HC passes Senate

[woolfe9999]

That's one reason I'm entirely skeptical about the same people single payer.

For sake of argument, let's say that you worked for me, and had created two very large programs. They turn out to be incredibly difficult to manage, and let's say that the people who have to deal with it are out of pocket 20%.

You then come to me saying that you have a new program which dwarfs that which you have done, but the claim is that it will knock off 20% of the costs now incurred.

Frankly that's going to be a hard sell. I'm going to tell you to demonstrate that you can make what you already have work, then come back to me.

Medicaid is killing states. In NY, our education budget is being cannibalized to pay for it. True, states have a good share of blame, but the whole concept was flawed from the beginning, and in 50 years the Dems have fought reform tooth and nail. Medicare D is another huge problem, and the only way it could be sold was to insert the "donut hole" and pretend that all was well.

In light of the above, what credibility do those who some would have take over the health care system have? I heal about "obstructionism", but I've not seen much of an explanation of what was being blocked, other than what seems to be a pig in a poke.

I don't consider trivial the ability of myself and others to provide quality care. If you can get the pols to demonstrate competence with something small, then I'll reconsider. I'm unmoved by "Republican obstructionists!" as much as I was by "terrorist supporters!"

I think what you are expressing here is a generic expression of suspicion about government, which is fine. But in the end, it isn't who is doing it that matters. It is whether it works. If you want precedent for a system that works, Medicare actually does work quite well. It has about a 4% overhead, and manages to do this while plugging itself into a largely private system that operates off of an inefficient itemized billing system. The reason Medicare is going red right now is because of rising costs right now, not because Medicare itself is inefficient. There are also precedents of other countries who have good healthcare systems where the payment end is handled by government.

The problem with anything like Medicare of Medicaid is that you cannot have piecemeal public health insurance that plugs into this inefficient system we have right now. It's why the public option would never have been a great cost container either. The only way to get the real cost savings out of public health insurance is for there to be only one healthcare payor for everyone, which can then completely simplify medical billing across the board. Then and only then can you get away from inefficient itemized billing and save costs.

But let's set that aside for the moment and turn your argument on its head. The current program of private insurance clearly isn't working right, is it? If private industry can handle the payment end of our healthcare system so well, then why are we in a cost crisis? So in your example, the current program is private health insurance. If it isn't working, it needs to be fixed. I am open to all ideas about how to do that and keep it an entirely private system. Problem is I haven't heard any just yet.

- wolf

 

[nobodyknows]

So tell us the difference between the US and Australia and precisely how we get the 1/2 off sale? It's not in insurance company profits.

Caveat- No deux ex machina. You have a completely different political structure, tax system and demographics.

Please, show us how we can provide the same standard of care for less than it costs us to provide now without any profit at all.

If you can do it, you'd be the first.

Is that all you have? If so y6ou should stay the hell out of healthcare discussions.

Go ahead with your negative attitude but remember those that say it can't be done are fprever being interupted by those doing it. If you were concerened about anything other then your own bottom line you would check into how Austriala does it instead of being such a naysayer.

 

[BoberFett]

You all seem to be ignoring the fact that government programs already account for half of the spending and only cover a small portion of the population. How do you expect programs run by that same government to cover everyone for the same cost that it currently covers just a fraction? Magic?

 

[Hayabusa Rider]

If it isn't working, it needs to be fixed. I am open to all ideas about how to do that and keep it an entirely private system. Problem is I haven't heard any just yet.

Why don't we find out just what our best options are before we decide what's best?

 

[blackangst1]

You all seem to be ignoring the fact that government programs already account for half of the spending and only cover a small portion of the population. How do you expect programs run by that same government to cover everyone for the same cost that it currently covers just a fraction? Magic?

Medicare cuts?

 

[Hayabusa Rider]

Is that all you have? If so y6ou should stay the hell out of healthcare discussions.

Go ahead with your negative attitude but remember those that say it can't be done are fprever being interupted by those doing it. If you were concerened about anything other then your own bottom line you would check into how Austriala does it instead of being such a naysayer.

So you don't know anything about health care, you don't know how to implement reform in the US, so you haven't a plan at all other than say Australia, Australia, Australia!

This here's the wattle, the emblem of our land. You can stick it in a bottle, you can hold it in your hand.

Amen!

 

[woolfe9999]

Why don't we find out just what our best options are before we decide what's best?

You think experts have not studied the healthcare industry extensively, and that people in the government haven't read their analysis?

My own opinion on single payor comes largely from a series of Harvard studies on the healthcare industry.

You can have experts study the issue till the cows come home, but unforunately you are going to end up with legislation that reflects political reality: that we have two parties who can't agree on whether the sun rises in the east every day and both parties will reject the expert opinion if it isn't in line with their ideology. If your expert panel says single payor is the way to go, the repubs will reject it as biased, and if it says we can vastly improve the system within the framework of private health insurance, the dems will do the same. This is how it works, and I think we all know this.

- wolf

 

[BoberFett]

People in government claim they are unable to read bills they're supposed to vote on. What makes you think they read any associated analyses?

 

[Zebo]

You all seem to be ignoring the fact that government programs already account for half of the spending and only cover a small portion of the population. How do you expect programs run by that same government to cover everyone for the same cost that it currently covers just a fraction? Magic?

Rest of world provides HC for All for half price or less- see chart. Problem we have is too many hands in cookie jar with corporate owned govt. The only people who should make profit are those directly related to care. Doctors, scientists, nurses, etc. But instead the most profitable things to be in health care is an insurance executive, lawyer or paper work submission specialist.

 

[Zebo]

Oh and in other news today - House dropped pubic option like a hot potato in reconciliation. Crap ass bill senate crafted wins.

 

[eits]

Oh and in other news today - House dropped pubic option like a hot potato in reconciliation. Crap ass bill senate crafted wins.

pathetic. i hate our government system right now.

 

[Hayabusa Rider]

You think experts have not studied the healthcare industry extensively, and that people in the government haven't read their analysis?

My own opinion on single payor comes largely from a series of Harvard studies on the healthcare industry.

You can have experts study the issue till the cows come home, but unforunately you are going to end up with legislation that reflects political reality: that we have two parties who can't agree on whether the sun rises in the east every day and both parties will reject the expert opinion if it isn't in line with their ideology. If your expert panel says single payor is the way to go, the repubs will reject it as biased, and if it says we can vastly improve the system within the framework of private health insurance, the dems will do the same. This is how it works, and I think we all know this.

- wolf

I have something of a unique perspective having done several things career-wise. One is health care, and another is having served in various capacities with the Federal government.

One thing that stands out to me is that politicians always have done their work and know the answers except that they don't. Someone will take a study and say "this is it", but fail to take into account not just the theoretical, but the practical costs of implementation etc.

Having seen first hand the sort of mentality which allowed Iraq, I recognize it in health care. You pick a desired end, then a preferred means and find data which supports your contention.

A third thing I've done is research as a biologist with an emphasis on intracellular goings on. What I've learned is that going the political route is the worst road to a grasp of reality. One does not reach a predetermined conclusion and demonstrate it by selective bias. Yet we go about accepting it in politics. You mention a particular study. Ok let's assume it's correct. Does it cross interdisciplinary lines to examine implementation and how it affect the current patient/provider relationship? Does it address distribution of resources, where there are low populations which still demand modern medicine and all that entails? Does it go into how changing the system will alter the supply of providers in the long term? How does one get this right with all it's complexities and interconnectedness of the system as a whole? How many politicians do you know that have the remotest grasp? I can make a study which details how to put a person on Mars, but actually doing it? That's another matter entirely. If politicians had approached the Manhattan Project as they do health care, we'd still be in committee.

Sadly I agree that the two parties won't get it right. My belief is that it's part of the partisan mindset. It goes like this-

My party is right.
Since my party is right I must support it.
I only support what is right and since I support my party it must be right.

It's this bizarre recursive thinking. The Party says it's all the Other Party's fault, so I have to attack the Other Party. Well it should be painfully obvious that most political hackery derives from this pathological relationship. Hardcore Reps never questioned Iraq, because all the evidence was there, just ask the powers that be who will whip out some document or other. Never did they say "Hey, WTF? Where are those WMDs you said were there?" Nope. Never happened.

Now we have some of the people who were incredulous at the above response blaming someone else because they opposed Iraq, er, their bill. Never did they ask what was done to ensure that timely and contextually appropriate analysis was done with the intent of revamping health care, nor did they bother to examine the political lay of the land within their own party. They fell all over themselves to get where we are now.

Yes, this lack of intellectual rigor coupled with the desire to blame anyone else is ultimately what caused this debacle, and it's never going to change, because no one in control on either side ever cared about health care, but getting approval for their particular agendas.

Governance by Demagogy doesn't work well.

 

[Lemon law]

In in due respects to Haybasusa Rider, its not productive or accurate to view health care reform as:

"My party is right.
Since my party is right I must support it.
I only support what is right and since I support my party it must be right."

If anything Hayabusa Rider has more accurately described the GOP rather than the more diverse democrats, but still at the end of the day we could have had a more honest debate and produced a better law.

But sorry Haybusa or anyone else, what we had for a health care system was a dying and untenable hunk of crud, and not only has major reform has been overdue for decades, the system we had was on the verge of total collapse.

We could have done ever so much better without the dishonest debate and partisan politics, but I applaud the death of the health care system we had. Now the next task is to fix the partials reforms we have and make them more viable.

 

[Patranus]

Its just so funny. The Democrats try and say that the GOP is in the pockets of the insurance companies and then pass this legislation.

HAHAHAHA.

The Democrats are totally screwing over their base and the base is lock-step with them.

HAHAHAHAHA.

 

[RyanPaulShaffer]

Haha, you stupid suckers are still trying to blame this on Republicans. News flash, f**ktards. Republicans are the minority. They had no power to do anything. This is all Democrats. You've been had. The Democrats have taken a shitload of PAC money from the health care industry and this is their way of repaying their donors. What a bunch of suckers you are. You've been sold out by your party and you're too stupid to realize it.

Succinctly put. +1 :thumbsup:

 

[Darwin333]

In in due respects to Haybasusa Rider, its not productive or accurate to view health care reform as:

"My party is right.
Since my party is right I must support it.
I only support what is right and since I support my party it must be right."

If anything Hayabusa Rider has more accurately described the GOP rather than the more diverse democrats, but still at the end of the day we could have had a more honest debate and produced a better law.

But sorry Haybusa or anyone else, what we had for a health care system was a dying and untenable hunk of crud, and not only has major reform has been overdue for decades, the system we had was on the verge of total collapse.

We could have done ever so much better without the dishonest debate and partisan politics, but I applaud the death of the health care system we had. Now the next task is to fix the partials reforms we have and make them more viable.

Of course your party is right and the other party is wrong. Exactly the point HR was trying to make.

Because of that, which you so kindly helped demonstrate, we will not get anything resembling true reform until the wheels come off.

 

[Darwin333]

Its just so funny. The Democrats try and say that the GOP is in the pockets of the insurance companies and then pass this legislation.

HAHAHAHA.

The Democrats are totally screwing over their base and the base is lock-step with them.

HAHAHAHAHA.

Umm, not sure if you realize this or not but they are passing laws that will apply to all of us.

 

[sciwizam]

NYT Column: A Less Than Honest Policy

The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.

Which is exactly what the tax is designed to do.

The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.
....
....
....
If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.


We all remember learning in school about the suspension of disbelief.


This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.


Can you believe it?


I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”
...
...

The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.


Those who believe this is a good idea should at least have the courage to be straight about it with the American people.

I never got the whole rationale behind taxing the "Cadillac" plans, can anyone explain how this is supposed to work?

 

[Genx87]

In in due respects to Haybasusa Rider, its not productive or accurate to view health care reform as:

"My party is right.
Since my party is right I must support it.
I only support what is right and since I support my party it must be right."

If anything Hayabusa Rider has more accurately described the GOP rather than the more diverse democrats, but still at the end of the day we could have had a more honest debate and produced a better law.

But sorry Haybusa or anyone else, what we had for a health care system was a dying and untenable hunk of crud, and not only has major reform has been overdue for decades, the system we had was on the verge of total collapse.

We could have done ever so much better without the dishonest debate and partisan politics, but I applaud the death of the health care system we had. Now the next task is to fix the partials reforms we have and make them more viable.

lmao you couldnt have proved her point more!

 

[Genx87]

NYT Column: A Less Than Honest Policy



I never got the whole rationale behind taxing the "Cadillac" plans, can anyone explain how this is supposed to work?

This is another example of why we cant trust politicians. This is like the AMT for healthcare. Sold on raping the rich, ends up raping the middle class.

 

[daishi5]

You think experts have not studied the healthcare industry extensively, and that people in the government haven't read their analysis?

My own opinion on single payor comes largely from a series of Harvard studies on the healthcare industry.

You can have experts study the issue till the cows come home, but unforunately you are going to end up with legislation that reflects political reality: that we have two parties who can't agree on whether the sun rises in the east every day and both parties will reject the expert opinion if it isn't in line with their ideology. If your expert panel says single payor is the way to go, the repubs will reject it as biased, and if it says we can vastly improve the system within the framework of private health insurance, the dems will do the same. This is how it works, and I think we all know this.

- wolf

You seem to support single payor healthcare systems because of research you have done which I have not. I will yield that a better informed person is probably right. However, why do you support the current health care bill when it does not contain anything even remotely close to a single payor system which you believe is key? Have I mistaken your position, do you support the current health bill which, to my knowledge, does not contain a single thing you have listed as important to health care reform?

And, I think you are actually proving Hayabusa's point. He says the government has not listened to the experts. You say the experts have shown how much benefit a single payor system offers. The government is not offering a bill with single payor. Therefore, I have to believe the government is not listening to the experts. It may have heard them, but it is not actually listening.

 

[woolfe9999]

NYT Column: A Less Than Honest Policy



I never got the whole rationale behind taxing the "Cadillac" plans, can anyone explain how this is supposed to work?

This is one of the most significant aspects of the entire bill, and very few people understand its intent, mechanics or purpose. In fact, its proponents are telling only half-truths about it, and the article above barely scratches the surface of what it means. The article exaggerates its impact in the shortrun, but pays little attention to its massive impact in the longer term. Its revenue implications are relatively trivial, and beside the point. The purpose of the tax isn't even to raise revenues.

As the article says, the tax puts a ceiling of $8,500 and $23,000 for individual and family plans, and puts a 40% excise tax on the excess over those ceilings. Also true is that the tax begins in 2013, which is when the major portions of the bill kick in, and by 2016 it will affect about 19% of of all healthplans. However, the effect will initially be trivial, as the tax only applies to the excess over those ceilings. Most plans will be taxed by about 1-4% of their total value, initially.

But here is the kicker. The ceilings on premiums that trigger the tax are set to go up yearly at the rate of inflation + 1%. However, insurance premiums go up by about 9% yearly, which is about inflation + 6.5. That means every year, more plans will be affected, and plans already affected will be taxed more.

This is going to have some unpredictable effects in the longer term, some good and some bad. Because the tax is 40%, it will become rather a draconian tax once plans start to exceed the ceilings by a large amount. No one will want their plans to be significantly over those ceilings. This will in some cases cause insurance companies to cut benefits from at first higher end plans, then middle of the road plans, to keep premiums down and stay within the ceiling. Yet companies who want to have "cadillac" coverage for their high paid employees will still demand Cadillac plans within the ceiling. To a certain extent, this will force insurance companies to become more efficient and cut their overhead in order to be competitive, as any company that can offer good coverage within the ceiling will do well versus the competition.

So in summary this tax will force health premiums downward (or more accurately, to not move up faster than inflation +1), and this will come partly from diminished benefits (the bad), and partially from improved efficiency and lower overhead in the insurance industry (the good). If you read the CBO report closely, this tax is where the real cost savings in the bill come from, with all the other cost savings measures being relatively trivial. In essence, the tax sets a pace on the growth of premium costs at inflation +1. But this isn't a sustainable rate, which is where the real, long term intent of the tax becomes clear.

By 2025, and certainly by 2030, basically all plans will be way over the ceilings in spite of every effort to keep premiums as low as possible. Many plans will be not only taxed but taxed heavily. People will scream bloodly murder about the tax, because health plans will now be taxed as income instead of being tax free like they currently are. Since people will not stand for it, the solution will either be to repeal or modify the tax, or else find some way of lowering healthcare costs. It will in essence burn down the system of private insurance unless it eventually gets repealed or modified. Conservatives will want to repeal or modify the tax to raise the ceiling and growth rate, but they will need 60 votes in the Senate to do that. Liberals will want to propose an alternative to private insurance that will lower premium costs and thus end the taxing of health benefits...

The odd thing in all of this is that progressives generally oppose this tax and favor the house tax instead, because the tax will affect some union benefits. They like the house tax because it is a millionaire income tax, yet it has no direct affect on healthcare costs and is just a generic revenue provision. Progressives should be looking at this in the opposite manner, and conservatives should probably be raising the bloodly flag over it. Yet it is largely flying under the radar right now, while issues like the public option and mandates are getting all the attention.

- wolf

 

[Ausm]

Umm, not sure if you realize this or not but they are passing laws that will apply to all of us.

P-Anus is not of this world...

 

[woolfe9999]

You seem to support single payor healthcare systems because of research you have done which I have not. I will yield that a better informed person is probably right. However, why do you support the current health care bill when it does not contain anything even remotely close to a single payor system which you believe is key? Have I mistaken your position, do you support the current health bill which, to my knowledge, does not contain a single thing you have listed as important to health care reform?

And, I think you are actually proving Hayabusa's point. He says the government has not listened to the experts. You say the experts have shown how much benefit a single payor system offers. The government is not offering a bill with single payor. Therefore, I have to believe the government is not listening to the experts. It may have heard them, but it is not actually listening.

Your question is a very good one indeed. I do support the current bill, but I have struggled to come to that position. In the shortrun, the bill will cover about 30 million more people, which is a good thing from a purely humanitarian perspective. Yet it is a deeply flawed approach because it will not control costs in a significant way (but see my above post about the tax provision in the Senate version which may do just that if it isn't repealed or modified.)

I see the legislation as a bridge to a single payor system. Basically, if you have just about everyone in the country now bought in to a broken system, and you have tax payers subsidizing the buy in, it will make the cost crisis in healthcare more acute. Consider what happens in 5, 7 or 10 years when premium costs have gotten much higher and the subsidies are not keeping up with the rise so that the people who initially got coverage under the bill cannot afford it anymore unless the subsidies are increased. Yet we won't want to keep increasing subsidies to match the rate of cost growth because that will be a deficit buster. Essentially, the key flaw in this bill will accelerate the public's realization that our system of private health insurance is broken by underlining the flaws in that system. Short term, the bill is good for insurance companies. Long term, I think it will spell their demise.

- wolf

 

[daishi5]

Your question is a very good one indeed. I do support the current bill, but I have struggled to come to that position. In the shortrun, the bill will cover about 30 million more people, which is a good thing from a purely humanitarian perspective. Yet it is a deeply flawed approach because it will not control costs in a significant way (but see my above post about the tax provision in the Senate version which may do just that if it isn't repealed or modified.)

I see the legislation as a bridge to a single payor system. Basically, if you have just about everyone in the country now bought in to a broken system, and you have tax payers subsidizing the buy in, it will make the cost crisis in healthcare more acute. Consider what happens in 5, 7 or 10 years when premium costs have gotten much higher and the subsidies are not keeping up with the rise so that the people who initially got coverage under the bill cannot afford it anymore unless the subsidies are increased. Yet we won't want to keep increasing subsidies to match the rate of cost growth because that will be a deficit buster. Essentially, the key flaw in this bill will accelerate the public's realization that our system of private health insurance is broken by underlining the flaws in that system. Short term, the bill is good for insurance companies. Long term, I think it will spell their demise.

- wolf

Just so I am clear, you support the current health care bill because it will make the situation worse for everyone, thus forcing good reform?

In my mind this falls under what I have heard phrased as the "chess piece" fallacy. In other words, people are not predictable. They will not move as you intend because they are not chess pieces whose movement is governed by well understood rules. I predict the outcome will not be what you predicted. I have no idea how different it will be, but I bet the people will surprise you.