Predictions for the Health Care Bill

[Undesired Walrus]

Not living in the US, I'm obviously not as well versed in the current mood as the Americans on this forum are, however, I've got the general impression that this bill has made it further than Clinton's ill fated health care bill of the early 90's.

So, what are the predictions for this bill's outcomes?

[T.A.M.]

Prediction:

1. Health Insurance Reform.
2. No Public Option.
3. Public Option Trigger (which you will never see initiated due to what will be required to trigger it).
4. The Insurance Companies win.

TAM

[Policenaut]

Like almost anyone will tell you they will pass something that will be called a Health Care or Health Care Reform bill. The details are the sticking point. It would be nice to have one bill that everyone can see and understand. But we don't have that. We have multiple versions floating around. The White House might make their own bill up now. And even when one is close to passing we'll likely see more last minute revisions that no one will read or know about much like the stimulus bill. I predict they will go the trigger option route. This is likely guaranteed to actually be "pulled" in the future though because the demands they put on insurance companies like admitting anyone with pre-existing conditions will bankrupt them in their current state. Change or die and I think many will die. I don't know about the co-op plan. This was promoted heavily for a few days and seemed to drop off the radar. All in all this is the exact opposite of a clear and open debate. I wish we had more facts.

[Undesired Walrus]

How does the stage at present work? Do various committees have to come to a consensus of a bill which is then merged into an odd conglomerate that is voted on? Or do they have several votes on several different bills, with the President signing into law the one he approves of the most? Does the President only serve at this stage to set the tone?

[Kestrel]

Originally Posted by Undesired Walrus

How does the stage at present work? Do various committees have to come to a consensus of a bill which is then merged into an odd conglomerate that is voted on? Or do they have several votes on several different bills, with the President signing into law the one he approves of the most? Does the President only serve at this stage to set the tone?

The House and Senate both pass a version of a bill. A conference committee comes up with a compromise between the two bills that is then approved by the House and Senate. After this final vote, the President can either sign the bill into law or veto it. The President doesn't have the power to change specific language, but can threaten to veto the bill if the language is not changed.

[MattusMaximus]

Three words folks: Public Option Trigger

ETA: I further predict that the vote on this health care bill will go almost identical to that of the economic stimulus, with the vast majority of Dems supporting it, a few Blue Dogs opposing to cover their asses in 2010, and all but two (possibly three) GOP Senators voting against it. I also predict that the rightwingers will go absolutely nuts about the GOP defectors and attempt to, once again, eat their own.

[Policenaut]

Snowe will be the only R supporter imo.

[Brainster]

Epic fail. I don't think it will decimate the Obama Presidency; failure to pass Hillarycare didn't hurt Bill Clinton.

[David Wong]

I hate that we're framing this in terms of the political horse race (will liberals be mad?!?! Will Republicans win?!?!?)

How about predictions for how the actual bill will turn out? Sources are claiming the public option has been dropped by the Senate in favor of a compromise (probably co-ops) but basically you've got a bill that a bipartisan committee could live with, despite all the screeching and silliness and town hall fistfights.

In that bill are massive reforms of the insurance industry to protect patients, coverage for a whole lot of people who can't afford it right now, and exchanges set up to hopefully force down prices by introducing choice into a system that has very little of it right now.

Isn't that more significant than the whole horse race silliness? It's this obsession over who's winning vs who's losing that makes it so hard to get actual information about the policy. We shouldn't be following politics like a sport.

[LordoftheLeftHand]

Originally Posted by T.A.M.

Prediction:

1. Health Insurance Reform.
2. No Public Option.
3. Public Option Trigger (which you will never see initiated due to what will be required to trigger it).
4. The Insurance Companies win.

TAM

That is where I'm placing my bet.

[kellyb]

Originally Posted by T.A.M.

Prediction:

1. Health Insurance Reform.
2. No Public Option.
3. Public Option Trigger (which you will never see initiated due to what will be required to trigger it).
4. The Insurance Companies win.

TAM

To that bolded part, I REALLY don't think the House will allow an "impossible trigger" to pass. As it stands now, they're saying they won't sign without a public option from the get-go.

[Policenaut]

I think the opposite of impossible. I think the trigger will be inevitable. The unintended consequence is that the economy will take a huge hit if many big insurance companies fail. Hmm...government takeovers?

[parky76]

All reforms will pass. Public option will not be part of the plan. Several large regional non-profit co-ops will be set up.

within 3 years, health care premiums will start dropping. Obama will be anointed Messiah.

=)

[kellyb]

Originally Posted by parky76

All reforms will pass. Public option will not be part of the plan. Several large regional non-profit co-ops will be set up.

within 3 years, health care premiums will start dropping. Obama will be anointed Messiah.

=)

How do you see premiums dropping in this scenario?

[Policenaut]

Have you seen anyone talking about co-ops? They've dropped off the map quite fast. I'm betting they've dropped that and are putting all their eggs in the trigger basket.

[boooeee]

Originally Posted by David Wong

I hate that we're framing this in terms of the political horse race (will liberals be mad?!?! Will Republicans win?!?!?)

How about predictions for how the actual bill will turn out? Sources are claiming the public option has been dropped by the Senate in favor of a compromise (probably co-ops) but basically you've got a bill that a bipartisan committee could live with, despite all the screeching and silliness and town hall fistfights.

In that bill are massive reforms of the insurance industry to protect patients, coverage for a whole lot of people who can't afford it right now, and exchanges set up to hopefully force down prices by introducing choice into a system that has very little of it right now.

Isn't that more significant than the whole horse race silliness? It's this obsession over who's winning vs who's losing that makes it so hard to get actual information about the policy. We shouldn't be following politics like a sport.

I'm not a big fan of Paul Krugman, but he hits it on the head here. It was just as frustrating during the election, where 95% of the reporting seemed to be about polling numbers, rather than the substance of each candidate's campaign.

[boooeee]

Originally Posted by kellyb

How do you see premiums dropping in this scenario?

The question wasn't directed at me, but I can see a few things that could help drop premiums:

Insurance Exchange - One of the reasons admin costs are so high in the individual market is that if you go through an agent, oftentimes 20% of your first year's premium goes to that agent. It usually drops to 10% after the first year. Obviously, insurance companies price this into your premium. A properly developed exchange would simplify the market and make it easier for individuals to comparison shop on their own, cutting the fat commissions out of premiums.

Underwriting Costs - Currently, insurance companies spend money to underwrite people applying for individual coverage. A necessary evil in a non-mandatory market. With the ban on pre-existing conditions, this should free up some money. I don't expect it to be significant, but it's something.

A Mandate to Buy Coverage - If the mandate is strongly enforced, this should bring in a lot of healthy people into the insurance pool, lowering average costs.

What could raise premiums:

Removal of Pre-Existing Condition Exclusion - In addition to the healthy members that the mandate will bring in, there are a lot of sick individuals that will be able to get insured.

Minimum Benefit Levels - High deductible plans are pretty popular in the Individual market right now. If the minimum coverage level to satisfy the mandate is set too high a lot of people that are covered today will be forced to "buy up" to a richer benefit plan.

What doesn't matter:

For profit vs. non-profit - Margins in the insurance industry are pretty lean (around 5% of premiums). Even non-profits have to build margin into their rates. They need cushion for the lean times. Insurance company profits are a distraction from what's really driving our high costs.


My own prediction: The reforms will lower premium trends below their current level, but premium will still rise higher than inflation, and we will continue to spend far more per capita than other countries. The reforms being discussed will eliminate some of the gross inequities in our current system, but won't do much to control costs. "Bending the cost curve" as they say, is going to take something much more fundamental and wide reaching (and I have no idea what that would be).

[MysteryMammal]

Originally Posted by T.A.M.

Prediction:

1. Health Insurance Reform.
2. No Public Option.
3. Public Option Trigger (which you will never see initiated due to what will be required to trigger it).
4. The Insurance Companies win.

TAM

I'm thinking that the reform to the insurance industry won't be much and will hardly impact the average American family.

[WildCat]

I voted "other" because none of the others fit what I think will happen.

Some sort of "reform" will pass, it will be piecemeal. Nothing will be done to integrate the bureaucracies of the existing federal gov't health plans (Medicare, Medicaid, SCHIP, VA, etc etc), it will simply be an attempt to plug holes hee and there. We won't get universal coverage, nor will there be mandatory health insurance. Nothing at all will be done about spiraling costs, that would involve stepping on the toes of big contributers to both parties. Each state will still be the only ones allowed to decide which insurance companies can operate within them, most coverage will still be employer-based, competiton will still be virtually non-existent among insurance companies and hospitals.

What passes will still leave gigantic gaps in coverage, and we will end up with pretty much what we have now - an expensive, inefficient system with more holes in it than Swiss cheese. But Obama and the Dems will claim victory, the rubes will be fooled, and we'll repeat the whole fiasco in 20 years.

My cynical $0.02

[T.A.M.]

Originally Posted by WildCat

I voted "other" because none of the others fit what I think will happen.

Some sort of "reform" will pass, it will be piecemeal. Nothing will be done to integrate the bureaucracies of the existing federal gov't health plans (Medicare, Medicaid, SCHIP, VA, etc etc), it will simply be an attempt to plug holes hee and there. We won't get universal coverage, nor will there be mandatory health insurance. Nothing at all will be done about spiraling costs, that would involve stepping on the toes of big contributers to both parties. Each state will still be the only ones allowed to decide which insurance companies can operate within them, most coverage will still be employer-based, competiton will still be virtually non-existent among insurance companies and hospitals.

What passes will still leave gigantic gaps in coverage, and we will end up with pretty much what we have now - an expensive, inefficient system with more holes in it than Swiss cheese. But Obama and the Dems will claim victory, the rubes will be fooled, and we'll repeat the whole fiasco in 20 years.

My cynical $0.02

Yah, well blame those in power who were bought by the insurance companies. Blame those who fabricated the "Town Hall Hysteria".

I will blame Obama for being too compromising, too gullible that bipartisanship will ever occur in Washington. Should have started with single payer, and compromised with public option. Aim low to start, and this is what you get.

What ever comes out of, I feel bad for Americans, who could have got something much better had fear not been brought into the equation.

TAM

[Policenaut]

Blame Obama and the d's for wanting to keep their jobs. D's control everything. And with the "nuclear option" they could pass almost anything they want. They don't WANT to pass it because they know it will get them all fired down the road. Up-heaving our system will be painful. It will cost tons of money. It will be messy. It won't be complete for many years. During that time all the problems will be blamed on Ds.

[Brainster]

Let's do the math here. The Democrats have 256 representatives in the House; they need 218 votes to pass the bill. A total of 23 Democrats have already said they will vote against the bill. That leaves Pelosi with a margin of 15 votes. But the progressives are indicating they will vote against any public option trigger.

Quote:

Dem Rep. Raul Grijalva, the co-chair of the Congressional Progressive Caucus, is issuing a strong rebuke to fellow liberals who may be inclined to accept a compromise involving a public option “trigger,” saying it would amount to waving a “white flag” and “a surrender.”

Grijalva made the claim after I checked in with his office for a comment on today’s Roll Call story reporting that some “key” House progressives are open to such a compromise. In a statement emailed to me, Grijalva said that most House progressives would in fact stand firm and still vote against a bill with a trigger:

“The vast majority of CPC is not prepared to wave a white flag on public option. A trigger would be a surrender.”

Greg Sargent estimates that there are 60 or so members of the CPC; if Grijalva is right about the vast majority, the trigger is not going to pass.

[WildCat]

And it just keeps getting more and more stupid:

Quote:

The fines would be the stick to enforce a proposed requirement that all Americans get health insurance, much as auto coverage is now mandatory. The penalties would start at $750 a year for individuals, and $1,500 for families. Households making more than three times the federal poverty level - about $66,000 for a family of four - would face the maximum fines. For families, it would be $3,800, and for individuals, $950.

So, you would get fined anywhere from $750 to $950 if you're an individual and don't buy health insurance. Far, far less than what you would have to pay for actually buying insurance. And if I'm not mistaken the bill would mandate that health insurance companies accept all applicants regardless of pre-existing conditions.

Do you see the problem here? You're better off paying the fines (even assuming you'd get caught every year) and waiting until you get sick before you actually purchase health insurance.

Maybe US politicians really are far more stupid than other countries politicians?

Quote:

But the fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, saying it's too expensive to mandate. White House officials have since backed away somewhat from that stance, but there's no indication that Obama would support fines.

It really, really doesn't get any more stupid than this folks.

I think my cynical response above wasn't nearly cynical enough.

[T.A.M.]

Originally Posted by WildCat

And it just keeps getting more and more stupid:

So, you would get fined anywhere from $750 to $950 if you're an individual and don't buy health insurance. Far, far less than what you would have to pay for actually buying insurance. And if I'm not mistaken the bill would mandate that health insurance companies accept all applicants regardless of pre-existing conditions.

Do you see the problem here? You're better off paying the fines (even assuming you'd get caught every year) and waiting until you get sick before you actually purchase health insurance.

Maybe US politicians really are far more stupid than other countries politicians?


It really, really doesn't get any more stupid than this folks.

I think my cynical response above wasn't nearly cynical enough.

I think it is a lot of speculative bullcrap at this point. The only answer is to wait and see what the WH proposes, and what actually comes to a vote.

TAM

[Policenaut]

Originally Posted by WildCat

Do you see the problem here? You're better off paying the fines (even assuming you'd get caught every year) and waiting until you get sick before you actually purchase health insurance.

I believe this is the exact thing that happened in Mass. and why their program is already costing much more than they anticipated. Part of their solution was to cut most funding for legal immigrants.

[Professor Yaffle]

Surely if you are having mandatory insurance, you are best to have a system where it is automatically deducted from your paycheck? I think that's how it works in Europeans countries that use this system.

[WildCat]

Originally Posted by Professor Yaffle

Surely if you are having mandatory insurance, you are best to have a system where it is automatically deducted from your paycheck? I think that's how it works in Europeans countries that use this system.

I don't see how that would work with private health insurance, unless you get it through your employer in which case it is already deducted.

[Professor Yaffle]

One way I can think of is that a certain amount (which covers basic insurance for any insurance company) is sent to an account that you can only use to spend on insurance.

That's how childcare vouchers (not mandatory) work in the UK.

[dudalb]

Frankly, a singer payer system was never in the cards.
Having said that, nobody looks good in this. The GOP resorted to scare tactics, and the Dems were just plain inept in dealing with them. I am still amazed the Town Meetings took the Dems by surprise since the Tea Parties back in April should have tipped them off to what the Conservative tactics would be.
And the Dems did not help themselves with little items like the intial figures in the House Bill being full of it, as came out with the Congressional Budget Office analyized them.
This will be the last time Obama leaves a major policy intiative in the hands of the Congressional leadership. As had been noted, he "overlearned " the mistakes made by the Clintons back in 1993/94 (ie, getting no outside input into their health plan at all) and went too far in the opposite direction.
My prediction, we will get a watered down health reform bill that really will not solve the problem.

[Undesired Walrus]

Originally Posted by WildCat

It really, really doesn't get any more stupid than this folks.

I think my cynical response above wasn't nearly cynical enough.

Wasn't that the main difference between Obama and Hillary's plans during the campaign? The one she got in a stink over and saying "shame on you Obama"?

Politically, it would be probably better to pass some kind of Healthcare bill, as I believe it was Bill's failure that caused the Republican's to seize control of the House in 94 and cripple his Presidency.

[fullflavormenthol]

My prediction that an extremely watered down bill is passed, which does little to help anyone. Incentives will be given for insurance companies to offer cheap insurance, but this insurance will be crap and not pay for anything. There will be a trigger, but it will never happen.

Eventually Republicans take control; point to the crappy cheapo insurance as a failed government program, and use it as a justification to stop any trigger for a public option. 20 years into the future the debate starts up again.

[WildCat]

I'm getting more cynical by the minute.

Quote:

As for Mr. Baucus’s effort, to help pay for his plan he would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.

http://www.nytimes.com/2009/09/09/he...1&pagewanted=2
And, of course, those costs would be paid for by consumers through higher premiums.

Quote:

Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“The idea of a stripped-down benefits package for people who have a good income and choose not to buy health insurance makes a lot of sense,” said Stan Dorn, a senior research associate at the Urban Institute. “But a catastrophic insurance policy does not make sense for lower-income people, because they cannot afford medical care short of catastrophic expenses. A catastrophic policy does not cover routine care.”

Once again, the idiots in Congress think the solution to our hopelessy piece-meal patchwork system is... more patches!

This would be laughable if it wasn't such a serious matter.

[WildCat]

Originally Posted by fullflavormenthol

My prediction that an extremely watered down bill is passed, which does little to help anyone. Incentives will be given for insurance companies to offer cheap insurance, but this insurance will be crap and not pay for anything. There will be a trigger, but it will never happen.

Eventually Republicans take control; point to the crappy cheapo insurance as a failed government program, and use it as a justification to stop any trigger for a public option. 20 years into the future the debate starts up again.

Yep.

[dudalb]

I honest to God think that some Individual States take the initiative, since nothing effective will be done on the Federal level for the forseeable future.

[MattusMaximus]

Originally Posted by Policenaut

Have you seen anyone talking about co-ops? They've dropped off the map quite fast. I'm betting they've dropped that and are putting all their eggs in the trigger basket.

Nope. Max Baucus is still talking about co-ops, and publicly at that.

[MattusMaximus]

Originally Posted by dudalb

Frankly, a singer payer system was never in the cards.
Having said that, nobody looks good in this. The GOP resorted to scare tactics, and the Dems were just plain inept in dealing with them. I am still amazed the Town Meetings took the Dems by surprise since the Tea Parties back in April should have tipped them off to what the Conservative tactics would be.
And the Dems did not help themselves with little items like the intial figures in the House Bill being full of it, as came out with the Congressional Budget Office analyized them.
This will be the last time Obama leaves a major policy intiative in the hands of the Congressional leadership. As had been noted, he "overlearned " the mistakes made by the Clintons back in 1993/94 (ie, getting no outside input into their health plan at all) and went too far in the opposite direction.
My prediction, we will get a watered down health reform bill that really will not solve the problem.

Agreed, I think he's learned his lesson. And I think the GOP had better be ready to deal with a much more tough President Obama than they're used to from now on.

[WildCat]

Originally Posted by MattusMaximus

Nope. Max Baucus is still talking about co-ops, and publicly at that.

And he thinks he can do that with less than $11 billion.

I have seen zero proposals to decouple health insurance from employment, which is one of the major weaknesses in US health inurance. Quite the opposite, they are protecting this outdated and severely flawed model at all costs.

If there's a worse way to do something about health insurance in the US I can't think of what could be worse than what Congress is considering now. But no doubt Congress can find a way to screw this up even further.

[dudalb]

Originally Posted by MattusMaximus

Agreed, I think he's learned his lesson. And I think the GOP had better be ready to deal with a much more tough President Obama than they're used to from now on.

Agreed. Obama's hands off attitude with one his self proclaimed major projects was a big mistake. Particularly since the House is notorious (no matter which party is in charge) for playing fast and loose with figures to make a bill look better. Obama should have seen that early on and put an end to it.
Supposedly, it was the phony figures that caused a great many of the Blue Dogs Senators to turn sour on Health Care, even before the Town Meetings.
I am betting the behind the scenes, Obama is really angry with the Democratic House Leadership for messing this up so badly.

[JoeTheJuggler]

Originally Posted by David Wong

How about predictions for how the actual bill will turn out? Sources are claiming the public option has been dropped by the Senate in favor of a compromise (probably co-ops) but basically you've got a bill that a bipartisan committee could live with, despite all the screeching and silliness and town hall fistfights.

In that bill are massive reforms of the insurance industry to protect patients, coverage for a whole lot of people who can't afford it right now, and exchanges set up to hopefully force down prices by introducing choice into a system that has very little of it right now.

So would you say that the bill you describe, at a minimum, is almost certain to pass?

I've got a lot of opinions on the subject, but I have to confess I have no idea what's likely to happen, and I'm a little afraid it'll be a repeat of what happened with the Clinton healthcare reform plan (i.e. nothing passed).

Further, do you think something like what you describe is likely to pass say before the end of the year? And if so, what's the soonest you think it might be implemented? (I've got selfish interest in the timing of all this.)