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View Diary: Health Care Reform Bill Mythbusting #1: "Junk Insurance" (133 comments)

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  •  They can mandate anything and everything... (2+ / 0-)
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    pico, thethinveil

    but each item adds to the cost, that must be paid partly by the insured and partly by various subsidies.

    There is no price control, nor do I believe any limit on co-pays.   So, while someone may have all of these goodies covered, there are two problems. Yes, there must be a 90% payout, that's 90 times X, but X is not defined.

    If the policy pays market price, with high co pays it may not be viable when a specific illness occurs.  Or with low co pays it may not be affordable.

    Whenever you focus on one thing, more is better.  But when looking at all human needs, housing, education, retirement security....then choices must be made.  With this bill the choice is not up to the individual to, let's say, do without psychological treatment by the medical establishment....you must pay for it.

    There is no free lunch....

    •  Again (3+ / 0-)
      Recommended by:
      Mark Warner is God, glynis, pico

      That gets into the cost issues... which I intentionally left out to avoid bloat.

      The intention wasn't that this address all concerns around the bill - just the narrow issue of whether the coverage is sufficient, regardless of cost.  I'll look at cost in another diary - the intention being it won't stand alone either as a singular defense of the bill.

      I guess everyone's got their own blog now.

      by zonk on Thu Dec 17, 2009 at 08:47:41 PM PST

      [ Parent ]

      •  It is also a fundimental issue of principle..... (1+ / 0-)
        Recommended by:
        pico

        Preface:

        "Mandates" are the key, one word for two different issues.
        This N.Y. Times article, describes the two distinct issues both, confusingly enough using the same term. The first mandate is the requirement that individuals purchase insurance:

          The proposals now before Congress would require just about everyone to buy health insurance or to get it through their employers — which would generally result in lower wages. In other words, millions of people would be compelled to spend lots of money on something they previously did not want, at least not at prevailing prices.

        This relationship between the need to pair subscription with coverage, either everyone is forced to buy a policy or you can't have universal coverage, was so clear that Paul Krugman castigated candidate Obama for fudging on this. In fact he felt strongly enough to support Hillary Clinton for being honest about the need for such universal requirement to purchase insurance. But Krugman, Academic credentials and Nobel Prize not withstanding, has wavered, becoming more a partisan democrat then the economist.

        This proposal for mandates to buy insurance. is naturally onerous and resented by most Americans. So over time the Democratic majority has watered down this requirement. It had been a firm mandate, backed up by criminal penalties, but this did not poll well. So in a bit of partisan flim flam this was gutted, by having the same bill that had been proposed and rejected by Republicans in the Senate Finance Committee reintroduced by Democrat Charles Schumer. It was then accepted by Democrats thus passing almost unanimously. Even Professor Paul Krugman criticized this, but oh so gently, as I described here.

        Other "Mandate" issue, what must be included in every health policy, This is usually determined by political clout rather than scientific principles. The insurance policies that will be mandated (1st usage) to be purchased by every individual, and subsidized by the taxes of all Americans is a complex packages of services. A portion of these are based on scientific verification of efficacy, that part of MDs actions that are verified by "evidence based" principles. The rest is the grab bag of traditional doctor's practice, including demands of patients for such things as useless antibiotics for colds, or the hand-holding placebo function of physicians, which certain people enjoy and others would prefer to get by speaking to their minister, family or the guys at the bar.

        More about such provision mandates from the Times article:

           A further problem is "mandate creep," which we’ve seen at the state level, as groups lobby for various types of coverage — whether for acupuncture, alcoholism and fertility treatments, for example, or for chiropractor services or marriage counseling.

           There are now about 1,500 insurance mandates among the various states, and hundreds of others are under consideration. The dynamic at work here is that the affected groups have a big incentive to push for mandates, while most other people are unaware of the specific issues and don’t become involved.

           Because mandates don’t stay modest for long, health insurance would become all the more expensive. The Obama administration’s cost estimates haven’t considered these longer-run "political economy" issues.

        So under this HCR law we will all have to pay for insurance, our own and those whom we subsidize, that include unproven practices mentioned above, but exclude abortions and dental care---something that those who must buy these policies will now find even less affordable. Every mandate is a choice, that had been made by the individual, but now is made by the government for every citizen. Every mandate increases the price of insurance, which means that since there will be a requirement that everyone purchase this, it has the effect of lessening the ability of the every American to have resources to purchase that which is not mandated.

        By not mandating Abortion, and going further and according to the house bill having an Negative Mandate, a proscription for this service, it will deny a given number of women the right to an abortion by diverting funds that could have been available to purchase insurance. The post HCR policy will have other services, such as marriage counseling, which is a cruel joke to the pregnant unmarried woman who does not want to carry her fetus to term.

        Such mandates will only grow even more under the federal government, which, unlike states, have the authority to "print money" to cover its excesses, thus keeping insurance rates low....right up until the harm to our fiscal integrity reaches the point of no return. In the name of prevention of individual disease, we court economic catastrophe, a national disease, we won't recognize until irreversible economic collapse.

        •  Sure... (3+ / 0-)
          Recommended by:
          glynis, pico, arodb

          I take it you're of the more libertarian 'no mandates, public option or not' set?  

          Not using that as a pejorative - it's actually a pool I myself dabble in... though, as I said in another comment, I'm more of the theoretical libertarian than the practicing type.

          What you point out, I think, is one of the biggest, broadest, and worthy of consideration libertarian oppositions to this bill... or at least, the mandates.

          In a calmer world, more able to discuss such issues - we would give a good hearing and debate to the idea that there are economic dangers to extensive government mandates.

          I guess everyone's got their own blog now.

          by zonk on Thu Dec 17, 2009 at 09:04:20 PM PST

          [ Parent ]

          •  Sorry the comment was so long... (1+ / 0-)
            Recommended by:
            pico

            its from my personal blog that has been waiting for a worthy interlocutory such as yourself to engage in discussion.

            If you get the time the first part describe the two distinct meaning of the single word, "mandate"  The problem being discussed is mandates for services, such as mental health, family counseling, preventive care etc.

            Each of these may be useful, but not everyone wants to have all their problems addressed by the Medical Model.  Some may want to have a religious counselor, or maybe take a trip to Europe and forget about their problems.

            Heres the key part from a NY Times article, that is a major issue:

            A further problem is "mandate creep," which we’ve seen at the state level, as groups lobby for various types of coverage — whether for acupuncture, alcoholism and fertility treatments, for example, or for chiropractor services or marriage counseling.

              There are now about 1,500 insurance mandates among the various states, and hundreds of others are under consideration. The dynamic at work here is that the affected groups have a big incentive to push for mandates, while most other people are unaware of the specific issues and don’t become involved.

            This is a valuable discussion, perhaps the first at this level.  Yet these discussions are not taking place, rather it is political football.  As Howard Dean said the Democrats have forgotten that they are dealing with a bill that affects real lives, and want to "win" by passing the bill.

            That is the travesty.  It could take a year to get this right, and during the time Republicans could come aboard, especially if we actually addressed malpractice seriously.

            Winning in this case is not the goal, but getting this complex bill right is.

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