Kucinich Amendment Stripped from House Health Care Bill
According to Progressive Democrats of America and this OpEdNews piece, the Kucinich Amendment to waive federal ERISA regulations that might hold up state single payer movements has been stripped out of the final House health care bill. This will be a blow for state single payer movements because insurance companies may now be able to file disingenuous court cases holding up the implementation of any legislative victories. (This is reminiscent of what happened in California after that referendum on car and other types of insurance back in the 1980s.) It's important to note that it's not a fatal blow, however, because speaking objectively federal ERISA regulations may not actually impact single payer systems. But it's still not a chance we wanted to take.
Also, the public plan for the uninsured is not tied to Medicare rates, which probably means that even the skimpy 9-10 million people estimated to sign up by the CBO for the original plan is a big overestimate. It is even possible, if the plan resembles the one in the Senate HELP bill, that no one would sign up for this plan; in other words the plan would be moribund.
As Pelosi said would happen some time ago, the surtax on the rich
has been significantly reduced as a funding source. This raises the
obvious question of where they are getting the rest of the money. I
guess we'll know tomorrow.
The full version of this blog post is available at ZBlogs. (You will need to click the link twice as the first time you'll see the Emergency Funding Appeal.)
Why does it feel like the republicans are 'still' in charge?
October 29, 2009 3:43 AM | Reply | Permalink
Because Sync...THEY ARE. Gold old Repubicrats.
C
October 29, 2009 9:40 AM | Reply | Permalink
Because they are, except these Republicans are called Democrats.
Only about a third of the Democrats in Congress are the kind of people that most people think of as Democrats. The rest are whores to the wealthy and corporate special interests every bit as much as the Republicans.
October 29, 2009 1:10 PM | Reply | Permalink
Dennis lent hope to the process. I hope this doesn't make the whole thing Moot, Or worse, a greater pilferage to the pockets of the least among us.
The well connected DO so hate to pay for their own supper.
October 29, 2009 12:42 PM | Reply | Permalink
Public option proponents have consistently claimed the public plan would compete with private insurers "on a level playing field." Private insurers must negotiate rates with physicians and hospitals, and the new verion of the public option now appears to propose that rather than impose Medicare + 5 rates on these providers.
This will reduce the cost savings vis-a-vis private plans, but should not eliminate them entirely, and might still provide incentives for many tens of millions of Americans to sign up. For more on the potential numbers of those eligible, see
http://www.healthbeatblog.com/2009/10/who-would-be-eligible-for-a-public-option-far-more-than-10-of-the-population.html
My own view is that private insurers pay providers too much, and so the "level playing field" may be level but at too high an altitude. On the other hand, Medicare reimbursements, while fair overall, provide a windfall to some providers while leaving others struggling to stay afloat financially. Ultimately, it will be negotiations rather than flat rates that will be necessary to impose both rigorous cost cutting and equitable reimbursements on the healthcare system. In the meantime, the House leadership is adapting to politial realities in accepting a modification demanded by some House members in districts that claim to be under-reimbursed by Medicare. It would at least be a start, but we don't even know whether the new House version will make it through the full legislative process.
October 29, 2009 4:11 PM | Reply | Permalink
The size of the public plan is a question I am trying to get a better grasp on. Certainly the results coming from CBO on the bill are not at all encouraging. The new estimate is 6 million in the public plan by 2019.
Of course, Mahar disputes that. However, her estimate seems to have some hocus pocus in it, because she counts all the uninsured as being eligible for the exchanges, which is at odds with the bill. Plus, she forgets that some of those uninsured will be shifted to Medicaid. The big uncertainty, and the one I have trouble nailing down, is small businesses. But these lapses aren't terribly encouraging.
October 29, 2009 6:29 PM | Reply | Permalink
I think Maggie may exaggerate a bit, but even if that's true, the numbers are still substantial. If out of 47 million uninsured (a number that appears to be growing), even as few as 25 million are eligible (I would consider that a conservative figure), along with millions of self employed, plus employees of small businesses that choose to participate, plus those now insured who lost their insurance later, the total eligible population would seem to exceed what is typically assumed. The House bill proposes to expand eligibility after the first few years, but based on political expediency, has declined to specify how much. If the early experience is favorable, that would create pressure for significant expansion.
But of course all this is hypothetical until we see what the final legislation looks like.
October 29, 2009 7:19 PM | Reply | Permalink
Incidentally, thanks for the link to the CBO preliminary estimate for the revised House bill, suggesting a possible 6 million public plan enrollment by 2019. The CBO works in mysterious ways. Here, it suggests that the public plan would (a) average higher premiums than private plans in the exchange, and (b) tend to attract less healthy subscribers.
No explanation is offered, and I haven't seen elsewhere any suggestions that consumers could save money by subscribing to private insurance instead of the public plan. I'm guessing that the CBO may be engaging in its own bit of hocus pocus by averaging over the multiplicity of plans, from basic to premier, that public and private insurers would offer. If every insurer is required to offer the same basic benefits, I see no reason why the public plan shouldn't cost less for those, rather than more. On the other hand, if more generous plans attracted what CBO describes as "less healthy" individuals, then it would be understandable why a more generous public plan would cost more than a less generous private one. In any case, I would like to see the breakdown.
Finally, earlier estimates of enrollment have been far higher, but it appears that the CBO is concluding that if the public plan can no longer impose Medicare rates, its costs will be greater than previously estimated, and so its ability to attract subscribers will be reduced.
October 29, 2009 7:52 PM | Reply | Permalink
"My own view is that private insurers pay providers too much"
Really? And how do you know this? Once you start second guessing the market, where do you stop?
October 29, 2009 6:46 PM | Reply | Permalink
Hi Pirate - The failure of the market to work within the healthcare system is a well acknowleged reality with many causes, including the fact that patients lack the expertise to make informed choices. Empirically, the evidence that in some regions, providers offer and are paid for far more services than are needed on the basis of medical need has been cited by a number of sources. One of them is the Dartmouth group, as described in
http://dartmed.dartmouth.edu/spring07/html/atlas.php
Part of the problem is the fee for service payment mecchanism, which rewards quantity rather than value, but numerous other factors also operate to contribute to the excess.
October 29, 2009 7:23 PM | Reply | Permalink
Trying to push through this bill too quickly without considering the financial status of its intended participants is risky and may be too costly. However, the need for a change in general is still greatly needed.
It is also necessary for changes to be made within the medical industry itself.
Dr. Eva Mor is quoted as saying, “The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.
What we need in a health system is uniformity in pricing for procedures and services and modalities of provision of testing and procedures for diagnosis and treatment. By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars.”
http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
She couldn’t be more right. The medical industry needs to be as much a part of health care reform as the insurance companies.
November 14, 2009 1:25 AM | Reply | Permalink