Pun Salad

[An HTMLized version of a letter to my state's Democratic Senator.]

I was perusing your website and found this page, where you answer a telephone town hall question from "Emil from Salem" about maintaining one's current health insurance coverage under health care "reform".

Emil from Salem: My question is the same concern I believe others have reiterated. I'm retried [sic] on Medicare and I also have my private health insurance. If we maintain our own health insurance, will we be able to keep that? Or are we going to be forced in a matter of years into the government plan? If we're able to keep it, will we at some point be penalized by paying taxes on it?

Shaheen: No, no. My understanding, Emil, is that — and I know this is true of the bill that has come out of the committee in the Senate — if you have health coverage that you like you can keep it. As I said, you may have missed my remarks at the beginning of the call, but one of the things I that I said as a requirement that I have for supporting a bill is that if you have health coverage that you like you should be able to keep that. Now, if you're someone who has lost your coverage or you're underinsured or you've lost your job and as a result have lost your coverage then I think that public option, which would hopefully be more affordable than the other choices that you have, then that would be a plan that would be open to you. But under ever scenario that I've seen, if you have health coverage that you like, you get to keep it.

I've emphasized the key phrase above: something you consider a "requirement" for supporting the bill. The "you can keep it" formulation has been quite common: President Obama, and a host of other Democratic politicians have used it. So have outside groups: I've seen it at the AARP website and in Consumer Reports. (I can only assume that you're all reading off the same set of talking points.)

But it's not true. And if you're serious about it being a "requirement", you can't support the bill now under consideration in the Senate.

• The bill imposes a new massive and complex set of rules at the federal level on health insurance providers. If the "coverage that you like" happens to fall on the wrong side of these new regulations, you will not be allowed to keep it.

• Many Americans choose to self-insure: this is the "coverage they like". Under the proposed legislation, this is no longer an option; if they insist on keeping the "coverage they like", they will be subject to tax penalties and (possibly) jail time.

• The bill also includes many new expensive mandates on employers that will cause dramatic shifts in their benefit structure; it is simply not credible to assert this will not have drastic (but largely predictable) effects on their existing employees and the "coverage they like." The Centers for Medicare and Medicaid Services (CMS) estimates that under the House's version of the legislation, about 12 million employees would lose their employer-sponsored coverage.

• Most relevant to "Emil from Salem" is his aside that he's on Medicare and also "private health insurance". If this "private insurance" is Medicare Advantage, you're probably already aware that it's very likely that he will not be able to maintain that "coverage he likes". The CMS study also estimates that enrollment in Medicare Advantage plans would decrease by about 64 percent nationwide.

• Emil from Salem was also concerned about taxes on his coverage. You don't answer that concern directly, but the bill currently under Senate consideration imposes a hodgepodge of revenue-raising measures: limits on deductions, taxes on cosmetic surgery and drug manufacturers, fees on insurance providers and medical devices, etc. While Emil may not see a direct tax bill, the indirect effects will be passed along to him.

I dislike the proposed legislation for a number of reasons: it's hugely expensive (and relies on a number of tricks and dubious assumptions to hide its true cost); it's massively intrusive; it disempowers individuals, making millions dependent on government largesse; it will stifle medical innovation; it will kill American prosperity; it's really a government stealth takeover of the entire health care sector. But I realize that, since you're a Democrat, you might not think those things are a problem.

But I'm writing to you on the chance that your answer to Emil from Salem was not a cynical and dishonest talking-point ploy to deflect his concerns, and that you were not kidding about your "requirement". Again, if that really is your requirement, you must vote against this bill.

Thanks for your consideration,
Paul Sand
Rollinsford, NH