News Republicans' Plan to Repeal Healthcare?

[lisab]

The CBO is wrong. They have to use various assumptions in making their calculations. You could also look at the history of most all the government health entitlements. They never come out costing what they are projected to. The bill supposedly pays for itself by cutting Medicare, but it is also supposed to expand Medicare. Now anyone knows you can't expand Medicare with the same bill that is funded with cuts to Medicare.

When asked about this, President Obama couldn't answer and waffled on the issue completely. The Democrats know the bill will cost an astronomical amount, they will announce the need for new taxes to pay for it.

Do you have any links to support your claim that the CBO is wrong?

 

[adrenaline]

http://www.pnhp.org/news/2010/march/politicians-didn%E2%80%99t-get-it-right

as pro single payer I hate this health reform bill, as a business owner I hate it more.

Right now I pay close to half a million a year in health insurance premiums for my 45 employees. This bill does nothing to prevent my carrier from raising premiums 178% like it has over the ten years I have been partner. So, since health insurance premiums are my second highest overhead, what is to prevent me from dumping my employees on the public exchange where they will get suboptimal coverage, higher copays and deductibles? The paltry 700 dollar fine per employee only applies to companies above 100 but even if I had to pay that, I would still reduce my overhead by dumping my employees onto the exchange. Small to medium size businesses will be dropping their excellent group coverage and letting their employees fend for themselves in the exchange.

Employers are now allowed to have "health screenings" and if the employee fails them ( say for diabetes) the employer will now be able to charge that employee a higher share of their employer sponsered premiums.

It did nothing for the fact that as an employer with majority female employees under 55 my premiums are 48% higher than a similar business size whose work force is predominantly male ( and if you don't think this affects hiring decisions in the work place you are way too innocent.)


Luckily, I am senior partner and believe in ethical business practices but if you don't think my Republican partners who look at the bottom dollar isn't trying to capitilize on this ( after all, half a million divided up as profit sharing among four partners...) isn't riding my a$$ about this already...


Now for individual policy owners this was a good reform for them.

 

[Char. Limit]

Well you have a point there, but I was talking from a basic assumption in which they aren't subsidized.

Just because something isn't taxed doesn't mean you should then tax it IMO.

I think that we should get a sales tax exemption to groceries. Groceries that mean things you need, REAL food. Candy doesn't fit that list. Soda does.

 

[Pattonias]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

 

[Ivan Seeking]

http://www.pnhp.org/news/2010/march/politicians-didn%E2%80%99t-get-it-right

as pro single payer I hate this health reform bill, as a business owner I hate it more.

As a small business owner, I love it because it makes health insurance affordable where it never was before. The biggest single impediment to most people considering opening a small business is the cost of health insurance.

As a small business, won't you receive a subsidy to offset the cost of insurance? Also, the cost for companies that don't comply is, I thought, more like $2000 per employee. There have been a lot of numbers tossed around over the last few days, but I thought that was the penalty. Perhaps that is only for larger companies?

My feeling is that this bill is a pig, but it's the only pig in town. After 70 years of failed attempts, if this hadn't passed, it may have been a very long time before any significant reform was seen. With that in mind, isn't it better to pass this and amend as needed, rather than allowing the current system to continue indefinitely?

I too would have preferred a single-payer system. Apparently that was too big of a step for now. I guess that one comes down to Senator Snow's vote in the senate... and the two Independents.

 

[drankin]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

This is crazy. Can you reference any government programs that support that this would be even mildly successful? Providing free healthy food is not going to prevent obesity. It will just give people more food to eat. Healthy food can make you fat too.

 

[Dembadon]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

This is a false analogy.

Many U.S. citizens band together and cook food for the homeless/hungry on a regular basis. However, one cannot set up a tent and start handing out insurance policies to those who need them. You don't need to own a food company to feed someone.

 

[Count Iblis]

So if the Republican party regain control of the house and senate, are they able to reverse the bill?

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

 

[Count Iblis]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

Homeless shelters already offer free of charge food.

 

[Ivan Seeking]

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

Note also that a majority of Americans support health care reform. 59% of Americans oppose this bill, but 13% do because it doesn't go far enough. That stats suggest that we may well see as much as 55% approval by next November.

Just try to sell people on the idea that we now want to effectively cancel insurance for sick children who were previously refused insurance due to preexisting conditions.

 

[adrenaline]

As a small business owner, I love it because it makes health insurance affordable where it never was before. The biggest single impediment to most people considering opening a small business is the cost of health insurance.

As a small business, won't you receive a subsidy to offset the cost of insurance? Also, the cost for companies that don't comply is, I thought, more like $2000 per employee. There have been a lot of numbers tossed around over the last few days, but I thought that was the penalty. Perhaps that is only for larger companies?

My feeling is that this bill is a pig, but it's the only pig in town. After 70 years of failed attempts, if this hadn't passed, it may have been a very long time before any significant reform was seen. With that in mind, isn't it better to pass this and amend as needed, rather than allowing the current system to continue indefinitely?

I too would have preferred a single-payer system. Apparently that was too big of a step for now. I guess that one comes down to Senator Snow's vote in the senate... and the two Independents.

The tax benefits won't offset the half a million a year I pay, and this reform bill made no provisions for the insurance company to not raise their premiums ( which they will since I now have to provide coverage for all children of employees until 26 years of age and more dependants). If I was a small business hurting and looking to cost overhead, it would be easier to dump my employees onto the public exchange and fend for themselves. That is the bottom line. Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

we needed a change yes but this pig is out of control . I already have a bloated clerical staff just to deal with 300 plus private insurances, I honestly don't see my self opeining myself up to twice that number by accepting the public exchange. My partners have already foreseen the beaurocratic nightmare.

 

[Brian_C]

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

They will get plenty of votes from people who either got nothing from this bill, lost their employer provided coverage, or saw their premiums skyrocket as a result.

I think the Tea Party crowd actually helped the Dems pass this bill. They were able to argue that the bill represents real reform because all the 'evil right wingers' were against it. Reality is about to smack the American people right in the mouth.

 

[Ivan Seeking]

The tax benefits won't offset the half a million a year I pay, and this reform bill made no provisions for the insurance company to not raise their premiums ( which they will since I now have to provide coverage for all children of employees until 26 years of age and more dependants). If I was a small business hurting and looking to cost overhead, it would be easier to dump my employees onto the public exchange and fend for themselves. That is the bottom line. Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

I know that insurance companies will now be required to disperse 80% of the funds collected, for claims. So they do not have the option to arbitrarily raise prices without providing addtional coverage. At least, that's the theory as I understand it.

 

[Pattonias]

Is there any reason we couldn't pass insurance reform without the public option? Is anyone arguing that the reforms were not necessary? The biggest hang ups on the bill were over the universal public insurance option.

 

[calculusrocks]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

Doesn't Hugo Chavez do something like this in Venezuela?

 

[adrenaline]

I know that insurance companies will now be required to disperse 80% of the funds collected, for claims. So they do not have the option to arbitrarily raise prices without providing addtional coverage. At least, that's the theory as I understand it.

I will let you know , I just hope they don't raise their premiums over the next four years in a last hurrah...

 

[adrenaline]

Is there any reason we couldn't pass insurance reform without the public option? Is anyone arguing that the reforms were not necessary? The biggest hang ups on the bill were over the universal public insurance option.

This bill has no public option, only the insurance exchange where our federal tax dollars will now subsidize the private insurers like cigna, humana , blue cross etc etc. It's corporate welfare. They are trying to tack on an amendment but I'm sure it's not going to pass.

 

[calculusrocks]

adrenaline, is retirement an option in your situation?

 

[turbo]

I already have a bloated clerical staff just to deal with 300 plus private insurances, I honestly don't see my self opeining myself up to twice that number by accepting the public exchange. My partners have already foreseen the beaurocratic nightmare.

My cousin codes for a pediatric ophthalmologist who has many, many clients on Medicaid. The doc (who is also a friend of mine) doesn't mind the lower reimbursement rates because the coding for public insurance is very straightforward, and they don't delay and deny payments over and over again. That's very important for a small practice, because cash-flow problems and aged receivables can sink a small practice. When I was IT manager for a very large ophthalmic practice, one of my constant/recurrent duties was to identify insurance companies that were delaying or denying claims, resulting in receivables that were 60-90 days old. Banks don't like to extend your line of credit based on aged receivables like that. In my experience, it was the private insurance companies that caused 99% of the trouble by changing coding requirements, and kicking back any claims that were not properly coded to THEIR requirements, regardless of how many other insurance companies would have accepted the coding as submitted. We had three full-time coding experts for an in-house staff of 10-12 doctors, and those ladies were busy.

 

[adrenaline]

My cousin codes for a pediatric ophthalmologist who has many, many clients on Medicaid. The doc (who is also a friend of mine) doesn't mind the lower reimbursement rates because the coding for public insurance is very straightforward, and they don't delay and deny payments over and over again. That's very important for a small practice, because cash-flow problems and aged receivables can sink a small practice. When I was IT manager for a very large ophthalmic practice, one of my constant/recurrent duties was to identify insurance companies that were delaying or denying claims, resulting in receivables that were 60-90 days old. Banks don't like to extend your line of credit based on aged receivables like that. In my experience, it was the private insurance companies that caused 99% of the trouble by changing coding requirements, and kicking back any claims that were not properly coded to THEIR requirements, regardless of how many other insurance companies would have accepted the coding as submitted. We had three full-time coding experts for an in-house staff of 10-12 doctors, and those ladies were busy.

Your right, I tell people medicare pays me less but i probably spend 3 dollars for every 100 dollars i collect on clerical work and probably spend 33 dollars for every 100 i collect from private insurance. Most of us polled want single payer ( NEJM, JAMA) poll after poll shows most docs will take less payment just to deal with a more streamlined , consistent, single payer than the beurocratic garbage we have to deal with now.

How is this for a statistic, Duke Medical Center has 500 hospital beds and 500 full time coders, one coder per bed, what do you think the nursing ratio is?

 

[adrenaline]

adrenaline, is retirement an option in your situation?

No, I love what I do. Even though I have paid my student loans, I practice internal medicine in an area where there are so few of us left ( we have nine doctors who take call at the hospital for 45 docs who won't come to the hospital anymore ) that there would be a critical shortage of care if I retired. We see all the unsassigned , indigent patients and other docs patients along with ours that it is getting to be a nightmare but the situation is not getting better as more students owing half a million are going into lucrative interventional radiology, dermatology etc.

 

[turbo]

Your right, I tell people medicare pays me less but i probably spend 3 dollars for every 100 dollars i collect on clerical work and probably spend 33 dollars for every 100 i collect from private insurance. Most of us polled want single payer ( NEJM, JAMA) poll after poll shows most docs will take less payment just to deal with a more streamlined , consistent, single payer than the beurocratic garbage we have to deal with now.

That's something that the GOP and the blue-dogs don't want to happen for some reason. Health care costs could drop like a rock with a single payer system because medical practice overhead would plummet. Also, if you had a single coding guide-book and coding standard to deal with, not only would your administrative staff be much smaller, you wouldn't have to pay to re-educate them over and over as insurance companies come up with new ways to deny payment. Getting regular payments on claims (even at reduced reimbursement rates) would be a boon to private practices. As you might imagine, advances in ocular surgeries often come with some very $$$$ equipment. If you'd like to add new surgical laser to a new field office (we did!) your line of credit with the bank had better be healthy. That can be tough when you have receivables that are aged 2-3 months or more because the insurance companies deny and delay, and make you recode and re-submit. Meanwhile those insurance companies are investing that "float" and making money at the expense of medical practitioners.

This bill should have radically reformed health-care insurance. It did not. The health-care system in this country is struggling under the weight of massive bureaucracy imposed by the insurance companies, who often have regional monopolies. Progressives and true fiscal conservatives should join with willing members of Congress and keep fighting for a single-payer option. If the private insurers can't or won't compete, then they should get out of the business. The bill as passed is a boon to the insurance companies who get millions of new customers, many of them healthy, without reducing rates.

 

[adrenaline]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

 

[turbo]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

That would be ideal. Let every citizen buy into Medicare, and the younger, healthier people would reduce the experience rate of the older members. That would immediately reduce the payout per patient, and save Medicare some really big money, while keeping it solvent. If you want private insurance instead of or in addition to the public coverage, you buy it.

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why. Congress' constituency only includes us when they want our votes, and after the election, they do the bidding of the men with the money.

 

[mheslep]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That part of Frum's essay I think is a silly strawman. What would be proposed is a replacement bill, not a go-back-to-the-way-it-was repeal.

 

[adrenaline]

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why.

I believe the insurance lobby is the second most powerful, both dems and repubs have their pockets lined by them. That's why no public option and instead federally funded 30 million new clients for the insurance industry in the exchange. Oh Obama, you were pro single payer as a senator, now you kow tow to the industry, you let me down...

 

[mheslep]

Can the law be overturned some other way? There are two - one is that the law needs to survive a court challenge. I think it will, after Wickard v. Fillburn, but one can never tell.

W v F was a stretch it was, and this health mandate is different in that the health consumer is just that - a consumer not producing any saleable product unlike that wheat farmer. There are constitution limits on what the government can mandate. To make this law fly, the Dem's would have had to offer up some kind of rule that strikes a balance, that is maintains a balance, between the government's commerce regulation authority and the citizen's right to otherwise be left alone. Instead, their argument is that we need the mandate to make health care pay off, health care is a good thing, therefore the mandate is legal, which amounts to little more than the 'we want it that way' legal argument. If their logic holds, some examples of where the government can go next on the same basis:

• As it is in the national interest to have a large domestic auto manufacturing capability, IF you buy a car, it shall be a GM made car, unless you reside in Nebraska, Florida, Louisiana, or Montana.
• As it is in the national interest to have a well informed citizenry, you shall purchase a daily newspaper. Qualifying newspapers will be listed on a national exchange.
• As it is in the national interest to promote science and engineering education, all graduates of science or engineering academic programs or those with long work experience in these fields shall purchase a two year subscription to Physics Forums.

Edit: Here's the summary position of the Florida AG's suit:

Florida’s lawsuit will make three claims: that Congress lacks the authority to require individuals to buy health insurance; that the penalty for those who do not buy health insurance violates the U.S. Constitution’s tax-apportionment clause; and that the legislation violates the 10th Amendment by granting the federal government new powers.

http://blogs.wsj.com/law/2010/03/23/back-to-tallahassee-health-bill-suit-starts-taking-shape/

 

[mheslep]

Do you have a reference for an estimate of the risk? The CBO has released estimates projecting decreases in the deficit over the next 10 years.

See cost estimates: http://www.cbo.gov/publications/collections/health.cfmhttp://www.cbo.gov/publications/collections/health.cfm

Here's the right link, I think, for what you intended:
http://www.cbo.gov/publications/collections/health.cfm

The question is for what did CBO release a projection? The current reconciliation bill http://www.cbo.gov/doc.cfm?index=11376&type=1" Yes, that's the number, but is that 'health care'? Well for the first four years it is all taxes and no/little benefits, so I'd say no in that respect it is not 'health care'. Then there are other kitchen sink items thrown into 4872 such as the student loan program to make the bill's $numbers look better, but student loans are not health care either.

In any case, the actual health care part seems to have an total price tag of about $1 trillion over ten years. The bill pays for that with about $500B in new taxes, and by $500B in cuts to Medicare, both also over 10 years, without a corresponding change to Medicare's obligations. The problem of course as shown in the CBO main link that http://www.cbo.gov/publications/collections/graphics/health3.gif" . I see no way out of the US defaulting on Medicare obligations with current policy.

 

[mheslep]

This bill does nothing to prevent my carrier from raising premiums 178% like it has over the ten years I have been partner.

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.

Information about Insurance Plan Expenditures, and a Rebate to Assure Value
o 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.
o Americans will receive a rebate if their health insurer’s non-medical costs exceed 15 percent of premium costs in the group market or 20 percent in the small group and individual market. Using cost data from this year, rebates will begin in 2011 and the policy applies to all insurance plans.
[...]
Protection from Exorbitant Out-of-Pocket Costs
o Insurance companies will abide by yearly caps on what they may charge beneficiaries for out-of-pocket expenses, like co-payments or co-insurance charges. This will ensure that Americans are not forced to file bankruptcy due to high health care costs.
 Notification and Justification of Premium Increases
o Insurers will be required to publicly disclose the amount of any premium increase prior to the increase taking effect, and to provide a justification for the increase. This will limit the industry’s current practice of hiking up insurance rates in order to push less healthy individuals and small businesses off their rolls.

http://dpc.senate.gov/healthreformbill/healthbill54.pdf

 

[mheslep]

Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.