I think Republicans are succeeding at scaring people over health care again.

[Sam Spade]

After tomorrow (maybe Thursday), I'll read the health care bills and give you my opinion.  I know what to expect but I am curious as to the details.

Just as a simple political pointer, over each week of the last 6 weeks (at least) I have seen a different tax trotted out in the news to pay for the health care legislation.  Politically, that means that different ideas are being tested to see which ones people react less negatively to.

As in terms of numbers (without reading the bill, but I am close to certain) it translates rather simply also...  The health care legislation proposed will cost the proverbial "arm and a leg" and given the fact that it is health care, I would think it rather fair to project that it will also cost "a couple of unknown eyeballs in the future" as well unless there is a certain amount of rationing.

The math doesn't lie.

[Sam Spade]

I know what to expect but I am curious as to the details.

What are you expecting?

An attempt to centralize the health insurance process (i.e. coverage) and individual decision-making, probably through the back-door.  I'm sure this can result in us having universal coverage of some sort, though.

A dramatic increase in costs, which will probably be severely understated unless care is rationed to a great extent.

Torie is quite right on the rationing point - it is inevitable.  The point I would make is that there are different kinds of rationing available.  States mentions one not-so-obvious type immediately - rationing of health-care availability to persons. 

But in any type of system that is "government-centered", I expect them to focus one particularly effective (if not the most-effective) type of rationing - namely care in the last year of a person's life.  In other words, the elderly and the terminally ill (or thought to be terminally ill). 

In other words, basically, if the tables say that you are unlikely to survive past one year with X cancer, you don't get chemo.  This type of rationing probably will eliminate a certain amount of "exotic" treatments as well for other types of diseases that may not be terminal within one year.  Now, this doesn't mean that you wouldn't be able to get it (either in the US if privately allowed or elsewhere), so long as you can pay, but generally it would be out of most people's grasp.

Anyway, this has been and what I continue to expect will occur.  Myself, I would prefer what States is proposing to this, but that is not what I expect to happen, since most people don't see this occuring (or maybe want it to occur - your choice).

Oh, and yes, there are ways to pick off around the edges in terms of costs.  But that will not fix anything, even in the short-term, unless we can get another major private debt expansion, a possibility I consider close to nil.

[Sam Spade]

I've read about 100 pages of the Senate and House version now.  I was originally going to read them straight on through, with each one separate, but the House version is so vague in so many areas that I had to go and read the Senate version to compare so I could make heads or tails of the damn thing in certain places.  Both plans are surprisingly similar.

My impression on what I've read so far:  Both bills are essentially a disaster waiting to happen in terms of health care quality and health care costs. 

On the costs side, the language of the legislation (since taxes and expenditures are generally undefined) is all I have to go on generally, but I can put 2+2 together and come up with the massive funding needed.  In fact, it may actually be worse than I expected. 

In terms of employment, there are some weirdly perverse disincentives going on for the both the employer (e.g. don't hire full-time workers) and the employee (eg don't ever switch jobs) that I find fascinating and which, btw, were probably never thought out before writing.

As for the health care quality itself, that will require oodles of time (and I have to read about 1500 more pages), but as basics become familiar with 1) what a "qualified plan" is and 2) the fact that it would have to cover "essential medical benefits" as defined by the Medical Advisory Council (or MAC) under the Secretary of Health and Human Services.  The House bill also implies such standards may be "set in statute", which means health care lobbyists have someone else to go after - the Senate bill does not. 3) Become familiar with the term "cost-sharing" - it is essentially a fancy term for rationing the essential medical benefits within qualified plans, as would be defined by the MAC.

Oh, and Torie, both the House and Senate bills explicitly forbid "qualified plans" from charging more for "health status" (i.e. risky behaviors) and forbid said plans from imposing any pre-existing condition exclusions.  To connect, that is but one of an (almost unimaginable) number of provisions that I have read in the first 100 pages that I can translate (without numbers) into meaning "this bill will cost a ton of money" (because the expansion of government subsidies for private health insurance goes into upper middle-class households) and "private/employer costs to insure themselves or their employees respectively will skyrocket".  A similar type of system has been instituted in New Jersey and New York and, needless to say, it caused premiums in both states to skyrocket ridiculously.

I'll do the rest over the next couple of days and see if I can describe how the thing works in plain English.  By that time, we may have another piece of legislation to throw on the health care pyre for examination.