and Should be Killed
I agree.
• The worst part is the individual mandate coupled with no price regulation and no competition to private insurance from a robust public option.
The problem is the mandate, not a mandate uncoupled with other things.
Price regulation is normally a pretty bad thing, at best it can be a bad way to deal with a bad situation when you can't find an alternative. As for competition to private insurance, that's a silly concept, we need (and the extent that we have it could be debated) competition between private insurance providers, not a socialized insurance provider.
Nothing in the bill limits how much insurance companies can charge for premiums.
Good.
The Obama administration made a deal with the drug companies and reneged on its campaign pledge to allow Medicare to use its purchasing power to negotiate lower drug prices
More good.
• The Senate pays for part of the cost of the subsidies by charging a 40% excise tax on employer-paid health insurance policies costing more than $8500 for individuals or $23,000 for families. This is called a "Cadillac tax" but it's really a "Chevy tax". It would fall on approximately 19% of policies in its first year. Many union-negotiated policies cost more than this, especially for workers in high risk jobs. In addition many older people pay more than this in premiums. This will encourage businesses, in order to avoid the tax, to provide less expensive policies which have higher deductibles and higher co-pays paid for by their employees. (So much for President Obama's promise that "if you like the health insurance you have, you can keep it".)
Yes, this bill is all about taxes, and mandates. That's the problem.
if people have to pay more for their health care, they'll use less of it, which, economists says, will save money.
That's normally the way things work. Any claimed exceptions should require extraordinary evidence to back up the extraordinary claim.
In fact what it will do is discourage people from getting tested early for things like prostate or breast cancer or diabetes, or paying for drugs that can keep them healthier longer like cholesterol-lowering drugs, which will just lead to higher costs later if they get sick and need costly medical procedures.
While there are almost certainly exceptions for particular tests, overall earlier/more medical screening, increases costs it doesn't cut them. For each true positive (which might save money if a cost effective treatment is available, but may add extra costs in many scenarios), you get many true negatives (which add the additional cost of the test), and you also have false negatives (which may cause the person to think they are ok, and thus cause more health risk), and false positives (which add cost for treatment which itself can result in further health problems).
It might produce better results, which might be worth the extra cost, but the cost should be recognized and added in to any calculation.
• Congress gave drug companies a 12-year exclusivity period on biologic drugs, before such drugs can be sold at cheaper rates by generic manufacturers. In addition, by making small modifications (e.g creating a slow-release version), drug manufacturers can extend this exclusivity indefinitely.
This might be an area for some reform, but we should proceed carefully, and not have it be a "have to pass it now" type of bill.
Pass the cost-savings reforms to Medicare. In particular, abolish the Medicare Advantage program which subsidizes private insurance companies to provide Medicare drug benefits at a 17% higher cost than the government-run Medicare plan.
I'm not a big fan of the Medicare Advantage program, so I'm not going to put too much information in to defending it, but the 17% higher cost claim is at least somewhat dubious.
Use the Medicare savings to increase Medicaid eligibility to 150% of the Federal Poverty Level, and subsidize the states for the extra cost.
There is unlikely to be significant Medicare savings to use, and if there is any you just transfer the funds to Medicare, than that isn't reforming anything, just adding more big government.
Let Medicare use its negotiating power to lower drug costs and allow people to buy cheaper drugs in Canada.
Yes, government monopsony buyers, always a good idea...
Revoke the insurance company's anti-trust exemption
Not a good idea. See theincidentaleconomist.com
Let uninsured individuals buy into the Federal Employee Health Plan available to government workers, without any restrictions on pre-existing conditions.
Even dropping the "without any restrictions on pre-existing conditions" point, it could be pretty expensive insurance for these people if they aren't going to receive a public subsidy (and if they do, its still expensive, its just someone else is paying for it, or part of it).
If you force the "pre-existing condition" clause in to the plan, then you'll need a massive public subsidy if you aren't going to bankrupt the FEHP plans.
---
A better plan would be a more free market, minimalist plan. Allow for interstate competition between insurers, work on tort reform, work on ways to contain costs within the Medicare and Medicaid systems, before trying to expand them, or have government take over more insurance outside of them. Then look at the results and see if more is needed. |
