What Does a Bi-Partisan HC Reform Bill Look Like

[woolfe9999]

There is widespread talk among opponents of the HC bill the democrats have failed to approach HC reform in a bi-partisan manner. So my question to opponents of the current bill is, what sort of bill would you approve of?

To make this easier, here is a recap of the elements of the current bill:

1. Subsidizes uninsured people to purchase healthcare. Sudsidies would cover about 2/3's of the premium costs.

2. Individually mandates the uninsured to purchase healthcare, with a modest penalty for those who do not purchase. Mandate applies if premium cost is at or below 8% of income.

3. Mandates larger businesses to purchase healthcare for employees, with a per employee penalty applying to those who opt out.

4. Imposes regulations that prohibit denying coverage based on pre-existing conditions, and restrictions on rescission of health benefits.

5. Imposes a variety of cost control measures, including a statewide, then later national, exchange, regulations which cap the percentage of premiums that go to overhead and profit, etc.

6. Imposes new taxes to pay for subsidies. Either a surtax on income in excess of $500,000, or on premiums above a certain limit, depending on house of senate versions.

7. Makes some cuts to Medicare Part C, and imposes some cost control measures for Medicare in general.

8. Will close the "donut hole" for seniors paying for prescription drugs under Medicare Part D.

9. Increases poverty line limit on Medicaid eligibility. Paid for mostly by federal funds, with a small portion by state funds (starting in 2017.)

These are the major provisions/impacts of the bill. Which would you get rid of or modify, and what would you add?

- wolf

 

[StageLeft]

You forgot

10. Widespread increase in premiums/health care costs for the foreseeable future

 

[woolfe9999]

Whether that is true or untrue, it doesn't answer the question of what you or anyone else opposing the bill would propose as an alternative. If it is nothing, then say as much. If it is something, then tell me what it is.

- wolf

 

[CADsortaGUY]

There is widespread talk among opponents of the HC bill the democrats have failed to approach HC reform in a bi-partisan manner. So my question to opponents of the current bill is, what sort of bill would you approve of?

To make this easier, here is a recap of the elements of the current bill:

1. Subsidizes uninsured people to purchase healthcare. Sudsidies would cover about 2/3's of the premium costs.

2. Individually mandates the uninsured to purchase healthcare, with a modest penalty for those who do not purchase. Mandate applies if premium cost is at or below 8% of income.

3. Mandates larger businesses to purchase healthcare for employees, with a per employee penalty applying to those who opt out.

4. Imposes regulations that prohibit denying coverage based on pre-existing conditions, and restrictions on rescission of health benefits.

5. Imposes a variety of cost control measures, including a statewide, then later national, exchange, regulations which cap the percentage of premiums that go to overhead and profit, etc.

6. Imposes new taxes to pay for subsidies. Either a surtax on income in excess of $500,000, or on premiums above a certain limit, depending on house of senate versions.

7. Makes some cuts to Medicare Part C, and imposes some cost control measures for Medicare in general.

8. Will close the "donut hole" for seniors paying for prescription drugs under Medicare Part D.

9. Increases poverty line limit on Medicaid eligibility. Paid for mostly by federal funds, with a small portion by state funds (starting in 2017.)

These are the major provisions/impacts of the bill. Which would you get rid of or modify, and what would you add?

- wolf

keep 7 and maybe 9. The rest is crap.

ANY "reform" must not be "comprehensive" - it should be very detailed and direct so it can focus on a specific problem.

 

[ElFenix]

implement singapore's system 100%. and get all the fatties on exercise bikes.

 

[Patranus]

1) Deregulate insurance markets and allow for sale of policies across state lines (instant competition)
2) Require insurance carriers to offer products to those with pre-existing conditions (no price controls)
3) Set up national rules for health savings accounts. Allow health savings accounts to be folded into retirement plan.
4) Tort reform aimed at eliminating the cost of "defensive medicine"

 

[Ronstang]

No reform is going to work until they find ways to contain and cut costs in the current system first. Those in control are not interested in doing so. Politicians are not willing, or not capable, of approaching issues like you would if you were a business so this mess will just get worse.

 

[Patranus]

No reform is going to work until they find ways to contain and cut costs in the current system first. Those in control are not interested in doing so. Politicians are not willing, or not capable, of approaching issues like you would if you were a business so this mess will just get worse.

There is no way to contain costs unless care is rationed.

One way to "ration" care is tort reform as it would eliminate unnecessary procedures.

 

[woolfe9999]

No reform is going to work until they find ways to contain and cut costs in the current system first. Those in control are not interested in doing so. Politicians are not willing, or not capable, of approaching issues like you would if you were a business so this mess will just get worse.

You have any ideas for controlling costs?

- wolf

 

[StageLeft]

2) Require insurance carriers to offer products to those with pre-existing conditions (no price controls)

So they can just say the policy is a billion/year per person, effectively making this null.

 

[Hacp]

Things to do:
1) Increase competition. Make it easier for new companies to insure. That means deregulation.
2) Get rid of the AMA. They limit the number of doctors who graduate from medical school.
3) Doctors get pay through a salary, not per operation.
4) Find a way to pay for doctors salaries or make medical schools cheaper.
5) Force insurance companies to insure regardless of previous condition. Deductable and premium can be higher for the sickly but only X times higher. Three times sounds like a reasonable number.
6) Reduce federal funding for medicaid. It only makes it more expensive for those who actually pay for insurance.

Things not to do:
Give free healthcare to everyone.
Require everyone to get insurance(just gives insurance corporations more profit)
Increase medicare and medicaid spending

 

[woolfe9999]

There is no way to contain costs unless care is rationed.

One way to "ration" care is tort reform as it would eliminate unnecessary procedures.

If there is no way to lower costs apart from rationing, why are you proposing tort reform and opening markets across state lines? What is the purpose of those changes?

- wolf

 

[theeedude]

There is no bipartisan healthcare reform. GOP is not interested in it, or they would have passed it themselves when they were in power.

 

[Patranus]

If there is no way to lower costs apart from rationing, why are you proposing tort reform and opening markets across state lines? What is the purpose of those changes?

- wolf

Cost controls in terms of providing care.
If I want to buy a policy from another state that offers less coverage (and therefore costs less) I should be able to do that.

Places like California have massive regulations on companies and require them to offer certain things in their policies i have no use for but I am forced to pay for them anyways.

You are confusing 2 different issues.

 

[woolfe9999]

There is no bipartisan healthcare reform. GOP is not interested in it, or they would have passed it themselves when they were in power.

That is part what I am trying to determine here. Actually, I am not only interested in conservative opposition to the bill. There is popular opposition among independents, and some opposition among liberals as well. I suppose these three blocs actually have very different reasons for opposing the bill. Nonetheless, the exercise is valuable because the following question screams out for an answer - is even it possible to create a healthcare reform bill that enjoys majority support? If not, then why do polls show that a strong majority think that healthcare needs to be reformed? Finally, if we mostly agree that the system needs to be reformed but we cannot get any better than a plurality of voters to support any one way of reforming it, is it best to just leave the system as is?

- wolf

 

[woolfe9999]

Cost controls in terms of providing care.
If I want to buy a policy from another state that offers less coverage (and therefore costs less) I should be able to do that.

Places like California have massive regulations on companies and require them to offer certain things in their policies i have no use for but I am forced to pay for them anyways.

You are confusing 2 different issues.

Fair enough. But what is the purpose of tort reform if not to lower the cost of health premiums?

- wolf

 

[StageLeft]

is even it possible to create a healthcare reform bill that enjoys majority support?

Very possibly not.

then why do polls show that a strong majority think that healthcare needs to be reformed

Don't the majority of fat people want to lose weight? And yet what do they do? Keep eating.

It's very possible that the majority won't agree on something in which case it would have to be force fed to them. When that time comes hopefully it's for the better.

 

[Zebo]

Bipartisan would be leaving off the subsidy for those who can't afford government mandated private insurance. But I'm sure that's not what you mean - you probably mean populist. That would require copying Taiwan, France or any other first worlder who is insuring all for half or less.

 

[theeedude]

That is part what I am trying to determine here. Actually, I am not only interested in conservative opposition to the bill. There is popular opposition among independents, and some opposition among liberals as well. I suppose these three blocs actually have very different reasons for opposing the bill. Nonetheless, the exercise is valuable because the following question screams out for an answer - is even it possible to create a healthcare reform bill that enjoys majority support? If not, then why do polls show that a strong majority think that healthcare needs to be reformed? Finally, if we mostly agree that the system needs to be reformed but we cannot get any better than a plurality of voters to support any one way of reforming it, is it best to just leave the system as is?

- wolf

Majority of Americans thought Iraq had WMD. We can leave the system it is, but the trends are basically going to continue towards more Americans losing their coverage and burdening hospitals and passing it on to the insured, insurance companies raising rates to offset that, which would lead to more Americans losing their coverage, etc. It's a feedback loop at this point that if not broken will lead to system collapsing on its own. Which may be a worthwhile exercise to focus the minds of voters, sometimes people have to pay the "stupid tax" to learn because they don't have the foresight to do it otherwise.
I don't like the current bill, it's like mixing chocolate and manure. Not really edible, and not really good for plants either, but it's a "compromise," which is great by definition, right?

 

[woolfe9999]

Bipartisan would be leaving off the subsidy for those who can't afford government mandated private insurance. But I'm sure that's not what you mean - you probably mean populist. That would require copying Taiwan, France or any other first worlder who is insuring all for half or less.

I doubt adopting the French system would enjoy populist support, let alone bi-partisan support. I doubt any sort of healthcare reform would enjoy populist support. The idea of reforming healthcare might, but not any one particular method of doing it.

I am more interested in your idea of a bi-partisan bill. So you are saying that getting rid of the subsidies, and presumably the mandates that go along with them, would produce a bill that would enjoy bi-partisan support? Interesting. I think the progressives would totally cede from supporting such a bill. The only question is whether a large number of repluclians would then support it.

- wolf

 

[daishi5]

Majority of Americans thought Iraq had WMD. We can leave the system it is, but the trends are basically going to continue towards more Americans losing their coverage and burdening hospitals and passing it on to the insured, insurance companies raising rates to offset that, which would lead to more Americans losing their coverage, etc. It's a feedback loop at this point that if not broken will lead to system collapsing on its own. Which may be a worthwhile exercise to focus the minds of voters, sometimes people have to pay the "stupid tax" to learn because they don't have the foresight to do it otherwise.
I don't like the current bill, it's like mixing chocolate and manure. Not really edible, and not really good for plants either, but it's a "compromise," which is great by definition, right?

This just occurred to me, and maybe I just missed it. Why do we believe current trends will continue for more than a short time? Are we just assuming the baby boomers are the cause of the trend, and that they will have the same care as previous generations? Do we have good reasons to believe that the causes of the current trends will continue long term driving the system to this bad scenario?

I don't mean to be dismissive, but I just realized that this assumption that current trends will continue seems to be an un-stated assumption behind the health care argument. I have never seen any discussion or research into the trend to see if this assumption is actually valid. I know that people tend to assume trends continue when they are in mid-trend (real estate, tech stock, airplane stock, railroad stock, south sea, tulips), but I just wanted to know if anyone has actually looked at this assumption and tried to test its validity.

 

[Fern]

No reform is going to work until they find ways to contain and cut costs in the current system first. Those in control are not interested in doing so. Politicians are not willing, or not capable, of approaching issues like you would if you were a business so this mess will just get worse.

There is no way to contain costs unless care is rationed.

One way to "ration" care is tort reform as it would eliminate unnecessary procedures.

You have any ideas for controlling costs?

- wolf

I agree with Ronstang. Before people start making suggetsions how to fix the problems, the problems need to be indentified and understood. Let's try using a more rational business-like decision model instead the political one.

Seems to me the major root problem is our high cost. People like to compare our costs to those of other countries, typically in terms of GDP. Why are ours so much higher?

Do the various countries calculate their costs the same way so that were are sure we're comparing 'apples-to-apples'?

Which of our costs are higher and why? Until that is understood any suggested 'fix' is a stab in the dark. Is it excessive procedures? (IIRC, 50% of our costs are consumed by about 5 or 10% of the population. If so, and that is higher than Europe, that is where the focus needs to be, broad based stuff is the wrong tool etc.) Is it too many defensive medical proceedures here? If so, how to curtail that. Is our malpractrice insurance a problem, if so how does Europe etc handle that. Are our presription drug costs higher? (We know they are since they pay less per pill) If so, why and fix it. Do we have too few doctors? Why do we allow an antiquated-type cartel to have a monopoly over that area? Is our emergency room care too epxensive? If so why, what's the difference between an emergency room and a walk-in clinic other than the sign over the door?

After our problem of high cost has been effectively addressed, things like extending coverage to uninsured and/or underinsured will be easier (less expensive) to fix.

Fern

 

[ccbadd]

There is no bipartisan healthcare reform. GOP is not interested in it, or they would have passed it themselves when they were in power.

I guess George Washington should have dealt with it or maybe Hoover??? Possibly they were busy with more important things like our idiot congress should be doing now, jobs anyone??? Your statement is too narrow minded and you need to take the blinders off. Obama's priorities should be to help people who are hurting now and need work by fixing the economy, not using bogus stimulus bill to pay political dues and not trying to sneak unpopular legislation through!

 

[halik]

1) Deregulate insurance markets and allow for sale of policies across state lines (instant competition)
2) Require insurance carriers to offer products to those with pre-existing conditions (no price controls)
3) Set up national rules for health savings accounts. Allow health savings accounts to be folded into retirement plan.
4) Tort reform aimed at eliminating the cost of "defensive medicine"

2) Will not work. People with pre-existing conditions run up bills that are much higher than what they can actually afford in terms of the premiums. My best option as an insurer is to not write you a policy.




<- works for insurance company.

 

[Fern]

There is no bipartisan healthcare reform. GOP is not interested in it, or they would have passed it themselves when they were in power.

Looking at how difficult this is for the Democrats, I can understand how the GOP has never been able to do a big HC reform. I can't ever recall in my lifetime where the GOP has had super majorities in both Houses of Congress as well as the exec branch. BTW: Cloture in the Senate used to require 67 votes, instead of the 60 required now.

Fern