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Kill the bill: Eight reasons

[If the Senate's going to vote on the bill at some point in the wee hours of the night, tonight, it couldn't hurt to give them a call and politely share your views. --lambert]

[I'm going to shorten letsgetitdone's great comment here (hopefully that's OK), make it a little bit more lambert-esque, and immodestly sticky it. -- lambert]

Here are eight reasons the bill should be killed:

1) The bill gives almost no real help 'til 2014. In the short term, the bill does nothing about the fatalities, bankruptcies, and foreclosures that come from lack of insurance. Therefore, the very title of the bill -- "The Affordable Health Choices Act" --is a lie, despite band-aids for children and young adults, because the bill doesn't get people care in the short run at an affordable price that will protect them from financial ruin.

2) The bill guarantees price-gouging through 2014. The bill doesn't address the problem of insurance company rate increases from 2010 'til 2014. Based how the insurance companies have always behaved, we will see insurance premium increases from 50-75% in that time frame. That will increase the average annual cost of family coverage from the current $13,375 to $20,000-24,000.

3) The bill sells out women's reproductive choices. This is not something progressives should ever agree to, since it is a core principle of progressivism.

4) The bill forces people to buy a defective product. After 2014, the bill forces people to buy junk insurance they can't afford from private insurers. The subsidies don't do anything about high out-of-pocket costs, which will be great enough to drive middle class people into bankruptcies and foreclosure, especially since lifetime caps are still permitted. Further, the subsidies are not high enough to make insurance affordable except in the judgment of millionaire legislators who have no understanding of middle class family budgets. Worse, there are no enforcement mechanisms for the few regulatory changes that are made.** And since the bill frames health insurance as a means-tested subsidy -- that is, as welfare -- the already inadequate subsidies will be under constant assault by conservatives (both D and R).* And all that's before the insurance companies figure out new ways to game the system.

5) The bill will not cover 30 million additional people, as the access bloggers and career liberals keep repeating. The subsidies are not indexed to rising insurance costs, and therefore insurance even with subsidies will become increasingly unaffordable. In my view, it's doubtful that more than 15 million will be covered. Since US population will be increasing over time, we can expect the total number of uninsured to grow over time, so even after 2014 and taking into account the 15 million additional people covered, we will still be looking at 35 million uncovered, and 35,000 fatalities per year due to lack of insurance.

6) The mandate cannot be enforced. The IRS isn't really a very effective collector. It collects only a very small percentage of debts each year now. If there is widespread non-compliance with the mandates, the IRS won't be able to enforce them. In one way that's good. However, the IRS presence will be a constant irritant to people, and in addition, widespread non-compliance will increase the widespread disrespect and cynicism we already see with respect to our laws and their enforcement. Moreover, such enforcement as there will be cannot be done fairly or consistently.

7) The bill does not decrease the share of GDP being spent on health care. It's now about 17.5%. If GDP averages 3% growth over the next four years, which may not be the case if we have a double-dip recession, we're looking at health care costs outrunning GDP growth by probably about 7% per year. By 2014, health care expenditures could be about 22-23% of our economy, while other nations are still at 12% or so. This will make the US even more uncompetitive in international markets than we already are.

8) The political FAILout will kill real reform. In the short run, the bill makes it much more difficult to pursue real solutions to health care reform, because the elites and their enablers will whine about how hard they worked to pass this bill, and about how everyone should just wait until 2014 to see how things work out. In the longer run, the inflation in premium costs, the waiting period of four years while costs increase, and the actual experience of the system beginning in 2014, will all persuade people that it's useless to expect Government to help people with their problems. This bill is potentially a killer for progressive politics, if we let the Administration push us into the obvious wait-and-see posture that they expect from us.

In summary, we need to work as hard as we can to defeat this bill, and if we can't convince any Senators to kill it, then we have to come out the box in January breathing fire about how bad it is, and how much it needs to be repealed before the elections of 2010, and replaced with enhanced Medicare for All.

NOTE * That is, the appropriate precedent for incremental change is not SS, as "progressives" keep telling us, but AFDC.

NOTE ** The talking point that the bill will mandate that 85% of premiums be spent on actual health services means nothing unless there is enforcement, which there isn't. I'm guessing that the likelihood of the insurance companies opening their books to the Fed is the same as the banksters doing so: A big fat zero.

UPDATE Franken. Now I know why that YouTube of Franken + Lieberman + McCain was floating around. There are a lot of points that refute Franken above, but the most important one is the 30 million covered, which Franken uncritically repeats. Oddly, or not, Franken doesn't mention how the bill sells out women.

UPDATE Here's a fine laundry list of incremental improvements, which the author seems to sincerely believe will go a long way to restore faith in a process that left $350 billion on the table and sacrificing 35,000 lives a year (granted, down from 45,000) on the altar of health insurance company profits. Think of the increments as loot for the local barons. And think of the dead as peasants. That will help.

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CMike's picture
Submitted by CMike on

It does look like at reconciliation we'll end up with a requirement that insurers would immediately be prohibited from excluding health coverage for children due to pre-existing conditions and coverage of young adults on their parents’ policies through age 26.

See "Immediate Reforms" in the 4 page pdf summary of the House bill here

See "Medical Loss Ratio and Insurance Coverage" in the Reuter's Factbox here

Submitted by lambert on

I changed "no" to "almost no" and fairly characterized the other changes as a Band-Aid.

Valhalla's picture
Submitted by Valhalla on

why couldn't we have the few beneficial provisions without the linkage to mandates and 1-8 above?

A few more specific reasons to kill the bill:

1) they pulled out the language barring lifetime caps

2) no enforcements mechanisms to make insurers do the few 'good things' they're supposed to do. (Avedon)

3) huge Medicare cuts via the untouchable "Fed for Medicare". (Cannon)

4) taxing "Cadillac plans" (aka comprehensive care, Ian), which is just propagandaspeak for "screw the unions".

I like Lets' list because it's comprehensive and covers the main general points. Just wanted to throw out a few specifics too.

I'd also add that once everyone understands the mandates, sees their premiums rising, and that most of the 'benefits' don't kick in for 4 years, there'll be an awfully ugly backlash for the Legacy-D party, except I'm kinda looking forward to that part.

illusionofjoy's picture
Submitted by illusionofjoy on

Rumour has it that the Senate is set to vote on this beast at 1:00AM tonight (aka: obscenely early Monday morning). If ever there was a time to flood the offices of Senators with calls, it would be now.

Incidentally, while I was able to leave a message for Bob Casey Jr., Arlen Specter's voice mail box was full. I emailed the latter instead.

I fear that we may soon have to shift from "kill the bill" to "repeal the bill."

DCblogger's picture
Submitted by DCblogger on

and after it comes out of conference committee it has to be passed by the House and then the Senate.

so

we have time to whip up the opposition, or at least do as much as Corrente can do.

Anthony_JKenn's picture
Submitted by Anthony_JKenn on

There more than likely won't be any conference....Obama and Rahm Emanuel will simply lean on Pelosi and Hoyer to force a straight up-or-down vote on whatever passes the Senate...and the House passed bill will be rendered irrelevant.

A few threats of loss of earmarks or reelection financing shoud silence enough "progressives" to do the job....and caving in to the original Stupak amendment should do the rest.

Obama has to have that signing ceremony before Christmas or New Years, you know.

Anthony

DCblogger's picture
Submitted by DCblogger on

create a phony deadline which must be met, force vote without discussion and complete disregard to law and procedure.

Submitted by lambert on

That's exactly what's going on.

Submitted by hipparchia on

i wish i knew who the first "strategist" was who thought the democratic party needed to move right to compete with the republicans for votes [they're obviously outclassing the republicans in stupidity these days].

letsgetitdone's picture
Submitted by letsgetitdone on

Thanks Lambert for excellent revisions of my list, and thanks to everyone for commenting and especially to Valhalla for some very nice additions.

Lambert can you send the html of your revised list? If so, I'll post it at FiredogLake and AllLifeisproblemsolving.

Submitted by lambert on

I sent you a zipped file of the full HTML.

You may wish to edit or remove the bracketed material up top.

khin's picture
Submitted by khin on

...is that as I consider my position on this bill, the biggest reason I can see to support "killing the bill" is not on the list here. The biggest reason is: it's hard to imagine Obama and Reid just accepting a Clinton '94 redux without using every measure they have at their disposal, up to and including reconciliation. In other words, we can do better than this bill. I still don't agree that the bill is worse than nothing--the arguments above mainly show that there is tremendous room for improvement, which I already agreed with, but the question is whether we'll get it if we kill this version. Now that I've thought about it in response to letsgetitdone's reply, I'm currently leaning toward that we will.

letsgetitdone's picture
Submitted by letsgetitdone on

You're an open-minded sort.

Submitted by Elliott Lake on

People will be forced to pay money they can't afford to spare for crappy coverage, and Obama and his buddies will move on, saying, we did health care, give us a gold star, now shut up. And Congress will do the same--it will be a long time before it gets revisited ("wait and see how it turns out before you complain", "I trust Obama", etc.)
We're screwed. Being able to say I Told You So isn't enough solace.

jumpjet's picture
Submitted by jumpjet on

If they won't take health care reform back up, we'll replace them with presidents and members of Congress who will. If we fight for what we want, not what they tell us we should want, we'll get it if we're ferocious and persistent.