I think your post may be slightly behind the times, because the story today says that the current negotiations are to make the bill more acceptable to the Progressive Caucus, not less.

The one you posted about was a plan that was floated on Thursday to drop the Senate bill and was shot down pretty quickly as far as I can tell.  The plan right now seems to be to have the House pass the Senate bill as-is—which does have protections for pre-existing conditions—and then have the Senate pass a package of fixes to things like the excise tax through reconciliation, which cannot be filibustered and only needs a 51-vote majority.

Hopefully we’ve dodged the bullet.

I can only hope that Mnemosyne is correct and that the rumors of a “compromise” even weaker than the Senate bill isnt under discussion.  I mean, really.  The House would rather vote for a weaker bill than simply vote for the Senate bill because . . . they don’t like the excise tax?

At this point, I think Democrats should consider the Senate bill the least we can expect from our MCs.  Watering it down any further would be an inexcusable failure.

I know the alternative is *so, so much* worse, but I am thoroughly annoyed at the democratic congress and how they keep shooting their own legislation in the foot.

This article seems to be really poorly sourced and not based upon anything actually facing legislators right now… It takes some quotes out of context and puts different Representative’s words into the Speaker’s mouth.

Not that I wouldn’t expect this sort of thing, but it would take another vote in the Senate to weaken it that far.

And the article doesn’t say White House, why does Pam’s title?

I think the bill needs to die.

If there are mandates without a public option, it needs to die.  Yes, people will die without insurance, but more will die if we pass mandated insurance without a public option and/or strong regultions.

For profit insurance corporations are hugely profitable right now, but they are pulling so much money out of the system and out of most people’s pockets that continued growth (as Wall Street demands) is untenable.

People will start negotiating directly with their doctors for treatment instead of paying for “catastrophic” coverage that has high deductibles and covers little.  As more people drop out of the insurance con, the whole model falls apart.

By forcing everyone to become for profit insurance company customers, we prop up a failing system for another decade or so and suck even more money away from the middle class and give it to the upper 1%.  Having the IRS become debt collectors for a forced-market is a horrible precedent.

Passing nothing is better than this alternative.

Now if Pelosi is just playing hardball, like I hope she is, and hoping to get reconciiliation bills written before passing the Senate bill, maybe it won’t be so bad.

But this is a travesty.  And Obama is to blame.  He sat back and let Max Baucus write the bill.  He never led the reform and he’s been quite happy to give away anything that would help the people who elected him, such as single-payer and then the public option.

Yes, he’s better than McCain.  But he is not the change we need.  He doesn’t have the backbone for a fight.  Thanks to SCOTUS, it might be too late to get that change.

Pam wrote:

I fail to understand why there is a lack of support, other than being bought off by the insurance companies, for barring denial of coverage for people with pre-existing conditions.

OK, I’ll tell you, but you really won’t like the answer.  One in six Americans does not have health insurance.  Thing is, that means that five out of six do have health insurance, and a lot of us think that whatever the government does to “reform” health care coverage is just going to make things worse for us.

I had to have cataract surgery earlier this month, and wrote about it on my own poor site.  I noted how quickly everything moved between setting an initial appointment, diagnosis, having to switch ophthalmologists because my original one retired from doing surgery, having the Christmas/New Year holiday week intervene, and getting two different types of procedures done.  Then I included statistics from single-payer Canada, documenting average waiting times in that country.

One of my frequent commenters is the Phoenician, who visits and comments here as well.  He lives in single-payer New Zealand, and noted that he got fast service there himself, for ingrown toenails, because he went outside the system and paid for it privately!  He was trying to tell me that New Zealand’s single payer system is much better than ours, but (unintentionally?) told the truth and noted that, had he been poorer and forced to wait his turn in the government system, he’d would have been forced to wait, in pain, for four months!

I noted that toenails continue to grow even when ingrown, and during a four month wait a toenail will grow about half an inch, which, for some people, would be right out the front of their toe.

The real difference between American health care and the rest of the developed countries: our system is a for profit one.  Because we have medical care for profit, we have enough medical care to meet the demand, promptly.  Where Canadians and Kiwis have long waits, we actually have doctors and medical care facilities advertising for patients.

I see this as a real choice: a choice between high quality, promptly delivered health care for the majority of us — 5 out of 6 Americans have health insurance already — or universal health care coverage, but in a system that delivers lesser quality, slower service. What you would like to see, universal coverage with high quality, promptly delivered health care really is not part of the equation.

I don’t see what the problem is with having a cheap public system that covers some but not all things, Dana.  If national health care costs per capita end up being less than here (as they are in NZ), it’s simply a better deal than it is here.  Here we have no public system, and spend 17% of GDP on health care.  I’ll take the NZ hybrid system over this.

The current state of negotiations is somewhat better than this post lets on—Reid and Pelosi are working out a deal to pass the Senate bill with a reconciliation vehicle.  Here’s what’s on the table for reconciliation:

The changes being considered track closely with the agreements House and Senate leaders made in White House meetings last week, according to a source. They include the deal with labor unions to ease the tax on high-end insurance plans, additional Medicare cuts and taxes, the elimination of a special Medicaid funding deal for Nebraska and a move to help cover the gap in seniors’ prescription-drug coverage. Pelosi is also working to change the Senate provision that sets up state insurance exchanges. The House prefers a single, national exchange.

I’m not crazy about eliminating the excise tax, but other than that it sounds great to me.  The single national exchange may do a lot of the things we wanted the public option to do, keeping local insurance monopolies from screwing people.

Lovely, Dana—-who cares if thousands are bankrupted by cancer treatments or dying of AIDS because they can’t afford the drugs, so long as ingrown toenails are promptly cared for.

“Yes, people will die without insurance, but more will die if we pass mandated insurance without a public option “

Well there’s one I haven’t heard yet.

The real difference between American health care and the rest of the developed countries: our system is a for profit one. 

Dana, you are a nice guy, but I keep getting the impression that you don’t really understand how these things work. Full-out single payer systems like Canada’s are “for profit” systems: the doctors are individual entrepreneurs. They just get compensated by a non profit insurance public insurance system. Other hybrid systems (like France’s) are the same way: there is a mix pf private supplemental insurers and a “public option,” and individual doctors are compensated as independent actors.

What you are doing inadvertently is trying to claim that the supposed superprity of our health care system relies on for profit insurance. I am not ure that is believeable, or even helpful.

What you would like to see, universal coverage with high quality, promptly delivered health care really is not part of the equation.

The ever famous “America is too poor and stupid to deliver universal quality care” argument I see from conservatives. What the heck?

Dana, you really think we can’t do better than New Zealand?

I also want to note that, once again, Dana’s narcisissm on display here distracts the thread from the actual topic: nowhere does he mention why we would want to allow insurance companies to discriminate based on pre existing conditions or allow recission. Instead we get a cutesy down home story all about him mixed in with a set of talking points disconnected from the facts of how our and how foreign health care systems operate. One of the things I am convinced that divides the left and the right in this country is the problem of movement-conservatism-as-social-pose on display here from Dana. Though to be fully consistent with this literary genre, you would need to throw in a reference to how this ties in to the successful lives of your children. We’d be so distracted trying to correct your mistakes and misperceptions while tiptoeing around trying to avoid being perceived as attacking your children that you would successfully make the thread all about you while contributing nothing whatsoever.

Shorter Dana: I got mine, screw everyone else! (especially you Uropeons and wannabes like Neu Seeland!)

...which pretty much sums up why America is going down the tubes…

Please don’t turn this site into FDL. 

Thank you.

this is what i have been terrified of - that any effort, at all, to bring health care into alignment with reality would turn into something even *worse*

this is worse - now it will be *legislated* that adults with “pre-existing conditions” can be denied coverage.

Huh?  This is already the law.  Adults with pre-existing conditions can be denied coverage.  If this law is passed, it won’t say anything about that, because it is already legal.  It’ll only say you can’t do it for minors.

This trial balloon would very clearly be much worse than the Senate bill, which there’s no reason Democrats can’t pass with fixes through reconciliation.  As such, I’d be incredibly disappointed if they gave up on the Senate bill and decided to try to do something like this.  That being said, it also seems like it would, substantively at least, be very slightly better than doing nothing.  But it would come pretty fucking close to doing nothing.

I fail to understand why there is a lack of support, other than being bought off by the insurance companies, for barring denial of coverage for people with pre-existing conditions.

The issue is that if you have a ban on discrimination based on pre-existing conditions without a mandate, then anybody can just avoid buying health insurance until they get sick.  That’ll mean you have more sick people with insurance, which makes premiums go up, which makes more healthy people drop out, which makes premiums go up even more, and so on until the whole private insurance system completely falls apart.  It’s called a death spiral.  Really, nobody should write about health insurance without understanding this, as it’s one of the basic issues (and why a mandate is necessary).

For profit insurance corporations are hugely profitable right now, but they are pulling so much money out of the system and out of most people’s pockets that continued growth (as Wall Street demands) is untenable.

Actually, insurance companies are only a small part of the equation.  Rising health care costs are driven by provider price hikes, which lead to insurance company price hikes.  If we shut down every health insurance company tomorrow, we would still have skyrocketing costs, because hospital and doctor costs would continue to go up.

Yes, insurance companies are bad and need to be reined in, but if you only concentrate on insurance companies, you don’t actually solve anything.

The issue is that if you have a ban on discrimination based on pre-existing conditions without a mandate, then anybody can just avoid buying health insurance until they get sick.  That’ll mean you have more sick people with insurance, which makes premiums go up, which makes more healthy people drop out, which makes premiums go up even more, and so on until the whole private insurance system completely falls apart.  It’s called a death spiral.

Well that’s tough luck for the health insurance companies. If they want to avoid this death spiral, then they should call their congressmen and tell them to support a mandate with a public option.

The real difference between American health care and the rest of the developed countries: our system is a for profit one.  Because we have medical care for profit, we have enough medical care to meet the demand, promptly.

Dana, let me try to explain this to you in terms you can understand:  you are double paying for your health care.  You are paying once when you pay your health insurance premiums, and then you’re paying a second time when you pay your Medicaid/Medicare tax.  When they talk about how healthcare costs us twice as much as other industrialized countries, they’re talking about what the government pays for people’s healthcare and don’t count what people pay to their employer or directly to their insurance company.

We have, bar none, the most inefficient delivery system possible.  We’ve decided as a society that we’d rather pay $200,000 in a futile attempt to save a child’s life when we could have paid $50 to remove the rotting tooth that caused his brain infection.

Does it seem efficient to you that we paid $200,000 when we could have paid $50?

Well that’s tough luck for the health insurance companies. If they want to avoid this death spiral, then they should call their congressmen and tell them to support a mandate with a public option.

Okay, I have a question I keep wanting to have answered and no one can seem to answer it.  The Senate’s solution for the problem that the public option is meant to fix is to have people be able to buy into a plan that’s administrated by the US Office of Personnel Management, which is the agency that runs the federal employees’ healthcare.

What will the functional difference be between a public option run by HHS and a buy-in plan run by OPM?  The costs won’t be much different because OPM will be able to negotiate the same prices for the people on their plan as they they do for federal employees because they have the bargaining power of 1 million enrollees right now.  Yes, by having OPM administer the plan we won’t be able to shiv the insurance companies, but at this point I’m more interested in controlling the actual costs that are spiraling out of control—doctors and hospitals—and not just symbolically sticking it to the insurance companies.

So the name of the game is what, now?  To pass health-care reform while at the same time fucking the process up so badly that even if it works well, the public’s been so jerked around and pissed off at all the batshit and unjust compromises floated in the process that they’re unwilling to give any credit for it to the party that sponsored it?

Mnem is right about the insurance death spiral.  That’s not just a bad thing for insurance companies—it’s a bad thing for anybody who wants to buy insurance, since it basically renders the market dysfunctional.  That’s why the bill is built as it is.  Bans on pre-existing condition discrimination require mandates, mandates require subsidies, subsidies require tax revenue, and now you’ve got yourself a big bill.

Mantis, you know what they say about sausage-making.  Things get better when people actually eat the sausage.

“Mantis, you know what they say about sausage-making.  Things get better when people actually eat the sausage.”

That only applies if the sausage is eventually edible, and it only applies once people have started eating the sausage and not gotten sick.  Oh, and also that you’ve made the sausage in such a way that the Republicans can’t run effective ad campaigns talking about how the Dems tried to go all Sweeney Todd on them, and it was only the stalwart health inspectors of the Republican party that kept them from turning everyone with a pre-existing condition into meat pies.  Also also, that there isn’t a really good reason not to eat the sausage now that you know what’s in it.

Since none of this is going to be ready this year or, in all likelihood, the next few, they’re going to be going into the mid-terms and probably the next presidential cycle with everyone still pissed at them and no one talking about what a delicious sausage this turned out to be.

Mnem is right about the insurance death spiral.

It was actually jlk7e, but I’ve made the point many times, too.

The issue is that if you have a ban on discrimination based on pre-existing conditions without a mandate, then anybody can just avoid buying health insurance until they get sick.  That’ll mean you have more sick people with insurance, which makes premiums go up, which makes more healthy people drop out, which makes premiums go up even more, and so on until the whole private insurance system completely falls apart.  It’s called a death spiral.

All that needs doing here is to point out that if you suffer a catastrophic injury (which a) happens at random, and b) is expensive as fuck right off the bat), if you’re uninsured you’re on the hook for whatever treatment gets applied before you’re cognizant enough to fill out an insurance application and it gets approved.  I don’t think ANYBODY is suggesting we demand that insurance companies cover the treatments that happen before you applied for insurance, just that they have to cover whatever they need in the future.

It wouldn’t matter if I had an ironclad guarantee that if I contracted cancer at age fifty I could just pop an application in and have everything covered without spending anything until then, I would still have insurance ‘cause that doesn’t do shit for me if a semi-truck skids across the highway and puts me in a coma in intensive care for three weeks.

In *any* case, any mandate NEEDS to be in the context of legitimate and FUNCTIONAL cost-cutting measures, ‘cause telling people they have to buy shit is an engraved invitation for price-gouging.  (This is, incidentally, much of why health care costs are so high already—-it’s NOT a purchase you can hold off until the Memorial Day sale like a new sofa.

If anything, rather than a stated mandate such that you’re breaking the law if you don’t have insurance (which paves the way for punitive health-care denial or other unpleasantness to be later implemented on the popular justification that lawbreakers forfeit certain rights), there should be simply a tax on the uninsured, for a specific amount slightly above what is determined to be a fair and reasonable price for the policy one is foregoing.  That, then, exerts a sort of price control because if health insurance gets too expensive, it will be more cost-effective to pay the tax.  The tax can be used to fund medicare programs/public option/reimbursement for uninsured.  That way for insurance companies, jacking the price too high will put them on that death spiral.

Mnemosyne wrote:

</blockquote>We have, bar none, the most inefficient delivery system possible.  We’ve decided as a society that we’d rather pay $200,000 in a futile attempt to save a child’s life when we could have paid $50 to remove the rotting tooth that caused his brain infection.

Does it seem efficient to you that we paid $200,000 when we could have paid $50? </blockquote>

In it, he referred to the case of Deamonte Driver.  But what you neglected to mention is that Mr Driver’s mother was already Medicaid eligible, and had, in fact, been on Medicaid, but because of a bureaucratic regulation—she moved and didn’t keep Medicaid appraised of her change of address—lost her Medicaid coverage, and, when she had been on Medicaid had trouble finding a dentist who would accept Medicaid for her older son, because Medicaid reimburses such a low percentage of actual medical care costs.  This was a case of someone who was part of a single-payer system, Medicaid.  It hardly gives me confidence that the federal government can successful run anything in the takeover of health care.

”... so on until the whole private insurance system completely falls apart.  It’s called a death spiral.”

So, youre saying that there is no downside?

And yet, Dana, this is how conservatives specifically say how the system should function for all of the uninsured: expensive emergency care only for the dying, but no routine care or prevention. That is the exact opposite. I assume, too that you will refuse Medicare and be pulling your daughter out of the military lest she be victimized by a not-for-profit government health care system. Please engage the topic rather than resorting to non-sequiturs and talking points . They may score points among your friends in your rarefied community, but they are a petty annoyance here, particularly when you are cherry picking for the purpose of drawing more attention to yourself while we engage in a well meaning but futile effort to disabuse you of what we wrongly assumevare your simple misguided notions.

And yet, Dana, this is how conservatives specifically say how the system should function for all of the uninsured: expensive emergency care only for the dying, but no routine care or prevention.

This.  And when poor people with chronic conditions can’t get regular care, and have to wait until they’re sick enough to go to the ER, it costs 5-7 TIMES as much money to treat them, and the cost gets passed on to you anyway.  And we haven’t even discussed companies like WalMart, who deliberately underinsure their workforce and then tell them to go file for Medicare, dumping their employees on the public dole while complaining about their regulatory and tax burden, all the while enjoying political cover from conservatives.

The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.
YES. So often people without children are denied anything, because ZOMG think of the children!!!111
We deserve help too. I couldn’t get HEAP when heating oil was at $4.00/gallon. But if I had children, then yes I could have. It is such b.s.

It wouldn’t matter if I had an ironclad guarantee that if I contracted cancer at age fifty I could just pop an application in and have everything covered without spending anything until then, I would still have insurance ‘cause that doesn’t do shit for me if a semi-truck skids across the highway and puts me in a coma in intensive care for three weeks.

@Kyra - obviously some healthy people will buy health insurance without a mandate.  But a lot of people won’t, because nobody thinks a catastrophic accident is going to happen to them.  (Also, doesn’t car insurance cover injuries suffered in a car accident?)  I have no idea what the math is on all this, but it seems like there’s a general consensus among experts that banning discrimination for pre-existing conditions without mandating that people buy coverage will eventually result in costs getting out of control.

And that’s bad for everybody, not just private insurance companies.  Prices for individual plans will end up being too expensive for anyone to afford them.  I don’t see how that’s a good thing for anyone, unless you’re operating under a Leninist “the worse, the better” type mentality.  And that mentality has clearly served the left well over the last few decades, right?

In *any* case, any mandate NEEDS to be in the context of legitimate and FUNCTIONAL cost-cutting measures, ‘cause telling people they have to buy shit is an engraved invitation for price-gouging.

As I understand it, there are various mechanisms in the bill that make price-gouging more difficult.  In particular, the exchanges created a kind of regulated competition.  If one company decides to raise premiums for no reason, you have two things that might prevent this from succeeding - first, the other companies on the exchange that offer better rates for more or less the same thing will probably take business away from the one that is trying to raise prices.  Second, whatever regulating authority is in charge of the exchange can kick programs off the exchange if they raise rates for no reason.  This stuff probably isn’t perfect, but people who’ve actually looked into this don’t seem to think that there’s much likelihood of insurance rates going up for no reason with a mandate.

Beyond that, disputes about the mandate or the death spiral, or whatever, are beside the point.  Pam in the original post expressed incredulity at the idea that there was any reason to ban discrimination for pre-existing conditions unless one was bought and paid for by the insurance industry.  I suppose one can dispute the existence of the death spiral, or say the mandate is a bad idea without other things not in the Senate bill, or whatever else you please.  But the death spiral is the reason cited for why you can’t do pre-existing conditions without the mandate, and that inability is also why they’re not talking about pre-existing conditions for adults in this scaled back bill.  I think this scaled back proposal is pretty awful, but there is a real reason for not doing pre-existing conditions if you’re not doing a mandate.  Pam expressed incredulity at the very idea.  If she had wanted to say that the death spiral is overrated, that’s one thing, but she seemed to have no familiarity with the concept, which is why I explained it.

One of my frequent commenters is the Phoenician, who visits and comments here as well.  He lives in single-payer New Zealand, and noted that he got fast service there himself, for ingrown toenails, because he went outside the system and paid for it privately! He was trying to tell me that New Zealand’s single payer system is much better than ours, but (unintentionally?) told the truth and noted that, had he been poorer and forced to wait his turn in the government system, he’d would have been forced to wait, in pain, for four months!

What Dana fails to mention, because Dana is relatively subtle in his dishonesty, is that I was pointing out that I had a choice for this minor procedure.  It was around seven years ago; I could have waited and got it done for free; I decided to go private and had it done - by the same doctors, no less - immediately and paid for it out of my pocket.

As I pointed out, Americans do not have this choice.

And, as I pointed out repeatedly at the same time, I am currently going through a medical crisis with an infected spine.  Ambulances, more than three weeks in hospital, numerous doctors, MRIs, CAT scans, a PICC line, antibiotics, morphine, community nurses and home help.  It cost me nothing - well, I have to pay a nominal $1.50 for the drugs, and the buggers at hospital charged for TV rental.  That was about it.

So for minor conditions, I have a choice between private medicine and a puiblic system that rations using waiting time.  And for major conditions, I got prompt, good quality, and free-to-the-user health-care.  It wasn’t perfect, but it is getting the job done, I’ve had a lot of support, and my personal finances have ended up ahead due to not being out shopping for more than a month.

And Dana is busy clutching his pearls because I chose an American-style solution, once, while carefully leaving out that Americans do not have the choice, and leaving out what happened to me in the much more serious major crisis.

Yes, insurance companies are bad and need to be reined in, but if you only concentrate on insurance companies, you don’t actually solve anything.

You solve a lot.

Insurance companies provide no service.  They are middlemen facilitating payment, and their facilitation sucks funds out of our economy and straight into their pockets as profit.  Every cent of profit is money that was not spent on health care.

Every doctor/hospital/care facility has staff completely devoted to jumping through hoops and getting insurance companies to pay, since many of them increase thier profits by flat out denying claims the first time to see if anyone’s paying attention.  Every time they don’t have to pay their contracted obligation is profit.

I take it back about all doctors having staff devoted to insurance nightmares.  Plenty of docs here in Chicago take no insurance at all.  You pay up front, they give you a receipt so you can fight with your insurance company on your own time.  This is the wave of the future—more concierge doctors for the rich and more doctors who refuse to accept insurance for the rest of us.

If people are forced to buy insurance from for-profit corporations—with no public, socialized, government option—we’re fucked as a country.  The IRS as a debt collector for corporations?  Put that together with SCOTUS’s decision last week and kiss your ass goodbye.  Not only does it prop up a failing business model for insurance, but what’s to stop our future corporately-bought representatives from extending that model to other corporations.

Yes, having everyone in the same pool spreads the risk.  That’s why we need single-payer—everyone is in the pool.  Everyone is taxed.  Everyone receives care.

Taxing people and forcing them to buy a private, for-profit company’s product?  It’s insane.

Dana, fuck off and die.  I have good insurance and I’ve been waiting months to get a therapist for my son.  I have never been able to see a specialist in less than a week’s time, no matter the situation. 

Actually, if I were on state care, I could have a therapist already, but insurance companies reimbursement rates suck, too, so doctors are limited in how many they can take.

I have to use the mail-in pharmacy for any maintenance medication, per my insurnace company.  If I don’t, they don’t cover the meds.  Their mail in service SUCKS.  They repeatedly fuck up the prescription and then claim that my doctors filled it out “incorrectly”.  As if I hadn’t been around this cycle before! 

If we had a true market-driven system, I’d go to Target, where the pharmacists have always been good to us.  But it would cost us $$$$$$/month so we’re trapped in the company store, which has no market pressure to improve. 

That’s the big lie to the “free market brings us the bestest”: it’s not a free market.  You get insurance through your employer, and employers limit your options.  I hate Aetna, though it’s better than United Healthcare, but if we want insurance, that’s the only real option we have.  I can’t get that glorious blue Cross plan from 7 years ago b/c we don’t work there anymore.  I can’t even choose a pharmacist b/c Aetna gets to own my decisions.

We pay twice as much as any other Western nation for health care, and our lifespans and other health care outcomes are much worse.  But it’s the BESTEST SYSTEM IN THE WORLD, b/c it’s profit-driven and capitalism alway makes the bestest things come true.

What Dana fails to mention, because Dana is relatively subtle in his dishonesty, is that I was pointing out that I had a choice for this minor procedure.

There is a widely held stereotype that there are women who will take advantage of their looks and charm to hide a vindictive or malicious nature. As we see in the case of Dana, this is not limited to women nor limited to taking advantage of one’s good looks. Rather, Dana prefers to cloak his right-wing malice in a veneer of “I’m just a down to earth guy with a loving family and wonderful children who just happens to have discovered the common sense of conservatism and need to correct the naive liberals about the error of their ways.” It’s an essentially disingenuous enterprise. How is it that people “just happen” to have agreements with conservatism that “just happen” to line up perfectly with right wing talking points? In short, Dana, you’re just a right-wing hack mindlessly babbling talking points.

Phoenician—THANK YOU for your clarification of Dana’s comments. The “they wait forever in Europe, ya know” meme is infuriating and needs to be dispelled. WE WAIT HERE TOO. And, we don’t get better treatment or more speedy treatment if we are insured. I’ve waited months on several occasions for a freakin pap smear!!! It’s ridiculous.

And, as for the pre-existing condition mess, it’s disgusting. I have a sizable pre-existing condition for which I can not afford to be treated, even with GOOD INSURANCE. This is due to the astronomical cost of the surgery I need and the fact that we’d still be stuck with 10% of the bill. That’s about $50K, which is a complete joke.

This surgery is non-emergent but would have a HUGE positive impact on my health and well being.

I never thought we’d get health reform. I hoped and had my fingers crossed and voted for reform but was never confident that it would happen. Idiocy will be rewarded yet again and those of us with -re-existing conditions will remain marginalized.

Oh, and if you don’t have a PEC yet, don’t worry, you will…And that’s what people really don’t get. It’s not a matter of if, it’s a matter of when…

This “death-spiral” theory sounds like bullshit.  Why would someone get health insurance now in case they get diabetes later on, but if the diabetes would be covered if they waited to get insurance they wouldn’t be foresighted enough to get coverage in case they fall and break their leg?  Besides, employer health insurance covers pre-existing conditions anyways (and that hasn’t faced a death-spiral).  If I was young and healthy and feeling immortal, I’m not going to buy health insurance now in case I get diabetes when I’m old, I’d just assume that eventually I’d get a job with an employer who had health insurance. 

But you know what preventing health insurance companies from denying coverage to people we pre-existing conditions would do?  Make more of them covered and therefore able to manage their condition, instead of going to the emergency room, not being able to afford it, and costing us all.

Sorry, Alix. Pre-existing Condition…And they’re determining these in far more broad terms these days than they ever have before…

Insurance companies provide no service.  They are middlemen facilitating payment, and their facilitation sucks funds out of our economy and straight into their pockets as profit.  Every cent of profit is money that was not spent on health care.

They negotiate lower prices on behalf of their customers.  Hospitals don’t charge you $12 for a Tylenol because the insurance companies force them to.

If you leave doctors and hospitals out of reforms, you do exactly jack shit to solve the problem of spiraling costs because those costs are generated by the providers, not the insurance companies.  I know we like to think of doctors and hospitals as nice people who would love to help us if not for the insurance companies, but plenty of doctors and hospitals are in it for profits just as much as the health insurance companies are and if we ignore that piece of the puzzle, nothing will improve.

Trust me, I hate insurance companies as much as the next person—and in my personal experience with them, Aetna is one of the worst of the worst, so you have my sympathies—but punishing them without doing anything to rein in provider costs isn’t going to do a thing.

Why would someone get health insurance now in case they get diabetes later on, but if the diabetes would be covered if they waited to get insurance they wouldn’t be foresighted enough to get coverage in case they fall and break their leg?

If you’re in your 20s and know you have a family history of Type II diabetes, are you really going to rush to pay 30 years of premiums until you’re maybe diagnosed with it?  Or will you wait until you get sick and then buy insurance to defray the expenses?  An accident is usually a fairly discrete event—you fall down, you break your leg, you need crutches and x-rays—so a lot of people are willing to take the risk that it won’t happen to them since the expenses will be fairly concrete.  A chronic illness drags on for years and years.  There’s no magical day with lupus where you get your cast off and put away your crutches.

I didn’t have insurance for three years because my employer didn’t offer it.  Yes, I lived in fear of an accident every day, but I couldn’t afford to pay $400 a month on the private market just in case something bad happened, so I did without.  As soon as I did have employer-based insurance again, I rushed in to get all of my checkups that I’d been putting off because I didn’t want to spend $500 for an office visit and tests. 

Besides, employer health insurance covers pre-existing conditions anyways (and that hasn’t faced a death-spiral).

Depends on what you call a death-spiral.  Employers have been paying more and getting less for at least a decade now because of increasing healthcare costs, and part of those increasing costs is because insurance companies can no longer refuse to cover employees who have pre-existing conditions.  Prior to HIPAA, you weren’t guaranteed coverage just because your employer offered coverage—the insurance company could refuse to cover you for having pre-existing conditions.

There’s a couple of things here. I think most people are right in their own way. But for anybody coming late to things, here’s the problem.

The conservatives (when they’re not being manipulative bastards), are right about one thing. Bureaucracy can be a bad thing. It’s true!. It can really gum up the works and create a lot of unneeded expense. In fact, a lot of the problems that exist in the health care market, are due to bureaucracy.

What Caren says is THE problem with American health care. It’s the support staff required in order to navigate the endlessly complex maze of the various rules and regulations and pitfalls of the various insurance companies.

Obama himself made it pretty clear. If he were to build a system from scratch, it would be single payer. That by far is the most efficient, easily run, and sustainable health care system there is. Period. No ands ifs or buts. Individual countries may have difficulties, and it’s not perfect. But nothing is.

So why not single payer now?

In short, the economic effects could be devastating. First of all, you’re cutting all that bureaucracy. You’re talking hundreds of thousands of jobs..possibly into the millions. Nationwide. Huge economic impact. Secondly, insurance traditionally has a large presence in investment. Removing much of that presence could result in a drop in investment markets. Now, for poor me that doesn’t matter much at all. But for those on the verge of retirement, it’s a disaster (I say that there’s serious entitlement issues at play there, but that’s just me)

Now, a mature society could work through those things. But…yeah. You get the point.

On top of that, for the current plan, it’s been my experience that competition alone isn’t usually enough to reduce prices. You actually need the realistic threat of non-consumption. People just staying home, or saying no or whatever. Insurance companies actually have quite a bit of room to compete for prices, especially on the individual markets. However, as prices for individuals have been going up much FASTER, competition simply isn’t the answer. And there’s a lot of profits there too that could already be going towards competition.

Mandates are a good theory. But until insurance company profits are zeroed out, until they go down to that level, adjusting their income and yes, profit, makes very little difference in terms of price. They already have room to compete. It’s just more profitable not to. Mandates will only make that more so.

Oh by the way.

Just to make it clear, I support passing the plan even still. Then when prices don’t come down, then maybe people in power will grow up and actually start living in the real world.

i have had to pay so much extra for insurance because of that bogus diagnosis, and was NEVER able to get it changed or dropped or anything.
i also can’t get good mental health coverage because of the fibro diagnosis -... any mental health issues are *also* pre-existing and so they don’t have to give me ANY coverage.

Thanks, Dana, for helping play a role in making all of this happen!

Thanks, Dana, for helping play a role in making all of this happen!

As far as I know, denelian is neither Dana, nor is she related to Dana.  All she is is a fellow American and human being.

Why should the fact that she lives in unnecessary misery matter to him, good little conservative that he is?

On top of that, for the current plan, it’s been my experience that competition alone isn’t usually enough to reduce prices. You actually need the realistic threat of non-consumption.

I think that’s built into the mandate.  The insurance companies cannot charge you more than 8 percent of your income for premiums, and if you don’t like any of the plans offered, you can pay a fine that is 1.5 percent of your income (that’s one-and-a-half, not fifteen) and then buy insurance when you need it without any pre-existing condition bullshit.  So insurance companies are incentivized to offer affordable plans because people can opt out if the costs are too high.

“As far as I know, denelian is neither Dana, nor is she related to Dana.  All she is is a fellow American and human being.”

...which makes her one of the victims of Dana’s Conservative I-Got-Mine-Eff-You attitude. 

If Dana met Denelian, I’m sure he would behave, and would certainly not demand that she be in misery because of the suckitude of American Healthcare.  But because Denelian is just another member of the vast non-conservative hoards, I’m also sure he wouldn’t spend a second worrying about how Americans like Denelian are treated by our shitty system…

Now, let’s stress I’m not against misery per se.  The human experience contains misery aplenty, and there are always trade-offs in what we can adress and at what cost.  Hell, I don’t give all my money to charity, because I like my creature comforts as much as any person.

But what pisses me off is unnecessary misery.  We know a basic nationalised health system works out cheaper than the American system.  We are not talking about a trade-off between dealing with denelian’s misery and the taxpayers keeping their money; we’re talking about a situation where Americans pay more overall to keep denelian in misery (and insurance companies in profit).  It is unnecessary; anybody arguing for unnecessary human misery is arguing for evil.

“We are not talking about a trade-off between dealing with denelian’s misery and the taxpayers keeping their money; we’re talking about a situation where Americans pay more overall to keep denelian in misery (and insurance companies in profit).”

...and that’s exactly what “conservatives” like Dana want:  The wealthy (who are also morally upright… for some reason) get the benefits, while the poor (who are also morally suspect… for some reason) get the shaft.  Order prevails, the just are rewarded, the unjust are punished, and all is well with the universe.  And if Dana and his ilk have to pay more because of it, they’re perfectly okay with that.

I don’t know why they are, but there you go…

To whomever above was complaining about mail-in prescriptions:

Please, PLEASE check the Target, Walmart, Smiths, and K-mart $4/$10 formularies and see if your drugs are on there.  If they are, you can pay $10 for three months, which is LESS than most copays, and no waiting for the mail to arrive.

I’ve had many people tell me they cannot use this because their insurance won’t cover it, and they have to go through their insurance carrier’s mail-in pharmacy.  NOT TRUE.  If you pay for it yourself (remember, at $10 for THREE MONTHS - that’s less than $3.50/month per med), your insurance company has no business knowing WTF kind of meds you’re taking (and better sometimes that they don’t, ya know).  And if your meds aren’t on it but similar ones are, next time you go to the doctor, hike your ass in there with a copy of the $4 meds and ask if any can be changed to match the one the list.  I can’t tell you how many people are on $200 blood pressure meds when the generic $4 med is equal or superior in the evidence-based literature, just because it happened to be what the physician knows best. 

That’s a personal solution, but if everyone does it, it’s also a system-wide fuck-you to the idea that pharm companies can continually produce knock-off me-too drugs and get consumers to buy the new stuff when the old stuff is cheap and good.  Even if you have insurance, you shouldn’t be shouldering the system with $200 drugs when $4 drugs are appropriate. 

Also?  Don’t ever go to Walgreen’s.  They routinely charge five to ten times the price of meds at Walmart/Target/etc.  How they get away with that crap I cannot imagine, but they do.  Don’t help them at it, yeah?

It looks as if everyone is going to get screwed, so “health reform” should now die. The mandate is quite simply a gift to private insurance companies, by forcing people to buy from them.

The promised single-payer system is gone. The promised competition on insurance prices from a public option is gone. The promised Medicare expansion to help middle-aged consumers is gone. Now it looks as if the promised bar on denying coverage for pre-existing conditions will be gone, too, leaving these people both forced to buy insurance and forced to buy it at the high rates charged to those with such conditions (or forced to pay extra tax and still being uninsured).

What is left of this bill? Seems to me as if all that is left is fluffy rhetoric about expanding coverage (yes, because people are forced to buy it, even if they can’t afford it or don’t want it) and a give-away to private insurance companies.

The Democrats and Obama should be embarrassed: They failed. Miserably. (And you tea-baggers should be even more embarrased. For all of your crowing about individualism, what you get is a quite anti-individualistic result: individuals forced to buy products they don’t want from private companies, with fewer and fewer benefits in return - such benefits sacrificed one by one on altars of pragmatism and political compromise with the likes of vile rabble such as yourselves.) It is so charming to read in the New York Times about “what the American people are ready for” (not much, evidently, other than being patronized by politicians and screwed by private insurance companies).

Kyra @ 27
In the Commonwealth of MA, injuries caused by a vehiclur accident cannot, by law, be paid byyour health/medical insurance.  They must be paid by the vehicle insurance.  This is typically a redtape nightmare as the payments worm around between cos involved.  The best thing?  Make certain you get taken to a public hospital in a poorer city with lawyers on staff who take your side through the maze as your side gets the hospital its money.

And, as I pointed out repeatedly at the same time, I am currently going through a medical crisis with an infected spine.  Ambulances, more than three weeks in hospital, numerous doctors, MRIs, CAT scans, a PICC line, antibiotics, morphine, community nurses and home help.

That sounds fairly scary and tremendously annoying, Pho. I’m wishing you a speedy recovery.

This is why I had to stop reading Pandagon.  Pam using it to forward John Aravosis’s crazy nonsense.  Here the whole thing comes from deciding to read “children” in the most incriminating way possible.  Please stop.

FlipYrWhig, if this is why you had to stop reading Pandagon, then why are you commenting here?

Some of us, who happen to be over 19, were looking forward to health insurance companies not discriminating against people w/ pre-existing conditions.  I was thinking that was one of the few good things left in the reform.  If that goes too, then wtf are we passing it for?  Oh yeah.  The insurance companies, as Olivia reminds us.

Gee, as a 51 year old with Multiple Sclerosis, asthma, arthritis and osteoporosis…I really, really appreciate being left out of the pre existing conditions thing. My “Disease Modifying Drug” for MS costs in the neighborhood of $30,000 a *year*. My asthma medication is $400 a month. Not to mention all the other drugs I have to take for side effects from the MS drug, and then the side effects from those, plus the osteo drug, etc.

Without insurance, I’m screwed. Even with it, my rather comfortable salary is no longer terribly comfortable. I am very tired of watching the eternal circular firing squad which has been the Democratic party for lo, these many, many years.