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I have long maintained that progressives should accept an individual mandate only as part of a broad social contract with the government. The government must promise to ensure that every American has access to at least one quality, affordable, cost-effective health insurance plan, and only then can it demand Americans buy health insurance. The Senate bill completely fails to hold up its end of this social contract, and that is made clear by its i inclusion of “hardship” waivers.
Any person can get an exemption from the individual mandate if the cost of premiums exceeds 8% of his or her income. A properly working universal health care system does not have a “hardship” exemption. Instead of the government saying, “we will not force you to buy health insurance anymore because we let the insurance companies make it too expensive for you,” the proper response is for the government to say, “If your insurance ever starts to get too expensive, we will make sure you can afford it.”
It is the height of irony that the hardship waiver is for people whose premiums exceed 8% of their income, but for people making between 300-400% of FPL, the tax credits they get will only be sufficient to make the silver plan cost 9.8% of their income. One part of the bill is saying that spending 8% of your income on insurance is a hardship, and another part of the bill is only giving people enough affordability tax credits to make insurance cost 9.8% of their income. The “silver level” plans have a very low actuarial value 70%, and people would have the option of choosing the super-junk 60% actuarial value “bronze level” plans. So, the people between 300% and 400% FPL might technically have an option that will just barely cost just under 8% of their income, but it will be for nearly worthless junk insurance.
Restrictions on undocumented immigrants
The other item in the Senate bill that makes a mockery of the intellectual foundation behind the individual mandate is the draconian restrictions on undocumented immigrants. The bill would make it illegal for undocumented immigrants to buy insurance on the new exchange–even if they were willing to pay full price with no tax credits.
One of the points of an individual mandate was to get everyone into the system, so there is not more uncompensated care. Yet while this bill forces Americans to buy health insurance, it creates huge barriers to stop roughly 15 million people in the country from buying insurance even if they wanted to. And without a real employer mandate, the Senate bill makes it less–not more–likely undocumented immigrants will be uninsured. The bill puts in place an individual mandate to increase the number of people with coverage, but takes other important actions at the same time to reduce the number of people with coverage.
Why is it that people defending the individual mandate are not equally using the same arguments to forcibly push for less restrictions on buying insurance, and a real employer mandate? These two changes would probably do as much, if not more, to bring people “into the system” than an individual mandate.
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Jon – fyi
MoveOn is asking it’s members to write their Senators urging them to oppose the Bill entirely – approx. 40 minutes ago
link
sorry for the O/T
JOE LIEBERMAN’S OFFICE PHONE in CT is 860-549-8463. I just left him a message stating I think he is a total sellout piece of crap for what he did to health care reform. The girl who answered the phone said she’ll give him the message. FEEL FREE TO CALL HIS OFFICE and voice your displeasure. 860-549-8463.
Exactly as I imagined it: reform structured in such a way to force people to buy insurance that provides almost no coverage, and where out of pocket expenses are not capped.
This is a travesty of reform. We need Sanders to take a principled stand on this: strip the mandate from this bill and we’ll get back to you after passage.
One part of the bill is saying that spending 8% of your income on insurance is a hardship, and another part of the bill is only giving people enough affordability tax credits to make insurance cost 9.8% of their income.
So there’s a 8% to 9.8% mandate tax, not even counting deductible and copayments. Gosh, instead insurance companies (the only industry legislatively exempt from antitrust laws) collecting a federally mandated tax, why not have it collected and spent by the federal government?
Crazy talk know, but I’d note that the 2007 Kennedy-Dingell Medicare for All bill calls out(in Sec. 3):
“there is hereby imposed on the income of every individual a tax equal to 1.7 percent of the wages (as defined in section 3121(a)) received by him with respect to employment… that are in excess of $25,000″.
“there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to 7 percent of the wages… paid by him with respect to employment”.
http://www.govtrack.us/congress/billtext.xpd?bill=s110-1218
Klem, once [or even twice] is enough.
You’ve posted this message on every damn diary around here,
That’s getting perilously close to spam.
Mods?
We need to get them to pull the mandate and make it part of the “fix” for later. That’s the only way to get this bill through now, and revisited later — if the guaranteed customer base gets held back. Insurance companies will be on board for the later “fix” and we can try again for cost controls, public option, and real regulation.
The mandate doesn’t become operative until 2014 anyway, so what’s the rush?
God, do I want Dean so badly. PLEASE run a progressive challenge to this fucking phony in 2012. I would sell my house (if it COULD sell in this economy) to max him out.
It’s clear that the people in the Senate, and perhaps the people in the White House, just don’t think of regular people as human, deserving of the basic components requisite to life, liberty and the pursuit of happiness.
The American experiment is over. People in general just don’t believe in equality.
Some pigs are more equal than others. The ones who are less equal? Don’t get sick. If you do, die quickly.
I find Schumer, Gillibrand, and Durbin’s silence about the gutting of the bill positively unnerving and wonder if this is the tell that they are not loyal to all of the words they spoke and petitions they circulated for the public option since July or August. I mean, hey, what was that a publicity stunt to get them some attention? Don’t they have to stick to their word or is that just for little people like us? Are they going to stand by silently while we get this mandate rammed down our throats for crap insurance? hello!! Oh Senators???!!! Hello!! Are you there??!!
Kill this goddamn thing and kill it quick. This is nowhere close to what candidate Obama promised. I don’t give a rat’s ass about his legacy and I don’t give a damn if he’s a one term president. He sold every last one of us out, so he has only his lying-ass self to blame. Just who the hell does he think will support him? The disgruntled Republican and independent voters won’t even consider voting for him again, and he’s pissed off the liberals, so who the hell is left? Change we can believe in? My fat, white, ass!
Never mind American companies want a slave labor force. Never mind that if immigrants had the right to work legally they would ask for the same pay Americans get and that would stop depressing wages.
Immigrants work in low paying jobs like food. How does a healthcare bill cut costs if immigrants with drug resistant TB, Swine flu etc are coughing at work on your food because they are not yet sick enough to go to the emergency room?
Give everyone a few paid sick days and healthcare then they can go see the Doctor before they spread their disease to everyone else at work and the customers.
The argument that this would drive up healthcare costs is bull. For every 100 worry warts who turn out to be fine there is how many actually sick people for who a day or two of bed rest before returning to work would stop them from infecting everyone else they come in contact with.
The savings once we get the knack of it would be incredible if we could just reduce the flu 10%.
Never mind identifying food poisoning early by treating people who are sick rather than emergency room sick because by then how many more people have eaten the bad food?
Yes. Something needs to be held back, and Mandate certainly fits that bill. It’s got the worst optics and biggest value for insurers.
Of course that also means that Obama wants to deliver it for them.
I’m sorry you have hopes for Dean to run as an independent. When he ran for president in 2004 he was ahead in the Iowa caucus by 22%, but he didn’t have the simple common sense to pre-emptively inform Iowans that in the past he had called for Iowa not to be the first contest for party nomination.
Inevitably transcripts and video of tv interviews appeared out of thin air at the end of the Iowa campaign showing him dissing Iowa and he came in third place (which is what led to the ‘Dean Scream’). I don’t believe he has much common sense.
I think that president Obama is the most pragmatic true liberal since FDR. The Social Security plan that FDR signed paled in comparison to the bedrock program we have today.
I’m sticking with Obama through thick or thin…
Remember that, in 2004, Iowa Governor Vilsack’s wife endorsed Kerry. Why didn’t the Gov endorse Kerry himself? Because Iowa state law forbids a sitting Governor to endorse presidential (and maybe other) candidates.
As an Iowan explained to me at the time, in the Iowa caucuses everyone there knows for whom you “vote” — because you go and stand publicly with others also supporting the same candidate. Iowa state employees attending the caucuses had received the message from on high: Kerry, not Dean.
I’ve always wondered what Kerry promised Vilsack.
Jon, It’s really important to understand that that the affordability exemption, like the subsidies, is INDEXED to health inflation in a way that works against the public. (Page 334)
Over time, the affordability exemption will rise from 8% such that it could be 11% by 2019. It’s an un-freaking-believable screwage of working families.
Well, let me know after the midterms how that “sticking with him through thick and thin” works out for you, or, for that matter, us as progressive Democrats. This fraud is going to cost us 30 seats in the House, seven in the Senate and total loss of BOTH chambers in 2012. We have a HUGE amount of senate seats to defend in 2012 compared to the Republicans.
I would have preferred McCain than a loss of Speaker Pelosi. Other than the SCOTUS, there’s not much difference. Both are warmongers, for example.
Btw, I say this because, and perhaps it’s the “diva thing” and my being gay, but I LOVE LOVE LOVE Nancy Pelosi. So does my bf. She’s a wonderful liberal with courage and she is a VERY effective Speaker.
Hey, I still like the President, as a celebrity, but by now it should be obvious to even casual observers that “Change that is possible” means “Whatever’s good for the corporations.” Bipartisanship means that they can use the Republicans as a fig leaf to cover up their incompetence and desire to cater to Wall Street money. “We didn’t get anything done and it’s not our fault.”
Look, if you’re foolish enough to still support this administration, consider this. The President has never presented a vision. He left it up to Congress to design. Anyone surprised that we’re getting a crap sausage? If the President had Real, Honest-to-God, Principles, he would be fighting for what he thinks is right, not what the Insurance Companies and Pharma tells him we can have. He would be looking out for us, not his re-election war chest.
Instead, imagine what could have happened if he had come out at the beginning of the term and said this is what we’re going to do. We are going to give Medicare to everyone. You choose your doctor and they choose your treatments. Premiums are a payroll deduction, just another tax and you don’t get a choice. That’s what universal means; everyone shares the cost.
If you pay taxes (or should pay taxes), you are covered because you will have paid for it. Of course, all children, unemployed, disabled, work at home moms will be covered without premiums or copay. (That means that everyone will be covered including undocumented workers who pay taxes and the children of undocumented workers who go to school with your kids.) Costs to individuals will be comparable to what other industrialized nations pay (like Britain, France and Canada.)
For all of the seniors out there, you should know that we are going to make Medicare into a full, comprehensive insurance plan. There will no longer be a “donut hole.” We will cover long term care, mental health, vision, hearing and dental. You will never again have to buy Gap (Crap) insurance again. And for all of the doctors and hospitals out there, we will establish a professional and independent compensation board to determine fair regional fees. The compensation board will be independent of the Congress and while it will work to control costs, it will make compensation to providers reasonable. We will no longer attempt to pay for Medicare by squeezing it out of providers.
OK, now that the seniors and the doctors were on board, how possible would it have been to get an astro-turf movement going? Any screaming at town halls would have been at anyone against the bill. People who walked the streets during the election would have gladly flooded the streets. The administration could have controlled the debate and the bill. It would have passed by now and he would have had all of the political capital to do whatever he wanted. But that’s not what happened, is it?
The reason it didn’t, is because he never had any intention of doing it that way.
His constituents are Insurance Companies and Big Pharma. We were screwed from the moment we elected him. I bought into it too, big time.
So maybe it wouldn’t have happened exactly that way but you get the general idea. He could have done it. Present a really good idea that benefits everyone except the corporations and come out swinging for the fences. Control the fight. For those of you that insist that it’s better that we accept crap from Congress, well that’s certainly what you’re going to get. Enjoy. Support an administration that’s not fighting for us? Bullshit. It’s either incompetence or evil intent. You decide.
You just told Congress that there are no consequence for not doing the people’s will, for not getting things right. You’re going to keep getting crap from them because you agreed to it … and you earned it. Dean doesn’t want crap when we don’t have to have it that way, and neither do I.
Oh and by the way, if you’re still going on about the “Dean Scream,” you have so totally bought into MSM’s crap. There wasn’t anything wrong with his actions or his yell. It was a simply a passionate attempt to fire up his troops after a loss. The media, however, took it out of context, ridiculed him because his voice went up and used it to “prove” to the American electorate the he was “out of control.” Go on and tell me the media didn’t have an agenda in how they presented it; just news or something more? I wasn’t supporting him at the time, but I barfed when I heard Couric talk about it with that snide, sarcastic voice of hers (Repub shill that she is.)
Media, corporate interests and big money shot Dean down because they were afraid that they wouldn’t be able to control him. He was too dangerous. Unfortunately, they didn’t feel the same way about our current president.