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Gerry Clinchy
07-15-2010, 06:37 AM
NY Times
http://www.nytimes.com/2010/07/15/health/policy/15health.html?th&emc=th


The rules will eliminate co-payments, deductibles and other charges for blood pressure (http://health.nytimes.com/health/guides/test/blood-pressure/overview.html?inline=nyt-classifier), diabetes (http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier) and cholesterol (http://health.nytimes.com/health/guides/nutrition/cholesterol/overview.html?inline=nyt-classifier) tests; many cancer (http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier) screenings; routine vaccinations (http://health.nytimes.com/health/guides/specialtopic/immunizations-general-overview/overview.html?inline=nyt-classifier); prenatal care; and regular wellness visits for infants and children.

Other services that must be offered at no charge include counseling to help people stop smoking (http://health.nytimes.com/health/guides/specialtopic/smoking-and-smokeless-tobacco/overview.html?inline=nyt-classifier); screening and counseling for obesity (http://www.nytimes.com/info/obesity?inline=nyt-classifier); and tests for infection with the virus that causes AIDS (http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier).



The rules stipulate that no co-payments can be charged for tests and screenings recommended by the United States Preventive Services Task Force (http://www.ahrq.gov/clinic/uspstfab.htm), an independent panel of scientific experts. The rules apply to new health plans that begin coverage after Sept. 23 and to existing health plans that make significant changes after that date. The administration said the requirements could increase premiums by 1.5 percent, on average.

Too conservative an estimate of the premium cost increase, IMO.


Kathleen Sebelius (http://topics.nytimes.com/top/reference/timestopics/people/s/kathleen_sebelius/index.html?inline=nyt-per), the secretary of health and human services, said the rules would extend benefits to 31 million people in new employer-sponsored plans and 10 million people in new individual plans next year.

It makes immense sense to have a small co-pay for all but the most destitute individuals. But if we're talking primarily about employed individuals, should they not be able to afford at least a $5 or $10 co-pay (depending on the services)?

40 million X $10 = $400,000,000 ... about the amount that is being removed from Medicare ($500,000,000)

I do not at all dispute the value of these preventative care measures, but actuarily and realistically I don't believe that there is any reason to totally remove all co-pay in order to accomplish increased use of these services. And the co-pay revenue can be used to good purpose, even if it were put into a fund by the insuror for premium stabilization.

I don't expect a change in the trend for employers shifting of health insurance premiums more to the employees. As the premiums increase (as even the govt has admitted they will do), the costs to employees will become larger as well. If small co-pays can keep the premium increases more stable, it seems worth a shot.

Let us not forget the health care providers who perform these tests are not likely to be working for no compensation. Somebody is paying for it in some manner, shape or form ... the workers in higher premiums and/or other taxpayers to subsidize the premium costs.

sinner
07-15-2010, 08:23 AM
NY Times
http://www.nytimes.com/2010/07/15/health/policy/15health.html?th&emc=th





Too conservative an estimate of the premium cost increase, IMO.



It makes immense sense to have a small co-pay for all but the most destitute individuals. But if we're talking primarily about employed individuals, should they not be able to afford at least a $5 or $10 co-pay (depending on the services)?

40 million X $10 = $400,000,000 ... about the amount that is being removed from Medicare ($500,000,000)

I do not at all dispute the value of these preventative care measures, but actuarily and realistically I don't believe that there is any reason to totally remove all co-pay in order to accomplish increased use of these services. And the co-pay revenue can be used to good purpose, even if it were put into a fund by the insuror for premium stabilization.

I don't expect a change in the trend for employers shifting of health insurance premiums more to the employees. As the premiums increase (as even the govt has admitted they will do), the costs to employees will become larger as well. If small co-pays can keep the premium increases more stable, it seems worth a shot.

Let us not forget the health care providers who perform these tests are not likely to be working for no compensation. Somebody is paying for it in some manner, shape or form ... the workers in higher premiums and/or other taxpayers to subsidize the premium costs.

I ran an employer funded Wellness and Prevention program for a Fortune 500 company for 13 years in the 80s & 90s. Cost benefits were from $1:$2.26 to $1:$8.12 per year. Looks like a way to keep your employees healthy and at work.
The programs I ran were free to employees, their families, and retirees.
Company is still running those and the company might be consider conservative politically. COORS Brewery!
1981 to present.
The items studied were health care cost, productive, turn over and absenteeism. The item that contributed the most to the $ was productivity, not health care cost. WAKE UP!:rolleyes::rolleyes:

Gerry Clinchy
07-15-2010, 10:04 AM
Sinner, not sure exactly what you're saying here ... did you mean that for $1 spent on this program they got back $8.12 in productivity?

I think that when a company provides a benefit to employees that is not "required" of them, employees will perceive the benefit differently psychologically. That difference in perception could result in a higher level of dedication by the employees resulting in higher productivity. When an employee feels they are getting "only" what the govt has mandated, their perception of their employer would not change. It would become an "entitlement".

So, are you saying that this benefit will be of negligible value? Or, since you are in the insurance business, are you saying that a small co-pay would, or would not, be reasonable for a govt-mandated program?

With Medicare, the premiums continue to increase (as do those of the Medigap policies). Any of the worthwhile drug coverages start around $100/mo ... and still the system is "going south". Would small co-pays make some sense in the Medigap policies? Evidently, however, the govt mandates what features the Medigap programs may offer.

sinner
07-15-2010, 09:35 PM
Cost benefits are for a $1 spent by the company what did they get back!
Coors was self funded, self managed and self administered at that time.
In the 90s they bought into the HMO insurance models and took a negative "bath" on health care costs.
Studies vary on the results of co-pays, but very few have shown that they reduce appropriate use of the plan.

I believe that the return on health care investments would show numbers similar to COOR"s study. Maintaining the health of our work force and our seniors will make a major difference.
If you haven't look at MGVIP.com see what is coming at us from some MDs.
Keep posting and keep asking questions we must change health care.

sinner
07-15-2010, 09:40 PM
(I think that when a company provides a benefit to employees that is not "required" of them, employees will perceive the benefit differently psychologically. That difference in perception could result in a higher level of dedication by the employees resulting in higher productivity. When an employee feels they are getting "only" what the govt has mandated, their perception of their employer would not change. It would become an "entitlement".)

Many people would share that perception. AT Coors that was Bill Coors major concern and he would not allow us to publish the study (done by the U of Oregon). He did not want employees to think the company was doing this to save money!
Your perception was not supported in the 12 years I was there. We had an 80+% penetration into the work force by the time I retired.

All of my Medicare encounters including drugs have a co-pay. I am now a provider, consumer and researcher of health care. The first steps had to be taken (good or bad) and hopefully we can move forward to a better system.

Gerry Clinchy
07-24-2010, 09:44 AM
NY Times
http://www.nytimes.com/2010/07/24/business/24insure.html?th&emc=th

One relatively small part of the health care bill still leaves a lot of room for discretion on the actual regulations.

By the time bureaucracy is through with their regulations, I'm sure they will rival the Tax Code for complexity and sheer volume.

M&K's Retrievers
07-26-2010, 10:30 PM
Here's more:

http://www.humanevents.com/article.php?id=38249

Franco
07-26-2010, 10:45 PM
The goverment's solution to a problem usually creates a much bigger problem.

Taking Mr Friedman's quote a step closer to reality!

Gerry Clinchy
08-05-2010, 08:51 PM
http://www.nytimes.com/2010/08/05/opinion/05thu2.html?th&emc=th

Health Care Reform, British Style



Giving doctors more power over referrals and introducing for-profit health care management companies will introduce some American features to the British system. That will bring potential risks as well as potential benefits. Experience in the United States — where patients’ interests are too often shortchanged — shows that strong regulatory safeguards will be needed to make these reforms work.

Buzz
08-06-2010, 08:07 AM
What makes you thing that premiums will go up more than 1.5%?

My monthly premium is a little over $1,100, so 1.5% of that is around $16.5 per month. That would cover 12 of my $15 co-pays per year with some change left over.

Gerry Clinchy
08-06-2010, 08:44 AM
What makes you thing that premiums will go up more than 1.5%?

My own premiums went up 10% between 2009 and 2010. Unless the govt actually puts a cap on premiums, there is simply no way that you can take on a lot of people (who will pay little or no premiums) and pre-existing conditions not previously covered, & not have a large increase in premiums.

Remember, the young, working people will be paying a whole lot more (than they are now) than the older, sick, or non-working people. A penalty of $750/year is not nearly enough to cover the slack. And only a jerk would pay even $2000/year in premium if they can pay $750 in penalty instead. They can just wait until they get sick and get their insurance then.

If the govt regulates charges for services (as they do with Medicare), then will health care providers be mandated to charge more for cash customers? Like adding on a charge for not having insurance? Of course, we don't know that yet since the regulations haven't been written :-) Then the "extra" would have to be given back to the govt insurance fund?

M&K's Retrievers
08-09-2010, 10:35 PM
My own premiums went up 10% between 2009 and 2010. Unless the govt actually puts a cap on premiums, there is simply no way that you can take on a lot of people (who will pay little or no premiums) and pre-existing conditions not previously covered, & not have a large increase in premiums.

Remember, the young, working people will be paying a whole lot more (than they are now) than the older, sick, or non-working people. A penalty of $750/year is not nearly enough to cover the slack. And only a jerk would pay even $2000/year in premium if they can pay $750 in penalty instead. They can just wait until they get sick and get their insurance then.

If the govt regulates charges for services (as they do with Medicare), then will health care providers be mandated to charge more for cash customers? Like adding on a charge for not having insurance? Of course, we don't know that yet since the regulations haven't been written :-) Then the "extra" would have to be given back to the govt insurance fund?

As an insurance agent, I just received my first "reduction in commission" letter from one of my insurance carriers. I have made a career in selling health insurance to individual and employer groups for 30+ years. Because of Obamacare, effective 1/1//11, my compensation will be reduced 50% on a great deal of my in force accounts. My required service for these accounts did not go down - if fact it will probably increase. I get the opportunity of doing more work for less pay. What a frigging deal.

JDogger
08-09-2010, 10:50 PM
As an insurance agent, I just received my first "reduction in commission" letter from one of my insurance carriers. I have made a career in selling health insurance to individual and employer groups for 30+ years. Because of Obamacare, effective 1/1//11, my compensation will be reduced 50% on a great deal of my in force accounts. My required service for these accounts did not go down - if fact it will probably increase. I get the opportunity of doing more work for less pay. What a frigging deal.

Yeah, Mike. I've had sales gains the last four out of six months, but sales are still lagging compared to three or four years ago.
Sorry, say the bean-counters. Nothing for you, until we get ours.
It's not Bush's fault. It's not Obama's. It's our's.
Got any ideas?

JD

M&K's Retrievers
08-09-2010, 11:50 PM
Yeah, Mike. I've had sales gains the last four out of six months, but sales are still lagging compared to three or four years ago.
Sorry, say the bean-counters. Nothing for you, until we get ours.
It's not Bush's fault. It's not Obama's. It's our's.
Got any ideas?

JD

I'm guessing you don't make your living in the health care industry but you do sell and service a product.The product/service I sell remains in effect as long as the policy is in effect. How would you like it if suddenly because of a government requirement your compensation for business you had already written was reduced in half? I'm not talking slow pay, I'm talking the government tells the manufacturer (insurance company) that they can only pay and you can only make "so much" for your efforts.

JDogger
08-10-2010, 12:07 AM
I'm guessing you don't make your living in the health care industry but you do sell and service a product.The product/service I sell remains in effect as long as the policy is in effect. How would you like it if suddenly because of a government requirement your compensation for business you had already written was reduced in half? I'm not talking slow pay, I'm talking the government tells the manufacturer (insurance company) that they can only pay and you can only make "so much" for your efforts.

Well maybe the answer is healthcare that is not profit-driven.

Jess sayin, JD :)

M&K's Retrievers
08-10-2010, 12:17 AM
Well maybe the answer is healthcare that is not profit-driven.

Jess sayin, JD :)

Why don't we say that about any product?

Widgets regards,

jedisme
08-10-2010, 01:41 AM
Obamacare..lol. Bye grandma!

JDogger
08-10-2010, 03:20 AM
Why don't we say that about any product?

Widgets regards,

'Cause there's a difference between widgets and HC. Or...are you saying...that HC should be doled out according to your ability to pay? Sounds a lot like rationing to me. Bye Grandma. JD

Gerry Clinchy
08-10-2010, 06:55 AM
You can look at the up-side M&K, if premiums double, your gross compensation will remain the same :-) The next step would be for govt to determine that a "flat rate" would be more appropriate than a %-age because more $ is needed for sustainability of the program.

JD once the govt starts determining who can make a profit on what product, where do they draw the line?

Read in the NY Times yesterday that India face the question: Is food a basic human right? Does that mean that farming should become non-profit a well?

If govt determines that heating fuel is a human right, doe that mean that all energy producers should become non-profit?

Probably the last on the list would be the trial lawyers who do malpractice suits. If there is a $50 million settlement, the govt will determine that after expenses, the attorneys are only entitled to a max. amount of the proceeds up to $X; the plaintiff gets $X ... and the rest goes into the govt fund for health insurance/care. I have no doubt that the trial lawyers will be the last :-) ... very far down the line once there is no other business to convert to non-profit.

By chipping away at one group of wage-earners at a time, it makes it easier than taking on many all at once. After all, M&K may only represent 100,000 or so members of the citizenry (just throwing out a number) v. the 30 million who benefit from their sacrifice of income to the greater good.

Does it make you think of the German who said of the Nazis' methods: And when they came for me, there was no one left to speak for me?

M&K's Retrievers
08-10-2010, 08:54 AM
'Cause there's a difference between widgets and HC. Or...are you saying...that HC should be doled out according to your ability to pay? Sounds a lot like rationing to me. Bye Grandma. JD

As I have said on this site many times, those that can't pay or are uninsurable should be provided for by the rest of us that can. Don't screw up the entire system for everyone.

JDogger
08-10-2010, 11:42 PM
JD once the govt starts determining who can make a profit on what product, where do they draw the line?


Where it needs to be drawn, Gerry. Where it needs to be drawn...

State Public Regulation Commisions all the the time set, and approve the rates that utilities may charge, and yet the world has not come to an end.

JD

Gerry Clinchy
08-10-2010, 11:57 PM
Where it needs to be drawn, Gerry. Where it needs to be drawn...

State Public Regulation Commisions all the the time set, and approve the rates that utilities may charge, and yet the world has not come to an end.

JD

Actually, that worked pretty well for building the infrastructure of the public utilities. Here in PA deregulation began this year. It remains to be seen how this will work when one provider has the overwhelming majority of customers by virtue of their years' long monopoly. Competitors won't offer any larger discount from the dominant provider's rate than they need to get the customers. So, that one dominant supplier really is still in control of the rates.

However, the public utilities were limited to certain services. If the definition gets expanded to ever more industries based on a right to this, that, or the other thing it begins to sound like ... to each according to need; from each according to ability.

M&K's Retrievers
08-11-2010, 12:00 AM
Where it needs to be drawn, Gerry. Where it needs to be drawn...

State Public Regulation Commisions all the the time set, and approve the rates that utilities may charge, and yet the world has not come to an end.

JD

It seems to me that utilities are a product we all must purchase from a monopoly. Insurance is a different animal.

Where's my broom regards?

Gerry Clinchy
08-20-2010, 03:20 PM
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/health-bill-may-impose-marriage-penalty.aspx
A "Marriage Penalty" in the Health Care Bill



Some married couples would pay thousands of dollars more for the same health insurance coverage as unmarried people living together if the health insurance overhaul plan pending in Congress is passed.



People who got their health insurance through an employer wouldn't be affected, but people who bought subsidized insurance through new exchanges set up by the legislation would. About 17 million people would receive such subsidies in 2016 under the House plan, the Congressional Budget Office estimates.


For an unmarried couple with income of $25,000 per person, combined premiums would be capped at $3,076 per year under the House bill. If the couple got married, with a combined income of $50,000, their annual premium cap would jump to $5,160, a "penalty" of $2,084. Those figures were included in a memo prepared by House Republican staff members.


Under the Senate bill, a couple with $50,000 combined income could pay as much as $3,450 in annual premiums if unmarried and $5,100 if married, a difference of $1,650.



Republicans say the effect on married couples whose combined income made them ineligible for subsidies would be even greater -- up to $5,000 or more -- but that is more difficult to measure because it includes assumptions about the price of insurance policies.



Democratic staff members confirmed the existence of the penalty but said any remedy would create other inequities.


For instance, they said making the subsidies neutral toward marriage would lead to a married couple with only one breadwinner getting a more generous subsidy than a single parent at the same income level. "The Finance Committee, along with other committees in the Senate, took pains to craft the most equitable overall structure possible, and that's what we have here," said a Democratic Senate Finance Committee aide.

If a health bill passes with a marriage penalty intact, it will be far from the first example of federal and social benefits creating incentives to remain single. Under the law now, marriage can have a negative impact on a person's ability to claim the earned income tax credit and welfare benefits, including food stamps.

troy schwab
08-20-2010, 03:43 PM
Good stuff huh Gerry? So glad OBONGO got this passed........ ROFL

Gerry Clinchy
09-01-2010, 06:41 PM
NY Times
http://www.nytimes.com/2010/09/01/health/policy/01grady.html?th&emc=th
Deal Would Provide Dialysis to Illegal Immigrants in Atlanta



ATLANTA — Thirty-eight end-stage renal patients, most of them illegal immigrants, would receive the dialysis (http://health.nytimes.com/health/guides/test/dialysis/overview.html?inline=nyt-classifier) they need to stay alive at no cost under a rough agreement brokered Tuesday among local dialysis providers and Atlanta’s safety-net hospital, Grady Memorial.

The deal, if completed, would end a yearlong impasse that has come to symbolize the health care plight of the country’s uninsured immigrants and the taxpayer-supported hospitals (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier) that end up caring for them. The problem remains unaddressed by the new health care law, which maintains the federal ban on government health insurance (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/index.html?inline=nyt-classifier) for illegal immigrants



Illegal immigrants, and legal immigrants newly in the country, are not eligible for Medicare (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier), the federal program that covers most dialysis costs for American citizens with end-stage renal disease.

Grady volunteered to transport the patients to other states or their home countries and pay for three months of treatment. Thirteen accepted the offer. But in response to a patient lawsuit and news media scrutiny, the hospital eventually contracted with a commercial dialysis provider to treat the others in Atlanta for one transitional year.

That contract, with Fresenius Medical Services, expired on Tuesday.

Vital details of the agreement remain to be negotiated, including precisely how the patients will be distributed, how much Grady will pay and whether the arrangement will extend for patients’ lifetimes. But all parties said after meeting Tuesday morning that they were optimistic that they would reach an understanding and that patients would see no lapse in treatment.

“That would make me feel real happy because continuing with my dialysis, I need it to live,” said Ignacio Godinez Lopez, 24, who crossed into the United States illegally as a teenager and has been treated at Grady’s expense for four years. “I’m young, and without dialysis it would be taking my life.”

The patients in Atlanta have gambled that American generosity, even at a time of hostility toward illegal immigrants, would prove a surer bet than uncertain care in their home countries. Several said that the fates of those who returned home had reinforced their fears about leaving Atlanta.

Five of the 13 patients who left for Mexico with assistance from Grady or the Mexican government have died, according to Matt Gove, a Grady senior vice president. Most died while still receiving dialysis, although not always as regularly as recommended.

One patient, Fidelia Perez Garcia, 32, apparently succumbed in April to complications from renal failure (http://health.nytimes.com/health/guides/disease/acute-kidney-failure/overview.html?inline=nyt-classifier) after running out of Grady-sponsored treatments in Mexico. Patients with end-stage renal disease can die in as little as two weeks without dialysis, which filters toxins from their blood.

Ms. Perez’s mother, Graciela Garcia Padilla, said by telephone that her family was able to raise money for three additional dialysis sessions, at a cost of about $100 each. Ms. Perez then went 12 days without dialysis and persuaded a hospital to treat her only when she was close to death, Ms. Garcia said.

“They sent her to me just to die,” Ms. Garcia said. “Here, they let people die.”

At the same time, regular treatment in Atlanta has not guaranteed survival. Four of the 45 patients who were receiving dialysis at Fresenius clinics have also died, Mr. Gove said.

Nationally, about one in five dialysis patients die within a year of starting treatment, and about two in three die within five years, according to government figures.

The agreement would not address the broader concern of how to care for illegal immigrants in the region who have developed renal disease since the Grady clinic’s closing, or those who will do so in the future. At the moment, their only option may be to wait until they are in distress and then visit hospital emergency rooms, which are required by law to provide dialysis to patients who are deemed in serious jeopardy.


No one could read this without compassion for the patients. It still makes me angry that Mexico disses the US for being discriminatory against Mexico's illegal immigrants to the US, but fails so miserably to take care of its own citizens.

While Mexico has very inexpensive medical care, many of its citizens have so little money they can't afford it. Sounds like the same problem the US has ... just replace the #s & they still mean that the poor in either country can't afford medical care (or health insurance).

So a large portion of the "uninsured" problem will continue to exist unless illegal immigration is also addressed.