Jay Bullock wonders why he's not getting any response to a post which, in his view, called "half of the conservative cheddarsphere liars." (Actually, his post attracted a good number of comments for a local blog.) At issue is a list of claims about HR 3200, the Orwellian named "America’s Affordable Health Choices Act of 2009."
Claims on the list have been advanced by local conservative bloggers, but it actually comes from Liberty Counsel and a blogger named Peter Fleckenstein.
First, I'll give Jay some credit. From what I can see, the list is not a very strong piece of work. Some of the claims are wrong and others relate to valid criticisms of the Act's likely impact, but are not required by the Act itself. Still others are phrased in a very polemical way.
I haven't - and wouldn't - link to the list, so I guess I haven't been called a liar. Nor do I want to debate how good or bad the list is. It is not the issue. The proposed legislation is.
But Jay hasn't scored the points that he thinks he has.
For example, one of the "lies" (or so says Jay)are claims that health care will be rationed and the the government will decide what treatments and benefits are covered. Jay's response, essentially, is that the federal government will set only minimum standards and he is right to say that the language cited does not literally call for rationing and limitations.
But its not at all clear that the legislation would only set floors and not ceilings. In fact, that seems highly unlikely. Sec. 142 of the Act empowers the Health Choices Commissioner to set standards. Sec. 123 empowers a committee to make recommendations regarding qualifying plans to the Secretary of HHS. Nothing says that these recommendations and standards are limited to setting minimum qualifications.
In fact, one of the selling points of the plan is to reduce costs by adopting "best practices" which will necessarily mean deciding that some things ought not to be paid for. (As the President put it, preferring the cheaper blue pill to the more expensive red pill.)Anyone who actually has to take pills to alleviate a chronic condition knows that it's hardly that simple.
While it may be that these limitations will only formally apply to the public option, it's not that simple. First, to the extent that people get thrown into the public option, those restrictions on reimbursement become restrictions on their care. Of course, any contract for insurance is going to have restrictions on care. No insurer or employer can promise to pay for anything and everything, the fear here is that, if a public option drives out private alternatives (more on that later), then there will no longer be competitive discipline on the substantive provisions of insurance. Today, if you don't like what your employer has chosen, you can complain and employers - who use health care plans to compete for employees - can and do choose something else. To the extent that a public option becomes the - or one of the - only games in town, that won't be as likely.
Beyond that, to set minimums - particularly if they are extensive - is to set maximums. If you mandate extensive coverage for drug and alcohol coverage, you are either going to drive up the cost of the policy or cause something that isn't mandated to be dropped in order to meet an acceptable price point.
Jay refers to a "lying" editorial in Investors Business Daily that, in his view, falsely claims that the bill outlaws individual private insurance plans that do not meet government minimums. It does not, he says, because existing policies are grandfathered and they are - as long as the insurers don't sign up any more policy holders. In other words, if you have a policy and the company is willing to close its book of business, you'll have no problem. Otherwise, its to the exchange for you.
And the exchange is going to mandate a particular type of policy. Broad coverage and low deductible. The opportunity to save by buying bare bones coverage will be limited and the cost controls that will exist are likely to come by restricting care in ways that are not politically (as opposed to medically) harmful.
Jay repeatedly says that the plan leaves private employer provided insurance alone and that the public option is not subsidized. But that's true only in the most technical sense. No one really believes that the existence of a public option paying medicare rates will not impact private plans. Whether or not the public option turns out to be subsidized will depend on that impact. Will private plans subsidize the public option as they currently subsidize medicare? How will the credits provided to people who cannot afford insurance interact with the setting of "standards." i.e., will they be constructed in favor of the public option?
He is, of course, correct in that the bill does not call for "mandatory" end of life planning. It only provides that such planning will be paid for - presumably in ways that it is not today. (Having dealt with the death of two elderly parents - my Mom and Karen's Dad - there certainly was a lot of discussion of those matters.)
Of course you get what you pay for and that may not be all bad. But it is not surprising that there would be a certain sensitivity about the issue given the President's remarks about limiting care for those with limited life expectancy and the experience with that type of thing in other "universal care" schemes.
Jay can't understand why employers would drop coverage to pay the 8 % tax when nothing prevents them from dropping coverage now. He calls the suggestion that this is "the dumbest thing he has ever heard" which is a big claim from a high school English teacher.
But its not dumb at all. Currently employers who don't offer health insurance are at disadvantage in competing for employees. Because folks need to get their insurance from their employer, many will not consider positions that they might otherwise take if there is no insurance available. If there is an alternative, this becomes less of a disadvantage and some my choose to drop coverage. That possibility will be exacerbated if the public option undercompensates providers and drives up the cost of public plans.
Jay says he bets private companies come up with plans that undercut the 8 % tax for employers who don't provide coverage. That might happen if the mandates for coverage (the "essential minimums") don't make that impossible. I suspect that they will.
In a comment following his post, Jay touts medicare. Why do providers accept medicaid patients if the rates are so bad? Of course, some don't. But, for those that do, it is possible to engage in price discrimination since medicare and medicaid aren't open to everyone. We wind up subsidizing medicare and medicaid with our health care dollars as well as our tax dollars. With a public option available to everyone, that becomes more difficult and I have written elsewhere on why that may be a big problem.
He repeats the notion that medicare is a "model of efficiency" due to lower administrative costs. He counts it a virtue that Medicare, having overcharged for years to create a surplus that the government has squandered, has not charged even more. The administrative cost advantages of medicare may be exaggerated but its not surprising that they are there. It doesn't take much work to say "take it or leave it." Medicare is going bankrupt but Jay thinks it a selling point that this won't be for a few years.
I'm not sure that Jay should want a fight.