The best path forward on health care reform

Even before the Bay State debacle, Democrats faced no easy path forward on health care reform. If House Democrats like Bart Stupak, Anthony Weiner and Jerrold Nadler are to be believed, there are not 218 votes in the House for passing the Senate health care bill unchanged. Nor should there be, given the weak state-based exchanges in that bill and an excise tax that will encourage employers to downgrade the coverage they provide. Accepting a promise from the White House that problems will be fixed later would be idiotic. If the president didn't keep his campaign promises to let Medicare negotiate for lower drug prices or allow re-importation of prescription drugs from Canada, why would he keep any promises made to House Democrats now?

Key labor leaders are calling on Congress to pass a separate bill through the reconciliation process (requiring only 51 votes), while "simultaneously" passing the Senate bill in the House. I don't know what they have in mind for that separate bill besides fixing some of the problems with the excise tax on expensive health insurance policies.

Ezra Klein would prefer something like what labor is advocating (House swallows Senate bill, hopes for fixes through reconciliation), but the other option he lays out here seems far superior to me:

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar.

I would add a few more things to that smaller bill, like the money for primary care clinics that Senator Bernie Sanders has been fighting for.

Democrats could then offer the insurance reforms you can't pass through reconciliation as regular bills. Will the Republicans dare to vote against allowing re-importation of prescription drugs, or revoking the insurance industry's anti-trust exemption? Will they dare to vote against banning insurance companies from discriminating because of pre-existing conditions? I don't think so. We should be able to get 60 votes for all of those reforms and more. If we can't, everyone will be able to see who stood up for consumers and who voted to protect corporate interests.

The smaller bill wouldn't solve all of the status quo problems with health care delivery, but neither would the Senate bill. Politically, this course would be less risky as well.

Feel free to tell me why I'm wrong in the comments.

Debunking the EPI on the excise tax

The Economic Policy Institute report titled "Employer Health Care Costs Do Not Drive Wage Trends" has become the definitive study for those who oppose a "Cadillac (excise) tax" on expensive group (employer-provided) health insurance plans.  The EPI report has been cited by prominent bloggers on websites like Daily Kos and MyDD to "debunk" the supposed "myth" that health care costs are not a factor in wage growth or decline.  Well, it turns out that EPI gets it wrong on several fronts on the data and interpretation of the data alone.  Their conclusions, to say the least are at best simply mistaken.

The EPI's report is based on three fundamental (and as I will demonstrate, mistaken) claims.

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The anatomy of the 'Cadillac Tax'

There has been a lot of grumbling inside the progressive inner-divide on the health care debate about the so-called 'Cadillac tax.' The Senate-passed bill raises $150 billion over 10 years by this method. The idea is to recede the tax exemption on high-end employer-provided health insurance plans.  A lot of labor unions are understandably angry because their members have given up wages to keep and earn these benefits.  On the other hand, there seems to be somewhat of a meeting of the minds among the policy wonks that this is an effective cost control measure.  So what's going on?

I decided to actually look into the policy.  Who it applies to, whom it is going to affect and to what degree, and what the cost controls, if any, are.  I wanted to look into whether the claims of this being a cost control measure are true.  I also wanted to look into whether the claims of this being a policy that balances the health care woes on the backs of working people is true.  I must admit that I consider myself more of a policy wonk.  Perhaps I best self describe as a  empathy-driven policy wonk, however.

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Nelson, women and the health insurance bill

I am not a woman.  I wouldn't dare speak for women.  But my life and activism are intricately tangled with that of women and that of women's rights.  I worked hard - phone-banking night after night - in 2006 - to defeat Proposition 73, the first of three consecutive parental notification measures on the California ballot in as many years since.  We defeated 73.  We defeated every one of them since.  But the bastards keep coming back.  I took away my dad's pen when he was filling out his mail-in ballot last year and was about to vote for Prop 4, last year's parental notification measure on the California ballot.  I took away his pen and had a half-hour conversation with him until I convinced him to vote 'No.'

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Breastfeeding infant labeled obese, denied health insurance

Breastfed babies can be long and lean, short and fat, or anywhere in between. But I never heard of an insurance company citing a breastfeeding infant's "obesity" as a pre-existing condition before reading this story from the Denver Post:

By the numbers, [four-month-old] Alex [Lange] is in the 99th percentile for height and weight for babies his age. Insurers don't take babies above the 95th percentile, no matter how healthy they are otherwise. [...]

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

" 'Your baby is too fat,' she told me," Bernie said.

Up until then, the Langes had been happy with Alex's healthy appetite and prodigious weight gain. His pediatrician had never mentioned any weight concerns about the baby they call their "happy little chunky monkey." [...]

"I'm not going to withhold food to get him down below that number of 95," Kelli Lange said. "I'm not going to have him screaming because he's hungry."

Good call, Mrs. Lange. There is "no evidence to support 'dieting' or substituting other foods or liquids for human milk to reduce weight gain."

It's outrageous for an insurance company to use Alex's weight at four months of age as an excuse to deny coverage. Not that exclusions for other "pre-existing conditions" (such as a benign heart murmur that a child would grow out of without treatment) are any more defensible.

Also, the Lange family wouldn't have been shopping around for new coverage if their previous carrier hadn't raised their rates by 40 percent after Alex was born. I remember our insurance premiums went up quite a bit after our second child was born, but I don't think it was by that much. Then again, they went up 10 percent last year even without any new babies or health problems in our family.

Share any relevant thoughts in this thread.

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