Sunday, September 20, 2009

Health Care Reform

One of the biggest problems with healthcare reform is the insistence that it must take the form of a single bill, and that bill must be "everything to everyone." That is, the bill must:
  • Bring about universal or near-universal coverage;

  • Limit the abuses of the insurance industry; and

  • Maintain or reduce present levels of healthcare expenditure;

The Washington Post adds a fourth demand,
  • Malpractice reform,

despite there being no evidence that malpractice reform will advance any of the three other goals of reform - and plenty that it will not. (I've written quite a bit about the fiscal reality of "malpractice reform".)

It's not the worst unsigned editorial the Post has ever run, but Fred Hiatt is out to maintain the editorial board's reputation as a gang that can't shoot straight. At least half the time they time they don't know the target, don't actually want to hit it, or both. The editorial praises the atrociously deficient Max Baucus "reform" bill, while at best hinting at its most significant deficiencies: its deliberate underfunding of insurance costs for the uninsured working class, and its deliberate failure to provide any mechanism to pressure insurance companies to bring down insurance costs for people who don't have the good fortune to participate in employer-sponsored group plans. The Bacus bill bends over backwards to make sure that co-ops would be hamstrung and useless. I could cynically ask, how much did the insurance industry pay him (or promise to pay him) - except given the extent to which he kowtows is it truly cynical to ask?

A few years ago, I was paying for insurance through COBRA, continuing my wife's coverage through a full service Blue Cross/Blue Shield group plan. Over the course of eighteen months the price went from "really high" to "extraordinary", inspiring me to check out what I could get from other sources. Even through supposed "group rates" available through some professional organizations of which I'm a member, I couldn't find anything that came close to the group plan's benefits. In fact, the typical plan offered vastly less coverage, very high copays and deductibles, and... came at a similar cost. The only way I could "save" money would have been by using a catastrophic policy and covering "routine" medical expenses out-of-pocket, but given the health problems my family was experiencing at the time that would have been worthless. So I kept on paying under COBRA until my wife found a government job where... she became eligible for a Blue Cross/Blue Shield group plan that wasn't quite as good as her former plan, but was nonetheless very good - and, once again, offered at a group rate that was vastly below the "group" plans available to me as a self-insured individual.

The Baucus plan, quite deliberately, changes none of that. In that same position, I would have been offered only one other option - the co-op option Baucus has deliberately sabotaged, the overpriced "group" plan, or the useless "catastrophic care" plan. Had I faced a mandate at the time, but been ineligible for COBRA, I would have found the absolute cheapest catastrophic insurance plan that met the terms of the mandate, and been very angry at the government for making me waste my money on a useless POS of an insurance policy. The right-wing should be celebrating Baucus's crappy bill - in its present for, it stands to make their angry supporters even angrier.

Not surprisingly, given his obeisance to corporate interests, Hiatt's editorial page doesn't express any concern for the quality of health insurance that will be available to individuals. It does mention cost:
Asking families earning $66,000 a year to devote 13 percent of their income to insurance premiums - and more once deductibles and co-payments are involved - is asking them to assume a heavy lift.
They have a gift for understatement. A head of household with a $66,000 income takes home about $52,000. After the cost of housing, one or two cars, food, clothes... it's unlikely that the family has a great deal of wiggle room in its budget. Asking them to devote more like 16-17% of their take-home pay to an insurance plan - even more, to an overpriced insurance plan... and "more once deductibles and co-payments are involved" - is going to push a lot of families into foreclosure or bankruptcy. What a solution - rather than having your medical bankruptcy after you get sick (and your insurance proves inadequate), Baucus will force you into a preemptive medical bankruptcy! What's not to love?

I recognize why the disingenuous cowards, Jack Kingston and Darrell Issa, are afraid to put their (or is it our) money where their mouths are, and introduce an option allowing individuals to buy into the current federal insurance plan. (Maybe Kingston wrote a bill, but accidentally left it somewhere with his flag pin, never to be found?) But why doesn't Baucus have the cajones to add that option? (Or are we back to that "bought and paid for by the insurance industry" thing?) Conversely, if he thinks his watered-down co-ops are worth the paper their written on, why not require that federal employees obtain their coverage through co-ops? Including, of course, Senators? No, as you know, when a self-serving Senator is involved (and you rarely find another kind) sauce for the goose is never sauce for the gander - if he did that he would either have to fix the myriad defects in his co-op proposal or face hurricane-force blowback.

Top it off with this:
In addition, the proposal's version of an employer mandate - a so-called "free rider" provision that would penalize employers not offering insurance only if their employees obtained government subsidies - could have the perverse effect of discouraging employers from hiring workers from low-income families.
Are we sure Baucus hasn't changed parties? Given his apparent eagerness to cause the uninsured working and middle class to hate the Democratic Party, I'd swear he has his eyes on Michael Steele's job....

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