Delving into Obamacare -- The Things No One Is Talking About

sallyawp · 07-28-2009, 02:53 PM

The following are some exerpts from an article on fortune.com. If anyone here has delved into the several thousand pages of proposed health care bills, I would really appreciate their thoughts on the statements made in Fortune's article.

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If you read the fine print in the Congressional plans, you'll find that a lot of cherished aspects of the current system would disappear.

In promoting his health-care agenda, President Obama has repeatedly reassured Americans that they can keep their existing health plans -- and that the benefits and access they prize will be enhanced through reform.

A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy's Health committee, contradict the President's assurances. To be sure, it isn't easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

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In short, the Obama platform would mandate extremely full, expensive, and highly subsidized coverage -- including a lot of benefits people would never pay for with their own money -- but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can't have.

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1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts.

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2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.

Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage. So if a 20-year-old who costs just $800 a year to insure is forced to pay $2,500, a 62-year-old who costs $7,500 would pay no more than $5,000.

Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that's understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet.

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It's as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.

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3. Freedom to choose high-deductible coverage

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Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."

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4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It's worth diving into the weeds -- the territory where most pundits and politicians don't seem to have ventured.

The legislation divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don't have real insurance. Those are the GEs and Time Warners and most other big companies.

The House bill states that employees covered by ERISA plans are "grandfathered." Under ERISA, the plans can do pretty much what they want -- they're exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.

But read on.

The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the "qualified" policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we've already discussed. So for Americans in large corporations, "keeping your own plan" has a strict deadline. In five years, like it or not, you'll get dumped into the exchange.

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The outlook is worse for the second group. It encompasses employees who aren't under ERISA but get actual insurance either on their own or through small businesses. After the legislation passes, all insurers that offer a wide range of plans to these employees will be forced to offer only "qualified" plans to new customers, via the exchanges.

The employees who got their coverage before the law goes into effect can keep their plans, but once again, there's a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it's likely that millions of employees will lose their plans in 12 months.

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5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they're healthy and switching to fee-for-service when they become seriously ill. "That would kill fee-for-service in a hurry," says Goodman.

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Companies would have the option of paying an 8% payroll tax into a fund that pays for coverage for Americans who aren't covered by their employers. It won't happen right away -- large companies must wait a couple of years before they opt out. But it will happen, since it's likely that the tax will rise a lot more slowly than corporate health-care costs . . .

mrego · 07-28-2009, 07:57 PM

Musings on the theme about things nobody is talking about...
1. If members of congress and the executive branch don't participate in the universal health care scheme, there will be a complete revolt in this country.
2. Will millons of christian scientists, Amish, etc. be given a religious exemption of some kind?
3. Why in the world would we cover illegal aliens? Idiotic on every level.
4. Will we actually put people in prison for refusing government health care coverage?
5. If the Massachusetts system is failing, why would this scheme work?
6. Why not start small? If that works successfully, then expand to universal health care. If it doesn't, then good thing we started small. Universal dental care, universal vision or hearing care, even universal podiatric care would help low income people immediately, and it would especially help the poor who most often don't have that coverage and can't pay for it themselves while also benefiting society. So try this plan out on a smaller scale first.
7. So when we begin rationing health care to cut costs, will the elderly and the obese and the smokers and the alcoholics and the narcotics addicts and the non-helmet wearing motorcyclists be the first to be told 'no'? Aren't those all 'pre-existing' conditions?
8. How does anyone really believe that billions will be saved? The government has been trying literally for decades to save hundreds of billions from medicare and hasn't been able to. There won't be any savings, just as there haven't been any jobs saved by the stimulus bill.

vicariousparent · 07-28-2009, 08:27 PM

Remarkable example of one-sided reporting. Imagine a surgeon proposes a plan to take out your colon cancer, and someone claims it is a terrible plan, because you will get a scar.

sallyawp · 07-29-2009, 07:57 AM

vicariousparent, help me understand how one-sided the reporting is. What in the article is factually incorrect about the bills before Congress? What in the article is an exaggeration based upon the bills?

I'm looking for help here understanding the thousands of pages of the health care bill proposals. This is one of the most important issues of our time, with a result that will affect all of us for the rest of our lives, and I'm looking for insight here.

vicariousparent · 07-29-2009, 08:16 AM

^^ Well, take #1 for example. We need nationwide minimum standards for what consitutes a health insurance policy so that there is a level playing field. This would prevent insurers from marketing misleading policies that charge what seems like a competitive premium but in fact don't provide true coverage. This has resulted in serious problems that would be avoided by #1.

Look, the legislation needs to be written carefully and in good faith. Objective, constructive and balanced critiques are helpful. But one-sided articles that just try to highlight the negatives don't help advance reform.

Right now there are powerful interest groups who are trying to torpedo reform. They make too much money from the current system to let it change. And Republicans just do not want to let Obama succeed in this, because if he does pull it off it will be a huuuge feather in his cap. They have to stop this, otherwise they truly may become the "Grand Dead Party" as mini likes to call it.

Bay · 07-29-2009, 09:26 AM

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^^ Well, take #1 for example. We need nationwide minimum standards for what consitutes a health insurance policy so that there is a level playing field. This would prevent insurers from marketing misleading policies that charge what seems like a competitive premium but in fact don't provide true coverage. This has resulted in serious problems that would be avoided by #1.

I don't follow you here. If I am a 53-year-old single woman, why do I want to pay for a policy that covers fertility, prostate cancer and acne treatments? Are you saying that a policy that excludes those conditions, is not "true coverage?"

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But one-sided articles that just try to highlight the negatives don't help advance reform.

Reform that contains so many negatives should not be advanced.

cptofthehouse · 07-29-2009, 11:31 AM

Bay, all of us pay for things that our policies cover that we cannot possibly use. You aren't going to get a custom made policy.

Bay · 07-29-2009, 01:36 PM

That is my point, cpt. Why shouldn't we be able to purchase custom made policies? We do that with homeowners' insurance. Those who do not need extra coverage for jewelry/furs, earthquakes, etc., do not need to pay for it.

Right now, your insurance policy probably contains many exclusions you don't even know about. But you are receiving the benefit of those exclusions by paying lower premiums. Under the proposed plan, you will not have the choice to pick and choose plans based on exclusions:

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The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts.

Pizzagirl · 07-29-2009, 02:02 PM

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If I am a 53-year-old single woman, why do I want to pay for a policy that covers fertility, prostate cancer and acne treatments? Are you saying that a policy that excludes those conditions, is not "true coverage?"

What do you think you're doing now?

The difference between your homeowner / jewelry / fur coverage and this, is that I know upfront that I have X pieces of jewelry worth $XX. Are you able to predict the health coverage needs you will have?

mrego · 07-29-2009, 02:13 PM

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all of us pay for things that our policies cover that we cannot possibly use.

Completely untrue and it demonstrates shocking ignorance. Insurance rates are based on age and gender, etc. A male does NOT pay for pregnancy coverage, etc.

Bay · 07-29-2009, 05:05 PM

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Are you able to predict the health coverage needs you will have?

Well, a 53-year-old single woman can certainly predict many health coverage needs she won't have, like I said: fertility, prostate cancer and acne, as a few examples. Why should she have to pay for those coverages?

sueinphilly · 07-29-2009, 07:07 PM

<<all of us pay for things that our policies cover that we cannot possibly use>>

true in a group plan. Also, a family of any size pays the same. it doesn't matter if it's a married couple or a family with 8 kids. Totally unfair, yet that is how the Federal Employee Health plans ALL work.

FOXNews.com - Myths About Congress Exposed - Opinion
the truth about Congress's health insurance

Premium Rates the plan costs for Federal employee's

Kajon · 07-29-2009, 07:37 PM

According to today's reporting, the Health Care Bill as it stands is NOT satisfactory to either party. So why in the heck would they even bother with it. This is what drives me crazy!

Now this is scary during a Monday speech at the National Press Club, Congressman John Conyers (D-Mich) said regarding the health care bill and I quote "What good is reading the bill if its a thousand pages and you don't have 2 days and 2 lawyers to find out what it means after you read the bill" This is just foolishness. Maybe he could have canceled his speaking engagement and used the time to read the darn thing!!!!!

Today there was an insurance representative being interviewed on the radio. True, false or speculation - I don't know, but this is what she said.

1-Under the "proposed" plan doctors would be paid the same income regardless of how many patients they see in a day as long as they at least see 6 patients. Hello....where is the incentive to try and see more patients!

2-Say for example a person comes in with a sprained ankle and wants an MRI/Xray to see if there is any further damage. Again, according to the "proposed" plan the insurance will only cover further testing based on the patients statistical data. So she said a healthy young person will NOT be even considered for additional testing for one MONTH, but a person who meets the "data" requirement would be treated immediately.

This stuff just gets my dander up! Just take the flippin' time to get it right and kick all the lobbyists (from both parties) out of Washington. It is NOT about the Dems vs the Repubs' ----- it is about us!

Kajon · 07-29-2009, 07:39 PM

And another thing. Take the bills like the $700 million they want to spend on buying more land for 36,000 wild horses and put it in line BEHIND the health care bill. No wonder they can't get anything done.

mkm56 · 07-29-2009, 09:02 PM

Another "little" item that seems to be ignored
From NYPost.com

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But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else. Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time. Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96). Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy. He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31). The bills being rushed through Congress will be paid for largely by a $500 billion-plus cut in Medicare over 10 years

Under this plan I don't think one will have to worry about people with substance abuse problems--they will get no care as they are not deemed "participating citizens". Also if you have cancer and are over a certain age--too bad. The government will decide who deserves treatment and who doesn't .