Health care's done

Middle Class Tax Increase? (0.00 / 0)

I am generally in favor of the health care reform, enormously disappointed that the public option was killed (for now) but I am particularly disappointed by one specific consequence. Is it true that the use of an FSA for child care expense will be cut to half what it was before this legislation? If true, that's a significant middle class tax increase.

On the other hand, FSA's do have a moral problem in that they provide the greatest financial assistance to those with greatest ability to pay. To add insult, I've learned it's legal to pay for a child's summer camp tuition with an FSA if you are employed because it's considered dependent care.

Is it also true that elimination of the anti-trust exemption for the health insurance industry was not included in the final version of the bill?

I've written to Peter Welch and Bernie Sanders but received only generally worded responses that don't answer my questions.

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by: vtiluv @ Fri Mar 26, 2010 at 11:08:53 AM UTC

the clock is now running... (4.00 / 2)

...to do something about the guided missile into the middle class this bill has created through the individual mandate bereft of any meaningful cost controls. We have a few years only.

One way or the other, health care reform is far, far from done.

Nullius perfectus est

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by: odum @ Fri Mar 26, 2010 at 13:07:55 PM UTC

On the plus side (4.00 / 1)

According to Ezra Klein, there are no enforcement teeth in the mandate:

In 2016, the first year the fine is fully in place, it will be $695 a year or 2.5 percent of income, whichever is higher.

...

And what happens if you don't buy insurance and you don't pay the penalty? Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don't pay the fine. If this actually leads to a world in which large numbers of people don't buy insurance and tell the IRS to stuff it, you could see that change.

...

The irony of the mandate is that it's been presented as a terribly onerous tax on decent, hardworking people who don't want to purchase insurance. In reality, it's the best deal in the bill: A cynical consumer would be smart to pay the modest penalty rather than pay thousands of dollars a year for insurance. In the current system, that's a bad idea because insurers won't let them buy insurance if they get sick later. In the reformed system, there's no consequence for that behavior. You could pay the penalty for five years and then buy insurance the day you felt a lump.

Beware the Everyday Brutality of the Averted Gaze

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by: mataliandy @ Fri Mar 26, 2010 at 19:53:16 PM UTC

[ Parent ]

thank you (0.00 / 0)

I was just getting ready to point that out.

"That the people have a right to bear arms for the defence of themselves and the State ..."- Vermont Constitution Chapter 1, Article 16

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by: kestrel9000 @ Fri Mar 26, 2010 at 19:58:59 PM UTC

[ Parent ]

You're right! The repubs like HCR more than the Dems ... (0.00 / 0)

They can invest their health care profits in PR, beating on the Dems, as we see below.  

We failed in getting the truth out.  We used tactics, the other side has a strategy.  Until we take the time to get our fundamental message out, we will win half victories, mixed with defeats.  

We can govern ourselves better than they govern us!

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by: govt4all @ Sat Mar 27, 2010 at 00:30:40 AM UTC

[ Parent ]

Apparently... (4.00 / 3)

Being a Repub nowadays means going around acting like you've had a load of shit in your diaper for several days.

You can read JD's latest at five before chaos. Politics. Godlessness. Music. Films of questionable quality. It's all there, folks.

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by: JDRyan @ Fri Mar 26, 2010 at 13:34:21 PM UTC

there you go (3.50 / 2)

with the name calling again...

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by: Doug Hoffer @ Fri Mar 26, 2010 at 13:48:17 PM UTC

[ Parent ]

Not really. (4.00 / 1)

I never explicitly called 'em pants poopers. I leave that for people like Paul Beaudry.

You can read JD's latest at five before chaos. Politics. Godlessness. Music. Films of questionable quality. It's all there, folks.

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by: JDRyan @ Fri Mar 26, 2010 at 18:55:33 PM UTC

[ Parent ]

load (0.00 / 0)

LOL Jd:) It sure seems like you're right, though:)  

When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Sat Mar 27, 2010 at 06:26:47 AM UTC

[ Parent ]

Actually, it's far from "done" (0.00 / 0)

enjoy your "victory lap" but the "game" (as you infer) is still on. With Zero backing from the GOP/Conservatives, let's apply the "pottery barn" rule to health care.  which is, if you break it, you pay for it.  Of course, progressives have no intention of this since they will have ALL of us pay for the unintended consequences of this bill which will include the under-funding aspects.  How many failed government health care examples do we need before we understand it doesn't work:  rationing in Europe, underfunded/broke programs in Medicare and medicaid, woefully veteran's care, the fiscal train wreck of MA universal care (projected to be an $88M a year program from 2006 but is now $4B since 2006).

While the passage of ObamaCare marks a progressive triumph, its impact will play out over many years. Many of us fought this bill so vigorously because we believe the results will be: higher taxes, slower economic growth and lower quality medical care. As for the politics, the first verdict arrives in November. So, "game on".

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by: lhughes @ Fri Mar 26, 2010 at 14:11:15 PM UTC

And how about that never-ending war your guys started in the middle east? (4.00 / 3)

You didn't worry too much about funding that milstone, did you?  Yeah, yeah, I know..."9/11"..."9/11"..."9/11"..."9/11."

I guess Obama forgot to use the magic words...the "Bush Universal Justifier."

Unlike the war that you guys still "own" and protected as a sacrosanct patriotic mission for as long as you clung to power; we moderates freely criticize the healthcare legislation, and even Obama admits its just the best he could do under the circumstances.  Until the parasitic health insurance industry is forced to release its grasp on our healthcare, there will still be much to get done; but somehow I don't anticipate the "Party of No" contributing much to the effort to curb the insurance industry.  

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by: Sue Prent @ Fri Mar 26, 2010 at 14:34:46 PM UTC

[ Parent ]

getting (4.00 / 4)

a little tired of people referring to "rationing" in Europe

it's called a budget; I thought Conservatives liked setting budgets and sticking to them; and if the budgets are so woeful, how come the outcomes are similar to or better than in the U.S.? can you acknowledge that the current system is wasting hundreds of billions? talk about a train wreck

BTW - Medicare works pretty well or haven't you talked to any seniors recently? as for the cost, it's tied to cost increases (which needs to be addressed but I assume Republicans will fight that too) and to the funding source; a flat payroll tax that only applies to wages (conveniently exempting other types of income); can't wait for that fight...

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by: Doug Hoffer @ Fri Mar 26, 2010 at 14:44:48 PM UTC

[ Parent ]

Zero backing (4.00 / 2)

Zero backing was poorly thought out obstructionism. The republicans played that card in hopes of showing Obama to be ineffective. It didn't work and now the republicans are left explaining why they voted against concepts that their own party promoted and proposed.

Besides that point, what relevance is zero backing anyway? The majority rule not OK if it doesn't have support from all parties? How many supporting republicans would make it all better? one? 51? Would a small number of outliers make you comfortable?

I think that almost everybody has an issue with some item or items in the bill. But, no bill will ever pass on such a complex issue that satisfies all. It's a set of compromises. Unfortunately, we are at a point where we need to fish or cut bait. Evidently some chose to cut bait. I fully expect the bill to be tuned in the years to come. I suspect that the individual mandate will be removed. In any case, November is an eternity away.

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by: pete_n_vt @ Fri Mar 26, 2010 at 15:59:40 PM UTC

[ Parent ]

Heh.... "many of you" (4.00 / 3)

Many of us fought this bill so vigorously because we believe the results will be: higher taxes, slower economic growth and lower quality medical care. As for the politics, the first verdict arrives in November

.

And that same "many of you" didn't do jack shit when Bush was launching expensive wars of choice, raping the middle class with regressive tax policies and actually doing things that actually threaten freedom, so now we're supposed to take you seriously? What about the "many of you" who just can't stomach the notion of a black prez with a funny name? What about the "many of you" who are so historically ignorant you believe someone can be both a fascist and a socialist (as well as a Muslim and the Antichrist)? What about the "many of you" who are so gullible you actually believe the bullshit about "death panels"... or that somehow you're an "overwhelming majority"? That's the face of your movement.

You can read JD's latest at five before chaos. Politics. Godlessness. Music. Films of questionable quality. It's all there, folks.

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by: JDRyan @ Fri Mar 26, 2010 at 19:01:47 PM UTC

[ Parent ]

Anyone who calls HCR "ObamaCare" (4.00 / 3)

obviously has no interest in serious discussion.

"That the people have a right to bear arms for the defence of themselves and the State ..."- Vermont Constitution Chapter 1, Article 16

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by: kestrel9000 @ Fri Mar 26, 2010 at 20:01:45 PM UTC

[ Parent ]

I'd agree with that (4.00 / 1)

And I didn't even support the bill.

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by: ug @ Fri Mar 26, 2010 at 20:14:08 PM UTC

[ Parent ]

No "serious discussion" - among other deficits (4.00 / 2)

Calling a few modifications in the abusive and exploitative practices of the insurance industry Obamacare displays a lizard's level of critical thinking. Hell, this law is not even "health care" reform.

Even Obama doesn't call this tinkering bill "health care" reform because it isn't. The Democrats merely corrected or tweaked a few of the most obviously broken aspects and bad practices of a non-competitive insurance industry. The new laws only force the existing health care system to become bigger, not better.

We are long way from reforming health care.

sláinte,
cl

-- Religion is like sodomy: both can be harmless when practiced between consenting adults but neither should be imposed upon children.

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by: Caoimhin Laochdha @ Sat Mar 27, 2010 at 04:01:20 AM UTC

[ Parent ]

Whoa, Wyden! (4.00 / 2)

I confess: I used to write legislation for a living, and it is not pretty.  Yet, back in my day (twenty plus years ago), the influence of money on the Hill, while substantial, was nowhere near as corrosive as it is today.  That said, before we declare "game, set, match", we will have to watch how the regulatory and implementation process plays out.  More room for mischief, unfortunately.

I do not know if anyone caught the interview with Ron Wyden at Huffington Post.  Regarding the pending state lawsuits about the mandate, he claimed that states could always opt out of the mandate.  Here is the interesting revelation:

"Speaking to the Huffington Post on Tuesday, Wyden discussed -- for one of the first times in public -- legislative language he authored which "allows a state to go out and do its own bill, including having no individual mandate."

It's called the "Empowering States to be Innovative" amendment. And it would, quite literally, give states the right to set up their own health care system -- with or without an individual mandate or, for that matter, with or without a public option -- provided that, as Wyden puts it, "they can meet the coverage requirements of the bill."

If this is true and if it is allowable, ponder the implications for a state such as Vermont that might indeed want to set up its own system.  Perhaps this is something for the Racine-inspired panel, if enacted, to contemplate.

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by: Bruce Post @ Fri Mar 26, 2010 at 15:19:47 PM UTC

step (0.00 / 0)

God, what does that say about America if so many states choose to opt out of even this small step at health reform.

When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Fri Mar 26, 2010 at 15:50:30 PM UTC

Two opt-outs (4.00 / 1)

It says different things about different states. One might call it the red-state opt-out vs the blue-state opt-out (although I consider us all purple states).

A red-state opt out might be a stab at business as usual, with private health insurers getting some window dressing.

A blue-state opt-out could happen here in Vermont, where we could go single payer with cost controls and Canadian pharmaceutical importation.

The story will be about an increasingly fragmented country, with some states succumbing to the emotional manipulations of corporate PR and others rejecting those myths in favor of something empirical.  

Minor Heretic
"Damned for 25% of eternity"

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by: Minor Heretic @ Fri Mar 26, 2010 at 16:32:26 PM UTC

[ Parent ]

Blue opt out is problematic (0.00 / 0)

There was no ERISA waiver that survived in the final bill. ERISA says that you can't tell employers or  unions what kind of insurance they have to offer, taking a true single payer system off the table. Even a strict employer mandate becomes problematic.

It's also a problem that states can't even apply to opt-out until 2017 - which is after Obama will be out of office, and may therefore leave approval to the mercies of a Republican President.

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by: ug @ Fri Mar 26, 2010 at 16:40:27 PM UTC

[ Parent ]

ERISA (0.00 / 0)

Yeah, I have heard the same thing, but one experienced Vermont policy maker has told me that the ERISA waiver issue is often used to put up a roadblock, but that it is not necessarily iron-clad.  Yet, I know what I don't know, in this case, and someone else will have to examine this who has more knowledge than I do.

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by: Bruce Post @ Fri Mar 26, 2010 at 17:39:04 PM UTC

[ Parent ]

A roadblock in theory (0.00 / 0)

But it may not be in practice.  If the state offers a single-payer public option that comes in with better benefits and lower cost than any private plans available to employers in the state, how many employers will voluntarily choose the more costly, les beneficial plans?

Which employers will intentionally choose to lose money on health care in a very difficult economy where every penny counts?

Beware the Everyday Brutality of the Averted Gaze

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by: mataliandy @ Fri Mar 26, 2010 at 19:59:48 PM UTC

[ Parent ]

fragmented (4.00 / 1)

Minor, you're probably right about the increasingly fragmented country.  I suspect, though, that those states hollering about guv'ment intrusion will holler less at all the dollars coming their way once the new plan gets up and running.  But, in an way, we've been a fragmented country for a long time now.  The civil war has never really ended.    

When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Sat Mar 27, 2010 at 06:45:34 AM UTC

Imagine a 90-day suspension (4.00 / 1)

Of federal government spending in any state where 3 or more of the top 5 government officials say they want government out of people's lives. What would happen in those states if they had to go 90 days without highway funds, medicare payments, medicaid payments, unemployment insurance, post offices, social security, school lunches, farm subsidies, air force bases, prisons, federal courts, etc., etc., etc.

How long would it take for even the least informed people in those states to realize they REALLY REALLY LIKE government's role in their lives? What would happen if we let them feel what it would be like in their "perfect" government-free world?

There seems to be a huge disconnect between what people think government does (drain their money) and what it really does (keep them afloat). Imagine what it would be like if we bridged the disconnect by letting them feel the government presence in their lives through its absence.

(Yes, this is snark. I am not in favor of punishing innocent children and others just because they're surrounded by "teh stoopid," so I would never actually promote doing such a thing. But a tiny part of me wonders: if we are going to be running around gutting programs for the needy, why not focus those cuts in the places where even the needy are calling for less government, thereby buying extra support for those in other places who are less shortsighted?)  

Beware the Everyday Brutality of the Averted Gaze

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by: mataliandy @ Mon Mar 29, 2010 at 00:26:07 AM UTC

[ Parent ]

guvment (4.00 / 2)

You're right mataliandy.  But when big guvmnet gives them money or lets them  feel like they are ripping it off they are ok with it.  It is when big guv'ment calls in the chips and they want to be paid back in taxes or whatever, thus decreasing their wealth by a notch or two, that is when they scream about freedom.  Been that way ever since the revolution.

When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Mon Mar 29, 2010 at 06:55:18 AM UTC