Progressives React to Wyden's Healthy Americans Act
David Sirota, author of Hostile Takeover, had this reaction to the Wyden plan:
Oregon Sen. Ron Wyden (D) is courageously stepping forward and presenting universal health care legislation. Joined by Stern, the advocacy group Families USA and the CEO of Safeway, Wyden is ignoring the inevitable taunts of "Hillarycare" that will come from the right, and the knee-jerk attacks of "liberal" that will come from the corporate-funded faux "centrists." He is, instead, aiming for the real center of American public opinion which has long supported government intervention to create a universal health care system. ...We now have a U.S. Senator preparing to use the new Congress to force a real debate on universal health care is a major step forward. That debate will force the Beltway media and the country at large to start thinking once again about a big issue that confronts the nation - and hopefully, will get us back to focusing not on cults of personality, not on the horse race, but on challenging the hostile takeover of our government by Big Money interests and actually making substantive change that can improve the lives of millions of people.
Progressive health care policy wonk Ezra Klein, writing at The American Prospect's blog, had this to say:
It's been some time since I've run across a genuinely new health care proposal, but the comprehensive reform legislation Ron Wyden's unveiled today is just such a beast. ...I have to spend some more time with the legislation ("c'mon baby, open up to me, tell me your secrets..."), but my snap reaction is heavily favorable. It isn't everything I'd want, but imposing the combination of community rating and an insurance floor will be a huge step forward. The cost stability offered to employers seems very, very savvy, as does the forced conversion of 2006 health costs into salary increases.
The Lewin Group, the gold standard in health care actuarial data (I can't believe I just wrote that sentence), has evaluated the plan. Their conclusion? The plan would cover more than 99 percent of Americans, we'd save $4.8 billion in the first year and $1.48 trillion over the next decade.
How's that sound? To me, it sounds like precisely the sort of big thinking Democrats need to be doing now that they're back in the majority.
Finally, the Oregonian coverage today includes this bit of reaction.
"It is the most significant reform proposal put before Congress for many years," said Bill Kramer, president of a Portland health consulting firm that does work for the Oregon Business Council but played no role in the Wyden bill. "It will become the plan against which all others are measured and has a potential to frame the debate in Congress and the 2008 presidential campaign.
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December 14, 2006 |
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Posted by: politicallogic | Dec 14, 2006 9:37:30 AM
From close-up experience with the Federal employees health-care plan, and the insurance industry in general, I can tell you that Wyden significantly misrepresents how both work, and therefore his plan. Furthermore, pretty clear the chattering class of progressives amongst us who make their nut flapping their gums and tapping their keyboards don't really understanding the difference. I'll try to explain with some simplifications to make the explanation accessible. I'm assuming folks here have the maturity to not jump on possible errors that arise as a result of that simplification to try to distract from the substance.
The Federal employees plan has only a superficial resemblance to Wyden's plan. In the Federal plan, the Federal government is both the employer who makes the "employer" contribution and and the insurer who writes the checks. What you think of as the funds to pay doctors, hospitals, etc. for the set of very good basic coverages are primarily derived from the treasury, and from employee contribution for optional coverages such as long-term nursing coverage.
Insureds do deal with private companies such as Blue Cross when they have a claim. But those companies are simply administrators of the plan. They do not set the benefits, nor the criteria for deciding what to pay. The checks are not cut by the administrator, nor are the guidelines for coverage decisions actually initiated by the administrator as with private insurance. This sets up a very different dynamic in terms of where the private companies derive their profits from what Wyden is proposing.
The fact that Wyden is trying to pull a fast one is easily understood by juxtaposing these two comments on his own website:
The Healthy Americans Act creates a system of tax benefits and premium reductions that will ensure every American can afford a high-quality, private health plan that is comparable to what Members of Congress enjoy now.
Every time an individual interacts with state, local and federal government—registering their car, enrolling their children in school, applying for a driver’s license or paying their taxes—they can be required to verify their enrollment in a private health insurance plan.
As noted, Members of Congress do not have a private health insurance plan. They have a federal plan whose adminstration is contracted out to private companies. The big difference is where the profit (and profit motive) lies in the Federal employees system and Wyden's deceitful plan. As well as the difference in the costs to us of underwriting those plans.
If one needs any further proof that Wyden is trying to deceive, I just heard his rather slimy performance on Thom Hartmann (the end of the 8:00 hour, 12/15/2006).
First, he doesn't make it clear the critical distinctions just described between the insurance coverage he enjoys as a Senator and this plan. More importantly, he then went on to attack those who have advocated that we just have Medicare for all (which I do as a true progressive.) In fact, the problems with Medicare that have made the most news lately - the private prescription plans - are very similar to what Wyden has proposed here.
As part of his attack on Medicare, Wyden also threw in some gratuitous comments about the political reality of how the insurance companies aren't going away and how they employ a lot of people who would be out of work if we had Medicare for all. The honest answer to that is quite simple: If the core Medicare plan (part A, part B) were revamped into Medicare-for-all along the lines of the actual Federal employees health care plan, there would be a new industry and jobs for current insurance company employees as administrator of the Medicare system.
Ron is pulling a fast one here. Too bad a lot of the faux progressives here don't have a lot of real life experience to know it.
Posted by: torridjoe | Dec 14, 2006 9:44:11 AM
following up on my first post, there's a more extended analysis with more comments at DKos today...
Posted by: Sal Peralta | Dec 14, 2006 10:28:18 AM
I'd like to commend the Senator for even attempting to tackle this issue.
However, the working group used a $30,000 deductible as the example for the plan most likely to be chosen by the poorest Americans. Not one person in the poorest 20 percent of this country comes anywhere near $30,000 in assets outside of a relatively few that own a home. To what extent is this a significant improvement over no health care for that group of people given that people are likely to end up in bankruptcy regardless of whether or not they have this plan?
Also, is this a starting point for negotiations that will be watered down later, or is this basically a finished proposal? If the it's the former, why should citizens who want health care reform support this plan rather than the Conyers-Dingell plan? And why did the work group leave single payer off of the table, as some have suggested in the link provided by TorridJoe?
Posted by: Kari Chisholm | Dec 14, 2006 10:53:11 AM
Hey folks... I think it's VERY important to distinguish between the working group and the Wyden proposal. For example, in yesterday's thread, one commenter pointed out that the working group was planning a 2012 roll-out - but Wyden's plan kicks in just two years after passage.
I haven't studied the working group's materials, but don't assume that everything you see in there is also in Wyden's plan.
As for single-payer, I'd argue that the question isn't some ideological affinity for one financing model over another -- but a question of outcomes. This plan is affordable, comprehensive, portable, nondiscriminatory, reduces overall cost... if it accomplishes everything that a single-payer system would, why not support it.
Finally, I'd point you to Ezra Klein's follow-up analysis today:
BUT IS IT GOOD ENOUGH? Lot of interesting feedback on the Wyden plan, some of which I want to explore a little further. But first, I want to ask a question: Can anybody truly see Congress passing a piece of legislation and a president signing a bill that, in one stroke of the pen, dissolves Aetna, UnitedHealthGroup, Kaiser Permanente, Blue Cross, and all the rest? We're talking about the full dissolution of multibillion dollar corporations that employ thousands and thousands of people, contribute heavily to a wide swath of politicians and provide massive tax revenues to a large collection of states, and have been the sole providers of health coverage for nearly a century now. Forget whether you, or I, think their demolition would be a good idea: Do you see it as a possibility?I've tried to imagine it. Believe me, I have. But I can't. Not in the near-term, anyway. Which why I'm somewhat unimpressed by demands that Democratic proposals start from a single-payer stance and condemns any that don't as "signal[ing] a sell-out by the Democratic congressional leadership." Politics is the art of the possible, and so long as the health system is genuinely harming millions of Americans, the perfect can't continually be the enemy of the good -- the question must be whether what's achievable is good enough.
That said, insurers are a problem. But what you can't destroy, you may be able to reform. That's the strategy of the Wyden plan.
Posted by: Sal Peralta | Dec 14, 2006 11:11:49 AM
Kari, my concern is not based on ideological affinity toward one financing model versus another. My concern is that a plan involving $30,000 deductible is no plan at all when it comes to the day-to-day medical needs of most Americans, and that for a significant number of Americans, minimally 1-in-5, the Wyden plan doesn't really offer much protection from being financially wiped out by catastrophic medical expenses.
Again, I'm glad that the Senator is willing to tackle this issue. I don't claim to be wise enough to understand all of the ramifications, but it's important that people ask a lot of questions about this plan before jumping in and championing this policy just because Senator Wyden is "our guy". I like Senator Wyden. I trust Senator Wyden. But that doesn't mean that I think people should approach a massive reform proposal without a deeply skeptical eye or refrain from encouraging others to do the same.
How will it affect Oregonians covered under the OHP or other state policies?
To what extent will this actually reduce costs?
Are the anticipated savings from administrative overhead or reduced visits to the ER accurate?
If this is really a starting point for negotiation, can more be done for the poorest Americans than what this plan offers?
What does Governor Kitzhaber think about it?
etc...
Posted by: Congressional staffer | Dec 14, 2006 11:25:00 AM
politicallogic,
i'm not an expert on health care, but as a congressional staffer, i'm pretty sure that the FEHB plan is now (it may not have been before) run through private insurance, not just administeres by them. that is, i choose from a range of insurance companies who all offer different benefits at different employeee contribution levels.
Posted by: Kari Chisholm | Dec 14, 2006 11:53:34 AM
My concern is that a plan involving $30,000 deductible is no plan at all
Wyden's plan has no $30,000 deductible. That was merely one suggested example in the working group materials -- and is not in Wyden's plan.
Posted by: lin qiao | Dec 14, 2006 12:04:09 PM
I am another federal employee covered under FEHB. I guess I have trouble parsing the fine distinction between administering the plan and actually running the plan. I can tell you that checks are indeed cut by the plan I have chosen (Blue Cross in my case). However, I believe that politicallogic is fundamentally correct in a very important way: the employer contribution is coming out of the US Treasury, and thus Uncle Sam is deciding what the level of coverage will be. I have always been a bit shocked about what the federal employee Blue Cross plan fails to cover: regular eye exams, for example, unless one can demonstrate that one has some sort of ocular disease. My family and I had better, more comprehensive coverage when I was a Washington state employee than now as a federal employee.
In any case, the federal employee health benefit system is not a for-profit scheme.
Every year in the fall I get asked to choose between various plans with varying costs, as noted by congressional staffer but for all practical purposes, the choice comes down to Blue Cross/Blue Shield of Oregon versus Kaiser.
The Blue Cross plan administration for federal employees seems to operate primarily as a gatekeeper. BC seems to find any excuse to decide they need to "investigate" a claim, request "more information", and so on. I've seen this over and over again in regards to claims for my spoouse, who has various chronic medical problems and is certainly not a "profit center".
Posted by: BlueNote | Dec 14, 2006 12:17:19 PM
If Wyden's plan does not bring us to a single payer system, it at least is a step in the right direction. I would do everything in my power to cause the country to move to a single payer system based on universal coverage under Medicare A & B. But, as others have said, with the millions of jobs and billions of dollars of profits from private health care, it would literally take a revolution (the kind with guns and bombs)to dislodge the private insurance system from its choke-hold on the US health care system. Therefore, small steps in the right direction are probably the only realistic alternative we actually have. Of course, we could oppose all changes to the existing system and wait and hope that the entire private system collapses under its own weight, but that might be very painful for a lot of people, both insured and uninsured.
Posted by: Sal Peralta | Dec 14, 2006 12:47:54 PM
Kari, you make a fair point about differentiating between the work group and wyden's bill which was apparently derived from that effort.
Nevertheless, there is overlap, and the working group didn't pull that $30,000 number out of a hat. It may only be an example, but I'd argue that there's a reason they are floating that particular number that goes somewhat deeper than "it's just a random variable that we plugged in". These are public policy professionals. Nothing went into that report without a rationale.
BlueNote, treating the Senator's plan with a skeptical eye is not opposition. It is certainly not tantamount to opposition to any and all moderate reform on health care. I've never been very big on false dilemmas. The choice in front of us is not "accept this plan or let the entire system collapse".
If we're going to advocate for moderate reform then let's do it by moderating our rhetoric.
I'm not saying that this plan is without merit. What I'm suggesting is that people should approach this kind of reform with a great deal of skepticism. If the Bush era hasn't taught Americans to be skeptical about any and all major public policy initiatives, then nothing will. The fact that "our team" is now in charge shouldn't make us any less vigilant.
Posted by: peter | Dec 14, 2006 12:59:39 PM
kari,
if for one do not have "some ideological affinity for one financing model over another", nor do require a single-payer system. what i do require is a system that is not a huge hand out to insurance companies, without requiring real reform.
at the very least, if we are going to be handing billions of tax-payer money to insurance companies, who have a proven record of making money by cleverly denying care, then let's require them to put a citizens group on their board so we can review CEO salaries, and such.
Posted by: Gil Johnson | Dec 14, 2006 1:44:54 PM
I'm with peter. Having recently had arthroscopic knee surgery, I am now having to deal with an insurance company--Assurant, of all names--that is trying to deny paying its share of the fees (which after deductibles amounts to about half the cost). It appears that a signmificant portion of health care costs goes to a bureaucracy whose purpose is to get someone else to pay the bill.
Why don't we go to a single-payer plan and then give the insurance companies a severance package? Come up with a big nice round figure to pay the insurance companies to get out of the health insurance racket, say over five years. This may sound like a boondoggle, but if it would make the single payer plan political feasible, I would also bet it would cost the average citizen less in the long run.
Posted by: Kari Chisholm | Dec 14, 2006 2:32:03 PM
what i do require is a system that is not a huge hand out to insurance companies
Well, I guess the proof will be in the politics. I was just on a conference call where Senator Wyden was asked about this, and he laughed out loud and said: "If you think the insurance companies are going to have a big rally in support of my bill..."
Gil, I'll refer you to Ezra's comment posted above.
I'll also say that doing nothing (AGAIN) is an unacceptable outcome. For those who want something else, ask this: does this plan move the ball in the right direction?
Posted by: BlueNote | Dec 14, 2006 3:14:12 PM
It may be worth pointing out that insurance companies are not the only group getting rich under the current health care system. In my day job I have once or twice had the opportunity to see the compensation packages of some of the executives of certain local "non-profit" hospitals. While the hospital corporations themselves may qualify as "non-profits", I can assure you that upper management receives some of the biggest compensation packages I have ever seen outside of Wall Street. So when you talk about opposition to change, don't just talk about insurers.
Posted by: neverhadhealthcare | Dec 14, 2006 4:05:50 PM
What's that? I've heard of this so-called idea of 'health-care' but I have never experienced it. I thought it was normal to pay doctors $500 to visit for a sore throat. Am I missing something?
Posted by: Nurse Betty | Dec 14, 2006 4:16:31 PM
As a nurse who has worked jobs where 80% of my time was spent calling insurance companies instead of providing patient care, I can't tell you how despicable these corporate "plans" are to me. The insurance industry and the pharmaceutical industry must be removed from the equation.
I heartily recommend the "quote-of-the-day" by Dr. Don McCann, for analysis of various health care schemes:
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
I agree that we need a revolution, but it doesn't have to come with bombs.
And here is part of Dr. McCanne's comment about the Wyden sell-out proposal:
The Lewin report contends that price competition between health
plans, and greater administrative efficiencies will lower costs
significantly. If the consolidated efforts of employers have been
unable to control costs and waste, how can individual purchasers ever
expect to exert market pressures to achieve these efficiencies?
The last section of the Act list many other potential sources of cost
savings. Reading the list, the savings potential for many is simple
rhetoric, not supported by fact. Some of them would actually increase
costs. The Act excludes more effective cost measures such as those of
the single payer model.
The point is that costs will continue to increase and wage earners
will have to face those costs alone. Employers will have divorced
themselves from the problem and will not make an exception for health
care anymore than they already do for food, housing and transportation.
Wyden's plan falls apart since it depends on price competition of
health plans, which in turn depends on shifting more unaffordable
costs directly to those who need care.
Posted by: lin qiao | Dec 14, 2006 4:20:23 PM
Guess we ought to be counting on Joe Lieberman to line up to cut a sweetheart deal for his insurance friends....
Posted by: JustFacts | Dec 14, 2006 4:26:44 PM
Sal-- I'm glad you approach this legislation with lots of questions... we all should. But the whole thing about a 30K deductible is nowhere in Wyden's plan, so stop bringing it up. The baseline plan that is used as the benchmark for Wyden's estimates isn't even close to that much. Feel free to actually read the bill (or at least the support docs) before you spread misinformation: http://www.wyden.senate.gov/. There's plenty to like and not like about this bill but let's stick to what Wyden actually proposed when we're discussing its merits and problems.
Posted by: Sal Peralta | Dec 14, 2006 5:44:33 PM
Fair point, JTF. Wyden's plan calls for a $4,000 deductible . That'll teach me to put stock into an MD blogger that I happened to know and trust. Thanks for the head's up.
Posted by: Kari Chisholm | Dec 14, 2006 9:01:19 PM
Sal, buddy, you know I love you. But ya can't go misrepresenting the plan like that.
First, let's link to the report and provide people with the real information. It's here, on page 8, of the independent Lewin Group analysis.
Second, let's quote the relevant piece:
Catastrophic benefits: 100% payment level begins after you pay $4,000 out-of-pocket in coinsurance, co-payment and deductible expenses
Ya see? You get EVERYTHING covered after you've paid $4,000 in co-pays and other stuff.
But it's not like you get NOTHING covered up to that point! Instead...
* Adult preventive screenings and office visits - $15 co-pay, zero for preventive screening.
* Inpatient services - $250 deductible
* Home and office visits - $15 co-pay
* Outpatient physical therapy - $15 per visit
* Hospital inpatient - $100 per admission co-pay
* Accident injury/ER care and ambulance - no cost
* Outpatient surgery - 10%
....and it goes on.
In other words, you pay all these co-pays and minor deductibles and whatever... But once you hit $4000, it's considered a catastrophic event, and then EVERYTHING is paid for. But up until that point, you still get most everything covered.
Seriously, people, let's not go digging around trying to find the smoking gun that proves it's a crappy plan. Because it's not. The plan itself is the same very generous plan that members of congress have given themselves.
You can disagree on lots of points, but the idea that it's not generous enough is entirely silly.
[Disclaimer: I built Senator Wyden's netroots organizing website, but I speak only for myself.]
Posted by: Sal Peralta | Dec 14, 2006 9:24:31 PM
Sal, buddy, you know I love you. But ya can't go misrepresenting the plan like that.
Huh? I was mistaken. I admitted I was mistaken. How did I misrepresent anything in the last post?
Posted by: torridjoe | Dec 14, 2006 9:41:04 PM
he must have missed your post, writing in reply to previous one.
Posted by: politicallogic | Dec 15, 2006 1:17:12 AM
lin qiao correctly made the point in much fewer words that I was I trying to make in informal terms. I'll expand a bit since it seems folks have degenerated into flogging Sal over a particular detail.
First, the Federal Employees Health Benefit plan is what has been termed "managed competition" (rather than "managed care"). That reflects the first hand experience lin qiao was relating. The federal governments specifies the coverages it will pay for, and in effect the "carriers" simply say how much they want on top of the amount they will pass through to a provider to negotiate the transaction. Furthermore, when I said the federal government "cuts the check", that was shorthand for saying that Blue Cross essentially simply writes a check on a company account in which at least 75% of the costs of generating the deposits to the account are from the U.S. Treasury.
Second, "Blue Cross" is not a company. It is kind of a hybrid between a trade association of private companies and a franchise operation that those private companies pay for the right to be called a "Blue Cross" company. In some states, "Blue Cross" (companies) also administer Medicare. Blue Cross companies are just some of the companies federal employees can choose under the FEHB program to handle the logistics of making sure providers get paid federal funds to provide health care services to Federal employees.
Third, the choice Congressional Staffer makes in choosing who will do that logistics job is quite different than you or I, or our employer if we are lucky, makes right now in an insurance company. It is also quite different from the choice you or I would make under the Wyden plan. In the case of the FEHB, the carrier essentially has no business risk because of the size of the pool, who pays the large majority of the premiums, and the value of the premiums compared to the payouts for services. In addition, the carrier must offer plans that conform to the requirements set by FEHB. For you and I, the insurance company has a very different risk profile, and offers benefits they determine based on their private business considerations and profit objectives. We have to choose between whatever insurance companies offer at whatever price they offer it.
Fourth, Wydens' primary goal seems to be minimizing the risk to the industry on the theory that this will induce them to almost altruistically make it possible for everyone to become insured. As best I can tell he would do this by increasing the size of the pool, which he would in turn do by requiring everyone to carry insurance. He leaves it up to us to negotiate the contractual relationship with private carriers, and to figure out how the heck to pay for it. (It is always interesting to me how the faux progressives amongst us in Oregon always go for paternalistic authoritarian solutions like this.)
Fifth, single payer alternatives like Conyers-Dingell's Medicare-For-All, similarly reduce costs by increasing the size of the pool. However, they also indirectly provide us leverage by increasing our buying leverage. In direct contrast to Wyden's plan where we individually have to negotiate with carriers, the carriers have to negotiate whatever contract they can with us collectively. It should be clear which is the better position to be in as a forced buyer.
Sixth, Ezra Klein's really is offering a defense of the industry in the form of a false and refutable argument about the possible. As just one example, we learned from the Depression that when the people get agitated enough that business interests are faced with the choice of something or nothing, most things are at least negotiable. I'd say the current economic realities and health care crisis confronting most working in these times has reached the point that insurance companies really are facing the choice of having their very existence made uncertain, or acting as administrators of a single-payer plan --- as the Blue Cross companies do right now. I'm confident that "Medicare-For-All" is an easy enough sell with a large enough majority of the population to be an attractive political proposition if we don't have false progressives like Wyden and Klein selling us out and trying to deceive us.
Finally, Kari is just flat out wrong in arguing that The plan itself is the same very generous plan that members of congress have given themselves. (Reading Kari's posts on this blog, I chose to be generous and believe he doesn't really understand why his argument is wrong rather than being outright deceptive). The benefits be comparable, but there is no reason that the full costs to each individual will be the same, compared to the costs to each federal employee under the FEHB, because the two plans are paid for and administered quite differently. I have not yet seen any analysis which compares the actual full costs to each insured individual of the Wyden plan compared to the FEHB system that properly takes into account the buying power of a single-payer system like the FEHB program.
Posted by: peter | Dec 15, 2006 1:58:34 AM
ok, i have read the whole text of the bill now. i was too hard on Wyden earlier, this bill is wonktastically, DLC-licious. the pieces fit together like a jigzaw puzzle. however, this is not the kind of thing that excites most people. wyden's approach is not surprising to me--it's what i expect--however, he is also attempting a grassroots component, building support from the ground-up, and i just don't see this proposal succeeding in that realm.
i'd say it is a net step in the right direction (2 forward, 1 back). if he really wants to move things in the right direction, then he should include in this bill the right to buy into Medicare or the FEHB plan. let the insurance companies compete against a truly efficient health insurer. if they can't compete they can't compete--let's let the market decide.
either way, i expect bush to veto it.
Posted by: edison | Dec 15, 2006 2:00:18 AM
I'm not at all an expert in this, but ... as someone who has a family member with a serious medical condition that has significantly deteriorated over the last 3 years, I can tell you the current system is broken. The insurance companies are run by accountants (primary care providers are called: cost centers!) and medical care professionals are (nearly) as frustrated as I am. Until we take the obscene profits out of this 'industry', it will only worsen, IMO. Bill Frist probably wouldn't agree with me, though.
Posted by: Dickey45 | Dec 15, 2006 8:15:02 AM
OK, I don't know many people with $4000 laying around and I'm middle class. So, what if you don't have the $4000? Are you denied care, can they take away your house? Do the collectors come after you?
Posted by: DAN GRADY | Dec 15, 2006 8:25:47 AM
I am a bill collector. I have collected debt of every legal description, and for the first 18 years of my now 23 years was in the field of medical collections for the most part.
I won't collect of another medical provider again!
Acronyms, HMO's, PPO's, and the assortment of private insurance companies, and medical providers forming the very socialist concept of a collective system of medical providers owned and operated on the assumption that a cost/benefit/profit formula should be a foremost consideration when administering health care. If you think the evolution of healthcare delivery in America has changed for any other reason, and that the idea was to be able to deliver more care to more patients by holding down costs, you are either a rich doctor, or an insurance executive, or just so healthy or rich not to care.
When I lived in Las Vegas until we moved here in ’99, I was working for the top agency in the state that had the largest inventory of assignments of medical providers in the state, and as you might imagine we received many out of state patient accounts. I had been hired to work medical assignments that were for the most part disputed claims to the patient’s insurance. I was exposed to Oregon’s evolution of coverage as it related to out of area services, and had many opportunities to argue the minutia of these plans with their legal counsel as well as claims adjusters who’s main function was to detract, or discourage payment whenever the opportunity presented itself. This is a practice that all the insurance companies were deploying to one extent or another.
The point could be explained in it’s evolution over a 25 year period as Medicare/Champus standardize the claim forms for hospitals, and then all medical providers. These codings that were used in concert with these forms made the previously simple process of a claim, deliciously complicated for the medical providers, and patients to argue their claims to be paid, and eventually to ever receive the services at all!!
That’s right, the process of standardizing the claims, though effective in saving money for Medicare/Champus patients, was perverted over time by the private sector to eventually cast the sickest, and most costly patients out of their insurance rolls, and to deprive services with patients still in the system. The medical providers have less, and less to say about how to treat patients, and the profit motive has more, and more to do with what kind of care a patient will receive, whether the procedures are needed, or wanted to begin with.
'Capitation' became the final straw for me, as one month years ago I was part of a crew of specialists asked to work a huge number of unpaid claims over $2500.00. As we were to find out after rebilling hundreds of thousands of dollars in claims,and we waited in great anticipation for a flood of checks from insurance companies that were suspiciously easy to process that showed up in the form of a cancelled check of $0.00!! The insurance company, nor the medical providers we had been collecting for many years didn’t think it was important to tell us that they had been paid in advance for their services in a contractual agreement that had the insurance company deploy a formula of how many patients they should expect to see, and paid them 3 months in advance and that we were collecting the excess that the insurance company was not obligated to pay!!
This should not have been a big surprise, as they were evolving to this but, I would point out that the whole motive to provide care has been perverted to a profit motive, and little else. A Medicare/Champus single universal payer system is the only way in our form of democracy/free enterprise to deliver effective health care to everyone, instead of whomever can afford to be insured, or better put whom the insurance companies deem as affordable patients.
Posted by: Bob Tiernan | Dec 15, 2006 9:19:41 AM
Getting away from employer-based health insurance is
a very good thing. That was yet another stupid
consequence of government action during WWII. Imagine
having your auto insurance thru your employer. You
get laid off or fired, and then can't legally drive
around to interviews etc. Dumb, dumb, dumb.
Note that my support for getting away from employer-based insurance is all I'll say on this right now.
Bob T
Posted by: jen | Dec 15, 2006 10:32:04 AM
OK, I don't know many people with $4000 laying around and I'm middle class. So, what if you don't have the $4000? Are you denied care, can they take away your house? Do the collectors come after you?
You don't plunk down $4,000 right up front. It's meant to represent cumulative costs over the calendar year, and your out of pocket expenses shall not exceed that amount. People with insurance (as one would be under this plan) would be billed after the visit/procedure/etc. Most providers have payment plans.
Posted by: Bob Tiernan | Dec 15, 2006 11:57:24 AM
Torrid Joe:
The maintenance of private insurers as the primary
deliverers of care is the big sticking point, it seems.
Bob Tiernan:
Nothing really wrong with private insurers per se, but
problems arise when they get a captive market (like
with mandated auto insurance) thru government legislation.
Bob Tiernan
Posted by: Dickey45 | Dec 15, 2006 1:56:19 PM
But what if I break my arm and it costs $4000 to reset, cast, etc. Where one emergency visit costs $4000? What if I earn, say $23,000 a year at a nice college job in an expensive town where you come out, say, with $18,000 a year after taxes, medicare, etc. Your rent in a crappy single room apartment is $800 per month and your bus pass, food, electricity, clothes are, say $400 a month. That is $14,400 per year. That barely leaves $4000 for medical assuming you own no car, have no rental insurance, eat mac n cheese, and have no children, pets, need for entertainment, need for internet, or have a single hobby. Is that realistic?
You don't plunk down $4,000 right up front. It's meant to represent cumulative costs over the calendar year, and your out of pocket expenses shall not exceed that amount. People with insurance (as one would be under this plan) would be billed after the visit/procedure/etc. Most providers have payment plans.
Posted by: jen | Dec 15, 2006 2:37:46 PM
Unfortunately, the reality is that it is extremely rare to find insurance coverage that covers everything 100%. And also, unfortunately, health care is expensive. I have seen Medicare mentioned as a preferred model for universal health care (being single-payer and such), but a plan modeled after Medicare would leave you with potentially higher out of pocket costs because it doesn't place a cap on how much a patient has to pay. The plan being proposed at least places caps on how much you'll be spending.
Trying to come up with a plan for universal health insurance is meant to minimize the number of uninsured citizens. It's not meant to provide cost-free coverage. I verify people's health insurance for a living, and most insurance plans I see have lower benefits that what is being proposed.
Posted by: jen | Dec 15, 2006 2:40:10 PM
Let me revise my statement - Medicare offers some caps in certain situations, but in others a patient is expected to pay 20% without any out of pocket limit.
Posted by: Kari Chisholm | Dec 15, 2006 3:36:55 PM
OK, folks, I'm going to refer you AGAIN to my long post above.
There is no $4000 deductible. For almost everything, it's a $15 office visit copay or a $250 inpatient/outpatient deductible.
(Sal, when you say there's a $4000 deductible, you're misrepresenting the plan.)
A "deductible" is what you have to pay before you get ANY benefits. (Like a car insurance policy with a $1000 deductible; if you have $5000 accident, you pay the first $1000.)
The $4000 out-of-pocket number is what triggers the catastrophic everything-is-paid-for benefit. But before that point, you still get all the other benefits.
You'd likely be at tens of thousands of dollars in delivered health care before you hit that $4000 in out-of-pocket.
Dickey45 asked But what if I break my arm and it costs $4000 to reset, cast, etc. Where one emergency visit costs $4000?
Before you pay a dime out-of-pocket, the ambulance ride is free, as long as its within 72 hours of the accident. The ER care is free, also within 72 hours. Depending on what happens next, it's almost certainly a $250 deductible.
Please download the independent cost analysis (pdf) and read figure 2. It's on page 5.
Frankly, y'all should be THRILLED with that $4000 catastrophic benefit. It says this: No matter what all the other rules are, if you have so much medical care, so many visits, so many x-rays, etc. that you have run up $4000 in personal out-of-pocket expenses... then all those expenses shut down, and everything is free going forward.
Posted by: jen | Dec 15, 2006 4:02:00 PM
You'd likely be at tens of thousands of dollars in delivered health care before you hit that $4000 in out-of-pocket.
Indeed. What the patient pays out of pockets is much less than what the plan will cover. The plan already pays 90%, so unless you have major surgery, you may not even be paying $4,000 out of pocket a year. And if you do, the total bill will have been exponentially higher.
Some insurance is better than none. And this level of coverage is better than most.
Posted by: DAN GRADY | Dec 15, 2006 5:56:48 PM
I read the debate over the proposal made by the Honorable Senator Ron Wyden, and I'm warmed by the process of hearing debate about the details of how much will be a deductible, and the principles of how we will change health care coverage through the existing insurance companies. I realize this debate will eventually reach the place it needs to reach, or the debate will end all together!
I first heard this debate in intelligible terms on the AM Radio in 1986 as I was hauling my sister’s belongings over the mountain in a U-Haul with those annoying governors on the motor; I had both feet standing on the accelerator as I was going over the mountains to LA from Las Vegas. It was a Sunday morning and no less the Howard Cossell was the speaker on the subject. The “Conference of Medical Providers in Crisis” was the subject of his conversation for nearly 2 hours as I was crawling up the mountain at 20 mph. I wondered how this near-do-well lawyer and bloviator would handle such a complex issue, and I remember vividly how enlightened he really was. I felt as though I was listening to a college professor discussing his dissertation. The timing of this program and conference occurred precisely when HMO’s and PPO’s exploded on the scene!!
HMO’s and PPO’s were offered up as solutions for a long term approach in dealing with what was then, and still is skyrocketing health care costs. The truth in the end is if we keep the insurance companies in the process of major health care delivery we are just handing greater control, and greater profits for the insurance companies, and equally less medical care delivery to fewer patients at the same skyrocketing costs!! We could debate the issue in great details, as the devil would agree is were the hell really exists, or we can step back and recognize the painfully consistent history of American Healthcare under the thumb of the insurance industry!!
Medicare/Champus was then and is still today the most cost effective method of administering medical services while not depriving the patient and doctor the freedom of providing unfettered health care!! The history is unmistakable, and yet we won’t even consider discussing it as it seems to smack of socialism, or the myth of anti-Americanism!!
This constant backslide on this issue makes the insurance companies more entrenched in the problem, and does nothing to solve what is now a serious, chronic national crisis that will eventually highlight the huge disparity between our socio-economic classes, and possibly political and social chaos!!
Happy Thoughts;
Dan Grady
Posted by: politicallogic | Dec 16, 2006 1:50:30 AM
Wyden, Kari, and other advocates have consistently sidestepped the problematic part of this plan in their selective presentation of benefits without discussing actual total cost to the individual. (By the way, the figures Kari cites are on page 5 of the "Cost and Coverage Estimates for the "Healthy Americans Act" report dated December-12-2006 downloaded by link in Kari's Dec 14, 2006 9:01:19 PM, not page 8.)
First one needs to recognize that the assumptions as Sheils et al state them in modelling the supposed cost of the plan to individuals:
We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers “cash-out” their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.
is not really reflected in the law. The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find. Instead, Title VI, Subtitle B, Sec. 611(a)(1) on page 96 provides that Subtitle C, Chapter 24 of the Internal Revenue Code would be amended to add Chapter24A, Subchapter A, Sec. 3411, paragraph (c)(1)(a) that requires employers to remit a portion of what they previously paid for employee healthcare premiums to the government.
Crucially, the amount of money an employer would actually would be proportional to what an employee made before this plan went into effect, not the actual amount the employer paid, or what the employer would have to pay under the plan, which ever is less (paragraph (c)(1)(B)(i) p. 99). It is debatable whether the numbers in Shiels et al cost analysis are realistic. Particularly when one takes into account that employers will have a legal fiduciary obligation to fight tooth-and-nail to have every tax aspect of this law that is unfavorable to them removed.
Second, there is another issue that we have a right to have addressed: The cost analysis is predicated on vaguely stated assumptions about required employer contributions. The law as written talks about required employer contributions for "full-time equivalent employees" (p. 96) and defines FTEEs about as one would hope (p. 105). That is, as the sum of all hours worked by full and part-time employees divided by 40. We all are familiar, however, with how employers historically have hired part-time employees to avoid providing insurance benefits (reducing the transition payments discussed above that might be expected, incidentally). The issue that Sheils et al don't address in any depth is how much people who can only get part-time work, and for whom the employer's contribution will represent a smaller portion of their individual total premium costs, will actually have to pay out-of-pocket after whatever subsidies they are entitled to.
Based on the virtually unfounded numbers and superficial discussion provided in the cost analysis, which is the only information that our senator has chosen to give us about his plan, there is no reason that I can see to believe that these people will actually be able to afford their mandatory contribution under his plan. Nor is there any reason to believe, until he realeases the full mathematical details and assumptions of the model Sheils' et al claim to have used, that the actual costs to anyone under this plan will even be close to their rosy estimates.
Posted by: Kari Chisholm | Dec 16, 2006 4:24:41 AM
The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find.
It's on page 98, line 13, of the legislation.
Based on the virtually unfounded numbers and superficial discussion provided in the cost analysis
You're free to disagree with the proposal, but let's not go slandering the Lewin Group. They're generally considered the gold-standard in unbiased, independent, nonpartisan fiscal analysis in the health care industry.
Posted by: DAN GRADY | Dec 16, 2006 8:38:03 AM
Long story short guys is that we make a SSI/Medicare contribution in every paycheck in America aside from independent contractors which have been finely defined by the IRS to the extent it makes employer/employee escape from such a contribution very difficult, and risky for those whom would attempt to game such a plan.
Let me help you with the formula that would be all inclusive of cost/benefit analysis, as well as any inequities that may arise in the course of implementing a universal medical care delivery plan.
It's called "POLITICAL WILL" for "SINCERITY IN GOVERNANCE."
When the painfully obvious solutions are in plain sight you can assure yourself that the argument being made about the minutia of a plan in great complexity is the argument intent on dismantling the solution for a status quo agenda! The solutions for such an enormously complex issue is often made complex as a subterfuge to change!
We have 30 years experience in cost controls, and claim processing that has been very sustainable with Medicare. The only reason Medicare faces a crisis is because it was raided by those whom don’t want the competition in the market place through their agents in the form of our own Republican Leadership as they raided the trust fund. I refer you to the above stated solution as a cure all to skepticism over the feasibility of such a strategy!
They have had their solutions implemented repeatedly when the issue of their solutions is brought to the fore. We as a nation have endured the constant “kicking of this can” down the road until we finally find ourselves in a place that makes putting this off a ridiculous argument, so let’s keep shedding light on their arguments for what they plainly are, ridiculous!!
Happy Thoughts;
Dan Grady
Posted by: politicallogic | Dec 16, 2006 3:36:20 PM
The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find.
It's on page 98, line 13, of the legislation.
Kari, here is the text starting at page 98, line 10 in the PDF file linked at the "Stand Tall for America website":
http://www.standtallforamerica.com/cms/images/healthyamericansact.pdf
98
......
10 (c) TRANSITION RATES
11 (1) TRANSITION RATE FOR EMPLOYERS PRE-
12 VIOUSLY PROVIDING HEALTH INSURANCE --
13 (A) IN GENERAL - In the case of the first
14 and second calender years to which this section
15 applies, in the case of any employer who pro-
16 vided health insurance coverage for employees
17 on December 13, 2006, the employer share re-
18 sponsibility payment shall be, in lieu of the
19 amount determined under subsection (1), an
20 amount equal to ---
21 (i) 100 percent of the designated em-
22 ployee health insurance premium amount
23 of such employer, minus
24 (ii) the employee salary investment
25 amount.
On page 99, the text goes on to discuss technical definitions of the 'Employee Adustment Amount' that is the amount the employer must remit to the government. This whole section is the amendment to the Internal Revenue Code starting on page 96 I cited previously:
The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find. Instead, Title VI, Subtitle B, Sec. 611(a)(1) on page 96 provides that Subtitle C, Chapter 24 of the Internal Revenue Code would be amended to add Chapter24A, Subchapter A, Sec. 3411, paragraph (c)(1)(a) that requires employers to remit a portion of what they previously paid for employee healthcare premiums to the government.
Nowhere in this section does it provide a meaningful legal inducement for employers to behave in a way that unequivocally justifies Sheils et al argument that We assume that the savings to employers would be passed-back to workers in the form of increases in wages.
You also make the criticism:
You're free to disagree with the proposal, but let's not go slandering the Lewin Group. They're generally considered the gold-standard in unbiased, independent, nonpartisan fiscal analysis in the health care industry.
Slander is oral defamation. Defamation, in turn, is a claim which can harm the reputation of the subject of the claim. However, factual statements which are true, even if the truth of which diminishes the subject of the claim, are not defamation (ask RW, he's a lawyer). The bar is even higher when it comes to political debate. The quote you cite Based on the virtually unfounded numbers and superficial discussion provided in the cost analysis is true.
They provide no independently verifiable basis or data for their cost claims. Specifically, their discussion presents numerical conclusions with no presentation of the actual mathematics used to derive those conclusions from the data and their questionable assumptions. In fact, my comment notes Nor is there any reason to believe, until he realeases (sic) the full mathematical details and assumptions of the model Sheils' et al claim to have used, that the actual costs to anyone under this plan will even be close to their rosy estimate. This is not even remotely close to your accusation. Furthermore, it is a legitimate observation why extreme skepticism of Sheils' et al analysis, and this legislation, is justified.
As an educational aside, however, you clearly have made an implied accusation of defamation. That actually is much closer to being defamation.
Posted by: politicallogic | Dec 16, 2006 4:35:43 PM
Another troubling claim/assumption by Sheils et al which figures in their analysis and conclusions is found on page 10:
This approach greatly reduces the administrative costs now incurred by insurers under the current system. Insurance broker and agent fees for health insurance would be eliminated, as would medical underwriting costs. It also reduces premium collection costs by obtaining payment from a single source (i.e., the HHA) for all of those that they insure.
...
The HHAs would effectively organize regional populations into a large single group for each insurer, each of which is likely to include 10,000 or more members. Thus, by using the HHAs as a single source for enrollment and premium payments, insurers can be expected to cover these populations at costs comparable to those of existing large groups.
In plain English, they are saying this plan effectively is a single-payer plan. But it is a single-payer plan for insurance premiums to insurance companies, enforced by the government as collection agency, not a single-payer plan for medical services. (Why is it that NW "progressives" invariably embrace paternalistic, authoritarian solutions rather than genuine progressive solutions which put the interests and rights of the people ahead of powerful special interests?)
There is not buying power leverage here because the individual citizen is forced to make a purchase, but the government acts as the actual payer to the insurance companies as sellers (who have great lobbyists as this plan proves.) In a single-payer-for-service plan, sellers of services have a limited number of buyers, so that the our collective buying power gives us leverage.
If anyone has any doubt what RW and the other creators of this plan have in mind, they explicitly state that on page 13:
The program includes features designed to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. One of these features is that employer spending for health benefits converted to wages so that the worker faces the full cost of health insurance. This would give families the opportunity to retain some of this cash for other purposes by purchasing a less costly health plan. Also, families must pay the full amount of the added cost of selecting a higher cost health plan as further incentive to conserve on spending.
This is almost exactly what all those regressive right-wingers who don't believe equitable and accessible health care should be a right have been advocating ever since the first attempt at fixing our health care system in the 1990s. That is, the goal is to get people to make decisions about foregoing health care, or choosing lower-cost options, both of which have an increased risk of poorer outcomes, rather than actually fixing the real problems in our system. I think that is quite revealing about the actual values of the proponents of this plan, regardless of what they claim to be their political values.
As others have already commented here, the structural problems with our current system that force people to make financial decisions that put their health at risk are directly traceable to the fundamental conflict between the profit motive in our system as it is currently constructed and the goal of delivering the proper level and quality of health services to everyone. Single-payer-of-premiums to insurance companies models like this Wyden plan does nothing to address that fundamental conflict. To the contrary, this plan legitimizes the value the risks to our health are fairly traded of for profit. For the unverifiable costs analysis of Sheils' to come to pass, people will need to continually make tradeoffs in their health care.
Furthermore, because lower income people will by design be placed in position of making health care decisions which have bigger ramifications for their economic security, a strong argument can be made they will be forced to take more risks with their health. By the way, Section 123, Subsection (f) provides that if a person has to file bankruptcy any penalty imposed with respect to such person for failure to pay a HAPI plan premium shall not be subject to discharge. That is, if you have to go bankrupt, and under this compulsory plan the insurance company has assessed penalties (which also are not subsidizable incidentally and which presumably will compound) because you haven't paid premiums for whatever reason, you remain indebted to the insurance company until, if ever, you are able to pay. That is a direct consequence of this single-payer-of-premiums to private insurance companies plan. It is also right in line with the regressive right-wing bankruptcy "reforms" being enacted over the last several years.
In contrast to this regressive Wyden plan, a geniunely progressive single-payer-for-services to medical service providers plan like Conyers-Dingall Medicare-For-All addresses this problem directly by explictly giving buying power leverage to the people collectively. Furthermore, by enrolling everyone in that system, they also effectively create a powerful incentive for all of us to work together to continually improve it.
I think Ron owes it to us to make an oral statement in which he squarely addresses these facts and stating his personal values which the media can record and present to the public. Given his arrogant and condescending attack on Medicare for all supporters in the 8:00 hour of the Hartmann show 12/14/2006, it doesn't seem we should be holding our breath for a show of personal integrity like this any time soon.
Posted by: Peter Graven | Dec 16, 2006 9:29:08 PM
Has Kitzhaber commented on the legislation? His WeCanDoBetter group seems to have a much broader set of goals concerning delivery.
Posted by: DAN GRADY | Dec 17, 2006 10:29:26 AM
I would stand with the "politicallogic" in his assessments that a hodge-podge of private insurance plans coordinated with a universal Medicare styled plan is just a diversion from making the decision that should have been made 20 years ago.
We happen to be the laughing stock of the modern democratic world in so many ways since our Republican takeover. The subject that makes them laugh the most is to see our vast medical technology and science research reach amazing heights that our own citizens will never afford, and will likely be another service offered in their universal medical coverage in the near future.
We finance the research, the testing, and the process for cures and treatments across the board and it’s offered at a small percentage of the price just over the border in Canada. We have seniors, medical advocates, and politicians lauding a plan to buy in bulk medicines devised in the U.S. and sold in Canada for a fraction of the price as a remedy to lowering healthcare costs in our own country!! Am I the only one who recognizes the absolute absurdity of this???
Why should we be having such a ridiculous debate on such a ridiculous set of circumstances and not address how we got to this place? How can we correct it? Could it be that somebody of enormous power in our own country is profiting by this perversion?? Maybe the insurance and drug companies could have something to do with this???
Canada was the whipping post for how bad an idea of having a universal payer plan for health care delivery nationwide for the first decade of the plan, I don’t hear that argument much anymore, do you know why??
Could it be that the plan is still sustaining it’s self??
Could it be that Canadians have embraced their plan and worked hard to tweak, change, and correct the plan over the years and as a result made a very effective plan for all Canadians???
Could it be that they see the benefits at all levels of society that has brought Canadians closer together, and made their economy stronger for not being under the thumb of their insurance industry for their health care???
Could it be that bringing up the subject of Canada has been methodically villianized by the corporate media through the billions of drug companies’, and insurance companies’ advertisement dollars to convince Americans of some undefined absurd argument that Canadians aren’t Americans and some how the same principles would not work here??
Wake up Call America, Canada borders our northern border from one coast to the other, and they have competent, affordable, and viable universal healthcare for everyone, and we DON’T.
Happy Thoughts;
Dan Grady
Posted by: Kevin M | Dec 17, 2006 4:50:25 PM
H.R. 676: Expanded and Improved Medicare for All Act is supported by Congressman (and 2008 presidential candidate Dennis Kucinich. Why leave the profit-driven insurance companies in charge of health care when there is a proven better way? I want a real solution, not some compromise to the insurance companies, no baby steps that fail to address what is fundamentally wrong with the current system. Family members have been victims of HMO decision making (once example, my step-dad, a Sears employees, was not authorized to receive the tests that would have diagnosed lung cancer early enough to effectively treat it, he was given cough syrup by the doctors early in his illness though he requested further tests, many months later when those tests were finally authorized and he was diagnosed as having stage-four lung cancer and it was too late, the experimental treatment he received failed and he died late summer in 1997; he and my mother couldn't afford to make additional payments outside of the Sears plan). I'm sure others have their stories of how the system failed them or their families. I am not a health care expert, not even close but it seems that as long as there is a profit motive in health care there is a disincentive to do what is best for the people. Remove the insurance companies from the system. I think Wyden owes us an explanation of why he thinks his plan is superior to HR 676 and why he isn't supporting a senate version of that legislation. Thanks to all who have written advocating for this better way.
Posted by: Kevin M | Dec 17, 2006 4:54:57 PM
Correct link to Dennis Kucinch's statement on universal health care. Sorry about the error.
Posted by: Bobbi | Dec 17, 2006 6:56:53 PM
As a federal retiree under the FEHB system since 1976 I take issue with the notion that the FEHB is a single-payer plan. It is heavily subsidized by the government in that it pays for at least 2/3 of the premium and the employee/retiree's contribution is a before-tax deduction (I think), but the payors are the insurance co. and the patient.
I now pay $95/mo. for Kaiser coverage that includes dental!! Co-pays might amount to $200 in a bad year.
Contrary to the notion that individuals will have to deal with ins. co's, the Wyden plan sets up State agencies to offer citizens a menu of plans that are REGULATED so that they are affordable and available to all regardless of health status. One would hope that the agencies could go further in controlling costs by requiring evidence-based medical practice, prioritization of care a la OHP, electronic records, etc.
Finally, we love the low administrative costs of Medicare, but its cost-control methods are to cut provider reimbursement so that providers refuse to accept Medicare patients and to shift costs onto patients. In 5 years Medicare will start going broke, and by the time the boomers retire Medicare will suffer a $65 TRILLION deficit!! Lesson to learn: health care must be adminstered (prioritized and budgeted) closer to home, i.e., by the States with the financial backing of the Feds. Kudos to Sen. Wyden!
Posted by: DAN GRADY | Dec 18, 2006 7:32:11 AM
Finally, we love the low administrative costs of Medicare, but its cost-control methods are to cut provider reimbursement so that providers refuse to accept Medicare patients and to shift costs onto patients. In 5 years Medicare will start going broke, and by the time the boomers retire Medicare will suffer a $65 TRILLION deficit!! Lesson to learn: health care must be adminstered (prioritized and budgeted) closer to home, i.e., by the States with the financial backing of the Feds. Kudos to Sen. Wyden!// Bobbi
I would like to believe this argument is sincere. Medicare is in a budget crisis we can agree, though we disagree as to its remedy. A discipline in Congress to restore the Trust Fund, as well as a lifting of the income cap, and a huge infusion of contributions from the younger work force as part of the plan in a universal single payer plan would be more than enough to make it solvent into the future, and self sustaining. This strategy along with a Medicare program that can negotiate as a whole with drug companies and medical providers goes to making the program fair for all involved.
I would like to think that each state would have it’s heart in the right place when administering medical care through a Medicaid style grant program, but; this has proven a “divide and conquer” strategy for the GOP as they seize statewide power of smaller populated western states to deploy their own privatized programs to introduce the same programs nationally so as to erode support for the overall idea of universal payer program.
This path just ends up a path leading to were we started and with less resources and support to implement the solution we should have at the start. The history is unmistakable and we cannot afford to jump on that merry-go-round again and again as we have for the past 30 years.
Happy Thoughts;
Dan Grady
Posted by: politicallogic | Dec 18, 2006 9:26:55 AM
As a federal retiree under the FEHB system since 1976 I take issue with the notion that the FEHB is a single-payer plan. It is heavily subsidized by the government in that it pays for at least 2/3 of the premium and the employee/retiree's contribution is a before-tax deduction (I think), but the payors are the insurance co. and the patient.
Bobbi can take exception all he or she wants, but it simply illustrates that he or she doesn't really understand what he or she is talking about. The explanation of it's basic nature, and why that makes it much more a single-payer in essence has already been provided. The business model, decision-making power, and risks for insurance companies in their effectively administrative role in the FEHB system is very different from that for the products they offer to private businesses and individuals. (Not too mention that most reports seem to indicate that the majority of FEHB insureds choose a particular option from the Blue Cross group of companies.)
Contrary to the notion that individuals will have to deal with ins. co's, the Wyden plan sets up State agencies to offer citizens a menu of plans that are REGULATED so that they are affordable and available to all regardless of health status.
Bobbi is playing word games that here hinge on his or her use of the term REGULATED. Apparently, Bobbi is alluding to Title V: "State Health Help Agencies", referred to as HHAs in the text. The law does not provide that HHAs function as Bobbi implies:
Section 502 (a) PROMOTION OF PREVENTION AND WELLNESS primarily provides that the HHAs are to provide education and information to citizens about their legal obligation to buy insurance from the private companies, and collect statistics about citizen compliance (yes, the title is a misleading misnomer).
Section 502(b) ENROLLMENT OVERSIGHT primarily provides that the HHAs are to function as the administrative clerks and consumer sales force for the private insurance companies by disseminating sales information about the plans, collect enrollment forms, and report stats about compliance to the federal government.
Section 502(c) DETERMINATION AND ADMINISTRATION OF HAPI PLAN SUBSIDIES primarily provides that the HHAs are to administer the federal health insurance premium subsidies for eligible individuals and serve as the collection agent for the private insurance companies for any premiums subsidized individuals may have to pay.
Section 502(d) PREMIUM RATING RULES provides that the HHAs will perform the clerical task of confirming that the plans offered by the private insurance companies in their state meet the general coverage requirements specified in Section 111 of the law. (Curiously, Section 511 makes abortion an extra cost insurance option not available under the minimum plan subsidized individuals are eligible for. Even more curiously, Section 512 specifies Specific Coverage Requirements and the HHAs are not mandated to insure that insurance companies meet those requirements.)
Section 502(e) EMPOWERMENT OF INDIVIDUALS TO MAKE HEALTH CARE DECISIONS directs HHAs to provide information about the rights of individuals to make the most general of health care decisions about end-of-life care - like having your living-will respected. It does not explicitly protect Oregons' Right-to-Die statute by the way.
Section 502(f)-(h) charge HHA with several internal administrative duties.
Section 503 of Title V deals with money appropriations over the transition years to fund the HHAs and what HHAs must do to get those funds.
So despite what Bobbi claims without proof, the actual role of HHAs is not to make sure insurance companies plans are REGULATED so that they are affordable and available to all regardless of health status. In fact, the only meaningful regulation they do is to participate in making sure we have made our compulsory insurance premium payments and in actually collection those monies from subsidized individuals to make sure it gets to the private insurance companies.
This is quite in keeping with the explicit intent of the plan stated on page 13 of the Sheils' et al report noted earlier:
The program includes features designed to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. One of these features is that employer spending for health benefits converted to wages so that the worker faces the full cost of health insurance. This would give families the opportunity to retain some of this cash for other purposes by purchasing a less costly health plan. Also, families must pay the full amount of the added cost of selecting a higher cost health plan as further incentive to conserve on spending.
Even more importantly, we see in Title V that the HHAs are the mechanism by which the Federal government gets out of any role of using the collective buying power of us all to negotiate favorable rates. At the same time, Title V does not devolve corresponding authority and power to the HHAs. Wyden's plan quite fairly can be argued to be the biggest corporate welfare plan, at the cost of risking everyone's health and economic security, of all time.
The closer we look at Wyden's plan, the more we see just how bad it is. What is more disappointing is the amount of deceit is involved and how uniformed some of the most ardent supporters are.
Posted by: gobytrain | Dec 18, 2006 10:45:24 AM
All this blogging when it can be summed up with one word: Lame.
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Posted by: torridjoe | Dec 14, 2006 9:26:30 AM
The progressives who read about it at DailyKos think it sucks, actually. The maintenance of private insurers as the primary deliverers of care is the big sticking point, it seems.