Neil deMause

I wrote recently that I was worried that without a public insurance option in a health reform bill, “we could be left with a system that ‘solves’ the health care crisis by guaranteeing everyone access to expensive, crappy coverage.” Now Rolling Stone’s Matt Tiabbi has explained in terrifying detail why this is exactly what will happen. For example, check this out:

If your employer does not offer acceptable coverage, you then have the right to go into one of the state-run insurance “exchanges,” where you can select from a number of insurance plans, including the public option.

There’s a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance “exchange.” In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their shitty plans protected by a grandfather clause. Which means …

“If you have coverage you like, you can keep it,” says Sen. Sanders. “But if you have coverage you don’t like, you gotta keep it.”

Extra bonus points to Tiabbi for summing up the Republican argument that a public plan would be unfair to private insurance companies because they need to lard up their premiums enough to rake in a profit: “This is a little like complaining that Keanu Reeves was robbed of an Oscar just because he can’t act.”

If none of the options in the health reform debate strike you as particularly appealing, maybe that’s because one of the most popular options has been ruled off-limits by for consideration:

While Republican types freak out about the idea that government reform of health care will somehow involve government — economist Arthur Laffer’s “Just wait till you see Medicaid and Medicare run by the government!” was a classic of the genre — most people I know seem to be heading in the opposite direction. Why, they ask, is Congress spending so much time and money patching a system that is fundamentally broken?… [read more]

More on the public health insurance debate, this time on the faceoff between small business groups over whether it’s a great idea that will increase choice and lower premiums, or an unnecessary government intrusion into the private market:

As Congress prepares to do battle over health reform, a parallel dispute is shaping up among small-business groups that are staking out opposing positions on a key element of reform proposals: whether Uncle Sam will take on a bigger role in offering insurance coverage or leave the field to the private market.

The so-called “public option,” backed by President Obama and many Congressional Democrats, would set up a government-backed health insurance plan that would compete with private plans. Though details remain fuzzy, the proposal already has critics on both sides of the aisle decrying “government-run health care.” The American Medical Association and private insurers oppose any public option…[read more]

Why we need a public health insurance option, in 360 words or less:

When my friend was laid off recently, she was happy to learn that, thanks to Obama’s stimulus package, she’d get to keep her family health insurance at a cost of $330 a month.

OK, maybe “happy” is pushing it… [read more]

The San Francisco Chronicle’s Carolyn Lochhead — never my favorite reporter on social issues — has a long piece today on health reform that asserts:

It will mean higher taxes and, potentially, lower benefits for many people. It will mean putting the brakes on how doctors and hospitals practice medicine. It may require employers to provide health insurance and individuals to buy it.

None of these things will be popular. Cost containment, identified by the White House as a key objective, never is.

So let’s see: Taxpayers will have to share the pain, the insured, doctors, employers … anyone left out? Oh yeah, insurance companies. Nowhere in 1,600 words does Lochhead find room for the notion that insurers might have to take a cut in their soaring profit margins — though she cites the National Coalition on Health Care as calling for “short-term restraints” on costs, she fails to mention that one of the restraints they’re calling for is a cap on insurance premiums.

On the bigger picture, meanwhile, Lochhead’s article is murky on the question of exactly which problems health reform is supposed to fix. (This is a common problem in health care coverage, which has quickly come to resemble “horse race” style election stories: all about which side is winning, not whose policies would do what.) While she cites both rising costs and rising numbers of uninsured, these aren’t exactly unrelated trends — aside from those who can’t get insurance because of pre-existing conditions (which would, thankfully, be dealt with by many of the Congressional plans), the uninsured are mostly uninsured because they can’t afford it.

Since there are only two ways to enable people to afford something — make it cheaper, or give them money to pay for it — both problems would seem to require the same solution in the end: Reduce the amount of money flowing to the people who make money off of health care (insurers, doctors, and makers of the machines that go “ping!”). The alternative would be a system that solves a social ill by pumping government money into rich people’s pockets, and surely that’d never fly with … er, never mind.

…and as a companion piece on the web, a look at how insurance pools are supposed to work, and why so far they haven’t:

One of the keys to the various health reform plans kicking around Washington is “pooling.” The proposal floated by President Obama during the campaign, for instance, would establish a National Health Insurance Exchange designed to help small businesses and individuals reduce their premiums.

Pooling is a great idea in theory. But historically, it hasn’t succeeded at significantly expanding affordable coverage… [read more]

My latest assessment of likely health care reform plans in Congress is out in Fortune Small Business, and on the web at CNNMoney.com:

Barack Obama made health-care reform a central promise of his presidential campaign. But the shape any change takes will probably depend as much on Congress as on the new president’s plans.

“Unlike in 1993, Congress will own this debate,” predicts Len Nichols, director of health policy for the New America Foundation, based in Washington, D.C…. [read more]

Geared toward small-business owners, but a worthwhile overview of coming legislation for the general public as well. I tackle health care, taxes, and credit cards:

Health care: Still on the critical list

Last year: The cost of providing health insurance to employees continued to skyrocket, jumping by an average of 5.7% per employee after a 6.1% hike in 2007, according to a study by consulting firm Mercer. A survey by the National Federation of Independent Businesses found that health care was the number-one concern of small business owners, prompting the NFIB to become a major backer of an advertising campaign calling on the presidential candidates to make health reform a priority.

This year: President-elect Obama has endorsed a sweeping reform plan that would create a new National Health Insurance Exchange to allow more businesses access to insurance pools…[read more]

The headline pretty much says it all: Obama’s and McCain’s health care proposals have gotten plenty of ink, but whatever health reform we get isn’t likely to look much like either once Congress gets done with it.

In his Democratic convention acceptance speech sixteen years ago, Bill Clinton declared that as one of the first initiatives of his administration, he would “take on the health care profiteers and make health care affordable for every family.”

Two years later, his “Health Security Act” was dead, never having gotten even as far as a vote in Congress.

Nearly two decades of soaring premiums and reduced coverage later, health care is again at the top of the reform agenda in Washington… [read more]