What's Wrong With the Health Bill

This NYTimes editorial is almost surreal. In almost every respect it finds the Senate bill wanting and prefers the House bill but we all know that the final bill, the bill Obama wants, is the Senate bill. So a read of the editorial is basically a litany of everything that is is wrong with the health bill:

Here are the major differences:

FINANCING The Senate bill has the better financing feature to help subsidize coverage of the uninsured — a stiff excise tax on the most costly employer-provided health plans. The tax would provide a strong incentive for employers and workers to shift to lower-priced plans. Organized labor is strongly opposed to the tax and the House is cool to the idea, but it should be retained. Health economists of all political stripes see the tax as the major cost-reduction element.

The main source of money in the House bill would be an income tax surcharge on the amount by which incomes exceed $500,000 for individuals and $1 million for couples. This is eminently fair given that the wealthy benefited enormously from the Bush-era tax cuts. The Senate rejected such a tax, but should agree to extract more money from the wealthy.

If you see where the Times editorial deals with the objection to the excise tax as a tax on the middle class, you make sure to let me know. As it is, we are to believe "experts" about its "cost containment." I actually agree it will contain costs - by taking away health benefits from the middle class. Hell of a deal.

MEDICAL CARE REFORMS The House bill relies heavily on pilot projects within Medicare to determine which approaches to restraining medical costs might work best, but lacks a strong mechanism to drive successful reforms into widespread use. The Senate bill would empower an independent board to carry out successful reforms broadly within Medicare and recommend changes in private programs. The board is a crucial cost-control mechanism. It should be strengthened, by removing a 10-year exemption for hospitals and hospices.

but of course - a "commission" will "recommend" stuff. Proven cost control. Sheesh. Pathetic. Now let's get to the good in the bill - the stuff that actually matters and is real - as opposed to the phantom "reforms" the wonls are selling:

AFFORDABILITY Under the more generous House bill, low-income people would pay substantially less and get better benefits than under the Senate bill. The House bill has far better subsidies to help lower-income Americans with premiums and cost-sharing. The Senate bill offers better subsidies for middle-income people. House staffers calculate that a family of four earning $33,000 a year would pay $1,521 in premiums under the Senate bill, which is $530 more than under the House bill. The same family would be exposed to as much as $4,100 in cost-sharing under the Senate bill, which is $3,100 more than under the House bill.

Affordability is probably the most critical issue in winning popular support. The Senate needs to agree to more subsidies.

Winning popular support? How about in it being a good progressive bill? Indeed, this highlights just how feeble the Senate bill - which will be the final health bill, really is.

MEDICAID The House bill would expand Medicaid coverage to higher-earning people than the Senate bill does. It would raise Medicaid’s low payments to doctors in one crucial respect — paying primary-care doctors the same that Medicare pays. That would make it more likely that poor patients could find a doctor willing to serve them. The Senate should follow the House lead.

It should be it will not. Greatest piece of progressive legislation in 40 years is kind of a joke.

EMPLOYER MANDATES The House bill imposes higher penalties on employers who fail to offer coverage, a prod estimated to increase the number of covered workers by six million in 2019. The Senate bill has weaker penalties that would allow more employers to opt out, reducing by four million the number of workers covered. Under the House bill, employers would have to pay most of the premium and meet minimum benefit levels; the Senate has weaker requirements. The House bill is superior.

But the Senate bill will be the final bill - the greatest thing since sliced bread. What an embarrassment for "progressives."

INDIVIDUAL MANDATE The House has stronger penalties on individuals who decline to buy insurance and would exempt fewer individuals on grounds they could not afford to buy coverage. Given that the reforms would work best with the greatest number of people insured, the House provisions should prevail.

For once, given what the final bill will look like, I'd go with the Senate bill.

EXCHANGES Analysts disagree over whether it would be best to set up a strong national exchange while allowing states that meet national standards to operate the exchanges (the House bill) or to let the states set up exchanges with federal government oversight (the Senate bill). A national exchange would ensure greater uniformity and probably impose tougher standards. State exchanges would know their local markets the best. Either approach could work. The more important issue is how the exchanges would operate.

EXCHANGE RULES The House bill would merge individual buyers and small businesses into a large pool that would spread the risks among sick and healthy patients so as to keep average premiums low. The Senate bill would fragment the risk pools to the point that they might not function well.

I personally could not care less. the exchanges are a joke. I think they will be utter failures. National or state based.

PRESCRIPTION DRUGS The House bill would close the notorious doughnut hole, a coverage gap that leaves many Medicare patients paying the full cost of their medicines; extract bigger discounts from the manufacturers; and allow the government to negotiate drug prices for Medicare beneficiaries. The Senate should yield to the House on the drug makers, who will be making enormous profits from tens of millions of new customers and ought to contribute more to reform.

Should yield. Won't. The health bill is deeply flawed.

PUBLIC PLAN The House bill includes a relatively weak public plan that might end up charging higher premiums than competing private plans because it would attract the sickest customers. Even that modest plan has no chance in the Senate. If it has to be dropped in the interest of passing a bill, that is a price worth paying.

The one piece of MEANINGFUL reform in this bill should be jettisoned. will be jettisoned. what a joke.

Holding my nose does not even begin to describe how I feel about this bill.

Speaking for me only

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    Never mind (5.00 / 3) (#3)
    by Zorba on Sun Dec 27, 2009 at 02:30:34 PM EST
    "holding my nose."  My forehead has little squares permanently gouged out in it from all the time I've spent hitting my head on the keyboard.  Get rid of both House and Senate versions and start over.  From scratch.  With an affordable, widely available public option.

    Welcome aboard ;-) (5.00 / 7) (#4)
    by lambert on Sun Dec 27, 2009 at 03:43:07 PM EST
    Speaking of the middle class, Marcy does the math that Krugman doesn't.

    And so what if the "Cadillac" plans were negotiated by the unions in exchange for wage concessions? Under the bus with them!

    This administration seems (5.00 / 3) (#6)
    by cawaltz on Sun Dec 27, 2009 at 03:47:28 PM EST
    bound and determined to alienate every single group that actually put him into office. It's freakin' bizzare. Women, unions.....there simply isn't enough room under this darn bus anymore?

    It's a feature, not a bug (5.00 / 4) (#11)
    by ruffian on Sun Dec 27, 2009 at 04:57:28 PM EST
    Never let it be said... (none / 0) (#8)
    by lambert on Sun Dec 27, 2009 at 04:08:53 PM EST
    ... that the Democrats are incompetent!

    Meanwhile, [a|the] [strong|robust|triggered] ... (5.00 / 1) (#5)
    by lambert on Sun Dec 27, 2009 at 03:46:37 PM EST
    public [health insurance]? [option|plan] was never "MEANINGFUL," not once. Anything that can dwindle from an initial claim of 130 million to less than 10 million and still be called by the same name can only be an empty marketing slogan.

    Marketing slogans (none / 0) (#7)
    by cawaltz on Sun Dec 27, 2009 at 03:50:44 PM EST
    Our government seems to live by them for the past decade or so. I'm going to admit I was for a robust public option but I hopped off the support health care bus a long time ago when it became more than clear that my opinion of what robust was widely differed from what Congress's opinion of robust was.

    The darn thing needs to die.


    How smart does one have to be (5.00 / 8) (#9)
    by Anne on Sun Dec 27, 2009 at 04:38:53 PM EST
    to figure out that:

    (1) if we're having a crisis in health care, delaying it for at least another 4 years isn't going to be much help to people who need help;

    (2) if the government isn't going to question the premium structure being set by the insurance companies, and is simply going to hand over whatever amount the industry says it needs, it isn't the government that is running this show - it's the industry that has brought us to this point.

    (3) if a lot of people are going to be paying more for something they couldn't afford in the first place, and cost-sharing is going to put access to care out of reach for some who already have insurance, who is it that we're actually helping?  

    I have to write a check this week for three months' premium that is almost 20% higher than it was for 2009.  The good news is they've promised to hold this rate for a whole year, but I have no illusion that next year won't see another big rise.  Which they will tell me just pains them no end to have to pass along to me.  Boo-hoo...

    I don't know that I have ever been as disappointed in Democrats as I have been over the last three years, but something tells me my disappointment hasn't even gotten close to being as bad as I expect it to be over the next year.

    Next Year (none / 0) (#15)
    by cal1942 on Mon Dec 28, 2009 at 12:20:17 AM EST
    Not encouraging given this little gem.

    Obama may yet accomplish what eluded Bush.


    Indeed he may. (none / 0) (#17)
    by Romberry on Mon Dec 28, 2009 at 09:05:21 AM EST
    I said during the primaries and the general election campaign that it took a Republican to go to China and it will take a Democrat to kill Social Security. I think Obama is that DINO.

    A North Dakota Dem behind that bill? (none / 0) (#18)
    by Cream City on Mon Dec 28, 2009 at 10:58:11 AM EST
    Oh, gimme a break -- that's the state that gets more breaks than any state.  I've seen stated several times in several (good) sources that North Dakota is the leading welfare state in the country -- so here's the reply: Let's go after the leading group of welfare recipients in the country and cut farmers' subsidies.  That'll cost him re-election.

    This... (5.00 / 1) (#12)
    by NealB on Sun Dec 27, 2009 at 05:23:05 PM EST
    I wouldn't have a problem with that (5.00 / 1) (#14)
    by cawaltz on Sun Dec 27, 2009 at 07:45:52 PM EST
    if it actually looked like we were going to get decent health care in exchange. As it stands those same companies will just use the money to pad the pockets of CEOs and make up every excuse under the sun as to why they need to make more money.

    One of my favorites: (5.00 / 1) (#13)
    by lentinel on Sun Dec 27, 2009 at 06:22:52 PM EST
    EMPLOYER MANDATES The House bill imposes higher penalties on employers who fail to offer coverage, a prod estimated to increase the number of covered workers by six million in 2019. T

    I'll be counting the days 'til 2019.

    Did Adam Nagourney write it? (none / 0) (#1)
    by Salo on Sun Dec 27, 2009 at 02:15:13 PM EST
    Looks like his handy.

    Paragraph on PO (none / 0) (#2)
    by Salo on Sun Dec 27, 2009 at 02:18:33 PM EST
    Is the money shot. It tells Midwestern "liberals" what to think.

    I would go for the national exchanges (none / 0) (#10)
    by andgarden on Sun Dec 27, 2009 at 04:51:23 PM EST
    not that I think they're very meaningful. . .

    Interesting (none / 0) (#16)
    by cal1942 on Mon Dec 28, 2009 at 12:36:45 AM EST
    that the Times favors higher mandates while also supporting an excise tax that will clobber middle income people.

    So let's see how this all goes.  Make a higher penalty for non-performance that can only effect the lower 80-90% of earners and then levy an excise tax that will extact meaningful flesh from the same group.

    What was that that happened to Rome when the Senate excluded the upper tier from taxation while increasing taxation on the lower 90%.