Oh My ... the moment of truth

[ERD50]

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...

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.

-ERD50

 

[Martha]

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.

 

[HFWR]

Deleted

 

[ERD50]

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.

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.

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.

-ERD50

 

[ziggy29]

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.

 

[Independent]

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?

 

[ERD50]

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.... ).

-ERD50

 

[ziggy29]

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.

 

[Independent]

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.)

 

[Martha]

There are huge philosophical differences in what should be done which color what people think are good or bad ideas.

 

[REWahoo]

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.

 

[Martha]

What!!! I am orange.

 

[Texas Proud]

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...

 

[ERD50]

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:

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.

-ERD50

 

[ERD50]

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?

Color me - the color of money!


-ERD50

 

[Martha]

This would be a benefit IF other insurance reforms were made.

Absolutely.

This is why we end up with complicated legislation.

 

[ERD50]

(Have any Free Marketeers turned down government run Medicare?)

Not a fair question until I'm offered the choice of not contributing (plus get a refund of my share of the deficit $, since it all goes into a general fund anyhow), and there would need to be a free market in place so that I had a place to take my business to.

-ERD50

 

[harley]

The most amazing part of this vote to me is listening to the Conservative talk show hosts (Hannity, Limbaugh, etc) crowing about how this is the end of all of Obama's legislative priorities. So the Democrats don't have 60 seats anymore, they still have 59, which is far more than the 53 or 54 the Republicans had when they still got a lot of laws passed. There's penty of opportunity for health care reform, with just the slightest dash of bipartisanship added. I think there's a little too much attention being paid to the national aspects of the election, and not enough being paid to the fact that Martha Coakley was a horrible candidate. Overreacting much?

 

[Martha]

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?

Color me - the color of money!


-ERD50

People can get their arms around fraud and abuse but that is the easy part and Medicare already is working on that. Fraud control units recovered over a billion dollars in 2008. Same with digitizing health records, already in the works with last year's stimulus bill. Electronic billing also will save money and make fraud harder. I don't know the status of moving to electronic billing.

Lots of other waste but those are more difficult issues, such as why does excellent health care in one part of the country cost half as much as excellent health care in another part of the country. This is a tougher nut and there has been opposition to even experimentation by Medicare and Medicaid on new reimbursement mechanisms to reward efficient, quality providers.

 

[Martha]

I think there's a little too much attention being paid to the national aspects of the election, and not enough being paid to the fact that Martha Coakley was a horrible candidate. Overreacting much?

Yes. If I lived in MA I would have had a big problem deciding what to do. Her actions as a prosecutor would make it almost impossible for me to have voted for her, I don't know if I could have yellow dogged it or not.

 

[MasterBlaster]

Obama urges pared-back health care bill

Obama urges lawmakers not to try to jam a bill through Congress

Obama urges pared-back health care bill - Health care reform- msnbc.com

 

[Independent]

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:

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.

These are specific enough for me. I think the indefinite COBRA would initially meet my criteria of getting at least 50% support from the public.

But the insurance companies would say that the cost of keeping uninsurable people in the group indefinitely would raise costs and premiums by an unknowable amount. Employers would say (correctly) that the higher premiums would either be passed on to the active employees in terms of lower wages, or cause the employer to drop group insurance for everyone. This type of argument is used against the current bill.

So I imagine that we'd end up with just as many congressmen against this provision as there are against the current bill. I could be wrong, maybe the very limited scope and simple provisions (this doesn't take 2,000 pages) would pull a few across the line.

Regarding high deductible plans, they are already legal, and even encouraged through tax-deductible HSA's. So I don't see any legislation here.

Regarding small employers forming buyers co-ops, I didn't think they were illegal today. I'm not an expert in anti-trust law, I always think of it targeting price fixing and monopolies within one industry. If buyers co-ops are really illegal under current law, this is one thing which I'd expect to get my 50% of voters and 50% of Congress to agree on.

So, I get two maybes for my list.

 

[easysurfer]

Obama urges lawmakers not to try to jam a bill through Congress

Obama urges pared-back health care bill - Health care reform- msnbc.com

A strategy now might be to have a pared-back health care bill (retaining the things that there is a consensus on) and to dare others to vote against it.

His state of the union address next week is going to be interesting. Will, it have the tone of "We tried, have come so close to health care over-haul, but stil have some more to go" or will he come out swinging.

 

[haha]

Lots of other waste but those are more difficult issues, such as why does excellent health care in one part of the country cost half as much as excellent health care in another part of the country. This is a tougher nut and there has been opposition to even experimentation by Medicare and Medicaid on new reimbursement mechanisms to reward efficient, quality providers.

Let's just give anybody who lives in an expensive area $500 and a one way plane ticket to a cheap area.

Ha

 

[Gumby]

YouTube - Porky Pig Cartoon Ending "That's All Folks!"