Betsy McCaughey Is Wrong About Health Reform -- Again!

Saturday in the Wall Street Journal, Betsy McCaughey, well known for her distortion of health reform in 1993 as well as recently, made the following points about the health reform bill, HR 3962, which is being debated and voted on as I write this. As usual, she sprinkles some truth in among her assertions, which give them the patina of authenticity.

As I have done before, I am analyzing her points, one by one, so that you can better understand some of what is REALLY in this bill.

My rebuttal comments are in block format below.

OPINION - Wall Street Journal
NOVEMBER 7, 2009, 9:58 A.M. ET

By BETSY MCCAUGHEY
The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

What the government will require you to do:
• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• This provision is meant to protect individuals from price gouging and pre-existing condition requirements of the individual insurance market. The law does require all health plans, including employer provided plans, to abide by certain consumer protections, but most ERISA plans already meet those requirements. The plans are NOT designed by the Secretary of Health and Human Services. They are to be designed by an independently established public-private commission that includes patients, doctors, employers, and all stakeholders in health care.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

• Partly true. There is nothing in Section 224 (which begins on page 116 by the way) that addresses what you would be legally required to pay for a qualified plan. It is true that the Secretary will make a decision on what a qualified plan should cover, after recommendations from the advisory commission noted above.

•On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Partly true. As usual, Ms. McCaughey does not tell the whole story. The numbers quoted above are projected costs for the year 2016, which is 9 years away! The CBO piece referenced above actually says the following: • "Under the House bill, the maximum share of income that enrollees would have to pay for the reference plan in 2013 would range from 1.5 percent for those with income less than or equal to 133 percent of the federal poverty level (FPL) to 12 percent for those with income equal to 400 percent of the FPL."

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice--basic, enhanced and premium levels--but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Again, only partly true. The qualified plans are "floors" for benefits, not ceilings. The one size fits all is not an accurate description. There are several types of plans that can be selected, but all plans will have to include the basic stuff - including hospitalization, physician services, laboratory and diagnostic services, etc. - all benefits that are currently included in most benefit plans. But this provision protects consumers from those hidden exceptions that you don't find about until you get sick - that is what a "floor" is all about. Medicare operates the same way today. There is one basic set of benefits for Medicare, and most seniors don't complain that they don't have adequate coverage or choice of plans.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Partly true. But illegal immigrants can't be fined because they can't BUY this insurance under the House plan! And yes there is a penalty for not purchasing health insurance. It's called an "individual mandate" and America's Health Insurance Plans are pushing for this mandate, as are almost all other responsible analysts, since unless everyone is "in", those who select themselves out will end up in the ER anyway, and we will all pay for them as we do today. The tax penalty is not 2.5% of income, however, as many media outlets have reported. It's a more complicated formula and it will undoubtedly be revised in final legislation.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

• Again, this is only part of the provision. Technically, the information above is correct, but employers with a payroll less than $500,000 are exempt from the employer mandate. There is no penalty for payrolls of less than $500,000. Also, the Senate Finance bill does not have an employer mandate included, so it is questionable as to whether this provision will survive the coming debate. Still it may be instructive to note that the majority of medium to large size employers already pay at least 70% of the costs of insurance for their workers

Eviscerating Medicare:
In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Not true. The bill, sadly, does NOT fundamentally change how Medicare pays doctors and hospitals. Many providers wish it would! This is the type of "throw away "line that is calculated to get people riled up, but in no way educate them. There are "pilots" and "demonstrations" allowed for Medicare that would test payment approaches, but the only way those approaches would be more broadly applied is if they actually turn out to work to lower costs without affecting quality.

• AND, the government does not dictate treatment decisions. This is a flat out lie.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

• Hallelujah. Finally we might get a medical home. Most of us go from one doctor to another, many times on our own, with almost no one to help us coordinate our care. However, the medical home concept is just a "pilot" not a widespread mandate. If it works to help coordinate care and increase quality, great. If it does not, it will not be expanded.

•The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

• Not true. Medical homes are not HMOs. The payment mechanism is not yet worked out, so it will not necessarily involve a flat fee. No one will be forced to settle for a nurse practitioner, but I must say that if you have ever worked with one, you would love it! This is pure scare tactics.

• A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• We all know medical care is too expensive. All Republicans do is talk about cost control. But somehow all of a sudden cost control should not be a priority? Where do people think cost control is going to come from? It will come from better ways to pay doctors that are not based on doing more in order to earn more.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Mostly true but misleading. This section "allows" physician assistants to replace physicians for certain types of hospice care. The way this is phrased above suggests that there will be no physicians caring for hospice patients. That is absolutely untrue. The hospice law requires physician oversight and this does not change that. Since hospice patients have agreed to forego intensive medical care and most of their care is focused on making them comfortable, physician assistants are more than qualified to provide that care, and this provision allows hospice programs to expand their offerings by bringing in additional care providers like physician assistants and nurse practitioners.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Not true. This is way more complicated than the sound bite above. What is true is that the Institute of Medicine will study the geographic variations in cost around the country. There is a lot of evidence that paying more for care does not guarantee better care at all, and we need to know more about what those geographic differences mean. See article by Dr. Atul Gawande for more information on this.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Only partly true. Medicare Advantage plans have been receiving, on average, 14% more than traditional Medicare for treating Medicare beneficiaries for several years now. That is your tax money going to what is essentially an "overpayment." The government, which is responsible for these plans, has proposed that these plans "bid" for the right to get your business. The bidding process should help bring costs down and that's where the savings would come from. If MA plans have been overpaid by 14%, they should be able to do just as well with less. Of course the plans are upset about this. I am personally in a MA plan. I like it a lot. In fact, rather than providing me less benefits next year, my MA plan has INCREASED my benefits and lowered my deductible! Let the free market work and let these plans compete with each other for our business. There's no need to scare seniors about it.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

• There is nothing on page 756 that says "guide". This is what it actually says on page 756: "The Center shall develop protocols and strategies for the appropriate dissemination of research findings in order to ensure effective communication of findings and the use and incorporation of such findings into relevant activities for the purpose of informing higher quality and more effective and efficient decisions regarding medical items and services." (page 756) And it also says: "Nothing in this section shall be construed-- ''(A) to permit the Center or Commission to mandate coverage, reimbursement, or other policies for any public or private payer" (page 758)

Questionable Priorities:
While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Hyperbole. The bill does not "slash" Medicare funding, and there is no particular connection between the Medicare savings and these other programs.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• May I ask what is wrong with that? God forbid we should educate people about obesity and health at the local level. Is this some kind of not so subtle suggestion that ACORN might be providing these services?

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• This observation comes very close to nativist, anti-immigrant prejudice. From a pure economic standpoint, it would be helpful when we are treating people who don't speak English well, to be able to give them the appropriate care. If we don't it will cost more later on. There are citizens who do not speak English well, yet who will pay their premiums and obey all laws, but somehow it is "questionable" to help them answer their questions? Where is THAT coming from?

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Questionable priority? We should have only white men (and maybe a few women) providing care in our health centers and hospitals?

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

• Partly true. But only until the newborn in question is "deemed" to be eligible by the State or the Medicaid program. It's just a humane thing, Betsy. There's the newborn in the hospital, possibly needing additional care, and you would have them wait for days or weeks until their eligibility can be determined?

In summary, this is just one of many attacks there will be on the health care bills that will be voted on in the next few weeks. Ms. McCaughey has chosen elements that she considers controversial or troubling, and of course that is her right. But it is also our right as citizens who care about health reform to rebut these claims when they are not entirely true and try to help separate fact from interpretation.

And one more thing -- there is so much more in this bill that will help Americans get and keep affordable health insurance. There are subsidies for folks who cannot pay the full amount; there are prohibitions on those pesky lifetime maximums that run out just when you are the sickest; and there is preventive care to help you avoid being sick. Perhaps the reason those issues are not mentioned in the Wall Street Journal article is that it's just too hard to argue with good ideas.

 

Comments

[pb31]

Thank you very much for an excellent article. I only wish that it could get the same distribution as Ms. McCaughey's article got in the WSJ. The WSJ owes its readers a critique of Ms. McCaughey's reading of the bill (which has been shown before to be biased or wrong) by a person well versed in this subject. Almost none of the pundits I have seen or read are qualified to do this. You appear to be well qualified.

[Matt7]

Thank you for your work in laying this out. I only wish that this the kind of specific issues discussion -- truth and fiction, point/counterpoint, Q&A -- had been engaged in via print and electronic news media and outlets such as this, rather than the daily angst generating, manipulative, sensationalized headlines and right-wing parroting points that we've been subjected to for months.

Gratefully this first bill has passed the House. Now the additional work needs to be done in the Senate, with the President, and the American people. Hopefully, the public will get a clearer understanding of the specifics, so that they can remain engaged with their legislators to ensure the ultimate successful passage of an effective bill, that we ALL can be proud of.

[PerryWhite]

"The numbers quoted above are projected costs for the year 2016, which is 9 years away!"

Really? I think I'll stick with Betsy.

[blizb]

Betsy doesn't know what she is talking about. Those are only her OPINIONS!

She writes for an OPINION column.

What on earth does that have to do with FACTS??

People listen to so much Fox Opinionated nonsense they begin thinking that OPINIONS are truth.

OPINION is not FACT.

This article presents the bill and provides FACTS to inform you and show you that Betsy is wrong.

Just because you want to believe in her OPINION doesn't make your belief a FACT.

[huff-fan]

The public option will be open to those who don't have insurance through their employer, an ever increasing number, and to small business owners. I think someone is underestimating how many people that is. I used to sell insurance. Every small business I went to told me that they couldn't afford insurance for themselves and their families let alone their employees. Some companies may decide to drop coverage and pay the fines rather than provide coverage. Their employees will be eligible for the public option.

Employment-based health insurance is in big trouble and don't blame Obama. http://www.newsweek.com/id/215162

Also, young people and the self employed will be able to purchase the public option.

Insurance companies are fighting so hard against this bill because they will be unable to drop individuals, or deny care for preexisting conditions. They will have to carry adult children until the age of 27. There will be caps-on-out of pocket costs. And, they will lose their anti-trust exemption.

Kucinich made the point that 31 cents out of every health care dollar goes to administrative costs. Hospitals are spending money trying to get insurance companies to pay and insurance companies are spending millions finding ways to deny coverage. Under the house bill, they will not be allowed to deny coverage. Even if mandates send more customers to the insurance companies, they will be required to pay more claims, and they will be facing more competition.

[Matt7]

Good post. Thanks for the link.

[ewoman]

Great explanation. Thanks.

[vippy]

and this bill has not passed the senate yet. I bet they will take out that part!!!!

[huff-fan]

Affordability credits are available to American citizens and legal residents whose employers do not offer coverage or whose share of employer-sponsored health insurance costs more than 12 percent of their family income. HR3962 caps out-of-pocket for individuals at 5,000, families at 10,000

[EndTheEcho]

So can where was Betsy's when Congress was trying to rein in credit card practices that sound like this bullet point of hers?

Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

Sadly, I think most American credit card holders are quite used to this sort of corporate behavior. On her blog, the only post that came up for credit card is to issue debit cards to families to use like the cards for food stamps.

[Mustang00]

While I was hoping this would be a positive development, I'm very disappointed in what is presented here.

The average cost for a policy while no doubt DOUBLE. It has to.

The political special interests will all lobby for their med service to be included in the 'mandatory policy'. The liberals in congress will not be able to say no, so voila!....most policies will cost a fortune. That's as predictable as heat in the desert.

Younger people, especially, will be furious when they see how the Great One's health care reform will only reform one thing: THEIR WALLET, as it will make it much lighter.

[Gidster]

Based on what? Speculative fiction? Or the fact that the Credit Card industry raised rates punitavely the week after new regulations were imposed?

My fear is that the public option will be too restrictive, and consequentially have too small a pool to make it viable.

But with spineless Democrats and lying Republicans both getting millions from the insurance lobby and teh Medical Industrial Complex, they have been well paid to make it as weak as possible.

[vippy]

Leave it up to our leaders in Washington to really screw this one up. It is always about money.
Why our soldiers fight for them I have no clue.

[caveman1313]

500k in payroll is the point where employers must start paying.

that is not much.

does this mean that jobs at mcdonalds will now have health insurance included?

[balthus]

Let's hope so. Because people working at McDonald's surely can't afford individual plans, which means when they get sick and arrive at the emergency room, all of us have to pay for their treatment.

[MikeTN]

I totally agree with anyone who says that the USA needs serious health care/insurance reform. But, this bill is a damn mess! almost 2,000 pages that few, including most congresscritters I expect, can understand. Haven't they ever heard of the KISS technique? Keep It Simple Stupid!

I also don't like the fact that people would be fined for not having insurance. What are they going to do, put people in jail for not having health insurance ? give me a break.

All of this without the most important provision....not being able to control prices

[Gidster]

They suspend driving licenses for not having auto insurance......

2000 pages is not that much for sweeping reforms and regulations, and Congress people better da*n understand it, or take the effort to do so, that is what their job is, that is what they get paid for.....

[bkca]

Stupid comparison. I don't NEED to drive. And since when does the government place a requirement on a free born citizen to continue living here?

Citizenship means nothing anymore. The illegals have become more important and are catered to at every turn. I wish the government would put 1/100 of the effort that they put into this totalitarian bill and DEPORT the illegal alien criminals who are destroying southern california.

[NoLipService]

I suggest that the millionaire politicians who do not opt into this plan must be have a taxed assessed on them at 90% of their net worth. This money should go directly into funding this mandate. As long as they have their insurance paid for by us they will not feel the pain of paying for it like average Americans will have.

They are screwing us and using our money to fund their own plans which are the rolls royce plans that noone else can touch.

When they opt into the same plans they are wanting to force us into then I might feel differently about them.

[vippy]

I totally agree with what you are saying but what blows my mind is no matter how bad this bill will be our voters will vote for the same crooks again and again. So far no one held them accountable for their bad decisions, for sending our jobs overseas, for blowing up our deficit, etc. so what
do they have to lose? Are we stupid yet I have to ask?

[splathrop]

Oh, and here's another problem not mentioned in my previous comment. Once a middle class family of four with, say, $60,000 in wages is making $6500-$7000 annual payments out of pocket, what happens to Medicare?

How could you then defend a retired couple with the same income, from pensions, getting all their health care without making similarly large mandated payments?

[Linda Bergthold - Huffpost Blogger]

This is from the CBO letter and report -- it makes it clear that your family of four would not be overburdened --

"For instance, a single person with income of $26,500 in 2016 (225 percent of the FPL) would pay a premium of about $1,900 (after getting a premium subsidy of 64 percent) and could expect to pay another $900 in cost sharing (net of federal subsidies); thus, the average payment by such a person for the premium and cost sharing combined is projected to be $2,800, or about 11 percent of income. A family of four with income of about $54,000 (also 225 percent of the FPL in 2016) could expect to pay about the same share of its income for premiums and cost sharing. (Because use of health care in a given year varies widely, many people would pay less in cost sharing than the average, but some would pay more—subject to the limits on out-of-pocket costs that are specified in the bill.)"

As for the retired couple -- the Exchange and these plans do NOT apply to them at all. Medicare recipients pay about $100 a month for Part B (Part A is free), and if they have a supplemental or gap plan they may pay another $150 to $250 a month for premiums. So they will not be affected by these so-called "mandated payments" you mention.

Believe me, the Congress is very well aware of what they are asking the American people to do. They are trying to find a way to subsidize this mandate in a variety of ways so that no one is stretched too far in terms of purchasing coverage.

[TongoRad]

"Subsidize the mandate." This really sounds to me like subsidizing the Health Insurance company's profits. Unless this legislation has strict controls ala the Swiss plan, costs will continue to rise.
This legislation is a huge victory for private interests, not the people.

[splathrop]

Here's what seems wrongest about this to me. Right now most of the money that pays for healthcare comes from employers and is managed by them. Economists think of that money as part of wages, but employers are free to eliminate those benefits without raising wages, and many have. The proposed reforms risk putting that giant pool of money in play.

My guess is that if reform passes in its present form we will fairly soon see a system where healthcare is indeed mostly supplied via the public option, as major employers terminate coverage and pocket the substantial difference between their smaller penalties and their larger premiums. When inflation raises premiums further the pressure to cut employee health insurance will increase, as will the financial pressure on workers and the public option budget.

What will have been accomplished is that the gigantic expense of paying for healthcare will have been shifted from the business community to middle class individuals, who will then also be required to pay from their wages for the subsidies to the poor.

This can't work. We need a single payer system financed by progressive taxes. The money has to come from the people who have it.

[wildedge]

You've hit the nail on the head.

[Gidster]

This is a step toward that goal.

[FearlessFreep]

Too bad they removed the provision that would have allowed individual states to choose single-payer. (Nancy Pelosi made an excuse about not violating an Obama promise, though it's clear that Obama keeps his promises when HE wants to.)

[caveman1313]

progressive taxes? isn't that an oxymoron?

[bkca]

Sorry, I have no interest in paying for your health insurance. Get your own damn health insurance. It isn't my job to subsidize people that I'm not related to.

The fact that liberals are demanding others pay for their health care, child care, mortgages, etc. without even a hint of shame is just embarassing.

[balthus]

Hey pal - build, staff, fund and put your kids in your own elementary school, because it's not my job to subsidize people I'm no related to. And while you're at it, drive on your own roads, and ride your own buses. Then establish your own police and fire departments, and deliver your own mail across the country, because I'm sick of paying your way! And while you're at it, kindly man your own armed forces, hire your own experts to ensure your water and air are clean, and carry your own garbage to your very own dump, because demanding others to pay for services YOU use and depend on, without even a hint of shame, is just embarrassing.

[ghostpigeon]

Linda,

I'm happy a health care bill will probably pass tonight in the House, but some of it does disturb me. Didn't we elect Obama because, unlike Hillary Clinton he claimed he would NOT force people to buy private insurance plans? That's just a start and I guess it was inevitable some form of this would be adopted, but God sake's, the real kicker is that this plan does not kick in for nine years with a public option, as I read it. We could have a public plan next year if it was truly a priority to bring insurer's under control in their costs. Don't tell me that the government can't put together the structure needed to do this in more than a year. We do it when we go to war. It's done if it's considered necessary and what we have here, whether it's three, four or eight years, is a buffer which allows insurance companies to skyrocket their charges and kick up their profits for a significant amount of time BEFORE the reform can be implemented. It also allows them the same time to fill a future structure with their people to oversee the process - very typical of any reform of private industry. That's generally where we lose any significance in the reform process. Something's better than nothing, but this bill and the senate bill both guarantee we will still be at work on reform for the next 10 years. Should have gone for single payer

[Linda Bergthold - Huffpost Blogger]

Actually, the House bill was amended so that quite a few provisions would go into effect next year -- particularly those around insurance reform and extending COBRA.

[Linda Bergthold - Huffpost Blogger]

I agree we will be working on this for 10 years. Maybe more. But it's a start. And if you heard Pete Stark and other single payer supporters on the House floor, you would know that they think this is a good start, but of course not the end of what needs to be done.

[dzagama]

If I'm unemployed, can I get coverage by getting a menial type job... say, McDonalds?

[NoLipService]

You are joking right? Unemployment does not have anything to do with whether or not you have to get insurance. You will buy insurance or you will go to jail. So McDonalds will not be enough income to cover your premiums. If that is your skill level you will need to get a couple more jobs to pay the 15000 a year that the minimum policy is supposed to cost unless somehow you are subsidized.

[dzagama]

Well, I wasn't really joking, but from my understanding of the bill, *all* employers must provide health insurance to their employees.

Doesn't that include McDonalds?

If I'm wrong, which I suspect I am, I'll spend more time going through the bill.

[Citizen54]

The analysis is helpful but discouraging. The bottom line is that we will be required to buy insurance from an insurance corporation. I don't care if the policy is approved by some panel. Do we really think the prices are going to be different from what you get today with COBRA? The figures quoted look pretty expensive to me. People who are out of work opt out of insurance because they can't afford it. They don't choose to not buy insurance out of some libertarian defiance or because they're cheap or think they'll never need insurance. It's because THEY CAN'T AFFORD IT. How does making them buy something they can't afford solve the problem? Please, someone explain this to me. Five grand a year -- or whatever the penalty turns out to be -- is a lot of money for some people. Apparently our representatives and the author of this piece don't recognize that.

If everyone needs to be in the insurance pool, then make it truly affordable for every American, including those who are out of work.

I'm a lifelong Democrat but this mandate reeks of fascism. The corporate state, as Mussolini called it.

[Linda Bergthold - Huffpost Blogger]

I am sure other commenters will also help you with this question, but there ARE subsidies to help people buy insurance, and there are maximum amounts that people would have to pay as a percentage of their income. Those who earn less than 400% of the Federal Poverty Level will have substantial subsidies. However, it is not free. Nothing is free. You just can't let some people not pay while others do. The main issue the House has been wrestling with is how much subsidy can we afford?

[TongoRad]

Subsidies that go to the Health Insurance Industry, what a joke. It really does seem like we're going out of our way to justify and perpetuate the existence of profitcare. What value are they adding to our Health care system?

The central leitmotif of our current politics, seemingly on ever issue, is that the status quo is "too big to change."

Make no mistake, this legislature is massive bailout to an industry that is bleeding us dry and literally killing us. And yet some will claim victory.

[splathrop]

You've put your finger on it.

The House is wrestling with how much subsidy can we afford. But the real nut of the problem is different--how much mandated extra expense can ordinary Americans afford? Congress and business lobbyists have vastly over-estimated how much, and there's trouble ahead.

If you have to raise money, you have to get it from people who have it. Formerly middle-class America doesn't have money any more. You can't get it from them.

Single payer funded by more progressive income and payroll taxes, and maybe a Tobin tax, is the only real solution.

[wildedge]

Mandated insurance purchase without a STRONG public option is unjust, regardless of subsidies.

[weatherwaxx]

The problem is that it keeps insurance FOR-PROFIT, which means it will still be looking for ways to deny payment for doctor-prescribed treatment. I salute Dennis Kucinich.

[babeltek]

I have the same worries. But we also must remember that there is no such thing as "truly affordable for every American". NOTHING is "affordable" to those in debt, and to many of our poor and homeless.