Your speech was excellent! And, you have my full support for reform as long as it is real reform, not reform in name only. I'll just focus here on my suggested improvements.
You talked about the economic downturn. Great, but I would suggest making a connection between those economic conditions and health insurance reform. The fact is that genuine assurance of health care (single-payer) would be the greatest aid to the economy across the board for individuals, businesses small and large, cities, counties, states, organizations and anyone who employs someone or manages tax dollars and elements of the health care system. It would meet ALL of your goals thoroughly. I realize that we're not going to implement single-payer now, but the point remains. We're only taking half measures here, and, in absence of single-payer, a national government-run public option is essential.
You implied in your speech that it was only people on the left who favored single-payer. Not so - fully 75% of people favor at least a government-operated public health assurance option. A substantial number of those folks have insurance now and a substantial number must be conservative and moderate. Single-payer is not the far left idea you portrayed it to be. We, the citizens, have been very clear about what we want.
As it stands now, our plan is a boon for the for-profit health insurers who are not in need of financial help. There are some consumer-friendly changes to be sure. However, I caution that what is said in speeches be matched by what is in the bills. For example, I understand that, although we have been repeatedly told that people will not be excluded from coverage due to pre existing conditions, the bills don't contain that reform.
Your goals are 1) Security and stability for those who have insurance 2) Insurance for those who don't have it and 3) Holding down costs. Simply put, you cannot achieve 3) without the government-operated public health assurance option available widely.
Exactly what the public option will be, or even IF it will be, is unclear. For example, you said that it should compete with the private insurance programs on a level field by being funded primarily by premiums. That's fine, but next we were told that people who have private insurance cannot choose the public option. Thus, the only market in which it can compete is the uninsured market. That immediately means that it will provide no incentive for private insurers to control premium costs; in other words it won't be the competition we need. Simply put, the public option must be available to everyone. Co-ops just won't accomplish anything.
Another important aspect of controlling costs is to prevent insurers from charging differential premium rates for people based on pre existing conditions or other characteristics of the person -- age, sex, etc. There is nothing in your plan about this at all. While insurers may not be able to deny coverage to those with pre existing conditions, what's to keep them from charging so much that effectively people are still bankrupted for being/getting sick. So-called "high risk pools" are running the same scam right now. They are often the functional equivalent of "death panels."
If you use high-risk pools to help people in immediate need, we will have the very sick over here in one pool and the relatively well over there being covered by private insurance. Instead, if you make the real, complete reforms of the insurance industry immediately, there's no reason why they can't take on those who previously would have been denied by them and dumped into a high risk pool. After all, isn't that what the reforms are intended to accomplish? This can be done day one from your signing of the bill.
Premiums need to be stable within a reasonable range for ALL people. This is NOT the same as car or home insurance where the risk of using benefits can govern the premium prices people pay. This is health care financing where ASSURANCE of care should be the focus, not financial stability of insurers. It's not just catastrophic insurance as car and home insurance are. Almost everyone will be using the system from day one. Premium prices thus cannot be based upon the "risk' of using the benefits. Otherwise you will be taxing the sick for being sick as we are right now.
And without the public option widely available, there can be no controls on drug costs. I can understand why that particular can is being kicked down the road, politically, but we should position ourselves so that programs to save drug costs can be pursued in the future. Having a public assurance option large enough to negotiate drug prices is essential.
You said that individuals and small businesses who could not afford health insurance would be given tax credits to help them buy it. This is economic nonsense. Tax credits only help people who earn enough to pay taxes greater than the credits. And they do nothing to help with upfront costs, coming as they do a year later than the person has incurred the costs. The only effective scheme is to have the government provide direct assistance to buy the insurance on a sliding scale.
The mandate for individuals to obtain insurance coverage is frankly unworkable and political suicide. The truth is that most people who aren't covered want to be; they just can't afford it. Even young people who see themselves as invulnerable see the rationale for having insurance so that when they do need the care it's there. I've been told that, under the plans Congress is working on, individuals would be fined $3800 if they didn't buy the insurance. Whether it's $100 or $3800 that should not be a fine, it should instead buy them the insurance they need. If people can't afford it, how is a fine going to help that? The point I'm making is that a mandate is only ethical if there is a sliding scale upfront to help people buy the insurance. Imagine how angry at us people will be when enforcement of this provision starts.
And how can we justify a mandate to buy insurance if the only source of insurance is the for-profit health insurers? We will be mandating that people send a significant portion of their health care dollars out of the health care system (into the profits of the insurers). The health insurers are NOT in need of a bailout and the American people and businesses ARE; this plan runs in the opposite direction of who needs to help whom. Again it spells doom for the Democrats once people have experienced enforcement of this mandate. It's a poison pill.
How we will pay for costs beyond the saving that can be achieved within the system? The answer should be very simple really: If the private insurers are going to continue to make their profits, then their taxes need to go up to fund the health care system. Some of what they are taking out of the health care system needs to be restored to it. You mentioned the high price of the Bush tax cuts; they need to be undone. And stick by your idea that deductions should be limited for the very wealthy.
This picture is being needlessly muddled; and too much of it is about preserving the status quo of corporate for-profit insurance dominance. Single-payer would simplify everything and provide more economic benefit to everyone except big insurance. And it would not disrupt any part of the system that does not critically need disrupting. Again, what is this really about: Assuring health care for Americans or preserving the insurance companies profits? If they could have given us a good system, they should have done it long ago. The fact that they did not says volumes about how they will behave in the future.
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