The problem is that I thought many of Silver's questions required extremely detailed answers. Fortunately, over the past few days and weeks, I have written several articles carefully addressing some of his questions. Instead of writing a new, extremely long 10,000 word response, I answered several questions with a short blurb and a link to my very long explanation. Silver did not copy these links in his article, or address the full argument that I made in the linked articles. For example, Silver says about my idea of using reconciliation:
There's also the idea, which Jon has advanced, of using the reconciliation process for some parts of the bill but not for others. It's a creative idea, but I don't see how it works, since it's not like you can keep this a secret from people. If you plan to pass certain provisions under reconciliation so as to circumvent Ben Nelson, it seems to me nearly certain that Ben Nelson would counter-circumvent you by filibustering the parts of the bill that you attempted to pass under regular order. So you'd still end up with half a loaf -- although maybe a different half than you might have otherwise.
I would never try to advance a “secret” strategy by posting it on a public website. I linked to my article, which fully addressed how you would circumvent Ben Nelson to get the insurance regulations passed. To summarize, the easiest route is to include them in the reconciliation bill and force Ben Nelson not to vote against waiving the Byrd rule. To remove them would require 41 votes. I don't think all 40 Republicans plus Ben Nelson or Joe Lieberman would make the politically terrible decision to vote against a stand-alone measure on banning pre-existing conditions. Even if they do, Harry Reid has other options.
The best is to do a repeat of the expansion of the hate crimes legislation. Do you think Ben Nelson wanted to expand hate crimes protection to gays and transgenders? He had no other choice because it was attached to a massive defense appropriations bill. Do you honestly think if Harry Reid attaches extremely popular insurance reform (that Ben Nelson has publicly claimed to support) to a massive defense or agricultural appropriations bill that Ben Nelson would threaten to bring down the whole bill just for spite? That is not going to happen. This is how you actually play hardball as a Senate majority leader.
Finally, while I'm at it, I need to address another argument Silver made today:
But that money isn't really going to poor people -- it's going to Cigna! Then there's an argument I have much less sympathy for: that the $900 billion is not ultimately going to disadvantaged people, but rather to insurance companies. Some of the money, indeed, will turn into insurance company profits. But how much? Probably not very much: most likely about $30 billion of the $900 billion, or about 3.3 percent, which is the average profit margin in the insurance industry. The insurance industry is actually not very profitable -- it may be inefficient, but it is not especially profitable. The vast majority of that $900 billion goes to improve health outcomes for poor and sick people.
First, it is completely unfair to compare the profit margins of an insurance company (which just holds money and takes some off the top) to a manufacturing company that make things and adds value to the system. Second, these numbers are all wrong--the Senate bill sends $848 billion on coverage expansion; $27 billion is spent on small employer tax credits; $374 billion is wisely spent on Medicaid and CHIP, where you get much more health care for your dollar. Only $447 billion is being spent on affordability tax credits on the exchange. That money will only partially help cover the cost of premiums on the exchange. For the sake of argument, let's say people will need to pay roughly 150% in premiums out of their own pocket compared to what they get in tax credits. So, this bill will direct roughly $1 trillion to the private insurance companies.
Insurance companies (most being technically non-profit) on average do have relatively low profit margins, but that is not the issue. Huge executive pay, corporate retreats, company jets, etc. are not technically profit, but I still don't want my health premiums or tax dollars being used to pay for them. The issue is that the insurance companies spend shockingly little on care and huge amounts on overhead. The recent memo from the CBO made it clear: the best minimum medical loss ratio regulation we can hope for from the bill is 80% in the individual market. That means of the roughly $1 trillion this bill funnels to the private insurance industry, about $200 billion will be wasted on the insurance companies' overhead.
That sounds like a very bad deal to me. It is insane that, in our attempt to expand health insurance, one in every five taxpayer dollars we give to individuals will be wasted by the private insurance companies. It is completely legitimate to demand that if taxpayer money is being used to provide people with health care, that the vast majority of that money is actually spent on providing regular people with health care.
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