House "Affordable Health Care for America Act"

[nwsteve]

For some insight how a good idea has gone terribly bad, please read about some of the "wonderful" provisions of the House bill as described in this WSJ piece
Betsy McCaughey: What the Pelosi Health Care Bill Really Says - WSJ.com

As an example this proposed revision to Medicare
Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."
Obama may claim everyone can keep their docs but the legislation clearly indicates it is only a matter of time until everyone must comply with a govt determined gate keeper for services.
There was news clip from the Republicans this am detailing over 100 new agencies estasblished by this legislation. Some examples were these come from in found in
• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.
Guess we have identified the future for Acorn?
nwsteve

 

[youbet]

Guess we have identified the future for Acorn?

Possibly. Or perhaps a return to the "good ole days" I experienced growing up in Democratic Machine Chicago with several extended family members employed by the city. The pace and direction of our lives were set by our precinct captain, the ward committeman (ward boss) and on up the ladder. Now perhaps those folks will also be able to poke their fingers into your access to medical care. Oh boy.......... Grandpa needs a new hip? Go see the ward boss and he will likely say something like "Well, lets take a look at how many hours you've logged doing political work and we'll see what we can do......"

My fears are probably exaggerated. But in our neighborhood in the Richard J Daley days, it was a pretty darn tight political ship! So, for me, any thought of "community political action groups" being involved in rationing medical services is scary.

 

[ERD50]

The average person has a basic understanding of income tax. It is tax on income that you have to pay unless the rules say otherwise.

I'm with youbet on this - I've gotta think that your standing as a tax expert may have distorted your view of what the average person understands about taxes. That's probably not uncommon with experts in their fields. To me, that sounds a bit like saying the average person has a basic understanding of Quantum Mechanics, if they recognize it has something to do with energy and atoms, and some rules apply Those darn, pesky rules!

Even Timothy Geithner (considered by many to be above average in knowledge of tax matters) had trouble with that pesky definition of "income"!

But it's a bit of a sidetrack to the OP, so I'll start a new thread on the subject if you care to discuss further, let me know.

-ERD50

 

[tarheeljim]

Am I the only one who considers this a total debacle? Your kids and grandkids are going to pay trillions of dollars so we all can suck off the pig. Not only that, this pig that all are trying so hard to analyze whether 'I will be better off or worse off' will likely turn around and bite us all.

This will not end well, sad to say. Since when did the federal government take over anything and make it better?

Just a sad day when we all put so much faith in the government doing things better than private capitalism does. There are problems, to be sure, but nothing deserving this.

Just a sad day, for sure.

 

[samclem]

Uh, oh. Looks like the House passed this monstrosity.

WASHINGTON – In a tight vote, the House passed its sweeping health bill late Saturday, marking the biggest victory yet for Democrats in their drive to create near-universal health insurance.
The bill passed by a 220-215 margin, with one Republican, Anh "Joseph" Cao of Louisiana, joining 219 Democrats in favor. Thirty-nine Democrats voted against the bill. The passage came after House leaders made a surprise last-minute concession that blocks abortion from the new government insurance plan in order to win over wavering Democrats.

 

[free4now]

A sad day for the elite.

 

[M Paquette]

As an example this proposed revision to Medicare
Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

I do happen to know where this one comes from. A number of Medicare providers have developed strategies for gaming Medicare. These run from basic 'more tests' to generation of artificial billable events such as scheduling a full office visit (billable as such) to give a patient negative test results from an annual physical.

McAllen, Texas and the high cost of health care : The New Yorker

The Sec 399V changes just extend the pre-existing Public Health And Welfare Act of 2003, in the area describing grant programs already being run by the Department of Public Health. (These are the programs that supply everything from 'How to screen yourself for skin cancer' brochures to supply vaccines to community hospitals)

Here's a partial listing of preexisting programs: USC 42 - US CODE 42 - US Code - Title 42: The Public Health and Welfare - vLex

 

[samclem]

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.

 

[M Paquette]

House Bill passes 220-215

The Republican alternative bill failed 176-258 along party lines.

Senate debate on the bill can begin next week.

 

[free4now]

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]

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:

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.

 

[lets-retire]

Am I the only one who considers this a total debacle? Your kids and grandkids are going to pay trillions of dollars so we all can suck off the pig. Not only that, this pig that all are trying so hard to analyze whether 'I will be better off or worse off' will likely turn around and bite us all.

This will not end well, sad to say. Since when did the federal government take over anything and make it better?

Just a sad day when we all put so much faith in the government doing things better than private capitalism does. There are problems, to be sure, but nothing deserving this.

Just a sad day, for sure.

I'm on board with you. I think it is very bad legislation. If I had the coverage mandated by this law when the DW was diagnosed with a brain tumor she would still have it. My costs just for the surgery would have been at least 12 times higher. I am tired of coming here and attempting to explain why it is bad, only to be told I don't understand because I have good coverage. I have good coverage because I've worked my ass off to get it. When I started out I had no coverage but that has changed.

Many of the arguments I hear on hear are very self centered and typical of my opinion of the boomer generation. Things like, "I want to retire early but can't because health care costs are too expensive."

I agree there are problems with the current system, but how about we tackle those problems first. If it doesn't work then we aren't out billions of dollars and can go back to the drawing board and make the law better.

I find it very disappointing that so many people still believe the government can provide good care or outstanding service for anything. I say this as I sit here in pain from a misdiagnosed back injury I suffered while on active duty with the military. I'll quit now while I'm not so angry.

 

[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.

 

[ziggy29]

...failed 176-258 along party lines.

We're going to get what we deserve if we can't look beyond the "D" or the "R" next to someone's name. And the worse and more divided it gets, the worse it will get.

 

[teejayevans]

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

 

[lets-retire]

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

How did the abortion thing change the law? Was that available 72 hours? She said explicitly that the bill woudll be online 72 hours. The ENTIRE bill was not.

 

[ziggy29]

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.

Not even technically according to the quote. If you look at the quote again, the Speaker committed to the *final* bill being online 72 hours before a vote.

 

[MichaelB]

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!

 

[HFWR]

We're going to get what we deserve if we can't look beyond the "D" or the "R" next to someone's name. And the worse and more divided it gets, the worse it will get.

Hope you're not holding your breathe...

 

[ziggy29]

Hope you're not holding your breathe...

I'd be long dead if so. It's just a really sad commentary about the state of public affairs in the republic. What was it that Lincoln said about a house divided against itself? We seem to be approaching that condition ideologically these days.

 

[Dawg52]

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

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

 

[W2R]

My career has been entirely devoted to scientific and engineering areas. Insurance, bills in Congress, legal documents, and the like are not my cup of tea. OK, I admit it, this is really tough for me. Still, I really wanted to read the full text of what the House bill had to say about Medicare, instead of just a summary. As someone who will be eligible for Medicare in 3.5 years, it seems related to my retirement plans - - Medicare will be an important part of my retirement, supplemented by my federal health insurance. I bravely tackled

http://docs.house.gov/rules/health/111_ahcaa.pdf

which is the full text of the bill.

I found the section that I *thought* I really wanted to read (despite the lack of page numbers in the part similar to a table of contents), and couldn't make head nor tails out of it because it was full of references to the original Medicare bill and saying they were changing things like "or" to "and" on a specific line without saying what that really was, or discussing the complex way they intend to index each year's payments without saying how it was done before. And just because I am a federal employee doesn't mean that I like acronyms any better than the average person.

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.

 

[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]

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.