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The Devil We Know vs the Devil We Don’t.

During the summer Tea Party revolts, Obama described it as a struggle between the devil we know and the devil we don’t. It appears we have reached that tipping point where the devil we know (status quot) is becoming a better and better option.

The whole problem with the health care debate has been its neo neo liberal emphasis on cost savings. Maybe I am a tad old fashioned but trading greedy insurance companies profit for a government bureaucrat’s cost savings sounds like the same beast.

The Neo Neo Liberal virus is so strong that even an independent socialist like Bernie Sanders has argued a public option will “bring costs down” by competing with private insurance. We don’t need a public option as a safety net, nor as a non profit driven option for health care delivery, but to directly compete with private insurance itself. The problem with this whole debate has been the cost savings. The Democrats have taken a moral issue like health care and wrapped in a right wing discourse of cost savings.

The other day my mother mentioned watching a large clinic for the poor in Houston. For her this was a moral injustice that so many working folks had no access to health care. While certainly true, I pointed out that taking 40 million people and throwing them into our current system will create the right wings mythologized Canadian system.

My point here is if we want to be morally correct and deliver health care to all Americans the foundation of the health care debate is half ass backwards. Our emphasis should not be on cost savings but the major infrastructure and human capital developments that will be needed to deliver care to 40 million more citizens.

While I think the current public option will do more harm than good, its not the biggest evil out there in regards to health care reform. The great irony is that single payer, piggy backed on to Medicare would only need 51 votes in the Senate because its an existing program. But, the biggest evils out there is in the Senate plan.

Under the current Senate plan they will tax so called Cadillac plans. Cadillac being defined as any yearly employer / employee premiums of $7000 or more. Those $7000 or less plans are those with very high deductibles and high patient paid costs which are not included as health care costs. These HIINO plans may save employers money but do little to lower health care costs overall. If you are a teacher, government employee, or a union member, there is great likelihood your current plan will be taxed or be greatly reduced. Since the insurance company itself will be taxed the greater likelihood is you’ll find yourself with a high deductible and out of pocket expenses.

The Senate leery about business mandates has decided on individual mandates instead. It works like this, individuals are required to have insurance, if an employer hires someone without it, they face a fine to cover employee health care costs. It does not take an Einstein to figure which employee – insured, uninsured – that the employer will hire. In short, the Senate plan requires health insurance prior to getting a job.

While the House has been more sensitive to not putting reform on the back of workers, the public option is more than problematic. While the public option can take many forms, and as we saw recently it became the pro life option, its essence has been forming a public health insurance company to compete with the private sector. What many of these neo neo liberals fail to comprehend is that unlike the fear of the insurance executives, this competition based public option will function as an enormous dumping ground for the insurance industry. There is a far more likelihood that such a public option will serve a similar function as Fannie Mae. It will become a way for insurance companies to dump all the risk on taxpayers while receiving all the profit.

One must wonder if the whole notion of public option competition had any merit, why were not health care costs decreasing over the past 50 years with Medicare, Medicaid, and other government health care programs. If all it took was a government corporation to foster an era of competition, we should be drowning in it.

In many ways the status quot, and current health care reforms are the Devil We Don’t know. The biggest problem with health care reform thus far has been its added uncertainty to uncertainty. Listening to Obama talk about cost controls does not make me feel any more secure about my current health care. The mere fact that Obama has not mentioned infrastructure or human capital development in reference to health care reform does not make me feel more secure about 40 million more patients in our health care system. No, at best, it has made those who support universal, single payer health care feel uneasy about any reform.

I say let the Corporate Welfare Health Care Give Away Act die a natural death. Out of its ashes build upon government programs that even some tea baggers could support.

1. Lower the age of Medicare to 55 – or lower. This is the devil we know. I imagine this would cover a large chunk of the 40 million we hear about.

2. Like many states have already done increase the age of dependency coverage to 26. Another large chunk of uninsured yet not terrible expensive is this group.

3. Increase Medicare to 300% of poverty. For a family of four this would be roughly $60,000 a year.

* Its also worth noting all three of these reform only need the votes of 51 Senators.


One response to “The Devil We Know vs the Devil We Don’t.

  1. The Public Option, as originally described in the initial legislation, HR 3200, was really a government-administered, enrollee-funded health plan. The advantage is that enrollees would be paying only for the actual cost of medical care, not Corporate profits or shareholder dividends. The best idea was to make this an extension of Medicare, using the same reimbursement rates, and all of the same administrative apparatus of Medicare. Administration is only 1-2% of the cost of Medicare. Such a plan would be MUCH cheaper than private insurance. And if membership was open to anyone, including those who already had insurance, it would out-compete private insurers on cost and greatly reduce private insurance premiums in the long run, due it’s competing with private insurance.

    Such a plan would allow people the choice of a cheaper plan with exactly the same coverage as Medicare, or a more expensive private insurance plan with different coverage, and in some cases more coverage.

    Implementing such a plan would definitely bring the cost of medical care down. This is especially true if NO mandate to buy coverage is in place, since a forced increase in demand will INCREASE prices. (The notion that “cost-shifting” for the care of the uninsured onto insured individuals is illogical Corporatist nonsense. Mandating insurance increases demand, which always increases prices. )

    This type of Public Option is hard to ideologically oppose, even by radical free marketeers. It’s paid for by enrollees, not by taxpayers. All that’s lost is the ability of Health Care Insurers to profiteer off private individuals and taxpayers, under the banner of “improving” health care. In reality the only “improvement” is in Health Insurers profit margins–from the increased revenue of forced new enrollees, combined with the cost savings of continued reduction in both the quantity and quality of health care provided.

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