Why the Senate HCR Bill is Not All That and a Box of Chocolates

[laughingliberal]

Many supporters of the Health Care Reform bill on which the House is considering a vote would have us believe those who oppose the bill, in its current form are all willing to let thousands die for lack of a pony in the bill or that we are all of the kill the bill crowd or 'single payer or die.' None of those positions describe my position. My position is we do need to push til the last Dog dies for some changes in this bill. I believe the supporters, by and large, are sincere in the desire to see people helped. I would like them to take a few minutes to look over some of the problems we face once the bill passes. Then, I want everyone to call their Senators and Congressional Reps and express the concerns and ask them to fix it for real.

1) 30 million more people will have access to health care.
2) People will no longer be forced into medical bankruptcies

The truth is 30 million more will be mandated to have a health insurance policy. Those who get a subsidy may be able to afford the premium but a lot of them will not be able to afford the deductibles or out of pocket expenses. So, if they can afford the premium and have a policy, they may still not be able to afford to access the actual care. So, many will have a policy but not access to health care and they will have an extra expense of paying a premium. Now, many make the point that the bill allows people to see a PCP without out of pocket expenses (a visit for a checkup, if you will).First off the premiums they are paying would, likely, be enough for them to see a doctor for a checkup to begin with. Many who could, perhaps, afford the checkup do not see a doctor because they can't afford any treatments if something is found and I know all about this cause I am one of those, now. This is very similar to the position they will be in with their new insurance policy: if they see their doctor and something is found to be seriously wrong, they have no access to the treatments for the condition without coming up with the deductible and out of pocket costs which will be out of reach for many. They may (and this is not likely) find providers who will treat them without them having met their deductible yet but they will be billed for the differences and then be forced into bankruptcy over the bills. This bill will not stop medical bankruptcies.

When you start talking of those who do not qualify for a subsidy, it gets less certain they will even have a policy unless they are pretty well heeled. People with this sort of money probably already have coverage. Federal policy guidelines would put a couple making 52,281 per year outside the level for a subsidy. If that same couple happens to be older their premium will be quite high (There is nothing really to force the price of premiums down. We can argue if it will slow the rate of increases in the future but they aren't coming down from today's levels). My husband and I were paying $1200 per month for our premiums and that was before we dropped it almost 3 years ago. We all know that premium could be up to around $1700 by now. But let's just assume this couple is still getting $1200 rate. That is 25% of their income which is like a second house note in my part of the country and more than a mortgage in a lot of the country. I know very few at this income level who could afford a second house. Add to that the deductibles and out of pocket expenses and this couple will, no way, be able to afford this coverage. Now, they will get a waiver so they are not fined (as the policy is more than 17% of their income) but they will still not have coverage. So, these people get nothing from the bill. Let's assume they are a bit younger than the above couple so their premium is just under 17% of their income. That's a couple who will be paying $740 per month. At that income level it might be doable but it will be a stretch depending on the cost of living in their area (and this is a huge problem with the Federal Poverty Guidelines, they do not take this into account and the price of housing is never considered but that's another discussion entirely). Let's assume their mortgage is $1200 per month because in my area that is a modest home. They are now darned close to 50% of their monthly income going out just for the mortgage and their health insurance. If they have a car note, they're really scrapping, now. A lot of these people will not be able to afford the coverage (and if they do, they will certainly go bankrupt over the out of pocket expenses should they wind up with a serious illness). If they opt not to obtain coverage they will be fined. The fine may be affordable but they still don't have coverage.

3) This bill will stop denials for preexisting conditions

I have always said people who can already afford coverage but have been denied due to preexisting conditions is one of 2 groups who will be helped by this bill. First off, you have to realize the community ratings system in the bill allows a multiplier of 3X for age and a lot of older people are the ones with preexisting conditions. So, they're in the same boat as all older Americans as far as being able to afford the coverage. Now, until some bought out asshole in the Senate slipped that loophole allowing rescissions to continue into the bill I would have said younger people with preexisting conditions would be helped by this bill if they can afford the coverage. But, with that loophole in there, now, it is not clear this is, necessarily, true. These may find themselves facing the same issue many face, already. They pay for the coverage for a period of time and, as soon as the insurance company decides they are tired of paying out for them, they will search their medical files and history, find a condition they neglected to mention on their application, and call it fraud and cancel their policy. There is nothing I've seen in the bill which changes that scenario. Once that loophole got in there my previous belief that those who could already afford coverage or younger people with a preexisting condition would be helped got a lot more uncertain.

4)This bill will end rescissions and you will be covered as long as you paid your premiums

Untrue and addressed above

5) This bill will stop insurance companies from imposing annual or lifetime limits

Half true. It will not allow lifetime caps but they weaseled in a loophole for annual caps

6) This will expand Medicaid coverage for the poor

True. This is the 2nd group I have always said would be better off with the bill than without it (and I am in this group, now) and this one that has not changed. This will be a group who does not have coverage now who will have it if the bill passes. But, before we get out the party hats, it is important to note, though, that many areas have no practitioners who take Medicaid patients as the reimbursement rates are abysmal. Finding a primary care provider is doable in some areas but specialists are out of reach almost everywhere (at least everywhere I have worked with this population). So I, cautiously, call this an improvement because those who have, previously, fallen just outside the guidelines will now be eligible. I'm not discounting this. It was always very frustrating to work with patients who really needed this help only to have the state decide they made $2 a month too much money. But, just like those in the above scenario, many of the people who fall into this group will now have 'coverage' but many of them will still have no access to health care. So, maybe some help, maybe not, is the status of this part depending on the person and their medical needs and the area in which they live.

It is worth taking a minute to look at the unintended consequences (because we all know there are always unintended consequences).

The downward pressure on the working and middle classes here can not be overlooked: You have to consider the couples spoken of in # 1 & 2 above. Let's assume this couple is in their 50's and their income is just below the 400% of FPL level. Let's say they are making $50,000 per year. They are not rich but they're making it. They bought their home here a while back so their mortgage is $900 per month-below the 25% of income guideline. They have to commute for work cause housing near the job is out of reach. They have one car note and another paid for car. Let's assume they are one of the rare couples in the country who managed to get to this age without taking on debt after stagnant/declining wages over the past 30 years. So, they qualify for a subisidy which limits their part of the premium payments to $5000 per year, a little over $415 per month. Well, that's doable. The 2nd car is getting a little long in the tooth and they had hoped for a newer one but they'll keep this one going as best they can and get a policy cause they are at an age where it's smart to do so. They'll figure something out, eventually. Well, they are stuck right where they are. Because if their income goes up just 5% they are outside the guideline for the subsidy. Now, their premium is $14,400 per year or $1200 per month. Where will they find that extra $785 per month? Hell, they couldn't find the extra $300 for a newer car. Their income increase of $166 per month will decrease their disposable income by more than $600 per month. Two choices here: 1) they do without the coverage and hope they don't get sick, or, 2) they suck it up, and one of them (let's say the wife) gets a part time job to pay for the coverage and buy the newer car. Their lives are not as good. They have less time together but they have the insurance and the newer car. Then, the wife is diagnosed with a very aggressive breast cancer and must start treatments immediately. She has to quit the part time job. In addition their policy has a $2000 deductible and a $5000 out of pocket cap for the year. They can no longer afford the premium, anyway. If, by some miracle, they manage to keep making the premium so she can get treatment, they are still at risk of going bankrupt over their part of the expenses. And, even if they remain healthy, these people are not, without some miracle, ever going to be financially in the same place they were before their income went up $166 per month.

Let's assume a better scenario for this couple. The wife gets a job that provides coverage and it's a union job, working for the state. The pay is about the same but the benefits are great! They are ecstatic! Their part of the premium passed on from their employer is only $250 per month and it has an actuarial value of 90% with a $500 deductible and maximum out of pocket expenses of $1000 per year. They have it made! Then the Senate bill passes as is. Ut oh! The premiums are at the level which will be taxed. The insurance company raises the rates. The state's budget shortfall is already getting desperate. They change to a lower cost policy. The wife's part of the premium goes up $50 per month and now the coverage is 70% and the deductible is $2000 per year with an out of pocket maximum of $5000 per year. This means $7,600 dollars out of their pocket if one of them get seriously ill.

Let's look at one more part of the bill that gets little press but is quite damaging. That's the Ensign amendment. Those who thought they're good whether the bill passes or not because they have coverage at work are in for a real treat over this. This allows insurance companies to sell policies to employers which can target people with certain conditions with premiums grossly higher than those without. Heh! People buying on their own may not be discriminated against for having a preexisting condition but those who get their coverage through work will not be so lucky. The employer will be able to force you into a 'wellness program' and, if you don't meet certain goals, you will be charged vastly more for your part of the premium. Some of these goals, we can argue, would be within the control of the employee like losing weight or quitting smoking. But one of the conditions will be high cholesterol. Not heart disease, mind you, just a number on a lab report. Most cholesterol problems are genetic. They are virtually intractable to patient behavioral changes. Even if you are not at risk for any heart disease due to your cholesterol level, you will be forced to take statins to lower this number or pay through the nose for the coverage. And, just for myself, if I didn't have some serious risk for heart disease I would not be taking a statin drug I don't need if I had a choice. Besides that do you really want your employer this intimately involved in the details of your health? This amendment was made possible by a last minute executive order signed by Bush which removed some of the HIPAA protections that allowed you to keep your protected health information private.

The employer mandate: The bill will not require employers to provide coverage but will fine them if they don't provide it and an employee qualifies for and gets a subsidy to buy from the exchange. Look for single mothers in lower paid occupations (a mother with one child will qualify for a subsidy if she makes up to $58,800 per year) to have a hell of a time getting hired.

There's more, like the effects of the cuts to Medicare which will, likely, lead to a new push for privatization of that system and a huge backlash against the party once people see the ill effects of the bill but I'll stop for now. I hope this has illustrated that those opposed to this bill are not just heartless people who don't care if Americans die in the streets without insurance but that we do have some really legitimate concerns here that this bill will not help many and it will do a lot of damage.

Perhaps, instead of screaming at the opponents, we should be screaming at our legislators and letting them know we are aware of the poison pills in this bill and want them out of there. Right now they see 2 groups of constituents: the bat shit crazy right wingers who oppose the bill without having any idea what's in it and the supporters who thing we're entering a new age of social justice with passage of the bill. They need to know there is a big group out here who are demanding some real reform of this system and we don't think this bill is it.

[northoftheborder]

1. EXCELLENT analysis!!!!!!!!

[RaleighNCDUer]

2. A well reasoned, well written examination of the bill.

That'll fly like a lead balloon.

but thank you anyway.

[laughingliberal]

8. ROFL!!

True. Stocked up on flame retardant before posting

:hide:

[polpilot]

22. Gosh!! The insurance lobby wrote the bill & it's not good for consumers.

What a shocker!!

[Autumn]

3. Very good explanation,

and it makes a lot of sense. Thank you. :kick: K/R

[Nite Owl]

4. Thank you so much

this is such a clear explanation of the side effects of this so called reform.
I hope you can get this out there somewhere--ltte or/and email to Keith(Larry), Ed or Rachel. This is the discussion we should be having most people are totally unaware or they won't face up or admit to what is really there.

[CrispyQ]

5. Thanks for taking the time to post this, laughingliberal.

An excellent summation of what's wrong with this bill, while also addressing the tiny bit of good in it. Your final paragraph is spot on!

:thumbsup: :thumbsup:

[Cal Carpenter]

6. I hope to god some people read this and take it to heart

This is a very well-written, well-researched analysis.

Thank you SO MUCH for taking the time to do this.

[saracat]

7. The very best explanation of why the HCR Is bad I have ever read.

This should be mandatory reading for all who claim there is no downside to this bill .

[blindpig]

9. keep this kicked

Bunch of people around here need to read this, though I suspect that for some that it will not matter.

k&r

[Cal Carpenter]

11. Interesting too

that all the posters who are so forcefully arguing in support of this bill on other threads are not touching this one...

[saracat]

12. Because this isn't biased.It is just the facts.

[maryf]

124. the incentive isn't here...

;)

[maryf]

122. Kicking here!! nt

[Ignis]

178. Needs more kicking...much like the DLC.

:kick:

[saracat]

10. Kick for one of the best researched and analyzed posts ever on DU!

This is well worth reading.In fact it should be required reading no matter what happens with HCR because people need to UNDERSTAND how this will affect them.

[laughingliberal]

19. Many thanks, Saracat

:)

[leftstreet]

13. K&R

Nicely done!

[Autumn]

14. K/R

:kick:

[backwoodsbob]

15. excellent synopsis

Hats off to you and I hope you have your flame retardant undies on

[laughingliberal]

18. Indeed. I made sure to be suited out before posting. nt

[Cal Carpenter]

21. Hell, looks like you rendered people speechless

Well, I'll do my best to help keep this kicked in order to make sure everyone has a chance to rebut you :)

[laughingliberal]

23. Thanks!

:)

[slipslidingaway]

16. kick to find later ...thanks n/t

[bvar22]

17. Good job of laying out the truth.

K&R

:patriot:

[laughingliberal]

31. I'm not worthy

of such high praise from such a venerable source. Thank you!


:blush:

[fascisthunter]

20. K&R (nt)

[tpsbmam]

24. You know, I'm one of the people who stands to be directly affected (as most

of us will be) by this legislation. And I'm one of the people currently without health insurance. I had it for many years when I worked full-time, but my 2 serious preexisting conditions eventually forced my retirement (believe me, I'd give anything to be working again -- I spent many years in school and internships to learn my craft and I loved my profession).

I was subsequently barred from getting disability/Medicare because of a ridiculous & cruel Medicare loophole but, even with an attorney, I couldn't get past it. I was smart enough to save during my working years and I have some savings, including an IRA. By the time I was "retired" I soon after got a small inheritance and was able to combine that with a good chunk of my savings to buy my modest house outright, so I have no mortgage. It left me with less in savings to support myself with, though, and I now live on a monthly stipend from my IRA -- I take the maximum amount allowable without paying fines which, believe me, isn't a huge amount. Because of my savings and IRA, I'm not eligible for Medicaid (I worked in hospitals and believe Medicaid truly sucks anyway, as partially outlined in the OP). So I'm subject to this insurance mandate.

Sadly, my income indicates that I'm eligible for Medicaid, but I'm not. And I've been screwed by Medicare. So where does that leave me? I'm eligible for subsidies. But here's the hitch. I live in a community that has confronted American healthcare problems head-on. Thanks to the community approach, I now get most of the prescriptions I need at a pretty affordable rate (it recently went up but I can still swing it). Yes, there are two prescriptions I need that I can't afford but I do get one for free through the manufacturer. I have a PCP. I see the two specialists I need (a neurologist & a nephrologist) at no cost to me. I'm absolutely screwed if I need hospitalization (which has happened twice this year, leaving me with massive bills), making the current healthcare bill somewhat more attractive to me.

But here's the rub. The current bill may well end up costing me much more and render my current level of healthcare out of my reach. In the system I currently qualify for, insurance changes the picture -- I would not be eligible for many of these services. And it would leave me with deductibles & co-pays I can't afford. In short, I could well be royally screwed if this bill passes and may well lose much of the healthcare I currently get thanks to an aware community and good docs who get it and are willing to participate in these programs.

So I'm ambivalent. There are good arguments on both sides. I don't want to look at the issue selfishly -- might it hurt me but help others? At this point, I think not -- I think, as the OP argued well, that it stands to help a lot of people but also to hurt millions of people. If it truly is a step in the right direction, I'm more in favor of it. But frankly, I don't trust our representatives -- as much as I love some of the people (e.g., Bernie Sanders) assuring us that the bill will be rapidly fixed, I just don't see it happening given our current political environment and the potentially dire outcome of the upcoming elections.

I'm just plain torn, but as much as I yearn for legitimate health coverage, I don't see this bill as providing something that is going to benefit me. Believe me, I want to be proven wrong if the bill passes and millions of people really do get GOOD healthcare out of it and it's TRULY affordable.

[laughingliberal]

29. Excellent explanation!

And I'm right there with you! I'm torn and hope really, really hard that the bill will wind up doing more good than harm. I spend a lot of time trying to decide to just be happy with it but the problems I see keep nagging at me. I see a juggernaut of downward pressure heading straight for the working and middle classes that will, largely, negate the positive effects of the bill.

I would benefit (to some extent) from passage of the bill as we are living on very little income right now and would qualify for Medicaid. Whether or not that would grant me access to health care is questionable for the reasons I discussed in the OP but it would give me a chance at access I don't have now. So, being selfish, for me, would be to push for passage and decide all those people who still have jobs and all can bite me. So, I don't think my stand is selfish so much as taking a long view of the bill. I hope I am wrong and when it passes (cause I do think it will) we find all sorts of help for people that is not apparent from my reading of it at present. I'm very nervous about the idea we will pass it now and push to fix it as time goes on. There was a day in America that would have been sensible. With the climate I see in DC now, it is not hopeful we will see any changes down the road except the wrong kind of changes.

[tpsbmam]

132. Thanks. I suspect there will be many like me and many in other situations

who are really negatively impacted. I hope all speak out.......loudly!

[eridani]

39. This is exactly what happens to people in your situation in MA

Not that the majority who will never be expensively sick give a shit.

[tpsbmam]

128. I'm less than thrilled to have my fears confirmed. I'm a pretty good

hell raiser and will do so if that happens to me, not that it will necessarily do any good. I've already sent bills to two of my representatives, Heath Shuler & Richard Burr. I have massive hospital/ambulance/hospital physician bills and Burr has completely opposed healthcare reform of any kind while Shuler has thrown wrench after wrench in the process by opposing the public option & his religious, C-Street anti-choice crap (including supporting Stupak). So I sent them bills with a letter explaining that they have substantially contributed to my situation and, since they don't think I'm deserving of the same healthcare that I pay for FOR THEM, they should be responsible for the medical bills accumulated by their constituent at their behest.

[waiting for hope]

25. K&R -

Nicely done and :thumbsup: for telling it like it is. There is a delusion out there that this is going to help people, I fear the harm will outweigh any good.

[Tashca]

26. A must read..

and an excellent analysis!!!

K&R

[asdjrocky]

27. Very good work.

K&R!

[WillyT]

28. HUGE K & R !!!

:yourock:

:hi:

:kick:

[upi402]

30. i'll be forced to buy in, and not qualify for subsidy

and wont vote for the perps again

[Hissyspit]

32. kick nt

[unapatriciated]

33. k&r

[SandWalker1984]

34. Excellent post. Mandatory insurance does not = health care.

I've been screaming about this for months now.

Consider the following: Anthem Blue Cross (yes, the company wanting 39% increases in premiums) brags that a woman can still get a private insurance policy for only $156 a month. That may sound good to some until they consider this policy has a $1500 deductible, and then only pays for 30% of most medical procedures and tests, makes the woman pay up to $500 a day for a hospital room, and doesn't cover pregnancy or delivery costs at all. How good a policy is that? THIS is your future health insurance policy under the Senate bill. A promise of insurance for all but no limits on how bad that coverage can be.

Of course, my spouse and I will probably not be able to afford the insurance since we are over 50 and can be charged 3 times as much. So we will be forced to pay fines and still not have health insurance. Still worry that any medical event can wipe out our entire life savings.

I cannot for the life of me figure out why so many on DU keep saying this bill is better than nothing.

We fought long and hard to put Democrats back in power in Washington and I DID NOT FIGHT THAT BATTLE SO THEY CAN GIVE ME BETTER THAN NOTHING FOR HEALTH CARE REFORM.

Screw them!

[Echo In Light]

179. +1

[ProSense]

35. This isn't accurate

The downward pressure on the working and middle classes here can not be overlooked: You have to consider the couples spoken of in # 1 & 2 above. Let's assume this couple is in their 50's and their income is just below the 400% of FPL level. Let's say they are making $50,000 per year. They are not rich but they're making it. They bought their home here a while back so their mortgage is $900 per month-below the 25% of income guideline. They have to commute for work cause housing near the job is out of reach. They have one car note and another paid for car. Let's assume they are one of the rare couples in the country who managed to get to this age without taking on debt after stagnant/declining wages over the past 30 years. So, they qualify for a subisidy which limits their part of the premium payments to $5000 per year, a little over $415 per month. Well, that's doable. The 2nd car is getting a little long in the tooth and they had hoped for a newer one but they'll keep this one going as best they can and get a policy cause they are at an age where it's smart to do so. They'll figure something out, eventually. Well, they are stuck right where they are. Because if their income goes up just 5% they are outside the guideline for the subsidy. Now, their premium is $14,400 per year or $1200 per month. Where will they find that extra $785 per month? Hell, they couldn't find the extra $300 for a newer car. Their income increase of $166 per month will decrease their disposable income by more than $600 per month. Two choices here: 1) they do without the coverage and hope they don't get sick, or, 2) they suck it up, and one of them (let's say the wife) gets a part time job to pay for the coverage and buy the newer car. Their lives are not as good. They have less time together but they have the insurance and the newer car. Then, the wife is diagnosed with a very aggressive breast cancer and must start treatments immediately. She has to quit the part time job. In addition their policy has a $2000 deductible and a $5000 out of pocket cap for the year. They can no longer afford the premium, anyway. If, by some miracle, they manage to keep making the premium so she can get treatment, they are still at risk of going bankrupt over their part of the expenses. And, even if they remain healthy, these people are not, without some miracle, ever going to be financially in the same place they were before their income went up $166 per month.

Premiums are capped at 8 percent of income.

[laughingliberal]

36. It's totally accurate

Premiums are not capped at all. Some people will have a subsidy to keep the amount they pay for the premium at a certain percentage of their income . The subsidies apply to people who make up to 400% of FPL. It starts out with those who are at lower incomes having a subsidy to keep the amount they pay at around 3% and continues up to 400% where people will pay 9.8%. Once you make over that amount, you are responsible for the entire premium. Those who do not get a subsidy and whose premium would be over 17% of their income will be able to get a waiver so they will not be fined if they don't buy health insurance but they won't have coverage. That is exactly what was laid out in my post-the problems faced by those whose income increases slightly and no longer have a subsidy to help with their premiums. It is the exact problem people on Medicaid face, now. When their income goes up slightly, they no longer qualify for Medicaid and their increase doesn't cover the health care they lose.

You thought premiums were capped? No wonder you've been promoting this bill!

:rofl:

[ProSense]

40. No it isn't.

If your plan exceeds 8 percent of your income you're exempt from the mandate. Those are the premiums, and do not reflect the employer portion.

[laughingliberal]

45. Perhaps this will help

A Linky!!11!!

Here is the result I got from the calculator based on the Senate bill by typing in a single adult, 50 years old, at 350% of the FPL without employer coverage available:

Actual annual plan premium: $5,428
(age factor = 1.55)
Cap on premium as % of income: 9.8%
Person/family premium payment: $3,715
% of total premium paid by person/family: 68%
Person/family payment as % of income: 9.8%
Government subsidy: $1,713


Here is the message I got when indicating employer coverage is available:

Note: In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.8% of income for the employer-provided coverage.

Here is the result when that same person is entered as having income at 450% of income:

Cap on premium as % of income: None

Person/family premium payment: $5,428
% of total premium paid by person/family:100%
Person/family payment as % of income: 11.1%
Government subsidy: $0

[ProSense]

49. Maybe this will help

linky

[JDPriestly]

170. Poverty guidelines.

The 2009 Poverty Guidelines for the
48 Contiguous States and the District of Columbia
Persons in family Poverty guideline
1 $10,830
2 14,570
3 18,310
4 22,050
5 25,790
6 29,530
7 33,270
8 37,010
For families with more than 8 persons, add $3,740 for each additional person.
. . . .

SOURCE: Federal Register, Vol. 74, No. 14, January 23, 2009, pp. 4199–4201

http://aspe.hhs.gov/poverty/09fedreg.shtml

You have to have less than a thousand dollars a month to be below the poverty level.

[girl gone mad]

113. that's entirely different than premiums being capped at 8%...

which is what you claimed in the previous post.

[ProSense]

41. Here:

You pay for insurance, or you pay a penalty (assuming that the monthly premiums would not be more than 8 percent of your monthly income, in which case you're exempt from the mandate). Affordability is dependent on getting the distribution of the subsidies right, which is no easy task.

link

[laughingliberal]

50. Shocking! You link to an article that does not address the question

Perhaps this will help:

A Link to Clarify for Those You Attempt to Mislead


Exemptions for those who do not qualify for a subsidy are for those whose premiums will be over 17% of their income. Above that they can be exempted but they won't have coverage. People at 400% of FPL will be limited to paying 9.85 of their income. The subsidy will pay the difference, if any.

[ProSense]

52. You really don't understand what you're reading. n/t

[laughingliberal]

55. Somebody doesn't understand what they are reading

but it isn't me. I think people can use the calculator provided and see for themselves that premiums are not capped at 8%. Perhaps for those whose income dictate it but not for those outside that income level.

:rofl:

[ProSense]

59. OK, let me break it down for you using your example

based on someone making $50,000 a year whose income goes up 5 percent.

You claim: "Now, their premium is $14,400 per year or $1200 per month."

That's nearly 29 percent of their income or 14.4 percent if you're referring to $50,000 each.

Now, go back to the calculator and click the link at "Click here for tables showing results by income and age" below the recalculate button.

[laughingliberal]

71. The cap on premium as percent of income is -0-. I already showed that there is no cap on premiums as

a percentage of income for any figure entered that is above 400% of the federal poverty level. The premium I used in my example is based on the premium my husband and I payed until we lost our coverage 3 years ago. It was 25% of our income at that time as our income was $60,000. We had to continue my COBRA as my husband had just been diagnosed with cancer. The 50,000 figure I used should have been 56,000 and that was an oversight on my part as the $56,000 figure is where a 5% increase would put the couple over the 400% of FPL. I plead an oversight on that. Nevertheless, the premium we paid 3 years ago and the income we had at that time constituted 25% of our income and would not, under the Senate bill, qualify us for a subsidy. What that means is we would be exempt from the mandate which will exempt those who do not qualify for a subsidy if the premium is over 17% of their income. The point, here, is the premium is unaffordable and the exemption simply means they won't be fined for not purchasing insurance but they will not have coverage.

edited to insert space between 2 words.

[ProSense]

96. No you haven't. Misread:

You are basing your comments on this:

Note: In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.8% of income for the employer-provided coverage.

Which is actually a max based on a family plan. If you scroll down, it's explained:

For income up to: 400% of poverty
Maximum family payment of: 9.8% of income

It has nothing to do with the 8 percent limit for exemption on an individual income.

And even so, people will still be able to buy as much insurance as they want to.

[laughingliberal]

103. I don't know who you are arguing with or what you are arguing

There is no cap on premiums, whatsoever, for those whose incomes exceed 400% of the Federal Poverty Level. The only restriction on premiums is the community ratings which will allow a multiplier of 3x for age meaning those between 50 and 64 will very likely see the same premiums they do now.

If they are above 400% of Federal Poverty Guidelines they will get no subsidy to offset the cost of the premium. If their premium exceeds 17% of their income, they will be able to get an exemption so they would not be fined if they don't buy insurance. I don't see anything confusing about that. People above 400% of Federal Poverty guidelines who are older will pay a high premium or they will be exempted if they can't afford it. They pay through the nose or they go without coverage.


On edit: to clarify-I am speaking of people who do not have employer sponsored health care and are purchasing it out of pocket and who are at higher than 400% of FPL.

[ProSense]

112. "to clarify-I am speaking of people who do not have employer sponsored health care "

So when you said: "Let's say they are making $50,000 per year," you were talking about people in the individual market?

Are they small businesss owners? Self employed?


Accept this: Those who get insurance through their employer will not be forced to buy coverage if it exceeds 8 percent of their income.

They are then eligible for a voucher to purchase insurance on the exchange.

Premiums will go down for the vast majority of Americans given the subsidy structure.

[laughingliberal]

116. It does not matter, self employed or working for a small business that does not provide benefits

They will be purchasing it in the open market. I think it's important to address those people as they are a large group of the uninsured now who we say we are trying to help-people with jobs who don't have insurance.

People who get insurance through their jobs are not the main focus of this bill. The main focus was to help those nearly 50 million who have no coverage.

I never argued that anyone with employer sponsored health care would be paying more than 8%. I believe they are, largely, the people who made up that 80% we hear about who are 'satisfied with their health care.' I'm wondering why you have argued about the cap on those with employer sponsored health care when I never brought that up at all. I'm wondering if it is intended to confuse the two groups-those with employer sponsored benefits and those without. Perhaps it was meant to distract from the information I provided for those not fortunate enough to have employer sponsored health care?

Premiums will not be going down for those who make more than 400% of the federal poverty level. If you look at it, that is a lot of what my post is addressing-those who will be buying their own insurance and who are above or just below the level for a subsidy.

Some people may see their part of the premium go down with the subsidy. I don't recall saying anything at all about that. I did say the amounts the insurance companies are charging, right now, will not be lowered. Some people who are paying out of pocket now and who are at lower income levels may very well see a decrease in the portion for which they are responsible. Young people now purchasing their own insurance could see an increase as the insurance companies are limited to the multiplier in order to charge for age. This means it is highly doubtful there will be any more $100 per month premiums as some younger people enjoy now as that would limit the insurance companies to charging older people $300 per month and we all know that won't happen.

[girl gone mad]

114. Prosense, I just have to ask..

is English a 3rd or 4th language for you?

There are so many times where people just don't seem to be able to communicate with you. Maybe it would help if we could translate into another language so that you can understand what is being said.

[tekisui]

158. Their first language is Talking Point-ese

It doesn't easily translate to reality.

[inna]

90. LOL, oh the irony! That was a classical case of projection on your part, dear.

I hate to tell you this, but you appear to be completely confused and misinformed on this. FYI, your graph and links had absolutely no connection to your absurd claim that premiums were capped at 8% - in fact, they demonstrated that you were completely wrong.

Just so you know, premiums are capped as a % of income only for those under 400% of FPL (which equaled $43,320 for a single individual in 2009). Under the Senate plan, an individual at 300-400% FPL will have the premiums capped at 9.8% of annual income.
Any individual making above $43,320 is ineligible for subsidies and will have no cap on premiums.

In the example illustrated in the graph that you so conveniently provided, a 60 year-old individual at 500% FPL (i.e., $54,150 annual income in 2009) will pay $7,911 in premiums (which amounts to 14.6% of their annual income). And that is just the premiums, and they're lucky to live in a medium-cost area.


To provide an illustration for a 64 year-old at 401% FPL in a high-cost area:

Note: based on 2009 income and FPL (Federal Poverty Levels): 401% FPL = $43,428 (single individual) or $88,421 (family of 4)

A 64 y.o. single individual at 401% FPL ($43,428 annual income)
will pay $9,494 (which is 21.9% of their entire income) just in premiums,
before any out-of pocket expenses, deductibles and copays. None of it is subsidized.


Even worse, for a family of 4 at 401% FPL ($88,421 annual income),
premiums will be $25,591 (that is, 28.9% of their entire income).

[laughingliberal]

139. Excellent! nt

[Lydia Leftcoast]

61. Yeah, but what's the deductible?

For people over 50, the combination of triple premiums and deductibles may be entirely unsustainable.

[ProSense]

65. Out of pocket expences are also capped.

Insurance reform is going to make a huge difference in limiting deductibles. People who enjoy federal health benefits can certainly attest to that.

[Lydia Leftcoast]

67. You mean with one of those policies that covers only 60% of expenses?

And whose idea of "affordable" is being used?

And why have deductibles in the first place? No other country that I know of does (although some have copays).

Rah, rah, U.S.A., where the corporations retain their right to screw their customers, even under so-called "reform."

Aren't we special?

[ProSense]

69. You're right

this is the U.S. and the health system sucks. Guess what's not going to make it less sucky?



Wishing. There's a choice: keep the system that sucks or try to improve it. This bill improves it.

[Lydia Leftcoast]

73. Ah, but there's where we differ!

How is being forced to buy overpriced private insurance (even with a subsidy, i.e. corporate welfare) an improvement?

My total costs would go UP under this bill, and I'm struggling as it is.

I am furious at the Democrats for pretending to care about real people. If they REALLY CARED, they would tell the insurance companies to go to hell and accept the 5% MLR that they thrived on in the 1990a. They would ban deductibles. They would institute a public option open to all Americans.

With a Dem in the White House and whopping majorities in both Houses of Congress, they could have told the insurance companies and the Republicans and the for-profit hospitals to go to hell, drafted a health care bill consisting entirely of a public option and a nationwide network of health clinics, and people would have loved them.

I've talked to people about this bill. The way the Dems talk, most people THINK they're getting Canadian-style health care out of this bill. Yes, they're uniformed, but that's what they think.

They are going to be pissed when they find out that they're required to buy overpriced health insurance whether they can afford it or not. That's what this bill will mean for most people, especially those over 50.

[ProSense]

78. You are not forced.

If the plan goes above 8 percent of your income you are exempt. Currently if someone makes 50,000, that person could be paying up to 18 percent of his/her income. If your premium goes over $4,000, you would be exempt.

[Lydia Leftcoast]

87. So then such a person becomes uninsured anyway

And who is going to keep track for those of us whose income fluctuates markedly from year to year?

I see a huge bureaucracy brewing.

This whole complex non-system being proposed reminds me of the way medieval astronomers devised incredibly convoluted and ad hoc mathematical formulas to describe the apparent motion of celestial objects, because they believed that the earth was the center of the universe.

Just one change--positioning the earth as just another celestial body that orbits the sun--suddenly simplified the math required to describe the apparent motion of objects in the sky.

That's how I feel about these bills. They're incredibly complicated because we're ignoring (deliberately ignoring from the looks of it) the simplest option.

[ProSense]

91. No. Solution:

Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

more

[Raineyb]

129. Exempt. As in NOT covered? Isn't the point of reforming the system to make sure

people ARE covered. So by your own admission this bill Will not cover everybody.

Why the hell should anyone who cares about getting all Americans covered vote for this bill when it won't do what it's claimed to do.

[Lorien]

74. This bill only improves the profit share of the insurance companies

and you damn well know it. You can cut and paste as many misleading articles as you please, but that won't change the facts. We'll be forced to buy a product from a for-profit company that comes with SKY HIGH UNAFFORDABLE PREMIUMS, and DOES NOT GUARANTEE THAT CLAIMS WILL ACTUALLY BE PAID. This is not an "improvement"; it's flat out extortion.

[ProSense]

92. What about the people who participate in the non-profit plan?

Shouting angry bullshit doesn't change the facts.

[liberation]

155. ... and telling people to believe you and not their lying eyes is not the best way to conduct

and honest debate.


You are trying to make a case for a lubed stick is better than a dry stick when stuck firmly up one's rectum. That may very well be, but the thing is that most people simply don't care about having sticks stuck up there to begin with. Now carry on with all the hand waving and attempt at justifying a bill which just plain sucks and is a very moderate slight and timid change, not a "reform." If some of the DLC people are having trouble with the definition of the term "reform" I am sure we can chip in and send some dictionaries to their headquarters (there are also some very convenient and freely available dictionaries on line).


In the end, we're being told by the same people who were crooning about hope and change during the election, that those expecting actual change are being "unrealistic." So was it all just an electoral slogan and nothing more? Change is now being passed as "it is what it is" and "yes we can" is basically "well... what can you do? it's unrealistic." If that is the case, I would have appreciated being told that from the get go. I could have saved all the energy and time I dedicated campaigning for the Dems during the election... towards more worthwile purposes. Like working more over time, to get a nice rainy day fund if I were ever to have some serious health condition. Because some people pushing for this reform seem to operate under the impression that people do not have health care coverage out of personal choice...

[laughingliberal]

165. " ...a lube stick is better than a dry stick..."

Very good analogy and too accurate for comfort.

[laughingliberal]

107. The deductibles on typical policies are $2000

The maximum annual out of pocket is $5000 for an individual and $11,900 for a family.

[Lydia Leftcoast]

127. Hello bankruptcy

still.

What kind of out-of-touch millionaire Congresscritter thinks that $5000 is going to be affordable for everyone?

[inna]

102. Fail.

Please use more coherent links next time. This is so poorly and loosely worded, no wonder you got confused and misinterpreted that as "the premiums being capped at 8%". :rofl:


Come on, admit it, you were wrong:

Premiums are capped at 8 percent of income.

Are you ready to retract that now? }(


BTW, what Ezra was referring to was the so-called "hardship exemption" from the individual mandate to have coverage, for those who "choose" to remain uninsured. It exempts those who would face premiums of more than 8 percent of their income from having to pay a penalty for not buying insurance. If the lowest cost (i.e., "bronze") plan option exceeds 8% of an individual’s income, they are exempted from individual mandate - i.e., they are not required to buy insurance and are exempted from the penalty.

In no way, shape or form did it have anything to do with "premiums being capped at 8%" as you thought it did, hopefully you figured that out by now. :shrug:

[eridani]

37. But you didn't cite Krugman!! You didn't cite any expert at all!

Geez, what are we supposed to do here, just evaluate arguments that you think up all by yourself? What is this discussion board coming to!?!?!?

[jannyk]

38. Kick & Rec. Brilliant!!

[Beetwasher]

42. This Certainly Is A Very Long Post, If Very Inaccurate (My Substantive Response Included, SUPRISE!)

First let me say, since it seems like you spent a lot of time typing this thing, I will treat this as if you're sincere in your criticisms. But since you didn't back up a single thing with anything except your personal opinion and interpretation of the legislation, don't go asking ME for links and back up until YOU provide it first.

I will also try to be respectful, but I AM an asshole, so while I'll try, I can't guarantee I won't be an asshole.

That being said, here's the actual bill and the analysis of the bill for reference, since you neglected to provide it, so consider me one step ahead of you in backing up my assertions, since everything I reference is in there.

Analysis:

http://dpc.senate.gov/healthreformbill/healthbill49.pdf

Full Bill:

http://thomas.loc.gov/cgi-bin/query/D?c111:1:./temp/~c111Qg1fW6::

Now, on to the substance of your voluminous post:

1) 30 million more people will have access to health care.
2) People will no longer be forced into medical bankruptcies

Sec. 2707. Comprehensive health insurance coverage. Requires health insurance issuers in the small group and individual markets to include coverage which incorporates defined essential benefits, provides a specified actuarial value, and requires all health plans to comply with limitations on allowable cost-sharing.

You have some valid points. However, what you fail to take into account is that even if ONE person actually receives health care and is prevented from bankruptcy, then this will be an improvement over the current system. It's not perfect. No one is claiming it is. But it will make progress. The examples you cite are just that, examples that you made up without any backup, and for every example you give of someone who MIGHT not get coverage or MIGHT not be able to afford it, there will be countless others who WILL get health care or who WILL get subsidies or who WILL get medicare NOW who weren't able to before. There will be countless numbers of people with pre-existing conditions who want to pay for insurance but are not allowed to. There premiums will now be the same as everyone elses, regardless of their health status and it will be ILLEGAL for any insurance company to refuse or drope the. If this bill saves ONE LIFE, that will be ONE LIFE SAVED that would not have been saved if nothing is done. If this bill save ONE person from going bankrupt because of a catastrophic illness or accident, that's one more helped that would not have been helped if nothing is done. And please, don't even try to tell me that no one will be helped. That's bullshit and you know it.

"This bill will not stop medical bankruptcies."

Yes it will. There will be MANDATORY MINIMUM COVERAGES. That's a fact. Read the bill (or the analysis).

Sec. 1302. Essential health benefits requirements. Defines an essential health benefits package that covers essential health benefits, limits cost-sharing, and has a specified actuarial value (pays for a specified percentage of costs), as follows:
5
1. For the individual and small group markets, requires the Secretary to define essential health benefits, which must be equal in scope to the benefits of a typical employer plan.
2. For all plans in all markets, prohibits out-of-pocket limits that are greater than the limits for Health Savings Accounts. For the small group market, prohibits deductibles that are greater than $2,000 for individuals and $4,000 for families. Indexes the limits and deductible amounts by the percentage increase in average per capita premiums.
3. For the individual and small group markets, requires one of the following levels of coverage, under which the plan pays for the specified percentage of costs:
Bronze: 60 percent
Silver: 70 percent
Gold: 80 percent
Platinum: 90 percent
In the individual market, a catastrophic plan may be offered to individuals who are under the age of 30 or who are exempt from the individual responsibility requirement because coverage is unaffordable to them or they have a hardship. A catastrophic plan must cover essential health benefits and at least 3 primary care visits, but must require cost-sharing up to the HSA out-of-pocket limits. Also, if an insurer offers a qualified health plan, it must offer a child-only plan at the same level of coverage.

3) This bill will stop denials for preexisting conditions

Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status. No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past.

It will. The "loophole" you cite is bullshit.

"..as soon as the insurance company decides they are tired of paying out for them, they will search their medical files and history, find a condition they neglected to mention on their application, and call it fraud and cancel their policy."

It's perfectly reasonable to allow a policy to be cancelled if you commit fraud. This is pretty standard. And what you leave out is the new FEDERAL REGULATION AND ENFORCEMENT that are now available for redress should an insurance co. continue to drop people for fraud when they have not committed fraud.

Up until now, only state regulations have applied, and the problem is, not all states have the same standards or the same level of enforcement. So what ended up happening was states with lax enforcement would have shit-stain insurance co's abusing the fraud standards, while states with good enforcement would not have as many problems in this area. Take NY, our kick ass AG would routinely fuck up ins. co's that tried to pull this shit, so it was much less common. Now, there will be UNIFORM FEDERAL Guidlines and avenues of redress should you be dropped from your insurance for so-called fraud.

Will the shitbag insurance co's still TRY to do this? Yes, they will. There is NOTHING that would totally stop them from TRYING, just as there is NOTHING that will stop people from STILL attempting to murder other people even though murder is illegal.

You realize of course, by your reasoning, killing someone in the name of self-defense is a loophole in the laws prohibiting murder. People will try to get away with murder by claiming self defense even though it's bullshit. It doesn't mean we shouldn't pass laws against murder or still allow the clause for self defense. It's reasonable to allow you to kill someone in self defense, just as it's reasonable to allow an insurance company to cancel your policy if you tell them you were injured in an accident when you weren't. And I'm not saying this is necessarily a big problem in insurance, but it exists and it's stupid to allow people to keep their policies if they are committing fraud.

The issue is enforcement, not the legislation. You can argue you don't think it will be enforced properly and that's fine and valid, but that's still not a reason to NOT TRY to regulate. By that logic we shouldn't have laws against murder because some people still get away with it, and some places have shitty law enforcement that allow people to get away with it.

4)This bill will end rescissions and you will be covered as long as you paid your premiums

See above. It does.

5) This bill will stop insurance companies from imposing annual or lifetime limits

"Half true. It will not allow lifetime caps but they weaseled in a loophole for annual caps"

I half agree with your statement. Annual caps are WAAAY better than lifetime caps, but this certainly can be improved upon, but it's still WAAAY better than status quo.

6) This will expand Medicaid coverage for the poor

You agree this is true, then you go into a long diatribe making up examples for which you have not a single shred of evidence. It's all YOUR personal supposition. For every example you make up about someone possibly getting fucked, I could make one up about someone being helped. What's to refute?

"The employer mandate: The bill will not require employers to provide coverage but will fine them if they don't provide it and an employee qualifies for and gets a subsidy to buy from the exchange. Look for single mothers in lower paid occupations (a mother with one child will qualify for a subsidy if she makes up to $58,800 per year) to have a hell of a time getting hired."

Sorry, this is a load of crap and if they do this they are in violation of federal law. Will some places try and get away with this? Probably. There are laws against murder and yet people still try to get away with it. Doesn't mean we shouldn't pass laws against murder?

The bottom line comes down to this; the legislation is far from perfect. There are still going to be abuses of the system, but it establishes a nascent framework of Federal Legislation and enforcment that didn't exist before. Scumbags will try to game the system, thus it ever was and thus will it ever be for everything and anything, but that doesn't mean we shouldn't attempt to improve the system. It will need to be enforced properly and improved upon, just like every other major legislation that came before it. But if ONE person is helped, if ONE life is saved, if ONE person with a pre-existing condition gets the health care they need, then it's worth it. You will NOT be forced to buy insurance from an evil corporation. You can opt for a non-profit on the exchange or you can choose to pay the tax. But everyone needs to be in the system for it to work properly, and that's true for every health care system the world over that has any semblance of efficacy. And if you are so selfish as to be healthy, young but disgruntled at having to possibly pay a small tax so that sick people can get the care they need? Well, sorry, that's the height of selfishness and anathema to every possible progressive value that's been instilled in me.

I will not be responding to the myriad of attacks that I'm sure are forthcoming as I just don't have gumption or time to deal with them. I'll just say that as far as I'm concerned, and as far as pretty much all the relevant experts are concerned (yeah, I'm appealing to authority, sue me), including our progressive heroes (with very, very few exceptions) in the Senate and the House and elsewhere, this is a significant step in the right direction. I'll take their word for it over a bunch of loud, anonymous posters on DU any day.

Rejoice! Relief is coming! :loveya:

[laughingliberal]

53. Your opinion is duly noted

but you do not address the issues raised in my post. You certainly may and, obviously do, consider the problems created to be worth it. But I see no reason why people should not know what is coming.

And it isn't all going to be relief.

[Beetwasher]

54. I Addressed Every Issue In Your Post

And I did with the minimum of snark that my nature allows. And holy shit was that hard. :evilgrin:

[laughingliberal]

57. and the readers are welcome to read your rebuttal and form their own opinion. nt

[Beetwasher]

58. Indeed! Good Thing I Posted Links To The Actual Legislation For Them To Reference

Since you neglected to do so.

[laughingliberal]

60. Yes, thank you for that. I have encouraged people for some time to read the bill and form their own

opinions.

Just to address one point here. You wrote:

6) This will expand Medicaid coverage for the poor

You agree this is true, then you go into a long diatribe making up examples for which you have not a single shred of evidence. It's all YOUR personal supposition. For every example you make up about someone possibly getting fucked, I could make one up about someone being helped. What's to refute?

My evidence for this is years of working as an RN with patients who were dependent on Medicaid for their health care. The points I made about many areas having no providers who accept Medicaid are perfectly valid. I have encountered this issue in trying to obtain care for my patients in 4 different states where I have held licenses and practiced. I presented a balanced view of the Medicaid expansion and of the bill, overall. I have not called for defeat of the bill unless it is the Senate bill with no changes, whatsoever. But, I do think it's important for people to see some unintended consequences of which they may not have thought. You readily admit the bill is not perfect. Is there something wrong with continuing to petition and pressure our lawmakers about improvements we would like to see before they pass it? Would that not be a better use of time than flaming those with whom you disagree? I readily acknowledged some good the bill will do. I do think people need to know the cost/benefit ratio and I presented the information whereby they could evaluate that in light of their values, health status, income levels, and family situations.

[Beetwasher]

63. Fair Enough, But You May Not Be The Only Person With Relevant Experience In The Field Of Health Care

Discussing the subject. Some people may even have some experience in the financial and regulatory end of the industry. Keep that in mind.

For all you know I might be one of those people. Perhaps I work for a non-profit hospital system and deal with finance, revenue, cash flow, compliance and regulatory issues on a daily basis and know quite a bit about the subject. It may even be a part of my job to know the details of this legislation inside in out in order to position this non-profit hospital system to best deal with the forthcoming changes and efficiently implement system changes that may be required to better serve our clientele. Perhaps a large portion of that clientele happen to be those most in need of reform and access to coverage and care.

Or maybe I'm the Queen of England.

One never knows, do one?

[laughingliberal]

82. And I don't think I claimed to be

I am someone who would qualify for Medicaid under the expansion. And I live in an area where there are few, if any, providers who take Medicaid. Having Medicaid would certainly help me if I needed emergency care at a hospital but I doubt I will find a doctor here who would see me. At least, I was not able to find any PCP's in this area to see any of my adult patients. It does not matter, really. I have no health care now.

Perhaps you do work for a non-profit hospital corporation and this bill would certainly benefit hospitals both non-profit and for profit as there would be fewer patients with no pay source. There is some benefit to that. I do know, however, that the hospital industry is opposed to a public option, especially one that is tied to Medicare rates. That is one group who would, definitely, not benefit from the public option and is the exact reason Kent Conrad would not support a public option in the Senate bill.

I'm not sure why the resistance to what I am saying is so strident. I have never said no one would be helped by the bill but I still believe most will be affected by the bill one way or another and they have the right to know how it will affect them and determine, for themselves, how much benefit they see for what impact on their lives. I happen to believe the working and middle classes will be adversely affected in ways they are not aware of. I have no dog in the fight. I am among the poor, now and the bill will do no harm to me.

And I still think people can and should be contacting their legislators to push for more improvement and there is no reason to stop that until the bill is passed and signed. And even then we need to push for improvement.

[Beetwasher]

85. The Stridency And Passion (At Least On My Part) Is Due To The Misrepresentations

This bill will, without a doubt, be a net positive and an improvement on status quo. According to some, it is a steaming pile of shit with no redeeming qualities. I have issues with that characterization.

[laughingliberal]

93. I believe people can decide for themselves in what ways they believe the bill will benefit (or not)

them and others. I have not characterized the bill as a steaming pile of shit with no redeeming qualities. But the bill does a lot of things I would rather it did not and I think it is my right and the right of everyone to keep letting our lawmakers know the changes we want to see now AND after passage of the bill.

There are many defenders of the bill here who are fond of saying the bill isn't perfect but...

It isn't and no bill would be but there is nothing wrong with citizens of an allegedly free country working to see more of what they want and less of what they don't want passed by their elected representatives.

A lot of what I see here appears to be an attempt to shut down any criticism of the bill. It may pass as is and they may not make one damned change to it. But that doesn't mean I quit lobbying my representatives about it. I'm pretty sure the hospital and insurance lobbies are still in there pushing for more of their agenda. And, although we don't have their money and power, we can still pester the representatives. And we should.

[saracat]

94. And some of us have issues with mis-characterizations as to the alleged benefits of the plan.

I, too have looked at the Senate bill and like the couple used to illustrate the problems with this Bill in the OP, I also , for somewhat different reasons, would not benefit.There is also no member of my family who would benefit in any way.They would not be better off but they would actually be worse off as the result of the mandate.There are no price controls and nothing in the Bill indicates prescription prices will be controlled in any way.We will have many people for various reasons still having to pay for coverage and still being unable to get treatment or afford medicine. The deal was made with Big Pharma to ensure that aspect.
We should be screaming about all these poison pill provisions and demand they be removed before this is passed.

[laughingliberal]

110. Your post points out one of the most disappointing parts of this whole process

Never, in my wildest dreams, did I ever consider a Democratic President and Congress would let that Medicare part D stand without changing it to allow Medicare to negotiate rates for prescription drugs. If that wasn't the most obvious of all places to start looking for cost cutting measures, I don't know what was.

[grantcart]

108. And I thought Cliffordu was the Queen

[Lydia Leftcoast]

62. Oh, whoopdee-doo!

People have the "opportunity" to buy insurance policies that pay for A WHOLE 60% of their medical expenses. And if they're over 50, that may be all they can afford, especially if they're close to 400% of poverty.

That'll be a HUGE help if they need open heart surgery. :sarcasm:

This reminds me of what United Airlines does when it downgrades or eliminates a service. It issues cheery notices about how passengers will now enjoy the "enhancement" of not having to bother with the whole can when they order a soft drink. Stuff like that.

[Beetwasher]

66. And If Reform DOESN'T Pass They Will Be Better Of Exactly HOW?

They won't. They will simply be dead with no chance at all. But apparently that doesn't bother you in the least, huh?

[Lydia Leftcoast]

68. Well, since it's four years before the exchanges and mandate even go into effect,

your sense of urgency is puzzling.

For the time being, what we have is a ban on denial for preexisting conditions, but no requirement to make coverage affordable.

What is the urgency, "Let's pass this turkey before more people figure out what's in it"?

Looking at the responses to Krugman's column in today's NY Times, it seems that most of the people advocating passage of the bill THINK they'd get universal access to health care.

[Beetwasher]

70. Umm, People With Pre-Existing Conditions Will Be Covered Immediately

And there are a whole shitload of items to make coverage affordable.

[Lydia Leftcoast]

75. Affordable by whose standards?

The insurance companies are still allowed to charge people with preexisting conditions 3 times as much as others, which is unconscionable. The purpose of government is to ensure the welfare of the citizens, not the profitability of vulture-like companies.

[Beetwasher]

77. That's Bullshit, Source It

"The insurance companies are still allowed to charge people with preexisting conditions 3 times as much as others,"

Blatant lie. Source it.

[Lydia Leftcoast]

79. What is the truth, then?

Are insurance companies required to cover a 30-year-old with Type 1 diabetes for exactly the same premiums as a 30-year-old who hardly ever gets sick? If they aren't, they won't.

[Name removed]

81. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Lydia Leftcoast]

83. What's the exact language in the bill?

:shrug:

[Beetwasher]

86. Read It

I posted it once and I'm not going to do it again. If you are sincere in your quest for information, you will read the bill for yourself. Your requests for me to spoon feed you are repulsive to me.

[Lydia Leftcoast]

101. But I distinctly remember discussions of higher rates for preexisting conditions

someone telling me that no, the 3x multiplier was for either age or preexisting conditions.

[truedelphi]

175. You really should read it. Once you do, you'll totally

Understand how screwed we are.

Public option has (should it remain in the final bill) a 2 billion dollar government operational limit. Considering how much money is spent by Americans in a given year on HC, 2 billion is not much.

And much of it requires that you understand what they are talking about. If Section 14A is detailing how subsection of Some Former Bill Article 916 Part D will need reversed consideration, or other such legal gibberish (Which probably only the person who drafted article 916 Part D would ever know or understand) you can imagine how your brain will feel after consuming 2,300 pages of such stuff.

[laughingliberal]

88. I could just as easily post a link to the bill but it was widely reported that one of the big

differences between the House bill and the Senate bill is the community ratings model. The House bill allows a multiplier of 2x for age and the Senate bill allows a multiplier of 3x for age. That was an improvement in the Senate bill over the version which passed out of the Finance committee which had it higher than that.

It is one of the things the House was negotiating about-to have their community ratings model restored. This was part of the negotiations President Obama was involved in when Brown was elected in MA which stopped the process. I'm hoping it is one of the things that will be addressed in the reconciliation package they are working on now. I wish we were privy to more of what they plan to have in the reconciliation amendment. Another thing the House was trying to restore was their version of the exchanges which would have been national whereas the Senate leaves them as a state by state model. The president was in support of making both these changes to the Senate bill but it now remains to be seen what will come out.

[Beetwasher]

89. Age Is Not Considered A Pre-Existing Condition

Actuarial elements in pricing are pretty standard when it comes to insurance, but there are none for those with pre-existing conditions in the legislation.

[laughingliberal]

95. Sorry, misread the discussion

No, they are not allowed to charge more for preexisting conditions. The multiplier I was quoting was age. Although, at my age, age is starting to feel like a preexisting condition. :)

[unapatriciated]

154. but no penalties when they deny coverage...and they will, just like they did in California.

When the bill includes real penalties like they do for fraudulent claims, "misrepresentation of material facts" (used often and liberally by the ins. co. in denying claims and canceling polices) and like the penalties for health care providers (pages and pages found in this bill) then and only then will we be able to control some of the abuses that the Insurance Companies have been engaging in for too long.

[Beetwasher]

168. They Will Now Be Violating Federal Law

And will be subject to federal prosecution, among other things, such as being kicked off the exchanges.

[unapatriciated]

171. damn what do you have against regulations with penalties?

[truedelphi]

174. I mean, who ever needs a whole

Heart repaired?

Sixty precent of a heart repair probably will save time and equipment and be a much more "green" operation. Fewer sutures, and fewer gloves and masks.

And if the patient ends up leaking blood, maybe that can augment someone's compost.

It is a win-win for anyone concerned about the Planet's Health, I tell ya!

[jtuck004]

80. Minimum?

Your reply to "This bill will not stop medical bankruptcies."

was

>Yes it will. There will be MANDATORY MINIMUM COVERAGES. That's a fact. Read the bill (or the analysis).your assertion >that "mandatory minimum

Mandatory minimum coverage means that one is mandated to have minimum coverage. If the expenses exceed the annual cap, are not covered procedures, or are not paid according to the terms of the insurance they they are responsible for those costs. So if that minimal coverage is all they can afford, there is a very real possibility of bankruptcy. Also, if they cannot afford the coverage, and they get sick, bankruptcy is still a very real possibility.

Sec. 1501. Requirement to maintain minimum essential coverage. Contains findings of Congress related to the individual responsibility requirement.
Sec. 5000A. Requirement to maintain minimum essential coverage. Requires individuals to maintain minimum essential coverage beginning in 2014. Failure to maintain coverage will result in a penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter. For those under the age of 18, the applicable penalty will be one-half of the amounts listed above. Exceptions to the individual responsibility requirement to maintain minimum essential coverage are made for religious objectors, individuals not lawfully present, and incarcerated individuals. Exemptions from the penalty will be made for those who cannot afford coverage, taxpayers with income under 100 percent of poverty, members of Indian tribes, those who have received a hardship waiver and those who were not covered for a period of less than three months during the year.

Your post also stated:
"But if ONE person is helped, if ONE life is saved, if ONE person with a pre-existing condition gets the health care they need, then it's worth it. "

This sounds so similar to the justification for the wars in IRAQ and IRAN that I can't help but think about the irony. If tens of thousands of people are hurt, as long as it helps someone somewhere it's ok? I guess that depends which end of the stick you are on. If tens of thousands of people wind up with fines to be collected by the IRS (167 Billion estimated by the CBO - that's a lot of people), who is this going to help? This isn't going to even phase government employees, or people who work for larger companies such as the GE's or Walmarts - but hundreds of thousands of people are self-employed or work at small businesses are going to have to make decisions. How is it going to help a couple with a 2 kids who are can barely get by today to get a $2000 invoice and a $200 voucher in the mail every month so someone, who was getting taken care of in an emergency room, is now going to be able to go to one of the not enough, or non-existant primary care physicians, just so another insurance company executive can get a larger yacht? Note: The plan is not to get 30 million people health "care" - because they do have some - the plan is to enroll 30 million people into health "insurance" (for their "Protection" - the bill says so) - which is a very different thing. As you said, however, we could each make up our own stories, but you have noticed that only 15% of the people hold most of the wealth, and that there is 30% unemployment among those who make $12,000 a year? That 50% of kids must use food stamps during their lifetime? There are a lot of people who exist on the margins or jsut above, and it is not clear what the impact of this plan is going to be when the government mandates that they must do business with a private company. http://www.nytimes.com/2009/11/29/us/29foodstamps.html

We need 15 million jobs to get back to 5% employment, yet we are wasting our time with this? Can a doc write a script for a meal or a job?

Btw - with perhaps another million to a million and a half people likely to lose their homes to foreclosure this next year, have you seen a plan for sending them their vouchers or notices of fines?

And this new "Federal Enforcement" you speak of - are these the same people who have allowed yet another huge batch of salmonella contaminated food to enter our supermarkets, and the ones who had some very entertaining hearings with Mr Toyoda a couple weeks ago, while we are still being entertained by stories of out of control Toyotas on the highway?

I don't want to attack, 'cause this is really important. But there are a number of claims in the post that just don't seem to square the reality I am seeing today. I would be all over a public plan - but I cannot support policies that feed hard working people as customers to self-serving companies that practice murder-by-spreadsheet without giving them an option. A public one.

I have noticed that there is a religious exemption, however. I belong to the Church of the Flying Spaghetti Monster, so perhaps I am safe?

http://www.venganza.org/about/open-letter/

[Beetwasher]

84. No, The Mandatory Minimum Coverages Have To With The Levels Of Coverage That Different Plans MUST

Provide. Bronze, Silver, Gold, Platinum plans are mandated to provide minimum coverages, including free preventative care among other things.

I provided the links and references in my post.

[laughingliberal]

97. Here's a link to an article which covers the actuarial value of the different levels

It is from the Baucus plan from the Senate finance committee but these are the levels in the final bill as it stands now.

Under the Baucus bill health insurers could sell policies on the Exchange to individuals and small groups (employers with under 50 participating employees) with five different levels of coverage: Platinum, Gold, Silver, Bronze, and a Catastrophic ... These five benefit categories are defined on pages 17-18 of the Chairman's Mark of the America's Healthy Future Act of 2009. For example, the Bronze Benefit Package would have to provide coverage equal to an actuarial value of 65%. Silver would have an actuarial value of 70%, Gold 80%, and Platinum 90%. In each case there could be no lifetime limits, no cost-sharing (deductibles, co-pays) for preventive care, and out-of-pocket expenses could not exceed $5,950 for an individual or $11,900 for a family <snip>

http://www.ohioverticals.com/blogs/akron_law_cafe/2009/09/health-care-financing-reform-29-coverage-requirements-and-actuarial-value-of-policies-under-the-baucus-bill/

[jtuck004]

109. Yes, I understand that, but

As I read your post, I understood it to say that you thought that mandatory minimums had something to do with stopping bankruptcies.

"This bill will not stop medical bankruptcies." Yes it will. There will be MANDATORY MINIMUM COVERAGES"

As you pointed out, those are just levels of coverage. If someone goes in for a very serious medical problem and run up a $100,000 bill, and they only have 60% (Bronze) coverage, they could roll out owing $40K. That could result in bankruptcy. Minimums are not going to alter that.

[laughingliberal]

111. Huh, I don't believe I did address the levels of coverage required by the bill

Perhaps you aren't addressing me. I argue the bill will not stop medical bankuptcies.

I will say, however, there are annual maximum out of pocket expenses: $5000 for an individual and $11,900 for a family. That's enough to bankrupt people at certain income levels, though.

[jtuck004]

117. Sorry, stuck that under the wrong name

You did say that, and I was responding to the person that said it would stop bankruptcies

But in re-reading that annual out of pocket expense paragraph, I am not sure if they are talking about out of pocket for the policy, or out of pocket total. That was my first impresson as well, but since they have 60, 70, 80% etc levels, what would be the point in getting the more expensive ones?

Take a look at the heading of that paragraph I copied, tell me what you think.

[laughingliberal]

118. Maximum out of pocket is the amount of the expenses you pay out of pocket

like your % that is not covered by insurance (40% if you have a policy which covers 60%), co-pays. Your premium is not counted towards it. It does not, however include any expenses the insurance company denies such as a treatment for which they deny coverage. You could go and pay for that out of pocket but they would not count it towards your maximum out of pocket.

The maximum out of pocket is annual. It is the amount you pay out of your pocket after the premium costs and the deductible for the year. Once you have hit the out of pocket maximum you are covered 100% for the rest of that enrollment period. Generally, a policy with a higher actuarial value has a lower out of pocket maximum. The premium is higher but you reach 100% coverage much sooner. It may be the out of pocket for a bronze plan is $5000 with a deductible of $2000. The gold plan may have a smaller deductible with an out of pocket maximum of $2000.

Not sure which paragraph you refer to but I hope I have explained the question.

[Lydia Leftcoast]

134. So basically, they get you either way

You can have a low-deductible insurance policy and pay the insurance company a ton of money every month.

You can have a high-deductible insurance policy, pay the insurance company only half a ton of money every month, but if you get sick you're screwed.

What a country! We're so special! We can't have any of that no-deductible nonsense in our land of the free, can we?

[laughingliberal]

137. That about sums it up, yes. USA! nt

[jtuck004]

150. Yea, I got that

In the real world I know what out-of-pocket expenses means, and I also know the many qualifications to it. And I also understand how language can be used to qualify liability.

In this bill the cap is not under a benefit summary, it is under the cost of the premiums - that's seems odd.

Just figure a few of those people are going to run insurance bills well over half a million, and millions will have procedures in excess of 100,000 dollars

And they are going to limit out of pocket to 5000 or 11,000 something? Doctors and hospitals can spend whatever they want and they will be reimbursed? And we will use taxpayer money to make sure all these private insurance cos remain solvent over and above their premiums? Across the board?

I'll believe it when I see it.

[Beetwasher]

140. There Are Caps On Out Of Pocket expenses As Well

It will stop bankruptcies. Unfortunately, it's not a panacea, but it is a significant improvement over status quo.

[Moochy]

146. Kick for bracing hypocrisy

#1) well at least this part... "but I AM an asshole"

#2) "I will not be responding to the myriad of attacks that I'm sure are forthcoming as I just don't have gumption or time to deal with them. I'll just say that as far as I'm concerned, and as far as pretty much all the relevant experts are concerned (yeah, I'm appealing to authority, sue me), including our progressive heroes (with very, very few exceptions) in the Senate and the House and elsewhere, this is a significant step in the right direction. I'll take their word for it over a bunch of loud, anonymous posters on DU any day"

Wow, what worthwhile DU'er to follow! not at all a waste of time, and a refreshing honest stance. You really reveal what you think about people here, fellow DU'ers.

The important thing to remember here is that, despite veneer of politeness, you really are better than all of us, because you listen to teh wise and benevolent Sentorial Class.

[Beetwasher]

148. Veneer Of Politeness? I'm Guilty Of No Such Thing, How Fucking Dare You Even Accuse Me

n/t

[Moochy]

151. Mucho Meta

For what it's worth I agree with Bernie Sanders at this point, let's give it a shot and wring hands after it gets passed and fight for on the record votes for fixes in reconciliation.

Pass it now, if only for the avoidance of the huge downside risk* of not passing anything. :shrug:

(*politically speaking) on edit clarified the downside risk of inaction.
Have a Good Saturday
:+

[Beetwasher]

164. Moochy Meta

Indeed! Get 'er done!

And a good day to u,sir! ;)

[salguine]

43. Somebody please explain two things to me:

1) If this is what we get from the Democrats, why should I be worried about the Republicans taking back Congress?

2) Why, why, WHY are we not swarming through the streets by the hundreds of thousands burning shit down and sending health care executives fleeing for their worthless lives? Europeans wouldn't stand for this shit. Why do we put up with it?

[laughingliberal]

56. Good questions. nt

[Lorien]

76. 1). Repugs are religiously insane ON TOP OF being politically corrupt

2). The Fairness Doctrine was repealed by Reagan, and since that time the public has been lulled into complacency by the corporate media. Without a return of the Fairness Doctrine and ELECTION REFORM nothing will awaken the sleeping masses.

[laughingliberal]

105. +1 nt

[blindpig]

120. Damn good questions. n/t

[uponit7771]

44. ******ANOTHER UNINFORMED INACCURATE POST ABOUT THE BILL******

[laughingliberal]

51. ROFL! nt

[Name removed]

99. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Name removed]

115. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bryn]

46. I have Medicare via SSDI

It has worked very well for me that I want everyone to have it. Some people think this HCR is "better than nothing" or "can be fixed later". I am glad you put out the truth as to why I am against this one without Public Option/Single Payer for all.

K&R :kick:

[ibegurpard]

47. K&R

the stampede has already started and I think it's too late but what the hell...

[jtuck004]

48. K&R

[smalll]

64. Ponies? This has turned out to be more of a dog-and-pony show ---

they promised us ponies; they gave us this dog of a bill!

[laughingliberal]

119. +1 nt

[liberation]

159. We've gone from "hope/change/Yes, we can" to "What can you do? It is what it is..."

For what it is worth, when I started seeing people trying to equate advocating for basic human decency and empathy... with "wanting a pony" I started to get the feeling things were going to get interesting indeed.

We're expected to love ambiguous electoral slogans, and be chastised the minute we expect actual accountability for specifics and deliverables.

The sad part is the incompetence, shortsightedness and plain sense of entitlement from the DLC, which has utterly botched this "reform" in order to maintain their corporate funding channels for future elections. When you consider that a successful health care reform, would have been so utterly apparent to the majority of Americans... that would have guaranteed a level of electoral loyalty and brand recognition for the Dems (for at least one generation) that no amount of corporate campaign finance could have provided.

[mvd]

72. A few points/questions

1. Yes, I'm sure insurance companies will try the fraud angle all they can. But wouldn't they now have to prove you intentionally misled them? For example, forgetting about a condition shouldn't get you dropped. If there's a disagreement between you and the insurance company, I'd like to know what happens next.

2. You are right that the bill falls far short on price controls, and the subsidies are too little. It should be like in other countries - the sicker you get, the more paid care you get.

3. Mandates without a public option is a big problem with the bill. Everyone should be part of the system, but not with a private company the only choice when you don't even buy anything like a car to have insurance.

So, to vote for this and not prefer a newly constructed bill or passing things in parts, I would like to have some assurances that our Party leaders are open to major improvements and additions. They seem to be going backwards on that in the past few days. One thing that might convince me to support it is the time we've already taken in the process. People are suffering in the current system.

[laughingliberal]

100. Good points and good questions

As to #1: The insurance companies have always had to prove their case if the patient challenged them on it. But they cancel the coverage and it is then inherent on the patient to seek recourse. While all this is being determined, treatment is being delayed. You may prevail. But the big question to me is will you prevail while treatment can still be effective or while you are still with us? There have always been those who managed to prevail against the insurance companies. Very often in disputes I have had with them a threat of going to my state insurance commissioner was sufficient to back them off. The insurance companies have always known they will lose some of these cases. Their goal is to avoid covering the patient where possible and, failing that, to delay as long as they can. It is most common with catastrophic diagnoses. The point here is the patient will die or be closer to death once they lose the case if they do lose. If the patient dies they are off the hook for the money. If the patient is still alive they are likely closer to death and will not be alive as long to continue treatment. The cost/benefit analysis still makes this to their benefit.

In the now famous case of the woman whose policy was cancelled the day before she was scheduled for mastectomy (and chemo to follow) for failing to report treatment for acne. She did prevail but it took 4 months and her treatment was delayed that long which is catastrophic with that diagnosis. The insurance company is now covering her treatments but she won't be here long enough to receive much treatment. They saved a bundle by cancelling her and making her go through the process. Even with a stricter law, the financial incentive is still greater to do this than to not do it.

My belief is that if they had truly wanted to stop this practice they would have made the law such that the insurance company would have to prove the fraud before cancelling coverage. This way the treatment could commence while they were in the process of proving the fraud. If the patient were found to be fraudulent then there could be penalties for that. After all, the patient stands accused in these cases. Cancelling their coverage without proving the case against them does amount to a prison sentence being handed down before a person is convicted.

I can not see at all why the loophole even exists if, in fact, there is to be no denials for preexisting conditions. Why not just pass the law with some penalty for patients found to be defrauding the insurance company for something. The insurance company is not allowed to deny coverage to those with preexisting conditions and they are not allowed to charge more for them. My question, in light of this, is why there would be a loophole for rescissions at all?

As to the rest of your post, no arguments there.

[misanthrope]

104. The added irony of the example you use...

...Were the burden of payment on the insurance provider until the fraud case were settled with the patient then on the hook for the cost of treatment until that point, not only would she (the patient) have received the lifesaving chemotherapy but the debt she would owe would be substantially less. You see, services/treatments/meds charged to insurance companies are a fraction of what the individual pays for the very same things out of pocket due to the breaks they get in bargaining.

[laughingliberal]

106. That's exactly true

Should any of us be so lucky as to actually find a provider who would treat us without the coverage, we would pay a much higher rate than those the insurance companies negotiate.

I just don't get what purpose the loophole served (well, except to keep the campaign donors happy). There was a simple way to deal with the possibility of fraud by a patient which is far less likely than fraud on the part of the insurance companies.

[OmmmSweetOmmm]

130. laughingliberal, a huge thank you!

[Raineyb]

133. Why do they need a fraud provision in the first place? If they are mandated to cover people

regardless of their condition, past or present it wouldn't matter all that much if someone forgot a condition they had when they were younger. But let's say that they deliberately left out that they had some kind of surgery. So what? It has nothing to do with what is needed in the present or future. It would have to be covered anyway. The existence of a fraud provision can only there to allow the insurance companies to kick people off in the first place. That is to say it is only there to allow a loophole for which the insurance companies to continue their policy of rescission.

People need coverage regardless of their medical history and if insurance were truly being forced to cover everyone why would it matter what was or wasn't said about one's medical past.

[Lydia Leftcoast]

135. That's how it works in other countries that use private insurance

In those countries, "fraud" refers to the provider claiming payment for treatments that were never given, not to the patient forgetting to name a pre-existing condition.

[laughingliberal]

142. Yes. Providers can and do engage in fraud. The largest case of Medicare fraud in history involved

the for profit hospital corporation, HCA. And there is already legal recourse for companies which feel they have been defrauded that don't involve cancelling people's coverage and forcing them to delay or forgo treatment while they try to prove their innocence.

[laughingliberal]

141. Exactly! With a ban on denials for preexisting conditions & a ban on charging more for those who

have them, what reason at all was there to slip this loophole in? It would seem to me there are already laws on the books against fraud. If they, indeed, find some type of fraud I see no reason why they can't take the same steps any other business that felt it had been defrauded would have available to them. Put the onus on the accuser to prove their case if they have one.

[mvd]

147. Thanks, laughingliberal

That distinction is VERY important - patients must be able to remain on the plan in the meantime, or this loophole could affect many. :hi:

[laughingliberal]

166. You're quite welcome.

:)

[unapatriciated]

156. Yes treatment is being delayed and that is the end goal of the Insurance Companies.

To keep the monies in their pockets for as long as they can.
I know this from personal experience and a long. long battle with my insurance company (1991-2005).
They know up front that the only penalty for denying coverage is to provide it after the fight.
As a result of my long battle (that I won) I had to sell my home, my marriage was destroyed and the worst was the unnecessary crippling of my son.

[Marr]

98. Thank you for this.

Very well done.

[Vinca]

121. Your post lays out the problems with the bill better than any I've read.

As an older person with a pre-existing condition, I don't see how my husband and I will ever be able to afford the tripled price for a policy with deductibles and co-pays. If we could afford that kind of money, we'd have insurance now. We have 2 choices: impoverish ourselves completely to qualify for Medicaid or move to Canada (husband is a Canadian). This whole exercise has turned into such a song and dance. What a pleasure it would be to live in one of the countries that pays for health care via taxation. No worries . . . just present your card when you need treatment. And no one is left behind.

[maryf]

123. Thanks so much!!

big K&R!

[joeybee12]

125. Great analysis...knr...n/t

[pleah]

126. K&R

[jonathon]

131. Beautiful. Beautiful. Beautiful.

Thank you so much for taking the time to write this intensive and thoughtful analysis of the reality of the health insurance reform before Congress.

I have no doubt that if people really understood the full implications of this bill, we would reject this mandated privatization of the for profit health care system and fire every last politician who worked to create a bill that put industry profit over human health & dignity.

You did a stellar job in explaining it. I hope people will actually read the content instead of just clicking the unrecommend button.

Excellent job!

[GinaMaria]

136. Thank you

[scentopine]

138. Just like the DLC shills who trumpeted banking "reform" and NAFTA and energy "reform"...

this bill sucks the last bit of living wages out of the middle class and pounds us down. Its a neo-con "free market" wet dream. What a fucking nightmare. Heads should roll. Just more CEO welfare.

What's the next fucked up neo-con "great idea"? Cap and trade on health care benefits? Letting wall street use the premiums to speculate in the housing market?

[laughingliberal]

143. +1000 nt

[MisterP]

177. in 1982, Negroponte ordered Honduras to enact neoliberalism

so that investment would "pour in" and make everyone rich

by 1984, two-thirds of rural clinics were closed

by 1987, schools were being shuttered

in 1988, things came to a head and the Embassy annex was torched

this neoliberalism (messianic promises of prosperity for all, followed by impoverishment and breakdown) has been repeated in 70s Chile, 90s Argentina, 90s and 00s Dominican Republic, 90s Russia (producing 7-hour waits for privatized ambulances), and the U.S. since 1979 or '81

so whenever some Randroid starts screaming about Soviet queues, just show them Russia under St. Yeltsin (of course, they'll scream that it's all been faked)

[icee]

144. Kudos for the research, LL. We'd better quit forking around and

organize an IMF force to start handling some of these problems. If not, we are done as a country. Letters, faxes and emails to congresscritters won't do anything. It's time to get imaginative. An IMF force. Democratic Unground Impossible Mission Force. DUIMF. I'm free for assignment. Long as I don't get sick. Going to read your post again now.

[laughingliberal]

149. Impossible Mission Force! I love that! nt

[freddie mertz]

145. Thanks for this important, informative post, LL.

I was talking to the guy who fixes stuff for us in our house. He is 68 and voted for Obama, but is real worried about the Medicare cuts.

He thinks the president has screwed this one up, and is typical of the sort of :swing voters" that the Dems relied on to carry this state in recent years.

Dems may face some serious problems with this in the next two cycles, and probably after that too.

[laughingliberal]

152. I, too, am worried about the cuts to Medicare

I strongly support cutting the $1.77 billion in Medicare advantage subsidies but they, apparently, expect to find the other $323 billion in waste, fraud, and abuse as well as instituting best practices. I don't believe there is nearly that much money there to be found.

The catering to the wealthy interests often results in starting out with an idea that sounds good but winds up shooting themselves in the foot where Medicare is concerned. For instance, Clinton made the big push to go after waste, fraud, and abuse in Medicare. However, they largely left the hospitals alone and went after the home health industry. The reason being, as always, the hospital industry had huge sums of money to lobby our elected officials and the home health industry had little. So, instead of going after those who were responsible for more of the fraud and from whom they could recoup substantial fines, they went after an industry responsible for less fraud and from whom there was little to extract. In the process they decimated an industry that consistently showed it saved Medicare money in the long run by preventing hospitalizations.

I believe the cuts to Medicare which will be funneled into the coffers to provide funding for the subsidies which will be going to the private insurance companies to be a first step on the road to privatization of Medicare.

The teabaggers had it so wrong. Their signs should have said, "Keep your corporate hands off my government run healthcare."

[liberation]

157. The diversion from Medicare funds is one of my biggest concerns from the proposals so far...

... Right now medicare, albeit far from perfect, works pretty well in a majority of cases. However, it depends largely on proper funding... and honestly with the aging of our population the pool for medicare "customers" is going to increase. But without a matching increase in funding, medicare could very well go the way of medicaid: a woefully underfunded system which does not work (not because of the idea is bad, but because it is simply not funded... which is the "detail" conservatives conveniently forget when pointing out the problems with medicaid).

It seems from the analysis of the "reform" proposals I have read, there is a very realistic chance than in order to finance the "reform" they will be diverting medicare. That is very very very dangerous, and I can't believe more people in this forum are not having an issue with that.

Any legislation that may be passed looks more and more like it will be a fairly moderate and timid change, far from an actual "reform." Thank goodness we have people like Grayson in congress and Sanders in the senate. But we, the people, seem to be utterly outgunned in terms of representation. Which is funny because income taxes have surpassed corporate tax revenue... talk about taxation vs. representation problems.

[truedelphi]

173. As someone who spent twenty years doing elder care, I know this:

Doctors who had a geriatric speciality started retiring even fourteen and fifteen years ago, as they couldn't make a go of it in terms of MediCare payments to them.

I really have no idea where the money that is being termed "waste" will show up, but once again, Obama is either clueless or listening to some adviser who is probably hot tubbing with Grover Norquist as we type this.

[laughingliberal]

180. That advisor is Zeke Emanuel

and his goal is the privatization of Medicare complete with rationing. If this bill passes without an expansion of Medicare or we will see them incrementally privatize Medicare. If the bill fails to pass the push will come from the deficit commission.

[truedelphi]

181. I tend to believe that Zeke is certainly capable of doing this.

Is there a source though? I'd love to quote you on this, and I'd love to know I could offer a source as well.

[laughingliberal]

182. There are sources but I'll have to search

He is pretty much on record about it. I'll try to see what I can find in the next few days. PM me if you want so I can send you what I find.

[colsohlibgal]

153. Money Well Spent....

....by the lobbyists. What a great analysis, you should send it to Ed Schultz and Stephanie Miller, who have been beating on we progressives, including Kucinich and Maher, for not drooling over this crummy "reform". This is close to any antonym for the word reform.

Once it passes there's going to be a Hell of a lot of partying by the insurance leeches and big pharma.

The rest of us? Just don't get real sick - and if you do, they would like you to cash your check ASAP. Talk about death panels.

It's getting closer to the time to storm the gates.

[emilyg]

160. k/r

[SandWalker1984]

161. Don't forget the Ensign LOOPHOLE in the Senate bill

The Ensign Healthcare Loophole
posted by Greg Kaufmann
The Nation
January 8, 2010

Taken at face value, Senator John Ensign's amendment which was included in the final Senate healthcare bill sounds pretty decent: by meeting "wellness" standards people can receive discounts on their employer-based healthcare premiums. Stop smoking--pay less. Hit a certain weight--pay less. Meet a cholesterol target--you get the idea.

Dems probably should have stopped and realized since the amendment was offered by Ensign it probably wasn't motivated by "wellness" at heart.

In fact, it allows premiums to be raised from current levels, and then "discounts" would reduce the premiums to current rates. People who don't meet the insurance companies' targets could pay up to 30 percent more for coverage, roughly $4000 based on the average cost of family coverage. The amount could increase to 50 percent which is over $6,600 for a family.

There is also the problem that this is biased against people with a genetic predisposition to high blood sugar, hypertension, high cholesterol, being overweight and a host of other often hereditary conditions. It's also biased against a lower-income person working two to three jobs to pay the bills, who has to stop and chow down some fast food between jobs rather than get to the gym where he or she can't afford a membership anyway. It's even biased against communities that don't have grocery stores where they can find fresh fruits and vegetables.

So what does this all mean? Remember a central promise of healthcare reform--even the watered down version--how people with preexisting conditions weren't supposed to be denied coverage or forced to pay more for their insurance? That all sounded pretty good, right? Well, guess again.

"Incentives quickly become penalties for those who cannot meet the target," said Sue Nelson, vice president for federal advocacy at the American Heart Association (AHA). The AHA has led a coalition of more than 200 health and consumer organizations who oppose this Senate provision, including the National Organization for Women, American Cancer Society, the American Diabetes Association, and many mental health groups. "A wellness program could consist solely of a premium surcharge based on a blood cholesterol count over 200. There are significant potential unintended consequences such as burdening sicker employees and their families with significant increases in healthcare costs thereby making coverage unaffordable for those who need it the most."

Read the full article at:

http://www.thenation.com/blogs/notion/514042/the_ensign...


"burdening sicker employees and their families with significant increases in healthcare costs thereby making coverage unaffordable for those who need it the most" The Ensign loophole means that those with pre-existing conditions, while they cannot be denied access to health insurance, can be charged unaffordable premiums. If they can't afford the premiums, they still won't have health insurance/health care.

The Senate bill is a scam!

[laughingliberal]

162. Thank you, Sandwalker!

That is a great article and should be an OP. I have written here a few times about the Ensign amendment but it gets little attention. Not only is this a backdoor way to charge those with preexisting conditions more, it is a scary hit to privacy rights allowing your employer the right to your private health information. I don't even like to think about the abuses this new right of your employer will foster.

Anyone who thinks an amendment made possible by Bush's last minute executive order to strike down more of our privacy rights is a good idea must love the Patriot Act.

[OmmmSweetOmmm]

163. Sandwalker, you should post this as a response to all health insurance bill advocates who extoll

that people with pre-existing conditions are going to have "affordable" coverage.

This was one of my biggest questions when I heard about the bill in regard to pre-existing conditions and you've answered it.

Thank you and I am bookmarking this and with your permission would like to use your post as a source.

[truedelphi]

176. Thank you for posting this. n/t

[mrdmk]

167. nice job! k & r

[Dinger]

169. Belated Kick (nt)

[OmmmSweetOmmm]

172. Kick

[truedelphi]

183. It's been over 24 hours since I read this and I am still thinking

About all the ramifications of things you said.

Thanks you so much for offering all these details.

(BTW real "indie" scientists are showing that constant exposure to the types of signals sent by cell phones can disrupt the body's ability to have a normal cholesterol level. Statins may not have a thing to do with helping. And even if you never personally use a Cell Phone, you probably are affected by the cell phone antennae on the cell phone towers everywhere in this nation. We moved to a very remote area, but within about three weeks, a cell phone antennae was isntalled only three quarters of a block from our house.)