Friday, December 18, 2009

Not Much Of A Strategy

Another day, another compromise by liberal/progressive Democrats. The Washington Post reports today that

Earlier Thursday, in an interview with a Nebraska radio station, Nelson said even if the abortion issue were resolved, he still could not support the $848 billion package, complaining that the plan to cover more than 30 million additional Americans calls for dramatically expanding Medicaid, which is partially funded by the states. The Medicaid expansion would "create an underfunded federal mandate for the state of Nebraska," Nelson said, arguing that states should be permitted to "opt out" of that idea and find other ways to offer coverage to their poorest residents.

Why concession after concession by Democrats who believed candidate Barack Obama when as a candidate he expressed skepticism about a mandate for private insurance and enthusiasm for a public option? Even Paul Krugman, while realistically unenthusiastic, is on board, arguing today in The New York Times

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago....

Right now, let’s pass the bill that’s on the table.

Krugman contends the bill

would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick.

Well, sort of; and no. Section 2701, titled "Fair Health Insurance Premiums," addresses pre-existing conditions:

‘(a) Prohibiting Discriminatory Premium Rates-
‘(1) IN GENERAL- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--
‘(A) such rate shall vary with respect to the particular plan or coverage involved only by--
‘(i) whether such plan or coverage covers an individual or family;
‘(ii) rating area, as established in accordance with paragraph (2);
‘(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 2707(c)); and
‘(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
‘(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).

You could argue that being a smoker or elderly is not technically a "pre-existing condition," but blogger mcjoan at Daily Kos would not:

So what that means is that if you can be charged more than three times as much, for exactly the same plan, as someone younger than you. So being older is a pre-existing condition. So is being a smoker. Which makes sense from a profit-making point of view--these people could cost insurance companies more. But it also means that you can be charged more for being older or a smoker.

Apparently, legislators also don't consider such conditions as obesity or diabetes a "pre-existing" condition, as revealed in this Washington Post article:

By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol....

Critics say employers could use the rewards and penalties to drive some workers out of their health plans.

President Obama and members of Congress have said they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke....

The legislation would make exceptions for people who have medical reasons for not meeting targets.

But if the claim that the bill as currently written would ban rejection based on pre-existing conditions is questionable, the claim that rescission would be prohibited is almost laughable:

Section 2712 addresses "Prohibition of Rescissions:"

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).

Commenting in another post, mcjoan notes that "fraud" and "intentional misrepresentation of material fact" are typically used by insurance companies to deny or terminate coverage, common when the insured was unaware of a health problem, or for honest mistakes or inadvertent omissions on their applications. Lisa Girion of The Los Angeles Times wrote in June:

Executives of three of the nation's largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.

The hearing on the controversial action known as rescission, which has left thousands of Americans burdened with costly medical bills despite paying insurance premiums, began a day after President Obama outlined his proposals for revamping the nation's healthcare system.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses....

The executives -- Richard A. Collins, chief executive of UnitedHealth's Golden Rule Insurance Co.; Don Hamm, chief executive of Assurant Health and Brian Sassi, president of consumer business for WellPoint Inc., parent of Blue Cross of California -- were courteous and matter-of-fact in their testimony.

But they would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle....

Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives:


Nevertheless, as Markos observes,the standard response of liberals/progressives has been to "shrug their shoulders and say, "all right, we'll take whatever we can get." Why? The obvious answer is that liberals/progressives fell in love with the idea of health care reform- and especially the phrase- quickly and completely. And that they believe failure to pass a bill would make them appear incompetent and unworthy of holding power. And that the failure of their President, their party leader, to shepherd a major piece of legislation to passage would erode his credibility and, in so doing, their own.

But what was the strategic error? It is so obvious that it's easily ignored. Markos and Atrios (to whom he links) make parallel remarks almost in passing without recognizing the basic, simplistic truth they hold.

Markos: People are so quick to rush to embrace a bill that's not set in stone, which has been consistently eroded over the past year, at an exponentially accelerated pace....

Atrios (Eschaton): A bit tired of people demanding that progressives support a bill which doesn't exist....

So fundamental no one even noticed (even the comments of those two bloggers were in service of a different point). All along, congressional liberals/progressives have been asked: "Do you support the bill?" And instead of responding "what bill?" they've actually answered the question. Dealing themselves into a position of weakness has been almost as instinctive as it has been self-defeating.

We cannot say what the result will be- if we did, we'd be making the same error congressmen have been making all along by assuming that "health care reform" is not subject to modification, tweaking, and, almost exclusively, weakening.

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