Tuesday, August 11, 2009

Health Care Reform and Me - H.R. 3200

Over at Thomas I pulled up the synopsis of the bill. In a nutshell, it appears to be an attempt to be all things to all people, or at least major donors and voting blocs, whether they are the insurance companies or Medicare recipients. If you read the section titles you'll see what I mean. Danny Davis said there was a lot of negotiating going on, and he wasn't kidding.

This bill is the forest killer at 1,000 pages. It is the epitome of "nanny" government, so reviled by conservatives. I can't blame them. Reviewing Title IV -- Amendments to the Internal Revenue Code of 1986, SubTitle A Shared Responsibility, Part VIII Health Care Related Taxes (really!!) I see wording that would cheer the heart of any tax attorney yearning for full employment. Heck, there's even a new return to be filed, unless the IRS figures out how to incorporate this into the already finely detailed Form 1040 with all its attendant schedules and parts.

Skimming through the titles and clicking randomly throughout I see many amendments to existing laws. There are also new provisions regarding training of health care personnel and support for community health care centers. From participation requirements to waste, fraud and abuse it appears there is nothing this bill does not touch if it has to do with providing health care. Opponents should be forgiven for complaining about socialized medicine given the scope and breadth of this bill's reach. Like I said above, "nanny" government.

The public health option provides an option for people who cannot get or do not want employer provided health insurance. It offers protections and often specifies to a frightening level of detail what shall be provided. Like Single Payer, it will be subject to the vagaries of the budget process and the horse-trading that inevitably occurs.

It appears to be the current system, on steroids. Everyone pays something to participate or risks ponying up some cash to Uncle if they don't. It creats a new bureaucracy instead of expanding the current one (single payer) and it attempts to manage all of the details of how health care is provided, and to some degree what is provided. It is no wonder that genuine conservatives like Krauthammer are alarmed and the tinfoil hat conspiracists are having a field day. Peggy Noonan writes that people are scared and it's not hard to see why. So what then are we to do?


Brian said...

I understand the public option is just that- an option. If this is passed, people will have an option to participate, just as they can keep their own insurance policy if they so desire. If the public option expands access to basic health care through community health centers, that alone would be sufficient to address the needs of millions of Americans.

As to the price tag, a trillion dollars over 10 years works out to $100 billion a year. That is a big figure, but for a nation of 300 million, that works out to $333 in costs per person per year.

Now consider the cost to employers. Our small nonprofit provides 100% health coverage for our employees and pays $305 per month. Our insurance was the cheapest private insurance we could find.

Assume the taxes I contribute as an employer taxes were increased by$333 per year and 1 employee of 5 takes the public option. In that scenario, I as the employer would see my costs shrink by over $3000, while my employee would still have access to the health care of his or her choice.

What is wrong with this picture?

As best I can tell, the ones who stand to lose the most under the public health option are insurance companies and pharmacutacel companies who can collude to set prices so that when I comparison shop for my employees coverage, my options are either pay $305 per month or shift the majority of the cost to them with ridiculous deductibles.

Kheris said...

First of all, you illustrate an important point: the bill is written to appeal to as many constituents and stakeholders as possible. Sounds good on its face since more people will sign on if they see something advantageous to them, which appears to be the case for you. That doesn't make it a good bill or the right solution overall.

Second; this bill imposes requirements and entitlements that weren't present before, and negotiations continue to impose more requirements, such as limits on increases in health insurance premiums. That one sounds good, who wouldn't want to keep their premiums stable. But does the totality of all those requirements and entitlements ultimately serve a public good or are they just an opportunity for "nanny government" to tell us down to every jot and tittle what we must do?

Third, if the bill as written is intended to hold down premiums, it may achieve that goal. It is doubtful to me that it will help keep down health care costs. Medicare has funding issues in large part due to increasing health care costs and Medicare continues under this regime.

The price tag may seem workable to you now, but against what other priorities? What if that price tag starts to climb, as I believe it will. At the end of the day we are talking about a government managed exchange that looks like the private insurance industry of today only with a lot more rules. What is unclear is what happens to existing granfathered plans over time, including the FEHB, which is my plan. Do they eventually disappear into the dust heap of history? No one seems to know the answer to that question, but I'd bet the answer is yes. On that basis alone I can see the government's costs increasing, which means funding will have to increase. Will premiums cover that or increased taxes?

The CBO says this bill will increase the deficit by $239B over 10 years. That happens when you don't have sufficient revenues to meet expenses and start borrowing to make up the difference. We are running huge deficits now and Geithner has gone to Congress with yet another request to raise the debt ceiling so we can keep on borrowing. I believe it may be the fourth request this year. This country is in deeper financial trouble than we care to admit to. We need to seriously reconsider just what we want to pay for out of the public purse, whether we are talking health care or TARP.

Let's be clear, I don't think the status quo is all that wonderful, and frankly if I had to make a choice I'd opt for H.R. 676, which has its own flaws. But at least H.R. 676 isn't loaded with all the 'stuff' in H.R. 3200. If you want real reform H.R.676 is indeed the starting point.

RJ Baker said...

HR 676 might be a start but in time the costs to run the program too may run into money problems. Health care for all will cost money regardless. The government can't possibly continue to take on more and more debt. Someone has to pay. Who? Sounds more like you and I who pay taxes and luckily have a job will pay for it in the end.
My only hope is that private insurance companies will no be fazed out of business.
If this happens I only hope that government health care costs are cheaper and don't wreck the medical profession.