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View Full Version : Obamacare, Brave New World revisited



Bob Gutermuth
07-31-2009, 12:51 PM
http://www.wnd.com/index.php?fa=PAGE.view&pageId=105525

This bill smells badly.

YardleyLabs
07-31-2009, 01:37 PM
http://www.wnd.com/index.php?fa=PAGE.view&pageId=105525

This bill smells badly.
I think the author of the article forgot to take his medication.

Claim: Section 1308 allows the government to dictate mariiage counseling and mental health services.
Reality: Section 1308 provides that marriage counseling.therapy services and mental health serivces provided by licensed providers will be eligible for coverage.

Claim: Section 163 gies the government direct, real time access to personal finances including access to bank accounts.
Fact: Section 163 requies that all electronic transactions conform to standard for electronic transaction simplification (defined in the existing HITECH Act) to permit timely processing of claims.

Claim: Under section 1401 a Federal bureaucracy will be created to research the efficacy of medical treatment and will be permitted to collect data for this purpose.
Fact: Absolutely true, with provisions for protecting the confidentiality of private and proprietary information.

Claim: Sections 440 and 194 establish home visitation programs and parenting programs where the government will tell you how to raise your children.
Fact: There is no section 194 as far as I can tel. Section 440 provides grants to assist states that want to establish quality program to provide visitation and parenting programs for persons in need.

Claim: Medicare recipients will be advised at least every five years on how to end their lives sooner.
Fact: Can't find this. No section number was given. However, it sounds like they are referring to counseling with respect to "advanced planning options" under section 1233, including preparation of living wills and durable powers of attorney. Good service. Happily my father was well prepared in this regard and we were able to follow his wishes precisely when he could no longer direct his own care.

dnf777
07-31-2009, 02:05 PM
I think the author of the article forgot to take his medication.

Claim: Section 1308 allows the government to dictate mariiage counseling and mental health services.
Reality: Section 1308 provides that marriage counseling.therapy services and mental health serivces provided by licensed providers will be eligible for coverage.

Claim: Section 163 gies the government direct, real time access to personal finances including access to bank accounts.
Fact: Section 163 requies that all electronic transactions conform to standard for electronic transaction simplification (defined in the existing HITECH Act) to permit timely processing of claims.

Claim: Under section 1401 a Federal bureaucracy will be created to research the efficacy of medical treatment and will be permitted to collect data for this purpose.
Fact: Absolutely true, with provisions for protecting the confidentiality of private and proprietary information.

Claim: Sections 440 and 194 establish home visitation programs and parenting programs where the government will tell you how to raise your children.
Fact: There is no section 194 as far as I can tel. Section 440 provides grants to assist states that want to establish quality program to provide visitation and parenting programs for persons in need.

Claim: Medicare recipients will be advised at least every five years on how to end their lives sooner.
Fact: Can't find this. No section number was given. However, it sounds like they are referring to counseling with respect to "advanced planning options" under section 1233, including preparation of living wills and durable powers of attorney. Good service. Happily my father was well prepared in this regard and we were able to follow his wishes precisely when he could no longer direct his own care.

Wow. I thought scare tactics reached their zenith under Condy and Rummy, but this is still "pushing the envelope". There are some things I like about Newt Gingrich, but I believe it was he who ushered in the era of utter and total disregard for the truth or facts, when it comes to all things politics. Say whatever you want, so long as it helps achieve your goals. The end justifies the means, without bounds. Thank you for setting the propaganda straight Yardley.

K G
07-31-2009, 02:08 PM
Does anyone REALLY think this Health Care Bill will make it through the Senate?

kg

Steve Amrein
07-31-2009, 03:18 PM
I wonder what solient(sp) green taste like ?

Cody Covey
08-02-2009, 01:38 AM
I think the author of the article forgot to take his medication.

Claim: Section 1308 allows the government to dictate mariiage counseling and mental health services.
Reality: Section 1308 provides that marriage counseling.therapy services and mental health serivces provided by licensed providers will be eligible for coverage.

Claim: Section 163 gies the government direct, real time access to personal finances including access to bank accounts.
Fact: Section 163 requies that all electronic transactions conform to standard for electronic transaction simplification (defined in the existing HITECH Act) to permit timely processing of claims.

Claim: Under section 1401 a Federal bureaucracy will be created to research the efficacy of medical treatment and will be permitted to collect data for this purpose.
Fact: Absolutely true, with provisions for protecting the confidentiality of private and proprietary information.

Claim: Sections 440 and 194 establish home visitation programs and parenting programs where the government will tell you how to raise your children.
Fact: There is no section 194 as far as I can tel. Section 440 provides grants to assist states that want to establish quality program to provide visitation and parenting programs for persons in need.

Claim: Medicare recipients will be advised at least every five years on how to end their lives sooner.
Fact: Can't find this. No section number was given. However, it sounds like they are referring to counseling with respect to "advanced planning options" under section 1233, including preparation of living wills and durable powers of attorney. Good service. Happily my father was well prepared in this regard and we were able to follow his wishes precisely when he could no longer direct his own care.Well I could be wrong here but since the government will be the insurance company for all of us they will in fact be able to dictate all those things.

YardleyLabs
08-02-2009, 06:47 AM
Well I could be wrong here but since the government will be the insurance company for all of us they will in fact be able to dictate all those things.
I'm not sure i understand your point. However, under the bill, the government is not the insurance company for all of us. It is and remains the "insurance company" for Medicare. It is and retains a shared responsibility with state governments as the "insurance company" for Medicaid, and is and remains the "insurance company" and health care provider for the VA system.

Under HR 3200, there would be one health insurance plan that was operated by the government. However, there would be no limit on qualified, privately operated health plans. Being "qualified" means that individuals or companies purchasing those plans would not be subject to penalties associated with not having health insurance. In addition, individuals eligible for subsidized coverage would be able to purchase any qualified plan and apply the subsidy towards the premium. Finally, there would be no restrictions on individuals purchasing supplemental insurance on their own or on companies providing supplemental insurance coverages for their employees. The government is not the provider of care (as it is in the English system) and exercises no control over what services are offered or not offered subject to whatever state laws may exist regulating medical care.

All in all, the proposed approach follows the structure of what we have now -- both good and bad. Under my current insurance, if my doctor orders an MRI of my knees, it must be approved in advance by my insurance company and I must receive it from a specific provider. If I obtain the service without their approval or from a different provider, I must pay for it myself.

"Gotcha" provisions are the norm in our current health system. As an example, based on medical history, I have colonoscopies every 2-3 years. In the past, these have always been done in the hospital and my total cost has been under $200. For the last one, my physician suggested that it be done in his office because that is cheaper than the hospital. I agreed. However, the anesthesiologist that he used was not a participating physician and the lab used to analyze the samples was not a participating lab. Net result, the insurance company saved a lot of money and I paid almost $2000 out of my own pocket. Problems like this are built in to the approach we now use for coverage. Insurance companies point out thst they are not denying care, they are simply denying coverage. In the short term, because it builds on our current system, HR 3200 will do nothing to imrove that system or make it worse.

Before a plan is adopted, assuming that one is, I suspect that the "public option" will be dropped. I believe that will be a major mistake. The reason is that a government plan is less likely to rely on "gotchas" to save money. Competition from such a plan would make it harder for insurance companies to continue to play the fine print game in marketing their plans and I believe we would all benefit.

dnf777
08-02-2009, 07:48 AM
Before a plan is adopted, assuming that one is, I suspect that the "public option" will be dropped. I believe that will be a major mistake. The reason is that a government plan is less likely to rely on "gotchas" to save money. Competition from such a plan would make it harder for insurance companies to continue to play the fine print game in marketing their plans and I believe we would all benefit.

For years, the republicans have accused the dems of torpedoing their legislation, and accusing the dems of never offering alternative plans. The tables seem to have turned. I see tidal waves of opposition to the healthcare plans, but no alternatives, despite their admission that the current system is "broke".

The irony I see, is that republicans repeatedly claim that gov't cannot run ANYTHING with any semblence of efficiency, and how wonderful big corporations are....then why worry that a gov't plan will put private plans out of business. Surely, no one on this list or anywhere else would give up their expensive private insurance for affordable gov't coverage? I wonder how the VA or tricare survive?

HuntsmanTollers
08-02-2009, 08:21 AM
Originally from Yardley "The reason is that a government plan is less likely to rely on "gotchas" to save money. Competition from such a plan would make it harder for insurance companies to continue to play the fine print game in marketing their plans and I believe we would all benefit."

Under our current system who sets the standard for reimbursement rates for insurance companies? Who currently regulates the insurance companies? Why do you think they will do a better job in the future?

Regulation and administrative requirements are a major factor in health care costs. Nothing I have seen in the proposed bills decreases that. If anything it will be increased with the new government agency for oversight of the program.

Bob Gutermuth
08-02-2009, 08:27 AM
The govt cannot even run the post office, how in the H#LL are they going to run something as important as health care?

dnf777
08-02-2009, 08:30 AM
The govt cannot even run the post office, how in the H#LL are they going to run something as important as health care?

they've been doing it with medicare, VA, and Tricare. Certainly not perfect, but well enough to invalidate the blanket claim that they can't run anything.

Bob Gutermuth
08-02-2009, 09:33 AM
For my money, the government couldn't run a gas station at a profit if they stole the customers cars. Just look at all the fraud running rampant in medicare, I won't even begin to talk about the rippoffs going on in the Dept of Ag's foodstamp boondoggle.

Gerry Clinchy
08-02-2009, 09:49 AM
We do know that the government couldn't run that whorehouse out West after they confiscated it :-)

subroc
08-02-2009, 10:04 AM
The future of pain management

http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html

YardleyLabs
08-02-2009, 10:21 AM
Originally from Yardley "The reason is that a government plan is less likely to rely on "gotchas" to save money. Competition from such a plan would make it harder for insurance companies to continue to play the fine print game in marketing their plans and I believe we would all benefit."

Under our current system who sets the standard for reimbursement rates for insurance companies? Who currently regulates the insurance companies? Why do you think they will do a better job in the future?

Regulation and administrative requirements are a major factor in health care costs. Nothing I have seen in the proposed bills decreases that. If anything it will be increased with the new government agency for oversight of the program.
Insurance companies set the standards for reimbursement under insurance company plans. States regulate insurance companies but generally only with respect to issues of solvency, conformance with laws concerning cancellations and renewals, and conformance with laws concerning provision of legally mandated services. State regulations have little to no impact on the administration of health benefits.

For many years, I ran a successful national consulting practice designing health claims management systems and reviewing the administration of health benefits by insurance companies and third party administrators on behalf of major corporate clients and the insurance companies themselves (e.g., Mobil, MetLife, First Health Services Corporation, First Health Services). My primary qualifications for doing that when I started were my general background in health services administration and computer systems, as well as my specific background running Medicaid and improving Medicaid payment systems in New York City. The system we implemented in NYC was years ahead of anything existing in the private sector at that time (mid-1970's) allowing both more effective screening for erroneous and fraudulent billings and faster turnaround on payments (under 10 days) than was possible under private sector systems.

blind ambition
08-02-2009, 10:34 AM
The future of pain management

http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html


It appears as though they may be attempting to forstall becoming like Broward County (and coming to a neighborhood near you), good oversight if you ask me.

http://www.palmbeachpost.com/news/content/state/epaper/2009/04/05/0405pillmills.html?cxtype=rss&cxsvc=7&cxcat=0

subroc
08-02-2009, 11:22 AM
I guess I don't understand the comparison.

are you saying that because there may be some evidence of abuse in one part of a system that those in an unrelated part of the system must be made to suffer?

This is how you expect decisions to be made in obama care?

WoW!!!

HuntsmanTollers
08-02-2009, 11:29 AM
Yardley,

Technically insurance companies set the reimbursement rates however they base them off the what the government has determined to be 'fair and equitable' rates for medicare and medicaid. Therefore the government sets the standard. FYI both my wife and I have been involved in health care for quite some time. I will say that neither of us were doing it in the 70s though.

dnf777
08-02-2009, 11:44 AM
Yardley,

Technically insurance companies set the reimbursement rates however they base them off the what the government has determined to be 'fair and equitable' rates for medicare and medicaid. Therefore the government sets the standard. FYI both my wife and I have been involved in health care for quite some time. I will say that neither of us were doing it in the 70s though.

You're exactly correct. Where the problem arises, is that insurance companies are allowed to collaborate and fix prices, as where physicians must go at it alone. One side can collectively bargain, the other can't. I fail to see any "free market" in existence in health care. The insurance companies screw both docs and patients, all the while strolling to the bank.

YardleyLabs
08-02-2009, 03:55 PM
You're exactly correct. Where the problem arises, is that insurance companies are allowed to collaborate and fix prices, as where physicians must go at it alone. One side can collectively bargain, the other can't. I fail to see any "free market" in existence in health care. The insurance companies screw both docs and patients, all the while strolling to the bank.
Every major insurance carrier uses one of two sources of information concerning reasonable and customary charges: data gathered from payments under the plans they administer themselves or data accumulated by the Health Insurance Assocation of America (HIAA). Neither is associated with either Medicaid or Medicare. Medicaid, because of legal restrictions on it, often pays more for institutional care than private insurance companies while Medicare often pays less. Part of that relates to provisions of the medicare law that link its reimbursement to actual costs of care provided to Medicare recipients who are often cheaper to treat per day of care because a higher percentage of their hospital stays are convalescent.

GoodDog
08-02-2009, 05:56 PM
Yardly and DNF, you sure quote the regs very well, and I bet you have never even talked to a Real doctor who cares about their patients, and wants the best for them. If you would like to talk to one, who also believes this system will be an utter failure, and extremely expensive, just let me know, and I will send the my phone number. If all of the current government medical plans are run so well, why are they bankrupt? If you think your insurance has hoopes to jump through, try dealing with the government. Feel free to talk to a real live person who deals with this everyday. I am not saying our current system is good, I am not a fan of the insurance companies, but I must laugh as you give examples of what the government has run well. I think the government does a wonderful job with national defense, but that is about it. Your examples don't hold water. Oh and DNF, as far as what the Doctors can do--- you just don't accept that insurance. If you think a bunch of Dr's that don't accept a specific insurance doesn't have an effect, you are wrong.

Marvin S
08-02-2009, 06:21 PM
they've been doing it with medicare, VA, and Tricare. Certainly not perfect, but well enough to invalidate the blanket claim that they can't run anything.

You missed Medicaid, ;-). & Amtrak, FNM, etc. None well run.

While Medicare is fine, you have to enroll to protect your interests. I pity the person who is uninsured in this environment. I just don't pity them enough to want to help pay for any level of care for them.

But they will get care, it's just the bill paying departments that are tough to navigate when you are uninsured.

dnf777
08-02-2009, 07:32 PM
Yardly and DNF, you sure quote the regs very well, and I bet you have never even talked to a Real doctor who cares about their patients, and wants the best for them. If you would like to talk to one, who also believes this system will be an utter failure, and extremely expensive, just let me know, and I will send the my phone number. If all of the current government medical plans are run so well, why are they bankrupt? If you think your insurance has hoopes to jump through, try dealing with the government. Feel free to talk to a real live person who deals with this everyday. I am not saying our current system is good, I am not a fan of the insurance companies, but I must laugh as you give examples of what the government has run well. I think the government does a wonderful job with national defense, but that is about it. Your examples don't hold water. Oh and DNF, as far as what the Doctors can do--- you just don't accept that insurance. If you think a bunch of Dr's that don't accept a specific insurance doesn't have an effect, you are wrong.

GoodDog,
I talk to patients every day. And I talk to insurance companies on their behalf, everyday. I help patients jump through the insurance company hoops to avoid getting care denied, everyday. I AM a doctor. So is my wife. We know a little about the screwed up system we work in.

As for a group of doctors getting together and refusing insurance payments, that is collusion under the anti-trust acts, and we go to jail for that. That is what I alluded to in my previous posts, that insurance companies can collectively set reimbursement rates, but we can't collectively bargain back at them. Not a real free-market system.

First do no harm regards,
Dave

GoodDog
08-02-2009, 07:40 PM
Good for you Dave, nice to met you. When I refer to not accepting specific insurance, I am refering to it as the gas stations do it. Every where you look, gas is about the same price, yet there is no collusion there. No specific organized body saying what they will charge for fuel.

On another note, what type of practice do you have and where (now I see PA.). Always nice to meet fellow dog folks.

Wes

YardleyLabs
08-02-2009, 07:55 PM
Yardly and DNF, you sure quote the regs very well, and I bet you have never even talked to a Real doctor who cares about their patients, and wants the best for them. If you would like to talk to one, who also believes this system will be an utter failure, and extremely expensive, just let me know, and I will send the my phone number. If all of the current government medical plans are run so well, why are they bankrupt? If you think your insurance has hoopes to jump through, try dealing with the government. Feel free to talk to a real live person who deals with this everyday. I am not saying our current system is good, I am not a fan of the insurance companies, but I must laugh as you give examples of what the government has run well. I think the government does a wonderful job with national defense, but that is about it. Your examples don't hold water. Oh and DNF, as far as what the Doctors can do--- you just don't accept that insurance. If you think a bunch of Dr's that don't accept a specific insurance doesn't have an effect, you are wrong.
Good Dog,

I spent a part of my life as director of management for 18 hospitals, implemented the payment systems for a $4 billion Medicaid program, reviewed the management of commercial health benefit programs for plans covering more than one million employees, and designed and managed systems for clinical reviews of prescriptions. In all of these efforts I had extensive contact with the physicians using and affected by the programs in which I was involved.

Cody Covey
08-04-2009, 04:27 PM
Jeff what haven't you done lol :) btw check your PM's

Uncle Bill
08-04-2009, 05:38 PM
Good Dog,

I spent a part of my life as director of management for 18 hospitals, implemented the payment systems for a $4 billion Medicaid program, reviewed the management of commercial health benefit programs for plans covering more than one million employees, and designed and managed systems for clinical reviews of prescriptions. In all of these efforts I had extensive contact with the physicians using and affected by the programs in which I was involved.


It's taken a while, but we finally have an admission we can all understand. It had to be difficult to fess up to your ineptitude at helping develope a healthcare program so many despise, that they are now willing to obfuscate their freedoms in favor of another big government something-for-nothing program.

Is there any possibility that any of you libs will return to what this nation was founded on? Silly things like individual responsibility, and working for what you get. Will you ever see how corrupt YOU are when you applaud the idea of taking from those that earned it, and giving it to those that didn't? Do you not see the immorality of that form of class envy?

The only way your single-payer healthcare system can possibly hoodwink the electorate, is if the multitude of small businesses decide it's their way out of this incredible burden the unions foisted on the working class.

To think so many of you are actually believing what's being proposed by this spur-of-the-moment batch of nit-wits presently in charge, only furthers my views of your naivete. But then, being part of the sheeple that installed this current crop of socialists, it shouldn't surprise any sane American you are doing just what your leadership stated they would do, so you must be elated. Wonder how YOUR great grandkids will recall what you've done for them.

UB

dnf777
08-04-2009, 07:59 PM
Wonder how YOUR great grandkids will recall what you've done for them.

UB

They're gonna be too busy working to pay off Mr. Bush's debt to worry anything about ME!

Uncle Bill
08-06-2009, 03:57 PM
They're gonna be too busy working to pay off Mr. Bush's debt to worry anything about ME!


Au Contraire, 777...when your socialist friends put Obamacare into effect, we will ALL be worried for your survival, as I will for every Doctor I know.

UB

Pals
08-06-2009, 08:45 PM
Hey!! I'm gonna email the white house that you guys are propogating untruths about the great health care plan. ;)

Chicago scare tactics at their best. Everyday it gets worse, the sheer arogance of this administration is scary. If GW had issued a statement about turning in your fellow citizens-there would have been riots in the street.

Oh wait, we can blame Bush for all the angry Americans letting their idiot reps have an earful.

What a mess.

Bob Gutermuth
08-06-2009, 09:04 PM
Still up in the air about the govt medical care? Watch this:http://www.youtube.com/watch?v=ho-0SHFEgGo&eurl

YardleyLabs
08-06-2009, 09:30 PM
It's taken a while, but we finally have an admission we can all understand. It had to be difficult to fess up to your ineptitude at helping develope a healthcare program so many despise, that they are now willing to obfuscate their freedoms in favor of another big government something-for-nothing program.

Is there any possibility that any of you libs will return to what this nation was founded on? Silly things like individual responsibility, and working for what you get. Will you ever see how corrupt YOU are when you applaud the idea of taking from those that earned it, and giving it to those that didn't? Do you not see the immorality of that form of class envy?

The only way your single-payer healthcare system can possibly hoodwink the electorate, is if the multitude of small businesses decide it's their way out of this incredible burden the unions foisted on the working class.

To think so many of you are actually believing what's being proposed by this spur-of-the-moment batch of nit-wits presently in charge, only furthers my views of your naivete. But then, being part of the sheeple that installed this current crop of socialists, it shouldn't surprise any sane American you are doing just what your leadership stated they would do, so you must be elated. Wonder how YOUR great grandkids will recall what you've done for them.

UB

Your comments directed at my work history weren't very specific. Are you talking about my efforts at helping commercial insurance companies such as MetLife, Aetna, Travelers, CNA and First Health to improve their insurance programs? Or are you talking about my track record of having reduced Medicaid expenditures by an estimated $200 million in one year while overall nationwide expenditures increased by 14%? Or could it be my record of having reduced staffing levels at 18 hospitals by 19% over two years while improving the quality of care based on the results of multiple quality of care audits?

If you insist on being a blowhard, you may want to save your breath for something you know about.

If you detest socialized medicine, I would suggest that you take the first concrete steps to end it by foregoing all health care insurance for yourself and your family since that is the source of every scare tactic problem cited by opponents of reform. There is only one difference between the system that has been proposed and what we have now....more people would be covered. Like those covered by insurance now, the new people covered by the proposed programs would only pay a portion of the cost of the insurance they received.

Personally, I do not believe that employers should have anything to do with health insurance. It makes consumers insensitive to the cost of care, it adds an unsustainable cost onto the price of American produced goods and services that is not borne by employers in other countries, and it gives employers access to confidential personal health care information while also giving them incentives to exclude employees who are likely to drive up health care costs.

Businesses should not be permitted to deduct health insurance premiums as a business expense and individuals should receive no tax preference for health care or health care insurance expenditures. Doing these things would break the back of socialism in medicine and bring real market forces to bear on cost control. I can guarantee that our health care costs would plummet over night. However, if you insist on continuing the socialized system that we now have, I see no reason why anyone should be excluded.

dnf777
08-07-2009, 06:07 AM
Au Contraire, 777...when your socialist friends put Obamacare into effect, we will ALL be worried for your survival, as I will for every Doctor I know.

UB

My socialists friends? Although I have not personally met most on this forum, when I do, I will consider you my friend, no doubt. I would hardly consider this a "socialist" leaning group!

Different aspects of life lend themselves to different positions on the continuum of governance. Nobody has a problem with socializing the military. We all pay taxes, and we hope that supports a strong military for the "common defense". Business, we like to keep on the capitalist/individual-based part of the continuum. Education is a compromise somewhere in the middle, with most supporting a *good* public education, with private options for those who can and want to pay extra.

I think healthcare falls nearly into the same category as education. Would you not agree that we would all benefit from not having uninsured running out the cost for those of us who are? Or if we could unburden American industry from their crippling healthcare costs?

Some basic level of healthcare for all legal Amercians, then private plans for those who want them, will probably define a two-tiered system someday. The current system is unsustainable.

On this forum, those comments will likely get me labeled as socialist. On a different web, they'd be calling me a right-wing wacko! ;-)

In all regards, here's to a great weekend,
Dave

Uncle Bill
08-07-2009, 03:05 PM
I think healthcare falls nearly into the same category as education. Would you not agree that we would all benefit from not having uninsured running out the cost for those of us who are? Or if we could unburden American industry from their crippling healthcare costs?




Dave


For the benefit of us ignoramuses, please explain how American industry got strapped with those crippling healthcare costs in the first place?

As far as the uninsured running up our costs, I'd far rather take my chances with them, than having a governmental mandate that takes another of my freedoms away. Besides that, what makes you think EVERYBODY will pay for THIS "insurance"?

The libs are about as naive concerning this as they are in their beliefs about gun control.

Don't you realize this program isn't only about healthcare? It's just another program to further take your freedoms away, and control more of the sheeples lives.

If you and others in your profession are buying into this, you are as ignorant as the farmers that are falling for the minor changes in that Algore bill, and thinking "it's not all that bad". :rolleyes:

The sheeple are getting sheared and ripped off all at the same time. The education system has to be proud of their product. It's the 'other' area our founders failed to foresee, but then we can't blame them for not being completely clairvoyant. They had just created a free nation. How could they have known there would be so many willing to have those freedoms legislated away?

UB

dnf777
08-07-2009, 05:32 PM
For the benefit of us ignoramuses, please explain how American industry got strapped with those crippling healthcare costs in the first place?

First, I didn't call anyone an ignoramus. Morris Fishbein, editor of JAMA warned about this in the 40s, when companies began to offer healthcare coverage as an enticement. He was concerned that people would begin to expect employee provided care as an entitlement, and would become resistant to paying for healthcare. How prophetic he was.

Besides that, what makes you think EVERYBODY will pay for THIS "insurance"?

It's called tax. Don't you think that you currently pay for medicare and the VA system? By enlarging the risk pool, overall costs are reduced. It's the whole concept of insurance. By cherry picking only young, healthy enrollees, and dumping them when they get sick, or dumping them into the medicare system when they get "old and expensive" ie, "not profitable", the private companies are able to award themselves billions in CEO bonuses at your expense. In our current system, 30 cents of every premium dollar you send in, goes to administration. Not very efficient if you ask me. Unless I'm the CEO pocketing that green.

If you and others in your profession are buying into this, you are as ignorant as the farmers that are falling for the minor changes in that Algore bill, and thinking "it's not all that bad".

I don't know about farmers. I do know that the American College of Surgeons has been deeply involved in helping to formulate this legislation, and has offered advice and constructive criticism, and is not happy with all aspects of it.

How could they have known there would be so many willing to have those freedoms legislated away?

Especially under names like "Patriot Act"!!!

dnf777
08-07-2009, 07:34 PM
UB,

I was wondering if you could clarify something for me. I sense a huge paradox in the views towards health care from the right side. I posted earlier that certain allowances of socialism are accepted in America, ie the military providing for a "common defense" that we all pay into. You seemed to refute that health care in any form should be "socialized" in the form of a national policy.

Question for you...Isn't ANY type of health insurance "socializing" the risk of getting sick or injured? Everyone pays a small amount, shares the risk, and everyone is eligible to benefit if the need arises? The masses providing for the indivudual. So how is ANY form of insurance acceptable?

Under a strict capitalist system, doctors would set a price...as high as they can and still sell a service or product, regardless of anyone's ability to pay (as long as the rich can pay, and keep them in the black, right?--law of supply and demand) and people are either able to afford to pay for healthcare, mortgage their surgery (if they have adequate credit score) or just do without? Isn't that capitalism in its truest form?

Life is rarely black or white. There are usually shades of gray in between. I don't want a pure socialist system by any means, but I don't think pure capitalism serves the average American very well either.

I would be very cautious in thinking a pure capitalist system of healthcare is the answer. If you don't think so, just check how much a boob job is, and see if your cosmetic surgeon accepts low-paying insurance carriers. I wouldn't want my GP or cardiologist operating the same way.

Uncle Bill
08-08-2009, 11:39 AM
777 asks:

"Question for you...Isn't ANY type of health insurance "socializing" the risk of getting sick or injured? Everyone pays a small amount, shares the risk, and everyone is eligible to benefit if the need arises? The masses providing for the indivudual. So how is ANY form of insurance acceptable?"

By being something I choose from the many companies that offer it. If you can't recognize the difference, I can see how you have become part of the problem.

Since you can't bring yourself to say it, the unions caused business to get into the insurance payment perks that have skewed the healthcare costs so radically.

While I concur that todays system is far from ideal, what you and Jeff are allowing your messianic leader to ram down our throats is just asinine. If you can't recognize where this is leading, God help you all. You will have indeed been part of the annihilation of a truly great nation.

UB

YardleyLabs
08-08-2009, 12:29 PM
777 asks:

"Question for you...Isn't ANY type of health insurance "socializing" the risk of getting sick or injured? Everyone pays a small amount, shares the risk, and everyone is eligible to benefit if the need arises? The masses providing for the indivudual. So how is ANY form of insurance acceptable?"

By being something I choose from the many companies that offer it. If you can't recognize the difference, I can see how you have become part of the problem.

Since you can't bring yourself to say it, the unions caused business to get into the insurance payment perks that have skewed the healthcare costs so radically.

While I concur that todays system is far from ideal, what you and Jeff are allowing your messianic leader to ram down our throats is just asinine. If you can't recognize where this is leading, God help you all. You will have indeed been part of the annihilation of a truly great nation.

UB
UB,

If everyone paid 100% of their own premiums, I would agree that it is simply a matter of risk sharing. However, on average the insured part of our population only pays a relatively small percentage of their premiums. Employers, not consumers make the decision on what plan to use and the consumers are almost completely shielded from any of the economics associated with their health care decisions. For those reasons, it is a socialist system and suffers the problems of a socialist system.

There is no logic between those who are insured vs those who are not. In fact, there is nothing to indicate that the insured work any harder than the uninsured or that they made decisions that were generally better or worse. For that reason, I believe in universal coverage. I believe in a regulated market because of the absence of an economic market. However, my preference would be for regulations that simulate to the maximum extent possible the characteristics of a free market by increasing competition among pharmaceutical companies, managed care companies, insurance companies and others that have had something of a free ride for too many years at tax payer expense.

I also believe that over time we need to get employers completely out of the health care business. There is no reason that coverage should be tied to your job. Breaking that tie will do more to improve the competitiveness of American businesses than almost any other program that has been proposed by either party. To the extent that we put consumers in the position of choosing and paying for their own health plans, that will also add true competitive forces to the marketplace.

There are no capitalists involved on either side of our health care debate. We have those who currently enjoy virtually free health care under the current system and those who do not. We have those who profit from the current system where the consumer gets a free ride and businesses face few obstacles to unregulated growth at tax payer expense vs those who believe that in the absence of economic constraints on consumers that other approaches are needed to restore a semblance of fiscal sanity.

The reality is that few things threaten the future of our economy more than our existing runaway health care system. Currently, health care spending totals about 17% of GDP. Individual spending on health care is a small fraction of that total. Health care expenditures are growing at about 2 1/2 times inflation. Health care already consumes a greater share of GDP than all Federal government spending for non-health care purposes. The system is broken, and it will not fix itself.

road kill
08-08-2009, 12:38 PM
If you insist on being a blowhard, you may want to save your breath for something you know about. .


Look who's talking.
The pontificating bloviating champion of the board.

The Profesor Irwin Corey (The Worlds Foremost Authority) of RTF.

If words were gas you would be a humvee.
Use lots, go nowhere!!

YOU calling someone a "blowhard," that right there is funny, I don't care who you are!!

Evan
08-08-2009, 12:51 PM
UB,

The reality is that few things threaten the future of our economy more than our existing runaway health care system. Currently, health care spending totals about 17% of GDP. Individual spending on health care is a small fraction of that total. Health care expenditures are growing at about 2 1/2 times inflation. Health care already consumes a greater share of GDP than all Federal government spending for non-health care purposes. The system is broken, and it will not fix itself.And you believe Obama-care will? No one who is paying attention to the details will assert that America's current health care system is perfect, or that it is in no need of repair. But the media-fueled chanting of "It's time for a change" is based as much in emotion as in fact.

The best healthcare on earth is in the USA. Portions of the US healthcare system are in dire need of change & reform. But it is inconceiveable that you intellegent folks are prepared to throw the baby out with the bath water and buy into the notion that just any change is acceptable. What has the same government that has backrupted Social Security and Medicare done lately to earn so much of your trust?

What you seem to believe goverernment can give you, it can also take away, ration, include or exclude any part or any person at its own whimsy. Reforming the private sector right out of existence is a poor option, fellow Americans. Once we have given up our rights to choose, it's very hard to get them back.

Evan

Bob Gutermuth
08-08-2009, 01:02 PM
If socialized medicine is so far ahead of what we have now, why didn't Teddy Kennedy go to Canada for treatment?

Uncle Bill
08-08-2009, 01:24 PM
I now have the true definition of 'oxymoron'.... "a well educated Jeff Yardley". You have the audacity to print this?

"The reality is that few things threaten the future of our economy more than our existing runaway health care system. Currently, health care spending totals about 17% of GDP. Individual spending on health care is a small fraction of that total. Health care expenditures are growing at about 2 1/2 times inflation. Health care already consumes a greater share of GDP than all Federal government spending for non-health care purposes. The system is broken, and it will not fix itself."


And your answer is what's being proposed by the insane Democrats and their CF leadership?

Has the old adage of "jumping from the frying pan into the fire" have no relevance to your form of thought?

And you, like your 'other' so called independant "frogs-in-the-pot" believe that since the broken system won't fix itself, we'll go with something so incredulous it will turn our nation into the inevitable "Humpty Dumpty".

The sickening thing about your stance is it's a 'must for everyone'. From one boondoggle to another, but it only makes you happy, like is the socialistic way, if EVERYONE is made equally, universally, miserable.

I am a firm believer that people will pay for what they feel is important to them. Having been self-employed since 1980, I've paid for my own health insurance, as well as both sides of my FICA taxes. After my kids aged out, we cut back considerably on our insurance costs, by getting a high deductable policy.

Furthermore, if you had any onions at all, you'd be furious with what your politicians have for THEIR healthcare insurance...AND DEMAND WHATEVER THEY ARE FOISTING ON THE SHEEPLE, THEY PLACE THEMSELVES ON THIS "WE-CAN'T-DO-WITHOUT-THIS-IMMEDIATELY" PROGRAM.

You can't really be so dense you are willing to endorse what is being proposed, regardless of how badly you view the present system. If indeed you are that 'wounded-by-the-sword-you've-fallen-on", you have my sympathy. Just please stop promoting what this administration is pushing as the messianic answer for all of us.

UB

dnf777
08-08-2009, 05:27 PM
By being something I choose from the many companies that offer it. If you can't recognize the difference, I can see how you have become part of the problem.



Since you can't bring yourself to say it, the unions caused business to get into the insurance payment perks that have skewed the healthcare costs so radically.



While I concur that todays system is far from ideal, what you and Jeff are allowing your messianic leader to ram down our throats is just asinine. If you can't recognize where this is leading, God help you all. You will have indeed been part of the annihilation of a truly great nation.

UB

So socialism is OK if if benefits you, and you CHOOSE it?? Ok, I got it. Like I said in other posts, it was gov't run medicare that provides my 90 yo grandmother her life-sustaining chemo, while MY policy would have dropped her at the first renewal cycle. (not to mention, 12,000/year still needs another 'rider' for cancer treatement....only available to those with no cancer, of course)

While unions adopted this eventually, it was not unions per se who ushered in employee provided healthcare. Notice I said healthcare, not health insurance. Big difference.

If God were helping us all, there wouldn't be any need for health insurance...

YardleyLabs
08-08-2009, 05:56 PM
I now have the true definition of 'oxymoron'.... "a well educated Jeff Yardley". You have the audacity to print this?

"The reality is that few things threaten the future of our economy more than our existing runaway health care system. Currently, health care spending totals about 17% of GDP. Individual spending on health care is a small fraction of that total. Health care expenditures are growing at about 2 1/2 times inflation. Health care already consumes a greater share of GDP than all Federal government spending for non-health care purposes. The system is broken, and it will not fix itself."


And your answer is what's being proposed by the insane Democrats and their CF leadership?

Has the old adage of "jumping from the frying pan into the fire" have no relevance to your form of thought?

And you, like your 'other' so called independant "frogs-in-the-pot" believe that since the broken system won't fix itself, we'll go with something so incredulous it will turn our nation into the inevitable "Humpty Dumpty".

The sickening thing about your stance is it's a 'must for everyone'. From one boondoggle to another, but it only makes you happy, like is the socialistic way, if EVERYONE is made equally, universally, miserable.

I am a firm believer that people will pay for what they feel is important to them. Having been self-employed since 1980, I've paid for my own health insurance, as well as both sides of my FICA taxes. After my kids aged out, we cut back considerably on our insurance costs, by getting a high deductable policy.

Furthermore, if you had any onions at all, you'd be furious with what your politicians have for THEIR healthcare insurance...AND DEMAND WHATEVER THEY ARE FOISTING ON THE SHEEPLE, THEY PLACE THEMSELVES ON THIS "WE-CAN'T-DO-WITHOUT-THIS-IMMEDIATELY" PROGRAM.

You can't really be so dense you are willing to endorse what is being proposed, regardless of how badly you view the present system. If indeed you are that 'wounded-by-the-sword-you've-fallen-on", you have my sympathy. Just please stop promoting what this administration is pushing as the messianic answer for all of us.

UB
It's hard to figure out how to respond when your emotional reaction doesn't actually seem to be tied to any factual issues. With respect to participation in "the program" by members of Congress, no one is required to participate in any government operated program as part of HR 3200.

People are required to participate in "qualified" insurance programs -- which might or might not include the one you purchase now -- and employers over a specified size (It looks like they are now anticipating a payroll over $1 million) are required to provide an employer subsidized and qualified plan to their employees. Employers and individuals that do not meet this requirement are subject to penalties.

The Federal government health plans, including those provided to members of Congress, meet (or must meet) the definition of qualified plans. As a result, there would be no reason for anyone enrolled to change their plan of coverage. Similarly, if your plan meets the minimum standards for a qualified plan, you would have no reason to change. However, if you elected to change, you would be eligible to select from among any qualified plans included in a health exchange with no exclusions based on pre-existing conditions and no need to join special groups to meet conditions of participation. The only likely issue you would face would be if your current high deductible plan has an out of pocket cost limitation greater than $10,000 for you and your wife. If greater than that, the limit would need to be reduced to meet minimum standards. Even then there would be a few years before the change would need to be made.

As currently designed, the program does not remove choices, it increases them.

Gerry Clinchy
08-08-2009, 07:30 PM
The only likely issue you would face would be if your current high deductible plan has an out of pocket cost limitation greater than $10,000 for you and your wife. If greater than that, the limit would need to be reduced to meet minimum standards. Even then there would be a few years before the change would need to be made.


No matter what we do, herein lies the rub.

If we add 20 million people to such a plan, (which limits a family deductible to $10,000/year).

The first people who will want to jump on this program, would surely be those with pre-existing conditions. The government undoubtedly can provide this far better than private industry because when the expenses go through the roof, the government simply asks for more taxes. While a private insuror would be crucified for raising premiums, will there be equal outrage when the government does the same?

Since expense for the entire program will be equally shared, if the cost for insurance is more than the 2.5% tax on the 30 yr old earning $50K , that young guy may just find it cheaper to pay the 2.5% "penalty". That would likely inspire an increase in that tax ... until the cost of the health care insurance is equal to the tax (to remove the incentive for remaining uninsured).

If health care consumes 17% of the GDP now, I'd be willing to predict that after the plan is in place for 10 years, the cost will increase dramatically ... especially if there are no controls on providing subsidy of this program to illegal immigrants.

Also, if the our legislators increased SS benefits without anticipating the cost, or if they stole from SS surplus to fund other programs (as you mentioined a while back), if that does not consitute poor planning, I don't know what does. Habitually, our legislators see $ & can't resist spending it ... forgetting that the surplus was specifically generated to take care of the anticipated future costs that the math showed would eventually present themselves. Even when they momentarily plan something properly, then they mess it up.

Without cost controls any plan is doomed. So far nobody seems to have a clue in how to do this on a significant scale, i.e. one that makes a real impact on the overall $ amounts.

It is purely arithmetic.

dnf777
08-08-2009, 07:38 PM
While a private insuror would be crucified for raising premiums, will there be equal outrage when the government does the same?

My insurance premiums have gone through the roof, I don't know about yours! There has been triple-digit increases in health premiums from private insurers.

I haven't seen any insurance CEOs nailed to crosses...rather they are doing quite nicely, with increased bonuses and compensations.

There has to be a happy medium.

Gerry Clinchy
08-08-2009, 07:46 PM
I agree with you dnf777 ... we do crucify "the insurors" (generically) for this behavior, but we haven't focused on the executives who put their companies in these positions.

YardleyLabs
08-08-2009, 07:58 PM
No matter what we do, herein lies the rub.

If we add 20 million people to such a plan, (which limits a family deductible to $10,000/year).

The first people who will want to jump on this program, would surely be those with pre-existing conditions. The government undoubtedly can provide this far better than private industry because when the expenses go through the roof, the government simply asks for more taxes. While a private insuror would be crucified for raising premiums, will there be equal outrage when the government does the same?

Since expense for the entire program will be equally shared, if the cost for insurance is more than the 2.5% tax on the 30 yr old earning $50K , that young guy may just find it cheaper to pay the 2.5% "penalty". That would likely inspire an increase in that tax ... until the cost of the health care insurance is equal to the tax (to remove the incentive for remaining uninsured).

If health care consumes 17% of the GDP now, I'd be willing to predict that after the plan is in place for 10 years, the cost will increase dramatically ... especially if there are no controls on providing subsidy of this program to illegal immigrants.

Also, if the our legislators increased SS benefits without anticipating the cost, or if they stole from SS surplus to fund other programs (as you mentioined a while back), if that does not consitute poor planning, I don't know what does. Habitually, our legislators see $ & can't resist spending it ... forgetting that the surplus was specifically generated to take care of the anticipated future costs that the math showed would eventually present themselves. Even when they momentarily plan something properly, then they mess it up.

Without cost controls any plan is doomed. So far nobody seems to have a clue in how to do this on a significant scale, i.e. one that makes a real impact on the overall $ amounts.

It is purely arithmetic.
I think you raise some valid concerns.

- From a technical perspective, the $10,000 ia not a deductible. It is the maximum amount that a family would be required to pay in deductibles, coinsurance and co-pays before insurance would cover the balance.

- No plan, private or public would be permitted to exclude people with pre-existing conditions. I don't know if it is likely that the uninsured have a disproportionate number of people with pre-existing conditions. I suspect that they do snce some of those people are likely limited by pre-existing illnesses that affect their employability and many others have deferred necessary medical care that they will seek out once they have coverage. The most severely ill are probably already receiving Medicaid. However, a short term boost in demand is likely. I do not know how the CBO addressed this in their cost estimates.

- It is obviously possible for people to elect not to purchase insurance and to pay the tax instead. Those are presumably people who do not purchase insurance now. The 2 1/2% will at least reduce the extent to which these people burden the rest of us with their medical bills.

- Illegal immigrants are excluded from receiving any government subsidized coverage under HR 3200. They will remain a burden on providers who are unable to collect for services rendered and on State Medicaid programs, but this burden will not be increased by the bills under consideration. Increased demand for health services is likely with essentially universal coverage. Over the long term, health professionals would tend to think that this would actually reduce costs since more problems would be caught when they can be treated relatively inexpensively rather than when treatment costs much more and is funded under Medicaid. However, it is estimated that more than 20,000 people per year die because they do not receive the care they need as a result of the lack of insurance. Having these people live will probably cost more than simply letting them die the way we do now.

- I agree with your comment on cost controls. One of the advantages of the proposed program is that it eliminates prohibitions on cost controls embedded in the current Medicare program and establishes some intiatives to improve future cost control. The CBO cost estimates do not assume that these will be effective. Despite that, the CBO estimates that the program will reduce the deficit over the first five years and increase the deficit over the first ten years. The latter estimate is actually the result of $245 billion in costs that the CBO has attributed to the program but that are actually the cost of not implementing a freeze in Medicare physician payments as was mandated in 1996. That freeze has been waived every year since it was enacted. The CBO counts the cost of continuing that waiver as a cost of the proposed national insurance program (I'm not sure why this is appropriate.). If you remove that cost, the CBO actually estimates that implementation of the program is deficit neutral over its first ten years. Whether thst is true or not remains to be seen.

Evan
08-08-2009, 08:15 PM
There has to be a happy medium.Finally, a reasoned suggestion. I agree. I would strenuously assert that the current bill, which is still a work in progress, is not a sustainable, nor a choice -producing "happy medium".

I have a copy of the bill in its current form, and it's a monster of bureaucratic red tape. I'm working my way through it - a task many willing signatories appear unwilling to do. So far I have 10 pages of references to stipulations, all of which lead to the removal of personal choice in both short and long term health care.

Please take time out from this particular kernal of hope & change, and think clearly about its long term effects.

Evan

"'The nearest thing to eternal life we will ever see on this earth is a government program" ~ Ronald Reagan

Once they do this, getting rid of it will be harder than un-ringing a bell.

Gerry Clinchy
08-08-2009, 08:43 PM
- From a technical perspective, the $10,000 ia not a deductible. It is the maximum amount that a family would be required to pay in deductibles, coinsurance and co-pays before insurance would cover the balance

I do understand that it is not a deductible, but one serious illness will make the $10K look like chump change ... as you mentioned with your own situation earlier.


- No plan, private or public would be permitted to exclude people with pre-existing conditions.

And they won't be able to charge any more for those people who have pre-existing conditions, as I understand it. Insurance is all about arithmetic. And, as mentioned, the fellers in DC make the law, but the bureaucrats implement it. How can you make a law like this without doing the arithmetic first ... and telling people what those premiums are going to be (at least at the outset)? I pay $328/mo. for a plan with a $1500 deductible. It's about double what I paid 15 years ago when I was younger. Arithmetic again. More likely I'm going to give them a zinger bill than someone younger. The increased premium I pay v. 15 years ago doesn't begin to reflect how much I could cost them in just one even brief hospital stay.

Suppose the monthly premium for one of the "universal" plan, using the laws of probability & doing all the arithmetic, comes out to $550/month. That might seriously influence how many people are in favor of this fix for the broken system. I am absolutely sure that there are many people who believe that installing this universal plan will be a decrease in their monthly premiums (if they have insurance). I'm willing to bet that won't turn out to be the case within a few years, if not right at the outset.

Of course it will create administrative jobs in the Federal sector :-)


The 2 1/2% will at least reduce the extent to which these people burden the rest of us with their medical bills.


For the 30 yr old making $50K, that's a bit over $100/mo. If the insurance premiums are $200/mo. That dog won't hunt. I totally doubt that the monthly premium for this universal plan will be any less than $200/mo. when all is said and done. And that amount would undoubtedly go up frequently ... just as Medicare has required larger & larger contributions from the elderly.

Yes, there will be some savings from getting some diseases controlled sooner. Has anyone quantified that? v. the costs of providing the free insurance; v. the costs of subsidizing for those who have low enough income to qualify.


- Illegal immigrants are excluded from receiving any government subsidized coverage under HR 3200.

Well, that's interesting in and of itself. Since illegal immigrants seem privvy to other social services, I'm amazed that they will not find a way to get part of this pie.

Has anyone done anything about legislation to help us track these millions of people down and send them home?

While our legislators will not be compelled to give up their luxury health care plan, I think it would be appropriate that they receive only the "basic" plan at taxpayer expense, and pay for any "accessories" out of their own pockets. In that way, they could really get the feeling of how this universal plan operates. And it would be a great source of funds to put toward the universal plan. Has anyone mentioned how much is spent on this plan that our legislators enjoy?


If you remove that cost, the CBO actually estimates that implementation of the program is deficit neutral over its first ten years. Whether thst is true or not remains to be seen.

I'll believe it when I see it ... should I live so long :-)

Gerry Clinchy
08-08-2009, 08:46 PM
On the lighter side, I received an email that offered a suggestion to elder care.

At age 65, you get a gun and 4 bullets. You shoot 2 Congressman and 2 Senators. For this you get a life sentence in prison. No health insurance premiums. No income tax. 3 squares a day, and the best health care you don't have to be able to afford.

Gerry Clinchy
08-09-2009, 11:48 AM
Illegal immigrants are excluded from receiving any government subsidized coverage under HR 3200.

I realize I may not have been clear.

Although these illegals immigrants will not be receiving benefits under HR3200, some have estimated that the cost for medical care for these millions of people runs into billions each year. If I count the zeros correctly, if each of them cost $10,000 in health care each year, it would be $11 billion. It would be safe to say it probably runs somewhere between $1,000 to $10,000 (average). I've seen quoted that each anchor baby delivered costs $10,000. That could be about right.

So, it would appear that any cost controls for health care must also encompass the problem of illegal immigrants.

Bob Gutermuth
08-09-2009, 04:52 PM
Why should illegals get anything from the US Taxpayer except a one way trip back where they came from?

Gerry Clinchy
08-09-2009, 05:09 PM
Agreed, Bob. And doing something about those free services for people who are not citizens, is a significant cost control measure.

Medi-Gap coverage must be a money-maker for insurance carriers. I've received no less than 3 solicitations in the past week. I haven't done the research yet, but I'm told that Medi-Gap coverage will be as much as I pay for just regular health insurance right now.

M&K's Retrievers
08-10-2009, 12:09 AM
My insurance premiums have gone through the roof, I don't know about yours! There has been triple-digit increases in health premiums from private insurers.

I haven't seen any insurance CEOs nailed to crosses...rather they are doing quite nicely, with increased bonuses and compensations.

There has to be a happy medium.

I've been marketing group and individual health insurance for 35 years. When I first started in the business, there were hundreds of companies competing for your business. Now after years of increasing state and federal regulations and manadated coverage that number of companies has reduced to a handful. If health insurance was such a cash cow wouldn't there would be more players not less.

Out patient drugs account for 30% of medical expenses. Wonder why there are drug stores on every corner. I don't believe it's to sell film, magazines and asprin.

Another number is that 80% of an individuals medical expenses are incured within 12 days of death. What is Obama really telling you....

Gerry Clinchy
08-10-2009, 08:05 AM
M&K, it would be interesting to see if there are any other statistics you could find that would help us all better evaluate where costs are heaviest, and what ways cost controls could be effective. Obviously, if 80% of med expenses occur in the last 12 days of life, then there is a gorilla sitting in the middle of the room when it comes to cost control.

If they could accurately computerize drug comparisons (as was discussed somewhere earlier) ... which generic drugs could harmlessly be substituted for non-generics, that could make a big difference with Walmart and Walgreens (and other pharmacies) offering 90 days of generics for $10, and some free antibiotics as well.

Cost controls have to be at the core of having any kind of universal health insurance without breaking the bank.

I think there is a lesson in the fact that smaller insurors have not been able to survive government regulations. One cannot be sure which regulations may have had the most impact, but that deserves further investigation. This kind of legislation is just too important for the long term to "rush" into it.

What do the health insurors say they would charge for the universal plan that O proposes? That might give us some idea of what the government "alternative" might cost, at least at the outset.

I get a terrible feeling that they have not done the arithmetic on what the true costs will be. It is well and good to formulate a plan around what one believes is needed, but then you should fully investigate the honest cost of such a plan. Thus far, one of O's failings has been, I believe, that statements he made campaigning about what he would change, seem to indicate that he made these statements without recognizing the full ramifications of the changes he proposed. Either the homework wasn't done thoroughly, or the results of the research were not acknowledged.

dnf777
08-10-2009, 09:13 AM
If health insurance was such a cash cow wouldn't there would be more players not less.

Another number is that 80% of an individuals medical expenses are incured within 12 days of death. What is Obama really telling you....

Your first questions can be looked at different ways. Let me ask you this to answer your question. The banking industry has merged from hundreds if not thousands of independent banks into just a handful of large conglomerates "too big to fail", right? Are they not raping profits from us? What about insurance industry? What about defense contractors? Lockheed, Martin, Marietta, Boeing, Northrup, Grumman.....I think they're now merged into Boeing and LMM, two giants representing around a dozen former independent companies.

If all the other companies failed, then I would see your point. But if they have been bullied out of the market, or into a merger aquisition by a monopolizing company, they I wouldn't say that supports the argument that it's not a profitable market.

As for your second point regarding end of life issues, this is a very personal, delicate subject. The fact is, there ARE decisions that need to be made. WHERE to draw the line is the issue. I don't think anyone would argue with denying a 103 year old with renal failure, liver failure, and heart disease a heart transplant??? That's one extreme we can all probably agree upon, without debate. The other is a retired 65 year old who needs hip surgery to relive pain. Again, another example at the other end of the spectrum, with little debate. The problem arises with say an 80 year old, who's spouse, all the doctors, and patients' friends agree has reached the "end of the line" and would wish NOT to be kept alive by artificial means. Then comes the long, lost son out of the woodwork, threatening to sue if dear ol' Dad (who he hasn't seen in 40 years) is taken off life-support. Guess what, that person will now spend more in futile care to be kept alive for another week or two, because of defensive medicine, then they've spent their entire life.

I'm not saying what is right or wrong, but please don't think the big insurance companies will be your guardian angel when YOU start racking up big bills in the sunset years! THAT would take a LOT of kool-aid!

Gerry Clinchy
08-10-2009, 10:23 AM
Agree with you, Dave. These are personal decisions.

On organ transplants: Aren't these decisions already being made with organ transplants already ... by doctors' committees on how to choose between two recipients when only one organ is available?

It would also be interesting to study whether the acquisitions that may have occurred in the health insurance industry were a result of "healthy" companies being absorbed, or whether the acquisition was the result of the smaller co. seeking "survival".

In the title insurance business, there are only about 7 (I think) insurors in the whole country. It is an industry rule (don't know exactly what to call it) ... that if a title insuror goes belly-up, the other remaining companies assume the failed company's liabilities. This is to protect the consumers who had their titles insured with the busted company. Thus, this is what has constricted that particular insurance industry. Similar "mergers" have occurred in the life insurance industry as well at times in the past.

And what happens in situations like you described (of the one son demanding extended measures for his father) if the patient is indigent ... a nursing home resident whose total assets have been used up?

Certain nursing homes will keep patients when only their SS check is their monthly payment. (Not all nursing homes will accept this plan) The cost of nursing homes is off the chart for those who are paying their bills from personal funds ... let's say $4000/month. Yet the SS patient may be paying only $1000/mo. I suspect that the real cost of care is something between those two extremes.

With the total limitation of $5000 out-of-pocket/year, a chronic disease patient would become to the insuror much like the SS patient is to the nursing home. The premiums even on the government alternative would continue to increase.

I do not trust that the government (the legislators and bureaucracy) would have the self-discipline to properly use the windfall of insuring younger people (or taxing them for non-insurance) to offset the costs of more expensive insureds ... while working on cost controls to minimize the rate of premium increases.

In fact, I think that they are already looking for the tax and/or insurance of younger people to save Medicare from bankruptcy ... which is going to get worse as the babyboomers hit 65.

While we can say that private businesses have provided for their profits and perks for high-end employees, as reflected in their high premiums, we see the same thing in government. Fed employees do not belong to SS; they have their own plan. (State and municipal entities can also choose to provide an SS alternative). Legislators have luxury retirement and health insurance plans. I just don't trust that bureaucrats and legislators will do any better than the private insurors in improving this system.

I agree that the system as it stands is, in many ways, not the best. Yet, I don't see the present legislation as the correct "fix" ... especially when nobody is talking about the cost of the whole thing. They should be able to go to a private insuror, find out what such a plan would cost from them, and then give us some idea of the costs for the government alternative.

I'm afraid that most people simply think that this new plan will be near-free, or so inexpensive as to be negligible. I would be very surprised if coverage for a family of 4 would be less than $500/mo. That is a good deal less than coverage is now, but there are definitely going to be people who are shocked that it is as high as $500/mo.

Back to arithmetic. $500 x 12 = $6000. That is 2.5% for someone making $240,000. That individual would likely pay for the insurance. However, for the fellow making $70,000/year, that $6000 is 8.57% of gross. Will the fellow making $70,000 a year buy the insurance? The "penalty" will have to be higher than we are being told now, if we want to get these people covered. Will the fellow making $70,000 be among those eligible for "subsidy" of the cost? Where is the chart for how subsidies will be applied?

How can we evaluate the proposal without the arithmetic?

Some have mentioned that Medicare has controlled costs ... by simply telling providers that this is what they'll pay, take it or leave it. I don't doubt for one minute that charges for procedures are inflated at the ground level because the providers know that the insuror (Medicare or otherwise) will pay them less than they ask for. That kind of "fix" can only work up to a point. More arithmetic.

YardleyLabs
08-10-2009, 11:31 AM
While it is likely that end of life care is more expensive than it should be, I don't think the cost come anywhere close to 80%, Even under Medicare, spending per person in the last year of life is only about 3-4 times more expensive than spending on beneficiaries who are not in the last year of their lives. While many studies indicate that uniform standards and counseling on advance planning directives would significantly reduce costs, the savings would still be a small percentage of health care expenditures.

I suspect that some of the more difficult health care coverage decisions involve items that fall somewhere in the gray area between consumption and health insurance.

For example, when my first child was born (1973), normal childbirth was considered to be a consumption decision, not an illness covered by insurance. The cost of my daughter's birth -- including hospital and doctor -- was about $1,000 and we saved our money to be able to pay the bill. Had my daughter required special care, or had there been complications for my wife, insurance would have covered those bills. Today, child birth is considered to be a covered event.

If a pill were invented that, if taken daily, would completely prevent male pattern baldness, would that be covered as medical care, or would it be denied as pure consumption?

For pharmaceutical companies and manufacturers of medical devices, the golden goose is a chronic, non life threatening ailment for which the right drug or the right device can alleviate symptoms. When such treatments are identified, the first trick is to get the problem to be defined as a disease and then to advertise the "cure" to consumers who will be offered the contact information for physicians willing to prescribe the cure. Now, in fact, the treatment offered is never a cure. Rather, it is a palliative designed to reduce symptoms only if you continue the treatment forever.

A perfect example are sales of treatments for erectile dysfunction that now total around $4 billion, much of which is paid by insurance.

Another area of abuse are drugs that offer minimal benefits in comparison with over the counter or generic drugs but are marketed heavily to physicians and consumers to stimulate demand that is not warranted medically. Lipitor is a perfect example of this. It offers few benefits in comparison with drugs such as Zocor (simvastatin), but had sales of over $12 billion in 2005. Only through aggressive cost control efforts by insurance companies has this begun to change, but sales are still in the billions. 90% of that cost would go away if patients for whom simvastatin is appropriate took that instead.

Finally, there are the drugs that offer little real symptomatic relief but have an exclusive market and a large population in need. An example of this is Flomax. It offers some relief to men with enlarged prostates, but the benefits are relatively marginal. It is covered by almost all drug plans and therefore costs users almost nothing. However, it costs insurance programs more than $100/month per prescription with sales of more than $1 billion. Sales are sustained primarily by intensive marketing to consumers to, in the words of one business school case study, "intensify disease state awareness."

Similarly, NSAIDS such as VIOXX and Celebrex offer few benefits in pain relief relative to drugs such as ibuprophen and aspirin. The primary benefit is reduced gastric distress which is actually only an issue for a small percentage of those taking the generic drugs. However, sales of those NSAIDS were skyrocketing into the billions and were only brought closer to earth by the discovery that those same drugs increased the likelihood of coronary problems. Despite that, Celebrex sales remain in the billions with heavy direct to consumer advertising.

Effective health care cost control requires wading into a number of these issues and that will not be easy. It is clear that direct to consumer advertising is being used to stimulate demand for "treatments" that are best marginally useful, but where is the line between inappropriate marketing and beneficial consumer education? Where is the line between consumption and necessary care? Who should make that decision? It is not a question of whether or not the treatments should be available. The question is whether or not they should be covered by insurance. In fact, one can make a good case for saying that quality foods do more to improve health than many drugs. Why shouldn't my groceries be covered by health insurance? ;-)

Right now, the pharmaceutical companies are moving to become the biggest backers of national health insurance. They are sufficiently interested in the market expansion offered by universal coverage that they have agreed to give up some of the freebies they now receive totalling $80 billion over 10 years. How interested are they? The have reportedly committed $250 million for advertising over the next few months to support reform efforts. That does not bode well for cost control.

Gerry Clinchy
08-10-2009, 12:03 PM
Jeff, this would be the very crux of the problem.

I believe to show their competency, the legislators and administrators of existing programs, should delve into this cost control before they expect us to believe they will fix that later. What if they don't do any better at fixing that later, than they have so far?

If the cost savings are as significant as you would indicate, then they should tackle that first ... should have addressed it long before now.

Again, if government is going to put its hand in the machinery with all kinds of regulation ... they should have been able to compel the pharma companies to set up the computerization for drug comparisons already.

FWIW, the mfrs of all drugs used in Medicare/Medicaid pay the government back a "rebate" each year, based on the average wholesale price of the drug. Their method of compulsion? Pay the rebate or the drug will not be approved for use in the programs. This includes OTC, as well as scrip drugs. I filled out the forms for a company I worked for that mfg'd an OTC.

Since they haven't done things that they could have done to control a cost like this, I simply don't believe they will be any better at doing it once they have this massive program in place.

Bob Gutermuth
08-10-2009, 01:09 PM
http://www.foxnews.com/video2/video08.html?maven_referralObject=8052415&maven_referralPlaylistId=&sRevUrl=http://www.foxnews.com/

M&K's Retrievers
08-10-2009, 11:32 PM
Your first questions can be looked at different ways. Let me ask you this to answer your question. The banking industry has merged from hundreds if not thousands of independent banks into just a handful of large conglomerates "too big to fail", right? Are they not raping profits from us? What about insurance industry? What about defense contractors? Lockheed, Martin, Marietta, Boeing, Northrup, Grumman.....I think they're now merged into Boeing and LMM, two giants representing around a dozen former independent companies.

If all the other companies failed, then I would see your point. But if they have been bullied out of the market, or into a merger aquisition by a monopolizing company, they I wouldn't say that supports the argument that it's not a profitable market.

As for your second point regarding end of life issues, this is a very personal, delicate subject. The fact is, there ARE decisions that need to be made. WHERE to draw the line is the issue. I don't think anyone would argue with denying a 103 year old with renal failure, liver failure, and heart disease a heart transplant??? That's one extreme we can all probably agree upon, without debate. The other is a retired 65 year old who needs hip surgery to relive pain. Again, another example at the other end of the spectrum, with little debate. The problem arises with say an 80 year old, who's spouse, all the doctors, and patients' friends agree has reached the "end of the line" and would wish NOT to be kept alive by artificial means. Then comes the long, lost son out of the woodwork, threatening to sue if dear ol' Dad (who he hasn't seen in 40 years) is taken off life-support. Guess what, that person will now spend more in futile care to be kept alive for another week or two, because of defensive medicine, then they've spent their entire life.

I'm not saying what is right or wrong, but please don't think the big insurance companies will be your guardian angel when YOU start racking up big bills in the sunset years! THAT would take a LOT of kool-aid!

You are correct that several companies have merged (probably with hopes of administering a national plan) but many companies just stoped writing anything but the profitable lines i.e life, dental and disability income -lines which have little or no government mandates. They didn't fail they just had all they could stand. They could not make a profit.

As far as end of life decisions, it's certainly not the governments place to be involved in this.

As far as companies not being guardian angels when you start having bills, they can't terminate an individual nor run an individual off with rate increases because of their health.

M&K's Retrievers
08-10-2009, 11:49 PM
[QUOTE=YardleyLabs;482918]While it is likely that end of life care is more expensive than it should be, I don't think the cost come anywhere close to 80%, Even under Medicare, spending per person in the last year of life is only about 3-4 times more expensive than spending on beneficiaries who are not in the last year of their lives. While many studies indicate that uniform standards and counseling on advance planning directives would significantly reduce costs, the savings would still be a small percentage of health care expenditures.

End of life expenses are not limited to people on medicare and those in the position to "plan". They are incurred by everyone dying regardless of age hence the greater costs during the last few days of life.

Gerry Clinchy
08-11-2009, 06:34 AM
M&K

As far as companies not being guardian angels when you start having bills, they can't terminate an individual nor run an individual off with rate increases because of their health.

I'm glad you mentioned this. Several people mentioned rates increasing after onset of a disease. It's been a while since I was in the life/health insurance business, but I did not think they could do this. As long as you kept paying your premiums, your coverage continued as before.

However, I think it is "allowed" for health insurance companies to raise premiums as you age; or for basic rates of the company to increase periodically. My own rates have increased annually. Since I have had no health problems of any significance, I would have to attribute the increase to overall increases applied to all participants, or to my increasing age.

You might say that "The Blues" were among the first to offer "universal" health insurance. I don't know if it still exists, but they used to have one month, once a year, for "open enrollment". Anyone could sign up regardless of health conditions.

In my own case, originally I was covered by a Blue plan by my employer. When my company went out of existence, I was able to "convert" to an individual policy. The same held true for all employees. In fact, the company originally selected Blue coverage for this very reason ... so employees could continue coverage even if they were to leave that company. When "converting" to individual coverage, there were no forms to fill out except to notify Blue that you were converting. At the time, the premiums for individual coverage were only slightly higher than within the group plan (the company in question only had about a dozen employees so was not getting extremely low rates).

labman13
08-12-2009, 02:11 PM
I thought some would like to know I saw people protesting health care reform in Chicago today. On my way home I even saw people in the burbs which really got my attention. Besides Union pickets and W haters from the 04 election I haven't seen people gather on a suburban corner since the days after 9/11/01. It's not common to see this here

dnf777
08-12-2009, 09:39 PM
M&K, and Gerry,
Insurance companies must certainly CAN pull policies. This happens every day. Maybe they can't outright raise premiums, but they sure do drop policies. I see it in my practice all the time. There are more tricks in their books to deny payment than there are stars in the sky.

The gov't in not involved in end of life decisions. These "death panels" that Mrs. Palin refers to are nothing but payments to physicians who take the time out of their day to discuss living wills and advanced directives with patients and their families. If a lawyer sits down with a family for an hour, they get paid for it. Why shouldn't physicians? If a lawyer counsels a family regarding estate planning and wills, is it called a "death panel"? Is the elderly member being told by a jurist how they must legally die? Of course not. That is a scare tactic, and unfortunately in a gullible population, it is politically effective, and being exploited.

Bob Gutermuth
08-13-2009, 03:14 PM
Just say NO to osamacare and freebies for illegals

http://thehill.com/op-eds/healthcare-scheme-would-benefit-illegal-immigrants-2009-08-03.html

M&K's Retrievers
08-14-2009, 12:35 AM
[QUOTE=dnf777;484148]M&K, and Gerry,
Insurance companies must certainly CAN pull policies. This happens every day. Maybe they can't outright raise premiums, but they sure do drop policies. I see it in my practice all the time. There are more tricks in their books to deny payment than there are stars in the sky.

No they can not. For example, the only way a company can cancel an individual policy in a state is to cancel the entire block of like policies they have in that state. They can cancel for non payment of premium but not single an individual out for their condition or losses.

Having said that, there are misleading products or products with inside limits and restrictions that are unfortunately marketed to people via television advertising, salaried representatives or newspaper ads that do not always explain "the fine print". That's where people get hurt by not buying from (and, yes , paying more) from a legitimate company with the help of an professional insurance agent.

pat addis
08-14-2009, 04:45 AM
i called my representive to ask some questions and while i could not talk to him or any one else who seemed to know any thing. so here are some questions i would like to have anwsered. 1-what happens if in 5 years it doesn't work? 2-will it cover non citizens? 3-when it passes and they put 47 million people on it where are they going to get doctors?are they going to just make doctors take them which will mean that every on else will have a hard time trying to see a doctor ? please some one address these questions. and feel free to add more.

road kill
08-14-2009, 07:25 AM
I have one.

Could someone please show me the list of all the people that have been denied healthcare and died as a result of the denial of it in the last year?
2 years??
5 years?????

That's what I thought!!

dnf777
08-14-2009, 12:13 PM
I have one.

Could someone please show me the list of all the people that have been denied healthcare and died as a result of the denial of it in the last year?
2 years??
5 years?????

That's what I thought!!

Absense of proof is not proof of absense. 10th grade debate tactic. Come on, you're much better than that!

I could give you several names of patients who have died due to lack of care, because they chose not to burden their families with insurmountable medical expenses, but that would be a HIPPA violation. Besides, nobody compiles such a list. It would not benefit big pharma and insurance companies.

Steve Amrein
08-14-2009, 12:25 PM
Absense of proof is not proof of absense. 10th grade debate tactic. Come on, you're much better than that!

I could give you several names of patients who have died due to lack of care, because they chose not to burden their families with insurmountable medical expenses, but that would be a HIPPA violation. Besides, nobody compiles such a list. It would not benefit big pharma and insurance companies.


I believe the question was people who have died that were denied care. You mention "patients" that would show they are getting care.

dnf777
08-14-2009, 01:22 PM
I believe the question was people who have died that were denied care. You mention "patients" that would show they are getting care.

Again, very black or white view of the situation. It is far more complex.

We had a "patient" who just was laid off and lost his insurance. Is he not still a patient? People don't cease to exist just because they lose insurance, at least not to me. He called at 1am because he was stung several times by wasps, and was feeling a heavieness in his chest and was having trouble breathing. When i told him he may be having an anaphylactic reaction which could progress to respiratory failure and need to call EMS and get the the ER pronto, he told me about losing his coverage, and would wait it out at home.

Very easy to judge that as stupid, but here's a guy who's in his late 50s, worked all his life to pay off his small home, and ONE TRIP to the ER could wipe out his financial existence. If he gets intubated and put in an ICU for 3 or 4 days, that can easily total 50-60,000 dollars.

I hope that clarifies how he can be a "patient" and not receive care.

Fortunately, he turned out fine, and he's thankful he didn't take my advice. He got lucky, and saved a huge wad of cash. He thanked me and apologized. I thanked HIM, and apologized.

Mike Noel
08-14-2009, 02:26 PM
dnf,

First, do you have a name? If you have given it, I didn't catch it.

Second, is your practice taking on any new Medicare patients?

dnf777
08-14-2009, 02:57 PM
dnf,

First, do you have a name? If you have given it, I didn't catch it.

Second, is your practice taking on any new Medicare patients?

Name is Dave. Our practice is about 50% medicare or Pa Med-assist, and as of now, we take all-comers, regardless of ability to pay. My lawyer and plumber friends think I'm an idiot. Sometimes I agree. The public should be grateful that most docs are total morons when it comes to business sense!

M&K's Retrievers
08-14-2009, 09:33 PM
Again, very black or white view of the situation. It is far more complex.

We had a "patient" who just was laid off and lost his insurance. Is he not still a patient? People don't cease to exist just because they lose insurance, at least not to me. He called at 1am because he was stung several times by wasps, and was feeling a heavieness in his chest and was having trouble breathing. When i told him he may be having an anaphylactic reaction which could progress to respiratory failure and need to call EMS and get the the ER pronto, he told me about losing his coverage, and would wait it out at home.

Very easy to judge that as stupid, but here's a guy who's in his late 50s, worked all his life to pay off his small home, and ONE TRIP to the ER could wipe out his financial existence. If he gets intubated and put in an ICU for 3 or 4 days, that can easily total 50-60,000 dollars.

I hope that clarifies how he can be a "patient" and not receive care.

Fortunately, he turned out fine, and he's thankful he didn't take my advice. He got lucky, and saved a huge wad of cash. He thanked me and apologized. I thanked HIM, and apologized.

Just wondering, why did you apologise? For not getting out of bed at 1 AM.:rolleyes:

dnf777
08-14-2009, 09:51 PM
Just wondering, why did you apologise? For not getting out of bed at 1 AM.:rolleyes:

Not so much for anything I did or didn't do, but more on behalf of the system that put him through the mental anguish of having to decide between possible bankruptcy and possible death! (and that's not exaggerating!)

M&K's Retrievers
08-14-2009, 10:05 PM
Not so much for anything I did or didn't do, but more on behalf of the system that put him through the mental anguish of having to decide between possible bankruptcy and possible death! (and that's not exaggerating!)

Hell thats a no brainer. I'll take life and worry about the rest later. They can't take my house, one horse, my wife and I doubt they want the dogs. People in this country cannot be denied care. Paying for that care is another matter but it beats the alternative.

tpaschal30
08-15-2009, 06:48 AM
Not so much for anything I did or didn't do, but more on behalf of the system that put him through the mental anguish of having to decide between possible bankruptcy and possible death! (and that's not exaggerating!)

The government should be making those life and death decisions I suppose? Where did all this trust in government come from? Our founding fathers sure did not have it.

dnf777
08-15-2009, 07:35 AM
The government should be making those life and death decisions I suppose? Where did all this trust in government come from? Our founding fathers sure did not have it.

More "black and white" approach to issues. You're framing the question in unrealistic terms. Just for the record, if enrolled in medicare, VA, or Tricare, you are NOT denied emergency care under any circumstances. There is no decision to be made in that situation. Maybe I'm a little "softer" on these issues because I see it so frequently. Good, life-long working, taxpaying fellow Americans and neighbors running into serious financial trouble because of the system we currently have.

Do you realize that up to ONE HALF of medically-induced bankrupcies are with people who HAVE insurance!? Is that a good system?

dnf777
08-15-2009, 07:49 AM
Hell thats a no brainer. I'll take life and worry about the rest later. They can't take my house, one horse, my wife and I doubt they want the dogs. People in this country cannot be denied care. Paying for that care is another matter but it beats the alternative.

Well, this has come full circle then. You'd take the treatment, and let the rest of us pay for it, in other words! There is a recurring theme in this argument that I keep pointing out. Rather than debate the merits and facts of reform, the pro-insurance company crowd frames the entire complex debate in "black and white" terms, making it really easy to support their side. The gentleman I referred to was not give such a B&W choice. He was not told "die or go to the ER". He was told it might be life threatening. Now, how much is it worth to find out? ER visit is minimum $800, if nothing is wrong. If you knew it was life-threatening, even with a $10,000 hospitalization, yes, I would go too. But what if it's not? In his case it wasn't, and he saved a bundle. I don't think that in the richest, best country in the world, someone who's worked and payed taxes all their life should have to make such decisions at 1 in the morning, just because his factory fell victom to the recession.

Really, listen to the rhetoric...."keep things the same, or DEATH SQUADS will appear at your door!" "keep things the same or you'll be paying for every illegal alien in the world!" "over 55, and you're not worth keeping alive!"

But my favorite quote of all, coming from a protester, "I DON'T WANT GOVERNMENT COMING BETWEEN ME AND MY MEDICARE!!"

Lets keep the debate in bounds, with real facts, real concerns, and real solutions to the problems. Not scare tactics drummed up by industry-supported lobbyists and PR firms. (or, to be fair, industry supported advertisements in favor of Obama's plan, heavily laden with pharma provisions!)

Gerry Clinchy
08-15-2009, 08:23 AM
(or, to be fair, industry supported advertisements in favor of Obama's plan, heavily laden with pharma provisions!)

From the NY Times today:
http://www.nytimes.com/2009/08/15/us/15lobby.html?th&emc=th



WASHINGTON — Dick Armey (http://topics.nytimes.com/top/reference/timestopics/people/a/dick_armey/index.html?inline=nyt-per), the former House Republican leader, has quit his job with the lobbying firm DLA Piper amid complaints from its drug company clients about his work opposing President Obama (http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per)’s health care overhaul.
Skip to next paragraph (http://www.nytimes.com/2009/08/15/us/15lobby.html?th&emc=th#secondParagraph) http://graphics8.nytimes.com/images/2009/08/15/us/lobby_190.jpg Brendan Smialowski/Getty Images
Dick Armey

His departure is the latest example of the confusing entanglements arising from the health care debate.

To review the facts of this case: the drug companies who helped defeat the Clinton administration health care effort 15 years ago have now turned on Mr. Armey, who then was one of their most important Congressional allies. Now, having cut a deal with this administration to limit their share of the costs, the drug companies are on the other side. Foreseeing new profits from the expansion of health coverage, they are spending as much as $150 million on advertisements to support the president’s plan.


Originally Mr. O was in favor of negotiating better pricing from the pharma companies, but he's willing to give in on that in order to pass his health care baby. Not to mention the fact that O is on a regular "campaign trail" when his attention might better be given to other important issues of international affairs, etc.

There are improvements we can make in health care/insurance that could be made now without the rest of the albatross to weigh down things that both parties could readily support. One example would be the portability feature. Without the rest of the omnibus bill, both parties could support portability. As mentioned before, that was available with The Blues 18 years ago! If they could do it then & it has since disappeared, this is something that could be done again.

luvalab
08-15-2009, 08:55 AM
Gerry, first of all, don't be so reasonable--it gets people all befuddled. ;)

Second, I hadn't seen that article--thanks.

M&K's Retrievers
08-15-2009, 01:55 PM
Well, this has come full circle then. You'd take the treatment, and let the rest of us pay for it, in other words!

provisions!)

No, I wouldn't. I've always had coverage and as a self empoyed individual I still maintain coverage. My point is that no one in this country has to do without treatment and yes we all pay for it in the form of higher premiums which is reflected in part to providers passing the uncollectable charges on to those that have coverage.

The current system is not perfect but the crap they are trying to push down our throats is not the answer. Not even close.

Gerry Clinchy
08-17-2009, 09:37 AM
Maybe the concept of a "government option" will be replaced with a "cooperative" model. I think that was what The Blues were supposed to be originally.

http://www.newsmax.com/headlines/healthcare_public_option/2009/08/16/248386.html?s=al&promo_code=8574-1

AP story reported by Newsmax (conservative publication)

I think the "lesson" learned with Blue Cross/Shield, if they did start as a "cooperative", was that eventually you simply have to "pay the piper". Even a non-profit needs a profit on its product to remain functioning (covering administrative costs).

If this is the path chosen, then govt should set about cleaning up the fraud, over-charging, etc. with Medicare. O has said that Medicare will go bankrupt & made it sound like soon, so they better work on that pretty quick.

The insurance industry, doctors and hospitals should get together to find out how they can control costs without impairing quality care. This whole furor over a govt plan should have given everyone a wake-up call about taking constructive action.

M&K's Retrievers
08-17-2009, 09:42 PM
What happened to Did Not Finish 777?

road kill
08-18-2009, 06:48 AM
In a nutshell, this excercise, just like all of "the Obama's" efforts, are about redistributing wealth!!

Take money from those that have it and GIVE it to those who don't!!

end of story!!

Roger Perry
08-18-2009, 10:03 AM
If socialized medicine is so far ahead of what we have now, why didn't Teddy Kennedy go to Canada for treatment?

Because he is not a Canadian citizen:?:

Buzz
08-18-2009, 10:14 AM
No, I wouldn't. I've always had coverage and as a self empoyed individual I still maintain coverage.


Have you thought about what might happen if you got sick, couldn't work, couldn't pay your premiums, and your insurance got canceled?

road kill
08-18-2009, 10:19 AM
Have you thought about what might happen if you got sick, couldn't work, couldn't pay your premiums, and your insurance got canceled?


Under "the Obama's" plan, we will just take the wealth from someone according to what he has and redistribute it to someone else, according to what he needs!!:D

M&K's Retrievers
08-18-2009, 10:01 PM
Have you thought about what might happen if you got sick, couldn't work, couldn't pay your premiums, and your insurance got canceled?


Exactly! The system should address those that can't get insurance. Eithor they can't afford it or they are uninsurable. They should be covered by some government program. Providing coverage for those who don't want to pay for it or illegal aliens is not our problem. Don't "fix" something that works for 85% of the population if it's not broken. Get it?

Gerry Clinchy
08-22-2009, 06:22 AM
http://www.nytimes.com/2009/08/22/us/22vets.html?th&emc=th

As part of this discussion, some have cited the success of the VA health care system. Evidently, it doesn't always operate as we would hope.

Granted $24 million in bonuses is small potatoes compared to AIG and the investment banks, but who was watching the store at VA?

YardleyLabs
08-22-2009, 06:52 AM
Having helped to run a publicly owned and operated health care system, it would never occur to me to suggest that as a model for health care. The problem is not government operation, it's segregation between those receiving privately paid care from those receiving subsidized care.

When you create a system dedicated to serving a secondary population that is run by people who do not use the same system, you end up with second rate health care. Nursing homes that serve only Medicaid patients are paid as much for care as nursing homes serving private patients. However, they provide poorer care. In New York City, the city owned hospitals have physicians provided by the top medical schools in the country, the same physicians used in the top hospitals. Care in the city owned hospitals costs as much as care in the private hospitals, but it is not as good. The reason is simple. The people working in the system view the care as subsidized care for the poor. I believe that many in the VA system share the view that they are serving a secondary population, in part because the veterans who have the resources are more likely to obtain their care through the private health care system.

There is no such thing as separate but equal. In my mind, I hope that universal coverage insurance ultimately replaces VA care, Medicaid, and Medicare. There may be differences in the level of coverage, with members of the military receiving more comprehensive coverage than provided in the "minimum" qualified plan, but the subsidies should be available to allow all people the ability to select the plan they want. There is no reason that care providers should know if coverage is paid through a public subsidy, or by Exxon Mobil. That will help eliminate some of the inherent stigma that is attached to public care programs now so that poor people and Veterans receive the quality of care that is being paid for.

Gerry Clinchy
08-22-2009, 07:42 AM
Jeff, I did not mention at all about quality of care. I don't have the info to make a jugment.

What I was pointing out was the govt's lack of ability to "police" the VA system administratively. If they are not good at doing that for a much smaller system than the new one proposed, they are not yet suited to be effective on a much larger scale with more bureaucracy to monitor for fraud and abuse.

Since you mention that separate is not equal ... it occurs to me that even with universal care, those who have more $ will still be able to get better care either through better insurance coverage or through private payment.

According to the proposed plans, a certain "basic" plan will be required for all. That does not mean that everyone will get equal benefits. A long-term illness requiring $10,000/year in deductibles could still bankrupt a mid-income family. Might take a couple of more years to do it.

We will always have separation based on economic levels unless we decide to redistribute the income universally. It appears, however, that even in socialistic or communistic societies, there are those who live with more amenities, luxuries, etc. than the average citizen.

When China's bureaucrats are worried that its citizenry like capitalism a bit too much, there is something there to notice. (That info is only from a natural-born Chinese person now living in the U.S. but who continues to visit family in China.)

YardleyLabs
08-22-2009, 09:41 AM
Jeff, I did not mention at all about quality of care. I don't have the info to make a jugment.

What I was pointing out was the govt's lack of ability to "police" the VA system administratively. If they are not good at doing that for a much smaller system than the new one proposed, they are not yet suited to be effective on a much larger scale with more bureaucracy to monitor for fraud and abuse.

Since you mention that separate is not equal ... it occurs to me that even with universal care, those who have more $ will still be able to get better care either through better insurance coverage or through private payment.

According to the proposed plans, a certain "basic" plan will be required for all. That does not mean that everyone will get equal benefits. A long-term illness requiring $10,000/year in deductibles could still bankrupt a mid-income family. Might take a couple of more years to do it.

We will always have separation based on economic levels unless we decide to redistribute the income universally. It appears, however, that even in socialistic or communistic societies, there are those who live with more amenities, luxuries, etc. than the average citizen.

When China's bureaucrats are worried that its citizenry like capitalism a bit too much, there is something there to notice. (That info is only from a natural-born Chinese person now living in the U.S. but who continues to visit family in China.)
The point is that under the proposed package, the government will not be providing health care to any more people than it does now. There is a big difference between providing health care and providing health insurance. Medicare has been providing health insurance very well for 40 years. What is effectively being proposed involves providing the equivalent of Medicare as a public option (except with more limited coverage than Medicare) as one option and privately run health insurance programs on the other. Everyone would be required to purchase some form of coverage meeting the minimum standards and people with limited means would receive a subsidy to help pay part of the cost of the coverage they choose. Where does that involve the government in providing health services? It seems to me that it has the private sector providing health insurance as they do now but with a larger population and certain restrictions such as not being able to cancel people arbitrarily if they are paying their premiums and not being able to exclude people for pre-existing conditions. The public option involves the government doing the same thing under the same restrictions as it does not in Medicare. We in trn get more choices about where we buy our coverage.

Now there are different ways that universal insurance could be provided and other ways that national health services could be provided. However, the way that the administration has proposed is very limited and relies almost entirely on the private sector for health insurance management and entirely on the private sector for health services delivery.

Gerry Clinchy
08-22-2009, 11:25 AM
Once again, Jeff, care (or not care) the govt is not real good at controlling their bureaucracy ... and whether we're talking about universal health care or universal health care insurance, do we doubt that there will be lots of bureacracy involved?


Medicare has been providing health insurance very well for 40 years.

By "well" you would mean that it has taken 40 years to reach the verge of bankruptcy v. doing so in only 20 years? The bankruptcy thing, only what I heard in a speech by O. If they did it well, then it should be sustainable, shouldn't it?

I imagine that if Medicare did go bankrupt, if O didn't get this new health insurance program approved, he'd have heck to pay politically. If O believes Medicare is going bankrupt, and is pushing so hard for this more universal program, should he not have focused on making sure Medicare was fixed before the axe falls there? So, he gets his health stuff passed, and he is the hero of saving Medicare. 30 years from now, how do we fix the universal program when it gets in trouble?

BTW, those illegal immigrants. They could sink the boat. We know that O favored amnesty. Yup, McCain did, too, so I disagree with both of them. So, first he gets the health stuff passed, then moves onto getting the amnesty thing accomplished. Bait and switch, maybe? Add those illegals into the COB's calculations & I would expect that the cost #s will change quite a lot.


However, the way that the administration has proposed is very limited.

I don't think I'd term the proposal "very limited", but that is just a difference of perspectives.


and relies almost entirely on the private sector for health insurance management and entirely on the private sector for health services delivery.

But the govt will have a larger control over pricing. The results of this both through private insurors and Medicare is that providers raise their fees so that after the "powers that be" reduce them, they are still able to make their desired profit.

Perhaps what is really needed is to get real about the costs of procedures; or maybe it is the value in outcome-based payments, rather than fee for individual services.

I'd really like to hear what Dave, as a physician, could add to the discussion of the whole pricing thing since he has to deal with it first-hand.

twall
08-22-2009, 02:18 PM
If the administration is truly serious about cutting health insurance/healthcare costs tort reform would be on the table. Defensive practicing of medicine adds greatly to the costs of healthcare. It results in many additional procedures and tests being performed. And, increases costs.

Compunding the problem of unecessary tests, and prescriptions, are the people who come in and demand this or that test or drug. Doctors try to educate. But, many get worn down and give up and order the tests and scripts. Putting up with some of the peoples behavior when they don't get their way is not worth the hassel. A downside of increased information is people coming in self-diagnosing and expecteing a care plan to match their diagnosis. If they don't get what they want/expect they feel they have the right to be verbally abusive to the physician.

Tom

dnf777
08-22-2009, 02:28 PM
If the administration is truly serious about cutting health insurance/healthcare costs tort reform would be on the table. Defensive practicing of medicine adds greatly to the costs of healthcare. It results in many additional procedures and tests being performed. And, increases costs.

C
Tom

Amen!
And the true cost of defensive medicine is WAY higher than reported. The given numbers don't include things like time spent in depositions, time spent in legal planning committees, product liability costs to device manufacturers, documentation time costs.....just the added diagnostic tests alone are what we hear about, and that's just the tip of the iceberg. And it's all passed on to me and you, one way or another.

When I'm driving my GMC and a Bentley with plates "MEDMAL" passes me, it gets my hackles up.

Gerry Clinchy
08-31-2009, 08:31 AM
This is from Fox News, so I expect there will be those that feel it is slanted. However, it does point to verifiable sources. I just don't have enough paper here to print out over 2000 pages of the bill & law to which the new bill refers. It IS a long read. But one would expect that given the complexity of the issue being covered.

Perhaps this is the problem with our legislative system. They write new bills based on definitions from existing laws; some of which may very well be at odds with the new proposals designed to correct "old" errors. I wonder if even the staff members who put the bill together for their bosses actually realize that the definition of "pre-existing conditions" has loopholes for both private and public plans?

This is one of the problems, I think, with O's lack of experience in Washington previous to becoming President. When he tells crowds that pre-existing conditions will be covered, does he have a full grasp of the definition that is being used in the law? Will there be surprises later because the loopholes haven't been attended to?

If we are destined to have a public option, they should at least get it right & solve the problems that such legislation is intended to solve. They've got a lot of things they can fix while they take the time to get this done well.

And now to find out what I need to do about Medicare, as it looms on the horizon for me shortly.

Here's the article:
Tommy De Seno - FOXNews.com - August 13, 2009
US President Barack Obama delivers remarks on the health care system at the annual meeting of the American Medical Association in Chicago, Illinois, June 15, 2009. REUTERS/Jonathan Ernst (UNITED STATES POLITICS HEALTH

Gerry Clinchy
08-31-2009, 10:35 AM
cont'd


"You may have heard President Obama trumpet in many recent speeches his plan to have government run health insurance cover everyone's pre-existing medical conditions. As an example, he said to the American Medical Association on June 15, 2009:


"That is why we need to end the practice of denying coverage on the basis of pre-existing conditions. The days of cherry-picking who to cover and who to deny--those days are over."

That certainly sounds like signing up for one of the government insurance plans, no matter what ails you, will get you covered, doesn't it?


I was curious to see if the President is right about his plan putting an end to "cherry-picking" which illnesses to cover, so I decided to wade through the 1,018 page proposed health care law to find out if that's true.

Come with me on this fantastic voyage through a mess of cross-referenced and confusing legalese. As your tour guide, I have nearly 20 years experience in practicing insurance law, but reading this was not easy for me. We can get through it together though.

If the President wanted his health insurances to cover all pre-existing conditions, you'd expect some pretty simple language that says, "All pre-existing conditions will be covered." Take a look at what is written into the law instead:


Section 111 has this paragraph about pre-existing conditions:

A qualified health benefits plan may not impose any pre-existing condition exclusion...

Great! Looks like the President is telling the truth. Oh but wait, the paragraph doesn't end there. It continues...

... (as defined in section 2701(b)(1)(A) of the Public Health Service Act)...

Ok, that means we have to look up a whole other law - the Public Health Service Act (PHSA) - to find out what the definition "pre-exiting condition exclusion" is. But before we do that, the paragraph we are reading continues:

... or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.

Ok, the paragraph we are reading has ended, but we now have two tasks: Go to the PHSA and look up the definition of "pre-existing condition" in section 2701(b)(1)(A) and the definition of "health status related factors" in section 2791(d)(9).

When we Google those sections of the PHSA to read it, we run into a problem: The section numbers referenced in Obama's bill for the PHSA are the old numbers. The PHSA has been amended with new numbers, so our Googling has failed us.

Undeterred, we print out the full text of the PHSA so we can read the whole thing and find the correct section numbers. Much to our chagrin, it is 1,476 pages long. There goes our Saturday. But we are committed to this project, so we bear down and find the right sections.

Here is how the PHSA defines "pre-existing condition exclusion" in section 2701(b)(1)(A):

IN GENERAL.-The term "preexisting condition exclusion" means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.

That's great! I have to tell you, President Obama seems a man of his word...oh wait. We had two things to look up here in the PHSA, didn't we? Section 2701(d)(9) defines "Health Status-Related Factor" like this:

The term "health status-related factor" means any of the factors described in section 2702(a)(1).

Ok, what kind of dirty trick to waste our time was that? President Obama sends us to section 2701 for a definition, and the definition is"see section 2702." Why not send us right to section 2702? Sigh. Fine. Let's keep reading.

Section 2702 (a)(1) of the PHSA says:

(a) INELIGIBILITY TO ENROLL.-
(1) IN GENERAL.-Subject to paragraph (2),...

OK, stop right there. Just know that as we continue reading paragraph 1, we have to withhold any conclusion, because everything we are about to read is subject to paragraph 2. Ok? So let's continue with paragraph 1:

... a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

A) Health status.
B) Medical condition (including both physical and mental illnesses).
C) Claims experience.
D) Receipt of health care.
E) Medical history.
F) Genetic information.
G) Evidence of insurability (including conditions arising out of acts of domestic violence)

H) Disability.

Well, I have to tell you up to this point President Obama is still looking good. Paragraph 1 seems to say the Government can't deny you coverage based upon any of the above pre-existing conditions. Oh but I forgot - the whole thing is "subject to paragraph 2." Let's see what that says:

2) NO APPLICATION TO BENEFITS OR EXCLUSIONS.-To the extent consistent with section 701,...

OK,, stop right there. They are making us work again. We are going to continue reading paragraph 2, but we have to withhold conclusions because we have to make sure it is "consistent with section 701." All right, here is paragraph 2:

paragraph (1) shall not be construed-
A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or
B) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or overage for similarly situated individuals enrolled in the plan or coverage.

The bottom just fell out, and Obama is looking pale. The above language in paragraph 2 just put a whole bunch of power in the hands of the folks writing the policies when it comes to pre-existing conditions.


But before we analyze that, remember paragraph 2 has to be "consistent with section 701." So let's look at that. It says:

The purpose of this subpart is to enable the Secretary to provide a Federal program of student loan insurance for students in (and certain former students of) eligible institutions (as defined in section 719).

Wait ... what? What's that got to do with the price of tea in China? We are talking about pre-existing medical conditions and suddenly we get sent to a section about - I don't know - giving loans to foreign exchange students from Kenya?

I think I know what happened there. The Public Health Service Act was originally written in the 1940's and has been amended many times. Somewhere along the way Congress just got sloppy, and now there is a cross-reference that either makes no sense or the connection is so obscure even comedian Dennis Miller thinks it's a little far-fetched.

I think it's just a huge typographical error, so the only thing we can do is ignore section 701 and get back to paragraph 2 of Section 2702, which we were discussing above.

I know all of this is confusing, but let your trusty tour guide tell you where you stand:

What paragraph two says in part A is that policy writers for the government will be allowed to make the insurance you buy cover certain ailments, and not cover others (one of which may be a condition you happen to have, which is pre-existing).

What paragraph two says in part B is that policy writers for the government will be allowed to limit the amount, level, extent, or nature of the treatment you get for certain ailments (one of which may be your pre-existing condition).

So who will be writing your insurance policy? According to the President's plan, a new bureaucracy known as the "Health Benefits Advisory Committee." It will be made up of 27 people, and guess how many have to be a treating doctor: One.

So if you believe President Obama's quote to the AMA means that if you sign up for government insurance your pre-existing condition will automatically be covered, - you're wrong, and so is the President. You'd better read the fine print on whether the gang of 26 bureaucrats plus one doctor is going to cover your pre-existing condition or not. President Obama is giving them the power to not cover you.
----------
Seems like it would have been easier to write a new, clear definition of pre-existing condition and stipulate that it superceded and replaced definitions in previous legislation. Maybe they didn't realize the definition they were referencing? Worse, maybe they did.

Gerry Clinchy
09-04-2009, 07:02 AM
I admit to being confused by the NY Times article:



Ms. Snowe’s proposal recalls a provision of the 2003 law that added a prescription drug benefit to Medicare (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier). At the time, experts doubted that insurers would sell stand-alone policies covering only prescription drugs.
That law allowed the government to establish a prescription drug insurance plan in any geographic area with fewer than two private plans. But private insurers, seeing a lucrative business opportunity, rushed into the market, and the government never had to establish a plan of its own.
The Medicare drug benefit is thus delivered entirely by private insurers under contract with the federal government.


It has been mentioned elsewhere that the Medicare prescription drug benefit was ill-advised (by Bush) since it has cost Medicare too much money. However, retirees pay a premium for their drug benefit; and if it is all done by private insurors, how come it is costing the Medicare program money? I understand that the premiums on this coverage continue to increase; and the premium is deducted from the SS checks automatically.

The same article is discussing the govt only offering a public option where "affordable" health insurance is not available. They define "affordable" as



Congress would define “affordable” with a sliding scale based on income. Under a proposal being considered by the Finance Committee, Medicaid (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier) would be extended to anyone with income less than 133 percent of the poverty level ($29,327 for a family of four).
For people with incomes just above that level, insurance would be considered affordable if they could find a policy with premiums equal to no more than, say, 3 percent or 4 percent of their income. For people with incomes exceeding three times the poverty level ($66,150 for a family of four), insurance might be deemed unaffordable if the premiums were more than, say, 12.5 percent to 15 percent of their income.


The figures would mean
3% of $29,328 = $879.84 ($73.32/mo)
12.5% of $66.150 = $8268.75 ($689.06)
Thus, someone making about 2.26X the $29,328 would be deemed capable of paying 9.4X more for health insurance before it became "unaffordable".

I wonder if they intend to change the "tax" for not having health insurance. At the presently proposed 2.5% individyual tax (even for higher incomes), the fellow earning $66,150 would pay $1653.75/year. Or does the present proposal call for a sliding scale upward on this no-insurance tax?

If the govt views 12.5% as "affordable", then will that be what the govt charges for its public option? Keeping in mind that the govt's goal will be to use the premiums it collects from younger, higher-income individuals to offset the "losses" on the older insureds with pre-existing conditions.

The math of this actuarial principle only works if the amount you collect from the young, healthy people is sufficient to cover the much larger costs of the older, less healthy people. As Dave says, there is no escaping aging.

The problem with govt programs (using SS & Medicare as examples) has been that as soon as the govt sees reserves building, which is actuarily sound & should be intended, they can't resist spending those reserves. In the end, when those reserves would have been needed to sustain the program, they have already been spent. In the case of SS, the govt actually "borrowed" from SS to throw $ into the general budget.

If there is to be any public option, there would have to be an absolutely inviolate prohibition on the reserves that build from being spent in any other program, or for increasing benefits without commensurate actuarial soundness. Only then could any plan, run privately or publicly, maintain its actuarial soundness.

Am I mistaken, or is it correct that nowhere are there any estimates of how much someone will pay for the presently proposed public option? For those who are in favor of some type of public option (even if proposed as a "back-up"), they might end up being very surprised by how much it would cost.

I cannot believe that the private health insurors can't come up with a computer "model" of such a program. The govt should also have the computerization capability to do this. If so, why haven't they done so? If they have done so, why isn't it public information? The COB has extrapolated the costs of the program, but they have not translated it into the individual cost to each insured, it would appear.

Locally, this kind of thinking, in one of our local school districts, ended up costing the taxpayers $57 million! The basic outline of that situation. The school board was sold a bill of goods that by buying derivatives they would save $2 to $3 million on the financing of the district's debt (being used to build new facilities). The board members have since admitted that they never understood what the whole thing was, nor did they understand what the negative aspects might be. They essentially played the stock market with taxpayer money, but didn't even understand what they were doing! Bottom line, if they didn't understand what they were voting for, they had no business voting for it. Financially, it is now considered the most troubled school district in the entire state.

Gerry Clinchy
09-14-2009, 05:05 AM
http://www.nytimes.com/2009/09/14/health/policy/14kidney.html?th&emc=th

This story illustrates what we could fix now, even without an omnibus health care bill: provide sufficient funds for anti-rejection drugs instead of paying for a second transplant.

Perhaps this is the perfect example of "rationing". Is the govt betting that those younger people who need more than 36 mos of rejection drugs will not survive? Then they won't have to pay for a second transplant, due to the scarcity of organs? The only thing that makes sense since, in the case of kidneys, dialysis and/or a second transplant is more costly than the anti-rejection drugs. However, in the short term, if those people do not die, the increased costs of unlimited anti-rejection drugs would greatly increase overall costs.

Ironically, in this case unlimited rejection drugs are provided for those over 65, but not for those under 65.

Our existing laws seem not to make sense.

I did find it interesting that if she married, she could get coverage for her pre-existing condition by being added to her new husband's health insurance.

Gerry Clinchy
09-16-2009, 06:19 PM
Just received this via email:

"America’s Health Future Act of 2009 (http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf)" (pdf)
Press Release from Senate Finance Committee (http://www.kaiserhealthnews.org/Stories/2009/September/16/Baucus-Press-Release.aspx)People who earn as much as 133 percent of the federal poverty level ($14,440 for an individual, $29,400 for a family of four) would be eligible for Medicaid, the government insurance program for the poor.

The measure includes a health insurance 'exchange' where people could buy insurance and a system of health care "co-ops" rather than a government-run health insurance plan. Subsidies would help low-income workers purchase health insurance and small businesses would receive tax credits to help offset the cost of providing coverage.

The bill is projected to cost $856 billion over 10 years. It would be paid for with an excise tax on high-end health insurance policies, lower payments to the Medicare Advantage program and with fees on medical device manufacturers, clinical labs, drug makers and health insurance companies. Baucus negotiated the plan with five other finance committee members - including three Republicans - but no one in the GOP has endorsed the package.
--------------
Seems like Medicare may have to take a pretty big "hit" to help pay for this plan. This would mean, I would have to assume, that those on Medicare will have to acquire other insurance to make up for this loss of benefits from "Advantage".

Who will pay the "excise tax" on high-end health plans?

Will suppliers of medical products/services that are being taxed increase the cost of their products/services so the costs would be passed along to the consumer? That's how it usually works.

No free lunch. Somebody will pick up the tab. In this case, Medicare recipients, those who have good insurance plans, and all consumers who will pay higher prices for their health care products/services.

Might as well have just tacked on a payroll deduction for "health care subsidy". Simpler to administer; easier to understand. Nobody ever accused govt of being easy to understand :-)

M&K's Retrievers
09-16-2009, 10:45 PM
they just want to put the head...oh never mind

JDogger
09-16-2009, 11:26 PM
they just want to put the head...oh never mind

...and we have trouble interpreting ALPHA..OMEGA....

....Get some sleep

JD

M&K's Retrievers
09-17-2009, 11:05 AM
...and we have trouble interpreting ALPHA..OMEGA....

....Get some sleep

JD

Man, that was low:(