On Health Care Repeal -- part 2
January 21st 2011 14:32
At the last election, the Republicans approached the health care reform law with the slogan “repeal and replace”. While they have passed a repeal bill in the House of Representatives (never mind that it’s unlikely to pass the Senate, and would be subject to veto by the President) they have not offered a coherent replacement. While the current law is cumbersome and inefficient, it is better than what came before. While the Republicans were correct in saying that a plurality of the people opposed the law, an Associated Press poll found that this number was composed of people who thought the law went too far, with those who felt it did not go far enough. The number combined those whom consider the law a government take-over of healthcare with those who consider it a sell-out to the insurance companies. Some of those who oppose the law may have been convinced by the blatant misrepresentations that Republicans have used.
Most of the provisions of the health care reform law were desirable curbs on the insurance industry. One of the most important provisions required the insurers to cover pre-existing conditions. These are medical problems that were present before the policy was purchased, and may result in either a policy which doesn’t cover that condition or anything related to it, or a total inability to buy health insurance at any price. This is particularly meaningful at a time when unemployment is high, and most of the unemployed have been laid-off. While group policies for large corporations usually cover everything, when an employee is laid off, they may be forced to find insurance on the individual market, which is both extremely expensive, and subject to the pre-existing condition provision. Also, insurers may accept premiums for years, and then, when something happens, compare medical records with the application for insurance. If the application by chance omits anything on the medical record, the insurer could, and did, cancel the policy just when it was needed. In one egregious case,l a newborn infant was refused heart surgery because it was a pre-existing condition. There have been studies which show that as much as 50% of the United States population has pre-existing conditions based on insurers definitions. According to the Kaiser Family Foundation, “even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.”
The least popular provision, which has been subject to legal challenge, is the requirement that everybody have coverage, the mandatory buy-in. During the nomination process, then-Senator Clinton favored a mandatory plan, while then-Senator Obama said that it wasn’t needed, that people would purchase health coverage if it were affordable. He was wrong at the time. The mandatory nature of health coverage is what keeps it financially viable. Health insurance is essentially a form of shared risk, but also of transfer, where health people pay in, and withdraw the money when they get sick. A pool composed only of sick people would have everybody taking out and couldn’t work. Develop a voluntary plan without the pre-existing condition clause and you might as well put the application for insurance on the back of a consent form for open heart surgery.
What we’re faced with is a very serious political conflict, particularly among Republicans. The party has a history of opposing taxes going back to the Reagan administration, and this, combined with the unbudgeted wars and tax reductions of the Bush years, has resulted in serious deficits. Combining the various demands being placed on government at a time of high unemployment and lowered tax receipts is essentially no-win. Cutting spending means more lay-offs of government workers, fewer services, and reduced income. This, inevitably results in a downward spiral, as other workers lose jobs. The lower taxes, even for the richest people, that the party demanded and got keeps income down. Meanwhile, in the Devil’s Bargain that the Republicans made for Tea Party support, the freshman members of congress are demanding Draconian cuts in spending, without touching big ticket items such as defense, Social Security and Medicare. So far, the Federal government has saved the states from the consequences of their past mistakes by providing stimulus funds that allowed the states to retain police, firefighters and teachers. Without additional deficit spending until the economy recovers, conditions will get progressively worse. These are all factors, if not in the healthcare debate, then in the problems of governance, and of course they impose serious challenges in formulating a replacement for the current law. If, by chance the Republicans are able to achieve repeal, it’s hard to see what a practical replacement would look like. The only thing that has been mentioned is a series of tax credits that might help lower income people buy insurance on the individual market, but there’s a serious absence of details. With all its flaws, the Affordable Healthcare Law was an attempt to integrate ideas from both sides of the aisle and come up with an improvement over what was there before. Without it, we go back to a system that failed tens of millions of Americans, and no meaningful replacement has been proposed, or seems politically feasible in the current atmosphere.
Most of the provisions of the health care reform law were desirable curbs on the insurance industry. One of the most important provisions required the insurers to cover pre-existing conditions. These are medical problems that were present before the policy was purchased, and may result in either a policy which doesn’t cover that condition or anything related to it, or a total inability to buy health insurance at any price. This is particularly meaningful at a time when unemployment is high, and most of the unemployed have been laid-off. While group policies for large corporations usually cover everything, when an employee is laid off, they may be forced to find insurance on the individual market, which is both extremely expensive, and subject to the pre-existing condition provision. Also, insurers may accept premiums for years, and then, when something happens, compare medical records with the application for insurance. If the application by chance omits anything on the medical record, the insurer could, and did, cancel the policy just when it was needed. In one egregious case,l a newborn infant was refused heart surgery because it was a pre-existing condition. There have been studies which show that as much as 50% of the United States population has pre-existing conditions based on insurers definitions. According to the Kaiser Family Foundation, “even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.”
The least popular provision, which has been subject to legal challenge, is the requirement that everybody have coverage, the mandatory buy-in. During the nomination process, then-Senator Clinton favored a mandatory plan, while then-Senator Obama said that it wasn’t needed, that people would purchase health coverage if it were affordable. He was wrong at the time. The mandatory nature of health coverage is what keeps it financially viable. Health insurance is essentially a form of shared risk, but also of transfer, where health people pay in, and withdraw the money when they get sick. A pool composed only of sick people would have everybody taking out and couldn’t work. Develop a voluntary plan without the pre-existing condition clause and you might as well put the application for insurance on the back of a consent form for open heart surgery.
What we’re faced with is a very serious political conflict, particularly among Republicans. The party has a history of opposing taxes going back to the Reagan administration, and this, combined with the unbudgeted wars and tax reductions of the Bush years, has resulted in serious deficits. Combining the various demands being placed on government at a time of high unemployment and lowered tax receipts is essentially no-win. Cutting spending means more lay-offs of government workers, fewer services, and reduced income. This, inevitably results in a downward spiral, as other workers lose jobs. The lower taxes, even for the richest people, that the party demanded and got keeps income down. Meanwhile, in the Devil’s Bargain that the Republicans made for Tea Party support, the freshman members of congress are demanding Draconian cuts in spending, without touching big ticket items such as defense, Social Security and Medicare. So far, the Federal government has saved the states from the consequences of their past mistakes by providing stimulus funds that allowed the states to retain police, firefighters and teachers. Without additional deficit spending until the economy recovers, conditions will get progressively worse. These are all factors, if not in the healthcare debate, then in the problems of governance, and of course they impose serious challenges in formulating a replacement for the current law. If, by chance the Republicans are able to achieve repeal, it’s hard to see what a practical replacement would look like. The only thing that has been mentioned is a series of tax credits that might help lower income people buy insurance on the individual market, but there’s a serious absence of details. With all its flaws, the Affordable Healthcare Law was an attempt to integrate ideas from both sides of the aisle and come up with an improvement over what was there before. Without it, we go back to a system that failed tens of millions of Americans, and no meaningful replacement has been proposed, or seems politically feasible in the current atmosphere.
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Schmoozer