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Old 11-08-2009, 10:41 AM   #101
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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
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Old 11-08-2009, 11:56 AM   #102
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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.
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Old 11-08-2009, 12:56 PM   #103
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I'm not counting on anything just yet. The reason I ask is that DH has felt for over a year that his job position will be eliminated. He was very surprised that in 2009 his contract was renewed for another year. He's expecting that he will not be renewed in the spring of 2010. We're hoping for the best and planning for the worst.

He works for a county agency that provides an excellent health insurance plan at a very reasonable cost but COBRA would be outrageous for us to continue on his plan. It may be as much as $1200/month. As far as I know the govt 65% subsidy is only if you are laid off by Dec. 2009. I'd be thrilled if they would extend that. If they don't we'll be out on our own, shopping for health insurance while 55 years old with pre-existing conditions (high blood pressure, cholesterol, etc.)

One of my part time jobs offers a health care plan but the employee pays the entire cost and the plan has a limit of $250 in prescriptions and $10,000 in hospital expenses, which makes it pretty useless. It has a 6 month wait for pre-existing conditions. Also, open enrollment is now and we don't need it now, we might need it in spring or summer of 2010.

I'm expecting that we'll have to find our own insurance and get a high deductible plan with an HSA.

I know our monthly expenses and where we can cut back if the big "what if" happens. We have almost a years living expenses saved. Health insurance cost is the big ugly unknown. Not looking forward to this at all.
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Old 11-08-2009, 01:21 PM   #104
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I know our monthly expenses and where we can cut back if the big "what if" happens. We have almost a years living expenses saved. Health insurance cost is the big ugly unknown. Not looking forward to this at all.
Yes. It isn't the having of health insurance that bothers me. I want it. It's the sheer unpredictability and capriciousness of the current 'system' that bothers me.

Depending on what happens under the current system, my costs in 2010 for health coverage for my family could run from around 10,000 to about 23,500 for the year. I have to allow for what could happen if either daughter's individual policy is declared nonrenewable, what plans I might be able to move onto from COBRA, whether or not something might come up as a preexisting condition in the lookback period when COBRA expires, and whether or not I can clear my blackballed status in the MIB (a medical database shared by several hundred insurance companies who agree not to issue a competitive policy to anyone turned down for a similar policy by another member). The MIB exists courtesy of the antitrust exemption granted to insurers.

If someone in the family policy develops a condition before COBRA expires, then we would have to continue coverage through a guaranteed-issue HIPAA plan, very expensive, and stay in that plan until forced over to Medicare. Otherwise, I'd like to use a high deductible plan for catastrophic coverage and just pay out of pocket for all routine expenses and relatively minor care. I'm currently blackballed for these plans myself, as a colonoscopy years ago found a benign, non-cancerous, non-precancerous polyp. That was enough to get me flagged in the MIB.

I would very much prefer to have a known insurance cost, and a known deductible/max payment cost, if only to let me budget for next year.
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Old 11-08-2009, 07:17 PM   #105
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One of my part time jobs offers a health care plan but the employee pays the entire cost and the plan has a limit of $250 in prescriptions and $10,000 in hospital expenses, which makes it pretty useless. It has a 6 month wait for pre-existing conditions. Also, open enrollment is now and we don't need it now, we might need it in spring or summer of 2010.
Often, if you have a change in circumstances, you can enroll outside the open enrollment period (divorce, loss of job, those sorts of things count as change in circumstances). However, this doesn't sound like much of a plan.

I had cancer 13+ years ago so I certainly expect to have difficulty finding insurance with normal rates. I would be looking for a high deductible plan, probably. It's only for 18 months.

I really have to stop working. I'm losing my mind.

As several people have said, this is not law yet - so no point in counting on or worrying about too much. I'd like to think I can influence the process - but I truly doubt it.
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Old 11-08-2009, 07:48 PM   #106
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... As several people have said, this is not law yet - so no point in counting on or worrying about too much. I'd like to think I can influence the process - but I truly doubt it.

Agreed..I've stopped looking at things as either only black or white a long time ago. No sense obessing over it when it's not even law yet.
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Old 11-08-2009, 09:59 PM   #107
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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.
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Old 11-08-2009, 10:23 PM   #108
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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.

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Old 11-08-2009, 10:35 PM   #109
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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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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."
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Old 11-08-2009, 11:04 PM   #110
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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........
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Old 11-09-2009, 12:19 AM   #111
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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 think this is the plan for most government bills - obfuscate the whole thing so that they can make it up as they go along later! At the risk of making the lawyers here angry - that's what we get for letting them run the government. I'm also technically trained - give me a good technical journal any day than this kind of stuff!
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Old 11-09-2009, 08:19 AM   #112
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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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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.

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Old 11-09-2009, 08:23 AM   #113
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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"?

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Old 11-09-2009, 10:35 AM   #114
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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...
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Old 11-09-2009, 11:05 AM   #115
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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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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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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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- 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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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.

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Old 11-09-2009, 11:24 AM   #116
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Thinker25:
Just so someone says it: There's a more fundamental issue as to whether health care is a "right" that we can forcibly cause one individual to buy for another individual. I don't believe it is, but as a society we have made a different decision.

- We have a system that does pay for care for people who have exhausted their resources. Medicaid. You have to be really broke, then the government (i.e. other taxpayers) will pay for your care. Apparently this, too, is not sufficient for popular appetites. We want individuals to suffer far less financial distress when poor luck hits them. Okay, so how do we do that in the most efficient way?

- I think you'll find that people here understand what adverse selection is.

- There are market-based solutions that do not involve the government setting prices, do not involve the government directly providing health care, that provide lower-cost access to health care insurance for the sickest among us. There would still be some transfer of the private property of some people to others, but not nearly to the extent of the present House or Senate bills (where most Americans would be on the dole).

The Swiss model is a very promising approach, you might look at it further if you aren't familiar with it. Universal coverage, overall costs per person about 30% less than we pay in the US, patients are allowed a lot of choice in their treatment/doctors, and market forces are largely used to keep costs down. The government doesn't run health care there--they just set up the system that meets their societal goals and lets the private market accomplish those goals. Efficient and effective. The "government" (i.e. other taxpayers) do provide funding to help the poor buy insurance, but it is nothing as extreme as what we see in the House plan. Overall, people in Switzerland pay about 10% of their income for health care. It also gets rid of the crazy link we have in the US between employers and the health care of their employees, which would be a big boost to the US economy.

Here's a great article about the Swiss system that was identified by MPaquette . From another article linked to that one:
Quote:
In the Swiss healthcare system:
  • there is an insurance mandate for all individuals,
  • the government defines a what the insurance benefit will be for all standard health insurers,
  • insurance companies are not allowed to deny coverage to any individual,
  • health insurance and medical procedure prices are made publicly available,
  • in exchange for providing health insurance to consumers, insurance companies receive premiums from consumers and risk-adjustment payments from the government in order that insurance companies are not punished if they decide to insure a sicker population,
  • premiums are community rated, meaning that sick and healthy individuals pay the same price within each age group (the age groupings are 0-18, 19-25, >25 years old).
  • individuals are allowed to purchase supplement insurance as well (there is no regulated benefit for supplemental insurance),
  • there is significant cost sharing in all insurance plans (i.e.: deductibles, 10% coinsurance rates up to an annual ceiling),
  • open enrollment occurs twice per year (June and Ddecember).
In 2003, 49.7% of Swiss individuals choose ordinary deductible health insurance, 42.0% choose higher deductible health insurance, and 8.2% chose insurance with limited choice of provider networks (HMO-style contracts). Since only 8% of individuals are in managed care insurance firms, quality is fairly homogeneous across insurance companies.
The Swiss government does get involved with establishing treatment protocols, so it's not entirely consumer-driven. But it looks better than the plans on the table today.

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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.
Yes, there's a problem. But there are many rational ways to fix it. If you see legislation quickly crammed through with little public deliberation or buy-in across the political spectrum or the American population as a whole, I think that is an indication of an immature plan that has not benefited from the careful deliberation this big problem requires.
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Old 11-09-2009, 02:27 PM   #117
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Well put samclem.

It seems that some people are being interpreted as being against improvements to the shortcomings of the current system when they are actually against specific actions proposed as part of the govt fix. It's fine to fix today's shortcomings but let's not throw out the baby with the bath water........

Relating this to FIRE and our forum here, I retired based on the medical insurance DW and I have available to take us through to Medicare/supplement time. Now I'm concerned that the "improved" system may cost us more or that Medicare will not be as good as it is today. Due to the recession, we no longer have the cushion to tolerate much of that.

Fixing current problems is good. But doing so in ways that puts the FIRE status of people already staggering from the recession at risk should be avoided, IMHO.

I need and have good medical insurance. I can't pay more than I'm now paying for subsidized insurance from my previous employer and what DW pays for state subsidized insurance from Illinois. Please fed gov't, don't rock the boat while "fixing" all the the things people want fixed. Fix 'em, sure. But don't put me in jeopardy as an unintended consequence.
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Old 11-09-2009, 04:00 PM   #118
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As several people have said, this is not law yet - so no point in counting on or worrying about too much. I'd like to think I can influence the process - but I truly doubt it.
As written, even if it passed tomorrow, it wouldn't take affect until 2013.
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Old 11-09-2009, 05:32 PM   #119
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I think some of the mandates, such as eliminating the exclusions for preexisting conditions or health issues, are effective immediately.
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Old 11-10-2009, 09:25 AM   #120
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I think some of the mandates, such as eliminating the exclusions for preexisting conditions or health issues, are effective immediately.
I don't know how you can implement this without the individual mandate. It just doesn't seem possible to eliminate these without a universal coverage mandate because of the adverse selection problem.
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