Some initial thoughts on the proposed MPS health-care benefit changes

by folkbum

In short--and, as I'm up waaay past my bedtime, short is what you get--the devil is in the details.

The changes are summarized in the blue book for next Tuesday's meeting, available, here (pdf), and more thoroughly in this attachment (pdf, including a lot of annoying sideways pages). The district is offering two briefing sessions at Central Office on Monday prior to Tuesday's Board meeting (at 4:00 and 6:00), where presumably all this will be hashed out.


But here's what it looks like: Steep jumps in premiums for either plan, the PPO or the EPO (HMO), and steeper jumps in out-of-pocket costs for both plans. Indeed, the deductibles for the cheaper EPO plan, for example, increase ten times their present amount under the proposal.


The changes in premiums are not unreasonable by themselves. Under the current contract, teachers are paying 1% (single) or 2% (family) of their salary as a premium; here, the premium for most teachers would be either 12% or 14% of the plan cost. The current salary deductions for an average teacher earning $55,000 in base pay add up to about 5% of the plan cost; the change would hit younger teachers harder because the premium shifts from percentage of salary to percentage of the plan cost. And the difference in premium between the EPO and PPO is totally worth it for having broader choice of providers.

But combined with sharp increases in deductibles and out-of-pocket fees, the changes become significantly unreasonable. In the grand scheme, this is because the US health care system is full of crap, providing mediocre quality care at prices the rest of the world just doesn't have to endure, of course, and there's little any one of us can do to change that. But if this goes through, combined with changes to how pensions are calculated, and even assuming no other changes or reductions to the salary schedule after the contract expires in June 2013, teachers in MPS can expect 10%-20% less take-home pay, depending on what their salary is now.

Remarkably, many people will insist that this--like layoffs--is good for the local economy.

(As an aside: I wouldn't be surprised, even given this and the presentation of the facilities master plan report, if the most contentious item on the Board's agenda for Tuesday is the proposed changes to food service.)

Will Van Hollen personally pick seniors' pockets for the money, or does he have people for that?

by folkbum

JB Van Hollen, Wisconsin's Attorney General, declared today that following the logic-bending ruling in yesterday's health-care ruling (one of two against the law, not one of the dozen-plus in favor of the law), health-care reform in Wisconsin is "dead."

Here's some of what the now-"dead" law has done for people in Wisconsin:

• 35,998 Medicare Part D “Donut Hole” Rebate Checks: In Wisconsin, 35,998 Medicare beneficiaries have received a one-time, tax free $250 rebate to help pay for prescriptions in the “donut hole” coverage gap.
• Nearly $1 million to Plan for a Health Insurance Exchange: These grants will give States the resources they need to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed.
• $7.3 million for demonstration projects to address health professions workforce needs
• $200,000 for State Health Care Workforce Development Grants
• $3.8 million for the Primary Care Residency Expansion Program

Plus, you know, sticking it to businesses:

167 Employers Enrolled in Early Retiree Reinsurance Program: The Early Retiree Reinsurance Program (ERRP) provides much-needed financial relief to businesses, schools and other educational institutions, unions, State and local governments, and non-profits, in order to help retirees and their families continue to have quality, affordable health coverage.

This includes Wisconsin institutions like Briggs & Stratton, Kimberly-Clark, Northwestern Mutual, Wausau Paper, and West Bend Mutual Insurance; not to mention government institutions like Scott Walker's Milwaukee County!

One of the most exciting things about the Affordable Care Act is its funding for innovative, potentially game-changing experiments in better health-care delivery. Wisconsin's health care institutions have received, so far, more than $7 million to run demonstration projects to find the best ways to deliver more care to more people more cheaply. (Everyone seems to be linking to this story of in The New Yorker about such projects, so I may as well, too.) Those could be "dead" in Wisconsin, too.

Look, I don't really know what Van Hollen intends to do now--it kind of sounds like he doesn't, either--and he probably won't actually demand the money back from grandma and grandpa. Not in this snow, anyway.

But clearly he is not interested in protecting Wisconsin's seniors, businesses, and innovators. There was no need for him to say a thing about it today, much less try to set anything in motion that will hurt the state. Yet he did! Thanks again, GOP.

But what they really hate is the uncertainty

by folkbum

Millions of small business owners may now have to fire their employees or cut off their health insurance because of an activist judge in Florida. Plus, he just blew a, what? $500 billion hole in Wisconsin's long-term budget?

Thanks, GOP.

Is it too soon to start sending bon-bons to Anthony Kennedy?

Where's my shotgun?

by folkbum

The zombie lies are at the front door again.

More Paul Ryan deception on health care

Or, it's a day that ends in -y and Paul Ryan opened his mouth

by folkbum

About the only thing nice I can say about Paul Ryan's repeated insistence on writing about the health care bill just passed is that, bless him, he is one of the last of us who insist on spelling health care as two words, the way FSM intended it to be.

Aside from that, there is basically nothing to recommend in his latest op-ed fantasy. His starting point is the recently released Health and Human Services/ Center for Medicare and Medicaid Services report. Thankfully, Ryan does not repeat the fiction--one that ricocheted around the righty blogs last week--that the Obama administration buried the report. Such a claim is embarrassing to contemplate spreading, seeing as how there is nothing in the report that wasn't already widely known. The Congressional Budget Office told us all in its scoring of the bill back in March that total health care spending with the bill passed would be greater than total health care spending without the bill being passed. The CMS report says the same thing, and Ryan is hyperventilating like it's something new to panic about. Here's Ryan:

The health care law will increase national health expenditures by an additional $311 billion above current projections. This estimate refutes the Majority’s promise that the legislation would bend the cost curve down, not up.

Ryan is being misleadingly cynical in the most charitable interpretation--outright lying if I'm being less kind. For starters, this is pretty simple math: The Affordable Care Act adds about 34 million more people to the ranks of the insured, and according to both the CBO and CMS, total health care spending will increase about 1%. Got that? We're adding 12% of the population to the rolls at a cost of not 12% more, or even 8% more, but just 1% more. And that is total spending including the private sector, not merely government spending. Ezra Klein, please:

And that 1 percent is actually 1 percent and falling: When the legislation is fully implemented in 2016, the spending increase will be 2 percent. But cost controls kick in over those years and bring it down to 1 percent. Assuming the trend holds, the second decade will see national health expenditures fall below what spending would've been if the bill hadn't passed. So that's the bottom line of the report: We're covering 34 million people and come 2019, spending is expected to be one percentage point--and falling--above what it would've been if we'd done nothing.

Or, as actual actuary Jim Lynch (via) noted the other day: "I really don’t see where anyone can claim the actuaries’ report sheds new light on the health care legislation passed this year. And what is new is slightly favorable to Obamacare, not the other way around." In other words, the CMS report that Paul Ryan is whining about, no matter how you slice it, is good news for reform advocates, and bad news for naysayers like Ryan.

(The graph comes from a different Ezra Klein post, but I hope you can see how ridiculous Ryan's whining about increased costs actually is. Click for a bigger version, or follow that link.)

Here's lyin' Paul Ryan a couple paragraphs later:

Approximately 14 million people will be dropped from employer coverage as “…the per-worker penalties assessed on nonparticipating employers are relative low compared to prevailing health insurance costs. As a result, the penalties would not be a substantial deterrent to dropping or forgoing coverage.”

Now, if you're an average Racine Journal Times reader who comes across this line, what do you think it means? Do you think it means that the ranks of the uninsured will swell by 14 million people? Or at least that 14 million fewer people will be getting health insurance through their jobs than without the bill having been passed? That's a reasonable answer, based on what Paul Ryan gave you here. But remember, this is Paul Ryan we're talking about, so he's lying to you again. Let me quote some more from the CMS study, the same paragraph even, that Ryan quotes from (page 7 for those of you following along at home--my emphasis):

By 2019, an estimated 13 million workers and family members would become newly covered as a result of additional employers offering health coverage, a greater proportion of workers enrolling in employer plans, and an extension of dependent coverage up to age 26. However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their—and their employees’—advantage to end their plans, thereby allowing their workers to qualify for heavily subsidized coverage through the Exchanges. Somewhat similarly, many part-time workers could obtain coverage more inexpensively through the Exchanges or by enrolling in the expanded Medicaid program. Finally, as noted previously, the per-worker penalties assessed on nonparticipating employers are very low compared to prevailing health insurance costs. As a result, the penalties would not be a significant deterrent to dropping or forgoing coverage. We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 17 million, or somewhat more than the number newly covered through existing and new employer plans under the PPACA. As indicated in table 2, the total number of persons with employer coverage in 2019 is estimated to be 4 million lower under the reform package than under current law.

So when Ryan wants you to think the ACA means 14 million fewer people with employer-paid insurance, he's actually off by a full ten million people.

(And I am not even going to bother going into how wrong Ryan is on Medicare Advantage--if he wants to use the CBO to bash the ACA he should be using the CBO to bash Medicare Advantage, too. That's only fair, right?)

I have said it before and I will say it again now: I do not understand how someone who is so brazen, so brash, so sloppy in his representation of the facts continues to be lauded and taken seriously by people, particularly the media. How is it that the Journal Times can let all of this go without a fact check or a rebuttal by someone more firmly rooted in reality. Paul Ryan is unashamedly lying to his constituents, over and over and over again.

Good Point

by folkbum

Quote of the day (annotated):

Also too, it’s a lot tougher to counterfeit a chicken than to counterfeit a piece of paper.

I just read it for the comments

by folkbum

On the one hand, hilarious. On the other, scary what they believe to be true.

ATT, Caterpillar health-care "tax" scares explained

by folkbum

It didn't take long once the health-care reform bill was all but a certainty before the Usual Suspects here (in comments) and across the Cheddarsphere (1 2 3 4 5 6 7 8--I probably missed some) started braying that Corporate America was going to feel a pretty severe sting based on changes to the tax code contained in the HCR package. Earth-mover industry giant Caterpillar, for example, claimed it would have to fork over $100 million in just the first year based on this new bill. Or so commenters and bloggers claimed.

It seemed fishy to me at the time, but I didn't have the chance to go through and figure out exactly what it meant. But the other day apparently the Wall Street Journal--Corporate America's Official Spokesperson--ran an editorial rehashing the claims:

Yesterday AT&T announced that it will be forced to make a $1 billion writedown due solely to the health bill, in what has become a wave of such corporate losses. [. . .]

Black-letter financial accounting rules require that corporations immediately restate their earnings to reflect the present value of their long-term health liabilities, including a higher tax burden. Should these companies have played chicken with the Securities and Exchange Commission to avoid this politically inconvenient reality? Democrats don't like what their bill is doing in the real world, so they now want to intimidate CEOs into keeping quiet.

On top of AT&T's $1 billion, the writedown wave so far includes Deere & Co., $150 million; Caterpillar, $100 million; AK Steel, $31 million; 3M, $90 million; and Valero Energy, up to $20 million. Verizon has also warned its employees about its new higher health-care costs, and there will be many more in the coming days and weeks.

First of all, these are write-downs. Write-downs are, of course, different from normal expenses or regular write-offs; write-downs indicate the reduced future value of an asset. To be clear: These companies are not claiming gigantic new tax losses; they are saying some asset will be worth less in the future than they thought.

So what asset are these companies writing down? Ezra Klein explains:

When George W. Bush and the Republican Congress passed Medicare Part D in 2003, they were presented with a problem: The fact that the government was now offering prescription drug coverage might encourage these companies to dump the prescription drug coverage they were already offering employees. So Congress gave them a kickback: Companies that provide retiree drug benefits get a subsidy of about $1,300 per retiree per year in order to keep companies from ending their retiree drug plans at once and dumping everyone into Medicare. This subsidy is not just tax free but also tax deductible. Let me make sure that's clear: Not only did companies get a subsidy, but they could also deduct that subsidy from their taxes. Sweet deal.

This looked a bit nuts in retrospect, so Democrats ended the subsidy's deductibility. Again, let's be clear: They didn't end the subsidy. And they didn't make it taxable. They just said that it couldn't be used as a tax deduction.

The asset that these companies are writing down is free money from the feds. That's right--starting in 2004, the feds (read: taxpayers) began giving these companies free money to spend on their retirees' drug costs. And until this week, these companies also got to deduct the value of that free money from their taxes when they spent it.

Or, to put it yet another way: The new law demands that corporations pay taxes on the tax money we give them so that we don't spend tax money on pills for their retirees. Confusing? A little. But is this really something that conservative critics of the law ought to be hyping to the extent that they are? The fact that an essentially new (since 2004) corporate giveaway has lost its tax-deductible status?

When conservatives blog that ATT or Caterpillar will lose millions or billions because of "Obamacare," yeah, that sounds scary. But the truth--that these bloggers are defending not just tax giveaways to corporations but a loophole that lets those corporations double-deduct the giveaway--should shame those conservative bloggers.

Paul Ryan's Cajones II

by folkbum

Ryan, today: "By inviting market forces into health care, we can encourage a system where doctors, insurers and hospitals compete against one another for the business of informed consumers" (my emphasis).

Ryan, one month ago: One of only 19 House members (all Republicans) to vote against removing the anti-trust exemption enjoyed by insurance companies.

What's in the bill

by folkbum

With the health care bill about to become law--and, let's be clear, this was done with above-board and legal and usual Congressional practice, not even with "deem and pass" or reconciliation--I thought I would try to find easy info about what's in it and who's affected by it. Here are two good sources.

The Wall Street Journal walks through the timeline of changes in coverage and taxes. Note that even the conservative WSJ helps to point out the lie that "the taxes start now."

The LA Times lays out much of the same, but some more and different, information about the bill in convenient chart form. And you know how much I loves me some charts!

Debunking that "The Taxes Start Now" Lie

by folkbum

Ezra Klein helpfully provides this graph:



You will notice that the orange bars, meant to represent the revenue (or cost savings) of the health care bill just passed, are negative this year and wee tiny for the next two years. For all the handwringing among the righties about "the taxes start now" nonsense, they're actually exactly wrong about that.

You'll note that this chart also handily debunks the notion that this is a "takeover" of the health care sector or of 16% of the economy. While indeed $180 billion seems like a lot of money to spend or to count as revenue/ savings (looking at the far right of the graph), in 2019 the US is projected (.pdf) to spend $4.5 trillion on health care. For those lacking calculators at the moment, that means that when this bill fully kicks in, this bill will be responsible for about 4% of health care spending. It would take an extreme amount of dishonest manipulation to try to sell the idea that this is a "takeover" of anything.

I'm moderately proud to be a Democrat this morning

by folkbum

It took what, 60 years to get here? But the Congress has passed an historic piece of legislation that slightly nudges the health insurance situation in the United States to something closer to universal coverage.

Let's be clear: What was passed last night--the Senate bill will become law on Tuesday, when President Obama signs it--is a modest and disappointing bill. The bill to be passed later this week--reconciliation, which passed the House last night but needs to be passed yet by the Senate--makes the reform infinitesimally better.

However, there are some significant immediate benefits that will begin on Tuesday when the bill becomes the law of the land. Closing the odious Medicare Part D "donut hole" (something Republicans saddled seniors with after their dead-of-night antics passing that bill). Starting a new appeals process for those already covered by insurance, and making it harder for insurance companies to deny new coverage. Helping small businesses to afford to extend coverage to their workers. All of these are good things, and to be commended and celebrated.

And as time goes on, more elements of the reform will kick in, including cost controls and expanded access to basic and preventive care across the nation. These are also all good things, and to be commended and celebrated.

It's also worth celebrating that the Democrats seem to have held together (what was it Will Rogers said about us again?) and got something significant done. This is not something that has happened often in my lifetime. I think the last time may have been passing Bill Clinton's 1994 budget--you know, the one that led to a decade of unparalleled growth and record budget surpluses?--which, like health care, happened without a single Republican vote.

It is almost not at all surprising that Republicans held fast against it; after all, their leadership has been clear of late that that was their only strategy. (Some sensible Republicans have noted that this is a dumb strategy, not just for their party, but for the nation as a whole.) This is in contrast to previous decades when Republicans used to promote exactly the same kinds of reforms that are in the bill now.

I say almost, because in retrospect a couple of things are if not surprising, then at least disturbing. For example, apparently the process of how a bill becomes a law (everyone sing along, now) is "sleazy." Let's recap: Last spring and summer, the House and Senate held weeks of televised hearings on reform, released multiple full-text versions of reform bills, and debated all through the fall the best way to proceed. The House passed a bill in December. The Senate, overcoming a filibuster and days of Republican delaying tactics, also passed a bill. (I'm still looking for the sleazy part.) Last night, after hours of more delaying tactics by Republicans, the House passed the Senate version of the bill and it's now awaiting Obama's signature. That's the way Congress works, has worked, will continue to work. When both houses pass the same bill, it gets signed (usually) and becomes law. What's sleazy?

There is reconciliation. The House passed it last night, and the Senate has the votes to pass it as soon as they can overcome the inevitable delaying tactics by Republicans. But here's the second surprising-slash-disturbing thing: Republicans seem to remain unified against this part, as well. Which I literally do not understand, because the reconciliation bill does indeed make things better. It improves the Senate bill. It kills the "Cornhusker Kickback" and many of the other special deals that may have been the "sleazy" part and which have fueled a lot of the public and tea-party backlash against reform. It makes the bill cheaper, short-term and long-run. It fixes, by everyone's estimation, R or D, con or lib, many of the ugliest parts of the final bill being signed into law tomorrow. If Republicans were honest brokers instead of stubborn dolts, they would realize that the grand fight is over, and they lost, and they ought to be working and voting to make the winning bill more to their liking. Instead, they've continued to stonewall and delay and refuse to participate meaningfully in the governance of this nation.

Which is why, though I am only moderately proud to be a Democrat this morning, I would be utterly mortified and ashamed to be a Republican right now.

It's time to bring Health Care Reform home

by folkbum

I have long believed that Congress is not now, will not now, will probably not ever pass the health care reform bill that I would write. However, the Congress is now at a point where it must vote for the bill it has in front of it. Any further delay--and a failure to get this bill done now--is unconscionable and unforgivable.

There are whip counts everywhere you look, and according to Nate Silver, who counts better than just about anyone else on the internets, "if you take the seeming yes votes and add them to the people who are uncommitted but voted for the bill last time around, they add up to 217." That's one above the current magic number of 216.

The Washington Post is keeping track here, although they list as "undecided" some people who have clearly announced their yes votes or who would be insane not to vote yes. For example, Wisconsin's Ron Kind and Dave Obey are on there, and they're not very likely to vote no this time around. (Although if you live in their districts, it wouldn't hurt to give their offices a call and encourage passage--202-224-3121 is the House switchboard number.) Steve Kagen is on the WaPo's list of undecideds, too, not surprising after last week. Give him a call, too, even though he does not at present appear on anyone else's undecided list.

Steve Benen, who is as good a summation as Nate Silver is at math, lays out what this bill means:

The legislation is fully paid for, reduces the deficit in this decade, and even more in the next decade. It will bring coverage to 32 million Americans -- slightly better than the earlier estimate -- and extend Medicare solvency by at least 9 years while closing the prescription drug "donut hole."

This is on top of some obvious benefits that would accrue immediately and the clear long-term cost-reduction and coverage measures that kick in later. This is not a bill any self-respecting Democrat should balk at and, frankly, given Republicans' professed belief in deficit reduction and fixing Medicare, it ought to be something even the GOP can get behind. But Republicans have this thing called party unity, and that apparently is more important than saving lives or walking the talk.

Voting yes on this bill is a moral imperative, not to mention an electoral imperative. (It is easier to campaign on a record of having done something than on a record of having done nothing, particularly when the status quo is deeply unpopular.) It's time.

Milwaukee-based insurer targeted HIV patients for recission

by folkbum

Reuters--and not the Milwaukee media--has the story:

By winning the verdict against Fortis [now known as Assurant Health], Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.

Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators. [. . .]

Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.

Is this really the kind of behavior Mark Neumann and Paul Ryan want to stand behind as they oppose health care reform? Disgusting.

Mark Neumann, protecting us from health care

by folkbum

Thank goodness candidate Neumann is out there, pledging that, if elected governor of Wisconsin, he would "take steps to try to block a health care bill from taking effect" here. Because we need someone like Mark Neumann to make sure that none of these awful things come to pass here behind the Cheddar Curtain:

• barring insurance companies from discriminating against Wisconsinites with pre-existing conditions and from dropping customers who inconveniently get sick
• closing the Medicare Part D "donut hole" to save Wisconsin seniors money on prescription drugs
• opening an insurance exchange that would allow Wisconsin individuals to buy into group policies at lower rates
• providing subsidies for poor Wisconsin families to buy health insurance from Wisconsin insurance providers (this might create, you know, jobs or something, and Neumann probably doesn't want that to happen)
• offering help to Wisconsin's small businesses to make it easier for them to offer their employees health care coverage
• removing "lifetime" and limiting "annual" coverage limits that drive some Wisconsinites who have insurance to declare bankruptcy anyway
• building community medical centers in regions of Wisconsin that have shortages of primary care providers

If only all of Wisconsin's candidates had the fortitude to stand up for the status quo, where thousands die and millions more go uncared for because of this country's unique health care model!

A Mistake Kagen Doesn't Want to Make

by folkbum

I keep being occasionally relieved as I read all the lists posted yon and wide, of Democratic members of Congress who are wavering on health care now that we are inches from the finish line, lists that have not included any Wisconsin reps who should know better. In fact, if last week you asked me to put money down on which Rep would muck up the works, I might have guessed Gwen Moore--I have been afraid she would be hesitant to vote for the Senate bill (a necessary step in the process) because it was not progressive enough.

Pretty much last on my list of possible Wisconsin defectors was Dr. Steve Kagen. Why? When the man courted my endorsement in 2006, he sat across a Starbucks table from me and asserted, flatly, that comprehensive health care reform was his top priority. It was his signature campaign issue. And he was an easy yes vote in the House last year.

So what do I find today? Ugh:

Rep. Steve Kagen (D) of Wisconsin voted for reform, and is now hedging. "I have made the case to the speaker and also to the White House that we should take small pieces, small bites," Kagen said. "In the practice of medicine, I can't give a child a big pill. What do we do? We cut it up into pieces. Let's find things we can agree on."

WTF? Seriously? What is this about? His platform in 2006 was not "small bites," and it was a sight more progressive than the current versions of the reform package.

I will be calling Kagen's office tomorrow--hey, we all should: (920) 380-0061--to try to figure out what's going on. I mean, it can't be because Kagen thinks this will save his seat this fall. People who are planning to vote Republican or Tea Party or Martian or whatever aren't gonna suddenly turn around and go, Oh, yeah, Kagen's a swell guy! He lost those votes a long time ago, when he voted Yea the first time, if not long before that.

And anyway, I have yet to see a poll suggesting that any of the rogues gallery up nort' right now poses a risk.

And if Kagen really thinks this vote is the pivotal moment of this election, well, he's got two choices. He can enjoy the full support of state grass-roots Dems and stand on the right side of history, or he can vote no and wonder where his backers are come November.

(Greg Sargent compiles the list of others like Kagen who risk making a dumb mistake in the next couple of weeks.)

Yes There Are Consequences

By Keith R. Schmitz

For those of you continually warn that "a government takeover" of health care is going to be a disaster (hard to believe that $200 B a year could be a take over) and for those of you who want a "perfect" health care bill, today's New York Times editorial about what happens if reform does not pass is worth reading.

Do you feel lucky?

Paul Ryan votes to kill John Galt

by folkbum

Yesterday, a bill passed the US House of Representatives passed a bill by a remarkable margin of 406 to 19. This is not because Democrats have suddenly taken over an extra 150 House seats without your noticing; it is, in fact, because the bill is one following an ages-old American value: Corporate monopolies are bad for business, for consumers, and for workers.

The bill removed an exemption to anti-trust laws that was specially crafted for insurance companies. While states currently have theoretical authority to investigate and block insurance company monopolies, many simply don't: A study by the AMA (pdf) finds that the vast majority of markets are dominated by a single insurer, crossing the usual Department of Justice threshold for market concentration. In some states, a single insurance company writes upwards of 2/3 of the policies.

Here in Wisconsin, 52% of us are insured by WellPoint; in neighboring Iowa, 71% are insured by Wellmark. Across the lake, 65% of Michiganders are insured by Blue Cross. And so on.

One of the 19--all Republicans, by the way--who voted against removing the special protections insurance companies receive was Wisconsin's Paul Ryan. This may have something to do with where his campaign contributions come from, I can't say for sure. But in another way, it kind of surprises me. Ryan professes to be a fan of juvenile philosopher Ayn Rand, whose two-dimensional heroes (and, yes, I've read some of the books) tend to be self-made entrepreneurs who have to struggle for acceptance and success against the reigning corporate or political hegemony. By voting to allow insurance companies to maintain monopoly or monopsony power, Ryan is voting to keep the John Galts of the world shut out of a major sector of the US economy.

All of which just reenforces the pretty clear narrative about Republicans like Paul Ryan: While claiming to be pro-business, they ae actually just pro-existing business. Other health insurance reform measures, like those making it easier for small businesses to offer health insurance to their employees, have been shut down or shouted down by Ryan and his ilk. In return, they offer race-to-the-bottom proposals designed to enrich their corporate sponsors at the expense of working Americans--not something even Ayn Rand would approve of.

The Cost of Doing Nothing

By Keith R. Schmitz

Reported by the Los Angles Times, health care spending grew to a record 17.3% of the U.S. economy last year, marking the largest one-year jump in its share of the economy since the government started keeping such records half a century ago.

Obviously the cost of making us well is making the economy sick, and if we do nothing health care will eat us alive.

Sorry, the answer here is not tax cuts. Nor is it high deductible insurance plans, which are driving people into debt. What we need is thinking along the lines of sending a man to the moon, but thanks to our campaign financing system and rigid ideologues, the chances are slim.

Charts of the Day

by folkbum

1. How the health care bill helps:



2. What consensus looks like (via):



3. Keep in mind tonight: