Thursday, September 10, 2009

Obama's health insurance reform speech

The text here. Remembering the emotion of last year's squabbles between Democratic primary candidates on health care reform, it is notable that the current plan appears to be candidate Obama's insurance exchange plus Obama's subsidies for the poor plus Clinton's insurance mandates, with Edwards' method of enforcement. This is all, of course, leaving aside candidate Kucinich's health plan, Medicare for all, which is still the best plan, but that doesn't really matter at this point.

Judging from the president's words last night, it's pretty clear that the public option he envisions is an anemic thing, capable of providing care but not of providing it well enough to compete for customers who can afford to go elsewhere. That is a shame, and the Reaganites who believe government only works when it redistributes wealth upward will make some serious political hay out of it down the road. I know that sounds like politics rather than policy discussion, but it is in policy where we will pay dearly for this compromise.

Also, we heard it officially tonight: the president's plan will mandate that people purchase private health insurance, and use subsidies to help the poor afford it -- in other words, tax revenue funneled directly into the pockets of Wall Street health insurance investors. Free money for the bad actors who caused much of this mess in the first place. I still don't get this compromise. If you want to achieve universal coverage, why not just create a public option and sign everyone up for it? Then set it up so that the fees and services for the public option begin next year, and add a form to this year's taxes whereby people find out how much they owe for the public option, or can check a box to decline the option if they provide their alternative policy. No policy, no checking the box. No need for fines or other enforcement mechanisms than the IRS' current policies and staff. Universal coverage. Easy peasy.

How is forcing people to pay private insurance premiums preferable from either a political or policy standpoint?

On the other hand, there is this:
Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse.

It doesn't deal with the issues of millions of uninsured people, obscenely high malpractice insurance premiums, or of various other problems in the health care industry, and will only be as good as the organization charged with enforcing it, but this paragraph alone probably makes the bill worth signing. If the Democrats can't get a workable universal coverage/universal access bill out of the Senate, it would be worth their time to create a separate bill with these provisions alone to put an end to the most barbaric abuses in the system. I'm tempted to say I would prefer that even to universal coverage provided in the rest of the plan.

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