FYI

[brynndragon]

Today at 3PM on WBUR (90.9 FM and online at WBUR.org) fucking Romney and members of the state legislature will be discussing the new health care plan with the public. I'll be listening, because I want to know if my (and some friend's) impression that this is taking a nice notion[1] and turning it into a nightmare for people who are eking out a living or are (or become) GoLs[2].

[1] No matter how feasible you think it is (I'm up in the air about it myself), quality health care for everyone (aka universal health care) is a fabulous idea.

[2] Gentlepeople of Leisure, also known as the unemployed

Comments

[bikergeek.livejournal.com]

I wonder if "making health insurance available, but forcing the employee to pay 100% of the cost if they want it" (my current situation) passes muster under this law. Honestly, in my younger days, at the pay scale I'm making now, I probably would have passed it up and prayed I didn't get sick. Unfortunately at 40 years old "pray you don't get sick" isn't really a viable strategy any more.

[benndragon.livejournal.com]

I don't know if that qualifies as "offering healthcare" or not. I would hope not, but with fucking "I only like people who can give me lots of money so I can run for President" Romney in charge, I wouldn't count on it.

I think it's a fantastic idea to make companies pay for health insurance if they won't do it voluntarily. But charging companies $295/year and individuals up to $1200/year makes this whole thing into a farce. Gods, I want to hit fucking Romney with a clueX4.

[greyhame.livejournal.com]

Romney ain't in charge of shit, especially where this healthcare bill is concerned. It's strictly a compromise between the people who want an individual mandate, the people who want an employer mandate, and the demands of the federal government with regard to keeping that $385 million in federal funding. What Romney thought of this bill just didn't matter at any point in the process, because it was pretty much a given that whatever bill ended up approved by both chambers would pass by a veto-proof margin. Now, chances are Romney will line-item veto the employer assessment and offer some other idea for that instead, because he thinks $295/employee/year is just too high a price for poor, struggling businesses like Wal-Mart to have to pay. But that won't matter anyway, because the legislature will just override him and put the bill into law as it stands.

I don't like the individual mandate at all -- in fact, I don't like the employer mandate all that much, if we're talking about what the best solution would be; but if we're talking about what the best feasible solution would be, then an employer mandate is better than an indivudual mandate, since we just aren't going to get real single-payer health care anytime soon. And I think it's possible, with the expansion of MassHealth, and depending on how "affordable" gets defined and how much arm-twisting is done to the insurance companies to get them to offer low-cost plans that don't suck ass, for the individual mandate to fail to be really onerous. I'm reserving judgment on whether it will be onerous or not, since obviously a lot of these things haven't been determined yet. But if it ends up that the standard for affordability is a reasonable one, so no one is forced to make untenable choices in order to have the health care required by law, and that the health plans available at the lowest "affordable" level aren't all shitty high-deductible-low-coverage plans that are only cheap as long as you stay healthy, then the individual mandate is an acceptable price to pay to get broader coverage and to force non-insuring employers to contribute something -- $295/employee/year isn't a lot, but it's more than they're contributing right now.

Of course, there are other arguments that bear on this. Bob at Blue Mass Group argues that it's inappropriate for the government to require individuals to enter into contracts with private entities, and he's not wrong. But there were a lot of people, both in business and in the state government, who really wanted an individual mandate and no employer mandate, so unfortunately this bill was about the best thing we could get. It's not great, but it's far from a disaster.

[c1.livejournal.com]

I'm not sure where you got the $100 number: the last one I saw was the the *initial* goal for the law was $200/month, but the legislature balked at a number of chances to meet this goal, opting instead for the goal of an average policy cost of $300/month.
I'm not sure I can afford to live in this state with a second car payment.
How legislators are seeing fit to pat themselves on the back, calling this "a good piece of legislation" is beyond me. It's really a free handout to the insurance companies. No wonder the state's losing residents.
And, of course, Mitt won't call this a tax like it is, because he doesn't want to look like a "tax and spend Massachusetts liberal."

[benndragon.livejournal.com]

Uh. . . I don't see anything in my comment that refers to $100. I refered to $1200 per year for people who don't have health insurance, which is the closest I can see to $100. Did I miss something in someone else's comment?

I wonder if having some sort of "companies that have $more-than-X profits/year need to pay $something_more_than_individuals/year per uninsured employee" clause, which would compliment the "people who make $more-than-X/year need to pay in full for their coverage with no substidies or else get tax penalites", would be useful. I'd feel a lot better knowing the underemployed weren't paying more than Wal-Mart or Mobil for health care.

[greyhame.livejournal.com]

Looking at your original post, and c1's comment, I think it is a reference to the $1200 figure -- that is, you're talking about a yearly cost and c1 is talking about a monthly cost -- $1200/year = $100/mo.

[benndragon.livejournal.com]

Ah, OK. c1, that's the amount of the tax penalty for anyone who doesn't get insured, supposed to reflect half the cost of getting health care (I wonder if they're going to raise that to $1800 since they're now working with a base of $300/month?). I'm compared a person who doesn't get health care coverage for themselves to a company that doesn't pay at least partially for health care coverage for its employees, where the company is paying 1/4 of what an individual pays for what seems to me to be the same behavior (actually, the company gets a better deal, since they only need to partially pay for the coverage). That just feels wrong to me.

The answer to this difference when the host of the piece on NPR was, "But the insurance will be so damn cheap, everyone will have it!" Sounds like a smoke-and-mirrors response to me. My fears that the companies get off light, the private insurers get more money, and the taxpayer gets the shaft were most definitely not reassured.

[friode.livejournal.com]

Yeah. It typically costs something surprisingly close to $295 per _month_ to provide health care to an _individual_ (no spouse/domestic partner/child coverage there). I can't imagine companies saying ``we'll spend $3600/yr so that we don't have to pay the government $300/mo''

The $300/mo should come down if we can successfully get the people who pay for health insurance to not end up having to pay for both themselves and the poeple who don't pay for health insurance (which _is_ what happens now), but still...

[mr-teem.livejournal.com]

The Massachusetts plan makes me nervous because of the penalties imposed on those who make more than $48,000 or so (that's the number in today's Globe article and I understand it's been fluctuating) if they become uninsured. I have lots of friends my age who's COBRA benefits have long since run out and are underemployed but currently don't have coverage because they can't afford it. Conceded, the very poor will get coverage but the cost shifting is moving around in an odd way.

And, of course it does nothing to address the actual costs of health care although I've heard some state lawmakers on the radio imply that it will.

[benndragon.livejournal.com]

It seems really poorly thought out. It's not only a nightmare for barely-middling citizens, but for the bureaucrats who have to help people find solutions to problems like "I'm taking a month off between jobs, can you find a plan for me that only lasts a month and costs less than the fine?" I know, I'm assuming bureaucrats actually *work*, but if problems like that aren't solved there will be an agrarian revolt, with a mob that's especially infurated by the frustration of trying to find pitchforks, spades, and torches in the city of Boston.

[mr-teem.livejournal.com]

I'm not so sure about the poorly part. There clearly was a lot of compromising that went into this, as greyhame points out above. In fact, he reminded me what I thought of when I first heard of this plan. This is a creeping bit of the "ownership society" in action. What I don't see--and it may be that I haven't looked hard enough--is a statistical analysis. The costs are shifting around and there's a lot of uncertainty for small employers and those with medium incomes. Whether or not this is a good change will not only come on the top-note number of those insured by the plan as of it's adoption but also the longer term increase or decrease in small employers providing insurance, middle-income workers able to stay insured, population and employment changes as a result. (Sheesh. The numbers on the Social Security destruction plan were trivial compared to this--as I'm writing this I'm realizing how many variables there are.)

I'm subject to these changes because I'm employed in Massachusetts, of course. I was just explaining to New Guy (who is, of course, thirty and obliviously healthy) that if things take another downturn here, our employer could easily pony up $300/head and leave the 3,000 or so of us on our own to contract for health insurance since they pay far more than that now. (He doesn't see this as a bad thing.) Granted, that would cause a serious brain drain. But that would mean I could only get a NH policy, which would be somewhat suckier in their protections than the corresponding MA policy would be, depending on the insurer. (Live healthy or die. Heh. HCHP has a common policy for individuals, as I recall, since it's regional. BCBS, which I'm stuck with as of this year, actually writes different individual policies for NH and MA. They're technically separate companies in those two states.)

[dirkcjelli.livejournal.com]

is this ( http://en.wikipedia.org/wiki/Ownership_society ) what you mean by 'ownership society'?

[mr-teem.livejournal.com]

Yes.

[white-and-nrdy.livejournal.com]

Compromising, by nature, is what *neither* party entirely wanted in the first place, but what they "meet in the middle" on in order to proceed. Each side (or all, if more than one) presumably did their own research to determine what they think the best plan will be. The compromise that moves forward isn't *anybody's* best plan.

I think it's absolutely wonderful if a company, or a tribe, or even a small town wants to provide health care for everyone. And conceptually, I think that everyone should have access to more than the "don't get sick" health plan (which I've been on for 2 years - the end of that is 2 weeks away, thanks to a new job). But in practice, it comes down to wanting to please all of the people all of the time, which is impossible.

Once you try to mandate something like health care to a large number of people, by necessity it has to boil down the the lowest common denominator, and in the process it becomes less and less applicable to individual needs. Many think Canada's national health care system is great. For a long time I did. But then I heard individual Canadians complaining about the problems they've had getting adequate treatment and how much it costs and other problems.

Unfortunately, our population has grown so much that the days of the town doctor, who knew everyone personally and took good care of them, are long since gone.

I don't live in Mass. anymore, but my biggest concern is that this plan, which is supposed to be helping people, will actually end up screwing a lot of them instead. And I'm afraid the chance of this is rather good, since many of the state's plans end up being that way. :(

[friode.livejournal.com]

A month off from jobs should normally be trivially be solvable with COBRA, if you're going from a job that has traditionally paid for health insurance to another such job.

[tober.livejournal.com]

I would actually disagree with the statement that "No matter how feasible you think it is, quality health care for everyone is a fabulous idea." I could launch into a lengthy tirade[1] on this, but instead I'll just claim that this statement is pretty platitudinous and about as meaningful as any of the following statements:
Quality food for everyone is a fabulous idea.
Quality housing for everyone is a fabulous idea.
Quality sex for everyone is a fabulous idea.
Quality annual vacation to exotic locales with balmy beaches and fruity alcoholic beverages with tiny umbrellas in them for everyone is a fabulous idea.

[1] Tiny version of tirade: Regulation that distances individuals from the true cost of things that benefit them is bad. I am convinced that much of what is wrong with health care as it stands now is not that too few people are insured, but that too many people are insured - or, in other words, a much fairer (to all parties except insurance companies) market would exist with respect to health care if the vast majority of consumers of health care services paid out of their own individual pockets.

Why you want to insure everyone, according to my profs

[(Anonymous)]

According to my professors:

See, making people pay out of pocket for healthcare makes them reluctant to go to the doctor. So they won't pay to see the dentist for their infected tooth but run to the ER when their mouth is a festering pile of pus. Costs more to treat them, so it's economically inefficient in the long-run: pennywise and pound-foolish.
And the unfortunate individual now has a mouth that doesn't chew anymore.
What we should do that we don't do in healthcare is preventive medicine. So we get everyone insurance so they can see the doctor regularly, and pay for everyone's hypertension meds so they don't come in for the kidney failure from untreated hypertension.
That's the official med-school argument, anyway.

Extremely Corrupt Henchman Egregiously, Needlessly Alienating Good Users :-)