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TXduckdog
09-17-2009, 11:45 AM
The long awaited, supposedly bipartisan senate bill is now out. Interestingly, Baucus dropped the bipartisan effort at the last minute rejecting at least a dozen proposed GOP amendments.

It has no public option per se but it is loaded with stiff penalties with families facing tax penalties as high as $3,800 a year for not complying, singles $950. As one resident of Massachusetts where Mitt Romney imposed an individual mandate in 2006, this is like taxing the homeless for not buying a mansion.

His plan remains a public option by other means....imposing vast new national insurance regulation, huge new subsidies to pay for the higher insurance costs this regulation will require and all financed by new taxes and penalties on businesses, individuals and health-care providers.

His cost is $856 billion...the cheapest of all the other bills still pending. To help pay for this is the still as yet undefined reducing Medicaid costs. Fees on everyone from drug makers, insurance companies, medical device makers, labs and a whopping 35% excise tax on the plans that charge over $8K for singles and $20K for families.

Doesn't he know that these added fees will simply be passed along to the consumer in some shape or form?

Mandates for all citizens and legal residents to have health insurance. I find it terribly ironic that if liberal health care reform is supposed to be so good for us then why in hell does it require stiff, harsh penalties that force everyone to buy it? Geez--louise.

They require individuals to get health insurance from employers, or 2 other options but yet it doesn't require employers to provide insurance, but if they do...it has to be "qualified" coverage....what the hell does that mean and who regulates that?... but yet will impose a fee...read tax...on employers with 50 or more employees that go elsewhere and get subsidized government policies. Talk about a Catch-22.


To be fair there are a couple of positives....forbidding exclusion for pre-existing conditions, cancel coverage, and lifetime limits on coverages. My question here is...who is going to regulate this???

Coops and state based exchanges for individuals and companies to shop policies. Why not just require all insurers to offer the same plan...nation-wide?

All policies have to offer the same basic benefits...primary, preventive, hospitalization and prescription drugs. But yet singles, under 25 can opt out of certain coverages.

Then there is this thing about the government subsidies.....the subsidies in the Baucus plan go to people without a job-based plan and who earn under three times the federal poverty level, or about $66,000 for a family of four.

Take a family of four making $42,000 in 2016. While government would subsidize 80% of their premium and pay $1,500 to offset cost-sharing, they'd still pay $6,000 a year or 14.3% of their total income. A family making $54,000 could still pay 18.1% of their income, while an individual earning $26,500 would be on the hook for 15.5%, and one earning $32,400 for 17.3%. So lower-income workers would still be forced to devote huge portions of their salaries to expensive policies that they may not want or be able to afford.

How can these kind of subsidies be justified in light of Obama's promise that the reform package not add 1 dime to the budget deficit?

I guess this is a start but even other democrats like Rockefeller of WV is concerned about the affordibility element and says he won't support the bill.

So the way I see it.....this plan would increase the cost of insurance and then force people to buy it, requiring subsidies. Those subsidies would be paid for by taxes that make health care and thus insurance even more expensive, requiring even more subsidies and still higher taxes and that's even before other liberal Democrats see Mr. Baucus and raise him, and then attempt to ram it all through the Senate.

That about it?

Franco
09-17-2009, 12:42 PM
There go my employee insurance benefits, right out the window!

It will be cheaper for employers to pay the fine than provide some of the cost of empolyee health insurance.

TXduckdog
09-17-2009, 12:42 PM
ABC News' Teddy Davis reports:


It's not every day that you hear a Democratic senator charge that a fellow Democrat is proposing to raise taxes on the middle class, but that is what happened on Tuesday when Sen. Jay Rockefeller, D-W.Va., ripped into the health-care bill developed by Sen. Max Baucus, D-Mt., the chairman of the Senate Finance Committee.

The Baucus proposal would impose, starting in 2013, a 35 percent excise tax on insurance companies for "high-cost plans" -- defined as those above $8,000 for individuals and $21,000 for family plans.

Health economists believe a tax on high-priced benefits could help slow the growth of health costs by making consumers more sensitive to prices.

The tax contemplated by Baucus is also a big revenue raiser. It is expected to raise $200 billion, money that Baucus is hoping to use to pay for subsidies for the uninsured.

Given how much money this kind of tax can raise, Rockefeller says he understands why it is "tempting."

The West Virginia Democrat worries, however, that a lot of middle class workers, like the coal miners in his state, will end up facing "a big, big tax" under the Baucus bill because they currently enjoy generous employer-provided health care benefits which they receive tax free.

Referring to Baucus, Rockefeller said, "He should understand that (his proposal) means that virtually every single coal miner is going to have a big, big tax put on them because the tax will be put on the company and the company will immediately pass it down and lower benefits because they are self insured, most of them, because they are larger. They will pass it down, lower benefits, and probably this will mean higher premiums for coal miners who are getting very good health care benefits for a very good reason. That is, like steelworkers and others, they are doing about the most dangerous job that can be done in America."

"So that’s not really a smart idea," Rockefeller continued. "In fact, it’s a very dangerous idea, and I’m not even sure the coal miners in West Virginia are aware that this is what is waiting if this bill passes."

Rockefeller made his comments on a conference call with reporters which was sponsored by the liberal Campaign for America's Future.

Rockefeller, who sits on the Finance Committee, said that he cannot support the Baucus bill unless it receives major improvements during the amendment process.

Baucus, the Finance chair, is scheduled to discuss his "chairman's mark" with reporters on Capitol Hill at 12 noon on Wednesday.

YardleyLabs
09-17-2009, 12:45 PM
There go my employee insurance benefits, right out the window!

It will be cheaper for employers to pay the fine than provide some of the cost of empolyee health insurance.
So why do you provide benefits now when there is no fine and no obstacle at all to terminating the plans?

Buzz
09-17-2009, 01:00 PM
There go my employee insurance benefits, right out the window!

It will be cheaper for employers to pay the fine than provide some of the cost of empolyee health insurance.


Currently, it would REALLY be cheaper for them not to provide insurance. So, what's stopping them from dropping it now?

Buzz
09-17-2009, 01:00 PM
So why do you provide benefits now when there is no fine and no obstacle at all to terminating the plans?

Maybe I should read the thread before I comment...:o

M&K's Retrievers
09-17-2009, 01:37 PM
So why do you provide benefits now when there is no fine and no obstacle at all to terminating the plans?

Doh! Maybe it helps to attract and keep quality employees.

Franco
09-17-2009, 01:41 PM
So why do you provide benefits now when there is no fine and no obstacle at all to terminating the plans?


My employer provides a large part of my Health Insurance cost as a perk. I have always had my employers pay for most of my Health Insurance. They want thier compensation to be competitve within the industry that I work.

This current proposal could lead to the entire industry dropping insurance perks. There are a lot of companies looking to cut cost and this would give them a great excuse!

I can read the HR Bullitin now if this stupid bill were to pass; "It is no longer feasable to pay for your higher coverage cost. We suggest you get a plan from the gooberment. Good luck!"

YardleyLabs
09-17-2009, 02:44 PM
My employer provides a large part of my Health Insurance cost as a perk. I have always had my employers pay for most of my Health Insurance. They want thier compensation to be competitve within the industry that I work.

This current proposal could lead to the entire industry dropping insurance perks. There are a lot of companies looking to cut cost and this would give them a great excuse!

I can read the HR Bullitin now if this stupid bill were to pass; "It is no longer feasable to pay for your higher coverage cost. We suggest you get a plan from the gooberment. Good luck!"
If I understand what you are saying, your employer pays most of your health insurance cost now without any government compulsion in order to provide competitive compensation. You believe that once the government establishes a fine against employers that do not provide health insurance that your employer will suddenly decide to terminate the benefits it has provided without any penalty. The logic does not compute. Are you assuming that health insurance will be more expensive if the bill is passed? If anything, costs should go down since providers will not have as many patients who are unable to pay for their care and people who do not buy insurance now because they are in good health will be compelled to buy insurance, thereby reducing costs for others.

Franco
09-17-2009, 03:01 PM
If I understand what you are saying, your employer pays most of your health insurance cost now without any government compulsion in order to provide competitive compensation. You believe that once the government establishes a fine against employers that do not provide health insurance that your employer will suddenly decide to terminate the benefits it has provided without any penalty. The logic does not compute. Are you assuming that health insurance will be more expensive if the bill is passed? If anything, costs should go down since providers will not have as many patients who are unable to pay for their care and people who do not buy insurance now because they are in good health will be compelled to buy insurance, thereby reducing costs for others.

Yes, it would be cheaper for an employer to pay the fine than to provide most of the cost for health insurance.

Second, this could lead to many large corporations that have a responsiblity to thier share holders to reduce cost by not providig this perk.

Finally, NOTHING THE GOOBERMENT GETS THIER HANDS ON GOES DOWN IN COST.

zeus3925
09-17-2009, 03:19 PM
From Marketwatch:
http://www.marketwatch.com/story/the-new-silent-majority-in-the-health-care-fight-2009-09-16

Buzz
09-17-2009, 03:33 PM
Yes, it would be cheaper for an employer to pay the fine than to provide most of the cost for health insurance.

Second, this could lead to many large corporations that have a responsiblity to thier share holders to reduce cost by not providig this perk.

Finally, NOTHING THE GOOBERMENT GETS THIER HANDS ON GOES DOWN IN COST.


Franco, you're really messing with my head. As an employer myself, I am trying to figure out how it would be in my best interest to stop offering a perk intended to help attract good employees, in favor of paying a fine to the federal government.

Wouldn't it be in my best interest to keep offering that perk so good employees don't leave?

Man, I think I need a beer...

YardleyLabs
09-17-2009, 03:33 PM
Yes, it would be cheaper for an employer to pay the fine than to provide most of the cost for health insurance.

Second, this could lead to many large corporations that have a responsiblity to thier share holders to reduce cost by not providig this perk. .

Finally, NOTHING THE GOOBERMENT GETS THIER HANDS ON GOES DOWN IN COST.
It would be cheaper for your employer to terminate benefits now. No heath insurance cost and no fine. Why haven't they done so? I'm not even trying to argue. I simply don't understand your comment. A fine for eliminating benefits would actually reduce the savings your employer could realize by terminating your plan.

Franco
09-17-2009, 06:30 PM
First, do the two of y'all really think a Gov option would be competitive in the market place? Here is an analogy; How does Ford compete with GM or any other gov owned industry?

My point is that a $500. annual fine is a hell of a lot cheaper for the employer. All business could opt out of offering an insurance perk and instead, give thier employees more time off.

The gov can NOT be competitve because they own the deck, so to speak. They can set any rules they wish.They will run every private health entity out of the business.

There are a lot of financially strapped large corporations and if what Jeff is saying is accurate, then we might just see a flood of employers stop offering health benefits. Why should they if the gov wants to run it? Just as in, how will Ford be able to compete with Goverment Motors. That was BILLIONS of borrowed tax payer money the American people wil never see again.

If you don't see the socialist direction we are headed as bad, then you have to be for it. The gov has NO buisness getting into running my Health Care. I don't trust them and have 0 confidence in them to do well with it.

The reality of what the White House wants to do is have everyone that is working pay for equal coverage for those that don't. That is NOT what working Americans want!

Buzz
09-17-2009, 08:45 PM
What on earth does any of that have to do with any company deciding to drop coverage and just pay the fine? They are not compelled to offer insurance coverage now except as a perk to attract workers. If I as a business owner feel it is a good thing to offer health insurance now, why on earth would I decide that because the government is going to fine me for not offering it, now it's a good thing to drop it and pay the fine? It defies logic. If anything, the rapidly escalating cost of insurance is going to be responsible for workers losing employer based insurance.

And I keep hearing, well the government plan will be more competitive, so my company might drop my private plan and move me into the government plan. Well, don't you think they are free to switch plans and companies now? Just because you have a plan that you love now doesn't mean that come next year when it's time to renew benefits, you won't get moved into a high deductible plan with less coverage than you have now. There are no minimum requirements for coverage regarding max deductible and max out of pocket expense, but there will be with the reforms.

M&K's Retrievers
09-17-2009, 09:23 PM
It would be cheaper for your employer to terminate benefits now. No heath insurance cost and no fine. Why haven't they done so? I'm not even trying to argue. I simply don't understand your comment. A fine for eliminating benefits would actually reduce the savings your employer could realize by terminating your plan.

I guess you don't read others posts. They provide these benefits to attract and keep quality employees. If all employers could sh*t can their employee benefit plans they would and just pay a fine.

Buzz
09-17-2009, 09:47 PM
There are a lot of financially strapped large corporations and if what Jeff is saying is accurate, then we might just see a flood of employers stop offering health benefits. Why should they if the gov wants to run it? Just as in, how will Ford be able to compete with Goverment Motors. That was BILLIONS of borrowed tax payer money the American people wil never see again.



I don't know what you mean by the government running healthcare. They are talking about offering an insurance plan to compete with private insurance, not running healthcare. They are going to mandate that employers offer health insurance or pay a fine. Right not, business is not required to offer healthcare, and if they don't there is no fine. So why would there be a flood of employers stopping their health coverage because of any reform?

Buzz
09-17-2009, 09:50 PM
I guess you don't read others posts. They provide these benefits to attract and keep quality employees. If all employers could sh*t can their employee benefit plans they would and just pay a fine.

The only reason they would sh!t can their plans is if they no longer felt that they needed to offer them to attract workers, or if they couldn't afford them. In the current economic climate, either of these things could happen, independent of healthcare reform. And if that came to be, then we really need a public option that we can afford to buy on an individual basis.

M&K's Retrievers
09-17-2009, 10:01 PM
The only reason they would sh!t can their plans is if they no longer felt that they needed to offer them to attract workers, or if they couldn't afford them. In the current economic climate, either of these things could happen, independent of healthcare reform. And if that came to be, then we really need a public option that we can afford to buy on an individual basis.

Isn't that what I said ?

WRL
09-17-2009, 10:08 PM
If I understand what you are saying, your employer pays most of your health insurance cost now without any government compulsion in order to provide competitive compensation. You believe that once the government establishes a fine against employers that do not provide health insurance that your employer will suddenly decide to terminate the benefits it has provided without any penalty. The logic does not compute. Are you assuming that health insurance will be more expensive if the bill is passed? If anything, costs should go down since providers will not have as many patients who are unable to pay for their care and people who do not buy insurance now because they are in good health will be compelled to buy insurance, thereby reducing costs for others.

Sorry but your logic doesn't compute.

Use car insurance. Its required in my state. The people that didn't have it and never have had insurance don't have it. The people that will and always have had insurance still do, now we just pay more for it "cuz its the law".

How does my "insurance rate" go down? There are no more people going to "afford" it than can afford it now whether there is a fine or whatever.

And what if people/businesses get fined again and again.....are they gonna throw me in jail because I have no health insurance......hmmmm....get thrown in jail and guess what? Now I have FREE medical.

WRL

Gerry Clinchy
09-18-2009, 08:02 AM
I admit to being a bit "slow" ... but where did Baucus come up with his $8000/$21,000 maximum cost numbers? Might that be the cost of the plan that covers the Congressmen/women?

Such a "deluxe" plan for a person with a pre-existing condition might cost more. In which case, the insuror who insures those people takes on added risk for the pre-existing condition costs, and also gets hit with an excise tax on the cost over the max stipulated. Does that make the insurance for those pre-existing conditions even more expensive than it might otherwise be (as the tax gets passed onto the consumer)? A "luxury tax" on health insurance?


And what if people/businesses get fined again and again.....are they gonna throw me in jail because I have no health insurance......hmmmm....get thrown in jail and guess what? Now I have FREE medical.

Probably not jail ... not enough jails. Maybe an ankle bracelet? Then you can keep working to pay off the liens that the enforcement agency for the tax (IRS?) slaps on everything you own & cleans out your bank account. But cheer up, once you exceed $10K, you can go to one of those companies that negotiates away your tax liability for pennies on the dollar :-)

Buzz
09-18-2009, 10:24 AM
Gerry, it looks to me that in the interest of trying to write some kind of bipartisan bill, Baucus, or as liberals like to call him - Faucus has come up with something that will rile up both liberals and conservatives. Don't expect to see too many liberals trying to defend it. The only reason I've been replying to this thread is to try and understand where booty is coming from.

TXduckdog
09-18-2009, 10:42 AM
Buzz.....see my additional post on BaucusCare.

zeus3925
09-18-2009, 12:08 PM
HeyTex, how about combining all your threads on " Bacuscare" into one.

ducknwork
09-18-2009, 01:11 PM
HeyTex, how about combining all your threads on " Bacuscare" into one.

Getting carpal tunnel from clicking?
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Gerry Clinchy
09-21-2009, 10:20 AM
NY Times
http://www.nytimes.com/2009/09/21/health/policy/21insure.html?th&emc=th

I think this gets more confusing as it progresses:

On Sunday, President Obama (http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per) said he saw the need to protect union members, but he also defended the tax. “I do think that giving a disincentive to insurance companies to offer Cadillac plans that don’t make people healthier is part of the way that we’re going to bring down health care costs for everybody over the long term"

Okay ... we want everyone to have health insurance, but we don't want people to have health insurance that is too good, even if they are able & willing to pay for it themselves? But maybe it would be okay to have an expensive plan if it required you to maintain a lower weight, or stop smoking, or whatever is deemed to be "healthier" for you?

They say the Senate's bill now has 564 amendments. Who could possibly keep straight what the bill now provides for? Maybe that's the whole point: out of frustration people vote just to make it go away?

Julie R.
09-21-2009, 01:05 PM
For those that think businesses will continue to provide health coverage because it's the industry standard, like Franco's business and the auto industry.....remember that private, for-profit companies will also turn to outsourcing jobs abroad if it becomes too expensive. Or they'll find a way to use independent contractors rather than employees (thus not offering insurance nor required to). Insurance will become the labor union of this century, another bloodsucker on domestic productivity and another reason for more jobs to go abroad and more US companies to relocate out of the US, another thinly disguised way to transfer wealth from those willing to work for it, to those who aren't.


Maybe we should just let the UN come up with a world health plan :idea::grab: where the US can just insure the world so everyone can be healthy and happy.

Buzz
09-21-2009, 01:18 PM
For those that think businesses will continue to provide health coverage because it's the industry standard, like Franco's business and the auto industry.....remember that private, for-profit companies will also turn to outsourcing jobs abroad if it becomes too expensive. Or they'll find a way to use independent contractors rather than employees (thus not offering insurance nor required to). Insurance will become the labor union of this century, another bloodsucker on domestic productivity and another reason for more jobs to go abroad and more US companies to relocate out of the US, another thinly disguised way to transfer wealth from those willing to work for it, to those who aren't.


Maybe we should just let the UN come up with a world health plan :idea::grab: where the US can just insure the world so everyone can be healthy and happy.

Car manufactures have already explicitly stated that factories have been located in Canada over the US because of healthcare costs and the lack of well educated workforce here.

TXduckdog
09-21-2009, 01:39 PM
HeyTex, how about combining all your threads on " Bacuscare" into one.

Sorry man....different parts of it came up at different times. I don't know how to do that.....perhaps the admin could.

T. Mac
09-21-2009, 01:48 PM
NY Times
http://www.nytimes.com/2009/09/21/health/policy/21insure.html?th&emc=th

I think this gets more confusing as it progresses:






But just as much, the tax is intended to discourage the overly generous coverage that many experts say has helped propel the country’s reckless spending on medical care.

So, as congress' health care plan (not to mention most government employee plans) is one of the "best", it is thus one of the major contributors to the "country’s reckless spending on medical care"?

What I find very confusing is that nearly everyone says the real problem is the rapidiy rising costs for health care. And that this HC plan will try to fix that. But I do not read or see how that is going to happen unless the plan will limit or reduce coverages. And this would seem to mean that many of the critically sick people would be written off (as they are the ones that tend to generate the bulk of the claims and thus incur the bulk of the costs). If this is the case, what difference is it that you are denied coverage because of pre-existing conditions, or denied treatment because your plan does not cover those costs?

Part of the rhetoric promoting the plan is that the government will need to promote med students into choosing family medicine over specialties and this will be done by increasing salaries for GPs and increasing their abilities to semi-specialize. So now we are going to control/reduce costs by increasing the upfront costs? Further, looking at my state (CA), we have 10 medical schools. Last year these 10 schools produced less than 100 GPs. (I think the actual number was 88). It is hard to fathom how we are going to produce enough GPs to cover approx 40m additional patients in short order. There was some talk at one of the town hall meetings that nurses or nurse practioners would cover some of the overload. But the nursing programs are even more impacted than the med schools. It would seem that using the rules of econ 101, if you suddenly increase your demand significantly with limited production (numbers of doctors) you will increase the costs of care?

Another confusing point is that if health care costs are spiriling upward and the plan is to decrease these costs, primarily at the specialty/advanced care levels, what happens to all the folks who are now working at these levels. For example, if part of the plan is to decrease CT scans, what happens to all the CT techs, the engineers who maintain the machines, the manufacturing plants that produce the instruments, etc? And what does this do to the development of newer, more efficient machines of the future? Where do all these highly trained people go for work in this economy?

I just don't see how anything good can come out of this, without it hurting a lot more than it helps.

YardleyLabs
09-21-2009, 02:31 PM
For more than a decade, I made my living by placing consultants with clients on a full time multi year basis. Why did they pay me a significant premium to provide their staff? There were several reasons, but the primary one was to avoid paying for health care costs, pension costs, and severance costs. For most of our customers, those costs totaled 40-50% of payroll. For us they totaled 10% of payroll.

At one point we provided more benefits. However, some of our largest customers (think the mother of all telephone companies and the father of all computer companies) actually imposed caps on how much we could charge in excess of direct salary that were set so low that it was impossible to provide any non-legally mandated benefits at all. The only factor that constrained how many staff were purchased in this manner were IRS regulations that defne employees in a way that opened the buyers to charges that our staff were actually their staff and that they could be found liable for benefit costs.

Over time, the the maximum extent legal, I expect almost every company that competes on a global basis to eliminate benefits for their non-managerial employees. Discrimination laws (by job class, not race or religion) now prevent companies from having one set of benefits for highly compensated staff with another for everyone else. However, lobbyists continue to look for loopholes and continue to have success in creating new ones. In the meantime. moving jobs overseas is the ultimate loophole since it avoids both the discrimination charge and the threat of IRS audits.

The impact of this trend will be the collapse of employer paid health care benefits in most major industries. To save jobs, to make our businesses more competitive in the global economy, and to preserve health benefits for at least the lower 50-60% of our population, I see no alternative to publicly financed health insurance paid through general taxes, not payroll taxes.

charly_t
09-21-2009, 02:32 PM
I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t

dnf777
09-21-2009, 02:42 PM
I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t

As a physician, I spend MUCH more time jumping through hoops and filling our paperwork for private insurance than Medicare. After that, payment is reduced or refused outright more often form private insurance than medicare. Of course, medicare pays roughly 15-20% less. I'm not sure that public option is the solution, but I know SOMETHING has to change.

The first solution to excess paperwork I would propose, is allowing physicians to bill at the local average attorney's rate for filling out forms and require whoever requested said forms, pay! Around here, $250/hr is the going rate for legal work, and at that rate, I would supplement my salary by about $5000/month, less taxes, of course, assuming one hour per workday, which is about accurate. Pretty amazing.

I bet paperwork would disappear overnite.

YardleyLabs
09-21-2009, 02:55 PM
I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t
Actually, there are three ways to dramatically reduce the paper associated with medical claims:

Stop accepting health insurance altogether. Require all patients to pay at the time of service and let the patients seek any reimbursement for care. If claim forms need to be completed, charge a fee for completing them.
Institute a single payer health plan. This eliminates all requirements for coordination of benefits between plans (a fancy way of describing the efforts by insurance companies to force other insurance companies to pay all or part of a bill) and guarantees a standard set of rules and procedures for all claims.
Allow multiple payers but require all to implement uniform, electronic claim management procedures. This provides some of the benefits of option 2 but requires that insurance companies comply. No one really has the authority to force that compliance.Many physicians have elected to implement option 1. My family physician for 25 years recently shifted to a concierge practice. Each patient pays a flat fee of $2000/year. The doctor sees them as needed with same day appointments and 24 hour accessibility. There are no other charges for his service and he does not accept any form of insurance or complete any paperwork beyond the annual bill. He reduced his practice to 300 patients generating $600,000 in billings. He employs a single part-time nurse (his wife). His office is in his house. His net income has almost doubled and he is working fewer hours per week. He has coverage agreements with other physicians with similar practices so that he can still take vacations.

Option 2 is the great boogeyman of socialized medicine. It is the approach that has been implemented in many countries and is the de facto approach for care to Medicare patients (explaining the very low administrative costs for medicare), but is unlikely to be implemented for anyone else.

Option 3 is the approach taken in HR 3200 and will probably be part of any health reform. To be deemed to be "qualified" plans, health insurance companies will be required to conform with a uniform standard for electronic submission and management of all claims. This has the potential for reducing administrative costs significantly and for reducing medical errors (particularly related to prescriptions) and the incidence of duplicate testing.

dnf777
09-21-2009, 03:21 PM
Jeff,
My hat's off to your physician. I hope that both he and you are happy with the new arrangement. I would love to follow suit, but I can't remove gall-bladders in my garage! The ambulance (I mean gator 4x4) takes up too much room. :p

edit: emoticon added so nobody would think I'm serious!

YardleyLabs
09-21-2009, 03:46 PM
Jeff,
My hat's off to your physician. I hope that both he and you are happy with the new arrangement. I would love to follow suit, but I can't remove gall-bladders in my garage! The ambulance (I mean gator 4x4) takes up too much room. :p

edit: emoticon added so nobody would think I'm serious!
I'm not crazy enough to pay him $2000 for what used to cost me $200! I switched doctors immediately.:rolleyes:

Julie R.
09-21-2009, 03:54 PM
Too bad there isn't a way to force Congress and all federal and state employees to be a part of any health care reform. Then I bet we'd get some constructive ideas.

Gerry Clinchy
09-21-2009, 05:45 PM
Yardley

Many physicians have elected to implement option 1. My family physician for 25 years recently shifted to a concierge practice. Each patient pays a flat fee of $2000/year. The doctor sees them as needed with same day appointments and 24 hour accessibility. There are no other charges for his service and he does not accept any form of insurance or complete any paperwork beyond the annual bill. He reduced his practice to 300 patients generating $600,000 in billings. He employs a single part-time nurse (his wife). His office is in his house. His net income has almost doubled and he is working fewer hours per week. He has coverage agreements with other physicians with similar practices so that he can still take vacations.


While this might not work for you, Jeff, it might work pretty well for a family with 2 or 3 young'uns. And isn't that sort of the way an HMO works? The dr gets paid for the # of patients on his "roster", whether he sees them or not, but still collects each month.

Perhaps the legislative proposals should have made a provision for this type of program?

Yardley

I see no alternative to publicly financed health insurance paid through general taxes, not payroll taxes.

Bingo! The reason that the legislators are having a problem is that they keep wanting to tax only those in higher income brackets. They don't want to be accused of raising taxes for low & mid income people, because O said he wouldn't do that. He will ultimately have to admit he didn't have a full grasp of the situation, period, when he made such a promise. So they are doing all this tap dancing around the costs that cannot possibly be funded without more taxes for everyone. If they told the truth, the reform they propose would be dead in the water.

Medved referenced the phone tapes between Johnson and then-Senator Kennedy, where he flat-out admitted that Medicare would never get done if they revealed what the costs would be more than 2 years into the future. They knew doggone well it was a losing proposition when it came to funding.

Michael Medved interviewed Henry Waxmann (CA congressman) about health care. No matter how you slice it, there is no way that they can make this come out as a "break even" proposition. While Waxmann showed some courage in being willing to field some of the tough questions, I'm sure that Medved's audience had a raw nerve hit when Waxmann stated, " ... and people making $1 million should pay more taxes ..." Medved did comment on that premise just briefly.

Buzz
09-21-2009, 08:35 PM
I believe that the politicians have a problem because they took the one solution that I feel we will inevitably arrive at off the table before they even began.

YardleyLabs
09-21-2009, 08:52 PM
Yardley


While this might not work for you, Jeff, it might work pretty well for a family with 2 or 3 young'uns. And isn't that sort of the way an HMO works? The dr gets paid for the # of patients on his "roster", whether he sees them or not, but still collects each month.

Perhaps the legislative proposals should have made a provision for this type of program?

...

His pricing is for an individual, not a family.... It also only covers his personal services, not any tests or costs of referrals. He only accepts patients with comprehensive health insurance. He just won't accept it for payment of his own services.

Gerry Clinchy
09-22-2009, 05:44 AM
His pricing is for an individual, not a family.... It also only covers his personal services, not any tests or costs of referrals. He only accepts patients with comprehensive health insurance. He just won't accept it for payment of his own services.

Well, that sure is the way to get the best of both worlds ... for the doctor.

However, last year I had 3 visits for "water on the knee" (caused by slipping on a Nylabone!) The dr visits were about $150 -$170 each; 3 visits. Even a small accident like that can add up, just for the physician's services. Can see how it could work for a person who may have some chronic problem that requires monitoring at the primary physician level.

Gerry Clinchy
09-28-2009, 10:34 PM
Not exactly about Baucus care ... but again alludes to the elephant in the room
http://www.nytimes.com/2009/09/26/health/policy/26grady.html?ref=us


Grady will continue to assist the indigent patients, many of them illegal immigrants, in seeking care in their home countries or in other states where they may qualify for emergency Medicaid (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier) coverage.

As with the FL video, there seems to be a problem in getting either INS or the home countries to help in getting the illegal immigrants back to their home countries for care. Can't blame the home countries. Why would they want to take on the burden of this expensive, long-term care? OTOH, I sure don't understand INS's lack of action.

And they want us to believe that illegal aliens will not get health care? Tort reform, "defensive medicine", fraud, insurance company profits ... and the elephant in the room. Hundreds of millions of dollars now paid eventually by taxpayers, insured patients, and govt. How will any of the proposals change any of this? How will amnesty change any of this? Are these costs included in the costs of the proposals? And this would constitute at least 1/3 of the problem of the "uninsured".