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Where Are Reform's Beneficiaries?

"The main constituency for health reform consists of people who don’t think the present system is fundamentally sound," writes Matt Yglesias. "That’s a big part of the reason the public plan element of Obama’s proposals has become such an emotional touchstone for the left. The public plan is a fairly modest part of a fairly modest package of reforms, but it’s the slice of the package that holds out the prospect of eventual transformation of the system into something quite different and less driven by corporate profits."

That's a smart point: The primary constituency for health-care reform has a political attachment to it, and in particular, to the public option portion of it. This is not, however, the most obvious constituency for health-care reform. That honor goes to the uninsured, the underinsured, the unemployed and others lower on the income ladder who are likely to directly benefit from the bill, rather than abstractly benefit from seeing their ideological preferences included in the bill.

They, however, are not in the streets or at the town halls. Broadly speaking, they're politically marginalized: They don't vote or march or yell. They don't believe the political system is really responsive to them — which may be because it's not (pdf). Which of course means the political system is even less responsive to them, as no politicians fear the uninsured because the uninsured don't vote.

By Ezra Klein  |  August 24, 2009; 5:06 PM ET
Categories:  Health Reform  
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Comments

Health Reform's beneficiaries:

http://www.latimes.com/news/nationworld/nation/healthcare/la-na-healthcare-insurers24-2009aug24,0,6925890.story

Big Health.

Put the Pom Poms away, Ezra. It's nice coverage is being extended. It's not nice that it's going to be a boon to Big Health adding another trillon to its coffers. It frankly would be nice if you were covering it a little harder.

John

Posted by: toshiaki | August 24, 2009 6:09 PM | Report abuse

Do you really believe that those who are marginalized will cheer when they discover a mandate exists that they buy health coverage? Will these people be eager to discover what new forms need to be filled out and what items need to be verified so they may see if they qualify for a subsidy? Will they cheer this new bit of bureaucracy that is being thrown at them as political cover so that Barak Obama can state that our citizens finally have universal coverage? As Stanley Fish would say, think again.

Posted by: goadri | August 24, 2009 7:23 PM | Report abuse

Health Reform's beneficiaries:

http://www.latimes.com/news/nationworld/nation/healthcare/la-na-healthcare-insurers24-2009aug24,0,6925890.story

Big Health.

Put the Pom Poms away, Ezra. It's nice coverage is being extended. It's not nice that it's going to be a boon to Big Health adding another trillon to its coffers. It frankly would be nice if you were covering it a little harder.

John

Posted by: toshiaki | August 24, 2009 6:09 PM | Report abuse


you see I don't buy this for several reasons. First off there's an end to pre-ex so now they have to cover those that weren't covered before. Secondly they have the $170+ billion being "taken away" from Medicare Advantage (which btw, i think should be taken away).

And most importantly every bit of reform shows a required 85% medical loss ratio so they can't just raise rates to make a profit.

Who wrote that article becuase they really have no clue what's going on or even what's in the proposed legislation.

Posted by: visionbrkr | August 25, 2009 12:14 AM | Report abuse

@visionbrkr-

Insurance companies *lobbied* for an end to pre-ex. It will save them billions in underwriting costs. The individual manadate not only makes this possible, it guarantees millions of new paying customers.

An 85% MLR won't be hard to achieve with millions of new customers and no underwriting costs. In fact many companies had MLRs above 85% until fairly recently (suspicious, huh?)

The loss of Medicare Advantage subsidies will hurt, but it's such a blatant taxpayer rip-off that no one seriously thought it would last forever.

Posted by: bmull | August 25, 2009 6:05 AM | Report abuse

BTW I'm uninsured and I do vote. (I still feel politically marginalized however.)

Posted by: bmull | August 25, 2009 6:21 AM | Report abuse

bmull,

I agree with your points but I'll also give as an example my state of NJ and another example of MA.

NJ has guaranteed issue, no individual mandate but mandates for coverage galore. Its a liberal's paradise! Oh and we're required to have an 80% loss ratio and this past year it was 85%. I agree that some national carriers can actuarily adjust this number but that's the benefit of making it 85% nationwide that you won't have those regional adjustments and make it a more even playing field.

Mass. has all the same as NJ but also an individual mandate and costs are still going up but not as much as NJ.


To that end I think that it will be difficult to ascertain exactly if insurers will benefit or not from the current reforms and to say that they'll receive a financial windfall is wrong. None of us knows and while they will lose underwriting to a certain extent other costs will absolutely fill the vacuum and while some insurers are at 85% in some states in many other states they're at much lower numbers. To me an 85% loss ratio is more than fair. What other industry are companies told by the government what level of profit if any can be made? I will agree that profit in healthcare should be limited because what the product is but it still rubs many people the wrong way which is why you're hearing such screaming going on in the town halls. At least the screaming that's not contrived.

I hope reforms do pass so that those of you without healthcare can get it. And don't feel bad, we all feel somewhat politically marginalized with so many differing viewpoints.

Posted by: visionbrkr | August 25, 2009 10:26 AM | Report abuse

This posting convinced me to try to write something about why the public option will do nothing for poor people:
http://www.dailykos.com/story/2009/8/25/145637/435?new=true

The thing I did not mention is how this seems to connect to liberals' long term problem interpreting polling data. Back in early 2008 I sat through a couple presentations about how important it is to frame healthcare reform as a middle class issue. Advocates and Democrats seem to have internalized this bit of polling data to the point that they do not even use the word "poverty" when talking about healthcare reform.

From my perspective, this omission is a classic example of taking a truth and turning it into a lie. You cannot make the moral argument for healthcare reform without mentioning poverty. Without making the moral argument you are left with abstractions about "bending the curve" and arguments about what "more choice" means.

Posted by: BillTibbitts | August 25, 2009 3:37 PM | Report abuse

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