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Author Topic: Senate Health Care Bill
whitefire
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We talk a lot about getting insurance companies to compete, but when, for example, was the last time you saw a commercial for a real insurance company (Blue Cross, etc) on tv advertising "rates starting at $99/month"?
Especially targeting the young?
Maybe the employer based system makes this not cost effective enough, I don't know.
I think they could provide plans for young folks without jobs providing insurance relatively cheaply (I'm 26 and have a high deductible plan that runs $75/month each for me and my wife so I know its possible).
Imagine the problems that would be solved if there was a huge push by insurers to sell to 18 year olds. Many pre-existing conditions wouldn't be, early prevention would be a way of life, and people could choose their doctors, get to know them, and not have to worry about loosing them if they get another job.
I also wonder if you wouldn't end up with good/longtime customer benefits like you get with other insurance?
My point is considering you can get a decent plan for less than the cost of most folks cell phone bill, where's the need for the mandate, and why isn't this happening already?

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MattP
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quote:
My point is considering you can get a decent plan for less than the cost of most folks cell phone bill, where's the need for the mandate, and why isn't this happening already?
Because, as you've said, those plans are only available to the young and healthy. Get sick with anything but the most mundane occasional illness and any lapse in coverage leads to you being uninsurable. The young and sick start out that way. If a once-sick child's parents ever let their insurance lapse (if they even have it in the first place) then they are out of luck through no fault of their own. People that have chronic illnesses can't necessarily afford the deductible of the high deductible plans.

In other words, there are a lot of cases that simply have no options under the status quo system. Additionally, even if you think your current plan is adequate, insurance rates are trending up at 10-20% a year. That $75/month will double in five years while salaries likely continue to stagnate.

I also have doubts about how decent your plan can be at $75/month. I know my insurance over ten times that, though it is a "premium" employer-paid plan. How much is your deductible? What is the yearly/lifetime maximum payout? Which insurance company is it and what is their record for denying services? Do they have broad prescription support or do they only pay for a limited set of generics? Is that $75/month guaranteed for life? How much does it go up after you have a major illness?

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Pyrtolin
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Here's a good note on other cost control measures in the bill to help keep some downward pressure on the insurance companies, above and beyond the normal market forces that come into play when you can comparison shop and pick the best price/service offerings:

quote:
That's the market's solution to this problem. But the exchanges actually have a fail-safe solution, too. Rewind the tape to BCBS's decision to jack up premiums. Imagine that BCBS insures 420,000 people in California's exchange. As directed by law, they duly submit a notice to the Exchange Board saying they're increasing premiums. The exchange sends a letter back noting that underlying health-care trends don't justify that increase, which they're allowed to do under the law. BCBS says it doesn't care. The exchange, which doesn't much feel like being bullied, says fine, you're decertified. BCBS loses more than 400,000 customers, and has to reapply the next year.

And then, of course, there's the excise tax. Jack up your prices enough and suddenly you're paying a 40 percent surtax on the plan you're offering. Now you're way more expensive than the competition, and you're hemorrhaging customers.

(From: http://voices.washingtonpost.com/ezra-klein/2009/12/can_insurers_use_monopoly_pric.html
In general Ezra Klein has had some very good coverage of what's going on in the bill and how it's system will work)

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whitefire
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Matt -
To answer some of your questions. As I said, its a a high deductible plan ($2400/year), but for an additional $100/month/person I can upgrade to no deductible, with a $30 copay for all doctor visits and procedures. Its through Blue Cross, and has no lifetime limit, and the prescription coverage is average. My rates have only gone up $5/month for me, and in fact (due to recent law changes) have gone down for my wife over the last 3 years.
Mine is a version of the plan that is the preferred plan for CSX Railroad employees, and based on their experiences I have heard of no major record of denying service. Of course, they have the Cadillac version.
My point is if we got everyone buying into the system early many of the uncertainties of how much premiums will go up will be mitigated. Just like with life insurance - start earlier get better rates since they have longer to use your money when you're not sick.
Another thing I like is the HSA. Employers have the ability to contribute to it directly. Meaning you could keep you insurance even if you change jobs and all that might change is the contribution amount.
As for your other comments, no insurance, save life, has rates guaranteed for life, and I have always doubted the value of those $500-1000 per person plans. If employees had to pay those costs directly, weighing that with the cost of paying some or most of their regular care themselves, I doubt very much those plans would continue to be so pervasive. Maybe that means that my cheap coverage would get more expensive, but I doubt how much because people would demand a low cost plan. If we could get away from a system that is near exclusively employer based we'd see some real competition.
My simple question is why was all this information so hard to find?
If the exchanges made it simpler that would be great, and I might support that idea. For now, I think that insurers have no incentive to promote their products directly to individuals.
My thought is instead of mandating coverage maybe we need to make it easier for individuals to get out of their employer based systems, and either let the market take over (in the form of advertising, etc) or if that fails, set up an exchange program.

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FiredrakeRAGE
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I would think that one major healthcare improvement would be to require that businesses give 'healthcare' money directly to the employees, who could then opt-in to the company healthcare plan. Divorcing businesses from the insurance industry would do more for competition and lowering prices than anything else I can think of.
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JWatts
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I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

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Pyrtolin
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Here's couple of pieces that should also please a few more folks here:

http://feeds.voices.washingtonpost.com/click.phdo?i=05eee275aa8ee90a7242fe0e48874fcd

States can ditch the individual mandate, and many other parts of the new system, if they can achieve equal or better results in other ways:

quote:
The waiver was inserted by Ron Wyden and it gives states considerable flexibility to walk away from parts of the bill if they believe they can better address cost and coverage on their own. The legislative language itself is complicated, but during the Senate Finance Committee's mark-up, Wyden clarified it with the committee's counsel. "My reading of what we have in the bill now," Wyden said, "is if a state can demonstrate that they can meet the criteria -- particularly on cost containment, improving the delivery system -- they can do it without an individual mandate. And can I ask, counsel, is that a correct reading of the Waiver Amendment that I offered?"

Counsel's reply was one word: "Yes."

Also:

http://feeds.voices.washingtonpost.com/click.phdo?i=3db468cbbc74c967efb3d12a63fb560c

States can opt to allow insurance companies to cross their borders:

quote:
The legislation allows states to form voluntary compacts with one another. California and Oregon, for instance, could decide that they want to allow insurers to offer products across both states, as that means a larger market for insurers to chase and thus more leverage for the California/Oregon exchange.

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Pyrtolin
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Oh and:

http://www.bobcesca.com/blog-archives/2009/12/the_sanders_ame.html

quote:
Bernie Sanders has successfully added $10 billion for primary care. Some details:

-Forgives medical school debt for doctors who choose primary care, increasing the number of primary care doctors by 20,000.


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G2
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quote:
Forgives medical school debt for doctors who choose primary care, increasing the number of primary care doctors by 20,000.
no wait .... 500,000 ... no, 1,000,000 ... yeah, that's the ticket. If we're just gonna throw out made up numbers, let's make'em big! [Roll Eyes]

Hey by the way, according to this made up number, we could expect 20,000 new medical students. We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? That's right, the price goes up. It's okay, shout it out when you know the answer.

How much will it go up? As much as the market will bear of course. When you'll never have to pay for the cost of medical school, how much can a medical school charge you before you think it's too much? $100,000 a year? $500,000 a year? Maybe a million? What the hell do you care? You don't even need to see a bill. Go to med school, go to primary care and you're free and clear. This little idea virtually guarantees soaring costs for medical school students as it distorts the market beyond rationality.

Freaking brilliant. Just freaking brilliant. [Roll Eyes]

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Pyrtolin
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" We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? "

Or facilities expand so that supply can meet demand. Also, this didn't say total doctors- so some portion of those would be people who would have otherwise gone into more profitable but less necessary specialties going into primary care (which would implicitly bring down the need for specialists as well.)

Medical schools still need to attract students that won't be planning to apply for such relief as well, so this comparatively small amount isn't going to affect much in any case.

Tuition inflation in general is a separate problem that does need to be addressed though, as many such institutions use a lot of hand waving to milk the system or gain the prestige associated with higher price tags. I'd like to see a .5% or 1% tuition tax on all institutions that use aid programs as an incentive to keep them more honest in their pricing so that jacking up rates then selectively using internal scholarships to effectively reduce it for those that can't pull in external aide actually costs them something.

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G2
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quote:
Originally posted by Pyrtolin:
" We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? "

Or facilities expand so that supply can meet demand.

Expansion of medical schools? That has not been happening and there's no reason to believe this legislation will drive that.


quote:
Originally posted by Pyrtolin:
Also, this didn't say total doctors- so some portion of those would be people who would have otherwise gone into more profitable but less necessary specialties going into primary care (which would implicitly bring down the need for specialists as well.)

There is no proof of this assertion, implicit or otherwise.

quote:
Originally posted by Pyrtolin:
Medical schools still need to attract students that won't be planning to apply for such relief as well, so this comparatively small amount isn't going to affect much in any case.

There are about 67,000 medical students in the US. This is not a "comparatively small amount" they're talking about. It will most certainly affect the entire medical school structure.

quote:
Originally posted by Pyrtolin:
Tuition inflation in general is a separate problem that does need to be addressed though, as many such institutions use a lot of hand waving to milk the system or gain the prestige associated with higher price tags. I'd like to see a .5% or 1% tuition tax on all institutions that use aid programs as an incentive to keep them more honest in their pricing so that jacking up rates then selectively using internal scholarships to effectively reduce it for those that can't pull in external aide actually costs them something.

The problem is artificial manipulation of the market and your solution is even more artificial manipulation. When you're digging yourself into a hole, the first step is to stop digging.
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munga
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Pyrt,

Wouldn't it be great if the bill passed before Christmas?

Or, alternatively, think how monstrous the republicans will look, for denying people medical care over Christmas. It's a hollow victory but a victory still.

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Pyrtolin
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The Senate bill will be done, one way or another on the 24th (unless the Republicans stop playing absurd procedural games just for the sake of drawing out the process) Then the bills need to be consolidated into one and pass both chambers again; even if the House was going to rubber stamp the Senate bill, we'd need them to come back into session first.

We'll have the next step in the process by then at least, though.

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kmbboots
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quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
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munga
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I mourn the losses to this bill, and yet hope the modified thing gets through somehow.
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Pyrtolin
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quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
They're non-profit, and the rates are negotiated using the weight of the current government risk pool. It's definitely not Medicare +5% or anything as powerful as that, but it's more like a slice of toast, maybe with some butter, in comparison to the sandwich.
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JWatts
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quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. T

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
My point was in regards to the finally offering insurance across state lines. I've always believed that the restricting policies to state by state coverage did great harm to competition and ends up with higher payer premiums.

As for the phrase "Instead of a public option", you'd have to ask the Washington Times. I'd imagine that it was part of the horse trading to get the bill through the Senate. i.e. some senator said I won't vote for a public option plan and another senator said I won't vote for it without a national insurance policy option.

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Pyrtolin
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quote:
Originally posted by JWatts:
My point was in regards to the finally offering insurance across state lines. I've always believed that the restricting policies to state by state coverage did great harm to competition and ends up with higher payer premiums.

Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

You should like even better the provision that allows states to agree to allow full interstate competition on an individual basis so that they have the needed control to ensure that their standards are met.

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cb
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The vote to end debate passed in the dark of night, made possible by your money and mine being used to bribe, conjole and influence votes. So much for Obama ushering in The Most Transparent Administration Ever and The Most Ethical Congress ever.

So many of you wanted this 2000 page monstrosity and...for all intents and purposes...you've got it. Now be prepared to be told when to jump and how high. The federal government will now have complete largess in telling us how to live our lives since they now have total vested interest.

Once Cap and Trade (or some other kind of eco-nonsense similar to it) is passed these same caring bureaucrats will be able to come into our homes and tell us what temperature to keep our homes, how much water we can use and, eventually, even where we can live; all in the name of "global warming".

What a lovely Brave New World we have before us.

[ December 22, 2009, 11:36 AM: Message edited by: cb ]

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kmbboots
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
They're non-profit, and the rates are negotiated using the weight of the current government risk pool. It's definitely not Medicare +5% or anything as powerful as that, but it's more like a slice of toast, maybe with some butter, in comparison to the sandwich.
Ah...I didn't understand that the private firms mentioned where [i]non-profit[i] private firms.

cb, "we" didn't want a "2000 page monstrosity". "We" wanted a fairly simple public option or, better yet, single payer. "We" got a 2000 page monstrosity because of all the people who didn't want what "we" wanted.

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Pyrtolin
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Keep in mind that 2000 pages represents a lot of formal overhead because its written as amendments stacked on top of amendments and the like, rather than one finalized document.- the final bill when consolidated is likely to be about 400 pages.

(And about half of that is devoted to assorted cost control pilot programs that don't get much press because the CBO didn't rate them as their overall effectiveness was, as yet uncertain.)

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Pyrtolin
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quote:
Originally posted by cb:
The vote to end debate passed in the dark of night,



Nice use of incidental timing to connote shady business, when it was really just a logistical necessity because of procedural obstructionism.

quote:
made possible by your money and mine being used to bribe, conjole and influence votes.


AKA standard negotiation that has always been part of the process. The only shame there is that only one party was even willing to work out compromises to get something done; the Republicans' only goal here was to make sure that nothing happened.

quote:
So many of you wanted this 2000 page monstrosity and...for all intents and purposes...you've got it. Now be prepared to be told when to jump and how high. The federal government will now have complete largess in telling us how to live our lives since they now have total vested interest.
If by that you mean that now people will take a much more active interest in future healthcare reforms because we'll all be seeing the full costs, you're right. Now that the matter is acutely on the table, we won't be able to get away with ignoring the more fundamental problems for a decade and a half at a time, has has been the trend over the last half century or so.

quote:
Once Cap and Trade (or some other kind of eco-nonsense similar to it) is passed these same caring bureaucrats will be able to come into our homes and tell us what temperature to keep our homes, how much water we can use and, eventually, even where we can live; all in the name of "global warming".
And now you've left any form of apparent logic behind and just seem to be reciting fantasies designed to appeal to confirmation bias and scare people despite having not grounding in the real world.
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JWatts
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quote:
Originally posted by Pyrtolin:
Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

That's a completely unproven assertion that has no basis in reality. The Credit card companies migrated to the state that taxed them the least and didn't cap their rates aka "Delaware".

Every credit card company must still abide by the laws of the state a customer lives in. Have you never even read a credit card contract? They have all kinds of exceptions for various states.

So your argument is flat out wrong and even the example you state is flat out wrong.

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Pyrtolin
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quote:
Originally posted by JWatts:
quote:
Originally posted by Pyrtolin:
Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

That's a completely unproven assertion that has no basis in reality. The Credit card companies migrated to the state that taxed them the least and didn't cap their rates aka "Delaware".

Every credit card company must still abide by the laws of the state a customer lives in. Have you never even read a credit card contract? They have all kinds of exceptions for various states.

Some secondary conditions business conditions, sure, but as you note above, Delaware and South Dakota got most of them, because the were able to use local laws to skirt the usury lays in other states and ignore local State caps on interest rates. If those other regulations had been seen as equally important they could easily have spent the legal fees to get them officially loosened as well under the precedent they already had in their favor.
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