Jon, Another excellent piece. You said:

Regulations un-enforced are just like no regulations at all.

They’re worse, because they destroy the legitimacy of Government and persuade people that Government is impotent and can’t even enforce the law. If a situation develops where the Government enforces the mandates but not the regulations, I hate to think of the consequnces.

One more thing,I really don’t think that a pitiful PO of the kind that is in the House bill would do very much to keep the insurers in line. In fact, I think this whole exercise has only served to underline why Medicare for All is the only good solution for us. First it’s a business matter. The only way to radically cut national expenditures on health care in the near term is to institute Medicare for All and get insurance company overhead and profits out of the picture. Their overhead and profits are just not something the American people can continue to afford to pay.

However, even more important is the poison the health insurers introduce into the American political system. They are a source of great corruption and are undermining the legitimacy of the Government and the Party system by their actions. One of the best things that Medicare for All would do for us is to destroy them as a major political force. That alone makes Medicare for All worth doing.

Great point, you should use an example to illustrate though. My favorite is the SEC (not state level, but a shining example of toothlessness).

Here’s another pitfall that most every average American can identify with:

Neither bill proposed will help anyone navigate the claim forms, denial of care forms, the redundant bills, the run-around on the insurance phone lines, or general LACK OF CUSTOMER CARE demonstrated throughout the course of the insurance industry’s reign. People will still need to keep up with the bogus, hidden-charge laden, insurance premium bills, scour them for inconsistancies, overcharges and fine print and hand over an exorbitant sum of money for a service that is really nothing more than a middle man.

No Public Option = No Mandates…

WTF is so hard for Obama, his staff, the senate or the house to understand?

Senator Durbin just announced the National Nursing Association just gave their blessing to this legislation

Someone on the Democratic side of the Senate not only agrees with you, Jon, she actually put her concerns into the Senate record yesterday, despite the fact that she continues to follow corrupt Party-machine “Boss Tweed”-style orders to force through passage of this bill, as is, ASAP:

Mrs. FEINSTEIN. Mr. President, I rise to discuss an amendment to create a medical insurance rate authority and rate review process that I filed to the Patient Care and Affordable Choice Act.

Unfortunately, because of the objections of one of my colleagues, my amendment was not included in the final bill before us today.

I am profoundly disappointed. I would like to take a few minutes to discuss why I believe this proposal is so important and why, without it, we can expect to see skyrocketing health insurance premiums.

I am very concerned that health insurance companies will seek to exploit the time between passage of the bill, and 2014, when reforms are fully in place.

Credit card companies provide a useful example. Earlier this year, Congress approved major credit card reform legislation. However, the consumer protections it contains will not be fully effective until February 2010.

Credit card companies have taken full advantage of this interim period to raise rates, with many card interest rates increasing 20 percent over the last year.

I am very worried that health insurance companies will do the very same thing. And I believe the rate authority amendment is essential to stopping them.

[...]

This concern about premium increases stems from the fact that we are the only industrialized nation that relies heavily on a for-profit medical insurance industry to provide basic health care. I believe, fundamentally, that all medical insurance should be not for profit. [See previous remarks from Senator Feinstein on that point here.]

The industry is focused on profits, not patients. And it is heavily concentrated, leaving consumers with few alternatives when their premiums do increase.

As of 2007, just two carriers–WellPoint and UnitedHealth Group–had gained control of 36 percent of the national market for commercial health insurance.

Since 1998, there have been more than 400 mergers of health insurance companies, as larger carriers have purchased, absorbed, and enveloped smaller competitors.

In 2004 and 2005 alone, this industry had 28 mergers, valued at more than $53 billion. That is more merger activity in health insurance than in the 8 previous years combined.

Today, according to a study by the American Medical Association, more than 94 percent of American health insurance markets are highly concentrated, as characterized by U.S. Department of Justice guidelines. This means these companies could raise premiums or reduce benefits with little fear that consumers will end their contracts and move to a more competitive carrier.

In my State of California just two companies, WellPoint and Kaiser Permanente, control more than 58 percent of the market. In Los Angeles, the top two carriers controlled 51 percent of the market.

Record levels of market concentration have helped generate a record level of profit increases.

Between 2000 and 2007, profits at 10 of the largest publicly traded health insurance companies soared 428 percent from–$2.4 billion in 2000 to $12.9 billion in 2007. This is Health Care for America Now, Premiums Soaring in Consolidated Health Insurance Market, May 2009, citing U.S. Securities and Exchange Commission filings.

[...]

I am very concerned that this profit seeking behavior will only worsen, now that insurance companies know that health reform will change their business model.

Insurers know that come 2014, they will be playing by new rules: No discriminating based on preexisting conditions. No cherry picking and choosing to cover only the healthy. No charging women or older people astronomical rates. No dropping coverage once someone gets sick.

Insurers know these changes are coming. Listen to a comment made by Michael A. Turpin, a former senior executive for UnitedHealth. He is now a top official at an insurance brokerage firm, and he said that insurers were “under so much pressure to post earnings, they’re going to make hay while the sun is shining.”

“Make hay while the sun is shining.” That means these companies will try to make as much money as they possibly can, for as long as they can.

That is why a rate review amendment is so important.

Frankly, I wish the health reform bill before us would go further and eliminate the for-profit health insurance industry.

But since this bill chooses to maintain a for-profit industry, we must do the next best thing and ensure that it is thoroughly regulated. Insurance companies should not be able to take advantage of the fact that affordable health care is a basic life need. In effect, they have the power to increase their prices at will, knowing that people will continue to pay as long as they can afford to do so.

This amendment certainly will not fix all of the ills of a for-profit insurance industry, but I believe it makes a needed improvement in the underlying bill and will help protect consumers from unfair increases. Without it, I worry that consumers in far too many States will see major premium increases.

when they go to committee for reconciliation they sure as shit had better repeal the McCarran-Ferguson Act as part of what ever comes out…

if not part of the bill then first business back from holiday break…

if GOP wants to stiff Dems on this one they too will pay a price come Nov.

thanks for Feinstein’s words…

once again Democratic labias show up Democratic testicles as the silicone fakes that they are…Democratic Senate, a choir of castrati, servile sycophants to their corporate masters all…

“I wish the health reform bill before us would go further and eliminate the for-profit health insurance industry.

“But since this bill chooses to maintain a for-profit industry, we must do the next best thing and ensure that it is thoroughly regulated.”

Jon, this may be a little off-topic, but I’ll let you decide. I have read a number of different accounts of whether and/or how the mandate will be enforced. Someone in the comments on another thread said the IRS was technically supposed to enforce it but had no mechanism for doing so, another that it wouldn’t be enforced if premiums amounted to more than 8% of income, and a number of other assertions.

Since you seem to be the most knowledgeable person on FDL about this bill, can you post something that lets us know how and what the mandate actually means particularly WRT enforcement?

In fact, I think this whole exercise has only served to underline why Medicare for All is the only good solution for us. First it’s a business matter. The only way to radically cut national expenditures on health care in the near term is to institute Medicare for All and get insurance company overhead and profits out of the picture. Their overhead and profits are just not something the American people can continue to afford to pay.

That is the win we take away from this if we kill the bill–organize around Medicare for all, beefing up the system expanding it and increasing the political constituency keeping it whole.

If Feinstein is opposing insurer profit, given her conservative credentials, then where does that situate the blue dogs?

The scam works like this:

1) Reduce federal aid to force states to pick up slack until bankrupt
2) Transfer regulatory oversight to bankrupt and/or corrupt state agencies
3) Profit!!! (for industry “fill in the blank”

What was the first thing to go in the Senate bill? The anti-trust exemption repeal.
The public option came later.
Wonder why that is?
While everybody is up in arms about Obama, or the Senate, the healthcare insurance industry is laughing…..Their asses off. At us.

We need to revisit the anti-trust exemption again. You’ll see the HII sweat, then. Until then, there will be nothing to remind them of why they exist in the first place.

Cut to the chase. Two words: “Regulatory Capture.”

That is what this entire thing comprises.

What are our chances of getting any steppingstone for Medicare For All before 2014?

Absofuckinglutley, these regulations will be like the environmental and labor practices rules in the trade bills.

California attempted to enforce regulations against rescission. Unfortunately, the state encountered the well funded legal battalions of Big Insurance and gave up the fight because of the time and expense involved.
Even when there is a will, there may not be a way…
The current bill is a retrograde mess because it doesn’t even have a willow switch, let alone a stick, to wave at the offenders.

Wish I could say I’m shocked.

Slaughter’s for kill the bill.

“Letter to a Sincere LEftist”

http://www.jewishworldreview.com/1209/tracinski122309.php3

Other than political geeks or experts, I’ve yet to meet anyone who has any idea what their State insurance commission is up to. The commissions specialize in obscure rules that vary from State to State and are not understood by many citizens. In addition to being outgunned by industry, State agencies such as this are not likely to be well-known to the public or scrutinized by anyone, which leaves them vulnerable to political patronage and corruption. They are also likely to be underfunded. The corporations will love it.

I supported single payer and public option. But can you address Jon Walker the following?

Isn’t a for profit organization with a regulated loss ratio a pretty good thing, if the loss ratio is aggressively controlled by the government?

Like the CBO said (I think), if you tell an insurance company how much to spend on care and set it at 90 or 95%, aren’t you pretty much creating a public utility?

And what about the non-profits? If I am mandated to give money to a non-profit insurance company with a regulated loss ratio…. and I get a subsidy based on income… well, am I not getting pretty close to a tax based public option?

Now, I can see the structural problem here…. these companies can lobby to lower the loss ratio, and by not embedding the solution in a national program, it can be slowly dismantled. Loss ratio regulated non profits are less politically and structurally desirable…. but IF they are actually supported it seems like they could be pretty good.

Or do you disagree? I don’t know the answer, but it sort of looks this way to me.

Slim and None. And Slim is leaving town Real Soon Now.

Glad to see that someone on the other side noticed that the bill isn’t socialism. Thanks for the link.

There only was, is, or ever will be one single simple solution: drive the insurance industry out of business, into their well-deserved grave. Until that day, health care will be screwed up. Period.

Oh, and one of these days, recognition has to become official that pregnancy is a medical condition and its “treatment” is not a moral issue.

God, it’s so damned simple! A one page bill could say it all and put all of the horseshit in a burnable pile at the same time. Hard to believe how screwed up this country has become.

Isn’t there an even worse interpretation of the Senate bill? The current version is based on the House bill, right? If that’s true, then they removed the enforcement framework Jon referred to. That’s even worse than just having not put it in.

Just please note my assumption. The rightness of the conclusion is based on the rightness of that assumption.

Ah, yes, but it’s a completely American screw up. No one does that better than the U.S. of A.

Hello Oregon

Let me tell you the BIG SECRET ABOUT HEALTH INSURANCE.

first you must understand this:

The VA takes care of all of the Vets (govt run)
Medicare takes care of the Old (govt run)
Medicade takes care of the Poor (govt. run)
(yes the govt take care of all the risky people)

Health Insurance companies only take care of the Healthy.

A for Health Insurance Profit Company would go out of business if had to take care of Sick People.

Guess what the rest of the WORLD figured this out a long time.

The Health Insurance Business is a complete SCAM, remember if you get sick they will drop you, and they will drop you once this crappy HCR bills goes is pass. WHY? You CANNOT MAKE MONEY OFF OF HELPING SICK PEOPLE.

Due a lot of accounting tricks, insurance companies create a lot of phantom cost. Insurance companies ROI may be as high 25% or 35%

jedi, I don’t think you are addressing the issue of loss ratios. Regulated loss ratios, if they are actually regulated, force you to spend money on sick people, and define exactly what percent of the dollar goes to administration and profit.

My take is that DiFi isn’t really a Democrat- she just plays one on T.V. If she feels the need to pretend to be working for additional regulation, I guess that is a plus, but I wouldn’t hold my breadth waiting for her to actually do anything about it. As with Obama, watch what she does, not what she says. But still, this is good news. Maybe they are starting to sweat a bit over their sell-out. We will see.