• You Bet I’m Angry

    I’ve been holding back a bit lately. I haven’t clearly expressed how I feel about the importance of reform and the relevance of its demise. That ends now. This is Catharsis Week at The Incidental Economist and I’m letting my feelings show.

    Actually it started yesterday, vicariously though a guest post by Jack Rodolico, my brother-in-law. In his post Jack tells the story of his wife’s battle with a chronic illness and a health care system that isn’t helping her deal with it. This is a true story and one I’ve witnessed first hand. It illustrates a key purpose of health reform, to relieve the suffering and struggle of many like Christina who cannot obtain insurance and the access to care it facilitates.

    I will be deeply disappointed and angry if the possibility for relief for Christina and millions like her is cast aside by Democrats who won’t take one vote. I share Jack’s pain, anguish, and frustration:

    I am frustrated by the Democrats, who supposedly had 90% of the bill figured out months ago. They squandered their time in disagreement, completely unable to compromise in a timely manner.

    I am disgusted by the Republicans, who made a tactical decision to oppose health care reform as a means of grubbing for power.

    I am disappointed with the President, who should still be out there selling and campaigning for health care. In fact, he never should have stopped after he made his address to Congress back in September.

    As Aaron Carroll wrote last week, this is not a game! For Jack and Christina and countless others this is not about politics. This is real life.

    This isn’t a game; it never was. Like it or not, the problems in the United States health care system are real. I have cared for children who have – literally – died because of bad insurance or no insurance. I have personally known people who have lost everything because of a medical tragedy. And I swear to you, these illnesses involve children who were not lazy or shiftless or deserving of these problems in any way….

    Next week we’ll have a pretty good sense of whether or not this bill will pass. And whether it does or not, I will keep on [fighting for reform]. If it fails, nothing will have changed. If it succeeds, there will still be much to do.

    I won’t celebrate a “win”. This isn’t a game. And if the bill fails, so be it.

    I just wish so many of you weren’t so happy about it.

    To those of you who may be hoping for or (prematurely?) celebrating defeat of health care reform as a “win,” what is your solution? What do you say to Jack, Christina, the children Aaron Carroll sees? What if those individuals were your family members? What if you are the next one to lose a job, your insurance, to be hit with a chronic illness? What is so horrible about the Democrats’ proposed reforms that justifies denying so many so much? Where do we go from here on coverage and costs?

    Or are these not important questions for you? Is it all about the win? About denying Obama a successful first year? About the midterms? After seeing what lack of ability to obtain insurance can do to an individual I cannot fail to be disgusted with that perspective.

    In the coming weeks and months I’ll channel my anger into more constructive analysis and thoughts. I’ll cool off. I’ll get back to trying to suggest improvements to the politically possible. Right now I’m angry. The politically possible seems to be shrinking dramatically and quickly and for reasons I cannot yet accept. And neither can people like Jack and Christina. Nor should they.

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    • I am mad at all parties but mostly the president. Why not draft a bill (with details) and then pass it along to congress? It’s like letting the inmates run the prison.

      As a healthcare analyst I want reform badly as well. However I find the most recent incarnations of the healthcare bills completely devoid of actual reform. The proposals lack strong mandates and create perverse incentives for employers to drop coverage or for families to self insure.

      The blame for this can be spread evenly to both parties. But ultimately the president has shown little leadership in the construction of the bill and little follow through in terms of support. This is where my disapointment lies.

      • @Kimberly – Of course I share your feelings. But some (though not all) of your ire might better be directed at our system of government, not the President or congressional Democrats. (I’ll have more to say on the aspects of government that have led to our current state on health reform later in the week.)

        Obama didn’t draft a bill and submit it to Congress because that’s exactly what President Clinton did and we know what happened to his health reform agenda (boom!). In fact, as far as managing Congress, Obama’s approach has been quite good. Where he fell down was after the bills were finalized. Then he needed to adopt the broad and common structure as his own and sell it to America. He didn’t and still isn’t.

        There’s a lot more real reform in the proposals than you suggest. The individual mandate is real, though the strength of it phases in over time (in the Senate bill). The employer mandate on the Senate side has a few problems I’ve written about. But they aren’t so much an issue for coverage as for revenue. Plus, they can and likely will be modified over time. So, I view the bill (even the Senate version) as a very good start and worthy of support if one wants to see real change. That business about the Senate mandate being anti-family has been fixed. It’s fine in that regard.

        In general I would caution people (not necessarily you, I’m speaking broadly here) to avoid mistaking the problems with the process for problems with the bill(s). The bills are quite good, better than many things Congress produces. One cannot expect perfect, clean legislation free of interest-group influence and political deals. That’s just how our system works. I don’t like it but to expect better right now is not realistic. Given that, I think the Senate bill deserves to be supported and the good work of some Democrats and the Administration should be applauded. But it will all be for nothing if they don’t pass it. That’s what will really tick me off.

    • There are just some major issues that I can’t get my head around – perhpas you can help. As an aside, I don’t subscribe to the politics of either party. I am completely disillusioned with the whole system and both parties after watching this.

      What about the physician fee fix? Without a physician fix the economics of the bill are completely mis-stated. there is a massive cost to fixing those payment rates that should be part of the CBO score. It’s misleading. I understand they pulled it out of the bill and tacked it somewhere else but it’s a $250B line item that realyl must be addressed.

      Here’s a question for you on mandates. I am currenlty insuring my family of four for $6K/year and my employer kicks in another $6K. Even in the years I had children my rack rate medical expenses never exceeded (or came close to) the total of these amounts $12K. Why wouldn’t I self insure if the penalty for not carrying is $750 (or 2.5% of my AGI dependign on the bill)? Why would my employer offer coverage when the penalty for not doing so is $750? I would be happy to self insure if I knew I had guaranteed issue + ratings limited to 4:1?

      • @Kimberly – The physician fee issue goes back decades. It is debatable whether it belongs in the HR bill. The only good argument for it is that it is health related. But so are many other things not in the bill. The idea that the bill is cleaner, and more honest, if it isn’t larded up with year’s-old structural problems makes some sense. Reasonable people can disagree on that. But in the end it is just accounting and we need a health care fix. So why make it harder by making it seem more expensive?

        Employers have to attract employees. Workers like getting a tax break on health care benefits. That will keep employers offering coverage. Anyway, if they don’t, you go to the exchange. There’s a tax inequity there that ought to be fixed but it would make employers even less likely to offer coverage if it were. This employer mandate issue really is about revenue more than coverage.

        The individual penalty would be 2% of income when fully phased in. Maybe that’s not high enough for everyone. I don’t know how that figure was arrived at. The experience in Massachusetts is the penalty actually doesn’t matter much. Once it is law that you’re supposed to be covered the vast majority of folks get insured.

        The details may not be perfect and I’m sure they will be tweaked over time. The basic structure is sound.

    • The physician fix actually is in the bill. It’s a major source of funding for the bill and we know it’s not really a source of funds. So when the CBO scores the bill I think it’s important that we not tap in to funds that will never exist. The notion that physicians would somehow take a 25% pay cut in 2011 is not honesty. As for the rest of it, I guess we’ll have to see. Glad the debate is alive and well. Seems both sides have dug their heels in when we need cooperation the most.

      • @Kimberly – I think what you call the “fix” I call the problem and vice versa. In my terminology the “fix” would cost money, not save it. So, we agree that physicians will not take pay cuts, let alone a 25% one. But including the, um, “correction” of that in the bill may not make sense since it is the accumulation of years of absurd kabuki related to a broken payment update methodology. I’m OK with that being fixed outside of the budget of this bill.

        Anyway, when it comes to costs, what matters far more than the absolute size of the bill is whether there is any hope for “bending the curve.” Now I think we have a long (long, long, long) way to go in the debate over costs and “curve bending.” But this bill is a place to start. The status quo admits defeat on cost control.