I said something deliberately provocative on This Week, so I think I’d better clarify what I meant (which I did on the show, but it can’t hurt to say it again.)
So, what I said is that the eventual resolution of the deficit problem both will and should rely on “death panels and sales taxes”. What I meant is that
(a) health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care
(b) we’ll need more revenue — several percent of GDP — which might most plausibly come from a value-added tax
And if we do those two things, we’re most of the way toward a sustainable budget.
Yeah, we really have to think about having M&M pay for expensive procedures with a small likelihood of success, but that’s really a dumb way for a liberal to say it, especially considering the origin of that “death panels” term. But even so, “death panels” aren’t the only way to control costs.
We pay twice as much for health care as the other industrialized nations. At some point we’re gonna have to consider not just WHAT we’re willing to pay for but also HOW MUCH we’re willing pay for EVERYTHING, including routine care.
We can’t control M&M costs without addressing the entire health care market. And the best way to do that is a little thing called “single-payer.” While medical professionals deserve to be well compensated, “for-profit” health care makes as much sense as “for-profit” police and fire departments. Continue reading →
‘‘SEC. 2712. PROHIBITION ON RESCISSIONS.
‘‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee,
What’s the most important word in that long-ass sentence? I’ll give you a hint: It starts with an “e” and ends in a “t” with “xcep” in between. That’s what known in legal terminology as a “big fucking loophole” and it’s one of the reasons people despise lawyers.
Now before I go any farther I want to correct a mistake many people (including Ian) make. Rescission is not the canceling of a contract, it is the legal term for the unmaking of a contract. When a contract is rescinded the parties are supposed to be returned to the positions they were in as if the contract was never made. In the case of an medical insurance contract that means the insured is entitled to a refund of all premiums paid and the insurance company gets back whatever benefits it paid out.
So now let me drop a hypothetical on you:
So let’s say your employer provides you with medical insurance through Heartless Bastards of California. You have had your share of the premiums deducted from your weakly paycheck for the past five years but other than a few routine check-ups you didn’t see your doctor.
You hadn’t been feeling well so you went to the doctor and he/she ordered tests which confirmed that you have cancer. The good news is that it’s treatable, but you will need surgery and a year of chemotherapy and you will be unable to work until the treatment is completed.
Left untreated the prognosis is bleak and time is of the essence so the doctor recommends the surgery take place as soon as he obtains pre-approval from Heartless Bastards.
Your doctor promptly sends the bean counters at Heartless Bastards the two reams of paperwork they require for pre-approval and the estimated cost of your treatment is over $100,000 even if everything goes right. This causes an immediate review of your account by the legal department at Heartless Bastards. The review includes comparing the answers on your original application to the ones you gave your doctor (he sent them a copy of your entire medical file) and there are some discrepancies between the two sets of answers.
Two days later you get a certified letter from Heartless Bastards stating that they have reviewed your account and are rescinding your coverage based on fraud and/or material misrepresentation. They have enclosed a $10,000 check for the refund of your premiums, and the small print on the back just above the place for your endorsement states that signing and cashing the check constitutes a waiver of all claims against them.
What would you do?
Depending on the discrepancies in your answers Heartless Bastards may or may not be able to justify rescission and they gave you prior notice as section 2712 requires. But what if they just ignored the law?
Let’s say you had a stroke that put you in the hospital for over a month and left you permanently disabled.
Your medical bills for just the first month after the stroke total over $100,000 and the meter is still running. You didn’t have the foresight to purchase a private disability policy and you only have modest savings so you have to rely on Social Security Disability. This means you will suffer a big drop in income even though your rent/mortgage won’t change and your creditors will still expect payment each month.
Then you get that certified letter from Heartless Bastards saying that they are rescinding your policy based on fraud because you got the dates slightly wrong about some minor illness you had two decades ago. You didn’t get prior notice and their reasons for rescission are specious, but they do it anyway.
Then you begin receiving bills from every doctor, hospital, lab, ambulance company, pharmacy and/or other medical service provider that participated in your care and treatment. Each of those bills states that your insurance company has rejected the provider’s claim for services rendered and refused payment and therefore you are liable and they want their money right fucking now.
You’re broke and disabled. Any attorney willing to represent you will want a hefty retainer up front – they don’t take contingency fees on cases like this.
What are you gonna do about it?
Many people will give up, which is what those Heartless Bastards are counting on. Oh, they don’t really want to see you die, they just don’t want to pay your medical bills. It’s nothing personal, they are only fucking you over because their incomes go up if they do.
The bean counters and shysters receive raises and bonuses based on how many claims they successfully avoid paying. There is no incentive for them to do what is just and moral. They tell their feeble consciences that you will qualify for Medicaid or that you can file bankruptcy or something.
If your bills do get picked up by Medicaid then the taxpayers will pay for your treatment. This is commonly called “socialized medicine” everywhere except for all the rest of the countries in the world.
If you successfully discharge your medical bills through bankruptcy or by dying then the cost of your treatment gets passed on to the patients who have money in the form of increased fees.
Until we are willing to treat health care as a privilege for those who can afford it the poor will keep incurring costs that they cannot afford to pay. Whether we pay via taxes or by increased fees, one way or the other society foots the bill.
Obamacare forces people to purchase medical insurance through private insurance companies. It doesn’t provide them with any assistance if they need to fight those companies in court. Most people don’t have a lawyer on retainer but every insurance companies has a whole bunch of them sleazebags on their payroll.
They know most people won’t hire an attorney and file suit. They use legal terminology in their paperwork that is intended to intimidate people and convince them they can’t win. It’s often a bluff – in many cases just a letter from an attorney can get them to reverse course and pay the claims. But how many people have an attorney to write that letter for them? How many will simply give up without a fight?
The insurance companies are gaming the system in order to maximize their profits. Bad faith rescission and denial of claims are two of the tactics that they use. They will keep using those tactics as long as they are effective, and they will only act morally if is more profitable than acting immorally.
We cannot rely on regulatory agencies because that merely encourages regulatory capture and/or bribery. As we already see with numerous government agencies the enforcement departments are underfunded and they are managed by former employees/agents of the companies being regulated. It doesn’t matter what laws and regulations are on the books if they are not enforced.
The best way to disincentivize bad-faith rescission and denial of claims is to fight fire with fire. Since we privatized the payment of health care we should privatize the enforcement of the laws and regulations governing health care insurance. What do health insurance company bean counters fear most?
Lawyers (aka “ambulance chasers”)
More specifically, lawyers who will collect their fees and/or exemplary (punitive) damages directly from the insurance companies if they win their cases.
Right now there is every incentive for the insurance companies to cheat and few negative consequences if they get caught.
In my original hypothetical the insurance company wanted to avoid paying $100,000 in claims so they returned $10,000 in premiums and rescinded the contract. Technically you could say the net to them is zero – they got nothing and paid nothing.
But they avoided losing $90,000 which is a lot more than zero. If they are unsuccessful in their attempt at rescission they are still no worse off than they were originally. IOW – they have nothing to lose and something to gain by cheating.
What if the insurance company was subject to punitive damages and would have to pay the attorney’s fees of the people unsuccessfully tried to fuck over? In that scenario if the insurance company acted in bad faith and was unsuccessful they would not only have to pay the $100,000 in medical claims but also as much or more again in attorney fees and possibly several times that amount as exemplary damages.
IOW – they have a little to gain but a lot to lose by cheating.
Attorney fee awards are a way to finance legal representation for those people whose cause is just but whose wallet is empty. They also force the bean counters to increase the weight of the “risk” portion of their “risk/benefit analysis.”
Exemplary damages are intended to punish civil wrongs, such as where an auto manufacturer discovers a dangerous defect in one of their cars but does not issue a recall notice because they calculated it would be cheaper to pay off the dead and injured victims than it would be to fix the defect.
I realize that this is all pie-in-the-sky dreaming on my part and it will never happen. We all know there is no way that Obama and the Democratic Congress are gonna bite the hands that feed them. The health insurance companies bought them fair and square and like all honest politicians they will stay bought.
Besides, nobody likes lawyers anyway.
But since I’m day-dreaming about wild and crazy ideas to solve our health care problems, let me tell you of one idea that’s even wilder and crazier.
It’s “single-payer,” or as some people call it “Medicare for all.”
Single-payer is health insurance for everyone through a single government run insurance pool out of which the fees for medical services and cost of drugs are paid.
Single-payer health insurance collects all medical premiums/taxes and then pays for all services through a single government agency. It IS NOT socialized medicine – health care providers and pharmaceutical companies remain private rather than public.
Crazy stuff, huh? That’s the kind of bizarre and twisted ideas you come up with when you have a cannabis card and use it regularly.
Unfortunately, single payer was taken off the table by the Democrats at the beginning of the health care reform process and the A-list bloggers sat silently when it happened.
The Democrats and their A-list shills decided to use the “public option” as a negotiating ploy and by doing so they were successful in passing an old Republican plan with zero Republican votes.
All this change! All this hope! I can’t take it! I’m going to spontaneously combust!
The world is going insane, and while normally I like insanity, this is not the good kind. Obama has just passed national RomneyObamacare–a Nixon wet dream originating from the Heritage Foundation in the 1990s in opposition to Hillarycare, and yet lunatic “Tea Partiers” are running around vandalizing the houses of Congressidiots who voted for the heaping pile of shit, screaming that they are “socialists?”
Obama signs an executive order restricting women’s access to abortion, and so called “progressives” and “feminists” are having kool aid induced orgasms as they compare the passage of a Health Insurance Reform Bill that would be better served as toilet paper to the Civil Rights Act? What the fuck?
Well, maybe I’m being unfair. The Bill IS Historic. Historically shitty.
I find myself–and we all must admit that I am normally so cheerful and chipper, yes, you know you all love me– I find myself feeling gloomy. I’m walking around campus with my hands shoved in the pockets of my fake leather jacket with a cigarette hanging out of my mouth–and I don’t even smoke! Security officers are mistaking me for troubled youth and are performing random searches on me.
Well, I am troubled. I’m troubled about a lot of things, but in terms of politics and current events, I am troubled about the fact that, as MYIQ said a few weeks ago, there appears to be no end in sight.
But what really has me bummed out right now is the realization that there is no end in sight for the mess this country is in. The single biggest problem facing our nation is the illness in our political system. When I say “illness” I mean the equivalent of an inoperable cancer that has metastasized. If we fixed our political system then we would actually be able to do something about those other problems.
For most of my adult life I believed that the Democrats were the good guys so even when they were getting slapped around by the Republicans I could support them and hope that after the next election they would grow a pair and start standing up for the liberal ideals they campaigned on.
I finally realized that the majority of the Democrats who hold elected office are not only corrupt but they have the same agenda as the Republicans. Oh, the say they’re on our side, and when it’s time for them to represent us they might make some speeches andr play some parliamentary tricks but when the nitty meets the gritty they lose on purpose. Lots of times they don’t even bother to put on a dog and pony show anymore, they just vote to bail out Wall Street or take away our civil rights as if that’s what we wanted them to do.
Now as far back as I can remember the Republicans were corrupt and they tended to be pricks or assholes, and sometimes both, but they weren’t insane. Nowadays there’s a lot of GOPers that are crazy as shithouse rats. That not only includes the elected ones but the voters too. Then you got the tea baggers who don’t think the Republicans are crazy enough.
I can’t believe that I am living in a country–I country I have grown up loving with every fiber of my being despite its flaws–where this is happening. The passage of a bill that bails out the Health Care Industry is historic! And in honor of Women’s History Month we passed it on the backs of women and their reproductive rights! Cats bark! Fish have tails! Catholic Priests are ethical in their treatment of young children!
The whole world is going mad I tell you! MAAAADDDDD!
Of course, intellectually I understand, there is always hope. Democrats are going to lose a lot of seats in November and while the Republicans that come into office will be even worse, the door will open for real liberals, not phony “progressives,” to show Donna Brazile and Howard Dean’s “New Coalition” to be ineffective and thus we will be able to take our party back.
But sometimes, in this Golden Era of Hope and Change, politics just isn’t enough. For once in our lives, we needed policy. Good policy that would actually have given broke-ass students like me real Health Insurance. Just a few weeks ago, before my spring break, I came down with the flu and missed a week of classes I’m still making up. If I had insurance, I might have been able to get antibiotics and missed only one day, maybe two. This bill does nothing to help me. For one thing, I’ll be done with my undergraduates and possibly even my graduates by 2014. At this rate I’m going to have to start stripping for my ‘scrips, just like a number of poor senior citizens who will shortly be facing cuts in medicare due to this lame-assed bill.
Sometimes, I get tired. Sometimes, I don’t want to live life day to day anymore. Sometimes I think things will never get better. Trying to get something to eat, trying to fill up my gas tank–always being hungry, worrying about my mom, worrying about my friends, worrying about all the people around me at my school who are going through the same thing.
Sometimes, honestly, I’m just tired. And today, forgive me, but I have to lament over the fact that politics took precedence over policy. Sorry.
The pressure of a fixed mass and fixed volume of a gas is directly proportional to the gas’s temperature.
This relationship is known as the Gay-Lussac’s Law and a pressure cooker is an example of the law in practice. Cooking under pressure creates the possibility of cooking with high temperature liquids because the boiling point of a liquid increases as its pressure increases. High pressure and high heat can result in delectable dishes.
Cooking under pressure can be also dangerous because as liquids change phase into gases their volume expands greatly. For example, at atmospheric pressure the volume of steam is about 1700 times greater than the volume of water. To prevent pressure cookers from becoming bombs, relief devices (pop safety valves) are employed that are capable of relieving all of the steam the vessel is capable of producing.
America the Beautiful Pressure Cooker
The political pressure cooker is beginning to heat up. The power brokers and institutions that drive the nation have arrived unannounced on the doorsteps of America like a gaggle of unwanted, high maintenance relatives that demand hospitality for an unforeseeable time and that won’t take no for answer. Furthermore, they’ve announced that more relatives are on the way. Whatever plans America’s householders had, they’ve just gone out the window, with their household budgie and the relatives’ cat in hot pursuit.
People are justifiably angry with this incursion. Their budgie might not have been much, but it was “their budgie”, nurtured from birth into what it had become. Justifiably angry householders are trying to work out why the relatives arrived on their doorsteps and why they brought their fucking cat. Continue reading →
You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time. – Abraham Lincoln
There’s a sucker born every minute. – P.T. Barnum
We, the People, are born every minute. The last ten years provides ample evidence about the regularity to which Lincoln alludes.
Geese are but Geese tho’ we may think ’em Swans; and Truth will be Truth tho’ it sometimes prove mortifying and distasteful. – Benjamin Franklin
The Constitution of the United States is like a manual for building a nation of equals before the law. It embodies the wisdom that some people gain power and freedom by stealing the power and freedom of others. It enacts principles to thwart those who conduct such thefts. “Liberty” is a common code word for describing the nation’s promise of power and freedom to its citizens.
Interestingly, the founders were all too aware that the apparatus they made to uphold the liberty of the nation’s citizens, i.e. the government, could also fall under the influence of those who would thieve the liberty of others. Accordingly, citizens must be mindful of what they, and others, ask of their government, while using the government as a tool to promote liberty, and other Constitutional and DOI objectives, and thwart liberty thieves. Unfortunately, some citizens are so focused on defending their liberty from the government that they lose sight of the reason that the government was created, i.e. they lose sight of the enemies of liberty. They are so focussed on the tree, that they lose sight of the forest that is being clearcut all around them. Continue reading →
This was posted in the comments earlier but it deserves to be on the front page. Kucinich is a real liberal which makes him “unelectable” according to the media and the Democratic establishment.
Yes, I know he endorsed Obama last year. We all make mistakes. Get over it. He is also a co-sponsor of HR 676 (single payer)
Imagine you were rowing your boat gently down the stream and one of the oars got caught in the hatch. What would happen? Logic suggests that the current would slowly move you downstream as you spun the boat in circles.
O.K. Rowboats don’t have hatches, but Orrin Hatch is a creature and a feature of the ship of state and it is people of his intellectual and moral quality who are spinning the boat in circles when it’s clearly in need of proper direction. In fact, abandoning the first metaphor, they’ve piloted the US up the creek to where it is today. When you’re up this creek, you need a paddle, not an Orrin.
In response to Charles Schumer’s statement, that the Democrats can pass healthcare reform without Republican support:
Sen. Orrin Hatch (R-Utah), who joined Schumer on the show, said Democrats should not try to use reconciliation to force through a bill which could not overcome a filibuster in the Senate.
“If they use that, that would be an abuse of the process,” Hatch said. He also said creating a government health plan open to all would be a grave mistake. “If we do that, we’ll bankrupt the country.”
Earth to Orrin. What do you think you’ve been actively working at for the last 8 years? What do you think lying to the public to make a war in Iraq, and loosely regulating the financial community, have to do with the current economic situation?
The Republican Party set the stage for bankrupting the nation by adopting neo-conservatism as its political philosophy. Neo-conservatism, which is conservatism without moral and intellectual grounding, is bankrupt at the conceptual level, so it’s hardly surprising that Bush’s application of its principles gutted the economy of the nation. It’s also why so many Republicans continue working to bankrupt the nation by applying the principles they say prevent bankruptcy.
Ideologues whose brains can’t get beyond binaries are incapable of accepting the empirical world when it conflicts with their beliefs. One such belief is that public healthcare would bankrupt the economy, when every study ever published in The New England Journal of Medicine on the topic shows that public healthcare is more efficient and cost effective than private healthcare.
With people like Orrin at the helm, there is no reason to wonder why the country is up the creek. I can think of at least two good uses for a paddle.
Mark Twain, in “Cannibalism in the Cars,” suggested that cannibalism of the body politic is a logical outcome of the practice of the political values of the elected representatives of the United States, in dire circumstances. What would occur, if such dire circumstances did not require a natural disaster, but became a systemic feature of the political landscape?
In republics, persons elevated from the mass of the community, by the suffrages of their fellow-citizens, to stations of great pre-eminence and power, may find compensations for betraying their trust, which, to any but minds animated and guided by superior virtue, may appear to exceed the proportion of interest they have in the common stock, and to overbalance the obligations of duty.
Unfortunately, keeping the vested interests out is not a simple matter. How can it be when parties themselves are collective expressions of a set of weighted interests? Frankly, it is sensible for people of like purpose to strive together to achieve their aims, and there is nothing necessarily insidious about the practise. In fact, it’s a cornerstone of Democracy and civil society.
It is also, however, the entry way for corruption because the crux of the matter is not that people have differing and competing interests: it’s that they differ so greatly in terms of their power to realize those interests. When the power to realize those interests is used to unjustly deny the interests of less powerful, but equally or more deserving citizens, through a donation that is traded for a piece of unjust legislation, then it can be said that a positive feedback loop of corruption has been initiated.
The overly simple analysis that follows attempts to describe the basic workings of this system. Continue reading →
That’s obviously true. In fact, it’s so obviously true that no matter how dumb one might think Democrats are, they’re certainly not so dumb that they failed to realize that the GOP was highly unlikely to help Obama pass health care reform no matter what the bill contained. From the start, it’s been obvious to everyone — the Obama White House and Senate Democrats included — that the GOP would not help Obama pass health care reform. Why would the GOP want to help Obama achieve one of his most important and politically profitable goals? Of course they were going to try to sabotage the entire project and would oppose health care reform no matter what form it took. Everyone knew that from the start for exactly the reason that it was so obvious to Benen.
The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill. But — given the impossibility of achieving that goal — isn’t it fairly obvious that a desire for GOP support wasn’t really the reason the Democrats were constantly watering down their own bill? Given the White House’s central role in negotiating a secret deal with the pharmaceutical industry, its betrayal of Obama’s clear promise to conduct negotiations out in the open (on C-SPAN no less), Rahm’s protection of Blue Dogs and accompanying attacks on progressives, and the complete lack of any pressure exerted on allegedly obstructionists “centrists,” it seems rather clear that the bill has been watered down, and the “public option” jettisoned, because that’s the bill they want — this was the plan all along. (emphasis added)
Well no shit, Sherlock! That’s why I keep saying – “Failure is a feature, not a bug.” I’m glad to see that people smarter than me are starting to figure it out too.
One more time:
“Because that’s the bill they want — this was the plan all along”
Monday was the day of the liberal revolt on health-care reform. If you want a nice round-up of the commentary, see Mike Allen. What’s been striking, however, is the implicit argument that this is somehow a simple failure of liberal will. Rachel Maddow called it “a collapse of political ambition.” The problem, she said, is that “Democrats are too scared of their own shadow to use the majority the American people elected them to in November to actually pass something they said they favored.”
[…]
The problem, I think, is that there is a tendency to understand heath-care reform as an equal negotiation in which all sides want a deal, and you can game out various bargaining stratagems. But health-care reform is not a negotiation. It’s a campaign. Reformers wants a deal, even as some differ on its precise shape. The opposition wants to kill the deal entirely. And that gives the opponents a lot more power to say “no.” “No” isn’t their fallback position. It’s their position. The supporters — if they’re not sociopaths of some sort — actually do want to extend health-care coverage to 40 million people and regulate the insurance industry and create out-of-pocket caps and make life better for millions and millions of people. That makes it hard to say “no.” Being a decent person turns out to be a terrible weakness. And the pressure is even greater because the history of this stuff is that you don’t get a deal at the end of the day. Failure isn’t an unlikely outcome. It’s the default.
No, no, no ,no, no, NO!
Ezra just doesn’t get it:
FAILURE IS A FEATURE NOT A BUG!
Follow the money Mr. Klein. Which candidate got the most money from the health insurance industry and Big Pharma last year? Which party got the most money from the health insurance industry and Big Pharma last year?
What do you think the health insurance industry and Big Pharma were paying for? (Hint: It wasn’t to buy us all ponies)
As they say in Chicago, “An honest politician stays bought.”
We, the People, are born every minute. The last ten years provides ample evidence about the regularity to which Lincoln alludes.
Mark Twain, in 
The Confluence 