What Exactly Are We Arguing About Regarding This Health Care Bill?

After weeks of fighting over death panels and other assorted GOP lies, the Politico is confirming that the Obama Administration is now backing away from a public option in coverage. One question: What exactly is everyone fighting about?

Tomorrow, we will post a live chat with Angie Holan of Politifact to go over this more in depth, but in the meantime, let's break down what is actually happening.

What's In the Bill

Politifact actually did a nice breakdown of the major components of the bill, which include:

• Leav[ing] employer-provided insurance in place. Close to three-quarters of the country gets health care through work, and studies show many people like their coverage. A House version of the bill seeks to broaden that coverage by imposing new taxes on large employers who don't offer health insurance.

• [Creating a]Health insurance exchange. To help people who have to go out and buy insurance on their own, the plan creates an exchange, a virtual marketplace where individuals and small businesses can comparison-shop. The government would regulate the exchange so that insurance companies can't discriminate against people with pre-existing conditions, or charge wildly different amounts for similar coverage. (They will be able to set rates based on age, however.)

• More for the poor. The plan expands eligibility for programs like Medicaid and the State Children's Health Insurance Program. Some people of modest means will receive "affordability credits" to buy plans on the health insurance exchange.

• Electronic records. To reduce inefficiency and duplication of services, the government will invest in electronic health records, so doctors can see which tests and procedures patients have already had.

• Research on better treatments. A comparative effectiveness research center will conduct and publish scientific research to find which treatments are the most effective. The government hopes easy-to-access information for doctors, patients and insurance companies will reduce procedures and treatments that don't really work, wringing waste from the system.

• Medicare. The bill makes many changes to how Medicare pays doctors and other health-care providers. Taken as a whole, the new rules aim to pay doctors for good patient outcomes instead of paying them per procedure, also called "fee-for-service."

But there's a glaring, enormous red flag here:

• An individual mandate . This requires people to buy insurance, unless they qualify for a hardship exemption. The expectation is that everyone will be covered, either through their employer or through the exchange. People who don't buy insurance will have to pay a penalty on their taxes.

So, wait, those of us who can't afford health insurance are about to be penalized for walking around without it? Wait, wait, wait - where was the discussion of this? And what makes it even worse is that the lowest cost option may be completely off the table.

What's Currently In Negotiation

• Obama has backed away from a public coverage option. I first heard about this on Meet the Press yesterday, when Texas Representative Dick(face) Armey brought up his opposition to it. First, though, he had to try to get in some lies, which co-guest Rachel Maddow quickly shut down:

FMR. REP. DICK ARMEY (R-TX): Not, not whatsoever. Not when you see the kind of extreme thing you just saw, the-you know, I had my differences with President Bush, George W. Bush, there's no doubt about it. They were well aware of that. But when moveon.org ran those ads that compared President Bush with, with Adolf Hitler, I thought it was despicable.

MS. RACHEL MADDOW: They never did that.

REP. ARMEY: They did do it. I'll show you the ad.

MS. MADDOW: They didn't do that. They never ran an ad that compared...

REP. ARMEY: All right. Anyway. All right.

MS. MADDOW: MoveOn never ran an ad that compared Bush to Hitler.

REP. ARMEY: All right.

Then, Rep. Liar-Liar-Pants-on-Fire decided to explain that we wouldn't need a public option if we were simply able to buy insurance across state lines:

REP. ARMEY: It's an unfair fight. If you read the bill, they've built in taxes, regulations, administrations, requirements, fines, penalties that discourage the private option. But we have 1300 private insurance companies in America. If you want competition in the purchasing of insurance, just listen, just listen in to Congressman Shadegg from Arizona and let people buy across lines. Why can't I live in Texas, buy my insurance in Oklahoma? What if I were-Michigan passed a law that says if you live in Michigan you can't buy a car made in Alabama? You'd think me silly. But what you have now-so the fact of the matter is, let us have fair competition, my freedom to choose among the 1300 already existing private companies. The government is what prevents that from happening.

Luckily, Ms. Maddow don't play that:

MS. MADDOW: I don't know what state in the country has secretly more awesome health care than every other state in the country. I sort of feel like every state in the country is in the same pickle when it comes to out-of-control costs, dissatisfying coverage and a huge number of uninsured people. That's not going to be made better by allowing insurance to be bought across state lines. I think that the private insurance companies would be really, really, really excited if what came out of this debate was a requirement that Americans buy more private insurance that they were dissatisfied with, that allowed them to be dropped for-precluded from pre-existing conditions all the other things they do. There needs to be serious reform of private insurance, and the only way to get that is to have a public option that people can choose if private insurance continues to not insure our needs as a country.

This one goes out to Rachel Maddow:

On a side note to President Obama: No bitchassness. (For clarification, we are using definition one, specifically, "overall stank actions towards others through words, facial expressions, and/or song [...] throwing large amounts of shade").

The crisis in heath care isn't only that it's prohibitively expensive. It's how many Americans are subsequently uninsured because of the cost/lack of availability of heath care. Estimates vary, but at a minimum, 29 million Americans are uninsured, and a maximum number is close to 44 million.

Without a public option, what are we left with? While digital options like the exchange and streamlining billing will help cut costs, where does that leave those without the means to pay for insurance? Or the working poor, who may be offered insurance, but can't afford that kind of expense?

(Example - when I was 19, I worked at a restaurant. The average worker brought home maybe five or six hundred dollars a week. Our employers decided to offer coverage - at the rate of $300 a month. What did we get for the $300? Nothing. High co-pays, high deductibles, and a lot of things that weren't covered. One of my coworkers remarked he'd rather roll the dice in the emergency room, since it would probably end up cheaper.)

What We Don't Have a Clear Idea On

As the debate rolls onward, there are a lot of questions still pending, but the major one is how are we going to pay for this? Politifact says:

• Cost: The plan doesn't come cheap. Covering millions of people who are now uninsured will cost billions more per year. As a way to raise revenues, Obama has proposed reducing the deductions that the wealthy are allowed to take on their taxes. The House of Representatives rejected that, deciding instead on a new tax surcharge for the wealthiest households. We're still waiting to see what kind of tax measure the Senate will consider. [...] What kind of new taxes will be used to pay for health care? The Senate seems unlikely to go along with the House idea to put a surcharge on the wealthy. The Finance Committee has considered all sorts of ideas, including taxes on soda pop or capping the tax-exempt status of employer-provided insurance. What they will finally decide on is one of the great unknowns.

Aside from cost and coverage, what is the point of healthcare reform if it just plays the shell game with what we already have on the table? Obviously, if Dick(face) Armey's "1300 private companies" were doing something correct, we'd all be clamoring to join the ones that work.

But the non-partisan group over at the Institute of Medicine warns that our outlook is so grim, even existing coverage is under siege:

A number of ominous signs point to a continuing decline in health insurance coverage in the United States. Health care costs and insurance premiums are growing substantially faster than the economy and family incomes. Rising health care costs and a severely weakened economy threaten not only employer- sponsored insurance, the cornerstone of private health coverage in the United States, but also threaten recent expansions in public coverage. There is no evidence to suggest that the trends driving loss of insurance coverage will reverse without concerted action.

Overall, fewer workers, particularly those with lower wages, are offered employer-sponsored insurance, and fewer among the workers that are offered such insurance can afford the premiums. Moreover, employment has shifted away from industries with traditionally high rates of coverage, such as manufacturing, to service jobs, such as wholesale and retail trades, with historically lower rates of coverage. In some industries, employers have relied more heavily on jobs without health benefits, including part-time and shorter-term employment, and contract and temporary jobs.

In addition, early retirees are less likely to be offered retiree health insurance benefits than in the past. The states and the federal government have increased substantially health insurance coverage among low-income children and, to a lesser degree, among adults in the last decade. While these coverage expansions have mitigated the overall numbers of uninsured, many states are now under extreme economic pressures to cut their recent expansions of public programs.

Ultimately, we need to stay engaged with this issue up to the very end. After all, we've already lost end-of-life counseling and a public option - what will be sacrificed next on the altar of bipartisanship?

The Truth-O-Meter On Health Care: Our Greatest Hits, Vol. 1 [Politifact]Health Care Reform: A Simple Explanation [Politifact]
White House Backs Away From Public Health Care Option [Politico]
Transcript: Meet The Press [MSNBC]
Definition: Bitchassness [Urban Dictionary]
Comparing Federal Government Surveys that Count Uninsured People in America [rwjf.org]
America's Uninsured Crisis: Consequences For Health And Health Care [Institute of Medicine]