I'm disappointed in the attacks from DU on the House HCR Bill.

[berni_mccoy]

I've debated telling this story for some time, but it is clear to me I need to do so now. The current HCR bill will make a huge positive difference to families like mine. But the reasons are personal.

For those who don't know, I have two sons with type-1 diabetes, a chronic disease that is life impacting and with no cure. Type-1 is not a 'lifestyle' disease. It's an autoimmune disorder. Their immune system destroyed their insulin producing cells in their pancreas and they will be forever dependent upon insulin injections, counting carbs and a shorter life-span with devastating consequences. You can watch the video in my sig line to get an idea of what their life is like.

We were fortunate enough to be insured by my employer when my oldest son was diagnosed. He nearly died because we did not know the symptoms and he was sick with the flu when his diagnosis became critical. He was in a coma for a week and we needed emergency transport from our local hospital to Boston Children's Hospital. There were two doctors on board that special ambulance ride and as we would soon find out, that ride cost more than 25 thousand dollars. My wife and I also spent that week in the hospital learning how our families life will change and what we need to do to provide the best chances for our son to live a healthy life. It was a week of learning, praying and crying, but we got through it and now we are on the other side acting as advocates for a cure for diabetes and for health care reform.

About 2 weeks after we got home, the bill came from the hospital for that ambulance ride saying the insurance didn't cover it. After I spent 40 hours on the phone between the hospital and the insurance company, both pointing fingers at the other, I learned that the ambulance ride was not an "emergency" and that our insurance did not cover rides in the ambulance that weren't emergencies. We had United Health at the time and after I hounded them as to why it was not an emergency and that we never asked for the ride, the hospital simply did it, they told us that the hospital did not file it that way. By this time I started logging every conversation with anyone at the hospital or the insurance company I talked to. 20 more hours on the phone and I learned from the Hospital's billing office that they did check the proper paper work to file it as an emergency. I took this information back to United and they again said they were looking at the form and it was not checked. Back to the Hospital, this time, I wised up. I asked the woman at the billing office if she could fax me the form and show me the codes that had to be specified for an emergency. She did and over the phone we reviewed it.

She said, "See check box 19 as emergent need?"

I said, "Yep."

She said. "It's checked, do you see that?"

I said, "Yes I do. Thank you very much."

I then called United and asked them to look up the filing for the ambulance ride. At first they hesitated but I said, "You've told me you are not allowed to contact the hospital on this issue, so if you show me what needs to be done, I will do it." They had mentioned earlier that they were not suppose to contact the hospital regarding how to file a claim. I didn't believe that then and after this phone call, I never believed a word any insurance person ever said again. So the woman at United brought up the form and I said, "Is there some code or check that needs to be made on the form for you to cover this."

She said, "Yes, there is an emergent need requirement."

I said, "What part of the form? Is there an item number?"

She said, "Yes, section 19".

I should mention at this point that this phone call was being recorded by them.

I said, "Well that's very interesting, because I have the form in front of me that the hospital sent you, and it clearly shows that the check box #19, emergent need, is clearly marked."

Several seconds of silence...

She said, "Ah, so you are correct. We'll see that the hospital gets paid. *click*"

And I never got another bill on this issue. But that took 80 hours of phone calls over a period of 2 months, meanwhile the bill was on the verge of being referred to a collection agency.

But from that point on we have lived with fear. Fear of the next bill that won't be covered. Fear that the insurance companies will wear us down on these types of billing issues. Fear now because both of my sons are now type-1. Fear that if there is ever a gap in our coverage, we will be uninsurable. I'm self employed now and I pay a very large price for our insurance, more than double what I'd pay if the House Bill was made into law. I could hire someone for what I pay the insurance company. What happens when my sons become adults and are no longer covered by my insurance but their employer doesn't offer coverage? They'll have pre-existing conditions that make them uninsurable. And let's not even mention the fact that because they have a chronic condition that requires a steady supply of drugs and equipment that would easily consume a young person's income, they would have to cut corners on their health in order to just survive. Nearly every time they get the flu, there's a good chance they may need to go to the hospital. How will they afford that without coverage?

I know the current HCR bill could be better. But for my family the bill means no longer living in fear of missing a payment, no longer living in fear of the next uncovered expense, no longer living in fear for the health of my children. If you see me get upset at posts that call the current HCR bill crap, this is why. It would radically improve our lives if it were to become law. More than 14,000 children a year are diagnosed with type-1. More than one in 500 children have it. I am fortunate enough to be able to afford a very expensive plan to minimize our costs and provide for my sons. There are many who can not. The need for reform is now. Please forgive me if I'm willing to settle for the House's Public Option. There are millions more like me who are anxious for it and willing to support it.

[stray cat]

1. Thanks for your voice - those who can get insurance already don't get the costs

to those the bill really would help

[Cha]

2. Thanks for explaining in such

detail how this will help your family and others who could greatly benefit from this Health Bill, bernie.

Best Wishes to your family.

[John Q. Citizen]

3. Yes. the 2% of the population that could be covered by more expensive insurance in the house bill ar

depending on us to send the cost of health care into the stratophere, just like in MA

This bill is Romney care. It works great for the insurance industry, who pushed for romney care and who are pushing for this bill, but like in MA, as costs raise, then benefits are cut.

That probably won't impact you much, berni, because it sounds like you can afford the higher costs that will result.


But it will mean that the rest of us will be living forever under a system that insures we keep spending more and more for less and less.

I think that's very bad public policy. It's bad for people.

[berni_mccoy]

5. No, I really can't. This is why the current HCR bill is important.

Our premiums went up more than 25% this year. They do that again, and we will be in trouble. And to claim it is Romney care is ludicrous. MA doesn't have a PO or an exchange. There is only a mandate and little cost control in MA with an expensive penalty and little subsidy. It's nothing at all like the House bill and you know it. You're simply using scare tactics to fear people away from it.

[mike_c]

6. count on it-- the house bill will not do you any good unless...

...it is changed after implementation. Personally, I don't see that happening. The bill, as written, is a terrible reform bill. I'm not ready to accept a bad bill as being better than no reform at all.

I oppose this bill and hope it is defeated. We need single payer, universal health care for all Americans. Not this rubbish.

[berni_mccoy]

7. So you would not support any form of Public Option?

[mike_c]

8. so you would not support single payer universal health care for all...?

I did not say I would not support a PO. I fully support a strong public option that is open and attractive to all Americans, and which would become the model for implementing single payer. The current PO will be weak, limited in scope, hobbled so as not to disrupt insurance company profits, fully intended to impede any movement toward single payer, and it will likely be expensive to purchase, or at least not significantly less expensive than average investor-owned insurance plans. Congress has gone out of its way to make the PO a poison pill at the heart of its "reforms."

Single payer, universal health care is the REAL public option. The one that will solve the problems with American health care. Why do we have leadership that habitually AVOIDS real solutions?

[berni_mccoy]

9. Yes, I would. But that's not the bill that is up for a vote. And the bill is not as bad as

it is hyped to be by those here at DU. The improvements it makes far outweigh not passing it. Even the progressives in the House admit that. I don't know why the house won't consider a Single Payer. Maybe they believe it has no chance of passing the Senate. But millions like me would rather have the current house bill than nothing.

[John Q. Citizen]

14. The house bill is public option in name only. There is no cost containment, no effect on

the insurance industry, nothing except an illusion as regards the public option.

The CBO says that 6 million at most will be enrolled in the PO, as written, by 2019.

It's a sham. It's why the insurance industry signed onto the bill from day one and they still support it.

Just like they still support Romney Care in MA. It's what they want, but it's not a solution for people.

[supernova]

15. I view this bout of "reform" as an interim step

We have to start somewhere.

Even in Canada, they started out with one province on single payer and it spread to the rest of their country.

I view the attempt at insurance reform as a misguided, but necessary (for people for whom no care and denial of care is all just an abstract notion) step in their education.

But even this step will help some people, berni, Hamden Rice and possibly me. It will make things a little easier.

We should take this AND still work for UHC.

[bvar22]

22. The Democratic Party has taken steps....

... to ensure that what happened in Canada will NEVER happen here by stripping out the Kucinich Amendment.
Obama himself tried to have it defeated in committee, but failed.
The Kucinich Amendment had to be deleted behind closed doors by Pelosi.

"President Obama told the committee chairman, George Miller, to oppose Kucinich's amendment, and he did so, leading off the voting with a resounding "No." But the Democrats voted 14 to 14 with one member passing and two failing to vote. And the Republicans voted 13 to 5 with one member failing to vote. That added up to 27 yes votes and 19 no votes. Some Republicans may have voted yes simply because the chairman voted no, but they said they were voting yes for states' rights. And that would be a sensible, decent, and constitutional position. Why shouldn't states be permitted to do better, as well as worse, than Washington, even if the insurance companies bring in less blood money?}

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

[supernova]

25. There is no NEVER in politics

Despite what the WH thinks its doing. People used to say the same thing about getting women the right to vote.

There is always living to fight another day. UHC will have to happen by popular groundswell. And it will have to come because some state or community experiment works so well that the rest of the country wants in on it.

[bvar22]

29. That is precisely ....

...the Corporate Owned Democrats stripped out the Kucinich Amendment that would have allowed states to start their own Single Payer System.

To make sure that THIS does NOT happen:
"it will have to come because some state or community experiment works so well that the rest of the country wants in on it."

[supernova]

35. So?

Doesn't mean it can't happen ever. Just means the courts will be involved and the will have to strike that provision.

[bvar22]

95. So?

So this is a step AWAY from real Health Care Reform.
This Bill actually makes it HARDER for America to enact something that the rest of the civilized WORLD takes for granted.

These bills codify and further entrench the principle that Americans MUST BUY private Health Insurance from a Corporation.
Even the so called "Public Option" will be SOLD by a Private Corporation, NOT the US Government.

"A Uniquely American Solution".....indeed.
Shovel Public Money into the pockets of Corporations.

[John Q. Citizen]

26. I see Medicare as where we started. This current effort is a big step backwards. This

bill, if passed, will mean that the healthcare industrial complex will receive trillions from the tax payers and become far more stronger politically, and more ubiquitous than they are already.

This will make things harder.

For one thing, it will outlaw states from starting their own single payer system.

So I'm working against the Democratic bill. It's like NAFTA. It's bad for people.

[supernova]

27. You're forgetting one thing

The insurance industry will be required to pay out claims. They won't be able to hold on to the money the way the do now.

[John Q. Citizen]

32. If we give then trillions and trillions they can pay out claims, no problem. what about

when the money's gone? then what?

What about if they go belly up, like AIG? How will they pay out claims then? They won't.

Too bad.

[supernova]

33. And that will all add to the single payer argument

[berni_mccoy]

24. Sorry, but you are one of the people I am disappointed in. You ignore other important facts

the CBO states, such as 36 million more Americans will be able to afford health care who currently can't.

This bill will save lives and end the evil practices of the Health Insurance Industry. I know you want only Single Payer. But this Bill is an historic step forward for America.

[John Q. Citizen]

30. Those 36 million will, as long as the money holds out. And then what? Look no

farther than Massachusetts.

It's true. More people are insured now than used to be insured in that state since Romney Care came in. That's what they advertised and that's exactly what happened.

However, they just started cutting benefits for people, The reason is that there is no cost containment, just like in the bill in Congress.

And as the costs continue to rise, there will be less and less coverage and people will get less and less health care.

So the bill amounts to having a really big yard sale so people can get care, but when the money is gone so is the care. At the same time more and more money is removed from the system by the for profit health care industrial complex. That's why they support Romney Care and why they support this bill that you support.

That's not the kind of reform I want to be a part of.


I want something that actually solves the problem. You want something that masks the problem for a short time, but doesn't really solve it.

You want the national yard sale for health care. I want a long term solution.

You want to cover up the pain for a short term fix, instead of curing the patient.

[berni_mccoy]

34. "there is no cost containment" -- that's absolutely false.

Here's a link with many reasons why you are wrong.

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

[quiet.american]

28. John Q. -- I'm looking at cbo.gov -- which report are you basing your comments on?

Could you please give the me the exact link to the .pdf -- or the date would do, too.

[John Q. Citizen]

37. I'll find it for you. Give me few minutes.

[quiet.american]

38. You got it -- thanks. :) nt

[John Q. Citizen]

48. Here it is. It's on page 6

second paragraph (or first entire paragraph)

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel....


I found it by going through the Physicians for a National Health Plan web site. They offer some of the only high quality analysis i've been able to find on the web on all the various proposals during the last year.


Here is a link to their blog. It's got a lot of good info.

http://pnhp.org/blog/2009/11/04/cbo-on-premiums-and-cos...

[berni_mccoy]

57. In no way does this say what you claim it to say. You said only 6 million will be on PO

according to this. That's not what the CBO says. It says 6 million who currently purchase an individual plan (i.e. not employer sponsored or their own self-employed plan, but an individual plan) will stop buying an individual plan and buy into a group policy available on the exchange.

Dude, you really need to stop digging your hole deeper on this. Each time you post something, it's riddled with falsehoods.

[John Q. Citizen]

65. Here's the quote:

"Roughly one-fifth of the people purchasing coverage through the
exchanges would enroll in the public plan, meaning that total enrollment in
that plan would be about 6 million."

That estimate of enrollment reflects CBO’s assessment that a public plan
paying negotiated rates would attract a broad network of providers but
would typically have premiums that are somewhat higher than the average
premiums for the private plans in the exchanges. The rates the public plan
pays to providers would, on average, probably be comparable to the rates
paid by private insurers participating in the exchanges. The public plan
would have lower administrative costs than those private plans but would
probably engage in less management of utilization by its enrollees and
attract a less healthy pool of enrollees. (The effects of that “adverse
selection” on the public plan’s premiums would be only partially offset by
the “risk adjustment” procedures that would apply to all plans operating in
the exchanges.)



(Second pagagraph Berni, like I said
(bolding by JQC and quote marks added so Berni can see the CBO estimate)

Berni, I can't help it if your reading comprehension isn't that good. Please take this to your lawyer and have him or her explain it too you if you are unable to figure it out for yourself. Now I get why you think this is a good idea. Somebody told you it was and your critical thinking skills aren't up to figuring it out for yourself.

You don't understand the phrse total enrollment. It means everyone who enrolls in the public plan = about 6 million.

That's why everyone who speaks or write about this bill says the CBO estimates that total enrollment in the plan will be about 6 million by 2019.

Get it yet?

[berni_mccoy]

68. Once again, you ignore the fact that the CBO says 36 million more Americans will be covered

And they will be covered by Exchange qualified plans, that is, reformed plans equivalent to or better than the PO.

You just can't appreciate something that does good that isn't SP.

[John Q. Citizen]

78. Oh, I never said the the bill doesn't force people to buy private insurance. It does.

I said that no more than 6 million people would be enrolled in the public option. You said that wasn't true. Now you have changed your tune.


Yes, this is Romney Care. It forces people to purchase private health insurance from private companies.


I guess you made a mistake by not voting for Romney, eh?

You sure seem to like his Republican idea for health care reform.


Unfortunatly, it's failing in MA, so I don't have high hopes for doing it on a federal scale. I guess you have the audacity to hope that doing the samething over and over will cause it to have a different outcome this time.

I prefer a time tested method that works. I prefer real Democratic ideas instead of recycled Republican failures.

[quiet.american]

87. Whoa...

Citizens will have the option to enroll through their employers, purchase from the Exchange, enroll in the Public Option, or qualify for Medicare, Medicaid, VA, or TRICARE.

That's hardly a doomsday scenario of being forced to buy from a private insurer. And if someone wants to walk around completely uncovered, it's a 2.5% income penalty -- and as far as I'm concerned that's the "lay-a-way" plan for healthcare, because sooner or later, they and their families are going to need the kind of healthcare that is currently driving people into bankruptcy and sad, sad stories.

This plan is simply not the Romney plan.

Source for "2.5% penalty" -- under the 'Ensuring Shared Responsibility" paragraph:
http://edlabor.house.gov/blog/2009/10/affordable-health...

[Hekate]

90. 2.5% income penalty is hardly draconian, is it? Yes, sooner or later everyone will need it...

... even those who think they are Superman.

Hekate

[quiet.american]

59. Thanks, John Q. -- I thought that might be what you were looking at.

There's some important info, though, immediately preceding that paragraph that puts the "6 million" number in context.

Percentages will increase in nonelderly insured from 83% to 96% -- 21M purchasing insurance through the Exchange, 15M enrolled in Medicaid, and 15M more purchasing insurance through their employers. But you've read all this. I guess my point is, since the public option is not the whole of the plan, not everyone will be getting their insurance through it, nor want to get their insurance through it, but the percentage of those who are insured will still increase by 13 percentage points.

In terms of cost containment, this paragraph near the end of the document seems to sum it up:

All told, H.R. 3962 would reduce the federal deficit by $9 billion in 2019, CBO and JCT estimate. After that, the added revenues and cost savings are projected to grow slightly more rapidly than the cost of the coverage expansions. In the decade after 2019, the gross cost of the coverage expansions would probably exceed 1 percent of gross domestic product (GDP), but the added revenues and cost savings would probably be greater.

I like the Physician's website, but I also acknowledge that single-payer is not going to happen out of the gate. The GOP is pretty properly terrified though that single-payer will become a reality in the near future, so while I still think advocacy for it is important, I'd like to see people get some help now with this bill.

[John Q. Citizen]

72. Yep the public option will only cover about 6 million. So it offers no cost containment.

The lower costs comes from cutting federal dollars spent on Medicare and Medicade, just as the boomers start getting on to Medicare, if I read this correctly. Same page, at the bottom.

"Provisions Affecting Medicare, Medicaid, and Other Programs
Other components of H.R. 3962 would alter spending for Medicare,
Medicaid, and other federal health programs. The bill would make
numerous changes to payment rates and payment rules in those programs
(the budgetary effects of which are summarized in Table 1 and detailed in
Table 3). In total, CBO estimates that enacting those provisions would
reduce direct spending by about $426 billion over the 2010–2019 period."

[berni_mccoy]

76. The Public Option will make coverage affordable to 36 million more Americans

Even if they don't enroll in the PO, the other 30 million are benefiting from it.

[quiet.american]

83. I understand how one could draw that conclusion, but it's not correct --

http://edlabor.house.gov/documents/111/pdf/publications...

MYTH: HEALTH INSURANCE REFORM WILL HARM AMERICA’S SENIORS BY CUTTING MEDICARE BENEFITS AND REDUCING THE QUALITY OF SERVICES THEY RECEIVE.

FACT: Nothing in the House bill will cut basic Medicare benefits – the bill targets inefficiency, fraud and waste in Medicare, including gross and unwarranted overpayments to insurance companies that offer Medicare Advantage plans ("payment rates and payment rules"). In fact, the House bill will strengthen Medicare – by lengthening solvency by five years, closing the donut hole, lowering costs for preventative services for seniors, and expanding the medical workforce so seniors have more doctors to choose from. The AARP describes the changes included in the House bill best in their October newsletter: “…the changes actually aim to strengthen Medicare and improve beneficiaries’ care and access to physicians…”

http://edlabor.house.gov/blog/2009/10/affordable-health...

Reducing the deficit and ensuring the solvency of Medicare and Medicaid.

The legislation will be entirely paid for – it will not add a dime to the deficit. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive the quality health care benefits for years to come.

Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S. (married couples with adjusted gross income of over $1,000,000) and other tax measures.

The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.

Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually

As for 6 million/public option, I'm still not sure what your argument is as to how it doesn't contain costs -- the summation of CBO clearly indicates the sum total of the bill will do that. The public option alone was never meant to assume the entire burden of containing costs -- but in addition to the other parts of the bill, that is achieved.

[John Q. Citizen]

93. You misread my post. The CBO said that savings will come from spending less money on Medicare

And that is where the savings will come from.

Neither the CBO or myself made any qualitative statement as to whether that would be a good or a bad thing for seniors.

We only stated the facts that the reason the bill will save money is that it will require less money be spent on Medicare.


Now I'm not sure if that will be good or bad for seniors.


But I can tell you that I would prefer that what ever can be done to eliminate waste be done, and that Medicare be more fully funded to cover more things.

If this bill fails, as a whole, do you expect the Dems will introduce legislation that would make Medicare more efficient, without cutting the total amount spent on Medicare?


By the way, AARP is an insurance company that will benefit greatly in an economic fashion from the passage of the Dems health care bill, just as all the insurance companies industry wide will, so i don't really trust them as a source.

[quiet.american]

94. Heh :), speaking of misreading, my source was the Dept. of Education & Labor, not AARP.

(The Dept. of Labor's passage merely links to an AARP quote, but AARP is not the source of their statement.)

John Q., I re-read your post, and it still reads as strongly implying it is Medicare benefits that will be cut because of reduced spending, not merely the fat ("just as the boomers start getting on to Medicare").

I expect the bill to pass -- and even if there were no bill, I would very strongly expect that this administration would still be looking to cut the fat (read bloated and pointless payments to Medicare Advantage.)

[berni_mccoy]

41. Here's the one you want. 96% covered, 36 million more covered than now.

And a total reduction in the deficit.

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel....

[quiet.american]

49. Hey, thanks Berni -- I've got that one -- I'm interested to know what version 'Q' is looking at.

As you've noted, the CBO letter to Rangel simply doesn't back up John Q's conclusions, so I'd to be able to see the CBO version he's looking at.

[John Q. Citizen]

58. We are looking at the same one. It's just that Berni thinks that funding will never be cut and

will keep up with whatever the insurance companies decide to charge people into the future.

He is into "give me a fish and i eat tonight" instead of into "Give me access to the coast and I eat for life." He is OK with putting the insurance company smack in the way of getting to the coast. Can't go unless you go through them is his idea of reform.


My idea of reform is to do what people all over the world have done successfully to keep down costs and guarantee full access to quality care.


Berni likes the Republican model of a market based solution.

I like the Medicare model. It was thought up by Democrats back when they were Democrats. It's definitely not like anything the Repos have ever come up with.


I guess it's a microcosm of the sorry state of our party these days. We have the Democratic wing of the Democratic Party, and we have our corporate wing who pushed through NAFTA and gave the congress over to the Repos for the first time since Eisenhower back in 1994.

We have the majority of Democrats in Congress who voted against the Iraq war resolution, and we have the minority who got our country into that mess because they voted with the Republicans.

With Rahm inside the White House, it looks like the corporate Dems are now running the show, but I reject behaving like Republicans. It will only hurt the country and the party, just like it always has in the past.

[berni_mccoy]

64. Please don't tell other people what I think when you can't even be bothered to read the CBO

statement and report on it accurately. You are deliberately spreading falsehoods. Enough already.

[John Q. Citizen]

80. The CBO says the public option will enroll 6 million. It's right there. Please read it.

Private insurance will cover the rest.

Just like Romney Care in MA, which is failing.


Are you an insurance agent or something?

[berni_mccoy]

85. It also says that 36 million more Americans will be able to afford health care

A fact you keep denying and/or avoiding.

[John Q. Citizen]

91. It doesn't say they will be able to afford it. It says they will be clients of insurance companies.

ANd yes, that is true. They will be clients of insurance companies.

You didn't say if you are an insurance agent.

My spidey sense is tingling.

[kath]

102. BUT- and this a HUGH but - what they call "affordable" and what people in the real world can afford

are MILES, no OCEANS apart.
See posts by debbierlus on this issue under RomneyCare - IIRC, they call something like $1600/month just for PREMIUMS "affordable" for a family making $60-70 K... What total fucking bullshit! Figures I've seen for the various bills aren't much better.

[cry baby]

4. thank you - k&r

Hope you and your family are well.

[Fire1]

10. I LOVE it when corporate america gets bitched slapped.

But you are absolutely right. NO ONE should have to suffer 80 hours on a phone quibbling over health care coverage.

[HamdenRice]

11. I mentioned a similar reason to support incremental reform and was told I was selfish

even though my post said there are millions of people like me with previously existing conditions.

Purists don't give a fuck about the fact that this bill will save lives. They'd rather we bitch over a losing single payer effort and die than that the Democrats make incremental reform this time around and come back later to save even more lives.

[supernova]

13. +100 from another preexisting condition person

Would I love to have single payer?

Absolutely. And I will continue to work for it even after this bill passes.

However, I have congenital heart disease. I was born with a wonky heart. I didn't acquire it through years of bad health habits.

I a world where I can afford care, I require yearly cardiac checkups and tests. I require antibiotic prophylaxis for dental work or any internal work that might result in bleeding (and contact with not quite sterile equipment.)

Between been unemployed and having to clear the inevitable "preexisting condition" probationary period when I sign up, I've had about 10 years worth of worthless "insurance." And yes, I have let my health slip. I haven't seen a cardiologist in over 10 years. Does that scare me? You bet.

THis bill is not perfect, but it will begin to rectify a lot that wrong with the insurance market.

I think we should see the goal of UHC through single payer as another goal that we should still work toward. And those of us who need care now will still be able to get it. Maybe not perfectly, but definitely easier.

K&R for the OP too.

[Jennicut]

17. There are some here who want all or nothing. I am a diabetic too.

I have coverage through my husband's job but if he ever loses that job I could get denied coverage if we wanted to get it ourselves. I would be screwed. We would spend so much on health care costs for me, just to insure me or if not, to pay for insulin and test strips without insurance. I am sure you know that test strips are about $100 for a two pack without insurance. Ouch. Insulin is even higher without insurance. Either I would die from hypoglycemia or would have to pay.
We are not selfish, we are worried. I want us to just get a foot in the door to say we have as system that can be made into a true public option some day. Start somewhere. Single payer is great but I am realistic. We may not get much of this bill at first, but for others down the line it may help. Changes will be needed to make it a better bill but for me, just pass it already. "Waiting for a perfect bill" may take years, decades.

[Cha]

18. No, you're not the

one who is "selfish".

[sudopod]

47. Some people just aren't happy unless they are unhappy.

They just get off on being aggrieved. What's even better, eight years from now they'll talk like the whole thing was their idea and brag about how they voted for Obama twice.

[quiet.american]

12. Berni -- thank you putting this out there.

I'm thinking of those like your family in my support for this bill. And while I do not currently have this type of challenge, I know that one day I or someone in my family could wake up and find myself in a similar situation.

(By the way, I had the same "go-round" with UnitedHealth too, for a knee operation I had. They initially denied payment, then agreed to partial payment, then not, then maybe on appeal, then partial again, then finally paid the whole thing. Through this process, though, they were mainly arguing with themselves, as they were sending me snail mail every single day for about two months, each with a conflicting conclusion as to whether they were going to pay or not. I'd read the fine print before the operation and was fairly confident they had to pay, so I figured I'd let them wear themselves out -- they finally paid, and ended up sending me a check for an out-of-pocket expense I'd paid, but that they were supposed to. -- but spending 80 hours on the phone with an insurance company as you did is not something ANYONE should have to do, especially in the midst of a personal health crisis.)

[Cha]

20. President Obama's mother

had a similiar experience when she had ovarian cancer, in that..she was on the phone with insurance companies because they didn't want to pay bc of a "pre-existing condition".

<snip>

"The President reminded the audience that his mother, Ann Dunham Soetoro, had been diagnosed with ovarian cancer six months before she died. This is a cancer that is difficult to detect at its early stages and, once discovered, is often too far along for treatment to produce a positive outcome.

When Obama’s mother was stricken, she had health insurance coverage. Yet, as often happens, her insurance company sought to avoid coverage by arguing that her ovarian cancer had, somehow, been a pre-existing medical condition. Eventually, the insurance company accepted responsibility and paid the bills - but not before the President’s mother was forced to spend endless hours worrying and battling the insurance company at the very time she was battling for her life."

<more>
http://www.zimbio.com/Stanley+Ann+Dunham+Soetoro/articl...

[quiet.american]

39. Since the first time I read it, I've never forgotten it. nt

[berni_mccoy]

101. Thank you.

Yes, and I worry about those who don't have the time or ability to fight the insurance companies. This has to end and they have to be stopped from pulling coverage and squeezing money out of the blood of our citizens.

[donco]

16. It might not be perfect but it’s a foot in perfects door. nt

[bullwinkle428]

19. Do you see those of us who support a "Medicare for all" type program

as a kind of attack, either on your own situation or in general?

I personally have insurance from United Health (through my employer) as well, and have heard enough horror stories to make my pray on regular basis that I don't have anything too serious to deal with. I just want something truly substantial if/when United Health decides to push me off the cliff!

[berni_mccoy]

21. I see unfounded attacks on the House Bill. There is valid criticism, but there is also some bad hype

I would support Medicare for All as well. But there is serious fear mongering against the health bill by some who want nothing but Single Payer. That is, IMO, wrong and what I am disappointed with on this site. The current bill will indeed help millions right now.

[supernova]

23. I think he's talking to

the DUers who are openly advocating for even this modest attempt at reform to fail.

[HamdenRice]

31. Yes, it's a kind of attack. You want us to die because the bill isn't perfect.

That's the problem with people who prefer systems over the lives of real human beings.

[supernova]

36. I will fight all I can

but I will not die for someone else's mightier than thou lily-white principles.

[Raineyb]

46. This bill doesn't cover everybody? So what of the rest of the people who aren't covered

Is it okay for THEM to die as well instead of pushing for a system that covers EVERYONE? That' IS pretty damn selfish!

[mike_c]

56. hysterical much...?

Wanting real reform instead of wealthcare for insurance companies is "wanting you to die?" And you accuse US of being unreasonable?

Please start by overcoming your hysteria-- and that's what it is, plain and simple, when you begin equating forthright political discussion and differences of opinion about political leadership as someone wanting you dead. That is just crazy. You need to chill.

[kjackson227]

40. I feel your pain because I have an adult daughter with a pre-existing condition...

so, even though this HCR bill might be better than what we have now, I have to wonder EXACTLY how much better it will be, and what will happen to those with pre-existing conditions. Will these people be put into a "risk pool"? If this happens, then Texas already has a risk pool sponsored by BC/BS which costs around $700 per month or more (this was the cost about three years ago). In addition, IF they're put into a risk pool, I would bet my life that without some kind of oversight, the premiums will continue to go up, and we'll be faced with the same dilemma a few years up the road (unless they furnish those people with SUBSTANTIAL subsidies). Now, if these people aren't pigeonholed into a risk pool, then it might be an okay bill, afterall. There's just too many ways this bill could go. I'm beginning to feel that the insurance lobbyists and Repugs still have the upper hand which is making me feel nervous, and powerless. We'll just have to HOPE that the Dems have our backs and not cave in.

[berni_mccoy]

43. There is no risk pool in the current bill. The PO forces private insurance to use medical lost ratio

This way the PO doesn't become the risk pool. The insurance companies have to return 85% of their premiums to providers... excess returned to subscribers. And they cannot deny people because of risk.

Here is more on this for your information:

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

[kjackson227]

53. Okay, this reads well, so if they keep this as is we'll be good to go.

[slipslidingaway]

42. I'm disappointed that my Party silenced any real discussions of different...

HC systems and instead marketing an idea, that was then substantially weakened, to the people of the U.S.

Health insurance companies are losing customers and they stand to lose many more in the next two years as many people move to Medicare, couple that with polls showing over 60% of the people want a national HC system, so the insurance companies had to pretend they are giving in to the Democrats.

Big bailout for the insurance companies and will not cover everyone, will shift many costs to the customers with the low actuarial value of the plans being proposed and no real cost controls on services provided etc.

We need real access to health care, not damn insurance.

[geek tragedy]

44. You should have had lower expectations for DU.

As is the case with most political websites, there's a lot more interest in complaining than there is in solutions.

The single payer or nothing people being prime examples of those who value purity over human life.

[berni_mccoy]

45. There are two camps apparently: Those that support a PO or SP because it will help millions

of people and then there are those who only support SP and would rather have nothing instead, falsely claiming that the current bill is a bad bill. Yes, you are probably right. I need to adjust my expectations.

[geek tragedy]

50. You will note that the loudest screamers for "all or nothing"

have unanimously accomplished the latter.

[slipslidingaway]

52. When the leaders of our own Party silence any discussion of a not for...

profit system it is difficult to accomplish anything.

The Dems did not even have the courage to get a score from the CBO on a SP bill.

Leadership sided with the for profit companies, hard to counteract that when your own Party is in bed with the investors.

[berni_mccoy]

55. Let me be clear. In no way am I supporting what the House has done in regard to SP.

But I don't think the current PO bill is the trash that the SP-only crowd is making it out to be. It brings forth a tremendous amount of good for tens of millions of Americans. I can support the SP option as much as anyone here, but let's not shoot down a real step forward with reform and libel it into something it isn't.

[derby378]

63. Speaking as a critic of the House bill...

My main complaint has been that I would be forced into buying private insurance without having the ability to join a government-run plan. I have had several DUers tell me that this is not the case, that the bill actually has a provision where I can opt out of my employer's insurance program and then sign up for the health insurance exchange, including the PO. I appreciate their research, and I hope they're right.

Having said that, if I am blocked from joining the PO, then under the provisions of the House bill, I will be stuck with my current insurance plan which doesn't allow me to choose my own doctor, which refuses to reimburse my blood tests, which has turned down pain management treatments that would improve my family's quality of life, which denies us access to certain medications despite our doctor's prescription because they're not on some sort of corporate "approved" list - never mind that they're FDA approved. In other words, my health insurance will stay the same, if not get worse. And that is not something I can tolerate, let alone support.

I wish you and your family nothing but the best. I am truly sorry for what you've had to go through. But I know that once Obama signs whatever insurance reform package lands on his desk, most Democratic legislators in the House and Senate will never want to touch the issue of insurance reform ever again. That's why I want it done right the first time. I can do without single-payer, but my demand in lieu of single-payer is an actual public option that will put Big Insurance on notice instead of leaving them in the driver's seat.

[berni_mccoy]

66. You have a valid criticism. One thing I would point out though

plans are required to come into line with minimum standards. And one of those standards is that all plans will be required to allow patients to choose their own doctors. You might be stuck with your insurance company, but they cannot continue their existing plans without reforming them.

Sec. 202 says the grandfathered plans have 5 years to meet the standards of the PO. Again, that's not the best, it could be immediately. But it's better than not forcing them to reform.

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

[derby378]

70. Thanks - I appreciate that

Hang in there.

[berni_mccoy]

100. As do I.

[slipslidingaway]

69. My post was a response to someone else who does not understand...

that those who advocate for a not for profit system wanted a voice in the discussions.

Even Dr. McCanne of PNHP thought the original Hacker plan was compelling in January 2007, but it has been watered down.

We had a chance to have a real discussion and we did not, there are bad aspects of this bill, but most here will not even discuss them.

Just like the Dem Party, the same thing happens here on DU, any attempt to point out a potential loophole is met with silence or shooting down the messenger.

"You will note that the loudest screamers for "all or nothing"
have unanimously accomplished the latter."

[Raineyb]

54. I didn't know that trying to cover EVERYONE was a bad thing.

Will you be volunteering to be one of the people who fall through the cracks? You consider it an appropriate sacrifice right?

[berni_mccoy]

61. It's not. But neither is trying to cover MOST people.

One is perfect. The other is not. Even Medicare doesn't cover 100% of eligible. Why?

And those that will not be covered are not covered out of choice, not because of expense. It's not a "fall through the cracks" issue, it's that people would rather pay the penalty than be forced to do what the governments says they should.

[Raineyb]

84. But at what expense? Are you willing to be one of the people who remain uncovered?

I know I sure as hell am not. And I don't go so far as to think that people go without health care because they don't care. But if I have to choose between eating or having a roof over my head and having the insurance and even with the insurance it still won't cover what I need then the system is a problem, not me and it certainly is a case of someone falling through the cracks.

[slipslidingaway]

71. Silencing any real discussion is always a bad thing. n/t

[geek tragedy]

86. When you would rather not expand coverage at all rather

than expanding it to everyone, that is not a moral position.

[Raineyb]

89. I'm for fighting for a better bill rather than meekly swallowing whatever shit sandwich

is fed to me which is what you seem to be advocating.

I'm not about to cheer for a half assed bill when we can be fighting for a better bill before it's passed.

So I'm damn sure going to let my representatives know that this bill is NOT good enough.

Are you going to volunteer to be one of the "small percentage" who goes without since you think this bill is just dandy as it is?

[slipslidingaway]

51. 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..."

[slipslidingaway]

74. Not much discussion here. n/t

[optimator]

60. mandates is the piss in the punchbowl

sorry I won't drink it

[berni_mccoy]

62. HCR can't happen without a mandate. Period. People will buy it only when they need it

after an expensive situation has occurred for them. A mandate is the only way you can have no preexisting conditions.

[lumberjack_jeff]

67. K&R n/t

[slipslidingaway]

73. CBO - new information on H.R. 3962 - not much discussion here ...

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

The health care calculator at the Kaiser site which estimates premium costs is based on a 70% actuarial value.

"...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..."

[slipslidingaway]

75. Never replied to my post about how the bill would reduce the deficit...

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

72 billion from a program that will be needed in later years...crickets.

The headline news was that this bill would reduce the deficit by 104 billion...

BREAKING: CBO Releases Numbers On House Health Care Bill : Reduce Deficit by $104 Billion

...so where did that reduction come from, it appears a large portion (72 billion) is due to this new long term care insurance, aka CLASS.

While that is something to celebrate, the plan would have people paying in over the 10 year budget window for something they will need in the future, naturally this will be all gains until people start drawing from the fund. For reference this is shown on page 26, Table 3 of the CBO report.

It reminded me of the SS Trust Fund that was pre-financed and helped to reduce the deficits, especially during the Clinton and Bush years...

[berni_mccoy]

79. Since you've decided to respond so many times to my post, and I appreciate all the kicks...

but let me ask you this. Let's say the House goes along with you and says, "Yeah, Fuck the public option, it sucks anyways. Let's start all the fuck over and do Medicare For All." Do you really believe that will pass? Do you think they'll get 218 votes in the House? And if they do, do you think the Senate will also pass that? How many Americans will die because nothing gets passed? Are you willing to accept that?

[slipslidingaway]

82. I think a modified version of medicare for all would pass if our Party...

put the same amount of time into marketing the idea as they have the PO.

Educate the people first.

Obviously I'm not happy about the deaths, I'm certainly not happy about the bailout to the insurance companies because our Party was too cowardly to take a real stand agains the insurance companies.

And what has now happened is that our Party allowed time for others to misrepresent other HC systems - they have made the job harder.

Maybe you can answer some of the concerns raised with this bill, the low actuarial value which will force higher out of pocket expenses and allowing the medical loss ratio to be 85% and that even comes with a condition and override. Many more, just so not have the time now.

[nemo137]

77. A concrete example of how this bill will do good things in people's lives

and it only gets 9 recs. My parents and little sister are in the same boat as your and your sons. Whenever my mom talk about health care, or hearing about the HCR bill on the news, it's always in these mixed tones of relief and worry, you know? Relief that she has it, and worry that it won't be there, or that when C moves out of the house she'll be uninsurable. I get what you're saying.

[mmonk]

81. I have one child with autism and another with Crohn's disease.

The bill is better than nothing but falls short of cost containment and the care the rest of modern indutrialized countries enjoy. The bill, I doubt, will lower the financial burden for me nor change my life much since I am above 50 but not old enough for medicare. The Bill does not match the hoopla.

[Hekate]

88. Thank you so much for sharing that reality--and the video...

That video is beautiful and heartbreaking.

I too hope for perfection in HCR, but know we won't get perfection but we will get SOMEthing to build on.
I too wish the health insurance corporations would all just go to hell, but we live in the country we live in and sometimes we are just stuck with reform around the edges.

But I also hope and believe that with this as a base, we CAN build meaningful health care reform. For your little kids. For my grown kids. For all of us.


Hekate

[berni_mccoy]

99. Thank you for the kind words Hekate.

:

[Joe Fields]

92. My family has NO healthcare, Bernie! And I demand a better legislation.

You have healthcare. I don't. And believe me, my family has it's own sad stories to tell. My son needs a knee operation. I need back AND neck surgery. But the congress can take this piece of shit legislation and shove it up their asses. It's absolutely no good and I do not want it. I would rather suffer, than accept what will end up hamstringing millions of Americans.

[Cleita]

96. So the bill so far

has a non-optional public option

mandates poor people buy insurance or it criminalizes them for choosing between health insurance or food or paying the rent

doesn't do anything meaningful to regulate the insurers

takes tax payers' money and gives it to the insurance companies as subsidies for the same high deductible insurance that deny claims as often as they pay them

keeps health care tied to employment

Nope I can't see why people object to it.

I mean I can see how you see it as a light at the end of the tunnel for you. But shouldn't everyone have the opportunity to see that light at the end of the tunnel?

[alarimer]

97. This bill is simply a giveaway to insurance companies.

Your rates on the public option will be higher than whatever you pay now, won't cover anything and won't apply to most uninsured people.

It is a lousy bill.

[tigereye]

98. thanks for your common sense and moving post and good luck to your

family.

[Roland99]

103. Single Payer is what is needed. This is a lame stopgap at best.

[berni_mccoy]

104. What's needed is health care for those who aren't getting.

Single Payer is a way to do it, but it's not the solution being voted on.

The solution that will bring health care to 36 million more Americans is up for a vote and you can bet those 36 million Americans don't care if it's a PO or Single Payer.

[Roland99]

105. But of those 36 million, many have pre-existing conditions and will pay through the nose

esp. if their state "opts out".

AND, Single Payer COULD be being voted on if the freakin' corporatists didn't rule the Democratic Party.