Saturday, January 2
Monday, December 21
Response to 10 reasons to kill the Senate bill
Jane Hamsher wrote a list of 10 reasons to kill the Senate bill.
Ezra Klein responded. He didn't go far enough. Here is my response.
1. Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.You want to buy health insurance.
The fact that the price is now capped at 8% is a benefit. If *you* don't have health insurance, you're the working poor and you'll be given nearly free health insurance, or you're an idiot.
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
Show me the people today who can afford insurance and aren't buying it.
3. Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.
I'm a little worried about how this will shake out too. The minimum plans better be pretty good.
4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
Abortions are, frankly, cheap. $1000 or so. Women will still be able to choose them. I still consider this bad policy and extraordinary hypocracy (hey! let's have really poor people who can't afford the $1M to raise a kid be forced to give birth!), but to say it's tantamount to repealing Roe v Wade is fear mongering.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
These are the only tax increases:
"To pay for expanded coverage, the House bill imposes a 5.4 percent income tax surcharge on individuals making more than $500,000 and families earning more than $1 million. The Senate slaps a 40 percent tax on insurance plans with premiums above $8,500 for individual coverage, and $23,000 for family plans, among other levies."
That's not the middle class. The $8,500 for individual coverage isn't middle class. And the tax *starts taxing the benefits above $8,500*.
6. Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.
I'm severely disappointed in the 4 year lag. *4 years*? What? That's enough time for another president and congress to go in and repeal the whole thing. WTF. I will continue my boycott on health care providers until the act comes into force.
7. Allows insurance companies to charge people who are older 300% more than others.
Today, the common ratio is well over 5x. Decreasing the ratio to 3x is a reasonable, cautious first step. If the number was %200 you'd be screaming that was too high. Blowhard.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
That's just a bald faced lie. The 20 years can be extended 12 years in certain circumstances. Given that the 20 years is more like 10 because the government starts the clock when you start the drug trial, and takes 10 years to approve the drug, this rather makes sense. There should be some kind of "sliding scale" for drug patents. Otherwise, small-category drugs just don't get made (today's policy), and the industry does "evergreening" to extend the patents. I'd rather give more patent overhead to the drug companies, but we should be getting more back, because they'll just take, and take, and take.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
Re-importation was a bad idea to begin with. The only reason the Canadians pay less is because the government regulations there work better. Saying we'd buy their drugs would simply mean the drug companies would up the prices in Canada, or even stop selling drugs there. We need our system to work as well as the Canadian one, not have people in the North with affordable drugs.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.
Health care *DID* rise $10,000 per family in the last decade, under the current system. It erased the entire earnings growth of Americans during that period. Due entirely to this factor, Bush's presidency was literally the 2nd worst for American earning power in the history of the union. Since Washington.
If cost is the boogeyman, please describe a set of changes that *will* pass the senate and decrease costs, since any government plan is Socialism and Fascism. Or Rationing.
There is plenty of containment in this bill. Remember, there are requirements for insurance to pay more, and limits to how much they can charge. That will change how medicine is practiced. I know this seems paradoxical, but it's true. Today, doctors assume insurance will always pay. But they wiggle out, and the consumer gets stuck with the bill, or the hospital jacks up prices for the uninsured. If insurers really are footing everything, and can't wriggle out, there will be pressure.
Imagine this. 500,000 American families go bankrupt because of medical issues every year. Let's say the average bill per family is $100,000. That's $50B that insurers will now have to pay. Do you honestly think they'll just *take* that?
Now, a few reasons to pass the bill:
1. It might eliminate medical bankruptcy.
2. America's largest employer, Walmart, would be forced to offer health insurance.
3. I am treated the same as an illegal immigrant.
Changes I wanted that didn't make it in:
1. Insurers shouldn't be able to include "no american court jurisdiction over this contract" into health care contracts. An American contract should be settled by American law in American courts. It's just wrong to have a different kind of justice for health insurers.
2. The dispute resolution proceedure must be laid out in excruciating detail. Insurance companies today lie and cheat and break the law without compunction, because dispute resolution is not governed by American law and the state agencies don't work.
3. No discounts for insurers from doctors or hospitals or drug companies. The doctor must charge one price, otherwise is discriminatory pricing. Otherwise the buying power of the people is fragmented. Imagine a store where nothing has price tags, and they demand to see your tax return before checking a price. That's our health care system now.
4. Doctors and drug companies and hospitals must publish their prices according to the medicare code listings. As flawed as the medicare code system is, let's just standardize on that (or pick another one, whatever) and force everyone to use it. We'll save a lot of money right there, and allow price comparison.
Ezra Klein responded. He didn't go far enough. Here is my response.
1. Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.You want to buy health insurance.
The fact that the price is now capped at 8% is a benefit. If *you* don't have health insurance, you're the working poor and you'll be given nearly free health insurance, or you're an idiot.
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
Show me the people today who can afford insurance and aren't buying it.
3. Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.
I'm a little worried about how this will shake out too. The minimum plans better be pretty good.
4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
Abortions are, frankly, cheap. $1000 or so. Women will still be able to choose them. I still consider this bad policy and extraordinary hypocracy (hey! let's have really poor people who can't afford the $1M to raise a kid be forced to give birth!), but to say it's tantamount to repealing Roe v Wade is fear mongering.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
These are the only tax increases:
"To pay for expanded coverage, the House bill imposes a 5.4 percent income tax surcharge on individuals making more than $500,000 and families earning more than $1 million. The Senate slaps a 40 percent tax on insurance plans with premiums above $8,500 for individual coverage, and $23,000 for family plans, among other levies."
That's not the middle class. The $8,500 for individual coverage isn't middle class. And the tax *starts taxing the benefits above $8,500*.
I'm severely disappointed in the 4 year lag. *4 years*? What? That's enough time for another president and congress to go in and repeal the whole thing. WTF. I will continue my boycott on health care providers until the act comes into force.
7. Allows insurance companies to charge people who are older 300% more than others.
Today, the common ratio is well over 5x. Decreasing the ratio to 3x is a reasonable, cautious first step. If the number was %200 you'd be screaming that was too high. Blowhard.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
That's just a bald faced lie. The 20 years can be extended 12 years in certain circumstances. Given that the 20 years is more like 10 because the government starts the clock when you start the drug trial, and takes 10 years to approve the drug, this rather makes sense. There should be some kind of "sliding scale" for drug patents. Otherwise, small-category drugs just don't get made (today's policy), and the industry does "evergreening" to extend the patents. I'd rather give more patent overhead to the drug companies, but we should be getting more back, because they'll just take, and take, and take.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
Re-importation was a bad idea to begin with. The only reason the Canadians pay less is because the government regulations there work better. Saying we'd buy their drugs would simply mean the drug companies would up the prices in Canada, or even stop selling drugs there. We need our system to work as well as the Canadian one, not have people in the North with affordable drugs.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.
Health care *DID* rise $10,000 per family in the last decade, under the current system. It erased the entire earnings growth of Americans during that period. Due entirely to this factor, Bush's presidency was literally the 2nd worst for American earning power in the history of the union. Since Washington.
If cost is the boogeyman, please describe a set of changes that *will* pass the senate and decrease costs, since any government plan is Socialism and Fascism. Or Rationing.
There is plenty of containment in this bill. Remember, there are requirements for insurance to pay more, and limits to how much they can charge. That will change how medicine is practiced. I know this seems paradoxical, but it's true. Today, doctors assume insurance will always pay. But they wiggle out, and the consumer gets stuck with the bill, or the hospital jacks up prices for the uninsured. If insurers really are footing everything, and can't wriggle out, there will be pressure.
Imagine this. 500,000 American families go bankrupt because of medical issues every year. Let's say the average bill per family is $100,000. That's $50B that insurers will now have to pay. Do you honestly think they'll just *take* that?
Now, a few reasons to pass the bill:
1. It might eliminate medical bankruptcy.
2. America's largest employer, Walmart, would be forced to offer health insurance.
3. I am treated the same as an illegal immigrant.
Changes I wanted that didn't make it in:
1. Insurers shouldn't be able to include "no american court jurisdiction over this contract" into health care contracts. An American contract should be settled by American law in American courts. It's just wrong to have a different kind of justice for health insurers.
2. The dispute resolution proceedure must be laid out in excruciating detail. Insurance companies today lie and cheat and break the law without compunction, because dispute resolution is not governed by American law and the state agencies don't work.
3. No discounts for insurers from doctors or hospitals or drug companies. The doctor must charge one price, otherwise is discriminatory pricing. Otherwise the buying power of the people is fragmented. Imagine a store where nothing has price tags, and they demand to see your tax return before checking a price. That's our health care system now.
4. Doctors and drug companies and hospitals must publish their prices according to the medicare code listings. As flawed as the medicare code system is, let's just standardize on that (or pick another one, whatever) and force everyone to use it. We'll save a lot of money right there, and allow price comparison.
Monday, December 14
As california goes, so goes the nation
The twists and turns of health care debate have me thinking about California's legislature.
We can't pass a budget. We can't make a good choice about water. Our term limits throw power to lobbyists, we had third-world power outages. We can't manage to fund and improve our universities, or educate our kids (hello, Oakland Unified! How's that state takeover working?).
A "failed state" is how we talk about California now. Like Somalia.
At a federal level - in Congress - we see a broken system. The senate, a body dedicated to thoughtful improvement of America not subject to the 2-year vote cycles of the House, today requires several 60% votes to pass legislation. Today, the 40% that wish to block the political will of the majority represent 35% of the population. A triumph for small government!
50% simple majority votes exist for a reason. The minority, back against the wall, plays to its base and - simply in order to survive - blocks all legislation. With a 50% rule, they throw up their hands, go back to the electorate, and ask for more seats. Our two-party system works with there's a 50% rule. You might argue for or against the two-party system, but two parties means 50% votes.
To put it differently:
Reagan has destroyed our country.
Most of the country believe that whatever government tries, it messes up. That private industry always does better and cheaper. Despite massive indications to the contrary. "To really screw up requires congress", etc etc. Regan's legacy. In California we've raised bar after bar to enacting legislation. Taxes require 2/3 majority. Changes to previous tax laws require 2/3 majority. Starve the beast, was the cry. No government is the best government.
Government hasn't gotten better or smaller. It's more incompetent.
Beware politicians brandishing small government rhetoric. A politician either believes in the power of collective action (government) to do good, or they believe collective action doesn't work, and the job of the politician is to close down as much of government as possible to make America work better.
Or, the third choice. A small government politician might be a shameless opportunist, a politician for the riches and power that brings. How to tell the difference? Reagan, leader of the small government revolution, dramatically increased the size of government and the size of the debit. Same with George W Bush. The first George Bush wasn't acutally that bad - government stayed about the same size.
Today's Republicans take advantage of America's amnesia regarding Medicare Part D, a fiasco which should be in living memory. Seniors aren't terribly happy about the "doughnut hole", and it's hard to match the "expansion in government" rhetoric with the reality of their party's votes over the last 4 years.
Fox News, the leaders in American amnesia, still have a finger in this pie.
To wrap up, a tangent on the "failed state" metric reminds us what happened in the Palastinian elections between Fatah and Hamas. One was corrupt, one was nuts. After going with corruption for a few decades, the population voted in nuts. Their government switched policy to violent attacks on a stronger neighbor and inflexible ostracism from the world community leading to poverty, destitution, and a violent military attack. People are worse off in the short term, but arguably will be better assuming they ever get to vote again. The next party with sensible shoes will hopefully remember they can be voted out.
We can't pass a budget. We can't make a good choice about water. Our term limits throw power to lobbyists, we had third-world power outages. We can't manage to fund and improve our universities, or educate our kids (hello, Oakland Unified! How's that state takeover working?).
A "failed state" is how we talk about California now. Like Somalia.
At a federal level - in Congress - we see a broken system. The senate, a body dedicated to thoughtful improvement of America not subject to the 2-year vote cycles of the House, today requires several 60% votes to pass legislation. Today, the 40% that wish to block the political will of the majority represent 35% of the population. A triumph for small government!
50% simple majority votes exist for a reason. The minority, back against the wall, plays to its base and - simply in order to survive - blocks all legislation. With a 50% rule, they throw up their hands, go back to the electorate, and ask for more seats. Our two-party system works with there's a 50% rule. You might argue for or against the two-party system, but two parties means 50% votes.
To put it differently:
Reagan has destroyed our country.
Most of the country believe that whatever government tries, it messes up. That private industry always does better and cheaper. Despite massive indications to the contrary. "To really screw up requires congress", etc etc. Regan's legacy. In California we've raised bar after bar to enacting legislation. Taxes require 2/3 majority. Changes to previous tax laws require 2/3 majority. Starve the beast, was the cry. No government is the best government.
Government hasn't gotten better or smaller. It's more incompetent.
Beware politicians brandishing small government rhetoric. A politician either believes in the power of collective action (government) to do good, or they believe collective action doesn't work, and the job of the politician is to close down as much of government as possible to make America work better.
Or, the third choice. A small government politician might be a shameless opportunist, a politician for the riches and power that brings. How to tell the difference? Reagan, leader of the small government revolution, dramatically increased the size of government and the size of the debit. Same with George W Bush. The first George Bush wasn't acutally that bad - government stayed about the same size.
Today's Republicans take advantage of America's amnesia regarding Medicare Part D, a fiasco which should be in living memory. Seniors aren't terribly happy about the "doughnut hole", and it's hard to match the "expansion in government" rhetoric with the reality of their party's votes over the last 4 years.
Fox News, the leaders in American amnesia, still have a finger in this pie.
To wrap up, a tangent on the "failed state" metric reminds us what happened in the Palastinian elections between Fatah and Hamas. One was corrupt, one was nuts. After going with corruption for a few decades, the population voted in nuts. Their government switched policy to violent attacks on a stronger neighbor and inflexible ostracism from the world community leading to poverty, destitution, and a violent military attack. People are worse off in the short term, but arguably will be better assuming they ever get to vote again. The next party with sensible shoes will hopefully remember they can be voted out.
Thursday, December 3
60% of americans want public option - of course it can't pass
According to this poll, just about 60% of Americans want a public option in their health care.
http://www.reuters.com/article/newsOne/idUSTRE5B20OL20091203
The current senate rules require 60% of senators to pass a bill, and the Republican 40% represents 35% of the population.
Thus, our government is working as designed. Republicans have repeated over and over that government doesn't work, and we should pass only laws that are blindingly necessary. Here's a law that's contentious, where 40% of Americans think it's a bad idea. Thus, no law will be passed.
Just don't believe the meme when the Republicans say government can't be trusted because health care can't be passed. They created a system where a 65% majority is required to pass a law, insuring deadlock and inaction. A functional system would follow the people's will, or allow some path to modify and fix our currently broken system.
Allowing one third of Americans to block the will of two thirds is broken. Occasionally laws need tweaks and changes, as our society changes.
The 'failed state' of California is hamstrung by the same philosophy: we can't raise money without 66% of the population agreeing, which never happens. Yet "starving the beast" doesn't work, because people vote against tax increases yet demand their services and will change politicians who can't make wine from water.
Thanks, America. You're the greatest country in the world!
http://www.reuters.com/article/newsOne/idUSTRE5B20OL20091203
The current senate rules require 60% of senators to pass a bill, and the Republican 40% represents 35% of the population.
Thus, our government is working as designed. Republicans have repeated over and over that government doesn't work, and we should pass only laws that are blindingly necessary. Here's a law that's contentious, where 40% of Americans think it's a bad idea. Thus, no law will be passed.
Just don't believe the meme when the Republicans say government can't be trusted because health care can't be passed. They created a system where a 65% majority is required to pass a law, insuring deadlock and inaction. A functional system would follow the people's will, or allow some path to modify and fix our currently broken system.
Allowing one third of Americans to block the will of two thirds is broken. Occasionally laws need tweaks and changes, as our society changes.
The 'failed state' of California is hamstrung by the same philosophy: we can't raise money without 66% of the population agreeing, which never happens. Yet "starving the beast" doesn't work, because people vote against tax increases yet demand their services and will change politicians who can't make wine from water.
Thanks, America. You're the greatest country in the world!
Sunday, November 29
tooth bandit : victim paid $11k despite insurance
A rather terrible story about a woman who had her two front teeth stolen by a crazy person on SF Muni (lesson: stay on the bus, it has video). She spent two days in the hospital recovering.
Here's the amazing part:
Added insult: Despite having health insurance, Aronson says she was saddled with more than $11,500 in hospital and medical bills - including the $4,500 it cost for her replacement teeth.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/11/29/BA701ARFS4.DTL#ixzz0YHCtJNMc
Yes, Americans with private health insurance are happy with their coverage!
Here's the amazing part:
Added insult: Despite having health insurance, Aronson says she was saddled with more than $11,500 in hospital and medical bills - including the $4,500 it cost for her replacement teeth.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/11/29/BA701ARFS4.DTL#ixzz0YHCtJNMc
Yes, Americans with private health insurance are happy with their coverage!
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