The Hill on the cusp of healthcare

[eridanus]

But if you wanted health care reform, why would you support this bill?

Is non-rescission not reform? What about exclusions for pre-existing conditions?

 

[Westernskies]

I bet Hugo Chavez is celebrating tonight.

 

[Steve O]

Im glad I sold some stock last week...

The rest is in solid blue chips with good dividends and it's all tax advantaged...

Im not sure how much longer that will last though, they are gonna need a lot of taxes...

If any of you actually believe this will reduce the deficit Id like some of that Koolaid

Im hoping the PPT and the Fed have have the manipulation machine tuned up and ready to run...

As far as the actual reform goes I guess this means I can drop my expensive individual insurance and give less $$$ to the IRS instead

If I get really sick I can buy insurance after the fact...

I cannot see how this is gonna work

My state of Illinois has no income taxes on IRA withdrawls and my passport is good to go...

 

[ERD50]

Is non-rescission not reform? What about exclusions for pre-existing conditions?

And when do those take effect?

If I sprinkle some sugar on your mud-pie, can I ask - why don't you like your mud pie, you don't like sugar?

-ERD50

 

[eridanus]

And when do those take effect?

Are they reforms or not?

 

[youbet]

My state of Illinois has no income taxes on IRA withdrawls.......

Tonight it doesn't. But ya better check the newspapers in the morning!

 

[ERD50]

And when do those take effect?

If I sprinkle some sugar on your mud-pie, can I ask - why don't you like your mud pie, you don't like sugar?

-ERD50

Are they reforms or not?

Based on your (non)answer, it sounds like mud pie, maybe with some sprinkles.

Hey, what happened to transparency? When do those take effect?


-ERD50

 

[youbet]

Is non-rescission not reform? What about exclusions for pre-existing conditions?

You're answering my question with a question. That's silly. Why not answer me, then I'll answer you.

 

[clifp]

What about exclusions for pre-existing conditions?

To be honest I am not sure I like preventing insurance companies from exclude people who have pre-exisiting condition.

Now obviously in some case it is just bad luck or bad genes that you have a particular disease and it seems unfair that not only do you get hit with a bad disease but you and your family financially crippled. But shouldn't their be some consequences for the obese person who has diabetes or high cholesterol , the smoker, the gay man who engages in unprotected sex and gets HIV or another STD etc?

We allow insurance to exclude people from collecting life insurance, who race cars, mountain climb, fly airplanes, hang glide, or rock climb. Drivers who habitually drive too fast or drive drunk lose their insurance.

I know it sounds cold, but even the provision about preventing insurance companies from excluding kids with pre-existing kids, which evidently is very popular is troubling me a bit. As our understanding of genetics advances we will increasingly be able to predict potential problem with parents having kids. If parents are told that the odds are pretty high that if you have a kid, he will have a chronic disease, should society be forced to bear the entire consequences of their poor choice?

I don't think there is easy answers to the question, but I think we need to continually reinforce that actions have consequences if we are to control health care cost. One of my biggest philosophical problems with HCR is moved in the wrong direction on this front.

 

[eridanus]

Based on your (non)answer, it sounds like mud pie, maybe with some sprinkles.

Based on your (non)answer to my questions, it sounds like you agree. They are indeed reforms.

 

[eridanus]

I know it sounds cold, but even the provision about preventing insurance companies from excluding kids with pre-existing kids, which evidently is very popular is troubling me a bit. As our understanding of genetics advances we will increasingly be able to predict potential problem with parents having kids. If parents are told that the odds are pretty high that if you have a kid, he will have a chronic disease, should society be forced to bear the entire consequences of their poor choice?

Abortions are not funded under the health care bill.

 

[ERD50]

Based on your (non)answer to my questions, it sounds like you agree. They are indeed reforms.

Provide a page reference, and maybe I'll take a look and give an opinion. In the mean time, care to answer the question - when do they take effect? You seem to be afraid of that one.

-ERD50

 

[eridanus]

In the mean time, care to answer the question - when do they take effect? You seem to be afraid of that one.

I didn't ask or state anything about when they take effect. You did. I just stated that they're reforms.

 

[eridanus]

To be honest I am not sure I like preventing insurance companies from exclude people who have pre-exisiting condition.

Now obviously in some case it is just bad luck or bad genes that you have a particular disease and it seems unfair that not only do you get hit with a bad disease but you and your family financially crippled. But shouldn't their be some consequences for the obese person who has diabetes or high cholesterol , the smoker, the gay man who engages in unprotected sex and gets HIV or another STD etc?

Yeah, you're right. Actions do have consequences. Perhaps those people should pay more for health insurance but I don't think denying them all health care is the answer. At least, it's not the type of society in which I want to live.

Other countries have universal health care. They spend less than we do. What is their secret? (They're less obese, for one, so maybe a "fat tax" is part of the solution.)


Edit: Don't smokers have lower lifetime health costs than non-smokers? They die earlier.

 

[Steve O]

So when do these tax increases take effect

I was planning on deffering some income and buying a house with cash this year...

Wyoming, Texas and Tennessee are on the list...

Is Illinois a non recourse state

I mean why shouldn't I just quit paying the mortgage that will soon be under water and pack up and leave

Why pay $4500.00 in taxes on a house that's assessed at 200 K that I might get $120 K for and I owe 121 K

I could care less about my credit because I don't have any other debt and I don't need anymore...

These are things Im gonna have to find out soon...

 

[Steve O]

Tonight it doesn't. But ya better check the newspapers in the morning!

I quit reading the slanted so called "news" papers here years ago

 

[plex]

Interesting, found this fun calculator for the health cost subsidy:

Health Reform Subsidy Calculator -- Premium Assistance for Coverage in Exchanges/Gateways

Since I live on about $9-9.5K/year right now as a single, according to this, I would be within the 85-90% poverty level range (if I was in the sort of situation where I was pulling income to meet my cost of living). That would put me well within Medicaid territory according the calculator, not sure how I feel about that. Health insurance was quite cheap for those 30 and under before this subsidy system took effect (500/year or so), so certainly not a big change for someone in similar circumstances to mine in the future.

I tested out another run as well, to see what I would be paying in a FIRE type situation. From 40-64, as a single, if I lived on $20k/year (which is fairly comfortable) with a paid of house, it says that my insurance costs would be capped at 1.1K/year, which is about $4k less than I would expect to pay under the non-subsidy system.

These subsidies are going to be pretty expensive to maintain, that is a lot of money for the government to be paying out each year for a person's entire life. The median household income is 45K (http://en.wikipedia.org/wiki/Household_income_in_the_United_States), so most people would be getting pretty hefty subsidies. My example with a 20k single person's subsidy overlaps pretty well with the median household would get as a subsidy, since the median household contains about three people, instead of one.

Perhaps this requires a separate post? I found this pretty shocking.

 

[clifp]

Yeah, you're right. Actions do have consequences. Perhaps those people should pay more for health insurance but I don't think denying them all health care is the answer. At least, it's not the type of society in which I want to live.

Other countries have universal health care. They spend less than we do. What is their secret? (They're less obese, for one, so maybe a "fat tax" is part of the solution.)


Edit: Don't smokers have lower lifetime health costs than non-smokers? They die earlier.

The only thing I am sure of in the health care debate is I don't have answers.
Smokers do have higher health care cost than non-smokers, the argument has been made that because they payer higher taxes (for cigarettes) and they collect Social Security for a shorter period time they save society money. IIRC the data for the claim is pretty flimsy.

The preventing insurance company from denying people health insurance due to pre-existing conditions is something you and other highlight as one of the reforms of the bill. While I can definitely see some advantages of it, the unintended consequence is very likely to be there less is incentive for people to stop doing stupid things that drive up health care cost. I don't know if insurer are allowed to charge more for fat, smokers I think under the bill they aren't.

So while it is definitely a change, its not clear it is the right thing to do which make the reform claim somewhat dubious. Of course the pre-existing conditions provision in the bill doesn't take place until 2014, except for children which takes place immediately. Its hard for me to a label a bill a major reform when the main thing that that happens for next 4 years is raising taxes on wealthy folks dividends and such..

 

[donheff]

How so? I haven't followed the debate, so I don't know what you are referring to. What, specifically, about the bill is socialistic, and how exactly is a Hell on earth?

Maybe I watch too much cable news. Would I be happier not hearing these rants? Last night in the debate prior to passage, Boehner once again claimed this was going to bankrupt the country (notwithstanding that he remains happy with the Bush tax cuts for the top 1% leaving us with a $trillion defict); another GOP representative stated this this will destroy our constitutional form of government. Fox News pundits have been echoing those sentiments all week.

Is non-rescission not reform? What about exclusions for pre-existing conditions?

And when do those take effect?

-ERD50

A number of the changes, like non-recission, take effect almost immediately (some within 90 days and others 120 days). Here is a blurb just posted:

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.
​

The big change - mandatory enrollment - doesn't take place until after the next presidential election. This one is controversial (see posts below) but without some form of universal coverage you cannot require coverage for people with pre-existing conditions. The subsidies for 30+ million uninsured is why the bill is expensive and why insurance stocks are rising. But hopefully, the influx of large numbers of healthy people into the system will lower premiums for others if the invisible hand of market forces really works.

Many of us would prefer a single payer system, sort of a Medicare for all approach. But more of you find that approach anathema yet want to be assured that you can get affordable insurance when you want it and won't be tossed off when you need it by rapacious insurers. This bill (as it will be tweaked over the years) is the later.

Edit: I saw an online blurb about CA rep Devin Nunnes and realized he was the whack job who said our constitution form of government would be destroyed by this legislation. Apparently, he ranted at greater length earlier in the day:

Rep. Devin Nunes (R-CA) said on the House floor today that by passing health care reform, Democrats "will finally lay the cornerstone of their Socialist utopia on the backs of the American people."
Earlier today, Nunes brushed off reports of protesters shouting racial epithets at Congressmen, ascribing them at least in part to Democratic "totalitarianism" that makes people "act crazy."
Today on the House floor, Nunes railed against the Democrats' plan, saying "this debate is not about the uninsured, it's about socialized medicine."
He continued: "For most of the 20th century people fled the ghosts of communist dictators. And now you are bringing the ghosts back into this chamber."

 

[Gone4Good]

And when do those take effect?

The pre-existing condition ban kicks in for children within 6 months. For everyone else it starts in 2014. The ban on rescissions starts immediately.

 

[Gone4Good]

So now that the big legislation is all but passed, can we expect that all of those people who cried out for more cost control in the bill will use the pending reconcilliation process to introduce real, meaningful, cost control amendments?

Seems like a very good forum for Republicans to improve the bill. Should we start a list of their proposals as they come out?

 

[donheff]

So now that the big legislation is all but passed, can we expect that all of those people who cried out for more cost control in the bill will use the pending reconcilliation process to introduce real, meaningful, cost control amendments?

Seems like a very good forum for Republicans to improve the bill. Should we start a list of their proposals as they come out?

Good question. The Republicans ranted about the "Corn Husker" provisions, et al. But not one voted for the fixes that would remove those provisions. This think is law now. And the most controversial parts are delayed until after the next Presidential election. If the economy follows its typical course, things will look okay then and Obama will get re-elected. If so there is no way this will get flat out repealed before 2017. If the Republicans really care about America it is time for them to stop ranting and start negotiating changes that will really help.

 

[ERD50]

Thanks for providing some of the answers that eridanus was avoiding. I'll comment on those later, but for now...

If the Republicans really care about America it is time for them to stop ranting and start negotiating changes that will really help.

Please don't be so patronizing. The Dems had a super-majority. The R's could do nothing. The reason nothing passed earlier was they could not get enough support from the within that super-majority.

-ERD50

 

[ERD50]

I didn't ask or state anything about when they take effect. You did. I just stated that they're reforms.

So I'll give an answer, even though you were evasive:

They are 'changes'.

I won't call them 'reforms' until we get some idea that overall, with all consequences, unintended or not, and all costs considered, this is shown to be a benefit.

I think we can look at some of those consequences just a bit later....

-ERD50

 

[samclem]

If the Republicans really care about America it is time for them to stop ranting and start negotiating changes that will really help.

I think there are two lines of reasoning on this.
1) The Republicans should get in there and help fix the major things wrong with this law.
2) The Republicans should allow Democrats to make any needed fixes.

There are certain elements of the law that can't be fixed given the present construct. Specifically, regarding cost control--the bill presently envisions several government panels that will decide on the "proper" cost for various procedures, and determine if insurance companies are making to much money. Republicans would, in general, favor a market-driven approach: rather than have the government dictate how much a loaf of bread should cost, they'd prefer to let the market figure that out.

In a few months the test will come: The temporary "Doc Fix" will run out and Congress will have to decide to add billions to the budget to keep things going (and giving lie to the specious coat estimates used to sell this law) or watch as care providers refuse to see Medicare patients at a price that costs them money each time they administer care. This will happen right before the election. I'm sure Nancy et al have a plan to address this, so they won't need any Republican help to get themselves out of the jam they've created.

The way this legislation was passed was destructive and dishonest. When you go to a party and break all the windows out of the pace and smash all the stemware, you shouldn't expect to get a lot of help in cleaning up the place.