Dennis Fritz / March 23, 2010 6:46 AM

Unconscionable. The bill will madate some 30 million or more Americans buy private health insurance while doing next to nothing to contain rates or insure quality of service. It is just a gigantic gift to the insurance industry.

Civil / March 23, 2010 7:31 AM

While I'm uncomfortable with the mandated insurance purchasing I am very happy about ridding the country of pre-existing conditions and insurance companies ability to drop people who get sick after paying premiums.

Baldeesh / March 23, 2010 7:50 AM

I haven't read it yet.

Though I'm hearing there are some positive changes in it. I don't think it's perfect, but it's definitely a step in the right direction.

Though the sheer amount of wank it caused on twitter and facebook was unreal. Someone even went so far to call someone "not punk rock" for supporting the bill. I swear to God these were all adults in their late 20s and early 30s.

Oh boy / March 23, 2010 10:52 AM

A perversion of democratic process. The country will rue the day that we let such sordid tactics and bribery to grease legislation. They have significantly lowered the bar and opened pandora's box for future legislation. Remember - no party has a monoply on power.

The underlying economic model is based on near 100% participation (except politicians and their staffers, heh) When the individual mandate gets ruled unconstitutional, we will still be stuck with the remainder of the bill, which means that the fiscal house of cards that this is built on cannot stand and will become hugely expensive.

The fact that the CBO score could only come in under $1 trillion if it counted 10 years of revenue with only 6 years of cost underscores the fiscal quality of the bill. Of course, that score also included a significant raise in capital gains tax, which will retard capital formation and utilization, leading to less job growth (kind of a problem right now, don't you think?)

You cannot lower premiums by eliminating the ability to manage risk. The bill allows the gov't to control prices and mandate coverage goals, which are nice thoughts, but will lead to unnatural shortages and lower quality of care.

I am sure that the single twenty-somethings are going to enjoy being forced to buy an insurance plan that includes coverage they do not need, such as pre-natal care, geriatric care, etc... with a higher price than they actually require.

Premiums will be forced to go up in order to cover the pre-existing condition exemption. If a company cannot account for the high risk profile of an individual or group, it is forced to spreader that risk (read cost) over a larger group to offset that risk. This is basically the mortgage-backed securites economic model forced on to the insurance industry.

So we are going to see the results of an experiment where a small number of people design a complex system where the magnitude of any mistakes, resource dislocation, and uninteded consequences will be amplified.

What could go wrong?

Oh boy / March 23, 2010 10:53 AM

A perversion of democratic process. The country will rue the day that we let such sordid tactics and bribery to grease legislation. They have significantly lowered the bar and opened pandora's box for future legislation. Remember - no party has a monoply on power.

The underlying economic model is based on near 100% participation (except politicians and their staffers, heh) When the individual mandate gets ruled unconstitutional, we will still be stuck with the remainder of the bill, which means that the fiscal house of cards that this is built on cannot stand and will become hugely expensive.

The fact that the CBO score could only come in under $1 trillion if it counted 10 years of revenue with only 6 years of cost underscores the fiscal quality of the bill. Of course, that score also included a significant raise in capital gains tax, which will retard capital formation and utilization, leading to less job growth (kind of a problem right now, don't you think?)

You cannot lower premiums by eliminating the ability to manage risk. The bill allows the gov't to control prices and mandate coverage goals, which are nice thoughts, but will lead to unnatural shortages and lower quality of care.

I am sure that the single twenty-somethings are going to enjoy being forced to buy an insurance plan that includes coverage they do not need, such as pre-natal care, geriatric care, etc... with a higher price than they actually require.

Premiums will be forced to go up in order to cover the pre-existing condition exemption. If a company cannot account for the high risk profile of an individual or group, it is forced to spreader that risk (read cost) over a larger group to offset that risk. This is basically the mortgage-backed securites economic model forced on to the insurance industry.

So we are going to see the results of an experiment where a small number of people design a complex system where the magnitude of any mistakes, resource dislocation, and uninteded consequences will be amplified.

What could go wrong?

A. Lewellen / March 23, 2010 10:55 AM

I wish I knew. Ask me in a few years because at this point only time will tell.

R / March 23, 2010 11:27 AM

It's not a perfect plan, but nothing ever is. I am elated about the treatment denial based on preexisting condition ban.

For all the naysayers, I recommend you read T.R. Reid's "The Healing of America" to find out how incredibly backwards and corrupt the U.S. health care system is, and I am extremely proud of Obama for getting this done. I still love you, Barack!

stan / March 23, 2010 12:44 PM

Even if the proposed plan is not completely satisfactory (imo), I'd rather have some type of change than none at all.

anon / March 23, 2010 12:59 PM

@ohboy: capital formation is based on the tax on capital gains? You really do not know what you are talking about. Instead of Ayn Rand and Hayek, I suggest you read some of literature in the recent debate over taxing private equity (the underlying argument of the pro-private equity crowd was that the public vastly overstates the extent to which tax drives business).

With respect to health care, you are right, without the mandate, the thing falls apart because you need a large pool to spread risk. But there are other mechanisms congress can implement that accomplish the same thing if the mandate is held unconstitutional (which it probably won't be). The principle problem is consumers exert no downward pressure on price. Employers are the major consumer of health insurance and they are price insensitive because the tax deduction on health benefits. Bargaining takes place between hospitals and insurers. There are a number of reasons why the cost of care will likely go down: 1) the exchange will insert consumers back into the equation (however marginally) to exert some pressure on price; 2) employers are becoming cost sensitive because the tax savings no longer outweigh the benefits of unwieldy plans (see GE); and 3) incentives towards preventative care in the bill may drive down costs over time.

Of the goals the bill attempted to solve - 1) insuring the uninsured; 2) reducing costs; 3) preventing medicare insolvency - it only does a really good job of the the (1). But it does tackle (2) and (3) and can be built upon.

The new world order will certainly be different in a lot of respects (especially if it works). There will be a lot less specialization, which would be great because the profession is way over specialized and very few people go into primary care. Innovation will probably suffer (though not quite as much as people say, because NHS and other federally funded basic research R&D drives a lot of innovation). But health outcomes will probably be better and health costs will eat up less income. With our consumption habits naturally changing, this will ideally leave people with more disposable income and less debt.

Of course, that's wishful thinking. I'm sure most of it won't happen. But I'm almost certain your Randian disaster fantasy will also not play out.

Color Me Skeptical / March 23, 2010 2:04 PM

Well, the scope of government has certainly expanded, and probably not in a good way. I wonder how long it will take before personal choices and their health effects become included in the sphere of public concern.

Are you obese?
Do you eat fast food?
Do you drink alcohol? Too much?
Do you smoke?
Do you make responsible sexual choices?
etc...

These decisions have been acknowledged as personal up to this point, but they will eventually become part of the national dialogue. As such, they will be linked to their effects on government budgets and financial health. When that happens, we'll likely see efforts to reshape personal behavior on economic grounds and as a matter of national security. In fact, Michelle Obama has already mentioned that child obesity is a national security concern.

http://latimesblogs.latimes.com/booster_shots/2010/02/all-aboard-for-michelle-obamas-childhood-obesity-campaign.html

We typically see that individual rights lose out when framed in this manner. See patriot act, NSA wiretaping, etc.

Where do privacy rights fit in? Where is the line where one person's "rights" start to infringe on someone elses "rights"?

t / March 23, 2010 2:24 PM

It's shocking to me how freaked out a lot of people are by such small changes. A government takeover of health care? I wish.

Zoup / March 23, 2010 3:57 PM

I hate to be crude, but it feels like the country just had a major bowel movement after decades of political constipation. By 2010, any movement towards a better health system has redemptive qualities that I support for myself as a late twenties single and for my clients, the geriatric set.

LOL / March 23, 2010 8:52 PM

@anon
"capital formation is based on the tax on capital gains" Do you actually know what you are talking about? Do you live it or do you just read about it?

Its obvious you are not involved in the business world, citing literature, debate, and new world order (seriously?!?). These are not words often found in that setting. What you do find are words like margin, which commands focus on things like accountability and details. If you haven't noticed, we in the real business world are living in marginal times, so items like the capital gains rate have a serious effect on whether a project gets funding or not, what your time horizon for an investment may be, where you choose to make that investment, and on and on and on.

Stick with the academics kid. Because if you really believe that the principle problem is consumers exert no downward pressure on price, and your solution is to limit competition further than it is now, you aren't cut out for the real world.

Eamon / March 24, 2010 12:08 AM

It has the potential to be the greatest change to America in my lifetime. It'll mean huge savings for me personally and will profoundly change the lives of many of my friends for the better.

mike-ts / March 24, 2010 3:32 AM

There was such a wonderful opportunity to being true reform, and it was squandered. A good bill could've been crafted that acknowledged and took into account the concerns of people who saw a lot of bad in the bill.

Nearly anyone you talk with will agree that losing a lifetime of saving and building from a devastating health issue, sickness or accident, isn't the way to go. No one can see all the spaghetti and raffle ticket fundraisers to help family A, B, and C pay down $200,000 of bills can shrug and say, "Them's the breaks." Could they find a way to change insurance regulation, malpractice law, and form a new class of profession to police for real malpractice (no doctor will turn in another for malpractice)? Sure. Could we have a Medicare for coverage over say $30,000, and individual insurance for under that? Yup. I see a bunch of power hungry pols, an industry with its hand out to Uncle Sugar, and my sorry butt getting taxed for 4 years for something I can't use, all the while still having to pay ever rising insurance. Now that'll probably bankrupt me. *I* need a raffle.

And if you think it'll be like the Europe where you'll get health care even if you have a pot belly, be inactive even if you're thin, smoke whatever you want at your heart's content, and practice whatever romance you want to have, dream on. This bill will micromanage your life like you were on parole from prison. And you in health care: start TODAY living on a budget based on 70% of your current income, so you're not shocked when the ball drops. Ask anyone who receives Medicare/Mediciad payments how well Uncle Sugar pays vs. private insurance.

p.s.: read the reconciliation, which has more to do with federally insured student loans than the health care bill, and ask if there isn't something fishy here.

madachode / March 24, 2010 9:35 AM

It is a big mistake, the government is here to protect and organize our country but stay out of our lives and pockets. Who ever said this country was fair? Everyone has the oppourtunity to succeed in thier lives and are given the freedom to do it meaning get a job that has health care coverage. I should not have to pay extra taxes for someone that does not have coverage, they have the same oppourtuinity as me but went a different direction, too bad.
This will be quashed by the next president so I believe that we have nothing to worry about.

David / March 24, 2010 11:55 AM

I think, and am at least partially vindicated by the conversation, that this bill is a huge and important step forward in acknowledging that health care is a human right, not an economic one.

But it's also clear that this issue has been a football in a disgusting game for at least the past thirty years.

Republicans couldn't or wouldn't put up any kind of reasonable alternative plan, and decided they'd rather be spoilsports rather than contribute to substantive reform. That's not a political party, that's a cross between a college frat and a lynch mob.

The sickest thing in all this is the "I got mine, so fuck you" attitude that so many people seem to have. I'm looking right at you, Mr. Chode. You say you shouldn't have to pay taxes to cover people who have essentially squandered the same opportunities you got. That's a fundamental misunderstanding of both the "social contract" that we're all bound by, and a deep misunderstanding of social inequality in this country. If you think that everyone's had the chances you had, only made bad choices, you're delusional.

You remember the social contract, right? The one that says you're willing to give up certain rights in order to reap the benefits of society? THAT one? Yeah, you don't just to opt out of that one, buddy. Not unless you're willing to never drive an interstate highway, collect your own feces in a bucket, never rely on the police or fire department, and don't use electricity. Because, whether or not you like it, those are all social services which are paid for by your taxes. If you don't like it, get the fuck out of America.

David / March 24, 2010 11:55 AM

I think, and am at least partially vindicated by the conversation, that this bill is a huge and important step forward in acknowledging that health care is a human right, not an economic one.

But it's also clear that this issue has been a football in a disgusting game for at least the past thirty years.

Republicans couldn't or wouldn't put up any kind of reasonable alternative plan, and decided they'd rather be spoilsports rather than contribute to substantive reform. That's not a political party, that's a cross between a college frat and a lynch mob.

The sickest thing in all this is the "I got mine, so fuck you" attitude that so many people seem to have. I'm looking right at you, Mr. Chode. You say you shouldn't have to pay taxes to cover people who have essentially squandered the same opportunities you got. That's a fundamental misunderstanding of both the "social contract" that we're all bound by, and a deep misunderstanding of social inequality in this country. If you think that everyone's had the chances you had, only made bad choices, you're delusional.

You remember the social contract, right? The one that says you're willing to give up certain rights in order to reap the benefits of society? THAT one? Yeah, you don't just to opt out of that one, buddy. Not unless you're willing to never drive an interstate highway, collect your own feces in a bucket, never rely on the police or fire department, and don't use electricity. Because, whether or not you like it, those are all social services which are paid for by your taxes. If you don't like it, get the fuck out of America.

vise77 / March 24, 2010 11:56 AM

@madachode

I'm one of those people who apparently made the right choices in life, as I've always had jobs with health care, usually pretty good health care. And I take pretty good care of myself--eating right, working out, etc. That said, not everything is right and fair: Pre-existing conditions, for instance, which have screwed me more than once (is it my fault for pissing off Jesus when I was an angel waiting to be born, in that I was born with certain chronic conditions?) Or people who face signficant financial hardships for accidents, even those not their fault.

Spare me the crap about how the country was organized. Any cursory review of the process of creating the Constitution will find major and often very messy disagreements among the Founders, who had very different ideas about the paths this country would set. That's not to say we should treat the Constitution as a fortune-cookie saying open to any interpretation, but contrary the likes of Scalia, et al, the Constitution (through its relative vagueness and its ability to be amended by popular will and interpreted by the judicial branch) is more like hard soil into which one can plow, not stone that will never change.

And how on earth is this health-care plan so freaking radical when, at its core, is a boost for the insurance companies, who, in exchange for a few concessions, not get up to 30 million new customers?

Carrie / March 24, 2010 12:11 PM

madachode-- I really hope that you never eat out or buy coffee from a small, independent coffee shop, or use cashiers at the store. Because a lot of those people who are helping you don't have insurance and can't afford it. You think that they don't deserve it because they didn't go the route of corporate America? Interesting. And might I ask where we'd be without people who help us on a daily basis? just wondering.

Honest Abe / March 24, 2010 12:36 PM

Really, this quote just never gets old. There are always those who think that their "rights" are conferred by the labors of others.

"It is the same principle in whatever shape it develops itself. It is the same spirit that says, "You toil and work and earn bread, and I'll eat it." No matter in what shape it comes, whether from the mouth of a king who seeks to bestride the people of his own nation and live by the fruit of their labor, or from one race of men as an apology for enslaving another race, it is the same tyrannical principle."

- Abraham Lincoln

Spook / March 24, 2010 1:14 PM

finally America managed to swim into the wake of most civilized countries, including Cuba.

Yes this bill is far from perfect, but 32 million citizens will have health insurance who don't now.

The insurance oligopoly can no longer deny coverage for pre-existing conditions.

lots of tax credits for companies to provide insurance and

The fed. deficit will be reduced by $132 billion over the next 10 years

And if any one thinks people are gonna be "forced" to buy insurance than they're as crazy as the people who won't take advantage of the SLIDING FEES to purchase insurance. Hopefully SOON we will reform mental healthcare to treat them as well.

The truly sad thing is that we didn't get a PUBLIC OPTION to break up the insurance oligopoly.

As a frequent critic of Obama and Pelosi, I will raise my glass to them this weekend.
But the real praise goes to Speaker Pelosi
who insisted that Obama not downsize the senate version to a "skinny plan" I will therefore refrain from calling her "Nancy- Learjet- Armani-Pelosi" for the time being

O.K. now for my anger. I think any one who lives in a congressional district who's congressperson voted against this should not be allowed to get any of its benefits. Because If I lacked health insurance or had to pay the 40 percent increase in my premium that was just announced, I would have handcuffed myself to the door of my congressperson'shouse!

Cheryl / March 24, 2010 4:33 PM

It's a step in the right direction.