Rustic23
Thinks s/he gets paid by the post
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!
McCain's health "plan"
- Thread starter Martha
- Start date
Rich_by_the_Bay
Moderator Emeritus
Rustic23
Thinks s/he gets paid by the post
Rich,
I like that. Never heard it before.
I like that. Never heard it before.
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.
- 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.
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.
- 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.
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.
- 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.”
- 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.
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
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.
- 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.
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.
- 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.
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.
- Maintain existing state health reform plans if they meet minimum standards of the national plan.
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
- 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.
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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:
Hillary:
Hillary
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.
- 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.
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.
- 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.
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.
- 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.
Sheila Burke, the 2nd person listed, helped elect George W. Bush, worked on the Elizabeth Dole campaign, and is part of the McCain 2008 campaign.
Tom Campbell, the 3rd person listed, is a former Republican Congressman.
I know eridanus gave you some conservative names, but I did want to point out that lawyers as a group tend to be quite conservative.
Most folks who have served in the military do not even get the chance to use the VA health care system, so by default, most go to an "outside provider".
First of all, there is a classification system even to be considered for services. A summary is found here:
http://www.va.gov/healtheligibility/Library/pubs/EPG/EnrollmentPriorityGroups.pdf
For instance, even though I'm a priority group 3, I don't (can't) use services unless they are related to my "service related condition", and some "minor" services, such as the annual flu shot.
I don't even go there for services that I could get, since my primary care doctor is "outside" the system, and handles my "minor problem" within the scope of my current medical plan (on my former employers retiree medical co-pay plan).
What happens (and why you see some news on the VA system) is the fact that the "worst cases" are taken care of the VA - many more of the "difficult cases" (due to the rating system). When you are "stacking the deck", you have a lot to overcome to come up with a good picture.
Does the VA do a good job? Yes. Do they have problems (especially due to funding) and need to do a "better job"? Of course.
Just a little info on the VA system for your reading pleasure
(since "I'm there")...- Ron
youbet
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Martha.....
Thanks for posting the Hillary and Barack plan highlights and, more importantly, for including your comments. IMO, neither goes far enough towards being a universal plan.
youbet
Thanks for posting the Hillary and Barack plan highlights and, more importantly, for including your comments. IMO, neither goes far enough towards being a universal plan.
youbet
FIRE'd@51
Thinks s/he gets paid by the post
- Joined
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- Messages
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Rich, could you elaborate here? I always thought doctors either took MC patients or they didn't. The Washington Post article seems to indicate some doctors "cherry pick" by not taking new MC patients, but will continue to treat patients they already have who are on MC.
With regard to fees, for those doctors who accept assignment, my understanding is MC pays 80% of its allowed charge directly to the doctor, and the patient (and/or his supplemental insurance) picks up the other 20%. Are you saying that patients who choose not to purchase supplemental don't have to pay the remaining 20%?
You seem to be saying that, if I want to go to a doctor who isn't accepting new MC patients, I can agree to pay him his regular fee, and I can file directly with MC and get reimbursed for 80% of its allowed fee? I thought MC didn't allow this.
Rich_by_the_Bay
Moderator Emeritus
It has been a while since I had to worry about this stuff, but as of a few years ago...
- either the doc participates or doesn't; if not, any patient can be seen, charged full fare, and the patient pays the full fee. MC pays some amount to the patient when the claim is filed, but usually quite low; supplemental helps fill the gap for the patient.
- if a doc participates, he/she does so for all medicare patients. My understanding is that it is not legal to have some MC patients on assignment (e.g. old patients) while some are not on assignment (new pts)
- if the doc participates, he/she agrees to take the medicare allowable amount as payment in full. This is usually waaayyy below the doctor's usual fee, and MC pays only 80% of this already discounted amount. It is not legal to seek payment of amounts over the allowable from the patient when under participation. So, usual charge: $100; MC allows: $66; MC pays $52.80; Due from patient: $13.20 as payment in full. Doc eats the difference.
- if no participation, usual charge: $100; patient pays: $100; MC pays patient: $52.80 along with a notice that their doctor is charging more than "usual and customary" for the service (does wonders for patient relations).
Hope that helps. Maybe someone more current with this will pipe up.
