Last night a Senate vote cleared the way for a debate of the health care bill before the whole Senate. Sometimes writing in this blog is a good excuse to try to research the issues of the day and educate myself, and right now there is no bigger issue than health care reform. This is a complex issue to say the least. You have the uninsured, you have the ever-increasing costs of the whole health care system, you have the insurance companies, you have the doctors, you have the patients, you have the lawyers, and on and on and on. And then you have the bill before the Senate, which is over 2,000 pages long. Um, yeah, as much as I like to research this, I have no desire to read a 2,000+ page document. (Heck, have you ever read legislative documents? If you have, you know why I really have no desire to even read a 2 page legislative document! Actually, I have heard the criticism to the effect that legislators shouldn’t vote on things they haven’t even read. That’s really a straw man though. Truth be told, legislators never read the bills that they vote on. They really aren’t readable in that format, as they are so full of references to other documents and laws that are only reference by number that any attempts to do so would take forever. It wouldn’t be efficient at all. This is why legislators have staffs.)
So instead of discussing the whole bill and its merits, it is a bit easier to discuss just some of the high points:
The Public Option:
The public option is simply a government-run insurance provider that would compete against current private providers. The concern here is that the government plan would have an unfair advantage, since government also control the rules of the game. This may be a valid concern. However, it is not unprecedented to have government ran entities compete in the private market. In many states, the state government offer worker’s comp insurance that competes against that provided in the private market. Outside the insurance market, the U.S. mail competes against private delivers such as Federal Express and UPS. So this type of thing can be done.
This would mean that individuals would be required to purchased health insurance. This does seem a bit anti-freedom. If you don’t want to pay for health insurance, shouldn’t you have the option not to buy any? That said, this isn’t unprecedented either. States mandate that each of us buy automobile liability insurance. Furthermore, there is a reason this has to be, because of another provision of the reform.
No Exclusions For Pre-existing Conditions:
Of course we all know that currently insurers can deny coverage for certain things based on pre-existing conditions. The reform wouldn’t allow insurers to do this any longer. This is why the individual mandate is required. You can’t have one without the other. Otherwise you all but guarantee what is called adverse selection. What this basically means is that if given the option, people would not buy health insurance until they are actually sick or injured. The concept of health insurance only works if there are healthy people paying premiums to help subsidize the costs of those who require payments for their health care. If you don’t have that, there isn’t really a point to having insurance. So everyone has to understand that this is the cost of no denials for pre-existing conditions, we all have to pay up! (Actually, I am just reading a summary of the Senate version of the bill, and it appears in that version, insurers would be able to continue to deny coverage based on pre-existing conditions. Individuals denied for this reason would be referred to a national high-risk poop program until 2014 when the insurance exchange, which would include the public option, would become available.)
This really goes hand-in-hand with the individual mandate. If we are going to force individuals to purchase health insurance, then it needs to be as available as possible. So this mandate would state that employers must either provide health insurance or pay a penalty. Once again, this seems anti-freedom. But the fear here is that if you have a public option, employers will just start dropping their own plans and start encouraging employees to enroll in the public option. This penalty should discourage that.
Yeah, I think I am just more confused. Naturally, there’s a lot more to it than this. We apparently have an issue involving abortion and whether federal dollars will be allowed to cover those, which is pure politics (which actually is a reasonable concern for the public option, because politics may trump reason when it comes to what is covered and what is not). And the Senate version doesn’t match the House version, so who knows what will actually come out in the final version of the bill, or even if this actually passes.
I do think we can do better than our current system. What I do not know is if what we ultimately get here will be better. I am concerned that I don’t see a lot that appears to actually cut the costs of health care, so it just becomes more of a shell game of who pays the costs. My fear here is that Obama has stuck his neck out so far to get something, anything, passed in the name of health care reform that what ends up getting passed will at best be meaningless because it may be so gutted and at worse actually do more harm than good because it is full of half-arsed provisions.
I think I said this in my other health care post, but we may be better off going to single-payer and just getting it over with. I am not sure all the necessary ingredients that are required for a free market to work are there in the health care market. At the very least, I think whether or not the free market can work should be discussed. This is where I think the political system fails us. What will get passed will be far more about political considerations than about what is best for our society based on a discussion between knowledgeable (which obviously doesn’t include me!) parties. And that’s the real shame.