14 July 2009

I get letters

Not too many, and most are nice people with strange ideas, people selling something, or people wanting advice, but some of them just take my breath away:
"The most potent threat to the Obama administration’s fledgling health care plan may come not from the insurance industry or skeptical doctors but from the Congressional Budget Office. Earlier this week, CBO released preliminary estimates suggesting that the health care proposals [...] would cost $1 trillion and trim the number of uninsured by only 16 million."
nigga thats with a capital T. u need to check ur self before u wreck the country with dumb shit like that. obama (according to the c.b.o) spent 5.6 trillion dollars in his first month in office. on top of that he keeps spending money and investing in the wrong areas(ever here of pork). no matter how u implement a universal healthcare plan at this current time it is overwhelmingly econmically unsustainable.
p.s today's healthcare system sucks! now the question that remains is what better plan will work for the country.

I'm left speechless by this sublime piece, wondering if it could be an exceedingly subtle work of performance art. I mean, it can't be for real, right?

I'm also reminded of a great bit from The Princess Bride:


Similarly, that may be -- almost certainly is -- the first time in my life I have been addressed as "nigga." And in the context of a discussion of the Congressional Budget Office's score of health care reform and macroeconomics, it truly becomes a subversive thing of beauty. It's just not that common a term of reference in the health policy blogosphere (excluding Ezra Klein's blog, which should go without saying).

Anyway, this is a good time to point out that the House Tri-Com bill came out today, and it's even better than the Senate HELP bill, which was pretty good itself. (Note that the above commenter was apparently referring to the CBO score of the incomplete bill, not the final score, which comes much closer to universal coverage.)
Key facts in the early analysis of the House Bill:
  • Cost: $1 Trillion (about $300B cheaper than the Senate bill).
  • Coverage: 97% of Americans.
  • Public Plan: Hybrid strong-weak. Starts off at Medicare rates + 5% for docs; but must negotiate after a couple of years; participation is voluntary; self-supporting through premiums; and must comply with same regs as private plans. The CBO estimates that the public plan would enroll less than 5% of Americans.
  • Medicaid: only expands to 133% of FPL (as opposed to 150% in the Senate), and apparently lays groundwork for federalization of the program, which would be a huge boon to the states staggering under Medicaid costs.
  • Subsidies: up to 400% FPL on the sliding scale.
  • Individual Mandate: Present, enforced by a tax of 2.5% of AGI on those who do not purchase a policy.
  • Employer Mandate: Strong. 8% of payroll in companies with payrolls greater than >$400K, exemptions for small businesses.
  • Health Exchange: Regulates plans, run nationally, but states may opt out. No recissions, guaranteed issue, and community rating is required. Initially open only to individuals & very small businesses, but may expand later.
  • Time Course: Phased in over three years, largely to save money on the front or less charitably, to hide the costs on the front!
  • Financing: internal savings and surtax on the very wealthy.
There appears to be much more, such as filling in the Medicare drug price donut hole, etc. No, it's not perfect. To my surprise, it seems to be even more measured than the Senate Bill, and possibly even more do-able -- it costs less, covers more people, and even has less generous subsidies.

Better yet, there's a ton of overlap between the House and Senate Help bill, which is great news because now that these markers are down, it puts pressure on the more conservative Senate Finance committee to get in conformity or risk their bill -- and all their hard work -- becoming irrelevant. If nothing else, it's applying useful pressure on Baucus from the left. Well, the center-left.

And in this environment, I'll say that's good enough for me.


6 comments:

  1. Nigga, that's Obama with a capital "O"!

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  2. Shadowfax: I agree with you and thanks for printing the comment so we can all see how weird and hostile our fellow man is.

    Chris: I'm pretty unshockable but your comment leaves me speechless.

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  3. Maybe I am missing something here. The medical system we have now is too expensive. So we will put in a new system that will cost $1,000,000,000,000. Ummm, how exactly is this an improvement? Even assuming that the health delivery system won't be worse than it is now, which is a BIG assumption considering Gov't track record in efficiency, cost containment, and customer satisfaction, how is this an improvement if it costs more than we now spend? Whether I pay directly for my own health care, or it is paid by "the gov't", I am still paying for it. Every dime that the gov't spends is coming from the pocket of the taxpayer!!

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  4. This is worth repeating:
    "Universal health care isn't worth our freedom." From Dr. Tom Szasz in the WSJ this morning:


    Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.


    If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

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  5. @Toni Brayer MD - You're obviously reading more into that than I either intended, or can see - I was merely commenting on the irony of this particular commenter pointing out the lack of a capital, then forgetting one themselves.

    Or was I missing something originally? (Apologies if I've caused offense to anyone)

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  6. DOC: But approx 50% of the 'taxpayers' only pay FICA, and that
    burden may be relieved in the 2011
    time frame. Recent trial balloons suggest a big chunk of change is
    expected from the 3,000,000 taxpayers
    in the >$200k/yr AGI. In '06 this group had an aggregate AGI in the $2.5T range. Rangel feels they won't notice an additional $30-50B/yr increase in their tax load for health care although they may be required to chip in some more for deficit reduction when dream land ends in '11 or '12 and the significance of multi year $1T deficits begins to sink in.
    SCH

    ReplyDelete