Hot (pant! pant!)

It was 95F outside this afternoon, no weather for a penguin that's for sure. But out in it I was, because my Jeep has developed a shimmy at 45mph and I was trying to track it down (more details on MotoTux later). Man, this big bowl of ice cream that I just snarfed down sure hit the spot!

Now on to health care...

I've looked at the House bill fairly carefully now. It has a lot of good stuff in it. Here are the highlights:

1. Ends the various end-arounds that health insurers used to avoid having to actually pay for the health care that we pay them for -- no more rescission, no more pre-existing condition exclusions, no more arbitrary denials of care w/o recourse to a robust ombudsman.
2. Has a robust public option that uses Medicare funding as a carrot to get providers to participate in it. That solves most of my problem w/the notion of the public option being useless because no providers would accept it. This should also drive the private insurers to either lower their rates or provide better service, since they will no longer be able to compete based on being monopolies to which people have no real alternative.
3. It solves the problem of not all poor people being eligible for Medicaid by expanding Medicaid to cover all w/less than 133% poverty level.
4. It solves the problem of the working poor above that income level not being able to afford health insurance by a) taxing employers who don't provide health care insurance meeting minimal Federal standards, and then b) using the tax to fund subsidies for the working poor.
5. Solves the problem of private insurance being horribly expensive compared to group insurance by creating a new group for all those not currently covered by group insurance, and then requiring anybody who wishes to write insurance for individuals to participate in this group instead, much as multiple private insurers can participate in an employer's group plan.
6. Ends health care discrimination against women, older people, sick people, and people with pre-existing conditions. Everybody the same age gets the same rates, and insurance is must-issue -- an insurer cannot turn you down for any reason. 64 year olds can be charged only 2x what 18 year olds are charged, thereby spreading the cost of insurance more evenly amongst the age groups.
7. Ends "lifetime benefit limits" that are used to kick people with expensive conditions out of the health insurance system.
8. Mandates to end the "deadbeat problem" where I am paying not only for my health care, but also for the health care of the uninsured too (due to write-offs of uncollectible bills they run up at the ER etc., which in turn raises rates for the rest of us). Combined with the subsidies for the working poor and lower middle class, the expanded private coverage pool, and expanded Medicaid, this should basically mean everybody has health coverage.

So that's the good stuff with the bill. So what's the bad stuff?

1. Creates two new bureaucracies -- the bureaucracy for the new public option, and the bureaucracy to manage the private group coverage pool. This is going to cost money.
2. The tax on employers who are not currently providing health insurance for their workers is going to be inadequate to cover the cost of the subsidies. This is going to require a general tax increase to handle the subsidy problem.
3. The experience with MassCare shows that this is a massive give-away of public funds to the private insurers if the "public option" is eviscerated by either making its benefits too low or eliminating it altogether.
4. Maintains the multiple "healthcare ghettos" (Medicare, Medicaid, TriCare, VA, S-CHIP, ...) that allow pitting one group of healthcare recipients against another in competition for scarce healthcare funds. This nation has had plenty of experience with Separate But Equal in the past, and it works no better for healthcare than it worked for education. The least politically powerful group -- blacks in the segregation era, or the poor in today's era -- always end up the losers despite all the protestations of great intentions. If we are not all part of same healthcare system, we cannot work together to solve its problems -- we end up divided against each other instead.
5. Because it does not improve the overall efficiency of the healthcare system, overall healthcare costs will *not* go down. Those of us who are insured will see our insurance costs go down somewhat, but this will be offset by the "deadbeat tax" on employers that do not provide insurance, and by the increased taxes necessary for the subsidies for the working poor and lower middle classes. In short, I, personally, will be paying less out of pocket for my healthcare, but the nation as a whole will still be paying an unsustainable 16.5% of its GDP for healthcare. The inability to drive down costs is inherent in the fragmented nature of our healthcare funding system. For example, the C-section rate has risen to over 30% because doctors get paid more if the woman gets a C-section, thus they automatically do a C-section if there's even a hint of distress. Yet this actually harms women rather than helps them, because recover from C-section is much longer than recovery from natural childbirth and has much greater chance of complications. But without a central body that coalesces all this information and can use it to stop doctors from "gaming" the system for more money, there's no way to know which doctors are doing this, much less stop them from doing it.

To sum it all up: The House proposal solves the access problem, but not the costs problem. While insurance rates are likely to go down due to the competition from the public option, the fragmented funding system will still not have sufficient clout to force providers to quit providing frivolous and unnecessary care, and thus overall health care costs will not change, just some of it will shift from insurance premiums to taxes (the higher taxes needed for the insurance subsidies).

The fundamental problem of our health care system -- that it is currently sucking up 16.5% of our GDP and is thus economically unsustainable -- thus remains with ObamaCare. ObamaCare is a great half-step towards where we need to be -- universal and affordable health care for all -- but it is only a half step. Given the realities of the current U.S. healthcare system, it is unclear whether anything other than single-payer Medicare For All would ever have the clout to be able to drive health care spending down to where it needs to be in order to be fiscally sustainable for the United States. There is a reason why every single-payer system on the planet spends less and is more efficient than the US healthcare system: those economies of scale simply do not, and never can, apply to a fragmented multi-ghetto'ed health care system where providers can pit one ghetto against another in order to milk the system for profit. Only if we're all in the same system -- rich, poor, and middle-class alike -- will We The People have the clout to take on this $2.3 TRILLION dollar healthcare industry in America and put it in its place.

-- Badtux the Healthcare System