In this modern folktale adaptation,
the role of Br’er Fox will be played by: Congress
the role of Br’er Rabbit will be played by: The Insurance Industry
the role of The Brier Patch will be played by: The Health Reform Bill

Br’er Fox has caught ol Br’er Rabbit and is ready to tear ‘em apart and eat im up. Ol Br’er Rabbit knows dis could be the end of him…but he’s a craft ol rabbit.

As they head down the path, B’rer Rabbit spots a tangly Brier Patch. Now Rabbit jes love brier patches….he’s spent his life in brier patches and knows dey is full of places to hide and hard for others to get around in.

Seeing his chance of escape B’rer Rabbit wastes no time in pleading with B’rer Fox: “Mr Brer Fox,whatever you do….please don’t fling me in dat brier-patch…..please please please dont fling me amongst them briers”

Now B”rer Fox quickly falls for the ol tricksters ruse. He flings B’rer Rabbit right into that ol Brier Patch where B’rer Rabbit makes his escape amongst the briers and thorns …. laughin at his own cunning and devious ways.

Br’er Fox watches sadly as Br’er Rabbit scambers threw that ol Brier Patch unscathed and free to live, prosper, and fatten himself up.

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Br’er Rabbit and The Tar Baby

In the following tale,
The role of Tar Baby will be played by: The Health Reform Bill
The role of B’rer Fox wil be played by: Congressional Lobbyists and the GOP congressman
The role of B’rer Rabbit will be played by: Democratic Congressmen and Senators

Now ol Br’er Fox created this lil doll baby outa wood and smeared it with tar and other nasty sticky stuff. It looked like a real sweet little baby.
Now, Br’er Fox knew how badly Br’er Rabbit would want that ol Tar Baby and he was right. As soon as Br’er Rabbit spotted that lil baby he was obsessed with it …and willin to do jes about anything to get it. I mean it looked like somthin real…somethin sweet and innocent and somethin Ol Br’er Rabbit had been a wantin for years.

Finally ol Br’er Fox gave that tar baby to Br’er Donkey (er..I mean Br’er Rabbit) and it jes stuck to him like glue. Br’er Rabbit knew he’d been fooled but it were too late now….that ol Tar Baby was a nasty smelly ol’ thing and ol Br’er Rabbit was stuck with it.

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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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But guys, let me tell you – North Carolina got a spotty history of enforcing the freaking Clean Air Act, so I’m not cheerful about any health care enforcement that might be the state’s responsibility.

My prediction: once all the dust settles, the general assembly will take all regulatory control over health insurance out of the hands of our elected Commissioner of Insurance (currently the estimable Wayne Goodwin). An office will be created in the executive branch to protect Blue Cross/Blue Shield to the greatest extent allowable by law.

Whether the governor at the time is a Republican or Democrat, a former BCBS employee will be appointed to oversee that office.

You read it here first.

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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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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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So does this lack of enforceability oversight extend to the enforcement of mandates?

Wishful thinking?

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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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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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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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