Healthcare Reform

This is a post someone made at a differnt board:


I am very concerned that the public is not being given the facts about the proposals wh/ Obama's administration is making re: what they are referring to as "healthcare reform."

Part of my career has been spent analyzing healthcare legislation.

I have no dog in this fight; I am just an American, like you, struggling to deal with healthcare costs. I see the healthcare system in this country as bloated and rife w/ opportunities to trim fat so that the consumer's expenses are not so great.

I heard so many of you rallying around Obama b/f he was elected b/c you wanted "universal healthcare." Back in 2007, and in the months up to the election, I tried to explain that there will be no "universal healthcare" but rather - there will be insurance reform. Obama himself said nothing about "universal healthcare" yet I kept hearing the average Joe on the street saying he was voting for Obama b/c Obama would give us universal h/c.

And today, we are getting ready to be bombarded w/ all sorts of propaganda telling the public that the insurance "reform" that is getting ready to be passed in Congress is actually "healthcare reform" - BUT IT IS NOT.

I am only asking each of you to read the bill for yourselves. I have had to read all 615 pp of Sen. Kennedy's bill (wh/ will be voted on 6/16) and to shut out ALL THE PUNDITS and anyone speaking for Obama's administration. They are NOT telling you what is in this bill. They are skirting issues and putting a spin on it.

What are my politics? I am a moderate. I believe in a society's obligation to take care of children, the disabled, the elderly and those who are unable to care for themselves. I am not some right wing nutball interested in who wins elections for either party. I am interested in seeing real help for every American who struggles with healthcare costs.

SHOCKING FACT: the number one reason for bankruptcy in this country is b/c of medical bills.

That is what I want to see addressed: the COST of healthcare and increased access to AFFORDABLE healthcare.

What Kennedy's bill proposes are a few good things wh/ I think all of us can agree on, but parts of it are rather ominous and the President's Administration is trying to smokescreen those items.

Here is what I think most of us will like about the proposed legislation:

1. Kids up to 26 can stay on their parents' h/c insurance policy til age 26.
2. Medicaid qualifying threshold will still use poverty tables, but will increase your elibility to include 150% of your salary. So that means more people who are working and have children can qualify for Medicaid. For some people, this may help.
3. If your employer does not offer healthcare insurance, you will be offered a gov't insurance policy. HOWEVER - and please listen to this - you will still have premiums. This is NOT free healthcare. And further, ALL AMERICANS ARE GOING TO BE REQUIRED TO HAVE HEALTHCARE INSURANCE.

Let me re-state this. The President's administration has been using the figure of about 41-45 Million Americans being without h/c insurance. In that figure, they have included about 20 million + Americans whose employers DO OFFER insurance, but these people have chosen NOT to get insurance. Why? Some are young (in their 20s) and they do not feel they need it - and the cost of premiums would cut their checks down. But this legislation REQUIRES every American to have insurance. So these people who have refused coverage will be REQUIRED to have it now.

Also, that means the figure that the Pres's administration is using (40+ million Americans) is seriously flawed. In addition, that figure represents an estimation of illegal immigrants (non-citizens who are here illegally) wh/ may be anywhere from 12 to 20 Million individuals. I have search thru/ 615 pp of Kennedy's bill and I cannot find anything that EXCLUDES these individuals from having h/c insurance coverage in this country. The facts are, this bill mandates that EVERY CITIZEN has healthcare coverage. However, it then re-defines what they consider a citizen by requiring those that do not qualify as citizens to also have insurance. It is tricky language and I have put out requests to attorneys to please look at this legislation and figure out if I am reading it correctly.

Now raising the threshold on salary that a person can have and still qualify for Medicaid seems reasonable to me. It will cost all of us taxpayers more, of course, to pay for Medicaid. Your tax dollars are what pays for another person to be on Medicaid. However, the troubling aspect of this is that they are also LOWERING restrictions on assets that a person can have and still qualify for Medicaid. For some of us, that may be a GOOD thing - those of us living at poverty level and considered the "working poor" - and there are many of us. However, for those who are gaming the system, this is just making it much easier for them to sit on their duffs and get all sorts of subsidies handed to them. It is a dilemma!

But back to the things you will not hear anyone discuss about this bill. Or let's say - that the President's administration is already out there saying anyone who mentions this stuff is "spreading propaganda." (I heard this out of Howard Dean's mouth this morning on CNBC).

This is a concern: Your healthcare benefits that you now receive from your employer are going to be TAXED. Let me break this down for those of you who are clueless about how your employer handles the cost of your h/c insurance. Typically, whatever YOU PAY as your insurance premium each month is about HALF of the actual cost of the policy. So that means - let's say you pay $500 a month for healthcare. Your employer is picking up HALF the cost of your policy. So that means your employer is spending about $6000 more dollars a year to provide you w/ healthcare coverage. This administration wants to pass a provision to TAX that $6000 or so money. That means this money will be recognized as INCOME. This will LOWER your paycheck every month. In addition, tagging on $6000 or more each year to your salary may put some people into a new HIGHER income tax bracket. In addition, each employer is required to turn in a statement annually with every person's name, address, SS# and telephone number who receives insurance. This is for tracking purposes. Why? I have no clue.

And let me state again. If you are turning down your employer's policy right now, you are going to be REQUIRED to carry it once this bill passes.

Also - and this should be a CONCERN - and Howard Dean was trying to play games with this fact this morning - national review boards/agencies are to be set up (yes, this is in the legislation) to review healthcare consumption and limit what is appropriate. And one of the areas that is going to be closely monitored is END OF LIFE care. This means - after age 75 or 80, people w/ cancer are going to get palliative or hospice care but no treatment for cancer. Howard Dean tried to skirt this issue this morning by saying NO NO, we are not going to have "rationed healthcare."

Well, excuse me, Mr. Dean: if it walks like a duck and it quacks like a duck, as far as I am concerned, it's a duck. And these agencies who are going to oversee the consumption of healthcare are there to restrict its use (and thus, ITS COST) and that is RATIONED HEALTHCARE.

To all of you who have clamored for "universal healthcare" let me make this clear: you are NOT GETTING IT. You are getting mandated insurance. All that is going to change is you will be required to get insurance and your employer is going to have no choice but to get lower BENEFITS on those insurance policies.

LOWERED, LESS ROBUST BENEFITS.

In this legislation, there are many other things that concern me and should concern you as a taxpayer. This is not helping with LOWERING HEALTHCARE COSTS. Isn't that what we ALL wanted? Lowered costs?

Instead, this legislation will create more bureaucracy - more agencies to oversee agencies and each STATE. More federal interference as to what your state can offer you.

Get this: the legislation mandates a federal "oral care" program - and I can't believe it but it actually is written in there - $5,000,000,000 going to ADVERTISING (in English and Spanish) to remind people to brush their teeth. This ad campaign is to run for five years. And it will cost tax payers 5 billion dollars - so that you and your neighbors know that it is a GOOD THING to brush your teeth and get regular checkups.

Oh - and it creates a public health center for schools - but the only children who can use the center are children at poverty level. They get free sealants on their teeth, but you will have to pay for dental care for your kids. I am not saying this is a bad idea to take care of illegal immigrants' kids teeth. But I am saying - this is NOT universal healthcare. If it were, YOUR KIDS would get the same free dental exams and sealants on their teeth.

There is money in this bill to cover healthcare education for those wanting to go into healthcare careers - BUT ONLY IF THEY ARE A MINORITY ETHNICITY. I am serious. I am not making this up. My son and his fiancee are going into healthcare but they don't qualify for this money b/c they are caucasian. THAT IS FAIR? And that is how the majority of Americans want to see their tax dollars used? I am NOT talking about LOANS - it is clearly written - these are GRANTS.

There is SO MUCH MORE in this legislation and it is not going to be discussed. Congress is going to rubberstamp it and already, Obama's political machine is out on the street, calling the DEMS who disagree w/ the legislation "contrarians" and saying the objections that the GOP are bringing up are PROPAGANDA. They are determined to pass this legislation and they are determined to do it QUICKLY.

AMERICA: we got the BAIL OUT crammed down our throats and even the Senators and Congressmen had no time to really digest the legislation. I see the same thing happening here. THe President's Administration is bandying around the term "healthcare reform" but that is NOT what this is! This is INSURANCE MANDATES. And no, I did not pick this up from some pundit. To my knowledge, NO ONE else is calling this "insurance mandates." I am trying to inform you, my fellow citizens, what I have analyzed about this legislation on my own.

I am not taking some pundits word for it. I am not taking some biased Congressman's word for it; I am not reading what some Lobbyist has said about it. I have analyzed it myself. Some of it is so hard to wade through, I am still uncertain exactly what it means (b/c it changes language on previous enacted legislation/ACTS).

What I am asking is for YOU to read it. I am asking YOU to refuse to be fed the propaganda. Just b/c you wanted "universal healthcare" - do NOT be fooled into thinking this is something like Canada's system or UK's system. This is nothing more than insurance mandates.

Here is the bill. Huffington was good enuff to post the bill in its entirety. Please do not think I am asking you to be a fan of Huffington. If you have another source for finding this legislation in its entirety online, feel free to post a link:

http://www.huffingtonpost.com/2009/06/09/kennedy-health-care-refor_n_213509.html

Please find out for yourself what is getting ready to be demanded of you. I think we ALL AGREE - something needs to be done to lower the cost of healthcare, but this ain't it, friends! This is just rationed healthcare tied up in a mandated insurance box.

 

A lot of the things allegedly being hidden have been in public for a long time.

Mandating coverage was the single biggest difference between Hillary and Obama's plan. It seemed pretty obvious to me at the time that Obama would come around to Hillary's view on this eventually.

I've heard several stories on NPR over the last 48 hours about taxing benefits. Obama demonized McCain over this issue, and now he's come to McCain's line of thinking.

(See a recurring trend here? Obama says what he thinks will get him elected, then switches to the sensible position after winning. A tried and true politician strategy. In these cases, I think they were pretty predictable, which is why I'm not too upset. Obviously, I'd rather he just be honest, but that's politicians for you.)

As for "rationed care," we were bound to confront this problem eventually. If you want to contain costs, you simply can't have government pay fo $90k operations for an 85 year old woman so she can live an extra six months. People die. It sucks. Sometimes government shouldn't pay every price to prevent death. Sorry. If you really want to pay that kind of cost when you or someone you love gets in that situation, plan ahead and start saving. I don't think it's worth it if I ever get in that boat--I'd rather just die and let that money be used on providing health care or education for children.

The post is right about some things. It isn't going to be like Canada or Britain. Those on the right who've compared the Democrats' plan to those countries for years have sold the rest of us on that being what's in store. It isn't. The plan is going to resemble something more like the Swiss or Germans, where private insurers and private hospitals still exist. Democrats have been saying this for years, and Obama said it in the campaign repeatedly. It's only shocking if you weren't paying attention to what Democrats said they wanted to do.

He's also right about having stuff ramrodded through. The Iraq invasion and the bailout were both forced down our throats because we had to ACT NOW. In hindsight, a lot of bad decisions resulted in both instances. I like the idea of universal coverage, but I'd like to see it done at a pace that makes it easier for people to come to terms with the reality.

 

Actually I would like to bring up one your points for debate. In the section you were talking about a persons health insurance being taxed, you said you would have no choice on carrying a policy. That is not entirely correct. All that is required is that you are covered by health insurance. So in the case of married folks, if one person has the whole family covered, the other person if working does not have to carry an insurance policy and have it taken out of their check, and get taxed on it.

Now here is the second thing. There is a lot to consider here, but the facts are nothing is free. If you want more health care for folks, it is going to cost some money. You can try to make it up by reducing costs and such, but chances are there are costs somewhere. Everybody always wanting everything for free when this stuff costs money, and then they wonder why our government is in debt.

Is it worth the costs? Probably to many, probably not to many. It matters which camp you land in. Covered? Uncovered?

Lastly I would like to make a point about the bankruptcy issue. One of the reasons that the administrations wants everybody covered is to stop these bankruptcies. The amount of damage being done to the health care system because of these bankruptcies, is probably worth the amount of cost and hate incurred in order to get it fixed. Does anybody think it is right that somebody should be forced into a situation where they have a treatable medical condition, but they have to choose between life, and screwing the hospital by signing up for a procedure they never had the money for in the first place, and then stiffing the hospital with the bill? You can't tell me that these people going in don't know the costs of the procedure, and they know they can't pay it back. The whole thing is, why should they ever have to make such a choice in the first place? The facts are, that the very people that are getting help from the hospitals, are sending them into bankrupticy by not paying their bills, and if that happens, nobody can get help. So if they don't do something about it, it is a matter of time before hospitals start failing financially and were all screwed.

 

Once we start taxing the healthcare premiums in our paychecks, where does it end? For me, the federal income, FICA and state income tax will end up being about $2,500. I, like many people, don’t have the extra room in my paycheck. That will cost me either my house, my car, to curtail assistance to my terminally ill daughter or cause one of the twins to drop out of college. Either way, it’s a painful cut. And, if I am forced to take one of the first two options, my 820 credit score is out the window and I’ll feel the effects for years to come. And it’s being forced upon me. This will adversely effect millions of people. Maybe tens of millions.

And what if these new taxes aren’t enough? The government plan will be in place and it will have to be funded. Who will pay? It’s us via either new taxes again or tax hikes. And what will this new plan provide for? What are the services? Will it be buying heart transplants? Tummy tucks? Abortions? Plans like this only grow- they never shrink. If you don’t believe me, review the history of the social security program.

There are other ways to do this. Triage approaches…

 

I didn't read your whole post BP but most of it. I don't know if it will work or now. I know Bush had a proposal to tax healthcare to cover eliminition of AMT... which would have provided me nothing... so actually getting national healthcare for the same thing seems good to me. =)

My wife works at a hospital... and though no expert on healthcare I asked her what she thought drove costs so high... and her answer was because everyone didn't have healthcare. If everyone is paying into the system the cost per person can go down. In theory. Now... people without health care are still using the system... you can walk into any emergency room and get treated but they may not ever get any money.

I don't know whether national healthcare will work. It hasn't in some countries. It is a nice idea though.

I can tell you that many people's visions of a nice retirement with $$ to spare may be a pipedream. My parents had about a half million for retirement and my dad had an accident and now they are down to where they have less than $100,000 and he will soon need permanent long term care at about $5000 a month. Bottom line is that money will be gone soon and he will be on medicaid to keep my mom from going infinitely in debt. Sucks because my wife and I co-own a beach house with them and medicaid may be able to try to take it or force us to sell it.

Anyway... I don't think the plan will pass. While I think it is important idea... I just don't know if now is the time.

 

I, too, have heard the same argument that if nearly everyone had healthcare to pay their bills, then providers would charge much less. But as a practicle matter, I have a hard time thinking doctors, hospitals and pharmacutical companies will lower all charges by 25-40%, if even 10%. As an example, remember when gas recently rose to $4/gallon? Due to the increased cost of shipping, groceries went up over 25%. When gas went back down to under $2/gallon the prices stayed the same. In general, people don't give ground they had to fight over when it comes to pricing. That said, prices may come down, but I think I'll remain skeptical and be pleasantly surprised if they actually do.

 

I agree... I doubt rates will go down... but more money into the system somehow... all the extra money is got to go somewhere. The rates may be set by the healthcare system anyway... I know my provider sets what they will pay for x and y and the hospital just always matches that I think. I don't know how it will all shake out... but we certianly can't afford a big money sink right now. You'd have to spend a lot of time ironing out the short grass and I am just not sure the government can do that very well.

 

I'd like to ask a question: Who in here is dissatisfied with their health care? If so, will Federal Government involvement fix the problems you face?

It's my understanding that everyone--rich or poor, legal or illegal, insured or uninsured--gets health insurance right now. If you show up at a hospital with a wound or a life threatening condition, you get treated. That cost gets absorbed by those of us who have insurance as those costs are passed through to the insurance companies. It's why an aspirin costs $14.00.

Considering the level of care we currently have available to us, do we really want to reduce it to put the Federal Government in charge? Like it or not, the only way the Government is going to reduce cost without serious tort reform is to ration care, just like Kitzhaber did with the OHP.

Perhaps I'm out of touch. I've always had health insurance. It's either been offered by my employer or I've secured it privately. It's been expensive at times, compared to what I made, but it wasn't unjustly so. I'd really like some insight from others who want a single-payer system and why it's a good idea.

 

In fact there are some 40 million in this country that are not covered. In terms of why things are so expensive, it is because we give all of the power to the companies and not the consumer. If the government allowed for a truly open market on prescription meds the cost would be at least half.

I recommend the following Frontline, it should help people understand what healthcare can become here in the United States.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

 

Uninsured by choice is fine. The problem is those who want/need insurance and can't afford it.

And what would you do in the event of something catastrophic, like cancer, where treatment can run to thousands of dollars per month?

There are often efficiency gains when a system is done in a more broad fashion, rather than for a small segment of people. I don't think a national health care system would look much like the VA.

 

I don't have any problem with a system where there's a good federal insurance plan for those who can't afford private, in addition to private insurance for those who can.

Insurance isn't forcing doctors to provide labour for free. And most of the cost of such treatments is the drugs. Pharmaceutical companies aren't very into compromise or pro bono. And while you may be able to pay thousands of dollars per month (or do it on installment plans for years), many people can't. Not just people in poverty, but middle class people. The main problem for the uninsured isn't check-ups or blood work (though those can certainly add up if one is poor), it's the catastrophic effect on their life if they or a child of theirs ends up with a serious illness or injury. Injury or illness shouldn't reduce a family to poverty and/or bankruptcy.

I'm not against the VA. My point is simply that providing a service on a smaller scale is often more inefficient than providing it on a larger scale.

Whether it is "objectively efficient," it probably isn't. I'm not in favour of it because I think government can do it more efficiently than private enterprise. I'm in favour of it because private enterprise isn't going to sacrifice their bottom line for the needs of the less-fortunate, but government will if enough people are in favour of it.

 

I explicitly said it very likely wouldn't be efficient.

 

At least you are one of the few that is willing to admit that the quality of healthcare will go down for most of the country in order to provide healthcare to the ~5% of Americans that can't afford it.

 

No, I don't think that's a given at all. Inefficiency means it will cost more, not necessarily that the service will be worse.

 

I thought the number was more like 30million. Then I factored out some for the people that can afford it, but choose not to.

Either way, we're talking on the order of 10%.

 

We already can't afford it. If it needs to cost most to maintain the current level of service, then the service will go down.