Senate's HELP Bill Helpful?

A week ago, I posted a link to the Senate's Health, Education, Labor and Pensions Committee's "Affordable Health Choices Act" narrative with my statement that I would comment on it after a chance to review the long document. Today, President Obama noted that the Senate Finance Committee has not yet issued its proposal (which will probably deal with Medicare and Medicaid spending or savings), which is no small matter, because the two bills will have to be combined before the Senate votes on the penultimate bill (the conference committee opus will presumably be the ultimate bill). So, what you read in the Affordable Health Choices Act is not predictive of the substance of the Senate bill. But it's worth comment anyway.

The bill promises insurance market reforms. Since, under pressure from national employers and insurers, a game that the states and insurance industry has played has been insurer incorporation and policy-writing in states with employer-favorable insurance laws. However, some states have larded insurance laws with requirements for specific services demanded by provider, and sometimes patient, pressure groups. I wonder whether there will be federal licensing/certification of all health insurers in the United States which intend to write insurance under health reform legislation, and whether the federal government will usurp (a fighting word for "preempt" in this case) state health care insurance regulatory authorities. If so, there will be significant fight-back from the entrenched insurance regulatory interests, and their political and financial buddies, in all 50 states (except, perhaps, California which is so dysfunctional it might not even notice).

The bill seeks to assume that health insurers engage, with the federal government, employers and the public, in "the collaborative articulation of shared purposes" (a Harvard Law School phrase favored by the late professor Lon Fuller). Again, with my Brooklyn upbringing, I go back to the concept that where there's a lot of money to be divided up, expect the insurers to find techniques and devices to maximize their revenues and reduce their exposures to risks. In the 39 years that I have focused on health insurance, HMOs and other means of financing health care, I have never known an insurer to be particularly interested in anything other than its self-interest. I see no reason to believe that President Obama can change this perspective, reduce health insurers' greed, self-serving behavior and indifference to the suffering caused by their business plans, and control the inflationary pressure on health care costs that they generate.

Subtitle B, "Available Coverage for All Americans" will shunt many "health care" dollars into States' Affordable Health Benefit Gateways. Dollars that should be used to purchase health care will be sucked into bureaucratic byways, never to be seen again or accounted-for though government bean-counters will create expensive paper trail requirements. Instead of insurers getting their 25% overhead, the bureaucracy will share a chunk of that revenue. Where's the efficiency that President Obama promised?

Subtitle C, "Affordable Coverage for All Americans" promises subsidies in the form of a yet-to-be-defined "credit" system. There is a geographic adjustment provision, which if past experience is any guide, will favor southeast states (which will salve their Congresspeople's political wounds and give them something to point to in the next election).

Subtitle D speaks of "Shared Responsibility for Health Care" but only deals with shared responsibility for paying for someone else's alcoholism, smoking, drug use, lack of exercise, dangerous driving practices, poor eating habits, and understated but very real toxic industrial exposures.

Subtitle H deals with "Community Living Assistance Services and Supports." While this may be a laudable goal, should it come from the national health budget? Is it truly health care?

I have only dealt with subtitles of Title I. There's lots more, and I suggest that my readers look at this material critically. What is proposed is a mouse built by a committee. What we will get is an voracious uncontrollable elephant which will leave no grass standing in the health care arena.