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Health Care: President Obama's 8 Proposed Consumer Protections
Old 07-29-2009, 10:17 AM   #1
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Health Care: President Obama's 8 Proposed Consumer Protections

May be we're getting somewhere here . . .

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WASHINGTON -- President Barack Obama, just days before Congress's August recess, will head to North Carolina and Virginia Wednesday to press his health-care agenda, with a new emphasis on insurance regulation and new details on the changes he is seeking.
. . .
He will lay out eight consumer protections he wants in a health care bill: no discrimination for pre-existing conditions, no "exorbitant" out-of-pocket expenses, no out-of-pocket expenses at all for preventive health care, no dropping coverage in the event of a serious illness, no gender discrimination, no annual or lifetime coverage caps, more coverage for chronically uninsured or underinsured young adults, likely through their parents' plans, and guaranteed insurance renewal.
These make sense (depending, of course, on the details--what is "exhorbitant," etc), and I don't think he'll have much opposition. Unfortunately:
-- There's still no talk of breaking the employer/healthcare link. Apparently, the unions have such deep influence on those in the legislature and the executive branch that breaking this link is just not going to happen. Plus, since President Obama made such a point of lambasting McCain's plan to eliminate tax breaks for employer-provided health insurance, I think he'll have problems doing a quick U-turn.
-- None of this addresses health care costs--and some of the "protections" will probably drive them higher.
-- What good is a "protection" that makes health care policies more robust if a person can't get a policy? More employers will stop providing coverage if it gets more expensive (due to the "protections" and the increasing cost of care).

Anyway, with the "public option" becoming less likely, maybe we can move ahead with a national discussion of a private health insurance market where individuals buy their own policies, underwriting is eliminated, and cost control occurs via market forces instead of legislation and government committees. Government vouchers for the needy--just as we do with food and shelter.
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Old 07-29-2009, 11:04 AM   #2
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Originally Posted by samclem View Post
May be we're getting somewhere here . . .

These make sense (depending, of course, on the details--what is "exhorbitant," etc), and I don't think he'll have much opposition. Unfortunately:
-- There's still no talk of breaking the employer/healthcare link. Apparently, the unions have such deep influence on those in the legislature and the executive branch that breaking this link is just not going to happen. Plus, since President Obama made such a point of lambasting McCain's plan to eliminate tax breaks for employer-provided health insurance, I think he'll have problems doing a quick U-turn.
-- None of this addresses health care costs--and some of the "protections" will probably drive them higher.
-- What good is a "protection" that makes health care policies more robust if a person can't get a policy? More employers will stop providing coverage if it gets more expensive (due to the "protections" and the increasing cost of care).

Anyway, with the "public option" becoming less likely, maybe we can move ahead with a national discussion of a private health insurance market where individuals buy their own policies, underwriting is eliminated, and cost control occurs via market forces instead of legislation and government committees. Government vouchers for the needy--just as we do with food and shelter.
Without top down changes and mandatory coverage, these things only cause prices to explode.

Hillary-Care at least tried to address these issues. President O is just trying to prevent a big political loss.
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Old 07-29-2009, 11:19 AM   #3
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NYT has an interesting article today arguing for taxing health care benefits.

http://www.nytimes.com/2009/07/29/bu...nhardt.html?hp

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Old 07-29-2009, 11:23 AM   #4
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He is not writting the bill and in his press conference he was asked about his lack of direction in the process - basically he said he will wait for the bill to be passed by the congress and then decide to veto or not.
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Old 07-29-2009, 12:17 PM   #5
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It is a tough row to hoe - I think universal health care has been on every president's agenda since Truman - maybe earlier.
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Old 07-29-2009, 12:33 PM   #6
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Originally Posted by haha View Post
Without top down changes and mandatory coverage, these things only cause prices to explode.

Hillary-Care at least tried to address these issues. President O is just trying to prevent a big political loss.

I still can not get my head around this statement... and I am changing yours a bit...

Without mandatory coverage, these things only cause prices to explode.

Why? Why would the 'cost' of healthcare go down if there were mandatory coverage? I would agree that there would be some other people paying for the costs that do not today (and they might not be using any health care to boot)... but just because someone else is PAYING for it, does not mean the COST of it is reduced...

I do agree, the total cost of healthcare will go up with the proposals mentioned...
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Old 07-29-2009, 01:14 PM   #7
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A quick way to reduce health ins. costs is to eliminate government corportate taxes on all health related companies.
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Old 07-29-2009, 01:37 PM   #8
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Why? Why would the 'cost' of healthcare go down if there were mandatory coverage? I would agree that there would be some other people paying for the costs that do not today (and they might not be using any health care to boot)... but just because someone else is PAYING for it, does not mean the COST of it is reduced...
I don't know if costs would go down with mandatory coverage, but I can suggest some reasons it might.
- More preventative care. If people have coverage then they are more likely to get those Pap smears, checkups, immunizations, etc. These cheap procedures reduce overall costs to the whole system.
- More efficient care venues. Lots of the uninsured are now clogging up ERs with requests for routine care. It costs many, many times more to treat them there than in an urgent care clinic or a regular appointment. Their continuity of care would be much better, further reducing costs.
- And, the issue of who pays CAN make a difference in total costs. Right now,the costs incurred treating the uninsured get passed along (at high admin cost) until they eventually land at some payor with deep pockets. If the costs stay with the patient (paid partly by the patient as a copay and partly by insurance) that will reduce admin costs. And, to the degree the patient has some "skin in the game" via co-pays, there will be a natural tendancy to reduce use of the medical system.
- Even those who now have good insurance can benefit from mandatory coverage. Their premiums will be lower if the uninsured are covered (due to less cost-shifting to insurance companies.) Most importantly, if people knew they could leave their present employer and find a different job or start their own business and still have coverage, the whole labor market would get much more efficient. That helps everyone tremendously, though it would be a benefit that would be tricky to document. I'll bet it would be worth at least a .5% boost in GDP every year. That's real money.
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Old 07-29-2009, 02:45 PM   #9
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Originally Posted by samclem View Post
- More preventative care. If people have coverage then they are more likely to get those Pap smears, checkups, immunizations, etc. These cheap procedures reduce overall costs to the whole system..
Maybe, maybe not... I was discussing health care with someone a lot more liberal than me this weekend... I asked "sould the homeless guy get a heart transplant if he needed it?"... he said 'of course'... Me, I am not that generous... I think he should not... but I digress....



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- More efficient care venues. Lots of the uninsured are now clogging up ERs with requests for routine care. It costs many, many times more to treat them there than in an urgent care clinic or a regular appointment. Their continuity of care would be much better, further reducing costs...
Change the law!!! Allow the ER to say "this is not an emergency and we will not treat you"... And only treat the real emergencies... broken bones, heart attacks, car accidents, dog bites... the rest need to go to a Dr. in a box or somewhere else... no need to insure everybody to make this change...




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Originally Posted by samclem View Post
- And, the issue of who pays CAN make a difference in total costs. Right now,the costs incurred treating the uninsured get passed along (at high admin cost) until they eventually land at some payor with deep pockets. If the costs stay with the patient (paid partly by the patient as a copay and partly by insurance) that will reduce admin costs. And, to the degree the patient has some "skin in the game" via co-pays, there will be a natural tendancy to reduce use of the medical system.
But the proposal is not co-pay for routine services... so that is 'free'... And at what cost is this cost shifting? Maybe it is still cheaper to do this than to spend a trillion or two for sure...
But I do agree with the premise of this statement....

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- Even those who now have good insurance can benefit from mandatory coverage. Their premiums will be lower if the uninsured are covered (due to less cost-shifting to insurance companies.).
I would hope... but this is not clear either... if the people use their insurance more now that they have it paid for by the government, then total health care costs go up... so I might have a slightly lower insurance premium, but will likely pay more taxes...

I don't meet the level they talk about who will 'pay' these taxes, but I have a gut feeling that when the government takes $1 trillion dollars from somebody, that somebody is going to do their darnest to pass it along to me...

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Originally Posted by samclem View Post
Most importantly, if people knew they could leave their present employer and find a different job or start their own business and still have coverage, the whole labor market would get much more efficient. That helps everyone tremendously, though it would be a benefit that would be tricky to document. I'll bet it would be worth at least a .5% boost in GDP every year. That's real money.

Now, this is something I can see helping... but it is not in the plan either... and we also do not have to insure 'everybody' to do this...


So, except for a possible drop in ER costs, I do not see a lot of cost savings if we insure everybody...


And I think they are going after it wrong... change the cost side FIRST.. then say 'now that we have cost under control, we should be a great nation and make sure all of our citizens (and only citizens) are covered by basic healthcare coverage'.... This is a winning strategy to me...
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Old 07-29-2009, 05:39 PM   #10
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I think HaHa is correct about mandatory coverage. The problem is self segregation. Without mandatory coverage lots of young, healthy adults will forgo the cost of health insurance and toss the dice. Heck -- I did in my early 20s. With no limits on pre-existing conditions, they can sign up later, when they are older and/or sick. At that point they will be automatically covered at a high cost to the system. This is "reverse cherry picking." Health reform doesn't work well financially without mandatory universal coverage.

Digression: I have been irritated at the media discussion of the "public option." Most of them describe it as a sort of last resort HMO for people who can't get coverage elsewhere - a "medical system" run by the government. I have even seen them use the VA system as a model for the "public option." To the contrary, I always understood that the only "public options" that were ever under consideration were, essentially, Government administrated insurance plans as an "option" to private sector insurance. The idea being to offer decent, cheap, nonprofit (Government) insurance so the private sector companies would have a real competitor. Sort of Medicare for the masses with no subsidies from the taxpayer (fully funded by the subscribers). I would look long and hard at such an option -- kinda like TSP versus Vanguard. Am I wrong about this?
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Old 07-29-2009, 07:12 PM   #11
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To the contrary, I always understood that the only "public options" that were ever under consideration were, essentially, Government administrated insurance plans as an "option" to private sector insurance. The idea being to offer decent, cheap, nonprofit (Government) insurance so the private sector companies would have a real competitor. Sort of Medicare for the masses with no subsidies from the taxpayer (fully funded by the subscribers). I would look long and hard at such an option -- kinda like TSP versus Vanguard. Am I wrong about this?
I think you've correctly captured the talking points used to promote the "public option," but I don't think anyone believes it would really work that way. Medicare pushes costs onto the private sector--is there any reason to believe this "public option" would be different? Likewise, when dollars run short and the "public option" participants can't get care, the general fund will be there and Congress will use it. If the public option has cheaper premiums (again, due to taxpayer subsidies and cost-shifting), then people will flock to it, driving the bill to the government higher, increasing cost shifting even more, and leaving the private insurers to cover their costs with fewer clients. They'll be in a death spiral, crowded out by the taxpayer-supported system. Soon the public "option" would be the only option--which, I think is really the point after all.
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Old 07-29-2009, 07:40 PM   #12
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I have heard that anywhere from 70% to 90% of the population is OK with their current health insurance. It seems like when people are not OK there are two main complaints.

1. Portability at a reasonable cost
2. Portability or able to even get health care if you have a prior condition at a reasonable cost

So why not try and solve these two items first without destroying the current system that clearly a majority of Americans or OK with?

(I used the term 'clearly a majority' as I do not believe the polls are so far off that only 49% are happy with their current health care)
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Old 07-29-2009, 08:16 PM   #13
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A quick way to reduce health ins. costs is to eliminate government corportate taxes on all health related companies.
Now THAT is an interesting proposition.
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Old 07-29-2009, 11:35 PM   #14
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I think HaHa is correct about mandatory coverage. The problem is self segregation. Without mandatory coverage lots of young, healthy adults will forgo the cost of health insurance and toss the dice. Heck -- I did in my early 20s. With no limits on pre-existing conditions, they can sign up later, when they are older and/or sick. At that point they will be automatically covered at a high cost to the system. This is "reverse cherry picking." Health reform doesn't work well financially without mandatory universal coverage.

You just made my point... this is only COST SHIFTING... not cost containment... IF you are young and not in need of health care, then WHY should you pay for it The only reason is to shift cost to the young away from the people who actually DO use the system... again, this does NOTHING (or very little) to the actual cost of health care in the US




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Digression: I have been irritated at the media discussion of the "public option." Most of them describe it as a sort of last resort HMO for people who can't get coverage elsewhere - a "medical system" run by the government. I have even seen them use the VA system as a model for the "public option." To the contrary, I always understood that the only "public options" that were ever under consideration were, essentially, Government administrated insurance plans as an "option" to private sector insurance. The idea being to offer decent, cheap, nonprofit (Government) insurance so the private sector companies would have a real competitor. Sort of Medicare for the masses with no subsidies from the taxpayer (fully funded by the subscribers). I would look long and hard at such an option -- kinda like TSP versus Vanguard. Am I wrong about this?
And here is where we disagree... I do not see it as a separate plan that does not have gvmt subsidies... look at AMTRACK, look at the post office (except maybe now they do not require money... but they used to big time)... they SAY it will live on its own... but we know that the people who will get on this plan are the very sick and very poor... and the cost will be high.. and since they are high, they will subsidize them...
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Old 07-30-2009, 06:43 AM   #15
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I think you've correctly captured the talking points used to promote the "public option," but I don't think anyone believes it would really work that way. Medicare pushes costs onto the private sector--is there any reason to believe this "public option" would be different? Likewise, when dollars run short and the "public option" participants can't get care, the general fund will be there and Congress will use it. If the public option has cheaper premiums (again, due to taxpayer subsidies and cost-shifting), then people will flock to it, driving the bill to the government higher, increasing cost shifting even more, and leaving the private insurers to cover their costs with fewer clients. They'll be in a death spiral, crowded out by the taxpayer-supported system. Soon the public "option" would be the only option--which, I think is really the point after all.
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And here is where we disagree... I do not see it as a separate plan that does not have gvmt subsidies... look at AMTRACK, look at the post office (except maybe now they do not require money... but they used to big time)... they SAY it will live on its own... but we know that the people who will get on this plan are the very sick and very poor... and the cost will be high.. and since they are high, they will subsidize them...
This is the argument the country should be having. Your concerns on the "no" side and proposals/guarantees to assure a level playing field on the "yes" side. This is indeed cost shifting but cost shifting that sets up a reasonable health care envoronmnet where all Americans get care -- something I believe in. The nonprofit public option could (not necessarily would) help to drive real competition to drive costs down in the direction of the rest of the industrialized world - or not

Unfortunately, this discussion has disappeared and the public option is being described by the media as a VA like "system" for the poor. Even left leaning MSNBC is describing it that way about half the time.
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Old 07-30-2009, 08:42 AM   #16
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Actually, I'd support the "public option" if we could guarantee it would be a standalone system that only the truly needy could get into. I think the needy would be better served with vouchers so they could participate in the private plan, and that this would be cheaper and they would be better served overall, but it would be okay with me to use the same voucher money to set up a "civilian VA>" It would serve as our own little domestic demo program about how great government care would be if we instituted it across the whole population. Nothing would do more to kill the idea in the public's mind that government health care is a good idea.

If we do the right things to create a more open, efficient market (getting employers out of the picture, eliminating underwriting and "group rates", and, (yes, unfortunately) mandating that everyone buy coverage, etc) then more efficient private insurers/insurance will soon dominate the market. A good example is in mutual fund companies: Where the market is inefficient (401Ks, where employers pick the players) we have a high percentage of high cost, high kickback overhead providers. Where the market is more efficient (IRAs, where people buy their own MFs directly) Vanguard and Fido rule. There will be one or more "Costco for health insurance" providers if we set up the system properly.
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Old 07-30-2009, 09:33 AM   #17
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I think the needy would be better served with vouchers so they could participate in the private plan, and that this would be cheaper and they would be better served overall...

If we do the right things to create a more open, efficient market (getting employers out of the picture, eliminating underwriting and "group rates", and, (yes, unfortunately) mandating that everyone buy coverage, etc) then more efficient private insurers/insurance will soon dominate the market. A good example is in mutual fund companies: Where the market is inefficient (401Ks, where employers pick the players) we have a high percentage of high cost, high kickback overhead providers. Where the market is more efficient (IRAs, where people buy their own MFs directly) Vanguard and Fido rule. There will be one or more "Costco for health insurance" providers if we set up the system properly.
Hopefully, we will end up with something like this. I think it is the best result we can expect and one I would view as a huge improvement. More likely, we will stay with the employer based model and all it's attendant problems. But, as long as we end up with mandatory coverage, standardized minimum offerings, no pre-existing conditions, no cancellations, no caps we will be miles ahead of where we are today.
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