Health Care Reform

It appears that today might be the end of a very long road to health care reform. There's been a lot of debate on the subject really leading back before the election. The mainstream sounds like an echo chamber, so I'm hoping you guys have better insight. Will this bill do what the administration claims to do, or is it as bad for the future of America as Fox says?

Comments

Re:It is bad, wrong way to go about it

[Sircus]

Is there anything that the government runs that really functions correctly/efficiently?

Is there anything about the proposed act that is government-run? If there is, I'd missed it. It mandates a bunch of things that private insurance companies are required to do, but it doesn't set up a public option (aka government-run health care).

Re:A false choice, of course...

[Pojut]

Full bill: http://www.scribd.com/doc/28572002/Reconciliation-HR-4872-Full-Text

CBO report: http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf

Get to reading!

Re:Single payer system

[TyFoN]

The US spends more money in percent of GDP in health care than any other country in the world. The Greece debacle is more about a government that increased wages and welfare to a point that the economy could not sustain, but it has nothing to do about health care specifically.

Not so.

[gbutler69]

Study after study has completely debunked the myth that high malpractice insurance is due to frivolous lawsuits. High malpractice insurance is for the same reason their is high medical insurance. The insurance companies made bad investments and lost their shirts now they're raking everyone over the coals while still pulling down 20 to 40% profits.

Re:Neither.

[commodore64_love]

>>>Republicans had years in which they could have pushed through health care reform

They did.
Or have you forgotten the new Prescription Medicine Reform where people can get "free" medicine? Or the Tort Reform to help reduce expenses?

no reform.

[roman_mir]

This is not a 'health care reform'.

This is not even an 'insurance reform'.

What is going to pass is a few regulations that are supposedly going to make it not possible for an insurance company to drop coverage, to do rescission and a few more items. - This is good.

Here is what you are not going to get:

1. No optional public insurance against private insurance, the prices will not go down. Worse than that, what is happening is private insurance is raising prices to offset any of the new changes that will be coming with this 'reform'. Does not look good.

2. You probably are going to get a mandate, which is unfortunate given that you will have no public option. You will be forced to buy into expensive private insurance, there will be no choice or it looks like you will get some sort of a fine. Does not look good.

3. No cheaper drugs imported from other countries. The bill was introduced earlier this fall, but Obama actually killed it very very personally because he signed a deal with the manufacturers to do this: no competition from cheaper imported drugs AND the patents are to be extended from 5 years to something like 12 years. Does not look good.

4. Looks like US is one of the backwards countries that will try to limit women's access to health care they need. You going to get the 'reform' that will prevent any private insurance coverage for women that includes abortion. This is no joke, even for those who have coverage today, looks like they will actually lose it with this 'reform'. Does not look good.

The other part of it, the cost of it, that's a moot point. It was calculated that if Medicare was provided as a buy in for anyone at all, at cost (at cost - means whatever it costs, but no money is made for profit), or if there was a public option, then the reform could even save money. The way it is going to happen with no public negotiations with hospitals, no public negotiations with drug manufacturers, no import of cheaper drugs, no generics because the patents will be extended, well, I don't know if this will be cost neutral. It does not matter really, if US just cut its WAR cost, it's defense contractors costs they could probably fund the entire reform in health insurance and there would be enough money for the public education reform. Of-course that's not going to happen.

Anyway, Pelosi and Obama and the rest of them are lying sacks of shit. They do not want to take a vote on the public option, they will not take a vote on Grayson's proposal to just allow anyone to buy into Medicare at cost. This is not a health reform, this is just a little chunk of 'change' you were promised. Take it and be happy, cause you are not going to get anything better at all.

Re:Health care: break the MD cartel

[Malc]

In 1999, administration cost $1,059 per capita in the US, versus $307 per capita in Canada, per New England Journal of Medicine. So much for private businesses being better than the government. I've lived in Cyprus, UK, Canada, USA, Australia and China, and my experience, the UK has the most encompassing system, and Canada (Ontario at least) the most proactive and efficient. I totally hated the American system, and I can't say I'm much of a fan of what I saw in Melbourne. China was great as an expat because it was so bloody affordable, but that's not what we're discussing here.

Re:A false choice, of course...

[timeOday]

Now, let's get back to a real discussion regarding the pros and cons of health care reform!

This thread, and news coverage at large, are incredibly sparse on what the plan actually is! So here it is:

INSURANCE MARKET REFORM

• The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing conditions and prevent them from arbitrarily dropping policy holders.
• Insurance exchanges would be created where small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.
• The proposed changes would allow dependent children to remain on their parents' health policies until age 26.
• The Senate bill requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.

COVERAGE MANDATES, SUBSIDIES AND MEDICAID

• Individuals would be required to obtain health insurance. Those who fail to purchase coverage would face fines of up to 2.5 percent of income by 2016.
• Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.
• Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.
• Medicaid, the government healthcare program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.
• The proposed changes would get rid of a special deal to help Nebraska pay for the expanded coverage and boost aid to all states.

FINANCING

• The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.
• The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.
• The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax to some investment income as well for those high-income groups.
• The bill would impose fees on medical device manufacturers, insurance providers and brand name pharmaceuticals. The proposed changes would delay implementation of those fees.

MEDICARE

• The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.
• It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.

Re:A false choice, of course...

[svtdragon]

This bill is the minimum that can be done to remove recission and pre-existing condition clauses without destroying the system.

The economic logic is as follows: We want to regulate the insurers such that they don't exclude people based on pre-existing conditions. This makes sense.

However, once you try to apply that in practice, it gets hairier: if you cease to enable insurers to do that, then you get what's called an "adverse selection death spiral", wherein some healthy people drop coverage (since they know they can get it back as soon as they get sick) which worsens the risk pool. Because it's worse, those remaining members left in this new risk pool get charged higher premiums. These higher premiums cause more healthy people to drop coverage (since they're getting less for their money) which causes a repeat of the same cycle. As this goes on, the price of insurance gets so astronomical that only the sickest have it and nobody can afford it because the cost approaches the cost of the procedure you're supposed to be insured for.

The way we work around this is the unpopular part. We put a mandate on everybody that says "alright, since they can't kick you out anymore, you can't game the system: everyone has to be insured". Whether it's better to do this by putting the mandate on individuals or on employers is debatable, but what's on the table is an individual one.

Now that we're mandating everyone have insurance, we need to address its affordability, since mandates to buy things that people can't afford don't really work. This is where the subsidies (ie, costs) come in. This package is basically $900bn in subsidies for people who have trouble affording comprehensive insurance--including everyone from the average joe to a reasonable percentage of the slashdot crowd. The latest bill has caps on premiums set as follows: "[f]or people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income." The penalty for not buying insurance is $695/person/year with exemptions for financial hardship, etc.

The $900bn comes by way of medicaid as well as direct subsidies.

The rest, once those things are in place, are to cut costs/cut the deficit and regulate insurers. But the above is by far the bulk of the bill. While I personally wouldn't mind killing the insurance companies so we can institute a single-payer system, if you want pre-existing conditions gone, this is what you get.

This is not quite true.

[sean.peters]

In exchange, there are a lot of parts that are a big giveaway to insurance companies: because we've focused on giving everyone insurance instead of giving everyone health care, individuals are forced to buy insurance, but with inadequate oversight to ensure that insurance companies don't just gouge prices.

Actually, there are provisions in place to keep them from just charging whatever they want: they have to pay out at least 85% of revenues on actual medical care. Given that insurance companies have their own staff that they have to pay, this puts pretty strict limits on how much they can actually profit.

Also not true.

[sean.peters]

The case of Texas is instructive - they strictly limited damage payouts for medical malpractice cases... and their medical malpractice insurance premiums continued to escalate at exactly the same rate as the rest of the country. Nor was there any particular change in overall health-care cost escalation. So I think we can safely ignore this particular line of argument.