Wednesday, December 9, 2009

The final compromise

Well, to the surprise of no one, Democrats huddled together, thought things through, and came to the conclusion that once again weakness should rules the day and 4 Senators should be allowed to strongarm 56. Yes, the public option is finally out. Oh, they'll claim it wasn't abandoned and that it's still in there, somewhere, and you just have to squint, tilt your head, unfocus your eyes, and believe, then you'll see it. So what's in the deal?
As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don't step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed--contingent upon CBO analysis--to a Medicare buy in.

That buy-in option would initially be made available to some uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.
There's more, but that's largely the meat of it. A public option trigger. A mish-mash of national non-profit plans administered by private insurance. Some form of Medicare for the 55-64 set.

Problems? Well, the Medicare buy-in, is pretty much for Medicare in name only and not the real thing. They were unable to expand Medicaid. The public option is in there so people can point at it and say "Look!", but it will be in a form that will not only not be useful if it was enacted, but could never really be triggered. Finally, the "national non-profits" will be run by national for-profits who are the big, giant problem that this health reform was supposed to fix in the first place.

S0, mediocrity wins the day. The grand plan to move our health care system from a 3 out of 10 to a 4 out of 10 is scrapped to just try to make it a 3.1 or, more likely, a 3.09. As more details come out, actual specifics are leaked, and the CBO gives them their "this saves a dollar" cover, we'll likely find out how bad this actually is and all the loopholes that exist. But, for now, it looks as if this is pretty much on the same level of reform as the bill was with a utterly neutered public option that was previously in the bill. Once again, things seemed to have been negotiated on the basis of "looking like you're doing something" as everyone pretends that making a bill worse, arcane, and more confusing to placate 4 people who can't string together a coherent thought or honest statement on health care is a grand achievement. Twas ever thus. So get happy, the last big disappointment and compromise is finally over. *sniff* I'm going to miss getting mad over this stuff.

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