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Chris Bowers asks who's running the country

vastleft's picture

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dblhelix's picture
Submitted by dblhelix on

positioning the public option as not letting the wingnuts win is kind of self-absorbed.

There are three outcomes at this point:

1) an exchange w/ subsidies tied to the silver level.
2) an exchange w/ subsidies tethered to a separate low-income product (like Commonwealth Choice vs Commonwealth Care)
3) an exchange like Commonwealth Choice w/ low-income/uninsurable tethered to something called "public option" -- which pretty much is like high-risk pools today.

BaucusBill sets up a high-risk pool that will dissolve in 2013. So the high-risk pool will either get into 1) 2) 3) come 2013. What's best?

1) fairest -> probably a little more expensive for the rest of us
2) at least higher income w/ pre-existing get into "Choice".
3) High-risk pool + low-income seed so-called "public option" which will never be competitive. Who wants to join a ghetto?

As far as running progressive activism is concerned, that's a different story. I don't think you can be an activist and live off of ad money from reactionary forces. I think it's that simple.

Now, we know that we're getting a bad bill. I favor 1) above -- I don't want to see the concept of a real public insurance plan get trashed by 3) -- but regardless, the bill is gonna suck.

For months, much of the action on the blogs has been a mix of astroturf and real people. The political blog audience isn't that large. As the details of the bill are understood, you're going to see some pissed-off people. It'll get worse once 2013 rolls around. At that point, it's good-bye "progressives" because that's who'll be associated with this bailout.

I won't be upset. I'm really tired of this "fighting wingnuts" business -- at the end of the day, I have a real life and legislative bills have a far greater impact than "wingnuts" or "teabaggers" ever will. It's churlish at this point to pursue bad policy to prove some kind of a point. I would feel differently if Obama, or progressives, or someone would be kind enough to explain how a pool composed largely of medically uninsurable and low-income members scales up to become "competition" but nobody's doing that -- nobody's even trying to.

dblhelix's picture
Submitted by dblhelix on

thru that post and the comments. I disagree w/ the general sentiment that some sort of higher principle is involved -- like elevating progressives or beating wingnuts. Progressives had their shot a long time ago. Wingnuts? If I were given a choice between this bill (any form) vs hanging out with some 'birther' with a huge gut on a Harley, well, get the motor running ... head out on the highway ... looking for adventure ...

vastleft's picture
Submitted by vastleft on

And I think you have a great point that a life-and-death policy issue has been reduced to a game. I just wanted to clarify what your one-word title was disagreeing with.

dblhelix's picture
Submitted by dblhelix on

I went through it but could not find pricing info (unlike Choice). I'm assuming that it isn't 100% subsidized for all eligible.

What I noticed is that there were very few options -- 5 plans, and not all available in all locations.

If 2) is better than 1), that's fine. Do you know people on CCare who have given it a good review?

My initial reaction to it was something like my reaction to reasonably priced housing in my county (a county susidy program). You always know which houses get set aside as "moderately priced" because they're missing things like washers/dryers. Geez, just because you have a moderate income doesn't mean you don't do laundry! In this country, "low-income product" usually means a whole lot of people decide that you shouldn't get too much ...

mass's picture
Submitted by mass on

Care is the subsidized state insurance. I know lots of people on it. They are seeing some increases, but nothing like they would pay under Choice. People basically really like it. It's also our Medicaid. It's all rapped up in one. I don't know anyone who pays premiums for it, but I assume some do. To qualify you have to be less than 300% FPL. It's true, not all docs take it, but I don't know of any of the teaching hospitals who don't. It's definitely a better deal than Choice, and more cost effective for the state.

vastleft's picture
Submitted by vastleft on

For the working poor, not so much:

[Consider the scenario of] a 58 year old female working as a nurse’s aide in an organization that doesn’t provide health insurance. According to the law, the company employing her, in a worst case scenario, is fined $295. The nurse’s aide is forced to buy health insurance from the Connector, which would cost between 14% and 35% of her income, provided she doesn’t need to actually use the health care system, in which case it will cost more. If she requires hospitalization, it is likely she will have to declare bankruptcy if she chose the plan that costs 14% of her income, because she will be required to pay 20% of the hospitalization cost. If she chose the plan that cost 35% of her income, her remaining wages couldn’t possibly sustain her in Massachusetts.

We know that overwhelmingly the people who choose to purchase health insurance through Commonwealth Choice (the plan for those who do not qualify for subsidy, like the nurse’s aide), choose the cheaper plans. But many more have chosen to not buy into Commonwealth Choice. Chapter 58 anticipated this, and created fines to prompt people to buy into the system.

Everyone who reads the Commonhealth blog knows that this year, a person who refuses to participate will be fined $912 (3% of the nurse’s aide’s income). Perversely, the nurse’s aide will pay this fine, pay state taxes to support the health reform system, and not be eligible for reimbursed medical care.

dblhelix's picture
Submitted by dblhelix on

frankly, the fines are just another way of keeping premiums lower for the higher-income/healthy group (much like a "public option" could well serve the same purpose). I have a real problem w/ soaking the working poor, kind of in the same way I think we've gone overboard on using gambling for revenue, ciggie super-taxes, and so on.

vastleft's picture
Submitted by vastleft on

We wouldn't be scrutinizing the plan coming out of a Hillary Clinton administration and criticizing the details by which it got to "universal," and we wouldn't be busting her if she promised an open and transparent process and didn't follow through.

Because for so many progressives, it's about tribe and not policy. They expect that we're wired the same way.

dblhelix's picture
Submitted by dblhelix on

are the cuts targeted?

One thing is when you have everyone under the same program, everyone pays attention to the spending cuts.

If you segregate low-income, when they get slapped around, people tend to ignore it.

There's probably a lot of arguments to be made for 1) vs. 2).