I have a question for politicians like Rep. Raul Grijalva, Rep. Anthony Weiner, and the the folks at Firedoglake who would rather kill reform than enact the Senate bill: what kind of health insurance do you have?
(I suppose I should voluntarily share such information as well — I am insured by Blue Cross Blue Shield.)
The answer to that question with respect to any member of Congress is this: private insurance. “But no!” you say. Members of Congress have government-run health care! No, they don’t. This is a common misconception. They are not on Medicare, or some totally awesome plan called Congresscare. Members of Congress receive health insurance through the Federal Employees Health Benefits (FEHB) plan. FEHB offers federal employees — including members of Congress — a choice of private insurers. One might call such a system an “exchange.” If that sounds familiar, it’s because the Senate health bill (like the House bill) offers the uninsured a choice of private insurers (including a national non-profit) through an exchange.
The argument that passing nothing is preferable to passing the Senate bill goes like this: the Senate bill has no public option. Thus, the individual mandate would enrich insurance companies. And we can’t do that.
First, I think worrying about insurance company profits is a luxury enjoyed by those who have insurance. Most uninsured people would take private insurance over no insurance.
(Many progressives also take issue with the excise tax on high-cost plans. I favor that tax, although I think merely indexing it to inflation is not entirely fair, given that health care costs rise at a faster rate than inflation.)
Second, I have some uncomfortable news for every progressive who wants to kill HCR because they don’t want private insurers to enjoy bigger profits: your private insurance enriches the insurance companies. Denying the uninsured what you yourself enjoy is the most despicable sort of hypocrisy imaginable. And yes, I understand that private insurance in the exchanges would be subsidized. Guess what: if you receive private insurance through your employer, your insurance is subsidized too. It’s called the employer health plan tax exclusion.
I’ve spent the last year or so bashing the Republicans and the Liebermans of the world for doing everything possible to ensure that health care legislation is not enacted, and that the uninsured continue to go without. I never thought we would find ourselves in this predicament — to have passed a bill through both houses — only to have liberals kill health care reform at the eleventh hour. In fact, I don’t think I could ever have imagined a scenario in which liberals would be responsible for killing reform. But that is where we are.
When I registered to vote as an 18-year-old, it seemed to me that a belief in universal health care was central to “being a Democrat.” I still don’t see much point in being a registered independent — at least in states that have closed primaries. You simply disenfranchise yourself. But registering with a political party ought to be about more than maximizing your voting leverage. When you register with a party, you are making a moral statement — a statement about your core values and philosophy. Universal health care has always been the backbone of the Democratic domestic policy platform. This is why people who believe in universal health care tend to be Democrats.
If the Democrats choose to pass nothing — and it is a choice, because the House could pass the Senate bill tomorrow and enact reform, if House progressives would only allow it — then they will have abandoned their moral core on domestic policy. I’m still hoping they step back from the brink.
Matthew Spieler
Matthew Spieler is a former policy analyst for Congressional Quarterly, where he covered health care, education, labor, and veterans’ affairs. A graduate of The George Washington University, he has also worked as a reporter for CQ covering ...
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Tom says:
We want a health care bill that is fair to all with cost saving measures. Drugs from overseas. At cost health care without lobby and speical interest. A health care bill that Senitor Obama promised during his campaign.
Jeff says:
Excellent!!!!
Now if only they would all read this. They seem to want all or nothing. Well it isn't going to happen, so let's at least do SOMETHING for the uninsured. I for one already have great insurance; I'm not supporting this cause for myself, but for those without.
And now isn't the time to get caught up in our liberal morals and trying to use this bill to make moral points. Example: Some women's rights groups are angry there aren't more measures for abortion. Now is NOT the time to be worrying about that. If they put more measures in to allow for abortions, then the bill will certainly fail and the whole thing would have served no other purpose than to make a point about abortion--and then the uninsured would continue to be screwed. We need healthcare for the poor. That's the purpose of this thing, not some statement about reproductive rights. Let's pass this thing NOW and forget about making some kind of statement with it.
Dan Jones says:
Say it again. The House liberals need to wake up before they blow this. It's painful to watch. The only thing I can think of is that maybe they're doing it on purpose to make Obama seem more centrist and thus give him political cover. I doubt that's what's going on, but it would be the only excusable explanation.
Branwyn Lancourt says:
Unfortunately the bill as it is is in no way shape or form any type of substantial reform... Passing this would just be a way for Obama to say ' he passed health care' of course the reality would be a totally half assed bill which basically changed nothing.
Wellescent Health says:
One need only look at the status quo to see that the health reforms in either of the bills offer something valuable over what Americans now have. That said, applying a dogmatic all or nothing mindset is always a primitive way to approach problems and in this situation, abandoning health reform because of disagreements over specific portions of either bill would demonstrate incredibly poor judgment. Having a bill means that it can be amended over time. You cannot amend legislation that does not exist.
Dan Whalen says:
Branwyn - I don't agree at all with your position. The Senate Bill opens Medicaid to more people; it provides subsidies to help people buy insurance without spending more than a a percentage of their income (5% scaling up to 12% as incomes rise); it mandates insurance that offers real coverage, guarantees enrollment, and prohibits rescission; and it provides subsidies to small businesses to offer coverage to their employees. Plus, it includes scores of potentially cost-saving measures.
Seth Ackerman says:
So you want to compare the health insurance Grijalva has with the insurance a poor person would get under the Senate bill? Okay.
Grijalva's salary is $174,000, and on top of that he gets FEHB insurance. The standard FEHB family plan charges the enrollee $4300 per year in premium contributions - that's 2.5% of Grijalva's income - and pays out on average 87% of medical costs, meaning Grijalva has to contribute 13% out of pocket. A typical family of four incurs about $9500 in annual medical costs, so Grijalva would have to pay about $1200 out of pocket.
Whereas under the Senate bill, a poor family (say, one at 200% of the poverty line, $44,000 for a family of 4) would be legally required to pay $2800 in annual premium contributions – 6.3% of family income - for the privilege of receiving an insurance policy paying only 80% of its medical costs - 7% less than Grijalva's plan pays. Thus, the poor family’s out of pocket costs would come to about $1900 - more than half again as much as Grijalva’s.
Notice what a neat trick this is. The Senate bill lowers the cost of premiums for the poor family just enough to make its now-mandatory purchase of an insurance policy feasible (maybe). Result: Obama gets to declare the family "insured." But then, quietly, the Senate bill charges the poor family $1900 to actually *use* the insurance it was required to buy – much more than what Grijalva is charged - even though the family earns less than one-fifth what Grijalva makes.
Since the poor family’s actual discretionary income, after meeting basic expenses (rent, food, transport, etc.), is close to *zero*, it’s not hard to guess that the family probably wouldn’t actually use its shiny, new insurance very much. In other words, it wouldn’t actually get much health care.
But hey, maybe that’s a feature, not a bug. Obama does say his main priority is cost control, not coverage. And of course, with the health care crisis now solved – as Obama will no doubt announce at every opportunity through Nov. 2012 – nobody’s going to be overly concerned about the poor family and the little pickle it find itself in, right? After all, we’ve just witnessed the greatest achievement in liberal social policy since 1965.
The ridiculous attempts at moral blackmail coming from the pass-the-bill crowd really ought to stop. Why don’t you guys check in on what the single payer movement’s up to - www.healthcare-now.org – and think about what you could do to help. Because right now that’s not what you’re doing.
[SOURCES: Congress members’ FEHB premiums: Factcheck.org….Senate actuarial values/family premium contributions: CBPP….FEHB actuarial value: Congressional Research Service….Typical family medial expenses (2 adults 30-49, plus 2 kids <18): Commonwealth Fund….Poor family’s discretionary income: EPI via CBPP.]
Dan Whalen says:
Seth's comparison is misleading. While it would be great to offer everyone FEHB-equivalent coverage (and a Senator's salary) or a single payer system, neither are on the table under any realist appraisal of the situation. The pertinent comparison is to a person's coverage is we do not pass the Senate bill. Using Jonathan Gruber's numbers, here is what a family of four at 200% of FPL ($48,367) in 2016 would typically face.
No reform:
*annual premium $12,042 (33% of income)
*total risk $24,642 (68%) of income)
This assumes that the insurance policy has an out-of-pocket max (assumed here to be the HSA limit of $12,600).
Senate reform:
*annual premium $3,629 (8% of income)
*total risk $9,929 (21% of income)
I realize that 21% of income is a big chunk of money for someone at lower income levels. But it workable and certainly represents a much better situation than 68% (or more) of their income.
Starting over with reform this year is not going to happen. Neither the Senate nor the House have the stomach for it. Next year Democratic majorities will be smaller, and possibly gone, so re-starting won't happen then either. If you want health care reform then the Senate bill is the only alternative we have left.
If you want health care reform, however, the Senate bill need not be the end. The bill puts subsidies into place, and subsidies can be made stronger. And even if re-starting were possible, passing the Senate bill and then adding stronger subsidies is much more straightforward and easier process than beginning again.
Dan Whalen says:
source: http://www.kaiserhealthnews.org/Columns/2009/December/122109Cohn.aspx
Tedski says:
Hate to ruin everyone's rant, but Raul Grijalva opted out of the FEHB.
Seth Ackerman says:
It's nice to know Dan thinks a near-poor family paying 21% of their gross income in the event of illness is "workable." But in practice, with roughly zero income after taxes and necessities, it probably means the family will go bankrupt and/or throw itself on the mercy of charity hospitals, just as it would if the bill were 60% of income. In Massachusetts, to fund the subsidies they cut funding to free hospitals, so the poor ended up worse off in many cases.
And above all, as a political matter, this bill is designed and packaged as a way to declare the health care crisis over, regardless of the toothless assurances of well-intentioned liberals that somehow, maybe, subsidies will be increased later. Admid all the Democratic self-congratulation, who would notice people still can't afford health care, and if they did notice, why would moderate Congress members be wiling to vote for "even" higher subsidies - after all, "even" Barack Obama says he succeeded where nine presidents failed, and now we have universal coverage! Now is the time for a spending freeze, right?
DonnaDiva says:
Matthew, I am an Arizonan and though I don't live in Grijalva's district I can tell you that Raul is a great public servant and a profoundly decent man. You, on the other hand, strike me as interchangeable with any number of clueless elitist Villagers dispensing wisdom to us proles (whose lives you know exactly jack squat about) from on high.
Raul Grijalva represents a district that stretches across southern AZ from Nogales to Yuma, encompassing low income parts of Tucson and Phoenix, as well as a lot of poor rural communities. A lot of undocumented immigrants live in his district, and though they can't vote, they are his constituents. The HCR bill, with it's cruelly cynical exclusion of undocumented immigrants basically tells them to drop dead.
Now I'll await the responses on how denying coverage to undocumented immigrants was politically necessary because shut up you dirty hippie.
Matthew Spieler says:
I actually agree with your characterization of Grijalva -- I've always admired him. I just think he's absolutely wrong here. And a Villager I ain't, btw.
Dan Whalen says:
Seth - I admire your idealism. And I don't deny that with the Senate reform a serious health event creates a very difficult financial situation for people with low incomes. But the alternative is an impossible financial situation. I choose the available solution that makes things better rather than the unavailable solution that makes things perfect.
Under the Senate plan, there is no charge for preventative care and other care is priced at the plan's discounted rate rather than the full list price. This will directly help millions of people.
But Seth is correct that for many people insurance coverage will remain too expensive, so one last point. While the Senate bill does mandate insurance cover, it also includes an exemption for instances where the premium imposes a financial burden.
Tom Prezelski says:
Mr. Spieler, you may say that you are not a "Villager," but your one-paragraph biography speaks otherwise. I guess it is really not fair to disparage you for having attended George Washington University and for having spent most if not all of your professional career inside the Beltway, except that this article certainly reflects the Beltway Groupthink, namely that any Democrat who talks as if policy considerations should be ahead of strictly political ones is delusional at best and a dangerous extremist at worst. Your snide attempt to impugn the motives of Congressman Grijalva is not only based on a false premise, as has been pointed out, but is also the sort of rhetoric we should be trying to avoid when we are discussing issues of substance.
Congressman Grijalva came to Congress after a long career on the Pima County Board of Supervisors, a position that required him to deal on a daily basis with the most basic things that government does, the largely unglamorous work of making sure that the roads got paved and the sewers were working. When he first ran for Congress, there were those who dismissed his candidacy because his work as Supervisor focused on what they disparaged as the merely pedestrian needs of his constituents and that higher office required someone who had more sophisticated credentials, someone slicker and more fitting with the press corps preconceived notions of a model legislator. Understanding of ones constituency and the ability to deliver with regard to their needs was not a consideration with his detractors.
Someone with the Congressman’s background understands that bold political strokes and courageous stands are meaningless unless they actually produce results for one’s constituents. Given that the bill as it stands does little or nothing, and potentially makes the problem worse, why should the Congressman support it? Why should a bill be passed solely for the sake of passing a bill?
The beltway mentality holds that hollow political victories and stunts are far more important than dealing with actual policy, otherwise the Joe Liebermans of the world would not be taken seriously. Unfortunately, while we live in a real world where real people have problems that the Congress needs to deal with, smart-ass pundits like you still continue to see this merely as a spectator sport staged for the benefit of the press corps.
Tom Prezelski
Former State Representative
Tucson, Arizona
DonnaDiva says:
Very, very well said Tom. And can someone tell me, unsophisticated and uninitiated flyover gal that I am, what constitutes a Villager? Because if Matthew isn't one, he sure appears to be playing one on the internet.
Dan Whalen says:
Tom seems to misunderstand or misstate Matthew's point which basically said that Grijalva and others opposing the Senate bill had lost sight of the goal (helping people) for the sake of the hollow political victory of. Tom confusingly reverses this logic in his critique. There was nothing disparaging in Matthew's original post. I don't think the same can be said of Tom and Donna: I have no idea what a "Villager" is how how it could possibly be relevant to the debate, but it is unmistakeably hurled as an insult.
Tom - you state that the Senate bill "does little or nothing, and potentially makes the problem worse," but offer no evidence or support for that position. Your statement contradicts my reading of the bill as well as many other assessments. Can you explain your reasoning or offer examples?
DonnaDiva says:
Dan, you are using a computer and can easily Google the term. Stop being disingenuous and stop pretending that Matthew didn't disparage Rep. Grijalva. I don't know what you an accusation that a Congressman is telling people to "drop dead", but out here in the sticks we call it disparagement.
What one considers a policy victory as opposed to a political one, I guess, depends on one's perspective. From the standpoint of Raul Grijalva, he obviously doesn't feel that the Senate bill does enough for his constituents on the whole for him to accept the bitter pills - no public option, lack of cost controls, undocumented immigrant exclusion, excise tax - he is expected to swallow in order to pass the Senate bill as is. It's funny how the Village is oh-so-willing to compromise with the likes of Lieberman and Nelson, who could a rat's crap about human suffering, but is so quick to castigate Raul Grijalva for not falling in lock-step.
Dan, would you to care to provide us with links to all of your scathing posts condemning Lieberman holding up passage of the bill so he could strip everything out that offended his corporate donors? Could you do the same vis a vis Nelson? Speaking of Nelson, can you link to where you admonished him and his C Street buddy Bart Stupak for stalling the bill so they could insert anti-choice language in it?
I'm not assuming anything here. Maybe you did those things and I hope you did. I'm just looking for consistency.
DonnaDiva says:
I'm glad to know that Matthew has condemned Lieberman strongly.
http://thefastertimes.com/politicalupdate/2009/12/18/the-consequences-of-failing-the-uninsured/
Dan Whalen says:
Once again, the point of this post is that the Senate bill helps millions of people and the only available alternative is the status quo.
Matthew pointed out the consequences of Grijalva's oposition to explain why that stance is wrong. Was he harsh? Yes. But was he wrong? Well current estimates are that 20-40,000 people die each year because they lack health insurance, so no, by any objective measure he was not wrong.
In contrast, Donna and Tom have engaged in ad hominem attacks. I don't know Matthew (until a few days ago I had never heard of him) and I don't know if he is a Mensch or a Villager or the worlds biggest asshole. The thing is, IT DOES NOT MATTER! If we are serious about reforming health care then the arguments need to focus on facts and possibilities, not personal attacks.
So I'm sorry Donna, I don't have any attacks on Lieberman or Nelson (or Bayh or Lincoln or Landrieu either). That is not to say that I defend them; I think they're worse than useless, they were harmful to the whole process. But at this stage I see no constructive purpose in attacking them. I'll feel differently when they go up for reelection, so call me in 2012 when Lieberman and Nelson will face the voters.
I encourage everyone to argue health care reform on the merits using facts. Discover the actual contents of the bill. One of the biggest problems we face is that most people do not understand what the House and Senate bills include and what they do. For example, Donna claims that the Senate bill lacks cost controls. This is simply wrong. Cost controls are one of the areas where the Senate Bill is superior to the House bill. The Senate bill includes most every cost control and cost reduction idea available. Yes, they are all tests and pilot programs, but that is because none of the ideas have been proven yet.
Robin says:
It is tragic that we as a great nation can't figure out a solution to the uninsured situation. Other countries have already done it and it seems the same"pride" that got us to the top will ironically bring us to our knees if we don't embrace change. Until then, we have to take advantage of existing programs. There are at least two of
them which I feel everyone needs to know about. One is the "Patient Assistance Program" and two are free discount prescription cards that exist. I know of a site (www.medpap.ws)which goes over both .I hope this helps until we as a people truly realize we are only as strong as our weakest link.
Lioness says:
DOA -- Declare the current BAD LEGISLATION, tainted with every sort of vote selling and self interest and WASTE -- DEAD, so America can go on with life. Rather than trying to glue together this rotting corpse, a great health care correction can go forward on the basis of shared ideas. Rather than a comprehensive disaster, lets get on the road to correction that can lead toward Utopia (rather than stupid stubborn emptiness).
devis complémentaire santé says:
Thanks, very interesting article, keep up it coming :)