Jon — the WSJ link on the Schumer/Snowe amendment is for subscribers only; Kaiser Health News has a good story on the issue:

http://www.kaiserhealthnews.org/Stories/2009/October/02/individual-mandate-health-insurance.aspx

thank you made the change.

Well, Schumer’s got a far better political sense than the healthCos if what you say is true. If the law passes *requiring* people to purchase insurance, people won’t take long to figure out that it’s a huge transfer of wealth straight to healthCo balance sheets. There will be political hell to pay.

(Is this a good time for me to note, for the umpteenth time, that the CEO of UnitedHealthCare made over $25,000,000 ‘compensation’ in 2007?! That’s more money than the budget for my local school district that year, IIRC.)

I’d highly recommend this segment on Dr Nancy Schneiderman’s show today on msnbc on the AHIP move today. Around 5:25, she asks him about public option; he dodges. Around 5:40, she asks him how healthCos can ‘cut payments to doctors and hospitals’, and watch the AHIP guy dodge again.

Scarecrow — possibly of interest for you: I find it not at all surprising that Cantwell and Wyden are out front in rethinking health insurance in the U.S. Cantwell is from Washington State, which has a lot of health care expertise and also Group Health managed care delivery system. Wyden is from Oregon, where Kaiser Permanente is based.

Was I right to have kept having faith in Schumer?

Schumer’s a guy I’ve always trusted. I dunno why, I get the shady vibe off him more than I like I know, but somehow my internal good meter (stupid I’ll grant you but hey) always says he’s doing good.

People talk about Obama playing chess through all of this.

I don’t believe it. A guy like Schumer however, you can make that argument and mean it. Anthony Weiner used to work for Schumer, and when Schumer left congress Weiner took the seat, and Weiner’s been one of the biggest supporters and one of the most vocal of anyone in the Democratic party, hell of anyone at all.

Why the hell is AHIP freaking out?

I thought they wrote the fucking Baucus bill. A study of the magnitude of AHIP’s PwC report doesn’t get written up in hours; this had to be in the works for weeks at least. Why commission a study to torpedo a bill they wrote themselves (or had their revolving-door minions write to their specs)?

Very fishy. I just don’t think AHIP’s report was sitting on the shelf with the Schumer assumptions built-in, assuming Chuck had an amendment in his pocket.

I still think AHIP’s freakout is to make Baucus and Obama look less their captives. I, for one, am not fooled. We know who wrote the bill.

People in Washington refer to “Group Health” as “Group Death.” I have no personal experience with them, but have heard a lot of complaints about them through the years, sutff like delays and denials for specialist referrals, procedures, etc.

thank you. was thinking the same and was worried my inner cynic had won

I still don’t think there’s a snowball’s chance in hell that an individual mandate is constitutional, with or without the public option.

Still wish we would’ve started with single payer, that might’ve actually had a chance, but at the very least we’d be in a situation now where AHIP would be begging for a robust public option as the “compromise” instead of this bullshit “opt-out” crap. I still don’t get why anyone needs an “opt-out” for something that is already an “opt-in” to begin with. Public Option means you only purchase it if you decide to, or opt-in.

The whole health insurance money making scheme was built on the individual mandate. Without it things really start falling apart.

Add in from above:

You know, the cynic in me says the reason they’re including the individual mandate is to delay or kill the reform anyways. The day this bill becomes effective there will be a thousand lawyers with suits ready to file, and they will probably get an injunction until the cases are heard, since, as I said, I have a hard time seeing anyway possible an individual mandate is constitutional. They wouldn’t intentionally put something in the bill to delay it or kill it would they???? Nah, must be the cynic in me.

Oh yeah; I’ve called it that myself a time or two.

The explanation that I’ve heard is that back in the 1970s, Group Health was one of the first models in the US where doctors were on salary. The belief was that the ‘lousy docs’ who couldn’t build their own practices went to Group Health. However, as the costs of operating a primary care clinic skyrocketed in the 1980s and 1990s, many great docs saw Group Health as a way to do medicine without having to deal with the billing and finance end of things; they took a salary in order to avoid the headaches of dealing with insurance and billing.

The system is very, very large at this point and I know quite a few people who have been in it for years. The focus on ‘wellness’ in the Group Health model seems to be paying off over the long term; no system is perfect, but they appear to be doing a good job overall.

You mean the individual mandate penalty, right?

Having a mandate is one thing. Penalizing hard-working Americans for not obeying the mandate is another. Criminalizing those policy differences is quite something else.

having a mandate without a penalty is not really a mandate. That is just a suggestion.

I think the Senate Finance Members might have seen the vote to lower penalties as a freebie. The Republican didn’t care, since they’re not voting for the bill anyway, and anything that undermines the mandate is fine with them. They can say they voted against the mandate.

The Dems, on the other hand, presumably want to vote for some ultimate plan. But they know the structure of all of the bills depends on a strong enough mandate to make the risk-sharing pools effective, which means they know they have to have a sufficient penalty to discourage free-riders. But they can make a public, televised vote to lower/delay the penalties in the Finance Committee, but when Harry Reid merges Finance and HELP Committee bills, the penalties will reappear and just be part of the huge bill, which the majority of Dems will eventually vote for. So they have penalties but also be able to say that when that specific issue came up, they voted to reduce them. Just a guess.

AND THE KILLIN’ GOEZ ON AND ON AND…

Citizen Jon Walker:

The battle for national healthcare just started today. The last six months have been spent mobilizin’ troops, probin’ defenses and distributing ordnance and as of today the forces of wealth and power are tellin’ their troops in the Congress and the White House that instead of a guerrilla war of stealth and attrition, these political mercenaries are now gunna hafta stand up in front of a frontal assault from the mass of people and kill real public healthcare. Now let’s call a spade a shovel and give credit where credit is due for those most responsible for gettin’ the fight to this point. Start with FDL and citixen Jane Hamsher then credit Chuck Schumer (at least to this point), the progressive caucus in the House of Representatives, the unions (finally), Rachel Maddow, Keith Olberman and all the mass of folks out here in the netroots who have given time and money they can’t afford to fight this fight.

The distraction and misdirection tactics of the forces of the insurance industry came apart this last week when one by one startin’ with “triggers” and then taxes on union benefits, and then the infamous “opt-out” fell apart for all to see. We are now at the point where the corporations are tellin’ their mercenaries in the Congress that they are gunna hafta committ political suicide and kill real national healthcare in front of energized and educated voters who are poised to swarm the baracades at the polling places in 2010.

ObamaRahma is gunna turn out ta be Obama takin’ the long term credit for whatever comes outta this fight and Rahm takin’ a quick bow and runnin’ back to the House of Representatives in 2011 (just like he did in 2006).

KEEP THE FAITH AND PASS THE FUCKIN’ AMMUNITION, FEAR IS JUST A FOUR LETTER WORD!!

I don’t think Schumer so much planned to freak out the AHIP. I think he just saw the Dems heading to a political disaster like no other if there was an individual mandate without a public option. He is above all a political animal. He knows it would be a blood bath in the elections.

Very fishy indeed. Unless they believe that, in the end, the Baucus POS will get a real PO through some kind of maneuvering. In that case, they would be scared.

Sen. Chuck Schumer has been working to actively cripple or destroy the individual mandate

good.

But they know the structure of all of the bills depends on a strong enough mandate to make the risk-sharing pools effective, which means they know they have to have a sufficient penalty to discourage free-riders.

scarecrow, in MA my impression is that the mandate did not lower costs — for one year there was an improvement (my bcbs policy cost about the same but added prescription drug coverage) but after that first year post mandates, the costs have been rising again — big time and we in MA already have very high cost for insurance.

i know that the mandate is theoretically supposed to lower costs, but what is the actual data (for MA, for example)?

heading to a political disaster like no other if there was an individual mandate without a public option.

that makes a helluva lotta sense – but why that Opt Out Monstrosity ?

Schumer is from a blue state. NY would probably not opt out.

Why would the mandate–or lack of one–be more of a reason for AHIP freakout than a PO. PO would put them flat on their backs. A weakened mandate would only lessen their obscene profits.

Agree with Teddy. Something very fishy going on here.

PO would put them flat on their backs

i wish. but none of the pos currently under consideration do anything close to this.

Karen Ignagni looked far too cool and collected on the NewsHour.
I’m leaning toward the kabuki school of thought.

Yeah, yeah, I get that. It’s just that if AHIP is going to freak about anything, a somewhat weakened mandate wouldn’t be it.

i was actually thinking a weakened mandate could be something for ahip to freak about. they have a failing business model (iirc, more and more people either can’t afford to or are choosing not to buy health insurance) and the and a mandate gives the tens of millions of new “customers” with the IRS performing enforcement for them.

Yep. Thanks.

but, i should have added that i think teddy’s explanation is the best one.

I’m not following your logic here. Any mandate, regardless of the type of enforcement, will bring in a tremendous number of new customers buying junk insurance. Could a mandate of any kind be bad for them? I don’t understand.

i’m sorry i’m not being clear. english is my first language, but i’m still a novice. *g*

trying again….. with an example:

a weakened mandate, for example, one with a fine of $100 instead of a fine of several thousand dollars a year would, i’d think, be almost a mandate in name only because many people would rather pay a smallish fine if that was the only penalty.

am i still being too confusing?

I guess the logic is with a strong mandate they get 50 million??? new customers, whereas with a weakened one maybe they only get 30 million new customers??? So they would prefer the 50 million, wouldn’t they?

As I said above though, I can’t envision any legal theory under which an individual mandate to purchase private insurance is constitutional. IANAL but it strikes me as a no brainer. Of course warrentless wiretapping and unlimited detention of American citizens strikes me as no brainers too, and they sure as hell happened, and continue AFAIK.

Don’t believe anything a senator does until they vote. Schumer’s plan is to delay our care until it can be revoked. Just because he said or did something that gives the GOP a headache, doesn’t mean he is not going to join them in voting for the Baucus crapola. He may not plan it that way, but he is guaranteeing it’s failure by committee. Nothing is going to come from the senate on this. It will be from the House. Why? Because each member of the house is realizing just how little time they have left if they vote no. It’s that simple. Money won’t buy them a new life after congress. And they know by now that they can’t go home again.

Why isn’t it us setting the plan? Why are we not united in demanding free public health care for all? We have the numbers, the momentum and the right. Our Congress is bribed silly and there is no denying it. Make them do what we demand. Period. Stop giving in before it’s even a bill.

I’m with Norske and Citizen Hamsher… this is a call to action. Let’s get the troops out and storm the bastards.

Corporations and their addiction to profit are running and ruining this nation. Kill em.

I’m not buying any insurance NOR paying any penalty. over my dead body.

i live in MA and we’ve had an individual mandate since 2006.

Term limits would get these slackers doing their jobs and then outta town. Incumbency and seniority means the same old timers are running the show. We barely have a democracy in this country.

No taxation without representation.

We are not represented – No Pay No More

Has it been challenged in court? Maybe there’s cases pending there. I did a google search but my search skills just plain suck. I always get 10 million hits or zero hits.

It’s only fair that the individual mandate should be very weak until the health care industry proves it can control costs. In Massachusetts they started with a small penalty to get the law passed, and immediately jacked it up afterward. Maybe I’m being paranoid, but that’s what I’m afraid Snowe and Schumer are up to.

And Schumer’s idea for putting penalties into a trust fund is not new or radical. The Netherlands, for example, has the same system. The Netherlands even allows your heirs to claim the money after you die.

What I think is driving the AHIP revolt is not so much any single concern, but their sense that nobody is required to sacrificice (particularly other health care industry stakeholders) and yet people believe the insurers can lower premiums. That is not realistic.

I think it’s premature to call the AHIP report “dubious.” The public has never seen this kind of premium data before. (The CBO focuses on costs and savings for the federal government.) The burden is on those who doubt the AHIP findings to release their own analysis and then we should have public hearings.

i don’t know, but 3+ years later we still have it.

MA is kind of an interesting test case because we’ve had pretty decent insurance regulations (especially compared to much of the rest of the country) for years prior to the 2006 reform with mandate. for example, although i’ve had cancer, not only can i purchase an individual policy from bcbs, i got it at the same cost as any other woman my age who lives in my area (community rating). and that was before the 2006 reform.

so, if mandates actually do lower insurance costs because the young and healthy are forced to purchase insurance, we should have seen that effect (without confounding big regulation changes) in 2006.

I think it’s premature to call the AHIP report “dubious.” The public has never seen this kind of premium data before. (The CBO focuses on costs and savings for the federal government.) The burden is on those who doubt the AHIP findings to release their own analysis and then we should have public hearings.

imo, this is a really excellent point. in the ’90s the cbo did full analysis of various health care proposals including total national health expenditures including households, employers, state and local gov, and federal gov. there are so many ways to spin the data. for example, premium cost can go down a little while copays go up a lot. is that a price increase or decrease? we need the full picture to evaluate any of the plans now being considered.

i tried to make this point in a couple of diaries earlier this year:

http://seminal.firedoglake.com/diary/5899
http://seminal.firedoglake.com/diary/5900

it really pisses me off that our dem congress has not asked the cbo to do the proper analysis.

OK, just found one. It was dismissed in Mass. Superior Court, but is being appealed. The real interesting part is going to be when it gets to Federal court.

This isn’t settle yet. And if the Federal government passes one, you can rest assured there lawyers in all 50 states ready to file challenges. And it wouldn’t surprise me if at least one of them found a judge to issue an injuction delaying the implementation until the cases can be heard. It would take years, working its way up, consolidating, and finally reaching the SCOTUS.

I just can’t understand the logic of how it’s constitutional.

thank you for the info! very interesting. and probably very important (ianal though).

Wendell Potter was on Countdown tonight and the way he talks, Wall Street freaked out the CEO’s who then demanded the report be released. It sounds like the fact that health insurer stock prices went up when the Baucus bill was released might have hurt them in the end. All those investors now will see their stock go down if the end product is not as favorable as it appeared from the original bill and CEO’s are supposed to get stock prices up, not let them fall before their bonuses come in. With the weakened penalties, the stock is going to fall because there won’t be that same number of new customers.

Excellent point.

I always forget that the CEOs live in a world entirely different from our own, with different motivators. It’s very true that stock price is what drives them, certainly not the country’s well-being or patient’s coverage.

Yup. Stock prices, quarterly earnings, yadda, yadda.
So explain to me once again why we’re even allowing health care to be captured by a corporate, profit-making structure in the first place…?

As for Schumer, I agree with Jon W; as a political creature (and former chair of the Senate Dem reelection campaign), if he had failed to see the blowback coming from the healthCo version, he’d be an idiot. Schumer is far from perfect, but he’s also not an idiot.

Damn straight Norske.“This writhing corporate monster is fighting for it’s life and is capable of injecting venom to the very last.” They tried the land mines (triggers, co-ops, opt-outs.) But we’re coming down to the bone and the tactics are getting fiercer such as this petulant report that AHIP released today. What an arrogant, threatening piece of work. “If you do nothing we will raise your rates by 79%. If you pass this Baucus bill which is not perfectly to our liking we will raise your rates by 111%. You peasants had damn well better fall in line.” Y’all watch. Now begins the SERIOUS scrotum twisting. Skeletons will start walking out of Congressional closets, heartfelt bribery, and wall to wall television advertising by the CARTEL. Its going to be blood and eyeballs all over the floor.
I say we “GIVE ‘EM THE COLD STEEL, BOYS” (and girls, of course!)

I think this is right. Schumer is very political and very, very smart. He just prioritized the Party above the insurance industry.

It’s incredible just how many of this nation’s ailments can be traced right back to WALL STREET? I think this is an angle that has not been played up enough in the friendly media regarding the healthcare battle. With the anti-WALL STREET sentiment around the land along with Michael Moore’s new movie this could be pretty powerful stuff.
Ironic isn’t it? Wendell Potter’s role in all this as the repentant archangel. What a movie this all is!

Perhaps I might be able to suggest an easier connection between the weakening of the individual mandate and the “freaking out’ demonstrated by the AHIP ‘report’: the simultaneous end of pre-existing underwriting restrictions.

As someone who had open-heart surgery in ‘06 & as a result cannot survive underwriting, I have every incentive to stop paying my $10,000+ annual individual policy, put the money in the bank, pay whatever fine is levied and then get a policy when I needed treatment. My medical condition would typically allow this in that if I have a problem I will either drop dead immediately (literally) or (I hope) have sufficient warning in time to activate a new policy.

Either way it changes my position from the current loose/loose (gigantic premium & large deductible/cannot change companies) to win/win (no discrimination on premium due to pre-exisings/guarantee issue choice of lowest cost policy with my existing providers in network). Even allowing for frictional effects, such as phasing in of federal subsidies and ramping up of mandate fines, the profits of my current insurer, and hence my expenses, must shrink substantially. Of course if I simply drop dead it wouldn’t cost me anything at all (!!).

My wife, who has a minor pre-existing, is charged a 50% penalty on her own individual policy and would likely drop it entirely as it is a typical ‘junk’ policy simply paying the fine. I can see our out-of-pocket premium expenses dropping by 50+% even without a strong P.O. under these conditions. No wonder the likes of our current insurer – Humana – is howling!

Don’t take this report or this guy too seriously, He’s being accused of trolling here.

Another opinion on this

This is an analysis that relies on another consulting firm (Hay Group) to mess with numbers. If one thinks about this, this is the Private Insurance Companies THREAT to those with Private Insurance…if you think we are going to cut our profits…think again…as we are going to raise rates EVEN HIGHER because a Public Option healthcare plan may take away some of our customers.

They are talking like HCR will take effect immediately, which is not the case, so then consider all the rate hikes between 2009 and 2013 that are expected by Private Health Insurance Plans and say huh?

It is amusing that this report is really targeting those “Cadillac” policy holders…who to date get their health insurance FREE…oh my, they may actually have to pay for some of their health insurance premiums?

Yep, I can hear the GOP legislators now….it is unfair to make those with a substanial income actually have to pay for themselves…all because we now have to cover all those individuals with pre-existing conditions…wahhhhhh!