I’m sure the White House is thrilled to have AHIP’s health insurers as a whipping boy in their efforts to gather support for President Obama’s health insurance reform bill. After all, an industy full of despised monopolists seeking exorbitant rate increases and whose business model depends on denying health coverage to unsuspecting Americans is just the villain remedy a good doctor would prescribe.
But for the life of me, I can’t understand why anyone thinks there’s a genuine dispute between the White House and AHIP.
A year ago, the White House made a deal with the insurers, and as far as I can tell, the deal is still in effect. Under that deal, AHIP agreed to support the thrust of insurance reforms — to end denials based on prior conditions and modestly restrict their discretion in charging higher premiums for some than for others. The White House agreed not to challenge the basic structure of private insurance via wholesale replacement with a public system. Both sides have, so far, kept their respective promises.
So what are they fighting about? Here are the key principles they agree on:
1. There will be exchanges in which anyone not otherwise covered at work can purchase more or less standardized insurance on a guaranteed issue basis.
2. There will be mandates, with some exceptions, to require individuals and small businesses to purchase insurance on these exchanges or contribute to the costs if they do not.
3. The mandates should be enforced by penalties on individuals and businesses that do not otherwise provide coverage at work.
4. The federal government will, via billions in subsidies, help those subject to the mandates pay the private insurers’ premiums.
5. In the exchanges, there will be no significant public insurance competition for the private insurance industry.
6. There will be no serious effort to regulate rates at the federal level, and there may be some preemption of conflicting state regulation. The main focus of the federal regulation will be to standardize coverage and set other standards that will minimize needless competition and provide certainty to the insurers.
7. The federal government will make efforts to rein in escalating provider costs, to prevent the insurers from being squeezed between provider market power and consumer protests.
Those are the core principles, the basic framework of Obama’s proposal, and I can’t see any item on which the parties disagree.
AHIP is, of course, furious that the White House is picking on them. But they’re probably not that angry, because whatever support the President gets for his bill, that’s probably fine with the insurers. AHIP doesn’t want to kill the bill that saves them.
Mandates not strong enough? The President’s bill strengthens them. Provider costs a part of the problem? The White House agrees. A Public Option unacceptable? Gosh, it just doesn’t have Rockefeller’s vote.
And if you look at what AHIP is saying in its protest ads, the basic message is: the deal is still on, and we want this bill to pass. Just stop blaming us because we’re just a small slice of the problem.
Whatever fight they’re having is a distraction, and for the White House, a convenient ruse.
More:
TPM, Sebelius vs Ignagni at AHIP reports on the faux fight



58 Comments







As far as I can tell, they’re mostly fighting the regulations like mandated medical loss ratios, which though it doesn’t go far enough, isn’t trivial either.
Jason R:
Because there is nothing to prevent the insurers from raising premiums, the medical loss ratio is absolutely a trivial matter. Here is how it will shake out:I(I wrote this Dec 2009 and nothing has changed)the 85% can be changed to any number you like.
“The requirement for insurance companies to payout 85% of premiums is being touted by Senators Franken, Rockefeller among many others, as a cost containment measure. I challenge all those Frankens etc. to explain to the American people what, if anything, is contained in either the House or Senate bills that will prevent the following scenario from playing out.
Given: There is a mandate for all Americans to purchase health insurance.
Given: Those of lesser economic means will have their premiums subsidized by the taxpayers.
Given: We are all either individual purchasers and/or also taxpayers (we pay the subsidies).
Given: The insurance companies must spend 85% of premiums collected on health care.
Given: There is no limit set by either bill on the amount the insurance companies can charge for premiums.
What is to prevent the insurance company from raising the price of the premiums by 10X?
The individuals (who have to purchase insurance) can’t afford that, so, we all trot on down to our local Federal Health Insurance Subsidy/Welfare Office and sign up for subsidies. Of course that is an intrusive, time-consuming exercise because we have to disclose to the Federal Government all our financial and personal information in order to qualify.
Those individuals who refuse to participate and don’t buy insurance are now lawbreakers, “on the lam”, waiting for the government to find out and send their henchmen to collect.
Meanwhile, the insurance companies tell the docs and hospitals (the real healthcare providers) that now the $100k reimbursement bills they used to submit and get paid only $20k will now be paid in full. The healthcare providers love that so they are all for it. The insurance companies instead of being allowed to keep 85% of $1 trillion now get to keep 85% of $10 trillion. The individual pays the same in out of pocket premiums but is on welfare and the taxpayer is stuck with paying the monumentally huge subsidies.
Come on Franken, Rockefeller, anyone who is claiming this 85% rule will contain costs, explain how this contains costs and is not just another wealth transfer from the taxpayers to a specific oligopoly just like with the bank/wall street “bailout”/ i.e.wealth transfer.”
There is a very easy way for the insurance industry to respond to the 85% rule. Cut back on their pre-authorization staff. Almost all care given to any insured patient is subject to pre-approval. This involves hours on the phone that begins with secretaries and eventually works its way up to clinicians. The insurance companies throw every possible barrier into this process. My office has been working for 3 weeks now trying to get an approval for one patient for one visit. This is very common.
To cut their administrative expenses to meet the 85% rule they will just cut the insurance staff who handles this process. The math works out nicely for them. Less staff =more profit. Delayed and less care = more profit.
The math is not as good for providers. Unlike the insurance companies we want to take care of our patients. Initially we will be forced to hire more staff to deal with the delays in the process but we can only do that to a point. It will drive provider administrative costs up dramatically. Eventually it will just delay care and probably will cost some patients their lives
jm51,
Brilliant point. Its just a matter of scale for these thieves. 15 percent of 30 billion is a helluva lot more than 15 percent of 20 billion. But, we can’t blame the senators, they are a product of the greatest educational system in the World! But, perhaps its better that they look like dunces rather than as craven tools of the pluticracy. This whole kabuki dance is about sucking as much out of the taxpayers and insured as possible before the ultimate collapse of the system. I always say, when you don’t understand what’s going on, just follow the money [or did deep throat say that?]
lameold
Just some theater for the rubes. Obama needs to look tough against the bad guys. The same ones he’s gladly handing us all over to on a silver platter for 33 pieces of silver.
Yeah, I agree with seaglass. O is pretending to beat on health insureres just as he pretended to beat on Wall Street ‘fat cats’. Doubt anyone was fooled by either performance. No Oscar for you, O!
Obama, Methinks thou dost protest too much.
Bright shiny object to deflect attention from the real soultion. Medicare for all.
This is Kabuki theater, a sham, a pantomime debate to fool the sheeple into accepting what amounts to a massive giveaway to the insurance companies. The insurance companies can afford to spend millions to make it look realistic because they know what comes out of it is a huge windfall for them.
Yes, saw that. Now Kuchinich is enemy number one. Used to be Jane Hamsher. But dammit! I liked Ed. He had a list of the problems that high insurance costs foist on Americans. Didn’t say how this bill solves ANY of it, which is Kuchinich and Hamsher and the rests point. But they want to BELIEVE. Jesus Christ, he’s pleading with the House-the very few politicians left in this country that actually represent the people to TRUST the Senate and Obama?
Why? What good faith has Obama ever and I do mean EVER, shown a progressive? And the Senate are the biggest bunch of cronies in it for themselves people in this country next to Wall Street. I can’t believe how easily they are all fooled. And I knew the fix was in as soon as Wendell Potter did a 180 and wants the bill passed now.
I keep asking how dumb do they think we are? This is pathetic.
Also ED mentioned-drum roll-Obama’s presidency. “We must save it.” Oh really? Let me state for posterity I have never given a shit less about a man’s career than his. Earn your second term, buddy. Some of us actually pay attention to what you say and do.
If Obama isn’t willing to do anything to save his own presidency, why should we?
Ed Schultz on right now trying to sell this POS with the usual talking points. Disgusting. Setting it up to blame the “liberal left” when the bill fails. He’s such a dupe.
I was sorely disappointed with Ed today…! 8-(
I’m not. He’s a conservative ex Republican Democrat. Might as well have “DLC” stamped on his ass. He probably does in fact.
I found Ed to be unusually surreal tonight in his defense of the senate health insurance give-away bill. I especially enjoyed his sermon about why it is so necessary to pay the insurance companys’ protetcion money to prevent recision and pre-existing conditions. What I find so disengenuous about the argument is that the bill will not prevent bankruptcy from inability to pay health care bills. Most who have a middle class income and a serious illness will quickly go under and this bill does nothing to address this problem. Ed has danced his last dance for me.
I agree with you.
Ed needs to put his self in psycho talk.
Ed knew he way lying tonite, and he kept talking, and talking,
I’ve been watching him. Boy, in the end these Corp. clowns sure know where they’re bread is buttered don’t they? Ed has lost any cred. with me after this performance art piece. He’s a candidate for his own Psycho talk corner. The poor guy is looking more and more daily like his nemesis Beck.
Look at it this way. Either HRC passes or it doesn’t.
(a) If he supports it, and it passes, he’s a hero, gets to march in the parade, and keeps his show. If it doesn’t pass, he’s still a hero, gets to be a pallbearer in the funeral, and keeps his show.
(b) If he opposes it, and it passes, he’s a traitor, banned from the parade, and loses his show. If it doesn’t pass, he’s the scapegoat, banned from the funeral, and loses his show.
(a) is the easy choice if you’re on TeeVee. Especially if KO and TRMS already chose (a)
Ed has swallowed the party talking points hook line and sinker. He has lost all credibility with me. Too bad bcz I used to like watching his show.
Obama is a fraud and the sooner Americans wake up to that fact the better. Any self-respecting progressive should already know that.
And now there are 41 Senators for a public option but…..
And if supermarket-food,etc.- profit margins are less than 5 per cent ,why in hell do the insurers need 10-15 per cent?
Supermarket profits are low (2-5%) on an ITEM. Let’s say a can of peas for $5.00. How many time a year do you believe they buy and sell an ITEM with that $5.00? 10? 12? 20?.
Now calculate the supermarket’s gross profit.
I beleive it’s a phony fight with republicans too, this is such a boon to the health care industry I am amazed they are fighting it, I am amazed they are lobbying republicans to fight it.
Remember the “Morning Fred.”" Morning Sam.” cartoon skit on bugs bunny with the sheepdog and the coyote? They’re just going through the motions.
Fixed it for ya.
Polling showed that insurance companies were unpopular with the hoi polloi, so hence this contrived anger at the insurance companies who I am sure were complicit in this little soap opera. In a soap opera when someone dies it’s just part of the story line. In this soap opera, people die for real.
We’re here for the entertainment of, and to serve the wealthy and powerful. Even if the script calls for our death.
This is a “fight” that benefits everyone. Obama because he can look tough on insurers. Insurers because they can say that HCR wasn’t their idea* when it inevitably fails to control costs.
*It was their idea by the way. I used to work for an insurer.
you know, if you can post proof, this would make an incredible diary that I believe will go front board and viral
please to write it!
you remember when cheney had the oil companies write “the energy bill”?
I hope you can come up with proof and post a diary, even though we know it by event speculation, inside the industry proof will put an end to their bill and possibly get a real bill written
at the very least I think it will add pressure to remove the mandate
Margaret, I do like his Prairie Populism from time to time, M’dear…!
And I agree. It’s just I never harbored any illusions about him being a progressive or a liberal.
It’s all Grand Kabuki. Period.
So the removal of anti-trust exemption for the health insurance industry still isn’t finished. Here’s the last update I saw:
“UPDATE 1-US House slaps antitrust law on health insurers”
http://www.reuters.com/article/idUSN2419234420100224
Dr. Dean is on Ed right now and its pathetic. These guys are all caving to the Ins. companies. Potter’s so called cave was the capper. Old Potter did his job for his pals well didn’t he? I got news for everyone I can smell BS and Potter was the ultimate in it. This guy has played us all. But, I ‘ve dealt with guys like Potter. After all this over this man will eventually retire with a BIG FAT retirement in some other country gratis his old bosses.
Ed remember what Nancy Reagan said Just say NO TO DRUGS!
Real Progressives owe something to OBAMA? you must be using Meth
Obama track record has been real clear.
Obama is for more War (Ed Obama wants to Attack IRAN, this is why Rahm is trying to get rid of as many Dems in the House as he can)
Obama is against Drug Importation (Ed ask Dorgan what happen to his Bill, he was on your show)
Obama is against the Public Option
Obama is FOR the individual mandate (Ed how much did the insurance companies pay GE, MSNBC, How much did you sell out for ED)
David Axelrod, David Plouffe, want the HCR scam Bill to pass so they can get some huge Advertising Contracts from Pharma and Big Insurance, they have sold out, so Ed how much did they buy you for?
Obama is FOR the Excise Tax on Union Health Care Plans
Obama is for Busting up the Teacher’s Union
Obama is for WALL STREET BAIL OUTS and BONUSES (Ed your Boy Obama cheers when poor teachers get fired, and does nothing to punish Wall Street)
Ed your next show should be what OBAMA has done for PROGRESSIVES? (Ed this will be your shortest show ever, OBAMA has done nothing for LEFT)
ED by the way DK told you last night, Insurance Companies make money DENYING PEOPLE health Care!
The women on your SHOW still would lose their Health Care if this BILL passes? How? Ed the Insurance Companies would just raise the RATES on their converage to the point they could not afford it. Thus the need for a Public Option
Ed? Insurance Companies and Mother Teresa have nothing in COMMON. Ed you spoke like a complete MORON tonight, Blue Cross and Blue SHield can careless about Americans Health? They Don’t!
ED? Bring Max Baucus and the Insurance Executives that wrote the OBAMA Health CARE SCAM ON your SHOW, and ask them what is PROGRESSIVE about their REPUBLICAN HEALTH CARE PLAN.
ED THE LIBERAL LEFT OWES OBAMA A PRIMARY CHALLENGE AND THAT IS IT!
Of course it won’t work
I don’t get too exercised over the “treason” of supposed progressives who have thrown the public option, or Medicare buy-in, under the bus, because nothing, not this exchange plan, and not the public option, will work to hold prices down unless the industry is killed off. And out-of-control prices means we end up somewhere on the continuum of the number of people going without insurance trading off against the progressivley more ruinous subsidies required to keep any one insured.
We made a huge mistake in the 80s when we accepted the validity of the managed care concept. While noble in its expressed aim of controlling provider over-pricing and over-treatment, it soon was forced to abandon controlling the market via managing the care delivered, which was never going to be an easy thing even without pushback, and used the market freedom it had won to control the market and profitability by means of controlling everything except the quality of care delivered. You can make money at managed care only insofar as you manage to avoid providing care, so that what the industry’s good at. That and cartelling for fun and profit, which they get away with because we seem to have forgotten about this thing called monopoly pricing, or at least renamed the phenomenon as a good thing, “market power”.
So, no, any scheme to rescue the health insurance industry suffers, not just from the problem that that is a morally bankrupt end, but from the deeper problem that the rescue just won’t work. The exchanges won’t be able to impose on the industry any of the do-gooder reforms that are on the list cited, because all of them will cost the insurers money, and there will not be the political will to force anything that will raise the premiums of that majority of mandated people who have no pre-existing conditions. Nothing about the bailout that the mandate will give the industry will in any way change the malincentives that keep them from controlling prices. The price spiral will continue, even intensify. The idea that the insurance industry cartel will use enhnaced market power to dun lower prices out of the big providers, the hospital chains and Big Pharma, is a pipe dream. These three cartels are largely really just one cartel, the Unholy Trinity of our day.
At the end of the day, the price spiral will leave so many people uninsured that the political system will finally have to do something real about the situation, somehting that is not all window-dressing. We’ll do Single Payer and kill off the industry, then break up the provider cartels so that the single payer will be able to get costs down comparable to the rest of the industrialized world. None of the plans on offer have anything to do with what has to happen to move at all on this issue, so I’m not hacked at anyone for supporting or failing to support any of them. It makes just as much sense to be pro or con the Non-Juring Bishops of late 17th Century England. Who cares.
Great post Scarecrow and great explanation gt!
The Health Ins. crooks can taste it now. This is they’re dream come true. They will get their hands into all of our pockets and they’ll have the big guns of the IRS to back them up. This is a dark day for America.
Everyone involved in this multi-act melodrama knows the script. Has the parts down perfectly, and can be depended on to hit the marks exactly. This may look like chaos to outsiders, but insiders run these kinds of shows all the time.
It didn’t take long for Obama to make Dubya look like a man of integrity.
That we must do something does not mean we must do this particular thing.
And yet that logical fallacy, of which lawyer Obama is surely aware, is precisely the argument he’s using in his speeches this week.
Bush at least had the plausible deniability of stupidity or outright mental illness.
Obama does not, and thus by not only continuing Bush’s programs but pushing these others of his own, Obama is actually worse for America than Bush.
For those watching MSNBC’s coverage of this this week (including Olbermann/O’Donnell bringing on Moulitsas who called Dennis Kucinich a “little prick” – talk about a shining moment of projection there), this story about MSNBC and Jess Ventura seems relevant:
Jesse Ventura: MSNBC Tried to Shut Me Up
(in case HuffPost spikes the column, the full transcript is here: Jesse Ventura TYT Interview (w/ Transcript))
The essence of the story is that MSNBC had signed Ventura to do a 5-day-a-week show (like Olbermann and Maddow but years earlier). When MSNBC discovered Ventura was against the Iraq war, they paid him for all three years of his contract (which then required he not speak about it) and never aired a single show.
Don’t think the same thing isn’t going on here.
Though that’s not surprising – the health care bill as it stands is very clearly fascist, so the collusion between government and other businesses (in this case media) will be the same.
It was pretty disgusting watching corporate call boy obama rolling us his sleeves and doing his stand-up schtick against his health insurance pals and using their greed as a reason to pass a bill that gives them all of our business with the IRS as their enforcer.
And why would the health insurance companies raise their rates so much RIGHT NOW when this bill is still being considered if they are truly against this bill? THEY AREN’T, THEY WANT THIS BILL TO HAPPEN … it captures tens of millions of customers for them and a government subsidy to help people that can’t afford it to buy their product. How exactly is obama’s bill a shot against their bow?
Z
This is not a phony fight. I’m not pleased with this bill, but it will help millions of people, including 10 million or so who get covered under Medicaid, a public program. Another FDL diary, posted here: http://seminal.firedoglake.com/diary/34433, points out that the insurance companies are spending a million bucks a day fighting this fight. That’s pretty expensive to play a game of charades. The insurance company problem is that the mandate is really cheap insurance. People who pay the penalty can still sign up for insurance after they get sick. So the companies have to pay the bills for really sick people. That’s not their model, it doesn’t make money for them, and it’s what they’re fighting with all their might..
Serious question without snark here. How does someone unemployed, barely paying his mortgage and feeding his family, somehow afford mandated insurance? If he can’t afford it, he’s still not insured! For the life of me I don’t understand this. Tax credits won’t help people with no money. Am I missing something in these bills? The reason these people don’t have health insurance is they can’t afford it.
I think the canned response to that is, if you’re poor enough, you get subsidies from the government (taxpayers). Not sure if that covers everything (deductibles, co-pays, whatever). So it may be true that the poorest people will get “coverage” but, as pointed out in several posts above, that doesn’t necessarily result in actual “care.” I haven’t seen yet how they factor in the likelihood of increasing unemployment and higher percentages of people being subsidized. Whatever it is, since it involves for-profit insurance companies whose job it is to deny care whenever possible, it’s utterly unsustainable.
Its all about stopping people without Ins. from using the emergency room. Under most State laws now they must be treated even if they have nothing. This cash the Ins. companies want being funneled to them. They call these folks free riders. The truth is they can’t afford the Ins. and thats why their in the emerg. room. Many jobs do not provide Ins. for their employees and these folks are the ones showing up for care at the emerg. room. This is all about them.
Yes, I know, I am “them” – I am self-employed and haven’t had health insurance for 10 years. So far I haven’t had to use the emergency room, although if they offered dental care, I would have been there. Under this bill I will be forced to buy crap insurance that I will seldom use because I am healthy and don’t go to doctors or take prescription medicine unless it’s an absolute necessity. I would certainly prefer to pay a reasonable amount for catastrophic coverage that would actually cover a catastrophe, but that doesn’t really exist either. I’m about to file for bankruptcy to fend off the consequences of my house foreclosing, so that won’t be an option for me if I get hit by a bus in the next nine years. God, I do love this country.
Some tax credits, such as the Earned income Credit, are refundable.
It’s true that individual insurers are playing both sides, via support for the Chamber of Commerce ads, I suspect in an effort to shape the bill. My point is that the basic structure of the insurance portion is something they support. they just want stonger mandates/tougher penalties, looser regulations, etc — but I don’t think AHIP’s official position is “kill the bill.”
I agree with your other point, that the bill is a mixed bag; it has features I dislike, but also lots of worthwhile features, e.g., some of which concern expansions, extensions, more funding for public insurance and/or health programs — SCHIP, Medicaid, community clinics, better funding for Medicare, reduced subsidies for private Med Advantages, and so on. It’s why the left is deeply split.
The bill is a sellout. All these people screaming bloody murder over how bad the senate bill was a while back now can’t stop singing its praises. I look at gutless wonders like Ed on the Ed show who has flip flopped and you wonder what if anything the dems have on him. I hate to tell you a preexisting prohibition where they are allowed to increase my rates by 300% is like no prohibition at all. Many would argue you have a corporate party with the democratic and republican wings. Not much difference.
You people who think that pass this now and we will fix it later have got some screws loose. Look at reality, if they can’t get anything done with 50 votes in the Senate and the huge majority in the house then after this upcoming election where they will lose seats then how in the heck do you think they will do anything. I’ve seen it before, people gullibiliy never ceases to amaze.
Will someone pls send a copy of this to DLC suckup Ed Schultz? He spends his whole show begging progressives to support this insurance give away without any regard to what the bill actually does. Ed could care less about the mandates or the lack of cost controls in the bill, he just wants to save Obama’s presidency.
It’s all political theater designed to scapegoat the insurance companies for Obama’s failure to propose or support meaningful health care reform. The maddening thing for me is the outright charade and arrogance of this bogus dispute. Obama is looking more and more ridiculous and is acting desperate to pass anything called HCR.
It should be 60 and not 50 votes in the senate.
Worse then Ed is the phony turn coat Wendell Potter. This klown has played the traitor for the last yr. but I can almost guarentee all of u this guy was really the Ins. companies pt. man out here. All yr. he argues in public all over this country how we had to stand firm against the Ins. gangsters but here right at the end who plants the knife in Reforms back but Wendall himself. Why? because , he was always their champion always the guy who in the end would be set up so that we all would see we had no chance if Wendall said so and that it was time to bend a knee to his pals. Wendall will retire in glory among the health shit bags a true hero for an act well played on the stage of public opinion! This creep did his job well he even turned Ed at the end. The truth is and will be revealed one day that this phony turn coat was the Industries secret weapon all along .
Seaglass, could you point me to a link(s) about Wendell Potter on this matter? Thanks much.
Durbin, health care insurance will cost more under the government plan. Pelosi, we have to pass this bill so the American People can read “what’s in it!” Reid, 36,000 job loss is a good thing. What the ?????
Are we all on the same planet?
Durbin’s comments were indeed stunning. For those of us that have been trying to tell the truth about the costs of the bill to policyholders – it seems a little late in the day for Durbin to be admitting that ‘Gee – we don’t want you thinking your premiums are actually going to be going down…they just won’t up so fast.’THIS is the best the dems can do?
As far as the MSNBC line-up is concerned – they have sadly become the mouthpiece for this administration – in the same way FOX was for Bush – and I don’t like it any better. It’s depressing.
That checklist definitely shows how deep in the ahip pocket the White House is.