Impeding changes to our Health Care system

[classicman]

Hey Dux . . .

Whats the deal with this interpretation...

This is essentially health-insurance reform as little applies to the health-care delivery system and its costs. Here is the status of major provisions of the bills, mostly as they apply to employer plans provided to employees and retirees:

An issue that I think plays a major role in the end user/payor costs.

* The Senate’s Christmas bill dropped Medicare buy-in for pre-age-65 retirees; dropped the public-option plan and approved multistate “health exchange” private plans to ensure everyone has coverage available to them, to be overseen by the Office of Personnel Management.

* Due date for implementation: House bill 2013, Senate bill 2014.

* Overall cost for both bills is estimated at $900 billion over 10 years, but estimates are unreliable due to back loading of benefits in the early years while still collecting taxes.

* National (House bill) and state (Senate bill) “health exchanges” are created as insurance pools for individuals and small groups.

* Medicare Advantage plan phases out over three years (House).

* Medicare “doughnut hole” phases out by 2019 (House).

*

Hospitals are held accountable for preventable readmissions.

Does it say how? Won't they just pass this cost on somehow?
*

Employers will be required to “pay or play,” i.e., keep their current health plans or pay 8 percent of payroll (House) or $750 times every employee of 30 hours per week or more (Senate). Companies where $750 is a bargain will likely drop their private plans and take the state-managed “private” plan, setting the stage for a single-payer program later.

This seems really confusing. Isn't $750 a bargain for every company? They quote the average cost of a family plan to be something like $12,000. I must be missing something here, but what?

* A grandfather clause for five years under the House bill and unlimited by the Senate for employer health plans in effect on the day of enactment.

* Litigation against state health exchange plans would be subject to state laws (House bill) while historic Employee Retirement Income Security Act (ERISA) would continue national standards under the Senate bill.

* Work-place “wellness” is encouraged under the Senate plan which permits giving employee discounts up to 30 percent tax free for meeting plan goals.
* A long-term care program is included, but the details have not yet been thought through.

* Under the Senate plan, a 40 percent tax would apply to the excess of health-insurance premiums above $8,500 single and $23,000 married.

* High earners, under the House bill, would be subject to a 5.4 percent surtax above $500,000 single and $1 million married.

* Both bills have new taxes on medical devices, insurers, drugs, etc., all of which are likely to be passed to the public.

Well that sucks. . .

* Taxes under the House bill treat domestic partners as married. The Senate bill does not.

* Flexible spending accounts would be limited to $2,500 and indexed to the consumer price index rather than the medical cost index.

Again, all these points apply essentially to employer-sponsored plans for employees and do not address other issues such as access to and delivery of services. The Senate bill is almost certain to be the basis for a final bill as the Senate has already shown it cannot muster the votes for many of the House bill’s provisions.

Link

I don't know if this is spun or not, so I'm just throwing it out there for discussion.

Oh an after attempting to read some of this bill, I strongly suggest anyone with any problems relating to insomnia to try reading it.

Originally Posted by classicman

Hey Dux . . .

Whats the deal with this interpretation...

An interesting interpretation by the Chamber of Commerce, which is spending $millions, along with the insurance industry to oppose the bill.

But I would agree that more of the reforms are "insurance" reforms (particularly impacting small business, ie members of the Chamber of Commerce) but there are signficant provisions that focus on containing costs in the delivery system.

An issue that I think plays a major role in the end user/payor costs.

Does it say how? Won't they just pass this cost on somehow?

Yep it says how it will pay for the $900 billion cost...over 10 years.

In the House, its primarily from the 5.4 % surcharge on high income earners (over $500 K0 that will raise an estimated $500 billion over ten years...and the cuts in payments to Medicare Advantage providers who have been ripping off the system for years and getting an average of 15% over Medicare guidelines, but lettting addtional companies "bid" to offer the same services at a lower rate....expected savings about $150 billion.

That brings the revenue up to $650 bill out of the $900. The rest is less predicatable...including the taxes on medical devices, etc...but with tax credits to famlies up to 4 times the poverty level (about $88K...so many middle class families wont pay that tax)....and the least predictable of the remaining revenue is in the out years and from "savings" from greater efficiencies and technologies.....iffy.

The Senate takes a different approach with the tax on high end insurance plans, but it appears that will be modified to raise the level at which plans are taxed t0 the benefit of many middle class workers and add a 1% FICA tax on income over $200K.

Some have a problem with the top 1-2% of taxpayers bearing a large portion of the costs in new taxes. I dont have a problem with that at all.

This seems really confusing. Isn't $750 a bargain for every company? They quote the average cost of a family plan to be something like $12,000. I must be missing something here, but what?

What is accomplishes is to enable companies that are marginal in size (to big for the small pool and to small for cheaper policies provided through big companies) to end their own employer-plan and enter a plan with a larger pool of other small businesses....a bunch of companies pooling together can offer cheaper insurance that a single small/medium company alone....simply by having a greater number of people included, spreading the risk.

Oh an after attempting to read some of this bill, I strongly suggest anyone with any problems relating to insomnia to try reading it.

You have to be a policy wonk to really want to read the bill, but there are good section-by-section summaries.

My Voltaire reference..."the perfect is the enemy of the good"

Who doesnt want a perfect bill that provides both comprehensive insurance reform and reform of the delivery system...all w/o costs to taxpayers?

I'll take what I think is a good bill and build on that...because the political reality is that the perfect bill aint gonna happen......or "a half of loaf is better than none."

Will it work as envisioned? Probably not completely. No legislation this comprehensive plays out completely as planned...never has and never will. But IMO, it is a reasonable approach, with most costs covered, and a good chance that it will accomplish many of the goals.

Others disagree and neither side should be claiming they can predict the future. I dont think i have ever suggested it is a great bill (I have always said IMO, it is as good as I think it can be given the politics) or that it will be 100% successful and everyone will be happy and healthy. And, I have tried to explain it as I understand it.

And, IMO, it is bullshit for others to be screaming "failed" even before it is given a chance to succeed....or claiming that the "propaganda" or talking points are all on one side of the discussion here. That is dishonest to the point of being blatantly and purposefully ignorant (not referring to you).

Only time will tell.

Or..we can punt and put it off again as we have for the last 80+ years since Teddy Roosevelt first called for comprehensive health care reform for all Americans.

[TheMercenary]

Originally Posted by Redux

An interesting interpretation by the Chamber of Commerce, which is spending $millions, along with the insurance industry to oppose the bill.

Bullshit. The insurance companies are about to get a windfall profit and they know it, and you know it, but you refuse to say so. As I said before millions of dollars to the insurance industry is like pissing in the Great Lakes to that industry.

But I would agree that more of the reforms are "insurance" reforms (particularly impacting small business, ie members of the Chamber of Commerce) but there are signficant provisions that focus on containing costs in the delivery system.

Neither of the Bills do much to contain the costs of Healthcare with the exception of a few very narrow areas. There are no cost containments on what the insurance companies are going to cost those who currently have insurance in the form of co-pays and premiums.

Yep it says how it will pay for the $900 billion cost...over 10 years.

To bad there is absolutely no way that you or the whores who are making deals to pass this bill can ensure that is going to happen.

[quote]....expected savings about $150 billion.[/quotet]But you can't ensure that is going to happen. Now as we get down to the wire there is a lot of discussion about how much more expensive it is going to really be. But we will never know until it comes out of the SECRET and NON-transparent talks. Another lie from the Dems and Obama.

The rest is less predicatable........iffy.

The first honest statement you have made about what this is really going to cost the Taxpayers.

Some have a problem with the top 1-2% of taxpayers bearing a large portion of the costs in new taxes. I dont have a problem with that at all.

Of course you don't. It serves the greater plan of wealth redistribution by the Socialist Demoncrats.

What is accomplishes is to enable companies that are marginal in size (to big for the small pool and to small for cheaper policies provided through big companies) to end their own employer-plan and enter a plan with a larger pool of other small businesses....a bunch of companies pooling together can offer cheaper insurance that a single small/medium company alone....simply by having a greater number of people included, spreading the risk.

There is no promise that marginal sized companies are going to be able to enter the insurance exchanges.

My Voltaire reference..."the perfect is the enemy of the good"

Who doesnt want a perfect bill that provides both comprehensive insurance reform and reform of the delivery system...all w/o costs to taxpayers?

I'll take what I think is a good bill and build on that...because the political reality is that the perfect bill aint gonna happen......or "a half of loaf is better than none."

Which is a very dangerous view of how your guys want to deal with the taxpayers money.

Will it work as envisioned? Probably not completely. No legislation this comprehensive plays out completely as planned...never has and never will.

No shit!?!?!

And, IMO, it is bullshit for others to be screaming "failed" even before it is given a chance to succeed....or claiming that the "propaganda" or talking points are all on one side of the discussion here. That is dishonest to the point of being blatantly and purposefully ignorant (not referring to you).

Oh, sort of like the millions of jobs that are have been made by the last bailout and the lies Pelosi, Obama, and Reid made to the American public?