| Yesterday, I wrote about the things I like from the House health care plan. Here's the other side. First, it won't pass. That's a political issue, independent of the plan itself. It won't pass because too many Senators won't agree to a public option. Some for pure reasons ("I'm holding out for Single Payer") and some for the reason that they don't like government involvement. As an aside on that last point, I cringe every time I hear some IIE wingnut say "You don't want some bureaucrat between you and your doctor." WHAT THE @#*%^$ do these people think insurance companies do now? They approve or deny drugs, treatments, tests, specialized care - that's their job. Whether it's accomplished by the Blues or Medicare, there is no difference. The only way to have no one between patient and doctor is for the patient to pay all the bills. That's just reality. The next problem is the idea that there can be state-run exchanges in lieu of a Federal exchange. That would mean that Massachusetts can continue their program, and other states can set up similar programs. The problems with this relate to cutting the legs out of a true economy of scale. Then, we're back to the thing I keep harping on: I could find nothing in the full legislation that indicates "special deals" between private insurers and hospitals are banned. This will stifle any potential competition between the current preferred provider plus the public plan versus all other insurers. Further, the penalties are way too low. Companies (except for the very small) will have to pay 8% of payroll if they choose to not offer insurance. This is fine for any company with high salaries, but if you have a place like McDonald's where the median salary well under $20/hour, it is far cheaper to pay the fine. Further, the penalty to individuals is stipulated at two percent above a certain minimum. At a salary of $100,000, that's $2,000, far less than any insurance policy would be. At $30,000, it's $600/year, which is likely equal to a monthly premium payment. The term "administrative simplification" is terrifying. The text indicates that the paperwork burden will be lessened on providers. While I agree that the paperwork is onerous, without more clear direction of what is cut and what stays, it's a disaster waiting to happen. Next, as alluded to by commenter cbsmith, there are no options for chiropractic, naturapathic, homeopathic or other alternative and adjunctive therapies which often work better than standard AMA-certified options. Finally, there is nothing that approaches the fundamental problem of the profit motive. The state exchanges doom the public option to failure, even if it does pass, and the private insurers, medical device makers, pharma companies, doctors dedicated to dollars over patients, and large for-profit hospital chains are left to find ways to game the new system. I heard recently that if we do nothing, health care will consume 35 cents of every dollar of GNP in a decade or so. We can't afford that, and the only way to avoid it is fundamental change. Somehow, despite the 72% citizen approval for a public option that works, there seems to be a lack of political will on the Hill. |
