Perata and Nunez health care bills combined

I really hope they avoid an individual mandate (0.00 / 0)

Even with significantly more regulation, it's only going to accomplish one thing: making all of us pay through the nose for crappy health care. Massachusetts is experiencing the problems with individual mandate, as the costs of premiums are - we're shocked, shocked to hear - much higher than was anticipated.

Back in February I had a diary here going into more detail about the flaws of individual mandates. I think it needs to be prevented at all costs. The Núñez/Perata plan is a useful short-term reform, but the only real solution remains SB 840. Individual mandates are a big step in the opposite direction.

You can check out any time you like but you can never leave

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by: Robert Cruickshank @ Thu Jun 21, 2007 at 14:23:11 PM CDT

Individual mandates are bad (0.00 / 0)

if we are going to require that people have insurance, it gets to the point that we are giving money to the insurance companies with no real value added to us.  They just serve as 33% middleman.

Seems kinda crazy to me.

I'm proud to work for Kamala Harris for AG, but my opinions are entirely my own.

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by: Brian Leubitz @ Thu Jun 21, 2007 at 14:33:27 PM CDT

[ Parent ]

We agree there... (5.00 / 1)

to an extent. I agree that individual mandates are bad. If it costs less for someone to pay for everything out of pocket than to buy insurance and get the discounted price, then they should be allowed to do the former.

Robert, SB 840 is NOT a solution, and definitely not the only solution. I don't want the government choosing my grocery store, my clothing supplier, and I don't want them choosing my health plan.

The problem is lack of access, and that can be dealt far more rationally than a government takeover. The insurance companies are in need of a serious overhaul. Mend it, don't end it

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Thu Jun 21, 2007 at 14:40:06 PM CDT

[ Parent ]

the only way mandates make any sense (0.00 / 0)

is if the state is providing a universal, affordable quality care. mandating that people fork money over to insurance companies is mad, especially when said companies can refuse to cover preexisting conditions.

nearly every other developed country in the world has decent state-run universal health insurance. there is no valid argument for why it wouldn't work in california, which is bigger and richer than most of those countries anyway.

surf putah, your friendly neighborhood central valley samizdat

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by: wu ming @ Fri Jun 22, 2007 at 01:49:23 AM CDT

[ Parent ]

Couldn't agree more (0.00 / 0)

individual mandates that simply force us all to be customers of the current milking-us-dry insurance industry are a bad, bad, bad idea. The only way I would support required insurance is if it's single-payer or something like it, covered via well-thought-out taxation or cost that is appropriately progressive.

This would pretty much screw over any number of people I know, who I'm sure wouldn't qualify as "low-income" enough for a break but would be virtually unable to pay rent if they were required to take on high insurance company premiums.

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by: spit @ Fri Jun 22, 2007 at 10:12:43 AM CDT

[ Parent ]

Define decent... (0.00 / 0)

"nearly every other developed country in the world has decent state-run universal health insurance. there is no valid argument for why it wouldn't work in california, which is bigger and richer than most of those countries anyway."

Define decent. Is waiting 18 months to get bureaucratic approval for elective procedures decent? Is the government choosing my health plan for me decent? Is a monopoly decent?

Jesse Ventura said it best in his book, "I don’t support [single-payer] health care. I think any time you get a system where there’s only one provider, you get corruption. Competition creates better service and keeps prices down.

By its very nature, medical care can’t be a purely capitalist venture. If it becomes only about making money, we get to the point where we’re messing with people’s lives and health just to make a buck. We do need to have some kind of regulation or watchdogging system in place to keep HMOs from getting out of hand."

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Fri Jun 22, 2007 at 20:47:26 PM CDT

[ Parent ]

believing the lies (8.00 / 1)

I know that America's supposed to be exceptional and all, but the sad fact is that, despite the fact that we pay twice as much per capita for health care than any other industrialized nation, and yet by every important standard - quality of care, access, efficiency, equity, and life expectancy - we rate either dead last or next to last.  If you don't think we're entitled as a nation to any better than that, then enjoy your HMO telling you that life-saving procedure you need is experimental, and that there's a 4-hour wait at the ER, and that you can only see your in-network doctor, and that the hospital won't stitch you up until they figure out if you can pay them.  I don't know if you've ever left this country, but maybe you should.  It's not Booga-Booga land out there.

Also, both the VA and Medicare, those dangerous single-payer, single-provider systems, keep costs down FAR, FAR more than any private for-profit system does, despite being underfunded.  So your facts are nonexistent and predicatbly wrong.

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by: David Dayen @ Fri Jun 22, 2007 at 23:34:07 PM CDT

[ Parent ]

Apples and oranges... (0.00 / 0)

First off, I'm not defending the HMO's. Read the quotation by Jesse Ventura

"Also, both the VA and Medicare, those dangerous single-payer, single-provider systems, keep costs down FAR, FAR more than any private for-profit system does, despite being underfunded.  So your facts are nonexistent and predicatbly wrong."

I say apples and oranges for more reason than usual. They are both fruits, and all you're comparing is single-payers. And, the typical apples and oranges saying also applies.

The government SHOULD provide health care to those who otherwise cannot get private insurance, in this case, you mentioned the elderly and our veterans. That's different from expanding it to everyone

In countries where it's expanded to everyone, patients and doctors are not free to make their own decisions when it comes to particular treatments and procedures. While the hospitals and doctors are still considered privately owned, it’s the government that controls it with their funding.

Make no mistake, I'm not saying the same problems don't exist with private insurance. However, there is a key difference there: it is all in the contract that the patient signed. If the patients are unsatisfied, they can switch insurance companies or sue them, sometimes successfully. While the patient and doctor do not have full control over their medical decisions, it is still a greater amount than with a single-payer

Once again, you can outline all the problems you want with private insurance and you're probably right. However, that does not mean single-payer is the best solution. My position with private insurance is simple: mend it, don't end it

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Sat Jun 23, 2007 at 00:25:30 AM CDT

[ Parent ]

asdf (8.00 / 1)

While the patient and doctor do not have full control over their medical decisions, it is still a greater amount than with a single-payer

That's an assertion for which I just don't see any evidence. Lots of things are covered by no private insurance company, so it's not nearly as simple as "just switch providers, get a new 'contract'". And while it's fine and dandy to say "you can sue", the reality is that you need the procedure now, not a year from now after bickering your way through the courts.

Getting my wisdom teeth pulled -- which were causing me extreme pain of a kind that is pretty indescribable -- involved a weeklong battle with my insurance company while I suffered through. On the medical, rather than dental, front, I've had my insurance company refuse to cover me when I tried to switch to my own plan from my parents' -- why? Because I'd visited the doctor (gasp!) four times in the year before, when I BTW had walking pneumonia.

Switch? Who the hell was I supposed to switch to? Currently, insurance decisions wind up largely being made based on expense; it's not that I wouldn't love better insurance, it's that better insurance costs hundreds more per month and we simply can't afford it.

The marketplace doesn't have the kind of competition your idea is relying on. Healthcare isn't really optional, and the insurance providers hold all the cards. Meanwhile, doctors and hospitals wind up having to have whole staffs of people who can figure out all the weird-ass plans and deductables and co-pays (some of which are gigantic, so just having "insurance" is by no means a guarantee that you can get the care you need). Insurance companies are in the business of making a profit, not of getting people treatment -- there's a strong market incentive for them to minimize care while maximizing payments.

"mend it, don't end it" is a phrase, not a solution. I'm just not sure how you honestly think these problems can be solved within a for-profit insurance framework, with hundreds of different plans meaning different coverage for everybody based on income, and with any consumer choice being based on wealth and eligability for picky-ass companies who only want to insure those who least need insurance, rather than on health needs or individual circumstances. I don't honestly see how our system could get much worse than it is, and I'd honestly rather have some uniform application of standards of care

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by: spit @ Sat Jun 23, 2007 at 10:34:24 AM CDT

[ Parent ]

A lot of what you say... (0.00 / 0)

gets worse with a government-run system

"And while it's fine and dandy to say "you can sue", the reality is that you need the procedure now, not a year from now after bickering your way through the courts."

Okay, I need an elective procedure now under a single-payer. I'll have to wait 1-2 years

"Insurance companies are in the business of making a profit, not of getting people treatment -- there's a strong market incentive for them to minimize care while maximizing payments."

I don't have a defense for that. I just believe we can fix that more rationally than abolishing insurance companies and having a government monopoly. I'm not one of these libertarians who says "all government intervention is bad"

"I'm just not sure how you honestly think these problems can be solved within a for-profit insurance framework, with hundreds of different plans meaning different coverage for everybody based on income, and with any consumer choice being based on wealth and eligability for picky-ass companies who only want to insure those who least need insurance, rather than on health needs or individual circumstances."

And you seriously think the rich aren't favored in a single-payer? In countries with a single-payer, a black market exists for people who are sick of waiting in line and can afford to jump the queue. For example, they'll pay the doctor under the table so he'll see them right after the workday is over

And how on earth is a single-payer based on individual circumstances and health needs?

How many people do you think are uninsured now because they don't have access? It's not the 6.5 million claimed. 2 million of those people have incomes >$50,000 and why the hell do they deserve a subsidy when they can buy their own? 1 million are eligible for Medi-Cal or Healthy Families. 2.5 million are illegal immigrants, and why do they deserve free health care when legal citizens have trouble affording it?

The remainder 1 million doesn't have access to health care.

By the way, here's what'll help make costs go down: remove minimum coverage mandates. Okay, I guess the insurance companies should be required to offer minimum coverage, but I should have every right to opt-out of it. If I won't use treatment for alcoholism, I shouldn't be required to pay for it.

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Sat Jun 23, 2007 at 13:07:46 PM CDT

[ Parent ]

asdf (0.00 / 0)

Okay, I need an elective procedure now under a single-payer. I'll have to wait 1-2 years

As opposed the the current system, where you have to wait and your insurance refuses to cover it.

1-2 years is a number you pulled out of nowhere. There's often a lot of variation in wait times, because it depends on the procedure, as well as which country's system we're talking about. Actually, I believe a more commonly used number is 18 weeks -- about 5 months. Again, which is different from the wait times for many people here... how?

And how on earth is a single-payer based on individual circumstances and health needs?

My point was that the focus in a single payer system is what care you need, rather than how much you can pay for coverage. The thing that gets me about your complaints about access -- waiting in the queue, for example -- is that we already have a system that essentially rations out care, it just does it through income instead of who got in line first and needs the procedure most quickly. I'd say yes, that's a much more equitable and health-care-focused way to handle the situation, much more "focused on individual circumstances and health needs", rather than income.

2 million of those people have incomes >$50,000 and why the hell do they deserve a subsidy when they can buy their own?

Have you gone shopping for private insurance lately? Because for a family living in a high cost of living state, I can easily see how $50,000 would be hugely stretched trying to afford the premiums for most of these plans, especially for a family. My girlfriend and I now with her new job live on not much less than that, with CA State benefits (which are very much better than most people's) and no children. Let me tell you, the health insurance has an impact.

To be honest, I'm also less interested in bickering over the number of "uninsured" people we have -- because it's not the point. The uninsured are a problem that you're trying to minimize to suit your talking points, and one that needs a good solution. But beyond the uninsured are millions upon millions of people who have insurance that barely covers them, with huge co-pays and deductables that still prevent them from actually getting good health care.

What we have here is a full, systemic failure of the health care system.

If I won't use treatment for alcoholism, I shouldn't be required to pay for it.

BS.

"If I won't use public school, I shouldn't be required to pay for it."

You have no understanding for how insurance works if you're throwing out that line. The whole idea of insurance is that everybody pays for a lot of stuff they don't use, so that the stuff they do use is covered if and when they need it.

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by: spit @ Sat Jun 23, 2007 at 18:16:59 PM CDT

[ Parent ]

jkl; (0.00 / 0)

"As opposed the the current system, where you have to wait and your insurance refuses to cover it."

Who says my insurance will refuse it?

Also, I did not make up 1-2 years. If it's a life or death emergency they can deal with that immediately, but if you want an elective procedure, wait 1-2 years

"My point was that the focus in a single payer system is what care you need"

And people will demand unlimited care if the price is free. We don't have unlimited care

You completely ignored my black market reference. Plus, what makes you think the bureaucracy won't just grant priority to those who will pay more taxes for the rest of their life? If it's dependent on taxes, then why wouldn't they grant priority to those whose being alive will sustain it better? I'm not defending it, I'm just asking what makes you think that won't happen?

Your public school argument is apples and oranges. I've been responsible and haven't become an alcoholic, why should I be required to subsidize those who were less responsible? Public schools, on the other hand, are about ensuring equal opportunity because the parents' irresponsibility is not the kids' irresponsibility.

I'm not going to support a system that gets rid of personal responsibility. Why is it right to take my hard-earned dollars to pay for health care of smokers and other people who have made irresponsible choices?

Maybe there is some compromise that would make it so those who use it more will pay more. Regardless, the insurance companies are desperately failing the public and are in need of a serious overhaul, but I will not support putting the government in charge of what goes on in my doctor's office.

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Sat Jun 23, 2007 at 19:11:12 PM CDT

[ Parent ]

Agreed. And a bit of SICKO blog-whoring as well. (8.00 / 1)

I agree.  Individual mandates are besides the point; their only virtue, as near as I can tell, is that they keep the health insurance companies "in the game".  Very few people in politics want to cross them, or they believe that the only way to get reform is to co-opt the insurance companies by giving them a place at the table.

Won't work. They don't want a place at the table. They want whole f**king table, the dining room, and the house it sits in.

I just did a diary on DailyKos on how the health insurance industry is stage-managing the so-called health care debate.  By all means, take a look at it and recommend it if you like where I'm going with it.

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by: mbayrob @ Sat Jun 23, 2007 at 00:07:34 AM CDT

[ Parent ]

Not interested (8.00 / 1)

I'm not interested in any State plan the involves insurance companies.  At the very least, the state should expand it's MediCal system to allow individuals and small business - well, heck everybody - to buy into it and compete against the Insurance companies.  It can't be worse than the "coverage" you get at the low end of insurance premiums. (And we'll never get a tax increase passed while it requires a super-majority.)

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by: David in Burbank @ Thu Jun 21, 2007 at 14:46:06 PM CDT

Here is (0.00 / 0)

my offering on the subject.  Individual mandates is going to be a huge battle.  I dont think that the Democrats have room to give on the issue.  They have opted to go for a less ambitious proposal, which many of their allies will only support without mandates.  If the plan went further in terms of regulation private industry or opening up a governmental plan to anyone who is interested then mandates would not be a big issue (the Edwards approach).

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by: Julia Rosen @ Thu Jun 21, 2007 at 17:13:58 PM CDT

UHC Tax (8.00 / 1)

Institute a Universal Health Care tax across the board on income and corporate profits - then allow business or individuals who choose not to be covered by the State plan to apply for a refund of the tax each year by showing that they (or their employees) are covered at or above the state standard.  Also allow individuals and companies in the state plan to buy supplemental coverage and get maybe a quarter refund on the new tax.

I pay 12K a year for a family of four at Kaiser - and it's killing me and I don't like being limited to their doctors and facilities  - equivalent coverage at a lower annual rate would be greatly appreciated.  Only with the economy of scale offered by universal coverage will that happen. 

Those who sell insurance are gambling that the bulk of their customers won't get sick - that's a fools bet - unless they can find ways not to pay or charge more for premiums (plus there is the profit motive.)

And with a state plan - we can push more people into preventative health care saving the system and ourselves billions in emergency room expenses.

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by: David in Burbank @ Fri Jun 22, 2007 at 09:20:45 AM CDT

[ Parent ]

There'll be no individual mandate... (0.00 / 0)

The compromise got rid of it:

COMPROMISE: Guaranteed issue for everyone in the individual market without serious medical conditions. High risk pool for individuals with serious medical conditions, funded by a broad assessment on health plans. No individual mandate.

The Silent Consensus

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by: thelibertariandemocrat (VF2005) @ Fri Jun 22, 2007 at 20:43:16 PM CDT

Job-based coverage (0.00 / 0)

"And I think this new bill strengthens the tying of health care to employment, when that really should be severed."

I agree in theory, but the fact of the matter is that health coverage in the U.S. is tied to employment, and we're not going to change that this legislative session.  Unless and until we establish an entity to take the place of employers as benefit providers (such as SB 840 would do, if we could ever actually get it passed), then our choice is between employers offering coverage and individuals fighting for themselves.  Given that choice, I think it makes perfect sense to ask employers to contribute more to covering Californians, and to make ALL employers provide more so as to eliminate the free rider advantage companies like Wal-Mart enjoy.

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by: Leighton Woodhouse @ Fri Jun 22, 2007 at 23:44:07 PM CDT