kenberg, on Feb 26 2010, 07:20 AM, said:
I am not really happy about how things are going with the reform effort. I guess I have mostly said why already, but the brief version is that I think there are two problems, access and total cost, and the Dems have shown little interest in addressing the second. Of course the Reps have shown little interest in addressing the first. Oh well, what else is new?
I recorded the healthcare summit that Obama and the congressional leadership of both parties had at Blair House yesterday, then watched it in the evening, and my impression is quite different.
Both sides are intensely interested in bringing down costs, both to consumers and the government. So far as I can see, Obama has solicited and included ideas from all sides, provided that health experts were able to explain how those ideas would cut overall costs without impairing medical services. If the republicans had any ideas that have been left out, I didn't hear them.
On the issue of tort reform, it is possible that the republicans want to address it differently, but I did not hear any specifics from their side about how they want to do it. Because those are state laws, Obama proposes incentives for states that reform their tort laws to protect doctors. Perhaps the republicans want the federal government to override the states directly, but they did not come out and say so clearly (that I heard, anyway). The reason they did not do so, I suspect, is that Obama would have accepted their proposal in exchange for their support.
As to the costs to consumers, the conference clarified the philosophical and practical differences between the parties. Under the proposed bill, for an insurance company to enter the exchange its policies would have to meet some minimum standards for consumer protection, and those standards would be set by the federal government. The republicans strongly object to the federal government doing that, and it is precisely the setting of those standards that republicans call "a takeover by the federal government."
Obama conceded that companies could indeed offer cheaper policies if no minimum standards were in force, and identified that issue as one of the philosophical differences with his opponents. The republicans propose to reduce costs to consumers by allowing insurance companies to write policies in states with little or no consumer protection laws and sell them nevertheless in states that do have such laws. Obama finds that unacceptable.
The other major difference on costs to consumers has to do with pooling of risk. Obama and the democrats want very large pools that include both the healthy and the sick. Because many high-risk people now can't get insurance, there would be a temporary high-risk pool (similar to pools in about twenty states today) that such people could buy into, with federal subsidies. That pool would be disbanded in 2014, once the very large pools had absorbed the high-risk people. The republicans want to maintain the high-risk pools beyond 2014 (forever I guess) to allow insurance companies to exclude high-risk people and thereby offer cheaper policies.
The conference also clarified exactly what the republicans mean when they talk about hurting seniors by "cutting medicare." Medicare Advantage was established because insurance companies contended that they could compete successfully with the more structured Medigap plans if they had more flexibility. To allow insurance companies to get started with this while they got their efficiencies going, the federal government provided subsidies that were intended to be temporary. Today about 20% of seniors have Medical Advantage plans still subsidized by the 80% of seniors who don't.
Obama wants to eliminate that direct subsidy to insurance companies and redirect the money into closing the "donut hole" in prescription drug coverage for seniors. The republicans argue that eliminating that subsidy to insurance companies is "cutting medicare" for those who have Medicare Advantage plans and Obama argues that it is redirecting money appropriately.
McCain pointed out that the Senate bill eliminates the Medicare Advantage subsidy except for people who live in Florida, a provision he considers unconscionable. Obama agreed with that, and so do I.
The growth of wisdom may be gauged exactly by the diminution of ill temper. — Friedrich Nietzsche
The infliction of cruelty with a good conscience is a delight to moralists — that is why they invented hell. — Bertrand Russell
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