http://seminal.firedoglake.com/diary/12913

"As pointed out in the Charleston Gazette, moving children into the insurance exchanges ( those with parents who can afford to do that, you’d be out of luck if your parents can’t afford health insurance ) means these kids’ health care gets much more costly and covers much less:"

And this was their program. They are the ones who were responsible for getting this passed into law. I guess the temptation to let the lobbyists write the bill was too much for them.

Thanks, Democrats.

This really makes me mad. I'm not sure how much longer I want to call myself a Democrat. This is really disgusting.

Where you going to defect to Daniel?

You know, Libertarians are very much for personal freedom and doing away with the government's involvement in marriage and such.

A very gay friendly bunch we are.

We are friendly to all except those who want to tell us how to live.

And even then, we respect the right of those people to have their opinions. We just do not want them to be ruling over us.

The first 5 letters of Liberal and Libertarian are exactly the same!

Thanks Mark.

There is a lot about what libertarians believe I admire. The not telling other people how to live part, as you point out, has profound philosophical appeal to me.

But I'll never change what I believe in because a political party does or doesn't support it, so if the Democratic party keeps screwing over its base, I guess I'll have to become an "independent".

Me and Joe "the whore" Liberman.

It seems to me this is the type of thing we want to have happen -- get rid of all of the smaller medical care programs and merge them into one large one. Closer to single payer, in my mind.

I would like to see us take CHIPS, Medicaid, Medicare, veterans health care, workers compensation, all the COBRA policies and all of these miscellaneous programs and make one large one. Not gonna happen, of course. But it would be a major step forward.

I am not bothered by CHIPS being blended into the proposed plan, as long as the children continue to be covered, which they should be since there are significant subsidies for those who cannot afford to buy health insurance at the market rate.

I was thinking about this on a broader level.

This is exactly what begins to happen when major changes in policy take place. Each bureaucracy and each program with their own advocates start trying to defend the status quo for their own program.

Plan to make changes to make Medicare more efficient even as benefits are improved (which is the case in the health reform, particularly in the prescription drug area) -- the seniors go crazy.

Propose getting rid of medicaid as a program, states and counties and cities and those who make money off the status quo go crazy.

Plan to move uninsured children into the new system -- the advocates of CHIP go crazy.

If we considered moving the veterans into the new system, I have no doubts they would go crazy. The same would occur if the law eliminated workers comp and just handled on-the-job injuries under the new system.

How about all the money spent on drug treatment programs? Prison health programs? I think all of these should be folded into the new system, but they can't be because too many people need to protect their own turf.

Can we really blame the health insurance companies for fighting for their own turf when those receiving government funded health care are doing the exact same thing with their own individual programs?

This attack on the House Bill for including children in the new system as well as the uproar of all the seniors in the summer are perfect examples of how people move to defend their own turf, even as they claim they want to see sweeping changes.

I teach a class in developing public policy and this is always one of the lessons I teach the students -- the difficulty in getting rid of or altering programs because each one has its own bureaucracy, its own professionals who administer it, public agencies and private companies who make money off of it and its own constituency who receive the services and can be told that any change is going to be bad for them.

This argument over saving CHIPS is the exact same dynamic that is at play in the financial reform package and why Mr. Obama has not proposed getting rid of individual regulatory agencies. It makes sense to do so, but the turf wars would just make the process far more complex.

We will find the same thing as we move to energy policy and also as we deal with green house gases and climate change policy.

This type of "change-everything-but-save-my-program" attitude is also why we end up getting 2000 page bills like the House health reform bill with all sorts of complexities riddled throughout it. Everyone is protecting their turf and so compromises need to be made with everyone to get their support.

It is also one of the reasons we cannot get to single-payer. It is not just the insurance companies who would oppose it, it is all the constituencies, bureaucracies and people making money off the current system who would oppose it -- or at least want their special interest to be given special treatment.

It seems to me that rather than raising a ruckus over saving CHIPS, let it die, move the children to the new system and make sure they remain covered. CHIPS is not sacrosanct. Making sure children have access to health care is.

If we really want to move towards single payer, all federal and state programs which cover medical costs should be eliminated and put into the new system, including medicare, and then have the government cover the cost of different groups appropriately.

But we can't even get to that level of coordination of government programs because each program is untouchable to those who administer it, those who receive services from it and those who make money off of it.

(Rant over)

quote:

Originally posted by Rick Zimmer:
It seems to me this is the type of thing we want to have happen -- get rid of all of the smaller medical care programs and merge them into one large one. Closer to single payer, in my mind.

I couldn't disagree with you more. CHIP is a single payer program.

They're privatizing it. If I wanted lawmakers who would privatize things I'd have voted for Republicans.

If I wanted lawmakers who would take health insurance away from children, I wouldn't have voted for Democrats.

Of course advocates of CHIP are going to be upset. The program is being eliminated and there is no "system". The exchange is not a system. It's a "marketplace". Children whose parents can't afford health insurance will have no insurance. Parents will be forced to buy insurance which covers less that CHIP covered.

It's very much an open question whether the subsidies will be adequate, whether or not people are going to be able to afford 12% of their income plus $5,000 per year in deductibles, and $10,000 per families, what insurance companies will be required to cover, and whether or not there are any cost containment provisions. Please note that insurance companies are expected to raise their rates by 50% before most of these reforms even go into effect.

It's a big deal because it provides a defined benefit for children, it covers the children who need to be coved, it works, and it was hard won.

In any case, I agree with Senator Rockefeller who, as this article notes, introduced an amendment in the Senate to make sure this didn't happen. He knows how this is going to affect children in West Virginia. He wasn't happy about it at all. Neither am I.

If we truly wanted to move toward a single payers system, we would expand the single payer system we have now. That's all it would take. But you're talking about eliminating the single payer system we have now, 'putting them in the new system and then have the government cover the cost of different groups appropriately"?

You've just articulated privatizing Medicare, and moving to a "voucher system". This is the Republican position. It's a step on the way to getting rid these programs for good, in any way, shape, or form.

If this is the cost of being a Democrat- agreeing to eliminate the single payer system we have, then I really don't want anything to do with it.

I can understand taking some "moderate" positions and "compromising" sometimes- but a voucher system for Medicare- in your own words eliminating it- that's too much to ask all Democrats to accept. We're not Republicans. We shouldn't be forced into a choice between the Republican position and the Republican position on Medicare. We created Medicare. It provides benefits to seniors that private insurance might or might not and at a much lower administrative cost.

Should seniors have to do without government health insurance and go find it in the private market, because that's what you've just said.

This would not lead to a single payer system. This would lead to a completely private system. That's the wrong way to go.

Senator Rockefeller released this statement yesterday.

" The Congressional Budget Office has been very clear that replacing CHIP with private health coverage will lead some children to lose their health coverage altogether, which is harmful and intolerable. Health care reform should improve the coverage children have – not take their coverage away.

I have spent my entire career working to protect children and other vulnerable populations, and will keep fighting to protect CHIP as health care reform goes to the Senate floor, and then moves to conference with the House of Representatives. We must do all we can to shield children from harm. Always."

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There it is. This will take health insurance away from children in the name of reform according to the CBO. It's unconscionable. Shame on the Democrats. Shame.

Here is a link to the CBO analysis, dated October 29, 2009.

Preliminary Analysis of the Affordable Health Care for America Act

And from that report, here are the quotes of every time the analysis that mentions CHIP. None of them seem to say what Senator Rockefeller claims the CBO says. (The only thing I have not included are the tables where it is mentioned, simply because I can't copy them here as they are shown.

I doubt Rockefeller is directly lying. My sense is that Senator Rockefeller is interpreting some of the changes to indicate that the implementation of the law will result in children losing health care coverage. But the CBO does not indicate that.

And of course, much of criticism of the proposed House bill and the anticipated Senate one is based on what people think will happen as the law is implemented, not based on any clear picture of what will actually happen.

quote:

The estimate includes a projected net cost of $894 billion over 10 years for the proposed expansions in insurance coverage. That net cost itself reflects
a gross total of $1,055 billion in subsidies provided through the exchanges (and related spending), increased net outlays for Medicaid and the Children’s Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $167 billion in collections of penalties paid by individuals and employers. On balance, other effects on revenues and outlays associated with the coverage provisions add $6 billion to their total cost.

quote:

In addition, states would be required to maintain current coverage levels for individuals under Medicaid and some children in CHIP through 2019. Beginning in 2014, states would shift some children in CHIP to Medicaid, but the federal government would continue to provide enhanced reimbursement, which currently averages about 70 percent, to states for providing such benefits. CBO estimates that state spending on Medicaid would increase on net by about $34 billion over the 2010–2019
period as a result of the provisions affecting insurance coverage reflected in Table 2. That estimate reflects states’ flexibility to make programmatic and other budgetary changes to Medicaid and CHIP.

quote:

On a preliminary basis, CBO and JCT estimate that H.R. 3962’s provisions affecting health insurance coverage would result in a net increase in federal deficits of $894 billion over fiscal years 2010 through 2019. That estimate primarily reflects $425 billion in net federal outlays for Medicaid and CHIP and $605 billion in federal subsidies that would be provided to purchase coverage through the new insurance exchanges and related spending.

quote:

Roughly 21 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 15 million more enrollees in Medicaid than the total number projected for Medicaid and CHIP combined under current law. (Under the bill, CHIP would no longer exist in 2019.)

quote:

Costs to HHS (and especially CMS) of implementing the changes in Medicare, Medicaid, and CHIP as well as certain reforms to the private insurance market. Those costs would probably be at least $5 billion to $10 billion over 10 years.

quote:

Changes to the Medicare program and changes to Medicaid and CHIP other than those associated directly with expanded insurance coverage: Savings from those provisions are estimated to total $96 billion in 2019, and CBO projects that, in combination, they will increase by 10 percent to 15 percent per year in the next decade.

quote:

In H.R. 3962, the gross cost of the coverage expansions would represent an increase in this commitment. That increase would be offset only in part by the changes to net spending for Medicare,Medicaid, CHIP, and other federal programs (other than those associated directly with expanded insurance coverage), as well as some small changes in the revenues lost through tax expenditures related to health care.

From a footnote in a Table:

quote:

Under current law, states have the flexibility to make programmatic and other budgetary changes to Medicaid and CHIP. CBO estimates that, under the proposal, state spending on Medicaid and CHIP would increase by about $34 billion over the 2010-2019 period as a result of the insurance coverage provisions that are reflected in this table.

There was a supplement to the analysis issued by the CBO on November 4, 2009. CHIP is not mentioned in that supplement at all, except where it is shown along with many other programs in tables.

As far as I can tell, Senator Rockefeller is carrying water for those who support CHIP as a program, not necessarily those who want to make sure children are covered. If making sure children are covered is what they are really concerned about, then the solution does not need to be keeping CHIP, it is to change the proposed law to make sure the children are covered. But CHIP is what Rockefeller wants to save.

Turf war, nothing more, it seems to me.

The person who originated "the public option", Jacob Hacker, please excuse me if that's not spelled right, wanted CHIP and Medicare folded into the public option. According to the original plan, of course, the public option was going to cover many people. Now not so much.

However, privatizing Medicare truly is the Republican position and I would urge you to reconsider it. It's not a good idea in my opinion.

Same goes for CHIP in my opinion. This program is working. It provides a defined benefit to the children who need it. It seems unwise to me to force the parents of these children to buy private insurance. I know there are subsidies. However, there are vicissitudes of the private market and the performance of private plans that in my view are going to be inevitable.

And even just looking at it from the point of view of administrative cost, it would cost much more. That is, by the way, why they are expanding Medicare, because for that segment it will cost the government much less to do it themselves instead of giving subsidies for expensive private plans.

Is there really a compelling reason to privatize CHIP?

And you can't fold the VA into the exchange because the VA owns its own facilities and employs its own doctors.

Interestingly enough, Ron Wyden, Democrat, I think, if my memory serves me wants a "free choice" voucher system for Medicare. So I guess this idea isn't unheard of among Democrats.

But I think we should be very, very careful before we agree to dismantle Medicare. People get the insurance they need with very low administrative cost, much lower than private plans (Medicare Advantage, the part of Medicare the Republicans, and I guess Bill Clinton, succeeded in privatizing has administrative costs that are 12% more than Medicare) without having to deal with getting insurance on their own. The latter is no small issue for the elderly and disabled. It's a bad idea in my opinion, and it would give the Republicans complete vindication of their propagandistic rants that "government can't run anything."

quote:

Originally posted by Daniel:

However, privatizing Medicare truly is the Republican position and I would urge you to reconsider it. It's not a good idea in my opinion.

...

Is there really a compelling reason to privatize CHIP?

I am speaking totally in the abstract here, Daniel...kind of a "if I had my way" sort of thing.

First, if I had my way, we would be going to single payer. But we are not.

So, my second tier "if I had my way" is get anyone and everyone whose health care is paid through the government into this program -- and specifically the public option. Why? Simply to make it as big as possible and make it as close to a single payer system as possible, even if the government continues to subsidize medicare and other aspects at 100% as it does now.

As for CHIP -- there is no compelling reason to have CHIP. There is a compelling reason to make sure children have access to health care.

If I read the CBO analysis correctly. over the initial 10 years. CHIP is being eliminated and replaced by an vastly expanded medicaid program. And for those children at the higher end of the income level currently in CHIP, they will be covered by the parents new policy, the premiums for which will be subsidized under the new program.

If we are revamping the entire thing, no specific program should be held out as untouchable, as long as those who need it continue to get what they need.

Of course, the reality is we can't get there from here and we have to accept the hobbled together program we are getting. It's not the way I would have liked to have gone with this, but it's better than what we have now and we can then fix the new one, rather than continue suffering unde rthe current system.