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Old 01-20-2010, 10:33 AM   #21
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I think Senator-elect Brown should send Nebraska's Senator Ben Nelson and the AFL-CIO's Richard Trumka big bouquets, as the deals they cut did a huge amount to shine a light on this whole mess and get him elected.
+1

just needs to make it clear he ain't beholdin' to 'em...
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Old 01-20-2010, 10:37 AM   #22
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Ziggy....

There are ways to address adverse selection... and also address the fears people have... but these still do not address the costs..

Right now, I am in a small company and the price of health care insurance with a $4K deductible is almost $1,100 per month for a family policy... not cheap...

So, what can be done to address the fears of people...

If you have health insurance, they can not take it away from you if you get sick... period..

If you have health insurance, they can not raise the cost if you get sick..

You can move from plan to plan without pre-existing conditions... (note... not start a new policy, move...)

You can have pre-existing conditions excluded from a plan if you have not had a plan in the last... fill in the blank for a time period... say 3 months, 6 months... something... this eliminates the adverse selection process...

After a certain amount of time, all pre-existing conditions go away if you no longer have the problem... say you had cancer when you were 30 and did not have insurance.. and it is gone... no sign for 30 years... should you have that excluded I think not...

So there is a lot of insurance reform that can be done... but still, not addressing the cost part... until we get clear knowledge of costs, and have some skin in the game, nothing will be done...
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Old 01-20-2010, 10:42 AM   #23
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I think Senator-elect Brown should send Nebraska's Senator Ben Nelson and the AFL-CIO's Richard Trumka big bouquets, as the deals they cut did a huge amount to shine a light on this whole mess and get him elected.
Ben Nelson has asked that his special deal be withdrawn. It was shameful and did the party no favors.
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Old 01-20-2010, 10:47 AM   #24
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Ben Nelson has asked that his special deal be withdrawn. It was shameful and did the party no favors.
Not out of the goodness of his heart, though. Congresscritters don't understand the word "shame". My Way News - Neb.'s Nelson sees backlash on health reform plan
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Old 01-20-2010, 11:46 AM   #25
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Ben Nelson has asked that his special deal be withdrawn. It was shameful and did the party no favors.
The last I'd heard, he'd asked that his "special deal" be withdrawn and that language giving all states the same treatment be substituted. There are so many interlocking dependencies with this legislative "process" now. For example, even if the selected negotiators wanted to change the approved Senate bill to remove the Cornhusker Kickback, this or any other change would force the whole thing to go back to the Senate for another vote--where it's likely Senator Brown would be seated denying the Democrats the votes they need to invoke cloture.

It's a very strange turn of events. And a year wasted. Sometimes the "quick and dirty" method ends up taking a lot longer and produces worse results than the slow, deliberate approach. Like my home improvement projects. . .
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Old 01-20-2010, 12:25 PM   #26
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There are so many interlocking dependencies with this legislative "process" now. For example, even if the selected negotiators wanted to change the approved Senate bill to remove the Cornhusker Kickback, this or any other change would force the whole thing to go back to the Senate for another vote--where it's likely Senator Brown would be seated denying the Democrats the votes they need to invoke cloture.
Also, I assume that giving that kickback to all would mean running it by the CBO again and seeing the costs go up...

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It's a very strange turn of events. And a year wasted. Sometimes the "quick and dirty" method ends up taking a lot longer and produces worse results than the slow, deliberate approach. Like my home improvement projects. . .
Yep, I'm in agreement with some of the earlier posts - scrap this bill and work to pass some small, more easily understood stuff that would help in stages. Many people are skeptical of big government, and this bill got big and complex, and as it grew and more was seen about it, the more skeptical people became. I just don't think it is recoverable (good) - clean slate time.

-Allow ins cos to compete across state lines.

-Break the link between employment and health ins (drop the tax benefits for employers).

-Employers that do offer group ins should be required to offer some high deductible policies. These would be more affordable for people, and should reduce HC costs overall.

-Like Texas Proud said - once you've been in *any* plan for X years, you should be able to retain it as long as you continue to pay. That shouldn't be so hard on ins cos - in fact, they would probably welcome it - more business for them.

-Reduce waste in Medicare/Medicaid.

Education on all of the above. Make sure people understand the risks of dropping their ins and don't make it too convenient to go without (tempting for low income, low asset people - they will get coverage w/o ins).


Those steps would lower costs for all, and reduce the number of people w/o insurance. After reviewing the success/failures and making some fixes where needed, we could then see what it takes to cover additional people that fall between the cracks.

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Old 01-20-2010, 02:11 PM   #27
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But ERD there is just as much disagreement on your steps, maybe even more, than the proposed bills. As an insurer you can already compete across state lines if you want to play by the rules of the states where you want to do business. Many strongly object to the across state line competition of insurers without state regulation because the feds have not been willing to regulate insurance companies and set minimum standards. Many, many governors and state attorney generals have been against this because of the lack of consumer protections and minimum standards states want insurers to meet. You end up with a bunch of crap insurance policies from an insurer in one state that decides not to regulate at all, driving the other companies out of business or at least driving up costs of the good policies due to adverse selection.

I agree on the need to eliminate the special benefits given for employer based group health insurance. But the public doesn't seem to want that touched. And doesn't want to listen to arguments about how that could make things better.

I have lots of ideas too about what can be done. I think the only way to get heard on those ideas is to actually go work (volunteer) for a senator or representative on the issue. Otherwise, we are blowing smoke up our asses.
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Old 01-20-2010, 02:35 PM   #28
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Old 01-20-2010, 02:38 PM   #29
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But ERD there is just as much disagreement on your steps, maybe even more, than the proposed bills. .... Many strongly object to the across state line competition of insurers without state regulation because the feds have not been willing to regulate insurance companies and set minimum standards. ....
Well maybe that is exactly what needs to change in any new bill that might be presented.



Quote:
I agree on the need to eliminate the special benefits given for employer based group health insurance. But the public doesn't seem to want that touched. And doesn't want to listen to arguments about how that could make things better.
Well, we need a politician who can present this honestly and clearly as a positive. I ca see how it sounds like a take-away from people on the surface, but we know it is really a good thing. That needs to get communicated.

Quote:
I have lots of ideas too about what can be done. I think the only way to get heard on those ideas is to actually go work (volunteer) for a senator or representative on the issue. Otherwise, we are blowing smoke up our asses.
That is probably a better, more direct way. But then, a lot of people thought that a single party with so much power would have no problem getting something passed. I think that even discussions like these (which then get talked about with friends, relatives and so on), raise the awareness among the general public, and in some small way, affect the outcome of races like the one yesterday.

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Old 01-20-2010, 03:03 PM   #30
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I agree on the need to eliminate the special benefits given for employer based group health insurance. But the public doesn't seem to want that touched. And doesn't want to listen to arguments about how that could make things better.
What people who have good employer-based group insurance fear most is..... *losing* it. Maybe we should rethink how we approach this group and instead of making it seem like a "takeaway" from them, maybe this can be sold in a way that allows them to keep what they have AND alleviate one of their fears -- losing their health insurance.

I'd like to see a combination of some sort of "super-COBRA" type thing where someone continuously insured for (say) 5 years can stay in a group plan indefinitely without underwriting (the five year requirement might reduce the incidence of adverse selection). And I'd like to see more employer group plans offer high-deductible plans with more affordable premiums.

I'd like to see small businesses able to have some anti-trust laws suspended for the purpose of banding together to get more affordable group rates than are possible if they try to negotiate alone. This will make small business more competitive as it would make it more affordable for them to offer health insurance like the big boys.

These would fuel consumer choice, more high deductible plans might make people more cost-conscious consumers, and people would no longer be a job change or a layoff or an early retirement away from losing health insurance. It would at least partially sever the link between employment and health insurance. Entrepreneurs may finally be free to pursue their big dreams and create more jobs by not being tethered to Megacorp employment for the health insurance. Maybe some 50-somethings and early 60-somethings who are still only working for the health insurance could retire and open a job for someone who needs it more, knowing their health insurance can't be taken away as long as they pay their premiums.

These are just ideas and are by no means a comprehensive recommendation. I haven't even thought them through completely and maybe I'll realize something that eventually makes me think, "that was a stupid idea." But these are points that I think would have support of the people.
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Old 01-20-2010, 03:06 PM   #31
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But, I think this attempt at reform, done in this way, is likely dead. The question now is: Will we get right on the task of health reform again, this time approaching it from the political center, or will we let the issue drop and tend to other pressing issues (while both parties try to get maximum political mileage from the recently failed attempt). I think the adrenalin level and the blood pressures are still a little too high to expect a massive coming together, and most voters see the economy as more important right now. So, Congress should concentrate on other issues while the staffers start working on the health care issue in a low-key, "what can we all agree on" way.
I'd like to see something "from the political center", but I don't know if anything exists.

Can you think of any health insurance or health care "reform" that might not get the far left- or far right-wing votes, but could still get 50% in both houses because it appeals to the middle?
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Old 01-20-2010, 03:36 PM   #32
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I'd like to see something "from the political center", but I don't know if anything exists.

Can you think of any health insurance or health care "reform" that might not get the far left- or far right-wing votes, but could still get 50% in both houses because it appeals to the middle?
So along the lines of the Denver Post article that samclem just posted, maybe we don't need/want a "left", "right" or "centrist" idea - we just need some "good" ideas.

I think that "good" ideas, with honestly communicated pros/cons would appeal to enough people to get support.

Here's a thought exercise - name some legislation that had overwhelming public support: the first one that popped into my mind was the "Do-Not-Call" list. It wasn't a L, R, far-L, far-R, or C idea. It was a good idea. It flew through Congress (of course, they excluded themselves.... ).

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Old 01-20-2010, 03:38 PM   #33
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So along the lines of the Denver Post article that samclem just posted, maybe we don't need/want a "left", "right" or "centrist" idea - we just need some "good" ideas.-ERD50
That's what I'd like to see, though it's probably out in Fantasyland. I don't think any group, left, right or center, has a monopoly on good ideas.
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Old 01-20-2010, 03:41 PM   #34
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Sam - Okay, I'm not proposing that we should go ahead with the current bill.

I was asking if you (or any other reader here) can think of a "reform" measure that could really get more than 50% of the votes by picking up roughly equal numbers of R's and D's. Or, for that matter, the middle 50% of the voting public. I'm having trouble. This seems like some of the voters want to zig left, others want to zag right, but I can't define the "middle" on this issue.

I think that Ziggy's comment on something that lets people keep insurance is an idea, but I can't come up with a specific proposal.

(Maybe I should say "good" idea, rather than "middle". I don't want to get tied up in the language. I'm simply thinking that we don't have anything like a consensus on anything related to healthcare.)
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Old 01-20-2010, 03:58 PM   #35
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There are huge philosophical differences in what should be done which color what people think are good or bad ideas.
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Old 01-20-2010, 04:00 PM   #36
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There are huge philosophical differences in what should be done which color what people think are good or bad ideas.
I'm glad you clarified that for us. I prefer lime green myself.
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Old 01-20-2010, 04:02 PM   #37
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Old 01-20-2010, 04:04 PM   #38
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I agree on the need to eliminate the special benefits given for employer based group health insurance. But the public doesn't seem to want that touched. And doesn't want to listen to arguments about how that could make things better.

/snip/
This would be a benefit IF other insurance reforms were made... such as I mentioned before about cancellations, cost increases etc. Right now, one of the benefits of having employer based insurance is the insurance company has to live with the sick people in a big mega corp so they can get all the business.. but it is was just you alone against them, and you got sick... what incentive do they have to treat you right?

Now, I am in a plan that has very few people... and we get screwed on rate increases etc... and if we wanted to move to another plan we all have to fill out medical history forms etc. so we can be underwritten... I don't think mega has to do that... just say 'we have 170,000 people who want to pay you insurance money'... done deal...
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Old 01-20-2010, 04:04 PM   #39
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Sam - Okay, I'm not proposing that we should go ahead with the current bill.
.....

I think that Ziggy's comment on something that lets people keep insurance is an idea, but I can't come up with a specific proposal.

(Maybe I should say "good" idea, rather than "middle". I don't want to get tied up in the language. I'm simply thinking that we don't have anything like a consensus on anything related to healthcare.)
I think you are touching on why the current bills failed. I don't think the current bills had much to do with solving the problems (few "good" ideas), they were attempts towards achieving more govt control by the party in power.

I think there have been a number of proposals made in the last few posts that would meet the "good" criteria. I don't know how specific you can get, I think this (from ziggy) was pretty specific:


Quote:
I'd like to see a combination of some sort of "super-COBRA" type thing where someone continuously insured for (say) 5 years can stay in a group plan indefinitely without underwriting (the five year requirement might reduce the incidence of adverse selection). And I'd like to see more employer group plans offer high-deductible plans with more affordable premiums.

I'd like to see small businesses able to have some anti-trust laws suspended for the purpose of banding together to get more affordable group rates than are possible if they try to negotiate alone. This will make small business more competitive as it would make it more affordable for them to offer health insurance like the big boys.
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Old 01-20-2010, 04:19 PM   #40
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There are huge philosophical differences in what should be done which color what people think are good or bad ideas.
How about cutting the waste and fraud from Medicare & Medicaid that has been pointed out? Is anyone (voters that is, not the crooks perpetrating the fraud, or the small minority benefiting from the waste) philosophically opposed to that?

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