So -
here is a quick summary of the major points of the bill.
1) everyone will be forced to be insured, whether from an employer or purchasing it themselves. However, the deadline is 2014. The penalty for not being covered by that date is $750, or 2% of your total income, whichever is greater. Exemptions will be made for the extremely poor based on the poverty line.
This
is in effect a giant handout to the insurance companies, but at the same time it's necessary to reign in costs. Face it - health care has to be paid for, either through a tax increase or having everyone pay for it themselves. Personally, I;d rather just pay what I currently do in premiums and copays to the government in return for a health care card that lets me go to any hospital and get care without worrying over money at all like what Canada has, but this is basically an ultra-decentralized health care model.
Biggest downside to those already covered? We'll still have to worry about copays and all the other nonsense that comes with health insurance, so once again people will put off going to the doctor
even while covered because they can;t afford $30 for the visit and another $30 for every medication prescribed on top of their monthly premium.
Possible upside? Universal buy-in
should lower overall premium costs by increasing the risk pool. This is only a possibility though - the insurance companies could just sit back and rake in the profits of a better risk pool for them without lowering costs.
Worst downside? Calibrating exemptions by the poverty line. Let's face it - "poverty" isn't the same in every state, and when you're
just above the limit of an exemption, you're going to be in the uncomfortable position of possibly not being able to
afford insurance, but not being eligible for the exemption. It's not unlike Welfare or unemployment insurance, where there will actually be a
downside to improving your situation within a small range of income. Specifically, if you make between 100% and 400% above the poverty level, you'll get "credits," basically a government subsidy to help pay for coverage. At the lowest income levels, you'll likely just get free care from the government. It's not perfect, but it looks good.
2) Minimum benefits, and a consumer protection system. This is necessary. Our current system allows companies to make exceptions in coverage, and this will hopefully close those gaps so that no matter
what illness or injury befalls you, you won't be alone. There will be no more $250,000 lifetime limits on total coverage (which means anyone with cancer, HIV, or any other serious illness will be safe, where currently they're screwed after a certain amount of time). No more "pre-existing conditions" exceptions, which is absolutely necessary.
This is the good stuff, frankly. Right now we don't just have a problem where people aren't paying for coverage, or even that they aren't
able to pay for coverage - right now, we have a system where people can simply be
denied coverage regardless of ability or willingness to pay
just because they're already sick. This closes that loophole...but I don't know what the policy is on how much the insurance companies can
charge someone with a serious illness. This is pretty ineffectual if they are allowed to increase premiums by 500% for the people who need coverage the most.
3) No public option...but there
is a
state based "insurance exchange" for those not already covered by an employer.
Possibly good. Pooling resources and establishing a highly regulated market lets the people dictate their own coverage to a degree. TO participate in the pools (which will likely be the only plans used by individuals except the ultra-rich), the insurance company will be forced to use most of their premiums on actual coverage (the article says around 80%). You can't participate in the pools if you already get insurance from an employer, but that's not such a big deal. We could even hit the jackpot with the ability for the pools to negotiate lower drug costs and other such concessions. An individual has no position for bargaining, but a large pool of consumers has the ability to make demands.
4) Medicare efficiency increases.
That's nice. Good for the budget. Specifically rules out rationaing of care for the elderly - so none of Palin's absurd "death panels" here.
5) Employers with more than 50 employees provide coverage or pay a fine of $750 per employee. Less than 50 employees and they don;t need to provide coverage. They'll also get a tax credit (beginning at up to 35% of the money spent on coverage, up to 50% in 2014). It's a reasonable incentive, a good carrot and a reasonable stick. Small employers would also be able to join together to purchase combined plans, meaning even the small businesses can group together and form a pool large enough to actually negotiate rates with the insurance companies.
I'd say that's very reasonable for small employers, and it should help cover more people for less. Thumbs up.
6) Medicaid expansion. Medicaid will cover all individuals under 65 who make less than 133% of the poverty level. Basically, for a family of three, that means that you have to make less than $24,000 yearly to qualify.
That's definitely a boost for the poorest Americans, because if you're making that little money in most places in the country, you're in serious trouble.
7) Funding. For plans costing $8500 for individuals or $23,000 for families, you'll pay a hefty 40% extra tax on any premiums over that amount. There are also taxes on pharmaceutical companies, medical suppliers, and the insurers themselves. Overall projection?
Reduce the deficit by around $100 billion in teh first 10 years, and
over $700 billion for the ten years after that. Note - that's not a
cost, that's a
savings. That's a pretty sweet deal if it goes as planned.
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My overall opinion? Mixed feelings. It's a bandaid on what I think is a compeltely broken system...but then, it
is a pretty good bandaid.
I think it's far more complicated than necessary. I think that it doesn't address a single thing in the health care industry itself with how they determine costs and fees. I think that,. just like fire or police protection, health care coverage doesn't work well with a "market-driven" model because of the inherent lack of
choice. You can't
choose to simply not call the fire department because you can't afford it; in the same way, you can't
choose to just ignore appendicitis or cancer or HIV or a broken leg. Prices in teh health care industry are already not tied to supply and demand, and most of us get out insurance through our employers - meaning we don't get to choose among competing insurers, either. Just like there are some things that the private sector excels at, there are also things that it does not, and where public control is required. We already use public funding and regulation for fire, police, roads, etc. Health care is one of those
public welfare necessities - it's the reason every other developed nation in teh world already has a universal coverage plan.
I don't think it lowers costs as much as it
could. I say this only because of how much more Americans spend per capita on coverage (
without even covering everybody, it gets far worse if you only include those actually covered in that number) than anyone else,
without an increase in quality of care (with the exception of the wealthy who can solve their problems with money, we actually get
less quality of care than other nations see). I think that once again we're trying to do it "the American way" rather than looking at already-established successful examples in other countries, including ones that are extremely similar to the US.
My ideal would be the Canadian system - single payer, no premiums or copays, just show your card and you're good. To those who complain about waiting lists, I challenge them to try to get an MRI done today. Or even see their personal physician in a metropolitan area without waiting. The fact is, every system has waiting lists simply because there are (gasp!) more patients than doctors and facilities. By and large, this is not a bad thing, because
most health care needs are not
urgent. And the issues we
do have where people with severe injuries are made to wait are caused by overloaded emergency rooms - which themselves are caused by people without coverage who have no other choice but the ER for every concern. Universal coverage with no patient-level concerns over payment allows the system to triage according to available resources and urgency of need, like it should be, and increases the overall quality of care for everyone.
I could be said to "oppose" this bill because it's quite obviously not even close to what I want. But I
do think it will improve over the system we have now.
It's just that you can be better than shit, and still be crap.
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