We behaved ourselves during the recent budget debacle by not mentioning Obamacare. It wasn't easy since the Review was one of the few progressive publications that correctly pointed out the dangers in Obama's health bill while there was still time to do something about it.
But we did collect various stories over the past couple of weeks and will be posting excerpts and links in the coming days.
Here's how we described the problem a year ago:
Sam Smith, July 2012 - If
you’re having a hard time figuring out what the real status of
Obamacare is, don’t feel badly. What you are seeing in the current news
coverage and debate is another reflection of of the dysfunctional state
of our leadership class, a dysfunction driven in no small part by the
fact that our political debates have become increasingly controlled by a
post grad elite – lawyers, MBAs, economists, and products of journalism
school - to a degree never
before known in American history. This elite has replaced conscience
with complexity, explicit goals with fuzzy projections, facts with
verbiage, plain language with legalistic code, doing things with data,
and progress with process.
For
example, in recent years the number of lawyers in the Senate has varied
from 54 to 60 - or nine to ten times the percentage found in the
American workforce.
Throughout
history, good politics has depended on high social intelligence and
wisdom, connections with a constituency, and the ability to understand
and respond to the needs of the average citizen. As our politics has
increasingly been dominated by a grad school elite, it has become ever
more distant from those it is meant to serve. Further,
the training of this elite has tended to compartmentalize its thoughts
into the boxes and biases of specific specialties, leaving it
uncomfortable or incompetent in dealing with the holistic implications
of politics.
If
you think this is an exaggeration, go back and read about the battle
for a minimum wage, Social Security, Medicare, Medicaid or civil rights.
The public knew what they were going to get and how they were going to
get it. This is no longer the case.
Or
consider the fact that our current depression has been greatly
prolonged by economic theories acceptable to the country’s academic,
political and media elite but which are in direct contradiction to
empirical evidence.
What
was once a government of laws has become a government of incoherent
contracts and language not unlike that you avoid reading on your
computer in order to get your new software going.
We
are a nation collapsing from the top. Most Americans live in oases of
still relative sanity but are controlled by an elite that has lost its
capacity to converse with, explain to, or lead the rest of the land.
Further,
the liberal part of this leadership class has increasingly become
indifferent to, or contemptuous of, state and local power, despite the
fact that Americans have a much higher opinion of the local than they do
of Washington. Liberals also once had quite a different view – after
all, power decentralization was a major value of the left in the 1960s –
and even Washington had a better idea of how to handle the matter. As I
noted once:
The
Federal Boating Act of 1958 was an early and benign example of what I
came to think of as federal greenmail as Washington increasingly began
using the budget as a means of getting states to give up their 10th
Amendment authority over matters "not delegated to the United States by
the Constitution, nor prohibited by it to the States."
The
boating act was quite mild by today's standards. A Coast Guard history
said of it: "Among other benefits, this act made states essential
partners in this cooperative effort. Most of the states quickly enacted
boating safety laws involving boat numbering, equipment, and operation.
These laws were typically uniform, making it easier for boaters to be in
compliance when traveling from one state to the next.”
Under
today's rules the options given the states would have been early
eliminated in favor of hundreds of pages of federal regulations. Over
the following decades the use of greenmail would explode .
The
liberal obsession with federal control has reaped not only bad
legislation but much of the ill will that makes liberalism such a weak
part of today’s American political scene.
This does not, however, mean that even in a dysfunctional culture, good
can’t and doesn’t happen and it has with Obamacare. But it is randomly
and corruptly blended with the evil and the incompetent and the
dangerously uncertain. The elite’s two main political divisions want us
to choose between loving Obamacare and hating it. But we owe nothing to
them and the wise choice – painful as it may be – is to sort through the
mess and find the good and the bad and treat them as independent
satisfactions and problems. Here, from various sources, is some
assistance in this effort
The good
From NPR
Health insurance providers
can't cancel your coverage once you get sick – a practice known as
"rescission" – unless you committed fraud or intentionally withheld
facts about your health when you applied for coverage.
Youth can be covered under a parent's plan until they turn 26.
Children with pre-existing conditions cannot be denied coverage.
Health insurance providers may not place a lifetime maximum on benefits.
Insurers are required to give consumers rebates if they spend less than 80 to 85 percent of premium dollars on medical care.
Health plans created after Sept. 23, 2010, are required to cover certain preventative services without requiring co-pays, deductibles and coinsurance.
The law expands Medicare's coverage
of preventive services, such as screenings for colon, prostate and
breast cancer, which are now free to beneficiaries. Medicare will also
pay for an annual wellness visit to the doctor.
If you are older than 65, the law is narrowing a gap in the Medicare Part D prescription drug plan known as the "doughnut hole."
Employers must provide health insurance plans that offer birth control as part of their preventative services.
And what’s coming in 2014:
Adults with pre-existing conditions will not be denied coverage (this already applies to children).
People who don't qualify for Medicaid but
still can't afford insurance may be eligible for government subsidies.
The subsidies would be used to help pay for private insurance sold in
the state-based insurance marketplaces, called exchanges, slated to
begin operation in 2014.
Applicants will not be rejected for insurance because of health status once the exchanges are operating in 2014.
If a state does decide to expand Medicaid, people with an income at or below 133 percent of the federal poverty level would be eligible to receive coverage.
From Caspian X2
Insurers have less ability to change the amount customers have to pay for their plans.
Insurers can't just drop customers once they get sick.
Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.
If any state can come up with their own plan,
one which gives citizens the same level of care at the same price as
the PPACA, they can ask the Secretary of Health and Human Resources for
permission to do their plan instead of the PPACA. So if they can get the
same results without, say, the mandate, they can be allowed to do so.
Vermont, for example, has expressed a desire to just go straight to
single-payer (in simple terms, everyone is covered, and medical expenses
are paid by taxpayers).
Uncertainties and confusion
Now, here’s where it get complicated. . . . .
We do not know what plans
insurance companies have to work around the bill in order to earn more
money. The measure is dependent upon de facto subsidies to these
companies through such means as the mandate and therefore the insurance
industry’s manipulations are critical to the bill’s costs.
The rules for expansion of Medicaid
require payments from state budgets which more than a few states don’t
want to have to come up with. To the extent that states don’t
participate, it’s a problem.
What about the provision under which doctors pay will be determined by the quality of their care? This opens the door for extensive controversy, anger and problems.
Employers with more 50 or more workers
are required to have health insurance, but what if some break up their
firms into smaller operations? And what if smaller firms drop their
health plans? And what if large firms change the nature of their health
insurance? How many will be hurt and in what ways?
How will millions of Americans know what to do about this bill and when? This is a bill written for bureaucrats and insurance companies, not ordinary citizens,
And here are some of the people the individual mandate will be subsidizing:
Bad things
The individual mandate has been portrayed
in the liberal media as largely affecting people who don’t have
insurance as a matter of choice. This is highly unlikely. Although there
has been an striking lack of analysis of this constituency, it is
likely that a majority is made up of people who can’t afford healthcare
(or the individual mandate version), people laid off by firms, and
minorities in jobs without healthcare. The Obamacare backers have seemed
totally indifferent to this.
Ida Hellander, MD-
The individual mandate compels people to pay a penalty — the greater of
up to $695 per individual and $2,085 per family or 2.5 percent of
family income — if they don’t have other coverage and fail to purchase
an expensive and defective private health insurance product.
While the mandate may be “constitutional,” it is terrible health policy. Briefly, the main problems include:
The coverage under the ACA is so skimpy, with so much cost-sharing, it won’t prevent medical bankruptcy. It’s
really “underinsurance.” The coverage is unaffordable. In
Massachusetts, where a mandate plan has been in effect since 2006, the
cheapest policy for a 55-year-old is $5,000 and carries a $2,000
deductible. It costs $7,000 before even a penny of coverage kicks in.
The burden of the mandate falls on working and middle-income families,
who make too much for Medicaid but too little to afford private
coverage, even with the tax subsidies. It enriches the private insurance
industry with $447 billion in taxpayer subsidies. It maintains the
administrative complexity of the current system with over $400 billion
squandered on administrative waste The vast majority of the uninsured
are in working families. Hence, they are already paying taxes to support
Medicare (which pays for medical training and other necessary health
infrastructure), Medicaid, and other health programs. It doesn’t lead to
anything even close to universal coverage. ACA leaves at least 26
million uninsured.
There are innumerable factors that have not been calculated but could make a big difference. Take for example, this story by Greg Kauffmann of the Nation:
Since
August 2011, 89,000 children in Pennsylvania have lost their Medicaid
coverage, including many with life-threatening illnesses who were
mistakenly deemed ineligible. The state currently hasn’t a clue whether
many of these children have any health care coverage at all. In late
summer, the Pennsylvania Department of Welfare began notifying hundreds
of thousands of families by mail that they had ten days to provide
necessary documentation in order to keep their children enrolled in
Medicaid. If the family missed the deadline—or even if they met it but
DPW failed to process the paperwork within the ten days—they were dropped from Medicaid.
How many more such stories are waiting out there?
The individual mandate offers
no benefit to patients or the public that could not more cheaply and
fairly be executed by a public program. There is, in fact, no
justification for the mandate other than as a subsidy of private
insurers who are, in this case, totally unnecessary.
NPR: If you are covered
under a private Medicare Advantage plan, the law changes portions of
the plan, cutting payments to some of those plans. Critics say that
could mean the private plans may not offer many extra benefits that you
may have previously enjoyed, such as free eyeglasses, hearing aids and
gym memberships that they now provide.
Marcia Angell, MD -
Obamacare is simply incapable of doing what it is supposed to do --
provide nearly universal care at an affordable and sustainable cost. The
problem is that three years ago, in his futile efforts to win over
Republicans... Obama gutted the law before it was even passed. He made the private
insurance companies the linchpin of the new system, and promised them
millions of additional customers and billions of taxpayer dollars. He
also did nothing to rein in the profit-oriented delivery system that
rewards providers on a piecework basis for doing tests and procedures.
So with all the new dollars flowing into the system and no restraints on
the way medicine is practiced, the law is inherently inflationary.
Although
there are some provisions to curb the worst abuses of the insurance
companies, such as excluding people with preexisting conditions, there
is nothing in the law that would stop insurers from raising premiums. A
senior executive of the industry's trade association, America's Health
Insurance Plans, told me privately that that's exactly what the
companies will do if regulations cut into their profits. Thus, costs
under Obamacare will almost certainly rise even faster than at present.
No reform can work well or very long if its costs are unsustainable…
Many
of the uninsured who are subject to the mandate to purchase private
insurance will choose to pay the penalty/tax instead. That will lead the
insurance companies to raise their premiums, demand that the penalties
be greater, or both. Deductibles and co-payments will increase to the
point that many people will have insurance they can't afford to use.
(This is the case in Massachusetts.) ….
Obamacare
partially offsets the costs of federal subsidies to insurance companies
and Medicaid costs by cutting Medicare reimbursement to providers. That
means hospitals and other health facilities will take a hit, and many
are already struggling…
On
July 22, 2009, Obama said in a press conference, "Now, the truth is
that unless you have what's called a single-payer system in which
everybody is automatically covered, then you're probably not going to
reach every single individual." Bingo. Too bad he didn't hang on to that
insight, and use his rhetorical skills to make the case strongly to the
American public. If he had fought for single-payer health care at the
beginning of his administration, while he had both houses of Congress,
and mobilized public opinion behind it, he might have made it.
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Finally, perhaps the best thing about the bill is that it makes Medicare for all seem simple, sensible and sweet.