Health Care Reform - almost a done deal? DONE

[MotoH]

At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.

Instantly, Doug Tracy knew something was wrong with his son.

"He wasn't turning pink fast enough," Tracy said. "When they listened to his chest, they realized he had an issue."

That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.

Read more: http://www.star-telegram.com/2010/0...orn-with-heart-defect.html#tvg#ixzz0jaHceHC8"

I can't believe it. It's a baby! How could a health insurer deny coverage for something like this.

 

[NeoDevin]

How could a health insurer deny coverage for something like this.

Same reason they deny coverage for anything else they think they can get away with: Profit.

 

[Char. Limit]

Can't we all just get along?

Wait... looking at the way things are in this country, that's never going to happen.

Obviously, considering that the no pre-existing conditions clause doesn't take effect until september, we should boycott health insurance companies until september. Of course, this plan has many fundamental flaws, but then, so did the Bay of Pigs, the Iraq War, and Oprah, and we did that, right?

 

[edpell]

A technical point. People are using the word risk but this is only valid when talking about one person. When we talk about a pool of 1 million people it is no longer risk it is a highly predictable amount of money we will spend each year for medical care (i.e cost). Just as talking about one gas molecule is a different subject then talking about a volume of gas with 10^23 molecules.

So a pool of 1 million healthy people has an annual cost of X dollars for medical care and a pool of unhealthy people has an annual cost of Y dollars for care and a pool of mixed healthy and unhealthy has a cost of Z dollars per year. It is safe to say

X<<Y
X<Z
Z<Y

 

[mheslep]

I can't believe it. It's a baby! How could a health insurer deny coverage for something like this.

http://www.star-telegram.com/2010/0...born-with-heart-defect.html#tvg#ixzz0jaHceHC8
I think this is a case of the uninsured, not denial. To have a denial, there had to be an insurance policy in place. There was no insurance as I read the story, nothing to deny. I wonder what happened to Medicaid, if the problem here was affordability.

 

[Ivan Seeking]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Who knew it was still possible to get something big done in Washington?

Congratulations to President Obama, VP Biden, SOH Pelosi, and SML Reid, who dared to tackle America's unfinished business, and won! And it only took 100 years. The first President to attempt this was Teddy Roosevelt.

Bully Bully!

 

[turbo]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Who knew it was still possible to get something big done in Washington?

Congratulations to President Obama, VP Biden, SOH Pelosi, and SML Reid, who dared to tackle America's unfinished business, and won! And it only took 100 years. The first President to attempt this was Teddy Roosevelt.

Pretty impressive achievement, since there was NO bipartisanship, even on such an important issue. Rounding up Democratic votes in Congress is like herding cats, so Pelosi and Reid deserve extra credit.

 

[edpell]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Ivan, I still have virtually no idea what IT is.

I of course have read lots of commentary those who like it say it is the best thing since sliced bread and those who do not like it say the sky is falling. I have not and will not read 2000 pages of legal speak myself.

I take it you are on the like it side. What are some of the things it does?

 

[rootX]

So Dems will start implementing the new reform. It will take few years before the reform will start showing some benefits. However, the Reps will come into office for the next term (which I am confident about unless it's Sarah Palin again :P) and change all what Dems started?

 

[Ivan Seeking]

Ivan, I still have virtually no idea what IT is.

I of course have read lots of commentary those who like it say it is the best thing since sliced bread and those who do not like it say the sky is falling. I have not and will not read 2000 pages of legal speak myself.

I take it you are on the like it side. What are some of the things it does?

That's why, imo, it is so important to find reliable and balanced pundits, like David Gergen, and stick with them. They are paid to be experts and have the experience to provide the proper perspective. As with most any subject, one cannot become an expert by reading a document.

A few highlights, general expectations, and achievements:
Insures 30 million people who currently have no insurance, through a low-cost insurance pool
Eliminates lifetime limits on insurance plans
Eliminates "prexisting conditions" as a basis to refuse insurance to an applicant
Penalizes those who could afford insurance but have none.
Mandates that insurance companies disperse 80% of funds collected, for claims.
50% tax credit [credit, not a deduction] for small business medical insurance costs
Reduces deficit by $1.2 trillion over the next twenty years

There are many cost-saving features, the impact of which cannot be accurately estimated, so the CBO assumes a zero benefit. In fact we should see significant reductions in medical costs.

Philosophically, we have defined that health care is now a right, not a privilege.

David Gergen: an American political consultant and presidential advisor during the administrations of Nixon, Ford, Reagan, and Clinton. He is currently Director of the Center for Public Leadership and a professor of public service at Harvard Kennedy School.[1] Gergen is the Editor-at-large for U.S. News and World Report and the Senior Political Analyst for CNN.[2]
http://en.wikipedia.org/wiki/David_Gergen

 

[Char. Limit]

That's why, imo, it is so important to find reliable and balanced pundits, like David Gergen, and stick with them. They are paid to be experts and have the experience to provide the proper perspective. As with most any subject, one cannot become an expert by reading a document.

A few highlights, general expectations, and achievements:
Insures 30 million people who currently have no insurance, through a low-cost insurance pool
Eliminates lifetime limits on insurance plans
Eliminates "prexisting conditions" as a basis to refuse insurance to an applicant
Penalizes those who could afford insurance but have none.
Mandates that insurance companies disperse 80% of funds collected, for claims.
50% tax credit [credit, not a deduction] for small business medical insurance costs
Reduces deficit by $1.2 trillion over the next twenty years

There are many cost-saving features, the impact of which cannot be accurately estimated, so the CBO assumes a zero benefit. In fact we should see significant reductions in medical costs.

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says. After all, the CBO is part of government, and government is made up of people, and people are often wrong. What I'm trying to say is that the CBO might be wrong.

 

[Ivan Seeking]

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says. After all, the CBO is part of government, and government is made up of people, and people are often wrong. What I'm trying to say is that the CBO might be wrong.

There are never guarantees in Washington, but the CBO is highly respected by both parties and is considered the judge and jury. The fact is that the CBO tends to be very conservative in its estimates. That is why, for example, none of the cost reducing features were given any consideration. If they can't be quantified in concrete terms, then then don't get counted at all.

To argue that we can't look to analysis for guidance is to make us like blind men in a mine field. What I would not pay ANY attention to are people like Limbaugh or Beck, who have no basis for an opinion. The one certainty here is that the CBO is infinitely more qualified to comment that most anyone on television or the radio; or anyone else, for that matter.

 

[Char. Limit]

There are never guarantees in Washington, but the CBO is highly respected by both parties and is considered the judge and jury. The fact is that the CBO tends to be very conservative in its estimates. That is why, for example, none of the cost reducing features were given any consideration. If they can't be quantified in concrete terms, then then don't get counted at all.

To argue that we can't look to analysis for guidance is to make us like blind men in a mine field. What I would not pay ANY attention to are people like Limbaugh or Beck, who have no basis for an opinion. The one certainty here is that the CBO is infinitely more qualified to comment that most anyone on television or the radio; or anyone else, for that matter.

Now I wasn't suggesting not listening to the CBO at all. I was trying to imply that we shouldn't take the fact that you posited as, well, fact.

And please... I know better than to listen to people like Limbaugh and Beck... didn't you see my earlier post? Actually, FOX News is my favorite comedy channel.

 

[mheslep]

David Gergen: an American political consultant and presidential advisor during the administrations of Nixon, Ford, Reagan, and Clinton. He is currently Director of the Center for Public Leadership and a professor of public service at Harvard Kennedy School.[1] Gergen is the Editor-at-large for U.S. News and World Report and the Senior Political Analyst for CNN.[2]
http://en.wikipedia.org/wiki/David_Gergen

Eh? Are you saying Gergen is your reference for all the above? If so is that your synopsis of one of his broadcasts or is there a link?

 

[mheslep]

Reduces deficit by $1.2 trillion over the next twenty years

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says.

The CBO didn't say that. The actual text:

[...]
Effects of the Legislation Beyond the First 10 Years
Although CBO does not generally provide cost estimates beyond the 10-year budget projection period, certain Congressional rules require some information about the budgetary impact of legislation in subsequent decades, and many Members have requested CBO’s analyses of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. Therefore, CBO has developed a rough outlook for the decade following the 2010-2019 period by grouping the elements of the legislation into broad categories and (together with the staff of the Joint Committee on Taxation) assessing the rate at which the budgetary impact of each of those broad categories is likely to increase over time. Our analysis indicates that H.R. 3590, as passed by the Senate, would reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of gross domestic product (GDP).3 The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates.

In today's terms, that's $35 to $70B per year of deficit reduction, given their assumptions (see below).
That's it for the letter. There is no 2029 tabulated dollar figure hiding somewhere in an appendix.
http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf

In his http://cboblog.cbo.gov/" , CBO director Elmendorf has some caveats about that long term estimate:

[the second ten years] calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress. The current legislation would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time.

 

[edpell]

Mandates that insurance companies disperse 80% of funds collected, for claims.

Ivan, thanks for the insight. This is the first time I have heard about the above 80%. I like it.

 

[mheslep]

Ah, here's an example of why the health law's deficit estimates from CBO are likely bogus through no fault of their own, as exactly warned about by the CBO.

From the CBO director again:

[the second ten years] calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress. The current legislation would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time.

The point being that CBO is obligated to estimate from what's written down on the books, not how Congress perennially behaves. In this case http://www.cms.hhs.gov/SustainableGRatesConFact/01_Overview.asp#TopOfPage" says Medicare doc payments will be cut. CBO estimated accordingly. Later, either Congress or the executive calls an audible, as they have done for years.

http://www.businessweek.com/news/2010-03-29/doctors-get-reprieve-from-21-decline-in-payments-from-medicare.html"

March 29 (Bloomberg) -- Doctors slated to have their Medicare reimbursements cut 21 percent on April 1 got a reprieve from the Centers for Medicare and Medicaid Services, which is delaying lowered payments until after Congress reconvenes.

We'll see what happens when Congress gets back on the 12th.

 

[Sea Cow]

So Dems will start implementing the new reform. It will take few years before the reform will start showing some benefits. However, the Reps will come into office for the next term (which I am confident about unless it's Sarah Palin again :P) and change all what Dems started?

Not if (when) it proves popular, they won't.

As an observer looking in from a country with universal health care provided free at the point of need, I find the US debate rather mystifying, I must admit. I would hope and expect many of those who opposed the legislation to come to rather like the idea of healthcare as a universal right. It's quite a modest reform, really, but it's a start.

 

[Char. Limit]

The only problem with America is that even when a party has a supermajority, this is all they can get done. Two thngs that I would have liked to see included:

1. Public Option. Seriously Dems, biggest mistake you've made this term is taking that off.
2. Sell insurance across state lines. I'm not sure why this is a Republican idea (I thought the Republicans were FOR monopolies, not against them), but there's no reason not to put it in. Shame, congress, shame.

 

[mheslep]

Not if (when) it proves popular, they won't.

As an observer looking in from a country with universal health care provided free at the point of need,

Is it? Is it universally slow? Should it be called universal at all if the government decides that some tests or treatments won't be done, that, say, an MRI really isn't needed?

 

[mheslep]

The only problem with America is that even when a party has a supermajority, this is all they can get done. Two thngs that I would have liked to see included:

1. Public Option. Seriously Dems, biggest mistake you've made this term is taking that off.

You understand that the public option would never have passed?

 

[Char. Limit]

You understand that the public option would never have passed?

We don't know that. If Democrats were loyal to party (a bad trait normally, but here it's a good thing), it could have passed. Plus, if the FOX News Disinformation Machine (trademark) hadn't done so much, I think it would have passed...

 

[mheslep]

We don't know that.

Yes we do. People went on record saying they would not vote for it. Lieberman comes to mind - said he would join a filibuster against the original Senate bill.

If Democrats were loyal to party (a bad trait normally, but here it's a good thing), it could have passed. Plus, if the FOX News Disinformation Machine (trademark) hadn't done so much, I think it would have passed...

What do these hypotheticals have do with your original assertion?

 

[Char. Limit]

Yes we do. People went on record saying they would not vote for it. Lieberman comes to mind - said he would join a filibuster against the original Senate bill.

Lieberman might as well be a Republican, and I count him firmly in that camp. I also count him in the same camp as Arlen Specter... if you know which camp that is, as, being an intelligent person, I'm sure you do.

What do these hypotheticals have do with your original assertion?

You're right... my original assertion is that the public option should have been in the bill, and when you challenged that by saying it wouldn't have passed, I created the hypotheticals. Nevertheless, I believe that FOX News was the reason the public option didn't pass despite majority support for it.

Washington Post Poll
Talking Points Memo Poll
http://blogs.abcnews.com/theworldnewser/2009/09/majority-of-americans-support-a-public-option-in-health-reform.html
http://blog.american.com/?p=4754
Wall Street Journal Poll

 

[Sea Cow]

Is it? Is it universally slow? Should it be called universal at all if the government decides that some tests or treatments won't be done, that, say, an MRI really isn't needed?

In the US, it is not 'the government' but private insurance companies that make that decision. So yes, heath care is rationed here in the UK and there in the US. Here in the UK, the decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference) according to clinical criteria. There in the US, the decision is taken by profit-making companies according to the financial situation of the individual concerned.

I know which situation I prefer. I don't have to worry about health care. If I'm ill, I go to a doctor – and I'm seen, for free, that same day. There may then be a waiting period as I'm referred to a specialist for free – the system in the UK is by no means perfect, although waiting times have come right down in the last decade – it used to be much worse. But life expectancy in the UK is higher than the US. They're doing something right.

ETA: A lot of lies were told about the UK system in the run up to these reforms in the US. All I can say is, come here, stand in the street and ask people whether they favour the system we have or some kind of private insurance scheme. You'll be hard-pushed to find anyone, rich or poor, who does not favour our system. Every political party falls over itself to appear the most keen on the National Health Service. Even Thatcher did. Universal health care provided free at the point of need is great. Really. You'd like it.

You're not banned from going private, btw, if you so wish. But if you do go private, you still have to pay for the NHS for the rest of us through your taxes. In just the same way, you in the US are free to send your children to private schools, but still have to pay for the state schools that everyone else uses through your taxes. Certain provisions, such as health and education, can and should be considered a universal right and responsibility of citizenship. It's called society.

 

[CRGreathouse]

In the US, it is not 'the government' but private insurance companies that make that decision. So yes, heath care is rationed here in the UK and there in the US.

Absolutely. Further, health care will be rationed in any system. It's literally not possible to do otherwise.

I know which situation I prefer. I don't have to worry about health care. If I'm ill, I go to a doctor – and I'm seen, for free, that same day. There may then be a waiting period as I'm referred to a specialist for free – the system in the UK is by no means perfect, although waiting times have come right down in the last decade – it used to be much worse.

I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

 

[Sea Cow]

I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

It has improved, and yes waiting times were pretty awful. A lot more money has gone into health care in the last decade – it was underfunded for ages.

 

[mheslep]

In the US, it is not 'the government' but private insurance companies that make that decision. [...]

Absolutely. Further, health care will be rationed in any system. It's literally not possible to do otherwise.

I disagree with these characterizations, though I know it is often stated that way. Yes of course the insurance company uses my premiums to pay the medical provider, but I selected the insurer after some fairly careful background checking. My firm provided a number of insurer options. The benefits were clearly stated and I get exactly what I chose to pay for, including the care for a critically sick family member. Along the way nothing was denied. There are five-star quality hospital rooms out there which we didn't use and would not have been covered, but again we got what we asked for. I could have chosen a lame-insurer, there was one on the list as I recall, and no doubt I would have had problems.

The point being that if anyone did any rationing in my case (really a misuse of the term), I did it myself.

 

[mheslep]

[..]Here in the UK, the decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference) according to clinical criteria. [...]

The staff of http://www.opsi.gov.uk/si/si1999/uksi_19990220_en.pdf". How is NICE not the government?

 

[Sea Cow]

The staff of http://www.opsi.gov.uk/si/si1999/uksi_19990220_en.pdf". How is NICE not the government?

It is odd how you object to there being some democratic accountability for services run in the communal good.

 

[mheslep]

[...]I'll admit, my bad experiences in the UK were about two decades ago, when waiting time for a specialist was typically over 1 year (at least where I was). They've surely improved since!

Yep, agrees with what I've read and heard second hand - both the way it used to be and that the NHS has improved now. Still, NHS was called 'universal' back as now and in my opinion there is nothing 'universal' about a program that would make one wait a year for a specialist.

 

[mheslep]

It is odd how you object to there being some democratic accountability for services run in the communal good.

C'mon, I said no such thing above. Enough with the subject changing strawmen; it simply degrades the conversation. You stated the "decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference)". Is the board (NICE) employed and answerable by the government or not?

 

[mheslep]

ETA: A lot of lies were told about the UK system in the run up to these reforms in the US. All I can say is, come here, stand in the street and ask people whether they favour the system we have or some kind of private insurance scheme. You'll be hard-pushed to find anyone, rich or poor, who does not favour our system. Every political party falls over itself to appear the most keen on the National Health Service. Even Thatcher did. Universal health care provided free at the point of need is great. Really. You'd like it.

Ok, fine, I get you like it and NHS does well by you.

But I'm not so hard pushed to find those who disagree who have had first hand experience. I have several friends from the UK who won't touch the NHS. One of them, just back from serving with the UK forces in Afghanistan, visited me here last week. For a more public example, see the UK's MEP Daniel Hannan here:
http://www.youtube.com/watch?v=OAbaMS12aDY&feature=related

 

[CRGreathouse]

The point being that if anyone did any rationing in my case (really a misuse of the term), I did it myself.

I agree. There is rationing -- not everyone could afford to go the the world's best X surgeon for their X problems. I don't think this is bad or inappropriate, and I (as a capitalist) prefer systems that let individuals decide how to ration. For example, I have little money and prefer to severely limit the amount I spend on healthcare. Another person with my income might decide to spend less on housing and more on healthcare than I do. I'm glad to have that choice -- although because I have employer-subsidized health insurance, I still spend more than I would prefer on healthcare.

 

[Sea Cow]

Ok, fine, I get you like it and NHS does well by you.

But I'm not so hard pushed to find those who disagree who have had first hand experience. I have several friends from the UK who won't touch the NHS. One of them, just back from serving with the UK forces in Afghanistan, visited me here last week. For a more public example, see the UK's MEP Daniel Hannan here:
http://www.youtube.com/watch?v=OAbaMS12aDY&feature=related

Yes, Daniel Hannan's appearances on US TV were well covered here. He is considered an extremist right-winger even in his own right-wing political party, the Conservatives – whose leader, David Cameron, disowned him because of his comments. It is electoral suicide here to suggest getting rid of the NHS. I can't watch that clip at the moment as I'm sneaking a view of this at work, but I know the kinds of things he's been saying. Suffice to say that I think, having listened to this idiot, you'd be pleasantly surprised if you then stepped into a British doctor's surgery/hospital. What he does is take examples of isolated incidents and imply that these are the norm. They are not. He also takes examples of things that happened several years ago, problems that have since been solved.

That said, the UK system would be unworkable in the US. The physical buildings are owned by the state and doctors are employed directly by the state. Realistically, you couldn't go from what you have now to this. If I were American, I'd be pressing for a system like they have in France. Hospitals and doctors are not owned/employed directly by the state there. Instead, they have a system of universal national insurance, and they pay fixed amounts for particular treatments. You can then choose to go to a hospital that charges this standard rate or use the contribution as part-payment at a more expensive place, but the hospitals themselves are not run directly by the state. French healthcare is generally very good, although you do often have to pay money up front and go through the hassle of claiming it back.