Nelson and Reid Reach a Deal: Game Over

[Sam Spade]

And now the real fun can begin...

[Sam Spade]

Obviously, when the bill actually comes out, I'll read it and give commentary.  But assuming that most provisions are similar to past bills, there are a few points to be made.

1) Any of the actual health care benefits as they pertain to the bill do not go into effect into 2013.  Remember that.

2) The number of uninsureds should decrease because they will be forced to buy health insurance on the open market as individuals (if they don't have work) or companies will have to provide said health insurance (I'll have to read the exact language).  This is the bribe being given to the health insurance companies and is a giant tax on individuals and small businesses that goes into effect now (remember because none of the government handouts to protect individuals/small businesses go into effect until 2013).  Illegals, of course, I think get out of this tax, but I'd need to read the new language to make sure.

3) A good chunk of savings are being done by massive cuts in Medicare benefits to doctors and by largely changing the system of Medicare as we know it (the former will be the same, the latter is how it in the House bill - I don't know whether the Senate changes this).  Historically, any cuts in Medicare payments to doctors have been reversed via omnibus spending changes later on.  So there's a two-way street here, either the cuts occur and the spending on this bill will increase by a ton or I suspect most doctors will stop taking Medicare.

4) There are a number of other individual taxes in previous bills that I'm not going to go into now - basically, Republican or Democrat, you're going to get ass-raped over the next 3 years.

[Sam Spade]

If a significant number of docs stop taking medicare patients, I would think the end game is to increase the payments but ration, since the money just isn't there to increase the payments and not ration, no matter how much one might want to do that.

If marginal employers have to provide health insurance, they will cut wages or hire fewer people, which means really that the employees are paying the premiums, which is as it should be. No one thought that subsidizing the premiums of the uninsured poors and the sick with pre-existing conditions would be free, but  maybe over time there will be some offsetting savings derived from less use of the emergency rooms, and less cost associated with delayed health care (with the attendant exacerbating the medical condition to be treated).

So, my initial impression, Sam Spade, is that if your bullet points are the "worst" that is in the Bill, it may well have merit.

Heh.  Let me read the actual bill first.

Few points:
1) If an increasing number of docs stop taking Medicare, you will essentially ration the care given to the elderly based on income (or at least set up a two-tier structure).  Increase in Medicare payments will never happen, though I can see the rationing coming into play (and who decides this, btw).  The question with Medicare payments is simply whether the cuts are real or will be rescinded under pressure later on as they always have been.  That will effect what else occurs.  The elimination of Medicare Advantage is specifically to benefit AARP, as I am sure you are well aware of.

2) The premiums for individuals will, of course, be much higher than those obtained to through employers - that's the reason why I referred to it as a stealth tax.  I disagree that emergency rooms will see less action - go see what happened in Massachusetts under Romney's plan.

3) I am sure you are well aware of what this really is - a revenue-raising method through increased taxation to offset the massive drop in government revenues that is still ongoing today.  The health care changes are lasting, but secondary, because the general thought is that by 2013, the economy will be better and revenues will be up so that we can implement what we really want.  Fits along with everything else the government is presently doing, actually.  Extend and pretend.

[Sam Spade]

Sam Spade, premiums for individuals at the moment are substantially less than the premiums in a group plan (in my case about half as much), if the individual got individual coverage while healthy. Will that change?

In NY, individual plan premiums are roughly double group plan premiums for the same health insurance coverage unless you qualify for state reductions. 

Of course, you can only get the same health insurance coverage as a individual that you can get as a group with a couple of rather useless exceptions.