Health Care Reform - the morning after

[justdrew]

everyone who's not on medicare/medicaid is currently forced to buy insurance from private companies (unless they want no coverage).

Well we're not forced at all. If we don't want it, we don't have to buy it.

That's a HUGE difference.

but if one comes to need health care urgently and you don't have insurance, you're kinda screwed. what happens is you find an emergency room that'll see you (some for profit hospitals find ways to turn away indigent care even thought they're not supposed to) then you get a bill. all they do is the bare minimum. some bills don't get paid and the provider institution ends up eating the costs, and the patient get's less than optimal care and followup. everyone'll be much better off and will get help paying for it if needed.

People should be sure to select the non-profit insurers when they make their choice.

[justdrew]

Maybe "forced" was the wrong choice of wording. Penalized by the government for not supporting a private industry is more like it.

I just find that notion highly absurd.

I don't really know how much these new clients are going to be 'supporting' these insurance companies, if they choose to use the plans and liekly have a well of pent-up needs, these new clients are likely to be rather costly for the insurers for many years to come. national single payer still seems like the best choice to me, but it's a democracy and that plan didn't have the votes at this time, it could still come to pass in time.

nathan28, sorry, I'm not up to answering your detailed questions atm. but about the bankruptcy thing: what's so bad about declaring bankruptcy? The "homestead" protections prevent people from losing their homes and a large amount of tangible assets, it's just a way to get out of unpayable bills. Maybe it screws one's credit, but I'm not so sure of that, it can only be done once per seven years, so after having done it, you're a safer risk than before and are carrying less debt. I did it a few years ago and got a lot of credit offers in the mail afterward specifically to help rebuild. (didn't use any of the offers and remain semi-=debt free today) S

[Simulist]

No health insurance? No problem! — buy some, or get a fine! (The IRS will make sure you pay it if and when you ever get any money.)

The Democrats are certainly an innovative lot, aren't they?

Hey, maybe they can apply the same genius to the hunger problem that they've already applied to health care: legally mandate that people buy food!


"This is what 'change' looks like." — Barack Obama

[thurnundtaxis]

Thanks for the replies justdrew. I'm not sold. But I appreciate your perspective.

[matrixdutch]

Hi,

I'm new here, but would very much like to learn why the health care reform bill is bad since it seems great to those less fortunate. Here are the points in favor of the bill I know of:

WITHIN THE FIRST YEAR OF ENACTMENT

* Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.
* Insurers will be barred from excluding children for coverage because of pre-existing conditions.
* Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
* Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
* A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
* Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
* A tax credit becomes available for some small businesses to help provide coverage for workers.
* A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1. WHAT HAPPENS IN 2011
* Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
* Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
* A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
* Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
* Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
* An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

* Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
* An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
* The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable re-admissions. WHAT HAPPENS IN 2013
* A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
* The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
* The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
* A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

* State health insurance exchanges for small businesses and individuals open.
* Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
* Health plans no longer can exclude people from coverage due to pre-existing conditions.
* Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
* Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

* Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

* An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

[SanDiegoBuffGuy]

This is like saying the cure for the housing slump is to force renters to go out and buy a house.

[justdrew]

This is like saying the cure for the housing slump is to force renters to go out and buy a house.

or maybe it's more like: fixing the homeless problem by requiring the homeless to rent or buy a place to live and providing them with the money to do so if they can't otherwise afford to.

May I remind that we are all REQUIRED to buy automotive insurance? (if you have a car)

[freemason9]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

[SanDiegoBuffGuy]

Note to 23: "They" do not have the upper hand.

I've lived abroad three times in my life, I can always move out of the United States.

I'll say again, no one will make me buy health insurance. I am sovereign over my own body, I make decisions for my own health.

I have not had health insurance since 1998. I have owned my own business since September of 1999 so I have not had an employer offering me a plan. I have never needed a doctor or medical care in 12 years. What if I had been paying into this crappy system for the past 12 years at the cost I was quoted when I was "scared" and thought I needed insurance back in 1998-1999?

Let's do the math:
$320 per month
12 years x 12 months = 144
144 x $320 = $46,080.00

Hey, that's a big chunk of change!

It would even pay for a dreadful "accident" if it were to occur.

I've kept myself healthy the past 12 years by having an excellent diet, a strict exercise regimen and by avoiding risky beahviors/situations. I make those decisions. The healthcare system we have no does not encourage people to be this healthy (except in people who rebel, like me).

No one is going to force me to buy health insurance any more than someone is going to make me fight in the "War on Terror." It's bullshit. I'll just leave. I have friends everywhere all over the globe who will help me. Easy.

[SanDiegoBuffGuy]

justdrew: but I have a choice on whether or not I own a car. There is no choice here. No one can escape this.

[justdrew]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

could you please? I can't muster the argument atm, but iirc it's very solid.

[justdrew]

justdrew: but I have a choice on whether or not I own a car. There is no choice here. No one can escape this.

12 years by 12 months, but you didn't know you'd be able to save all that money, things could have been different. It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other. as a business owner: just build it into your cost-structure and it'll be fine. Everyone else will be too.

[marshwren]

Well, here's my two-cents worth, in response to a NYT editorial from today:

http://community.nytimes.com/comments/w ... d&offset=4

113.marshwren bridgeton, nj March 22nd, 20108:47 am
Seemingly lost amid all the cheers of joy or howls of complaint is the fact that this entire effort to "reform" how health care is paid for is as convoluted and overly-bureaucratized as it is for the sole purpose of keeping health insurance privatized and for-profit. Yes, there are many genuine cost-saving and patient-friendly improvements over the status quo, but genuine reform this is not. It is only when the US bites the bullet and adopts a Canadian-style, single-payer system that [is] real reform--universal coverage (instead of phased-in, approaching-universality over years or decades), with costs equitably spread over the entire tax base--will be achieved. Until then, we're stuck with psuedo-reforms designed first and foremost to keep private insurance companies in business and profits. Rep. Alan Grayson is readying legislation to bring US one giant step closer to this (Medicare for All Who Want It Act) which has 80 co-sponsors--those of us wishing real reform would be well advised to start lobbying for this NOW, having missed the boat on Rep. Conyers' "Medicare for All Act" (HR-676) last year. We can't afford to let another opportunity slip away.

[nathan28]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

Okay, I get it. You have what we might call a faith-based understanding of this bill.

[SanDiegoBuffGuy]

justdrew wrote:

12 years by 12 months, but you didn't know you'd be able to save all that money, things could have been different. It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other. as a business owner: just build it into your cost-structure and it'll be fine. Everyone else will be too.

I do not mean any disrespect to you as a human being in what I am about to write, drew...

Yes, I did know that I would have been able to save all that money. The proof is in the outcome. I didn't waste my money on a crappy system that makes its money by denying people care.

"Things could have been different." Oh, yes, I was scared once, too, about this sort of thing, but I liberated myself from the fear and took control. "What if something happens" is how they get you. People stay in awful jobs under stupid bosses for the same reason.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other." If you want to talk responsibility, talk to all of the people who drain the healthcare system by making poor lifestyle choices and making the decision to be unhealthy.

Build this into my cost structure? Yes, that's so easy. Do you own a business? I guess I just do that magically?

This health insurance bill benefits the insurance companies with a few scraps (ie "no denial based on pre-existing conditions") to the lowly masses. So goes life in America. No surprises here, really.