Done Deal?

BREAKING NEWS SASS!  HERE IS A SPECIAL "MEET THE SASS" FROM OUR POLITICAL EXPERT, WESTSISTA, AS THE UNITED STATES SENATE PREPARES TO CAST THE SECOND OF THREE PROCEDURAL VOTES TO END THE HEALTH CARE DEBATE. THANKS SO MUCH, WEST, FOR WRITING THIS POST AT THE LAST MINUTE!

I find it shocking, but not everyone has been glued to every passing nuance of this year’s health care debate.  Here’s my take on some of the most-used (but often misunderstood) buzzwords in this debate, and my understanding of the general outline of the Senate bill scheduled for a vote on Christmas Eve.

Public Option.  Something similar to Medicare -- a government run program.  Would provide at least some competition to private insurance in terms of premium rates.  Since Medicare’s administrative costs are approximately 2-3%, and private insurance has administrative costs up to 20% (they have to add in things like sales and marketing), the positive argument is that a public option would make health care dollars go further.  The negative argument is that the last thing we need is another big government agency, and that it creates another ongoing financial obligation when we don’t know how we’ll continue paying for the ones we already have.

Filibuster and Cloture.  The House can pass a bill with a simple majority.  Since there are 435 members of the House, a majority is 218 or more.  The Senate rules allow debate before a vote to continue indefinitely (filibuster) or until 60 Senators vote to end debate and force a vote (known as Cloture). 

Mandate.  This makes it illegal not to have health insurance.  Federal subsidies are available for anyone whose annual income is at or below 400% of the poverty level. To give you an idea, for an individual that amount is $43,320.  If you don’t obtain health insurance, you can be fined up to $750; that amount is equal to or less than the cost of 12 months of many health insurance plan premiums. Failing to pay the fine or get health insurance can lead to jail time, just as failing to pay your income taxes can.

What happens now:  The House already passed a bill (with a public option), but since the Senate just passed a different bill, they now go into “conference” -- to come up with a bill that both the Senate and the House can agree on, and the compromise bill has to have enough votes to pass both the House (218) and the Senate (60).  This conference would start in January, and the White House hopes it can be complete before the State of the Union address in late January 2010.

General outline of Senate Bill: 

• Expands Medicaid to cover more people.

• Mandates that everyone must have health insurance -- puts burden on individuals.

o      Allows health insurance companies to charge higher premiums for older people and those with pre-existing conditions  (some estimates are up to three times the premium of a “healthy” young person.

• Prohibits health insurance companies from:

o      Denying health coverage to people with pre-existing health conditions;

o      Dropping people from their health insurance plan after they become sick;

o      Charging varying rates based on gender or occupation; and

o      Applying overly restrictive lifetime and annual limits to coverage.

Although I am not happy with a health insurance mandate without a public option, I think the current Senate bill does bring some desperately-needed regulation to the health insurance industry.  Estimates are that this bill will result in 30 million more people with health insurance, which seems significantly better than nothing.  So I’ll be hoping for a positive Christmas Eve vote, a successful conference between the House and the Senate in January, with a health care reform bill signed into law in late January.  No matter what you are hoping for, this is far from a done deal.

Comments

[Flannista]

When I woke up yesterday to the news that the Senate had voted 60-40 toward stopping debate of health care reform, I knew the Sassistas! should post about it. It seemed historic. However, I had no idea where to start, so I emailed West and asked her to provide a layperson's overview of the legislation. In a matter of moments, she shot me back an email with that overview AND an offer to write a longer post. I was thrilled. Thanks again, Westsista!

[Flannista]

Westsista -- why has this reform caused so much acrimony? Republican Party Chairman, Michael Steele accused Democrats of "thumbing their nose and flipping the bird to the American people" and "I intend to have my foot on the throats of the Democrats on this issue and hold them accountable."

On the night of the vote, Sen Tom Coburn (R-Okla.) went to the Senate floor and proposed that the American people "pray that somebody can't make the vote tonight" -- referring to the 92-year-old, wheelchair-bound Sen. Robert Byrd (D-W.V.)

Has the health care debate been that sorry?

[Flannista]

I am a healthy older person with no pre-existing conditions. However, West, you write that my health insurance will go up. Do you know by how much? I'm already paying $1,002.34/month.

[Flannista]

And what's with Joe Lieberman (I-Conn.)? Doesn't he get a lot of money from health insurance companies?

[Flannista]

Sorry for all the questions, West. Health care reform seems to be the issue that has pasted the term, "socialism" on the Obama presidency. Why?

[half-a-sista]

Flann, you don't want death panels do you? What if your grandmother gets a "death" vote from one of those panels? And what about free enterprise and capitalism and the chance for insurance companies to make more and more money? They may move to India or China to insure people there because they can't make money in the U.S. Being sarcastic, of course.

The debate hasn't been about what's good for the American people. It's about what's good for careers, campaign coffers or political parties.

I don't understand how we can afford the military budget and two foreign conflicts, but can't afford to provide health care to every American from cradle to grave.

[Flannista]

I still don't get the "socialism" label, half-a. We pass legislation for defense spending. Why not health care spending? Isn't keeping citizens healthy in the interest of the national defense?

People are arguing until they are red in the face about this issue. Why aren't we having these kind of vociferous debate when we vote on defense spending?

[half-a-sista]

Socialism is a bad thing because it threatens to destroy capitalism. People forget that we already have a form of socialism in the Social Security program and I don't see people returning their Social Security checks to "fight" socialism.

We believe we need to spend approximately 50% of the budget on defense, homeland security, and other discretionary military spending to keep America safe. To debate the American military involvement in conflicts around the world would be deemed unpatriotic by some and no elected official wants to be labeled "unpatriotic" or "socialist" for that matter.

[Flannista]

I get that socialism is a bad thing because it threatens to destroy capitalism. Why is health care reform being labeled "socialist" and not Social Security? Why health care, specifically?

[Jerseysista]

I think this health care issue has ignited the socialism accusations when Medicare does not because conservative Americans are willing to live with a little socialism to take care of the elderly. They are not willing to live with it to take care of the poor. I think it goes to the issue of how conservative America interprets the foundations of this country. They strongly believe we should provide people opportunity to succeed on merit but we should not provide aid to those unable or unwilling to reach for that brass ring. There's a real view out there that if we provide aid, the country will start losing its pioneer, can-do quality and that the less able will suck the able dry. I think too many have drunk the Ayn Rand Kool-Aid.

[nowayasista]

We have failed in this debate to define our objective. What is health care? Does it mean any procedure for anyone at any time? If so, the country would be broke in no time.

A good post, West. Objective without all of the crapola and emotion. We do have socialism with Medicare, Medicaid, Social Security and any many other levels we do not even think about. Public education, law enforcement are just two. Why health care? Well, those that have paid their bills generally get pretty good care. And it is pricy. To add people to those rolls who do not pay the full tab will just add to the cost of those that do. A "subsidy" is nothing more than my tax dollars going to someone else.

The expense ratios of Medicare vs. private insurers is not an apples-to-apples comparison. Truth is if health insurance is such a lucrative gig there would be a lot of players and there are not.

We should be able to provide some kind of basic coverage for all. But should we underwrite lung damage for someone who smokes? Liver damage for those that drink? Diabetes treatment for those that do not take care of their weight? Heart disease for those with lousy diets ? I think not. If we excluded self-inflicted ailments and just said "that's your nickel" we would make enormous progress and bring costs down.

[Flannista]

Thanks, Jersey, for your opinion about why "socialism" has been so vehemently applied to health care and not other programs cited by both you and nowayasista. I think you're on to something. Again, TRM is not every conservative Republican out there, but I can't tell you how many times in the last six months he's been throwing Ayn Rand quotes into stuff he says. He considers himself one of those pioneers, by the way, but got a $5,000 loan from his father to start his business more than 35 years ago. That was a lot of money back then. He's hardly a "can-do" American, but now can fly in a private jet to the Mayo Clinic for any health ailment or treatment.

noway -- I did not know that there were NOT a lot of health care insurers out there. Their lobbyists are everywhere on Capitol Hill, however. Does a portion of my health insurance premium go to pay for them?

Also, how to we determine if a disease like diabetes is genetic or self-inflicted? Who would make that determination? Is that a panel of another kind?

[Jerseysista]

If they are obeying the law, none of the premiums collected by health insurers goes to pay for lobbyisits.

[Jerseysista]

Corporate funds are not used for lobbying. The funds for lobbying are collected by PACs that solicit the insurers' executives and employees for contributions.

[Jerseysista]

Let me take that back. None of the premiums goes to paying "influence money" or to paying hired lobbyists. That is collected by PACs. But insurers do have employees that attend committee meetings and contact legislators to urge the company's position on legislation. Those employees are part of the insurer's expenses. I doubt that those employees' wages are backed out of the equation before presenting expenses to the regulators when getting premium rates approved.

That, by the way, is another overlooked point. We already have regulation of health insurance premiums, as those premiums must be approved by state regulators who review reasonable company expenses and morbidity rates. It is not a free competitive market even now.

[treesta]

The national health insurance debate goes all the way back to FDR, if not Teddy Roosevelt. Those opposing it have branded it as socialism all along. It's interesting to google it and FDR, and read about the debate back then. There was a huge debate on the floor of Congress when Ted Kennedy was a young senator and Nixon was president, that is fascinating to watch and read in light of today's debate.

Noway says, "To add people to those rolls who do not pay the full tab will just add to the cost of those that do. A "subsidy" is nothing more than my tax dollars going to someone else."

But ALL of our tax dollars go to someone else.

The elderly or those who don't have children aren't allowed to exempt themselves from the portion of their tax dollars that goes to educating our youth. Those who can afford private schooling cannot exempt themselves from paying for the education of the poor. Yet in our country we have decided that we have a moral obligation to educate all, so the rich and the childless must subsidize the education of all of our youth.

The younger workers in our society aren't allowed to exempt themselves from paying for the retirement funds (Social Security) or medical funds (Medicare) for our elderly. Those with the means to fund their own retirement and elder care cannot exempt themselves from paying for the care of our poor elderly. Yet in our country we have decided that we have a moral obligation to care for our seniors, so the rich must subsidize the care of all of our seniors.

Like many in our country, I believe that we have a moral obligation to find a way to provide basic health care for all of our citizens. No different than providing an education for all or taking care of our seniors. Are the bills coming out of Congress perfect? Of course not. But 40 million Americans without health care, many of whom ARE working taxpayers, by the way, is simply unacceptable.

My humble two cents worth.

[frida]

Noway...ever heard that alcoholism is a disease? Also people with lousy diets may be the poor?

The public option would still be best. Penalizing people for not buying in seems to me a really stupid and counterproductive idea. But I like the whole thing better than nothing.

[treesta]

Here is a speech written and delivered by FDR about what he called, "The Second Bill of Rights." It's only a couple of minutes. Listen.

http://www.youtube.com/watch?v=UwUL9tJmypI

[Jerseysista]

Thanks for the link, treesta. Makes efforts for providing health care seem trivial in light of the broad and socialist proposals FDR was making. What rage FDR's speech would incite had it been made in this day of blogs, FaceBook and Twitter. He essentially had the leverage of the radio pulpit with only a few media outlets to carry a debate against him. These days everyone has a megaphone.

[Carolyn]

Okay, I'm lost. It's because I'm lazy to a certain degree, and because I get bogged down in all of the small print when it comes to this legislation. I guess I don't understand if it's a good thing or a bad thing. My neighbor asked me if I'm simply "for" or "agin" this legislation. I said against because -- again, somebody tell me, like I'm a two-year-old, how're we gonna pay for this? And, I'm not the only one who shudders to think of the government running this thing, right? I mean, remember the $2,000.00 toilet-seat debacle? And what will this do to my choices? Why should my work provide me with healthcare insurance out of its pocket when it don't have to? But, all that being said, when I told my neighbor that I was against it she was so downcast that I questioned her interest.

Turns out that she has no insurance at all and needs to have an expensive MRI. That set me to thinking all over again. I've begun to take insurance for granted, for sure. Still . . . the government doesn't exactly have a sterling track record for running things without incredible waste and plenty of pork being spread around. Still again, Americans without access to adequate healthcare is unacceptable. But, my God, are we ever ever going to see a budget that's not deeply in the red again? I hate passing all this on to my nephews and their children. Ugh. As ya'll can see, I'm ever which way on this one . . .

[Westsista]

WOW! Lots of great comments and excellent points! This is a lively and intelligent discussion -- the kind that we should have been having this past year between Democrats and Republicans. Unfortunately instead we had a ridiculous circus.

Remember that there's a continuum between capitalism (the free market drives everything and competition determines your share) and communism (everything is planned and everyone shares everything). There is no pure capitalism or communism so every country is somewhere in the middle. Socialism is that some things are planned -- and that everyone is entitled to some basic share, but after that basic share there is also competition in the system and some people get a much larger share.

As a country, we have decided we don't want to see sick old people starving and dying in the streets. So we have social security and Medicare to ensure a basic income and basic healthcare for all people over 65. This is absolutely a move away from "pure" capitalism and toward socialism, and both of these programs were fought vehemently by Republicans, using many of the same arguments as the ones you hear now. (Don't think I am picking on Republicans -- that is just a fact, as it is a fact that at one time it was Democrats who fought bitterly against civil rights for blacks.)

There are some other programs that we have that are socialism as compared to capitalism, like Medicaid (health care for the extremely poor), Disability (income and health care for the disabled), and S-CHIP (health care for children).

Defense spending is not socialism.

[Westsista]

Flann, I think Sen. Coburn was an ass for saying what he did about praying some Democrat couldn't make the vote, but in fairness, I don't think we can say he meant Byrd specifically. And yes, the back-and-forth on this is so wretched that instead of intelligent discussion we get this sort of stupidity.

I don't know whether premiums will go up. Most people think they will because there is no competitive pressure to help bring them down.

Yes, Lieberman gets lots of money from health care interests as do lots of other Senators. This is where I think the mainstream media breaks down. During any debate of this type, we should be able to easily track exactly how much money has been received from any interested party. If this info isn't easy to obtain, that's another issue for legislation.

[Flannista]

West -- I'm feeling Carolyn's pain. How much will health care reform cost and where is the money coming from?

[Flannista]

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SPECIAL HOLIDAY ANNOUNCEMENT!!!!

The Sassistas! would like to take a very short break in this incredibly intelligent sass stream to announce that tomorrow, the 'sphere is hosting its FIRST ANNUAL HOLIDAY COOKIE EXCHANGE!

So get ready to pick out a couple of recipes to share in the 'sphere tomorrow!

NOW BACK TO REGULAR PROGRAMMING
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[Flannista]

treesta -- thanks for posting that FDR radio speech -- wow, he would be run out of office today. Jersey, your comment about it is right on the sass.