on healthcare reform

I've buried my head in the sand for a while on this one, having wanted to wait until the dust settled a bit.

some positives
Health care reform helps people with pre-existing conditions big-time, as in some people will actually be able to get insurance when they couldn't before.  Under our old system, people with high-risk conditions like depression, cancer, or heart-disease could be denied private coverage and then not be granted state coverage because the waiting list was too long.  Additionally, children will be more protected, not being able to be denied coverage for pre-existing conditions, as well as being able to stay on a parent's plan longer.

some negatives
"High-income earners — families making more than $250,000 — will pay several thousand dollars more in Medicare payroll taxes starting in 2013. Their unearned income, now exempt from the payroll tax, would also be subject to a 3.8 percent levy" [3]  Not cool.  And then everyone has to be insured or pay a penalty as of 2014?  Seriously?  Instead, how about if you need state coverage later you pay more if you weren't insured previously?  Gah.  It just feels like the penalty is in the wrong place.

My overall opinion?  It's a toss up.  I like that coverage is going to be more accessible, but don't like the way they're shuffling the money around.  Law is iterative, and I'm okay with this being a step in the process, but I'd like more steps to be taken as well.



Lucas Sanders said...

My head hasn’t been buried quite as far in the sand as yours, it seems, but I don’t claim to be an expert on the bills either. So, take anything I say with a grain of salt.

[Also, why does Blogger not support the blockquote tag? Grumble. I’ll just resort to italics, I guess.]

“And then everyone has to be insured or pay a penalty as of 2014? Seriously? Instead, how about if you need state coverage later you pay more if you weren't insured previously? Gah. It just feels like the penalty is in the wrong place.”

I don’t necessarily disagree with the concluding sentiment; I’d love to see a way to make reform work without forcibly mandating that people get coverage. But your thinking-out-loud alternative proposal seems silly. By this logic, why not simply deny government-sponsored coverage to people who had previously decided to forgo buying coverage? (Partial answer: because one of the ideas behind this bill is that we want poor people to actually have coverage instead of shifting unpayable emergency room bills onto the rest of us...)

If you really do need government-sponsored coverage — that is, if you need coverage and private-sector coverage isn't a viable option — then it seems that your budget is already far too tight. Especially if you were choosing not to buy coverage at all until you ran into major health problems. Is that really the time and place for society to impose financial penalties on you?

ajb said...

I just don't feel like it's the government's responsibility to make sure its citizens are responsible for themselves. It's funny...phrasing it as a tax break for those who are insured feels more right to me than a tax penalty for those who aren't, but that's essentially saying the same thing. In the end it makes sense, my gut reaction was just aversion.

Lucas Sanders said...

I agree that it’s not the government’s responsibility to ensure that its citizens make wise decisions. But I disagree on the comparative gut reaction between incentives and taxes: I’d rather have the tax because it feels more honest — and, I suspect, drives a more careful assessment of the policy’s wisdom.

I’m currently undecided as to whether I think universal health coverage is good public policy at all, seeing as how universal coverage as public policy inevitably means that the government is making that decision to some extent for its citizens; I’m inclined to say yes, for wholly pragmatic reasons, but I’m not sure.

All this said, if universal coverage is good public policy, I don’t see why a single payer system isn’t the way to go. If you’re going to have a policy of universal coverage, why not implement a program that directly achieves that? It seems to me that the current approach just adds regulatory requirements on both ends of the transaction...

ajb said...

It's a good point. If everyone is required to have coverage, it would be more efficient to unify coverage. The problem is that people want options, whether or not options are good, and that the healthcare providers, who lobbied for the bill, I believe, wouldn't be happy with that. But I'm also still undecided as to whether or not universal public health care is good, or if it would work.

Lucas Sanders said...

Well, I think the notion of choice is a red herring here. Presumably the very point of making coverage mandatory is to restrict our choices: to ensure that there is some clearly-defined core level of coverage that everyone has. I doubt I’ll be able to go out and buy a $5 health insurance policy that covers me only for chicken pox and not pay the fine for refusing coverage.

Given this, it seems wasteful not to deliver that minimum to everyone as cheaply as possible, then let people shop for supplemental plans that provide any desired services not covered by the core single-payer plan.

Again, all this assumes that universal coverage is a desirable policy goal, and neither one of us is confident on that point.

JBB said...

There are other constructive and market-driven ways to make health care affordable and make people responsible for their decisions. I switched to an HSA two years ago and it is amazing how much more prudent I am with choices--while still caring for my health---in things like OTC or prescription when I am paying for it directly. The CEO of Whole Foods had some constructive suggestions that actually would work in his August 2009 op ed piece.
But the real hot pink elephant in the living room is that this entitlement program is unsustainable and will lead us and our children into bankruptcy and a killed golden goose. It does stop laying. Also see today's Journal about the real effects of squeezing rocks: "The Rich Can't Pay for ObamaCare
The president intends to squeeze an extra $1.2 trillion over 10 years from a tiny sliver of taxpayers who already pay more than half of all individual taxes. It won't work."
It is always easier to spend another's money. Just try it on your kids when they "have" to have something and then have them pay for it out of their allowance or money they have toiled hard to earn. Decisions magically change.

In short, a pig in a poke that may ease the pain short term but underneath the bandaid, the sore will be getting infected.