Health Care Reform for Freedom

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Health Care, Wingnuts Being Wingnuts

More evidence health care reform is mostly safe from being repealed, from Andrew Leonard:

The best bet that Republicans have for derailing healthcare reform isn’t today’s vote, but rather their long-term plan to deny funding for implementation. And yet it’s hard to see how such a strategy would end up creating anything besides an ongoing atmosphere of chaos and uncertainty that would make it very difficult for the insurance industry to operate. There is going to be heavy pressure, behind the scenes, on Republicans not to rock the boat now that the insurers have figured out how they are going to make money.

And they will make money. More Americans with private health insurance means more profits for healthcare insurers, and it also means more consumption of healthcare services. Which leads us directly to the third leg of this triumvirate. As Steve Benen, blogging at the Washington Monthly, points out, nearly one-fifth of the 1.1 million jobs created since the passage of the ACA have been in the healthcare sector. It has consistently been one of the best-performing sectors of the economy. It’s hard to see how adding another 30 million Americans to the ranks of the health-insured will chip away at that success story. The opposite seems more likely.

Well, actual empirical evidence that something is really truly real and true doesn’t make a dent with wingnuts, especially if Hannity/Beck/Limbaugh et al. are telling them it isn’t true, based on the fact that Beck can write something about it on a chalkboard. But the fact that the insurance industry is coming around on this and doesn’t want most of health care reform repealed is a strong indication that most of it will not be messed with.

Congressional Republicans are going to have to put on a good show for the home folks, of course, so it wouldn’t surprise me if the House does pass the “Repealing the Job Killing Health Care Law Act”, because they know it’s unlikely to be passed in the Senate and most certainly would be vetoed.

I think, after that, they’ll target two or three provisions in the bill, because they have to give their supporters some kind of trophy to put on the wall. So maybe it will be a squirrel head and not a tiger head, but something.

However, the one part of the bill that polls say most people don’t like, the individual mandate, is going to be fiercely protected by the insurance industry lobbyists. Which means that Senate Republicans will get on board with it. But right now most of the Right so fervently believes that the individual mandate is evil and unconstitutional and the work of the devil, that I can’t imagine they’re going to be satisfied with the squirrel head. It’s possible failure to rescind the individual mandate could bite the GOP in the ass in 2012.

Anyway — I titled this post “Health Care Reform for Freedom” because I want to make a different point.

The Republicans have dubbed their healthcare bill the “Repealing the Job-Killing Health Care Law Act.” The primary evidence for their assertion is based on a line in the CBO analysis of the bill that estimates that the labor supply might drop by one-half of 1 percent as a result of the passage of the ACA. The Republicans multiplied the total number of jobs in the country by half a percent and came up with a total of 650,000 jobs lost. But, as has been pointed out innumerable times, a drop in the labor supply is not the same thing as employers cutting jobs because costs are too high. According to the CBO, healthcare reform could result in a lower labor supply because workers may voluntarily leave their jobs, secure in the knowledge that they would still have access to healthcare.

In other words, it’s not jobs that would be reduced. And I think even House Republicans can’t possibly be stupid enough not to understand that. Well, OK, there’s Michele Bachmann. But most of them can’t possibly be that stupid. I assume they can tie their own shoes and eat with a fork, and such.

I have met people who say they are holding on to a job mostly for the health benefits; otherwise, they’d rather work freelance. So I suspect the CBO is right; that once people can trust they can still get affordable health insurance without holding on to a job, some people will give up jobs they otherwise don’t need and let someone else have them. Seems to me that would reduce unemployment, not add to it.

And then there are the people who cannot change jobs because they have pre-existing conditions. This is another point righties can’t seem to grasp. I give you, for example, Don Surber:

Now that Republicans plan to vote on repealing this unconstitutional law, Democrats are throwing up make-believe numbers to scare people.

From the Washington Post: “As many as 129 million Americans under age 65 have medical problems that are red flags for health insurers, according to an analysis that marks the government’s first attempt to quantify the number of people at risk of being rejected by insurance companies or paying more for coverage.”

So, 65% of the 200 million people with health insurance through their employer are so diseased no one will insure them.

This makes no sense.

The story does not define just what these red flags are.

But the 65% figure contradicts what Democrats previously said about the uninsured.

From the story: “The new report says that, of those Americans who are uninsured, 17 percent to 46 percent have medical conditions, depending on the definition used.”

Behold the lack of critical thinking skills. Surber assumes the “pre-existing conditions” issue only exists among the uninsured, but that’s not what the article he quoted says. That’s 65 percent of all Americans, not just those who don’t have insurance now.

And of course this is significant because there must be millions of people in the U.S. who do have insurance now but who would be uninsurable if they lost that insurance, which happens every day.

New York state already has a “guaranteed issue” provision, so that if you take a new job, or change jobs, your new employer’s health insurance provider can’t refuse to insure you because you have a pre-existing condition.

And you know what that gives people? More freedom. If you don’t like your job, if you get a better offer, you can leave your old job knowing that you will be able to get health benefits from your new employer.

I understand that people in other states often are stuck in jobs because they are afraid they will lose their insurance if they leave, even for higher salaries, because the lack of health insurance is too much of a financial risk for most people.

Don’s problem is that he doesn’t understand what insurance is:

Of course it makes sense that those with health conditions would be more likely to seek health insurance than those who are healthy — which is one of the arguments against Obamacare; not everyone needs health insurance.

This is the sort of idiocy that does inspire one to bang one’s head on the wall and scream for a while to make the pain go away.

This guy assumes you don’t need health insurance until you get sick. Does he think you don’t need auto insurance until you smack into a tree? That you don’t need homeowner’s insurance until after the tree crashes through your roof?

Does he not understand that if you wait until you have a health condition before you try to purchase insurance, in most states, the insurers won’t sell you a policy? For any amount of money?

Does he not understand that the insurance companies’ business model requires that lots of people get insurance policies who don’t need them (at the moment)? How does he think insurance works? You pay your premiums — a few hundred dollars a year — and then poof! Bills for medical care in the tens of thousands magically disappear!

Of course, the cost of medical care does not disappear. So when the healthy 26-year-old who didn’t bother to sign up for his employer’s health benefits gets hit by a truck and gets hauled into the emergency room and runs of tens, maybe hundreds, of thousands of dollars in medical bills he can’t pay, guess who pays for that health care? Everybody — the hospital pads everybody else’s bill to cover the money they lose from people who can’t pay. Contrary to wingnut mythology, emergency rooms ain’t “free.”

And if the accident leaves him with a condition that requires long-term care and rehabilitation therapy, good luck finding a medical facility that will provide that if the guy can’t pay. Emergency rooms are only required to stabilize people so that they don’t die; after that, most of the time, you’re on your own.

People without insurance who get medical care they can’t pay for are costing all of us. People with jobs who have access to health benefits and choose to not sign up are freeloaders.

And people wonder sometimes why I refuse to “reason” with wingnuts.

Anyway — I want to go back to the freedom thing. Once the health care reform act is fully in place, with the individual mandate and guaranteed issue provisions intact, millions of people will be set free — to change jobs, to leave jobs and strike out on their own, to finally get medical treatment for conditions that are holding them back. Lots of people will be given career and other choices they don’t have now.

Unless —

At New Republic, Jonathan Cohn writes that it’s still possible health care reform will be nullified by wingnut activist judges ruling from the bench. And one never knows what the courts will do, including the Supreme Court. However, I can’t imagine Justice John Roberts et al. ruling against something the insurance industry wants, and the insurance industry wants the individual mandate.

See also Cohn’s attempts to “reason” with a wingnut lawyer behind one of the constitutional challenges of reform:

A few weeks ago, I spoke with Hyder at his office, in order to learn more about why he had brought this case. He said his motive was straightforward. He’s opted not to carry health insurance because he doesn’t think the benefits justify the price, and he doesn’t want the government forcing him to do otherwise. Okay, I asked, but what if he gets sick and needs hospitalization? How will he afford those bills? It was a distinct possibility, he agreed, patting his waist and noting that he was a little overweight. But those potential bills would be problems for him and his hospital, he suggested, not society as a whole.

When I told him that I disagreed—that his decision to forgo health insurance meant other people would be paying his bills, via higher taxes and insurance premiums—he politely and respectfully took issue with my analysis. The discussion went back and forth for a while, but soon it became apparent that our differences went beyond the finer points of health care policy, to our most basic understanding of the rights and obligations of citizenship. “It’s a complete intrusion into my business and into my private life,” he told me. “I think it’s one big step towards a socialist society and I’m purely capitalist. I believe in supply-side economics and freedom.”

Freedom? whose freedom? He wants to be “free” of having to pay for health insurance. And who wouldn’t? It’s expensive. I wish I could be free of it, too. But to pay for this “freedom,” millions of other people have to be less free, because they are tied by their health insurance to jobs they might wish to leave.

The Cohn article goes on to explain the legal precedents for the constitutionality of the individual mandate, which is a pretty good read, too.

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11 Comments

10 Comments

  1. c u n d gulag  •  Jan 19, 2011 @1:46 pm

    It is now as if we literally occupy two completely different physical worlds. One based on facts, numbers and empirical evidence, and the other on beliefs and feelings. And all of those beliefs and feelings run 180 degree’s counter to whatever any facts, numbers and empirical evidence may show.
    Why is that, do you think?
    “Well, I believe in the opposite of whatever Liberals believe in.” And, as Colbert memorably stated, “Fact’s have a notoriously Liberal bias.” So, here we are…
    Maybe if we could take over Glenn’s chalkboard, or find a Christian ‘Oracle at Delphi,’ to divine chichen entrials, and smoke from the mystical fires, they might actually come around. Especially Beck’s board. They believe his chicken-scratchings more than they’ll believe chicken entrails.
    At least at one time, they’d agree with some scientific evidence – they’d harumph, but they’d grudgingly go along. Now it’s, “Whatever YOU say, I’m against it!”
    Maybe if we could somehow get them to understand why it is that things don’t fall UP! Ah, but gravity runs counter to faith. Don’t, after all, the souls of the worthy ascent to Heaven? I guess it’s all a lost cause. And the world would be laughing about our countries denial of facts and science, but for the ‘fact’ that ‘science’ has armed our now mad nation to the teeth. How do you say, “YIKES!” in Chinese, and 100+ other languages?
    I can’t see any solution to this standoff between facts and beliefs. If someone else does, I’d be happy to listen.

  2. Stephen Stralka  •  Jan 19, 2011 @4:28 pm

    According to the latest census data there are about 261 million Americans under 65, so if 129 million of those people have red flag medical problems, that’s actually about 49%, not 65%. Which is still slightly more than the 17 to 46 percent of uninsured Americans who are estimated to have medical conditions, but then it still isn’t an apples-to-apples comparison.

    Since one of the largest groups of uninsured Americans is adults age 18 to 24, it seems reasonable to guess (I haven’t confirmed this yet) that the percentage of young adults who are uninsured is greater than for the population at large. If that’s so, then it would make sense that there is a slightly lower rate of medical conditions among the uninsured, since they tend to be younger on average.

  3. moonbat  •  Jan 19, 2011 @5:52 pm

    Over the last month, I kept hearing the phrase “Job Killing” coming out of the mouths of republicans at every turn, even at the most inconsequential moments, and so I just assumed it was some Frank Luntz hypnosis – get Team R to repeat a certain meme, over and over, until they create enough fear to block what normal people would call progress.

    I like the idea of calling it Health Care Reform for Freedom, but I fear (know) that Team D is so inept at marketing, they wouldn’t know a public relations gift if it were dropped in their lap. And so no matter how ridiculous they sound, the Rs once again, define the rules of discourse.

  4. c u n d gulag  •  Jan 19, 2011 @5:58 pm

    Liberals trying to discuss the real, empirical, world with Conservatives is like talking about Quantum Physics with a Bible Scholar, or String Theory with a Klansman.
    I still don’t see how we reach any mutually beneficial conclusion.
    So, I guess we don’t. How do we even try?

  5. kanino  •  Jan 19, 2011 @7:05 pm

    Green eggs and ham!
    Would you eat them in a box?
    Would you eat them with a fox?
    Would you like them here or there?

    What the Republicans don’t want to see is that they are positioning their selves in a corner of absurdity, where they don’t envision a massive revolt of ideologies and common sense from the citizens of this country. They are playing chicken with the population hoping that their zombie excuses will prove beyond doubt that is possible for people to roll over and die simultaneously in massive numbers, like the unemployed, when history tell us otherwise. Their demise will come from assimilating ideas from the past where individuals disappeared from the system in small numbers, here or there. The future presents itself not as a light and occasional rain of unfortunate and desperate individuals, but as a river of injustice. These shepherds are trying to save the herd by leaving the lost sheep to die in the mountains, hoping that it will be the last one. Countries don’t survive with that lack of imagination.

    From the book “__ ________ _____(1)”

    Nevertheless, most societies have repudiated cannibalism since the beginning of times, and the main reason is not moral or ethical, it’s social security. If you could eat an individual from another community, there is a strong risk that, given the situation, you

  6. kanino  •  Jan 19, 2011 @7:08 pm

    could be eaten by members of your own community.

    From a Republican point or view, there are two ways of telling the truth; one appears to be saying something interesting; the other one is lying.

  7. tom b  •  Jan 19, 2011 @8:27 pm

    I can hardly wait until 2012. The GOP will nominate some pea-brain, like Pawlenty, Huckabee, or Palin, instead of someone who can sound rational in public, like Romney.

  8. Kyle  •  Jan 20, 2011 @1:32 am

    Glad to see this article, because I don’t see the economic argument for health care reform stressed enough. It harms American business to be saddled with health care costs double our national competitors. And the dysfunctional nature of health insurance in this country means you are taking a hell of a risk with your health and financial health leaving a corporate job with employer-supported insurance — with a chilling effect on entrepreneurship and innovation and voluntary labor mobility that economic Republicans supposedly support.
    Bottom line, if the American system is so great, why does it cost more and cover less people? That’s a glaring price signal for anyone not sticking their fingers in their ears and prattling on about how we’re the best because we’re America lalalalala socialism lalalala Canadian waiting lists.

  9. don surber  •  Jan 20, 2011 @8:49 am

    No offense, but that’s exactly what I said. 65% of the 200 million people with private insurance.

  10. maha  •  Jan 20, 2011 @9:38 am

    No offense, but that’s exactly what I said. 65% of the 200 million people with private insurance.

    You don’t seem to know what you said; you complained some data is bogus but provided no proof other than an apples and oranges comparison with different data, and you seem not to understand how it is uninsurable people have insurance.

    See if you can follow this: People with pre-existing conditions who have insurance now obtained insurance while they were still healthy, before they had pre-existing conditions. However, once you have a condition, if they lose that insurance there’s a strong possibility they would not be able to purchase insurance again, from any insurer, at any price, either through employee benefits or private policies.

    The way the system works now, in most states if you don’t obtain insurance before you “need” it, you may not be able to get it. Ever. If you lose your insurance because you change jobs, in most states the insurance provider of your new employer is under no obligation to accept you as a customer if you have a pre-existing condition. This is not a matter of just having to pay more; it’s a matter of being turned down, period.

    Again, this depends on the state. Here in New York (and a handful of other states) we have state guaranteed issue laws, so people can change jobs without worrying about losing their insurance. And if you don’t have a job you can purchase a private policy after your COBRA benefits run out, no questions asked. But that’s unusual. In most states, you’d just be out of luck.

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