The Baucus Bill

First, a little stock music: as was pointed out in this Metafilter comment, Humana, Aetna, Cigna and UnitedHealth all had a stock gain of more than 3.5% after Senator Max Baucus announced his bill.

I waited most of the day to write about this because I was honestly not sure how the bill would sort out, and I wanted to look at the Chairman's Mark (Baucus' first draft of the bill for negotiation) myself before I jumped in all aggravated with the riot elbow. I've been pretty sure for the last two months that whoever Baucus is representing, it's not Americans -- but this bill seems, all in all, to be pretty clear proof. A rundown:

An insurance mandate for individuals. That means that if you don't buy insurance, you'll be fined by the federal government. This is a major money-maker for insurance industries, who want federal laws to force new customers into the market. Democrats should hate it because it punishes people who are already lower-middle class and have it hard enough; Republicans should hate it because it's a government intrusion into something that should probably be an individual decision.

The free-rider policy. This forces businesses who employ individuals receiving government health insurance services (i.e. Medicaid or other subsidized health services) to pay a fee towards defraying that cost. Ezra Klein has been excoriating it all day -- for the simple reason that it makes businesses less likely to hire low-income employees. If you could hire a high school kid for $7.25 an hour or a mother of three for $8 an hour (because her children are Medicaid recipients), which would you do? This policy expressly reinforces the cycle of poverty. Whether you're on the left or the right, it's a loser.

An end to the use of pre-existing conditions as a means by which insurance companies can deny insurance. This is a good thing, but the insurance companies are likely to raise rates to counteract lost profits caused by having to actually insure sick people. Call it a wash: we'll get more, but it'll come out of our pockets, not out of the insurance companies'.

Medicaid and Medicare expansion and subsidies. This is the bill's method of addressing what drives much of our desire for reform -- the tens of millions of uninsured Americans left out of our current system. It's also, I think, President Obama's key demand: insure the uninsured, and increase national health. The question is how much we will pay to get this, and how we'll do it; Senate Republicans have treated almost any expenditure in this direction as completely nonnegotiably unacceptable. I would also point out, to opponents of the public option, that in its absence what we are getting is an expansion of the considerably more government-centric single payer system that is Medicaid and Medicare.

No cost containment. This is President Obama's other big request -- a way by which we can slow or stop the double-digit yearly increases in health costs that are throttling industry and household finances. A public option -- government competition -- is the best way to control these costs; in its absence, many have suggested regulations on executive pay, profit-taking, coverage maximums, or other insurance industry mechanisms that enrich individuals at the expense of the country. The Baucus plan has neither -- and in this respect, fails entirely to get to the root of the problem. This is why the bill is so popular with the insurance industry and its stockholders: it maintains the gravy train, as is pointed out in this NYT "Room for Debate" brief.


All in all, as much as I want some kind of reform, I can't get behind this bill, which is why I'm glad, I guess, that it has no Republican support (and, as 538.com points out with much better prose, not much Democratic support, either). Back to work, Senators.

What's the Public Option, Anyway?

Fivethirtyeight.com has an essay up about people's misperceptions and misconceptions about the public option, and how it's not even accurately defined in poll questions, much less in the answers of regular voters. So here's my best crack at a short definition of the public option as it appears in the House bill that passed earlier this August:

The public option is a set of government-run health insurance options available to those who make less than 400% of the poverty line and who have no employer-provided health insurance.

Estimates of the number of people who would actually choose this option vary widely, but the range of estimates I see is somewhere less than twenty million, and somewhere more than seven million. No seniors would be affected (although they might be affected by other parts of health care reform). No person would be 'forced' into public option insurance -- there will also be standardized private options made available to the same people.

So when I see people up in arms about socialized medicine, or a government takeover, I feel like there's a certain amount of disinformation at work -- this is a policy that bends over backwards to make sure that everybody gets to choose the insurance they want. It simply creates opportunities for working families, small business employees, and others who make too much to be eligible for Medicaid, but not enough to be able to afford terrifically overpriced private insurance. The argument that the public option will put private insurers out of business assumes 1) that the government-run insurance option will be so successful that private insurers can't compete, and 2) that our system of private insurance is somehow financially dependent on the working poor and the lower middle class -- that they'll collapse if 10-15% of the population, many of whom are uninsured or underinsured, choose a government option. That doesn't, to me, make sense -- how can you price a group of customers out of the market, deny them the opportunity to be covered, and then turn around and argue that you can't survive without them?

For more, here's a description of the bill at OpenCongress and a journalist from the Nation describing the public option.

An End and No End

"For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die."

-- Senator Edward Kennedy, 1932-2009

"I called Blue Shield today to find out when they would resume paying UCLA for Janni's care. Surprise, surprise, they knew nothing about the State's Department of Managed Health overturning their denial. They asked me to fax the letter from the state to them, then told me that UCLA had not sent medical records to them for the last 15 days so they were about to deny care again! I don't understand how they can deny when they have already denied. That would be a denial of the denial."

--Michael Schofield, father of January Schofield, aged six

Awakening?

A short link round-up, today, because oddly -- and I maybe have to chalk this up to more thoughtful parts of the media taking a little bit longer to mull over complicated issues like health care -- there seems to be an awful lot of really good writing about national health care reform in the electrowebs today.

First, a super-brilliant post on Metafilter demonstrating that some of the most untrue stories about health care reform come, in fact, directly from health insurance companies and related industry media organs. The post has links to a John Stewart interview with the originator of the "death panels" story, who one day later resigned from the board of directors of Cantel Medical.

Second -- and I'm not ashamed to say I look to a movie critic as a moral touchstone -- Roger Ebert made a pair of posts (part one, part two) that, among other things, point out that the "end" of the public option caused a big gain in health insurance industry stocks, compare "death panels" to the slogan "king of beers", and find the ethical roots of communally shared health care in Matthew 25, verses 31-46. It's kind of a tour de force.

Third -- Andrew Sullivan has collected and archived his posts on health care, which include the "views from your sickbeds" -- stories of what it's like to go through critical illness with American health insurance.

Finally, this op-ed by Gail Collins isn't as good as some of the stuff above, but she makes the point that the 'Gang of Six' that has been responsible for slowing down reform directly represents 2.77 percent of the American people. Thanks, guys! Allowing a small elite to paralyze reforms that serve the majority was exactly what James Madison had in mind when he argued for a bicameral legislature.

Heavy Is the Chest that Wears the Gunk

I taught myself to use the GIMP to create this masterpiece:

Well worth it, well worth it.

So why junk up a perfectly good centrist? Because centrism doesn't mean chase money and votes in a completely self-servingly strategic fashion. Here's the NYTimes analysis of why Lieberman voted repeatedly to limit damages that could be awarded to people that sue insurers:

"Many of Mr. Lieberman's friends said he had no alternative but to take this position because it was the one favored by the insurance industry. The industry is important to Connecticut's economy and has generously donated to Mr. Lieberman's campaigns over the years."

Well, you know, everybody has constituents, right? At least he's a continuous and strong supporter of private health insurers, right? Lieberman in 2004, during the Democratic primary:

"LIEBERMAN: There is a morally scandalous fact-that that 43 million Americans don't have health insurance, 2 million more than when George Bush became president. I'm proposing to create a national health insurance pool like the one that members of Congress get our insurance from. If you don't have insurance now, you'll be able to get it, probably free, if you're among the low-income working poor. If you're a child, you will be covered by insurance at birth. If you are fired from your work or lose your job, you will not lose your health insurance."

Sounds great, Joe. People really should have health insurance, and since this is the electoral primary and public options for health care are really popular among Democrats, I'm sure this will really help your primary numbers! But what's this business about "probably free"? Oh, right. It's wiggle room, so that he can crawl back to the insurers that fund his campaigns, tongue lolling like an overheated spaniel:

"I don't favor a public option," Lieberman told Bloomberg News in an interview broadcast this weekend. And I don't favor a public option because I think there's plenty of competition in the private insurance market. We have a unique opportunity, a real opportunity to do this year what we've been trying to do for years, which is to reform American healthcare, I think the one thing that will stop that is pressure on the so-called public option. Let's get something done instead of having a debate,"

So the new message is threefold. One: we are doing GREAT. Helluva job. It is absolutely not true that the senators most likely to oppose the public option come from states with the least competition in health insurance or that Lieberman's home state of Connecticut is dominated by Wellpoint, which commands more than 50% of the state market (although the people of Connecticut are fed up -- their state legislature just overrode a Republican veto to establish universal healthcare statewide). Second: Lieberman is on the side of a nebulously defined 'we' -- which doesn't mean Democrats, exactly (Lieberman is technically an independent) or his constituents (see above state policy, which is overwhelmingly supported by residents of Connecticut). I'm guessing that health insurance companies make up a good bit of this 'we', and it's true -- they've been trying to write health policy for decades. Third: shut up already! Why is everybody debating what's best and not just jumping in with some halfhearted, bandaid-on-a-sucking-chest-wound reform-lite package? This, I think, is a very respectful echo of what we could call the Bush Doctrine.

So all told, until you get on board, Joe, you're going to have a chest full of poorly Photoshopped gunk.

EDIT: Also, there is a rhymey bunch trying to kick you out of the Democratic Party.