What the healthcare plan does NOT do

[alaric]

The healthcare plan just passed by Congress does a number of important things that are needed to fix America's broken health-care system.  For example, it outlaws the practice of rescission — revoking the insurance coverage of patients whose care has become more expensive than the insurance company planned on.  For another, it is claimed that it will make health insurance available to 32 million Americans who don't have it; but it will do so at the cost of making it illegal to opt out, and fining those who choose not to buy medical insurance.

"Come the revolution, Comrade, we will all eat peaches and cream!"

"But I don't like peaches and cream..."

"Come the revolution, Comrade, we will all eat peaches and cream ... and we will ALL LIKE it."

We really don't know all of the things Congress's health care plan does and doesn't do, because Congress hasn't deigned to tell us yet.  But the following are a few of the most important things that we know it does not do:

• It does not detach health insurance from employment.  If you change your job, you'll still have to jump through all the hoops of changing insurance again, and you'll still have to settle for whatever plans your employer is able to qualify to offer, even if they don't actually meet your needs or if they're more comprehensive (and more expensive) than you want.  (Unless, of course, you can afford private insurance.)

• It does not establish a level playing field.  Big employers will still be able to negotiate better deals than smaller ones — in fact, it doesn't do anything to make any guarantee that small employers will be able to get group health plans at all; it just fines companies with fifty or more employees that don't or can't — and insurance companies will still get away with paying as little as pennies on the dollar for services that you will still have to pay full price for if your plan does not cover them.

• It does not stop insurance company accountants from making medical decisions.  Your insurance can still refuse to cover treatment that you need because they don't want to spend the money, under the ruse of declaring it medically unnecessary — effectively, practising medicine without a license.  (As noted above, at least it will prohibit them from cancelling your coverage altogether.  But that may be little help if they can still deny you needed care.)

• It does not get insurance out of minor services that nobody would even need insurance for, were their costs not driven up by the overhead of having the insurance company involved.  (Routine office visits, for example.  Many rural doctors have, in recent years, begun refusing to take insurance for routine office visits, because if they don't have to hire and pay the clerical staff to do all the insurance company paperwork and jump through the insurance company hoops to stay contracted, they can do an office visit for about what the insurance company wants for a copay anyway.)

• It does not put Congress on the same footing as everyone else.  Congress will continue to have a choice of about six medical plans, all of them cushy premium plans of the type that the healthcare bill will tax as "Cadillac plans" if offered by a private employer.  Congress, of course, will not tax its own plans.  Once again, there is one law for Congress, and one for all the rest of us.

• But perhaps most importantly of all, Congress once again did not listen to America.  This bill has become steadily more unpopular during its passage through Congress, starting with distrust of the vast size of the bill and Congress's unwillingness to disclose what was actually in it, increasing as the reports slipped out of one backroom deal after another to buy votes for the bill, and peaking with the swell of fury over "deem and pass" (which the House backed away from only at the last moment).  Discussion on the House floor last night showed that Congress is well aware that as many as 60% of Americans did not want this bill.  But they passed it anyway; because, really, when did Congress last give a rat's crap about what America actually wants?  Even then, the final five votes to pass it were gained only by pandering to Rep. Stupak of Michigan with a promise of an executive order banning abortion funding — which, paradoxically, has both pro-life and pro-choice groups enraged.  (The pro-choice groups, because they feel Obama betrayed them and broke his promises — again; the pro-life groups, because they think Obama didn't betray the pro-choice groups enough.)  Rep. Stupak apparently knew this would be unpopular, because as little as half an hour before the vote, his office was reported to be denying the existence of such a deal.  But he did it anyway.  This is, after all, Congress.

According to news reports, the CBO analyses say this healthcare plan will reduce the deficit.  I, for one, an unable to follow how huge new expenditures to expand Federal programs can save money.  Any time a government plan spends more money and yet somehow still reduces the deficit, the odds are it does it by taking more money out of everyone's pockets.  Congress, remember, has no money of its own¹.  Every dollar it spends comes out of your pocket (and a high and rising percentage of those dollars are spent on interest from times it spent money it didn't have at all). Whenever government gets bigger, everyone else gets poorer.

Unfortunately, government never willingly becomes smaller.

[1]  Unless, of course, it just runs the printing presses and prints more fiat money.  But that takes money out of your pocket too, by diluting the money supply and decreasing the value of the dollars you already have.  If government prints money and increases the money supply by, say, 25% (to make the math simple), the effect is exactly as though it just took 20 cents of every dollar you have, including your savings and your investments.