How Fox News Could Kill People and Health Reform from Firedoglake

http://seminal.firedoglake.com/diary/6370

 by Scarecrow

http://www.youtube.com/watch?v=UTN_v1UAevc

There's been some concern about why the House reform bill -- America's Affordable Health Choices Act -- delays availability of the public plan until 2013. But to understand that better, you need to spend a few minutes watching any of the cable "news" shows, and especially Fox News, as they discuss the various health care reform proposals. In short, it's about the taxes.

I had just watched President Obama's Rose Garden news event on MSNBC, saw Andrea Mitchell then turn to Pat Buchanan for comment (!!!) and then over to Fox News to see a completely uninformed anchor interview Reps. Marsha Blackburn (R-TN7) and John Yarmuth (D-KY3). Yarmuth did his best to explain what the bill actually does, and Blackburn did her best to flat out lie about it. And that's what we're in for.

All the anchor wanted to talk about was how that terrible tax increase on the "so called wealthy" ($350,000/year doesn't qualify) and "so called super rich" ($1 million just doesn't go as far as it used to) would be, and how the guy who operates the hot dog stand on the corner outside the NYSE will get wiped out by the Democrat's new taxes.

You would never know from the cable news anchors or the vast majority of panelists that the House and Senate HELP Committee bills will end hateful insurer policies like rescission, denial for previous conditions and other forms of discrimination. Nor would you learn that tens of millions of uninsured people will gain coverage, that underinsured people will be protected with stronger basic plans. And those changes in Medicare payments aren't about reducing the need for covering people currently uninsured and improving payment incentives; no, they're about reducing care and services for Medicare patients -- an absolute lie.

And never mind the misinformation about the public plan. Marsha Blackburn just made up stuff on that.

So, why do the current bills start the public plan no sooner than 2013 and phase in eligibility? As Eza Klein noted, the driving force is the need to keep the CBO rating at or below about $1 trillion over ten years, and the current House bill hits that goal pretty close.

Here are the tradeoffs: People who leave their current insurance (e.g., at work) and instead choose an insurance plan on the exchange are entitled to federal subsidies to help pay the premiums. That means if 130 million Americans move from non-insured or insured at work to plans on the exchange, including the public plan, the cost of the subsidies could be huge, if a substantial number of those people were low-income.

So to limit the initial hit on the budget, the House (and Senate) bills deliberately include several features to keep the initial budget impact to the arbitrary $1 trillion over ten years. I see several such features:

1. Schedule the exchange (and the public plan option) for 2013. It's conceivable this could have been open sooner, but that would just increase the initial 10-year budget impact.

2. In the first year, limit eligiblity for the exchange (and public plan) only to those who are currently uninsured or to employees of small businesses (10 or fewer employees)

3. In the second year, raise eligibility slightly to small businesses with 20 or fewer employees

4. In subsequent years, give the Secretary of HHS discretion to gradually enlarge eligiblity to larger business, as the exchange (and public plan) gain experience/ability to expand.

There are other details, such as use of Medicare providers (unless they opt out) and Medicare payment rates (as reformed by 2013) for the first 3 years. But the basic idea is to limit eligibility early on to give the institutions a chance to develop, but probably more important, to keep the first 10-year cost impact below the magical $1 trillion level.

Of course, in a rational world, with responsible leaders, we'd realize that "it's the economy, stupid, not the federal budget" that matter. The way to save money on health care across the economy would be to accelerate the transition from the financially unsustainable system we have to the one we need to get to. You'd introduce the cost-saving reforms and the transitions as quickly as possible, allowing for usually start-up problems and suprises -- things we probably can't avoid. Over time, an accelerated schedule would probably save us more money that we saved in the initial 10-year budget, which is what CBO looks at.

But if we want Congress to accelerate this schedule and open the gates, we must also ask them to increase the $1 trillion budget impact ceiling they've imposed on themselves. Watching cable news shows focus almost exclusively on a very progressive proposal to raise even the $1 trillion for the slower schedule, we should have no illusions about how easy getting even that amount will be.