First Read of House Health Care Reform Act (H.R. 3200)

The House Ways and Means Committee published H.R. 3200 “America’s Affordable Health Choices Act” at over 1,000 pages. Newspapers and cable television have exhaustively instigated the class warfare, tax the rich aspects of the Act. By now everyone knows the proposed tax increases and penalties for not participating, so I won’t go there. Savings from a more enlightened approach to Medicare and Medicaid reimbursements have also been widely discussed.

I would like to focus on the consumer benefits of the Act first, and then what I see as the positive impact for the enlightened private health insurers. Most aspects of the Act start in year 1 (Y1), however certain existing individual and group insurance plans would be grandfathered for up to 5 years. While grandfathered plans might not have to include regulated essential benefits, it is not clear whether they still can rescind policies and exclude preexisting conditions in Y1.

Most regulation appears to be controlled at the federal level, but there is talk in the Act of states participating in enforcement. Federal regulators would set essential benefits including hospital, outpatient, mental health, prevention, maternity and drugs. No co-pay would be allowed for preventive care.

Three levels of benefits would be supported in the exchange, with maximum out of pocket starting at $5K for individuals and $10K for families in Y1. In subsequent years, out of pocket maximums would rise with the CPI. Private insurers could still offer higher cost plans with richer benefits outside the exchange.

All plans open to new members must be guaranteed issue with no preexisting condition exclusions, whether within or outside the exchange. Federal regulators would control premiums for exchange plans based on an actuarially determined 85% payout ratio. Private plans would have to bid to participate on the exchange. Within the exchange, regulators would redistribute premium dollars to compensate for adverse selection amongst private insurer participants.

Federal regulators would also determine the adequacy of private insurer networks. Premiums could vary by age, but not more than 2 to 1 from youngest to oldest. Area or location premium variations would be regulated by state authorities.

The controversial public plan would be modeled after Medicare, paying providers 5% over Medicare rates in years 1, 2 and 3. The public plan would have to be self sustaining following receipt of seed money from the federal government. The premiums charged would need to be high enough for an honest actuarial accounting of a going concern.

There are some interesting opportunities for both the private insurance and pharmaceutical industries to actually increase profits. The two most important provisions for private industry are that the public plan is allowed and even encouraged to contract with private insurers for administrative services, and drug benefits are part of the essential benefit package.

The commentary that risk sharing among private insurers discourages innovations to save cost is ludicrous. The history of private insurers controlling cost is nonexistent. Private insurers are primarily administrative agents now anyway as their risk business has been shrinking for decades. They have been pursuing the relatively risk free Medicare Advantage business with a vengeance, so risk sharing in the exchange and administrative work for the public plan is just an extension of their current business model.

The UnitedHealth Group (UNH) and Humana (HUM) conference calls have implied that the risk based business is dying quickly and they need to adapt. So why don’t they just capitulate and admit the government is actually giving them a lifeline?

Pharmaceutical companies might complain that the buying power of the public plan puts them at a negotiating disadvantage. My conclusion is that consumers now considering many of their most profitable blockbusters discretionary is a far bigger worry. All an investor has to do is listen to the last few Pfizer (PFE), Johnson & Johnson (JNJ) and Merck (MRK) conference calls to get the message.

I have written extensively about the healthcare industry death spiral based on their reluctance to break free from their own rhetoric. Then earlier this week Johnson & Johnson stated during its conference call that only 10% of its revenue goes to research and development. The old stories no longer carry any weight.

Disclosure: Author is long PFE.

Comments

[Living4Divi...:]

Thanks for the terrific article.

Questions:
1. what do you figure are the odds that this bill will pass as is ?

Jul 16 10:07 AM

[Living4Divi...:]

I realize they are passing a surtax to fund the health insurance
Question 2. what are the tax penalties for not complying for the
a) individual employee ? and
b) hiring company ?

Jul 16 10:09 AM

[Duude:]

"The public plan would have to be self sustaining following receipt of seed money from the federal government. The premiums charged would need to be high enough for an honest actuarial accounting of a going concern."
This is a pipe dream. I don't care what they write into the bill now, it will be edited out later when premiums escalate, or the government will eliminate certain expenses in running the government option from premiums paid by government option participants with the remaining expenses paid by all taxpayers. The goal isn't to compete, its to move all low income and middle income households into government subsidized healthcare. That's when things get real interesting. Can the democratic party continue blocking tort reform as premiums escalate? Will they start down the path of rationing care? Will they deny life saving care to elderly Americans? Considering how rampant fraud is in medicare and how completely inept government has been in stopping it, can we expect they will ever get a handle on it as they expand the government's role? Obese Americans contribute greatly to America's healthcare bill. Will we ever see the government drop ludicrous policies that call obese Americans handicapped and not responsible? Stay tuned as healthcare expenses either reach 30-40% of GDP a decade from now or government starts rationing care.

Jul 16 10:23 AM

[SPOTS:]

As a medicare and health care insider, I have said for 3 years that it was absolutely certain that Congress would create a national insurance plan. The reason that it assuredly will happen is that medicare is in impossibly terrible shape. Much worse than the people understand. The numbers say it will fold in 2017. But even that near date paints it much better than it is.

So the only way out is to bury the disastrous numbers in a national health plan. The plan is in 2 basic stages: 1) create a national insurance plan funded by taxpayers 2) merge it with medicare, probably under the guise of saving overhead costs. 3) Use the tax increases to prop up medicare.

To summarize: much less medical care for much more tax, for everyone.

Jul 16 11:39 AM

[mb2:]

There is NOTHING good about this bill. PLEASE tell your representatives to vote against this.

www.house.gov/house/Me...

Jul 16 12:36 PM

[Mr. Ed, Jr.:]

'The UnitedHealth Group (UNH) and Humana (HUM) conference calls have implied that the risk based business is dying quickly and they need to adapt. So why don’t they just capitulate and admit the government is actually giving them a lifeline?"

Maybe UNH and HUM see it not as a lifeline, but as an anchor. Interesting that the author asks why the CEO's can't see that the government knows what is best for them, and is acting in their best interests. Oh. if only they weren't so blind....

The author makes a very dangerous assumption that the bill that will be presented now and passed will be the same a year from now. Or even 6 months.

A few amendments (slipped in at 3 AM and passed unread) and other policy changes made by the "Health Care Czar" could quickly turn this bill into the total nightmare scenario of government-run health care.

This government has already-- and very clearly-- demonstrated that they cannot be trusted.

It is also time to end this policy of ramrodding legislation through without allowing it to be discussed and debated-- or even read--by "We the People".

Enough.

Jul 16 12:40 PM

[ERCaptain:]

Want to see the current example of governement run health care? It is the VA system. A visit takes a day; quality is often questionable; the infrastructure is usually terribly outdated..
for veterans, it is often used, but would they if they didn't have to?

How about other social programs?
Medicare? Disaster
Medicaid? Broken
Social Security? Disaster

And now we want to turn over your Health to these morons in Washington....

Have we all lost our minds ?

Jul 16 01:08 PM

[CaptainJJack:]

Here is a flash: health care will be rationed.

Here is another flash: Health care IS being rationed RIGHT NOW.

That is what motivated Michael Porter, who probably knows more about competition and free markets than anyone on the planet, to write an entire book on the problem.

We WILL have rationing. The only question is how it will be done.


On Jul 16 10:23 AM Duude wrote:

> "The public plan would have to be self sustaining following receipt
> of seed money from the federal government. The premiums charged would
> need to be high enough for an honest actuarial accounting of a going
> concern."
> This is a pipe dream. I don't care what they write into the bill
> now, it will be edited out later when premiums escalate, or the government
> will eliminate certain expenses in running the government option
> from premiums paid by government option participants with the remaining
> expenses paid by all taxpayers. The goal isn't to compete, its to
> move all low income and middle income households into government
> subsidized healthcare. That's when things get real interesting. Can
> the democratic party continue blocking tort reform as premiums escalate?
> Will they start down the path of rationing care? Will they deny life
> saving care to elderly Americans? Considering how rampant fraud is
> in medicare and how completely inept government has been in stopping
> it, can we expect they will ever get a handle on it as they expand
> the government's role? Obese Americans contribute greatly to America's
> healthcare bill. Will we ever see the government drop ludicrous policies
> that call obese Americans handicapped and not responsible? Stay tuned
> as healthcare expenses either reach 30-40% of GDP a decade from now
> or government starts rationing care.

Jul 16 01:28 PM

[awake09:]

Thank you for that link. The "Honorable" Brad Sherman from Los Angeles has now heard my side of the matter.


On Jul 16 12:36 PM mb2 wrote:

> There is NOTHING good about this bill. PLEASE tell your representatives
> to vote against this.
>
> www.house.gov/house/Me...

Jul 16 01:34 PM

[bricki:]

Thank you for the good summary.

Unfortunately I think we are in a position where there are no good alternatives. Medicare is in a impossible financial hole. Costs for the existing system are running at 17% of GDP and are growing faster than inflation and at the same time are delivering sub standard care if your standard is measurements like longevity and mortality rates, rather than the ability to have the latest MRI technology at every street corner. What we have now is not competitive to the better plans in place in the nations we are competing with, and it will continue to get worse.

Serious reform IS needed and now at least somebody is stepping up to the plate and giving it a try. I am sure mistakes will be made in this process and there will be unintended consequences. But to do nothing is also a decision, and a decision that I think would a very bad one for this country.

Jul 16 02:34 PM

[Pat C:]

I originally freaked out, trying to figure out how I was going to increase revenue to offset a minimum 8% increase in costs (80% payroll) since we have a small (35 part-timers) service business. I'm am settling down a little bit but the devil will be in the details. It provides for a small business tax credit, but it looks like it is only available to really small businesses with virtually no employees. It seems to assume that if you have alot of employees you are profitable which is certainly not our case. This thing looks like a real disincentive for new small businesses to hire people. I sure would like to do something for our folks to keep them.
The 8% employer contribution in lieu of the coverage does not get credited against the employees cost which is really troublesome (paying for employee health insurance and getting abolutely no credit for it in your employees eyes - what a deal I can't wait to step up to that?!).
I don't know about everybody else out there but this a very, very big deal for small businesses.

Jul 16 04:58 PM

[User 422955:]

The answer to "Living 4 Dividends'" first question is: Almost zero. Why? Very little legislation passes "as is" when it has so many more steps (hurdles?) to go.

Thanks, Bricki, for a good summary of the problem. There is a lot to dislike about this bill. Deals had to be made with the hospitals and Big Pharma, in order to get at least this far. That means the waste in the US health care system (waste = what we spend over and above what other countries with similar health care outcomes) will have to wait some more.

Health (actually, illness) care is eating up our GDP. Those of you who oppose this bill, what do you support?

Jul 16 05:33 PM

[Mr. Ed, Jr.:]

This is from Investors Business Daily:

It's Not An Option
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT

Congress: It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

[The rest of the editorial is at www.ibdeditorials.com/... ]

Jul 16 08:04 PM

[291442:]

Here is where this needs to go:
1) Affordable health insurance should not be contingent upon an employer. This leaves a lot of room for the insurance industry to figure out comprehensive coverage at a significantly lower price than today. Note...none of this catestrophic crap that may save your house if you are laid up with cancer or a transplant.
2) Eliminate pre-existing clauses. This is just a way insurance plans game the system and deny coverage to those who are sick and need help.
3) There has got to be a way to control prices. While I would be cautious with regulating prices, there may be no other way. I would start with making pricing and pricing practices very public. There is extensive gouging especially from hospitals on outpatient services. Somebody's ox will be gored here...so be it.
4) Get doctors back to doctoring and not searching for ways to get richer. Enforce Stark provision that prohibit MDs from self-referal. There are too many ancillary service businesses where MDs have ownership and refer their "sick" patients.

There you have it. Make insurance available to all through affordable plans. The insurance companies would have a large pool of enrollees. Control costs first by making consumers aware, and then by regulation if that fails. Enforce existing laws...get mds back in the business of doctoring the sick.

Jul 17 09:07 AM

[phil from E...:]

Is there a stated lifetime maximum benefit?

The maximum 2 to 1 premium difference between young and old is a significant cost increase to the young with individual coverage or no coverage.

Jul 17 09:22 AM

[Eye:]

Not only will there not be enough money for healthcare, there will not be enough doctors. Every one is worrying about paying for healthcare, the demographics and ramifications of national healthcare legislation suggest you should be more worried about just getting it. Fewer and fewer bright people will be willing to spend and borrow $250,000 to get through med school to work in a "public" system. The older doc's will retire "en mass" as reinbursements drop and the paperwork continues to go up. Find a good GP 20 years younger than you are who has made a commitment to his community and treat him courteously. There is no guarantee he will be there in three years but if he is you want him to still be your doctor.

Jul 17 09:36 AM

[MSimon:]

"2) Eliminate pre-existing clauses. This is just a way insurance plans game the system and deny coverage to those who are sick and need help.
3) There has got to be a way to control prices. While I would be cautious with regulating prices, there may be no other way. I would start with making pricing and pricing practices very public. There is extensive gouging especially from hospitals on outpatient services. Somebody's ox will be gored here...so be it.
4) Get doctors back to doctoring and not searching for ways to get richer. "

Items 2 and 3 are contradictory.

To get item 4 you are going to have to lower the cost and time for medical school. Otherwise you wind up with not enough doctors.

Supply and demand meet at a PRICE. Set the price too low and demand outstrips supply.

Why does the USA spend so much on health care? We are richer than the rest of the world and want that added 6 months of life and will pay a lot for it.

Why do we pay for air conditioning when previous generations didn't need it? We can afford it. Why have average house sizes grown? We can afford it. etc. etc. etc.

Jul 17 09:48 AM

[CaptainJJack:]

I generally agree that market prices do an effective job rationing goods and services.

However, in order to set an accurate price, you have to have a sense of what you are buying, and there is no effective way to measure quality of care.

As Michael Porter, in Redefining Health Care, puts it, you know the free market is working right when prices DECREASE over time and quality increases over time. In most markets, this is true.

But, not in health care. We see all the time where some parts of the country spend much less and have better results.

We see where PPOs and HMOs are doing well because they only contract with hospitals that have very reduced emergency care and very availablity for uninsured -- and no teaching hospitals.

Further they hire MDs and lawyers to figure out ways to get out of paying for coverage -- in effect one version of rationing procedures -- just like the government except that it is far more arbitrary.

Worse, MRIs and CAT scans are now profit centers in many clinics, and heart centers are common in many more hospitals because the procedures are so profitable.

We have a very broken system


On Jul 17 09:48 AM MSimon wrote:

> "2) Eliminate pre-existing clauses. This is just a way insurance
> plans game the system and deny coverage to those who are sick and
> need help.
> 3) There has got to be a way to control prices. While I would be
> cautious with regulating prices, there may be no other way. I would
> start with making pricing and pricing practices very public. There
> is extensive gouging especially from hospitals on outpatient services.
> Somebody's ox will be gored here...so be it.
> 4) Get doctors back to doctoring and not searching for ways to get
> richer. "
>
> Items 2 and 3 are contradictory.
>
> To get item 4 you are going to have to lower the cost and time for
> medical school. Otherwise you wind up with not enough doctors.<br/>
>
> Supply and demand meet at a PRICE. Set the price too low and demand
> outstrips supply.
>
> Why does the USA spend so much on health care? We are richer than
> the rest of the world and want that added 6 months of life and will
> pay a lot for it.
>
> Why do we pay for air conditioning when previous generations didn't
> need it? We can afford it. Why have average house sizes grown? We
> can afford it. etc. etc. etc.

Jul 17 10:25 AM

[YoYoMama:]

Thank you Michael Steinberg for posting a link to an actual bill, reading it, and summarizing. Most SA contributors simply want to lambast health care reform without going to the trouble of actually reading and posting for us what is being proposed, whether in agreement or not.

Many good comments as well.

DUUDE: "Can the democratic party continue blocking tort reform as premiums escalate...rampant fraud is in medicare...Obese Americans contribute greatly to America's healthcare bill....

MY RESPONSE: All valid points. Cost-containment is essential to reform and is being completely ignored by the majority party. We need insurance reform to protect consumers, but insurance companies need to be protected as well from irresponsibility and needless lawsuits.

MB2: "There is NOTHING good about this bill"

MY RESPONSE: Those who have pre-existing conditions which prevent them from receiving health coverage, or who are the 75% of medical bankruptcy filers who HAVE insurance, will disagree. I also disagree that 100% lock-stock-and-barrel that this is a bad bill. Have you read it in its entirety? If not, then you are not educated enough on the issue to make the comment.

To Mr. Ed, Jr: Thanks for posting the WSJ article. If this is true, at the end of the day, this is not a bad thing, if we are talking about the sphere of PERSONAL health insurance (and not employer group insurance).

My own experience with personal health plans is it's a complete ripoff. They will not cover pre-existing conditions, they typically DON'T pay on your claims, and the coverage is rendered non-existent by pages and pages of exemptions. Most of those who are now filing for medical bankruptcy took out personal health insurance with the assurance they would be covered, only to discover on the back end that the company will not pay, to their own financial ruin.

Isn't the point of insurance to PREVENT this from happening?

If personal health insurance is done away with, I promise, those who are on it will welcome the government plan, because I can promise you, there is NOT MUCH to give up.

Jul 17 10:32 AM

[Howard_T:]

My question is, "Why is the Obama administration in such a hell of a hurry to get a bill passed?" It appears to me that taking our time, looking dispassionately and carefully at all the alternatives, and only then coming out with a viable and affordable plan is our best course. Instead, we are being pushed, prodded, panicked, and propagandized into sipping from this kool-aid vat. The old saying is that if you want something badly, that's exactly how you will get it - badly. Is the current administration in a hurry to get the parade over with before we discover the true nature of the emperor's wardrobe?

Jul 17 11:06 AM

[Paco6945:]

1. There is a difference between health care and health insurance. If health care costs were equivalent to food costs, no one would be talking about health insurance. Do we need hunger insurance?

2. Generally, children and young adults (under 30?) don't need much health care. If you don't believe me, price out individual health insurance for a 10 year old. There are exceptions, but that's the point.

3. Health care is not a right. Neither are food and shelter.

4. Auto and home insurance are typically of the "catasrophic" nature. $500 deductible for autos; $2500 deductible for homes. No such thing as co-pay (except 80/20 on home insurance for major losses) Why? Because I share the risk with my insurance company, my premiums are lower. Health insurance should be the same. $5,000 deductible. Premiums would be in the $150-$200 per month range.

Jul 17 11:38 AM

[jarco:]

This article ignores the overwhelming issue; namely, cost control. While Medicare, for example, will pay 85% of the cost billed by the provider and sets a further ceiling, lack of cost control and incentives for efficiency virtually condemns the plan at the outset.

In addition, current Medicare practice allowing participant’s unfettered access to specialists, continues to add costs to an already bankrupt system. While this may be curtailed in any new population wide plan, failure to curtail this provision within medicare is problematic. Further, it seems like the vast majority of recently (past year) introduced TV drug advertising pushed one to “ask your doctor” if a certain drug would be good for them. Aside from ramping up tax-deductible advertising costs, ask your doctor mandates (or should) an office visit. So, there’s another what $75 or more fee times how many patients call their doctor. My guess, 1M x $75 x 12 different drugs/yr. = $900 million not including the cost of the drugs.

Gag, who designed Medicare? The same like minded folks now tackling the :”New Health Care”?

Jul 17 11:57 AM

[ozzy:]

The author is completly in the dark re healthcare reform. The problem is everyone wants healthcare but no one wants to pay for it, NO ONE, if all paid hospitals would not have to charge "outrageous" prices to those that can pay to cover those that can't. And why should all get the same level of care? Those that can't pay automatically get the same as those that can...why? It is not like that in the rest of our culture, why should it be here. We all don't get to drive the most expensive car, eat in the most expensive restaurants.

The article is so full of holes it is clear the author does not have a clear understanding of the whole system. As presented to us, the gov system will be a disaster for those that currently have coverage and ok for those that don't. However, don't be fooled into thinking you will get the same level of care that is available now. And don't be fooled into thinking we do not have the best care in the world now. WE DO, but WE WON"T if this gets passed. Once again productive members of our country will wind up paying for those that aren't.

I would suggest that those on the gov system get treated in a gov hospital with gov docs or pay the price themselves to get treated in the "private" sector facilities.

This is going to be a very expensive disaster

Jul 17 12:05 PM

[ozzy:]

One other comment, what are we going to do when we no longer have doctors worth having. Let's see, I could go to 4 years of undergrad school, 4 years of medical school(incredble hard) and 3 years of residency(possibly longer) and then get paid a nominal amount to use to try and payoff my 200k loan l had to take out to go to med school. We will no longer get the best and brightest. When that happens we are all in for a bad time

Jul 17 12:11 PM

[ozzy:]

jarco, where did you get the 85%paid for covered costs? Do you know what covered costs are? Have you looked at medicare payment schedules? You need to do some reasearch.

Jul 17 12:15 PM

[jackooo:]

Obama will save us.

Jul 17 12:52 PM

[jackooo:]

I'll vote for this government plan when all of Congress is under the same plan!! What are the chances of that happening?? Between zero and nada.

Jul 17 12:54 PM

[jackooo:]

Where does it say that the average or richer person has to subsidize other people or their children?
I do not get the dependent tax write off. I did not have the pleasure of conceiving them.
So what do I get? I get to pay for their schooling. Pay for their incarceration. Pay for their welfare. Pay for their medical care. Pay for their housing. Anddd now pay for their health insurance?
Wise up democratic congress & Obama. I would like to keep some of the change you promised in MY pocket!!

Jul 17 01:03 PM

[dilettantedude:]

this is simply ignorant. overhead expense in medicare is a bit above 3%, compared with 20% - 25% for private plans. i suppose if it actually is in terrible shape (evidence, please?), then our private pay scheme is far worse. we could easily pay for an expansion of the medicare program for all citizens with far lower overhead by using the huge private healthcare premiums we all pay today anyway.

the us is the only industrialized country in the world that would rather use its money to maintain a huge offensive standing invasion force and kill foreigners for oil, than to pay for health care and a decent education for its citizens.

next time please do try to use some facts and an intelligent rationale.


On Jul 16 11:39 AM SPOTS wrote:

> As a medicare and health care insider, I have said for 3 years that
> it was absolutely certain that Congress would create a national insurance
> plan. The reason that it assuredly will happen is that medicare
> is in impossibly terrible shape. Much worse than the people understand.
> The numbers say it will fold in 2017. But even that near date paints
> it much better than it is.
>
> So the only way out is to bury the disastrous numbers in a national
> health plan. The plan is in 2 basic stages: 1) create a national
> insurance plan funded by taxpayers 2) merge it with medicare, probably
> under the guise of saving overhead costs. 3) Use the tax increases
> to prop up medicare.
>
> To summarize: much less medical care for much more tax, for everyone.

Jul 17 01:39 PM

[dilettantedude:]

it's refreshing to see someone who doesn't indulge in the hypocrisy of claiming any of the higher human virtues like mercy or compassion for those less fortunate than you are. just keep the money and to hell with everyone else. god forbid we should pay for better schools or healthcare if it doesn't benefit us personally. much better to spend that money on ourselves for granite kitchen countertops and another 500 square feet of 'bonus room.'


On Jul 17 01:03 PM jackooo wrote:

> Where does it say that the average or richer person has to subsidize
> other people or their children?
> I do not get the dependent tax write off. I did not have the pleasure
> of conceiving them.
> So what do I get? I get to pay for their schooling. Pay for their
> incarceration. Pay for their welfare. Pay for their medical care.
> Pay for their housing. Anddd now pay for their health insurance?
>
> Wise up democratic congress &amp; Obama. I would like to keep some
> of the change you promised in MY pocket!!

Jul 17 01:44 PM

[Dr A J:]

There is no question which side of the aisle the author is on.Anyone with any intellect would not want the govt. so involved in a most important area. Is there any area where the govt. has shown they are able to efficiently manage,Social security, Medicare etc.etc. ???????

Jul 17 03:01 PM

[HerrHansa:]

Wrong plan at the wrong time. Across the country are many low wage part time and temp workers without any health insurance, and this bill would do nothing to get them insured. So their solution now is often to wait until problems are so bad they need a trip to the emergency room. This has led to emergency rooms shutting down across the US, since they are money losers for most hospitals (note: don't get seriously injured in some states, like Alabama).

Push smaller employers to provide health care, and they are more likely to push their workers to temp status, part time, or independent contractors. California already tried a few laws to increase health care coverage, and the result was an increase in temp workers, and more part time earners. That results in even fewer insured, or able to afford insurance. So once again the pressure falls onto emergency rooms.

How many part time and temp workers will go for a $5000 a year Federal Health Insurance plan? What incentive do any of these people have to adopt such a plan as long as an emergency room (and usually free service) are not too far away?

Unless some mass epidemic comes along that wipes out a large segment of low wage earners, I don't see any solution happening in the US. Emergency rooms will continue to close, and as the population increases there will continue to be fewer insured, regardless of government programs.

Jul 17 03:24 PM

[Old Rick:]

From www.ibdeditorials.com/... comes this quote from page 16 (of over 1000) of HR 3200, The Health Care Power Grab Act of 2009,

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

For dilettantedude: Give me a break! We've been paying more and more for schools and getting less and less result for the last 30 years. No one in the USA goes without some degree of health care. The poorest go to ERs, get care, and the rest of us pay the bill (the 49% who actually pay income taxes anyway). What this crock of a bill does is dumb down health care in the same manner our schools have been dumbded down, take good schooling (or good healthcare) away from the top and force everyone to a lower level, thereby achieving a long time liberal goal of "equal outcomes". I hope you enjoy your Orwelllian society Dilly. I'll be gone in a few years and you will get to pay for this mess! Enjoy!

Jul 17 04:31 PM

[Paco6945:]

A major cost factor is that many people go to emergency rooms with non-emergencies -- because emergency rooms are "free" for anyone who wants to get around paying. On top of that, emergency rooms risk getting sued if they don't dot every i and cross every t when it comes to care. Compare that with a visit to a medical clinic or a GP with a sprained ankle, a sore throat, or a cold.

There needs to be major changes in laws to shield hospitals and doctors from lawsuits when someone shows up at an emergency room without a real emergency and without the means to pay.

Jul 17 05:09 PM

[YoYoMama:]

As to your point #2, apparently you don't have a special needs child. Try getting a special needs child insured on personal health insurance.

The only way my special needs child is covered is to hide his condition and pay for ALL his care out of pocket, which requires a minimum $4,000 a year out of pocket.

As to your point #4, at this point the only way many Americans afford personal health insurance is to obtain the "catastrophic" policies. They ARE NOT in the price range you are quoting!!

My family is extremely lucky to obtain a personal health policy for $500 per month. The catch? Our deductible is $10,000, our prescription deductible is $1,000, and our son's condition is not covered. We pay $4,000 in out of pocket for his doctor's visits and prescriptions, which we must order overseas to afford them.

For this total $11,000 or so a year outlay, you see the deductibles we are subject to. We also have a policy with 20 pages of exemptions they will not pay for, which essentially renders the policy useless. Yet doctors will not see us without the insurance!!

To obtain insurance that covers everyone (including my son), we would paying about $1,200 - $1,300 a month. So it's pay one way, pay the other.

As to your #3 - One can work for food and shelter and find these necessities within one's budget. But people do not plan to have brain tumors or cancer or car accidents, or bear a child with health problems (as I have). Tragedies of health are not something we "work" towards, and one cannot possibly fathom the costs when they happen.

I pray to God you don't have that attitude if you fall victim to cancer or an accident and can't afford the care you need to keep you alive.


On Jul 17 11:38 AM Paco6945 wrote:

> 1. There is a difference between health care and health insurance.
> If health care costs were equivalent to food costs, no one would
> be talking about health insurance. Do we need hunger insurance?<br/>
>
> 2. Generally, children and young adults (under 30?) don't need much
> health care. If you don't believe me, price out individual health
> insurance for a 10 year old. There are exceptions, but that's the
> point.
>
> 3. Health care is not a right. Neither are food and shelter.
>
> 4. Auto and home insurance are typically of the "catasrophic" nature.
> $500 deductible for autos; $2500 deductible for homes. No such thing
> as co-pay (except 80/20 on home insurance for major losses) Why?
> Because I share the risk with my insurance company, my premiums are
> lower. Health insurance should be the same. $5,000 deductible. Premiums
> would be in the $150-$200 per month range.

Jul 17 05:39 PM

[YoYoMama:]

We need not get our knickers in a twist over "subsidizing" the poor and sick. Your current health policy does that already.

Where do you think the insurance company gets the money to pay for the sick and injured? From the ones who are healthy and don't make policy claims. When the policy claims exceed the money they get in, they jack up their rates for everyone - not just the poor and sick.

This is how insurance works. So why are we getting in a lather?

On Jul 17 01:03 PM jackooo wrote:

> Where does it say that the average or richer person has to subsidize
> other people or their children?
> I do not get the dependent tax write off. I did not have the pleasure
> of conceiving them.
> So what do I get? I get to pay for their schooling. Pay for their
> incarceration. Pay for their welfare. Pay for their medical care.
> Pay for their housing. Anddd now pay for their health insurance?
>
> Wise up democratic congress &amp; Obama. I would like to keep some
> of the change you promised in MY pocket!!

Jul 17 05:45 PM

[YoYoMama:]

Please copy/paste the portion in the bill about "forced" abortions.


On Jul 17 01:46 PM RECON605 wrote:

> H.R. 3200 is UNCONSTITUTIONAL.
>
> Write your Congressmen/women to vote NO against this bille as it
> infringes on our constitutional rights to free choice.
>
> Also, there is ahidden portion of FORCED ABORTIONS in their agenda.
>
>
> Definitely not a free choice system.

Jul 17 05:47 PM

[YoYoMama:]

RE: schools

Actually, I'm here in Texas, and our public schools do a fine job of educating our children. It's because the Texas goverment mandates standards for the schools (TAKS), tests the students yearly on these standards, and publishes the reports on school performance yearly, giving parents the option of moving to districts that perform better.

Government can do well, or do ill, and it's best not to generalize, as education efficacy is determined state by state.


On Jul 17 04:31 PM Old Rick wrote:

> From www.ibdeditorials.com/...
> comes this quote from page 16 (of over 1000) of HR 3200, The Health
> Care Power Grab Act of 2009,
>
> "Except as provided in this paragraph, the individual health insurance
> issuer offering such coverage does not enroll any individual in such
> coverage if the first effective date of coverage is on or after the
> first day" of the year the legislation becomes law.
>
> For dilettantedude: Give me a break! We've been paying more and more
> for schools and getting less and less result for the last 30 years.
> No one in the USA goes without some degree of health care. The poorest
> go to ERs, get care, and the rest of us pay the bill (the 49% who
> actually pay income taxes anyway). What this crock of a bill does
> is dumb down health care in the same manner our schools have been
> dumbded down, take good schooling (or good healthcare) away from
> the top and force everyone to a lower level, thereby achieving a
> long time liberal goal of "equal outcomes". I hope you enjoy your
> Orwelllian society Dilly. I'll be gone in a few years and you will
> get to pay for this mess! Enjoy!

Jul 17 05:53 PM

[lorddarley:]

A main flaw in our system is inequality. The tax breaks and pricing of of medical care are prejudiced in favor of those who are in large groups, and who do not buy individually.

Let's first start with the tax inequality. If you work for a company that provides insurance, you pay no income tax or employment tax on the company share of the premium, or on the portion you pay (assuming there is a 125 plan at the company). It's a great deal for those lucky enough to have those jobs.

If you are self-employed (like a guy thrown out of work who is struggling as a "consultant"), you are screwed. First, the amount you pay for your policy is taxable for self-employment tax purposes. That is a non-deductible 15.3% add-on to your insurance cost. Also, if your consulting practice is not making money, the insurance is not deductible against your other income (like withdrawals from an IRA while you are trying to get back on your feet) except to the extent your overall medical costs exceed 7.5% of your adjusted gross income.

So the little guy, who doesn't have that great job with a big company or a government, pays more taxes. It gets worse. If he or she tries to go without insurance, here's what happens. Get sick, and the hospital will charge three times what it would have charged if you had been employed in a well-managed group, or if you had been in Medicare, which negotiates low rates for its large group.

The effect of unfair tax law, and unfair pricing prejudiced against individuals, is at the heart of the problem. If we could self insure, and get the same tax breaks and pricing, I (and many others) would drop insurance in a minute, and we would then get some market discipline in this abused sector of the economy.

Jul 17 08:03 PM

[W.E. Heasley:]

Assume for a moment that the Economy is your vehicle. Your vehicle has a leak in the radiator and two flat tires. Do you fix the vehicle so you can get to work? Or do you immediately put a new roof on your house?

What in the wide, wide, world of sports does Carbon and the Health Care Industry have to do with how we got into the current recession and how we get the Economy back on track?

The published unemployment rate is 9.5%. Add in the self employed and contract labor, then the real rate of unemployment is 15%.

Unemployment is the vehicle that needs repaired. We don’t need a new roof.

Jul 17 10:09 PM

[vloscomp:]

I like your reasoning, but what is the alternative for the self-employ that can not get insurance because of "pre-existing condition" (and that include obesity). I want to know what is your solution for them.

Currently, those individual goes to the ER and the tax payer picks up the bill. I am guessing that you favor the "equality" of the current system.


On Jul 17 08:03 PM lorddarley wrote:

> A main flaw in our system is inequality. The tax breaks and pricing
> of of medical care are prejudiced in favor of those who are in large
> groups, and who do not buy individually.
>
> Let's first start with the tax inequality. If you work for a company
> that provides insurance, you pay no income tax or employment tax
> on the company share of the premium, or on the portion you pay (assuming
> there is a 125 plan at the company). It's a great deal for those
> lucky enough to have those jobs.
>
> If you are self-employed (like a guy thrown out of work who is struggling
> as a "consultant"), you are screwed. First, the amount you pay for
> your policy is taxable for self-employment tax purposes. That is
> a non-deductible 15.3% add-on to your insurance cost. Also, if your
> consulting practice is not making money, the insurance is not deductible
> against your other income (like withdrawals from an IRA while you
> are trying to get back on your feet) except to the extent your overall
> medical costs exceed 7.5% of your adjusted gross income.
>
> So the little guy, who doesn't have that great job with a big company
> or a government, pays more taxes. It gets worse. If he or she tries
> to go without insurance, here's what happens. Get sick, and the hospital
> will charge three times what it would have charged if you had been
> employed in a well-managed group, or if you had been in Medicare,
> which negotiates low rates for its large group.
>
> The effect of unfair tax law, and unfair pricing prejudiced against
> individuals, is at the heart of the problem. If we could self insure,
> and get the same tax breaks and pricing, I (and many others) would
> drop insurance in a minute, and we would then get some market discipline
> in this abused sector of the economy.
>

Jul 18 01:25 PM

[think4myself:]

If this plan is so wonderful, then our elected officials should adopt it for themselves. Then I would start to believe it is a good idea for the rest of us. Until them I have to believe it is just another Washington power play.

Jul 18 11:38 PM

[sue brannan:]

Name me one federal program that has been right for the tax payers of this nation. Government stuck its finger in the farming pie and ruined small family farms, medicare is a mess, now they want to tell us when and how much we can be sick and how much treatment we can have.

Jul 25 01:15 PM

[sue brannan:]

NO, congress will not adopt it for themselves, they have medical care for life and will do nothing to change that perk!


On Jul 18 11:38 PM think4myself wrote:

> If this plan is so wonderful, then our elected officials should adopt
> it for themselves. Then I would start to believe it is a good idea
> for the rest of us. Until them I have to believe it is just another
> Washington power play.

Jul 25 01:18 PM

[vloscomp:]

Allow me to name a few for you: 1) the DOD created the internet 2) the NEC made nuclear power possible 3) the PBS and NPR did and do a wonderfull job of reporting unbiased information 4) the DOT manage the roads that you drive on every day (shocker ain't it) 5) the Federal Reserved had and doing a great job (lol) 6) the EPA is making sure that my childrens, childrens will have a clean earth (snuf ...)

I am not defending government spending or mismanagement, but the US government is for the people and by the people. There are times that they will make mistake, but they have to try to improve otherwise we are doomed. I want the HC plan to fail or succeed on its own merit and not by speculators and lobbyist who opposed it just for the short term gain.


On Jul 25 01:15 PM sue brannan wrote:

> Name me one federal program that has been right for the tax payers
> of this nation. Government stuck its finger in the farming pie and
> ruined small family farms, medicare is a mess, now they want to tell
> us when and how much we can be sick and how much treatment we can
> have.

Jul 25 08:44 PM

[bigolfascist:]

It isn't what the Progressives want. They want total control from cradle to grave. They don't care about private insurance; it is their goal to wipe it out. They are using the "frog in a pot" approach. If they wanted to give the uninsured the same health care as Congress they could. It's called the Federal Employees Health Benefits (FEHB). It's a group program. ALL Federal employees and retirees are covered under it if they elect it. There is no "Gold-Plated" health umbrella as stated in the propaganda. There are various carriers, and one selects the level of coverage under each program, and pays accordingly. All the government would have to do is enroll the uninsured and underinsured in this program, then walk away and let the system work. They don't want to. They wouldn't be able to control every aspect of your life: what you eat, what you drink, how much you weigh, what your BMI is. All this is related to "cost reduction", just like the "End of Life" section. The SHHS is going to decide on "end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life
sustaining treatment." So...the State decides when and how I go out, huh? This portion must have been written by Ezekiel Emanuel, Rahm's brother. Let's make genocide a family affair.

The introduction to the bill:"To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes." Those "other purposes" concern me.


On Jul 17 09:07 AM 291442 wrote:

> Here is where this needs to go:
> 1) Affordable health insurance should not be contingent upon an employer.
> This leaves a lot of room for the insurance industry to figure out
> comprehensive coverage at a significantly lower price than today.
> Note...none of this catestrophic crap that may save your house if
> you are laid up with cancer or a transplant.
> 2) Eliminate pre-existing clauses. This is just a way insurance plans
> game the system and deny coverage to those who are sick and need
> help.
> 3) There has got to be a way to control prices. While I would be
> cautious with regulating prices, there may be no other way. I would
> start with making pricing and pricing practices very public. There
> is extensive gouging especially from hospitals on outpatient services.
> Somebody's ox will be gored here...so be it.
> 4) Get doctors back to doctoring and not searching for ways to get
> richer. Enforce Stark provision that prohibit MDs from self-referal.
> There are too many ancillary service businesses where MDs have ownership
> and refer their "sick" patients.
>
> There you have it. Make insurance available to all through affordable
> plans. The insurance companies would have a large pool of enrollees.
> Control costs first by making consumers aware, and then by regulation
> if that fails. Enforce existing laws...get mds back in the business
> of doctoring the sick.

Jul 26 10:46 AM

[noczarbama:]

Seems to me that the dems were spewing that it was the GOP that was trying scare tactics on seniors, now the GOP is using shock n awe (Nancy Paleseshutups' comment). Well, wake up America. Obama said Change you can believe in. And he meant it. We are losing more and more of our freedoms each day as Americans. Republicans protecting the rich has become a walk in the park compared to the selling out of the middle class by Barack. This health care "reform" along with the cap and trade will be the end. Ever wonder why or HOW Mr. Prez can get away with having CZARS( that are under NO regulation) do his dirty work FOR him. Czar....sounds a little facist to me.
Barack keeps trying to put the blame on Bush for his "inherited" economic problems, but adding this astronomical additional debt to it doesn't sound like sound fiscal handling to me. I have faith that there are still enough fellow Americans that are unlike blue dog Dems, those who will stand up to Obama, and not fall to their knees under pressure. Makes one wonder what he has on them to make them cowtail to him. I'm hopeful that come next election time that voters will vote these cowards out.
Do you see people running to Canada or other foreign countries for health care? I thought not. Take action America. Illegal aliens are getting your social security and democrats are willing to give them more of YOUR hard earned money. My father had his guts blown out in WW2 and died at an early age. He never got all his benefits nor did his own children. But the politicians in this country are willing to give it to illegals and smile while doing it. Let's do all we can to stop them, and take this country back. We are on the brink of losing this country, and it may soon be too late. Our Constitution has been totally forgotten by Washington, and no one holds these politicians feet to the fire. Phone your elected officials, and then let as many politicians in each state you can know of your objection to this health reform of Obama and the dems. You'll find out it's really that serious if you delay in letting them know.


On Jul 17 11:06 AM Howard_T wrote:

> My question is, "Why is the Obama administration in such a hell of
> a hurry to get a bill passed?" It appears to me that taking our time,
> looking dispassionately and carefully at all the alternatives, and
> only then coming out with a viable and affordable plan is our best
> course. Instead, we are being pushed, prodded, panicked, and propagandized
> into sipping from this kool-aid vat. The old saying is that if you
> want something badly, that's exactly how you will get it - badly.
> Is the current administration in a hurry to get the parade over with
> before we discover the true nature of the emperor's wardrobe?

Jul 31 11:41 PM

[unnerved:]

Everyone complains, everyone in Congress points to the escalating cost of healthcare and the fact that it runs at 17%GDP and is rising each year. Others in this report are correct. This bill is an attempt to hide and shift the failure of Medicare and the pending disaster. No one talks of the real cost of healthcare expenses in the USA.......The Federal Government. The Fed is the single largest employer in the Unite States. No one looks at the cost of the cadillac heathcare shared by members of Congress, their staff and aall federal employees. Not withstanding the elevation of such benifits under continuing and newly negotiated contracts. Benifits that are the best in the world. Now!!!...let's understand that this group of individuals are exempt from this legislation. (Can you figure out now, why the unions support this measure). So tell me, where is the savings and how will the goverment bring down costs for the rest of us when it has no intention of ever raining it itself and the benefits enjoyed by themselves. We should all understand that when mice are in charge of guarding the cheese factory.......well you should know the rest. Lead by example, or step aside.


On Jul 16 02:34 PM bricki wrote:

> Thank you for the good summary.
>
> Unfortunately I think we are in a position where there are no good
> alternatives. Medicare is in a impossible financial hole. Costs for
> the existing system are running at 17% of GDP and are growing faster
> than inflation and at the same time are delivering sub standard care
> if your standard is measurements like longevity and mortality rates,
> rather than the ability to have the latest MRI technology at every
> street corner. What we have now is not competitive to the better
> plans in place in the nations we are competing with, and it will
> continue to get worse.
>
> Serious reform IS needed and now at least somebody is stepping up
> to the plate and giving it a try. I am sure mistakes will be made
> in this process and there will be unintended consequences. But to
> do nothing is also a decision, and a decision that I think would
> a very bad one for this country.

Aug 09 08:38 PM

[Smonster:]

Unfortunately, 98% of the commenters on this blog have not read the proposed hc report. More facts are missing than are present, and most of those present facts are distorted. But, I guess everyone is entitled to their opinion. It would be really beneficial if each and every American could sit down with the designers and builders of this hc proposal, and have the entire thing explained in simple terms, without any political slant. ThaT is what we should all demand of our representative politicians, and immediately. Then we could all discuss the pros and cons of the proposal.

Aug 11 11:20 AM

[mickeysix:]

"It would be really beneficial if each and every American could sit down with the designers and builders of this hc proposal, and have the entire thing explained in simple terms, without any political slant."

that's the problem with a bill this big: you can't get a complete AND fair picture of the legislation that way especially from politicians. that's why i've decided to bite the bullet and read the entire thing for myself. (pray for me.)

so far, i'm not overly impressed, but then again most of the first title of the bill is given to definitions and outlining of responsibilities. really interested to read more and cross-reference all the myriad sections of the bill, and see it finally take shape in my mind.

i must admit, i'm not optimistic that i'll end up happy.

Aug 18 08:44 PM