House "Affordable Health Care for America Act"

[samclem]

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Originally Posted by free4now A sad day for the elite.

I think some people are now using "elite" in place of the no-longer-fashionable "bourgeoisie." But I always know what they mean, and where they are coming from intellectually.

[free4now]

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Originally Posted by samclem I think some people are now using "elite" in place of the no-longer-fashionable "bourgeoisie." But I always know what they mean, and where they are coming from intellectually.

I'll rephrase: sad day for those with AGI > $500k single.

[samclem]

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Originally Posted by free4now I'll rephrase: sad day for those with AGI > $500k single.

If only the damage were restricted to their number.

On a separate note, truth was again a casualty of the new process in Congress.

From the 24 September Weekly Standard:

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TWS: Madam Speaker, do you support the measure to put the final House bill online for 72 hours before it's voted on at the very end? PELOSI: Absolutely. Without question.

Now, "Absolutely. Without question" sounds unambiguous to me. But, it turned out to be, well, not true. The bill achieved final form today (after a fairly significant revision regarding federal funding of abortion). And it was voted on tonight.

[teejayevans]

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Originally Posted by samclem From the 24 September Weekly Standard: Now, "Absolutely. Without question" sounds unambiguous to me. But, it turned out to be, well, not true. The bill achieved final form today (after a fairly significant revision regarding federal funding of abortion). And it was voted on tonight.

Technically is was online for 72 hours, yes, there was the abortion change,
but the other 1900 pages didn't change.WS isn't known for being fair &
balanced.
TJ

[Dawg52]

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Originally Posted by free4now I'll rephrase: sad day for those with AGI > $500k single.

That's the kind of sad I'm looking for.

[Martha]

Letsretire, I don't think most of the arguments here are self centered, though of course we tend to talk about how things might effect us. Right now I am under the best and the least expensive risk pool in the nation. I may very well pay more under reform. And where you got poor service under government provided health care, the VA now is an example of superior service. But anyway, we are not talking about government actually providing health care. We are talking about regulating the insurance industry and providing subsidies and working on clear issues that we have with medicare costs.

The health insurance market didn't "work." So the government steps in to regulate. It should have done more years ago.

Well, someone has to say it:

I hope the the house and senate can come to a reconciliation and that we end up with health insurance reform. I just know too many people who are without insurance or risk losing insurance. I think that things are getting worse and worse and more and more people and small businesses are having trouble paying for medical care. I think that it is unfortunate that we are doing a fix based on the current system and propups of that system, rather than trashing it, and I am sure that there will have to be tweaking. I even think that I/we could have designed better interim solutions before the exchanges go into effect. There were other proposals that I liked better and were simpler, specifically the Wyden plan from a couple of years back. I also think that there has to be a lot more done to get our arms around the cost issues. We will see what the final version ends up looking like and then I can comment more. But I am glad it is moving forward.


Personally, things that really tic me off about the sausage making in these bills are diversions like abortion and illegal immigrants. Other diversions have even included requirements for insurance to pay for unscientific treatments like prayer. Our politicians make political decisions that are often not the best for all but are pandering to a specific group. The biggest pandering is probably to the insurance and pharmaceutical industry. So I am not blindly confident in government to come up with the best solutions to problems. But nevertheless, private industry has failed in health care delivery and it is time for government interference as messy as it is.

Well, I am going to let this very frustrating topic rest for a while and see what developes as the senate works on their bill.

[lets-retire]

I've heard on here often that health insurance is too expensive, but health insurers only make and average of 8% profit. It is obvious to many that the problem isn't with health insurers.

Keep thinking the VA gives good service. Rich once stated the VA center where he is, was rated one of the best in the country. That was the last VA hospital I sought treatment at and it was very substandard.

[MichaelB]

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Originally Posted by Martha Letsretire, I don't think most of the arguments here are self centered, though of course we tend to talk about how things might effect us. Right now I am under the best and the least expensive risk pool in the nation. I may very well pay more under reform. And where you got poor service under government provided health care, the VA now is an example of superior service. But anyway, we are not talking about government actually providing health care. We are talking about regulating the insurance industry and providing subsidies and working on clear issues that we have with medicare costs. The health insurance market didn't "work." So the government steps in to regulate. It should have done more years ago. Well, someone has to say it: I hope the the house and senate can come to a reconciliation and that we end up with health insurance reform. I just know too many people who are without insurance or risk losing insurance. I think that things are getting worse and worse and more and more people and small businesses are having trouble paying for medical care. I think that it is unfortunate that we are doing a fix based on the current system and propups of that system, rather than trashing it, and I am sure that there will have to be tweaking. I even think that I/we could have designed better interim solutions before the exchanges go into effect. There were other proposals that I liked better and were simpler, specifically the Wyden plan from a couple of years back. I also think that there has to be a lot more done to get our arms around the cost issues. We will see what the final version ends up looking like and then I can comment more. But I am glad it is moving forward. Personally, things that really tic me off about the sausage making in these bills are diversions like abortion and illegal immigrants. Other diversions have even included requirements for insurance to pay for unscientific treatments like prayer. Our politicians make political decisions that are often not the best for all but are pandering to a specific group. The biggest pandering is probably to the insurance and pharmaceutical industry. So I am not blindly confident in government to come up with the best solutions to problems. But nevertheless, private industry has failed in health care delivery and it is time for government interference as messy as it is. Well, I am going to let this very frustrating topic rest for a while and see what developes as the senate works on their bill.

Well said!

[FinanceDude]

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Originally Posted by Martha Letsretire, I don't think most of the arguments here are self centered, though of course we tend to talk about how things might effect us. Right now I am under the best and the least expensive risk pool in the nation. I may very well pay more under reform. And where you got poor service under government provided health care, the VA now is an example of superior service. But anyway, we are not talking about government actually providing health care. We are talking about regulating the insurance industry and providing subsidies and working on clear issues that we have with medicare costs.

No, we are not. We are talking about the govt running healthcare. The so-called "public option" will run all the privately held insurers out of business. The govt can undercut and rebate the cost of the "public option", making it easy for employers to drop whomever they now have and take the "public option". If that isn't taking freedom of choice away I don't know what is.......

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The health insurance market didn't "work." So the government steps in to regulate. It should have done more years ago.

Name ONE program the govt "runs well" Social Security? NO Medicare/Medicaid? NO And on and on....the govt has yet to show me they can run anything without massive fraud and wasteful spending.

[Gotadimple]

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Originally Posted by FinanceDude No, we are not. We are talking about the govt running healthcare. The so-called "public option" will run all the privately held insurers out of business. The govt can undercut and rebate the cost of the "public option", making it easy for employers to drop whomever they now have and take the "public option". If that isn't taking freedom of choice away I don't know what is....... Name ONE program the govt "runs well" Social Security? NO Medicare/Medicaid? NO And on and on....the govt has yet to show me they can run anything without massive fraud and wasteful spending.

The government doesn't run any of the programs you list. They make the administrative rules and oversee the result. They won't 'run' a private insurance company either. They'll outsource it the same way they outsource Medicare and Medicaid.

Government 'run' public options exist at the state level today. They compete with existing private carriers. They do not have the majority of the enrollment even though they offer broader coverage and lower premiums.

Rita

[samclem]

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Originally Posted by Gotadimple The government doesn't run any of the programs you list. They make the administrative rules and oversee the result. They won't 'run' a private insurance company either. They'll outsource it the same way they outsource Medicare and Medicaid.

I think this is a distinction without a difference. If the government sets reimbursement rates, determines what the policy premiums will be, and pumps a big slug of taxpayer money into the program (and that is the plan, to start), it doesn't matter if it is a GS employee or a contractor hired by the government who is doing the paperwork. Or doing the medical exams. If the government wants to foster competition between private insurance companies (a laudible goal), then why don't they simply change the laws to encourage that competition rather than standing up a government entity to compete? Is there any potential conflict of interest when the government competes against private industries that it inspects and regulates?

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Originally Posted by Gotadimple Government 'run' public options exist at the state level today. They compete with existing private carriers. They do not have the majority of the enrollment even though they offer broader coverage and lower premiums.

- Are these government-run plans open to everyone? If they offer lower premiums and broader coverage--I wonder why they aren't more popular? Yugos were cheaper than most other cars, and on paper they were just as good, but for some reason they didn't succeed in the market.
- If states could print money (as the feds can), I'll bet they'd offer lots more bells and whistles in their medical plans. And I bet they'd be deeply in debt and as fiscally irresponsible as we are at the Federal level.

I'm fairly optimistic that the "public option" won't make it any farther than this House bill, the Senate won't go there. But the Senate bill (as written) will do so much to drive up the cost of insurance, and will do so much to make even more people dependent on the government (to give them their subsidy so they can pay the inflated premiums), and will do so much to redistribute the private property of those who earned it to those who did not, and will do nothing to break the bizarre link between employers and the health care of their employees, that it is a big step backward from where we are today. Even without the "public option."

[thinker25]

Right now we have a system where people are unable to get affordable health insurance if they are not employed and not in good health. If you are desperately ill sometimes you can get on Medicaid and SS Disability but that is not easy or certain.

I know people with cancer who are going bankrupt, losing their houses and so on, trying to pay their bills for treatment. Does anyone have a solution that is an improvement on some sort of government program? Because if not, we need some government intervention.

There is a trend in this discussion (not only here, I mean in general) to assume that right now anyone can get health insurance and care if they try. This is simply not the case. If they can get into a high-risk pool, it is often so expensive that it is ruinous financially.

There is a huge pool of people who don't have health insurance, can't get it or afford what they are offered, aren't sick enough for Medicaid and SS Disability. It's not for lack of trying. It's for lack of money, or being declined due to pre-existing conditions.

Worse yet, right now we have people WITH insurance who have payment declined and their policies cancelled because they "didn't disclose" a pre-existing condition (say, acne at age 15) when they applied for the insurance - something in no way related to treatment they need for pneumonia or cancer.

We desperately need guaranteed insurance and mandated insurance for all. If you don't understand adverse selection and how mandated coverage for all affects costs, I can try to explain it again.

It will be interesting and scary to see what is finally presented to the President as a bill to sign. This is so watered down already...

[Gotadimple]

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Originally Posted by samclem I think this is a distinction without a difference.

Finally, you understand that what the House bill is to the state of insurance today

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Originally Posted by samclem If the government wants to foster competition between private insurance companies (a laudible goal), then why don't they simply change the laws to encourage that competition rather than standing up a government entity to compete?

I agree with you completely. That would be the elegant, less costly solution, but, then we have politics. My opinion is the clearest way to re-election is to say, "see we resolved the problem by taking on the insurance companies head-to-head." People really don't want government to be the solution to their problems but to rule in a way that problems are minimized.

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Originally Posted by samclem Is there any potential conflict of interest when the government competes against private industries that it inspects and regulates?

Good question, but rhetorically, is there any conflict of interest when government inspects and regulates industries using the industries' guidance and counsel for the inspection and regulation? It's SOP.

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Originally Posted by samclem - Are these government-run plans open to everyone? If they offer lower premiums and broader coverage--I wonder why they aren't more popular?

On a state-run basis, there are no plans open to everyone, they are restricted to special classes: public employees, indigent, high risk health cases.

On a federal basis, there are two: Medicare and Medicaid.

From personal experience I can tell you that cheap sometimes does not sell. Psychologically, if the cost of something is too low, a buyer will hesitate out of concern that something is not right. What was not right in the case of the state-run health care plan was that a wide range of physicians were available, but extra programs that provide discounts or health information were not.

In the case of Medicare, Medicare Advantage programs are very successful for those who are healthy and willing to change doctors. The difference is that there may be an add-on premium for Medicare Advantage, but in addition to the same coverage as Medicare, the buyer receives access to discounts for non-covered items such as glasses and hearing aids. The government's buying power hasn't been leveraged to provide the same perks.

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Originally Posted by samclem I'm fairly optimistic that the "public option" won't make it any farther than this House bill, the Senate won't go there.

Boy, I hope so.

-- Rita

[FinanceDude]

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Originally Posted by Gotadimple The government doesn't run any of the programs you list. They make the administrative rules and oversee the result. They won't 'run' a private insurance company either. They'll outsource it the same way they outsource Medicare and Medicaid. Government 'run' public options exist at the state level today. They compete with existing private carriers. They do not have the majority of the enrollment even though they offer broader coverage and lower premiums. Rita

Uh, no........

[ERD50]

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Originally Posted by samclem The Senate is a little more conservative than the House, and some of the interests are different.

I'm guessing that the House passed this fully aware that it faces problems getting past the Senate. But those Representatives can go back to their constituents, point to the specific sections that group approves of, and say "See, I was working for your interests - (not my fault if the Senate turned it down, complain to your Senator, but vote for me!)".

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Regarding the timing of any changes: To make the bill appear to be less costly over the next ten years, some of the proposed "reforms" start taxing people and businesses immediately, but the more costly provisions (subsidies for most people, mandated medical coverage for various things) don't go into effect for many years. This allows the whole "end of ten years" math to look like the new goodies cost "only" a trillion more dollars. In truth, the meter is just starting to run at that point, and the costs go up very quickly.

I was wondering just why so many of these proposals are phased in so late in the game, especially considering how important we are told this is, and how we must "act now!". It's all a shell game to make the dollars look better to the general public - what a scam! And some people wonder why some of us are so distrustful of government run programs!

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Originally Posted by Gotadimple The government doesn't run any of the programs you list. They make the administrative rules and oversee the result. Rita

I guess we can stop blaming the CEO's of the insurance companies and financial sectors for any of the problems that people cite. After all, those CEOs don't "run" the companies, they just make the administrative rules and oversee the result. And they outsource a lot of the work also. Can't be held accountable, nope, no way.

If the govt can "make the administrative rules", they can "run" the private companies out of business.

-ERD50

[ERD50]

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Originally Posted by Want2retire I didn't expect to understand everything, but frankly I came away from it more befuddled than enlightened. I don't think I learned anything at all from this. I might as well be a kindergarten dropout for all I got out of my efforts. (Honestly, I really didn't flunk Sandbox 101). What a demoralizing and humbling experience. Guess I will have to skulk back to scientific documents that I am better prepared to read, and just rely upon the summaries of this bill.

I'd say that Science is Science, and Politics is Politics. Makes me wonder how they can offer a degree in "Political Science"?

-ERD50

[Sue J]

Does anyone know when this would go into effect? Assuming some version gets passed by the senate would the changes happen within a few months? Or would it be a year or two? I skimmed through the bill and didn't see it.

[W2R]

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Originally Posted by Sue J Does anyone know when this would go into effect? Assuming some version gets passed by the senate would the changes happen within a few months? Or would it be a year or two? I skimmed through the bill and didn't see it.

Sue, as I understand it the Senate has to pass it (which may not happen at all), and the President has to sign it. Then, my guess is that there will have to be an appropriations bill to pay for it before any spending can be done. At least, that is the way federal budget matters are usually done. Basically I am clueless but I would suspect a few months? Maybe February? Someone else will have a better idea than I do.

Edited to add: I just heard on "Meet the Press" that some provisions of the bill will go into effect the moment the bill is passed - - such as pre-existing conditions.

[samclem]

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Originally Posted by Sue J Does anyone know when this would go into effect?

Sue, there are some very big differences between this bill and what we believe is being worked on in the Senate. The next step is for the Senate tp\o pass some piece of legislation, then for the two bills to be melded together in the reconciliation process, then for both houses to vote independently on the new combined package.

The Senate is a little more conservative than the House, and some of the interests are different.

Regarding the timing of any changes: To make the bill appear to be less costly over the next ten years, some of the proposed "reforms" start taxing people and businesses immediately, but the more costly provisions (subsidies for most people, mandated medical coverage for various things) don't go into effect for many years. This allows the whole "end of ten years" math to look like the new goodies cost "only" a trillion more dollars. In truth, the meter is just starting to run at that point, and the costs go up very quickly. But the increased taxes will only impact people who either pay taxes, are employed, or buy goods or services.

Bottom line: You should not make any plans based on what you see in the House bill at this point. There will be a lot of changes. About the best things you can do now are:
-- If you've got medical insurance today, get any treatment you might need before employers start changing their coverage to meet the government mandates.
-- Looks for ways to shield assets from the taxman. Somebody's gonna be paying for all this stuff, and there aren't enough "rich" people in the world to do it. Besides, you can be sure their lawyers and CPAs are well ahead of the game.

Inspirational words:

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Some folks are born silver spoon in hand, Lord, don't they help themselves. But when the taxman comes to the door, Lord, the house looks like a rummage sale. -- J. Fogerty , "Fortunate Son" 1970

[ziggy29]

I think the Speaker made a mistake by ramming through -- and insisting on -- provisions that have little or no chance to survive in the Senate. The "public option" would appear to be one of those examples. It appears there is no realistic chance that it will have 60 votes in the Senate.

Some folks in the House leadership seem more concerned with what a health care reform bill would look like "in their dreams" than with drafting something that could actually survive in the Senate and go to the President.