Possible compromises for healthcare reform
While I do think that the success or failure of healthcare reform rests squarely on the shoulders of the Democrats in Congress and with the president, I still wish that Republicans would come aboard with some reasonable compromises. At this point, though, the Democrats have several options on the table and while I think there is reasonable room for compromise they could always….
….pass a healthcare reform bill via reconciliation. Yes, the Byrd rule makes this tricky. Serious holes could be shot through the bill. But it can be done. Democrats should seriously consider this approach given the continued strength of their majorities in both the House and the Senate. Whatever is cut out during the process can be added back in later. Rather than worrying so much about public opinion should they pass the bill in the wrong way, Democrats should worry about public opinion if the bill fails altogether. That’s a lot more memorable then some abstract legislative process with as benign sounding a title as “reconciliation.” But…
…if reconciliation is too daunting, Democrats could take a Republican bill and remake it into a bipartisan bill – rather than the other way around. Market and tort reforms could be coupled with subsidies (or vouchers) and some broadly popular reforms like an end to pre-existing condition clauses and some sort of optional national exchange. All the reforms I mention below could be packaged together as one bigger bill. Or…
….the Democrats could do this incrementally, with smaller moves and compromises made one at a time – in three or four separate bills over the course of a year or two or three.
First: expand Medicaid to 200% of poverty while at the same time deregulating the insurance market so that insurers could sell insurance across state lines. Shift the regulatory burden from the states to the federal government to avoid the same problems we’ve seen in the credit card industry. Finally, have the federal government pick up the tab for the Medicaid expansion.
In the next bill, introduce an excise tax on “Cadillac plans” while at the same time tackling tort reform. Toss in some vouchers (subsidies) for low-income families to purchase private health insurance. The Cadillac tax will eventually hit enough people to start a shift away from employee-based health benefits. In the future, the vouchers can be adjusted as more and more people leave the current system to purchase personal, portable insurance.
Third, lower the age of Medicare recipients to 50 while at the same time introducing significant means-testing. Change the fee-for-service model to one which relies on results rather than services rendered. In other words, have a Medicare bill that adds more healthy, younger people to the pool, while reducing benefits and/or raising premiums for wealthier elderly while at the same time changing the biggest and most fundamental flaw with how service providers are paid.
Somewhere in here pass a VAT. Put a bunch of money into community health centers, and nursing programs. Deregulate the medical cartels allowing more barefoot doctors, nurse practitioners, and midwives to provide more of our health services. Let low-cost, easy access, for-profit medical centers set up in shopping malls and other easy access places. Make sure Medicaid is accepted at these new walk-in clinics. Let Wal*Mart run them from its stores, all across the country. Let people start tax-deductible HSA’s regardless of the their health insurance.
And so on and so forth. Plenty can be done – even incrementally – to enact change in the status quo. Things can get better for people without enacting sweeping change that scares voters and kills the process in its tracks.
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I know of plenty persons who’ve sold their houses at the top of the market, are totally capitalist (and, being OUR world, implicitly mindful of moral boundaries and, not being chumps, knowing where / when the government wrongly allows shady industry practices.)
Typically they haven’t yet bought back owing to strong doubts about whether that market has fixed itself unfettered (assets finishing the process of passing from weak hands to strong hands.)
Some are in the happy circumstance of being able to live anywhere.
Californians, they often can’t even think of checking out Las Vegas, known to currently have residential bargains galore. That’s because being middle aged they generally have exhibited risk factors that have already thrown them into what’s commonly known in medical economics circles as premium death spirals. Medicare (National Health Insurance for the elderly) is still 10 + / – years off, the many policy choices being a handful of cartel players’ means of slicing and dicing so as to isolate
those likeliest to fail providing industry
MSR’s (medical service ratios–profitability measure.)
Then, though not rescinded (though the industry’s executives have brashly asserted before Congress their right to rescind (cancel policies) lives on,) they typically receive letters indicating, perennially, 25 or 30 or 33% premium increases designed to bleed them off the policy rolls. They receive letters saying they’re welcome to stay as appreciated customers, but their policy (the sliced / diced no longer risk-free cluster of persons’ policy) is no longer marketed (“active,”) but rather is “frozen.”
The companies know these people, equally lacking a risk-free status, are unwanted by the other companies, and they know these customers know that.
(Yep. They know that we know that they know that we know….that they’re indistinguishable from a protection racket run by persons with the morals of earthworms.)
As each policy is state-bound, these persons can’t even consider moving out-of-state.
Even if Obama got what he asked for, and even though he’s a former Prof. of Constitutional Law at the Univ. of Chicago, and even though the cartel is in part cutting off its nose despite its face (the newly unemployed, even health risk-free) will no longer pay their premiums, there’s still some doubt a major change can survive a challenge before the overly George W. Bush-appointed Supreme Court.
Obama has expressed mindfullness of the deaths and financial damage done to families by the first year of failing to change the essentially corrupt system, but guess what Barry, that’s not cutting it with me.
If the Democrats would stay united behind their common principles in the process, maybe Hillary actually could be more effective legislatively.
What may be most desirable overall, though, is quite simple:
REPEAL THE HEALTH INSURANCE CARTEL’S IMMUNITY FROM THE ANTI-TRUST LAWS!
With 30% of costs going to administration (but with even cartel shareholders obviously shafted by management–after that 30% the companies actually produce bottom line mediocre profit metrics) there should easily emerge plenty new competition.
Only then would (also necessary:) outlawing exclusions for risk likely eventually mean the end of premium death spirals, which VIRTUALLY ALL OF YOU (YEAH YOU–READERS, MR. KAIN, TRUE / SLANT OFFICERS, )WILL SOONER OR LATER CONFRONT.
Even then it’s possible they’ll retain the premium death spiral practice (insurance of the now you see it, now that you need it you don’t variety.)
That’s why I think it’s also alternately time to petition persons like Attorney General Jerry Brown in California to explore whether actions lie in contracts, fraud, fiduciary duties, insurance regulations, etc.
(OFFERED AS PRINCIPLE AND POLICY COMMENTOR–NOT LEGAL ADVICE–CONSULT YOUR OWN LAWYER, CLASS ACTION FIRM, LOCAL PROSECUTOR, AS TO YOUR OWN
SITUATION)
http://sites.google.com/site/evernewecon
E.D., once again you offer some very good ideas on how our elected representatives could assist all the people of this great country and compromise on key areas to get something good enacted. Won’t happen though; the GOP thinks by just saying NO they will win the war. I think they too misread the anger in this country toward Washington and will be swept out of office in the next election cycle. Only when we elect new faces will your ideas have any chance of being considered. Care to run for office, you would make a great Representative!
Erik:
With all due respect, my friend: What part of NO do you not understand?
Here’s the way legislative compromise works. The governing and/or majority party writes a bill according its own lights with respect to their understanding of the national interest and so as to implement their agenda constructed within their ideological framework.
Then they add bits in of the opposition’s agenda to entice some members of the opposition on board. If the Democrats wanted to adopt as their core legislative vehicle the Republican agenda for HCR, they’d be Republicans.
Second. We already compromised e-fucking-nough. Fuck that shit. Obama and the Dems adopted an HCR architecture designed by Mitt fucking Romney. If the Republicans don’t like it, fuck them.
If HCR doesn’t pass this year in roughly current form, it won’t pass for 15 years in any form, the irrational and unsustainable system we have will continue barrelling toward collapse and maybe some loudmouth asshole Tea Party type will happen to be President when it all crashes and they have to impose single-payer as a “bailout” package, and then I will laugh.
Jack – Honestly, I’m not sure the Democrats have the balls to do this without compromising. If they’ve got what it takes, good for them, but they act like they’ve got a minority with 59 seats in the bloody Senate. Liberals may have better wonks on their side, but their political class leaves much to be desired.
In response to another comment. See in context »Erik:
Let me modify my prevous comment. What part of “WE ALREADY COMPROMISED” do you not understand?
Now, indeed you may be correct that the Dems don’t have the testicular fortitude to pass what’s on the table. In which case, nothing will pass, the parasitic insurance companies will continue their bloodsucking, the system will become more irrational and more unsustainable, until it implodes, and then we WILL Be able to build a new system from scratch. Or from the rubble, anyway.
I’m just telling you. The Dems starting over with a GOP bill is a non-starter. Won’t happen. If the Dems tried to do that and then added in their core agenda item, universal coverage, they’d instantly lose all the Republicans anyway. And if the Dems tried to do that and did not add in their core agenda item, they’d be Republicans.
We’d end up with a crappy bill that would not make the system more rational or sustainable, that would privilege profits over people, that would FAIL and that the Dems would get blamed for.
I’d rather come back in ten or fifteen years with the following argument: “In 1994 Bill and Hillary Clinton told you the system was in crisis and headed for collapse. For rank, ephemeral, partisan advantage, the Republicans lied in opposition to Reform and you, the American citizenry, believed the Republicans. In 2010 Obama, Pelosi and Reid told you the system was in crisis and headed for collapse. For rank, ephemeral, partisan advantage, the Republicans lied in opposition to Reform and you, the American people, believed the Republicans.
“Now the system HAS collapsed. Who do you believe now? The Republicans or your own lying eyes?”
In response to another comment. See in context »Why are we even talking about health care…..americans need jobs…and obama would destroy every job in the private health care insurance industry…does that make sense?
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