I remember that this blog got its first real push when I took on Friend of Fox Jane Hamsher on her health reform propaganda back in 2009. Today, Jon Walker of Hamsher's Firedoglake (the Left arm of Teabagger Central) has an article on health reform - namely telling everyone what a bad idea health insurance exchanges are. He quotes from a Paul Krugman blog post that is not even clearly targeted at health insurance exchanges as designed in the health reform law to make his case, and goes after Ezra Klein for promoting regulations of the exchanges while also whining that there aren't enough regulations in the health reform law.
Doesn't make much sense? It's not supposed to. Let's see Walker's example of "independent journalism:
Health insurance is extremely complex and people just don’t have the knowledge about how an insurance policy works and the statistical likelihood of developing medical problems to know what is the best deal for them.This is neither independent nor journalism. Obviously, Walker has not read the health care law, or just doesn't understand it very well. He thinks that an unregulated market is the same as a regulated one (which is why he compares the exchanges under this law to your employer's bargaining power with insurers). Or, he's being an intentional propagandist. This is my personal suspicion. Yes, it's a complicated process to figure out what kind of services you will need and pick insurance for just that. If that were the case in the health insurance exchanges even after health reform, Walker would have a point. But with health reform, Walker has built a house of cards, fairly easy to deconstruct.
First, all insurance companies - in and out of the exchanges - must offer essential benefits to their members. In addition to prohibiting pre-existing condition discrimination (including in price), the law spells out minimum benefits; among them:
(A) Ambulatory patient services.Not only are all these set as basic, essential benefits for any plans sold through the exchanges to anyone, these are the floor of basic benefits. On top of these, the Secretary of HHS has the authority to determine additional benefits so that the benefits will equal a typical employer benefits package. Remember that all plans also must abide by the following: no lifetime or annual benefit limits, a limited out-of-pocket maximum set by the law, no being dropped when you get sick and no-copay preventive care. The out-of-pocket maximums are as follows:
(B) Emergency services.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
- 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
- 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
- 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).
- 400%+ FPL: $5,950/individual and $11,900/family.
So there goes one of the two very weak bases of Walker's argument - that the plans in the exchanges will be too complicated to choose from because people don't have enough time and know how to figure out if their needed services are included. Their needed services are included, no matter what plan they choose. Period, dot, end of story.
There is no way to say that under health reform, the choices in the exchanges will be so cumbersome that people will end up choosing the wrong coverage for themselves and be left out in the cold when it comes to being covered when the need arises. One can argue that subsidies should be higher or out-of-pocket limits should be lower, etc. etc. but one cannot be knowledgeable about the new law, intellectually honest and still claim that the exchanges, as designed in the law, will confuse the heck out of health care consumers. Basically, the marketplace in this case is designed to weed out the bad products, and provide choices between good (meeting essential benefits) and better (exceeding essential benefits at the same cost) products. People may still fail to choose the most cost effective product for them, but system safeguards ensure that they will not choose a product that will leave them high and dry when they need health care the most.
Then what are consumers essentially choosing? They are choosing from benefits that are additional to the essential benefits that are regulated by the law and the HHS, and they are choosing their cost-sharing, within the defined parameters of the out-of-pocket maximum as mentioned above. Thus the bronze, silver and gold plans - which basically state what percentage of the payments are covered by one's plan until one reaches that out-of-pocket maximum, often known as the "actuarial value" of the plan. This, too, is essentially mostly for people who do not receive federal subsidies, as subsidies are calculated to match the silver plan (i.e. 70% actuarial value, with out-of-pocket limits depending on income).
It's not just that the set of essential benefits are set by federal law and regulations. It is also that both state and federal regulators are empowered with an enormous amount of oversight over the exchanges, including with the ability to kick off insurers who don't play by the rules from the exchanges or for unjustified premium increases.
Lastly, praytell, oh dear purity left, if the exchanges are such a bad idea and will just confuse people with all these choices, why exactly is it that you were gnashing your teeth to add yet another ... ahem, option ... known as the public option to these same exchanges? That question has one of three possible answers: (1) they never really cared about the public option - it was merely a weapon to bash Obama with, (2) they wanted to confuse these poor people using the exchanges even more, or (3) they don't really believe that these exchanges as designed are a bad idea.
Here's what I think Jon Walker and Firedoglake, and The Professional Left is doing: they are trying to kneecap health reform before it has the chance to take full effect. First, it was the individual mandate - the basic, simple idea that in order for everyone to have coverage, if you can afford coverage, you must have it. Now, it's the whole idea of the exchanges itself. This is sabotage, plain and simple. They are essentially still trying to convince their slim sliver of the ideological purist movement that health reform was not worth it, that it should have been killed, and the status quo would be better. I don't see how their behavior would have been any worse if they had been in bed with the far Right forces trying to dismantle health reform.
This pre-emptive war on health reform that the likes of FDL continue to wage is not simply about health reform, either. It is about an animalistic, ritualistic, sadistic unabated hatred for President Obama. Purism is never designed to push towards the pure - that is the myth they want you to believe. Purism is designed to put up an unreachable marker and then conveniently bashing someone for not being able to reach that marker. It's about moving the goalpost out so far that no one can get there. Purism is set up to fool people into an all-or-nothing playing field where you always get nothing.
But it's dangerous. It's even more dangerous because we are talking about health care reform. We are talking about people's lives. We're not talking about some abstract set of principles; we are talking about health care, for crying out loud. Spreading the type of constant lies, misinformation and propaganda that is the forte of Firedoglake, many front page posters at Daily Kos and other supposedly "progressive" web sites is tantamount to playing with those lives. It is no better than directly helping insurance companies, the hospital industry and others dismantle the most aggressive and expansive health reform legislation since Medicare (probably even including Medicare, since Medicare only covered a certain population). And because these are done ostensibly from the "Left," it is all the more helpful to the corporate agenda.
Before the idiots start, yes, I am saying that FDL and their friends are an willing instrument of the anti-progressive and pro-corporate Right wing of this country. You betcha.