Hijacked in entirety from DrSteveB at dkos.
Since
we all want to get health some (any?) kind of health reform" we are
being told by Washington insiders to set aside our advocacy for single
payer and join in with the kumbaya negotiations with enemy (AHIP) to
get 'er done. Sure, as a matter of policy and economics, single payer
is the best way to reduce and control costs, and also get to universal
comprehensive coverage. However, as a matter of realistic power
politics, I am told by the powers that be that we can't do it this
year, so we should settle for what is doable.
Okay. I'll bite.
Let's get the best plan we can get with 50% plus one in each house of
Congress. And as usual, that means 51 Senators, since we have a larger
and more probably liberal majority there.
But can we please
please stop pretending that we can or should "negotiate" with AHIP?
This idea that the private insurance companies are compromising is nonsense!
Ron Brownstein provides some happy talk in the Atlantic
regarding talks between SEIU Andy Stern and Karen Ignagni, president
and CEO of America's Health Insurance Plans, the industry trade
association. Supposedly, there is a convergence around the goal of
"universal" coverage with progressive calling for "guaranteed issue"
while the insurance companies get "individual mandates." They are of
course opposite sides of the same coin. The insurance companies would
have to sell you an insurance plan product; the police power of the
state would require you to buy it.
Brownstein does point out that the "only" thing left to negotiate is "affordability." Gee. Is that all?
Community
rating is the term for setting the cost of a plan (your premium) based
on everybody in the same insurance pool, and not basing it on your
individual risk. It ends the practice of most insurers in most states
charging different customers different prices (not just premium, but
also deductible, copes, exclusions, etc) based on age, health status,
location. This is important since even if they have to sell it to you,
and even if you have to buy it, if you have a serious pre-existing
condition (i.e. are actually sick and need care), they may charge you a
million dollars to buy the plan. Or exclude your prior condition. Or
set a million dollar deductible. Or 50% copay. Or whatever makes it so
they can still make a profit, even if they have to sell you plan and
you have to buy it.
Therefore, community rating helps a bit
with this, though once again the devil is in the details. What is the
community, that is the pool, on which your plan rate is set? Is it just
the small company who is your current employer; in which case, one
person getting sick increases the rate a lot for everybody? It is
always better (for we the people) to have the community pool be as
large and unselected as possible. Of course, the best would be a single
big insurance pool covering all Americans. Hmmmm... I wonder if there
is a name for something like that...?
Of course, if there were
also a broadly available public option, open say to everybody, then the
insurance companies would have to compete for your business.
So there has been lots of talk about AHIP compromising and being weak 'cuz everybody hates them.
Yes, insurers ought to be operating from a position of weakness, and
their business model is increasingly inadequate, and everyone should be
able to imagine a health system without their participation. Alas, we
have on our side Senator Max "lobbyists just want what's best for America" Baucus negotiating for our side, who knows what we are going to get.
Actually
it was pretty funny reading Brownstein's Atlantic piece about Andy
Stern/SEIU trying to find common ground with Karen Ignagni/AHIP, having
just read the NY Times a day before reporting just the latest collapse of the phony grand coalitions,
with AFSCME and SEIU pulling out when AHIP & Pharma were signaling
no compromise was possible on Public Option, and silence on Community
Rating.
On the other Michael Hitzlitz gets it better than most in today's LA Times:
The
genius of modern marketing is pouring old material into new packaging.
Over the years this has given us yogurt in tubes, prechopped salad
greens in cellophane bags and, most recently, the health insurance
industry's new image as a friend of reform.
In December, the
industry's trade group, AHIP (for America's Health Insurance Plans)
revealed that it had experienced an epiphany and decided for the first
time to support the principle of universal healthcare -- insuring
everyone in America, regardless of health condition.
It
described its change of heart as the product of three years of sedulous
soul-searching by AHIP's board of directors, who claimed to have
"traveled the country and engaged in conversations about healthcare
reform with people from all walks of life."
As a connoisseur of
health insurance lobbying practices, however, I withheld judgment until
I could scan the fine print. What I found by reading AHIP's 16-page
policy brochure was that its position hadn't changed at all. Its
version of "reform" comprises the same wish list that the industry has
been pushing for decades.
Briefly, the industry wants the
government to assume the cost of treating the sickest, and therefore
most expensive, Americans. It wants the government to clamp down hard
on doctors' and hospitals' fees. And it wants permission to offer
stripped-down, low-benefit policies freed from pesky state regulations
limiting their premiums.
As for universal coverage, which is
the goal of many reformers (if not yet the Obama administration), the
industry will accept a government mandate to take on all customers, as
long as all Americans are required by law to buy coverage.
[snip]
The
insurers think government intervention is fine if it applies to
customers they don't want. The way they put it in their reform plan is
that we need a system that "spreads costs for high-risk individuals
across a broader base" -- the base consisting of all taxpayers, that is.
Who
are these "high-risk" individuals, by the way? At an AHIP convention
last year, I heard a prominent industry consultant describe the
customers the industry is desperate to dump on taxpayers as those with
multiple chronic diseases, like diabetes sufferers with asthma or
cancer patients with heart problems. He called these people "clinical
train wrecks." (Nice way for someone connected with the "caring
professions" to talk, isn't it?)
So how about this:
Insist that the CBO do an honest, complete, side-by-side comparison that includes true single payer such as John Conyers HR-676 United States National Health Insurance Act, and the alternative of a strong public option such as Pete Starks' HR-193 AmeriCare (keep what you have if want to; strong public option of expanded and improved Medicare otherwise),
and whatever it is that HCAN, Obama and Baucus, etc are proposing as of
now. Heck, for that matter, they should also look at whatever it is
important Republicans such as Enzi or Grassley or AHIP are proposing.
And,
then lets have a straight up and down vote... on the best plan that can
get 51 senator (heck let's make it 50 + vice president Joe Biden; gotta
give him something to do).
Let the Republicans (and if need be
blue dog DINOs) block the best real reform we can get now. One option
is to bypass the filibuster via budget or reconciliation. The other is
to make them REALLY filibuster by having the Senate Majority Leader (I
hear he is one of us) disallow or revoke Senate Rule 22 (which it is his power to do) and actually force them to vote.