John Conyers and Dennis Kucinich are correct, it isn't HR 676 and it's not as good as HR 676. It is however a very good compromise, and for all the incrementalists and political realists out there in TVland, it provides a good foundation to build on.
What it is is HR 676 with a chunk of HR 3200 added on at the end, some revenue provisions added, illegal aliens excluded, covered benefits slightly less generous, and the part about turning the hospitals and other institutions into non-profits removed.
Hospitals are a biggie. I do really like the provision in HR 676 for turning all the investor-owned providers [hospitals, nursing homes, imaging centers etc] into non-profits. This wouldn't be cheap, but, for hospitals at least, they're only about 20% of all hospitals, so this should be doable.
And we should do it, because these places cost more and deliver less, and kill you 2% more efficiently too. Moreover, the sooner we do this, the better, since they're now slavering to increase their ranks, as is their wont. Leaving them in place to continue stealing from the taxpayers is just icing on the cake for them.
Still, I can see setting aside taking on the hospital lobby for another day, another bill. This is one of those don't let the perfect be the enemy of the good compromises I could grit my teeth and live with for awhile, in large part because on of the provisions from HR 676 that stays in this amendment is global budgeting for all institutional providers.
So, we wouldn't be removing the profit motive, but there would still be some heavy-duty government-imposed price controls imposed on them nonetheless. A decent start.
For illegal aliens, Hr 676 starts off
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) IN GENERAL.—All individuals residing in the United States (including any territory of the United States) are covered under the USNHC Program entitling [...]
and not-quite-HR676 adds one word
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) IN GENERAL.—All individuals lawfully residing in the United States (including any territory of the United States) are covered under the Medicare for All Program entitling [...]
but is otherwise identical in residency requirements. For all kinds of reasons we need to just suck it up and treat anybody who needs it, but I just want to mention that people who are here illegally and have used fake Social Security numbers to get jobs are paying into the system and will continue to do so, whether or not we allow them to get any of the benefits.
[Yes, not-quite-HR676 changes all the references from US National Health Care program to Medicare for All program.]
Speaking of benefits, the covered benefits spelled out in the amendment are slightly rearranged from the way they're spelled out in HR 676, but it looks like vision and dental care would only be covered up to age 21. Got to leave something for the insurance companies to sell supplemental insurance for, I guess.
It's a way better benefits package than any of the ones that are likely to come out of the exchanges, or even the much-vaunted public option, and there are no copays, no deductibles, no cost sharing of any kind for covered benefits. You pay your taxes and once you're over 21, you buy your own glasses pay the dentist yourself. Another trade-off that can be lived with [says the blogger who plunked down $500 for two pairs of glasses a few years ago].
Speaking of HR 3200 [indirectly] the parts of it that get included in not-quite-HR676 aren't bad, though I'm skeptical of the prevention and wellness stuff and haven't looked into the "best practices" part enough to have an opinion.
From the table of contents [begins on page 855] for the stuff gets included:
TITLE I—COMMUNITY HEALTH CENTERS
- Sec. 2101. Increased funding.
TITLE II—WORKFORCE
- Subtitle A—Primary Care Workforce
- Subtitle B—Nursing Workforce
- Subtitle C—Public Health Workforce
- Subtitle D—Adapting Workforce to Evolving Health System Needs
TITLE III—PREVENTION AND WELLNESS
TITLE IV—QUALITY AND SURVEILLANCE
- Sec. 2401. Implementation of best practices in the delivery of health care.
- Sec. 2402. Assistant Secretary for Health Information.
- Sec. 2403. Authorization of appropriations
Increased funding for community health centers, more nurses and primary care physicians and public health officials, oh yeah!
I'm leaving the funding and revenue provisions for another post, but they start on page 22 if you want to read ahead.
- hipparchia's blog
- Login or register to post comments
- 1+[encrypted]+#b94+
Printer-friendly version
Front page
Comments
This is a bill that could actually pass
...with little or no changes, in my opinion. I don't think many or even any countries with national health care actually insure illegal aliens, for example. My guess is that vision and dental might be left out in a real bill, which would put us in a similar position to Canada and Australia, and although I'd favor leaving it in that is not such a terrible outcome.
When I talk about single payer bills to others that I am trying to "sell" Medicare for All on, I'm going to mention this bill, mainly because of the illegal immigrants issue. (That really ticks some people off who otherwise wouldn't be. IMO it should be considered a separate issue, regardless of one's feelings on it.)
Try ZBlogs: an explicitly leftist community. www.zmag.org/blog
i don't know if it would pass or not
but i'd happily support it.
not all illegal aliens are paying into the system, but some are, and it's apparently a substantial amount.
silly to not cover vision and dental, but practically everybody leaves it out, so we'd be following the rest of the pack.
Oh
I didn't mean it would pass this Congress. No way!
But it's a bill that I think could reasonably pass, unaltered except for the usual minor add-ons, in a future US Congress as the enactment of single payer.
Try ZBlogs: an explicitly leftist community. www.zmag.org/blog
:)
in a very future congress, i'm thinking. although with enough pressure from voters and other outside [preferably moneyed and with a conscience] groups, it could maybe pass in the not-too-distant future.
Vision can be more than eyeglasses.
My father went blind from macular degeneration. Would that be covered?
You can get blood poisoning and die from untreated dental infections. (The teeth are close to the brain.)
Not happy that the body can be dissected into parts, some of whose health isn't important to the whole.
i'm with you, actually
i was being a touch snarky, but you're right, it makes no sense to pretend that eyes and teeth are magickally immune to real health problems.
Thanks for the overview
hipparchia!
I could live with these provisions also, for the time being.
I imagine that, with regard to illegal aliens, they would still be eligible under the EMTALA for emergency care so we wouldn't have people literally dying in the streets, at least from emergency situations.
Interestingly, this amendment addresses some of the concerns raised by Bruce Webb (they were hardly mine) in his diary on Open Left last week.
Every apathetic citizen is a silent enlistee in the cause of inverted totalitarianism.—Sidney Wolin
you're welcome
bruce is right in that you have to eventually come up with a way to pay for whatever legislation you propose, but just because it's not included in the bill when it's introduced doesn't mean that cbo can't score it.
yes, emtala would be part of an imperfect safety net. of course, it would be better if people who get swine flu could go to the dr right away and get a prescription for tamiflu, rather than going around sick for days, coughing and breathing on the rest of us.
This bill's taxes
...are higher than in HR 676. This bill has effectively a 14% payroll tax, whereas HR 676 has, if memory serves, an 8.5% tax. This might partly be made up by HR 676 having higher taxes on the rich (a 10% surtax on the top 1% of income earners, for example, whereas this bill's highest surtax is 5.4%) but my guess is that this bill is deliberately being more gradual in lowering the amount of money devoted to health care.
Which does lead me to a potential issue with this bill: how much would it actually lower health expenditures for the average person?
Try ZBlogs: an explicitly leftist community. www.zmag.org/blog
hr676 = 9.5% payroll tax
4.75% each on employer and employee, plus a fairly high income tax on high-income individuals.
what would this one be like?
back when i had insurance, i paid ~$450/month. at a 6% payroll tax, i would pay ~$125/month.
median household income is just under $50,000/year. this household would pay $3000/year, or $250/month. for everything [except vision/dental], not just premiums.
average premium for a family is iirc ~$12,000/year, with employers paying ~70% [$8400] and employees paying ~30% [$4000/yr, $330/month]. that's just premiums. total costs per family are closer to iirc $16,000/year, with families generally picking up the remaining $4000/year, or another ~$330/mo on top of their share of the premium [unless their employer is contributing to their hsa]. don mccanne has more.
contrast that with what the present legislation defines as affordable.
those people whose employers are paying all or most of the premium for a generous plan with little out-of-pocket expenses would feel an unaccustomed bite from this payment scheme.
on the employer side, very large employers pay ~8% of their payroll in health insurance, the smallest employers pay something like 20-25% of their payroll in health insurance. an 8% across the board tax would take a bite out of those employers that aren't paying anything toward their employees' health insurance, but it would definitely help a lot of others.
Has the transactions tax gone away?
That was a two-fer -- pay for the bill and slow the velocity of speculation by the banksters.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
transactions tax
i'd rather see a transactions tax go into the general fund, where it could be used for whatever.
i was sticking with the payroll tax for my examples, figuring that's what would be the biggest impact on the 'average' person or family.
other than that, i haven't waded all the way through this section yet.
CHOICE is key to any reform
We should learn from the Kucinich Amendment experience.
1) There is bipartisan support for CHOICE - of all committees it was added through House Energy (which has the most number of Blue Dogs)
2) The health insurance industry is dead afraid of it (hence it was removed from the bill)
In this regard, I think the biggest failure of progressives in the netroots was banking on this mysterious (designed to fail) public option, as opposed to simply requesting the CHOICE to buy into Medicare.
Sure keep the Kucinich amendment in there to let states create single-payer, but make Republicans and Democratic legislators explain why people and companies who want to get from under the thumb of the parasites and pay a "premium fee" through payroll (coupled with the uninsured, recently laid off etc), for a proven effective and efficient public program.
I want to believe Americans are ready to dump insurance industry completely - I really do. But I think if we simply give people the choice to dump them, of all things "the market" will do it itself.
choices
In this regard, I think the biggest failure of progressives in the netroots was banking on this mysterious (designed to fail) public option, as opposed to simply requesting the CHOICE to buy into Medicare.
yep. i concur, a huge failure. that should have been their final line in the sand, the choice to buy into medicare. instead, they didn't even start with that position.
far too many progressives have way too much faith in markets and too little belief that government ought to work for the people.
I want to believe Americans are ready to dump insurance industry completely - I really do.
me too.
polls consistently show that when you explain it clearly [and it only takes a sentence or two], about 2/3 of the people really do prefer a medicare-for-all system. if we were talking about presidential elections, that percentage is referred to in reverent and jubilant tones as a landslide victory.
With no
'Public option' where the Hell are the cost controls? And please don't say regulation because the new Dems are incapable of it. Speaking of which this whole fiasco might be an exercise in futility if Barney Frank can't get strong re-regulation passed. If the economy goes south again forget about it. Then we will really be screwed.
par4
'competition' does not lower prices
not in health care anyway. in fact, there's a fair amount of evidence that 'competition' raises spending in health care. the public option will provide competition to keep the insurance companies honest is a myth.
simply removing the private insurance industry as payers for essential medical care would free up an estimated $400 billion per year, an amount that would easily provide full health care to all the 45+ million uninsured without adding a dime to the federal budget.
there would be further savings from all the other provisions in hr 676, but just taking this one step wipes out the problem of leaving 15% of our population uninsured.
what is the mechanism
we all ready have a bill that passed the house, you don't really suppose something good will come out fo conference?
something good come out of conference?!
no, i don't expect that at all.
if, after all, the present legislation [hr 3962 and related] goes down in flames, there may or may not be a chance to re-introduce single payer quickly. if there is, weiner's version will have already been scored by the cbo [i presume], whereas hr 676 has not been.
i don't actually expect that to happen either, but having some semi-official estimate of costs and taxes is going to help me at least when talking to rl people [progressive bloggers be damned] about single payer.
and if you're going to talk about actual cbo scores, then you ought to have some understanding of what got scored. i suppose you could view this as an arsenal-building exercise, just in case, more than anything else.
maybe it's vastly different in liberal-land, but when i talk to my small-govt, religious-fundamentalist, limbaugh-listening, tea-partying friends and neighbors, my best hope of swaying them is through economic populism. here's hoping weiner or whoever releases the cbo scoring for this amendment.
besides, bernie sanders has said he'll propose both amendments in the senate, a "state's rights" single payer a la kucinich and a substitution a la weiner.
Time Magazine article on healthcare reform, from 1974
Great analysis Hipparchia. And I agree, Weiner definitely moved the ball forward with this Amendment by providing more details on how a Medicare for All system would be administered and funded.
I just came across this interesting April 1974 Time Magazine article that discusses how Ted Kennedy's Single Payer system and Richard Nixon's (for lack of a better term) Obamacare were stalemated. So Kennedy worked out a compromise with Nixon's ally Ways and Means Chairman Wilbur Mills.
http://www.time.com/time/magazine/articl...
Unfortunately for the country, the Kennedy-Mills bill got slowed down in the summer of 1974 by the Watergate investigation and Nixon's resignation. It then got stopped all together that fall when Wilbur Mills rather dramatically blew up his career in the company of a stripper. Its interesting to note how far right the Overton Window
has moved. Beyond simply that Richard Nixon would have been cool with HR 3692, Kennedy's original single-payer had at least one GOP co-sponsor (New York's Jacob Javits) and Kennedy-Mills single payer lite bill also had a Republican co-sponsor (Kennedy's fellow Bay Stater Edward Brooke).
I can't do a direct link, but you can read CRS summaries of the Kennedy (S. 3), Nixon (H.R. 12684) and Kennedy-Mills proposals (S. 3286) by selecting bill search here
http://thomas.loc.gov/bss/d093query.html
and thank you for the tip
thanks also for the links, which i will add to my growing list of stuff to read.
:)