Nqi Kho Mob?
Enriched insurers main outcome of Obama health plan
Kaum ib hlis 2009 By Roger Bybee
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Like a photograph slowly developing, recognizable features of the Democratic health care reform plan are finally taking shape. Insurers stand to receive $465 billion in subsidies via the Senate Finance Committee version of reform, while those citizens failing to pay for private insurance could face fines ($750 for failure to buy single coverage, $1,900 on family policies), all without an effective "public option" that would serve as a measuring stick to monitor and discipline private insurers. Moreover, many Americans—perhaps 25 million—will remain uninsured.
"Obviously, this plan won’t work because middle-income people are right at the border line, caught between unaffordable premiums and unaffordable out of pocket expenses," said Dr. Don McCanne of Physicians for a National Health Program. This perverse outcome should be no surprise, given that former Wellpoint insurance lobbyist Liz Fowler played a central role in helping Senate Finance Chair Max Baucus (D-MT) write the committee’s $829 billion bill, which is serving as the framework for reconciling the differences among the three main Democratic bills. (According to the Washington Post, Baucus raked hauv $ 3 lab hauv kev txhawb nqa los ntawm kev noj qab haus huv thiab kev pov hwm kev lag luam ntawm xyoo 2003 thiab 2008, suav txog 20 feem pua ntawm nws tag nrho cov nyiaj pab.)
The new mandate is a product that is "both defective and unreliable," in the words of Dr. Steffie Woolhandler of Harvard Medical School. The required payments in the least-expensive "silver" plan, for example, will be far out of reach for many middle-class families. Before receiving any coverage, families making $54,000 must shell out $5,000 in deductibles before their insurance kicks in, along with paying out another $5,300 in premiums.
Yog tias cov nqi them ntau dua 12 feem pua ntawm tsev neeg cov nyiaj tau los, tsoomfwv yuav muab cov nyiaj pab them nqi kho mob kom pheej yig dua. Txawm li cas los xij, qhov nyiaj pab no tsis siv rau cov kev txiav tawm loj heev. Ntxiv mus, raws li cov New York Times (9/6/09), "To compare health plans, experts often focus on the percentage of medical expenses paid by insurance, on average, for a given population. This figure ranges from 70 percent to 95 percent under the House bill’s options, but it would be less than 70 percent under Mr. Baucus’s proposal."
Lub phiaj xwm Baucus, uas tau teem sijhawm pib xyoo 2013, tab tom npaj rau lub sijhawm thaum 41 feem pua ntawm cov neeg Amelikas tau tshaj tawm txog kev nyuaj them nqi kho mob, raws li tsab ntawv tshaj tawm xyoo 2007. Poob av, muab los ntawm Lub Koom Haum Nyiaj Txiag. Qhov cuam tshuam ntawm Baucus / Wellpoint txoj kev npaj yuav ua rau muaj kev ntxhov siab heev uas Democrats tau pib ua kom muag muag los ntawm kev ntxiv nyiaj ntau Medicaid (NYT, 9/30/09).
Thus, the most promising part of the sweeping "omnibus" reform bill is a provision for virtually immediate help for the low-income uninsured. While the exact scale of the new assistance to low-income people is uncertain, a number of Democrats see pumping up Medicaid as a means of helping both poor and middle-class families. Separate bills in the Senate and House also contain provisions inserted by Sen. Bernie Sanders (I-VT) and Rep. James Clyburn (D-SC) that would quadruple the level of spending for community health centers because: "Even if universal health care were enacted, there would still be some 60 million Americans located in areas without doctors, so the community health centers are vital for providing primary care, dental care, and mental health treatment," explained a Sanders spokesperson.
Kev xaiv pej xeem
Lacking a public option, the plan has been scorned by Dr. Howard Dean, former Democratic national chair, as "a giveaway to the health insurance industry." What makes this giveaway so extraordinary is that the health insurance industry is one of America’s most unpopular institutions. The favorability ratings of the health insurance industry are lower than the tobacco industry. A 2009 Teb chaws USA no survey revealed that just 4 percent regard the insurers as "honest and trustworthy."
The industry’s windfall is an appalling comment on the hollowness of American democracy in the face of overwhelming corporate power. While largely reviled by the public, the for-profit health insurance industry has been warmly welcomed by the Congress, the White House, and elite media as a legitimate and valuable ally in the cause of reform. This same gulf between elite and popular opinion was visible in the near-total exclusion by elites of the most popular model for reform, the "single-payer" or "Medicare for all" proposal.
Tej zaum qhov kev xaiv tsa tshaj plaws ntawm tus neeg them nyiaj ib leeg tau ua los ntawm ua lag ua luam lub limtiam (5/16/05), because it explicitly referred to systems where the government has essentially replaced the private insurance industry: "67 percent of all Americans think it’s a good idea to guarantee healthcare for all US citizens, as Canada and Britain do, with just 27 percent dissenting." But the single-payer plan was immediately ruled "off the table" in Baucus’s words: "We are Americans. We’re different from Canada; we’re different from the United Kingdom" He was presumably not referring to the United States’ distinctively poor health outcomes (e.g., higher infant mortality, shorter longevity) delivered at much higher per-capita cost ($7,290 for the U.S.) when he spoke of the American "difference."
President Obama has similarly excluded the single-payer plan from consideration. Obama, once an advocate of single-payer while an Illinois state senator, now argues, "The vast majority of people currently get health care from their employers and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy."
Obama’s argument was forcefully refuted by Dr. Marcia Angell of Harvard Medical School on "Bill Moyers Journal": "What he has essentially advocated is throwing more money into the current system…. Our problem is that we spend two-and-a-half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don’t get our money’s worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let’s throw some more money into it."
Moreover, the transition to a single-payer system need not be "disruptive," as it involves replacing the bureaucracy, rules, and paperwork imposed by 1,500 health insurers with one public entity and one comprehensive set of benefits. Recall that in a pre-computer era, tens of millions of senior citizens were enrolled in Medicare just 11 months after President Lyndon Johnson signed the bill in 1965.
For-profit insurers are eager for the version of "reform" now under consideration. Also standing to benefit are major non-profit insurers whose motives and mode of operation is virtually identical to the for-profits, such as Blue Cross/Blue Shield, Kaiser Permanente, HealthPartners, and Group Health of Puget Sound. "The only thing the insurers are willing to accept is a lot of new customers, at whatever premium, and they’ll be happy with that," Angell reports.
In exchange for the universal mandate, America’s Health Insurance Plans (the 1,300-member insurer trade association) has agreed to do away with pre-existing conditions after one year in considering applications or coverage of specific illnesses. However, the provision may prove difficult to enforce. As United Electrical workers political director Chris Townsend told me, "What’s to stop them from denying you on the basis of a bad credit record with medical bills?" Further, "In exchange for issuing policies to sick people, insurers get to jack up premiums for older people…letting them charge four times more," writes long-time health advocate Trudy Lieberman (Columbia Journalism Review, 9/23/09).
The Baucus plan also lacks a strong "pay or play" employer mandate, with small fees for failing to provide insurance, so that corporations will continue to undercut their competition by withholding expensive health benefits. And it proposes that key regulations for the health insurance industry be unilaterally written, without Congressional review, by a private group of state insurance commissioners, long known for their servility to the industry and their lack of transparency (LA Times 9/28/09).
Kev koom tes nrog tswv yim
Tnws cov tuam txhab tshuaj tau taug kev mus rau hauv kev sib cav txog kev noj qab haus huv tam sim no raws li kev lag luam nrog cov txiaj ntsig siab tshaj plaws. Raws li Angell hauv nws phau ntawv Qhov Tseeb Txog Cov Tuam Txhab Tshuaj, Hauv xyoo 2001, kev lag luam tshuaj tau txais txiaj ntsig ntawm 18.5 feem pua ntsuas raws li qhov nruab nrab rov qab los ntawm kev muag khoom. Ntxiv mus, hauv 2002, 10 lub tuam txhab tshuaj muaj txiaj ntsig tshaj plaws tau txais $ 35.9 nphom - ntau dua li lwm lub tuam txhab 490 ntawm Fortune 500 ua ke.
Los ntawm 2000 txog 2007, cov txiaj ntsig ntawm cov ntawv pov hwm kev noj qab haus huv loj tau nce 428 feem pua. CEO them nyiaj ntawm 10 tus neeg tuav pov hwm loj tshaj plaws nyob nruab nrab ntawm $ 11.9 lab hauv xyoo 2008. Lub sijhawm xyoo 2000-2005, cov neeg tuav pov hwm kev noj qab haus huv tau nce lawv cov neeg ua haujlwm los ntawm 32 feem pua txhawm rau txhawm rau txheeb xyuas cov neeg mob tau txais txiaj ntsig zoo dua txhawm rau txhawm rau txiav nyiaj thiab kev tso cai thiab yog li ua kom cov txiaj ntsig zoo tshaj plaws. Nrog rau qhov chaw ua haujlwm loj no, cov thawj coj tau them nyiaj ntau, thiab cov txiaj ntsig loj, nws tsis xav tsis thoob tias cov nqi tswj hwm siv 31 feem pua ntawm Asmeskas kev siv nyiaj kho mob ntiag tug. (Los ntawm kev sib piv, cov nqi tswj hwm hauv Medicare tsuas yog 3 feem pua.) Rau cov tuam txhab tuav pov hwm cov txiaj ntsig 'cov nqi tswj hwm ntau dhau rau cov nyiaj tsis tsim nyog txhua xyoo ntawm qee qhov $ 400 billion, raws li kev tshawb fawb xyoo 2003 los ntawm Woolhandler thiab lwm cov kws tshawb fawb hauv Harvard Medical School.
Lub caij no, cov tsev neeg ua haujlwm tau raug kev txom nyem los ntawm cov nqi siab dua, uas tau nce 131 feem pua ntawm xyoo 1999. Cov nqi them txhua xyoo rau tsev neeg kev noj qab haus huv tau nce mus txog $ 13,375 hauv xyoo 2009, nrog cov neeg ua haujlwm thiab lawv tsev neeg tau pab nyiaj $ 3,515 feem ntawm qhov nruab nrab, ntau dua ob npaug ntawm qhov lawv them. cuaj xyoo dhau los. Ntau tus tswv ntiav neeg ua haujlwm tau nce zuj zus tsuas yog txo cov kev pab them nqi kho mob raws li qhov tsis muaj nqis. Qee 47 lab tau tso tseg tsis muaj kev pov hwm txawm tias ua ntej qhov pib ntawm kev lag luam poob qis tam sim no. Raws li kev tshawb fawb los ntawm Harvard Medical School cov kws tshawb fawb, txij li qhov kev poob qis, kwv yees li 14,000 tus neeg tau raug yuam mus rau hauv qib txhua hnub thiab tsis muaj kev pov hwm ua rau kwv yees li 45,000 tus neeg tiv thaiv kev tuag txhua xyoo. Kev tshawb fawb los ntawm California Nurses Association tau tshawb pom tias cov tuam txhab tuav pov hwm tau txais txiaj ntsig ib txwm tsis lees paub, qhov nruab nrab, 21 feem pua ntawm tag nrho cov ntawv thov kev noj qab haus huv hauv California, nrog Cigna tsis lees paub qhov zoo tshaj 40 feem pua. Ntau lab tus neeg Asmeskas yog li tau ntsib kev ncua tsis kawg thiab cuam tshuam ncaj qha rau tus kws kho mob-tus neeg mob kev sib raug zoo ntawm cov kev kho mob rau cov nyiaj pov hwm yuav tso cai thiab them rau. Lawv kuj tau nquag ntsib cov kev coj ua piv txwv thiab kev dag ntxias.
"It will take at least a decade for real change," McCanne ruefully predicts. "It will take about four years for the national insurance exchange to be set up for the uninsured and then at least another six years before people conclude that it simply doesn’t work. What’s going to wake people up is that middle Americans are going to find out that they still can’t pay for health insurance or health care. Even if they can afford insurance premiums, they’ll be unable to afford the out of pocket deductibles."
Hmoov tsis zoo, cov tuam txhab tuav pov hwm cov txiaj ntsig thiab cov chaw muag tshuaj muaj cov peev txheej loj uas tau ua pov thawj muaj txiaj ntsig zoo hauv kev cuam tshuam rau Congress, Kev lag luam kev noj qab haus huv tag nrho ntiav ntau tshaj plaub tus neeg saib xyuas ib tus tswv cuab ntawm Congress. Ntau tshaj 350 tus tswvcuab yav dhau los ntawm Congress lossis cov neeg pabcuam hauv pawg nom tswv tau raug ntiav los tos txais rau kev hloov kho kev lag luam. Big Pharma ib leeg yog siv nyiaj ntau heev. Raws li cov Washington Post: "The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million."
Health-care interests have been both generous and strategic in their campaign contributions. "[The health insurance industry] has donated more than $19 million to federal candidates since 2007, 56 percent of which has gone to Democrats," reported ua lag ua luam lub limtiam. In particular, conservative "Blue Dog" Democrats who have generally been highly sympathetic to the industry have received about 25 percent more than their fellow Democrats, according to the Center for Responsive Politics.
Elite Vs. Public View of Insurers
One of the most misunderstood components of the health-care debate is the "public option." Many Americans assume that it is a voluntary version of the single-payer model, which would somehow exist alongside the for-profit insurers, a view reinforced by hysterical Republican attacks that it would lead to a single-payer system or "socialized medicine." Others have understood it as an extension of Medicare which anyone could choose to join—a far cry from the three major Democratic bills. Finally, a large number of supporters—including many progressives in Congress—see it as a critical element necessary as a measuring stick for the performance and premium levels of the for-profit industry and, thus, the only effective cost-control mechanism (if the option was broadly inclusive).
A NY sij hawm/CBS poll released September 24 shows a stunning 65 percent majority (with just 26 percent opposed) for "the government offering everyone coverage in a government-administered health insurance plan—something like coverage that people 65 and over get—that would compete with private health insurance plan." A 47 percent plurality of Republicans favored such a plan. Unfortunately, the public option will not be able to live up to that vision. No public plan put forth thus far would offer it to all Americans.
As written now, the Baucus plan offers a weak network of cooperatives hatched by Sen. Kent Conrad (D-ND) as its version of the public option. "These non-profit insurance cooperatives would be pitted against already-existing for-profit insurers who have well-established provider networks and quasi-monopolistic market share," notes Kip Sullivan, a Minnesota health activist and author of Health Care Mess.
Further, the final version of the public option will almost certainly force any public health-insurance entity to conduct itself exactly like private for-profit insurers. Even advocates of the public option like Sen. Charles Schumer (D-NY) have spoken of forcing the new public option plan to operate "on a level playing field" with private insurers who have long monopolized markets in many states. Under these rules, the public option will neither serve as a vibrant alternative nor be in a position to force down premium costs. "The public option would face the same administrative and marketing costs of insurers and trying to gain entry to the same delivery system," points out McCanne. "The public option won’t be able to do anything to cut costs. If the public option has to function on a ‘level playing field,’ it will be forced to function like any private insurance company."
Ntxiv mus, cov kev xaiv pej xeem yuav qhib rau thawj zaug nkaus xwb rau cov neeg muaj ntawv pov hwm tshiab uas xaiv qhov kev xaiv los ntawm Kev Pov Hwm Pov Hwm Kev Noj Qab Haus Huv. Kev tso npe nkag yuav raug txwv rau 25 txog 30 lab mus txog rau 2019 - muab cov kev xaiv rau pej xeem tsuas yog ib qho me me ntawm kev ua lag luam, nrog rau lwm yam kev puas tsuaj.
Cov kev xaiv pej xeem tau txais kev poob qis rau lub Cuaj Hlis 29 hauv Pawg Neeg Saib Xyuas Nyiaj Txiag Pov Hwm Pov Hwm. Ua raws li ob lub 15-8 pov npav tawm tsam qhov sib txawv ntawm cov kev xaiv pej xeem - tsis yog ze rau tus qauv nyiam los ntawm 65 feem pua hauv qhov tsis ntev los no NY sij hawm/CBS poll—Baucus smirked, "No one shows me how to get to 60 votes with a public option." However, public option advocates are considering a procedure under which they would assemble 60 votes to defeat a Republic filibuster and then use a "reconciliation" procedure that would require only 51 votes for the public option.
Hauv Tsev, ntau dua 60 tus tswvcuab ntawm Progressive Caucus, txhawb nqa los ntawm AFL-CIO Thawj Tswj Hwm Richard Trumka tshiab, tau hais tias tsis muaj kev npaj khomob yuav dhau mus yam tsis muaj kev xaiv rau pej xeem. Hmoov tsis zoo, qhov kev xaiv muaj zog tseem tsis tau tsim. Lub sijhawm no, cov kev vam meej tau muab qhov hnyav dhau los ntawm tsuas yog ob kab ntawm House bill HR 3200, raws li kev tshuaj xyuas ntawm Kip Sullivan, thiab muab qhov tsis yooj yim ntawm txoj cai lij choj, nws yuav yooj yim heev rau kev vam meej, muaj lub siab zoo. congresspeople yuav tsum tau muag ntawm ib tug toothless pej xeem xaiv.
Woolhandler worries that the final Democratic plan will be a national version of the highly unpopular Massachusetts "reform" plan enacted by Republican Mitt Romney: an individual mandate, high premiums, fines for those who don’t buy insurance, and a lack of cost controls on insurers and providers. "It will be Massachusetts writ large," predicts Woolhandler.
Raws li lub sijhawm no, tsuas yog qhov chaw ci ntsa iab tseem muaj cov lus thov kom nthuav dav Medicaid rau npe kawm thiab ntau lub chaw noj qab haus huv hauv zej zog rau cov neeg tau nyiaj tsawg. Puas muaj kev pov hwm kev noj qab haus huv rau txhua tus? Kev ywj pheej los ntawm kev cuam tshuam bureaucratic tas li los ntawm cov neeg tuav pov hwm? Kev kho mob uas pheej yig? Txog tam sim no, cov cai no - hauv paus hauv tag nrho lwm lub tebchaws siab heev - yuav nyob twj ywm npau suav ncua hauv Asmeskas.
Roger Bybee yog tus kws sau ntawv ywj pheej thiab tus kws pab tswv yim tshaj tawm uas nws txoj haujlwm tau tshwm sim Dollars & Sense, The Progressive, Multinational Monitor, American Prospect, thiab Txawv Teb Chaws Txoj Cai nyob rau hauv tsom.
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