Health-Care Reform: How the Bills Stack Up

Click on this link to see the health care bills compared in the House and Senate.

Enough of The Mob

Washington -- The Democratic National Committee today released a new web ad "Enough of the Mob" highlighting the angry mobs of a small number of GOP and special interest backed rabid right wing extremists who are disrupting thoughtful discussions about the future of health care in America taking place in Congressional Districts across the country.
"It's become clear that Republican leaders, having lost every major legislative battle on Capitol Hill, the confidence of the American people and two consecutive national elections, would rather incite angry, special interest funded mobs and disrupt and drown out legitimate discussion of the issues instead of working for real solutions for the American people,” said DNC Communications Director Brad Woodhouse.
“This activity is reminiscent of the manufactured, Republican Congressional staff protests during the Florida election dispute in 2000 and the more recent displays of right wing extremism at McCain-Palin rallies in last year’s election. These acts of mob rule are a direct result of and are being encouraged by Republican leaders who have vowed to ‘break’ the President for political gain and who have said that they hope that the President fails. This is the very type of anger and extremism that cost Republicans dearly in 2008 – and it is bound to back fire again.”

The "spontaneous" crowds at health care reform rallies

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
The Word - Hippie Replacement
www.colbertnation.com
Colbert Report Full Episodes Political Humor Tasers

Organizing for Health Care Reform

Why do we need health-care reform? Everything is fine just the way it is.

What’s Not to Like?

Reform? Why do we need health-care reform? Everything is just fine the way it is.
By Jonathan Alter | Newsweek Web Exclusive

Jul 31, 2009

Go ahead, shoot me. I like the status quo on health care in the United States. I've got health insurance and I don't give a damn about the 47 million suckers who don't. Obama and Congress must be stopped. No bill! I'm better off the way things are.

I'm with that woman who wrote the president complaining about "socialized medicine" and added: "Now keep your hands off my Medicare." That's the spirit!

Why should I be entitled to the same insurance that members of Congress get? Blue Dogs need a lot of medical attention to treat their blueness. I'm just a regular guy and definitely deserve less.

I had cancer a few years ago. I like the fact that if I lose my job, I won't be able to get any insurance because of my illness. It reminds me of my homeowners' insurance, which gets canceled after a break-in. I like the choice I'd face if, God forbid, the cancer recurs—sell my house to pay for the hundreds of thousands of dollars in treatment, or die. That's what you call a "post-existing condition."

I like the absence of catastrophic insurance today. It meant that my health-insurance plan (one of the better ones, by the way) only covered about 75 percent of the cost of my cutting-edge treatment. That's as it should be—face cancer and shell out huge amounts of money at the same time. Nice.

I like the "lifetime limits" that many policies have today. Missed the fine print on that one, did you? It means that after you exceed a certain amount of reimbursement, you don't get anything more from the insurance company. That's fair.

Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.

Yes, the insurance company status quo rocks. I learned recently about something called the "loading fees" of insurance companies. That's how much of every health-care dollar gets spent by insurance companies on things other than the medical care—paperwork, marketing, profits, etc. According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in "loading fees." Even good insurance companies spend close to 30 percent on nonmedical stuff. Sweet.

The good news is that the $8,000 a year per family that Americans pay for their employer-based health insurance is heading up! According to the Council of Economic Advisers, it will hit $25,000 per family by 2025. The sourpusses who want health-care reform say that's "unsustainable." Au contraire.

And how could the supporters of these reform bills believe in anything as stupid as a "public option"? Do they really believe that the health-insurance cartel deserves a little competition to keep them honest? Back in the day, they had a word for competition. A bad word. They called it capitalism. FedEx versus the U.S. Postal Service, CNN versus PBS—just because it's government-backed doesn't mean you can't compete against it. If they believed in capitalism, the insurance companies would join the fray and compete.

I'm glad they don't. I prefer the status quo, where the for-profit insurance companies suck at the teat of the federal government. Corporate welfare's what we've got, and it's a damn good system. Through a wonderful program called Medicare Advantage, the insurance companies receive hundreds of billions of dollars in fees to administer a program that the government is already running. Don't touch that baby. You'd be messing with the handiwork of some fine lobbyists.

You know what part of the status quo I like best? It's a longstanding system for paying doctors called "fee for service." That's where doctors get paid for each procedure they perform, as if my auto dealer got paid separately for the steering wheel, brakes, and horn instead of for the car. Fee-for-service is why the medical care at that doc-in-a-box at my mall is so superior to the Mayo Clinic or Memorial Sloan-Kettering Cancer Center, where the doctors are on salary. Who would want to mess with that?

OK, if you really press me, I'm for one change. It's the one that Republicans trot out to prove they're "reformers," too. We could save our whole system if we just capped malpractice awards. Two of our biggest states—California and Texas—did it a few years ago and nothing has changed there, but who cares? It sounds good.

So tell your congressmen and senators when they're home for the summer recess that it's too soon to address this issue. We've only been debating it for 97 years, since Theodore Roosevelt put national health insurance in the Bull Moose Party platform of 1912. We've only had 745 congressional hearings on the subject (I made that number up, but it's got to be close). That's not enough! Let's study this problem more before we do anything about it.

Did I say "problem"? Who said there was a problem? Not me. I like the status quo.

Find this article at http://www.newsweek.com/id/209817

© 2009

There may be hope yet for a public plan

Tapped: The Group Blog of The American Prospect

July 28, 2009



IS IT HEALTH CARE PANIC TIME?

Like Dana, I'm extremely dismayed by what I see coming out of the Max Baucus committee. But TAP alum Ezra Klein cautions that this isn't the final version of the bill and that there may have to be some concessions for liberals to go along too:

The question is whether Baucus's final product will matter. Rockefeller and the other Democrats on the committee have felt excluded from the negotiations and will want major changes before they can sign onto the final product. Then the Finance bill will have to be reconciled with the more liberal legislation built by the HELP Committee. Then it will have to go to the floor, where it will need the support of people like Russ Feingold and Bernie Sanders and Sherrod Brown just as much as it will need Ben Nelson and Evan Bayh. And then, if it passes those tests, it will have to be reconciled with the House's legislation.
It's frustrating to see this group of conservative senators having so much influence on the health-care bill, not only because the states represented make up a tiny proportion of the population relative to their influence but also because their political interests lie in making reform as ineffective as possible in order to ensure reform doesn't pay political dividends for their opposition. But Klein adds some useful context to think about as Baucus and friends strip almost everything useful out of the finance committee's version of the bill.

-- A. Serwer

Posted at 11:57 AM | Comments (1)

MUMBLINGS ON THE FINANCE COMMITTEE HEALTH BILL.

The AP has an anonymously sourced report on the compromise health-reform legislation emerging out of the Senate Finance Committee. It isn't looking good. Some features of the bill:

No government-funded public-insurance option, and no national health-insurance exchange. These features of the House tri-committee and Senate HELP bills are intended to bring down costs by fostering competition on the largest scale possible. Instead, Finance is suggesting regional health co-operatives in which private insurers compete without government intervention. This is likely to lower premiums somewhat, but the smaller size and geographic reach of the co-ops will make them far weaker than a national exchange. And no for-profit company is likely to offer a plan as inexpensive as national public insurance.
An individual mandate to buy health insurance, but no employer mandate. This is regressive. Large employers that refuse to offer health coverage to their workers will have to reimburse the federal government for part of the cost of subsidizing those workers' coverage....
BUT Finance also drastically reduces the number of people eligible for subsides, to only those within 300 percent of poverty ($32,490 for an individual or $66,150 for a four-person family). Senate HELP subsidizes those within 500 percent of poverty and the House bill subsidizes those within 400 percent. Those plans are far more supportive of middle-class families and the self-employed.
Like the House and HELP Committee, Finance would prevent insurers from denying coverage or charging higher premiums because of pre-existing conditions.

House moderates -- like the Blue Dogs -- are likely to grasp on hard to whatever the Finance Committee suggests and run with it, calling it the only politically viable compromise. That's why Finance's proposal is so important. We don't know yet whether Finance, like the House and HELP, will aggressively expand Medicaid coverage. But probably the most worrying aspect of this compromise is how drastically it weakens competition, by asking insurance companies to compete only on a regional basis, and only with one another. This is a plan that leaves employers and insurers in the power seats, while giving consumers far less support than either of the other reform proposals on the table.

--Dana Goldstein

Public Says It's Smarter Than Congress on Health Care

While almost half of Americans believe they have a good understanding of the issues involved in proposals to overhaul the health care system, two-thirds do not believe the same about the lawmakers who will vote on them, according to a Gallup poll conducted July 26.

Would you say that you/members of Congress have a good understanding of the issues involved in the current debate over national health care reform, or not?



Fifty-eight percent of Republicans say they personally have a good understanding of the issues but only 20 percent believe that's true of Congress. Forty-seven percent of Democrats regard themselves as knowledgeable on health care with 34 percent saying they believe Congress understands the issues too. Forty-one percent of independents say they know the issues, but only 26 percent say Congress does.

Dear Mr. President- No Government-Run Health Care

From Daily Kos:

Dear Mr. President
by Hunter
Sat Jul 25, 2009 at 02:20:04 PM PDT

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.


But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all. Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.


I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Study Links Rise in Health Care Costs to Job Losses

Business Week July 23:

In a first-of-its-kind study, the non-profit Rand Corp linked the rapid growth in U.S. health care costs to job losses and lower output. The study, published online by the journal Health Services Research, gives weight to President Barack Obama’s dire warnings about the impact of rising costs if Congress does not enact health care reform.

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of “excess” growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP.

For example, the study estimated that a 10% increase in excess health care costs would reduce employment by about 0.24 percent in the motor vehicles industry, where 80% of workers are covered by employers. The retail industry, however, where only one third of workers are covered, saw only a 0.13% percent drop in employment. Economy-wide, a 10% increase in excess health care costs growth would result in about 120,800 fewer jobs, $28 billion in lost revenues, and $14 billion in lost GDP value.


This study provides some of the first evidence that the rapid rise in health care costs has negative consequences for several U.S. industries,” said Neeraj Sood, the study’s lead author and a senior economist at RAND. “Industries where more workers receive employer-sponsored health insurance are hit the hardest by rising health care costs.
To rule out the possibility that the economic effects were caused by some other industry-wide factor, the researchers compared U.S. industries with their counterparts in Canada, which has publicly financed universal health care. They found no similar percent change in employment in the corresponding Canadian industries over the 19-year study period.

The rate of growth in U.S. health care costs has outpaced the growth rate in the gross domestic product (GDP) for many years. In 1940, the share of GDP accounted for by health care spending was just 4.5%. By 1990, it had reached 12.2%, and 16% in 2005, when health care spending totaled nearly $2 trillion, or $6,697 per person, far more than any other nation. This year health care spending is on track to equal 18% of GDP.

RAND researchers underscore that their findings do not necessarily mean that rapid growth in health care costs results in large job losses in the overall economy, since losses in industries that cover most of their workers are at least partially offset by gains in those industries that don’t insure. Of course, the workers themselves may not find those jobs equivalent.

The study was partially funded by Bing Center for Health Economics at RAND and the U.S. Department of Health and Human Services.