generation of Senate Dems moves into positions of power, because good Lord, Dem leadership is presently terrible at consistent messaging. But I applaud the caucus for getting the job done, and resisting the urge to expel Lieberman. You deal with him on November 3, 2010, when you either have 60 votes without him, or you have between 53 (this would be enough of a buffer so you don’t allow someone else the power to kill a majority through grandstanding) and 59 votes with him (assuming, as I have, you still have a majority). That is the correct time to expel him from the caucus/strip his chairmanship/exact your pound of flesh. To do so now would make him seem virtuous, which would be the worst thing imaginable.

4. I don’t know… you say it’s a teeny tiny step forward…. but I do believe the fact that there are freaking MANDATES to participate in a private industry SIMPLY because you are alive is absolutely insane and a giant step backward, especially as you have *NO* option of choosing a public plan instead.

   Anyway, I guess my question is, if you think it’s such a teeny tiny step forward, how are you sure it’s actually forward and not backward? How can you be sure the tinkering will make things BETTER? I think that’s overly optimistic and not at all in tune with the history of things. I believe that the precedent set for making people buy into private plans is actually going to go the other way, more towards the companies profit, and even less for personal protections.

   Just keep in mind that tinkering can ALWAYS go both ways, and yet all progressives I’ve seen are convinced we should take this, because tinkering with it in the future will make it better. Consider me unconvinced.

   1. Jemand, sure, going backwards is always a risk with any legislation. But… does that mean we just don’t pass anything unless it’s iron-clad and perfect?

5. also… the kinds of plans lower income people will be able to buy with their 8% of income, won’t really cover much. It will not be *insurance.* They will still have to pay out of pocket in the event they need any care. This is compared to the present system, where it would be possible for them to put aside 8% of their income against chance of injury into a bank account, a private account they actually *COULD* depend on in the event they became sick, and not the insurance company, where it will fall into a black hole you’ll never see anything out of again.

   All the plans out there that are currently available to lower income people really are immensely worse than a simple bank account, in the amount of money you are ever likely to see back out of, and in the amount of red tape and hassle for proving you are actually sick. Anyway, I DO think it important to compare to that, and not just the premium costs absent reform, because this IS an insurance plan that is possible today, but would be illegal and impossible in the future.

   Although, once the no pre-existing conditions rule is put in place on the companies, everyone will just pay 2% of their income to the IRS until such time that they get sick, at which time they’ll apply for health insurance since they cannot be refused. Anyway, the companies will complain to congress, who will of course see things their way, and remove all the protections and any progressiveness left in the bill. This is why I am so convinced that tinkering will make things worse instead of better.

6. Personally, I think the best idea would be to have the bill not cover men’s or women’s reproductive systems. Let universal health insurance cover everything else.
   (Frankly, I’m kinda impressed that it got this far, but it needs to be a lot better.)

7. Personally, I think the best idea would be to have the bill not cover men’s or women’s reproductive systems. Let universal health insurance cover everything else.

   Yeah, because women, making 75 cents for every dollar a man earns, can effortlessly afford things like cesarean sections out of pocket, and if they can’t, hey—-that’ll teach the dumbasses to go get themselves pregnant, amirite?

   Look. Men and women don’t have the same healthcare needs concerning their reproductive systems. Why should women be fiscally punished for having a nonstandard (read: male) body?

8. I’m with Shark-Fu; there’s a lot of work left to be done.

   Lieberman’s bill is worse than nothing. It mandates the buying of insurance without a guarantee of affordability. It will help some poor people get insurance. It will still keep insurance out of affordable reach for many working class people (those who aren’t fortunate enough to get affordable healthcare through employment) who earn too much to qualify for a subsidy, but not enough to buy insurance.

   This bill isn’t just a giveaway to insurance companies. It’s designed to bust unions, too. All that talk about “Cadillac plans”, you know, insurance plans that actually do a good job of covering healthcare? Well, those plans are going to be highly taxed. Which means employers are going to either stop offering them, or scale back the healthcare coverage until it resembles the “pay for coverage that doesn’t cover anything, while paying for actual healthcare out of pocket” plans that are the only thing available to people on the private market (well, the only thing available to people who don’t have more money than God).

   Plans like the self-funded plan offered through my union will end up folding. The benefits that come from collectively coming together will be absent—then, we’ll get the non-benefit of being charged like individuals—complete with folks with pre-existing conditions having to pay more. Complete with women getting to pay more, too.

   I’m with this assessment—if the House can’t erase the damage done to this bill, kill the motherfucker. A mandate without protections is worse than no bill at all. The Senate thinks this single mother ought to be able to afford $11,900 in annual out of pocket healthcare expenses. The House thinks I can afford $10,000. Funny, because there’s no way in hell I’d be able to convince a bank I could afford that much in mortgage payments; now my legislators are thinking I can afford the equivalent of a second, more expensive home?! My current insurance (a union-negotiated benefit) caps out-of-pocket at $3000 per family. That shit is going to come to a screeching halt when “cadillac plans” (who do those fucking uppity tradespeople think they are, anyway?) are effectively abolished.

   I’m beyond livid. This isn’t healthcare reform. It’s healthcare deform.

9. One problem with the fight over the public option is that it’s sucked up all the oxygen to discuss other portions of the bill that were going to have much more significant impact on health care generally. Even the House version of the public option was so miniscule as to have a negligible effect on keeping premiums down or acting as competition for insurance companies.

   As a result of this focus, people seem to think that the mandates were a corollary to the public option, when really the mandate is the natural consequence of the guaranteed issue. If you structure insurance so that an insurer cannot turn someone down for coverage or deny a claim on the basis of a pre-existing condition, you’ve created a significant incentive to forego insurance until one gets sick. Individual mandates are a necessary consequence of eliminating denials of coverage for pre-existing conditions, in order to defeat that incentive.

   As for taxing so-called “cadillac” plans, what seems to be missing from most people’s analysis is how it will operate as negative pressure on the premiums of those who have high-end plans. An insurance company isn’t going to want to raise premiums about that threshold, so as to avoid triggering the excise tax and thereby encouraging unions or other institutions to choose a different insurer. I’d also point out that, if one uses FEHB (or “the same health insurance as members of Congress have,” as it is so frequently referenced) as a guideline, even the most expensive insurance still falls below the “cadillac” threshold of $21,000 annually for a family plan – and that’s before Sen. Rockefeller increased the threshold to $23,000.

   Is the Senate bill the legislation I would have written? Absolutely not. However, I think it’s about as good as we’re going to get out of this Senate, and this Senate is about as good as we’re going to have for quite some time.

10. You’re right, Obama is not Bush lite. And this bill does have high points, and I will do my very best to focus on those if the bill passes in the coming days.

    But as far as my personal support, I’m not buying the “greater good” business I’ve been reading about lately. I don’t accept that health care for all must come at the expense of health care for women. I don’t buy that a “teeny step forward” is worth taking a giant step backward in terms of women’s rights and health.

    I don’t buy it in principle, and I don’t buy it for the simple fact that abortion is one of the most commonly-performed medical procedures in the US. Even setting every justified argument about women’s rights as bargaining chips aside–how can any worthwhile reform refuse to cover a procedure which affects people equally as heart disease, and affects more people than hypertension or cancer?

11. I think the House bill is a huge disappointment, but the Senate version is even worse. No public option and a mandate?? That is like punching every low-income/middle-income American in the face. I take this very personally, because I am low-income and uninsured. There is no way I can afford health insurance. My partner can’t either. Half of my family is uninsured, and many of my friends are too. I have never felt more disposable in my life than during this health care debate. Just because I don’t make a certain amount of money, I don’t have any access to health care. So if I get sick, I’m screwed. If I get injured, I’m screwed.

    Last time I got sick, I waited until I couldn’t take it anymore, went to the emergency room, and was slapped with an $800 bill for three hours of their time. I called around for any kind of assistance, and they told me if I didn’t have children or a drug problem I didn’t qualify for assistance. I called the hospital to ask if there was anything I could do, maybe arrange a payment plan, and they told me, “We are not a charity.” I heard a nurse refer to me as a “customer,” while I was lying in a hospital bed.

    I feel like if you don’t have money/privilege in this country, you are disposable. It’s sickening. I should not be forced to purchase insurance that I cannot afford, and I should not be forced to pay for health care when it’s NOT MY FAULT that I happen to be alive in this country and occasionally get hurt or sick cause you know, that’s what humans do. I guess myself, my partner, my family, and my friends don’t deserve access to health care, even though we’re employed, tax-paying American citizens.

    I don’t know, maybe I shouldn’t have believed everything people told me about the American Dream when I was young. Maybe I should have known better. There is no equality here. There is no level playing field. There never has been, and the complete failure to reform our health care system just goes to show that.

    I cannot support the Senate version of the bill and I can barely support the House version. I am crossing my fingers for the public option but I’m not holding my breath. Please, everyone, write your senators and representatives and put pressure on them to stand up for the people they’re supposed to represent. Pressure them to salvage this shitshow before it’s too late and we end up with something even worse than the status quo: a motherfucking mandate.

12. I don’t understand. I thought the ENTIRE point of this bill was to make health care accessible to everyone by having a public option.

13. Jill, do you think it’s constitutional to require every single adult to enter into a contract with a private corporation under terms set unilaterally by that corporation, including the decision whether or not to terminate coverage? It’s not quite the same thing as requiring car insurance, because you’re not legally required to own a car, and it’s not the same thing as requiring vaccinations before sending a child to public school, because you’re not legally required to send your child to public school.

    And yeah, what they think is “affordable” would be funny if it weren’t so dire. My cab driver the other day — about 27 years old, male, single, no major health problems, probably just the kind of customer insurance companies are creaming to reel in — said to me, “How am I supposed to afford an extra $200 a month for anything?” He’d pay the fine instead of paying for coverage. And I bet most young, healthy people in his position would do exactly that. What are they going to do, make the fine bigger than the premiums? (I know, don’t give them any great ideas.)

14. the “cadillac” threshold of $21,000 annually for a family plan – and that’s before Sen. Rockefeller increased the threshold to $23,000.

    Throughout this whole debacle, plans that cost over $10,000 have consistently been referred to as “cadillac” plans. From the New York Times:

    “Under the Baucus plan, insurers selling a plan costing more than $8,000 for an individual and $21,000 for a family would have to pay a 35 percent excise tax on the excess amount.”

    What do you get for an $8000 plan? A plan that covers actual healthcare needs, as opposed to catastrophic-only care, with very little out-of-pocket expenses after one’s deductible is met. Those plans are employer-provided plans, and are a part of worker benefits.

    In the same article, you’ll see this quote:

    Even union plans, which tend to offer the most generous coverage, are expensive because they frequently cover a number of older workers or some who retired early and have not yet reached Medicare age. Jim Hoffa, president of the Teamsters union, warned that the middle class, not the rich, would bear the brunt. “It taxes the wrong people.”

    That’s why my plan costs over $10,000 a year. Because I, as a younger union member, am subsidizing older retirees—they only pay a little over $600 a month to get the same coverage I do because they are on a fixed income. That so-called “cadillac plan” is making it possible for older workers to retire—and let’s face it, contractors are not looking to hire 60 year old tradespeople whose bodies have been beat to hell from a lifetime of physical labor.

    Which brings me to—the so-called “young invincibles” that Meowser alludes to up above….the folks who supposedly are part of the problem because they don’t carry insurance. As Meowser points out, the reason they aren’t carrying insurance is because….wait for it….they can’t afford to. The only young people I know with insurance are tradespeople. Everyone else doesn’t earn enough money. When the “choice” is “rent, utilities, food, transportation, etc. or health insurance?” it’s pretty clear where folks’ fiscal priorities are going to be.

    Because if people were being paid decently, this wouldn’t even be a conversation. Out-of-pocket medical expenses, on top of other daily grind expenses, are more than what most people can afford. That’s a big part of why we have such abysmal outcomes for the money we spend on healthcare in the U.S.—people postpone going to the doctor because they can’t afford to be sick. Postponing care makes outcomes worse.

    And trying to tell that to liberal folks who make six figures is an exercise in frustration. They mean well, but they really don’t get it, because they haven’t lived it. Conservatives are even worse, because they think poor people are covered by Medicaid, when most poor people make too much money to qualify. I couldn’t qualify when I was unemployed. I couldn’t get on All-Kids for my daughter either, because my insurance plan has one price for everyone—there is no separation of costs (one person pays the same as a ten-or-more person family; either everyone is covered or no one is covered—and this is typical for building trades’ plans).

    In 2014, this plan would leave more people without healthcare coverage, or without coverage that meets their healthcare needs. Catastrophic-only care is completely worthless. If you don’t earn enough money to pay for catastrophic-only care and still be able to pay hefty doctor’s fees out-of-pocket, you’re going to go bankrupt anyway, especially since you’re going to lose your job if you’re that sick or injured.

15. La Lubu: I think you misunderstood me. I’m female, and I want my health care, all of it.
    The problem is that women’s health gets used as a football every time something like health care reform is even suggested. So if men’s health gets kicked around like a football, they’d finally understand and wise up. (Especially if viagra got taken off the table.)

16. As long as American workers’ pay stagnates while the profits of increased productivity go almost exclusively to the wealthy, these problems are intractable. The root cause of the unaffordabiliyt of health insurance and the root cause of the outsized influence of corporations in the American political universe are the same. Just sayin’.

17. “It would be great to scrap this bill and start over and get a better bill out there, but that isn’t a realistic possibility.”

    I have yet to see this really supported with anything coming close to an reasonable argument. The fact that the bill isn’t instantly going to improve the lives of anybody besides medical-insurance-shareholders, maybe, is not factored in enough, and the notion that stopping this bill is tantamount to stopping heathcare reform period is without justification. One even has to buy into the Republican position in a way to say this is the only chance for healthcare-reform, because what both positions assume is that this is a kind of war, and when a side wins there isn’t really re-takes.

    That’s not how democracy works, and every concession to anything but that democratic struggle, which is a far cry from the war-metaphor in which winner-take-all rules the day, is not political pragmatism, but self-sabotaging cowardice. If the democrats were pragmatists about the matter, they would kill the bill, because it is phony idealism-without-idealism that passes for “being realistic” in this country. The favorite ideological slogan of corporate democrats is just that we “be realistic”. If we’re going to slam politicians for their ideological fixations, this is the one.

    Before anyone can invoke the name of the “millions of uninsured,” I am and have been one of them for years, and I oppose this legislation.

18. La Luba:
    If you think it generally costs over $8750 a year to get quality health insurance for a self-only employee plan, you’re incorrect. Again looking to FEHB, you see many quality HMO or FFS plans for far less than that. My insurer, CareFirst, is covering my $60000+ of medical expenses for about $6500 annually in premiums and less than a hundred annually in co-pays and deductibles. I can’t say for certain, since I don’t have the opportunity at the moment to verify, but I suspect that none of the FEHB self-only plans cross the “cadillac” threshold.

    As for your subsidization of older workers, I’ll admit that I wasn’t aware of that structure, and you’re right that it merits a fix. However, my firat response to that situation, were I a union lobbuist, would be to work for a definition that excluded that type of subsidization from the calculation, rather than trying to remove one of the few cost-control measures from the bill.

19. @Meowser,

    While I’m not the Supreme Court, I’ll take a stab at your question to Jill. Such a law, as I understand it, creates a uniform tax on every American relating to the total cost of health care divided by population–the fair share of the taxpayer for their economic burden should they require health services. If the individual has proof of health insurance coverage, they are eligible for a tax subsidy that covers 100% of that tax. Thus, there is no “requirement” of health coverage, but an economic incentive in the form of a tax break to purchase insurance.

    If the penalty is lower than the cost of an insurance plan, the basic rational move if one does not fear being uninsured is to pay the fine. If the goal is to encourage the purchase of insurance, then the fine must be more than the cheapest available health insurance plan, as you correctly pointed out. If the goal is merely to have each person pay their fair share of what they burden the health care system if they are uninsured, then the fine would be set at that rate. If that cost is cheaper than the cost of the cheapest insurance plan, then, as noted above, their rational choice would be to pay the fine, as they would have technically already paid their fair share in the form of the uniform tax.

    My guess is that the market will adjust to the fine, and insurance companies will offer coverage to individuals like your cab driver at a price cheaper than the fine. If costs are truly inflated, then these insurers would be stupid not to underbid the government, because they now have a chance to get new customers who actually would have an economic incentive to purchase insurance.

    But at no point is this a restriction on any right that I see. It’s an income tax, and the government’s been doing that since the Sixteenth Amendment got ratified in 1913. But you will have the freedom to get taxed without the subsidy if being uninsured is important enough to you to so choose.

20. La Lubu, Erica A, Dawn, Meowser, Joe — I agree, agree, agree, with everything you all have said (and I love La Lubu’s phrase, “health care deform”). I also think it’s noteworthy that many defenders of the bill use the Rumsfeldian Q & A style (“Is this the bill I want? No. Is it the best bill we can hope for? Yes.”) to answer tidy little questions they pose to themselves. This bill is a setback, it is going to hurt people, it lets the insurance companies dictate the limits of the possible, and yeah, it also is another incremental give-away of women’s rights to the lady-haters, described as “reasonable compromise”. But that’s actually not the worst of it — bad as it is. What’s the worst of it is that it doesn’t give the people what they voted for. It bugs me most of all that it makes such a mockery of democracy; people voted for real health care reform, and they aren’t getting it and they are being lied to about that fact. It’s awful.

21. Oh, Nicholas. If only it did what you said. What it does is bill everyone for the inflated cost of health-insurance-company-mediated medical care, with all the profit-grabbing contained therein. The point of single-payer, which would be much more like what you describe above, is to divide the cost of health care itself (not health care + insurance company profit margins) across the population in the form of a progressive (not perfectly equal) income tax.

    Your belief in market mechanisms — after everything we’ve seen across 2008-2009 — & their capacity to arrive at some kind of happy equilibrium for the populace — I don’t know what to say. Maybe, to be fair, I should ask if you meant something slightly different than what you said.

22. ” But we should probably knock off the comments about how Obama is “Bush lite” (or “Bush same” or “Bush worse”). Because, well, that’s just not true, and it makes us sound totally divorced from reality and perspective when we say it.”

    Jill, care to defend this assertion? You’ve been an Obama groupie for a long time, but I never hear you argue against his critics. I remember enthusiastic support on your part from before the election, but no counterbalancing criticisms after all his subsequent decisions. All the talk about improving the bill falls flat when it’s coming from people who refuse to criticize the president. And speaking of negotation skills, it’s the liberal bloggers, the ones who abandon any leverage they might have over the white house by prematurely accepting the measliest crumbs thrown their way, who need to learn them, not the Democrats (as if the leadership was ever really pushing for reform to begin with).

    1. Care to defend how Obama is not Bush Lite? Are you kidding?

       Yes, I was an Obama supporter during the election, but I’m hardly a “groupie.” I’ve been critical of Obama, and I’ve said many times that he isn’t a liberal dream candidate. He’s a moderate. He’s not my ideal. But I still think he’s a good leader.

       As for the negotiation skills of liberal bloggers… huh? Who exactly are we “negotiating” with?

23. I cannot support this legislation if it continues to have a mandate that every person purchase private insurance. I am unemployed and have been for a year. I cannot *afford* private insurance. With my numerous pre-existing conditions, i’d be lucky to get a worthless “catastrphic care” policy for anything less than $500 a month.

    Let ’em fine me. I don’t have the money to pay it. What will they do, jail me? Fine. Let them jail me.

24. AnonymousCoward, it may be possible to get self-only health insurance for less than $8750 a year, but probably not one that will meet the needs of the average tradesperson. (in my Local, folks use the shorthand of “ten grand” to refer to how much insurance costs to refer to both the employer-provided benefit—none of that $8750 comes off our checks—and the $1000 deductible for a family, which is $500 for single people with no dependents. As I am a single parent, I use the “ten grand” shorthand, too).

    One of the reasons this is a “cadillac plan” I mentioned above. Younger members subsidize older members. Also, members without dependents subsidize those with dependents. That $8750 is the employer-provided benefit whether you are a single person with no dependents or a head-of-household with several. Members who do not have pre-existing conditions are subsidizing members who do (or members who have people with pre-existing conditions in their families).

    What isn’t commonly known outside the building trades is that currently employed members are subsidizing the insurance costs for unemployed members. If you are familiar with the Family and Medical Leave Act, you will notice how there are special clauses dedicated to the special condition of tradespeople re: “banked hours”. For every hour worked over a certain minimum (which varies by Local—in my Local, it started out 140 hours, then went to 160 when the economy hit the bricks after the Bush appointment, and is now down to 150), extra credit hours go into an “hours bank” that the member can draw on when he or she is unemployed. Members can bank up to six months worth of hours (extra hours just go towards keeping the Fund solvent).

    In addition, we have a benefit for injured members via our health insurance. Tradespeople who get injured or are seriously ill usually can’t work due to physical incapacitation. For those members, there is a small stipend that increases the longer a person is out of work. There are 26 weeks of benefits. It’s not much (much lower than unemployment for the first six weeks, with a slight raise that is still far from unemployment for the next six weeks, but the following weeks are roughly the same as unemployment). When I was off after my emergency c-section, this was a big help.

    Those are not benefits that any for-profit insurance company is going to offer. That’s why my Local, like most building trades Locals, has a self-funded plan. My Local isn’t large enough to do this on its own; there are 27 Locals covered under my plan, which is administered by Trustees (half of whom are business managers of Locals, with the other half composed of contractors—like the apprenticeship committees!). We have special conditions. It is important to us that our members not be left with nothing during bouts of unemployment, illness, or injury.

    What else makes our plan a “cadillac” plan? We have vision coverage. We have dental coverage. We have low out-of-pocket costs, and a maximum of $1500 in out-of-pocket for individuals, $3000 for families. It covered all three years of my daughter’s physical, occupational, and speech therapy due to prematurity (I did not pay an out-of-pocket for this as that was covered by Early Intervention, as was her developmental therapy). It covers hospice care for the terminally ill. It covers a lot of little things like that that make a big difference in people’s lives, but that are considered “luxuries” by those fortunate enough to be able to pay for that out-of-pocket. (try explaining the need for hospice care to someone who can afford household help, or who can afford to take a month or two of unpaid leave)

    Often, the term “cadillac plan” is bandied about with descriptions of relaxing massages, cosmetic nose jobs, botox and such (none of which my plan covers, nor have I ever seen an actual health care plan cited that does). But the reality of “cadillac” care is: just plain old good health care. The type of care everyone should receive. Period.

    And yes, the only way to make that affordable is via single payer. The public option was the compromise for the nonconsideration of single payer. Insurance companies vigorously fought that, because the public option would handily demostrate how much more effective a single-payer plan would be; how much more affordable healthcare would be without the need to satisfy stockholders. Stockholders that are used to returns higher than can be expected in the average market. Stockholders that expect people to be tossed on the scrap heap if a profit can’t be made from them.

    We need a public option, period. We also need to have the eligibility for subsidies to be based on the actual costs of living in various geographical areas, rather than basing it on the “federal poverty level” which is based on the cost of food and does not take things like housing, child care, transportation, or existing/ongoing medical costs into consideration. The cost of food hasn’t skyrocketed the way housing, utilities and transportation has, and child care costs are a necessity for single parents to keep working. Those are serious weaknesses that result from the people formulating the bill never having lived the reality of making do on what the average U.S. resident earns. They don’t call the Senate “the Millionaires Club” for nothing.

25. Oh, and politicalguineapig, thank you for the explanation. I was hoping that was it, but I wasn’t sure! In any case, I think it wouldn’t work out that way; I have no confidence that there wouldn’t be a lot of folks in charge of those decisions agreeing to the compromise that you intended as a mental exercise—a wake up call. I still remember the ‘the law isn’t discriminatory against women, it affects pregnant people equally’, and I know damn good and well that wasn’t a reference to pregnant transmen.

26. GallingGalla:

    The affordability calculation is based off of income. None of the proposals expect someone with an income of $0 to be able to afford insurance – any spending at all would exceed 100% of your income, let alone the 8% in the Senate bill. Also, you seem to forget that, under the new law, insurance companies will no longer be permitted to adjust premium rates based on pre-existing conditions. That’s why the bill has to have the mandate – so that there is less incentive to avoid insurance while healthy and only enter the risk pool once one becomes sick.

27. I find myself not surprisingly agreeing with GG.

    I’m not unemployed, but underemployed (thank you mother effing transphobic SF Bay Area attorneys) and will be cutting my hours back even more in Janurary when I go back to school. My limited extra cash goes almost exclusively towards stuff that is needed to get me (hopefully) a decent job that either has insurance or pays me enough where any sort of mandate won’t kill me-hair removal, hormones, wardrobe, etc). For those of us living on the edge, that mandate had better have pretty damn good subsidies.

28. The affordability calculation is based off of income. None of the proposals expect someone with an income of $0 to be able to afford insurance

    AnonymousCoward, I can’t speak for GallingGalla, but unemployed people who receive unemployment benefits do have income. And if they have no dependents, those unemployment benefits can and will negatively affect them when it comes to subsidies. Several years ago, I had an unemployment benefit of roughly $300 per week, with an additional $100 per week for my daughter. $400 bucks a week. I could not qualify to get healthcare for even just my daughter on that (I had run out of banked hours) because that was considered sufficient income to live on. And I was living on it. But I couldn’t afford insurance on it, because after meeting other necessities (housing, utilities, food, gas…that sort of thing) there wasn’t the additional (almost, at that time) $800 a month for COBRA. I made “too much money” for Medicaid.

    Could you meet your basic needs for yourself and a child on $800 a month? How about even just for yourself? Yeah, me neither. So I went without insurance and crossed my fingers. Luckily, nothing happened.

29. La Lubu:

    AnonymousCoward, it may be possible to get self-only health insurance for less than $8750 a year, but probably not one that will meet the needs of the average tradesperson.

    There’s a pretty good reason why “the same health insurance as members of Congress receive” became the standard in talking about various health insurance programs: it’s really good insurance. It’s also the same insurance every federal employee gets, which covers everyone from people who sit in cubes all day to all sorts of tradespeople and former tradespeople.

    As for your discussion of the various fringe benefits of your health insurance (many of which appear to be unemployment insurance rolled into your health insurance), have you considered the fact that you’re not going to be getting those benefits if we were to go to a single-payer system? Getting the country to accept health care as a fundamental right with a country-wide risk pool is going to be hard enough. Getting unemployment benefits rolled into that package at the same time would be an impossibility – just look at the conservative opposition to extending UI in the stimulus bill. You would have to spin out the out-of-work benefits from your health insurance, and deal with it separately from the federal single payer health care program. I’m no tax attorney, so I can’t say for certain, but I suspect you could do the same for the hour-bank and unemployment stipend.

    Moving to the unquestionably health-related benefits, those aren’t as out-of-reach as you seem to claim. My out-of-pocket cap is at $1,900 for an individual, and I’m unlikely to ever hit that despite having a rather expensive chronic illness, because there’s little to no percentage-based cost-sharing. It includes excellent vision and dental. It also covers hospice care and physical, occupational, and speech therapy for a child born premature or with a birth defect.

    Insurance companies vigorously fought that, because the public option would handily demostrate how much more effective a single-payer plan would be; how much more affordable healthcare would be without the need to satisfy stockholders. Stockholders that are used to returns higher than can be expected in the average market. Stockholders that expect people to be tossed on the scrap heap if a profit can’t be made from them.

    We need a public option, period.

    If you recall, the only public option that could get anywhere was one that was so hamstrung that it would be more expensive than private insurance, and only open to a select few.

    We also need to have the eligibility for subsidies to be based on the actual costs of living in various geographical areas, rather than basing it on the “federal poverty level” which is based on the cost of food and does not take things like housing, child care, transportation, or existing/ongoing medical costs into consideration. The cost of food hasn’t skyrocketed the way housing, utilities and transportation has, and child care costs are a necessity for single parents to keep working.

    This part, at least, I can’t disagree with. The FPL is a problematic eligibility threshold, to put it lightly, but it’s so ingrained into legislator’s instincts that it’s hard to make headway on changing it.

30. “Care to defend how Obama is not Bush Lite? Are you kidding?”

    On issue after issue there’s been continuity between the Obama administration and the Bush administration. I’ll grant that the Democrats are slightly better, but there’s enough similarity to make the “Bush lite” epithet well-deserved.

    “Yes, I was an Obama supporter during the election, but I’m hardly a “groupie.” I’ve been critical of Obama, and I’ve said many times that he isn’t a liberal dream candidate. He’s a moderate. He’s not my ideal. But I still think he’s a good leader.”

    As I recall you were one of those who gushed over Obama, but I won’t press the point. I haven’t see much criticism of Obama coming from you, unless you consider the fact that you claim he “isn’t a dream candidate” or “he’s not my ideal” to be criticism.
    Btw, for such a great leader, how do you explain his absence from the health care debate once the election was over?

    “As for the negotiation skills of liberal bloggers… huh? Who exactly are we “negotiating” with?”

    The white house needs progressive support to win elections, which means there are constant unstated negotiations between progressives and the white house. As of now, they take progressive support for granted because progressives have shown themselves willing to graciously accept whatever crumbs are thrown their way. Even if you grant that a few crumbs are better than nothing, it’s better to fight for more, otherwise that’s all you’ll get.

    RJ Eskow says it better:

    “There’s a basic structural flaw in the Klein/Cohn/Krugman position, too: that it’s either this health bill or nothing. I believe that’s a false choice. Opponents of the Senate draft don’t all believe that no reform is better than this bill. But they should act as if they do. Once you say the Senate bill is good enough, the negotiations with the left are over.

    The Senate health bill has been improved in some areas, including strengthening the Medicare cost containment commission and – most critically – once again lifting lifetime caps on coverage. Like McJoan, I believe that’s a direct result of the outcry on the left. Fear of a progressive backlash has already improved this bill, and it may continue to do so – if we don’t back down too soon.”

31. La Lubu:

    GallingGalla suggested that she has been unemployed for about a year, so I assumed (perhaps unreasonably) that any UI had run out. Also, I can’t find details on exactly how much the Senate bill expands Medicaid, but if it’s as “high” as 150% of FPL, someone making $400 a week with one dependent would still qualify.

    Regardless, the point remains: unless the government can point to an affordable (defined as 8% of income) health insurance program that meets the minimum coverage requirements set out in the legislation, there’s no obligation to buy insurance and no fine assessed.

    1. … and, for those folks for whom 8% of their income is not actually “affordable” to them, AnonymousCoward, what exactly do you suggest? “Eh, too bad, fuck ’em”?

32. Cara, that seems to be the case.

    8% of my income is not available.

33. Cara:

    If you’re taking that tack, what about the folks who don’t have insurance now but will under the reform bill? What do you suggest they do while Congress executes a Hail Mary play to try and get a more progressive plan despite not having the votes? “Eh, too bad, fuck ’em?”

    More substantively, you aren’t taking into account that the mandate isn’t even triggered until that 8% is higher than a qualifying health insurance plan, which means that the mandate isn’t hitting the lowest-earning workers. As everyone keeps pointing out, correctly, health insurance is rather expensive. Even in the self-only market, I doubt that the mandate will be triggered by anyone needing self-only coverage making less than $40,000, because one would be hard-pressed to find a health insurance plan that charges less than $266 per month. In the family market, that number will be markedly higher, since family insurance plans are significantly more expensive. Also, you’re not taking into account the subsidies the new bill provides families making under $88,000.

    1. AC, my stance is that if some people are better off under the reform bill, and others are not but break even, that’s a compromise that really sucks, but is probably worth taking as a step towards something better. If, however, some people are better off and some people are worse off, that’s not a compromise I’m willing to take. I am absolutely, under no circumstances, willing to support a bill that will cause some people who do not currently have access to health care to still not have meaningful access to health care, and yet also have to pay for not having it.

       I don’t know whether or not this bill does that, though I am incredibly concerned both for myself and others. Frankly, I’ve heard too much conflicting information, and I have absolutely no idea who to trust, anymore. My point was rather that your assertion as you worded it came off as incredibly blasé, and ignorant to the fact that 8% of one’s income is far from affordable for a lot of people.

34. Wait — Anyonymous Coward — are you saying La Lubu shouldn’t support single-payer cause screw poor people, she’s got hers as a unionized employeed? Seriously?

35. Kathleen:

    No, I’m saying that her support for single-payer and her opposition to the tax on “cadillac” health care plans is inconsistent, because both result in the elimination or spinning off of the non-health-care benefits she talks about preserving.

36. Cara:

    My frustration comes from trying to find what basis people have for believing that some people are going to be worse off (excluding the wealthy who will be hit by the increase in taxes in the House bill). Often, as with GallingGalla’s concern that pre-existing conditions would trigger obscenely high insurance premiums, the concern flies in the face of what’s actually in the bill (see Sec. 1201 of the bill, http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf p 78, which establishes the only bases for adjusting rates are family/self, rating area, age, and tobacco use).

    Specifically responding to the concern that some people are going to be worse off, when I look at this chart ( http://www.kaiserhealthnews.org/Columns/2009/December/~/media/CC9EB727BC494A1BB5FE01E9B71EA036.gif ), I’m at a loss for who is going to be harmed by the mandate when combined with the guaranteed issue and the subsidies.

    It’s also important to note, as Eugene Robinson did in the Post this morning, that “[f]or the first time, we will enshrine the principle that all Americans deserve access to medical care regardless of their ability to pay.” That’s monumental, and I really don’t believe Robinson is overstating it when he says that this bill will be remembered as a “landmark accomplishment.”

37. I do not think the Dems are bad at negotiating at all. They did a pretty good negotiating act between what the people who vote for them want and what the insurance industry lobby wants. The people got a bill that seems better than the status quo, the industry got access to a huge class of uninsured people who have to buy from them with no cost controls. Win-win?

38. (many of which appear to be unemployment insurance rolled into your health insurance)

    No. AnonymousCoward, you clearly have either never worked a physically demanding job, or if you have, you have conveniently forgotten everything you once knew about it. The benefits in the plan I described were inserted specifically because injured or ill workers are ineliglible for unemployment. If you are unable to go to work, you cannot collect unemployment benefits. While an office worker may be able to go to work with a broken arm, a tradesperson cannot. Get it now? And yes, those types of benefits could be covered, probably more effectively via a change in unemployment benefits to cover such situations—after all, the banked hours clause was effortlessly written into the Family and Medical Care Act, to keep workers with banked hours from having to exhaust those hours before receiving their benefits paid (which would penalize those workers).

    One of the reasons people are plunged into poverty is because of illness and injury, and their ensuing inability to receive benefits. Just sayin’.

    Now, you keep mentioning “self-only”. That tells me you have a strong support for individualized solutions, rather than collective ones. As a union member, I am biased toward collective solutions, because they work better for those without a “safety net”. Yeah, sometimes you get to “pay more”, as I am doing now, to subsidize: members with more dependents, members with pre-existing conditions (more serious than mine), older members on a fixed income, unemployed members on banked hours, unemployed members on medical leave. However, there will be a time when I will need that boost from others (as I have in the past), so it all evens out.

    What you are advocating is an every-person-for-him-or-herself outlook. If a person doesn’t fit the template of the “good” insurance risk (relatively young, able-bodied, healthy, no dependents, preferably male to avoid those pesky women’s reproductive issues and things like greater propensity to diabetes, hypothyroid, depression, etc.)—fuck ’em. It’s ok to leave those people with higher healthcare costs.

    Because while insurance companies will be required to take people with pre-existing conditions, there is nothing to prevent them from charging those people more via greater co-pays or out-of-pocket expenses. And as one ages (read: more likely to be unemployed and experience age discrimination when trying to get re-employed), you get the bonus of higher premiums!

    Once the mandate is in place, you can rest assured that employers are going to stop offering insurance benefits in droves—because they’ll lose the tax benefit that comes from providing decent insurance, and “hey, people can purchase this on the individual market now”—with all the drawbacks that entails.

    Part of the reason for the high cost of medical care is the insurance industry and their denials of claims. The sheer amount of man- and womanpower put into getting the sons of bitches to pay on a claim. The annual arm-twisting negotiations to steer patients—I mean, “customers”, toward certain medical providers in exchange for lower rates, a practice which drives up rates for those who don’t have the patient base to get such perks, not to mention the uninsured. (sweet bedda matri, have you ever looked at an insurance bill and seen what you’d be paying if you didn’t have insurance? Think that may be why over 60% of bankruptcies in the U.S. are due to medical bills?)

    The public option is popular because people are familiar with Medicare. My folks are on Medicare, as are my grandmothers. They get good care, and don’t have the hassles that they had when on insurance. My mother had to be her own bookkeeper throughout her cancer treatment for her primary provider, as they would fuck things up, overcharge, and deny on a regular basis. She had to spend a lot of energy researching and being her own advocate in order to see that treatments were covered. On Medicare, she doesn’t have to argue with anyone, and her care is covered—she can focus on staying alive. She also has fewer worries about being in the wrong place at the wrong time—with Medicare, she’s covered no matter where she runs into health problems, unlike with her HMO (which has a strict geographic boundary—if something had happened to her at my house, she’d have been screwed—her HMO has no outlet here).

39. I’d also like to say that on the flip side, (working class) folks are also very familiar with the difficulties of qualifying for Social Security disability, which tempers any idea about subsidies—what kind of hoop-jumping will we have to go through? What assets will we be allowed to have? I haven’t seen anything that says a person will be allowed to retain assets (home equity, retirement savings) in order to qualify for a subsidy. I know people who eventually qualified for disability after a serious injury, but the process took years and a good lawyer.

    Once employers stop offering insurance, people like me will be hit hard. I’ll have to pay more (as a single parent and an older woman), yet without the assistance of the safety net formed by my current insurance that covers me and my daughter for the same price (and a lower price than what I will end up paying as a single parent on the “insurance exchange” once my plan no longer exists). Last time I looked, a single parent of one child who earns more than $48,000 a year gets no subsidy—and I expect to pay more than what I am paying now. What I have now doesn’t come off my check—it’s a tax benefit to the employer, and is part of my wage package. When my plan no longer exists, it will be a de-facto wage cut.

    Now, $48,000 is nothing to sneeze at, sure. But keep in mind that even in central Illinois, that’s not rich. Right now, during peiods of unemployment, I don’t have to pay for insurance as long as I have banked hours. That will come to a screeching halt—and my unemployment benefits will prevent me from being fully subsidized. That’s the problem with tying these insurance benefits to the Federal Poverty Level—it doesn’t take into consideration actual living needs. That formula was conceived when the primary beneficiaries of benefits were war widows. There was a different assumption about who was poor, and what types of assistance they needed. Those parameters have changed, a lot. Yet the forms of assistance and the considerations taken haven’t—except in punitive measures (welfare work requirements regardless of too-small subsidies for childcare, higher education not qualifying as a work requirement, that sort of thing).

    So yes, there will be people hurt by this because of the subsidy formulas. Older people and people with no dependents especially. And don’t think insurance companies won’t charge higher costs for pre-existing conditions in forms other than higher premiums.

40. La Lubu, I am a fan of you.

    🙂

    AC — your rhetorical style is the kind that announces its own “realism” constantly but in fact has just swallered all the kool-aid on offer. Your position is that if we can’t provide decent health care to everyone, either because it’s “too expensive” (it certainly is, if you have to pay for health insurance company profits along with the care) or because “the public won’t support it” (because, sigh, people are mean, whattareyougonnado).

    Your position is like saying an umbrella won’t keep you dry because rain is wet.

    How do you make health care less expensive? By taking profit gouging out of it. How do you make people less mean? By including and protecting them, not creating insanely punitive sliding scales. A family has to make 88k a year to qualify for a subsidy? That’s effing brutal, it’s going to make the middle to lower middle class HATE this plan, and it’s going to make them more resentful about shouldering more than their fair share, which will make them meaner. This plan is just terrible.

41. (less than 88k, obvy — say, two parents making 44k each plus their kids. That’s a teacher married to a police officer, or a store manager married to an office admin, that’s not rich people).

42. La Lubu:

    I’m going to point out your most egregious error first, and then get into the rest of the substance of your comment.

    You think that my repeated use of the term “self-only” means that I “have a strong support for individualized solutions, rather than collective ones.” This is patently absurd. “Self-only” is regularly put in contrast to “family plan,” as in “someone who is purchasing insurance to cover themselves” versus “someone who is purchasing insurance to cover themselves, a spouse, and possibly other dependents.” I think your decision to read something entirely novel and completely ridiculous into a frequently used term is illustrative of your reading of the Senate bill generally.

    No. AnonymousCoward, you clearly have either never worked a physically demanding job, or if you have, you have conveniently forgotten everything you once knew about it. The benefits in the plan I described were inserted specifically because injured or ill workers are ineliglible for unemployment. If you are unable to go to work, you cannot collect unemployment benefits. While an office worker may be able to go to work with a broken arm, a tradesperson cannot. Get it now? And yes, those types of benefits could be covered, probably more effectively via a change in unemployment benefits to cover such situations—after all, the banked hours clause was effortlessly written into the Family and Medical Care Act, to keep workers with banked hours from having to exhaust those hours before receiving their benefits paid (which would penalize those workers).

    One of the reasons people are plunged into poverty is because of illness and injury, and their ensuing inability to receive benefits. Just sayin’.

    I’m well aware that many tradespeople cannot work after a serious injury. I think it’s fantastic that unions are able to work together to provide that protection for their members. That doesn’t transmute that protection into insurance to pay for medical treatment. Just because they are strongly related doesn’t make them the same thing.

    What you are advocating is an every-person-for-him-or-herself outlook. If a person doesn’t fit the template of the “good” insurance risk (relatively young, able-bodied, healthy, no dependents, preferably male to avoid those pesky women’s reproductive issues and things like greater propensity to diabetes, hypothyroid, depression, etc.)—fuck ‘em. It’s ok to leave those people with higher healthcare costs.

    As I said before, I’m one of those people who wouldn’t stand a chance in the individual market. And I’d like to make sure that those who don’t have employer-based coverage get access to coverage. That’s one of the reasons I support the Senate bill.

    Because while insurance companies will be required to take people with pre-existing conditions, there is nothing to prevent them from charging those people more via greater co-pays or out-of-pocket expenses. And as one ages (read: more likely to be unemployed and experience age discrimination when trying to get re-employed), you get the bonus of higher premiums!

    Again referring to FEHB, because it’s a diverse market that appears to have been the inspiration behind many of the provisions in the Senate bill, if you look at the various plans (available at http://www.opm.gov/insure/), you see a wide variety of types. There are the plans for healthy people, with low deductibles and high cost-sharing, and there are the plans for sick people, that have higher premiums in exchange for very low out of pocket costs.

    If anything, it’s low-income *healthy* people who are worse off under this bill, because they had little exposure to health-related financial risk (due to said good health), but now have to pay for insurance rather than gamble on remaining healthy.

    Once the mandate is in place, you can rest assured that employers are going to stop offering insurance benefits in droves—because they’ll lose the tax benefit that comes from providing decent insurance, and “hey, people can purchase this on the individual market now”—with all the drawbacks that entails.

    I suggest you read the bill (http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf ), page 349, section 1513. Employers who don’t offer health insurance will be paying for it anyway.

    Part of the reason for the high cost of medical care is the insurance industry and their denials of claims. The sheer amount of man- and womanpower put into getting the sons of bitches to pay on a claim. The annual arm-twisting negotiations to steer patients—I mean, “customers”, toward certain medical providers in exchange for lower rates, a practice which drives up rates for those who don’t have the patient base to get such perks, not to mention the uninsured. (sweet bedda matri, have you ever looked at an insurance bill and seen what you’d be paying if you didn’t have insurance? Think that may be why over 60% of bankruptcies in the U.S. are due to medical bills?)

    That’s why the bill includes Section 2719, which requires both internal and external appeals processes, as well as gives grants to states (in Section 2794) to establish consumer protection offices to help navigate said processes.

    Additionally, as I discussed above, I am entirely aware of how much my health care would cost without insurance, which is why I was so desperate to keep it.

    I’d also like to say that on the flip side, (working class) folks are also very familiar with the difficulties of qualifying for Social Security disability, which tempers any idea about subsidies—what kind of hoop-jumping will we have to go through? What assets will we be allowed to have? I haven’t seen anything that says a person will be allowed to retain assets (home equity, retirement savings) in order to qualify for a subsidy. I know people who eventually qualified for disability after a serious injury, but the process took years and a good lawyer.

    Having helped a few people get SSDI, I’m familiar with what a long, painful slog it is. Fortunately, the subsidy program at work here doesn’t also look at assets (Section 1401, page 251). Indeed, the bill specifically bars States from looking at assets (Section 2002, page 420).

    Once employers stop offering insurance, people like me will be hit hard. I’ll have to pay more (as a single parent and an older woman), yet without the assistance of the safety net formed by my current insurance that covers me and my daughter for the same price (and a lower price than what I will end up paying as a single parent on the “insurance exchange” once my plan no longer exists). Last time I looked, a single parent of one child who earns more than $48,000 a year gets no subsidy—and I expect to pay more than what I am paying now. What I have now doesn’t come off my check—it’s a tax benefit to the employer, and is part of my wage package. When my plan no longer exists, it will be a de-facto wage cut.

    Employers will have a disincentive to stop offering insurance, as discussed above.

    Additionally, a family with income below 400% of the FPL will receive a subsidy (Section 1401, page 245), as well as being expected to share less costs (meaning co-pay / co-insurance limits) (Section 1402, page 261).

    So yes, there will be people hurt by this because of the subsidy formulas. Older people and people with no dependents especially. And don’t think insurance companies won’t charge higher costs for pre-existing conditions in forms other than higher premiums.

    Given that the bill contains limits on how much cost-sharing a plan may have (Section 1302(c), page 108), I’m at a loss for how. Certainly, people with chronic illnesses will have higher out-of-pocket expenses, which is to be expected so long as there’s any cost-sharing at all.

    ——-

    Kathleen:

    A family making $90,000 a year is making twice the national median household income (see, for instance, http://en.wikipedia.org/wiki/Household_income_in_the_United_States ). Literally 80% of the country will be income-eligible for some level of subsidy. That level of income isn’t rich, but it’s not so poor that not giving them a subsidy for their healthcare can accurately be described as “effing brutal.”

    Also, my “realism” is not so much about what the American people can be convinced to support (for instance, the public option continues to be well supported by the public, last I looked), but rather what 60 Senators can be convinced to pass. There are at least two “Democratic” Senators who really don’t give one whit whether this bill passes or not, and they’re more than willing to kill it if they don’t get what they want. Since they’re holding a large number of uninsured people and people with pre-existing conditions hostage, they get what they want (for now).

43. I don’t know what to think about this bill passing (or not). I am worried…very worried…that it will make things worse based on everything I have read.

    So, I tried googling this and I couldn’t find an answer: does anyone know if the bill will do anything to stop the privatization of Medicaid (I mean, the waste of money to a middleman that is “managed Medicaid”)? Because, straight Medicaid was awesome. Managed Medicaid SUCKS ASS.

44. the difficulties of qualifying for Social Security disability

    Uh yeah no kidding…… 🙁

45. I mean difficulties of applying.

46. RD, I don’t know what you are talking about, getting on disability is easy. That’s why we hear all those fakers stories, not becuase of any sort of confirmation bias.

    I am not happy with this bill, but I want to see what happens when the bills are merged.

47. RD, I don’t know what you are talking about, getting on disability is easy.

    I dunno about that, thetroubleis. Everyone I know that has been seriously injured, enough to take them out of the workforce, has had a difficult time getting qualified as disabled. The problem comes up with say, someone having their spine crushed or their leg crushed, and “well, you can’t work the trades anymore, but you can do something,” even though employers aren’t keen to hire aging, unskilled in that “something“, workers with a disability (especially when it involves chronic pain and heavy meds to manage that pain).

    On the flipside, it is easy for people with conditions like cancer, MS, and such to get it.

48. I think troubleis was being sarcastic.

49. Lu Lubu, I was was joking. I’m still working on my SSI case.

50. Acck! Sorry for my stupidity!! I should have known that!

51. Hey, it’s fine, don’t worry about it. I forget about that whole no tone on the internet thing sometimes.

52. Heh. We need eyeroll icons on this blog!

53. La Luba, you say:

    “Last time I looked, a single parent of one child who earns more than $48,000 a year gets no subsidy—and I expect to pay more than what I am paying now.”

    Could you please tell me where you last looked? As far as I know, both the Senate and the House provide subsidies for those making less than 400 percent of the poverty line. The official Census bureau poverty line for a two person household is $14,051.

    This subsidies would be made available for any single mother making less than $56,000 dollars.

54. I believe it was in the previous incarnation of the Senate bill, before the House had got ahold of it.

    It has been really hard to keep up with the ever-shifting changes in this bill, because so little information was being put out there. It’s easy to find tables that show the benefits for a four-person household, but not for anyone else. I still haven’t found a sample policy from this insurance exchange; it’s one thing to say “insurance will be affordable” but it’s another thing to display what’s actually covered—after all, there’s posters up on utility poles in my neighborhood that read, “Finally! Affordable health insurance!!” that advertise for a low-cost plan that doesn’t cover anything—it just gives you coupons for aspirin and shit. I’d love to pay 8% of my income for a plan that covered me like the one I have now—-but I’m thinking that 8% figure is for a bare-bones plan with high deductibles and high out-of-pocket “limits” (read: you’ll never reach the limit, because it’s more than you can swing on your income. seriously. $10 grand in out-of-pocket? Not on what I make!). FWIW, I’m paying over 13% of my pretax income; and 16% of my actual take-home (I sock a lot away in a 401k as a hedge against a surprise! no pension!, and I won’t qualify for Social Security ’till I’m 70).

    What I’m irate about is the punishing of union members for negotiating increased health care benefits (like vision and dental, which are considered fluffy, unnecessary “cadillac” luxuries, or covering more of the cost for fixed-income retirees rather than crushing those folks under the weight of more costs). The costs of health care reform shouldn’t be borne on the backs of union members. Yeah, we’re doing alright when we’re working (which we increasingly aren’t). No, we are certainly not wealthy. (And no, we don’t take home $50-60 an hour, either).

    This plan, in its current incarnation, will strongly encourage employers to abandon providing health insurance for workers. It will especially encourage the public sector to abandon its healthcare plans. That won’t happen immediately, but yeah, things will get ugly in 2014. I live in the rust belt. You can’t get a school referendum passed here in nonwealthy communities. There is anger against people who work for the public sector; they are perceived as being “fat cats” by people who are hurting more. My county is laying off fourteen sheriff’s deputies for Christmas. They make around $40-50 grand a year. Not poor, but not rich either. If you read the newspaper editorial responses or listen to talk radio, you’ll hear about how “it’s their own fault” for getting pensions—that’s a big source of anger. Several 911 operators are also slated for layoff (full disclosure: dispatchers are represented by my union. when that plan becomes public, there will be a lot of talk about how badly they are overpaid because they start at over $30 grand. my union will catch the blame for that as the starting pay used to be around half that much—with astronomical turnover, as you might imagine from a high-stress, high-responsibility, low-pay job. There was so much mandatory overtime from the turnover, that when the pay went up, the overall cost of staffing didn’t go up very much—and the turnover vanished.)

    Not a day goes by in this recession that there isn’t a letter about how the reason this city is broke is because of pensions for police, fire department, and schoolteachers. The attitude is “fuck those people—let ’em save their own goddam money.” They are the folks catching the most blame right here, right now for the economic crisis, now that the autoworkers have been screwed and their jobs are already on the fast-track for outsourcing. (So many tradespeople are laid off right now, we’re kinda flying under the radar.)

    Because that, is the politics of anger. When people are so beaten down that they know they aren’t going to see justice, there’s a strong corollary of…..”fuck it. if I’m going to suffer, I want to see you suffer, too.” And whatever target is the closest and most visible is the target chosen. The people who are really, personally responsible for this mess are isolated and invisible to the subjects of their theft, duplicity, irresponsibility and incompetance. As they are from the consequences of their own actions, unlike the rest of us.

    I’m not inclined to take it as an article of faith that there are enough controls that I’m not going to get screwed by the insurance companies when my plan no longer exists (because it will be taxed to the hilt for providing usable benefits). I’m already going to be screwed on the face of the information available, as an older woman with a child. I will be charged more for a far more limited plan than what I have now, on the basis of my age and the cost of covering my daughter (what I pay now covers us both at no extra charge for a dependent or for my boldness in living past 40).

    At least Louise Slaughter is on the case.

55. La Lubu:

    Did you actually look at any of the citations I provided earlier? You don’t have to take it “as an article of faith” when the text of the bill is online for anyone to read.

    If you were to read the bill (or even my discussion of the bill, above), you would know that employers are fined if they don’t provide health insurance for their employees. You would also know that it caps a plan’s maximum out of pocket expenditures (which is $2,000 for a self-only plan, and $4,000 for a family plan).

56. you would know that employers are fined if they don’t provide health insurance for their employees.

    And again, as a union person, my healthcare benefits are a negotiated item in the contract. In a self-funded insurance plan. Not a plan purchased from an insurance company. (we save money that way—we can provide good benefits because we don’t have to make a profit). What is going to happen to my plan, is that we will be either forced to cut benefits (like vision and dental), or charge full freight to retirees, or charge more to members for adding spouses or children to the plan, or charge graduated payments based on age (the way the “healthcare reform” package does—a nice, hearty “fuck you” to older people).

    My employers (for the most part) are small enough to avoid the fines. Plus, when the fine is $750 per worker, and the cost of providing insurance is much,much higher, it makes more business sense to pay the fine, especially when you can argue that an individual worker can get cheaper insurance on the insurance exchange (and workers under forty probably can—for themselves and not their families).

    How this plays out with plans like mine that are composed of unions and employers is unclear. In a sense, it could be argued that union members are in double-jeopardy for not being able to make a self-funded plan balance out after the large tax penalty for providing good benefits, plus they still fall under the penalty as individuals if they don’t have an insurance plan.

    Taxing plans that offer good benefits is like levying fines against drivers who keep their vehicles in good condition—rotate the tires, change the oil, maintain the brakes, etc.—fining people whose vehicles are less likely to cause an accident. Explain that to me. Explain why it makes sense to punish people for having a plan that makes it more affordable to get healthcare (via low deductibles, low co-pays, and low-out-of-pocket caps), and thus less likely to incur the increased costs that come from postponing care.

    And don’t think that public sector workers aren’t going to get screwed. Once various public entities appeal that their employees should get cheaper insurance on the exchange in order to save taxpayer dollars, you can rest assured these entities aren’t going to be fined. Some employees may save money this way. Older employees and those with dependents will see their costs increase.

    (Yeah, I’m being cynical. But I live in Illinois, a state that is really hurting financially. There is a growing movement to abolish pensions for state employees because of the cost. You don’t think that when the insurance exchange is up and running, that public employees won’t be dumped onto the lower-benefit exchange?)

    What I read shows that for people who make 350% of poverty level or more, their out-of-pocket expenses are capped at $5,000 for an individual or $10,000 for a family. That is a crushing expense. That is a bankruptcy level expense.

    I’m open to having my mind changed. Can you provide me with a link that shows what a sample plan looks like? I’ve read that there will be several choices from different insurance companies. I have yet to see what the actual plans will look like. Right now, all I know for certain is that if I have to buy insurance on the exchange, I will be charged up the ying-yang because I’m older. Possibly at 2:1, possibly at 3:1.

    What I am left wondering is, why isn’t the plan I am covered under considered as a template for how to make healthcare work for the entire nation via a government-run, nonprofit public option? There are 27 Locals in my plan. There are plans similar to mine, with even better benefits and/or a lower cost because there are more participants. So—if a bunch of business managers and contractors can make a small plan run efficiently, why can’t the “insurance exchange” do the same? Why isn’t the insurance exchange offering the same benefits? Why is the “basic” plan on the exchange a 70-30 plan (plan pays 70%, you pay 30%)? Why are vision and dental considered “premium-plus”? Aren’t eyes and teeth still parts of the body?

    What I’m saying is: imagine how much more cost-effective a plan without a profit can be. A plan that doesn’t have to pay dividends to stockholders.

    Again, I’m open to having my mind changed. If you can explain to me how much more cost-efficient a for-profit plan is; how much better the benefits will be on the exchange, because the companies participating are allowed to pocket 30% of the proceeds…hey, I’m all ears.

57. (my other comment hasn’t been approved yet, but I need to make a correction!)

    I cited a $750 fine per employee for not providing insurance—I was wrong. The fine is only for businesses that have 50 or more employees, and the fine is only $400 per employee. Again, I’m not sure how that would be defined in terms of something like my plan, which is more-or-less a “collective” of 27 Locals and their signatory contractors…..unlike FMLA, which went into great detail in its description of building trades’ plans, and insuring that people under plans like mine wouldn’t get hosed, this legislation doesn’t seem to have language that addresses these issues.

58. La Lubu, you certainly have my respect for explaining some of these issues. I certainly learned a great deal.

    I think this will be an overall benefit for most people. I certainly will benefit. I think. In any event, I don’t think that the health insurance companies are even the main issue. It’s just really all about incentivizing cost control by health care providers. Doesn’t do enough in that area either, but it *does* force the insurance industry to focus on pushing down costs on the provider end…I mean, even with a mandate, I doubt that the insurance companies can survive without doing that. It’s just been easier being evil to their customers as a means or survival.

    We were already looking at the end of corporation provided health care (at least insurance that was worth a damn). I think we will come back to the issue over the time period, because I suspect events will outpace the legislation’s progression–I strongly suspect that 2010 is going to be a very hard year, and 2011 is when the wheels fall off.

59. I strongly suspect that 2010 is going to be a very hard year, and 2011 is when the wheels fall off.

    shah8, I’m with you there.

    Here’s what I saw instantly on the face: the Family and Medical Leave Act has language in it to protect building trades people from having to exhaust our bank hours before employers have to contribute to our health insurance because…..labor unions were invited to the table. We weren’t invited to the table this time; the decision was already made to screw us, so we could be held up as an example to the right wing, “see? we fucked over labor! we’re acting in good faith!!”

    Labor isn’t the reason we didn’t get universal health insurance the last time around. Labor only insisted that we not get fucked over in the process—we were all for universal health insurance, as our plans (then as now) require a heavier contribution from us—shit, our disposable income is evaporating too. The “disposable income” that is actually the savings we need for rounds of unemployment—or, at least that’s how it functions in my single-income household.

    But….the political courage to do what was needed (cost control on the provider end, a nonprofit system of payment to providers) was not there, because the Democratic party has this dysfunctional relationship (like a jilted lover) with rightward-leaning (primarily) white folks, and is willing to ignore their base in order to woo those people who’ve left the room (long before Elvis did) back. And then turned around and blamed organized labor for it.

    I expect that the Employee Free Choice Act will be blocked until after the 2010 elections, to insure labor’s support. EFCA is being held hostage to keep labor from being openly against this plan (again, I emphasize, in it’s current incarnation). Labor was told, point blank, that we sit down and shut up, or EFCA disappears. Period. Exclamation point.

    Whether EFCA actually comes forth after that, is anyone’s guess.

    Also…remember S-CHIP and the <a href="http://www.dailykos.com/storyonly/2007/10/8/105939/723Frost family? There was a huge uproar from the right about how much the family had in assets, as they bought a house in 1990 for $55,000. The prevailing notion from the right was that they should first become homeless before receiving assistance. That tempers my view of how much people will be allowed to have in assets before receiving subsidies.

60. La Lubu, I just have to say I am loving your comments in this thread. I’m actually closer to Jill here (I supported passing the bill even with its very significant flaws) but you’ve spoken so clearly and thoroughly about several different issues surrounding the subject and I’ve learned a lot.

    1. Seconding amandaw’s comment. Lubu, your insight is always welcome, but it’s really opened my eyes here to more of the nuances of this bill. I’ve read a lot of about it (I’ve been a little obsessed, honestly), but so much of the “how this is actually going impact people from different walks of life” is left out by the talking heads. So, thank you for your comments and your patience.

61. What the hell’s wrong with The New Republic?

62. It also puts into specific clarity Sen Landreiu’s threat to submarine the bills if the “cadillac” provisions are altered.

    Never ever miss that chance for class war!

63. La Lubu:

    And again, as a union person, my healthcare benefits are a negotiated item in the contract. In a self-funded insurance plan. Not a plan purchased from an insurance company. (we save money that way—we can provide good benefits because we don’t have to make a profit). What is going to happen to my plan, is that we will be either forced to cut benefits (like vision and dental), or charge full freight to retirees, or charge more to members for adding spouses or children to the plan, or charge graduated payments based on age (the way the “healthcare reform” package does—a nice, hearty “fuck you” to older people).

    It’s not providing vision and dental insurance that causes your plan to be more than $8,500 for a self-only plan, or $23,000 for a family plan, because there are plenty of insurance plans (like almost, if not all, of the FEHB plans) that cover those things to an excellent degree, and don’t cost that much. From what you’ve already said, it’s the fact that you’re not only paying for your own health insurance, but also the health insurance of retirees, plus including out-of-work insurance within the same plan. I’ve yet to see anything in the law that would prevent your self-funded insurance organization from splitting it into separate plans (one that pays for health insurance, and one that pays for out-of-work insurance), and possibly recognize the subsidy to retirees as something other than an ordinary insurance premium.

    My employers (for the most part) are small enough to avoid the fines. Plus, when the fine is $750 per worker, and the cost of providing insurance is much,much higher, it makes more business sense to pay the fine, especially when you can argue that an individual worker can get cheaper insurance on the insurance exchange (and workers under forty probably can—for themselves and not their families).

    The fine is in addition to the lack of benefits leading to more difficulty in attracting workers; the employer is paying for nothing (at least nothing that is of tangible use to them) rather than paying for something.

    Taxing plans that offer good benefits is like levying fines against drivers who keep their vehicles in good condition—rotate the tires, change the oil, maintain the brakes, etc.—fining people whose vehicles are less likely to cause an accident. Explain that to me. Explain why it makes sense to punish people for having a plan that makes it more affordable to get healthcare (via low deductibles, low co-pays, and low-out-of-pocket caps), and thus less likely to incur the increased costs that come from postponing care.

    Doesn’t it strike you as a little bit laughable that you’re referring to obscenely expensive health insurance policies as “mak[ing] it more affordable to get healthcare?” As I’ve been saying, and you’ve been ignoring, you can provide good health insurance benefits for less than the threshold for the excise tax.

    And don’t think that public sector workers aren’t going to get screwed. Once various public entities appeal that their employees should get cheaper insurance on the exchange in order to save taxpayer dollars, you can rest assured these entities aren’t going to be fined. Some employees may save money this way. Older employees and those with dependents will see their costs increase.

    I think it’s vastly more likely that the exchanges will be opened up to larger employers than to see Congress specifically move to exempt public sector employers from the requirement to insure their workforce.

    You’re also assuming that the exchanges will have “lower benefits,” which is a tad myopic, since not everyone has access to incredibly expensive health insurance.

    What I read shows that for people who make 350% of poverty level or more, their out-of-pocket expenses are capped at $5,000 for an individual or $10,000 for a family. That is a crushing expense. That is a bankruptcy level expense.

    That’s not true. The out-of-pocket maximum for even the most basic plan for an individual plan for someone making between 300% and 400% of the FPL will be 67% of the $5/10k, meaning $3350 or $6700 (Sec. 1402). Yes, that’s still a relatively high number, but it’s far better than the current exposure to financial risk.

    I’m open to having my mind changed. Can you provide me with a link that shows what a sample plan looks like? I’ve read that there will be several choices from different insurance companies. I have yet to see what the actual plans will look like. Right now, all I know for certain is that if I have to buy insurance on the exchange, I will be charged up the ying-yang because I’m older. Possibly at 2:1, possibly at 3:1.

    No, I can’t provide you with a sample plan, because the essential plan requirements (exactly what has to be covered with what levels of cost-sharing and whatnot) is a matter delegated to the Secretary of Human Health and Services. I can tell you that the scope of the essential benefits “is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary” (Sec. 1302).

    Regarding the rates for older people purchasing insurance, you’re again comparing the reforms to some ideal world, rather than viewing them in comparison to what the situation is right now. Right now, an insurer can charge an older person in the individual market much more than 300% of the rate for a younger person.

    What I am left wondering is, why isn’t the plan I am covered under considered as a template for how to make healthcare work for the entire nation via a government-run, nonprofit public option?

    Because your plan is obscenely expensive, and one of the goals of health care reform is bring down the ridiculous amount of money we spend on health care.

    Why is the “basic” plan on the exchange a 70-30 plan (plan pays 70%, you pay 30%)?

    I believe you are misunderstanding what the bill means by “full actuarial value.” When the bill says that a bronze plan pays for 60% of the full actuarial value of the benefits, that doesn’t mean that each individual pays 40% of their medical expenses. It means that the plan pays for 60% of all of the medical expenses incurred by all of the enrollees in the aggregate.

    Why are vision and dental considered “premium-plus”? Aren’t eyes and teeth still parts of the body?

    I’m at a loss for what you’re talking about, because I can’t find any provision designating vision and dental to be “premium-plus,” or what that would even mean.

    Again, I’m open to having my mind changed. If you can explain to me how much more cost-efficient a for-profit plan is; how much better the benefits will be on the exchange, because the companies participating are allowed to pocket 30% of the proceeds…hey, I’m all ears.

    I understand that just about no one has read the entire health care bill, but it would be nice if people would be conversant in the basics of what it does before discussing it. It has been relatively well-reported that the bill requires insurance companies to expend at least 85% of collected premiums on medical expenditures, and refund premiums on a pro-rata basis if that percentage is too low (Sec. 2718).

    As for whether for-profit insurance is better than not-for-profit insurance, that’s not the relevant comparison. What’s important is whether or not the reforms in this bill make for a better health care system than the health care system as it stands, and whether the bill can plausibly be made better (accounting for the difficulties in getting a bill through the House and Senate).

    I cited a $750 fine per employee for not providing insurance—I was wrong. The fine is only for businesses that have 50 or more employees, and the fine is only $400 per employee. Again, I’m not sure how that would be defined in terms of something like my plan, which is more-or-less a “collective” of 27 Locals and their signatory contractors…..unlike FMLA, which went into great detail in its description of building trades’ plans, and insuring that people under plans like mine wouldn’t get hosed, this legislation doesn’t seem to have language that addresses these issues.

    This is incorrect. The $400 payment is a fine for having an excessively long waiting period, and isn’t the fine for employers failing to insure their workers. There is also a $3000 fine for employers who offer insurance, but whose workers still need subsidization to afford the insurance.

    As for how it will apply to your collective, the bill uses existing tax law principles to determine whether a group of employers are aggregated or not, and therefore doesn’t seek to reinvent the wheel.

    That tempers my view of how much people will be allowed to have in assets before receiving subsidies.

    When the law specifically states that assets aren’t relevant to the determination of whether a person gets a subsidy, what basis do you have for concern on the matter? Is there other language you see in the bill that is problematic, or is it a general sense of “it has to be a terrible bill regardless of the actual language, so there’s got to be a reason why subsidies won’t be available?”

64. AnonymousCoward, I find it curious that you consider my plan to be “obscenely expensive”, when the cost is affordable when I am working, and my six months of bank hours mean that I pay nothing, nada, at precisely the time when I could not afford insurance. Frankly, we (the beneficiaries of my plan), would increase the bank hours if we could.

    And frankly, I’m finding it laughable that you can’t understand that the cost of my plan is based on charging people who can afford it that $8750, while supporting those, covering those, who can’t afford it. It’s a socialistic plan. That $8750 covers a single person whose is 20 years old, with no dependents, and no prexisting conditions. The same $8750 covers a family of seven–or more. With pre-existing conditions. It covers older working people at no extra charge for our age. It covers retirees at a lower rate than what working people pay. And…..this $8750 is not off our check—the tax benefit goes to the employer. Which means at the bargaining table, when that 40% tax is slapped onto our plan, it ain’t gonna be pretty. And that will be a significant wage cut on the check, as we will have to pony up more from our checks in order to keep our plan from folding.

    And no, we’re not going to find that in the private market or on the exchange. The 20-somethings with no dependents and no pre-existing conditions (when talking about the existing private market) would, but not the families and not the older people. And I’m not including the out-of-work benefits or disability benefits in that assessment. I’m just talking about the basic healthcare plan (albeit with the low deductible and low out-of-pocket maximums).

    You’re really expecting me, and the brothers and sisters in my union, to be enthused about the possibility of seeing our plan fold, because, hey—if we’re young enough and don’t have kids, we’ll be able to find cheaper insurance on the exchange? Nevermind the fact that by and large, we don’t fit that profile? But hey, suck it up! You brought us into this mess with your “obscenely expensive” insurance that covers families and retirees for $8750 a year! It’s those poor, suffering insurance companies that need a break! Don’t you know a third of insurance company executives are out of work, and their unemployment benefits are running out?

    Sweet bedda matri. Yeah, I’m cynical. I own that. Do you have any idea what is going to happen when this plan is instituted? It’s not going to be affordable. That’s right, it isn’t going to be affordable. Why? Because protecting the profits of insurance companies and pharmaceutical companies was prioritized over affordability for the average working person. In 2014, the sheer numbers of people getting on to the plan and using it, is going to cause one or more of the following: (a)reduced subsidies for people entering the exchange, (b)reduced eligibility for folks going into Medicaid, (c)asset tests, (d)reduced healthcare benefits (hey! that’s already happening with this bill when it comes to home health care for the disabled!), (e)high deductibles (converting the exchange to “catastrophic only”), (f)high co-pays for services (gee, wonder if physicians are going to let us run a tab?), and of course (g)high-out-of-pocket maximums. In other words, a return to the status-quo of out-of-affordable-reach healthcare, but with federally-mandated insurance company profits.

    What won’t happen: insurance companies being told to suck it up and deal with less profit. Healthcare providers being told to suck it up and deal with lower payments. Because for the love of Maude, those are the people who deserve their money. It’s those goddamn electricians and plumbers who are making obscene wages and carrying obscene benefits.

    Remember, the decision was made early on to fuck over labor; to fuck us over for doing the same thing for our members that this insurance plan purports to do for the public at large—cover the people who can’t cover themselves. And our plans are openly being compared to Goldman-Sachs’ plush benefits, which certainly aren’t covering people only earning $400 a week in unemployment benefits.

    The only way this is going to work is by cutting the profit motive out of it. Right now, the idea is to balance out the burden of folks with pre-existing conditions by charging older people double or triple. How that’s going to work out in terms of that famous 8%, in practice, not in theory? Because you can’t get to there from here. Charging me 2:1 is more than 8% of my income. So, what’s it going to be….8% for younger people, but 8% or whatever the higher rate is (2:1 or 3:1 depending on age) for those who are older?

    Remember, those “young invincibles” aren’t carrying insurance because they aren’t paid enough. They aren’t going to be bringing more money into this plan. That’s the big part of the problem right there—the gap between what people are paid and what it actually costs to live.

65. Anonymous Coward, who exactly are you? A lobbyist?

66. AnonymousCoward, I find it curious that you consider my plan to be “obscenely expensive”, when the cost is affordable when I am working, and my six months of bank hours mean that I pay nothing, nada, at precisely the time when I could not afford insurance. Frankly, we (the beneficiaries of my plan), would increase the bank hours if we could.

    And frankly, I’m finding it laughable that you can’t understand that the cost of my plan is based on charging people who can afford it that $8750, while supporting those, covering those, who can’t afford it. It’s a socialistic plan. That $8750 covers a single person whose is 20 years old, with no dependents, and no prexisting conditions. The same $8750 covers a family of seven–or more. With pre-existing conditions. It covers older working people at no extra charge for our age. It covers retirees at a lower rate than what working people pay. And…..this $8750 is not off our check—the tax benefit goes to the employer. Which means at the bargaining table, when that 40% tax is slapped onto our plan, it ain’t gonna be pretty. And that will be a significant wage cut on the check, as we will have to pony up more from our checks in order to keep our plan from folding.

    I’m getting a bit of whiplash, because you’re describing $5,000 in a worst-case-scenario out-of-pocket expense as “crushing” for someone at 350% of the FPL, and yet you’re insisting that your $8,750 insurance plan is eminently affordable. I can assure you that if the Senate plan had been “Anyone can get insurance who wants it, for the low cost of $8,750 a year!” it would not have gone over well.

    And this whole conversation has become absurd, because if your plan really does cover both the employee and any dependents for only $8,750, that makes it a “family” plan rather than a “self-only” plan, and means that the premium is one-third of the amount necessary to trigger the excise tax for excess benefits. At that point, no, it’s not overly expensive, which is why it won’t be taxed. If the Senate bill goes through exactly as written right now, the worst case is that your group will either have to pay an additional $100 per person with no dependent (40% of the $250 over the $8,500 threshold) in excise tax (1% of the total annual premium for those without dependents), or shift the numbers slightly so that people with no dependents whatsoever pay $250 less, with those with dependents paying slightly more (given the reasonable assumption that more people have dependents than do not). Of course, I don’t know what your trade is, so if it qualifies as something “high-risk,” the cap is increased and even your self-only premiums are not high enough to qualify for the excise tax.

    Sweet bedda matri. Yeah, I’m cynical. I own that. Do you have any idea what is going to happen when this plan is instituted? It’s not going to be affordable. That’s right, it isn’t going to be affordable. Why? Because protecting the profits of insurance companies and pharmaceutical companies was prioritized over affordability for the average working person. In 2014, the sheer numbers of people getting on to the plan and using it, is going to cause one or more of the following: (a)reduced subsidies for people entering the exchange, (b)reduced eligibility for folks going into Medicaid, (c)asset tests, (d)reduced healthcare benefits (hey! that’s already happening with this bill when it comes to home health care for the disabled!), (e)high deductibles (converting the exchange to “catastrophic only”), (f)high co-pays for services (gee, wonder if physicians are going to let us run a tab?), and of course (g)high-out-of-pocket maximums. In other words, a return to the status-quo of out-of-affordable-reach healthcare, but with federally-mandated insurance company profits.

    Slides may be fun, but I don’t recommend incorporating them into arguments by way of “slippery slopes”. None of those things are in this bill.

    What won’t happen: insurance companies being told to suck it up and deal with less profit. Healthcare providers being told to suck it up and deal with lower payments. Because for the love of Maude, those are the people who deserve their money. It’s those goddamn electricians and plumbers who are making obscene wages and carrying obscene benefits.

    Section 2718 (telling the insurance companies to suck it up and deal with less profit) and Section 2794 (telling insurance companies to suck it up and deal with lower payments if they want to try to raise premiums ‘unreasonably’) suggest otherwise. On the provider side, Section 3403 (establishing an independent review board for Medicare that will likely lead to cutting provider reimbursements in some areas) suggests otherwise.

    Right now, the idea is to balance out the burden of folks with pre-existing conditions by charging older people double or triple.

    That’s not the idea at all. The costs of people with pre-existing conditions are balanced out by the healthy people that are now obligated to purchase health insurance, or pay a “shared responsibility payment” (the mandate fine) which covers the risk-mitigation of pre-existing conditions down the line.

    How that’s going to work out in terms of that famous 8%, in practice, not in theory? Because you can’t get to there from here. Charging me 2:1 is more than 8% of my income. So, what’s it going to be….8% for younger people, but 8% or whatever the higher rate is (2:1 or 3:1 depending on age) for those who are older?

    That’s not how it works. The 8% is the threshold for affordability. If there is not a plan for you (meaning including any increase due to age, past tobacco use, or rating area) that costs less than 8% of your income, then you are exempted from the mandate.

    Remember, those “young invincibles” aren’t carrying insurance because they aren’t paid enough. They aren’t going to be bringing more money into this plan. That’s the big part of the problem right there—the gap between what people are paid and what it actually costs to live.

    Some are, some aren’t. I know plenty of young professionals who are certainly paid enough to purchase health insurance, if not for the fact that the individual market is currently a complete rip-off. Admittedly, this is “anecdata”, and I know quite a few young people who would love to have health insurance, and simply cannot afford it.

    —-

    Kathleen:

    Anonymous Coward, who exactly are you? A lobbyist?

    Nope, though I did make quite an effort to get into the ACLU’s Washington Legislative Office. I’m an attorney working for the federal government, enforcing (and occasionally drafting) various safety laws and regulations.

67. La Lubu, I love you.

68. I’m getting a bit of whiplash, because you’re describing $5,000 in a worst-case-scenario out-of-pocket expense as “crushing” for someone at 350% of the FPL, and yet you’re insisting that your $8,750 insurance plan is eminently affordable.

    Five grand on top of the cost of insurance and the deductible? Yeah. I consider that crushing. Not to mention, when I was referring to the $5000, I am keeping in mind that when my plan folds up, insurance is going to be a hell of a lot more expensive for me, since I will have to pay extra for my daughter and extra for my age (I’m a lifelong nonsmoker, so I guess I get a little break there). That 8% of income is for the bare-bones 70/30 plan that doesn’t include vision or dental. I’m assuming that in order to get health benefits (not including the disability or unemployment benefits that come with mine, just the health care benefits themselves) similar to my existing plan, I will be paying the same percentage I’m paying now just to cover myself, plus a hefty increase for my child and my age penalty.

    because if your plan really does cover both the employee and any dependents for only $8,750, that makes it a “family” plan rather than a “self-only” plan, and means that the premium is one-third of the amount necessary to trigger the excise tax for excess benefits.

    Yes, my plan really does cover families of any size, and people of any age or health condition for only $8750. But the devil is in the details, because that’s the price it is for single folks, too. Since there isn’t any contingency language in this bill to cover plans like these (as there is in FMLA, since labor was part and parcel of the process), who knows how that will be decided? There isn’t any language in Illinois’ All-Kids plan to address plans like mine either; on the application I was supposed to separate the cost of my daughter’s insurance from mine. I explained that this wasn’t possible, sent in a copy of the plan along with a letter from the plan administrator (figuring that hey, maybe they’d just split it down the middle, since there were two of us?), but was denied.

    I don’t know what your trade is, so if it qualifies as something “high-risk,”

    I’m an electrician. That’s considered to be “low risk” if you’re employed by the State of Illinois, something that we (the IBEW) are trying to get corrected for our State employees. All I can tell you is, it’s certainly high-risk when you buy life insurance on the private market (as I do).

    None of those things are in this bill.

    I didn’t say they were. I said they would be, when the brainchilds behind making sure corporate profits were protected first realize exactly how expensive this is going to be, particularly when so many people are out of work. I’m basing my prediction on how Early Intervention was scaled back (it used to cover all children who fell under the at-risk guidelines; now you basically have to be on Medicaid, TANF, or WIC to qualify). I’m also basing my prediction on how disabled people fare under the existing bill—take a closer look, and you’ll see how home health care was gutted. I guess the prevailing notion was “fuck those people; let ’em go to a nursing home.” After all, it’s not like the disabled have a well-oiled lobby machine like, oh, like the insurance companies and big pharma.

    If there is not a plan for you (meaning including any increase due to age, past tobacco use, or rating area) that costs less than 8% of your income, then you are exempted from the mandate.

    Gee, thanks. I’ll also be exempted from insurance. Well, maybe not if I’m unemployed.

    Admittedly, this is “anecdata”, and I know quite a few young people who would love to have health insurance, and simply cannot afford it.

    All of the young people I know who aren’t tradespeople are completely unable to afford insurance. Then again, I live in the rust belt where full-time work is a rare and precious thing. Hell, work is a rare and precious thing. Yeah, that’s anecdata. What isn’t: my state just borrowed money to be able to keep paying unemployment benefits. There’s that many unemployed, and that little left to go around in the state coffers.

    That’s another thing—the practice of employing people part-time to avoid paying benefits. If they’re only giving you 25 hours a week at Wal-Mart or Lowes, what then?

    AnonymousCoward, I’m going to go out on a limb and assume you live in D.C. or the environs. I don’t know how often you get out and drive through Flyover Country™ but the view from your window is starkly different than the view from mine. It’s ugly out here. Chicago is hurting, but it looks like the Emerald City compared to downstate. It is seriously ugly downstate. And yeah, anecdata and all……but I’m finding it really hard to believe that there are that many areas of the country that are doing alright, to balance out the areas that are like mine.

69. La Lubu, I appreciate the insight and information you’re providing. And I’m inclined to your side of the argument. But I think you’re kind of missing the basic point.

    This reform bill attempts, or at least is supposed to attempt, to basically level the health care market – to bring up the people who have no or bad health coverage, at the expense of people who have better than average coverage.

    You have significantly better than average coverage. Kudos to your union on that.

    But if we’re going to socialize this, that’s going to mean that people who have great coverage today are going to have less great coverage tomorrow. If we had single payer, this would be directly handled; we aren’t going the single payer route, which means that the money has to be extracted from you less directly – in the form of higher premiums, taxes on your benefits, mandates on your younger coworkers, etc.

    There is no mathematical way to bring up the bottom without squeezing the top while keeping the overall cost the same or lower.

    You’re at the top.

70. You’re at the top.

    No, I’m not. I’m comfortably in the middle* (when I’m working—which, can’t be counted on. Can’t be counted on for anyone now, but periodic unemployment is a feature for construction workers. Now, I’m not complaining….I knew that when I got in the game. It beat the hell out of any other realistic alternative I had. But….the wages/benefits we make as construction workers are a trade-off against that periodic unemployment, as well as the reduced lifespan we get. Just a friendly reminder.).

    And that’s the problem. This is a regressive system. Because when people in the middle are suddenly redefined as being “at the top”, in order to keep a real, progressive tax system out of the picture…..let’s just call it what it is, shall we? Class war.

    No, believe it or not, electricians (hi!), plumbers, carpenters, painters, ironworkers, tinners, boilermakers—or for that matter, police, firefighters, schoolteachers, nurses, salespeople, truckers, folks who work in cubicle city, etc.—-are not “at the top”. Can those of us who are working weather a little hit? Yes, we can. Can we weather a few extra thousand hit? No, we can’t. Meanwhile, the folks who actually are at the top quintile can rest assured that they aren’t taking any bigger of a hit than the people two quintiles down below.

    This is a hit on the middle. While providing a guaranteed benefit to the folks who actually are at the top. People like this:

    Ins. Co. & CEO With 2008 Total CEO Compensation
    ■Aetna, Ronald A. Williams: $24,300,112
    ■Cigna, H. Edward Hanway: $12,236,740
    ■Coventry, Dale Wolf: $9,047,469
    ■Health Net, Jay Gellert: $4,425,355
    ■Humana, Michael McCallister: $4,764,309
    ■U. Health Group, Stephen J. Hemsley: $3,241,042
    ■Wellpoint, Angela Braly: $9,844,212

    Let’s not pretend that families making 350% of the poverty level are on the same financial ground as the folks living in McMansions, or especially actual mansions, ok? Especially when it is impossible to provide oneself with housing, utilities and food on what is called “the poverty level”, let alone things like transportation, child care, and health care.

    If the poverty level actually reflected the bare-bones cost of living, we wouldn’t even be having this conversation. But of course, we’d also have to institute a progressive system of paying for healthcare.

    *yes, I realize I’m doing better than most single mothers. That’s because I work in an occupation primarily occupied by males. Since this is a feminist blog, I’m taking the tack of considering that since my income would be considered middle income by male standards, it can be considered middle income even when earned by a woman.

71. La Lubu:

    Let me begin by pointing you to Sec. 9001, (b)(3)(C)(ii), which says that the higher limit applies to those “who participates in
    a plan sponsored by an employer the majority of whose employees are engaged in a high-risk profession or employed to repair or install electrical or telecommunications lines.” Further, in defining the term, paragraph (f)(3) of the same section specifically includes the construction industry. That kicks the self-only threshold up to $9850 and the family threshold up to $26,000. I don’t know how your union or your plan is organized, but that may take it entirely out of reach of the excise tax.

    Five grand on top of the cost of insurance and the deductible? Yeah. I consider that crushing. Not to mention, when I was referring to the $5000, I am keeping in mind that when my plan folds up, insurance is going to be a hell of a lot more expensive for me, since I will have to pay extra for my daughter and extra for my age (I’m a lifelong nonsmoker, so I guess I get a little break there). That 8% of income is for the bare-bones 70/30 plan that doesn’t include vision or dental. I’m assuming that in order to get health benefits (not including the disability or unemployment benefits that come with mine, just the health care benefits themselves) similar to my existing plan, I will be paying the same percentage I’m paying now just to cover myself, plus a hefty increase for my child and my age penalty.

    You keep assuming that your plan is going to fold up under this new legislation, for reasons you haven’t specified. You’re in a union, so it’s clear that you have some significant negotiating power – is the concern that even that negotiating power won’t be enough to keep the insurance plan in the contract?

    As for the 8%, it’s not “for the bare-bones 70/30 plan that doesn’t include vision or dental.” The 8% number simply is used to determine whether or not you are required to purchase insurance or pay the “shared responsibility payment.” If insurance is deemed to be unaffordable for you, there are options you could choose (like getting a catastrophic coverage plan if you’re under 30 and are getting a self-only plan), but the bill does not require you to purchase insurance for 8% of your income.

    Further, you’re not counting the subsidies, which in your case would be substantial. Assuming you’re at 350% of the poverty line, your expected contribution would be $416 per month (50995 / 12 * 9.8%), and the government will pay for the difference between that and the second-lowest-cost silver level plan.

    Yes, my plan really does cover families of any size, and people of any age or health condition for only $8750. But the devil is in the details, because that’s the price it is for single folks, too. Since there isn’t any contingency language in this bill to cover plans like these (as there is in FMLA, since labor was part and parcel of the process), who knows how that will be decided? There isn’t any language in Illinois’ All-Kids plan to address plans like mine either; on the application I was supposed to separate the cost of my daughter’s insurance from mine. I explained that this wasn’t possible, sent in a copy of the plan along with a letter from the plan administrator (figuring that hey, maybe they’d just split it down the middle, since there were two of us?), but was denied.

    There *is* language in the bill to cover plans like yours, though. I didn’t just pull my analysis from the nether-regions of space: it’s in the bill. Paragraph (a)(1) clearly states that the unit of measure for determining “excess benefits” is the employee, not the plan as a whole. Paragraph (f)(1)(B) of Section 9001 states that if the coverage is other than self-only coverage, and actually provides coverage to another beneficiary, it’s considered “other than self-only” and thereby is governed by the higher limit.

    I didn’t say they were. I said they would be, when the brainchilds behind making sure corporate profits were protected first realize exactly how expensive this is going to be, particularly when so many people are out of work. I’m basing my prediction on how Early Intervention was scaled back (it used to cover all children who fell under the at-risk guidelines; now you basically have to be on Medicaid, TANF, or WIC to qualify). I’m also basing my prediction on how disabled people fare under the existing bill—take a closer look, and you’ll see how home health care was gutted. I guess the prevailing notion was “fuck those people; let ‘em go to a nursing home.” After all, it’s not like the disabled have a well-oiled lobby machine like, oh, like the insurance companies and big pharma.

    What happened to: “What won’t happen: . . . . Healthcare providers being told to suck it up and deal with lower payments.”

    I admit I don’t know a whole lot about how home health care is currently funded, but some quick Googling suggests that these cuts were designed to target excessive profit margins of home health agencies. See, for instance, http://www.magicvalley.com/news/local/article_4ef4fa84-b08b-5eac-b59b-ab53682b7df1.html:

    However, AARP Idaho Director Jim Wordelman said the home health care industry is using “scare tactics.” His organization stands behind the cuts, calling them necessary for eliminating “waste and overpayment.”
    “There is a lot of fear but these cuts will not affect care or access for Medicare beneficiaries. If it did, we wouldn’t support it,” Wordelman said.
    He points to the Medicare Advisory Payment Committee’s 2009 “Report to Congress: Medicare Payment Policy,” calling for significantly reduced fees based on its finding that home health-care agencies enjoyed an average profit margin of 16.5 percent in 2007.
    MedPAC estimated 2009 profit margins at 12.2 percent.

    Do you have any specific details of how you feel home health care was gutted?

    Additionally, what *could* happen isn’t really relevant to what is happening. The Senate could have passed a single-payer bill that was perfect in every way, and I could spin a tale of how malicious legislators could come back in a few years and turn it into a nightmare.

    Gee, thanks. I’ll also be exempted from insurance. Well, maybe not if I’m unemployed.

    As discussed above, even if your plan were to go away (despite your bargaining power and the apparent fact that the tax doesn’t affect your plan), you would receive substantial assistance in purchasing insurance.

    All of the young people I know who aren’t tradespeople are completely unable to afford insurance. Then again, I live in the rust belt where full-time work is a rare and precious thing. Hell, work is a rare and precious thing. Yeah, that’s anecdata. What isn’t: my state just borrowed money to be able to keep paying unemployment benefits. There’s that many unemployed, and that little left to go around in the state coffers.
    That’s another thing—the practice of employing people part-time to avoid paying benefits. If they’re only giving you 25 hours a week at Wal-Mart or Lowes, what then?
    AnonymousCoward, I’m going to go out on a limb and assume you live in D.C. or the environs. I don’t know how often you get out and drive through Flyover Country™ but the view from your window is starkly different than the view from mine. It’s ugly out here. Chicago is hurting, but it looks like the Emerald City compared to downstate. It is seriously ugly downstate. And yeah, anecdata and all……but I’m finding it really hard to believe that there are that many areas of the country that are doing alright, to balance out the areas that are like mine.

    You guess correctly, for the moment. It wasn’t too long ago that I was living in central VA (or “Real Virginia,” as the Republicans are wont to call it), and I can tell you it’s not great down there either. That’s part of why I moved inside the Beltway – there are jobs here.

    However, my point was simply that there are an economically significant number of people (if I had to be more specific, I’d say mainly young professionals) who could afford insurance (or better insurance, rather than catastrophic coverage) but choose not to because they are generally healthy, don’t foresee getting sick, and would prefer to spend the money on other things. Bringing these people into the risk pool spreads the risk of illness amongst a larger group, and thereby lowers costs for everyone.

    No, believe it or not, electricians (hi!), plumbers, carpenters, painters, ironworkers, tinners, boilermakers—or for that matter, police, firefighters, schoolteachers, nurses, salespeople, truckers, folks who work in cubicle city, etc.—-are not “at the top”. Can those of us who are working weather a little hit? Yes, we can. Can we weather a few extra thousand hit? No, we can’t. Meanwhile, the folks who actually are at the top quintile can rest assured that they aren’t taking any bigger of a hit than the people two quintiles down below.

    At the risk of jumping in the middle of you and A Guy In Denver, I don’t think that’s what he was saying. He said “you have significantly better than average coverage.” The later reference to “squeezing the top” was in the context of health insurance, not incomes generally.

72. A guy in Denver — that’s just not true. You’re buying into the scare tactics of health insurance lobbyists. Take it from an American living in Canada — good health care for everybody is absolutely possible. And you’re also buying into the really foolish idea that markets can be “leveled”. Maybe you are just mixing your metaphors, and you meant playing field, but in fact I think the word choice is telling about what you (wrongly) believe to be a possible outcome of the current plan. If you put health care into the market, the only profitable option is more of what we have now: many people getting totes screwed. It will never, never, never be “level”. For a level playing field, you cannot use market mechanisms (Anonymous Coward is another believer in the markets in this sort of pie-eyed way). In any human system, a few people are going to get totes screwed (trot out your Canadian anecdotes here) — but in market systems, lots and lots of people do.

73. Once the health insurance companies gain the wealth given to them by a nationwide mandate, good luck trying to achieve anything even approximating the public health plans of other countries. Pretty fancy footwork to call this a tax. What other tax is paid directly to a private party? Even if a tax, it’s about as regressive as they come, given the fact that most uninsured are in that position, not by choice, but because they do not believe they can afford insurance. This plan requires them to buy it. Guess this administration and Congress know how to get blood from a turnip and water from a stone.

74. A guy in Denver — that’s just not true. You’re buying into the scare tactics of health insurance lobbyists. Take it from an American living in Canada — good health care for everybody is absolutely possible.

    I never said it wasn’t.

    What isn’t possible is bringing up the bottom, without squeezing the top, while keeping total costs the same or lower. That’s not insurance company propaganda, that’s math.

    I’m a single-payer fan, myself, so my susceptibility to insurance company fearmongering is pretty limited.

75. Well, a Guy in Denver, being just a girl I might not be great at math (though I do always find it charming when men use “that’s just math” as a put-down in an argument) but I do think an important subtraction — of private health insurance company profits — would indeed keep total costs “the same or lower”. Current U.S. spending on health care is astronomical, as are — huh — health insurance company profits. Dude, you do the math.

76. I am not using “that’s math” as a putdown, nor as a gendered insult, Kathleen. I am using it as a description of reality. It IS math.

    Private health insurance company profits would not make a significant difference to the outcome. Total health insurance industry profits are about 3.4% of gross revenue. Far from being “astronomical” in its profit, this is one of the less profitable sectors of the health care system, which comes in with margins around 13% overall.

    Putting 3.4% back into the system, even if you could get all that money (you can’t), and even if it would all go to the poorer folks (it wouldn’t), would not make a significant difference in the overall cost structure or in the allocation of benefits. Even if administration costs are zero, even if we magically find the capital to replace the private capital earning that 3.4%, the total sum (while large in absolute magnitude) is small in relation to the increases in benefits that we must get for the poorest among us.

    Insurance company profits come out to around $13 billion, out of a total health care expenditure (all sources) of $2.2 trillion-with-a-T. It’s like having a restaurant bill of $220, and one of the line items on that bill is “mints”, for which they charged $1.30. Yes, not ordering the mints will reduce the bill – but not in any meaningful way. We’re certainly not going to feed the poor from the savings.

    It has become something of a theme among some good-hearted folks in favor of health care reform that if we could just get rid of the insurance profits, we could pay for everything easily. We couldn’t. Plans made on that basis are doomed to fail.

    We are essentially socializing medicine. We’re doing it in a fucked up, corporate-welfare way, rather than just being sensible and setting up a single-payer system, but socializing something means flattening the distribution. Flattening inherently means that the people towards the top are going to get less.

    La Lubu and her family are, in terms of their health care situation, toward the top. They have to give something up, or this reform MATHEMATICALLY cannot be made to work.

    We should have single-payer because it would be fair and more humane, and would make life at the bottom quarter or half of our economy a lot more survivable. We have to recognize that there are costs to providing that social justice, however, and in this case that cost is going to have to be that many of us who right now have gold-plated health care are going to have to make do with less – to live more simply, so that others may simply live.

77. Guy in Denver — spare me the noblesse oblige, especially when it is delivered in a tone of stern lecture. Canadian health care *is* gold plated, and it’s for everyone. Or, to just think about the U.S., check it out:

    http://fdlaction.firedoglake.com/2009/12/29/if-this-were-germany-denmark-belgium-or-france-we-would-not-need-affordability-tax-credits/

78. No. La Lubu and her daughter are, as she said, comfortably in the middle, not at the top. Coal miners, retirees, and middle-class and working-class folks are “at the top” by your definition as their plans are “Cadillac plans.” If you want to see the real Cadillac plans, take a look at what Congresspeople get. Or, say, Goldman Sachs execs, who pay $40K a year and no other costs or treatment/referral requirements.

    I agree that single-payer is preferable. I don’t want to put words into LaLubu’s mouth, but I wouldn’t be surprised if she concurred. The public option was the compromise in place of that, and that’s been demolished.

    Yes, let’s talk about math. Premiums depend upon the company where you work, the size of the company you work for, the makeup of the employees there, the state you live in. . .a whole host of factors. Calling these plans “Cadillac plans” as if they were on par with what, say, the CEO of Amex is getting is disingenuous. You can get very average (or below average) and be paying that much in premiums (between you and your employer) per year. Quoting Ghandi and preaching simplicity* to people who are already vulnerable is ridiculous, especially if you’ve done the math, as you claim.

    *As someone who practices VS, I really wish people would get off of that soapbox. So many proponents look down instead of up when they want to preach to people to give up stuff.

79. Sheelzebub: I am going to quote you on that “so many people look down instead of up….” line, it’s awesome!

80. There is one CEO of Amex. There are 100Ks of La Lubus. What she has described as her plan is considerably above average, not “middle”. Middle is not all that great. Furthermore, please do not make assumptions about what my level of health care is. I have NO coverage from anywhere – I cannot afford it, but make too much for public programs. We go to the local clinic for owies and fevers, and pray fervently every day not to get something horrible, because we have no way to pay for it. I am not preaching DOWN to anybody, ma’am.

    But I am sorry if my tone has been harsh. That was not my intent. I want to see everybody get care.

81. maybe it’s “considerably above average” in comparison to other Americans. That’s sort of the point. It’s most definitely middle to LOW compared to all the other countries who have socialized health care better than ours for half price.

82. There is one CEO of Amex

    But there is not just one CEO in the nation, and there are many other C-level executives in each corporation besides–and these people get far, far more and pay far, far more than the likes of La Lubu or your average American.

    Might I also remind you that you are not the only person posting here or reading this blog who is without insurance? LaLubu herself has been without it, as she’s stated upthread. You do seem to be making an awful lot of assumptions yourself.

83. And Sheelzebub, if we took every one of those CEOs and took every penny of their compensation – even ignoring the impact on business, and on the decisions that people would make in the future – it wouldn’t be a drop in the bucket of what we need to pay for health care reform.

    It’s good politics to emphasize the high salaries and compensation of corporate executives, but it isn’t good economics, because that money just isn’t very important in the big picture.

84. A guy in Denver, finding out you don’t have health insurance and yet you are totally a believer in the dominant narrative that we just can’t provide good care to everybody because it’s too expensive and that’s too bad, but life is hard, suck it up — it just makes me really, really sad. I mean, American politics show that lots of people, maybe most, buy that narrative even if it hurts them to do so.

    It helps one understand how feudalism succeeded for so long: lots & lots of peasants just bought into the idea that the aristocracy was indeed better than they were and any challenge to their superiority would bring down the wrath of god.

    What’s weird here, though, is that there are *perfectly visible examples* of alternative systems that work *just fine* (Canada is hardly free of successful businesses despite the dreaded health care; in fact, they survived the recent economic crisis in much more unscathed fashion than did the U.S.). But so many Americans like you are still convinced that living in an hideously brutal and unfair universe is just the way it’s gotta be. That’s equal parts strange and tragic.

85. Kathleen, are you saying the universe isn’t brutal and unfair? ‘Cause if so, I want to live there.

86. I haven’t said we can’t provide good care to everybody.

87. I agree that single-payer is preferable. I don’t want to put words into LaLubu’s mouth, but….

    Aaahh, go ahead. Single payer is preferable. And possible, too. (just follow Kathleen’s link).

    As I said before, the benefits of my plan are not “gold plated.” The annual cost to working members paying into my plan are higher than what a young, healthy person with no dependents would pay under the typical insurance plan specifically because we are “living simply so that others may simply live”; to wit, paying more so that the less fortunate among us have health care. Period. There is no gym membership. No yoga classes. No plastic surgery. Just standard health care (along with vision and dental—and it frustrates the living shit out of me why eyes and teeth are somehow considered “extras” in the insurance biz).

    And it bears repeating: the decision to fuck over organized labor, and tax the hell out of our plans, was a political strategy to try and win over Republican and Blue Dog (read: right-to-work state) votes. It was a bone to throw to conservatives.

    Whether my plan falls under the “cadillac” tax or not will depend on what happens between now and 2014—what the conference committee does to try to bridge the gap between the House and Senate versions, or if there is language added later to protect non-profit, labor-created plans. Other unions will not be so lucky, as there are more retirees than working members (electricians die off earlier than factory workers). They’ll have to dump their retirees in order to remain solvent—with those retirees getting the bonus of much, much higher premiums (age penalty) on a fixed income (while not being old enough for Medicare, and not having a low-enough income for Medicaid, since most of them will be single-person households). Those retirees sure will learn an expensive lesson on “living simply, so that others may simply live.” But that’s ok. No CEOs will be harmed in the making of that film.

    Now with that said, back to the real meat of the matter—wealth disparity in the United States. “There’s only one CEO of AMEX” indeed. For all the claptrap I’ve heard in my life about how the greatest amount of wealth is found in the “middle classes”, I have yet to see any evidence of that. Both wealth and income disparity have increased exponentially during the course of my life; right now, the top 10% has over 70% of the wealth (in the U.S.). Come to think of it, the top 10% (those with incomes over $104,700) earn almost half the income. (for left-wing commie pinko source, visit here.)

    Now think about that. Tell me again who has all the wealth? Because no one seems to give a shit about the impact hammering the folks in the middle, to give the top a break is going to have on the economy. This economy has been literally shoveling money from the bottom to the top throughout the course of my life—and the economy has been getting worse. Repeat after me, once more with a feeling: trickle-down economics doesn’t work.

    Politicalguineapig, this isn’t the “universe” being unfair. This isn’t a tornado, earthquake, virus, or other natural disaster. This is a human-created system designed to benefit the wealthy at the expense of the nonwealthy. The wealthy aren’t being required to pay proportionately in order to insure that the vulnerable amongst us are covered. They also seem to avoid the usual voluntary simplicity lectures that uppity working class people get (“what are you complaining about? You’re not homeless yet!”). Bah. The hundred-thousand La Lubus of this nation don’t have anywhere near the wealth of the relatively smaller-numbered CEO and high-octane executives.

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