Actual Health Care bill.....

[YardleyLabs]

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-...3200ih.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]

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]

Hasn't the left been contending this all along?

[YardleyLabs]

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]

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]

We don't need osamacare.

[dnf777]

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-...3200ih.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'

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!

[Gerry Clinchy]

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]

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]

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??