The Most Progressive Legislation In 40 Years

One of the arguments forwarded during the health bill debate was that the provisions would get stronger over time, as a constituency for new services developed. I thought it a doubtful assertion at the time (consider that no new government program - yes, a public insurance program - was created) and I imagine folks who argued that assertion are thinking it is doubtful now too. From today's NYTimes:

For starters, Republicans say they will try to withhold money that federal officials need to administer and enforce the law. [. . .] “They’ll get not one dime from us,” the House Republican leader, John A. Boehner of Ohio, told The Cincinnati Enquirer recently. “Not a dime. There is no fixing this.”

[. . . ] Senator Orrin G. Hatch of Utah, a senior Republican on the Finance Committee, has introduced a bill that would eliminate a linchpin of the new law: a requirement for many employers to offer insurance to employees or pay a tax penalty.

[. . .] Republicans say they will also try to scale back the expansion of Medicaid if states continue to object to the costs of adding millions of people to the rolls of the program for low-income people.

What you will have left is an individual mandate and state based exchanges (with inadequate subsidies.) Would that still be "the biggest progressive accomplishment in 40 years?"

Speaking for me only

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    I raised this months ago (5.00 / 2) (#1)
    by andgarden on Tue Sep 21, 2010 at 10:46:19 AM EST
    Let's see what the hand-waivers have to say now.


    Heh (none / 0) (#21)
    by gyrfalcon on Tue Sep 21, 2010 at 03:30:09 PM EST
    Hand-waivers.  Heh.  <giggle>

    I giggled, too... (5.00 / 2) (#25)
    by Anne on Tue Sep 21, 2010 at 03:57:05 PM EST
    Goes to show just how committed andgarden is to his law career...



    GRRRRR (5.00 / 1) (#29)
    by andgarden on Tue Sep 21, 2010 at 07:56:04 PM EST
    And on top of what is being (5.00 / 4) (#3)
    by Anne on Tue Sep 21, 2010 at 11:02:58 AM EST
    threatened legislatively, we have the insurance companies working hard to circumvent the new law, as well:

    Some of the country's most prominent health insurance companies have decided to stop offering new child-only plans, rather than comply with rules in the new health-care law that will require such plans to start accepting children with preexisting medical conditions after Sept. 23.

    The companies will continue to cover children who already have child-only policies. They will also accept children with preexisting conditions in new family policies.

    Nonetheless, supporters of the new health-care law complain that the change amounts to an end run around one of the most prized consumer protections.

    "We're just days away from a new era when insurance companies must stop denying coverage to kids just because they are sick, and now some of the biggest changed their minds," Ethan Rome, executive director of Health Care for America Now, an advocacy group, said in a statement. "[It] is immoral, and to blame their appalling behavior on the new law is patently dishonest."

    As David Dayen points out,

    However, this is not the only area where we're seeing something like this. The ACA creates a law forcing a high medical loss ratio; insurance companies try to game it (consumer advocates appear to have won the first round, however). The ACA put into place early provisions like limiting annual and lifetime limits and allowing children to stay on their parents' policies until the age of 26; insurance companies use that as a pretext to jack up premiums, far beyond the cost of these measures. The ACA chopped the donut hole in half in the near term and eventually will eliminate them; pharmaceutical companies may respond by increasing drug prices to offset the cost of the discount.

    So in addition to having to fend off the slow chipping away of the law by the GOP, especially if they gain power over one or both houses of Congress, Democrats have to deal with the foxes they left in the henhouse, who are systematically working to preserve their own profits at the expense of consumers. This could have been mitigated by real competition in the marketplace through a public insurance option, or of course removed as a problem with a single-payer system. Neither of those options occurred, and we're left with a health care system still hampered by a giant profit-sucking machine at its center.

    It's not hard to feel had when the industry's response to accusations of non-compliance is a version of "yeah - so what?"

    The biggest mistake Dems made - over and above their not being willing to even discuss single-payer - was in building in so much delay in implementation; I would be surprised if there is even a shadow of the ACA still visible by 2014, but not shocked at all if, by then, the crisis in health care is even worse than it is today.

    I still marvel at how badly this was handled - all to preserve a dysfunctional system being run to make money for investors.  

    Progressive?  No.  A tragedy-in-the-making, and an embarrassment?  Oh, yeah.

    I think in some sense (5.00 / 1) (#5)
    by CST on Tue Sep 21, 2010 at 11:13:46 AM EST
    the phasing of this was a poor choice.

    If covering all pre-existing conditions was required from day one there would be no "loophole" for them to squeeze through re. kids with pre-existing conditions.

    As for raising premiums, I think we're starting to see in MA the fight really beginning between the regulators and the insurers.  So far, it's a mixed bag with wins and losses on both sides.  The most encouraging thing is just to see the fight happening - and the politicians continuing to take this seriously and look for answers and solutions.

    I think if there is any chance of this happening nationally, we need people in congress who are going to continue to fight this battle.  Unfortunately I don't see that happening as much on a federal level.  Certainly not if the republicans win - they will be fighting to eliminate it.


    An alternative theory (none / 0) (#10)
    by vicndabx on Tue Sep 21, 2010 at 11:31:38 AM EST
    .....extending such coverage in child-only policies "provides a very powerful incentive for a parent to wait until their child becomes very sick before purchasing coverage."

    Zirkelbach added that in 2014, when similar protections kick in for all individuals with preexisting conditions, virtually all Americans will be required to get health insurance.

    With no such mandate currently in place, however, the result over the next several years could be that the pool of children insured by child-only plans would rapidly skew toward those with expensive medical bills, either bankrupting the plans or forcing insurers to make up their losses by substantially increasing premiums for all customers. And Zirkelbach said the effect could be compounded if only a few plans remain in the market.

    Key point: plans are not "gaming" the system.  There needs to be money for covering services rendered.


    Gold Rush (5.00 / 3) (#4)
    by Stellaaa on Tue Sep 21, 2010 at 11:13:36 AM EST
    Then you have the speculating types gearing up for a gold rush.  Meanwhile nothing for the little people till 2014, only Bernie the Socialist got something for the Community Health Clinics that is available now.  

    My boy Bernie (5.00 / 1) (#22)
    by gyrfalcon on Tue Sep 21, 2010 at 03:32:34 PM EST
    <very nice to see your name again here>

    Other things that might remain (5.00 / 3) (#6)
    by MO Blue on Tue Sep 21, 2010 at 11:19:22 AM EST
    Cuts to the Medicare budget

    Medical expense percent of income tax exemption rate 10% vs 7.5%

    Excise tax on good employer provided health insurance.

    Note the equivocation (5.00 / 5) (#8)
    by lambert on Tue Sep 21, 2010 at 11:29:36 AM EST
    Just like a program can be "historic" without actually making any real difference, "the biggest progressive accomplishment in 40 years" might not add up to much of an achievement.

    By contrast, the "everybody in, nobody out" model of single payer would have yielded concrete material benefits to millions, and with The Greatest Orator Of Our Generation defending it....

    Oh well. It was much more important for the Ds to bail out the insurance companies than to save 45,000 lives a year. And people wonder why there's an enthusiasm gap....

    Furthermore, you also have insurance (5.00 / 3) (#17)
    by Buckeye on Tue Sep 21, 2010 at 12:47:01 PM EST
    companies jacking up rates in states like Connecticut and Colorado, blaming the increases on Obamacare, even though the rate increases are waaaaay above the incremental costs.  Since the anti-trust exemption was lifted, nor was a public option added, consumers have no choice but to absorb the increases or drop their health plan.  And this is happening right in the teeth of the worst recession/job market in over 70 years.

    "Progressive Legislation"... (5.00 / 1) (#24)
    by kdog on Tue Sep 21, 2010 at 03:41:47 PM EST
    we can probably call term that an oxymoron at this point.  If it comes from Congress and is signed by the President, it must be regressive.

    Just look at the DREAM act...progress can only be gotten on the shady side, maybe...as an add-on to a defense spending bill.  Pathetic.

    Yeah (5.00 / 2) (#26)
    by Ga6thDem on Tue Sep 21, 2010 at 03:58:59 PM EST
    anyone had to be watching knew this was coming. There was no way the GOP would give up the mandates.

    Bah. Switzerland proves you're wrong. (2.00 / 1) (#9)
    by Dan the Man on Tue Sep 21, 2010 at 11:30:30 AM EST
    Heck, in Switzerland they' don't even have medicare.  The elderly are in the exchange too.  If we're really lucky, the elderly will get the same wonderful option here in the US also.

    The Swiss highly regulate their health system (5.00 / 6) (#11)
    by MO Blue on Tue Sep 21, 2010 at 12:02:44 PM EST
    We do not and we will not.

    I feel extremely lucky that as a person over 65 I have the wonderful option of participating in Medicare. It is a shame that younger people here aren't as lucky.

    BTW a few things you failed about the Swiss system:

    Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.
    The Swiss government does not "ration care" -- that populist bogeyman in the American debate -- but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs -- at a higher level than in the United States -- so they have an incentive to avoid unnecessary treatments.
    In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it.

    I saw that, too, and decided it would (5.00 / 1) (#14)
    by Anne on Tue Sep 21, 2010 at 12:15:09 PM EST
    be just "details, details" in the eyes of those who don't want to be bothered getting beyond the headlines.

    The Congress isn't willing to really regulate the insurance industry, and unless and until it is, this horrible "game" will go on - and we will be the ones who suffer.

    Can hardly wait for the year-end profit reports...


    Part not true (none / 0) (#16)
    by TeresaInSnow2 on Tue Sep 21, 2010 at 12:38:58 PM EST
    Switzerland does ration care in some areas.  For instance, national mammography screening is offered every two years to women over 50.  When even such a guideline was proposed here in the US, it was met with such huge protest about care rationing that the govt almost denied proposing it....

    I suspect there are more examples; this is just the one I can easily recall.


    Even in U.S. we have guidelines on what care can (5.00 / 5) (#19)
    by MO Blue on Tue Sep 21, 2010 at 01:01:29 PM EST
    be given and how often tests can occur. In the case of mammography screening, IIRC our guidelines are more generous than most European countries for women who have insurance or are able to access some of the free services made available by various cancer organizations. OTOH we currently ration care by financial ability to pay for tests or treatment.

    The Swiss, per the article, use another method to insure doctors do not order unlimited tests or drugs.

    Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.

    If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.
    ...the Swiss health insurers are not shy about using their muscle with physicians.

    Pius Gyger, director of health economics and health policy at Helsana, the country's biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.

    "If there's something strange, we knock at the doctor's door," he said. "For doctors, it's an incentive to treat economically, but often perceived as a threat."

    He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, "it's an easy exercise for us and it has an effect."  

    Since "the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system", the above mentioned practices may not have a major impact on the quality of care that people receive.


    another reason (none / 0) (#2)
    by CST on Tue Sep 21, 2010 at 11:01:26 AM EST
    to keep the Rethugs from controlling Congress.  If we can.

    That second proposal (and maybe third?) seems veto-able.

    It's the first one that's the real concern.

    All of this will be an issue if we lose the presidency.  The only way any of it will stick is if we hold the house, senate, and pres long enough for this to become the "status quo" and people will see the benefits, get use to it, and fight losing it.  That's one of the major issues with the start date for a lot of this being 2014.

    Well, sadly, (none / 0) (#7)
    by vicndabx on Tue Sep 21, 2010 at 11:22:03 AM EST
    I doubt many of us Americans were prepared to make the hard sacrifices necessary to truly do anything else.

    Further, with the economy in recession, setting the country up for job losses in the future would not be a good thing.

    Will the republicans repeal any of this?  I doubt it.  The pre-existing condition stuff alone is a huge positive for many.  

    So it was never (5.00 / 5) (#12)
    by Big Tent Democrat on Tue Sep 21, 2010 at 12:03:40 PM EST
    "the greatest progressive accomplishment in 40 years?"

    Oh please (none / 0) (#13)
    by cawaltz on Tue Sep 21, 2010 at 12:12:23 PM EST
    Tell me the Republicans and Democrats will keep MY favorite part of the health care deal.

    I look forward to the day when my daughter gets to convene a committee to determine whether or not she should risk her life to bring new life into the world. It's always great when people who have 15 minutes  of responsibility once a month for 10 months get the same weigh in on signing on to an 18+ year obligation that has tremendous physical, emotional, and financial repercussions as the person taking on the actual 18+ obligation.

    Oh nevermind, I forgot Democratic House member Lipinski and his good friend from across the aisle have that covered and are presently working on making it law.


    I have recently seen headlines re (none / 0) (#15)
    by oculus on Tue Sep 21, 2010 at 12:30:32 PM EST
    improved access to hospice care and home visits to Medicare enrollees in rural areas.  Attributed to new HCR.  

    Haven't heard of that in (5.00 / 1) (#23)
    by gyrfalcon on Tue Sep 21, 2010 at 03:36:23 PM EST
    this rural area, FWIW.  If you see another headline, please post a link?  I'm old enough to be personally curious about this.

    Here is the LAT article re (none / 0) (#27)
    by oculus on Tue Sep 21, 2010 at 05:45:13 PM EST
    hospice care:  link

    And here is LAT article re home visits (none / 0) (#28)
    by oculus on Tue Sep 21, 2010 at 05:47:54 PM EST
    to Medicare patients:  link

    Thanks! (none / 0) (#32)
    by gyrfalcon on Tue Sep 21, 2010 at 10:52:26 PM EST
    This would have been fantastic (none / 0) (#33)
    by gyrfalcon on Tue Sep 21, 2010 at 11:01:19 PM EST
    for my mother in the last years of her life.  She was incredibly resistant about going to the doctor anyway, and then with her increasingly immobility, it was a major struggle to get her there when she would go.  (And of course, good old Medicare only pays for a wheelchair if you need it inside the house, not if you only need one to go out to get to your doctor!)

    She fit all the criteria the article mentions.

    If it said anything about rural areas in particular, though, I missed it.

    I'm old enough that when I was a teenager, the family doctor still routinely made house calls when you were really down with something, not to mention you got to check into the hospital the night before if you had to have surgery.  Sigh.


    And yet (none / 0) (#18)
    by jbindc on Tue Sep 21, 2010 at 12:52:07 PM EST
    There is an article in today's WaPo (sorry, no link) that talks about how some pharmaceutical companies may raise their prices to offset the new Medicare "doughnut hole" discount.  No company has yet made plans to so available just yet, but patient advocates are watching carefully.

    Did I miss something? (5.00 / 1) (#30)
    by NYShooter on Tue Sep 21, 2010 at 08:48:34 PM EST
    I don't know if the increases I wrote about here a few weeks ago were due to the "donut hole" issue, or just sticking it to us because they can.

    Specifically, and I'm talking "cash" prices, no insurance:

    A. One medication, taken twice a day, that will be required as long as I live went from $600/mo. to $1200/mo, snap! Just like that.

    B, another med, similar to the first, went from $350/mo to $650/mo.

    As I said, these are "cash" prices, and I'm blessed that, so far at least, I've been able to make my premium and co-pay payments to a pretty good Ins. Co.("pretty good" in that, at these prices they don't hastle me too much as I've heard other companies do)

    In questioning my pharmacist, a close personal friend, about this breathtaking gouging, he said the worst part is the pharma cos seem to have targeted meds that serve chronic diseases & illnesses. In other words, long  term med requirements.

    Big Pharma, as Big banks, have broken free from their tether of greed, and are now enjoying the thrill of full blown, orgiastic, sociopathic avarice.

    Rotten to the core.


    Great deal Obama negotiated for (5.00 / 1) (#31)
    by MO Blue on Tue Sep 21, 2010 at 08:52:21 PM EST
    us on prescription drugs. Aren't you impressed? :-(

    yup, (none / 0) (#35)
    by NYShooter on Wed Sep 22, 2010 at 12:07:56 AM EST
    it's like they're saying to me with another of Obama's favorite slogans..."So wadda you gonna do?"

    You've checked into generics or (none / 0) (#34)
    by gyrfalcon on Tue Sep 21, 2010 at 11:04:20 PM EST
    older versions of similar drugs?  I only ask because docs presribed an incredibly expensive brand-new drug for my mother in her last years that I only figured out after she'd passed away most likely wasn't really necessary and any of several older OTC versions would at least have been worth trying out.

    yeah, thanks, but (5.00 / 1) (#36)
    by NYShooter on Wed Sep 22, 2010 at 12:11:21 AM EST
    Brand filed suit vs Generic....and won.

    Ahh, the genius of the marketplace at work.

    The "invisible hand" (sliding a stuffed envelope across the desk)


    The problem is (none / 0) (#37)
    by jbindc on Wed Sep 22, 2010 at 10:16:49 AM EST
    Some people can't take generics. I take a prescription - it's $125 for a 3 month supply.  I tried the generic version ($40 for a 3 month supply).  Generic version gave me a dry hacking cough, so in effect, I am punished because I have to take the brand name.  (I'm not on Medicare).