The headlines are not quite accurate. It's being called sweeping, a landmark...but most absurdly, it's being called a health care bill and folks are celebrating like it's law already. We've been clear for quite a while around here that this isn't health care reform but health insurance regulation reform. And this part of the process was completed, but it was ugly. The final vote totals were the result of intraparty negotiation we've seen the likes of before...situations where a conservative Democrat would check with Rep. Clyburn, find the bill at hand was definitely going to pass, then vote against it for local political advertising purposes.
The bill will not be what I'd really like to see. But reforming, re-forming the way health care is paid for is critical for the economy for reasons touched on earlier in the discussion. The accusation that the bill under development at the time was health care rationing; the response was that health care is rationed now, by wealth. That argument made clear to individuals the central physical, rather than ideological, problem with a profit-driven health care system, and Republicans dropped it like they had grabbed the business end of a hot poker.
From a human perspective we might call what we're experiencing a health care shortage, but from an economic perspective there is no such thing as a shortage. Businesses do research to determine how many widgets (like health insurance policies) they can sell at various price points. They pick a price point from the range which gets them the revenue and profits they need to stay in business. Price it too low or too high, and you don't get the revenue you need you buy the material necessary to make and distribute the product in the first place.
What is happening now is American industry is treating profit as a fixed expense. They budget a specific minimum profit and make day-to-day decisions in service of that goal. They are, in fact, legally obliged to do so; these decisions are never made on a purely economic basis. So, for instance, it is said that tax increases on corporations are transparently transmitted to consumers in the form of price increases. But the same operational requirements would make them retain tax cuts and other government subsidies as profit rather than cutting prices. Business' goal is to expand then maintain.
This determines how businesses behave in the market, which is the means by which America distributes goods and services, and it's one thing when you're talking about garden equipment; it's another thing entirely when you're talking about things as necessary as water, electricity, health care, things we need but are too small as individuals to create for ourselves. This is where government comes in. This is where government always comes in, not on the specific issues but in the pattern. That which we must have, which we are too small as individuals to create for ourselves is the realm of government. And due to our economic philosophies, health care...and paying for it...is now squarely in this territory.
And it's why this legislation will be important. The health insurance industry is dying of the equivalent of morbid obesity, and a mechanism must be prepared to pick up that industry's function when it finally falls and cannot get up.
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Pre-emptive Hitlerian photo taken after the vote
Take a gander.
http://news.yahoo.com/nphotos/Speaker-Nancy-Pelosi-Rep-George-Miller/photo//091108/480/ec8ca60c7c9b4e3c98929c6575c0c9f3//s:/politico/20091108/pl_politico/29281#photoViewer=/091108/480/ec8ca60c7c9b4e3c98929c6575c0c9f3
Somebody's gonna "go there" in the blogosphere. Might as well get it over with!
That's pretty funny.
The George Washington picture will make it hard to stick...look for a tighter crop.
Geo. Washington wasn't conservative enough for some
How could Washington's ghost allow Pelosi to stand next to his portrait? He must've been a closet liberal!
Now how many of us really
Now how many of us really think that this bill is reform?
you all are too funny with this picture
lol
Beware "Unintended" Consequences
Beware of the "unintended" consequences.
Scare quotes, Darkstar? What
Scare quotes, Darkstar?
What are the consequences we should be wary of?
Not Scare Quotes
This isn't a case of scare quotes at all.
Medicaide reimbursement rates are being cut. In Maryland, it's a double whammy because Maryland provides matching funds. So, what will stop the government from doing so in the future?
When the CBO gave its estimates of cost, it wasn't the bill that passed. It's estimated that the costs are MUCH greater. So, what does that mean for taxpayers down the line?
Requiring EVERYONE to have insurance and then having the IRS manage compliance?
Let's be real: 2000 pages of legislation is BOUND to contain some shady stuff.
So, what will stop the
It sounds like you want to assume the government will do everything fearful that you can think of.
As a practical, rather than ideological, matter, what's wrong with that?
Real, not Imagined.
Medicare cuts are real, not imagined.
An example of the government changing the terms of a social program can be seen with Social Security. Remember, the money received was not subject to federal taxes until Clinton's term where the change was made.
As a practical matter, I see it as another mechanism to get your taxes reviewed by the I.R.S. For years now, reviews of answers to tax questions posed to the I.R.S. has shown the answers to be wrong and/or inconsistent. And when the I.R.S. gives you a wrong answer, that is no excuse for making a mistake on your tax form. So, if more taxes are owed because of bad advice given by the I.R.S., you are up a creek and that means, also, paying any penalities.
Medicare cuts are real, not
"What's to stop them from X?" is imagined.
And if a new agency is created to handle collections, that's an expansion of government and duplicating existing collection channels is a waste of resoource.
Bad tax advice from the IRS is so far from the issue I think it's an unnecessary distraction to raise it in connection with health insurance regulation.
Problems are much easier to resolve if you don't falsely conflate them. You know this as a developer. You would not try to write a single routine to resolve your view and controller issues at once, would you?
"What's to stop them from
It's an essential question that asked and even you do so.
It's overall a waste of resources. The federal government should not be able to dictate what individuals have to buy if they don't want to buy it. The policy that has to be policed and enforced, in this case, IS the problem and the waste.
When the I.R.S. is going to be used to enforce the law, an agency that's supposed to deal with tax issues, not health care, it's not an unnecessary distraction.
"What's to stop them from
I don't ever ask "What's to stop them?" I ask "What are the odds?"
I also ask, "What do you want me to think the odds are?"
Okay, how about the IRS handle the collections and let whatever law enforcement agency review their work, determine who needs to have a discussion and handle it?
We're talking health insurance regulation.
You realize there is no market for health insurance, that it's a bigger and longer-standing market failure than the credit markets, right?
And the market is the only distribution mechanism you recognize as moral and valid, right?
So given the current players and their known behavior, how do you suggest health care be distributed? And how will you get the current players to accept whatever changes you suggest when they really don't want to?
The Difference Being?
The difference with what I wrote being, what?
For not having health insurance? You don't see the insanity in that?
There are reforms that could be made that would help. Ensuring portability removes the COBRA problem. Enabling insurance pools reduces the problem of affordable insurance for individuals because a pooling mechanism exists as it does with bigger companies.
No. I recognize when the market is immoral and wrong.
Above I gave 2 that make sense to me. Adding ending of the "pre-existing condition" escape clause would also help.
And the market is the only
But a moral and valid means of distributing goods would necessarily be a market, right?
How do you compel insurance companies to cover people they currently, consciously, chose not to cover? What would that do to premiums?
What does that actually mean? If I buy insurance in New York, then move to Maryland, is my insurance governed by Maryland law (forcing me to change policies) or New York law (which means insurance companies will do what credit card companies did)? Or will you override local law with new federal regulations, expanding the government and justifying more taxes?
As long as the pool isn't federally managed?
You can just say these things but consider what actually has to happen to bring your preferred options to pass.
I see the insanity of not having health insurance, and in making policy decisions that insures that insanity continues.
Right...
"What's to stop them" implies a response must be made. "What are the odds" allows for possibilities but recognizes most of them simply never arise.
But a moral and valid means
Yes. People try it now with varying degrees of success.
You compel them by changing laws and it would put upward pressure on prices UNLESS you can do things to expand the overall pool.
Correct.
I've never said reform wasn't necessary only that the what is being done, now, is wrong.
I Understand
OK, I understand. My comment stands in your context. Cost pressures will force a change and that change will be in coverage and price, just as it is happening now. Only it will be the government and having the government determine life and death is something I don't like.
Seems like the involvement
Seems like the involvement of the government is the only problem you have with the legislation.
So lets give you what you want. Let's do stuff to enlarge the insurance pool, let's make all the policies portable, and let's eliminate the exclusion of folks with pre-existing conditions.
Think about what is necessary to make the changes you see are needed. Who, exactly, do you think is going to do those things?
No, Again
I have no problem with the government adjusting the regulations to make all of what I wrote, possible. After that, let's see what the market does.
Never mind the market. What
Never mind the market. What will the people and corporations participating in the market do? You have 40+ years of example...what are the odds they'll do the right thing? The health insurance industry has already said nothing short of universal mandates with penalties that would cost more than premiums would keep them from raising policy premiums. And that's to say nothing of next year's rate hikes.
You SEE the choices they want to make. What would the government have to do to compel these actual monopolies to stop taking payments with no intention of making them on the other side? Why are you not taking this into account? The state of the health insurance market is absolute failure. The Feds already pay for half the population's medical insurance. Where would the industry be without the massive subsidies they already get (which include the tax breaks companies get for providing employer based insurance)? It would have died long ago.
And because no one will do what's necessary, it will die because we're too pissed at them to bail them out. When that function inevitably collapses, who is going to pick it up? The government, that's who.