http://www.nytimes.com/2009/06/06/health/policy/06health.html

Quote :

"All Americans would have access to “essential health care benefits,” with no annual or lifetime limits, employers would have to contribute to the cost of coverage and the government would create a new public insurance program under sweeping legislation drafted by Senator Edward M. Kennedy and circulated Friday. Under the legislation, the government would subsidize premiums for people with incomes up to 500 percent of the poverty level ($110,000 for a family of four), and private insurers would have to pay out a specified percentage of their premium revenues in benefits. The new government-run program would pay doctors and hospitals at Medicare rates, plus 10 percent. ... The bill gives no indication of how Mr. Kennedy would pay for his proposals, other than by requiring contributions by individuals and employers. ... Under the Kennedy bill, individuals would be subject to financial penalties if they did not have health insurance. The Treasury secretary would set the amount of the penalties, at “the minimum practicable amount that can accomplish the goal” of expanding coverage. The penalties would be added to a person’s tax bill and collected by the Internal Revenue Service. People would be exempt from the penalties if “affordable health care coverage is not available” or if the premium payments would cause “an exceptional financial hardship.” President Obama recommended such a “hardship waiver” this week. Under Mr. Kennedy’s bill, the secretary of health and human services would establish a panel of experts, the Medical Advisory Council, to recommend a minimum package of insurance benefits. If Congress did not disapprove the recommendations, insurers would generally have to provide the benefits. The bill stipulates that the “essential benefits” include doctors’ services, hospital care, maternity and newborn care, prescription drugs and mental health and substance abuse services. Any group health plan or insurance company that provided coverage for children and their parents would have to offer to continue “dependent coverage” for the children through age 26. In effect, young adults could stay on their parents’ policies. ... Under the bill, the federal government would make grants to the states to establish insurance marketplaces or exchanges. Those entities, known as health benefit gateways, would disseminate information about premiums and benefits and would help people enroll. The new entities would also act as financial intermediaries, receiving subsidy payments from the government and sending the money to insurance companies. The insurance exchanges would also redistribute money among health insurance plans, from those with a large share of healthy subscribers to those with large numbers of sick people. ... The secretary of health and human services would establish the new government-sponsored plan, which would compete directly with private insurers. Republicans strenuously oppose a government-run plan, but Mr. Obama says it is needed to “keep insurance companies honest.”"

So...

Mandatory health care for all. Not only will you pay premiums, your employer will pay premiums and if you want private insurance (as opposed to .govcare) you will likely pay an additional premium. In addition, your taxes will be used to pay for further premiums to fund .govcare for families making less than 100k per year.

In addition, if you're young and healthy and don't have a need for extensive medical coverage, that's just too damn bad because you don't have a choice. If you don't pay for it out of pocket, you'll pay for it in taxes, which will surely be a very cost effective way to get the money. Interestingly, if affordable coverage isn't available (which just leads to the question as to what the purpose of this is if not to provide affordable coverage) you can get an exemption, so in addition to subsidizing families at +500% of poverty, your taxes will further pay for the entire costs for certain segments of the population that aren't on medicare/caid and for whom this massively expanded program has failed.

And the hell with what YOU want in your insurance. Your benefits will be decided by a panel of politicians, who will determine what services are "necessary". If you are unable medically to have children, you will still pay for maternity care. No plans on doing drugs or becoming a junkie, no family history of alcoholism? Too bad, you will pay for substance abuse coverage.

Finally, in a flash of brilliance, not only will this coverage be paid indirectly via 3 different taxes applied at different locations all going to the same place, but it will then be redistributed to another middle man at the state level (also subsidized by taxes) who will oversee the monies and pass them out to the various insurance companies, guaranteeing equal payments to all, regardless of how good or bad you run your company. Of course, this will be perfectly efficient and no losses or price increases at all will occur due to the increasing number of middle men between you and your doctor. And this probably further rules out people like the doc in NYC who offered all his services at a flat rate of $70/month + $10 a visit who was shut down by the NY government because only insurance companies are allowed to offer medical services at flat rates.

Further if you are an insurance company, you will be required to spend a certain amount of your revenue on benefits no matter what and you will also be required to cover "children" up to age 26, and you will be competing directly with .govcare which is paid for entirely with tax revenue (what happens to funding in a recession?) which means unlike your company, which has to worry about revenue streams and expenses and keeping premiums competitive and collecting your total premiums from individuals, businesses, the state and the federal government, your newest and biggest competitor just has to raise taxes (FOR THE CHILDREN!!) when expenses start exceeding revenue.

I am fully in agreement that our healthcare situation in this country needs fixing, but how in the hell can anyone think this monstrosity is an improvement?

6/7/2009 7:15:50 PM

Quote :

"In addition, if you're young and healthy and don't have a need for extensive medical coverage, that's just too damn bad because you don't have a choice."

Just in reading what you quoted, it doesn't seem like it requires "extensive" medical care.

Quote :

"The bill stipulates that the “essential benefits” include doctors’ services, hospital care, maternity and newborn care, prescription drugs and mental health and substance abuse services. "

essential != extensive

Quote :

"your taxes will further pay for the entire costs for certain segments of the population that aren't on medicare/caid and for whom this massively expanded program has failed."

Just how big is that population of people that can't afford insurance but aren't on medicare/caid?

Quote :

"Your benefits will be decided by a panel of politicians, who will determine what services are "necessary"."

The cool thing about this is, we can vote them out. This is assuming we actually cared enough to be outraged outside of message boards, which doesn't really seem to be the case.


Other than that, I generally agree with you that it doesn't give me good feelings about the government trying to manage ANYTHING.

6/7/2009 7:52:14 PM

Quote :

"Your benefits will be are currently decided by a panel of politicians businessmen, who will determine what services are "necessary" "profitable"

[Edited on June 7, 2009 at 8:12 PM. Reason : b]

6/7/2009 8:12:07 PM

just another step in the wrong direction. I hope it fails.

I just dont understand why we are forcing businesses to pay for health insurance. Dumb move

6/7/2009 8:15:06 PM

Quote :

"essential != extensive"

Aside from the obvious ones already included which aren't essential (maternity / newborn care, if you can't afford insurance for yourself and your family already, you shouldn't be getting coverage for more members of your family) you would be deluding yourself if you don't think that after a few years of lobbying, "essential services" will include things like, IV fertilization, acupuncture, massage therapy, homeopathy and "Prayer Based Healing". Also invisalign braces (can't have our children suffering the mental anguish of normal braces) and contact lenses (ditto for the stigma of wearing glasses). And don't forget nutritional counseling, and personal exercise specialists to combat the obesity epidemic. And what about people who can't have children, why should they be paying for maternity care they don't have need of? I guarantee you that my definition of essential services, and even you definition are significantly different than the definition of essential services the government will come up with.

Quote :

"Just how big is that population of people that can't afford insurance but aren't on medicare/caid?"

If you believe the government numbers, about 46 million people.

Quote :

"The cool thing about this is, we can vote them out. This is assuming we actually cared enough to be outraged outside of message boards, which doesn't really seem to be the case"

Because our voting record has done so well for us in keeping government expenditures and non essential services down right? I mean, look how quickly we got ourselves out of Iraq. And thank god that moron Pelosi who wrote that horrible stimulus bill is gone. And imagine where we would be today if all of the representatives that voted for the Patriot Act where still in office, or even worse, elected one of the assholes who voted to renew it as president.

Quote :

""Your benefits will be are currently decided by a panel of politicians businessmen, who will determine what services are "necessary" "profitable""

Difference is, I don't have to pay for it. I could pay cash and never pay a dime to any insurance company ever. Hell, the doc in NY demonstrates that it would even be possible to subscribe to my doctor's services and have unlimited access without having to deal with any middle man. Of course, the NY government already ruled that you can't do that (can't have ordinary citizens and doctors contracting to provide low cost health care, only the government or corporations approved by the government can do that), and I assure you such a thing will be banned nation wide under something like this. Further, under something like this, even if I wanted to pay my doc in cash, I'd still be paying for health insurance as I will be required by law to cary it and penalized if I don't (in taxes, and if I refuse to pay those taxes, well, you know where that will lead).

(BTW, reference for the doctor in NY in case you think I'm making that up http://www.wten.com/Global/story.asp?S=9946049)

Quote :

"I just dont understand why we are forcing businesses to pay for health insurance. Dumb move"

Because clearly the best way to reduce the cost of health care is to reduce the number of buyers. Group buying power has never ever been shown to work.

[Edited on June 7, 2009 at 8:26 PM. Reason : adf]

6/7/2009 8:17:15 PM

Quote :

""I think the status quo is unacceptable and that we've got to get it done this year. If we don't get it done this year, we're not going to get it done," Obama said."

Wasnt someone on here saying how only republicans use scare tactics?

Going door to door. Maybe they can sell some GM cars while they are at it.

http://www.cnn.com/2009/POLITICS/06/05/democrats.health.care/index.html

[Edited on June 7, 2009 at 8:42 PM. Reason : .]

6/7/2009 8:37:42 PM

Obama wasn't the one pushing for mandatory insurance. That was Clinton's (and the majority of Senate Dem's) idea. I suppose Obama has to go along with it as a political trade-off to get the Senate on board with his other health care proposals.

Obama's political capital may never be higher, and he has a near filibuster-proof majority in congress. In that sense, if it doesn't get done this year, it may never get done. I don't have a problem with that statement. The problem I have is that he said his main goal is to reduce costs, but expanding coverage will increase costs. His proposals don't attack the root causes of our excessive health care tab, which have more to do with an unhealthy populace, high-paid doctors, overregulation and a high barrier to entry in the health insurance market.

6/7/2009 9:07:41 PM

Quote :

"Your benefits will be decided by a panel of politicians"

They already are, I'm a state employee. Those with private insurers have it even worse, your benefits are decided by corporate bureaucrats that you don't even get to vote on. At least I get to choose my tormentor.

6/7/2009 9:11:14 PM

^ Apparently, people just seem to be happier when they can choose how they are fucked, even if the fucking is the same as if they had no choice.

Quote :

"Hell, the doc in NY demonstrates that it would even be possible to subscribe to my doctor's services and have unlimited access without having to deal with any middle man."

Let me guess, you're free to do that now but you don't?

[Edited on June 7, 2009 at 9:39 PM. Reason : .]

6/7/2009 9:32:59 PM

when does he mention that he wants to tax you health plan, thereby raising your salary by including your health plan cost as part of your salary...raising your tax burden. Something he said he would not do on the campaign but now says is on the table.

[Edited on June 7, 2009 at 9:50 PM. Reason : .]

6/7/2009 9:45:18 PM

Quote :

"Under the Kennedy bill, individuals would be subject to financial penalties if they did not have health insurance"

better than having the same societal scum going to the ER for free b.c they would rather spend their McDonalds paycheck on 40's and rims. After taking irresponsibility for their own health these same people will end up costing the tax payer more money.

NONETHELESS I do not approve of the government paying for the subsidization of said health care expenses. Though i have heard some theory, but have not seen much numbers or proof yet, that a state subisdized program would save "Big Business" a lot of money of having to otherwise provide the same services they would choose to provide for their employees as far as healthcare is concerned.

6/7/2009 10:00:16 PM

Quote :

"when does he mention that he wants to tax you health plan, thereby raising your salary by including your health plan cost as part of your salary...raising your tax burden. Something he said he would not do on the campaign but now says is on the table."

I guess that has bipartisan support. Obama now supports the republican health tax.

6/7/2009 10:03:59 PM

Quote :

"They already are, I'm a state employee. Those with private insurers have it even worse, your benefits are decided by corporate bureaucrats that you don't even get to vote on. At least I get to choose my tormentor."

Again, you can choose to not participate. As it stands right now, you can choose not to pay for insurance and pay cash if you want. Under the proposed system, you wouldn't have that choice. Regardless of whether or not you want to pay for a particular coverage one way or the other you will.

Further, just because the system is fucked up now does not in any way shape or form suggest that we should continue to allow it to remain fucked up, or fuck it up even worse.

Lastly, I know that we like to pretend here that people come to our houses and hold guns to our heads and make us buy things, but you really do have the power to vote with your wallet. If you don't like something you don't have to buy it. Sure for most people it is easier and more convenient and cheaper to take their employer care and say screw it, but no one ever promised that refusing to give money to people that don't give you what you want would be easy or convenient. I'm sure the bus boycott was rather inconvenient for a number of the participants but it worked, and such a thing could work again if people actually had the resolve to stand up for themselves these days.

Quote :

"Let me guess, you're free to do that now but you don't?"

I did for a number of years because the cost of insurance wasn't worth it for me. My total health expenditures for a year were less than $1,000. Why in the world would I pay $300/month for insurance in that instance and then have to still pay co-pays or deductibles?

As far as specifically contracting for a monthly flat fee, no I don't have that option, or at least I haven't met a doctor that provides that service here. But you can be damned sure that if a doctor did, I would be seriously reconsidering the insurance I have now. But I imagine such an attempt here would be met with the same reaction, the insurance industry using the meddling power of the government to shut it down.

Quote :

"better than having the same societal scum going to the ER for free b.c they would rather spend their McDonalds paycheck on 40's and rims. After taking irresponsibility for their own health these same people will end up costing the tax payer more money. "

You missed the part about people who didn't have "affordable plans", or who had a "hardship" in paying for their plan would get a waiver from the costs and taxes, and still have their care subsidized. So in addition to them still getting free care, instead of the loss coming in the form of a write off for the hospital, it will come in the highly efficient form of the government taxing you and your employer, sending that money to a tax funded organization to give that money to the person in question (hopefully) in the form of some voucher which will then be redeemed by the insurance company that provides the .govcare to pay the hospital. And like I said before of course there will be no inefficiencies or middle man losses here.

[Edited on June 7, 2009 at 10:11 PM. Reason : ghj]

6/7/2009 10:06:35 PM

Quote :

"Why in the world would I pay $300/month for insurance in that instance and then have to still pay co-pays or deductibles?"

My wife and I pay around $180 a month combined for a pretty good plan from BCBS. I mean, gg on getting lucky that year and not having a catastrophe, but I think I'll rather pay that small sum for peace of mind.

Quote :

"Further, just because the system is fucked up now does not in any way shape or form suggest that we should continue to allow it to remain fucked up, or fuck it up even worse."

This is what you ultra free marketers don't understand. At all. It will FOREVER remain fucked up because people that are smarter than you, have more money than you, and more power than you will always be the ones calling the shots and deciding what something costs you. I don't have a ton of hope that the government will really be much of a check on that power any time soon, but there is at least the chance there. With big business, we're all at their whims and you're a delusional fool for thinking a perfect free market in that libertarian fantasy land in your brain would solve this.

[Edited on June 7, 2009 at 10:13 PM. Reason : .]

6/7/2009 10:08:56 PM

Quote :

"I did for a number of years because the cost of insurance wasn't worth it for me. My total health expenditures for a year were less than $1,000. Why in the world would I pay $300/month for insurance in that instance and then have to still pay co-pays or deductibles?"

that's a legitimate concern and there is plenty of merit to it, but how would you deal with an emergency? Serious question - what if you come down with adult-onset diabetes and need expensive medication for the rest of your life? No insurance plan will take you then with your pre-existing condition. What about a broken leg? What you wake up one day and feel a lump on one of your nuts? What if you have a kid born with a handicap?

is your view "well, tough shit - i took a gamble and lost, now I have to just die early, or go into debt for the rest of my life"? Or.... would you go run to Medicaid?

6/7/2009 10:13:57 PM

This legislation is an utter train wreck.

Could someone point out how this is going to help the uninsured get treated?

6/7/2009 10:16:20 PM

And your plan most be in part paid for by your employer, likewise the reason I no longer do so is because my care is paid for by my employer, and it makes more financial sense. But as far as the catastrophe goes, overall the chances of something that major are pretty low, and even if I had a catastrophe, I still have options. Many hospitals allow you to pay over time if you don't have insurance and in reality in the most risky behavior I was engaged in at the time (driving) I already had substantial medical coverage.

As for the peace of mind bit, had the option to purchase catastrophic insurance been readily available (unfortunately another victim of our already too meddlesome government) I would have considered purchasing it, but since it was not peace of mind was not worth paying for.

But such a problem won't be solved by the federal government mandating that every company cover every thing that some politician can be bribed into introducing into the bill.

Quote :

" It will FOREVER remain fucked up because people that are smarter than you, have more money than you, and more power than you will always be the ones calling the shots and deciding what something costs you."

Yet so many things in our life don't suffer the same problems, including things that are even more necessary than health insurance (like food). I don't suppose that has anything to do with people being more able to pick and choose among providers of other things rather than being locked into an extremely limited series of options as dictated by politicians and tax law and meddling that prevents you from even buying such products from anywhere except producers in your own state.

Quote :

"I don't have a ton of hope that the government will really be much of a check on that power any time soon, but there is at least the chance there. With big business, we're all at their whims and you're a delusional fool for thinking a perfect free market in that libertarian fantasy land in your brain would solve this."

No more a fool than anyone who has looked at the history of our government and still thinks they will have a snowballs chance in hell's sauna of reducing our costs or complexities and problems.

Quote :

"Serious question - what if you come down with adult-onset diabetes and need expensive medication for the rest of your life? No insurance plan will take you then with your pre-existing condition. What about a broken leg? What you wake up one day and feel a lump on one of your nuts? What if you have a kid born with a handicap? is your view "well, tough shit - i took a gamble and lost, now I have to just die early, or go into debt for the rest of my life"? Or.... would you go run to Medicaid?"

Broken legs are cheap. Even if I had to pay it on credit, the monthly payments even with interest would beat the insurance costs. As for cancer, again, young and healthy, and honestly the likely hood was just too small to worry about. Same with diabetes. As far as the kid, I wasn't trying or planning on having any at the time so what did it matter? But yes, sometimes you think, "tough shit, I gambled and lost" and get on with your life.

But as I said earlier, had some useful form of catastrophic insurance (you know, real insurance, not health care) been available, I would have considered such an option, but it's not, largely due to government interference.

6/7/2009 10:31:16 PM

^^ you mean, except for the part where the article says
"All Americans would have access to “essential health care benefits,” with no annual or lifetime limits"?

[Edited on June 7, 2009 at 10:32 PM. Reason : .]

6/7/2009 10:31:46 PM

Quote :

"Yet so many things in our life don't suffer the same problems, including things that are even more necessary than health insurance (like food)."

it's ironic that you picked an industry that is being completely fucking destroyed by big business conglomeration (and stupid gov't subsidies)

Quote :

"But yes, sometimes you think, "tough shit, I gambled and lost" and get on with your life."

yeah, that is, if you still have a life. i.e. you're not dead, or you're not in bankruptcy with your wages being garnished for the rest of your life

6/7/2009 10:35:36 PM

^ That's another thing that concerns me about these things, and I've yet to get a satisfactory answer. Assume for a moment that such a plan really does exist. Any american, regardless of ability to pay, no limits what so ever... how long should Teri Schiavo been allowed to live?

If I'm dead, there's no real point in worrying about whether I could have afforded my medical bills or not. As for eternal bankruptcy with wage garnishment, so I would essentially be on the same plan being proposed right? Eternal payments for services without a choice in the matter? At least in that instance I would have received a benefit from those services.

[Edited on June 7, 2009 at 10:38 PM. Reason : dslfj]

6/7/2009 10:36:36 PM

Quote :

"Yet so many things in our life don't suffer the same problems, including things that are even more necessary than health insurance (like food)"

Oh, that makes sense, especially when you consider how simple growing and delivering food is compared to providing insurance. I think this recent Wall Street blow up and all the others like it goes to show what happens when the information is asymmetrical. Who exists outside of the businessman to insure that this doesn't happen? The government. You can claim all day that you don't have to do business with anyone, but once the powers have wrested all control of the market and shut out any potential new comers because the initial capital required to start is insurmountable or they've secured legislation doing the same, there is no hope.

You keep railing on and on about the government, when the reality is its the sheeple. I mean look at you, you spend gobs and gobs of time on your soap boxes in these threads and I've never once seen you mention any sort of advocacy or grass roots type of stuff you're involved in. Maybe you are, but you've never mentioned it. I don't like government inefficiency, but I certainly like the fact that they can make laws and protect us if we motivate them to do it. Good luck getting cartels to do that.

Quote :

"how long should Teri Schiavo been allowed to live?"

Once she had been declared brain dead then the family should have been given some time (days, weeks?) to say their lasts and the plug should be pulled. The same thing would happen under the new plan as the old, with a court hearing evidence to decide if she was really brain dead.

[Edited on June 7, 2009 at 10:45 PM. Reason : .]

6/7/2009 10:42:36 PM

fwiw, this is similar to the Massachusetts plan, which apparently some people have been able to opt out of...I think. I'm not sure. There was a story on NPR about this where some people could possibly get a waiver or something.

I was never a fan of mandatory coverage. I'd rather have a 2-tier system with a basic level of coverage to reduce out of pocket expenses and self-purchased insurance for the rest of the costs, be it costs for a more expensive plan or catastrophe insurance or something like that (or money from an emergency fund for the poor). It's close to what they have in parts of continental Europe. I know it's what they have in Holland, and even the WSJ said it was sensible at one point.

6/7/2009 10:46:00 PM

Quote :

"Oh, that makes sense, especially when you consider how simple growing and delivering food is compared to providing insurance."

No other insurance is even close to as expensive or meddling filled as healthcare, and it shows. Insurance isn't complicated, it's a transfer of risk. Complying with ridiculous government interventions which restrict competition for services and goods is what is complicated.

Why is it I can get surgery performed on both of my eyes for less than $2500, but 15 minutes with a doctor at the ER for abdominal pains is $4000? Both doctors are full medical doctors who went through the same requirements any other doctor must, but surgery + doctor time + follow up visits is significantly cheaper at one than doctor time + blood work at another. Why? Because one isn't covered by "health care", can you guess which one? Why is it that a visit with my vet is $50 but a visit with my PCP (if it wasn't covered by my insurance) is $150? Same reason, because my vet has to compete on price, my PCP doesn't.

Quote :

"Who exists outside of the businessman to insure that this doesn't happen? The government. You can claim all day that you don't have to do business with anyone, but once the powers have wrested all control of the market and shut out any potential new comers because the initial capital required to start is insurmountable or they've secured legislation doing the same, there is no hope."

And a significant part of why the system exists as is, is due to government interference. Insurance is one of the only things that you can no by law purchase from any provider except those in your own state and that you can't effectively shop around for because tax law punishes you and your employer for doing so. Why then, when the problem (as you readily admit) is a significant lack of competition and choice and legislation eliminating the same, would we even dream about encouraging the government to get further involved and thus add more complexity and more competition restricting and eliminating legislation while at the same time directly competing with existing companies and ensuring that competition will be further eroded?

If the problem is lack of choice, how is removing more choices solving the problem?

Quote :

" I mean look at you, you spend gobs and gobs of time on your soap boxes in these threads and I've never once seen you mention any sort of advocacy or grass roots type of stuff you're involved in. Maybe you are, but you've never mentioned it. "

I contact my representatives and make my views known, but that is about the extent of it. I have a significant distrust of any group claiming to represent the views or opinions of a larger group of people. NRA, Italian American Human Relations groups, the Libertarian party, I don't trust any of them. My life is my own to look out for and no one else's. If they happen to be on the side I'm on, writing letter to the same effect or demonstrating and protesting (another activity I'm not fond of) then more power to them, but I don't like to entangle myself in any organized systems like that.

Quote :

"I don't like government inefficiency, but I certainly like the fact that they can make laws and protect us if we motivate them to do it. Good luck getting cartels to do that."

The trick is, I know what motivates a business. Politicians on the other hand, are slippery creatures. The devil you know and all that.

Quote :

"Once she had been declared brain dead then the family should have been given some time (days, weeks?) to say their lasts and the plug should be pulled. The same thing would happen under the new plan as the old, with a court hearing evidence to decide if she was really brain dead. "

What happened to no limits?

6/7/2009 11:07:53 PM

I didn't read this thread past skimming the first post...

but I think that we are trying to solve the wrong problem. We don't need to figure out how to make health insurance more affordable. We need to figure out how to make medical care more affordable.

6/7/2009 11:40:50 PM

^Duke's right

Quote :

"is your view "well, tough shit - i took a gamble and lost, now I have to just die early, or go into debt for the rest of my life"? Or.... would you go run to Medicaid?"

He'd be crying to the gov't that he needs help with his medical payments and be the biggest supporter of universal health care; since now he has direct incentive to be a mooch off the system.

6/7/2009 11:51:05 PM

Quote :

"I think that we are trying to solve the wrong problem. We don't need to figure out how to make health insurance more affordable. We need to figure out how to make medical care more affordable."

I had to do a double-take, but I agree with this statement.

We have to address the costs of medical care instead of worrying so much about how to "keep insurance companies honest". Insurance company profit margins alone don't begin to explain the skyrocketing costs of our complex health-care system.

6/8/2009 12:21:16 AM

I'm hesitant to say "tort reform" because it usually just ends up being an excuse to go after the trial lawyers, while limiting the right of patients who truly do end up screwed to sue.

6/8/2009 12:41:58 AM

Quote :

"but 15 minutes with a doctor at the ER for abdominal pains is $4000?"

Where did this come from?

6/8/2009 7:35:18 AM

Quote :

"He'd be crying to the gov't that he needs help with his medical payments and be the biggest supporter of universal health care; since now he has direct incentive to be a mooch off the system."

Because of course, everything I've said up to this point, including my continued emphasis on not only the availability of private charity for such events, clearly indicates that my first instinct will be to run to the government and throw all of my principles out the window. If it makes you feel like you're on the right side of this argument to pretend that I would turn colors given the right set of circumstances, then go right ahead and pretend, I'm not in the business of curing delusions.

Quote :

"We have to address the costs of medical care instead of worrying so much about how to "keep insurance companies honest". Insurance company profit margins alone don't begin to explain the skyrocketing costs of our complex health-care system."

Well, it is a part of it. Lack of competition means that existing companies can pretty much get away with raping you out the ass and your options are which scent of lube you prefer. For now you still have the option to not play their game, but it appears that is quickly becoming an option the government wants to take away. Other factors include as PinkandBlack points out, a need for some tort reform. There is also the proliferation of "health care" as opposed to "health insurance". Again, I reiterate that the cost of getting surgery done on your eyes has continued to go down over the years, despite advances in the technology used, while the cost of a broken arm has risen along with the rest of health care (http://www.washingtonpost.com/wp-dyn/content/graphic/2006/04/07/GR2006040700882.html). Again, the reason for this is in part because surgery on your eyes is not covered by hardly any insurance and therefore must be cost competitive and people shop around, where as no one shops around for a hospital (even though you do have a choice, even if an ambulance comes for you). Hell, even something as simple as a $250 / $500 per incident deductible similar to your car insurance would help substantially approve things as those first few dollars of health care must now compete on price.

Quote :

"Where did this come from?"

My own visit to the ER last year. 15 minutes with a doctor and a student doctor (yes, they bill you for seeing a student doctor), blood work and an EKG. Incidentally, they billed my insurance company more than they would have billed me if I didn't have insurance. I received more actual medical care / advice on the ambulance ride over than I did in the ER, and the ambulance was only a mere $600



[Edited on June 8, 2009 at 8:00 AM. Reason : asdf]

6/8/2009 7:54:26 AM

I'll support your right to not have health insurance as soon as the hospitals regain their right to turn any uninsured bean eater, country
bumpkin idiot, or welfare queen right out the door for anything beyond an imminent life threatening emergency; unless of course they got Ca$h in hand.

This way everyone else who visit the hospital gets lower bills. Also, the next time I visit the ER with blood rushing out of my head I do not sit in the lobby for 1 hour waiting for some dude with heart burn who went to the ER b.c he does not have insurance or the senorita who brings her 10 kids b.c they have a sniffle.

Quote :

"student doctor"

student doctor??

lol u mean an intern or resident?

[Edited on June 8, 2009 at 8:50 AM. Reason : a]

6/8/2009 8:44:58 AM

Quote :

"Lastly, I know that we like to pretend here that people come to our houses and hold guns to our heads and make us buy things, but you really do have the power to vote with your wallet."

Choosing not to have health insurance is effectively putting the gun to taxpayers heads. If you need medical services that you can't pay for, you still expect to receive medical services. This is the root of the problem. There are too solutions: require everyone to have insurance or deny healthcare to those without insurance. The second option is inhumane. That leaves one option, get over it. If you don't like it, you still have a choice: move to another country or commit suicide.

6/8/2009 11:24:09 AM

Not true. We have had hospitals longer than they have been required to provide free care to all. What people did back then was the pay hospital would refuse care, so instead of going to a hospital that will not treat you people made their way to a charity run clinic. However, I realize this is not possible today, because federal and state regulations have made it nearly impossible to operate a free clinic, which are today required to satisfy all the requirements of a pay hospital, including licensed and insured staffing. But that's fine, they passed a law turning all pay hospitals into free hospitals, therefore satisfying the demands of the AMA which was sick of competing against retired doctors in free clinics and the lawyers which were sick of not being able to sue.

6/8/2009 11:59:17 AM

My statement still stands LoneSnark

Quote :

"I'll support your right to not have health insurance as soon as the hospitals regain their right to turn any uninsured bean eater, country bumpkin idiot, or welfare queen right out the door for anything beyond an imminent life threatening emergency; unless of course they got Ca$h in hand. This way everyone else who visit the hospital gets lower bills. Also, the next time I visit the ER with blood rushing out of my head I do not sit in the lobby for 1 hour waiting for some dude with heart burn who went to the ER b.c he does not have insurance or the senorita who brings her 10 kids b.c they have a sniffle. "

6/8/2009 12:03:39 PM

Quote :

"Also, the next time I visit the ER with blood rushing out of my head I do not sit in the lobby for 1 hour waiting for some dude with heart burn who went to the ER b.c he does not have insurance or the senorita who brings her 10 kids b.c they have a sniffle."

This happened to you?

6/8/2009 12:05:32 PM

Quote :

"but I think that we are trying to solve the wrong problem. We don't need to figure out how to make health insurance more affordable. We need to figure out how to make medical care more affordable."

I've been saying this for a while, now. But no one in DC wants to address that issue, because the solution to it is obviously less gov't.

6/8/2009 6:15:18 PM

Obama said to be open to taxing health benefits

Quote :

"WASHINGTON — President Barack Obama is leaving the door open to taxing health care benefits, something he campaigned hard against while running for president, according to senators who met with him Tuesday. Senate Finance Committee Chairman Max Baucus, D-Mont., raised the issue with Obama during a private meeting with the president and other Democratic senators and later reported the president's position: 'It's on the table. It's an option.' The White House said later that Obama did not want to go that route."

http://www.wral.com/news/political/story/5265810/

6/8/2009 6:21:51 PM

^ I'm 100% against this.

Nonetheless I do not expect to agree with everything a president, that i voted for, does while in office. If this is the policy that I can most resent Obama for in 20 years than i can live with myself for not voting McPalin.



[Edited on June 8, 2009 at 6:24 PM. Reason : l]

6/8/2009 6:24:05 PM

6/8/2009 6:24:18 PM

The proposals to come up with the estimated $125 Billion per year needed for Obama's health care expansion include:

1. Pigovian Taxes, including taxes on sweetened beverages, and higher taxes on alcohol.

2. Taxing employee Health Care benefits over a certain amount, maybe $11,000.

3. Raising taxes on the rich by limiting how much they can deduct.


None of these 3 options are particularly palatable. Obama is lobbying for #3, since he promised not to raise taxes on the middle class and that is exactly what a tax on employee benefits would amount to.

6/8/2009 6:57:45 PM

why not....

4.) Increase taxes on the 2nd and 3rd quintiles are will be the main beneficiaries of said health care plan yet play little in federal taxes.

As many of the plans participants probably could afford healthcare insurance on their own (if their employer does not provide it) but choose not to b.c they instead choose to have Tine Warner Cable with the premium package to go with their 60" TV payment, lease a new Ford Mustang, and drink enough alcohol every week to drown John Belushi.

I just fail to understand how the working poor and to a point the working class have managed to work themselves into barely paying any taxes yet still pull out their pockets asking for more in return in gov't services. I always saw social security as "retirement insurance" of you are not responsible enough to save so we will take 6.5% out for you that you can get later. With a $90,000 ceiling since those earning more than this will probably have no need for social security at 65.

Why can't UHC be the same if it has become unavoidable system at this point. Everyone pays a flat X% with a ceiling of $90,000 since everyone earning half that and up likely will have employer provided insurance to begin.

I also do not like the bill freezing doctor payouts to some arbitrary number such as the "medicaid +10%"

Quote :

"Any group health plan or insurance company that provided coverage for children and their parents would have to offer to continue “dependent coverage” for the children through age 26. In effect, young adults could stay on their parents’ policies."

This I DO SUPPORT. I know a few situations where people i've known have gotten punched in the gut but unexpected medical experiences in the "purgatory" period of graduation and getting their new job. Since parents employers only offer one pick its not the "ZOMG FREE MARKETS IF THEY DON'T LIKE GO ELSEWHERE"; this just equals sorry son tough shit.

Quote :

"on the rich by limiting "

What is rich? Income, capital gains, estate? Would this be regionally adjusted. The only thing fair remotely is a flat "healthcare" tax. Incorporating this into the progressive tax system is straight up repressive in my opinion. People have the freedom to eat McD's everyday, smoke a carton of cigarettes, and never leave the trailor home to exercise once they get back from their job of being the receptionist at Jiffy Lube. This does not mean that they should get a "free pass" from contributing to their healthcare which instead goes to the hard work of America's innovative and professionals.

[Edited on June 8, 2009 at 7:32 PM. Reason : l]

6/8/2009 7:22:23 PM

The thing that scares me the most about this socialized health insurance BS is that all the politicians are talking about is the cost of the insurance itself. But I haven't seen anyone mention how they plan to increase the nation's medical infrastructure to handle all of these newly insured people (I believe currently something like 20% of the nation is uninsured). We have shortages of doctors and nurses as it is. And once the government is running everything they're likely to start putting in price caps which will make being a medical professional even less appealing.

I think if this thing goes through we're just going to end up with two systems. One public system that everyone pays into but no one in the top 30% of earners bothers to use b/c of the massive waiting lists and substandard care. Then there will be a private system where the people who can afford it get the good health care. Which will lead to more cries for taxing the rich b/c they don't deserve all the good stuff to themselves and poor people should be able to afford good healthcare too .

6/9/2009 1:06:02 PM

^ Or it might be like it is in Britain. Probably not, because Americans are fat, stupid, and lazy, but mayhaps.

I've heard some doctors say they'd rather get paid through UHC than not get paid at all, which is what happens when people go bankrupt trying to pay for medical expenses, but these doctors seem to be in the minority. /anecdotal

Besides, the real money is in plastic surgery. Holy crap, those dudes make a lot of dough.

6/9/2009 1:28:06 PM

Again, can someone tell me where this bill tells the currently uninsured 20% how to get insured?

It requires people who make a lot to subsidize health insurance for those not earning as much. That's only a redistribution of wealth between those who already have health insurance. And requiring a tax penalty for those who don't get health insurance is only valid for those who have jobs. Unless, of course, the government will require those who make no money to pay a regular premium to not have health insurance. And if someone takes the tax penalty for not being insured, they're still not @!(#*%^ insured!

That's utter nonsense. It makes no sense. And where does the bill say how someone in between jobs or someone who just finished school will get insured? What if their parents aren't insured or they're over 26? This whole thing is nonsense! If you asked me to intentionally write legislation for the specific purpose of screwing over the nation, I couldn't do any better than what they did here. And what about the discussion of small businesses and self-employed people? Are we still ok with them just not being covered?

Maybe this could reduce the uninsured from 20% to say... 17%. While at the same time only completely destroying our entire system.

6/9/2009 1:28:26 PM

Quote :

"I'll support your right to not have health insurance as soon as the hospitals regain their right to turn any uninsured bean eater, country bumpkin idiot, or welfare queen right out the door for anything beyond an imminent life threatening emergency; unless of course they got Ca$h in hand. This way everyone else who visit the hospital gets lower bills. Also, the next time I visit the ER with blood rushing out of my head I do not sit in the lobby for 1 hour waiting for some dude with heart burn who went to the ER b.c he does not have insurance or the senorita who brings her 10 kids b.c they have a sniffle."

I am all for such a reform, but I fail to see why that should have any impact on whether someone should be able to choose to have or not have insurance. The failure of one subset of society to behave is not justification to disallow another subset their freedoms.

Quote :

"student doctor?? lol u mean an intern or resident? "

I assume it was a resident but it was billed as "Student Doctor" so I couldn't say for sure.

Quote :

"If you need medical services that you can't pay for, you still expect to receive medical services. This is the root of the problem. There are too solutions: require everyone to have insurance or deny healthcare to those without insurance. The second option is inhumane. That leaves one option, get over it."

Yes, the problem is people expect to be able to receive goods and services from others without being able to compensate them. But there is nothing inhumane about denying non critical services to people who can't afford to pay for them in some way or fashion. What would be inhumane is denying services to people who can't pay for them, and simultaneously denying people with the capability to provide such services the ability to do so at no or reduced costs. Besides, being humane is not within the domain of the government. It is up to society to be humane. The distinction between legal and moral and illegal and immoral should always be kept in mind.

It's also worth noting that even under such a system with magical free money from the government for all, there would still be a denial of services for people who couldn't afford them. It would come in the form of resource shortages and just simple economics. I assure you that even under ObamaCare you will still have bean counters and bureaucrats using their spreadsheets to decide whether your chances of survival for a given procedure is worth the pay out for it.

Quote :

"If you don't like it, you still have a choice: move to another country or commit suicide."

I have a third choice which is to continue to petition for a change that isn't included in your false dichotomy.

Quote :

"If this is the policy that I can most resent Obama for in 20 years than i can live with myself for not voting McPalin."

No one here has suggested you should have voted for McCain, or that the result would turn out different. However, it does pose the question: If in just a few short months, the reality of actually trying to use the government to bludgeon a new healthcare system in to place has Obama reconsidering taxing health benefits, how many other great and magical promises (NO LIMITS!!!!!) will we find falling to the realities of life?

As I said, the system needs fixing, but government control is not the fix we need.

Quote :

"This I DO SUPPORT. I know a few situations where people i've known have gotten punched in the gut but unexpected medical experiences in the "purgatory" period of graduation and getting their new job. Since parents employers only offer one pick its not the "ZOMG FREE MARKETS IF THEY DON'T LIKE GO ELSEWHERE"; this just equals sorry son tough shit. "

This is where temporary and catastrophic insurance should come in. Temporary already exists (and actually, is a lot like what catastrophic should be) and is relatively cheap (150/month when I last used it). Mommy and daddy can pick up the tab if need be, but the insurance companies should not be forced to insure a legal adult and non dependent under the provisions of insurance for children.

Quote :

"People have the freedom to eat McD's everyday, smoke a carton of cigarettes, and never leave the trailor home to exercise once they get back from their job of being the receptionist at Jiffy Lube. This does not mean that they should get a "free pass" from contributing to their healthcare which instead goes to the hard work of America's innovative and professionals."

And this is the worst part of a government paid health system, because you are absolutely right, you shouldn't be able to fuck up your life and expect someone else to pick up the tab. Unfortunately, instead of this meaning that you will be forced to pick up the tab, our politicians will implement policies (for the children of course) which will erode at your rights and freedoms to live life as you see fit. It will start with easy things, like smoking (they're working on it), drugs (they've pretty much got that covered), transfats (next on the chopping block) and sodas and such (they are already talking seriously about taxing these). And of course they will claim its for the better good and such and designed to save you money but one way or another it will just be more things which will actually raise the over all costs you pay.

Quote :

"Maybe this could reduce the uninsured from 20% to say... 17%. While at the same time only completely destroying our entire system."

And the worst part is, we could probably accomplish the same thing by refining our existing services and getting people who are currently eligible to actually enroll. I've seen some numbers that suggest (if I can find them again I'll post them) that a good 10-20% of those uninsured are eligible for existing government programs, they just don't know it, or haven't enrolled.

[Edited on June 9, 2009 at 2:09 PM. Reason : asdf]

6/9/2009 2:06:09 PM

if this becomes a reality i'll be worried

6/9/2009 2:33:02 PM

Quote :

"And the worst part is, we could probably accomplish the same thing by refining our existing services and getting people who are currently eligible to actually enroll. I've seen some numbers that suggest (if I can find them again I'll post them) that a good 10-20% of those uninsured are eligible for existing government programs, they just don't know it, or haven't enrolled."

It sounds like a big part of the current proposal is that it is entirely opt-in. How are people going to know that they need to get health insurance of they're going to pay for it on their taxes anyway? There are ogles people out there who would never do taxes if they never got a nasty letter from the IRS after they missed the filing date!

And don't for a second tell me that businesses will be on top of their game. Small business are going to have the bills due for this kind of thing and be like "wait... what? we were supposed to do something?".

But with all of this junk in the bill it seems to make it less likely that you'll ever be able to show up to a hospital front desk and get to see a doctor when something BAD happens. "Oh, didn't you know we have a government program you could have registered for LAST MONTH that would have allowed you to get treated now?"

6/9/2009 2:43:31 PM

What I don't understand, regarding the competitive nature of private insurance companies to keep prices low, is how this would lower health care costs more than a government provider.

A business will not necessarily charge for goods and services at a minimum profit margin. I would think that it would charge the highest price that it could, so long as the consumption of its product does not decline.

If that business must lower its prices to reflect more closely those of a competitor, that competitor would still be charging the highest cost that it could, so long as it maintains maximized profit.

Right? or am I missing something?

6/12/2009 5:56:43 PM

Efficiency. Over all, health insurance of any type raises the costs of health care. This is because there are costs associated with billing insurance, tracking claims, processing claims and of course profit for both the insurance company and the doctor. A government program adds even more inefficiencies into the system. In addition to the costs above, there are now costs to tax you, process the tax receipts, distribute the funds to insurance companies and subsidize users who can not or do not pay their full share of the costs. In addition, now there must be tracking for multiple avenues of fraud, fraudulent billing by doctors, fraudulent billing by the insurance companies, fraudulent claims and internal fraud at the doctors, the insurance companies and at every level of the government that is involved (state and federal). In addition, the purpose of the government program will be to be all things to everyone, which by its very nature will mean that many people are paying for services and programs they neither need, nor use. Also,the very nature of the government being involved means there must and will be considerably more programs associated with the basic package, programs that either private companies would not or could not institute. For example, where as a private insurance company would love to be able to dictate every thing you can and can't eat, the best they can do is raise your rates, running the risk of losing you to another competitor. By comparison, not only can the government raise your rates and you can't do anything about it (taxes) they can also use the full force of law to actually prevent you from exercising your rights to personal liberty and the consequences thereof. So while BCBS might send you fliers in the mail about not eating that 4th Big Mac, the government can actually send police to make sure you don't. And if you don't believe that it could happen, you need only look as far as anti smoking legislation to see that it already has.

6/12/2009 6:50:11 PM

David Rose, a Professor of Economics at the University of Missouri-St. Louis, frames the problem well:

Quote :

"Health care reform: The real problem is lack of competition BY David C. Rose 06/11/2009 The Obama Administration and congressional Democrats are moving full-speed ahead on health care reform. The Republican minorities in the House and Senate are acquiescent. Has the tide turned in favor of nationalized health care because of an emerging consensus that something must be done? Is the current proposal a good thing? The answer to the first question appears to be yes, but the answer to the second question is no. Let's not quibble about the current state of health care. There is justifiable angst about the uninsured because even though most Americans end up getting health care when they need it, the current approach produces incredible anxiety and is ridiculously inefficient. There is also dissatisfaction with the quality of health care, particularly the increasingly shabby way insurance companies treat patients. But let's not quibble either about the long-term effects that Obama's plan will have on American health insurance, which will be ultimately to push nearly all Americans into government-provided health insurance. Instead, let's ponder whether such a move is a good thing. A fundamentally important factor to consider before we start making changes is competition. The problem with American health care is not excessive competition; it is insufficient competition. The reason for rising frustration with insurance companies is that patients can't do what patrons they do when they receive poor service at a restaurant, which is to go elsewhere. Most health insurance is tied to employment, so most patients are stuck with their insurance company. And it shows. The solution is not less competition, but that is the assumption behind the Obama administration's plan and what it will produce. The solution is more competition. Other insurance markets are very competitive, so why is the health insurance market so uncompetitive? The answer is that during World War II a tax break was extended to non-wage benefits such as health insurance premiums paid by employers. Over time, this effectively tied most American health insurance to employment. This forces patients to fire their employer before they can fire their insurance company. It is small wonder why we get such poor treatment from insurance companies. The key to returning true competition to health care is to make it possible for individuals to fire their insurance company, which requires eliminating the tax break on employer-provided health insurance by extending it to privately purchased policies. Part of the reason why Medicare is a good deal is that the government can drive a hard bargain with health care providers in the form of artificially low reimbursement rates. In a competitive market of many insurers, however, if a single insurance company tried to drive a hard bargain with a health care provider, it would find itself laughed out of the room. Artificially lower reimbursement rates don't cover the full cost of procedures, so health care providers shift costs to everyone else. In other words, the relative lack of competition in today's market leads to higher insurance costs for people who aren't old enough to qualify for Medicare. Extending Medicare-like insurance to everyone is a fallacy of composition: What works for some cannot work for all as a matter of logic. In a competitive market, however, driving such hard bargains is impossible, so relative prices reflect actual relative costs. The kind of plan the Obama administration envisions gives us the worst of both worlds. Its artificially low premiums will drive most private insurance out of business. Once there are no private insurers left, there will be no place left to shift costs. In a very short time, then, we'll have no reduction in cost due to cost shifting, and we'll have substantially less competition. The absence of competition will result in higher actual costs. This has been the experience in countries with nationalized health care, which is why many have an even worse entitlement problem looming than the United States. The better solution is to eliminate the preferential tax treatment of employer-provided insurance. That also, indirectly, would reduce the scale of the other major problem in American health care: covering the uninsured. Now it is very difficult to purchase insurance if you are not employed or if you work for a very small employer. Once insurance migrates out of large employer pools, sufficiently large pools will become possible with individualized insurance. Customers then would be able to vote with their feet if they are unsatisfied, and those who don't work for large employers no longer would have to pay higher premiums than everyone else. There still would be some uninsured people. But that could be handled directly through insurance vouchers. A comprehensive voucher program would eliminate even further distortions and that would produce significant reductions in costs, not just shift costs. Indeed, we already have such a program for something that is even more important than health care. With all its faults, food stamps have essentially eliminated the problem of hunger in America. Food stamps are vouchers that solve the problem in question directly while preserving competition. Small wonder they work so well. David C. Rose is a Professor of Economics at the University of Missouri-St. Louis."

http://www.stltoday.com/stltoday/news/stories.nsf/editorialcommentary/story/6150D842268AC879862575D1008041C4?OpenDocument

6/13/2009 4:49:50 PM

I would rather there be better and nicer free clinics than have universal health care. Paying over 100 bucks for a check up when you dont have health insurance is a dooozzzyyyyyy. Shit paying 25 bucks with insurance is sometimes sucky.

however in a perfect world general practice doctor offices would be looked upon in the same way as police and fire stations. A place that all tax payers contribute to and then provided if and when needed.

[Edited on June 13, 2009 at 6:05 PM. Reason : my perfect world]

6/13/2009 6:02:31 PM