Thanks for commenting!  I really liked what you said here:”The more I read about this bill the less I seem to know”.  I think that’s true of many things.  If you haven’t yet read my first post (found here) I’d encourage you to do so because what you expressed there is like, one of the foundational philosophies of my life.  These kinds of issues are far, far more complex than they’re made to seem by media pundits and partisan commentators.  And I’ve found in my life that the more I learn about a particular subject, the more I find I still have yet to learn.  So I think its wise to be wary of the strongly opinionated or impassioned.  Not that there’s anything wrong with passion as long as its carefully placed.  But I think its rare in politics that something comes along that is absolutely bad or absolutely good.  Honestly, I think most of us probably never acquire enough information to make a truly informed decision about most policy proposals.  That doesn’t mean we don’t try to do the best we can, it just means its probably a good idea to always maintain a certain humility about our conclusions.

Anyway, on to the real question.  That claim is actually a new one to me, and that’s surprising because I thought I’d heard all of them.  I searched the internet for a bit and couldn’t find anything about it and in fact I couldn’t find much about family planning and health reform in general.  And I think there’s a reason for that.  By this time I’ve read the portions of the initial house bill pertaining to the public plan several times over.  And from what I’ve seen, the bill doesn’t really describe any details about what the public plan will cover, outside of stating that it will be bound by the same regulations as other private insurance plans that participate in the healthcare exchange.  That means it will be required to have drug coverage, maternity coverage, inpatient coverage, etc.  The details about the plan are left up to the appointed administrators of the plan who will adjust coverage and rates on a regular basis, just like any other insurance plan. I checked again just to be sure and you can read about it in the original bill starting on page 116.

And I think that’s a very important thing to remember that most people seem to misunderstand.  The public plan will just be a non-profit health insurance company with administrators appointed by the government.  Once established it would operate just like any other health insurance company, without government subsidies or tax-payer money to help them out.  It will be one choice out of many.  I don’t know of any circumstances where one would be forced to choose the public plan.  Even those receiving insurance subsidies from the government will be able to use them to buy a private healthcare plan.  The CBO estimates that less than 5% of Americans will be on the public plan ten years out.  My point being that even if the public plan ended up having some kind of bizarre pregnancy wait period, though there doesn’t seem to be evidence that would be the case, one could just switch to another plan.

And the fact that that choice will exist will pretty much ensure that the public plan’s coverage doesn’t deviate too much from what would be expected or what the people want.  In fact, that’s one of the goals of the public plan is to increase competition so that private insurers, and the public plan, will both be more responsive to the needs of the market.

Anyway, I know it can be tough to find reliable sources of objective information these days.  I think if you’re reading factcheck.org you’re starting out well.  I’ve always liked them quite a bit, along with politifact.com.  So those are two reader-friendly places to get information.  If you want more I’d suggest checking out the official bill summaries (which I’ve posted here) along with the CBO analysis which can also be found on that page.  Next I’d say the Lewin Group and the Kaiser Family Foundation would be good places to look.  The first one leans a little conservative and the second one’s a bit liberal but they’re both relatively moderate and are considered powerhouses in the healthcare policy arena.  Since you guys are also heading into medicine (assuming this is the heather I think it is) then you could also check out what the AMA has to say about it (found here).  They are traditionally very conservative and this is the first time they’ve endorsed a healthcare reform plan since their inception.  So that was pretty big news.

Of course to complicate all this the House bill that everyone’s been talking about this whole time is now actually pretty dead in the water.  It looks like the bill being produced by the Senate Finance Committee (which was half republicans and half democrats) is the new bill to look to and its likely it will be released tomorrow.  After that there will be probably about two weeks of modifications made before we’ll really know what the contents of the final senate bill will really be.  Then it still needs to be combined with the House’s bills and then voted on by everyone again.  So we still have a ways to go in all this.  One thing that’s frustrated me a bit about this whole discussion is how so many people had hardened opinions way back before a single bill was even written!  Even now it still seems early to me for anyone to know their opinion on the bill.  The most controversial elements are still very much in flux.

Anyway, like usual, that was way long.  Sorry about that.  If you have any more questions feel free to send them my way, and I hope you can check back in and comment on the blog in the future.

Saw a link on Gaylynn’s FB with your blog address, and I have been reading a few of your posts. The more I read about this bill the less I seem to know, so I am just trying to be patient and not get passionate about one side or another before I feel secure in my opinion.

That being said, I recently read more of a commentary on this bill from another friend where she spoke of women having a time period before they were allowed to get pregnant – meaning that those insured by this public plan would have their ‘family planning’ dictated to them by their insurance policy. In this same commentary, my friend quoted the common analysis of the bill which I saw was debunked by factcheck here: http://factcheck.org/2009/08/twenty-six-lies-about-hr-3200/.  So I realize that she is very passionate about her opinions, and probably doesn’t know all the facts. But I cannot seem to find the truth or falsehood to her claim of the timeline regarding women becoming pregant and wanting to keep their pregnancy. Have you heard or seen this before?

I appreciate you taking the time to share your views. It’s refreshing to hear someone talk about it candidly and openly rather than blindly passionate. Thank you.

Heather Christensen

Thanks for commenting on the blog!  Yeah it can be difficult to figure out what’s true and what’s not, especially when we’re dealing with an issue like healthcare that tends to inflame passions and inspire fear.  But I don’t know that you have to read the entire bill to figure it out.  In fact that might not even be the best way even if you had the time since its pretty legalistic.  Honestly I’ve probably only read a little over half of it at this point.  I’ve just stuck to the more debated parts and I don’t feel like I’ve missed out on much.

But I’m not sure even that’s necessary.  I think you can get a pretty good overview by reading the official bill summaries, the CBO analysis, and then maybe a few summaries and analysis from the major think tanks.  If you want to get a balanced perspective I’d suggest checking out the Lewin Group for a somewhat conservative viewpoint and the Kaiser Family Foundation for a more liberal take (though when reading their analysis make sure they’re talking about the right bill, both those organizations are reviewing several minor bills as well.  The only finished bill following Obama’s original plan is HB3200).  Both these groups are mainstream and generally trustworthy, in my opinion, despite their leanings.

Then I’d suggest reading through the major fact-checking organizations to cut through the myths.  Politifact.com and FactCheck.org are both fantastic and they do very thorough and non-partisan work.  And you might want to check out what the AMA says about the House bill.  I think their perspective is important since they’re coming from the viewpoint of the physician and they are an undeniably conservative organization.  In fact there’s an example of an organization that was certainly “anti-obama” to begin with, but the bulk of its members now support this healthcare reform plan.  Anyway, if you checked out all those sources, I think you’d be in a pretty good place.  And it shouldn’t take more than 8 hours or so (which is not an insignificant amount of time but this is an important subject).

I certainly don’t expect you to simply trust my opinion, and I’m not at all offended that your still skeptical, but I tried to back up most of my points with original sources and links to analysis by people smarter than myself, so if you still have concerns about any of the myths listed above I’d suggest checking out those links, and I’d be happy to discuss any of them more if you want to.

For what its worth I was not a fan of Obama’s plan initially.  Frankly, I thought it was a bit too conservative.  It was definitely the most conservative of the plans presented by democrats during the primaries.  I thought he was just pandering to republicans (a lot of good that did).  But I’ve come around over time and while I would say I definitely support the plan, I have my concerns as well.  Frankly the house bill as it stands isn’t much like what I would think ideal reform would look like, but as it always is in politics, its not a choice between this and some hypothetical perfect option, its a choice between what’s politically feasible right now or nothing.

Ok, with that said, on to your questions.  On the issue of them trying to push reform through early.  Honestly I was kind of ambivalent.  I was following the news pretty heavily at the time and there was a CFPR conference call like a month before congressional recess in which Senator DeMint opined that if they could stall the bill until recess he thought they could kill it and it would be “Obama’s waterloo”. It was around that time that the new rallying cry of “slow down!”  and “Democrats are trying to cram this through!” seemed to pop up.  So in short I think that concern was kind of manufactured as a strategy.  I mean they started working on this in Late February/Early March a week after Obama’s speech to the joint sessions of congress.  We have to remember that just because congress only started drafting the bills a couple months ago, that doesn’t mean they just started thinking about it recently.  Almost all of the wording was hammered out long ago.  My understanding is that the congressional process is more about deciding what to include and not to include.  So I don’t know that 6 months is a particularly short working time, even for something this massive.  Especially when the country had at least 6 months previous to Obama’s election to analyze his healthcare proposals, which have turned out to match the current bills in pretty much all important ways.

As for the Canada thing I really wish I hadn’t included anything about that because in retrospect it just reinforces this false idea that Canada is relevant to the current debate.  Also, I’ve since realized that my wording there was quite confusing.  First-off, by “non-essential”, what I meant was simply “elective”, which is the term most used by the statisticians.  What I was trying to communicate in that sentence was just that whenever you hear someone talking about long wait times for surgeries in countries with single-payer healthcare the only statistic anyone ever seems to brings up is Canada’s wait times for elective surgeries.  I don’t have any particular statistics on non-elective surgeries but I was just commenting on how the implication of the fact that critics of Canada always cite that one statistic is that their non-elective surgery wait times don’t support their argument and are likely as good or better than ours.  Once again, I don’t know that that’s the case (thus my use of the word “implication” and the lack of a citation), I was just trying to poke a little fun at Canada’s critics by highlighting their selective use of statistics.  And I was trying to be a little more casual with that section since none of those arguments were crucial to my point (which when you get down to it was just that fears of long lines because of Canadas long lines are unfounded since we’re not looking at changing to anything like canada’s system).

In truth Canada does have a pretty crappy healthcare system, which is why critics of single-payer healthcare always use it as an example.  And I have no doubt that in general one would wait longer in Canada for most things than one would here since their system is so underfunded.  But in the relatively famous 6 countries study by the commonwealth fund, they’re the only country that’s consistently worse than us on issues of timely access to care.

So sorry if that was confusing.  I didn’t mean to imply that I had more information than I presented there and I may have to consider editing that section if its coming off that way to a lot of people.

Anyway, thanks again for commenting.  I’m going out of town this afternoon but I’ll definitely post up a couple more healthcare related things next week so I’d certainly like to hear your opinion on those as well if you have the time.

I was just curious what you thought about Obama’s original idea to push the plan through before the August recess?

I’ll give you mine…I don’t know all the details to the plan and unfortunately I really don’t know who to believe has the complete truth…its tough because I know you have always been Pro Obama and so you obviously have bias towards him and his plan…the other folk on the opposite side I’m sure have some bias as well…so it is kind of frustrating. Again, not that I don’t trust you, I think I would need to read the entire bill myself to get the real story…and even then I probably wouldn’t understand the implications of the things written…I would think that the best people to believe would be those that were Pro Obama to begin with and disagree with the bill or those that were anti Obama to begin with and agree with the bill…and as far as I can tell there is a lot more of the former than the latter.

Anyway thanks for the effort, I really am trying to hear both sides of the story and form my own opinion, and I am VERY conservative but am always willing to hear someone out.

By the way please define “non-essential” surgeries. When I first read that, my first inclination was to think of things like plastic surgeries…cosmetic stuff…but don’t think that is the case at all. So give me a definition and a source for your non-essential surgeries. I heard the former president of the Canadian medical association on TV last night saying that there were indeed very long wait lines for many surgeries….so again is essential only emergency?…is it surgery if you have cancer?…or what…What about an elderly lady who falls and breaks her hip…is fixing her hip essential…or a high school athlete that blows out his knee…or a 40 year old lady who has 10/10 painful periods every month and wants her uterus out…are those essential surgeries?…I know we are not trying to copy Canada…but you did mention it above.

Thanks man, look forward to hearing your reply

Ryan Skinner

Anyway, I don’t know where to start here so this may be a little scattered.  Obama did actually say “I won’t sign a health bill unless its deficit neutral”.  See here for one example: http://durhamcounty.mync.com/site/durhamcounty/news/story/39103/president-talks-health-care-in-the-triangle/.  He has said it repeatedly.  So I wasn’t just assuming that was the case.

And, no, I don’t think the CBO analysis supports your assumption that the bill will add to the deficit.  The House hasn’t even voted on the legislation yet.  When the CBO said the bill in its current form would still run 239 billion over, many in the house said they were “Devestated” and were back to the drawing board.  My point is that everything is still in flux.  The CBO reports that come periodically are like check-ins to see how things are developing.  We won’t know if the bill is deficit neutral until the house finishes amending their version and passes it, the senate finishes their three versions, passes one of them, and then the senate and house versions are melded together and the CBO analyzes the result.  I hope, as you do that the final bill is deficit neutral and I think its likely that if they are not Obama will maintain his promise, especially since, in this case, it was so specific and publicly known.

And I don’t know why you seem to think I’m pro-government or super liberal because that is not the case.  I got one of my degrees in business management and am a big fan of private industry and free markets.  I’m an independent who only recently converted to centrism from a life of libertarianism.  I absolutely do not support a government run healthcare system.  In fact, I don’t support government participation in the healthcare delivery system at all.  I would be adamantly, furiously, opposed to it.  Fortunately, that’s not what this bill contains.  This bill is about fixing malfunctioning market forces.  Its about providing competition where currently there is none.  Its about providing comparable information so consumers can make informed choices about their care.  Its about reducing costs with market principles so the uninsured can afford to purchase their own care.  And its about reforming the system such that American taxpayers don’t have to continue to fund the care of the uninsured through the emergency room.

This is the same healthcare plan that Nixon presented when he ran for president, it is almost the exact same plan that Mitt Romney proposed for America.  Its a very, very moderate plan.

I’ll be writing another post soon where I detail why I choose to support the plan, despite its flaws and imperfections, but the quick version is that it delivers on nearly all of the important things that the healthcare policy community has been wanting for years.  That’s why organizations like the American Medical Association, the American Hospital Association, and others who have traditionally been opposed to democratic healthcare reform have enthusiastically supported and endorsed the current House bill, despite their reputation as very conservative organizations.  This is not a left-wing bill in any way.  If it was, I would not support it.

The Salon article was interesting, but unfortunately the author demonstrated misunderstandings of basic elements of the bill.  For example she says, “what if my insurance company goes belly up because of undercutting by its government-bankrolled competitor” when you and I both know by now that the “public plan” is not tax-payer funded, not government bankrolled, and therefore has no advantage over private insurance.  I don’t know how many times I have to say it.  Here it is from the official bill summary,” Public option must be financially self-sustaining, as private plans are.”  Here it is from ITUP analysis,”Public Plan: Self-sustaining with out public subsidies”.  The Kaiser Family Foundation’s analysis says the House Bill will, “Finance the costs of the public plan through revenues from premiums.” Here it is from the CBO, “…but as long as the public plan charged premiums that covered its costs (as it is supposed to do under the proposal), those amounts would be offsetting…”. And you can read it in the bill yourself on pages 119 and 120 http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf You can also read a pretty thorough description of how many people would leave private insurance for the public plan on pages 3-8 of the CBO analysis I linked earlier.

Look, the idea that the public plan is a government run entity that will lead us down the path to single payer is just plain not true, which is why it was Myth #6 above.

And I’m not sure where you got this statistic.  ”I agree with most proponents of Obama’s plan that this plan will lead to single-payer because the private sector will be unable to compete.  ”  But I would like to see your source if you have it because I would be very surprised if most proponents of Obama’s plan believe it will lead to single-payer.  As I stated in this original article I know very many single-payer advocates and even they don’t believe this plan will lead to single-payer.  Most of them are against it. Single-payer is not popular among democrats.  It really, truly isn’t.  I’ve spoken personally with democratic legislators about single-payer healthcare and even most of the very liberal ones do not think its right for America.

These problems are the reason I wrote this article.  Its not that I don’t understand the conservative perspective.  As a life long, hardcore conservative I understand very well the concept behind promoting free-enterprise over government solutions and individual responsibility over entitlement philosophy.  Its that as someone passionate about healthcare, who will actually have to spend my life working in whatever healthcare system we create, and who has looked forward for years for a bill like this to be written (whether by a democrat or a republican), it tears me apart to see it being dragged down by myths and misinformation in a way that no bill has before it.

Disagree with the bill if you want to.  I have absolutely no problem with that.  But disagree with the actual bill.  Read the non-partisan analysis and the reports of the bill’s actual content.  Keep up with the fact-checking organizations to see what’s really true.  And then make your judgement.  That’s the whole point of this post.

I don’t know that anything I’ve written will change your opinion.  If it doesn’t that’s OK.  But it has been an enjoyable experience overall.  This site was created to promote debate and as I said, I would much rather be having a back and forth like this than just a bunch of favorable responses.  But I probably won’t have time to respond again since this week is a busy one for me and I’m already behind.  Thanks again for participating in the blog and I hope to hear your perspective on future articles.

Raising taxes to cover the costs such that nothing will be added to the deficit does not seem to me to be realistic.  I am, of course, no expert, and I have not drudged through the thousands of pages of legislation that is currently floating through the House.  But given the CBO estimates that it will add at least in the hundreds of millions to the deficit seem so suggest that I am right.  I take it that Obama never said that he would only pass a deficit neutral health reform package, but that you are assuming this from a statement that he made that he wanted to pass more deficit sensitive legislation?  Well, I hope that is what he does.  

On this issue, like most, really, I think that everyone is on the same side.  We all want the best care for the most people delivered in the most efficient and cost-effective way possible.   Some people believe that the government can provide that; others, like me, have more faith in the private sector than in politicians and beaurocrats.  

This is all to say that I continue to disagree with your assertions.  I think that this will be prohibitively expensive, I think that services will be rationed, as they are in other countries with single-payer or socialized care.  While I agree that terms like “death panels” is totally inflammatory, there is still a reality to be dealt with that 80% of costs come in the last year? six months? of life and that curbing those is an easy way to cut down costs, and that Obama himself has said this, and that there was something unsettling about government-paid doctors initiating conversations with the elderly about their end of life care, and that enough rational people felt uncomfortable such that they agreed to change the language.  I agree with most proponents of Obama’s plan that this plan will lead to single-payer because the private sector will be unable to compete.  Already, some of the provisions in some bill out there makes it cheaper for small businesses to dump private health care coverage in favor of the public option. 

This article was written by a very liberal woman who still loves Obama but harbors the same issues as I regarding his plan.  Sometimes it is easier to understand a different perspective when it comes from someone who share’s one’s own philosophy.  So here it is  “obama’s healthcare horror” http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

ps i detected no difference in the civility of my early comments v the later ones, and i understand that people don’t like others to disagree with them, but there is something off-putting and self-righteous about congratulating the person on the other side of the debate for improving their tone.  just saying.

So with that said, the capps amendment would not prohibit the public plan from paying for abortions that are forbidden under the hyde amendment.  Meaning that under both the capps and hyde amendment, the public plan could choose to cover elective abortions.  This is because, unlike medicare and medicaid which are limited by the hyde amendment, the public plan is not a tax-payer funded insurance plan.  Its called a “public plan” because it would be available to the public and immune from certain regulations, not because its funded by the public.

Now this, “But what it also means is that the private plans that receive federal funds may also cover abortion services.  The idea is that the federal funds are segregated from the other funds.  But money is fungible.  ” is a valid argument.  I would argue that segregated funds are not meaningless and in fact money is segregated in real ways commonly in accounting and for tax purposes.

But before getting too deeply into that I’ll first point out that the private plans aren’t really receiving “federal funds”, its individuals who will be receiving tax credits who will use that money to purchase a private healthcare plan.  If this is concerning to you then I ask this question, “what about the grant money we give to students?  The tax credits for new home buyers?  The salaries of government employees?  Should we be monitoring these things to make sure none of that money is used to purchase private health insurance plans (most of which currently cover abortion)?”

Alexandrea, it is apparent from this statement that you still don’t understand my position.  I never said that the plans won’t cost money.  In fact, quite the opposite.  I’ve said several times that they are going to be expensive.  Deficit free does not mean cost free.

First off, the public plan portion of the healthcare reform bill will be cost-free to the government.  It will not provide free care to anyone.  Those who participate in it will pay premiums and co-pays like any other plan.  This will cover the cost of the public plan.  The real cost to the taxpayer comes in the form of subsidies to the poor and to an expansion of medicaid.  Those will be expensive, no doubt. In fact its likely to cost a bit over 1 trillion dollars, but that doesn’t mean 1 trillion will be added to the deficit.  The bill also calls for a certain number of cost saving measures, that the CBO estimates will make up for a large portion of that cost.  Then to cover the remaining costs, there are several ideas being floated, most prominently a focused tax increase on those making over 250,000 per year, but there are other ideas out there too.

In no way, at no time, have I claimed that somehow 50 million people are going to get health insurance without anybody paying for it.  That would be ridiculous.  But creating a bill that pays for itself through cost saving measures and tax increases should in no way strain anybody’s imagination.  It is very common historically for a president to issue an edict that a particular reform effort must be “deficit neutral” in that congress must balance the cost of the program by finding new ways to pay for it.  And President Obama indicated at the beginning of his term that he was going to make this a more common practice.  And once again, I’m pretty sure even republicans in congress believe that the eventual bill will be deficit neutral.

I think questioning the CBO’s predictions is reasonable.  They’re not always right, but I think historically they overestimate cost as often as they underestimate.  In two recent examples, the recession ended earlier than they predicted and the bank bailout has cost less than they expected.

So are they perfect?  Of course not.  Are they non-partisan?  I think most people would say so.  Certainly their estimations are just about the best we have.  And when they line up with predictions from third-party organizations we can have some confidence in the likely result.

But what it also means is that the private plans that receive federal funds may also cover abortion services.  The idea is that the federal funds are segregated from the other funds.  But money is fungible.  

You are right that I do not trust Obama to create a plan that is deficit neutral.  How one would add 50 million people to a plan and not reduce any services and do it at no additional cost to anyone defies my imagination.  But not yours.

The Kennedy-Dodd bill and the tri comission bill are very different.  The whole 1 trillion thing was a red herring because nobody, and I mean nobody, was taking the kennedy-dodd bill seriously.  That bill is irrelevant to the current debate.  It didn’t even come from the same house of congress!  So to suggest that the new bill is just a reworking of the old bill is certainly walking on shaky ground to say the least.

And once again, I discuss politics with a lot of conservatives and I’m not sure I’ve ever heard someone try to insinuate that the CBO is a liberal organization or that they are swayed by the president.  If you want to rest your argument on that assumption then once again, that seems like shaky ground to me.  If you know of any non-partisan organizations or even republican politicians that are claiming that the CBO predictions for this are a sham then let me know because I’d be interested to see it.

Has the president added to the deficit?  Of course.  But he didn’t claim the stimulus would be budget neutral.  He made a very public promise on this one, and he made it repeatedly.  And the legislature has committed to work on their bills until they are budget neutral.  Signing anything else into law would be a very public and stupid blunder. I think what we’ve gotten down to here is that you just don’t trust Obama to do what he says so you are freeing yourself to assume he’ll do whatever is convenient to support your position.  Look you can guess that he’ll break his promise and the bills won’t be budget neutral if you want.  I don’t know many republicans even that would support you on that but you can do it.  But don’t go around acting like I’m nuts for not accepting your guess as fact.

The coverage of the public plan is absolutely irrelevant.  The real issue was whether or not the healthcare exchange was going to require private plans to cover abortion (and because of the capps amendment they cannot) and whether or not subsidies given to low income individuals could be used to pay for abortion (and because of the capps amendment they cannot).  The public plan can choose to cover abortion or choose not to, because once again, it is not funded with taxpayer dollars.

I think you may be misunderstanding what I’m referring to when I say “public plan”.  I’m not referring to the healthcare plan overall, I’m referring to the specific provision of the bills that call for a public health insurance plan with the special ability to compete nationally.  Whether or not this plan is publicly funded is not up for debate.  It will not be funded by tax dollars and will not draw from the general fund, that is an accepted fact by democrats and republicans alike.