ObamaCare for Real This Time

President Barack Obama has been frequently criticized over the past several months for failing to get personally and deeply engaged in the health care reform process. While he avoided the political blunder of the Clinton Administration during it’s reform effort (developing a complex bill and, in essence, telling Congress to take it or leave it) the Obama Administration’s approach had it’s own problems.

President Obama was never truly out of the reform process. His aides were always deeply involved in negotiations. He made personal phone calls to lawmakers in both parties, led meetings in the White House with key Congressional players. But there’s a difference between talking about health care reform and negotiating health care reform. And it appears President Obama was rarely engaged in detailed negotiations. The result: President Obama was blamed for ideas and provisions (think pork) included in the reform bills Congress passed which he may never have supported.

Back in October I wrote that President Obama needed to get personally engaged in reconciling the various committee bills into a House and Senate version of health care reform (the manager marks developed by Speaker Nancy Pelosi and Senate Majority Leader Harry Reid). My point was that the chances of reform improved “if Congress – and the public – have a clear understanding of the Administration’s legislative ambitions.” The post went on to say “President Obama wanted Congress to participate in the reform process. They have. Now it’s his turn.”

Again, I’m not saying President Obama and his Administration was disengaged. But they also were not defining the legislation either.

This is no longer the case. According to the Associated Press “House and Senate negotiators resumed marathon talks with Obama at the White House around 9 p.m. Thursday. The president left the Cabinet Room meeting shortly after 1 a.m. Friday and the session ended about 25 minutes later. The Washington Post reports on President Obama’s personal involvement in working out a critical compromise with labor leaders. (The compromise, according to the Post, exempt union members from a proposed surtax on expensive insurance plans until 2018, five years after the legislation would take effect. This was not the President’s first “marathon” negotiating session with legislative leaders. Nor was it the first time he negotiated with interest groups. But it’s clear President Obama is now deeply engaged in fashioning health care reform legislation.

While Presidents usually do not get personally involved in drafting legislation, health care reform is far from typical legislation. We’re talking about impacting one-sixth of the nation’s economy and a legislative effort decades in the making. The chances of President Obama simply accepting whatever health care reforms Congress came up with was nil. Earlier involvement might have saved lawmakers a lot of pain – what will be the political cost for House Democrats who voted for a government-run health plan running for re-election in moderate districts? – but there was no doubt he would be actively at the table before the bill was finalized.

Health care reform will move quickly now. The Associated Press, in the story cited above, says it’s only a matter of days, if not hours. President Obama would like to have the health care reform bill signed into law prior to his state of the union address later this month or early February. Since Democratic leaders have pledged to put the legislation online for at least 72 hours before a vote is taken, that doesn’t leave a lot of time.

But there’s another motivation driving the midnight meetings: fear that Republicans could actually win the special election in Massachusetts to fill the vacancy created by the passing of Senator Edward Kennedy. Democrats are so concerned about the potential for an upset, they featured President Obama in a video email to Democratic voters in the state warning that the fate of health care reform depends on the outcome of the election. If the Republican long-shot effort succeeds, Democrats will need to pass health care reform before the Senator-elect can be sworn in. While they can challenge the results of a close race for awhile (and thereby delay certification of the election) the longer they resort to that tactic the greater the political danger.

Regardless of the motivation, President Obama’s personal engagement in negotiating the health care reform bill that Congress passes means he will own the result. The legislation will not reflect everything President Obama wants (or doesn’t want) concerning health care reform, but it will embody what the Administration could accomplish concerning health care reform.

The term “ObamaCare” has been tossed around loosely. Virtually every version of reform legislation considered by Congress was described as such. This was inaccurate. Those bill’s belonged to Congress, not President Obama.

The health care bill that will emerge in the next few days, the bill likely to arrive on his desk in the next couple of weeks, that is the legislation that will be a part of President Obama’s, that will be “ObamaCare” – for better or worse.

13 thoughts on “ObamaCare for Real This Time

  1. I thought CF Mother’s post was one of the best written comments on this excellent blog. I am truly mystified, as well, by how anyone could give it a thumb’s down. Until I evened the “score” with a thumb’s up of my own, there were 4 thumb’s downs to 3 thumb’s ups!

    What gives?

    What did she say that was incendiary or controversial in any way? I, too, am mystified by this whole debate.

    There is so much selfishness going on from every quarter that I find it mind numbing.

    I thought the whole point of insurance was to pool risk so that if you are one of the rare victims that need help, it will be there for you–subsidized by those who don’t need it. This, to me, is inherently socialistic.

    To carve up these little fiefdoms where the pools exclude those most likely to need help, and include only those who are most likely to not need help, that’s no longer insurance at all.

    That’s adding weights to the Roulette Wheel so its owner always wins.

    Shame on Nebraska and other states that demand special privileges to earn the vote that will help us all.

    Shame of those who can afford coverage but won’t buy it, confident that ERs can’t turn them away in extremis.

    Shame on brokers who prefer the status quo and its confounding complexities that guarantees dumbfounded customers for the brokers’ services.

    Shame on propagandists that lie blatantly to guard profits or win votes.

    Shame on a system that works so well for some and so horrifically for others.

    Shame!

    • I agree with James’s point. I thought CF Mother’s comment was one of the most elequent essays on the need for reform. I have serious problems with several key components to this legislation, but I also have serious problems with several aspects of the status quo.

      I can’t imagine why anyone would give a thumbs down to CF Mother’s comment. You may disagree with her call for reform, but her statement was reasonable and her point of view valid. Health care reform is complicated. It’s political. But it also needs to be addressed with compassion and understanding for one another. I think CF Mother made an extremely valuable contribution to this blog and to the debate in general.

      • I didn’t rate her either way because it is a half-thumbs up and half-thumbs down. She has some valid extremely points but is typical of the cluelessness of what is needed for reform. She blames everything on the insurance companies. She needs to understand what is really going on and put an equal part of the blame on the health providers – they are the ones who are actually causing the cost crisis.

        I think the reality of the current bill is that insurance rates are going to go way up because the healthy people will decide it is cheaper to pay the penalty and get insurance when they need it (it’s like buying car insurance to pay for your car after you wrecked it) than keep up their insurance current. With the healthy people out of the risk pool, insurance costs will soar.

        Either guaranteed issue needs to be dropped OR the penalties need to be sky high to really force everybody to get insurance. Personally, I think the second is preferable and would solve her problem too.

        However, looking at the big picture, the current bill is worse than the status quo.

        • You write: “The healthy people will decide it is cheaper to pay the penalty and get insurance when they need it.”

          But that’s exactly the problem with the way things are now, at least on the individual market. If you need insurance, you can’t get it.

          Would there not be some way to actuarially value what a young, healthy person’s contribution to the system is and peg the penalty at this?

          Say you are 22 years old, and in excellent health, and your premium costs are X.

          Subtract from X all administrative costs plus all pro-rated benefits that people of this age and health are predicted to siphon out of the system in terms of reimbursed medical payments.

          You come up with a figure that is somewhere around 75 percent of X.

          Make the penalty somewhere near this, even a bit less, and I believe the vast majority of 22 year olds would opt in.

  2. My wife and I are both over 60 and self-employed. Our “Cadillac” group health insurance plan — with a $5,700.oo co-pay — went up 51.9% last year, and another 10% this year.

    Our insurance company bases it’s rates on our ‘group’ experience. As far as they’re concerned, we’re a group of 2.

    Due to my wife’s pre-existing condition (Rheumatoid Arthritis), we haven’t found an insurance company that would ‘accept’ us in the Individual market. How that’s even legal, I don’t know, but rates in the Individual market are lower because insurers can “cherry-pick and lemon-drop”, as our family doctor explained it.

    So we’re very much in favor of Health Care REFORM.

    But it’s very easy to favor Health Care REFORM, yet oppose the current bill, for many reasons, including:

    1. The taxes start immediately, but the benefits take longer to start than it took us to win WWII.

    2. Flim-flam budget projections.

    3. Union workers exempt until 2017 because they need time to re-negotiate contracts. How nice for them. Non-union workers get to subsidize union workers.

    4. Government workers — millions of them — also exempt until 2017. Why? Does OMB need 7 YEARS to renegotiate THEIR contracts?? Oh, wait, government workers don’t HAVE contracts. But that’s okay. The rest of us will subsidize them. After all, they’re so underpaid, and don’t have things like COLA pensions and subsidized healthcare, even after they retire — you know, like the rest of us. Oh, wait. My bad. The rest of us don’t have that. Well, who cares. We’ll subsized them anyway.

    5. Nebraska exempt. The rest of us will pay their way.

    6. Florida exempt.

    7. Louisiana bribed.

    I’m really surprised there’s no exemption in this marvel of a bill for bullfighters, because their job is so dangerous.

    What reform there is in this bill is delivered in the most expensive, unfair and corrupt way possible. We badly need and want health care reform. This bill ain’t it.

    • JT It sounds like you and I are in similar situations vis a vis difficulties as self-employed folks in the current insurance market.

      The one difference between us is our age. You mention that you and your wife are both in your 60s. If health insurance reform does become law, it will not do so until at least 2014, at which point you both will almost certainly be ensconced in the bosom of Medicare.

      I am 57 and have 8 years for me–and 13 years for my wife–before we can get some kind of minimal safety net for catastrophic health problems.

      As of now, we are paying nearly $21,000 a year on the individual market for us and our two sons. It has gone up every year we have had this policy, dating back to 1983.

      I do not believe we will be able to keep paying for health care long enough till Medicare kicks in. If we are forced to drop this current policy, our “pre existing conditions” (statin and antidepressant use) make us uninsurable.

      My question to you: would your objections to the current reform proposal–a stinky sausage of a bill, by almost any measure–be undercut in any way if you were, say, in your 50s now?

      This bill, flawed as it is, looks to be my only decent chance of eventually escaping what has become a “bankruptcy on the installment plan” situation for me and my family.

      I wish it were a better reform, but anything is likely to be better than the status quo for us right now, as it would be for CFMother, too.

      The problem, alas, is that the numbers of Americans who merely dislike the status quo, as opposed to hate it, aren’t high enough, evidently.

      • Hi, James.

        Yes, very similar…just at different points on the conveyor belt.

        You and your wife are, indeed, in a tougher spot, i.e., longer to go to reach Medicare. (I have 4 years to go, the wife, 3.

        But Medicare won’t cover everything we’ll need, and supplemental insurance rates are surging, too. The proposed ‘reform’ bill would cut $500 Billion from Medicare, thru ‘efficiencies.’

        Will it actually happen? Well, maybe. Maybe not. And maybe Seniors will scream and it won’t happen. But if it does, will it make doctors more willing to take new Medicare patients…or less?

        We’re thinking of moving, and my feeling is that we probably should do it before we reach 65, so we can find good doctors and see if we can get in with them before we’re on Medicare. Isn’t that absurd?

        Because we own our own (very, very) small business, we just barely qualify for group insurance. We have NO negotiating leverage at all with the insurance companies, have worked with different brokers, but nothing makes any difference. The price is always the same (high), and the rates go up with little or no connection to actual costs — at least that I can see. Our annual increases are ALWAYS at LEAST 10%, often a good deal more. And they’re ALWAYS more than the increases for the Federal Employees’ programs. THEY have negotiating power. And there may be some cost-shifting going on.

        Our insurance broker (honest person) doesn’t think we can get insurance in the lower-cost individual market, because of our conditions. And, so far, she’s right. So if we want to sell the business and retire early, we can’t buy insurance!

        Health insurance has been ‘corporatized’, nonprofits sell out to for-profits, who give the state a few million for special programs, and then start jacking the rates up.

        I’d rather be insured by the (old-style) Mob. Sure, they might knee-cap you, or even whack you, but they wouldn’t do it in front of your family.

        The old Mob had some integrity, unlike the new insurance companies, who look for technicalities to cancel your insurance after you get really sick. Of course, they didn’t want to dump you BEFORE then — they’d lose all those fat premiums you’ve been paying.

        Long rant, but the nutshell is, health care — and health insurance — should be nonprofit. For-profit corporate insurance companies add absolutely NO value, but tremendous overhead cost, to health care.

        I’ve spend (wasted) a lot of time trying to solve this problem for my wife and myself, and have no solutions. Neither do my insurance brokers.

        Extreme solutions:
        1. Move to Maryland. No medical underwriting, so we’d save a chunk, but eaten up by moving/housing transaction costs, and possibly higher costs of living.
        2. Move to Mass. Their expensive state plan might be cheaper than our current plan.
        3. Move to Canada.
        4. Move to Europe (England? France? Italy?)
        5. Move to Cuba.
        6. Get a job at Walmart. 🙂
        7. Become a government worker. 🙂
        8. Join a union. 🙂

        It’s beyond absurd.

        By the way, I completely ‘get’ your situation. We’re in that “bankruptcy on the installment plan” treadmill, too — albeit with fewer years to go.

        I might feel differently about the bill if we were your age. I’m also concerned about going broke before we hit Medicare, but you have longer to go, so it’s harder to see making it thru.

        Part of the problem is that we’re (self-employed folks) a small minority. Most people either have employer health insurance or Medicare. And most people like their coverage and aren’t hurting too badly for what they’re paying. I think most people are concerned about folks who are struggling, or who don’t have insurance, would like to see them covered, but don’t want their insurance costs to go up big time, or pay 40% excise taxes, to see that happen.

        We need a health insurance bill. Something a lot simpler than this massive dog’s breakfast they’ve cobbled together. No carve-outs. No bribes and/or special exemptions/deals for Nebraska, Louisiana, Florida, organized unions, government workers — all paid for by the rest of us.

        And no cozy deals for insurance companies, big Pharma, hospital groups, doctor groups, and anyone else I missed. And no more barbeques for lobbyists at Sen. Baucus’s ranch. How is this stuff even LEGAL???

        When they started this bill, we supported it. We thought, well, at least there’ll be a Public Plan. Something for to keep pricing pressure on the corporate insurance oligopolists. But they dropped that like a hot rock. Then they dropped the Medicare over 55 buy-in option. (We would have signed up for either in about 2 seconds, which is what had the insurance companies scared shitless.

        They’re not scared anymore.

        Maybe Brown winning in Mass. will allow some across-the-aisle compromising in Congress, and maybe that will lead to a revised, simpler and more honest bill. Stranger things have happened.

        My first choice is Single Payer. Period.

        2nd choice is anything with a Public Plan option, which I’d join instantly.

        3rd choice (or 2nd) is allowing buy in to Medicare at 55. Would solve your problem, too.

        4th choice is setting up a clone of the Federal Employee Health Plan for ‘the rest of us.’ Would instantly solve the pre-existing problem and, I think (?) stop age rating.

        That’s all I’ve got. Good luck to your and your family vis a vis health insurance.

        John

  3. We should not turn our backs on your son. Health Insurance SHOULD NOT be rated according to one’s pre-exisiting conditions but on lifestyle choices: overweight, smoking, alcohol, etc…
    Else where is the personal responsibility and accountability?
    Also, everyone should be required to buy health insurance else how or who can afford to cover the pre-exisiting conditions?
    People’s life choices/options should not be disadvantaged due to one’s health conditions. I am mother too and I felt your pain, your triumphs and more importantly your love. We need changes but I am not sure if all of the changes in the bill will head us in the right direction especially on the cost issue but it does look good for you and your son and I am happy about that.

    • Jeanette, I agree with you to some extent about the lifestyle choices business.

      But here is a question:

      Suppose your parents found each other by what some obesity researchers have called “assortative mating”–in this case, because there is such a stigma against obesity in our country, the only person each could find with any interest in them was a fellow obesity sufferer.

      They have you and perhaps some siblings. Maybe some of you and your brothers and sisters are highly prone to obesity. You grow up, want to find someone to marry, and find your own options narrowed by stigma. You, too, end up marrying and mating with a fellow obesity sufferer.

      To what extent do you believe that a person with a very hefty genetic tendency towards gaining and guarding weight is fat because it’s a “lifestyle choice”? There are obese people who manage to lose significant amount of weight through tremendous effort. There are even obese people who, after having lost this weight, manage to keep it off long term. But there are very, very few of these. Do you seriously believe that all overweight people are intentionally choosing a fat lifestyle?

      My mother died from cigarette smoking, and I hate cigarette companies and their duplicitous racketeering executives with a passion that borders on the homicidal. However, once my mother was addicted, to what extent did her continuing to smoke seem a 100 percent lifestyle choice?

      How about a 12 year old kid (the average age that smokers used to start in the US when Joe Camel ads and the like were legal) who experiments with cigarettes because his friends think it’s cool? Addiction and the upregulation of nicotine receptors in the brain can begin after as few as 13 cigarettes. To what extent is it a lifestyle choice when you do something dumb in the 7th grade and you can’t shake the habit despite your best efforts?

      A lot of people like to say that we are total determiners of our fate, that we can pick and choose healthy lifestyles or unhealthy ones, and the difference is just a matter of personal character.

      I don’t believe the other school of thought either–that we are all hopeless victims of anything that happens to us.

      But it’s a lot more complicated than pure free will vs. helpless determinism. It doesn’t help when corporations spend endless promotional dollars trying to get us to do behaviors that help their profits at the expense of our health.

      • I don’t think it is as complicated as you think. Look at Japan and other countries and their obesity numbers. Why is America the fattest country? It is because of our sedentary lifestyle and preference for fast food. Obesity is something that people can do something about. Watch Biggest Loser and you will see all kinds and ages of people who transform their lives in the process of losing weight. I don’t believe that everyone should be model thin. In fact, Aetna has readjusted their weight guidelines and they are very generous with more of a rate up for a combination of lifestyle choices like smoking + body mass. How can you answer what statistics tell us about body mass and heart disease, diabetes, and even cancer? There is clearly a predisposition to a susceptibility to certain diseases if you are overweight. I do believe if there is a will there is a way. Change is the catalyst that breathes life into our every movement. We can better ourselves if we are willing to readjust our thinking. Bumps and bruises are life’s path so we have to do our best in everything or else we might succumb to being less than our potential.

        “Time does not exist except for change.” Aristotle

        “The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice there is little we can do to change until we notice how failing to notice shapes our thoughts and deeds.” R. D. Laing

        My Dad also died from Esophageal cancer from a lifestyle of smoking and drinking. Yes it was cool to smoke when he was a young man and Yes the health risks were not known and Yes he tried but he could not stop smoking and Yes he died too young because of it and finally Yes if had been able to stop smoking then Yes he would more than likely be alive today.

        I saw him become a slave to his habit and I have never and will never drink or smoke because of it.

        So Yes we all have choices and those misfortunes that life deals us regardless of whether they are lifestyle or non lifestyle all become our own personal mountain to climb just like the son of the CF’s mother. He triumphed over his challenge and came out the winner and he should be applauded for that and not punished for getting access to Major Medical health insurance. He will probably live alot longer than what the life expectancy of someone with CF because he chose to take the high road and make healthy choices.

        • Jeanette, I don’t think we are actually disagreeing here. I, too, believe people can make choices in their lives. And you concede, as your father’s example shows, that sometimes people can get ensnared in ways they did not originally foresee happening, and once ensnared, can have a devil of a time getting loose.

          My whole argument here is that to put it all on the individual level is as much a mistake as to blame “society” for every “victim’s” woes.

          There are things that are within our control, and things that are not.

          Another example, one that is shared by the very wealthy and the very poor alike: ease of walking around the neighborhood.

          I think that everyone agrees that one of the best things people can do for their health is to be more physically active. One of the best, most natural, and least likely to lead to injury forms of physical activity is walking.

          If you live in a neighborhood with sidewalks and a relatively low crime rate, it’s not all that hard to go out and take a walk every day.

          But many planned high end communities don’t even have sidewalks–they were purposely designed so people have to drive (or if they do go for walks, walk in the streets themselves–something that older folks aren’t going to feel comfortable doing.)

          Ditto for crime-infested urban areas. What parent is going to be happy sending his kid out to play, or for that matter, taking an evening stroll himself/herself?

          There are numerous ways to foster healthy lifestyle choices on the individual level, but there are also Big Picture concerns that I believe should be taken into consideration, too.

          The same rugged individualists that are always preaching about taking personal responsibility for everything are the first to cry “nanny state” when any kind of proposals are suggested that might make this easier for people to actually do (proposals ranging from regulating transfats in restaurants, to removing the “First Amendment Rights” of tobacco companies to put Joe Camel billboards next to elementary schools, to mandating sidewalks in housing developments.)

          You can’t put all responsibility on individuals, then construct a laissez faire society where corporations have free reign to undermine human will power in every conceivable way, so long as it drives purchases (Big Macs and Cinnabons, Marlboros and Bud Lite, AK-47s and hookers.) And then shackle any lawyer who seeks damages for injuries that result

        • “The same rugged individualists that are always preaching about taking personal responsibility for everything are the first to cry “nanny state” when any kind of proposals are suggested that might make this easier for people to actually do (proposals ranging from regulating transfats in restaurants, to removing the “First Amendment Rights” of tobacco companies to put Joe Camel billboards next to elementary schools, to mandating sidewalks in housing developments.)”

          Based upon the above statement it would seem to me that the “rugged individualists” are fairly consistent in their beliefs.
          However, I disagree with you, I think that the “rugged individualists” of which you write are also proponents of the “Nanny State.” The belief that government should regulate poor behavior crosses the ideological spectrum. The “Nanny State” concept is simply a continuation of the Andrew Volstead philosophy of the “government regulating morality.” I would challenge you to find an upper class conservative community in the US that has not embraced the basic tenets of the “Nanny State” that you describe.

  4. Questions for those who do not support health care reform

    Twenty years ago our cheery toddler was diagnosed with cystic fibrosis. Afraid, we dug into the medical research to understand the disease that threatened his future. We healed through optimism, roused by the news eight days after his diagnosis that the gene that causes CF had been found, opening the door toward a cure. We knew that our heroes, the researchers and his doctors, would continue to find ways to protect his future. We were no longer afraid of CF.

    The fear that woke me in the night was of losing our health insurance because our son was on every insurer’s no-fly list. While my husband’s profession was periodically roiled by layoffs, he decided against the security of opening his own firm because the cost of carrying coverage for our eldest son was too high, the thread on which his health care dangled too slight.

    With luck, we made it through our son’s childhood without a gap in coverage. Now 22, he’s kept his health thanks to his medical care and his own glorious determination not to allow CF to cramp his style. He earned his black belt, went to college, joined a fraternity, and drives a 1961 Buick LeSabre. He spent a year in China, learned Mandarin, and discovered that even the drug that enables CF patients to digest food couldn’t help him digest raw sea cucumber. He backpacked through Thailand, had his wallet and passport stolen, but managed to hang on to his meds. This spring he will graduate with a degree in chemical engineering from UMass Amherst’s honors college, with a concentration in biochemistry. His resume includes summers researching the transmembrane conductance regulator, the protein channel in our cells that, when malformed, causes cystic fibrosis.

    We can’t wait to see what this kid is going to do next. Next, however, has filled me with that old middle-of-the night fear. Our son will age off our family policy in April. He must shape his future not according to his dreams and ability, but in ways that will ensure that he keeps his health insurance. He must find an employer with health benefits that will hire a new college graduate in a poor economy. Or he must extend his full-time student status until he’s 25, putting off career plans and his desire to support himself. Despite his wanderlust and world-wide opportunities, he must remain a resident of Massachusetts, an isolated island where CF patients are not pariahs to health insurance companies.

    I tell our story not because it is unique. Other families have been harmed, rather than merely threatened, by the ruthlessness of American health insurance. I tell it to ask a question. It is for you, the person reading this who does not wish the current effort to reform health care to succeed, who calls it “Obamacare” and “socialized medicine”. Help me understand your position, because I am mystified.

    Are you a parent? Do you know that the bill under debate will prevent insurers from dumping people with pre-existing conditions, like my son or, perhaps, someone in your family? Do you believe that anyone who needs health care can get it somehow, or that illness happens only to other families?

    Are you a fiscal conservative concerned about cost? Do you realize that the current system discourages small business development and blocks young adults’ opportunities to succeed, the foundations of a growing economy? Do you believe access to health care is not as essential as access to education in preparing our next generation of skilled workers?

    Are you are an insurance executive? Do you devise new ways to make it difficult for my son to obtain prescriptions and services as cost-saving measures? Would you prefer to cover the cost of his lung transplant, because he has not been able to get the treatments he needs to stay healthy? Or have you decided that the ultimate cost-saving measure is to let CF patients and other chronic burdens to your bottom line die young?

    Help me understand why, rather than reforming the American health insurance system, we should turn our backs on my son and the promise he and other young Americans like him offer all of us.

Comments are closed.