Health Care: The House’s Vote to Repeal
by Linda Beale
Health Care: The House’s Vote to Repeal
crossposted with Ataxingmatter
Well, they’ve done it. The House Republican majority pressed ahead with their repeal of health care reform, putting us (if their bill were to become law) right back in the mess of spiralling health care costs, tens of millions of uninsured Americans, and no handle at all on how to deal with it. The vote was 245-189, with three purported Democrats joining the entire Republican House membership in voting for Big INsurance and against ordinary Americans. See Herszenhorn, House Votes to Repeal Obama Health Care Law, New York Times, Jan. 19, 2011. For background, see this “backgrounders” (available on BNA) from the House Energy and Commerce Committee chaired by Republican Fred Upton (noting the priority for repealing “Obamacare”).
The health reform passed last year was far from perfect–partly because it was based on a Republican-generated model for health reform that relied too much on private sector self-policing, rather than setting up a single payer system or at least a public medicare-like option to compete with the private system we have now. Our medical system without reform combines the worst of all possible worlds–very high cost (much more costly than those of our peers like Canada) and mediocre service (for all but the wealthiest oligarchic members of our society, who are empowered by their wealth and able to get just about anything they want). So the Republicans have taken a less-than-perfect bill that at least provided medical care for 30 million uninsured Americans with a mandate for coverage that made that insurance affordable and at least addressed some of the painful examples of insurance company power to put their profits above reasonable medical coverage of their customers by eliminating the pre-existing condition provision (which could impact insurance coverage for about half of all Americans, according to a recent study discussed in the Times) and they have proposed simply saying no and putting us back at square one.
If their proposal had offered a better way to achieve the much needed objective of providing universal insurance (or at least coverage for the 30 million aided by the reform legislation), then that might be something worth looking at. But they haven’t bothered to do that. And regretably, the “free market” alternatives that they pushed during the discussion of the existing bill don’t promise much. We’ve had a free market in insurance for decades. That’s why we have a problem. INsurance is too lightly regulated, with companies able to pit state against state and get by with almost no regulation. Insurers put profits first, and have become notorious for denying coverage for technical faults that shouldn’t result in denial of coverage or just delaying payments for so long that insureds end up suffering significant economic damage that the insurance plan was supposed to prevent. They write policies intended to provide skimpy coverage for those who aren’t likely to need it, and shun people who are likely to need medical expense assistance since they are the ones that keep their profits from soaring even higher.
The Republicans’ primary idea of “reform”?–allowing sales of insurance across state lines and enacting tort reform. See, e.g., tweets from Rep. Shimkus, including this one (Jan. 19, 2011) re “we will allow sale of insurance across state lines, allow sm biz to join together to purchase plans, enact meaningful tort reform.”
Let’s consider tort reform. What David Hylton and others have shown is that there is really no need for tort reform. Awards have actually not been skyrocketing, and the tort process works fairly well to provide a remedy that would otherwise be missing for medical malpractice–such as when the wrong arm or leg gets operated on or the wrong organ implanted, etc. Hospitals have adopted better oversight because of tort cases that challenge them to greater competency. Tort reform as preached by most Republicans amounts to a claim that any system that gives some measure of remedy and justice to ordinary victims is bad, because it cuts into the profits of insurers. In other words, tort reform is a euphemism for politicians in the pockets of Big Medicine.
What about the idea of competing across state lines? That’s the worst nonsolution imaginable–it removes the little bit of regulatory power that individual states have, lets companies troll for healthy customers by aiming their policies towards that clientele while rejecting those that they might have to pay for; and invites insurance companies to engage in the kind of “what favor will you do me” arbitrage that already has states sacrificing good policies to entice bad companies to “use” their subsidies. Without strong federal regulation, it would be a health care disaster. The idea is based on a ideological view of economics 101 that says that increasing competition will always improve the market place. But that “law” of supply and demand doesn’t really work the way that economics 101 suggests in the first place, and it is even less of a reliable rule when we are talking about something like health care.
Let’s play the hypothetical game we love so well in law schools. Imagine one state that requires hospitals and clinics to satisfy various requirements to operate and another that doesn’t. Clinics that don’t have to satisfy requirements operate more cheaply. And insurers that insure only patients who use those clinics can pay out less. So that probably means you can get cheap insurance if you buy from a company that requires you to use those cheaper, unlicensed clinics. Interested? I doubt it.
These and many other issues would arise in a market where insurance companies could pit state against state to pick the regulatory regime that pleases them. See, e.g., Ezra Klein, Selling Insurance across state lines: a terrible, no good, very bad health-care idea, Washinstong Post, Feb. 17, 2010 (noting what happened with the “freeing” of credit card banks do operate cross-border and concluding that such moves would not insure more Americans or save money but make insurance more expensive for the sick and maybe cheaper for the healthy–“a great proposal if you don’t ever plan to be sick and if you don’t mind finding out that your insurer doesn’t cover your illness”); Why Buying Health Insurance Across State Lines Minght Not be a Good Idea; Allowing health insurers to sell across state lines is a BAD idea on Democratic Underground (suggesting that our experience in opening up the credit card interest is a good warning, since credit card banks moved to the states that allowed the highest interest rates). So insurance across state lines is likely to be a race to the bottom in health care coverage, with a race to the top in premium pricing for anyone who really may have a serious illness that needs to be covered. The result would likely be cheap coverage for healthy individuals that mostly don’t need it and out-of-sight expensive coverage (but still probably unsatisfactory) for those who do.
In other words, the primary plan that the Republicans have offered so far as their panacea for “reforming” health care is one that is of great benefit to Big Insurance (allowing it to select the regulations it wants to abide with and make profits from healthy people while disregarding those who may really need insurance) and dastardly for all of us who will, inevitably, get sick or have an accident and need medical care. Only a universal, national plan of some kind will satisfactorily address spiraling medical costs and growing medical needs.
Further, the Republicans have been utter hypocrites in the way they have dealt with this. They say they oppose the bill at least in part because it will be costly. Let’s evaluate that. FactCheck.org shows that their claim that it will “add over $700 billion in red ink over the next decade” is simply “bogus.” A Budget-Busting Law?, FactCheck.org, Jan. 19, 2011 (and the Democrats’ claims are also exaggerated). The Republicans conjure up $115 billion of administrative costs over the next ten years, but the CBO–our best arbiter on these issues–says those numbers are way too high and that the cost will be a modest 10-20 billion. The Republicans claim that estimates that show costsavings are based on doublecounting, but the CBO is “simply not doing that”, according to FactCheck. The Republicans have added in monies that they themselves want to spend to increase their claims about the law’s cost (as though that is bad)–even though they support that separate expenditure for the “medicare fix” for doctor payments and it is not even a part of the health reform law! Id.
And they aren’t really serious about ensuring that we finally reform our health system to begin to address the costs. If they don’t achieve repeal by the honest way, then they intend to exercise minority veto of the majority’s legislative preferences through trying to choke off money –both appropriations and the mandate that most employers provide a health insurance benefit for their workers. As John Lewis noted ” It is unbelievable that with so many people out of work and millions of people uninsured, the first act of this new Congress is to take health care away from people who just got coverage.” House Votes to Repeal Obama Health Care Law, New York Times.
Further, they are being untrue to the basic principles of individual responsibility that they claim to support. The individual mandate is a mechanism to ensure that people can’t choose not to buy insurance, using their funds for other needs, and then freeload off the system at the expense of all of the rest of us. It is the only such mechanism that the Congress has been able to agree on in all of these post-war years when our peers in the developed world long ago found a way to achieve universal coverage at a decent cost. Yet instead of decrying freeloading, the Republicans have decried the mandate as government intrusion. That makes a good soundbite for the Fox-Hannity crowd, but it isn’t what’s going on. And they aren’t offering any other solution to the problem.
You want to know what I think, really? I am in one of these very pessimistic moods. The Democrats weren’t able to use their majority wisely but wasted it trying to achieve “bipartisanship” rather than honing their message about how government can and does serve the people to help people separate the huge amount of pseudo-news chaff from the hearty grain of information that we need to have a sustainable democracy. Now we’ve got the Republican minority calling the tunes in Congress–or at least making it even harder to do anything decent . And as long as the Senate sticks to the stupid tradition of allowing a minority to veto any decision it doesn’t like through the filibuster rule, that will continue.
Because the reality is that the Republicans don’t want to address the real problems that face this country. They just want to keep mouthing the same old shibboleths of “free market” and “competition” and “property rights” that they have used for so long to further the interests of the monied upper class, no matter what the result for the US economy and the public weal. They want to oppose progressive policies (even ones that were proposed first by Republicans). And they don’t give a damn about whether the 50 million uninsured Americans can get decent health care. They don’t even give a damn about addressing long-term fiscal needs of the country. They just want to fire workers (especially ones that are unionized) so that bosses and owners can take home even more of the profits, and let Business go on as usual.
Unless something crazy happens in the Senate this isn’t worth getting all worked up about. All show and no go.
And Prof. Beale is really worked up on this one.
Well, I agree, Prof. Beale is really worked up.
This was nothing more than political theater. There was no chance of this making it out of the Senate and the GOP knows this. This was a nod to the Tea Party, and to their base….”See, we tried”……
Their next moves are equally predictable. They will now try and chip away at the legislation for the next two years. They want to keep this as a divisive, hot button issue for 2012.
As a health policy analyst, it’s kind of comical. But this is what I do. I think I got about 550 emails yesterday….good god.
Has anyone mentioned that the GOP needs 60 votes in the Senate to pass anything?
Granted, it was a promise “check-off” vote. There are two strategies ( 1) repeal outright and start over, 2) cjhip away at the most offensively bad portions) to modifying this horribly complex and badly written monstrosity of a bill. Now we can get to modifying a really bad bill to make it useable.
I have said this many times, but it’s amazing to see how bad the Dems are at legislating. Refer to my above description of this bill for an example. Furthermore, also amazing is the deaf ear that the Dem legislators have.
They have won the argument whether we need healthcare reform! They have lost the argument on how best to reform it resulting in this highly contentious bill.
This article reflects the partisan, uncaring (their way or no way), political ineptness of the Dem approach at legislating.
Ah, CoRev,
This post refects your partisan approach to . . . well, everything.
“cjhip away at the most offensively bad portions”
What, in your mind, are the three most “offensively bad portions” that could be chipped away without damaging the rest of the bill?
What are the three most “useable” parts of the legislation?
Joel, since when has discussion been partisan? Having an alternative opinion and approach is anathema to Dems. Why?
Not in priority order. Good: Provides insurance coverage for some who do not already have it; provides some level of competition by creating insurance pools; and provides a minimum standard for HC insurance plans.
The bad concepts are as much conceptual as implementation. Bad: adds a huge, only partially funded, entitlement program when entitlements are eating up the available budget expenditures; ill defines the HC benefit package, leaving too much to administrative definition without legislative input; removes too much individual freedom to make HC decisions; removes too much freedom from HC decisions from Dr/patient decisions because of #2 above; was based upon disingenuous fiscal limits/estimates and partisan implementation/voting which in part adds a bad smell to the overall bill’s actual implementation; has only limited political support; serious doubts of constituionality of portions.
And these are only some of the bad parts. We can discuss the 1099 issue, and the personal mandates, unsupported demands on states, etc.
Joel, since when has discussion been partisan? Having an alternative opinion and approach is anathema to Dems. Why?
Not in priority order. Good: Provides insurance coverage for some who do not already have it; provides some level of competition by creating insurance pools; and provides a minimum standard for HC insurance plans.
The bad concepts are as much conceptual as implementation. Bad: adds a huge, only partially funded, entitlement program when entitlements are eating up the available budget expenditures; ill defines the HC benefit package, leaving too much to administrative definition without legislative input; removes too much individual freedom to make HC decisions; removes too much freedom from HC decisions from Dr/patient decisions because of #2 above; was based upon disingenuous fiscal limits/estimates and partisan implementation/voting which in part adds a bad smell to the overall bill’s actual implementation; has only limited political support; serious doubts of constituionality of portions.
And these are only some of the bad parts. We can discuss the 1099 issue, and the personal mandates, unsupported demands on states, etc.
CoRev,
“entitlement program when entitlements……………..”
You are talking ideology.
What is the difference between an “entitlement” and a “public good”?
The issue among some republicans is: the only ‘public good’ they recognize is empire and jobs in and outside the beltway for the military industrial complex, whose bagmen deliver the goods.
Unwarranted influence makes war profitting a ‘public good’.
The debate was succinctly related the other day on a CBS affiliate I listen to for traffic, politics sometimes gets in the way of the traffic report.
The dem talked delivering a public good, which is not understandable to most republicans in and outside the congress.
The republican talking point was ‘cut down the rotted tree……
When ideology gets in the way of discussion…………………….
There are two poles in the debate: insurers not insuring any risk and healthy people staying out of the risk pool.
The aged are already on medicare, the poor on medicaid. That leaves about 50M without insurance.
What is the public harm of those 50M not getting preventive treatments? Life style bigotries aside.
Anyway between medicaid and medicare, and uncollectibles driving up hospital fixed costs, every body needs to get their head out and look what 16% of GDP going to health delivery gets, far down the list in the world?
Is it a punblic good to be 7th or 38th in the world comparing population health outcomes while spending the most?
At least you know the mandates are personal and not on businesses which is a republican idea, and false.
So the simple solution would be to have enabled people to buy into medicare at around $1000/month per person. That would solve the access problem, but not the cost problem. Or better to have just passed Wyden Bennet which would have build a nationwide exchange based on the federal employees health plan and abolished employer provided health care. You would have had a choice of a number of plans. One of the issues of course is do you make the base bare bones (for example no infertility or viagra coverage) or more full. If bare bones, one could provide optional add ons, but they would become expensive due to adverse selection.
Repubs go on the record (again) opposing a Lib FUBAR program. If you think Obamacare is unpopular now, wait until the “individual mandate” and other taxes and fees kick in. People without health insurance getting bills for $200/mo under threat of penalty and garnishment…..
The absolute best thing to happen for the Dems is that this program dies in the courts or legislatures, then you can just demogogue the issue for political gain.
Joel, it appears that I mispoke when referencing a two part plan. The Examiner actually says: “House Republicans are pursuing a three-part strategy. Part One was repeal; they promised to do it, and they did it. Part Two is replace, which in coming months will involve House votes on a series of GOP health care measures. And Part Three — since full repeal can’t win in the Senate — is another series of votes on measures to repeal individual parts of Obamacare. The net result will be that Republicans gradually push more and more House Democrats — and perhaps some in the Senate — away from an all-or-nothing defense of Obamacare.“
As I did say, the reform argument is over and won by Dems. Why, after many Dems admitted parts of the bill were offensive/less than optimum are they in an all-or-nothing defense of Obamacare.
What I see is a losing political strategy. A little bit of bipartisan acceptance in drafting the bill, although would have shifted some credit to the republicans, would NOT have politically tainted this bill. It is so tainted that the republicans have an opportunity to claim the political high ground by acceptably reforming the HC reform bill, and leaving the taint on Obama/Dems.
Another example of how badly the Dems have misplayed their political cards. I also see it in the disappointment, embarrassment, and denial of many of the liberal commenters/comments here. Long term political damage is possible for the Democrats caused by their political ineptitude. Reagan was rifght about Democrats over reaching.
Not to pick on bones but I felt I must 🙁
“The health reform passed last year was far from perfect–partly because it was based on a Republican-generated model for health reform that relied too much on private sector self-policing, rather than setting up a single payer system or at least a public medicare-like option to compete with the private system we have now.”
This statement is not true since the healthcare legislation is pass with democractic votes, and 100% Republican opposition vote. So there is no such thing as republican model in the bill, since it’s all democrat.
I knew the bill is basically flawed and possibly doomed when our former speaker Nancy stated something like We will pass it so you can find out whats in it. It’s like a used car salesman saying you can buy it first then you find out if you like your car.
It’s a typical congress bill with so much special provisions in fact drove up the cost of healthcare. I just felt democrat really disappoint the people that they lost the mandate to really properly revamp the healthcare bill.
Well, I guess we just have to see if the Republicans have any brighter ideas…. Shame on them if they screwed up as well… I think American people deserve better from our elected officials…
sammy,
FUBAR, the republican approach yields FUMTU!!
You know when that acronym was introduced? Where?
“So there is no such thing as republican model in the bill, since it’s all democrat. “
Ummmm NO!!!
The thing was FUMTU’ed by republican threats of fillibuster!!..Some folk here don’t go by talking points.
And the republican model is shiufting wealth to the top 1%, noithing else.
Deficits and perpetual war for the 1’ers dividends, and coupon clipping.
Everyone aside the 1’ers owe their soul to the company store.
CoRev, coverning “some” who can’t afford it means about 30 million people, which isn’t as trivial as you made it sound. Otherwise, your top-3 are decent choices.
Re your bad stuff, it doesn’t remove individual freedom to make HC decisions, it increases this freedom. Unless I’m wrong, which is possible, everyone continues to have the ability to do whatever they want and it’s just a question of whether insurance pays for it or it comes out-of-pocket; by establishing minimum standards of coverage and covering more people (two of your good parts), affordability becomes less of a barrier to making the choice you and your doctor desire. If you know of any choices that the bill eliminates entirely even if you’re willing to pay out-of-pocket, or choices that the bill declares may no longer be legally covered, feel free to share.
I disagree with most of your other bad parts but agree it raised that constitutionality issue, which SCOTUS eventually will decide. This likely would been avoided if “politics” didn’t interfere with language in the bill. (I think Obama didn’t want to label the mandate as a tax and tax credit, which would accomplish the same thing.)
FUBAR is probably the stage after SNAFU (Situation Normal, All F*cked Up), an Army term that describes the situation when a bureaucracy tries to run something complex, like health care.
ILSM sopme here don’t go by talking points, then that’s all he provides. Admittedly, it is off the “one trick” ponbt we’re used to seeing from him. Good on’Ya!
Gracias
The fact that you have a certai, partisan, canned view of the health care bill (brought to you by the folds at the RNC) in no way tells us anything about the Democrats ability to legislate. The fact that you either think it does or think you can slip that bit of illogic past anyone is, well, same old CoRev, I guess.
Often, CoRev will at least pretend to use something other than bald assertion in his arguments, but not this time. Every bit of what he offers here is just the world according to CoRev. His view of the bill. His view of the politics. His small-minded claims about Democrats.
The goal of a troll like CoRev is to divert discussion from substance to his insubstantial claims. If you allow him to lure you into discussing his views as if they matter to the wider discussion, he has you. If CoRev wants to discuss the health care law with adults, he ought to raise his approach to an adult level. Otherwise, he ought to be corrected for taking a silly, flailing, BS-heavy approach. Engaging his argument is a waste of time, because his argument is hollow.
Or like space exploration, or national defense, or a highway system, or a research reactor.
And, oh, by the way, both FUs refer to the Army, or more broadly the US military, not any old bureaucracy. Guys in uniform don’t generally make up catchy acronyms for what happens at the license branch or GM or the American Rifle Association. sammy is, um, misconstruing a bit here.
Pox,
You have misread just a wee bit. The assetion was that the bill was based on Republican ideas, not Republican votes. Your observation that no Republican voted for the bill in no way addresses the reality that many of the elements of the bill were crafted by Republicans as an answer to Clinton’s health care proposal, and that mandatory participation was legislated in Massachussets at the behest of Senator Brown when he was Governor there. Need to get those pesky facts right if you wanna make an honest argument.
Up pops KH saying: “The goal of a troll like CoRev is to divert discussion from substance to his insubstantial claims.” with the epitome of examples of which he speaks. Did he say anything? Did he say anything about the topic?
Nope! Just another KH personal attack. I will repeat my question to Joel: “since when has discussion been partisan?”
KH, you’re a tool of your own biases.
Hey, Tool, saying this: “…that mandatory participation was legislated in Massachussets at the behest of Senator Brown when he was Governor there.”
And then adding this snark: “Need to get those pesky facts right if you wanna make an honest argument.” Care to show us when that ole pesky fact of Scott Brown being Governor of MA. Here’s what Wiki says: “Before his election, he served as a member of the Massachusetts General Court, first in the State House of Representatives (1998–2004) and then in the State Senate (2004–2010).” Just so I wasn’t too wrong in my understanding of Brown’s creds.
Always snark or personal attack and seldom an honest argument. That’s you, Tool.
Pax
Your use of willful ignorance is too typical of arguments concerning the health care legislation. The current law is what it is as a result of every effort to entice Republicans to join on to the legislative initiative. Its ancestral roots grow out of Republican designs for “health care reform” that were being offered and discussed when Republicans actually participated in the legislative process. Over the past several years we’ve seen little but obfuscation and resistence to legislative product from a poor excuse for a “loyal opposition.” Now they come forward not with pro legislation that would do something useful, but anti legislation that is aimed at no more than fanning the discontent of their ignorant base.
Me thinks Jack, may exagerate with: “Its ancestral roots grow out of Republican designs for “health care reform” that were being offered and discussed when Republicans actually participated in the legislative process.”
Ancestral roots? maybe only in Dem/liberal talking points land?
Can you provide your source for this? It might be interesting to discuss.
Try Rommneycare in Mass, essentially the core is that system on the whole us basis.
Lyle, Romney clims is it not based on the MA HC system. Dunno it well enough to have an opinion.
Dan, car to comment???
From what I can see, Hillarycare, Romneycare, and Obamacare differ in subtle ways but are fundamentally all the same. They all seek universal coverage, but don’t socialize the industry (like the UK), don’t have single-payer (like Canada), and do rely on a mandate and the insurance industry along with the application of some leverage. Republicans don’t want a mandate and don’t like Romneycare–claiming it’s “Republican” really does not fly, and dredging up old insincere Republican ideas doesn’t help. Republicans don’t want socialized medicine and they don’t want a single-payer system (they actually hate Medicare, as evidenced from Reagan to Ryan’s Road Map). They don’t want universal coverage. Stop pretending that they do.
CoRev:
Entitlements are only a small portion of the past budget. Your issues are on two off budget wars and tax breaks from 2001/2003. Healthcare reform is funded today and even moreso later as the cost of not having it supercedes the cost of it.
SCOTUS does not have to decide on anything. It can look the other way and not review it and/or allow a COA Appeals verdict stand. Nothing is mandated for SCOTUS.
CoRev:
You are partisan. Boehner or McConnell? The party of “No.”
My point is very simple, if you voted for it, it is your law, your bill, doesn’t matter whose the author. Gotta take responsibility for it’s pros and cons.
It seems to me the healthcare bill was passed with haste because something needs to be done. Unfortunately, the congress still have elemenents that do not have American people at heart.
I really felt that this past congress, the democrate partyfailed in their great opportunities to capture the heart and mind of American people. A law, even very well intended, perhaps as a whole have more good points than bad points. But provisions such as 1099 rule, 2.5 percent surtax on essentially retiring baby boomers. May be just enough to kill public support for the law.
A lot of our health care coverage woos comes from not addressing core issues such as whose the ultimate payers for service, what is affordable realistic coverage to cover the maximum amount of people. What is too costly for the public to afford. This question actually resonants throughout our society, why do we have such structural problems in states such as California, illinois?
We do have universal coverage in the us. It is called Medicare. It’s not perfect, but it is there…
Again my point is, when you are in charge, you are responsible. If you drive a car and hit a person. Can you blame Ford, Chrysler for sale of the car. You as the driver made a decision to get inside the car and drive… Drive responsibly…
Run, I am conservative. You are not, that makes us both partisan. Having a view point and an open discussion is the foundations of our country. Why do Dems think that is such a bad thing?
Michael, I skimmed the article, then did a search for the phrases you said were there. They weren’t. Please point us to them or their equivalents. Thanks.
Obama guaranteed re-election – repeals and replaces Obamacare with the French system, or better yet, the Swiss system. Implementation about one week, costs savings, about 30%, quality, available to all, universal care, no rationing and no waiting. Republican president campaign – make sure every voter knows what the Obamacare health tax and costs are, make sure everyone knows how heavy handed and miserable it is, then in 2012 after a new GOP president gets in, repeal and replace with French or Swiss system. problem solved.
From the comments posted above, one would think that the title of Linda’s post was “Health
Care Legislation: What’s Your Opinion?” She answers virtually every criticism of the bill in her post. Opinions to the contrary are little more than that, opinions. Linda provides ample references, when appropriate, and, otherwise, provides a detailed and comprehensive analysis of the deceitful character of the Republican dream of dismembering the legislation that was finally passed. Perfect? Not in the opinions of many, but most of its short comings became part of the package in Obama’s effort to create a “bipartisan” piece of legisaltion. Republican complaints of having been left out of the legislative process are bull shit and well documented as such if one had read the on going press reports at the time of the initial debate. In effect Linda’s post stands on its own with little to be accomplished by the input of the nay sayers who have nothing substantive to add to the discussion.
CoRev-
Here’s the statement regarding a mandate:
But as part of that contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements. In addition, if federal tax benefits or other assistance accompanied the requirement, states and localities could receive the value of the assistance forgone by the person failing to obtain coverage, in order to compensate providers who deliver services to the uninsured family.
CoRev-
Here’s some dealing with the pre-exisiting:
Congress would establish goals for universal coverage. The goals could include a certain percentage reduction in uninsurance rates in each state over a period, and steps towards ending multiple programs and eligibility criteria. Congress would also establish boundaries in policies that could be adopted in reaching the goals (e.g. that no person could face unreasonable coverage costs as a result of their medical condition)
Here’s a part dealing with removing the tax exclusion:
Today we subsidize for insurance very efficiently. In fact, the current form of subsidy encourages an inefficient overuse of medical care by most non-poor Americans while providing little or no help to the lower-paid uninsured, and it actually exacerbates the problem of uninsurance for many Americans. This happens because by far the largest subsidy for insurance for working Americans is the tax exclusion for employer-sponsored insurance. The exclusion means that the portion of a worker’s compensation devoted to employer-paid health insurance is not subject to federal or state income taxes, or payroll taxes. In aggregate this subsidy dwarfs even the value of the mortgage interest deduction. John Sheils and Paul Hogan valued the subsidy in 1998 at over $111 billion at the federal level and nearly another $14 billion in exemptions from state taxes.[5] In contrast to a subsidy aimed at those who need help the most, a tax exclusion provides most help to upper-income workers (who are in the highest tax bracket) with the most generous coverage. Sheils and Hogan have estimated the average annual federal tax benefits in 1998 as ranging from $2, 357 for families with incomes of $100,00.
But the exclusion is highly inequitable. Sheils and Hogan estimated the average annual tax benefit at just $71 for families with incomes of less than $15,000. Thus the exclusion provides little help to lower-paid workers, who often face hardship in paying for family coverage or out-of-pocket costs, and it is not available to workers lacking an employer-sponsored plan. It is hard to imagine a less efficient system of subsidies for helping people to obtain coverage.
Jack,
That’s not in fact true. This is what I do, and there are some legitimate criticisms of this bill. In fact, there are likely some adjustments needed. But, that’s another topic entirely…
Mike
Michael, thank you!
You are right! We cant do anything about it now but learn to live with it and maybe find other solutions to make the health care better like implementing another bill that would ensure insurance or health care to low class workers or even the unemployed.