September 28, 2009

Ho hum! Another Monday, another story of official indifference to the lack of affordable health care. In the words of Barney Frank: On what planet do these people live?

The affordability question vexing Democrats is whether those with moderate income will be able to afford health insurance, even with the subsidies the legislation would provide and all sorts of new rules aimed at controlling costs.

Because the legislation would require nearly all Americans to obtain health insurance, affordability is a potentially serious political issue. That is particularly so because most people would incur a financial penalty — payable along with income taxes — if they did not obtain coverage.

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, last week attacked the requirement to have insurance, the so-called individual mandate, as potentially imposing a crippling penalty of $1,500 on a family earning as little as $25,000 a year.

“It’s a pretty heavy burden for low-income families,” Mr. Grassley said in committee debate.

You know it's bad when Chuck Grassley is the voice of the working poor.

Some liberal Democrats are already suggesting that the legislation may not be worth adopting if it will end up forcing Americans to buy health coverage they really cannot afford.

“I am sympathetic, and I understand the concerns, and I appreciate as well the political volatility around the question of mandating or requiring coverage,” said Senator Debbie Stabenow, Democrat of Michigan, who is also on the finance panel. “The big question we have all grappled with is how do you make sure everybody is in, and that’s a tough one. It comes down to whether or not ultimately in this bill we can say this is affordable for people.”

Well, Debbie, I'd say the big question is: Who benefits? I don't doubt your sincerity, but I don't think everyone on the committee sees it the same way you so. Ultimately, is this a billion-dollar giveaway to insurance companies, a balm to the massive egos on the Senate Finance committee, or an actual solution to a very serious problem - namely, lack of affordable health care? I'm guessing the last is not all that important to the boys of the Senate Millionaires Club.

There are two obvious ways of making coverage more affordable, and neither is workable.

One would be to sharply reduce the cost of health care across the board, thereby limiting the cost of insurance. This is a chief aim of the Democrats’ bill, but it would require sweeping improvements in efficiency, including higher-quality, lower-cost treatment and better use of technology — all goals of the legislation, but not about to happen anytime soon.

The other obvious way would be to sharply increase government subsidies to help middle-class people buy insurance. Ms. Stabenow, for instance, has proposed capping the amount moderate-income Americans would have to pay for insurance premiums at 6.5 percent of income, with the subsidies paying the balance. The legislation now sets that cap on premium costs at 12 percent.

But President Obama has already sealed the top of the affordability box, telling everyone in his speech to Congress on Sept. 9 that he will not accept a health care bill that costs more than $900 billion over 10 years. And subsidies are already the biggest-ticket item.

Because after all, maintaining all those wars is expensive! Gotta prioritize here!

Some top White House officials, however, see a third way, a potential escape hatch: exempting more families and individuals on the basis of income from the penalty for failing to buy insurance, a fine that for families could run as high as $1,900.

The bill proposed by Senator Max Baucus of Montana, the Finance Committee chairman, would waive the penalty if the cheapest insurance, even with subsidies, would cost 10 percent of a family’s income.

Lowering the waiver threshold to 5 percent of income is a risky move, because limiting the threat of a penalty could leave more people uninsured, undermining a main point of the legislation.

Oh, come on. We all know the point of the current legislation as it stands. It's to put 40 million new victims on the insurance company rolls, thus ensuring massive quantities of campaign cash in the bank accounts of the cooperative politicians.

The Congressional Budget Office estimates that while there would be 29 million fewer uninsured people as a result of the legislation, a separate 25 million people would still be uninsured in 2019 — about one-third of them illegal immigrants.

Sparing more people from the penalty would certainly increase the projected number of uninsured, by tempting more people, particularly younger Americans, to continue going without insurance. But White House officials think the number of people willing to risk going uninsured would not rise by much, perhaps two million people. The budget office has not issued projections yet, and some Democrats warned that the erosion could be much worse.

Oh well! What's another two million college students who can't afford a doctor when they get the swine flu - a disease that has disproportionately fatal results in their age bracket?

And in the end, that may be the smallest price to pay to avert what could be a devastating political argument against the Democrats’ plan: that working-class Americans would be penalized heavily for not buying insurance they say they cannot afford.

Think of how amoral that argument is. People aren't really human, they're merely chips to be used in a high-stakes political poker game. Nice 'hope and change' there, President Obama.

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