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The other health-care reform option

My preference is that House Democrats pass the Senate bill and then run their fixes through the reconciliation process. But I think there is an argument that the current health-care bill has been terribly compromised by the months of controversy, the shady deal with Ben Nelson, the ambivalence of key legislators, the endless meetings with industry players, the wasted time, and the collective freak-out of congressional Democrats in the aftermath of Scott Brown's election.

There is another option.

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar. Medicare buy-in had more than 51 votes as recently as a month ago. The Medicaid change is simply a larger version of what's already passed both chambers. This bill would be shorter than a Danielle Steel novel. It could take effect before the 2012 election.

If health-care reform that preserves the private market is too complex and requires too many dirty deals with the existing industries, then cut both out. But get it done. Democrats have a couple of different options for passing health-care reform this year. But not passing health-care reform should not be seen as one of them.

By Ezra Klein  |  January 20, 2010; 1:32 PM ET
Categories:  Health Reform  
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Comments

How's that help me if I'm 42 and my kid has a pre-existing condition, or if I'm 28 and get cancer and my insurance wants to drop me?

Posted by: twcunningham | January 20, 2010 1:35 PM | Report abuse

Good point. Elimination of pre-existing condition restrictions is extremely popular. The bill would still be short and sweet.

Posted by: cnic | January 20, 2010 1:40 PM | Report abuse

"How's that help me if I'm 42 and my kid has a pre-existing condition, or if I'm 28 and get cancer and my insurance wants to drop me?"

It probably doesn't...but to do that you have to deal with the devil (in the form of, you know, legislating with all of its attendant and messy compromises) and Americans don't appear to like that very much [see, for instance, the book Stealth Democracy - http://books.google.com/books?id=roOhDUnlulsC&dq=stealth+democracy&source=gbs_navlinks_s]

Posted by: y2josh_us | January 20, 2010 1:42 PM | Report abuse

It doesn't - you just pay until you are broke and eligible for Medicaid.

But seriously, I think Ezra is right in that the mood of the taxpayer/voter is fairly dark right now and nobody is real interested in entertaining the antics of Aetna Senator Lieberman or any of the other con artists that have made such a shambles of a once-noble goal.

Posted by: luko | January 20, 2010 1:43 PM | Report abuse

It doesn't. And it's not my first choice. But it helps a lot of people.

Posted by: Ezra Klein | January 20, 2010 1:44 PM | Report abuse

Eliminating pre-existing condition restrictions would allow people to game the system by not buying insurance until they are seriously ill. That's why you need a mandate, at which point we're back to complexity.

Posted by: fuse | January 20, 2010 1:46 PM | Report abuse

The key to expanding Medicare is the pricing. How expensive would it be?

Posted by: fuse | January 20, 2010 1:47 PM | Report abuse

I think that the house should pass the senate's bill and then do what Ezra suggests. Best of both worlds. Some changes to the health care bill can be done through reconciliation. The biggest problem is the 50 state exchanges, which can be fixed later. If the current bill doesn't get passed in some form, the dems lose the house and some seats in the senate. No one will even care what is in the bill, as long as it passes and dems can claim a victory.

Posted by: srw3 | January 20, 2010 1:47 PM | Report abuse

Sounds great for coverage, but with the deficit commission and with the GOP obsessed with entitlement spending, a Medicare buy-in and nothing more would not be good. You'd at least need the preexisting condition thing for the politics, and the MedPac for future cost controls...

http://business.theatlantic.com/spending%20GDP.jpg

Posted by: Chris_ | January 20, 2010 1:48 PM | Report abuse

I like this idea. It's like going back to basics. And who in their right mind is going to vote against helping additional seniors get medicare?

As for the pre-existing conditions bill, the cost mechanism is the issue. But I say put it in a bill by itself and push it through. Make ConservaDems and Republicans vote against it and kill it if necessary.

Break this stuff in pieces and then start voting on it. The BIG BILL idea is just not going to work. As much as we'd all like it to.

Posted by: tx-il | January 20, 2010 1:50 PM | Report abuse

Medicare buy-in option, plus Medicaid expansion, plus employer mandate (or option for employer to buy in to Medicare). Employer plans can't have limits or pre-existing condition clauses. That would eliminate a lot of the problems.

Posted by: AuthorEditor | January 20, 2010 1:54 PM | Report abuse

This sounds worthwhile and the right reaction to all the crap that's been happening. You keep it liberal, you keep it simple, you keep it popular. The other stuff (regulations and exchanges and mandates) which is complicated and not so popular, you pass on a bipartisan basis as part of healthcare cost control. Works for me.

Posted by: dhs08 | January 20, 2010 1:55 PM | Report abuse

Still need 60 votes for each vote on reconciliation?

I could be wrong- but maybe that is why Congress is always behind the public!

Byzantine processes of the Senate chamber as a means of holding up reform

Posted by: sasha2008 | January 20, 2010 1:56 PM | Report abuse

"I like this idea. It's like going back to basics. And who in their right mind is going to vote against helping additional seniors get medicare?"

Are you kidding me? You don't think the GOP can't start age-resentment as a tactic? The answer to who in their right mind is going to vote against this is, uh, well, anyone 18-40.

Posted by: twcunningham | January 20, 2010 1:57 PM | Report abuse

This does make some sense although for reasons that I do not understand many Dem politicos seem unwilling to impose the necessary tax on the wealthy even though doing so in this context would be very popular I think and would be an opportunity for everyone to say that the public has been heard. I think the best option is still for the House to pass the Senate bill and then do reconciliation to tweek it through reconciliation in the direction of the discussions that have taken place on the excise tax, et al. Of course, that requires Dem politicos who instead of panicing over a special election in a state that already has universal health insurance lost by a candidate who didnt like meeting actual voters and didnt know her Red Sox and probably would have lost by more votes if not for Dem voters who voted for her only because they wanted to save health care reform, decide that they really are prepared to do that they were elected to do. In any event, Dem leaders and the Prez need to get together and decide for what they have the necessary votes and then announce that is what they are going to do, instead of having more public debate that makes it look like Dems dont know what they are doing. As to preexisting conditions you could always try to pass that as separate legislation with an individual mandate and see if there are 60 votes for that (Sen Snowe?) or at the very least you could I think pass legislation on a strong bipartisan basis that eliminated preexisting exclusions for children. And you might also be able to pass that they cant cancel someone because they get sick as part of that.

Posted by: gregspolitics | January 20, 2010 2:07 PM | Report abuse

Wouldn't all the Medicare stuff sunset after 5 years though?

Posted by: TheDopefish | January 20, 2010 2:08 PM | Report abuse

"The answer to who in their right mind is going to vote against this is, uh, well, anyone 18-40."

You are right, GOP will attempt age-resentment...but it's not going to work. And the good thing is, there are NO Republican Senators who are 18-40. That's the only good thing about having old white men in the Senate. They won't vote against expanding medicare.

Posted by: tx-il | January 20, 2010 2:11 PM | Report abuse

I've wondered why the Democrats didn't take this approach from the get-go, especially given the failure of Clinton's sprawling healthcare reform. This approach makes more sense as a first step, it's a clear first step toward single payer (which I don't really support, but I understand that's a goal) which can be expanded on later. Expand it once, then expand it again--maybe by growing SCHIP.

The problem is, they tried the kit-and-kaboodle approach first. Now, it's going to be hard to scrap it and attempt this more modest approach. The best strategy, almost certainly, but one that, a year ago, would have been guaranteed to succeed. Right now? Not so much. If it can't be put together and passed before the 2010 elections, probably not at all.

Posted by: Kevin_Willis | January 20, 2010 2:11 PM | Report abuse

Absolutely the way to go, except I suspect you would only be able to get Medicaid up to 150% of poverty at least in the first round. Not perfect, obviously, but Medicare buy in at 50+ goes a long way to deal with the preexisitng condition issue, since obviously us geezers are the ones must like to have pre-exisiting conditions. Dems often get themselves tied up in knots with the 'but what about ...' question, trying to craft some solution which will deal with every aspect of the problem, but this solution would do a lot of good and strengthen their hand with folks who are actually more likely to vote in the mid-term elections, the aforesaid geezer crowd.

Posted by: exgovgirl | January 20, 2010 2:11 PM | Report abuse

fuse,

that's a very valid point that folks like Ezra don't even consider. Part B alone for those currently eligible for it costs up to $320 a month. Then there's part A (hospitalization) that SHOULD cost more because if you're 50 you haven't paid as much into it as you would if you're 65. and then there's part D for prescriptions. Oh and the supplement to cover the gaps where Part A and B don't pay.

Oh and we're back to unaffordable and an obscene mess.

But yes at least we wouldn't hear that its 2000+ pages. That's refreshing, no?

Posted by: visionbrkr | January 20, 2010 2:12 PM | Report abuse

Medicaid expansion to 200% of the fpl? You must be kidding. The governor's of the 50 states would revolt against the Obama administration. If you think Massachusetts was bad, think about the uprising around the country when in all the states the Governor and all the state legislators campaigned daily, where they live, against the federal government's medicaid expansion.

It would be a bloodbath for the Democrats in 2010 and 2012!

Posted by: lancediverson | January 20, 2010 2:19 PM | Report abuse

This idea leaves many people screwed - those of us who are self-employed, work for a small business, etc. The individual insurance market is a disaster. If you are over 40 and have ever had anything more than the flu, or have ever taken a prescription medicine, they will not sell you a policy. Seriously, pre-existing conditions are not just the big chronic diseases, they are ANYTHING that the insurer might have to fork out money for.

And if you are lucky enough to get insurance, as soon as you actually use it for something other than checkups, they raise your rates and start looking for ways to cancel your policy.

I really don't want to be so exposed by my current sub-par insurance until I can get Medicare. There are a lot of people in the same position, and many who just can't get affordable insurance or any insurance at any price. The House should pass the Senate bill. It's got problems, but at least it's a start.

Posted by: nancymp | January 20, 2010 2:20 PM | Report abuse

I wouldn't have a problem with a bill like this, but what about those under 50 who are in the individual market (me)? I would still be at the mercy of a merciless market, and it will eventually break the bank (at least then I could get Medicaid). There still has to be some kind of not-for-profit "public option" for those who want insurance, but who wouldn't be eligible for Medicare/aid, and won't be able to afford private insurance (if they could even get it, since there would be nothing to regulate cherry picking).

So, pass the damn bill we have, then do reconciliation for the rest. Or give the Republicans a deadline to come up with a bill of their own...oh, never mind ( I will resume banging my head against the wall now.)

Posted by: tnoord | January 20, 2010 2:23 PM | Report abuse

"If health-care reform that preserves the private market is too complex and requires too many dirty deals with the existing industries, then cut both out."

It's only complex because liberals can't separate the idea of true universal coverage from government funded programs. In Germany, the government provides less than 15% of total spending (vs. 46% in the US) yet the system covers everyone. A move to something like that here would be much less disruptive than any incarnation of single payer and result in improvements for everyone.

The key is not federal funding, but the overall organization and committment to universality. Instead of reform, you propose more government spending on what is crippling the economy. Medicare buy-in for 50+, another patch in a dysfunctional patchwork, wouldn't be affordable for most individuals or sustainable for the country. Medicaid extension to 200% of poverty wouldn't do anything at all about *care* for those folks with payment rates that are already rejected by a significant number of providers.

There is no silver bullet that will convert a dysfunctional model to anything acceptable or simple plan that will put us in a better place. The only option is for Democrats to use every opportunity to educate themselves about what works elsewhere and craft a serious reform plan.

It's appalling that 15 years after the last debacle, this whole exercise started without any real plan on the part of the Democrats. And almost a year later, the bill that is now in jeopardy still doesn't provide one.

Posted by: Athena_news | January 20, 2010 2:30 PM | Report abuse

Ezra,

I like the reconciliation idea for a couple reasons. As you said, it is an easy sell based on direct, understandable government action through programs with high approval. It also cannot, by any means, be painted as a give away to the insurance companies. In other words, it would fit the populist mood of the country.

The downside is obvious: You lose the good regulations and the exchanges. But can't the Senate split the difference, and at least save some crucial regulations. Pass the bill you outlined through reconciliation, then, before the November elections, put another bill through the Senate. This would simply ban discrimination based on preexisting conditions. As so many Republicans are on record as supporting such a policy, you have two options. Worst comes to worst, the measure fails and Republicans have to answer to why they voted against such a ban. Best comes to best, and you have a pretty darn good health care reform plan, minus the exchanges.

Posted by: NickKilstein | January 20, 2010 2:33 PM | Report abuse

Ive always thought that the way to pass the public option would be as an insurer of last resort. basically to say "We know the individual insurance market is broken- once you have a pre-existing condition then it doesn't make sense for anyone to insure you. If you are willing to pay 15% of your income pre tax (or whatever number you pick) then we will insure you."

This is voluntary. This simply gives people a choice and doesn't take away anything from anyone. It would be a massive good for anyone who is currently being screwed by the system. No one is freeloading.

Posted by: spotatl | January 20, 2010 2:33 PM | Report abuse

Democrats hold a 256-178 (!) majority in the House. They have a responsibility to pass the Senate version of the bill immediately. If the Democratic party has the opportunity to pass comprehensive health reform when they have a 256-178 majority, and they fail to do so, then there is no point to having the party at all. They are, in that case, against health care reform, it's that simple. If they don't pass the Senate bill immediately, they will catapult themselves into political oblivion.

Posted by: opinionpieces | January 20, 2010 2:38 PM | Report abuse

Bingo! That's the best idea I've heard all day.

It should be clear to anybody with eyes to see and ears to hear that this Health Care Bill is deeply unpopular. Maybe it should be done (but not the Senate bill as it stands?!! Surely it needs some serious work!) but a voting majority of every state or district that has walked into a voting booth since early November has repudiated it. Maybe it is good for us (and I think it is, or would be with some tinkering) but the dogs don't like it!

We need to recalibrate, eat some humble pie, withdraw this bill and focus "like a laser" on jobs, jobs, jobs and more jobs!

The problem is we are putting the cart before the horse. We are asking folks to trust the government with one sixth of the American economy and one of the most necessary and crucial functions of their lives (their health care, for God's sakes!) when we have yet to show that the government can really be trusted to excercise that power competently and effectively. Passing bills is not doing things. Getting things done is doing things. And when the bills we pass and the money we spend don't seem to get anything done (i.e the "Stimulus Bill", which was too small and too stucturally compromised to have the power to show results that could be seen and appreciated) but we keep passing bigger and more complicated bills that people won't see the good of (maybe) for four or five years, and telling them that it's "good" for them.....we seem arrogant and elitist and out of touch. Pride goeth before a fall.

Barack needs to stop playing golf (with bankers??!!??), dump Geithner and Summers, scale back health care to Medicare and Medicaid expansion (which looks like compasionate help in time of need, not social engineering) and tax banks and credit card companies to pay for it. Hell, just tax bank and credit companies for the principle of it. And start acting like a Democrat!

Posted by: rvanwye54 | January 20, 2010 2:38 PM | Report abuse

Like all of you, I have watched this election debacle closely today to see how health reform would fare. And from what I see, we started the morning with "we have to get reform passed now" to an approach now of "how can we do this incrementally." This will be demoralizing enough for the Democratic based, but if we keep going moving in this direction, it won't take long for the conversation to be "how do we scrap this with a plan to take it up again later this year." Which won't happen.

Posted by: jbrichgels | January 20, 2010 2:43 PM | Report abuse

This is the worst idea I've ever seen you commit to print, Ezra. I have to assume it comes from frustration which is quite understandable, but abandoning 98% of the original intent of the bill just to get "something" passed will surely backfire just as badly as the other bad options. Democrats will have spent a year working to benefit a solidly Republican voting block to the exclusion of nearly all Democratic voters.

Posted by: BigTunaTim | January 20, 2010 2:45 PM | Report abuse

Ezra - Medicare buy-in is not possible for 50+. I highly doubt it would have anything close to 51 votes or that it would even be allowed to come up for a vote. Every hospital and Doctor in the country will be against this idea. Don't underestimate how powerful these 2 group are. Remember that the original idea of early buy-in for 55-64 was gaining some traction until AMA and AHA came out against it.

And why would this idea get a majority in the House? Blue Dog Dems won't vote for something without any payfors.

Wishful thinking....

Posted by: MBP2 | January 20, 2010 2:47 PM | Report abuse

Question- does anyone know how long the House has to pass the Senate bill?

ie- suppose nothing happens for 6 mos, Obama's popularity improves, the economy improves, whatever- can they pass it then or will the window have closed?

Posted by: Quant | January 20, 2010 2:49 PM | Report abuse

Sorry, didn't see your payfor of taxing the wealthy. Still think opposition from Docs and Hospitals would be a big problem.

Posted by: MBP2 | January 20, 2010 2:52 PM | Report abuse

I agree. The problem with this idea is that you cannot spend six months talking about health care reform as one thing and then immediately sell anyone on the idea of Medicare Buy-In as Health Care Reform.

We are one damn roll call vote away from near-universal health care and we can't buy the unions off with changes in the budget?

Posted by: twcunningham | January 20, 2010 2:53 PM | Report abuse

i'm thinking AGAIN that the over/under on people misunderstanding the IDEA and length of a pre-existing condition on here is at least 5 (6 if you include Ezra).

here again is my what is becoming daily posting of this:


http://www.statehealthfacts.org/comparetable.jsp?ind=352&cat=7&sort=a&gsa=2

WHile this does not apply to all it does apply to small group policies (usually 2-50 employees). People really need to understand the laws better. HIPAA went into effect in the 1990s and people still don't get it. Maybe Ezra you could read up on it and do a blog post on it to educate the readers here on it.

Posted by: visionbrkr | January 20, 2010 2:53 PM | Report abuse

Or, they could also simply open to the public the already existing FEHBP. It serves the Federal employees across the entire country, it uses existing insurers and operates at cost. The non-federal employee member would pay the total cost of the program (employee contribution + the employer's contribution), or their employer might be legislated into paying the employer's share.

FEHB is a good insurance exchange. Government bean counters describe several types of policies (high coverage, low premiums w/hi co-pay, HMO, etc) and the insurance companies name their price. Head to head competition helps lower the price to the buyer, we cannot be dropped, and our premium is impersonal (meaning 53 year-old me gets insurance at the same price as 23 year-old me would pay). It pays for itself.

Posted by: margaretmeyers | January 20, 2010 3:01 PM | Report abuse

Some decent ideas here, and a response to the inevitable collapse of the current legislation -- not sure how it would play electorally, but I suspect the Ds would be better off in the long run.

Posted by: scarlota | January 20, 2010 3:03 PM | Report abuse

A surtax on the wealthy is OK but I would rather see it paid for by a tax on Wall Street financial transactions and the big banks.

Posted by: pwkennedy | January 20, 2010 3:03 PM | Report abuse

Keep it short and simple.

Posted by: pwkennedy | January 20, 2010 3:04 PM | Report abuse

I 100% disagree that the Dems should start over.

No, we can not afford another year, or even another month, of health care controversy.

Immediately pass the darn Senate bill.

In the meantime, put the focus on JOBS JOBS JOBS stupid, and maybe reigning in wallstreet (and in the background, fixing the health bill via reconciliation).

Posted by: Lomillialor | January 20, 2010 3:11 PM | Report abuse

There's a very simple, non political, explanation for the outcome in Massachusetts.

Massachusetts already has great, cheap, public health insurance from the state. Why risk losing it for the watered down congressional plan?

It just wasn't in the majority's best interests to sacrifice their own great health insurance for 30 million who have nothing.

Posted by: Kev11721 | January 20, 2010 3:12 PM | Report abuse

scarlota,

actually most of the ideas are honestly AWFUL and would never work if people truly thought them through or if they were to work they'd take years and as much money as the existing reform would cost. Let me say this as plainly as possible.

THERE ARE NO FREE LUNCHES. Let me give you an example.

margaretmyers,

you do realize that the FEHBP is set up to handle a set number of people and if it was just automatically thrown out to everyone it would collapse on itself, right? They don't have the systems to handle the tens of millions MORE people that would enroll. They don't have the service people to handle it. They don't have (I'd expect) computer systems able to handle it. It would be a mess. Also the cost (as i said before) would be nowhere near what most expect to save. I really think people assume Medicare is free sometimes. People on Medicare get Part A after having worked and reach age 65 but Part B costs $$$ and Part C and D both cost money too.

Again there are NO FREE LUNCHES.

Posted by: visionbrkr | January 20, 2010 3:12 PM | Report abuse

Medicare buy-in option, plus Medicaid expansion, plus employer mandate (or option for employer to buy in to Medicare). Employer plans can't have limits or pre-existing condition clauses. That would eliminate a lot of the problems.

Posted by: AuthorEditor

Well, except that your last point will raise the cost of employer-sponsored healthcare, in which case, employers will opt out and take the fine.

Wasn't anyone paying attention last night??? They talked to voters in MA yesterday, and voters want bipartisanship in legislation going forward. And by bipartisanship I DO NOT mean that the Republicans have to acquiesce to whatever the Democrats want...that is NOT bipartisanship. The bill must be created from the center, be limited in scope, and easy for people to understand, in order to be sellable.

I suggest expanding Medicaid, with greater assistance from the federal government (not full federal coverage though), paid for with a tax on Cadillac plans (no union exemptions), along with some tort reform. Let's ease into this process, so people arent' getting freaked out...

Posted by: boosterprez | January 20, 2010 3:23 PM | Report abuse

>>you do realize that the FEHBP is set up to handle a set number of people and if it was just automatically thrown out to everyone it would collapse on itself, right? They don't have the systems to handle the tens of millions MORE people that would enroll.>>

There's no reason to think this is true. Scaling computers should be trivial. If they have to hire more phone reps, it would help the employment situation.

50 times as many people may be another story, but that's not where we are.

Posted by: fuse | January 20, 2010 3:26 PM | Report abuse

fuse,

the FEBHP now serves about 8 million people. YOu don't think this expansion as ezra plans it would increase that to 20 million? That's not as easy as flipping a switch as some would assume. Also if the contracts those participating doctors have with FEBHP are much less lucrative than they have with say an Aetna or United Healthcare then absolutely the docs would cry foul and be against it.

If it was as easy as some on here make it seem they would have done it already. And again and most importantly it would not be free or close to free as I expect some assume.

Posted by: visionbrkr | January 20, 2010 3:35 PM | Report abuse

One thing that sometimes comes up is that reconciliation sunsets but as I read the Byrd rule there is no sunset so long as the provision is deficit neutral after the 5 or 10-year period. Do you know if that is correct Ezra?

I think that offering everyone who would have been eligible for the exchanges an opportunity to buy into FEBHP is a great idea. I always wondered why that wasnt just used in the first place. Is there some problem some of us are missing Ezra?

Posted by: gregspolitics | January 20, 2010 3:36 PM | Report abuse

Jeez, I'm in my 50's and am hardly a "senior". Nor do I wish to be on Medicare (few of the docs here will take Medicare patients). I can go to ehealthinsurance and find a much better deal. Our coverage through an employer is even better.Make Medicare available to 50-somethings and the employer option will probably go away for us.

My point is that the only folks who'll want this are without options, so you'll saddle a program already headed for fiscal problems (broke in 2017) with folks needing lots of care (and who haven't paid into the system as long as those already on Medicare).

Better to focus on how Medicare is gonna be solvent when my age cohort is truly "senior".

Posted by: Beagle1 | January 20, 2010 3:37 PM | Report abuse

@visionbrkr:

Trust me, I understand how individual insurance works for self-employed, in California anyway.

(1) HIPAA guaranteed issue of individual insurance only applies to those who have had group coverage/COBRA within the past 63 days. No help for those not coming from group insurance.

(2) California has no "Guaranteed Issue", unless you are coming out of the state High Risk Pool. I.e. if you are not "HIPAA eligible" (see #1), no insurer has to issue you a policy.

(3) The CA state high risk pool is useless; there are a limited number of spots, always a huge waiting list, and high premiums for lousy coverage.

(4) The only good news in CA is that IF an insurer does issue you a policy, there is a 12 month maximum on any pre-existing condition exclusions.

(5) And, as I mentioned before, the insurer can raise your rates whenever they want. If health care reform passes, I will very likely ditch my current insurer for doing exactly that - despite the fact that in the last decade, I have only exceeded my deductible twice.

So, again, in CA anyway, the self-employed and those whose employers don't provide health coverage...are pretty much at the mercy of the private insurers.

Posted by: nancymp | January 20, 2010 3:39 PM | Report abuse

@visionbrkr:

Trust me, I understand how individual insurance works for self-employed, in California anyway.

(1) HIPAA guaranteed issue of individual insurance only applies to those who have had group coverage/COBRA within the past 63 days. No help for those not coming from group insurance.

(2) California has no "Guaranteed Issue", unless you are coming out of the state High Risk Pool. I.e. if you are not "HIPAA eligible" (see #1), no insurer has to issue you a policy.

(3) The CA state high risk pool is useless; there are a limited number of spots, always a huge waiting list, and high premiums for lousy coverage.

(4) The only good news in CA is that IF an insurer does issue you a policy, there is a 12 month maximum on any pre-existing condition exclusions.

(5) And, as I mentioned before, the insurer can raise your rates whenever they want. If health care reform passes, I will very likely ditch my current insurer for doing exactly that - despite the fact that in the last decade, I have only exceeded my deductible twice.

So, again, in CA anyway, the self-employed and those whose employers don't provide health coverage...are pretty much at the mercy of the private insurers.

Posted by: nancymp | January 20, 2010 3:43 PM | Report abuse

nancymp,

you are then the exception to the rule from what i can tell around here. there is so much misinformation being spread by both sides its really sickening.


They should just have the House approve the senate bill (if Dems there have the stones to do that) and call it a day and FINALLY work on getting jobs back that will lead to taxes that could actually pay for some of this entitlement expansion.

Posted by: visionbrkr | January 20, 2010 3:57 PM | Report abuse

Beagle1 I agree with your post 100%. I offered an alternative on this board only because I know that Dems will want to do SOMETHING. In reality, I'd prefer that they focus on the most urgent need, that being Medicare solvency. IMO, if you solve that, insurance costs are likely to go down because doctors and hospitals won't be relying on private plans to cover the costs of Medicare shortfalls in revenue, which is what happens now. And the easiest way to help with solvency is to take away the limit on taxation for Social Security and Medicare, or at the very least create a donut hole of exemption, and then start taxing again.

Posted by: boosterprez | January 20, 2010 3:59 PM | Report abuse

"And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar" - Ezra

Apparently the lesson of the automakers didn't sink in. Do any liberals ever pay attention wo what employers are saying? More than one-third of large employers are unhappy with their insurance (almost half of small businesses are) and 60% say that they will be be increasing cost sharing by employees with higher co-pays and deductibles.

Employers, the center piece of both House and Senate plans, are facing cost pressures that make it increasingly difficult for them to offer affordable coverage. And yet Ezra, you want to "forget about costs" and pour more government money down the bottomless well that is US health care.

We can't forget reform, we have to get down to making some fundamental changes.

Posted by: Athena_news | January 20, 2010 4:35 PM | Report abuse

boosterprez,

It is just stupid to support an expansion of Medicaid, even if reimbursed by the federal government to take the cost burden from the states. Medicaid was not designed to be a program for the middle class and working poor. It is essentially a charity program for the destitute. If you think Doctors will have a tough time accepting more Medicare reimbursements, just think what they will do if they are offered more Medicaid patients.

Medicaid is the ghetto of the various types of health insurance. The goal should be to get people off of Medicaid as opposed to add people to that program.

Posted by: lancediverson | January 20, 2010 4:46 PM | Report abuse

"The goal should be to get people off of Medicaid as opposed to add people to that program." - lancediverson

The goal should be to get everyone into the same program...we need a universal plan. It doesn't have to be single-payer or a public plan but it does have to be UNIVERSAL.

Posted by: Athena_news | January 20, 2010 5:13 PM | Report abuse

why not show some real balls and demand medicare for everyone? Anyone without other coverage pays a bigger chunk on a sliding scale based on income.

Posted by: sparkplug1 | January 20, 2010 5:23 PM | Report abuse

"If you go that route, you admit the whole thing seemed too opaque and complex and compromised."

Why shouldn' you admit it, if it's true?

"So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy."

Make that Medicaid buy in between 50 and 60, with means testing and revenue comes from capping the deduction for employer provided cadillac plans and you've got yourself a deal. :)

"If health-care reform that preserves the private market is too complex and requires too many dirty deals with the existing industries, then cut both out."

Just exactly why did the Dems have to go and screw around with the private market to begin with? They should have offered a public option/insurance exchange/medicare buy in, defined who would be covered, what plans would be covered, and what it would cost and left their grasping, controlling mitts off the private market altogether.

Posted by: bgmma50 | January 20, 2010 10:01 PM | Report abuse

"Eliminating pre-existing condition restrictions would allow people to game the system by not buying insurance until they are seriously ill."

Yes, it would.

"That's why you need a mandate, at which point we're back to complexity."

Instead of a mandate, you have a 2 year sign up period during which anybody can sign up regardless of preexisting conditions. Those who choose to opt out are then subject to either a waiting period or to exclusion or limitation of coverage for preexisting conditions. Carrots work lots better than sticks. With the additional advantage of being cheaper to police.

Posted by: bgmma50 | January 20, 2010 10:07 PM | Report abuse

"Revenue comes from a surtax on the wealthy."

Here's all you need to know that Ezra Klein is a leftist hack and not a serious policy person. If he were a serious policy person he would call for taxing benefits like the overwhelming consensus of economists.

Posted by: bdell555 | January 20, 2010 10:15 PM | Report abuse

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