The Policy Argument For A Health Insurance Assistance Bill

Joining fellow Village blogger Matt Yglesias, the disingenuous Ezra Klein also throws bouquets to Chris Bowers for his public capitulation on the public option.

There are two aspects to Chris' position which are indefensible. First, Chris was one of the foremost proponents of arguing for the public option as the vehicle for establishing progressive influence in the legislative sausage making. Day after day he urged the Progressive block to hold the line and criticized those who showed signs of breaking ranks. His about face NOW is simply inexcusable. If a progressive ACTIVIST cannot hold the line, how in blazes can that same progressive activist ask pols to do it?

Second, Chris has now adopted the Village Blog style of pretending that it is the "reform" in the health bill that provides insurance coverage for 30 million uninsured Americans. That is a bald faced lie. It is indeed the favorite lie of the Village Bloggers. The provision of insurance assistance has nothing to do with the Exchanges and the individual mandates, the provisions considered sacrosanct by the Village Bloggers (now joined by new Village Blogger Bowers.) It is the expansion of Medicaid eligibility and federal subsidies to the less well off for the purchase of insurance. Has it not occurred to Bowers that he can support health insurance assistance without supporting the individual mandate, the Exchange and the regressive excise tax? More . . .

There is no evidence that supports the idea that a robust Exchange, much less the puny exchange now in the Senate bill, will control health insurance costs.

There is no evidence that supports the idea that an excise tax on "Cadillac" plans for union workers will lead to a transfer of compensation in the form of wages from reduced health care benefits. Of course companies will reduce the health benefits they will offer to avoid the tax. What they will not do is transfer significant savings to workers.

There is no sound PROGRESSIVE policy argument for supporting the "reform" parts of the proposed Senate health bill, other than the public option.

On the other hand, there are profound progressive policy arguments for strongly supporting a health insurance assistance bill that taxes the well off in order to pay for insurance for the less well off. And Village Bloggers, including new Village Blogger Bowers, are leveraging the natural progressive support for a policy that will tax the rich in order to provide a benefit for the less well off in order to round up progressive support for the noxious and unacceptable "reform" package that is in the Senate bill (save for the public option.)

I support the health insurance assistance components of the proposed health bills unconditionally. Put that portion solely to a vote and let's whip for the votes of all Democrats.

I support the public option contained in the "reform" portions of the health bills.

I can accept mandates in the "reform" portions of the bill with a public option. Without a public option, I can not.

I have no objection to the "regulatory reforms" that are envisioned though I am confident that they will be ineffective.

I can accept the Exchange if a public option is included and the Stupak Amendment is defeated. If there is no public option, there is absolutely no reason to risk a Stupak Amendment for the Exchange.

Chris Bowers has demonstrated no thinking, no principles and no commitment to the political objectives he championed all year long. His position is indefensible and wrong.

Speaking for me only

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    Well Ezra's article (5.00 / 3) (#6)
    by lilburro on Thu Dec 03, 2009 at 10:23:59 AM EST
    is even more goofy -

    I'd add to this that my read of the history is that social policy programs generally get better, rather than worse, over time. Right now, there are a lot of people who worry they'll lose something they have if health-care reform passes. But no one is currently receiving benefits from the plan. If it passes, however, then health-care reform develops its constituency, which has the power to protect its important provisions and expand where necessary. That's how Social Security grew, and Medicare, and Medicaid. [emphasis supplied]

    Without the public option, there is nothing in this bill that remotely resembles Social Security, Medicare or Medicaid.  An exchange is not a "social policy program," it is a marketplace.  An exchange holds no guarantee for anyone.  And heck, the principle behind the exchange (market competition) is not exactly a progressive approach, it sounds more Republican than anything else.  Give Republicans something to run on if it works!  Great!  I can totally see them using the Exchange as a pretext for destroying all of the social policy programs listed above.  But I digress.  Who believes the public option can be inserted later if the bill is passed without it now?  C'mon.  

    And as far as Bowers goes, he falls into the same "moral" style of argumentation that Yglesias and Klein have previously used.  It's just a guilt trip.  And it is done really, really poorly - instead of making the moral argument for the most progressive parts of the bill, they only use it for the least progressive parts of the bill, and only throw out the "moral" argument when they are being defensive of it.  It would have been nice to see progressives use the moral argument on offense, and make a better bill.  But Obama didn't do this, so his sycophants did not either.

    And why throw in the towel on this bill?  There are plenty of people who have already done so, more than enough.  Jeez.

    Precisely (none / 0) (#7)
    by Big Tent Democrat on Thu Dec 03, 2009 at 10:35:02 AM EST
    We do not need the reforms for the progressive result they are touting.

    I am actually (none / 0) (#9)
    by lilburro on Thu Dec 03, 2009 at 11:11:10 AM EST
    quite confused by this "social policy program" characterization.  Maybe Ezra will answer my question in chat.  Because I simply have no idea at all what he is referring to.

    Private insurance marketplaces (none / 0) (#10)
    by MO Blue on Thu Dec 03, 2009 at 11:12:41 AM EST
    in my experience do not result in price competition. Medicare has what could be called a marketplace for supplimental coverage. When comparing exact same plans (non Advantage), the price differential is not more than a couple of dollars. Think maybe they agree on the price?

    Then you get cute tricks like this from Pharma.

    Over the last few years, drug-makers have embraced a startlingly simple tactic for fending off competition from generic brands: paying them off. In a nutshell, the company that holds the patent on a profitable drug strikes a deal with the maker of the cheaper generic brand: you hold off on marketing your generic for several years, and in return, we'll give you a share of our profits on the drug.
    That was made more or less explicit by Frank Balsino, the CEO of Cephalon, which makes the sleep-disorder drug Provigil. In a 2006 interview, Baldino trumpeted recent deals with four generic drug-makers that kept generic versions of Provigil off the market until 2012, declaring: "We were able to get six more years of patent protection. That's $4 billion in sales that no one expected."

    But pay-for-delay doesn't work out nearly so well for consumers. Generics are sometimes priced as much as 80 or 90 percent cheaper than the name brands. For instance, the cholesterol drug Zocor costs $164 a month, while a generic version costs just $12 a month. Pay-for-delay deals will cost consumers an extra $35 billion over the next decade, by keeping those cheaper generics off the market, according to a recent Federal Trade Commission study. And it's the uninsured, who pay out-of-pocket for drugs, that disproportionately pay those costs. TPM  

    Wow (none / 0) (#14)
    by lilburro on Thu Dec 03, 2009 at 12:41:26 PM EST
    and to think leaving these things in Pharma and the Insurance Biz's hands is now called a "social policy program."

    Not sure why you say that (none / 0) (#15)
    by gyrfalcon on Thu Dec 03, 2009 at 01:16:03 PM EST
    Seems to me in a mature market, which is what Medicare supplemental insurance very much is, the result you see is generally what happens when the products within it are pretty much the same and easily comparable by the consumer-- a relatively flat playing field.  The market weeds out the ones who overcharge, and the ones that underbid below what's sustainable for a business either drop out or raise their prices.

    The cost of Medicare supplemental policies is really quite modest and seems to me rather to demonstrate the idea that the market can work to keep prices lower in the right circumstances.

    Disclaimer: I'm NOT a fan of the idea that market principles will solve any and all problems, particularly in health insurance.

    But it does seem to me that under Medicare-type situations-- ie, where the products on offer have to meet some kind of minimum government standards, making them easily comparable point-by-point, and the comparison tables are easily accessed, it does help.  As I understand it, that's the basic principle behind the much-maligned "exchange," and as far as i can tell it's a reasonable one that will help to at least some extent if Obama/Congress aren't serious about actually reforming health care or even health insurance.


    Exactly how modest are premiums (none / 0) (#16)
    by MO Blue on Thu Dec 03, 2009 at 04:00:57 PM EST
    for Medicare supplemental insurance considering that they only pay 20% of allowable expenses.

    Congress considers a premium of $8,501 Cadillac coverage (also covers prescription drugs, vision). 20% of that would be $1,700 annually.

    My combined premium for Medicare prescription drug (also Federally subsidized) and supplemental coverage exceeds that amount. If I took the rate for 20% coverage and calculated it so that it was 100% coverage my annual premium for only private insurance would be around $11,900 per year.    


    Stlil pretty modest, IMHO (none / 0) (#17)
    by gyrfalcon on Thu Dec 03, 2009 at 04:22:19 PM EST
    considering that Medicare patients are by far the most expensive demographic in terms of health care dollars.

    Also, Part D is still quite new and at this point vastly more complicated to navigate in choosing a policy, since each one has a different formulary, so it really doesn't fit in the circumstances of mature market + standardized and easily comparable product I was talking about.  Choosing a part D policy still an incomprensible maze for most seniors, which is of course much to the benefit of the insurers, and will remain so until and unless the government forces standards on it.

    I agree with your basic point in your first post, btw.  I just think Medicare supplementals are the one place in the whole f***ed-up system that actually sort of works, and only because it's been heavily circumscribed by the gummint.

    Personally, I think the whole idea of making a profit out of health care is obscene to the point of outright nausea.  But then I'm a lifelong DFH.


    question for BTD (none / 0) (#1)
    by DFLer on Thu Dec 03, 2009 at 09:28:05 AM EST
    You've referred to Bowers getting paid a couple of times in the last few days, as in "paid political operative" etc., as if this is a new thang.

    I'm just wondering, getting paid by whom?


    Joe Sestak (none / 0) (#2)
    by Big Tent Democrat on Thu Dec 03, 2009 at 09:29:23 AM EST
    Who I suspect will now break his promise to not vote for a bill without a public option.

    Correction (5.00 / 1) (#3)
    by Big Tent Democrat on Thu Dec 03, 2009 at 09:37:23 AM EST
    Bowers' relationship with Sestak ended on October 9.

    How much does a guy like Bowers make from his blog (none / 0) (#4)
    by DFLer on Thu Dec 03, 2009 at 09:48:51 AM EST
    I do not know (none / 0) (#5)
    by Big Tent Democrat on Thu Dec 03, 2009 at 09:52:34 AM EST
    I take it you disagree with the idea that his actions might be impacted by his relationship with Sestak and the fact that Specter might vote against a bill without a public option.

    I can accept that. Probably a cheap shot on my part.

    I'll take it out of the post.  


    I do not necessarily disagree that (none / 0) (#8)
    by DFLer on Thu Dec 03, 2009 at 10:44:02 AM EST
    his actions might be impacted by his relationship with Sesta

    at all. Just trying to follow the money, as I was unaware of the previous consulting job. Thanks for clearing it up in your post.

    I also appreciate your new post re the responsibilities of activism vs punditry.

    See you in the peanut gallery.


    Ezra (none / 0) (#11)
    by lilburro on Thu Dec 03, 2009 at 11:59:33 AM EST
    answered my question:

    Wilmington, N.C.: Hi Ezra. In reference to Chris Bowers' support for the current bill, you refer to the way historically social programs (Medicare, Medicaid, Social Security) expand. But with the exception of the public option, what significant "social policy program" is in the health bill? I don't consider an insurance exchange to be a "social policy program" for example. Thanks!

    Ezra Klein: The individual mandate, paired with the subsidies and the insurance regulations and the exchange, are a major new social policy program. It is a basic structure for universal health care, which we have never had in this country. And as more people move to the exchanges over time, and the mandate and subsidies are strengthened to go the final few miles to universal health care, it will become more so.

    In other words, magic pixie dust (none / 0) (#12)
    by andgarden on Thu Dec 03, 2009 at 12:01:37 PM EST
    well we all recall (none / 0) (#13)
    by lilburro on Thu Dec 03, 2009 at 12:03:26 PM EST
    the humble origins of Medicare, that mandated insurance purchasing free market exchange for seniors.  rolls eyes