The question with an individual mandate is subsidization and affordability. If we pass a law levying an individual mandate and subsidizing premiums down to $50 a month, there'll be few complaints. A mandate with no subsidization, however, is an impossible burden on millions of families. When evaluating an individual mandate, that's where liberals need to focus: The generosity of the subsidies. The Wyden Plan, for instance, subsidizes up to 400 percent of the poverty line. The Massachusetts plan subsidizes up to 300 percent. The Schwarzenegger plan subsidizes up to 250 percent. That looks too low, and I'll talk more about it later today.
I look forward to seeing that, Ezra is very good on this issue.
This plan is very reflective of the Governor's newest persona as a post-partisan. What makes it ultimately unsatisfying and potentially dangerous is that it lacks the same thing the Governor lacks: core beliefs. Instead of trying to jerry-rig all of these different ways to find the money so that everyone in the state has a low, vague level of health care (if I read this right, under this plan my premiums would go up and my coverage would go down), why not step back and try to lay out what the end goals are? I believe that health care is a right and not a privilege. I believe the money spent on health care today is enough to fund a successful, robust system where people get quality care, doctors and hospitals make money, and the public at large is generally healthier. If that was the goal, you wouldn't continue to perpetuate this myth that employers have an obligation to make sure their employees are healthy. On this score I completely agree with the LA Times editorial board:
The problem is this: It makes no sense to legally and permanently make Californians' access to healthcare dependent on their employers. Companies hire workers and pay them for their time, talent, muscle and brains. Employers must meet certain standards to do business in the state - complying with workplace safety laws, paying the minimum wage, providing workers' compensation insurance, etc. But they should not become the primary mechanism for the state to deliver vital services to citizens.
This is more true here than elsewhere because so many Californians who need insurance have only marginal or temporary relationships with employers. Companies, meanwhile, face plenty of challenges just staying in business and keeping up with the dynamics of the modern marketplace without being saddled with a new health insurance tax.
What ends up happening, and would still happen, is that people would stay in dead-end jobs because of their health insurance, because the subsidies wouldn't be big enough to justify the poor care and the cost of going it alone. And American companies are less competitive because they stand alone in bearing the burden of health care. And taxing companies who opt out of paying for employee health care by 4% of profits is a pittance compared to actual health care costs for companies. You'll end up with a de facto state-run health care system with no possibility to rein in costs. The cost-containment strategies, mainly HSAs and telling people to join a gym, are laughable. Employers can't provide health care and compete in a global marketplace, and the state cannot fund health care without keeping costs down. The plan does neither.
(Never mind the fact that a key point of funding this mish-mash is by taking $2 billion out of the public health system. The funding aspect of this is almost totally ridiculous.)
Another core belief of mine is that no plan should keep in place and largely intact the for-profit insurance system which, through greed and dirty dealing, benefits from its own stinginess in denying care and trying to eliminate the sick from their rolls. The Governor's plan would be the greatest thing ever to happen to the private insurance industry. It would give them four or five million new consumers, who they would be required to provide with care. That's a positive step, but it does nothing to contain costs for those consumers based on age or occupation. Insurance companies can jack up rates that Californians MUST pay. How's that for a license to print money?
The CNA has a very good roundup of this plan which I urge you to read. And I'm pleased with the reaction of Art Pulaski of CalFed.
"While the Governor's healthcare proposal includes some positive elements, it is the wrong prescription for California's health care crisis. This proposal will be a boon to insurance companies, but a bust for most workers. This plan requires all Californians to buy health insurance with no guarantee that it will be affordable or that coverage will be adequate. We are concerned that the plan creates an incentive for employers who currently provide health care to drop coverage and instead pay only a minimal tax."
That's it in a nutshell. And I really hope that Democrats in the Legislature, who were very nearly effusive in their praise of this strategy, wake up and figure this one out. Perata and Nuñez are pretty much alone in their support. Is this tactical? If so, it's the worst tactical maneuver I've ever seen, and calls into question what their goals for health care really are. It doesn't seem to be changing a broken system. It doesn't seem to be making health care affordable for everyone. It doesn't seem to be doing anything but making insurance companies rich.
This is a very Republican program in that it puts the risk and burden of health care, largely, on individuals. Just like moving pensions to defined contributions from defined benefits, just like proposals to privatize Social Security instead of keeping it protected, just like "free trade" causes job insecurity for the vast amount of America's workers, the message to individuals is simple: YOYO. You're On Your Own. That's what this proposal is for Californians. |
