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January 19, 2010

Brown/Coakley, Healthcare, and Democrats

Posted by tunesmith at 06:39 PM

At the time I'm writing this, Brown has a solid lead over Coakley in Massachusetts (I just misspelled it and corrected it) with 2/3 of precincts reporting.

Here are my predictions going forward.

  • Brown will win and be seated as the 41st Republican Senator.
  • Democrats will not attempt to rush the health care bill through conference before Brown gets seated. The optics are horrible.
  • The House will pass the Senate bill, and Obama will sign it into law.
  • There will be some half-hearted attempts at reconciliation for some improvements.
  • Netroots will again get furious about whatever isn't in the bill going forward, or if the reconciliation bill isn't passed.
  • Progressives left and right will agree with Republicans more and more often that the Obama administration is a failure.

Beyond that, it's hard to say. I'm currently feeling pretty discouraged at the direction we're heading, and not for the reasons that many in the netroots aren't.

If I were to phrase it in a way that others would agree with, I'd say that Obama has done a piss-poor job at communicating with the base. If I were to phrase it in a more controversial way, I'd say he's done a piss-poor job at managing the base's expectations. The base is crazy, and that's about where I get off the train. Obama's failure is that he didn't neutralize the base. The base is basically agreeing with the Republicans that the health care bill is awful, and since Republicans are more set up to run against the Democrats than the base is, then that means Republicans get elected.

The base is wrong and stupid, but there's nothing to be done about that short of a massive education effort that won't get through to anyone. We've still got people arguing that dumping the current bill and starting over with reconciliation would be an improved approach, as if them saying it often enough makes it true, not paying attention to the fact that a reconciliation bill would do nothing for ridding society of medical bankruptcy. The Senate bill is a good bill, far better than a good bill, and it can be built upon. On a night like this it seems no one cares about that.

More later, I'm sure, as I get my head on straight again.

January 12, 2010

Explaining The Mandate

Posted by tunesmith at 11:44 PM

It's worth reviewing some of the basics about the health insurance bill.

There are basically two entirely different ways that the health care system currently hurts the sick and the poor. The first is that health care costs are skyrocketing, and responsible health care is getting more and more expensive. But the second is that when serious medical problems do occur, people can go bankrupt and lose their life savings. This is a structurally different problem, in that it is possible to make premiums more affordable without doing anything to protect people from medical bankruptcy.

There are several health insurance practices that make medical bankruptcy possible, such as pre-existing conditions, rescission, and annual/lifetime maximums. In order to protect people from medical bankruptcy, these practices need to be ended.

Here is the problem. The reason these practices are in place are because they make it cheaper for health insurance companies to pay out claims. If they exclude people with pre-existing conditions, they have protected themselves from paying predictable medical costs. If they kick someone off a policy after they get sick (rescission), they've saved themselves a lot of money in expensive care. If they have annual or lifetime caps, they save themselves from having to pay the most expensive of claims, from people who have already racked up hundreds of thousands of dollars in expenses.

If they instead had to pay all of these costs, they would undoubtedly be passed along to consumers in the form of higher premiums - even higher than they are now.

What would the result be of this? As health insurance premiums get more expensive, the population becomes more likely to gamble by choosing not to buy health insurance. The healthier someone is, the more likely they are to gamble. When a healthy person leaves, it means the average health of the people left in the insurance plan is worse, which makes the premiums even more expensive. And then it happens again - more healthy people leave, premiums go up. This repeats, and accelerates. The reason we know this is because it is already happening.

The only way to solve this is to get more healthy people into the insurance plans. Then premiums go down for everyone. That is why the mandate is required. Without the mandate, we simply cannot afford to end pre-existing conditions, rescissions, and plan maximums, and it will still be far too possible for people to suffer bankruptcy just from getting injured or sick.

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