US Politics XXXVIII

[TrackerNeil]

Additionally, IMO, the government should not be able to tell an insurance company what their policy MUST provide. A consumer should be able to opt out of some service, not be forced to have some expensive, government-mandated policy shoved at them.

If there were a public plan similar to the NHS I might sympathize with you, but since all health insurance (except for Medicare) is privately provided, the government has a direct, rational, and compelling interest in regulating what policies are offered and under what terms. Now, I'd prefer that we simply adopt a single-payer system, and I think that's what will eventually happen, but until then we're going to have to settle for what we can get through Congress. It's a hell of a lot better than what we had.

[Aemon Stark]

Again, I'm not ThinkerX, but to let you know sooner rather than later, he's a part-time postal employee in Alaska; not involved in the health care industry at all.

Nadie - the choice to have a plan that costs less because it doesn't include maternity benefits that are not needed has been taken away. The plans that I was looking at, on the low end, the catastrophic-type policies, rose from $68/month to $250/month solely because maternity benefits needed to be included. How does that make "health care more affordable for the American family"?

Even though mine is unusable by my choice, now I'm "just a uterus", no matter what, from a health insurance standpoint. Ridiculous.

Shryke - risk pooling is all about choice. If I choose not to smoke, my risk pool becomes that of nonsmokers. If I am of normal weight and cholesterol, my risk profile is elevated compared to others.

You have no idea what you are talking about.

It's as if all of a sudden, "being obese" was "no longer a pre-existing condition", and all of fat America's health insurance premiums went down because thin Americans were charged more.

On the contrary, you were simply benefiting from unsustainable compartmentalizing of risk pooling into small, costly subgroups. Risk pooling is not about choice at all but about reducing the risk for the insured (flattened costs) and for the insurer (maximize the number of insured people). So, yes, that means that costs will and must go up for some people, but then $68/month is ridiculously low. There is no inherent right to "choices" that by their very nature are directly responsible for much higher costs (often unaffordable) for others and for the whole insurance system generally.

[Ormond]

Again, I'm not ThinkerX, but to let you know sooner rather than later, he's a part-time postal employee in Alaska; not involved in the health care industry at all.

Nadie - the choice to have a plan that costs less because it doesn't include maternity benefits that are not needed has been taken away. The plans that I was looking at, on the low end, the catastrophic-type policies, rose from $68/month to $250/month solely because maternity benefits needed to be included. How does that make "health care more affordable for the American family"?

Even though mine is unusable by my choice, now I'm "just a uterus", no matter what, from a health insurance standpoint. Ridiculous.

Do all-male families get to buy policies which cost less and don't contain maternity benefits?

If not, I can see that as being gender discrimination. If they are paying the same price as families with adult females, then I don't see how you can say that the regulation treats you as "just a uterus".

[sologdin]

am sure would be bemoaned by many as "uanffordable

is this attempting to pooh-pooh the fact that health insurance is unaffordable for millions of persons?

[Ormond]

Yes. I had previously been checking family policies. However, I also, just now, went to ehealthinsurance.com and plugged in a policy for a non-smoking male with my birthdate and a non-smoking female with my birthdate. The male plans, although they stated maternity coverage, were less expensive. And since it is physically impossible for a male to need "labor and delivery" care, that's the reason why.

Then I disagree with that policy, because I think that people of all sexes should be helping to pay for labor and delivery, if it is considered a necessary part of health care for Americans.

Obstetrical care isn't just for the health of the mother; it also contributes to the health of the infant, so I think as a single male I should be helping to pay for that just as a childless male my taxes help pay for public schools.

[Shryke]

On the contrary, you were simply benefiting from unsustainable compartmentalizing of risk pooling into small, costly subgroups. Risk pooling is not about choice at all but about reducing the risk for the insured (flattened costs) and for the insurer (maximize the number of insured people). So, yes, that means that costs will and must go up for some people, but then $68/month is ridiculously low. There is no inherent right to "choices" that by their very nature are directly responsible for much higher costs (often unaffordable) for others and for the whole insurance system generally.

Exactly.

Risk Pooling is, by definition, NOT about choice since it's about combining a ton of low cost people with a few high cost ones.

And as stated above, the "choices" you so vehemently defend are the core of the problem.

[Shryke]

Speaking of that legal battle: http://tpmdc.talkingpointsmemo.com/2010/03/health-care-lawsuits-splitting-govs-and-ags-nationwide.php?ref=tn

Lawsuits challenging the new health care reform law have popped up in several states and are drawn nearly entirely on partisan lines, in some cases fracturing top state government officials where the governor is a Democrat and attorney general is a Republican who joined the legal challenge. In Missouri, Lt. Gov Peter Kinder ® so badly wanted to be part of the lawsuit that he bucked his Democratic Gov. Jay Nixon and the attorney general to say he'll be joining the other attorneys general on his own.

There are a handful of other splits across the country -- Michigan, Washington state, Pennsylvania and Colorado -- which create a tough political climate for anyone attempting to get something done at the state level. Louisiana is the one bipartisan example, with Gov. Bobby Jindal ® and Attorney General Buddy Caldwell (D) agreeing to join the lawsuit.

Essentially, all the Rs want in and none of the Ds do.

And the Rs that REALLY want in are the ones running for Governor this fall. :)

Also, an opposite example: http://www.huffingtonpost.com/2010/03/25/georgia-attorney-general_n_512970.html

Georgia lawmakers reacted to Wednesday's news that their Attorney General, Democrat Thurbert Baker, would not sign on to a multi-state lawsuit to block the health care bill in his state by filing papers to have him impeached.

[Aemon Stark]

Then I disagree with that policy, because I think that people of all sexes should be helping to pay for labor and delivery, if it is considered a necessary part of health care for Americans.

Obstetrical care isn't just for the health of the mother; it also contributes to the health of the infant, so I think as a single male I should be helping to pay for that just as a childless male my taxes help pay for public schools.

To take this to its logical conclusion, it would be some sort of violation of "choice" to be paying for any kind of coverage that you could not personally benefit from at the time you were paying for it. To take an example, someone who'd previously had their gall bladder removed should not, according to Chats' argument, have to carry "cholecystectomy" coverage if such a ridiculously narrow form of insurance existed.

[Shryke]

Oh, and here's a fun kick to the balls for all those Fiscal Conservatives here who were linking the story about AT&T and the like posting massive losses ($1 billion for AT&T) due to the new Health Care Bill: http://www.fastcompany.com/1599951/healthcare-bill-will-cost-att-1-billion-may-lead-to-cut-in-retiree-drug-coverage-whos-to-bla?partner=rss

Turns out the problem isn't that the government is stopping the 100% subsidization of their retirees (thus making them actually pay for their own employees), but that they are closing a little loophole:

The 2003 Medicare prescription drug bill, still in effect, gives a tax deduction to companies that provide prescription drug benefits for retirees. In fact, these companies, including AT&T, can deduct 100%--every single penny--of the money they spend on prescription drug benefits from their taxable income. Thus, AT&T gets to keep a whole chunk of money from being taxed, which basically means they get to pocket more of it. The government even goes one step further and subsidizes (read: pays for) a whopping 28% of those prescription drug benefits in the first place, to make prescription drug benefits as affordable as possible for the companies. The companies get both a 28% discount and a nice tax break, all to encourage them to provide prescription drug coverage.

But there's a loophole in the law big enough to drive a Chevy Suburban through. These companies get to write off the entirety of their prescription medication plan, even though they're actually only paying for 72% of it. The new health-care bill simply closes that loophole, and says that companies can still deduct every penny they pay on prescription drug benefits from their taxes--but only the money they've paid, not the 28% that the government hands them. That's where the billion dollars comes from: AT&T is no longer allowed to deduct things they didn't pay for in the first place.

No wonder Waxman was confused.

[Shryke]

To take this to its logical conclusion, it would be some sort of violation of "choice" to be paying for any kind of coverage that you could not personally benefit from at the time you were paying for it. To take an example, someone who'd previously had their gall bladder removed should not, according to Chats' argument, have to carry "cholecystectomy" coverage if such a ridiculously narrow form of insurance existed.

It's essentially advocating that Health Insurance be abolished and replaced with something like an HSA.

[Annelise]

For instance, I have read (per the New York Times) that all policies must now offer maternity coverage as standard.

Do you have a link to the article by chance? I haven't pulled it up and I'm not identifying where that's in the reform time line for 2010. Not sure if I'm just missing it because I'm looking for the wrong phrasing, or if this is too summarized, or what:

Insurance Reforms

* Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. (Effective 90 days following enactment until January 1, 2014)

* Provide dependent coverage for adult children up to age 26 for all individual and group policies.

* Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prior to 2014, plans may only impose annual limits on coverage as determined by the Secretary. Prohibit insurers from rescinding coverage except in cases of fraud and prohibit pre-existing condition exclusions for children.

* Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.

* Provide tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees.

* Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. (Effective 90 days following enactment until January 1, 2014)

* Require health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. (Requirement to report medical loss ratio effective plan year 2010; requirement to provide rebates effective January 1, 2011)

* Establish a process for reviewing increases in health plan premiums and require plans to justify increases. Require states to report on trends in premium increases and recommend whether certain plans should be excluded from the Exchange based on unjustified premium increases.

http://www.kff.org/healthreform/8060.cfm

[alguien]

I found a middle-of-the-road priced one (which I am sure would be bemoaned by many as "uanffordable") that "includes" them, but at zero benefit. ;) Corporate ingenuity for the win.

Well, I'm glad that you won't have to spend more money. Good on you! I'm assuming your company's insurance policy would have had this cost go up as well?

Wankers. All of them. Someday, you will regret having voted for them, much as I regret voting for them.

I'm sure its possible, but so far this administration has done pretty much exactly what I expected them to. I'm quite certain it was a better choice than the alternative, even from a fiscal sense.

And honestly, I don't think spreading maternity care costs is quite the same as outlawing abortion. ;) YMMV.

[aeu]

I don't really have too much contribute, but I am very curious about one thing:

Chats,

If it's not too personal a question, may I ask why you are shopping for insurance on your own? Surely your company offers health benefits, no?

[The Progressive]

Including, according to the august Friedrich August von Hayek, Health Care:

The Road To Serfdom (Chapter 9)

/pimpslap

Hahaha, that's an awesome find.

I'm utterly shocked that FLOW neglected to mention this particular nugget from von Hayek in the other thread, given how much he pimped "The Road to Serfdom" as the intellectual guidance for rightwing opposition to healthcare reform.

Chat,

Given your agreement with ThinkerX here, I'm curious as to if you also agree with his proposal to introduce single-payer system in the US and salary/price capping for health services providers as the alternative?

[Lightning Lord]

Obama to allow offshore drilling

The proposal — a compromise that will please oil companies and domestic drilling advocates but anger some residents of affected states and many environmental organizations — would end a longstanding moratorium on oil exploration along the East Coast from the northern tip of Delaware to the central coast of Florida, covering 167 million acres of ocean.

Under the plan, the coastline from New Jersey northward would remain closed to all oil and gas activity. So would the Pacific Coast, from Mexico to the Canadian border.

The environmentally sensitive Bristol Bay in southwestern Alaska would be protected and no drilling would be allowed under the plan, officials said. But large tracts in the Chukchi Sea and Beaufort Sea in the Arctic Ocean north of Alaska — nearly 130 million acres — would be eligible for exploration and drilling after extensive studies.

Count me as one of the supporters that is bothered by this. I believed that the other party had the motto "Drill baby drill," not the side I voted for. I know Obama has indicated that expanding offshore drilling was something he would consider, but this just seems foolish. Does he really believe that this is going to be met with similar compromise by the Republicans? The ones who, you know, already said they're not going to cooperate for the rest of the year.

Also, Congress seems to only have enough time to consider one more big issue before the mid terms take over. In November. What month is it now? Do we actually only elect Reps to work for 14 months?

[ThinkerX]

Chat...I have to respectfully disagree with you on this:

The US government does not confiscate assets like some banana republic. We are the deepest and most transparent capital market in the world. Investing in the US = fucking safety, generally, unless you don't know how to read a set of financial statements or have been swindled by a master like Bernie Madoff.

Note the response of 'Sczech' in this thread, particularly where he is talking about what government action did to private stake holders in the US automotive industry:

http://downstreamven....com/topic/3575

A few months ago, Obama gave us a lesson on how to treat debt and equity obligations of GM. In order to bring back GM from bankruptcy quickly, the Obama administration unilaterally decided to devalue the claims of GM creditors. Bondholders and stock holders of GM lost their wealth overnight. Some of the bondholders complained at the Supreme Court, but the court refused to listen to their case. In other words, we were witnessing a government confiscation (=100% tax on property) of private wealth without any legal recourse or defense possibility.

Triskelle:

Thinker - I am not sure what you're trying to say via your last post. If you've found good insurance on the individual market, good on you. But I don't get your other point.

No, I do not have 'good' insurance - just the 'injured in accident only' thing that comes from having a bank account, and I doubt that will qualify under the new law.

As to the rest, yes, the medical industry *is* in a bubble, in that costs are much higher than they would be because of insurance and medi-whatever. I said it before: many years ago, if you showed up at the ER with a relatively common injury and had neither insurance nor medi-whatever, the docs would give you the quickest and cheapest treatment they could to get you out of there, because there was no money to be made off of you. That happened to me a couple times way back when. If, on the other hand, you had insurance or were covered by medi-whatever, they'd tack in all sorts of tests and prescriptions and whatnot - at least on the billing form though not always in reality - simply because they could get away with it. I *KNOW* people this happened to - and this was in small town Alaska. A couple of them did challenge the tab - even though it was covered by insurance or medi-whatever, and had the bills drastically reduced.

[Shryke]

I don't think it's a bubble because that implies it will, at some point, pop.

[ThinkerX]

I don't think it's a bubble because that implies it will, at some point, pop.

Assume for a moment it is a bubble, and then try to imagine what it would look like when it did pop...

[Shryke]

Assume for a moment it is a bubble, and then try to imagine what it would look like when it did pop...

Sorry, I'm too busy assuming I'm riding a unicorn.

I'll get to your flight of fancy some other time.

[The Marquis de Leech]

Exactly.

Risk Pooling is, by definition, NOT about choice since it's about combining a ton of low cost people with a few high cost ones.

And as stated above, the "choices" you so vehemently defend are the core of the problem.

To further illustrate risk pooling in action, New Zealand has a very successful system of Accident Compensation Insurance: all such cover is provided by a compulsory state-run monopoly ("the Accident Compensation Corporation"), which is not only a very efficient way of handling insurance, but which also saves our courts from having to deal with people suing over accidents.