But looks what happens when they leave the Byzantine structure intact as the lobbyists have already cemented before this went widely public: The providers have to accept reimbursement for Medicare patients at Medicare rates, which aren't great. They may treat Medicaid patients at Medicaid rates - much worse. They get stiffed by employer-hired insurers who have nothing to lose by stiffing them - no real recourse for bad behavior, and they made sure that protection stayed in place - even for the NEW popukation in the exhange.    Who does that leave to bear the burden of cost shifting? Taxpayers, obviously, for those who then get public asistance. It leaves the employees who fell afoul of their employer-provided benefits exposed to fantasy prices. They can't get out of it if they aren't poor enough for public support, unless they destroy their credit, face collection or go bankrupt. It also leaves the insurers with smaller patients bases without the negotiating power that large insurers with large patient armies (largely from large companies) can wield on negotiated rates. People in the smaller pools or the individual market are in a bad position.

Now: Cut Medicare reimbursement rates and limit testing and procedures, etc., as they are going to do (because they must), and what happens to all of the above?

Under HR 3200 we say, first, put a lot more of them on Medicaid. Second, take a lot of them and let them have "the exchange." A huge patient base where we will mandate minimum benefits, guaranteed issue, and rate setting. But ait - what about people who STILL aren't poor enough or Medicaid or rich enough to afford premiums, especially for a family. Well, we'll subsidize them. Maybe we'll give them a government run program as well, for a few of them.

So, even though you are ratcheting down reimbursements and costs, you can balance all of that over time, without "unfair subsidies," with mandated rate setting that will allow private insurers (or even nonprofit insurers) to function, without enhancing the deficit, and without taxing the middle class, and without anyone losing their employer-provided coverage they love so much (because they are ignorant), even while preserving the hundreds of billions or so in insurance administrative costs, and the employer's tax breaks, and, in fact, the bulk of the employee benefits industry? "Yep, we can do all that, with constant monitoring and a four or five year start up window."

That, I think, is Obama's my plan. It's stupid, ineffectual, inefficient, and I support it.

Is that irony?


It's better than the status quo.