Hope our reps in AR drop by today and see that photo of a rally in Fayetteville.

Ahem.

It seems to be that more and more of the folks inside the beltway allow themselves to get distracted by any shiny object, no matter how smart they may be.

And unfortunately, a lot of folks inside the beltway just aren’t all that smart.

Numbers we need to stress the numbers Public Option will cost less than current plan. Drug Prices for Americans the same as other countries pay right now will save how much?
The GOP counters tort reform lawyers we point out that states with tort reform have not seen cost cuts.
We need to frame this GOP plans cost more money because they are slipping their insurance and drug company friends cash.
Also isn’t Holy Joe’s wife a lobbyist of some kind?

Excellent article. Large subsidies and mandates without a public option would help a little in the short term and hurt a lot in the long term because they’d only give insurance companies more power to raise prices. By far the most important thing is getting the best structure for a public option that we can because that’s hard politically. It will be comparatively easy politically to subsequently strengthen the public option and add more subsidies, particularly once it’s demonstrated its value on a smaller scale.

In a recent Washington Post op-ed, Charles Krauthammer put “tort reform” on the top of his wish-list for reducing the costs of the health care system. Gov. Rick Perry of Texas in the Washington Examiner boasts that Texas tort reform that capped injured patient’s damages was the answer to his state’s problems

Contrary to Perry’s claims, a recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

http://washingtonindependent.com/55535/tort-reform-unlikely-to-cut-health-care-costs

Everytime we bring up cost the GOP counters Tort reform we need to be prepared if we make the cost argument.

i’ve only started reading the cbo report of nov 6 (and i think there are a couple more i haven’t read yet), so i’ll have more to comment on after i’ve done some more reading, but i do have a couple of comments (and some questions) to start.

like most cbo reports (and articles written about them) the cost figures are confused and/or confusing (to me at least) because of the focus on fed budget numbers and the almost complete absence of actual healthcare cost figures — we need numbers for total costs (total national health expenditures) and the component elements which at the minimum would include fed budget figures, costs to state and local govs, costs to households (including break downs by income level) in taxes, premiums, out of pocket expenses (copays, deductibles and coinsurance) and employers.

so, for example, this statement:

The weaker public option selected by the House saves the government $25 billion. If the House had been able to pass the public option tied to Medicare rates it would have saved $110 billion.

is about the cost to the fed gov. but what does it say about the cost of healthcare to the nation? i don’t know. does any one have primary sources for this info? i’d really like to see some real cost projections for the po as currently constructed (and any possible alternative designs), and not just fed budget numbers.

the other comment i’d like to make before continuing my reading is that savings to the fed budget do not necessarily translate into increased subsidies. so i disagree with this statement:

If progressives had been successful in getting the robust public option it would have increased subsidies by 18% — a sizable increase.

according to the nov 6 cbo report (is there a more recent one i should be reading instead?), hr 3962 “would yield a net reduction in federal budget deficits of $109 billion over the 2010-2019 period.” putting aside for the moment the insanity of decreasing the fed deficit at this time, this shows that there is money available to put towards increased subsidies and it is not the public option that prevents that from being done.

more later….

Pelosi clear stated that she planned to use the savings from a robust public option to increase the tax credits

that’s a political decision by speaker pelosi (and an idiotic one imo) not an economic decision. for example, why not use the $109 billion already available?

my point is that the po and subsidy fights are only artificially connected, and i see no reason why we should accept that. it’s just political nonsense.

I think that the subsidies are critically important because I believe that the public option, assuming it survives the Senate (and we all know that passing a bill, *any* bill, is far more important to the Obama admin/Dem leadership than passing a *good* bill) will be crushed by the private plans on the exchange dumping their sicker/poorer/unwanted patients onto the PO. If even the CBO is willing to admit patient dumping will happen in spite of the risk balancing mechanisms, then I believe we can take it as a sure thing.

(In terms of your post the other day on PO Tipping Points you can put me down as a believer in the ‘Near Complete Failure’ scenario)

At the higher subsidy tiers, the cost of premiums + maximum OOP becomes pretty staggering. Between 300-400% FPL you’re talking something like 20% of income, after subsidies, at risk for plans that, especially for women, will be allowed to be pretty darn lousy. I think a lot of people are going to take the 2.5% tax penalty instead, and resent the hell out of it.

And of course above 400% you’re on your own, subsidy wise.

The reason the PO and subsidies are tied together, IMO, is more a long term thing than short term. Let’s be real, budgets are made up and voted on every year. And the political party in power, while seemingly not being enough of a difference IMO, does make some difference. And if the PO is so weak as to not hold down costs on premiums, I think it’s inevitable that the result will be that fewer folks are going to get subsidies in the future.

Let’s face it, if you budget 10B for subsidies, if the premiums average $25,000 per year rather than $18,000 per year, than more people can get subsidies from the same 10B. And don’t kid yourself. In future years, they’re not going to budget it based on the same formula as today. They will take a number, and fit the subsidies to the number, rather than the number of folks needing subsidies and coming up with a number. That’s just the reality of Washington.

Sorry, I just read that again, and it’s less than clear to me, so pretty sure it will be unclear to others. Arghh I’m having a bad day.

Book Salon is up at the Mothership with Paul Tough’s Whatever It Takes: Geoffrey Canada’s Quest to Change Harlem and America hosted by Andrea Batista Schlesinger.

I think Jon Walker’s last paragraph above says it pretty damn well, as to why the PO is important, and at least somewhat tied to subsidies, as to the last sentence. Thank you Jon.

@ selise 6

selise,

Here is an article by the National Coalition on Health Care that I’ve perused before, so I’m pretty sure it doesn’t have what you’re looking for. But on the last page of references, it might be a place to start??? I’ll admit I haven’t looked at any of the source references, so I’m not sure.

Regardless of what happens with reform, subsidies are inadequate and will have to be increased. That’s just a fact. So why waste precious resources fighting for more subsidies? All progressives’ remaining efforts should go toward holding the line on abortion and preserving the public option.

you know, i think i would probably buy the argument if we were talking about actual healthcare costs (as i outlined above) and not fed budget numbers. i mean so what if some element of the policy saves the fed budget $10 billion dollars (just a made up fig for an imaginary policy element that has nothing to do with the po) if it ends up costing state gov $100 billion and households $10 billion? you see where i’m going with this? without the actual national healthcare cost analysis, the fed budget numbers don’t tell us much.

thank you! all possible clues gratefully accepted!

if the po could save substantial costs (total healthcare costs – not just fed budget numbers), i’d agree. but i just haven’t seen any analysis that shows it does that. maybe it exists and i’m just ignorant of it (or have forgotten it) — in which case i hope someone will point me to it. i’ve spaced out about stuff before and maybe today is one of those days….

but so far as i can tell we don’t have any analysis showing that the po (either the current one or one of the alternatives in hr 3200 or the help committee bill) would provide a substantial savings to our total national health expenditures.

Huh, I just read it again, and think I see my mistake now. Too late to edit though. It was making my head hurt and I wrote it!!!

But the first sentence of the second paragraph is, well, inverted. Either the $25,000 and $18,000 numbers need to be reversed or the phrase “less people can get coverage” needs to replace “more people can get coverage.”

I think. My head still hurts.

Probably need to back off the keyboard for awhile.

Have a great weekend folks!!!! Stay well, have fun, and BE SAFE.

Well, most cerainly, the current PO won’t, IMO. Which is why I’ve contacted both my Senators (Warner & Webb) and urged them to block the bill. At this point I think no bill is better than a bill. I wrote a post yesterday outlining why, and I’m no good at finding stuff here at FDL so I can’t link it, but I won’t repeat it here.

But a robust a real PO, I think could put downward pressures on INSURANCE PREMIUMS. Now, obviously, there’s only so far that pressure can go without, as you rightly discuss, controlling the costs themselves. But, IMO, the private health insurance industry is so bloated with waste and unnecessary profit, that a strong PO could have some real, and meaningful impact, on premiums. It would force private insurers to cut out a lot of the waste and eventually, maybe even the profit.

So, I see a strong PO as being important to subsidies in that I believe it can exert a good deal of influence on insurance premiums in the short to medium term. Now, in the long term, other things will have to come into play that control the costs directly. I think you and I agree on that, and the first place I’d start is with specialist pay and the device manufacturers and the pharmacuetical (sp???) industry.

And with that last spelling buthery I really will be off. Having a weird, “off” day today. Not feeling myself at all. Have a good weekend selise, and be safe.

Take care,

Joe (OldFatGuy)

The CMS actuary report suggests that the House negotiated-rates PO would save 5% compared to the private insurance market. However premiums would be 4% higher due to adverse selection. (page 6)

The bottom line though is on page 30 where it shows total national health spending as %GDP increasing from 17% –> 21% over 10 years regardless of reform. That proves this bill is not really “reform”.

http://republicans.waysandmeans.house.gov/UploadedFiles/OACT_Memorandum_on_Financial_Impact_of_H_R__3962__11-13-09_.pdf

Everyone here and elsewhere seems to take an oddly fatalistic view of risk adjusters: that they’re not provided for in any of the current bills and that, to the extent they are, they have no regulatory teeth. Shouldn’t we be on our Congressmen about this? This would give the public option a much greater shot at giving private insurers a run for their money. What’s the catch? Why isn’t this getting more attention?

Right…in which case (if that’s accurate) this bill really shouldn’t pass. It will just give more talking points to Republicans. People say it’s something we can build on. I disagree. I think it’s far more likely a halfway measure will only defer the tough decisions until things are much worse than they are now. If we let Republicans and Lieberman take the fall on this, we’ll be in a much better position to come back with real reform later next year or in 2011. It’s not about legislative ‘purity’ or getting a perfect bill, believe me. It’s about getting something that works and not just around the fringe. With unemployment at +11% and probably higher next year…and for an indefinite period, reform is urgent. I happen to think we’re in for European style permanent =/- 10% unemployment.

you liberals are idiotic. Check below from CMS that will DOOM reform as YOU know it. You need to bend the cost curve and nothing the dems are doing will do that, especially not the public option.

http://www.politico.com/livepulse/1109/CMS_House_bill_increases_health_care_costs_.html

I especially like the below:

Pg 16 – “The additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases, cost-shifting, changes in providers’ willingness to treat patients with low-reimbursement health coverage.” Translation: A crush of newly insured patients could be a shock to the system.

And also this:

Pg. 6 – A public plan would cost 4 percent more than private plans because its utilization rules would not be as strict as the private sector.

And Ms. Hamsher you find it nice to make fun of Republican’s that have abortion coverage at the RNC’s plan (its since been removed) yet you bash insurance companies and accept their AD money?

Just a touch hypocritical no?

I think a lot of liberals like me know this will increase private costs and that’s our intention, to drive them out of business. I think people are underestimating how much the new regulations will drive up the cost of private insurance and make the public option very competitive – i.e. no pre-existing conditions, recissions, limits on OOP, the “Cadillac plan” tax – all these main profit sources for the insurance industry will be eliminated and they’ll have to jack their rates sky high. Then they open the public option to everyone.

Welcome, pal.
So glad you came to contribute to the conversation.

HI:

Just a quick question.

Do you consider the fact that interest payments on the accumulated debt of roughly $5 trillion dollars which comes out of the yearly government budget a good, bad or indifferent thing? And were it not for this obligation that same amount of money could be spent for other national priorities?

Been trying to coax Masaccio into estimating that. Yes, it’s almost impossible to assess what “savings” are when you don’t know what “costs” are — and as you say, costs to the government and costs to individuals are two separate things.

thanks pal.

Yes I’d like to contribute. Most on here have the right idea that the Democrats reform efforts are no reform at all and Republicans are even less so. You know the problem with a public option (even one tied to medicare rates) is that if NO providers will accept it then its not of much use to anyone, right? The idea should be to slowly bring provider payment rates down, eventually to a point where capitation is done. That’s the only thing that controls costs. If you bothered to read CMS’ report it reads similar to what the insurers said about a month or two ago and were blasted by you all for. It said the individual mandate penalty wasn’t strong enough and CMS agrees saying that “The balance of 18 million uninsured are estimated to choose not to be insured and to pay the penalty associated with the individual mandate. For the most part these would be individuals with relatively low healthcare expenses for whom the individual and family healthcare premiums would be significantly in excess of the penalty and their anticipated health benefit value.”

Are you all going to come out now and blast CMS for speaking the truth?

A crush of new patients would be a shock to the system. And when you give providers a drastic reduction in payment (as done also with the doc-fix that Republican’s voted against) along with adding 35 million uninsured to the system the entire system will come crashing down (although that sounds like what many of you want). You do realize though when you destroy the system there will be no care for you either, right? No care for the uninsured? If vindication is ALL you want then you’ll get your way. If true reform is what you want then you’ll do it the right way, truly reducing cost where its at its height (doctors)

it doesn’t “increase” costs. it has no effect. if you wanted to truly affect healthcare reform you’d do something about cost. Little to nothing done in that aspect. Side deals the president made early on in the debate made sure of that. Do you know that Pharma last year raised their rates on average about 20%. Why? They knew reform was coming. They could SAY they were taking a 20% haircut and end up losing nothing. All they gain is government subsidies. The only thing that keeps insurers in line is getting rid of pre-ex and instituting a strict MLR that doesn’t allow insurers to get around it. Is that going to be done in the end? Who knows. And God forbid they take on the doctors who CHARGE the amounts that they do (7x what other countries do). In the end its just another welfare project by a democratic government that we can’t afford. Once the stimulus money is spent and state budgets are bloated to the point of more furloughs maybe libs will get the idea that costs need to be cut. Sure you can raise some taxes on the rich and maybe you’ll get some more money from that but the rich realize how to keep that money away from the IRS. They’ll find a way. That’s what they keep your tax lawyers around for.

I can’t devote the time to read the CBO report as it relates to overall health care expenditures. But regarding the portion of those costs that are assumed by the government, namely, yearly revenues to cover the costs of Medicare, VA benefits and Medicaid, this takes care of the population over 65, the poor and veterans, with some degree of overlap among these groups I would imagine. Federal programs covering children also are contemplated here.

These government assumed costs are 16% of GDP or roughly $2 trillion dollars yearly, the oft sited figure. We also know that the brunt of health care costs are incurred by the elderly, which again are largely government covered costs.

The health related costs incurred by the rest of the insured population is roughly $4 thousand dollars for singles and $13 thousand for families of four in health insurance premiums/year, some portion of which is assumed by employers. The costs to cover the uninsured are covered by the insured and in part by hospitals, it seems.

What the total yearly costs incurred by this portion of the population under 65 is harder to quantify but some reasonably accurate number could be given, one would think.

If this breakdown is accurate it seems to me that the savings to government health expenditures due to aspects of the pending legislation is all you can reasonably expect to be quantified with much accuracy. And if the PO yields a savings of $25 or $110 Billion over 10 years to the federal budget it can only do so by lowering premium and other related costs and secondarily to the associated cost of subsidies.

This is likely the method they employed to arrive at the savings to the federal budget they site in their report, but I would imagine that they describe how they arrived at their results in the Methods portion of the CBO report.

The issue of subsidies is important but it is not as important as the public option.

That depends entirely on what kind of public option we’re talking about. If the public option uses Medicare’s provider networks, which was the most important criteria of a Jacob Hacker style option, then I would probably agree. But a public option that does not use these networks and is not available to the whole population, regardless of whether it has rates tied to Medicare, is less important than subsidies for a very simple reason: it isn’t going to work well. Providers will reject a puny public option, especially one that pays at Medicare rates, because its population will be too small to use as a good bargaining chip. Medicare rates are almost as likely to be a size disadvantage as a size advantage: if you lack them, you can attract customers with a wider provider network. If you have them, you have lower premiums but a shoddier network. It’s a two way street.

Including the weaker public option basically allowed Pelosi to increase subsidies by 4%. If progressives had been successful in getting the robust public option it would have increased subsidies by 18%

But if what we want to do is make the bill cheaper, why ignore still other possibilities — like further raising the threshold on Medicaid eligibility? If they raised that threshold to say 185% of poverty level I’d gladly toss out the whole bill and take that alone as a replacement.

And I have to laugh that you are still referring the public option tied to Medicare rates as “robust.” If that is robust, then what is the Jacob Hacker style option? Super-duper-robust? This is absurd.

There’s nothing surprising at all that 18 million people will reject the individual mandate and pay the penalty – I’ll be one of them, until Day 1 when the public option kicks in. The PO might still cost me more than my health bills would, but as a young healthy American I’d consider it my patriotic duty to buy into the public option. So will millions others like me and that’s a factor CMS, etc. don’t take into account.

Liberals are glad the individual mandate is weak – that’s why Schumer weakened the penalty – and we’re glad that will mean less additional customers for the private industry. Which means less revenue for them to compensate for all the new costly regulations – you don’t explain why you think I’m wrong that they’ll have to jack their rates if they want to keep making money.

The one thing I do agree with you about is that doctors payments will have to be one of the big savings sources in the future, we all know that, but that fight has to be postponed until we get the framework established.

One thing you should never do is rely on your youth to protect you from the diseases.

I say this as someone who wound up with a diseased gallbladder that put me in intensive care right before my 29th b’day. Fortunately, I was in the USAF so didn’t have to worry about the coverage but would have been SOL had I not been in the military

Great article! They are absolutely inseparable. In fact, what the public needs to understand is that these two are joined at the hip. It’s when they are put together that the benefits of the public option become apparent! http://cli.gs/23yYaM/

bad. yes.

fortunately we’ve got a cms report to work with now. it’s not complete, but it’s the only thing i’ve seen that considers national health expenditures (now if we could just get a break down into subcategories…. what can i say, i’m a data geek. *g* )

thanks joe! just got the cms report a little while ago. bmull @20 has the link.

got it, thanks. (i’m a little slow, just saw it today). will take discussion of the cms report to jon’s post on it:

http://fdlaction.firedoglake.com/2009/11/15/cms-negotiated-rates-public-option-would-still-be-better-than-private-insurance/

if you see this comment, follow me over to jon’s post for discussion of the cms report…. (link above in comment @38)

actually I believe the mandate penalty and the opening of the exchange/public option (if initiated) would be simultaneous. I don’t think an overbearing liberal like Ms Pelosi would have it any other way, so you won’t have to worry about a mandate penalty. The question is if/when the public option ends up being more expensive than private insurance if “employee dumping” happens how much MORE will you be willing to pay to stick it to insurers? 10%? 20%? How deep do liberals pockets go?

after looking at the cms report, i not so sure that i don’t agree with kevin — as far as costs go, the subsidies aren’t getting enough attention. the po is just not that big a deal regarding costs (although there are other reasons to support it, i don’t think cost savings are a big one).

So why do you think the U.S. pays so much more for medicine than other developed countries (2X per capita) and has so much worse outcomes? And why do you think it will cost even more in the U.S. to “reform” the industry?

medicine? You mean prescriptions? Well if its that then its because the government doesn’t have the “stones” to take on Pharma because they used each other to get reform to pass and then stripped out all of the savings one by one by one in order to save the IDEA of reform even though there’s no reform going on here.

If you’re speaking of the entire system its because all entities are profit driven to a fault. Its not just insurers (but it is them too). Its doctors, its hosptials (to a very small extent because their margins are smaller than anyone in the sector) and its pharma. Medical devices too. no one doesn’t get blame here.

What do I think should happen?

I think the government SHOULDN’T be involved as a “payer” because we’ve seen through medicare fraud’s scary statistics how badly that works. That’s why single payer would be an absolute mess. We should require all insurers to be non-profit. The government should set prices on everything from simple 5 minute office visits to open heart surgery (just like they do in canada). Doctors shouldn’t be able to own a stake in a lab or x-ray facility so they can siphon off additional profits there. We also should require Pharma to give us the same deals that they give the rest of the world. raise the rest of the world’s costs 5% and you can decrease ours 20%.

Now all this being said we should move to this type of a plan slowly so as to not shock the system too badly and end up with no doctors left to treat us all but that is eventually what we should strive to get to.

OK. Now I understand where you’re coming from. I agree with some of what you type and disagree with other parts. But as I wrote on the subject of medical economics as far back as 1991, I’m no longer interested in watching the details of how the U.S. economy is committing slomo suicide over this issue. But I am still curious about how other people think about it. So thanks for your reply.

thanks. just out of curiousity, what do you disagree with?

Personally I feel all of this should be out of politicians hands or better yet we should have all politicians term limited to two to three terms max so that they’re not destroying the system for the benefit of Palooka county back home. I also believe that the same can be said for almost every single bill that comes out of congress.

The fundamental economic problem with the medical industry is that they have pricing power owing to the knowledge gap between buyer and seller. Additional economic power is garnered because the customer is vulnerable. I called this the mafia of the intelligentsia, intelligentsia owing to the knowledge gap, mafia, rather than cartel, owing to the vulnerablity of the customer. Other MOIs are lawyers and colleges.

What to do? Not an easy problem. One easy thing would be to reduce the knowledge gap, which would be pretty pro forma in the internet era. But the MOI controls the information or, by campaign contributions, owns the govt, so there is no entity which would work on a website that would include all the info currently available, with appropriate caveats for when then info is uncertain.

Specififically, I disagree with your aversion to govt involvement. In fact, I think that medicare fraud included still results in a lower cost than the “private” mafias.

The foreign country models are instructive because they do it better than the U.S., which is why I raised that point. I think the U.S. will never do it as well as other developed countries because the U.S. has a lot of stupid wingnuts.

I agree that if we could reduce the knowledge gap then that would solve many problems. The problem is that for some reason healthcare has barriers to reasonable understanding. I know many CEO’s that are absolute geniuses in their industries but when it comes to healthcare they haven’t a clue. Also there’s many in the country without internet access (poor and rural areas) that the net wouldn’t be the total answer but it could help a good many. I was directed once to a site I believe in Washington state that gave pricing on sets of charges of simple surgical procedures and they had a high, middle and low pricing model. The more I think about that do you really want to take the cheapest price? Why are they cheaper? Some good blend of not only cost but performance should be involved too and how does the layperson analyze that to decide where to go for their open heart surgery if that’s the path you’re leading us to?

As far as government involvement I obviously disagree. I watched the 60 minutes piece a couple weeks back and the government admits to medicare/medicaid fraud in the 60-90 billion per year range. Private insurers profits were what, 15-20 billion last year? Force them to be non-profit (and take that 15-20 billion for the common good) but keep their models of cost containment, utilization review etc because we’ll need them once we get to the eventual rationing that will be a part of any system eventually.

Oh and I do agree with your wingnuts post as long as you’ll agree that they’re on BOTH sides of the political circle.

The fundamental economic problem with the medical industry is that they have pricing power owing to the knowledge gap between buyer and seller.

i disagree because almost no one deals primarily with providers regarding cost — that all goes through insurance companies. maybe that didn’t use to be the case, but it is now.

Very good point you make regarding the willingness of many liberals to opt for the PO if they are elegible, or even if they are not meaning those that are currenly insured by by private insurers and would be willing to pay a fine.

There is is enormous ill will toward private insusrers and deservedly so their amoral financing of health costs. It is curious that theCBO or CMS that they would assume that this hostility against rapacious insurers would cause people to shun them.

Furthermore there is the added incentive for young healthy people to enroll in the PO as that will lead to lower premiumms for all PO enrollees as that number increases. With the added benefit that all this will lead to the eventual demise of for profit insurers hopefully.over time.

oh and for proof that the large majority of the US population has not a clue about healthcare listen to CSPAN radio whenever healthcare is the topic. The idiots on both sides of the spectrum are so clueless its amazing.

Heck I went to a healthcare “town hall” when Rep Pallone (I’m in NJ) was speaking just to see what it was like. He actually stated that in NJ insurance companies can offer a rate on the individual market of say $13,000 for a family but then when health questions are answered and if there are health factors involved that individuals prices can go up to say $20,000 or more. NO THEY CAN’T. NJ is a guaranteed issue, modified community rating state. The rates are posted on the NJ DOBI’s website for just that reason. My God if the ones WRITING the laws don’t have a clue then what can we expect of the balance of the population??

EXACTLY. Ever try to ask a doctor what he or she charges? If you’re not private pay they’ll laugh at you. If anyone ever bothered to read an explanation of benefits they’d see what was billed and what was paid.

You find it nice to make fun of Republican’s that have abortion coverage at the RNC’s plan (its since been removed).

According to reports like this one at Politico, the RNC has decided to stop covering health insurance plans that cover an abortion to their employees, though they have for nearly two decades.

I wonder if there’s a way to find out how many of the RNC’s employees actually have used that coverage and had an abortion since 1991.

How many members of the Republican Caucuses in the House and Senate still have insurance plans for themselves and their families that cover abortions?

For that matter, I wonder how many of the non-Democrat members of the Democratic Caucus in the House who voted in favor of the Stupak Amendment to H R 3962 have insurance plans for themselves and their families that cover abortions.

I’d very much like to know how many of them have used their coverage to have an abortion.

in any event, after looking at the cms report, i disagree with jon (unless my math is all wrong). the amount the po, as currently constructed saves is about $2 billion a year, or less than 0.05% of total national health expenditures.

as far a cost goes, i’d rather see better subsidies. the current bill has no cost controls (other than a 10% decrease in medicare spending?!?). combine no cost controls with an individual mandate — and that looks like a disaster to me.

is anyone taking a look at what is happening in MA? (and as far as i can tell, our romneycare looks better than what congress is coming up with (i’ve been assured by an aide in my representative’s office that since we already have a waiver with the HHS, we can keep our exchanges — apparently i’m not the only one who thinks that as unsustainable as our reform is the national one is looking worse).

Ever try to ask a doctor what he or she charges?

they can’t tell you (unless possibly if you are going to be paying out of pocket) because they may have a 100 different contracts for different insurers, etc. probably at least dozen’s of different price levels.

this only goes to further my point that not only does the general public not know what is covered in its plans neither do members of Congress.

I wonder if for example same sex domestic partners can have coverage under the DNC’s plan? Wouldn’t that be just as ironic as the Republicans having abortion covered under theirs?? Has anyone thought to ask??? What an embarassment for them if it didn’t. I have no idea if it does or it doesn’t but someone should be asking them and I can tell you their off the cuff answer.

“I don’t know”.

sorry that’s a load of crap. Why can’t they keep track? A simple computer program can tell them what each procedure code pays. They sign a contract with every insurer that details what they get paid. Its not that difficult if they cared to try. In fact I bet it would save them money to ensure they’re paid correctly. Its just that they’re lazy and can’t be bothered.

Ever see a hospital bill that hasn’t been paid by an insurer yet but has the contractual adjustment in place. I’ve seen it plenty of times.

OT: knoxville, i haven’t forgotten that i owe you a conversation…. just hopefully some convenient time during daylight hours and when i’m fully caffeinated.

sure the billing office can tell you (if you give them your insurance info), but not the docs. how are they supposed to know?

In early 2003, I had insurance that did not cover root canals. I had to get one, so I went to the endodontist recommended by my dentist. When I went for the preliminary appointment, I set up the appointment for the actual root canal and asked his receptionist how much it would cost. She told me that it would be over $1,000. I was a student and couldn’t afford it, I explained. She told me that if I could pay the whole thing the day of the procedure, she’d reduce it by 20%. Great, I thought. When I went for the operation, the endodontist suddenly decided that a root canal was not such a good idea. So he simply ripped the entire root of my tooth out and charged me $400. He decided that $400 for 10 minutes of work was better than $800 for an hour’s worth. As I was leaving, his next patient wsa already waiting for him in the waiting room. Yup, he had only scheduled to see me for 15 minutes.

good point. Although I would think that the office manager (who usually resides within the office) should be able to tell you. Also most major insurers pay about the same amount. There’s not as much variation in payment rate as you would think.

Honestly I’ve never thought to ask a doctor’s office what they charge for an office visit and just for kicks I may try the next time and see what kind of a reaction I get.

wow.

this only goes to further my point that not only does the general public not know what is covered in its plans neither do members of Congress.

No fucking way that’s what it tells me. I would not be surprised at all to learn that several Republican members of Congress found out mighty quickly that their health insurance plans cover abortions when their teenage children came home unexpectedly pregnant.

i didn’t realize how bad it was until i started reading about it recently. the number of people and the waste of money negotiating all those contracts and then keeping track of all the different billing. yuck, what a waste.

I haven’t told that story before because it just seems so small compared to the stories of real tragedies that we hear about all the time, stories about private insurers who commit “murder by spreadsheet” and defraud people every day.

well, since jon is not around to argue with me (in the good way) about why i’m wrong, i’m going to call it a night….

be well all….

g’nite!

you’re right. but it’s really aggravating none the less. maybe especially because of the deceit and greed from someone we are supposed to be able to trust with our well being.

p.s. sorta related to our previous delayed conversation, some background by way of a comment i left recently on another thread (just in case you are interested).

thanks! now i really (probably *g*) am out….

The fundamental economic problem with the medical industry is that they have pricing power owing to the knowledge gap between buyer and seller. Additional economic power is garnered because the customer is vulnerable. I called this the mafia of the intelligentsia, intelligentsia owing to the knowledge gap, mafia, rather than cartel, owing to the vulnerablity of the customer. Other MOIs are lawyers and colleges.

Good one.

Another factor is that there can be no choices of “Cadillacs or Chevys” Health care is either good enough or it is not. All deserve good enough.

What seems to motivate a lot on the right is the notion that they want to be able to buy life when others can’t. You make it available to all and there’s no prestige in it.

.There is no magic bullet waiting for a rich person to come along and buy it;. and I for one pray it will never be that way,

you know that would be true IF those in congress were covered under the RNC’s plan but they’re covered under the FEHB plan. Oops, there goes that theory although I’m sure that’s happened under the FEHB plan and its been used by democrats and republicans alike.

absolutely, although insurers have been really cutting back from what i hear on their “credentialing dept’s”. That being said its better than medicare that doesn’t even have one (which is the main reason you have medicare fraud). Heck you or I could set up shop as a medicare provider and make millions. Its sad that drug dealers in Miami are giving up the drug trade for a much more lucrative trade in names of medicare recipients (giving them hundreds of dollars) all while they still millions or more.

If the government set prices that everyone could charge it would save a lot of time/headache on the providers and insurers side (although many would lose their jobs and do we want that now in this 10+% unemployment time??

the only positive to that is that death eventually comes for us all, even the rich.

The concern I have with the future is that of biologics. When cancer drugs eventually cost $100,000 or more and keep people alive say another 5 years who can afford the $100,000 cost? There’s no financial way to give it to all (unless the government sets the price of biologics which they seem none too willing to do). That will be the next rationing on price. Who gets the life saving drugs??

I knew this months ago (almost a year in fact) and I’ve stated it around. How come President Obama didn’t care to tell us that THIS was the true price of Pharma’s $150 million towards the ads for reform??

http://www.nytimes.com/2009/11/16/business/16drugprices.html?_r=1&hp

actually I think their numbers are a bit off. I’ve seen about a 15-20% increase in rx costs. Isn’t it nice that reform can make drug makers even MORE profitable.

i’m trying to figure out your ‘beliefs’ – are these based on global experiential realities or faith based ignoranance? you see, the developed world manages to provide satisfactory health care as a human birth right to citizens that politicians owe their electorate and get paid by that electorate to do that. what makes you think you are so exceptional that you have to reinvent the wheel to accomodate for profit corporate interests over and above human beings? perhaps you do not care about humanity in general bc if you did you would not be hanging around a website like this where your inexplicable ‘beliefs’ just does not carry any water

sona,

you know I’d agree with you but these FACTS just keep getting in the way. I applaud President Obama for taking on medicare fraud and correctly reporting the scary statistics but is this really the way to go to ensure healthcare for all that we all can afford? The only thing that ends up helping are those that steal from the system. Are you in favor of that?

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/15/AR2009111502488.html?hpid=topnews

Thanks, you make good points too. I don’t think this will lead to the total demise of the private insurance industry, but I think in about 10 years that 70-80% of people will be on the public plan. The rest will pay more to the private industry out of ideological spite – they’d rather cut off their nose to save face.