Is that one sentence clear and concise enough? ;-)

DCBlogger has numerous posts demonstrating that just because you have health insurance does not mean you are going to get the medical care you need. The fact is that a great many people who go bankrupt because of medical expenses do, in fact, have health insurance.

What the bill seems to be morphing into is a way to force people to buy shitty coverage that won't really help pay the bills which means people won't necessarily be getting medical care. As DCB used to say all the time, we need health *care* not insurance. Insurance don't mean jack if there is no care involved.

So long as for-profit insurers are involved "bottom-line beauracrats" will be trying to limit health care.

As BTD pointed out today, the government could increase subsidies to cover more people without mandating people buy insurance. That's not reform, it's simply helping the poor within a lousy system, but at least it doesn't punish those who still cannot afford private insurance (that will likely fail them anyway).

The mandate part isn't about helping the poor, it's about helping the insurance companies. Even if real reform isn't possible, there's no reason to bail out insurers. Look at the banks. They gave them a bunch of money before instituting new regulations so when the time came to try to reign them in, they were fat on taxpayer money and could lobby even harder against reform. If we give insurance companies 11% of all Americans' salaries, we'll never be able to contain them. They'll be even more powerful than they are now.

And Ian Welsh, building on work marcy did, does the math on exactly what not only the Senate bill, but the House bill will cost a family of four earning 300% of the poverty levels or $66,150 (where the subsidy ends). After taxes, shelter, food, and healthcare the family will have about $10,000 a year under the Senate bill and $14,000 under the House bill to spend on everything else (education, clothing, utilities, transportation, debt, etc.). Under the Senate bill, a family would be expected to pay 31% of its income on healthcare. Under the "better" House bill, it drops to a meager 25%. That's a hell of a lot of money for most people, especially when you realize that even after spending that, you could still be bankrupted by healthcare costs.

If you don't have universal coverage, you can't fight diseases like the current swine flu, the possible bird flu, the drug resistant TB, and other communicable diseases.

Just because you are generally safe for the moment from the "killer problems", like heart disease and cancer, doesn't mean that someone in a bar can't cough on you and put you in a hospital. When they plug you in to an IV, every one of those bags of salt water [normal saline solution] is $250 bucks. A week in the hospital with a bad case of the flu and you are wiped out financially.

Does anyone really want to be stuck in a dead end job because they need the health insurance?

People may not worry about illness in their 30s, but how about accidents. Do they ski, scuba dive, sky dive, surf, play sports? What happens if there's an accident? What happens if you get punched out in a bar? How about an unplanned pregnancy?

The big thing is, the more people who are covered, the cheaper it is for everyone. Do you really want the hassle of worrying about this at some point in the future when there's a chance of taking care of the problem for everyone, forever?

for resisting the intergenerational warfare that so many are fomenting and/or succumbing to.

yes, it IS a good thing to cover more people than we do now, but as gqm pointed out insurance isn't care. the massachusetts experiment has resulted in a lot of insured people who can't actually afford to get CARE simply because it's all they can do to pay the premiums. they don't have any money left over for the copays, deductibles etc. i know i've seen links somewhere around the blogosphere about this, but can't remember where. pnhp.org would probably have something.

the netherlands switched to a system resembling mass's [everybody must buy insurance, some subsidies will be included] at about the same time, but they only had about 3% uninsured to start with. now they still have about 3% uninsured, but before the uninsured were people with enough money that they felt they could afford to pay their own bills, whereas now the uninsured are largely the very poor who used to get free care under the old system. this seems to be happening in mass too.

we really do need to fix medicare, including putting more money into it [despite what obama keeps saying about needing to take money out of it] and if we're going to put more money into it [read: raise taxes] why shouldn't we ALL be able to benefit?

all those other countries have lower costs because they have lower prices for health insurance [if it exists] and for doctors, hospitals, drugs, etc. the best way, and the way that almost all of those countries do that, is for the govt to control the prices [in germany the sickness funds, rather than the govt, set prices, but even they are closer to being quasi-governmental organizations than our insurance companies would be even under 'reform']. single payer is very efficient for that.

what anthony wiener said, what value do the insurance companies bring? sure we're rich enough a country that we can give pricey insurance to everybody, but the system IS leaking huge sums of money that we could be spending on the environment, education, and other worthy liberal causes.

those are a few off the top of my head. if you can give us some specific objections that your son [or his compatriots] raises, let us know.

I feel that my best one-line argument is that giving more money to private, for-profit insurance companies, can't be something that liberals would support.

Their argument, as I understand it, is "Isn't it a net good thing if we get more people covered by health insurance."

I'd say, you have to address their "net good" argument, rather than giving your argument.

Your counter is: No, it's not a net good even if some of the result appears superficially to be what you might want. That's like saying: if we collectively paid extortion money to the mob so they would "protect" the poorest and most vulnerable. wouldn't it be a "net good"? After all, the poorest and most vulnerable are now out of danger; they're not being threatened, anymore. Problem solved.

The "solution" shifts the burden to everyone, instead of to those who are causing the surface problem (the "need" to be "protected"), and legitimates (or ignores) and perpetuates the underlying problem (the extortion, or more broadly, the existence of the mob). It makes the situation worse for everyone, even those it's trying to help.

Here's a similar analogy: In some city, say USAville, the mob rents the only available housing, dilapidated as it is, at exorbitant prices to most of the residents and raises its prices at will. The city government turns a blind eye to the arrangement (because it's on the take) but it can't ignore the growing numbers of homeless, including, of course, the most impoverished.

A few reformers in the city propose building city housing but only for those aren't already in mob housing—they say, "if you like your housing, you get to keep it," not mentioning, if you're in existing housing, you have to keep it; they understand the mob/city "relationship." The mob says, "Nice plan but, if you want to keep getting 'campaign contributions' from us, you better jack up your rents to match ours and restrict your housing to lower-income people. And if you give people subsidies for your rentals, they better be able to use them to rent from us as well. No unfair competition! Oh, and, since you're 'fixing the homeless problem,' make homelessness a crime and make everyone to rent." City officials agree and glowingly tout a "basket of housing options." Voilà, homeless problem solved.

Your son's friends are saying, Well, it's a net good. Everyone has housing now.

It's better to fight to clean up the city, end the graft and clear out the mob, or at least, offer city housing to everyone at fair, even non-profit prices, not at mob prices.

I'm not sure if that analogy works but the standard spiel isn't working its magic so there it is. Just viewing something as a "net good" narrowly often leads to bad solutions and unintended consequences. It might not even be a "net good" depending on how big the net is.

control of Medicaid and change the eligibility.

Off the top of my head, and therefore probably not the best plan:

1. Any person residing in the United States whose gross income is below 250% of the poverty level (or any family whose gross income is below 300% of the poverty level) would automatically be enrolled in Medicaid.

2. No deductibles, no co-pays, and prescription coverage included. Any person whose income exceeds those guidelines but who has proof of being denied insurance due to a pre-existing condition automatically qualifies for full-coverage, lifetime Medicaid, period.

3. Eligibility determination is the first day of coverage. No oftener than every five years absent a change of income, eligibility should be re-examined. If a person is brought to an ER or hospital with an acute illness or injury and has no insurance, temporary eligibility is automatic (coverage for all current illness /injury-related costs, with further coverage to be determined after the patient's condition is stabilized; the minimum period of coverage in such instance shall be no fewer than 120 days.)

4. Eligibility will include routine checkups, vaccinations, an eye exam and glasses or contacts annually, an annual dental exam and any routine dental care, and coverage for any long-term medications and associated supplies required (diabetics' insulin or other Rx plus associated supplies such as a glucose testing meter, alcohol swabs, an insulin pen or pump or syringes, and a minimum quarterly checkup to ensure good blood sugar control and prevent complications such as macular degeneration or diabetic neuropathy from going undetected or untreated; asthmatics' Rx; CPAP machines and associated supplies; hypertension prescriptions and checkups no less often than quarterly; all required therapy for injury rehabilitation; all followup medications for catastrophic injury or illness, e.g. antirejection drugs for transplant patients, post-chemo or post-surgical preventive followup medications for survivors of cancer, etc.)

5. Eligibility will include women's health care: an annual gynecological checkup starting at puberty, with mammography as ordered by a qualified provider (FNP, ARNP, OD, MD). In the first trimester, pregnancy termination shall be covered, period.

6. For women whose health (mental or physical) is at risk, pregnancy termination shall be covered, period. (This applies also to pregnancy where complications arise, in which case if the termination can be done via c-section to result in a live baby, not only such delivery and post-delivery care for the woman, but also for the baby will be covered; should a live delivery not be possible, delivery or termination shall be covered, no questions asked; and if the neonate dies, funerary arrangement costs shall be covered. The idea here is that the mother's life is no less important than the fetus, period.)

7. For any eligible adult woman who so desires, a tubal ligation shall be covered. Likewise, for any eligible adult male who so desires, a vasectomy shall be covered.

6. Remuneration for providers:

a. Participating providers shall be paid a set salary per month, which shall be determined by paying at least the same wage a similarly-qualified provider would receive in a state-salaried public-health position. This rate would be subject to an annual increase no less than the COLA provided with Medicare/Social Security payments in a given fiscal year.

b. For those providers who see more than five progam-eligible patients per day for more than 30 consecutive days in any given 180-day period, a clerical assistant's salary will be paid at the rate of two hours per day for every day in which the provider sees five or more eligible patients, to reduce the paperwork burden and allow the provider to spend more time with patients.

c. Any clinician, therapist, or other provider who participates in the program for a minimum of three years can have up to $100,000 per year of student loans from nursing, medical or allied health school repaid -- or any federally-insured student loans including those for undergraduate preparation repaid/forgiven upon participating for a minimum of five years.

d. Hospital fees /room charges will be reimbursed at the same rate as Medicare reimbursement for similar services (and this reimbursement will be raised at a rate similar to the Social Security COLA rate, to be recalculated no less often than every seven years but no more often than every three years)).

e. Any provider whose practice treats program-eligible persons as 1/3 or more of the total practice patients will be enrolled in a national, free-to-the-provider malpractice indemnity program. However, a provider against whom more than two actions for malpractice arise in any fiscal year or against whom in any five year period more than four such cases arise shall be suspended from all participation, including indemnity coverage and loan forgiveness.

That's a start. Y'all can improve on it.