The Democrats Want Higher Taxes And Have The Public Option Back On The Table

[Charles_Main]

Just like Social Security and Medicare, right?

Uh, no. You may have noticed in your paycheck that Medicare Part A is funded through a payroll tax on people who aren't using it. Part B is partially funded through premiums, which cover about 25% of its costs.

The public health insurance option, on the other hand, is required by statute to cover all of its costs by charging premiums.

Really so they charge everyone, even those who can't afford insurance right now right.

 

[Political Junky]

Cons prefer to have people uninsured, thus clogging up emergency rooms. Then we all pay for their care with our taxes. Make sense? Of course not.

 

[rightwinger]

The well used Liberal mantra of "fairness". I admitted no such thing in my response. I completely refuted your contention that it would make HC insurance "more competitive" as there is no competition with the govt and their endless pool of money. The cost numbers continue to go up even with the HC plan in its infancy. The fact is the govt can't run anything cost effective. Medicare was stated to cost 12 million by year 1990. In actuality, the cost was 107 billion by that year. Tell me again how the govt plan will cost less.

Sorry you aren't allowed on both sides of the fence here...

Either the Government provides a better more cost effective product that private insurerers can't compete with

Or as you say....."The fact is the govt can't run anything cost effective."

You are going on the assumption that govt HC is competitive. As it is not based on my previous explanation, thye are not. Since govt provides no such competition in what is true level playing field competition, that is a mute point. The other poster stated that Govt HC will increase competition when in fact there is none because govt has an endless pool of money at their disposal. No one responding seems to grasp that as no one has argued against that point. Nice way of avoiding the actual debate.

So you admit the Government program would be more efficient and provide a better product at a lower cost

A win for the American People.....tough shit for the Insurance industry if they can't compete

 

[mudwhistle]

Cons prefer to have people uninsured, thus clogging up emergency rooms. Then we all pay for their care with our taxes. Make sense? Of course not.

You mean like the way Obama and other Democrats wants this to continue with illegals?????

I think you're confused on this issue.

The right thinks everyone should pay their fair share....not continue to have millions of people sucking off of the rest of us. How else do you think our taxes will go down? After all lower taxes is their number one priority....not screwing everyone they don't like the way Liberals seem to want.

 

[Greenbeard]

You agree with everything I posit and then somehow wish for a different outcome.
Never happen.

No. Your arguments (the few that you actually made) centered on cost-shifting, which as I pointed out can't occur if customers can flow freely between insurers. Thus the entire rationale that providers can continue wasteful spending when a public option is present in the market falls apart. Which means their only option is to ease their demands on private insurers, which ultimately puts downward pressure on your premiums.

Really so they charge everyone, even those who can't afford insurance right now right.

Who is "they"? Medicare? The whole point of the post you quoted is that Medicare doesn't finance primarily through premiums. And low-income seniors fall into the category of dual eligibles, people who can get health care through both Medicare and Medicaid.

And if "they" refers to the proposed public option, it won't have people who can't pay premiums. Those people will be in Medicaid, which states will be expanding over the next four years.

You mean like the way Obama and other Democrats wants this to continue with illegals?????

Do you think they should've brought illegals into the health care system with this law?

The right thinks everyone should pay their fair share....not continue to have millions of people sucking off of the rest of us. How else do you think our taxes will go down? After all lower taxes is their number one priority....not screwing everyone they don't like the way Liberals seem to want.

If you're getting insurance through your employer, you're not paying any taxes on those benefits even though they're compensation. That's a big subsidy you're getting for that insurance.

 

[The Rabbi]

You agree with everything I posit and then somehow wish for a different outcome.
Never happen.

No. Your arguments (the few that you actually made) centered on cost-shifting, which as I pointed out can't occur if customers can flow freely between insurers. Thus the entire rationale that providers can continue wasteful spending when a public option is present in the market falls apart. Which means their only option is to ease their demands on private insurers, which ultimately puts downward pressure on your premiums.

There you go again. First, customer cannot "flow freely between insurers" as they will have been dropped from their company health plan onto public option.
Do providers have "wasteful spending"? Really? Any evidence for that, that the cost of healthcare is due to waste?
They will increase their demands on private insurers because they will need to make up lost revenue from government reimbursements. This is already the case, as you yourself admitted. Public option will make it worse, not better.

 

[Greenbeard]

There you go again. First, customer cannot "flow freely between insurers" as they will have been dropped from their company health plan onto public option.

It's becoming pretty clear that you're not familiar with how the health care markets work today or what the reform law does to it. So let's have a little crash course.

Broadly speaking, there are two markets for health insurance: the group market and the individual market. If you're getting a plan through your employer, you're in the group market. You're subsidized by the government and enjoy certain HIPAA protections against pre-existing conditions exclusions, unreasonable rate differences based on health status and things like that. Those protections have existed for over a decade.

The individual market, on the other hand, is where people who don't get coverage through work go to buy policies. They don't get the government subsidy that people in the group market get (which is especially significant because people who don't get coverage through their job are often lower-income than their peers in the group market), they often don't enjoy the consumer protections that people in the group market have, and it's generally a very opaque marketplace.

One of the primary goals of the insurance market reforms in the law is to make the individual market look a bit more like the group market. And it does that by creating a new structure through which individual policies are sold: the health insurance exchange. This is a transparent marketplace, governed by certain consumer protections, where you can buy quality insurance.

If your employer drops coverage, that means you leave the group market and shop for plans in the exchange (there are even provisions for doing this voluntarily: 1) certain employers can take their employees into the exchange to shop if they choose to and 2) free choice vouchers are available if your premiums through work are high enough--these let you take your employer's contribution and buy your own plan in the exchange). You don't get dumped on the public option--note that there isn't even a public option on the books at this time so that suggestion makes no sense. What happens is, you enter the exchange and pick the plan you like from a menu of options. If a public option existed, it would be one of the choices on that menu of options.

So, yes, customers can freely flow between plans in the exchanges.

Do providers have "wasteful spending"? Really? Any evidence for that, that the cost of healthcare is due to waste?

This is health economics 101. First of all, part of the reason I quoted that section of the MedPAC (and I suggest at some point you actually read it, it's interesting stuff) is because this is exactly what they're talking about. That said, last year Thomson Reuters put the number at $650-$800 billion per year. But the obvious inefficiency of medical providers is no less important than their 182% (on average) markup of services over the actual cost of treatment.

As I've said in another thread, there is at least one alternative to the public option that I think would probably be even more effective than it.

They will increase their demands on private insurers because they will need to make up lost revenue from government reimbursements.

To reiterate: you can't cost shift from A to B when people in B can simply go to A. Cost shifting requires immobility on the part of those who're on the short end of the stick.

Let me ask you this: do you believe the American health system is as efficient right now as it can possibly be? That providers are charging exactly what they need to charge to sustain and flourish, with a healthy profit margin for those providers who are for-profit? In other words, do you think there is absolutely no health care cost problem in this country?

This is already the case, as you yourself admitted. Public option will make it worse, not better.

You're either not reading what I'm saying or not understanding it. I assume it's a little of both.

 

[mudwhistle]

You agree with everything I posit and then somehow wish for a different outcome.
Never happen.

No. Your arguments (the few that you actually made) centered on cost-shifting, which as I pointed out can't occur if customers can flow freely between insurers. Thus the entire rationale that providers can continue wasteful spending when a public option is present in the market falls apart. Which means their only option is to ease their demands on private insurers, which ultimately puts downward pressure on your premiums.

Really so they charge everyone, even those who can't afford insurance right now right.

Who is "they"? Medicare? The whole point of the post you quoted is that Medicare doesn't finance primarily through premiums. And low-income seniors fall into the category of dual eligibles, people who can get health care through both Medicare and Medicaid.

And if "they" refers to the proposed public option, it won't have people who can't pay premiums. Those people will be in Medicaid, which states will be expanding over the next four years.

You mean like the way Obama and other Democrats wants this to continue with illegals?????

Do you think they should've brought illegals into the health care system with this law?

The right thinks everyone should pay their fair share....not continue to have millions of people sucking off of the rest of us. How else do you think our taxes will go down? After all lower taxes is their number one priority....not screwing everyone they don't like the way Liberals seem to want.

If you're getting insurance through your employer, you're not paying any taxes on those benefits even though they're compensation. That's a big subsidy you're getting for that insurance.

Pretty soon you won't be...because the fine for not having coverage is much lower then the costs. Soon companies will be dropping coverage for their employees in favor of just paying the fines. Also paying premiums through payroll deductions is in all respects a tax. At least that is what the US Government used as a defense in various lawsuits around the country.

I suspect you're a plant. How the fuck would you know about the bill?

It's extremely hard to find a copy of the current form of the Health Care bill much less understand it.

Unless you were involved in the drafting and rewriting of this monstrosity or have been coached on the subject it's very difficult to understand....even though I have some legal background and I was at one time licensed in the state of Tennessee as an insurance agent I have to go through third parties to get most of my information.

 

[boedicca]

Cons prefer to have people uninsured, thus clogging up emergency rooms. Then we all pay for their care with our taxes. Make sense? Of course not.

That's highly inaccurate.

Take a look at the MA ObamaCare-esque experiment. Everyone is covered, costs are out of control, and emergency rooms are just as crowded.

Why - when doctors' schedules are full, people use the emergency room as a drop in clinic. Having or not having insurance doesn't change that dynamic.

The combination of heavily subsidized demand and tight, over-regulated supply is a textbook formula for perpetuating the big, chronic price increases that bedevil today's health-care system.

Instead of attacking the real causes of the explosion in costs -- the combination of overly generous state aid and a dearth of competition among hospitals and physician groups -- Massachusetts is vilifying prestigious, non-profit insurers, and punishing them, believe it nor not, with price controls. In April, Governor Deval Patrick refused the request of carriers such as Harvard Pilgrim, the top-rated plan in the country, for premium increases of 8% to 32%. Instead, his administration is refusing all rate hikes over 7.7%; any rate requests the administration rejects are automatically held at 2009 levels.

In explosive emails released last week, Robert Dynan, chief of the financial analysis unit at the Division of Insurance, told Commissioner Joseph Murphy that the price caps would cause a "potential train wreck" and threatened "catastrophic consequences for the non-profit industry." Dynan warned that the non-profits, unlike national giants such as WellPoint (WLP, Fortune 500), operate on such slim margins that the controls could drive them into bankruptcy. Even now, four of the biggest insurers are threatening to stop taking new patients at rates so low they lose money on each new enrollee.


5 painful health-care lessons from Massachusetts - Jun. 15, 2010

 

[Meister]

Why are you afraid of a public option?

Not really afraid of it. I just like living.

Well ...thats why it is an OPTION. You are welcome to keep your existing policy

Why do you insist on denying other Americans the right to choose?

Keep my existing policy and funding a public option? Where's my right to choose?

 

[boedicca]

Don't you get it? The Big Government Class doesn't think you are smart or deserving enough to choose for yourself.

 

[boedicca]

And here's some info on MA emergency room usage:

The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use.

According to state data released last week, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year.

When the Legislature passed the insurance law in 2006, officials hoped it would increase access to primary care doctors for the uninsured, which would improve their health and lessen their reliance on emergency rooms for the flu, sprains, and other urgent care. Residents began enrolling in state-subsidized insurance plans in October 2006; everyone was required to have coverage by July 1, 2007.

But, according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician.


Emergency room visits grow in Mass. - The Boston Globe


Now, how about that Berwick The Rationer being appointed to oversee Medicare?

 

[The Rabbi]

Somewhere I heard a stat that most people who go to emergency rooms in fact are covered by insurance. And also that non emergency usage of emergency rooms, while certainly supported with anecdotal evidence, is not a big contributor to the cost of health care.

 

[boedicca]

The biggest use of health care is end of life care.

Berwick's appointment to Medicare means an agenda of rationing care to the elderly - which will undoubtedly mean shortening some lives as care is denied.

 

[Greenbeard]

Pretty soon you won't be...because the fine for not having coverage is much lower then the costs. Soon companies will be dropping coverage for their employees in favor of just paying the fines.

That would be a nice outcome but it's unlikely since the preference for employer-based coverage is strengthened under this law (in all the years employer-sponsored coverage has dominated the insurance market, there hasn't been a fine to coerce employers into providing it--they've done it for other reasons).

I suspect you're a plant. How the fuck would you know about the bill?

I've read it. All of them actually, starting with the original House bill, H.R. 3200, in the summer of 2009. In fact, I've also read all of the Republican health care bills in the current Congress, too.

It wouldn't make much sense to take an interest in the subject and follow the public debate if I didn't want to become familiar with what was being debated. Am I unique in thinking like that?

It's extremely hard to find a copy of the current form of the Health Care bill much less understand it.

No, it isn't. Every bill introduced in Congress is available on THOMAS, the Library of Congress's site. Under "Search Bill Summary & Status" search by bill number. H.R. 3590 is the root bill, H.R. 4872 is the much smaller reconciliation bill that amended it. Or, if you want more of a community feel as you're reading it, read it on Open Congress. Or on Gov Track.

If you prefer comprehensive summaries instead of the actual text of the law, there are about a hundred places you can go:

NASMD's summary
Kaiser's summary
Summary from some law firm
Section-by-section walk-through from the Senate Dem Policy Committee

In addition, THOMAS will show you the official summary of the law compiled by the Congressional Research Service when you search for it and OpenCongress provides its own section-by-section summaries.

I'm pretty sure at no point in American history has information been so readily available from the comfort of your living room. Please start making use of it.

Unless you were involved in the drafting and rewriting of this monstrosity it's very difficult to understand....even though I have some legal background.

No, I didn't design it but I'm confident I have a pretty good handle on it.

 

[Greenbeard]

Instead of attacking the real causes of the explosion in costs -- the combination of overly generous state aid and a dearth of competition among hospitals and physician groups -- Massachusetts is vilifying prestigious, non-profit insurers, and punishing them, believe it nor not, with price controls.

I agree with this. We have to start going after providers. I'd like to see Massachusetts attempt to revive and revise an experiment it ended a long time ago.

Berwick's appointment to Medicare means an agenda of rationing care to the elderly - which will undoubtedly mean shortening some lives as care is denied.

Keep us updated on that.

 

[boedicca]

We have to start going after providers?

What on earth do you mean by that? Drafting them to work longer hours for no pay?

 

[boedicca]

Berwick's appointment to Medicare means an agenda of rationing care to the elderly - which will undoubtedly mean shortening some lives as care is denied.

Keep us updated on that.

He's already told us in his own words:

"The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out there. There is going to have to be a very difficult democratic conversation that takes place. The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open."


RealClearPolitics - Why Donald Berwick is Dangerous to Your Health

 

[Greenbeard]

As your own article points out (and the link to my thread explores a bit), providers in various places have cornered the market and driven up health care costs using their market clout. Insurers don't have enough leverage to hold down reimbursements at the negotiating table, leading to runaway premiums. This has to be addressed. I've pointed out in the linked thread the way I'd like to see states address it (the Maryland all-payer rate setting model). Do you have another preference? Or do you not even agree with the article you brought into the discussion?

 

[Greenbeard]

He's already told us in his own words:

"The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out there. There is going to have to be a very difficult democratic conversation that takes place. The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open."

That's can't be! I thought health care resources existed in infinite abundance.

Anyway, let us know how that statement affects his administration of CMS.