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Old 07-15-2009, 05:25 PM   #81
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I was simply trying to be descriptive of what the House Democrat's bill proposes to do - mandate insurance for everyone (or pay a penalty) and then subsidize the cost of that plan for low and middle income participants through a wealth transfer mechanism. There, less emotionally charged? It is politically correct I guess. Although the House Democrat's bill was notably light on who they are hitting up to pay for this plan. Long on the pro's and short on the cons.

And move me from the ant column to the grasshopper column on this one it looks like.
Heh. The thing is, when it's an incremental approach it's a frog in a pot kind of situation. Each time you add another tax and another subsidized program, you bring the ants and the grasshoppers a little bit more toward balance, and those who want it to keep going that way want small chunks to anesthetize our senses so we don't know we're being boiled alive. That can be worthwhile to a point, given that many revolutions have been fought over the have nots feeling farther and farther behind -- but if allowed to go too far, as I said, continuing to work longer and harder to maximize and increase income would increasingly become a sucker's game, and it's critical that we not let it get *that* far.

Though in the end, depending on how it's done and how it's financed, FIRE people could be among the biggest "winners" in health care reform...
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Old 07-15-2009, 06:21 PM   #82
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Sounds like the best option would be to give the individual the choice of opting for the national plan or a private plan.
This is inherently not really fair though. The govt plan gets backing and funding from our tax dollars. Private plans do not. Therefore the national plan will always be cheaper because it is being subsidized. Eventually the imbalence of those on the subsidized plan vs the private plan will become SO great that only the VERY wealthy would ever be able to afford the private plan. This is why some people call the dual plan "stealth govt healthcare" because that is what would likely happen.
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Old 07-15-2009, 07:16 PM   #83
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RE: cost reductions -

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I talk about this every once in a while. This is where you need the experts. This is why it is important to listen to people like Rich and Meadbh when they talk about evidence based medicine. Or when they talk about checklists in hospital rooms before doing a procedure (first, wash you hands. . . ). This is where it is important to look at the differences between different clinics and hospitals and why certain ones have as good or better outcomes at a lower cost. I think that one thing we can do is try to figure out a mechanism to reward best practices.
Agreed - if the govt wants to demonstrate to us how well they can orchestrate these efficiency improvements, here's an idea:

Implement a round of savings programs, take the savings and use it to cover more people. The reduced ER visits and preventive care benefits will result in even more savings which can be used to cover even more people, etc, etc, etc,... until everyone has been covered and we haven't spent any more of our kids/grandkids money.

What, we need to show results!!?? That'll go over big in DC

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Old 07-15-2009, 07:34 PM   #84
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I've always paid cash for routine doctor visits so little things don't get on my "official record." My various insurance over the years have never declined me for "apparently never seeing a doctor," all they know is I've only made a couple benign prescription claims and they keep renewing me.
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Old 07-15-2009, 07:52 PM   #85
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So far I'm encouraged. One thing I feel is key that insurance has to be mandatory, like education is, to make this work. Of course, our education is tax-based; and people who choose to go outside public education still have to pay for the general education goal. Not going into arguments about the state of education, its funding, whatever--just saying our national policy has been to provide education through high school for every kid.

It sounds like our government is working toward an insurance strategy that will also require participation and that the people who are not making enough to pay their full freight will get a break (but cannot opt out). There are a lot of economic interests to work with, but it looks to me like we are making progress. I'm truly amazed.
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What to make of this?
Old 07-15-2009, 09:09 PM   #86
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What to make of this?

Is this a sign?

Clicking the link labeled:

"What's in the Health Care Reform Bill For You?"

http://energycommerce.house.gov/Pres..._13reasons.pdf

Brings up:

Quote:
404 Not Found
The document you requested (http://energycommerce.house.gov/Pres..._13reasons.pdf) was not found on this server.


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Old 07-15-2009, 09:21 PM   #87
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Is this a sign?

Clicking the link labeled:

"What's in the Health Care Reform Bill For You?"

http://energycommerce.house.gov/Pres..._13reasons.pdf

Brings up:





-ERD50
Probably a broken link. I did a simple search for "what's in the health care reform bill for you?" You can find that document here:

http://edlabor.house.gov/documents/1...lpFamilies.pdf
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Old 07-15-2009, 09:34 PM   #88
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Probably a broken link. I did a simple search for "what's in the health care reform bill for you?" You can find that document here:

http://edlabor.house.gov/documents/1...lpFamilies.pdf
Thanks, the other links on that page that I tried worked OK, hmmm, I thought this was the administration that was supposed to be so interweb/tube savvy

Well, there are some things in there that look like they could help. But the devil will be in the details. Maybe far too early to tell, but at least that pdf didn't seem to include any options for a high deductible policy, for those who might want to self-insure up to a point.

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Old 07-15-2009, 09:46 PM   #89
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But maybe you do not need certain tests and certain treatments for a good outcome. There is much to be done on the good medicine side as well as the dollars and cents side. For example, I read an article that areas with high numbers of cardiac surgeons (per capita) there were far more bypasses and other cardiac procedures than areas with lower numbers of these specialists. But the outcomes were the same. Maybe a bit of rationalization when looking for work to do? Our health care sector needs to be encouraged towards best practices. Something to think about when thinking about what is the best way to compensate for care.

I agree with your statement.... how does the proposals fix the problem?

And why can we not fix the problem you state WITHOUT insuring 47 million more people on the taxpayer's dime
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Old 07-15-2009, 09:55 PM   #90
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I saw on the news an interview with Dr. Timothy Johnson... I believe ABC


He asked the Prez about a panel of 25 people... the prez said something about them being experts and recommending procedures to follow etc... so I guess there is medical rationing buried somewhere in the bill....

(my opinion... no fact).... so it strikes me that there will be a panel that will say what we will spend money for and what we will not... just like the current insurance companies.... but this is gvmt mandate... so it is 'law'... wonder if you can pay for it yourself and get it done? IIRC, this was against the law in Hillary's plan....
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Old 07-15-2009, 09:59 PM   #91
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WOW... just read the one pager.... NOTHING in there to reduce costs...

"no more co-pays or deductibles for preventive care".... well, who is going to pay for it

"an annual cap..." again, who is going to pay for my services if I need them?

"job and life choices will no longer be based on health care coverage" how? I will still have the same plan at work... with the same insurance company.... they 'guarantee' that all the time...
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Old 07-16-2009, 07:05 AM   #92
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If your high deductible plan can continue to exist in the future, the $4000 public plan may cover more stuff with less out of pocket maximums. So far they are saying there will be minimum requirements that must be met for coverage by the public plan and ultimately the employers too. No word on required coverage for completely private plans. I'm assuming the out of pocket max they are talking about will be less than $10,000.
The only minimum standard is required for a qualified health benefits plan. There is no language specifying whether the plan is employer, individual or government, only that it be a qualifying plan. If the bill is passed, the only plans available, from what I've read, will be qualifying. Policies currently in effect will still available to those who have them, but no new enrollees will be accepted if the plan doesn't meet the minimum standards. The minimum required coverage is quite extensive and pretty much covers everything. The list starts on page 27 of the bill.

The maximum out of pocket cost share is $5000 for individual and $10000 for a family, in addition to the increase in the cost of the insurance. With the restrictions on pricing, I think the "baseline" will be the highest risk people and the lower risk people will, obviously pay less than that. The least risk will be 1/2 of the highest risk. We might receive a refund every year from the insurance company, but we will still have to pay the money up front. I also haven't read anything in the bill that works on limiting the increase in doctor's bills. If the insurance companies see that they are going to have to give money back, why not pay the doctor's more money? Either way the money goes back to the consumers or the providers, not the insurance company. If someone told you you had to give up $10k and gave you two options of who to give it to (no knowledge of background and both appearing equal) would you really care who received you money?
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Old 07-16-2009, 09:31 AM   #93
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I've always paid cash for routine doctor visits so little things don't get on my "official record." My various insurance over the years have never declined me for "apparently never seeing a doctor," all they know is I've only made a couple benign prescription claims and they keep renewing me.
There is no "official record." If you applied for a new health insurance policy you would have to disclose visits (if there was a question about doctor visits or who you see as a doctor) even if you paid with cash. Otherwise you would be lying which is arguably fraud.
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Old 07-16-2009, 12:25 PM   #94
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Given that there are several committees working on reform, with three about to pass their own bills, I think it still is too hard to know where things are going to shake out.

Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?

A political scientist I heard on the radio suggests passing a reform bill without spending too much time on the costs because if we worry about cost too much it won't get done. Then, once we have all the citizens covered there will be tremendous pressure to reduce costs. Not advocating here, just passing a position along.
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Old 07-16-2009, 12:34 PM   #95
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Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?
That's a tough question to answer.

Do I regret having some level of guaranteed basic health care for seniors? No.

Do I regret how Medicare has evolved, what it has done to the cost structure of health care in the U.S. and how unsustainably expensive it's getting? Yes.

In other words, I support the ends, but the means stink.
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Old 07-16-2009, 01:09 PM   #96
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. Despite the cost, Does anyone really regret Medicare?
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That's a tough question to answer.

Do I regret having some level of guaranteed basic health care for seniors? No.

Do I regret how Medicare has evolved, what it has done to the cost structure of health care in the U.S. and how unsustainably expensive it's getting? Yes.

In other words, I support the ends, but the means stink.
Yes, it is not helpful/useful to look at some positive outcome and say that justifies the entire package. That leads to all sorts of bad decisions and I could give endless silly (and serious - ethanol) examples.

Especially, one must look at what alternatives would have done for us. It's similar to some of the energy threads we have going on. You can never justify a personal windmill because it "saves energy", because alternatively, the same investment (in energy and money) in a commercial windmill will produce far more energy. You can't look at things in a vacuum. Analyze all the options and pick the best one.


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because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost.
History about to repeat itself? Heck, it's only us old pharts that remember LBJ.

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Old 07-16-2009, 01:11 PM   #97
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Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?
I regret Johnson lied about the cost and created a funding system which was doomed to move costs from the then current beneficiaries to future beneficiaries. If he had simply bellied up to the bar and funded Medicare in real time with current taxes paying for current benefits, we'd be OK with it today.

Now, Obama seems intent on doing the same thing......... understate costs and create funding schemes that will lead to future generations paying for benefits we get today.

One day the house of cards will crumble.......
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Old 07-16-2009, 01:19 PM   #98
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A political scientist I heard on the radio suggests passing a reform bill without spending too much time on the costs because if we worry about cost too much it won't get done. Then, once we have all the citizens covered there will be tremendous pressure to reduce costs. Not advocating here, just passing a position along.
I understand you are not advocating, so I will question along with you.

Did this political scientist describe how well this process has worked for MediCare? I think we ought to learn from history.

I had it beat into my head and I've seen the evidence that the time spent planning a project has huge paybacks. Yes, you need to move forward and not just leave the project on the drawing board forever. But I don't think that "we will figure out how to pay for it later" is the right time to leave the drawing board.

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Old 07-16-2009, 01:50 PM   #99
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I understand you are not advocating, so I will question along with you.

Did this political scientist describe how well this process has worked for MediCare? I think we ought to learn from history.

I had it beat into my head and I've seen the evidence that the time spent planning a project has huge paybacks. Yes, you need to move forward and not just leave the project on the drawing board forever. But I don't think that "we will figure out how to pay for it later" is the right time to leave the drawing board.

-ERD50
The problem is that our political system doesn't work well in solving these types of problems. We have, I believe, five committees separately working on health care reform. It is big, messy and complicated, and will get messier as the pork falls in to buy votes. The drug lobby and insurance lobby can only be overcome by people not letting up on harping on their legislators to get something done. We won't end up with a single pay even if it happened to be the best result because of lower admin costs because of rules regarding saving a dollar if you spend a dollar (because the savings are at the individual and employer side, not the government side).

I am leaning towards getting something done even with flaws because no matter what it is going to have flaws.
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Old 07-16-2009, 02:51 PM   #100
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I am leaning towards getting something done even with flaws because no matter what it is going to have flaws.
Flaws are unavoidable, I certainly don't expect perfection, but whatever system they propose should be demonstrably better than what we have, or they should go back to the drawing board (not do nothing).

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The problem is that our political system doesn't work well in solving these types of problems.
Interesting observation. Maybe the govt should get out of the way then? One of their efforts to help, tax benefits for companies providing health care, has back fired and made people's health care dependent on staying with a single employer.

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