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The Untimely Death of Long-Term Health Insurance
The Administration’s decision to pull the plug on long-term health insurance in the new healthcare law (so-called Community Living Assistance Services and Support or, as it was known by healthcare insiders, CLASS) offers an important lesson.
As written, the law had three incompatible parts.
First, it required beneficiaries to receive at least $50 a day if they had a long-term illness or disability (to pay a caregiver or provide other forms of maintenance). That $50 was an absolute minimum. No flexibility on the downside.
Second, insurance premiums had to fully cover these costs. In budget-speak, the program was to be self-financing. Given the minimum benefit, that meant fairly hefty premiums.
Third, unlike the rest of the healthcare law, enrollment was to be voluntary. But given the fairly hefty premiums, the only people likely to sign up would know they’d need the benefit because they had or were prone to certain long-term illnesses or disabilities. Healthier people probably wouldn’t enroll.
Yet if the healthier didn’t enroll, the program would have to be financed entirely by the relatively unhealthy — which meant premiums would have to be even higher. So high, in fact, that even the relatively unhealthy wouldn’t be able to afford it.
End of story. End of program.
Why, oh why, didn’t the Obama administration make life easy for itself and for Americans by choosing the simplest and most efficient system for both primary and long-term health insurance — Medicare for all?
The lesson: If a public insurance system has minimum benefits and must pay for itself, it can’t be voluntary. Everyone has to sign up.
Or something else has to give — benefits have to be more flexible, or the program can’t be expected to pay for itself.
For example, Medicare and Social Security are mandatory. Everyone effectively signs up through their payrolls. Even so, questions arise about how flexible their benefits have to be if the programs must be self-financing.
So what does this mean for the remainder of the new healthcare law? Its fate hinges on the so-called individual mandate — the requirement that everyone, including younger and healthier people, participate (or pay a fine if they don’t).
Today’s decision to jettison long-term care offers clear evidence why that individual mandate is so necessary.
Unfortunately, the mandate isn’t popular — because it wasn’t modeled on Social Security or Medicare but based instead on private insurers who’ll want to maximize revenues. It’s also vulnerable to constitutional challenge, largely for the same reason. The Supreme Court will likely decide its fate this term.
Why, oh why, didn’t the Obama administration make life easy for itself and for Americans by choosing the simplest and most efficient system for both primary and long-term health insurance — Medicare for all?
It didn’t because it wanted to get Republican votes. It got almost none. And now the Republicans are enjoying the prospect of the law being dismembered piece by piece, starting today.
Robert Reich, one of the nation’s leading experts on work and the economy, is Chancellor’s Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. Time Magazine has named him one of the ten most effective cabinet secretaries of the last century. He has written thirteen books, including his latest best-seller, Aftershock: The Next Economy and America’s Future; The Work of Nations; Locked in the Cabinet; Supercapitalism; and his newest, Beyond Outrage. His syndicated columns, television appearances, and public radio commentaries reach millions of people each week. He is also a founding editor of the American Prospect magazine, and Chairman of the citizen’s group Common Cause. His widely-read blog can be found at www.robertreich.org.
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54 Comments so far
Show All"Why, oh why, didn’t the Obama administration make life easy for itself and for Americans by choosing the simplest and most efficient system for both primary and long-term health insurance — Medicare for all?"
Yeah, no kidding.
"It didn’t because it wanted to get Republican votes. It got almost none. And now the Republicans are enjoying the prospect of the law being dismembered piece by piece, starting today."
No, actually it was Obama pleasing his corporate backers, period -- the whole of the Medical Industrial Complex. Presently the Obama Administration is doubling down on the drug wars, reaffirming the "evil weed" and threatening medical marijuana concerns. Are the Republicans making him do this? No, but this is for his friends in BigPharma. Health Care Reform was a very, very long theatrical.
Yes, Obama's singular focus has been and continues to be amassing a corporate funded billion dollar 2012 campaign war chest. Obamacare is nothing more than refried Massachusetts Romneycare corporate welfare program that will assure Obama gets lots of corporate cash.
Obamacare assures that even fewer older workers will ever retire, thereby further reducing job opportunities for young Americans.
Reich needs to seek treatment for the denial syndrome that afflicts him.
I am sure that our friends in Big Pharma are working on that drug right now. Or maybe they can take one of their anti-depressants that they now say is good for nerve pain, and say that it goon for denial syndrome. Yeah, that works for me.
My major wake-up call to the whole political system -- really putting it under a microscope -- was my six-year brush with Paxil. I am six years off of it and I still suffer from PTSD from the withdrawal and memories of how I behaved while on it. I don't know how some people get on and off these poison pills easily -- some do. One of my online friends who went through this horrendous journey with me, as we both belonged to the same support site, ended the pain of life on anti-depressants last week. She was never able to completely get off them, for whatever reason. I visit the site once and while to connect with people and that's how I read this news and it just devastated me. It does take a lot of tenacity and grit to get through this.
Next to Paxil the people that suffer the most in withdrawal and have the hardest time getting off the drugs are those who have used Effexor and its evil twin Cymbalta. I was absolutely devastated to see these commercials for Cymbalta that don't even talk about depression, just chronic back pain. I have had chronic back pain since a dance injury when I was 20. My back pain was never worse than when I was Paxil. Literally could not get out of bed sometimes for several days. And, of course, while on Paxil I didn't give a crap about much of anything, except when I went through manic moods while on it and spent money I didn't have in ways that I never did before in my life and haven't since.
BTW, I heard a story on NPR about a study for back pain relief: Massage came out on top. And it's true. With the right person and the right type of message it is amazing how well it works. I had totally forgotten this. I only go once a month, but I spend most days with minimal pain and with each month passing it gets better.
I'm not sure of the exact cost of Cymbalta once a month, but I'm pretty sure it's well over $300 a month. If you had a massage once a month it would cost between $65 and $80, depending on where you're located. I pay $75. I am also, of course, uninsured, but I hear that people with really good insurance can get Cymbalta covered but not a massage.
I should add that despite the numerous problems I still suffer as a result of having been on Paxil, I am so happy that I am no longer a Pharma slave. Between the six years on and three years of the worst of the withdrawal, it was eight years -- eight years of sheer hell. Financially I am still paying for it and will for a few more years. All of the problems for which my doctor recommended this are still in my life and they're actually worse. I deal with persistent depression and anxiety, and a certain amount of agoraphobia, which I never suffered pre-Paxil. The people I really feel bad for are the kids who were put on this stuff with no choice in the matter and are now desperately trying to get their lives back or even finding out who they are. Aside from the physical mayhem the worst part of these strong psychotropic drugs is the way they take a normal brain and totally twist it like a pretzel until you become someone you don't recognize. I won't go into what these drugs do to a creative mind. It's really, really depressing.
"LONDON | Tue Oct 7, 2008 7:34pm EDT
(Reuters) - The herbal remedy St. John's Wort effectively treats symptoms of major depression, an analysis of previous studies found on Wednesday.
St. John's Wort extracts tested in the different trials were better than placebos and as effective as standard antidepressants with fewer side effects, the researchers reported in the Cochrane review, a journal that analyses medical and scientific studies.
"The studies came from a variety of countries, tested several different St. John's Wort extracts, and mostly included patients suffering from mild to moderately severe symptoms," Klaus Linde of the Center for Complementary Medicine in Munich, Germany wrote.
The herb works in a similar way to some prescription antidepressants by increasing the brain chemical serotonin, involved in controlling mood."
http://www.reuters.com/article/2008/10/07/us-depression-stjohnswort-idUSTRE496A2M20081007
Just make sure to get a reliable brand that has a standardized dosage. It takes about 2 to 3 weeks before it's effective and, aside from mild depression, has no withdrawal effects.
Check out the following video on YouTube
http://www.youtube.com/watch?v=UDlH9sV0lHU
A book on the topic
http://www.amazon.com/gp/product/0307452417?ie=UTF8&tag=thneyoreofbo-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0307452417
Author of book giving a talk about it
http://www.booktv.org/Watch/11502/Anatomy+of+an+Epidemic+Magic+
Bullets+Psychiatric+Drugs+and+the+Astonishing+Rise+of+Mental+
Illness+in+America.aspx
There is a book about the stomach being the second brain, a friend of mine was telling me about it. Always protect your stomach because a lot of these medications do more harm than good.
Sorry to hear about your struggle with Paxil, Samalabear. I understand completely where you're coming from. I too have suffered from depression and anxiety, and find myself now, for reasons outside of my control, about as depressed I've ever been. Yet because of my past experiences with antidepressants, I refuse to take them. Antidepressants both increase anxiety and, as you say, leave you devoid of feeling. Neat little trick, which is solved by adding tranquilizers and sleeping medications to the mix.
After not commenting much for a while, this is the 2nd response I've felt compelled to make tonight, commiserating with others about our corrupt, punitive medical system. It is indeed politicizing...except if you're psychotropic zombie, in which case Obama could nuke Iran and you'd still be grinning like a silly ass.
Exactly what I was going to say. Republican votes my a$$. They didn't want to piss off their sponsors, and future clients/employers.
The health care bill that so many democrats think is so great is a sick joke when compared to the real universal plans in effect in other western countries. The democratic party is so corrupt and right wing they didn't even propose a real universal system but chose instead to subsidize a failed private system incapable of providing health care to the population at a reasonable price. They actually stole the idea from a right wing think tank. How pathetic!
I don't think that even Democrats think that Obama's heath care system is great. They believe that the Democrats are really trying to make things better for the working people of the nation but that the strength of the Republicans have not allowed him to get anything better---and THAT IS THE PROBLEM.
To believe that the Democrats are better than the Republicans is to be unable to realize that there is really no difference between the two corporately funded political parties. Both of these political parties are funded by, and working for, the same corporate interests. Got that? They are essentially the same. No one is the lesser of two evils. It is a tie.
Our only chance of having a government that heeds the voice of the people is to never vote for either a Republican or a Democrat. It seems to me to be so very clear. I don't understand the loyal Democrat or Republican who will continue to vote for candidates who they can expect will ignore them as soon as the ballots are counted (if, in fact they are). Democrats and Republicans have been purchased by the big bucks and they don't give a _uck for you or me.
The final nail was driven with the vote for the Orwellian named "Patient Protection and Affordable Care Act of 2010". This then was the point that many learned that the 'system' is tilted away from economic justice and that we all (99% of us) are being victimized by a system that enhances the priorities of the 1% .
Just so, as with current climate action, alternative energy and taxing policies, people are, slowly every so slowly, coming to the realization that the majority are on the receiving end of policies that are against our well being.
Once the super committee has its say, with its undoubtable outcome that social services have to be reduced, the ground swell will rise, perhaps even to revolutionary levels. In the past individual groups have been targeted, today we all are victims and everyone, the whole world included, have come to the conclusion "Enough is Enough". Economic Justice for All not just for Americans and Europeans, everyone!
Paul Krugman and other Democratic apologists assured us that we should support Obamacare because we could fix it later. Well, congratulations, Krugman - indeed, the fix is in.
Maybe they meant fix like "I'm going to get my dog fixed."
I'll bet Obamacare turns into a nightmare.
Hello awesome,
It was a nightmare the first second it was proposed to Congress! Until it is totally gone the only positive thing that can be done is to polish the turd.
Obama is a front for the rich white run corporate interests. He is a liar and a sell out, I will vote for any viable 3rd party candidate. Never a Republican, they are traitors to the American political system that call democracy. They themselves and the treasonous bastard 5 on the supreme court whose law they created Citizens United, has killed America as we know it. These are Group of 5 are the worst kind of traitors to our country, This is free speech you treasonous corporate bastards
The corporation friendly US Supreme Court will uphold Obamacare's individual mandate, thereby establishing a precedent enabling corporations and the politicians they own to force you and I to buy other defective products.
The Democrats are pathetic, money mongering, craven, worms and the Republicans are deranged, dangerous, take the money and run, screw everyone else, filth.
No one in his/her right mind can possibly vote for anyone with either of the faces of the oligarchic, Janus head party.
Obama is a front for the rich white run corporate interests. He is a liar and a sell out, I will vote for any viable 3rd party candidate. Never a Republican, they are traitors to the American political system that call democracy. They themselves and the treasonous bastard 5 on the supreme court whose law they created Citizens United, has killed America as we know it. These are Group of 5 are the worst kind of traitors to our country, This is free speech you treasonous corporate bastards
Get off this black/white thing, fool.
Its what got Obama "elected" in the first place.
Uh, don't forget the anybody but Bush's GOP successor, the joke is on the Dems anyway. We still got a Bush replacement.
More evidence that America has morphed into a Corporatocracy!
Let's face it . . . there is only ONE PARTY now in America- THE AMERICAN CORPORATIST PARTY!
Exactly this Dim party shilling, big state as savior bullshit, has a Victorian musty odor to it in an age of networked decentralist, cooperative, non hierarchical, global revolution.
The Obama team was too clever by half in this mess.
Aware that Amerikan health care is an utter disaster--and getting more expensive & onerous all the time--they tried to cook up a policy shift that would mitigate SOME of its worst aspects.
Of course, they had to placate the bloated health care industry in charge of the current system -- so even a measly public option was strangled in the cradle. (And certainly no universal or even expansion of Medicare was acceptable.)
Compromise after compromise was the modus operandi, and not surprisingly, Rahm Emmanuel appears to have been petulant field commander behind this fiasco.
With such a corporate friendly and heavily compromised bill lumbering down the runway, Obama seemed deluded enough to believe that a number of his colleagues in the OTHER daffier wing of the Amerikan Corporate Party might be lured into coming aboard for the maiden flight.
Fully aware that this sucker could barely clear the ground, Republicans gleefully opened fire on it with every gun and missile in their arsenal.
Although it is certainly true that Obama is a corporate and Wall Street hack, fairly untainted by principles or loyalty to anything except wealth & power, he also seems absurdly foolish when tangoing with his corporatist allies across the aisle.
Gore Vidal put it rather succinctly:
Obama's mistake is that he "believes the Republican Party is a party when in fact it's a mindset, like Hitler Youth, based on hatred -- religious hatred, racial hatred. When you foreigners hear the word 'conservative,' you think of kindly old men hunting foxes. They're not -- they're fascists."
Obama isn't "absurdly foolish".
Obama IS devious, and a better actor than his idol Ronny Raygun was. That is why Obama has pushed through more GOP legislation in 2 years than most GOP Presidents pushed through in 4 years.
Obama is the best corporate money magnet the Dims have ever had.
And what is the sad reality of Long-term Care ... that 20% of Americans will need LTC ..That there is a 50% chance with couples that one will need LTC. People pay thousands of dollars per year to insure their cars, with a very low claim rate ...how else do insurance companies make money.. yet in a situation where people have a much higher probability of needing LTC, they balk
.
.States make auto insurance mandatory ...either you have it or you pay a huge fine and god forbid you get in an accident... If you don't have car insurance, all of your assets are at risk and claims are paid by everyone in an uninsured pool.
Same with longterm care...you need LTC and you must spend down your assets leaving the second spouse in poverty, or you go on Medicaid and bankrupt your state and county... With the boomers reaching the LTC age, the proverbial pig will be moving through the python ..LTC will be a major, major problem ... And if insurance companies can sell it with a large profit, why can't the government at a lower afordable mandated premium.
I'd much rather pay 1% or 2% more on my payroll tax and not have to worry about hundreds fof thousands in liability for LTC ...I do not want to bankrupt my family ...I want the home care option ...I don't want my wife of sons changing my diapers or lifeguarding my dementia... True ignorance is alarming .. Even the author.. Reich misses the reality of LTC... Do you want your diapers changed by your kids ...do you want to bankrupt your family in this awful economy ..
"And if insurance companies can sell it with a large
profit, why can't the government at a lower afordable
mandated premium."
The government could very easily, ducksawce (this has been successfully done in other countries), and we would all be happy, but that would require acceptance of the dreaded antithesis of capitalism, the 's' word, which our great, free ;>) MSM would rather have its tongue cut out than favorably mention.
Just stopped by to also point out that it was Obama's desire to appease the big health insurance and drug companies that prevented the 'medicare for all idea'.
That was the main reason, not any desire for Republican votes. As even my doctor noted yesterday, "Wall Street really likes Obama." Yep ...
Don't just put this all on Obama. He was too passive, leaving it to Max Baucus of Montana, that sniveling little puke, to take any semblance of single-payer off the table at the outset. Montana borders on Saskatchewan, where Canada's single-payer plan began. So near and yet so far away.
I used to think that, too, but shortly after the Obamacare debaucle Margaret Flowers did an interview and she said from the beginning everything was coming out of the WH. And she should know, because she was one of the Baucus 8 arrested. Baucus didn't give away the measly public option. That was Obama behind closed doors -- and without any Republicans twisting his arms. He gave it away completely in August of 2009 and yet it was still being argued about in public for a few months more, as if it could still happen. Obama drove a wedge between union and non-union workers when he said that union workers' don't have to worry about their benefits being taxed (so-called Cadillac policies). That's how he got union leaders to start applauding for Obamacare. Team Obama was completely in charge of this.
While I agree that Obama sold out, and sold out very early in the process (before he was elected), you also can't ignore the show of power being displayed through the corporate media against any kind of health care reform in 2009. All the main media outlets were allowed to basically channel the worst kinds of criticisms and fear-mongering non-sense to the masses (e.g., death panels), while simultaneously not fact-checking any claims or telling the people the truth. This corporate media is the same one that benefits from our fabulously corrupt election system, receiving much of the revenue from campaign spending in the form of advertising. The show of force being made through these mass media channels would be enough to scare any Democrat (particularly one who desires re-election more than anything else in life) away from even thinking about real reform. It was their "shot across the bow," in case Obama or anyone in his administration would have any thoughts about real reform.
But, the real tragedy in all of this is that Obama Care seems almost certain to fail. When it fails, the public will be led to believe that gov't-organized health care in any form has been proven to be a failure, and should never ever be tried again.
Much the same way that the tragedy for my generation, that we might actually find a presidential candidate who is worth voting for, worthy of investing any hope at all, is nothing more than a pipe-dream...Obama kills hope. He kills dreams. And he also kills future opportunities for people to make real reforms. Can you honestly say that the US would be any worse off with McCain-Palin? They wouldn't have done nearly as much damage to progressive spirit.
I still can't get over the betrayal. Early on in his Chicago years, Obama associated himself with the likes of Dr. Quentin Young an indefatigable proponent of single payer systems. Google Dr. Young and see the smiling Obama with the distinguished Doctor. It's so sad.
Yes, awesome, it reminds one of a young, happy, benevolent Ebenezer Scrooge joyously cutting capers at the Fezziwigs' Christmas party while the fiddler plays "Sir Roger de Coverley".
Oblahblah was just using his face, as he did so many others, as a stepping stone.
Why, oh why, did Obama ever think the Republicans would, at any time, for any reason, even for the betterment of our country, make nice with him, help him attain his goals, and those of the country's majority. The Republicans' goal is to make him a one-term president, openly stated by Mitch McConnell (R). So yes, why didn't Obama make it easier on everyone and just initially, agressively promote a system that has already proven effective and efficient, one that isn't profit-driven, that has one goal, which is to provide medical care? That program is Medicare~~for all.
I hope you're asking rhetorical questions. Obama's ploy of working to compromise has always been a sham. We all (should) know that the primary purpose of the medical-industrial-complex is NOT to heal people, but to make money.
Tricky - develop and pass a plan that is designed Not to work and then say See We Tried.
We've seen that 3 card monte scam by the oilybomber multiple times now -
All designed to disparage and denegrate progressive values when they have Never been tried or implemented.
When did the president get the power to arbitrarily cancel a program that Congress passed? Isn't that the kind of things that dictators do?
Yes. Do you get it yet?
This is just another example of capitalism feeding on itself. This system is so fractured. Medicare for all is the only reasonable solution as most other countries have figured out. I guess this will mean a lot of new classes on how to take care of your elderly parents and rehabilitation.
The anti-trust exemption granted to insurance companies should be lifted. Simple. Let them compete with each other for our premium dollars. Bet we'd see a rapid drop in premiums and a concomitant increase in benefits per dollar.
The question that remains about Obama is: Is he incompetent or is he doing this on purpose? But if he and his administration were truly this incompetent, would they be able to manage to be so consistent?
You do realize, of course, that if Medicare were expanded to cover everybody, then it would be able to fund itself. And nobody but the very richest would buy private coverage, except as a supplement. Just like in the socialist sinkhole that is Europe. Those poor people must be crying for Free Enterprise to come to their rescue.
Seriously, what happened to the pragmatism that used to characterize the USA? We didn't care where an idea came from or who thought of it; all that mattered was if it worked.
Corporate longterm care in America totally sucks. Unless you have read the regulations you have no idea how americans are being cheated and robbed blind.
Health insurance and nearly all longer term insurance programs are not viable.
All insurance presupposes that payout events are predictable long term.
All insurance depends on economic growth, a healthy currency and investment climate, so that the value of collected funds is maintained.
With global financial crisis and instability, wars, peak oil and global warming, say good-bye to predictability and a healthy growing economy. All insurance presupposes those at risk can afford to pay insurance. Big payout events are increasing. Even keeping the money in banks is an uninsurable risk.
With economic downturn, jobs dissappearing rapidly, cost of living increasing, say goodbye to affordibility for the 99%.
Being an american is a large-bore colorectal experience. And not just from the health care perspective.
"Unfortunately, the mandate isn’t popular — because it wasn’t modeled on Social Security or Medicare but based instead on private insurers who’ll want to maximize revenues. "
I heard Reich on NPR a year ago talking up the health care plan, and lamenting that people just didn't understand their collective responsibility and that's why they were balking. He did not even mention the disjunction of a for-profit, crappy system and mandatory participation by force of law, at that time it seemed he was trying to equate medicare and mandatory coverage.
Wait til Joe Sixpack gets that letter from the IRS indicating he owes hundreds of dollars for not buying expensive, unworkable crappy product for sale by those trying to make a fast buck. That will endear Democrats to just about everyone. Hope so.