2009-08-14 The public option will be run by insurance companies/woozle

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Having dug about halfway into this article, here's what I see:

"Finding the HELP Committee bill"

Sullivan claims that the legislation is difficult to find. Searching Wikipedia for "Obamacare" takes you to a section of a page about "Obama administration proposals" for healthcare reform. That section describes the Obama-Biden plan, which (as I understand it) was intended as a guide to what the administration would support; Congress created its own plan essentially from scratch, and that's what we're discussing here.

The next section of that same Wikipedia article ("Congressional proposals") explains that the bill currently under discussion is the Affordable Health Choices Act; following that link, you find pretty quickly that the bill in question is HR 3200, introduced July 14.

So why couldn't Sullivan, writing on August 8 or later, find the bill number?

"Summary of Section 3106 in semi-plain English"

He says the legislation is in two parts, one of which is the Affordable Health Choices Act and the other of which is the additional Chairman's mark on coverage at which he directs his ire, so I took a closer look at that.

One of the first things I see, on getting past the table of contents, is this: "A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage." Already, this would be a tremendous improvement over what we have now, so there would have to be some pretty horribly destructive provisions to counteract that before I would see this as a bad bill.

Looking back at Sullivan's piece, the next thing I see is this: the "insurance companies" which he frets about in the title will be nonprofits (the "health insurance companies" we all know and loathe, such as those franchised(!) under the Blue Cross / Blue Shield name, are for-profit, some of them publicly-traded (i.e. they make enough money to be a good investment -- that's your healthcare dollars, going into the hands of people who have enough money to make more money off the mere fact of having lots of money).

Furthermore, they will generally be created by much the same process which creates similar companies for Medicare -- and my understanding is that Medicare recipients are generally quite happy with the care they receive, so this would appear to be a good model for expanding into mainstream care.

Yes, it looks like some of these same much-loathed for-profit companies will be delivering services under Obamacare -- but they will be using the Medicare model for delivery, and that seems to work. "Run by insurance companies" is a scare tactic aimed at liberals, just the latest addition to the anti-reform arsenal which had been previously used so effectively with conservatives.

"Decoding Section 3106: Is it one 'option' or multiple 'options'?"

Sullivan then fusses about the term "community health insurance option(s)", claiming that (a) it's not clear why the words "community" and "option" are needed and that (b) the bill's language is confusing because it switches freely back and forth between the singular and plural forms of that phrase.

It seems clear to me that they chose that phrase so that they would have a specific term to mean "the thing we're talking about here", to avoid confusion. It is defined in 3106-b-2 as:

health insurance coverage ... that complies with the requirements for being a qualified health plan; provides high value for the premium charged; reduces administrative costs and pro-motes administrative simplification for beneficiaries; promotes high quality clinical care; provides high quality customer service to beneficiaries; and offers a wide choice of providers.

No, this doesn't define how these goals are achieved or measured, but it does set forth the general goals which they are trying to implement, and those goals seem like good ones to me.

"Section 3106 proposes multiple "options," not a single Medicare-like program, but this is not apparent at first.", sayeth Sullivan. Well, it seemed pretty clear to me. A "community health insurance option" is basically a health insurance plan that meets certain criteria; one uses the singular when discussing a single plan that someone might join (whether actual or hypothetical), and the plural which discussing them as a group. Occasionally we see the singular used to refer to the idea rather than a specific insurance plan, but I don't see how this hinders understanding.

I'm not saying that I'm without reservations about this. The bill seems to be describing a service-provider-contract setup which was the basis of reforms which did more or less ruin the mental healthcare system here in North Carolina (a horrible fact which I have experienced first-hand) -- but it nonetheless seems to have worked at the Federal level (Medicare), it doesn't do anything to hurt existing insurance, and again it specifically requires universal access (one of the problems at the heart of the NC system's woes) so I'm willing to give it a go despite the surface similarity. Almost anything would be better than what we have now.


Headlining with the claim that Obamacare "will be run by insurance companies" is yet another anti-reform scare-tactic and covers over the fact that Sullivan's article is basically picking nits and putting them under a microscope, hoping to gross people out by how nasty they look up close. This may in truth be a flawed bill -- can we realistically expect anything better this time around, and do we really think that supporting Obamacare now will pre-empt or delay further reform later? Are we going to insist that any reform must achieve certain goals or we must oppose it -- and keep what we have now?

A final point to consider: If this bill is flawed to the point of being undesirable, then shouldn't our energy be directed towards encouraging our representatives to make specific changes to it (either when the time comes for reconciliation between the House and Senate version, or after it passes/fails), rather than just voting it down?