Matt Yglesias

27 Responses to “Health Care Bills Comparison Table”

1. Don Williams Says:
   June 19th, 2009 at 4:52 pm

   I think they need to work on the medical privacy issue:
   —————-

   “Maryland State Police airlifted the 27-year-old woman to Prince George’s County Hospital Center early Sunday morning after she was injured in an incident involving a sex toy attached to a saber saw blade, TheBayNet.com first reported.

   The man who called 911 about the incident admitted attaching the sex toy to the saw and then using the high-powered, homemade device on his partner, according to the St. Mary’s County Sheriff’s Office.

   The saw cut through the plastic toy and wounded the woman, according to TheBayNet.com. The injuries were severe enough for medevac, but the woman was released from the hospital Monday and is recovering from her unusual injuries.

   Investigators talked to the woman, who told them she suffered the injuries during a consensual act and that she and her partner were trying something new and no crime was committed, the sheriff’s office said.”
   ————
   Oh well –at least they weren’t regulating the financial industry.

2. Njorl Says:
   June 19th, 2009 at 4:55 pm

   There’s been a certain amount of panic this week about the politics of health reform, but we can see here that the process continues to move forward. Even the relatively timid Finance bill would do a lot to improve the lives of tens of millions of Americans.

   The finance bill might do some good in the short run, but the political damage it would cause in the near future makes it a net negative.

3. joejoejoe Says:
   June 19th, 2009 at 4:59 pm

   The final bill is going to resemble the House bill and is going to be passed under reconciliation and all the ink spilled on what Max Baucus thinks and the inner workings of the almighty Senate is going to be, in hindsight, a giant waste of fucking time. The stuffy asshats in the Senate are going to get rolled by Speaker Pelosi, President Obama, and the people. For once.

   And the cooling saucer can go Cheney themselves with their horseshit internal rules. It’s easier to move from fry cook to management at McDonald’s than it is to pass a bill with a popular majority in the Senate and that’s just fucked.

4. StevenAttewell Says:
   June 19th, 2009 at 5:02 pm

   Joe^3: I hope you’re right.

   One thing that does pop into view is that the HELP bill (although they need to get their damn act together and get a complete bill scored) and the House bill are virtually identical, and that the Finance bill is pretty close – with the significant omissions of the public plan and the employer mandate. My guess is that when you get through the melding of the two Senate bills and the reonciliation process between the House and Senate versions that we’ll wind up somewhere in between, which should leave us in a good place.

5. fostert Says:
   June 19th, 2009 at 5:06 pm

   That’s the scariest chart I’ve seen in a while. Looks the individual mandate I oppose is now a sure thing. But nothing about pre-existing conditions, which are completely off everyone’s radars. And if it’s off the radars, it won’t end up in any of these bills. So, I’ll have to buy insurance, but the insurance company won’t be required to provide any coverage. For me, doing nothing is better than any of these plans. I pay 100% of my costs now. With these plans, I pay 100% and have to pay insurance premiums on top of that.

6. Carlos Says:
   June 19th, 2009 at 5:20 pm

   Don’t worry fostert, pre-existing conditions are mentioned: those actuarial ratios mean that they can’t jack up the price on you if you’re sick, they can just charge you more if you’re older. Everyone, from the House to the Senate to the insurance industry, is onboard with eliminating this aspect of the American system, which if you ask me is the most disgusting thing about our healthcare system today (if you told me a year ago we could get rid of this abuse, I would have taken any reform plan you offered).
   Now, the insurance industry might just be talking the talk and attempt to continue their practices under the radar. If you’re really concerned about discrimination against pre-existing conditions, you might be someone who really supports a public plan, because the government will not have incentives to cheat those rules.

7. Carlos Says:
   June 19th, 2009 at 5:22 pm

   To be more clear, pre-existing conditons are covered under the row of the table marked “Insurance Regs.” As a physician, this is a huge victory for me, and the part of the plan most worth fighting for (I’m thrilled its not even controversial). Even the much-maligned AMA has made this their key plank for reform.

8. StevenAttewell Says:
   June 19th, 2009 at 5:48 pm

   Just to chime in with Carlos:

   Banning discrimination in offering coverage and rates on the basis of pre-existing conditions is in the HELP bill and the House Bill – I’ve read them, it’s in there. It just didn’t make it onto the chart.

9. Brian Says:
   June 19th, 2009 at 5:49 pm

   Could someone fill me in on the meaning of the ratios that follow the term “modified community rating”? What’s the difference between 2:1 and 7.5:1?

10. JonF Says:
    June 19th, 2009 at 6:07 pm

    Re: But nothing about pre-existing conditions, which are completely off everyone’s radars.

    Look in the portion titled “Insurance Regs”. Prexisting conditions are not mentioned by name, but the three things that are (guaranteed issue, community rating and a ban on recissions) mean that insurance companies could not deny policies or jack up the premiums to unaffordable levels nor cancel them retroactively on people with preexisting conditions. Basically, just what you (and every other sane person) want.

11. fostert Says:
    June 19th, 2009 at 7:17 pm

    “Look in the portion titled “Insurance Regs”.”

    Okay, this looks better than I thought, but what I see is “no rescissions.” That a very good start, but it applies to those who already have insurance. But if you’re trying to get into the market, what is there to prevent an insurance company from offering a policy that simply doesn’t cover certain treatments. I’ve faced two issues in trying to get insurance. Most companies won’t even offer a policy, and that appears to be dealt with in the current plans. Great. But the few insurance companies that will offer me a plan will exempt certain services from the coverage (specifically spinal injuries and neurological problems). They still give me “coverage,” but not the coverage I specifically need. And that’s the kind of detail that is critical to me. There doesn’t seem to be anything that says an insurance company must cover EVERY treatment. They have to offer a policy, but does that policy cover EVERYTHING, or just MOST things? If it’s most things, I’ll guarantee that what I need won’t fall into the ‘most’ category. My concern is that some important words are missing from this discussion. We talk about ‘coverage’ when we should be talking about “full coverage.” My other concern is that anything can happen to a bill when it goes to conference. What will get removed from these proposals then? I know this, insurance surely do not want to cover me. If they can avoid it, they will. They never paid for anything when I did have insurance.

12. Steve LaBonne Says:
    June 19th, 2009 at 7:51 pm

    I found this quote from a story in today’s Chicago Tribune quite interesting:

    The best way for the industry to preserve the private insurance market — and derail the campaign for a single-payer system — may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.”If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected,” he said.

    We’re being sold a bill of goods- a bailout for the ailing health insurance industry, not reform. I say let ALL versions of this bill die and see if Miles’s prediction is on the mark.

13. deniseb Says:
    June 19th, 2009 at 9:03 pm

    Brian,

    Community rating at 7.5:1 means they can use demographic information like age & sex in determining rates, and the highest rate can be up to 7.5 times the lowest. That sounds outrageously high to me.

14. Steve Says:
    June 19th, 2009 at 9:28 pm

    If they mandate that all are required have health insurance but don’t do anything to make it substantially cheaper and don’t give people an out if they believe they can’t afford it (not if the government decides that they can’t) I imagine a large number of people will simply revolt in some way.

15. Bob Knisely Says:
    June 19th, 2009 at 10:36 pm

    Three points about “health care reform”:

    First, no one is talking about how many Americans are ALREADY on Federal health care, with the government as payer. These would include ALL US military and their families, ALL retired US military and their families, ALL federal employees and their families, active and retired whether Executive, Legislative, or Judicial branches, ALL Medicare and Medicaid recipients, ALL Federal prisoners.

    Toss in ALL state and local government employees, and it’s a heck of a large number. NO ONE IS TOTALLING THIS CROWD!

    If you put the UNINSURED on ONE side, and the GOVERNMENTALLY INSURED on the other, who’s left? Let’s see the numbers!

    Second, the President has already endorsed the Federal Direct Student Loan Program, originated and operated by civil servants in the Department of Education. This is because it’s simpler, cheaper, and probably fairer. The parallels with single payer health insurance are PALPABLE, but NO ONE is talking about them. Why not?

    Third, and very important, SENATORS AND CONGRESSMEN receive VERY GENEROUS health care benefits, and are not taxed for them, and they’re paid for BY THE GOVERNMENT, and WHO ARE THEY to deny similar benefits to others? Are they THAT MUCH BETTER THAN WE ARE?? SHOW THE DETAILS!

    It is important to keep mentioning all three points, especially the last, because we need to open the OVERTON WINDOW to a wider public discussion! Check it out! Get with it!!

16. StevenAttewell Says:
    June 19th, 2009 at 11:27 pm

    Steve:
    They are making it cheaper in several ways: community rating, guaranteed issue, and mandated % spent on care will lower premiums directly. Then the subsidy (see poverty line here) will bring premiums down for all individuals making from 133-500% (depending on which version) of the poverty line.

    An individual making as much as $54k a year, or a family of 4 making as much as $110k a year would receive a premium subsidy (although probably a rather small one, given that they’d be at the top end of the scale). For an individual making around $14k a year, or a family of four making $30k a year, the subsidy would be virtually 100%, or they’d be automatically eligible for Medicaid.

    Bob:
    Approximately 83 million people are on government health insurance, 177.4 million people are covered by employer-based health insurance, 25 million people have individual private health insurance, and about 45-50 million people have no insurance. (see here)

    That’s the politically tricky bit – the traditional employer-based system is falling apart, but it’s still got a massive inertia.

    Re: student loans, because the number of people who are involved with the private student loan business is quite small, it’s a minority of banks. The number of people who have vested interests in the private health insurance business is larger by several degrees of magnitude.

    Re: Federal health care, show what details? Yes, it’s true, they get health care from the govt (although technically it’s a bulk purchasing deal through a variety of plans, but whatever).

17. DTM Says:
    June 20th, 2009 at 1:52 am

    So a small sidenote:

    My understanding is that the HELP bill still doesn’t have the public option filled in for the following reason. Hagan and Bingaman wanted to water it down into the Conrad co-op plan. But Sanders then refused to go along. Some people are concerned because this means the details of the public option may have to be added to the HELP bill as an amendment. But I would suggest the bigger picture is that as long as people like Sanders keep playing hardball, something like the House version of the public option is the likely outcome, at the worst in the fall when it reverts to budget reconciliation.

18. fostert Says:
    June 20th, 2009 at 5:16 am

    So what is that community rating of 7.5? Sounds to me that they can charge me 7.5 times times normal cost. A normal cost would be around $12k. Multiply that by 7.5 and and it’s about what I make. Okay, less, but it’s still way out of line. So after my taxes, I have to come up with $86K a year? I’ll be in in jail and you will pay my medical costs before I do that. If you let them charge me that, I will go to jail just to spite you. Look, I have freak situation where a simple slip can be devastating. If it results in my death, then it’s simple and doesn’t cost much money. But if it results in me not being able to move any limbs, it becomes a very expensive prospect. And I’m sure you want to pay for it (yeah, right). But I have a solution. As for now, I have enough heroin to kill myself. And I have someone who will inject in into me. So tell me why I need insurance. I’ve already paid for what I need. You want me to pay more?

19. fostert Says:
    June 20th, 2009 at 6:18 am

    I suffer now from some disease that Western doctors can’t diagnose. The Eastern ones probably can. Not because they are better, just because it’s their diseases. A doctor in Iowa ain’t gonna know much about Dengue Fever. But he can produce the same result. There really isn’t anything you can do about it anyway. And it correlates very well with nervous system problems. Which I have. And they will get worse. Want to insure me? Oh, and by the way, my spinal cord has an inch jog at the C-4 vertebra. Not a single doctor who has seen my X-ray has not been completely shocked. It’s not that they hadn’t seen it before, it’s just that those people didn’t walk. And I do. But those X-Rays have been legally admitted as evidence in a case that was settled quickly. But they are public record and I can’t lie about them. Anyone who saw those X-rays would surely not want to insure that person. And then there’s the bee issue. I don’t have a normal allergy, I have something that no doctor can explain. I had to take the RAST test five times in three different hospitals. The results were described as anomalies. You don’t even want to know the numbers, you wouldn’t believe them anyway. No doctors did, and they did the tests. Want to insure me now?

    I barely want to insure myself. And I don’t, really. I keep some money around in case I break a leg or something.

20. fostert Says:
    June 20th, 2009 at 6:34 am

    Oh, and I fractured my skull twice. So think about this, I can’t hide all my records. If I could just hide some of them, I’d still have too much to hide. And there’s enough to find easily that any investigator would dig deeper. I’ve had way too many medical instances to hide anything. Well, I still can hide what might have happened elsewhere. What happens in Vegas doesn’t always stay in Vegas, does it? Ensign has learned that. But what happens in Thailand really does stay there. The Bush’s know that.

21. fostert Says:
    June 20th, 2009 at 6:51 am

    “I can’t hide all my records.”

    Your records are in your bones anyway. Although those aren’t easily accessible when you’re alive. But when you’re dead, everything is fair game. And we do it.

22. Steve LaBonne Says:
    June 20th, 2009 at 9:56 am

    That’s the politically tricky bit – the traditional employer-based system is falling apart, but it’s still got a massive inertia.

    That’s why it may be best to just let it finish falling apart, instead of making a very expensive but in the long run futile effort to shore it up and dishonestly calling that “reform”.

23. Tim H Says:
    June 20th, 2009 at 11:16 am

    I haven’t been following this very closely, so the chart is a great help. So what plan did the CBO score? Do they need a fourth column for that? What were the differences. Many thanks to anyone that can answer.

24. StevenAttewell Says:
    June 20th, 2009 at 11:56 am

    Fostert: we don’t know what 7.5 means; I’d hold off until then.

    Tim H: basically, the CBO scored the HELP bill on the left, but crucially without the employer mandate or the public plan, which no doubt had a big impact on the overall cost and the number of people insured – employer pay-or-play raises a lot of revenue, hence more budget neutral, and a lot of people are expected to migrate over to the public plan.

    It was a mistake by Dodd and whoever the staffers were who let the incomplete bill get scored – they should have either included those elements or waited to score.

25. StevenAttewell Says:
    June 20th, 2009 at 12:04 pm

    Fostert: checked it out. “adjusted community rating with rate variation capped at 7.5:1.”

    However, the bill (Finance version) bans “health status rating.” So I’m not entirely sure what the upshot is.

    I guess my advice would be, fight like hell for the public plan.

26. JonF Says:
    June 20th, 2009 at 3:55 pm

    Re: That’s why it may be best to just let it finish falling apart, instead of making a very expensive but in the long run futile effort to shore it up and dishonestly calling that “reform”.

    You’re making a ontradictory argument, assuming both that the private insurance system will and won’t fall apart. But with this reform in place, if the private insurance system does fall apart you’ve already got something there (I am assuming a public plan in this argument) to take its place and evolve into true national healthcare. Where’s the problem?

27. senilicide Says:
    June 22nd, 2009 at 4:52 am

    Yes healthcare reform is all about taking care of dipshits like fostert who have a host of medical problems and are being screwed by the current system but can’t be bothered to learn anything about the pending proposals