The truth is coming out about the new health care bill – and some of it ain’t pretty.
The state may have to exclude nearly 5,000 people from the program next year, and more than 37,000 by 2009, depending on how many people enroll and how much they contribute, according to the Commonwealth Health Insurance Connector Authority. Because the budget for the plan is capped at $160 million through next June, people who apply for enrollment may be denied if there is not enough revenue available.
Mmm. Sounds like that’s going well. Can’t wait ’til some of those thousands of people get hit with tax penalties for not buying health insurance that they can’t afford.
And here, in a nutshell, is why an individual mandate is such an awful idea:
Board chairman Thomas Trimarco, Gov. Mitt Romney’s secretary of Administration and Finance, questioned whether draft contribution levels for people making up to 150 percent of the federal poverty level were high enough, saying the $10 per month proposal was too low.
“I would like to know the percentage of people in that group who have cell phones. The cost of that is far more than $10 a month” Trimarco said, later adding that people in that economic stratum should prioritize health care before cable television and cell phones.
Putting aside the painfully obvious point that some people need cell phones for their jobs, or use a cell as their only telephone, here’s the question: who gets to decide how you spend your money? You?
Or this guy:
It is really unbelievable to me that the Republicans, who make such a stink over tax cuts being about whether you or the government knows how best to spend your money, could turn around and push a monstrosity like this individual mandate. I’m looking forward to the Republican presidential primary campaign ads:
SCARY-VOICED ANNOUNCER: “Mitt Romney wants the government to decide whether you can spend some of your hard-earned money on a cell phone so that you can always get in touch with your kids, or whether you have to buy expensive, bare-bones health insurance.”
CANDIDATE WHO IS NOT ROMNEY: “I’m Candidate WINR [that’s pronounced ‘winner’ –ed]. And I think you, not the government, should decide how you want to spend your money to meet your family’s needs. Because you, not the government, know your family best.”
You know what they say: everyone loves a WINR.
. . . .whose campaign coffers Richard Lord fattened to land a seat on the Connector board?
President of the Board of the Massachusetts Medicaid Policy Institute. Hey, what a grand idea, have the “lord” of the corporate community preside over how to keep enlarging MassHealth. Expanding “access” this way will satisfy some of the advocates at the expense of continuing to break the state budget. Many corporations are so adept at getting out of paying their fair share of taxes into state coffers; Romney never did quite come thru on that campaign “Close the corporate loopholes” pledge, did he? (While we ordinary citizen taxpayer peons aren’t so good at getting out of it, and I don’t mind paying my share if we all get our money’s worth.) Getting “Many more people covered” with medicaid expansions will be cause for celebration in the short term and will distract folks from thinking that maybe ALL employers oughtta pay in to the pool for health coverage. And it certainly will keep the insurers happy ‘cuz still no one is requiring them to spend a required percentage of what they collect on actual healthcare. And, hey, they’re the same companies collecting the dough from these medicaid expansions, and from the Chap 58 “Mandate” etc, now aren’t they? Hey, what’s going on here? A very good question indeed.
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I really am saddened to have to say that I believe the MA Chap 58 law will fail and that the individual mandate stinks. I’m saddened and I’m really pissed. The entire country is looking to this “MA Miracle” reform law as a model for other states and the f—ing entire country!!! And I know that the people of this state can do much better to solve the health care crisis than this Chap 58 Romney-Healy-AIM-healthcare plan. We need something akin to Improved Medicare For All (with real prescription drug coverage, for one thing) on the state level and then as a universal national health insurance program for the entire country. Isn’t it time we join the rest of the civilized world on this one, and maybe pay 1/3 to 1/2 LESS for healthcare per person as they do? (and they ALL have better health status indicators; the US ranks 37th).
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I and many many other advocates and other healthcare professionals firmly believe that we can actually cover everyone in the state with good affordable health insurance and that to accomplish that we must require that all “stakeholders” pay in a fair share. Kind of like we all pay in for our Dept of Public Health and we all get clean drinking water and safe food in public places, etc And we all pay in for police and fire services which are there for all of us. Period. (yes, improvements are needed, but at least we all have the services)
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And if we the citizens of the Commonwealth undertook the real reform thats required to accomplish those worthy goals, goals that most folks in the state actually agree with according to multiple polls, then we must cut out most of the huge amount of waste that chews up about $15 Billion (yes, Billion) of the $56 Billion spent on healthcare in MA last year (see full report at http://www.HealthReformProgram.org).
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We already pay enough into the state’s healthcare system to cover every resident with truly comprehensive insurance coverage. Now its time to demand that healthcare dollars be spent on healthcare. What a novel idea. Check out our organizations website for critiques on the Chap 58 law and for info on efforts that are well underway to accomplish the fundamental system reforms that are required for successful sustainable affordable universal healthcare reform.
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They’re not closed? Where are they?
All of these bizarre, baroque, and ultimately stillborn schemes to avoid the obvious – universal single-payer healthcare. Virtually every other first-world country does it, they pay way, way less than we do, and get care that’s demonstrably at least as good.
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The good news is that people are finally starting to wake up a little. Ten years ago, if one mentioned universal single-payer healthcare in the US, one was whooped upside their head (I have the scars to prove it). Now Ned Lamont is talking about it, and nobody seems to be going postal.
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Here’s the opportunity for our bluest of blue states to be a beacon for the rest of the country – let’s get ‘er done! Not only would we have better health care for less, and for everyone – think of the businesses that we could attract here by ending or slashing their healthcare costs.
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[yes, yes, I know, I know, it can never happen… insert Realpolitik Weltschmertz response here…]
He’s a real gem, isn’t he?
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That being said … if they don’t pay for the health insurance, someone else is. Now, actually I don’t have any problem with socializing the crap out of health care — what is insurance except for “private socialization”, anyway? But it’s better that those folks be insured than not — for all of us. Better health, better use of bucks. You can argue about the best way to provide that, but if you read Health Care for All’s blog, you can see the Connector Board folks are trying to balance services, access and out-of-pocket costs within their budget — and it ain’t nohow easy.
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Universal coverage — or near universal — requires mandates on someone — either individuals, employers, or the state. You can say this is the wrong one, but if it is, you better start talking about something that’s politically feasible, or make it feasible somehow. Good luck with that.
I’m under the impression it’s extremely unlikely that low income folks will ever get tagged with the tax penalty, for exactly the reasons David states — it’s just too cruel, too stupid, politically untenable. Those folks will unfortunately be the ones in the doughnut hole — left out.
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And no, as you can tell, it’s not real 100% universal coverage.
And if you thought tracking down illegal aliens was a dumb job for the state police, just wait until law emforcement is charged with collecting against low-income Massachusetts residents who can’t afford this. Did I say low income? Hell, even a lot of moderate income residents won’t be able to afford this for this. $500/week wasn’t that long ago for me, and I remember all too well what was left over at the end of the month. Didly-squat.
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And I can speak to David’s point about the Massachusetts Republican party. I was in a room full of people where Kerry Healey was holding forth, and she explained her position on this issue. She felt as though Massachusetts business had done more than their share to provide health insurance, and as a matter of “fairness” and “individual responsibility,” an individual mandate was necessary.
Dunkin’ Donuts and Wal-Mart do SO MUCH for their employees, they must be bleeding. [/snark]
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Toss the individual mandate, edge up the employer mandate, put a progressive income tax on rich people, use that newfound money to give us higher-quality, lower-cost-per-person state-run health care.
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Anything is better than the fucking HMOs. Even being insured these days is no guarentee of decent care, and that’s WITH the double-digit cost increases per year.
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After 6 years uninsured, I realized upon getting back on (thank god) to an HMO (Blue Cross) how much crappier the quality of service was. And you’re supposed to be grateful or something that you’re not one of the unlucky uninsured.
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But fer goodness sake, work on the margins here; don’t lament the past. Chapter 58 passed with YOUR democrat majority Legislature. They’re not going to adopt Universal health tomorrow; they’re not going assess your big, bad, children-eating corporations.
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You know this.
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So, given that your representative has handed you Chapter 58 and abdicated significant decisions to the Connector. How much should the Connector decide a single person earning $15,000 must pay monthly for insurance.
There are so many problems with the MA reform Bill its not funny, unless you think scradenfroh is funny.The supposed saving grace of this reform was that poor folk would be protected from the financial burdens of the individual mandate via subsidized commonwealth Healthcare insurance plans. Now people(the newspaper) are finally realizing that under chapter 118H section 5 of the final bill“if the director determines that amounts in the fund are insufficient to meet the projected cost of enrolling new individuals,the director shall impose a cap on enrollment in the program”. The core problem with this bill is that it was written by the most powerful Healthcare providers and insurance lobbyist and not a result of the demands of an informed and political active electorate.
To be honest, I happen to be quite happy to see a Republican questioning whether or not, in this or any given social program, the rich are paying their fair share and not dumping the unpaid burden on those who might, as is indicated above, eventually be denied care they’re be penalized for not receiving.
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And to the question of “who decides you should spend your money?”–Well, this seems like a line straight out of the Grover Norquist playbook. The fact of the matter is the government decides how your money is spent every single day, so I find it a bit disingenuous to try and make political hay out of this one instance in which a GOP bureaucrat–who one might expect to suggest the $10 was too high, if anything–comes out and explicitly discusses the practicalities of who’s paying what, how it may be a problem, and making a suggestion on how to adjust it.
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The man should be given a metaphoric standing ovation for 1.) Pointing out flaws in his bosses policy, 2.) Going against the traditional philosophies of his party, and 3.) Being a GOP cabinet member and policy bureaucrat whose actually doing his job!
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Trimarco can’t do anything about the program–it’s been passed by the legislature and signed into law by the Governor–and so he’s doing, remarkably, all he can do to mitigate the flaws and damage of structural inequities that are surfacing in its infancy.
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Perhaps an impolitic approach at phrasing, what he said about those earning 150% above the poverty line is completely correct–but rather than saying they “should” re-adjust their priorities, he should have left the question of their own personal choices out of the equation, as such things inevitably provoke the average person’s libertarian anti-government reflex. “Should” I re-adjust my priorities to support the percentage of federal taxes I’m paying that goes toward outrageous loads of military spending? No. But does it matter either way?
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I think the default quote I have as part of my signature says it all…
Mill believed Gov’t was mainly for defense, cops, and anti-cheating (SEC, for example). Not clear he’d support any sort of gov’t supported health care, whether Medicare, Medicaid, or the gerry-rigged MA plan that I still don’t understand.
… Insofar as there is a sufficient utilitarian justification, Mill supported vice-taxes, government intervention on animal welfare, etc.
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Mill went into great detail as to his theory of the limits of inidividual freedom–which essentially consists of disallowing the harm of other individuals, of the restriction of their own freedoms to the extent that they do not violate that exception as well–and Mill made is clear that harm could be caused by omission, giving such examples as not paying your taxes.
I respectfully disagree with your interpretation of Mill’s views.
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If confronted with reasonable question of role of gov’t – ie, some Americans think gov’t should play greater role in health care, others think less – he’d tend to be: less.
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If you want to defy Big Picture, and instead cite narrowly, I think you’d be hard pressed to deny that one of Mill’s overarching beliefs about utilitarianism is that national boundaries do not apply. MA citizens would be required to slash all forms of gov’t spending in order to help starving worldwide.
what Trimarco was saying. He wants low-income people to pay more. He thinks the contribution levels are too low, and he thinks that if poor people can’t afford them, well they can goddamn well give up their cell phones, feed their kids on Kraft mac&cheez, sell their cars, move into homeless shelters, do whatever it takes to be able to make the monthly premiums. Because THE GOVERNMENT has decided that buying health insurance is more important than all of those things.
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Look again at what Trimarco is advocating for (there’s a Globe article about it today). I don’t think you’ll be quite as big a fan when you’re done.
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As for Norquist, give me a break. Of course gov’t decides how to spend tax money. But this is different. This isn’t saying to people “we will take 5.3% of your income, and then do with it what we want,” which is the usual tax situation. This is gov’t saying “on top of that, you MUST go into the private marketplace and buy THIS expensive product, because we think it’s more important that you buy that than have a car that works, live in a bigger apartment, buy better food for your kids, etc.” That’s what I don’t like about this program.
If not $150 per year for insurance for someone making $15,000, then how much?
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And, he didn’t once mention cars, mac and cheez. He mentioned an item that he believed is discretionary. In that respect, cars and food are different from cell-phones.
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Better to ask is how many of the people have cable tv, dine out, go to SOX games, take vacations to florida. I don’t know the answer, but that’s are the question to ask and Tremarco ask it.
for harvard-pilgrim to buy 1 full page sunday globe ad?
gary –
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1. good question, which i see you’ve posed a few times. i’ve found in the past that it’s hard to get BMG takers from the mega-libs spend/spend/spend crowd. i’ll take a shot.
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2. but first – i don’t fully understand the MA health care plan. my default belief is: it won’t work.
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why? i think health care reform is very hard, with lots of unintendend consequences. i believe any plan that could work would require politically tough decisions that would inflame some entrenched interests.
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since i didn’t see a lot of fireworks – ie, no huge spending on “Harry and Louise” type ads – i assume we now have a plan that doesn’t cause strife but also doesn’t work.
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3. i work at a school where about 75% of kids are eligible for free/reduced lunch. about 70% of our parents have cell phones. i know this b/c we routinely them to praise when kids do well and ask for help when kids mess up, so we have all their home and cell #s.
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fwiw, most of these are single-mom households, and i think parent cell phones serve some critical “family values” functions. yes, cells obviously have a social function, too, but while obviously a decade ago nobody had these things, i think they are a “social good” in certain aspects of holding an extendend family together, even more so than in traditional nuclear families. not $80 a month plans. but $30 a month plans that allow these moms to require their kids to check in often, if briefly.
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zero go to sox games, btw. when we take students to sox games (i.e., a donor will give us some extra seats), it is always their first time.
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4. finally –
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food, rent, clothes on 15k. it’s tough. yes, there’s some discretionary spending. cable. take-out dinners. vacations seem to be mostly visiting relatives in other states.
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so, given the hand we’re dealt, if we need some contribution to make the plan work politically, $150 a year sounds reasonable to me. it could be deducted from the Earned Income Tax Credit, which might solve the collection issue.
I happen to think Chap. 58 may work, but only because there are relatively few people without coverage in Mass, contrasted against other states.
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But, of the people who don’t have coverage, 50% are single, no dependents. It’s my understanding that’s the $15K threshold (150% x poverty level). And, Tremarco’s comments were to the effect that someone with no kids earning only $15K should be able to pay more than $10-$12 per month.
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And, I think he was spot on, as I posted when I saw his statement. So, I respect your reply and ask to think about someone earning $15K with no dependents.
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What should he or she pay for health insurance?
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For my two cents, I think the number is probably around $40 or $50 per month. I’d have to double check the EIC rules, but I think this person wouldn’t qualify, so he or she is probably taking home $13,169 after fed, state, fica and medicare.
with your $40 or $50 a month figure.
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although if your take home is $1100 per month, then you’re kinda screwed in boston area, giving the prices to rent a room here versus, say, in worcester.
“i think health care reform is very hard, with lots of unintendend consequences.”
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Every other developed nation in the world (save Switzerland) has universal single-payer healthcare. It costs, on average, half as much per person as healthcare here. It produces results that are at least as good as we have here.
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How tough could it be, if it works everyhere else? Are Americans somehow inherently inferior to other folks and thus unable to do what they can?
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Sheesh.
::Egg on face::
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I read that completely wrong. I thought it said for people who make 150% more than fed. pov. level, rather than 150% of the level, which now I can see it saying.
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Wow, and there I thought some amazing Republican had emerged to do the right thing… I really should have known better.
or are people posting a lot more 4 letter words on bmg than they used to?
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am i being too sensitive to say that it’s kinda distracting and trashy?
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or should i just go f*** myself and stick it up my ***?
no, you don’t have to go fudge yourself nor do you have to stick it up your arse.
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I was merely exclaiming at how utterly mistaken I had been.
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… This reminds of when it was going to be a big huge deal on TV–weeks before the episode was even going to air–when E.R. was going to feature the word “shit” in an episode as part of the script. South Park satirized it perfectly, seeing how many times it could get away with saying the word “shit” in a single episode without provoking the censor.