Ezra Klein answers Jane Hamsher's '10 reasons to kill the bill'
I've gotten a lot of requests to respond to Jane Hamsher's list
<http://www.huffingtonpost.com/jane-hamsher/top-10-reasons-to-kill-th_b_\
399245.html> of 10 reasons to kill the Senate bill. At this point, I'm
not sure there's much in the way of productive dialogue to be had here.
Some of the list is purposefully misleading and is clearly aimed more at
helping activists kill the bill than actually informing anyone about
what is in the bill.
Some of it points out things that really should be changed in the bill
but aren't central to the legislation itself, and are simply being
leveraged to help activists kill the bill.
But maybe there's some utility to putting the document in context.
1) Forces you to pay up to 8% of your income to private insurance
corporations -- whether you want to or not.
"You," huh? For the 85 percent of the country already covered by
health-care insurance, it doesn't force "you" to do anything at all.
People on Medicare are not going to be paying money to private
insurance. People with employer-based care will not see their situation
change.
For the nearly 50 million Americans caught in the ranks of the
uninsured, here's the deal: The bill expands Medicaid, a public program,
to cover about 20 million of, uh, "you." Private insurance gets nothing.
If you make more than 133 percent of the poverty line, but less than 400
percent, there's a huge system of new subsidies to help you afford
private coverage.
There are also new regulations on insurers forcing them to spend between
80 percent and 85 percent of every premium dollar on medical care,
barring them from rejecting you or charging you higher premiums due to
preexisting conditions, ensuring they can't place any annual caps on
insurance benefits, and more.
But here's the catch: So long as insurance won't cost more than 8
percent of your monthly income, you have to buy into the system. You
can't wait until you get sick or get hurt and and then buy insurance,
shifting the costs onto everyone else.
The cost of having a universal, or near-universal, system is that people
have to participate. The promise is that, for the first time,
participation will be possible.
2) If you refuse to buy the insurance, you'll have to pay penalties of
up to 2% of your annual income to the IRS.
Again, who's "you?" If you don't have employer-based coverage, Medicare,
Medicaid, or anything else, and premiums won't cost more than 8 percent
of your monthly income, and you refuse to purchase insurance, at that
point, you will be assessed a penalty of up to 2 percent of your annual
income.
In return for that, you get guaranteed treatment at hospitals and an
insurance system that allows you to purchase full coverage the moment
you decide you actually need it.
In the current system, if you don't buy insurance, and then find you
need it, you'll likely never be able to buy insurance again. There's a
very good case to be made
<http://voices.washingtonpost.com/ezra-klein/2009/11/the_individual_mand\
ate_is_too.html> , in fact, that paying the 2 percent penalty is the
best deal in the bill.
3) Many will be forced to buy poor-quality insurance they can't afford
to use, with $11,900 in annual out-of-pocket expenses over and above
their annual premiums.
How many is "many?" For a look at how various families will fare with
reform and without reform, see this table
<http://www.kaiserhealthnews.org/Columns/2009/December/122109Cohn.aspx>
, and this article
<http://www.tnr.com/blog/the-treatment/what-reform-means-families-repons\
e-firedoglake-others> . But if you don't want to click the links, this
graph, which shows the financial risk that medical costs pose to
families with different incomes with and without reform, tells the
story:
[Rec Reform - Dollars.jpg]
<http://voices.washingtonpost.com/ezra-klein/Rec%20Reform%20-%20Dollars.\
jpg>
The vast, overwhelming majority of families will be better off under
this bill. The families in the greatest danger get the most help. They
will have insurance that they can use, and if they need it, subsidies to
help them afford it.
Compared with the status quo, in which about 50 million people have no
insurance and tens of millions more have insurance they can't afford to
use, this is a massive improvement. As Jonathan Cohn writes, "This is a
hugely progressive program to bolster economic security, the likes of
which we haven't enacted in this country for a long, long time."
4) Massive restriction on a woman's right to choose, designed to trigger
a challenge to Roe v. Wade in the Supreme Court.
The Senate bill is better than the House bill on this score, but it's
still disappointing. That said, the restriction here is not on the right
to choose, but on whether primary insurance covers abortion.
In the House bill, the exchanges can't offer primary insurance that
covers abortion. In the Senate bill, individual states can choose to bar
abortion from their exchanges, but it is not the default.
5) Paid for by taxes on the middle class insurance plan you have right
now through your employer, causing them to cut back benefits and
increase co-pays.
"You" probably don't have these plans, which are tilted towards the
rich, not the middle class. Your plan probably doesn't cost more than
$23,000 a year. And if it does, the only part that gets taxed is the
part in excess of $23,000 a year.
The average family health-care plan costs about $13,500 -- almost a full
$10,000 less than the plans this policy taxes. If we don't manage to
slow the growth in health-care costs, this policy will, over time, hit
plans that are less generous. But economists consider the excise tax,
which functions as a tax on insurers who let premiums grow too quickly,
one of the most effective cost-control mechanisms
<http://voices.washingtonpost.com/ezra-klein/2009/10/explaining_the_exci\
se_tax.html> in the bill.
There's an equity aspect here, too: The problem with the excise tax is
that it doesn't go far enough. All plans should be fully taxable. This
policy begins to chip at the edges of one of the most regressive
elements of our system: Health benefits, which are mostly given to
better-off workers, are protected from taxes, while income isn't. A
worker at Wal-Mart with no health benefits sees his entire paycheck
taxed. If that worker goes to buy insurance on his own, the money he
uses to buy it is taxed. A worker at Goldman Sachs with a $40,000
health-care plan is getting $40,000 of his paycheck tax-free. It's
wildly regressive, and not something that liberals should support. More
here
<http://voices.washingtonpost.com/ezra-klein/2009/05/health_reform_for_b\
eginners_th.html> .
6) Many of the taxes to pay for the bill start now, but most Americans
won't see any benefits -- like an end to discrimination against those
with preexisting conditions -- until 2014 when the program begins.
It's not even clear what Hamsher is referring to here (the accompanying
link is broken). The main tax in the bill is the excise tax, which
starts in 2013, not "now."
And the bill isn't funded primarily by taxes. It's funded primarily by
changes to Medicare.
It would be useful if Hamsher explained what tax changes people are
going to notice in, say, 2011. My understanding is that the answer to
that is, essentially, "none at all." The word "many" is obscuring a lot
more than it's illuminating here, making it seem as if the majority of
the bill's funding mechanisms trigger immediately. They do not.
7) Allows insurance companies to charge people who are older 300% more
than others.
The status quo is that insurers can charge people as much as they want,
and they can refuse some people altogether. Hamsher doesn't present it
this way, but the bill is a huge improvement on this front.
8) Grants monopolies to drug companies that will keep generic versions
of expensive biotech drugs from ever coming to market.
This is correct. The bill gives pharmaceutical companies a 12-year
exclusivity period, and then changes get 12 years atop that. It's one of
the worst elements of the bill, and should be changed.
9) No re-importation of prescription drugs, which would save consumers
$100 billion over 10 years.
This isn't really part of the bill, so much as it's a failure to pass a
change that people have been trying to pass for a decade now. People
should keep trying. But saying you'll torpedo trillions in subsidies and
protections for the poor if you don't also get drug re-importation is a
bit like saying you'll refuse to pay the sale price for this TV if Best
Buy doesn't also let you use a coupon.
10) The cost of medical care will continue to rise, and insurance
premiums for a family of four will rise an average of $1,000 a year --
meaning in 10 years, your family's insurance premium will be $10,000
more annually than it is right now.
It's not even clear what this is supposed to mean. According to the
Congressional Budget Office, this bill reduces
<http://voices.washingtonpost.com/ezra-klein/2009/12/to_repeat_the_cbo_f\
ound_that_p.html> the average cost of premiums by a little bit for most
people, and a ton for the people the bill directly affects.
According to the Center for Medicare and Medicaid Services, the bill
cuts spending
<http://motherjones.com/kevin-drum/2009/12/chart-day-healthcare-spending\
> in the long term. According to everybody, it decreases the deficit.
The bill has at least five major cost controls
<http://voices.washingtonpost.com/ezra-klein/2009/12/five_cost_controls_\
in_the_sena.html> that won't exist in its absence. Hamsher, earlier in
this list, came out in opposition to two of them. And the bill does all
this while covering more than 30 million people, ending the ability of
insurers to discriminate based on preexisting conditions, creating a new
and more competitive insurance market, taking the first steps away from
fee-for-service medicine, and much more.
And that's the problem with Hamsher's list more broadly. The points
about the bill's provisions are, in most cases, misleading. Sometimes,
the facts are off. Other times, Hamsher obscures the affected
population. But much more problematic is that Hamsher's list implies
that the bill is failing relative to a world in which we don't kill the
bill.
But in that world, there's still no drug re-importation. Still 50
million uninsured. Still rampant cost growth.
In the world where we pass the bill, most everything gets somewhat
better, if not good enough.
More people have insurance.
The insurance industry ditches its worst practices.
Fewer families go medically bankrupt.
More people catch diseases early, when they can be cured, rather than
late, when they become fatal.
People who would otherwise have died live.
The medical system begins the process of updating itself for the 21st
Century, and responding to the cost pressures it's placing on the rest
of the country.
The world in which we kill the bill is a world in which everything just
continues to get worse, and politicians are scared away from the issue
for decades.
A world in which we pass the bill is a world in which things get better,
and politicians remember that they can pass big pieces of legislation
that take on, or begin taking on, big problems.
http://snipurl.com/ttdpy [voices_washingtonpost_com]
--- In FairfieldLife@yahoogroups.com, "raunchydog" <raunchy...@...>
wrote:
>
> I signed the FDL petition with this note:
>
> Dear Senator Harkin,
>
> This bill gives my employer an incentive to drop my excellent group
plan
> which will then force me to buy junk insurance with such a high
> deductible that I cannot afford to use it. The insurance companies
will
> make a profit on my premiums and if I do not use my insurance because
I
> cannot afford to pay the out of pocket deductible on top of the
> premiums, profits are even better. No wonder healthcare stocks
> skyrocketed the day after the Senate passed the bill!
>
> The evil of this bill far outweighs any good you hope will come of it.
> The Republicans cannot wait to hang this pig around your neck. You
> should have forced this bill into reconciliation. At least there, you
> could have fought for a woman's right to choose and the public option
or
> perhaps single payer. Now you have neither and you face losing House
and
> Senate seats in 2010 despite all the noise the Democrats made on the
> Hill pretending to fight for the little guy.
> http://fdlaction.firedoglake.com/2009/12/21/10-
> 10 Reasons to Kill the Senate Bill
>
<http://fdlaction.firedoglake.com/2009/12/21/10-reasons-to-kill-the-sena\
\
> te-bill/> By: Jane Hamsher
> <http://fdlaction.firedoglake.com/author/Jane-2/> Monday December 21,
> 2009 7:10 am
>
> FDL has become the go-to place for coverage of the health care bill
due
> to the work of our incredible team. Jon Walker's second-to-none
> knowledge of the health care bill has made the policy and political
> analysis he offers up at FDL Action
<http://fdlaction.firedoglake.com/>
> a driving force. Dave Dayen's reporting at the FDL News Desk
> <http://news.firedoglake.com/> , Marcy Wheeler 's research and
> in-depth analysis at Emptywheel <http://emptywheel.firedoglake.com/> ,
> Laura Flanders' interviews at GritTV, our FDL
> <http://firedoglake.com/> team of writers and editors, and our
> community members at The Seminal <http://seminal.firedoglake.com/>
> provide the most independent and comprehensive picture of what's
> happening moment-by-moment on the health care debate to be found
> anywhere.
>
>
> So, I asked them to help make it simple: how do we let people know
> what's going to happen to them if the Senate bill passes? Everyone
> put their heads together and came up with a list:
>
> Top 10 Reasons to Kill Senate Health Care Bill
>
> 1. Forces you to pay up to 8% of your income to private insurance
> corporations whether you want to or not.
> 2. If you refuse to buy the insurance, you'll have to pay
> penalties of up to 2% of your annual income to the IRS.
> 3. Many will be forced to buy poor-quality insurance they can't
> afford to use, with $11,900 in annual out-of-pocket expenses over and
> above their annual premiums.
> 4. Massive restriction on a woman's right to choose, designed to
> trigger a challenge to Roe v. Wade in the Supreme Court.
> 5. Paid for by taxes on the middle class insurance plan you have
> right now through your employer, causing them to cut back benefits and
> increase co-pays.
> 6. Many of the taxes to pay for the bill start now, but most
> Americans won't see any benefits like an end to discrimination
> against those with preexisting conditions until 2014 when the
> program begins.
> 7. Allows insurance companies to charge people who are older 300%
> more than others.
> 8. Grants monopolies to drug companies that will keep generic
> versions of expensive biotech drugs from ever coming to market.
> 9. No re-importation of prescription drugs, which would save
> consumers $100 billion over 10 years.
> 10. The cost of medical care will continue to rise, and insurance
> premiums for a family of four will rise an average of $1,000 a year
> meaning in 10 years, your family's insurance premium will be
> $10,000 more annually than it is right now.
>
> Background information on each point:
>
> 1. Hardship Waiver And Restrictions On Immigrants Buying Insurance
> Undercut Arguments For An Individual Mandate, by Jon Walker
>
<http://fdlaction.firedoglake.com/2009/12/21/2009/12/18/hardship-wavier-\
\
>
and-restrictions-on-immigrants-buying-insurance-undercut-arguments-for-a\
\
> n-individual-mandate/>
> 2. What's in the Manager's Amendment by David Dayen
>
<http://news.firedoglake.com/2009/12/19/whats-in-the-managers-amendment/\
\
> >
> 3. MyBarackObama Tax by Marcy Wheeler
> <http://emptywheel.firedoglake.com/2009/12/16/the-mybarackobamatax/>
> 4. Emperor Ben Nelson: All Your Uteruses Are Belong To Me by
> Scarecrow <http://seminal.firedoglake.com/diary/19778>
> 5. The Senate Bill is Designed to Make Your Health Insurance Worse
by
> Jon Walker
>
<http://fdlaction.firedoglake.com/2009/12/21/2009/12/15/the-senate-bill-\
\
> is-designed-to-make-your-health-insurance-worse/>
> 6. Best way to "Fix It Later" Is With No Individual Mandate
> Now by Jon Walker
>
<http://fdlaction.firedoglake.com/2009/12/21/2009/12/17/best-way-to-%E2%\
\
> 80%9Cfix-it-later%E2%80%9D-is-with-no-individual-mandate-now/>
> 7. The Senate Health Care Bill is Built on a Mountain of Sand by
Jon
> Walker
>
<http://fdlaction.firedoglake.com/2009/12/20/the-senate-health-care-bill\
\
> -is-built-on-a-foundation-of-sand/>
> 8. The Devil in Anna Eshoo's Details by Jane Hamsher
>
<http://fdlaction.firedoglake.com/2009/12/21/2009/11/02/the-devil-in-ann\
\
> a-eshoos-details/>
> 9. Liveblog of the Dorgan Reimportation Amendment by David Dayen
>
<http://news.firedoglake.com/2009/12/15/dorgan-reimportation-amendment-u\
\
> p-for-a-vote/>
> 10. Answering Nate Silver's 20 Questions on the Health Care Bill
> by Jon Walker
>
<http://fdlaction.firedoglake.com/2009/12/21/2009/12/16/answering-nate-s\
\
> ilvers-20-questions-on-killing-the-senate-bill/>
>
> The Senate bill isn't a "starter home
>
<http://iowaindependent.com/23933/harkin-think-of-health-care-reform-as-\
\
> a-starter-home> ," it's a sink hole. It needs to die so
> something else can take its place. It doesn't matter whether people
> are on the right or the left once they understand the con job
> that's about to be foist upon them, they agree. That's why
> Harry Reid and President Obama are trying to jam it through as fast as
> they can, before people get wise. So email the list
>
<mailto:?subject=Top%2010%20Reasons%20to%20Kill%20the%20Senate%20Health%\
\
>
20Care%20Bill&body=I%20just%20read%20the%20top%2010%20reasons%20why%20we\
\
>
%20should%20kill%20the%20Senate%20health%20care%20bill.%20You%20will%20n\
\
>
ot%20believe%20what%20is%20in%20here.%20Read%20it%20here.%0A%0A%20http%3\
\
>
A%2F%2Ffdlaction.firedoglake.com%2F2009%2F12%2F21%2F10-reasons-to-kill-t\
\
> he-senate-bill%2F> to your friends and family, tweet it
>
<http://twitter.com/?status=Top%2010%20reasons%20to%20killl%20the%20Sena\
\
>
te%20bill%20from...@firedoglake%20sign%20the%20petition:%20http%3A%2F%2F\
\
> bit.ly%2F7IYhDf%20%23liebercare%20Please%20RT> and spread the word.
>
> Sign the petition: kill the Senate bill.
>
<http://action.firedoglake.com/page/m/5958d6df/45920d03/634f4e09/3dc6524\
\
> 4/3029940327/VEsC/>
>
http://fdlaction.firedoglake.com/2009/12/21/10-reasons-to-kill-the-senat\
\
> e-bill/
>
