There are many decisions that we make, personal or political, which we can research, draw upon similar experiences, evaluate data and then based on our own values and situation, reach an informed conclusion. Then there is what we call "Faith," how we deal with regions that are beyond verification.
"Religion" and "Faith" are synonyms, since religion is of the realm of the non-verifiable. Because of this, such faith is also non-refutable. Religious people can and do lose their faith, but it is rarely through logical refutation.
Understanding the totality of the United States Health Care system, thousands of Federal Laws and regulations, modified by fifty different states, is unknowable to mere mortals. It is the sheer complexity of it. The Current Health Care Reform, now in two bills passed by both houses of congress, adds to this morass; as the approximately 2000 pages of each understates the complexity, as each clause relates to other existing programs that must be then understood to evaluate their merits.
I'm going to attempt to illustrate how little we know, how little we can know by one single section with the acronym:
C.L.A.S.S
Almost everyone on this site could explain the Public Option, or how the bill will affect abortion access, perhaps most knowing the specific language under debate. Yet, as important as these two elements are, the bill is so much more. Not only by what it does address, but by what is tacitly accepted into the permanent structure of our national health care.
The following is a new program that is included in both the house and senate versions of this bill. To go along with this diary, I ask you to answer the poll now. and then return to my response and links for reference.
Please
Answer
Poll
Before
Proceeding
Now for the answer. Class stands for Community Living Assistance Services and Supports (CLASS) Act , which would create a national insurance trust, which would provide a modest cash benefit to seniors and persons with disability. This recieved a pass from the CBO, which is referred to as non partisan, even though the head of this agency is chosen by the respective leaders of each house of Congress.
The Actuarial Department of Medicare is truly non partisan, with the director appointed by the president, in this case Clinton, but not subject to change with each administration.
Let's look at how each of these agencies viewed this bill which I excerpt from this essayon the Actuarial Report. That happened to have been read by the Department head Rick Foster, who thanked me for publicizing it.
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Two agencies with different dedications to precision, CMS and and CBO
The Actuarial Department of the CMS performs some of the same functions as another more well known agency, The Congressional Budget Office, CBO. It is useful to compare how these two agencies reported on a component of the House Bill, a federally sponsored long term disability program called CLASS.
First the CBO from it's analysisof HR-3962 (pg 13):
As noted earlier, the CLASS program included in the bill would generate net receipts for the government in the initial years when total premiums would exceed total benefit, but it would eventually lead to net outlays when benefits exceed premiums. As a result, the program would reduce deficits by $72 billion during the 10-year budget window and would reduce it a smaller amount in the ensuing decade....In the decade following 2029, the CLASS program would begin to increase budget deficits. However the magnitude of the increase would be fairly small compared with the effects of the bill's other provisions, so the CLASS program does not substantially alter CBO's assessment of the longer term effects of the legislation.
Compare this with the actuarial reportfrom CMS
(pg 11)
In general, voluntary, unsubsidized, and non-underwritten insurance programs such as CLASS face a significant risk of failure as a result of adverse selection by participants. Individuals with health problems wold be more likely to participate than those in better than average health.....a classic "assessment spiral" or "insurance death spiral" ......there is significant risk that the problem of adverse selection would make the CLASS program unsustainable.
The CBO ignores the fact that this program is required to stand alone, precluded from being subsidized by federal funds. In this way it is similar to the same requirement of the "public option" for general health insurance. Yet, the CBO scores the revenue from premiums that should be treated as reserves as reducing the deficit, and then dismisses the anticipated cost when payments to subscribers will be due as "fairly small compared with the effects of the bill's other provisions." This enables them to ignore the ultimate actuarial inconsistency, and the specific requirement in the bill that this title be evaluated independently.
In contrast the CMS actuarial report describes the program for what it is, "a classic "insurance death spiral" open to "adverse selection" that would make the CLASS program unsustainable without breaching the stricture of the program standing on its own. Also not mentioned by either agency, is that because this will require future support, a bailout if you will, the premiums will be cheaper than those of the private insurance industry that are required to be actuarial sound. This will increase the expected growth of this program, and the scale of the bailout when the time comes for it.
This program is illustrative of how this bill is being passed not only by misrepresentation, but simply by the obfuscation of the massiveness of the legislation. I've written an essay of 6000 words, and I have hardly scratched the surface. And, paradoxically, the more I discover, the more defects that I write about, the less effective it is, since ultimately those who support this are acting on faith.
Details, especially those that militate against this bill, are simply deflected as being from the opposition, as biased, as "Republican Talking Points." My quoting the Chief Medicare Actuary, Rick Foster, along with the report of his 80 person department of economists and health care professionals, is simply ignored by those who have become "true believers."
Perhaps, I have become a "true believer" in the nefariousness, the harm that will come from this bill, and as such I am the victim of what I describe here. I only wish that actual engagement were possible, as even though difficult, it is worthwhile to transcend "belief" on such a vital issue.