The Goal of Health Care Reform

There's absolutely no question that the health care bill is a gigantic boondoggle for the health insurance agencies. Millions of Americans are being forced to become new customers yet the agencies aren't being forced to lower costs. I get that - I'm just not sure it's the most important thing about this bill.

Desmoinesdem told us yesterday about a piece from MarketWatch in a post called, "MarketWatch: Health care reform good news for insurance industry". Her persuasive piece reminded me of a high school friend of mine who has taken to routinely posting health insurance stock prices on Facebook. Arianna Huffington compared arguments for the bill to the debate surrounding No Child Left Behind, calling it "Leave No Special Interest Behind." All these arguments were most famously summed up by Dr. Howard Dean when he called the bill "a bigger bailout for the insurance industry than AIG".

Here at MyDD, Desmoinesdem and Jerome are arguing against the bill in its current form, and Charles says he leans that way too. I disagree, and Jonathan seems to as well. This blog is a microcosm of the larger party, where we see Bill Clinton, Barack Obama, sixty percent of the U.S. Senate, Paul Krugman, Vickie Kennedy, and the inventor of the public option, Professor Jacob Hacker, squaring off against Dr. Dean (update: I should point out that Dr. Dean has walked back his comments), the bulk of the Netroots (including Markos, Jerome, Arianna, and Jane Hamsher), and many leading House progressives.

The health care debate between the left reminds me of the climate debate between scientists and conservative economists. "How much will addressing climate change cost?" is not the right question to ask. Instead we should ask, "How much will addressing climate change cost vis-à-vis not addressing it?" When it comes to health care, the question to ask is not, "Will this bill hammer the insurance companies?" The question we need to ask is, "What's more important, screwing the insurance companies, or lowering the deficit, bringing insurance to 30 million more Americans, and forcing coverage of pre-existing conditions?"

Joe Biden says one should never question another person's motives. We all have our priorities, and most of them are admirable - but for me, expanding insurance now is the top health care priority, and though I would have put financial regulations and clean energy first to gain political capital for a better bill, the inferior bill is nonetheless worth it. As Jonathan said, "This bill isn't perfect, but it may be the best chance at reforming the system that there will be for a long, long time."

I'm not going to compare this bill to what it could be; I'm going to compare it to what we have now. It sucks, but it sucks less than what we're used to. Covering 30 million more Americans for less than the cost of the Iraq war, all while lowering the deficit, is worth a Ben Nelson boondoggle and an insurance company give-away. It may taste bitter, but hey, the caffeine is worth the bitterness each morning, and this is no different. And just as you can put sugar in your coffee even after you've drank half the cup, we can improve this new system in future years.

It's an argument you've heard before but I stick with it: Every time we blow it on covering more Americans, it's decades before we get to try again, only to blow it again. We HAVE to pass this bill if we're going to increase insurance coverage in this country. Cost containment, however, is a different story. Washington seems to be capable only of fixing what's right in front of them, never taking a long-term view. Well, health care costs are becoming a more and more immediate issue every day. There is no way this country can sustain itself with health care costs eating up more than 20% of the GDP, which is we're rapidly headed. If we don't address insurance now, we may never address it. If we don't address cost containment or the for-profit model now, we will definitely return to it in a relatively short amount of time. And when this bill succeeds in its limited aims, we'll have an even stronger case for the public option than we do now.

Here's what Roger Hickey said at the Huffington Post:

In 1964, when the civil rights movement was trying to pass the Civil Rights bill, southern Senators succeeded in watering down provisions to guarantee voting rights, citing states' rights. Martin Luther King and the movement he led took what they could win in that historic bill, but knowing that political change would never occur (and elected officials would never respect the rights of black communities) unless people had the right to vote. So the movement went to the grass roots all over the South... On March 7, 1965, a voting rights march was met with violence on the Pettus Bridge. And on August 10, Congress passed the Voting Rights Act of 1965... Our movement should see this health care act as just one step toward real health reform.

This bill may improve in conference, and even if it doesn't, I still feel that this is our best chance to insure 30 million of our brothers and sisters, and all profits aside, save some lives. Let's do it.

The Institute of Medicine's methodology says 22,000 people died in 2006 because they didn't have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we're looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on...

On its own terms, the bill is the most important social policy achievement since the Great Society. It will save a lot of lives and prevent a lot of suffering. But moving forward, it also makes future improvements and expansions easier. A lot of the hard work of health-care reform -- in particular, the money for subsidies -- will finish this year. If reformers want to come back for the public option or more subsidies in a future year, they won't be doing it atop a $900 billion price tag that's being battered by tea parties and industry and everyone else. This bill doesn't have all the good stuff it should have, but reformers can stand atop what good stuff it does have and focus their energies on what good stuff is left to achieve.

Tags: health care reform (all tags)



Re: The Goal of Health Care Reform

your diary makes a lot of assumptions.

Like that the Insurance Companies will play nice (there are no enforcement mechanisms for the regulations in the Senate Bill)

by jeopardy 2009-12-23 12:22PM | 0 recs
Re: The Goal of Health Care Reform

I've seen you make this argument several times.  If an insurance company violates one of these federal regulations, are you saying the Department of Justice wouldn't have jurisdiction to pursue the violation?  Also, does the bill provide for a private right of action for these violations?

Any info you can provide would be appreciated.  Thanks.

by HSTruman 2009-12-23 01:00PM | 0 recs
Re: The Goal of Health Care Reform

Have you seen me explain why the courts are a pathetic way of enforcing it?

And the Senate Leadership has said that it's up to the states to enforce it.

by jeopardy 2009-12-23 01:18PM | 0 recs
Re: The Goal of Health Care Reform

Proof that the courts won't be able to enforce these new laws (like they enforce all the other laws in the land)?

by NoFortunateSon 2009-12-23 02:10PM | 0 recs
Re: The Goal of Health Care Reform

Reminds e of the immigration debate. What's the point of passing new laws if the courts can't/won't/don't enforce the current laws on the books? Indeed why do anything at all, best to simply bury our heads in the sand.

by vecky 2009-12-23 03:12PM | 0 recs
Re: The Goal of Health Care Reform

I've given you the LA Times article about why CA can't enforce their ban through the courts.

by jeopardy 2009-12-23 03:14PM | 0 recs
This and that are the same?

Read it already. I thinking your drawing isolated examples from the population to try and justify a prejudiced conclusion.

by NoFortunateSon 2009-12-23 03:53PM | 0 recs
Re: This and that are the same?

yes, it is the same.

This bill dumps it to the states, which again, have not been able to enforce it already.

and that's in a state that WANTS to enforce it. Not all states are going to have progressive insurance commissioners.

And this bill doesn't even provide the money to the states for enforcement. It's really bizarre how bad the Senate Bill is in terms of enforcement.

by jeopardy 2009-12-23 04:12PM | 0 recs
Re: This and that are the same?

oh, and i'll keep an open mind here.  

please point out where in the Senate Bill it sets up an enforcement scheme or even gives some Federal Agency the task of enforcing it.

I'm willing to look at what you provide.

by jeopardy 2009-12-23 04:21PM | 0 recs
Here's some more info about it 23/senate-bill-still-leaves-health-insu rance-companies-unchecked

The Senate bill removed the public option. The public option would have been a benchmark by which to judge the private insurance companies. It would have served as a check on the private insurance companies.

With the public option gone, the only other check left on the for-profit private insurance industry is regulation. Can under-enforced regulations really serve as a check on a very wealthy and powerful industry? The answer is "no," and that is the pitfall of the Senate bill.

The Senate bill leaves enforcement of regulation up to the same state insurance commissioners that have failed us so far. The bill does not even remove the anti-trust exemption for health insurance companies.

Some state insurance commissioners are overly friendly to the insurance industry. Even Max Baucus, who wrote the bill, admits he is "not sure" about trusting the state insurance commissioners.

The few state insurance commissioners who try to take on the insurance companies are often hopelessly out-gunned. The California insurance commissioner's office is one of the best in the country, but was forced to admit it did not have the resources needed to stand up to the biggest insurance companies.

Is there is anyone who can honestly tell me how this bill will actually work to enforce these regulations around the entire country? Not the nice sounding bullet points, but a detailed analysis how our unreformed, broken, state-based insurance regulation enforcement mechanisms will ever be able to handle their expanded job functions. If there is, I have not seen it. Regulations un-enforced are just like no regulations at all.

The Senate bill puts into place some very nice-sounding regulations, but does not add the super powerful policing force needed to make them a reality. The old dirty tricks we have come to hate from the private insurance companies may mostly disappear, but only because they will morph into brand new ways to game the system.

The most critical failing of the Senate bill is that it still leaves the private insurance companies unchecked.

They will not face competition from a public option, there will not be a truly robust risk adjustment mechanism to de-incentivize cherry picking, and the state insurance commissioners meant to enforce the new regulations will lack the will and/or the funding to take them on.

Rules without a policeman strong enough to enforce them are just empty promises.

The House bill, on the other hand, had three important checks on the health insurance industry. It had the public option, a national regulatory framework, and a repeal of their anti-trust exemption. The Federal government is the only body possibly big enough to police the largest for-profit insurance companies.

If Democrats pass a "reform" bill (like the Senate bill) that lacks any real checks on private insurance-on the industry from which people will be forced to buy insurance-it will be a disaster.

Democrats created this "reform," and they will be forced to own it-along with every new trick the private insurance companies invent to abuse their customers. If you are going to give Americans a box labeled "health care reform" for Christmas, it better actually have real reform inside.

by jeopardy 2009-12-23 01:20PM | 0 recs
Re: The Goal of Health Care Reform

I'll sum it up for you.

Basically, the reason this isn't working in the courts is because the insurance companies get to fight each and every instance. So when a big insurer rescinds, say 500,000 policies, each one has to be litigated.

What happens is that it gets tied up in court for years, while the person goes bankrupt and dies.

Meanwhile, the states lack the resources to litigate hundreds of thousands of cases.

Another part of the problem is that the law on fraud (which is what the insurance companies usually claim) is apparently written in such a way that it helps the insurance companies.

Finally, the insurance companies buy off people right at the end if they are going to lose, getting people to stipulate that they did indeed commit "fraud"

by jeopardy 2009-12-23 01:30PM | 0 recs
Re: The Goal of Health Care Reform

So are you proposing some sort of Federal Bureau of Insurance with FBI type powers?

Or would you prefer something more like the FAA? FCC? IRS? BTF? FCC? FDA? NIH? FEC? FTC? SEC? NLRB? FEC? DOE? DOT? CDC? DOD? FEMA? WMD? DHS?

by QTG 2009-12-23 01:47PM | 0 recs
Re: The Goal of Health Care Reform

Is WMD really a federal agency?

by vecky 2009-12-23 03:13PM | 0 recs
Re: The Goal of Health Care Reform

I would prefer that we don't have to rely on weak regulations to do it - we need a PO or Medicare expansion.

But if we absolutely have to do it by regulations, we need to tighten up the law on fraud, make very large punitive damages available for deterrence, and yes, have the Federal Government Executive Branch do it.

by jeopardy 2009-12-23 03:23PM | 0 recs
Re: The Goal of Health Care Reform

I understand you don't think the regulations will be enforced.  What I'm trying to understand is (a) whether the Department of Justice could prosecute violations and (b) whether individuals have a private right of action.

I suppose it would be nice if a separate regulatory scheme was created, but I'm not sure what that would look like, and that's not how these things usually work.  And frankly, a regulatory scheme based upon a combination of state enforcement supplemented by federal criminal enforcement and private civil suits is actually pretty darn useful.  Sufficient?  Who knows.  But much better than what we have now.

by HSTruman 2009-12-24 05:31AM | 0 recs
Re: The Goal of Health Care Reform

yes, individuals will have a private right of action.

like they do in CA and many other states now, and it is not stopping recissions.

In fact, leaving it up to the courts is immoral and cruel. It takes years to fight these things in court, while the person dies and goes bankrupt from medical costs and attorney fees.

by jeopardy 2009-12-24 06:33AM | 0 recs
Re: The Goal of Health Care Reform

Regulatory enforcement actions involve the courts as well, most of the time, so I'm not sure the distinction you're drawing is actually all that clear.  

The goal, obviously, is to create a deterrent for abusive conduct, so that no one has to address improper action after the fact; since once you get to that point, something is already lost.  Making these practices a violation of federal law is a big deal.  My impression is that the DOJ can, and likely will, police this conduct in at least some circumstances.  If insurance companies continue these practices, they're also going to be facing pretty serious civil liability through individual law suits.  That combination, along with the ability of the HHS Secretary to block companies from the exchanges for this kind of BS, will help.  Again, is it sufficient?  Probably not.  But it's clearly a step in the right direction.  

by HSTruman 2009-12-24 08:08AM | 0 recs
Re: The Goal of Health Care Reform
These are curiousity related questions, not challenges to the diary:
1)Are there any limits on insurance companies premiums for patients with preexisting conditions?
  1. How is this a net positive. One segment of population gets covered when they werent before. But another segment that elects not to spend a lot of money on insurance , now are forced to pay for that insurance. Where is the significant net positive tradeoff in this?
  2. Just from a private perspective, how does one determine a fair premium for a preexisting condition in the private market that is affordable? If I own an insurance company and I am forced to compete with another, what is the government going to do to even out the risk between me and my competitor in taking on high risk patients.Wouldnt it have been better just to let private companies compete across states in a true free market, let them get their profits,  and then have the government fund people with preexisting conditions under a public option?
by Pravin 2009-12-23 12:37PM | 0 recs
Re: The Goal of Health Care Reform

1) Yes. Limits on premiums are dictated by income (upto 400% of FPL).

2) Two studies show that between 22-45K people die each year because of a lack of health-insurance coverage. Putting a huge dent in that number is a net positive trade-off.

3) WTF - why should the govt get stuck with all the patients who are sick, while the pvt. companies get all the healthy ones?

by vecky 2009-12-23 03:17PM | 0 recs
Re: The Goal of Health Care Reform

But how does pricing for preexisting conditions work? How would company A price a patient versus Company B? What if one company gets an inordinate amount of high risk patients while the other company just sits idly by?  

by Pravin 2009-12-27 06:47AM | 0 recs
Very nice diary, but one minor correction

All these arguments were most famously summed up by Dr. Howard Dean when he called the bill "a bigger bailout for the insurance industry than AIG".

Howard Dean has indeed thrown his support behind the Senate bill.

At 2:25 in the following video from Rachel Maddow: eY

by NoFortunateSon 2009-12-23 02:09PM | 0 recs
Re: Very nice diary, but one minor correction

Maybe men in black suits visited him in the dead of the night.

Hey, his hair looks wet... maybe some "enhanced interrogation" tactics were used.

by vecky 2009-12-23 03:18PM | 0 recs


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