Tag: health care

Advocates for moving ahead with health-insurance reform in its current form need to read this story from The Washington Independent:

At issue are employer-based wellness programs, which aim to prevent common conditions related to smoking, overeating, lack of exercise and other unhealthy behaviors — conditions such as diabetes, hypertension and high cholesterol. Both the House and Senate bills promote such programs, but the Senate bill, critics argue, would allow employers to raise rates on all of their workers, then lower them only for folks who meet certain wellness targets. Such a system would effectively force less healthy workers to subsidize the insurance plans of those more fit — an unfair penalty in the eyes of many medical groups.

“Incentives quickly become penalties for those who can’t meet the requirements,” said Sue Nelson, vice president for federal advocacy at the American Heart Association. “This would really become medical underwriting by another name.”

Current regulations allow group plans to offer rewards up to 20 percent of premium rates for employees who meet certain health goals. The Senate health-reform bill would effectively make that rule law, while also bumping up the variation allowance to 30 percent — roughly $4,000 for the average family plan. The Senate bill would also allow officials at the Health and Human Services Department to go even higher — up to 50 percent.

Outside of the group market, the Senate provision would also create a 10-state pilot program testing the advantages of the wellness incentives for individuals buying insurance on their own.

Health advocates are right, of course. Offering discounts for certain behaviors is a backdoor way of charging the less healthy more for their insurance. The insurance companies, after all, are not going to forego their profits; if they offer discounts to some, then others will have to pay more to offset the discounts.

“When you start picking people off on an individual basis [and] reducing their premiums individually,” Sen. John Kerry (D-Mass.) said during the Finance Committee markup, “you do not adjust for what else may be happening within that [coverage] universe, and then other people are picking up the overall costs.”

My fear is that this is not the only timebomb in the legislation and that many will detonate only after it is too late.

The reality is that we have allowed this debate to go off the rails. The primary goals — universal access to affordable insurance that covers most healthcare problems — have lost out to something that might be good for insurers and the elected officials who take their campaign contributions, but does little for the rest of us — a decision to keep the insurance industry whole.

Rather than challenge the industry’s monopoly, we are mandating coverage and helping lower-income folks pay for it with subsidies, essentially shovelling billions of tax dollars into the pockets of the insurance cartel.

At the same time, the handful of new regulations and restrictions that have been floated are rather weak, and riddled with loopholes like the wellness-program exemptions, which prompted this response from a “former insurance industry executive,” who told the Independent that “it will take little time for companies to exploit the loophole in the Senate bill.”

“Insurers can smell profits a mile away,” said Andrew Kurz, former chief financial officer at Blue Cross-Blue Shield Wisconsin. “This is a loophole they will drive right through on day one.”

This, and all of the other loopholes.

I hate to see reform fail, but I’d rather have real reform than reform in name only. Afterall, we may not get another bite at the apple on this for a long, long time.

I missed this story on Thursday, but it is worth posting today because it shows the dangers the healthcare reform bill poses in its current form.

If, as the Times reports, the impact will be limited, leaving the vast majority of people to deal with an only modestly changed market:

Now that the Senate has caught up with the House by passing a sweeping health care bill, lawmakers are on the verge of extending coverage to the tens of millions of Americans who have no health insurance.

But what about the roughly 160 million workers and their dependents who already have health insurance through an employer? For many people, the result of the long, angry health care debate in Washington may be little more than more of the same.

As President Obama once promised, “If you like your health plan, you can keep your health plan.”

That may be true even if you don’t like your health plan. And no one seems to agree on whether the legislation will do much to reduce workers’ continually rising out-of-pocket costs.

Again, I am not arguing that the bill should be killed — I remain ambivalent, convinced that a better bill could have been crafted had progressive Senators and the president stood up to Ben Nelson, Joe Lieberman and the moderates and stopped reifying them, but also concerned with the political damage defeating the bill could cause.

What I think needs to happen is that bill supporters need to be honest. Stop painting the bill with such overheated language and just tell the public what it likely will do and how that is good for all. There is too great a danger that the hyperbole will backfire, that the millions who are unaffected by reforms, who find themselves at the mercy of the industry, will turn their back or worse — buy into the BS arguments coming from the GOP.

The health insurance reform plan approved by the Senate the other day can best be likened to a misdirection play in football, where all the action seems to be going in one direction while the real play is heading in another. In this case, we a plan being called “once-in-a-generation reform” — a bit of overstatement, really — when what we have is relatively modest insurance reform that expands coverage by mandating consumers buy plans from an a cartel-like industry that holds all the cards.

The misdirection here is the opportunity the bill gives the White House and the Democrats to claim a victory even if it is rather hollow — no public option (let alone any thought of a single-payer, Medicare-for-all approach) to create competition to keep costs down, no expansion of Medicare, no changed incentives, no alternatives for businesses stretched to their limits, but millions of new customers for the insurance companies.

So, is it worth passing? That’s a difficult question. There are good things in this bill and there is the possibility that it can be used as a foundation on which to build real reform. The problem is the discourse surrounding the bill. If it were being described by the press and the president as what it is — something short of reform — that would be OK. But it’s not. It is being described as once-in-a-generation reform and that creates the danger that this bill has become a once-in-a-generation chance to fix our broken system. If the House cannot fix it, cannot toughen this bill up, progressives need to walk away from it.

I’m not sure I agree fully with Howard Dean that the healthcare bill now on the table should be scrapped — I think he’s correct on his criticism of the bill, but I’m not sure killing it will bring us back to a place where we can start over. The system as it exists is rigged against real reform, so killing this bill might just mean the end of any chance for reform.

That said, Ruth Marcus is being too dismissive — Dean’s argument must be addressed head on.

The voting has begun and, according to the reports, Democrats are going to get the 60 votes they need to keep the debate going on the healthcare bill. Call it both a big victory and a Pyrrhic victory. Big, because it keeps debate moving forward, keeps the possibility alive that we will have some level of reform; Pyrrhic, because the reform in question is likely only to have an incremental benefit while transferring a vast amount of cash from ordinary Americans into the pockets of the insurance industry.