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Nancy Pelosi explains why you can't pare back the health-care bill

From a conference call yesterday:

One of the most appealing pitches to the American people about health-care reform is never again will you be discriminated against because of a pre-existing condition, or if you've paid your premiums and you get sick, your policy can't be cancelled, or to prevent recessions when people are halfway down the hallway on a gurney to the operating room and then their coverage is rescinded ... it's a much longer list.

Some people have suggested that we should do [those insurance reforms] freestanding. But it's important to note the following: You can't do that freestanding unless you have the basic underpinnings of a bill, because otherwise you're making a statement, but you're not making a difference in anyone's life because it's not tied to the accountability of the insurance companies. You could get all of those things -- insurance companies will price it out of everybody's range. So they would be factors for increased costs and premiums, rather than reforms of the insurance industry, unless they go along with a bill that is underlying that we hope that we will be able to pass before too long.

So there are some things that sound easy, but you might as well send somebody a get-well card because they don't have any more impact, except maybe they make you feel good for the moment -- maybe a get-well card might be more effective as a matter of fact, because it's sincere.

The good thing about Nancy Pelosi explaining why paring the bill back to the insurance reforms won't work and Barack Obama explaining why that won't work is it makes it much harder for either of them to turn around and pretend that this will work.

By Ezra Klein  |  February 3, 2010; 10:02 AM ET
 
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Comments

"You could get all of those things -- insurance companies will price it out of everybody's range."

Isn't that because it costs more? And it won't be out of everybody's range, that's just hyperbole.

I find her line of reasoning to be spurious. Banning rescission clauses, except in cases where there is willful disregard for one's own health, would be meaningful. However, I strongly believe we need to price risk. It's not "discrimination"- at least not with the connotation her words apply. If you want to eat 5000 kCal per day and sit in front of the computer typing in blog comments without exercising, I don't want to pay for the risk you are adding to my pool.

It's probably better to just offer "discounts" to the healthy, based on simple measures such as BP, resting pulse, and the results of a urine test. It works for life insurance, it should work for health insurance too.

Posted by: staticvars | February 3, 2010 10:33 AM | Report abuse

The explanations by Pelosi & Obama of why paring the bill back won't work aren't just a good thing because their statements have the effect of making it hard to backslide away from a comprehensive bill but also because they signal a strong commitment not to backslide.

Posted by: wintershag | February 3, 2010 10:36 AM | Report abuse

"You could get all of those things -- insurance companies will price it out of everybody's range"

You see this where she flies violently off the tracks. COSTS would price it out of everyone's range. Ezra you know that. If we give everyone coverage and only make people pay for it (individual mandate) WHEN they're sick and using it it won't work.

The other problem that no one will speak of around here is that the woman that is the most powerful person in Congress and is having a conference call with progressive bloggers?

That's like Trent Lott having a conference call with Andrew Breitbart, Matt Drudge and Rush Limbaugh about the best way to make policy.

Posted by: visionbrkr | February 3, 2010 10:38 AM | Report abuse

You also can't make incremental fixes if they threaten to reduce the sacred 47 million excuses for universal healthcare.

How would ideologues ever pass the holy grail of liberalism if pragmatic policy ever got a chance to put a dent in the size of the "crisis"???

Posted by: whoisjohngaltcom | February 3, 2010 11:03 AM | Report abuse

The reason you have to pass the entire bill is that the only way cost balance out for insurance companies. The bill contains the carrot and the stick. Stick- Insurance companies will have to offer insurance to everyone regardless of pre-existing conditions, they can't rescind, they can't cut you when you get sick. In exchange, they get the carrot- the bill includes a mandate making millions of new customers- including the prime young healthy people they want to insure- buy into the system. The reason premiums can stay affordable is the economy of scale. You can't just pass the part that cost a lot of money. Premiums will skyrocket.

Posted by: cminmd1 | February 3, 2010 11:17 AM | Report abuse

whoisjohngaltcom:
You also can't make incremental fixes if they threaten to reduce the sacred 47 million excuses for universal healthcare.

How would ideologues ever pass the holy grail of liberalism if pragmatic policy ever got a chance to put a dent in the size of the "crisis"???
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Three is no changing the mind of those who believe that health care access, or a high school education, or social security for all citizens not "pragmatic".

Conservatives play a disingenuous game in disputing the number of uninsured. On the one hand there are so many that it is too expensive to deal with them. On the other hand there are so few that we should ignore them.

Posted by: HuckFinn | February 3, 2010 11:40 AM | Report abuse

First, Huck, I don't see any proposals that cover all 47 million. Therefore, we can assume that there are other factors to consider beyond just how many people are covered by a policy.

Second, ending rescission, making health insurance portable, more competitive, and ending the tie between insurance and employment are all things that could (and should) be fixed now.

However, each of these will also erode the 47 million into an increasingly small and more affordable problem, making universal healthcare less necessary.

And since universal healthcare -- and not the plight of those 47 millions -- is what liberals really want, actual progress will not be permitted. You guys aren't here to fix the problem -- you're here to entrench a very specific solution. And 47 million be damned.

Posted by: whoisjohngaltcom | February 3, 2010 12:19 PM | Report abuse

"You could get all of those things -- insurance companies will price it out of everybody's range. So they would be factors for increased costs and premiums,"

It's going to be priced out of everybody's range anyway. The House bill is a prescription for increased costs and premiums. Unless Miz Nancy has figured out how to repeal the laws of supply and demand.

Posted by: bgmma50 | February 3, 2010 12:53 PM | Report abuse

Let's just admit that the mandate without risk pricing is basically getting the relatively poorer and healthier to pay for the relatively richer and more ill. If that's your comprehensive only reform, to practice generational warfare, you can shove it.

It just seems like all of this is nonsense if we aren't going to make serious changes to Medicare. We need a wedge to get sane Republicans to provide cover on this issue.

Posted by: staticvars | February 3, 2010 12:57 PM | Report abuse

Staticvars- most people are not barred from insurance due to lifestyle. That would almost make sense. Most people are barred because of something they have no control over. I can't buy on the private market because of a tiny blood clotting issue. All I have to do for it is take a cheap generic medication a day and go for about 6 blood test a year. I have had no kids, no major illness and am a fit, healthy eating, non-smoking, infrequent drinker.

Posted by: cminmd1 | February 3, 2010 3:23 PM | Report abuse

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