Health Care Politics

Originally posted by Purplehawk

I'm confused. Why is it so important that I state an opinion? I will do so when I'm ready.

Which is fine, Purp, but I find it highly unfair that conservatives on this board have been accused numerous times for not having their facts straight, or being premature, or legislation being deliberately taken out of context and that's when they aren't being accused of blind partisanship or dirty politics. I feel like if one wants to wait for the final version before making any concrete conclusions, that is fine, but why not just state that what is currently in the works would be unacceptable or at the very least needs to be tweeked? Liberals aren't being disloyal to their party by making sure that their legislators know that they would prefer certain aspects are changed.

I'm sorry if it seems like I am singling you out. I try very hard not to truncate posts or pick and choose what I respond to, because I believe that would be unfair (Sometimes posts are so long that I can't do this effectively). I believe I responded to each part of your post. The townhall meetings are being debated in another thread, and I believe any posting about them here should reflect how people can connect to their legislators without falling into partisan divides. Unfortunately I feel that your posting really put people on the defensive and deflects from debating the policy as it exists. Since townhalls are only one way to to let our legislators know the will of the people I don't feel that attempts to focus solely on them validate your claims that they bar effective communication between legislators and their consituents.

The tea partiers, Birthers, and LaRouchies appearing at these townhalls are NOT there to engage in democratic debate. Their instructions are to intimidate, to disrupt the message in as obnoxious a manner as possible and to prevent the representative and his or her constituents from engaging in any meaningful dialogue. And that's exactly what is happening. This is an organized effort to shut down the townhalls, not to engage lawmakers in a two-way dialogue about health care.

The tea partiers, Birthers, and LaRouchies appearing at these townhalls are NOT there to engage in democratic debate. Their instructions are to intimidate, to disrupt the message in as obnoxious a manner as possible and to prevent the representative and his or her constituents from engaging in any meaningful dialogue. And that's exactly what is happening. This is an organized effort to shut down the townhalls, not to engage lawmakers in a two-way dialogue about health care.

Please provide proof for this statement, thank you.

Oh dear god please tell me that this isn't being discussed in reference to actual legislation. Alternative medicine is untested, often based on superstitions and also totally irresponsible for anything other than perking people up who might be 'a bit down' or something similar. Whilst nobody denies the psychological effect of these remedies, they are pretty much always based on pseudo-science, total lies and misinformation.

I actually agree with you and would not chose this myself. But, just because I don't agree with someone doesn't mean I wish to force them to do it my way, that's all.

And, no--as far as I know, this has not been part of the legislation. On behalf of a couple alternative-friends, it would be nice to see them be able to opt out and leave them to their own fortunes.

This being said, if they end up in an ER--they need to either pick up that tab or be opted back in (perhaps with a penalty at that point).

Those are just things I've mulled over and the question had been put out there as to things I personally would like to see/not see. Frankly, don't think it's going to happen so it's probably all academic.

Well, I can tell you that I am very much in favor of a public plan. I think this will be a key to competitiveness and bringing down premium prices...at least one of the keys.

I think bringing down the cost of health care is vital, and that if we can bring down the cost of health care then the cost of insurance premiums will come down as well.

Most states already mandate what are called medical loss ratios - which means they require that insurance companies operating in the state must spend a set portion of the premiums they receive in medical procedures as opposed to administrative costs. NJ, I believe, has a 75% medical loss ratio, which means that an insurance company operating in NJ must spend at least 75% of the money it receives as premiums on health care. If it spend more, say 80%, it can consider raising premiums, if it spends less then it has to give the money back to it's members as a rebate.

But the problem is that simply mandating that insurance companies spend a fixed minimum percentage of the premiums they receive on health care does nothing to reduce the cost of health care. It encourages the insurance company to operate as efficiently and effectively as possible, but has no effect on the actual cost of providing health care.

Bringing down health care costs means understanding why health care costs so much, and there are lots of factors at play there. Malpractice insurance, government intrusion, unhealthy high risk lifestyles, lack of price controls on prescription drugs, expensive new technologies, over proscribed unnecessary tests and procedures - all play a role in causing health care costs to rise.

But how do you fix that? Ensuring that every American has a health insurance plan doesn't address any of those causes. So how do you fix it?

Tort reform? Not part of the plan

Less government intrusion? That's gonna increase.

Price controls for prescription drugs? Not part of the plan, thankfully (in my opinion).

Sin taxes? What "sins" should we tax - smoking, obesity, multiple sex partners, skydiving, etc, and how do we tax them? {also not part of the plan, but certainly being discussed}

Reduce access to technology to only proven technologies? That's in the bill, but I'm not so sure it's a good thing as many unproven technologies are highly effective (for example Methotrexate is a cancer drug which is frequently proscribed to help control inflammation associated with Rheumatiod Arthritis - not a proven technology but a side effect noted by cancer patients with RA which has now become a norm in treating RA). That also leaves open the question of how you "prove" that a technology is effective. I seem to recall a book (and movie) about an insurance company denying a patient access to what they considered an unproven technology that might have saved the patient's life.

That leaves figuring out how to get Doctors to proscribe fewer unnecessary tests and procedures. But how do you know if a test is unnecessary or not? Certainly a patient is in no position to debate whether they need angioplasty or not.

Develop best practices? Unfortunately, in most circumstances, they've already been established and are generally recognized by the medical community. Mandate best practices? That takes away the physician's judgment and expertise and the patients wants and needs. {FYI - best practices are included in the bill and are voluntary}

Provide cash rewards for medical facilities or practices that proscribe the fewest additional tests and procedures? That's part of the bill under Title I Improving Health Care Value, in the Sections on controlling Medicare costs ( Section 1123 (http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111KNwnai:e283426:) to be exact)

As far as I can tell, with the exception of the cash payouts for proscribing the fewest tests and procedures for Medicare providers, there's nothing in the bill which will bring the cost of medical care down. So premiums will continue to rise and be increasingly less affordable.

*** edit **
Sorry - I was researching as I was typing and then other posts popped up because I was researching and typing so slowly.

And, no--as far as I know, this has not been part of the legislation. On behalf of a couple alternative-friends, it would be nice to see them be able to opt out and leave them to their own fortunes.

I haven't seen anything about alternative therapies in the bill. Some insurance companies do cover alternative therapies for specific conditions (acupuncture is covered under my plan for something or other).

Opting out, as far as I can tell, is permitted but comes with a 2.5% income tax. So, you can opt out but you gotta pay to opt out.

Please provide proof for this statement, thank you.

Here you go. I have posted this link several times already, as has Redheart.

Right-Wing Harassment Strategy Against Dems Detailed In Memo: ‘Yell,’ ‘Stand Up And Shout Out,’ ‘Rattle Him’ (http://thinkprogress.org/2009/07/31/recess-harassment-memo/)

Specifically the memo, which I have seen in use in a townhall meeting, calls for actions like these:

– Artificially Inflate Your Numbers: “Spread out in the hall and try to be in the front half. The objective is to put the Rep on the defensive with your questions and follow-up. The Rep should be made to feel that a majority, and if not, a significant portion of at least the audience, opposes the socialist agenda of Washington.”

– Be Disruptive Early And Often: “You need to rock-the-boat early in the Rep’s presentation, Watch for an opportunity to yell out and challenge the Rep’s statements early.”

– Try To “Rattle Him,” Not Have An Intelligent Debate: “The goal is to rattle him, get him off his prepared script and agenda. If he says something outrageous, stand up and shout out and sit right back down. Look for these opportunities before he even takes questions.”

The full 10-page memo can be seen here: Memo Details Co-ordinated Anti-Reform Harrassment Strategy (http://www.talkingpointsmemo.com/documents/2009/08/memo-details-co-ordinated-anti-reform-harrassment-strategy.php?page=1)

Here's a link to a story from the Richmond Times-Dispatch detailing how they are busing these tea partiers and Birthers to and from the townhall sites.

Bus tour set to protest Obama health-care plan (http://www2.timesdispatch.com/rtd/news/state_regional/state_regional_govtpolitics/article/BUSS23_20090722-222402/281595/).

Other links:

HCAN Playbook For Thwarting Town Hall Protesters (http://www.talkingpointsmemo.com/documents/2009/08/hcan-playbook-for-thwarting-town-hall-protesters.php?page=1&ref=fpa)

I'll have to finish this later, Sherlock. Impromptu meeting to deal with.

I believe in the Obama method of confrontation:

"I need you to go out and talk to your friends and talk to your neighbors. I want you to talk to them whether they are independent or whether they are Republican. I want you to argue with them and get in their face," he said.


Then candidate Obama: Source - SF Gate (http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2008/09/17/politics/p185733D40.DTL&type=politics)

So this is the so called "discussion?" If someone opposes the president's plan, then they are a "mob". Hmmm, no dissent needed, I suppose. Just like the stimulus and all the other programs, BHO doesn't need Republicans...why doesn't he just pass it?

But the problem is that simply mandating that insurance companies spend a fixed minimum percentage of the premiums they receive on health care does nothing to reduce the cost of health care. It encourages the insurance company to operate as efficiently and effectively as possible, but has no effect on the actual cost of providing health care.

I feel silly but if they are operating better wouldn't that transfer to the doctor to the patient?


Price controls for prescription drugs? Not part of the plan, thankfully (in my opinion).


Why are you against controls on prescription drugs? I have to wonder why my father can get his prescriptions through the VA for approximately $95 a three months supply (and this cover insulin, cholesterol and high blood pressure among other drugs) yet when he was on private insurance paid upwards of $120 per month. If the VA can do it why can't private companies. I definately think some drug policies should be in this new bill.


Sin taxes? What "sins" should we tax - smoking, obesity, multiple sex partners, skydiving, etc, and how do we tax them? {also not part of the plan, but certainly being discussed}

This is just ridiculous.

That leaves figuring out how to get Doctors to proscribe fewer unnecessary tests and procedures. But how do you know if a test is unnecessary or not? Certainly a patient is in no position to debate whether they need angioplasty or not.

As far as "unnecessary" procedures go you'd have to ask the question of how to reduce such procedures without binding a doctors hands. That's what you're saying correct? So many diseases and ailments have many of the same symptoms it's hard to narrow things down. Perhaps ease of seeking a second or third opinion? Most people don't seek second opinions for fear of denial by their insurance companies. Especially specialist care.

ETA: Gator! :wave: ITA.

I think bringing down the cost of health care is vital, and that if we can bring down the cost of health care then the cost of insurance premiums will come down as well. agreed. We just disagree on how. Progress. :p

Bringing down health care costs means understanding why health care costs so much, and there are lots of factors at play there. Malpractice insurance, government intrusion, unhealthy high risk lifestyles, lack of price controls on prescription drugs, expensive new technologies, over proscribed unnecessary tests and procedures - all play a role in causing health care costs to rise.

Agreed that Malpractice insurance is out of control and adds to cost. I would like to see tort reform. That being said, this may have to come in a second step, but I see no reason that we can't keep asking for it and expressing that wish to our representatives. Nothing is a lost cause just because it's not included now..or set upon the table "now".

Government intrusion? Just kind of plopped that in there as an assumption, don't you think? Or, perhaps we are interpreting "government intrusion" differently again. Just to be clear, I think it's high time the government DOES intrude and set some guidelines and supervision..in fact, years past time.

Unhealthy lifestyles and risks? Always more work can be done here....and I believe there are many ways this can be done with public education and incentives...some of those incentives possibly being incorporated into reforms.

Other reasons listed also make logical sense but it appears you have left a couple large ones out....the Uninsured and the billions in costs that have to be covered through either premiums, government or hospitals and doctors themselves or force them to shut down. Many hospitals have shut down non-mandated ERs because it has become too expensive for them to run...putting more pressure on the mandated ones (who are, themselves, cutting corners and not giving treatment in some cases...to try to survive).

Wow, I wonder how we fix this? Oh, I know--make a public option available at reasonable rates to those who cannot currently afford private insurance. People can then actually go to a *doctor* in an office and get treated for simpler things like ear-aches and the flu, freeing up the higher-cost true emergency care for true emergencies, less waiting and less cost for those same subsidies that would have had to cover the uninsured nonpayment of $1000 to an ER for an ear-ache, but only $50 to a doctor and $10 for medicine.

Wow, that kind of sounds like a good deal for everyone (especially since the uninsured don't usually like ERs and five hour waits, either). We might save a little bit of money here. All that money we are currently paying in subsidies to pay the hospitals for the uninsured's bills can be going to create them an actual plan--so much cheaper, cause it keeps them out of the ER (for the most part, unless it's a true emergency, of course) and so much less a cost! Brilliance!

Less government intrusion? That's gonna increase.
Really? It's going to be any worse than corporate intrusion or complete failure to the client when they dump them and deny ? Your insurance company doesn't approve or deny your doctor's treatments they just say "Hey! have your doctor send us all the bills, we'll pay them. We trust him and you and will pay anything you send us."????

:whistle:

Are you talking about rules and regulations? Let me get out a coin and turn this over...corporations making the rules and regulations or the government (flip!) ....corporations need to make a profit and don't give all access to coverage or can deny coverage of all or part of anything to protect themselves while dumping a 'expensive' sick person on their butts because it hurts their bottom line.

This person then shows up after a year of non treatment with catastrophic health issues and the Government has to bail the ER out of non payment (because the person has already lost their home and business when they showed up three months before, with no other choice, because of denied access to normal health care outside of ER).

Seems to me the government's involved already. I think it's prudent that we at least let the government give this guy their own plan so they can cut their own cost and save tax payer money. It's apparent the Insurance Company meant to off load the "problem children" there anyway.

I'm all for a public plan.
Price controls for prescription drugs? Not part of the plan, thankfully (in my opinion). You like paying more for the same drugs than anyone else in the world? Okay--well, to each their own.

Sin taxes? What "sins" should we tax - smoking, obesity, multiple sex partners, skydiving, etc, and how do we tax them? {also not part of the plan, but certainly being discussed}
[staff edit]...but I believe the proposal [staff edit] was for a "soda" tax. You know, that high-fructose, supercharged bubbly stuff that is rotting kids' teeth and making diabetics out of some (of their own free will, of course--they buy it themselves, true enough). I think the figure was a 3 cent tax per can/bottle. Ow!

You know, the homeless can make more on the recycle rate for cans and bottles than that. I didn't hear that big a stink about paying 3 cents a can for recycling...but if those pennies go to health reform, suddenly it's an horrible burden and a terrible threat to American freedom and liberty (sorry, yes--hyperbole, but I wanted to make the comparison clear).

The rest of that list...well, I see you use hyperbole, too! Very colorful list it is.

At this point, I'm going to beg your pardon and skip on because my stitches are aching and my husband's giving me that eye that says, "shouldn't you be back on the sofa, recovering?"....editing out of any other points here after do not constitute an unwillingness to address them on my part or a forfeit in point on any of them that I may wish to come back to later on....they do constitute a need to get off my computer and go lay down. I do beg your understanding and hope they will be picked up by others and debated for their merits.

I feel silly but if they are operating better wouldn't that transfer to the doctor to the patient?

Not necessarily. The largest health insurance provider in the US had a profit margin of 3.9% in the first 2 quarters of this year. Using the NJ example, that means that the total costs for that company were 96.1% of revenue (75% for member medical care, 21.1% for administrative costs, and 3.9% left over for profit). Unless we mandate that health insurance providers be non-profits, those companies are entitled to make a profit.

http://www.politifact.com/truth-o-meter/statements/2009/jul/23/barack-obama/health-insurance-company-turned-profit-not-rec/

Why are you against controls on prescription drugs? I have to wonder why my father can get his prescriptions through the VA for approximately $95 a three months supply (and this cover insulin, cholesterol and high blood pressure among other drugs) yet when he was on private insurance paid upwards of $120 per month. If the VA can do it why can't private companies. I definately think some drug policies should be in this new bill.

Because price controls result in fewer drugs being available, especially newer, more expensive drugs. There are many new life saving cancer drugs which are not available in countries with price controls because they cost too much to make and the drug manufacturer won't sell them at a loss.

One reason drugs cost so much more in the US than the rest of world is price controls. Drug companies are forced to sell their drugs in some countries at a loss and they recoup those losses by jacking up charges in the US.

This is just ridiculous.

But if we're looking at ways to lower the cost of medical care, and high risk lifestyles lead to increased medical costs, then you have to figure out how to get people to stop living those high risk lifestyles. One suggestion being floated around is a sin tax. Smokers already pay sin taxes for every pack they smoke, but some elected officials have suggested that they might consider taxing obese people to encourage them to life healthier lifestyles or to offset the increased cost of providing them with health coverage.

As far as "unnecessary" procedures go you'd have to ask the question of how to reduce such procedures without binding a doctors hands. That's what you're saying correct? So many diseases and ailments have many of the same symptoms it's hard to narrow things down. Perhaps ease of seeking a second or third opinion? Most people don't seek second opinions for fear of denial by their insurance companies. Especially specialist care.

Absolutely! I have no idea how to do that, but from what I've been reading today, that's one of the keys to reducing costs.

Ditto on the howdy to Gator!!!! We've missed you my friend!

So this is the so called "discussion?" If someone opposes the president's plan, then they are a "mob". Hmmm, no dissent needed, I suppose. Just like the stimulus and all the other programs, BHO doesn't need Republicans...why doesn't he just pass it?

You have never seen or heard an Obama advocate acting like these right-wing protesters are acting, Ray, nor will you ever. I worked on the front lines of his campaign, you might recall, and our version of "getting in someone's face" was nothing at all like what was happening at Sarah Palin's rallies or these health care town halls, for example. There were no occasions upon which Barack Obama had to snatch the mic away.

Again, with all that being said, the Republicans have no sway in this debate, other than to voice their opinions. All BHO has to do is get his own caucus in line and voila, he gets his single payer system.

It amazes me that the focus is on these protests, when the Democrats have so many folks, IN THEIR OWN PARTY, who have stymied the passage of the heretofore unread bill.

Perhaps it makes for good copy to the hyper left partisans to blame tea parties (or whatever obscenity the Rachel Maddow's of the world choose to use), insurance companies and so forth for the drag on the bill, but the numbers don't lie.

Purple, you have 60 Senators and a filibuster proof House, so pass it already, and own it.

OK, enough. I'm seriously sick of the inability by a few of our experienced posters to remain on topic and frankly enough is enough.

If you are a long time member and fail to stay on topic in these threads then from now on you will receive a permanent forum ban. No warnings, no talks you'll just be gone. You've all been here long enough to know I'm not kidding. No more border line comments, you'll just find yourself gone and have no way to come back.

Every time you post you better ask yourself if this is what the thread is for, because if it's not then you might be banned for the post.

You have never seen or heard an Obama advocate acting like these right-wing protesters are acting, Ray, nor will you ever. I worked on the front lines of his campaign, you might recall, and our version of "getting in someone's face" was nothing at all like what was happening at Sarah Palin's rallies or these health care town halls, for example.

Actually that isn't true. I was harrassed by a couple guys in my neighborhood campaigning for Obama and they actually had the nerve to go up to my 6 year old son and start on him. When I went up to intervene and they started talking about Obama and I very politely said I wasn't interested because I didn't plan to vote for him, they freaked out and started calling me ignorant because obviously he was the best choice and telling me all about the evils of McCain. I hadn't even said I was voting for McCain (because I wasn't planning on it, and I didn't). They stood on the sidewalk of my neighborhood and belittled me as I stood there in shock until finally I told them I was going to call the cops.

I later called the campaign headquarters in my city and asked to talk to a supervisor. I then got into a fight with him over the phone because he saw nothing wrong with the guys behavior. So please don't act all high and might and say it is only a Republican thing, because that is just an out and out lie. It's politics, from my seat Democrats and Republicans are equally bad.

To bring this back to Health care. I am in favor of a public option in health care, just not the current bill that is being looked at. The current bill doesn't really seem like it is going to adequately address the issue. I really don't like the idea that private health care is going to be so limited. I feel like there should be a true choice in health care, which I don't see with this bill- at least as of right now.

Threatening phone calls to Representative Brad Miller (D-NC) over the health care bill have escalated into a death threat (http://tpmdc.talkingpointsmemo.com/2009/08/dem-congressmans-office-his-life-has-been-threatened-over-health-care-bill.php?ref=fpblg).

He'll be discussing health care with constituents one on one over recess. No town hall meetings for him after a caller told his D.C. office that "'Miller could lose his life over this." They did get the caller's phone number and have turned the information over to the appropriate authorities.

Health Care supporters have released a strategy document (http://www.talkingpointsmemo.com/documents/2009/08/hcan-playbook-for-thwarting-town-hall-protesters.php?page=1) prepared by Health Care for America Now (HCAN) and Organizing for America (OFA), which gives excellent advice on how to counter the disruptive behavior of the anti-Health Care crowd. It is nothing like the one the right is using.

1. Do not debate on their "policy" points. Remember, they are seeking a platform to distort the truth about reform by making health care about abortion, rationing, euthanasia, etc. Rather than try to reply with the truth (which won't move them anyway) we should respond with our message and at every turn re-focus the agenda on communicating with the Member of Congress.


2. Interrupt them when they get disruptive and refocus the meeting: Line up a number of people who feel comfortable interrupting and prepare them with statements like:


3. "Excuse me, I came today to listen to Representative XXX explain how this bill is going to make health care more affordable for me and my family. We're being gouged by insurance companies that just want to make more profits while we struggle to keep up with premiums and co-pays. Representative, how are you going to fix that?"


4. "I'm retired and can't afford my prescription drugs because I'm on a fixed income. Representative, how is this bill going to affect me?"


5. "I want to hear the Representative speak. He's the one voting on the bill. Representative, how will this bill help people who already have insurance at work?"


6. "What I'm worried about is how we're going to keep the insurance companies from continuing to charge people more for being sick and keep them from taking away coverage when we need it most. What's the plan for that?"


7. Don't get into a shouting match with them. Instead, prep people on our side to keep raising the questions that we want answered. Repetition is the key. We need to arm our side with questions that play to the strength of our message and make sure we keep bringing them up over and over so that the press recognizes those central themes. We should also phrase those questions strategically to help move the message.

"Over the last XX years, insurance company profits have risen XXX %; in this bill you would regulate insurance companies so that they can no longer deny people with pre-existing conditions and would have to play by fair rules. Isn't that right, Representative XX?"


"Isn't it true that this bill would guarantee everyone a choice of public health insurance option that will lower cost overall in the system?"


8. Address the MOC directly with a positive message: Remember, these Members need cover and they are getting beaten up by right wing zealots in these meetings. We want to let the Member know that we appreciate his efforts to hear constituents and that we, the majority, agree with him.


9. We should demonstrate that we are the majority by chanting: When the other side gets too loud, we should shut them down with chants that counter their message like "Health Care Can't Wait!" and "Health Care Delayed is Health Care Denied" and prep people to chant at key points when the other side gets most disruptive.


10. Follow up with the Member one-on-one: This experience may have been trying for your MOC. Make sure that you thank him and that you let him know that the majority is with him. He needs to know that we will provide cover and support him at every turn for his leadership on this issue.

Good old common sense and a polite manner go a long way.

Why are you against controls on prescription drugs? I have to wonder why my father can get his prescriptions through the VA for approximately $95 a three months supply (and this cover insulin, cholesterol and high blood pressure among other drugs) yet when he was on private insurance paid upwards of $120 per month. If the VA can do it why can't private companies. I definitely think some drug policies should be in this new bill.
I wish some people over here could see this - people complain that prescription charges have just gone up to £7.20 ($11) for any drug. Whilst of course drug companies have to have the money to do research (although most of that is done in universities and is paid for by the taxpayer) far too much effort goes into producing 'look alike' drugs that enable the company to have a new patent.

I find it interesting that CNN is refusing to show (http://theplumline.whorunsgov.com/health-care/cnn-refusing-to-run-ad-critical-of-insurance-industry/) an ad that is critical of the insurance industry.

Whilst of course drug companies have to have the money to do research (although most of that is done in universities and is paid for by the taxpayer) far too much effort goes into producing 'look alike' drugs that enable the company to have a new patent.

Although I'm sure Chirs and Brian with their backgrounds could address this in more detail than can I, in the US a chunk of the funding for pharmaceutical research comes from the pharmaceutical companies. They provide grants to research hospitals and Universities for the research and have the license to patent, manufacture, and reap the profits from any therapies that result. While the research is conducted at hospitals and universities across the country, it's not paid for by the taxpayers.

That's been the cause of a good number of ethics complaints in the US because pharmaceutical companies, somethings with hundreds of millions of dollars invested in research, have an interest in ensuring the results from studies are promising. There have been charges that the companies actively suppress negative results. Though I've heard the accusations, I haven't researched whether any of these charges have ever been investigated and judged to be true, so I'm merely reporting what I've heard regarding ethics complaints and not necessarily learned to be true through research.

agreed. We just disagree on how. Progress.

Woo Hoo!!!!!!! :)

Government intrusion? Just kind of plopped that in there as an assumption, don't you think? Or, perhaps we are interpreting "government intrusion" differently again. Just to be clear, I think it's high time the government DOES intrude and set some guidelines and supervision..in fact, years past time.

In one of the multiple article I read about the sources of high costing health care was government intrusions into patient care. It was based on an analysis about the difference between the cost of premiums for similar health insurance plans in states with rules that differed only in that one mandated that specific treatments be covered while the other did not. In the state with the mandated treatments the cost of premiums was notably higher.

There are areas for which, in my opinion, Insurance companies must be held to account. Three specific situations come to mind - pre-existing conditions, canceling policies for sick people, and lifetime maximums.

Coverage for people who develop illnesses

If a person who is covered by a plan gets sick, the insurance company shouldn't be able to cancel their plan. To me that's just unconscionable. A related problem, and possibly bigger, is the increased cost of providing care and resulting increase in premiums.

If you develop a long term illness, the cost of your health care is likely to rise. Since the cost of premiums is comprised of direct medical care plus administrative costs plus profit, and the portion attributed to profit and administrative costs is set by the states in their mandated medical loss ratios, then as the cost of care goes up the cost of the premiums will also go up. For a large to medium sized group plan, that increase may not be all that noticeable because the pool across which those costs are absorbed is so large. But with a small group plan or an individual plan, those increases may be astronomical. Those increases in premiums may make it next to impossible to afford the premiums anymore.

I'm not sure what the answer is. Does the government mandate than insurance companies can't increase premiums in any one year more than the inflation index for health care? Then the cost of individual plans is going to increase a lot because of the increased risk of loss associated with an individual plan, which means that more people will be unable to afford individual plans and more small companies will be unable to afford small group health insurance plans.

Does the government leave it to the insurance companies to work out with the individuals they cover? Then the people covered are stuck because they might not be able to afford the increase in premiums, and when you or a family member is sick, you aren't in any position to debate with some nameless person on the phone at the insurance company. The net effect, more sick people not getting the care they need.

The only solution I can think of is to allow trade organizations and other groups to offer group health insurance to their members. That way small companies and individuals could participate in a larger group and the costs of one person getting sick would be absorbed over a larger population and result in lower overall increases in premiums.

Preexisting condition exclusion clauses

The Kennedy Kasslebaum bill (I might have the name wrong) passed many years ago makes excluding pre-existing conditions more difficult for insurance companies, provided you've had coverage for the condition in the proceeding 18 months. But the rules are extremely complex (http://healthinsuranceinfo.net/getinsured/delaware/group-health-plans/can-a-group-health-plan-limit-my-coverage-for-pre-existing-health-conditions/).

Some employer sponsored plans prohibit pre-existing condition clauses in their group health plans while others do not. Plans which prohibit pre-existing condition clauses are generally more expensive than those which do not.

Part of me sees this as an individual issue, and I know that sounds harsh, so let me explain. If you have a pre-existing condition then you make choices about which health care plan you purchase based on whether the plan excludes pre-existing conditions or not. When I've switched jobs in the past I've always made sure that the health insurance plan offered by the company I was interviewing with covered pre-existing conditions. That's a choice I always made and it meant that I frequently had to choose the most expensive plan offered by the company.

That same behavior could be emulated by an individual purchasing an individual health insurance plan. Yes, it'll be more expensive. But, to me, that's the cost of choosing a plan that covers pre-existing conditions because the only people looking for an individual plan that covers pre-existing conditions, are people with pre-existing conditions.

As before, allowing individuals to join a group plan offered through a trade association they belong to, or even the state or federal government health care plans, would help reduce those increased costs.

Lifetime Maximums

Lifetime Maximums are another sticky issue. Many plans have lifetime maximum of $1 million. That may seem like a huge amount, but if you have cancer or your child has cancer, you can hit that maximum in no time. To be honest, I think lifetime maximums are unconscionable. The people who hit them are either extremely sick or old and eliminating coverage for them is just wrong.

It could be that this issue is one that is best addressed on an individual basis, but I'm not sure. In theory you could buy a plan with no lifetime maximum, but it would probably cost more (and I'm not sure if they're even available). The thing is that you don't think about ever hitting the lifetime maximum until you or someone in your family gets extremely sick. At that time it's too late to change because you'll get stuck with the pre-existing condition stuff.

Unhealthy lifestyles and risks? Always more work can be done here....and I believe there are many ways this can be done with public education and incentives...some of those incentives possibly being incorporated into reforms.

Other than sin taxes, which are being discussed but have not been amended into the bill, there isn't much. There's stuff about research into stop smoking programs and healthy lifestyles programs, but much of that research is already being conducted by NIH so it's just transferring that research to a different branch of the government.

Wow, I wonder how we fix this? Oh, I know--make a public option available at reasonable rates to those who cannot currently afford private insurance. People can then actually go to a *doctor* in an office and get treated for simpler things like ear-aches and the flu, freeing up the higher-cost true emergency care for true emergencies, less waiting and less cost for those same subsidies that would have had to cover the uninsured nonpayment of $1000 to an ER for an ear-ache, but only $50 to a doctor and $10 for medicine.

My concern is that you appear to be making an assumption about the "public option" that isn't supported by what's actually being offered in the bill.

The bill is offering the following as the public option:

- expand Medicare / Medicaid to 1.33 times the federal poverty level, and

- provide taxpayer assistance for premiums over 1/12 of your annual income for anyone whose company doesn't provide health coverage and whose income is more than 1.33 times the federal poverty level and less than 4 times the federal poverty level.

That, in a nut shell, is the public option. And because of government mandates in other parts of the bill, the cost of individual plans offered as part of the public portion of the exchange are likely to be higher than they are now.

Just for reference purposes, a single person making 14,630 or less would be required to enroll in Medicare or Medicaid. A single person making 14,631 to 44,000 would be eligible for additional taxpayer assistance in paying for premiums, to the extent that those premiums exceeded 1/12 of their annual income. That means that if they make $15,000 they can get assistance to cover the cost of premiums over 1250, for income is 20,000 it'd be for premiums over 1667, for 25000 it's premiums over 2083, for 30000 it's premiums over 2500, for 35000 it's premiums over 2917, for 40000 it's premiums over 3333, and for 44000 it's premiums over 3667.

And the cost of premiums is the average cost of the three lowest costing basic plans - not necessarily the plan you choose.

And if your employer offers a plan that costs less than 1/12 your annual income, you aren't eligible even if you can't afford the premiums on that plan.

Disinformation of the Day: Senator Chuck Grassley (R-IA) using Senator Ted Kennedy's brain cancer to spread fear of rationing among seniors.

"In countries that have government-run health care, just to give you an example, I’ve been told that the brain tumor that Sen. Kennedy has — because he’s 77 years old — would not be treated the way it’s treated in the United States. In other words, he would not get the care he gets here because of his age. In other words, they’d say ‘well he doesn’t have long to live even if he lived another four to five years.’ They’d say ‘well, we gotta spend money on people who can contribute more to economy.’ It’s a little like people saying when somebody gets to be 85 their life is worth less than when they were 35 and you pull the tubes on them."

I wouldn't be surprised if Ted comments himself, but this is shameful. Both senators are covered by government-run health care with the government - us as taxpayers - paying a large percentage of the coverage cost. Since we also pay their salaries, we're paying their premiums, too.

On another front, the DNC is out with a great web ad on the astroturf town hall protests.

PtTBkxvBq88

From what I've been able to ascertain, with an assist from Media Matters (http://mediamatters.org/research/200908050017), all the major networks except Fox and CBS have caught on to, and are reporting on, the orchestrated nature of the protests.

The ad ends with: "Call the Republican party. Tell them you've had enough of the mob." The GOP picked up on that bit and forwarded these calls to the DNC offices (http://www.npr.org/blogs/health/2009/08/dems_bash_back_on_town_hall_ta.html).

Regarding the drug company / research funding / etc, I can talk...at length...about it, if anyone needs a nap. I have worked at a small pharma and now at a University (on medicinal chemistry research), plus I know a few people "within" the industry, so I've accumulated a lot of ability to talk about it :yuhup:

Disinformation of the Day: Senator Chuck Grassley (R-IA) using Senator Ted Kennedy's brain cancer to spread fear of rationing among seniors.

What Grassley saying is true. In some countries the government run health care program would not have provided for Senator Kennedy's care because of his age and other health conditions. Because the Kennedy's are wealthy he could have obtained the care from private sources, but not the national health service.

Both senators are covered by government-run health care with the government - us as taxpayers - paying a large percentage of the coverage cost. Since we also pay their salaries, we're paying their premiums, too.

Actually, no. Both Members of Congress and their family members are eligible to enroll in health coverage plans paid for by the taxpayers, but the plans they enroll in are provided through private insurance companies, not government run.

I'm not going to wade into the whole protests against government controlled health care are evil thing because the mods have asked us not to go there, but I can't help but question the political advisability of defaming such a large portion of the population (which is more than 52% according to Rasmussen).

What Grassley saying is true. In some countries the government run health care program would not have provided for Senator Kennedy's care because of his age and other health conditions. Because the Kennedy's are wealthy he could have obtained the care from private sources, but not the national health service.
If he means the likes of North Korea, that may be true. Always easy to to point out the extremes. But if he means the usual vilified countries such as the UK or Canada then it wouldn't be true at all.

[staff edit]

Mom is right about Congress' health plan...here's the site

FEHBP-Federal Employees Health Benefit Plan (http://www.opm.gov/insure/health/planinfo/index.asp)

Please note that they can pick any state's plan or a nationwide plan (All are PRIVATE INSURANCE OPTIONS)

And isn't it grand? There's even a Health Savings Account option.

More do as I say and not as I do, I suspect.


ETA: Come on Midnight, you know better than to put a source from an obvious partisan site. You're much better than that. Of course, no one has any argument about ACORN breaking into foreclosed houses, do they? That's social justice. But here, when so many people have reasonable questions about the bills being rammed through, now they are a mob.

The Dems and the President would probably be better served in talking instead of vilifying dissent as "mob rule". I don't see it as a mob, but more as "community organizing". Man, ain't irony something?

Rasmussen (http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/august_2009/confidence_in_u_s_health_care_system_has_grown_in_ recent_months):

Seventy-four percent (74%) of voters rate the quality of care they receive as good or excellent. In May, just 62% of adults said the same.

Polling last week showed that 47% of voters favor the health care reform plan working its way through Congress while 49% are opposed. However, those who oppose it show more intensity: Just 25% Strongly Favor the legislation while 41% are Strongly Opposed.

Fifty-four percent (54%) of U.S. voters say tax cuts for the middle class are more important than new spending for health care reform, even as President Obama’s top economic advisers signal that tax hikes may be necessary.

What Grassley saying is true. In some countries the government run health care program would not have provided for Senator Kennedy's care because of his age and other health conditions. Because the Kennedy's are wealthy he could have obtained the care from private sources, but not the national health service.
As you say Kennedy is getting treatment because

a. he's very rich and
b. he's got a gold-plated insurance scheme

How many people of his age and his condition in the US get no treatment whatsoever because they are not insured or because their insurance doesn't cover that condition? I am willing to bet a small pile of galleons that a higher proportion of people of his age with his condition get treatment in Britain (or indeed any other developed country outside the US) than in the US.

Of course an NHS has to make difficult decisions about who to treat towards the end of life and what treatment to give. But those decisions are made in the public arena (http://www.nice.org.uk/media/97C/9D/EoLConsultationSummaryResponses.pdf) on the basis of the clinical evidence. They are not made in secret by commercial organisations; nor do they depend upon the size of your wallet (although as you say if you have mountains of money you can go private)

Chris without giving us a dissertation do you know what proportion of pharmaceutical research is publicly funded. There are complaints over here that private companies take over publicly funded research when it's close to market and thus gain patent protection (and huge profits)

My concern is that you appear to be making an assumption about the "public option" that isn't supported by what's actually being offered in the bill. ...

I think we all are going to do a little assuming because there is still not a final bill, nor even the only bill, and it is continually being amended. I do understand that not all the wording of all the bills are accessible (or even available) at this time. But if we are to go by what is simply outlined above, and assume that none of that changes, it is still a better deal than what most have at the lower income levels.

For one, more citizens are picked up by the expansion of Medicare/aid and now there is a mechanism for others to have plan prices (whether public or private) brought down through subsidy and competition, to a reachable level. In other words, there are cases where at an income of $20,000/yr and premium rates for someone of 50 yrs old could be $500/mo ($6,000/yr) for one of the less expensive plans right now --this of course, right now, varies by state and locale (and loosely based on actual quotes received in *this* local).

Clicking off some of those figures and putting in my own income at home, I am already knocking 75% off a health plan...that's a good deal since at the previous price, there was no health plan at all or hope of even finding one. That also means that, if this were in place earlier this year, I would have seen greatly increased income retention, as well, because I would not have incurred several thousand in ER bills (and most likely would have had issues resolved before even needing an ER). An overall great savings.

Just as a side note, I was doing some calculations and discovered that I could have flown to England, received care there, and flown back *fully* cured and still had a savings of several thousand dollars after my ER visit in May (which did NOT cure).

I know that how this is viewed may be different for someone who does have coverage already, and those people will have to decide for their own situations what they are looking for. But, I think for the uninsured, this is vastly improved.

All this being said, once all the bills have been amended, blended and adjusted....these figures above could change. What I'm hoping for is that the main principle of having a combination of ideas bring those plan prices down to that level where those who are working, by just out of range, can now get insurance at all (public or private from an exchange/work).

The other hope is that those who do have coverage, like many of my friends and family, may actually see reductions in those premium prices and no longer have to fear that coverage will disappear when they need it most (either by direct drop or premium hike).

I would like to be able to see that anyone who needs medical attention can actually have access to a doctor's office and expect reasonable medical attention and not be blocked by their "status" in the system, or told their only option is an ER.

It is my hope that some of the burdens be taken off the ER so that true emergencies can be seen and they do not feel they have to make "who to treat" decisions (legally or through slight of hand).

Another part of the plan I've heard some about and am encouraged by, is the help that could be offered to young medical students to encourage them along, and possibly find ways to decrease their academic debt to become qualified doctors. One of my sons is currently studying and hopes to become a Pathologist at a college.

This just shows how so much of the possible reform has the potential to directly affect our larger family and show some real life financial relief, increased quality of care (like having care at all!) and future improvement in lifestyle and prosperity over all.

I think we all are going to do a little assuming because there is still not a final bill, nor even the only bill, and it is continually being amended. I do understand that not all the wording of all the bills are accessible (or even available) at this time. But if we are to go by what is simply outlined above, and assume that none of that changes, it is still a better deal than what most have at the lower income levels.

But will it be? Look at the public option, as it's described in the bill in Congress, rather than the platitudes being offered by politicians.

The only bills not currently available are those which have not been proposed. HR 3200, the only bill currently proposed, is available. The public option in HR 3200 is virtually identical to the Senate version of the bill Kennedy is working on.

Both bills expand Medicare / Medicaid eligibility to 1.33 times the federal poverty level

Both bills provide for public assistance in paying premiums on an insurance policy, for those who qualify, if those premiums exceed 1/12 of your annual income.

Under both plans, for the most part, in order to qualify for assistance you must
- have income less than 4 times and more than 1.33 times the federal poverty level
- not have an employer sponsored plan whose premiums cost less than 1/12 your annual income
- not be eligible for VA or military benefits
- be a legal resident

Under both plans, for the most part, the cost the premiums is calculated as the average cost of the 3 least expensive basic plans offered in your area.

Under both plans, people who qualify for the public option will be responsible for paying their premiums, paying their co-pays for office visits, paying their co-pays for prescriptions, and paying whatever their co-insurance percentage is after meeting their deductible.

From what I've been hearing about the public option, people (and thats a generic people, not you specifically) seem to think they're going to get free health care under the public option and that is absolutely not true.

For one, more citizens are picked up by the expansion of Medicare/aid

I'm OK with expanding Medicare / Medicaid. I'd go further than then bills and make it 1.5 or 2 times the poverty level.

and now there is a mechanism for others to have plan prices (whether public or private) brought down through subsidy and competition, to a reachable level.

Where? the only subsidy will be premiums in excess of 1/12 your income. While that will certainly help in the example you provided (to the tune of about $4300) that person would still be responsible for paying his / her deductible, co-insurance, and co-payments. For basic plans that might be a deductible of $500 - $1000 a year, 20% coinsurance, and $25 co-payments for Dr visits. While that's better than nothing, it's still not much.

And those prices are based on today's cost for insurance. Government mandates, like requiring coverage for pre-existing conditions, and limits on how much premiums can increase each year, will cause prices to go up. Federal mandates that certain treatments be covered (aka family planning) will also cause prices to go up.

As I've said, probably a trillion times before now, I'm not opposed to doing something to help those who can not afford insurance purchase it. I think it's a must to help those people get access to affordable coverage.

But, if that's the objective of the plan, why does it mandate that every insurance plan sold in the US come under government control? There are ways of providing assistance for the uninsured that don't require the government to meddle with private insurance.

For example, the Federal Employee Health Benefits Plan could be opened up to private citizens who don't have insurance. They could be provided assistance in purchasing a plan subject to the same requirements as specified in the public option section HR 3200. But the government would keep its hands off private insurance. And any negotiating about price and provided services would be between the government and the insurers as it applied to the plans they offer to employees and uninsured citizens.

Sounds pretty simple.

(1) Expand medicare / medicaid to 1.5 times the poverty level

(2) Open the federal employee benefit plan to legal residents who do not have insurance and don't qualify for medicare, medicaid, VA or other military medical benefits. Provide assistance to anyone making less than 4 times the FPL to the extent that the premiums on a plan exceed 1/12 of their annual income. calculate the cost of premiums as the average of the 3 lowest costing basic plans in their area. Garner their wages to ensure payment of premiums.

That would do the exact same thing you're talking about without the government taking over control of private health coverage.

For one, more citizens are picked up by the expansion of Medicare/aid and now there is a mechanism for others to have plan prices (whether public or private) brought down through subsidy and competition, to a reachable level.


Redhart, where does this competition come from? The public option does nothing to foster competition when the one party is both the umpire and the first baseman in the equation. You mention that more people will be picked up by Medicare, which itself is insolvent.

Another key fundamental question is this. If you add 47 Million people to the government health rolls, where are the doctors going to come from to service them?

The President has already demeaned pediatricians by implying that they would take out tonsils to make a buck. Specialties are going by the wayside, so where will the doctors come from?

What Grassley saying is true. In some countries the government run health care program would not have provided for Senator Kennedy's care because of his age and other health conditions. Because the Kennedy's are wealthy he could have obtained the care from private sources, but not the national health service.

But we're not talking about "some countries." We're talking about the United States of America, where Kennedy's illness would render him uninsurable by most private health care insurers. That is shameful... but it's all too true.

Seems to me the U.S. has enough disparity in coverage that we don't need to go abroad to find something to fit our preferred arguments.

Actually, no. Both Members of Congress and their family members are eligible to enroll in health coverage plans paid for by the taxpayers, but the plans they enroll in are provided through private insurance companies, not government run.

The U.S. government owns, operates and adminisrers the plan that covers our senators, representatives and other government officials. The insurance companies are there to provide a product, not administration. Meaning they don't get to make coverage decisions or to decide which claims to pay. This is essentially the plan President Obama wants to become the public option.

I'm not going to wade into the whole protests against government controlled health care are evil thing because the mods have asked us not to go there, but I can't help but question the political advisability of defaming such a large portion of the population (which is more than 52% according to Rasmussen).

On the details of the plan, respondents remained supportive of many of the rough outlines of the health-reform effort as originally described by President Obama. Sixty-three percent said they would support providing health-care coverage for all Americans, even if the government had to subsidize those who could not afford it. Fifty-six percent said they supported a "public health insurance option" to compete with private plans. Fifty-seven percent support raising taxes on those with annual incomes over $280,000 to pay for the plan. Eighty percent said they would support a bill that required insurance companies to offer coverage to anyone who applies, even those with pre-existing medical conditions. [...]

Obama also retains significantly more credibility with public than with his Republican foes when it comes to tackling the problem. [...]

TIME Health-Care Poll: Americans Back Reform, Worry Over Details (http://www.time.com/time/politics/article/0,8599,1913426,00.html)

I can't help but question the political advisability of defaming such a large portion of the population

They have threatened Rep. Brad Miller's (D-NC) life. Hung an effigy of Rep. Frank Kratovil (D-MD) from a noose in front of his district office. Called on Chris Dodd to drink a toxic cocktail of drugs and alcohol as a way to cure his recently diagnosed prostate cancer. Nothing by way of defamation there.

Purple, before we start throwing stones at glass houses, I heard nothing from our Community Organizer in Chief about this:

Consider this: In the spring, anti-war protesters blocked access to a job fair at the University of California-Santa Cruz and caused Army and National Guard recruiters to be escorted off campus by university police. According to one recruiter, "the situation had degraded" to such an extent that the recruiters feared for the safety of students and law enforcement officers.

Prominent conservatives like David Horowitz, Ann Coulter, Bill Kristol and Pat Buchanan have been attacked with pies and salad dressing during on-campus speeches. At UC-San Francisco, a crowd of students blocked access to and scuffled with College Republicans whose crime was merely handing out flyers to students. At Washington State, protesters disrupted, shouted down and threatened actors in a satirical play.


Source: American Council of Trustees and Alumni (http://www.goactablog.org/blog/archives/2006/10/problems_with_p.html)

Of course there is the Ruckus Society, a big supporter of the President:

Ruckus itself has no problem getting paid, reaping six-figure grant awards from the likes of Ted Turner and the “caring capitalists” at Ben & Jerry’s. When the multinational corporation Unilever bought the ice cream maker in 2000, it agreed to continue Ben & Jerry’s bizarre flavor of philanthropy for the foreseeable future. The Turner foundation has also contributed heavily to Ruckus, including over $150,000 in grants made via The Ecology Center, Inc., a Montana group where Ruckus’ first slate of officers met in the mid-1990s.

Ruckus’s primary contributions to the activist agenda are its “action camps”: weeklong boot camps for leftist protesters, usually held a few weeks prior to a major organized demonstration. A few hundred young Ruckus recruits typically attend each camp, where they are trained in the finer points of “police confrontation strategies,” “street blockades,” “urban climbing & rappelling,” “using the media to your advantage,” and “learning to lock your head to something” (among other things).

Source: ActivistCash (http://www.activistcash.com/organization_overview.cfm/oid/188)

If you doubt Ruckus' support of the President?


Ruckus to take back america: Obama gets real so should we... (http://ruckus.org/blog/?p=23)

Democracy Now!!! (http://www.democracynow.org/2008/6/6/adrienne_maree_brown_of_the_ruckus)


The point? Every video I've seen has shown the "mob" being reasonable and vocal. The lefties have organized thugs like Ruckus. Let's be careful before you label 54% (See previous post on Rasmussen) as mob rule.

:rolleyes: Can't we ever post about these things without pointing fingers? I think people on both sides are being immature - past and present in protests.

Let's be better behaved than the DNC (hey, call them up, they're being mean!!) and the RNC (press "1" to be redirected back to the DNC!!). Monster_Mom and Redhart have been trying to discuss the merits of the plans. I suggest following that lead and posting about the merits of the plans rather than the merits of the protests.

ETA: Both sides seem to fit this cartoon:
http://cache.boston.com/bonzai-fba/Third_Party_Graphic/2009/08/06/0806anderson__1249570006_3252.jpg

But will it be? Look at the public option, as it's described in the bill in Congress, rather than the platitudes being offered by politicians.

The only bills not currently available are those which have not been proposed. HR 3200, the only bill currently proposed, is available. The public option in HR 3200 is virtually identical to the Senate version of the bill Kennedy is working on.

Both bills expand Medicare / Medicaid eligibility to 1.33 times the federal poverty level

Both bills provide for public assistance in paying premiums on an insurance policy, for those who qualify, if those premiums exceed 1/12 of your annual income.

Under both plans, for the most part, in order to qualify for assistance you must
- have income less than 4 times and more than 1.33 times the federal poverty level
- not have an employer sponsored plan whose premiums cost less than 1/12 your annual income
- not be eligible for VA or military benefits
- be a legal resident

Under both plans, for the most part, the cost the premiums is calculated as the average cost of the 3 least expensive basic plans offered in your area.

Under both plans, people who qualify for the public option will be responsible for paying their premiums, paying their co-pays for office visits, paying their co-pays for prescriptions, and paying whatever their co-insurance percentage is after meeting their deductible.

From what I've been hearing about the public option, people (and that's a generic people, not you specifically) seem to think they're going to get free health care under the public option and that is absolutely not true.

Well, as someone who has been uninsured/covered until just this month (and even then, only through a brand new program that wasn't there a year ago), I can tell you that : Yes, the plan above would have helped me, and not in a small way. The plan above would have included me, personally, within the medicaid section of which I am not currently included. The plan above would have enabled me to seek medical attention BEFORE it became an ER crisis and would have paid for the procedure that would have corrected it before it became a bill in the thousands for my family to deal with.

Of course, with proper care, I might have been making much more money, too. Repeated health issues have caused me work loss. Had I not been working for myself, in my own business, it could have cost me my full job as I'm not sure an employer would have put up with my repeated attacks and subsequent time off. As a business owner...I am not sure I could have kept an employee like me for the last year who required so much sick time off.

I would have been much better able to pay my way. Now, with the procedure, I am told to expect full 100% recovery with full productivity.

Because of application for help, half my bill was picked up by a charitable grant I qualified for. I'm still left with $15,000 to pay (and to figure out how). That money could have been completely saved with proper care, of which I was barred from at the time. The hospital (of which I intend to pay ...somehow) will also have gotten their money much faster, enabling them to operate better. Because I would not have tied up their ER with an unnecessary emergency, it would have been less crowded and more efficient.

I am not one who "wanted" the free ride. Quite frankly, I would much rather pay my way and have always taken pride in that in the past (and I am not a spring chicken). But, for myself and others like me, there has to be a way to be ABLE to do that, and the system made it impossible.

I do not think most people above poverty level expect everything free. I don't from what I've heard so far. What I want, and my friends is something that is reachable and not impossible to achieve within this current system. I can't imagine not paying in some way, shape or form, for this type of service. Whether that came from taxes, cuts or some other way, was unsure in the beginning and now being hammered out in the legislature. But it would be unreasonable on my part to think that it would simply be "free". Most of us just want "fair" and "accessible". We aren't looking for hand-outs, just a little breathing room to allow us to do the rest ourselves. I speak, of course, for myself and those *I* know who are in similar situations in my family and area.


I'm OK with expanding Medicare / Medicaid. I'd go further than then bills and make it 1.5 or 2 times the poverty level.
I am okay with this as long as we continue to streamline and correct some of the issues with the medicare/medicaid system. I believe they will be looking at how to do this, too. So, I await more details on that end. It may end up being more effective to keep this system at lower levels and fill the existing insurability hole with the subsidy/exchange plan...or, another way. I'm okay with it in principle if we can hammer out some of those issues.

For basic plans that might be a deductible of $500 - $1000 a year, 20% coinsurance, and $25 co-payments for Dr visits. While that's better than nothing, it's still not much.
Again, it is much more than you know coming from that "nothing" place. And that 'something', as I outlined above just by my case, should create small, positive effects throughout the system for all. Multiply that by the number of "nothing" Americans estimated out there and that is actually quite a bit of something. :err: Well, you know what I getting at:p

...and, again I must go and have run out of time, so will leave the rest of the points for other members to consider.

Okay, Chris.

In my opinion, the plans on the table do not address two key elements that contribute to the current problems of cost in the health care landscape.

I would like something done to address tort reform around limiting exorbitant lawsuits.

Many doctors are forced to pay tremendously high medical malpractice rates:

Not surprisingly, doctors in some of the biggest cities pay the highest premiums, with those practicing in the Miami area coping with the worst prices. Top rates for coverage there run more than $65,000 for internists, $227,000 for general surgeons, and nearly $250,000 for ob/gyns. Elsewhere, internists are paying as much as $50,000 in Detroit, $41,000 in Chicago (up 30 percent), $34,000 in Houston, and nearly $30,000 in Philadelphia (also up about 30 percent).

Source: Medical Economics (http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=108537#section1)

None of the bills on the table address Tort Reform, although there have been, at least anecdotal, evidence in states that pass tort reform (like OHIO (http://www.cg-ins.com/news/?p=1790#more-1790)) rates can stabilize.

The second thing I'd like to see addressed is wider market options. I'm talking free market. I like the idea of coops or even a National Insurance Exchange as long as the government is the administrator and NOT a player in the system. There is no free market option if the government both provides a plan AND makes the rules.

Who said we want more free market options? I sure don't. :no: We already have entire generations of mostly lousy experience with health care and the American free market. It's no good for consumers who must always pick up the tab when they - those who run the market - mess up.

I have already written all my representatives and told them that I would rather have the president veto a bill that comes through without a public option, then leave it out of this proposed plan. In my opinion, to leave it out would so weaken the repair as to be like putting a band-aid over a wound when it clearly needs suturing.

As purple just said, we've already had the fully free system without one and have seen the "totally free system" has its limits, it has left gaping holes, often times ruthless and heartbreaking to many (whether by design or by accident) and has become unstable and unsustainable. I would say it has been given more than enough chance to prove itself. The next two styles are the hybrid system as we are discussing here and is currently being drafted into proposals or a fully government, single-payer system.

The public plan is the safety net the system does not have right now. There is the lowest net (medicare, which also needs revamping--it's net is stretched too tight, but at least still functioning at the moment). That net does not cover a vast area. The Free INsurance system has become too narrow and people are falling off what is becoming a tightrope above. Sometimes they hit the net...many do not.

It is my believe that the "Public Option" net would encourage, through competition and option, for the Private tightrope to lower and broaden a bit. Would they lose some profits? Maybe. They may also become more inventive and find ways to offer better service, lower prices to lure more up and keep them out of the net below.

There are private insurance corporations already operating in systems that have public options. Some countries have larger nets...others have larger high beams. But countries like Singapore have been touted for their "hybrid" systems. I believe Australia also has a hybrid private/public health care system of sorts. Even in countries where health care has been fully nationalized and government run, private insurance operates to fill in extras and upgrades for those who wish it.

The point is, there appears to be a whole spectrum of systems already running and working in the world's nations that tells me, yes...it can and does work.

Finding the right combination of private/public in our country is the task. But, I have no doubt it can be done and it won't destroy private enterprise. I'm sure Americans can do this with their own flair ;)

I do believe that everyone's health care is in danger, and increasing numbers of Americans will be in increasing danger of losing private health plans they currently have if the system isn't severely adjusted now. We've heard the warnings for decades now. Our parents have already passed this on to us. There may not be much left to pass it on to if we do not address it here and with us. This system is on an increasing spiral, much like the housing bubbles and credit crisis, and will become unsustainable for all, then costing tenfold more to replace/correct later.

Just like choosing not to fix a hole in the roof because it will cost money, the cost in not fixing it and having the walls and floors rot out (and the hole enlarge) will only be worse. Sometimes you have to bite the bullet and just get the job done.

There is also the human cost of failing to correct this now. That's, of course, is incalculable.

But we're not talking about "some countries." We're talking about the United States of America, where Kennedy's illness would render him uninsurable by most private health care insurers. That is shameful... but it's all too true.

Not his plan, and not mine. It prohibits the insurance company from canceling you because of illness (I actually called the company and asked). According to the person I spoke with, and we're covered by United HaelthCare one of the largest Health insurance companies in the US, they don't have any plans that allow the company to simply cancel a patient because h /s he develops an illness.

The insurance companies are there to provide a product, not administration. Meaning they don't get to make coverage decisions or to decide which claims to pay. This is essentially the plan President Obama wants to become the public option.

Then you do need to take some time and actually read the public option in the health care bill, because that is absolutely not true.

The bill establishes a Health Choices Administration which will act kind of like the HR department for the entire country. Every health care plan, whether it's a private, employer sponsored group plan or private individual plan will be provided the the Health Insurance Exchange which will be under the administration of the Health Choices Administration.

The Health Choices Administration will have the authority to dictate what each plan must cover (like family planning services) but will not administer the day to day details of the plans. That will be the responsibility of the Insurance provider. This authority, BTW will extend to every plan sold in the US, not just plans offered in the public area of the exchange.

The Health Choices Administration will have the authority to dictate medical loss ratios (which dictate the percentage of premiums received that must be spent on medical care as opposed to administrative costs). The Health Choices Administration will not have the authority to set the cost of premiums in offered plans. That will be a function of the level of service (basic, premium, premium plus), what the government mandates must be covered (like family planning services), and will be set by the insurance companies.

For the public portion of the exchange, the Health Choices Administration will issue it's requirements and insurance providers will bid plans they believe meet those requirements. The Administration will select those plans for availability in the Exchange which they believe provide the best value.

People qualified to participate in the public portion of the exchange will be able to select and enroll in a plan that they believe best meets their needs. The day to day details of administering the plan and determining what claims will or will not be covered, will rest with the insurance provider the person selected.

The insurance provider will administer the plan and will set the rules for what is and is not covered under it's plan. If you need medical care, if you want to have whatever treatment you receive be covered by your health insurance provider, then you will have to meet the insurance providers rules - like seeing a participating provider. You can always go to see a doctor without using your insurance, but then you will be responsible for paying the doctor.

I am okay with this as long as we continue to streamline and correct some of the issues with the medicare/medicaid system. I believe they will be looking at how to do this, too. So, I await more details on that end. It may end up being more effective to keep this system at lower levels and fill the existing insurability hole with the subsidy/exchange plan...or, another way. I'm okay with it in principle if we can hammer out some of those issues.

Medicare / Medicaid fraud is a HUGE issue that must be addressed, but it's not covered in the bill.

The only thing I could find in the bill to address rising costs was a cash reward to the providers with the lowest utilization rates (the lowest rates for Dr appointments, tests, equipment, prescriptions, and other medical procedures from their patients).

Not his plan, and not mine. It prohibits the insurance company from canceling you because of illness (I actually called the company and asked). According to the person I spoke with, and we're covered by United HaelthCare one of the largest Health insurance companies in the US, they don't have any plans that allow the company to simply cancel a patient because h /s he develops an illness.

I am so sorry they did away with that head-banging smiley! IF Ted Kennedy didn't have the excellent plan he has through the government, he could very well be one of those people who, like President Obama's mother, spends the last of his life arguing with his health insurance provider. Private insurance companies do have an appalling habit of cancellilng people's insurance when they develop life-threatening illnesses like cancer. That doesn't happen in those "other countries" you were speaking of.

And the public plan is intended to be an expansion of, or a mimic of the plan government officials now enjoy.

My family and I are covered through United Health Care, like you, and Aetna. Both policies were gotten through the companies we once worked for. Each has a non-cancellation clause. My daughter works for the same company I retired from and carries one of their employer-provided plans. Her policy does allow for cancellation in the event of "pre-existing conditions." I could hardly believe it when she showed me that.

I'm still refusing to be drawn into a debate on policy this early in the game. I want to see what comes out of the Baucus committee and have a chance to compare all three bills, which just makes good sense to me.

Reading the last couple of pages here, I think, just as your average American, that the biggest problem is this:

The problem we have now is due to a combination of separate problems that we may or may not be successful at solving all at once.

There are so many issues on the table, as Monster Mom so wonderfully laid out, and so many that are not even touched on in the bill.

I don't think Comprehensive Reform is really the way to go when a problem is so complicated.

I think each problem needs to be addressed individually and maybe a few can be bundled together if they are related enough.

I mean, as some of you have already realized - people agree that at least some reform is necessary, so now we're just haggling about the price, as Cap'n Jack says. And I think we can do a better job of reaching some kind of agreement or compromise if we treat each problem separately.

And as someone who at least studied a bit of Administrative Law in law school, I can tell you that the biggest problem with legislation is that it usually sounds good and makes people feel good (especially Environmental legislation), but usually doesn't accomplish what it was meant to accomplish.

Like the Comprehensive Immigration Reform bill, I think this one will die, and I think that's a good thing, not just because I disagree with it, but because it involves too many things at one time and still misses out on some important reforms that can be made.

I would be happy if we could take each issue and discuss and debate separately and come up with a bill (if one was found to be necessary) that would address that issue and that issue alone. Again, being open to the fact that some bundling of issues may be necessary. But NOT all.

And one thing IMHO that is important - not every problem in human life can be solved by legislating it. This world is not perfect and no amount of legislation will ever make it perfect.

We can only do our best with what we are given.

I think with that attitude we can probably find a better way to fix what needs to be fixed and leave alone what needs to be left alone instead of trying the shotgun effect of trying to fix everything when not everything needs fixing.

Cheers.

Medicare / Medicaid fraud is a HUGE issue that must be addressed, but it's not covered in the bill.

The only thing I could find in the bill to address rising costs was a cash reward to the providers with the lowest utilization rates (the lowest rates for Dr appointments, tests, equipment, prescriptions, and other medical procedures from their patients).
Again, the bills are works in progress and there may be more yet to come. If not, I suggest we encourage our representatives to continue to seek improvements and tighten up loopholes where the issues are causing problems.

And, yes, I've heard that Medicare/aid fraud is one of the problems of the system. Agreed, this is one of the things that should be delved into--if not in a first bill, then in further reform. It is quite possible that we may not be able to do it all with one epic bill...pragmatically speaking.

I am so sorry they did away with that head-banging smiley! IF Ted Kennedy didn't have the excellent plan he has through the government, he could very well be one of those people who, like President Obama's mother, spends the last of his life arguing with his health insurance provider. Private insurance companies do have an appalling habit of cancellilng people's insurance when they develop life-threatening illnesses like cancer. That doesn't happen in those "other countries" you were speaking of.

You, and others here, have stated multiple times that insurance companies routinely cancel people coverage when they sick. Please present your evidence. Not sob stories, but actual statistics from a reputable source.

And the public plan is intended to be an expansion of, or a mimic of the plan government officials now enjoy.

Please, read the bill.

Because what I described is EXCATLY what's in the bill.

My family and I are covered through United Health Care, like you, and Aetna. Both policies were gotten through the companies we once worked for. Each has a non-cancellation clause. My daughter works for the same company I retired from and carries one of their employer-provided plans. Her policy does allow for cancellation in the event of "pre-existing conditions." I could hardly believe it when she showed me that.

A pre-existing condition is any condition for which you've received a diagnosis or treatment from a medical provider in the 6 months prior to enrolling, and only of you haven't had continuous coverage. If you go from job A to job B and you don't go without health insurance during the interim, they can't preclude coverage for a pre-existing condition.

If you've had your insurance for 5 years and suddenly get sick, the insurance company has to cover you.

Again, the bills are works in progress and there may be more yet to come. If not, I suggest we encourage our representatives to continue to seek improvements and tighten up loopholes where the issues are causing problems.

But if you refuse to read the bills, how do you know where the holes are?

Here are several questions I have, because I've read the bill:

(1) If the intent of the program is to provide health insurance for those who can not afford it, then why does the bill stipulate that all insurance plans offered in the US be under the control of the Health Choices Administration? Why does the government have to take over control of currently held privately managed and sponsored insurance programs, when the individuals covered under those plans already have insurance, if the intent of the bill is to provide coverage for those who do not have it?

(2) Why are family planning services, including abortion, required in every plan? Isn't that something people should be able to choose when selecting a plan as opposed to having mandated?

(3) How are people who can't afford insurance, even with taxpayer assistance, supposed to be able to afford a 2.5% failure to obtain insurance tax on their income?

(4) Who defines what an acceptable insurance plan is? What if someone prefers a catastrophic plan as opposed to a full, basic plan? For instance, if a parent has college age children, the college the children attend has student health services that provides basic health care to students, and the parents decides to purchase catastrophic health insurance for their college age child as opposed to full basic coverage, will those parents be subject to a 2.5% failure to obtain acceptable insurance tax on their income?

(5) What is the difference between the funded and the unfunded portions of the plan from years5 - 10 and 10 - 15, on an annualized basis? The $1 trillion over 10 years figure doesn't reflect the fact that the gap between the funded and unfunded portions of the plan increase annually, to such an extent that by year 10 the unfunded portion is over $168 billion just for that year and growing each year thereafter.

(6) How are we going to add more people to the Medicare / Medicaid roles when those programs are already insolvent?

(7) What measures are reflected in the bill to reduce health care costs? I've only seen one - cash bonuses for doctors and facilities with the lowest utilization rates. What else is there?

You, and others here, have stated multiple times that insurance companies routinely cancel people coverage when they sick. Please present your evidence. Not sob stories, but actual statistics from a reputable source.

I'm afraid what you call "sob stories" are as close as you're going to get. If the insurance companies have contributed their cancellations to a central body that keeps track of denials, I am unaware of it. What we do have are tens of thousands of testimonials from Americans who've suffered as a result of those arbitrary decisions.

Moving on, the editorial pages of the nation's newspapers are beginning to take a closer look at the protests being staged at the August town halls our House representatives are holding across the country. Economist, Princeton University professor, and Nobel Laureate Paul Krugman has an excellent take today on what's going on out there (http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=2). He writes of a town hall held by Representative Gene Green (D-TX) in which "an activist turned to his fellow attendees and asked if they oppose any form of socialized or government-run health care. Nearly all did. Then Representative Green asked how many of those present were on Medicare. Almost half raised their hands."

Medicare recipients who don't know they're enjoying government-run health care? Good grief!

A new organization called Conservatives for Patients’ Rights has entered the anti-health care fray. CPR is run by Rick Scott, formerly head of a for-profit hospital chain called Columbia/HCA. He was forced out amid allegations of widespread Medicare fraud. The company eventually pleaded guilty to overbilling state and federal health plans,and was assessed the largest fine in Medicare's history: $1.7 billion dollars. Here's video of Scott being pressed on the issue by a CNN anchor who I think is Sanchez?

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I wouldn't want this guy on my team.

If the insurance companies kept such records, that'd be...risky...since those records, like the steroids test results from 2003 in baseball and countless other "secret" documents, risk being exposed. And that'd make them look bad. So all the examples of rescission are going to be, as you put it Mom, "sob stories". But I think there's enough of those sob stories that the tears are able to fill a lake :yuhup:.

'Dung asked a little while ago about the percentage or funding for research, etc. This is a personal opinion, based on observing pharma, but where I think the drug industry in this country is going is they are going to essentially "outsource" almost all research and development to small pharma or university settings. They'll let the NIH, small pharma venture cap, and smaller unrestricted funds do the initial funding to get compounds to the point where they are ready to be brought through phase II and III clinical trials, then they'll form a partnership or buy the drug (or company) outright and bring it through those trials (which are the expensive ones). I can't give percentages, but increasingly big pharma is going to act sort of like a middle-man. They'll never give up their R&D entirely, but the days of people like me getting almost guarunteed jobs at a Merck or Astra are gone - it's a knife-fight to get those jobs now.

Last notes: fully support modest (aka, still have right to sue, but easier to get frivolous claims dismissed and limiting damages) tort reform, but if the figures I'm hearing are correct, it won't make much of a dent in the health care cost to do tort reform. But it's a good start. And, I believe that in 2007 a small medicare fraud task force was formed, and Obama (well, Holder actually) is stepping up the efforts to use this task force to combat fraud. I linked the story a few pages back. I'd like to see the effort expand nationwide, instead of the limited cities it's in. It costs $ to hire the investigators and prosecute the frauds, but I think the direct and indirect cost reductions make up for it.

Last notes: fully support modest (aka, still have right to sue, but easier to get frivolous claims dismissed and limiting damages) tort reform, but if the figures I'm hearing are correct, it won't make much of a dent in the health care cost to do tort reform.
In Common Law there is the concept of a 'reasonable man' Doctors are always going to make mistakes - just as we all make mistakes. I believe they should only be liable if their mistake is such that it would not have been by a "reasonable and competent doctor". So for example it might be that a doctor who took the wrong kidney out was liable (because it's incredibly rare for that to happen and almost certainly fatal) whereas a doctor who made a lesser mistake would not be liable - I guess it would clear 99% of liability cases out of the courts. I am interested in this because we seem to be going the same way over here - commercial TV is full of ads for "Ambulance chasers Direct" and the like

On the question of research if a small firm does the research and sells out that's the way the market works but if the drug is in part because of publicly funded research there has to be a mechanism for the taxpayer to collect.

Where a drug is merely altered slightly to continue the patent there has to be a way of telling the medical profession and the public that it's a rip off.

On the question of research if a small firm does the research and sells out that's the way the market works but if the drug is in part because of publicly funded research there has to be a mechanism for the taxpayer to collect.

Where a drug is merely altered slightly to continue the patent there has to be a way of telling the medical profession and the public that it's a rip off.

The NIH and NSF and any granter does get a share of the proceeds, as does the original researcher(s). Taxol and Florida State (chemists there came up with what's called a "semisynthesis" to address a severe supply shortage of taxol, which by that point was already clearly going to work as an anticancer drug) are a great example of this. I forget the percentages, but if work does lead to a patent then the NIH isn't left high and dry.

The second point? Patent agencies really have got to stop granting new patents for a new formulation and / or courts have to declare them invalid. Or other small changes. I'd make sure that stuff like old drug, completely new indication isn't caught in this crackdown, though, because some of those have real benefit to patients. AZT, the first antiretroviral, was off-patent for about 20 years for its original indication and the company that ended up marketing it for HIV treatment (Burroughs-Wellcome? I forget who...) did a screen of every compound they had and found that it was great vs. HIV. Then they did the clinical trial, etc. They invested the effort, and they got their reward of a patent for the HIV indication, and they deserved it, since they put a lot of $ in and if they didn't get that patent then no company would ever rescreen old compounds for new indications since there'd be no profit. And there would be missed opportunities for society there.

If the insurance companies kept such records, that'd be...risky...since those records, like the steroids test results from 2003 in baseball and countless other "secret" documents, risk being exposed. And that'd make them look bad. So all the examples of rescission are going to be, as you put it Mom, "sob stories".

With so may anti-insurance company groups out there, I'd be surprised if those statistics haven't been gathered. It also means, by the way, that one of the argument we've heard over and over and over and over again here as fact, can not be verified.

I actually took the time to research the issue. Guess what? It's illegal for an insurance company to cancel a person's policy because they get sick. Pre-existing condition are a different matter, but if you've had continuous coverage for more than 6 months, and you get sick, your current insurance company can't cancel your policy.

I've been accused of hysterics for the unforgivable sin of reading the bill and attempting to argue the issue on the actual facts. If we want to find a solution to the problem that we can all agree on, then we need to get rid of the hysterics and focus on the facts. Sob stories are great fodder, but they do nothing to find a solution we can all agree on.

Last notes: fully support modest (aka, still have right to sue, but easier to get frivolous claims dismissed and limiting damages) tort reform, but if the figures I'm hearing are correct, it won't make much of a dent in the health care cost to do tort reform.

I've been reading the same stuff. Tort reform will make Doctors happy and might have a slight impact on their malpractice premiums, especially in specialties, but won't have a huge impact overall. From what I can tell, it seems cost increases can be directly attributed to the number of tests and additional procedures proscribed. In some regions and facilities those rates are low while in others they're very high. And high test areas aren't necessarily the high income areas. There doesn't seem to be any relationship between the number and cost of tests ordered and the income level of the community.

I'm not sure how to control that. Best practices certainly help, and the research I consulted showed that in areas of medicine where best practices are established and have been around for years, that there is little variability. But in areas of emerging medicine, or where advances are occurring daily, there may be best practices but they aren't followed as uniformly and that results in higher test rates in some facilities.

I'd really like to know why the federal government needs to take control over private, employer sponsored health insurance, if the issue was to provide health insurance for uninsured American's. Why not just provide the public option, without taking over private insurance?

With so may anti-insurance company groups out there, I'd be surprised if those statistics haven't been gathered. It also means, by the way, that one of the argument we've heard over and over and over and over again here as fact, can not be verified.

It can be verified. One needs only the courage to read the stories of real people who've been in that situation.

I actually took the time to research the issue. Guess what? It's illegal for an insurance company to cancel a person's policy because they get sick. Pre-existing condition are a different matter, but if you've had continuous coverage for more than 6 months, and you get sick, your current insurance company can't cancel your policy.

Are you also claiming something that can't be verified? I don't see a link.

I've talked with a load of people who've gotten the shaft on the "pre-existing condition" clause. A woman who quit smoking in her twenties developed lung cancer in her sixties. Coverage denied. Another woman who enjoyed cross-country skiing until her fifties denied coverage for a hip replacement after a fall in her late seventies. A friend of mine who died several years ago from a rare and aggressive cancer spent her last months fighting her insurance company, which denied her claim by saying her extremely rare form of cancer probably began when she worked for another company. Thus her former employer's insurance underwriter should have to pay.

I think it's fair to say that some insurance companies have used those "pre-existing" clauses as a cudgel.

I actually took the time to research the issue. Guess what? It's illegal for an insurance company to cancel a person's policy because they get sick. Pre-existing condition are a different matter, but if you've had continuous coverage for more than 6 months, and you get sick, your current insurance company can't cancel your policy.

The "pre-existing conditions" is the loophole. Some of us who think that insurance companies are too often cutting people loose through rescission based on pre-existing conditions think that this loophole needs to be addressed. If the insurance company is the judge and jury on what a pre-existing condition is, then what redress do consumers have when they feel that they've been booted based on a bogus reason? That's how they legally get around what is illegal. I'm not disputing that it's illegal to cut them loose; I'm disputing the impression that you are leaving that insurance companies don't legally cut people loose based on flimsy pre-existing conditions claims. It may all be hearsay and sob stories, but at some point I can't ignore the river that's flowing by from all the tears of frustration shed by those whose claims were denied based on the pre-existing clause when logically they shouldn't have been denied.

It can be verified. One needs only the courage to read the stories of real people who've been in that situation.

Stories we've been told are true and simply have to accept on faith. But how often have we bemoaned politicians for exaggerating and outright lying to us? Sob stories make for great TV, but don't make for great policy. If you want solution to actually SOLVE problems you gotta know what the problems are. And that means separatign fact from fiction and dealing with the cold hard facts.

Are you also claiming something that can't be verified? I don't see a link.


Here are several sources:

US Department of Labor (http://www.dol.gov/index.htm)

Legal Match ("http://www.legalmatch.com/law-library/article/cancellation-of-health-insurance-policies.html)

Now how about yours?

I've talked with a load of people who've gotten the shaft on the "pre-existing condition" clause. A woman who quit smoking in her twenties developed lung cancer in her sixties. Coverage denied. Another woman who enjoyed cross-country skiing until her fifties denied coverage for a hip replacement after a fall in her late seventies. A friend of mine died several years ago from a rare and aggressive cancer spent her last months fighting her insurance company, which denied her claim by saying her extremely rare form of cancer probably began when she worked for another company. Thus her former employer's insurance underwriter should have to pay.

In all of these examples the insurance companies broke the law and your friends should have contacted an attorney.

The law (HIPPA and Kennedy Kasselbaum) states that an insurance company may exclude providing coverage for a pre-existing condition only under specific conditions. The law defines a preexisting condition is anything for which you have received care or a diagnosis in the 6 months before you enrolled in your current plan. However, if you had continuous coverage, meaning you had health insurance for the preceding 18 months with no more than a 63 day gap in coverage, even with a different carrier, then coverage your pre-existing condition can not be excluded. And the exclusion only applies for the first 12 - 18 months of coverage.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Stories we've been told are true and simply have to accept on faith. But how often have we bemoaned politicians for exaggerating and outright lying to us? Sob stories make for great TV, but don't make for great policy. If you want solution to actually SOLVE problems you gotta know what the problems are. And that means separatign fact from fiction and dealing with the cold hard facts.

Somehow I can't really equate the collective suffering of so many Americans with lying politicians. The latter are supposed to be doing something to ease the suffering, not to increase the bottom line of those companies who fund their perpetual re-election campaigns.

What you've written there - "Sob stories make for great TV, but don't make for great policy" - goes pretty far by way of explaining why so many of us turned away from the Grand Old Party in the last two elections. It's soulless and heartless to dismiss the real problems of real Americans in such cavalier manner.

Now how about yours?

Chris already has me covered.

In all of these examples the insurance companies broke the law and your friends should have contacted an attorney.

You miss the point. These people died.

Somehow I can't really equate the collective suffering of so many Americans with lying politicians. The latter are supposed to be doing something to ease the suffering, not to increase the bottom line of those companies who fund their perpetual re-election campaigns.

What you've written there - "Sob stories make for great TV, but don't make for great policy" - goes pretty far by way of explaining why so many of us turned away from the Grand Old Party in the last two elections. It's soulless and heartless to dismiss the real problems of real Americans in such cavalier manner.

They do make for great TV and play into people's fears. But those stories don't tell us how widespread the problem is. And whenever anyone dares ask for such data, we get called cold heated and get accused of only wanting to further line the pockets of our rich insurance company buddies.

If you want to solve a problem you have to know how widespread the problem is. What it's sources are. Facts matter.

There are web sites that sell helmets for children learning to walk. Why? Because a couple of kids fell down when they were learning to walk and suffered cracked skulls. The sites and baby stores are full of horror stories of ER visits and stitches and CT scans.

The thing is, while kids do sometimes fall and get hurt when they're learning to walk, is the problem so widespread and likely that kids need helmets? Yes, the stories are horrible and sad. But do they represent enough of a risk that children really need helmets when they're learning to walk?

Facts matter.

I've stated multiple times that I believe we need to do something to provide coverage for those without insurance. I just think this bill doesn't do what it's been promised to for the uninsured, and takes far too many liberties away from citizens covered under private plans.

Chris already has me covered.

Not with statistics.

You miss the point. These people died.

You miss the point. The insurance companies, in the examples you cited, broke the law. It's illegal for them do what you say they did.

Yes, they're sad horrible stories. And laws have been passed making such action by insurance companies illegal. Since the problem has been remedied, do we really need a program nationalizing health insurance for everyone to fix a problem that's already been fixed?

Okay. I concede nothing. But I'm through with this conversation.

If the insurance companies kept such records, that'd be...risky...since those records, like the steroids test results from 2003 in baseball and countless other "secret" documents, risk being exposed. And that'd make them look bad. So all the examples of rescission are going to be, as you put it Mom, "sob stories". But I think there's enough of those sob stories that the tears are able to fill a lake .

There is also the tactic of raising someone's insurance premium to unreasonable levels to force them, financially, to cancel the policy. This is what happened to my friend in town. After the diagnosis of a brain tumor, her husband's premium went from $400/mo to $1400/mo. They could not afford to keep it and, of course, now no other insurance company will accept them.

But..there is witness testimony posted...I believe by Wab, a few pages ago by a Health Insurance executive whistle-blower, under oath, that states the same thing. If you go back, it is there...if testimony to a congressional hearing is acceptable.
The 6/24/09 testimony of Wendell Potter before the U.S. Senate Committee on Commerce, Science and Transportation (http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf) (pdf file)
But if you refuse to read the bills, how do you know where the holes are? Not at all, I don't refuse to read *one* of the bills, but I do refuse to accept them as absolute canon at this point. When JKR has a first draft of her first book, that did not mean that she wasn't going to go back in, edit, take out some parts--put in new ones. Again, these are works in progress. I have read "parts" of some of the proposals. None of these will fly if a President vetoes them because they were not what he directed them to bring him. So, basically, I just don't give them the same weight as others might...although they do provide hints to where some legislators are attempting to go with things. It's not absolute *canon* until it's copyrighted and printed. I accept them as what is "proposed", not "what will be" by the time the processed is finished.

I've also had some experience with bills at a state level. They tweek that language right down to hours before voting on the final bill. Often, language is massacred on some of these things and meanings not clear because of the haste of just getting something on paper...these things are usually waded back into and "fixed" and/or edited later.

In fact, I don't think I've ever seen an initial draft of a bill actually remain unchanged by the time the final vote is taken. And, often, it looks so totally different by that time it is hardly the same bill it started out to be. ...at least, in my experience. But, legislative process could probably be a whole thread and don't want to divert from the spirit of the issues and get bogged down in legislative legalese until we get much closer to an actual, merged and fully polished work.

As Monster_Mom pointed out, last time I cried about sob stories without links.

This is "a congressional subcommittee transcript (http://energycommerce.house.gov/Press_111/20090616/transcript_20090616_oi.pdf)" Caution: 168 page pdf transcript. They noted 20000 cases they found and that Wellpoint (http://energycommerce.house.gov/Press_111/20090727/20%20Performance%20Review%20of%20Underwriting%20Su pervisor.pdf) would evaluate based on how well their employees saved money post-claims, which I interpret to mean "how well they cut people loose who had valid claims based on other pre-existing conditions"

Slate (http://www.slate.com/id/2223680/) article which has a couple terms which should be censored. There's been Congressional testimony about rescission and an investigation. I can't just ignore that and pretend that it isn't happening. Many of these rescissions were likely technically legal but ethically and morally...challenging.

Yes, just because something is "illegal" doesn't mean that loopholes aren't found and exploited to do the illegal, in a legal way.

Just like not treating uninsured ER patients if they can technically get around it by simply not doing the diagnostic test that would confirm the more expensive treatment, and treat for a minor ailment instead. Loopholes...tricks, go arounds. (Personal reference I actually witnessed first hand).

And, here's a source to a story of one of our friends here in town (since I often site the personal experiences of my friends here). This one actually made the news for a change. My husband was the co-worker and supervisor with this poor woman's son (she was uninsured, btw). So we heard this first hand but can also source it with a trustworthy, outside source. You bet...it's illegal, and it happens all the time around here. Hopefully it will add a little credence to some of the other claims that it "really is this bad" (and, btw, this happened just a week after my knee incident) from our area.

From the LA Times: http://articles.latimes.com/2007/jun/13/local/me-calls13

These occurrences need to be addressed. Loopholes that allow it need to be closed, and it would be nice to do it in this legislation if possible. This is what I'm getting at when I say this is more than a left/right ideology issue. This is a human & American crisis and resolutions of both the Insurance industry and medical industry, fraud and everything else that leads to stories like mine and the one posted above, should be sought by every American. We cannot accept the status quo any longer. As Americans, we cannot in any civilized conscience not attempt to reform this horrible mess, in my opinion.

I'm also grateful to the conservatives who ARE willing to look at solutions, even if we don't agree on the "how" all the time. There is a segment out there that is truly in denial of the need to change. We do need to get a good picture of the actual depth of the malfunction, and the seriousness of it.

Stuff just keeps getting nastier by the hour with the health care town halls. There were two yesterday in which riot conditions broke out. Imagine trying to attend a meeting like that with a bunch of conservative activists banging nonstop on the doors and windows, and shouting epithets at the top of their lungs. I've been asked not to post pictures or videos, but I do have links to share:

Scene after Fire Marshals ordered the doors closed at Rep. Kathy Castor (D-FL) (http://tpmtv.talkingpointsmemo.com/?id=3137094&ref=fpblg)

That's just the conservative activity at one entrance. These folks also banged nonstop on the doors and windows while shouting epithets loudly enough to make hearing inside virtually impossible.

Sarah Palin is now claiming (http://tpmdc.talkingpointsmemo.com/2009/08/palin-obamas-death-panel-could-kill-my-down-syndrome-baby.php?ref=fpblg) that Obama's "death panel" might decide to euthanize her Down syndrome baby.

And, in an even worse escalation of hostilities, these tea partiers have threatened SEIU with gun violence (http://theplumline.whorunsgov.com/labor/seiu-gets-threatening-phone-call-youre-gonna-come-up-against-the-second-amendment/) if they attempt to do what the tea partiers are already doing: as in disrupting the town hall meetings.

"I suggest you tell your people to calm down, act like American citizens, and stop trying to repress people's First Amendment rights," one caller warned. "That, or you all are gonna come up against the Second Amendment."

Isn't it incredible that someone could say something like that ^ without a hint of irony?

Here's another:

"If ACORN/SEIU attends these meetings for disruptive purposes, and you have a license to carry....carry. If ACORN/SEIU attends these townhalls for purposes of disruption, stop being peaceful, and hurt them. Badly."

The SEIU wasn't the only Obama ally receiving threats on Friday. An official of the AFL-CIO, which has pledged to counter conservative protests at these town hall events across the country, said that union received angry emails throughout the day as well - mostly deranged accusations that it was promoting communism and socialism.

And for some reason, the tea partiers are shrieking about ACORN, which isn't involved in the townhalls at all.

My staff and I are getting it as well. It has gotten so bad that we've had to hire armed security people to protect us while we work. Based on an incident that occurred today, I now have to go about with two personal bodyguards. I met them for the first time an hour ago. They're posted wherever I happen to be, and it makes me livid that something like this can happen in America - the land of the free and the brave. Bah! Our telephones at work and at home are being monitored 24/7 for threatening calls. And the feds are now involved.

Sarah Palin is now claiming (http://tpmdc.talkingpointsmemo.com/2009/08/palin-obamas-death-panel-could-kill-my-down-syndrome-baby.php?ref=fpblg) that Obama's "death panel" might decide to euthanize her Down syndrome baby.


This coming from someone who complains bitterly about others dragging her kids into politics.

As an aside this week the wife of the Australian Prime Minister was taken ill in Cairns. Despite the availabilty of private hospitals the local public hospital was seen as the best option for emergency treatment.

http://www.smh.com.au/national/right-as-rein-pms-wife-checks-out-of-hospital-20090807-eczf.html

I'm so sorry to hear that these measures have had to be taken for your safety. In my opinion, there should be no need for that in a civil society, especially when discussing something like health care. I have to wonder what is wrong with some of these people.

This coming from someone who complains bitterly about others dragging her kids into politics.
LOL...that was my first thought when I read that story. Also, the amount of wild claims and outrageous hyperbole out there, once more.

This is going back to the proposed "mandatory *offer* of counseling"?? Btw, that clause just makes sure it get offered and if accepted, paid for. The patient does not have to take the offer, make a specific decision based on that offer or the counseling and the whole thing has been blown totally out of proportion and reality, in my opinion. It isn't even close to "euthanasia" or "putting Granny on an ice flow" (as put by Chris Mathews on Hardball this afternoon). Honestly, this is getting to the point of ridiculousness with some misinformed people.

Rush Limbaugh is amping a lot of this by announcing the location and times of the town hall meetings on his radio show. He has also taken to comparing Democrats to Nazis, the President to Adolf Hitler, and popped up with a new one today in which he brought in Benito Mussolini as someone Obama is emulating.

The Anti-Defamation League is out with a statement (http://www.adl.org/PresRele/HolNa_52/5579_52.htm) today shaming Limbaugh and other conservatives for bringing Nazi and Hitler comparisons into the debate on health care. ADL’s national director, Abe Foxman, took direct aim at Limbaugh for his extended comparison (http://mediamatters.org/mmtv/200908060049), on yesterday’s show, between the modern Democrats and the Nazis, for advocating things like smoking bans and being "against big business."

In recent days, street protests against President Obama’s health care plan have gotten ugly, with some protestors appearing in photographs wearing swastika and SS symbols.

That prompted Rush Limbaugh to remark on his radio program that, “They accuse us of being Nazis, and Obama’s got a healthcare logo that’s right out of Adolf Hitler’s playbook.” He went on to compare certain Democratic Party policies to those of the Nazis.

“Comparisons to the Nazis are deeply offensive and only serve to diminish and trivialize the extent of the Nazi regime’s crimes against humanity and the murder of six million Jews and millions of others in the Holocaust,” said Mr. Foxman. “I don’t see any comparison here. It’s off-center, off-issue and completely inappropriate.”

ETA: One last thing. Media Matters has begun documenting everything Limbaugh says on his radio show in a new feature called Linbaugh Wire (http://mediamatters.org/limbaughwire/). Today's three-hour rant can be read on this link (http://mediamatters.org/limbaughwire/2009/08/07). Hour Two was unbelievable: He accused the President of "inciting violence."

Stuff just keeps getting nastier by the hour with the health care town halls. There were two yesterday in which riot conditions broke out. Imagine trying to attend a meeting like that with a bunch of conservative activists banging nonstop on the doors and windows, and shouting epithets at the top of their lungs. I've been asked not to post pictures or videos, but I do have links to share:

Imagine trying to pass out flags and having SEIU activists assault you. (http://stlouisteaparty.com/2009/08/07/union-thugs-deliver-unprovoked-beating-on-black-conservative-at-carnahan-town-hall/)

Scene after Fire Marshals ordered the doors closed at Rep. Kathy Castor (D-FL) (http://tpmtv.talkingpointsmemo.com/?id=3137094&ref=fpblg)

That's just the conservative activity at one entrance. These folks also banged nonstop on the doors and windows while shouting epithets loudly enough to make hearing inside virtually impossible.

Castor planned to attend the event at the last minute. It was initially scheduled as a meeting for Florida State Rep. Betty Reed (http://newsbusters.org/blogs/mike-sargent/2009/08/07/tampa-paper-tampers-town-hall-story) and was officially sponsored by the SEIU (Castor attempted to get taxpayer's to pay for the cost of producing adverts of the event but was denied because SEIU involvement made it a political, campaign event).

Because Castor has refused to meet with those opposed to nationalizing health care, those opposed to the plan showed up to make sure their voices were heard.

Members of Congress are supposed to be available for their voters. My Member has already stated in public that he'll vote for HR 3200 when it comes before Congress and has refused to schedule a public town hall to discuss health care. Representative Castor, from what I've read, has also refused to schedule a public meeting on health care. She was more than happy to meet with a rally supporters, but she had not interest in meeting with voters from her district who have questions and possibly hold a different opinion.

Neither she, nor my Members are alone. Rep. Scott (http://www.11alive.com/video/?maven_playerId=immersiveplayer3&maven_referralObject=1208541313) has also reportedly refused to meet on health care and got quite angry when asked about how he'll vote on the issue when asked about it in an open Q & A session.

With something as important as this which has consequences for each of us, you'd think our elected representatives would be willing to listen and answer questions.

Sarah Palin is now claiming (http://tpmdc.talkingpointsmemo.com/2009/08/palin-obamas-death-panel-could-kill-my-down-syndrome-baby.php?ref=fpblg) that Obama's "death panel" might decide to euthanize her Down syndrome baby.

Here's her full quote

“The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

The disabled community has expressed concern with the plan in Congress because it does not address the care disabled individuals, especially autistic children, need (http://www.wect.com/global/story.asp?s=10821632). Some of the Medicare/aid cutbacks proposed are cuts in services vital to treating autistic children.

It all comes down to rationing. (http://www.americanthinker.com/2009/08/obamacare_and_me.html)

Still doesn't explain why the woman who quit because she wanted a private life and for people to leave her kids out of politics can't resist popping up and thrusting her kids at the camera.

I have a serious disability and have never been denied any of the treatments or equipment which I need. American counterparts I've met are reduced to near penury buying the stuff they need to survive.

Which is why I have no patience with health-care reactionaries in the US. Nationalised health care works. dozens of western countries have it. It's not perfect but it works, is more cost-effective than the US system, returns better results on whatever base-line metric you choose to use and is no less restrictive in choice of care than US private policies (which you yourself have said dictate which facilities are "authorised" for policy-holders).

Sometimes you have to laugh and scratch your head about just what is going on in the minds of the protesters.

"There was a telling incident at a town hall held by Representative Gene Green, D-Tex. An activist turned to his fellow attendees and asked if they “oppose any form of socialized or government-run health care.” Nearly all did. Then Representative Green asked how many of those present were on Medicare. Almost half raised their hands."

NYT (http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=1)

Sometimes you have to laugh and scratch your head about just what is going on in the minds of the protesters.

"There was a telling incident at a town hall held by Representative Gene Green, D-Tex. An activist turned to his fellow attendees and asked if they “oppose any form of socialized or government-run health care.” Nearly all did. Then Representative Green asked how many of those present were on Medicare. Almost half raised their hands."

NYT (http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=1)

Maybe because they know how horrible Medicare is and they don't want that for the rest of the country.

(and imagine my shock to see someone from the left finally admitting that the plan amounts to government-run health care.)

Even with the full quote, I have to ask: what mandatory death panel? To the best of my knowledge they're offering non-mandatory end-of-life counseling (http://www.factcheck.org/2009/07/false-euthanasia-claims/). Like "do you have your will prepared? Does your family know your wishes? If you are unable to make a decision yourself as to care, does your family know how aggressively you want this treated?", etc. If an elderly person doesn't want said counseling, they don't have to go. No squad is going to come after them to make them go to the meeting. This isn't 1984, or any other totalitarian regime, much to the surprise of some who seem to think that way.

Besides, one panel couldn't possibly see every elderly or Down's Syndrome patient in the United States. Unless they devoted 1 second per person or something. The math just doesn't add up.

Maybe because they know how horrible Medicare is and they don't want that for the rest of the country.

(and imagine my shock to see someone from the left finally admitting that the plan amounts to government-run health care.)

He was merely noting that Medicare is government-run. And Medicare gets consistently higher satisfaction (https://www.cahps.ahrq.gov/content/NCBD/Chartbook/HEALTHPLAN08/cahps08chart19.htm) ratings than most insurance plans.

Yup, that chart there makes Medicare look really horrible. The number of respondents is high enough to make the margin of error low for the survey.

1. What is your impression of the state of the health care system in the United States?
Things need to be changed. I volunteer at the local hospital on a three to four times a month, and I've noticed how uncoordinated everything is - the nurses complain about the doctors, the pharmacists argue with the doctors, Central Supply is annoyed that people expect to have such-and-such equipment delivered immediately even if they don't accurately describe what they need, etc. So, basically there is a lot of inter-department disagreements and nothing is done to resolve the issue. We like whining. (However, it really depends on nurse/pharmacist/doctor. Some people I've met are awesome and others not so much).
Also, incompetence is tolerated not just in the Healthcare industry but throughout America. My mom likes to blame this on the 'positive reinforcement' movement that forces her to tell a late worker - Hey! You're an hour late but at least you came to work today!
But the hospitals aren't always to blame. People are responsible for themselves. We need to focus on preventative medicine. And insurance companies have a hand in rising costs, too. Healthcare is more about the money and less about the patient.

2. Do you think the United States could do better?
Yes, considering we're supposed to be one of the most advanced nations in the world.

3. What countries do you think the United States may be able to look to for inspiration or lessons, good or bad? If you are covered under such systems, what are the positives and negatives of your country's system?
I don't know. No system is perfect, so I guess we could pick and choose the things that will work for us.

4. What do you think the cost of health care reform will be? Are you willing to pay the cost? If so, what costs are you willing to pay? If not, why not?
I'm lucky that my parents can afford a decent healthcare plan. Yes, reform will be expensive, but our government has an obligation to its people. And our taxes aren't really that high when compared to those of Sweden, Turkey, France, and Poland. (http://moneycentral.msn.com/content/Taxes/P148855.asp)

5. Any other thoughts?
I don't think universal healthcare will work in this country, but I think everyone has a right to have insurance. Again, We need to focus on preventative medicine.

Maybe because they know how horrible Medicare is and they don't want that for the rest of the country.

Then one assumes they would have the courage of their convictions and go private.

(and imagine my shock to see someone from the left finally admitting that the plan amounts to government-run health care.)

He didn't. The agitator raised the bogeyman of government control. Green simply pointed out that Medicare was government run.

Even with the full quote, I have to ask: what mandatory death panel? To the best of my knowledge they're offering non-mandatory end-of-life counseling (http://www.factcheck.org/2009/07/false-euthanasia-claims/). Like "do you have your will prepared? Does your family know your wishes? If you are unable to make a decision yourself as to care, does your family know how aggressively you want this treated?", etc. If an elderly person doesn't want said counseling, they don't have to go. No squad is going to come after them to make them go to the meeting. This isn't 1984, or any other totalitarian regime, much to the surprise of some who seem to think that way.

Interestingly enough, my husband went down to the V.A. for a pre-op visit and they offered "couciling" from a social worker. It was free. They asked him if he had a living will, and the questions above. He was happy to say, "Yes, I would like help with this."

Hubby came home with a living will and put his wishes on paper should something go wrong, which of course, no one is expecting but we all know can happen with any general anesthetic surgery.

How is what is proposed different than the V.A. is already doing? He did not refer to it as a "death panel", btw. He was pleased that he was offered the opportunity to make his wishes known. He stated that he needed to do that as a responsible husband and father, anyway.

In my opinion, the reports of "death panels" are highly exaggerated (and I would call them downright false and just provocative language).

As far as health reform creating this sort of thing, it seems that the rest of the western world has managed to do it without creating "death squads" or the rumors of euthansia that seem to be prevalent right now.

He was merely noting that Medicare is government-run. And Medicare gets consistently higher satisfaction (https://www.cahps.ahrq.gov/content/NCBD/Chartbook/HEALTHPLAN08/cahps08chart19.htm) ratings than most insurance plans.

Yup, that chart there makes Medicare look really horrible. The number of respondents is high enough to make the margin of error low for the survey.

I do not buy the argument that Medicare is horrible for those who rely on it. It has it's issues that need to be addressed (like the aforementioned medical claim fraud and cost factors), but it has been operating for many years and saving the lives of the elderly, helping many who are on fixed incomes and would never have been able to afford health care find some quality of life and basic care in their golden years. In many ways it has been a success.

We really don't need the rightwing spin on this. I've already posted the original instructions the conservative protesters were given to specifically disrupt these town hall meetings, so the picky-wicky stuff just isn't going to fly. Come to think of it, Redhart also posted the same thing. What would you do with a mob of loud, obnoxious people who came with the express intent of making a mess of your opportunity to engage your constituents? I attended one myself and I saw (and heard) what they're doing. The script is the same all over the country.

There is no way the Republican Party can spin its way out of this.

I didn't approve of hateful politics when it was being practiced by the anti-war left forty years ago, and I don't approve of it now when it's practiced from the right. Asking a rude question at an open meeting is fine; disrupting a meeting for the purpose of preventing people from talking to one another is just not.

The SEIU wasn't involved in these meetings until the rightwingers went stark raving mad. Now I understand the AFL-CIO is joining the fray, and they're already under attack sight unseen. This is madness.

I have yet to see a single Republican denounce what these lunatics are doing.

Mark Kleiman (http://www.samefacts.com/archives/watching_conservatives_/2009/08/whos_calling_whom_a_nazi.php) of the Reality Based Community has a great take on the Nazi slurs the right is hurling:

1. Wingnut opponents of health insurance reform have been claiming that a provision in the House bill requiring that insurance companies cover counseling for patients who want to prepare advance directives - not, of course, any requirement that patients receive such counseling, but merely that they be offered professional help in terminal-care planning - is part of a campaign for euthanasia. No just your garden-variety teabaggers and radio talkers, either. John Boehner, the House Minority leader, said:

"This provision may start us down a treacherous path toward government-encouraged euthanasia."

2. One of the slogans used by the Nazis to justify murder was to call it "euthanasia."

3. Therefore, in wingnut logic, Obamacare = Naziism.

4. Some of the teabaggers are carrying posters with swastikas (and other Nazi references, such as Obama's features photoshopped onto a photo of Hitler) designed to make that point.

5. Nancy Pelosi complains that carrying swastikas is not a way of engaging in reasoned discourse.

6. The most extreme of Washington, DC's three right-wing newspaper editorial pages pretends that Pelosi was calling the teabaggers Nazis, and defends the mobs against an accusation that was never made. [...]

Kleiman pokes a little fun there, but Steven Pearlstein's "Republicans Propagating Falsehoods in Attacks on Health-Care Reform (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080603854.html?hpid=topnews)" has to be the gold standard of responsible political commentary. Column below the jump.

Republicans Propagating Falsehoods in Attacks on Health-Care Reform


By Steven Pearlstein
Friday, August 7, 2009


As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don't agree. Today, I'm going to step over that line.

The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.

There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.

Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.

The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.

There is still a vigorous debate as to whether one of the insurance options offered through those exchanges would be a government-run insurance company of some sort. There are now less-than-even odds that such a public option will survive in the Senate, while even House leaders have agreed that the public plan won't be able to piggy-back on Medicare. So the probability that a public-run insurance plan is about to drive every private insurer out of business -- the Republican nightmare scenario -- is approximately zero.

By now, you've probably also heard that health reform will cost taxpayers at least a trillion dollars. Another lie.

First of all, that's not a trillion every year, as most people assume -- it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.

Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year.

The Republican lies about the economics of health reform are also heavily laced with hypocrisy.

While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.

When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn't, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly.

Government negotiation on drug prices? The end of medical innovation as we know it, according to the GOP's Dr. No. Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing.

Can there be anyone more two-faced than the Republican leaders who in one breath rail against the evils of government-run health care and in another propose a government-subsidized high-risk pool for people with chronic illness, government-subsidized community health centers for the uninsured, and opening up Medicare to people at age 55?

Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.

If health reform is to be anyone's Waterloo, let it be theirs.

We really don't need the rightwing spin on this. I've already posted the original instructions the conservative protesters were given to specifically disrupt these town hall meetings, so the picky-wicky stuff just isn't going to fly. Come to think of it, Redhart also posted the same thing. What would you do with a mob of loud, obnoxious people who came with the express intent of making a mess of your opportunity to engage your constituents? I attended one myself and I saw (and heard) what they're doing. The script is the same all over the country.

There is no way the Republican Party can spin its way out of this.

I didn't approve of hateful politics when it was being practiced by the anti-war left forty years ago, and I don't approve of it now when it's practiced from the right. Asking a rude question at an open meeting is fine; disrupting a meeting for the purpose of preventing people from talking to one another is just not.

The SEIU wasn't involved in these meetings until the rightwingers went stark raving mad. Now I understand the AFL-CIO is joining the fray, and they're already under attack sight unseen. This is madness.

I have yet to see a single Republican denounce what these lunatics are doing.

Mark Kleiman (http://www.samefacts.com/archives/watching_conservatives_/2009/08/whos_calling_whom_a_nazi.php) of the Reality Based Community has a great take on the Nazi slurs the right is hurling:

1. Wingnut opponents of health insurance reform have been claiming that a provision in the House bill requiring that insurance companies cover counseling for patients who want to prepare advance directives - not, of course, any requirement that patients receive such counseling, but merely that they be offered professional help in terminal-care planning - is part of a campaign for euthanasia. No just your garden-variety teabaggers and radio talkers, either. John Boehner, the House Minority leader, said:

"This provision may start us down a treacherous path toward government-encouraged euthanasia."

2. One of the slogans used by the Nazis to justify murder was to call it "euthanasia."

3. Therefore, in wingnut logic, Obamacare = Naziism.

4. Some of the teabaggers are carrying posters with swastikas (and other Nazi references, such as Obama's features photoshopped onto a photo of Hitler) designed to make that point.

5. Nancy Pelosi complains that carrying swastikas is not a way of engaging in reasoned discourse.

6. The most extreme of Washington, DC's three right-wing newspaper editorial pages pretends that Pelosi was calling the teabaggers Nazis, and defends the mobs against an accusation that was never made. [...]

Kleiman pokes a little fun there, but Steven Pearlstein's "Republicans Propagating Falsehoods in Attacks on Health-Care Reform (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080603854.html?hpid=topnews)" has to be the gold standard of responsible political commentary. Column below the jump.

Republicans Propagating Falsehoods in Attacks on Health-Care Reform


By Steven Pearlstein
Friday, August 7, 2009


As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don't agree. Today, I'm going to step over that line.

The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.

There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.

Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.

The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.

There is still a vigorous debate as to whether one of the insurance options offered through those exchanges would be a government-run insurance company of some sort. There are now less-than-even odds that such a public option will survive in the Senate, while even House leaders have agreed that the public plan won't be able to piggy-back on Medicare. So the probability that a public-run insurance plan is about to drive every private insurer out of business -- the Republican nightmare scenario -- is approximately zero.

By now, you've probably also heard that health reform will cost taxpayers at least a trillion dollars. Another lie.

First of all, that's not a trillion every year, as most people assume -- it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.

Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year.

The Republican lies about the economics of health reform are also heavily laced with hypocrisy.

While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.

When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn't, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly.

Government negotiation on drug prices? The end of medical innovation as we know it, according to the GOP's Dr. No. Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing.

Can there be anyone more two-faced than the Republican leaders who in one breath rail against the evils of government-run health care and in another propose a government-subsidized high-risk pool for people with chronic illness, government-subsidized community health centers for the uninsured, and opening up Medicare to people at age 55?

Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.

If health reform is to be anyone's Waterloo, let it be theirs.

What are they doing? Exercising their first amendment rights. It was actually a pro-health care union who are the only ones to have committed any form of violence in this.

It's really quite simple. It's fine to come and ask questions and express concerns, however negative, about the heathcare bills in Congress. It's just thuggery to shout and scream and chant and make it impossible for anyone to discuss the issues or learn the facts. Because if they were truly interested in expressing their concerns and learning what their representatives thought, then they would be just as attentive and respectful of everyone's rights as the other people (not making a fuss) attending the meetings.

It's even possible that people who thought they were for the reforms to change their minds against legislation, based on what their representative tells them. But given all the shouting and ugliness, no one learns anything. So I have to conclude that the objective isn't to express concerns, but rather to disrupt any discussion. That's not an exercise of democracy at all.

Freedom of screech is not protected by the first which, BTW, only applies to official suppression. A private citizen or establishment can be choosy.

What are they doing? Exercising their first amendment rights. It was actually a pro-health care union who are the only ones to have committed any form of violence in this.

Judy is right in concluding that "the objective isn't to express concerns, but rather to disrupt any discussion." Having sat through one of these meetings myself, I can also attest that Wab's "freedom of screech" is an appropriate description of what happened, protected or not.

I wish there was a way to roll this information at the top of each new page, but since there isn't, I'll just repeat myself:

Right-Wing Harassment Strategy Against Dems Detailed In Memo: ‘Yell,’ ‘Stand Up And Shout Out,’ ‘Rattle Him’ (http://thinkprogress.org/2009/07/31/recess-harassment-memo/)

Specifically the memo calls for actions like these:

– Artificially Inflate Your Numbers: “Spread out in the hall and try to be in the front half. The objective is to put the Rep on the defensive with your questions and follow-up. The Rep should be made to feel that a majority, and if not, a significant portion of at least the audience, opposes the socialist agenda of Washington.”

– Be Disruptive Early And Often: “You need to rock-the-boat early in the Rep’s presentation, Watch for an opportunity to yell out and challenge the Rep’s statements early.”

– Try To “Rattle Him,” Not Have An Intelligent Debate: “The goal is to rattle him, get him off his prepared script and agenda. If he says something outrageous, stand up and shout out and sit right back down. Look for these opportunities before he even takes questions.” Emphasis mine.

The full 10-page memo can be seen here: Memo Details Co-ordinated Anti-Reform Harrassment Strategy (http://www.talkingpointsmemo.com/documents/2009/08/memo-details-co-ordinated-anti-reform-harrassment-strategy.php?page=1)

Here's a link to a story from the Richmond Times-Dispatch detailing how they are busing these tea partiers and Birthers to and from the townhall sites.

Bus tour set to protest Obama health-care plan (http://www2.timesdispatch.com/rtd/news/state_regional/state_regional_govtpolitics/article/BUSS23_20090722-222402/281595/).

KDOG, do read Steve Pearlstein's essay (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080603854.html?hpid=topnews) if you haven't already done so. Paul Krugman's "The Town Hall Mobs (http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=2)" is also a good source of information and badly-needed context.

We're receiving an incredible number of emails and phone calls discussing how much of what we're seeing and hearing from the right-wingers now should be considered incitement.

Specifically the memo calls for actions like these:

Strategy Memo– Artificially Inflate Your Numbers: “Spread out in the hall and try to be in the front half. The objective is to put the Rep on the defensive with your questions and follow-up. The Rep should be made to feel that a majority, and if not, a significant portion of at least the audience, opposes the socialist agenda of Washington.”

– Be Disruptive Early And Often: “You need to rock-the-boat early in the Rep’s presentation, Watch for an opportunity to yell out and challenge the Rep’s statements early.”

– Try To “Rattle Him,” Not Have An Intelligent Debate: “The goal is to rattle him, get him off his prepared script and agenda. If he says something outrageous, stand up and shout out and sit right back down. Look for these opportunities before he even takes questions.”
Emphasis mine.

Your cut and paste job is amazing. I find it hilarious that in nearly every quote that is posted it is copied into the forums and key parts left out of it. Fantastic.

Even with the full quote, I have to ask: what mandatory death panel? To the best of my knowledge they're offering non-mandatory end-of-life counseling (http://www.factcheck.org/2009/07/false-euthanasia-claims/).

Where did she say mandatory? Considering the attacks Palin faced during the election, including people who questioned why she chose to have a Down's child and suggested that (http://www.rationalmind.net/2008/08/30/freaks-on-parade/) choosing to have a Down's child (http://ruleofreason.blogspot.com/2008/09/palins-down-syndrome-child-and-right-to.htm) somehow made her unfit,[/url] can you blame her?

Besides, one panel couldn't possibly see every elderly or Down's Syndrome patient in the United States. Unless they devoted 1 second per person or something. The math just doesn't add up.

In the UK the National Health Service is the 3rd largest employer in the world, after the Red Army in China and the Indian Rail Service. In lieu of the language about the creation of the National Health Corps in the US, I'd have to say that the government is planing a hiring spree.

He was merely noting that Medicare is government-run. And Medicare gets consistently higher satisfaction (https://www.cahps.ahrq.gov/content/NCBD/Chartbook/HEALTHPLAN08/cahps08chart19.htm) ratings than most insurance plans.

His posted was edited after I quoted it.

As I read it he was commenting in the inconsistency in people who are on Medicare complaining about the plan nationalizing the health insurance industry. I merely commented that perhaps they are concerned because they've seen the effects of nationalized health care first hand in Medicare and don't want that expanded to every citizen in the US.

******On another topic*************

According to this article (http://city-journal.com/2009/eon0805sp.html) in city journal, the CBO has severely under-estimated to cost of nationalizing health coverage by about $1 trillion.

The CBO is actually being kind to the would-be reformers. Its analysis likely understates—by at least $1 trillion—the true costs of expanding health coverage as current Democratic legislation contemplates. Over the last few months, my colleagues and I at the consulting firm Health Systems Innovations have provided cost estimates of health-care reform to both Republican and Democratic members of Congress, and we’ve posted these estimates on our website as well. We believe that the Democratic bills currently under consideration in the House and Senate would cost $2.1 trillion and $2.4 trillion, respectively—much higher than CBO’s figures.

The discrepancies between our estimates and CBO’s stem from our different assumptions about a key issue. The Democratic plans envision a government-run insurance program, modeled after Medicare, that will compete with private insurers. How many people would opt for coverage under this public insurance? We believe that both large and small employers would have powerful incentives to shift their employees out of private coverage and into the public plan. Like the Urban Institute, we estimate that roughly 40 million people would make the shift. CBO seems to assume, however, that large employers would use the public plan only sparingly and that only 11 million people would move from private to public insurance—which would, of course, result in lower costs.

******Edit*******
Moving out of the pointed fingers and onto to the content of the Bill currently before Congress, HR 3200, let's look at Title VIII Health Care Related Taxes, specifically Section 421 Credit for Small Business Employee Health Coverage Expenses.

I have to admit that this was one of the provision I was most interested in reading because many Small Business find insuring their employee so expensive that they don't provide coverage or the coverage is so costly that their employees can't afford to purchase it. This credit could go a long way towards helping those companies provide affordable health coverage for their employees.

Here's the text of the section in full. I've been attempting to understand it for several days now, and haven't gotten far.

BTW - this is one of many reasons why I believe READING the bill is so important (an effort no one has ever complained about, until now). Also, note the effective date of the credit - December 31, 2012. When you hear estimates of the cost of this plan it's worth remembering that many of it's phase-ins and effects don't kick in until just after the 2012 Presidential elections. That means that the full effects of the program are only reflected in the last 6 years of the 10 year total. The cost going out beyond 10 years is significantly higher.

Anyway, here's the section. enjoy!

SEC. 421. CREDIT FOR SMALL BUSINESS EMPLOYEE HEALTH COVERAGE EXPENSES.

(a) In General- Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to business-related credits) is amended by adding at the end the following new section:

`SEC. 45R. SMALL BUSINESS EMPLOYEE HEALTH COVERAGE CREDIT.

`(a) In General- For purposes of section 38, in the case of a qualified small employer, the small business employee health coverage credit determined under this section for the taxable year is an amount equal to the applicable percentage of the qualified employee health coverage expenses of such employer for such taxable year.

`(b) Applicable Percentage-

`(1) IN GENERAL- For purposes of this section, the applicable percentage is 50 percent.

`(2) PHASEOUT BASED ON AVERAGE COMPENSATION OF EMPLOYEES- In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the percentage specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000.

`(c) Limitations-

`(1) PHASEOUT BASED ON EMPLOYER SIZE- In the case of an employer who employs more than 10 qualified employees during the taxable year, the credit determined under subsection (a) shall be reduced by an amount which bears the same ratio to the amount of such credit (determined without regard to this paragraph and after the application of the other provisions of this section) as--

`(A) the excess of--

`(i) the number of qualified employees employed by the employer during the taxable year, over

`(ii) 10, bears to

`(B) 15.

`(2) CREDIT NOT ALLOWED WITH RESPECT TO CERTAIN HIGHLY COMPENSATED EMPLOYEES- No credit shall be allowed under subsection (a) with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid by the employer to such employee during such taxable year exceeds $80,000.

`(d) Qualified Employee Health Coverage Expenses- For purposes of this section--

`(1) IN GENERAL- The term `qualified employee health coverage expenses' means, with respect to any employer for any taxable year, the aggregate amount paid or incurred by such employer during such taxable year for coverage of any qualified employee of the employer (including any family coverage which covers such employee) under qualified health coverage.

`(2) QUALIFIED HEALTH COVERAGE- The term `qualified health coverage' means acceptable coverage (as defined in section 59B(d)) which--

`(A) is provided pursuant to an election under section 4980H(a), and

`(B) satisfies the requirements referred to in section 4980H(c).

`(e) Other Definitions- For purposes of this section--

`(1) QUALIFIED SMALL EMPLOYER- For purposes of this section, the term `qualified small employer' means any employer for any taxable year if--

`(A) the number of qualified employees employed by such employer during the taxable year does not exceed 25, and

`(B) the average annual employee compensation of such employer for such taxable year does not exceed the sum of the dollar amounts in effect under subsection (b)(2).

`(2) QUALIFIED EMPLOYEE- The term `qualified employee' means any employee of an employer for any taxable year of the employer if such employee received at least $5,000 of compensation from such employer during such taxable year.

`(3) AVERAGE ANNUAL EMPLOYEE COMPENSATION- The term `average annual employee compensation' means, with respect to any employer for any taxable year, the average amount of compensation paid by such employer to qualified employees of such employer during such taxable year.

`(4) COMPENSATION- The term `compensation' has the meaning given such term in section 408(p)(6)(A).

`(5) FAMILY COVERAGE- The term `family coverage' means any coverage other than self-only coverage.

`(f) Special Rules- For purposes of this section--

`(1) SPECIAL RULE FOR PARTNERSHIPS AND SELF-EMPLOYED- In the case of a partnership (or a trade or business carried on by an individual) which has one or more qualified employees (determined without regard to this paragraph) with respect to whom the election under 4980H(a) applies, each partner (or, in the case of a trade or business carried on by an individual, such individual) shall be treated as an employee.

`(2) AGGREGATION RULE- All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as 1 employer.

`(3) DENIAL OF DOUBLE BENEFIT- Any deduction otherwise allowable with respect to amounts paid or incurred for health insurance coverage to which subsection (a) applies shall be reduced by the amount of the credit determined under this section.

`(4) INFLATION ADJUSTMENT- In the case of any taxable year beginning after 2013, each of the dollar amounts in subsections (b)(2), (c)(2), and (e)(2) shall be increased by an amount equal to--

`(A) such dollar amount, multiplied by

`(B) the cost of living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins determined by substituting `calendar year 2012' for `calendar year 1992' in subparagraph (B) thereof.

If any increase determined under this paragraph is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.'.

(b) Credit To Be Part of General Business Credit- Subsection (b) of section 38 of such Code (relating to general business credit) is amended by striking `plus' at the end of paragraph (34), by striking the period at the end of paragraph (35) and inserting `, plus', and by adding at the end the following new paragraph:

`(36) in the case of a qualified small employer (as defined in section 45R(e)), the small business employee health coverage credit determined under section 45R(a).'.

(c) Clerical Amendment- The table of sections for subpart D of part IV of subchapter A of chapter 1 of such Code is amended by inserting after the item relating to section 45Q the following new item:

`Sec. 45R. Small business employee health coverage credit.'.

(d) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2012.

Your cut and paste job is amazing. I find it hilarious that in nearly every quote that is posted it is copied into the forums and key parts left out of it. Fantastic.Perhaps you could post examples of what key parts were left out.

Well, in reference to the text above regarding credits to Employers giving employee health coverage, I will say: :lol: this does need clarification. I'm trying to understand it, too.

I would like a legal type to decipher it. I drove my Real Estate agent crazy requesting "translation" of every legal document (because I did read them all) and clarification.

I hope this gets cleaned up for any final versions.

The second point is, it does seem clear they are speaking of giving tax "credits" to employers who offer their workers coverage. Indeed, it is very expensive right now for employers to do so and fewer and fewer employers (especially small business) can afford to do so. I have not worked for a company that has done so personnally since the early 90s.

What also is clear is, just like individuals who have been "priced out" of the health insurance market, there are companies who have, too. Many would like to offer the coverage, but cannot at the current time. The new health reform plan is attempting to reverse this trend by A) lowering group premiums through exchanges to make them more affordable and B) offering more tax credit on the other end to help offset businesses (but the formula above, I guess..which needs to be clarified for "regular people" who might have only studied science in college, rather than law or accounting!).

So, this being said--If I remember correctly, the "tax credit" in conjunction with other changes (ie: removing stateline buying restrictions was another) was something that Senator McCain proposed himself. I don't have a problem with that. I don't have a problem with lifting stateline purchasing restrictions IF certain safeguards are put into place (regulation). I did not think that alone was going to help the uninsured, however, and I still don't. But, I'm happy to see the idea incorporated into a larger effort.

It looks like they have put a clause to exempt the credit *if* that health insurance premium is over $80,000 for one employee (this sounds like the cadillac type of insurance. I don't know many people that could afford insurance of that price!). I'm fine with that. Again, these things may change by the time we have *a* final bill and the other versions are "melded" in. Hopefully, by that time some of the language will be clarified.

Where did she say mandatory?

my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’

"Will have to"= mandatory

In the UK the National Health Service is the 3rd largest employer in the world, after the Red Army in China and the Indian Rail Service.
Link?

I'd be interested to know because it's a matter of minutes to discover that Wal-Mart (http://walmartstores.com/FactsNews/FactSheets/#EmploymentandDiversity) and the US defense forces (http://www.defenselink.mil/faq/questions.aspx) have more personnel than the less than one million in the NHS (http://www.personneltoday.com/articles/2007/08/07/41848/nearly-1-million-employees-on-nhs-electronic-staff-record-integrated-hr-and-payroll-system.html).

If you look here (http://www.bls.gov/news.release/empsit.t14.htm) you will see that the USA has 13,000,000 employed in healthcare - proportionally more than twice as many as in Britain

Looking at Sections 421 and googling for help in figuring it out, here's what I came up with.

The govn't will provide assistance to small businesses with fewer than 25 employees paid more than $5,000 a year. That assistance will be a tax credit equal to 50% of the cost of the health coverage expenses paid by the employer, subject to the following phaseouts and limitations:
- no credit will be allowed for employees paid more than $80,000
- no credit will be available if average compensation for the company is greater than $40,000
- no credit will be available if average compensation exceeds average compensation ( Section (e) (B) which I am clearly not getting)
- credit will be phased out for each employee greater than 10
- credit will be phased out when average compensation for company is between $20,000 and $40,000.

So, what's that mean in practical terms? Well that's a prime example of the government making this really really really complicated.

The full 50% credit is only available to companies with 10 or fewer employees who make more than $5,000 a year, whose company wide average total compensation of employees making over $5,000 is less than $20,000, and only for those employees who make less than $80,000.

Companies with 10 to 15 employees making more than $5,000 a year will see the amount of credit they're eligible for phased out as follows:

10 or fewer employees get full credit
11 employees, get 93% of credit
12 employees, get 87% of credit
13 employees, get 80% of credit
14 employees, get 73% of credit
15 employees, get 67% of credit


Companies with 16 or more employees making more than $5,000 a year will receive no credit.

The credit will be 50% of the total cost of coverage incurred by the employer. The credit will be reduced for any employers whose average total compensation exceeds $20,000 by a ratio of the excess to $20,000. The average total compensation is the sum of the compensation paid to all employees making $5,000 or more divided by the number of employees making $5,000 a year. The percentage of coverage costs available as a credit will be calculated as follows:
average total compensation less than $20,000, credit = 50% of coverage costs
average total compensation = 25,000 - credit = 37.5% of coverage costs
average total compensation = 30,000 - credit = 25% of coverage costs
average total compensation = 35,000 - credit = 12.5% of coverage costs
average total compensation > 40,000 - credit = 0% of coverage costs.

The credit will not be available for the cost of coverage for any employee making $80,000 or more per year.

As an example, if you have a Mom and Pop shop with 2 employees (Mom and Pop) and total compensation for Mom and Pop is $80,001 or more, then they will not the eligible to receive any credit on their health coverage because their average total compensation of $40,001 or more exceeds $40,000.

If Mom and Pop employ 2 folks to help out and pay those folks $40,000 a year, they get no credit. If Mom and Pop pay those 2 folks $30,000, they get 12.5% of their coverage costs as a credit. If Mom and Pop pay those 2 folks $20,000, they get 25% of their coverage costs as a credit.

If Mom and Pop employ 4 high school kids to help out in the shop and pay those 4 kids minimum wage to work approximately 20 hours a week (total compensation $7,540 for the 4), then Mom and Pop will be entitled to receive the full 50% credit.

Net effect # 1 - fire the more expensive labor, hire a bunch of high school kids, and expect those kids to work more than 13 hours a week so that their combined salaries reduce your overall average.

Net effect # 2 - don't pay anyone more than $80,000. Or, if you do, don't provide them with health benefits.

Net effect # 3 - don't have more than 15 employees. Or, if you need more staff and already have 15 employees, then hire a bunch of high school kids, pay them minimum wage, and work them fewer than 10 hours a week so they don't get calculated as FTEs.

Many companies already fire more senior paid employees and outsource to India (or other countries). I fail to see the difference. If they are that kind of company, they probably don't have any left. By the way, I believe there are supposed to be tax credits coming for those companies who do not outsource, soon. But, that is another subject.

Mom and pop with $80,000.01 and the four kids will be getting other tax breaks for being in that income range, but can afford insurance. I could at that point. Second, their insurance is probably going to be less expensive than it used to be. Net result: they have a boost in overall net income.

The company will also be paying less money, in theory of course, for their group plan. For the employees that qualify, they will be receiving a tax credit if they meet the qualifications. Remember, these are "credits" on things they are already paying tax on right now. Any credits would probably help them, even if they don't get full credits...or credits at all if the result is they are now paying (or can afford) to get health coverage for their employees. What credits are they getting now?

Again, we are not looking at whole pictures here of all the benefits just "who gets the extra credit and who does not". This does not mean they will not be getting financial benefit through the system. This is the problem I have with taking apart small sections of one incomplete bill.

We do know that upcoming legislation is attempting to balance out (with tax credits) and alleviate some of the burden on small business by this type of legislation.

I'm having trouble with the concept that a company gets a product they might already have for less money, possibly now with some additional tax credits (if they qualify), but it will cause them to suffer? Even if they don't qualify for all the tax credits meant for the most struggling companies?

Mom and pop with $80,000.01 and the four kids will be getting other tax breaks for being in that income range, but can afford insurance.

What additional credits? We're focusing on health care here, and under the bill they'll receive no small business assistance whatsoever. Oddly though, as a family they will receive taxpayer assistance to enroll in the public option, because that limit is for income up to 4 times the federal poverty level and for a family of 4, 4 times the federal poverty level is 88,000. So, they won't get any assistance to provide health care for themselves and their employees as part of their business but will qualify to receive taxpayer assistance as part of the public option.

Second, their insurance is probably going to be less expensive than it used to be.

Based on what? There is nothing in the bill to reduce the cost of health insurance but lots of mandates that will increase it's cost. I've mentioned many of them in previous posts. If you're aware of something in the bill which might reduce heath coverage costs, by all means, present it.

The company will also be paying less money, in theory of course, for their group plan.

Again, based on what? Please show what in the bill will reduce the cost of health insurance.

For the employees that qualify, they will be receiving a tax credit if they meet the qualifications.

For employers with fewer than 15 employees paid less than $40,000 on average.

Remember, these are "credits" on things they are already paying tax on right now.

No, they don't pay taxes on health benefits now. The cost of employee health benefits is deductible as a business expense. That deduction will be taken away as part of the bill and only small business that qualify for the credit will be allowed to deduct that portion of their health benefits when calculating their taxable income.

That's one of the methods proposed to raise revenue to provide the public option - tax the health benefits of people who have them by no longer allowing businesses to deduct the cost of health benefits.

Any credits would probably help them, even if they don't get full credits...or credits at all if the result is they are now paying (or can afford) to get health coverage for their employees. What credits are they getting now?

See above. Currently they can deduct the full cost of any health benefits they provide. They will no longer be able to do so when the bill passes.

Again, we are not looking at whole pictures here of all the benefits just "who gets the extra credit and who does not". This does not mean they will not be getting financial benefit through the system.

Oh - but we are. See the bill amends the Internal Revenue Code such that the cost of employer sponsored health benefits are no longer deductible, except under specific circumstances. The only circumstance where employer sponsored health benefits are deductible is if the company is a small business with fewer than 15 employees and the average annual salary is less than $40,000. And then the deduction is 50% of the cost of health benefits at the maximum.

This is the problem I have with taking apart small sections of one incomplete bill.

Feel free to read the entire thing, then. It's more than 1,018 pages long now.

We do know that upcoming legislation is attempting to balance out (with tax credits) and alleviate some of the burden on small business by this type of legislation.

This is the upcoming legislation to provide health coverage credits for small businesses.

I'm having trouble with the concept that a company gets a product they might already have for less money, possibly now with some additional tax credits (if they qualify), but it will cause them to suffer? Even if they don't qualify for all the tax credits meant for the most struggling companies?

Currently the full of employee health benefits is deductible. That will end with the passage of this bill. After that point only qualifying small businesses will be permitted to deduct a portion of the cost of their employee health benefits, based on the phase outs and limitations specified in Section 421.

That means that the cost of providing health benefits for non-qualifying small businesses will go up by whatever their federal tax rate is. It'll go up for qualifying small businesses as well, but not by as much.

If you have 16 employees, and provide each with $2,400 in health benefits and your federal income tax rate is 30% - you'll be paying an additional $11,500 in taxes after the bill passes. That bring the total cost of providing health benefits to $49,920.

If your 16 employees make $39,000 or less on average, the 8% penalty for not providing health benefits will be less than the new cost of providing health benefits. What do you think that employer will do, continue to provide the benefit or pay the fine and let their employees enroll in the public option? They could bump their employees pay by $3,120 (the cost of the health care benefit plus the taxes due on it) so that their employees could better afford a plan.

I have just a few broad observations to make.

Other than seniors already on Medicare and the poor, most of us with insurance will keep what we have right now.


The new health insurance exchange will provide insurance options for individuals and small businesses to purchase insurance from private companies at discounted rates and rules that make no distinction on the health condition of the newly insured. Low-income workers and their employers will be eligible for government subsidies.


One of the options available through the exchange may well be the "public option" - a government-run insurance company, in effect. That assumes it survives in the Senate, which isn't likely unless Democrats do use the Reconciliation process and pass their plan and not bother about Republican obstruction.


Health care reform will not cost a trillion dollars a year, as Republicans claim.

I remember a time when Americans understood that sometimes big change requires everyone to lose a little something in order to make a healthier whole. We saw it during the second World War, only to recede into our comfortable little tribes when the war ended. We need to find that sense of unity, of what one nation truly means - and here's a big hint: that definition is not entirely Tribe Right's or Tribe Left's.

Just out of curiosity, how much would an average American pay for private insurance? Just a ballpark figure for a single person's basic cover.

I have just a few broad observations to make.

[list] Other than seniors already on Medicare and the poor, most of us with insurance will keep what we have right now.

Except that the rules which govern what is and is not covered will be determined by the government, not by me when I choose from the plans offered by my employer or by my employer when he / she chooses which plans to provide. The cost for those plans will change based on what the government mandates.

If the objective is to provide affordable coverage for those who can not afford it, why does that require the federal government taking control over private health insurance?

The new health insurance exchange will provide insurance options for individuals and small businesses to purchase insurance from private companies at discounted rates and rules that make no distinction on the health condition of the newly insured. Low-income workers and their employers will be eligible for government subsidies.

Prove it. Show me where. Where does the bill set forth the discounted rates and how much are the discounts?

Here's a hint - they aren't there. That whole discounts rates thing isn't true. And providing health benefits for employees will become more expensive because the cost of those benefits will no longer be deductible.

One of the options available through the exchange may well be the "public option" - a government-run insurance company, in effect.

Again, where is it? Because what you are describing isn't the public option as it's described in the bill.

The public option is taxpayer assistance provided to qualifying individuals to purchase private health insurance from the exchange (the the extent that the average cost of premiums of the three lowest costing basic plans exceeds 1/12 of their annual income).

That assumes it survives in the Senate, which isn't likely unless Democrats do use the Reconciliation process and pass their plan and not bother about Republican obstruction.

Reconciliation allows for budget bills to pass with a simple majority of 51 votes. The rules for it are very complex - for instance, anything that doesn't affect the budget isn't permitted. That means the rules in the bill governing the creation of the public option won't be permitted. The rules in the bill allowing the government to nationalize the insurance industry won't be allowed. The rules in the bill mandating coverage for family planning and abortion, won't be allowed. And anything that doesn't have a budgetary impact, like the Health Insurance Exchange, will require a 60 vote majority to pass.

And if Democrats are actively pushing Reconciliation as the means by which they'll force this travesty on the American people, then they must be desperate. The Democrats have 58 votes - 60 if you county independents who caucus with them. They only need 60 to pass, and they don't think they'll get 60, then maybe, just possibly they need to reconsider the bill and go back to the drawing table. Draft something that American's can support and believe in as opposed to something that strikes fear in their hearts.

Health care reform will not cost a trillion dollars a year, as Republicans claim.

More than a trillion dollars over 10 years, with the majority of those costs coming in the last 5 years. And those estimates are from the CBO and are probably on the low side.

When it comes to this sort of thing, facts matter. Not marketing or talking points, but the actual facts. And as we all know, when it comes to insurance and the government, the devil is in the details. If you really want to know the facts, take the time to read the bill currently on the floor in the House. Figure out what it means and what it's implications are. Do research and ask whether the mandates and programs described in the bill will actually solve the problems they're supposed to solve. But don't rely on talking points and platitudes from politicians.

Just out of curiosity, how much would an average American pay for private insurance? Just a ballpark figure for a single person's basic cover.That depends on the individual. For me, I was looking at close to $600/month because of my "pre-existing condition". I couldn't afford that so I had to go without. It also probably depends on the actual insurance company too.

What additional credits? We're focusing on health care here, and under the bill they'll receive no small business assistance whatsoever.
There are other reform bills--currently three, to be melded at a later date. Some of the other tax credits are for a reduction in overall income tax rate..yes, in a non-health area of tax law, but all will come together as "relief" for that middle class. I'm looking at the "big" picture.

Second, their insurance is probably going to be less expensive than it used to be
Based on what? There is nothing in the bill to reduce the cost of health insurance but lots of mandates that will increase it's cost. I've mentioned many of them in previous posts. If you're aware of something in the bill which might reduce heath coverage costs, by all means, present it. One of the whole points of the legislation is to reduce costs and start shrinking premium rates for those who are struggling under increasing burdens..stop the spiraling and reverse it. While you may have an opinion that this bill draft and the other bills, once melded and refined, will not do this, this is one of the major things the legislation is supposed to be doing through competition, regulation and reigning in medical costs. There are a lot of economist I have read that do think this could work. Many of those have been posted here. We have posted links to economist who say "yes, it will work" and others that say, "no, it won't". We could play that game, but I'd rather not as it will most likely come down to who's economist can beat up who's economist.

I am no CPA, but I posted an exchange with you just yesterday and showed how what you had quoted from the house bill would have saved me thousands just this last year when applied to my situation. I also pointed out how it would have rippled out in savings throughout the system. That is also my opinion in how it will eventually work in practice in the larger population.

Again, this legislation, when complete, is intended to help reduce the cost of insurance and bring it down to affordable rates for both private and group. If you wish to contend it won't, that's fine. It is my belief that it should work based on the cooperative and exchange model as well as entering in the public plan into a more competitive platform (as well as additional measures to cut costs from the other end).

Just out of curiosity, how much would an average American pay for private insurance? Just a ballpark figure for a single person's basic cover.
That varies so much depending on age and condition right now. But, I can tell you that my husband and I used to have policies that ran us $800 for two...that was several years ago.

My town friend here told me her husband was playing $400/mo premiums until his diagnosis of a tumor. It then went up to $1400/mo just for him (at which point, they had to drop it because they could not afford it).

Another friend and her husband pay $1800/mo just in health premiums. She said she sometimes goes without heat in the winter and they eat a lot of tuna to afford that. She's scared to death they will raise it again and they could not afford it if they do.

Quotes I called around for ran $500-800/premiums a month for my age recently. That would be around $1K-1600/mo for us as a couple (although, hubby's a bit older so it may go higher on his).

If the objective is to provide affordable coverage for those who can not afford it, why does that require the federal government taking control over private health insurance? While I'm aware this is the way it seems to be tauted by the opposition to reform, in actuality the government is not "taking over" private health, just regulating and closing up some loopholes that have allowed apparent exploitation of those who are elderly or ill.

To me, "taking over" the industry would be pushing out the insurance corporations all together and replacing it with one, large government plan as in a single payer system.

Of course, if this capitalistic version of reform doesn't go through, I'm all for doing it the second way instead. If the current system finally implodes without a successful reform, that may be what we end up with in the end after the system has a full blown crisis.

Prove it. Show me where. Where does the bill set forth the discounted rates and how much are the discounts?

Here's a hint - they aren't there. That whole discounts rates thing isn't true ...and this is based on looking at the unfinished draft of one of the bills? You keep saying "the bill" as if it is the only one. While I understand it is frustrating that more of the legislation isn't on the table to dissect, or being changed, reworded and amended as it heads towards voting...you may need to step back and understand that the bill that you are quoting left and right is not the "last word" right now, nor the only one. But, the basics and proposals of what is being worked have been laid out.

As far as reconciliation, I feel like this may be the only way we ever get health reform through a legislature. It sometimes appears that, no matter what, opposing forces simply want to stop anything this administration attempts to do--especially if it was promised to the majority that had voted for this administration last November. Many people have been waiting decades for health care reform. The current system is crumbling and the number of people at life and death risk every day is growing as it spirals out of control. Bankruptcies due to medical bills no one could pay, the government has to subsidize and costs out of control with premiums going up so fast they are surpassing people's ability to keep up with them.

Except that the rules which govern what is and is not covered will be determined by the government, not by me when I choose from the plans offered by my employer or by my employer when he / she chooses which plans to provide. The cost for those plans will change based on what the government mandates.The government will set minimum benefits. And if insurance plans want to differentiate themselves and attract customers, all they'll have to do is offer better benefits. That's not the same as having the government restrict or limit your benefits or choices. The insurance plans will have to compete both on price and benefits. I don't see the problem here.

Here is what Politifact has to say on this issue (based on an email that was circulating opposing reform, and rating it's claims point by point):

• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process) Barely True: Section 123 establishes a Health Benefits Advisory Committee that makes recommendations on what types of health insurance coverage will be defined as basic, enhanced or premium. The committee will be chaired by the surgeon general, with members appointed by the president, the comptroller general, and representatives of federal agencies. This committee makes recommendations on insurance regulations, so in that sense it does set standards for benefits. But it does not make decisions about treatments for individuals.

• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None. Pants on Fire!: Section 142 outlines the duties of the Health Choices commissioner, who is charged with regulating insurers. The commissioner should seek insurers to offer different types of insurance, including basic, enhanced and premium. Individuals will be able to choose among competing insurers who are regulated via the exchange.

http://www.politifact.com/truth-o-meter/article/2009/jul/30/e-mail-analysis-health-bill-needs-check-/

Their ratings go from: True, Mostly true, Half true, Barely true, False and "Pants on fire!" (my fav :lol:)

So, it seems it was based in "some" truth, but at times has been exaggerated or misrepresented as to the scope of regulation and benefit setting.

Perhaps you could post examples of what key parts were left out.

Actually, Purple gave a direct link to the memo. The first thing that is noticeable is the lack of headings as otherwise set forth in the article she partially posted. I've read the memo. It does call for certain strategies, but mostly reminds people to remain respectful.

However, the most important point is that the person who sent out this memo is no "Republican operative" or Big Corporation operative. He has a PAC that has only a few dozen followers, which has raised about $5,000 and donated about $1700 worth (and I don't recall if it was mentioned to whom), and a twitter account with less followers than that.

THAT'S grassroots as far as I'm concerned. And since the internet makes it possible to get things out quickly and to many people (and Obama supporters should know that - wasn't that part of his campaign?), this has obviously gone viral and is all over the place and accessible to everyone.

Therefore, it is also not a secret.

So personally, I think that the memo should not be used in support of some "Republican" conspiracy argument. It was a grassroots memo that went national.

Can we move on from it already?

And, yes, I disagree with just disrupting for the sake of disrupting. But if the Rep or Senator refuses to answer questions, uses only the usual talking points, circles around the questions instead of answering them, then yes, the public has a right to get angry and demand a straight answer, which is all they are looking for.

And I don't have a link, but on the World News Tonight on ABC on Friday (could have been Thursday), they had a very fair and balanced report on all of this and included two citizens, African-American, who both had questions they felt were not being answered. The gentleman stated that he had read all of it and didn't understand a word of it.

So can we drop the Republican conspiracy thing, or white racist conspiracy thing, or whatever other theory is floating around the liberal MSM, unless and until actual incontrovertible evidence comes out about it. Because otherwise the constant repetition of it is just pointless and leads to pointless arguments.

The fact is that Tea Partiers and Townhallers have been relatively calm and civil. Frustration has been exhibited, yes. Some shouting, yes. But all in all, compared to a typical liberal protest, it's been pretty sedate.

Until SEIU came in and it's been going downhill from there.

Tea Partiers, Townhallers, and just the general American public have questions and want answers and are otherwise exercising their First Amendment rights, as is their right, and as was the right of Code Pink and all the other war protestors over the last 8 years (and to which Bush was nothing but tolerant and even amiable).

Perhaps we can just call this part of the discussion off-limits so that we can talk about the SUBSTANCE of this monstrosity. Or we can move it to a separate thread instead.

That varies so much depending on age and condition right now. But, I can tell you that my husband and I used to have policies that ran us $800 for two...that was several years ago.

My town friend here told me her husband was playing $400/mo premiums until his diagnosis of a tumor. It then went up to $1400/mo just for him (at which point, they had to drop it because they could not afford it).


Yikes.

I realise that it depends on age and other factors but that's scandalous.

Top cover with one of the local insurers (http://www.nib.com.au/home/newtonib/products/Pages/jfytopcover.aspx) runs at $29 per week.

There are other reform bills--currently three, to be melded at a later date. Some of the other tax credits are for a reduction in overall income tax rate..yes, in a non-health area of tax law, but all will come together as "relief" for that middle class. I'm looking at the "big" picture.

Prove it.

Show us the bills.

One of the whole points of the legislation is to reduce costs and start shrinking premium rates for those who are struggling under increasing burdens..stop the spiraling and reverse it.

If one of the the objectives is to reduce the cost f premiums so that those unable to afford health insurance can afford it, then what are the cost cutting provisions contained in the bill?

BTW - The Kennedy bill currently in the finance committee in the Senate and HR 3200 currently proposed in the House are, according to Nancy Pelosi, virtually the same.

I am no CPA, but I posted an exchange with you just yesterday and showed how what you had quoted from the house bill would have saved me thousands just this last year when applied to my situation. I also pointed out how it would have rippled out in savings throughout the system. That is also my opinion in how it will eventually work in practice in the larger population.

You assume that the assistance that would be provided to you was based on the cost of premiums for the plan of your choosing. But that's not what the bill proposes to provide. The will provide assistance to the extent that premiums exceed 1/12 of your annual income, but the premiums are the average cost of the 3 lowest costing basic plans available in your area.

The President has defined a basic plan as one with a $2500 deductible, and 80/20 split, and a small copay for office visits with vision, dental, and prescription coverage.

Just googling basic plans in my area, the average cost of the 3 lowest costing such plans for a 65 year old nonsmoking woman is approximately $250 a month. That's $3,000 a year. (it's slightly lower for a 35 year old nonsmoking woman).

That's what your assistance will be calculated from, $3,000 - 1/12 of your annual income. If the result is 0 or positive, then you get nothing. If the result is negative, then you get whatever that result is in taxpayer assistance.

You've said that you preexisting condition makes health coverage impossible to afford because the premiums are over $40,000 a year. Insurance companies set premiums at that level to cover the increased cost of care required to treat that pre-existing condition. If the government mandates that all insurance providers must cover pre-existing conditions, what makes you think the cost of those premiums will come down?

While I'm aware this is the way it seems to be tauted by the opposition to reform, in actuality the government is not "taking over" private health, just regulating and closing up some loopholes that have allowed apparent exploitation of those who are elderly or ill.

Um, no. Read Section 102, again. Every health plan available in the US will be under the control of the Health Choices Administration. The Health Choices Administration will define what will and will not be covered.

To me, "taking over" the industry would be pushing out the insurance corporations all together and replacing it with one, large government plan as in a single payer system.

Which is the ultimate objective of those involved in developing the plan. (the tapes are already out there so it's no use attempting to claim otherwise).

Of course, if this capitalistic version of reform doesn't go through, I'm all for doing it the second way instead. If the current system finally implodes without a successful reform, that may be what we end up with in the end after the system has a full blown crisis.

There's absolutely nothing to indicate that thr current system is on the brink of imploding.

...and this is based on looking at the unfinished draft of one of the bills? You keep saying "the bill" as if it is the only one. While I understand it is frustrating that more of the legislation isn't on the table to dissect, or being changed, reworded and amended as it heads towards voting...you may need to step back and understand that the bill that you are quoting left and right is not the "last word" right now, nor the only one. But, the basics and proposals of what is being worked have been laid out.

Amazing how we've never had any problem with anyone reading the text of legislation before but now we do. I can't help but wonder if that has to do with the fact that many elected officials would prefer that citizens just accept their promises as fact, when politicians have never shown a great propensity for truth-telling.

There is only one bill currently proposed. It's HR 3200. As Pelosi has said repeatedly, the Kennedy bill currently in the Senate's Finance Committee, is virtually the same bill. The other Senate bill hasn't even made it out of draft form for submission to the CBO for full cost estimates.

It sometimes appears that, no matter what, opposing forces simply want to stop anything this administration attempts to do--especially if it was promised to the majority that had voted for this administration last November.

And many of them are shaking their heads now wondering what they heck they did.

Health Care reform, as it is currently being proposed, is not supported by a majority of Americans. Opposition to it is as high now as it was when Hillary Clinton's Health Care bill died.

That doesn't mean that a majority of American oppose some sort of plan to provide affordable coverage to the uninsured. They just oppose this plan.

*****Edit*****

A rather interesting letter from the CBO relating to preventative care has been released.

Representative Nathan Deal had asked the CBO to provide some information about health care cost savings as a result of increased access to and encouragement for preventative care. We all know the old adage - an ounce of prevention equals a pound of cure. I've always understood that early diagnosis of conditions, like cancer, can lead to lower costs overall and higher survival rates.

The CBO said the following (http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf):

“In making its estimates of the budgetary effects of expanded governmental support for preventive care, CBO takes into account any estimated savings that would result from greater use of such care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”

One example is the standard for care for smokers. My neighbor, a 48 year old 20 + year smoker, was recently diagnosed with stage 1 lung cancer. She has no family history of cancer, but was a 20 + year smoker. She was diagnosed by accident when she was undergoing pre-surgical testing for an unrelated medical condition. Because she was diagnosed early her treatment, while still aggressive, appears to have been successful (knock on wood) and she's now a 2 year post treatment lung cancer survivor.

She was young for lung cancer and her cancer was caught at a very early stage. Lung cancer isn't generally caught at such an early stage. Her's was caught because she'd had a chest X-ray a few years earlier when she developed pneumonia and her Dr had an old X-Ray to compare her new X-Ray back to (much like they do with mammograms). Because her cancer was diagnosed so early and her treatment was so much more successful and less expensive in the long run (had it not have been for her early diagnosis she'd likely be dead now) physicians are now developing a best practices protocol for mandating annual chest X-Rays for smokers, starting at age 40. the X-Rays will be compared year after year for any signs of non-age related changes.

Only about 20% of smokers (current or former) ever develop lung cancer. Should preventative care include mandatory annul screening for lung cancer among smokers and non-smokers? If the argument in support of such screening is that it will reduce the cost caring for and treating advanced lung cancer, well that appears to be untrue because the increased cost of providing the screenings will exceed the cost of treating the disease.

Oh - and she's alive today because her insurance company required her to get a chest X-Ray before her unrelated surgery that identified the cancer in the first place. She received treatment at the Lombardi Cancer Center in DC, at the encouragement of her insurance company cancer liaison because Lombardi has one of the best lung cancer treatment programs in the country. So you can kinda say that her insurance company saved her life.

And, yes, I disagree with just disrupting for the sake of disrupting. But if the Rep or Senator refuses to answer questions, uses only the usual talking points, circles around the questions instead of answering them, then yes, the public has a right to get angry and demand a straight answer, which is all they are looking for.

I also agree that disruption for the sake of disrupting is not right. I also agree that if constituents don't feel their questions are being answered, they have a right to ask. I disagree with *how* some of these are asking, however.

I've taken several trips to the state capitol for hearings on various issues and/or legislation. Often, groups show up who have an interest in either supporting or opposing the same. This is pretty normal. I've also seen how this is handled. There are courtesy and decorum rules within hearing chambers. Things are done very orderly and if a person (doesn't matter which side) were to begin shouting out of turn, interrupting whoever has the the floor/microphone, whatever..they would be taken by the capitol security out of the meeting. End of story. They also don't allow t-shirts with political logos on them or signs over a certain size. Everyone is given these rules and everyone knows the consequences if the rules of decorum and manners are broken. For the most part, everyone follows them. Everyone gets heard (or equal time given to a limited number representing both sides if there are hundreds or thousands who show up--obviously, there is only so much time).

Permits are given if one's group wants to hold a "rally" or other peaceful gathering to show support or opposition (or any other reason). Everyone knows what "peaceful" means.

Now, while we could argue the ethical or moral value of lobbyist and corporate entities helping to organize and bus people to events, the fact is this is not illegal. There is a difference with encouraging people to break normal courtesy rules to disrupt. While townhalls are not legislative hearings, I think the same rules should apply.

There are many outlets for the public to access their representatives. Townhalls are one. Phoning their office, faxing their opinions and questions, writing to them and even making face to face appointments with their office are another way. I've found my representatives to be very communicative with me when I approach them in this way. Sometimes I don't like thier answers :lol:, but I don't think I've ever not been responded to or shut out (although my reps sometimes don't agree, my opinion is logged).

I guess my opinion on all this is that there is a line between being allowed to ask and being so disruptive you don't allow an answer or force officials to shut down an event so that no one's questions are answered. This is all I will say on this at this point.

The fact is that Tea Partiers and Townhallers have been relatively calm and civil. Frustration has been exhibited, yes. Some shouting, yes. But all in all, compared to a typical liberal protest, it's been pretty sedate.

Until SEIU came in and it's been going downhill from there.
typical liberal protest? My view holds for liberal, conservative or "other". Disruptions and violence simply should not be tolerated in my opinion.

Regarding "SEIU", if an individual gets involved in physical or disruptive behavior, they should also be ejected. As far as them being involved, that is their right as much as any organization or entity involved on the opposing side of the argument. This is not illegal. Nor are they somehow corrupt or evil simply for supporting one side of the argument. They are a group of people who have chosen a side in the issue they feel represents their group best...just like corporations who are involved and other organizations on the opposing side. Again, as long as they are attending civility, no problem. If they get out of line, disruptive and/or violent...I encourage law enforcement to step in and take away the offending individual as, at that point, they are stepping on the supporting message (as well as the opposing) as well. SEIU, in and of themselves, I have no problem with. I personally know many members in my community and they are all decent and nice people. I am not a member of this organization myself, but have worked with members of this organization on endeavors and, in my area, they've always been respectful, courteous and law abiding.

Prove it.

Show us the bills.

Proof...here you go. According to Reuters there are multiple Health Care Reform bills on the way in various level of draft. This has been well publicized. Reuters should be a good source reference. This is dated August 10th:

Lawmakers in Congress are working on three versions of proposals to overhaul the U.S. health care system. Many of these changes would be phased in over a number of years.

In the House of Representatives, three committees have each approved changes to one House bill. The changes will be melded by House leaders into final legislation before a floor vote expected in September.

In the Senate, the Health, Education, Labor and Pensions Committee has approved its version and the Senate Finance Committee is working on a separate health care overhaul bill....
http://www.insurancejournal.com/news/national/2009/08/10/102872.htm

Also, this same article has an answer to the small business tax credit...this is one of the things that is included (according to this article) in the "Senate" proposal version:


Senate Finance proposal

◦Expected to provide refundable tax credit for individuals up to 3 times the poverty level.

◦To provide a small business tax credit.

So answers a previous issue we were just discussing as well and where the idea of a "small business tax credit" comes from...and why, just relying on "one" of the proposals (as this article also verifies the intent for melding of the legislation later) as absolute canon.

If the government mandates that all insurance providers must cover pre-existing conditions, what makes you think the cost of those premiums will come down?
It is my belief that in conjunction with the other efforts throughout the reform bills, that it will affect premium prices. Just "forcing" a company to cover pre-existing conditions will not. If it were that easy, we wouldn't need such sweeping legislation. It's the combining of cost cutting efforts, exchanges and co-ops, competition AND regulation (as well as other factors) that is theorized to produce beneficial effects for all. Not only bring prices down for those like me, to be able to just "reach" them, but to lower them for people like you and those who already have insurance, benefiting us all. It is also my opinion that if this has worked in other countries (or system's "similar" to this), we have at least a good chance of it working here.

What I do know is that what we have is NOT working for millions here, and one of the most expensive in the world. Re: Wab's post for $29/wk premium for "top" coverage. Wab...is your country's system a fully government one or a "hybrid" basic subsidy, government, private system of some sort? That link did look like a private insurance policy.

Redhart, your assertion that there are ways to cover pre-existing conditions is antithetical to the notion of insurance to begin with.

Insurance, in all forms, is a collective pool of money paid into a central repository on the notion that things will be paid out only as needed. Costs are covered because the larger percentage of those covered will not get a debilitating or cost prohibitive ailment, and those that do are paid for based on the whole who pay premiums.

When a requirement is put out there to cover those with pre-existing conditions, you are demanding that a known cost be implemented, and therefore that automatically jacks up the premiums for all members, because now the pool of covered people contains a larger pool of sunk costs.

Basically, it's like mandating that my auto insurance carrier must insure me even if my car is already totaled.

Now, I'm not saying that those with pre-existing conditions should not be covered, however, there should be ways to select coverage a la carte, instead of mandating some sort of collective insurance plan that would include things that aren't required by the policy holder.

My wife and I are getting into our 40's and have no plan for more kids, but my state's insurance coverage MUST have prenatal care and in vitro fertilization coverage, as well as acupuncture, chiropractic, holistic medicine, etc. I'm not opposed to them, but I should have the option to pick and choose my coverage and reduce my premiums accordingly.

Regarding "SEIU", if an individual gets involved in physical or disruptive behavior, they should also be ejected. As far as them being involved, that is their right as much as any organization or entity involved on the opposing side of the argument. This is not illegal. Nor are they somehow corrupt or evil simply for supporting one side of the argument. They are a group of people who have chosen a side in the issue they feel represents their group best

That puts you in direct conflict with Nancy Pelosi and Steny Hoyer who called such questions un-american (http://blogs.usatoday.com/oped/2009/08/unamerican-attacks-cant-derail-health-care-debate-.html)

Proof...here you go. According to Reuters there are multiple Health Care Reform bills on the way in various level of draft. This has been well publicized. Reuters should be a good source reference.

You claimed that there was other legislation that proposed some sort of middle class tax relief, though not necessarily as part of the health care legislation but as part of the "big picture", but you've yet to provide anything relating to that legislation so that we can look at it. On what do you base your belief that middle class tax relief will be provided?

The health care bill count is three, per Reuters and everything I've been saying for the past several days. One - HR 3200 - is in the House. The other two are in the Senate Fiancnae Commitee. One of the two - the Kennedy Bill (http://help.senate.gov/BAI09A84_xml.pdf) - is supposedly virtually the same as HR 3200 and even carries the same name - The Affordable Health Choices Act.

The other still exists in a Senator's head and hasn't even been submitted to the CBO for costing.

As I've said before and will probably say again, you can find HR 3200 and the changes to it by googling Thomas, HR 3200. I'd provide a link by Thomas keeps timing out so that would be a waste.

The House version of the bill is easier to search because it's been added to the Congressional record, The Senate version of the bill hasn't been added to the Congressional Record and is still in pdf form, so it's a little harder to search.

So answers a previous issue we were just discussing as well and where the idea of a "small business tax credit" comes from...and why, just relying on "one" of the proposals (as this article also verifies the intent for melding of the legislation later) as absolute canon.

Except that the language in HR 3200 and the Kennedy bill are virtually identical. The house version is slightly more complicated, while the Senate version imposes a 3 year limit on the availability of the credit, grants it for larger companies (up to 50 employees), uses an average income exclusion of $50,000, and sets fixed amounts for premiums (1000 for individual , 1500 for 2 adults or one adults with kids, 2000 for family), the sections are virtually the same.

No one has ever complained about us reading and commenting on proposed legislation before. Ever. Why now? What is it about the "health care" bill that you guys are afraid to discuss?

It is my belief that in conjunction with the other efforts throughout the reform bills, that it will affect premium prices.

Yes, they will go up.

Just "forcing" a company to cover pre-existing conditions will not. If it were that easy, we wouldn't need such sweeping legislation. It's the combining of cost cutting efforts, exchanges and co-ops, competition AND regulation (as well as other factors) that is theorized to produce beneficial effects for all.

Theorized by whom to reduce costs for all? There are no cost cutting efforts in any of the bills. There are a number of mandates which have been demonstrated to increase premiums by a huge margin in states which have mandated them in the past (community pricing in NJ is one example).

Not only bring prices down for those like me, to be able to just "reach" them, but to lower them for people like you and those who already have insurance, benefiting us all.

Please show me what makes you believe this? Other than promises by politicians I've seen nothing to indicate that prices will go down and lots to indicate that prices will go up for everyone. I've listed many of those reasons previously and all you keep saying is prices will go down. Well, other than faith, what convinces you that prices will go down with any of this legislation?

Redhart, your assertion that there are ways to cover pre-existing conditions is antithetical to the notion of insurance to begin with.

...and yet, other countries have managed to pull this off. Why can't we?

That puts you in direct conflict with Nancy Pelosi and Steny Hoyer who called such questions un-american
So be it. That is my opinion whether it is contrary to someone else's or not. I said it was not illegal --I also pointed out there are some "ethical" issues that can still be debated. And, for the record, Pelosi did not call raising questions unamerican:
"...Drowning out opposing views is simply un-American. .." I believe she was calling the practice of shouting them out in a manner as to shut down conversation at all, un-American.
http://blogs.usatoday.com/oped/2009/08/unamerican-attacks-cant-derail-health-care-debate-.html
I saw nothing in the comments from the link that stated they believed actual "violence" should be tolerated by anyone (from any side).
You claimed that there was other legislation that proposed some sort of middle class tax relief, though not necessarily as part of the health care legislation but as part of the "big picture", but you've yet to provide anything relating to that legislation so that we can look at it. On what do you base your belief that middle class tax relief will be provided?
That sort of takes us off topic and was worthy of a mention to make the point, but if you want to pursue it, we should probably take that part over to the Obama Admin. thread.

As far as parsing up sections of one health reform bill (that is still undergoing changes), I have no problem with that as long as it is understood that this is a bill in flux and change and not absolute canon yet. Questioning one little bit of one bill without taking the entire synopsis of proposals (written down or promised by the President and others involved in creating this) will often do the entire package effort a disservice. For instance the question pertaining to how making pre-existing conditions exempt from denial will reduce the cost of premiums. The obvious answer is: it won't. The reason is, this is not the part of the bill that is dealing with items that will reduce premium prices.

It is like asking how will making the upholstery in a car the color tan (to reduce interior temperature, rather than black) keep it's tires inflated better when attempting to evaluate the entire car?

All Members of Congress know that a lot of horse trading goes into a final piece of legislation, so they deliberately put in items that can be discarded later. Not only that, but even items that are put in for sincere reasons, without the intent of being negotiating points, often get dropped or changed anyway. And further, picking out an item here or there without the legislative analysis of its impact or background does the item disservice, lacking the true context. Finally, I don't think any of us here are legislative analysts, so I don't see the point of debating an item that is part any of the five bills currently before the Congress.

I think debating concepts of what should or shouldn't go into such a bill is more productive.

All Members of Congress know that a lot of horse trading goes into a final piece of legislation, so they deliberately put in items that can be discarded later. Not only that, but even items that are put in for sincere reasons, without the intent of being negotiating points, often get dropped or changed anyway. And further, picking out an item here or there without the legislative analysis of its impact or background does the item disservice, lacking the true context. Finally, I don't think any of us here are legislative analysts, so I don't see the point of debating an item that is part any of the five bills currently before the Congress.

I think debating concepts of what should or shouldn't go into such a bill is more productive.

Comicbook, I agree that there is horsetrading going on, but right now it's only between the each of the Democratic representatives versions. With Senator Shumer talking pushing this through using reconciliation (a budget move that only requires 50 votes - the so called "nuclear option"), there doesn't seem to be a lot of debate going on. That's what's generating a lot of this animus.

So, if you are truly sincere about looking at everyone's ideas, and to dispel the notion that Republicans don't have a plan:

Congressman Tom Price of GA, who is also a practicing physician leads the Republican Study Commission who introduced HR 3400 - the Republican alternative.

There is a detailed SUMMARY (http://rsc.tomprice.house.gov/UploadedFiles/RSC_EPFA_Three-Page_Summary--FINAL.pdf).

Here is the text of HR 3400 (http://rsc.tomprice.house.gov/UploadedFiles/RSC_Health_Care_Text--FINAL.pdf) - (It's only 268 pages. I read HR 3200, I challenge the opposition to read this one.)

All Members of Congress know that a lot of horse trading goes into a final piece of legislation, so they deliberately put in items that can be discarded later. Not only that, but even items that are put in for sincere reasons, without the intent of being negotiating points, often get dropped or changed anyway. And further, picking out an item here or there without the legislative analysis of its impact or background does the item disservice, lacking the true context. Finally, I don't think any of us here are legislative analysts, so I don't see the point of debating an item that is part any of the five bills currently before the Congress.

I think debating concepts of what should or shouldn't go into such a bill is more productive.

So we should discuss the talking points and marketing but not the actual content of the bills?

If you want to effect change you have to be ahead of it, be informed and let your member of Congress know how you feel about legislation before it's proposed and ratified on the floor.

Why do you guys have such a problem with that?

Complaining after the fact is a total waste of time.

Here is the text of HR 3400 - (It's only 268 pages. I read HR 3200, I challenge the opposition to read this one.)


Thanks for posting this - I just started reading it. Any idea what the CBO's cost estimate for this was?

Guess what - HR 3400 provides a public option without nationalizing health insurance.

It does that under Title XXXI - Individual Membership Associations (listed in it's actual language below).

You can read the section yourself, but in short it allows any organization to offer health insurance to all of it's members, without discrimination.

How could that help? Because of issues we've talked about before.

By pooling risk across a larger group, when one individual falls ill, the increased cost of providing care for that one one individual will be absorbed across a larger pool and won't increase that one individuals coverage costs by such a large margin.

It also provides for taxpayer assistance for low income individuals to purchase a health insurance program. It does that under Title 1, Section 101 - Refundable Tax Credits for Health Insurance Costs of Low Income Individuals.

Low income individuals - those earning less than 2 times the federal poverty level are entitled to a refundable tax credit equal to which ever is lower - the premiums they pay on a plan or a fixed amount = $2000 for an individual, $4000 for a couple, and $500 for each dependent (so a single Mom with 2 kids would get whichever is lower the premiums she pays or $3000 as a refundable tax credit.)

I'm heading over to the pre-existing condition section next, since that seems to be an area we're interested in, and will post it as soon as I've read it.

**** Edit ***** Pre-existing Conditions

Pre-existing conditions can make it impossible for an individual or family to afford health coverage. We've seen a number of examples cited here before where a pre-existing condition makes the cost of premiums for a plan exceed $40,000 a year. HR 3400 requires states to provide a high risk pool for individuals and their families who can not find acceptable insurance coverage, and provides funding for the states to do so. Those pools are created under Title II, Subtitle A Safety Net for Individual with Pre-existing Conditions.

Now I'll move on to the small business assistance.

****** Edit **** Small Business Assistance

Because of the cost of health insurance coverage, some small businesses can't afford to provide it for their employees or the cost of providing such coverage is so expensive that their employees can't afford the premiums. This bill allows trade, industry, or professional associations and Chambers of Commerce to provide a listing of qualifying health benefit plans as part of their membership. The bill requires trust funds to continue health coverage in the event the association should become insolvent and additional reporting and non-discrimination requirements to the association. It also makes it a violation of federal CRIMINAL law for any association which violates the rules regarding health coverage.

Now we move on to SCHIP and Medicare / Medicaid reforms.

******Edit SCHIP Reforms ******

SCHIP is a program wherein the state provides health coverage for children in families living at or near the poverty level. One problem with SCHIP is many families who qualify for coverage have not enrolled in it. This bill seeks to remedy that and ensure that children are covered.

First - a child living in any family at less than 2 times the regional poverty level qualifies. On a federal level that 44,000 for a family of 4 (though there may be regional differences in that level).

Second - CHIP can be expanded in any state to 3 times the federal poverty level only if it's currently covers 90% of those eligible.

Currently enrolled pregnant women and children can not be tossed from the plan by the state if the state fails to meet any of the above rules.

****EDIT **** Tort Reform

HR 3400 has tort reform in Section V

**** EDIT **** More Doctors

HR 3400 provides for additional low interest student loans for medical school and will pay up $50,000 in interest and principal on those loans if the physician agrees to be a primary care physician for 5 years.

BTW folks, it's a myth that there is no bipartisan effort. Even the Senate HELP Commitee has over 100 amendments that Republicans added. They didn't get everything they wanted, but it doesn't seem reasonable to assume they would.

And I don't think any of us have the legislative experience to effectively discuss line items in the bills. My IQ and reading comprehension are in the top 1% of the country, and I've found myself shaking my head in disbelief over some of the "interpretations" of the contents of the bills. Yet, I haven't thought it wise to weigh in with my own version, since it isn't my area of expertise anymore than it is anyone else here.

And I don't think any of us have the legislative experience to effectively discuss line items in the bills. My IQ and reading comprehension are in the top 1% of the country, and I've found myself shaking my head in disbelief over some of the "interpretations" of the contents of the bills. Yet, I haven't thought it wise to weigh in with my own version, since it isn't my area of expertise anymore than it is anyone else here.

That's why we read and when we have questions we call our legislators. We'll never learn about our government and know whom to elect if we don't participate beyond the process of just voting. Secondly this is why bills oughtn't be that long or have language that is mindnumbing. If you have a comprehension rate in the upper 1% can you honestly claim that these people are smarter than you are? That you aren't qualified to read what these people hope to pass? I think you do yourself a disservice and further do the people who are actively participating in the language of these bills a disservice as well.

Thanks for the link, Gator! I hope to have time this weekend to read through the Republican bill. At least now the liberal cry of "if you have something better why don't you show it" should lessen.

That's why we read and when we have questions we call our legislators. We'll never learn about our government and know whom to elect if we don't participate beyond the process of just voting. Secondly this is why bills oughtn't be that long or have language that is mindnumbing. If you have a comprehension rate in the upper 1% can you honestly claim that these people are smarter than you are? That you aren't qualified to read what these people hope to pass? I think you do yourself a disservice and further do the people who are actively participating in the language of these bills a disservice as well.

:tu::tu:

And complaining about someone else's interpretation when you're unwilling to say what they might have misinterpreted.........that's just .....:(

Frankly, I don't think they are smarter than me :lol:. And I have been able to understand the legislation (gobbledygook and all). But despite my own healthy self-regard :D, I don't think I'm a legislative analyst. I'm watching for key features that are important to me and my daughter and me, since we are both disabled and have had insurance problems for 30 years. I haven't agreed with some of the armchair analysis posted here, like the difference between defining minimum benefits and somehow limiting better benefits. Setting a bottom for benefits does not also set a ceiling. I pointed that out but it was ignored.

I pay $200 a month for Medicare (it isn't free btw), which does have a fixed set of benefits. However I also pay an additional private insurance premium every month, so I can have drug coverage during the donut hole period, where I would have to shell out thousands of dollars otherwise. We'll see similar gap insurance plans or even entire premium plans that exceed the base coverage. The insurance companies will try to exploit any new opportunities out there. The consumer will win since premiums will need to be competitive, and benefits will need to be attractive.

Yet the armchair analysis provided in this thread implied that a minimum benefit meant restricted maximum benefits. That was nowhere in the legislation. That's why I am leery of amateur interpretations.

Well, and I don't really want to get partisan here, but think I need to for just a moment and will attempt to do so with all respect.

We have a lot of misinterpretations out in the media right now. Palin's "death panel" statement of late is a good example based on a passage in the bill regarding counseling for Living trusts and such. Obviously, one side of the argument interprets things one way, the other side very differently. Many of us are very wary of interpretation that come from those who do seem to have a political bent, no offense, just sort of a fact of life right now around this issue. We could debate whether it "should" be that way, but anyone watching coverage of the issue on the news understands what I'm talking about.

I also have a high reading comprehension, but am not schooled in the legal and accounting terminology. My education was more in the earth science area (want to discuss logarithmic equations to calculate potential energy release from a set distance of California transform fault? I'm your girl! :p )

If someone had a Portuguese document, and no one spoke Portuguese but one person, it forces all to rely on the reader's interpretation. If the interpretation is incorrect...or, if it can be interpreted in different ways, no one else would know.

Monstermom seems to be a highly intelligent person. Kudos to her and she has my full respect for her obvious intelligence..but, those of us who do not read legalese would also like other interpretations from varying sides of the argument. To do that, we look to legislative leaders or articles who have had experts look at this for us, to highlight their interpretations as well. That seems only fair, since we do not speak Portuguese.

I'm sure if I were reading an Italian document, and doing the translating for all on a very hot issue, and no one else spoke Italian, you may want to find an independent interpreter and alternate translations, as well.

And complaining about someone else's interpretation when you're unwilling to say what they might have misinterpreted.........that's just .....:(I have responded to key issues like the meaning of minimum benefits. I don't have the hand strength to refute line by line. I'd rather read professional analysis of the legislation, than correct amateur analysis.

I have responded to key issues like the meaning of minimum benefits. I don't have the hand strength to refute line by line. I'd rather read professional analysis of the legislation, than correct amateur analysis.

I've yet to see any "professional analysis" other than legislators saying this bill will do this, that, or the other thing but not point out to the public why that would be so. If the legislators would care to refute those claims by "amateurs" then they need to look hard at why the bill is so hard to decipher. They might, I don't know, want to actually read the bill. Alot of the amateurs are electing them into office. Part of their job is to help the amateurs understand what is going on.

It seems like liberals want to stay stuck on talking points (thereby painting independants and conservatives as heartless or uncharitable) and thus remain devisive rather than fix what is wrong with the actual bill as it now stands. Or maybe they want to pass it that way so they have an something to run on in the next election?

To read the whole bill is an admirable goal. And when my legislators vote, I want them, if they haven't been able to read the whole thing in between all of their other duties, to have a good idea of what's in there via some of their staff having been given the grunt work.

However, for those in opposition to health reform, I'd rather that they stick to factual attacks instead of the myriad of fictional ones that have cluttered up the "real" debate. Sites like politifact (http://www.politifact.com/truth-o-meter/) and factcheck (http://www.factcheck.org/) are jammed full of debunked misinformation being thrown around. To be fair, not every poor fact is on the part of those opposed; some of those in support are throwing around poor facts too (and both organizations are calling them on it).

So, yes, I'd like people to have read the bills before they support or object to what's in there. But, to our people in the public, with microphones or keyboards in front of them, please stick to real attacks instead of fictions.

As an aside, I think that the Senate bill that the "new gang of six" are debating is in the minds of a lot of people in the room. The NYTimes published a picture a couple weeks ago of the room, and it was jam-packed with aides. The senators got the cushy seats, while several of the aides looked rather...uncomfortable...on the side. I can try to dig it up in the archives if anyone wants.

Well, and I don't really want to get partisan here, but think I need to for just a moment and will attempt to do so with all respect.

I didn't think your post was partisan at all. I thought it was nice.

We have a lot of misinterpretations out in the media right now. Palin's "death panel" statement of late is a good example based on a passage in the bill regarding counseling for Living trusts and such.

The "death panel" thing is probably something we should discuss more. HR 3200, the bill with end of life counseling mentioned in it, provides for doctors to be provided a financial incentive when the refer sick or elderly patients to end of life counseling or provide that counseling themselves. While calling it a "death panel" may be an exaggeration, I'm not sure I'm comfortable with the government giving doctor's a kick back for every end of life referral they make. Doctor's don't get kickbacks for other referrals (like X-rays) so why should they get them for these?

Obviously, one side of the argument interprets things one way, the other side very differently. Many of us are very wary of interpretation that come from those who do seem to have a political bent, no offense, just sort of a fact of life right now around this issue. We could debate whether it "should" be that way, but anyone watching coverage of the issue on the news understands what I'm talking about.

I agree. :cool:

I also have a high reading comprehension, but am not schooled in the legal and accounting terminology. My education was more in the earth science area (want to discuss logarithmic equations to calculate potential energy release from a set distance of California transform fault? I'm your girl! :p )

How can I get my tomato plants to produce more? Quick - I need an answer before the mods tell us it's off topic!!!! :lol::lol::lol:

Monstermom seems to be a highly intelligent person. Kudos to her and she has my full respect for her obvious intelligence..but, those of us who do not read legalese would also like other interpretations from varying sides of the argument. To do that, we look to legislative leaders or articles who have had experts look at this for us, to highlight their interpretations as well. That seems only fair, since we do not speak Portuguese.

Thanks! Please, if you've found articles offering different interpretations, please post them. I hated studying government speak in school and still hate reading it. I'd appreciate anything which might clarify what I've misunderstood. But complaining about the fact that I'm actually reading the bills and offering my understanding of sections of those bills, seems highly unfair to me.

It seems like liberals want to stay stuck on talking points (thereby painting independants and conservatives as heartless or uncharitable) and thus remain devisive rather than fix what is wrong with the actual bill as it now stands. That's not a fair assumption. I just don't think that any of us are qualified for line by line decryption of the bill. I read extensively at many prominent newspapers and other reputible news outlets, and I feel they have better resources for this kind of line by line information since they rely upon experts to do the analysis. I read the various opinions and get a feel for where I stand based on sometimes conflicting information.

Any bill is going to be a mishmash of compromises with various details that will please or displease equally. This is sausage making. The end result is going to taste better than it looks right now. But all legislation is like this. It would be lovely if they didn't speak in gobbledygook, but they always do. It would be lovely if they didn't have oddball provisions, but they always do.

One more thing on the blasted death panels. This was a Republican provision. And it reimburses doctors for providing information for patients who request information on living wills or end of life counseling. It is triggered by a patient's request. And it pays for something that hasn't been paid for up to now. Every time I see a new doctor, they automatically ask me if I have a living will or would I like to set one up. They are just trying to keep from having a mess if I should fall too ill to give them clear directives. This kind of inquiry from a doctor has nothing to do with euthanasia, or death panels. And it happens now with no reimbursement associated with it. If a doctor spent his time discussing it with me now, he would not be able to get an insurance reimbursement for his time. The provision just provides a reimbursement for something that we all should do.

I don't think that one need be a "professional analyst" to try and comprehend what's going on here. We're all consumers of health insurance products, one way or another. It is the uninformed consumer that allows himself to get taken.

I expect our elected representatives to read any bill that they vote on, especially one that involves the money that we're talking. This is 1/6th of GDP. There is a huge impact here, and it is personal.

I've read through several very personal stories on this board alone that show just how intimate this particular issue can be. The reason there is such a variety of interpretations and factual errors is that the PLAN as we know it, doesn't exist. It's a set of multiple plans with no clear detail that we can really understand.

The point is that a "one size fits all" mentality WILL NOT work here. Redhart's needs are different from ComicBookWorm's which are different from Mom's or even mine. Is it too much to ask what the real details are, for something that is critical?

Is it bad form to oppose certain aspects of what is known of the President's plan, on the basis of a perceived loss of the insurance I currently have?

No one opposes Health Insurance Reform. How is it that if you are against the President's plan, that you are against all reform?

No one is going to lose their insurance. That doesn't require legislative analysis. It's been guaranteed by every bill under consideration. Frankly, I'd love for us to go single-payer. All they'd have to do is eliminate the age requirement for Medicare. We already have the bureacracy in place. But that isn't under consideration, and may never be, given how powerful the insurance lobby is.

But I do know that no one is going to be sent to death panels. No one is even going to be pressured to sign living wills. And no one will be forced out of their current insurance.

Of course there are several plans being proposed right now. None of this legislation has hit the floor of the Congress. All we have are bills that have been reported out of several committees. There hasn't been any floor debate on real legislation. The full membership hasn't had a chance to add amendments or alter provisions. However, we have heard a lot of fear-mongering about euthanasia and rationing (as if insurance companies don't ration already). I don't mind discussing the issues. But surely there are better information sources for detailed legislative analysis than any of us posting here.

Guys, I have to leave. My hands are in agony and I'm not doing myself any favors by continuing to post. Health care and health insurance reform are exceptionally important to me, but I can't type anymore.

IThe "death panel" thing is probably something we should discuss more. HR 3200, the bill with end of life counseling mentioned in it, provides for doctors to be provided a financial incentive when the refer sick or elderly patients to end of life counseling or provide that counseling themselves. While calling it a "death panel" may be an exaggeration, I'm not sure I'm comfortable with the government giving doctor's a kick back for every end of life referral they make. Doctor's don't get kickbacks for other referrals (like X-rays) so why should they get them for these?



End of life counseling, as incentivized in this bill, is just repugnant.

We own a horse barn, and owners of elderly horses talk to my wife about "end of life" plans for horses that cost too much money to keep healthy.

Liberals like Charles Rangel and Henry Waxman, co-sponsors of this bill, are seeking to reduce people to the treatment we give animals.

How vulgar.

End of life counseling, as incentivized in this bill, is just repugnant.

We own a horse barn, and owners of elderly horses talk to my wife about "end of life" plans for horses that cost too much money to keep healthy.

Liberals like Charles Rangel and Henry Waxman, co-sponsors of this bill, are seeking to reduce people to the treatment we give animals.

How vulgar.

What? Point to where in the bill it reduces people to animals.

I honestly can't believe that I'm having to repost these link(s) a third time. The misinformation about this provision is staggering to me. I'm a lukewarm supporter of the current bill(s), but the amount of misinformation regarding this one provision is making me more of a supporter of the bill.
Palin at politifact (http://www.politifact.com/truth-o-meter/article/2009/aug/10/palin-death-panel-remark-sets-truth-o-meter-fire/)
Euthanasia at factcheck (http://www.factcheck.org/2009/07/false-euthanasia-claims/)
Not gonna kill granny (http://www.politifact.com/truth-o-meter/statements/2009/jul/23/betsy-mccaughey/mccaughey-claims-end-life-counseling-will-be-requi/).

This is what I was talking about in my last post. The end-of-life counseling authorizes payment for counseling. It doesn't mandate it. It brings dignity INTO the equation, rather than out of it.

Distortions of the actual bill, like the ones about the end of life counseling, do a dis-service to those who actually want to debate the merits of the bill. It's running a sucker play on those who believe that the government is going to euthanize granny. That isn't gonna happen. By whipping up these fears, and exploiting them, it distorts and distracts from the real debate we should be having.

What? Point to where in the bill it reduces people to animals.


Chris, it is not distortion nor is it a distraction. Obama wants doctors to get paid for recommending end of life counseling; such counseling can include suicide. When dogs and cats and horses have afflictions that are too costly to cure, we euthanize them and call it humane. That's OK for animals, but not people.

Some people call it "dignity", others a violation of the sanctity of life.

Obama doesn't need this, and other objectionable provisions, to reform healthcare. IMO, it is a liberal play at injecting secular progressive policies into our society.

Chris, it is not distortion nor is it a distraction. Obama wants doctors to get paid for recommending end of life counseling; such counseling can include suicide. When dogs and cats and horses have afflictions that are too costly to cure, we euthanize them and call it humane. That's OK for animals, but not people.

Some people call it "dignity", others a violation of the sanctity of life.

Obama doesn't need this, and other objectionable provisions, to reform healthcare. IMO, it is a liberal play at injecting secular progressive policies into our society.

What does the end of life counseling cover exactly? I have been trying to find out specifics because until I know about the specifics I don't know how to feel about it.

If it is designed for elderly patients as a way to convince them to stop taking medicines because they are nearing death anyhow, I would find that completely insensitive.

such counseling can include suicide

The bill doesn't include euthanasia counseling, I already linked to the factcheck about it. If your information, from a reliable source, is better, prove me wrong.

Here's the text, as quoted on the factcheck:
H.R. 3200, page 425: Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning … .
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders … .

I'm not seeing any "covers suicide" in there. Or "encourages suicide".

I think you've got your facts wrong here Pensieve, and I hope that this clarifies it so that you don't fear the bill as much. If my evidence can't convince you that they aren't encouraging suicide, I'm sorry, but all of the facts point to your information, whatever it's source (what is its source??), being wrong.

I'm not seeing any "covers suicide" in there. Or "encourages suicide".

Not even Rangel and Waxman are dumb enough to spell it out in such blatant terms. That's why this bill is full of ambiguous language wide enough drive a truck through.

Please read this column: 'End-of-Life' Counseling Intensifies Health Care Debate (http://www.foxnews.com/politics/2009/08/06/end-life-counseling-intensifies-health-reform-debate/). Maybe this will help you to understand why this provision is so dangerous.

What does the end of life counseling cover exactly? I have been trying to find out specifics because until I know about the specifics I don't know how to feel about it.

If it is designed for elderly patients as a way to convince them to stop taking medicines because they are nearing death anyhow, I would find that completely insensitive.If people don't set up living wills, then when something serious happens no one is sure what to do. Does the person want to be on tubes indefinitely, or do they want the plug pulled if there is no hope? What kind of circumstances do they consider hopeless (since there are varying degrees of minimal brain function)? Who do they want to care for them--which family members, etc? What hospices or other facilities do they want to care for them? Who do they give power of attorney to for these decisions? Everyone should do this, but most people don't get around to it. That why the Terri Schiavo case was such a mess. Different family members had very differing opinions.

That's all they mean by end of life planning. You don't have to be old to need it, and it has nothing to do with asking old people to give up their medicines and die.

Not even Rangel and Waxman are dumb enough to spell it out in such blatant terms. That's why this bill is full of ambiguous language wide enough drive a truck through.

Please read this column: 'End-of-Life' Counseling Intensifies Health Care Debate (http://www.foxnews.com/politics/2009/08/06/end-life-counseling-intensifies-health-reform-debate/). Maybe this will help you to understand why this provision is so dangerous.

I just read it, and for something from Fox News it was remarkably fair and balanced. It reiterated what Chris just said. It acknowleged the fears but then disputed them.

I can't understand suggesting that the euthanasia provisions are hidden like the DaVinci code. It's just not there at all.

Not even Rangel and Waxman are dumb enough to spell it out in such blatant terms. That's why this bill is full of ambiguous language wide enough drive a truck through.

Please read this column: 'End-of-Life' Counseling Intensifies Health Care Debate (http://www.foxnews.com/politics/2009/08/06/end-life-counseling-intensifies-health-reform-debate/). Maybe this will help you to understand why this provision is so dangerous.

Read it, it made me understand why it isn't dangerous at all :D.

From your link:

A Harvard study released earlier this year directly linked end-of-life counseling with lower health care costs and better quality of life for patients with advanced cancers.

Better quality of life...sounds good to me.

But the sessions are not required, as President Obama reassured seniors last week at an AARP town hall meeting, when one woman said she'd been told that the policy requires everyone of Medicare age to be visited and told they have to decide how they wish to die.

Well, if you don't want it, you don't have to have it. The government won't force you.

The White House says even though Medicare would reimburse for the counseling sessions, it wouldn't conduct them.

"These decisions will be made by doctors and patients," White House spokesman Robert Gibbs said.

And, we won't need to travel to Washington - or have them travel to us - to have these sessions.

So, all in all, that article made me less afraid (when I read it over the weekend and again today).

Thanks for reassuring me further!

That's all they mean by end of life planning. You don't have to be old to need it, and it has nothing to do with asking old people to give up their medicines and die.

I just read it, and for something from fox news it was remarkably fair and balanced. It reiterated what Chris just said. It acknowleged the fears but then disputed them.

I can't understand suggesting that the euthanasia provisions are hidden like the DaVinci code. It's just not there at all.

"Health providers would be required to explain to seniors the end-of-life services available, including palliative care and hospice." In some states, like Montana, the laws allow doctors to broaden palliative care to give a patient the means to end their own life if they so choose. Oregon and Washington flat out allow euthanasia as an "end of life" option.

So you see, as Reps Boehner and McCotter said in a statement last month (as quoted in the article), "This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law". What they're saying is that once you introduce a broad legal term such as "end of life counseling" into the law, you essentially let the genie out of the bottle.

What's funny, is most of the links I just searched through, the debate is defined as palliative care vs. euthanasia. Palliative care aims to keep the patient comfortable and living until a natural death, whereas euthanasia is of course an artificial death.

Brief searches haven't found specifically whether Montana, Washington, or Oregon require their physicians (or even allow them) to discuss euthanasia as part of the palliative care. Perhaps my search terms are wrong.

Oregon: Death with Dignity act (http://egov.oregon.gov/DHS/ph/pas/index.shtml)

Washington: Death with Dignity act (http://www.doh.wa.gov/dwda/)

Montana: I will cite personal experience, which I will not discuss.

What? Point to where in the bill it reduces people to animals.

It was an analogy.

The bill provides physicians with a financial incentive to have end of life counseling sessions with their patients. It limits those conversations to once every 5 years unless the patient is diagnosed with some chronic or life threatening condition.

I don't have any problem with physician's suggesting that their patients have such conversations with their family members and their attorneys or providing their patients with informational booklets about end of life planning. I have a problem with doctors and their nurses or assistants being paid to provide such counseling or being paid for referring their patients for such counseling.

I don't have any problem with Medicare developing booklets on end of life considerations for their patients.

Distortions of the actual bill, like the ones about the end of life counseling, do a dis-service to those who actually want to debate the merits of the bill. It's running a sucker play on those who believe that the government is going to euthanize granny.

And putting words in people's mouths does as well, Chris. No one said euthanize granny. We've said that we're uncomfortable with the federal government paying doctors to counsel patients on end of life planning.

Some things I noticed from the most recent posts, and some things that I think can bring the two reasonable sides together are this:

1. The health care system in this country is complicated, the issues are complicated and personal, and the bill that is supposed to fix all of that is complicated and bloated and practically unintelligible, even by our brightest citizens.

2. From the perspective of the opposition, this bill is being force fed to the American people in a manner that is incompatible with the complicated and personal nature of the issue. Surely the supporters must see this.

3. From the perspective of the opposition, the President and some of his supporters, have, in the past, clearly and unequivocally stated that they support a SINGLE PAYER SYSTEM, which, I believe the current polls show, the majority of Americans do NOT want.

The supporters are claiming "no" regarding that support, but the evidence is to the contrary.

Add to that the Law of Unintended Consequences, the most obvious one being the "public option" has a high probability of causing the whole thing to go "single payer": If the gov't is offering an INEXPENSIVE option, what do you think employer's are going to do? Don't corporations and companies, big and small, like to save money so they can realize a bigger profit? Of course they do. So there is the "unintended consequence" that employers will move over to the gov't option, and therefore citizens will NOT be able to keep their doctors, or keep the plan they have that they like, and the insurance companies will likely go out of business due to the competition from the gov't that they can't beat since the gov't is not reqiured to make a profit like insurance companies are, leaving only the gov't and hence a single payer system.

What is the opposition left to think?

That is why people want this all to SLOW DOWN. This issue is so complicated and involves so many working parts that time must be taken to make sure that if you're going to fix it, it gets fixes as best as is possible.

For instance, the first rule should be - if it ain't broke, don't fix it.

Fix what needs to be fixed and leave alone what is working just fine.

Where is tort reform?

Where is an analysis of how when gov't became involved in the whole thing, that's when the cost problems, and other problems, started?

Where is the analysis of the "46 million people that don't have insurance" (not a higher number according to Obama at his townhall today)? Isn't the real number of people without insurance for long periods of time really more like between 8 and 11 million?

If so, shouldn't we concentrate on THAT issue, hone in on the real problems, instead of overhauling the entire system that 85% of Americans are happy with?

As with the "comprehensive immigration reform" that tried to do exactly the same thing - push through legislation that was unintelligible, didn't address some of the most salient problems about a complicated problem - this particular bill should be scrubbed and we should all agree to start over, and start slowly but surely, identifying each portion that has a problem and focus our efforts on solving that problem, if it can be done.

Frankly, as a lawyer who has to read statutes all day long and case law, I think that all laws should be written in plain English so that an 18 year old can understand them, even with a lack of real world experience.

The fact that highly intelligent and experienced Americans are having a hard time understanding it speaks volumes about the bill.

Instead of fighting to keep it or some other versino of it, we should all be demanding that they scrap it and start over, and definitely with a more bipartisan approach and not a "We won so you have to do as we say" approach.

And finally, to put all this in perspective. Something sort of similar happened during our nation's youth. A bit posted on The Corner on National Review Online by Rich Lowry. I especially like the last sentence:

I just finished reading Gordon Wood's excellent forthcoming history of the early republic, An Empire of Liberty. He describes the reaction to Congress voting to double its pay in 1816. It's not exactly analogous to today, but Pelosi and Hoyer would surely be appalled by such a clamorous show of lack of respect for our hard-working elected officials:

Now the people had a chance to make their resentment felt. Throughout the country public meetings composed of both political parties denounced the law that had raised the salaries of congressmen. Several state legislatures along with Fourth of July orators bitterly condemned it. Glasses were raised in criticism; the compensation law, noted one New York editor, was “toasted until it is black.” In Georgia opponents even burned the members of Congress in effigy.

Critics of the raise were especially incensed at Congressman Wright’s indiscreet comment about not being able to enjoy a good glass of wine and cited it over and over to great effect. Popular outrage was unprecedented, and the reputation of Congress was severely tarnished. Even congressmen who had voted against the law had to promise humbly to work to repeal it and to return the salary they had already received. In the fall elections of 1816 nearly 70 percent of the Fourteenth Congress was not returned to the Fifteenth Congress. In January 1817 a chastened lame-duck Fourteenth Congress met to debate the issue of exactly what representation meant, and by and large it determined that the people had every right to instruct their congressmen.

Emphasis mine.

And I'll leave you with that.

:D

Whoa...I was out most of the morning. You guys were busy :lol: Pardon me if I don't get to every point...
The "death panel" thing is probably something we should discuss more. HR 3200, the bill with end of life counseling mentioned in it, provides for doctors to be provided a financial incentive when the refer sick or elderly patients to end of life counseling or provide that counseling themselves. While calling it a "death panel" may be an exaggeration, I'm not sure I'm comfortable with the government giving doctor's a kick back for every end of life referral they make. Doctor's don't get kickbacks for other referrals (like X-rays) so why should they get them for these?
I think it was meant to encourage doctors to follow through. I'm fine with dropping the "kick-back" part, if it is, indeed, included. But, I also have to agree that this is not an unreasonable provision of a bill. This is not unusual, either. My husband just went through this counseling (and voluntarily agreed with it) at the V.A. hospital (Veteran's Administration for those out of country).

He will be having a rather serious surgery later this month at the VA, and the VA--as a matter of normal procedure, offered him the opportunity to sit down and discuss the "what if" issues. He had been meaning to do a Living Will, anyway. He took this opportunity to get one done. The VA paid for it. A social worker did it all legal. They also went over what his wishes where if "something happened". Point by point they recorded "his wishes". He named an executor, and back up executor. Now, we are not expecting the worst in his case, but he did appreciate having his wishes put down nice and legal so that, in the small chance something did go wrong, they were documented. No one suggested he seek suicide. No one forced him to discuss anything he wasn't interested in or pressured him to not seek medical attention if things got more serious. Didn't happen.

In other words...this is already being done in many places. Our own Veteran's Administration does this as a course of routine. I think it's a good idea...and it was a Republicans idea. Kudos!

I do not have a problem with this and am supportive of this. I'm not sure where the kick-back comes from, but if that is true, I am assuming it is to cover the doctor's time explaining what it is and what benefits (or not) there are to his patient. It also seems like it might provide financial encouragement for doctors to follow through on this to make sure patients have their *option* explained. I think good doctors would probably do this whether they get a kick back or not (and should). It does seem redundant that they make it mandatory AND offer a kick back to the doctor (if that is true). One or the other should cover it. If it's mandatory, then there's no need for a kickback. I could live with the kick-back being dropped to save costs in the system. The social worker or trained counselor should be covered if mandatory, however. That doesn't seem negotiable.

How can I get my tomato plants to produce more? Quick - I need an answer before the mods tell us it's off topic!!!!
(psst.....leaves yellow, more nitrogen and/or iron. Black spots on bottom of fruit: more calcium like a gardening lime preparation; careful--tomatoes also like acid, lime will de-acidify so you will have to add something to acidify soil as well.)
The point is that a "one size fits all" mentality WILL NOT work here. Redhart's needs are different from ComicBookWorm's which are different from Mom's or even mine. Is it too much to ask what the real details are, for something that is critical?
True--each citizen has different needs and concerns while looking at this plan. I, of course, look at what is proposed and then analyze to see if it will help me and those like me. I'm sure each one here does, too.

Part of the issue about not having something "concrete" and finished (the HR bill is still in flux, even though it's at least on paper) is that it's difficult to check "promises", "analysis" and "political rhetoric" against something tangible...or that will stay put (not changing, finished). Unfortunately, it seems like it may be months before we finally get to that point. Each piece of legislation has many steps ahead of it before we arrive at that "final" worded document. Even some legislators have complained it is difficult to discuss many aspects without a final version. Yet, to get to that final version we must have the due process. Not a perfect system, for sure. This is the way it's often done.

I was following some state legislation last month and they changed the wording every two days, it seemed, giving both opponents and supporters fits trying to follow along and keep current. So, for those who have never followed bills this closely (and these legislation are even more complex than most) it is not surprising at the frustration at the system at work. But, the final bill will come...points will clarify, be omitted, amended and finally put into a concrete, real live piece of full legislation. We just have to wait for the process to do its job.

So, Pensieve, you're going on a "slippery slope" argument? As in, if euthanasia's legalized in a state, and the state says that in any end of life counseling the topic of euthanasia is "ok", then by proxy the Waxman bill is potentially allowing payment for counseling which broaches the topic of euthanasia?

I have no problem with inserting a carefully worded amendment which says "medical professionals shall not be allowed to endorse or suggest euthanasia" to cover it. I do think, though, that patients may bring it up themselves - and I think that the law has to be written so that if the patient brings it up it doesn't automatically disqualify the physician from getting reimbursement from medicare. I can see a strong incentive to submit the bill and conveniently omit that the patient brought up euthanasia, if that's the case. Wording on such an amendment must be very carefully considered to avoid opening up a bigger problem than the small one that was closed.

Regarding my choice of words, the politifact article I linked used the terms. And, with the end-of-life counseling being called repugnant and vulgar, with the strong implication that the government would step in to encourage people to kill themselves and save society the money, I sought to reassure that that is not the case. I have no problem trying to close a small loophole, but I do have an issue with the thinking that the counseling is mandatory, or that it involves death panels, or exaggerations of that sort that have managed to make their way into the media in just the past week. I'm a stickler for discussing what's actually in there, and those feared provisions, as presented by some prominent political figures, are just not in there.

I misspoke about the GOP's health care bill - HR 3400, Empowering Patients First Act.

Previously I'd stated that the plan provided a refundable tax credit to low income individuals. That is correct, however the credit is in addition to allowing individuals to deduct the cost of health insurance premiums when they purchase them on the individual market.

So, the bill provides the following:

To bring costs down in the individual market for health coverage the act allows membership organizations to offer health insurance to their members. The bill makes money spent on purchasing an individual health care plan deductible from your federal income taxes. The bill provides an additional refundable federal tax credit for low income families of $2000 for an individual, $4000 for a couple, and $5000 for a family up to 2 times the poverty level. The credit is phased out between 2 and 3 times the poverty level.

To bring costs down for small businesses, the plan allows associations - professional, trade, industry - and Chambers of Commerce to provide health insurance to their member groups.

The bill allows individuals to opt out of Medicare or their employer sponsored health benefit plan, and gives them a credit to purchase a plan on the individual market should they so desire.

The bill also allows individuals and small businesses to shop across state lines for insurance if the insurance in their state is prohibitively expensive (more than 10% above the national average).

There's more, but that's what needed to be corrected and I'm too tired to type more.

"Health providers would be required to explain to seniors the end-of-life services available, including palliative care and hospice."Only if the senior requested it. And it doesn't have to be seniors. Terri Schiavo was rather young. Any of us could be hit by a truck at any time (and in her case it was a drug overdose).

The bill also allows individuals and small businesses to shop across state lines for insurance if the insurance in their state is prohibitively expensive (more than 10% above the national average).That's an almost insoluble problem since state insurance commissioners set differing standards for insurance industry operation within their states for their constituents. This provision would violate those standards and open some real constitutional challenges surrounding states rights (coming from the right for a change).

As for HR 3400, tax deductibility for insurance isn't all that helpful for low to middle income families that might only pay 10-15% tax. Take my own problem with a very real $12,000 premium. I'd get $2-3000 in refundable credits (Head of Household usually splits the difference between a couple and an individual), and then I wouldn't even get a tax deduction since I don't pay taxes (Social Security and disability insurance). But let's pretend I do pay taxes. It would still only represent maybe $1000-1500 more depending on my tax rate. Where would I get the additional $7000 or so?

Oh and I receive slightly more than three times the poverty rate, so it looks like I wouldn't qualify at all. Therefore it seems that I would be back to the public dole (at least for health care) for my daughter and myself.

That's why I never get excited for Republican health plans, since they only seem to benefit the upper middle class and above. The rest of us poor slobs are left in the lurch.

There's an interesting article in today's Guardian (http://www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health) about the downright lies that are being peddled in the US about Britain's health service. Almost everything you will have heard on anti-reform adverts or Fox news is completely untrue. (and the few true things you read refer to when the previous government was in power and trying to privatise it by stealth) Kennedy would have been treated here - heart complaints are treated in the elderly etc. (and of course our life expectancy is higher than in the US)

Seeing you in here 'Dung reminds me I never answered one of your questions...one of the things that academics in basic research (like me) like is that usually company funds are "unrestricted". Thus, when Merck gives my advisor $$, he doesn't need to spend it on any given project.

Most of the big pharmas give $$ to chemistry and biochemistry research groups in the US which are "unrestricted". The payoff for them in the end is twofold: first, the publications coming out of such groups aren't subject to patent, so they get the results of the research for "free", and second, it builds goodwill which can be used for recruiting some of us later on for full time jobs.

Pharma funding for groups involved in clinical research is a different ethical beast which I won't profess to know much about. The ethics there are far murkier.

As for HR 3400, tax deductibility for insurance isn't all that helpful for low to middle income families that might only pay 10-15% tax. Take my own problem with a very real $12,000 premium. I'd get $2-3000 in refundable credits (Head of Household usually splits the difference between a couple and an individual), and then I wouldn't even get a tax deduction since I don't pay taxes (Social Security and disability insurance). But let's pretend I do pay taxes. It would still only represent maybe $1000-1500 more depending on my tax rate. Where would I get the additional $7000?

Oh and I receive slightly more than three times the poverty rate, so it looks like I wouldn't qualify at all. Therefore it seems that I would be back to the public dole (at least for health care) for my daughter and myself.

That's why I never get excited for Republican health plans, since they only seem to benefit the upper middle class and above. The rest of us poor slobs are left in the lurch.

Exactly! I believe this was one of the suggestions of McCain during the campaign. I sat down and took a serious look at this idea and came to the same, exact conclusion that CBW just did...tax credits don't help if you don't pay that much in taxes due to being in the lower brackets. It would certainly help the upper brackets and maybe even make it worth their while. But, those are the ones taht already have insurance (mostly--except for those that have lost their policies due to pre-existing conditions and such).

So, this would help "some", but not nearly as many as need the help and the help is more offset to the group that needs it less.

This plan wasn't so helpful to me, personally.

There's an interesting article in today's Guardian (http://www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health) about the downright lies that are being peddled in the US about Britain's health service. Almost everything you will have heard on anti-reform adverts or Fox news is completely untrue. (and the few true things you read refer to when the previous government was in power and trying to privatise it by stealth) Kennedy would have been treated here - heart complaints are treated in the elderly etc. (and of course our life expectancy is higher than in the US)

Thanks for posting this, Dung. I try very hard to stay out of the US healthcare debate because I don't feel it's appropriate to me to comment on a system that I've never used, which is why I feel even more furious when people who've never used the UK health service try to drag it into the debate as an example of a "bad" "socialist" system. When partisan lobbying groups tell deliberate lies about the UK system, it makes me incandescent.

As you have pointed out, the problems with dental care stem largely from the Thatcherite reforms which abolished free dental check-ups and subsequent "market-based" funding reforms which made it not worth dentists' while to take on new patients. The "socialist" dental care system we used to have worked just fine, until Thatcher/Major/Blair tried to make it less socialist.

The Telegraph (an extremely conservative British newspaper) ran an article a couple of weeks ago on how the British people who have appeared in US anti-reform ads complaining about the NHS were quoted out of context and misled about how the interviews were going to be used.

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/barackobama/5907827/Barack-Obama-feels-the-weight-of-history-as-health-care-battle-heats-up.html

There's an interesting article in today's Guardian (http://www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health) about the downright lies that are being peddled in the US about Britain's health service. Almost everything you will have heard on anti-reform adverts or Fox news is completely untrue. (and the few true things you read refer to when the previous government was in power and trying to privatise it by stealth) Kennedy would have been treated here - heart complaints are treated in the elderly etc. (and of course our life expectancy is higher than in the US) I haven't looked at the article, yet, so maybe it answers my question, but do you have proof that what is being said on Fox News is untrue?

There are horror stories in any country that is meant to provide a world-class system of health care. That doesn't change whether its privately or publicly-funded treatment programs. IMO it boils down, less to the service provision, and more to do with the backroom bureaucracy that allows people to go untreated for lenghty periods of time. Nothing to do with the quality that is on offer. What needs reforming is the processes and procedures for getting patients seen to. Less red tape and more immediate access to treatment.

The stories being painted by those in opposition to the proposed reforms to US health care, are the extreme cases. The UK has socialised healthcare and for the great, vast majority of people, it works. My 91 year-old grandmother has a heart condition and had an operation at the age of 89 to correct an issue. She's now on an NHS(taxpayer)-funded exercise regime for the elderly. She paid into a system for as long as it's existed without cause to use its services at all and now it's paying her back. Her treatment has been world class, as it is for a lot of people. I don't begrudge her that treatment as a taxpayer, nor do I anyone else. Philosophically I'm happier to give to the NHS than I am to other parts under the umbrella of welfare benefits.

The problem with these types of counter-arguments is that people accumulate a wealth of negative stories without paying due attention to the positives, which by the way, are numerically superior. You see, people don't write about the positives because we expect good results and no-one wants to really read about how well treated someone was. Reminding people that the system works doesn't sell newspapers. So all that's ever printed in the media are the cases that go wrong for one reason or another. It's how reporters 'report' the news these days and notably by those in ideological opposition to the government of the day.

To understand socialised health care in a foreign country, you must do a proper fact-finding mission. Explore the entire system and make the statements you are making based on fact. This is precisely why, as a UK citizen, I don't comment on the US system.

Morgoth, I don't doubt the veracity of your assertion, and frankly, I don't think that putting either Canada or the UK up as examples of what not to do is very helpful to the argument. There are viable and tangible bills to scrutinize which should be enough to pave the way.

The issue here is about scale. No matter how efficient the bureaucracy, the difference is in administering a plan for 61 Million people (UK) versus 300 Million and the subsequent cost associated with such. Right now, the rule of thumb on taxable income is about 50%. What I mean is that US politicians, regardless of party, are hesitant to cross the 50% mark of total taxes taken from income. Any bureaucracy that size would necessitate that.

In my opinion, the President and the Democrats in Congress have a noble purpose in insuring the uninsured, but the method is to bring those that are insured down to a level that would strain the infrastructure and inflate costs. Why must we accept a system defined by the lowest common denominator?

The only real example US citizens can point to is Medicare, which despite all claims is on target to go bankrupt within a few years. It is a one size fits all program which does not means test, nor does it allow freedom of choice. In my mind, it's hardly the paragon of health bureaucracy to follow.

Right now, the rule of thumb on taxable income is about 50%. What I mean is that US politicians, regardless of party, are hesitant to cross the 50% mark of total taxes taken from income. Any bureaucracy that size would necessitate that.
While varying state and local tax rates make it variable, income tax rates are no where near 50% at this point for most citizens. Here's an excerpt from an article I was reading done in 2003 by Nobel prize economist Paul Krugman, explaining that Americans have it pretty good right now, and if you are in an upper tax bracket...you have lower taxes than from anytime BEFORE the New Deal.
"...Very few Americans pay as much as 50 percent of their income in taxes; on average, families near the middle of the income distribution pay only about half that percentage in federal, state and local taxes combined.

In fact, though most Americans feel that they pay too much in taxes, they get off quite lightly compared with the citizens of other advanced countries. Furthermore, for most Americans tax rates probably haven't risen for a generation. And a few Americans -- namely those with high incomes -- face much lower taxes than they did a generation ago.

To assess trends in the overall level of taxes and to compare taxation across countries, economists usually look first at the ratio of taxes to gross domestic product, the total value of output produced in the country. In the United States, all taxes -- federal, state and local -- reached a peak of 29.6 percent of G.D.P. in 2000. That number was, however, swollen by taxes on capital gains during the stock-market bubble.

By 2002, the tax take was down to 26.3 percent of G.D.P., and all indications are that it will be lower still this year and next.

This is a low number compared with almost every other advanced country. In 1999, Canada collected 38.2 percent of G.D.P. in taxes, France collected 45.8 percent and Sweden, 52.2 percent.

Still, aren't taxes much higher than they used to be? Not if we're looking back over the past 30 years. As a share of G.D.P., federal taxes are currently at their lowest point since the Eisenhower administration. State and local taxes rose substantially between 1960 and the early 1970's, but have been roughly stable since then. Aside from the capital gains taxes paid during the bubble years, the share of income Americans pay in taxes has been flat since Richard Nixon was president.

Of course, overall levels of taxation don't necessarily tell you how heavily particular individuals and families are taxed. As it turns out, however, middle-income Americans, like the country as a whole, haven't seen much change in their overall taxes over the past 30 years. On average, families in the middle of the income distribution find themselves paying about 26 percent of their income in taxes today. This number hasn't changed significantly since 1989, and though hard data are lacking, it probably hasn't changed much since 1970.

Meanwhile, wealthy Americans have seen a sharp drop in their tax burden. The top tax rate -- the income-tax rate on the highest bracket -- is now 35 percent, half what it was in the 1970's. With the exception of a brief period between 1988 and 1993, that's the lowest rate since 1932. Other taxes that, directly or indirectly, bear mainly on the very affluent have also been cut sharply. The effective tax rate on corporate profits has been cut in half since the 1960's. The 2001 tax cut phases out the inheritance tax, which is overwhelmingly a tax on the very wealthy: in 1999, only 2 percent of estates paid any tax, and half the tax was paid by only 3,300 estates worth more than $5 million. The 2003 tax act sharply cuts taxes on dividend income, another boon to the very well off. By the time the Bush tax cuts have taken full effect, people with really high incomes will face their lowest average tax rate since the Hoover administration.

So here's the picture: Americans pay low taxes by international standards. Most people's taxes haven't gone up in the past generation; the wealthy have had their taxes cut to levels not seen since before the New Deal. Even before the latest round of tax cuts, when compared with citizens of other advanced nations or compared with Americans a generation ago, we had nothing to complain about -- and those with high incomes now have a lot to celebrate..."
http://www.nytimes.com/2003/09/14/magazine/the-tax-cut-con.html?pagewanted=2

One of the reasons for our deficit is that taxes have not been raised for quite some time, even when bills for two wars and other expenses have been added to the budget.

Do I want taxes to sore? Of course not, but I think we can afford a little tax here and there if we are getting benefits to the system that will cut the government's cost on the other end.

For instance, if you have an uninsured man walk into an ER (or limp in) for treatment for a badly infected cut and he runs up a $10,000 bill he cannot pay (really bad, has to be put on IV antibiotics because it has gone septic and threatens his life). The hospital then asks the government for a subsidy to defer the non-paid bill. Let us say the government pays 75%, then the hospital raises it's prices on Tylenol tablets from $5 to $6 to cover the loss and passes it onto your insurance company...who raises premiums and passes it on to their clients.

How enabling those who do not have insurance to cut costs in the system works like this...

Now, the same man pays "something" into the system if he isn't in the lowest, income group. Let us say he pays $50/mo. That's money directly to the system. Let us also say he now has access to a basic care doctor and goes to them when the infection is small. $10 out of pocket, $25 for meds. The government or private company (depending on the plan he chose) now only is picking up the cost of the balance of a doctor visit and medication cost. The government saves nearly $5,000 on this one patient since they do not have to pay a subsidy to the hospital to cover a larger bill. PLUS...this patient has actually now paid at least something into the system (he was not paying anything into it before), whether that is to the private insurance company or the public plan. The savings to to all parties are very apparent in this. The government's costs are now decreasing instead of increasing and offsetting the cost of the reform itself.

To me, this is a no brainer. This is going to decrease our national budget in subsidized payments for the uninsured because most of us are already paying for their care. With reform, they are now able to at least start contributing to their own care themselves, and decreasing the burden on everyone else.

Other ways making health care beneficial to the economy is the big reduction in medically-associated bankruptcies. Think of the burden that will help alleviate in our recovering credit and banking industry, as well as the mortgage and housing areas of our economy.

When I add to this the the emotional factor (and my personal opinion) of, as a country, we can't stand by and watch the sick and poor to go without care (and possibly die because of it) simply to make sure no one has to pay any more tax, well...I'd rather have the tax. I think we can afford it if applied correctly and kept relatively minimal through efforts to cut government ER room subsidies and savings to our markets through reduction of bankruptcy as just a couple examples.

In my opinion, the President and the Democrats in Congress have a noble purpose in insuring the uninsured, but the method is to bring those that are insured down to a level that would strain the infrastructure and inflate costs. Why must we accept a system defined by the lowest common denominator?

Again, if you look at the Krugman article above regarding taxation levels in our country and the burden the uninsured and under-insured issue already is on our economy, I come to a completely different conclusion and opinion.

That's an almost insoluble problem since state insurance commissioners set differing standards for insurance industry operation within their states for their constituents. This provision would violate those standards and open some real constitutional challenges surrounding states rights (coming from the right for a change).

The bill states that in order to be sold across state lines, the insurance company must meet the laws of both states. So if you live in California and want to enroll in a plan offered from Arizona, then the insurance provider offering the plan must meet both California and Arizona laws.

As for HR 3400, tax deductibility for insurance isn't all that helpful for low to middle income families that might only pay 10-15% tax.

It's worth remembering, however, who pays taxes in the US. Those with income below $33,000 generally do not pay any federal income taxes. $33,000 is about 1.5 times the federal poverty level for a family. The children in those families qualify for SCHIP (because that goes to 2 times the poverty level). The parents may not qualify for Medicare or Medicaid, but they'd be eligible to deduct the cost of premiums from their income and be eligible for a $2000 refundable tax credit for one parent or a $4000 refundable tax credit for 2 parents.

That $2000 translates into $167 a month ($4000 translates into $333 a month) for health insurance. In my area that $167 for one adult or $333 for two would cover more than 90% of the premiums.

The Democrats plan only provides a benefit to the extent that the premiums exceed 1/12 of their income. At 33,000 a year they have income of about 2,500 month and will only receive a benefit if their premiums are more than $2500. Under the Republican's plan they'll get a credit no matter what their premiums are.

Redhart, your analysis AND the President's plan completely disregards a key element in the rise of health care costs, and that is medical liability suits and the need for tort reform.

The Health Coalitions on Liability and Access (http://www.hcla.org/pdf/HCLAReportFINAL.pdf) has a well documented report on the current Tort Crisis and its impact on health care.

The problem has become so pervasive that about
one-third of orthopaedists, obstetricians, trauma surgeons,
emergency room doctors and plastic surgeons
can expect to be sued in any given year; practicing
neurosurgeons can expect to be sued even more
often — every two years, on average — and nearly
three out of five OB-GYNs have been sued at least
twice in their careers. Most of these cases are meritless:
data for 2006 show that some 71% of cases are
dropped or dismissed, and only 1% of cases result in a
verdict for the plaintiff. Nevertheless, the cost is staggering,
with even those cases that result in no payment
to the plaintiff costing an average of $25,000 to
defend against. Meanwhile, the average jury award
has escalated from about $347,000 in 1997 to
$637,000 in 2006.

This has led to shortages of specialists (which adding 47 million new insurees to the rolls will not ameliorate)

An American Hospital Association survey found
that fifty-five percent of hospitals were reporting
difficulty recruiting doctors because of the medical
liability crisis;
• Three out of four emergency rooms reported
diverting ambulances due to a shortage of specialists,
and more than twenty-five percent of hospitals
said they had lost specialist coverage due to
the medical liability crisis;
• Forty-four percent of neurosurgeons reported
having to limit the type of patients they treat, with
seventy-one percent no longer performing
aneurysm surgery,twenty-three percent no longer
treating brain tumors and seventy-five percent no
longer operating on children;
• Fifty-five percent of orthopaedic surgeons avoid
some procedures due to liability concerns; one out
of five have stopped performing emergency room
calls; six percent have eliminated all surgery and
one out of twenty retired early;

You want real savings? Try this:


A recent updating of the findings of a 2003 HHS report on defensive medicine to the most recent year in which data were available put the
costs at as much as $170 billion per year.
Comprehensive medical liability reform, including
reasonable limits on non-economic damages, would
reduce national health care costs by a similar
amount.Medicare spending alone would be reduced
by $17 to $31 billion per year.

In my opinion, if the President says any funding source is on the table, why doesn't he get his fellow trial lawyers to help out?

I do have to wonder why some form of tort reform isn't included, but it isn't the panacea that I would like it to be, if the numbers I hear are correct. The indirect effect of lowering unnecessary testing via doctors being less afraid of lawsuits may be more savings than the malpractice premiums, etc.
OK, dueling links: It'll save billions!!! (http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002816.html)
vs. Factcheck: it won't save much. (http://www.factcheck.org/president_uses_dubious_statistics_on_costs_of.html )

Perhaps we could get these links to have a wizarding duel to settle the matter?

My own personal take is that they should include some form of tort reform, but they need more, much more, to fix all the problems in the nation's health care. One measure can't do it alone, it'll be lonely and it'll need friends.

More radical idea: the government pays all doctor's malpractice premiums. This one is a "Chris Special" :lol:.

Well, the more I learn, the more I do like tort reform if we can still guarantee protection to citizens who might be *truly* harmed in the medical world. But, I've said that before.

But like Chris, I tend to be a bit pragmatic about how much we can do with one bill. We may need separate legislation.

Well, the more I learn, the more I do like tort reform if we can still guarantee protection to citizens who might be *truly* harmed in the medical world. But, I've said that before.

But like Chris, I tend to be a bit pragmatic about how much we can do with one bill. We may need separate legislation.

You'll get no argument from me on this point. The article I posted previously indicates that the number of suits filed is actually diminishing, but the payouts are expanding. I think reasonable limits on the "pain and suffering" items (those exclusive of actual damages caused by malfeasance) are fine. That would allow litigation to proceed while keeping the costs down.

Also, a loser pay system would discourage frivolity. As noted, MD's actually win over 70% of the suits filed, so in a loser pay system, they would not incur the court costs which also jack up malpractice rates.

Take a typical specialist where I live in Florida. Their average salary can be well over $300K for a neonatologist, however their med/mal insurance runs anywhere from $100K to $150K per year. Those costs tend to get shifted to the patient or the doctor stops performing certain procedures.

Apparently, spreading misinformation (or, if you prefer, legitimate concerns) has caused the Senate Finance committee to just drop the end-of-life counseling (http://online.wsj.com/article/SB125012322203627701.html). Maybe it'll come back as a stand-alone bill, like it was originally introduced.

More radical idea: the government pays all doctor's malpractice premiums. This one is a "Chris Special" :lol:.Chris, I assume that's said with tongue firmly in cheek, but you've hit the sore spot I have with this bill (and many others). "The government" doesn't have any money with which to pay malpractice premiums. "The government" is a fiduciary (and often a poor one, IMO) of monies belonging to the taxpayers. I think too often people think of "government money" or "government spending" and don't stop to realize that it's our money we're talking about. Yours and mine. And there isn't a limitless supply of it. Whether government involvement in health care is a good or bad thing should not be the issue before "how in the world are we going to pay for this." I'm of the opinion that when you can't afford something, you don't buy it. You do something to increase your income or you cut something else out of your budget. You don't just keep borrowing and borrowing. Hopefully I'm not coming off as heartless and not caring about people who need health care and can't afford it, and therefore need some kind of insurance. That's not my intention. I just think we need to acknowledge that we can't afford it and address that issue first.

ETA: I know, I should have said "this issue" instead of "this bill" as there isn't a final draft of a bill on the table - but I trust you understand what I mean. :)

Apparently, spreading misinformation (or, if you prefer, legitimate concerns) has caused the Senate Finance committee to just drop the end-of-life counseling. Maybe it'll come back as a stand-alone bill, like it was originally introduced.
Well, geesh. You know, this was a republican contribution that I actually liked. What a shame, I do think it could have been so beneficial.

The "can't afford it" argument can go both ways. Currently, the cost of the current system is costing the government mega bucks already. They are paying subsidies to ER's to keep them open when the uninsured can't pay. They are paying the cost in the credit industries with the high number of medically-caused bankrupcies and forclosures on homes.

When medical cost skyrocket...not only do Insurance companies and their clients pay higher premiums, but the government pays higher bills, too.

I do agree, we need to find ways to pay for this. Several are on the table. Some of that "pay" is coming in streamlining the system and looking for excesses that can be addressed. Some of the money will come if previously uninsured actually start paying at least small amounts into the system. Other cuts will come when some of those subsidies to keep ERs open start to decline because the uninsured can actually go to private physicians to make an ER visit unnecisary...and at a lower cost, or even averting a minor issue that becomes a medical ER necessity.

And, of course, there's been talk of raising tax (ie: on the top brackets of income, on cadillac policies, on items like "soda pop", etc).

These are only a few, but there does seem to be a concerted effort to really find a way to pay for this, and make it pay for itself over the long haul.

As we get closer to a finished piece of legislation, we might have a better idea how all those things will (or won't) work toward that end.

<snip> The "can't afford it" argument can go both ways. <snip>
My "can't afford it" objection applies to more than just this bill, including what the government is already doing in the health care field. I just didn't go there in an attempt to keep the post on topic to the thread (and had to do a lot of editing before I posted it, in that regard. :lol: )

Chris, I assume that's said with tongue firmly in cheek, but you've hit the sore spot I have with this bill (and many others). "The government" doesn't have any money with which to pay malpractice premiums. "The government" is a fiduciary (and often a poor one, IMO) of monies belonging to the taxpayers. I think too often people think of "government money" or "government spending" and don't stop to realize that it's our money we're talking about. Yours and mine. And there isn't a limitless supply of it. Whether government involvement in health care is a good or bad thing should not be the issue before "how in the world are we going to pay for this." I'm of the opinion that when you can't afford something, you don't buy it. You do something to increase your income or you cut something else out of your budget. You don't just keep borrowing and borrowing. Hopefully I'm not coming off as heartless and not caring about people who need health care and can't afford it, and therefore need some kind of insurance. That's not my intention. I just think we need to acknowledge that we can't afford it and address that issue first.

ETA: I know, I should have said "this issue" instead of "this bill" as there isn't a final draft of a bill on the table - but I trust you understand what I mean. :)

While I like the idea of socialized health care I too have issues with where will the money come from and how will it be paid. That seems to be what Americans want answered the most. Can you blame them? If the system works and people are treated to great quality care in a timely fashion then I personally do not mind paying a little extra in taxes.

The bill that they want to pass is a 1000 pages long and who has the time to read through that. I mean things need to be simplified down so that the average citizen can read it for themselves. I think that is what is provoking some of the fear that is going around. People want to be reassured that when they go to the doctor that the quality of care will be up to standard. Rationing health care is a fear that I have seen Seniors in particular raise as well. When fear takes over like this it's very hard for people to listen.

If the government truly wants to get this passed they need to sell their message better imo. With all the partisan bickering I would be surprised if any kind of reform gets done.

With a Hat Tip to Gator for pointing it out, I give you an overview of HR 3400, the GOP's health reform bill entitled "Empowering Putting Patients First". (http://www.govtrack.us/congress/bill.xpd?bill=h111-3400)

In summary, the act provides the following:

An enhanced individual market

To bring costs down in the individual market for health coverage, the act allows membership organizations to offer health insurance to their members. The bill also makes money spent on purchasing an individual health care plan deductible from your federal income taxes. The bill provides qualifying low income individuals and families who may not pay any taxes the option of receiving a refundable federal tax credit of $2000 for an individual, $4000 for a couple, and $5000 for a family.

Increased Affordability for Small Businesses

To bring costs down for small businesses, the plan allows associations - professional, trade, industry - and Chambers of Commerce to provide health insurance to their member groups.

Coverage for those with High Risk Conditions or Pre-Existing Conditions

The bill provides credits and funding to states which create a high risk pool for individuals whose pre-existing medical conditions preclude them for obtaining affordable health coverage.

Other Benefits

The bill also allows individuals and small businesses to shop across state lines for insurance if the insurance in their state is prohibitively expensive (more than 10% above the national average).

The bill allows individuals to opt out of Medicare or their employer sponsored health benefit plan, and gives them a credit to purchase a plan on the individual market should they so desire.

The bill provides for tort reform, physician payment reform, and increased fraud prevention, investigation, and enforcement.

The bill provides loans and repayment options to make medical school a bit more affordable.

The bill requires states to enroll at least 90% of the CHIP eligible children before expanding eligibility to 3 times the poverty level.

****
I can hear the complaints now that the bill benefits the rich over the poor because of it's tax benefits. So let's look at a few examples to see if that assertion turns out to be true. I've used the expand function to make this shorter and easier to read.

Any individual or family living at or below 1.33 times the federal poverty level qualifies for Medicaid / SCHIP coverage. That doesn’t change in either bill, so the benefit for those families under either bill is the same.

Children living in a family at or below 2 times the federal poverty level qualify for SCHIP coverage (for a single parent with 2 kids that’s below $36,620; for a Mom and Dad with 2 kids that’s $44,100). Their parents, however, do not. That will not change with either bill. What benefit will be available to Mom and Dad under either plan depends on how much they make, how much their insurance premiums cost, and how much they pay in taxes.

At $30,000 a year her income is below 2 times the federal poverty level for a family of 3, so her children would qualify for coverage under SCHIP. Because her income is more than 1.33 times the federal poverty level, she would not qualify for Medicaid.

Under HR 3200, the Democrats plan, if her employer provides a health benefit which costs her less than 1/12 her annual income (or $2,500) she gets nothing. If the premiums paid for a health insurance plan provided by her employer or purchased from the federally controlled Health Insurance Exchange exceeded 1/12 of her annual income, she will be eligible to receive additional taxpayer assistance. The benefit would be the extent to which the average of the three lowest costing basic plans exceeded 1/12 of her annual income.

So she’d get a benefit if the average cost of premiums for a basic plan exceeded $2,500 a year, or $208 a month. If her employer offered a less expensive plan or she found a less expensive plan from the Exchange, she’d get nothing. Note that the benefit isn’t calculated from the plan she chooses, but rather the average cost of the three lowest costing basic plans.

Under HR 3400, the Republican’s plan, that Mom would be able to deduct either the cost of any premiums she paid when determining her taxable income or would receive a refundable tax credit equal to the lesser of the premiums she paid or $2,000. She could even split the premiums and use part to reduce her taxable income to 0 and then use the rest as a refundable credit. If her employer offered a plan which she couldn’t afford, she could opt out of her employers plan and enroll in an individual plan and receive the benefit described above.

If this Mom’s premiums are less than $4,500 then the Republican’s plan offers her the greatest financial benefit.

For the Democrats plan to provide this Mom with a greater benefit, because she will be eligible to receive a $2000 refundable tax credit under the Republican plan, the cost of the premiums she pays will have to be at least $4,500 ($2000 more than 1/12 of her annual income).

This Mom makes more than 2 times the federal poverty level, so her kids don’t qualify for SCHIP and she doesn’t qualify for Medicaid.

Under HR 3200, the Democrat’s plan, because her income is less than 4 times the federal poverty level for a family of 3, she may qualify for additional taxpayer assistance, depending on the cost of the premiums she pays.

If her employer provides health insurance and the cost of the premiums she pays for that insurance is less than 1/12 of her income, which is $5,000, then she will not be eligible to receive any taxpayer assistance. If her employer does not provide health insurance, or the cost of her employer sponsored coverage is more than $5000, then she’d be eligible to receive additional taxpayer assistance.

That assistance will be equal to the excess of the premiums she pays for her employer sponsored plan or a plan she purchased from the Exchange over $5000. If she purchases a plan from the Exchange, the cost of the premiums used to calculate her benefit is the average cost of the three lowest costing basic plans offered through the Exchange.

Under HR 3400, the Republican’s plan, because her income is more than 3 times the federal poverty level, she is not eligible to receive the refundable credit. If her employer sponsors a plan and she opts out of it, she can purchase health insurance from the individual pool and deduct the cost of premiums for that plan from her federal income taxes. If her employer does not sponsor a plan, she can purchase health insurance from the individual pool and will be able to deduct the cost of premiums for that plan from her federal income taxes.

For this Mom, which plan offers the biggest benefit depends on how much the premiums on her insurance plan are and her tax bracket. According to the Tax Foundation, the average federal income tax paid by families with $60,000 annual income is about 16%.

If her premiums are less than $5,000, no matter what federal income tax rate she pays, the Republican plan provides her with a greater financial benefit.

Assuming she pays 16% in federal income taxes, and her premiums are less than $5,952 a year, then the Republican’s plan provides her with the greatest financial benefit. If her premiums exceed $5,952, then the Democrats plan provides her with the greatest financial benefit.

Under HR 3200, the Democrat’s plan, she’d pay an additional tax.

Under HR 3400, the Republican’s plan, if her families coverage coverage came from her employer, then she’d get nothing. If she purchased her families coverage from the individual market, then she’d get to deduct the cost of premiums paid on their plan, to the extent of the national average paid for premiums by employers.

For this Mom, the Republican’s plan nets the most benefit. But that benefit is limited to the national average paid for premiums by employers. According to this 2007 survey by AHIP, the average cost of premiums for a non-employer sponsored family plan in 2007 was $5,800. Assuming that $5,800 is still the average cost of premiums for a family plan, then the amount she could deduct when determining her taxable income would be $5,800. Her net benefit, assuming she pay 23% of her income as taxes, would be about $1,300.

Alwaysme, in my opinion, the problem isn't the partisan bickering, but the lack a starting point for people to actually write legislation from. The Speaker and the President have been pretty hamhanded with their approach, saying that anyone that doesn't support their measures is against reform. Nothing could be farther from the truth. My suggestion to get something done is to identify the objectives:

1) We want to curtail spiraling costs
2) We want improve access
3) We want to cover the uninsured who WISH to be insured
4) We want to preserve the innovation that makes American health care the envy of most of the world

The devil is in the details, for sure, but I've certainly not heard those with the power seek to look at compromise or solutions that go back to those tenets, while being mindful of the fears and concerns of those that oppose government-based health systems.

While I like the idea of socialized health care I too have issues with where will the money come from and how will it be paid.

There are about 307 million people in the United States (http://www.census.gov/population/www/popclockus.html).

The Budget Office says the Obama socialist medicine plan will cost us $1 Trillion.

Using simple division, each person in the US (legal or not) will cost about $3,300 to support. Remember, some want illegal aliens covered too.

Given that not all of the aforementioned 307 million pay taxes, that per person cost will actually be higher for those of us who do pay taxes.

Even if Obama keeps his word not to raise taxes on those of us who earn less than $250,000+/year, it stands to reason that there is a huge funding gap that remains unexplained.

Remember, Obama said that his plan wouldn't add to the federal defecit. Yet he doesn't clearly explain the alternative.

IMO, it's because he doesn't know. OR, he knows but doesn't want to say until/unless his plan is passed.

Alwaysme, in my opinion, the problem isn't the partisan bickering, but the lack a starting point for people to actually write legislation from. The Speaker and the President have been pretty hamhanded with their approach, saying that anyone that doesn't support their measures is against reform. Nothing could be farther from the truth. My suggestion to get something done is to identify the objectives:

1) We want to curtail spiraling costs
2) We want improve access
3) We want to cover the uninsured who WISH to be insured
4) We want to preserve the innovation that makes American health care the envy of most of the world

The devil is in the details, for sure, but I've certainly not heard those with the power seek to look at compromise or solutions that go back to those tenets, while being mindful of the fears and concerns of those that oppose government-based health systems.

Well like I said in my earlier post being that the bill is so many pages I think that is one of the main issues right there. People just want to know what this reform covers exactly and they have the right to know. That is why I believe they need to simplify it.

Seems to be that the opposition is growing towards the bill. At this stage they need to take a step back and work together. Wishful thinking on my part.

I have never understood the huge rush in getting the bill passed immediately. When you deal with something as personal as someones health care it should be given plenty of time. People are going to want to know every last detail.

I have never understood the huge rush in getting the bill passed immediately. When you deal with something as personal as someones health care it should be given plenty of time. People are going to want to know every last detail.

Some, like me, think the Dems want to rush this through so as to deny the opposition time to organize against it. Problem is, in their haste they are trampling independents and moderates (Dems and GOPers) whom they need to pass ANYTHING.

President Bush understood this in getting the prescription drug benefit passed in 2003.

Some, like me, think the Dems want to rush this through so as to deny the opposition time to organize against it. Problem is, in their haste they are trampling independents and moderates (Dems and GOPers) whom they need to pass ANYTHING.

President Bush understood this in getting the prescription drug benefit passed in 2003.
I would say you're exactly right, but given that there's really no particular bill yet as far as I know, I think you're being a bit hasty. I'm sure nothing would please the president more than having a bill everyone agreed on, but that's a statistical impossibility, so why waste time?

I would say you're exactly right, but given that there's really no particular bill yet as far as I know, I think you're being a bit hasty.

There are a couple of bills, each at a different stage in the Legislative Process.

In the House you have HR 3200 and HR 3400.

HR 3200, the Democrat's Bill in the House, only awaits debate in 2 committees (Budget and Oversight / Reform) before it'll be referred to the entire House.

HR 3400, the Republican's bill in the House, has been referred to the committees, but has not been debated or approved by any committee.

Thus far the Republican's bill is not being considered by anyone while the Democrats bill is poised to go before the entire House shortly after Members return from their August recess.

In the Senate, HR 3200's equivalent (which has been referred to as the Kennedy Health Reform Bill), has passed through every committee except the Finance Committee. You can find the text of the bill here +++> http://help.senate.gov/BAI09A84_xml.pdf.

So you basically have the Affordable Health Choices Act in both the House and Senate and backed by the Democratic leadership and the President, and the Empowering Patients First Act in the House and backed by the Republican leadership.

Waiting until the bill's have become law to express concern with them, would be kind of like closing the barn door after the horse got out.

The haste was in reference to the political assessment, not concern over the contents of the proposed legislation.

The haste was in reference to the political assessment, not concern over the contents of the proposed legislation.

What political assessment? Pensieve stated that he felt the liberal Democrats were ramming the legislation through and trampling the independents and moderates whom they need to pass the legislation.

If "ramming it through" means "without votes from republicans", then I would suggest that perhaps Obama has suggested that the Democrats will / should do that, should efforts in the Senate Finance Committee to secure a bill that some Republicans can support fail.

However, if "ramming it through" means "going so fast that no one has time to actually lodge opposition", I think that charge is misplaced. After all, aren't there a lot of town hall protests? And hasn't this process taken multiple months already, with at least a couple more to go? I think that they are taking their time on the bill, so trying to say it's going to fast is mistaken to me.

Any CBO score on HR 3400? Or did they not bother / didn't get to it yet?

Also, apparently a rather large ad campaign (http://www.politico.com/blogs/bensmith/0809/Strange_bedfellows_coalition_begins_massive_ad_cam paign.html) in support of reform is gearing up for later this month. I think the money trail behind this one is fairly transparent - it traces back to PhRMA and a few other groups. No hiding the money source or the people behind it for them. Hopefully they'll stick to facts about the reform bill in their ads; it'll be a nice change.

ETA: Politifact has a "what's IN the bills (http://www.politifact.com/truth-o-meter/article/2009/aug/13/health-care-reform-simple-explanation/)" column up. Seems fairly written, too.

And new factcheck one taking move-on to task a bit for exaggeration (http://www.factcheck.org/2009/08/health-care-meets-shark-week/) (or, as they term it, simplistic and misleading)

If "ramming it through" means "without votes from republicans", then I would suggest that perhaps Obama has suggested that the Democrats will / should do that, should efforts in the Senate Finance Committee to secure a bill that some Republicans can support fail.

If the Dems fail to get their own "blue dogs" to accept the changes, never mind the GOP, and the Obama admin still pushes it through then he basically welshes on his bipartisan commitments of his campaign. Which means it's a bad bill.


However, if "ramming it through" means "going so fast that no one has time to actually lodge opposition", I think that charge is misplaced. After all, aren't there a lot of town hall protests? And hasn't this process taken multiple months already, with at least a couple more to go? I think that they are taking their time on the bill, so trying to say it's going to fast is mistaken to me.

To whit the term "town hallers" may as well be a four letter word and, according to the media, the bill ought to be passed despite them not fixed or amended because of them. They aren't taking their time. They are trying to cover their backsides and stall long enough for the furor to die down so they can pass the bill the way they want it passed.


Any CBO score on HR 3400? Or did they not bother / didn't get to it yet?

Shamelessly looks to Mom and Gator... :huggles:

Also, apparently a rather large ad campaign in support of reform is gearing up for later this month. I think the money trail behind this one is fairly transparent - it traces back to PhRMA and a few other groups. No hiding the money source or the people behind it for them. Hopefully they'll stick to facts about the reform bill in their ads; it'll be a nice change.

Like Obama stuck to the facts when he reported the AARP was behind the bill and the AARP slapped him down (Like Obama stuck to the facts when he reported the AARP was behind the bill and the AARP slapped him down for it? The only facts I've seen have come from the only bill currently on the table. If there are other resources that directly refute the wording in the bill other than "that's not what that means" or "that's not going to happen" I'd like to see it.)for it? The only facts I've seen have come from the only bill currently on the table. If there are other resources that directly refute the wording in the bill other than "that's not what that means" or "that's not going to happen" I'd like to see it.

What political assessment? Pensieve stated that he felt the liberal Democrats were ramming the legislation through and trampling the independents and moderates whom they need to pass the legislation.
That would be the one

Like Obama stuck to the facts when he reported the AARP was behind the bill and the AARP slapped him down for it? The only facts I've seen have come from the only bill currently on the table. If there are other resources that directly refute the wording in the bill other than "that's not what that means" or "that's not going to happen" I'd like to see it.

I'm equal opportunity. Here's politifact's greatest hits (http://www.politifact.com/truth-o-meter/article/2009/aug/13/heath-care-fact-checks-greatest-hits-vol-1/). Obama's got two on there. The AARP one is rated here (http://www.politifact.com/truth-o-meter/statements/2009/aug/12/barack-obama/obama-goes-too-far-when-he-says-health-reform-bill/) as "barely true". If you read back to my post, I noted I "cringe" when i hear politicians I support distorting the truth.

Honestly, I think the media in this whole thing is out for itself. The more controversy they drum up, the better. They'd be out of a job if it was a quiet failure to get health reform or a quiet concession. That's why the Senate Finance committee work is frustrating them, I think, since that is perhaps the most important area to look at now but it has the least amount of news coming out from it. (in case you didn't notice, I don't buy that the media has a liberal bias or a conservative bias. I buy that the media has a "controversy" bias, since that sells stories)

I can hear the complaints now that the bill benefits the rich over the poor because of it's tax benefits. So let's look at a few examples to see if that assertion turns out to be true. I've used the expand function to make this shorter and easier to read.
:lol: DANG...you heard me thinking as I was reading it! Impressive!
Under HR 3400, the Republican’s plan, that Mom would be able to deduct either the cost of any premiums she paid when determining her taxable income or would receive a refundable tax credit equal to the lesser of the premiums she paid or $2,000. She could even split the premiums and use part to reduce her taxable income to 0 and then use the rest as a refundable credit. If her employer offered a plan which she couldn’t afford, she could opt out of her employers plan and enroll in an individual plan and receive the benefit described above.
Okay...are you saying that if her *taxable* income is at 0, she would still receive money back in a credit? I mean...they would send her money and she's not paying any taxes, but they will send her a tax refund in the form of a credit?

In other words, she's buying $4,000 a year in insurance, but gets to deduct that amount. Now, if that $4,000 reduces her to $0 "taxable" income, the gov would then send her more money?

I can see some possible issues here but would like to hear back, because perhaps I'm understanding that incorrectly.

While I await clarification...

Something that hits me is all these "credits"...and yes, it does seem like all the insurance cost to the consumer (be it individual, business or "organizations") comes in offset credits instead of real reduction in premium prices.

Now, certainly this is one way to do it. I have to wonder...what is going to happen to the income for the government if this goes into effect? How much is this going to cost the U.S. in lost income?? See, cutting spending of the government is one way to decrease the deficit. Increasing income is another. But, with the deficit we have right now, can the U.S. afford to decrease it's own income like this?

And, for the point of example...I remember Bush getting us involved in a couple of wars (one, I supported...the other I did not) that cost our country a whole lot of money. It was at this point he cut taxes, also. These taxes mostly increased the incomes of the more wealthy. Low and behold, the deficit started blooming. That's not hard to understand. Other than for example and a lesson in the past, I'll leave it there for this thread.

Now, we have just spent a lot of money for economic stimulus stemming from the credit crisis. Again, I will not debate the pros or cons of that idea, but just stating that we need to pay for this (right or wrong). If we start cutting all the taxes again, after running up bills again...at least to the degree you have here without offsetting it with income from another source, isn't this going to massively inflate the deficit as much as adding spending would? The two ways you increase a deficit is: 1) government spending (yes, we've been doing a lot of that) or 2) decreasing government income.

Doing BOTH seems a bit suicidal to me, economically. Where do the offsets in lost income...or massive savings on the other end in spending to offset all these tax credits, come in?

I don't think anyone *likes* taxes, but at the same time the pragmatic mind understands the bills must be payed.

However, if "ramming it through" means "going so fast that no one has time to actually lodge opposition", I think that charge is misplaced. After all, aren't there a lot of town hall protests? And hasn't this process taken multiple months already, with at least a couple more to go? I think that they are taking their time on the bill, so trying to say it's going to fast is mistaken to me.
:tu: Exactly. This is a *process* that is going to take a lot more time. And, there's ton's of debate in both the legislative halls and every other hall (pointing to the amount of pages just in this forum). I've also noticed that many of the town hall opposing citizens seem to often roam over a course of grievances, without focusing on the debate at hand sometimes. It would be nice to see focused attention on actual health reform in events that are *supposed* to be showcasing that debate. This board, to the moderator's credit, has succeeded (most of the time) to do so in a relatively civil manner. Perhaps as we go out among our neighbors and public events, we can carry that spirit to those venues and encourage each side (pro or con) to focus on the issues. We may find that the country gets a lot further in the discussion and debate.
Like Obama stuck to the facts when he reported the AARP was behind the bill and the AARP slapped him down for it? The only facts I've seen have come from the only bill currently on the table.
Right...AARP has been in the process and has expressed many glowing evaluations of the legislation in progress. They even co-sponsored an ad on July 14th that was publicly glowing and encouraging (seePolitifact site (http://www.politifact.com/truth-o-meter/statements/2009/aug/12/barack-obama/obama-goes-too-far-when-he-says-health-reform-bill/)) So in one sense, they have been "endorsing" in spirit and praise. This being said, they have not "officially" endorsed in a legal sense, any bill. The President should not have used the word "endorse", but rather "been supportive", or another term. This is why it's so important to chose words carefully. It happens. This being said, AARP has issued very supportive statements about the upcoming legislation and the prospect of benefits for its members as a possible result (but withheld *official* endorsement).

:lol: DANG...you heard me thinking as I was reading it! Impressive!

Okay...are you saying that if her *taxable* income is at 0, she would still receive money back in a credit? I mean...they would send her money and she's not paying any taxes, but they will send her a tax refund in the form of a credit?

Yes. That's what a refundable credit is and why the percentage of people paying negative taxes has increased.

When you prepare you income taxes you calculate your income, plus or minus a few things, and arrive at your Adjusted Gross Income. Then you deduct your standard exemption and itemized or personal exemption. That gives you your Taxable Income. You multiply your taxable income by the tax rates to arrive at your Tax Liability. From that you deduct your credits - some of which are refundable and some of which are not refundable (the child and dependent care credit are non refundable while the Earned Income Tax Credit is refundable). Non-refundable Tax credits are deducted first, and can only reduce your tax liability to zero. Refundable tax credits come next and they can make your Tax Liability negative. If they do, you will get that money in a check from the federal government.

A real simple example - if your tax liability is $1 and you have a refundable tax credit of $2,000, then you'll get $1,999 from the government in cash.

In other words, she's buying $4,000 a year in insurance, but gets to deduct that amount. Now, if that $4,000 reduces her to $0 "taxable" income, the gov would then send her more money?

No.

She can make a choice to (a) use the $4000 to deduct from her taxable income so that her taxable income is reduced, (b) use the $4000 as a refundable tax credit so that her tax liability is reduced to 0 or negative, (c) use a combination of the two.

In the example I provided (the Mom of 2 making 30,000 a year) she'd qualify for a $2000 refundable tax credit (because her kids would be covered by SCHIP - if it was her and her kids then she qualify for more). If she spends $4000 purchasing a health care plan, she could deduct $2000 from her taxable income and then deduct the $2000 refundable tax credit from her tax liability (a total of $4000). She could not deduct the $4000 and then take the $2000 credit.

In this example, if I ignore the child credit and assume she she didn't itemize and had no other credits or exemptions other than herself and her children, she'd have a taxable income of about $11,500 and a tax liability of about $1,500 , before the health care costs were deducted. Deducting the $2000 from her taxable income reduces that to $9,500, which results in a tax liability of about $950. Deducting her $2000 refundable tax credit, gives her a tax liability of -1,050 , which she'd get in a check from the federal government. The net financial benefit to her under this plan would be $2,550 (because she'd go from owing $1500 to getting $1050).

The net financial benefit to her under the Democrats plan would be $1,500 - the excess of her premiums of $4000 over $2500 (1/12 her income).

I can see some possible issues here but would like to hear back, because perhaps I'm understanding that incorrectly.

Sounds to me like you got it correct, assuming I got it correct. :)

Something that hits me is all these "credits"...and yes, it does seem like all the insurance cost to the consumer (be it individual, business or "organizations") comes in offset credits instead of real reduction in premium prices.

Yes and No. There is enhancement for fraud investigation and enforcement, but that's primarily Medicaid and Medicare. There's tort reform, but I'm not sure how much a real effect that'll have on reducing real health care costs.

The only reduction in premium prices comes from the enhanced individual market. By allowing membership organizations to provide health insurance to their members, the administrative cost of managing a health care program is spread across a larger pool of people as are the risks associated with an expensive illness. That will keep costs down and keep premiums from increasing exponentially when you or one of your family members gets sick.

It'll also offer more flexibility to choose what you need from the individual market as opposed to taking what you get from the employer or government controlled markets. Like Gator stated earlier, when you get to be old like he is :p, you don't need stuff like infertility or family planning anymore, but you still have to pay for those riders. The enhanced individual market will allow you to select and pay for what you choose and not what you don't want. So you could purchase a pre-existing condition waiver rider or infertility rider or family planning rider, or just go with the basic core package. And what you pay would be determined based on what you select.

Now, certainly this is one way to do it. I have to wonder...what is going to happen to the income for the government if this goes into effect? How much is this going to cost the U.S. in lost income?? See, cutting spending of the government is one way to decrease the deficit. Increasing income is another. But, with the deficit we have right now, can the U.S. afford to decrease it's own income like this?

The CBO hasn't run the costs on the program yet, so I don't know what the cost will be. I suspect it'll reduce revenues to the government because taxpayers will be paying less in income taxes. That won't necessarily be a bad thing because those taxpayers will have health insurance where they didn't before.

And if I present the full theory, the initial drops in revenue would be offset by increased spending because people would have more money in their pockets (but I thought that would open a whole new can of worms so I didn't, but then I did).

And, for the point of example...I remember Bush getting us involved in a couple of wars (one, I supported...the other I did not) that cost our country a whole lot of money. It was at this point he cut taxes, also. These taxes mostly increased the incomes of the more wealthy. Low and behold, the deficit started blooming. That's not hard to understand. Other than for example and a lesson in the past, I'll leave it there for this thread.

You're right, that's probably best for another thread somewhere, but the claim that the Bush Tax Cuts benefited the rich at the cost of the poor and resulted in blooming deficits is not true. To keep it short - the Bush tax cuts kept revenues at almost the same level as they were in 2000 (the increases in the deficit were due largely to spending as opposed to revenue decreases) and they eliminated the 10% tax bracket and provided the refundable child tax credit which benefited the poor and shifted the tax burden to the rich.

Now, we have just spent a lot of money for economic stimulus stemming from the credit crisis. Again, I will not debate the pros or cons of that idea, but just stating that we need to pay for this (right or wrong). If we start cutting all the taxes again, after running up bills again...at least to the degree you have here without offsetting it with income from another source, isn't this going to massively inflate the deficit as much as adding spending would? The two ways you increase a deficit is: 1) government spending (yes, we've been doing a lot of that) or 2) decreasing government income.

I believe current estimates show that only about 25% (or less) of stimulus funds have been committed. We could take those un-committed funds back into the treasury.

Doing BOTH seems a bit suicidal to me, economically. Where do the offsets in lost income...or massive savings on the other end in spending to offset all these tax credits, come in?

The theory under the Republican plan would hold that since individuals have more money in their pockets they'll spend more which will result in greater job growth, increased wages, and increased tax revenues.

The opposite effect, under the Democrats plan, would be to reduce the amount of money in both individuals and corporations pockets which will reduce spending and further increase job loss and wage stagnation or even cause wage loss (as corporations won't be able to deduct the cost of providing their employees health coverage anymore).

I'm not going to comment on either only to say that, assuming that nothing else changes, under the Republican plan revenue will go down while under the Democrats plan spending will go up. Which is greater is unknown because the CBO hasn't done an estimate for the Republican plan.

I don't think anyone *likes* taxes, but at the same time the pragmatic mind understands the bills must be payed.

Absolutely. And Chris et all - I'm not sure why the CBO hasn't estimated the costs of the Republicans bill yet.

I am equally interested in the language of any Bill in reference to limitations on the administrating entities and the establishment of checks and balances. Will a federal entity or state entity administer the program and oversee enrollment and application? Will this be an appointment position or an elected office? What controls will be implimented to safeguard personal information such as income, health records, and financial access?

I am obviously interested in the nuts and bolts of any government expansion, but these concerns are paramount, IMO, to maintaining some level of public control and access while limiting government ability to run an end around on the 4th Amendment "For our own good". With the ire and anger over "The Patriot Act" so fresh in our minds, I am startled at the lack of interest in similar concerns with something potentially so much more intrusive. Is there anything more personal than healthcare?

I am equally interested in the language of any Bill in reference to limitations on the administrating entities and the establishment of checks and balances. Will a federal entity or state entity administer the program and oversee enrollment and application? Will this be an appointment position or an elected office? What controls will be implimented to safeguard personal information such as income, health records, and financial access?

I am obviously interested in the nuts and bolts of any government expansion, but these concerns are paramount, IMO, to maintaining some level of public control and access while limiting government ability to run an end around on the 4th Amendment "For our own good". With the ire and anger over "The Patriot Act" so fresh in our minds, I am startled at the lack of interest in similar concerns with something potentially so much more intrusive. Is there anything more personal than healthcare?

Excellent point. Some folks don't want their phones tapped in search of terrorist activity, but they're OK with the government deciding how their healthcare system functions and who's in charge? Scary.

This is a video of Pelosi in 2006 with anti-war protestors and 2009 against current health reform legislation protestors, but it furthers my point about the hypocracy in the Democrats.

http://www.breitbart.tv/06-flashback-pelosi-tells-anti-war-protesters-im-a-fan-of-disruptors/

This is a video of Pelosi in 2006 with anti-war protestors and 2009 against current health reform legislation protestors, but it furthers my point about the hypocracy in the Democrats.

http://www.breitbart.tv/06-flashback-pelosi-tells-anti-war-protesters-im-a-fan-of-disruptors/

Good example of how Dems don't like taking their own medicine.

Speaking of examples, here's one of democracy in action: Senators exclude end-of-life provision from bill (http://news.yahoo.com/s/ap/20090813/ap_on_go_co/us_health_care_end_of_life_2)

Senator Chuck Grassley of Iowa, top Republican on the Senate Finance Committee, said in a statement Thursday that the provision had been dropped from consideration because it could be misinterpreted or implemented incorrectly.

This takes the teeth right out of what was, IMO, a very slippery slope towards widespread legalized euthanasia in America.

As if abortion wasn't bad enough...

I have lost a lot of respect for Pelosi since her Un-American remarks about these health care reform protestors.

While I think some of it has been out of hand. The ones that come there and are angry but ask real questions should not be looked down upon. Opposing views does not equal Un-American and asking hard questions does not equal Un-American. I think as a citizen you should ask and expect answers from your government. This is a huge overhaul and an expansion of government. It is only natural for there to be questions.

Instead of calling people names I think selling the image of this health care bill better is what is truly needed.

I am equally interested in the language of any Bill in reference to limitations on the administrating entities and the establishment of checks and balances. Will a federal entity or state entity administer the program and oversee enrollment and application? Will this be an appointment position or an elected office? What controls will be implemented to safeguard personal information such as income, health records, and financial access?

Howdy! Long time no see!!!!! How are you?

From what I understand, with the Democrats bill, HR 3200, there are no checks and balances. The bill will create a new federal Health Choices Administration and federal employees will manage it's day to day operations, including enrollment and application. The Health Choices Administration will be a cabinet level agency as part of the executive branch. It's head will be appointed by the President and approved by the Senate.

The Republican's bill has safeguards regarding escrow of funds and financial stability of membership organizations or trade / industry / professional associations that offer health insurance to their members. Those organizations are prohibited from underwriting the insurance, they are simply the group sponsor.

The Republican's bill also has the high risk pool which would be under the control and administration of each state. I'm not sure what the specific rules regarding safeguard of private information were at the state level were.

I am obviously interested in the nuts and bolts of any government expansion, but these concerns are paramount, IMO, to maintaining some level of public control and access while limiting government ability to run an end around on the 4th Amendment "For our own good". With the ire and anger over "The Patriot Act" so fresh in our minds, I am startled at the lack of interest in similar concerns with something potentially so much more intrusive. Is there anything more personal than healthcare?

Very good points.

I'm not a fan of the Democrats bill, so my comments here reflect that bias, but from what I can tell the Democrats bill grants the federal government quite a bit of control over health care and the rights of patients, beyond the right to appeal a decision, isn't terribly evident. In fact, I haven't located the section discussing the patient's right to appeal anywhere in the Democrats bill. As the final decision maker is the government, patients won't have the right to sue for wrongdoing either.

This takes the teeth right out of what was, IMO, a very slippery slope towards widespread legalized euthanasia in America.

As if abortion wasn't bad enough...

Abortion in general or abortion in regards to the bills? Here's the factcheck (http://www.factcheck.org/2009/07/surgery-for-seniors-vs-abortions/) saying no public money would be allowed for abortions, since none of them seek to overturn the Hyde Amendment. .

And, I wish that provision had stayed in; I think that it's a horribly misunderstood provision and I think your slippery slope wouldn't have come true.

Incidentally, it's legal NOW for medicare to reimburse for the "gravely ill" end of life counseling. Already (http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/). It was contained in the 2003 Medicare prescription drug bill. (apologies for the somewhat sarcastic tone of the link - it's a blog, but they then provide this link: )
Thomas link (http://thomas.loc.gov/cgi-bin/cpquery/?&dbname=cp108&sid=cp108d60yh&refer=&r_n=hr391.108&item=&sel=TOC_2103579&).

Text:
The conference agreement provides coverage of certain physician's services for certain terminally ill individuals. Beneficiaries entitled to these services are those who have not elected the hospice benefit and have not previously received these physician's services. Covered services are those furnished by a physician who is the medical director or employee of a hospice program. The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning. Payment for such services equals the amount established for similar services under the physician fee schedule, excluding the practice expense component. The provision would apply to consultation services provided by a hospice program on or after January 1, 2005.

So, we're either already on the slippery slope, or it's much ado about nothing, or it's politics at play, trying to find a way to get people's emotional hackles up against the bill, instead of getting people's rational brains involved. We haven't heard of a scandalous increase in "you should really pull the plug" stories in the last four years, so I think that doctors are doing their jobs right and there really isn't anything to fear.

I'm no fan of Pelosi, but not for this thread. I wish Hoyer was Dem leader.

Thanks for clearing that up Chris on abortion.

I had heard conflicting statements on the matter. Even as a Pro-choice woman I do not believe if this health care bill is passed that tax payers should have to pay for abortions. That is such a hot button issue with many people morally opposed to the idea.

Thanks for clearing that up Chris on abortion.

I had heard conflicting statements on the matter. Even as a Pro-choice woman I do not believe if this health care bill is passed that tax payers should have to pay for abortions. That is such a hot button issue with many people morally opposed to the idea.

I may be wrong (not a first), but I believe there is provision made for funding in extreme cases (incest, rape and danger to the mother's life) under existing law. I would assume most jurisdictions would at least consider these exceptions.

My problem is the lack of definition either way. In short the state level administrator, an appointee by all evidence, will have authority to make a judgement on this type of spending. As it wouldn't appear to be an elected possition, that would give a relatively important decision to one person who has no mechanism to be held accountable directly by the people.

I may be wrong (not a first), but I believe there is provision made for funding in extreme cases (incest, rape and danger to the mother's life) under existing law. I would assume most jurisdictions would at least consider these exceptions.


You're correct that the current law has that exception, assuming that the factcheck did their job right (and they rarely have led me astray).

Abortion in general or abortion in regards to the bills?

In general...

Thanks for clearing that up Chris on abortion.

I had heard conflicting statements on the matter. Even as a Pro-choice woman I do not believe if this health care bill is passed that tax payers should have to pay for abortions. That is such a hot button issue with many people morally opposed to the idea.I wouldn't agree with that either, even though, seems we already have something in place for that. IMO, the bill should only cover those for basic things or start off that way. One thing I couldn't see the bill involving are specialists.

Excellent point. Some folks don't want their phones tapped in search of terrorist activity, but they're OK with the government deciding how their healthcare system functions and who's in charge? Scary.
Yes indeed. And the worst and most disturbing part of this is the rush to get such a huge reform bill passed through. Do some people have no understanding that once we implement it, there is no going back as with much things passed by the government. We cant say "oops that was a bad idea" and assume we can reverse the damage. Open the flood gates for further deterioration of our privacy and more government.

And it boils my blood to see the Democrats lying through their teeth and downplaying their health care reform as a massive government takeover.

And it boils my blood to see the Democrats lying through their teeth and downplaying their health care reform as a massive government takeover.

And it boils my blood, and I would bet some others, when lies and half-truths are used to fight the reform. I'm not accusing you of this, but I think that a quick check of politifact and factcheck make it apparent just how much lying is going on by opponents, too. I don't mind fighting against the bill based on things that are actually in the bill. I just am angered and saddened when I see the various ways in which the actual language of the bill is being distorted into lies which prey on people's emotional side in order to combat health care reform.

And it boils my blood to see the Democrats lying through their teeth and downplaying their health care reform as a massive government takeover.And it boils my blood when I see sweeping statements that are driven by misinformation and/or fear. I don't see where the takeover is defined in any of the bills before Congress.

The bill will be health care reform... period. It is regulation of an industry that is alternatively choking or abandoning the average family and small businesses. It does not take away your choice of doctors, health plans, or insurance companies. It does not make your health care decisions for you. It will not establish death panels or kill off senior citizens. It doesn't replace the insurance bureaucrat who currently makes your health care decisions with a government bureaucrat.

However it does establish minimum health care standards. But just because it establishes minimum standards, doesn't mean it sets maximum standards--insurance companies will set that.

Excellent point. Some folks don't want their phones tapped in search of terrorist activity, but they're OK with the government deciding how their healthcare system functions and who's in charge? Scary.

A poor analogy as the first was a clear breach of the constitution.

Whoa there!

Thinking that a fellow member is wrong doesn't give you the right to call his/her thoughts pathetic.

Duly noted and amended although I was referring to the analogy not necessarily the thought behind it.


For those looking for just how much the recent smearing of the NHS is bunk checking out a few British sources is a simple way to see around the lies.

All sides of the media and politics (save the odd extremist) are united in the opinion that while the NHS is not perfect it is nothing like the US right portray it and, given the choice, they'd keep the NHS over a US-styke service anyday.

Even the reliably right-wing Telegraph (http://blogs.telegraph.co.uk/finance/jeremywarner/100000571/us-healthcare-expenditure-the-biggest-waste-of-money-in-the-world/) opines: "US healthcare makes even the notorious inefficiences of state spending in the UK look tolerable by comparison."

http://www.guardian.co.uk/politics/2009/aug/14/health-nhs

http://www.guardian.co.uk/society/2009/aug/14/ministers-doctors-defend-uk-nhs

http://www.guardian.co.uk/commentisfree/poll/2009/aug/14/nhs-health

http://www.timesonline.co.uk/tol/news/politics/article6797165.ece

http://www.timesonline.co.uk/tol/news/politics/article6795952.ece

http://www.timesonline.co.uk/tol/news/uk/health/article6795429.ece

http://www.newstatesman.com/2009/08/nhs-health-support-cameron

http://www.independent.co.uk/news/world/americas/the-brutal-truth-about-americarsquos-healthcare-1772580.html

http://www.independent.co.uk/opinion/leading-articles/leading-article-the-healthcare-debate-comes-back--across-the-atlantic-1772533.html

http://www.independent.co.uk/opinion/commentators/christina-patterson/christina-patterson-the-big-problem-with-the-nhs-isnt-funding-1772538.html

http://www.independent.co.uk/opinion/commentators/rupert-cornwell/rupert-cornwell-america-needs-to-cool-down-1772532.html

That list is from today's home pages, no Googling required.

And it boils my blood when I see sweeping statements that are driven by misinformation and/or fear. I don't see where the takeover is defined in any of the bills before Congress.

The Democrats Bill, HR 3200, in Title I, Section 102 states the following:


(c) Limitation on Individual Health Insurance Coverage-

(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.

Every plan offered in the US after the bill becomes effective must meet the requirements and mandates set forth by the Health Choices Administration, except grandfathered plans, and those plans must come under the control of the Health Choices Administration after a 5 year phase in. If you switch jobs or change insurance companies after the bill becomes effective, the plan you'll be enrolled in will be controlled by the Health Choices Administration. If your insurance company makes any changes to a grandfathered plan, then the entire plan must come under the control of the Health Choices Administration.

A grandfathered plan is defined in part (a) of that subsection and is any plan in existence the day before the bill becomes effective which does not admit any new members except the dependents of existing members after the bill becomes effective and doe snot make any changes to it's plan after the bill becomes effective. That exception is phased out after 5 years (which is part of the reason the 10 year estimates of the cost of HR 3200 are misleading - because the bulk of the costs don't hit until years 3 or 5).

In order to participate in the Health Insurance Exchange a plan must meet the requirements and mandates set forth by the Health Choices Administration.

In summary - under the Democrats plan in HR 3200 and the Kennedy Bill, the Health Choices Administration will be charged with controlling every health plan offered in the US.

This is actually one of the aspects to the Democrats plan which I don't understand. If objective is to provide a public option for those unable to afford health insurance or whose medical conditions make the cost of purchasing a plan prohibitively expensive, then why not just do that? Why create the Health Choices Administration and subject every plan offered in the US to it's dictates?

I think we can accomplish the objective of providing affordable coverage for every person in this county without the federal government taking control over every health insurance plan offered.

However it does establish minimum health care standards. But just because it establishes minimum standards, doesn't mean it sets maximum standards--insurance companies will set that.

Under the Democrats bill, HR 3200, only those items which are authorized by the Health Choices Administration may be provided in an exchange participating plan. Insurance companies can provide riders beyond what's mandated by the Health Choices Administration, and offer those riders as part of the exchange, but those riders can't be part of their core package and they can not exclude coverage, they can only expand coverage.

So if the Health Choices Administration says every plan must cover breast augmentation, then every plan must cover breast augmentation.

It's also worth nothing that those minimum standards will cause the cost of health insurance to rise for every American. Community pricing, which is required in Kennedy Bill, is one example. Part of the reason Health coverage in NY, NJ, and Mass is so much higher than the rest of the nation is community pricing.

So, while my plan may cost $2400 a year now, it's cost will likely increase sharply if the Democrats bill becomes law.

Plans will be grandfathered because they don't meet minimum standards. People end up in plans that give the impression that certain benefits are covered, but when the time comes, they find out they aren't covered. Or they are denied coverage for something that seemed to be covered, but then the insurance company pulls a fast one and finds a loophole to deny coverage. Minimum coverage standards will eliminate that.

Frankly, these are the types of reforms that would happen even if a public option was dropped since they also want to reduce insurance company abuses. The public option is only one of the reforms on the table. They are probably going to have a coverage mandate which would be a windfall for the insurance companies--all those young healthy people paying premiums with no claims.

How do you know that it'll cause prices to increase? (Beyond the increase in cost that would have happened without government intervention - right now I'd be happy if the increase in health care costs kept pace with inflation).

What are the exceptions in section (a)?

What are the minimum standards being talked about? I highly doubt surgically enhanced boobs will be a government-covered expense.

Plans will be grandfathered because they don't meet minimum standards

I should have posted part (a) defining grandfathered plans- Sorry! I didn't post part (a) because people have complained about me putting too much of the bill in my posts and I posted it before. To prevent confusion, here are parts (a) defining grandfathered plans and (b) defining the grade period. I used the expand tags so you only need to click on the portion you want to read instead of seeing the whole thing (although these sections are fairly clear and short).



(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(1) LIMITATION ON NEW ENROLLMENT-

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.



(b) Grace Period for Current Employment-based Health Plans-

(1) GRACE PERIOD-

(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.

(B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:

(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.

(iii) Such other limited benefits as the Commissioner may specify.

In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division

(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.

In summary: Any plan with members enrolled in it the day before the bill becomes effective will be grandfathered from coming under the control of the Health Choices Administration for 5 years. If the plans accept new members they will no longer be grandfathered and must come under the control of the Health Choices Administration. If they make any changes to their plans they will no longer be grandfathered and will have to come under the control of the Health Choices Administration.

They are probably going to have a coverage mandate which would be a windfall for the insurance companies--all those young healthy people paying premiums with no claims.

Those healthy young people are already factored into the equation with medical cost ratios. Many states have medical cost ratios which dictate what percentage of premiums paid to an insurance provider must be used for medical care and what percentage may be used to cover administrative costs and profits. NJ has a 75% medical cost ratio, which means that 75% of the cost of premiums received must be used for direct medical care and the remaining 25% can be used for administrative costs profits. The largest and most profitable insurance company made 3.9% profit last year.

How do you know that it'll cause prices to increase? (Beyond the increase in cost that would have happened without government intervention - right now I'd be happy if the increase in health care costs kept pace with inflation).

By looking at the example of NJ and Mass when they implemented some of the same mandates as are required in the Democrats bill. These examples are cited in this study (http://www.heritage.org/research/healthcare/cda06-04.cfm) on the effects of state mandates on health coverage prices by the Heritage foundation.

What are the exceptions in section (a)?

I posted the whole section above.

What are the minimum standards being talked about? I highly doubt surgically enhanced boobs will be a government-covered expense.

Probably not, though in Brazil they are. Same with nose jobs, liposuction, and butt implants, but I digress.

There are a number of mandates contained in the Democrats bill. Mandatory coverage for family planning, community pricing, prohibiting pre-existing condition exclusions, guaranteed issue and renewal, restrictions on price sharing, anything the Secretary of the Health Choices Administration deems to implement, including the recommendations of the Health Benefits Advisory Committee.


(a) Establishment-

(1) IN GENERAL- There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(2) CHAIR- The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.

(3) MEMBERSHIP- The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:

(A) 9 members who are not Federal employees or officers and who are appointed by the President.

(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.

(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.

Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.

(4) TERMS- Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.

(5) PARTICIPATION- The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children's health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.

(b) Duties-

(1) RECOMMENDATIONS ON BENEFIT STANDARDS- The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the `Secretary') benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.

(2) DEADLINE- The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.

(3) PUBLIC INPUT- The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.

(4) BENEFIT STANDARDS DEFINED- In this subtitle, the term `benefit standards' means standards respecting--

(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and

(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).

(5) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS-

(A) ENHANCED PLAN- The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).

(B) PREMIUM PLAN- The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).

(c) Operations-

(1) PER DIEM PAY- Each member of the Health Benefits Advisory Committee shall receive travel expenses, including per diem in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code, and shall otherwise serve without additional pay.

(2) MEMBERS NOT TREATED AS FEDERAL EMPLOYEES- Members of the Health Benefits Advisory Committee shall not be considered employees of the Federal government solely by reason of any service on the Committee.

(3) APPLICATION OF FACA- The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the Health Benefits Advisory Committee.

(d) Publication- The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.


(a) Process for Adoption of Recommendations-

(1) REVIEW OF RECOMMENDED STANDARDS- Not later than 45 days after the date of receipt of benefit standards recommended under section 123 (including such standards as modified under paragraph (2)(B)), the Secretary shall review such standards and shall determine whether to propose adoption of such standards as a package.

(2) DETERMINATION TO ADOPT STANDARDS- If the Secretary determines--

(A) to propose adoption of benefit standards so recommended as a package, the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption such standards; or

(B) not to propose adoption of such standards as a package, the Secretary shall notify the Health Benefits Advisory Committee in writing of such determination and the reasons for not proposing the adoption of such recommendation and provide the Committee with a further opportunity to modify its previous recommendations and submit new recommendations to the Secretary on a timely basis.

(3) CONTINGENCY- If, because of the application of paragraph (2)(B), the Secretary would otherwise be unable to propose initial adoption of such recommended standards by the deadline specified in subsection (b)(1), the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption of initial benefit standards by such deadline.

(4) PUBLICATION- The Secretary shall provide for publication in the Federal Register of all determinations made by the Secretary under this subsection.

(b) Adoption of Standards-

(1) INITIAL STANDARDS- Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.

(2) PERIODIC UPDATING STANDARDS- Under subsection (a), the Secretary shall provide for the periodic updating of the benefit standards previously adopted under this section.

(3) REQUIREMENT- The Secretary may not adopt any benefit standards for an essential benefits package or for level of cost-sharing that are inconsistent with the requirements for such a package or level under sections 122 and 123(b)(5).

Not to go back, but my question about the bill still stands and has not been addressed by anyone.

If objective is to provide a public option for those unable to afford health insurance or whose medical conditions make the cost of purchasing a plan prohibitively expensive, then why not just do that? Why create the Health Choices Administration and subject every plan offered in the US to it's dictates?

BTW - HR 3400, the Republican plan, provides for a public option without granting the federal government control over every health insurance plan offered in this county.

Because 2008 was likely a down year for many companies, I looked up a 2007 (http://www.reuters.com/article/pressRelease/idUS187049+15-Jul-2008+PRN20080715) set of figures.

Profits for the five largest insurers were 4.2% (16.8 bill. on 404 bill. total revenue). They covered 211 million people between them. They covered slightly less people in 2007 than 2006, but I don't know if that's due to rescission or economy or "other".

According to Rasmussen, 54% of American's would prefer that Congress not pass a bill this year than pass the Democrats bill.

http://www.rasmussenreports.com/public_content/politics/toplines/pt_survey_toplines/august_2009/toplines_healthcare_bill_august_13_14_2009

That doesn't mean they don't believe there's a need for reform, but that they'd prefer Congress take the time to develop the best solution for all.

My problem is the lack of definition either way. In short the state level administrator, an appointee by all evidence, will have authority to make a judgement on this type of spending. As it wouldn't appear to be an elected possition, that would give a relatively important decision to one person who has no mechanism to be held accountable directly by the people.
I don’t know anything about this provision, so I am not conceding it exists or my support or lack thereof for it, but the mechanism of being held directly accountable by the people is oft talked about and rarely exercised. One, a person who is making individual medical decisions should not have to consider for a moment whether it would be politically supportable, and two a person who can be fired can a) be removed immediately if they do something that warrants it and b) would be subject to mechanisms of removal far greater and more simplistic than elections.
I wouldn't agree with that either, even though, seems we already have something in place for that. IMO, the bill should only cover those for basic things or start off that way. One thing I couldn't see the bill involving are specialists.
Well, a specialist can be an important part of basic health care. A specialist could be necessary to save a person’s life depending on what sort of illness they have and even simply for preventative medicine or more common medical illnesses. I don’t think anyone would say a visit to a gynecologist shouldn’t be covered for women (or an obstetrician if pregnant), but that is a specialty.
Yes indeed. And the worst and most disturbing part of this is the rush to get such a huge reform bill passed through. Do some people have no understanding that once we implement it, there is no going back as with much things passed by the government. We cant say "oops that was a bad idea" an
We’ve been talking about health care reform in this country my entire life and for my parent’s entire lives, it’s been what? 65 years? This isn’t a rush. This isn’t the first time law makers have considered it, so they probably had some provisions already written that they support. Either way, there is going back if it turns out to be a massive failure. Few things are permanent. We got rid of prohibition and that was a Constitutional Amendment…
And it boils my blood to see the Democrats lying through their teeth and downplaying their health care reform as a massive government takeover.
I’ll let you in on a secret, Democrats are not trying to take over every aspect of society. The fact that we tend to support a larger government has nothing to do with controlling you in any way, but rather has to do with the fact that we support things like ensuring everyone has access to basic health care and food and a place to sleep at night. And while we tend to concede that the government isn’t perfect and support changes where necessary, we aren’t afraid of the government, that’s why we don’t have a problem with making it bigger. We have a strong liberal democracy, and while Republicans have been going to chant at town halls that it “works for us” the truth is, it doesn’t “work” for all of us. People shouldn’t have to choose between their house and their health, people in this country shouldn’t die because of lack of health care.
Profits for the five largest insurers were 4.2% (16.8 bill. on 404 bill. total revenue). They covered 211 million people between them. They covered slightly less people in 2007 than 2006, but I don't know if that's due to rescission or economy or "other".

Who needs big profit margins when you work in a trillion dollar industry? That’s a pretty big 4.2%.
According to Rasmussen, 54% of American's would prefer that Congress not pass a bill this year than pass the Democrats bill.
First, I would say that Congress isn’t done writing their bills. Things will change before anything is passed, and what the question says is “passage of bill working its way through Congress”. Second, I cannot see question order or demographic information on that poll without paying $19.95 (a month) and to me those are important parts of determining whether or not I believe in the result. I think even the question as it is read has a Conservative bias. A less biased question would ask whether they support the passage of one of the current bills (because of the multiple bills, this just isn’t a good question in general, but I’ll continue), passage of the bill with changes (if changes, it could ask what kind of changes or a degree of changes), or not passing any bill.

We’ve been talking about health care reform in this country my entire life and for my parent’s entire lives, it’s been what? 65 years? This isn’t a rush. This isn’t the first time law makers have considered it, so they probably had some provisions already written that they support. Either way, there is going back if it turns out to be a massive failure. Few things are permanent. We got rid of prohibition and that was a Constitutional Amendment

We've been talking abut nationalizing health care for man many year, but other than Hillary's bill, which was defeated, and Medicare, there has never been a bill which grants the federal government control over every health plan available in the US and prohibits individuals from purchasing a plan outside of the government's control (and may assess a fine on them if they do so).

Why Congress, especially Speaker Pelosi and Senate Majority Leader Hoyer, feel the need to rush their bill through is beyond me.

I’ll let you in on a secret, Democrats are not trying to take over every aspect of society. The fact that we tend to support a larger government has nothing to do with controlling you in any way, but rather has to do with the fact that we support things like ensuring everyone has access to basic health care and food and a place to sleep at night. And while we tend to concede that the government isn’t perfect and support changes where necessary, we aren’t afraid of the government, that’s why we don’t have a problem with making it bigger.

That's one of the differences between Democrats and Republicans - Democrats think government is the answer while Republicans think government is the problem.

I think we can find a solution without allowing the federal government to take control over ever plan sold in the US. I'm still at a loss to explain why the Democrats bill seeks to grant the federal government control over every health plan offered in this country, if the objective is to provide affordable health coverage for all.

I think HR 3400, the Republican's plan, comes a lot closer to offering a plan which will provide for those unable to afford health insurance due to pre-existing conditions or high cost health conditions or the high cost of health insurance.

We have a strong liberal democracy, and while Republicans have been going to chant at town halls that it “works for us” the truth is, it doesn’t “work” for all of us. People shouldn’t have to choose between their house and their health, people in this country shouldn’t die because of lack of health care.

Every person in this country has health care - they just have to pay for it. Some have to pay out of pocket while others have insurance to help with the costs. Neither plan, either the Republicans or the Democrats, will make paying for health care easier or provide free health care to anyone but the those who already qualify for Medicaid (and even Medicaid has cop-payments).

Under the Democrats bill, unless you qualify for Medicare or Medicaid, you will be expected to pay 1/12 of your annual income as premiums, you'll be expected to meet your deductible (up to $10,000 for a family) and you'll be expected to make your co-payment and co-insurance payments (which can vary by plan and may be 20, 25 or even 30% of the cost of treatment).

Who needs big profit margins when you work in a trillion dollar industry? That’s a pretty big 4.2%.

It doesn't even put the industry in the top 20 most profitable.

First, I would say that Congress isn’t done writing their bills. Things will change before anything is passed, and what the question says is “passage of bill working its way through Congress”. Second, I cannot see question order or demographic information on that poll without paying $19.95 (a month) and to me those are important parts of determining whether or not I believe in the result. I think even the question as it is read has a Conservative bias. A less biased question would ask whether they support the passage of one of the current bills (because of the multiple bills, this just isn’t a good question in general, but I’ll continue), passage of the bill with changes (if changes, it could ask what kind of changes or a degree of changes), or not passing any bill.

Rasmussen is one of the more reliable polling companies. I won't pay the $19.95 either, but the data they released showed that among those making 40,000 - 75,000 a year (the middle class), a majority oppose the Democrats bill. Support is about split among those making $20,000 or less.

Yes - the Democrats bill. The only bill currently making it's way through Congress. No other bills are making their way through Congress.

I think the Senate Finance Committee has yet to actually write their bill precisely because they are going through the give and take of compromising, taking their time about it (I really don't feel that this is a rushed process - I think the claims that it's being rushed are misplaced, since it is an issue that's been talked about for years and we've already had HR 3200 online for about a month, plenty of time for people to find all the things that are wrong in it and also apparently plenty of time for them to make stuff up that's wrong with it too), and ultimately whatever comes out of the Senate Finance Committee is likely to be the closest to a bill.

What I'm betting it'll be:
Health co-ops with an opt-out if people don't want to buy coverage. There will likely be minimum standards set for co-ops - that way, people can't enter the co-op and then find out that a simple procedure isn't covered. I view the "minimum standards" as being a consumer protection, not a government takeover. The administrator of the plans will still be in the private sector. The profits from insurance companies that also meet the minimum standards will also stay in the private sector. The various insurance companies aren't going to disappear and it's likely they'll stay profitable. It's like setting a standard that, if you build an airplane, it must be capable of flying before you put passengers on it. One might ask "why would anyone build an airplane that can't fly", but the answer is always the same: greed. If someone could get away with defrauding people on their way to make a quick buck, they'll probably try. So by setting a minimum standard, the government is saying they won't be conned.

Right now, I think that the assessment of a few people that the brouhaha over the House bill is largely a sideshow is accurate. The real action's taking place in the Senate, and that's where I think the bill will emerge from. And, they're taking their time about it, too - perhaps they are trying to get it right?

I just looked it up, the CBO hasn't scored the HR 3400 by now. I don't know why; however, from your description of it I wouldn't be surprised if it comes in more expensive than the Democrats plan. If the tax credits are "refundable", then that does mean that there will be money coming back to the taxpayer, even if they had zero income tax liability. That could be a large chunk of change.

Besides if people were worried about their family budgets, they could always take the basic plan (co-op or public option) which would be low cost, and then buy a rider plan from an insurance company.

It would be exactly like taking Medicare and then buying a private Medi-Gap policy, which ends up giving seniors 100% coverage for a very low added rate monthly. And when seniors do that currently, they also have their choice of any doctor and any specialist without requiring any referrals or insurance bureaucrat approvals. Nor are there any government bureaucrats involved in their health care decisions. What Medicare does or doesn't cover is defined by the Medicare administrators, but the issuers of the Medi-Gap policies know that and know exactly what costs they have to pick up.

Frankly I don't know why people are so afraid of government single-payer health care. I don't know any seniors (including myself) who dislike Medicare. In fact they love Medicare. And that's including most people who don't even have Medi-Gap policies, so they end up paying around 20% of many costs and copays on others.

And I agree with Chris, I don't see what's wrong with defining a minimum benefit. That's not the same as defining a maximum benefit. It just ensures that patients don't end up holding the bag for a procedure they thought was covered, but wasn't. It certainly doesn't impair anyone's ability to purchase additional insurance, nor is it a takeover of health care. It's just the addition of some important consumer protections. I certainly don't mind knowing exactly what my coverage will be when I get insurance.

Frankly I don't know why people are so afraid of government single-payer health care. I don't know any seniors (including myself) who dislike Medicare. In fact they love Medicare. And that's including most people who don't even have Medi-Gap policies, so they end up paying around 20% of many costs and copays on others.

The problem is the more we as citizens turn over to the government, the more we both come to rely on the government, and, what's worse, the government comes to a more controlling status over America's destiny. By maintaining an option for private healthcare, or private pay it continues to offer John Q. Taxpayer options, while not while not delegating too much control over people's lives.

And I agree with Chris, I don't see what's wrong with defining a minimum benefit. That's not the same as defining a maximum benefit. It just ensures that patients don't end up holding the bag for a procedure they thought was covered, but wasn't. It certainly doesn't impair anyone's ability to purchase additional insurance, nor is it a takeover of health care. It's just the addition of some important consumer protections. I certainly don't mind knowing exactly what my coverage will be when I get insurance.

I am with you and Chris on this. Defining a minimum is fine, but a ceiling is pretty much a waste legislation. We may as well not have a National Healthcare System if people who have real need find themselves excluded.

And, I wish that provision had stayed in; I think that it's a horribly misunderstood provision and I think your slippery slope wouldn't have come true.

Incidentally, it's legal NOW for Medicare to reimburse for the "gravely ill" end of life counseling. Already. It was contained in the 2003 Medicare prescription drug bill. (apologies for the somewhat sarcastic tone of the link - it's a blog, but they then provide this link: )
Thomas link.
I wish they had, too! And the V.A. also does this. I think it's a shame that they took it out. :no:

Every plan offered in the US after the bill becomes effective must meet the requirements and mandates set forth by the Health Choices Administration, except grandfathered plans... GOOD!!! :tu: To me, this is a check in the plus column. :hmm: you keep saying this like it's a bad thing.

Probably not, though in Brazil they are. Same with nose jobs, liposuction, and butt implants, but I digress.
:scared: oh my, yes ---we have enough provocative issues to discuss already :rotfl:

If objective is to provide a public option for those unable to afford health insurance or whose medical conditions make the cost of purchasing a plan prohibitively expensive, then why not just do that? Why create the Health Choices Administration and subject every plan offered in the US to it's dictates? Because I don't believe this one simple thing would do it. Again, the Insurance companies, in my opinion, have had free reign and have exploited it badly to the detriment of our citizens. Just like we need laws that say, "Stealing's a nono, killing's a nono, breach of contract is a nono..." they seem to need a few boundaries, too. Also, a simple public plan doesn't address other things like fraud and increased measures to do this, or an international medical data info system to cut down on paperwork (and costs associated with that), etc.

We've been talking abut nationalizing health care for man many year, but other than Hillary's bill, which was defeated, and Medicare, there has never been a bill which grants the federal government control over every health plan available in the US and prohibits individuals from purchasing a plan outside of the government's control (and may assess a fine on them if they do so).
If you mean control like regulating them so they can't pull things like raising premiums on very sick people to get them to cancel the policy, GOOD!

In my opinion, this "control" is long overdue and stops some of the foolishness that's been going on.

Why Congress, especially Speaker Pelosi and Senate Majority Leader Hoyer, feel the need to rush their bill through is beyond me. Rush? I agree with Plimpy that this has been thought about for years and years. You don't think they were already outlining after the election last year, as far as writing them down? A lot of these ideas are not new, but have been banging around in the halls of congress waiting for a legislative piece of paper to stick to. It will still be months until we have a final piece of legislation. Again, this is a "process".

I think HR 3400, the Republican's plan, comes a lot closer to offering a plan which will provide for those unable to afford health insurance due to pre-existing conditions or high cost health conditions or the high cost of health insurance. There are *parts* that have some charm of HR3400, but overall, I don't like the tax-credit based philosophy it uses to get it done, I don't think it will cover near as many people, and I know it would not help me as much as HR3200. I see more deficit problems with it...not through spending this time, but through strangulation of income. But, I can see why it's right up the GOP ally as they seem to want to get rid of government. That bill might do it...and many other things in government that would have to be cut because it reduces the U.S. income (thus what it can spend)...like on the deficit. We need to work on that, too. That's a GOP war cry, but not now with HR3200?). Hopefully you will understand when I say, it's not my cup of tea, as a left-leaner. That being said, perhaps there are things in it that can be borrowed into a composite bill.

I think the Senate Finance Committee has yet to actually write their bill precisely because they are going through the give and take of compromising, taking their time about it I went to Senator Fienstein's office yesterday in person, to voice my support of Health Care Reform and specific issues I would like to see, support in the current house bill, or don't care for.

Her staffer gave me a six page plain-text synopsis of what the Senate bill has in it and hopes to accomplish and how. If you would like, I could put it in an expandy-box on the forum for all to see.

I view the "minimum standards" as being a consumer protection, not a government takeover. EXACTLY! :agree: I'm not sure why the opposition wants to call them "government control"...well, yes I do. Personally, I think it's just to scare people.

We have minimum standards for our drinking water, for pesticide content in foods, for smog control and emissions on cars, for work safety, for...well, all kinds of things. This is no different. Corporations have shown they cannot regulate themselves over and over. In my opinion, whenever we give them more freedom, they seem to show they can't handle that responsibility yet (example: Rolling back regulations on Wall Street recently, now having to put them back plus maybe a few more).

The problem is the more we as citizens turn over to the government, the more we both come to rely on the government, and, what's worse, the government comes to a more controlling status over America's destiny. By maintaining an option for private healthcare, or private pay it continues to offer John Q. Taxpayer options, while not while not delegating too much control over people's lives.
Another way to look at it is, the more the government removes some of the burden on our backs, the more other stuff we can do. And what is the government? Its the people, voted--appointed--or hired to serve the people.

Given my choices of turning over control of my health care to a corporation, or to a government by the people, for the people and of the people....I'm going with the government. I know what the corporations already did with my health. That was no choice at all.

Uninsured, I had no choice. There was no access without the golden ticket. If you can't get one of those because you are not "profitable" (either lack of money, or too expensive), then..well, there's your death panel, in my opinion. That's what we already have. I'm soooooooooooo ready for a change :agree:

I went to Senator Fienstein's office yesterday in person, to voice my support of Health Care Reform and specific issues I would like to see, support in the current house bill, or don't care for.

Her staffer gave me a six page plain-text synopsis of what the Senate bill has in it and hopes to accomplish and how. If you would like, I could put it in an expandy-box on the forum for all to see.
I would be interested in seeing that if you have the time to post it. :)

Well, a specialist can be an important part of basic health care. A specialist could be necessary to save a person’s life depending on what sort of illness they have and even simply for preventative medicine or more common medical illnesses. I don’t think anyone would say a visit to a gynecologist shouldn’t be covered for women (or an obstetrician if pregnant), but that is a specialty.True, but for the most part, it's only a yearly exam most women visit the GYN for anyway, right?

I think we should start with the basics first and then work our way up, you know, after we see how things go first.

I guess what we need, is something informing us what type of doctors would be covered by a public option...basic physicians, or the specialists too (OB/GYN, Dentist, Optometrist, etc.)

I would be interested in seeing that if you have the time to post it. :)

Here ya go...


THE AFFORDABLE HEALTH CHOICE ACT


Approved by the Senate Committee on Health, Education, Labor & Pensions
July 15,2009

After more than a month of committee mark-up in which over 160 Republican amendments were accepted, the Senate Committee on Health, Education, Labor & Pensions (HELP) approved the Affordable Health Choices Act. This legislation lays the foundation for comprehensive national health reform. Our bill, combined with the work being done by the Senate Finance Committee, will make health care affordable and available to all Americans. Fully 97 percent of Americans will have coverage, a major achievement.

This brief summary outlines the key features of the legislation:

Guaranteeing quality, affordable health coverage for all Americans.
Making coverage fairer and more comprehensive.
Protecting Americans against ruinous medical costs.
Giving immediate assistance to retirees to help with the high cost of coverage.
Providing an immediate benefit for evidence-based preventive services.
Creating a new voluntary insurance program for long term services and supports.
Transforming health quality through delivery system reform.
Improving the health of all Americans through prevention and wellness.
Building a health care workforce to meet the needs of the 21st century.
Fighting health care fraud and abuse.
Improving access to innovative medical therapies.


Title 1. Guaranteeing Quality, Affordable Coverage for All Americans

Building on what works. Everyone who likes his or her current health insurance -- whether employer, individual or government-sponsored -- can keep it.

Fixing what's broken: the American Health Benefit Gateway. The American Health Benefit Gateway is a new federally sponsored and state run way for individuals and small employers to find and purchase quality, affordable health insurance. Each Gateway will create new and accessible health insurance markets in each state to make purchasing health insurance easy and reliable. Gateways will make sure coverage is high quality and there when consumers need it the most. Plans will have new incentives to keep enrollees healthy. For eligible individuals and families, signing up will be consumer friendly. Enrollees will be able to fill out applications in many locations and be enrolled in the insurance coverage appropriate for them.

Only insurance plans meeting high standards for quality and benefits will sell through the Gateway. For those with incomes up to four times the federal poverty level ($43,000 in annual income for an individual), premium subsidies will be available on a sliding-scale basis according to family income. Based on their ability to pay, enrollees will be responsible for out of pocket expenses with clear limits. One option available to consumers through the Gateway will be a publicly-sponsored plan called the "Community Health Insurance Option."

Gateway plan benefits will be as extensive as those offered to Members of Congress. At a minimum, these benefits will include: outpatient services; emergency services, hospitalization; maternity and newborn care; medical and surgical care; mental health & substance abuse services; prescription drugs, rehabilitative and laboratory services; preventive and wellness services; and pediatric services.

Fixing what's broken: Insurance Market Reforms. Far-reaching changes will be required for new health insurance coverage:


Guaranteed issue: Insurance companies will be required to take all applicants. For the first time ever, they will not be permitted to deny coverage to anyone.
No medical underwriting or pre-existing condition exclusions: Insurance companies will be forbidden to write or to price policies based on health status, medical condition, or gender.
Community rating: Insurance companies will charge everyone premiums that may only vary by family composition, type of plan, geography, tobacco use, participation in wellness programs, and age. Age rating will not vary by a factor more than two to one.
Medical loss ratios: Insurers will report publicly how much of premium dollars are spent on medical costs versus non-medical costs such as marketing, administration, and profits.
Coverage for young adults: Insurers will allow young adults extra time to stay on their parents' coverage plans.
Elimination of lifetime and annual benefit caps.
Elimination of insurance policy rescissions.

Supporting Small Business. A new health insurance credit for businesses with 50 or fewer workers will cover up to half the cost to the employer of providing health insurance for their workers. The credits phase out as the firm size increases, and the assistance is most generous for firms with lower-wage workers.

Sharing Responsibility -- Individuals. In a voluntary market with guaranteed issue, many healthy people wait until they get sick to purchase coverage, driving the price of insurance beyond most people's reach. That is why the HELP bill sets a new requirement for all individuals to purchase health insurance. Just as failing to obtain car insurance carries a penalty, so too the HELP bill requires those who fail to fulfill this requirement to pay a fine. Those who do not have affordable coverage available to them will receive a hardship waiver. An exemption is also provided for those who have religious objections to health care coverage.

Sharing Responsibility -- Employers. Shared responsibility requires everyone to help solve America's health care crisis. That includes government, insurance companies, medical providers, individuals and employers. Except for small employers with 25 or fewer workers, those businesses not providing coverage for their workers will be asked to contribute to the cost of providing publicly-sponsored coverage for those workers. The maximum assessment will be $750 annually for full-time and $375 for part-time workers.

Creating a new voluntary insurance program for long term services and supports. The HELP legislation creates a new national insurance program to help adults who have or develop functional impairments to remain independent, employed and stay a part of their communities. Financed through voluntary payroll deductions, this program will remove barriers to independence and choice (e.g., housing modifications, assistive technologies, personal assistance services, transportation) by providing a cash benefit to individuals unable to perform two or more functional activities of daily living. The large risk pool created will make added coverage more affordable and reduce incentives for people with severe impairments to spend down to Medicaid.

Improving access to critical health care services. The AHCA legislation expands funding authorizations for federally qualified health centers, the National Health Services Corps, and community-based mental and behavioral health services. The legislation also reauthorizes the Wakefield Emergency Medical Services for Children program.

Immediate assistance with the soaring cost of health care for retirees. Retirees not yet eligible for Medicare face extraordinary challenges in receiving affordable, quality health care. Costs for coverage are soaring, but businesses face more and more pressure to cut back on retiree coverage. To help retirees keep the coverage they have, the legislation establishes a reinsurance fund for retiree health coverage that is estimated by the nonpartisan Urban Institute to reduce premiums by over $1,200 a year for a family policy.

Title II. Improving health quality through Delivery System Reform

A National Quality Strategy. The United States lacks a coherent strategy to improve the quality of our health care system. Consequently, health outcomes and quality initiatives vary widely. As President Obama has said, these activities have been haphazardly left to "Islands of Excellence." This title requires the Secretary of Health and Human services to establish a new national strategy and infrastructure to improve the quality and performance of the U.S. health care system. The strategy will target priority areas, use health information technology, and focus on health outcomes and population health. An interagency working group will coordinate and implement health care quality improvement initiatives. Quality measures will be identified, developed and endorsed. A streamlined and integrated quality reporting process will minimize the burden on providers. Key initiatives include:


Developing a national strategy for quality improvement.
Establishing an interagency working group on health care quality.
Setting comprehensive quality measure development.
Creating a quality measure endorsement and public reporting system.
Forming a Patient Safety Research Center at the Agency for Healthcare Research and Quality.
Supporting and developing Community Health Teams.
Implementing Medication Management Services in treating chronic disease.
Improving regionalized systems for Emergency Care, including acute trauma.
Reporting and reducing preventable readmissions.
Facilitating shared decision making.
Evaluating the presentation of prescription drug information.
Establishing a new Center for Health Outcomes, Research and Evaluation.
Meeting the promise and opportunity of Administrative Simplification.

Title III. Improving the Health of the American People through Prevention & Wellness

In clinical medical settings, in communities, in health care training, in our workplaces -- there are significant barriers to leading a healthy lifestyle. The incentives are misplaced and encourage unhealthy behavior. As President Obama has said, preventative care is "one of the best ways to keep our people healthy and our costs under control." The key Prevention and Wellness provisions in the HELP Committee legislation include:

Establishing a federal Prevention and Public Health Council to coordinate federal agencies and to develop a national strategy with public health goals and objectives for the nation.
Changing medical school and residency curricula to teach the next generation of health care professionals how to prevent unnecessary disease.
Removing barriers to preventive services.
Creating a Prevention and Public Health Investment Fund to expand the nation's investment in prevention and public health.
Establishing the Right Choices program to give uninsured adults access to preventive services until full insurance coverage is made available through Gateway.
Authorizing the development and expansion of School-based Health Clinics.
Setting up an oral healthcare prevention and education campaign.
Awarding community transformation grants to prevent and reduce chronic disease.
Developing a "health aging, living well" program to improve the health status of the pre-Medicare eligible population.
Improving immunization coverage of children, adolescents, and adults through evidence-based interventions.
Requiring chain restaurants to disclose calories on menus and menu boards.
Encouraging a healthy start by requiring employers to provide break times and locations for breastfeeding mothers to express milk.
Expanding opportunities for employers to reward employees for participating in wellness programs from the current 20 percent to a 30 percent premium discount.
Sets up a Coordinated Environmental Public Health Network to track incidence, prevalence and trends in priority chronic conditions.
Requiring reimbursement for essential preventive services to provide incentives for preventive services such as screenings for diabetes, depression and colorectal cancer, tobacco cessation, and nutrition counseling.

Title IV. Building a health care workforce to meet the needs of the 21st century

A strong health care workforce is essential for the successful health reform. The Affordable Health Choices Act will improve access to and delivery of health care services for all Americans by increasing the supply of a qualified health care workforce, enhancing workforce education and training, and providing support to the existing workforce.

Key provisions include:

Increase the supply of qualified health care workers by providing low-interest student loans, loan repayment programs and scholarships for students and mid-career health care providers.
Establish a National Health Care Workforce Commission to determine current and projected workforce needs, and to advise Congress and the Administration how to align workforce resources with national needs.
Create state health care workforce development grants to enable state partnerships to support innovative activities to increase the numbers of skilled health care workers.
Setting up new loan programs for nurses, mental and behavioral health providers, and allied health professionals.
Developing a Ready Reserve Corps for service in times of national emergency.
Supporting advanced training for family medicine physicians, pediatricians, nurses, physician assistants, pediatric and general dentists, direct care workers, geriatricians, mental and behavioral health professionals, community health workers, public health professionals, and nurse faculty.
Forms a Centers of Excellence program to encourage and mentor minority applicants for healthcare workforce positions.
Creates a Primary Care Extension Program to education and provide assistance to primary care providers about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health.

Title V. Preventing Fraud and Abuse

The National Health Care Anti-Fraud Association estimates that three percent of all health care spending -- or $72 billion -- is lost to health care fraud perpetrated against public and private health plans. Fraud committed against public and private plans increases the costs of medical care and health insurance for employers, families, and taxpayers, and undermines public trust in our health care system. Our legislation will ramp up efforts to combat fraud, especially in the private health insurance market, giving new tools to states and federal agencies to stop and prevent fraudulent activities.

Title VI. Improving Access to Innovative Medical Therapies

Follow-on Biologics. Patients now face extraordinary costs for innovative new medical therapies based on the techniques of biotechnology. The legislation will establish a way for FDA to approve new or "follow-on" versions of these lifesaving medicines. Just as generic drugs have lowered the costs of health care, so too these new biologics can bring the cost of these new medicines within the reach of the patients who need them. The legislation also includes a balanced way to resolve the patent disputes that can stall approval of follow on biologics. Finally, the legislation includes the incentives for innovation, by giving manufacturers of innovative biologics a 12-year period of market exclusivity for their products.

Expanded Participation in 340B Program: Section 340B of the Public Health Service Act enables safety-net hospitals and other providers serving a large volume of low-income and uninsured patients to access discounts on pharmaceuticals. Among other changes, the HELP legislation expands the drug discount program to allow participation by free-standing children's hospitals, free-standing cancer hospitals, rural referral centers, sole community hospitals with a disproportionate share hospital percentage greater than eight percent, and all critical access hospitals.

Right now, I think that the assessment of a few people that the brouhaha over the House bill is largely a sideshow is accurate.

I'm not so sure I would characterize the people complaining about the House's bill as a sideshow. There were quite a few complaints about Cap and Trade, which only passed the house ans was stalled in the Senate, but no one characterized that brouhaha as a sideshow.

People are concerned with the language in the House Bill and expressing those concerns to their elected officials. I highly doubt the House would have delayed voting on the bill before the recess had the brouhaha not happened. I suspect the House will vote on the bill shortly after returning from the recess.

The real action's taking place in the Senate, and that's where I think the bill will emerge from. And, they're taking their time about it, too - perhaps they are trying to get it right?

The Senate has always been a more deliberative body while the House has typically been more reactionary. Once the Senate votes on a bill, whatever they approve will enter conference committee with the House and then a joint resolution will be issued and voted on by both houses.

I certainly hope the Senate is trying to get it right, but Kennedy's bill, which is a cousin of HR 3200 and almost identical, has passed through every committee except the Senate Finance Committee, and the Senate Finance Committee is all that stands in the way of that bill going before the entire Senate.

I just looked it up, the CBO hasn't scored the HR 3400 by now. I don't know why; however, from your description of it I wouldn't be surprised if it comes in more expensive than the Democrats plan. If the tax credits are "refundable", then that does mean that there will be money coming back to the taxpayer, even if they had zero income tax liability. That could be a large chunk of change.

I don't know why the CBO hasn't scored the bill. Does anyone know whether the CBO goes on recess when Congress does? Perhaps that's why.

GOOD!!! To me, this is a check in the plus column. you keep saying this like it's a bad thing.

I do think it's a very bad thing, for multiple reasons. It's not the government's place to tell a private citizens what type pf health coverage he or she can or can not have. It's not the government's place to mandate what my private insurance does or does not cover. It's not the government's place to dictate what I pay for my private health coverage.

If the government want to issue such dictates and mandates for those in a government run taxpayer subsidized program, then fine. But not private health coverage that isn't subsidized by the taxpayers.

The government screws up everything it attempts to do. It doesn't do things more efficiently or effectively. When the government takes over costs increase and quality decreases.

Because I don't believe this one simple thing would do it. Again, the Insurance companies, in my opinion, have had free reign and have exploited it badly to the detriment of our citizens. Just like we need laws that say, "Stealing's a nono, killing's a nono, breach of contract is a nono..." they seem to need a few boundaries, too. Also, a simple public plan doesn't address other things like fraud and increased measures to do this, or an international medical data info system to cut down on paperwork (and costs associated with that), etc.

The only programs that have problems with fraud are the government run ones. Fraud in private insurance is almost unheard of.

The fraud reduction efforts only apply to MediCare / Medicaid / SCHIP and to individuals attempting to receive taxpayer assistance as part of the public option.

Automation without efficiency doesn't cut down on paperwork. It cuts down on paper, but the work is still done. Automation doesn't necessarily cut down on costs either. You may have 3 fewer $30,000 a year employees, but you've replace them with $40,000 of equipment and software and a techie paid $110,000 a year.

Here's the actual bill approved by the Senate HELP committee (http://help.senate.gov/BAI09A84_xml.pdf) . It's the cousin of the House Bill we've been referring to by it's Congressional Record reference number - HR 3200. The synopsis is the talking points and marketing for the bill. When it comes to the government, the devil is in the details.

The government screws up everything it attempts to do.

Well, maybe you should get rid of the military and replace it with mercenaries. Wait, that's what happened in Iraq and didn't Blackwater do a bang-up job.

The only programs that have problems with fraud are the government run ones. Fraud in private insurance is almost unheard of.

Links?

I've asked this question before and didn't get an answer. I'm going to ask it again. Those who are in favor to the Health Care Bill (3200?) what is it that you like? We've heard a lot about what people don't like about and I have yet to really hear what people do like about it.

Well, maybe you should get rid of the military and replace it with mercenaries. Wait, that's what happened in Iraq and didn't Blackwater do a bang-up job.

(a) Offtopic

(b) False. Blackwater was hired to provide security for embassy personnel and state department employees who didn't want to travel around in military convoys. The US military did the rest, and yes, they did a bang up job.

Links?

The average health insurer’s anti-fraud investigative unit has an annual budget of slightly more than $1.9 million and 19 fulltime employees......

......Medicare’s annual anti-fraud budget is $465 billion.

http://www.insurancefraud.org/stats.htm

The average health insurer’s anti-fraud investigative unit has an annual budget of slightly more than $1.9 million and 19 fulltime employees......

......Medicare’s annual anti-fraud budget is $465 billion.

http://www.insurancefraud.org/stats.htm

This figure is incorrect, and I think if you scroll down to a point two or three below it, that becomes clear.

Medicare spends less than 0.2 cents of every $1 of its $456 billion annual budget combating fraud, waste and abuse. (Miami Herald, August 11, 2008)
And I question the average number provided as well. There are lots of HMOs and many health insurance companies break themselves up by state even if they are a nationwide company (like Blue Cross and Blue Shield of ____).

Using the source material for the information you provided on the average health insurers anti-fraud unit, the National Health Care Anti-fraud Association, an article from 2008 (with 2007 data, from what I have read this has gone up in 2008) (http://www.nhcaa.org/eweb/dynamicPage.aspx?webcode=member_services&wpscode=NHCAANewsBrief062008#article8)
Blue Cross and Blue Shield companies' anti-fraud investigations resulted in overall savings and recoveries of more than $249 million last year, according to data released by the Blue Cross and Blue Shield Association (BCBSA). The combined return and savings result for all Blue Cross and Blue Shield companies' anti-fraud units was $5 dollars for every $1 dollar spent on anti-fraud efforts.
If they get $5 back for every dollar spent, then it sounds like they spent approximately $49.8 million in 2007.

While this is still less than the amount spent by Medicare, the figures on the link you provided seems to imply Medicare does it more efficiently.
Every $1 spent on Medicare fraud prevention would stop $10 in fraud.

And this doesn't even get into the reasons for the differences. Perhaps doctors do not try to scam the companies because they get paid for keeping costs low. Why pretend to run more tests when you get paid to run fewer tests? Also, people on Medicare are some of the more vulnerable people, so they seem much more likely to open themselves up to medical identity theft.

Here ya go...


THE AFFORDABLE HEALTH CHOICE ACT


Approved by the Senate Committee on Health, Education, Labor & Pensions
July 15,2009

After more than a month of committee mark-up in which over 160 Republican amendments were accepted, the Senate Committee on Health, Education, Labor & Pensions (HELP) approved the Affordable Health Choices Act. This legislation lays the foundation for comprehensive national health reform. Our bill, combined with the work being done by the Senate Finance Committee, will make health care affordable and available to all Americans. Fully 97 percent of Americans will have coverage, a major achievement.

This brief summary outlines the key features of the legislation:

Guaranteeing quality, affordable health coverage for all Americans.
Making coverage fairer and more comprehensive.
Protecting Americans against ruinous medical costs.
Giving immediate assistance to retirees to help with the high cost of coverage.
Providing an immediate benefit for evidence-based preventive services.
Creating a new voluntary insurance program for long term services and supports.
Transforming health quality through delivery system reform.
Improving the health of all Americans through prevention and wellness.
Building a health care workforce to meet the needs of the 21st century.
Fighting health care fraud and abuse.
Improving access to innovative medical therapies.


Title 1. Guaranteeing Quality, Affordable Coverage for All Americans

Building on what works. Everyone who likes his or her current health insurance -- whether employer, individual or government-sponsored -- can keep it.

Fixing what's broken: the American Health Benefit Gateway. The American Health Benefit Gateway is a new federally sponsored and state run way for individuals and small employers to find and purchase quality, affordable health insurance. Each Gateway will create new and accessible health insurance markets in each state to make purchasing health insurance easy and reliable. Gateways will make sure coverage is high quality and there when consumers need it the most. Plans will have new incentives to keep enrollees healthy. For eligible individuals and families, signing up will be consumer friendly. Enrollees will be able to fill out applications in many locations and be enrolled in the insurance coverage appropriate for them.

Only insurance plans meeting high standards for quality and benefits will sell through the Gateway. For those with incomes up to four times the federal poverty level ($43,000 in annual income for an individual), premium subsidies will be available on a sliding-scale basis according to family income. Based on their ability to pay, enrollees will be responsible for out of pocket expenses with clear limits. One option available to consumers through the Gateway will be a publicly-sponsored plan called the "Community Health Insurance Option."

Gateway plan benefits will be as extensive as those offered to Members of Congress. At a minimum, these benefits will include: outpatient services; emergency services, hospitalization; maternity and newborn care; medical and surgical care; mental health & substance abuse services; prescription drugs, rehabilitative and laboratory services; preventive and wellness services; and pediatric services.

Fixing what's broken: Insurance Market Reforms. Far-reaching changes will be required for new health insurance coverage:


Guaranteed issue: Insurance companies will be required to take all applicants. For the first time ever, they will not be permitted to deny coverage to anyone.
No medical underwriting or pre-existing condition exclusions: Insurance companies will be forbidden to write or to price policies based on health status, medical condition, or gender.
Community rating: Insurance companies will charge everyone premiums that may only vary by family composition, type of plan, geography, tobacco use, participation in wellness programs, and age. Age rating will not vary by a factor more than two to one.
Medical loss ratios: Insurers will report publicly how much of premium dollars are spent on medical costs versus non-medical costs such as marketing, administration, and profits.
Coverage for young adults: Insurers will allow young adults extra time to stay on their parents' coverage plans.
Elimination of lifetime and annual benefit caps.
Elimination of insurance policy rescissions.

Supporting Small Business. A new health insurance credit for businesses with 50 or fewer workers will cover up to half the cost to the employer of providing health insurance for their workers. The credits phase out as the firm size increases, and the assistance is most generous for firms with lower-wage workers.

Sharing Responsibility -- Individuals. In a voluntary market with guaranteed issue, many healthy people wait until they get sick to purchase coverage, driving the price of insurance beyond most people's reach. That is why the HELP bill sets a new requirement for all individuals to purchase health insurance. Just as failing to obtain car insurance carries a penalty, so too the HELP bill requires those who fail to fulfill this requirement to pay a fine. Those who do not have affordable coverage available to them will receive a hardship waiver. An exemption is also provided for those who have religious objections to health care coverage.

Sharing Responsibility -- Employers. Shared responsibility requires everyone to help solve America's health care crisis. That includes government, insurance companies, medical providers, individuals and employers. Except for small employers with 25 or fewer workers, those businesses not providing coverage for their workers will be asked to contribute to the cost of providing publicly-sponsored coverage for those workers. The maximum assessment will be $750 annually for full-time and $375 for part-time workers.

Creating a new voluntary insurance program for long term services and supports. The HELP legislation creates a new national insurance program to help adults who have or develop functional impairments to remain independent, employed and stay a part of their communities. Financed through voluntary payroll deductions, this program will remove barriers to independence and choice (e.g., housing modifications, assistive technologies, personal assistance services, transportation) by providing a cash benefit to individuals unable to perform two or more functional activities of daily living. The large risk pool created will make added coverage more affordable and reduce incentives for people with severe impairments to spend down to Medicaid.

Improving access to critical health care services. The AHCA legislation expands funding authorizations for federally qualified health centers, the National Health Services Corps, and community-based mental and behavioral health services. The legislation also reauthorizes the Wakefield Emergency Medical Services for Children program.

Immediate assistance with the soaring cost of health care for retirees. Retirees not yet eligible for Medicare face extraordinary challenges in receiving affordable, quality health care. Costs for coverage are soaring, but businesses face more and more pressure to cut back on retiree coverage. To help retirees keep the coverage they have, the legislation establishes a reinsurance fund for retiree health coverage that is estimated by the nonpartisan Urban Institute to reduce premiums by over $1,200 a year for a family policy.

Title II. Improving health quality through Delivery System Reform

A National Quality Strategy. The United States lacks a coherent strategy to improve the quality of our health care system. Consequently, health outcomes and quality initiatives vary widely. As President Obama has said, these activities have been haphazardly left to "Islands of Excellence." This title requires the Secretary of Health and Human services to establish a new national strategy and infrastructure to improve the quality and performance of the U.S. health care system. The strategy will target priority areas, use health information technology, and focus on health outcomes and population health. An interagency working group will coordinate and implement health care quality improvement initiatives. Quality measures will be identified, developed and endorsed. A streamlined and integrated quality reporting process will minimize the burden on providers. Key initiatives include:


Developing a national strategy for quality improvement.
Establishing an interagency working group on health care quality.
Setting comprehensive quality measure development.
Creating a quality measure endorsement and public reporting system.
Forming a Patient Safety Research Center at the Agency for Healthcare Research and Quality.
Supporting and developing Community Health Teams.
Implementing Medication Management Services in treating chronic disease.
Improving regionalized systems for Emergency Care, including acute trauma.
Reporting and reducing preventable readmissions.
Facilitating shared decision making.
Evaluating the presentation of prescription drug information.
Establishing a new Center for Health Outcomes, Research and Evaluation.
Meeting the promise and opportunity of Administrative Simplification.

Title III. Improving the Health of the American People through Prevention & Wellness

In clinical medical settings, in communities, in health care training, in our workplaces -- there are significant barriers to leading a healthy lifestyle. The incentives are misplaced and encourage unhealthy behavior. As President Obama has said, preventative care is "one of the best ways to keep our people healthy and our costs under control." The key Prevention and Wellness provisions in the HELP Committee legislation include:

Establishing a federal Prevention and Public Health Council to coordinate federal agencies and to develop a national strategy with public health goals and objectives for the nation.
Changing medical school and residency curricula to teach the next generation of health care professionals how to prevent unnecessary disease.
Removing barriers to preventive services.
Creating a Prevention and Public Health Investment Fund to expand the nation's investment in prevention and public health.
Establishing the Right Choices program to give uninsured adults access to preventive services until full insurance coverage is made available through Gateway.
Authorizing the development and expansion of School-based Health Clinics.
Setting up an oral healthcare prevention and education campaign.
Awarding community transformation grants to prevent and reduce chronic disease.
Developing a "health aging, living well" program to improve the health status of the pre-Medicare eligible population.
Improving immunization coverage of children, adolescents, and adults through evidence-based interventions.
Requiring chain restaurants to disclose calories on menus and menu boards.
Encouraging a healthy start by requiring employers to provide break times and locations for breastfeeding mothers to express milk.
Expanding opportunities for employers to reward employees for participating in wellness programs from the current 20 percent to a 30 percent premium discount.
Sets up a Coordinated Environmental Public Health Network to track incidence, prevalence and trends in priority chronic conditions.
Requiring reimbursement for essential preventive services to provide incentives for preventive services such as screenings for diabetes, depression and colorectal cancer, tobacco cessation, and nutrition counseling.

Title IV. Building a health care workforce to meet the needs of the 21st century

A strong health care workforce is essential for the successful health reform. The Affordable Health Choices Act will improve access to and delivery of health care services for all Americans by increasing the supply of a qualified health care workforce, enhancing workforce education and training, and providing support to the existing workforce.

Key provisions include:

Increase the supply of qualified health care workers by providing low-interest student loans, loan repayment programs and scholarships for students and mid-career health care providers.
Establish a National Health Care Workforce Commission to determine current and projected workforce needs, and to advise Congress and the Administration how to align workforce resources with national needs.
Create state health care workforce development grants to enable state partnerships to support innovative activities to increase the numbers of skilled health care workers.
Setting up new loan programs for nurses, mental and behavioral health providers, and allied health professionals.
Developing a Ready Reserve Corps for service in times of national emergency.
Supporting advanced training for family medicine physicians, pediatricians, nurses, physician assistants, pediatric and general dentists, direct care workers, geriatricians, mental and behavioral health professionals, community health workers, public health professionals, and nurse faculty.
Forms a Centers of Excellence program to encourage and mentor minority applicants for healthcare workforce positions.
Creates a Primary Care Extension Program to education and provide assistance to primary care providers about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health.

Title V. Preventing Fraud and Abuse

The National Health Care Anti-Fraud Association estimates that three percent of all health care spending -- or $72 billion -- is lost to health care fraud perpetrated against public and private health plans. Fraud committed against public and private plans increases the costs of medical care and health insurance for employers, families, and taxpayers, and undermines public trust in our health care system. Our legislation will ramp up efforts to combat fraud, especially in the private health insurance market, giving new tools to states and federal agencies to stop and prevent fraudulent activities.

Title VI. Improving Access to Innovative Medical Therapies

Follow-on Biologics. Patients now face extraordinary costs for innovative new medical therapies based on the techniques of biotechnology. The legislation will establish a way for FDA to approve new or "follow-on" versions of these lifesaving medicines. Just as generic drugs have lowered the costs of health care, so too these new biologics can bring the cost of these new medicines within the reach of the patients who need them. The legislation also includes a balanced way to resolve the patent disputes that can stall approval of follow on biologics. Finally, the legislation includes the incentives for innovation, by giving manufacturers of innovative biologics a 12-year period of market exclusivity for their products.

Expanded Participation in 340B Program: Section 340B of the Public Health Service Act enables safety-net hospitals and other providers serving a large volume of low-income and uninsured patients to access discounts on pharmaceuticals. Among other changes, the HELP legislation expands the drug discount program to allow participation by free-standing children's hospitals, free-standing cancer hospitals, rural referral centers, sole community hospitals with a disproportionate share hospital percentage greater than eight percent, and all critical access hospitals.

Thanks, Linda. :)

Though, without knowing their exact definition of "affordable" and "hardship", I am a bit leery of this section of that summary:

Sharing Responsibility -- Individuals. In a voluntary market with guaranteed issue, many healthy people wait until they get sick to purchase coverage, driving the price of insurance beyond most people's reach. That is why the HELP bill sets a new requirement for all individuals to purchase health insurance. Just as failing to obtain car insurance carries a penalty, so too the HELP bill requires those who fail to fulfill this requirement to pay a fine. Those who do not have affordable coverage available to them will receive a hardship waiver. An exemption is also provided for those who have religious objections to health care coverage.

The government screws up everything it attempts to do. It doesn't do things more efficiently or effectively. When the government takes over costs increase and quality decreases.

The only programs that have problems with fraud are the government run ones. Fraud in private insurance is almost unheard of.

Isn't that an awfully sweeping gneralisation? How, in a world that contains corporations like Enron, can anyone trust corporations so much, and also distrust government so much?

At least you can punish government in elections and by other democratic means. Your average citizen has no control over corporations, unless he/she manages to get government to impose controls on those corporations. Which clearly hasn't happened enough in many cases in recent years.


I'd like to hear how you support such a general statement concerning government 'screwing up everything it does'. And, seeing that this is the very general statement on which all your arguments seem to depend, I hope that this question isn't off topic.

Isn't that an awfully sweeping gneralisation? How, in a world that contains corporations like Enron, can anyone trust corporations so much, and also distrust government so much?

Ever waited on line before boarding an airplane? Ever been the the DMV? How about been audited by the IRS? Ever read the procurement integrity act and attempted to bill the government for services you or your employees have provided to it? How about education - think kids today are smarter and more capable than they were 50 years ago?

At least you can punish government in elections and by other democratic means. Your average citizen has no control over corporations, unless he/she manages to get government to impose controls on those corporations.

You don't have to buy the products offered by any corporation. You have no choice when it comes to the government - especially when it comes to government bureaucracy. And with this health care bill of the Democrats, not only will you not have a choice, but the government will fine you if you make a choice that doesn't meet their standards.

(a) Offtopic

You made the sweeping generalisation that the government "screws up everything it attempts to do" which raises the question why not privatise the US military as it is an arm of the government and, by this logic, screws up everything it does.

(b) False. Blackwater was hired to provide security for embassy personnel and state department employees who didn't want to travel around in military convoys. The US military did the rest, and yes, they did a bang up job.

Then why did the Iraqi govt chuck it out at the first chance?

Well, I just spent 1.5 hours putting together a killer post/reply ....which just accidentally disappeared in a power blip :argh:
Don't you hate that?

So, I'm cutting it WAY short now :lol: and just attending to the last post because, I now see, most of it just echos what others said anyway:

You don't have to buy the products offered by any corporation. You have no choice when it comes to the government - especially when it comes to government bureaucracy.
I have no choice when it comes to corporations. None...nada. They won't take me, I can't pay them enough to take me, and they basically have left me to die without so much as a bouquet of flowers and note: "So sorry you might die, it's not personal--just business."

This is the problem...for millions of Americans there is NO CHOICE ALREADY under the Corporate, health care system!! They need to have some regulations, just like corporations exploited children in factories for profit (and also claimed that it would kill them if it was regulated, but didn't) and laws were needed to "protect Americans" from exploitation...like laws and amendments were needed to free and protect human slaves, like safety and health rules and regulations were created when corporations were spewing massive amounts of pollution and chemicals into rivers saying they could not afford to change, and yet they did and survived...

How is this any different than protecting the American citizen by the government that is by the people, for the people and of the people?? They will survive. Corporations have always claimed they will not, but adapt and change. They screamed "Government take over!" for Social Security, Child Labor laws, Pollution restrictions, and any other time public health and safety became such a large issue, and the cry was so loud from corporate exploitation of (children, resources, health and safety, etc)that the government did have to step in for the public good.

I, for one, do not wish to return to the day before FDR when 9 yr olds worked 12 hour days in factories, workers often died because of lack of safety codes in industry, and massive chemicals were spewed into our lakes and rivers without a second thought (Love Canal, and so many places in the U.S.). When there were "Company Towns", tent cities and bread lines in every city.

Of course, back then, you could see a doctor and pay him with a chicken :lol: Now, it costs you $12,000/yr in a policy to be accepted for an appointment. And, for those that cannot afford the minimum private policy (and are not poor enough for medicaid)..there is no choice, none, nada. I used to joke that I was had the "Spiritual Insurance Policy"...which means, I go to church and pray I don't get sick.

This is the U.S.. We have put a man on the moon, created innovations in so many fields it's not funny, and have never shirked from a challenge. The fact our country does not have a national system is embarrassing, frankly. The fact that our country would whine over a couple percent tax on the wealthiest (who has done so well in the last eight years after their rates were rolled back by Bush) and put that over their fellow man and health of their country, is appalling to me.

From where I sit, if reform does not go through in this pass with a hybrid system (which can work, other countries like Australia has shown us that), I will be working for a single-payer, truly government run system and won't shed a tear for the health insurance industry at all.

I am not in fravor of Obama's plan because he still is adamant about preserving the tort system as it is. However, and economists agree, effective healthcare reform and national coverage is not a long term possibility without protecting our doctors and healthcare providers and manufacturers from the floodgates of lawsuits. Obama is a lawyer. He won't bite the hand that feeds.