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The Obama Health care Budget

President Obama signs the State Children's Health Insurance Program (SCHIP) bill into law on February 4th. The bill expands coverage to an additional 4.1 million school age children.
Pieces of the health care portion of the Obama budget are leaking out.

Based upon published reports, the Obama “down payment on health care reform” will include:

  • $634 billion to help pay for health care reform over the next ten years.
  • $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
  • Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
  • Cutting Medicare HMO payments by $175 billion over ten years.
  • Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
  • Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
  • Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.

The biggest spending reduction is the cut to Medicare HMO payments. This one is hardly a risky political move as everyone has expected it. That said, in no event would they
get the full $175 billion in savings because it is simply impractical
to implement such a major change in the Medicare Advantage program by
the next enrollment season which begins late this fall.

Interestingly, the Obama budget reportedly calls for creating a system where the private Medicare plans will bid market to market
to compete with the traditional Medicare plan rather than continuing
the current system where the government tries to set the rates for them.

Ironically, that was the original Republican idea for using the competitive value of managed care to reduce long-term Medicare costs
and is what should have happened in the first place rather than this
temporary system of overpayments the HMO industry has been fighting to
keep permanent.

With $318
billion in tax increases and another $175 billion in Medicare HMO cuts,
the $634 billion "down payment" only contemplates a total of another
$141 billion in federal health care cuts <>over ten years (which amounts to about 1% of annual federal spending each year).
That is hardly a rounding error on a federal health care budget that
CMS just announced will already total $1.19 trillion in just 2009.

This week, CMS estimated that at present trends annual national health care spending would reach $4.35 trillion or 20% of GDP by 2018.

If
the Obama administration is serious about not “kicking the can further
down the road” then any overhaul of our health care system has to do
more than fritter around the edges with spending reductions.

More,
it needs to be paid for from real savings—not half of the "down
payment" coming from tax increases as they are reportedly proposing.

If
the plan is to raise taxes to pay for a big part of health reform that
just means they better raise enough taxes to pay for the $4 trillion
health care system CMS says we are going to have in 2018.

As
the budget details come out over the next few days the question we all
need to be asking is, Just what is this administration willing to do to
make health care affordable over the next ten years?Affordability
will have a lot more to do with the how this administration deals with
the $2.5 trillion we already spend every year not whose taxes we can
raise.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

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  1. I have been paying to my healthcare insurance since I start working! half of my life but’ since then I have never used it just a few times! because my husband was active military so I used the base hospital, where is that money I have been paying for?

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  3. I try to look at both sides of the issue. Basically, this law allows for health care to be more affordable for all families by placing a limit on the coast of health care services. Since the coast of health insurance is reduced by this law. This new law also states that students can be claimed on their parents’ health insurance until you are 25 years-old. The new law would also prevent insurance companies from dropping people due to new policies, which insurance companies have been known to do in the past. While health care is a good thing, there are drawbacks to this law.
    It was predicted by congress that the nation’s spending was going to increase because of this law. In order to keep up with the all of the new consumers, insurers began to eliminate child-only policies that they once held. This could lead to many children without the health care they need. Wall-Mart, who had started giving health care to part-time employees, has recently abolished this policy. The store chain insists that the new law had nothing to do with this decision, but it is public knowledge that their profits have gone down since the law was put into place.
    While making sure every person gets health care might be beneficial to low income families, it will cost insurance agencies more money. As a result, insurance agencies might have to adjust their policies to fit spending habits, such as reducing the benefits on their plans. It might be better if both sides had to make sacrifices, and not just one.

  4. hi!,I like your writing so a lot! proportion we communicate extra about your article on AOL? I need a specialist on this space to unravel my problem. Maybe that’s you! Looking ahead to look you.

  5. Aren’t all of the previous comments above about the symptoms of something much more basic? The only area of health care that has stayed at the same rate of inflation as the overall economy is elective cosmetic surgery. We must find a way to establish incentives based on market forces. But we have a public (not just a President) who are so addicted to subsidies of one kind or another, that past Republican plans such as health savings accounts and catastrophic insurance only have not gotten off the ground. The public (even the “poor” of Las Vegas) are so debt ridden that this proposal couldn’t be considered even if the public realized its merits.
    For all the rhetoric, for all the economic pain it would cost MOST of us (including me) health care costs will ONLY be controlled by MARKET FORCES. We need to be telling the American people what the real needs are to be able to control health care costs. And besides all of this, the Medical Industry enjoys the capability of developing any medical product or procedure that comes to mind, knowing in some cobbled together fashion it will be paid for. It doesn’t matter WHAT the costs are, just that they’re always paid. We wouldn’t be talking about any of this if everyone was on their own as a health care consumer. See my blog (http://www.revive-america.us/politics/obamacare/) about the BASIC issues behind all the noise about “health care reform”.

  6. Fried Chicken? Mediciad Inducements?
    The 101 Dumbest Moments In Business 2003 EDITION Whiffed pitch No. 6: blatant stereotyping. By Mark Athitakis April 1, 2003 (Business 2.0)– GRAND PRIZE WINNER, DUMBEST MOMENT OF 2002 Which leads to the question, Who is Chicken Man? & Why were whole fried chickens selected?
    In September, insurance company AmeriChoice brings trucks to blighted neighborhoods in New York City and gives away coupons for “free chickens” as an incentive for the underprivileged to switch their Medicare coverage. New York state senator Carl Kruger files a complaint with the state attorney general. The 101 Dumbest Moments In Business 2003 EDITION – April 1, 2003 Apr 1, 2003 … Just don’t tell him about the “Chinese health balls.” ….. In September, insurance company AmeriChoice brings trucks to blighted … New York state senator Carl Kruger files a complaint with the state attorney general….. Falling on his sword, Welch announces he’ll give up most of the perks,…2009 and 2010 $120,000 from your tax dollars.
    Chicken Feed? Chicken Pox?
    Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools. These checks came from AmeriChoice Health and on the surface seems like fine gifts. Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share or induce its share of the market place. This is not allowed as a use of your taxpayers dollars, yet it happens.What does it really cost the City of Philadelphia to receive this money? Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that? PS… Did the Mayor send for Chicken Man or was he approached by Chicken Man? The Mystery Widens! Can Chicken Man save the Liabraries?
    Dirty Birds? Chicken Wings Take Flight?
    CEO of AmeriChoice Health Bolts.. Was that Chicken Man? John J. Kirchner – Director, Operations John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations. Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009.
    Chicken Gate Returns? Bad Eggs?
    Will this mystery man or woman or chicken ever be caught? Will the “secret eggs” given out to housing authority officers Clinics, Doctors and whoever, make it into through that crispy crust prepared by their Home Office Line Chefs?. Will the Doctors who collected all those extra eggs for sharing thier patients recipes with the Home Office Line Chefs ever really be rewarded? Will the Great Head Chef Chicken Man or whomever that directed and approved all to avoid, overlook the rules, laws and regulations Menu, ever be really compensated for their true worth or will Salmonella remain the dish served for Medicare and Mediciad Industry.
    PS Is the Chicken Man a Blues Brothers Wanna B??? HEALTH INSURANCE COMPANY PROFITS IN 2007:A Whole lot Of Chicken UnitedHealth Group —$ 4.654 BILLION. UnitedHealth Group owns, AmeriChoice Health.

  7. THE DIFFERENCE in the law of the land AS APPLIED.
    The difference in the law as applied to a “person vs a corporation” on one hand the corporation, has a formal contract signed with the government not to break the health laws,, rules and regulations, so any violations that occur now become trivial, as well as evidence recovery denied, jury trial denied, and of course any claims submitted to the government really don’t exist. The person a doctor not a corporation, jury trial allowed, evidence gatherning allowed, of course no formal contract signed with the government his mistakes are real. The very same laws ,rules and regualtions in place apply to both but this means that any person is now screwed and must go to jail.There are a lot of lessons to learn from this unfortunately don’t violate the law is not one of them.
    It’s true that relators argued that because United Health agreed to comply with all those trivial regulations when it contracted to become a prescription drug plan sponsor,as well as sign a formal contract of compliance. The court found such a theory of liability overly broad. “If Relators’ theory were correct,the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,”the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government’s payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and they have not done so.”Turning next to relators’claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’state law claims and refused to grant relators leave to amend.
    Case1
    Fifth Circuit Ruling Affirms that Psychologists are Not immune from Fraud and Abuse Scrutiny September 6, 2010 Posted In: Compliance , Stark and Anti-Kickback By The Health Law Partners on September 6, 2010 9:13 AM | Permalink
    Dr. Sam Smith Hill, III’s 2008 healthcare fraud conviction was affirmed by the 5th Circuit on August 25, 2010 (US v. Hill, No. 09-40749 (5th Cir. Aug. 25, 2010). Found guilty in five counts of healthcare fraud by a jury, Dr. Hill’s indictment alleged that he fraudulently billed Medicaid from 2001 to 2008. Having founded a children’s behavioral clinic in Corpus Christi, Texas that provides psychological services to underprivileged children, the indictment contended that Dr. Hill billed Medicaid for services performed by his Licensed Psychological Associates (LPAs). The Texas Medicaid guidelines prohibit billing Medicaid for services not rendered by a physician. Dr. Hill asserted that he only billed for the work he performed; however, the 5th Circuit disagreed, citing Dr. Hill’s statements to FBI agents claiming “that he knew he was violating Medicaid billing rules, but that the rules were ‘wrong and immoral.'” The court, thus, found there to be “sufficient evidence from which the jury could conclude that the billing included the LPA time,” affirming the lower court’s conviction.
    While not given as much attention as other fraud and abuse violations, even mental health professionals must be aware of increased fraud and abuse scrutiny.
    For more information, please contact Abby Pendleton, Esq. or Robert S. Iwrey, Esq. at (248) 996-8510, or visit the Fraud and Abuse specialty page, the Compliance specialty page, or the HLP website.
    Case2
    FCA claim alleging aggressive marketing tactics by health plan provider dismissed
    Publication: Health Law Week
    Date: Friday, June 4 2010
    The U.S. District Court for the District of New Jersey dismissed a qui tam action brought by two former employees of healthcare plan providers alleging violations of the False Claims Act (FCA) arising from excessively aggressive marketing methods. United Health Group Inc., a provider of access to healthcare services, had as its subsidiaries AmeriChoice and AmeriChoice of New Jersey, which each offered Medicare Advantage plans. Charles Wilkins and Darryl Willis (the relators), who were each employed by United Health Group and AmeriChoice, initiated a qui tam claim against United and its two subsidiaries under the FCA alleging numerous violations of Medicare and Medicaid regulations governing administration of the Medicare Advantage plans. The complaint alleged that the defendants engaged in unauthorized and aggressive sales methods in marketing the plans — including the provision of illegal cash payments to providers to induce them to change beneficiaries to AmeriChoice and the provision of illegal kickbacks to doctors for obtaining the names of patients they could call and approach. The defendants moved to dismiss. The district court concluded that the complaint failed to identify a single instance in which the defendants submitted a false claim to the government for payment as required to prosecute a qui tam claim as relators under the FCA. Under applicable federal appellate court precedent, the absence of such an allegation was fatal to the relator’s false certification claim. The relators’ theory of liability at base was that because United Health agreed that it would comply with all Centers for Medicare and Medicaid Services regulations, and because it was at times in violation of some regulations, it committed fraud each time it submitted a claim for payment. The district court concluded that this contention confused the conditions of participation in a Medicare or Medicaid program with the conditions of payment, and would open the door to a flood of tort claims of a type not contemplated by the FCA. Moreover, the complaint failed to allege that the violation of any regulation was actually relevant to any funding decision. As a result, the complaint failed to state a claim on which relief could be granted and, accordingly, the defendants’ motion to dismiss was granted.
    Source: Health Law Week, 06/04/2010
    Copyright © 2010 by Strafford Publications, Inc. http://www.straffordpub.com / All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement. ”

  8. Beatrice Wilkinson Welters is President Obama’s nominee for ambassador to Trinidad and Tobago. No surprise, her husband Anthony Welters, is an executive with UnitedHealthGroup which brought in $200,000-$500,000 in campaign donation for the election and another $100,000 for the Obama crowning inaugural. Beatrice Welters donated $4,600 to the Obama campaign in each of the years 2007 and 2008. Her husband, Anthony donated $4,600 in 2008. The Welters’ two sons were also $4,600-donors: Bryant, reportedly 19 years old today, donated $4,600 in the second quarter of each of the years 2007 and 2008, when he was an unemployed student, and Andrew, reportedly 17 years old today, an unemployed student, donated $4,600 in the second quarter of 2008.
    http://maggiesnotebook.blogspot.com/2009/11/beatrice-wilkinson-welters-ambassador.html
    BACKGROUND*
    Anthony Welters has been President of Public and Senior Markets Group at UnitedHealth Group Inc. since September 2007. Mr. Welters has been Executive Vice President of UnitedHealth Group Inc., since December, 2006. He serves as Chief Executive Officer of AmeriChoice Health Services, Inc. He served as Head of Public & Social Markets Group of UnitedHealth Group since August 2007. Mr. Welters co-founded AmeriChoice Corporation (AmeriChoice) in 1989 and served as its Chief … Executive Officer and President from 1989 to December 2006. He served a number of senior positions in the federal government and in private industry. He served as an Attorney for the securities and exchange commission and an Executive Assistant of U.S. Senator Jacob Javits. Mr. Welters served as Director of Federal Affairs and as Assistant Vice President of corporate development of AMTRAK. He served as an Associate Deputy Secretary of the U.S. Department of Transportation. Mr. Welters serves as Chairman of the Board of Morehouse School of Medicine Inc. Mr. Welters served as Chairman of AmeriChoice Corporation from 1989 to September 2002. He serves as Vice Chairman of New York University, Morehouse School of Medicine the NYU Hospitals Center and the Library of Congress. He serves as Vice Chairman of the Board of Trustees of the Morehouse School of Medicine in Atlanta. He serves as Trustee of Morehouse School Of Medicine Inc., The. Mr. Welters has been a Director of Qwest Communications International Inc., since July 25, 2006, CR Bard Inc. (formerly known as Bard C R Inc.) since February 1999, West Pharmaceutical Services Inc., since March, 1997 and AmeriChoice Corporation since 1989. He serves as Director of Horatio Alger Association, The Congressional Black Caucus foundation Inc., The An-bryce Foundation and the Wolf Trap Foundation for the Performing Arts. Mr. Welters serves as Council Member of the National Museum of African American History and Culture. He serves as Trustee of the Healthcare leadership Council, New York University Law School and Medical Center and the National board of the Smithsonian Institution and is a Member of the Young presidents’ organization. He is a recipient of the Horatio Alger Award in recognition of his achievements and contributions to society and serves on the board of that charitable organization. Mr. Welters holds a JD from New York University of Law and a BA from Manhattanville College. He is admitted to the bars of New York and DC.
    FEDERAL JUDGE SAYS IF THEY DID NOT PROMISE OR SIGN ANYTHING, KICKBACKS ARE OK??? WHICH IS NOT TRUE BY THE WAY.
    Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
    MEDICARE FRAUD, MEDICADE FRAUD, AND KICKBACKS AND BRIBES BUSINESS AS USUAL,INSIDER INFORMATION GIVEN. 9B BS ONE THING BUT WHAT ABOUT YOUR “HANDS OFF POLICY” BY THE DOJ AND CMS AND HHS, AND WHY NO INVESTAGATIONS OR AUDITS TO CONFIRM OR HELP? “SELF DISCLOSURE BY CARRIER ANOTHER JOKE”.
    WHAT ABOUT “TAXPAYERS TO PREVENT AND STOP AND PREVENT FRAUD FOR MEDICARE AND MEDICADE” WHAT ABOUT WILLIS AND WILKINS BEING FIRED FOR NOT WANTING TO BREAK THE HEALTH FRAUD LAWS?
    NJ CEPA CLAIM NOW ON FILE…..FALSE CLAIM UNDER APPEAL AND FILED….. WHERE WAS ANY HELP FROM THESE DEPARTMENTS?
    The U.S. District Court for the District of New Jersey dismissed May 13 a qui tam action alleging violations of the False Claims Act (FCA) by United Health Group and its subsidiaries. According to the court, the complaint failed to state a claim upon which relief could be granted under the FCA. Relator Charles Wilkins began employment with United Health Group and its subsidiary AmeriChoice in October 2007 as a sales representative. Relator Darryl Willis began employment with United Health Group and AmeriChoice in 2007 as the general manager for Medicare/Medicaid marketing and sales.
    In their qui tam complaint, relators allege 11 violations of Medicare and Medicaid regulations. The United States declined to intervene in the case and the relators filed an amended complaint that stated one federal count—violation of 31 U.S.C. § 3729(a)(1)-(3)—and nine state law counts. United Health moved to dismiss under Fed. R. Civ. P. 12(b)(6), arguing relators failed to plead the elements of a “false certification” claim, they failed to plead any anti-kickback violations, and failed to adequately plead a conspiracy. Relators alleged that because United Health entered into a contract expressly certifying that it agreed with all “terms and conditions of payment,” they made a false claim when they submitted claims despite any one of the 11 purported regulatory violations alleged in the amended complaint. Rejecting relators’ express false certification claim, the court found “[not once in the Amended Complaint have Relators identified even a single claim for payment to the Government.”The court also held relators’ implied false certification claim failed. According to the court, relators argued that because United Health agreed to comply with all CMS regulations when it contracted to become a prescription drug plan sponsor, and because at times it was in violation of some regulations, it therefore committed fraud each time it submitted a claim for payment. The court found such a theory of liability overly broad. “If Relators’ theory were correct, the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,” the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government’s payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and [t]hey have not done so.” Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
    United States ex rel. Wilkins v. United Health Grp. Inc., No. 08-3425 (D.N.J. May 13, 2010).
    FCA claim alleging aggressive marketing tactics by health plan provider dismissed
    Publication: Health Law Week
    Date: Friday, June 4 2010
    The U.S. District Court for the District of New Jersey dismissed a qui tam action brought by two former employees of healthcare plan providers alleging violations of the False Claims Act (FCA) arising from excessively aggressive marketing methods. United Health Group Inc., a provider of access to healthcare services, had as its subsidiaries AmeriChoice and AmeriChoice of New Jersey, which each offered Medicare Advantage plans. Charles Wilkins and Darryl Willis (the relators), who were each employed by United Health Group and AmeriChoice, initiated a qui tam claim against United and its two subsidiaries under the FCA alleging numerous violations of Medicare and Medicaid regulations governing administration of the Medicare Advantage plans. The complaint alleged that the defendants engaged in unauthorized and aggressive sales methods in marketing the plans — including the provision of illegal cash payments to providers to induce them to change beneficiaries to AmeriChoice and the provision of illegal kickbacks to doctors for obtaining the names of patients they could call and approach. The defendants moved to dismiss.
    The district court concluded that the complaint failed to identify a single instance in which the defendants submitted a false claim to the government for payment as required to prosecute a qui tam claim as relators under the FCA. Under applicable federal appellate court precedent, the absence of such an allegation was fatal to the relator’s false certification claim. The relators’ theory of liability at base was that because United Health agreed that it would comply with all Centers for Medicare and Medicaid Services regulations, and because it was at times in violation of some regulations, it committed fraud each time it submitted a claim for payment. The district court concluded that this contention confused the conditions of participation in a Medicare or Medicaid program with the conditions of payment, and would open the door to a flood of tort claims of a type not contemplated by the FCA. Moreover, the complaint failed to allege that the violation of any regulation was actually relevant to any funding decision. As a result, the complaint failed to state a claim on which relief could be granted and, accordingly, the defendants’ motion to dismiss was granted.
    Source: Health Law Week, 06/04/2010
    Copyright © 2010 by Strafford Publications, Inc. http://www.straffordpub.com / All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement.
    2009 and 2010 $120,000 from your tax dollars.
    Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools.
    These checks came from AmeriChoice Health and on the surface seems like fine gifts.
    Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share of the market place.
    Honest Kickbacks Honest Bribes
    Judical decision, It’s true there is email thanking AmeriChoice health for their $25,000 gift and requesting a larger amout for the pending year etc. from Community Health Center located in Bridgeton N.J. etc. It’s true a licensed Health Agent was fired for his refusal to deliver these checks. It’s true this behavior violates all the laws concerning bribes, kickbacks,fraud and Stark laws.
    What is Bribery Any Way? a form of corruption,is an act implying money or gift given that alters the behavior of the recipient. It’s also true that the various Government agencies were notified of these frauds as well as a FCA case being filed.
    It’s true this taint’s all the business then received from Community health center to AmeriChoice Health Company and then submitted to Mediciad and should be then held accountable and subject to all the violations of the health laws involved.
    Are Kickbacks becoming a normal way of doing business ?
    It’s true that relators argued that because United Health agreed to comply with all those trivial regulations when it contracted to become a prescription drug plan sponsor,as well as sign a formal contract of compliance.
    The court found such a theory of liability overly broad. “If Relators’ theory were correct,the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,”the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government’s payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and they have not done so.”Turning next to relators’claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’state law claims and refused to grant relators leave to amend.
    It’s true many additional laws were broken and proof furnished but no copy of checks to suppot the bribes only the unapproved forms and email etc.
    I think the Federal courts have already decided that not only is Honest Fraud OK but Honest Bribes as well as Honest Kicbacks are OK. It’s amazing a Federal Judge thinks bribes and kickbacks and fraud are to trivial for the court system to waist their time on. What should courts spend their time on and since when do you have to certify compliance for non-violation of any Federal And State Kickback laws??

  9. Coventry healthcare/Health America/Health Assurance is one of the worst insurance companies. They put pressure on physicians not to prescribe more than 1 medication. They harass physicians that perform procedures. They deny all claims. Insurances should not be able to get away with this. They are so powerful that they arm twist physicians if they bring any issues to their attention. They have the worst customer service.

  10. I’m willing to let anyone out of the insurance mandate, if they want. When you get in a car crash, or get sick, we’ll let the nurses put you in the “dying pretty soon” room. But you aren’t getting care.
    The whole point of insurance is to have everyone in the pool of insured. If people want out, that’s fine, but you won’t get any care either. And don’t bother trying to get insurance after you get sick. You can’t do that with car insurance: it isn’t fair to do it for any insurance.
    For the people that don’t want the insurance mandate: I’d seriously like to know what you expect to happen. Write it here. Are you 1) planning never to get sick? 2) independently wealthy & don’t need insurance: you’ll just pay cash? 3) just going to go to the hospital & plead poverty and let the govt pay? I’ve heard incredible amounts of complaining, but I haven’t heard how this would play out in your mind, with things the way they were. People are having to stay with jobs they hate, just to keep insurance. Self-employed people have incredibly high rates (going up) & have no options to shop around if they have the slightest pre-existing condition. Insurance companies are raising rates to squeeze more $$$ from existing customers, and forcing others to go without, so when they inevitably get sick, the govt has to pay. No bumper sticker phrases: how are you going to do it?
    Go.

  11. This whole healthcare plan gives me themhercrum. I mean, whose to say that it won’t be the precursor to the development of the American socialist state?!? Obama’s treading a fine line with his power here, and I for one, am not going to sit here and tacitly take whatever he spoon feeds us…

  12. Agree totally – get rid of insurance companies and have one universal health care service for all, not much chance of that happening though is there?
    Seriously, the changes in law will provide access to 40 million people who otherwise do not have medical cover, surely that in itself should be celebrated? Better this then a large % of the population missing out altogether or have American’s become so concerned for themselves that they are happy to maintain an underclass of people who do not have access to first world health facilities?

  13. If the health care law is so good, lets require Obama, his cabinet and the entire congress to be subject to it as well. What’s good for the goose …..

  14. What does America fear from a universial health care system? Surely it is important that Governments look after the most in need. USA has the worst record of any 1st world country in meeting the health needs of its people. Some third world countries have a better health system. It is obviously an American thing? The rest of the world believes in looking after the health of its people, the invisable hand of the market cannot look after the most in need – it requires intervention? The rest of the world looks on with amazement that such controvesy and debate is occuring over a basic human right such as access to an affordable and quality health system? Who cares about the cost? Don’t buy one aircraft carrier this year and you may be able to look after your own people. Caring for people is the mark of a advanced democratic civilisation, America should be ashamed of the current system.

  15. If this health care bill was any good then Obama and the white house would not have to bribe or blackmail anyone for their vote.

  16. If reform is passed, what’s keeping insurers from covering everyone, and jack up the premiums? If my insurance goes up 100%, it’s just as useless to me as if they just refused to cover me due to preexisting conditions. I can’t afford it.
    As much as I’m not enthused about the current bill, I see no reason at all to believe that “starting from scratch” or spending more time to get a bipartisan bill will result in anything better. I feel absolutely certain that it will only be weaker, weaker, weaker.

  17. Transparency is lacking in the Health Care debate.
    When Pres. Obama invited other points of view t a summit where all the issues would be “on the table,” he put his presidency on the line.

  18. Simply discontinue the healthcare coverage of the house and senate until the American people has sufficient health care equal to the care we pay for for those who are suppose to work for us. I know this will get them off of the pot and make something happen for the American public. the same concept of asking one little boy to divide a candy bar in half and let the other choose first. Put the decision maker in the position of equal consideration for the other party or risk loosing something valuable
    John Singletary

  19. I have listened sporadically to the debate and have
    not heard one word mentioned about the best of patient
    care first, then cost.
    I fully understand the dilemna between health care and cost.
    If my doctors during the past 46 years were concerned
    about cost for my health care, this note may have not
    been possible. I have had the best care money can buy
    due to concerned doctors who put my care ahead of cost.
    Because of their decisions, this handicapped individual
    has been a tax paying contibutor to society for the last 55 years. And I have enjoyed every minute.
    Put the patient care first in the hands of the doctors not the insurance companies.

  20. It seems to me that the opposition puppets (GOP’ers)of health care reform have no clue or desire about how to reign in the exploding cost to our nation or to any American citizen.
    The biggest problem is, everyone keeps pointing the finger at why they are irresponsible, unethical, and lack truth in their decision making all in the name of making profits!
    I say slice all health care industries into little local co-ops where the insurance is paid for by community service initiatives and local and state subsidized bonds. Allow health care escrow accounts to be invested in the facilities and local businesses that provide health care and use a federal program to allow outside exceptions for things not produced in the local area.
    Dismantle the insurance super-giants and retrain their innocent employees who would normally get mulched like old leaves for the big shareholders and CEOs stakes! Reinforce insurance regulation and start handing out jail time for those who think they can steal from the American taxpayer for being sick!
    Sooner or later, we all get sick! Why should the insurance companies pretend they are our fairy god-mothers only to turn out to be hyenas and vultures when we are at our weakest and most vulnerable moments?

  21. Obama’s health care plan has nothing to do with health care just follow the money. Who is going to benefit and who is going to foot the bill for his health care plan? His whole plan is to get the government off the hook and the citizens of the United States on the hook. Everyone being forced to have health insurance will benefit the health insurance industry and take the health-insurance costs away from government responsibility. There is no limit put on the cost of health care at all. That will remain the same and insurance costs will only rise higher and higher. Guess who is going to be responsible for paying for the higher insurance costs along with higher health care costs. What we need is affordable health care. Health care that doesn’t bankrupt the household. Right now you have to mortgage your house in order to pay for the health care bill. You think it’s going to change in the future? Guess again. You are the one who will be responsible to come up with the dollars for hire health care and higher insurance costs!

  22. My best friend had state ins for a year, she moved away for 6 mths and came back 3 mths ago. Her income has not changed, she still cannot find a job, she started college today. She completed the state paperwork again, for her and her 4 yr old daughter, and mailed it to them over a month ago, she is now having health problems and they keep telling her they do not know where it’s at, who has it etc…If the State of Ohio (wood co.) cannot even get this right, how are they expected to get anything else that has to do with health care right?

  23. hay people of earth how are u going to raise taxes when the people that pay taxes are out of work and can no longer pay taxes oh do u pay taxes on your unemployment check that will do it and then ill get sick and die because there is no health care ,it never got passed

  24. in addition, i do not want my doctor to be forced to pay excessively for his insurance, nor is he in the business of buying custom software and hiring specialized staff to just file a simple claim form for reimbursement from the insurance company.
    i favor global coding for medical procedures so no matter who your insurance is, the administrative duties will be lessened. BCBS uses one set of diagnostic codes, aetna uses another, cigna uses one similar to both but with its own quirks. adminstrative costs for your doctor’s staff to enter one covered procedure and follow it through to actual payment of the claim may even rival your monthly insurance premium. information technology has added another layer of costs and duplications to the high cost of health insurance. insurance billing procedures is now a field unto itself requiring a two year degree in order to obtain an entry level position. as far as electronic medical records are concerned, it would be prudent to keep both paper and electronic records until laws can catch up with the technology. imagine yourself as a plaintiff trying to explain to the judge that you ‘spoke with tons of people,’ what they told you and what action was taken. you will have no proof. “They told me it was all in the computer” would be laughable as an offer of proof even though it may be true.
    i want access to any and all records with regard to my care. i want safeguards and firewalls so records might be secured from additions, post-dating, deletions, ‘corrections’, changes, and any other ways of altering a record.

  25. no one here in massachusetts noticed but now for those who use MassHealth or its other 2 plans, a not for profit dental provider can (and do) recoup $19.00 per patient per visit. this is mass general law. the net result is that it takes 4 visits to get your teeth cleaned, 6 visits for a crown (which you pay for yourself). it also provides incentive for your dentist (if you’re over 21) to pull rather than save your teeth because only the upper and lower 4 anterior teeth are covered for various degrees of restoration. should you have trouble with your back teeth as you get older, you won’t be able to afford to get them worked on. get your pliers out. at a rate of 10 patients per dentist per day, a crew of 8 dentists (both supervising and students) and this figure is conservative, will realize $1,520.00 per day before even looking into a patient’s mouth. the not for profit avenue encourages quantity of care rather than quality to be its governing factor.

  26. The Proposed Budget to the Healthcare Plan seems to fit the description of benefits Obama is promising as an out come to the changes being made to the healthcare system in the united states. Even if in order for this plan to work our taxes need to increased by a small portion, i think it is worth it, and the ten year goal will hopefully be reached. For this will effect not only our generations health but it will secure a stable healthcare plan to out children in the future. It will be worth the pay for and the wait for if we get a stable insurance system with low cost, and a system where you don’t have to declare bankruptcy for getting sick or taking your uninsured child to the hospital.

  27. The Proposed Budget to the Healthcare Plan seems to fit the description of benefits Obama is promising as an out come to the changes being made to the healthcare system in the united states. Even if in order for this plan to work our taxes need to increased by a small portion, i think it is worth it, and the ten year goal will hopefully be reached. For this will effect not only our generations health but it will secure a stable healthcare plan to out children in the future. It will be worth the pay for and the wait for if we get a stable insurance system with low cost, and a system where you don’t have to declare bankruptcy for getting sick or taking your uninsured child to the hospital.

  28. The Obama Plan, at first, seems to be the logical thing for a nation in a recession and time of economic difficulty. As you know, many of the residents of the U.S. are having trouble finding work and a means to pay for necessities such as health care. The Barack Obama website states that the plan will “Offer a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.” The Obama plan may provide for these people but at the expense of those who, although struggling to pay for their own health care, can afford basic health care insurance. The health care plan will raise the taxes of those who can afford to pay for the insurance. Also, by making a public health insurance option, the Obama plan will cause an increase in insurance rates from independent insurance companies. The plan will create a “health choices commissioner” who will decide what insurance companies have to provide as “essential benefits”. The commissioner will decide how much insurance companies can charge for basic health insurance so naturally, the cost of health insurance will rise.
    The plan will also affect the pharmaceutical industry here in the United States negatively. My family, and many other families are concerned about what may happen to our relatives jobs and thousands of others jobs across the country. The pharmaceutical industry employs millions of people across the U.S., it also spends billions, and makes billions of dollars each year developing and distributing new medication to Americans. Under the Obama health care plan, President Obama plans on using “safe and affordable” medications from foreign countries, such as Canada, to lower the cost of drugs for people here in the United States. Although this seems like a great plan to some, others like myself, don’t see it in the same light. The money that the pharmaceutical industry puts into our economy can only be a good thing in this time of recession and if the industry is set aside to bring in new “cheaper” drugs then this would cause a negative effect on an already struggling market.

  29. There are many different universal health care plans.
    I am wiling to support any plan that moves this country toward universal health coverage for all Americans. But, I can understand ,best the one outlined by John Edwards.
    _________________
    Alargamiento De Pene

  30. What happened to……..WE THE PEOPLE!
    It is no longer about …….you and me!
    For the “1st time in my adult life” I am afraid for OUR Country and the direction those leading it.
    CHANGE! We are getting change and not the kind of change most of us expected.
    For the Government to make the drastic kind of healthcare reform being pushed by Obama is going to be one more push to ruin our country. Not fear, FACT!
    I pay one third of my $3,000 dollars a month income for my health insurance and my medicine. I like knowing that if I need to see my specialist I can pick up the phone and be in his office within two – three weeks. If I have a sore throat I can see my doctor the next day and sometimes on the same day that I make the call. I sacrifice the new car, fancy clothes, vacations, for what is important to me!
    Obama has refused to tell the American people that have insurance what HIS CHANGE is going to do for everyone. I feel like he is punishing those that have insurance and forcing us to pay for those without and and make everyone wait in the same long government lines for doctor care,(but unfortunately not everyone is equal to everything we do and have in life! And yes his plan does include illegal’s, don’t let him tell you it doesn’t, because later he will say that he did not add them but congress did). Therefore, forcing EVERYONE to wait in long lines and months to see a family doctor, even longer for a specialist and tests. Private insurance companies that will continue operating for a short time will have to follow federal laws. So will the doctors. Eventually, there will be no private insurance, just the lousy government run healthcare similar to the one in Canada and England. Less people live in England than in the U.S. but more people die from breast cancer there than here every year because it takes too long for tests. The delays don’t save lives.! Also, there is going to be penalties on doctors when they don’t know what is wrong with you and have to run several tests……forget the effort on the doctors part when he is fined for running too many tests! ( I THINK THE LIMIT IS 4)! I want the same coverage I pay for today when I am a senior citizen. I want Obama to tell me that my coverage will NOT change!!
    IF THE GOVERNMENT CAN DO A BETTER JOB PROVIDING HEALTHCARE THAN LET THEM START WITH THE VETERANS HEALTHCARE AND HOSPITALS FIRST. FIX THEIR GOVERNMENT MESS AS PROOF of being capable of effectively adding billions to a healthcare program!
    HAVE YOU BEEN IN A LOCAL VETERANS HOSPITAL LATELY?????
    It is a BIG mess!
    Another thing that bothers me is that Obama said that he was going to do things differently from the Bush Administration………….
    His first complaint was all the spending Bush did while in office 8 yrs……
    Well, Obama has outspent every President ever in office and he managed to do it in the first 100 days in office without the effects of 9/11 on our country or the expense, without a Katrina and all its expense and those supported by the move for over a year along with all the damage . No Rita! Just handing out money in a variety of directions that has put this country into more debt! HOW MUCH MORE DEBT WILL WE BE IN AT THE END OF HIS TERM??????????
    Number two was the war in Iraq that he blamed on the Bush Administration. But now instead of one war we have two. He is slowly moving men and women out of Iraq but since January added military to Afghanistan where we are fighting the same bad people that Bush went after and Obama was against! THESE ARE ONLY TWO EXAMPLES! I DON’T HAVE TIME FOR THE REST!
    CHANGE…………….OR ………………….MISTAKE!
    One more thing I would like to ask. If the Clinton years were so great why did so many companies and industries merged together to survive? We had more mergers in the 90’s than in the years prior! Why did many companies falsify their records to make it look like they had better numbers than they really did? If the 90’s were so great why lie about profit margins? Obviously the problems were already there but revealed when 9/11 hit and took a toll on our economy like it did! The problems were already starting in the 90’s, grew in the 2000’s, and going to explode if Obama does not STOP spending OUR money!
    I WOULD LIKE TO KNOW WHY OBAMA, CONGRESS, AND THEIR FAMILIES ARE NOT INCLUDING IN THIS WONDERFUL HEALTHCARE PROGRAM. I WANT THE SAME PROGRAM THEY ARE PROVIDING TO THEIR FAMILIES!

  31. 107 PEOPLE DIE WORLDWIDE EACH MINUTE.
    THAT’S 153,000 DEATHS EVERY DAY.
    HOW GOOD OF HEALTH CARE YOU HAVE WILL
    MEAN NOTHING WHEN THAT DAY COMES FOR
    YOU TO BE AMONG THAT 153,000.
    ARE YOU A CHRISTIAN ON YOUR WAY TO
    HEAVEN…OR ARE YOU STILL BOUND FOR HELL?

  32. Many people appear to denegrate socialized medicine, but some simple facts are hard to swallow.
    There is a free national health service in England. Also there is health insurance like here in the US and you can just pay cash. So there are options. All this for only 20% income tax for the vast majority of tax payers.
    Here in the US there is no free socialized medicine, but we have to pay around 30% income tax. All this for a health insurance system that most consider a national; scam that is far greater than a Bernie Madoff Ponzi scheme.
    Socialized medicine may not be the best system, but having it and a 10% reduction in taxes and then having to pay $0,000 per month to the insurance vampires looks very appealing.

  33. My wife is a Family Practice physician. We have seriously started to consider which country we should move to. Physicians as a whole are intelligent individuals. If they see their opportunities in this profession shutting down they will be able to go to another profession and become successful. If our brightest individuals leave or don’t even enter the profession what will the status of our health care be then?

  34. Ok I guess I’m missing something. Your going to fix the problem without costing us the americans any money. So if this bill is passed the middle class will not be hit with any new taxes hidden in the bill the Senate and Congress pass again(as always)? Second and most upsetting is the President said it will be mandatory for us WHO can afford it to get coverage(middle class again). And those who still can’t are exempt and will be covered. No I didn’t warch him on tv but read what was said on the net from the farce.
    What bothers me the most is the President is going to make it MANDATORY to carry insure guess we are just giving up and letting first steps of a dictatorship moving in. Thought this was America where we have the right to choose. These are my oppions. Not happy with the President,Senate,Congress and my represenitives from NJ.

  35. After the government takes over health care insurance the next step will be to keep costs down. One way they are going to keep medical costs down is by forcing you to have healthy habits. They are going to force you to stop smoking. Two, they are going to take away your beer. Alcohol is not good for you, liver damage. Three, they are going to take away sugar and sweets. Sugar makes you fat and causes heart problems. Four, they are going to make you go out and walk everday. Exercise is good for your health. This will be inforced by the neighborhood police scout. Five, you will be required to buy 4 vegetables everyday. Your local neighborhood scout will make sure that you eat all 4 everyday. Six, you will be required to eat dinner in the government cafeteria so that healthy eating can be monitored and enforced.
    Does this sound silly to you? Remember you are forced pay for car insurance, ticketed for not wearing your seat belt or talking on your cell phone to name a few.
    Little by little your rights and freedoms are being taken away.

  36. One point that none of you get here is that you are not getting free health care from the Government. The way this is going to be financed is by forcing each and everyone of you to go out pay for Health Insurance. Pretty much the same way the government forces you to pay for car insurance. If you don’t get health insurance on your own you are going to be fined.
    The people that are behind this bill are Hospitals and Doctors. In the past factories covered workers and now that they have moved to China, cause they don’t want to pay heath coverage or American wages. That leaves Doctors without large Corporations paying for health care. Now most Doctors are making good money, but it is never enough for them.
    So folks this is what you get for buying cheap goods from China. Your job is gone and now you have to pay for your own health care. For most of the young healthy people out there you have to pay for all the sick people.

  37. Do not let the public go. We need public healthcare. We are willing to finance bow & arrows in Utah, but not health care.
    I am for the health public option. What do I need to do to help get this passed though.

  38. We need to bring back the public option. It is one of the most important components.
    Insurance (any kind) is unique because it defies normal economic supply/demand principles. The phenomena of “Adverse Selection” says that the risk spreading mechanism itself is damaged by low-risk people who opt out. In essence, young healthy people say, “I’m young and healthy… I’d rather just NOT participate and keep my money, but thanks anyway.”
    Now I pose the question: Should anyone be able to opt out of paying for roadways? (Highly socialized…except in Orlando and a few other places where there is a tole booth every 50 feet. Last time I traversed the city I wanted to shoot myself. Thanks so much, Mickey Mouse).
    Should anyone be able to opt out of paying for police, fire departments, or military? (Much like health insurance, all risk spreading mechanisms. All incredibly socialized).
    Lastly, do you want to see the country pay 25% of GDP for healthcare? How about 50% (Now at 17% up from around 6% a decade ago and climbing faster than Chuck Yager in a test jet).
    Health care insurance is an important risk spreading mechanism. Meanwhile, costs should be very actively managed. People with families should not have to work for large companies (groups) to attain low cost coverage. That effectively dampens job liquidity and hinders broader economic markets. What happens when GM closes down a plant and 800 workers find themselves constrained to working for another big company to find health care comparable to what they had before for their family? (Ever notice how manufacturing plants are often planted in small towns where there aren’t a lot of other big companies?) Job liquidity demands that health care decisions be completely separable from the job. So the current system patently discourages free markets and value flows rather than encourages them.
    ….Research “Adverse Selection” and understand the underlying economics involved. “High Risk” pools are not going to get the job done.

  39. I feel like the only way to really fix the health care system is for America to move to a universal health care program, yes I said it, socialist health care! Being able to see a doctor should be a basic right for every American regardless of their situation. We shouldn’t have to worry about breaking the bank everytime we need a check up. A socialized program would lower costs for the public and would allow for everyone to see a doctor even if they become unemployed. The problem lies in the fact that Americans have become too greedy and the insurance and drug companies don’t want to part with any of their profit. Yes, this would mean that doctors wouldn’t make quite as much, but look at all the other people that don’t have a doctor’s salary and they manage just fine. I don’t understand all the properties to Obama’s plan but it seems like it’s atleast a step in the right direction. Let’s learn from the other countries around the world that have affordable health care programs and follow their example!!

  40. If he want to pay for it Tax all those high paying excs more.. or Celebrites making 20 million amovie or sports player make $$$$$ Hell just go broke quit you job and live off the government.

  41. The BS out of his mouth that you can keep your insurance ,,that is if your employer keeps it and nots opts out for the government crap. I say if you need it allow who ever to buy into medicare now. Double it on their salary. Hell why am I paying for it when i can’t use it til 65. what if I die before I can even get access to medicare lots of people die before 65.

  42. THE SOLUTION TO THE HEALTH CARE PROBLEM IS KICK ALL ILLEGALS OUT OF THIS COUNTRY. THERE THE ONES BREAKING THIS COUNTRY AND ALL THE WORKING PEOPLES POCKET BOOKS. IM TIRED OF PAYING FOR THESE PEOPLE.

  43. My problem with the whole thing doesn’t stem from the specifics of it. It stems from a broad and sweeping truth.
    Any changes of this nature (that actually pass) are geared towards helping the rich, the corporations, or the government. If it didn’t, then it wouldn’t pass because they are the ones pulling the strings.

  44. The President may want to help the average Joe but the problem I have is this plan does nothing to require more personal responsibility. The Percent of noninstitutionalized adults age 20 years and over who are overweight or obese is 66 percent !! We need to tell folks to change their life by exercising! This is far less cost that a government run high tax health care overhaul. Actually our system needs a tune up but not an overhaul. One of the areas for tune up is health fitness. So get out there and do something so you want be going to the emergency room for a sore belly.

  45. If you are really serious about health care reform then you have to break the big myth! By that I mean the one created by the baby boomers. The one that makes us believe that our system is the greatest on earth. We( the baby boomers) worship our doctors because when we were growing up the doctor came to your home, got very little sleep, hardly ever played golf and was lucky if he saw his family more than 4 hours a day. In other words you could trust him to have your health in his hands. NOT YOUR MONEY IN HIS HANDS. Now you have to get permission from the ins. co.before you can have any serious treatment. Come on folks! PAY ATTENTION! Wouldn’t you rather have the gov. in control versus the ONLY FOR PROFIT INS CO? MR. PRESIDENT TEAR DOWN THE MYTH!

  46. For many years thousands of American Consumers have been injured because of defective prescription drugs and Medical Divises. This is driving Medicare and Medicaid up and the American Public is at risk. In 1962 Congress omitted from the FDCA ACT Product Liability for Prescription drugs and Medical Divises. With Preemption of the law placed a protective shield up for the prescription drug companies and leaves the public at risk. There Is No Law. Show me the Law. Healthcare can never be affordable as long as the drug companies continue to cause injury and kill the public and not made accountable. There is no law. No Federal Law and No state Law. Show me the Law.

  47. My younger sister was recently diagnosed with Stage 3 breast cancer. Her policy with Anthem BC in California, has a $10,000
    deductible and her monthly premiums are $800. This is the policy that she could afford, but no longer can.
    With the deductible , premiums and care that her insurance has refused to cover what is her chance at a cure, or further treatment. Does she die because of this country’s lack of healthcare? I myself have had no health insurance for over 10 years due to a pre-existing kidney condition which gives me hard to control hypertension. I take 4 BP medications per day. I need a renal angiogram, and other tests which are way above my ability to afford as I live on a fixed income. I occasionally skip medication as the pills are very expensive. What is my future?
    So this is a whole family unable to get health care, with potentially fatal consequences, due to no system available but “cherry picking” private for profit companies. Below has been taken and somewhat modified from another site but it about states it all. Mr. President, Is anyone listening ?
    The truth is that there are gaping holes in our health care safety net and that most of these safety-net services are neither effective nor efficient in providing chronic-disease prevention, detection, or treatment. The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year and thousands more to die of other diseases. And for those who are unmoved by this shameful injustice, the data also show that for many hard-working, middle-class families, a diagnosis of cancer sets in motion a series of unfortunate events, including job loss, loss of employer-based insurance, bankruptcy, and all too often, premature death. For too many hard-working “average Americans,” paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry.
    Surveys have documented widespread dissatisfaction with the way health care access is currently rationed in the United States. Patients are angry, health care providers are frustrated, and businesses leaders are concerned that the rising cost of health care premiums is undermining their ability to compete in the global marketplace.
    The United States continues to have the worst record for health care access among all industrialized Western nations. And we are asking the President to propose specific policies intended to mitigate the misery and death caused by lack of health care access.

  48. Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.
    HEALTH INSURANCE COMPANY PROFITS IN 2007:
    1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
    2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
    3. Aetna Inc. — $ 1.831 BILLION
    4. CIGNA Corp — $ 1.115 BILLION
    5. Humana Inc. — $ 834 million
    6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
    7. Health Net — $ 194 million
    The huge insurance company profits—BILLIONS EACH YEAR—could be used to provide quality healthcare for millions of people, and to pay physicians adequately for their work.
    We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.
    The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/
    FOR MORE INFORMATION: http://www.insurancecompanyrules.org/learn_more/the_roster/ and http://www.pnhp.org/

  49. O.K. O.K.
    First of all we can use statistics and bend them anyway we want to prove our point or theory. I have to say being in the medical and legal profession I think that to really implement a good overall healthcare system we need managed care, Case management and medical management. I have worked as an RN for over 10 years; I have been a case manager, medical manager and now a certified legal nurse consultant. There is no “magic wand” to undo what has already been done so let the past be a lesson but move on to work toward our future. I think that not for profit is an oxymoron! We need people who work in health care, understand the interworking to be the leaders in our “REFORM”. If you are not in the business of healthcare than you do not understand it. If you are not in the legal profession than you don’t understand it. If we can recognize that people are always going to be uninsured or underinsured, then we can focus on utilizing and managing what they do have. Managing the care will allow us to:
    1. Give the best quality of care at the best price.
    2. Eliminate the MD’s who run test on patients that they don’t need (or their reimbursement for such)
    3. Make the practitioners pay if they make a mistake.
    4. Have DRG’s but remember that all people are not affected by disease the same and allow for some leniency one a case by case bases. (If demeaned necessary by a concurrent review)
    5. Have guidelines for healthcare providers with penalty so that hospitals that do allow GN’s and med students to practice beyond their scope are punished for trying to save a buck by not having appropriate staffing ratios)
    Attorney’s are not the enemy, without them malpractice would be worse than it already is!
    It’s already a shame that the people are the ones that suffer for the negligence of providers, and most of them don’t have the luxury of retribution due to “tort reform”.
    I’m not saying that tort reform is bad I’m saying that anyway you look at it; it’s the people that pay.
    Taxing the “rich” is not the answer.
    I have worked with great staff and hospitals and I have worked with staff that was so totally inept it would make you vomit.
    The people “running” healthcare should be competent healthcare professionals. That focuses not only on managing the care, but on monitoring the competencies of the providers as well.

  50. I have 3 children and have been divorced for 8 years- my x- husband is not paying health insurance as ordered by the St. Louis Courts. I only found this out because – my son went to the doctor and I was billed for the whole amount- they let me know that my x-husband Tom cancelled my son’s health insurance. I hope who ever receives this email does something about this…. Governor Jay Nixon’s office have been working with me in doing the best job that they can. I am behind President Obama – he looks out for our children! Thank you. I hope if there are further steps for me to take please let me know…..I am not receiving child support either- and I am putting three children through college while he is out playing golf and gambling at Ameristar Casino’s in St. Louis, Mo instead of taking care of his kids. I am trying to do my best and I thank God that we have a President who cares about the people. Sincerely, Karen

  51. Please STOP DROP AND ROLL,
    As long as big co. are in control of health care it will not work. People that become DR. are about helping people. As long as the $ is the deciding factor pecple will suffer. Why should health care be decided on if you can afford it. As long as thers is money to be made guess what? Just look at the profit of health ins. oo.. That is where that money it going, STEP UP AND ADMIT THE REAL DEAL.
    We can take care of each other. LET’S DO IT NOW.

  52. Medical IT is being pushed by the IT vendors(surprise!), and the policy doctors that want to mine the data to retrospectively deny coverage for everything that they can think of. No night work. No weekends. No adult supervision. No accountability for even the stupidest errors. Dr. Syndey Wolfe, for example, is still at Public Citizen after obvious errors on Bendicin and Breast Implants. Sounds like good work to me. I am certain there will be no shortage of government policy doctors.
    IT will rushed to market with huge bugs. It will reduce productivity, and paradoxically increase utilization of a whole host of procedures like colonoscopy which are recommended for screening, but reasonably rarely performed. An IT prompt will increase utilization of a whole host of procedures dramatically.
    The cost saving aspects will work out in a similar manner to pre-authorization, gatekeeper, HMO’s, pay for performance,and a number of other methods designed to curb utilization. A new layer of expense, a new army of clerks and programmers and hassle will be added, but people that want to see an orthopedic surgeon for their knee will still find a way through the system.
    It will be expensive. Utilization will increased dramatically.
    On another matter, it is a testiment to the power of the Trial Bar than even reform minded readers of this blog are afraid to step on their toes. Utilization will never budge without iron clad tort reform. Most of the middle class and all poor will have their babies delivered by nurses and medical students before this happens. By then, it will be too late.
    Oh, and in case it hasn’t occured to everyone, malpractice rates are about to skyrocket from insurance company losses caused by this financial crisis.
    Maggie, if you are reading, in the Tobacco Bill, there was a proviso which would limit Trial Lawyer pay to a maximum of $20,000.00 per HOUR, which the lawyers defeated. Think about that when you think that your mother’s anesthesiologist will be paid $16 per fifteen minutes in the operating room at three in the morning.
    As a society, we are backing into the position that we would rather have a lawyer sue for a less-than-perfect outcome than a doctor to treat us in the first place.
    We think that the care will always be there. Believe me when I tell you that critical specialists will disappear very soon if something is not done. Plenty of doctors, but not plenty of general surgeons, orthopedic surgeons or OB’s willing to do emergency (read the medical care that you actually benefit from) care in the very near future.
    Tort reform would help reform gain support from doctors. Anyone who thinks that reform will come by vilifing MD’s and going over their heads, to the “people”, may be on the wrong track.
    It is huge huge political mistake to make health care for all paid by high earners. Most of these people are not rich, but they are influential. This alone will doom it.
    If you want to redistribute wealth, fine. Have at it. But make it a separate proposal. Don’t mix universal coverage with this. It will really confuse the message.
    Anyway, by the time this financial crisis there will be no rich left to pay for it.
    There is a crisis; if the solution doesn’t include iron clad tort reform it will fail. Oh well.
    (As an aside to Maggie, I went to public school, as do my kids. Most of my classmates in college were poor kids from Bronx HS of Science, which at the time was a good school. My point is simply doctors are not wealthy. I am willing to bet that the ones you know making a million are OB’s doing fertility for cash. These people will not be affected by Big Brother’s plan. In my city the people making over a million are are all hospital presidents and malpractice trial lawyers. They are making millions and working banker’s hours.)

  53. TO SAM:
    While I agree in part with your statement to the doctor concerned as to how the Obama plan will impact him personally, I do not agree with the remainder of your comments.
    Tell me where healthcare is free in the civilized world. I know of no such place. It is paid for by exorbitant taxes in France, England , Germany, Canada and everywhere you look. The only thing you get for nothing is NOTHING.

  54. Re your post Sam March 2nd 2009.
    While I can understand your concern, surely as a doctor your proirity is your patients health and not the amount of money you’ll be earning or the hours being put in.
    America remains the only Western Nation without free Healthcare. While some systems like the one in the UK need reform and are not a good example, others like France, Spain and Canada are prime examples of National Healthcare systems working at their best.
    An ealry poster mentioned profit and that is exactly what healthcare here in the USA is all about. There is something wrong about a company making profit off the sick and dying citizens of this country. A government run system works for everyone, even the doctors who still earn good money – don’t worry Sam you’ll be well taken care of 😉

  55. I am a doctor and was wondering how the Obama health care plan will affect my income and work. Am I going to be working more hours, less hours or the same. Am I going to be making more money, less money or the same.

  56. In response to some of the comments above I have to say the following.
    A 1.5% tax on all GROSS earnings avoids those individuals who for whatever reasons pay no taxes. That is a tax that is imposed before decductions and other tax evasion methodologies are applied. Having that tax applied to consumers in the form of a sales tax would be a cumbersome methodology and it would not be getting contributions from the industries that are currently benefiting from the industry such as the pharmaceutical, oil, energy, tobacco, etc.
    Do not blame the illegal aliens and others for the healthcare problem, blame the current system that allows them to gain such access and a bizarre payment methodology that assigns them to a Medicaid support program almost instantaneously. There will always be individuals who through no fault of their own will require healthcare but have no means of paying. In 1964 (the year before Medicare) the elderly were not in a position to pay for healthcare but there were not droves of elderly laying at the hospital and physician office steps being denied care. The same is true for the illegal aliens and others today.
    As to fraud, the factor used by major insurers 10 years ago to overcome the fraud and abuse was 13%. I know that this has increased but in many ways it can be quickly and easily addressed. Some (not the majority) of it is true fraud in the legal sense while much of it is a sort of “legitimate” abuse fostered by the payment schemes that deny certain coverage and allow others.
    The issue at hand is to generate an economic process applicable to healthcare that will allow coverage for all U. S. residents and a payor system that is competitively driven. The government and politicians do not understand that type of entrepreneurism. Get the government out of healthcare management.

  57. If you want to help the healthcare system, you should be kicking off these so called “poor” people that are using the medicare/medicaid system fraudulently. I am surrounded by people on welfare that get medical treatment and prescriptions and come home and suck down as much whiskey and beer as they can, get all slopped up, fight and have to go get stitches….it is rampant fraud on all ends of this thing…I for one am tired of paying taxes to hold up the health care of a bunch of fakers.

  58. The college kids have stolen the car and the credit card and are on a binge!! They are spending money that does not yet exist and will never exist if they don’t get out of the way.
    Healthcare is a great thing if you need it, but dangerous if you don’t need it. No one can make you sicker quicker than a doctor.
    Shield us from John Edwards and doctors will save more money than you can imagine, no matter who the payor is.
    A person’s appendectomy does not need to be on a nationwide data base. Spare me the BS about EHR.
    If there are no profits then there are no tax revenues. Who do you think is going to generate profits just to have them looted?

  59. If you think this is bad turning it over to Washington to base care on who gives them the largest campaign contributions will be 1000 times worse. Do we really want our healthcare held hostage every three years to budget politics? We had a good functioning system that was destroyed by the politicians I just don’t understand why anyone thinks they are the solution.
    FOr profit physicians are the same as for profit hospitals, for profit insurance companies and non profit hospitals and insurance companies. Executives of non profits make ridiculous salaries. What people need to learn is profit is not a bad thing in a true free market.
    Where you have major problems is when politicians restrict the free market allowing excess profit. A basic principal of free markets is competition, that’s why you don’t see insurance companies making more then 6% profit, any more and new competitors would enter the market and take their business. When government limits competition making it hard for other companies or products to compete that allows those favored companies to earn excess profits and over pay staff or stockholders.
    When politicians require certificate of need that allows those with the beds or equipement to profit excessivly.
    We must get goverment out of healthcare and reintroduce competition ina major way.
    For an example take my business. I own TPAs, our service is very defined, we are easily replaced, and there are a ton of us and it’s not hard to start one. Because of that we have next to no margins. Our administrative fees are lower then any insruance company, Medicare, and any other plan in the system. If we don’t do a great job at a competitive price, and have current technology we are gone and no one even notices. Years ago over 60% of those with employer insurance where in self funded plans. Then Ted Kennedy decided we should all be in HMOs, Democrats decided they wanted everyone with a couple super large nationally regulated carriers, States decided they wanted more premium tax dollars, and Congress passed bills every year making self funding less attractive. It’s a far superior product to what the large carriers sell but political it wasn’t popular.
    That is how our system was destroyed, not just in this case but almost every major malfunction in our system today can be traced back to political tinkering and “reform”. The last thing in the world we need is Ted Kennedy who created half this mess telling us how to fix it. More Regualtion and reliance on Washington is 100% certain to doom us all to generations of TERRIBLE healthcare far worse then anything we have seen to date.

  60. Howdy Nate, I am as opposed to for-profit hospitals as I am to for-profit health insurance. The unfortunate reality is that even non-profit hospitals sometimes exhibit the same predatory behavior as the private ones. I don’t know what the solution should be, but I am pretty sure that the incentives for any organization providing healthcare should be aligned with the wellness of its constituency, not with maximizing cash flow. I know that it is a fairly naive approach to somehow expect that a multi-billion dollar industry will be operating on the basis of ideals and public good and do so efficiently.
    The obvious solution is to have the government, which is supposed to represent us all, run healthcare services. I can see you grin, or laugh, and I know that the government track record in running anything is less than stellar.
    In today’s environment, by definition hospitals want to perform more services and charge more for each one. By definition, payers want to pay for less services and pay less for each one. That’s what they need to do to maximize profits. I don’t see anything here that anybody is driven to do in order to provide patients with appropriate care and/or individual doctors with fair compensation. Everybody is out for the bottom line.
    How do we change that Nate? It does not work well at all.

  61. Richard C. Ferreira MD, JD
    I completely agree with the program that you have outlined. We need strong individuals to carry out such a program that are more concerned about restoring healthcare to the people than profiting from the money healthcare can bring to the table. This represents one of the truly viable options to moderating costs as this attacks the problem of out-of-control insurers. I think that this should be the first step in healthcare reform. It should not cost billions to implement such changes and could be done with existing dollars. Yes there are other issues that it does not address that drive up costs such as unnecessary regulation, rapidly escalating drug costs, social issues associated with medical care, malpractice concerns, etc., but I would address your issue first and then after a period of time move forward and address other issues.
    I would rather see a 1.5% national sales tax instead of an income tax as everyone would have access to the healthcare system, but not everyone pays income tax. (illegal immigrants and other types of income that fly under the income tax radar)
    If you combine lifestyle changes and a defined benefit (rationing), you will go a long way in reducing costs.
    P.S. America can’t stomach the last two paragraphs, but it is nice to talk about change. As long as there is a tobacco industry in this country and no willingness to end this, then there will be no willingness to improve other aspects of healthcare. I’d be the first to give my EMR money to the tobacco farmers in exchange for eliminating the production and use of tobacco.

  62. A few comments need to be addressed. Hospital fees are very expensive but by using the Medicare DRG schedule combined with the actual reported costs (which all must do in each state)it is possible not only to rduce costs but to concentrate services to facilities with the best performance and greatest experience. I know this because I did just that when I put together the CABG contract that was an all inclusive fee for all professionals and all hospital services for $25,000. That fee was less than Medicare reimbursement.
    Competition among the insurance providers should turn on the services that they provide and not the performance of healthcare professionals over whom they have no control. It should rest with prompt payment and clear coverage guidelines. When one insurer pays claims within 30 days and another takes 90 days or denies coverage then the enrollee suffers. This should not exist but it does and it has not improved with legislative acts but has improved in New York with an aggressive Attorney General going after the companies. Again my experience as a healthcare insurance exective tells me this.
    Finally, it does not matter whether I am a specialist or primary care, but to clarify I am a retired general surgeon with over 20 years of experience in group administration in the So. California market and an executive with a major insurer on the East coast that was acquired by United Health.
    What I am saying to anyone who will listen is that the complex plans proposed by the politicians (and Obama) addressing healthcare involving multiple goverment managed programs with money taken from Peter to pay Paul will fail. They always have and they always will. Reform and revamp will not work. Create a new and defined program with all having a stakeholder position and you will see success.

  63. JBCollins
    Assuming average spending if you eliminated ALL carrier profit you mention you could insure 3 million people. Where your propoganda falls apart is your proposal for government single payor. If you would look at those profits you quoted in billions as a percentage of revenue they generally come in around 6%. Every government plan operating has around a 10% loss rate due to fraud. So far from saving 6% of spending and insuring 2 million people or less you are actually proposing s system that would spend 16 billion more then the current system and cost millions of people their insurance. Oops, think they call that unintended consiquences of good intentions, you still just killed people though.
    “engaging in rampant price gouging that discourages patients from going to the doctor, and has resulted in 50 million Americans without healthcare.”
    So everyone can have a good laugh please explain how insurance companies gouge on provider billing. And if you can cite one valid study showing 50 million americans are without healthcare I’ll never post here again….
    Margalit Gur-Arie why are you ok with for profit hospitals and providers but against for profit insurance? I can’t think of any logical explaination for that. Your OK with the person providing care taking advantage of peoples illness, thus having no choice but to buy care, to make a profit but are mortally opposed to a company selling a voluntary financial instrument from profiting. What’s your train of thought on why one is acceptable but the other is not?
    “The result will be that the profits of private payers will increase by leaps and bounds. Is that what we are trying to achieve? ”
    Have you ever taken 5 minutes to research carrier profit before you make wild claims like this? Can you name any time in history where carriers have averaged 10% profits? In a free market carrier profits will NEVER increase like you fear. If carrier profits ever approached anything close to what you are saying numerous other entrants into the market would drive them back down. There is no historical basis for your claim but decades of proof it wouldn’t happen. The only way carrier profits could increase like you fear is if Congress artificically limited the market to a few national super carriers…oops thats right that has been a stated goal of liberals for 40 years. I guess we better watch out then.

  64. “As far as fees to hospitals, physicians and healthcare providers, the private insurers are far better equipped to deal with those rates than federal government.”
    And your reasoning for this would be? It hasn’t seemed to work so far in containing costs, so why would it with a 1.5% health tax? Where is all this “competition going to come from? As an MD are you going to negotiate your fees with patient? Are you a primary care doc or a specialist?

  65. While there are many good thoughts and excellent analysis in this thread, I don’t see a single suggestion that will change the upward trajectory of medical costs. Medical costs are a function of fees and utilization. Push down on one and the other rises. This simple function has been at work for over 30 years leading to higher medical costs and we are still not talking about a viable solution.
    It is obvious to me that if one wishes to control medical costs, then one must assure appropriate care. The issue, and only issue, with which we must deal is how to assure appropriate care. I don’t want to quibble about the meaning of appropriate care. I mean care that is necessary and sufficient and provided in a timely manner to solve a patient’s medical problem. One cannot solve the medical cost problem with competition, single vs private payers, universal or limited care, rationing, or any other scheme in current use. If care is not controlled to assure appropriateness, none of these really matter.
    I don’t want to waste time dissing the current systems, but ultimately, there is only one solution and it’s only a question of how long it will take policy makers to recognize it. Care must be coordinated. To keep this short, I’ll say only that we cannot depend on either the care providers or the payer(s)to coordinate care. Both of their fundamental interests lie elsewhere. The care coordinators must be independent of both yet trusted by all parties, payers, providers, and patients.
    I personally worked in a care coordination system and can attest that it drove medical costs down by 30 to 50 percent. I challenge any other health care model to match that performance. Applied in our current system, the savings could largely fund coverage for the uninsured.

  66. The “revamp” or “reform” of the healthcare economics in the United States is merely a continuation of policies and activities directed by politicians with a 10 year plan. Let’s face reality, the problem is now and not 10 years from now when a new political gang can father and promoye another “revamp” or “reform”. The reality is that what is now proposed is piecemeal and has been done before. If done again it will only fail and create another political opportunity in 10 years or less.
    I do agree with the President’s plan to let private industry administer and manage the insurance plan(s) however I have a lot of disagreement with continuing any federal program, including Medicare, Medicaid and the now passed children’s health program. Aside from the military maintaining its own network and structure I would propose a plan to cover all Americans from cradle to the grave.
    I would fund this plan with a health tax on all gross earnings of every individual in the United States and while I am not equipped to justify the figure I have been told by many individuals with knowledge and experience that this could be done with a tax of 1.5%. By individual, I mean every real person and every legal individual or corporation. This a tax on gross earnings with no allowed deductions.
    As far as fees to hospitals, physicians and healthcare providers, the private insurers are far better equipped to deal with those rates than federal government. The mere fact that the three major insurers turned a profit on their Medicare Advantage products while the Federal lost money for the same time period is really adquate proof of their ability to effectively manage.
    As to other bloggers who are concerned about care denials, I would propose that there are three critical steps that must be taken and this would require federal and state action. A first step is to define the health coverage and I would propose the acceptance of the plan currently in place for the senators and congressmen as the health care coverage to be available to all residents.
    The second step is to make it mandatory that the private insurer invoved with accepting the enrollees must offer that plan to all residents of a state or region (an area larger than a single state to provide a reasonable population base) and the premium would be the same for all enrollees of that state or region. The insurer must make that plan available to all residents of that state or region and the premium would be paid through the central agency responsible to the insurer on an enrollee basis.
    The third critical step is the elimination of the various risk pools currently in use by Insurers that deal with not health factors such as the size of a business or the zip code of an enrollee. There would be a single risk pool applied. That date would arise from the actual experience for that state or region or even a national risk pool.
    This plan would end employer control of the plan and all contributions from employers but would make all industries, including healthcare and healthcare insurers cognizant of healthcare costs. A 1.5% tax on gross earnings would apply to all and its distribution to the insurer would be a federal charge.
    The above plan is a national system but is not nationalized healthcare and it would allow what we as Americans have always proven. That is that the entrepreneurial system fostering competition will produce the best results for all. It also will end the abomination of dependence on employment for affordable healthcare.
    There are other aspects to what I propose but they are numerous an involved to be mentioned or even ennumerated in the simple blog.

  67. > How can anyone in Massachusetts think this law is ok?
    I really don’t know. In Massachusetts “insurance” is supposed to mean “somebody else pays” and this silly law says “no, you pay”. It’s just gotta go — it is SO un-Massachusetts.
    t

  68. This is my experience with Massachusetts health care reform;
    Health insurance plans are not affordable and have high dedutables.
    Because of the individual mandate I was forced to sign masshealth application which states the state can recover my assetts when I die.Sign this document or be fined.
    Discriminated by income and age.I will be charged double from a younger person.As with income;middle income pays double from low income brackets.
    The fact is if anyone makes any extra money it will increase your payment.
    This only encourages welfare.
    If a person does not sign up they will be fined through DOR.
    The Massachusetts lawmakers turn a blind eye to any and all complaints,so does the Governor’s office.
    How can anyone in Massachusetts think this law is ok?
    My hope is someone will put a stop to this madness.

  69. Deron, eliminating for-profit insurance and promoting healthy life styles are not mutually exclusive. We all agree that the solution must actually be an aggregate of multiple changes. Eliminating profiteering from health care is just one piece of the puzzle, but a critical one.
    Let’s assume that we spend the HIT money wisely (big assumption) and we are able to improve efficiency, reduce duplication of tests, increase generic usage and reduce costs overall. What do you think is going to happen? Are patients going to pay less for coverage? Are physicians going to see higher reimbursements? I don’t think so. The result will be that the profits of private payers will increase by leaps and bounds. Is that what we are trying to achieve?
    Yes, I know that Medicare/aid will see some savings as well, but is that enough bang for the buck? Can we do better?

  70. “Contrary to what the media and single payer proponents are telling you, insurers don’t make people sick.”
    No, they just yank their coverage when people are sick.

  71. “As the budget details come out over the next few days the question we all need to be asking is, Just what is this administration willing to do to make health care affordable over the next ten years?”
    Good question Bob. I can tell you what they’re not going to do: attack the real cost drivers.
    $19 billion to be spent on HIT and only $1 billion spent on battling chronic illness and encouraging healthy behavior. What a joke!

  72. Don’t mistake health insurance for health care. Health insurance companies do not drive the cost of health care. I’m not particularly thrilled with their profits and executive salaries, but focusing on them will not get you very far in terms of cost containment. Contrary to what the media and single payer proponents are telling you, insurers don’t make people sick. People make people sick.

  73. Congressman John Conyers has introduced HR 676, THE UNITED STATES NATIONAL HEALTH INSURANCE ACT, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services. Only a single-payer approach will end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor, and has resulted in 50 million Americans without healthcare.
    HERE’S WHAT YOU CAN DO TO HELP:
    E-mail, call or write to your Senators and Representatives and ask them to support HR 676 – SINGLE-PAYER healthcare reform. You’ll find easy contact information here: http://www.usa.gov/Contact/Elected.shtml

  74. Why isn’t anyone really looking at why our healthcare costs are so high?
    Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-diminishing insurance denials.
    HEALTH INSURANCE COMPANY PROFITS IN 2007:
    1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
    2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
    3. Aetna Inc. — $ 1.831 BILLION
    4. CIGNA Corp — $ 1.115 BILLION
    5. Humana Inc. — $ 834 million
    6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
    7. Health Net — $ 194 million
    The huge insurance company profits—BILLIONS EACH YEAR—could provide quality healthcare for millions of people, and to pay physicians adequately for their work.
    We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.
    The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/

  75. Robert wrote: “Affordability will have a lot more to do with the how this administration deals with the $2.5 trillion we already spend every year not whose taxes we can raise.”
    I fully agree with you. But I don’t see how a significant change in the total spend is coming this year, or next. That will be the second wave of health care reform under Obama, probably in the second term.

  76. Dan D – The stimulus included $10B for the NIH and upped the annual budget from $29B to $39B. That’s huge and the floor essentially for future NIH funding is now set at least $40B annually.

  77. Dan,
    This is an old canard, hopefully succesfully discredited at least among THCB readers. Promotional budgets are larger than R&D budgets … and don’t forget that R&D includes studies for new uses of established drugs, and development of the so called “me too” drugs (i.e. pharma comp. x wants a statin, or triptan, or whatever succesful class, “too”).
    If the Obama admin. just offers a well run public plan (an improved medicare), it will, as B. Sagdiyev put it, “crush” all private competitors in open competition, except for some very well off who will insist on gold plated health care and choose commercial insurance since they are able and willing to pay the price.

  78. If the $634 Billion is any indication of Obama’s health care plan, Obama is planning a radical change in the health care system. The plan has not yet been laid out and already Obama is earmarking more than half a trillion for it and explaining that it will just be the beginning of what will be necessary.
    One of the reasons that health care seems to be so expensive (among many others) is the cost of research and development in order to procure new treatments and drugs.
    At the moment the health care industry has a significant incentive to pour money into research and development because of the possibility of making money. What will happen when this incentive is marginalized when the government has taken over the health care system? Will our advancements slow down or even cease?
    http://www.weeklypoint.com/2009/02/26/obama-budget-plans-634-billion-down-payment-for-health-care-reform/

  79. Robert writes, ” . . . in no event would they get the full $175 billion in savings [from Medicare Advantage] because it is simply impractical to implement such a major change in the Medicare Advantage program by the next enrollment season which begins late this fall.”
    According to the charts at the end of the budget message, the first cuts in MA ($11 billion) won’t come until FY 2012.

  80. On Tuesday night, February 24, President Obama announced that he was initiating a major healthcare reform and that portions of it are to be completed by the end of this year. As a healthcare consultant, I sincerely question what is going to be reformed when the Obama Administration does not have a cabinet member appointed over Health and Human Resources. In addition to having no leader in place, there are no committees in place and no corresponding Congressional committees in place; therefore, we must fear healthcare reform being conducted in a vacuum! Finally, I am the first person in line to suggest that we must address healthcare reform and its various components, but it is extremely terrifying to think that a few people who do not work and live in our industry are going to try to significantly affect it.
    John O. Goodman, President
    J O Goodman & Associates, Inc.
    jgoodman@jogoodmanassociates.com
    http://www.heartandvascularblog.com

  81. I say tax the rich for a while until we can really reduce costs long term in a more meaningful way.
    This will require systemic changes that include-
    – more primary care
    – more home care
    – more prevention (individual and institutional)
    – more public health
    – more ethical and compassionate rationing especially at the end of life
    – more rigorous efficacy and safety standards
    Then maybe we can achieve the holy grail of HEALTH CARE SYSTEM SUSTAINABILITY?
    Dr. Rick Lippin
    Southampton,Pa

  82. No help for uninsured/underinsured. Same as usual with still projected 20% GDP healthcare bill. Don’t call me Pres. Obama until you really have something worthwhile.

  83. The CBO scoring of the Medicare HMO/Advantage proposal doesn’t register savings until 2012, so I’m not sure the post’s pessimism re: the infeasibility of the policy is on target … it’ll take a few years to generate the new bidding process, but the numbers pile up in the outyears.

  84. Do you want a for-profit business making decisions about your health care?
    For-profit health care insurers can deny doctor recommended treatments based on their bottom line and sometimes people die.
    But the CEOs still get their bonus at the end of the year.

  85. I see the Obama plan is more realistic in trying to reform health care than your previous article “For the Obama Administration Health Care Reform Will Require Tough Cost Containment”. It is not possible to move a large mountain appreciably over a short period of time.

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