Some basic questions need to be asked & answered before health reform of any kind proceeds

[debbierlus]

Some BASIC, very simple questions that need to be answered BEFORE any health care legislation is passed.

1. Affordability

What does affordable health insurance mean? What percentage of a person's income should be going to health care costs? Is health insurance considered affordable, if a person or family can barely afford the monthly premiums and copays yet they still are able to make them? What if the person or family can afford the monthly premiums but not the deductibles, if they should incur the need for a high cost procedure or illness? What income level will be eligible for government assistance to purchase health insurance coverage? Will eligibility be determined solely through gross monthly income regardless of other set monthly expenses (example, monthly student loans payments)? Will the insurance companies have any set limit on what they can charge for coverage? Will insurance companies be mandated to charge the same price for coverage of individuals or families or can insurance companies vary the rates based on their own criteria?

2. Accessibility

Will all citizens have equal access to health care & health services (under 'insert plan here')? Or, will accessibility be limited by the type of health insurance coverage a person or family can afford to buy? If so, what type of access will the various levels of insurance buy? What type of coverage will be available for a person who can only afford to buy 'catastrophic' coverage? What type of deductibles will have to be met before insurance of any kind begins to pay for the costs? Will insurance be required to pay for all medical procedures ordered by a person's physician? Will the insurance companies be mandated to cover everyone without any regards to 'pre-existing condition' & if yes, will the people with pre-existing conditions pay the same rate for the same insurance or will the insurance companies be allowed to charge a higher rate? Will physical therapy, chiropractic, & complimentary health care services (acupuncture, massage, etc) be required under a full coverage plan? What defines a full coverage plan? Will there be set guidelines by the government to define different levels of mandatory coverage for each type of plan offered (randomn examples - all full coverage plans must cover mammography). Will there be any type of health care system set up for people who can not purchase a full coverage plan such as clinics & health centers? Will the new system jeopardize the funding of any current clinics or health centers already in place?

3. Health Care Costs

Will health insurance companies be ordered to implement mandatory government cost cutting measures to reduce costs to the consumer? Will health insurance company executives be subject to maximum pay limits? Will the health insurance companies still be allowed to make a profit on health insurance? If so, will there be any limits placed on the amount of profit health insurance companies can make?

And, on & on...Let's have some REAL health care debate with all sides of the discussion participating.

If I had only one question to ask, it would be: Given that private health insurance companies charge 100% more for health care administration then the Federal Goverment (using the medicare model where 3 dollars of every hundred is spent on administration compared to 33.00 dollars of every hundred in the private sector) - why don't we just switch to a government administered payment system for our current health care system?

[Eric J in MN]

1. RE '3. Health Care Costs'

"Will health insurance companies be ordered to implement mandatory government cost cutting measures to reduce costs to the consumer?"
Even if they cut costs, they won't pass on the savings to us. They're for-profit companies.

"Will health insurance company executives be subject to maximum pay limits?"
No.

"Will the health insurance companies still be allowed to make a profit on health insurance?"
Yes.

"If so, will there be any limits placed on the amount of profit health insurance companies can make?"
No.

[debbierlus]

2. Jesus tap dancing christ - unrecommeds already

For what, wanting a real health care debate?

For believing that the American people should be given some basic information about health reform?

For wanting a open dialogue?

Surreal.

[sketchy]

6. These are good questions

Recommended.

[earth mom]

10. I hear ya-the takeover of DU is accomplished. nt

[Eric J in MN]

3. Regarding Affordability and Accessibility....

...this summary of the House Democrats' plan may answer some of your questions:


----------------------------------------------------------------------------------
http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-AFFORDABILITY-071409.pdf

AFFORDABILITY CREDITS

Effective 2013, sliding scale affordability credits are provided to individuals and families between 133% to 400% of poverty. That means the credits phase out completely for an individual with $43,320 in income and a family of four with $88,200 in income (2009).

 Premiums: The sliding scale credits limit individual family spending on premiums for the essential benefit package to no more than 1.5% of income for those with the lowest income and phasing up to no more than 11% of income for those at 400% of poverty.

 Cost sharing: The affordability credits also subsidize cost sharing on a sliding scale basis, phasing out at 400% of poverty, ensuring that covered benefits are accessible.

 The Health Insurance Exchange administers the affordability credits in relationship with other federal and state entities, such as local Social Security offices and Medicaid agencies.

CAP ON TOTAL OUT-OF-POCKET SPENDING

The essential benefit package, and all other benefit options, limit exposure to catastrophic costs with a cap on total out of pocket spending for covered benefits.
----------------------------------------------------------------------------------

[sandnsea]

5. And the Senate HELP Plan

The July version.
http://help.senate.gov/Maj_press/2009_07_15_b.pdf


Guarantees of solid benefits for everybody, with limits on out-of-pocket spending with no annual or lifetime limits.

Insurers must provide insurance to people with pre-existing conditions and premiums can only vary based on family structure, geographic region, the actuarial value of benefits provided, tobacco use and by no more than a factor of 2-1 for age.

Coverage expanded to adult children up to age 26.

Insurers must provide the percentage of premium that is expended on medical service and non-claim costs.

An individual mandate, so that everybody gets into the system shares the costs with fines of no more than $750 and waivers for hardships.

A public plan, Community Health Insurance Option that must be covered by premiums, payments to doctors and hospitals negotiated rather than set by Medicare

Choice of public and private plan, for uninsured, small businesses with less than 25 employees, and those with a premium share over 12.5% of their income.

Small Business Credits - employers with 50 or fewer full-time workers who pay 60 percent or more of their employees’ health insurance premiums will be permitted to receive tax credits for subsidizing coverage. Credit amounts are based on the type of employee coverage, the size of the employer, and the proportion of time the employer paid employee health insurance expenses, and are available for up to 3 consecutive years.

Self-employed individuals who do not receive credits for purchasing coverage through the Gateway are eligible.

Small Business Program Credits. Beginning in 2010, eligible. Employers required to pay 60% of premiums or be assessed $750 for each full-time employee not covered and $375 for each part-time employee not covered, except for businesses with fewer than 25 employees.

[truedelphi]

8. And in return for this wonderful wonderful deal a simple

Agreement from the President and those suipporting htis in Congress, that the vultures known as the health care insurance provders can continue with their vulturous 24 to 35% surcharge just for processing the American citizen's health needs.

In France,these people would have been shot already!

[sandnsea]

9. I honestly don't care who gets the money

I care that people get health care. Which is more important to you, depriving insurance companies or getting people health care?

[truedelphi]

11. Look to Massachusetts and see what happens when the insurance

"Providers" are left in the loop, so that then the people like you and I (or our employers) have to foot an impossibly expensive bill, the entire proposal ends up becoming unpopular and starts to sink.

I don't like being in a situation where my head is by my ankles, with my buttocks in the air, but if that is the position that you enjoy, you are definitely living in the right country, run by the right Corporate Tools in Congress.

[sandnsea]

12. Massachusetts has 97% coverage

If/When they discover insurance is doing them in, they will be in a position to go to the people and let the people decide if they would like to keep health care for all and move to single payer. Better than the other 49 states.

[truedelphi]

14. I have friends who moved out of Massachusetts because they simply

Could not afford the premiums or the penalties.
You are a bit younger than me, dear, and when you have to live on a very small income, and Corporate America is no longer your friend (Believe me, when I was younger, Corp America loved me,) I am betting you will wake up and see what life is like for those who don't have Corporate incomes.
I also dislike the notion of rewarding the very parasites who should be facing charges of "wrongful death." I paid $ 1,000 a month for COBRA and all the insurer did was stall me on my treatment until the COBRA expired. Rat bastards are they, and I shall curse them until I have no longer any breath to curse them with.

[sandnsea]

15. I'm On Subsidized Insurance

I always love it when people make presumptions that I support subsidized insurance because I'm rich. I support it because I have it and my husband and I wouldn't have been able to resolve so many health issues without it. I could never in my life have paid $1,000 a month for insurance, not ever. I still have a missing tooth because I chose to help my kids when the baby got pneumonia.

So as I generally suspect around here, the people objecting to incremental change are the people who really don't know what the fuck they're talking about. Their "small income" is what families are raising kids on all over the country.

[truedelphi]

17. We certainly did not WANT to pay $ 1,000 a month for

Insurance. In order to afford it, we had to cashout some retirement funds to do it. Pay penalties etc. With M's health in decline at that point, we could not afford to go without the insurance.

The tax code itself is proof to me that Congress never gets around to the incremental changes that are needed. You would think that they would have it stipulated up front that if you take money out of a legit retirement fund, you not get hit with the penalties, if the reason for moving the money out is to pay for an illness or to pay for health insurance.

There are some obscure forms to fill out for the IRS to perhaps pay us back some of the penalties we paid. Have no idea if they wil approve them or not.

[sandnsea]

20. Want to pay??

Cash out retirement funds??

You have hit the jackpot. You are clueless.

I have gone to the feed store for ampicillin because I couldn't afford a doctor. You ever done that?

Clueless. I don't give a crap who gets the tax dollars. I have a health care plan I can afford. I don't care if these dumbass Republicans would rather pay higher taxes to insurance companies. I just don't. If we can get 97% of people with the same kind of coverage I've got, that would be incredible.

And I still don't have optical or dental.

[Merlot]

4. The repubs only plan is do delay, delay, delay any movement on reform

if that doesn't work, they'll obstruct.

[emilyg]

7. k/r

[Honeycombe8]

13. We need a public option. That's what needs to be discussed. nt

[Cal33]

16. In addition to all of what you suggest above, we could also learn

from the experiences of other industrialized nations which have
had very good results with ensuring medical care to all of their
citizens over the past 50 to 60 years. They ought to really
know, don't they?

I've recently read that among the 30 wealthiest nations in the world,
the U.S. ranks 27th in terms sof life expectancy, and 30th (last)
in terms of infant mortality. In spite of our paying the most money
(nearly double of the next highest) for health care. This is nothing
to be proud of.

Where does all that money go to? To the people advocating that we
maintain the present status quo -- the pharmaceutical and health insurance
companies. Republicans all. And the Republicans persist with their
propaganda and lies to perpetuate this system, which is causing our
nation to go bankrupt.

In the past 10 years the profits of the insurance and pharmaceutical
companies have increased 3 times faster than the wages of the average
American family.

Don't they realize that if our nation goes bankrupt altogether, they
(the Republicans) won't be making any more money either?" Either
they can't think that far, or, they deliberately want our nation to
go bankrupt, so that somehow they will then be able to have more
power and control? Maybe they're hoping to go back to the old days
when all the nations of the world were ruled by kings, emperors and
nobility (that's them, they hope), and the rest of the people were
the commoners and serfs (another name for slaves).

[grantcart]

18. 4) System Incentives

We need to have a system that incentifies prevention and health over repair and maintenance.


Without that change costs will continue to spiral up and quality continue to go down, regardless of how the insurance part of it is restructured.

[quiller4]

19. As other posters indicate-we already have answers to all these

questions about the house plan and most of them re ccurrent senate proposals