Thursday, August 13, 2009

From a list I post on:

Drinko Hall: Home of The Ohio State University...Image via Wikipedia

This is a post I sent to a listserv. I was helping a member understand a passage she thought would "end private health insurance in a draft bill."


Holy white button down dress shirt, Sally! Those are pretty confusing sections you have isolated for us to try to understand. But isolating those passages seems to be the problem. Let me explain.

One of the really good things about being a university professor is that I have access to experts who are actively analyzing those passages and all the others in the various proposed bills and commentary. Now, this is a good opportunity to note something. All people, those who understand the language of lawyers as well as the rest of us unwashed masses, are able to benefit from the fulfillment of the promise the President made during the campaign, that he planned to to conduct open government. This, he is doing to a degree we have not seen since the days when Congress posted bills on public notice boards. Certainly it is a far more transparent government process than we had during last Administration's 8 years, when the Democrats in the Congress (never mind the people like us) didn't get to see drafts of bills during their drafting, or even during "mark up", and just got bills of hundreds of pages in the few hours when they were brought to the floor for one of the famous "up or down" votes. But I digress.

I was able to bring your excerpt to a learned person who was already conducting a detailed analysis of the entire text and he kindly clarified the question you had about this section.

He first commented that a section like the one you copied cannot be understood in isolation, but must be understood with respect to other sections of the bill. Notice how even in the excerpt you posted, reference is made to other sections. The draft on the web is LONG.

He then stipulated that the bill creates a "health care exchange". That means any health insurance company in any state can belong to this exchange. It’s voluntary, but why wouldn’t they want to belong to it? Employees will be offered a cafeteria style choice of health plans (which is what members of congress get, and which is what I get in a more limited form from my government employer, The Ohio State University), and the menu will necessarily include their current insurance carrier, but will also give them the option of other plans, as well. There is no force, and no coercion, except that now, insurance companies will be forced to compete with each other.

Everybody likes a little competition, right? You know, a little market force is added to compete with the plan or plans that company executives offered, because they got some sweet inducements from the salesmen from whom they selected the plans they offer.

If the employer has had the same insurance for the last 10 years, say, and chooses to keep the same insurance plan forever, that plan is grandfathered in. But if there are any major CHANGES in the plan, then your employer has to offer the cafeteria-style plan that is formed by the new insurance exchange.

Try to remember when your employer agreed to increased premiums, higher co-pays, or otherwise altered coverage. I know I can recall these changes almost every year. You see, the President and his "lackeys" are trying to save Capitalism by making it work and forcing monopolistic practices to end, at least in health insurance. I would like him to do that to a number of other sectors in the economy, but that will have to wait I guess. Again, the selection of insurance plans WILL contain the current insurance company, and if one is happy with that, one doesn’t have to change. But there is NOTHING in there that forces anyone to switch to the public insurance plan.

Currently, few have Congress or OSU style choices of insurance plans. The employer chooses a plan, signs a contract, and open enrollment is basically a choice of taking what they give you, or paying 100% of the premiums for your own policy. As this bill is drafted now, it will give a choice of every health insurance company operating in your state, and each one has to offer three levels of plan. Instead of “what we give you or nothing,” you could have a dozen or more options every year.

Here’s something else my consultant added; Canada still has private insurance, which covers 15% of the population, and in Australia, they have a hybrid system, and everyone is happy. Private insurance isn’t going anywhere anytime soon, unless they simply can’t operate in a competitive environment. Despite having many conservative governments in various Provinces, Canadians have never voted out their health system, even with private insurance being available for them to to select. They don't want to, and this is shown each election, because Canada is still a Democracy. Not only that, unlike our bicameral, three part government, which is designed on purpose to make change very difficult, parliamentary systems like Canada's are designed to be more responsive to political change.

Here is something else to ponder. The bill says there can be no got you stuff about previous conditions or other reasons to drop you. That's got to be change we can learn to like, no? It also makes employees better able to change jobs without worrying about loss of all coverage. I know as a fella gets old like me, the prospect of job mobility or even career change becomes a dream of youth, but this can be ended with the right legislation. Instead of having to do my thirty-years-to-life in my current job because I have to wait until Medicare kicks in, I can join the entrepreneurial class and cash in on my accumulated fame and glory as a consultant or something...without worrying that just when I make the move the cancer will come for me at last and I won't be able to afford The James. Oh no!

The President's transparency initiative during the construction of this bill does something else. Whether for good or ill, all the lies and scare tactics of the people who like supporting CEO millionaires and stockholders with their health dollars are being heard. [And did you know that employers can deduct the money they spend on your health benefits, but that if you bought your own insurance and paid the premiums yourself, they would not be deductible? We are all actually supporting the corporations for this "benefit" with a tax subsidy!] And true or not, contemplated for real or not, the people's concerns are registering.

You don't want anybody to tell granny that she should pick a suicide method? We hear you. It won't be in the final bill. Check. [Not that it was here to being with, but I'm just sayin'.]

You don't want the a panel of doctors or G-men to kill your child with Down Syndrome. It won't be there. Check.

You don't want to be told which doctor to go to. OK boss. It's not gonna be there. Check.

In fact, with all the nightmare scenarios the logic challenged can think of being scare mongered with at all points of the compass, there are a whole lot of things that the drafters of the bill are learning they'd better not put in the bill. You gotta' credit that crafty new President we have, he made it possible for you to imagine the absolute worst nightmares anybody can dream up, just so you can say you don't want them included in any bill he signs; and so that the Congress can learn from you what they'd be committing political self-immolation if they dared to include them the bill they send to the President. I wish they'd done that with the Patriot Act (they didn't you know).

Happy dreams, everybody, and do sleep well. I will, because I live in an open democracy now.

On Thu, Aug 13, 2009 at 10:50 AM, sallyreb2001 <> wrote:
This is from the Open Congress website, which I believe has no party affiliation. I actually posted from it previously to support my contention that private insurance will definitely be phased out. this is language in the bill, not Fox news...Private insurance companies will be forced to become part of the 'insurance exchange' From

(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:CommentsClose CommentsPermalink
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