Impeding changes to our Health Care system

[xoxoxoBruce]

Originally Posted by glatt

I work at a law firm. It's been a while because I'm in a managerial position now, but I've had to read the US Code and read laws as passed and go back to the Code to try to piece together what they mean. It's painfully fucking slow and tedious and you are never really sure that you got it right.

Since that's the case, how the fuck can the Supreme court decide what the scope, and/or intent, of the law was supposed to be?

[Griff]

Remember when the Republicans didn't read the unPatriot Act? This is that again. We elect them to read this crap because we don't have time to. Someone in their office should read eveything they vote on or we should just go with direct democracy.

[TheMercenary]

Originally Posted by classicman

lol - very nice! but still no chart and you didn't post any poll data either - you're slippin

[Spexxvet]

Originally Posted by Griff

...we should just go with direct democracy.

Hell no! Then I'd have to read that shit! Just give me the executive summary and tell me where to sign. :p

Here is a good example from the House bill, The America's Affordable Health Choices Act of 2009

The initial draft of the bill is 1,018 pages in its entirety. The reason it is so many pages is that it uses large fonts, short lines of text, with wide spaces between lines (and each line numbered) so that it can be marked-up by the committees as they review it.

Is it really a 1,018 page bill or are the Republicans playing theatrics when they wave it around and drop it on the table to a loud "thump" to make a dramatic point! Nope, with normal fonts/spacing/formatting, it is probably not more than 100-150 pages.

Now the example:
Title II is the proposal for a health insurance exchange (Subtitle A), including a public option (Subtitle B).

In the full text, 1000+ page draft bill, Title II is described in pgs. 72-143 (71 pages) - you dont want to read this, not because of the length, but rather because it can be confusing with all the references, including grammatical edits, to existing laws and the US Code.

In a cleaner version (with the removal of some, but not all of the extraneous references to existing code)...Title II is described in pgs. 22-42 (20 pages) and the total 1000+ page bill is reduced to 57 pages...but still not the easiest document to read.

In a section-by-section summary, Title II is covered in 4 pages (pg 4-8) and the total 1000+ page bill is reduced to 35 pages.

And the most basic, one page, "at a glance" descriptions of:
the Health Insurance Exchange

Public Option

IMO, most members of Congress do not need to read the full 1000+ page original text bill to understand the proposed health insurance exchange and public option (or any provisions), but every member should read more than the one page "at a glance" summaries.

There is no reason why any interested citizen cannot read the 35 page summary to have a reasonable understanding of the bill.

And can we now stop with all the 1,000+ page bill nonsense?

[xoxoxoBruce]

Every bill is carefully read, dissected, and digested, by knowledgeable people.

Those people then tell their bosses, to tell their lobbyists, to tell the congressman's staff, to tell the congressman, what it says... and why he's for or against it.

[TheMercenary]

Swiss Health Care Thrives Without Public Option

http://www.nytimes.com/2009/10/01/he...y/01swiss.html

[TheMercenary]

Panel Finishes Work on Health Bill Amendments

The bill would require most Americans to have insurance, would offer federal subsidies to help pay the premiums and would significantly expand Medicaid. To help offset the cost, it would cut hundreds of billions of dollars from the projected growth of Medicare, impose a new excise tax on high-cost insurance plans and charge annual fees to insurers, drug companies and manufacturers of medical devices.

http://www.nytimes.com/2009/10/03/he...tml?ref=health

[classicman]

Under the Baucus bill, a family of four making $63,000 would have to pay 11 percent of its income for health insurance, according to Kaiser. By comparison, an earlier bill from the Senate Health, Education, Labor and Pensions Committee with more generous subsidies required the same hypothetical family to pay about 7 percent of its income for premiums — a difference of about $2,500.

The legislation provides the most generous subsidies to those at or near the poverty line, about $22,000 for a family of four. That's where the problem is concentrated because about three-fourths of the uninsured are in households making less than twice the poverty level.

For a family of four making $45,000, federal subsidies would pick up 71 percent of the premium, according to the Kaiser calculator.

For a family with an income of $63,000, the subsidies would only cover 36 percent of the premium.

A family making $90,000 would get no help.
Pollitz said the subsidies disappear rapidly for households with solid middle-class incomes. That could be tricky for a self-employed individual who has a particularly good year financially.


Another problem is that people won't be able to get the insurance tax credits immediately after the bill passes. To hold down costs, the assistance won't come until 2013, after the next presidential election.

Link

Is this fear or fact? You try and decide.

[classicman]

Acknowledging the affordability problem, Baucus' committee voted Friday to exempt millions of people from the requirement to buy insurance and reduce penalties for those who fail to do so. But that would mean leaving at least 2 million more uninsured — not very satisfying to Democrats who started out with the goal of coverage for all.

"I think we've got to do something about it," said Sen. Chuck Schumer, D-N.Y. "We've got to make sure health insurance is affordable for the middle class."

Well that right there is an understatement.

[xoxoxoBruce]

Originally Posted by TheMercenary

Swiss Health Care Thrives Without Public Option

http://www.nytimes.com/2009/10/01/he...y/01swiss.html

While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.
Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.
If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed.

On average, out-of-pocket payments come to $1,350 annually. Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600.

As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.

That is partly because the Swiss health insurers are not shy about using their muscle with physicians.

You think the AMA will go along with that?
I didn't see anything about Swiss malpractice policies, either.

[TheMercenary]

Not just the AMA, and btw many specialists abhor the AMA, but few are going to go along with significant changes to reimbursement willingly. I think most feel some wave of change coming but there will be a showdown over it and a lot of people are going to be caught in the middle of it. Each individual entity which received monies from the current model, including patients, is going to have a dog in the fight. Some will win and some will lose big time. Right now the only big winner I see is the traditional Lady-in-waiting of Congress, the insurance companies.

I agree the insurance companies will be one of the big winners if there is no public option included in the final reform.

But I dont see any of these provisions as a big win for the insurance industry:

* ending exclusions on pre-existing conditions
* requiring caps on total out-of-pocket expenses
* eliminating cost-sharing (no co-pays or deductibles) for preventive care
* mandating a required level of basic benefits
* forcing greater competition in order for an insurance company to be included in the health insurance exchange

They would certainly lose under the swiss model in which the insurance companies are highly regulated at the federal level, including being forced to operate as a non-profit in providing a basic level of coverage to all citizens.

There is a reason why most of the insurance industry lobbying money is working as hard as it is against comprehensive reform.

[TheMercenary]

Originally Posted by Redux

I agree the insurance companies will be one of the big winners if there is no public option included in the final reform.

But I dont see ending exclusions on pre-existing conditions or including caps on total out-of-pocket expenses, or eliminating cost-sharng for some preventive care, or mandating a required level of basic benefits, or forcing greater competition in order for an insurance company to be included in the health insurance exchange as a big win for those companies.

True, but those costs will be paid by someone, the government, the individuals, or the other non-insurance parties involved, which is why the model will ultimately fail to deal with the root problems of the current system.

They would certainly lose under the swiss model in which the insurance companies are highly regulated at the federal level, including being forced to operate as a non-profit in providing a basic level of coverage to all citizens.

I prefer this model over that being proposed.

There is a reason why most of the insurance industry lobbying money is working as hard as it is against comprehensive reform.

No doubt. They are still in the back pockets of the Congress.

There is a reason why most of the insurance industry lobbying money is working as hard as it is against comprehensive reform.

And, even under the Swiss model you prefer, the government subsidizes consumers when the costs exceed a government set percentage of income. Someone always has to pay.

IMO, greater competition (like the proposed exchange), along with standardized federal regulations (like those I listed above), are still is the best way to lower costs and/or ensure a basic level of service.

I am open to other ideas, but all I hear are complaints and misrepresentations of the proposals on the table, and not solutions.

I suggested earlier how I would pay for it (increasing FICA taxes on high income wage earners). The other proposals most under consideration also are targeted to the top 1-5% of taxpayers.