What Will "Health Care Reform" Actually Look Like?

My series on political bargaining was intended to point out that what "health care reform" will eventually look like is effected by how you bargain for it now. Consider Ezra Klein's most recent post:

I keep recommending this Families USA brief (pdf, but worth it!) outlining the 10 most important elements of health-care reform. The public option is one of them, to be sure, and I think there's a substantial chance it will be present in the final legislation. But what about the expansion of Medicaid to 133 percent of the poverty line? That's a solid 20 million poor Americans who don't have coverage now, and will soon. What about the out-of-pocket caps, so no one goes medically bankrupt ever again? Or the assurance that no insurer can ever discriminate based on a preexisting condition? Or the subsidies for working Americans who can't quite afford coverage? Or the requirements that insurers spend more money on medical care and less money on premiums? Or the guarantee that the gruesome practice of rescission will finally end?

Even accepting Ezra's premise (and I do not), how does Ezra know all of this will be in a final bill? If today the public option can be jettisoned, what can go tomorrow? Max Baucus does not even have a bill on the table. Ezra suggests progressives bargain against themselves. Here's the ultimate question for Ezra, how does he expect all those good things to stay in the bill if progressives follow his advice and bargain against themselves?

Speaking for me only

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    What will it look like (5.00 / 5) (#2)
    by Dadler on Mon Aug 24, 2009 at 03:20:51 PM EST
    It will have oozing boils, wiry hair on its nose, a grotesque overbite, and a peg-leg (sorry, you don't qualify for a prosthesis).

    Seriously, I'm more than a tad skeptical right now that ANYthing of value is going to come of any bill passed by our current band of DC poli-hookers.  It feels like its too late.  Yes, Obama could do this or that, orate, go to the mat, sure he could, but that is seeming more and more like the wish for another person to step out of his body.  

    Poli-ho's... (none / 0) (#4)
    by kdog on Mon Aug 24, 2009 at 03:27:10 PM EST
    I'm stealing that one my friend:)

    It will look like the cats who will write it and pass it and not have to live under it...diseased with a crooked spine.


    IMO (5.00 / 5) (#5)
    by lilburro on Mon Aug 24, 2009 at 03:28:11 PM EST
    if there is no public option then the mandates are going to be a colossal failure.  I am of that school of thought.

    BUT the issue here is that Ezra is writing from some time in the future.  What bill is Ezra talking about?  There is no bill yet.  And how can this even be true?

    It's better than anything the major Democrats proposed in the primary, much less anything that passed four committees in Congress.

    A bill without a public option is not "better than anything the major Democrats proposed."  It's notably worse.

    Unfortunately, the only items that seem to be (5.00 / 1) (#7)
    by my opinion on Mon Aug 24, 2009 at 03:41:44 PM EST
    set in stone are:
    1) You will be required to pay the insurance companies what ever they want for a policy. No guarantees of what that policy covers or how much it covers.
    2)The required payments will be enforced by the IRS. So, basically the insurance companies will be allowed to tax you.
    3)The tax break you get now for policy costs out of your paycheck will disappear.

    Yes (none / 0) (#15)
    by TeresaInSnow2 on Mon Aug 24, 2009 at 06:01:14 PM EST
    This bill implements a privatized, limitless, regressive, unregulated tax.

    And Democrats are responsible.  



    And that (none / 0) (#22)
    by cal1942 on Tue Aug 25, 2009 at 01:40:18 AM EST
    will kill the party.

    Not only does Ezra need to ask himself (5.00 / 9) (#9)
    by Anne on Mon Aug 24, 2009 at 03:53:22 PM EST
    how he can be sure all these "good things" will ever be in a bill, he has to do more than just accept that these are good things.

    Expansion of Medicaid?  Unless there is a federal subsidy, Medicaid is an unfunded mandate that is the responsibility of the states.  It's great to expand the program to cover more people, but where are the states getting the money?

    Out-of-pocket caps?  Whether or not one goes bankrupt depends a good deal on whose pockets are being measured for the cap.  While one person may be able to manage with a cap as low as $5,000, for someone else, that is financial disaster.

    No discrimination for pre-existing conditions?  Sounds great, but no one's talking about whether the insurance companies will be able to charge higher premiums for pre-existing conditions; if they can, for some people, it will still be unaffordable.

    Subsidies?  Wonderful.  But why would we need them if everyone is going to be covered?  Why shouldn't premiums be able to come way down?  what's really happening is not that the insurance companies are lowering premiums, but that the government has made a  commitment to make sure the insurance companies get every dollar they want to charge.

    Spending more money on care and less on premiums?  Ending the practice of rescission?  Why not sell us the Brooklyn Bridge while they're at it?  Who is going to make sure that more money - how much more, by the way? - gets spent on care?  

    The issue, dear young Ezra, is not insurance, it's CARE.  C-A-R-E.  A little four-letter word that has gotten set aside while we discuss how the insurance companies can benefit from reform, but packaging it in a way that nakes it look like they are making the supreme sacrifice.  

    We have more than enough apologists for the insurance industry; if Ezra really wanted to make a difference, he would put the focus where it belongs: on health CARE.  

    I won't hold my breath.

    If I had listened to Ezra I would be shocked (5.00 / 4) (#10)
    by Militarytracy on Mon Aug 24, 2009 at 04:12:47 PM EST
    right now the public option was still even a possibility.  Before, per Ezra, is was too much for any pundit to hope for....thank God the common man just isn't in the mood to die for pundit opinions these days.  That whole notion is very 2001.

    absent a public option, (5.00 / 1) (#11)
    by cpinva on Mon Aug 24, 2009 at 04:29:42 PM EST
    and there is no "reform", merely a reshuffling of the (already stacked) deck. unless a sword (metaphoric, of course :)) is put to the insurance company's throats, they have zero incentive to change anything they're now doing.

    the public option is the key, and that's why it's being lobbied so hard against.

    I have a question (5.00 / 1) (#12)
    by samsguy18 on Mon Aug 24, 2009 at 04:55:12 PM EST
    What happens to the hospitals now serving the uninsured.......like Cook County Hospital here in Illinois? What is their plan....close them down.

    What do you mean? (none / 0) (#13)
    by Militarytracy on Mon Aug 24, 2009 at 05:28:03 PM EST
    I'm not understanding your question.

    hospitals are state run/ federally funded (none / 0) (#16)
    by samsguy18 on Mon Aug 24, 2009 at 06:02:19 PM EST
    These public service hospitals are supported by tax dollars.The dollars that are set aside for these hospitals and physicians presumably would be used to provide coverage to the uninsured.One would assume these patients should be able to go to any private hospital. They should have a choice. Under the new plan there shouldn't be
    a need for them.

    I'm not sure why you presume (none / 0) (#18)
    by Militarytracy on Mon Aug 24, 2009 at 06:10:51 PM EST
    that the money used to provide coverage to the uninsured would be immediately cannabalized.  I worked in a hospital business office when my daughter was an infant.  Not my fave job.  It was a county hospital but it was also a for profit hospital.  They took the uninsured in order to qualify for the fed money, but they took the insured as well and made money on them.  So I don't understand how such hospitals would be "shut down" or how the funds would instantly be cannabalized.  If there is one place where everybody lives in reality though it is on the floors of a hospital and those hospitals will advocate for themselves if and when needing to at every turn.  If you are weak of nerve you don't work in administering any sort of healthcare for very long.

    The Cook County Hospital system (none / 0) (#20)
    by samsguy18 on Mon Aug 24, 2009 at 06:41:23 PM EST
    Is totally funded with tax dollars...The hospitals in the system are not for profit.I know it's hard to believe.You don't hear much about them. There are a number of similar hospital systems across the country. The patients we get are the unemployed...single parents.. the working poor.... new legal and illegal immigrants etc. All of them on Medicaid or uninsured. The patients can also receive free medication as needed.

    Wonderful hospitals (none / 0) (#25)
    by Militarytracy on Tue Aug 25, 2009 at 07:25:56 AM EST
    I had not heard about them.  If such hospitals existed in this area I would fight for them.  It seems to me that they could easily swing into public option hospitals.  Are we ever going to have everyone 100% insured though.  No, it isn't possible.  Since Ronald Reagan threw all of our poor and mentally ill into the streets we will always have people out there who are unable to fill out paperwork.  As my spouse says, there will always be uninsured because nothing is 100%.

    "County Hospital"... (none / 0) (#14)
    by kdog on Mon Aug 24, 2009 at 05:36:41 PM EST
    keep that down sams...the spolied socialist anti-socialists obviously haven't noticed, and if they do they'll start picketing the entrance to the ER.

    LOL (none / 0) (#17)
    by samsguy18 on Mon Aug 24, 2009 at 06:03:33 PM EST
    Well (none / 0) (#1)
    by Ga6thDem on Mon Aug 24, 2009 at 03:03:46 PM EST
    I would imagine the next thing would be the expansion of medicaid.

    Subsidies (none / 0) (#6)
    by waldenpond on Mon Aug 24, 2009 at 03:39:54 PM EST
    and tax credits aren't going over too well....

    New Splits

    If insures can't deny coverage, what's the buy in? Most won't be able to purchase coverage at $2000-3000 per month.  Caps?  what's the level?  Is it meaningful or a gesture.  Details please.

    Well, (5.00 / 8) (#8)
    by andgarden on Mon Aug 24, 2009 at 03:47:38 PM EST
    this is where the rubber meets the road, and it's exactly why there needs to be a public option available to everyone.

    Everyone (none / 0) (#24)
    by cal1942 on Tue Aug 25, 2009 at 01:58:07 AM EST
    including employers in lieu of private insurance.

    Balls (none / 0) (#19)
    by Zorba on Mon Aug 24, 2009 at 06:15:52 PM EST
    That's what is missing here.  Lyndon Baines Johnson had a lot of flaws, but he knew how to get things done- arm-twisting, bribery, cajoling, manipulation, threatening, just plain jawing, and whatever else it took.  He got Medicare/Medicaid passed with these methods.  Obama needs to take a page from the LBJ method of politics.

    Yeah (5.00 / 1) (#23)
    by cal1942 on Tue Aug 25, 2009 at 01:52:58 AM EST
    but the whole idea about Obama, what his supporters swooned about, was that he wouldn't be an LBJ type, a warrior not afraid to savage the other side and not bothered about beating his own party into line.  They wanted someone who would go into a gun fight unarmed.

    President Obama invited honest discussion, so ... (none / 0) (#21)
    by Sumner on Mon Aug 24, 2009 at 08:21:22 PM EST
    Of course we won't have "Death Panels". That is too literal language. Just as our War Department ("Department of Defense", euphemistacally), couches death and killing and torture and maiming in innocuous euphemisms, (e.g., "collateral damage" for the killing of innocents), so too will be government's mandatory "health care".

    Think government Katrina-style health care. Or consider how we know that drug abuse is a medical problem, yet look how government treats that illness. Look how government used top DoJ go-to lawyers to craft impimaturs to "legitimize" torture and co-opted psychologists to concoct torture regimens upon its captives.

    As if government doesn't already try to micro-manage people's lives right down to minutiae, once mandatory government "health care" is in place, the mass surveillance system will really kick in and ostensibly monitor for living habits, because "poor behavioral choices" will now have a direct cost upon society.

    Consider the Georgia Guidestones. Of course they want eugenics. Eugenics is often subtle, even present age-of-consent laws past puberty are a form of eugenics. Medicine will be used for political ends and political control, whether prohibited by law, or not. Complete sexual histories will be compiled within medical histories and those will be used for shaming. Just look how J. Edgar Hoover targeted Dr. Martin Luther King, Jr, with FBI sexual spying information, in order to try and blackmail him into quitting the Civil Rights movement.

    Who will government choose as guinea pigs for patent medicines by Big Pharma? How bad will abuses get with Big Pharmas's free ride impunity, that their lobbyists are said to have already purchased from our can-do congress? How will that impact on such alternatives as homeopathics, diet and/or medical marijuana? With government's black hole debt, will the US join other countries in the wholesale and dubius manner in which those countries already obtain, harvest and sell human organs?

    What will such a mandatory health care system morph into once it is solidly locked into place and controlled by lobbyists?