Health Insurance Premium Assistance Is Not Reform

While starting with the now to be expected insulting Very Serious Person approach, what interested me about this Ron Brownstein post was this:

In his Washington Post op-ed Thursday, Dean wrote: "I know health care reform when I see it, and there isn't much left in the Senate bill." Yet the bill that Dean so casually dismisses would spend, according to the Congressional Budget Office, nearly $200 billion annually once it is fully phased in to help subsidize insurance coverage for over 30 million Americans now without it. That's real money--the most ambitious and generous expansion of the public safety net since the Great Society under Lyndon Johnson. And that money, based on the Census results, would flow most into minority and working-class white communities.

(Emphasis supplied.) Certainly expanding health insurance premium assistance for the less well off is a very good thing, but no one can seriously argue it is reform. Oh btw, 200 billion dollars annually? Where'd that number come from? And what Congress is going to approve it? I'd like to hear more about that number. Finally, health insurance premium assistance can be done via reconciliation, as Dean has called for. So the Senate bill is really not critical to what Brownstein is arguing is the key provision of "health care reform." The more they write, the more nonsensical the Very Serious People are becoming.

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    I find "..to help subsidize" (5.00 / 1) (#3)
    by KeysDan on Fri Dec 18, 2009 at 10:23:57 AM EST
    insurance coverage to be puzzling.  Is the plan to subsidize the  coverage for some fully, as in Medicaid; to assist in meeting the cost of the premiums, or to help to assist meeting the cost of the premiums. And, of course, what is the formula, in the latest round?

    Question (5.00 / 3) (#4)
    by hookfan on Fri Dec 18, 2009 at 10:29:02 AM EST
    If premium prices continue to rise (and I think they will), and there is no cola for the subsidies (iirc there is not), and wages remain stagnant (and they will, especially with the downard pressure of so many unemployed), then aren't the vaunted subsidies functioning as marketing mechanisms to ensnare people into a bad situation? What you are going to wind up with very shortly is a host of people just mandated a penalty tax, no real coverage, no actual healthcare, likely to occur prior to full enactment of "reform" in 2014. How dysfunctional will these subsidies be at that time?

    Yip (5.00 / 1) (#10)
    by SOS on Fri Dec 18, 2009 at 11:17:53 AM EST
    Health Insurance Premium Assistance Is Not Reform

    No! Ya don't say!

    Fascinating. Spending money = reform. (5.00 / 1) (#20)
    by Cream City on Fri Dec 18, 2009 at 02:54:24 PM EST
    Well, gosh, on that basis, Bush was a heckuva reformer with what he did with the federal budget!

    Really, some of these village bloggers are just village idiots with their stupid statements.

    "Digital Left." I kind of like that. (none / 0) (#1)
    by oculus on Fri Dec 18, 2009 at 10:12:12 AM EST

    I'm learning a lot (none / 0) (#2)
    by kidneystones on Fri Dec 18, 2009 at 10:12:15 AM EST
    I'm learning that after surviving Nixon, Reagan, Bush I and II and countless Dem screw-ups I can still be horrified by the naked thieving and brute greed of vested interests. I actually didn't think I could be shocked anymore. (via Atrios)

    I was wrong.

    Take a shower (none / 0) (#5)
    by Militarytracy on Fri Dec 18, 2009 at 10:40:07 AM EST
    Then read the Brownstein piece, you won't even need a blow dryer.

    I think premium assistance (none / 0) (#6)
    by Steve M on Fri Dec 18, 2009 at 10:45:56 AM EST
    is a bit of a camel's nose under the tent.

    The model for the Senate bill is that the folks who don't earn as much have their annual premiums capped at a certain percentage of their income, with the balance to be made up through government subsidies.

    In other words, the bill effectively shifts the cost of premium increases from the individual to the government, for anyone whose premiums are already at the cap.

    This is important because we know from our experience with Medicare that the government is unlikely to stand around and allow itself to be gouged for very long.  Sure, the lobbyists will keep pushing for their boondoggles like Medicare Advantage, but experience teaches us that Medicare has done a better job of containing cost increases than the private sector.

    The government has the power to do something about premium increases, but by sticking the government with the bill for those increases, we give it a much greater incentive to do so.

    Fair point (5.00 / 1) (#7)
    by Big Tent Democrat on Fri Dec 18, 2009 at 10:51:20 AM EST
    So let's go further and go to Medicaid Buy-In, and eliminate the exchanges to avoid the Stupak problem.

    We need to start stipulating on this too (none / 0) (#8)
    by cawaltz on Fri Dec 18, 2009 at 11:04:22 AM EST
    if this is the route we were to go. Just dumping people on the medicaid roles without placing federal requirements on the program and a discussing rates would end up a disaster.

    As opposed to? (none / 0) (#9)
    by Big Tent Democrat on Fri Dec 18, 2009 at 11:09:28 AM EST
    Not offering them Medicaid?

    I do not see your point.


    My point is (none / 0) (#11)
    by cawaltz on Fri Dec 18, 2009 at 11:19:04 AM EST
    if you don't fix Medicaid then you will have a bunch of people having health insurance in name only. Lots of states do not have adequate providers on their roles and certainly not enough to handle the burden of 30 million additional people.

    That is an exisiting problem (none / 0) (#15)
    by Big Tent Democrat on Fri Dec 18, 2009 at 11:39:20 AM EST
    not one that would be created by the proposal I make.

    asdf (none / 0) (#12)
    by TeresaInSnow2 on Fri Dec 18, 2009 at 11:22:20 AM EST
    Few doctors accept Medicaid.  If you add more patients to the rolls, you  further dilute and reduce care for those already on Medicaid, while also diluting care for those newly joining.

    If I were you, I'd find yourself a Medicaid recipient and follow them to the doctor.  See what it's really like to be on Medicaid.

    Or if you can't do that, go visit the office of a doctor who accepts Medicaid....if you can find one.


    I know which is my point (5.00 / 1) (#14)
    by cawaltz on Fri Dec 18, 2009 at 11:38:18 AM EST
    What needs to happen is there needs to be a revamp with federal standards presented to the state in return for funding(like what is done with Medicare). Furthermore there needs to be a discussion on rates for physician providers(which I gather are considered too low). However adding 30 million to a government run program could end up being a step in the right direction if it is done right. Medicare was able to bring costs down because they cover about 10% of the population. 30 million happens to ALSO be about 10%(actually a little higher than according to 2000 census) of the population. Something that significant in size might be a way to put pressure on the market.

    It isn't perfect but I could see if this was done correctly an improvement for lower income people in a program they are reliant on simply because a larger pool of people are also invested in it.

    That is providing the Democrats have the guts to go back to the bargaining table and demand that we spend at least as much time an effort to something about 1/6 our GDP as we did important issues like flag burning and steroids and sports and equal amounts of money as we do for wars and the banking and insurance industry.

    For the record, I'm not suggesting anyone hold their breath. Representation seems to be a somewhat loose term unless you have an LLC or corp after your name these days in DC.


    For you then, this won't be reform (none / 0) (#13)
    by andgarden on Fri Dec 18, 2009 at 11:34:12 AM EST
    until we require Dr. to accept whatever insurance the government directs them to accept. You know, one way we could do that would be to preempt licensing laws and condition their licenses on insurance acceptance.

    I'll bet Drs would love that.


    We have requirements for doctors for Medicare (none / 0) (#18)
    by cawaltz on Fri Dec 18, 2009 at 11:45:50 AM EST
    Medicare, the Federal insurance program for those over 65, prohibits doctors from charging more than 15 percent above its established rates and requires them to file Medicare claims for any services for patients covered by the program. Some states have an even smaller percentage margin like NY.

    Some of the doctors have been "testing" these limits which would suggest revisiting it wouldn't be a necessarily bad idea anyway.


    Bingo! (none / 0) (#21)
    by suzieg on Fri Dec 18, 2009 at 08:27:18 PM EST
    my retarded daughter (none / 0) (#19)
    by Molly Pitcher on Fri Dec 18, 2009 at 11:49:05 AM EST
    was on Medicaid for years, but she always had the option to use our insurance instead (grandfathered in).  After her dad died, she got Medicare.  Medicaid still pays a lot for her group-home care, tho she gives it all of her fairly fat SS check. What I know is that to get quality medical care, I have to stipulate up front that I will pay her bill.  (GPs who don't speak good English were quite acceptable for a gyn exam--until she balked and I insisted on a real Gyn. and offered to pay.)  I am really irritated that the county insists on her going to one of their Medicaid doctors even tho she has the Medicare. (Even the agency workers say that you must travel to another county to get excellent care.)

    You've basically hit the crux (none / 0) (#16)
    by ai002h on Fri Dec 18, 2009 at 11:39:21 AM EST
    of the reason why progressives always lose these battles. This method of negotiating even permeates with progressive stalwarts like Bernie Saunders. They show their cards early by their unwillingness to threaten opposition to the bill. By saying that you're for the bill right away, you immediately weaken your hand against the Ben Nelsons and Joe Liebermans of the world, who claim unequivocal opposition until all their demands are met, and even then, will still refuse to endorse the bill in case they see something else they don't like.

    Oops..wrong thread..ignore (none / 0) (#17)
    by ai002h on Fri Dec 18, 2009 at 11:39:48 AM EST