Obama health care plan explained

[David Wong]

That's a good point. Reform is essentially going to bring in two very distinct groups into the insurance risk pool. The first group are the people with pre-existing conditions that can't get approved for coverage today. Obviously, this is going to increase costs.

But those people without coverage are already getting "covered" in the sense that when they are forced to seek care, they can't be denied, right? And the hospital or provider just eats the bill (that is, tries to set up a payment plan but if the person has no money, accepts that they'll never see payment).

So those costs have already made their way into the sytem, haven't they? Because the providers have to up their prices on everything else to cover the non-payers?

I'm not trying to make an argument for or against the system, I want to make sure I understand this. Because I thought one of the primary things driving up costs right now was the uninsured being unable to pay for preventative care (such as prescription drugs to control high blood pressure to prevent a stroke) and don't seek care until it becomes an expensive emergency (stroke, surgery, hospital stay, rehab) and thus costing 500 times more than the pills would have.

From my laymen's point of view, it seems like the only way those people are saving us money is if they die before seeking treatment. Otherwise I don't see how looping them into the insurance system increases cost. There is already a cost, and one that could be reduced if preventative care was available to them.

Right?

 

[David Wong]

Can someone clarify for me, as I am not overly familiar with the minutia of the US health care.

When you buy "health care insurance" does it cover medications, or is that to be purchased seperately?

Depends on the plan. Mine has coverage for prescription medication, but different drugs have a different co-pay based on how expensive the drug is, and the insurance company can make demands regarding which medication is used. I have chronic heartburn, but the only medication that actually worked wasn't covered. The one they did cover, didn't work. So, yes, the insurance company gets a say in your treatment.

 

[JoeTheJuggler]

Thanks for you're help, but I still have no idea how this is related to universal health care. It just seems like a simple reform to me. Are his plans in any way comparable to the NHS?

I think this has already been answered by now, but from what I see on the comparisons on the kff site, many of the different reform bills do require universal insurance (everyone has to have something--either qualify for medicaid or buy some type of insurance plan, often including a public plan).

As I mentioned, the "Obama Plan" as shown on the kff site is mostly a set of guiding principles or goals. One of them (under the category "Individual Mandate" in the kff comparison grid) is "The plan must put the country on a clear path to cover all Americans."


But yes, from what I read, this stuff should more properly be called "health insurance reform" rather than "universal health care".

 

[JoeTheJuggler]

So this system will mean you have to be insured?

Many (I think most) of the proposed plans fulfill Obama's goal of universal access to healthcare with an "individual mandate" (i.e. requiring everyone to have coverage one way or another). I think some plans attempted to achieve the goal by expanding medicaid eligibility.

At least one I looked at (I think it was a Republican plan) looked like it would actually further limit how many people have access to health care--it seemed more focused on the goal of limiting or reducing costs than on getting universal access.

 

[JoeTheJuggler]

My health insurance doesn't even cover doctor visits, much less medication.

I think at least some versions of the reform bill seek to address this. When there is an "individual mandate" just as with a state requirement of liability insurance for driving, there is some minimum standard. Obama specifically mentioned making routine checkups and testing (mammograms and colonoscopies, for example) a requirement.

Here's the quote:

We will require insurance companies to cover routine checkups and preventive care, like mammograms, colonoscopies, or eye and foot exams for diabetics, so we can avoid chronic illnesses that cost too many lives and too much money.

 

[boooeee]

But those people without coverage are already getting "covered" in the sense that when they are forced to seek care, they can't be denied, right? And the hospital or provider just eats the bill (that is, tries to set up a payment plan but if the person has no money, accepts that they'll never see payment).

So those costs have already made their way into the sytem, haven't they? Because the providers have to up their prices on everything else to cover the non-payers?

I'm not trying to make an argument for or against the system, I want to make sure I understand this. Because I thought one of the primary things driving up costs right now was the uninsured being unable to pay for preventative care (such as prescription drugs to control high blood pressure to prevent a stroke) and don't seek care until it becomes an expensive emergency (stroke, surgery, hospital stay, rehab) and thus costing 500 times more than the pills would have.

From my laymen's point of view, it seems like the only way those people are saving us money is if they die before seeking treatment. Otherwise I don't see how looping them into the insurance system increases cost. There is already a cost, and one that could be reduced if preventative care was available to them.

Right?

They're getting some care right now, and it is being delivered inefficiently. But a lot of people are simply doing without care and suffering through it. These costs are going to start flowing into the system.

Also, because the costs for the unhealthy are currently outside the insurance pool, even if it becomes cheaper to cover them in the insurance pool, they're still going to be far more expensive than the average risk in the existing pool, thus raising premiums. The savings are going to be fall to the hospitals. Hopefully, they will pass those savings on to the insurance companies with lower negotiated rates, but who knows.

There are going to be a lot of competing factors coupled to reform. Some will raise costs, others will lower costs. If I had to put money on it, I'd bet on costs increasing overall, but I hope I'm wrong. Either way, I think it's the right thing to do.

 

[JoeTheJuggler]

They're getting some care right now, and it is being delivered inefficiently. But a lot of people are simply doing without care and suffering through it. These costs are going to start flowing into the system.

And they're currently not paying any premiums into the system.

If they're all required to buy a plan (even at a partially subsidized rate), there will also be money flowing into the system that wasn't there before.

 

[JoeTheJuggler]

Very few universal healthcare systems use the NHS model. Many European countries use a mandatory insurance system which seems to be the way Obama is going. That's why I asked about a risk compensation pool - all the European countries that use this system had to put it in place to counter adverse selection problems.

Is this what's addressed in the kff site (see links I've posted already here) under the category "Creation of insurance pooling mechanisms"?

If so, it looks like there's a variety of different approaches being proposed.

 

[boooeee]

And they're currently not paying any premiums into the system.

If they're all required to buy a plan (even at a partially subsidized rate), there will also be money flowing into the system that wasn't there before.

True. They'll pay into the system, but far less than what they'll get out of it. That's the whole reason why insurance companies don't cover them now.

 

[Undesired Walrus]

But didn't Obama campaign on the proposal that you weren't obliged to buy the insurance? It's how it differed from H.Clinton's plan, causing her 'shame on you Barack Obama' moment in Ohio.

 

[JoeTheJuggler]

But didn't Obama campaign on the proposal that you weren't obliged to buy the insurance? It's how it differed from H.Clinton's plan, causing her 'shame on you Barack Obama' moment in Ohio.

According to the kff page I've cited, Obama wants the reform bill to put us "on the road" to covering everyone. Several of these plans propose to meet that goal by the individual mandate, but I don't think Obama is big on that.

ETA: I remember the mandate being part of Clinton's plan during the primaries, but I also remember that I didn't know anything about what Obama had in mind back then. My issue with Clinton & healthcare was more like a prejudice, I confess. That she abandoned a single payer system coincident with accepting more healthcare industry money than anyone else--or at least more than any other Democrat-- really bugged me.

 

[boooeee]

But didn't Obama campaign on the proposal that you weren't obliged to buy the insurance? It's how it differed from H.Clinton's plan, causing her 'shame on you Barack Obama' moment in Ohio.

He did. If I remember correctly, his health plan at the time was far less ambitious and was focused more on getting all children covered.

 

[Undesired Walrus]

When does he plan to do that thing he was big on in the campaign - putting the debate between drug companies and health professionals etc on c-span? I can't remember what it was exactly that is supposed to be shown, but he criticised the clinton admin ecause these events, whatever they were, took place behind closed doors.

 

[Thunder]

Which will drive up costs.



Which will drive up costs.



Which could drive up costs.

No. It will reduce profits. HMO CEOs will have to survive with $2.9 million a year instead of $3 million a year. Ho hum.

Also, keep in mind, requiring HMOs to pay for preventative tests and care will ultimately REDUCE costs because the need for dramatic treatments and surgery will decrease.

More preventative care means healthier people and catching problems earlier..BEFORE more expensive treatments are needed.

But ALL insurance companies will have to follow the same rules. So in the end, it will all work out.

 

[Dr. Imago]

Speaking as a physician, without meaningful tort reform on a federal level (as has been done in some states, like Texas), any proposed changes will be meaningless. Most physicians order "unnecessary" (i.e., confirmatory) tests out of fear of missing something that they probably already knew... and the subsequent litigation, if by chance in the rare case they did miss something. Most physicians have no idea how much those tests cost or, more importantly, how much the patient is billed when they order them.

As far as "incentivizing" people to get preventive care, this will not work as well unless there is a substantial carrot-stick approach. What I mean is that people need to be rewarded, somehow, for getting preventive care (e.g., tax breaks, etc.) and punished for poor personal health choices (e.g., not maintaining an "acceptable" BMI, smoking, etc.). Unless people can feel this in a tangible way and put their good health on as high of a priority as having, for example, the latest version of the iPhone or all the premium channels on their local cable outlet, we are not going to substantially improve the health of this country and decrease costs. We are more numerous, older, fatter, and sicker, as a whole, far more now than we ever have been as a population. The onus of good health begins with the individual, the vast majority of which crossing my path in the hospital have put themselves there secondary to their own bad habits and summation of poor lifestyle choices.

Lastly, I would far from consider myself in a "for profit" medical care model. I do, however, feel like I should be compensated well for working, on average, 55-60 hours a week, in my particular practice specialty, making life-and-death decisions and trying to do what's best for patients under my care all under the constant specter of being involved in an expensive and time-consuming lawsuit whether or not medical malpractice was actually committed. If you punish physicians in any way, shape, or form monetarily (by cutting reimbursements, analyzing practice patterns and publishing outcomes, etc.), there is going to be a decreased access for patients of the most highly trained members of the healthcare team for the potentially unsupervised practice of far less well-trained midlevel counterparts. I have been around long enough to ensure you that that prospect alone scares me more than anything else, both as a provider of high-quality care to patients as well as a healthcare consumer.

Just some thoughts.

~Dr. Imago

 

[David Wong]

Speaking as a physician, without meaningful tort reform on a federal level (as has been done in some states, like Texas), any proposed changes will be meaningless. Most physicians order "unnecessary" (i.e., confirmatory) tests out of fear of missing something that they probably already knew... and the subsequent litigation, if by chance in the rare case they did miss something.

Speaking as a patient, I'm glad I have the ability to litigate if a blown call on your end ruins my life. Sorry, but you don't fix a health care system by taking away the patient's right to seek restitution for a mistake that may cost him his ability to work and quality of life.

Lastly, I would far from consider myself in a "for profit" medical care model. I do, however, feel like I should be compensated well for working, on average, 55-60 hours a week, in my particular practice specialty, making life-and-death decisions and trying to do what's best for patients under my care all under the constant specter of being involved in an expensive and time-consuming lawsuit whether or not medical malpractice was actually committed.

I'm sure my policeman father would like to be compensated even a fraction as well as you, for making equally important life-and-death decisions. It's fine that you want to make a lot of money, profit is the American way. You don't have to apologize for it. But there may not be enough money in the system to keep paying physicians at the current (very high) level.

Lots of people work far more than 55-60 hours a week, by the way. For a fraction of the money.

If you punish physicians in any way, shape, or form monetarily (by cutting reimbursements, analyzing practice patterns and publishing outcomes, etc.), there is going to be a decreased access for patients of the most highly trained members of the healthcare team for the potentially unsupervised practice of far less well-trained midlevel counterparts.

One way or another, other countries with universal health care systems have gotten around this issue, have they not?

 

[Peephole]

Don't worry, doctors in countries with proper, universal health care are still filthy rich.

 

[boooeee]

No. It will reduce profits. HMO CEOs will have to survive with $2.9 million a year instead of $3 million a year. Ho hum.

Also, keep in mind, requiring HMOs to pay for preventative tests and care will ultimately REDUCE costs because the need for dramatic treatments and surgery will decrease.

More preventative care means healthier people and catching problems earlier..BEFORE more expensive treatments are needed.

But ALL insurance companies will have to follow the same rules. So in the end, it will all work out.

For all the talk of "profiteering" by health insurance companies, I have yet to see any substantiation of this. From a recent article in the Wall Street Journal:

Consider WellPoint, the biggest private health insurer on Wall Street, which has about 35 million customers nationwide. Last year, it paid out 83.6% of revenues in expenses. Net, after-tax income as a percentage of total revenue came to a princely 4.1%.

This focus on health insurance company profits is a populist diversion. They are not the cause for the high cost of healthcare in the US. If any thing, it could be argued that it keeps them low since it incents insurance companies to negotiate low rates with hospitals and doctors.

 

[The Painter]

Speaking as a patient, I'm glad I have the ability to litigate if a blown call on your end ruins my life. Sorry, but you don't fix a health care system by taking away the patient's right to seek restitution for a mistake that may cost him his ability to work and quality of life.



I'm sure my policeman father would like to be compensated even a fraction as well as you, for making equally important life-and-death decisions. It's fine that you want to make a lot of money, profit is the American way. You don't have to apologize for it. But there may not be enough money in the system to keep paying physicians at the current (very high) level. Lots of people work far more than 55-60 hours a week, by the way. For a fraction of the money.



One way or another, other countries with universal health care systems have gotten around this issue, have they not?

Very high level? What is a very high level? BTW half of what you get charged is to pay for the malpractice insurance. You so you can have the right to sue. That's what you said you wanted, so you have to pay for it.

 

[David Wong]

This focus on health insurance company profits is a populist diversion. They are not the cause for the high cost of healthcare in the US.

Then what is? I've read enough to know that Torts are only a tiny fraction of it. If the insurance company shareholders aren't sucking all of the money out of the system, then who is?

If any thing, it could be argued that it keeps them low since it incents insurance companies to negotiate low rates with hospitals and doctors.

This has always been a source of confusion for me; it seems like in reality they would keep each other in check but somehow this hasn't happened. Or are you suggesting that costs would have somehow skyrocketed even faster if for-profit insurance companies hadn't been involved?