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Kill the Bill: Nine Reasons

letsgetitdone's picture
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Here are nine reasons the Senate health care reform 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 on 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. (Note 2) 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). (Note 1) 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 bill facilitates the march of the American political system away from Democracy and toward Plutocracy. By failing to curb rising premium costs in the period up to 2014, the bill adds further to the income insurance companies can use to block further health care reform. So, it hurts the sustainability of health care reform and it's ability to gain strength over time. This highlights another progressive core principle violated by the bill. Every bill must be evaluated in terms of its political effect on democracy, and whether or not it facilitates the evolution of American democracy toward Plutocracy. Bills, like this one, whose effects will be to weaken rather than strengthen the sustainability of democracy, ought to be opposed in principle by progressives.

9) 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 of 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 1: That is, the appropriate precedent for incremental change is not SS, as "progressives" keep telling us, but AFDC.

NOTE 2: 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.

(This post began as a comment on a post by khin, was revised by lambert to sharpen up some of its points at correntewire, and was revised again by me for this posting. So, it's a serial collaboration.

(Also posted at firedoglake.com and the Alllifeisproblemsolving blog where there may be more comments)

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DCblogger's picture
Submitted by DCblogger on

ladkiddo

I’ve said it before and I’ll say it again, this bill, if passed will be an albatross around the neck of the Democratic Party for years to come. This is not an instance where passing anything is better than passing nothing.

Submitted by lambert on

.... "IRS as a collection agency" propagated. If we didn't do that, we were certainly early adopters.

khin's picture
Submitted by khin on

lets and I talked about this over at FDL, and he said it was a valid tenth reason even if not something that was too important to state explicitly. But I think it's extremely important to state, and is actually my biggest reason, so here's reason #10...

10. We can probably pass a bill in the Senate via reconciliation. Obama and Reid have just spent six months negotiating a health care bill and so they almost certainly feel that not passing anything at this point would be a political disaster. Therefore, they very likely will cave in and pursue reconciliation if forced to do so. Although as Nate Silver has pointed out, it is quite possible that senators like Nelson and Lieberman would vote against any non-reconciliation follow-up containing other provisions, these also happen to be the most flawed provisions of this bill, so no one should be shedding any tears if we wait on them. This would be the best of both worlds: we pass provisions like the Medicaid expansion and Medicare buy-in now, avoid passing the most flawed provisions, and the Democrats also avoid a worst-case political scenario.

letsgetitdone's picture
Submitted by letsgetitdone on

Reason no. 10 it is.

a little night musing's picture
Submitted by a little night ... on

why you think this:

we pass provisions like the Medicaid expansion and Medicare buy-in now, avoid passing the most flawed provisions,

is a likely outcome of reconciliation? Why wouldn't reconciliation just lead to parts of the existing bad bills being slapped together? Why would they make it into a better bill than nay we have seen?

This seems unlikely in the extreme to me.

letsgetitdone's picture
Submitted by letsgetitdone on

Reconciliation is restricted to bills with a major budgetary impact. So regulatory provisions can't be taken up without waiving the Byrd rule. Neither can the mandates, nor the insurance exchange, since these are regulatory. So, all that can be considered under reconciliation are things like expanding Medicaid and Medicaid, establishing a PO, and/or having subsidies. Once these are passed with 50 + 1 votes, then they can worry about the 60 vote bills needed for regulation. So the irony is that the legislation we really need to cut the insurance companies out of the action in certain population segments, to give people subsidies, and to perhaps create a public program to compete with the insurance companies can all be passed with 51 votes.

You might ask well don't we need regulations on the insurance companies? My answer is that it depends on how many people we take away from their market and how many others within that market we give the choice of a PO to. If we do a good job with that before we tackle regulations, then they will have the choice of accepting regulations, or seeing everyone sign up for the PO. In other words, if we get reconciliation done first and done well enough, we can give them Hobson's choices.

a little night musing's picture
Submitted by a little night ... on

that what would emerge from reconciliation would be what you say. I just don't see the "leadership" having any interest in expanding Medicare, for example. (Medicaid, sure, because it is "welfare".)

And, if regulation of the insurance companies cannot be part of the reconciliation package, that means no elimination of recission, no guaranteed issue, no caps on out-of-pocket expenses... I don't think these are throw-away items. Certainly not if any "public option" was as weak as what we've ended up with in the House bill - which, again, seems to me to be the most likely outcome.

I'm sorry, this still just seems like a species of wishful thinking to me.

Submitted by gmanedit on

10) This bill is profoundly antidemocratic.

katiebird left a wonderful comment at, I think, Suburban Guerrilla (sorry, can't find the post): "I wish I understood more about the relationships between subsidies & premium limits & total health care expenses. Oh, and just WHAT is included in the various gold/silver/rusty-metal plans."

It goes against the American sense of fairness that we're being segmented into these faux-Olympic tiers.

And just what is included? Will a healthy young bronze-policy holder who gets hit by a bus get whatever they need without being ruined financially, or be refused some treatment because they are carrying the wrong color card?

letsgetitdone's picture
Submitted by letsgetitdone on

The Democrats are becoming profoundly anti-democratic. The Whigs have taken over the Party.

Submitted by gmanedit on

The Senate bill allows a premium charge of 300 percent for older folks. Isn't age a preexisting condition?

letsgetitdone's picture
Submitted by letsgetitdone on

That's interesting, isn't it. Age discrimination is prohibited in Federal programs according to law. So, the immediate legal question raised by the bill, is whether insurance companies will be able to both accept the subsidies and then have price discrimination by Age.