Health Insurance Discussion

[JRScott]

Article I Section 8 does not enumerate Health Care as a power of the Federal Government thus all present bills are really unconstitutional.

The Constitutional things they could do such as Tort Reform and Ensuring more intrastate competition between insurance companies is not in any of the bills.

[SweetGeorgia]

Why would it scare you to death? You pay for lots of things you don't have to use. (Or at least I do).

You get "self pay" discounts because you've been able to ask for them in advance. If I'd been uninsured last year, I'd be on the hook for better than $150,000 right now (just medical). My insurance company paid nowhere near that. It's great that you take care of yourselves, but my point is that sometimes you're in no position to negotiate ahead of time for a planned expense.

I've often commented that if I'd smacked a pedestrian with my car instead of getting sick, we'd both be better off - I had real insurance for that.

I keep hearing this $1 trillion pricetag for reform being thrown around, and I keep thinking, will United or Wellpoint give us the same deal? Of course not. It sounds like a lot of money, but it isn't, and I don't imagine reform will get any easier when the insurance industry controls even MORE of the economy. Will we be ready when it's 20% of GDP? Maybe we should wait for 25%.

[DownNotOut]

We often hear there are 47 Million uninsured Americans. I would love someone to break this list down by who these people are. How many are voluntarily uninsured? How many are temporarily uninsured? How many are illegals? How many are eligible for existing programs? I believe the actual number of uninsured Americans is around 10-15 million. Why can't we look to assist these people without overhauling the entire system?

My family are part of those "uninsured" and we CHOOSE to be that way. To be honest, all their talk of "requiring" health care coverage and "fines" for not purchasing it make me ill enough to actually want to see a doctor!

This whole thing scares me to death. We take responsibility for our own health and the health of our children through other means rather than allopathic medicine. We are more health conscious and homeopathic. We grow our own organic produce and herbs, mill our own wheat, get our own milk right from the cow, etc. And we don't take medication. I have no desire to be forced into this system and why should I be punished for it?! Why can't the government just leave me alone?! On the rare occasion that any of us has had to see a doctor, we have a holistic physician who is supportive of our choices and we have no problem being self-pay. Why do I have to change that? We have found that when you tell people you are self-pay, you get a discount. Probably because they know they are getting money in hand and don't have to file paperwork for it.

I'm sure they'll be many who argue with me or blast me with "what ifs", but this is how we have lived for many, many years and we are happy. There are only two people I trust enough to put my life in their hands and that's God and my husband.

[justplaintired]

I work in a small DME store. Family owned and operated. It isn't a big business and most of it is Medicare business. That and private insurance. I do alot of the book work and deal with insurance payments. I see so many cases of denials from private insurance companies it blows my mind. One of these companies which was mentioned earlier is the all time worse. They deny whenever and whoever they can. They deny for this and they deny for that. It's sickening. So to me healthcare reform is a must, plain and simple. I see so many good people come in who need equipment, and if Medicare is their primary there is really no problem. Medicare lays it out very simply what they will pay and what their allowable is. And then they pay. Secondarys pick up sometimes, some are better then others. But their is no guarntee, none. I see this almost everyday. I know some think providers like this store are money hungry, but this store isn't. We are in the business mostly to help people, it's a joy being able to help someone, but when insurances don't pay the provider, the provider can't keep it's doors open. It's scary to think so many out there don't realize just how screwed up this system has become. Premuims have gone up, sky high, and coverage has gone down.

I am not an expert, I am a consumer and also someone who sees what a messed up system this is almost everyday. It is time for a change, and another thing, I think blaming Obama for this mess is beyond rediculous, and to blame him for the bail out mess, we really should remember the first bailouts came before he was ever in office, so be fair. Surely no one in their right mind thought he could change this mess overnight. This mess was started long before he stepped into office and it doesn't appear that anyone before him actually tried to help fix this mess he didn't create.

[justbroke]

I think the prices can be controlled via a single-payer model. What do you think HRx? i think there is absolutely no healthcare reform until a real, actual, and tangible way to reduce costs is introduced. I just haven't seen that yet.

I'm not afraid of reform. I'm afraid that I'll be paying more... even with the reform.

[lrprn]

I will bet anyone on this Forum, $100, that my healtchare plan costs will rise in 2009 and 2010... even though there's a claim of lower costs and a $1B pricetag on the reform. As a matter of fact, I expect my costs to rise about $100/month, so I won't even be losing any money on this bet. Who will take my bet?

I'll take it with one added condition - if no health reform passes, I'm willing to bet that your current health insurance private company will raise your annual premiums more than $100/month to ensure they can continue to have large profit margins as millions of the formerly insured lose their jobs and their health insurance along with it. Why do you think big insurance and big pharma are fighting so hard against reform?

There is no perfect plan, no sure bet, for healthcare reform. The one thing that is certain and pretty much everyone seems to agree on - the current pay-for-procedure model that is reimbursed only by for-profit private insurance companies in this country is a dismal failure. I deal with that failure face to face every single day I work - good people who have bad things happen that they did not deserve, including those who have good insurance now and they still are going under financially.

Yes, we do have the best healthcare system in the world.....BUT ONLY IF YOU CAN PAY FOR IT.

Don't want government between you and your doctor? Your insurance company is there now between the two of you rationing the care you can receive now, not by whether the treatment is proven by research to accomplish what it should, but solely by that treatment's cost - why is that ok?

Something has to be done, because the current system cannot be propped up much longer. Hospitals are going broke. Several have already closed their doors this month. Thousands of hospitals are laying off staff not because they aren't needed - they are desperately - but because they can't pay them any longer. There is no staying with the status quo.

For those who don't like the health reform draft bills that may be proposed by the House and Senate, then what ideas does the opposition have to fix these problems? Just addressing tort reform won't do it, not by a long shot. C'mon - let's hear those ideas and the facts that support them.

[justbroke]

The problem with a fee-per-proceedure vs. salary model is that some doctors would rush patients through so that they could do as many procedures as possible to make more money. With a salary, that eliminates that problem. But it also introduces the problem of salaried people not doing enough work.

I agree. We need something better than both of those two schemes. However, for the rate I pay for medical care, I like the fee-per-procedure. I've never felt rushed, and my care has been consistent and excellent.

I think this may be the problem that everyone is trying to struggle with. I'm paying nearly $7,000 a year for health insurance. That doesn't include my out-of-pocket which looks like it will be over $1,000 this year. (That $8K represents less than 5% of my annual salary.) A below-the-median income family would have a tough time paying that... and if they are paying that, they are certainly lacking things in other areas.

Also, in the new plan, they try to lure the medical providers into this new scheme by offering incentives for diagnosing conditions the first time around. I don't see how you can do that. The cost of properly diagnosing most conditions, requires thousands of dollars in medical tests. At the same time, they're pursuing to decrease costs, so the tests go out. That's why I never understood why anyone would think that to reduce costs, you have to reduce testing. An "unnecessary" MRI might uncover something that is not the chief medical complaint for that visit. How about an annual MRI? Or one on a wellness schedule?

I don't see how you fix it without making the whole thing either single-payer or the government taking over the entire system. I just don't see it.

[TooMuchCredit]

The problem with a fee-per-proceedure vs. salary model is that some doctors would rush patients through so that they could do as many procedures as possible to make more money. With a salary, that eliminates that problem. But it also introduces the problem of salaried people not doing enough work. So maybe a combination of the 2, fee-per-procedure with a cap.

I do think whatever we pay should by a % of our salary instead of a flat fee, even if things were kept the same insurance is provided just within a company. Right now regardless of your salary, you have to pay the same amount for you coverage. This burdens the lower paid workers more than the higher paid workers.

[justbroke]

Okay, so Nancy Pelosi just walks out of the White House and tells us that this plan will, amongst other things, lower costs.

I will bet anyone on this Forum, $100, that my healtchare plan costs will rise in 2009 and 2010... even though there's a claim of lower costs and a $1B pricetag on the reform. As a matter of fact, I expect my costs to rise about $100/month, so I won't even be losing any money on this bet.

Who will take my bet?

[justbroke]

The cost of covering the uninsured is separate from the related question of how to "bend the curve" of the country's overall health-care spending. The goal is to achieve this by expanding "comparative effectiveness" research into what treatments work best, and by nudging health-care providers into models in which they work closely together and are paid on salaries, instead of charging for each procedure provided.

This is the problem I eluded to earlier. I still don't see where it actually reduces costs. I only see where it... increases coverage. Most of the things that I read are "theoretical" and say things like "we should be able to", "we should see reductions".

I could never write a contract with that type of ambiguity in my profession!

The goal is to achieve this by expanding "comparative effectiveness" research into what treatments work best, and by nudging health-care providers into models in which they work closely together and are paid on salaries, instead of charging for each procedure provided.

This reads to me like... we will only cover treatments that are known to work. I've seen actual cases where insurers already do this. And when insurers do this, we say that they are not looking at the individual, but only looking at costs. For example, HMOs not using MRIs unless there is enough evidence to warrant the cost of one... where the MRI is actually more effective. I don't see the government ever getting it right in this case. What you'll see is a list of proscribed treatments for particular scenarios/diseases/cases and that's all the attending physician will be allowed to do.

By the way, that statement says it all. "Nudging health-care providers into models in which they work closely together and are paid on salaries, instead of charging for each procedure provided." To nudge means to push which means legislative authority to penalize healthcare providers who charge by procedures!

So, how do you "nudge" the healthcare providers into this model? You reduce reimbursement rates so they are incentivized to run with a salary model (pure overhead-driven model) over a per procedure model. I haven't ever seen this work well. The early day HMOs did this (where the HMOs ran their own clinics), and we saw what happened in the 1990s with that.

Wow.

[lrprn]

Being a registered nurse, I've paid very close attention to all sides of the healthcare reform issues. This article from today's Washington Post gives the best (and by far, the most factually accurate) summary answering questions about healthcare reform compared to anything I've seen to this point from reliable news sources.

8 Questions About Health-Care Reform Reporting by Ceci Connolly and Alec MacGillis

President Obama will address a joint session of Congress on Wednesday in an attempt to restart his push for reform. Obama has said he hopes to provide affordable coverage to every American while reining in medical spending over the long term. Democratic lawmakers, who return to Washington on Tuesday, have been wrestling with the issue for months but are far from agreement. Here’s a look at some ideas being considered and the impact they might have.

#1 If I don't have health insurance now, how will reform affect me?
Under the proposals being considered, people without insurance will be required to get it. They will be able to buy coverage on a new "exchange," a marketplace in which private insurers will offer plans (possibly alongside a government-run option or a nonprofit cooperative). The government will subsidize the cost of plans, on a sliding scale, up to a certain income: Liberal Democrats want help extended to families earning as much as four times the poverty level ($88,000 for a family of four); conservative Democrats want to limit help to families earning $66,000 or less. Plans offered on the exchange will have to comply with much stricter rules than those that exist in today's Wild West individual insurance market — prohibitions on denying coverage based on preexisting conditions, limits on how much prices can be determined by people's ages, caps on out-of-pocket spending and limits on "rescissions," or the practice of voiding coverage based on technicalities after someone submits a big claim. Meanwhile, the poorest among the uninsured will probably be covered by expanded Medicaid eligibility.

#2 If I currently have health insurance, how will reform affect me?
Not that much, at least initially. The legislation is intended to preserve the existing employer-based insurance system -- at first, only small businesses and people who aren't covered through their jobs will be allowed to buy plans on the new exchange. Over time, access to the exchange may be broadened, though this raises the possibility that if people buy insurance on the exchange instead of on the job, employer plans may be left with a smaller pool of employees who have greater health-care costs, a situation that could make those plans hard to sustain. The Democrats' hope is that your employer-based insurance premiums will grow more slowly if the health-care system as a whole is more rational and less wasteful. People now covered by individual plans will be able to get better-regulated plans on the new exchange, possibly with government subsidies. People now covered in the workplace won't have to worry as much about losing coverage if they lose their job or want to start their own business -- they would turn to the exchange for new coverage.

#3 How much is reform likely to cost?
The price tag for covering the uninsured comes in around $1 trillion over the first 10 years, just under double what the new Medicare drug benefit was expected to cost. The proposals would pay for about half of this by squeezing money out of Medicare and Medicaid, including the subsidies that now go to private insurers that offer Medicare Advantage plans and the Medicaid payments that go to hospitals caring for a disproportionate share of the uninsured -- the hope is that more of these hospitals' patients would be covered after reform. Much of the remainder would be paid for through new tax revenue. House Democrats want an income tax surcharge on those earning more than $1 million, President Obama wants to reduce the itemized deductions for wealthy taxpayers, and moderate Senate Democrats have talked about taxing the most costly of employer-provided health plans. The cost of covering the uninsured is separate from the related question of how to "bend the curve" of the country's overall health-care spending. The goal is to achieve this by expanding "comparative effectiveness" research into what treatments work best, and by nudging health-care providers into models in which they work closely together and are paid on salaries, instead of charging for each procedure provided. (Graph shows how upward steep curve is "bent" lower by proposed changes.)

#4 How much does the federal government now spend on health care?
(Graph shows that the federal government pays about a third of health care costs now. The rest is paid with private and public money.)

#5 What will happen to small businesses under health-care reform?
Small businesses now have a difficult time buying coverage for employees. They have a smaller pool of people to cover than large companies do, so coverage costs can soar if the workers tend to be older or if even one person happens to get very sick. The proposals seek to solve this problem by letting small businesses buy coverage on the new exchange, where their workers would be pooled together with all the other people on the exchange, spreading the risks more broadly. The proposals also include various tax credits to help small businesses obtain coverage. At the same time, the proposals require businesses of a certain size to provide coverage or pay a penalty. The House bill originally mandated that companies with a payroll of at least $250,000 offer insurance or pay a fine ranging from 2 to 8 percent of payroll depending on the company's size; conservative Blue Dog Democrats, however, demanded that companies with annual payrolls of $500,000 or less be exempt from any mandate. The Senate Health, Education, Labor and Pensions Committee bill has a penalty of $750 per full-time worker and exempts firms with fewer than 25 employees. The Senate Finance Committee is considering a lesser penalty -- charging businesses the cost of subsidizing those employees who qualify for public assistance in getting their own coverage.

#6 I keep hearing about plans to create a "public option" or health insurance cooperatives. How would those work?
The House Democrats' plan and the Senate health committee's plan both would offer a new government-run insurance plan, or "public option," on the new exchange. People would buy it just as they would a private plan on the exchange: They would pay premiums, and if their income is low enough, they would get government subsidies to help cover the cost. It would be available only to those people allowed access to the exchange -- initially, small businesses and people without employer-based coverage. Under the initial House plan, the public plan would pay doctors and hospitals reimbursement rates 5 to 10 percent higher than Medicare reimbursement rates. The thinking is that this would make the plan competitively priced compared with private plans -- spurring them, it is hoped, to reduce their own prices -- while somewhat allaying the concerns of providers who say Medicare reimbursements are too low. Blue Dog Democrats in the House want the plan's reimbursement rates to be negotiated with each provider, instead of tied to Medicare, which would probably mean higher reimbursements and premiums. Moderate Senate Democrats opposed to a public option are considering creating nonprofit insurance cooperatives, which would be seeded with federal money but run by the people who belong to them, not the government. Supporters of the public option are questioning whether the co-ops would have enough heft to compete with private insurers.

#7 What is likely to happen to my Medicare coverage under current proposals?
The vast majority of benefits provided by Medicare to 45 million senior citizens and people with disabilities would not be changed. Under the House bills, premiums for Medicare prescription drug coverage, known as Part D, would increase slightly. That increase would be offset by deep discounts on medications bought in the coverage gap known as the "doughnut hole."

Overall, the result would be lower out-of-pocket costs on prescription drugs for most seniors, according to the Congressional Budget Office.

Most of the bills Congress is considering would provide higher reimbursement to doctors, especially primary-care physicians. But hospitals and insurance companies that sell managed-care plans, called Medicare Advantage, would have lower-than-expected government payments.

Democrats initially included a provision to allow Medicare to reimburse physicians for end-of-life consultations. But false accusations that the provision would lead to government "death panels" have prompted lawmakers to rethink the idea.

#8 What do the current bills have in common, and what are the major legislative challenges that lie ahead?
Bills approved by the Senate health committee and three House panels are similar in many respects. All four versions would:

* Require every American to carry insurance, with discounts for people who cannot afford it and penalties for people who refuse to buy coverage.

* Require most employers to contribute to the cost of employee coverage or pay into a health fund, while small firms would be exempt or receive tax credits to reduce the price.

* Expand the Medicaid health program for the poor.

* Provide insurance discounts for people earning less than 400 percent of the federal poverty level, or about $73,000 for a family of three.

*Impose new restrictions on insurance practices, such as prohibiting the denial of coverage because of preexisting conditions.

* Create a new marketplace, dubbed an "exchange" or "gateway," for individuals and small businesses to comparison-shop for insurance.

The Senate Finance Committee has yet to release a bill but is circulating a more modest draft that would cost less than $900 billion over 10 years and provide smaller subsidies for purchasing insurance.

In the coming weeks, the three House versions will be merged into a single bill and brought to the floor for a vote. Any Senate Finance Committee bill would be merged with the health committee's version and sent to the floor. If both the House and the Senate approve bills, differences would be hammered out in a conference committee and sent to both chambers for final action.

From http://www.washingtonpost.com/wp-srv...ons/index.html

[Mi Bankruptcy]

I found the house bill posted below on the blog. It also has a link to the bill. That is being said, I have not had enough time to read all of the proposed for healthcare changes. What I have read does not seem too bad. People went crazy with 1996 welfare reform act which is saving money. Those people that are on SS or using medicare. I just hope it is available in 35 years when I want to collect since I have been paying into it since the age of 15.

http://governmenthealthcareblog.com/

[justbroke]

Back to healthcare.

I always buy the most expensive insurance package from my employer, because I travel for work. This is an EPO (Exclusive Provider Organization) which provides the least out-of-pocket of any of the plans we have. It is costing me, with a Dental HMO, $580/month for a family of four. No worries, I can afford it... but, it seems it goes up every year and there are some very sneaky things they do with coverage.

While the majority of my office visits are covered, wellness exams covered, lab work covered, etc, etc... they get me on specialists (80/20 co-pay). Additionally, there are questionable aspects if I'm out of State. I called them on that, and they said that they actually do cover me out of State and out of network at 100% for emergencies (emergency room with admission).

The spiraling cost of healthcare, in my book and based on my review, is in prescription medicine costs, litigation, losses (due to public healthcare) due to negotiated pricing. The problem isn't in medical billing, lack of care, or anything like that. Our mortality rate isn't from our lack of a good healthcare system.. it's from what we eat.

Prescription Medicine Costs: I worked in Pharma before. While they may spend $100M to create a new drug, they make billions on it afterwards. If you have a problem, there is someone out there (Phizer, Astra, Merck, Aventis) who either has a pill or will create one for you!

Litigation: I have a very close friend who is a NeuroSurgeon. She's good. She's only been sued once, but cried when it happened because she didn't even operate on the person. The patient sued everyone affiliated with the hospital. She is private practice with 4 other neurosurgeons. They have their own equipment including their own MRI equipment. The cost of her malpractice insurance is more than an affluent household makes in Greenwich Village, Connecticut. Translates directly to costs.

Losses: losses come in two forms, but my Doctor discussed this with me recently. He says that he loses money by seeing medicare/medicaid patients becuase the reimbursement rates are pre-set and don't take anything into consideration. He states that they are way too low. On the other hand, even though private insurance (Blue Cross/Blue Shield, Aetna, UnitedHealthcare, CIGNA) have group rates, where there are industry established rates for things, he still makes money.

Now I mentioned negotiated pricing on purpose. I stayed overnight in the CICU just for "observation" once. It was absolutely nothing, but the nurse talked me into staying overnight so I could some tests in the morning. ANyhow, the bill was over $14,000 including the tests. My insurance company paid the industry standard (reasonable costs) of about $7K and I owed nothing (as I went to the emergency room and was "admitted"). I saved $50!!!

However, what about the guy without insurance. He gets the $14K bill. Now that has got to stop.

The information printed above is my own personal experience. I did not research any website or look at CNN or even base it upon anything the current Administration is looking at. However, I'll say that the problems are not where they would have you believe they are. Like my personal physician, I feel sorry for doctors if there is a public option because that would certainly hurt the doctors, and many will go out of business. My prior two doctors went out of business over medicare/medicaid "lack of" reimbursement. And they wonder why there's so much medicare/medicaid fraud.

[OhioFiler]

Obama's initiative to instigate, review and discuss health care reform is the one of the best social interest initiative we've seen over the past eight years. It's definitely better than the wasteful, "War on Terror" move.

Obama's initiative is a power grab. Nothing more or less.

Obama continues the "wasteful" war on terror by wasting billions of dollars and hundreds of lives in Afghanistan yet the left seems to not even notice this war since Bush and Cheney are gone.

[OhioFiler]

[FONT="Trebuchet MS"]Privately operated health insurance is already a mess. This unrealistic fear of "government" control doesn't make any sense. People have this false idea that privatization of an organization will have the best interests of people at hand, which is completely untrue. Health Care is a major, major money making business, and a lot of big wigs money is a risk if health insurance is improved to start paying out for coverage versus denying everything to keep growing their bottom line. Obama's initiative to instigate, review and discuss health care reform is the one of the best social interest initiative we've seen over the past eight years. It's definitely better than the wasteful, "War on Terror" move.

The status quo is the worse thing that can be down with health insurance situation right now. Is a universal or government operated insurance the answer? Not necessarily, but across the board reform is needed sooner rather than later.[/FONT]

The status quo is the finest health care system in the world, bar none. Why is keeping the status quo worse than socializing the industry and operating it like the Canada, Great Britain or French models?

The key to reform is getting the damn tort lawyers out of the system. Interestingly, this concept is not addressed in the current bills being discussed in Congress.

We often hear there are 47 Million uninsured Americans. I would love someone to break this list down by who these people are. How many are voluntarily uninsured? How many are temporarily uninsured? How many are illegals? How many are eligible for existing programs? I believe the actual number of uninsured Americans is around 10-15 million. Why can't we look to assist these people without overhauling the entire system?