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Health-care reform is anything but scary
When Jim Villanucci was kind enough to invite me on to KKOB for a few hours last week, I was expecting the usual tea party accusations that health-care reform is a government takeover of 1/6 of the economy.
What I wasn’t expecting was to hear such a high percentage of callers admit that they, or someone in their family, receives some kind of taxpayer-subsidized health care.
They uniformly said current government health programs were working just fine. Strangely, though, many callers claim that the newly passed reform is a socialist government takeover.
Beyond the hypocrisy of enjoying government health care while trying to deny it to others, the tea partiers have missed the biggest story about reform: It is the furthest thing imaginable from a government takeover of health care.
All health-care reform does is take the current private system and ensure access to care for sick people. That’s it. That one basic principle of guaranteed issue requires three follow-ups: community rating, full participation and some subsidies, but those are simply necessary components to enforce the idea that pre-existing conditions shouldn’t stop you from getting care, whether you currently have insurance or not.
Carter Bundy
How else?
Seems pretty common sense that a health-care system should cover sick people. In order for sick people to get care, the first thing you have to have is “guaranteed issue.” That just means that insurance companies have to offer coverage to everyone, and they can’t kick you off if you get sick or if your illness is an expensive one.
But, of course, that means nothing if the insurance company smiles at you and says “sure, we’ll cover you. For $5,000 a month.” There have to be caps on what the premiums are, or there’s not even a chance of covering pre-existing conditions.
Caps are called “community rating,” and the new reform has a weak version of community rating. The new law doesn’t require everyone to pay the same thing – insurance companies can charge healthier people as little as 1/3 of what sick people pay. But at least there is some community rating.
Guaranteed issue and some community rating are necessary elements to covering people when they get sick, but they’re not sufficient. If you know you can buy insurance even after you get sick, don’t you have a strong incentive to not pay anything until then? Yes.
That’s where the “individual mandate” comes in. If you did everything else right, but didn’t require everyone to participate, existing insurance pools would suffer from “adverse selection” – only the sick would be in the pools.
After all, why would you ever pay a dime into the system if you knew you could get coverage if you became sick? The real term that ought to be used is “full participation,” because that’s all it is. Without full participation, the system collapses.
What I’d love to hear from opponents of full participation is how else the system can take people with pre-existing conditions without collapsing from adverse selection. How do they avoid people dropping out and free-riding until they’re sick?
Finally, if you’re going to require full participation, you also have to make sure that no one’s budget gets busted in the process – whether individuals or small business – so there have to be subsidies for lower-income people. Businesses with fewer than 50 employees aren’t required to buy insurance at all, but if they want to (and many do) they’ll get help as well.
Who pays for those subsidies? The short version is that unless you’re a millionaire or run a private company that scams profits off of taxpayers and seniors in Medicare Advantage, it’s not you.
What’s so scary?
That really is the bulk of health care reform. Insurance companies have to offer coverage within a range of prices, they can’t cut you off, everyone has to participate, and there will be subsidies for those who can’t afford it and for small businesses.
We’re using the same system we’ve had for a century, we’re using the same private providers, and we’re using the same private insurance companies. The only difference is now insurance companies can’t exclude or kick people out for being sick. That’s socialist in what way?
If anything, the 2010 version of health care reform is timid. After all, it’s nothing more than the 1994 Republican alternative to the Clintons’ proposals, and even as recently as 2006 Republican superstar Mitt Romney was defending Massachusetts’ individual mandate – the one he signed into law as the Republican governor of Massachusetts.
So let’s not pretend that the health-care reform that just passed is some socialist plot, or government takeover, or the end of freedom as we know it. Only two types of people make those claims: those ignorant of what’s in the bill, and those who know better but who are hoping for political gain based on fear.
Conservatives will talk of “repeal and replace,” but not a single conservative alternative passes the first principle of any health reform: ensuring coverage if you get sick.
While there is some merit in some of the conservative ideas that didn’t make it into this year’s reform, particularly on some cost issues, their plans ultimately boil down to “don’t get sick.” That’s not reform, and it’s certainly not health care. All they’re left with is pretending that health care reform is scary, when the truth is it’s anything but.
Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.
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I am personally ambivalent on health care reform, and believe, if we must have spent a year working on something, a public option would have been the better way to go.
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With regards to this bill – and I believe young-guns touched on this – it is unconstitutional. The bill drafters make the following case:
1) The decision to not purchase a product (in this case, health care) is an economic activity;
2) The product (in this case, health care) is a significant part of the national economy;
3) It’s so significant that it is most correct to say that it is of interstate significance; and
4) Congress can regulate interstate commerce,
If we accept this logic, then we accept that Congress can require us to purchase any product whatsoever provided that the product in question is acquired a) with dollars and b) is so important that our decision to purchase it it has a nation-wide economic impact. In short, if we accept this logic, we accept that Congress can require us to:
1) Invest in the stock market
2) Purchase Walmart stock
3) Purchase cars
And so on. Worse still, one of the arguments in the bill is that the requirement to purchase the product (in this case, health care) will create millions of new consumers, thus increasing demand for the product, thus creating supply of the product. . . and which will also, no doubt, create an economic environment of interstate significance. In short, the logic being put forward doesn’t just say that you can be required to purchase a product that exists. It says that Congress can pick any product, even one that nobody yet owns, and require us to purchase it. It’s unconstitutional in an astonishing way.
There’s no other way about it. If we accept the bill, we accept that Congress can force us to buy stock in Walmart – that Congress can have the IRS fine us if we decline to do so.
And that is scary.
Well I suppose we have to be more PC in our terminology. I lived in a country that proudly had what they called socialized medicine, heck they even had an official Socialist Party. So shall we call it something more PC? How about government run and funded health care for all? Does that make it more favourably viewed by the listeners? I still contend the backlash and problems heaped on ObamaCare going forward will doom any chance at government run and funded health care for all in the future.
I think it would be useful for us all to stop using what are, again, imprecise and anachronistic terms to define this debate. “Socialism” or “Socialized Medicine” are such a vague and loaded terms that their use always shuts down the conversation. And it doesn’t begin to reflect the variety of ways other modern countries are addressing health care for ALL of their citizens.
We have so many options. But only if people stop fearing change.
No one here seems to be able to make things short and simple. Access to health care is a right not a commodity to be bought and sold. Health insurance is not a century old. It was started in the later 1940′s after WWII. We in the USA spend more of our GDP on health stuff than any other country in the world. Yes, I am a retired ED nurse. I believe in access to care for all and not through the most expensive setting, the emergency department. True emergencies are dealt with immediately. Mr. Swickard’s recent event sounds like a true emergency. He should have nothing to fear in the new health reform act.
I do think those who are dreaming of socialized medicine in America need to remember what country they are living in here. Considering the extreme polarization and divisons created by ObamaCare (yes, a far cry from socialized medicine so far), and the likely backlash and future problems that will be heaped upon it, that dream is even further than ever from reality.
Compassion = tyranny.
Love = Bondage.
Money = Happiness.
Freedom =
Ignorance = Bliss.
Isnt’ it amazing that when necessary, dramatic, paradoxical metaphors can be drawn for every timeless principle and every ulterior purpose?
“Tyranny is forcing others to do what YOU think is best. That is the antithesis of freedom.”
Please. Don’t insult me or others with the teabagger jargon. We all do things everyday that are not what or how we’d choose, but we do because it is for the betterment of all.
Thinker – please read the declaration of independence. You may be shocked to find that we as a country declared as self evident (meaning obviously true, and requiring no proof, argument or explanation) that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness. We need not “achieve” life, liberty and the pursuit of happiness – these were given to us on our birthday by our creator.
This is not some moot point but a crucial part of the thinking that created one of the greatest documents ever seen on the face of the earth – the United States Constitution. Understanding freedom may help you to understand why the free market has brought the United States such heretofore unheard of prosperity. The lack of an understanding of freedom is what allows an otherwise intelligent person to advocate for this socialist system that will so clearly destroy the prosperity that took 200 years to create.
What you and Mr Bundy are advocating for is not compassion – it is tyranny. Compassion is a beautiful and voluntary act that happens countless times a day across the country (see the work of the Shriners for example). Tyranny is forcing others to do what YOU think is best. That is the antithesis of freedom.
You can not possibly understand the “fear” behind “Health Care Reform” if you don’t understand the gift that is freedom.
The goal of ObamaCare and the desire of Carter is to hasten the path to a single payer government run health care system. Carter works for a union that represents government employees, this is a great step forward. And we should stop using the word insurance, and not get bogged down in details. More people will pay more, health care options and quality across the board for most Americans will be reduced. And by the way, the debt will grow as a result.
This discussion really should be about how we, the richest country on the earth, can create practical and innovative ways to help our fellow citizens be as healthy as possible so that they can achieve “life, liberty and the pursuit of happiness”. Instead, we are coming at it backwards, simplistically fixating on taxes and blaming victims, mixing in political philosophy that has no relationship to the human condition, and ending up doing little or nothing about this huge economic and moral burden. Meanwhile, other first (and second and even third) world countries which are able to hold two complex ideas in their collective heads at the same time sail WAY ahead of us.
Michael, you’re so right: we should not be talking about health “insurance” reform. We need to throw away that system as wasteful, anachronistic and obsolete. While many of us use health care/insurance less, no one will be able to bet on not using it at all–and most of us cannot predict the unpredictable occurrence of things like accidents, cancer or infectious diseases that go bad. And as much as we want to blame people for their health problems, many are at least 50-75% the result of genetic predispositions that are exacerbated by modern life. We will all need to use the health care system, and since we are all living longer, we will need to use it more as we get older. We need to stop pretending that everything in human existence should be sold on the “fair market” like a carpet in a Baghdad Bazaar.
As a health care professional, I appreciate that you benefited from what is a true emergency at the ER. That is why ER’s were created: to provide care to those who have potentially or fully life-threatening emergencies. I am guessing that you probably have a primary care provider, someone who you could see during business hours, however, and I am guessing that you have either Medicare or similar coverage. So when you went to the ER, you probably had an idea of what your current health issues are, and you probably didn’t consider how much it would cost. You didn’t want to die that day, and you went and got help.
However, did you also notice the folks in the room around you? I promise there were many hardworking and decent people there for whom the option of insurance is simply not a possibility. Some are poor, but don’t qualify for assistance; some work and make enough money to disqualify them for help but still can’t afford the $600/month premiums and pay their rent. Others are disqualified from even high deductible plans because they survived childhood illness, cancers or have preexisting chronic conditions like heart disease and diabetes.
I have worked with uncountable numbers of patients who avoided the expense of primary care, only to have to enter the ER and then the hospital for emergency heart surgeries or amputations of a diseased limb or severe respiratory distress necessitating life support and long stays in the ICU. They were “betting” that they wouldn’t need those services, and being responsible, in their minds, by avoiding wasteful expenditures in their tight family budgets.
I just had a patient who is under 35 who was deemed uninsurable by his employer’s health insurance company who is now facing a $40K bill for an emergency he never could have predicted. He will survive, but may need a long recovery period, will probably lose his job. However, for those of us here who like to wave the “everyone gets health care in this country, but it’s not my job to pay for it” may I remind you that Dona Ana County and the City of Las Cruces have multimillion dollar programs coming out of your taxpayer dollars to cover these kinds of expenses: Indigent Care. His bill may be partially or wholly paid by YOU–only, instead of the several hundred dollars it would have taken to discover his illness two months ago, it will now cost 1000 times that. The sad thing is that if indigent care won’t help him, he will be pursued and sued and essentially lose any property or future earnings he may have. All because he was in the wrong place at the wrong time, life-event wise.
We are facing a crisis in this country, not of lack of money but of lack of compassion and recollection that we are all intertwined in this journey. You can mock that sentiment, but it has its roots in the most ancient of teachings, and when great nations or civilizations forgot that we are all in this together, they fell. So lets stop talking so much about the almighty dollar, and talking more about the human face of our health care system.
We spend more on national defense that the entire planet combined. Our health care system ranks 35th on the planet; behind third world countries like Morocco. Even those fortunate enough to have health insurance will discover when it comes time, you’re going to be denied the coverage you thought you had. Yet we still doubt the practicality of universal health care? I guess it’s true–the commercial with the egg frying in the pan and the moderator saying “this is your brain on drugs.” The baby-boom generation matured into the idiot nation.
Carter wrote, “But, of course, that means nothing if the insurance company smiles at you and says “sure, we’ll cover you. For $5,000 a month.” There have to be caps on what the premiums are, or there’s not even a chance of covering pre-existing conditions.”
You cannot have both ways. If it is “insurance” then it has to reflect risk of cost/lloss as a basis for premiums. If it is something else, then call it something else, but it is not insurance. If Americans want to disgard the institution of shared risk then that should be the vote rather than to “reform” insurance in a way that makes it no longer insurance.
We do currently have a full safety net in America. No one dies on the street. Take my case: two days ago (Monday at 4 p.m.) I was rushed to the ER at Mermorial. No one asked about payment when I came in or even if I had insurance. They just immediately, and I do mean immediately started lowering my heart rate of 220 beats a minutes from a sudden heart dysfunction. Yes, I owe quite a bit of money for the five hours but I am still here and quite satisfied.
Now this is the current system. Are you sure this “reform” is going to be better? A young person like you looks at this far different than someone who life hangs by a thread. I live fruguly driving an old car to make sure I do have money for such emergencies though in this case I paid 10% when I left that night and will pay the rest on time. And yes, I went to the head of the line when I got there but that is just the thing that happens when it involves the heart. They were not playing favorites. Ten years ago I grabbed a kitchen knife incorrectly and stood in the “stupid” line at Memorial to get several stiches. There were there for me then as they were Monday.
One of these days you too quite well might experience a rush into the ER to save your life. You do not need the safety net now, but if you destroy it politically, what then? Do not ever use political solutions for an economic or especially a medical problems. Period.
Thinker, the “50 odd million” is an very inflated figure. Also, insurance is a CHOICE, they could have it if they wanted to PAY for it. Not our fault that they would prefer to pay for lottery tickets, cigarettes, alcohol, fastfood, and other unecessary items that, for the most part, unhealthy practices. Not our responsibility to pay for these people.
You’re welcome Thinker. I don’t think there are many who would say we don’t need reform in health care, or to lower costs, or to find a way to cover people too poor or sick to paticipate in health care. This is why it is so frustrating to see DC operate, they pass up the easy things to push idealogical agendas instead of practical, pragmatic solutions and honest, transparent funding mechanisms. This is why the vast majority of Americans are feed up with government.
Thanks, Dr. J for the well-elucidated response. It makes it easier to understand your positions in the health care debate. Much of what concerns you, then, is HOW we pay for health care, rather than if? That is certainly a good place to be coming from.
Spin doctors like Mr. Bundy are in full effect trying to soften the blow that this disaster will bring to our country. A few weeks ago, those advocating this plan were actually trying to say that this legislation was going to save us money. Now they’re telling us a tax increase and a VAT tax are most likely going to be necessary. But, according to Mr. Bundy, you have nothing to fear because we’re from the government and we’re here to help. Shame on you, Mr. Bundy, shame on you.
Mr Bundy begins from a faulty premise, that is “pre-existing conditions shouldn’t stop you from getting care, whether you currently have insurance or not”. The truth is that any sick person in the United States will get health care regardless of insurance. If you go to a hospital you will get treatment, period. If you go to a government health clinic (also known as a free clinic) you will get treatment, period. Therefore, the United States health care system already ensures access to care for “sick people”.
Mr Bundy’s second argument that “[g]uaranteed issue and some community rating are necessary elements to covering people when they get sick” is likewise faulty. The best way to demonstrate this is by example. It is well known that the current education system in the United States fails to educate every child. Applying Mr. Bundy’s logic we should require every child to attend a government run school (charter schools and private schools will be abolished), we should substantially increase class room size and we should artificially cap (and reduce) teacher pay. Even Br. Bundy should recognize that this will only guarantee further failure.
Next Mr. Bundy recognizes that under this bill most insurance companies will go out of business and doctors will quit accepting new patients. Therefore, the socialist face of this bill is revealed by requiring “full participation”. This goes against the very fabric of American society and contrary to the founding principles of our form of government. Another example will illustrate my point. Under Mr. Bundy’s theory, because the United States government owns GM and Chrysler, every person over sixteen should be required to purchase either a GM or Chrysler automobile regardless of need. What would happen to Ford, Toyota or any other car manufacturer?
I recognize that there are problems with the current health “insurance” system. However, most of these problems are as a result of government regulation and restriction. For example restrictions on “interstate” purchase of health insurance. If I am dissatisfied with my current insurance I can only change to another “state approved” provider, where is the free market in this scheme. Furthermore, under Mr. Bundy’s future plan for insurance “pools” my choices will be further reduced and any economist will tell you that supply vs demand will result in higher premiums.
Scrap the bill and start over with some common sense reforms. Eliminate mandates and “community rating” (aka caps). Remember we have the best health care system in the world because it is privately run and government has a hard enough time delivering the mail, much less something as complicated as health care insurance.
Glad you asked Thinker. Being a Democrat, I have much interest in seeing the poor and infirm be taken care of in our great society (pardon the pun, but LBJ knew how to do things like this with broad bipartisan support, he was a leader). First of all, the part of ObamaCare that covers these unfortunates is good and I would support that. However, it is how this is paid for and explained to Americans that is the problem. The progressives want to create class warfare and say the rich will pay, ha, ha, they can afford it and nobody likes them anyway so why worry (Carter’s assertion). However, if you read the economic literature about how effective raising tax rates are at creating revenue (the ETI, or elasticity of taxable income, in fact co-written by MIT economist Dr. Gruber, one of Obama’s main economic advisors that was strangely silent when tax-the-rich was proposed as the funding source for ObamaCare). The studies show an ETI of .5 for increasing taxes on the higher income people, which lowers the hoped for $1.2 trillion from the rich tax down to $671 billion. Where will the difference come from? Right, not the rich but all of us in some soon to be determined hidden taxes.
The other problem is taxing businesses, as we know they do not pay taxes but collect them, from all of us, not just the rich, but the ones who use their products and sevices, so another $250+ billion on us.
Then there is cutting Medicare ($500 billion more or less), with the help of a shadowy Medicare Advisory Board. This board is charged in ObamaCare with finding ways to cut costs and recommend treatments changes for Medicare. And the Congress is powerless to change anything they propose unless the come up with a 3/5th majority vote and no debates allowed. Also, if Congress wants to change even one thing in the proposal, they must have a substitute that does the same thing financially. No mentions of all this overriding the rules of the Senate and House on voting, it takes precedent over any House and Senate rules. But will any politician really cut Medicare? Probably not much, so where will the funding come from to make up the difference? You got it, all of us again, not just the rich, in some soon to be defined hidden taxes.
So my proposal would be a transparent and open tax (I know they hate transparency in DC and thus maybe not feasible), maybe an increase in all income tax rates, that funds all these poor and infirm, and couples it with an individual mandate to buy insurance for everyone. Include another transparent tax for funding a large expansion of doctors, nurses, hospitals, clinics, and medical equipment (which will really bend the cost curve with supply/demand fundamentals) and that is all you need to help a huge majority of Americans, not just a few winners as ObamaCare does. You don’t have to have the federal governmen seize control of regulating the insurance companies from the states (why do that since you can’t buy insurance across state lines anyway), nor do you have to make the majority of Americans lose their existing policies and have no choices in coverage as ObamaCare mandates. The problem is that my proposal will not solve the progressives view of punishing someone and rewarding others, nor will it increase the size and control of government, so the left wing would never like such a proposal. But with just a little bipartisanship, ObamaCare could have turned into AmericaCare, had we had leaders in Congress who are honest, objective, and not care about creating winners and losers.
Dr J: While I have read your objections to what you call “Obamacare” time after time, I have never read a thing in your posts about what you propose to do to cover the 50 odd million of uninsured people in this country. Do you really think the answer is to just do nothing? Forget the moral disgrace of the wealthiest nation in the world leaving it’s people to bankruptcy and suffering–which NO other first world country does–can you not see the huge economic restraints we place on our businesses by not having a better approach to healthcare in this country?
Please, enlighten us all as to the specifics of an ideal “Dr.J-care Plan”.
Sorry, just more cherry-picked half truths and distortions from an obvious “winner” in this polarizing legislation that creates winners and losers in America and thus divides us all. Both sides of the debate are well informed and know how it will effect them personally, that is why it is so divisive. Many will gain and get a new free or heavily subsidized entitlement and some features they value, since it is almost free. The majority will get to pay the huge, mostly hidden fees and taxes (which you ignore and say only the “rich” will pay, hardly) and have many choices removed from what they have today, and all at a higher cost they don’t need. Carter, do you really think the majority of Americans will pay less for health care and insurance premiums and get better care under ObamaCare? If you do, you need to take some economics courses at NMSU or UNM. Perhaps you should read about the multi-billion dollar writeoffs most all companies with retiree Rx programs will be forced to take, and about the $250 billion + in taxes on the health care industry that will get passed on directly to all of us, not just the “rich”. All these dishonest, hidden taxes and fees will hit the majority of Americans, and they know it too. There is no free lunch, and the “rich” will not pay for this new trillion dollar entitlemet. It would be best if the chain of distortions and misinformation from the ObamaCare winners would stop and they would just tell us the truth here.