| At some point later today, I plan on curling up with the Baucus bill (pdf) and picking over the good, the bad, and the ugly. In the meantime, Ezra Klein's already on it. While many of us disagree with Ezra on the priorities, goals, and purpsoe of healthcare reform, I think it's safe to say the dude knows his sh*t. Here's what he thinks (so far), with some guerilla comments sprinkled throughout:
CBO score? Swoons! "According to the CBO, the bill covers 94 percent of legal residents and actually reduces the deficit. More to the point, it keeps reducing the deficit as time goes on." (A robust public option would only make the score better.)
Health insurance exchange? Surprisingly progressive. "In other words, by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes." (All the more reason to include the public option into the bill!)
Coverage? Comprehensive, but... "This is much better than what many people get now. But given the insufficiency of the total funding, the question is how much cost-sharing is allowed in these plans."
State regulation? Possibly transformative. States could form "compacts" with other states with a similar regulatory environment to allow insurers to sell policies across state lines. National plans meeting certain regulatory standards could be created. "Presumably, that plan would also have more bargaining power and substantial efficiencies of scale, as it will be national, rather than confined to a single state. This could prove seriously transformative in the private insurance market." (I am not optimistic as to believe states' attempts to regulate insurers won't be undercut by federal officials; nor is bargaining power a sure way to lower costs when there's still the inefficiencies and profits of private insurers propping prices up.)
Individual mandate? The fine is logical. "This is, on some level, paying for services that will be rendered. It's not a penalty as much as it is a charge, as the uninsured actually do use care, and the rest of us actually do pay for it." (Doesn't justify the morality or cost of forcing individuals to purchase private plans, though.)
Insurance cost variation? High. The variation cushions the impact to profits of the implementation of the community standard - forbidding insurers to discriminate against customers based on pre-existing conditions. It's a ratio of how expensive a policy for a certain risk category can be compared to the lowest offered price. Insurers can charge more for age, tobacco use, family situation, or geography. "At the end of the day, the maximum variation, which is to say the plan for the most expensive risk as compared to the least expensive risk, is 7.5:1, which is quite high."
Affordability? Bleh. Subsidies for folks making up to 300 percent of poverty level are "pretty good." And if you get sick? "...pretty much that people making more than 200 percent of the poverty line will be less ruined than they'd be under current law, but still facing tens of thousands of dollars in out-of-pocket expenses a year."
Co-ops? Neutered. "As I understand it, they have to bargain with each provider and drug manufacturer and hospital and so forth separately, meaning they're denied one of the main advantages of size. The insurance industry is, in other words, being protected from not just public competition, but co-op competition."
Free-rider provision? Hates it. "This isn't just the worst policy in the bill. It's one of the worst policy ideas I've ever seen. It creates a huge incentive to build a workforce that entirely excludes low-income workers." Was it intended to compel big corporations - like Wal-Mart - to offer its employees health insurance? |
