Category Archives: Health Care

Spoiled Brat Corporations Whine Again

Posted on by

Immediately after the health care bill passed, some major corporations complained that the bill would cost them millions of dollars. AT&T claimed it would suffer a $1 billion loss. A new article in Fortune says these companies are considering dropping their employee benefit health insurance and paying the fine instead. They think it might be cheaper to “pay” than to “play.”

The Fortune writer, Shawn Tully, wrote “The legislation eliminated a company’s right to deduct the federal retiree drug-benefit subsidy from their corporate taxes.” Read that carefully. The corporations were deducting a government subsidy from their corporate taxes as if it were a cost. They’ve lost that “deduction,” which was actually bare-assed corporate welfare.

They’ve been doing this since January 2006, when the Medicare Part D act went into effect. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) had the government reimbursing employers 28 percent of the cost of retiree drug benefits that met certain requirements. But the same act also allowed employers to deduct 100 percent of the cost of prescription drug benefits, including the 28 percent that was subsidized by taxpayers already.

As Brad DeLong pointed out, this meant that for companies in the 35 percent tax bracket, $63 of every $100 spent on prescription drug benefits was being paid by taxpayers.

The just-passed health care reform bill closed the “double dip” and allows companies to deduct only that part of their prescription drug benefit costs they paid themselves. And now some of these companies are complaining that their business models will just about collapse if they can’t continue to deduct the subsidy, because just deducting the amount they actually spend on drug benefits will break them.

Of course, a gaggle of rightie bloggers jumped on this article as proof that Obamacare will destroy America, screaming about taxes and penalties, when what really happened is a cut in corporate welfare.

Now, it may very well be true that dropping employee health benefits and paying the penalties would be more cost effective for these companies, but it would have been even more cost effective for them to drop employee health benefits before there were any penalties. And they didn’t. And they didn’t because it would be harder for them to hire quality people if they don’t offer benefits. As long as that’s true, they’re going to offer benefits.

The other Big Lie implied in the righties’ screeds is that the health reform law will drive up health care costs more than they would have gone up otherwise. Ain’t so. Last year, the Kaiser Family Foundation estimated that without reform the average cost of an employee benefit family policy could go from $13,375 (the average in 2009) to $30,803 by 2019.

So Where Were These People Before the HCR Vote?

Posted on by

Margaret Talev writes for McClatchy Newspapers:

Questions reflecting confusion have flooded insurance companies, doctors’ offices, human resources departments and business groups.

“They’re saying, ‘Where do we get the free Obama care, and how do I sign up for that?’ ” said Carrie McLean, a licensed agent for eHealthInsurance.com.

I read somewhere that con artists were going door to door, telling people they were being registered for “Obamacare” and asking for a signup fee. I don’t know how successful the con is. But the McClatchy story tells me that lots of people thought the fought-over health care reform bill was supposed to create a taxpayer-funded program to pay for their health care. Sorta like Medicare for all, a.k.a. “single payer.” And, apparently, that’s what many people wanted.

Many people should have said something about what they wanted several months ago.

Of course, it’s entirely possible some of the callers seeking “free Obama Care” were former town hall-storming tea partiers who figured, well, as long as its free, I might as well take advantage. Imagine their surprise to learn that, not only is there no program called “Obama Care,” there is no new federal program providing taxpayer-paid-for health insurance upon which one might hang the name “Obama Care.”

The closest the law comes to providing such a thing are the funds designated for state-administered high-risk pools. This is supposed to be a stopgap measure to help people with pre-existing conditions until 2014, when insurers will lose the ability to deny coverage to people with pre-existing conditions. But some states already had high-risk pools, so that program isn’t entirely new, either. It’s just better subsidized to make it more affordable.

One of the weirder talking points coming from the Right over the past several months is the demand that the President and federal lawmakers who created “Obamacare” be required to enroll in it. But the state insurance exchanges that the HCR bill will eventually establish are more or less modeled after the Federal Employees Health Benefit Plan, in which most federal employees are enrolled.

Further, nobody will be required to enroll in the insurance exchanges. Indeed, the HCR bill got so hacked down that most people will not be able to enroll in them even if they want to. And the exchanges are not providing taxpayer-subsidized insurance. They are just a means to make more affordable private insurance available to some people who are not insured through employment. The public option would not have been subsidized, either, other than administrative costs.

So to all the “patriots” screaming about “socialized medicine”: you wish.

Freakonomics Is Stupid

Posted on by

It never ceases to amaze me the way people who lack the critical thinking skills God gave turnips manage to make a living as “experts.”

In Becker’s opinion, the health care bill that passed recently is a disaster for at least two reasons. First, it seems to do little or nothing to deal with the single most important shortcoming of our current system: the fact that people pay very little on the margin for the medical care that they receive. Imagine that you could show up at a car dealership and have any car you wanted, and as many cars as you wanted, for no marginal cost. The market for cars would be in complete chaos, and people would have too many cars, and the ones they had would be too nice.

That is more or less the situation we now have with health care. It isn’t pretty to talk about, but if it costs $200,000 to keep an octogenarian alive for a month, someone has to pay for it. If it were the children of that octogenarian who had to cover part of the bill, and paying for that last month of life was the difference between being able to pay for the octogenarian’s grandchildren to go to college or not, there would be some hard choices to make. With health care expenditures approaching 20% of GDP, there are going to be tough choices. Markets cannot function when the people who receive the benefits of a good or a service are not the ones who are paying for it.

And, you know, it’s all about markets functioning. Now perfectly healthy people are going to storm hospitals and demand MRIs and appendectomies and spinal taps, and it’s going to be chaos. But if we have to choose between Grandma and sending little Sally off to college, then Grandma is off to the Soylent Green factory. That’s how markets (blessed be them) work.

Update: Let me spell this out — The “freakonomics” guys are arguing that a free market system is the superior means for delivering health care, because medical costs will respond to market forces the same way that the price of consumer goods respond to market forces. That’s what I’m saying is stupid.

As far as rationing end-of-life care, I found the example appalling. The decision of how aggressively to treat Grandma’s medical condition should not depend on whether the family can afford to pay for it or not. There are countless variable factors in real-world situations that make these decisions difficult, but ultimately the decision of when to switch to palliative care should be a purely medical one.

HCR Wins Big for Colorado Democrat

Posted on by

News you won’t hear from Faux —

Rep. Betsy Markey raised a record $505,000 in the first three months of the year, with the bulk of the money flooding in after she announced March 18 that she’d vote for the Democrats’ health-care reform bill, her campaign said Sunday.

“There have been plenty of big bills come through Congress this year, but I don’t think I’ve ever seen grass-roots support spring up like this,” Markey campaign spokeswoman Anne Caprara said. …

… Kyle Saunders, a political scientist at Colorado State University, called Markey’s first-quarter numbers “amazing.”

Just don’t read the comments to the online article. It attracted teh crazies like a picnic attracts ants.

Update: Evan McMorris-Santoro writes in “The Town Hall Dog That Didn’t Bite“:

On their first recess break since passing historic health care reform legislation, members of Congress have not faced anything like the crowds and anger from anti-reform advocates they faced last summer, when guns, shouts and even fist fights became a part of more than a few town hall meetings. A review of local press coverage from the past week shows that the rage that met members on the weekend the House passed the health care bill has, for the most part, not followed them home. …

… In Colorado, Rep. Betsy Markey, Democrat who switched from a No to a Yes vote on reform’s final passage in the House, held a telephone town hall after receiving threats of violence from people angry at her health care vote. The conference call format certainly didn’t turn constituents away — according to local reports, about 8,000 called in from Markey’s Ft. Collins-area district. Reports from the meeting say that even though there was a lot of talk about the reform bill, little of it was of the “you’re turning us into a communist dictatorship” variety. The Ft. Collins Coloradoan reported that “the bulk of the questions focused on uncertainty about how the reform plan will play out, particularly in the area of cost control.”

Other representatives say their town halls have reverted to being sparsely attended wonk sessions. The exception to this is in New Hampshire, for some reason. Rep. Carol Shea-Porter (D) and Rep. Paul Hodes (D) were targeted by NH tea party groups, and the tea baggers turned out to scream and harass. But, as I said, New Hampshire appears to be the exception.

Also, the Tea Party Express rolled through the Saint Louis area today, stopping in a park in the suburb of Saint Charles. You can’t always read events from a photograph, but I’ve seen more intensity at a barbeque.

Gubmint for Me, but Not for Thee

Posted on by

Joan Walsh has a good article at Salon called “What’s the Matter With White People?” that documents the “tea partiers” don’t grasp that health care and other reforms are to help them. They only see that their taxes are going to be used to help other people.

This point is reinforced by a recent article by Ron Brownstein.

In a mid-March Gallup survey, 57 percent of white respondents said that the bill would make things better for the uninsured, and 52 percent said that it would improve conditions for low-income families. But only one-third of whites said that it would benefit the country overall — and just one-fifth said that it would help their own family.

Compounding the confusion is a recent article by Kate Zernike in the New York Times that found many of the “tea partiers” are unemployed or retired and receiving various kinds of government assistance, even as they demonstrate against government assistance.

Mr. Grimes, who receives Social Security, has filled the back seat of his Mercury Grand Marquis with the literature of the movement, including Glenn Beck’s “Arguing With Idiots” and Frederic Bastiat’s “The Law,” which denounces public benefits as “false philanthropy.”

“If you quit giving people that stuff, they would figure out how to do it on their own,” Mr. Grimes said.

Which is something of a departure from past populist movement sparked by hard economic times.

The Great Depression, too, mobilized many middle-class people who had fallen on hard times. Though, as Michael Kazin, the author of “The Populist Persuasion,” notes, they tended to push for more government involvement. The Tea Party vehemently wants less — though a number of its members acknowledge that they are relying on government programs for help.

They also say “the government” caused their own and the nation’s hardships, which I guess is true inasmuch as government stepped aside and allowed the financial sector to lead the nation off a cliff.

Anyway, I’ve argued in the past that Lyndon Johnson’s Great Society program caused a huge shift in attitude in white Americans about government. People who had been just fine with help from government programs initiated by FDR and Truman suddenly decided government shouldn’t be giving out “hand outs” when a large percentage of the recipients were African American. And, of course, Republicans (including Nixon and Reagan) hammered home the theme that “entitlements” were going to greedy (and nonwhite) people who wouldn’t work and who drove their new Cadillac to the grocery story and paid for their groceries with food stamps.

Being from the Ozarks myself, I could take you home with me and show you white families who have survived on government assistance for generations, but because such families tend to live outside the suburbs of the boonies they are mostly invisible to media. But I also know (I know my people; I’m related to most of ’em) that these same white folks, who rarely have regular jobs and who survive by the grace of food stamps (although I understand they use cards now) and Medicaid, will tell you they don’t think “those people” ought to be getting welfare.

Ah-HEM.

Anyway, Joan Walsh mentions research that found working-class whites bailed out of the Democratic Party beginning in the mid-1970s. It actually began during the Nixon Administration, but possibly not yet in large numbers. But what shook so many working-class people loose was a combination of factors that began with Republicans like Nixon painting “welfare” as a process by which white taxpayers were handing out money to chronically unemployed (i.e., lazy) black people. The other part of that process, of course, was that the Democratic Party itself abandoned New Deal-style progressivism.

Of course, another part of the problem might be the way President Obama and other Democrats kept trying to assure people that, if you already have employee benefit health insurance, your insurance won’t change. This was to calm fears that everyone’s doctor was about to be hauled off to the gulag, where you couldn’t see him without a stamp from the Bureau of Health Care Rationing. But maybe the message that got through was “this legislation is just for unemployed people.”

Walsh concludes,

So there’s a long history here of Republicans preying on white working-class insecurity, and Democrats mostly ignoring it, that shapes the response to healthcare reform. That’s why, to me, it was so important for Democrats to pass the bill, flawed as it was. Democrats need to deliver on their promises, with tangible benefits for their voters, and if whites remain suspicious now, maybe watching the bill’s colorblind protections help all groups can change white opinions about social spending. Maybe not. But Democrats are going to have to do a better job of selling the bill’s benefits to everybody to prevail in November, and Brownstein’s column framed the problem without name-calling.

That’s about where I come out also.

Four Days Later

Posted on by

The Senate Dems defeated all of the GOP junk amendments intended to derail the reconciliation package. Senate Republicans have been using every procedural trick they can find to slow down the Senate from doing anything. However, someone discovered a provision that didn’t fit the reconciliation rules. So it has to go back to the House. However, the fixes are minor, and at this point it seems unlikely that the House Dems would balk at making the changes.

From reading their sites, I’m not sure some righties understand that the former Senate bill remains law even if the reconciliation package were to be defeated. I get the impression they think defeating the reconciliation bill (which, among other things, repeals Ben Nelson’s “cornhusker kickback” that provided extra money for Medicaid recipients in Nebraska) will make the whole thing go away. It won’t.

Some rightie sites (and a few leftie ones) are touting the “discovery” that states may opt out of the mandate, which (some say) undercuts any arguments that the mandate is unconstitutional.

The provision (which I remember reading about some time back) is that a state can choose to opt out of the federal program entirely (not just the mandate specifically) IF it comes up with an alternative program that provides its citizens with the same access to coverage at the same rates, and with the same consumer protections. You and I know that’s not going to happen. And since the mandate is essential to keeping down the cost of insurance premiums for everyone, cutting the mandate alone would put a state afoul of the law. But I’d say it was a smart move on someone’s part to insert that into the bill.

[Update: See also E.J. Dionne, “Health Care and the New Nullifiers.”]

More troubling are the threats of violence and acts of vandalism aimed at House members and their families. But many of us speculated we’d see violence from the Right if the Democrats actually got serious about enacting progressive change.

And, of course, nothing has changed yet. All we’ve done so far is put a process in motion that will bring about change eventually.

I thought of that yesterday when I tried to get a Lipitor prescription refilled. I got into a new group plan through the Freelancer’s Union last year that saves me considerable money on premiums over my old individual insurance, which I simply could not afford. However, the group plan (through the infamous Anthem Blue Cross) is much less generous about actually paying for stuff. There’s always some reason prescriptions cost more than the $10 co-pay, for example, although the extra amount I’m required to pay varies from month to month.

But yesterday I was told I’d have to pay $95 to get a monthly supply of Lipitor. I told the pharmacist they could keep it. My arteries will just have to harden until I can get better insurance. (But, Anthem Blue Cross, isn’t the Lipitor cheaper than paying to treat heart disease? You’d think they’d encourage me to take the Lipitor instead of penalizing me.)

But mine is a minor problem compared to that of Robert Hollister, who has stage 4 cancer and who is falling through the cracks in the reform bill. He lost his job, and in September his insurance will expire. The HCR bill provides for subsidies for high-risk pools so that people like Hollister can get affordable insurance. However, there is a three-month waiting period, and even then he can’t apply until he has been without insurance for six months. Without chemotherapy, he doesn’t expect to live that long.

Such provisions are put in to protect insurance companies — they’re to discourage people from dropping their existing insurance companies in favor of the subsidized insurance. But where’s the protection for Robert Hollister?

HCR: Bump and Grind

Posted on by

The bump is a bump in the polls. Current polling says that a small majority of Americans are now in favor of the health care reform bill. So much for the Republican argument that “we have to stop this thing because the people don’t want it.” Nate Silver explains why he thinks the bump will fade a bit but not go away completely.

The Grind is the continued effort by Republicans to derail it. Part of the deal the Senate Dems made with the House Dems was to pass the reconciliation package unaltered. So Republicans are trying to load it up with junk and daring the Dems to note vote for it, like a provision to prohibit sex offenders from purchasing viagra. If Dems don’t include that, see, it must be because they sympathize with sex offenders.

Are challenges to the constitutionality of the mandate a real threat? Zachary Roth at TPM says could be, James Rosen of McClatchy Newspapers says probably not.

If you read nothing else today, be sure it’s David Leonhardt’s column in the New York Times:

For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.

Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.

Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform’s effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan.

Update: Tea Party could hurt GOP in the midterms.

Update: Thanks to alert reader Bob for this.

Good Point

Posted on by

Rep. rush Holt (D-NJ) writes,

I’m reminded of one of the last times we voted on a Sunday: March 20, 2005, when Republicans forced an extraordinary vote to intervene in the case of Terri Schiavo.

To know what a real government takeover looks like, one should revisit that resolution.

Yep, that’s what a real government takeover of health care looks like.

The Republican strategy seems to be to go after the mandate as unconstitutional, according to the Republican definition of “unconstitutional,” which is “any law we don’t like.”