House Democrat Health Plan

[Reverend Rick]

Is it quite possible that the change we can believe in is when our President changes his mind?

 

[Autodidact]

So Rick, my question to you. Is it really worth spending twice as much as any other country to be sure that people like jamaesi are denied health care? Is that valuable enough to pay 15% of our GDP for? Or are you willing to spend half as much and let jamaesi have health coverage?

 

[Alceste]

Your argument, in a nutshell, is the following:
“We shouldn’t vote for health care reform because I don’t understand it.”

Coming late into this, but just wanted to say that coming recently from a job that consisted of reading laws and writing policies and guidance about them, I'm frankly shocked that Kathryn finds this one difficult to understand. The laws I was working with were British, though. American legislators are apparently much better at the delicate art of "plain English." (Maybe that's the only kind they know. )

I haven’t heard anything close to a negative with this bill. I can’t find anything negative in it...

Will someone, anyone, give me a decent explanation of a problem with this bill?? It’s too complicated or we should wait (wait for what exactly?) really don’t cut it, and have little to do with the actual bill itself. Seriously, help a non-US out here.

OK, From a Canadian:

Sec. 122(c/2/B). I have a problem with allowing insurance companies to charge individuals $5000 and families $10,000 worth of deductibles (not including premiums!!!) That seems like a lot! I haven't "cost-shared" that much money in my entire life all put together. Because Canada has a single-payer system, I have never had to "cost-share" one red cent, so that just looks insane to me. Why would any first world nation tolerate such an outrageous sum?

Sec. 142(c) and 221 (e) do not provide adequate privacy protection for sensitive personal information. It should refer to the Federal Privacy Act by name and affirm the data collected will be processed in accordance with it. (That was, after all, my specialty. ). For an example of the kind of detail needed, check out the amendment to the Social Security Act in Sec. 163 '1173A(b) and (c)'. That one looks pretty good.

OK, I've had a pretty good glance now - enough to tell you what's wrong with it. From what I gather, it accomplishes the following:

1. Prohibiting private insurance companies from gouging customers, denying coverage, misleading the public, rejecting customers on the basis of existing medical conditions, and dropping customers for any reason other than fraud or non-payment of fees.

2. Establishing an agency (Health Insurance Exchange) that offers information about, subsidies for and access to an assortment of private insurance policies as well as one public option that does not appear to differ from private insurance in any significant way.

3. Increased funding for a number of useful health-related agencies, like community health centers.

4. Increased taxes of 1 % on individuals earning $350,000 a year, 1.5% on people earning over $500,000 a year and 5.4% on people earning over $1,000,000 a year.

5. Penalizing individuals and businesses who do not buy insurance or offer it to their employees with a tax (2% of income).

6. Setting a cap on insurance industry profits (companies will be required to issue rebates if a certain undefined ratio of profits is exceeded).

While 1, 3, 4 and 6 are great, I'm sure we can both agree 2 and 5 are vastly inferior to a universal, single-payer health insurance system. All the US plan might accomplish is a slight reduction in costs by setting a cap on corporate profits, and a slight expansion of coverage due to the subsidies. There will be no reduction in headaches or bureaucracy, and no impact on the very serious problem of millions of insured people delaying or avoiding medically necessary health care because they can't afford the deductibles.

This might be an effort to weaken the health insurance industry so that they can't afford to keep up such a sustained and well-funded misinformation campaign when the Dems whip out the REAL health insurance plan 10 years down the road. One can only hope. This one is a joke.

Better than what they have now, don't get me wrong. Better by miles and miles, but still horrific compared to the health care we enjoy in the rest of the western world.

 

[Alceste]

Just wanted to remind everyone of the proposal as it was written before it was tailored to suit a bunch of nutcase free market ideologues, health industry lobbyists and that chattering minority of average Americans who are as loud and pushy as they are easy to manipulate.

http://www.pnhp.org/docs/nhi_bill_final.pdf

Now, wouldn't that be simpler? I mean, if simplicity is REALLY what the Republicans are after...

 

[jamaesi]

No insurance for anyone. Outlaw health insurance period. I know, you think the good reverend has completely lost it now. It is a radical idea, just hear me out.

Insurance is suppose to be for folks to pool their risk and share the burden in the UNLIKELY event something bad happens to one of us.

The insurance model is a great idea until everyone has a claim. Here lies the problem. Everyone is going to get sick some time.

Think about it. We are not insuring against something that MIGHT happen, we are buying insurance for something that WILL happen.

Take MRI's for instance. Do you think a doctor could get people to pay over 3,000 for the test if it where not for insurance? They would have to sell the test for what the market could bare. Health insurance enables the medical profession to over charge for services.

People are so stupid. Why do we not rail against expensive tests? I will tell you why, because the insurance company pays the bill and not the individual.

Lets apply this principle to another industry and you suddenly see how stupid it sounds.

You have a plumbing problem in your house and you call the plumber. He comes out and gives you an estimate to unclog your toilet for 8,000 dollars. You get on the phone and call another plumber. Now, if all plumbers charged that much, you would have a problem. Is the problem the plumbers charge too much or we don't have plumbing insurance?

Right, so how does that help me to afford health care when I don't have /any/ money to spend on that MRI or any other necessary health treatment? (Funny you should mention an MRI, it's something I desperately need right now.) Should I just go crawl into the closest ditch to die?

BTW, the true cost of an MRI is $2,000 dollars, counting the cost of using the machine, the doctor visit where the doctor orders an MRI, the tech that does the MRI, the radiologist who interprets MRI, and the surgeon who gets the MRI and decides what to now. For just the MRI that's 500-600 dollars but that varies a lot, those suckers cost a couple million each. Thanks for hypothetically knocking it a whole $1,000 down for me. It really makes so much of a difference, I grovel at your superior ideas.

Now what about one of your white conservative bible-thumpin' hard-workin' breathen get sick. Now because they were like the fabled ant instead of me the lazy, undeserving grasshopper, they saved up money. Oh wait, looks like they got cancer right before they were set to retire. Oops! And they didn't even smoke and they lived a healthy life. What bad luck. Well, they have enough to treat the cancer for a little bit (but probably not enough to beat it, cancer can be a bit expensive) and have nothing to live on or retire with. When should they join me in the ditch?


As Smoke said, you're going to put us back a hundred years and weren't those just the bestest living conditions?


You also didn't answer my other question, surprisingly enough. Do you still think that the disabled are so well taken care of in the USA or are you FINALLY going to stop mindlessly repeating that BS?

 

[Kathryn]

Yes, I do realize they are written in legal jargon. But even for legal jargon, these bills are particularly difficult to decipher.

I didn't need that link, since I've been reading these bills directly from the White House's website.

I don't understand why people are so tolerant of politicians who are clearly not reading and understanding what they are voting on. Isn't it obvious that they if they do not have a clear understanding of a bill, they are choosing to cast a vote for reason OTHER than what is contained in the bill?

I find this excerpt from said bill to be particularly ironic:

Oops, never mind - you can't cut and paste from the government website (I wonder why not?) and I sure as HECK don't want to try to write much of this crap out. I'll give you just a tiny little taste of hell instead (sigh, here I go...):

"(x}(l) Subject to subclause (ll) For purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and for each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890 (a)."

Or - oh this is great:

From page 628:

"(4) Requirement for transparency in process -

(A) In General - In convening multi stakeholder groups under Paragraph (2) with respect to the selection of quality measures, the consensus based entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening.

(B) Selection of organizations participating in multi-stakeholder groups.-
The process under paragraph (2) shall ensure that the selection of representatives of multistakeholder groups include provisions for public nominations for, and the opportunity for public comment on, such selection."


Now - this is not the WORST of the bill - these are just totally random sections that I scrolled through. There's worse - much worse - but to be honest, since I couldn't cut and paste it, it was just too much hassle to try to write it out. My brain doesn't think this way - and neither do the brains of most Americans, I would wager.

Apparently the brains of most politicians don't operate this way either since by their own admission, they rarely read the bills put before them for a vote.
Lawmakers, read the bills before you vote - The Boston Globe

 

[Kathryn]

Maybe the Republicans haven't read it, I don't know. I know the Democratic leaders and commentators have read it. It's not that hard. It's not like reading is some secret skill that only the elite have. The thing is available on line! I don't understand what you're complaining about. Would you like a link to a Cliff's Notes version?

Bills are long. That's how legislation is.

If you haven't read it, how do you know it's incomprehensible? Someone's lying to you again, Kathryn, guess who.

So you've read this bill, Autodidact? And you understand it? You've read the entire thing? And you think your representatives have also?

By the way - I believe there are FOUR bills out there, not just one. I could be wrong about that.

Not to be prideful, but I need to point out something about myself:

I read over 700 words per minute. I type over 80 words per minute. I read an average of 2 non fiction books per week - just for fun. Most of these books are either related to history or philosophy. When I do a bible study, I use my Greek/Aramaic/Hebrew concordance and research the original meanings of words. I built my professional career on writing policy manuals and employee handbooks for midsize companies - which meant reviewing their current manuals, correcting errant legal jargon and policies, and creating a manual and employee handbook that was simple to read and to implement, and that followed the letter and intent of current employment laws. Often this meant researching laws from all fifty states (employment laws differ tremendously from state to state).

I am telling you this to make a point - my reading and interpretation skills are pretty sharp - and far above average. (But let's not discuss math skills...LOL!)

I've been reading and researching this bill for weeks now - and it sucks. It's very difficult to understand, and will be even more difficult to implement in reality.

Our representatives are not voting because they agree or disagree with the details of this bill. They are voting along party lines and ideological lines - with their careers and personal agendas at the forefront of their decision.

But that's nothing new. It's just dissappointing.

 

[Reverend Rick]

You also didn't answer my other question, surprisingly enough. Do you still think that the disabled are so well taken care of in the USA or are you FINALLY going to stop mindlessly repeating that BS?

Mindless is a bit harsh. I believe you're entitled to health care based on what you told me. You seriously need a disability advocate.

I know what it costs for a MRI Jamaesi. I have had 15 of them in my life time. I also know how much GE and Toshiba charge to rent those machines each month. I know the cost of maintenance and calibrations fees. My company has built and installed this kind of equipment.

The MRI uses magnetism, so technically the person who gives you the test may be a radiologist, but that would be a coincidence. The CT machine uses radiation, not the MRI.

But what do I know, I'm mindlessly rambling on.

Some people slip though the cracks of any system. Those people who genuinely need help and are not receiving it should receive charity. But Liberals don't believe in charity do they?

 

[Alceste]

Mindless is a bit harsh. I believe you're entitled to health care based on what you told me. You seriously need a disability advocate.

So you accept that s/he doesn't have access to health care, but you choose to ignore the fact that s/he's already had lawyers and advocates and assessments - the whole nine yards. This was meticulously described in a long and detailed post and confirmed by Auto, an actual lawyer who has advocated for people in that position.

And you're surprised that s/he's a little stroppy and irritable with you?

I'm surprised you're surprised. You are being very irritating. Surely you can see that. You claimed that the US looks after the disabled, s/he demonstrated more than adequately for any sane person that it certainly doesn't look after him/her * and you keep banging on that she must OF COURSE have access to health care, s/he just hasn't tried this thing, or that thing, or whatever - all of which s/he's tried.

* (and s/he is clearly disabled - my dad was just off work for 6 months and bedridden with back pains. He couldn't make it up the stairs, let alone go to work. The difference is that he has hassle-free access to free health care because he is Canadian, and saw a multitude of doctors and specialists during this time. At least one a week, not to mention 3 emergency room visits. This unfortunate period only cost him a slight reduction in pay during his period of disability.)

Stories like that one are heartbreaking. Truly. I wish s/he'd been born in Canada. S/he would be so, so much better off. Can you really compare that story to the stories your side bandies about where certain Canadians might have to wait a few months for a hip replacement - which they then get for free?

 

[Jackytar]

- which they then get for free?

<groan>

Jackytar
Resident nutcase free-market ideologue.

 

[Autodidact]

I don't understand why people are so tolerant of politicians who are clearly not reading and understanding what they are voting on. Isn't it obvious that they if they do not have a clear understanding of a bill, they are choosing to cast a vote for reason OTHER than what is contained in the bill?

Me neither. Why does anyone vote Republican? Senator Charles Grassley, ranking Republican on the Senate Finance Committee, obviously hasn't read it. Or is he just a big liar-head? You tell me. Because the bill he's describing bears no resemblance to the actual bill.

(A) In General - In convening multi stakeholder groups under Paragraph (2) with respect to the selection of quality measures, the consensus based entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening.

(B) Selection of organizations participating in multi-stakeholder groups.-
The process under paragraph (2) shall ensure that the selection of representatives of multistakeholder groups include provisions for public nominations for, and the opportunity for public comment on, such selection."

Now - this is not the WORST of the bill - these are just totally random sections that I scrolled through. There's worse - much worse - but to be honest, since I couldn't cut and paste it, it was just too much hassle to try to write it out. My brain doesn't think this way - and neither do the brains of most Americans, I would wager.

I'm sorry, what is your objection to this? I don't see what the problem is. Is it that you don't understand these provisions, or you think they're bad, or what?

So what is your problem with the proposed health care reform again?

 

[Autodidact]

So you've read this bill, Autodidact? And you understand it? You've read the entire thing? And you think your representatives have also?

No, of course not, who has time? But then again, I'm not complaining about not being able to. I don't feel the need. I have people do it for me:
Congressional Budget Office
Commerce Committee
Kaiser Family Foundation
Rand Corp.

Analyzing legislation is a specialized skill. I prefer to read the unbiased analyses of professionals like these.

I agree, though, in an attempt to appease the Republicans and the Health Insurance industry, the bill(s) are much more complicated than they need to be. I strongly support Single Payer Universal Health Care, which would be simpler, cheaper, and more effective. But apparently I'm not going to get that, so I can live with this, I guess. I'm not crazy about it, but we have to take some action or we'll go broke, both nationally and individually.

The current right-wing talking point is that it's too complicated, even though they're the ones who asked for the complication. It's another right-wing distortion. They can't attack the substance, so they make things up and pose phony objections. The fact is, it's a good bill, it will help, and they should support it.

 

[Autodidact]

Mindless is a bit harsh. I believe you're entitled to health care based on what you told me. You seriously need a disability advocate.

No, actually, he needs new policy. Under our current law, jamaesi and millions like him are not entitled to health care. That's the policy you support, and that is costing us billions more than it would cost to cover him. Why do you support this policy?

Some people slip though the cracks of any system. Those people who genuinely need help and are not receiving it should receive charity. But Liberals don't believe in charity do they?

It's not some people, Rick, and it's not slipping through. It's millions of people that the system is designed to deny service to. And that's what we're paying for, literally, we pay people to make sure jamaesi doesn't get medical care, instead of paying the same number of people to provide it. Why again do you support that?

 

[T-Dawg]

This source may help the debate...
Canadian Healthcare System "Imploding", page 1
The OP is nothing, but the resulting debate is interesting... I was particularly interested to find out that the source liberals use to put America in 37th place in healthcare is from 2000 and comes from a leftist group with an agenda, that skewed the results (ie, they car accident fatalities as part of the healthcare industry, according to the guy who posted the source). WHOm Are They Kidding? | Glen Whitman | Cato Institute: Commentary

Sometimes I have to wonder which side is the one giving propaganda, if not both (probably both) =/. Why can't both sides just stay honest?

EDIT: Here's another thread related to the healthcare debate: The CNN Truth Squad (disinfo squad): False rumors influencing health care debate , page 1

 

[tumbleweed41]

But Liberals don't believe in charity do they?

Generalization and massive distortion.

United Way, Peace Corps, Doctors without Borders, Remote Area Medical, etc....

I am sure you would describe each of these organizations as "Liberal"

 

[tumbleweed41]

This source may help the debate...
Canadian Healthcare System "Imploding", page 1
The OP is nothing, but the resulting debate is interesting... I was particularly interested to find out that the source liberals use to put America in 37th place in healthcare is from 2000 and comes from a leftist group with an agenda, that skewed the results (ie, they car accident fatalities as part of the healthcare industry, according to the guy who posted the source). WHOm Are They Kidding? | Glen Whitman | Cato Institute: Commentary

Sometimes I have to wonder which side is the one giving propaganda, if not both (probably both) =/. Why can't both sides just stay honest?

EDIT: Here's another thread related to the healthcare debate: The CNN Truth Squad (disinfo squad): False rumors influencing health care debate , page 1

[SIZE=-1]The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task.

Here are the spreadsheet details for your to look over.

[/SIZE]Health system attainment and performance in all Member States

The Healthy Life Expectancy ratings from the late '90s

World Health Organization Disability Adjusted Healthy Life Expectancy Table (HALE)

Total Health Expenditures from 2002-2005

Total Health Expenditures as Percent of Gross Domestic Product (GDP) 2000-2005 - Country Rankings

 

[T-Dawg]

Nice links, but they don't say anything about the issue I brought up - the calculations are flawed.

I'll post it again just in case people missed it the first time: WHOm Are They Kidding? | Glen Whitman | Cato Institute: Commentary

Does anyone have any arguments against this information?

EDIT: Here's quotes:

Take "Financial Fairness" (FF), worth 25 percent of the total. This factor measures inequality in how much households spend on healthcare as a percentage of their income. The greater the inequality, the worse the country's performance.
Notice that FF necessarily improves when the government shoulders more of the health spending burden, rather than relying on the private sector. To use the existing WHO rankings to justify more government involvement in healthcare is therefore to engage in circular reasoning, because the rankings are designed to favor greater government involvement. (Clinton's plan would attempt to improve the American FF score by capping insurance premiums.)

Suppose, for instance, that Country A has health responsiveness that is "excellent" for most citizens but merely "good" for some disadvantaged groups, while Country B has responsiveness that is uniformly "poor" for everyone. Country B would score higher than Country A in responsiveness distribution, despite Country A having better responsiveness for even its worst-off citizens.

The WHO rankings have also been adjusted to reflect efficiency: how well a country is doing relative to how much it spends. In the media, however, this distinction is often lost.
Costa Rica ranks higher than the United States (number 36 versus number 37), but that does not mean Costa Ricans get better healthcare than Americans. Americans most likely get better healthcare -- just not as much better as could be expected given how much we spend. If the question is health outcomes alone, without reference to spending, we should look at the unadjusted ranking, where the U.S. is number 15 and Costa Rica is number 45. (And even the number 15 rank is problematic, for all the reasons discussed above.)

The WHO rankings implicitly take all differences in health outcomes unexplained by spending or literacy and attribute them entirely to health system performance. Nothing else, from tobacco use to nutrition to sheer luck, is taken into account. These variables were excluded largely because of underlying paternalist assumptions about the proper role of the health system.
If the culture has a predilection for unhealthy foods, there may be little healthcare providers can do about it. Conversely, if the culture has a pre-existing preference for healthy foods, the healthcare system hardly deserves the credit. Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking people's preferences as given, deems some preferences better than others, and then praises or blames the health system for them.

 

[Jackytar]

No insurance for anyone. Outlaw health insurance period. I know, you think the good reverend has completely lost it now. It is a radical idea, just hear me out.

Insurance is suppose to be for folks to pool their risk and share the burden in the UNLIKELY event something bad happens to one of us.

I think the Reverend got it right. He's identified the key reason health care is so expensive in this country. And, as I've said, cost containment is the real issue, folks.

The third party payer system has driven up costs more than anything else. Medicare, especially, is a "blank check" operation but private insurers are bent this way as well. My perfectly healthy brother-in-law recently went to his doctor for a sore throat (his first visit in years). The doctor recommended he get a CT of his neck. I suppose he suspected a tonsillar abscess or some other kind of growth but his wife and myself, both in the medical field, examined him and could find no indication for this. Just an obvious run-of-the-mill strep throat that required cheap antibiotics. Still, he agreed to the test because it was to be paid for by a third party - his insurance company. Cost about a thousand bucks and exposed him to radiation unnecessarily. (The scan was negative.) Would he have paid this if it was his own money? Might he not question the doctor as to whether this was necessary? Maybe take a "wait and see" approach before shelling out the shackles?

What if we had grocery insurance that worked the same way as health insurance? We'd all have steak and lobster every night and leave the Kraft dinner for the uninsured.

But the Rev is only half way there in his thinking. What's the alternative? George Bush and the Republican congress took a stab at it. They created the Health Saving Account (HSA). A tax sheltered account that we could contribute to and draw from for routine health care spending coupled by a catastrophic insurance policy (really what insurance should be). Doubles as a bonus IRA of sorts if we are responsible and fortunate enough to make it to retirement and not spend the money along the way. If brother-in-law had such a policy it would be his money that he was spending for that CT. That doctor would have had a harder sell to make.

As a Libertarian I thought this was a good idea. Consumer-driven health care would surely bring down costs. Except for one nagging reality...

For this or any other free-market approach to work we have to be willing to deny care to those who have not or could not save enough money for current needs. We would have to turn our backs on suffering. As it stands now, I cannot walk into a Toyota dealership and get a Corolla with no money and no credit. That's the free market. But I can get an emergency appendectomy - roughly the same cost.

It's like if you said to a child - "If you don't eat your vegetables you won't get ice cream" and then give ice cream to the kids who didn't eat their vegetables anyway. The vegetable-eating incentive is fatally eroded by this.

Unless and until we are willing to deny care to those who are suffering based on ability to pay THERE WILL BE NO STRICTLY FREE MARKET SOLUTION TO HEALTH CARE.

So if you don't think health care is a right, start behaving that way. Go to a town hall meeting, stand up to the mic in front of the cameras and say "I think the irresponsible and the unfortunate should be denied health care in America."

Otherwise, let's hear your plan.

Jackytar

 

[tumbleweed41]

Nice links, but they don't say anything about the issue I brought up - the calculations are flawed.

I'll post it again just in case people missed it the first time: WHOm Are They Kidding? | Glen Whitman | Cato Institute: Commentary

Does anyone have any arguments against this information?

Flawed according to whom? You or Glen Whitman?

Of course the WHO is a more liberal leaning organization whose purpose is to improve health worldwide.

While the one of the CATO institutes functions is to "limit government".

The data is not "flawed", it is however limited. Do you have any alternative data to introduce that shows the quality of health care in America is of a high standard? Or that those who need help, are indeed helped?

 

[tumbleweed41]

Unless and until we are willing to deny care to those who are suffering based on ability to pay THERE WILL BE NO STRICTLY FREE MARKET SOLUTION TO HEALTH CARE.

So if you don't think health care is a right, start behaving that way. Go to a town hall meeting, stand up to the mic in front of the cameras and say "I think the irresponsible and the unfortunate should be denied health care in America."
Jackytar

Seems like that is exactly what some on this thread are advocating.