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Movin’ Meat has up a post in which he cites the case of Anthem Blue Cross Blue Shield paying claims late and says:
Actually, that's pretty much SOP for most insurers: deny and delay at will, and dare providers/consumers/regulators to punish them. Fines (when there are any) just go back to the insureds as increased premiums, and any time the providers/consumers are fatigued out of demanding the insurers actually pay, that's pure profit for the insurance company.
Pass. The. Damn. Bill.
As I said in the comments there, I don’t see how any of the three (perhaps soon to be four) health care reform bills that might be passed would eliminate this issue. The bills don’t get rid of insurance companies so the business models for the companies won’t change and bad insurance companies won’t suddenly become good ones. I suppose supporters can argue that Federal law will be better at regulation than State law but in rebuttal I would simply mention the Great Financial Crisis of Twenty-Aught-Eight. Whoever was at fault in that Crisis, no one can argue that having the Federal government regulating the financial industry made companies behave in a saintly manner. Incentives are incentives even for the best companies in any industry and every industry has some bad apples. All the Federal law in the world won’t change that.
What intrigues me about this is that it’s representative of a firm belief in some quarters: passing Obamacare will make all the problems with our health care and our health insurance magically disappear. Movin’ Meat believes Obamacare will make insurance companies stop delaying claim payments. Yet Obamacare doesn’t get rid of health insurance companies. Similarly, at the health care summit, Representative Louise Slaughter said:
I have a constituent that you won’t believe and I know you won’t, but her sister died, this poor woman had no dentures. She wore her dead sister’s teeth which of course were uncomfortable and did not fit. Do you believe that in America that’s where we would be?
Yet according to The New Republic:
The Senate and House health reform bills are relatively silent about dentistry. (The word "dentist" appeared once in the 1,502-page Senate Finance committee draft bill.) Child coverage has been expanded. Provisions are included to strengthen the dental work force and to address other infrastructure concerns. Yet these bills do relatively little to ensure adult access or to apply a careful delivery reform lens to dental services. (The status of stand-alone dental plans within proposed insurance exchanges raises delicate concerns, for example.)
Based on that analysis, I don’t know why Slaughter would think Obamacare would magically produce dentures for her constituent.
A week ago, Movin’ Meat was claiming that we had to pass the health care bills in order to eliminate rescission. Yet the House health care bill still allows for rescission in the case of “clear and convincing evidence of fraud” subject to third-party review. The Senate bill is even more gentle, allowing for rescission in the case of fraud or intentional misrepresentation; this is not an improvement over most State regulations and existing Federal regulations. When the Exchanges are up and running in 2014, everyone will have to buy health insurance so there will presumably be no conditions under which rescission can happen. But until then passing Obamacare will not eliminate rescission.
If Obamacare passes, it will be interesting to see what happens to all the stories about people who suffer from denied claims, delayed claims, lack of dental care, and being dropped by their insurers because they left something off their applications. I don’t believe the problems will magically cease. I do believe those on the Left will magically stop talking about them.
My understanding of the current state of the heath care reform bills was that the House had passed one and the Senate had passed a different one. That is, both bodies had already passed a version of Obamacare. With the election of Scott Brown, it is almost impossible to imagine the Senate being able to pass another health care reform bill since the Democrats no longer have the 60 votes necessary to shut down a Republican filibuster. Therefore, the most likely scenario for getting a health care reform bill out of Congress and onto President Obama’s desk was for the House to scrap their already passed bill and pass the exact bill the Senate has already passed. The House and Senate could then pass a completely different second bill which made changes to the just-passed Obamacare bill to incorporate some of the features that are in the House-passed bill but not in the Senate-passed bill - and possibly to incorporate some of the ideas President Obama introduced a week ago. Since the Senate would still not be able to muster 60 votes, the follow-up bill would have to be passed via the 50-votes-needed reconciliation process designed to handle budgetary matters. Thus the follow-up bill could only address matters that could at least semi-reasonably be construed as having to do with the budgetary matters for which reconciliation was intended. Voila! Obamacare becomes law in two bills.
Then on Sunday I read this post by John Podhoretz and became hopelessly confused. Podhoretz is arguing that there are no good option for the Democrats when it comes to passing Obamacare and outlines the four bad options he sees. In the course of that outline he totally confused me with statements like:
The bill that has been voted out of the Senate committee for consideration of the full Senate... Republicans have enough votes to filibuster this bill. [snip]
The way to muscle this legislation into law is for the House to give up its bill, bring the Senate bill (after it’s passed with 51 votes) up for a vote, pass it, and have Obama sign it. [snip]
Even if the Senate does pass the bill through the 51-vote reconciliation process ...
I kept re-reading this and thinking that I must have missed something: Podhoretz seems unaware that the Senate has already passed a bill but surely that can’t be true. I finally decided that either Podhoretz was talking about some other Senate health care bill I was unaware of or there was some legal - not political - reason the House could not just pass the already-passed Senate bill.
Then (thanks to Neo-neocon) I read Keith Hennessey and my confusion subsided. My understanding of the strategy is correct. You can read his detailed and useful explanation of the process here. It is pretty much as I understood although I had not really thought about - and love - his description of the “Byrd bath” necessary to avoid the Republicans raising points of order in order to derail the passage of the follow-up bill via reconciliation.
Thank you, Mr. Hennessey, for reassuring me I had not wandered into some alternate reality. Now if I could just figure out what I missed in Podhoretz’ post, all would be well.
Some references for discussion of health care reform:
H.R. 3962 - This is the version of health care reform passed by the House on November 7, 2009. This bill is 2016 pages long. Cite this bill as ‘‘Affordable Health Care for America Act’’. From the link, you can download a pdf of the bill or read a hyperlinked version on THOMAS.
H.R. 3590 - Despite the HR designation, this is the version of health care reform passed by the Senate on December 24, 2009. This bill is 2409 pages long. Cite this bill as “Patient Protection and Affordable Care Act”. From the link, you can download a pdf of the bill or read a hyperlinked version on THOMAS.
President Obama’s Health Care Proposal - This is a little confusing. You can download the pdf of “the President’s key improvements” but there is also a list of items headed “Summaries of Key Elements of the President’s Proposal” which doesn’t really match up with the pdf.
A transcript of the February 25, 2010, Health Care Summit from the Washington Post - I like the fact that this is indexed by speaker.
I read Megan McArdle’s blog at the Atlantic website daily. That’s “read” as in present tense. But I’m feeing annoyed enough that I may soon either be saying “read” as in past tense or changing “daily” to “when I can stomach it”. The Atlantic changed the format for her blog. Actually, they apparently changed the format for all the blogs. So what’s the problem with the new layout, you ask? Let me tell you.
1) I have to click through to read any article longer than a few lines. Since McArdle rarely writes anything short, I have to click through for everything.
2) Once I click through and read one article, there are no navigation features. That is, I cannot ask to read the previous article or the next article. So if I go to her site and she’s got four new things up, I go:
- click and read article 1
- back to main page
- click and read article 2
- back to main page
- click and ...
Well, you get the idea. James Fallows assures us that:
what tech-world people call "performance" -- how fast things happen on a site -- seems a lot better with this new system.
That’s not much consolation when any time saved by better performance is lost by the need to constantly manually move from page to page.
3) And speaking of improved speed: perhaps the system loads faster because we’re getting far, far less functionality. Less text, of course, since we’re not seeing whole posts but also we’ve lost the thing on the right side that tells us what each of the other Atlantic bloggers has last written about. Since I read no one but McArdle regularly, I loved this. If someone else’s blog title looked interesting, I’d click through. Now they could be writing about how to do cold fusion on my kitchen counter and I’d never know it. And I’m not interested enough in them often enough to make it worth my while to click over without some kind of lure. And the pictures - which are all we now see of the other bloggers - are not going to do it.
There are also no archives. That is, I can’t click on a month to see what McArdle was saying in, say, October 2008 when the financial system was melting down. I can see last week and I can see a particular day but that’s it.
4) Commenters lost their handles. They switched to a new comment system so everyone had to create a login on that system. If someone else somewhere else was already using your handle, too bad. I got caught with this (curse whoever decided “Elise” was now a somewhat popular name) and found it mildly annoying. I imagine people who have commented regularly for years found it maddening. At least this explains why they didn’t port over commenter logins: they couldn’t. Hearing that should have given someone pause about whether this was really a good idea.
5) If there are a lot of comments, they now run to multiple pages. Under the old system even a zillion comments just took up one page. And - at least with my computer - splitting them into multiple pages isn’t making displaying them go any faster.
6) A link to what McArdle has written for the magazine stays stickied at the top of the list of her posts. Since I’m mildly absent-minded, I’ve now clicked on that three times thinking it was something new. Minor but oh, so annoying.
7) This is the one that I really, really, really hate: I can’t figure out a way to search just through McArdle’s columns. Prior to the new design all her columns were grouped together under:
http://meganmcardle.theatlantic.com
If I wanted to find everything McArdle had to say on, for example, Toyota I could use Google’s advanced search to do so:
toyota site: http://meganmcardle.theatlantic.com
Poof! Back would come all the McArdle posts that mentioned Toyota. Now McArdle’s posts are partitioned out into various categories: Business, Politics, Personal, whatever. McArdle’s writings on Toyota might be under Business (http://www.theatlantic.com/business), they might be under Politics (http://www.theatlantic.com/politics), they might even be under Personal (http://www.theatlantic.com/personal) if she owns a Toyota. If I search just the Business URL, I’ll miss anything she’s written about Toyota under the other categories.
Plus even if I do guess the correct category* and search, say, the Business URL for Toyota, I’ll get not only what McArdle has written but what other Atlantic contributors have written. I can narrow it down a little by adding McArdle as a search term but then I get her posts; pages that list her posts; and worst of all posts by other contributors where the name “McArdle” appears anywhere else on the page - like, say, under her picture next to the post.
So, I hate the design and I don’t think it’s just because I’m a curmudgeon who is cranky about change. I think it’s because I don’t read the Atlantic: I read McArdle. Imagine my horror at discovering that Andrew Sullivan - oh, no! - expressed my sentiments exactly:
a blog is inherently a live process and conversation and anyone who actually understands blogging's intimate relationship to its readership - and the critical importance of conversation to the endeavor - would never have dreamed of turning it into a series of headlines. That's what worries me deeply. Not the inevitable transitional glitches but the philosophy behind it.
Or, as a commenter as McArdle’s post announcing the changeover said after the event:
Worse, is how Megan herself seems to be diminished by the Atlantic. Her blog, which predates her arrival at the Atlantic. Has now become a mere collection of links to recent work.
The bottom line is that the redesign has made McArdle’s blog function like a magazine: a table of contents; go to page 37 to continue reading the article; pages have to be “turned” manually; she’s lumped in with everyone else in the “issue”; no consideration for people who want to read or write comments. I understand that the Atlantic has to make money and I gather than they believe this new design will increase revenue. Maybe they’re right and if the 345 comments on McArdle’s post about the health care summit and the 113 posts on her recent open thread are any indication, I’m the only person annoyed enough by the new design to cut back on my visits. (Although a quick skim indicates some people are using the open thread to complain about the re-design.)
And perhaps the Atlantic will put at least some of it back the way it was. The Fallows’ post I cited above is dated Friday, February 26. In it Fallows recognizes that the blogs don’t quite work in the new design: he does not like the click-through and believes the individuality of each blogger has been lost by the compressed, no picture, standardized format. He says that he will put up some posts over the weekend and will work with the tech team to see if the new layout can be modified. He concludes : “As ever, I am optimistic.”
A later update to that post says:
Update: I am optimistic that this will change, but find the new approach such a straitjacket that I won't even try to work within its constraints until it is fixed.
I’m with Fallows.
*****
* Interestingly, today I see that most recent post on Toyota - written before the conversion to the new system - is showing up twice on her main page, once under Business, once under Politics. I don’t remember noticing that a couple of days ago although I may just have missed it. All the comments are under only one of the posts, in this case the one in the Politics category. Two other recent posts are also under two categories with the comments under only one category. I guess this makes it more likely I’ll find the posts if I can guess right on any category when I do a search but this is some seriously ugly stuff.
It is easy to be brave from a safe distance. - Aesop
Today on This Week, host Elizabeth Vargas and House Speaker Nancy Pelosi had the following exchange about passing health care reform:
VARGAS: ... What do you say to your members, when it does come to the House to vote on this, who are in real fear of losing their seats in November if they support you now?
PELOSI: Well first of all our members -- every one of them -- wants health care. I think everybody wants affordable health care for all Americans. They know that this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. And many of the same forces that were at work decades ago are at work again against this bill.
But the American people need it, why are we here? We're not here just to self perpetuate our service in Congress. We're here to do the job for the American people. To get them results that gives them not only health security, but economic security, because the health issue is an economic issue for -- for America's families.
I think Pelosi has a good point. Ideally members of Congress should be about more than just getting themselves re-elected. The problem is that it’s very easy for Pelosi to say this: she has been in the House since 1987 and took 71.9% of the vote in the 2008 elections. So I wonder if she’d be willing to take the same stand if there was any chance she’d lose re-election this November, if it was her service in Congress that was in danger of not being perpetuated.
Here’s my proposal: Nancy Pelosi should tell her fellow House Democrats that if the House passes a health reform bill and the Democrats lose their majority in the House, she’ll resign. From the House.
I only saw bits and pieces of the health care summit but it bothered me that President Obama was calling everyone by his or her first name. After all, no one was calling him “Barack”. Maybe this is the way things worked in earlier presidencies and I just missed it but it sounded weird to me.
From JustOneMinute, quoting the Wall Street Journal (emphasis mine):
President Barack Obama will use a bipartisan summit Thursday to push for sweeping health-care legislation, but if that fails to generate enough support the White House has prepared the outlines of a more modest plan.
His leading alternate approach would provide health insurance to perhaps 15 million Americans, about half what the comprehensive bill would cover, according to two people familiar with the planning.
Half? I simply do not understand how we ended up in this position with a Democratic Congress and a Democratic President. Surely the priority for Democratic health care reform would be - should be - to make sure people who don’t have health insurance get health insurance. Sure they went off-track a little and instead of a ten-page bill that made sure people without health insurance could get health insurance, they ended up with a bill that has an additional 1,990 pages that do who knows what. Now they’ve realized they may not be able to pass their 2,000 page bill. So do they eliminate the 1,990 pages of dreck and keep the ten pages that actually get everyone health insurance? Of course not. They eliminate the coverage for half the uninsured and keep, well, I have no idea what they’re keeping.
I’m sorry to repeat myself but this just makes me nuts. If President Obama, Harry Reid, and Nancy Pelosi had any sense between the three of them then on January 21, 2009, they would have proposed a bill that made sure people without health insurance could buy it if they wanted to. Let everyone who wants to buy into the Federal Employees Health Benefits Plan or buy into Medicaid or buy whatever insurance they want and subsidize those who cannot afford to do so. That should have been their priority and it would have been politically feasible. Even all those people who are very happy with their existing health insurance worry about what would happen if they lost their jobs or their premiums skyrocketed. As for paying for it, they could have used some of the money that went into the stimulus bill. Heck, David Plouffe himself said that health care is a jobs creator.
Insuring the uninsured would have solved the most urgent of our health care problems and bought the country time to figure out how to lower health care costs. And since the Democrats would have successfully accomplished the task of protecting everyone’s health insurance they would have had political capital to help push through the rest of their health care reform.
Instead, Obama and the Democrats ceded not only the best political ground but also the best moral ground and committed themselves primarily to lowering health care costs. They acted as if extending coverage was a sort of dessert they'd promise not consider unless they managed the Brussel sprouts of cost control. That's a strange approach for Democrats and particularly Democrats in control of the Federal government.
Clive Crook believes that Obama’s closing statement at the health care summit:
did crystallise the key point of difference between the two sides. Democrats mainly want to expand coverage, and promise to contain costs in order to pay for it. Republicans have the opposite priorities: first contain costs, which they say would make insurance more affordable.
I don’t see it that clearly in the transcript but even if Crook is right, he goes on to acknowledge that:
Up to now [Obama] has emphasized cost control first, broader coverage second--because that is where most voters seem to be. Relatively little effort has been spent on making the case for wider coverage, and on persuading the country that this is worth paying for. Making the switch now comes a little late.
In other words, what could have been - should have been - a golden opportunity to accomplish what I always assumed was a key Democratic goal of insuring the uninsured has been frittered away. We’ve spent a year on a health care reform bill that probably won’t pass; we’ve spent a year with the uninsured staying uninsured; we’ve reduced the chance of any bill that covers the uninsured getting through Congress; we’ve done nothing to address health care costs; and while we were failing to accomplish all that we also weren’t paying much attention to stuff like improving the economy and getting people back to work. (Although if the health care reform process is any example, the economy and the unemployed might be better off if Congress and the Administration don’t try to help them.)
What the heck happened?
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