Tuesday, March 9, 2010

Rush Job

All you self-styled progressives who think - to stretch a term - that HCR is worse than nothing or that things must get worse before they get better or whatever - I bring you a fresh reason for calling your Congress-person to urge a yes vote in the House: Rush Limbaugh has promised to move to Costa Rica if it passes. MOVE ON. RUSH!


BadTux said...

But Rush will change his mind as soon as he realizes that the Costa Rican constitution explicitly enshrines health care *as a right*, and in fact, Costa Rica has a socialist healthcare system where access to a doctor is a right. Of course, Rush wouldn't take advantage of that socialist healthcare system because then he'd have to associate with brown people, he'd buy private health insurance and see private doctors instead, but still, if he's fleeing socialist health care, it's like jumping out of the frying pan into the fire, yo!

So no, don't expect it to happen. Rushbo is just flappin' his gums, as usual.

- Badtux the Amused Penguin

Suffern AC said...

I note that he is fleeing to a country that has no army and has not had one for 60 years. How can you be secure without an army? He won't feel safe there and will just come back.

Mitchell J. Freedman said...

Another example of an otherwise good progressive--Mr. Quinn--accepting rhetoric as reality. That is the problem with the HCR as currently structured in both the Senate and House bills.

Kucinich is spot on that the HCR is a hoax. Its most hopeful parts don't even kick in for years to come, and will not be improved upon by Obama or any other Democratic Party leader. They will simply say, "Solved," and move on to the next item of gossip on the agenda of the Villagers.

BadTux said...

Mitchell, one of the things that irritates me about those on the radical left is their refusal to see reality. The reality is that the core reform of this bill -- that all employers either be required to provide health insurance, or pay a fine to be used to subsidize health care for their employees -- is supported by close to 80% of Americans in every poll I've seen since KFF started polling on health reform over a decade ago. Most of the other core features -- the ban on pre-existing illness rejections, the subsidies for health insurance for those who can't afford it, etc. -- have support in the mid 70's. Every single-payer system ever proposed has only barely broken 50% at best, depending upon how you word it ("Medicare for All" gets the best support, at 56%, but that's still far less than 80%).

Politicians may be idiots, but their staffers can read polls just as well as I can. The reason why your beloved single payer was never on the table isn't because it's a bad idea or unpopular or anything, it's because of the simple reality that the core reforms in the current bill are supported by more people than single-payer ever was. And for better or for worse, many of our representatives believe that their job is to, well, represent -- i.e., that living in a democracy means that we deserve to get what we want, good and hard. That's just reality in a democracy -- representatives who believe their job is to do what their constituents want them to do.

In other words, flinging wild accusations and talking about vast conspiracies when Congressmen are simply doing what polls say their constituents want just makes Kucinich look like a loon. 'Nuff said on that.

- Badtux the Democracy Penguin

Mitchell J. Freedman said...

BadTux, admit the plan(s) does/do nothing for people in 2010, 2011, 2012 and 2013, and you'll start to see some reality.

Medicare for All was never on the table and that is why it "only" polled with a majority of support, not 80%. Many of the politicians are bought and sold by the insurance company lobby, or are you that wedded to your delusion?

People live with employer based insurance, and we need to detach from that in a way that actually helps people, which is why Medicare for all made the most practical sense. The political will was lacking because primarily because of the power of the insurance company lobby in terms of contributions and smear campaigns they can fund.

But if they stood up as a group, it is amazing how that lobby can be defeated.

Overall, it would have been a better negotiation to start with Medicare for All. And if you can't see that, then you need to speak to someone who negotiates for a living. I guess that's what bothers me about YOU.

TheTrucker said...

If the bill does not pass then Kucinich and his moonbat supporters will fry in hell just like the rest of us as the Republican fascists take over this country. _THAT_ is called reality.

BadTux said...

Mitchell, the KFF polls long pre-date current healthcare reform efforts. KFF has been polling health care since *1997*, tossing out various possibilities for health care reform and seeing how they polled.

You might not like the current bill, but a) its general approach to health care reform is one that is supported by more Americans than single-payer is, and b) it isn't all that unusual, with similarities to the Swiss and Dutch systems. Heck, it shares a lot of characteristics with Baron von Bismarck's Health Insurance Bill of 1883 and Britain's National Insurance Act of 1911, both of which eventually led to true universal healthcare in their respective nations. There's certainly things to complain about with the current bill, but there's no reason to hyperventilate and rant about bizarre conspiracy theories, all that does is make you look like a loon.

- Badtux the Healthcare Economist Penguin

Shag from Brookline said...

Didn't a lot of Nazis end up in Costa Rica after WW II?

Back in the late 1960s, early 1970s, I invested in a coffee plantation in Costa Rica. The development time for harvesting coffee beans was 5 years. In late year 2, a red bug was noticed on the trees. By the 5th year, the red bugs were in control. (This was not called a "tax shelter" at the time. Fortunately, because of higher tax brackets, Uncle Sam subsidized most of my loss.)

Mitchell J. Freedman said...


It is not even close to any of the examples you choose. It is a giveaway to insurance companies because there is no cost control, e.g. no limit on what they can charge individuals with pre-existing conditions and continuing to allow Big Pharma to charge whatever the heck it wants to consumers. And the subsidies are in reality subsidies to the insurance companies funding the difference in the unregulated cost of the premiums or co-pays.

Medicare was supposed to be the stop on the road to national health insurance, i.e. Medicare for All. Yet, the selfishness of the seniors who say "No government health care, and leave my Medicare alone!" was the most disappointing in this year long discussion.

You also ignore my point that none of the things you may like about the plan go into effect until several years from now, if at all. Finally, call me a loon, but you are the deluded one to not see how insurance company lobbies play a role in how Kent Conrad, Bart Stupak, Blanche Lincoln, Evan Bayh, the Nelson Boys, and Max Baucus think and vote. That is not a "conspiracy" in the tin-foil hat (as opposed to more mundane legal) meaning. That is how the institution works from a structural standpoint.

But go ahead. Drink the Kool Aid. Obama and company have painted themselves in a corner where they look bad to David "Fluffy" Gregory for not passing anything, and look bad to the low-information voter (i.e. independents) for what they pass since it gives no immediate benefits for anyone for the next three years--except insurance companies. The Obama/Dem leaders' only hope is for an increase in the intra-mural warfare between Brahmin Republicans and Tea Partiers, something Harry Reid in particular wishes for every day as he views his sinking poll numbers in Nevada.

Anonymous said...

The following, if it has not been removed from the Senate bill, will influence costs. Sec. 2718 would essentially allow profits to be regulated down to whatever regulators deem fair. “Rebate” being the key word. MLR:
‘‘(A) REQUIREMENT.—Beginning not later than January 1, 2011, a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year, provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the issuer on costs described in paragraphs (1) and (2) of subsection (a) to the total amount of premium revenue (excluding Federal and State taxes and licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance under sections 1341, 1342, and 1343 of the Patient Protection and Affordable Care Act) for the plan year (except as provided in subparagraph (B)(ii)), is less than—
‘‘(i) with respect to a health insurance issuer offering coverage in the large group market, 85 percent, or such higher percentage as a State may by regulation determine; or
‘‘(ii) with respect to a health insurance issuer offering coverage in the small group market or in the individual market, 80 percent, or such higher percentage as a State may by regulation determine, except that the Secretary may adjust such percentage with respect to a State if the Secretary determines that the application of such 80 percent may destabilize the individual market in such State.”
The key consideration is: “or such higher percentage as a State may by regulation determine,…”. It is also important to understand that the Insurance Industry has not been transparent about the MLR and so the bill allows unlimited flexibility to the State regulators. Combine that to their ability to enforce rebates, and, this provision could in fact be used to squeeze every last bit of inefficiency out of the Insurance Industry. And there should be a chain reaction effect because as regulators squeeze insurers, they will in turn apply more pressure to providers.
If the importance of Sec. 2718 (comment #38) is understood, and then if that understanding is applied to the Maryland model : http://online.wsj.com/article/SB125288688445707403.html , it becomes fairly clear that though the MLR regulating may be the most effective way to drive down costs, there may not be anywhere close to as much inefficiency as some thought there to be. The ‘cost-shifting’ that the Maryland experiment clearly shows also suggests that in the other 49 states Medicare and Medicaid reimbursements, being below cost, do maintain ’some’ downward pressure on payments from insurers. This because insurers were negotiating their costs downward to what the market would tolerate. What little inefficiency as what might exist would therefore need to come from lower compensation for doctors and related industry executives, and less from iatrogenic costs. These though will not make a significant difference without limits on care.

~ray l love

BadTux said...

Which reminds me that private insurers pay only 35% of the costs of healthcare in the United States, and looking at the major insurer's SEC statements, their MLR's seem to be hovering at around 80% already. Insurers have been demonized for somehow 'causing' the high costs of health care, but in fact if 100% of all premium dollars went to health care rather than 80% of them, we'd only save 7% on our national healthcare costs. Which is nothing to sneeze at, but decidedly points out that the problem with healthcare costs is *not* the insurers, but, rather, the providers. The insurers have been doing some evil things -- arbitrary denials etc. -- but this has all been in response to the untenable situation they're placed in by health care providers, who say to the American public, literally, "Your money, or your life", little different from a common mugger in Central Park.

Note that it's the specialists in life-threatening illnesses -- the ones who *literally* can say "your money or your life" -- who are getting the big bucks. Family docs? Most of them are barely surviving, because they don't have the ability to hold up individuals and insurance companies at gunpoint. If you don't get the treatment you need when you need it when diagnosed with leukemia, you *die*, and the oncologists and surgeons who treat leukemia get *big* bucks. If you don't get your routine health checkup on time, on the other hand, it's pretty much 100% certain that you *won't* die. Which is why the family practice docs are pretty much screwed right now.

In short: The evil stuff that the insurance companies are doing is an *effect*, not a *cause*, of high medical costs. So I'm not hopeful that this bill will do a whole lot to control high healthcare costs, insurers are a fairly minor component of that problem. On the other hand, the numbers don't support the assertion that insurers are causing high healthcare costs either, and hyperventilating in the face of these numbers simply isn't warranted.

Anonymous said...

Hey Tux.

Because I agree with the "radical left" on some issues, and since you claim we refuse to see "reality" (which is mostly true), I thought I'd take this opportunity to argue that there are some exceptions?

Section 2718 of the Senate bill is essentially single payer in disguise. This: "i) with respect to a health insurance issuer offering coverage in the large group market, 85 percent, or such higher percentage as a State may by regulation determine;...", will eventually allow for a baseline percentage that will probably be something around 89.453%, or whatever. It will of course vary on a State by State basis but the important thing is that the rebate provision takes away the incentive for gouging and there is only so much that can be done in that regard. And applying pressure on insurers that they will in turn apply to providers is quite clever and efficient, and with sound incentives.

I suspect though that Sec. 2718 has less of a Socialist smell than single payer. This of course makes the politics easier and yet leaves the 'radical left' feeling slighted. But some of us on the left recognize Socialism no matter how well disguised it is and we also understand the need for discretion.

Mitchell is correct though about the Dems doing a very poor job of negotiating HCR. The 'why' side of his argument is wrong though. The Dems were simply naive about 3 things. 1) They failed to understand the cost-shifting, and Medicare fraud, and therefore made fools of themselves in regards to admin costs. 2) Their arrogance about admin costs, combined with their perceived history of unintended consequences, made their negotiating starting point, that of single payer, something that invoked visions of 'The Road to Serfdom'. 3) The Dems are avoiding the issue of wealth distribution but it is the central issue of HCR. This is why they allowed wishful thinking to make admin-cost inefficiencies their flagship in the first place. Not to suggest that the Dems do not see the need to redistribute wealth, but instead that they are trying to do so surreptitiously. This is in part though because the working-class is divided along racial lines and so the Dems are in a difficult situation. They must in effect risk alienating their wealthy constituents while transferring wealth from them to the poor constituents of the opposing Party. But of course the Dems initially believed that the cost burden was hidden in the inefficiencies of the admin costs. So they are, in the end, just wingin' it. But had they thought of Section 2718 in the first place, things would have gone much better.

But hindsight is 20:20. HCR was no easy thing with our jagged political landscape -- and we still have not faced up to the prevalence rate issues, and that is where the more serious problems are lurking.

~ray l love

TheTrucker said...

I will say it ONE MO TIME: Assuming that the _FIX_ bill (which is an up and down vote in the Senate) will:

Make UNearned income above $250k (this cutoff only because of Obama pledge and rightarded stones) taxable as a Medicare tax just as is wage income is. (and it looks like this will happen)

THEN: The tax on Cadillac insurance can be scaled way back, and there will be sufficient funds to grant the same MEDICAID funds to all the states that were granted to Nebraska (thus ending the cornhusker special)

AND: The budget deficit will be reduced by _MORE_ than the original bill.

What is at issue it seems is the desire to also expand the subsidies and to throw student loan legislation into the same salad bowl.

It gets real nutty.

But let as assume that the "fixed" HCR bill passes and is signed into law. At that point it should be a stroll in the park to bring a Public Option add on to the floor of the House and the Senate. And if such a stand alone bill (could also include Medicare Buy in for 55 and older) in the 60 vote Senate, then Republicans are invited to filibuster it and I hope they do. Because that will hand the elections to the Democrats and we will pass it next year.

Thank you very much. The Public Option and Sarah Palin are the gifts that keep on giving.

rosserjb@jmu.edu said...

The difference between the Dutch/Swiss systems and the HCR proposal is that theirs involve non-profit insurance companies. Indeed, the power of the insurance companies can be seen in that there has been no push, aside from the vague efforts to get single payer that have gone just about nowhere, to undo that. Heck, we used to have non-profit health insurance companies, such as Blue Cross/Blue Shield, but they got bought up by for-profit ones. The US is the only OECD country with such for-profit health insurance companies, but somehow there has been no push to undo that.

This is true even of the other semi-socialist proposal that was in the House bill but not the Senate one, and has at times had support from Obama, unlike single payer. That would be the public option, which would make us more like France and Germany, that is if we had non-profit health insurers handling the employer-provided parts of such insurance. However, the negotiations between the House and the Senate seem to have become dominated by the abortion issue and the Stupak gang, so that trying to get public option in is probably dead in the water. As it is, there are good parts in the bill that would be an improvement over the status quo, even if all that is going on is essentially an extension of the existing system somewhat with some tweaks and minor reforms.

BadTux said...

Actually, Swiss insurance companies are for-profit. They're just not allowed to make a profit on the "base" compulsory insurance, just on add-ons. The regulation of MLR's above accomplishes much the same thing.

What baffles me is that this bill is very conservative in its construction. As you note, it makes tweaks and minor reforms in the current system, it doesn't attempt to overturn it entirely. This fits with the basic conservatism of the American people, the majority of whom prefer to move slowly on things like this. Yet people who claim to be conservative are having the vapors over the bill. I expected the far left to get the vapors over the bill because it doesn't impose the sort of socialist medicine system they believe is necessary, but am baffled over "conservative" opposition. Just goes to show that partisanship is more important than principles to so-called "conservatives".

dinoibo said...
This comment has been removed by the author.