Why does H.R. 3200 make PROVIDER participation VOLUNTARY, while MANDATING citizens to purchase....

[Faryn Balyncd]

insurance?


(And require, by the way, that if you do not meet the MEANS TEST for eligibility to purchase the public option (4xFPL) you purchase PRIVATE INSURANCE, or be FINED 2.5% of your income if you can't afford it.)

What was the price paid to get the AMA to sign on to supporting this bill? (other than the obvious answer, that it mandates that Americans purchase insurance but NOT that physicians participate in the public option)?

Is this the first step in setting a precedent for the TWO TIERED SYSTEM that the AMA continues to lobby for ------- specifically, for the "private contracting" for physician services outside of Medicare?



Howard Dean clearly articulated the essential element of reform:

"If Barack Obama’s bill gets changed to exclude the public entities, it is not health insurance reform…it rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again."

- Howard Dean


http://wonkroom.thinkprogress.org/2009/02/24/dean-public-option/

Our current challenge is to make sure that the public plan (though it will not be Medicare) is one that is available for ALL Americans to opt in to, and one that has wide provider participation (as does Medicare), and not a stigmatized, limited participation plan (more similar to Medicaid).


But the simple fact is that H.R. 3200's current version of "reform" is to mandate that lower income Americans BUY IN TO a second-class MEDICAID-esque plan that many, if not most, physicians will not participate in, while mandating that Americans with incomes above 4xFPL purchase PRIVATE INSURANCE.


And H.R. 3200 is NOT a plan that offers all Americans under 65 the option to choose MEDICARE, or any decent public option.


But H.R. 3200 certainly IS, in its current form, a huge financial windfall, if not a bailout, for the insurance industry and entrenched healthcare interests. (& this is even before the Senate - & Baucus, Nelson, Wyden, & Lieberman et al - gets a hold of it)







Do you think H. R. 3200 meets Dr. Dean's definition of true "reform"?






Should it not, at the very least:

- - - require physician participation in the public plan, and

- - - allow ALL Americans, including middle class Americans with incomes over 4xFPL, to choose the public option?












:kick:

[stray cat]

1. If they don't participate and they are a certain size - they get charged a fee.

[Fearless]

8. I believe that is employers not doctors.

[ibegurpard]

2. This is not reform

not even close.

[NightWatcher]

3. the corporate whore congress strikes again. bought and paid for

[ananda]

4. You guessed it.. corporatism.

nt

[zeemike]

5. Borrowing from pink floyd.

Tell me is something eluding you sunshine
Is it not what you expected to see
If you want to find out what's behind these old lies
You'll just have to blow yourself through this disguise.

[juno jones]

6. Yes!

As it stands now, we are creating a two-tiered health system, simply dumping the working class into the already overburdened system without any expansion or guarantee of services.

People drive hours to get to the public clinics in our city. The wait times for appointments stretch into months. This is
because no one is mandated to take medicare or the WA state insurance (which itself has a waiting list of months to years to obtain) so no docs take it, natch.

Clinics will become overburdened, wait times will grow, physician choice will be limited...the 'nightmare' of the public system will become a self-fulfilling prophecy. Of course it was engineered to be just that because we cannot have a robust and competitive public system unless the rich cough up their fair share...now, mind you, if they had all along, the working poor would be able to afford decent coverage and we would never have had this problem....

edit:because typing with a bandaid on one's finger leads to some exciting mistakes...

[foginthemorn]

9. The clinics in my state are very overburdened already. The state

contracts with the big name health providers--even the big University health system--but then ASSIGNS the people to a public clinic---the main provider--and it takes weeks to get an appointment. Or they tell you to go to the ER. the whole system is a joke and meanwhile the big 'providers' rake in the money from the state.

[juno jones]

19. Wecome to DU!

:hi:

[havocmom]

20. That describes pretty much ALL 'healthcare' in my area

Wait for months of appointment
Drive for hours to get there
May or may not find doctor is available for your appointment
Doctor may or may not be contracted with your insurer (and it seems to change without notice)
Doctor may or may not have been fired
Doctor may or may not have been extradited to another state where he was wanted for sex crimes*
Doctor may be in, but does not actually have time to treat you like a human being. Cursory glance and phone call to pharmacy (made by assistant)

Drive for hours while blood pressure hits danger zone just thinking about the failure of the whole system

Get bills
Call to get bills straightened out
Get bills with over due notice
Call to discuss fact that payment checks were cashed so why same bills over and over?

Take blood pressure meds and wonder why they don't seem to help blood pressure

And we have pretty good insurance.


* actually happened, and yes, he WAS a GYN too. So much for big clinics' HR hiring/screening.

[phantom power]

7. Because we have govt by the corporations, for the corporations.

This is what happens when you allow industries to contribute to campaign funds, and allow them to "lobby" congress. They write their wet-dream legislation, and lean on Congress to pass it. And frequently, it gets passed.

[ipaint]

10. Because every dollar put into opening access to healthcare for

all americans must come out of the for profit medical industry and it's shareholder's bottom line. Any investment in the collective health of American citizens is money they can't hoard.

[ipaint]

11. Kick

Waiting for an answer from the pro plan people.

[eomer]

12. Looks wrong to me -- can you explain how you reached those conclusions?

"MANDATING citizens to purchase insurance"

It looks to me like the public option is available to everyone:

SEC. 202. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

(a) Access to Coverage- In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

Since enrollment in "another qualified health benefits plan or other acceptable coverage" is at the option of the individual, it looks to me like everyone has the choice of declining all their other options and getting their coverage from the Health Insurance Exchange. Within the Health Insurance Exchange, the public option looks to me to be open to anyone who chooses it.

"(And require, by the way, that if you do not meet the MEANS TEST for eligibility to purchase the public option (4xFPL) you purchase PRIVATE INSURANCE, or be FINED 2.5% of your income if you can't afford it.)"

This also looks wrong to me. The means test of 4xFPL is not for eligibility to purchase the public option; rather it is for eligibility for a subsidy to help pay premiums. The way I read it the only requirement for eligibility to purchase the public option is to not be enrolled in some other qualified plan. Since enrollment in some other qualified plan is at the option of the individual, effectively everyone is eligible to purchase the public option.

I'm here mostly to learn so I'd welcome any info you have that would indicate my interpretation is wrong.

[CTyankee]

13. This is kinda the same scenario as Medicare presently is. The fact is that everyone is now mandated

to pay for Medicare in payroll taxes. If you work and are on a payroll, you don't get out of it. Period.

When you DO reach 65 a fee for Medicare Part B (drs visits) will be automatically taken out of your Social Security check each month (about $95), UNLESS you have private insurance that covers it. If you don't, and you opt out of the fee, you will be assessed MORE in your monthly fee when you DO go on Medicare. I opted out when I was covered under my husband's policy at his job so I was not penalized when he retired and we both had to go onto Part B.

This is what exists NOW. Everybody loves Medicare. This part of the deal is a no brainer...

[Faryn Balyncd]

16. I think your interpretation might be correct.

[Fumesucker]

14. "I can envision a day when you will have to show proof of insurance at the job interview".

-Hilary Clinton, during the 2008 primary campaign..

I guess Hilary is psychic, eh?

Eh, anyone who *didn't* see this coming is terminally naive.

[Orwellian_Ghost]

15. Indeed

K&R

[yodoobo]

17. Its not necessary

Providers will join up. There is no need to require them.

They sign will up, because they want to stay in business.

[ipaint]

18. The public option has no teeth.

DR. DAVID HIMMELSTEIN: Well, the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. So, you put your signup office on the second floor of a walkup building. And people who can't navigate stairs are the expensive people.

DR. SIDNEY WOLFE: Get rid of the heart failure patients.

DR. DAVID HIMMELSTEIN: Or you have your signup dinners in a rural area at night, where only relatively healthy people are able to drive and stay up that late. So, there's a whole science to how you sign up selectively healthier patients. And the insurance industry spends millions and millions of dollars on that. And would continue to as they've done under Medicare. Selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.

And there's really, despite regulations in Medicare that says you can't do that, that's continued to happen. And it means that every time a patient signs up with a private plan under Medicare, we pay 15 percent more than we would pay if that same patient were in the Medicare program.

BILL MOYERS: We the public?

DR. DAVID HIMMELSTEIN: We the public. But it's not been efficient. It's been effectively a subsidy. And that's what we fear will happen with this public.

DR. SIDNEY WOLFE: Well, we also have some experience. Because in seven states, ranging from Washington to Minnesota, to other states, Maine, they have tried what amounts to a mixture of a private and a public plan. And it's way too expensive as David mentioned. As long as you have private plans in there, everybody still has to do all the bookkeeping.

So, it has failed. I mean, as Einstein has said, the definition of insanity is doing something over and over and over again, and expecting to have a different result. We've seen the same unsatisfactory, unacceptable result, in state after state after state after state after state, why mess up the whole country with it?

DR. DAVID HIMMELSTEIN: And I'm suffering through it as a doctor in Massachusetts, where we've done really the closest model to what Obama is proposing. And our plan is already starting to fall apart. They're already draining money out of the community clinics and public hospitals that have been the safety net.

http://www.pbs.org/moyers/journal/07102009/profile2.html#stats


What a strong public option would do-

"But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare's, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market."

http://tpmcafe.talkingpointsmemo.com/2009/06/07/public_health_care_option/


The public option we are being given-


The more complete CBO analysis of the HELP bill concludes:

The new draft also includes provisions regarding a “public plan,” but those provisions did not have a substantial effect on the cost or enrollment projections, largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates—and thus was not projected to have premiums lower than those charged by private insurance plans in the exchanges.

http://wonkroom.thinkprogress.org/2009/07/15/why-the-houses-public-option-is-better-than-kennedys-public-option/

If the rates paid to providers and premiums paid by consumers are the same as a private plan what is public about this???