tmccarthy0's picture

    We Need the Stinking Mandate

    We need the mandate.  The Supreme Court will rule on Monday, probably and it seems to me they've either struck the mandate down or the entire law down. Striking the mandate alone is going to have a number of negative effects on the insured and uninsured, the first of course being that 45  - 50 million people will continue to be without health care. But it is much more complex than that, and we have an example of what will happen without the insurance mandate.

    Washington State Health Services Act of 1993

    In 1993 when I first began working on the issue of health care as a professional, was the year we passed the most extensive insurance reform law in the nation. As a state we were seeking near universal coverage for the citizens of Washington State. What passed the legislature that year was this:

    Waiting periods for pre-existing conditions were effectively abolished and insurers were required to sell policies to anyone who could pay. To attempt to control costs, the law provided for premium caps to be phased in only if competition among insurers failed to moderate increases. It also included mandates that uninsured individuals buy their own policies and that employers pay at least 50 percent of the cost of insuring their workers, and that uninsured individuals buy their own policies.

    It sounds really good doesn't it? But there you see it, the dreaded mandate, one that requires employers (like Wal-Mart) to pay at least 50% of the cost of insuring their workers and that the uninsured buy their own policies.

    But as luck would have it by 1995 a new legislature was seated and the individual mandate was repealed and the employer mandate was repealed and what happened afterward should be a lesson to every American.

    Within 18 months of the adoption of the law, key features of the Health Services Act of 1993 were repealed. Most notably, the mandate that all citizens of Washington purchase insurance, and employers not only offer insurance to their employees but they pay at minimum of 50% of premiums, was repealed.  Legislators left in place new consumer protection provisions, a.) eliminating waiting periods for pre-existing conditions; b.) guaranteeing that an insurance policy would be issued to anyone who could pay. (does any of this sound familiar??, it out to republicans are planning the same thing, even extending the "keep your kids on until they are 26 provision") It is a great intention, to keep the populace happy, and so not particularly motivated to change congressfolks.

    The Cost: The number of insurers writing policies for individuals began to shrink immediately.   Higher-risk individuals bought policies that were previously unavailable to them causing premiums to rise, and some healthy people took their chances and dropped their coverage.

    Washington's new health care policy was much like the national bill today, the Health Services Commission, appointed by the governor, was instructed to produce a menu of the types of services that would be required for a basic insurance policy.

    Unintended Consequences:

    There were many;

    As I stated above, by 2000 there were more uninsured Washingtonians than when the law was enacted in 1993. In 1993, 11% of Washingtonians were uninsured by 2000 15% were uninsured.

    By 2000 only 2 insurers selling individual policies were left.

    A onetime open-enrollment period (3 months) was enacted; no waiting period for pre-existing conditions was guaranteed, encouraging consumers who most needed insurance to sign up. (Does this sound familiar to anyone, anyone at all?)

    Premiums rose drastically, the high was around 35%.

    The two individual insurers left had ceased to write new policies, leaving those who could afford to purchase the policy out of the system.

    This also affected small business because premium increases had become too expensive for a small business to afford.

    It's a lesson for the nation, pay attention folks, this is important.

    But I fully expect the Supreme Court to strike down the mandate. They have insurance. I wonder though, will those members of the Supreme Court take the blame for the catastrophe that is waiting in the wings if or when the mandate is struck down?


    Medicare for all, take off the caps on all income.

    Medicare for all ......I also won't a pony.

    You have to convince the voting public that they agree with you.

    Bill Mahrer made a comment that Bill Clinton would have sold Obamacare as a way to get freeloaders to pay for their health care. This suggests that Obama faced an easy task. Mahrer forgets that Clinton failed in his effort for major health care Reform.

    Soundbites are easy. Getting reform passed is hard.

    Should read "I also want a pony."

    Prez might need Congressional approval to open Medicare to all; I'm not sure the same is true of opening the VA to all at the actuarial cost + 10%.

    That's what Lyndon would do, if the Pugs horsed him around this way, but he had a famously large "pecker" Your guy, not so much...

     The mechanism for collecting the Medicare and Social Security taxes was already in place.

    All we needed to do was tweak the system, to make it better.

    Medical care IS  a Social Security

    Collect from all, including the Super rich,  to support the  SOCIAL  SAFETY NET ………..Take off the  CAPS

    Why do we need a maximum taxable earnings cap?

    “For 2012, the maximum taxable earnings amount for Social Security (OASDI) taxes is $110,100.”

    Tell Congress to stop weakening Social Security as they attempt to privatize it. They need to  Strengthen Social Security  make it better.

    Force the rich to help support the safety net, we don't need spectatators.

    A reasonable and rationale resolution that should be enacted in our quest to achieve a positive solution!

    A truly, working mans candidate, would push for it. 

    FDR signed the Social Security act in August 1935

    It is imperative that each generation strengthens it and doesn't allow it to be weakened, by those opposed to the very ideal.  

    To the self-serving capitalists; Social Security is Socialism and the idea of taxing them, to support the American peoples safety net, makes them cringe at the thought.

    Don't ask them to support American families, they only want American families to send their kids to fight wars, to protect THEM,  your well being is of no concern. 

    It would be interesting to know how many of the 1% actually file for and collect their ss benefits, even tho' to them I'm sure it's regarded as a pittance.

    How can we find out?

    Shame the 1%,

    That is;  if they have the conscience to feel shame. 

    I remember reading an article about this, will do some research when have chance.

    I think the article said Warren Buffett didn't collect his and there was a small listing of those who did and didn't.

    very interesting. From this article, it is apparent his family needed the healthcare public option too.  Hmmm, how quickly they forget.

    I  notice that no commenter to this blog has attempted to address the case study in this blog which outlines the possible consequences of the Supreme Court striking down the individual mandate in the legislation. 

    The Medicare for All answer is an inadequate answer to the problem, if it is this difficult to get universal coverage through legislation that keeps private insurers in the loop, there is almost no chance of expanding Medicare to all citizens which would limit the services private insurers could cover.

    This was our experience in Washington State with insurance mandates that were repealed and the consequences that came with that decision of the legislature. More people became uninsured, private insurance became all but impossible to obtain for individuals, and costs rose, in some cases astronomically.   It has implications about what the nation could be in store for, if the mandate part of ACA is struck from the legislation. The consequences I've referred to are worth discussing, because of the severe impact they could have on the economic future of the country. We are already being consumed by high costs in health care, this suggests those costs could skyrocket to an even greater degree.  It is another financial catastrophe in the making.  The discussion of the size of any person's balls is straw man FDL issue, but won't give us a greater understanding of what could happen in the future because of a decision that will most likely take place on Monday.

    Let's walk through this: Step 1: regulator (state or federal) outlaws lifetime caps, cherry picking, variable pricing. 2. carriers, citing unprofitable market, leave.3. government (Vermont ) steps in. It's 3 that's missing in your story.

    I forgot 2a carriers seek approval for 100% premium increases-STATE insurance commissioner denies.

    But friend, they don't and won't just leave.

    This is a multi-billion dollar, maybe trillion-dollar, industry that employs many hundreds of thousands, maybe millions, of people. Regular people.

    They won't go gently into that good night because some state insurance commissioner puts up insuperable barriers.

    Try that, and you won't just have CEOs, the Chamber, Harry and Louise, and Sheldon Adelson down your throat, you will also have all them "little people" these companies employ down your throat.

    Can you imagine the headline: Progressives kill off sixth largest industry in country!

    Good news is, all these out of work people have insurance coverage. Now, if they can only find a way to put food on their families...

    Have you perchance conflated health care (18% of GDP) with health insurance , whose vig, while an unconscionable 20% or so, all ends up in Conn?

    No, I don't think so.

    Well, how about we put some real numbers with dollar signs in front of them to help crystallize the consequences?

    About five years ago I started shopping around for health insurance after the work in these parts started thinning out and Mr. flower got an inkling he was soon to be out of a job. I have a pretty serious pre-existing condition and I didn't want either one of us to be without insurance.

    Here is the dollar amount I was quoted five years ago:  $1859/mo.

    That was for me only.Well, me and my pre-existing condition. That amount was what I had to pay every month...on top of an annual $5000 deduction. On top of the condition that the insurance company would not cover any costs associated with my pre-existing condition for the first two years of the policy. This was BC/BS of Michigan...the only company that would issue me a policy because they were required by law to cover everyone regardless of their health. There was no rule in place that said they must charge the same price as a policy issued to the average individual, which was around $350/mo. This was for an average fancy stuff.

    The layoff came, COBRA ended and needless to say I could not afford the BC/BS policy so I went without coverage.

    After the ACA passed, they did away with those ridiculous conditions and premiums which made it much easier to be covered. Like many states, Michigan set up an exchange especially for people with pre-existing conditions to buy policies that filled in the gap between now and when the ACA goes into full effect in 2014. Through this exchange the cost to me would be roughly $358/mo.

    The above really has nothing to do with the mandate. But it does show how spreading the burden of cost over all shoulders eases the load on those who have a persistent need. It shows that there is a need for a public option.

    Now, if this were all to disappear, the $358 premium would disappear as well, returning to the $1859 or probably worse. The insurance companies are gonna get their goddam money one way or another.

    The mandate is needed if a public option is not an option.

    The mandate is needed if a public option is not an option.

    The basis for the fear of many...NO public option was advanced.

    This mandate may be, the proverbial "camels nose under the tent". 

    An attempt to grab more power and the people clamored for it. 

    But if the public option had been available, we would have clamored for it instead; of accepting a government run amok and its laws of unintended consequences, coming back to bite us in the  

    This is a great example flower thanks for this.

    I knew when I wrote my post last night that TmacC was going to come kick my ass over it.  This is a good argument.

    But, I say, it's a good argument about state regulation (the Romney position in 2012) over what really is a national issue.  Meaning that, sure, if Washington State makes it expensive for private insurance carriers to do business while doing business in Kentucky is largely high margin, insurers will dump Washington State unless Washington's population is high enough to make it worth their while at lower margins.

    Federal regulation isn't the same thing.  It's one thing (and no small thing) for a company to decide to do business in Kentucky but not Washington.  But it's a far larger thing for a company to decide to do business not in the U.S. but in Brazil.  It also makes very little sense, once you are operating on a global scale, to try to ignore the largest consumer market in the world.  This is actually at the heart of most of my economic arguments, which is that, for the most part, businesses will pay any price for access to US consumers and that, in the end, we ask for too little.  We could, for example, easily end offshoring just by telling U.S. businesses that if they outsource labor abroad, they cannot sell domestically.  Those companies that decide not to sell in the U.S. can also be stripped of domestic status, including the protections of the bankruptcy code. Companies could then do the math and choose between the U.S. and Russia as a place to do business.

    The same is true with health care.  National legislation tells Cigna or Aetna or UHC to either conform or try their luck in some other country.  That's a very different proposition than leaving Washington.


    re:selling here the offshored product, we used to have a sanction against that called the picket line. Taft-Hartley, outlawing secondary boycotts, took care of that obstacle.

    It is a complicated issue.

    If other countries that we have trade agreements with, have socialized medicine, are these costs incorporated into the price of the traded goods? 

    Do our manufacturers/producers have a disadvantage, if we tack on the added costs of employer provided healthcare to every widget made?  

    When NAFTA was agreed to and it was suggested we would lose our sovereignty, our control. Did that spell the end of  employer provided Healthcare in America?

    Did we have to go with private insurers, because manufacturers and producers wanted to trade goods, without being burdened with social issues?  

    Manufacturers and producers want no part of protecting the cause of safety nets. They even hate OSHA

    Keep out these cheap foreign goods, it leaves American workers unprotected and unable to wrest control from the capitalists.

    OSHA can be a pain in the hind parts. But the system provides a way to pass on the cost of protecting workers to clients that cannot be avoided by most providers of a product or service and thus becomes simply a part of the cost of buying the product. 

    It would be within the logic of NAFTA to insist that all manufacturers who enter the market play by those rules in order to level prices without resort to currency speculation. In that sense, the loss of sovereignty you refer to is less about what happens in the U.S. and more about how other countries operate. The disputes with China about working conditions is often presented as a purely humanitarian concern but is also a dispute about real costs and how their ledgers should be measured against ours. (they are carrying a significant portion of our debt, etc.)

    I think arguments for tariffs (keeping cheaply made goods out of the market) should be separated from arguments about how to make the market more humane for everybody involved. I understand how tariffs would help us as a nation to provide more openings to do work here. But I object strongly to the idea that choosing that path is free.

    Like you said, it is complicated.

    The case study is evidence of what the consequences will look like if the mandate is struck from the bill.  I think that is pretty simple and straight forward, it seems congress is going to make the same mistakes that Washington State legislators made by keeping all the goodies, including barring insurers from discriminating against those folks with pre-existing conditions, which is going to be one very expensive proposition for insurers. It would be a travesty if fewer people were insured as a result of the Supreme Court severing the mandate from the bill, (if that can even be done).  But will I be shocked when it happens, no I will not.

    I've heard it said that Clinton failed because the Insurance companies fought so hard against his plan. This time Obama tried to co-opt the Insurance Companies reaction by giving them what most industries would consider a sweetheart deal; a lot more business by way of the mandate.  But getting in bed with the Insurance companies didn't work either,  they still fought against the ACA.  

    So, the only option left, it seems to me, is to get rid of the Health Insurance Companies as we know them and offer Universal Health Care using their already established infrastructure.  In other words, Nationalize the Health Care Industry. (How do you think that would sell in an election year?)



    I can hear the screams of socialismmmmmm echoing from freeperville right now! It is interesting to think about though.

    Some more socialism would be a good thing.

    (How do you think that would sell in an election year?)

    "SEE FOLKS we were right, LOOK Obama is a socialist" 

    "It came out of Kenya" 

    Shrieking "ahhhhhhhhhhnoooooooooo"; the seed is planted  

    Find the Birth certificate, before were consumed

    He's one of THEM 


    Yeah, that's kind of what I thought would happen ... but they're doing that anyway.  

    So why not have it be FOR something ... and perhaps, if we pushed back hard enough, we could destroy the power of that message once and for all.




    Imagine interviewing some grandparents who lived during the Great Depression, telling us how FDR saved the country.

    How fearful they are that their grandchildren may not be so fortunate.

    We have been brought low by the same group that brought us the Great Depression; it doesn't mean we have to remain low. 

    Get more stimulus money working for America, and Americans can do the rest. 

    America can do better if we're given the resources. Been there done that.

    Unless you want to return to the days of Bush; we've been there and done that too.


    That grandparent you mention is actually, my mother, who was born in 1918, and has spoken to me often through the years about the Depression and her admiration of FDR.



    Doing that would be fulfilling a dire prophecy by a god of those on the right side of the aisle , see

    or the wikipedia entry on same here

    Listening to Reagan, it's hard to disagree.

    Except; I didn't hear any solutions to the problems we face, other than; the need to block Socialism.

    He mentions how a doctor might be told, he cant practice in a particular jurisdiction, because there are to many now.

    The free market would dictate that too, unless the doctor or graduate wanted to give away their services for free.  

    Maybe healthcare would be cheaper? 

    Reagan's first point is that in 1927, a Socialist party candidate said Liberalism is Socialism in disguise.  Gee, and some record company guy said the Beatles would never amount to much ... (I was going to say Hitler predicted the Third Reich would last 1000 years, but why drag Hitler into this discussion?)  

    I hate that b*llsh*t domino theory of snowballing Socialism.  "If we have socialized medicine, eventually your son will have to wait to be told by the government what job he will do ... "  No such thing has ever happened, has it?  And yet, no one ever laughs in the faces of these cretins or challenges the theory as complete crap.


    NO !!! please dont bring up the unspeakable name.wink

    I placed this over on Destor's post, so, risking accusations of spamming, here it is again.  Saw this on UP with Chris Hayes this AM.  This discusses the human side of the health care mandate issue.  FWIW, I think it would be terrible if this loses and it all goes away.

    Quotes from PP's first article:

    "Why is the public option such a big deal? Isn’t it true that only about 5% of Americans would even be covered? But the issue was never about how many people would actually use it. Its mere existence would give teeth to all the parts of the bill that deal with private insurance – such as a ban on pre-existing conditions. If these companies (which have proven they can’t be trusted) have to deal with competition, it keeps them honest."

    PS: It's "mere existence," eh? Not enough a lot of people couldn't ditch their for-profit plans and move to the public option. If the for-profiteers need that kind of pressure, then folks need to be able to switch, and they couldn't. So this is nonsense. Beyond, I fail to see why we need a public option to ensure that for-profit plans have a waiver for pre-existing conditions. Guaranteed issue is guaranteed. So if you're turned down, you have a case.

    And we always knew the public option itself was not very exciting – most of us wanted single payer, just like in all other Western industrialized nations. But single-payer was never considered – it was dropped from the very start, leaving us with the public option as a compromise. If the Democrats had at least fought for single payer, I could be okay with not having a public option in the final bill. But instead, progressives were duped – and the public option took on a great importance because it was our final concession.

    PS: "If the Democrats had at least fought for single-payer, I could be okay with not having a public option in the final bill." Huh? First of all, NO ONE has any right to complain that single payer was "dropped." It was never on the table. No candidate ran on it, except maybe those who also decided it was okay to get .00001% of the vote in their own district.

    But somehow, Chron would be pacified if we had fought and lost on something that was never on the table AND ALSO didn't get the thing that he's now complaining about not having. Really? Progressives seem enamored of the fight, but utterly indifferent to the actual result. They shit on the result, but mourn the absence of a losing fight. I guess that makes for good movies, but...

    At Daily Kos, a diarist argued yesterday that – assuming all of this is true – we don’t know what Obama’s motivations were in killing the public option. He could have made what was viewed as a pragmatic decision – a “chess move” that turned out to be an abject failure. But it was precisely because they cut a deal behind closed doors that we’ll never know. It’s these kind of backroom deals that disempower progressive activists who deserve transparency.

    PS: I like transparency. It is a good goal. Important to democracy. But it seems to me that Obama made a calculation that he needed AHIP, etc., on the side of the bill instead of against it. That was a calculation and maybe it was wrong. Maybe it was right. But the lack of "progressive input," as Dij goes on about, doesn't change whether that decision was correct or wise in terms of getting a bill. Again, Obama and everyone else was looking back at the failure of Clinton health care. So they decided to go a different way.

    Progressives would have us believe that there was a dark, sinister, corporatist motive here on Obama's part. I don't see it. They also seem to think if only Obama had "fought," things would have turned out differently. Or even if they had turned out badly, at least we would have fought. I prefer moving forward however imperfectly to fighting and losing.

    And here's why: When you get something, real people get real benefits. When progressives "fight the good fight and lose," they get nice memories and maybe a book deal in their sixties, but no one but them is helped.

    More recently, I wrote a blog entitled "The Democrats' Authoritarian Health 'Reform' Bill and the Ascendency of Corporatism in the Democratic Party" in which I critiqued Obama's Clintonian New Democratic corporatist ideology of trying to use subsidized private sector entities to achieve supposedly "progressive" policy results, thus promoting a corporate takeover of the public sector.

    I explained why, in my view, this is likely to lead to failure both in bringing meaningful progressive change, and in creating a politics that can keep Democrats in power.

    This is an add on at the bottom of your second link. I found it interesting in light of our discussion, previously, about Clinton v Obama relative to progressive ideals.

    Not to re-argue the point, but Clinton's overall thrust was a move to the right and an adoption of a corporatist approach to solving social problems. New Democrat. DLC. Third Way.

    Part of Obama rejected this approach--which gave progressives "hope"--though another part was always centrist. The only thing about Clinton centrism, and you pointed this out when we were going back and forth, it does get things done.

    I am by now the last person you expect to cut Obama any slack on the machinations surrounding the health care bill . that said I think 2 words that we have not yet seen in this blog or the comments are " Max Baucus" as best I understand in order for a bill to proceed under reconciliation instructions it must originate in a budget committee . Enter Max. Of course the fact that Obama is presently running his campaign with Jim Messina who was Baucus' chief of staff ought not give us any confidence in the future

    Rog, the reason you run into someone who's "tainted" every time you turn around is this: No one "untainted" is willing to get "tainted" to un-taint the tainted.

    And every time they try, they get tainted and have to move over to the other side with their fellow tainted. Taint, or be tainted.

    This is the Groucho Marx paradox. Karl was all for getting tainted, believing that, since everyone was tainted, no one was tainted. But that was a long time ago.

    Christians put it this way: Blessed be the tainted, for they shall inherit the earth (and not pay inheritance tax)--a very tainted place, as I understand it.

    I am serendipitously reminded of a good friend who worked at the Mustang Ranch. She was complaining about the need to pluck out occasional greying pubic hairs, and my third wife, the hooker, admonished, referencing hair dye "If you paint your pubes avoid the taint" (now back to family hour.. )

    I could a memory to that one...but I won't-:)

    Or: If you're not part of the problem, you're not part of the solution.

    I thought if you're not part of the solution you're the precipitate.

    I don't know about that - since us tropes are just a singular tangent space of a quartic surface, they don't give us that kind of information.

    Jolly, actually I do mention Max Baucus. 

    This blog was not meant to elicit yet another discussion about the Great Disappointments & Predictions of Progressives and how the rest of us are plain dumb Obamabots.  It just wasn't and it isn't, I think we have had that discussion far too many times, it gets us no where. In fact it is as lame as reading anything more about the Orly Taitz obsession with our Kenyan President. 

    Tthis blog, as I keep reiterating, describes an important example of the possible consequences of the mandate being struck from the law. Leaving all of the goodies in, just like the Washington State Legislature did way back when. It was a complete disaster.  It left more people uninsured, created an insurance market with wildly rising unpredictable costs, and instead of expanding the pool of insurance providers in the state it actually chased providers away.  It is a very important issue, one that we might have to grapple with as a nation as soon as tomorrow.

    Everyone knows what Baucus did when Sen. Kennedy died, but it is irrelevant to this blog. I don't know why we have to keep fighting the same lame shit over and over again, it is what it is, right? Now we are going to have to deal with whatever the consequences will be as a result of the decision tomorrow.  What happened in Washington gives us a view into the future, I think that is worth discussing.  I also thought it was worth people knowing. Knowledge could help us avert some of the possible consequences.

    In general these fights break out over and over again because it the haggling over the nuances of history.  Bring up the Civil War and see what kind of brewhaha breaks out in the thread.  Some people are more entertained by this kind of wrangling than others.

    In particular, people I think are just in a holding pattern because the decision hasn't come down yet.  Once it does, then people can start bickering about next steps (with all the finger pointing and flame wars about who is to blame, etc). 

    I always thought that the idea would be to drive out private carriers through medical loss ratios combined with rate regulation, and thus backdoor single payer by building on the initial very limited public option as then raised. Alas, premium regulation was still left to the states and they strangled the baby public option in its crib. So much for eleventy dimensional chess.

     What happened in Washington gives us a view into the future, I think that is worth discussing.  I also thought it was worth people knowing. Knowledge could help us avert some of the possible consequences.

    "I have but one lamp by which my feet are guided, and that is the lamp of experience. I know no way of judging of the future but by the past."


    Knowledge could help us avert some of the possible consequences.

    You got that right TMC .....The Obama experience could have been averted ?

    Had candidate Obama kept his promise; the Battle for Wisconsin, may never have happened?

    Detroit may not have needed a bailout? 


    Now comes the work to get the people elected who are going to improve it rather than undermine it.

    Or at least to filibuster a repeal.

    Hey, that's not how we do things on our side, Flav.  We'll filibuster, lecture people about civility, and then allow half of the bill to be repealed, with the other half repealed last minute, as a rider.

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