Map of life expectancy at birth from Global Education Project.

Thursday, July 16, 2009

The House Bill

First, a correction, thanks to KWC, who clarifies that Unabomber Ted K's sanity was never actually adjudicated. He was adamantly opposed to the insanity defense his attorneys proposed and did not wish to be declared insane, and so he ended up accepting a plea bargain. As I wrote previously, I don't doubt that he is mentally ill, but I was referring only to this conclusion by psychiatrist Sally Johnson who evaluated him for the court:

In Mr. Kaczynski's case, the symptom presentation involves preoccupation with two principle delusional beliefs. A delusion is defined as a false belief based on incorrect inference about external reality that is firmly sustained despite what all most everyone else believes, and despite what constitutes inconvertible [sic] and obvious proof or evidence to the contrary. Delusional thinking occurs on a continuum and it is sometimes difficult to differentiate between over valued ideas or preoccupations and delusional thinking. It is helpful at times, to review the belief system in association with the individuals behavior over time. In Mr. Kaczynski's case, it appears that in the mid to late 1960s he experienced the onset of delusional thinking involving being controlled by modern technology.

TK may well have delusions or at least stubborn misconceptions about his family, and he certainly meets criteria for one or more personality disorders, but in describing his beliefs about technology as delusional, Dr. Johnson elevated a difference of opinion to a diagnostic criterion for schizophrenia. That was the only point I wished to make. (I should stop there but I will just add that I don't think his ill will toward his family is best explained as delusional; it seems to me that the simpler explanation is that his social skill deficits are responsible for his impaired relationships.)

Now, for today's business, you can read a fair summary of the House health care reform bill here. You probably won't want to read the entire bill because it's more than 1,000 pages and it's going to be pretty thoroughly worked over before anything hits the president's desk anyway so why bother. Among the good or at least good enough points in the bill given that we aren't going to single payer:

  • Requires community rating and bans medical underwriting. In other words, insurers have to take you and charge you what they charge everybody else in the area, except for a differential based on age.

  • Creates minimum benefit requirements including coverage of preventive services, and caps out of pocket expenses.

  • Establishes an insurance exchange so you have one-stop shopping and can find the plan you like the best.

  • It includes a publicly sponsored plan.

  • Subsidies for low income people are probably decent (although there's likely to be a group of people in their fifties and early sixties who fall through the cracks, since their premiums will be high).

  • Wipes out the existing Medicaid payment system for doctors and improves payment for primary care services (see yesterday's post).

  • Closes the doughnut hole.

  • Ends the "Medicare Advantage" rip-off of the taxpayers.

  • Has a play or pay requirement for employers which can be gamed, but will at least slow down the perverse trend toward dumping coverage of employees that would probably happen without it.

Problems? Won't quite cover everybody, some people still won't be able to afford coverage or will prefer to pay the penalty. The latter problem will create some adverse selection, which has the potential to feed on itself if policymakers aren't careful about fine tuning the incentives into the future.

Biggest problem: Doesn't do enough to control costs. Politically, I recognize that will have to come later, but it will have to come or the whole project is doomed within a few years. Update: You don't have to take that from me, having read this post [joke], the CBO weighs in to agree. Still, in its present form, I say vote yes on the House bill.

BTW, Dennis Kucinich still wants a single payer bill which is sweet of him but it ain't gonna happen right now so I figure we need to be dead fish for a while and go with the flow.

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