some people have waited a 100 years for this kind of reform… universal health care has been something presidents have been talking about since the turn of the last century. This bill wasn’t universal health care, but it was the closest this country has ever come to it, including Medicare.
stomvsays
After all, once you’ve waited 65 years you get to single payerish Medicare.
This isn’t a political victory but a moral victory for the country no one should go broke becuase they get sick. Why any GOP senators wouldn’s vote for the Reconciled bill boggles my mind.
robespierresays
Like Olbermann said in the link, this is not a good thing:
<
p>”This is not health, this is not care, this is certainly not reform…. They must now not make the defeat worse by passing a hollow shell of a bill just for the sake of a big-stage signing ceremony.
You have just agreed to purchase a product. If you do not, you will be breaking the law and subject to a fine. You have no control over how much you will pay for the product…. The bill now is little more than a legally mandated delivery of the middle class (and those whose dreams of joining it slip ever further away) into a kind of Chicago stockyards of insurance. Make enough money to take care of yourself and your family and you must buy insurance — on the insurers terms — or face a fine.
<
p>This provision must go. It is, above all else, immoral and a betrayal of the people who elected you, Sir. You must now announce that you will veto any bill lacking an option or buy-in, but containing a mandate. And Sen. Reid, put the public option back in, or the Medicare Buy-In, or both….
<
p>No single payer? No sale. No public option? No sale. No Medicare buy-in? No sale. I am one of the self-insured, albeit by choice. And I hereby pledge that I will not buy this perversion of health care reform. Pass this at your peril, Senators, and sign it at yours, Mr. President. I will not buy this insurance. Brand me a lawbreaker if you choose. Fine me if you will. Jail me if you must.”
<
p>Amen, Mr. Olbermann.
<
p>No victory laps here. The democrats sold out many of us out just to get something they could call a victory to throw in the Wingnuts faces. But its a horrible, immoral piece of legislation. I’d love to send the re-Pubicans packing too, but not at the expense of the people sold out by this bill that will create thousands of new positions within the IRS to investigate the insurance policies of taxpayers and assign penalties. How is this supposed to he humane and progressive? WTF am I missing?
<
p>A horrible, immoral piece of legislation whose only purpose is to spite re-Pubicans, not help those too poor to get insurance.
the Massachusetts bill is as golden as people like to pretend it is — we went from 92% coverage to 96/7% coverage, after expending significant resources. If anything, Massachusetts should be a warning call to Democrats in DC about what happens if you pass a mediocre “universal” bill without addressing costs, and without keeping the effort going toward improving that lousy bill in the years ahead. Deval Patrick’s health care “jobs” bill should have been a part of Massachusetts 2006 HCR from the start, and I honestly think it has as much potential to do good in and of itself as the entire 2006 effort by targeting HC costs.
which is why I join the call to target the Steve Lynch types. Defeat them, swap them with a few more public option votes, and we’ll get our public option after striking fear into any remaining corporatists. Harry Reid has promised a stand-alone vote on the public option this year in the Senate so the progressives in the Senate would go along with this bill — I think we should hold Harry Reid to that promise. This bill just passed was only better than nothing, that’s it. The reconciliation effort is only better than what was just passed.
is bullpucky. A stupid statement, along with many at that time from many on the left who should have known better.
<
p>He, like the others, will come to regret it, if he hasn’t already.
liveandletlivesays
I agree we needed reform. This falls far short of what we needed. It’s great to look at the bright-side. It’s important to pay attention to the down-side. There are many middle class folks who aren’t going to be able to afford this mandate. This bill still need a lot of work, and we need a public option.
It was brilliant posturing. As bad as the bill was (and it was bad compared to what it could have been), it could have been much uglier if we didn’t have people like Keith railing about the Senate’s efforts from the start.
<
p>Honestly, I think the Ezra Kleins of the world and the “pass-anything”s of the world did far more damage to getting decent health care reform than Keith Olberman. I doubt you’d find a single person anywhere that’s pushed harder for HCR than Olbermann…. I honestly think you should eat those words and apologize.
tbladesays
…it was an impressive effort, but as far as the bill goes? Meh. I expect better from my government.
He in the days before his leave to see his ailing father believed passing this bill was better than nothing and the public option is still alive
yellowdogdemsays
You expect better from your government? I don’t expect anything from my government. You get what you work for, and those of us on the left failed to do enough to push the issues that we allegedly care about. Nevertheless, this is a historic piece of legislation — much better than we on the left deserve. Thank you, Barack Obama, and Nancy Pelosi, and Harry Reid, and all our elected officials who made this happen.
Millions of people worked their asses off in getting this. What we did now was more than we’ve been able to do in 100 years. I suppose anything less than free golden ponies would be a failure in your book, but a victory against gigantically powerful special interests on health care has thus far, in this country, proven almost impossible. The bill was certainly compromised, but it turns out it had to be if we were to be able to get it through. Despite all the millions lobbyists spent just to kill this bill, especially after Citizens United, they could have spent billions and probably would have if we, say, went after Single Payer.
lasthorsemansays
because it contained personally identifiable information about my attempts to aid my parents in the elder care department.
<
p>Victory in what exactly, the destruction of America?
Engineered financial depression.
Destruction of health care and now on to rationing of energy and world depopulation? How progressive.
Can someone tell me exactly how this is supposed to ruin us forever?
<
p>Because all I see is something that’s pretty much already like what we already have here in Massachusetts, where yes cost controls were punted, but otherwise I am experiencing absolutely no difference in the quality, availability or cost of my family’s care between now and when our health reform passed. Am I just lucky? Is there something going on that I’m missing while I eat my organic arugula and sip my chardonnay while picking out which Lexus I’m going to buy with my trust fund money?
<
p>I see a couple of taxes on the margins, some well-meaning restrictions on what insurance companies can do, I see a framework for increased pooling of self-insurance plans, and an individual mandate which I kind of hate the idea of, but is pretty much the only choice if you’re not going to have Medicare for All.
<
p>That’s about it. It’s not how I’d design a system from scratch, but if you were going to tinker with the system we have, this seems pretty minimal. This is not burn the Constitution and hole yourself up in your compound stuff.
p>That said, it’s not just apocalyptic nutjobs that hate this bill SO BAD.
<
p>I get that GOP politicians have to say that this is the worst thing that ever happened to the country but I don’t understand why I’m supposed to believe that this is the case. All I get is “Grar Socalism!” and “Taxes Bad!” with a sprinkling of “Baby killer!” and “Illegal Aliens!” mixed in.
<
p>So, again, pretty much standard GOP boilerplate from the past 20 years or so.
<
p>I tried to talk to one of my very Republican co-workers about this today, but he was just so full of rage that he would not even shake my hand when I suggested we call a truce and drop the subject. It just doesn’t make sense!
I just don’t understand the over-the-top rage-n-pain reaction. It’s like there’s nothing in it for them at all. There just seems to be very little of “Well, it’s not all bad” … just pure amygdala.
<
p>They need someone on their side to talk them down. Nobody’s trying. And they’re going to keep losing.
And what you learn is that this is all learned behavior. They learned it from the pundits and the genuine yahoos who the pundits gave a layer of ‘legitimacy’ too. If you were a yahoo before and were afraid to speak up in polite company, well be afraid no more.
lasthorsemansays
I was “early retired” from an excellent job I loved because I was politically in the way of their penchant for corporate compliance training. I was an obstacle, a thorn in their corporate cock sucking ways with my extensive knowledge of what the industry used to be and how it functioned. Not a corporate problem though as they can buy nine degreed engineers on my salary in China. My input on building inferior products and the waste of those resources aside all of it is still far more profitable. To them.
kirthsays
Lasthorseman pissed off his bosses by telling them they were doing it wrong, so they let him go.
<
p>In my world that’s what happens to anybody who does that. If it happens when they’re young, they have time to recover and rebuild their career or start a new one. When they’re old, not so much.
lasthorsemansays
removed all semblance of sanity from a once productive American based company.
I think we’re all in debt to Lasthorseman for stating what needed to be said. Not only was it authentic frontier gibberish, it expressed the courage little seen in this day and age.
No public option (but with a mandate), no Medicare buy-in, and certainly no single payer:( Plus, some provisions don’t take effect until 2014. On balance, better than the status quo, but with a lot of disappointments along the way.
… be ecstatic about whatever passed as the first attempt. The history of previous entitlement legislation teaches us that it never starts out as good as it’s potential.
laurelsays
needs to be the LGBT civil rights package:
Passage of Employment Non-Discrimination Act for LGBTs
Repeal of Don’t Ask Don’t Tell
Passage of Uniting American Families Act
Repeal of Defense of Marriage Act
Tax amnesty for gay workers who have to pay income tax on the value of health benefits for their partners (that provision was excised from the HCR – surprise, surprise)
<
p>It’s time to stop baiting LGBT people with promises of a good life in paradise (defined as “we’ll get to your rights…after the next election”). It is time for the Democrats to put up or shut up.
stomvsays
but the rest of it? Not in 2010 I’m afraid. Perhaps some nibbling around the edges, particularly at the state level. I won’t get my cap-and-trade either, and will have to be made content with a few bits and bobs about carbon.
<
p>Health care sucked up all the oxygen for a long long time, which is a shame. It’s an important step on the journey of public health in America, so I’m glad we did it.
Pelosi has promised her caucus that she won’t make them vote on something like health care again before the next election… so, unless we raise righteous fury, I think we can kiss finance, climate, dadt, enda, and efca goodbye until 2011 at best.
<
p>Then again, I like the idea of raising a righteous fury and making the Pelosi give her caucus at least one or two more tough votes…
petrsays
Those carping about the imperfections in this bill ought to realize that this is, indeed, the best possible law. In the abstract, where almost nobody but lasthorseman lives, there are improvements to be made. But a slippery slope argument can be made that we’ve just gone and pushed the gorilla over that cliff…
So where’s the contradiction? Well, Congress’s support for community rating and universal access doesn’t fit well with its insistence that health-care reform must rely on private insurance companies. After all, measuring risk, and setting prices accordingly, is the raison d’être of a health-insurance company. The way individual insurance works now, risk and price are linked. If you’re a triathlete with no history of cancer in your family, you’re a reasonably good risk, and so you can get an affordable policy that will protect you against unforeseen disaster; if you’re overweight with high blood pressure and a history of heart problems, your risk of becoming seriously ill is substantial, and therefore private insurers will either charge you high premiums or not offer you coverage at all. This kind of risk evaluation-what’s called “medical underwriting”-is fundamental to the insurance business. But it is precisely what all the new reform plans will ban. Congress is effectively making private insurers unnecessary, yet continuing to insist that we can’t do without them.
<
p>While it would be nice to ban insurers outright, which, let us face it, is what single-payer would do, the provisions of this bill are the first real step in that direction. The ability to deny coverage, and the relatively lax attitude towards cost is (was) the basis of health insurers profitability… The loss of that, in concert with the tensions Surowiecki details, are the death knell for private insurers. Yeah, it won’t be as quick and as emotionally salving as moving directly to single-payer… sigh… but it is going to happen.
One could imagine insurers competing under cost and quality just like other products that are regulated. For instance, let’s imagine that one insurer has a restricted doc network, but it’s like, the Mayo Clinic. Cheaper, good care. Another has a broad network, good results. Good care, more expensive, but you keep your current doc. Another has cheap care with maybe a higher % of physicians’ assistants and nurse practitioners actually seeing patients.
<
p>Maybe a Wal-Mart type company comes in and tries to commodify/cheapen the whole thing. Maybe a fancy-pants insurer comes in with fancy coverage.
<
p>There’s plenty of variation and competition to be had. Gaming the risk isn’t the only way to compete.
petrsays
One could imagine insurers competing under cost and quality just like other products that are regulated
<
p>Car insurers are regulated, but it is only considered universal for that subset of the population who chose to own cars. The ability of consumers to opt-out of other regulated products is the governing limit. There are no subsets of the population who can voluntarily choose not to get ill, or hurt… Choosing not to partake of insurance is really only a choice to increase cost for oneself and the system as a whole.
<
p>In addition, risks are limited in scope: to return to the issue of car insurance, the insurer has a pretty good idea, once they decide upon insuring a car, how much, and under what circumstances they’ll have to pay out, even in the worst case scenario. It’s often written into to policies. Health insurance cannot work in this manner: a mere splinter can become infected and cause death.
<
p>
There’s plenty of variation and competition to be had. Gaming the risk isn’t the only way to compete.
<
p>With respect to risk, there’s no games: too many people get sick and/or hurt too often. And, as mentioned, no limiting price can be attached (without cruelty): The insurer has no view, or control, over the ultimate cost of any given policy. The only game is to either deny coverage to those whom illness is a near certainty, or hope that chance favors a random, non-coincidental, occurrence of need.
<
p>Of course, the market is also brutal, and the distance between the relative ease to profits under the old system, and the new imperative to actually manage costs, care and assets will place further strain on those rapacious old codgers who thought themselves so smart, who were only really cruel. Profits (and thus margins) will be that much thinner and the market, little caring about laws and logic, will punish health care companies that don’t deliver the historic (and, frankly, obscene) levels of profits. Even the most adroit of executives is facing much smaller profits. It remains to be seen if they have this capacity to be adroit. Looks like Charlie Baker picked a good time to start looking for a new career.
<
p>The governing inequalities are, clearly, ironclad. There really is no road to profit absent the ability to be cruel (deny coverage). The clean meaning of the single-payer is the absence of the profit motive.
<
p>What I suspect will happen (and might already be happening in Mass…) is that present insurers will limp along shedding clients to the state insurers. I’m looking into CommonWealthCare as we speak…
… service, they initiate a death spiral. If you attract sicker people into your pool, you risk having a lousy pool. If the pool gets lousy enough, it takes you under. This is why, in general, you don’t see one insurer sticking it’s neck out with overly consumer-pleasing features.
<
p>In the new paradigm, this might be even more a problem because of anti-denial features of the bill. This is supposed to be mitigated for the private insurers with the mandate. In Germany the way they mitigate this is that the private insurers actually wind up swapping cash based on the quality of their pools – sort of like the luxury tax on for MLB (although in Germany the mechanism really works – MLB not so much).
We finally did it. This is why we elect Democrats! To get thing done!
some people have waited a 100 years for this kind of reform… universal health care has been something presidents have been talking about since the turn of the last century. This bill wasn’t universal health care, but it was the closest this country has ever come to it, including Medicare.
After all, once you’ve waited 65 years you get to single payerish Medicare.
I think keith Olbermann said it best back in December.
http://www.msnbc.msn.com/id/34…
<
p> All I might add is “Amen”.
This isn’t a political victory but a moral victory for the country no one should go broke becuase they get sick. Why any GOP senators wouldn’s vote for the Reconciled bill boggles my mind.
Like Olbermann said in the link, this is not a good thing:
<
p>”This is not health, this is not care, this is certainly not reform…. They must now not make the defeat worse by passing a hollow shell of a bill just for the sake of a big-stage signing ceremony.
You have just agreed to purchase a product. If you do not, you will be breaking the law and subject to a fine. You have no control over how much you will pay for the product…. The bill now is little more than a legally mandated delivery of the middle class (and those whose dreams of joining it slip ever further away) into a kind of Chicago stockyards of insurance. Make enough money to take care of yourself and your family and you must buy insurance — on the insurers terms — or face a fine.
<
p>This provision must go. It is, above all else, immoral and a betrayal of the people who elected you, Sir. You must now announce that you will veto any bill lacking an option or buy-in, but containing a mandate. And Sen. Reid, put the public option back in, or the Medicare Buy-In, or both….
<
p>No single payer? No sale. No public option? No sale. No Medicare buy-in? No sale. I am one of the self-insured, albeit by choice. And I hereby pledge that I will not buy this perversion of health care reform. Pass this at your peril, Senators, and sign it at yours, Mr. President. I will not buy this insurance. Brand me a lawbreaker if you choose. Fine me if you will. Jail me if you must.”
<
p>Amen, Mr. Olbermann.
<
p>No victory laps here. The democrats sold out many of us out just to get something they could call a victory to throw in the Wingnuts faces. But its a horrible, immoral piece of legislation. I’d love to send the re-Pubicans packing too, but not at the expense of the people sold out by this bill that will create thousands of new positions within the IRS to investigate the insurance policies of taxpayers and assign penalties. How is this supposed to he humane and progressive? WTF am I missing?
<
p>A horrible, immoral piece of legislation whose only purpose is to spite re-Pubicans, not help those too poor to get insurance.
<
p>I’m beyond furious.
If you live in Massachusetts this is pretty much already the case.
<
p>Just sayin’.
the Massachusetts bill is as golden as people like to pretend it is — we went from 92% coverage to 96/7% coverage, after expending significant resources. If anything, Massachusetts should be a warning call to Democrats in DC about what happens if you pass a mediocre “universal” bill without addressing costs, and without keeping the effort going toward improving that lousy bill in the years ahead. Deval Patrick’s health care “jobs” bill should have been a part of Massachusetts 2006 HCR from the start, and I honestly think it has as much potential to do good in and of itself as the entire 2006 effort by targeting HC costs.
which is why I join the call to target the Steve Lynch types. Defeat them, swap them with a few more public option votes, and we’ll get our public option after striking fear into any remaining corporatists. Harry Reid has promised a stand-alone vote on the public option this year in the Senate so the progressives in the Senate would go along with this bill — I think we should hold Harry Reid to that promise. This bill just passed was only better than nothing, that’s it. The reconciliation effort is only better than what was just passed.
is bullpucky. A stupid statement, along with many at that time from many on the left who should have known better.
<
p>He, like the others, will come to regret it, if he hasn’t already.
I agree we needed reform. This falls far short of what we needed. It’s great to look at the bright-side. It’s important to pay attention to the down-side. There are many middle class folks who aren’t going to be able to afford this mandate. This bill still need a lot of work, and we need a public option.
It was brilliant posturing. As bad as the bill was (and it was bad compared to what it could have been), it could have been much uglier if we didn’t have people like Keith railing about the Senate’s efforts from the start.
<
p>Honestly, I think the Ezra Kleins of the world and the “pass-anything”s of the world did far more damage to getting decent health care reform than Keith Olberman. I doubt you’d find a single person anywhere that’s pushed harder for HCR than Olbermann…. I honestly think you should eat those words and apologize.
…it was an impressive effort, but as far as the bill goes? Meh. I expect better from my government.
He in the days before his leave to see his ailing father believed passing this bill was better than nothing and the public option is still alive
You expect better from your government? I don’t expect anything from my government. You get what you work for, and those of us on the left failed to do enough to push the issues that we allegedly care about. Nevertheless, this is a historic piece of legislation — much better than we on the left deserve. Thank you, Barack Obama, and Nancy Pelosi, and Harry Reid, and all our elected officials who made this happen.
Millions of people worked their asses off in getting this. What we did now was more than we’ve been able to do in 100 years. I suppose anything less than free golden ponies would be a failure in your book, but a victory against gigantically powerful special interests on health care has thus far, in this country, proven almost impossible. The bill was certainly compromised, but it turns out it had to be if we were to be able to get it through. Despite all the millions lobbyists spent just to kill this bill, especially after Citizens United, they could have spent billions and probably would have if we, say, went after Single Payer.
because it contained personally identifiable information about my attempts to aid my parents in the elder care department.
<
p>Victory in what exactly, the destruction of America?
Engineered financial depression.
Destruction of health care and now on to rationing of energy and world depopulation? How progressive.
Can someone tell me exactly how this is supposed to ruin us forever?
<
p>Because all I see is something that’s pretty much already like what we already have here in Massachusetts, where yes cost controls were punted, but otherwise I am experiencing absolutely no difference in the quality, availability or cost of my family’s care between now and when our health reform passed. Am I just lucky? Is there something going on that I’m missing while I eat my organic arugula and sip my chardonnay while picking out which Lexus I’m going to buy with my trust fund money?
<
p>I see a couple of taxes on the margins, some well-meaning restrictions on what insurance companies can do, I see a framework for increased pooling of self-insurance plans, and an individual mandate which I kind of hate the idea of, but is pretty much the only choice if you’re not going to have Medicare for All.
<
p>That’s about it. It’s not how I’d design a system from scratch, but if you were going to tinker with the system we have, this seems pretty minimal. This is not burn the Constitution and hole yourself up in your compound stuff.
that Lasthorseman doesn’t need much provocation to hole himself up in the compound.
And stop bothering us.
<
p>That said, it’s not just apocalyptic nutjobs that hate this bill SO BAD.
<
p>I get that GOP politicians have to say that this is the worst thing that ever happened to the country but I don’t understand why I’m supposed to believe that this is the case. All I get is “Grar Socalism!” and “Taxes Bad!” with a sprinkling of “Baby killer!” and “Illegal Aliens!” mixed in.
<
p>So, again, pretty much standard GOP boilerplate from the past 20 years or so.
<
p>I tried to talk to one of my very Republican co-workers about this today, but he was just so full of rage that he would not even shake my hand when I suggested we call a truce and drop the subject. It just doesn’t make sense!
I just don’t understand the over-the-top rage-n-pain reaction. It’s like there’s nothing in it for them at all. There just seems to be very little of “Well, it’s not all bad” … just pure amygdala.
<
p>They need someone on their side to talk them down. Nobody’s trying. And they’re going to keep losing.
<
p>Ah well. They’ll snap out of it somehow.
And what you learn is that this is all learned behavior. They learned it from the pundits and the genuine yahoos who the pundits gave a layer of ‘legitimacy’ too. If you were a yahoo before and were afraid to speak up in polite company, well be afraid no more.
I was “early retired” from an excellent job I loved because I was politically in the way of their penchant for corporate compliance training. I was an obstacle, a thorn in their corporate cock sucking ways with my extensive knowledge of what the industry used to be and how it functioned. Not a corporate problem though as they can buy nine degreed engineers on my salary in China. My input on building inferior products and the waste of those resources aside all of it is still far more profitable. To them.
Lasthorseman pissed off his bosses by telling them they were doing it wrong, so they let him go.
<
p>In my world that’s what happens to anybody who does that. If it happens when they’re young, they have time to recover and rebuild their career or start a new one. When they’re old, not so much.
removed all semblance of sanity from a once productive American based company.
I think we’re all in debt to Lasthorseman for stating what needed to be said. Not only was it authentic frontier gibberish, it expressed the courage little seen in this day and age.
I’m stealing that photo.
It is totally my FB profile pic, yo.
No public option (but with a mandate), no Medicare buy-in, and certainly no single payer:( Plus, some provisions don’t take effect until 2014. On balance, better than the status quo, but with a lot of disappointments along the way.
… be ecstatic about whatever passed as the first attempt. The history of previous entitlement legislation teaches us that it never starts out as good as it’s potential.
needs to be the LGBT civil rights package:
<
p>It’s time to stop baiting LGBT people with promises of a good life in paradise (defined as “we’ll get to your rights…after the next election”). It is time for the Democrats to put up or shut up.
but the rest of it? Not in 2010 I’m afraid. Perhaps some nibbling around the edges, particularly at the state level. I won’t get my cap-and-trade either, and will have to be made content with a few bits and bobs about carbon.
<
p>Health care sucked up all the oxygen for a long long time, which is a shame. It’s an important step on the journey of public health in America, so I’m glad we did it.
Pelosi has promised her caucus that she won’t make them vote on something like health care again before the next election… so, unless we raise righteous fury, I think we can kiss finance, climate, dadt, enda, and efca goodbye until 2011 at best.
<
p>Then again, I like the idea of raising a righteous fury and making the Pelosi give her caucus at least one or two more tough votes…
Those carping about the imperfections in this bill ought to realize that this is, indeed, the best possible law. In the abstract, where almost nobody but lasthorseman lives, there are improvements to be made. But a slippery slope argument can be made that we’ve just gone and pushed the gorilla over that cliff…
<
p>James Surowiecki encapsulates nicely:
<
p>
<
p>While it would be nice to ban insurers outright, which, let us face it, is what single-payer would do, the provisions of this bill are the first real step in that direction. The ability to deny coverage, and the relatively lax attitude towards cost is (was) the basis of health insurers profitability… The loss of that, in concert with the tensions Surowiecki details, are the death knell for private insurers. Yeah, it won’t be as quick and as emotionally salving as moving directly to single-payer… sigh… but it is going to happen.
One could imagine insurers competing under cost and quality just like other products that are regulated. For instance, let’s imagine that one insurer has a restricted doc network, but it’s like, the Mayo Clinic. Cheaper, good care. Another has a broad network, good results. Good care, more expensive, but you keep your current doc. Another has cheap care with maybe a higher % of physicians’ assistants and nurse practitioners actually seeing patients.
<
p>Maybe a Wal-Mart type company comes in and tries to commodify/cheapen the whole thing. Maybe a fancy-pants insurer comes in with fancy coverage.
<
p>There’s plenty of variation and competition to be had. Gaming the risk isn’t the only way to compete.
<
p>Car insurers are regulated, but it is only considered universal for that subset of the population who chose to own cars. The ability of consumers to opt-out of other regulated products is the governing limit. There are no subsets of the population who can voluntarily choose not to get ill, or hurt… Choosing not to partake of insurance is really only a choice to increase cost for oneself and the system as a whole.
<
p>In addition, risks are limited in scope: to return to the issue of car insurance, the insurer has a pretty good idea, once they decide upon insuring a car, how much, and under what circumstances they’ll have to pay out, even in the worst case scenario. It’s often written into to policies. Health insurance cannot work in this manner: a mere splinter can become infected and cause death.
<
p>
<
p>With respect to risk, there’s no games: too many people get sick and/or hurt too often. And, as mentioned, no limiting price can be attached (without cruelty): The insurer has no view, or control, over the ultimate cost of any given policy. The only game is to either deny coverage to those whom illness is a near certainty, or hope that chance favors a random, non-coincidental, occurrence of need.
<
p>Of course, the market is also brutal, and the distance between the relative ease to profits under the old system, and the new imperative to actually manage costs, care and assets will place further strain on those rapacious old codgers who thought themselves so smart, who were only really cruel. Profits (and thus margins) will be that much thinner and the market, little caring about laws and logic, will punish health care companies that don’t deliver the historic (and, frankly, obscene) levels of profits. Even the most adroit of executives is facing much smaller profits. It remains to be seen if they have this capacity to be adroit. Looks like Charlie Baker picked a good time to start looking for a new career.
<
p>The governing inequalities are, clearly, ironclad. There really is no road to profit absent the ability to be cruel (deny coverage). The clean meaning of the single-payer is the absence of the profit motive.
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p>What I suspect will happen (and might already be happening in Mass…) is that present insurers will limp along shedding clients to the state insurers. I’m looking into CommonWealthCare as we speak…
… service, they initiate a death spiral. If you attract sicker people into your pool, you risk having a lousy pool. If the pool gets lousy enough, it takes you under. This is why, in general, you don’t see one insurer sticking it’s neck out with overly consumer-pleasing features.
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p>In the new paradigm, this might be even more a problem because of anti-denial features of the bill. This is supposed to be mitigated for the private insurers with the mandate. In Germany the way they mitigate this is that the private insurers actually wind up swapping cash based on the quality of their pools – sort of like the luxury tax on for MLB (although in Germany the mechanism really works – MLB not so much).
… about is that this is a glimmer of hope that Congress can and is willing to ‘tackle the big stuff’ (see my sig).