[Vision2020] Health care {insurance} reform passed

[Andreas Schou]

>
>
> You're probably being facetious when you said the Chinese will be paying
> for the $250 senior giveaway (not the kind where they give seniors away:)
>

What I meant is that the senior giveaway was a pretty bad idea. It's not
paid for 'til 2012, when some of the (small) associated taxes, like the tax
on class 1 medical devices, come online. However, given the low year-to-year
costs of issuing treasury bills, especially given the international rush to
buy American currency, our float of the costs is likely to cost only a
couple tens of million dollars. Tens of millions of dollars are a lot of
dollars on an absolute scale; on a relative scale, it's peanuts.


>
> Apart from all the deals they had to make to get this bill passed.
>

The two largest of those deals are going to be repealed in reconciliation
these week.

There's no good reason for the Nebraska deal. There's a good argument,
however, that the Louisiana deal should stay. There's a peculiar reason for
it. After Hurricane Katrina, the combination of federal disaster-relief
money and private insurance payouts increased the median on-paper income in
Louisiana by 40%. When this number was inserted into the Medicaid funding
formula, it resulted in a drastic reduction in Medicaid funds to Louisiana.
>From a rational perspective, the insurance payouts weren't "real" income;
they were compensation for a massive statewide destruction of wealth. What
the "Louisiana Compromise" does is zero out that phantom 40% increase,
restoring Medicaid funding at the prior level.

The unanimous partisan nature of the passage.
>

It passed on a unanimously partisan vote because the Republicans made a
practical decision to oppose any plan the Democrats proposed, whatever the
cost and whatever the plan. From a purely mercenary political perspective,
this was a good idea: their unanimous opposition held up the bill for eight
more months than it ought to have been. It did, however, prevent even good
Republican ideas from being inserted into the bill.

http://www.nationaljournal.com/njmagazine/nj_20100320_9241.php


And of course the INSURANCE MANDATE (which pisses a lot more than right
> wingers off (I'm more aligned with dems than repubs so I don't want to see
> them in power again).
>

I get that, Garrett. But I can't think of a way to preserve an insurance
market without a mandate. To do so, you have to work within a 3.3% profit
margin while moving the most expensive cases into the market. In order to
balance those risk pools out without drastically driving up costs to the
consumer (or the government), there needs to be compulsory participation for
healthy people.

If that doesn't happen, the most rational market participation strategy is
to wait until you get sick (and thus have a pre-existing condition) to join
the market. That means that the insurance market is a de facto single-payer
system, subsidized by the government, where the profits go to private
corporations.

Do you have a better idea?

-- ACS
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