Overview of Senate Health Care Bill

Combine this with the climate change legislation (in pretty much any form that’s been seriously proposed) and a lot of our hopes for the Obama administration will end up resting on Raleigh.

Kind of like how that big branch in my back yard started out on the trunk, but is now resting on twelve inches of snow.

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At Firedoglake, DDay had a rather discouraging review of how insurance regulations do not get enforced:

California regulators admitted Thursday that for more than a year they didn’t even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because it feared they would be outgunned in court.

In early 2007, the Department of Managed Health Care pledged to fine the state’s largest insurer for “routinely rescinding health insurance policies in violation of state law.” But they never did.

The department’s director, Cindy Ehnes, told The Associated Press on Thursday that, when it comes to rescissions, the agency has had success in forcing smaller insurers to reinstate illegally canceled policies and pay fines, but Blue Cross is too powerful to take on.

Knowing that Blue Cross’ lawyers could keep them tied up in court for years, California declined to take the big guns to court. (Is this sounding like the IRS’ enforcement of tax code?)

DDay observes, “[K]eep in mind with all of this that California’s Dept. of Managed Care is the biggest entity enforcing insurance regulation in the entire country [and] illegal rescissions still occur routinely in the state of California.”

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It also looks as if Kerry’s “prudent purchasing” provision is in the Senate bill.

The MLR of 85% (page 204) is a big plus, but I like the idea that instead of merely requiring exchange plans meet that minimum threshold, they must actually disclose their MLRs. That would increase competition by allowing consumers to choice the insurer with the lowest MLR (unless the insurers collude to all hit the same number). I’d also like to know who gets to decide how the MLR is defined.

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Are we really counting on the mandates to increase demand, which in someone’s theory, costs should come down? Hahahahahahaha. Good one!

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Increased funding to Community Health Centers is great news. Those are the places that so many of us go because we can’t afford to see a doctor or a dentist — and they have a positive, real-world effect for people who need medical help.

I’m very lucky to have been treated by a number of these facilities over the years, and our own Western North Carolina Community Health Services — under the leadership of Dr. Polly Ross — is one of the finest in the country. In fact, Buncombe County recently contracted with WNCCHS to provide access to basic health care (medical, dental, mental) for about 10,000 more of our neighbors.

Dr. Ross also happens to be one of the best HIV/AIDS doctors in the region. Asheville is very lucky to have her.

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A talk radio caller just asked a question that’s become a tiresome staple of those opposed to health care reform: “If you were seriously ill and you needed the best health care in the world, where would you go to get it?”

Let me answer that question by asking myself another: “If you were going into outer space, which country’s space technology would you most rely on to keep you safe?”

America’s, of course.

Both questions conflate quality technology with access to it. Somebody else might have $200,000 lying around to spend on going into outer space, but not me. I can’t afford it – any more than I can afford to go to the Mayo Clinic in Rochester, MN when I get sick and have inadequate insurance or none at all.

The issue is access for everyone, not who has the best technology that only a few get to enjoy.

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Another feature I notice about the back-and-forth on the Senate bill among the progressive community is the uneven split between the policy wonks and the non-Beltway community, between the people who eat, sleep and breathe policy and the people more concerned with eating and having a place to sleep.

The wonks who favor the bill (even Jacob Hacker, the author of the public plan), keep insisting that while seriously flawed it’s a good start and something to build on. Don’t focus on what’s not in it, they insist. Look at what the bill does. It provides decent coverage for people who otherwise wouldn’t have any insurance. We won’t get this chance again for a generation, etc. Their focus is on politics and policy.

What they don’t get at is the Main Street effects of the mandate on household budgets. A commenter at Pam’s Houseblend writes:

If this bill were to pass as is…

It would remove any chance I have to access health care.

If I am forced to purchase insurance, even the cheapest plan, and then pay the first 1,200 out of pocket and co-pays, I won’t be able to do anything but pay the premium or the fine. I won’t be able to afford to actually use the insurance.

The only thing I can afford now is regular trips to the dentist, an M.D. is out of the question. If this passes I will have to forgo all care and I don’t see how I will be able to make my rent! This is a nightmare for me, it is causing me such stress that it is almost unbearable.

I don’t know what I’m going to do, there is a good chance this will make me homeless if it passes.

I don’t have a good read on how widespread such effects will be. What concerns me is that they seem to be off the radar for most in the pundit class.

Marcy Wheeler lives in Ann Arbor, MI and has a fair read on how decisions made in D.C. effect the working class in Michigan. Marcy did a quick look at the family budgeting effects of the mandate on middle class families: The MyBarackObamaTax. Her findings weren’t encouraging.

It doesn’t help that some of the bill’s promoters (even the president) are making what one commenter called the National Lampoon sales pitch: “If you don’t buy this bill, we’ll kill this dog.”

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