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There are two legitimate paths to passing health care reform that use reconciliation. One is a reconciliation sidecar, and the other is a brand new bill using only reconciliation. This reconciliation-only option appears to have the support of DCCC chairman Chris Van Hollen, who thinks the Senate bill is politically toxic. If Democrats go this reconciliation-only route, a politically smart move would be to go big, but go very focused. Make sure the bill at least addresses the single biggest problem with our health care system: medical bankruptcy. It would be very possible to use reconciliation to pass simple measures that could prevent all medical bankruptcy in this country.
The fact that if people get really sick they can go bankrupt or can’t afford needed medical care is the worst moral problem with our health care system. Things like rescission or refusal to cover based on pre-existing conditions are disgusting practices by private insurance, but the main reason they are so terrible is because they can cause medical bankruptcy or create unmanageably tough financial choices because of medical cost.
Reconciliation could be used to create a new program, or use the existing Medicaid and Medicare programs, as a form of universal catastrophic insurance. Simply write the bill so that if any American without insurance gets seriously ill and is forced to spend a large percentage of their income (say over 12%) on health care in a year, they will (after spending that amount) automatically be covered by Medicaid or Medicare. This idea is modeled after a similar, near-universal catastrophic insurance program in Singapore called Medishield. For example, if a family without insurance makes $45,000 a year and has a child who needs chemotherapy that costs $50,000, after the family spends $5,400 (12% of their income) on medical costs, the family is automatically covered by Medicaid or the new program.
The threshold could be a percent of income like the example above, some level of medically induced poverty, or a mixture of the two. One’s level of medically induced poverty would be your total income minus the cost of an extreme medical emergency. If medical costs cause your effective income to go below a certain threshold (say 185% of federal poverty level), you are automatically enrolled on Medicaid. So, for a family of four making $50,000 a year spending $9,200 on medical costs, sending their effective income below $40,792 (185% of FPL), they are automatically enrolled in Medicaid. But if that family of four was making $70,000, they would need to spend $29,200 before automatically being enrolled in Medicaid.
To prevent insurance companies from gaming the system, there would need to be some form of a ban on rescission or annual and lifetime limits. Even if, due to the Byrd rule, an outright ban would be impossible through reconciliation, it should still be possible to use a special free-rider tax on insurance companies that sell policies with annual or lifetime limits to effectively end the practice. The plus side to this is it would give the government a financial incentive to make sure insurance companies are not ripping off their customers.
If it were up to me, I would use reconciliation to create Medicare for all. Given that Medicare for all is unlikely, I would strongly back using reconciliation for a large expansion of Medicaid, SCHIP, and Medicare that deals with the bulk of the uninsured. But if Democrats are afraid of the complexity of even that solution, they still need to achieve something big with health care. I think just ending medical bankruptcy by creating, through reconciliation, a universal catastrophic insurance program would be a politically smart solution, and the most “scaled down” reform we could get without it looking like a full retreat and an epic failure.
Ending medical bankruptcy polls very well. The program would extremely easy to explain, and would be focused enough to address a major fear. “If an American gets very sick in this country, we will make sure they will not go bankrupt and lose their home as a result.” If Democrats had spent the past year focused on simple and direct ways to solve our health care problems, instead of a corrupt Rube Goldberg plan to enrich the insurance and drug companies, maybe they would not be in such terrible political shape right now.
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This would be great for people who have surprising and costly ailments and accidents, heart attacks, strokes, cancers discovered after a dramatic ER-visit type incident. It would be essentially useless for people who have no insurance and walk around with various problems but can’t (and don’t) have them checked out because they know that they can’t afford $600 blood tests, $900 ultrasounds, $1,500 CT scans or $2,200 MRIs that would be needed to give them clean bills of health. Or people with chronic ailments who aren’t getting treatment because ongoing monitoring represents small but untenable chunks of cash that they just can’t part with, because before they spent enough to get to 185%FPL they’d still have lost their ability to keep the lights on or put gas in the car.
For all the talk about no bill is meaningful without a public option, any bill that doesn’t contain mandated coverage with capped premiums for people with “pre-existing” conditions and doesn’t contain cost-containment is even more meaningless if it’s coupled with a bandaid solution like this that would be big and showy and pointed to as “solving” an important problem because “no one can go bankrupt.” There’s an extraordinarily wide gulf between bankruptcy and affordability that a lot of people would fall into under a scheme like this.
If a family making $50,000 a year goes bankrupt after spending $9,200 on health care, then they are living wrong. And for those walking around without insurance because they “cant afford it”, I say to them, it’s all of the OTHER stuff you cant afford: perhaps the big house, the cell phones and i-pods, CD’s, DVD’s, the new car???? Get rid of the STUFF, and you will be able to afford health insurance. HI should be number one on the priority list. After it is paid for, you live on what is left.
It is time for Americans to leave home, cut the unbilical cord, get off the dole, stop being victims, stop hoping someone else will take care of you. Ultimate freedon is independence which is the lack of DEpendence.
And if no company will sell them insurance?
Benjamin Franklin1766 — On the Management of the Poor
Category: Poverty
I am for doing good to the poor, but I differ in opinion of the means. I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. In my youth I travelled much, and I observed in different countries, that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer.
Benjamin Franklin1753 — letter to Collinson
Category: Poverty
Repeal that [welfare] law, and you will soon see a change in their manners. St. Monday and St. Tuesday, will soon cease to be holidays. Six days shalt thou labor, though one of the old commandments long treated as out of date, will again be looked upon as a respectable precept; industry will increase, and with it plenty among the lower people; their circumstances will mend, and more will be done for their happiness by inuring them to provide for themselves, than could be done by dividing all your estates among them.
Benjamin Franklin1771 — Autobiography
Category: Poverty
This gave me occasion to observe, that when Men are employ’d they are best contented. For on the Days they work’d they were good-natur’d and chearful; and with the consciousness of having done a good Days work they spent the Evenings jollily; but on the idle Days they were mutinous and quarrelsome, finding fault with their Pork, the Bread, and in continual ill-humour.
On Why pre-existing conditions disqualify… It is plain and simple..People will get insurance when they are sick and need it..then drop it when they get well. This bankrupts the ins. companies and also drives up the cost of those who purchase it for a lifetime, like ME. Insurance is “shared risk.” Those who do not share the risk should not be allowed to benifit from the pool. SORRY. This is not about the wrong or right thing to do..This is about upholding the American way of life. There are plenty of countries who provide socialized medicine. If that is what you want, then go there. No one is stopping you. But leave my country and my way of life alone. I like driving my truck and paying for my own health insurance. I like freedom of choice. And with it comes responsibility..and that, I like too
Let’s see.
$50,000 per year for a family of four.
Take out roughly 30% for Federal, State taxes and SS/Medicare
$1k per month for Rent/mortgage ($12k for the year – most likely low in at least half the country)
$150 per month for utilities (which is low)
$250 per month for a car payment and insurance (again, low)
So we are now at $18.8K available and haven’t gotten to food, clothing or anything else.
So yeah, a $9.2k hit for health costs will most likely bankrupt (especially since I haven’t had any insurance costs in the $18.8k remaining.
Perhaps if we got rid the the unsustainable entitlement programs Medicare, Medicade, SS, and wars were ended, your taxes would drop to a sustainable rate.. You then would have NO problem purchasing health care. But instead, you continually look for someone to take care of your problems. That is why these entitlements cost so damn much..and there seems to NEVER be a end to their growth. Dont you see that your taxes are going to soar to pay for this new welfare program. (that is what it is). I simply cannot understand why anyone would choose to blindly send more money to the feds, for “God knows what”, instead of keeping your hard earned money and spending it the way you deem fit? I’m sorry, but it just doesn’t make sense. THINK!!!!! Oh, and the $250 car pmt? Get rid of that. How much is your car ins? But that’s OK??? That is more important than health ins??
Priorities??…rethink them
Ah, so do your parents and grandparents know you want to go back to the days of the elderly living in abject poverty and eating dog and cat food as it is cheaper than human food?
Social Security is the SINGLE biggest reason not all elderly are living in poverty today and scrounging in garbage cans.
FWIW, I have been ready and willing to work but unable to find anything more than a part time minimum wage job in six years. I drive an 18 year old Ford Escort that is falling apart. I carry only liability insurance and it still costs me over $600 per year WITH a clean driving record.
Given that, even with reasonably good health, I could not afford the $1,200 a month it would cost me to purchase health insurance on the open market.
Please return when you have some concept of the reality for folks not in your little isolation bubble.
guess what? Ben Franklin was jus wrong. Modern economies work a lot better when there are strong safety nets. We no longer live in the 18th Century. End of story.
Some people would buy insurance when sick and then drop it. Some of us, who are never going to not be sick because we have chronic illnesses don’t have that luxury, but we can’t get insurance coverage either. Most things that are considered “pre-existing conditions” don’t go away. We’re not talking about people getting coverage for a torn ACL and dropping it after surgery and physical therapy. We’re talking about people with diabetes and arthritis and endometriosis and epilepsy and bipolar disorder and histories of cancer who need consistent and ongoing medical care and monitoring and would like, very much, to be “responsible” and have “freedom of choice” just like you, but are being denied because insurers won’t take us, or will only offer us limited coverage at onerous and untenable prices.
For the vast majority of mostly “healthy” people, sounds like a plan to me. It’s cheaper for them to pay out of pocket up to a certain amount, with the government kicking in to cover NECESSARY care over that amount, than it is for them to fork over thousands of dollars to subsidize healthcare financing schemes for OTHER people when they recieve no medical attention themselves.
Unless you’re a bought and paid for member of the corporatist fascist wing of the Democratic Party, this is a no brainer.
After 40 years of systematically creating an economy in which truly massive numbers of people would be left behind, I don’t see how the corporatocracy can now turn to those same people and demand they fork over thousands of dollars a year for services they will never use. These are the people who should subsidize pubic health? I think not.
There’s nothing wrong with paying out of pocket rather than giving your money up front to any healthcare financing entity. Meanwhile, there is NO LOGIC in medical pricing. Between the government and “consumers” we need to force some logic into the system.
I think the “free market” people have a point here. As a collective, ie., a “market” we can’t automatically sustain just whatever irrational price someone else demands for their services. With the rest of country faced with the real economic effects of “structural adjustment” as a byproduct of globalization, the medical field will be subject to the same conditions as everybody else.
The Senate Bill seeks to delay this by hurting the same people over and over again, that pesky former middle class. But, the truth is, the corporatists haven’t been paying attention and there’s no more blood in that particular stone.
A little reality, please.
Meanwhile, older people should be able to buy into Medicare early–should they CHOOSE to do so. Chronically ill younger people can have their own special arrangement with the government. You know, it happens sometimes.