And now for a intelligent point from the other side of the aisle.

[apocalypsos]

David Frum makes some very good points about the health care reform bill and how Republicans dealt with it - badly.

Look, the HCR bill is not perfect. Frankly, I like a great number of things in the bill, but I'm still pissed as hell that there's no single-payer or public option. Exactly how long is it going to take us to catch up with the rest of the civilized world, honestly?

That said, as someone pointed out on ONTD_P, "I love how this country can remain intact through a Civil War, two World Wars, slavery, Reconstruction, Jim Crow laws, the Civil Rights movement, the Vietnam era, the Cold War, and 9/11, but the moment the House passes a health care bill by a narrow margin, the Republic falls apart and we're all doomed." The Republican response was ridiculous, and a year or so down the line when America isn't a smoking crater infested with ravenous zombie nurses, what then?

David Frum throws out from very good points, from the fact that you can't really negotiate with someone you've made out to be Brown Hitler The Grandmother-Smothering Anti-Christ, to this particular gem that I keep dwelling on:

Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

It's sarcasm, of course -- no sane person would actually go before their constituents and argue for these -- but still.

As I may have already mentioned, the place I work is a call center for Medicare Part D plans. The plan I occasionally answer the phones for when it gets busy - I work in another section that deals mostly with returned mail - means talking to seniors on the phone about their drug plans. These are people who get incredibly upset at having to pay their deductible -- you can only imagine how worried they get about their slim finances once they hit the donut hole. And this is the Republicans' base. They can certainly try to take back the HCR bill, but it's things like closing the donut hole (and the fact that the Republicans used so much terrifying hyperbole America just has to make it another six months without being infested by the ravenous zombie nurses or the shiny new pillow-carrying Smother Squads before the Republican voters catch on) that are going to make repealing a large part of the HCR bill an unpopular move.

That's what gets me about the response to the bill. There are things genuinely wrong with the fucker, not even that it's not even a tenth as socialist as the Republicans claim or socialist enough for me. It's not right enough for them, and I get that. But there was a way to go about fighting its contents that didn't involve accusing Obama of planning to grow questionable facial hair, set puppies on fire and lob their burning carcasses at your great-aunt.

And at this point, even if the health care reform bill fails on a lot of things, it can't possibly fail to the point Republican leaders and media pundits claimed unless it spontaneously generates Captain Trips. Which may just come back and bite them in the ass come election time.

EDIT: Also, copied from the Crooks and Liars site and boosted from deirdre_c ...

Ten benefits which come online within six months of the President's signature on the health care bill:

1. Adult children may remain as dependents on their parents’ policy until their 27th birthday
2. Children under age 19 may not be excluded for pre-existing conditions
3. No more lifetime or annual caps on coverage
4. Free preventative care for all
5. Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
6. Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
7. The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
8. Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
9. Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
10. AND no more rescissions. Effective immediately, you can't lose your insurance because you get sick.

I want to rub myself shamelessly against that entire list. :D

Comments

[lilacsigil.livejournal.com]

This is why - even though the changes the bill makes are pretty minor - I'm really thrilled for America. The second people get used to having these tiny little bits of healthcare, they'll fight tooth and nail not to have them taken away.

[apocalypsos.livejournal.com]

Seriously. The Republicans fought tooth and nail against Medicare back in the day. Now, they'd have to be braindead to take it away, and they know it.

[anne-jumps.livejournal.com]

That's why they didn't want it! They didn't want it because it was POPULAR with the people and it would solidify Obama's legacy. That's what this is all about. Who cares if it would actually HELP people, the important thing is that Obama's 'team' 'loses' and theirs 'wins.'

[allthelivesofme.livejournal.com]

Exactly! #4 and #10 make me a particularly happy Evil Socialist, but the whole list is great.

[marag.livejournal.com]

The problem is that I don't think it *will* bite them in the ass come election time. I think that Republican voters will continue to believe their lies even when ravenous zombie nurses don't materialize.

It's sort of like those cults where the leader says the world will end on X day and X day passes, he says "Oh wait, I actually meant NEXT YEAR" and everybody believes him even after he says it eight different times.

I thought David Frum's post was excellent, however. If the Republicans had acted like him, I bet there would have been an excellent HCR bill that handled the concerns of both sides. It still wouldn't be perfect--because how could it be?--but it would have been better.

[apocalypsos.livejournal.com]

Knowing the majority of Republican voters, they'll imagine there's ravenous zombie nurses attacking their house even though there aren't and everybody else -- the neighbors, the mailman, the paperboy -- tells them as much. It IS their MO, after all.

[marag.livejournal.com]

::snort:: Exactly! They're gonna see ravenous zombie nurses under every bush, even if the rest of world points out that they look a lot like squirrels and robins.

[lilacsigil.livejournal.com]

Coming from a country with universal healthcare, even here we have people who want to remove it (zombie nurses, evil doctors, coming in contact with poor people, etc.) Those people always vote right-wing (and the crazy socialists like me always vote left-wing), but no-one gives a shit because the hardcore on both sides are *never* going to change their votes, barring a shake-up of the whole system.

It's the swing voters who matter, and they're the ones who can be scared by the idea that zombie nurses will show up (or at least that Obama will tax them to death and mismanage their elderly parents' medicines), but will put that aside when in fact they can keep their college-age kids on their healthcare and no zombie nurses show up to tell them otherwise.

YUNIONS! THE YUNIONS! ARE COMING!

[myniamh.livejournal.com]

My mother was a scrutiniser in the last federal election (Greens) and she was horrified at the small amount of people that swung the vote!

She was also horrified at the amount of penises drawn on the ballots.

[paradoxymoron.livejournal.com]

...I think I have the flu. Just the flu.

Who's bright idea was the donut hole, anyways? 25% covered, 0% covered, 95% covered? Shady.

[apocalypsos.livejournal.com]

I feel so bad for some of these people. The last time I was answering the phones at work, I talked to a woman whose husband fell into the donut hole in February. I think he had cancer. All I could think was, "Who could possibly support throwing down two thousand dollars on ONE drug? You know, other than an insurance company?"

[paradoxymoron.livejournal.com]

The drug company who spent all that money to develop, test, and market it. They need to get paid, yo.

THAT is a damn expensive & bitter pill to swallow.

[black-rider.livejournal.com]

Drugs are expensive to develop, test, and market, and companies rely on blockbusters to fund other stuff, it's true...

That said, I'm absolutely certain that were they to develop a quality drug and sell it at a reasonable price to folks who needed it, they would still make a profit.

Maybe not in the first year, but soon enough that they wouldn't go out of business, and their shareholders wouldn't show up at the corporate offices carrying torches and pitchforks.

[lilacsigil.livejournal.com]

Well, some drugs really do cost $2000, especially some cancer drugs. But here, they'd be paid for by the government. (And this is not to deny that price inflation in the US is really bizarre! You pay so much!)

[apocalypsos.livejournal.com]

Yeah, exactly. I mean, I get that the drug company has to be paid, but at the same time, it just creeps me out that there are people who support a company telling a guy sick with cancer, "Hope you have a couple G's to pay for that all by your lonesome!"

[lilacsigil.livejournal.com]

Yeah, that's the thing that gets to me, too! Here, the government negotiates prices (though Bush wanted us to dismantle that, ha ha ha) so it's like we've bought with a giant bulk discount. If the insurance companies were working properly, they'd be doing that negotiation for the patients in order to lower their own costs. Instead, you had a system where they just throw out the sick people. I wonder if that will change now that the insurance companies have to offer a lot more insurance?

[idadebeautreux.livejournal.com]

I work for a biotech/pharmaceutical company. We manufacture protein replacement therapies for people with very rare orphan genetic diseases. Most afflicted people would die by the age of 3 without the drugs we manufacture. No one else was making drugs for these diseases, and most analysts felt that there was no way to be successful in marketing drugs to such a tiny niche market - but my company has been going strong for over 25 years. It costs a tens to hundreds of millions of dollars and about 10-15 years to get one single drug candidate through R&D, 3 sets of clinical trials, FDA approval, and to market.

Some of the drugs we make cost $150,000 to $300,000 for a single year's worth of therapy. Insurance companies put limits on how long they'll cover that expense, unfortunately, which causes people to try to get by without the drug until they really need it, trying to stretch their coverage. It sucks... but my company also manufactures at least one drug at a substantial loss to supply it to just 3 people in the entire world who aren't able to be on anything else.

Do some big pharmas make insane amounts of $$ on expensive drugs? Yeah. But smaller biotech companies are kind of in a tough position, making drugs for very small markets, but needing a lot of cash to pay for expenses: $150,000 is only enough money to support 2-3 scientists, salary only, for 1 year. I've got equipment in my lab that costs $450,000. Science is dang expensive :( It's a sucky situation.

So... (sorry, I'm long-winded) YAY FOR INSURANCE COVERING THIS STUFF.

[kijikun.livejournal.com]

Can't I also be fined under this bill a shit load of money because I cannot afford insurance though? Seriously, I don't have money for insurance and there isn't a public option.

[tinylegacies.livejournal.com]

No, that's a misconception.

You can have a penalty tax assessed on your income taxes but it's minimal.

There definitely needs to be a single payer or public option though.

You can read more about the tax here.

[eleigh.livejournal.com]

I think the fine is $600 and something. But I think, from what I understand, people have until 2014 to get insurance.

[sabra-n.livejournal.com]

The requirement to buy insurance doesn't kick in until 2014, I believe, and that same year there will be various measures (like state health insurance exchanges) to help the uninsured get insurance at a rate they can hopefully afford.

[sabra-n.livejournal.com]

Oh, and there's this!

"In 2014, once the state-run insurance exchanges are up and running, people who earn up to 400 percent of the poverty level (or $88,200 for a family of four) would not have to pay more than 9.5 percent of their income on premiums. People with low incomes could pay as little as 3 percent. The government would help subsidize the rest."

[andraste]

I'm so happy that the USA has finally made some forward progress on public health care. Speaking as an Australian whose family would be bankrupt five times over without public health care and obtainable insurance, I think this will help a lot of Americans even though it doesn't go far enough.

[wrenlet.livejournal.com]

I'm of the opinion that all the Republican lawmakers with that rare skill known as "negotiating in good faith" have been driven out of the party. Things used to happen in Congress with grumbling on both sides, but grudging respect at least for the process. I want to say Newt Gingrich sunk the first nail in that coffin but it probably goes back further than him.

(I was watching a Twitter list set up by Ezra Klein for the debate yesterday, and there was a guy on there posting quotes from the '35 debates on Social Security and Medicare and the '93 debates on Clinton's deficit reduction plan. Did you know the 90s were supposed to be full of DOOOOOOOOOM AND RECESSION because of his budget? Me neither.)

[palmetto.livejournal.com]

Oh, the bit about community health centers makes me so ridiculously happy. I'm using one for my basic healthcare right now due to being an old uninsured college student (...damnit, 27. I'm 29!) and they're ~awesome~.

Wait, no, the entire damn thing makes me ridiculously happy.

[tinylegacies.livejournal.com]

Thanks for the link to the Frum article - it really does make a lot of good points.

And shockingly, the comments there didn't make me rage.

[xianghua.livejournal.com]

The one thing I am worried about- and I'm still glad it passed- is the small business thing. I'm one of two employees for the small business I work for, and while I've got insurance from somewhere else, I don't know how my boss is going to be able to afford insurance even for himself, things are so tight right now. He's high risk, too.

I'm sure we'll find the money for it when it comes down to it, but right now, I'm worried about it.

[laurelin-kit.livejournal.com]

1. Adult children may remain as dependents on their parents’ policy until their 27th birthday

This makes me want to cry with joy, because under the previous system, no insurance would touch me after I turn 25.

[kutsuwamushi.livejournal.com]

I'm turning 27 in a couple of weeks. It kind of makes me want to cry, but for a different reason.

[rosykate.livejournal.com]

I just feel so much safer now. My mom actually has really good health care, and the fact that I get six more years of that...I am not screaming with fear on the inside anymore. \o/

[sabra-n.livejournal.com]

Re: #1:

OH THANK BETSY. No, really. I thought that the parental insurance thing lasted until your 26th birthday, and given that I'm graduating school and turning 26 at roughly the same time, I was fairly worried about what would happen if I couldn't find a job.

Also, the small business thing - big thumbs up to that. Maybe now my dad's boss won't have to shop around for new insurance every few years because the old company was upping its prices too much. And since I'm likely to work in a small business once I graduate - yeah, thumbs up.

[kutsuwamushi.livejournal.com]

Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.

I'm glad this bill passed, sort of, but this part makes me so angry. We needed a public option, and what we got was a requirement to buy expensive insurance or be fined. As an adult with a pre-existing condition who doesn't have a good job, this probably won't be affordable--even half of what I've been quoted on the private market isn't affordable. And I've seen very little information about how subsidies would apply and how much they would cover.

Hopefully there isn't much of a gap between being eligible for Medicaid and being able to afford one of these plans, but knowing how government services usually work, I don't have faith that there won't be.

[sabra-n.livejournal.com]

Here's what I found. (That's a PDF, BTW.)

On the penalty:

"Require U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income.

The penalty will be phased in according to the following schedule: $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income in 2015, and 2.5% of taxable income in 2016. Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment.

Exemptions will be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants*, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples)."


*Since illegals can't use the state health exchanges. (That's my footnote of bitterness.)

The PDF also has info on the premium credits and cost-sharing subsidies, which you receive as long as you're making no more than 400% of poverty-level income.

If your employer has more than 50 employees, they have to give you insurance. If it's 25 or less w/ avg. salary of less than $50,000, they can get the full tax credit to help buy insurance for employees - the credit phases out as the avg. wage and size of the business increase.

By 2014 every state has to have health insurance exchanges. Every exchange has to have at least two providers, and at least one that's an NPO. The costs with exchanges are regulated in various ways my addled brain can't untangle right now. I hope this was helpful. :)

[kutsuwamushi.livejournal.com]

That was helpful. It looks like I'm eligible for an exemption, which is good, and that the subsidies are really fucking confusing and no wonder hardly anyone has tried to explain.

It remains to be seen how much removing the profit motive from a health insurance company can do. Health care for people with chronic illnesses is still really, really expensive; all of that premium isn't just going to line the pockets of insurance company execs. I'm not sure that the NPOs will have premiums low enough to make a difference for people for whom insurance is so far outside of their range.

[sabra-n.livejournal.com]

Yeah, 501(c)(3) status doesn't remove money concerns, because you need to think about your funding all the time - it just means that hopefully you have strong founding principles and motivations aside from money. The biggest NPOs are run as slickly as any corporation, actually, for better and for worse.

[thecomfychair.livejournal.com]

omg, I didn't realize that #1 went into effect so soon, that is just...oh man, that comes at the right time. I'm going to have to read up on the details.

[dmlpacker.livejournal.com]

Thank you for this summary. I'm ashamed to say that I haven't been keeping up with the hooplah at all.