the reforms outlawing rescission/denial for prior condition meant people got coverage, and increased care compared to the situation before.

in MA these were in place prior to the 2006 reform (we also had community rating prior to 2006). so the associated costs involved can’t be attributed to the 2006 reform. the mandate came later (in 2006), along with commonwealth care for subsidized plans (medicaid was rolled into this – imo a very important and good element of the reform).

not controlling costs in MA has resulted in taking $$ from hospitals that provide free services to the very poor and/or disabled, scaling back on coverage for legal immigrants and i was just reading about how people in commonwealth care would no longer be automatically re-enrolled every year, even though they continue to qualify, because it would save $$ by covering less people. these cost savings all affect the people who are most in need.

wrt to the cms report on disruptions in provider supply – my reading of it was that the disruptions were based on cost (possibly as well as capacity – at least i’d expect capacity would also be an issue). since medicaid pays providers less than medicare which pays less than private plans, what happens in effect is that care would be rationed by cost, but instead of based on an individual’s ability to pay (as is now the case), it would be based on ability of the individual’s plan to pay. so we get healthcare rationed by class (which as an aside fosters the opposite of social solidarity — something we could use more of in these times especially).

in the case of true universal healthcare, via sp for example, in addition to the cost savings — there is also the time savings of healthcare providers (in not having to spend so much time with the various insurance related issues). i recently saw a paper on this issue, and the time saved was not iirc small (will go looking for the reference later). this would have the affect of providing a boost in effective healthcare capacity. would it be sufficient? i have no idea, especially without reading the paper again.

finally, if there are to be disruptions in provider supply, my preference is that they fall on all of us so that rationing can occur wrt to need and not social class (which is the case with people segregated into medicaid, medicare and various private insurance plans). in this way we’re all in the same boat with our interests aligned — changes that help one help us all. when it’s only the sick and poor and unconnected who suffer, finding the political will to do the right thing is much harder.

Moreover, since the system would be asked to provide care to the 34 million people who now have some insurance to pay for it, there would be disruptions in “supply” — we could have shortages of health care providers. that too seems predictable: before, we weren’t providing much care for these people, except in emergency rooms, but now they have access to much broader care, so we’ll need more providers — and if they don’t show up right away, there would be disruptions.

That seems to parallel what Massachusetts discovered. Their mandate help lower the total number of uninsured, so a lot more people started demanding care because they had some insurance to pay for it. But the mandate (plus an exchange) alone didn’t solve the cost problem, and the reforms outlawing rescission/denial for prior condition meant people got coverage, and increased care compared to the situation before. Total health expenditures went up and there were disruptions in provider supply.

These are entirely predictable consequences of solving only part of the problem, but they are not arguments for NOT solving that part.

If somehow, the reforms provided true universal coverage, not just 34 million more, so that 40-50 million more people could get more care because the insurance system now covered them, then we could expect these same logical consequences to occur, minus the savings we’d expect from a unified accounting system (presumably, sp has lower admin costs) plus transition costs (unknown) — so we’d also expect temporary shortages/disruptions in providers because they’d now have to provide care to 50 million more people that they’re not currently caring for. If per-person provider costs were not addressed, then the total National health expenditure would go up, just as the CMS report predicts for 3200.

That wouldn’t be an argument against sp; it’s an argument for thinking through the consequences of insuring millions more people and what it costs to give them adequate care, compared to what they get now, and taking steps to deal with those predictable consequences.

*

The inartful compromises have ruined it.

Progressives have to stand against a bad bill.

As someone said last night, there has to be progressive activism in Congress for the creation of voting blocks to take a stand on the various issues being subsumed by compromise, like the one that’s being formed demanding that there be no decrease in access to abortion.

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:-) :-) :-) :-) :-) :-)

One of the absurd disconnects of financing reform is assumption by CBO and JCT that any health care cost decreases to employers will pass-thru to workers in the form of higher wages.

I can guarantee that employers see this $3000 savings as theirs and not the workers.

Without a public plan, where do they think their ex-employees would be able to obtain healthcare?

see MA. we don’t have a public plan, and i don’t see what it would add. it all depends on the quality of the regulation. (i live in MA and i purchase my insurance policy as an individual).

and here’s the scary thing, i think the MA reform is better is almost all ways than the house bill. when i called the aide in my rep’s office to ask about that, i was assured that MA would get to keep our exchanges because we already have a waiver from the HHS (health and human services). they apparently had it all researched and also think we’d be better off keeping our own exchanges and rules.

in other words, it looks like romneycare may end up being better than obamacare.

Some see a “public option” as a stepping stone to single-payer.

i’ve asked everyone who’s ever said that to me to please explain how that happens. no one has even been willing to attempt it. i’ve tried to figure out how it might be, but can not. in fact, i think it takes us further away from single payer. as far as i can tell the stepping stone idea is just wishful thinking.

Others, think that the status quo will collapse sooner without a public option, and that would be a good thing.

i don’t buy this one either. in my book, it’s never ok to wish for disaster on any person. i’d rather work to limit collapse and the damage it causes.

my position is that i don’t think a public option, at least as currently designed will work. i think the entire reform will fail (as it is doing in MA) due to uncontrolled costs, but that it will take years before it’s clearly failed (with many “lets give it another year” delays). and in the end we will be back to square one, only the country will be in a worse situation and no one will trust either the dems or progressives with healthcare reform because we screwed it up so bad.

that’s why i think, even if we can’t block the current reform, progressives, rather than supporting it, should be very critical (only honestly of course) and distance ourselves from it — all the while using the opportunity to say why we don’t think it will work but that other options, like single payer would. making clear that the public option is NOT single payer is really important if the public option is going to, as i think, be a massive failure.

The main thing the Business Roundtable wants is that no one gets out of the individual mandate and that there be no public option. They are super paranoid that these things are going to cause terrible cost-shifting, even though CBO and others have said cost-shifting is a minor problem.

The status quo in health care is completely unsustainable. It’s something that’s been forgotten as the debate rages in Congress.

I don’t think that it’s been forgotten, but it can be used by Democratic Party leadership in taking the Stupak Amendment that is now part of H R 3962 out of the final bill that comes out of conference. Stupak will not be able to get more than 30 House Democrats to vote against the final merged bill just because his amendment was removed.

On the other hand, if the Stupak Amendment is part of the final bill that comes out of conference, it seems to me that the Democratic leadership would have to be blamed for caving when they didn’t have to.

Meanwhile, as the Senate version is being worked out, facts like those presented in this post should be emphasized again and again in order to dismiss Miss Connecticut (Lieberman), Nelson and Lincoln, and push them out of the way.

From the update above, it looks like Reid’s already on it. Reid might just pull it off in the Senate yet. And he should be roundly thanked if he does, or loudly blamed if he doesn’t.