The health care law has emerged as a defining issue in the U.S. Senate campaign between Democrat Lee Fisher and Republican Rob Portman.
Fisher said he would have voted for the law, which when fully implanted in 2014 will provide health care coverage to millions of uninsured Americans.
But Portman has assailed it as a “new entitlement program we can’t afford,’’ and is vowing to vote to repeal the measure and “replace it with something better.’
Portman ticks off a list of ideas he insists would reduce crushing health care costs – limiting damage awards on medical malpractice lawsuits, offering refundable tax credits to help low and middle income people buy insurance, allowing small businesses to band together to buy less expensive policies, and permitting insurance companies to sell across state lines.
It would be so great if conservatives would find out what’s in the health care law before opposing or commenting on the health care law. I’m not even talking about reading the actual law, because it was really heavy to lift, as they demonstrated to us many times, and very long and complicated.
I’m talking about doing any reading, at all, on health care reform.
Currently, states regulate insurers. Liberals feel that’s too weak and allows for too much variation, and they want federal regulation of insurers. Conservatives feel that states over-regulate insurers, and they want insurers to be able to cluster in the state with the least regulation and offer policies nationwide, much as credit card companies do today.
To the surprise and dismay of many liberals, the Senate health-care bill included a compromise with the conservative vision for insurance regulation. The relevant policy is in Section 1333, which allows the formation of interstate compacts. Under this provision, Wyoming, Colorado, Arizona, Utah, and Idaho (for instance) could agree to allow insurers based in any of those states to sell plans in all of them. This prevents a race to the bottom, as Idaho has to be comfortable with Arizona’s regulations, and the policies have to have a minimum level of benefits (something that even Rep. Paul Ryan believes), but it’s a lot closer to the conservative ideal.
I don’t know if it’s sheer laziness or deliberate bad faith, but this seems to be Round Two of the conservative campaign to misinform on health care reform.
Further:
“Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.” This is the very purpose of the exchanges, as defined in Section 1312. Insurers are required to pool the risk of all the small businesses and individuals in the new markets rather than treating them as small, single units. That gives the newly pooled consumers bargaining power akin to that of a massive corporation or labor union, just as conservatives want. It also gives insurers reason to compete aggressively for their business, which is key to the conservative vision. Finally, empowering the exchanges to use prudential purchasing maximizes the power and leverage that consumers will now enjoy.
There’s also a tax credit for small business, and the largest single provider of primary care in this country, federally-qualified community health centers, are protected from malpractice claims under the Federal Tort Claims Act.
When you hear “repeal and replace” think “death panels”. Same thing.
El Cid
Reminder: the interminably stupid, offensive, ultra right wing and honored CNN commentator Urk Urkson argued that there really are death panels, they’re in the FDA, because they aren’t approving quickly enough the a seemingly successfuly anti-cancer drug.
Also, SOSHULLISM! OBAMA = HITLER!
Tax Analyst
I vote for “bad faith”, it’s pretty much the watchword for the GOP these days.
cleek
if the Dems knew fuckall about messaging, they’d have started a huge informational campaign six months ago, outlining what it is the HCR does. they’d mail out brochures, they’d buy blocks of TV time, buy segments in major magazines, absolutely flood the country with information.
alas
4tehlulz
It’s deliberately lazy bad faith.
Chad N Freude
Laziness vs. bad faith = breath mint vs. candy mint.
Alwhite
Having dealt with Congress critters for 50 years I would say that a very large majority of them have no clue what is any bill they vote on. They rely on staffers and party leaders to tell them how to vote and then how to run, for or against the bill. Thats just lazy.
This is one of the reasons opinions like those in the DC Post are so critical, its one of the few places that can pop the balloon. The dishonesty has to be called into account but can’t be until facts penetrate the beltway.
General Stuck
What wingnuts hate most about the HCR is universal coverage. It is an ideological kick in the stomach to their dog eat dog mentality. Or, that maybe somebody might get something free. They don’t need to read the bill to know they hate it mostly for this reason. It was the circle closed on The New Deal, the last stand of opposing a completed national social contract with the country, the entire country.
The items that will give the plutocrats heartburn are important on the no no list, but universal coverage for health care goes directly against their core beliefs. And besides, the plutocrats got a mandate to make them unwholey and are mostly just nervous about big change, that now they will have to milk the profiteering tit with the other hand.
edit – and now we will all wait if the regulatory regime put in place will work to lower overall HC costs. I kind of doubt it without a non profit choice within the relative protection of the federal umbrella. Hope I am wrong,/
bago
OT, but fun article on “zee mosque”.
http://www.guardian.co.uk/commentisfree/2010/aug/23/charlie-brooker-ground-zero-mosque
Kryptik
@El Cid:
Is that the same drug that was pulled because the side effects were too great for its comparable use? Sounds like another one of those ‘DEREGULATION NOW!’ arguments.
Then again, no surprise. And no surprise that the Tort Reform bandwagon keeps on rolling and growing despite having no ox to pull it with.
On an OT note: Tomorrow, barring rain, I’m finally gonna drop down into the mix of the protests at Ground Zero. My sign ideas: “Radicalism Is The Real Enemy (Whether Muslim, Christian, or Pastafarian)” and a wholly snarky, almost mean one: “I Support Hummus (Because It’s Delicious).”
I’m simply worried about the snarky one being misread and ending up on Newsbusters or something because of some ‘Dumb Motherfuckers’.
J sub D
and
are not the same thing at all. But you knew that, didn’t you?
Chad N Freude
@cleek: And what makes you think the Democratic candidates understand what’s in the law? Any candidate proposing to replace things already in the law with things already in the law is setting himself up for a lesson in humiliation, if only the Dem was capable of pointing it out.
kay
@J sub D:
May people purchase health insurance across state lines?
Yes.
Wisely, the people who worked on the health care law decided not to turn health insurance into the credit card industry, so they crafted a provision to avoid the inevitable race to the bottom that conservatives were hoping for.
El Cid
@Kryptik: I don’t know. After a few minutes of Urk Urkson the brain gets fuzzy and I become aware of a growing nauseousness, and it’s these qualities which make him such an excellent Macon, GA councilman and CNN commentator.
Martin
And now there are Rob Portman ads on the site. I’ll consider it a feature as I will now recognize the guy if he’s elected or I spot him in a crosswalk while driving to work.
ricky
I don’t know if Obama is a Muslim or Kenyan but if I say he is, the sheer lazy will follow me whether my faith is deliberate or accidental as long as it is repeated often enough.
cleek
@Chad N Freude:
well i don’t. but i’d expect candidates would learn, along with the rest of the country, from the campaign.
debbie
Portman proves himself to be nothing more than an empty suit. I recently saw his political ad which included a tagline of “Now That’s Change!” Ha! His real tagline should be “Change Back to the Way It Was.”
I think jobs may matter even more than health care reform as an issue in Ohio. Last week, I listened to an interview with Kasich about how he was going to bring jobs to Ohio. He replied that he’d sit down with business leaders and work out all kinds of deals “on their terms” (his words). Combine that with his plan to turn the Ohio Department of Development over to a group of 12 CEOs with all kinds of independent authority, and we see just how regressive the Ohio Republican Party has become. I don’t think this kind of whoring out to corporations is going to go very far here.
Zifnab
If it’s laziness and bad faith, then Fisher should have no trouble knocking it down. Bottom line, Democrats should be able to clean the clocks of any Republican making arguments this terribly off base. They should have tv ads centered around it. They should have teams of people showing up at opposition events handing out literature saying, “Your candidate supports our legislation, at least in name, but doesn’t have any clue that it’s already on the books.”
“Republicans are idiots” should be a freak’n center point of every Democratic race in the country right now. Republican policy is absolutely horrid. There is no excuse for a Democrat’s message team to be losing, short of a money landslide in favor of the opposition (the California governor’s race, for instance, gets a pass).
Martin
The HCR bill doesn’t allow for the purchase of policies across state lines in the sense that people expect. Yes, it does allow and encourage states to form compacts which allow policies to flow across, but the burden is on the states to do it (which I think are unlikely except in smaller states), and then on insurers (who are usually pretty happy with the state-level monopoly they have under the existing policy in smaller states). It’s not a right given to the individual, so I would say that this bill doesn’t provide for consumers to buy across state lines in a meaningful way.
You’ll see it done, particularly in the situation of insurers that have multi-state monopolies. The existence of those monopolies demonstrate where state laws are already reasonably close and where a compact would be easy to achieve. The insurer will sell the ability to eliminate costs by cutting their number of policy types in half without disrupting consumers, and you’ll end up with policies sold across state lines with absolutely no more choice for consumers than you have today.
It’s a step in the right direction, but a much smaller step than people credit it for. Breaking the state control of insurance will be very difficult, and the Senate in particular, are disinclined to help that along as representatives of their state more than representatives of their voters.
kay
@Martin:
I don’t agree with the idea of “breaking the state control of insurance”.
Insurance was regulated at the state level for a reason: people were getting robbed. I haven’t seen anything to indicate that allowing a race to bottom would benefit consumers. They’d purchase the least expensive policy in the least regulated state and the insurer would pick the state law it would be interpreted under.
States have an interest in their citizens not purchasing crappy insurance. The under-insured citizen is then going to rely on the state they live in (not North Dakota) to provide health care. They aren’t going to be showing up in the red state’s emergency room, when they find out the policy is garbage. They’re going to be showing up in the blue state’s emergency room.
Zifnab
@kay:
Well, it’s tricky.
Right now we’re having a grudge match in the Senate and the White House over who will run the Consumer Credit Protection Department. The person who heads that department gets to make rules that affect credit card holders nationally. The way insurance companies are divided up now, a lot of the HCR regulations seem like they will still take place at the state and local level.
When any given state has a single insurance company dominating 70%+ of the market anyway, are we really losing all that much if they all consolidate down to a basement in Delaware?
kay
@Martin:
Who got stuck with the bill on all those foreclosed houses, when national lenders swept in and wrote all those uncollectable loans?
The state where the property was located.
The same thing would happen with health insurance.
kay
@Zifnab:
We try this again and again, it fails again and again, yet hope springs eternal.
It’s those pesky state regulators that are making X too expensive.
Church Lady
The tax credits for small businesses are not all they are cracked up to be. My understanding (and that of our accountant) is that, in order to get it, you have to have less than 17 employees and their average wage has to be less than 39K. We have 19 and we pay more than starvation wages. He says that, as written, we won’t qualify. I hope that is one that gets changed for the better. As it stands, not a whole lot of small businesses will qualify and we are being crushed on the the cost of providing health insurance to our employees.
kay
@Church Lady:
Well, Portman isn’t offering a tax credit for small business.
He’s offering a tax credit for low and middle income individuals.
For you, he’d like you to be able to “band together” to buy a cheaper policy. I don’t know why you can’t do that on an exchange, and I would suggest the pool will be bigger if individuals and small business are in it.
Martin
@kay: I’m not arguing that regulation of insurance by the states is a bad thing. I’m arguing that getting them to cede that authority and control to the feds is going to be very difficult. As it stands, they use that control to ensure that there are insurers dedicated to the state – both for the benefit of consumers and to ensure that insurance is a solid part of the job base. In most small states, insurance is at least 5% of the labor market. If those states allow policies to be sold across state lines, what of those jobs? Do you think Nebraska, and Ben Nelson are excited by the prospect that 5% of their job market might flee to Iowa or NY or CA?
Martin
@kay: Well, we already have national insurers. They write 50 different policies in 50 different states, and have the actuaries and adjusters to support that, and they’re all for-profit, IIRC. Any large corporation is buying insurance from them rather than negotiate with 50 different insurers.
But the current system isn’t helping keep costs down. It adds enormous overhead to the national players and it creates monopolies within the states which wipes out competition there. The national players know they don’t need to compete that much with the local ones because their customer bases are pretty different.
There really isn’t a great solution as you have artificial markets (the states) fucking up a more natural marketplace, and you have a regulatory nightmare that’s 75 years in the making. Even going to federal regulation is going to be hard because Alabama isn’t going to be too tolerant of California’s vision on health care and v/v, and you can’t get this passed without getting a reasonable representation across states. That’s why this is SOOO much easier in the House.
J sub D
@kay:
I know, just like with credit cards, people are just too stupid to shop around for health insurance. It’s best if we have the wise and benevolent federal government micromanage these things.
Excuse me while I go barf.
kay
@Martin:
There are minimum federal requirements within the law that raised the bottom in Mississippi and (will probably) lower the bottom in California.
I’m not looking at it from the market side. I’m looking at it from the regulatory side.
Even if there were a tough federal requirements scheme, what’s to say there wouldn’t be two huge national insurers at the end of all this deregulatory fevor?
They were hoping to avoid that, by having a state join with at least one other state. They think they’ll get some competitive action, without the monopoly downside.
kay
@J sub D:
Well, it’s different than credit cards. It’s worse. When you buy your cheap North Dakota policy, you’re going to end up in your state of residence emergency room, on their Medicaid program.
They have an interest in making sure that doesn’t happen, because whether your policy is worth anything or not, you’re going to receive medical care not in the state of purchase, but in the state of residence.
States ended up mandating minimums on auto insurance not because they give a rat’s ass about holding your hand, but because the state was ending up with your bill.
Warren Terra
I just love it when people claiming to offer ideas for controlling healthcare costs suggest capping malpractice claims – it’s practically a cast-iron guarantee that they’re morons, or that they think their audience members are.
We’ve done the experiment, in huge states: capping malpractice awards has no effect on medical inflation – none whatsoever. It isn’t even effective at reducing malpractice premiums (turns out the biggest decider there is the rate of return in the stock market that the insurers are getting on the float from their banked premiums).
There are good reasons to suggest that we practice too much defensive medicine in this country, and a cost-benefit analysis might even indicate that we should be more accepting of the occasional medical error. And maybe as part of revamping the culture of medicine and medical education along such lines malpractice suits might need to change. But capping the awards demonstrably does nothing towards this – indeed, it’s hard to see how any capping mechanism that left room for the redress of legitimate claims could, or whether it should.
kay
@J sub D:
You’re taking this weirdly personal. It’s not that states or the federal government want to manage your purchasing decisions because they care so deeply about your welfare.
They just know you’ll buy the cheapest available policy and stick them with the bill, because they can’t turn you down for medical care.
It’s really not an ideological decision. It’s about the money.
Warren Terra
@ Jay sub D
By letting credit card companies shop around for the state with the lowest standards, we wound up with legalized usury, and companies flinging cards like confetti to trap the least wary consumers. But at least – even after Congress was convinced by the usual lobbyists to make personal bankruptcy harder – you can still declare yourself bankrupt.
If we get a similar race to the bottom among state regulators of health insurers, with low-population and traditionally regulation-unfriendly states offering lax rules in order to host the nation’s health insurers, so we get the medical insurance equivalent of our predatory usurous credit card issuers, what will be the equivalent of declaring yourself bankrupt? Declaring yourself dead?
The whole point of health insurance, even more so than other catastrophic insurance, is that you need it to cover and to help you at a time when you’re likely vulnerable and confused and you’re entering into a whole realm where you don’t really know what’s necessary. You need the insurer to be plausibly on your side, not to be some rapacious ghouls who’ve discovered that the regulatory framework of the American protectorate of Palau is usefully lackadaisical.
Martin
@kay: The problem is that the states are not disinterested parties here. Sure, MS might come up and CA down, but it’s the details that matter because it’s the details that get fought over. What kind of coverage for birth control, for abortion? Those are the places where states dig in because those are the issues that get people elected. And the matter of jobs can’t be discounted because the issue works is way out to the federal level. Nelson doesn’t opposed HCR because he’s a big dick, he opposes it because insurance is still a big industry in Nebraska and federalizing it is a downside risk for his state, and 1 out of every 12 voters in Nebraska works in that industry.
Personally, I favor nationalizing health care. I favor doing away with the regulatory hurdles that some states put in to regulate behavior that they know they can’t outlaw. Be aware, however, that this is not without risks. The more national insurers become, the more national care providers and suppliers will become. The system will favor those that can write national contracts vs local ones. The local pharmacies will get seriously squeezed, the local hospital run by the church, even the public hospitals run by universities are going to have to work harder to get equal participation. Places like Wyoming, that are currently protected by an artificial market, will have a harder time getting good coverage as insurers will favor more ‘efficient’ markets, and efficient markets are not good for anyone in the minority – be that demographic, geographic, or based on market needs.
In such a system, it’s necessary to have state and local influence. But it needs to be appropriate influence, and I’m not at all sure how to achieve that. I’m concerned that in a not-government-run national system, that rural areas, that groups like native americans, that special-need patients, that people in unusual occupations – all of these groups will come out worse off. Yeah, we’ll bend the cost curve, but at a pretty high price. The only thing I see that might hold that outcome off is Medicare – it’s large enough to force necessary inefficiencies into the market.
Martin
@Martin:
Just to make my point here clear to Kay – it’s related to your point in #32. A nationalized system has the potential to fuck over communities and small states leaving them with the bill for care. Somehow they need to have some kind of influence to ensure that doesn’t happen – either directly (something they can vote on) or indirectly (guarantee a certain level of services for a given population, etc.).
kay
@Martin:
I think this is a fair compromise.
One of the things that interested me when I really started reading about health care was what a big role federally-qualified community health centers play in primary care.
They’re invisible, because it’s poor people, but I actually used one, for a pregnancy and delivery almost 20 years ago when I didn’t have insurance, and I liked the model. It was total care, nutrition, the whole works, and it wasn’t physician-centered, which was nice, because I wasn’t “sick”.
I’d go to one here if one was available, for primary care, rather than a private “medical group” and I have health insurance.
I was simply unaware that we have this huge network of non-profit and public health care delivery outlets, in place.
I don’t know why that can’t be expanded even more so we’d have truly non-profit primary care for everyone.
kay
@Martin:
That’s the anti argument in the longer paper I linked to.
The make-up of the Senate (as you know) gives small (and rural) states the same influence of states like California and New York, so it was inevitable that would be a concern.
Basilisc
It’s just been so sweet being a Republican since they discovered that nothing they say actually has to be true – that they can just make sh** up!!
kay
@Martin:
Ultimately, Martin, I’m wary. I think it’s understandable, considering the recent national experiment with deregulation. You want a national marketplace that meets the 50 state differing regs to write and issue policies, and I’m afraid we end up with Mississippi style standards, across the board, at the national level.
Texas managed to hang onto some of their state law regarding cash-out mortgages, and while it may have been an “unnatural marketplace” the sleaziest lenders went elsewhere, like California.
Comrade Kevin
@J sub D:
People who get insurance through their employers usually don’t have much choice. Are they “too stupid” as well?
tofubo
you asked “sheer laziness or deliberate bad faith”
as with everything republican these days, it’s a little from column ‘a’ and a little from column ‘b’
anon
Everything the Democrats have put forth on this bill has been a lie. Why the fuck should anyone take their word for what the bill means?
For that matter, if you know damn well that what they are saying is nothing but lies why do you take them seriously? Is it because you are so pathetic you can’t even bring yourself to reject someone lying to your face?
The people must PUNISH the democrats for their pathological lies.
kay
@anon:
Well, you don’t have to take their word for anything, was sort of my point.
No one knows how to fix health care quickly without massive disruption of the economy and delivery, so they tick of these lists of painless quick-fixes where no one sacrifices anything, but that’s naive and essentially a lie.
If it were as simple as “refundable tax credits” or “tort reform” we would have done it long ago.
Portman’s list is a fantasy. It’s pain-free. It’s going to be harder than that.