oh yeah, we’re so awesome

good job, obama, with your ground-breaking healthcare reform that really doesn’t do much beyond requiring people to be insured. in fact, this pretty much sums up how i feel about it:

It’s hardly an open question whether this was more a political victory than a policy victory: a year ago, Pelosi swore there would be a public option. There is none. There is no cap on what insurance companies can charge people with so-called pre-existing conditions, including being a victim of domestic violence or sexual assault — insurance companies just can’t refuse to cover you, but they can charge what they like and, worse yet, you’ll be required to buy it or pay a fine. Obama’s mandates that employers provide their workers with insurance turned into a mandate that individuals buy their own insurance if employers don’t. Conservative Ben Nelson’s abortion-related provisions – which require companies participating in the health insurance exchange to send patients two bills (one for regular insurance and one for “abortion” insurance) in order to highlight for Americans that women sometimes have abortions, and they hope, reduce Americans’ support for it — remain part of the legislation despite the outcry from the pro-choice community.

at this point, i honestly couldn’t care less. this was a clusterfuck from beginning to end, and i see nothing to get excited about. or am i missing something?

  1. for some reason I'm not logged in so I'll comment as not-me said:

    To be fair there are a lot of good things:

    Community rating – http://motherjones.com/kevin-drum/2009/12/end-health-insurance (I’m not entirely clear on how the community rating provisions are written or which version goes into the final bill, but it’s in there)

    End of lifetime coverage caps, end of pre-existing denial in 2014, end of pre-existing denial for children immediately, kids can stay on their parents’ coverage until age 26 effective immediately, some level of “coverage” for roughly 20-30 million new people though I’m not clear on how good it’ll be, expansion of medicaid eligibility to anyone under 133% of the federal poverty level rather than only to people under that level who have children are disabled or etc, an option for states to opt-out of the bill if they can demonstrate a way of getting it done cheaper/more effectively (the most likely being universal single-payer being implemented in some liberal state — and hopefully succeeding, providing people w/ concrete examples of how it works, etc.) Uhhh lesse… Bernie Sanders got a bunch of funding for additional community health centers put in. I go to one here in Lompoc and it’s excellent. Obviously there are the subsidies which may or may not be grossly inadequate, it isn’t clear to me at this point. It’s also possible to get a waiver for the individual mandate if you demonstrate financial hardship (defined as ?????), so it’s kinda shitty to think that for some people the best thing this bill does is nothing but it’s better than no waivers at all. The employer mandate was replaced w/ tax credits to incentive small businesses (under 50 workers I believe) to provide coverage + fines for anyone employing 51+ workers if they don’t provide coverage. I know there’s some other positive stuff but I think that’s pretty good off the top of my head.

    The downsides are pretty big and pretty glaring: potentially forcing people to buy shitty insurance they can’t afford, employer “mandate” got shifted to something less concrete, the “at least it’s not Stupak” abortion stuff, (as I understand it) the fact that a lot of the better regulatory stuff won’t apply to the group policy market, etc.

    I’m glad for the sake of politics that this is getting passed. It helps the Dems electorally this Fall and, yknow, let’s face it. Until we get campaign finance reform it’s either them or the GOP. At the policy level I really don’t know what to think beyond that it’s safe to say that there are exaggerated displays coming from both sides of the fence. “Biggest progressive achievement since blah blah blah” versus takes that’re more along the lines of the one you quoted. I’m in wait-and-see mode.

    • slimlove said:

      well, that stuff all seems good. i guess what really frustrates me – and i’ve said it multiple times – is the requirement to purchase insurance without doing anything to control market rates. it’s great that more lower-income people will be covered by medicaid (it really is), but what about the growing sector of the middle class who make too much for that but still can’t afford insurance? what about the freelancers and contract workers with pre-existing conditions (like a friend of mine, who’s pre-existing condition isn’t even that big a deal) who CAN qualify for insurance, even now, but find the costs to be really prohibitive? i just feel like there’s going to end up being this subset of people who are still uninsured and paying the government’s fine because it’s cheaper than what insurance is available to them.

      • fauxpopuli said:

        Yeah, it’s an important question that I really don’t have an answer to. The optimistic take is that once HCR becomes law and the world doesn’t immediately fall apart at the seams into some socialist hellscape full of lava pools and gargoyles snatching newborn babies, it’ll be that much easier to get momentum going to fix the flaws. We shall see.

        I’m not entirely clear on how the community rating stuff works vis-a-vis the lack of an explicitly defined limit on coverage increases, but my understanding is that regulators will have some sort of say in approving/rejecting rate hikes *in the individual market* and the HMOs will have to plead their case. I’m not on the details, so I’m hoping somebody puts out a nice concise “What happens now?” article that can address this. I don’t think it’s quite accurate to say that there’s nothing in HCR limiting rate increases but I need to do more homework. If I understand the concept right then in theory an individual plan for your friend should get more affordable while coverage for a “healthy” person with no pre-existing conditions would get less so.

  2. for some reason I'm not logged in so I'll comment as not-me said:

    Oh and the Frum article highlights one other positive I forgot: they’ve closed the Part D donut hole so seniors in asshole states won’t have to pay out the ass for their medication yearly. (CA picks up the tab, though I dunno for how much longer that would’ve continued)

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