Clinton proposes Health care quality improvements-indicates Medicare expansion & Fed employees plan

[papau]

will be her universal approach. I like it - She says no "single payer" - just "expanded Medicare"and joining Federal employees insurance prog -LOL - as if Medicare is not single payer.

Looks like she is taking the Edwards/Richardson Approach- but with Richardson's flat out expansion of Medicare to 55 before the Richardson/Edwards "universal" kicks in - and then going in the direction of Richardson's Fed Employee plans availability.


It will be interesting to see the details.



http://blog.aflcio.org/2007/08/24/clinton-romney-unveil-contrasting-health-care-visions

Clinton, Romney Unveil Contrasting Health Care Visions

by Seth Michaels, Aug 24, 2007

Sen. Hillary Clinton (D-N.Y.) and former Gov. Mitt Romney (R-Mass.) both have been involved in health care—but with vastly different goals. Clinton spearheaded the effort for comprehensive reform during President Bill Clinton’s administration, while Romney signed problematic legislation in 2006 that required Massachusetts residents to buy their own health insurance. Now, each has made a major address this week on health care—offering starkly different visions for the future of our nation’s system.

Clinton, like other Democratic candidates, is looking for ways to broaden coverage, share responsibility and fix the market failures that have crippled the health care system. Romney, meanwhile, wants to leave more families in the hands of private insurers whose bottom lines don’t often match with quality, affordable care.

Clinton’s address was the second in what she says will be a three-step process of unveiling her plan. In her first speech, in May, she talked about controlling costs, expanding prevention programs and making coverage more affordable. Yesterday, she discussed ways to improve health care quality in a speech that took place at a familiar location: New Hampshire’s Dartmouth-Hitchcock Medical Center, where in 1993 she announced her first attempt at a universal health care program.

According to the Nashua Telegraph, Clinton offered a wide variety of specific programs to improve health care quality. In particular, Clinton would provide billions in emergency funding to train and retain nursing staff. Her proposals also include increased Medicare reimbursements for doctors who obtain special training and certification, improved electronic record keeping and a “Best Practices” program for the latest medical research.

While she hasn’t fully unveiled the portions of her plan that would provide universal access, she suggested some of the mechanisms by which she planned to do so. According to The Washington Post:

Clinton said her universal health care plan would not involve a single-payer government system. Instead, she said, she would consider expanding Medicare and allow people to join the federal employees insurance program.<snip>

[pinto]

1. Any proposal that expands access to Medicare is at least a step in the right direction.

While I favor Medicare for all, across the board, I realize it will not happen in one fell swoop.

[papau]

3. I agree - and this is easier to explain than Edwards - so far - she still has details to lay out so

it may get as complicated as the Edwards approach - indeed I expect it will if she is to not stop like Obama at "universal availability" and actual tries to match Edwards "universal coverage" approach..

But as so far stated, it makes for a good sound bite proposal.

[pinto]

6. I pay $95/mo for Medicare, and while I'm liable for a 20% co-pay

of their 'covered costs' - which are usually only about 60-80% of 'billed costs' from a provider, I've been able to get most providers to accept assignment - meaning they take Medicare as payment in full (except for some outside lab work). Denials for reimbursement have been few, and depend a lot on how the provider codes their services to Medicare for payment. No dental, though.

[papau]

9. It is $180/mon for my employers Medi-gap coverage - but like you - no dental - and

I am still getting cavities and gum inflammation - and there are no cheap dentists.

The Medi-gap does remove the need for paying for Medicare Part D drug coverage in theory - except the co-pays are $50 per month per refill for some pills.

There does not seem a true "Medi-gap" product out there - it is all limited coverage crap that costs nearly $360/month for the two of us - $4320 for the wife and myself per year - but which I fear not paying for (we are heavy users of medical care.

I may sign up for Part D next year. The math makes the decision a toss-up.

[reprobate]

13. The closest to a true medi-gap policy is option 'F'.`

It pays the actual difference between what Medicare pays and the doctor's bill.

My wife insisted that I get that coverage since I have a heart history. In our experience so far however, her option 'C' has been sufficient as all doctors so far have taken Medicare assignment.

I don't understand your statement that the medigap policy removes the need for paying for Part D, unless your employer covers it. I found that the secret to Part D is getting the doc to prescribe generics whenever possible. For example, I take six drugs daily - three morning and three evenings. When we started Part D I did a lot of research to find the generic functional equivalents to the drugs I was taking. I found equivalents for five of them and my doc agreed they were good choices so we changed. The only one that didn't go generic was my statin drug, but we did change from Lipitor to Crestor. Even then that one brand name drug puts me slightly into the donut hole at the end of the year. But that's acceptable, since Crestor dropped my LDL cholesterol from 90 on lipitor to 68 with Crestor. A significant decrease.

[papau]

14. My employers offering of a group medi-gap to retires covers drugs -the

generic is required when available - but many of mine do not have generics. The total "retail" for the wife and myself is about $24,000 where the co-pays are about $6,000 per year combined total for both the wife and myself.

There are no medi-gap options (like "C" or "F" ) in the offered employers plan - but it covers about 25% more than what outside medi-gap policies cover (a reflection of the buying power of the Met).

[Donnachaidh]

2. yet more pandering to the insurance companies

these wooden bridges over the roaring fires of corporate greed. Tell me, will the chronically un-insurable be included in this mess?

I highly *doubt* it. :eyes:

[papau]

5. All 3 are saying the "chronically un-insurable" are "included" via no pre-existing conditions under

writing will be permitted.

The use of Group insurance pricing instead of individual health policy pricing while save the country more than $100 billion - and that will come out of the pockets of the insurance industry. Not as nasty to the insurers as I would have been - but still a major step in the right direction.

[antigop]

4. papau, please read it again. It says "she would CONSIDER expanding Medicare" n/t

[Mojorabbit]

7. I want to know

what this means
“Best Practices” program for the latest medical research.

I want to know who will determine what the best practices is. Hubby went toe to toe with a big carrier that wanted him to practice to their standards, not his. I am hoping we won't have a bunch of bean counters determining what standards should be.

[papau]

10. “Best Practices” program means better care in general than "standard practice" which

is what the ins co's cover.

It still does not "experimental" procedures - and we will still have to fight for making those procedures "best practice"

It also means the Doctor MUST know the best practices for a given condition - and as these change all the time, it is a continuing education requirement.

Lastly - Merke's manual is today's Bible for standard practice (and it is just an overview - but it is a complete great overview) - there will need be set up a database that explains the changing "best practice" as defined by the Fed's.

[Mojorabbit]

12. Merke is not

the be all for standard practice by a long shot. A good doctor tailors the treatment to the patient instead of a cookie cutter approach. This is my concern and my husbands.

[papau]

15. I agree - but your claims examineer is not doing much more than checking Merke n/t

n/t

[Nite Owl]

8. What does allowing people

to join the federal employees plan or medicare mean pricewise? What does it mean for someone self-employed? When you work for a company they pay the bulk of the premium but when you have to pay the whole thing yourself it's a fortune. Nice to allow us to join and at least get something but single payer would allow anyone to get care without all the paperwork and extra costs.

[papau]

11. It means group underwriting rules with no ability for the insurance co to claim

no coverage because of a "pre-existing condition".