HuffPo's Sam Stein has a new report today, that Rep. Dave Camp (R-Mich.), chairman of the powerful House Ways and Means Committee, is acknowledging the House leadership is giving up repealing health care reform, and claims that they will be focusing on repealing the individual mandate.
To be polite, that is bunkum.
Stein is usually one of the good examples of real reporting at HuffPo, but alas this is a typical mainstream media case of too much stenography of a what a politician says, and not enough actual background and investigative reporting.
As I have noted correctly before, there is zero chance that Republicans and the corporate wing of the Democrats will actually repeal just the individual mandate. And I don't believe the corporatist wing of the Supreme Court will do it either.
Just a reminder that the mandate is what AHIP and insurance companies want. It is the basis for their own preferred plan: make everybody buy their inherently overpriced and defective product.
Politically, the individual mandate was supposed to be the compromise that "sensible mainstream inside-the-beltway" proponents of health care reform had to agreed to, in return for which AHIP and others were not supposed to fight (too much) against much of the good stuff in the health reform bill with regards to guaranteed issue, some degree of community rating, a minimum percentage that is supposed to be spent on actual care (and not profit and overhead), and other oversight and regulations limiting their abuses. Of course that deal was supposed to also include the public option, to keep the insurance companies honest and ostensibly to provide them some real competition.
Indeed, if there were ever really were a bill that was narrowly limited and defined to just eliminating the individual mandate, I would urge everybody to support that. The mandate without at least a strong public option is an abomination.
But that is not what this is really about. But what is really going to happen, what this is really about, is that this is all cover for a whittling away of those regulations and oversight. It is already happening with various waivers and extensions and deferrals that the Obama Administration has been granting as they begin roll out health reform.
So keep you eye on what is really going on. They will talk about individual mandates, to say nothing of needing more flexibility, common sense, free market, competition...
They will say:
"We tried but the bad liberal Democrats in the Senate wouldn't let us."
Therefore, they will go on to say, here are reforms and fixes we need:
"A common sense market based approach"
"That bad government take-over Obamacare is too inflexible, too one size fits all"
"We need more benefit design flexibility."
"We need more market flexibility"
That is what we are going to be hearing. And they will be trying to get enough support from conservative, blue dog and corporatist Democrats to be successful in chipping away at the good stuff we did get in health reform.
All those phrases, "common sense" and "market based" and "inflexible" and "benefit flexibility" are code for weakening or getting rid of: guarantee issue (cannot be denied insurance even at high cost due to pre-existing conditions) and community rating (price for insurance is not based on your individual risk, which is needed to make guarantee issue meaningful), the limits on medical expense ratio (insurance companies have to use the money to pay for health services, not overhead, marketing, profit and their own salary) and protection against rescission (dropping your coverage and refusing to pay once you get sick).
Most of the good stuff is already pretty weak in reality. They will be working legislatively and in the regulatory process, to make it weaker still.
Furthermore, they will go for a divide and conquer approach:
They will try to divide young versus old; they will say:
"Why should the young pay more to cover the old."
Which really means weaken community rating.
They will set the healthy against the sick; you will be hearing:
"Why should the virtuous healthy (they will say) pay more, in order to be able to make coverage affordable for those bad people who get themselves sick (overweight, poor diet, alcohol and other drugs, poor, minority, whatever)."
This translates as an attack on guarantee issue, and community rating, and rescission protection and minimum medical expense ratio.
The problem remains that they cannot, nobody can, make money by insuring sick people. Taking care of sick people is too expensive (even after those other necessary cost cutting reforms) to pay for themselves. Avoiding adverse selection, avoiding having sick people in their insurance pool to begin with, and finding ways to dump people once they get sick, is the main basis on which the private health insurance industry competes. That is what they did, do, and will continue to do.
That is why, in addition to other good and necessary reforms with regard to drug and procedure costs, and hospital and provider payments, the underlying and overarching necessary reform remains single payer.
The best policyremains "Improved and Expanded Medicare for All": a single universal "All America" insurance pool. There should be no issues of adverse selection. Everybody-in and Nobody-out. It would be paid for by the same progressive taxation we pay for other federal government goods and services including social security, military security and payment on the interest of the national debt. There would guaranteed and automatic enrollment. In addition to getting rid of the problem of adverse selection there would be the savings from getting rid of the private insurance companies as a wasteful unnecessary intermediary. There would be the additional cost savings benefit from monospony (single buyer, multiple sellers) in paying for services, equipment and drugs. There would be added benefits of global budgeting and strategic planning. At the end of the day, single payer is not a dream, it is only system that can actually work.
