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Old 04-09-2008, 05:42 PM   #61
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It's just too bad that Hill's and Ob's plans are vague and their attitude about successful enactment stinks. They may be less vague than McCain's, but they're vague nonetheless. And, as typical, neither has even secured the nomination and yet both are already blaming the "stonewalling Republicans" for the Dems future failure to get an extensive med plan enacted. Why do they insist on putting the excuses and blame for failure out in front of even attempting to get the job done?

I want to send someone to Washington who accepts the responsibility for getting the changes made. Not someone who says they are the one(s) to get the job done but don't blame us when we fail in the future 'cause it ain't our fault. It's those bad guys on the other side of the aisle...... Sick...........
Yes, it is unclear if any candidate will be able to get traction on the issue. However, I tend to think the Dems are more likely to address it. I suspect that this issue is much lower on the priority list for republicans.
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Old 04-09-2008, 06:01 PM   #62
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Yes, it is unclear if any candidate will be able to get traction on the issue. However, I tend to think the Dems are more likely to address it. I suspect that this issue is much lower on the priority list for republicans.
You could be right. This might be one of those things that keeps getting pushed back like SS and Medicare.
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Old 04-09-2008, 07:01 PM   #63
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Yes, it is unclear if any candidate will be able to get traction on the issue. However, I tend to think the Dems are more likely to address it. I suspect that this issue is much lower on the priority list for republicans.
My take is that the smart money this time around is to bet the party, whichever way you lean. A split congress / White House on this one will probably mire down for so long that it will be too late for us 60-ish types.
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Old 04-09-2008, 07:23 PM   #64
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I know Oldbabe apologized, but I appreciate her frustration and I think no apology is needed. She can't find someone to sell her health insurance. Isn't that frightening? In that position I certainly would be on a soap box too. And McCain's plan does nothing for her at all.

Just to clarify. I do have individual health insurance at $280/month with a $2700 deductible that EXCLUDES my skin cancer and my entire spinal/back area (because of a compressed cervical disk in my neck which gives me no trouble at all but was diagnosed once seven years ago).

I am concerned about myself of course but am more concerned for those like my brother and my oldest son who are blue collar workers who are sick and out of work or working for companies that do not offer health insurance. Neither can afford the premium on a individual policy if a company would cover them. In my brother's case, no company would touch him. He also has severe dental problems that are untreated (but dental treatment is a whole other expensive problem).

My brother has no recourse except to get better. That's going to be quite a feat. More likely without continuing treatment he will slowly deteriorate and die. He is 49 years old. He's currently trying to get disability from SSI. And in case anyone is wondering why family can't step in to help him. My dad is giving him a place to live and helping with some finances. I have offered to help him as well but my brother and I aren't close at all and he has ignored my offers.

Although my brother's particular story has its own difficulties, I don't think his situation in general is uncommon. I have heard over and over women my age (who are of modest means) mention that their response to illness and injury is to tough it out, and NOT go to the doctor. I have a friend who suffered through kidney stones while using natural/alternative treatments to dissolve them. Luckily, she was able to cure herself. There's a whole subculture of alternative treatment advice on the Internet for people without health insurance who are desparate for relief from their illnesses. Alternative treatments help many but, of course, cannot very often cure cancer or heart disease, for example.

I don't think that universal health insurance is a right -- in the sense of life, liberty and the pursuit of happiness. And even with Universal coverage people are not going to get everything they want and need. But I do think that our country could afford some basic coverage, especially for children, with some rearrangement of priorities.
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Old 04-09-2008, 11:05 PM   #65
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None of the plans are set up the way I would set up a plan. But of the three, McCain's is the worst.

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Which of the two Dem plans do you favor? Why? Leave McCain out of it. We have to pick between Hill and Ob before we get to pick between one of them and McCain.
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Old 04-09-2008, 11:17 PM   #66
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My take is that the smart money this time around is to bet the party, whichever way you lean. A split congress / White House on this one will probably mire down for so long that it will be too late for us 60-ish types.
Rich....

For us 60-ish types, we're likely to be on Medicare by the time a new universal plan is defined, funded and implemented. If you're looking for something to allow you to RE pre-Medicare, good luck! Maybe a new universal plan will be in place to help those currently in their mid-50's or younger, but not the 60 yo crew.

Remember, these will be most of the same politicians who currently are bringing you paralysis on SS, Medicare, Immigration, ending the Iraq war, etc.
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Old 04-10-2008, 12:13 AM   #67
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I universal health care does indeed seem inevitable (I hope).
Not sure we can rely on inevitable!

In CA we recently had a popular republican governor, leader of the dem majority and the democratic majority legislature fail to come up with a decent health care reform proposal (ie if not now, when?!).

It will take a HUGE commitment and it needs to be priority 1 if anything is going to happen - let alone a comprehensive reform.
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Old 04-10-2008, 07:35 AM   #68
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For us 60-ish types, we're likely to be on Medicare by the time a new universal plan is defined, funded and implemented. If you're looking for something to allow you to RE pre-Medicare, good luck! Maybe a new universal plan will be in place to help those currently in their mid-50's or younger, but not the 60 yo crew.

Remember, these will be most of the same politicians who currently are bringing you paralysis on SS, Medicare, Immigration, ending the Iraq war, etc.
True, but it is likely IMHO that Medicare will be heavily included in some aspects of health care reform - it's 'broker' than SS.

I'm grateful that I was able to finagle carry-over health insurance so that when I FIRE I'll be covered (albeit at very high, out-of-pocket rates) until MC kicks in.
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Old 04-10-2008, 07:50 AM   #69
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For those of us who think we will be home free when medicare kicks in, this article from Sunday's Washington Post may cause concern

On Medicare and scorned by Docs
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Old 04-10-2008, 08:03 AM   #70
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For those of us who think we will be home free when medicare kicks in, this article from Sunday's Washington Post may cause concern

On Medicare and scorned by Docs
Physicians have a choice re: MC patients. They can "accept assignment" which means that you agree to consider MC payments as full fare and won't bill the patient for the difference, or you can NOT accept assignment in which case you can bill the patient for your full fee, and MC reimburses the patient for whatever they decide is full.

MC fee schedules are unrealistically low, and they pay only 80% of that as a rule. Bottom line is that in primary care, it is not financially feasible to run a private practice as a viable business if MC assignment is a major part of it. Of course, there is intense pressure from patients and the feds to participate.

It's a mess. Medicare supplemental tries to fill the gap, but is fairly expensive, too (though less so than full private insurance). But I don't think the doctors are "scorning" patients, they just don't want to run a shop where your revenues are less than your expenses. After 12 years of training and 6-figure debts, I guess they figure they deserve an income greater than $30k a year.
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Old 04-10-2008, 08:56 AM   #71
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NO THANKS! I'll just keep making my $680/month payments to BC/BS for my family of 4.
Except that it may well become $750 next year and $850 the year after that, and heaven help you if someone in your family develops a chronic or serious condition.

IMO, keeping coverage affordable without forcing adverse selection on to insurers and severing the link between employer and health insurance are probably the things that need to happen most, regardless of whether (and how much) government sticks its nose into health care. I'm generally a free-market libertarian but based on what I'm seeing in this issue, I'm not sure the free market can accomplish these goals.
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Old 04-10-2008, 09:26 AM   #72
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This is the second time I have seen the Kaiser Family Foundation quoted as if it has no political agenda. I am not say they do, or don't, however, I went to there web site and looked at their board of directors. I had a hard time figuring out where the conservators are. Board of Trustees - Kaiser Family Foundation On the other hand, it is easy to see people like Cokie Roberts, or Donna Shalala, lots of lawyers, not noted for conservative views, College professors also not noted for impartial views. So I for one take there studies with a grain of salt. The fact that you can find lots of people that agree with them does not make them right, just popular.
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Old 04-10-2008, 10:12 AM   #73
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vive Ron Paul...

Chief Justice Burger, with Justices Rehnquist, White, and O’Connor, wrote: “in an effort to become an omnipotent [] problem solver[,]. . . the court distorts our constitutional function”; “the importance of a governmental service does not elevate it to the status of a fundamental right”; “assumption of a legislative role [is] one for which the court lacks both the authority and competence”; “llegal aliens have no right whatever to be here, and the state may reasonably, and constitutionally, elect not to provide them with governmental services at the expense of those who are lawfully in the state”; “the constitution does not provide a cure for every social ill, nor does it vest judges with a mandate to try to remedy every social problem.”

we can't afford to fix the health care system, it is plain and simple.

The 'free market' doesn't have anything to do with giving people something they haven't earned. There are no solutions to this problem.
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Old 04-10-2008, 10:52 AM   #74
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Other countries afford it and do it at a lower cost than the cost the US already incurs per capita for health care. And the outcomes for those countries are no worse and some say better.

As a country we chose what we value. If we value health we can pay for it. For the most part, we already do pay.
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Old 04-10-2008, 01:00 PM   #75
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Martha......

Perhaps you prefer not to comment on the two Dem candidates' plans, but since you seem very knowledgible about med coverage, I'd appreciate knowing which plan you prefer? If our number one issue going forward is health coverage, which of the two Dem candidates should we be pulling for, as the Dems finalize their nomination process, to wind up with the best national health strategy going forward? Why?
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Old 04-10-2008, 01:03 PM   #76
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I value vacation to Hawaii, cold beer, good scotch, and several other things, so you all pony up and send your checks! That's the way democracy works!
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Old 04-10-2008, 01:18 PM   #77
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I value vacation to Hawaii, cold beer, good scotch, and several other things, so you all pony up and send your checks! That's the way democracy works!
Or, in this case, is it two wolves and a lamb deciding what's for dinner?
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Old 04-10-2008, 01:23 PM   #78
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Rich,
I like that. Never heard it before.
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Old 04-10-2008, 01:44 PM   #79
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Martha......

Perhaps you prefer not to comment on the two Dem candidates' plans, but since you seem very knowledgible about med coverage, I'd appreciate knowing which plan you prefer? If our number one issue going forward is health coverage, which of the two Dem candidates should we be pulling for, as the Dems finalize their nomination process, to wind up with the best national health strategy going forward? Why?

Sorry Youbet, missed your last post.

My preference of the plans out there is Senator Wyden's plan. But I guess the candidates can't take someone else's plan, they have to invent their own.

As between Hillary and Obama, there are good and bad aspects to both. The biggest weakness to Obama's plan is not requiring everyone to have insurance. This creates a number of problems. However, in this case I would not chose to vote for one or the other based on the details of their plan, but more on the likelihood of one or the other being able to get a coalition together. I am still torn on that issue.

Anyhow, some comparisons between the two:

Analysis - health08.org

A. Requirement to obtain or offer coverage

Hillary:
  • Individuals must have health insurance coverage.
  • Large employers must provide an employee plan or contribute to the cost of coverage.
  • Most small employers are not required to offer or contribute to coverage costs but are provided incentives to do so.
Obama:
  • Require all children to have health insurance.
  • Require employers to offer “meaningful” coverage or contribute a percentage of payroll toward the costs of the public plan.
Martha: If we are forced to keep insurance companies, I think we need to have everyone participate in order to prevent adverse selection, prevent people from waiting until they are ill to get coverage, and to spread the cost.


B. Expansion of public programs

Hillary:
  • Medicaid and SCHIP safety net strengthened “for the most vulnerable populations” to plug gaps, such as lack of coverage for poor, childless adults.
Obama:
  • Expand Medicaid and SCHIP.
  • Create a new public plan so that small businesses and individuals without access to other public programs or employer-based coverage could purchase insurance. Plan coverage would offer comprehensive benefits similar to those available through FEHBP.
  • Coverage under the new public plan would be portable.
Martha: Well, it is about time people want to cover the childless poor. But why so many plans? How about just the public plan and ditch the chronically underfunded Medicaid and SCHIP programs. One of our problems is too many programs.

C. Premium subsidies to individuals

Hillary:
  • Refundable tax credit to help working families pay for coverage.
  • The value of the credit would be set to ensure that premiums could not exceed a fixed percentage of family income, while maintaining price consciousness among consumers.
Obama:
  • Make federal income-related subsidies available to help individuals buy the new public plan or other qualified insurance.

D. Premium subsidies to employers


Hillary:
  • Refundable small business tax credit to provide an incentive to offer employee coverage. (High-income small businesses would not qualify.)
  • A “retiree health legacy initiative” would provide qualifying public and private sector employers offering retiree health plans with a tax credit to offset catastrophic health expenditures, “as long as savings are dedicated to workers and competitiveness.”
Obama:
  • Federal subsidies would partially reimburse employers for their catastrophic health care costs if the employers guaranteed that premium savings would be used to reduce employee premiums.
Martha:

I favor splitting off insurance from the employment relationship, but odds are that won't happen.

E. Tax changes related to health insurance


Hillary:
  • Employer-provided health premiums would continue to be excluded from income taxes except for “the high-end portion of very generous plans for those making over $250,000
Obama:

No provision.


F. Creation of insurance pooling mechanisms

Hillary:
  • New Health Choices Menu would be offered to all Americans through the FEHBP, offering the same private plan options available to members of Congress along with a public plan option similar to Medicare.
  • Benefits would be at least as good as an FEHBP benchmark plan, including mental health parity and usually dental coverage.
  • Employers could buy coverage through the new Health Choices Menu on behalf of workers or early retirees.
Obama:
  • Create a National Health Insurance Exchange through which individuals could purchase the public plan or qualified private insurance plans.
  • Require participating insurers to: offer coverage on a guaranteed issue basis; charge a fair and stable premium that is not rated on the basis of health status, and meet standards for quality and efficiency.
  • Require plans of participating insurers to offer coverage at least as generous as the new public plan.
  • Exchange would evaluate plans and make differences among them transparent.
G. Changes to private insurance

Hillary:
  • Require private insurers to provide coverage on a guaranteed issue and guaranteed renewable basis.
  • Prohibit insurers from “carving out benefits” or charging higher rates to people with health problems or who are at risk of developing them. Limit premium variations on basis of age, gender or occupation.
  • Require insurers to meet minimum loss ratio (including limiting marketing costs) and “ensure high value for every premium dollar.”
  • Require all insurers that participate in federal programs to cover preventive services based on recommendations of US Prevention Services Task Force and promote chronic disease management.
Obama:
  • Prohibit insurers from denying coverage based on pre-existing conditions.
  • Children up to age 25 could continue family coverage through their parents’ plan.
  • In market areas where there is not enough competition, require insurers to pay out a “reasonable share” of premiums on patient care benefits.
  • Prevent insurers from abusing monopoly power through unjustified price increases.
  • Require health plans to disclose the percentage of their premiums that actually goes to paying for patient care as opposed to administrative costs.
Martha: This will only work if we require everyone to have insurance, otherwise we are going to have big adverse selection problems.


H. State flexibility

Hillary:
  • State option to band together to offer same type of choices in a region of the country as Health Choices Menu.
Obama:
  • Maintain existing state health reform plans if they meet minimum standards of the national plan.
Cost containment

Hillary:
  • Proposes a 7-Step Strategy to Reduce Health Costs:
    • A national prevention initiative;
    • A “paperless” health information technology system;
    • Chronic care coordination to improve outcomes;
    • Elimination of insurance discrimination to help reduce administrative costs;
    • An independent “Best Practices Institute” to help consumers and other purchasers and plans make the right care choices;
    • “Smart purchasing” initiatives to constrain prescription drug and managed care expenditures (permit the Secretary to negotiate prices for Medicare prescription drugs, limit direct-to-consumer advertising of prescription drugs and change patent laws to increase the availability of generic drugs; and reduce payments to Medicare Advantage plans to create more level reimbursement with traditional Medicare); and
    Linking medical error disclosure with physician liability protection.
Obama:
  • Invest $50 billion toward adoption of electronic medical records and other health information technology.
  • Promote insurer competition through the national Health Insurance Exchange and by regulating the portion of health plan premiums that must be paid out in benefits.
  • Improve prevention and management of chronic conditions.
  • Initiate policies to promote generic drugs, allow drug reimportation, and repeal the ban on direct price negotiation between Medicare and drug companies.
  • Pay Medicare Advantage plans the same as regular (traditional) Medicare.
  • Require hospitals and providers to publicly report measures of health care costs and quality.
  • Promote and strengthen public health and prevention.
  • Reform medical malpractice while preserving patient rights by strengthening antitrust laws and promoting new models for addressing physician errors.
About out of space, will continue in next post
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Old 04-10-2008, 01:46 PM   #80
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Here is the rest of the comparison between Hillary and Obama. I am going out for an adventure. I may comment more later:

Improving quality/health system performance


Hillary:
  • Provide federal recognition to “physician-driven” maintenance of certificate (MOC) programs that promote continuing education about latest advances in care and procedures.
  • Invest in independent private-public, consensus-based organizations to certify performance for enhanced reimbursement; identify gaps in existing quality measures; set priorities for development of new quality measures; and disseminate most effective protocols and treatments through a Best Practices Institute.
  • Fund improvement of web-based tools to provide consumers with user-friendly information on provider performance and development of tools to promote informed patient choice about treatment options.
  • “Incentivize” quality through increased federal payments (e.g., Medicare and FEHBP) for excellence in care and for innovative care delivery systems.
  • Prohibit payment of “never events” (such as preventable infections) in FEHBP and other federal programs.
Obama:
  • Support an independent institute to guide comparative effectiveness reviews and required reporting of preventable errors and other patient safety efforts.
  • Reward provider performance through the National Health Insurance Exchange and other public programs.
  • Address health disparities, promote preventive care and chronic disease management, and require quality and price transparency from providers and health plans.
  • Require health plans to collect, analyze and report health care quality data for disparity populations, and hold plans accountable.
Other investments

Hillary:
  • Provide federal funding to address nursing though new training and mentoring programs, linking nurse education and quality and encourage diversity and cultural competency in healthcare workforce.
  • Support initiatives to reduce health care disparities, including funding for more accurate data collection, development of quality measures targeted at reducing racial and ethnic disparities, and prioritizing the development of medical homes designed to improve quality for minorities.
  • Strengthen consumer protections for long-term care insurance.
Obama:
  • Expand funding to improve the primary care provider and public health practitioner workforce, including loan repayments, improved reimbursement, and training grants.
  • Support preventive health strategies including initiatives in the workplace, schools, and communities.
  • Support strategies to improve the public health infrastructure and disaster preparedness at the state and local level.
Financing

Hillary
  • Campaign estimates cost to be $110 billion a year when fully phased in. $35 billion to be financed by savings from quality and modernization initiatives. Additional $21 billion in savings from Medicare private plans, recapturing Medicare and Medicaid payments to hospitals for the uninsured, and constraining prescription drug costs. Also $54 billion in revenue from limiting the tax exclusion for employer-paid health insurance and discontinuing tax cuts for those with incomes over $250,000.
Obama:
  • Campaign estimates cost to be between $50 to $65 billion a year when fully phased in. Expects much of the financing to come from savings within the health care system. Additional revenue to come from discontinuing tax cuts for those with incomes over $250,000.
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