Impeding changes to our Health Care system

[classicman]

The other shoe to drop is that if they change the subsidy eligibility so that coverage is affordable, the cost estimates already done change dramatically. This is not good. I guess Nancy was right that we'll have to pass it to see whats in it. Well???

[classicman]

The main reason the Democrats' health care bill will be a budget buster once it fully phases in is the Democrats' rank capitulation to corporate interests - no single-payer system, in order to mollify the insurers; and no negotiation of drug prices, a craven surrender to Big Pharma.

http://www.truth-out.org

[classicman]

91 charged in Medicare fraud crackdown

A nationwide law enforcement crackdown has charged 91 people — including doctors and other medical professionals — with participating in Medicare fraud schemes involving $295 million in false billing.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said Wednesday that 70 people were charged in indictments unsealed Tuesday and Wednesday and 21 others were charged earlier, beginning Aug. 24. Charges were filed in Baton Rouge, La.; Brooklyn, N.Y.; Chicago, Dallas, Detroit, Houston; Los Angeles and Miami.

At a news conference, the attorney general said that those arrested are "jeopardizing the integrity of our health care system." Sebelius called the law enforcement initiative "a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries.

Eleven of the people charged were doctors, three were nurses and 10 were licensed health professionals.

Over half the defendants — 46 — and $160 million of the total in phony claims announced Wednesday came from South Florida, still leading the nation in Medicare fraud.

In Miami, U.S. Attorney Wifredo Ferrer said investigators noticed a new twist in which people who already were receiving Medicare disability checks were recruited with promises they could live in a halfway house in South Florida — as long as they agreed to receive mental health services they did not need. Many were addicted to drugs or alcohol, and some were homeless, and Ferrer said they would be threatened with eviction if they did not participate in the fraud scheme.

"They were already in the system. They were lured in by the promise of having housing. It was, 'Come and have a fresh start in Miami,'" Ferrer said.

Every one of them should immediately lose their licenses and have to pay back every penny PLUS.

[TheMercenary]

Originally Posted by classicman

91 charged in Medicare fraud crackdown



Every one of them should immediately lose their licenses and have to pay back every penny PLUS.

Agreed, plus time in prison. Hard Time.

[TheMercenary]

Imagine that....

The Washington Post reports that about a third of states have not made much progress in setting up ObamaCare's state-based health exchanges, but doesn't note that several, including Florida, Louisiana, and Kansas, have already made it clear that they won't set up exchanges at all. That's not an insignificant consideration, because, as The Post explains, the health insurance exchanges are kind of a big deal:

State-based exchanges are crucial to achieving the law’s goal of vastly expanding access to health insurance. They will be open to an estimated 24 million Americans for whom health plans have been particularly expensive — those who buy coverage on their own or as employees of a small business. The exchanges are intended to control costs by creating a larger pool of customers and allowing them to comparison shop. Many customers will also qualify for federal subsidies.

If a state is unwilling or unable to run an exchange, the federal government can step in. But the prospect of taking over exchanges in multiple states could prove logistically and politically unpalatable for the Obama administration.

It's a political challenge because if a state decides it doesn't want to participate in ObamaCare, it will be hard to avoid the (accurate) appearance that the federal government will be effectively taking over the state's individual health insurance market (the health exchanges are expected to become the hub for essentially all individual health insurance policy purchases). Indeed, the Post report accepts this notion when it says that "technically, states have until Jan. 1, 2013, to demonstrate enough progress to avoid a federal takeover."

Logistically, setting up the health insurance exchanges is going to be a pain in the neck for anyone, especially when it comes to making determinations about which individuals qualify for new health insurance subsidies. But the Department of Health and Human Services faces a slew of potential difficulties that are specific to the federal exchances. For example, there's the minor problem that there isn't any money set aside to set up the federal exchanges. Also, the way the law is written, it only allows its insurance subsidies to go to people who purchase insurance through state-run exchanges. Needless to say, that would only compound the political problems: The states that opposed ObamaCare the most would not only end up with federally run exchanges, they'd end up stuck with a mandate to purchase health insurance—health insurance that's projected to rise in cost following ObamaCare—but none of the subsidies designed to ease the pain of the mandate.

http://reason.com/blog/2011/09/12/tr...=Google+Reader

[Lamplighter]

One of my Senators announced a new reform for Medicare.

The headline and short text astounded me because he (Dem) has
partnered with Paul Ryan (Rep) to make changes in Medicare.
Wyden started his political career in Oregon working with seniors,
so he has been trusted by them... so far.

My reaction was WTF ???

In any case, the following article describes the Wyden-Ryan proposal in some detail.
It is long... and Forbes is highly biased towards business, etc., but this is the meat.

Forbes
Avik Roy
12/15/11

Ron Wyden and Paul Ryan's Bipartisan Plan for Health Care and Medicare Reform

This morning, Democratic Sen. Ron Wyden (Ore.) and Republican Rep. Paul Ryan (Wis.)
have shaken up Capitol Hill with an intriguing, bipartisan plan for reforming Medicare,
and also the private-sector employer-sponsored insurance system<snip>

The basic idea behind competitive bidding is that, say, on a county-by-county basis,
you let private plans and traditional Medicare offer plans with the same actuarial value compete,
to see who can offer the same package of benefits the most efficiently.
Each plan in a given county will name a price for which they are willing to offer these services,
and seniors are free to pick whichever plan they want.
However, the government will only subsidize an amount equal
to the bid proposed by the second-cheapest plan.
If you want a more expensive plan, you have to pay the difference yourself.<snip>

The plan would only go into effect for people aged 55 or younger today.
These future seniors would buy insurance on a “Medicare Exchange,” which
would require plans to guarantee coverage regardless of pre-existing conditions,
and require plans to charge similar premiums to those who are healthier or sicker.<snip>

Wyden-Ryan would expand means-testing throughout the Medicare system.
Currently, higher-income individuals pay more for Medicare under the program’s
traditional benefit for outpatient physician services (Part B),
and also for the newer prescription-drug benefit (Part D).
Under Wyden-Ryan, means-testing would also apply to the
premium support payments offered through the Medicare Exchange.<snip>

One of the most intriguing aspects of the Wyden-Ryan plan is its drive
to gradually migrate our inefficient, employer-sponsored private insurance system
to a true individual market where people buy health insurance on their own.<snip>

.

Right away I see negatives.
* health care costs do not vary by county... ZIP codes are better delineators
* reimbursement to 2nd-lowest bid leads to 2nd-lowest quality of care
* freedom to chose more expensive plan assumes one can afford it
* Two- or multi-tiered systems pit the younger against the older
* It appeals to those whose goals are to eliminate Medicare
* It entices employers to eliminate existing health plans

Right away I see positives.
* means-test in Medicare system is logical
* prohibits exclusion for pre-existing or more serious conditions
.

[Clodfobble]

plans with the same actuarial value

There are so many factors that go into each plan's coverage I'm not sure how they could possibly equate one with another. We are in the midst of a non-voluntary health insurance change right now, as a matter of fact. And while Mr. Clod's employer did everything in their power to make sure the new plan was completely equivalent to the old plan, just through a different insurer, we've already come across differences that will impact us significantly, first and foremost being the list of in-network providers. Both lists may be of roughly equal length, but it is not the same list, and we are quite invested in choosing precisely which doctors we see.

But I've always said the employer-based system is stupid, so I do like the potential for open competition among plans. But I'm also in favor of eliminating the idea of pre-existing conditions, and requiring everyone to carry a plan of some sort. The whole thing ought to look like the auto insurance industry, IMHO.

[Lamplighter]

Originally Posted by Clodfobble

<snip>But I'm also in favor of eliminating the idea of pre-existing conditions,
and requiring everyone to carry a plan of some sort.
The whole thing ought to look like the auto insurance industry, IMHO.

My experience with families of kids with developmental disabilities made
the "pre-existing conditions" the best feature of "ObamaCare" and
that requirement for all other health care plans was the best aspect of it all.

My concern for non-Medicare plans is, in fact, sort of like the auto policy situation.
In shopping around you can go for the lowest premiums, but when it's time
to get the car repaired the real world of private insurance raises it's ugly head,
and this is particularly so when there are high cost injuries (medical) involved.

[Griff]

The means testing aspect makes sense, but we know people will game the system by hiding assets. There will have to be a lot of over-site which will cost money and increase complexity.

[TheMercenary]

Well it sort of is starting to look like that with the individual mandate. Only that comes from the STATE, not the Feds. Is it a tax or is it not? Is it a requirement for individuals to take money earned and require them to give it to private enterprise? They would have avoided the mess by providing a Government Option, but that would have opened up a whole nother mess. Either way it is not a done deal, yet.

[BigV]

Why we need a Single Payer health care system.

[Lamplighter]

I wish those who oppose single-payer insurance would set forth their
arguments against it, take a stand and defend their complaining.

[henry quirk]

Lamp, if by 'single payer insurance' you mean, "...one entity -- a government run organization -- collects all health care fees, and pays out all health care costs.", then I stand opposed for the same reason I stand opposed to any and all collected efforts that don't allow me to bow out and go it alone, that being (redundantly): the fuckers won't let me.

Not your job (or any one's) to care for me, pay for me, or provide a safety net for me. That's MY job.

Not my job (or any one's) to care for you, pay for you, or provide a safety net for you. That's YOUR job.

I wish all the busy-bodies would just butt out and leave me be.

You want I should sign a piece of paper absolving you and yours of any responsibility for me? Fork it over...I'll sign (as long as it's understood it's a two-way street...that is: you leave me be to sink or swim; I leave you be to sink or swim).

How folks come together voluntarily and organize themselves and care for each other is none of my concern...go as 'collectivist' as you like...just: leave me alone.

Stay out of my life, my business, my health, etc.

When and if I need a doctor (or any product or service, for that matter): that's my problem, not yours (and vice versa).

[classicman]

HQ - Just asking here...
Do you drive?
Use public transportation, roads, highways and/or bridges?
Do you go to public beaches, libraries or parks?

[henry quirk]

"Do you drive? Use public transportation, roads, highways and/or bridges? Do you go to public beaches, libraries or parks?"

I do all these things.

Please, don't be coy: make the point we both know you're going to make so I can *dismantle it.









*and I will dismantle your point...not in any way you'll agree with or like, of course... :|