Health Insurance You Can Not Afford to Use Is Worse Than No Insurance At All

[McCamy Taylor]

There is something worse than having no health insurance in the United States---being forced to scrape up your nickels and dimes (and thousand dollar bills) to purchase health insurance that you will not be able to use.

Consider the plight of a family of three living on $28,000 a year (over the cut off for total health insurance premiums subsidies in the Senate version of HCR). That family will have to pay $1250 a year to a health care plan---or pay a $750 year fine. Note how close these two numbers are to each other. This is no accident. If forced to choose between giving the federal government one and a half week’s income or spending two weeks income to buy some kind of health care, most frugal Americans are going to buy some kind of health care. Even if it is shitty health care.

Myth But some health care insurance is better than no health care insurance.

Not if you can not afford to use it.

That same family, living very slightly above the poverty level, will almost certainly find itself saddled with huge deductibles. You know, the $2500 per person, $10000 per family kind. That is pretty standard right now for low end policies. And once they max out their credit cards paying the upfront money for Dad’s coronary bypass surgery, the family will find that their insurance does not cover 100% of the remaining costs. It won’t even cover the traditional 80%. They will be lucky if they are only stuck with 40% of the tab---which the hospital will demand up front, before the surgery is done. Some plans will only pitch in a few hundred dollars for each day you spend in the hospital--hardly enough to pay for hospital mark up Tylenol.

Since Dad will be unable to get the surgery that would keep him working, he will be forced out of work, at which point he will apply for Social Security Disability. A year or so later, he will get his Medicare card in the mail. At that point, if he still has any myocardium worth saving, the U.S. tax payers will foot the bill for his CABG.

When Mom gets a breast lump, she will put off the biopsy, because she does not know for certain that it is cancer---and spending a few thousand dollars to take out a benign lump would devastate the family’s fortune. By the time the cancer has declared itself, she will be in too much pain to work. She will go the disability route and may even find her quest for government insurance expedited in some states. At that point, she will start palliative chemotherapy and radiation therapy….at tax payers’ expense.

Junior’s asthma will go untreated, because the family can not afford doctor’s visits, a home nebulizer and pricey medication. (They have used all their disposable income paying for their crappy insurance.) He will receive his treatment at the local ER, where he will be hospitalized for an attack that could have been prevented if only he had health coverage his family could actually use. The hospital bill will be so high that his insurance will kick in and cover at least part of the bill (“Hurray!” says the hospital administrator). The family will be forced to pay off the rest of the debt by taking out a second mortgage on its home---assuming it owns a home. This cycle will be repeated. Junior will miss school and fall behind. He will have to take so many rounds of rescue steroids that he will turn into a little butter ball---increasing his risks for diabetes, high blood pressure and premature heart disease.

When Sis gets pregnant, she will discover that her insurance plan does not cover termination----because her family is poor enough to qualify for partial federal premium subsidies. (Note that most private insurers currently cover termination). She will have to deliver the child. If she is smart, she will get on Medicaid, which will cover obstetric care for her and her unborn child. That will transfer more of the health care expense burden to the taxpayers. Once the baby is born, she may drop out of school---ending her chances of ever getting a decent paying job with good benefits. The baby will remain on Medicaid, which will cover its expensive shots. Mom will be left without useful insurance, which in some communities (like rural ones or the ones that bomb Planned Parenthood clinics) will mean more unplanned pregnancies.

That same family would actually be better off with the $1250 dollars. If no one develops a serious illness, that money could be used to pay for birth control pills for Sis, pediatric follow up and medication for Junior, cholesterol lowering meds for Dad. Mom will be out of luck either way.

Myth The notion of unusable insurance only applies to the (shiftless) poor. My middle to upper middle income family will be well protected.

If you believe that, I have some swampland I would like to sell you.

The Senate is poised to allow insurance companies to offer something called “nationwide plans.” That means the company can write its policies in Mississippi and sell them in New York. State insurance rules will no longer count. If the nation’s health insurers decide that they no longer want to cover mammograms or mental health services or screens for diabetes, you will have to take it up with Joe Liebermann. Too bad you are not one of his constituents.

In this era of health insurance consolidation, in which one or two companies commonly dominate large geographic regions, you are likely to find that the only policy you can afford will be one of these “nationwide polices”. If your insurer decides that the surgery to remove the tumor that is robbing you of your vision is “elective”, then you will have a very hard time seeking relief from the courts, since you will have to sue in the federal court system which is notoriously back logged. Forget about switching plans. If there is another insurance provider in your area (doubtful) that company will have the exact same policies and rates as the company you just dropped. It will probably be easier to quit working and apply for disability. Medicare will raise no objections to your neurosurgery.

If you develop lymphoma, you will have to be prepared to stay overnight in a motel every time you go for chemotherapy, because your out of state plan will have no oncologist in your area. And whatever you do, don’t develop a complication that requires emergency hospitalization. If you do, the admitting physician, radiologist, pathologist and everyone else who lays hands on you will send you the bill. If your insurer decides that one orthopedist can cover all its clients in Alabama, take a number and get in line.

Note that any attempts to force insurers to make care available to clients will be shouted down with cries of It will raise health care premiums . Never mind that the nation’s insurance plans will all have raised premiums as one---something they are legally entitled to do, since they have anti-trust exemption. That means they can set their rates as high as they want, and you will have to pay what they are asking---or hand over $750 to the feds and forgo insurance coverage. And don't expect your premiums to be be anywhere near $1250 a year. You are likely to be paying ten times that amount.

Myth But older folks and people with pre-existing conditions will finally be able to get insurance.

Being older does not necessarily make you richer--and that is what you will have to be in order to afford private health insurance. The Senate allows plans to charge more to older people. Free market competition is supposed to keep costs low. But, as I point out above, there is no free market when it comes to health insurance. There are only state insurance boards. And these will soon be relics of the past.

Insurers will set rates as high as they possibly can. For young folks, who think of themselves as immortal, rates will be kept pretty low, to encourage them to buy in. Middle aged Americans, who actually have some chronic health problems or who are concerned about their future health, will be the ones most eager to participate in the new program. Therefore, they are the ones who will be gouged.

The Senate's "reasonable annual limits" will be especially useful to insurance companies when it comes to the chronically ill and middle aged, because they will encourage reverse cherry picking. I.e. people who have expensive medical problems will drop their private insurance and get on Medicare---something you can do, as long as you prove that your illness keeps you from working. So, for instance, if your child has schizophrenia and you discover that your private plan has a ridiculously low annual cap on mental health care, you will switch him to public insurance which will have no cap. If he is run over by a drunk motorist and suffers brain damage and needs lots of rehab (that your insurer will not cover) the feds will start picking up his medical tab. COPD, congestive heart failure and arthritis will join renal failure/dialysis as conditions that will automatically get people on Medicare. The government's share of the nation's health care will continue to rise, even as privates collect more in premiums.

Note that chronic illness is directly tied to socioeconomic status in this country. The sicker you are, the less likely you are to have thousands of dollars lying around to hand over to an insurance company.

Myth This is just a temporary measure. If private insurers get too greedy, Congress and the White House will rein them in.

Yeah. Right. The same way they checked the growth and greed of the Military Industrial Complex. The way that the nation's banks have been punished for the mortgage meltdown. The way that the telecommunications consolidations were stopped. The more money we pour into the coffers of private insurance companies, the more political clout they will have in Washington. The more they will be able to argue that the preservation of these companies---and their enormous CEO salaries---is necessary for our country's economic security. "Too big to fail" is not just a stupid saying, it is the law of the land in our nation's capitol.


Myth But if the Democrats serve the public a horse’s head on a platter and call it “Health Care Reform” the voters will be so happy they will elect Democrats into the White House for the next one hundred years.

You can fool some of the people all the time and all of the people some of the time, but you can not fool anyone who gets a ten thousand dollar medical bill in the mail. Federally mandated health insurance that does not prevent bankruptcy in the event of illness is not insurance. It is extortion. Federally mandated health insurance that does not encourage people to get necessary preventive care is not “healthy”---except for insurance company profits.

[debbierlus]

1. The President and Congress are enslaving us to the health care industry

It is disgusting. And, it is deeply WRONG.

[phasma ex machina]

8. +1 K&R nt

[Greyhound]

94. +11

[grytpype]

108. :cry:

+---------INSURANCE-JAIL----------+
| :cry: :cry: :cry: :cry: :cry: :cry:|
| :cry: :cry: :cry: :cry: :cry: :cry:|
| :cry: :cry: :cry: :cry: :cry: :cry:|
| :cry: :cry: :cry: :cry: :cry: :cry:|
| :cry: :cry: :cry: :cry: :cry: :cry:|
+---------INSURANCE-JAIL----------+

Why oh why didn't Obama bust up the mean insurance companies!!!!!

Why did we TRUST him???

Why did he TRAITOR us like this??????

It makes me want to.... I don't know.... cry?

:cry: :cry: :cry: :cry: :cry: :cry:

:cry: :cry: :cry: :cry: :cry: :cry:

[closeupready]

116. Congress already started the process of bringing back indentured servitude with Bankruptcy Reform

in 2005 (sponsored by Joe Biden, by the way).

So this shouldn't really be too much of a surprise to people who have been paying attention.

Sucks nonetheless.

[Cleita]

2. K&R

[BlueIris]

3. Yep.

This is the crux of it, the problem I've had since the very beginning; aside from the fact that I believe the individual mandates are the equivalent to fascism, of course.

Kill it dead, apologize, and start alllll over again is the only solution I see here.

[stray cat]

4. People should be able to opt out of health care - no mandatory insurance or mandatory care?

[Ruby the Liberal]

5. Thank you for taking the time to explain this.

This bill must die.

[Dragonfli]

6. Excellent post, well reasoned and to the point of the resistance to this bill

The facts need to be known by the uneducated on the subject as well as to those in denial.
It is actually quite a harmful bill and the facts are being obscured to sell it to the gullible.
Those that know the facts are not and would not, support such criminal extortion for lobby money and corporate favors.

I like to put it in terms my working class associates on the job would and do understand:

"The Insurance Companies want to run a health protection racket that requires everyone in the neighborhood to pay up or they won't get to see a doctor. If you do not wish to pay Vinnie for "protection", Uncle Sam will provide the muscle to force you to pay.

These thugs don't treat illness, dress wounds or perform medical tests, but you have to pay them anyway, and just like any gangster running a protection racket, they provide no service yet you are under threat to pay them as much as they want, according to their terms or get your legs broken.

Anyone that would promote such an idea has nothing honest to defend it with because it is vile.
I question the motives of any apologists that would try to argue me into promoting an agenda that will directly cause harm to myself and others. I am not a republican, I care about people and don't agree with selling them out and myself with them.

Fuck them and their anti-working class pro-corporate agenda."

I would like to take the examples you gave to work with me (if you don't mind) as I believe you've done an excellent job of debunking the myths that are being sold to the general public in order to try to manipulate undeserved support.

Propaganda does not work as well with the working class as The conservadems and Rahm Emanuel think it does.
Most people I talk to get it right away, but the myths are being pushed hard right now and I would prefer they had access to the facts that are being hidden from them.

[laughingliberal]

18. Very good analogy about the protection rackets. nt

[dkf]

7. Wow I'm impressed. Well reasoned and well thought out.

Thanks.

[tomm2thumbs]

9. should be mandatory reading - and I mean that for Obama - have you sent to WH?

I would forward to any & all nightly MSNBC shows to look into as well - thanks for posting

[laughingliberal]

19. I'm fairly certain none of this would come as a surprise to the President

Which is why it's just unconscionable for him to ask us to support it or pretend it helps the people.

[Amonester]

87. Personally, I think the President himself does not have much...

time to really know about all these pesky little details of what it will be like for millions of American families.

He 'relies' way too much on the 'advices' given to him by the close circle or retardlicans in disgise his sold-out advisers are.

But if I were the OP's writer, I would sure take the time to send a copy of it to: http://www.whitehouse.gov/contact ASAP.

(I Hope Someone Who Can Easily 'Wear Ordinary People's Shoes' Will Read It And Will Tell The President HIMSELF About It.)

Otherwise, we're screwn.

[Flatulo]

10. Good post. Here in MA we have to buy insurance at gunpoint. A decent

plan with no annual limts and no $10,000 annual deductable will run anyone who is not in abject poverty around $1400 per month. Since this is about 1/2 of the take home pay of some one who earns around $45K, most people opt for a cheaper plan. These cheaper plans will absolutely and utterly bankrupt you if you are unfortunate enough to get seriously ill.

What an absolute cluster fuck. Tear it up and start over, and keep the fucking industry lobbyists 100 miles DC.

[leftstreet]

11. K&R

[Lydia Leftcoast]

12. Those are EXACTLY my concerns

I already have insurance that I can't afford to use. If the price goes up any more, it will be totally unaffordable for me, and I would like the option of dropping it and crossing my fingers till I'm eligible for Medicare.

[truedelphi]

42. Sorry you are at that point.

When we have policies that are expensive, and we have to face deductibles,
then we don't end up getting treatment, but instead, are subsidizing the wealthier crowd, who I guess may be getting some help from having insurance.

[FlaGranny]

57. That's exactly what I had to do.

I went without coverage for 4 years beginning at age 61. Fortunately I have no major medical problems. Being without health care for years even makes an atheist pray for good health.

[Digit]

13. K&R

[BzaDem]

14. McCamy, the "nationwide plans" ONLY applies to states that enter into interstate compacts

In other words, a customer in New York will NOT be able to buy a plan in Mississippi unless New York passes a law entering into an interstate compact with Mississippi that allows this (and they wouldn't do that for any state that have wide regulatory gaps).

Here is a summary of the relevant section of the bill from Senator Debbie Stabenow's site:

http://stabenow.senate.gov/healthcare/Patient_protection_section.pdf

"Sec. 1333. Provisions relating to offering of plans in more than one State. By July 1, 2013, requires the Secretary, in consultation with NAIC, to issue regulations for interstate health care choice compacts, which can be entered into beginning in 2016. Under such compacts, qualified health plans could be offered in all participating States, but insurers would still be subject to the consumer protection laws of the purchaser’s State. Insurers would be required to be licensed in all participating States (or comply as if they were licensed), and to clearly notify consumers that a policy may not be subject to all the laws and regulations of the purchaser’s State. Requires States to enact a law to enter into compacts and Secretarial approval, but only if the Secretary determines that the compact will provide coverage that is at least as comprehensive and affordable, to at least a comparable number of residents, as this title would provide; and that it will not increase the Federal deficit or weaken enforcement of State consumer protection laws."

Emphasis added.

[wolfgangmo]

65. Divide and conquer

It's the same old strategy that the repukes, blue dogs and other corporate flunkies have used since the Raygun years, divide and conquer. As the insurance companies know that they will never get exactly what they want on the fed level due to too much public scrutiny, they go to the state level where they can use their supperior money to force anyone consumer groups watching these crooks to fight on 50 fronts simultaniously.

This is a backdoor strategy.

But hey, what could go wrong? Surely no state would give up it's citizens wellbeing for some profit and campaign cash? Ahem. After all look at what happened when we allowed that to happen to credit cards. Why in the years since CC deregulation no states have loosened their laws in order to get the banks to move to their states, have they? (South Dakota and Deleware) And interest rates, which used to hover about 2% above savings rates haven't skyrocketted, have they? (30% CC vs. less than 2% savings). And we aren't getting hit with exhorbitant fees, are we? ($39 late fees per transaction).
Nope, you are right, we can trust the corporations. They have our best interests at heart.

[suffragette]

98. 31 Congressional Dems make the same point McCamy does

Democrats: Health Bill Undercuts Consumer Protections
http://www.cbsnews.com/blogs/2009/12/17/politics/politicalhotsheet/entry5990684.shtml

Provisions in the Senate and House health care bills that would allow insurers to sell plans across state lines would effectively wipe out strong consumer protections in 17 states, a group of 31 congressmen are warning Democratic leaders.

The changes would impact more than half of the U.S. population, they said. The representatives who wrote to congressional leaders on Tuesday asked them to eliminate the interstate compact provision language currently in the bills, which they said "will lead to a race to the bottom in insurance regulation and severely threaten the important and often lifesaving protections the residents of our states enjoy."

"The negative impact of these provisions cannot be understated," they wrote. "They can and will eliminate access to important health services that so many Americans depend on."

Under the Senate bill rules, insurers would permitted to sell policies in multiple states while only being subject to the regulations of the state in which the policy was written or issued. The House bill has more stringent language: It would allow states to decide among themselves which regulations to use.

The PDF copy of the letter is here: http://www.consumerwatchdog.org/resources/CompactLetter.pdf

[Hello_Kitty]

99. I guaran-damn-tee my dumb ass state will jump on it in a hot second

The politicians in Arizona have a remarkable ability to fuck the people who live here over. Matter of fact, I bet they'll get right to work dismantling whatever regulations we have here to attract insurance cos. to locate their corporate headquarters here.

[Matt Shapiro]

111. How come you left out the next paragraph from Stabenow's site?

Here it is:

"Allows insurers in the individual and small group markets to offer a qualified health plan nationwide, which is subject to only the State benefit mandate laws of the State in which the plans are issued; but requires such plans to provide the essential benefits package. Allows States to enact a law to opt out of allowing the offering of nationwide plans. Requires insurers to file plan forms with each State in which they will offer nationwide plans for review."

Note that State benefit mandate laws (the ones that mandate minimum benefits provided by these "national" policies) are not applicable, whereas State "consumer protection laws" are. They must be different animals.

Note also that the first paragraph that you quoted required States to enact a law opting IN to compacts, whereas the second paragraph quoted here requires states to enact a law opting OUT of nationwide plans.

The first and second paragraphs do seem to contradict each other.

Note also that none of this is the actual language of the bill. This is a summary. And this summary is as clear as mud.

My guess is that many, if not most, States with good minimum benefit standards will end up with nationwide policies with crappy benefits if this excuse for a health insurance reform bill is passed.

[Jefferson23]

123. If that is allowed in the final bill, this alone is an outrage. n/t

[Laelth]

15. k&r for the truth, however depressing.

Very well said. Thanks.

:dem:

-Laelth

[laughingliberal]

16. Thank you for taking the time to address all these points so well

All the things wrong with this bill are overwhelming and trying to explain it to soundbite nation is daunting, to say the least. One point where it is even worse than you point out is that, once Dad is approved for Social Security Disability, it will be 2 years before his Medicare card arrives. This is not a change. It was suggested they might lower the waiting time but it was not done.

Anyone who doubts the above scenario regarding how crappy these policies are going to be might want to check in with our friends in MA who got 'universal health care.' This is, essentially, the MA plan only worse.

[quiet.american]

17. Myth: The assumptions in this OP. It gets just about everything wrong.

I just have to ask myself, why would someone want to put something like this OP out that is just completely false? There are things in the legislation one could legitimately complain about, but why just make stuff up?

A family of three making $28,000 a year is at approx. 151% of poverty level. Families and individuals at 100% of poverty level would pay no more than 2% annually of their income towards insurance premiums. Based on this information, and the affordability credits table in the House bill (the Senate bill percentages appear to be very close) in year 1, a family of three making 28,000/yr would start out paying approximately 3.0% of their annual income for insurance premiums. After that, there would be an annual increase to top out at 5.5% of their income, with the government subsidy of over 90% of the cost of premiums remaining the same.

The math:

28,000 x 3% = 840.00/yr for health insurance for a family of three

The Senate bill would require that their annual out-of-pocket costs be no more than one-third the standard costs, the House bill is more specific and limits their out-of-pocket to $1,000/yr. And out-of-pocket means that if even someone, or everyone in the family developed a catastrophic illness, the maximum they could be charged out-of-pocket is $1,000. (Links for this info are at the bottom of this post. The "2%" figure comes from the 'Making Coverage Affordable link' found at that link.)

About the breast cancer scenario:

Senate Backs Preventive Health Care for Women
By ROBERT PEAR and DAVID M. HERSZENHORN
WASHINGTON — The Senate voted Thursday to require health insurance companies to provide free mammograms and other preventive services to women, and it turned back a Republican challenge to Medicare savings that constitute the single largest source of financing for the bill.
http://www.nytimes.com/2009/12/04/health/policy/04health.html?_r=1&scp=8&sq=russ%20feingold&st=cse">Link

plus,

"The Patient Protection and Affordable Care Act will eliminate any co-pays or deductibles for recommended preventive care and screenings, such as cancer screenings and mental health screenings." (excerpted from bill summary, link at end of this post)

plus,

An Essential Benefits Package
(b) MINIMUM SERVICES TO BE COVERED.—Subject to subsection (d), the items and services described in this
subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder
services, including behavioral health treatments.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well-baby and well-child care and oral health, vision, and hearing services, equipment, and supplies for children under 21 years of age.
(11) Durable medical equipment, prosthetics, orthotics and related supplies.
(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 224, to ensure the provision of quality health care and financial security, that—
(1) provides payment for the items and services described in subsection (b) in accordance with genrally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and
services;
(4) complies with section 215(a) (relating to network adequacy); and (5) is equivalent in its scope of benefits, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage in Y1.

The above language is taken from the House bill; (the Senate bill seems to be offline since Reid may be unveiling the final version to send over to the House soon). Last version of the the Senate bill kept the essential benefits package.

About the fine:
Long story short, $95 four years from now, rises yearly thereafter; $750 does not kick in until 2016, but if you're a family of three who can pay $840/yr, with a $1,000 out-of-pocket limit, why wouldn't you want insurance?

"Individuals who can afford to purchase health insurance coverage and do not do so will face a penalty of $95 in 2014, $350 in 2015, and $750 in 2016 (indexed thereafter)."

As for the rest, anyone can access the links below to see for themselves how what's actually in the bill doesn't fit in with the OP's assumptions about what's in it.


Links used for reference for my post:
Senate Bill Summaries/FAQ : http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
NYT article: http://www.nytimes.com/2009/12/04/health/policy/04health.html?_r=1&scp=8&sq=russ%20feingold&st=cse
Online Percentage Calculator: http://www.onlineconversion.com/percentcalc.htm
House Bill, premium rates as percentage of income is on page 252: http://www.opencongress.org/bill/111-h3962/text
Federal Poverty Guidelines: http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

[Lydia Leftcoast]

20. But there would still be deductibles, which are unknown in the rest of the world

Further excuses for companies not to pay out.

[BzaDem]

21. Yup. Thereofre, kill all the other help in the bill. Because there are still deductibles. n/t

[Bluenorthwest]

66. I am reminded of a Paul Simon song

A one trick pony
One trick is all that horse can do
He does one trick only
It's the principle source of his revenue

See how he dances
See how he loops from side to side
See how he prances
The way his hooves just seem to glide
He's just a one trick pony (that's all he is)
But he turns that trick with pride.

[quiet.american]

22. In this scenario, the family couldn't be charged more than $1000, or one-third the standard.

Further, the Essential Benefits package eliminates many now-standard copays and other things which insurance companies charge to a deductible.

[McCamy Taylor]

25. Different sources, different interpretations. Of course, the courts will decide.

And the insurance companies will be able to afford better attorneys than the consumers.

A family of three with income of $27,465 (150 percent of the poverty line) would have to pay $1,250 for premiums, or over $400 more than under the House bill. Many families with incomes this low already struggle to pay the rent and utilities and put food on the table and could have difficulty paying this much for health coverage.

http://tpmdc.talkingpointsmemo.com/2009/11/cbpp-despite-insufficient-subsidies-health-care-bill-enormous-step-forward.php

The Senate bill contains a provision long sought by the health insurance industry lobby AHIP. It would allow for the sale of “nationwide plans.” Theses plan would not be required to follow the state laws regarding what medical treatments must be covered.
These nationwide health plans will, in effect, gut state health insurance regulations and create a race to the bottom. What will likely happen is what happened with the credit card industry: all the card companies moved to the two states with the absolute lowest regulations.
snip
I fear for the millions of Americans who will lose their current health insurance coverage because of this law. If you have a medical condition that your insurance company must cover by state law, but is not part of the new essential benefit package, you are in serious danger of losing that coverage. Unless your state opts out of the “nationwide plans,” there is a very high probability that your insurance company will “leave the state” and drop your coverage. That company will just move to another state and start selling a “new,” less regulated, nationwide plan in your state.

http://fdlaction.firedoglake.com/2009/11/19/at-the-request-of-ahip-senate-bill-guts-state-health-insurance-regulations/

As for the general character and honesty of the unhealthy insurance industry, check out this link:

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of a healthy person's dollar on medical care because he or she won't need much medical care. And the insurance industry accomplishes this through two main policies. "One is policy rescission," says Potter. "They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment."

And don't be fooled: rescission is important to the business model. Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. "No," they each said.

Potter also emphasized the practice known as "purging." This is where insurers rid themselves of unprofitable accounts by slapping them with "intentionally unrealistic rate increases." One famous example came when Cigna decided to drive the Entertainment Industry Group Insurance Trust in California and New Jersey off of its books. It hit them with a rate increase that would have left some family plans costing more than $44,000 a year, and it gave them three months to come up with the cash.

http://voices.washingtonpost.com/ezra-klein/2009/06/the_truth_about_the_insurance.html

The Bush administration attempted to make Medicare a four letter word, in order to discourage folks from demanding a single payer model (I have an old journal about it if anyone is interested). But Medicare is still better than any private I have ever been on----both from the point of view of a consumer and a provider. Medicare does not leave me scrambling to find a specialist to treat a girl with seizures. It does not deny payment (after the fact) for the neurosurgery to remove a woman's brain tumors. It does not call doctors and threaten them with sanctions if they do not stop a woman's lung cancer treatments and put her on hospice. I have seen the absolute inhumanity that is the modern American health insurance industry and frankly, I would rather go to dinner with the NRA than with a CIGNA rep. At least the NRA sells a product you can use to put food on the table.

[quiet.american]

36. Thanks for the links, but even the first one calls the bill "an enormous step forward."

First, apologies where apologies are due. Your first link shows where you got your figure of $1250 from the non-profit's study.

Personally, I do think that's too high and like the House figures better. However, the coverage would still bring a great deal of healthcare security to a family of three, as referenced in my original post. When the bill goes back over to the House (Pelosi has strongly stated it will not be accepted at face value and negotiations will continue), I would anticipate the final annual figure for a family of three will be somewhere in the middle of the House and Senate figure -- probably between $900-1000.

A couple thoughts on the nationwide plan coverage drop -- the bill contains provisions prohibiting dropping because of pre-existing conditions and prohibits recission, but if it's still possible to be dropped, Bernie Sanders has this on his website:

Beginning in 2014, insurance companies would be barred from discriminating against applicants based on pre-existing conditions, health status, or gender. Before 2014, uninsured Americans with a pre-existing condition would have access to an immediate insurance program, which would help them maintain affordable coverage.

In fact, I've just checked out his "Good & the Bad" section on the bill (it's pretty comprehensive), and found myself thinking that if Sanders himself posted any of the "good" on DU right now, he'd probably be hooted down and called a shill for the insurance companies. Bernie Sanders!

[clear eye]

46. There you go again--diverting a point about dropping entire policies due to no longer

having to follow some states' tough regulations on coverage, for which the bill offers no protection, to something about pre-existing conditions, which is the one situation the bill does mention.

There seems to be a lot of bait and switch in your comments--first, the House bill instead of the Senate, now the protection against pre-existing condition denial for the actual danger of discontinued policies due to cos. no longer having to meet certain costly requirements.

In NYS we have a good, partially subsidized low-cost plan for working people and families just above Medicaid elegibility that insurers are mandated to offer. The proposed bill will eliminate it.

[quiet.american]

51. Whatever, knock yourself out with your fantasy about who I am and what my motives are. nt

[pattmarty]

64. Well, well, that fucking statement told us all I think we need to know.

[quiet.american]

71. Which is what, exactly? nt

[pattmarty]

76. Nothing. My answer was to a statement that had NOTHING about....

......healthcare and was just a generic one sentence "bitch". Kinda of like saying I hate winter because it's cold.

[pattmarty]

63. Your "fantasy" figure of 1000 per year for the family is only their...........

........up front cost for a policy. Then you have copays and deductibles. AND, more importantly you are leaving out the subsidies (paid for by the taxpayers) that would cover the remainder of this fictional family's policy. It's a fucking shit bill, a Republican's wet dream, and the only shilling is you standing up for it. We all have to see what comes out of conference to make a final call, but so far as the "process" has ground on, it has gotten progressively worse. Furthermore Sanders says (as late as Thurs or Fri) that he is NOT SURE of supporting the final bill. I think if you have "good" insurance now, you could give a fuck because it ain't gonna affect you or so you think. My belief is that it will affect "most" people that have insurance already in ways that will only be known after this abortion is enacted (in 2014 by the way). ANYONE would have to include in the cost of these policies the 800 billion dollar cost too, which a lot are forgetting is an extremely large "cost" also. This will STILL cost us more than the other industrialized countries because of the FOR PROFIT insurance companies handling the payouts. Wake the fuck up, it's a shit bill as it now stands. It comes a time when you have to say "enough is enough". I understand compromise, but this is fucking capitulation.

[quiet.american]

70. I don't have insurance now. And I live in this country, so what "other countries" have is irrelevant

While you put ideology above all, I have no access to healthcare right now. But thank God, you've got your ideology!

[pattmarty]

74. Why in the fuck don't you enlighten ALL of us on this board..............

............of your circumstances? I am a working class citizen and I fucking have a huge problem with your "blanket whining". Put up, or shut up, motherfucker!!!

[quiet.american]

79. You have a problem, period. nt

[stillwaiting]

78. When you get this mandated crap insurance you STILL won't have affordable

access to health care though.

With sky high deductibles and extremely large co-pays you will have little protection from bankruptcy should anything happen to you or any family members health.

You WILL be able to help subsidize the insurance companies profits though (and perhaps executives compensation packages). This is what I get to do right now. I have received little to no benefit in helping me manage health care costs, and I have ZERO peace of mind about my financial stability in this ridiculous nation.

[quiet.american]

80. No -- I've run the numbers for myself and I will be able to swing it. nt

[laughingliberal]

30. "Based on this information, and the affordability credits table in the House bill ....

(the Senate bill percentages appear to be very close) ."

We all know the House bill is almost acceptable (except for the screw women's rights part). Saying the Senate bill percentages appear to be very close leads me to think we don't know what they really are. Do you know what they are? Does anyone? Why are we going to pass a bill whose defenders use words like "appears to be?" Why can't we know what it is instead of what it appears to be? What else are we guessing or reading tea leaves to try to discern? Why isn't the bill on the internet so we can see it? Our legislators may not be bothering to read it but, perhaps, some of us would like to. After all, someone spilled the beans on the right of the insurance companies to impose annual caps getting slipped in there after we've heard all along that there would no longer be lifetime or annual caps on coverage. Somebody leaked that. I have no doubt there were those who hoped to pass the damned thing before we knew so we could find out in the middle of treatment for a catastrophic illness that our coverage had reached its limit. Just what I want to hear when I've finished half my chemo treatments. How do we defend that? Getting half your treatments done is better than none? When would we have found that out? And what else are they hiding? Their credibility is in question. Quite a few people are going to be on the hook for a lot of money to pay for these policies. We would like to know what we will get for it. The talking points do not make up for the lack of real information. What's the old expression? Don't buy a pig in a poke? Well, this is a pig in a poke at this point.

[quiet.american]

33. When Reid releases the next version of the bill, then we'll know.

That's why I'm not speaking in definite terms. I'm looking forward to it being available to see what changes have been made.

That's why I used the language I did.

[laughingliberal]

34. I understand that. My problem with this is they are about to ram the damned thing through before any

of us know. Reid will likely release the version of the bill around the same time they are voting on cloture. Guess it doesn't matter. Obviously they're going to pass it no matter who likes it or doesn't like it. I know the Senate version is worse. I'd just like to know how much worse.

[quiet.american]

37. Yes, but it's going back over to the House, too. And Pelosi is not going to rubber-stamp it.

Nancy Pelosi said this on Wednesday:

excerpt:
“The president said from the start, ‘I believe that the public option is the best way to keep the insurance companies honest and increase competition. If you have a better idea, put it on the table,’” Ms. Pelosi said. “So we will see what they have on the table.”

She added: “My members like our bill. So we have to show them why we would go someplace else.

excerpt:
Ms. Pelosi was not shy about chiding the Senate to get things moving. She also made clear that the House was not going to simply accept the Senate bill and that further negotiations would be needed.

“How I judge their bill and ours is the same way,” Ms. Pelosi said. “It is about affordability for the middle class, security for our seniors, a responsibility to our children in terms of reducing the deficit, taking down costs, and accountability for the insurance companies. I think both of our bills have that.”

But even as Ms. Pelosi stressed that she had yet to see the completed Senate bill, she said there were aspects of the House version that were clearly stronger, particularly in the proposed taxes to raise money to pay for the legislation.

excerpt:
“Our priority on the public option, the emphasis was not on ‘public’ — the emphasis was on ‘option,’ on something ‘other than,’” she said, adding that she had yet to see details on an alternative Senate proposal to create at least two national, nonprofit insurance plans modeled after those offered to federal workers, including members of Congress.

“I know that many members of the United States Senate, probably more than 50, share the same concerns that we have in the House about the accountability of the insurance companies,” Ms. Pelosi said. “And that was the main point of a public option. So it will be interesting for us to see what they have in the bill.”

[laughingliberal]

41. Well, God love her. I hope you're right. I believe Nancy is committed to

some more progressive ideas than we got out of the Senate. But the reality is she has some real conservative scumbags over there, too, and just looking at how Stupak and the Democratic wing of The Family got that horrid amendment through is major cause for concern. Then, if the House makes any changes to the Senate bill, it's back to the Senate for another round Joe, the Asshat. It's been very frustrating to watch our party start out with a weaker bill than we wanted and then compromise down from there. With these majorities? We've gone through the looking glass, without a doubt.

[quiet.american]

43. I hear you, can't say I'm not frustrated, too. Especially since I don't have insurance. nt

[laughingliberal]

45. Me either. We lost everything a couple of years ago. Our life is pretty much scraping it up for gas

& food with homelessness looming in the near future. The awful reality is I would, actually, probably qualify for Medicaid under this bill and it would help me but I think it very well may be a disaster for our working and middle class people. Not sure why I should care since I'll never get back there again but I'd like to think we could retain some slim hope for upward mobility for those coming behind us. I really think it's another step backwards in that area.

[quiet.american]

50. Truly sorry to hear of your circumstances. I've been on that precipice myself.

And the worrying at times was excruciating. To this day, I can't believe that my situation eventually worked out each time, just in time, but I do wish the same for you.

To tell you the truth, having run the figures for myself as a single 40-something, my premiums would be slightly lower than they were when I had insurance through an employer and I would be covered for more things. As we've been saying, we won't know until we see the final version, but even what's on the table now would be affordable for me (I'm in the 250%-300% bracket), and would give me much-needed peace of mind.

[clear eye]

40. And a mandated "pig in a poke" at that. n/t

[clear eye]

31. You are confounding the House bill w/ the Senate bill, perhaps intentionally.

During conference what usually happens is the bill morphs to the whatever in each version pleases big corporate donors, so it makes sense to envision what will happen if the Senate version prevails.

You are also confounding what out-of-pocket expenses are permitted under the exchanges and what will be permitted in plans for everyone else. (Most people won't be permitted into the exchanges.) Last I read, even the House bill capped out-of-pocket expenses at $5K for individuals and $10K for families.

And you completely ignore the creative ways insurance companies find for not covering expensive crucial treatments, and lack of explicit prohibitions in either bill for those practices. The favorites are to call doctor-prescribed treatments "experimental" or "elective", leaving people w/ a choice on the one hand of permanent disability or death, or on the other, bankruptcy.

"I just have to ask myself, why would someone want to put something" out that completely misrepresents the bill that's under debate--the Senate bill--by cherry-picking from what's in another bill (the House bill)?

For DUers who want to be able to predict accurately what their situation will actually be, notice that although the "essential benefits package" includes that impressive list of services and products, it doesn't say the insurance has to cover anything prescribed falling under that list.

You don't sound stupid, so I smell an ulterior motive. We have lots of pr people from insurance cos. or associations pop up on DU whenever the debate heats up.

[quiet.american]

32. Why is it someone who disagrees must be working for the insurance companies?

What really makes your remark rich is that I currently do not have insurance.

Yes, I deliberately pointed out where I was using House language. (And further to that, Pelosi has stated the House will not just accept the Senate bill, it will be reworked ).

A family of three making $28,000 would certainly qualify for the Exchanges, if they survive the final version or, alternatively, for the federal plan similar to what the Senate and Congress are offered now.

No, I'm not completely ignoring the creativity of the insurance companies. There is actually strong regulation in the bill.

And again, I pointed out where I was using House language, and why.

Also, the bill does have language that expressly says the essential benefits must be paid for by the insurance companies.

[clear eye]

38. Odd that you don't acknowledge the permitted "caps" on coverage. n/t

[quiet.american]

39. Alright then, go to page 252 of HR 3962 and take a look at the cap figure for 150%-200%.

The 5k figure applies to the highest income bracket -- 350%-400%.

[clear eye]

52. Misleading again. CAPS are not the same as out-of-pocket expenses.

In fact they make out-of-pocket limitations moot. If coverage cuts off at $200K/yr. for instance, then anything after that will have to come from the individuals pocket, no matter how much it is.

The above is for the benefit of DUers who might be misled by your deceptive post.

[quiet.american]

53. Who said this: 'Last I read, even the House bill capped out-of-pocket expenses @ $5K for individual'

Yes, that's right -- you.

So what are you talking about?

Yes, I used the wrong word, yet still answered the substance of your...remark.

Adding to this post that the only reference I've seen in the House legislation that references 5k and 10k is in relation to out-of-pocket expenses:

"Caps annual out-of-pocket spending. Will cap annual out-of-pocket spending at a maximum of $5,000 per individual and $10,000 per family to prevent bankruptcies from medical expenses."

And this is what the bill summary says about caps on coverage:

Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able to engage
in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s
health status. In addition, they can no longer exclude coverage of treatments for pre-existing health
conditions. The bill also protects consumers by prohibiting lifetime and annual limits on benefits. It also
limits the ability of insurance companies to charge higher rates due to health status, gender, or other
factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and
family size.

[clear eye]

55. Capping out-of-pocket expenses is not the same as a coverage cap.

And I'm talking about the bill under discussion--the Senate bill, not the House bill. Boy, slippery little devil, aren't you?

[quiet.american]

72. Since you seem wholly unable to actually read the bill or any of its summaries for yourself, here:

Senate Bill HR 3590:


HR 3590

Sec 1001. Amendments to the Public Health Service Act.

PART A--Individual and Group Market Reforms

"Subpart II--Improving Coverage

Sec. 2711. No lifetime or annual limits

(a) In General.--A group health plan and a health insurance officer offering group or individual health insurance coverage may not establish--
(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary.


Summary language:
No Arbitrary Limits on Coverage
Insurance companies will no longer be able to place lifetime limits on the dollar amount of the coverage for which they will pay, and will be restricted in their use of annual limits.

[clear eye]

83. The latest buzz is that this provision has been "compromised" out. n/t

[quiet.american]

84. We'll have to see. And see what comes back from the House as well. nt

[cornermouse]

59. Essentials which you don't appeart o be taking into account.

Otherwise known as a reality based look at this situation to get a more accurate perspective. I'll let you fill in the blanks for your own area.

A years worth of deposits $28,000

Rent or house payment per month $____ x 12 months
Utilities per month $____ x 12 months (electricity, gas, water, telephone, internet or cable)
Food per month $____ x 12 months
Car payments per month $____ x 12 months
Car insurance payments per month $____ x 12 months (if applicable)
Gas for the car $____ x 12 months
Credit card payments $____ for the year
Clothing for 3 people $____ for the year
Cash per week $____ x 52
School supplies and lunches $____ x 52 (lunches and milk breaks may or may not be paid for by other programs)
Mandatory health insurance payment $850.00 - $1,000 a year
Co-pays for any medical care $____ for the year

Anyway you look at this the added burden of mandatory health insurance is going to be catastrophic at this level of income and I'm not including dental care because barring severe pain or abscess a family living on $28,000 a year isn't likely to be seeing the dentist.

[quiet.american]

82. So, how does that scenario improve if they have to add in unsubsidized health costs? nt

[Lorien]

93. No dental, vision or mental health care

and what about pre-existing conditions? Kids with autism? A bi-polar parent? Do they get any help at all?

[wolfgangmo]

69. Another perspective from a primary care clinic.

Perspectives are funny things. What may seem reasonable to someone not used to dealing with insurance companies, looks another way to someone who has seen firsthand just how dirty and underhanded they are. Let me be clear about this, insurance companies break the law every minute of every day. Every time that they deny coverage for a contracted service they are breaking contract law. They problem patients and doctors have is that we don't have the shear number of dollars or lawyers to throw at legal delays and shenanigans that the ins. cos. have. We don't have their deep pockets.

So let's look at your post line for line and see what the insurance companies can do with your precious congressional document.

"An Essential Benefits Package
(b) MINIMUM SERVICES TO BE COVERED.—Subject to subsection (d), the items and services described in this
subsection are the following:
(1) Hospitalization. "

But at what levels? What percentage will they cover? WIll they cap it? Will they call your normal standard of care treatment "experimental?" And please don't tell me they won't. I see these treatments denied for that very reason daily for treatments that have been the standard of care for 30 years and despite the fact that it is illegal for them to do that.

"(2) Outpatient hospital and outpatient clinic services, including emergency department services. "

See number one above. Sure they have to cover it, but at what levels and will they restrict covered services, essentially saying to the hospitals "if you do this treatment for this patients, then we will audit your entire record and make you spend 100s of thousands of dollars in staff expenses defending your previous payments. And yes, I've seen this done. Needless to say the hospital no longer offers that treatment to the patients of that insurance company.

"(3) Professional services of physicians and other health professionals. "

Don't make me laugh. At this time doctors are lucky to get paid 50 cents on the dollar for their time by insurance companies. And the docs will wait anywhere from 6 months to 6 years to get paid.

"(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate. "

As appropriate? - I could drive an earth mover through that loophole

"(5) Prescription drugs. "

Hmmm. Does anyone else smell Medicare part D showing up in the future on this one?

"(6) Rehabilitative and habilitative services. "

Without definitions this could mean anything. It could mean that for rehab a patient with a spinal injury would be given access to a room with a TV and a "Dancin with the Oldies" DVD.

"(7) Mental health and substance use disorder
services, including behavioral health treatments. "

"Just say NO."

"(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention. "

Mandatory vacinations with no oversight, no clinical studies, no guidelines on additives, and best of all blanket immunity. Oh wait, they already have that one.

"(9) Maternity care. "

"Just say NO." But if you don't then abortions are not paid for you slut.

"(10) Well-baby and well-child care and oral health, vision, and hearing services, equipment, and supplies for children under 21 years of age. "

All the formula our subsiduary want to shovel on your kids. Sure it will make him sick, but we are just looking out for the long term interested of our shareholders by assuring ourselves an ongoing supply of chumps/patients/customers.

"(11) Durable medical equipment, prosthetics, orthotics and related supplies. "

See number 10.

"(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 224, to ensure the provision of quality health care and financial security, that—
(1) provides payment for the items and services described in subsection (b) in accordance with genrally accepted standards of medical or other appropriate clinical or professional practice; "

Accepted as defined by our paid docs who are either just greedy enough to rubber stamp whatever the hell documents our lawyers put in front of them or so incometent that they could never keep a license of practice if they actually saw human beings.



The point here is that the insurance companies can and will deny treatment and can and will screw everyone involved. They break the law every minute of every day now so what makes you think that this cash give away to these crooks will change anything, except now the companies will get to use the IRS to collect money from you, in essence turning a government agency into their own private collection agency. This bill is fascism.

[laughingliberal]

122. And you 'aint just whistling Dixie

I've had the pleasure of fighting the vultures from both ends of the spectrum. As a customer and an employee of a number of providers. I've seen not one regulation of the industry in this bill that does not have glaring gaps. In essence, I see them still able to use the same dirty tricks they always have to avoid claims payments. Passing a law in one thing, enforcing it is another. And having a team of attorneys and a gaggle of bought off legislators to interpret the damn law any way you want goes a long way goes a long way in protecting you from ever having to do anything you don't want. Look at the cases where they have been found guilty in the past. What do they get? A slap on the wrist and a fine that doesn't even cover the CEO's private jet fuel?

Hell, I had one company try to deny payment for a prescription my doctor ordered saying it was not the preferred (read cheapest) drug. I had to inform them it was the only drug with FDA approval for the diagnosis and ask what drug they would prefer. Of course, I had a totally non-medical idiot on the phone who could not give me an answer. At that I had to threaten to take it to our state insurance commissioner (look for diminished power in that office) before they backed their criminal asses off and covered it. For God's sake, people I'm an RN with the knowledge base to fight the hell out of these people and I struggled with them. What in the hell is a lay person going to do up against them. If you can barely afford the coverage where are you going to get the money for an attorney to fight them when they deny your life saving treatment for a catastrophic illness? This bill will barely slow this kind of crap down. Couple that with the fact that a significant number of new patients in the system is going to overload the state regulatory offices and your chances of falling through their cracks is far greater than not. This bill is fascism. Our government is about to order us, under penalty of law, to do business with for-profit, private companies who have engaged in criminal behavior for years with impunity and will be going to work for these corporations collecting for them and punishing us for refusing to buy our 'protection.'

And providers trying to get pre-auth for a procedure you need. How many weeks can you hold off while they claim they didn't get the paperwork from your doctor? Hope it's not an imminent need. Then it's not covered for the same reason listed above. It's experimental. Or it's a step procedure-the doctor has to have tried 'a' before they'll cover 'b.' So you get to stay sick a while longer to prove their preferred treatment or drug doesn't work. No one between you and your doctor, my butt. These have always been the people between you and your doctor and now we're leaving them in charge. Just say NO to corporate run health insurance protection rackets foisted on you by your government.

[Lorien]

91. And where are they on deductibles? Mine is 12k before coverage even

STARTS, and I pay for my own insurance ($250.00 a month).

[RevRN]

101. You don't unsdertand the damage this bill will cause

What about the taxes those with adequate health insurance will have to pay to supply the welfare for the insurance industry? You haven’t included that in your cost analysis. I know the goal is bring everyone down to the same low level of care but is that moral? What so you think this will do to our already massive administrative costs? I have worked in the system for 30 years and this is how it currently works. Your provider orders a study; the order goes to a secretary. The secretary calls the insurance company for approval and is placed on hold for 30-45 minutes if they don’t receive a message telling you the insurance company employees are a meeting and they are not taking calls. Then secretary battles it out with some clerk at the insurance company who denies it. The secretary then passes it to a nurse. The nurse repeats the above process and is passed to a nurse at the health insurance company who denies it. Then the nurse at the providers’ office passes it to an MD who repeats the above process. Sometimes it takes several days to get one study approved.
How do you think the insurance companies will respond to all these new patients driven to them by the mandate? The more they delay and deny care the more money they make. They will just not hire additional staff. This will mean providers are providing less care at higher cost.
The senate has not taken this into consideration because the bill was written by the health insurance industry.

[inna]

23. KICK

[clear eye]

24. Thank you for taking the time

to write all the examples that show what is wrong w/ saying what I actually heard Sen. Sanders say yesterday, "We have to remember that at least millions of more people will have "healthcare". I was trying to think how I would explain to DU that having insurance is not the same as having health care, especially when a mandate is enacted. If mandated private insurance doesn't have strict price controls, the incentive for the companies is to price full-coverage plans until they are prohibitive for businesses and out of reach for all but the wealthiest customers. Then they can charge just about everyone else for mandated limited plans what they used to charge for full plans. The mantra yesterday was that at least if people are insured, they won't be faced w/ bankruptcy due to medical bills. This flies in the face of what has happened under the similar Romney-care in Massachusetts, where medical bankruptcies are still all too common.

I don't know whether your examples were taken from your experience w/ poor policies your patients had in Texas, or from research about the Mass. situation, but I think you must have helped many DUers to understand what they have at stake in not having a bad bill pass--to foresee the actual consequences.

Whenever I hear someone say "The perfect shouldn't be the enemy of the good", I think, "Faux reform stymies real reform". In this case it threatens to be not even faux reform, but enactment of legal extortion. This applies even if we have a privatized public option, since unless the price controls and coverage requirements are in place and firmly enforced, the "public option" may only be useless plans partially subsidized.

Again, I am grateful for all you put into the research and writing of this piece. Perhaps you can also get it published in a newspaper as an op-ed.

[McCamy Taylor]

28. Insurers will offer plans designed to do one thing and one thing only...

...keep your from paying the $750 fine. That is the only benefit many Americans will get from their piece of paper. And it will cost a lot more than $750.

I have watched in horror as the health care reform debate became the "how can we make CIGNA richer?" debate. I expected the insurance industry to try to kill HCR. I never expected the insurance industry to co-opt it.

The only reason that medical providers are not screaming about this is they know that most everyone who is actually sick will end up on federal government insurance, and the feds will pay the bills. Unfortunately, your disease has to spiral out of control before the feds step in. And in the meantime, the opportunity for disease prevention, which would cut our outrageous per person medical expenditures in half, will be lost. I have a suspicion that a fair number of specialists, pharmaceutical companies and others would be more than happy to see folks deprived of preventive care if its means a bottomless purse paying for the treatment of their complications. However, people in the primary care specialties (I am in Family Practice and Public Health) who pride themselves on keeping people healthy are fighting an uphill battle, when the simplest disease prevention, like effective diabetes management, is out of the reach of the average American.

[nightgaunt]

26. Health insurance companies are salivating at this harvest of souls

How can they lose with this? They have Obama, the Republicans & Red Dog Conservodems makes it near impossible to get anything that will make things better for those of us under threat from this. Just imagine your wages garnished to pay for the Death non-care or the fine? Ahh lose the house or apartment or be able to eat and then go to the emergency room and die waiting for it or finding it closed. Ahh, the joys of free enterprise! Are you dead yet? You may want to be as growing numbers are finding the easy way out of this developing hell on earth. Then the only ones left will be able to afford it or will die young. What a no win deal for us or conversely a all win deal for the corporations who have their profit over your life as the reason to exist. Don't you just love that? The American way as has been peddled to us for decades.

[bertman]

27. McCamy, you're ON FIRE! Keep up the good work. Rec. nt

[kath]

29. WIsh I could rec this 10 times. Way to go, McCamy!

[juno jones]

35. K&R!

One of the most succinct analyses of the situation, from a health care pro, no less.

Thank you.

[TorchTheWitch]

44. how does a family of 3 live on $28,000 a year?

even without health insurance? When I worked at a desk job the most I could make after 20 years was $35,000 a year, and I'm single with no dependants. It was not enough to survive on. I drove a piece of shit car that was paid for and only had liability coverage, never ate out or otherwise spent money on entertainment, no cable TV, no cell phone and the cheapest dial-up internet connection I could find. No creditcards or other debt, but I could never make ends meet, often had to borrow money from family to keep from getting the electricty shut off or pay the rent on time or get some problem with the piece of shit car fixed... not that I was in any position to pay it back. I had zero savings and not a dime to spare to put toward savings. To say I lived from paycheck to paycheck is a fucking understatement. And this was back in the late '90's when the economy was supposed to have been so great.

Just WHERE do people live where a family of three can survive on $28,000 a year especially now???

[laughingliberal]

47. Yeah, the federal poverty guidelines, on which all subsidies are based

are absolutely draconian. And no allowances for the differences in cost of living in various states or regions. And I read the other day, that unless Congress acts to change it, it will likely be lowered by $7 per month next year (2010). Not a lot of money but a move in the wrong direction. FPL for a single person is under $11,000.

[kjones]

88. My family....

I'm the oldest (20) of 6 children of a family of 8. My family has lived at least for the past 6 years on my
fathers salary of approximately $45,000.
Maybe my mother works the system really well, or maybe we're all just really good at being cheap as dirt, but
it's certainly possible.
(I know, not the same case described, but it seems comparable)

The hard part is feeling like a loser when you get your own cans back from the food drive hah.
(No...really the hard part is being poor)

The good: No crippling debt! Always a positive.


I live in Indiana, so maybe that's why it's possible.

[Kitty Herder]

48. K&R!

[democracy1st]

49. K & R

[nightrain]

54. knr. It's actually "health insurance middle income people still cannot afford". Stop. Period.

This seems to be still okay with Obama and Rahm. If we couldn't afford it previous to health insurance reform, what changed/improved that it's affordable now?

[pecwae]

56. knr. nt

[Little Star]

58. k&r

[voteearlyvoteoften]

60. Read and weep

knr

[pattmarty]

61. You said it a hell of a lot better than I can. It's "funny" that all the.............

........so called progressives (I hate that fucking term) keep saying, as the bill bounces through committees and both houses, that we can fix it at the next stage. Well all I see is that at each stage it gets "progressively" worse. I started calling this piece of shit, a piece of shit before the August recess. The closer that anyone looks at "the bill" the stinkier it gets. This abortion reminds me of just a larger version of Bush's "Medicare reform" (ie: privatizing Medicare).

[clear eye]

85. The progressives haven't been saying that.

For the most part, the progressives have been behind "Medicare for All".

[pattmarty]

124. Well maybe you and me. But seriously, there are a lot here at DU............

.............that want something, anything rather than nothing. My opinion is yes, you can compromise and get something that you may not love, but something that you still can "live" with. The "line" for me was when they dropped the PO and went for Medicare buy in at age 55. I thought even at that time from what I saw of the bill it was still a POS but I was willing to "support" it. I am afraid that the "progressives" (I still prefer liberal) in both the House and Senate will all cave and support this abortion. So no, not ALL progressives are behind Medicare for all.

[Vinca]

62. I wish I could recommend your post a million times.

[IsItJustMe]

67. HCR = scam = racket

[onlyadream]

68. This is making me sick

it's like watching a train wreck...

[Maineman]

73. I just sent this message to my senators (Maine)

I would like to thank you for continuing to take care of insurance companies.

I was concerned about the CEOs losing their $10,000,000 plus salaries. I was concerned about their ability to maximaze profits at the expense of health care for people who actually need health care. I was concerned that too much money was going toward health care and not enough was going to profit, advertising, corporate perks, etc.

Good job. You make me real proud to be a Mainer!

[Blasphemer]

75. K&R... nt

[Vinnie From Indy]

77. Just brilliant!

One of Du's best writers right here!

[AuntPatsy]

81. Excellent piece...now since it is more than obvious that we are aware

of what will happen if this type of bill passes...the question becomes...how can we stop them?

Nothing has been signed yet..

we seriously need to figure out a way to stop them from pushing anything through without ALL of us being given the chance to read through it's contents, after all, we are not children and it will effect us, not them...

[Dinger]

86. K & R

[kestrel91316]

89. K&R

[Lorien]

90. $2,500.00 per person ??? Bwahahaha! Try a 10,000-12,000 deductible!

I'm a low income person who pays for their own insurance, and that's what my deductible is. I have a 20% copay after that. I wrote about this a few days ago and all of four people responded. This is an issue that NO ONE in the MSM even touches on, and until you mentioned it few on DU mentioned it either. How the hell does anyone come up with 12k when they only make 24k to start with?

[subterranean]

100. Well, you're one of the people the reforms will help.

After 2014, the government will pick up the tab for your insurance premiums, and there will be limits on deductibles too (a lot less than $10,000). You may even be eligible for Medicaid under the new rules, unless Ben Nelson has his way.

[Lorien]

102. Got a link for that?

[subterranean]

103. I stand corrected.

At $24,000, the subsidies would only cover a portion of your premiums (the Senate bill is slightly less generous than the House bill). Here's a calculator to determine roughly what your subsidy would be:
http://healthreform.kff.org/SubsidyCalculator.aspx

Also, I could have sworn I read that the bills would limit annual out-of-pocket costs (including co-pays and deductibles) to $5000 for an individual and $10,000 for a family. However, I looked at both bills again and could find no provision specifying that. So I withdraw my comment about the deductibles.

[SandWalker1984]

92. We can't find 5 progressive Senators?

4 corporate prostitutes masquerading as Democratic senators can absolutely take out a true and transparent public debate on health care, eliminating a public option for all Americans or Medicare access for Americans over 55 (but it should have been access to Medicare for ALL Americans),

but we can't find 5 progressive or "liberal" Democratic senators to stand together, united for the people, and just say "NO, everything stops in the Senate on this vote until this bill is fixed to give every American access to a public option like Medicare."

Several have spent time going on shows such as Keith's, Ed's and Rachel's over the past few months, spewing what appearently was just political rhetoric about why a true public option was the only way to get meaningful health care reform and competition for the private insurance corporations and their monopolies.

Where are they now?

If Bernie Sanders, Russ Feingold, Chuck Schumer, Ron Wyden and the others vote for this sham bill that's nothing more than a bill to protect the insurance corporations profits, that has no meaningful public competition for them, then these senators are no better than Ben Nelson & his gang, or the Republicans that at least have never mandated we buy expensive, private insurance or pay fines/go to jail.


If you agree with me, then contact these senators offices and tell them you want them to stand on principles, even if this corporate enslavement bill goes down in defeat. We will respect and support them for taking a principled stand for us, which now more than ever is needed in our Congress.

[glitch]

97. +5 nt

[glinda]

95. Right now I have that and am going broke.

[LWolf]

96. I already have health insurance that I can't afford to use.

So the $$$ that I, and my employer, pay into the plan is not used to provide the care I need. If I had anything left over after paying for the premium to pay deductibles and copays, I'd go get a mammogram or a pap while I still could. I'd get the strange moles appearing on my arms and legs looked at to make sure it's not skin cancer. I'd get the blood test that would allow me to continue with my thyroid prescription. I'd get some chiropractic care for my constantly painful back. I'd get a doctor to look at the ankle that has twisted and buckled so many times that it is permanently swollen and sore.

My insurance company can count on not having to pony up for those things, since there's nothing left over after the premium.

How is mandating that premium going to change that?

[Myrina]

104. .. there has got to be a Supreme Court/constitutional challenge in here somehwere ...

... the gov't can't force anyone to buy something, can they? Seriously?

[Flatulo]

115. Massachusetts has been doing it for several years now. nt

[EVDebs]

105. Assuming no 'pre-emption'...can state insurance commissioners regulate ?

Can state insurance commissioners regulate the insurance companies that will be profiteering off this national disaster of a 'healthcare' system ? If the goal WAS affordability and furthering the 'public interest' after all ...

[suffragette]

106. Thank you for your apt and effective countering of the better than nothing

argument.

Passing something that takes us in the wrong direction just to get something passed is foolhardy.

[Pooka Fey]

107. KnR

[mother earth]

109. Agree, on all points made.

Thanks for this outline, MT!

K & R

[girl_interrupted]

110. K&R

[bajamary]

112. The Vichy (corporate) Democrats

These Corporate Democrats have been in the pocket of big Wall Street and Big Pharma all along.

Obama has shown his true color: green as in money not as in environment.

I also was horribly fooled by Obama as I worked many months, like so many others, to get him elected.

I'm from Chicago and my old Congressperson was Rahm Emmanuel. So when I heard that Obama hired him as his Chief of Staff, a chill went through my body.

With this awful health care bill that gives us no public option yet it gives Big Insurance and Phama billions more in profits, I now have a horrible chill going through my soul.

I, for one, will not get fooled again by Mr. Obama. No votes, no money and no good karma to him and his gang of Vichy Democrats.

[Earth_First]

113. ::slowly stands and begins slow clapping ovation::

:applause:

[zorahopkins]

114. I Did NOT Vote For THIS Sort of Change

I am so depressed about all of this.

I had HOPE. Hope that things would change FOR THE BETTER.

Instead, things have changed for the worse.

Instead of the people in DC being concerned about the poor and those without, they want to take care of the Rich and the "Haves".

I'm in tears.

[glinda]

117. Yup. buy insurance from States that don't provide rights like Texas. Woot! Fun!!!!

[Username 12]

118. K & FUCKING R!!!

Excellent, well-written, skewers the hypocrites!

[sythe200]

119. Doesn't this whole post

sort of ignore the economic realities of the bill? The insurance companies will be unable to deny anyone coverage, which means that high risk and already sick people will have to be covered (at enormous cost). Also, companies will be forced to charge premiums based on age, nit risk. This will force companies to charge the same premiums to high and low risk people which will again be very costly. And lastly, insurance companies won't be able to raise premiums without the approval of the government, which they will almost certainly not give. So insurance companies will be faced with exploding costs and no ability to increase premiums to cover those costs. The end result of course, is no more insurance companies. Who knows where we'll go from there?

[tooeyeten]

120. horse manure

"But if the Democrats serve the public a horse’s head on a platter and call it “Health Care Reform” the voters will be so happy they will elect Democrats into the White House for the next one hundred years."

This is the crap Rahm is feeding Congress and Obama.

[mzmolly]

121. How long does it take to spend $1250 on a hospital visit? How much do you think

people making 28,000 per year have to pay for health insurance currently?

[noiretextatique]

125. the point is: people who have micro insurance now or no insurance

will likely have the same type of insurance after this "reform," i.e., insurance they cannot afford to use. i was in that position before i got a job that offered real insurance, and this was the result. i felt a lump in my breast when i had micro insurance and if i had been diagnosed with breast cancer then, i couldn't afford to pay for treatment, and i couldn't afford to have a pre-existing condition when i got real insurance. so...i waited until i had real insurance to get the mammogram...and i was diagnosed with breast cancer. thankfully the tumor wasn't large and the cancer had not spread to my lymph nodes or anywhere else. but my doctor told me if i had been diagnosed earlier, i probably wouldn't have had to do radiation, and chemo wouldn't have been a consideration. thankfully, i took a test that determined chemo would not benefit me.
that's the current reality of what many people have to deal with, and nothing in this bill currently addresses that reality.