SHARE THIS SHOW:
RELATED CONVERSATIONS:
RECENTLY ON TOL:
TOL Our Town
- A tumblr site dedicated to the people and places that make up Oregon and Southwest Washington.
TAGS:
Over the past year we've discussed many aspects of possible healthcare legislation on Think Out Loud, from the role of employers in providing health insurance to the region's low Medicare reimbursement rates. We've explored health promotion, doctors' salaries, and personal healthcare values.
All that while the country debated the future of healthcare in this country. Now that's coming to an end. On Sunday night Congress passed a major overhaul of the nation's healthcare system. President Obama is expected to sign it into law on Tuesday. The Senate will take up some of the revisions probably this week.
Oregon's four Democratic representatives voted yes on the bill. Republican Greg Walden voted no. Congressman Peter DeFazio had a particular hand in getting an adjustment in Medicare reimbursement rates that's kept them particularly low in Oregon. After the vote he told OPB reporter, Rob Manning:
When the administration knew we were serious, and they could lose the whole bill, we negotiated around the clock, and we got something that is justifiable, that’s been studied time and time and time again by experts and panels and commissions saying this system is not fair, it’s not equitable, it doesn’t work. And it penalizes the states that are doing a better job, and rewards states that are doing a worse job, and it’s costing the taxpayers money.
This bill will provide coverage for as many as 32 million people who are currently uninsured at a cost of $940 billion. People with insurance coverage currently may not see any major changes, but they may be affected by some of these things in as soon as six months time:
- insurance companies will be prohibited from placing lifetime limits on medical coverage
- insurance companies will no longer be able to cancel policies of people who are sick
- children will be considered as dependents until age 26 instead of the current age of 18 or 19 (depending on the state you live in)
- children with pre-existing conditions will not be denied coverage
- adults with pre-existing conditions will be eligible for subsidized coverage
And by 2014 there would be even more changes including, among other things, fines for employers with more than 50 employees who do not provide health insurance
What do you think of this overhaul to the healthcare system? Which change will affect you the most? How might it change the healthcare you receive?
GUESTS:
- John Evans: Anesthesiologist at Providence St. Vincent's Medical Center, president-elect of the Oregon Medical Association and president of the Medical Society of Metropolitan Portland
- Neal Wallace: Health economist and associate professor of public administration at Portland State University's college of urban and public affairs
- Pam Mariea-Nason: Director for health policy and community engagement for CareOregon
Tagged as: congress · obama · politics · rx
Photo credit: Jasleen Kaur / Creative Commons
-
Considering that the insurance companies wrote most of the bill it shouldn't surprise anyone that it favors those companies at the expense of the public who naively believed that there was going to be a universal system installed.
Caterpillar has already said the new bill will cost them $100 million a yr. Many of the largest companies that are already getting out from under health care benefits they can no longer afford, will shut down in the US and move their operations off shore. This bill will be an unmitigated disaster for America and will NOT improve public health one iota.
Health stats on infant mortality/morbity and declining longivity (relative to other western nations) will continue their downward spiral. We're diddled.
-
There were several bullet points in the bill that will be enacted immediately...as in right now, as of the signing of this bill. One of them is to halt the exclusions for children and people at high risk, or as you put it, "when they need it most". For the average adult, those changes will take effect in 2014.
A few more immediate changes include tax breaks for small businesses to help cover their employees and for adult children to be able to remain on a parents plan until the age of 26...for the recent college grads out there that have been shut out of the job market, this is really helpful.
-
"...and for adult children to be able to remain on a parents plan until the age of 26...for the recent college grads out there that have been shut out of the job market, this is really helpful."
Provided that you are UNDER age 26. Not all college graduates are under 26, but some of us are still shut out (or feeling shut out) of the job market.
-
Letter I mailed,
Dear President Obama and Congress of the United/Divided States of America,
Once again, We've compromised too much. Without a Public Option, there is no competition for the Insurance Companies. They will only prosper further with a mandated Client Base and Government Subsidies. We are very disappointed that we don't have the "Single Payer System" and now no Public Option. Most of us still don't understand the entire Complex Bill. I'd strongly suggest to make this clear and simple each step of the way and vote incrementally on key segments of the bill, so that we are all more clear and informed with each step.
Ultimately, Preventative Health begins with a Healthy Planet. We are deeply frustrated and outraged with allocating more funds towards "Dirty Fossil Fuels and Lethal Toxic Uranium, along with other highly radioactive chemicals. We haven't even dealt with millions of gallons of the deadly waste that is leaching into ground water and into our Bio-Rich Water System. It is extremely irresponsible to put our lives and health at RISK especially when we have a tremendous source of knowledge and evidence of where this path takes us. This is true "Terrorism".
Simply stated, "Toxins and Poisons equal Sickness, Death and Bankruptcy".
Please look at the Entire Costs, The Entire Risks, of Energy Choice that affects All Health or "Life" on this living Planet.
Please direct Excessive Corporate Dollars first and then wisely Our Hard Earned Dollars urgently towards Cleaning up the Toxins.
We do have Healthy Solutions. We have so much Potential to make "Wise Decisions", but We only have a very narrow Window to make "Appropriate Transition".
Thank You for listening and hopefully Speaking for the "Common Good" for All Life on this intricately Connected Planet of Life.
Frustrated yet still Hopeful,
We are informed and very concerned.
Loretta Huston -
Department of intended consequences: with this not-so-wonderful reverse Robin Hood thing (rob the working poor to give ever more to the bloated obscenely rich corporations and their executives) Obama and the others who engineered what is nothing less than a Health Insurance Company Bailout will also do the following: employers who provide health insurance as a benefit to employees now will refuse to do so - why should they, if everyone must buy their own insurance - yet salaries will not increase to help workers be able to afford the mandatory insurance purchase; auto insurance companies will no longer pay for medical expenses when one of their drivers causes someone else to get hurt, why should they if everyone is mandated to buy their own health insurance - not that premiums will go down because of this, oh! Mercy NO!!! Landlords, potential employers, car insurance companies, really anyone who has or wants to exert some kind of power over someone else who needs what they have to offer, will require evidence of health insurance before they rent to, insure or employ anyone. Jails and prisons will overflow with those who, having been unable to afford the purchase of health insurance and being unable to pay the IRS-enforced penalties (read the bill - the IRS will be the enforcer) will have to go to the slammer because they have become a "deadbeat" according to IRS rules. Supposedly there are "subsidies" for the working poor to help offset the cost of purchasing health insurance. Those subsidies will be very small. Do you know any of the working poor who can squeeze even a subsidized several hundred new dollars out of their income? I sure don't! The cheapest health insurance I can find right now is MORE than my gross salary. Nothing I have read about this legislation will change that.
In my opinion, this is the "new Communism." That is: from each, all that they earn, to a few, all that they desire.
I don't have much use for lawyers, frankly, but in this instance I would think some enterprising legal type would jump at the chance to represent 32 million gotta-buy-or-jail folks in a class action lawsuit. Of course, that would mean actually getting the federal courts to certify these hapless poor folks as a class to permit such an action to go forward, and considering the federal government passed this legislation, that would render the whole mess moot.
-
Sally,
This explainer post from the NYT makes it clear that there might indeed be subsidies that would bring down the cost of insurance for people who are between 133 and 400% of the poverty level to somewhere between 3 and 9.5% of income. Meaning that — depending on how much you make — you could very well find a policy that is MUCH less than your entire gross salary.
Dave
-
Letter I emailed:
Thanks for passing the bill. I expect to benefit from no-recision, raising the caps, a national market (eventually), lower premiums from a larger insurance pool, ending the anti-trust exemption for health insurance companies (separate legislation), increased scrutiny of overhead costs and outcomes.
I'd like to have seen a Medicare-for-all or single-payer option to buy (I am in the individual market, not under an employer's group plan, too well-off for Medicaid and too young for Medicare).
Finally, some progress. This bill's better than none, and it can be built upon. It was now or never, with elections looming later this year.
-
I agree that medical insurance needs change. Legislating consumer protection policies is important. Making those policies national and not state by state ensures equality.
However, I emphatically disagree having to pay more taxes to cover the costs of insurance for others. And I loath the idea of a single payer system funded by people like me who work hard for what I have.
I am tired of being forced to compensate for those who make poor choices. I chose to finish school so as to be employable. I chose to work to gain insurance for my family. I choose to drive a older used car and live in a home I can afford. I choose to make insurance a priority over designer purses, a $20,000 wedding, $4.00 designer coffee, $200.00 designer cell phone bills w/internet access, the list goes on and on.
I'm sick and tired of the poor poor pitiful me whining and entitlement mentality that seems so pervasive in our country. This country was built on the backs of people who knew what it was like to work, to sacrafice. Now we are a nation of give me, give me, give me....while sitting back and watching tv, collecting all the government benefits.
-
By your comments you are rather nastily implying that those who do not live as you do have made "bad choices". I CHOSE to continue working even at a low paying job and despite severe health problems. I CHOSE not to incur high-five-figure debt to finish a 4-year degree which trust me - I worked in higher education for YEARS - does NOT buy you a decently paid career any more. I do not own my home, I rent, have a roommate, drive a 29 year old car with 300K miles on it, share a cell phone, can't afford a landline, take public transportation wherever conceivably possible, my TV for which I cannot afford cable anyway is a 1993 model, I have zero nice furniture and shop for clothes at Saint Vinny's charming emporia. NOW do you think that I am living up the high life just so I can stick others with my health bill? Carrolldj - you frankly do not know anything about what you are opining. Why not try educating yourself about the TRUE state of the economy before blathering such blatant tripe.
-
My question is why health care reform required such a massive & complex new program? I believe it would have been better to simply reform the flaws in the Medicare program (which is needed anyway) and then expand coverage to anyone as was the original intent 45 years ago.
-
Excellent point...why couldn't Medicare have been expanded to all? Is that not essentially what the single-payer systems in pretty much every civilized nation amount to? (Note I did not include the U.S. as a civilized nation...seeing as how we have been failing in caring for the elderly, educating the young, and looking after the health of one and all.)
-
What is happening in Oregon in terms of health care reform that will help with improving health care overall.
-
Prediction. The individual mandate will be found unconstitutional, causing the rest of the bill to be ineffective and pointless. How unfortunate, the one opportunity we had to revolutionize health-care and Mr. Obama sat back and made nice. Democrats didn't listen to their own party members who have insisted over-and-over for a public option. Now, because they have no public option the bill will probably be found unconstitutional on the grounds that you can't force humans to purchase something from a private company only on the grounds that they are alive, with the only alternative being suicide. Just yesterday the great Neal Conan compared the argument to auto insurance, which any idiot should be able to realize, is a completely inaccurate comparison. Actually all the NPR coverage hads somehow shied away from this obvious issue. I am never one to claim bias in the media, but I think by avoiding this important objection, much of the media has done a disservice to the Democrats in the long-term.
Perhaps, Democrats and their lawyers don't believe the individual mandate through private companies is an issue? Or are they just trying to seem cohesive, or on message? I can't understand it. Maybe I am missing something? But it seems like it would have been better for the Democrats to have addressed this objection themselves, rather then leaving it for the other side.
-
The argument that the government can't mandate its citizens buying some thing such as health insurance is completely specious. I don't have any choice about buying a war in Afghanistan or nuclear weapons. I'd prefer to not buy those first please.
-
It isn't specious at all! The dishonesty by many Democrats to admit this is scary to me, as a Democrat---I can't understand it. Or, do they just not get it? Are they just not smart enough? Do they not want to tarnish the brand? Do they think we are crazy? What is it?! We spend all this time, even the coverage on this show, discussing the lame details, and technicalities, about the plan. When we repeatedly overlook the elephant in the room. The elephant has been mentioned on this blog by several people on previous shows about health-care and it is never addressed. Not only is it never addressed, but it is never combated by anyone in any meaningful way. Tell us how we are wrong? Where is the precedent of the government forcing us to directly support private companies only on the basis that we are alive? Where is it?
-
"Do they not want to tarnish the brand?" What brand -- the Democratic Party? The Democratic Party has had a smudge on its chin at least as far back as the 1920's or 1930's. Will Rogers once said, "I am a member of no organized political party -- I am a Democrat."
-
Penny From Eugene...Thanks....That's helpful....
-
How will this change my life? Well for starters more of my family will finally be able to get health insurance. But more broadly it will allow so many of my fellow Americans to be covered. People will be able to worry less and in turn be happier and focus on other areas of thier life. This isn't only about access to medical care/insurance, it is also the overall mental health of the population.
This isn't a complete fix but it is a very good start!
-
I am a healthy, active 25 year old male. I eat healthy, exercise every day, and have no health issues which require regular doctor visits. Last year, I applied for health insurance and was quickly rejected. I can only conceive of two reasons for this: My having been without insurance for the prior year, or my knee surgery 10 years ago.
This bill means that I, and other young people like me, need not fear rejection because we might threaten some companies bottom line.
-
I personally am glad that my partner (who posted above) will have a chance to purchase in the future coverage he's had to return to school to get.
-
Is the new Health bill yet another crafty bit of legislation that will "Privatize profits" and "Socialize Risk"?
I can't say that I hear much talk about how the bill will reduce the cost of providing health care benefits. We will require most everyone to buy insurance - guaranteed customers for the industry - and add to the financial burden of the federal government, and the citizens of our country to pay for this service.
SteveinBend
-
Two thoughts:
1) The Republican Party doesn’t seem to stand for anything anymore, other than “Get Obama.” And the only ideas Republicans seem to have brought to the Health Care debate amounted to: “If Obama wants it, we’re voting no.”
So of course the President had to push through the legislation as a strictly Democratic bill, fighting the Republicans’ monolithic bloc with another of his own.
2) Any meaningful Health Care reform has to be comprehensive or it simply won’t work. That is just a fact. Yet, for all the cliché’d rhetoric spewing forth from the right-wing, Obama’s bill is simply not a radical proposition. As William F. Pewen, former senior health policy adviser for Republican Sen. Olympia Snowe (Maine) wrote in an opinion piece in Saturday’s Oregonian: “…the core of the Senate's legislation closely resembles the very bill the Republicans offered in 1993 as an alternative to the Clinton plan.”
http://www.oregonlive.com/opinion/index.ssf/2010/03/missteps_eroded_bipartisanship.html
-
I was watching the coverage of the signing ceremony in the East Room, and one of NBC's reporters (Kelly O'Donnell, I think) reported that Senator John McCain (R-AZ) had said, "This means no more cooperation for the rest of the year."
Gotta love those Obstructionist Republicons.
-
It is a step in the right direction,but at the same time we are squeezing doctors who treat Medicare patients, we pay college basketball coaches over 1 million per year! When is this country going to get its priorities straight??
-
Greed is how we have arrived at this place.
Could government ever consider using this plan as a model for their own healthcare benefit?
This action would show change, less greed, and hope for a healthy American society of all people no matter what class.
Or may we the people choose to change what we offer all government employees? Our healthcare benefits have changed, how can our government stay the same.
-
Since all citizens are required to purchase health insurance, the Oregon Health Plan is no longer needed. How much money will the state of Oregon save now that the Oregon Health Plan is no longer needed?
-
I have a question that maybe you can answer. My understanding of the new law is that If you are unable to purchase insurance for some percentage of your income you are eligible for a high risk pool or you are allowed to purchase catastrophic coverage intended for persons younger than 30. This would suggest that while insurance companies are not allowed to withold coverage for pre existing conditions they will be allowed to charge different rates for similar individual coverage. Doesn't this allow cherry picking? Isn't this similar to what we already have in Oregon with OMIP?
-
I did find a site (Kaiser Family Foundation) that has a plan summary and comparison. Don't confuse this with Kaiser Permanente health insurance, this seems to be a different organization. See:
http://www.kff.org/healthreform/sidebyside.cfm
There seems to be a mandate that insurers must provide four defined levels of plan, labeled in the KFF doc as "bronze, silver, gold, and "young invincibles." It also outlines the percent-income and income level provisions. I believe you would not be restricted to just buying the young invincibles plan ("under 30 plan" as you title it).
Insurers like to slice and dice all their customers as much as possible (or as much as legislation will allow), so they can discontinue or raise rates on the most expensive pools and keep the "good" pools, the ones they can collect money from who rarely use services. This is why it is most important to have the provision that people cannot be dropped. They give the best rates to large groups, like Intel or the State Employees, higher rates to small employers (under 50 people), and even higher rates to individuals, and even higher rates still to individuals they have rejected and put into a high risk pool (OMIP, OHP).
I believe OMIP is contracted so that the plan administrator cannot charge more the 1.5 times some "base" rate, and I don't know how that's enforced but I assume it is a state law or statute. So that, right there, mandates a cap on the high risk pool that prevents the $5,000/month premium being charged.
The single-payer-plan theory is that it's better to create a single pool of 3,000,000 covered individuals, the average costs and premiums go down, or are minimized. Other countries have found this to be the case (go read T.R. Reid's "The Healing of America." plug plug)
So, if OMIP, instead of being 7,000 people covered, was a policy of 100,000 people nationwide with all states participating, that would have bargaining power and spread the risk over more people. The current bill does not seem to eliminate risk pools or enforce caps, but I hope it will cause pools (individual and risk) to expand to larger size (instead of being separated state-by-state, it would be regional or national) and gain economies of scale and rate leverage. A cap should be enacted.
-
I’ve heard all the discussion about INSURANCE, but not about the underlying cost of care, which is unsustainable. Is there anything in the bill that allows us in Oregon to address the health care practice and payment issues that now reward the most expensive care and has relatively few incentives for promoting quality and cost improvements.
-
When will I be able to buy ‘affordable’ health care?
When will the total I pay now be reduced? -
Some Conservative Republican State Attorneys General are going to sue because they think it is unconstitutional to Federally "mandate" buying insurance.
The best outcome would be that they win in the Corporative State Conservative Republican dominated US Supreme Court and then the Bills are revised so that all Americans have to pay Federal Taxes into a Single Payer Universal Health Care System that covers all Americans and completely bypasses the parasitic Medical Industry Corporations.
The US needs to join the other civilized nations of the world, like Australia, Canada, Norway, France, Great Britain, etc.
-
The problem I have with the OHP is that the lottery isn't fair. People who live alone are less apt to get coverage. Two to three times less likely. That's because the OHP makes a lottery entry for each individual, but if the individual is chosen, they provide OHP coverage to everybody in the household. In effect, each person in a 4-person household gets 4 chances to get health coverage. A person who lives alone only gets one chance. Since there isn't enough money to cover everybody, the people who live alone are left out. The lottery is rigged!
-
I have complaints about OHP too, but they relate to the particular medical conditions I am dealing with.
-
Does the provision for young adult childred to remain on parent insurance to age 26 activate immediately? I certainly hope so!
-
I wonder how many people who would prefer to keep working past age 62 or 65 or even seventies are going to in essence be forced to retire in order to get Medicare because there is no way they can pay for even (probably minimally) subsidized health insurance. Many of us have employers who do not pay for health insurance as a benefit (and maybe big multiple-employee companies are going to be required to provide health insurance or face fines but most small businesses, over 90 percent of this country's employers, are exempt). Manyof those companies who do provide also ding the employees for part or all of the premiums deducted from their pay but with salaries not keeping pace with the cost of the insurance, how exactly does this work? It seems to me that our celebrated falsely-named "representatives" did not bother to consider the many intended and unintended consequences of this falsely-named "reform."
Worse yet the spin doctors are at it: they are now calling the "reform" "universal changes" which deliberately mis-appropriates the PROPERLY named "universal healthcare" and TWISTS IT for their own agendas.
We had a saying a number of years ago: If you are not terrified, you are not paying attention.
-
I, too am concerned about how the change in rules covering pre-existing conditions will be handled.
I am 49, and I suffered a stroke over 1-1/2 years ago. I have fully recovered (the medical term is that I 'show no neural deficit' -- although at the time the impact was profound). My doctors and specialists have determined the cause, and are completely confident that it was a one-time event, and I am at no more risk of further complications than an average man my age, and in fact, because of my general health and other factors, I probably am at LESS risk of future similar related problems.
I am now unemployed, and am paying (subsidized) COBRA (and have never had a lapse in coverage in my life). I would LIKE to start a company (as an entrepreneur), but have been assured by my doctors that 'til now I would not be able to get private insurance, owing to my situation and medical history.
In effect, this situation is forcing me to find employment at a company that offers reasonable medical coverage, as opposed to starting a new small business. It is my understanding that it is generally acknowledged that small business growth is the engine that first fuels an economic recovery.
However, I believe there is no such thing as a free lunch -- Are we to believe that this change will come without other adverse impact or otherwise shifted expenses?
Also:
Thank You for referring to the bill that was passed as "Health Insurance reform" and not "Health Care reform" -- there is MUCH more to be done to reform Health Care, and with so much money at stake, we can be sure that the existing interests will be fighting mightily to make sure they (continue?) to get what they *each* see as 'their fair shares' of the considerable pie.
-
MarkKKlein:
speaking to you as someone who went onto COBRA, and then onto OMIP, I'd recommend that you do act on obtaining insurance, perhaps not today, but do not wait until the last month of your COBRA before acting. In fact, start shopping now even if you will keep your COBRA the full 18 months (or whatever they are extending it to these days). It can take a few months to apply for individual insurance (records transfered, applications reviewed).
If you are applying for an individual policy (not a group policy by re-hiring into another job) I am going to speculate that your medical event will red-flag you as having a preexisting condition. If you are rejected by one or two insurers for an individual plan, and your COBRA coverage is expiring, you are eligible under Oregon state OMIP plan for what they call a portability plan. It will cost a little more than what you are paying your (former) employer's plan. I didn't get dental/vision coverage with OMIP portability: I pay all dental out of pocket now. If you can afford it, OMIP is better than the risk of going uninsured. It was a safety net for me; I'm just lucky to be able to afford it. If you let coverage lapse 30 or 60 days after COBRA, you're in another pickle.
I was surprised to discover that my group plan (CIGNA) would permit me to extend medical, dental and vision under COBRA, but when I asked them to extend an individual policy in month #17 of 18, they said, sorry, we don't write individual policies in your state. Try shopping for a company on a web site like esurance.com to find out the going rates and plan options.
Verify well in advance that your current physician is "in plan." If not you'll have to shop for another doctor. You may also find you can't get dental and vision coverage, so make use of all the dental work you need done now if you have dental coverage. And brace yourself for being rejected by individual insurance, for me the rejection letter was a shock, I really thought I had no problems but insurance companies don't care after they make their pronouncement.
Since you are entrepreneurial, I can't speak to whether there are other options like getting a small-business policy. My guess is that having a few employees will not make your insurance any cheaper.
-
I am sure that like all other legislation the devil is in the details. I am sure that some will benefit more than others . I am sure that the initail 10 years will be rocky--for me, as a physician they may be ugly.
We need to keep in mind that we care for most chronically ill people already , through our taxes if they have Medicare or Mediciad OR through cost shifting . They are teated when they reach the ER in heart failure from untreated hypertension or are hospitalized with widely metastatic breast cancer. Not all preventive care saves money( believe it or not) but access to regular primary care , looking internationally, does save money by catching things before they get to the end stage
I do think medicine is one of the only services where what you pay depends so much on who you are. What is the "cost" of an MRI? That's unclear. The charges may vary from $600 to $1800 depending on whether you have medicare , medicaid, private insurance or are self pay. It will take years for medical costs and charges to be come rational, and there will be some very difficult adjustments along the way. Of course we are all afraid our coverage will be cut , since the sticker prices are so high. So is the providers overhead ...
Thank Gosh for Rep DeFAzio negotationg equity in Medicare payments across regions.
-
LynnB,
Where you write: "I do think medicine is one of the only services where what you pay depends so much on who you are. What is the "cost" of an MRI? That's unclear. The charges may vary from $600 to $1800 depending on whether you have medicare , medicaid, private insurance or are self pay. It will take years for medical costs and charges to be come rational..."
Humor me for a second. Think of all the makes and models of automobiles, all the millions of little parts and repair procedures. Every auto shop has a huge parts book with prices, and a procedures book with estimated procedure cost (time, materials). We've been doing that for decades.
I will point out that all the other industrialized countries (Europe, Americas, Asia) have figured out how to write some form of a "price book" for medical costs, drugs, and procedures. To repeat: All the health systems in the world with better outcomes than ours have implemented a fixed price and fee schedule. I'm sure it was panful to produce, and these have to get revised, and for the innovative new stuff you have to "wing it." But there are 15 other countries that have blazed the trail ahead of us folks, this is not rocket science any more.
The insurance industry and drug companies appear to be calling the shots for this today, IMHO. Only in the U.S. are we experiencing a 3x price disparity, without even blinking, and without taking action. The hospitals, drug companies, insurers, and even doctors, and their lobbyist groups are playing a shell game with costs, so easy to do. (It's notable that the AMA finally came around to support reform this time, in 1992 they came out for the staus quo.)
rhetorical questions:
1) what does the Veteran's Administration charge its clients for an MRI ?
2) What is the internal cost to the VA for that MRI, and how is it paid for?
3) Why do we have no price control or bargainng power over prescription drugs, where outside the U.S., the same pills from the same manufacturers cost so much less? Why do we pay double for the same thing?
4) If this is a "market" and markets are supposed to be efficient, why does it seem there is no "market" at work here, and terrible waste?
5) Does anyone seriously want to defend the current U.S. health care "market" as efficient?
Therein we will find answers to our problem.
-
When it takes 100% of your income to survive where the hell is the 5% insurance cost you are now required to pay, come from, exactly?
-
FYI those who think subsidies might be the answer - look at many of the explainer posts such as appearing on msnbc. As individuals we will be required according to this bill as passed to pay out ALMOST TEN PERCENT OF OUR GROSS INCOME for premiums before we are given subsidies. DO THE MATH.
-
Perhaps someone on the show can explain the costs in a simple manner... when I divide 32M into 940B I get a little more than $29K per person... is that ~29K over a period of years, if so how many?
Second thing, I currently pay about 4% of AGI for family healthcare... seeing that jump to anywhere near 9.5% would result in a significant withdrawal from the local/regional economies... if others are in similar situations, did anyone analyze the short/long-term impact to the overall economy before voting for this thing?
Last thing, I agree completely with those lamenting the lack of a public option to counter-balance the insurance industry.
-
Employers require participation to keep premiums affordable. The number of participants and the demographics of the group play as much a part of setting the premium as does the plan benefits that are chosen. Keeping the premiums affordable help the employer and the employee.
-
I am a 48 yr old woman and have lived in the Pacific Northwest most of my life. Other than a few years in my early 30's I have never had health insurance, even though I have always been gainfully employed.
One of the big reasons I so enthusiastically voted for Bill Clinton was because of his promise of health care. Frankly, even though I also enthusiastically voted for Baraq Obama, I didn't think he'd be able to pull it off, (a health care bill, that is).
One of my biggest frustrations is listening to people, your guests among them, talk about how some benefits or procedures might now cost something. Really?! Yes, services cost money. As a taxpayer, I am expected to pay for services such as schools that because I am childless I won't be directly benefiting from. I am more than happy to do this because schools help create a sound society.
Well, if some of you are now going to pay for your neighbors health care, then so be it. This also helps create a sound society. If you don't drive a car some of your tax money still goes to road maintenance.
Recently on NPR I heard a republican who's name I can't think of say, "taxes just keep going up and up, when will it end?" Well, never. For goodness sake that's like saying "my grocery bill just keeps going up and up, when will it stop?" Again I say, we must pay for services.
Please, tax me and give me some benefits for my money.
Thank you for your show. I listen every day.
Devon Wright
-
2000 or 2700 pages written primarily by the insurance companies or their proponents? What is hidden in the fine print that we aren't aware of?
Warren Buffett uses the float (premiums paid) generated by Berkshire Hathaway's insurance companies as interest-free money to invest as he deems prudent.
Float is not invested to decrease premiums or improve quality of health care. Buffett's insurance companies follow the laws, but our paid in premiums do not directly improve our health care, they make a minority of people rich.
-
I know Buffett's companies are in life insurance and auto insurance (Geico). But is he involved in any company doing health insurance? I don't think so, the big health insurers are all independent. Cigna. Wellpoint. Aetna. Kaiser. Humana. United Healthcare.
-
So what happens to someone like me - my husband is self-employed, practically unemployed. We have to pay our own insurance and it's $300 per month with a $2500 deductible. It's crazy expensive to go to the doctor. With 2 small children we have to be coughing up a lung to go in because it's so much additional money. How does this reform help me? What we have is like having to insurance at all. Forget preventative care. We're just trying not to get sick.
-
"Trying not to get sick." Pretty much sums up what the Republicons were pushing as a health care plan.
Believe me, I can understand your pain...I have mediocre coverage through my partner's employer, and the premiums withheld from her pay exceed the stated amount of benefits per covered person (Benefits of $2000 per plan year vs. Premiums of $2100 + $150 deductible + $20 Office visits + 30% co-insurance on other procedures, such as allergy shots and immunotherapy serum.)
-
I am an independent contractor in publishing. My industry (textbook publishing) has been severely impacted by both technology and the recession. I can no longer depend on having adequate freelance opportunities, though I've been in the business for 40 years.
I am 63 and uninsured. I never know what my freelance income will be for a given year. My income varies from poverty level to 4X above. What sort of insurance plan will give me some security under these uncertain fiscal circumstances for the next two years until I can enroll in Medicare?
Thank you.
Ava Hayes
Springfield, OR
-
My father in law and 3 freinds all have small business in the valley are. They were looking at having to drop the health insurance they offer their employees. If I am reading this right, this could be life changing for all involved. Not only for their employees, who will pay less by going with the exchange, but life changing for themselves. This will free up money for them to grow once again, and retain some really good people that may have quit because the insurance the employee may have lost.
-
i'm self-employed for the last 10 years and my income has fluctuated dramatically in the last few years. my wife and i have a baby coming any day now and when she arrives, our premium will be $610/month with a 5K deductible from our individual plan through Providence.
i'm wondering if the incentives that are being offered for small businesses will make it more beneficial for my family to use a business issued health insurance vs a individual family plan. the only employees are my wife and i...
-
I've been wondering why industry has not been screaming loudly to unburden them from the shackles of health insurance, which puts them at a competitive disadvantage internationally. And why small business, the creator of most new jobs in the country, doesn't do likewise.
Recently I had the epiphany that industry is fine the way it is with a work force in virtual slavery because of the need for health insurance. What employee can leave if they lose their family's health care? How can an employee, with any creative, entrepreneurial thoughts, afford to strike out on his or her own to create a small business if they lose their family's health care?
I hope this legislation helps us become more competitive. But I also fear there is too little addressing the underlying costs of health care. As John Kitzhaber once said, giving health insurance to everyone only adds more deck chairs to the Titanic. But maybe it will buy us time to really and truly address the faults of the system.
-
I often wonder the same thing. You would think it would benefit companies (specifically), to have the costs of health insurance eased. You would think, it would make the US workforce more competitive. I think, it boils down to people not wanting to be self-critical. Wanting to seem like unwavering pigheaded cowboys---by not wavering from tradition and the message of their affiliations. It's conformity!
-
This is a good question. Strangely, the U.S. Chamber of Commerce---"Fighting for Your Business(r,tm,c)" they say---came out opposed to health care reform before there was a final bill, then made a big-money push to the finish line:
August 13 2009 NY Times: Ad Watch: US Chamber of Commerce
"Chamber officials would not discuss the amount they are spending but said it was “multimillions of dollars,” making this ad buy one of the biggest by a single group so far in the health care debate. The ads began running on Wednesday [August 2009] on network television in 20 states"
March 14 2010 NY Times: Millions spent to sway Democrats on Health Care
"The Chamber of Commerce is leading the opposition to the health care bill with a coalition called Employers for a Healthy Economy. In two weeks, the group has bought more than $7 million in television advertising and plans to spend up to $3 million more. Americans for Prosperity, a group financed by David Koch, the oilman, is also jumping into the fray with an advertising campaign of nearly $1 million."
Some five or more years ago, there was an insightful New Yorker article describing how the health care system was killing, had killed, the U.S. automotive industry. Just a few years later, look what happened as there was a final stake through the heart of two of the "US big three." I think the case made was a built-in cost of $1000 or $2000 is incurred for each vehicle, directly attributable to health care costs that were not incurred by competitors (overseas or in foreign-owned US plants). If you want to blame unions you miss the point: blame the difference in health care costs between the US and every other industrialized nation!
Why the Chamber is opposed is, well, is it a mystery? Big Pharma is a member, the article tells you where they are putting their money. It seems that at the Chamber, the biggest pot of money talks the loudest, not membership or headcount.
-
Is there any info on people who have Blue Cross/Blue Shield of oregon Med Advantage plans now?? BC/BS of oregon has always been "Not for Profit" as is the existing Med Advantage plan available in Oregon now. Unfortunately, we have been pooled with all Med Advantage plans in the country and consequently will be subjected to all the billions of dollars that will be taken out of Med Advantage. This is not fair to us in my opinion. We have not had any so called special benefits the "for profit" plans have had but I've not heard this mentioned.
-
This bill has real and meaningful consequences for young adults with cancer. Currently, cancer is the leading natural cause of death for young adults. These young adults also have the leading rate of no insurance. They are unable to stay on their parents' insurance (if not in college or if forced to drop out due to their illness.) If they survive their illness, they have the "cancer label" -- an exclusionary preexisting condition. This bill will change all of this for young adults under 26. We have something to be thankful for!
-
We need to throw all Conservatives of both parties out of office and start running this nation for The People instead of for The Corporations.
And pass a US Constitutional Amendment that takes away "person hood" from Corporations and explicitly limits their charters, in scope of business and term of life.
Corporations have become the Frankenstein Monsters that Mary Byshe Shelley wrote about metaphorically.
-
Worthy of note, this legislation was passed by alleged liberals and both Pharma and Insurance companies are predicting greater profits; while the rate of taxation is also predicted to increase (today NPR). The power of information gathering by both government and industry has also been increased with the stroke of the allegedly liberal POTUS pen.
Rather then think that the Conservatives are the problem, address the real problem that we have self-serving politicians that are exempt from the laws they pass for the rest of us, in office rather then “Statesmen”. -
Conservatives are not 'the' problem, but they are definitely a big part of the problem. They didn't want any reform at all. So really, through all these years, they have been much of the 'entire' problem. Because if it wasn't for conservatives we would have had health-care reform a long time ago, and the current health-care reform would have been more effective. But, yes, Democrats apparently are almost as bad.
-
This health care bill would have been lot more effective if the following was done
1. Tort Reform. By reducing the cost of malpractise insurance the medical profession would have reduced the cost of medical service to the patients
2. If Engineering jobs can be outsourced to Asia to reduce cost why not outsource medical jobs also to reduce cost.
3. Import more Doctors from outside so that the Doctors so that with incresed supply of Doctors the Cost will come down.
4. A simple MRI costs $1500 in Oregon. The same quality MRI cost $200 in Asia
Prakash
-
I have been confused about the not-for-profit status that many people attribute to Blue Cross / Blue Shield (see cliffr's comment in todays posts).
In most cases, BC/BS is a for-profit organization, although when BC and BS started they were not-for-profit. Look here on wiki:
http://en.wikipedia.org/wiki/Blue_cross
Some excerpts:
"Blue Cross and Blue Shield developed separately, with Blue Cross plans providing coverage for hospital services, while Blue Shield covered physicians' services... Blue Cross is a name used by an association of health insurance plans throughout the United States.... The Blue Shield concept was developed at the beginning of the 20th century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians... In 1982 Blue Shield merged with the Blue Cross Association to form the Blue Cross and Blue Shield Association."
"Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to "special tax benefits" under IRC 833. In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations. Some plans are still considered not-for-profit at the state level..."
"...Blue Cross and/or Blue Shield insurance companies are franchisees, independent of the association (and traditionally each other), offering insurance plans within defined regions under one or both of the association's brands...."
"The 14-state WellPoint is the largest Blue Cross Blue Shield member, and is a publicly traded company [WellPoint is definitely a for-profit company]. Other multi-state organizations include CareFirst in the Mid-Atlantic and The Regence Group in the Pacific Northwest. The largest non-investor owned member is health Care Service Corporation, which operates four Blue Cross and Blue Shield Plans in the Midwest and Southwest."
[emphasis and comments were added].
-
From the regence 2008 annual report at
http://www.regence.com/about/annualReport/annual-report.jsp
it seems Regence is non-profit.
"....medical care for Regence members consumes nearly 89 cents of every premium dollar..." (2008)
"Unlike some other companies, Regence doesn’t measure success by how much money we make – we’re a nonprofit company. Instead, we set our sights on meeting the health care needs of our members and facilitating their use of the health care system. With members as our highest priority, our unwavering focus today is on cost as a barrier to care. We’re committed to reinventing health care so it does a better job for the people it is intended to serve."
Makes you feel good, doesn't it? That said, I will tell you, when I was shopping in the individual insuance market, the plan I could get from Regence was not remarkably different than the for-profit competition, and they turned me down for individual insurance. When I was a state employee many many years ago, BC/BS was my insurer, and it was a Cadillac plan compared to what's offered today to individuals, and it was not cheap to buy either.
So, as a member, you may be their highest priority, but it still is a club with doors that shut to keep some members from joining. I got in via the back door: OMIP high-risk portability pool, 1.5x higher premium. That's very noble of them to be the plan administrator for OMIP. I still can't see evidence showing that their non-profit status has produced better results, lower costs, more coverage, or significantly different benefit plans.
-
Whether a corporation is "for profit" or non-profit really makes little real world difference these days in how the money works insofar as paying obscenely high executive salaries and bonuses. Nonprofit status is pertinent much more to tax issues on the corporation.
Interestingly in the 90's the so-called "nonprofit" status of BCBS in another state was completely and utterly trounced in the courts because BCBS claimed itself to be nonprofit and then proceeded to act in fact just like its for-profit buddies.
Please don't make the mistake of thinking that just because a corporation is nonprofit that it has your best interests at heart "above its own." All it truly means in day to day business is that they have more money to pay their executives as they're paying no taxes. A charitable organization is more likely to think of others - although some of the biggest and most well known are increasingly being attacked for having their administrative costs be such a high percentage of donated dollars that it's little more than a scam to the unwary people who might be or be considering donating.
-
There is a common misconception about the term "Not-for-Profit," and that is the belief that a not-for-profit organization is prohibited from making a profit, whereas the true meaning (coming from my accounting textbook) is that a not-for-profit organization's prime motivation is service to its community, rather than profit as is the case with a for-profit corporation (such as ExxonMobil, just to use an example that everyone loves to hate.)
The not-for-profit is allowed to make a profit, it is merely that profit is not its prime motivation. (How else would many charitable Not-for-Profit organizations be able to expand their services other wise -- such groups as Salvation Army, St. Vinnie's, YMCA/YWCA, Susan G. Komen for The Cure, etc. just to give a few examples.)
-
People have a difficult time in the US sometimes getting the treatment they want. Cancer options are limited due to insurance exclusions and government approval.
-
Cool…interesting info., I wish we could have more input, personal experiences, IceBerg Perfume
-
Useful information, many thanks to the author. It is puzzling to me now, but in general, the usefulness and importance is overwhelming. Very much thanks again and good luck! Personalized stickers
-
Comments are now closed.
Throughout the discussion over the past year, I have been hearing that exclusions for pre-existing conditions will be prohibited. I am all for banning these exclusions, but let's do it right up front, not a gradual phase-in or a delayed ban that doesn't kick in until the current freshman senators are running for re-election. This delay will do nothing more than give the insurance companies a big window to look for more reasons to exclude people or rescind their coverage just when they need it most.
I am surprised that insurance companies haven't figured out the concept of excluding people for the most common pre-existing condition: life.
(Okay, I admit it...I am somewhat cynical...but I keep hearing about all the efforts that the right-wing wacko Republicons are going to just to derail it.)