Impeding changes to our Health Care system

[Clodfobble]

Originally Posted by classicman

I did a little preliminary checking just in case... the rates I was getting were 300-400% more than what my total premiums are now.

Yeah, my understanding is that it's really not for people who are capable of getting any kind of medical insurance on their own. It's for those who are completely unable to get a premium of any kind, and are stuck with literally tens of thousands of dollars a year in out-of-pocket medical costs. 300-400% of your premium is still quite possibly less than they're currently paying in medical bills, so it's a better deal for them.

[classicman]

Yes it is - or potentially is. Its different if you are insured and there is the possibility of changing jobs. Its kind of a killer actually.

[Clodfobble]

Right, because in the end, you do like the protection insurance gives you, just like everyone else. You just think some people shouldn't get to be part of that group... why? "I already got mine, Jack," is a bullshit philosophy to live your life by.

[TheMercenary]

Originally Posted by Clodfobble

You just think some people shouldn't get to be part of that group... why? "I already got mine, Jack," is a bullshit philosophy to live your life by.

No where have I made that statement. In fact I said if the gobberment were going to go to the extent of controlling our lives by mandating insurance they should have gone all in and had a public option completely paid for by the gobberment and directly competed with the insurance companies. But they did not, they caved to the insurance companies by not providing the public option. So that puts the complete burden on all of us with insurance. That is a bullshit philosophy to support...

[Happy Monkey]

All possible plans would be funded by the people who can afford to pay, whether through taxes or premuims. I agree that a public option would add efficiency, and further believe that single payer would be even better, but we had to deal with the fact that all Republicans and some Democrats wouldn't do it.

But paying more for less coverage is the status quo, not the fault of HIR. I'm sure the Republicans and the insurance companies will take great glee in blaming all of the companies' misbehavior on the new laws, but they've been doing it for years.

They'll probably be on their worst behavior for a while, in hopes of getting a repeal. I hope it backfires on them.

[TheMercenary]

So instead we have traded a good plan for "getting any plan passed" at great cost to the taxpayer that will be ineffective in controlling costs and add to the deficit? The plan is a one party plan, owned by the Dems, passed by an all Dem Congress and signed by a Dem President. It was ramrodded through passage. Not a good way to pass enormously expensive Bills. This will backfire on them.

[xoxoxoBruce]

The plan is a one party plan, owned by the Dems, passed by an all Dem Congress and signed by a Dem President.

If that's true, then why didn't they pass the plan they wanted?

[TheMercenary]

Originally Posted by xoxoxoBruce

If that's true, then why didn't they pass the plan they wanted?

Because they had to deal with the details in their own party. Don't get me wrong, if the Repub's were in charge of the whole thing they wouldn't have done any better.

[Happy Monkey]

Originally Posted by TheMercenary

So instead we have traded a good plan for "getting any plan passed" at great cost to the taxpayer that will be ineffective in controlling costs and add to the deficit?

It eliminates "preexisting conditions". That's worth the rest of it. Plus there are plenty of other good parts, which make it worth it all the more.

[TheMercenary]

Originally Posted by Happy Monkey

It eliminates "preexisting conditions". That's worth the rest of it. Plus there are plenty of other good parts, which make it worth it all the more.

I would agree that the elimination of the pre-existing condition is good. But you can't put one good thing in a 3000 page bill and call it good, not at the estimated long term costs to the taxpayer.

"Hey great button on the dash, to bad the car is a piece of shit."

[TheMercenary]

July 19, 2010
An Ugly Preview of ObamaCare

By Robert Samuelson
WASHINGTON -- If you want a preview of President Obama's health care "reform," take a look at Massachusetts. In 2006, it enacted a "reform" that became a model for Obama. What's happened since isn't encouraging. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people's health. Unfortunately, Obama has done the same.

Like Obama, Massachusetts requires most individuals to have health insurance (the "individual mandate"). To aid middle-class families too well-off to qualify for Medicaid -- government insurance for the poor -- the state subsidizes insurance for people up to three times the federal poverty line (about $66,000 in 2008 for a family of four). Together, the mandate and subsidies have raised insurance coverage from 87.5 percent of the non-elderly population in 2006 to 95.2 percent in the fall of 2009, report Sharon Long and Karen Stockley of the Urban Institute.

People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, note Long and Stockley in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.

But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.

Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else -- schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.

State leaders have proven powerless to control these costs. Facing a tough re-election campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or less) and individuals -- an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 percent to 11 percent. More settlements are expected.

Attacking unpopular insurance companies is easy -- and ultimately ineffectual. The trouble is that they're mostly middlemen. They collect premiums and pay providers: doctors, hospitals, clinics. Limiting premiums without controlling the costs of providers will ultimately cause insurer bankruptcies, which would then threaten providers because they won't be fully reimbursed. The state might regulate hospitals' and doctors' fees directly; but in the past, providers have often offset lower rates by performing more tests and procedures.

A year ago, a state commission urged another approach: Scrap the present "fee-for-service" system. The commission argued that fee-for-service -- which ties reimbursement to individual services -- rewards quantity over quality and discourages coordinated care among doctors and hospitals. The commission recommended a "global payments" system to force hospitals, doctors and clinics to create networks ("accountable care organizations"). These would receive flat per-patient payments to promote effective -- not just expensive -- care. Payments would be "risk adjusted"; sicker patients would justify higher payments.

But the commission offered no blueprint, and efforts to craft consensus among providers, consumer groups and insurers have failed. State Senate President Therese Murray, an advocate of payment change, has given up for this year. "Nobody is in agreement on anything," she told The Boston Globe.

All this anticipates Obamacare. Even if its modest measures to restrain costs succeed -- which seems unlikely -- the effect on overall spending would be slight. The system's fundamental incentives won't change. The lesson from Massachusetts is that genuine cost control is avoided because it's so politically difficult. It means curbing the incomes of doctors, hospitals and other providers. They object. To encourage "accountable care organizations" would limit consumer choice of doctors and hospitals. That's unpopular. Spending restrictions, whether imposed by regulation or "global payments," raise the specter of essential care denied. Also unpopular.

Obama dodged the tough issues in favor of grandstanding. Imitating Patrick, he's already denouncing insurers' rates, as if that would solve the spending problem. What's occurring in Massachusetts is the plausible future: Unchecked health spending determines government priorities and inflates budget deficits and taxes, with small health gains. And they call this "reform"?

from: http://www.realclearpolitics.com/art...ld_106358.html at July 22, 2010 - 05:04:04 PM CDT

[Happy Monkey]

Eliminating preexisting conditions requires the mandate. The mandate requires subsidies. My guess is that takes up quite a few of those 3000 pages. All whinging I've heard about the plan is either
a) About the mandate or the cost of subsidies, which are required.
b) Far outweighed by the elimination of preexisting conditions.
or c) that the plan doesn't go far enough, with which I and most Democrats agree. If there had been any non-tool Republicans to offset the tools among the Democrats, maybe we could have done something about that. Hopefully some time in the future, we will. But that's an argument for doing more, not an argument against doing what was done.

[TheMercenary]

Originally Posted by Happy Monkey

Eliminating preexisting conditions requires the mandate. The mandate requires subsidies. My guess is that takes up quite a few pages. All whinging I've heard about the plan is either
a) About the mandate or the cost of subsidies, which are required.
b) Far outweighed by the elimination of preexisting conditions.
or c) that the plan doesn't go far enough, with which I and most Democrats agree. If there had been any non-tool Republicans to offset the tools among the Democrats, maybe we could have done something about that. Hopefully some time in the future, we will. But that's arn argument for doing more, not an argument against doing what was done.

And none of that controls costs which is why it will fail in the end. And none of that requires that everyone contributes, only that those who have insurance and money pay for those who don't. And none of that will fix the problems in healthcare, Mass tried this approach, see above link, and it failed. You have deluded yourself. So far the government programs of Medicaid are expensive, bloated, and inefficient, and this is the same government that is going to control this bill. There is so much wrong with this Bill it does not outweigh the good. There was so much potential for the Dems to do the right thing, they failed.

[Happy Monkey]

Originally Posted by TheMercenary

And none of that controls costs which is why it will fail in the end.

We'll see what happens on the exchanges. But if they don't work, then "the end" could be the impetus to go public option or single payer. It would be nice if we didn't have to take the long way round, but we are giving them the rope to hang themselves. Hopefully we're willing to be hangmen when the time comes.

And none of that requires that everyone contributes, only that those who have insurance and money pay for those who don't.

The only alternative to that is to let poor people die in the streets. Our current method is emergency rooms. At least under the new system, the poor will be able to get preventive care that way, rather than just catastrophic care.

And none of that will fix the problems in healthcare,

That's... unspecific. There will probably be plenty of problems it doesn't fix. It's only 3000 pages, after all. but it does fix the biggest problem - preexisting conditions. And that fix has the further effect of curbing the second biggest problem - recisions. If you can't cut someone for a preexisting condition, you can't cut them for not reporting it.

So far the government programs of Medicaid are expensive, bloated, and inefficient,

But less so than private insurance, so I agree that a public option would have been great.

But, as I said, things the bill doesn't do are things to do in the future. They aren't arguments against what the bill does.

[TheMercenary]

Originally Posted by Happy Monkey

The only alternative to that is to let poor people die in the streets. Our current method is emergency rooms. At least under the new system, the poor will be able to get preventive care that way, rather than just catastrophic care.

That is not happening now and never has, so what makes you think that this Bill will fix something that is not broken? What makes you think that if given the opportunity that the poor will seek preventative care. They often don't take care of themselves now so how would this change? Not to say that some would not take advantage of some preventative care in the future, nor would this be a bad thing. Take for example smoking. Do you think there will suddenly be a rush on people taking smoking cessation classes? How about alcoholism among the poor? Do you think the poor who drink excessively or have other abuse problems will suddenly seek out a healthier lifestyle?