I know people have been asking about a “short read” on the current state of HCR that can be used for the 85% of the population (all of our non-BJ-reading friends, family, neighbors & carpool drivers) who haven’t had the time or interest to follow the ongoing soap opera. The NYTimes editorial “If Reform Fails” seems like a pretty good start. (Read the whole thing, at the link.)
As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation. Are they really satisfied with the status quo? And is the status quo really sustainable?
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HOW REFORM WOULD WORK: … Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.
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The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.
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46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.
…
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It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.
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The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.
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BUT I HAVE INSURANCE: While most Americans have insurance, many pay exorbitant rates because they have no bargaining power with insurers. That includes many of the tens of millions who buy their own insurance — the unemployed, the self-employed, and those whose employers do not offer insurance…
…
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BUT I LIKE MY INSURANCE: Most Americans get their insurance through large companies, with large group bargaining power. While they complain about premiums and paperwork, most seem satisfied with their coverage…For this group, the real advantage of reform is security. If they get laid off, decide to be self-employed or switch to a smaller employer that offers no insurance, they will still be guaranteed coverage — even if they are a cancer survivor or have heart trouble or any other pre-existing condition. And they will be able to buy insurance on the exchanges.
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I’M JUST WORRIED ABOUT COSTS: You should be. The cost of medical care is rising far faster than wages or inflation… Many reforms that people instinctively believe should cut costs — computerization of medical records, paying doctors for quality not quantity of services, and prevention programs to promote healthy living and head off costly illnesses — cannot yet be shown to lower costs.
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Pending reform legislation, specifically the Senate bill, would launch an array of pilot projects to test reforms in delivering and paying for care. It would also create a special board to accelerate the adoption of anything that seemed to work. That seems a reasonable way to go and a lot better than standing by as costs continue to spiral out of control. The Republicans’ proposals — including their call to cap malpractice awards — would make only a small dent in the problem.
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WHAT ABOUT THE DEFICIT?: Republican critics of health care reform have done an especially good job of frightening Americans with their talk of bankrupting the Treasury. The truth of the matter is that the pending reform legislation has been designed to generate enough revenue and savings to more than offset the substantial cost of expanding Medicaid and providing subsidies to the middle class.
…
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Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.
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*****
And now we return y’all to our regular late-weekend-night listening pleasure…
__
(This would’ve been taped a few years after I heard Ms. Griffith introduce this song, during a performance at a midwestern university, talking about her first experience touring the bars of Norway doing “American cowboy music”. As a Texan, she was… impressed… by the Norwegians’ barroom standards: “We came through Oslo three times [over the course of several weeks] on that tour, and every time they’d have the stage built up a li’l bit higher, but no matter how high it got they could *still* toss the drunks up there with the band! Guys’d finish their bottle and just toss it away, not even lookin’ where it was gonna land… shuuuure, we do that in Texas, but we alus LOOK before we throw, ’cause it’s only polite to know who you’re threatening to brain!… “
Mike Kay
[peace-lovin-hippie]
but, but, but… this is a give away to evil corporations!
killl teh bill!
[/peace-lovin-hippie]
KDP
Thank you for posting this. I clicked over to the link earlier, but I’m happy to read it again.
Linda Featheringill
I have struggled for years to understand why so many people do not support what is in their best interest. And I have failed for many years to understand that phenomenon.
I don’t know. Maybe people enjoy being miserable.
Pass the bill.
Mark S.
That cracks me up every time I see it.
A lot of us bitch about the Dems (I certainly do), but it always helps to have cheerful reminders how much worse the opposition is.
Punchy
But….but…but….we can’t have n#ggers and sp#ks suck free health care!
signed,
RLimbaugh
sfinny
I work in the insurance business, although not in the healthcare part. As an advocate of the single payer system, well, I’m not exactly representative of my workplace or a popular person when it comes to that issue. I get that we can’t overnight get rid of 550K in jobs in the health insurance business. Other countries have made plans to address this economic dislocation. But here it is not possible, so therefore the compromises made in the existing HCR legislation. My frustration is that after these compromises we are still endlessly compromising. There are so many forces against change; the insurance companies, the pharmaceuticals, the doctors, the hospitals that we can’t get anywhere.
But anywhere is this bill. Is this perfect? No. But it sets in place a change. And one change can lead to another.
JGabriel
TPM, Hayworth Fundraising Ad Depicts ‘Conservative Actor’ McCain In Avatar-Like Warpaint:
Only in the GOP would they think the Na’vi are the bad guys. These are the people who expect to take over the House and Senate this year.
Can we get the Democrats to pay to air these ads, currently online only, on TV?
Nationwide?
.
jon
Whenever I’m told how we can’t mess with the status quo because we have the best healthcare in the world, I remind myself that the Spanish had the best navy and that the Romans had the best plumbing.
JGabriel
@jon: And how the Germans had the best engineering.
What, too Godwin?
.
Sly
@sfinny:
You could make the argument that the reform effort doesn’t go after pharmaceutical companies and medical providers to any meaningful extent and have a legitimate point. I would agree with the pharmaceutical aspect, because the 12-year exclusivity guarantee on brand-named drugs is pretty galling. I wouldn’t necessarily agree with the provider point, for two big reasons:
1) A lot of cost inflation comes from fee-for-service payments. A provider gets paid for every test, surgery, drug, etc, that they perform or prescribe. Even if these things have nothing to do with actual care. This is especially true in hospitals, where everything is done under one roof. The legislation starts to put a big dent in this through bundled payments, especially through Medicare reimbursement, by shifting to bulk payments for care related to the condition in question. A lot of physician orgs have been fighting this tooth and nail, even though most recognize that fee-for-service is one of the most inefficient ways to pay for medical care.
2) The CMI has a truly abysmal procedure for screening Medicare providers/suppliers before the billing period commences. They can’t even check FBI databases to see if the signature on the application matches a previous fraud conviction. As a result there is a ton of money being wasted in Medicare fraud. Meanwhile, Medicaid has less fraud because the CMI can contract that screening to the states (and often does as a condition of further reimbursement). Legitimate providers generally don’t like this, as is often the case with any law-abiding business being forced to deal with more red tape in order to find the law-breakers. They’re especially not going to like in South Florida, which is a hot bed of provider and DME fraud, because the CMI will be able to prioritize which areas get more enhanced screening.
There are some others, but those are the two big ones.
What I cannot fathom is how anyone could credibly argue that insurance companies get off easy with the legislation. The exchange model fundamentally alters how insurers can operate with respect to the individual market, and that’s the place where the majority of bad practices occur. Rescission, claim denials, exorbitant rate hikes, etc. All of those things will be much more difficult to do in a market that has much better rating/issue/MLR requirements than what currently exist in a majority of states.
I’m a single payer advocate too, and acknowledge the fact that a policy designed to put every single health insurance company out of business or, at the very least, relegate them to a supplemental insurance model that you see in some European countries and with Medicare, is something that will meet a lot of resistance. But the fact that private, for-profit insurers will still exist, even if its in a more regulated form, does not in any respect mean that they “win.”
arguingwithsignposts
And we continue on the road to ruin. sigh.
Svensker
@arguingwithsignposts:
Why is it ruinous to do business with Iran?
someguy
Thanks for putting out the talking points AL. They leave out a key one which is that the new system is going to be absolutely dismal because it’s going to be a federally regulated industry, subject to political whims and bureaucracy and all the usual problems, and God help us when/if the Republicans ever are in charge of government again…
But…
It’s going to be less dismal than the system we have. And that’s worth something.
jeffreyw
Morning coffee tastes better out of my new Tunch “Obey” mug.
Marshall
I just got the letter from Aetna Friday – they are apparently raising all premiums (or, at least, all self insured premiums) in Virginia by 29% (in our case, in April). The timing is perfect.
WereBear
I think President Obama is using a Third Way, which is not Republican or Democrat, which confuses people.
How well it works is the most important part, of course, but he is one of the few national leaders who seem to acknowledge that we are living in a brave new world, and is trying to do things in a brave new way.
I once had a work meeting involving behavioral strategies, Satanism, and Pink Floyd, (this was in the mid-80’s,) and one thing I did get out of it was the question: Who was this person when they were ten years old?
My parents grew up with working outhouses and my father didn’t have electricity at home until he was 12. He can work an ice box which uses ice.
At ten, I had a home with two bathrooms, and my own tape recorder and typewriter. We had television and radio and a refrigerator.
I believe that was the biggest sociological leap of the 20th century, and we are still being governed by people who are on the other side of that leap.
Bill E Pilgrim
@WereBear:
http://en.wikipedia.org/wiki/Third_Way_(centrism)
The Collapse of Bill Clinton’s Third Way
It may be exactly what he’s thinking, but it’s certainly nothing new.
WereBear
@Bill E Pilgrim: No, I don’t mean pick a point in the middle. (But I appreciate now that I wasn’t clear, and I thank you.)
I’m discussing things are are not really on the spectrum; I was speaking of the way the Obama administration handles communicating the policy, since the press is a hostile organism. There is compromise, as well, but I wasn’t until Obama weighed in as a communication that the on-street conversations improved in quality.
MikeJ
-ic. Not Republican or Democratic.
Carry on.
Bill E Pilgrim
@WereBear: Okay I was just responding to the “I think he’s using a Third Way” part, in case you didn’t know the history of the term.
I think he is pretty much a Clinton-style Democrat, actually. Dealing with twists that didn’t exist then of course, in addition.
Some people are not at all happy about that, some are. It’s what a lot of the fuss is about, really.
harlana peppper
What I want to know is, if this thing does pass and goes into effect in, what, 2012? – will subsidies be available to those without insurance or those paying exorbitant rates right now, prior to? will anything happen immediately after passage of the bill? how many more will die in the next two years, because they were not fortunate enough to benefit from the proposed legislation? I ask this because I heard some talk (albeit some time ago) that relief in the form of subsidies will be available upon passage of HCR to carry us over into 2012.
RSA
@jon:
As I’ve said elsewhere, the U.S. has the best healthcare system in the world in the same way that Italy has the best automotive industry in the world. Why, people even travel to Italy from abroad to buy Ferraris!
harlana peppper
@WereBear: This is a great observation. What I don’t understand is why conservatives actually want us to move backward, they want the working poor, working class and unemployed to go back to using outhouses, if they are lucky enough to have one, and live without electricity and all the basic comforts, eat poisoned meat, die early because of lack of adequate health care, etc., because we are undeserving. I know this is an old, ear-worn observation, but the obstructionism when no viable alternative is offered is just evil and borders on psychopathic.
Michael
Episode #27,459 on how Conservative Southern Republicans are never engaged or involved in episodes which display racial animus, and attempts to say such are an evil librul MSM plot. And Robert Byrd was a klansman!
http://www.dailykos.com/storyonly/2010/3/6/843669/-What-Comparing-the-1st-lady-to-a-chimp-isnt-funny-CEO-of-Tenn-hospitality-association.-
These are the guys who like to watch “Blazing Saddles” just so they can hear the townspeople they identify with say “ni55er”. The real theme of the movie flies over their heads.
Starfish
I am reading this article in Business Week about a woman whose husband had kidney cancer. I am not sure how it is going to end, but it does point out a lot of what is wrong with the current health care system.
kay
@harlana peppper:
As I understand it, no. 2012. They have to set up an insurance exchange. First in any exchange are small businesses with 20 or fewer employees. It’s supposed to be completely operational by 2014.
As a point of reference, it took two years for Medicare prescription drug plan to fully kick in, and that was one segment of one program.
There was also mass confusion, you may recall. The senior center and the hospital here had to set up volunteer booths to help older people navigate the thing.
WereBear
@kay: Signing up for Part D was one of those evil circuses, and it was my husband’s prescriptions which were breaking us.
Apparently there is no one in a Republican administration who would be caught dead explaining how something works. A) they don’t know and B) they are always wrong.
harlana peppper
@kay: Thanks, I certainly remember the mayhem following the passage of Mcare Part D. I just can’t bring myself to try and read the proposed legislation right now, I’m so damned worn out with all of it. For the life of me, I just cannot understand why they don’t just let us buy into Medicare, that seems to be the most cost-effective way to go, a system is already in place and operating.
kay
@harlana peppper:
Currently, the parts that go into effect immediately are the fixes to Medicare, some insurance regs, and “targeted assistance” to those 55-64. IMO, they are the group that are actually desperate.
You’re screwed if you’re 55-64 without insurance. I got nothing to offer those people, and they’re terrified. If you’re unemployed, it is likely you are going to have the most difficulty finding a job at that age and that just adds to the sense of doom. Who is going to get hired back first? The thirty year old or the fifty five year old? Who is more likely to need and use health insurance?
They know it, too.
Brian J
The impression I’ve gotten after seeing what the experts of all stripes have said (at least those who aren’t hardcore in one direction or the other) is that this represents the best effort thus far at controlling costs. And as most would recognize, health care costs are what we need to worry about in the coming decades. If we begin to make progress there, our budget issues aren’t nearly as scary. Plus, as the editorial states, the new programs are fully paid for.
Shock of all shocks, that’s what the Obama administration is doing: running big deficits now and trying to do reduce them over the long term. Perhaps they could be making more progress over the medium term, but their long term focus seems exactly right.
mr. whipple
Will they ever get this done? I’m so tired of it all.
And if they do, will there be much rejoicing or just relief and a rehash of the feeling that these people we elected in congress really do suck pretty freaking hard?
harlana peppper
@kay: Depressing as hell, I don’t fall into that group but my premiums are exorbitant, I have very little left at the end of each month, altho my tax refund will help pay for my meds which eats up my high deductible w/in 6 months, at least / then I have 6 months left to recover before deductible kicks in again / first of the year is the time I get most nervous
BrianM
Something I’ve not seen explained: why do no private companies act as the equivalent of the exchanges? From a risk-pooling standpoint, 100,000 employees of IBM shouldn’t be all that different than 100,000 employees of various small companies, yet it seems insurance policies for small companies are way more costly (per covered employee) than for large ones.
I know that small companies can’t band together, but why does no single insurance company go after that market?
Links to explanations? I can think of some, but none of them seem convincing to me.
WereBear
Our car’s engine died and my tax return came back about the same time. It’s rare that it works out that way, so thank the FSM.
Our medical debt was worsened even with it, because of a new treatment the insurance refused to pay for. The doctor and pharmacist got it covered, but it didn’t backdate, and we weren’t going to stop the drug regimen that had already begun.
The finance/insurance segment of our society is stealing our life and selling in back in slivers, and they have to stop. Regulation and enforcement is the only way that will stop. I think the bill addresses that in a way I find reasonable.
kay
@harlana peppper:
The most dishonest part of this whole sad circus was the Medicare buy-in for 55 and older. Insurance companies must have loved the idea, because 55 and older use more health care. Imagine if they could just forget all about that part of the population. That’s their freaking dream scenario. They’d insure the healthiest age groups, and the feds would pick up the costliest portion: 55 to whatever.
Providers objected, because they believe Medicare reimbursement is too low.
I loathe Lieberman, but he wasn’t working for insurance companies in that instance. He was working for providers. It was there that I started to doubt nearly everything I read. The AMA held a crowing press conference when it was defeated. Olympia Snowe SAID it was providers she was protecting. It was ignored.
Sly
@BrianM:
Because under current law, with few exceptions (the Mass. Connector, etc), such markets don’t exist. Plus, it depends on what you mean by “go after that market”.
In terms of the profitability, combined small business pools would offer a pristine opportunity for insurers to cherry pick businesses with low actuarial risk and shove high risk businesses out of the market, just like they’ve been doing with the individual market for decades. Keep the healthy, discard the sick, profit. Plus its likely that many low risk businesses still wouldn’t join the pools, because the entire purpose of such pools is having those that are likely to cost less subsidize those that are likely to cost more. It shouldn’t come as a surprise that retail sales businesses are far less likely to offer insurance than small manufacturing companies.
In terms of offering a better deal to section of the market that’s getting shafted, insurance companies simply don’t work that way. Health insurance competition, even in the limited sense in which it currently exists, is based around risk selection. Not price or product innovation (making something better/cheaper).
Brian J
@kay:
Reading stuff like that almost makes me think there is some sort of grand compromise that is possible.
Some have suggested that only the federal government is capable of insuring the population as it gets older and/or sicker, based on the cost and, going into the future, the ability to detect who might get sick before they do so. I can see the logic in such claims.
Now, there’s something theoretically appealing about consumer-driven health care in the form of MSA/HSA-type deals. It’s far from a settled topic, to say the least, and consumers would need proper information to make the right calls. But, to make things very general, it’s a far easier call to not run to the doctor each time you cough than deal with the costs of a disease on your own. Perhaps leaving decisions like that to individuals would be a idea.
Is a system where the small decisions are left to individuals but the bigger costs are dealt with through the federal government a good idea? Is it possible for something to be constructed given the political situation we find ourselves in?
Kirk Spencer
@Sly: Supplementing a good answer…
There’s a bit of monopolistic behavior in here as well. If you’re the only game in town, maximizing profits does not go hand-in-hand with maximizing customers or maximizing service to the customers.
If they want it, they have to come to you regardless.
Small pools (small companies) have higher risk, and as a result have to pay more. That’s better for the bottom line. Especially when you can then massage the payments through rescission, review, and renegotiation. Oh, and a lack of requirement to let anyone see behind the curtain.
numbskull
This is a “short read”, Annie?
Get back to me when you get it down to three sentences: A beginning, a middle, and an end.
:)
kay
@Brian J:
I think it’s too complex for people to make all of those decisions and have something like a job, and a life.
Here is an example. Months ago there was a huge shit storm over a simple suggestion that maybe women get too many mammograms. Remember that? There was a conspiracy angle, all sorts of speculation.
Last week, a study came out that said perhaps men are being over treated for prostate. The study came with very specific recommendations for questions to ask your health care provider. But, we’re talking about a real investment in TIME, there. You have to 1. read the recommendation, 2. act on it, 3. take a flier on second-guessing your doctor.
I just think the world has gotten so complex, that hoping that people can mount this huge learning curve and “make good decisions” on every issue from finance to medical care is asking a lot.
Are they going to have time to do their own jobs? Can we really ask them to read up on medicine and finance ( for example) and operate as an informed purchaser in a huge complex specialized marketplace? They have to trust providers. They don’t really have any choice.
WereBear
@kay: A good point, and I’d add in that you could have a lowest common denominator Power Point presentation that could get people to where they could make such a decision… and they still wouldn’t make a big momentous decision on their own.
They would prefer someone else make it, and be wrong, than risk them making it, and have no one else to blame.
Sly
@Kirk Spencer:
There’s good argument to be made the insurers operate in concert, through their anti-trust exemptions, to divide the risk pool among themselves and leave all the liabilities for non-profits and public programs to pick up. They all get their own little turf and bleed it dry. You can see this in a lot of states, particular those with relatively large number of metro areas: One company has a 70%+ market share in one area, another company has similar dominance in another, etc. I think some of this is explicit collusion, while a lot more of it is probably due through corporate mergers. Mergers which don’t have to go through the DoJ and entail levels of market concentration that would get an automatic denial in any other economic sector.
What grinds my gears is that all this is implicit in the way we pay for health care. Health insurance simply doesn’t work like any other competitive enterprise, and Ken Arrow’s “Uncertainty and the Welfare Economics of Medical Care” put the final nail in that coffin 40 years ago. Yet everyone assumes it does, and I get told “You clearly know nothing about economics” by libertarian sycophants for daring to question their unexamined “free market” dogma. If this is an exemplar of free market economics, then so is OPEC.
Jackson
Thanks for the Nancy Griffith tune. I sure miss having her in Austin.
kay
@WereBear:
I had to purchase health insurance for a period of time, and it was hard to measure.
I ended up getting help from a friend of mine who put together this elaborate comparison chart, but even she wouldn’t weigh in on the quality of the insurer. Were they slow pay or no pay on claims? Bad reputation? SOLVENT? We didn’t know.
I ended up joining the Chamber of Commerce to buy a policy. I think the Chamber is a wholly owned subsidiary of the GOP, so that sucked.
The whole experience sucked. I spent weeks on it. Not just that, of course, but I was preoccupied for weeks.
FlipYrWhig
@RSA:
That’s pretty good. My retort is about education: if you think the US has the best healthcare system in the world, surely you think the US has the best education system in the world, right? Because people come from all over the world to study at Harvard, Stanford, the University of Texas, etc.
(That’s geared specifically towards conservatives, who _always_ complain about education. Personally, I don’t have nearly the complaints about education that I do about health care.)
Jane_in_Colorado
St. Olav’s Gate was actually written by Tom Russell, a fine singer-songwriter who has recorded some songs with Nanci Griffith. Here’s Tom doing it:
Jane_in_Colorado
I don’t know what happened to my link, which can be seen when I try to edit it but not when I save it. Anyway, here it is in plain text: http://www.youtube.com/watch?v=X_YBJxpRuMM
kay
@WereBear:
I’m going to be a little easier on them than that. The response to the mammogram recommendations was partly political. It fed very nicely into the conservative line that Democrats are rationing health care, and it fed very nicely into the liberal line that insurance companies are out to skimp on health care. But it was an outcome study. It asked the question: is the risk of a mammogram itself worth the benefit of early detection, in younger women, when the mammogram recommendations apply across the board?
People went crazy. How can we even discuss health care if this is the response to such a mild suggestion?
WereBear
@kay: Well, yes, I agree that your example showed how the media, at least, will not make any pretense of actually discussing it.
In fact, of late I’ve been asking people this question: “When was the last time you noticed the news explained anything?”
They get indignant about it, which is good.
Now I can, and I have, made some tricky medical decisions. But I’m able or willing to do that, from the research to the ability to buck authoritarian consensus. Some are not.
kay
@WereBear:
The media response to the study wasn’t bad, except they focused on one profit motive, and not both. They mentioned the benefit to insurance companies, fewer mammograms mean fewer payments for mammograms. Correct. But another entity benefits from payment for testing. Providers. Fewer mammograms mean fewer payments for mammograms. They don’t have to be accused of operating in bad faith, but the fact is, they profit from testing. Fact. Discuss. Both sides, in light of new study.
If we can’t even mention that, we can’t have this discussion. We’re not ready. It’s still too scary.
KDP
@BrianM: Actually, there does exist a mechanism by which small businesses can pool together in order to offer employees better benefits packages. This is through the use of outsourced HR services. When I started at my company, we used TeamAmerica (since defunct). Now we use TriNet, which used to be Gevity. This firm handles payroll and benefits for our small firm (4 people, including the CEO on payroll). The benefits that are offered are somewhat limited due to our small size. For example, our boss can select one health insurance provider and type of plan for us. In our case, it’s Aetna and some form of HMO. If we had more than 25 employees, we would have additional options for insurer (like Aetna and Kaiser). Unfortunately, the use of these firms imposes an additional operating expense on the firm. Many small businesses may not a) be aware that they could outsource benefits and payroll to a company like this, or b) choose not to take on the additional operating expense of paying another firm to manage these services since to do so will also mean having to pay out a share of the contracted health insurance premiums (at least in California employer must pay a portion of the premium).
Uloborus
I gotta tell you, guys, but most doctors I’ve met working and having a family in health care have no desire to run extra labs and so forth for profit. In fact, the entire system ticks them off pretty bad, and they feel like insurance companies strangle them into doing it by creating arcane requirements for what they will and won’t cover. Doctor wants to test X. Insurance company will not pay for it unless they test Y and Z first. Doctor wants to prescribe X cheap generic, insurance company will only pay for Y expensive name brand. I’m not even sure what the insurance company gets out of this, since they hate treating patients at all, but doctors complain about this stuff. Loudly. Insurance companies get between them and their patients.
Oh, and they blame hospitals a lot for it, too. They hate sending someone to a hospital, because they don’t know what kind of unnecessary stuff the hospital will do.
But, most of all, they hate rescicion and the thousand other techniques insurance companies use to avoid the basic concept of insurance, having the healthy people pay for the sick people. Somebody here already said that the basic strategy of the industry right now is to take profitable healthy people as customers, and boot the sick people to the curb. Doctors certainly feel that is true.
NovShmozKaPop
Speaking of Oslo, I was there a year ago as a performer and had a wonderful time. Norway is great: really nice folks (some extremely intoxicated ones as well.) High taxes and high prices (would you believe something like $100 for a pizza for three?) BUT anyone can go to the doctor and universities are free as well.
Lurker
@kay
As requested, here’s another update on my attempt to purchase guaranteed-issue group health insurance by forming a general partnership with my spouse.
I have what I need now to purchase guaranted-issue group health insurance. I have:
1) a notarized general partnership agreement
2) a filed and published DBA
3) a EIN from the IRS
4) a business checking account
The last part was actually the hardest, because my spouse has no credit history. Only I have a credit history. We could not open a joint business checking account at a credit union, because most credit unions now require that all applicants have a FICO score of 600 or higher. We successfully opened a business checking account at Wells Fargo using my credit history alone.
So, now that we meet the minimum legal definition of a “business” here in California, all I need to do is pick a plan. Technically, I can now buy any plan from any insurer I want, without preexisting condition discrimination or rescission.
However, I can’t afford all of the plans available. I’m leaning towards a HSA-compatible HMO at Kaiser Permanente to keep premiums priced within my reach.
If I go that route, I’ll open up a health savings account at a credit union like Stanford FCU or Alliant. I’ve had HSA-compatible coverage in the past, so I have some savings in an HSA right now at HSA Bank. HSA Bank sucks. It charges too many fees, and it also pays too little in interest for smaller accounts. That’s another reason I’m leaning towards an HSA-compatible plan: a chance to transfer my HSA away from HSA Bank.
I’d also like to add that although a general partnership could solve problems for some people with preexisting conditions, I think it is insane. It is not a real fix to most people’s health insurance problems. I’m still harassing my Representative to pass health care reform.
hamletta
I, too, would like to vouch for the awesomeness of the Norwegian people.
Last year, there was a great little gospel choir from Oslo on tour, and naturally they spent Easter with us Lutherans. They were wonderful.
Their director circled back to Nashville for Pentecost and filled our frozen chosen, middle-aged choir with the Holy Spirit. This guy is incredibly talented. I’ve never heard my choir sing like that, before or since.
We all went out to lunch and had a grand time, but when I got home, I found out about the murder of Dr. George Tiller.
Dr. Tiller was an ELCA Lutheran like we are, and we’d apparently had a semi-violent incident in the narthex that day, and for a while, I thought there might be some Krazy Kristian jihad against us.
Turned out it was just a homeless guy who freaked out enough that they had to call the police.
mclaren
Reform has already failed. It has failed catastrophically.
Except for the kooks and cranks and crackpots who infest this forum, the judgment is unanimous:
“The Village Dems will try and tell you that the Senate health bill is the “most progressive legislation since 1965.” We all know this is laughably ridiculous. There is no real, effective reform in the bill. There is no real check on the insurance companies. There is no real check on health care costs.
“The best that can be said about the Senate bill is that it does include a large increase in Medicaid funding…”
(From TalkLeft)
The medicaid funding increase is meaningless, a classic scam, since state after state is now so insolvent that they’re all cutting medicaid right and left. Let’s be clear here, people: more than half of the states in America are broke. Many states are so insolvent that if they shut down all their state offices tomorrow and fired all state employees, they would still be hundreds of millions of dollars or billions of dollars in the red.
Examples include Nevada, which is now in a state of emergency, and if it fire all state employees tomorrow and permanently closed all state offices would still have a deficit of 333 million dollars. And that deficit continues to increase as the economy worsens.
California is of course a well-known fiscal basket case, with a deficit of 24 billion dollars and counting. Each time California cuts vital services and furloughs more state employees, the deficit gets worse, because California can’t cut services or fire state personnel as fast as their economy is sliding down the toilet.
This is true of states across the board.
So providing additional medicaid funding to Nevada and California and the other states will merely decrease the size of the worthless IOUs these insolvent states are giving to contractors and state employees. It will do nothing to provide medical care. The federal government can provide funding to the states and then issue mandates all it likes, but in the real world, when states are in a condition such fiscal emergency that they’re issues worthless paper scrip IOUs to their employees, the reality on the ground is that any medicaid funding will never go to fund medical care — it will get sopped up in the general fund and merely help to reduce the state deficits (and then, only slightly).
“Why does Wall St love healthcare reform? Because the current bill has no healthcare reform in it. There are no changes to either market structure, industry structure, reporting, or incentive structures.
“In fact, it’s a de facto bailout of health insurers. Welcome back our old friends rescission, premium inflation, and price discrimination – all flavours of moral hazard. Say goodbye to, well, better health care.
“Why does Wall St. love healthcare reform? As the chart shows, money’s poured into health insurers over the past few days – hot money from hedge funds in search of, by the microsecond, fake, value-destructive alpha. Why? Because a massive transfer of wealth from society to pharma/hmo shareholders is written into the so-called reform bill.”
(From Harvard economists Umair Haque.)
“If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers’ monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.
“Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage. The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries — in the range of $20 million a year — and on return on equity for the company’s shareholders.”
(from Howard Dean.)
““It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the health care crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry,” said [National Nurses Union] co-president Karen Higgins in a statement.
“Sadly, we have ended up with legislation that fails to meet the test of true health care reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations,” she added.”
(Nurses Union: Senate bill isn’t real health reform.)
The Medical Cartel: Why are MD salaries so high?
“MDs in the U.S. make about $200,000, which is between 2 and 5 times as much as doctors make in other countries. How do we explain the significantly higher physician salaries in the U.S.?
“One explanation is the restriction on the number of medical schools, and the subsequent restriction on the number of medical students, and ultimately the number of physicians.”
America’s health insurance cartels are the problem
“…Large healthcare bureaucracies operate as mini-monopolies that together form one giant cartel fixing prices, probably more because of the inertia of infrastructure than any deliberate collusion.
“There aren’t enough market forces, that is competition, to make healthcare affordable. (..) Capitalism works, but there is none here.”
And from Sam Stein at the Huffington Post:
The market concentration for health insurance is so monopolized in some areas that insurance companies are willing to raise prices and lose customers in an effort to improve their bottom line, a leading insurance broker told Wall Street analysts on Wednesday.
In a conference call organized by Goldman Sachs Global Investment Research, Steve Lewis, a highly regarded broker at the world’s third largest insurance broker, Willis, painted a picture of the health insurance market in which employers seem likely to be priced out of coverage. . . .
Insurers are able to do this in part because the markets in which they operate have no adequate competition . . . employers in many markets know “that they’re not going to be able to trade down pricing very significantly” (i.e. find cheaper coverage) and, as such, would likely only change plans or become self-insured if there was a “fairly significant” disruption in service.
. . . The remarks are as clear an indication as any that while the health insurance industry suffered greatly from the recession it remains remarkably well positioned to recoup those profits going forward — principally because companies can raise prices without worrying about the market hit it will take.
Of course the infantile crackpots who infest this forum will explode in the usual tantrums when faced with the documented fact that the current health care “reform” bill contains no actual reform. Unable to deal with reality, the kooks on this forum prefer to hurl themselves onto the carpet like three-year-old and shriek insults and hysterical denials.
Regardless of their histrionics, the cold hard fact remains that nothing in the current health care bills before congress will do anything about the health care cartels and big pharma monopolies, the AMA’s restriction of medical schools to artificially pump up doctors’ salaries to 5 times what they are in other countries, the insane greed-driven inflation in the cost of medical scans and tests (a CAT scan that costs $1500 in America costs $40 in France or Germany), the fee-for-service pricing that drives up costs to 500% or 700% or in many cases 15,000% what they are for the same medical services in other developed countries…
…Instead, it’s much easier for the kooks and cranks and fringe lunatics who infest this forum to howl mindless invective at anyone who points out these documented facts.
Health care reform has already failed. It has failed catastrophically, it has failed permanently, it has failed colossally.
We will eventually see some kind of health care reform — but only when the current system breaks down completely. Will this occur because so few Americans can afford decent health care that when the next pandemic hits, the entire country dissolves into chaos, empty cities full of corpses in the streets, burning hospitals, and deserted countrysides willed with open pits of plague victims?
Or will America simply slowly degenerate, like the former Soviet Union, until so few people have adequate health and the economic burden damages out economic competetiveness so badly that America turns into a third world country, and even the greedy overpaid American doctors and insurance company executives agitate for reform?
Or will the insurance industry succeed so well in driving customers away that it enters such an extreme death spiral that it finally implodes, along with overpriced hospitals that can’t get enough people who can afford to use them and eventually shut down?
Or will average Americans simply rise up in rage and burn down the hospitals and drag doctors and nurses out of their rolls royces and lynch them after their uninsured children die because they were turned away at the emergency room?
I don’t know. And it doesn’t really matter. Like the U.S. military-industrial complex, the American health-industrial complex is so corrupt and so dysfunctional and so powerful and so saturated with trillions of dollar of greed-driven lucre with which to bribe congress and lobbyists that it has shown it can’t be reform. This means that destruction and collapse is the only alternative.
Given the number of people who have been condemned to death and slow horrible suffering by America’s sadistic medical-industrial cartels, I can’t say I’ll shed a tear. Obliteration seems just.
NovShmozKaPop
Yes, with the odd exception they pretty much do suck in a big way, soft and weak and not really prepared to inconvenience themselves much. If they had the balls to force the GOP to actually stand up and filibuster I think we’d see some action. But it’s too inconvenient.
Anyway, there may not be much of a reaction one way or the other for a while considering that the best of the bills doesn’t go into effect for another three, count ’em, three years…certainly not in time to help out anyone currently in a jam.
Kilkee
Love, love, love Nanci. Speaking of the health debacle, she’s had problems of her own lately, which, sadly, have impacted her singing. Thank God that at least presumably she can afford care.
deadrody
Sorry, but any Op-Ed that trots out the thoroughly debunked “uninsured” number of 46 million is not worth the paper or pixels it is printed with.
How debunked is it ? Even Obama doesn’t use that number anymore. Meaning anyone that DOES continue to use it is either 1) a moron, or 2) completely in the tank for the far left, or 3) just a liar.
In any of those 3 cases, that makes their little piece of fiction just that, fiction. Not surprising it would be in the liberal rag of choice, the NY Times.
As for the conclusion that we “cannot afford the status quo”. That may be true in some skewed perspective, but the alternative, where this ridiculous HCR bill passes, now that this country REALLY cannot afford. Literally.
bob h
I have the blue bag in my driveway every morning because I feel the closure of the Times would be an enormous loss to the nation.
Lurker
Cleek, I ♥ your pie filter. I can’t believe how much mclaren and deadrody praise pie.