This article is a really poor piece of journalism. It has dozens of paragraphs of text that can be summarized as "the senate passed some form of the healthcare reform bill", without any loss of information. It barely touches upon what's actually in the bill, and it uses some surrounding wording to make it appear grand, except that it doesn't sound grand at all.
Is it a minor piece of legislation everyone calls a "reform", or is it an actual reform? What's actually in the bill? Who exactly will it affect and how? What changes, exactly, will it make? The article doesn't answer any of these questions.
IMHO, the most significant aspects of the bill—making it genuine reform—are:
* Insurers will no longer be able to exclude people on the individual market for pre-existing conditions, they won’t be able to take your insurance away when you get sick (on the pretense of “oh, you didn’t report this case of acne you had as a teenager, therefore you lied to us on your application form and we don’t have to pay for your cancer treatments”), and they are sharply limited in how much they can charge different premiums to different groups of people.
* Since the previous rule creates a big moral-hazard problem (if the insurance companies have to take you no matter what, why not put off buying insurance until you actually need it?), there is a mandate for just about everyone to buy health insurance.
* Since paying the full cost of health insurance would put a very very large dent in a lot of poor and lower-middle-class people’s budgets, there is a system of subsidies in place to keep the cost of insurance below (IIRC) 10% of a family’s income.
* The subsidies are paid for by things like taxes on the most expensive health-insurance plans, so (according to the Congressional Budget Office) the overall system does not add to the Federal debt, and even slightly decreases it.
A summary of the Senate’s bill is here (scroll down to “Summary of the Patient Protection and Affordable Care Act”):
The claim that it does not add to the Federal debt is an accounting trick. The CBO is legally obligated to stick to a certain set of accounting rules, but this bill was designed to game those rules.
For example, the CBO measures a 10 year time horizon. The plan is for the cost saving measures to begin immediately, while we will only start paying out subsidies in a few years. So the CBO is scoring this bill by comparing the first 6-7 years of benefits to 10 years worth of revenues.
Another game being played is "mandatory" spending cuts. The CBO is required to assume they will occur. Historically, "mandatory" spending cuts are nearly always repealed at the last minute.
Another fairly major aspect of the bill is that it bans no frills insurance (high deductible, excludes routine care). This is likely to induce people to consume more unnecessary medicine (see the RAND experiment).
Another fairly major aspect of the bill is that it bans no frills insurance (high deductible, excludes routine care)
Oh my. I had no idea. That was the only insurance that can be called "insurance" with a straight face, and they took that away.
Is there at least an option to self-insure? Or do I need to give $100 to insurance co, just so that they can pass $50 to the doctor for routine care - something I could very well do myself without paying the middleman.
Jonathan Chait, The New Republic:¹ “According to the Congressional Budget Office, the Senate bill would reduce the deficit by more than one hundred billion dollars over the next decade. Some critics have asserted that the savings are an illusion produced by phasing in the higher taxes more quickly than the benefits, but this is incorrect. At no point do the costs exceed the savings. Indeed, the savings accelerate more quickly over the long run—CBO calculates² that reform will save on the order of a trillion dollars in its second ten years.”
Chait also notes that the bill contains a number of experiments in cost control which the CBO does not credit with any savings in its budget estimates, because we don’t really know yet how effective those experiments will be.
The CBO numbers assume the mandatory spending cuts will not be repealed (since they are required by law to score the bill as written). Such mandatory spending cuts in previous bills tend to be repealed periodically.
Additionally, the CBO also does not account properly for the fact that when you lower the marginal cost of additional medicine, medical consumption increases. This bill bans high deductible insurance , even though high deductible insurance is the only tried and true method for reigning in medical spending.
Do you understand the details of the reconciliation process? If you do, could you shed some light on it? It was my understanding that the point of having two versions of the legislation that later go into reconciliation is to avoid filibusters for controversial parts that might increase federal budget (such as public option). This would mean that the democrats could easily include public option into the final bill with 50% + 1 votes, which would almost certainly happen. If this is the case, why do you say the final version will look more like the senate version of the bill?
Not every pill is The Pill, not every man is The Man, and not every reconciliation between the houses of Congress is Reconciliation, so to speak. Hence your confusion.
A bill passed under the reconciliation rules cannot be filibustered, but only budget-related resolutions that meet certain very strict criteria can be passed through the reconciliation process. Some folks were making a lot of noise along the lines of “if this gets filibustered we’ll just pass something through reconciliation”, but that hasn’t happened and at this juncture I don’t think it will happen.
What’s happening now is a very different process: negotiators from the House and Senate are going to try to come up with a single bill text that can still get a majority of the house and sixty votes in the Senate. They still need sixty Senators because the bill that emerges from these negotiations is governed by the same cloture rules as a normal bill.
Is it a minor piece of legislation everyone calls a "reform", or is it an actual reform? What's actually in the bill? Who exactly will it affect and how? What changes, exactly, will it make? The article doesn't answer any of these questions.