My Thoughts on Health Care, Part IV

In Part III I wrote about my concern that the Senate health care bill was becoming similar to the Medicare prescription drug law in the sense that it appeared to provide new benefits, but contained a number of poison pills that made the legislation a step backward in many respects.


I discussed my fears to a political friend of mine who also opposed the Medicare law but seems to support the current bill, and he pointed out two differences that made this bill worthwhile: the fact that it’s paid for and doesn’t add to the deficit, and the so-called medical loss ratio rule, a rule requiring insurance companies to spend a certain percentage (I believe it’s 85% in the Senate bill and maybe the House bill as well) on actual health care and not administrative costs, advertising, executive pay, etc.


The bill’s funding mechanism and that it doesn’t add to the deficit (in fact, it reduces the deficit) are good things, to be sure.  I also find it curious that the same Republicans who complain about the deficit going up now weren’t responsible enough to speak out about the same things back then when they were busy passing the unfunded Medicare drug benefit into law.  But by itself the issue is not enough to win me over, for the same reasons that I don’t share conservatives’ concern about running up deficits in the short term to help people in need.  As Conservative Hero Dick Cheney put it, deficits don’t matter.  And I’d rather have a bill that gets everything else right but adds to the deficit in the short term than what we have right now, a pro-corporate bill that’s scrupulous about the deficit.


The medical loss ratio rule is more important to me because it represents an actual attempt by the government to really clamp down on exorbitant rates and take control of our health insurance system.  But I’m skeptical about how effective the rule can be.  For one thing, I trust government to do the job itself a lot more than I trust government to try to make private, profit-motivated businesses to do the right thing.  For another, even if the rule can be enforced, it doesn’t stop businesses from raising premiums – and thus, their own salaries – in absolute dollar amounts, as long as they make sure to spend some of that extra money on health care, which could be spent on totally useless or wasteful procedures (who cares, the government is paying them for it through subsidies anyway).


So I’m still undecided.  I’m gonna need to hear some more arguments and see some more indication that this bill is moving in a more liberal, pro-government direction before I get on board.

DECEMBER 26 2009 UPDATE: On December 24 the Senate passed the health care bill both in cloture and in final passage by the same margin, 60-39-1, and with the same people voting the same way.  To me, this feels like a missed opportunity for liberal Senators like Roland Burris (D-Ill.), Bernie Sanders (I-Vt.) and Sherrod Brown (D-Ohio) to vote against the bill from the left on final passage.


If I had been a U.S. Senator, I would’ve voted for the bill in cloture to get the bill out of the Senate, but (assuming I knew it would pass regardless of my vote) I would’ve voted against the bill on final passage for the reasons I’ve discussed before.  If my vote had been the deciding vote for final passage I would’ve voted for it for the same reason, to get it out of the Senate and move the process forward.


However, for the final post-conference bill, I am still undecided, though I’m starting to see more and more weight toward the “kill the bill” viewpoint.  I would not be motivated by the same desire to move what will most likely be something I see as a seriously flawed bill into law.  For that bill, I would have to seriously evaluate it on the merits before I support it – on both the cloture vote AND on final passage.

JANUARY 25 2010 UPDATE: Quick thought experiment regarding medical loss ratios.


Let’s say an insurance company gets $1.00 in total revenue a year, and spends 70% of it – $0.70 on actual health care.  They take home $0.30 for themselves.


In comes Big Government saying they have to spend 85% of it on health care now, and can only pay themselves with 15% of their costs.  So if they keep revenue the same, they have to spend $0.85 on health care, and only keep $0.15 now.


But let’s say they double their premiums so they now bring in $2.00 a year.  15% of $2.00 is $0.30 – or what they were making before the new rule set in.  Voila, they’re back to where they were to begin with, except now they also have all these new captive customers to exploit.  In fact, with these new captive customers, they probably wouldn’t even need to double their premiums to make back what they lost with the medical loss ratio rule.


Let’s say they triple their premiums, making income $3.00 a year.  15% of $3.00 = $0.45.  Hey, they’re making even more now!


Of course, it’d be more helpful if I had the actual numbers to play with, but I don’t feel like digging for them right now.  Suffice to say that it might be more complicated but the same principles apply, just with a whole lot more zeros.

My Thoughts on Health Care, Part III

What You Need To Know: A Summary For You Lazy Asses

·         I had previously written that I would not support a health insurance bill that had an individual mandate to buy or have health insurance but not provide a public option to go with it.  Lo and behold, that’s what we have in the Senate bill.

·         What troubles me is that, much like the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, this bill appears to provide benefits and make peoples’ lives better, but comes with all kinds of conditions and poison pills that actually set back my ideological and policy goals.

·         If I were a Senator, I would vote Yes on cloture just to get the process moving and get this bill out of the Senate and into conference with the much better House bill.

·         On the question of whether I will actually support the final bill if it’s mostly similar to the Senate bill, as it most likely will be, I am as yet undecided.  My decision will largely hinge on whether I feel the final product will be a real step forward or will be yet another looks-like-a-step-forward-but-really-is-a-step-backward piece of crap like the prescription drug law was.

Back in September I wrote that I could not support a health care bill that would impose individual mandates to have health insurance without providing a government-run public option of some kind.  After a tense standoff with an anti-public option Gang of Four consisting of Senators Joe Lieberman (ID-Conn.), Ben Nelson (D-Neb.), Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.), the public option in the Senate bill was removed and replaced with a three-part concession to liberals.  The first two parts, a triggered public option and an Office of Personnel Management-overseen mini-exchange of private plans, were largely useless and negligible, but the third part, an actual Medicare buy-in for uninsured 55-64 year olds, was better than what we hoped for – remember, the Medicare buy-in was the best type of public option, as I explained in Part I.


Well, as with so many things that are too good, this one turned out to be not true.  Senator Lieberman, who has by now become a de facto Emperor Palpatine, single-handedly seized control of the Senate and had the Medicare buy-in removed, leaving us liberals with… nothing.  No public option or other major expansion in government health insurance in the Senate bill.  That’s unfortunate, as I have stated previously that “I refuse to support any bill that has an individual mandate without a public option.”


So now, the question for me is, given the lack of public option or other government health insurance alternative in the Senate bill, and given my previous statement, do I support it or not?


I’m approaching this question as a person who, like most Democrats in Congress, opposed the 2003 Medicare Prescription Drug, Improvement, and Modernization Act.  I mapped out my line of thought here (emphasis not in original post):


I was thinking about the Medicare prescription drug legislation of 2003 and how most Democrats voted against it, but the few that voted for it were denounced by the left as centrist sell-outs.


That legislation provided government subsidies for prescription drugs for Medicare recipients for the first time, so ostensibly it was a step forward, right?  But the left opposed it because it was a step backwards ideologically (the benefit was only available through private plans, so it transferred power from the government to the private industry) and financially (it undermined Medicare’s finances).  In so opposing it, they would have denied prescription drug coverage, however subpar, for millions of seniors.


Now we have to look directly at the fact that, at least at face value, this bill, even with no PO and Medicare buy-in, still would subsidize health insurance for millions of people who won’t, don’t, and/or can’t get it right now, as well as enact some badly needed reforms.  At the same time, by locking in a captive market it’s a huge piece of corporate welfare.


So, on balance, does this move us forward or backward?  I’m very conflicted on the answer to that question right now.  I loathe so much about the bill, but at the end of the day I can’t deny the possibility that this bill could make life easier for so many people.  We just have to try and figure out if those near-term gains would result in bigger setbacks further down the road.


To expand on this, the Medicare prescription drug law provided subsidies for prescription drugs to seniors for the first time, BUT:


  1. It did so through private insurance companies
  2. It was not paid for
  3. It had no kind of cost control (most notably, it had a provision preventing the government from bargaining for lower prices)
  4. By giving all the power to drug and insurance companies and no power to government it consolidated the profit-motivated drug and insurance companies’ control over health care and, thus, our lives.  So while it may have appeared to be a step forward, my estimation was that in fact it was a poison pill that would set us back.


Now with this Senate health insurance bill, it’s largely looking like the same kind of deal.  People will get subsidies for health insurance – yay! – BUT:


  1. It will do so only through private insurance companies
  2. It will be paid for, thank goodness
  3. It has little cost control (most notably, no public option or any other kind of institution exerting downward pressure on costs, prices and rates)
  4. Again, it gives all the power not to our democratically-elected and accountable government, but rather to the same profit-motivated drug and insurance companies that have put and kept us in this mess to begin with and the same ones that make money off of people’s suffering and dying. (Even worse, where the prescription drug benefit was voluntary, this is NOT and you will be forced by law to have/buy private insurance as long as you’re alive and in America.)

So, much like the Medicare drug law, it appears to be a step forward, but it could actually be a poison pill-laced step backwards.  If so, how can I in good conscience oppose the Medicare drug law but support this bill?


If I were a Senator, I would vote Yes on cloture just to get the process moving and get this bill out of the Senate and into conference with the much better House bill.


However, on the questions of final passage on this bill, and on cloture and final passage on the final bill assuming it will be mostly similar to the Senate bill (and it most likely will be), I am as yet undecided.  My decision will largely hinge on whether the final product will be a real step forward or yet another looks-like-a-step-forward-but-really-is-a-step-backward piece of crap like the prescription drug law was.  To properly make that judgment, I will have to compare the Senate health insurance bill and the status quo with the prescription drug law and its status quo.

2010 Massachusetts Senate Special Election, Democratic Primary

The special election in Massachusetts to replace Senator Ted Kennedy has been a rather quiet and low-key one, without really any kind of strong ideological or policy disputes.  All the Democrats have been kind of saying the same bland liberal things, which is good in the sense that everyone is a liberal, but bad in that no one is super liberal, which is what we should be expecting in a Senator who is not only representing one of the most liberal and safely Democratic states in the Union but who is filling the seat once held by Ted Kennedy, one of the most liberal stalwarts ever to have served in the Senate.

What I’m looking for in this election is someone who will go beyond the call of liberal duty, so to speak.  Someone who isn’t just satisfied with the usual, standard-fare cabinet of liberal policy positions, but who will constantly strive and push for me.  And someone who doesn’t just spew tame rhetoric about people who need help, but who will openly, explicitly and proudly cherish, defend and demand activist government and the idea that government does indeed have a very large role in promoting the general welfare of its people.  That’s what I want to see in the next U.S. Senator from Massachusetts.

In other words, someone who will make Ted Kennedy proud.

I can’t say that any of the four Democratic candidates completely fill that position yet.  Two, Attorney General Martha Coakley and Boston Celtics co-owner Steve Pagliuca, have mostly been offering tame rhetorical stew, about her oh-so stellar record in protecting consumers and his oh-so stellar record at creating jobs, respectively.  City Year co-founder Alan Khazei has been impressively detailed in his policy proposals and emphasized clean government, but his proposals and rhetoric are still not as high on the liberalism scale as I’d want.

The last candidate, Rep. Michael Capuano (MA-8) has a somewhat shifty and abrasive manner and is the biggest career politician out of the bunch.  His campaign has focused heavily on the constituent services and pork he’s brought back for Massachusetts, which strikes me as parochial and short-sighted.  He doesn’t quite seem to have the personal charm and integrity that Kennedy had, and I don’t think he fits exactly into my ideal.

But what he does have going for him is a very liberal/progressive record in almost eleven years in the U.S. House of Representatives, the most aggressively liberal/progressive and pro-government rhetoric in the campaign, the most wholehearted embrace of Ted Kennedy’s legacy and the continuation of his work, membership in the Congressional Progressive Caucus, the endorsement of Progressive Democrats of America, and the cosponsorship of H.R. 676, the bill that would establish Medicare for All.

It is for these reasons that I believe Mike Capuano is the best and most strongly liberal candidate running for the United States Senate from Massachusetts, and I endorse Mike Capuano for the United States Senate.