Passing the bill is the right thing to do, but we do all our fellow Americans a huge disservice by ignoring the realities of all the problems millions of Americans will continue to face long after this bill becomes law.
Once the bill becomes law, all of its unfinished business will start to come out of the woodwork. People need help immediately, and despite the spine tingling oratory from the president, this bill only provides for immediate help on the margins.
Until this car is taken out for a drive, making sense of how people will access help immediately is not easy to figure out. But my fear though is that despite the rhetoric, Americans are not going to get the relief we have long needed, well into the distant future.
This is why we will continue this fight without missing a beat because, for so many, the change will be years down the road and will come at a glacial pace.
You don't have to agree with what I'm writing, and I suspect some of you won't, and of course, this is your right. But I do urge everyone to read what mcjoan had to say yesterday. There is no one doing finer reporting on this legislation than mcjoan and her diary yesterday, On Not Clapping Harder for Insurance Reform is must reading.
Some points worth considering.
The Individual Mandate.
Some see immense legal and perhaps even constitutional problems with the mandate that will force Americans to buy private insurance. If there were a public option, the sting of the individual mandate would be largely neutered. An opt-out provision to combat this problem is one way to solve the problem but not the only way. The simplest, easiest, and most morally appropriate way to address this problem is by passing a public option - an option that will allow individuals to decide whether their dollars, and their health ultimately should be entrusted to a profit-driven corporation, or a government program.
To ignore this reality, is to put your head in the sand, and many of us fear the consequences of this in 2010 1nd 2112. Now Harry Reid has said he will offer a public option amendment in the next couple of months, that would be ideal, but don't hold your breath.
High Risk Pool.
The 5 billion funding for the high risk pool is one of those "starts this year" selling points. This is supposed to help Democrats when they go back to their districts and attempt to explain to a thoroughly confused and demoralized populace what they can expect from this historic legislation right away.
President Obama says if you've got a pre-existing condition and have been turned down for health insurance, you'll be able to get it before 2014 via this newly created and funded high risk pool. Well, we're talking about a huge number of Americans, and 5 billion in funding. Could someone please tell me how this is going to work? You should read this from Health Affairs to see the complexity of setting up a high risk pool, and how Minnesota has one of the only good ones that is relatively affordable and works.
This is right off the White House web site. Not good, folks, not good at all. Anyone know what it's going to cost?
This is from Alternet, it's my question and it should be yours as well.
How can $5 billion cover all currently uninsured "high-risk" individuals (including individuals with pre-existing conditions, which apparently includes anybody who is actually sick) as well as any "high-risk" individuals who lose their insurance between now and 2014?
Nobody seems to know.
Individuals and small business.
The individual and group market is where I find myself, and we're the ones being most brutalized by the out-of-control and predatory insurance industry.
I have still not located one satisfactory explanation for my simple question, what if anything, will control skyrocketing premiums in the individual and small group market between now and 2014?
When my own premium was increased at renewal 28%, I was forced into a dangerous high deductible plan. I now have a $3000 deductible and huge cost sharing with massive co-pays and out-of-pocket costs. I no longer have meaningful coverage, I have insurance in name only. And I pay almost $600.00 a month for this.
If we see continued price gouging in the small group and individual market, I believe this will put the President in a very difficult position with the electorate in 2012. Is he going to campaign on more promises, "trust me, I promise in 2014, the price gouging will end. Trust me you're gonna love the exchange." Someone needs to explain to us, how this is going to work.
As Drew Altman at the Kaiser Family Foundation notes in a tremendous essay When Premiums Go Up 39%
All this underscores a basic point: rising health care costs and insurance company practices are leading not just to more expensive premiums, but to skimpier, less comprehensive coverage as well; slowly redefining what we have known as health insurance. To be sure, some economists argue that this is precisely what should happen, that people should have more "skin in the game." But this is not likely how regular people see it. Appropriate cost sharing is one thing, but we may be reaching the point in the individual market where the policies many people have simply cannot be considered meaningful coverage.
The hardship waiver.
Giving Americans a healthcare hardship waiver, is a kick in the face. This is from Chuck Schumer. People want to know who's being left out, this begins to answer that pesky question.
Frankly, I believe, the American people want what every other industrialized nation on the planet has figured out how to provide all its citizens. Americans want guaranteed and affordable healthcare. We don't want to be excluded from the system any longer with new insanities called hardship waivers.
Tens of millions of Americans cannot wait until 2014, what is being done for them--now?
I'm supporting this bill for Americans like Betsy Case. But where is the relief for Betsy before 2014? Will she be able to buy into the high risk pool? If so, at a cost she can afford? She can't afford $177 for the Husky Connecticut public program for children, how will she afford the costs of an inadequately funded high risk pool?
The questions go on and on and on.
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