Senate Health bill

JoeTheJuggler said:
The insurance reforms (removing at least lifetime caps and "unreasonable" annual caps, doing away with rescission and pre-existing condition exclusions) are worth the effort. (That rescission business was getting really crazy.)

Removing effective monopolies in some states will certainly improve competition competition. As I mentioned above, mandating low-risk people to pay something rather than nothing should help lower per-capita costs.
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Doesn't the insurance exchange remove monopolies in all states? I know they have some eligibility criteria, individuals who aren't covered by their employer or small employers, but it's not limited by location is it? It would seem to me if this exchange thing were done right, it would be open to all from everywhere and that would be your competitive pressure. I haven't read the bill yet though I plan to this weekend so I hope to understand it a bit better then.
 
JoeTheJuggler said:
As they say, politics is the art of the possible. Do you think something significantly better was possible (given the need to placate Lieberman and the Blue Dogs in order to get cloture in the face of a Republican filibuster)?
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Agreed. Anyone who thought they were going to get exactly what they wanted out of this thing was fooling themselves from the get-go. The realists knew that everyone would have to play give-and-take on a piece of legislation this big, and it is only the ideologues on both sides who are freaking out at this stage. I swear if I get another frakkin' email from MoveOn about this issue I'm going to kick in my computer screen :mad:

And also, is what we're likely to get better than nothing (the status quo)?
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Well, I'm hopeful that it'll be a good thing, on balance. Of course, time will tell. I also think that there will be many years of inevitable tweaking and adjusting to come. Again, this is to be expected with something this huge.

Thankfully, it looks as if this thing will finally be done by about year's end. I know the GOP is going to do everything they can to stall it, but they are quickly running out of tricks. Soon, the inevitable will occur, and then the Congress can move on to other important issues (and the media can shut the hell up about this one :) )
 
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jdp said:
Doesn't the insurance exchange remove monopolies in all states? I know they have some eligibility criteria, individuals who aren't covered by their employer or small employers, but it's not limited by location is it? It would seem to me if this exchange thing were done right, it would be open to all from everywhere and that would be your competitive pressure. I haven't read the bill yet though I plan to this weekend so I hope to understand it a bit better then.
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I haven't seen anything in the bills that introduces actual competition. As far as I can tell all the exchanges are is a government version of esurance.com. The states will still control the insurance industry, meaning residents of some states will still have just 2 or 3 insurers to choose from.

And we'll still have massive publicly-owned hospital chains whose primary mission (by law) is increasing stockholder value. And if they cure a few patients along the way so much the better. And people wonder why health care inflation is so much higher in the US than any other country on the planet.
 
WildCat said:
I haven't seen anything in the bills that introduces actual competition. As far as I can tell all the exchanges are is a government version of esurance.com. The states will still control the insurance industry, meaning residents of some states will still have just 2 or 3 insurers to choose from.

And we'll still have massive publicly-owned hospital chains whose primary mission (by law) is increasing stockholder value. And if they cure a few patients along the way so much the better. And people wonder why health care inflation is so much higher in the US than any other country on the planet.
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My understanding is that it would operate exactly like the Federal Employee program. Is the Federal employee package the same for say a postal worker in Texas and Maryland? Or are the options also limited by state law? I kind of thought that by and large all federal employees had essentially the same options that it was a national thing.
 
WildCat said:
I haven't seen anything in the bills that introduces actual competition. As far as I can tell all the exchanges are is a government version of esurance.com. The states will still control the insurance industry, meaning residents of some states will still have just 2 or 3 insurers to choose from.
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From the summary:

Information about Insurance Plan Expenditures, and a Rebate to Assure Value

Each year, insurers will report the percentage of Americans’ premiums they spend on items other than health care costs, such as bureaucracy, marketing, or executive compensation.

Before the Exchanges are established, Americans will receive a rebate if their health insurer’s non-medical costs exceed 20 percent of premium costs in the group market or 25 percent in the individual market.
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This sounds like a good way to encourage competition.

I also thought there was some language in there that bans state regs that allow for effective monopolies, but I can't find that. (Maybe that's only something from the House version?)
 
JoeTheJuggler said:
Yeah. I have no problem with people feeling strongly that this is a bad bill, but this sort of thing is idiotic:

http://politicalticker.blogs.cnn.com/2009/12/16/gop-senator-freezes-health-care-debate/
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I heard that listening to the Senate debates on CSPAN today. I couldn't believe it; I tunned in, listened for a while and turned it off. Then about an hour later I came back and within a few minutes the Senator from Vermont came to the floor and withdrew the amendment, they had already been reading it for like 3 hours.
 
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MattusMaximus said:
Agreed. Anyone who thought they were going to get exactly what they wanted out of this thing was fooling themselves from the get-go. The realists knew that everyone would have to play give-and-take on a piece of legislation this big, and it is only the ideologues on both sides who are freaking out at this stage. I swear if I get another frakkin' email from MoveOn about this issue I'm going to kick in my computer screen :mad:
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There was never any "give-and-take". Progressives pretty much dropped things like a single-payer plan before the process even started, bills were then presented and right-wingers took out whatever the insurancy companies didn't like, then Lieberman took out some more, just to spite Liberals.

That people aren't very happy about this, is more than normal.
MattusMaximus said:
I also think that there will be many years of inevitable tweaking and adjusting to come.
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I wouldn't put money on it.
 
Peephole said:
There was never any "give-and-take". Progressives pretty much dropped things like a single-payer plan before the process even started,
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As long as you define Obama as "progressive" and ignore that real progressives (like the PDA) did no such thing. In the Senate, though, there was never a chance for anything like single payer to get a supermajority, so it's a moot point. If there was never a chance at all of getting it, we really couldn't get any concessions for giving up on it.

Where I'm torn is that we could be screwing up some future chance at real reform by entrenching the insurance system as the way we do healthcare. Who knows, at some future date, single-payer might not have been unthinkable. But this bill would probably make it impossible for the foreseeable future.

On the other hand (that's at least the third hand, I know), this bill could save at least some lives and will definitely improve many who can't wait for that possible future.
 
Ok so two commentary points I heard just made were that those with preexisting conditions can be charged up to 50% more and older people can be charged significantly more too. I am skimming the bill now but if someone knows exactly were to look feel free to point it out. :p
 
Random said:
Unless there are price controls in place (fat chance), the subsidies will be worse than useless. There will be nothing stopping the health insurance companies from simply raising their rates to suck up the subsidies indirectly. (Well, there will be the miracle of the free market, but since that hasn't worked in 40 years, I'm pretty sure it won't work now.)
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It reminds me of what I have observed in higher education. College costs too much for many people to afford, and so the government ups the loan amounts that students can pull out to fund their education. Colleges look at the numbers and figure that students can also work a job on the side and get money from parents and so they increase the cost of tuition to reflect this. Hence within a few years the subsidy (loan) that would pay for tuition becomes a starting point from which the college expects you to pay more.

Then people complain about how college costs too much and many people cannot afford it, and so the government ups the amount...

I forsee any mandated insurance buy in becoming the same thing. Best yet, the money will be given in the form of a tax credit...:rolleyes: So I forsee a lot of people who can't afford to actually pay for the crapsurance and end up paying a fine at the end of the year or finding themselves in trouble with the IRS.
 
fullflavormenthol said:
Then people complain about how college costs too much and many people cannot afford it, and so the government ups the amount...

I forsee any mandated insurance buy in becoming the same thing.
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I'm pretty sure the part I cited above about the requirement that insurance companies report what percentage of premiums are spent on anything other than healthcare benefits, and effectively a limit on how much companies can charge above and beyond the benefits paid out is meant to prevent that sort of thing.



jdp said:
Ok so two commentary points I heard just made were that those with preexisting conditions can be charged up to 50% more and older people can be charged significantly more too. I am skimming the bill now but if someone knows exactly were to look feel free to point it out. :p
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This page has links to the full text, a quick summary and a detailed summary. I hadn't heard either of those two things.
 
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JoeTheJuggler said:
I'm pretty sure the part I cited above about the requirement that insurance companies report what percentage of premiums are spent on anything other than healthcare benefits, and effectively a limit on how much companies can charge above and beyond the benefits paid out is meant to prevent that sort of thing.

This page has links to the full text, a quick summary and a detailed summary. I hadn't heard either of those two things.
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Thanks for that I am looking through it now. Perhaps what they meant with respect to age was SEC. 2701 a 1

‘‘(1) IN GENERAL.—With respect to the pre10
mium rate charged by a health insurance issuer for
11 health insurance coverage offered in the individual
12 or small group market—
13 ‘‘(A) such rate shall vary with respect to
14 the particular plan or coverage involved only
15 by—
...

20 ‘‘(iii) age, except that such rate shall
21 not vary by more than 3 to 1 for adults
22 (consistent with section 2707(c)); and
 
JoeTheJuggler said:
From the summary:



This sounds like a good way to encourage competition.
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A bit, not far enough IMHO.

I also thought there was some language in there that bans state regs that allow for effective monopolies, but I can't find that. (Maybe that's only something from the House version?)
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Dammit, I saw an article on this earlier and forgotr where it was. IIRC, there are provisions allowing insurers to sell across state lines, and subject only to Federal regulations, but to do so the state in which it's being sold must pass a law in the state legislature allowing it. Otherwise, only policies from insurers regulated by that state may be sold there.

Apparently, the state legislators don't want to give up their right to screw up health care drive up insurance prices play kingmaker collect gobs of cash from insurance lobbyists "protect the consumer" from the big bad insurance companies.
 
I was just reading this WSJ opinion by Senator Coburn (R-OK) and it's interesting how things are twisted around. In the article Coburn states:

For instance, the Reid bill (in sections 3403 and 2021) explicitly empowers Medicare to deny treatment based on cost.
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Which isn't even true. Section 3403 in sub-sub-sub section (ii) states (at about page 1004

‘‘3 (ii) The proposal shall not include
4 any recommendation to ration health care,
5 raise revenues or Medicare beneficiary pre-
6 miums under section 1818, 1818A, or
7 1839, increase Medicare beneficiary cost
8 sharing (including deductibles, coinsur-
9 ance, and copayments), or otherwise re-
10 strict benefits or modify eligibility criteria."

while Section 2021 doesn't even seem related, it creates an "Elder justice coordinating council" and deals with Elder Abuse, Neglect, and Exploitation.

He then goes on to note that:

The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans "shall provide coverage for" services approved by the task force.
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Section 2713 seems to me to only provide a coverage floor, I see noting in that section that would prevent say a mammogram (using one of his examples) at 40 if the plan wanted to provide it. Only that all plans would have to provide it by 50.

He makes a good point about the civil penalty (which someone here made) but other then that articles and commentary like this is what makes it hard for people to really figure out what's going on here.
 
WildCat said:
JoeTheJuggler said:
This sounds like a good way to encourage competition.
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A bit, not far enough IMHO.
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I think I was responding to the claim that there's nothing in the bill to encourage competition.
ETA: Here it is: "I haven't seen anything in the bills that introduces actual competition."

But I agree, it's not enough. A non-profit public option would have offered some competition. (ETA: The public option stayed in the House version of the bill--though it probably won't make it into a merged version. Still, you did mention "the bills".)

ETA: Also the language in the House bill, I believe is stronger about removing the antitrust exemption for insurers.
 
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Saturday morning, CNN reports that they've reached an agreement on the abortion language that Sen. Nelson agrees with.

http://www.cnn.com/2009/POLITICS/12/19/health.care/index.html

Sen. Bill Nelson, D-Florida, agreed, saying the deal follows the principles of the Hyde amendment, which prevents federal funds from being used for abortions.

"Anyone who is in the exchange who also gets a federal subsidy because they're poor, if they choose a private insurance policy and want any kind of abortion coverage, they have to write that part of the premium from their own personal funds," the Florida senator said.
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So much for not wanting the government interfering with the doctor-patient relationship.
 
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