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UNDERNEWS

Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of ten of America's presidencies and who has edited alternative journals since 1964. The Review, which has been on the web since 1995, is now published from Freeport, Maine. We get over 5 million article visits a year. See prorev.com for full contents of our site

March 19, 2010

WHAT'S REALLY IN THE HEALTHCARE BILL?

Sam Smith

As noted here before, the healthcare bill is a horrible mixture of the good and the bad. Because, in the end, it will improve healthcare for many people, it is probably best to pass it and deal with its problems later, but it still remains in large part a god awful measure. Here's a rundown on some of the good and the bad:

HOW MANY ARE BEING HELPED?

The Obamites brag about the bill providing new health care for 32 million people.

- In addition nine million of these, according to the CBO study, are presumed to be people moving to a another form of health care - i.e. from their employer based insurance (4 million) or presently non-group insured (5 million) moving to exchanges.

- Half of the improvement (16 million) would be due to improvements in Medicaid and CHIP. You don't need a 2000 page bill to do that.

- Subtract the Medicaid and policy shifters from the calculation and you end up with 16 million new people getting insurance. And this is not, for the most part, because the Democrats are providing it (although there will be tax credits to help some). A big reason will be a hidden tax known as the individual mandate. Thus Obama and the Democrats are claiming credit for giving people something when they are instead requiring them to do it with their own funds. This would be like claiming credit for increasing millions of people's incomes by reinstituting the draft.

- In sum, about 16 million people are being substantially helped and about the same number are being manipulated into thinking they are getting more than they are.For example, private insurance costs can be expected to soar, but tax credits are unlikely to rise at the same rate.

THE MANDATE

The individual mandate is unconstitutional. As constitutional attorney David Rivkin has explained, it goes far beyond the standard judicial excuse of regulating interstate commerce: "What's unique is the mandate [is] imposed on individuals merely because they live - not connected with any economic activity, not because they grow something, make something, compose something. Merely because they live. And this is absolutely unprecedented." Even when the government decided to ban drinking during Prohibition, it at least had the decency to pass a constitutional amendment.

Although the Democrats and the media don't want to talk about it, it's worth noting that even the Congressional Research Service would only go as far as to say that Congress "may have" the power to impose mandates but also called it the "most challenging question" of the measure.

If this provision is upheld in the courts, nothing would prevent the government from, for example, ordering people above a cetain BMI to buy memberships in private health clubs and to attend them at least three times a week.

THE INDUSTRY SUBSIDY

By requiring new insurance from inefficient private providers instead of through a government program, the administration is subsidizing the insurance cabal by billions of dollars. Further, even though the public option provision fell far short of what it should have been, Obama's back room deal with the industry to knife it is one of the strongest reasons why he should not be encouraged to run again for president.

THE STALL

An amazing number of provisions won't go into effect for four to nine years. One of the problems with this is that if, during this period, the GOP gains control of the Congress, there is nothing to stop them from stalling these programs further. In addition, the Democrats are playing an extraordinarily dangerous political game - taking immediate credit for things that may not happen for years to come. In fact, the first significant benefits to anyone will not occur for four years according to the CBO calculations.

For example, not until 2014 would employers be banned from denying coverage or providing higher premiums for women or older people. What if our civil rights laws had been written that way, say, giving restaurants four more years to ban blacks?

MEDICARE DRUG FUNDING

The reconciliation bill includes additional Medicare drug funding, closing the so-called doughnut hole in coverage.

NEW MEDICARE TAX

Business Week: "Already in the Senate bill, a higher Medicare payroll tax will be assessed on individuals who make more than $200,000 a year or families with income of more than $250,000. The reconciliation bill includes an additional 3.8 percent Medicare tax on unearned income such as dividends on these high earners."

EMPLOYER MANDATE

Business Week: "Under the Senate bill, if an employer with more than 50 employees doesn't offer coverage and has just one employee who qualifies for a new tax credit, the company must pay a fee for every full-time employee on its roster. The reconciliation bill raises the penalty to $2,000 from $750, though it subtracts the first 30 employees from the calculation.

ABORTION FUNDING

Not currently addressed in the bill.

THE MEDICARE-MEDICAID METAPHOR

The liberal Center for Budget Policy & Priorities claims that "this legislation [will] produce the greatest gains in health coverage since the enactment of Medicare and Medicaid 45 years ago." This is an insult to Medicare and Medicaid, which were, after all, public programs and not regulations. There is a huge difference between providing someone with something and ordering them to buy it.

WHO NEEDS A CONSTITUTION IF THE BUDGET IS BALANCED?

The legislation includes a flagrantly anti-constitutional provision, as described by the CBPP:

[] The legislation would establish an Independent Payment Advisory Board to develop and submit proposals to slow the growth of Medicare and private health care spending and improve the quality of care. The President would nominate the board's 15 members, who would require Senate confirmation, for staggered six-year terms.

If the projected growth in Medicare costs per beneficiary in 2015 and thereafter exceeded a specified target level which it almost certainly would do in many years the board would be required to produce a proposal to eliminate the difference. The board could not propose increases in Medicare premiums or cost-sharing or cuts in Medicare benefits or eligibility criteria; it would focus on proposals for savings in the payment and delivery of health care services.

The board's recommendations would go into effect automatically unless both houses of Congress passed, and the President signed, legislation to modify or overturn them. If the board recommended changes that the President supported, the President could veto any congressional attempt to block them, and a two-thirds vote of both the House and Senate would be required to override the veto.[]

This provision is contemptuous of the basic concept of our constitutional government.

CUTTING MEDICARE COSTS

One of the big sleepers in the bill is the plan to "institute efficiencies" in Medicare programs. In fact, Medicare is far more efficient than any private insurance plan in the country.

Consider this snippet from CBPP: "The legislation would reduce annual payment updates to hospitals, skilled nursing facilities, hospices, ambulatory surgical centers, and certain other providers to account for improvements in economy-wide productivity. It would also reduce payments to home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities." And just what will happen to service and its availability?

Remember: one person's efficiency is another's lack of service.

OTHER PROVISIONS

CBPP - Within months, insurers that offer coverage of policyholders' children (including in existing plans) would be required to allow adult dependents younger than 26 to be added to such coverage. In addition, new insurance plans would be barred from excluding children's pre-existing conditions from coverage and would have to cover certain preventive services at no charge to enrollees.

EXPANDED MEDICAID ELIGIBILITY

Saving the best until last. As the CBPP puts it:

"The plan would expand Medicaid up to 133 percent of the poverty line for all children and adults younger than 65 who are lawfully residing in the United States and not eligible for Medicare. This would mean that millions of low-income parents, as well non-disabled low-income adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states with waivers), would become newly eligible for health coverage through Medicaid. Medicaid is the most cost-effective way to provide comprehensive and affordable coverage to people with very low incomes and thereby ensure that the low-income uninsured gain coverage. "

IN SUM

The bill will provide about 16 million poor people with significantly better health care. It will force millions more to buy health insurance, softened by tax credits that will not keep up with rising policy costs. 

It will put some restrictions on the insurance companies in return for providing them a multi-billion dollar annual subsidy.

It will declare the right of the government to order you to buy something whether you want it or not, and will it establish a budget commission with supra-constitutional powers. Both these provisions would be struck down by a rational Supreme Court (such as we haven't seen in some time) or the Constitutional shall have to be "deemed" substantially amended.


10 Comments:

Anonymous Anonymous said...

This bill is poison. Like you said, all that really needs to be done is to expand medicare for those who can't afford health insurance.

What we need is more education on this subject - something the corporate media absolutely refuses to do for obvious reasons.

The other thing you didn't mention is the medical records provisions. This data will be used by everyone for everything imaginable. And it will be a method for further control and restriction of our freedoms.

Can mandated vaccinations and "medication" for those who question the supreme authority of the government be far off?

March 19, 2010 10:42 PM  
Anonymous Fact sheet: the truth about the healthcare bill said...

http://www.huffingtonpost.com/jane-hamsher/fact-sheet-the-truth-abou_b_506026.html

March 20, 2010 9:19 AM  
Anonymous Anonymous said...

Et tu, Sam?

FWIW, here's my letter to Dennis Kucinich:

So how did they get to you, Mr. Kucinich?

Did your opposition to Obama's gift to the insurance and pharmaceutical industries start to waver when Rahm Emanuel went to the House Progressive Caucus a month ago and called you and your colleagues "a bunch of fucking retards" for not seeing the benefits (more campaign money) of voting for the bill the health care lobby drafted?

Maybe it was Mr. Obama's letting you ride on Air Force One. Is that plane really cool? Maybe you got a complimentary bag of (vegan certified, of course) pretzels.

Maybe Mr. Obama offered to create your 'Department of Peace', making you its first Secretary. If that's the case, but sure and ask for an office with a window. Doing nothing all day gets pretty boring if you don't at least have a window to look out.


In the press conference in which you announced your switching your vote you admitted that the bill is still a bad bill -- as you have been telling everyone for months. You rationalized your new support for the bill on the grounds that a defeat for Obama's health care bill would "delegitimize" Obama's presidency. In other words, you think Obama's presidency is legitimate and worthy of protection. That is an odd defense, coming from someone who sought to impeach Obama's predecessor, Bush, because he started a couple of illegal wars, violated the Geneva Convention, and pushed through the civil liberties disaster called the PATRIOT Act. In case you haven't noticed, Mr. Kucinich, the current president, the man whose 'legitimacy' you hope to preserve, is expanding Bush's illegal wars into Pakistan, Yemen, Somalia and even Colombia. There has been no congressional authorization for these illegal acts, either. Obama has also pledged to give the military and intelligence services free reign when it comes to their treatment of 'detainees' (the Obama administration, consistent with the preceding administration, refuses to call prisoners taken in this war 'prisoners of war', because prisoners of war have rights under the Geneva Convention). AND (last but not least) Obama just pushed through a reauthorization of the PATRIOT Act (in addition to defending warrantless wiretapping of American citizens). In other words, Obama is doing all the same things that you thought warranted impeachment proceedings for Bush. But, when it comes to Obama, you throw away your integrity to defend him.

How does it feel to have affirmed Rahm Emanuel's assessment of you?

March 20, 2010 9:25 AM  
Anonymous Anonymous said...

Jane Hamsher has a better analysis of the bill at:

http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/#comments

March 20, 2010 9:46 AM  
Anonymous Anonymous said...

Given the recent behavior of 5 of the members of the Supreme Court, I think passing this bill will amount to serious trouble for the American people. I have no doubt that we will all be required by this Supreme Court to purchase private insurance from for profit companies, and be harshly treated if we cannot afford it.

The last thing I want to see is the Constitution interpreted to allow this corruption. But given the recent campaign finance decision, I can only be certain that if they make a decision about health care, that it will be the most corrupt decision possible.

Honestly even with my employer offering health insurance, the plan is a big donut, so I already put off health care because of the costs. This bill will insure I go less often as costs rise. I have chronic conditions I would love to have properly treated, but the costs I would run up would bankrupt my family under our current health insurance policy. If I'm going to have something serious happen it better happen while I am in my car, because the health portion of my auto insurance is much better than anything my health insurance offers.

March 20, 2010 12:16 PM  
Anonymous Anonymous said...

"Fact: The bill will not bring down premiums significantly, and certainly not the $2,500/year that President Obama promised during his campaign...
Fact: The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can't afford to use.

A family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income -- out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible....
Fact: This bill will mandate that millions of people who are currently uninsured purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties. Some will be assisted with government subsidies....

Fact: The excise tax will result in employers switching to plans with higher co-pays and fewer covered services.
Older, less healthy employees with employer-based health care will be forced to pay much more in out-of-pocket expenses than they do now."

http://www.huffingtonpost.com/jane-hamsher/fact-sheet-the-truth-abou_b_506026.html

Personally, I'm retired drawing Social Security. My wife has Parkinson's and works at a union supermkt. We can't afford to pay more out of pocket or have her employer forced to drop us so that Obama can pimp for the insurance co.s. we don't know how long my wife can work, but we do know that the feds keep pushing back her retirement age, and should she become unable to work before that time, there's already a two year wating period for Social Security disability because they're so underfunded they don't even have the staff to talk with any new applicants for two years. But they have funds for CIA bullshit and Israel's bullshit and Bernanke's bullshit.

March 20, 2010 3:55 PM  
Anonymous affinis said...

The indexing provisions in this bill – i.e. the inflation adjustments – are extremely bad news. These constitute some of the worst provisions in the bill – and they’ve received essentially zero attention from the media.

For example, with the excise tax on “more expensive” health insurance plans – the indexing provisions fall far below the actual rate of increase in health care premiums, and would result in an increasing proportion of the population being hit with the tax every year – until ultimately everyone would be hit. When Obama talks about “bending the curve” – part of the idea is that the excise tax will result in continual increases in copays and deductibles. The idea is that this would discourage people from using medical care (i.e. reducing “demand” – which under conventional economic theory would apply downward pressure to medical costs). However, I personally think this is a terrible idea – e.g. when someone has chest pains, they’re going to defer seeking treatment because of the high copays and deductibles.

Sam writes “If the projected growth in Medicare costs per beneficiary in 2015 and thereafter exceeded a specified target level which it almost certainly would do in many years”. The indexing provisions (for Medicare “target levels”) are set up to be below the medical inflation rate. This will result in effective cuts in Medicare not just in “many years”, but large and increasing Medicare cuts pretty much every year.

March 21, 2010 3:01 AM  
Anonymous another letter for dennis said...

FUCK YOU DENNIS KUCINICH- What did you REALLY GET for Selling us out, you piece of shit?
Posted on March 17, 2010 by willyloman
by Scott Creighton
The worse part of this, aside from the passage of this criminal fucking bill and the mandate to force poor working slobs to buy flawed insurance from corrupt corporations, the worse part of all this, is going to be the insufferable Obamaites will use this moment as a coranation of their self-important, self-absorbed, egotistical masterbatory delusions of grandure. There will be no living with these fucking freaks just like it was after Bush’s “MISSION ACCOMPLISHED” speech. The fucking morons went on and on in their little cocoons for almost a year, riding high on their self satisfaction. Expect the same from the Obamatrolls. Leave it to Dennis to reignite the Obamalove express. This sets us back a year at least. All because the fascist Obama scared the shit out of some little man.
No, I am wrong. The worst part of all this is the fact that this bill is just a pleasant fiction… it’s the Privitization of our entire healthcare system in a pleasant little package. Just like Dennis said the other day, this bill will be the next big step in privatizing Medicare, Medicaid, and all the rest. That’s what Kucinich is voting “YES” for and THAT is why he can’t be forgiven for doing so.
Dennis took a plane ride with Obama and sold us out. Threw us right the fuck under the bus. He sold us out after talking to Obama and Pelosi. He sold us out because he was told that without his support other progressives would also hold out and Pelosi would have to use the “deem and pass” trick to force Obamacare on the American people. That action would harm her rep and Obama’s rep. So he flipped his vote without getting a goddamn thing in exchange.
The one thing he said at the end was that he “didn’t like the process” that has taken place on this bill, when he was asked about the threat of the “deem and pass” possibility. He hung his head and said, “look, if your looking for someone to say they approve of the way this bill was handled, I’m not the guy. I don’t like anything about how this bill was passed. I’m voting “yes” and that is it.”
Possibly a little insight into what happened on that plane flight to Cleveland. BUT I DON”T GIVE A SHIT. Real leaders continue to stand NO MATTER WHAT THE FUCKING CONSEQUENCES.
Here that Dennis? you piece of shit.
Did Martin Luther King cave, you cowardly motherfucker? Did JFK in the end?
They were heros, you’re a punk. End of story. End of live blogging.

March 21, 2010 1:49 PM  
Anonymous affinis said...

Here's an entry/thread from FireDogLake - folks discussing forming a new party. I'm posting it here to encourage crosstalk.
I think there's potential common ground.
http://seminal.firedoglake.com/diary/36624

March 22, 2010 3:29 AM  
Anonymous Anonymous said...

you missed verichipping.
so they can pick us up like the martians did in tom cruise's War of the worlds.
Charles Kafka

March 26, 2010 6:39 PM  

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