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The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

Yesterday, the Democratic Caucus of the House listed the provisions of the health reform bill that will take effect “as soon as health care passes,”

The legislation would:

  1. Prohibit pre-existing condition exclusions for children in all new plans
  2. Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
  3. Prohibit dropping people from coverage when they get sick in all individual plans
  4. Lower seniors prescription drug prices by beginning to close the donut hole
  5. Offer tax credits to small businesses to purchase coverage
  6. Eliminate lifetime limits and restrictive annual limits on benefits in all plans
  7. Require plans to cover an enrollee’s dependent children until age
  8. Require new plans to cover preventive services and immunization without cost-sharing
  9. Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions
  10. Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.“By enacting these provisions right away, and others over time” the Caucus declares, “we will be able to lower costs for everyone and give all Americans and small businesses more control over their health care choice.”

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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  3. To help cover the sick and the poor is a FASC Concept that states that to build a Health Care Forum within our Government Institution is a Peoples right to do so and this is Protect Under the Constitution as a Human and Civil Right. So in plan words if the poor and the sick could only afford to pay $5.00 to $10.00 per month this would to bring a balance toward the broken tax system, to add up this number 32 million to 100 million sick and poor people x $5.00 per month. This will place back into the system $116 million $to 500 million dollars per month. The cause and effect of this will reduce the purposed Health Care Tax Forum, to bring about a reduced effect so not to a over  burden system. Take my faith in this and almost all the poor and sick would be happy to pay in and help rebuild the United States failed tax system. Also To bring about a balance of trust lost between the people and Officials.
     Under a Federal Health Care Group built by my friends and I. {You see the poor, as you see them}, as for them they see them self not poor, but of a different race of people and environment and have faith it that which was in the past that so many do not have a clue of what God and Country is all about.
      Will be up dated today  3/25/2010
    Issue 1.
    FASC tax and pay in Forum, A Concept to help the Poor and Sick.
    FASC Concepts of a guideline of income and a fair payment for the poor to the rich.
      CLASS                                            INCOME                                                    MONTHLY PAYMENTS
     {A} formatt for people making up to $29000.00 per year, EST of monthly cost up to $40.00 per month
     {B}                                       up to $19000.00 per year, EST of monthly cost up to  $30.00 per month
     {C}                                       up to $12000.00 per year, EST of monthly cost up to  $20.00 per month
     {D}                                       from 0.00 income to $9000.00 per year /   cost up to 0.00 to $10.00 per month
                                                                                 MIDDLE CLASS TO THE  POOR
     {A} {B} {C} {D} classification based on one person If married policy can be devided or stayed. These are concept numbers to open the mind…………..
      Submitted by Marh Hidabrand,asked would it not be better to build on , instead of droping off of the {A}{B}{C}
     {E}                                       up to $49000.00  per year,EST of monthly cost up to     $50.00 per month
     {F}                                       up to $59000.00  per year,EST of monthly cost up to      $60.00 per month
     {G}                                       up to $69000.00 per year,EST of monthly cost up to       $70.00 per month
     {H}                                       up to $79000.00 per year,EST of monthly cost up to       $80.00 per month
     {I}                                        up to $89000.00 per year,EST of monthly cost up to       $90.00 per month
      To balance a payment plan to fit within the bills, within a home……….{J} {K} {L} {M}     exc………………….
      Need to balance to stay around $200.00 for above income and below $300.00 for the rich ?
      The same incentives apply if husband and wife wish to pay separate.
       The same incentives apply for the poor, even if all they can pay is $3.95 per month. No one is cut out of the rebuilding of the inter structure of Health care and the USA.
      The money is a investment into our further and is to be tax free, just the money paid in.
     
     You may ask: what about Medicare ? {is it not possible to merge Medicare into this concept ?}
     With in this movement the {A} {B} {C} {D} will remove health care from a company so that  a company can see into the building of other projects and put people back to work.
      With the formatted goal of the use of this new concept, to form a more perfect Union within the design of the Health Care program offered, we submitted the up to 2 Trillion dollars per year. This will build a safety net / a buffer to maintain balance.
      The  billion dollars per year is at a high EST. based at $10.00 x 250 million people. As you can see the numbers above suggest a very high in pack of funds, we can not project a high in pack because dollars are not a constant.
    at 100 000 000 million people x 10= $1 000 000 000   billion low ball figures
    1 billion x 4 weeks = $4 billion dollars
    4 billion x 12 months = $48 billion dollars
    so at 100 000 00 the numbers would have to increase to $40.00/per month x $40.00
    $40.00 x 48 000 000 000 = $1 220 000 000 000 per year at 100 000 000 people
    In the US the progression is:
    Hundred – 100
    Thousand – 1,000
    Million – 1,000,000
    Billion – 1,000,000,000
    Trillion – 1,000,000,000,000
    Quadrillion – 1,000,000,000,000,000
     and the interfacing of the FASC Card  http://www.federalactsecuritycard.mysite.com
      We need to see into the inter structure of the Presidents concept,without this right we can not help,no matter how much we wish to. It would seem that if you do not play follow the leader on just one concept ,that the door is not really open.
      We offer the following concepts and we believe that it will be one that all can respect. 
    FASC Concepts of a guideline of income and a fair payment for the poor to the rich.
    This is a concept to build on…….a idea, a way to bring life to hope where there is none.
      CLASS                                            INCOME                                                    MONTHLY PAYMENTS
     {A} format for people making up to $29000.00 per year, EST of monthly cost up to $40.00 per month
     {B}                                       up to $19000.00 per year, EST of monthly cost up to  $30.00 per month
     {C}                                       up to $12000.00 per year, EST of monthly cost up to  $20.00 per month
     {D}                                       from 0.00 income to $9000.00 per year /   cost up to 0.00 to $10.00 per month
                                                                                 MIDDLE CLASS TO THE  POOR
     {A} {B} {C} {D} classification based on one person If married policy can be divided or stayed. These are concept numbers to open the mind…………..
      Submitted by Marh Hidabrand,asked would it not be better to build on , instead of dropping off of the {A}{B}{C}
     {E}                                       up to $49000.00  per year,EST of monthly cost up to     $50.00 per month
     {F}                                       up to $59000.00  per year,EST of monthly cost up to      $60.00 per month
     {G}                                       up to $69000.00 per year,EST of monthly cost up to       $70.00 per month
     {H}                                       up to $79000.00 per year,EST of monthly cost up to       $80.00 per month
     {I}                                        up to $89000.00 per year,EST of monthly cost up to       $90.00 per month
      To balance a payment plan to fit within the bills, within a home……….{J} {K} {L} {M}     exc………………….
      Need to balance to stay around $200.00 for above income and below $300.00 for the rich ?
      The same incentives apply if husband and wife wish to pay separate.
       The same incentives apply for the poor, even if all they can pay is $3.95 per month. No one is cut out of the rebuilding of the inter structure of Health care and the USA.
      The money is a investment into our further and is to be tax free, just the money paid in.
     
     You may ask: what about Medicare ? {is it not possible to merge Medicare into this concept ?}
     With in this movement the {A} {B} {C} {D} will remove health care from a company so that  a company can see into the building of other projects and put people back to work.
      With the formatted goal of the use of this new concept, to form a more perfect Union within the design of the Health Care program offered, we submitted the up to 2 Trillion dollars per year. This will build a safety net / a buffer to maintain balance.
      The  billion dollars per year is at a high EST. based at $10.00 x 250 million people. As you can see the numbers above suggest a very high in pack of funds, we can not project a high in pack because dollars are not a constant.
    at 100 000 000 million people x 10= $1 000 000 000   billion low ball figures
    1 billion x 4 weeks = $4 billion dollars
    4 billion x 12 months = $48 billion dollars
    so at 100 000 00 the numbers would have to increase to $40.00/per month x $40.00
    $40.00 x 48 000 000 000 = $1 220 000 000 000 per year at 100 000 000 people
    In the US the progression is:
    Hundred – 100
    Thousand – 1,000
    Million – 1,000,000
    Billion – 1,000,000,000
    Trillion – 1,000,000,000,000
    Quadrillion – 1,000,000,000,000,000
     and the interfacing of the FASC Card  http://www.federalactsecuritycard.mysite.com
      We need to see into the inter structure of the Presidents concept,without this right we can not help,no matter how much we wish to. It would seem that if you do not play follow the leader on just one concept ,that the door is not really open.
      We offer the following concepts and we believe that it will be one that all can respect.
      A FASC Concept, Children should be covered by moms or dads coverage at no extra cost. I once heard that their was a saying that is within the Christian world, it is in the best of man that through a concept of God, that He smiles on those who help the poor. Now this is your faith, as shared with people. 
     

  4. do the idiot right wingers really believe they have more weapons and more soldiers than us? they better think again before we eat them and piss on the soles of their families, excuse my french. we can do it and we intend to do it if necessary. they should leave well enough alone, or else.

  5. We have unknowingly harming and even killing our children and pets. We are giving them cancer and other diseases they are unaware of.
    Please review the sites below.
    They will show you how.
    Spring and Summer are upon us. Arcenic wood is a killer.
    Help me to spread the word. There is a fix, however this healthcare problem is nation wide.
    http://www.ewg.org/node/8700
    http://www.ewg.org/reports/poisonwoodrivals
    http://www.ewg.org/node/20370
    http://www.ewg.org/reports/poisonedplaygrounds
    http://www.ewg.org/node/15160

  6. This will sound like a stupid question (maybe it is), but what does “as soon as health care passes” mean?
    Also, for #1: I have insurance, which excludes my child’s pre-exisiting condition (which I have to pay for out of pocket). They told me today (3/23) that they will still exclude my child’s condition because it is an existing plan. So I have to drop my plan and purchase a new plan? Is that how this works?

  7. problem is the “puppy’s are dying so we must do something quickly” always leads to a knee jerk reaction that ends up (always in the governments case) to cause an enormous unintended problem as it tries to solve the existing one. case in point soc sec and medicare. these two programs, while they were deemed necessary to help those who could not help themselves have cost us dearly, medicare is 30+ trillion in debt and the soc sec trust fund is far beyond bankrupt and is loaded with IOU’s from mostly democratic but in truth both parties having raided it over the years… no doubt something needs to be done but this solution is a bad thing for the health care situation and the country’s economic outlook for decades to come… I have to blame the progressive takeover of the democratic party, they have wanted this for decades and now have the control they wanted, time for democrats to wake up and smell the coffee and kick that rats out of the barn… seriously is having the IRS and the federal health bureau, that will be created by mandate of the bill to manage your care, really what you want – or was it just some fair treatment by ins. companies you were after… this will effect us all badly, it will only take time to see that…

  8. MATTHEW HAS CONVINCED ME
    Going on welfare. No need to excel now. Be just like the UK and France.
    All you working slobs, have a nice time, supporting us welfare bums.
    We don’t appreciate what you do, and if you try to stop working, we’re going to protest, like all the ILLEGALS in D.C. today.
    Going for some beers now, and get some ‘rays. Keep working — Obama has created more welfare folks.

  9. DO NOT BELIEVE YOUR LYING EYES OR THAT LYING CALCULATOR
    No. 1 STEAL-O-CRAT LIE — “we know more, so STFU.”
    Bull.
    START OVER — TOO MANY LIARS.
    http://www.indexmundi.com/switzerland/ethnic_groups.html
    +++++++++++++++
    “How many Africans, Latinos and ILLEGALS live in Switzerland? Only six percent — not nearly 50% in USA.”
    Actually, Switzerland has one of the highest immigration rates in the world. One quarter of its population is foreign-born.
    +++++++++++++
    SWITZERLAND:
    Ethnic groups:
    German 65%
    French 18%
    Italian 10%
    Romansch 1%
    other 6%
    Definition: This entry provides an ordered listing of ethnic groups starting with the largest and normally includes the percent of total population.
    Source: CIA World Factbook – Unless otherwise noted, information in this page is accurate as of September 17, 2009
    WOW! What a lot of WHITE immigrants!
    Facts — the tax-loving liberal’s worst enemy. Right after calculators.
    Howl at the moon if you want, liberals. But 2+2 will still equal four. Duh.

  10. I’m willing to relax and see what happens when the bill passes. Can’t be any worse than the mess Bush left this country in a year ago.

  11. Harris, James, Peter, Barry, Nick, Paola, Nikc, Frustrated,
    Harris– Yes, I totally agree about # 9–thanks for highlighting it.
    James- Under the reconciliation bill the Federal govt is offering substantial help to all states — I believe (not entirely certain) that Washington is cover 100% of additional costs as well as extra money to states that were already covering childless adults.
    Peter– Good point.
    But brand name hospitals that overcharge are already being “outed” in Massachusetts– and these are essentially good brand-name hospitals . But they’re charging too much
    I think you’re going to see more and more of this “outing”–even before reform rolls out. More and more people are calling for “transparency” in hospital pricing. It’s not just that some hospitals charge more than others, but the secrecy surrounding the deals they make with insurers is becoming better-known.
    See my post on Maryland on “HealthBeat” (www.healthbeatblog.org) In Maryland, the state sets the rates for all hospital charges, adjusting for differences in local prices, how many Medicaid and uninsured patients the hospital sees (eating the losses on Medicaid and the charity care), whether it has extra expenses because it is a teaching hospital, etc.
    All insurers pay hospitals the same amount–i.e. the rates that the state sets for that hospital. t. Medicare and Medicaid also pay these set fees–Medicare has agreed to do this as long as growth in its reimbursements for hospital care in Maryland remain below the national average–and it has. Meanwhile, non-profit hospitals have more stable revenues, and average a 2% to 3% surplus- which gives them v. good bond ratings. And when you look at insurance premiums as a percentage of income, Maryland is the lowest in the U.S. A win/win all around. Quality is also very good if you compare an academic med center like Hopkins to academic med centers in other states.
    This system has been workign in Maryland for more than 30 years. (Many other states were doing the same thing–but in the 1980s, as Republicans took over state governments, they were anti-regulation and killed the programs. Democrats managed to hold onto Maryland.)
    It was a pretty wonky post; I was surprised to see it re-posted . . . seems to be much interest in the idea.
    Will it work everywhere? No. But I wouldn’t be surprised if some states try it. (It would be hard for Washington to do–you really need to know the hospitals, what patients they are seeing, etc.. Though states would need Federal oversight to avoid corruption, pay-offs, etc.
    Finally, and most importantly, Medicare, which pays 40% of hospital bills, is going to get much, much tougher with hospitals–including brand name hospitals–refusing to pay for preventable readmissions, errors, and inefficiency.
    Under the reconciliation bill, for the first time Medicare will have the power to roll out pilot projects that change what it pays for, and how it pays– nationwide– without needing to go through Congress.
    This is HUGE. In the past, many pilot projects have been very successful–but Congress (and lobbyists ) killed them. This will no longer happen. Medicare will be able to turn these pilot projects into nationwide Medicare policy.
    Meanwhile, will brand-name hospitals start telling Medicare patients– “we no longer do by-passes because Medicare doesn’t pay enough.” Not on your life. I can’t think of a hospital in the U.S. that could keep it’s doors open if it didn’t have Medicare patients.
    And going forward, the number of Americans on Medicare/ Medicaid is only going to increase.
    Barry– A very good question.
    The answer, I think, lies in the fact that Zurich is a very expensive city (I’ve been there.) Probably very few people in Zurich qualify for a subsidy. And my guess is that premiums in Zurich are significantly higher than in other parts of Switzerland because the cost of labor and real estate are much higher.
    I also thought premiums sounded high — particularly for families. Though the Swiss are nearly as over-medicated as we are, and pay a very high price for drugs (since Pharma is a big part of the economy.) And perhaps they make premiums lower for individuals because many of those singles are younger and healthier, while making premiums higher for families where mother or father are likely to be older than singles. This is just a guess.
    But I did keep searching, and everything I found suggests that premiums for the “basic benefits” are high in Switzerland–and that the “basic benefits” are what you and I would want for our families.
    And at least one source said that people are expected to spend 10% of gross income before getting a subsidy. Europeans are accustomed to spending more of their own money on healthcare (and taxes to provide healthhcare to others) than we are.
    Finally, the NYT story that provided the numberswas a pretty recent, long story–and there’s no correction. I have to think that if it was way off-base, someone who lives in Switzerland, or has friends or relatives in Switzerland would have written in. . . The Times is not always accurate in its interpretations of things, but it doesn’t usually get numbers just totally wrong . . . (Or if it does, there is a correction.)
    Paola– Thanks for setting the record straight on diversity of the Swiss population.
    Nick– Politco.com has announced that the memo who are referring to was a fake– circulated by the Republican party.
    Frustrated– Unfortunately in places where there are more doctors, doctors’ fees are higher! Market competition just doesn’t work in healthcare the way it works in other markets. People assume that the more expensive doctor is better. And when you’re really sick, you’re not looking for a discount doctor. (80% of our healthcare dollars are spent when people are very sick.)

  12. I’m not sure how I feel about this particular bill. It could be a start, but it has potential to be a problem. Personally, I think the focus should be on cost control first. According to a study done by PriceWaterhouseCoopers, over half of all money spent on healthcare is spent unecessarily. Then on top of those corrections, allow the sale of drugs manufactured in other countries to be sold here, retract the law that only allows 100,000 new doctors a year into the system (this was put into affect due to lobbying by the AMA), and create a single payer system that will give us buying/negotiating power. This will lower overall costs, lower individual costs, and cover everyone.

  13. “but only after the group has been max rated.”
    Ok, what was the upcharge for the group?

  14. DO NOT BELIEVE YOUR LYING EYES OR THAT LYING CALCULATOR
    No. 1 STEAL-O-CRAT LIE — “we know more, so STFU.”
    Bull.
    START OVER — TOO MANY LIARS.
    http://www.indexmundi.com/switzerland/ethnic_groups.html
    +++++++++++++++
    “How many Africans, Latinos and ILLEGALS live in Switzerland? Only six percent — not nearly 50% in USA.”
    Actually, Switzerland has one of the highest immigration rates in the world. One quarter of its population is foreign-born.

  15. Why are democrats being told to avoid talking about the details of the CBO score?
    Explicitly. From a Thursday memo on the subject:
    “We cannot emphasize enough: do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. Instead, focus only on the deficit reductions and number of Americans covered.”
    Emphasis theirs, not mine. Also:
    “The inclusion of a full SGR [‘sustainable growth rate’ – ML] repeal would undermine reform’s budget neutrality. So, again, do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. Instead, focus only on the deficit reductions and number of Americans covered.”
    “As most health staff knows, Leadership and the White House are working with the AMA to rally physicians support for a full SGR repeal later this spring. However, both health and communications staff should understand we do not want that policy discussion discussed at this time…”
    I’d ask what they were so afraid of, but I already know the answer – and so do you. A rush job is never good for anyone and this bill is going to wreak havoc on the healthcare of this nation and the envy of the world.

  16. Random thoughts (I forgot my tele-prompter) in response to the half wits list and subsequent comments:
    1) WellPoint increase premiums 29%, Obamacare increases taxes on old people by 31%
    2) Americans generally, (until recently) are not like the Swiss or the Germans or the Canadians. We are not rule followers (Slaughter House maneuver). Entrepreneurs are founding father, rugged, individualist’s types. Make me cover a 26 year old dependent (dependent being the operative word) on my company’s group policy, and I cancel dependent coverage for everybody. I promise not to tell all the other employees it was your dependent that encouraged me to cancel dependent coverage (at least not in a provable way).
    3) America is not like Switzerland. We have let in a lot of fuzzy, ill smelling, penniless, foreigners…like most of our forefathers. Switzerland does not.
    4) Pre-Existing Conditions of children are always covered under insurance policies in my state if you bother to buy the coverage before the child is born or gets sick.
    5) Why limit dependents to age 26. Why not let the parents add their loser kids to their Medicare policy…oh yeah, that is what we are doing.
    I’m learning to speak Costa Rican. Thanks for listening. LD

  17. so hot swedish bikini models are 25% probobility not Swedish???? Does that make them just hot bikini models or is none of it real to start with?

  18. “How many Africans, Latinos and ILLEGALS live in Switzerland? Only six percent — not nearly 50% in USA.”
    Actually, Switzerland has one of the highest immigration rates in the world. One quarter of its population is foreign-born.

  19. no Peter, the cmpanies policy said dependets over 19 had to be full time students. Then the state passed a law saying carriers had to cover dependents that are unmarried until age 29.
    When a sick over age dependent is added to the plan the groups rates go up to cover those claims. As I told Margalit there is a slight amount of pooling the claim over the carriers entire block but only after the group has been max rated.

  20. “The policies were canceled b/c the patient got sick.”
    Actually no Bev, the policies were audited becuase they got sick they were cancelled, like I have said, becuase they lied. There is a difference, you on the left like to pretend there isn;t because they make for great sob stories but the fact remains NO ONE that was honest on their app has ever been canceled for being sick, something your argument doesn’t allow for.
    Also prettier then I look, I like setting the bar low

  21. “this group was fully insured not self funded and they didn’t have a high deductible.”
    So, the company policy stated specifically it did not cover dependents and their carrier had no legal obligation to cover the dependent but the State said the company had to pay out of it’s own pocket? If that’s true Nate you’ll need to get me a link.

  22. Nate;
    The policies were canceled b/c the patient got sick. The invented reason for canceling the policies was b/c the patient (supposedly) lied on their application, which provides a convenient excuse for canceling b/c they got sick. If they (supposedly) lied on their application but never got sick, the insurance would not be canceled, as the premiums would still be collected but no payouts need to be made. All in the semantics, which of course you understand very well b/c you are smarter than you act.

  23. “I suggest you do some reading– particularly about insurers in Cal. Insurers can go back and claim that when the person applied for the policy years earlier he or she “hid” a pre-existing condition that is related to their current health problems and cancel coverage.”
    You just proved my point, they weren’t canceled for being sick they were cancelled for lieing on their application to get a cheaper rate. As an ex journalist you should know how misleading your comment was to claim they are being canceled for being sick when you know full well that isn’t true as yur latest comment shows. This type of disinformaiton and propoganda is why we are in such a mess. Try being honest with the public then maybe the public will support an honest bill. With all the lies why should we trust anything labeled reform?
    “I suggest you read BKM’s comment and tell her that she should have “saved” more so that she could cover the cost of her child’s cancer. ”
    I answered BKM, I think what is even more disgusting is people such as yourself lieing to the public and telling them they can all have the best care available. You can’t even deliver poor care, Medicaid, or so so antiquated care, Medicare, yet you have no problem telling BKM and others we will do everything we can to save every life, complete lies, we must draw the line somewhere and some people will die, it’s reality.
    “Aren’t her claims spread over a much larger pool, such as all small employers contracted with that payer in that state?”
    Yes and no….there that will teach you to interupt rants with informative quesitons. Yes it is pooled but only after the group is max rated. Depending on the state that can be 10% higher then base line or 300%+ of baseline. This groups premiums would have been 40-50% lower minus this one dependent pushed on them by the State to save Medicaid money. If they weren’t pooled it would have been even worse.
    Peter you weren;t thinking, this group was fully insured not self funded and they didn’t have a high deductible. Assumptions will get you every time. There is a difference between an employee buying insurance then having a large claim and the state comming to you and telling you that you will now pay this person’s claim who doesn’t even work for you and is an adult.

  24. praetorius,
    It took CMS 556 pages to write regulations defining which providers are eligible for stimulus incentives and what they have to do to get it.
    556 pages, about 1/5 of the entire health reform bill, to define something that in plain English would probably take 20 pages with a dozen tables.
    I guess that’s how they write in Washington.
    The biggest mistake the Dems made was failing to provide a good summary early on.

  25. Maggie,
    Why is the bill so long? Maggie for Congress. There would be less animosity if people learned to read or had the benefit of your edits.
    The problem with the bill is its failure to address the genesis of the high cost and low quality conundrum which is 20 years of government policy itself.

  26. Barry, this doesn’t look bad:
    http://www.osec.ch/internet/osec/en/home/invest/worldwide/handbook/living_in_switzerland/income_cost_of_living.html
    and this:
    According to an AC Nielsen Euro-Barometer study conducted in 2005, Switzerland is one of the most expensive countries in Europe, after Norway, Denmark and Finland. The main items of expenditure in one’s budget are insurance, such as health insurance, invalidity insurance, unemployment insurance and private insurance policies (23% of a typical household budget in 2004), accommodation and energy (17%), tax (13%) and food and clothing (11%).
    Other recurring monthly expenditure includes transport and fuel (12%), restaurant meals (6%), healthcare (5%) and communications (2%). In 2005, disposable income – the amount remaining after compulsory deductions (social security contributions, taxes, basic health insurance, etc.) – amounted to 72.6% of gross household income, averaging CHF 8 967.

  27. “The government provides subsidies to help pay those premiums only if the premiums exceed 8% of your income.
    30% to 40% of Swiss households receive subsidies.”
    Maggie — So, in Zurich, if we use the low end estimate of $14,400 per year for family coverage combined with having to spend at least 8% of income before you qualify for a subsidy and only 30%-40% of the population qualifies, it implies that most of the population, at least in Zurich, makes more than $180K per year ($14,400/.08). This just doesn’t sound right. What am I missing?

  28. “Now 80 hard working people and the employer are forced to pay her $250,000 a year in claims.”
    Nate, since you always talk employer self insured I thought the employer purchased stop loss insurance for the big claims? Also you say the employer and employees are stuck with the claim, I thought you sold them high deductible insurance with a large carrier? And wouldn’t the employees like to know that if they get sick there’s also $250K there for any one of them? The nature of risk is just that – risk, most of the time you win, but a few times you loose.

  29. “Privately they have told Medicare that, in the future if it leads the way in cutting waste and overtreatment, they would be happy to follow.”
    Ok Maggie, would this include reimbursement negotiations with large hospitals that control large percentage of their local market? And which insurance company is going to go first with these “tough medicine” reimbursements? And when patients find that the hospital they were going to suddenly won’t cover certain procedures what do you think they’re going to do – go down the street.

  30. One thing that seems to largely be left out of these discussions are the costs to the states vis-a-vis the changes in Medicaid. We are getting into some serious billions here and the states cannot operate at a deficit to cover the state share of the costs. Any serious discussion of the costs really must include the impact on state governments. Otherwise we have the mother of all unfunded mandates heading down the pike.

  31. Some have previously stated that no one is denied care in the current system and certainly a lot of uninsured patients show up at the ER and get treated and or admitted. Sounds like the same people are now saying that their rates, already jacked up to cover the care delivered to the unisured, will go up a lot more? Isn’t a lot of this uncovered care already figured in the current increasingly high rates? Those opposed – is the predicted increase in utilization via more cost efficient methods (primary care for instance)that is predicted to occur when unisured become insured a lot higher than the very cost-inefficient ER care that is currently being delivered?
    And lets get over the idea that suddenly the majority of people are going to lose weight and act responsibly any time in the near future.
    I agree with Nate when I see someone reaching for my wallet but on the other hand I want kids covered with effective care regardless of the economic sins of their parents.
    I guess I just need to get harder and tell the acute MI that we can’t let him sit in the ER until his daughter gets the payday loan approved.
    Hopefully we can convince the Core Measure overlords to include language to the effect that Quality Care definitions that are time or resource related will be tiered according to ability to pay:
    For those with independent means, the Platinum AMI plan standard, which incorporates best evidence, will be door to balloon of less then 90 minutes. Platinum plan patients will be seen first and treated first.
    Gold AMI plan patients able to pay on an ammortized schedule will be seen after platinum plan patients.
    Bronze and tin plan patients will be seen only as time and the charity fund allow and are excluded from Core measures.
    Performance on the AMI core measures will be publically posted for each plan, so each economic class of Americans can decide which hospital serves their economic class best.

  32. Nate, maybe this angry thread is not the place to ask informative questions, but I would like to understand.
    You say that “Now 80 hard working people and the employer are forced to pay her $250,000 a year in claims.”
    Aren’t her claims spread over a much larger pool, such as all small employers contracted with that payer in that state?

  33. ALREADY COVERED
    “Being able to get specialist treatment makes a difference in pediatric cancer, and lots of kids are shut out due to insurance problems.”
    Sir, all sides have agreed to regional/national coverage pools for cancers, et. al. That is a settled issue.
    It is the STEAL-O-CRATS who have added 2,700 pages of SOCIALISM to your son’s problem.
    Blame STEAL-O-CRATS, not others.
    Shame on you, STEAL-O-CRATS, Socialists, and Commie-lovers.

  34. WRONG, WRONG, WRONG
    CBO said Medicare was going to be 1/10th of what it is today.
    Why should anyone with a brain believe the CBO?
    Get out a calculator and start adding. This is a MESS.
    And a lot of flat-out lying by incompetents who could not hold a job in a solvent organization. They refuse to guarantee this will work — shame on them.
    ——————
    “Today’s news about the CBO mark-up make it all but certain that the bill will pass.”

  35. It’s interesting that immediate benefit #9 in the current health reform bill — giving consumers an effective right to an external appeals process when a health insurer denies benefits — has gotten so little political and media attention. It was the center of a huge political battle in the late 90s when McCain and Kennedy and the Dems proposed the bipartisan HMO patient rights bill and got shot down by the insurance industry. It’s just one of many good provisions in the bill which hasn’t received adequate attention.

  36. ndrew, Peter, Everyone, Discouraged MD, Margait
    Andrew & Paola-
    Yes, the Swiss system is very good. But you don’t seem to understand that what the Swiss define as “basic” benefits are equivalent to what this legislation promises everyone.
    The Swiss’s definition of “basic” is very high. To get an idea of how rich the basic benefits package is consider this: In Zurich a family plan for a family of four that offers the “basic” benefits costs roughly $1200 to $1500 a month– or $14,400 to $18,000 a year. A single adult pays $350 to $400 a month or $4200 to $4,800 a year (New York Times 20009)http://www.nytimes.com/2009/10/01/health/policy/01swissbar.html
    The government provides subsidies to help pay those premiums only if the premiums exceed 8% of your income.
    30% to 40% of Swiss households receive subsidies. The other 60% to 70% pay for them in higher taxes. (Wealthy people in Switzerland pay significantly higher total taxes than wealthy Americans pay here.)
    Everyone in Switzerland is required to buy this basic insurance and insurers must charge everyone the same price, regardless of age or pre-existing conditions.
    The supplemental policies that people can buy cover dental, private rooms in hospitals and greater choice of hospital. But the basic package covers everything that we would cover under our reform legislation–in other words, virtually everything that you or I might want..
    Peter– You ask a reasonable question: If Medicare saves money through reforms, won’t hospitals and docs just charge people under 65 more to make up for their losses?
    Answer: Private insurers also would like to cut reimbursements by cutting waste inefficiency and overtreatment. But when they tried to do that in the 1990s, they wound up on the evening news, accused of killing people by denying care. (Part of the problem is that sometimes they refused to pay for unnecessary care, but sometimes they refused to pay for needed care.)
    There was a huge backlash from the public and the media, and insurers said okay, we’ll pay for almost anything– and pass the cost along in the form of higher premiums.
    Privately they have told Medicare that, in the future if it leads the way in cutting waste and overtreatment, they would be happy to follow. (I have this on good authority– the head of MedPAC.)
    Private insurers just want Medicare to provide political cover. But they would love to be able to cut spending And cut premiums because then they would gain market share.
    Keep in mind: their one goal is higher profits. If they can make more money by charging lower premiums and gaining market share, they would be happy to do that.
    Meanwhile, Medicare (which has enormous market clout) will be highlighting the waste, inefficiency and preventable medical mistakes in the system.
    Medicare’s reforms will ripple throughout the system. First, hospitals will have to clean up their act to meet Medicare’s demands for more efficient care. (Medicare pays about 40% of hospital bills.) Hospitals are not going to
    reduce infection rates only for Medicare patients–but for everyone. Their going to start using check-lists during all surgeries, etc. They are going to take more time with discharges so as to avoid preventable readmissions (which Medicare will no longer pay for.)
    Meanwhile, more and more doctors are going to join accountable care organizations (Medicare will be rewarding docs who do this) where they will be on salary. Fee-for-service encourages over-treatment. Salary doesn’t. Again, everyone saves.
    Many fewer docs are going to be leasing or buying diagnostic testing equipment because Medicare is slashing fees for tests done in the docs’ office. We know that when they have the equipment they recommend twice as many tests–that’s how they pay for the equipment. If Medicare slashes fees, it won’t be worth it to buy or lease the equipment-
    I could go on. But Medicare is such a large force in the marketplace that it will change the way everyone does business. In addition, Medicare reforms are also like to be adopted by Federal Employees Health Insurance. If you
    include what the governmentpays for federal employees as well as Medicare/ Medicaid, the VA etc, you find that the government pays more than 50% of all health care bills–and its share is growing.
    Finally, under reform, private insurers will be tightly regulated. They won’t be able to save money by shunning the sick. They won’t be able to over-spend on administrative costs. They’ll have to cut reimbursements- or go bankrupt. So they will be very eager to follow Medicare’s lead.
    Below, responses to two or three more individual comments.
    But first, a general comment to those who object to the idea of helping to pay for comprehensive, high quality care for others– the same care that you would want for yourself
    I’m sorry, but it’s happening. The majority of people in this country believe that, as a civilized society we have a moral obligation to make sure that everyone has access to good health care.
    Today’s news about the CBO mark-up make it all but certain that the bill will pass. (Yes the CBO mark-up is only a guesstimate, but moderate legislators need this guesstimate in order to vote yes.)
    Secondly– on how the legislation saves money as I said, the bulk of the savings do Not come through these benefits.
    The bulk of the savings come through Medicare reforms that cut fees for some services that are over-priced or provide little benefit and Medicare reforms that change the incentives– rewarding docs and hospitals for high quality, not volume, and penalizing hospitals for inefficiency and and preventable medical errors.
    See my reply to Peter above.
    Under the legislation, Congress has little power to stop Medicare from reining in costs. That is crucial
    I realize that some people on this thread prefer name-calling to thinking and reading, but if you are interested in thinking and reading, here is an excellent piece on how the legislation reins in costs by Judy Feder http://bit.ly/8Z4dAd
    Also, see my post here.http://www.healthbeatblog.com/2010/03/peggy-
    noonan-vs-the-new-england-journal-of-medicine.html
    Nate– You suggest insurers never cancel policies when people become sick. I suggest you do some reading– particularly about insurers in Cal. Insurers can go back and claim that when the person applied for the policy years earlier he or she “hid” a pre-existing condition that is related to their current health problems and cancel coverage.
    Also, under the current legislation insurers are not allowed to put an annual or life-time cap on how much they pay out.
    Those caps leave children suffering from cancer uncovered after just a few years.
    I suggest you read BKM’s comment and tell her that she should have “saved” more so that she could cover the cost of her child’s cancer.
    Exhausted MD–
    AS I made very clear in my post, insurers can still exclude adults with pre-existing conditions until 2014, but they must cover children.
    The reason this has to be phased is that a) we need to raise the money for the subsidies that a great many low-income and middle-income adults suffering form pre-existing condtiions will need. (We could simply raise income taxes this year to raise the money, but in the middle of a recession/depression this is not a good idea. Also, the insurance industry is going to have to
    figure out what to do with the many people now involved in figuring out how much to charge sick people. Many of these “underwriters” will be out of a job. In addition, insurers have recalculate how much they need to charge
    everyone in a particular community now that sick people with pre-existing conditions are included in the pool. Premiums will rise sharply in some states unless they can find other ways to save money.
    We’re talking about major structural changes in a $2.6 trillion industry. You can’t just flip a switch and do it without creating serious economic problems.
    It’s terrible that these people will have to wait until 2014– but at least now there is light at the end of the tunnel. This country has let them wait for more than 40 years. Did you work for hc reform in the 1970s? Or in the early 1990s?
    Margait– Thanks for continuing to be a voice of reason in very angry thread.

  37. BKM how much should I have to pay for your decision to have kids? Why do you feel entitled to the fruits of my labor? In a magical world we would all have access to every treatment imaginable and everything possible would be done to extend life, if even for a day. Problem is we don’t live in a magical world were bills are never due. So the question is do you beleive there should be any limits to the amount of my money you spend?

  38. “Nate, I don’t understand how your clients suffered under this regulation? By having an uncovered severely ill child?”
    An employer with 80 employees suddenly forced to cover the 28 year old dependent daughter of an employee. It actually started a few years prior to that when Ohio first passed the law. She hit the plan for $250,000 a year on average.
    Instead of the entire tax paying base of Ohio covering her under Medicaid the government forced her off Medicaid onto this employer plan. Now 80 hard working people and the employer are forced to pay her $250,000 a year in claims.
    It did finally come to an end this year when she got married.
    Why should a small group of employees unlucky enough to work with someone who has an overage dependent child ill or the small business employer unlucky enough to employee them be required to cover the cost?
    It is a terrible law and poorly though out. It’s only purpose was to save the government money at the expense of innoncent people.

  39. “children are at the mercy of their parents and it is not right to punish them for mistakes they did not make.”
    Margalit,
    Children did not make the mistake of electing this bunch of thieves, yet they will be punished forever.

  40. I agree with Dr. Andrew that the basic health coverage guaranteed for everyone should be pretty basic, probably more basic than in Switzerland.
    However, a policy with a low actuarial value (~50%) doesn’t really solve the problem. Such a policy could still induce high costs for both the insurer and the patient, and a low-income patient is unlikely to be able to pay for out-of-pocket expenses.
    What is really needed is a basic policy with high actuarial value but with reduced benefits, restricted network, and strong utilization controls. This ensures that the patient can get the basic care needed, while being able to afford any out-of-pocket expenses.
    Of course, anybody who can afford it can also buy with their own money additional benefits, a wider network, or more permissive utilization controls. Similarly, anybody who has the financial resources to partially self-insure, can choose to save some money by opting for higher deductibles, HSAs, and other policies with lower actuarial value.

  41. Frank,
    I would respectfully submit that the US is not going bankrupt because of the measly spending on critically ill or disabled children.
    I would further submit that the refusal to take care of our less than perfect children is causing America to go morally bankrupt.
    There is no recovery from the latter.

  42. Effective date on the bill is 2014 so the only Immediate Benefits we will feel is the tax increases that are effective ASAP. and The unions will control our health cause all the people in change of our healthcare cause we are all to stupid to know whats best for us. One more benefit it takes one more step closer to big government that we have no control over.

  43. I have a child who is a cancer survivor. He was diagnosed when he was 2 with a cancer that has about a 30% 5 year survival rate. We had insurance, but found out that we were in the category of “underinsured”. We ended up owing about 100K in uncovered expenses. We met many families in even worse situations – kids who had exceeded their lifetime caps after one year of treatment, families who were dropped from insurance, families with insurance that had crazy exclusions. Not having adequate coverage makes a huge difference with pediatric cancer because it makes the difference between being able to travel to a center that specializes in that kind of cancer and having to stay with a local hospital. It makes a huge difference in pediatric cancer because the research and survival rates are increasing so fast. We were able to take my son to a cancer center that specialized in his type of cancer. He went onto a clinical trial. About 4 years later, they published the results – being on that trial gave my son a 60% chance as compared to the 30% chance he was initially given at the local hospital. He is still alive and cancer free today, 6 years later. Being able to get specialist treatment makes a difference in pediatric cancer, and lots of kids are shut out due to insurance problems.

  44. I take a deep breath now…
    I am displeased about this whole debacle for two reasons:
    1. The process has been dishonest, manipulative, one big shell game; and
    2. The focus is all about who gets the money for treatments – treatments which, as the lastest data shows – usually don’t even work (called “band aids” as they mask the cause of the health problem and simply address symptoms, which means the underlying problem becomes “chronic,” which means more treatments for symptoms, more money, etc.)
    FACT: Most disease is caused either by lifestyle choices (what we eat, drink, smoke; whether we move our bodies or not, etc.) and/or environmental factors (stress, toxins in water, air, etc.)
    FACT: Very little disease is biologically based/genetically based.
    And our approach? Very little attention to lifestyle, almost NO attention to environment, bulk of attention on genetics.
    In a word: crazy.
    P.S. For anyone wanting references to my “FACTS,” they are too numerous to post, but a place to start: google “the Cornell-China-Oxford Project.”

  45. “Something akin to the Swiss system whereby everyone in the country gets basic health care. We can decide what is/isn’t included in basic health but if you want more, you buy a supplemental private policy. Insurance companies are private but highly regulated, like utilities.”
    First, let’s look at utility regulation in the U.S. Since electric and gas utilities are extremely capital intensive businesses, they are what economists call natural monopolies. That is, it doesn’t make economic sense to have multiple competitors serving a given geographic region so we’ll just have one and regulate what it can charge. Regulators generally allow utility companies to charge rates sufficient to cover all of their prudently incurred costs including depreciation and the cost of capital, both debt and equity. Residential, commercial and industrial customers all largely pay their own way without much in the way of cross subsidies. The more you use, the more you pay. If you stop paying, your service is cut off even if there is a risk that you might freeze to death, which happens sometimes. U.S. insurance company profits as a percentage of premiums are already quite modest by U.S. corporate standards. Moreover, non-profits control more than 40% of the health insurance market including virtually all of the market in high cost Massachusetts. The bottom line is that health insurance is expensive because health CARE is expensive, not because insurers are earning excessive profits or paying their CEO’s seven figure compensation packages.
    As for the notion of providing basic care, most liberals define basic care as a robust insurance policy comparable to what the Federal Employee Health Benefits Plan offers members of Congress. It probably has an actuarial rating in the high 80’s to 90% or thereabouts. If we’re really serious about bending the medical cost growth curve, we would make a much more intensive effort to combat fraud in Medicare and Medicaid, enact sensible tort reform including health courts and robust safe harbor protection for doctors who follow evidence based guidelines, and we would adopt a much more sensible approach to end of life care, especially in the case of patients with Alzheimer’s, dementia and late stage cancer. We would have good price and quality transparency tools available to both patients and referring doctors so the doctors could better guide their patients toward more cost-effective healthcare choices. Finally, employers and labor unions would start to show more interest in limited network and tiered insurance products that reward more cost-effective choices with lower premiums.

  46. RANK IGNORANCE
    ” .. Nate, I don’t understand how your clients suffered under this regulation? By having an uncovered severely ill child?”
    Madam, with respect — have you ever taken a class in Macro-economics?
    When Moody’s warns that the USA is nearing BANKRUPTCY —
    http://www.csmonitor.com/Money/2010/0316/Moody-s-hints-at-move-that-could-be-catastrophic-for-US-debt
    does that register with you?
    This is bull. Barking-mad insane. Why should some work long hours, so others can SPEND WITHOUT CONSEQUENCE?
    Matthew, you’ve convinced me. This passes — I’m going on welfare. You can support me. Too bad for you — please don’t go back to the UK, and make me get a job. That would be mean.

  47. “Or, would you feel more comfortable in a world where insurers could drop customers who became sick– after those customers had paid premiums for 10 or 20 years??”
    What fantasy world are you living in Maggie? Where is this even possible in America? THe only way they can drop a sick person with individual coverage is to pull the entire product from the state and cancel it. That impares their license and they can’t write those types of polcies for usually 5 years. In group you can’t cancel one person in a company becuase they are sick. Its a BS arguement becuase you don’t have any legit reasons to pass this BS bill. This whole bill is propgated on lies.
    “You have “maxed out” on your policy. We won’t be paying for any more treatment. Godo luck.”
    Another BS argument. Not to speak for someone else but what logical people want is for someone that knowningly buys a 200K max policy to save money not then complain and expect more then 200K in benefits when they get sick. Not nearly as compelling of an argument when you state it correctly is it?
    FYI lifetime max’s were implemented for legal reasons, the government requires carriers to account for risk and be able to cover the risk they assume, how do you budget for infinity, something a business writer should have picked up on. Next what do you think hospitals will do when given an unlimited policy to bill against? Life time max’s make sure plans aren’t abused by providers doing anything and everything becuase they know it will have to be paid by law. Something else any decent business writer would have addressed.
    “but the cost will be spread out over an enormous number of people.”
    By this logic the ideal system would be tax payor funded, yet in reality States pass laws every year to shift the burden from the huge pool of tax payors to the much smaller pool of group insurance purchasers. Expect 20-50% increase to premium from this bill first 2 years. $700 penalty and guarantee issue with no pre-ex will BK the entire sytsem.
    “If insurers know that they must pay out a certain percentage of premiums in reimbursements, they will make an effort to be much more efficient when it comes to administrative costs.”
    Or if they are in Boston they will conspire with the providers to drive up cost so their allowable margin is of a higher amount…can I get an amen peter?
    “A bunch of really sick kids are not going to bankrupt anybody,”
    Tell that to TennCare, HI, and Oregon I think was the other one. SCHIP is being scalled back this year in a handful of states so obviously Margalit yes it will BK some.

  48. #7 (covering children up to 26 years old) is really rather cheap, considering that these are “young and healthy”, and it’s not completely free – parents still have to pay more than if they just covered themselves.
    Margalit you are so off base. No wonder reform sounds good to you. FYI in the real world the young healthy 26 year olds don’t take the insurance, they will either pay the $700 penalty or under current system just not have coverage. In the real world this provision was created to move severly ill and high cost 26 year olds off Medicaid and onto private insurance. I have had clients suffer under this regualtion.

  49. MATTHEW, YOU NEED TO THINK
    If SOCIALIZED medicine is so outstanding — how many non-Europeans travel to Europe for higher education?
    Answer: DARN FEW.
    IMHO, that tells the tale about the quality of services in the USA vs. UK/Europe.
    Yeah, yeah, the USA is screwed up. Cry me a river — the USA is OVER-RUN with ILLEGALS. How dumb they must be. Not.
    As for this — “a bunch of really sick kids are not going to bankrupt anybody ..”
    Serious, reasonable people, using CALCULATORS, compute that Medicaid, Social Security and Medicare are either (1) technically BANKRUPT or (2) nearing BANKRUPTCY. This year, for the first time ever, Medicare has PREMATURELY cashed in those USA bonds that the Chinese COMMIES love to lecture MESS-IAH about.
    “Not going to bankrupt?” HA! Sure — and MESS-iah has executive experience!
    What the frack is the big rush? Medicare was debated for EIGHT years. What’s involved here — buying a used car?
    Start over — weed out the LIES.

  50. “But in general, expanding coverage to the uninsured won’t save money. Cutting back on waste and overtreatment will– and the Legislation gives Medicare the Power to Do This Without Interference From Congress.”
    Maggie, I support waste/overtreatment reduction for Medicare, but what about the rest of us? If you believe that Medicare’s cost savings are just added to private insurance costs then it’ll be the rest of us who will see no benefit to this.

  51. It’s amazing how heated and emotional everyone becomes about this issue. Reading the comments here, it seems very simple to summarize each camp.
    Humanitarians: who want to give everyone a chance at healthcare because they know people who are being left out who WANT it but can’t afford it. This is noble, but others who don’t understand problems with healthcare see this as a threat to their current situation.
    Individualists: who want to only pay for their own healthcare. This is logical, but when stated it sounds incredibly selfish, because it’s usually people who have a lot of money complaining about paying more.
    Statisticians: who tell us that such and such a statistic proves that most people have insurance and are happy with healthcare as it is now.
    There’s more, I’m sure, but these are the most clear.
    It’s interesting to me, having spent two years abroad in Sweden where the healthcare is socialized. I can see the arguments here all having merit.
    I think it comes down to whether most people agree that there is a problem, and if they do, whether most people can agree on a solution.

  52. 11. and then you will be forced by a gov’t to buy a product from a private entity.
    12. increase national debt
    113. remove any incentive for doctors to improve care
    114. slow down scientific advances in medicine
    115. return to 1970′ medicine
    116. wait in line to get care
    117. less doctors, nurses, more paperwork! etc, etc, etc..

  53. I would love to see a Swiss style system here. The problem is that there seems to be no political feasibility to get there from where we are now in one single step.
    I do agree that the current bill is flawed and incomplete and will need to be amended and evolved at very short notice, but in order to make any kind of progress, I am perfectly willing to take a tiny small step, and if it starts out with security for the tiniest citizens, even better.

  54. My point, which you choose not to recognize, is that the benefits you enumerate do NOTHING to pay for themselves. Unlike you, I care about being able to pay for it all. And please don’t tell me the CBO certifies that it will save money. That is a joke. They accept the parameters/givens that Congress gives them and then they do the math. The “givens” input by Congress is pure fiction.
    Charging a healthy 25 year old a $500 penalty will not induce him/her to buy insurance. It will induce him/her to pay the fine annually until they need health care. Then they buy insurance. The result is an ever sicker (and more expensive) risk pool.
    What do I favor? Something akin to the Swiss system whereby everyone in the country gets basic health care. We can decide what is/isn’t included in basic health but if you want more, you buy a supplemental private policy. Insurance companies are private but highly regulated, like utilities. Basic health care wouldn’t cover high cost low return procedures, such as heart or lung transplants and probably would only cover generic drugs. But I believe you could deliver 80% of health care for 20% of the cost (or 90% for 40%; pick your cut point). We do not need to provide the same high quality world class health care to everyone. We do not provide the same quality food, clothing or shelter. I can accurately predict someone’s life expectancy based on their zip code and yet no one is suggesting we move people to more affluent zip codes to improve survival. We should accept that providing pretty good health care pretty cheaply is good enough as a given. If you want more, you pay for it.
    The point is that if you don’t have everyone in the pool, voluntary participation whereby anyone can buy in at any time, is a prescription for fiscal disaster. So, would i willingly pay more each month to support a terribly flawed plan? No, I wouldn’t.

  55. Here is the deal with children: They do not get to make their own decisions. Even if you are a conservative who thinks that adults should not “wait until they get sick”, or that folks without insurance are part of some underground economy, or that they should not buy cell phones and TVs so they can afford insurance, or whatever, children are at the mercy of their parents and it is not right to punish them for mistakes they did not make.
    A bunch of really sick kids are not going to bankrupt anybody, and I will gladly pay a little more each month for the knowledge that kids will be safe at least from this one misfortune. How about you Dr. Weinstein?

  56. WRONG
    The writer obviously cannot use (1) a calculator and (2)
    common sense. To wit:
    “Prohibit pre-existing condition exclusions for children in all new plans.”
    They’ll be BANKRUPT, genius. And USA medicine will be as SLOW and INCOMPETENT as the UK.
    “Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool”
    HEY GENIUS — even your hated Michael Porter agrees with that. But your crew had to have WWIII. Brilliant, Einstein.
    “Prohibit dropping people from coverage when they get sick in all individual plans”
    See previous, “BANKRUPT”
    “Lower seniors prescription drug prices by beginning to close the donut hole”
    See previous, “BANKRUPT”
    “Offer tax credits to small businesses to purchase coverage”
    NEWS-FLASH: small business HATES TAXES and Chicago THUGS. Google NFIB.
    A SICK, Harvard Law JOKE on the USA — already, lawyers are filing appeals.
    The USA as third-class as Europe — what an accomplishment. Not.

  57. “Andrew– I’m not sure what you are saying. Would you rather that children suffering from cancer not be cover by health insurance?”
    Maggie, your straw man response isn’t fooling anyone. In fact, in every single post of yours that appears on this otherwise reputable website only further beats the morality horse that has already been bludgeoned to death by President Obama.
    Expanding coverage necessitates reducing costs. This bill does not do that, and anyone with a single firing neuron of economic sense knows that. Adding a large contingent of people, many of whom are very sick, to the financial black hole that is our current health care system will not lower costs. It will cause them to explode.
    It’s morality vs. reality. Try wandering into the latter world someday.

  58. Hmmm, I think you are very wrong about #2, as what I am hearing tonight is ending the disgusting policy of denying insurance access for preexisting conditions does not take effect until 2014, like some other features, including getting onto medicaid roles. Maybe now for children, but what about the adults?
    So, Ms Mahar, care to advise people without coverage now for such illnesses and doubtfully will not get it for another 3-4 years to “hang on, you’ll be saved”.
    But, what are they hanging by, their necks!?
    This is why the legislation should NOT be passed until ALL the aspects are fully clear and understood, NOT PASSING IT NOW AND LEARN WHAT IS IN THE BILL NEXT MONTH OR NEXT SEASON!!!
    What is the motivation to reexamine the mistakes when some of these legislators will finally come to realize they are gone at the end of the year? When you lose your job but are finishing up by going through the motions, do you really care what happens at the office?
    And don’t say you do, that is a lie!

  59. Alex, Andrew, David, Peter, Margait
    Alex– many thanks for the head’s up: it should be “until age 26.” Somehow, when cross-posted from Health Beat this was cut off. Not sure what the problem is with #10– though the quotes should be closed at the end.
    Andrew– I’m not sure what you are saying. Would you rather that children suffering from cancer not be cover by health insurance?
    David– Good point.
    Would you prefer to live in a society where insurers can tell parents: “Im sorry, your 7-year-old’s cancer” (Or your 35-year-old wife’ cancer) has now cost us $200,000.
    You have “maxed out” on your policy. We won’t be paying for any more treatment. Godo luck.
    Or, would you feel more comfortable in a world where insurers could drop customers who became sick– after those customers had paid premiums for 10 or 20 years??
    Yes, including the sick in our insurance pools will make insurance somewhat more expensive, but the cost will be spread out over an enormous number of people.
    Also, since you’re an M.D., I’m guessing you’ll be able to afford it. (Even if you’re one of the loweat-paid–a parimary care doc– the average mid-career salary in your specialty is $170.000. This means that you earn more than 99% of all Americans.
    But you’re not willing to help the sick among that 99%???
    Peter– #1 and #10 would rein in system-wide cots.
    If sick children don’t get care, they are likely to become expensive adults in our system (assuming they survive.)
    A great many poor kids with asthma, other respiratory problems,decaying teeth, and other problems that could be treated–if caught fairly early– could grow up to be
    relatively healthy adults. Deny them care now and pay later.
    On #10– If insurers know that they must pay out a certain percentage of premiums in reimbursements, they will make an effort to be much more efficient when it comes to administrative costs. Most insurers could pare administrative costs– esp. when it comes to advertising, marketing and lobbying, they are often not getting good value for the buck. Too much money spread around in a n unthinking way.
    These costs are not the major reason why healthcare costs so much, but every unnecessary heatlhcare dollar saved is a dollar that can be used to cover all of us.
    But in general, expanding coverage to the uninsured won’t save money. Cutting back on waste and overtreatment will– and the Legislation gives Medicare the Power to Do This Without Interference From Congress.
    See this post on HealthBeat http://www.healthbeatblog.com/2010/03
    /peggy-noonan-vs-the-new-england-journal-of-medicine.html
    Margait–
    Thank you. A spot-on rejoinder to Andrew’s comments.
    I think you summed it up when you wrote: “So what sort of insurance do 85% of us really have? Is it possible that many of the lucky 85% own only the illusion of heaving health insurance?”
    We’re all at risk. And even if we don’t need them now, these benefits give us a safety net.

  60. “when numbers 1,3,6, and 7 take effect”…..”for the 85% of us who are working and have health insurance, our costs will rise significantly”
    If 85% of us have adequate insurance, wouldn’t that mean that #3 (getting kicked out when you get sick) cannot occur?
    Wouldn’t it also mean that #6 (lifetime and annual measly limits, so no really serious stuff gets fully covered) is not there to begin with?
    As to #1 (preexisting conditions for children), isn’t it a bit cruel?
    #7 (covering children up to 26 years old) is really rather cheap, considering that these are “young and healthy”, and it’s not completely free – parents still have to pay more than if they just covered themselves.
    So what sort of insurance do 85% of us really have? Is it possible that many of the lucky 85% own only the illusion of heaving health insurance?
    Is it also possible that #2 will reduce the infamous cost shifting that presumably increases premiums to offset free care for the uninsured?
    And could it be that #5 and #10 would contribute a little to reduced premiums as well?

  61. Maggie, not one of your 10 lowers system costs. I won’t get a subsidy or be able to deduct insurance/health costs from my taxes. I also fear my group will be profit prey for the insurance industry.
    Dr. Weinstein, you support pre-exist exclusion, dropping sick people from coverage, annual/lifetime maximums and not covering dependent children? The fault with your argument about the 85% working with health insurance is none of those are taxed on the benefit and are also subsidized by their employer for their health costs.

  62. “What happens right now when the Health Insurance Companies jack up your rates and drop you when you get sick? YOU DIE.”
    Aside from the fact that this is untrue, it is not the point. The point is that for the 85% of us who are working and have health insurance, our costs will rise significantly when these are put into effect. What is there in the bill to prevent this? You cannot mandate that an insurance company cover more expensive clients and not expect them to raise rates accordingly.

  63. What happens right now when the Health Insurance Companies jack up your rates and drop you when you get sick? YOU DIE.

  64. What do you think will happen to my premiums when numbers 1,3,6, and 7 take effect? I suspect they will skyrocket.

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