With the passage of the health care bill hanging by a thread, the purity trolls are posting diary after diary saying, in effect, "this bill sucks, but we should pass it anyway". In the process, they are repeating a lot of the misinformation, disinformation, and outright lies that they have been spreading around Daily Kos for months, while they were advocating to kill the bill outright. It almost seems that the view that "this bill is a steaming pile of **** " has become the conventional wisdom around here.
The following are three of the biggest talking points being spread by the disinformers:
- The mandate will force us to buy health insurance from (greedy, evil) for-profit insurance companies.
- With government-mandated demand, the (greedy, evil) insurance companies will be able to make huge profits by jacking up their rates to even more outrageous levels.
- This means that the bill is a huge giveaway to the health insurance companies. (Subtext: since everyone knows that all corporations are utterly opposed to the interests of all real people, this means that the fact that insurance companies are not fighting it tooth and nail means that the bill must be bad for consumers.)
- Single payer / public option is the ONLY acceptable health care funding mechanism.
All of these claims are false. They have been repeatedly debunked, but the disinformation brigade keeps trotting them out anyhow. Apparently, they have learned from the Republicans -- it doesn't matter if your talking points are lies, as long as you keep repeating them as though you believed them.
Lets start with the mandate. The bill requires that people who are not already insured will have to buy insurance from an insurance organization or pay a "fine" that will come to a maximum of 2% of their income. The bill REQUIRES that at least one of the health insurers in each exchange be a not-for-profit, so talking point about forced to buy from a private company is complete bullshit. To be included in the exchange, insurers (whether not-for-profit or for-profit companies) will have to meet minimum standards for coverage, which will be set by an independent regulator.
Now as to rates. The bill sets minimum standards for medical loss ratios (MLRs). All insurance companies, whether for-profit or not, will have to spend at least 80% of individual and small-group premiums, and 85% of large-group premiums, on medical care or prevention. If not, they have to rebate the difference to the consumers. The remaining 15-20% after paying for medical care has to cover everything else -- claims administration, rent, phones, marketing, management salaries, and -- if anything is left -- stockholder profits. Thus, the insurance companies CANNOT jack up their rates, except to the extent that they are paying more for medical care. Otherwise, they just have to give the difference back. The regulators are empowered to tighten these limits further in the future.
The Bill will also outlaws rescissions, and prohibits insurers from discriminating against pre-existing conditions. That means that "medical underwriting" to recruit well people while screening out sick people is no longer possible, and the people who spend all day poring over medical histories to find some excuse for canceling a sick person's policy will be out of work. The minimum list of conditions and treatments to be covered will be set by an independent regulator, so most of potential for denial of treatment will be eliminated.
The cap on MLRs will drastically change the incentives to insurance companies, to the benefit of consumers. The present system virtually forces insurers to behave evilly. Corporate officers have a fiduciary duty to maximize profit, and the way you do that now is by charging as much as possible, doing as much as possible to screen out sick people, dropping formerly healthy people when they get sick, refusing to pay for anything you can get away with not paying for, and delaying payment as much as possible for the rest. But what's the point of straining to deny payment of a claim, when you just have to rebate the money back to the policy holders in any case?
In fact, the incentives will now run the other way -- with the cap on MLR, the only ways to increase profit will be (1) to INCREASE medical payouts (since every $850 you pay out means another $150 to cover overhead and profits) or (2) to process claims more efficiently. But processing claims efficiently means PAYING them -- not paying people to find reasons to deny coverage. With this change in incentives, even private insurance companies will look a lot more like regulated utilities, and a lot less like Snively Whiplash.
The Bill is clearly designed to accomodate private (and especially not-for-profit) insurance companies, but that doesn't mean that its opposed to the interests of the consumer. With the limits on profit imposed by the MLR restrictions, a lot of the more aggressive (i.e. evil) for-profit companies will probably drop out of the business, as they will no longer be able to meet Wall Street's profit demands and their own management's outrageous salary expectations. That will tend to favor the not-for-profit insurers like Blue Shield, Kaiser, and WHA.
With the 80%/85% MLR restriction, no rescission, no discrimination against pre-existing conditions, mandatory coverage for a list of conditions to be determined by an independent regulator, and 100% coverage of preventive care, I don't think there will wind up being that much difference between the not-for-profit option that the bill REQUIRES to be in each exchange and what we would have gotten with single-payer. Remember, even with single-payer, SOMEONE has to administer the claims, and governments would likely wind up paying private contractors to do it. There may even be some advantages to this model -- different not-for profits could still offer some consumer choice, and having independent not-for-profit boards would help shield the health system from political changes. Suppose a future Republican administration appointed someone opposed to health care to run the single-payer system, the way the Bush administration did to EPA and OSHA.
The bottom line -- despite what the Firebaggers and purity trolls would have you believe, the HCR bill as it presently stands will mean a HUGE improvement in health care, and not just for the people who are presently uninsured / uninsurable. This is not something that progressives have to hold their noses and swallow, this is a triumph for progressivism, Democrats, and the Obama administration.