President Obama: Make Sure Families Can Afford the Insurance They Are Forced to Buy

When President Obama speaks before the Congress on Wednesday night, he will tell the nation in more specific detail what he wants to do to make the health care system work for everyone. 

He’d had better pledge to make sure good health insurance is affordable for all Americans – because he’s already made a deal to force all of us to buy insurance.  And if is not affordable, he could get a bill, but there will be hell to pay later – not from “the left,” but from working Americans.

A good way for President Obama to start is to get clear about big deals he – and Democrats – have already made with the insurance industry.  All the pundits are talking about the bi-partisan agreement that we should force the insurance companies to sell insurance to everyone who wants to buy it.  No more denying people coverage because they have already been sick (pre-existing condition) or because they are too old, or dropping people from coverage if their conditions cost the insurance company too much money.  The pundits call this an easy and important reform to pass, because it is popular and the companies have already agreed to it.  

But the insurance companies think they’ve already gotten something big in return:  the Federal government will require everyone in America to buy health insurance.  It’s called an “individual mandate” and most of the pundits and policy wonks assume President Obama has already agreed to it – even though he steadfastly refused all through the Presidential campaign to endorse requiring people to buy insurance, despite huge pressure from Hillary Clinton and many “experts.”   His argument at the time was that rather than use the power of the Federal law to force people to buy insurance, his government should make sure that health insurance was so easily available – and affordable – that people would want to buy insurance for themselves and their families.  

Apparently, Obama is now willing to give the insurance companies what they wanted all along – a mandate that will force 47 million people who don’t have insurance (and everyone who loses their job or their employer-sponsored insurance) to quickly buy an insurance policy.  In exchange, the companies will allow Obama and the Congress to pass laws that try to stop their discriminatory sales practice. The policy wonks encouraged this deal, saying the companies can’t be expected to sell insurance to people only when they get sick.  But the individual mandate means a massive windfall for the insurance companies – all those millions of people who will have to buy insurance.

What do Obama and the Democrats get?  They had better make sure the insurance industry sells decent insurance policies are affordable for those millions of people who are going to be forced to buy them.  If that doesn’t happen, they could get a populist backlash that blows up in the Democrats faces – after health reform is passed. 

OK, so Obama has done the “easy part” – agreeing to a windfall for the insurance companies.  How does he make sure people are happy with the quality and cost of the insurance they are going to be forced to buy? 

Well that’s where the public option comes in – giving the private insurance companies price competition from a non-profit insurance company that sells good insurance at affordable prices, and giving us all some transparent benchmark information about how cheaply a company can sell insurance with good, reliable health benefits.   

That’s also where the “insurance exchange” comes in – setting strong standards that assure buyers that they can count on the quality of benefits of insurance policies sold through the exchange by private insurance companies – and by one public insurance company.

That’s where the subsidies for poor and working class families come in – to assure they can afford insurance policies. 

Conservative call to “cut back” health reform can backfire – on Obama.

These essential parts of reform – affordability, decent benefits, and the public option – are the very elements that would disappear if President Obama and the Democrats agree to the conservative calls to “cut back” on the overall scope and cost of the health reform we’ve been talking about. 

Cut back on affordability?  Some conservative lawmakers (including Democrats) want Obama to “cut back” the cost of his overall bill to a ten year cost of 700,000 billion dollars.  Most experts think that if you don’t spend at least 1.2 trillion over that decade-long period, you won’t be able to keep premiums and out-of-pocket costs affordable for most of the millions of people who will be forced to buy insurance. 

Cut back on the insurance exchange?  Other conservatives want Obama to “cut back” on the package of health benefits that private companies will be allowed to sell in the exchange.  What good are insurance policies that don’t cover the treatments people need when you get sick – or require that you pay expensive co-pays?

Cut back on the public option?  And as we have seen, other conservatives want to get rid of the public option.  We can trust the insurance companies (and the free market) to keep prices affordable. Don’t worry that most insurance markets are dominated by only one or two big companies, they argue. 

So the conservatives have managed to get Obama and the Dems to buy into the deal that will force millions of us to buy health insurance.  And now they are demanding that Obama “compromise” by getting rid of all of the pieces that Democrats have devised to make sure families can afford the insurance they will be required to buy. 

On Wednesday night, President Obama should explain the deal he’s already made – and then explain the deal he proposes to make with the American people to make sure we can all afford good, high-quality health care. 

Follow Roger Hickey on Twitter: www.twitter.com/rogerhickey

Comments

[Berryives]

What a bad joke it's all becoming. This 1017 page means-tested monstrosity should end up going where the Clinton plan went, to hell.

I agree with another poster above who is bothered by having to contribute to Medicare and Medicaid, and then having someone tell them to are mandated to buy high-priced insurance.

The answer: It's Single-payer, stupid!

Oops, I forgot to deliver my MoveOn lemon to my senator, Bingaman. So what?

[Jaiquois]

Reading the info on the new health care insurance and the continuing presence of the health care insurance industry to maintain their profit margins is like pushing sand against the tide. The health care (pharmacy) will not budge on maintaining their profits, whether increasing costs to the non-dual individuals by a 50% cut in drugs for dual eligibles or keeping the windfall from the doughnut hole profits by not letting the government negotiate drug prices, as it did before the enactment of the Medicare plan moving Medicaid recipients into the plan. This is the type of greed that brought down the financial industry and the plan may create additional financial burdens on a public already reeling from the blow of the "Great Recession".

[Freestyler]

Understandably, health care reform has become a confusing mess of alternatives and choices and options and misinformation so that most people couldn't possibly understand what's going on, including, I fear, most members of Congress.

How could anyone? It was a campaign promise, but most people didn't know what they were cheering for. And now, the critical need to have affordable health care for all is being beaten up right and left as deals ("agreements") are forged -- which most of us have no understanding of.

So, tonight, I'm hoping Obama will override the confusion with reality-based inspiration that will result in all the people at HCR bash sobering up and putting together something that makes sense for all, taking into account Roger Hickey's rational concerns.

My cynical side (which has been overactive these past months) says "get real." My hopeful self (which has been severely tormented these past few months) says "bring it on."

[noneIn2008]

Including the families of the undocumented workers.

[LyssaBarnes]

This is why I think Medicare and Medicaid need to be scrapped and all services fall under the public option umbrella. I think that it is unfair that I would be forced to buy health insurance while still paying for Medicare and Medicaid with my tax dollars, seeing that my family is not eligible for coverage under either one of them.

[cybexg]

Obama originally rejected most of the fines. Now, the blue dogs and repubs are putting the fines back in while doing away with the public option??? What has happened to this country? Where is the man I voted for...why is he not standing up against this?

[DragonflyChase]

Thanks for this Roger:
"That’s also where the “insurance exchange” comes in – setting strong standards that assure buyers that they can count on the quality of benefits of insurance policies sold through the exchange by private insurance companies – and by one public insurance company."

I think it's fair to require everyone to purchase coverage as long as the coverage is affordable and fair.

Just like in California with car insurance. We don't mind having to buy it, because we got tired of uninsured motorists (who get in the most accidents, being irresponsible, and all) getting their claims paid for free by the rest of us who had insurance. Car insurance is very affordable now, because of that. They've just got to make sure that it's fair and affordable, then it should be a slam dunk.

And about putting insurance companies out of business. They know how to rework their policies to still be profitable. They may have to cut their CEO bonuses and trim that 30% overhead, but it will be a character building experience for them.

Like it has been for us.

[Coinyer101]

THEY CAN PUT THEIR FINES AND PENALTIES WHERE THE SUN DON'T SHINE!

[blindhog]

There are so many poor that trying to get more money out of them will only cause an uprising we haven't seen since the Revolutionary War!

The poor have paid the price of Reagon tax cuts, Clinton's NAFTA and union destruction, and Bush's unnecessary war, financial deregulation and blind eye to the hiring of illegal immigrants.

If the representatives don't see that we are teetering on the brink and that taxing the poor more doesn't push us over, they are igornantly living in a ivory tower with no windows.

[Otaku1031]

We need Single Payer, period. The people who complain that it forces them to pay for someone else's bad habits are missing the bigger picture. A heathier nation is more productive and secure. It's a rising tide that floats all ships.
They also seem to miss the fact that their own catastrophic illnesses will be covered without them being forced to sell their homes when their insurer drops them for having the misfortune to get sick.

Mandating the purchase of health insurance is a recipe for disaster. The price of said insurance WILL go up. When California mandated automobile insurance, my premium immediately went up 25%. When I asked why (no tickets, accidents, "good driver" rating) the agent told me that (off the record) since I had to buy their product they could charge whatever the law allowed. And if I was caught driving without insurance, I was subject to criminal penalties.
What kind of penalties will be imposed on those who cannot afford a mandated health insurance policy? Jail, bankruptcy, refusal of treatment at hospitals or clinics? Will the "public option" mean that you have to go to prison to get affordable health care?

[tbone99]

Coming soon to a prison near you - cells filled with minimum wage and unemployed workers who chose to feed their kids over buying health insurance.

[marty7]

Dannion Brinkley who wrote "Saved by the Light" and has had many visions that have come true. One he said is that the health insurance will be the manner in which we all get micro-chipped. Then eventually they will be able to send a virus through the chip and eliminate lives. We are a sick society and do you think Health Insurance is going to cover you. I am going to pay the fine, it will be cheaper then a policy. Ever see how much you have been cheated by auto insurance? Sad to see Obama play into the hands of big business that he promised to protect us from.

[tbone99]

Who knew he was in league with space aliens too!

[ThePeacemakers]

Mandates folks?
Connect the dots. If there are a bigger pool of policies with everyone required to make purchases (subsidized by the gov. for some, others will find themselves in a donut hole too rich or too young or not sick enough to make it REALLY affordable, but struggling affordable)

Connect the reform dots to this:
http://www.nytimes.com/2009/09/06/business/06insurance.html?_r=1&em/

Became clear as day what's happening after I read this.
Hasta la vista.

[no body]

An excellent explanation of WHAT we need to accomplish in Healthcare Reform can be found here http://www.brookings.edu/reports/2009/0901_btc.aspx. HOW do we do this? By using the finest physicians, best scientists and evidence-b­ased-medic­ine from around the country and the world to come up with “Best Medical Practices” electronic medical workbooks using
XML http://en.wikipedia.org/wiki//XML) ,
XML schema http://en.wikipedia.org/wiki//XML_schema) ,
XForms http://en.wikipedia.org/wiki//Xforms) and
web-services http://en.wikipedia.org/wiki//Web_service) (savings Director Orszag's 700b, no medical errors) which are IETM Class V compliant documents http://en.wikipedia.org/wiki//IETM) that when filled out are checked for accuracy and completeness in real-time and saved to a third-party (savings malpractice 100b). The workbooks are created, maintained and continuously updated (always learning) by the regional Health Information Technology Research Centers, CDC and HHS in conjunction with the Health care Industry to provide an effectivity rating for the different treatments, the ability to produce a prognosis and cost of treatment in real-time. In addition, Senator Sanders 400b in administration costs would be greatly reduced because we would only have one set of forms country-wide and they can be easily automated. Also because IBM http://dita.xml.org/sites/dita.xml.org/files//IDCMSBlue.pdf) and the DOD for their interactive electronic training manuals are already using these technologies the CBO can score the savings.

[lldem1]

If we decide to insure pre-existing conditions, are there safeguards in place to ensure people don't go off insurance and then sign up when they need it? If it's mandated, this won't be so much a problem unless the penalty is less than the premium.

Will there be a penalty against businesses who decided to drop health insurance because now their US employees can join the government plan?

Will there be penalties for insureds who don't care of their health? As many know, I am definitely in favor of the public option, but I don't really want my tax dollars providing health care for people who smoke, drink alcohol, have STDs, or are considered overweight. I don't want the government plan taking care of people who refuse to take care of themselves--so maybe these groups have huge premiums but then they are shown what their premiums could be if they lost weight, stopped smoking, or stopped drinking alcohol. I guess if you have an STD maybe you're out of luck or we just won't cover sicknesses related to your STD or new STDs. Maybe give you some condoms. : )

[humaneismyth]

thanks for exemplifying why we need single payer

[Otaku1031]

Did you think you were the ONLY one that your health insurance company is covering? Your private health insurance premiums are already subsidizing sick people. If you pay $5K per yr. (plus an employer match) for coverage and, luckily, you don't get sick, do you get your money back? No, it goes to pay the bills of those who DID get sick, had accidents etc. Some of those people will get more out of the system than they put in, of course. This is why they get dropped by the insurer; they're liabilities. All the insurance companies do is move money around; they add no value whatsoever to the delivery of health care. Indeed, because of the profit motive, they greatly impede the speedy delivery of said care.
A single-payer system will take the money (via taxes) that you USED TO GIVE the insurance company (who then gave it to various health care providers after skimming off their percentage) and use it to pay for your doctor visits, my kids' flu shots, your grandmother's hip replacement etc. If we do this right, you won't have to worry that your kid gets denied coverage for a life-threatening illness because the for-profit insurer drops your policy. No denial for pre-existing conditions, portability from one state/job to another, no lifetime caps, no breaks in coverage due to unemployment.
Now do you understand why this is a good thing?

[tbone99]

Now coming to a private prison near you - jails filled with single mothers and minimum wage workers who
bought their kids food instead of healthcare insurance.­....

[Mason]

I also worry about this possibility, but the penalty now is just a civil penalty equal to 2.5% of taxable income, which might be cheaper than the cost of purchasing a policy! Of course we have no guarantee that won't change.

[tbone99]

Do the people who suggest this have any idea how difficult it is to be poor , to have your
ability to hold your job dependent upon a working car , which is only duct tape away from a thousand dollar bill or the catastrophe involved in getting behind on the heating bill.?Do they understand that child care coverage is often equal to rent and the two together mean meals of ramen every day?
Poor people and minimum wage workers already have no room to move , they are sinking. We do not need to dig holes and push them in- we need to give them a hand so they can boost themselves out!

[TheBurdicks]

We are children, lost and leaderless in the dark forest, so preoccupied with the trees that we may never find our way out.
Pubilc option, triggers, mandates, insurance, co-ops, taxes, penalties, socialism, yakety, yakety, yak.
The reality of the forest is that we spend twice what other advanced countries spend and get the worst health care of any advanced country. Facts and health statistics don't lie. This is our deplorable situation, one which we clearly cannot afford.
The ways out of the forest are simple.
We can pick the cheapest or the highest quality system among those of other advanced countries and just copy.
Or we can be real Americans and cull through the systems of all advanced countries, selecting their best elements, and assembling a new composite system incorporating all of the best features. The best health care in the world at the lowest possible cost. Isn't this the ingenuity that once made us the greatest country in the world? Design quality in before manufacturing the product , just as we taught the Japanese after World War II.
If we stumble along with our divisive debates, or worse, enact some permutation of the nonsense being bandied about in Congress and by Mr. Obama, we are doomed to be lost in the forest for a while longer.
I believe Winston churchill once said, "You can always count on the Americans to do the right thing, after they have tried everything else."