You might be wondering why I haven’t written about the President’s HealthCare bill. The reason is that I have very little to say.
This, I realize, is unusual. But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.
Nevertheless, I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.
Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms. The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years.
I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges. But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it.
The President also will need to keep an eye on Senate moderates. I would favor sending Joe Lieberman on a special mission to South Korea. A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.
There is no need to worry about the Republicans. They can be counted on to vote against any reform bill that even attempts substantive reform. Universal coverage is not their top priority, and they definitely don't want to pay for it.
As for the details: I’m glad to see higher subsidies for those who earn less than $44,000 or more than $66,000—though I think that subsidies for a family of four earning less than $66,000 are still too low. I prefer the numbers in the House bill (See a table comparing the president’s proposal to the House and Senate bills here.) But the subsidies can be revised when we see just how much insurance is going to cost in 2014.
I’m delighted to see that insurers are required to pay a larger percentage of medical expenses; as regular readers know I think that high co-pays and deductibles serve as a barrier to needed care. But I would hope to see co-pays limited to 10% of medical costs for all families earning less than, say $100,000 , not just for families of four earning less than $33,000. See second table here. But again, these numbers can be amended .
I’m glad to see a tax on unearned (investment ) income to help pay for the bill. That money will help fund the $11 billion that the president promises for community centers over five years—more than the $ 8.5 billion that the Senate offered. This is an excellent investment; community centers have already shown that they can serve as medical homes.
When it comes to penalties for those who choose not to buy insurance, I’m afraid they are still too low. As Igor Volsky points out over at the Wonk Room, the president’s plan “may make it easier for younger Americans to opt out,” and we need those young, healthy citizens in the pool if we want insurance to be affordable for everyone. Volsky lays out the differences among the Senate, House and President’s plans in a clear, concise chart.
Finally, since I can’t read President Obama’s mind, I’m not going to bet how this will turn out. I’m just glad that the White House hasn’t given up.
Hi Maggie:
I read the preliminary detail every letter of it on what I could find. As you said it is a start.
I was happy to see the tax on unearned income, the generic pharmaceuticals pitch, the lesser penalty on business, and the improved subsidies. I really did not see much control on innovational costs or hospital billing which in my humble opinion is still a problem.
I was waiting to see what you would say on this new proposal.
Any idea what Obama is referring to with this statement from page 10?
http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf
“Protect the Social Security Trust Funds. The President’s Proposal provides that, if necessary, funds will be transferred to the Social Security Trust Funds to ensure that they are held harmless by the Proposal.”
run 75441–
I realy don’t think that they can cut fees to hospitals or spending on high-tech medicine in the legislation.
The mintue they try to do that, the lobbyists will cry RATIONING! and the bill will never pass.
But Medicare can make those cuts, and once it does, private insurers (which already follow Meicare when it comes to reimbursements) will follow.
This isn’t something that Congress will ever pass, but it is something that the executive branch can do through Medicare.
My guess (and I’m note sure) is that in the next couple of years we will see that Medicare can do quite a bit without going through Congress–as long as it has backing from the executive branch.
I’m still waiting to see who they appoint as director of the Centers for Medicare and Medicaid (CMS).
I agree that this bill would be a very good beginning. I will be disappointed if House liberals refuse to vote for it.
Finally as Dean says the president deserves some credit for coming back and not taking “No” from the Party of No.
Hi Maggie:
I was wondering what kind of argument would/should be made for young, healthy people (such as me, although, I am exempt due to income level) to purchase health insurance aside from a kind of Jesus-inspired pride from helping their fellow man?
Keith–
I’m not religious.
But I do believe in “There but for fortune, goes me” (when you see a very poor or sick person, you realize that, with just a bit of bad luck (an accident or having been born in the wrong place at the wrong time) you could be this person. I also believe in Do Unto Others As You Would Have Them Do Unto You(again, it’s a matter of recognizing our common humanity.)
It’s great that you are young and healthy, but it’s important to remember that we are all mortal, and all in this together.
Tomrrow you might not be so healthy. A year from now your mother might need healthcare that neither you nor she can afford.
And one day, you might have a baby that is seriously ill and needs help that you and your wife cannot possibly afford.
We all need to think collectively–not just in terms of “me and my family” but in terms of “all of us.”
Beause each of us may need nelp from “all of us” at any time.
If you are not willing to help contribute to teh carry for everyone today, why should anyone help you, your baby, your mother or your wife tomorrow?
I can’t help but notice that that most young and healthy people believe that if they are in a terrible car accident, or suddenly develop a malignant brain tumor that hospitals will take them in and that doctors will take care of them–that they “must”.
But if you are not willing to contribute to the insurance pool, why is society obiligated to take care of you??
(I think we should take care of you–I certainly wouldn’t leave you bleeding on the street outside the hospital. But I don’t quite understand the sense of entitlement if you’re not willing to contribut to the heatlh insurance pool that protects all of us. )
Finally, I just would prefer living in a society where I dont’ have to step over the bodies of very poor an d sick people as I go to the subway.
Keith, health care should be viewed like we view fire fighting. In both cases the general public is adversely affected when individuals face the challenge of either bad health or a fire. A fire can spread and sickness can spread. Long ago we recognized this in the case of fire fighting, and we do that entirely with a shared risk system – we all help pay for fire departments, even though most of us never need their services. The same reasoning dictates that we all need to help pay for health care even if we are young and healthy. It is just a part of living in a civilized society.
Vaughn,
There are some notable differences between firefighting and healthcare. First, the tax burden required to finance firefighting is low and quite manageable whereas the cost of healthcare is very high and growing at an unsustainable pace. Second, at least in the suburbs, much firefighting and emergency response is performed by uncompensated (financially) volunteers with tax money only covering equipment, supplies, physical facilities and insurance. Third, firefighters don’t expend scarce resources extinguishing unnecessary fires. Fourth, fires are not deliberately set and then extinguished to protect against lawsuits. Finally, prevention and better building codes, materials, smoke detectors, etc. have drastically reduced the number of fires during the past several decades as well as the severity of many that do occur.
The unlikely stars of both moral and economic imperatives for US health care reform have indeed arrived
Failure is really not an option at this time except for the most self destructive among us.
Dr. Rick Lippin
Southampton,Pa
I think that all humanism resulted from the kind of Christian-Judaic religion (and that influenced by Aristotle). So, I think without it, we probably wouldn’t be having this discussion. I think democrats are a little more on the side of Jesus.
I would also like to say that I’m with you guys, and that I hope health reform passes, so maybe we will inch our way towards a kind of single-payer system. It’s rather schizophrenic in having a system where the police patrol the streets to protect us from being hurt and then if they just can’t save us in time we in effect saying “Well, you’re on your own, now” and whistles on his marry way.
We are REQUIRED to use our bodies and so I think we should have a system that requires it to help us use our bodies.
Vaughn, Barry
Vaughn– I agree. And before we had fire departments, if your barn burned down neighbors would help you build a new barn.
Barry– You write: “Finally, prevention and better building codes, materials, smoke detectors, etc. have drastically reduced the number of fires during the past several decades as well as the severity of many that do occur.”
It strikes me that if we made the same investment in public health that we have made in making fires less likely, health care wouldn’t be as expensive, because there wouldn’t be as many sick people.
Here I’m thinking of investments in gyms, gym teachers and nutritious food in public schools, investments in cleaning up the environment in poor neighborhoods, safe parks,
smoking cessation clinics,
pre-schools, dental care in schools . . .
Rick– yes, I agree. At this point, we really don’t have a choice. We’re heading for a wall
Keith- I wouldn’t limit the call to help each other to the Judeo-Christian tradition. You find it in all religons.
“It strikes me that if we made the same investment in public health that we have made in making fires less likely, health care wouldn’t be as expensive, because there wouldn’t be as many sick people.”
Maggie – You make a fair point. The issue, I think, is where does the money come from? There is no question that taxes are likely to increase considerably over the next five years or so, just to address our fiscal imbalance. I think we need to figure out how to make existing social programs perform better and reduce costs. If we can free up money by doing that, we could fund some of the initiatives you suggest. I’ll outline a few examples of program failures as I see them.
In primary and secondary education, for example, in New Jersey, we have 31 special needs districts, called Abbott districts after a landmark court case, out of over 600 districts statewide. Fully half of our $9 billion or so of state education aid goes to these 31 districts yet student achievement is still poor. It’s extremely difficult to fire incompetent and underperforming teachers. Teachers unions often oppose the expansion of charter schools and they certainly oppose vouchers to allow students to attend private and parochial schools. It can be difficult to remove disruptive students from the classroom. In effect, we are just expected to throw ever more money at the same failed system year after year.
My wife’s college roommate is now a sociology professor at a small college in Ohio. One of her smaller classes consists of all African American students from low income and inner city backgrounds. When she asked them what the environment was like where they went to high school, most said it was violent with fights, drugs and “girls popping out babies every year.” When she asked if they were able to learn much, they just laughed. One student said it was his goal to make his teacher cry every day until she finally quit. Another said that if you were our teacher and asked us to do something, we would just say *!*! You and throw our books at you. I think taxpayers should be able to expect more of an effort from students than that.
We have spent a lot of money on public housing since the 1950’s. Many of those high rise apartment buildings became slums and thousands of units have since been torn down. Many years ago, a congressman whose name I can’t remember said “you can’t take the people out of the slums until you take the slums out of the people.” He meant that if you give them a nice new apartment, they need to be able to take care of it and keep it clean.
The bottom line is that a huge amount of money was spent on the poor since LBJ was president and much of the spending was ineffective and unproductive. When programs don’t work within a reasonable time and after considerable effort, we need to figure out why and try a new approach. Too often, the knee jerk reaction is to throw ever more money at the same failed programs hoping they will work if we just commit “more resources.” Both taxpayers and the poor themselves deserve better.
Barry–
First, many of the programs that were part of LBJ’s war on poverty did work. I remember them and saw the effects.
Medicare helped bring seniors out of poverty.
And “Headstart” was a success. In fact, upper-middle-class communities saw the success and began building pre-schools, modeled on Head-Start, for their children.
Where would we get the money for a war on poverty today?
Instead of bailing out industries that are not able to succeed (the auto industry, for instance), we should let the market do its thing (they should go under) and use those taxpayers dollars for social programs–investing in human capital–education, etc.
We also should reform our tax schedules: at this pont, the very wealthy pay historically low rates on both earned income and investment income.
Secondly, we should invest in exccellent public education k-12 and some of the other social safety nets that other developed counries offer. We also need to raise overall taxes for the very wealthy (inheritances taxes, VATs )
so that, as a nation we can become a largely middle-class country–as we were in the 50s and 60s and as most European countires are today.
As a largely middle-class nation we would enjoy more ecoomic stability and greater social solidarity.
Barry–P.S.
Your wife’s college room-mate is teaching college sudents who came from poor schools
My daughter actually teaches poor kids in those schools.
She is able to help them.
And she has observed that most of the teachers who choose to teach in these very difficult shcols–and hang in there–are very good teachers.
None of Emily’s students (or her friends’ students) try to make them quit.
If Emily is out sick, some of her students cry. They are afraid that something happened to her. And they greatly prefer going to school to beomg at home.
Her class represents a “safe place” for them.
And almsot all of her kids are reading at, or above, grade level, at the end of the 1st grade..
That’s her goal. She realizes that if they are good readers, that will be their “way out” of the place they have been born into. That’s also why she teaches 1st grade. It’s crucial– a turning point in a chld’s life.
That was my mistake. I didn’t mean to say humanism was only in the Judeo-Christian ethic. I meant that all humanism comes from a religious tradition.
Film critic Roger Ebert has a blog or two written about health care reform.
Here is his latest.
I think you will enjoy it.
http://blogs.suntimes.com/ebert/2010/02/the_gathering_storm.
I’m curious, Maggie, why you think this bill is just a first step and will be amended frequently? Most bills are left alone. Maybe once every score years something like a Medicare Part D comes along and it’s tooth-and-nail the whole way.
Dems should be giving us the best possible bill they can right now.
Billy–
Wheen Social Security was first passed it did not include most women or African Americans.
I can imagine a Congressman saying –how can I vote for this? But the majority did vote for it, with liberals realizing that, over time it would be amended.
Medicare has been amended many times.
There is no way that we could pass one piece of legislation that would restructure the entire health care industry– a $2.7 million industry (17T of the U.S. economy) without many additional bills and amendments.
This is a very complicated restrucuturing of an enormous industry– it will require many pieces of legislation.
Billy—
All of the big pieces of social legislation have been amended many times.
For example, originally social security did not cover African-Americans or most women. At the time, a fair-minded legislator might have thought: how can I vote for this?
But by voting for it, he started the process. And, sadly, at that point most Americans were not willing to extend Social Security to blacks or women.
Medicare has undergone many revisions in terms of the fee schedule and how we pay hospitals as well as co-pays, deductibles and Medicare taxes.
Medicaid has undergone may revisoins as we the federal government tries to expand access– and the SCHIP legislation (a separte bill) finally began to address the needs of poor children.)
If you look at the history of labor legislation, worker’s rights, etc. you’ll see a similar history of amendments.
Legislation regarding pensions has been constantly revised.
When dealing with huge social problems, it’s just impossible to get the legislation right the first time. Often, the country just isn’t ready for the optimal solution. Or–we don’t know what the better solution would be until we try something, see the problems, and begin to fix them.