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RX: Health Care by Christmas?
As the Senate races a midwestern storm to pass sweeping healthcare overhaul legislation by Thursday morning, we're taking an hour to look at what many months of wrangling and last-minute deal-making will mean for the our healthcare system.
Whether you see this bill as a lump of Christmas coal or a progressive diamond, there are still plenty of outstanding questions. For example: after the Senate and House versions are reconciled, what will the final bill look like? Will it have a public option? Will the insurance exchange be set up on the state or federal level? How will funding for abortion be handled?
More broadly, what will the coalescing bill mean for doctors, patients and insurance companies? What will it mean for you — your coverage, or your premiums... or your health?
And if you had tuned out from the national debate, but are tuning back in for the home stretch, what questions do you have now?
GUESTS:
- Ron Wyden: Democratic U.S. Senator from Oregon
- Peter DeFazio: Democratic U.S. Congressman representing Oregon's 4th district
- Donna Smith: Congressional correspondent for Reuters
- John Evans: Anesthesiologist at Providence St. Vincent's Medical Center and president-elect of the Oregon Medical Association
- Ellen Pinney: Executive director of the Oregon Health Action Campaign
Tagged as: congress · health · rx
Photo credit: Mallamace / Creative Commons
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Interestingly, Medicare Advantage is a govoernment financed health system. It receives a government subsidy to insurance companies. The senate bill set to pass tomorrow provides a phased in payment approach. In 2014, high performing MA plans are eligible for quality bonuses for care coordination and management activities. It may be possible for MA plans to grandfather extra benefits to current enrollees. House and Senate bills go to conference when final details will be ironed out.
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Our healthcare future now goes behind close doors to a House-Senate conference committee with the Senate version likely to dominate. The good news is that most conference committees have heavy White House involvement. We need to let the decision makers like Sen. Christopher Dodd, Conn, Harry Reid, Nev., Max Baucus, Mont., and Tom Harkin, Iowa along with from the House Charles Rangel NY., George Miller CA, and Henry Waxman CA know how we feel. Now is not the time to celebrate.
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The senate bill is an abomination, an utter failure. What is almost as upsetting as the quality of the bill, is in order to save face and not tarnish the brand, Democrats are pretending it is a 'good thing.' Sorry Martha, this is not a victory! This is not 'mission accomplished.' We threw the baby out with the bath water. Mr. Obama and the senate failed miserably. Many supporters and media outlets are rushing to their defense in a claim of nuance, when they are nothing but apologists. Unless some miracle happens in final reconciliation of the bills, this health-care reform attempt marks the pathetic death of the hope pledged by Mr. Obama and longed for by his supporters. We should hold him and our senate accountable and not attempt to rationalize, or find a couple of positive needles in the haystack because we are too embarrassed to admit defeat, or show anger towards our fallen hero Mr. Obama.
The way this legislative debate played out is personally very, very, discouraging. The puppeteering by the Democrats of the senate and Mr. Obama in an attempt to seem on-message and cohesive by putting up a united front is noisome, and even Febreze won't get the stench out of their expensive clothing.
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Yes, sorry, 'the baby' is universal health-care, single-payer or a public option. I didn't want to sound more like a broken record then I already do.
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I am concerned that the taxes to pay for the program start in 2010 with no benefits until 2014. Insurance companies will be taxed on their premium revenue (for all polcies not just cadillac) and they will have to pass it through to consumers as premium increases which will hurt all of us but particularly those of us who pay our own premiums. This has already happened to me in october when Oregon began assesseing insurance companies a 1% tax to pay for the uninsured. My company increased my premiums immediately. This could be a major issue for a lot of people and could result in an increase in the uninsured as premiums rise above their ability to pay.
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No one knows whats in the plan now. The original plans had none of the worrisome things so many were terrorized by special money interests. there was nothing about "killing off granny" there was nothing about meicare goin away there was nothing about stopping anyone's existing health care. Special Money interests lied and spun because they make gobs off of what we have now.
No one knows what is in the new program, but I will bet that hardly anyone will get any healthcare that is not getting it now. no one without health care will get anything from this "program". from what i can tell it does raise some taxes, but so far seem not to offer anything most Americans need. what was wrong with a "public option"? so many of us have nothing, an "Option" was better than nothing.
there is another alternative
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Recently AARP Oregon held workshops on Finding Work @ 50+. In a non-scientific poll of the participants, more than 30% were withouth health insurance. These are people who want to work! We estimate there are are 105,000 Oregonians aged 50-64 without insurance.
We've been working hard with our Congressional delegation to make sure this bill includes affordable, quality coverage for all - which means insurance coompanies can't charge outlandish premiums based on age.
To paraphrase former Sen. Mark Hatfield, you can't have a healthy economy without a health population. More than 422,000 Oregonians will receive coverage when this bill passes, and that's healthy news for all of us.
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Oregon's exceptional efficiency and quality of care for Medicare patients has ended up hurting our state. Doctors and hospitals in Oregon already receive some of the lowest Medicare payments in the nation. That's incredibly unfair. Hopefully the new legislation will open the door to improve Medicare rates for efficient states, to insure that Oregon seniors will have access to doctors and other providers.
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The bill is a failure. It requires all American’s to get insurance or pay a fine, but offers no public option. This does not help the uninsured or the underinsured. It does not address the issues of coverage portability, of doctor fee's & compensation, of excessive medical testing, of insurance company monopolies, medical law suits or the other issues that make our health care so expensive. Whoever is elected president in three years will have to revisit this again. What a waste of time of time and our taxes. Makes me think about moving to Canada.
Vernon in Oregon
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In a recent New Yorker article, the publication I respect the most, Atul Gawande makes a lame case about how the pilot programs in the senate bill are commensurate to the Agricultural Extension programs of the US government in the early part of the last century. It is surprising that such an oblique and poorly wrought comparison got past the New Yorker's editors. At a simple level agriculture is in a fundamentally different sector of the economy---agriculture is conceptually a part of the manufacturing sector, not the service sector as is medical care.
Farmers easily adopted changes, because they initially guaranteed larger profits. The economics were about increasing output, they were not about cost savings while producing the same amount. The goal was to increase output which would lower the cost of crops because the market could easily meet demand, if not saturate the market---that won't happen in medicine it is a service. The delineation in agriculture was clear. It is not at all clear in medicine. It is not clear that if doctors can do things less expensively that those savings will be passed on to the consumer or even to the insurance companies. There is no incentive to lower prices of medical care that come from within medical community. It will not bring in more customers. Doctors don't cut costs so they can perform more surgeries in a day---like trying to growing more turnips because you can sell more turnips. Medical care does not work that way, it is an entirely different economic model. Doctors have no incentive to save us money, because it fundamentally doesn't make them more money.
When the Agricultural Extension programs began the science based improvements were new to most of the world, new research indicated how to farm efficiently. Much of the world is already providing lower cost health care, we do not need pilot programs to reinvent the broken American wheel when other countries are already doing it. Study the evidence of what works in other countries, adopt those changes, then start pilot programs to see how you can improve upon what is already shown to work---that is the efficient method.
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Go for it. Pass a bill this year and use experience over the next several years to fine tune it and make it better. Why not? That's the way Social Security and Medicare have worked.
And anybody who really wants to move to another country to avoid a change in our health care system can do so anytime. The rest of us will work to make it better.
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If the bill does not include a public option it is an epic fail. I think this whole problem could have been avoided if we enforced antitrust laws.... if AIG was too big to fail what happens when these huge healthcare companies fail
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In the New York Times (22 December 2009) an article by David Leonhardt applauds Mr. Wyden's insurance voucher program. The article says "anything that gives workers more choice and forces insurers to compete harder is a step in the right direction." But, what effect are vouchers really going to have? How can we be sure vouchers won't just result in lower cost plans with half the coverage? Or consumers just choosing cheaper plans to spend less money. Yes, there are budget airlines but you give up an assigned seat, pay for food, pay for luggage and who knows what else. Health-care is about saving physical lives it is not something we should gamble with when other models already work, it is unethical.
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I was one of the people who worked hard for Measure 23 in 2002 (Universal Single-Payer For All Oregon); obviously I want Single-Payer. I'm most worried about the unrestrained corporate profits that the Senate bill supports. Because people are required to buy insurance in a noncompetitive market, the Senate is handing the heads of American citizens to the insurance companies on a silver platter.
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As a young Oregonian, I'm very disappointed that the powers that be have yet again succumbed to wealthy lobbyists and ignored the wishes of the public. This was a giveaway to the health insurance industry at our expense. Insurers now have a guaranteed source of customers with the individual mandate and we don’t stand a chance of fair practices against this Goliath.
What’s more: Senators Landreau and Nelson held out the bitter end and got huge Medicaid kickbacks for their state. What did Oregon get? Did we get a resetting of Medicare reimbursement rates for Oregon? No. Oregon remains at the bottom of the pile.
I don’t see a whole lot in this bill that benefits the general public versus what benefits the insurance companies. It just makes you wonder why we worked so hard to get Democrats elected to Congress.
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I wrote to your radio guest, Senator Wyden, to express my concerns and opposition to the health care reform Democrats are driving down our throats and his staff wrote back a boilerplate answer, addressing none of my concerns.
Why does the federal government get to force me to buy health insurance?
Senator Wyden likes to present himself as the defender of the little guy, yet he's handing insurance companies a huge win here.
This bill will essentially cost $1 trilion. ... One hilarious farce is that the politicians say a bunch of that comes from "savings" from Medicare. Ummmm, yeah, that Medicare that's supposed to be broke within 5 to 10 years. What is Medicare, anyway? Tax dollars. So they're taking from one pot of taxes to create a new one.
This whole thing infuriates me. How is it that President Obama and the Democrats are going to get a "political victory" by passing this legislation that more than half the country opposes? This isn't how Roosevelt's New Deal went down.
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stop watching fox news more than 70% of the nation wants a public option
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I want to know what Greg Walden has to say. Where does he stand on Health Care. Isn't this an issue for republicans?
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I have just a couple of questions for the guests and Mr. Obama
With the economy reeling from the current economic climate and a projected cost of the health care bill starting at 1 TRILLION dollars who is going to pay for this with unemployment so high and more cuts coming?
If this is such a wonderful plan why is the president, Senate and congress not proclaiming they will go on the plan when it and if it becomes law?
The answer to these are easy, the American people will be the only ones to suffer the fate of this plan. With (as mentioned on the radio) about one million people from the western states who will have insurance that did not have coverage, it seems the cost will be a little high form my point of view.
One little point I feel should be said and it was said by a Republican, Democrats seem to be more interested in getting the votes instead of crafting a good bill! With votes along party lines are we the people getting the best value from the people we elected? No!
Since when does the government have the authority to be in the health care business or is this another of the rights they have given themselves
Like I said above if this is so great then all of the people should be on the plan including the government bureaucrats! -
I believe health reform should also include a clause that prohibits doctors from picking and choosing patients according to their health insurance. Too many doctors will not see medicare or Oregon Health Plan patience. I think it is discrimination.
Jackie Fitzgerald
La Grande, OR
541-663-1106
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It will get worse, Jackie. The Senate bill cuts fees paid to Medicare doctors by 21%, and as you may have heard, Medicare already pays Northwest doctors terribly. Doctors spend over a dozen years past college in training and don't get started in their careers until their late 30's. The answer is to pay doctors more and insurance executives less, not the other way around like this healthcare bill will do.
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Thank you for reading my comment. I am a Medically retired veteran I recieve healthcare from my work and TriCare from my military retirement. how will this effect my these plans
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The bogus "health care reform" bill that is emerging from the Senate's Democratic Party Caucus, if enacted into law, would force millions of Americans to buy insurance from the same corporations whose profit-gouging and bloated CEO payouts caused America's crisis in health-care coverage in the first place.
This is like using police to line up Christmas shoppers outside an alley with a gang of thugs in it so they can be mugged -- and threatening to fine or jail them if they get out of line.
To make this horrible situation worse, not only would the insurance gangsters get millions more guaranteed victims, if the victims themselves can't pay, we -- the citizens and taxpayers of the United States -- will have our pocket (the U.S. Treasury) picked to make sure the crooks get their loot.
On top of all that, there's no public option; no early Medicare buy-in; no cap on insurance costs (not even for those of our fellow citizens with pre-existing medical conditions) and no method for insuring that everyone in our nation will receive the health care that he or she needs, without worrying that illness or injury will throw them into bankruptcy.
Howard Dean is right. It's time to start over and get it right.
Fixing the health insurance crisis should be simple: extend Medicare to everyone. -
$8500 is a Cadillac plan? Family insurance plans are easily $1000/month now.
The Senate bill seems like the worst of all worlds. Taxing insurance plans over $8500 at 40% seems excessive. The House plan seems much more reasonable: tax individuals that make over $500K or couples who make over $1Million, instead of taxing a lot of middle class folks who supposedly have "Cadillac" insurance plans provided by their employers.
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Maybe I wasn't clear! It's $8500 for an individual, or $23,000 for a family.
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My question is about all those ads for prescription drugs, esp on tv. Is there any action in either house to prohibit the ads? I read that New Zealand is the only other country that permits such ads. the change could occur gradually so that the revenue loss to the media companies will not be so drastic. Think of all the funds that will then be availabe for research!
Thank you
Alice
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Couldn't we pay for universal healthcare by ending our military adventures around the world? Iraq, Afghanistan, hundreds of military bases around the world.
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My husband and I are watching all of this carefully as it could significantly affect our upcoming decisions this year. He is working on a degree and I've been the one with the full-time teaching job with benefits. Now I am pregnant with our first child and I don't want to have to work the 60+ hours a week that teaching involves just so we can have health insurance. My husband has a seasonal job and spends most of his free time looking for a full time job with benefits but it's not easy to find these days for people who don't yet have their BA degree. At the moment it would cost us about $485 a month to pay for private insurance, which is somewhat steep; but health care is an absolute necessity with a new baby in the home.
We are very much hoping for a public option that we can buy into so that I don't have to work full time to get the insurance benefit. We're afraid that without that, there won't be enough incentive for private companies to really lower the rates and premiums for people like us who are not making much money. We also need pre-existing conditions go bye-bye, and also it would be good to have COBRA extended so I could use that. But if these things don't go through, it is very likely that I will have to work full time just so we can have the health insurance benefit; as much as I love teaching, I want to focus on my own child.
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I wonder why there is such resistance about government involvement in health care. There is little or no objection to the health care provided for military (and I am not objecting), and who wouldn't want the congresssional health care plan. But for those of us who PAY the taxes that fund all of that, us citizens who are, THE PEOPLE as in the phrase, "...for the people.", there is a powerful myth that it is "unamurican" for citizens to expect they will always have access to health care no matter their financial status.
Having lived overseas for many years, it always amazed me that even in totalitarian states, citizens were guarranteed health care. As soon as politicos or those leaning the right hear that, the argument switches to the quality of that health care. No, the point is they had guarranteed health care. Then the issue of corruption comes up, no the point is....
Quality and corruption are different issues that can only be addressed AFTER there is health care for all citizens.
The point I have not heard in all of this, maybe because I've been busy supporting the economy by Christmas shopping, is the percentage of profit the average small business would no longer allocate to health care plans, if employees had access to health care independently of the work place. How much could small businesses or any business improve their product or service if health coverage for employees was reduced or even made redundant by government health care plans?
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I think our male Senators and congressional reps are missing the point when they think of the abortion restrictions as a "special interest" issue. The issue is really an EQUAL RIGHTS in the healthcare system. The Senate bill would permit states to not provide abortion coverage in their health exchanges yet would still require uninsured women to purchase it. States that do permit it would require an onerous procedure where women would be required to write TWO checks for their healthcare. Men aren't required to do this, even though my religious beliefs might not want MY taxes to go to pay for adulterous married males to get their STDs (sexually transmitted diseases) treated instead of THEIR private funds. Women are NOT a "special interest group" and whether they exercise choice or not, 51% of our Senators' constituents should not be be forced to buy insurance that discriminates against us on the basis of our gender.
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Excellent point. Thanks for bringing it up.
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There are two MAJOR problems with the two lauded 'good' aspects of the Senate version: prohibiting kicking paid customers off the rolls and eliminating denial of coverage based on preexisting conditions. First, these don't begin for 3-5 years, giving the industry all the time it needs to whittle away at these new regulations. Second, there is no talk about how much they can charge to take on these new customers with their preexisting conditions. The insurance industry can still charge whatever they want; sure, we'll happily take you on as an insuree, but you'll have to pay 20-30-40% of your income...
This whole discussion is rather academic, however. If anyone wonders who will win in this proposed reform, just look at the value of the stocks of the industry over the last few days. They're skyrocketing.
Thanks.
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The Senate version allows preemption of aspects of state HC regulation which means state efforts to reform the system for lower premium costs or wider coverage may be at risk--
Please describe the preemptions of state efforts made possible by this Senate version
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I want to thank our US Senators and our House members who showed the courage to take positive action NOW! Health and health care is a complicated set of systems, yet there is so much good accomplished in these efforts. Health (and economic) security for individuals and for a society that is burdened with unsustainable increases in costs while mediocre outcomes. For seniors, better prevention and discharge planning/care coordination while extending Medicare solvency. For the boomers, security against discrimination (age, gender, pre-existing conditions). For health providers, better HIT and research and support!
So how do WE...patient/consumers, health providers and families help implement and support all this work to be done?
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The Congress and the Senate is not or does not wish to listen to the American public. Regardless if we have health care reform, the facts are these: Insurance premiums are to expensive! If one is on a fixed income like me, the insurance premiums I am forced to pay is to expensive. I do not want insurance premiums to compete with my cost of living especially when one is a healthy person. For the past 44 years of my working life I have only used my medical insurance twice, yet because I am now 66 years of age I am placed into the category of the aged even though I do not take any form of medication. I do not like being discriminated because of age. The public option that I would like is one where one has the real option of choosing death as foretold by nature, and opting out of paying for expensive medical insurance programs that keep doctors, insurance CEOs and hospital employees employed for life through the premiums I am forced to pay. Besides, isn't our final destination after death a better place to be......a place were real social standards are enforced for all and not just for congressmen and senators? Yes there are a plenty of medical insurance plans to choose from, but unless your are of the wealthy class, the are to expensive.......period.
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If you are discriminated against because of age for health insurance then i was discriminated against when i was 16 and paying higher auto insurance and it wasn't right...
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Yesterday at some point on OPB I heard a person say that the goal is not to provide high quality insurance to everyone, rather with the Cadillac Penalty (etc) it is to reduce coverage to minimum and equal. Shortly after that was Howard Dean saying bad legislation is the new good legislation. Yes, this is an improvement…
If you tax my business I just raise my prices, or I find a way to pass it on! The consumer always pays the taxes imposed on any business.
We could have it all yesterday if the legislation that passed is what Congress and ALL branches of Government have to use, no option. However as long as Congress and the Executive are exempt from the laws they crap out the citizens will continue to get screwed.
Oh, in my opinion the health car system existing; is a failure. -
I am young and single. I *do not* want health insurance or to pay for it. I recently bought a house and my budget is pretty tight. I cannot comprehend how the US Congress came to the conclusion that they can mandate that citizens must buy health insurance from private corporations. Doesn't this infringe on rights to liberty and pursuit of happiness?
My pursuit of happiness certainly doesn't include lining the pockets of health insurance executives.
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but if you are in an accident and hurt badly taken to the emergency room without healthcare you will owe too much in healthcare bills when you leave with the work lost because of your time in the hospital you will default on your home and be a bigger burden on me and my tax dollars. that is how they justify it and...... they are right
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I agree with you. No anti-trust law has been passed, no public option either, yet you, a young healthy person who might want to take his chances and pay out of pocket if something comes up, will be MANDATED to purchase health insurance from the same healthcare system that is the source of the problem in the first place. Oh, but now the IRS will do the dirty work for them of penalizing you if you refuse to join. I was flabbergasted to hear Senator Wyden talk about improving the "market place" of health care when the principle of the market place is competition based on choosing NOT to buy if we don't want to. Prices do NOT come down when the health insurance companies will know we are FORCED to buy, and when they are still allowed to collude to set prices. It's a travesty.
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A major contributing factor to the cost of so-called health (sick) care in this country, and it's not generally addressed, is that people make lifestyle choices which are counterproductive to the whole picture. Most people don't HAVE to be sick. We can deal with the majority of health conditions, and avoid many of them in the first place by adoping healthy diet and lifestyle patterns. It's a lot about making good choices and taking personal responsibility. Of course, it's not in the interest of the medical community (many of whom have very little real "health" training) for this to be implemented into the plan. Hospitals and and drug companies would go out of business. I'd like to know, what's the lifestyle of some of the people pushing for these changes? Are they lifestyles that they would recommend for others...
or not?
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But, steven, this isn't about justifications, this is about rights. I can't see how it's constitutional to make me join the health gambling that is insurance. By making me pay for private insurance from a private corporation, they are essentially making me gamble away money out of fear.
And if I am "in an accident," then it will happen either at work where my work will pay my bills, or it will happen in a car where my car insurance will pay my bills, or it will happen in my home where my home insurance will pay my bills. I'm not sure exactly why I should be forced to subsidize the people who actually use the health system. (When I have gone to the doctor, I have always paid out of pocket since I save money for this sort of occurrence). Especially, the way this bill has gone forward, I will have to buy insurance from a *private* company. If the bill simply socialized health care, I wouldn't be opposed.
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In response to the bill's discrimination against women's rights (as mentioned above by rosecityfriend) and the bill's forcing the insured to purchase coverage from the insurance industry, the uninsured should refuse to purchase coverage in protest.
Humans are not cars. Driving an automobile is, yes, a choice. But I can't exactly choose not to live. I should not be forced into supporting the insurance industry, with no other options but a penalty. We didn't need to rush this bill, we have waited so long already. Doing it wrong the first time does more harm then waiting to get it right. It will be much harder to make any real reforms once this bill is enacted.
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This is exactly my feeling on the matter. I do intend to refuse to purchase coverage and I will refuse to pay any fines for it. If necessary, I will take the IRS to court over it. The US Congress does not have the authority to make me purchase anything from any private company.
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MatthewSkondin,
I want to do the same! I wonder if you (we) could prevail in court. I can't think of any other scenarios that are similar. Everyone tries the auto insurance comparison but of course that doesn't apply. It seems like legally or conceptually the government would have to directly purchase the insurance for you, or give you a physical voucher or check to pay for 100% of it, regardless of your income. Maybe TOL can have some lawyers on a future show to discuss the legality of this issue, because it seems pretty interesting and I don't know of any precedents, but then again I know little about law. I guess I can do some research online....
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Well... I Agree!
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Before your lawsuit becomes necessary, I am in the process of organizing a local protest action against the bill for these reasons. Our Senators aren't really listening to the private phonecalls and emails; publicly, they are merely giving talking points instead of holding open town halls to genuinely listen, and they will continue to do so until their contradictions receive enough serious media attention that Joe and Jane Public Citizen hear and question the contradictions too. If you're interested, email me at rosecityfriend@aol.com
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I also have concerns about Medicare cuts to pay for these massive changes that I'm not sure will improve the overall health care of people in our country, regardless of age.
Oregon has one of the lowest doctor/hospital Medicare reimbursement rates in the U.S. Why should my doctor continue to treat me when he is already reimbursed less than his costs? I've known 2 people who moved for family reasons and had a hard time finding doctors in their new location who took new Medicare patients. One with serious health conditions had to commute 100 miles to see her doctor in her former community.
AARP may be in support of these new bills, but I cancelled my AARP membership because I didn't see them lobbying for reform that would keep Medicare in effect for the next generations, only cuts to pay for new programs that won't even cover many uninsured people until 2013 or 2014. What was their payoff, I have to wonder.
To the caller who wondered why some people don't want to give poor people health care, I don't think that is the question. Rather I think we live in a very flimsy cardboard house of health care and without thoughtful provisions to provide more than a quick fix voted on under pressure, we are all going to be wondering why we still don't cover everybody and probably why some doctors decide to retire early rather than be caught in expectations that there will be care for everyone, without adequate reimbursements
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A primary aim for Medicare Savings proposals in the health care bill is to sustain Medicare over time. The Senate bill promotes cuts to some home health agencies, boosting payment for primary care, provisions for delivery system reforms and imiprovements in value and efficiency. The bill also phases out the Medicare Advantage government subsidy to insurance companies, and goes after fraud and abuse.
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The Senate bill cutting funds to home health agencies is a disaster, and they can't begin to presume what the "inefficiencies" are. I was the medical power of attorney for my elderly parents before my dad died and my mom finally went into a nursing home. They both wanted to remain in their own home as long as possible, where it is cheaper to provide care I might add. How is cutting funds for home health agencies going to hold down healthcare costs?? There were numerous other problems with Medicare that were related to TOO LITTLE money, not TOO MUCH money, like rules that make elderly patients be discharged from hospitals after 3 days unless they are getting "tests". When elderly patients are recovering from serious infections, they are often still too sick to be discharged home and too weak to be discharged to nursing homes (where they may get MORE infections) and yet doctors' hands are tied because the hospital won't get paid if the Medicare rules aren't followed. The doctor and I would try to figure out some additional test to subject my parent to buy another day or two in the hospital before discharge was required. This is the problem with the government getting TOO involved in trying to micromanage healthcare instead of simply requiring health insurances to be non-profits, extending anti-trust laws to their business, keeping health insurance a choice instead of a mandate to provide them incentive to providing good inexpensive care, and paying doctors and nurses better than insurance executives and congressmen.
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I don't have the confidence that JDeMonnin has in the stated reasons for cutting Medicare. Those talking points just don't jibe with the reality that more seniors will need home health care, which is often more cost effective than expensive nursing home or hospital care, and can be less distressing to the patient.
There was an opportunity to reform Medicare, but it was blown in this excessive overhaul effort. Killing the reviled Medicare Advantage, which I pay extra for and appreciate the extra coverage, is not going to save the system. And if there is that much abuse and fraud, why not fix it now and not use it as an excuse to rob the seniors to pay for future promises that may not help the overall system much.
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A question was asked about Cobra subsidies. Here is some current info from The Society for Human Resources Management:
COBRA Subsidy and UI Extension Signed Into Law
On Saturday, December 19, 2009, the U.S. Senate passed the Fiscal Year 2010 Department of Defense (DOD) Appropriations Act by a vote of 88-10. This federal spending bill included important provisions to both
1. Extend and expand the COBRA subsidy program that was enacted under the American Recovery and Reinvestment Act (ARRA) and
2. Extend expanded unemployment benefits through February 28, 2010.
The House also passed this same spending bill on December 16, 2009 by a vote of 395-34. President Obama immediately signed this bill into law (P.L. No: 111-118) after Senate passage on December 19, 2009.
COBRA
The COBRA subsidy program extension in the DOD bill will:
· Expand the ARRA’s COBRA premium subsidy period from nine to 15 months
· Change the end date for eligibility for the subsidy from December 31, 2009, to February 28, 2010
· Provide a retroactive period of 60 days (commences upon enactment) for payment of premiums for eligible individuals whose subsidy period expired on November 30, 2009
· Require a special notice outlining these changes within 60 days to all eligible individuals on COBRA on or after October 31, 2009, or those who are terminated after this date
· Clarify the original COBRA subsidy program, noting that eligibility and notice are based on the timing of the qualifying event
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Want this done now, and done right?
MAKE CONGRESS SUBJECT TO IT; and all the laws & Regulations they pass!
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Why is everyone so scandalized by the idea of a) a public option and b) a single-payer system (a la Medicare, Britain's National Health System, Canada's, many European nations)?
If we have a single payer system, then there would be less confusion about where to send the claims (whether filed by the physician or dentist, or filed by the patient).
If we have a public option, then those who are happy with their present coverage can stay where they are, as President Obama has said many times (some people just can't hear it unless it comes out of the mouth of some syndicated radio blow-hard such as Limbaugh the pain-pill addict or O'Reilly the Republican mouthpiece), and the rest of us who wish to change can do so, especially if we can get better coverage for less money.
Abolishing the exclusion for "pre-existing conditions" is a must, as well. Do you know that the leading cause of death is life? Yes, every one of us who is alive right now is doomed to die. Thus, an unscrupulous insurance company could deny benefits on the basis of 'life' being a pre-existing condition. We MUST do away with excluding pre-existing conditions, as the roots of many illnesses are hidden during childhood. Many people who have asthma, for example, are exposed to environmental factors that lead to it early in life, only to be diagnosed in their 20's 30's and 40's. In fact, many transpeople have feelings during childhood, but do not know what to do about their feelings until they are older, sometimes in their teens (the lucky ones) or in their 30's (the less fortunate). Transgender issues have been covered on this show, Think Out Loud, as well as To The Best of Our Knowledge, Talk of the Nation, and This American Life.
Finally, we must include coverage for ALL procedures. Yes, abortion too, which must be maintained as safe and legal, and hopefully rare. But we will have a much better chance at keeping abortion rare if we can have REAL sex ed in school -- teach teenagers where babies come from and how to prevent it. Yes, teach abstinence, but not as a standalone form of birth control, but as a first option, then teach our children that if they choose NOT to say 'no' how they can best protect themselves and their partners.
(Sorry if my comment seems a bit circuitous, I tried to get everything in about health care/health insurance reform.)
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I am very concerned about losing my Medicare Advantage plan! What exactly are they proposing?
I am also very concerned that the Senate plan is being financed by the above and taxing the so-called Cadillac health plans of union members who have given up pay raises to maintain these plans. What happened to taxing the wealthy?
I don't think we can get real reform without getting influence out of politics by having a government financed election system.