A blessing in disguise. The current health insurance reform SUCKS. Let's use this time to fight!

[debbierlus]

Reid is saying no bill before next year.

I am sorry, but that isn't much of a heartbreak. The legislation is horrible. In a nutshell, it mandates citizens to buy overpriced and non-comprehensive insurance from the private corporations that broke the health care system. TENS of millions will be without ANY insurance. Tens of millions more will be unable to afford anything but catastrophic coverage which hardly covers anything, even in the case of a catastrophe. Millions will pay a penalty from opting not to buy a product they can't afford and not choosing the cheap suck ass castrophic coverage.

The public option, in the best case scenario would cover 2%. CBC estimates those covered will pay MORE under the public option then under a private plan.

It does nothing to control costs, and it would quickly become financially insolvent (as is the case in MA, where I live - they are slashing the budget everywhere to keep it alive, but that will only work for so long - soon they will start cutting the health care benefits and making people pay higher co-pays - and soon that won't even be enough).

It allows the insurance companies to raise premiums up to 25% right off the bat.

It does mandate the insurance companies will not be allowed to deny coverage for those with preexisting conditions. It doesn't stop them from denying coverage utilizing the hundreds of other scumbag tactics they have developed to not pay out for claims.

In sum, this legislation sucks. And, the fact that it is being delayed, it gives us time to FIGHT for real reform. Single payer or a public option open to everyone. We need to organize. We need to lay out our terms and STICK TO THEM. We need to make ourselves MATTER. We failed to unite over the summer, we were all waiting with fingers crosses for Obama to outline his magic plan and Congress to fight for us. It didn't happen.

We have been given the gift of more time. And, it should not be wasted whimpering and whining to Congress making demands for a non-existent public option. We need to demand real health care reform.

If we can convince them that implementing real health care reform is the magic key for decades of democratic power, they might go along...

Peace

(Here are a couple of relevant articles from my journal. I have tons of related links on health care reform that pretty much document the evolution of the legislation over the past year)...

http://journals.democraticunderground.com/debbierlus/33...

http://journals.democraticunderground.com/debbierlus/32...

[debbierlus]

1. At least counter, if you are going to unrecommend

[Jackpine Radical]

2. I kicked ya over the hurdle, Deb.

I haven't commented much in your threads, but I have been aware and appreciative for a long time of the passion, knowledge. insight and compassion that you're bringing to this issue.

[JaneFordA]

98. I really don't understand...

... why anyone would unrecommend an article as great as this one is????

GREAT article! Way to go!

[Cleita]

3. I wish there was somebody, a high profile public person

like Cindy Sheehan or the late Martin Luther King, who could organize a large movement like the civil rights movement of the sixties to descend not only on Washington but on the headquarters of Senators and Congressmen, who are being obstructionists in this. It would take organizing busloads of people to descend on these communities and conduct rallies on the steps of their offices. It would take someone who could raise funds to pay for those who can't pay their own way and someone with the political connections who could rally Democratic clubs across the nation to get them to get their members to participate. It would take organizers to charter buses and to find places where people could camp. The scattered protests that are going on today with the dedicated people doing it aren't being noticed much except to get those people arrested. It shows how little regard they have for their constituents.

Also, we need to keep the message simple and call it access to Medicare for All. Unfortunately, coming on winter is not a good time of the year to go camping, but maybe it will show them just how much we mean business. We need to surround Washington and many state capitols with "hoovervilles" of the uninsured and underinsured and those dedicated to meaningful national health care for everyone.

[Kansas Wyatt]

42. I wished Democratic Members of Congress would actually read the DU

Instead of sending over their minions and operatives to attack and put down anyone who is speaking out against getting screwed by their alleged Health Care Reform / Giveaway to the Insurance Industry crap.

Then again, maybe Rahm has Agent Mike busy on new priorities.

[Cleita]

51. This thread is full of them and they can't even get their facts straight. n/t

[inna]

4. +1.

The "reform" (or rather, deform) doesn't kick in until 2013 anyway, so i'm not sure how significant this current delay is.

My personal preference would be to abort this travesty of a reform now, and start over with HR 676.

[Cleita]

5. +1

[Dr Robert]

6. how inane can you get?

The PO will pass.
And you'll probably be upset when it does.

[Cleita]

8. I'm really curious as to why you are here.

You keep slapping down anyone who wants a public option that is access to Medicare for everyone. It's what this nation needs. Please stop making baseless accusations about how upset or how much crow someone is going to have eat when a public option, that no longer exists, passes.

[Egnever]

16. That most absolutely is not what this nation needs.

What this Nation needs is a health care system modeled on the best health care systems in the world. Not a health care system designed on catch phrases.

[Cleita]

20. The best health care systems in the world are the ones modeled on

what the OP has set out, or single payer systems. Even Tom Daschle and President Obama have stated that single payer universal health care like our Medicare is the best health system, but they also admit they can't do it here because of the health insurance cartel. So it will take the will of the people to get it done. Please get out of the way if you can't be helpful.

[HughMoran]

22. "Please get out of the way"

Says the raving person who's single-handedly spamming another thread on healthcare to death with emotional screams not backed with any facts or realistic counter-proposals. Yeah, and I want a puppy too.

[Cleita]

24. You don't know what you are talking about.

So don't hurl accusations at those who do.

[Egnever]

28. .

[Dr Robert]

29. do you ever question your position? doubtful

if you had, you would realize that your deathgrip on Single Payer is a stumbling block to progress.

You won't even consider the repercussions of what a sudden move to Single Payer entail.

You just want what you want regardless of the facts.

That's called irrational attachment.

[Cleita]

37. If you have actually read my posts, you will find that my compromise

position is a public option that everyone can access and that is comprehensive. That is a true option, one that everyone can choose if they prefer it, not just 2% of the uninsured.

[Dr Robert]

39. a Public option that everyone can access = Single Payer

Are you really willing to deny the uninsured the coverage they will get with the PO just so you can fight to save a little money for yourself?

[Cleita]

43. It will probably lead to that in the end if the private insurers can't compete.

However, what happened to all the talk about free markets being best? All of a sudden when this health care cartel that has a stranglehold on our health care dollars has to compete on the open market, they are all verklempt about it.

[Dr Robert]

56. exactly. but it can't happen all at once.

I want the Health Insurance Mafia dead as much as you do.

I just know that if we try to kill them immediately they will hurt us all on their way down.

This has to be done incrementally just as Howard Dean said.

[clear eye]

104. Ya know, that's exactly what most people said to MLK as he started to integrate the South.

Things just don't work that way. Public opinion gradually changes on an issue, as it has on the desirability of publicly financed health care. Then, when the iron is hot, a movement builds, and the big change is made in a short time. Enforcement lags behind, and things get tweaked or improved, but the major change pretty much happens all at once, as an expression of new public opinion.

And like the "Segregation Forever" folks in the early 1960s, you're on the dying side.

[bertman]

96. WRONG, Dr Robert. A PO that everyone CAN access is NOT Single Payer. Get YOUR facts straight.

A PO is just that--an OPTION. No one has to select it if they are happy with the insurance they have --or do not have.

A PO could easily be set up within the existing system and would be a hybrid of Public and Private healthcare. I could choose to keep my current insurance where I pay $850 per month for my wife and me, plus $2500 in deductibles, plus copays, plus whatever the overage is on my Cap. I could. But I doubt that I would. Because that would be my OPTION.

The Congress seems determined to keep the PO as far from any form of Single Payer as possible. Although I would prefer Single Payer, I could accept a strong PO that has a HUGE base of insured, lower rates, no pre-existing conditions allowed, no denial of claims for specious reasons, negotiated rates for physicians, negotiated rates for pharmaceuticals--even if it were administered by some insurance company bureaucrat as the current faux-PO iterations seem to be.

[clear eye]

102. Single-payer means ONE entity pays the providers.

As in single=one.

[truedelphi]

124. + 1,000 n/t

[HughMoran]

47. I agree

Nicely stated.

[pattmarty]

92. Medicare 1965, dipshit.

[clear eye]

99. You'd probably lose your middle-management job w/ a health insurance firm. n/t

[John Q. Citizen]

100. Sudden move? since 1965 we have had single payer for those 65 and older.

How about this? Every year, enroll people from 5 years younger, so the first year people 60 qualify, the second year people 55 qualify, etc.

Romney Care doesn't work.

Why don't we do something we already know works?


Instead of attempting to re-invent the wheel with these radical new ideas that never seem to work.

The Clinton plan, Managed Care, was a complete failure where it's been tried. It doesn't work.

Romney/Obama Caare is a complete failure, it doesn't work.

We know single payer works, and it works all over the world.

Are you suggesting Americans are too stupid to implement it and make it work?

[twitomy]

119. FYI Medicare is going broke,

And the enrollees still have to buy "Medigap" insurance, and it pays so crappy to the providers that they would be out of business if thats all there was.

In short,

Medicare-for-all would be a disaster unless some major changes are made to it.

[HughMoran]

45. I showed you facts in a post below to counter your argument

...then you changed the argument. The accusations are warranted.

[Cleita]

48. In your words, if the accusations are warranted

go look in the mirror. You have been doing all those things you accuse me of and any DUer who searches your posts will see that.

[HughMoran]

50. Oh, so now it's about me?

Pull out every argumentative technique when you're losing - it's really impressive!

[Cleita]

55. You just so don't make sense.

When you have something that is logical let me know

[HughMoran]

57. So now you're projecting

Perfect. There are still like 3 argumentative techniques you haven't resorted to yet - but I'm a patient man.

[Egnever]

27. One again since you cant sem to digest it.

The top rates system in the world is Frances and it is most definately not single payer.

Also I dont really care who says what. I dont let other people tell me what to think or to think for me.

As someone else in this thread stated Howard Dean and Krugman both say this is a good bill but that doesnt shut you up does it?

[juno jones]

36. France also runs a tight ship as far as those companies

go. They are highly regulated in France and if we could get that, that might be OK.

But this bill is a giveaway to to insurance companies with no real regulation or oversight whatsoever and by tying the cost of the "PO" to the cost of private insurance it makes it unaffordable to many of the people this legislation was supposed to serve.

[Egnever]

38. Where are you getting your info from?

There is both regulation and oversight. Why do you just make things up?

[juno jones]

74. I dunno.

Here maybe.

But I can also read. This bill ain't gonna help me or most other working stiffs, Not like it matters to the upper middle class that is this board's demographic.

I basically see that you guys have bought into the emperor's clothes for years and now want every one else to do so, because you will be humiliated otherwise. Too bad.

You are stupid to pay for capitalistic unregulated for-profit health insurance when every other civilized country has a real plan. Can I say it clearer? I mean, I just love those CEO's and their millions of dollar bonuses. I just feel my fucking purpose in life is to make sure their lives are taken care of, even as I can't pay rent, bills, food, etcetcetc.

You views are never going to go over with the people you are trying to 'help'. The staff at my restaurant is smarter than that. They want medicare for all, and don't understand why anyone would oppose that.

[fascisthunter]

117. I Understand why they oppose it

because they benefit from the current system, and it has nothing to do with medical care.

[Cleita]

40. If you actually knew anything about the French system, you would know

that basic, comprehensive health is paid for by the government like our Medicare is. Here read something.

http://unsilentgeneration.com/2009/10/21/french-medicar... /

2. The model is something very close to a Medicare-for-All system–only better. As Rodwin describes it: “It’s not government run but government financed. Like Medicare and Social Security, it is funded by compulsory payroll taxes with some income tax contributions. But doctors work predominantly in private, office-based, fee-for-service practices, and there is a mix of public and private hospitals. The main difference from Medicare is that the entire resident population is covered and the benefit package is more generous.”

Read the whole article. If you don't like it, the French government has a website in English that explains it all to you.

[Egnever]

61. You are correct I was wrong about the participation of private insurers.

And their level of participation.

[kenny blankenship]

54. You don't know what Assurance Maladie is? 80% of health spending in France PAID BY GOVERNMENT

It covers basic illness and is paid for out of a mix of payroll and income taxes. Only 20% of healthcare money spent in France is supplemental private insurance, and that small remainder represents mostly NON-PROFIT "mutuelle" associations. Canada also has supplemental private insurance on top of its government insurance plan.

Canada is a single payer country, in that basic health care is paid by the government and this preponderance of social insurance typifies the national system. AND FRANCE IS ALSO A SINGLE PAYER COUNTRY. You may be signed up with a mutuelle but your basic care there is being paid for by the government (L'Assurance Maladie Securite Sociale) . In fact, France pays EVEN MORE of its total health care bill through the government run plan than does Canada! In Canada 70% of all health care spending is paid out by the government; in France it's 80%.

Apparently, you have the term "Single Payer" confused with socialized medicine as in Britain's National Health Service.

[Egnever]

60. I stand corrected

[clear eye]

101. Italy ties w/ France for the best outcomes and it has gov't Nat'l Health Insurance n/t

[Dr Robert]

26. I question anyone who opposes the Public Option

'Single Payer or Bust' is a losing proposition.

Your assertion that the PO no longer exists is a blatant misrepresentation.

Your crow awaits.

[Cleita]

44. We have a right to be in the fight.

What you want is for us to put our tail between our legs and leave even before the fight has began.

[Dr Robert]

52. You want to give up right as we're about to achieve something wonderful, just because you want more

[clear eye]

103. And we think the current faux-PO "is a losing proposition"

big-time with private-insurer escalated costs that will fall like a ton of bricks where taxes and fees usually fall--on the middle class. We can substantiate what we're saying w/ the outcomes of similar programs in Massachusetts and Tennessee. And with the superior outcomes of most of the European countries, Canada, and Taiwan who all have at least gov't narional health insurance, two having the entire health system nationalized. World Health Organization data show total % of their GDP going to healthcare as remarkably stable at ~8%. Ours is ~18% and skrocketing (the CBO says the PO will add to expense, not save money) while our outcome ranks 37th.

So, please, just make your case with substantiating data about how much it will help us. Nobody's interested in your opinion about who can present their views and who can't. Last I looked, you weren't an administrator.

[DireStrike]

66. Any relation to "Dr Robert" in Grayson's healthcare town hall discussion?

The one that a local FL channel carried live with chat?

I hope not. That would make it hard to take you seriously.

[pattmarty]

93. I don't take him seriously at all. His place is to start shit, plain & simple.

[fascisthunter]

116. We know why you are here

[Dawgs]

7. Howard Dean, Alan Grayson, and Paul Krugman all disagree with you.

Why should I listen to you over them?

[Cleita]

11. Because they are wrong in this instance.

Senator Bernie Sanders and Congressman Dennis Kucinich and others agree with the PO, so why don't you listen to them instead?

[Dawgs]

30. Are Bernie Sanders and Dennis Kucinich Doctors/Economists?

I like Sanders and Kucinich, but I tend to go with experts I respect over politicians I just like.

[Cleita]

46. They are lawyers who have spent years studying the issue and have come

to the conclusion that it is the best and most economical way to deliver health care to everyone who needs it. Go to their websites and read what they have to say about it. I love Dr. Dean and company, but in this they are wrong.

[Mithreal]

112. You don't respect Sanders or Kucinich?

[Dr Robert]

41. you put an awful lot of weight into your opinion

Kucinich and Sanders want Single Payer, just like you.

They are irrational in this regard.

[HughMoran]

9. It saves me $25,000/year

In my case, you want to shiv me in the back. I work for a company of 10 people.

[Cleita]

13. Betcha it doesn't save you anything if the bill that passes is the one they

are trying to promote. It's people like us who set the standards much higher and ride our politicians about it, that forces them to throw a few bones to us. Try to get them to throw the bones with some meat on them still. What they are trying to do now is dig up some old bones and tell us it's reform. It's not.

[HughMoran]

18. Do the calculations yourself...

http://healthreform.kff.org/SubsidyCalculator.aspx


Any of the 3 bills (House, Senate HELP, Senate Finance) saves me $25k/year. Don't just say something not backed up by facts.

[Cleita]

23. And those are the bills that Joe Lieberman and others needed for a vote

like Olympia Snowe and Mary Landrieu have stated they won't support. What you will get is a trigger. We already have a trigger in Medicare Part D that has never triggered because it's useless. Every time a trigger has been used, it's a ploy to keep any public option for anything from ever happening. But good luck!

[HughMoran]

25. So first it's the current bills, then it's a "trigger" that will be added 'cause you say so'

You're a real piece of work - let me tell you. You can't lose an argument because you change the base argument once you lose the current one. Good luck to you and this argument style ->

[Cleita]

49. I'm not saying so, just read the news today.

As a matter of fact just read DU today. The links are all there.

[pattmarty]

94. you must be a fucking lawyer. You know the FINAL bill won't be.........

........either of the bills discussed here, right? The final bill EITHER will not have the so called public option or one in name only. If the two bills now look like crap, the final version will be a real POS.

[twitomy]

120. Not only will it be crap it will be unconstitutional

If there is a mnadate to buy private insurance. You would think more people here would recognize that having the govt force someone to buy something from a private company is BLATANTLY unconsitional. And dont compare this with car insurance because no one forces you to drive. Its a "privilige" afterall.

[slipslidingaway]

77. Using the health reform calculator, note the explanation at the bottom left...

"Explanations

Based on H.R. 3962 as introduced in the House on October 29, 2009.

The premiums are illustrative examples in 2009 dollars. For a 40 year old single adult, the premium for a basic plan is assumed to be $3,500 for a plan with a 70% actuarial value (a basic plan under the House proposal)."


http://www.democraticunderground.com/discuss/duboard.ph...
http://pnhp.org/blog/2009/10/27/the-actuarial-squeeze-o... /

The actuarial squeeze on low and middle income families

"...The best private insurance available today – employer-sponsored health plans – have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.

The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[clear eye]

106. In H.R. 3200, the cap for an individual is $5K/yr and for a family, $10K.

Not chump change.

[bertman]

97. Hugh, if you work for a company of ten people and your healthcare premiums are $40,000

per year, as you stated in another thread a day or two ago, then you should be happy if the government simply says that states must open their borders to EVERY healthcare provider who wants to serve them.

My company has twelve employees. We have been purchasing health insurance as a group for three years. Every year we SHOP. Usually there are at least five or six companies in the shopping pool. This year we are spending around $10,000 per husband/wife for "decent" coverage with only $2500 deductibles.

I'm not suggesting that the benefit of having wide-open competition is THE answer, or even AN answer to the problem, because I prefer Single Payer or a Robust Public Option, but I am using that to show that there are other ways that your premium dollars could be driven down.

[Echo In Light]

10. Uniquely American

[sabrina 1]

12. Rec'd because I agree.

And I think Dems should look at what happened in Virginia and NJ where the base didn't show up to help as they did in 2008 and not assume that 2010 will be a repeat of all the other elections since Bush took over the WH.

They lecture and deride and slam anyone who speaks out against this blatant gift to Big Corps. Rahm tells them to stfu. So confident are they that the base 'has nowhere else to go'. Maybe, but people have to be enthusiastic about something, before they work as hard as they did to get a Democratic Majority.

We all know how easy it is for Big Corps to find loopholes, especially in a bill that is 2000 pages long. In fact, they probably wrote in the loopholes.

Dems if they want to stay in power, better start listening to those who elected them. I think that is being 'pragmatic' (one of the favorite words of political operatives).

[Egnever]

14. yet another post full off falsehoods and mad ravings because of those falsehoods.

k&U

[Cleita]

17. Stop hurling accusations about falsehoods and mad ravings if

you can't be specific about what is false and what is mad.

Be sure you include your sources when you do.

[Egnever]

35. Ok lets start with cost controls shall we? Mad raver

the op claims there are none.

yet here it is.

SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.
2 ‘‘(a) IN GENERAL.—Each health insurance issuer
3 that offers health insurance coverage in the small or large
4 group market shall provide that for any plan year in which
5 the coverage has a medical loss ratio below a level specified
6 by the Secretary (but not less than 85 percent), the issuer
7 shall provide in a manner specified by the Secretary for
8 rebates to enrollees of the amount by which the issuer’s
9 medical loss ratio is less than the level so specified.

And thats all the time I will waste on you cause you are clearly sticking your fingers in your ears and refusing to believe anything that goes against your pre concieved notions.

[Cleita]

53. Your argument is a one about money.

You talk about health care as a commodity to be bought and sold on the free market.

My argument is about access to health care, it's about patient and doctor. Yours is about delivering goods to the consumer and this is how it has been framed in Congress. No other country in this world that successfully delivers health care to all its citizens treats it like a commodity. Go to the HealthCare Canada website and read how they do it and what it costs them. I think you will find that your figures crumble to dust.

I would love to continue this argument, but I have to go to work so that I can afford my health insurance, and I get Medicare too.

[Egnever]

59. My argument is that this OP is crap

[slipslidingaway]

63. If Wendell Potter is correct, average medical loss ratio was 95% in the 90's...

so it seems we moved have moved down from there.

http://www.pbs.org/moyers/journal/07102009/transcript2....

"WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves..."


http://healthcare-legislation.blogspot.com/2009/11/does...

"...The American Medical News on August 24 reported that, for the second quarter of this year, the average medical loss ratio of the largest publicly traded health plans was 85.2%, but ranged from 82.9% to 86.8%.

But limiting insurers’ administrative expenses is not necessarily the most beneficial strategy for insureds. Ensuring a high actuarial value of benefits provided would be best. The Congressional Research Service earlier this year reviewed “actuarial value” issues. The actuarial value provides an estimate of the proportion of health care expenses a plan likely will pay. As the economy has deteriorated, so has the actuarial value of employer-sponsored health insurance. Individuals covered by employer-sponsored health insurance these days get lower actuarial values and less protection

Workers with employer-sponsored health insurance face underinsurance and unaffordability as their insurance costs more, covers less, and health care costs rise, a study published in the June 2 online issue of Health Affairs found. In Trends in Underinsurance and the Affordability of Employer Coverage, 2004-2007, Jon R. Gabel, senior fellow at the National Opinion Research Center; and Roland McDevitt, director of research for Watson Wyatt Worldwide, found that health care plans covered slightly fewer medical expenses in 2007 than in 2004 (80.1% versus 81.4%), and covered much less for workers who were in the upper half of spenders..."

[Egnever]

67. The 85% though is a floor its not necesarrily what it would be set at

I wouldnt cry a bit if that floor was set higher but to claim there is no cost control is silly.


So basicaly according to your links the floor is set right were we are today.

the average medical loss ratio of the largest publicly traded health plans was 85.2%

That means it wont get worse than it is today, and it might even be better as it is up to the secretaries discretion.

[slipslidingaway]

68. Why not go back to the early 90's when it was 95% :)) if we want to make sure...

our health care dollars are spent wisely. It also could go lower according to the section below that is bolded.

If we are really fighting the insurance companies why not write into the legislation a number higher than the current average.



I understand it is a floor and since their fiduciary responsibility is to shareholders, it is hard to believe they would move very far from that number.

http://energycommerce.house.gov/Press_111/health_care/h...

"Sec. 102. Ensuring value and lower premiums. Amends the Public Health Service Act to require health
insurance issuers in the small and large group market to meet a medical loss ratio of not less than 85%, effective
for plan years beginning January 1, 2010. Directs the Secretary to require that plans in the individual market
also meet a medical loss ratio of not less than 85% so long as it does not destabilize the existing individual
market. If plans exceed that limit, rebates to enrollees are required . In determining the methodology for the
medical loss ratio, the Secretary is to design it to ensure adequate participation by issuers, competition in the
market, and value for consumers."

[Egnever]

70. That would be great!

Unfortunately its not what we got. I dont think we are fighting the insurance industries though. I think we are trying to cover people and slow the ever increasing costs of the plans.

[slipslidingaway]

73. I agree we are not really fighting them, if we were single payer people...

would have at least been invited into the room for some balance. The message was clear to the insurance companies when they received invitations and not for profit advocates were left outside the gates.

[clear eye]

108. No, 70% is the floor in the latest incarnation.

And you think 85% might be a bit too low?

[eridani]

90. Bullshit. That is not "cost control"

Cost control is what countries like France, Germany and the Netherlands have. Government just tells insurers and providers what the prices are going to be. That changes only if those folks provide explicit justifications for change.

[clear eye]

107. That's an out-of-pocket control mostly for people in the exchange, not a "cost" control.

Runaway costs, including provider pay rates and overhead are not capped, and can still bite the middleclass in the behind when the premiums continue to skyrocket, in the form of higher taxes and a falling dollar due to exacerbating the enormous deficit. Also, the premiums businesses will have to pay, which have crippled our economy, won't be subsidized. They say that small businesses will be exempt from any employer mandate, but I don't believe that refers to businesses who already provide insurance.

Furthermore, the rebates and subsidies, in this climate of economic recession and budget crisis are bound to be minimal. And what does "specified by the Secretary" mean in terms of dollar amounts?

See, no cost controls.

[blindpig]

15. k&r

It is the biggest lie to come down the pike since our latest round of Asian wars.

[slipslidingaway]

19. knr nt

[G_j]

21. K&R!

[slipslidingaway]

31. How affordable will the plans really be ???

Links here...

Health Care Reform Bills - Does Actuarial Value Trump Medical Loss Ratio?
http://www.democraticunderground.com/discuss/duboard.ph...

"...The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[dflprincess]

64. The annual out of pocket caps allowed by this bill are so high

($5K single, $10K family) that a lot of people who are paying for coverage still won't be able to afford care. The bill also allows for premiums and out of pockets to go up annually - whether your income does or not.

It's pretty much the "system" we have now - and we all know how well that works.

If Congress & Obama insist on keeping the insurance companies involved, then perhaps they should look at how Hawaii has been doing things for the last 35 years. Hawaii is the one state that would have an understandable reason to opt out of this scam.

[slipslidingaway]

69. And if plans pay out less in general more out of pocket expenses...

will be paid by many people, except those able to afford a gold policy instead of the basic plan with a 70% actuarial value.

We need to hit the reset button and have a real debate, I'll have to learn more about the system in Hawaii - maybe it will require a personal visit.

[dflprincess]

82. There was an article in the New York Times about it a few weeks ago

http://www.nytimes.com/2009/10/17/health/policy/17hawai...

Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more. If health care legislation passes in Congress, the rest of the country may barely catch up.

Lawmakers working on a national health care fix have much to learn from the past 35 years in Hawaii, President Obama’s native state.

Among the most important lessons is that even small steps to change the system can have lasting effects on health. Another is that, once benefits are entrenched, taking them away becomes almost impossible. There have not been any serious efforts in Hawaii to repeal the law, although cheating by employers may be on the rise.

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.

Somewhere in the article it mentions that the plans offered must be low deductible, low copay.

The company I work for has an office in Hawaii. Those of us on the mainland are getting a craptacular "consumer driven" (aka don't even think about using this) plan. The employees in Hawaii get something different - but the rest of us don't get to see what it is. The plan most of us have will have a $1,200 deductible with 10% "coinsurance" after the deductible is met. The maximum out of pocket is $3,700 (preventative care is covered up front & the numbers I'm giving are single coverage). Prescription drugs will not be covered until the deductible is met. There is growing evidence that high deductible plans save money in the short term but at the 18 months to 2 year point begin to cost everyone more money as people have put off visits and medications because of the cost. Eventually ER visits, admits and hospital stays increase.

We can put pretax money in a HSA which carries over from year to year. However, the federal limit for that is $3,050/year so you can't even put enough in it to meet your out of pocket max. And the real irony? I work for a "wellness" company.

The other fun part of the HSA? When you have $2,000 in it, you can put in into a mutual fund - where it can "grow faster". (No shit, that's what was said). Yeah, putting my health care dollars in the stock market seems like a great idea - it worked so well for my 401K.

[slipslidingaway]

87. Thanks for the article, maybe more people will have insurance under ...

the proposed legislation, but the trend toward paying higher deductibles and co-pays does necessarily translate to care for the reason you mentioned.

Sounds like you need to move as to be enrolled on the Hawaii plan.

A "wellness company" sounds great, but as long as their allegiance is tied to profits for investors, the people lose. The market has been a roller coaster ride since 2000, as we know it does not always grow, sometimes it shrinks.

[inna]

65. They have no shame, trying to pass this monstrosity of government-mandated RACKET for the profiteers

as a "health care reform".

Disgusting, simply disgusting.

[slipslidingaway]

71. Agreed, the insurance companies are running out of customers...

and they know it will get worse in the next couple of years as more people move to Medicare.

Health plans' profits decline along with membership numbers
The prospect for earnings growth looks slimmer as insurance companies run out of costs to cut but hit a limit on premium hikes.

http://www.ama-assn.org/amednews/2009/08/24/bisb0824.ht...

[Egnever]

72. interesting point

However if the plans are all inside an exchange and consumers have a choice between plans competition inside those plans should cause actuarial values to increase no?

[slipslidingaway]

76. According to the new CBO letter, no subsidies for more extensive coverage...

surely there will be plans with higher actuarial values, for those who can afford to pay for a higher level of protection against their portion of the bill.

The numbers in the health care calculator on the Kaiser site are for a plan with a 70% actuarial value, not sure if everyone realizes that fact.

And as far as I know people will still be subject to the occassional out-of-network charges, a whole other discussion.



4 page pdf
http://www.cbo.gov/ftpdocs/106xx/doc10691/hr3962Subsidi...

"...The enclosed table focuses on enrollees who purchase a “reference” plan (the premiums for which equal the average of the three lowest-cost “basic” plans, as defined in the bill), because federal subsidies would be tied to that average. Such a plan would have an actuarial value of 70 percent, which represents the average share of costs for covered benefits that would be paid by the plan.

Although premiums under H.R. 3962 would vary by geographic area to reflect differences in average spending for health care and would also vary by age, the table shows the approximate national average for that lower-cost reference plan — about $5,300 for single policies and about $15,000 for family policies in 2016. Enrollees could purchase a more expensive plan or more extensive coverage for an additional, unsubsidized premium — and CBO anticipates that many enrollees would do that, so the average premiums actually paid in the exchanges would be higher (although average cost-sharing amounts could be lower than those shown in the table)..."

[Mimosa]

80. See, big insurance is dictating the rules. n/t

[slipslidingaway]

85. They have one responsibility and that is to the shareholders :( n/t

[Egnever]

83. Hmm I am not seeing where that defines what the actuarial value must be

nor where your bolding applies. The bolding suggests people could purchase supplemental insurance over and above whatever the plan they had has but without a subsidy to do so, not that they would lose the subsidy that helped them pay for the original plan.

[slipslidingaway]

86. Top of page 4 in the CBO llink - reference plan ....

and I agree with your interpretation about subsidies and why I posted "no subsidies for more extensive coverage..."


"Estimate for "Reference Plan" in 2016 -- Average of 3 Lowest-Cost Basic Plans
Actuarial Value Average Premium Avg. Cost Sharing
Single Policy 70% $5,300 $2,000
Family Policy 70% $15,000 $5,500"

or page 1

"Subsidies and Payments at Different Income Levels Under H.R. 3962

The enclosed table focuses on enrollees who purchase a “reference” plan (the premiums for
which equal the average of the three lowest-cost “basic” plans, as defined in the bill), because
federal subsidies would be tied to that average. Such a plan would have an actuarial value of
70 percent, which represents the average share of costs for covered benefits that would be paid
by the plan. Although premiums under H.R. 3962 would vary by geographic area to reflect
differences in average spending for health care and would also vary by age, the table shows the
approximate national average for that lower-cost reference plan—about $5,300 for single
policies and about $15,000 for family policies in 2016. Enrollees could purchase a more
expensive plan or more extensive coverage for an additional, unsubsidized premium—and CBO
anticipates that many enrollees would do that, so the average premiums actually paid in the
exchanges would be higher (although average cost-sharing amounts could be lower than those
shown in the table). The figures are presented for 2016 in order to illustrate the likely situation
after the proposed changes in insurance markets were fully implemented. (A downside of that
approach is that the figures are harder to compare with those observed in 2009.) ..."

[truedelphi]

125. Very good points you are listing.

Even if some here at DU will find their premiums more affordable, will they be able to cover up to 30% of any health expenses they have?

[SammyWinstonJack]

32. Just watched 'SICKO' again.

Why we put up with being treated the way we are, by the CORPORATE government is beyond me.

We really should DEMAND UNIVERSAL SINGLE PAYER HEALTH FOR ALL AND NOW!!!!


Any less is simply UNACCEPTABLE!!!!

[juno jones]

33. K&R! n/t

[Joe Fields]

34. 100% in agreement, debbierlus!! k&r.

We know that the negotiations are still underway, and that nothing is set in stone. Like you say so well, now is the time to ratchet up the noise on our side. People seem to forget that the squeaky wheel gets the grease.

[Generator]

58. It does nothing to control costs

Yep. So, isn't that what Obama said the whole point of this charade was? Oh no, if it looks like a charade... If we don't have Obama in our corner-we have to fight him, the blue dogs, the Republicans, the freaks-ie Lieberman-and it leaves us exhausted and sicker than before.

But yeah-if we weren't poor, demoralized and propagandized this might work.

As said down thread-we need a leader. Reid, Pelosi, and Obama aren't them.

[Egnever]

62. yes it does

‘‘SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.
2 ‘‘(a) IN GENERAL.—Each health insurance issuer
3 that offers health insurance coverage in the small or large
4 group market shall provide that for any plan year in which
5 the coverage has a medical loss ratio below a level specified
6 by the Secretary (but not less than 85 percent), the issuer
7 shall provide in a manner specified by the Secretary for
8 rebates to enrollees of the amount by which the issuer’s
9 medical loss ratio is less than the level so specified

[clear eye]

115. Do you think we will believe your confused interpretation more the second time around

than we did the first time you posted it? (#35) Strange.

[slipslidingaway]

75. Using the health reform calculator, note the explanation at the bottom left...

http://healthreform.kff.org/SubsidyCalculator.aspx

"Explanations

Based on H.R. 3962 as introduced in the House on October 29, 2009.

The premiums are illustrative examples in 2009 dollars. For a 40 year old single adult, the premium for a basic plan is assumed to be $3,500 for a plan with a 70% actuarial value (a basic plan under the House proposal)."


Links here...
http://www.democraticunderground.com/discuss/duboard.ph...


"...The best private insurance available today – employer-sponsored health plans – have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.

The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[debbierlus]

78. I love you. Thanks for the thoughtful post!

[slipslidingaway]

84. My pleasure and thank you for keeping the issue alive :))) ...

maybe later I'll post the note about the calculator and the actuarial values in a separate thread.

[Myrina]

110. +10

[slipslidingaway]

121. Thanks, people need to know. :)) n/t

[Mimosa]

79. I think we've been sold out by the Dems!

The Democratic Congress could get through whatever they want. But IMO they are doing what the corporate paymasters dictate. They don't care about US!

Michael Moore and Ralph Nader think the same way too.

[debbierlus]

81. Until we allow ourselves to realize fully who represent and really understand the implications

We will continue to be enablers. We could have tremendous power over the dems, if we just exerted it. As long as they know we will be there no matter what....

They will ALWAYS choose their corporate sponsors over us.

[slipslidingaway]

88. Bingo! nt

[jgraz]

89. We need to demand a floor vote on Single Payer

None of this behind-the-scenes, "it'll never pass" bullshit. Let the Single Payer advocates bring a bill to the floor and get every goddamn member of Congress on the record as to where they stand on Single Payer Health Insurance.

This is a vote we can't lose, because even if the bill fails, we'll have a concrete list of who our enemies are.

And, hey, it might not lose.

[pattmarty]

91. I am really glad you posted this. I am also against "BOTH the House.........

.......bill and the Senate version. Neither does anywhere enough to "regulate" the outrageous excess of the Insurance companies. It's really a shame that MANY Du'ers scream when someone like you brings up these important issues on the bills. I always hear something is better than nothing, or the best one "we can FIX it later". Trouble is, with legislation there usually is NO later. A good example is the Bush "Medicare reform act", what a piece of shit that is. My opinion is with the political climate today is we scrap the bill and go for a strong regulation (anti trust etc) of the insurance industry and in a few years (remember this shit bill won't be fully in force until 2019) when people are still pissed off at health insurers we can pass single payer. Again, good for you posting this.

[Lydia Leftcoast]

95. This bill is an example of the passive-aggressive approach to fighting health care reform

"You want health care reform? OK, we'll give you the most convoluted, expensive, maddening, inadequate version of corporate welfare we can dream up, and we'll CALL it health care reform. Then everyone will hate it, and the idea of reform will be discredited for a generation. BWA-HA-HA."

That's what it looks like. I am beyond disgusted. Everyone who isn't either an insurance company employee (and even some of them despise their employers) or a brain-washed right-winger admits that the current system sucks, and this legislation props up the current system at the greatest cost to both individuals and the federal treasury.

[bvar22]

105. Do the Math:

New Price Tag = $900,000,000,000.00 for 10 years

Enrollment in the "Public Option" = about 6 Million after 10 years.


Where O Where is ALL that money going?

Wall Street got their Trillion Dollars.
Now the Health Insurance Industry (the incestuous 1st Cousin of Wall Street) is going to get their Trillion Dollars.

"A Uniquely American Solution".....indeed.



K&R



"I don’t represent the big oil companies. I don’t represent the big pharmaceutical companies.
I don’t represent the Enrons of this world. But you know what?
They already have great representation in Washington.
It’s the rest of the people that need it.”
---Paul Wellstone’s Last Commercial





No wonder they had to get rid of him.
I'm a Wellstonian Democrat.

[Myrina]

109. AMEN !!!

Big and Rec!!!

[soarsboard2]

111. Call Reps NOW!!!!!!!!

Call your representatives! The house is going to vote on the Weiner
amendment this week, which would replace the house health care bill with
HR676 - Medicare for all. Let's FIGHT for single payer!

http://tools.advomatic.com/35/hcn /

[slipslidingaway]

113. I agree with Kucinich, there should not be a vote on the Weiner amendment...

http://www.democraticunderground.com/discuss/duboard.ph...

[Joe Fields]

114. bless you, debierlus! I said a couple of months ago that, in the form

that the legislation was presently in, at the time, that I hoped it wouldn't pass. The legislation is even worse now! I need healthcare. I don't need another scam, all sugarcoated. I am a person of almost no means, but I could find a way to D.C., because it is so damned important to my future, and the future of my family, if WE COULD ALL SHOW OUR STRENGTH IN NUMBERS, to show the teabaggers that they are just a pimple on the ass of the American electorate, and should not be paid attention to.

We need rallies and marches. The squeaky wheel gets the grease, and we cannot allow a sliver group of paid shills to stop real reform in its tracks.

I am not an organizer, but I would give anything for someone to step up and organize a huge rally and march in Washington, to dwarf the teabaggers little party. I would find a way to be there.

[humbled_opinion]

118. Finally someone sums it up profoundly... Thank you for this post.

[Jack Sprat]

122. Why should anyone worry about the insurance industry?

The truth is that most of us would like to see them out of business forever and for good, with a single payer government plan for everyone. This would cut the cost of healthcare and be well worth 895 billion.

The legislation that is being considered now isn't worth spending 5 billion, muchless 895 billion. This will end up being the legislation that sank the Democrats and gave the Repubs new life if this results in no real competition to reign in the rising cost of private insurance. We will be dead..real dead.

[eilen]

123. I totally agree

this bill sucks red baboon ass.