If health care bill passes, some changes would start fast

[babsbunny]

http://www.mcclatchydc.com/227/story/81725.html

By David Lightman | McClatchy Newspapers

WASHINGTON — More money for community health centers. Immediate help for the uninsured. No more lifetime limits on coverage.

Under the health care legislation that's moving through Congress, these and other benefits would take effect quickly and should produce a noticeable impact on consumers, according to many independent analysts and Democrats.

"This would be a substantial package that could probably be quite helpful," said John Holahan, the director of the health policy center at Washington's Urban Institute, a research group.

[MNDemNY]

1. And the taxes.

[HughMoran]

22. against paying for covering more people?

Are you a Republican?

[MNDemNY]

27. When it goes into the bottom line of the industry, yes, I am against such a tax.

[HughMoran]

28. It's going to help people - like the industry or not

I hate the industry, but you can't say with a straight face that the millions more covered and elimination of existing conditions and lifetime limits and regulation and community health centers and subsidies and all the other reforms isn't going to help a lot of Americans.

[nightrain]

35. at a huge cost to individuals and great benefit to the corps. Not worth it in my book.

Throwing good? money after bad. Perpetuating a totally dysfunctional (non-)system.

[HughMoran]

36. ALL of us are currently paying these con artists to rape us now

How on EARTH do all these reforms actually make it worse in your mind?

[nightrain]

38. not ALL of us. Some people have divested themselves more and more from the

robbers.

How it makes it worse? One example--mandating that a person purchase a private corporation's product when it is unaffordable.

[HughMoran]

39. I have to buy it to protect my children

I don't have a choice. I also think that everybody should share the burden - my rates are higher than they need to be due to uninsured, fraud and the ratio that insurance companies get to keep of my dollars - all of these issues are being addressed in this bill.

[nightrain]

41. probably your rates are higher than they need to be because of

the ?30% overcharge for exec compensation, advertising, claims deniers, etc.

[laughingliberal]

43. I'm not sure how to convince people there is a difference between selling someone a policy and

covering their health care needs. Many people who get a policy will be in the position a lot of people who have policies now are in-don't have the money to meet their deductibles.

The law forbidding the insurance companies from denying people with preexisting conditions is, essentially, negated by leaving the loophole on rescissions in. Even better for them, really. Collect the premiums til someone needs expensive care then cancel them for 'fraud.'

I hope there is some help with the addition of the CHC's.

I think most people who are pushing this mess of a bill are sincere in their belief it will do some good. I wish their faith was well founded but I fear it is not.

[nightrain]

49. I know.... Sometimes I think many are so desperate for what seems like

an answer, that they don't fully understand the ramifications and implications.

[HughMoran]

53. Yes, only those who are opposed can 'fully understand the ramifications and implications.'

Right?

[nightrain]

54. when people are desperate, they grasp. (don't stalk)

[HughMoran]

56. Ummm, you don't want to talk to me in the same subthread now?

Now I'm stalking even though you were making underhanded remarks about people 'like me'?

[laughingliberal]

61. Perhaps those who spent their lives working in the current health care system and fighting insurance

companies to get care for their patients are able to read the bill with an eye to all the pitfalls the industry wrote into it and are, therefore, opposed. Perhaps we see things there that the politicians who wrote the bill aren't making clear.

I don't know why the supporters continue to argue. Of course the bill will pass. I just know it won't be the help people think it will be. And no amount of bashing on those opposed is going to make this bill an answer to the problems with this health care system.

[pundaint]

60. No against paying a corporation a 20% bounty on my coverage, and for those in need of help.

And against giving an industry incentive to raise the total cost of our healthcare even further above world norms because going forward that's the only way to increase the value of their 20% cut off the top.

How can this most obvious risk go without widespread outrage? This bill will consume all the remaining money if pretty short order.

[dflprincess]

2. Also from the OP's link

Both bills provide immediate aid for the uninsured. The Senate would provide $5 billion to help finance a temporary program that would provide coverage to uninsured people with pre-existing conditions, effective 90 days after the bill is signed.

The House bill also would create a temporary insurance program for those who have trouble getting coverage, effective immediately upon passage.

"In general it's a good idea," Holahan said, "but how much would people pay to get into it? There are so many questions we don't know the answer to." Those questions presumably will be resolved in upcoming House-Senate Democratic negotiations.

All they're providing is "coverage" nothing is said about what the out of pockets will be and if people will actually being able to access care.

[aquart]

3. Does "coverage" include a description of what that entails?

I really need a line in the bill slipped in that outlaws deductibles.

[MercutioATC]

5. Deductibles are never going away...nor should they (in most cases).

Modest deductibles ($10-$20 for a primary care physician visit) are a great gatekeeper. Even that $10-$20 will weed out a lot of abuse.

[Warpy]

7. It will also weed out the marginal workers until they are so sick

they need to be hospitalized when a timely, fully paid doctor visit would have kept them healthy enough to keep going outside the hospital.

Deductibles and copays need to be pro rated like everything else and no one making a poverty level wage should ever have them.

Insisting the poor pay deductibles and copays is penny wise and pound foolish. It will cost much more in the long run as unnecessary hospitalization costs mount up.

[cali]

8. And at the CHCs they are pro-rated and if you can't afford anything

you pay nothing.

[MercutioATC]

9. I understand your point, but I don't think it's economically feasible.

The better accessibility a system offers, the greater opportunity for abuse. A modest copay helps to mitigate that.

[Warpy]

11. You are acting like abuse will be a huge problem, that

everybody is basically dishonest and will submit themselves to poking, prodding, needles and bloodletting just to game the system.

It's a pretty sick view of your fellow citizens.

The fraud rate on all public programs is actually quite small at the client level. The fraud is being committed by providers, not patients.

Again, the whole idea is royally stupid and a waste of money on unnecessary hospitalizations.

[MercutioATC]

13. Yes, I DO think it is (and will continue to be) a significant problem.

To be clear, though (as nightrain pointed out) I'm speaking more in reference to copays than deductibles.

[Warpy]

15. And you're dead wrong for the reason I cited.

I worked in health care.

Banker?

[MercutioATC]

18. Air traffic controller

...and new liquor company owner.

If I was a banker, I'd have all my problems solved.

[laughingliberal]

52. RN since 1982. Where the hell does this crap come from?

Yeah, we have physicians who abuse the system. But patients? This just smacks of a new form of the 'welfare queen' mythology.

And it sounds suspiciously like some of Bush' rhetoric about the 'ownership society.' The thinking being if people have to spend more of their own money, they will budget their health care better. I could just scream! A few days with me they would change their tune. The absolute desperation I would feel when I would make a call on a patient, find them seriously ill, and,. on questioning, they didn't have the money to see the doctor and didn't call the doctor cause they were too ashamed to tell them they had no money if the office said they needed to see them. The people I found who had been having chest pains all day but begged me not to call 911 cause they couldn't pay the ambulance bill when it came in. God, what kind of nightmare hell of a country have we become?

[nightrain]

24. Actually, in my experience as a healthcare practitioner, financial abuse

by patients/clients is so much more rare than the financial gaming that goes on by larger/greedier agencies/corporations.

The premium costs, large deductibles and copays virtually assure that people who buy these policies probably won't be able to use them much unless their incomes have increased sufficiently, which is not likely.

[MercutioATC]

26. I agree.

But patient abuse IS an issue.

We don't say "Well, teachers molest fewer kids than Priests, so molestation by teachers isn't an issue"...

Corporate abuse IS, by FAR, a greater problem...but patient abuse should also be addressed.

[nightrain]

30. Minor,from my perspective, knowing how much actual care has been delayed, denied, unprovided, my

focus is on providing care first, and worry about any minimal amount of patient/client financial abuse later.

[MercutioATC]

31. We can do both.

One doesn't have to be done "first".

Guidelines that both provide care for those who need it AND deter abuse are possible...

[nightrain]

34. yeah, and if it comes down to money for care, vs money for deterrence, I go with care.

[MercutioATC]

37. You're creating an artificial battle.

We don't have to make that decision...especially since deterring abuse costs virtually nothing and provides more money for care.

[laughingliberal]

59. Thank you so much for that. My patients, as I said upthread, were much more likely to not see a

doctor when they really needed to because if financial concerns. It is just evil to want to make it unaffordable. I get it why the insurance companies do think this way but fellow citizens? What the hell is wrong with us?

[juajen]

57. I have a co-pay of 30 dollars for a specialist visit.

I broke my arm and have to have physical therapy three times a week. My total cost for co-pays for my therapy for the month are around 400 dollars, a prohibitive amount on my limited social security funds. Co-pays are ridiculous. I do not see any reason for them, except to punish the poor for being poor.

[nightrain]

62. yes. That's very unfortunate. Would the practitioners be willing to

accept a lesser amount of co-pay? They might. I do when there are financial difficulties.

[laughingliberal]

14. That was my experience with patients who had high dedcutibles nt

[Warpy]

46. Mine also

There is nothing like actually working in health care to give you a better perspective on this stuff.

Deductibles and copays are counterproductive for marginal workers. They turn out to be much more expensive in the long run.

[nightrain]

10. what you're describing is more like a co-pay than a deductible.

Deductibles are much larger amounts than one has to pay before the insurance policy kicks in. In the proposed bills they are in the thousands. That is on top of the costs for the insurance policy premium and different than a co-pay for a visit.

[MercutioATC]

12. You're absolutely correct.

...and my intent was to address copays.

Thanks for the correction.


Personally, I think deductibles are just an economic issue, just as they are with car insurance. You can get lower deductibles and pay a higher premium or you can bet on not having claims and save money by choosing a higher deductible.

[nightrain]

19. If deductibles are high enough, they are definitely prohibitive. think about it...

For one person with a middle income, not subsidized, uninsured now--several thousands for the premium, several thousands for the deductible, then the co-pays. Makes it quite unlikely that unless it's an emergency or near-emergency, care will not happen. This is very unaffordable.

[MercutioATC]

23. I wasn't adressing the need to making basic health care affordable.

I was addressing the idea that open access to all health care should be free.

Yes, the person presented in your scenario should be subsidized (or, in some fashion, affordable access to health care).

[dflprincess]

20. My employer provided "coverage" has a $1,200 deductible as of Jan 1

Nothing, except a few preventative tests, is covered (including prescriptions) until I've paid that amount out of pocket. All together I have an annual out of pocket of $3,700. We do get to open "health savings accounts" to cover these out of pockets, but those couldn't be started until Jan 1 so right now there is nothing in it and, in a strange twist, the Federal limit for what you can put in a HSA is $3,500 - $200 less than the max out of pocket.

More and more policies are going to these sorts of out of pockets. The House bill allows a deductible of $1,500 and max annual out of pockets of $5,000 for a single person and $10,000 for a family.

All this "reform" is going to do is add to the ranks of the underinsured, it's not going to help a whole lot when it comes to being able to afford care.

[MercutioATC]

25. HSAs credit you the entire year's balance as of the start date.

You have whatever you designate as your yearly contribution available from day 1 of the plan.

Don't get me wrong...I despise both the House and Senate bills (obviously, the House bill slightly less).

[dflprincess]

29. That's not what we were told by HR

FSA's credit everything at the beginning of the year, HSAs do not. That is because HSAs are your personal account and, unlike the FSAs can carry over from year to year.

The other scam with the HSAs is, once you have $2,000 in it, you can (and this was said to us like it was so exciting and good) is that you can INVEST IT IN A MUTAL FUND!!! - Like a 401K. Just hope the market doesn't tank about the time you need that bypass surgery.

[MercutioATC]

32. I might be mistaken.

I have an "HSA", but it's through an "FSA" program. It doesn't roll over and any monies still in the account after the end of the year (actually, after a 3-month grace period) are forfeited.

Please check again, though. I know that my plan credits me my entire yearly contribution as of the beginning of the year.

[dflprincess]

64. I went out to check the website

the full credit for my 2010 FSA has already been added (but because we have a HSA too, the FSA is now legally limited to dental and vision expenses only). The HSA only shows the $100 my employer contriubted 1/1 to "start it off" :puke:.

[Lydia Leftcoast]

55. Those aren't deductibles--those are co-pays

Deductibles can be literally thousands of dollars. Deductibles mean that up to a certain point, you have to pay the FULL COST of EVERYTHING>

[Berry Cool]

4. Yeah, I want to know how much this "coverage" is going to cost me

and whether it's going to be perceptibly better than going with no coverage and hoping for the best.

[nightrain]

16. depends on your income. If you are low enough then there's a subsidy (which actually is an

admission that the insurance policies are unaffordable). If your income is middle class, then you get slammed. There's no subsidy and the bills differ, but generally the premiums will cost several thousands a year, plus the deductibles of several thousands, then the co-pays on top of that.

That's the "reform" we get. DIsgusting.

[Winterblues]

63. The House bill also would create a temporary insurance program

But you know this will never make the final Bill. Temporary Programs have a way of becoming permanent with Government and we know the Government will not be allowed to create an Insurance Company/Program.. Ain't Gunna Happen....

[Cleita]

6. When I was a kid in grammar school there was a rich kid in our

class whose parents overindulged him, so he always had pockets full of change I guess to buy candy with. He used to amuse himself throwing change on the playground and watching the poor kids go scrambling for it. I'm sure the extra "candy" money was quite "helpful" to those poor kids who often didn't even have a sack lunch to eat. This tossing of pennies and nickels of health care hope to people, who really need so much more and yet will scramble in the dirt to pick up what is thrown there, is what this health bill reminds me of.

[flamingdem]

17. Bernie Saunders clinics are promising nt

[laughingliberal]

45. Yes. Wish we had more details on them. Nothing else I've seen in the bill is promising

Anyone know much about the CHC's?

[nightrain]

47. if they are staffed by NHSC personnel who leave after their

year or so of obligation is over, then I fear for the fragmentation/lack of continuity of care people will receive at them. But, in the short term, it's good to have more funding for them. If it's very affordable and of high enough quality, providing adequate referrals and follow-up, then some folks will benefit.

[laughingliberal]

50. Thanks. I just keep searching for anything that might be a redeeming factor in the bill

This and the Medicaid expansion is about all I can see that is some help.

[nightrain]

51. Medicaid expansion is a real mixed bag. Most states are having severe

financial problems and are reducing benefits. I think it's crazy how much disparity there is between states. I mean really, is it ethical that folks in State A with greater economic resources and willingness to provide more comprehensive services should have greater access/provision of care than folks in State B with fewer economic resources. Or is it actually more ethical to provide a high level of care to all in the US, regardless of location?

My state is currently reducing payments to practitioners such as myself, reducing benefits across the board to Medicaid folks. It's capricious care, and sometimes of lesser quality.

[coti]

58. Easily the best thing about the bill.

Many of them already exist but the increased funding will help.

[slipslidingaway]

21. Why do we need an individual mandate to make some of these changes. n/t

[nightrain]

33. (good to see you) We don't, huh? But, the mandate is probably part of the

deal made to the corps, huh?

The ping ponging should be interesting, eh?

[slipslidingaway]

40. Yes, part of the deal and even spelled out in their TV ad ...

"...if everyone is covered..."

http://www.youtube.com/watch?v=R36YJl8SagU

Good to see you too, it was nice to get away for a bit.

:hi:

[nightrain]

42. thanks for the video. Sickening. Glad to see you back. I can appreciate

the desire to get away. It gets to be too much at times.... I periodically take breaks too.

[slipslidingaway]

44. You're welcome and thank you ...

best to you and yours in the New Year.

:)

[nightrain]

48. same to you and yours! :))