HCR Mission Not Accomplished

I'm not seeing a whole lot of difference between the jubilant cheers of last night and this morning on progressive blogs and websites over passage of the health care reform bill and Bush's Iraq War mission accomplished speech.

On May 1. 2003, less than 2 months after the initial invasion of Iraq, George W. Bush declared "mission accomplished". At the time, not much of anything had been accomplished other than printing up the banner. Saddam Hussein wouldn't be captured until months later and Iraq itself, well, it's still not even close the beacon of democracy Bush promised 7 years later. Economically, Iraq is a mess having been turned from a developed country into an IMF/World Bank developing country required to put austerity spending into place. Iraq simply went from the neo-con dream to the neo-liberal dream.

Health care reform is in no better shape. The bill is nothing more than a complex infrastructure of exchanges, mandates and unsustainable subsidies. The few insurance regulations in there carry little enforcement and cheap fines, so cheap that it will be cheaper for insurance companies to become scofflaws than provide the required coverage. There are no direct cost or premium controls in the bill and there is no public option. It's argued that the mandates alone will control costs, but that only means that actuarially the cost should go down. The problem is that premiums are not determined actuarially. There is no reason to believe that the subsidies will keep up with premium increases.

The other promise of health care reform was that a person can keep what they have if they like it. That's just not true. There is no employer mandate and the structure encourages employers to drop coverage and dump people into the exchanges. The insurance provided in the exchanges can pay as little as 60% and over $5000 deductibles. That's enough to keep many people afraid to go to their doctors.

The bottom line here is that the Democrats wanted an early health care victory as much as George W. Bush wanted an early victory in Iraq and both were happy to manufacture one in lieu of the real thing, but what good is a political victory if it doesn't translate into policy victory? So, cool your jets Kossacks and HuffPosters. HCAN, amateur hour is over. It's time to do the real health care reform work to control premiums, remove unnecessary administrative costs, and improves the way care is provided.

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UPDATE: I just noticed a sneaky change that no one's talking about. Remember how you could get reimbursed from your health care savings account for over the counter medicines or other items such as cough medicine, contact lens solution? That's ending with the health care reform bill. The bill also increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses. The bill also limits contribution to $2,500 per year. I've never been a huge fan of MSA accounts because they have been used over the years by employers to reduce benefits, but since this bill does little to reduce costs, it's another slap in the collective middle class face to tax and disallow use of these accounts.