Monday, March 22, 2010

#211 HCR--Public Option Passes!!! (sort of)

Just as the Blogman predicted many posts ago. Okay ... it dare not speak its name, but the Public Option is a part of the Bill passed yesterday, at least in embryo. As long as we're into health-speak, let's call it "sub-public" or "pre-public"--analogous to the medicalese of "sub-clinical" or "sub-symptomatic" or "pre-something-or-other" (like cancer)-- all euphemisms that physicians are wont to use as ass-coverage for conditions that are not quite there, but not-enough-not for the medicos to bet their malpractice insurance on it. In this case the condition is benign, and in a healthy state of viability.

For just barely visible in the full-body scan of the Health Care Act of 2010 is the germ of government-run health care. The GLOBAL ideal, ultimately. The sub-pre-public-option symptomology is right here:

The uninsured and self-employed would be able to purchase insurance through state-based EXCHANGES with SUBSIDIES available to individuals and families with income up to 400 percent of the Federal Poverty Level (FPL = $22,050 for family of four).

FUNDING available to states to establish exchanges ...

Individuals and families who make between 100 percent and 400 of the poverty level and want to purchase their own health insurance on an EXCHANGE are eligible for SUBSIDIES ... Eligible buyers receive PREMIUM CREDITS and there is a CAP on how much they have to contribute to their premiums on a sliding scale. ( summary)
What you've just read is a LEVER that can lift the world--or, as the "losing" side, the Republicans and Blue Dog Dems, will soon characterize it, a CANCER that will grow into full-blown "socialized medicine." (Let's hope so.) They will do this, mark my words, when they discover that their "government-takeover" propaganda just isn't going to work, because the new bill is so overwhelmingly PRIVATIZED, at least on the surface. The losing side has actually "won" a great victory--the insurance companies have been SAVED--at least in the short term. Our NC Blue Cross CEO, for example, is quoted as being quite fond of the outcome, as will the American people, soon enough.

I'll get back to those key provisions in a minute, but the fact is that the new bill IS a bipartisan one--the Republican nay-saying ironically brought that about--a bill no different in essentials, for example, from one that Nixon (yes) was trying to work out with a Democratic Congress years ago (Watergate intervened), or, most notably of late, the Ted Kennedy-Mitt Romney program (despite the latter's denialism) of near-universal health care instituted for Massachusetts, a state with a powerful insurance-company presence, by the way. And that's the point. Except for Veterans and Medicarians, it will be much the same old market-place, buy-and-sell, private health insurance business as usual, under the new bill. Big-Health-Insurance got a windfall, in fact: 30 million new customers! They're still nominally in charge, for awhile.

However, the "reform" bill (by no means an "overhaul") has just enough reform in it to TAME the private insurance monopoly, and over time, I believe, to kick it to the curb. Setting aside the long-overdue prohibitions on pre-existing-condition exclusions, lifetime-coverage caps, and important others, the key words in the quote above are EXCHANGES, FUNDING, and SUBSIDIES. It doesn't take a Fred Hayek or anyone from the Chicago School to recognize "The Road to Serfdom" (DM #94-95)--call me a happy serf, then, when it comes to health care. For, in fact, Who's really in charge? You guessed it: the gub'ment--whether State, or ultimately Federal. They will have enormous LEVERAGE to control what's going on in those "free-market" Exchanges.

Of course there will be healthy competition among the various companies in this "food-court" (it's been called) approach to buying insurance, but the Feds are going to be paying close attention to Who gets What-and-How-much funding, and Where the buyer-subsidies will be spent. Even to the point of setting up their own stall if the private companies don't cooperate, price-wise. It's conceivable, and the precedent for going to such extremes is in the bill. Here it is: up until 2014 health insurers don't have to cover ADULTS with pre-existing conditions, so the government will. A special "temporary" entity, administered and funded by some federal agency or another, will be set up to insure "high-risk" folk who will not be eligible for coverage by private companies until that time. What can we call this little wrinkle?--unadulterated Public Option.

The KIDS get it six months from now. That's why the little darlin' pictured above is making faces at the insurance companies and their bed-fellows in Congress. (Let's pretend.) She's got a pre-existing condition. And there's nothin' they can do about it. No separate federal program though: Big-Health-Insurance must expiate its cardinal sin of denying coverage to high-risk children virtually NOW.

I'd like to see the Republicans and Blue Dog Dems run their campaigns this year on a platform of repealing THAT. Make my day.

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