Welcome to European Tribune. It's gone a bit quiet around here these days, but it's still going.

"the virtually complete powerlessness of the left"

by fairleft Mon Mar 22nd, 2010 at 03:39:26 PM EST

Photobucket

The main thing about passage of a ho hum health care bill (I'm not one who thinks it brings the apocalypse) is that it highlights the quote that is my headline. Glenn Greenwald put it like this (emphasis in original throughout):

What's not debatable is that this [health bill negotiation] process highlighted -- and worsened -- the virtually complete powerlessness of the Left and progressives generally in Washington. If you were in Washington negotiating a bill, would you take seriously the threats of progressive House members in the future that they will withhold support for a Party-endorsed bill if their demands for improvements are not met? Of course not. No rational person would.

Regardless what you think of the bill itself, will anyone on the left attempt to open the 'why are the left and progressives completely powerless' Pandora's Box? Because, until we do, the powerlessness will continue. It won't get worse, of course, because it can't get any worse. As Greenwald highlighted in a column btw ridiculing the WaPost's Ezra Klein,


. . . this bill was negotiated using the standard, secret, sleazy Beltway lobbyist/industry practices that candidate Obama frequently condemned and vowed to defeat.  And these industries extracted such huge benefits as a result of these secret deals -- a bill shaped to their liking and profit objectives -- that they are essentially in favor of it. . . .

The way this bill has been shaped is the ultimate expression -- and bolstering -- of how Washington has long worked.  

While that was happening, progresssives and leftists were pressuring and extracting promises from dozens of ostensibly leftist, public-option-supporting Congresspeople. And what happened with that?

For almost a full year, scores of progressive House members vowed -- publicly and unequivocally -- that they would never support a health care bill without a robust public option. They collectively accepted hundreds of thousands of dollars based on this pledge.  Up until a few weeks ago, many progressive opinion leaders -- such as Moulitsas, Howard Dean, Keith Olbermann and many others -- were insisting that the Senate bill was worse than the status quo and should be defeated. But now? All of those progressives House members are doing exactly what they swore they would never do -- vote for a health care bill with no public option -- and virtually every progressive opinion leader is not only now supportive of the bill, but vehemently so. In other words, exactly what Rahm [Emanuel] said would happen -- ignore the progressives, we don't need to give them anything because they'll get into line -- is exactly what happened.

Any pipsqueak pwoggies gonna ask for their money back? Okay, enough, let's let the serious soul-searching on the left and among progressives begin. NOT.

AFL-CIO: House Approves Historic Health Care Reform (". . . what AFL-CIO President Richard Trumka calls a 'momentous step toward comprehensive health care.'")

Michael Moore: Republicans Should Be Happy -- Health Care Bill Will Save Their Lives, Too

BarbinMD (Daily Kos): It Took Too Long ("It took too long, but we've finally won the first battle in the fight of Ted Kennedy's life. A matter of right, not a privilege, indeed.")

Noam Chomsky: Health bill sustains the system's core ills [but] Despite its flaws, I'd have 'held my nose' to pass reform, renowned intellectual tells Raw Story [Chomsky says the key charm point for him is that the bill will really stop insurance companies from denying coverage based on pre-existing conditions.]

Paul Krugman: Five-Year Plan (". . . health reform -- imperfect, compromised, but real -- has happened")

Dennis Kucinich: How key Democrats voted on health care bill ("Kucinich says that what moved him wasn't any special deal for Cleveland, but concern for the impact of a defeat of health care to the Obama presidency.")

Matt Yglesias: Perspective ("Now that it's done, Barack Obama will go down in history as one of America's finest presidents.")

Yup, there's yer pwoggie-land for you. Flat on its back again with hosannas for the steamroller.

Display:
There are at least three distinct processes to consider here:

1.The Content of the final HCR bill

  1. The process that content was arrived at

  2. The process of selling the outcome and moving on to next business.

I will leave it to the experts to judge whether the content of the Bill is better than the current status quo. The consensus on the left and centre appears to be broadly left (even if much less than hoped for) and the consensus on the right sees to be that it is much, much worse than the status quo - a virtual Armageddon on the extreme right.

The negotiating process is as it always was - competing centres of power - big pharma, health care providers, insurance industry, blue dogs, Republican, Mainstream corporatist Dems and progressives trying to get as much of their agenda enacted as possible.  By definition no one group can get all of their agenda implemented unless they have a monopoly of power.  The power brokers like Rahm have to decide what constitutes a critical mass of support - who they have to have on board, and who they can afford to ignore.  In the US big  money is always going to be critical - exacerbated by the recent Supreme Court decision.

Selling the outcome is also crucial.  The Right is in no doubt that this is a major defeat - perhaps bring an end to the Reagan revolution of the 1980's and heralding an era of Dem dominance similar to that of FDR and LBJ.  A lot depends on whether or not Dems manage to screw things up in the meantime - but now the momentum is undoubt3edly with the (relative) left.  It all depends on whether this momentum is sustained, and on whether defeats are avoided en route.  The Overton window will start moving if further successes back this up.

The Left has the power to screw all this up - and to build a movement to keep things moving in the right direction.  They will get little credit for this - and all the blame if it all goes wrong.  But don't underestimate the importance of building up a mass movement to sustain and consolidate the gains made.

notes from no w here

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Tue Mar 23rd, 2010 at 06:14:06 AM EST
I think Frank hits on the key issues here - the Left is not powerless by accident - (and arguably, if one were to compare the Left to certain other "factions" - perhaps the Greens? - then the Left are not as powerless as some...)

Anyway, my point is that the Left is not powerless by accident, it is powerless in comparison to the Right and it is so because we live at the culmination of decades long work and planning by the Right to make it so.

If the Left wants to reverse this, it needs to put the work into movement building and also building ways to shape the discourse. The Right have in recent times bought up much of the media, but their key victory was in seizing on the Oil Crisis to set the frame around economic discussion.

Now we've had a crisis that was an opportunity in the other direction, but the Left failed to set the frame - in part because it was lacking a properly organised base movement - but also because the work has not been done to craft alternative frames and proposals...

It's all hard yakka at the moment, for little reward, but if we keep working on building an infrastructure to fill the gap left by the shrinking of the unions and keep working on trying to find alternative frames and proposals for how the economy and society actually can work, then next crisis we'll be in with a chance...

And in that vein, the international evidence is that for all the flaws of the HCR bill, the way it pushes forward the principle that "everyone should be covered" has the potential to help build solidarity in society... which is vital...

by Metatone (metatone [a|t] gmail (dot) com) on Tue Mar 23rd, 2010 at 07:51:43 AM EST
[ Parent ]
the way it pushes forward the principle that "everyone should be covered" has the potential to help build solidarity in society... which is vital...

It will force opponents to wear their insolidarity on their sleeve... assuming supporters call them on it.

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 08:11:15 AM EST
[ Parent ]
"everyone should be covered"

I realize this is a MAJOR talking point, but the bill of course doesn't do that. It requires people to get health insurance (regardless of its quality). If they don't they aren't provided it free, they are fined. Many millions of people will not be getting health insurance, and those numbers will increase a great deal as subsidies are reduced and premiums continue to increase if not skyrocket.

Of course, everyone in the U.S. now has a right to health care in the form of emergency room care, and that right will continue in the future.

fairleft

by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 10:51:56 AM EST
[ Parent ]
It requires people to get health insurance (regardless of its quality). If they don't they aren't provided it free, they are fined.

If people's income is less than 4/3 of poverty level, they will qualify for medicaid and won't have to buy insurance.

If people would pay less than 8% of their income for insurance, they won't be fined. And the fine is not supposed to be more than 2.5% of income.

At least according to The New York Times' How the Health Care Overhaul Could Affect You

Starting in 2014, anyone with an income below 133 percent of the poverty level -- or about $29,327 in 2009 for a family of four -- will be eligible for a rejuvenated Medicaid program. Medicaid's often anemic reimbursements will be increased to the same level as Medicare, making more doctors willing to accept it.

...

Starting in 2014, most Americans will be required to buy health insurance or pay a penalty.

The penalty will be phased in, starting at $95 or 1 percent of income in 2014, whichever is higher, and rising to $695 or 2.5 percent of income in 2016. But families would not pay more than $2,085.

American Indians don't have to buy insurance. Those with religious objections or a financial hardship can also avoid the requirement. And if you would pay more than 8 percent of your income for the cheapest available plan, you will not be penalized for failing to buy coverage.

Those who are exempt, or under 30, can buy a policy that only pays for catastrophic medical costs. It must allow for three primary care visits a year as well.

I find the religious exception ridiculous and the Indian exception insulting, but then again I am not religious and will defer opinion on the Indian exception to Crazy Horse...

But apart from guaranteeing free coverage for the poor, it also does the very important

If you are refused coverage because of your health, you can get insurance from a new high-risk pool.

The pool will be established within six months and will operate until 2014, when insurance companies can no longer refuse applicants with pre-existing health problems. Annual out-of-pocket medical costs will be capped at $5,950 for individuals and $11,900 for families.

$6,000 is a lot of money, but you can rake up that much for a couple of nights in the ER so this will mean health care costs will no longer spiral out of control so hopefully the number of bankruptcies caused by health care expenses will be greatly reduced.

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 11:17:24 AM EST
[ Parent ]
I said the bill makes health insurance a requirement, not a right, and I don't see any disagreement on that point. And yet, we hear a great deal of just plain lying propaganda that somehow a right to health care has been established by the bill.

I suppose we could in mangled English call the new bill's requirement a "'right' if I'm willing to pay for it'. But that's of course exactly the situation right now. When the auto insurance companies got state legislatures to make car insurance a legal requirement, there was remarkably little celebration then of the dawning of the right to car insurance.

For an individual, 133% of the poverty level is a yearly income of $14,444. For a family of four, 133% is $29,401. For everyone making more than that truly pitiful amount of money, they won't be fined if they pay up to, in 2014, an additional 8% 'income tax' for health care. There are no % restrictions going forward from 2014.

http://www.fns.usda.gov/SNAP/government/FY10_Income_Standards.htm

We know that 'welfare provisions' are always in the first line of stuff the government cuts back in a 'fiscal crisis', which is the 'next big thing' here in the states, so looking forward I hear a giant sucking sound among the bank accounts of the bottom half.


fairleft

by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 01:20:46 PM EST
[ Parent ]
Are you insured?

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 01:24:12 PM EST
[ Parent ]
Utterly unresponsive and changing the subject, again.

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 01:30:16 PM EST
[ Parent ]
Let me be more explicit.
For an individual, 133% of the poverty level is a yearly income of $14,444. For a family of four, 133% is $29,401.
Let me remind you that poverty level is 60% of median income. Median income, which is (per your figures) approximately $18k, covers 50% of the population. Therefore
For everyone making more than that truly pitiful amount of money
obviates the fact that a great many people make "that pitiful amount of money", and they will be insured for free.
they won't be fined if they pay up to, in 2014, an additional 8% 'income tax' for health care.
Assuming, that is, that they are not insured already and that they would have no health expenses otherwise. Based on my experience, if you faint in a public place and the paramedics come and take you to the ER for observation and you're discharged the following morning you can be hit with an $8,000 bill. 8% of $18k is about $1500 a year. Sounds like a deal to me, especially if you have any kind of pre-existing condition for which apparently there's a $6000 per-person, $12000-per-family of-4 cap on out of pocket expenses in the bill
There are no % restrictions going forward from 2014.
Yes, because after 2014 the public exchanges become operative or something.

Now, I would be more receptive to your claims if you happened to be uninsured, had a serious condition, or had been made bankrupt by health care costs.

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 01:40:59 PM EST
[ Parent ]
What claims am I making? Please recall that my initial point is that no right to health insurance has been established by the bill. I imagine that you agree, but think that the bill is still a good thing. Fine. To state my second point more clearly: 133% of poverty level excludes a large number of truly but unofficially poor people. My third 'claim' is that "they won't be fined if they pay up to, in 2014, an additional 8% 'income tax' for health care." A statement which you also appear to agree with but explain is not such a bad thing considering. So the only claim that you might disagree with is the second one above, which really is just a subjective opinion matter.

Your claim is that an additional "8% income tax" in exchange for a bad/catastrophic health insurance sounds like a good deal to you, especially for an individual making $18,000 a year. I'm surprised you think so, but I've never been that poor and, okay, fine, maybe you have been and know what you're talking about.

fairleft

by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 01:54:12 PM EST
[ Parent ]
Your claim is that an additional "8% income tax" in exchange for a bad/catastrophic health insurance sounds like a good deal to you, especially for an individual making $18,000 a year.
Well, quite. I did say
Based on my experience, if you faint in a public place and the paramedics come and take you to the ER for observation and you're discharged the following morning you can be hit with an $8,000 bill.
When I was a graduate student in California my girlfriend, who actually had a good job with employer-based HMO coverage, almost had a nervous breakdown when she got that $8,000 bill in the mail, and it was paid for by her insurance.
I'm surprised you think so, but I've never been that poor and, okay, fine, maybe you have been and know what you're talking about.
Thanks for answering my are you insured question.

Now, you don't get the public services you don't allow yourself to be taxed for. So maybe that 8% goes some way towards allowing the US government to afford the level of public services that people from civilised countries have come to expect.

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 02:02:56 PM EST
[ Parent ]
Do think it's a reasonably good thing to do, at this point in the very successful 30-35 year project of redistributing U.S. wealth from the middle and bottom to the top, to tax the working poor and 'lower middle' an additional 8% of their income, for distribution mostly to doctors and large health and insurance corporations?

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 05:30:40 PM EST
[ Parent ]
for distribution mostly to doctors and large health and insurance corporations

I would dispute that: the distribution is mostly to the uninsured.

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 05:32:54 PM EST
[ Parent ]
What? Those previously without insurance will be paying (for most of them) a hefty percentage of their incomes to the health insurance companies, which will transfer much of that revenue to doctors, hospitals and drug companies and then keep the rest. In many cases added to those payments from individuals will be 'subsidies', a chunk of money from the federal govt, also going to the health insurance companies, which will transfer much of that revenue to doctors, hospitals and drug companies and then keep the rest.

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 11:20:38 PM EST
[ Parent ]
Many of those without insurance will be paying much less that they would have otherwise paid for care. And a good fraction of those will be paying nothing.

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Wed Mar 24th, 2010 at 03:32:22 AM EST
[ Parent ]
The question was:

Do think it's a reasonably good thing to do, at this point in the very successful 30-35 year project of redistributing U.S. wealth from the middle and bottom to the top, to tax the working poor and 'lower middle' an additional 8% of their income, for distribution mostly to doctors and large health and insurance corporations?

which refer to "the working poor and 'lower middle'" and not to those at 133% and below of the poverty level. The folks I refer to in my question by and large cannot afford health insurance now, so they rely on emergency room care and distribute little of their income to the health care borg. The health care borg doesn't like that, and now will demand of such folks, with the U.S. govt as their enforcer, up to 8% of their income now but the sky's the limit in the future.

fairleft

by fairleft (fairleftatyahoodotcom) on Wed Mar 24th, 2010 at 10:51:26 AM EST
[ Parent ]
"poverty level is 60% of median income"

Sources: US Census 2008 State Median Family Income by Family Size (xls), 2009 DHHS Federal Poverty Guideline (pdf). NB. (i) The unit "HH" is not strictly speaking correct; Census and FPL reference unit is "family" for income reporting; (ii) FPL range by family size for Hawaii and Alaska specifically are different than that assigned all 48 states and DC.

This is an image of the xls median income table modified to demonstrate, Federal Poverty Level (FPL) threshold is not 60% of median income.

The ratio calculated in the RED lined box is 48-state FPL divided by State Median Income of a 2-person family. For more information about how the US Census computes FPL thresholds each year refer to How the Census Bureau Measures Poverty.

Diversity is the key to economic and political evolution.

by Cat on Wed Mar 24th, 2010 at 06:50:20 AM EST
[ Parent ]
Subtitle B--Public Health Insurance Option

SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.
commercial insurance is the public option, if your age, income >133%, or state agent disqualifies enrollment in Medicaid.

SEC. 113. INSURANCE RATING RULES.

     (a) In General- The premium rate charged for an insured qualified health benefits plan [QHBP]may not vary except as follows:

            (1) LIMITED AGE VARIATION PERMITTED- By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.

            (2) BY AREA- By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).

            (3) BY FAMILY ENROLLMENT- By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.

but... the Health Choices Commissioner authority to underwrite QHBPs for, say, experience-rate pre-existing conditions, trumps "general" limitations on premium range. There's no effective date in this version for high-risk pool regulation.

SEC. 206. OTHER FUNCTIONS.

     (a) Coordination of Affordability Credits- The Commissioner shall coordinate the distribution of affordability premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits plans.

      (b) Coordination of Risk Pooling- The Commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among QHBP offering entities offering Exchange-participating health benefits plans of premiums collected for such plans that takes into account (in a manner specified by the Commissioner) the differences in the risk characteristics of individuals and employers enrolled under the different Exchange-participating health benefits plans offered by such entities so as to minimize the impact of adverse selection of enrollees among the plans offered by such entities.

SEC. 166. LIMITATIONS ON PREEXISTING CONDITION EXCLUSIONS IN GROUP HEALTH PLANS IN ADVANCE OF APPLICABILITY OF NEW PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS.

 (a) Amendments to the Employee Retirement Income Security Act of 1974-

            (1) REDUCTION IN LOOK-BACK PERIOD- Section 701(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(a)(1)) is amended by striking `6-month period' and inserting `30-day period'.

            (2) REDUCTION IN PERMITTED PREEXISTING CONDITION LIMITATION PERIOD- Section 701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) is amended by striking `12 months' and inserting `3 months', and by striking `18 months' and inserting `9 months'.

            (3) INAPPLICABILITY OF INTERIM LIMITATIONS UPON APPLICABILITY OF TOTAL PROHIBITION OF EXCLUSION- Section 701 of such Act shall cease to be effective in the case of any group health plan as of the date on which such plan becomes subject to the requirements of section 111 of this division (relating to prohibiting preexisting condition exclusions).

      (b) Effective Date-

            (1) IN GENERAL- Except as provided in subparagraph (B), the amendments made by paragraphs (1) and (2) of subsection (a) shall apply with respect to group health plans for plan years beginning after the end of the 6th calendar month following the date of the enactment of this Act.

SEC. 205. OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN.

     e) Medicaid Coverage for Medicaid Eligible Individuals-

            (1) IN GENERAL-

                  (A) CHOICE FOR LIMITED EXCHANGE-ELIGIBLE INDIVIDUALS- As part of the enrollment process under subsection (b), the Commissioner shall provide the option, in the case of an Exchange-eligible individual described in section 202(d)(3), for the individual to elect to enroll under Medicaid instead of under an Exchange-participating health benefits plan. Such an individual may change such election during an enrollment period under subsection (b)(2).

                  (B) MEDICAID ENROLLMENT OBLIGATION- An Exchange eligible individual may apply, in the manner described in section 241(b)(1), for a determination of whether the individual is a Medicaid-eligible individual. If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding under paragraph (4). In the case of such an enrollment, the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency.



Diversity is the key to economic and political evolution.
by Cat on Tue Mar 23rd, 2010 at 02:38:10 PM EST
[ Parent ]
2009 Federal Poverty Level Guidelines
effective until 31 March 2010

Source: DHHS

Federal and state agencies refer to monthly and weekly FPL tables to determine and calculate amounts of income assistance available to FPL-qualified families, regardless of imputed net income. For example, MD offered me $16/mo. of Food Stamps, based on 143% FPL income. Yes, I declined this aid.

re: health insurance

An individual reporting annual gross income of $18,000 is 166% FPL. Income eligibility for Medicaid enrollment is less than or equal to 133.33% FPL threshold per family size. This person, if adult and not disabled, reporting 166% FPL income will be denied Medicaid coverage and instructed to enroll in the "exchange-qualified" health plan of his or her choice.  

H.R. 4872.RH
Subtitle C--Individual Affordability Credits
SEC. 243. AFFORDABLE PREMIUM CREDIT.

      (a) In General- The affordability premium credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in an amount equal to the amount (if any) by which the premium for the plan (or, if less, the reference premium amount specified in subsection (c)), exceeds the affordable premium amount specified in subsection (b) for the individual.

      (b) Affordable Premium Amount-

            (1) IN GENERAL- The affordable premium amount specified in this subsection for an individual for monthly premium in a plan year shall be equal to 1/12 of the product of--

                  (A) the premium percentage limit specified in paragraph (2) for the individual based upon the individual's family income for the plan year; and

                  (B) the individual's family income for such plan year.

            (2) PREMIUM PERCENTAGE LIMITS BASED ON TABLE- The Commissioner shall establish premium percentage limits so that for individuals whose family income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier.

Affordabiltiy credit and premium percentage applies  only to Basic plan enrollment Y1, Y2. Reported gross income does not determine the premium value ("rate") of a Basic plan. "Initial" and "final" are lower and upper bounds, respectively, of an index. EX. Basic plan, 1-person, $18K, 166% FPL --> (18,000)(.0366)(.5) = $329.40 p.a., $27.94/mo. That is maximum share. "Affordability credit" = Basic plan rate - max share.

The Sec and Healthy Choices committee will set, or contract, with "exchange-participating" insurers maximum plan rate for each exchange-qualified benefit category plan. AFAIK, 85% loss ratio for each benefit category is only the cost constraint on rate value and premium percentages beside CPI.

Statutory annual deductible is $5,000 for FPL 166% individual's Basic plan. The actuarial ratio (as above) is 97% insurer liability, 3% beneficiary liability, regardless of total annual value of benefits payable exceeding deductible amount.

Maximum total out-of-pocket expenses for 1-person FPL 166% is $5,329, or 29% gross income, excluding liability.


Diversity is the key to economic and political evolution.

by Cat on Wed Mar 24th, 2010 at 09:43:22 AM EST
[ Parent ]
Maximum total out-of-pocket expenses for 1-person FPL 166% is $5,329, or 29% gross income, excluding liability.

Is that better or worse than currently?

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Wed Mar 24th, 2010 at 09:54:37 AM EST
[ Parent ]
NB. correction above: total OOP $5,658.80, or 31% gross annual income; total annual premium $658.80.
Categorically, insurance coverage is a "better" thing than being harrassed by bill collectors. As far as individual cost goes, I'd guess the subsidized premium price ($54.90/mo) is market competitive with employer group rate ... outside any top-20 metro area-- for Basic plan benefits --i.e. catastrophic coverage. More important, the "subsidy" applies only to Basic plan. Value is all about the benefits and where your medical provider is located.

What else can I say? John Doe's also paying ~ 7.25% FICA+FUCA bi-weekly plus federal and state income tax.

Pre-tax shelter of individual payer's premium would smooth comparisons more. Currently, employees take advantage of payroll and Sec. 125 ("cafeterial plan") deductions for various expenses that reduce their taxable income. I believe, I saw a provision about that but can't locate it at the moment.

SEE ALSO - Kaiser Health Reform Subsidy Calculator. I chose age 28. Reconciliation Proposal [sic] NB. Kaiser posts some annual premium price that must be based on one of their existing products that conforms to Basic plan benefit schedule; "Advanced settings: Click here to see the policy parameters" -- estimates computed to lower bound or minimum (3%) of affordability premium percentages by FPL band. Tsk. $18K Man is 166% FPL not 150%; Unca Sam does not make that kinda mistake. Note also, provision of the act states, the subsidy is not a cash payment to the insured. Subsidy is paid by gov directly to the insurer.

So Kaiser's doing a bit of sales massage on the "value proposition" by the numbers.

Diversity is the key to economic and political evolution.

by Cat on Wed Mar 24th, 2010 at 02:31:23 PM EST
[ Parent ]
I read 1/12 as 1/2. Or something. The resulting total annual out-of-pocket expense therefore is slightly greater.

(18,000)(.0366) = $658.80 p.a., or $54.90/mo.

$5,658.80, or 31% gross annual income

Diversity is the key to economic and political evolution.

by Cat on Wed Mar 24th, 2010 at 10:14:28 AM EST
[ Parent ]
fairleft:
I said the bill makes health insurance a requirement, not a right, and I don't see any disagreement on that point

In many statutory insurance programs (certainly in Germany) it's both: everyone is entitled to health insurance, but everyone (not on public assistance) is required to pay in. There's a lot of things wrong with the plan, but this is not one of them.

When the auto insurance companies got state legislatures to make car insurance a legal requirement, there was remarkably little celebration then of the dawning of the right to car insurance.

Interestingly, all European companies that have mandatory universal health insurance have mandatory automobile insurance as well.

There aren't a whole lot of libertarians over here.

The fact is that what we're experiencing right now is a top-down disaster. -Paul Krugman

by dvx (dvx.clt št gmail dotcom) on Thu Mar 25th, 2010 at 07:15:13 AM EST
[ Parent ]
all European companiescountries, surely?

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Thu Mar 25th, 2010 at 07:16:14 AM EST
[ Parent ]
oops

The fact is that what we're experiencing right now is a top-down disaster. -Paul Krugman
by dvx (dvx.clt št gmail dotcom) on Thu Mar 25th, 2010 at 08:15:34 AM EST
[ Parent ]
everyone is entitled to health insurance, but everyone (not on public assistance) is required to pay in

And since Americans refuse to tax themselves to fund public services, then they get stuck with an obligation to pay for private health insurance. Now, that 8% o income that's written as a threshold in the law is called "a tax", as if that were a term of abuse (remember the reason they got is is that they refuse to be taxed). And it's also told "a handout to the medical and insurance industrial complex" which would likely be the one managing and delivering health care in any case because if the government ran health care by statute they'd likely just outsource service provision to the private sector.

So, what is the supposed "perfect" alternative here? The government nationalizes the health care sector and doesn't fund its operation out of taxes?

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Thu Mar 25th, 2010 at 07:28:09 AM EST
[ Parent ]
The notion that people can get the services they consider necessary without paying reasonable taxes to finance them is to my mind a failure of governance.

The fact is that what we're experiencing right now is a top-down disaster. -Paul Krugman
by dvx (dvx.clt št gmail dotcom) on Thu Mar 25th, 2010 at 08:20:41 AM EST
[ Parent ]
It is untrue that a right medical care (beyond emergency room care) has been established. My criticism on this score is of the many in the mainstream media who have pretended otherwise, apparently in order to suck liberals and leftists into celebrating passage of the bill. I'd prefer that we be honest about the bill, and that's all I'm asking for.

In fact, the right to medical care in the form of emergency room care may have been disestablished, we'll just have to see how it goes on that score.

fairleft

by fairleft (fairleftatyahoodotcom) on Fri Mar 26th, 2010 at 01:11:01 AM EST
[ Parent ]
a couple of nights in the ER

$5,950? About 12 hrs in-patient OR customary fee for any one surgical procedure in- or out-patient, gubmint may remit the unpaid balance billed to uninsured... as they do, ultimately, already after settling for cents on with the medical provider. The bill changes formalizes hospital authority to determine Medicaid eligibility of and enroll uninsured person for purposes of remit.

H.R. 4872
"Health Care and Education Affordability Reconciliation Act of 2010" formerly-known-as H.R. 3590.

Subtitle A--Medicaid and Health Reform
SEC. 1701. ELIGIBILITY FOR INDIVIDUALS WITH INCOME BELOW 133 1/3 PERCENT OF THE FEDERAL POVERTY LEVEL.
wherein a state may also determine enrollee's "individual affordability credit," if any, BECAUSE Medicaid and SCHIP coverages annual entail satisfaction of out-of-pocket expenses/"cost-sharing" quota (calculated as a percentage of HH income) before 100% actuarial benefit. In my case, in MD SCHIP, 10%.

Subtitle C--Standards Guaranteeing Access to Essential Benefits
SEC. 121. COVERAGE OF ESSENTIAL BENEFITS PACKAGE.

(c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-

            (1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

            (2) ANNUAL LIMITATION-

                  (A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

Annual DEDUCTIBLE in addition to TOTAL PREMIUM PYMTS per annum for "exchange-qualified" MINIMUM BENEFIT SCHEDULE

                 (B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

                  (C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.

PLUS beneficiary's LIABILITY equal to 100% total billed less actuarial value (%) assigned to the insurer, or 30% of total billed of covered and uncovered benefits. No lifetime limit on benefits means there is no limit to beneficiary's liability.

           (3) MINIMUM ACTUARIAL VALUE-

                  (A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

                  (B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

See also
SEC. 203. BENEFITS PACKAGE LEVELS.
NYT can't help you.

6) RANGE OF PERMISSIBLE VARIATION IN COST-SHARING- The Commissioner shall establish a permissible range of variation of cost-sharing for each basic, enhanced, and premium plan [BENEFIT CATEGORIES], except with respect to any benefit for which there is no cost-sharing permitted under the essential benefits package. Such variation shall permit a variation of not more than plus (or minus) 10 percent in cost-sharing with respect to each benefit category specified under section 122.

SEC. 162. ENDING HEALTH INSURANCE RESCISSION ABUSE.

      `(f) Rescission- A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2). The Secretary, no later than July 1, 2010, shall issue guidance implementing this requirement, including procedures for independent, external third party review.'


Diversity is the key to economic and political evolution.
by Cat on Tue Mar 23rd, 2010 at 01:40:37 PM EST
[ Parent ]
i'm surprised no-one has commented on the starkly surreal fact that one night in ER with some checkups costs that much.

something seriously distorted here.

sounds like there's a budding market for smelling salts!

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Tue Mar 23rd, 2010 at 03:50:32 PM EST
[ Parent ]
...because Americans know it to be true.

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 05:14:08 PM EST
[ Parent ]
Of course, everyone in the U.S. now has a right to health care in the form of emergency room care, and that right will continue in the future.

So you think that 1) this is an acceptable state of affairs; 2) the bill isn't an improvement on it?

The brainless should not be in banking -- Willem Buiter

by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 11:18:47 AM EST
[ Parent ]
  1. No, but for many of the near poor it will likely be preferable to paying a large and increasing portion of their income for really bad health insurance.

  2. In general, looking at the big picture, no. The bill is viciously class war, re-distributing billions of dollars from those who can barely or can't afford it to the investors in and executives of the 'health care borg'. Nothing is done to control profits/costs. On the other hand, there are several improvements over the present situation, such as closing the pharma gap for the elderly.


fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 01:26:59 PM EST
[ Parent ]
but without reform an 82% increase.

The graph indicates that national health spending is projected to be $4,530,000,000,000 (trillions) in 2018, an increase of about $2,000,000,000,000 over the 2010 levels. That's with health care reform, which the CBO estimates will save $138,000,000,000 (billions) over the next 10 years.

http://www.declineoftheempire.com/2010/03/a-rounding-error-in-the-right-direction.html

And we're talking about an un-health system that already costs roughly double what it does in other industrialized nations. And we the people will be required to pay that 80% increase in costs -- unless we're 'lucky' enough to have income below 133% of the poverty line. But hey, it could've been a tiny bit worse, I guess, if we believe the CBO.

fairleft

by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 02:05:49 PM EST
[ Parent ]
... both what would be (+) the moderate wing inside the Democratic Party and what would be the radical wing outside, are precisely in the concrete flaws in the system as policy, which will attract the attacks of the "Tear It Down!" brigade that will have the most bite.

For example, a 4% employer "pay or play" mandate, with the "pay" going to an employees health insurance exchange account, would be more effective as a mandate than the Individual Mandate, and would leverage all the reactionary populist outrage at the Individual Mandate, while the fight for a Medicare Buy-In inside the exchanges can remain on the basis of premium-funded coverage.

Yet both combined are a substantial step toward a taxpayer funded not-for-profit universal system.

A critical question is who can pivot more quickly in defeat, progressives losing the fight for a good bill now or radical reactionaries losing the fight to prevent any bill at all from passing ... I will assume that one or the other will pivot more quickly than the winners, the "moderate Democrats" who would have been Rockefeller Republicans before that wing of the Republican party was purged by an alliance of the Taft Republicans and the newly-Republican Dixiecrats.

Can progressives and radicals pivot more quickly from the fight over the comprehensive bill to the fight to fix the health care exchanges than the radical reactionaries can pivot to fighting over the structure of the exchanges?

A lot of that depends on how many election cycles the radical reactionaries can trap establishment Republicans in a "Tear It Down!" policy stance. The lock in the next election cycle is already a given. The lock in 2012 is likely, since its hard to imagine the standard bearer getting the nomination without calling for a total repeal. But if that lock remains in place in 2014, it could well be possible for progressives to make substantial headway in the second mid-terms, when the President's party normally does better than they did in the first mid-terms.

(+ assuming organizational coherence, that is)

I've been accused of being a Marxist, yet while Harpo's my favourite, it's Groucho I'm always quoting. Odd, that.

by BruceMcF (agila61 at netscape dot net) on Tue Mar 23rd, 2010 at 07:26:56 PM EST
[ Parent ]
Reagan-era Republicanism (that's the Democrats) versus know-nothing "Turner-Diaries conspiracy theorists." Try that out in an Overton window.

As she inched toward the triumphant win, Nancy Pelosi issued a fact sheet about the bill that cheerfully quoted an E.J. Dionne editorial. The passage:

An op-ed by E.J. Dionne on Friday reveals that the current health reform legislation pending before Congress was "built on a series of principles that Republicans espoused for years."

The electoral-politics aspect of what just happened with health care is a bit strange.  It seems to me that the Republicans capitulated entirely to Tea Party sentiment, a move that sets them up for a Sarah Palin candidacy in 2012, which in turn is a move that sets them up for a crushing general-election defeat. Meanwhile the Democrats spent the health care debate fleeing from their own base, a move that... well, I don't know what it means, exactly, but it does make me a little ill. The whole picture is strange: Democrats running as Republicans, Republicans running as Turner-Diaries conspiracy theorists.

http://trueslant.com/matttaibbi/2010/03/22/baby-killers/

fairleft

by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 01:05:09 PM EST
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 03:11:42 PM EST
[ Parent ]
to make the exact same mistake on two blogs.

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 06:33:46 PM EST
[ Parent ]
you cared enough to write that comment.

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 11:29:13 PM EST
[ Parent ]
fairleft:
Meanwhile the Democrats spent the health care debate fleeing from their own base, a move that... well, I don't know what it means, exactly, but it does make me a little ill. The whole picture is strange: Democrats running as Republicans, Republicans running as Turner-Diaries conspiracy theorists.

tell it matt.

what does it say about a society when such a rotten bill is a step forward?

sounds like a lot of folks might be getting religion to save going to jail.

matt's description of the cognitive dissonance is frighteningly real.

and yet... the alternative, doing nothing, was worse.

oh well, the fact is that the media loves a new narrative, and the dems winning anything of serious significance certainly qualifies.

in the country where symbolism most trumps reality, this is a very significant shift.

the fact that jerusalem status quo is collapsing might give Obama another chance at something historical now.

..after he pushes through legislation on bank regulation and immigration, that is.

kicking and screaming every step of the way, america is being dragged into taking responsibility for its alliances, track record and global intentions.

the media eye outside the usa's info-ghetto is getting sharper, and the internet is busting pinholes in its firewalls.

you can feel it all converging towards a massive reality crunch. stay steady folks.  

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Tue Mar 23rd, 2010 at 04:10:40 PM EST
[ Parent ]
The Democrats already showed during the Clinton years that they can have all the success they want if and when they decide to pass business Republican legislation. Nothing new here, and no, forget progress on Israel or financial regulation. Big business-friendly 'progress' on immigration, yes.

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 05:35:04 PM EST
[ Parent ]
Why did Obama succeed where Clinton failed? Was the 1992-4 Democratic-controlled congress to the right or to the left of today's on health care, and how was Clinton's plan different?

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Tue Mar 23rd, 2010 at 05:53:49 PM EST
[ Parent ]
... in its assumption of a natural Democratic majority in the House of Representatives, the 103rd Congress had Tom Foley as Speaker, not Nancy Pelosi, and the proposal was a centrist proposal in the House turned into a center-right proposal in the Senate ... the Senate legislation was like the Republican 1994 alternative legislation (back when they did such things), with a couple of extra largely toothless restrictions on health insurance companies tossed in and a 15m expansion of Medicaid tacked on.

Plus a far greater share of physicians support reform, because they work in a system that is far more broken than it was in 1994.


I've been accused of being a Marxist, yet while Harpo's my favourite, it's Groucho I'm always quoting. Odd, that.

by BruceMcF (agila61 at netscape dot net) on Tue Mar 23rd, 2010 at 07:34:40 PM EST
[ Parent ]
Clinton succeeded in ending welfare, deregulating banks and consolidating mass media.

fairleft
by fairleft (fairleftatyahoodotcom) on Tue Mar 23rd, 2010 at 11:33:35 PM EST
[ Parent ]
I'm asking about the Democratic-controlled Congress in 1992-4.

The brainless should not be in banking -- Willem Buiter
by Carrie (migeru at eurotrib dot com) on Wed Mar 24th, 2010 at 03:31:04 AM EST
[ Parent ]
with my response, and happily accept your 'F' grade and the two rex.

fairleft
by fairleft (fairleftatyahoodotcom) on Wed Mar 24th, 2010 at 05:32:03 PM EST
[ Parent ]


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