Forging Ahead on Health Care Reform

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[Electrolass]

Dare I hope that the baby will not be cast out with the bath water?  My greatest apprehension during the entire health care bill debate process has been that we Progressives will reject the House health care legislation in its totality because of the perceived lack of a public option.  The bill remains intact with all the where to fores and here to withs intact.  The 1,100 plus pages has withstood more than a few onslaughts against its intent and integrity.  This regulatory heavy bill will level the playing field in such a way that a public options can exist and thrive.  Without it, no public option could compete with private health insurers who can determine coverage, premiums and payouts with impunity:  the classic Superman is vulnerable because he follows the code and the bad guys don't.

Here are a few indicators that the health insurers and the umbrella companies who own them are preparing for CHANGE:

1.  Many of the current investment prospectus show that health insurance assets have dropped about a percentage point.   This means simply that investors are expecting their "cash cows" to dry up a bit.  This would only occur if the reforms proposed in the House/Senate bill were to take effect.  The reforms are crucial in severing the strong ties between investment and health insurance.  The leftover premiums that you and I pay should not be redirected to other members within the company or to investors.  They should rightly be held over to serve as a buffer during a rough year.  In the old days, there was a requirement for minimum pool of funding to be maintained.  Such requirements would be reinstated.  

2.  Various health insurers have already begun sending out "test" notices to individuals covered under group plans offering them private plans.  If my company wasn't locked into a group rate, they could be paying for my individual coverage that is half of the premiums they pay for my group coverage.  When companies invest money in marketing design, you know something is afoot.

3.  The presence of other related health care bills in both Senate and House suggest that plans already are in play to begin shifting money in support of those agencies which would be directly involved in implementing public health.  

Individually, each of these indicator mean little, but the sum of them implies a shift in politics.  I do not wish to see an "incremental" approach to health care reform adopted.  If one reads Ted Kennedy's book, True Compass, one will find that he applied that term to the health care debate that occurred in the nineties.  It was no surprise to me to read Senator Kennedy's description of tactics used then that mirror those employed by Republicans today.  Indeed, the reticence of conservative democrats hindered and eventually helped stall health care reform then, as it threatens to do now.  The good news is that Senator Kennedy believed that battle was barely lost, and that it might have been won had President Clinton simply forged on past the rhetoric and the stalling tactics.  

I have no doubt in my mind that today, we have a President who is willing to push on through to see health care reform come to fruition.  I cannot help but feel that perhaps the Lion of the Senate shared his views on winning with our President, and that may have some influence on Obama's decision to place principle before the polls.  

As a nation, as individuals, we must refrain from dining at the all or nothing table that forms the buffet of the modern political stage.  We need to peer past the end of the world, black and white, doomsday picture too often presented by political pundits who hope to swell their ratings.  A goal lies before us, and we must take our own bearing periodically to know when each step brings us closer to it.  No path into uncharted territory ever lie in a straight line free of obstacles and points where we must temporarily deviate from our plotted course.  Let us encourage our Congress folk to press forward on this issue, and be willing to give them the swift boot when they stray too far from course.  

[Sister Artemis]

good thoughts, electrolass - but one question:  11,000 pages?  I'm at a loss for what you are referring to.  I thought 2700 or so was the number being tossed around.  Good gracious, don't let Mitch "TurtleFace" McConnell hear that much larger number!

[daMamma]

2700 may be the Senate version, the house is just over a thousand pages.  Gosh knows what we will get for poundage of paper when they reconcile the two!

[Electrolass]

Oops!  Type-o.  That would be the original draft from HR 3200 with its 1,100 pages.  Yes, the revised version, HR 3962 is somewhat larger, but the bulk of the hard hitting regulatory reform were drafted in the first House version. 

Thats what happens if you blog and take strong antibiotics.  Sorry for the confusion.

[Sister Artemis]

Okay.... *wipes forehead*

But still DON'T LET MCCONNEL KNOW!!!!!!!  what with the Rethugs playing fast and loose with facts, they'd probably run fast and hard with that 11,000 number.

[justafarmer]

McConnell is my senator and Bunning too, and they are just so total assholes....

Healthcare reform should be just THAT...HEALTHCARE REFORM...NOT insurance companies getting a captive consumer group!

If I could afford health insurance on my piddling $1,500 a month family income, I would have it! But the insurance companies want ALL my freaking income and won't pay for anything!

I own my farm outright without a mortgage and all this nonsense about how emergency room care is free for anyone is a freaking LIE!!!!

I have NEVER had free ER healthcare...first thing that happens when my family goes to the ER and I say we don't have insurance, they want at least $300 in cash right off the bat...and that's just so we can get to the ER!

I do not know ANYONE who has gotten "free" ER care unless they were in a traffic accident and unconscious when they got to ER.

I'm so sick and tired of the LIES!!!

[daMamma]

In many states there is no up front ER fee, but the uninsured do pay a considerable amount more than the insured do through their insurance company coverage.

The uninsured pay more to cover the shortage from insurance company payments.

[justafarmer]

In many states there is no up front ER fee, but the uninsured do pay a considerable amount more than the insured do through their insurance company coverage.

The uninsured pay more to cover the shortage from insurance company payments.

hi daMamma!
Here in Kentucky, there are DEFINITELY upfront fees!
And, yes, the uninsured who pay out-of-pocket pay (like us) WAY more in actual medical bills than those who have insurance upfront, but when it comes down to bottom-line, those of us who pay out-of-pocket pay WAY less than those who pay $20-30,000 a year with $10,000 deductibles and co-pays.

And THERE is what is broken about out healthcare system!

Why should my family have to pay 3 to 4 times as much for healthcare than a family that has that outrageous health insurance premium? We don't even make that much total income! Why are people comfortable paying that much for a product that is complete crap?

I'm completely mystified.

[Lani]

I have never understood this claim that the uninsured get free health care in ERs.  The people I know with no insurance (including me at one time) did NOT get free care.  We were hounded unto the ends of the earth for payment.  We were harassed without end.  Threatened.  Denied further care regardless of the seriousness of the care needed. 

I was hooked up to IVs and being rushed to ICU when my insurance company denied care.  Within seconds, I was dumped, told to get dressed and get out.  No one even helped me to call friends for a ride home.

[BigSlick]

Here's something I found posted by a commenter named David Rozgonyi over at HuffPo.

http://blogs.ngm.com/.a/6a00e0098226918833012876a6070f970c-800wi

Those who know me here may know some of my history already so forgive me if any of this is repetitive.

I lived in Japan off and on for well over a decade, spanning much of the Clinton years and the first year of W.

I enjoyed the best healthcare in the world before coming back to the USA post-9/11 only to find BuschCo literally gutting our country.

We may have challenges in front of us, but things are much better now than they were under Bush.

We aren't hiding ourselves from the sad truth that W and Darth sold us out, and McTaint would have been even worse still.

We don't just wake up from a 10-year NeoCon nightmare to find the world is all perfect again, it takes time and effort from all of us.

I am a firm believer in Universal Single Payer and if the Public Option is left out, we will not get there until our children reach the age that we are now.  Please support the Public Option, expansion of Medicare, and other steps that will lead to USP for everyone.

[Sister Artemis]

I have never understood this claim that the uninsured get free health care in ERs.  The people I know with no insurance (including me at one time) did NOT get free care.  We were hounded unto the ends of the earth for payment.  We were harassed without end.  Threatened.  Denied further care regardless of the seriousness of the care needed. . . .

And, if you are anything like me, you paid those debts off, in the end.

Definitely not free.  Add to the cost of the charges (inflated ER charges, I might add), the cost of collections, interest, and (in one of my situations) court costs -- all because I could not pay it off as fast as they wanted, even though I was making consistent payments which were stretching my budget very thin.

Grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr.

Okay, another emoticon needed:  angry growling tiger face!

[judi]

I have no doubt in my mind that today, we have a President who is willing to push on through to see health care reform come to fruition.  I cannot help but feel that perhaps the Lion of the Senate shared his views on winning with our President, and that may have some influence on Obama's decision to place principle before the polls.  

I agree...I still have hope in our president, holding on my a thread, but still hope.  I get my hope back when he gives a speech like yesterday, filled with compassion and empathy ...I get it back when I hear he walked into a meeting that Sebelius is having with the insurance companies re their rate increases...and he is holding a letter from someone who cannot afford to pay.
Now I may be getting fooled, wont be the first time...but I am willing to place my bet on this president and this bill...it may not be what I want, what WE as a country want, but it is a start

What really convinced me was that guy, gosh forget his name..former insurance executive,  on KO...he supports this bill...says it is not enough, but a start to reign in these companies and their obscene profits made from denying coverage and claims.

For me, some know me here I am pretty hyper active at times..have to do something...so now my strategy...I get newsmax, humanevents, etc...so when I get their list of who they are targeting to call to vote NO...I call and ask them to vote YES...figure it is at least negatively wiping out that one call...

my friend is in dc today...(I almost went)..there is a huge demo as the insurance companies meet....

so let us get going...start making calls, write letters, keep the heat up...we must pass this bill...I truly agree that at least it is a start...dont let this opportunity pass us by ....once again

(Modified by Forty Watt to attribute quote)

[futurexpat?]

I have some hope, but it's really slim. Anything is better than nothing at this point, but that's not a good point to be. If we had seen the President out there doing this a year ago, I think this might have been done and over with by now, and it would have been better than what we are looking at now.

[Electrolass]

I feel for your frustration.  I try to remember that if I feel upset, there are old timer Democrats out there who have fought this battle since the early seventies when Ted Kennedy tried to take the fight to Washington in earnest.  I just finished reading Ted Kennedy's, True Compass, and I was reminded again of the long days, months and years of battles that have taken place between Democrats and Republicans, and the cost to the party that occurred after the passage of the Civil Right Act, and many other similar acts that helped our nation usher in a new era of integration. 

Those Democrats back in the day did stand up for what they believed, and they paid a heavy price.  The Republicans and those Americans who reviled liberals for daring to desegregate America and pollute it with people of color have hammered Democrats for three decades.  Republican politics ceased long  ago to be about finding better solutions for America, but has devolved into a simple rhetoric of "death to any and all policies supported by Democrats."   But now, with the election of President Obama, a whole new portion of our population has entered the fray in earnest, and I truly believe that together, old school and new age Progressives/Democrats will pick up the banner and take this fight right back to 'em.  It is happening now.  A new body of Americans with a zest for liberal democracy has taken to the streets.  They are learning, adjusting, feeling it out, but they are moving, and they don't like what they see in Washington. 

It is so difficult to see the world from so far up top, but I have gained hope from my trips back east, from talks with friends and associates.  I personally experienced several encounters with the so called minority of African Americans who have stated in no uncertain terms that they feel that they have an obligation now to return the favor and begin taking a stand for liberal values that helped propel civil rights to the forefront of politics in the 50's and 60's.  The political landscape has changed drastically, and what the conservatives want simply cannot be unless they think they can turn back time and disenfranchise a whole sector of the country.  I think not. 

Be of hope. We might find ourselves pleasantly surprised.  Meanwhile, find a sunset and marvel at the unique of the sun that only we Alaskans can see from our unique place on the globe.  Somehow, all will be well.

[Electrolass]

The comments regarding payment of services for emergency care by non insured really struck home with me.  I dropped out of college because of emergency room bills to the tune of $20,000.  I just couldn't pay the credit cards debt (to pay the bills), make rent and pay for school.  It hurt, and I have never forgot the lesson.   Up until June of last year, I worked workers compensation with my company, and I learned a lot about how health care is billed paid for and the difference between what is billed to folks with insurance, what is billed to workers comp and what the average joe/jane on the street pays. 

Again, all roads lead back to health insurance companies. 

1.  health insurance companies have contracts with providers whereby rates paid are set.  The doctors agree to take insured patients up front with no or copay based on the premise that the insurance companies will pay a set amount for services rendered.  The AMA report shows that insurance companies have a TENDENCY to not honor those contracts and short pay the provider.  Who do you think makes up for those shortages?

2.  Many for profit hospitals (Remember when every large city had at least one not for profit hospital?  Not so much now) also have contracts with insurance companies to cover patients with no or little payment of front, and they too get stiffed.  If the person on the gurney with IVs just learned that they aren't going to be covered, so did the doctor.  Who do you think makes up the difference? 

3.  Insurers blame their inefficiencies on the Medicare billing system, but in fact, the complexity of the billing system arises from practices the insurers themselves helped to put in place.  Complex billing codes thrust on hospitals and providers as a means of compartmentalizing procedures and care in an effort to maximize profits.  Far from encouraging the growth of health care, I believe these practices have forced providers and hospitals to provide bargain package health care that forces people to stick to narrow, predetermined, one size fits all treatment.   

Health insurance companies are in the truest sense of the word "middlemen" and yet they have managed to get the upper hand in this industry.  For many years now, health insurance companies have been riding high on a baby boomer generation that considered health insurance a necessity and were willing to pay for it.   Group insurance was an added boon.  How many people who are on group insurance plans really take the time to match their Explanation of Benefits to the medical bills?  How many people actually asked their employers how much they pay per month for their insurance premiums (for those whose companies pay the majority or all of the bill)?  My current employer pays approximately $570/month for my insurance premium.   My private insurer charged me $265 per month.  I paid a $2800 deductible for 100% coverage, and I got to keep my deductible in an HSA.  Why would I care?  My employer pays the bill.  I do care because I need a job, and what my employer loses in profits affects my job. 

The current health care bill does not hand over a "captive market" to the insurance companies.  If the bill passes, the insurance companies will NOT be able to cut benefits, and undercut payments to providers.  That is what all the wordiness does.  It reforms the Federal Tax code, the Health Services Act, the Social Security Act and drastically limits what the health insurance companies can do to maximize their profits at the expense of the insured. 

A pubic option depends on a strong public health system. Funding must be procured (or shifted) to build that system.  Trying to place a load on the medicare system prematurely will bog down an already struggling system which is in the process of being refurbished (Obama/ Dept of Health and Human Services) I believe in preparation for a time when public health takes on the burden of getting affordable health to the public.  We need more doctors, more nurses (nurses have been especially hard hit as hospitals and private providers turn to med techs as a means of cutting costs) and more clinics before we attempt to front load the system to quickly. 

Plan:  Cut out the middleman, reorganize the system to get costs down to an acceptable level and then begin the task of putting together system of providers and hospitals that can manage the needs of our nations health care needs. 

[daMamma]

The Senate Parliamentarian role in getting health care for all passed may be more important than we can imagine.  Think of him as the referee.

A rather long, but quite interesting article from the NYTimes.

Parliamentarian in Role as Health Bill Referee

WASHINGTON — In the fall of 1968, a serious dark-haired young man arrived in the capital to do what serious young men here do: study law. Alan S. Frumin was calm, analytical and possessed of a dry wit. To his classmates, one trait stood out. He was a whiz at mastering the mind-numbing rules of civil procedure.

Today, Mr. Frumin puts his procedural acumen to use as the parliamentarian of the United States Senate. Most of the time, it is a quiet, under-the-radar kind of job. Not these days.

As Washington enters the final act of its long-running health care drama, Mr. Frumin — a nonpartisan civil servant who got his start as a precedents writer for the House — is in a starring role. His rulings on arcane procedural questions may determine whether President Obama winds up signing a health care overhaul or whether the administration’s signature policy initiative collapses.

http://www.nytimes.com/2010/03/14/us/politics/14rules.html

<forgot da link>

[Electrolass]

Very good comment. Viva la wonkers (the term for those who love the details).