Replies to This Discussion

Permalink Reply by Renee on November 12, 2009 at 12:14pm

Hello Carol ~ First off – In salute to your local doctor and to all those who supported his efforts
as well as to: judy, Rock Hinkle, Jan, etc’s. postings
and back to Carol – because your co-worker got my ire up !

Doesn’t seem your congressman’s son has read any of the bill(S) – yet he has spun quite a yarn . . .
I would have thought you were referring to Kit Bond, but he’s your senator – is he Ike Skelton’s son?

Here, from my view, is a general composite of the bill(S) in Congress . . .

First off, I suppose that by the “government plan”, he means a “public option”. The public option is
NOT a “government plan” – which I will say more about a little later – but first, I’d like to say what
I think IT IS and, that is, a non-for profit public plan which will cover only about 5% of Americans –
and ONLY those who do NOT have coverage through an employer, Medicare, Medicaid, SSDI, SSI, CHIP and the Veterans Administration. Also small businesses will be able to purchase coverage for their employees if they have less than 25 employees. It is meant for those people because they are the ones thought not able to get affordable insurance from the large private insurance companies because they do not have bargaining power as individuals and because of pre-existing conditions and being dropped by carriers when they used their insurance coverage.

(I have taken the liberty of creating the acronym APIP regarding the public option – meaning America’s public insurance program – for the purposes of this posting.)

Now most Americans have insurance through their employer, Medicare, Medicaid, SSDI, SSI, CHIP and the Veterans Administration. NONE of those people will be permitted to choose the public option whether they want to or not – whether for benefits, premium cost savings or any other reasons. The plan will ONLY be available to a small sliver of individuals and small business with less than 25 employees.

So people will NOT be permitted to leave their private plans to jump on-board the public option as your
co-worker suggested – JUST NOT ALLOWED . . . Only exception is if someone is paying a large private insurance company for a private plan as an INDIVIDUAL and if, because of benefits, premiums, etc., they want . . . yes, INDIVIDUALS ONLY, could choose the public option – however, that population is extremely small. And, if you think that all of the large private insurance companies combined are truly worried about losing the very, very, very minimal number of people who might now be paying $1,000+ a month to the large private insurance companies because that’s what they have to do as an individual purchaser – (and, come on, how many people do you think like that there are out there – probably many less than 50-100,000 nationwide) – especially given all the potential new customers they are going to get given the MANDATE to purchase insurance – then please come on to NYC, because I have a bridge to sell you . . .

OK, moving on, a public option is also NOT a “government plan” like: Medicare, Medicaid, SSDI, SSI,
CHIP or the Veterans Administration. Those plans are funded directly through the federal budget.
Rather, APIP (America’s public insurance program), would receive a ONE-TIME infusion of funding
(over a per-determined period of time) to get started and operational – and after that it MUST be a SELF- SUSTAINING NOT-FOR-PROFIT HEALTH INSURANCE COMPANY ! It must generate its own profit margin !

APIP is anticipated to be set up and administered by government employees who will be responsible to negotiate on a national, state, regional and local basis with health care providers including: PHARMA, hospitals, nursing homes, palliative and long term care centers, home health care agencies, doctors, nurses, dentists, medical device equipment providers, etc. – and establish rates of service on behalf of the health and wellbeing of their members – as well as for the financial soundness of APIP.

Since APIP would be negotiating on behalf of a large pool of people, it would be able to negotiate for lower premiums, deductibles and co-pays for its members than those people would have been able to get as individuals. And there will be the flexibility of negotiating nationally with PHARMA to drastically cut RX costs – while negotiation on a state, regional and local basis to create a fair playing field for providers such as hospitals, nursing homes, palliative and long term care centers, home health care agencies, doctors, nurses, dentists, medical device equipment providers, etc. and, thereby, not create a one-size-fits-all pricing
– because that sort of pricing can, and has, unfairly hurt some areas, particularly rural areas, very hard.

Just one other consideration at this point is that the pool of people in APIP will likely be a sicker pool than an employer-based plan because these are people who: have not had insurance, may have been denied coverage because of pre-existing conditions or dropped from coverage for using their insurance, more than likely have not had much regular health care maintenance and more than likely are of lesser economic means which could include not as good nutritional care, etc. – so that could tend to drive the cost of premiums, deductibles
and co-pays up.

Some would say that since health insurance coverage will now be mandated that the “healthy 25 year olds” in the public option will offset the sicker people in the pool. However, I’m not so sure about that. Just using your co-worker’s guesstimate of a $600 monthly premium – I wonder – would a “healthy 25 year old”, who didn’t want to purchase health insurance before, prefer to pay the mandated $600 monthly premium – OR – just the $750 annual tax penalty? My guess is they might likely choose the lesser $750 annual tax penalty.

So, APIP’s premiums, deductible and co-pays could have to be figured higher than would be necessary to cover someone in the large private insurance companies that cover the employer-based plans. But, that can be offset by APIP’s not having to pay for advertising, lobbyists, profit to stock holders and multi-million incomes, stock packages and perks to the executives who run the company. So, it’s yet to be seen what the premiums, deductibles and co-pays – along with benefits of a public option would turn out to be.

Next, your co-worker also has convoluted math! If the public option costs $600 a month – the member HAS TO PAY $600 A MONTH ! – NOT $300! This part of his argument is at best nonsensical and misleading – and, at worst, well, I will hold my tongue about his possible intentions . . .

He suggests that the consumer will pay $300 and that the government is subsidizing $300. WOW . . .
I have no idea how he arrived at that . . .

The way it works in the bill(S) is this . . . since insurance coverage is going to be mandatory – there is going to be a tax subsidy figured on a sliding scale. The sliding scales in the various bill(S) are different figured on a means test between 150 to 400% above poverty level so I’m just going to go with one bill that gives a high tax subsidy but it is an actual figure, that being, “$88,000 for a family of 4” – meaning that, a family of 4 earning $88,000 or less – which purchases insurance throughout the year – can become eligible for a tax subsidy (however, no mention yet of what the amount of the subsidy would be). The tax subsidy would be in the form of a tax deduction at the end of the year.

Since I haven’t heard of any suggestion of the amount of what the tax subsidy would be, and as it will be on a sliding scale, please allow me to just pick a middlin’ number to use for an example here . . .I will pick: $200 a month for a single person and $400 for a family of 4 – and to simplifier it further, I will go with your co-worker’s figure of $300 a month tax subsidy for anyone who receives a tax subsidy – no matter their income or marital status.

However, there is one VERY IMPORTANT POINT !!! That tax subsidy is available to EVERY American in the “below $88,000 family of 4” category – who purchases insurance – and who files a tax return and claims the tax subsidy – REGARDLESS of which insurance plan they paid into – the public option OR their EMPLOYER-BASED PLAN – which is provided by a LARGE PRIVATE INSURANCE COMPANY !

So, back to your co-worker’s example – if APIP’s plan cost’s $600 a month – every member of APIP MUST PAY the $600 PREMIUM EVERY MONTH – and then they may – depending on their income, if they file taxes, receive a tax subsidy at the end of the year.. – JUST THE SAME as the people enrolled in the large private insurance company employer-based plans will ALSO be eligible – depending on their income, if they file taxes – to receive the VERY SAME TAX SUBSIDY. THEREFORE, the large private insurance companies are NOT at ANY DISADVANTAGE in the area of the tax subsidy.

And, now, regarding your co-worker casual mentions that the insurance companies cannot afford to cut their premiums, well, I won’t go into challenging the ludicrousness of that statement. I’ll just say – which monopoly can you remember that ever ventured that they COULD afford to cut their billing costs ? ! ? ! ?

Also, your co-worker suggests / threatens that the large insurance companies (the poor darlin’s) . . .sigh . . .
in order to stay solvent, their premiums will “possibly” go up. WHAT ?!? To stay solvent ! ! ! – Will POSSIBLY go up ! ! ! The large private insurance companies have ALREADY ANNOUNCED a 12-15% increase for next year in anticipation of the legislation which places a small tax on their HUGH profits ! ! ! Forget possible !!!
And, by the way, maybe I’m wrong, but I don’t think this is the first LARGE increase the large private insurance companies have put through in the last 10 years to “stay solvent”. fyi . . . Re: Net income, which is revenue minus expenses – for the 2nd quarter, 2009 – UnitedHealth earned $859 million. But that's not a record for quarterly net income. During the same period in 2007, UnitedHealth’s net income was $1.23 billion. And WellPoint, Aetna, Cigna, Humana and Coventry Health Care had similar trends.

Next, IMPORTANT POINT – a public option is NOT, NOT, NOT “government sponsored health care” where the government gets involved and makes things worse by telling us what treatment and procedures we can have and when – or which doctors we can see, with little say on our part. NO ! That is the practice of the large private insurance companies – primarily through their HMOs ! ! ! I have read time and time again on SG about people not being allowed to see a specialist, having to wait months to see a doctor, even read a post on SG of a woman whose husband was denied treatment for YEARS and his condition deteriorated so much that even though he eventually was “permitted” PAP treatment, he died as a result of his heart damage. NO !!! What the public option would be is a “government ADMINISTERED” public not-for-profit health insurance program – MODELED ON THE FEDERAL INSURANCE PROGRAM USED BY THE CONGRESS AND PRESIDENT !.

And, instead of using the formula of the large private insurance companies of denying and delaying visits with specialists and pre-authorizations for treatments, holding up payments – and requiring additional LONG delays with rounds of APPEALS – in order to achieve greater savings and to drive profits – the public option would seek fiscal soundness through a completely different framework and structure.

The public option would be established for the benefit, health and wellbeing of its members, the best quality relationship with its roster of health care providers, and its fiscal stability. And, to achieve the best “bottom line”, the public option would seek to promote preventive care and early treatment – rather than have to spend excessively for expensive treatment later on (eg: particular savings in the areas of diabetes and heart disease). Therefore, it would be counter-productive to deny or delay visits, pre-authorizations and payments. And, it would be idiotic all the way around, to cause long, drawn-out delays with appeals – because in a public option – they serve no purpose.

So, if you hear your representatives ask – Do you want a “government run health care program”?
– I suggest you stand up and say – YES, I DO !!! I want a “federally administered” public option that works exactly like your federal employee health insurance program !

But, moving on . . . the public options that are currently being proposed by Congress have been “concessioned” to death and are NOT in any way what a public option was intended to be ! The current proposals are now only for a tiny slice of uninsured people. And, while it will help those people, it will not provide for the measure of “choice” which would be the foundation for the necessary overall reform of our people’s health care and our nation’s health care delivery system and the reigning in of costs that’s needed for our country’s long-term health care needs. Instead, the current public option proposals, will more likely prove only worse for our overall deficit.

So, who really benefits ? – the large private insurance companies ! The current bill(S) give the large private insurance companies the ammunition to cry out that they are being mercilessly overtaxed – and overburdened by the unfair “government insurance plan” that’s going to drive them out of business – and that they must, therefore, pass along those excessive and unjust burdens that are being placed on them in the form of higher premiums, deductibles and co-pays – while they are gaining, perhaps, millions of new customers under mandated coverage. – And the politicians who are drawing up this REFORM who will continue to receive large campaign contributions and other perks – and then highly powerful and lucrative jobs in Washington when they leave office.

It should come as a surprise to no one that the worst of this health "insurance" reform won't go into effect until 2013, conveniently after the next Presidential election.

Actually the public option was meant to be just what your co-worker feared – a plan that would provide actual “CHOICE” for all individual and employed Americans (although it would still EXCLUDE: Medicare, Medicaid, SSDI, SSI, CHIP and the Veterans Administration covered individuals.) AND IT WOULD REMAIN THAT ANYONE WHO WANTED TO KEEP THEIR CURENT PLAN, COULD DO THAT !
BUT, if someone wanted to join APIP, then they could choose APIP instead.

– Then your co-worker, and the large private insurance companies, would have something to worry about because if Americans could choose a health care plan on the merits of benefits, premiums, deductibles and co-pays – with the benefit of being in a very large pool, not-for-profit health care entity with very low administrative costs which negotiates on a national, state, regional and local basis with health care providers on behalf of the health and wellbeing of their members ( LIKE THE MEMEMBERS OF CONGRESS’ INSURANCE PLAN ) – instead of its priorities being advertising, lobbyists, profit to stock holders and multi-million incomes, stock packages and perks to executives – YES ! – then APIP WOULD BE a competitive force to the large private insurance companies. But, the weak, measly public option now being proposed is nothing for the large private insurance companies to even look askance at.

I agree that the cost of APIP – in fact – the entire health “insurance” reform (as Obama has taken to calling it) has to be covered somehow and I am NOT in agreement with how it is currently planned to be covered. The cost of the program falls too much on the middle class and lower earning Americans in the form of tax increases by – DECREASING THE USE OF FSA’S and RAISING THE TAX DEDUCTION FOR MEDICAL EXPENSES FROM 7.5% TO 10 % and ADDING A TAX PENALTY FOR THOSE WHO CANNOT AFFORD INSURANCE.

And in addition to that, the Congressional Budget Office, itself has said – and Congress also admitted during the Finance Committee hearings on the Mark – that the insurance companies will pass directly onto consumers the tax increase that Congress has placed on the large private insurance companies – and, the very next week, the insurance companies publicly announced that the increase was in the works! So, in addition to the DIRECT tax increases, there is also the LARGE increase in premiums, deductibles and co-pays that the insurance companies are passing along to EVERYONE who NOW has insurance, as well as to EVERYONE who will be required to purchase MANDATED health insurance.

So, ALL OF THIS is going to add up to one large financial burden for many middle income and lower earning Americans for a wrung-out, anemic APIP (which is only going to get even worse as it goes through the Senate and then the Conference Committee) – and in the end it will be entirely too costly for our country.

And, just today, on the news it was announced that the MOST IMPORTANT, overriding consideration of the bill(S), that being, that the COST CURVE trajectory HAS TO BE DOWNWARD in the out years – that HAD, HAD, HAD to be the MOST CRUCIAL ELEMENT of the bill(S) – well, that downward cost curve trajectory is now NO LONGER THE PROJECTED OUTCOME of the currently proposed bill(S) according to Congress’ own Congressional Budget Office ! And that is only allowing for what Congress has accounted for in the bill(S).

For instance, no matter how one may feel about the illegal immigration issue – and although illegal immigrants are not supposed to be able to be covered in the health “insurance” reform – any suggestion to require anything other than that a person state that they are a citizen or, perhaps, provide any proof of citizenship other than the falsified documents readily purchased and currently used by illegal immigrants – was opposed and rejected from the bills – and the impact of the health “insurance” reform covering – what is estimated will be approximately 12 million illegal immigrants – HAS NOT BEEN SCORED into the cost of any of the bill(S).

And, so, what will the currently proposed bill(S) accomplish? Well, they MAY actually try to
achieve the 15-year goal of getting all the health care providers to use ONE insurance form –
BIG WHOOPIEDOO ! ! ! And the large private insurance companies will get more customers and make more profits through larger premiums, deductibles and co-pays. And approx 12 million individual and small business Americans may be able to afford health insurance through APIP. And some might be in favor of 12 million illegal immigrants being able to get coverage through APIP.

Oh, yes, and every woman who falls into the category of the “family of 4 with an income below $88,000” category – WHETHER she has insurance in the public option OR through her employer based plan OR she is covered through her husband’s insurance – since she will be considered eligible for the tax subsidy – she will be issued an insurance policy exactly the same as she now has – except that it will exclude coverage for her health care should she feel she needs to have an abortion – which is a Constitutionally legal procedure.

Most women who find that they need to have an abortion almost always choose to self-pay rather than have that shown on their medical records so that regulation being imposed by Congress will not have tremendous financial impact. However, whether in the case of rape, incest, domestic violence, tremendous emotional, financial or physical hardship, the physical ill health of the fetus or, even if the life of the mother is at stake – this is the ONLY EXCEPTION – where the GOVERNMENT is making the decision to place restrictions and limiting a woman’s rights – particularly women of lesser means. And if ANY health “insurance” reform bill passes – this will affect women in EVERY / ALL ! – PRIVATE, EMPLOYEE-BASED AND PUBLIC OPTION HEALTH INSURANCE PLAN ! ! !

So, considering all this, particularly, the tax increases on the middle class and lower income earners (plus cuts in Medicare) – as well as even LARGER than expected increases by the large private insurance companies to cover the taxes placed on them – to pay for this “REFORM” – and considering that there’s so much else hidden from sight and not shown in the bill(S), I fear that the currently proposed bill(S) will prove to be too much of a negative impact to our nation’s economic health and wellbeing.

And, very sadly, this is written by someone who was an ardent proponent of health CARE reform –
but with a PURE PUBLIC OPTION. And, so, I now have to stand firmly against the health “insurance” reform(S) going through Congress.

My take . . .
Renee

sleepycarol said:

Okay today I was sitting at lunch and thought I would open up the can of worms. LOL!!

Our congressman's son works at school. He is super smart and doesn't know how to have a good laugh -- you know the type, all business. He is our IT person. He has some good ideas, and then some that are way over most people's heads.

I asked him what he thought of Obama's health care plan. With 2000 pages, I wonder how many have actually read it AND understand it. I didn’t ask if him or his dad had actually read it (we only have a little over 15 minutes to eat).

He said there is a quota on the number of doctor's that graduate every year. He said this law was put on the books back at the turn of the 20th century because there were too many doctors and the pay was low. In order to drive up doctor's wages the put a quota on the number of doctor's graduating. He claims the law is still on the books and needs to be repealed. The more doctors we have, the cheaper the care in theory.

He said that states regulate the insurance industries. In any given state, the number of companies allowed to do business is limited in each state according the states regs. Over all the United States there are many insurance companies, but they are limited to certain states. He said many of the regulations needs changed or deregulated in order to broaden the pool of available insurance companies in each state. Competition should be a good thing.

His theory is that with the advent of a government backed plan premiums will be more affordable, at the expense of additional taxes since the cost will have to be covered some how. An example used is that the government will provide a $600.00 plan, the consumer will pay $300.00 for this $600.00 policy. At this point, we do not factor in the additional taxes needed to pay for the $300.00 the government is subsidizing. The private insurance companies cannot afford to cut their premiums and thus their premium is still at $600.00. Well who wants to pay $600.00 when they can get the same policy for $300.00. Consumers will decide to go with the government plan, leaving the private company in a bind with the losses of revenue this backlash as created. So in order to stay solvent, their premiums will possibly go up. When the private company raises their premium, more will sign up for the government backed plan. Thus is creates a cycle. At some point, the government will have to bail out the insurance companies or let them sink. His theory is that for the first five years, there will be a honeymoon phase. The next five years will see the tug of war start between private insurance and the government plan. By the time 20 years have went by, consumers will wish that they had a choice of private plans to choose from as our choices will be controlled by the government.

I think he has some very valid points.

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Permalink Reply by Renee on November 12, 2009 at 12:35pm

Hey Rock ~

Thank you ! I had the itchin' to respond to SOO many postings on this subject on this discussion and at other times when I've read about people's insurance injustices. And I was really proud of how long I held back and sat on my hands - but, then, Carol's co-worker really got my ire up ! - and the flood gates just burst loose . . .

By the way, if I haven't already told you, I always appreciate your postings !

Wishing you a really restive sleep study today . . .

Pleasant Dreams,
Renee

Rock Hinkle said:

Wow Renee really, you need to quit holding back on us. Where have you guys been hiding this gem of a voice. That was simply amazing!

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