Can your conscience live with killing the bill?

There has been a loud pronouncement by self-proclaimed representatives of the left-netroots that the Senate bill must be killed in order to be saved. Or improved. Or some such thing. Never mind the absolute incoherence of logic in the argument of killing the patient to save it. I don't want to talk to Adam Green or Jane Hamsher. I want to talk to the people they talk to. The people that sign their petitions. I want to share my feelings about what I feel I would be doing if I had a hand in killing the bill.

If they are successful in killing the bill (which, thankfully, they won't be since among the progressives in Congress, cooler heads seem to be prevailing), health care/insurance reform is over for more than a decade. This idea that we can bring it back next year or in 2011 with some sort of a left-right populist alliance if we fail now is bullshit. Before you sign one of their petitions to kill the bill, let me remind you what you will be putting your name to:

Killing $10 billion (in the Senate bill) or $14 billion (in the House bill) of community health center funding. Vermont's independent Senator Bernie Sanders - perhaps the most progressive member of Congress has secured this funding in the Senate bill. The Senate version of this bill will make primary care affordable and accessible for 25 million more Americans than is currently the case. Today, the United States is one of the worst performing countries in terms of deaths from preventable illness. In fact, 100,000 more people die in the United States from preventable illness every year than would if we had the same rate as the top performing countries. Community Health Centers cut down on those preventable deaths. People have a doctor to go see. They get medication at a cheap, affordable rate. Community Health Centers save lives. This is real health care. I can't live with signing off on something that would kill a law that could save as many as 100,000 lives a year.

Denying health insurance coverage to 31 million additional Americans. 31 million. 45,000 Americans die every year due to the lack of health insurance coverage. If we kill the bill, we damn those people to death. Every year. For ten years. Maybe more. I might be one of these people one of these years. You might be one of these people one of these years. No. I can't say no to expanding coverage and saving lives simply because coverage isn't being expanded my way. I can't deny 31 million people health insurance to stroke my ego. I can't have a chance to change that 45,000 number downward and be proud that I stopped that - however imperfect - effort. I can't have that on my conscience.

Refusing the best chance to create pressure on insurance companies to lower premiums: People in the kill-bill crowd like to loudly denounce the mandate as immoral because the government is forcing you to purchase a private product. And it might be a crappy product. And you are forced to buy it no matter how much it costs or the IRS will fine you, and if you can't pay it, arrest you and put you in jail. This is all mostly misleading. The so-called mandate is reasonably weak (and quite reasonable, actually) - one is exempt from it if their premium costs more than 8% of their income. So to recap, no one is forced to buy coverage that is unaffordable. Secondly, insurance companies will know that if they want the people who may not have employer provided coverage to actually buy it from them, they are going to have to offer products in that reasonable price range, or people will be able to opt out, and there is no force of law or fines holding them captive. If insurance companies want a captive audience, they will have to provide coverage within that affordable range. Remember also that insurance companies are not allowed to charge one more based on income. That means that if they want a family making $75,000 (who get no subsidies) to be subject to the mandate, they have to provide coverage with all the required medical services covered for $6,000 a year or less for every family. What's more, the bill eliminates co-pays and deductibles for recommended preventive care, bring your cost down even further.

No, I will not be helping kill this opportunity to create a downward pressure on both premiums and actual cost of care to individuals and families.

Denying needy families assistance to purchase coverage: Once the exchanges are in place, individuals and families who have the most trouble affording coverage will have substantial help. The Center for Budge and Policy Priorities sumw up how substantial this help is. The premium assistance is on a sliding scale for people up to 400% of poverty. Here's how the premium assistance works out:
  • Under 100% of Federal Poverty Level, you pay nothing. Nada. Zilch.
  • Between 100 and 400 percent of poverty, you pay on a sliding scale from 2.8% to 9.8% of your income, maximum. Take a look at the table on this page if you want to know exactly where you'll stand with respect to the assistance and what your premium would be at most before the subsidies kick in.
Today, annual family premiums in 18 states are 18% or more of family income, and the national average stood at a staggering $12,300 last year. We are paying the price, and the price is too high. No, I can't live with killing significant premium assistance to poor and middle class families who are having the toughest of times.

Here, I should say a word about actuarial value, as smart people will inevitably read on the above linked page about actuarial value. And then, some detractors will scream that with a policy with an actuarial value of 70%, the insured still pays 30% of the costs (including your premium and out of pocket expenses). That's true, but 30% of your costs isn't 30% of your income. The Senate bill's actuarial value of 70% is for families of three earning $45,775 or more, and the House bill reaches it at a far more generous level of $73,240 or more.

But that's not all. Out-of-pocket expenses are limited on a sliding scale (as are premiums) for people up to 400% of poverty, and above that, to $5,950 for individual plans and $11,900 for family plans.  Out-of-pocket expense is all of your medically necessary expenses except for your premium. That includes co-pays, whatever your share is at the hospital, etc.

And, as I mentioned above, you will have no co-pays or deductibles for preventive care, regardless of how you get your insurance. So you would actually have to be sick to reach your out-of-pocket limits, and not have to go into your savings just for staying healthy and having regular checkups.

Killing important insurance reform: Killing the bill would kill enormously important insurance reform. If I help kill the bill, I will be helping insurance companies:
  • Continue to pick and choose which essential services they cover and how much they make you pay for routine, preventive care. The Senate bill will "eliminate co-pays and deductibles for recommended preventive care, including preventive care for women."
  • Continue to deny coverage based on pre-existing condition. Like acne. Or domestic violence. Or pregnancy. Or for a toddler, being too big.
  • Continue to kick people off their insurance rolls just as soon as they get sick.
  • Continue to con people into high deductible plans and then refuse to pay their fair share even after that.
  • Continue to let insured people lose their house because of their staggering, non-capped out of pocket expenses.
  • Continue to place annual and lifetime caps on benefits so that the patient loses, no matter what.
  • continue to make their bureaucrats stand between people and their treatment.

to list just a few. No, I cannot, in good conscience, preserve the status quo and allow the insurance companies to ruin more and more and more lives with no oversight and no accountability.
 
No. I have made up my mind. I will not let my ego, or my anger against Joe Lieberman, or my agony for the public option turn into a destructive force against a huge step forward in health insurance reform.

I know what the retorts are. What about handing over all these customers to the insurance companies with a mandate? Am I willing to have that on my conscience? Yes I am, if that means I don't have to have all these above things on there.

I cannot live with killing the bill. My conscience won't let me. So no, I won't be joining the status quo caucus - on the right, or on the left.