Brian Beutler of TPMDC has the details of what is supposed to be the grand compromise that will allow Harry Reid to pass a health care reform bill through the Senate at the 60 vote threshold. Beutler’s report is more detailed and somewhat contradicts what Dana Bash is reporting for CNN. According to Bash, the public option was jettisoned in favor of expanding Medicare to people aged 55 and creating an option for people to buy into the Federal Employees Health Benefits Plan. But Beutler reports that the public option is still alive in trigger form.
As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would [be] offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.
Now, why would for-profit private insurance companies create non-profit nationally-based plans? Would they do that purely to avoid triggering a public option? I suppose that that might make some kind of business sense, but it’s pretty convoluted.
Here’s the Medicare part of it.
That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.
This means that you can pay into a single-payer plan, which might be some sort of moral victory but doesn’t seem to make a lot of policy-sense either. And it doesn’t do much for people who are too old to stay on their parents’ plans and not yet fifty-five. We’re still going to be screwing people in their peek earning years (the group that is most tax-averse and most conservative).
There was some talk of expanding Medicaid to people earning up to 150% of the poverty rate. That is what the House bill calls for. But the deal allegedly keeps that rate at 133%.
Harry Reid thinks he has 60 votes for this deal, pending Congressional Budget Office (CBO) scoring of the Medicare expansion. I don’t know if that means Olympia Snowe will look favorably on the trigger or Ben Nelson will back down on his abortion threat. But it looks like something will pass the Senate before Christmas. And then the House will get involved again. Each house of Congress will meet to merge their two versions into one final conference report. And that will be the bill both houses have to pass to get a bill to the president’s desk.
It’s too early to say whether the bill will be good at expanding access to affordable health care or help the budget deficit. But it will be a very good bill for health insurance reform. And that is something.
I’m liking it a whole lot! In fact, I think it will have a better chance of being really good for a lot more people than any version of the public option.
Here’s Ezra Klein’s considered favorable early review of what he suspects it will be:
http://voices.washingtonpost.com/ezra-klein/
My only issue is that I wish it would all be effective the day the President signs it.
The devil is in the details. It’s too early to guess how this will all come together and what it will mean.
I see the public sector mandate, and people forced to pay lots more for poor coverage, even those who are already covered (and rates will rise as pre-existing conditions are factored out of the equation.)
What I’m not seeing in these proposals are cost control mechanisms, and I don’t believe there is a market mechanism that will accomplish this effectively. I don’t see how this can be done as long as those with the whip hand in all this are asking for profit growth. Nudging the market is, at best, only a temporary patch, anyway.
And let’s be clear on this, medicare isn’t a single-payer system. It’s just one more insurance program in the constellation. A national health system is the only thing that can be called single-payer.
The market mechanism is to make the cost so high you can’t afford it. Then you won’t buy. The problem with debating costs is that costs have two meanings. One meaning is the total expenditures. That is what the Senate and the insurance companies use. So less service equals lower costs. The other meaning is unit costs, i.e. how much does each test, office visit, drug, or operation cost. That is what most of us think of as costs. In fact, most of us only care about out-of-pocket cost. For cost as total expenditures to drop, there are only two mechanisms. The unit cost can drop, but there are powerful forces such as the AMA, Eli Lilly, et cetera, against that approach. Or unit volume can drop. That is accomplished by pricing more people out of the market.
Booman,
Assuming, as you say, the Senate might pass their version before Christmas, is it realistic that Obama would have a bill to sign before the New Year? If not, what would be your guess as to when he would get it?
Definitely not before the New Year.
I don’t know the schedule for the holiday recess, but it would be a couple of weeks after the reconvene.
My bet, once we passed the August break threshold, was that we would see something on the President’s desk before the State of the Union address. That prediction looks like it will play out if this reporting is true.
Keep on failing, Democrats. It’s expected by now.
Why would the Medicare buy-in be expensive before subsidies? That makes no sense.
I’m with Kevin Drum when it comes to this:
http://motherjones.com/kevin-drum/2009/12/public-option-finale
However, I’m waiting for more details on the Medicare buy-in. If it’s what Conrad wants, I am against reform and I believe it should be filibustered. If you can actually buy into the real Medicare-pool, and if they use Medicare payment rates, I can get behind the reform on the whole.
Because the 55-64 demographic is the single most expensive demographic to cover in the private insurance market, so putting them on a public plan without subsidies and with real premiums would make them the most actuarily costly plans possible.
Why would they be discriminated by age, though? Wouldn’t they just join the entire pool of 65+? Or would they form their own pool, on a “level-playing field” with negotiated rates rather than Medicare rates like Conrad wants?
They would literally buy-in to Medicare, meaning that they would pay premiums based on their actuarial risk. Medicare recipients have paid in over their careers and have no premiums. The cost of their care is hidden from view.
/meaning that they would pay premiums based on their actuarial risk./
I was assuming that they would not be paying based on actuarial risk.
I was assuming that it would be like a pool where they wouldn’t see their individual costs, just a premium that they’d all pay. Basically, one premium price for all…no discrimination based on health/age, etc.
The beginning of the end of Medicare. Next the 80+ will be charged extra.
So have the 55+ crowd. Most have paid for 33 to 37 years. One big pool makes more sense, assuming you actually want to craft a healthcare plan and not drown Medicare in the bathtub.
True, but it still should be much cheaper than the same people buying insurance on the individual market (and more reliable coverage), and cheaper than through an employer if the employer’s costs are included. If it’s a market at all, 55 yr olds will pay more than 25 yr olds.
What concerns me is how it plays into the Republican’s long-run generational warfare play. The boomers get this all at once, most of Gen X not for several years. I can hear the whining now. And many liberals fall for this, though less, at least in the blogosphere, than a few years ago. Maybe people have learned.
I can think a few reasons other than the threat of a trigger. But they depend on who is eligible to buy into this exchange within an exchange. To be in an exchange as the bills are currently written, you essentially have to be in the individual market; to be in the nonprofit exchange within an exchange, you might have to be subsidized.
The incentive for insurance companies to create a non-profit plan has to do with the fact that all of the people in the exchange are new customers who are being subsidized with government funds (a portion of the 40 million or so without insurance). What this plan does is reduce costs to the government without necessarily reducing premiums of people outside of the exchanges. Look for employer-based premiums to rise fairly rapidly if this is enacted.
It looks more and more like healthcare reform is going to shape up as one of the major issues in 2010, and if played well might put Republicans on the defensive for their “party of No” strategy.
But that will require that Democrats state flat out that this bill is a first baby step but not the complete reform that is needed and point out the likely effects on the premiums of everyone outside the exchanges.
The way the Medicare extension is shaping up, only a few people in the 55-64 age group would be able to afford the full cost of Medicare premiums (estimated to be slightly over $500 a month).
when one is dying of thirst, even a bucket of piss is palatable.
if you think voters are gonna look at this pile of shit and say “oh look, the democrats delivered”. you are outta your mind.
Yep, and if we don’t crank up the narrative that the fight for healthcare reform, especially to premium costs, is not over, the teabaggers will take that anger and drive us off a cliff.
well, good luck with that one.
personally, i think progressives should find some common cause with the more working class teabaggers, those who despise both the republicans and the democrats (ie, not the palin people or the birthers).
and then work together to primary the fuck out of both parties.
Unfortunately for your idea, progressives plus the few teabaggers who are really fed up with both parties do not constitute a majority even in so-called blue states.
And to primary somebody requires having a credible candidate and an organization that can turn out hundreds of thousands of folks to vote.
There are a few progressive candidates primarying Democrats who might be able to win the general election. But there are no independent teabaggers primarying Republicans; those primary candidates are being sponsored by the corporate Club for Growth.
And to build a 50-state organization from scratch that can turn out large numbers takes more than a couple of years. Even working within the party, it took movement conservatives sixteen years to elect someone (Reagan) who was not triangulating. And thirty years to get a majority in Congress. And thirty-eight years to have a president and both houses of Congress. And twenty-four years to stack the Supreme Court.
i know all that. it’s fantasy, i admit.
to be honest, i don’t even see the purpose in participating anymore. my old man is convinced, and i grow more and more convicned everyday, that we’re on the same path as the USSR in the days before collapse.
your vote doesn’t really matter all that much. money matters, and that’s about it.
Letting people into Medicare little by little is probably a better approach than creating a whole new program. It is creeping medicare for all, so I don’t think it will survive. We will accept this, then it will be taken away to satisfy Joe Lieberman or some other rotten bastard.
I think the naysayers are just pissed because “their idea of reform” i.e. the public option, is replaced by a better idea – something that MORE people will benefit from. It’s just not their idea. What’s wrong with more people getting better healthcare and lower premiums?? Howard Dean supports this and stated on CBS that “this is probably what should have been done from the beginning”.
The only reason I consider myself Independent and not a Democrat is because as a whole too many Democrats, IMHO act like “Eyeores”, about any legislation that doesn’t pass their “liberal purity” test. The negativity about any potential idea that might appeal to a broad group of people (and not just themselves) is stunning.
Granted we don’t know the details yet, but it might just turn out a lot better than the public option would have EVER – even in 2014.