Healthcare reform

[Y2HH]

Anyone else here get the feeling that this will wind up in the Supreme Court?

 

Where it gets shot down in the standard 5-4 supreme court vote?

 

If its a liberal issue -- it fails 5-4, and it if it's not -- it passes 5-4. If the justices were 5-4 liberals, the opposite would happen. I, for one, and deeply troubled by the fact that our highest court has been infected with the idealism on either side. I find this to be as big of an issue as anything else in this bought and paid for country.

[kapkomet]

Anyone else here get the feeling that this will wind up in the Supreme Court?

 

 

If the "Slaughter Rule" is implemented, it should end up there. And it should be a 9-0 unanimous decision against the bill. You want to talk about a constitutional crisis... if they do that the filibuster is a pimple on an elephant's ass in scale of sleazability. Let's all hope that doesn't happen, because that would be devastating to our rule of law.

[StrangeSox]

“With the Slaughter Solution, House Democrats have exposed themselves as willing to abandon the most fundamental element of legislating – a transparent, up-or-down vote— in order to achieve a unpopular partisan objective. This is highly disturbing and in some ways, dangerous. The American people do not want this health care bill and they certainly don’t want the democratic process turned on its head in an effort to pass it over their objections.”

 

LOL. How can anyone say that with a straight face?

 

Also can someone provide a reasonably unbiased explanation of the "Slaughter Solution"? A google search just returns a bunch of conservative blogs and opinion pieces.

Edited March 16, 2010 by StrangeSox

[kapkomet]

LOL. How can anyone say that with a straight face?

 

Also can someone provide a reasonably unbiased explanation of the "Slaughter Solution"? A google search just returns a bunch of conservative blogs and opinion pieces.

Because they don't live in the Obama fantasy land that you do? Sounds pretty simple to me. You all want your health care at all costs, and don't care that the MAJORITY of the people DO NOT WANT THIS BILL. That's crystal f***ing clear for you, although I know you can't understand English like this.

 

Without the political crap it will start, the Slaughter rule is being pushed so that the senate bill will be "deemed to already be voted upon and passed" by the House so that it can go to the president's desk for signing. It is against Article I Section 7 CLEARLY where it says both houses of congress must vote on the same bill before it can get signed.

 

The argument is that since reconciliation is going to happen after the "slaughter rule" occurs, that there's no harm in it.

 

The political crowd (like me) now comes in and says that if you monkeyf***s can't pass it the right way, then don't pass it. Get the f***ing message that people DO NOT WANT THIS BILL.

 

Health industry reform? Yep. All about that. This bill? f*** no.

[kapkomet]

http://www.cbsnews.com/stories/2010/03/15/...in6300344.shtml

 

March 15, 2010

Will "Obamacare" Create Two Americas?

Ben Domenech: The President's Plans for Health Care Promises to Result in a Class Divide

 

(The New Ledger) Ben Domenech is editor of The New Ledger.

--------------------------------------------------------------------------------

 

Here’s the worst thing you probably haven’t heard about President Barack Obama’s health care plan, which he and his allies are about to force through the Congress despite enormous opposition from the American people: it makes everything onetime vice presidential nominee John Edwards once said about the class divide of “two Americas” come true.

 

The dirty little secret of this plan-which wouldn’t be a secret if opponents of this legislative package weren’t distracted by a dozen other wrongheaded policies in it-is that it will bring a major and irreversible upheaval to America’s labor markets. In a time of economic tension, this plan will displace millions of workers and push more people into becoming contract employees, resulting in increased instability for working families.

 

One of the many original stated goals of the White House’s health care reforms was the promise that you can keep your health plan if you like it. However, the White House wanted to give businesses much-needed relief from burdensome health costs. Like the desire to create a new entitlement while reducing the budget deficit, these aims are nearly impossible to reconcile, so Obama chose a path that accomplishes neither.

 

The president’s plan penalizes an employer for not providing insurance, but the government will subsidize the health care of workers without employer-provided insurance. This effectively allows workers to receive the same compensation package they get today, but with government footing the health-benefits part of the bill, so employers have no need to make up the difference in cash.

 

The economic benefits of that subsidy far outweigh the penalties-for low income workers, it can result in an enormous difference of over $17,000 per year.

 

It’s obvious what will happen under this plan: it will not make economic sense for any small business which employs lower-income workers to offer health insurance. And any small business which does so will almost certainly fail, burdened by higher costs than their competitors.

 

This dilemma could be solved by making the penalties more draconian, but that too would cause business failures, and as with the individual insurance mandate, too steep a penalty would make the plan even more coercive and unpopular.

 

As John Goodman of the nonpartisan National Center for Policy Analysis recently described it, “High-paid workers with employer-paid insurance will cluster in some firms, while average- and below-average-wage workers will cluster in others. Overall, ObamaCare will create irresistible economic pressure to restructure the entire labor market.”

 

The only likely outcome of this plan will be for companies to drop coverage entirely. Younger, lower-income workers will be eligible for a subsidy and forced into the health exchanges. That will compel them to do something that doesn’t make economic sense. Most young workers don’t use health care much-unless you give them an incentive to over-consume care by paying for it up front for them.

 

There’s a final step here, though, that’s critical to understand: once those younger and lower-income workers are forced into a system that eliminates rational decision-making, they are made beholden to these taxpayer funded subsidies, and face massive penalties if their income rises such that they lose the subsidies. The marginal tax penalty for an individual moving up from to $40,000 a year to $45,000 is massive, as also for families earning $95,000 versus $90,000, creating an artificial cliff that dramatically penalizes success.

 

Thus a new picture of Obamacare emerges: it will force people to pay for what they don’t want and purchase what they don’t need, in a massive expansion of the size and power of government. The entire proposal functions not as a method of improving care or lowering premiums but as a massive regressive tax falling disproportionately on the young and those on the lower end of the income scale. And once in place, it will trap its supposed beneficiaries in ways that cannot be undone.

 

Combine this regressive tax with a massive increase in spending via a government entitlement which will only grow, and you have a recipe for long-term economic stagnation and the permanent enshrinement of two Americas into our national social policy.

 

Keep preachin', brother. You think we have a cost crisis now... just wait.

 

 

[KipWellsFan]

http://www.cbsnews.com/stories/2010/03/15/...in6300344.shtml

 

 

 

Keep preachin', brother. You think we have a cost crisis now... just wait.

 

Ben Domenech (born December 31, 1981, Jackson, Mississippi)[1] is an American conservative writer and blogger who co-founded the RedState group blog. In March 2006, he was hired to write a conservative blog for washingtonpost.com but resigned after three days amid allegations of plagiarism during his college years to which he later confessed.[2] After apologizing and ceasing online activity for some time, Domenech returned to continue editing and writing for Redstate, Human Events, and other publications.

 

...

 

The blog, "Red America", launched on March 21, 2006, but Domenech resigned three days later after only six posts, after other bloggers posted evidence that Domenech had plagiarized work from the Washington Post, The New Yorker, humorist P. J. O'Rourke, and several other writers.[17]

 

Domenech was first accused of appropriating a chapter from O'Rourke's 1990 book "Modern Manners" for an editorial in The Flat Hat, a weekly student newspaper at William and Mary.[17][18] O'Rourke denied Domenech's claim that the humorist had granted permission to use his words, adding that he couldn't recall ever meeting the college student. [19] Blogs Eschaton and Daily Kos soon posted links to movie reviews of Bringing Out the Dead, The Bachelor, and The World Is Not Enough written by Domenech for the same student paper. The reviews appear to be taken nearly verbatim from reviews published by Salon.com and an amateur Usenet reviewer named Steve Rhodes.

 

The Flat Hat investigated and eventually concluded that the paper had published 35 articles by Domenech, including 10 with suspicious similarities to works by other authors, including ones by National Review editor Jonah Goldberg. [20][21][22] Commenters at Daily Kos also uncovered two examples of plagiarism in reviews written by Domenech for National Review Online in 2000 and 2001. The first finding, a review of the movie Final Fantasy: The Spirits Within, contained a lengthy passage nearly identical to one by Steve Murray of the Cox News Service.[23]. The second, a review of a Wallflowers' album, borrowed passages from one published in Rolling Stone by Tom Moon earlier the same month[24].

 

http://en.wikipedia.org/wiki/Ben_Domenech

Edited March 16, 2010 by KipWellsFan

[StrangeSox]

Because they don't live in the Obama fantasy land that you do? Sounds pretty simple to me. You all want your health care at all costs, and don't care that the MAJORITY of the people DO NOT WANT THIS BILL. That's crystal f***ing clear for you, although I know you can't understand English like this.

 

Without the political crap it will start, the Slaughter rule is being pushed so that the senate bill will be "deemed to already be voted upon and passed" by the House so that it can go to the president's desk for signing. It is against Article I Section 7 CLEARLY where it says both houses of congress must vote on the same bill before it can get signed.

 

The argument is that since reconciliation is going to happen after the "slaughter rule" occurs, that there's no harm in it.

 

The political crowd (like me) now comes in and says that if you monkeyf***s can't pass it the right way, then don't pass it. Get the f***ing message that people DO NOT WANT THIS BILL.

 

Health industry reform? Yep. All about that. This bill? f*** no.

 

Just shut the hell up already. You're a broken record straw man.

 

I was referring specifically to whining about the Democrats not wanting to do a straight up-and-down vote. It's been Congressional Republicans blocking straight majority votes.

[NorthSideSox72]

If the "Slaughter Rule" is implemented, it should end up there. And it should be a 9-0 unanimous decision against the bill. You want to talk about a constitutional crisis... if they do that the filibuster is a pimple on an elephant's ass in scale of sleazability. Let's all hope that doesn't happen, because that would be devastating to our rule of law.

 

 

Because they don't live in the Obama fantasy land that you do? Sounds pretty simple to me. You all want your health care at all costs, and don't care that the MAJORITY of the people DO NOT WANT THIS BILL. That's crystal f***ing clear for you, although I know you can't understand English like this.

 

Without the political crap it will start, the Slaughter rule is being pushed so that the senate bill will be "deemed to already be voted upon and passed" by the House so that it can go to the president's desk for signing. It is against Article I Section 7 CLEARLY where it says both houses of congress must vote on the same bill before it can get signed.

 

The argument is that since reconciliation is going to happen after the "slaughter rule" occurs, that there's no harm in it.

 

The political crowd (like me) now comes in and says that if you monkeyf***s can't pass it the right way, then don't pass it. Get the f***ing message that people DO NOT WANT THIS BILL.

 

Health industry reform? Yep. All about that. This bill? f*** no.

 

Kap, you really have gone off the deep end here. Not with being frustrated with this particular bill, which some people indeed don't want. But with this absurd idea that the Dems are somehow being less than legal or somehow worse than the GOP, when various versions of this bill have already had majority support that was knocked down by GOP Filibusters.

 

Here it is Kap. One, you are a huge supporter of the Republicans, so stop acting like you are not. Two, you are in complete denial of the fact that they TRIED to pass this health care bill "the right way", and couldn't. Three, your first post above is Rush Limbaugh territory - its THAT over the top ridiculous.

 

I don't even like this particular health care solution, as I've said before - but you have personally laid waste to any sort of reasonable discussion on the matter with these kids of posts.

 

[NorthSideSox72]

As a great example of how psychotic the discussions of this topic have gotten, even among those voting on it, here's a great moment...

 

Rep. Mike McIntyre of North Carolina is among the at least 22 Democrats who indicate they will vote against the bill.

 

"Health care reform is needed, but the bill before us is too expensive, does not adequately address rising medical costs and skyrocketing insurance premiums, and tries to do too much too soon," McIntyre said in a statement Monday, confirming his opposition to the legislation.

 

So... it doesn't go far enough... and it tries to do too much... too soon.

 

Buh?

 

I could see his latter point, if he hadn't oddly combined it with the former.

 

[Y2HH]

As a great example of how psychotic the discussions of this topic have gotten, even among those voting on it, here's a great moment...

 

 

 

So... it doesn't go far enough... and it tries to do too much... too soon.

 

Buh?

 

I could see his latter point, if he hadn't oddly combined it with the former.

 

He could have meant many things by saying this -- I agree with his point that it does nothing to control costs from the source...the doctors and hospitals are still allowed to continue charging any arbitrary amount they want, such as they do now. Which solves nothing except who pays for it and who can pay for it.

 

He may have meant too many less important things to into effect right away, while more important things don't go into effect for years.

Edited March 16, 2010 by Y2HH

[NorthSideSox72]

He could have meant many things by saying this -- I agree with his point that it does nothing to control costs from the source...the doctors and hospitals are still allowed to continue charging any arbitrary amount they want, such as they do now. Which solves nothing except who pays for it and who can pay for it.

And that more granular point I agree with as well. This plan, and others Congress have toyed with, try to artificially reduce costs charged by insurers, but do nothing to change the bizarre billing methods of doctors and hospitals.

 

I've said many times before... the fundamental flaw here is that the presence of insurance companies, whose rates are basically flat per service, removes the normal capitalistic controls in place in other consumer-provider relationships. You have to find a way to get that consumer CHOICE back into play, or you will never be able to properly control costs.

 

[Balta1701]

And that more granular point I agree with as well. This plan, and others Congress have toyed with, try to artificially reduce costs charged by insurers, but do nothing to change the bizarre billing methods of doctors and hospitals.

 

I've said many times before... the fundamental flaw here is that the presence of insurance companies, whose rates are basically flat per service, removes the normal capitalistic controls in place in other consumer-provider relationships. You have to find a way to get that consumer CHOICE back into play, or you will never be able to properly control costs.

Actually, the Senate Bill (I'm focusing on that because I don't know yet where to find the actual reconciliation deal) includes quite a few points which would make Medicare do exactly what you're asking for, which is why the CBO keeps saying it will produce significant long-term savings. Funding comparative effectiveness research, to figure out whether or not the surgery that costs 100x more is actually better or worse for you than the cheaper treatment is a good start, and that is in both versions. Beyond that, there are significant competitive incentives built into the bill to actually have Medicare begin paying better for better outcomes, rather than just sheer number of procedures done, which is the current format.

These include value-based purchasing programs for hospitals and physicians and payment penalties for hospital-acquired conditions. The bill also requires HHS to establish and update annually a national strategy for health care quality measurement and improvement. The Senate bill establishes accountable care organization and hospital readmission reduction programs, a national pilot program for payment bundling, and a demonstration program for chronically-ill beneficiaries to receive home-based primary care. The bill also includes a host of payment extensions and improvements, including several for rural areas, but it includes only a one year 0.5 percent positive update for physician payment (in place of the 21 point reduction that was otherwise scheduled), leaving for another bill the inevitable sustainable growth rate fix.

 

Although the bill cuts Medicare Advantage payments, it provides performance bonuses for Medicare Advantage plan care coordination and management and for quality achievements. It prohibits Medicare Advantage plans from charging beneficiaries higher cost sharing for specific services than is allowed in the fee-for-service program and requires plans that offer extra benefits to give priority to cost-sharing reductions and wellness and preventive care services over benefits not covered by Medicare. HHS is given authority after 2011 to refuse to offer Medicare Advantage and prescription drug plans that significantly increase beneficiary cost sharing or decrease benefits. For traditional Medicare beneficiaries, the bill removes cost-sharing obligations from most preventive services, including an annual wellness visit and personalized prevention plan. The bill would also require Medigap policies C and F, two of the most popular offerings, to include nominal cost-sharing to reduce use of Part B services.

 

...

A signature feature of the Senate bill is the creation of a new 15-member independent Medicare Advisory Board composed of health care, health policy, and health economics experts as well as representatives of employers, third-party payors, consumers, and the elderly appointed by the President that is responsible for presenting Congress with proposals for reducing excess Medicare cost growth. In years when Medicare costs are projected to exceed a target rate, the Board will be required to make a proposal to reduce cost growth, which will go into effect unless Congress, following expedited procedures develops an alternative proposal. The Board’s proposals cannot ration care; raise taxes or Part B premiums; change Medicare benefit, eligibility, or cost-sharing standards; or reduce payments for providers whose payments have already been reduced by the market-basket adjustments, which will limit the Board largely to reducing Part C or Part D expenditures. The CBO scored the Board as saving $23.4 billion over 10 years.

That also neglects to mention the creation of the "insurance exchanges", which should give many more people a legitimate option to shop around for an effective plan, and should also give people much more information on how to make those choices by making that info available.

[NorthSideSox72]

Actually, the Senate Bill (I'm focusing on that because I don't know yet where to find the actual reconciliation deal) includes quite a few points which would make Medicare do exactly what you're asking for, which is why the CBO keeps saying it will produce significant long-term savings. Funding comparative effectiveness research, to figure out whether or not the surgery that costs 100x more is actually better or worse for you than the cheaper treatment is a good start, and that is in both versions. Beyond that, there are significant competitive incentives built into the bill to actually have Medicare begin paying better for better outcomes, rather than just sheer number of procedures done, which is the current format.

That also neglects to mention the creation of the "insurance exchanges", which should give many more people a legitimate option to shop around for an effective plan, and should also give people much more information on how to make those choices by making that info available.

These items themselves could be positive, but no, they aren't giving me exactly what I am asking for. Consumer choice is still a non-player here.

 

[Balta1701]

Consumer choice is still a non-player here.

What sort of consumer choice are you referring to? The ability to shop around before going in for surgery to see who has the lowest price?

[Y2HH]

And that more granular point I agree with as well. This plan, and others Congress have toyed with, try to artificially reduce costs charged by insurers, but do nothing to change the bizarre billing methods of doctors and hospitals.

 

I've said many times before... the fundamental flaw here is that the presence of insurance companies, whose rates are basically flat per service, removes the normal capitalistic controls in place in other consumer-provider relationships. You have to find a way to get that consumer CHOICE back into play, or you will never be able to properly control costs.

 

It's impossible to get consumers choice when consumers have no idea what they paying for or why they need it.

 

When you're car engine dies, you shop around, find out the cost of the new engine and labor to install it properly...for non emergency care/non emergency surgery, you can't ask a doctor or hospital, how much is that going to cost so I can shop around at other hospitals and see if I can get a better deal from an equally skilled surgeon. They perform the procedures first, THEN tell you how much it cost...it's backwards. So the only method the patients have to shop around right now is different insurance companies.

[Y2HH]

What sort of consumer choice are you referring to? The ability to shop around before going in for surgery to see who has the lowest price?

 

For non emergency medical care, yes. Why not? It's the ONLY industry on the planet that performs services BEFORE they tell you how much said services cost...and they can NEVER quote how much a service costs.

 

Take eye exams for example, they will tell you EXACTLY how much a eye checkup costs BEFORE it's performed.

 

Now take a yearly physical exam...they have no idea...it's some arbitrary amount and you don't have to worry about it, they'll tell your insurance company how much it was AFTER it's performed.

[NorthSideSox72]

For non emergency medical care, yes. Why not? It's the ONLY industry on the planet that performs services BEFORE they tell you how much said services cost...and they can NEVER quote how much a service costs.

 

Take eye exams for example, they will tell you EXACTLY how much a eye checkup costs BEFORE it's performed.

 

Now take a yearly physical exam...they have no idea...it's some arbitrary amount and you don't have to worry about it, they'll tell your insurance company how much it was AFTER it's performed.

That's what I am getting at.

 

Obviously emergency care is a different thing, there's not really going to be any shopping around.

 

[Balta1701]

That's what I am getting at.

 

Obviously emergency care is a different thing, there's not really going to be any shopping around.

So...here's my question, especially to Y2HH...how exactly do we accomplish this without completely blowing up the entire current insurance system? A big part of the reason why shopping around is impossible is that once you're affiliated with an insurer, especially an HMO, you're basically locked in to their network. There's never going to be a price advantage to going outside of their network once you're insured, thus, the only way to get actual competition I see would be to get insurance companies to massively expand their network, at great cost to them.

[Y2HH]

So...here's my question, especially to Y2HH...how exactly do we accomplish this without completely blowing up the entire current insurance system? A big part of the reason why shopping around is impossible is that once you're affiliated with an insurer, especially an HMO, you're basically locked in to their network. There's never going to be a price advantage to going outside of their network once you're insured, thus, the only way to get actual competition I see would be to get insurance companies to massively expand their network, at great cost to them.

 

From the start, I've maintained I'm fine with reform if it is, in fact, comprehensive. What I see right now is nothing more than changing who pays for the care, and how it's paid for -- it does nothing to lower the cost of the care whatsoever, because the same people creating the arbitrary bills will continue to create them -- it's just offset by someone else helping to pay for it.

 

HMO's can easily be changed to allow you more choice -- rather than having to need a referral from a PCP, you allow the person to go wherever they want so long as their PCP says they need to see that sort of specialist. Simple and done. Right now, you're PCP not only has to approve the specialist, but they basically pick them, too. This has ALWAYS been poor practice.

 

Anyone NOT on a HMO gets to choose now, like myself, however the choice is still limited as all I get to know is where the doctor was educated and if they're board certified in that specialty. I still have no idea what they're going to be charging me. The problem remains, however, that there isn't much choice when it comes to insurance providers -- there are a few main health insurance providers in IL, and that's the choice you have for insurance. And if you're company has BCBS, you get BCBS...you have no choice other than to go out on your own. You should have choice in that, also. There should be MUCH more choice on that front. Then, choice needs to be opened on the other end, too. PCP's shouldn't be picking who you see, just that you NEED to see them. PPO's don't have to deal with that...if you want to see a specialist, you can, anytime you want.

 

But the basic choice of who cares for the insured should be THEIR decision, so long it's in their insurance companies network, which are HUGE networks, by the way.

Edited March 16, 2010 by Y2HH

[Balta1701]

there are a few main health care providers in IL, and that's the choice you have for insurance. There should be MUCH more choice on that front. Then, choice needs to be opened on the other end, too. PCP's shouldn't be picking who you see, just that you NEED to see them. PPO's don't have to deal with that...if you want to see a specialist, you can, anytime you want.

This is exactly why some of us wanted a national public plan as an option. It immediately creates a competitive market in every market in America, most of which, as you note, currently border on being monopolies.

[Y2HH]

This is exactly why some of us wanted a national public plan as an option. It immediately creates a competitive market in every market in America, most of which, as you note, currently border on being monopolies.

 

It creates a government monopoly, and that's bad.

 

The current semi-monopoly's only exist because of the laws preventing out of state competition.

 

When I want to buy a TV, I'm not FORCED to buy it only in IL...insurance should be no different. There are MANY insurance companies out there, a lot of them non-profits, that many of you would love to be able to negotiate with.

Edited March 16, 2010 by Y2HH

[Texsox]

It's impossible to get consumers choice when consumers have no idea what they paying for or why they need it.

 

When you're car engine dies, you shop around, find out the cost of the new engine and labor to install it properly...for non emergency care/non emergency surgery, you can't ask a doctor or hospital, how much is that going to cost so I can shop around at other hospitals and see if I can get a better deal from an equally skilled surgeon. They perform the procedures first, THEN tell you how much it cost...it's backwards. So the only method the patients have to shop around right now is different insurance companies.

 

Actually to make the comparison correct, most of the time the auto insurance company has a list of pre approved service shops that you are required to use and which they have pre negotiated rates.

 

I know last year my girlfriend, who is uninsured because her private school does not offer insurance, needed an expensive test and she shopped around for prices. There was very little difference between prices. They all offered a standard "cash price". Not much different than trying to save a couple dollars on gas or an iPod.

[Texsox]

It creates a government monopoly, and that's bad.

 

The current semi-monopoly's only exist because of the laws preventing out of state competition.

 

When I want to buy a TV, I'm not FORCED to buy it only in IL...insurance should be no different. There are MANY insurance companies out there, a lot of them non-profits, that many of you would love to be able to negotiate with.

 

And their prices are still not low enough for most Americans to afford. I have yet to hear of a plan anywhere that someone making $20,000 to $25,000 can afford. Should it really cost as much as a rent payment to have health insurance? And that doesn't even included co-pays and deductibles once you need the insurance.

[Y2HH]

And their prices are still not low enough for most Americans to afford. I have yet to hear of a plan anywhere that someone making $20,000 to $25,000 can afford. Should it really cost as much as a rent payment to have health insurance? And that doesn't even included co-pays and deductibles once you need the insurance.

 

People only making 20,000 have other issues altogether. They'd be better of going on welfare and having free health care as it is...not to mention they'd make more than 20k.

Edited March 16, 2010 by Y2HH

[southsider2k5]

This is exactly why some of us wanted a national public plan as an option. It immediately creates a competitive market in every market in America, most of which, as you note, currently border on being monopolies.

 

It creates exactly what is decried by all of the "fair" labor advocates which is a plan that can undercut everyone else's pricing and drive everyone else out of business.