Health Care Reform - Universal/Public Option

[JPhillips]

Arles: You've said you support increased access to insurance. That costs money. How would you pay for it?

There's no honesty to saying you support providing coverae for the uninsured but don't support any means of raising revenue to pay for it.

[Mizzou B-ball fan]

Originally Posted by flere-imsaho

We tried to have an honest debate, but opponents of health care reform brought up "death camps." Where was your outrage then?

Yet again you want Obama/Democrats to reach out and find common ground with groups not only diametrically opposed to their policy initiatives, but intent on being as obstructionist as possible in this matter. Which reminds me, I must have missed your posts criticizing those who disrupted the town halls this summer and exhorting the GOP in Congress to "have an honest debate about the real concerns surrounding this bill" with Obama & the Democrats. Perhaps you could link to some of your posts on this subject?

1. I never voiced any support for the 'death panels' talk. You must have been thinking of a different MBBF. I do think patients should be advised of their options and make sure they know exactly where they stand. I also think that doctors should be able to make a call when all options have been exhausted to remove life support. Some kooks would likely say that I'm in favor of 'death panels' by saying that. I'd just say I have common sense.

2. I never said anything about wanting Obama and the Democrats (sounds like a '60s rock band) to 'reach out'. I've been very consistent in saying quite the opposite. I've said they need to stop pretending that they need some sort of support from the opposition to get a good bill through. If it's a good bill, Obama shouldn't have any issues pushing it through. It's fun to blame Republicans, but they don't start looking bad until the Democrats actually come to an agreement and put forth a bill they agree on as a party. I think the Republicans look relatively silly right now because they're having to find reasons to 'oppose' the bill when the Democrats can't even agree what the hell is in the bill.

[JPhillips]

Originally Posted by Mizzou B-ball fan

1. I never voiced any support for the 'death panels' talk. You must have been thinking of a different MBBF. I do think patients should be advised of their options and make sure they know exactly where they stand. I also think that doctors should be able to make a call when all options have been exhausted to remove life support. Some kooks would likely say that I'm in favor of 'death panels' by saying that. I'd just say I have common sense.

2. I never said anything about wanting Obama and the Democrats (sounds like a '60s rock band) to 'reach out'. I've been very consistent in saying quite the opposite. I've said they need to stop pretending that they need some sort of support from the opposition to get a good bill through. If it's a good bill, Obama shouldn't have any issues pushing it through. It's fun to blame Republicans, but they don't start looking bad until the Democrats actually come to an agreement and put forth a bill they agree on as a party. I think the Republicans look relatively silly right now because they're having to find reasons to 'oppose' the bill when the Democrats can't even agree what the hell is in the bill.

You have, on numerous occasions, taken shots at Obama for not being bi-partisan enough. Do we really need to start copying and pasting posts?

[Mizzou B-ball fan]

Originally Posted by JPhillips

You have, on numerous occasions, taken shots at Obama for not being bi-partisan enough. Do we really need to start copying and pasting posts?

No, I've made sarcastic posts about the hypocrisy of this administration when they promised to put aside partisan talk and work together with the Republicans only to do the exact opposite once they were in office. Any shots were made to point out just badly this administration has failed in that regard.

[flere-imsaho]

Originally Posted by Mizzou B-ball fan

1. I never voiced any support for the 'death panels' talk.

That wasn't what I said. I asked where was your outrage when the "death panel" first came about?

You criticize health care reform supporters now for demonizing the opposition, but did you criticize the health care reform opponents for the non-constructive, completely obstructive "death panel" attack?

I very much doubt it, of course, but I'd be more than interested in seeing some documented example of your even-handedness.

[Mizzou B-ball fan]

Originally Posted by flere-imsaho

That wasn't what I said. I asked where was your outrage when the "death panel" first came about?

You criticize health care reform supporters now for demonizing the opposition, but did you criticize the health care reform opponents for the non-constructive, completely obstructive "death panel" attack?

I very much doubt it, of course, but I'd be more than interested in seeing some documented example of your even-handedness.

While I enjoy the higher standard that I'm held to as opposed to most posters in these threads (i.e. you're expecting me to be the "Jesse Jackson Voice of Reason" against the death panel kooks), I've been very consistent in not showing support for any of the goofballs who went to the extremes in this debate. I may agree with certain parts of the message, but I have never endorsed some of the delivery methods being used. I know some would love that to happen so they could lump me in with some of these knuckleheads, but that's not happening.

[JPhillips]

Originally Posted by Mizzou B-ball fan

While I enjoy the higher standard that I'm held to as opposed to most posters in these threads (i.e. you're expecting me to be the "Jesse Jackson Voice of Reason" against the death panel kooks), I've been very consistent in not showing support for any of the goofballs who went to the extremes in this debate. I may agree with certain parts of the message, but I have never endorsed some of the delivery methods being used. I know some would love that to happen so they could lump me in with some of these knuckleheads, but that's not happening.

You've just stated that anyone criticizing the death panel stuff is trying to distract from legitimate debate.

[Arles]

Originally Posted by JPhillips

Arles: You've said you support increased access to insurance. That costs money. How would you pay for it?

There's no honesty to saying you support providing coverae for the uninsured but don't support any means of raising revenue to pay for it.

I've been very clear that I support a limited subsidy to private insurers/certain uninsured people to help cover the cost of health insurance premiums. I'm even open to incentives for covering certain "preconditions" to help address that issue.

My main focus is try and whittle away at the uninsured without impacting the 70+% of people who have good insurance options through their employer. This way we can see how many people we can help insure at a much lower cost.

Right now, nothing being proposed will impact costs at all. If that is a goal,
I would even be open to having private insurance treated as more "catastrophic care" (thereby lowering the cost for most people) and having a flexible spending account for doctor visits and prescriptions. That's about the only thing I could see that would actually help control costs.

[JPhillips]

But even your proposal costs money. Where would it come from?

[Arles]

Originally Posted by JPhillips

But even your proposal costs money. Where would it come from?

If you do it in a progression (ie, a tax credit/incentive to help those below a certain wage level first and evaluate), the cost is significantly less. I don't mind spending some tax-payer money on it, but I want to know that it's working and not impacting negatively the huge percent with affordable, quality health care right now.

Plus, adding a crapload of uninsured to our health infrastructure could have other serious "unintended consequences".

So, in a novel approach at government spending, I would like to setup a few plans to cover people (that may cost some money - but not a ton) and see if they actually work over a few years. Since the government isn't providing the coverage (just subsidizing private premiums), the risk is minimal. As to the cost, it would have to be prioritized with some of the other budget items. I would expect that some concessions in other areas would help pay for it.

[JPhillips]

But you're dancing around the issue. If Medicare can't be cut and taxes can't be raised, where does the money come from? Any increase in coverage takes money. You can be against spending, but if that's your position you can't also be in favor of expanding coverage.

I'm not so much talking about amount, which we'll not see eye to eye on, but mechanisms for spending. It's easy to be for expanding coverage if you never get around to explaining how you'll pay for it.

[Arles]

Originally Posted by JPhillips

But you're dancing around the issue. If Medicare can't be cut and taxes can't be raised, where does the money come from?

We have a budget going on $3+ trillion, you're telling me we can't find the money to subsidize a portion of premium coverage for those without employer covered insurance and making under a certain wage level (say 50-60K)? They did a study for this in California and found that a premium subsidy starting at a high % for those uninsured under 45K and phasing out by 80K would cost around 2.5 billion. Other smaller states like Oregon and Nevada were found to be less than 1 billion. Even if you assume a middle average of 1.5 billion for all states (more than it should cost), you are at 70ish billion nationally. Given we just saw 300 million given to someone for one vote, I'm sure we could find a way to cut around 1-2% of our national budget to pay for this plan.

Any increase in coverage takes money. You can be against spending, but if that's your position you can't also be in favor of expanding coverage.

Ah, the Patrick Ewing "We may make a lot of money, but we spend a lot of money too". Instead of looking at how to add to the budget, why is it so taboo to ask the government to cut well under 100 billion in other areas (out of over $3 trillion) to help cover the uninsured?

I'm not so much talking about amount, which we'll not see eye to eye on, but mechanisms for spending. It's easy to be for expanding coverage if you never get around to explaining how you'll pay for it.

You pay for it by cutting the 60-70 billion from other areas and prioritizing like you or I would do if we incurred an expense that wasn't expected in this economy. This could involve cuts in military spending, social programs or the amount allocated to other "pork" projects. All you would have to do is cut 5% total from the discretionary spending portion of our budget to pay for this. If we don't want to do that, then covering the uninsured obviously isn't the priority to our congress that I think it should be.

[JPhillips]

The point is until you get specific about how you'll pay for it everything is fantasy. Sure there are ways to pay 60-70 bil(although I would add that the ten year cost for the Senate bill is just over 80 bil a year). The key, though, is how, and after your idealized how then you need to look at what might actually pass a vote in the House and Senate.

[cartman]

Gawdamn, I love The Onion...

Like Hell I'm Going To Let Some Black President Help Me Pay For Dialysis | The Onion - America's Finest News Source

Like Hell I'm Going To Let Some Black President Help Me Pay For Dialysis
By Dan Laird

I take pride in who I am. Always have, always will. I've worked hard my whole life and have never taken anyone's charity, and I'm not about to start now, no matter what. I'm telling you, there's no way I'm going to sit back and let some black president of the United States try to devise a structure to help me pay for the dialysis treatment I so desperately need to survive.

Not over my dead body.

Just who does this Afro-American occupant of the highest office in the land think he is, anyway? Look, I've got nothing against black people, but some of them act like the whole world owes them something. For example, important government subsidies on my dialysis.

You know, I don't recall asking for some black commander in chief to embrace protections that would prohibit insurance companies from dropping my coverage on a whim and operating as if my continued existence on earth were nothing more than a strategic liability. Plus, if I go along with this progressive health-benefits scheme, he'll probably hold it over my head every time I receive vital care with the aid of the government to which I already pay taxes.

Sorry. I've got too much self-respect for that.

Obama needs to know that there's still one American willing to watch his body drown in its own deadly internal toxins rather than have long-overdue reform crammed down his throat.

Fact is, nobody wants some too-big-for- his-britches black president butting in to suggest that everyone, including me, needs to be treated with dignity. Yet this Obama thinks he can just waltz in and and tinker with a health care system that destroys people like myself every single day.

Can you imagine what'd it be like if he weren't just half black?

Seriously, when Obama's done drumming up support for legislation that might allow me to see my daughter graduate from college and prevent me from dying before my 50th birthday, what's next on the agenda? Will he try to keep my life's savings from evaporating in a stock market that operates free of serious governmental oversight? Is there any aspect of capitalism run amok that this guy won't tamper with? Really, Obama, thanks but no thanks. The last person I need help from is some black leader of the federal government in a position to perhaps improve my quality of life.

The worst part is that I'll have to put up with this guy being a black president for at least three more years. I guess all I can do is try to hold out for the 2012 election. Maybe then we'll get a white president back in office. Maybe he'll have the common decency to let me suffer in peace.

[CamEdwards]

Originally Posted by JPhillips

The point is until you get specific about how you'll pay for it everything is fantasy. Sure there are ways to pay 60-70 bil(although I would add that the ten year cost for the Senate bill is just over 80 bil a year). The key, though, is how, and after your idealized how then you need to look at what might actually pass a vote in the House and Senate.

Seems to me like you're leveling criticism at Arles when you should be leveling criticism at Harry Reid and the Senate health bill. As Arles has already pointed out, the total cost of the Senate bill comes with the assumption (or promise) of $1.9 trillion in cuts to Medicare over the next decade... cuts that at this point are purely hypothetical (or "pure fantasy" if you prefer that term).

While you demand that a guy on a football message board get serious and specific about how to pay for his plan, you're perfectly willing to let REAL legislation pass that relies on nebulous promises to cut spending at some point in the future in order to keep costs down.

Why the heck don't you hold our politicians to the same standard you hold your fellow FOFC'ers?

[JPhillips]

Well we should start from the same set of facts. One, the 1.9 trillion is over two decades. Two, that isn't all cuts, reductions in spending growth account for a lot of that number.

I'm not asking Arles for specific legislation, I'd be happy with a plan on where his spending could come from. That's exactly what the Senate bill already does. You may not believe it, but there is a plan on where the money will come from.

[CamEdwards]

Originally Posted by JPhillips

Well we should start from the same set of facts. One, the 1.9 trillion is over two decades. Two, that isn't all cuts, reductions in spending growth account for a lot of that number.

I'm not asking Arles for specific legislation, I'd be happy with a plan on where his spending could come from. That's exactly what the Senate bill already does. You may not believe it, but there is a plan on where the money will come from.

Yeah, the same kind of plan the underwear gnomes had in that South Park episode. It's missing a crucial step (actually voting for the cuts in Medicare), but as long as you ignore that (and hypotheticals about reductions in spending growth), it sounds great!

I guess by that standard we can take the $72 billion in overpayments our government made in FY2008, and use it to fund the plan that Arles has come up with.

[JPhillips]

There is a difference between a plan and a lack of a plan, no?

And how can any program be paid for ten years into the future? Are you in favor of killing every multi-year project in the defense budget? After all, how can you have any certainty of what future congressional votes will be?

[CamEdwards]

Originally Posted by JPhillips

There is a difference between a plan and a lack of a plan, no?

And how can any program be paid for ten years into the future? Are you in favor of killing every multi-year project in the defense budget? After all, how can you have any certainty of what future congressional votes will be?

Those multi-year projects don't affect 1/7th of our economy. As for the "plan", didn't the House just vote to eliminate cuts to Medicare in next year's budget? I'd feel a helluva lot more confident about these cuts being real if the party pushing for them was willing to start the cutting now.

[cartman]

Originally Posted by CamEdwards

Those multi-year projects don't affect 1/7th of our economy.

So you are saying, even at the high end of estimates, that the economy is only going to produce a total of ~$12 trillion over the next 10 years? Or are you saying that there aren't multi-year national defense projects, of which total spending is close to 1/7th of our economy?

[CamEdwards]

Originally Posted by cartman

So you are saying, even at the high end of estimates, that the economy is only going to produce a total of ~$12 trillion over the next 10 years? Or are you saying that there aren't multi-year national defense projects, of which total spending is close to 1/7th of our economy?

I'm saying there is no one multi-year national defense project that comes close to 1/7th of our economy, and continued funding for each of those multi-year national defense projects are approved or rejected on a regular basis. That's a far cry from how the funding for health care reform would operate, and it's a silly comparison to make.

[cartman]

Originally Posted by CamEdwards

I'm saying there is no one multi-year national defense project that comes close to 1/7th of our economy, and continued funding for each of those multi-year national defense projects are approved or rejected on a regular basis. That's a far cry from how the funding for health care reform would operate, and it's a silly comparison to make.

Again, since when would $800B to $1.2T over 10 years equal 1/7th of the economy, when all predictions show at least $150T of GDP over 10 years?

[CamEdwards]

Originally Posted by cartman

Again, since when would $800B to $1.2T over 10 years equal 1/7th of the economy, when all predictions show at least $150T of GDP over 10 years?

Dude, I didn't say it would COST 1/7th of our economy, I said it would affect 1/7th of our economy.

Those multi-year projects don't affect 1/7th of our economy.

[cartman]

Originally Posted by CamEdwards

Dude, I didn't say it would COST 1/7th of our economy, I said it would affect 1/7th of our economy.

You are saying one thing, but inferring another.

Yes, most estimates show that health care spending is roughly 1/7th of the economy, approximately $2 trillion per year. The way I read your posts, you are trying to say that any new government healthcare spending would affect the entire $2 trillion amount, which is quite a stretch. There is a big difference between saying it would have an impact in an industry that is 1/7th of the economy versus saying flat out it would affect 1/7th of the economy.

[Arles]

Originally Posted by JPhillips

The point is until you get specific about how you'll pay for it everything is fantasy. Sure there are ways to pay 60-70 bil(although I would add that the ten year cost for the Senate bill is just over 80 bil a year). The key, though, is how, and after your idealized how then you need to look at what might actually pass a vote in the House and Senate.

My numbers were based on a plan that would do full premium coverage for all people under 40K and some for those up to 80K (even including those working). So, I way overshot what I had in mind.

To cover premiums for those under 40K and have it lowered and phased out to 80K ONLY for those without employer-provided insurance - that would cost around $25 billion annually and could potentially cover 20+ million uninsured. To pay for that, I would cut from the following sources in the discretionary spending part of the budget:

$40 billion - Off-budget
$70 billion - health and human services
$515 billion - defense
$150 billion - war on terror
$8 billion - EPA budget

From those 5 sources, I'm pretty confident we can come up with $25 billion. Heck, if we froze last year's spending (instead of raising it 5%), we'd save $40 billion right there.

[Galaxy]

Originally Posted by flere-imsaho

"Turn it on" is a common phrase when discussing expensive technology that doesn't literally mean it costs $X to flip the switch. What they probably mean is that once you flip that switch, you've just committed to $X in electricity costs, $Y in operator costs (i.e. salary), $Z in insurance, $A in other staff, etc....

This is why it's sometimes cheaper to run the machine 3 days a week but 14 hours a day as opposed to 5 days a week but 8 hours a day.

I know what he meant. I was just suprised at the dollar amount (not sure why).

[Galaxy]

What kind of insurance will be paying for (type of coverage, co-pays, ect.)?

I find it funny that such an urgent matter won't kick in for another few years (and gives the Dems a great chance to blame the GOP if they get power by then and kill/change the plan). The whole bill just takes money from one pocket and puts it into other, while printing more money we don't have, and a political play. No real actual changes to the health care system.

[CamEdwards]

Originally Posted by cartman

You are saying one thing, but inferring another.

Yes, most estimates show that health care spending is roughly 1/7th of the economy, approximately $2 trillion per year. The way I read your posts, you are trying to say that any new government healthcare spending would affect the entire $2 trillion amount, which is quite a stretch. There is a big difference between saying it would have an impact in an industry that is 1/7th of the economy versus saying flat out it would affect 1/7th of the economy.

I'd say the two are closer than trying to compare this health care bill with the VH-71 helicopter project. But I apologize... a multi-year defense project would not have the same kind of impact on our economy that health care reform would have.

Better?

[JPhillips]

Cam: The problem is you're asking for something that can't be done and something you're quite comfortable with in other contexts. There's no way to spell out in detail every cut in Medicare for every year. All that can be done is set targets for cuts that will keep the bill on track. The budget has to get passed each year and can't legally be set years in advance.

What you see as faking the numbers is the way budgeting works for any multi-year expense. Sure, targets aren't always followed, but that's a different problem than saying the targets are a purposeful sham.

I'd probably prefer a Medicare commission that sets rates that would then get a simple up or down vote on the whole package, but that has problems as well.

[cartman]

Originally Posted by CamEdwards

I'd say the two are closer than trying to compare this health care bill with the VH-71 helicopter project. But I apologize... a multi-year defense project would not have the same kind of impact on our economy that health care reform would have.

Better?

You were trying to paint the picture of health care reform as affecting a full 1/7th of the economy, which is what I was pointing out as incorrect. The military spending was just a corollary to point out that a multi-year government spending project doesn't take over the full financial impact of an industry in the overall economy.

[lynchjm24]

Edward, I hope you are still out there because you've asked for my 'plan'.

Let me start by saying that the concept of 'quality, affordable' health care is a mirage. It may as well be a search for a pink unicorn. If you want quality healthcare you have to pay for it, it can't be affordable here, and we can't be compared to other nations in the world because we have items on our federal balance sheet that they do not.

I'm not a military expert and I'm certain that there are certainly cuts that could be made in military spending, but I do understand that there is a certain level of spending we must maintain in order to ensure the safety of the people in this country, nevermind what we attempt to do abroad.

The economy has to be considered the most important factor still. Healthcare reform is useless if it hamstrings the economy. Our economy is built on the eggshells of consumer spending and at this point jobs are king.

This won't be very well written, because it's going to be long and rambling and let's face it - it's a message board about a simulation football game . Generally none of us are going to change each other's minds anyway, so why kill ourselves trying.

First some stats from the Wall St. Journal today that show some evidence that our health care system's results aren't as bad as many try to claim:


Death rates dropped significantly for eight of the 15 leading causes of death in the U.S., including cancer, heart disease, stroke, hypertension, accidents, diabetes, homicides and pneumonia, from 2006 to 2007. (Of the top 15, only deaths from chronic lower respiratory disease increased significantly.) The overall age-adjusted death rate dropped to a new low of 760.3 deaths per 100,000 people—half of what it was 60 years ago.

The death rate from coronary heart disease dropped 34% from 1995 to 2005, though it is still the biggest single killer in the U.S. Deaths from cardiovascular disease dropped 26% over the same period. Deaths from stroke dropped 29% since 1999. Average total cholesterol in adults aged 20 to 74 dropped to 197 milligrams per deciliter in 2008 from 222 in 1962.

The death rate from cancer, the second-biggest killer, dropped 16% from 1990 to 2006. That reflects declines in deaths due to lung, prostate, stomach and colorectal cancers in men, and breast, colorectal, uterine and stomach cancers in women.

I do agree that there is some need for 'health-care' reform in this country. What would my 'plan' be? Here we go Eddie:

1. We need to move away from a fee for service model. Currently, you go to the doctor, they get paid. They generate more revenue from someone chronically ill by seeing them more often then they do by keeping them healthy and out of the doctor's office.

A huge part of reforming payment is to look at what's called bundle payments. If a physician is treating a patient who has asthma, that physician might be paid a rate for the year that represents a reasonable and appropriate payment to incent them to do things that might not be office-visit-based. So, the physician might take those resources and have someone visit the patient's home and look at what the patient has in their home and how their home is organized, because there may be things going on there that actually are influencing the office visits.

Hospitals need to be paid in a manner that generates better outcomes and fewer readmissions. So, the hospital might very well receive a bundled payment that might include the work-up on the front end, the care that's delivered and anticipate whatever follow-up care might be necessary. Instead of paying a hospital that continues to readmit the same patients for the same conditions.

2. That leads to something Bucc touched on a couple of pages ago: Personal responsibility. Around the 4th of July there was an article posted on this thread where a woman was told as she left the hospital to not eat a hot dog. Of course, she said, it's not the 4th without hot dogs, ate one and then was readmitted for her heart condition. Until there is a level of personal responsibility the cost of care will continue to rise beyond what is sustainable. Obesity of course being the greatest issue going forward.

There seems to be only one way to get people to act responsibly and that is rewarding them or penalizing them financially.

3. You can't address the uninsured without requiring everyone be covered. Covering the sick uninsured without also forcing the uninsured healthy will only lead to a financial disaster. What they have written into these bills will not get the young healthy people insured because there is not enough of a penalty.

4. Health insurance needs to go back to being insurance. Arlie hit on it a few times when he talked about catastrophic insurance. That is where we need to go. Coverage can't be for an office visit every time someone has the sniffles. You don't get Geico to send you a check everytime you put a small scratch in your car - health insurance should be insurance - not a blank check to utilize in every way shape or form.

5. There needs to be public and private investment in IT and infrastructure. Billing needs to be standardized and simplified. I do this for a living and when my wife had a baby earlier this year, I'm still trying to decipher some of the bills I get, what they are for and what is legitimate. Medical records are also a complete disaster at this point, and can only be improved.

6. A move away from the ridiculous state mandates that exist. Many states require coverage of things like in-vitro fertilization or other expensive non-medically necessary items. For example, lifestyle drugs like Viagara need to be covered by insured plans.

7. The ability for people to buy individual insurance products across state lines.

How do you pay for it? I'm not sure, because I'm not exactly sure what this plan would cost. There will be a need to subsidize low income people and families and there will be a need to reward some businesses and corporations that provide benefits to employees.

To me that is why incremental change is necessary. I don't think anyone can truly correctly estimate what the financial cost is. Making small incremental changes allows for the change to be implemented over time and giving us time to measure the financial impact.

Just putting together something like a public option without knowing what your risk pool will be or what you'll be able to generate in premium leaves the American taxpayer with a potentially huge unfunded liability. Costs in an insurance pool can spiral out of control quickly as the sick continue to stay in your plan, but your good risk leaves as the costs become prohibitive due to the utilizing members. If the government had a plan with a few million people that were generally unhealthy they could end up with a huge problem on their hands because the risk sours quickly. I can assure Nate Silver that solely having a lot of capital does not make selling insurance a profitable or break-even proposition.

Let's be honest, this legislation isn't about health care - because everyone has access to healthcare currently. It might be a lot more expensive then they would like it to be but except for some very rural populations, everyone has access to healthcare. This is about the transfer of wealth and allowing more people to protect their assets against illness and disease. Admitting that reality would make the debate easier as it would be less emotional and the true costs could be explored. It's not 'unfair' that some people have good health insurance and some don't. So let's stop pretending that health insurance is a 'right' and debate what we are actually going to do which is transfer wealth from some to others.

[lynchjm24]

Oh yeah, one thing you can't pay for this legislation with is Medicare cuts, because there is no way they will ever happen. Just take a look at the nation's demographics and who benefits from Medicare, nobody who wants to get reelected is going to follow through with those votes.

[JPhillips]

You're on a good roll until this crap:

Let's be honest, this legislation isn't about health care - because everyone has access to healthcare currently. It might be a lot more expensive then they would like it to be but except for some very rural populations, everyone has access to healthcare. This is about the transfer of wealth and allowing more people to protect their assets against illness and disease. Admitting that reality would make the debate easier as it would be less emotional and the true costs could be explored. It's not 'unfair' that some people have good health insurance and some don't. So let's stop pretending that health insurance is a 'right' and debate what we are actually going to do which is transfer wealth from some to others.

This is the problem with so much of the debate on healthcare. It's assumed that the other side is lying. I'm in favor of a public option and it has nothing to do with transfer of wealth.

[CamEdwards]

Originally Posted by cartman

You were trying to paint the picture of health care reform as affecting a full 1/7th of the economy, which is what I was pointing out as incorrect. The military spending was just a corollary to point out that a multi-year government spending project doesn't take over the full financial impact of an industry in the overall economy.

Actually, multi-year defense projects were brought up by JPhillips as an attempt to point out that there are some programs that can't all be paid for up front. That was it. Everything else is just arguing in the weeds, which admittedly is where the supporters of this health care reform would prefer to argue, since it means they're no longer defending the bill in the Senate.

[cartman]

Originally Posted by CamEdwards

Everything else is just arguing in the weeds, which admittedly is where the supporters of this health care reform would prefer to argue, since it means they're no longer defending the bill in the Senate.

Opponents saying 'ZOMG, 1/7th of the entire economy is going to OBAMACARE' is pretty deep in the weeds as well, and doesn't reflect the content of either the house or Senate bill.

[lynchjm24]

Originally Posted by JPhillips

You're on a good roll until this crap:



This is the problem with so much of the debate on healthcare. It's assumed that the other side is lying. I'm in favor of a public option and it has nothing to do with transfer of wealth.

I'm not saying they are 'lying'. I'm saying that by complicating with the idea that it's about healthcare and not health insurance makes the debate more difficult because it's emotional.

Like the ridiculous talk about the death panels. It's just over the top political nonsense that doesn't get anyone closer to a satisfactory result for anyone.

The legislation as it's written is straight up wealth transfer. I mean there is a 5% tax on GROSS income over $500,000. What else can you possibly call it?

[Galaxy]

Originally Posted by JPhillips

You're on a good roll until this crap:



This is the problem with so much of the debate on healthcare. It's assumed that the other side is lying. I'm in favor of a public option and it has nothing to do with transfer of wealth.

What is the public option exactly? Is it an actual government plan or is the government buying plans from other companies? What will it cover? What type of co-pays, deductions, coverage, ect.?

[lynchjm24]

Originally Posted by Galaxy

What is the public option exactly? Is it an actual government plan or is the government buying plans from other companies? What will it cover? What type of co-pays, deductions, coverage, ect.?

Parsing what we see in the media because I haven't read the bill. It would be a government administered plan that they don't purchase from other companies. The benefits would be extremely rich and there is much debate as to how they would pay providers, how many members they would have and what the demographic makeup of that membership would be.

In other words, some seem to support the idea, but I don't even know if there is any consensus as to how it would work even among the supporters. The far left wants the plan to reimburse at the same level as Medicare. That isn't even in the realm of possibility, providers would turn the members away at the door since most medicare reimbursements are below the cost of delivering the care.

[CamEdwards]

Originally Posted by cartman

Opponents saying 'ZOMG, 1/7th of the entire economy is going to OBAMACARE' is pretty deep in the weeds as well, and doesn't reflect the content of either the house or Senate bill.

It's a good thing I didn't come close to saying that, and we were way into the weeds by the time I even mentioned the 1/7th figure. But hey, thanks for proving my point.

[cartman]

Originally Posted by CamEdwards

It's a good thing I didn't come close to saying that, and we were way into the weeds by the time I even mentioned the 1/7th figure. But hey, thanks for proving my point.

This is pretty close

Originally Posted by CamEdwards

Dude, I didn't say it would COST 1/7th of our economy, I said it would affect 1/7th of our economy.

[Galaxy]

Originally Posted by lynchjm24

Parsing what we see in the media because I haven't read the bill. It would be a government administered plan that they don't purchase from other companies. The benefits would be extremely rich and there is much debate as to how they would pay providers, how many members they would have and what the demographic makeup of that membership would be.

In other words, some seem to support the idea, but I don't even know if there is any consensus as to how it would work even among the supporters. The far left wants the plan to reimburse at the same level as Medicare. That isn't even in the realm of possibility, providers would turn the members away at the door since most medicare reimbursements are below the cost of delivering the care.

Would doctors/hospitals have the right to opt/refuse to take it (if they are paid like Medicare/Medicaid)?

[cartman]

Originally Posted by Galaxy

Would doctors/hospitals have the right to opt/refuse to take it (if they are paid like Medicare/Medicaid)?

According to supporters, yes. According to detractors, no. That's about as clear an answer you'll get unless you take some time to read the bills yourself and form your own conclusions based on what is out there.

I don't mean that to be curt, but the text of the bills is out there, in a searchable format. Here's the House bill:
Text of H.R.3962 as Placed on Calendar Senate: Affordable Health Care for America Act - U.S. Congress - OpenCongress and the Senate one currently opened up for debate: Text of H.R.3590 as Amendment in Senate (OC Prepared): Patient Protection and Affordable Care Act (Legislative... OpenCongress

There's a whole lot of BS being passed around by both supporters and detractors, but the true text of the bills tells the story. I prefer to get my info as close to the source as possible, and avoid the inevitable 2nd and 3rd time removed interpretations.

That being said, until the Senate passes a bill (which can change quite a bit during debate), and then the House and Senate committee meet to hash out differences between the two, we won't know the final form.



edit: and I'm not saying that bills are written in a clear and concise way. They can be maddeningly confusing. But for the general questions, they can be answered with quick searches of the bill text. Asking questions about interpretations of a passage in a bill is one thing, but saying "does bill X have this" is another.

[lynchjm24]

Originally Posted by cartman

edit: and I'm not saying that bills are written in a clear and concise way. They can be maddeningly confusing. But for the general questions, they can be answered with quick searches of the bill text. Asking questions about interpretations of a passage in a bill is one thing, but saying "does bill X have this" is another.

Well... for example he asked... what would the copays/deductibles/etc be.

The house bill provides for basic/enhanced/premium plans (they could come up with a better name then premium by the way which just further confuses the matter). It defines them in ways like this:


A basic plan shall offer the essential benefits package required under title II for a qualified health benefits plan with an actuarial value of 70 percent of the full actuarial value of the benefits provided under the reference benefits package.

Which is then further defined as:

(b) Minimum Services To Be Covered- Subject to subsection (d), the items and services described in this subsection are the following:

(1) Hospitalization

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

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

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

(5) Prescription drugs.

(6) Rehabilitative and habilitative services

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

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

(9) Maternity care.

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

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

What they seem to mean is that the basic plan would be 70% of the value if all of those items were paid in full.

All of which is a lot of words that doesn't really actually tell you what is covered or at what level. There is a little bit of language about what coinsurance payment limits are limited to, but the bill just says things like 'copays will be determined by the secretary'. How can anyone tell you what you are going to spend on medical costs until they define what is covered and at what level?

[lynchjm24]

So based on that list...

Are glasses covered for children 21 and under? It seems to indicate that vision and hearing supplies are covered for children under 21.
Hell based on the way that sentence is written you'd expect toothpaste to be a covered benefit.

Orthotics are covered? Orthotics are excluded on most private insurance plans today.

How about Rogaine? Propecia?

How about advanced reproductive technologies like zygote transfer and artificial insemination?

How about inpatient substance abuse coverage? Is it limited in any fashion or can you check in every year for a month long stint for the rest of your life?

Emergency rooms are covered... so what's the penalty for using an emergency room for non-emergency care?

Maybe these details exist and I can't find them, but just creating a secretary and then giving them broad powers to set limits after the legislation is passed seems crazy.

[cartman]

Originally Posted by lynchjm24

Maybe these details exist and I can't find them, but just creating a secretary and then giving them broad powers to set limits after the legislation is passed seems crazy.

The details aren't there, but the text describing how they will be set is immediately after the section you quoted.

(b) Duties-CommentsClose CommentsPermalink

(1) RECOMMENDATIONS ON BENEFIT STANDARDS- The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘Secretary’) benefit standards (as defined in paragraph (5)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.CommentsClose CommentsPermalink

(2) DEADLINE- The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.CommentsClose CommentsPermalink

(3) STATE INPUT- The Health Benefits Advisory Committee shall examine the health coverage laws and benefits of each State in developing recommendations under this subsection and may incorporate such coverage and benefits as the Committee determines to be appropriate and consistent with this Act. The Health Benefits Advisory Committee shall also seek input from the States and consider recommendations on how to ensure quality of health coverage in all States.CommentsClose CommentsPermalink

(4) PUBLIC INPUT- The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.CommentsClose CommentsPermalink

(5) BENEFIT STANDARDS DEFINED- In this subtitle, the term ‘benefit standards’ means standards respecting--CommentsClose CommentsPermalink

(A) the essential benefits package described in section 222, including categories of covered treatments, items and services within benefit classes, and cost-sharing; andCommentsClose CommentsPermalink

(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 303(c)) consistent with paragraph (5).CommentsClose CommentsPermalink

(6) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS-CommentsClose CommentsPermalink

(A) ENHANCED PLAN- The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 222(c)(3)(B).CommentsClose CommentsPermalink

(B) PREMIUM PLAN- The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 222(c)(3)(B).

[lynchjm24]

Originally Posted by cartman

The details aren't there, but the text describing how they will be set is immediately after the section you quoted.

Which leads back to the same question. How can you know how much something will cost when you don't even know what it is?

People don't like insurance companies? I get that... but if you don't like insurance companies do you think you are going to like the Health Benefits Advisory Committee. Non-elected public officials who are given broad powers based on those few paragraphs.

I'm no Constitutional scholar, lawyer or even a student of history... but a lot of this legislation seems to fly in the face of State rights.

[cartman]

Dola,

This will probably come across as harsh, but I couldn't think of a better way to frame it.

The business of elections of politicians is usually broken down into terms that the lowest common denominator in the voting pool can relate to.

The business of laws and governance is usually broken down into terms that politicians and bureaucrats can understand.

Very rarely do the two worlds meet. The question is "should they". In my opinion, no. That is why we have representational government, not direct governance.

[lynchjm24]

Originally Posted by cartman

The business of laws and governance is usually broken down into terms that politicians and bureaucrats can understand.

It's sort of funny that this isn't one of those times.

[cartman]

Originally Posted by lynchjm24

It's sort of funny that this isn't one of those times.

I thought you said you weren't a politician or bureaucrat?

As I mentioned above (and you quoted), the final bill is far from finished. A lot can change in the Senate debate, as well as the conference committee between the House and Senate. And that is right at the heart of the politician and bureaucrat interpretations.

[lynchjm24]

Originally Posted by cartman

I thought you said you weren't a politician or bureaucrat?

I'm not, that's why I understand what I've read of the bill. I don't know if I can say the same for some of the folks who are voting on it.