Politics Obamacare

Now, what is covered, as 'minimum coverage' I'm not sure.

So, I have to have insurance at $600 in 2014, $1200 in 2015, and $1500 in 2016. My current plan costs my employer and I $3200, so I am OK.

If you are broke and you need insurance, I think there are ways to get something now, and if you do get a job later, it will have to cover your previous illness.


I'm not sure all the people without are cheering this. A lot of them were pocketing that $1000-$2000 a year and hoping they didn't get sick. Some needed the money, others wanted to get a new HDTV.

I'm not sure why there are a lot more people who aren't huge supporters of this. Going to town hall meetings, parades, bumper stickers. If some company screwed me out of it because they only hire 'part-time' workers, or if I had a per-existing condition, or no money to pay.

 

There is no expectation that everyone will be covered. Best estimates are that maybe 25 million out of the current 40+ million w/o insurance would be covered....3-5 million of those are young adults who can now stay on parents plan until they are 26.

Of the 20 million expected to buy insurance, more than 60% would be subsidized at some level (which is reasonable considering that those 250+ million on employer plans are subsidized by employers. The key is to bring more young, healthy (low risk) consumers into the insured market by offering several levels of insurance at different rates through Insurance Exchanges where companies compete for consumers (unlike the mostly closed system in most states). This provides the incentive to insurance companies to be able to cover pre-exisiting conditions, etc. for everyone.

The biggest source of revenue is the .9% tax on medicare for those with wages over $200k (which also seems reasonable to me, given that they dont pay any FICA tax over their first $108,000 in income); the tax also applies to investment income and these additional medicare taxes would generate $several hundred billion over ten years.

There are also new taxes on medical devices, tanning salons (John Boehner would likely pay more for his year round tan) and other business related taxes, generating another $100 billion over ten years.

There is also a savings of $500 billion in medicare over ten years by making the Medicare Advantage program more competitive (not paying the few providers more than 8-10% over what the cost would be if provided directly by Medicare). This has been grossly abused by the MA providers who now receive close to 15% over Medicare costs and more competition would drive the cost down w/o eliminating services.

Cost to consumers currently w/ insurance would be constrained through the new 80/20 or 85/15 loss rations (80/85 percent of premiums must be for patient cared and related services depending on large employer plans v individual consumers - only 15/20 percent for admin costs and profits). This year alone, more than 3 million consumers will receive more than $3 billion in rebates from insurance companies that have overcharged.

Those are the high points as I understand them. It has to be complex because one provision wont work w/o the other (eg you can get pre-existing conditions covered w/o providing a larger, less risky pool).

It certainly is not an ideal solution and would require alot of tweeking, but IMO it is a reasonable first step in the right direction ultimately leading to a single payer system (we cant get there from here w/o some type of intermediate steps like these).

last thought
In the long run, health care costs are brought down through a greater focus on preventive care (no co-pay), eliminating redundancies in testing (you should not have your primary care physician ordering a blood test for you and then sending you to a specialist who will then also order a blood test), greater competition through the Insurance Exchanges and MA reform, the investments in health technology in the bill, etc.

 

Next question:
Who is going to oversee these changes? Some current department, or will an entirely new one need to be created?

Preventative care is entirely in the hands of the individual. Having insurance will get some people to change, but most won't. Poor food choices and a sedentary lifestyle contribute more to the cost of health care then anything. This is not an insurance issue.
In addition, preventative care is effective only if people get to see their physicians regularly. Getting a doctors appointment isn't going to get any easier just because you have insurance.Not being able to get in to see the doctor leads people to the ER, which is the most expensive part of health care. Just greatly reducing that alone would save a fortune. Another great place to reduce costs would be prescription medication. Insurance companies shouldn't have to foot the bill for Big Pharma's profit margins. If meds were more affordable, there would be fewer hospitalizations.

Redundancies in testing isn't going away. There have been too many cases where something serious was either found, or disproved, by redundancies. No physician is going to skip this step if for no other reason than it leaves them wide open for a lawsuit.

 

I disagree. I have to see a doctor next week and had to see my general doctor and had a CT scan last week. Each place asked for my health insurance card right up front. They didn't ask "how would you like to pay for this?" Or "do you have insurance or no insurance?"

If I didn't have insurance and didn't care about the expense, I would have had to go to the ER last Saturday. But the proper thing to do in my case was to see a regular doctor during business hours and get a prescription.

My two medicines were $18.31 and $0.00. I didn't have my prescription insurance info and I'm not even sure if I have any to be honest.

I don't know how much the CT scan was. Nor, do I know how much any of the doctor visits will be. I don't have any co-pays with my HSA type plan.

 

As I understand it DOH will oversee.

As for "Poor food choices and a sedentary lifestyle contribute more to the cost of health care then anything" I'd add substance abuse, smoking and Alcoholism to that list. I think education and treatment can help reduce those numbers. Right now if you need D&A treatment or are obese it's highly likely your insurance company won't pay jack for it. New rules are requiring counseling and treatment for these issues.

As for your comments on people using the ER- I think if people have insurance and can see a regular Dr. ER use will drop a lot. I read a recent study that showed the US ER use is #1 in the world. I believe that's because that's the one place you can't be turned away.

 

I agree with the add ons and the education and treatment.

Insurance will pay for detox. Which ones and how much I don't know. Insurance also has high reimbursement for gastric surgeries like lap bands and stapling.

IF they can see their doctor, yes. I lost count over the years of the number of patients that told me they called their PCP but couldn't be seen for X number of days, so off to the ER they went. The vast majority of PCPs are overbooked due to an overall decrease in physicians doing primary care. (The trend has been towards specialization for quite some time now.)

You are correct about the ER. They can't turn anyone away.

 

Just when you think you've heard it all, wingnut radioman Michael Savage has a new explanation:

and Glenn Beck selling tee shirts for $30

 

Every once in a while I think I've heard it all then suddenly "Bam!" Someone comes out and says the dumbest thing I've ever heard.

 

One small, but significant, piece of the prevention puzzle is expanding access to primary care, particularly, inner city and rural areas. The ACA includes $1.5 billion in grants to build/renovate Community Health Centers. The stimulus bill included $2 billion as well (creating jobs to build these facilities) and as a result more than 3 million patients have already been served.

This is another bi-partisan idea, like many provisions in the ACA (including individual mandates; first proposed in the Republican alternative bill to Hillarycare back in 92 **). Bush funding for CHCs resulted in doubling the number of patients receiving care at these facilities.

The Importance of Community Health Centers

But to today's Republicans.....this is just another example of more western european style socialism.
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** The Individual mandate's Republican roots:

 

Great
Inner city and rural areas are severely under served.

Where is the staff going to come from to fill all these new buildings? A skeleton staff that chugs through patients like an assembly line doesn't do anyone any good.

IIRC, this bill is supposed to add some 15000 IRS agents to squeeze more money out of everyone, but I haven't heard a single thing about increasing the number of doctors and nurses.

Call me crazy, but I think the best thing this country can do to reduce healthcare costs is to get rid of the for-profit heath care system. The amount of hand wringing over the rising costs of healthcare have suspiciously paralleled the number of health care systems being bought by for-profit corporations.

 

Another provision of the law will pay med school (and nursing school) costs and/or existing loans for those who commit to working in inner cities and rural areas. Will it be enough, probably not. But these areas will be better served than they are presently.

The 15,000 IRS agents is one of those Republican false talking points (ie lies). Fact check.

This wildly inaccurate claim started as an inflated, partisan assertion that 16,500 new IRS employees might be required to administer the new law. That devolved quickly into a claim, made by some Republican lawmakers, that 16,500 IRS "agents" wouldbe required. Republican Rep. Ron Paul of Texas even claimed in a televised interview that all 16,500 would be carrying guns. None of those claims is true.​

The IRS’ main job under the new law isn’t to enforce penalties. Its first task is to inform many small-business owners of a new tax credit that the new law grants them — starting this year — which will pay up to 35 percent of the employer’s contribution toward their workers’ health insurance. And in 2014 the IRS will also be administering additional subsidies — in the form of refundable tax credits — to help millions of low- and middle-income individuals buy health insurance.​

I agree on the need to go to a non-profit, single payer system. I just dont believe it was possible to get there directly from here given the entrenchment of the current employer-based, private insured system. The political support does not exist for such a drastic change, but this is one small step in the right direction.
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If they all promise to move, I'd be willing to cede them Alabama, where the "ten commandments" judge is running for governor and where it is illegal to sell sex toys or Mississippi which has effectively closed the last family planning (including abortion) clinic in the state. And, when the next major hurricane hits the gulf coast, they can do w/o any federal assistance or financial aid.

 

as a small business owner, i can't wait to have a chat with IRS agents. two agents can't even come up with the same numbers for income taxes, healthcare should be a real treat.

i'm a contractor, can anyone give a good reason why i shouldn't just hire illegals?

cash under the table, no social security taxes, no healthcare taxes, no unemployment, etc. cost about half of doing business the right way.

yet they still can collect it all. if you can't beat them...

 

But Ron Paul's 16,500 "armed government thugs" might still come knocking on y0ur door.



"This (law) will not stand, it will be overturned."

Sorry, Ron.

 

I am not sure about your last thought above. How do you prevent the aging process? I think you can delay certain things but unless we find cures to diseases, they are going to happen. For example if we lower the instances of diabetes in certain populations, i.e. Southern males, lengthening life spans we may see increases in treatments for prostate cancer. In some of these trade-offs we may see costs go up.

Eliminating redundancy in testing as you describe, won't likely happen because a specialist is often ordering new tests to protect himself - if the specialists depends on a dated test, a test from an unfamiliar source, or a less comprehensive test is going to need to order tests anyway. Does the bill address malpractice exposure?

How is taxing medical device makers giving them a greater incentive to innovate? How is lower profit margins on prescription drugs make more money available for new, more risky research or research to benefit small populations?

Having a public option, Insuance Exchange, does not mean lower premiums - is there evidence this will happen? In education there are public and private options - costs have not gone down, the opposite is true.

Given X supply of doctors and other health care resources and now adding more people chasing those resources, to me indicates pressure for prices to go up. does the bill address getting more doctors, hospitals, nurses, medical device makers, pharmaceutical companies, etc.?

I fear this mess of a bill has put the US on the road to having worse health care.
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You misrepresent my position. My preference is a free market type solution. I also believe a single payer solutionwould be far better than Obamacare.
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In addition it is not clear to me what is to stop a person from not getting insurance subsidy or not (assuming they will have some cost) and waiting until they get sick to sign up at the last minute since they will be guaranteed coverage? What is to stop me from getting the smallest amount of coverage possible and then upgrading to a better policy if I need it?

This is a mess of a bill - there are far to many unanswered questions given how long the bill has been law.

 

Cures for diseases are found through greater investment, including govt. investment, in medical/health related R&D, like to NIH....not cutting research while increasing defense spending and permanent tax cuts for the wealthy.

Eliminating redundancies is brought about through more integrated health delivery systems, like the Mayo model, where primary care physicians and specialists actually communicate and work together to develop a course of action/testing/treatment, and Accountable Care Organizations (ACO) model for Medicare, both of which are emphasized through funding in the law.

This is the same old argument that a relatively small tax of highly profitable industries are gross disincentives to innovate and that is not the case.

Insurance Exchanges, which were another Republican supported idea not too long ago, increase competition in what is now a relatively closed market. Providers will also have new medical loss ratios that I have mentioned several times.

Your pre-determined position and bias is showing, particularly since you have stated on several occasions, you dont know whats in the law.

It is easy to be for the extremes, either free market or single payer, when neither is an option given the political realities that neither could be enacted.

The Insurance Exchanges will have an "open season" - a month or so every year where you chose your plan. No changing or adding until the next open season, like the current employer-based market.

This mess of a bill has already helped millions of people save on their health care or expand their coverage - 9 million seniors who now have lower drug costs through eliminating the medicare donut hole, 3 million young adults now have coverage through their parents plan, millions of kids with pre-existing conditions can not be denied coverage (all with pre-existing condition cannot be denied starting in 2014), lifetime limits have been eliminated (preventing the number one cause of personal bankruptcy), several $billion in rebates this year as a result of insurance company over-charges.

And in a few years, for the first time, millions more will have access to affordable care and significant choice in the level of coverage they desire - this doesnt matter, according to Sen. McConnell.

I could go on or I could highlight more of the conservative lies and fear mongering, but I know it wont change your mind. You want a perfect solution in an imperfect world and you want it through either extreme - free market/single payer - and evidently dont see the benefits above as a step to an improvement over the existing failed system.

 

And judging by this comment (the flip side equivalent would be Democrat = Socialist), you are unwilling to listen to anyone questioning the legislation.
This is a massive bill that hardly anyone read before it was passed. The talking points brought up in this thread are good ones but Conservatives have legitimate questions about this law.

Disappointing.