America's Affordable Health Choices Act of 2009 - The USCHO debates

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

You may want to know what you're talking about next time. The GOV'T gives empolyers a tax deduction to provide employee insurance. People cannot receive the same deduction.

You're missing the point, which is individuals are highly unlikely to get the insurance by themselves at the same rate as a corporation does. The corporation has leverage, the individual doesn't. Furthermore, how does shopping across state lines help? Problem #1 is providers don't take every insurance policy under the sun, so if you live in Florida but got insured by Eskimo Life but were the only one in your area who had them, you're most likely $h!% out of luck when it comes to finding someone who takes them. Secondy people do receive a tax deduction for health care if from their employers. Its all pre-tax. How does that fact affect your calculations???

 

[walrus]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

So why can't you get insurance from anothe state? Government.

There are 1300 insurance companies nationwide. I'm pretty sure there would be enough competition if people could shop across state lines.

I agree, we should be able to, but I can't

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

DOH!!!
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GOPers for pulling plug on grandma? Posted: Friday, August 14, 2009 1:30 PM by Mark Murray
Filed Under: Congress, Republicans
From NBC's Mark Murray
The answer to that question is obviously no.

But it does appear that some Republicans who are raising concerns about end-of-life provisions in the House health-care bill -- like Chuck Grassley, John Boehner, and Thaddeus McCotter -- voted for a similar provision that was contained in the 2003 Medicare prescription-drug bill, which passed Congress and was signed into law by George W. Bush.

Here's the provision in that 2003 bill, per Time magazine's Amy Sullivan (emphasis mine):


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.


Well, as Sullivan and Plum Line's Greg Sargent point out, Grassley, Boehner, and McCotter all voted for the 2003 legislation.

A Boehner spokesman tells First Read that comparing the 2003 bill to the 2009 health-care legislation is "mixing pebbles and boulders." The 2003 provision, he adds, "applied only to hospice patients (i.e., people already near death), not everyone on Medicare."

But if Boehner was fine to vote for that 2003 provision isn't that still -- borrowing Boehner's own logic about the House health-care bill -- sending us "down a treacherous path toward government-encouraged euthanasia," as he has said?

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VERY interesting...

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

You're missing the point, which is individuals are highly unlikely to get the insurance by themselves at the same rate as a corporation does. The corporation has leverage, the individual doesn't.

How do you get car insurance? Why doesn't your employer provide that? How come you can often get lower costs if you switch providers?

Furthermore, how does shopping across state lines help? Problem #1 is providers don't take every insurance policy under the sun, so if you live in Florida but got insured by Eskimo Life but were the only one in your area who had them, you're most likely $h!% out of luck when it comes to finding someone who takes them.

Different states have different mandates making policies cost less. Ask someone in New York if they'd like to pick up a policy from their neighbor in Penn. It would cost them less then half as much for coverage.

Again, I go back to car insurance. I could go with a really cut rate insurer, but I don't because I want to be able to take my car into certain shops. I know where I'm able to take my car because I looked at my policy ahead of time.

Secondy people do receive a tax deduction for health care if from their employers. Its all pre-tax. How does that fact affect your calculations???

People cannot get the same deduction if they do not go through their employers. I would love to be able to get a catestrophic policy on my own and deduct it from my taxes and bank the difference, but I can't.

Can you now see how the gov't has contributed to less competition, more mandates and ultimately higher costs?

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I agree, we should be able to, but I can't

So now gov't get to be the solution to their own problem?

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

What an utterly sackless party...

http://hosted.ap.org/dynamic/storie...ELS?SITE=CONGRA&SECTION=HOME&TEMPLATE=DEFAULT

Good to see Palin still calling the shots.

MinnFan,

Comparing health insurance to car insurance is apples to oranges. For one, car insurance is a lot less complex. Next, you can't shop the country for any car insurer, they (in my state at least) have to be operating here. Next, like medical insurance, your cost is going to be determined by where you are, not where the insurer is. For example, car insurance in North Dakota is probaby cheaper than in New York. However, if you called the ND company and said insure me at your state's rate in New York City, they'd probably laugh their head off. Why? Because with more accidents/theft/repair costs/etc it costs more to have a car in NYC. This is pretty basic, but stop me if there's something that you're missing here.

Shopping for insurance with any company in the country would be a logistical nightmare. First you'd need total electronic records and billing which isn't here yet (but which would have to be mandated by the govt, something you seem to be against in all cases). Next, every provider would have to be up to speed on every one of the 1,300 companies selling insurance by your estimate. Yikes - talk about paperwork. You'd be waiting months to get an appointment just to give them time to figure out who you have and what they'll pay for each procedure.

Like a lot of your ideas, they work well in a perfect world, but don't have any practical application in the one we live and the one humankind will be living in for the next century.

 

[Kepler]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

IINM, the Dems are going to pull the provision from the bill, so both parties are sack-challenged.

Perhaps once the Dems should stand up and say, "You know, that's such an effing ridiculous distortion that we're not even going to bother explaining it. Figure it out for yourselves." The 28%ers would go nuts, but (1) they'll go nuts anyway when Becky and Rushy tell them to, and (2) the middle would probably respect it. A healthy contempt for moronic charges is no vice.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

IINM, the Dems are going to pull the provision from the bill, so both parties are sack-challenged.

Perhaps once the Dems should stand up and say, "You know, that's such an effing ridiculous distortion that we're not even going to bother explaining it. Figure it out for yourselves." The 28%ers would go nuts, but (1) they'll go nuts anyway when Becky and Rushy tell them to, and (2) the middle would probably respect it. A healthy contempt for moronic charges is no vice.

I don't think its a done deal that they're pulling this away. Remember two things: 1) if Grassley doesn't vote in favor of the Finance committee's bill, he can kiss off any deals he's made, 2) as best I can tell its only him saying that this one committee has dropped it. Once out of committee I'm speculating this makes it into the final draft, because as you say only stupid people will be swayed by this argument.

What I am seeing the last couple of days is a necessary but so far well done push back by the White House. They're exposing hypocrites, friendly columnists are pointing out ridiculous innuendos, union "peacekeepers" are starting to show up at forums to keep it fair , the President attracts far more news coverage for his town halls than anybody else, and Sarah Palin won't S T F U!

 

[ScottM]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I read on Bloomberg that there are about 3,300 lobbyists involved in this process, or about 6 for every Member of Congress. So, that may indicate something right there. I kind of miss the old "smoke filled rooms" ...

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I read on Bloomberg that there are about 3,300 lobbyists involved in this process, or about 6 for every Member of Congress. So, that may indicate something right there. I kind of miss the old "smoke filled rooms" ...

That's why the bill is so large. There has to be something in there for each of the lobbyists.

 

[dropthatpuck]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

What an utterly sackless party...

http://hosted.ap.org/dynamic/storie...ELS?SITE=CONGRA&SECTION=HOME&TEMPLATE=DEFAULT

Good to see Palin still calling the shots.

MinnFan,

Comparing health insurance to car insurance is apples to oranges. For one, car insurance is a lot less complex. Next, you can't shop the country for any car insurer, they (in my state at least) have to be operating here. Next, like medical insurance, your cost is going to be determined by where you are, not where the insurer is. For example, car insurance in North Dakota is probaby cheaper than in New York. However, if you called the ND company and said insure me at your state's rate in New York City, they'd probably laugh their head off. Why? Because with more accidents/theft/repair costs/etc it costs more to have a car in NYC. This is pretty basic, but stop me if there's something that you're missing here.

Shopping for insurance with any company in the country would be a logistical nightmare. First you'd need total electronic records and billing which isn't here yet (but which would have to be mandated by the govt, something you seem to be against in all cases). Next, every provider would have to be up to speed on every one of the 1,300 companies selling insurance by your estimate. Yikes - talk about paperwork. You'd be waiting months to get an appointment just to give them time to figure out who you have and what they'll pay for each procedure.

Like a lot of your ideas, they work well in a perfect world, but don't have any practical application in the one we live and the one humankind will be living in for the next century.

You're so cute, you good little socialist.

This thing's DOA unless he gets the attorney lobby fudge off his nose....which he won't because the selfish SOB really doesn't care about a reasonable plan which includes some sort of TORT reform - he only cares about a bill that pays back his cronies - much like the stimulus package(s).

I'm going to enjoy watching him wither on the vine after the BS he's been perpetrating on the American peeps.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

One might say that this statement lacks tact. Am I supposed to feel awesome about this - that you feel ASHAMED to agree with me? Good God. Slap Shot and I rarely agree on anything, but when we do I'd say that makes me happy, not ASHAMED. Christ.



Just as an FYI - the bill's over 1000 pages long, but I've been taking a look through it nonetheless.

OK, I forgot the sorry.

If its private sector you hold the gun. You are able to go to someone else. The gov't is the only one who can legally force you to do anything.

In the private sector each individual controls their fate. With the gov't you're just one of many others who holds the same gun so don't be surprised when its turned on you.

This is a fallacy. Most people carry insurance from their employer and they hold the gun, only if they want to. The individual can complain all they want but they do not control what happens.

Kepler's inevitably pathetic response will be that ZOMG NO YOU DONT CONTROL YOUR FATE IN THE PRYVATE SECTUR EIHTER.

But I like what you've said here about many people holding the same gun. In the private sector, if you don't like what your plan is doing, you can get a different plan. Not the case under government. It's their way, or the highway.

Most companies do not offer burger king type insurance options. You get what your employer offers. Rarely the HR folks ask what people are interested in.

Except you can't really just go out and get another plan b/c your insurance is generally paid for and chosen for you by your employer, and its exorbitantly expensive to get another plan on your own.

exactly.

Then why not give individuals the same deductions that companies get on health care? Seems like a more sensible solution than a massive gov't instusion.

So why can't you get insurance from anothe state? Government.

There are 1300 insurance companies nationwide. I'm pretty sure there would be enough competition if people could shop across state lines.

A few comments on going it alone. If you ask most people who are self employed the cost is ridiculous as the insurance co. respond to volume when they make deals. 20 yrs ago my Fa-in-law tried to get insurance for he and his employee- bare minimum was 800 a month for catastrophic. This isn't possible now. It would be well past that. If you are young and have a direct line to God then maybe you can know catastrophic will be enough.

The highest population of my pts without coverage are people who can't afford stuff on their own. Also it must be considered that many companies have folks that know the ropes when bargaining for coverage. Not saying people couldn't become savvy but it isn't easy to make sure you know everything you need to.

Also insurance companies can reject a single person with multiple problems or charge ridiculous amts for a premium. If you are in a group they cannot do that, they take blanket risk. They can raise the company rate if they usage is higher but the medical train wreck still has coverage. This has been an issue for years for people who have medical dx. The insurance company can reject pre-existing conditions and sometimes they decide a person had a condition and reject claims. The burden then becomes the patients to prove they did not have the problem.

As to the insurance across state lines- what a cluster F that would be. Just having a few people who have insurances from out of state is a nightmare. Each state has separate laws and requirements for what must be covered, what is excluded. Many of these are age dependent, diagnosis dependent, etc and vary by state. How do you deal with a company who is not required to cover a mammogram in Alabama but the patient lives in Mass where coverage is required? What do you do with a complaint if the patient lives in one state and the insurance company is in another? What about an appeal- each state has different rules. There would need to be :shudder: some regulations to deal with that.

Each company has different procedures for how things are coded for billing. Within each company there are multiple (read that with a few zeros in the big ones) different plans, all with different options. These things change by the day. Each company can have different times when they change medication formularies. Each company has a different way to process appeals, prior authorizations, pharmacy agreements and exclusions. Every insurance company has a panel of accepted providers and makes deals with different providers for reimbursement rates. It can take months and mucho bucks to get on a panel. On average for a small practice like mine it takes a minimum of 6 weeks to get vetted for a new plan (and a blizzard of paperwork) At this point we cannot predict what the variables are and have mostly one state to deal with. How would one be able to keep track of all the different places to call, panels you were on etc. What do you do when you need stuff on the east coast and the company is on PST or visa versa?

Many of the coding patterns and billing things are not standardized. Before you do anything you would need to standardize a bunch of things and put some form of regulation in place to debulk things. This is not in the insurance companies' best interest. They save millions and more a year by denying things a few times and requiring clarifications before they accept stuff and pay out. They also put time limits on when things need to be done. Each company is different. If you think the debate about what we have now is fierce (fueled in part by very clever insurance folks who have a great deal to lose in any reform pkg that passes) wait til you see what they mobilize if we try to standardize stuff!

Cynicism lives. I saw 3 patients today who could afford their meds. I saw more unstable patients who were unstable because their coverage changed and the meds they were on jumped tiers or were excluded. If it weren't for HIPA I would love to post a running log of what I saw and how messed up it is. To really appreciate the idiocy of it all you need all the details.

For everyone who thinks they have a choice and that they hold the gun I would love for you to be able to talk to my patients whose guns are shooting blanks.

Oh, and short of an act of GOD there will not be standardized EMR (electronic medical records) for yrs. It is already a nightmare (for another day)

whew. Thank goodness it is Friday.

 

[Patman]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

The thing is there are alternatives we haven't tried before using the last option which we can't undo.

Why not forbid companies or other collective entities from buying insurance coverage plans. How about opening up plans across state lines. Why not public price publishing? There are scores of different ideas which would could work and change things.

What's wrong with taking different steps before breaking the entire system.

les, you know we can't solve humanity... all you're asking is for a more equal share of the pain... the plans involved do not find ways to improve the process. They just try to use some economies of scale to pull some tricks... but since its gov't it won't quite work like that.

BTW, les, the employer does not hold the gun... the insurance company does not hold the gun... the doctor can always make amends, bankruptcy is still an unfortunate option but it is there, the hospitals can always decide to consider it a charity case. There are always other means. The government does none of those things and will use the power and weight of the law to avoid doing so because those who will be in power believe in the whole system because its FAIR.

The fact of the matter is costs have gone up because we're asking for more... otherwise somebody should be able to jump in on that market inefficiency in some manner. If it comes down to an argument of resources then we'll have to spend and provide less. We're told that 5/6's of the nation is currently covered and does so being (let's say) 25% more expensive. To make things work out we'll have to cut our costs, as a nation, by one-third per person.

Yes, this means the expense per person will have to come down 1/3rd which means that certain things that are done today will have to be not done under gov't care to bring us into a balance with other nations. So, who doesn't get cancer treatment, hip surgery? Who gets the right to decide that? Why does my government decide?

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

The thing is there are alternatives we haven't tried before using the last option which we can't undo.

Why not forbid companies or other collective entities from buying insurance coverage plans. How about opening up plans across state lines. Why not public price publishing? There are scores of different ideas which would could work and change things.

What's wrong with taking different steps before breaking the entire system.

les, you know we can't solve humanity... all you're asking is for a more equal share of the pain... the plans involved do not find ways to improve the process. They just try to use some economies of scale to pull some tricks... but since its gov't it won't quite work like that.

BTW, les, the employer does not hold the gun... the insurance company does not hold the gun... the doctor can always make amends, bankruptcy is still an unfortunate option but it is there, the hospitals can always decide to consider it a charity case. There are always other means. The government does none of those things and will use the power and weight of the law to avoid doing so because those who will be in power believe in the whole system because its FAIR.

The fact of the matter is costs have gone up because we're asking for more... otherwise somebody should be able to jump in on that market inefficiency in some manner. If it comes down to an argument of resources then we'll have to spend and provide less. We're told that 5/6's of the nation is currently covered and does so being (let's say) 25% more expensive. To make things work out we'll have to cut our costs, as a nation, by one-third per person.

Yes, this means the expense per person will have to come down 1/3rd which means that certain things that are done today will have to be not done under gov't care to bring us into a balance with other nations. So, who doesn't get cancer treatment, hip surgery? Who gets the right to decide that? Why does my government decide?[/QUOTE]I do not believe there is much avenue for charity cases when the hopitals are so far in the red. The Dr can make ammends how? In an ideal world this sounds wonderful. If we write someone off we can be libel for fraud because we didn't provide that same service for free to the insurance pt. You actually need to provide significant documentation re financial need to provide free care (not like it used to be).

As to who decides- I see no difference b/w the government or an insurance company. Is there one? The insurance co is a FOR PROFIT venture. Don't ever forget it. They are not driven by what the best outcome is, only the cheapest. They have a much stonger motivation to keep you from care than a not for profit plan. Why the paranoia re the 'gov't making decisions'? there is nothing in this bill or any proposal I have seen that would make them involved with care decisions. They mandate the doctor can get paid for having discussions that did not get reimbursed before (and took considerable time) but there is no requirement saying what should be said.

 

[MCFan16]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

O-Man giving up?

WASHINGTON – Apparently ready to abandon the idea, President Barack Obama's health secretary said Sunday a government alternative to private health insurance is "not the essential element" of the administration's health care overhaul.

The White House indicated it could jettison the contentious public option and settle on insurance cooperatives as an acceptable alternative, a move embraced by some Republicans lawmakers who have strongly opposed the administration's approach so far.

Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama has been pressing for the government to run a health insurance organization to help cover the nation's almost 50 million uninsured.

 

[Patman]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

IIRC, the human mole (Waxman) and the disgraceful gentleman from Wellesley (Frank) have both said that co-ops are the same thing but different. Like before, we'll have to see what the bills look like before its over.

 

[walrus]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

http://www.wrongreform.com/Myths___Lies.html

 

[ScottM]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Fat tax ...

Cosgrove says that if it were up to him, if there weren’t legal issues, he would not only stop hiring smokers. He would also stop hiring obese people.

“

We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

Today, the great American public-health problem is indeed obesity. The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s. As a convenient point of reference, a typical car tire weighs 20 pounds.

He is acknowledging that any effort to attack obesity will inevitably involve making value judgments and even limiting people’s choices. Most of the time, the government has no business doing such things. But there is really no other way to cure an epidemic.

http://www.nytimes.com/2009/08/16/magazine/16FOB-wwln-t.html?_r=1&ref=magazine

 

[LynahFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

http://www.wrongreform.com/Myths___Lies.html

A few interesting points, but I don't understand his argument that employers would rather cut their 11% of payroll on healthcare and instead pay the 8% tax, thus saving 3%. If that was the companies' mindset, why wouldn't they just go ahead and cut the coverage right now and save the whole 11%?

I'm also curious about the assertion that large companies pay more (in terms of percentage of payroll per employee) than small ones. Is the coverage provided by those two groups really the same, or are the large companies buying from Gold Plated Deluxe, Inc while the small businesses are buying Joe and Billy Bob's Insurance-4-U, LLC? If so, then the cost comparison really isn't valid.

 

[walrus]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

A few interesting points, but I don't understand his argument that employers would rather cut their 11% of payroll on healthcare and instead pay the 8% tax, thus saving 3%. If that was the companies' mindset, why wouldn't they just go ahead and cut the coverage right now and save the whole 11%?.

Because other companies keep insurance and until their is public option they need the insurance to retain employees? I see the point about saving 3 percent but not sure its really a good one?