Contents:
Ok I'll start with a couple summaries. Here's a
very quick overview from CBS:
http://www.cbsnews.com/8301-503544_162- ... 03544.html
And a more detailed one from Christian Science Monitor:
http://www.csmonitor.com/USA/Politics/2 ... ans-to-you
CSM's piece is more tailored to what it means specifically for some individuals, so it's a little more detailed.
The only places saying really contradictory things are ones from places with very obvious conservative agendas (Heritage Foundation, American Enterprise Institute, CATO Foundation, Paul Ryan, etc.).
Old_School wrote:My main concern is that the bill had over two-thousand pages and some senators blatantly admit to not having read it all. You're not supposed to sign a contract without reading the fine print, so why would they vote for a bill they haven't even fully read? Also, I don't much care for how people will have to buy insurance or be penalized. Having insurance is a good idea, of course, but since when is it Uncle Sam's job to force people into it? Also, what right does the government have to fine businesses that choose a private insurance company over theirs?
The constant repetition that the bill is 2000 pages is really disingenuous. Most comprehensive bills have that kind of length. It's because, like computer code, bills have to be written in very specific (legal) language. It's not the kind of thing you can normally read through. (The USA Patriot Act, for example, was 300-pages long. Very few people actually read it; most of it is comprised of legalese anyhow.)
Typically, you have people who are well-versed in legal documents read it (or sections in it), summarize the main contents, and go with that. A lot of other private organizations also scan the bill and summarize it or predict the outcomes, for better or worse depending on the organization's purpose.
One thing that was funny about all of this was how abortion became such a big factor. First, anything in the bill that'd allow federal funds to be used for elective abortion wasn't included. That apparently wasn't enough, so specific language was added in to state exactly that federal funds wouldn't be used for elective abortion. That also apparently wasn't enough, so Obama signed an executive order on Wednesday stating the same thing. Now, you
still have some people claiming that the bill would allow federal funds to be used for abortion... So, yeah, if you see that, then it's a clear indication that the source is suspect.
The individual mandate seems to be the most contentious part. I'll get to that in a second.
ShindoW wrote:I don't keep up with politics (I know, shame on me, but I just plain don't understand them) but my teacher made a good point: Why enforce someone to buy insurance? He compared it to car insurance, somehow. I wish I could remember exactly what he said... Like, why should we penalize someone for something that only effects them? I'm not sure if that was it. When I remember, I'll definetly write it down here. XD
Comparing it to car insurance would actually support an individual mandate... Insurance
does affect more people than just yourself; it has to do with the nature of insurance and how it operates. To put it simply, insurance is meant to spread risk. So if something happens, you're not responsible for the full cost of it. This works when it's a rare event (fire, auto accidents, expensive illness, etc.) and there's a large number of people for whom it doesn't happen (i.e., not everyone's house is burning down, not everyone gets into an auto accident, not everyone needs to use $10,000 of medical services a year, etc.).
So, the individual cost of insurance (such as your premiums, copayments, deductibles, coinsurance, etc.) is a function both of your own habits,
and that of other people in the same risk pool. If you have as many people in the risk pool as possible, and you can expect that they'll be in that risk pool for a long time, then it's possible to bring the overall cost of insurance down for everyone.
The reason why many states have a requirement for auto insurance is because getting into an accident without insurance, if you're unable to pay for the damages, shifts the costs to everyone else. Health insurance has that component, plus the effect of decreasing the cost for everyone when more people are in the system in the first place.
Individual mandates
This seems to be the biggest sticking point. It's a $95 tax that wouldn't take place until 2014. Ideally, the people who are unable to afford that, or insurance itself, would be able to take advantage of a lot of subsidies that are
also included in the bill.
Imperial Knight wrote:The idea behind the individual mandate, as I understand it, is that it's there to make the ban on discrimination for preexisting conditions work. The idea being that without it too many healthy people would opt out of getting insurance, driving premiums up for everybody else. It's also my understanding that there is a "hardship exemption," where people who cannot obtain affordable insurance are exempt from the fine for not having insurance.
The ban on pre-existing condition discrimination (which is my favorite part of the bill, but more on that later) is a slightly separate issue. The idea behind the individual mandate is that it's a way to get younger, healthier people who feel they don't need insurance (cf.
exigence in one older thread) in the system. Since (a) when they do end up needing health coverage and can't pay the bills, everyone
else suffers from higher costs, and (b) having them in the system to begin with decreases costs for everyone involved.
The most important concept here is adverse selection. What that means is basically if you offer insurance based on a particular risk (e.g., the expected amount that people on average will use in medical expenses), then the insurance plan is more likely to attract people who are more likely to exceed that risk, and is more likely to deter people who are more likely to be below that risk. That ends up driving costs up for insurance overall, and makes it even more unaffordable, often for the people who need it the most.
You're right however that there's a hardship exemption. There's also a religious exemption, and an exemption for Native Americans (many of whom are covered under IHS, but I'm not an expert in that). More importantly, there are some subsidies for poorer individuals, and the insurance exchanges which should be around in a few years (by 2014, again) should also help with that.
phyco126 wrote:Forcing people to buy health insurance is basically the same as arresting a homeless person for being homeless. It makes no sense when people just can't afford it.
See what I was saying above in response to Imperial Knight on a hardship exemption, and subsidies for poorer individuals.
Regulations
So yeah, my favorite aspect of the bill is in the regulations. There are a lot of things that insurance companies are able to pull that really screw up the market--most of those are related to asymmetric/imperfect information (you might've heard me use this term in other posts on the same subject). Basically, an insurance provider knows full-well the value of what they're providing to you: they have control over how much they'll reimburse expenses, whether they'll cover something in the first place, and if you'll be dropped for any reason, or if you'll be accepted in the first place. Meanwhile, the consumer knows very little information--he just has to take it on good faith that his insurance will cover him when he needs it.
This is what leads to some of the worst practices in insurance, like excluding people with "pre-existing conditions" (and I put that in quotation marks since, well, I have "pre-existing conditions" if you ask some insurance companies... my doctor knows that I don't, but hey, insurance actuaries know more about medicine than doctors, am I right?) or dropping people once they get sick (and are more likely to start using the services that they thought they were paying insurance to cover).
The regulation in the bill is a great start to leveling the playing field. The only thing that'll take effect in the near future is the prohibition on excluding children from coverage for pre-existing condition. The same regulation will be applied for adults in a few years--however, I think insurance companies are going to respond early rather than wait until the last minute (as it's in their best interest to have someone insured for as long as possible).
Solana wrote:Personally, I'm very grateful for the 'no denying for pre-existing conditions' and hope that the result of a government plan will be to inject a little competition among the private companies and cut down on the crazy high costs. Not sure if that will be the case, (I'm no economist) but here's hoping. I think it'll be a lot cheaper to focus on prevention and trying to keep Americans as healthy as possible to start with.
Cost-control is a bit thing, and there are some things in this bill that'll help there. Some of the barriers to interstate competition should be removed, and getting more people into the system overall will keep costs down. The ultimate thing, though, would be a public option to add pressure to keep the cost of medical services themselves down.
Insurance exchanges and a few related ideas are actually a few of the things incorporated in the bill as a result of Republican plans (Rep. Paul Ryan's "Roadmap" is the only actual Republican proposal I've seen--I think the bill incorporates some of the Roadmap's better ideas, but the Roadmap itself doesn't do anything near enough to help cost-control). KF