Mandating that people buy private health insurance is the wrong thing, but I don't think it's so bad that it overrides the counteroffers of a rescission ban and an expansion of Medicaid subsidies.

I don't buy the argument that allowing the Senate bill to pass into law will somehow diffuse people's dissatisfaction with the health care system. This bill is garbage, and I don't seriously see active progressives or significant numbers of polled voters satisfied with it. A public option was a clear majority priority, and there isn't one. Even the House version's public option wasn't one.

It seems the first thing you have to learn about politics is that the fight for justice never, ever stops. It doesn't matter whether that stop is based on winning or losing. Satisfaction and discouragement both accomplish nothing.

I think the effort that would go into opposing this bill would be better spent improving it, and pushing the next bill. Because there will be another one. We might have to replace some conservative Democrats to get the votes first, but there are elections with which that can be done.

There's been considerable debate on the Senate health care bill where it belongs: among democrats.

Some progressives want to scrap the bill - and start over, I guess. There's a sense that it reall is worse than nothing, since the mandate in the absence of some form of public option or other cost controls amounts to rewarding the industry's bad behavior, not only with taxpayer subsidies, but with citizens' own earnings.

I'm starting to get the idea that people simply can't get anything they actually want without carving it out as a compromise from the plutarchy. And really, once I look at it in that light, I become less concerned about whether the health insurance industry is getting something it doesn't deserve. It's (mostly) not my money, after all.

But I have to admit that we are getting something in return. It's not WORTH it, and it's not just, but it's something.

The more interesting discussions have to do with the political tactics involved in the debate of whether to reject the bill. How are voters going to react? If progressives kill this bill, and nothing passes in its place, will progressive voters really stay home rather than voting in the midterms, scuttling the (non-) majority they barely held together to pass this turd of a bill?

I have to admit this claim sounds absurd. Reid has been whining about not having 60 votes for years, bringing into sharp focus that the quality of legislation turns on the number of good legislators you can get in the Senate. If it's becoming apparent that we can't get what we want with as many votes as we have (and it sure as hell isn't 60), why in the world would people not continue voting for more and better Democrats? Wouldn't the first thing to cross people's minds in explaining such a failure be the same thing we've been told for years?

Maybe it has something to do with the fact that conventional wisdom holds that Reid has his magical 60 votes when he obviously DOES NOT. Despite the fact that Lieberman and Nelson are "in the caucus" (ever seen a liberal Republican?), they are clearly not constituting your hallowed 60 vote majority if you strip out the entire centerpiece of meaningful legislation just to get them to ALLOW A VOTE on the bill. Nonetheless, voters have been hearing this magical "we finally have a filibuster-proof majority", and still wonder why the fuck nothing worth a damn can get done.

Regardless, everybody is pretty much coming to terms that nobody is going to get what they want, and the debate has moved to the consequences for "fixing it in post". The discussion is about which outcome will get more left-wing voters to the polls in the next election, because the Senators we have are obviously not enough. One must compare estimates of base voters demoralized away from voting by the Senate's paralysis against estimates of those energized by the fact that, well, we got a bill, which is more than we've had in decades, even if it's worse than nothing.

Will more voters be demoralized if the current bill passes, or if it doesn't? THEN, compare to how many voters will be ENERGIZED by the argument (presuming this message, "more and BETTER Democrats", is pushed competently) that we still need more votes in the Senate, if the current bill passes, or not.

It's a complicated calculation. I have no damn idea.

Dear Senator,

I would like to eat at the cafeteria during my lunch break every day, but all they have on the menu are shit sandwiches. I could go for a plain hamburger or even a BLT, if I could. Can you guys do anything about this? I know it's a stretch, and I don't expect much, but I figured I'd at least ask.

Thanks,
Joe Constituent

--

Dear Joe,

Yeah, I brought up the lunch menu issue at the last staff meeting. Turns out we got a smokin' deal out of the bargain! As part of a sweeping new lunch program, we got the cafeteria to drop their prices on shit sandwiches by 50%! They're going to call them "Freedom Burgers", now. We made the program mandatory for everyone, so we'll be taking the meal costs out of your paycheck from now on. You won't notice a thing.

Bon Appetit!

Your Senator

--

Dear Senator,

Thanks...
/deadpan

The next time I have a problem, I'll be sure to keep it a secret from you.

Joe Constituent

The public option is out.
Medicare Buy-in is out.

All we have left is a Medicaid subsidy expansion, and an alleged ban on rescission (except in cases of "fraud" and "willful misrepresentation", which is what most rescissions are based on currently),

in exchange for:

A personal mandate that people buy crappy private insurance, without any regulation to control costs or pricing.

Tough choice. It seems socialism is perfectly acceptable, as long as we are not just subsidizing, but mandating the purchase of a lobbyist's client's services.

The Singularity has already happened. Now we are merely discovering the consequences.

We are surviving serial crises in the growing shadows of slowly falling giants.

The Senate bill is no better.

Only in America can you turn a push for a social safety net into mandatory corporate welfare.

Canada is a better place to be uninsured than the US.

The House health care is looking more and more plutocratically compromised the more I hear about it.

I keep reading that the public insurance option in it is only really available to around 6 million people - the rest don't qualify, including more than a hundred million people currently uninsured. So the public option isn't any kind of option for most people. It's a public option in name only (hereafter: "POINO").

That being the case, it is almost as bad as the personal mandate to purchase insurance without a PO of any kind, as I've said before. It's one thing to subsidize insurance industry profits by spending tax dollars through Medicaid; it's another to force people to do it themselves. That's disgraceful. It's equivalent to raising taxes on the poor and middle classes, something President Obama has most clearly promised against. But if the "tax" is levied by insurance companies, and not government, he can get away with it on a semantic technicality.

Now, with that said, this particular bill might be better for me specifically, because I'm likely to be one of the few who can qualify both for the public insurance option and the expanded Medicaid subsidies. I won't know until I can see what's on offer.

Well, well. Something passed the House, finally, barely.

Here's the inventory:
* Insurers are banned from rescission of customers with pre-existing conditions, as predicted. I don't know if they're banned from refusing new subscribers based on pre-existing conditions, however. They also lose their anti-trust immunity (which, frankly, I didn't even know they had to begin with).
* There's a public option! So this makes the preceding question moot, since the PO isn't going to turn anyone away on that basis - it's a federally-instituted health insurance co-op, in essence.
* There are subsidies for people with low incomes, paid for with what appears to be a tax increase on households making more than half a million dollars a year. And really, who cares about their taxes?

On the other hand:
* There's a personal and employer mandate. Everyone is required to buy some insurance. Given the existence of the PO, I can live with this. I won't have to give my money to for-profit thugs. I look forward to seeing what kind of plans the exchange will have when it gets off the ground.
* There was an amendment tacked on that prohibits the funding of abortions by PO plans or government-subsidized private plans except in the cases of rape, incest, or maternal endangerment. That's a bummer, but it's not a bad bone to throw conservatives. It was also obviously not a show-stopper.

Of course, we're not there yet. There is still the much more difficult Senate to pass, and the inevitable House/Sentate conference compromise process.

But it appears the cube has rolled onto a brand new side. It's progress. It's history. I approve.

Jiminy Jester Christ - Did I just say that about an act of Congress?

Hm.

There is a difference between prohibiting rescission (insurers dumping customers for pre-existing conditions only when they get sick, AFTER they have been paying premiums for months or years) and banning the practice of denying enrollment on the basis of pre-existing conditions entirely. So the idea, previously floated, that I could "game the system" by not buying insurance until I needed it, may not be as viable as I thought.

But what is clear is that any public option - even any co-op - needs to be playing by the same rules as private insurers. But it seems to be the case that, by their very definition of their natures, that can't happen.

The ability for an insurer to deny enrollment alone, never mind coverage after enrollment, tilts the playing field in their favor. A public insurer, be it government or a co-op, is in the business of insuring people, not making a profit. Thus, all those with pre-existing conditions will invariably be forced to enroll in public insurance plans while private insurers cherry-pick healthy customers. Private insurers thus get the better end of the deal, because the costs to insure healthy people are less than the costs borne by public insurers who won't turn sick people away.

Now, on the other hand, public insurers save costs by not having pay for profits or marketing. It's hard to say, however, how this will balance out. It's like trying to weigh the amount of money you lose to file sharers who won't buy copies of your work when you release it for free distributions against the amount lost to those who won't buy it because they hate DRM, or don't even hear about it in the first place because you're too paranoid about piracy. Who will come out on top in terms of fiscal feasibility is hard to say without data - and there is none, because it hasn't been done yet.

Businesses often oppose competition by government on the basis that government has an "unfair" advantage in the marketplace. But this is a textbook case of exactly the opposite.

So, in order to truly level the playing field, either private insurers are going to have to be prohibited from denying enrollments of patients with pre-existing conditions, or we can leave it at prohibiting pre-existing rescission only. While prohibiting pre-existing rescissions is certainly called for, I somehow doubt that any public option or co-op plan will really succeed if it remains disadvantaged by a lopsided ratio of sick customers.

Talking to a friend, I realized a few more things about my health care realizations.

It isn't quite true, as I have been suspecting, that the likeliest contested outcomes of the current health care & insurance reform fights now ongoing in congress would have absolutely no affect on me. I found something that matters to me, and, thankfully, it's not even something that's hotly contested among the party that matters: the Democrats. It's not even specifically contested by Republicans - although they certainly want to block it as part and parcel of sending anything even spoken of politely by the Democratic majorities down in flames.

Surprisingly, it isn't the public option.

As I mentioned in my last post on this subject, it seems that health insurance is less about protecting health as it is in protecting financial assets. But it isn't just catastrophic emergency care that bankrupts people - it's slow, creeping diseases. Parkinson's, Alzheimers, Cancer. None of these will send you to the emergency room to get the kind of care they can't refuse to the indigent. It WILL cost your ass an arm and a leg. For emergency care, insurance doesn't mean the difference between getting or not getting care. But for some illnesses, it does. In those situations, insurance means more than mountains of debt that don't matter anyway - it means the difference between persistent suffering and living a livable life.

So I'll be very happy to see provisions in most of the bills being debated - provisions that aren't really being debated themselves - that would prohibit private insurance companies from denying coverage or claims on the basis of pre-existing conditions.

So this will mean that, so long as I'm healthy, I have the freedom to "game the system" and not buy insurance until I really need it.

Now, insurance companies will say (and I understand where they're coming from) that it's not really fair to allow people to do that. That would be like being able to buy home insurance after your house burned down. But really, I don't have much sympathy for this argument, because those who make it just happen to be the very same assholes who refuse to tolerate the really quite modest tax increases that would be needed to fund what every other developed country in the world has taken for granted for decades: single payer health care.

So suck it up, fat cats: You're lucky enough you don't have to pay for my prescriptions, check-ups and flu shots. I think you can help pay for some of the costs of chemotherapy for the destitute and indigent if they happen to need it.

Now, granted, they still have the balls to wedge in a personal mandate, requiring all Americans to fork out for some form of insurance. Without a public option, this amounts to a despicable handout to an insurance industry that doesn't deserve it. I know I'm sure as hell not going to give these fuckers my money, even if it means having to pay penalties to the government instead. But at least I know I'll be able to get some kind of actual insurance when I know I'll need it.