I’m 51 years old and this bill is, without question, the biggest progressive advance in my adult life. You have to go back to the great environmental acts of the early 70s to get close, and to the civil rights/Medicare era to beat it. That’s four decades, the last three of which have constituted an almost unbroken record of conservative ascendency. And now that ascendancy is just days away from being — finally, decisively — broken. Warts and all, we’re on the cusp of passing a bill that provides all of this:
- Insurers have to take all comers. They can’t turn you down for a preexisting condition or cut you off after you get sick.
- Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
- Individual mandate. (Remember how we all argued that this was a progressive feature back when John Edwards and Hillary Clinton were championing it during the primaries?)
- A significant expansion of Medicaid.
- Subsidies for low and middle income workers that keeps premium costs under 10% of income.
- Limits on ER charges to low-income uninsured emergency patients.
- Caps on out-of-pocket expenses.
- A broad range of cost-containment measures.
- A dedicated revenue stream to support all this.
A trillion dollars in benefit for low and middle income workers. 95% of Americans insured. Medical bankruptcies on the verge of disappearing. And for the first time ever, an acknowledgement that decent healthcare ought to be universal in the United States.
But the bill must die because it is not a well-disguised single-payer plan, or something. Which is why it’s obvious Paul Krugman’s a paid Emanuel shill, too:
(W)hat we’re getting will, in its overall results, work a lot like a single-payer system. It will be an imperfect, inefficient simulation; but those on the left who decry it as terrible, evil, nothing but a giveaway to the insurance companies are missing the very real good it will do.
After presenting two charts:
At this level of abstraction, it’s basically the same as single-payer.
Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable. (Emphasis mine)
The best way to understand the mandate business is that if you installed a single-payer system tomorrow, it would abolish premium payments — but everyone’s taxes would have to go up. Single payer is a far more efficient way to deliver this part of the health care system precisely because it skips the profitability factor, but you will pay either way.
Put another way: some Canadians pay higher taxes than we do, but then if you add the cost of health insurance to what we pay in taxes Americans have higher costs. That’s because their system holds down costs extremely well: about $5,452 per Canadian compared to $8000 per American.
Here’s the Canadian government’s chart of income tax rates. You’ll notice their system manages to be simpler than our own, and taxes a family making $50,000 ($52,500 Canadian at the time I write this) is 22%, or $11,000.
But that’s it. There’s no insurance payment to make. Whereas currently, an employer-provided plan for that same family is over $13,000 split between employer and employee, even as we tax that family’s income in America at a rate of 25%.
This bill will end all that. Yes, you could do away with the inefficiency of profit and move to an absolutist form of single-payer, but not with the Congress existing between now and at least November 2010. As for the public option, it isn’t dead — it’s just not in this bill.
It is still possible to get a public option if we demand it hard enough to make that happen.
Don’t even start on insurance stock prices. Nate Silver has already destroyed that argument. under this legislation, health insurers would virtually become regulated utilities. Reinsert the removal of the anti-trust exemption, and that’s exactly what you’d have: health insurance as a regulated public utility.
But Jane Hamsher and David Sirota won’t hear it; they want to stop the 11-Dimensional Chess game because the bill isn’t good enough…yet. Never mind that not one of them can name a major progressive change that came in one omnibus bill. Social Security? Nope! Civil Rights? Don’t be silly.
This is the most progressive thing Washington has accomplished in three decades, and it won’t happen all at once.
Again, this is because the GOP forced the White House to make a deal with every. Single. Stinkin’. Democratic Senator. But instead of talking about how to make Congress more progressive, too many direct their vitriol at Rahm and Obama, who don’t have a Senate vote.