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TXduckdog
08-06-2009, 10:50 PM
Here's a section by section, line by line analysis of the proposed healthcare bill. It's unbelievable.

http://www.lc.org/media/9980/attachments/healthcare_overview_obama_072909.pdf

Print it out, read it and pass it around.

No wonder they tried to ram this through so fast.

YardleyLabs
08-07-2009, 06:46 AM
I wouldn't vote for the bill being described in the referenced memo either. Fortunately it has little to do with any of the bills being considered in Congress. The operative word in your post is "unbelievable". For example:

The memo states:

"Sec. 122, Pg. 29, Lines 4-16 - YOUR HEALTH CARE WILL BE RATIONED!"

The actual language for section 122 of HR 320 follows:

"SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.
(a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--

(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

(4) complies with section 115(a) (relating to network adequacy); and

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum Services To Be Covered- The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services, including emergency department services.

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

(9) Maternity care.

(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
(c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-

(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

(2) ANNUAL LIMITATION-


(A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).


(B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.


(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.

(3) MINIMUM ACTUARIAL VALUE-


(A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).


(B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed." The bill describes the minimum standards of coverage for a health plan that would qualify as meeting the requirement that everyone purchase insurance. It does not limit what additional benefits might be included in a plan, but it does set a floor. I suspect that if you compare these benefits to the plans you now have, some will find that this proposal is richer but that most will find that this plan is comparable to what you have now and that for some it is more comprehensive. Nothing in the bill prevents more generous plans. In particular, many plans have lower deductibles and coinsurance than the minimum qualified plan standard described in the bill. A legitimate cost question is whether this standard is too rich or if a lesser standard might make more sense at least for now to save money. However, I would be interested to see what language in this section is being interpreted as mandating rationing of care as stated in the memo.

So far, I have only researched about one third of the comments made in the memo. I haven't found any part that is closer to the truth than this one. The only "Liberty" I see in this piece authored by the "Liberty Counsel" is taking liberties with the truth. Their memo has nothing to do with anything except distortion. If you are actually interested in what is and is not included in the bill, in an easily researched format, the entire text is available on the Library of Congress site at http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

By the way, HR 3200 is being redrafted to reflect the agreements ade with Blue Dog Democrats to reduce costs. The Senate plan is also different from HR 3200. Final language should become clearer in September.

TXduckdog
08-07-2009, 10:18 AM
Jeff......the source document you are looking at is different from what Liberty used. They used the bill printed in it's entirety by the GPO.

Here is the source document used by Liberty.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

Here is the actual wording for Sec 122; pg 29; lines 4-16:

(2) ANNUAL LIMITATION.—
4 (A) ANNUAL LIMITATION.—The cost-shar5
ing incurred under the essential benefits pack6
age with respect to an individual (or family) for
7 a year does not exceed the applicable level spec8
ified in subparagraph (B).
9 (B) APPLICABLE LEVEL.—The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con15
sumer Price Index (United States city average)
16 applicable to such year.
17 (C) USE OF COPAYMENTS.—In establishing
18 cost-sharing levels for basic, enhanced, and pre19
mium plans under this subsection, the Sec20
retary shall, to the maximum extent possible,
21 use only copayments and not coinsurance.

Now I will admit....Liberty's info is an "interpretation and projected understanding of the wording", their actual words from the phone call I made to them this morning.

Perhaps your source document is part of the redraft?

What would be your interpretation of the subpoints 'Annual Limitations' and for that matter 'Minimum Actuarial Value'?

Is not the 'Annual Limitations' not referring to a cap on cost sharing? It sure could be interpreted that way.


So yes, I am actually interested in what "is and is not" introduced in the bill....so lets knock off the editorial comments about "taking liberties with the truth" and "distortion". No need to go into partisan attack mode.

As the bill stands now....there is a helluva lot of "splainin' " to do.

Buzz
08-07-2009, 11:22 AM
I don't see how any part of that language could be interpreted as the rationing of healthcare. As Jeff stated, it sets the minimum benefit, or the maximum out of pocket for the insured for the most bargain basement plan.

quote:
So yes, I am actually interested in what "is and is not" introduced in the bill....so lets knock off the editorial comments about "taking liberties with the truth" and "distortion". No need to go into partisan attack mode.


It's hard not to react that way when you see a bunch of scared crapless people raising hell at town meetings around the country because they are purposely being misled on the facts by people that have a greed based interest in seeing things remain the way they are. As someone who part owns and operates a small business, I am more terrified of being priced out of the market for healthcare than anything I've seen proposed so far in Washington. Just for my family, we pay over $10,000/year for a high deductible plan. With the premiums and deductible and coinsurance, last year my family doled out over $17k for healthcare last year. About what it cost me to keep a roof over my head.

Bob Gutermuth
08-07-2009, 11:31 AM
Yes and the misleading or outright lies are from the pro Osamacare side.

brandywinelabs
08-07-2009, 11:36 AM
When I start having to pay $5K each for my wife and I, that would lead to more rationing. I already need surgery on both knees and my back. But I deal with it until it fits the budget. One major expense per year. But with a deductible of $5K. That is a whole lot more deductible per yr than I have to deal with now.....

Buzz
08-07-2009, 11:43 AM
When I start having to pay $5K each for my wife and I, that would lead to more rationing. I already need surgery on both knees and my back. But I deal with it until it fits the budget. One major expense per year. but iwth a deductible of $5K. That is a whole lot more than I have to deal with now.....


But that is the floor for benefits. They are not saying that every plan would have $5k out of pocket per person.

Buzz
08-07-2009, 11:44 AM
Yes and the misleading or outright lies are from the pro Osamacare side.

For example?...

Bob Gutermuth
08-07-2009, 11:50 AM
The whole package is a lie, why else would they be trying to ram it thru congress so quickly. Remember that congress is fulll of lawyers, and you can tell a lawyer is lying cause his lips are moving.

dnf777
08-07-2009, 12:01 PM
The whole package is a lie, why else would they be trying to ram it thru congress so quickly. Remember that congress is fulll of lawyers, and you can tell a lawyer is lying cause his lips are moving.

If ramming something through congress makes it a lie, then the Iraq war must.....oh, never mind.:-?

YardleyLabs
08-07-2009, 12:04 PM
Jeff......the source document you are looking at is different from what Liberty used. They used the bill printed in it's entirety by the GPO.

Here is the source document used by Liberty.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

Here is the actual wording for Sec 122; pg 29; lines 4-16:

(2) ANNUAL LIMITATION.—
4 (A) ANNUAL LIMITATION.—The cost-shar5
ing incurred under the essential benefits pack6
age with respect to an individual (or family) for
7 a year does not exceed the applicable level spec8
ified in subparagraph (B).
9 (B) APPLICABLE LEVEL.—The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con15
sumer Price Index (United States city average)
16 applicable to such year.
17 (C) USE OF COPAYMENTS.—In establishing
18 cost-sharing levels for basic, enhanced, and pre19
mium plans under this subsection, the Sec20
retary shall, to the maximum extent possible,
21 use only copayments and not coinsurance.

Now I will admit....Liberty's info is an "interpretation and projected understanding of the wording", their actual words from the phone call I made to them this morning.

Perhaps your source document is part of the redraft?

What would be your interpretation of the subpoints 'Annual Limitations' and for that matter 'Minimum Actuarial Value'?

Is not the 'Annual Limitations' not referring to a cap on cost sharing? It sure could be interpreted that way.


So yes, I am actually interested in what "is and is not" introduced in the bill....so lets knock off the editorial comments about "taking liberties with the truth" and "distortion". No need to go into partisan attack mode.

As the bill stands now....there is a helluva lot of "splainin' " to do.

The cost sharing they are talking about under the "Annual Limitation" is the maximum limit on the amounts of money that an individual or family would be required to pay as coinsurance or deductibles. Thus, it you incurred $5,000,000 in medical expenses in the course of a year and might otherwise have faced $100,000 in coinsurance and deductibles, under this plan your out of pocket costs would be capped at $5,000. It ids not a limit on what is covered, it is a limit of what is not covered.

So yes, they are taking "liberties" with the truth since this is an absolutely standard clause included in the best policies (as in most generous) to limit the financial exposure of insureds and there is no way that they have misunderstood what this clause means unless their primary occupations are as dog catchers.

YardleyLabs
08-07-2009, 12:12 PM
When I start having to pay $5K each for my wife and I, that would lead to more rationing. I already need surgery on both knees and my back. But I deal with it until it fits the budget. One major expense per year. But with a deductible of $5K. That is a whole lot more deductible per yr than I have to deal with now.....

Actually, my current health plan, which costs $550/month, has a $5,000 limit of out of pocket expenses for an individual or $10,000 for a family. My daughter and her husband's policy (through a major corporation) includes a $3,000 per person/$7,000 per family out of pocket limitation. Many companies actually allow their employees to select among different coinsurance, deductible, and out of pocket limitations, paying higher or lower premiums based on the choice made. This bill does nothing to prevent that. It simply states that everyone must at least be offered this level of minimum coverage for the plan to be considered "qualified".

By the way, this is not a deductible; it is a limit on maximum out of pocket expenditures from all sources: deductibles and consurance.

Are you suggesting that the limits should be set lower even if that costs more?

Bob Gutermuth
08-07-2009, 12:15 PM
Hasn't the left been contending this all along?

YardleyLabs
08-07-2009, 12:30 PM
Yes and the misleading or outright lies are from the pro Osamacare side.
Do you have examples? I am inundated with lies every day from opponents talking about things that have not been included in any bill submitted in either house. Most of the advertising is blatantly false.

The reality is that every proposal on the table assumes that coverages will be provided through insurance programs that follow the structure of employer sponsored plans now in existence. Only two types of changes are made: minimum standards of coverage to prevent policies from cutting off benefits to those most in need, and the provision of coverage options for most of those who are not eligible for benefits based on employment, age, disablity, or poverty.

The biggest change is that it makes it mandatory for individuals to have at least a minimum amount of coverage -- whether purchased by the individual or provided by their employer -- or face penalties for failing to purchase such coverage. It provides subsidies for lower income people to purchase such coverage if they meet defined financial limits. However, people that have the means to buy insurance but choose not to are subject to financial penalties.

The reality is that the opposition to health reform is lying because they cannot win based on the truth.

zeus3925
08-07-2009, 12:32 PM
I had some surgery recently and spent two days in the hospital. The bill just for the hospital stay was $30,000 (not the surgeon or other expenses). Lucky, I had Medicare and a good supplemental plan or I would have had to eat the bill. As it was, the government and the insurance paid $10,000.

I am sure those charges also went to pay for those that show up for treatment at the hospital without insurance.

I like the set up I have now, but, the others without coverage are costing the rest of us through the nose. We need a change in the system.

Bob Gutermuth
08-07-2009, 12:37 PM
We don't need osamacare.

dnf777
08-07-2009, 12:40 PM
Jeff......the source document you are looking at is different from what Liberty used. They used the bill printed in it's entirety by the GPO.

Here is the source document used by Liberty.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

Here is the actual wording for Sec 122; pg 29; lines 4-16:

(2) ANNUAL LIMITATION.—
4 (A) ANNUAL LIMITATION.—The cost-shar5
ing incurred under the essential benefits pack6
age with respect to an individual (or family) for
7 a year does not exceed the applicable level spec8
ified in subparagraph (B).
9 (B) APPLICABLE LEVEL.—The applicable
10 level specified in this subparagraph for Y1 is
11 $5,000 for an individual and $10,000 for a
12 family. Such levels shall be increased (rounded
13 to the nearest $100) for each subsequent year
14 by the annual percentage increase in the Con15
sumer Price Index (United States city average)
16 applicable to such year.
17 (C) USE OF COPAYMENTS.—In establishing
18 cost-sharing levels for basic, enhanced, and pre19
mium plans under this subsection, the Sec20
retary shall, to the maximum extent possible,
21 use only copayments and not coinsurance.

Now I will admit....Liberty's info is an "interpretation and projected understanding of the wording", their actual words from the phone call I made to them this morning.

Perhaps your source document is part of the redraft?

What would be your interpretation of the subpoints 'Annual Limitations' and for that matter 'Minimum Actuarial Value'?

Is not the 'Annual Limitations' not referring to a cap on cost sharing? It sure could be interpreted that way.


So yes, I am actually interested in what "is and is not" introduced in the bill....so lets knock off the editorial comments about "taking liberties with the truth" and "distortion". No need to go into partisan attack mode.

As the bill stands now....there is a helluva lot of "splainin' " to do.

Anytime I see that much small print, with a signature line below all of it, I make these two assumptions:

1) A good screwin' is a comin' :shock:

2) Might as well sign, because you're gonna get it anyway!

Mortgages, inurance policies, consent forms, cell phone agreements, court papers, cable tv contracts......the list represents daily life!

Have a GREAT weekend, on that note! :p

Gerry Clinchy
08-07-2009, 01:30 PM
Jeff


(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.


I take this to mean that all preventative care will be "free" to the insured?

If so, I wonder whether they have properly estimated the cost of this program.

Jeff, I'm not entirely sure that a government plan will cost as little as $550/mo for two people (I'm assuming all your kids are now independent), with that $5000 deductible.

First, we need to learn how to control health care costs in the free market. Whether that involves looking at what private insurance companies are doing (or not doing!); what Medicare and Medicaid are doing (or not doing); whether tort reform will play a role, simultaneously with strengthening the medical profession's own self-disciplining procedures. If we don't control health care costs, no matter who does the insurance we're going to have a problem paying for health care for everyone.

Right now everyone who's insured is paying for those who are not. And that's not going to change under this program. Without controlling the cost of care, we are missing the boat.

As our population ages, costs are going up. We've already seen this happening, and the bulk of the baby boomers haven't even reached Medicare age. No denying it, as humans age, their bodies need more "repairs".

I guess I just don't have faith in the government for accurately estimating costs of its planned programs. Bad planning has run Social Security into the ground. Doing the same with Medicare and Medicaid. Have to believe the root is in bad estimating skills.

Someone recently mentioned a doctor who believes there is no way to address increasing costs without addressing the primary chronic illnesses, such as diabetes, hypertension, heart disease, etc.

Jeff

By the way, HR 3200 is being redrafted to reflect the agreements ade with Blue Dog Democrats to reduce costs. The Senate plan is also different from HR 3200. Final language should become clearer in September.

Will the legislators have any more time to thoroughly read the bills' changes to see if they actually "repair" failings in the original bills? This is a real concern.

A radio transmission of Specter's town hall meeting in Philadelphia, revealed that he got the biggest boos when he used a statement to the effect of "we have to make quick decisions". He explained that in a large bill like this, because they have to act quickly, they split up the bill among several staffers; then come together to discuss the sections. I think that can lead to problems in fully understanding the larger picture. For change as radical as this one, this needs more careful attention.

YardleyLabs
08-07-2009, 03:05 PM
Jeff


I take this to mean that all preventative care will be "free" to the insured?

If so, I wonder whether they have properly estimated the cost of this program.

Jeff, I'm not entirely sure that a government plan will cost as little as $550/mo for two people (I'm assuming all your kids are now independent), with that $5000 deductible.

First, we need to learn how to control health care costs in the free market. Whether that involves looking at what private insurance companies are doing (or not doing!); what Medicare and Medicaid are doing (or not doing); whether tort reform will play a role, simultaneously with strengthening the medical profession's own self-disciplining procedures. If we don't control health care costs, no matter who does the insurance we're going to have a problem paying for health care for everyone.

Right now everyone who's insured is paying for those who are not. And that's not going to change under this program. Without controlling the cost of care, we are missing the boat.

As our population ages, costs are going up. We've already seen this happening, and the bulk of the baby boomers haven't even reached Medicare age. No denying it, as humans age, their bodies need more "repairs".

I guess I just don't have faith in the government for accurately estimating costs of its planned programs. Bad planning has run Social Security into the ground. Doing the same with Medicare and Medicaid. Have to believe the root is in bad estimating skills.

Someone recently mentioned a doctor who believes there is no way to address increasing costs without addressing the primary chronic illnesses, such as diabetes, hypertension, heart disease, etc.

Jeff


Will the legislators have any more time to thoroughly read the bills' changes to see if they actually "repair" failings in the original bills? This is a real concern.

A radio transmission of Specter's town hall meeting in Philadelphia, revealed that he got the biggest boos when he used a statement to the effect of "we have to make quick decisions". He explained that in a large bill like this, because they have to act quickly, they split up the bill among several staffers; then come together to discuss the sections. I think that can lead to problems in fully understanding the larger picture. For change as radical as this one, this needs more careful attention.
They define preventative care but it is unclear how CBO has estimated the costs. Most health professionals believe that preventative care will reduce costs over time but in the short term it is treated simply as a cost. The CBO, as I understand it, has included no estimates of any future savings from improved prevention. By the way, this is also the approach used by private insurance companies as I discovered over years of negotiating plans.

My own plan is $550/month for a single person (me) and the $5000 is a maximum out of pocket cost, not a deductible. That is, my deductible, copayment and coinsurance costs over the course of the year are capped at $5000. Over that amount the insurance pays any co-pay or co-insurance. I hit that limit in 2006 and may do so again in the future. This is consistent with the HR 3200 limit.

I agree that health care cost control is critical and a large part of the bill addresses efforts in that direction. Plans that are more effective at controlling costs will be able to offer lower premiums and potentially better benefits than those that do not. Hopefully those plans will attract more customers and be more profitable for their operators. However, it is interesting that much of the opposition to a "government" option is that the government may be better at controlling costs and drive private carriers out of business because the government is the one offering better benefits at a lower cost. Why does that fear exist? One reason is that Medicare experience has suggested that such an outcome is possible. To get private insurance companies to play a greater role in Medicare, the Bush administration offered them a bonus under which they were paid 13% more for coverage they provided than the government was paying for the same service. That became a major source of new profits for the insurance industry and one of the cost savings proposed by the administration is to eliminate this bonus.

With respect to planning, bad planning has nothing to do with increasing costs under Social Security and Medicare. Social Security costs are highly predictable. Based on actuarial estimates under Reagan, social security taxes were raised to a level that would fund the plan for decades to come. However, the surpluses generated by Social Security over the last 30 years have been systematically spent to fund tax cuts and increased spending. Some of that increased spending has been on improvements in social security benefits that were not the paid for with additional tax increases. Medicare has been harder to predict because so much of our improvements in health care have been for expensive new ways to extend life (not necessarily quality of life) at huge expense. Without Medicare, these treatments never would have been developed since few could have paid the bill. However, the budget busters have come from unfunded additions and corporate welfare. I already mentioned the 13% bonus paid to private insurance companies. The drug benefit as it was implemented was primarily designed to help pharmaceutical companies by requiring Medicare to pay list prices that are not paid by any other third party payor.

When I was in college, I studied under some of the top health economists in the country. At that time health care cost less than 7% of GDP and people were horrified that it might increase to 10%. Now it is 16% and growing.

Personally, I believe that there are only two possible approaches for controlling this growth. First would be to eliminate all health insurance and let the market take over in full. Thousands might die because of care they do not receive, but I guarantee costs will fall. The alternative is to require universal coverage to force all to feel the pain and then to regulate costs more effectively. Our current costs are not the product of a free market. They are the product of a market where the consumers -- patients and the doctors that oversee their consumption of services -- do not pay the bills. As a result, any care covered by insurance is seen as virtually free and the result is a grotesque level of over-consumption. The providers of care are understandably afraid of what will happen if someone finally starts watching the check book. By the way, when I say providers, doctors are not high on the list. While they used to be kings of the mountain, today they have been reduced to relative serfdom. The real profits lie in "managed care" which is managed only for the benefit of stockholders, pharmaceutical companies, manufacturers of medical equipment, etc.

TXduckdog
08-07-2009, 04:11 PM
The cost sharing they are talking about under the "Annual Limitation" is the maximum limit on the amounts of money that an individual or family would be required to pay as coinsurance or deductibles. Thus, it you incurred $5,000,000 in medical expenses in the course of a year and might otherwise have faced $100,000 in coinsurance and deductibles, under this plan your out of pocket costs would be capped at $5,000. It ids not a limit on what is covered, it is a limit of what is not covered.

So yes, they are taking "liberties" with the truth since this is an absolutely standard clause included in the best policies (as in most generous) to limit the financial exposure of insureds and there is no way that they have misunderstood what this clause means unless their primary occupations are as dog catchers.



Jeff:

That's a very good analysis. Tell me, if this whole plan can be as succinct and straightforward as you make it, why is the cottonpicking thing a 1000 pages??

TXduckdog
08-07-2009, 04:30 PM
Personally, I believe that there are only two possible approaches for controlling this growth. First would be to eliminate all health insurance and let the market take over in full. Thousands might die because of care they do not receive, but I guarantee costs will fall. The alternative is to require universal coverage to force all to feel the pain and then to regulate costs more effectively. Our current costs are not the product of a free market. They are the product of a market where the consumers -- patients and the doctors that oversee their consumption of services -- do not pay the bills. As a result, any care covered by insurance is seen as virtually free and the result is a grotesque level of over-consumption. The providers of care are understandably afraid of what will happen if someone finally starts watching the check book. By the way, when I say providers, doctors are not high on the list. While they used to be kings of the mountain, today they have been reduced to relative serfdom. The real profits lie in "managed care" which is managed only for the benefit of stockholders, pharmaceutical companies, manufacturers of medical equipment, etc.

I have to believe there are more than 2 options. I have to think serious tort reform would go a long way to alleviate stress on costs.

And what gives you any confidence whatsoever in the government being able to regulate costs?

This is precisely the point of all this uproar.....regulating costs. Can you really tell me with a straight face that government regulation of costs is the way to go??!!

YardleyLabs
08-07-2009, 04:35 PM
Jeff:

That's a very good analysis. Tell me, if this whole plan can be as succinct and straightforward as you make it, why is the cottonpicking thing a 1000 pages??
The last time I looked, the laws and regulations governing Medicare and Medicaid ran about 20 feet. My health insurance policy runs about 200 pages in a type font that I can't read even with tri-focals. Part of the problem and one of the things that also makes the program a little less experimental than many believe is that the structure of health coverage programs is very well defined. We have been learning how to write coverage policies since the 1950's and have a pretty good idea of where to find the pitfalls. The downside is that it means that people have learned to make the language specific rather than broad and specificty results in lots of pages.

YardleyLabs
08-07-2009, 04:45 PM
I have to believe there are more than 2 options. I have to think serious tort reform would go a long way to alleviate stress on costs.

And what gives you any confidence whatsoever in the government being able to regulate costs?

This is precisely the point of all this uproar.....regulating costs. Can you really tell me with a straight face that government regulation of costs is the way to go??!!
A market economy requires a market of buyers and producers that are both at risk financially. The incentives are distorted if either party is protected from financial consequences. In health care there simply is no economic market resulting in massive distortions. This is not a new problem, but it has no easy solutions. What we are doing now is completely broken and the result is costs that are skyrocketing and health outcomes that do not justify the cost. Regulation is not a good substitute for competition. Unfortunately we don't have any.

WRL
08-07-2009, 06:38 PM
Jeff,

Do you have existing health issues? What is your age etc?

I have my own health care insurance policy.

I pay $160 for one person and have a "break point" (that is what they used to call out of pocket expenses) total of $2600/yr.

My policy includes prescriptions.

Why is your policy so expensive?

A $550 cost per month would be a HUGE increase for me along with a out of pocket expense of $5000/yearly.

WRL

Pete
08-07-2009, 06:49 PM
[QUOTE][The whole package is a lie, why else would they be trying to ram it thru congress so quickly. Remember that congress is fulll of lawyers, and you can tell a lawyer is lying cause his lips are moving/QUOTE]

What I'm trying to figure out is how the hell it took so much thought ,consideration and time to figure out what kind of dog to own,,,,but lets hurry up and run this health bill through by yesterday.

Pete

YardleyLabs
08-07-2009, 07:13 PM
Jeff,

Do you have existing health issues? What is your age etc?

I have my own health care insurance policy.

I pay $160 for one person and have a "break point" (that is what they used to call out of pocket expenses) total of $2600/yr.

My policy includes prescriptions.

Why is your policy so expensive?

A $550 cost per month would be a HUGE increase for me along with a out of pocket expense of $5000/yearly.

WRL
Lee,

It's a lot cheaper than the $750/month I used to pay. The policy has no maximum limits, includes pharmacy care, has $20/$40 co-pays for physician services, $100/day co-payfor the first five days of hospital coverage, and no deductibles for in-network care ($1000 deductible for out of network). It's a BC/BS PPO policy done through the local chamber of commerce. The one year I hit my max out of pocket was a period when I ran up $65k in bills for two ER visits, three days inpatient care for diagnostic testing, and two ambulatory surgery visits for testing, on top of a variety of outpatient tests.

I suspect the primary reason for the cost differential is geographic and age (I'm 60) based. If I were 30, the premium would be half what I pay. There are no health condition differentials permitted, but I am definitely in the category that drives up everyone else's costs having consumed well over $100k in medical services in the last three years with a lot more on the horizon.

Before I canceled our company health insurance plan, the premium for family coverage (2 adults and any number of kids) was over $24,000/year (up 300% in 10 years with a reduction in coverage). I paid the first $500/month, but it hit the point where none of my staff were able to pay their portion of the premium. I canceled the plan, gave the employees the amount I was contributing and watched most of them join the ranks of the uninsured.

Henry V
08-07-2009, 08:13 PM
http://www.politifact.com/truth-o-meter/ has checked most of the facts in the memo that started this thread at http://www.politifact.com/truth-o-meter/article/2009/aug/06/your-guide-health-care-distortions/.

Many of the supposed facts in the memo and many other things being said about the current proposal from the left and right are given their "pants on fire" grade.

Eric Johnson
08-08-2009, 07:21 AM
It's important to remember that whatever is passed is merely enabling legislation....it enables the writing of rules and regulations by the department (HHS). Thus, language that reads "they shall do this" can become 40-50 pages of rules and Congress will have absolutely no say in what is said in these rules without passing an amendment.

For instance, the requirement for counseling for senior citizens doesn't state how or what they'll be counseled on. It could very easily become counseling on assisted suicide.

Eric

YardleyLabs
08-08-2009, 08:18 AM
It's important to remember that whatever is passed is merely enabling legislation....it enables the writing of rules and regulations by the department (HHS). Thus, language that reads "they shall do this" can become 40-50 pages of rules and Congress will have absolutely no say in what is said in these rules without passing an amendment.

For instance, the requirement for counseling for senior citizens doesn't state how or what they'll be counseled on. It could very easily become counseling on assisted suicide.

Eric
The full text of the advanced care planning clause that you appear to be referencing is in section 1233 of the original HR 3200 and may be read at http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c1110yoZNA:e513253: (http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/%7Ec1110yoZNA:e513253:). The terms of that language, which is very specific, address only counseling with resect to actions that an individual may take to specify their wishes with respect to how they will be treated in the event that they are no longer able to direct their own care. The bill does not make that counseling legal -- it already is -- or illegal. All it does is to allow a physician to bill for the service and be reimbursed for the service they are providing.

As far as I know, assisted suicide, where legal, cannot be addressed through an advanced planning document. That is, you cannot leave an instruction indicating that you should be euthanized in the event that you are in a coma. I would expect, if I lived in a state where assisted suicide were legal, that I would be able to obtain counseling from my physician concerning that option. I doubt that I would care if that service were reimbursed by my insurance or not.

Ultimately, national health insurance is nothing but insurance. It extends the system for paying for care. It doesn't provide care, it doesn't make care legal, and it doesn't make care illegal notwithstanding hysterical horror stories told by harbingers of doom (aka FOX Network and the relics of the right).;-)

road kill
08-08-2009, 08:24 AM
Lee,

It's a lot cheaper than the $750/month I used to pay. The policy has no maximum limits, includes pharmacy care, has $20/$40 co-pays for physician services, $100/day co-payfor the first five days of hospital coverage, and no deductibles for in-network care ($1000 deductible for out of network). It's a BC/BS PPO policy done through the local chamber of commerce. The one year I hit my max out of pocket was a period when I ran up $65k in bills for two ER visits, three days inpatient care for diagnostic testing, and two ambulatory surgery visits for testing, on top of a variety of outpatient tests.

I suspect the primary reason for the cost differential is geographic and age (I'm 60) based. If I were 30, the premium would be half what I pay. There are no health condition differentials permitted, but I am definitely in the category that drives up everyone else's costs having consumed well over $100k in medical services in the last three years with a lot more on the horizon.

Before I canceled our company health insurance plan, the premium for family coverage (2 adults and any number of kids) was over $24,000/year (up 300% in 10 years with a reduction in coverage). I paid the first $500/month, but it hit the point where none of my staff were able to pay their portion of the premium. I canceled the plan, gave the employees the amount I was contributing and watched most of them join the ranks of the uninsured.
Now I understand your position on this.
You've decided to let ME (and others who are gainfully emplyed) help pay for your medical bills!!

YardleyLabs
08-08-2009, 08:27 AM
Now I understand your position on this.
You've decided to let ME (and others who are gainfully emplyed) help pay for your medical bills!!
Thank you for the offer, but I pay my own bills just fine.

dnf777
08-08-2009, 10:04 AM
Now I understand your position on this.
You've decided to let ME (and others who are gainfully emplyed) help pay for your medical bills!!

So you're gainfully employed and have private insurance. So am I. I have never used my health insurance. Therefore, if you ever have had a claim on your healthcare, I have helped pay YOUR medical expenses. AAghh! I'm a victim of socialism!!:-x

(I made a few assumptions there, so please correct me if I'm wrong, and I'll find someone else complaining about paying for others to pick on)

Just makin' a point, not trying to get personal,
Dave

road kill
08-08-2009, 12:44 PM
I am not exactly sure if I am "gainfully" employed any more.
I think I am a "not for profit" LLC now.;)

But cynicism aside, I have been thru the cancer ordeal (my wife).
We had as good of insurance as we could have.
Still cost about $200,000 out of pocket.

I got thru it, all bills paid.
We fought it out and lasted 11 months.
Maybe the best 11 months of our 33 years together.
Lost almost everything buying time.

Who has the right to take that option/time away from us?

I would do it again in a heart beat.
I want that option on the table.
I don't want someone else to decide for me.

stan b & Elvis

dnf777
08-08-2009, 06:09 PM
I am not exactly sure if I am "gainfully" employed any more.
I think I am a "not for profit" LLC now.;)

But cynicism aside, I have been thru the cancer ordeal (my wife).
We had as good of insurance as we could have.
Still cost about $200,000 out of pocket.

I got thru it, all bills paid.
We fought it out and lasted 11 months.
Maybe the best 11 months of our 33 years together.
Lost almost everything buying time.

Who has the right to take that option/time away from us?

I would do it again in a heart beat.
I want that option on the table.
I don't want someone else to decide for me.

stan b & Elvis

Our family is going through a similar situation. My grandmother (90) is going through chemotherapy for inoperable cancer. Most though she wouldn't tolerate it 16 months ago when this began. She has gone through it almost unscathed to everyones delight. We have had over a year (and still counting, thankfully) because of her treatment.

This was all done through gov't run medicare, with coal-miner's retirement filling the gap. Out of pocket cost to them....zero.

With all the bashing of gov't run program, I can tell you that private insurance would NOT have covered her latest round of chemo. (that's assuming she wasn't dropped after her diagnosis, as soon as her current policy was up for renewal) Again, I didn't want to get personal, but I was making the point that all insurance programs are a form of socialism...sharing the cost/risk to benefit all who may need it. A pure capitalist would merely say, "what, me pay for you?? no way!" You can either afford healthcare or not on your own. Insurance companies will maximize profit to shareholders by dropping sick people, and signing up healthy people who don't need it.

best regards,
dave

Eric Johnson
08-08-2009, 09:01 PM
Jeff-

I spoke a hypothetical and you sneered at it as though it were a real argument.

My point was and is that no bill in Congress is the "plan". What is in Congress is only enabling legislation. The bureaucrats will write the "plan" and that scares the stew out of me. Where Congress says, "A is the law." folks who are not accountable to anyone will write the regulations. The same point was just made by the former Sec of HHS under Clinton....and he's opposed to the "plan" for just that reason.

Eric

YardleyLabs
08-08-2009, 09:19 PM
...

But cynicism aside, I have been thru the cancer ordeal (my wife).
We had as good of insurance as we could have.
Still cost about $200,000 out of pocket.

I got thru it, all bills paid.
We fought it out and lasted 11 months.
Maybe the best 11 months of our 33 years together.
Lost almost everything buying time.
...
Stan,

I am sorry for what you went through. My father's experience with a combination of heart surgery and cancer -- paid for by Medicare but with co-insurance amounts exceeding $250,000 -- was similar. With my mother, who had a massive stroke at the age of 44, it was even worse. My father had a policy through Union Carbide that looked great but my mother went over the lifetime max. The million dollars in costs came from my father. There is a reason why medical are a primary cause of personal bankruptcy.

Despite the lack of coverage, both my mother and father received the medical care they needed, and it sounds like your wife did also. Regulations and limitation and bureaucratic interpretations affected the cost of care received by your wife and by my parents. Under any of the plans being considered your costs for your wife and my family's costs for my parents would have been reduced. Is that good or bad?


Jeff-

I spoke a hypothetical and you sneered at it as though it were a real argument.

My point was and is that no bill in Congress is the "plan". What is in Congress is only enabling legislation. The bureaucrats will write the "plan" and that scares the stew out of me. Where Congress says, "A is the law." folks who are not accountable to anyone will write the regulations. The same point was just made by the former Sec of HHS under Clinton....and he's opposed to the "plan" for just that reason.

Eric
I wasn't trying to sneer and apologize if that is the impression I left. The reality of course is that regulations determine the details of all legislation and the regulatory process is where lobbyists exercise their greatest influence. The alternative would be to have laws that were 20,000 pages long instead of 1,000. However, there are limits to what can be changed through regulation and the scare tactics being used to combat health reform seem to have no basis in any proposals that are under consideration.

tpaschal30
08-09-2009, 07:59 AM
The real scare is bureaucrats against whom there is no legal recourse will be making our health care decisions.

road kill
08-09-2009, 09:00 AM
It finally hit me what the issue is here.

Very few intelligent people want the Gov't. to run/control healthcare, they just want theirs for free!!

"READ the BILL!!"

dnf777
08-09-2009, 10:12 AM
The real scare is bureaucrats against whom there is no legal recourse will be making our health care decisions.

As opposed to multi-millionaire CEOs who are currently rationing care? The reason we're even having this discussion is because greedy corporate types are making healthcare availability less ands less to even those who have insurance.

I heard that half of the bankruptcy claims due to medical expense come from people who HAVE health insurance. I was shocked to find that my 12,000/year policy excludes many types of cancer treatment!! Who's rationing that? It ain't the gov't!

road kill
08-09-2009, 10:37 AM
As opposed to multi-millionaire CEOs who are currently rationing care? The reason we're even having this discussion is because greedy corporate types are making healthcare availability less ands less to even those who have insurance.

I heard that half of the bankruptcy claims due to medical expense come from people who HAVE health insurance. I was shocked to find that my 12,000/year policy excludes many types of cancer treatment!! Who's rationing that? It ain't the gov't!
One of the things Ilearned is that no matter how good you think your insurance is if you get deeply into cancer and the heavy treatments (chemo, radiation etc.), YOU DON'T HAVE ENOUGH!!

On this I am 100% correct.
Had great insurance (so we thought), lost everything.
401K, savings and our home.
Paid every single cent to every one and am doing very well now, thank God, but it was brutal!!
But we did get all the care we asked for.
I would do it exactly the same again, I pray none of you ever have to face that.
But as hard as it was, imagine dealing with a Gov't. run operation........

People were helpful and we navigated our way thru.
Imagine what you run into in your daily lives in regard to frontline Gov't. employees.
No offense to anyone, but I bet everyone here has a horror story about dealing with the DNR, DOT, IRS, SS, etc.

That's the fear,

"READ the BILL!!"

tpaschal30
08-09-2009, 02:24 PM
As opposed to multi-millionaire CEOs who are currently rationing care? The reason we're even having this discussion is because greedy corporate types are making healthcare availability less ands less to even those who have insurance.

I heard that half of the bankruptcy claims due to medical expense come from people who HAVE health insurance. I was shocked to find that my 12,000/year policy excludes many types of cancer treatment!! Who's rationing that? It ain't the gov't!

Private companies you can sue. The government must grant you permission to sue it.
You have the opportunity to get another policy. With single payer(which is the left's goal) you will not have that opportunity.
The health care debate is not about health care. If it were there would be discussion of increasing the amount of hospitals and providers. Instead we are discussing giving even more access to health care which will increase demand further while supply remains the same or could decrease. The only option is to ration with that scenario.

ErinsEdge
08-09-2009, 03:20 PM
Jeff,

Do you have existing health issues? What is your age etc?

I have my own health care insurance policy.

I pay $160 for one person and have a "break point" (that is what they used to call out of pocket expenses) total of $2600/yr.

My policy includes prescriptions.

Why is your policy so expensive?

A $550 cost per month would be a HUGE increase for me along with a out of pocket expense of $5000/yearly.

WRL
Lee, it's the age and I suppose region. My insurance (self-employed) I hardly ever used, went once a year to the gyn, paid the few other expenses like eye care, but once you get past 55, the insurance goes up $60 a month every year, and in the last 2 years $100 a month so now I just increase the deductible. Mine is close to his with a $2500 out of pocket. And just wait until they start bugging you to get that colonoscopy, if your state doesn't cover it, and your out of pocket doesn't cover it because it is not "done for a reason." You just make sure you HAVE a reason. I'm not complaining, it covers more than my old plan which covered nothing. But I can choose the Dr I want to go to and not have someone tell me who I have to go to-that is important to me.

JDogger
08-09-2009, 03:42 PM
Private companies you can sue. Can you say malpractice insurance=$$$=increased costs? The government must grant you permission to sue it. Maybe civilian review boards would be a better way to go. Keep the lawyers and juries out of it
You have the opportunity to get another policy. Maybe, maybe not. With single payer(which is the left's goal) You might be correct, and what pray tell is the goal of the right? Does the right have any plan at all? you will not have that opportunity.
The health care debate is not about health care. Oviously, we have some of the best health care if you can afford it. If you can't you're SOL. The debate is about costs and coverageIf it were there would be discussion of increasing the amount of hospitals and providers. Instead we are discussing giving even more access to health care which will increase demand further while supply remains the same or could decrease. That is a part of the problem with for-profit healthcare. The only option is to ration with that scenario. It is already rationed with the current scenario.

Regards, JDogger

dnf777
08-09-2009, 04:17 PM
Private companies you can sue. The government must grant you permission to sue it.
You have the opportunity to get another policy. With single payer(which is the left's goal) you will not have that opportunity.
The health care debate is not about health care. If it were there would be discussion of increasing the amount of hospitals and providers. Instead we are discussing giving even more access to health care which will increase demand further while supply remains the same or could decrease. The only option is to ration with that scenario.

Okay, let's debunk that nice sounding reply.

1) you cannot sue most health insurance companies, because they made sure they manage their own pension plans, and are therefore unable to be sued for monetary reward. Do you not recall the case in TN where a HMO was being sued for denial of care? The judge threw it out. I believe it was Bill Frist's company who walked away from that one, but correct me if I'm wrong.

2) ask anyone on this list if once diagnosed with cancer, diabetes, heart disease, etc...you can simple find another company to write you a policy!! Most of those "high risk, low profit" people end up being dumped into...you guessed it....medicare/medicade.

3) "ration" is the new scary word. Got a news flash, health care is rationed right now, or people like RoadKill and millions of others would not have discovered they don't have "enough" insurance. Economics is the study of allocating scarce resources, and by scarce, that means not enough for everyone who wants some. That has been, and always will be the case with health care. If a 99 year old is turned down for a heart transplant, that is rationing. In that case, makes good sense. Its a matter of where you draw the line.

In my experience as both a patient and physician, I find medicare easier to get approval from. When they deny, there's a mound of paperwork to go through, but you usually get what you ask for in the end. With the Blues, its a flat out denial, with no recourse.

I stand to lose big with national care. I'm not all happy with it. But anyone who's dealt with our current system, knows its broke. At least we have a dialouge now, and not continuing to bury our heads in the sand.

tpaschal30
08-09-2009, 04:17 PM
Malpractice is a factor ,but not the major factor in prices. Lack of competition and restriction of trade by the AMA.
Me being nearly as right wing as you can get would like to see the end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance (i.e., a major medical policy with a high deductible). Second, it would end tax exemption of employer-provided medical care. And, third, it would remove the restrictive regulations that are now imposed on medical insurance—hard to justify with universal catastrophic insurance.
How much would your groceries be if you had an 80/20 plan paying for them and what would you eat?
Allocation of resources is best done by a free and open market. Health care has few market forces. The problem with for profit health care is not the profit. Boob jobs, Lasix, and other elective procedures have gone down in price. Why? Because the patient is paying the bill. He find info on the procedure, provider, and price. Price is never in the conversation with third party payers except between the ins company and doctor.

dnf777
08-09-2009, 04:28 PM
Had great insurance (so we thought), lost everything.
401K, savings and our home.
Paid every single cent to every one and am doing very well now, thank God, but it was brutal!!
But we did get all the care we asked for.
I would do it exactly the same again, I pray none of you ever have to face that.
But as hard as it was, imagine dealing with a Gov't. run operation........



And that's the system we want to keep???

Our family dealt with two elderly cancers. My Great-Uncle had private insurance. By the time he died, they lost their house, their substantial life savings, and most everything, much like your situation. They then raised HER premiums to unaffordable levels, and she went uninsured with chronic lung disease, home 02, nebulizers, and lost the rest of what she managed to hold onto.

My Grandmother, as I mentioned already, is going through her third round of chemo. She is medicare with coal-miners insurance to cover 100% of the gap. (a union benefit, but not to start another thread ;-)) The gov't has paid well over 100k in her case.

Given the two cases above, I'd be more paranoid and disruptive at lobbyist-sponsored meetings about the current system!