# Health Care Reform Bill Draft Released



## R y a n (Apr 4, 2005)

Jonathan Cohn, over at The New Republic and an expert on healthcare reform in the US, has the scoop on the coming Healthcare reform:

http://blogs.tnr.com/tnr/blogs/the_trea ... s-out.aspx



> The Senate Help, Education, Labor, and Pensions (HELP) Committee just released its proposed health care legislation for markup next week. That's right--it's the actual bill. Not conceptual language. Not leaked drafts. _This is actual legislative language that the committee is making public._
> 
> The committee will have a hearing on Thursday and begin formal markup next Tuesday. Sometime between now and then we'll get the final language. But this document is closer to final than anything we've seen yet. *You can read it online here*, in all of its PDF glory.
> 
> ...


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## Bowstring (Nov 27, 2006)

There are subsidies available to people making up to 500 percent of the poverty line, plus an across-the-board increase in Medicaid eligibility up to 150 percent of the poverty line.

The working class is getting nailed, seems like there are subsidies for every social program being proposed. Medicaid is funded by the states i think, so more taxes for the tax payers.

I thought most states had health programs like Minnesota's MinnCare funded by the tax payers already.


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## TK33 (Aug 12, 2008)

This is a good idea but it has some serious flaws. The first and biggest to me is tort reform. They have got to find a way to get the malpractice suits under control. The women in Florida last week was one that should have been compensated but their are dozens of cases a year of multi-million dollar payouts for stupid and risky procedures that are usually elective. Another thing that ties into this is malpractice insurance rates. If the gov't wants to mess with healthcare then they have to regulate this too.

The other thing is getting the billing correct and getting the bills (copays) paid on.

Maybe there will actually be some bi-partisanship on this bill and it will work but I doubt it. At least you have the option to stay in your current plan.


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## Bowstring (Nov 27, 2006)

Its a start, I just hope it doesn't screw up the insurance for the other 260 million that have insurance.


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## Bowstring (Nov 27, 2006)

More info,

FACTBOX: U.S. healthcare overhaul begins to take shape
Mon Jun 8, 2009 3:23pm EDT

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WASHINGTON (Reuters) - Details of a proposed overhaul of the U.S. healthcare system are beginning to emerge as two Senate committees writing the legislation prepare to hold public reviews in the coming days.

Here are some details of what lawmakers are considering based on an early draft of a bill being written by the Health, Education, Labor and Pensions Committee headed by Democratic Senator Edward Kennedy and on discussions with interested parties.

INSURANCE MARKET REFORMS

* A new public insurance plan would be created with payments to hospitals and doctors set at 10 percent above the government's Medicare health insurance program for the elderly and disabled.

* Employers and individuals would be required to obtain health insurance coverage, with subsidies to help those who cannot afford it.

* Insurance companies would be barred from refusing to cover people because of health history.

* Insurers also would be required to cover some preventive services.

* Annual or lifetime limits on coverage would be prohibited.

* Children would be allowed to stay on parents' insurance plan up to age 26.

INSURANCE GATEWAY OR EXCHANGE

* Grants would be provided to states to create "gateways" to act as a clearinghouse for individuals and small businesses to buy insurance.

* Reinsurance funding would be provided for plans participating in the gateway.

* A Medical Advisory Council to establish a minimum benefit for companies participating in the gateways would be created.

* Gateway participants would be encouraged to upgrade their information technology to help reduce duplication of treatments and lower costs.

OTHER COVERAGE PROVISIONS

* A sliding scale of subsidies for the purchase of insurance for people with incomes up to 500 percent of the poverty level would be established. Continued...

Continued at,
http://www.reuters.com/article/smallBus ... dChannel=0


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## R y a n (Apr 4, 2005)

Bowstring said:


> Its a start, I just hope it doesn't screw up the insurance for the other 260 million that have insurance.


How many people are in the U.S.? How many of them currently have employer provided coverage?


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## jacobsol80 (Aug 12, 2008)

WHO pays and HOW MUCH? Will existing taxes go up or will there be a whole new set for us to look forward to? Oh wait! I know, us middle class joes will be stuck holding the bag.


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## hunter9494 (Jan 21, 2007)

yep, it is that tired a$$ old system of redistribute the wealth. Osama is predictable. balance benefits on the back of the workers, people will soon tire of this $hit when they start seeing the bills and tax increases.


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## Bowstring (Nov 27, 2006)

R y a n said:


> Bowstring said:
> 
> 
> > Its a start, I just hope it doesn't screw up the insurance for the other 260 million that have insurance.
> ...


306,633,454 and 44 million uninsured. That should mean 262 million have health coverage. Employers, self employed and individuals pay.

How much? This a year old data,
YEARLY PREMIUMS FOR FAMILY HEALTH COVERAGE RISE TO $12,680 IN 2008, UP 5 PERCENT, AS MANY WORKERS ALSO FACE HIGHER DEDUCTIBLES

Workers Pay An Average Of $3,354 Annually Toward Family Coverage,
More Than Double What They Paid Nine Years Ago

Growing Shares of Workers Now Face Deductibles Of At Least $1,000,
Including More Than One-Third Of Those Covered By Smaller Firms

More at,

http://www.kff.org/newsroom/ehbs092408.cfm

I agree with TK33, Tort Reform is necessary to control costs, along with other operating cost controls for insurance companies,clinics and hospitals.


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## omegax (Oct 25, 2006)

So far, that can't be so bad, can it?

I suppose this pretty much just represents the easy parts to get through Congress.

As far as the 500%, I don't have a problem with that. I'm assuming it's a sliding scale. I make well above the poverty line, and if I had to buy a family plan, it would probably be more than my house payment.

I want to see more on cost savings. So far, this is pretty much Massachusetts' plan, and there were some families that were having trouble paying their premiums, there. You can't just subsidize that problem away, when costs are going up this much faster than inflation.

I'm guessing you guys aren't too jazzed about the forthcoming "public plan".


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## Bobm (Aug 26, 2003)

Has any govt run program ever come even within half the estimated costs or done anything efficiently?

After watching these fools the last few years how anyone can want them running healthcare is beyond me.

And they dont care one bit about us this is 100% about political power.


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## Chuck Smith (Feb 22, 2005)

the one major concern I have is the pre existing conditions......

Those people will pay the same rate as a healthy person.

Think of it....a diabetic who has to do regular testing, take medications, etc. Will pay the same amount as a healthy person of that age. THAT IS WRONG!

Why should I a healthy person pay for an unhealthy person.

As a business owner what will happen is that people will restructure and not have full time employees but make them part-timers or independent contractors to side step these laws. Then the buck will get passed onto tax payers. Number one example is Real Estate Agents. They work for a company but are "independent" so the company does not have to pay work comp or health insurance. Other companies will do the same. Then what they would be forced to pay in on Health insurance they will offer it to them in salary or hourly wage instead. So as a worker why not put that money in my pocket and get the state funded stuff. Or employers will just pay less in salary for the work to be covered.

------------- side note ----------------------------

Another thing people ***** about the $1000 deductable. Most deductibles are floating. Which means if you go see a doctor and it costs $500. the next visit costs $1000. So $1500 in these two visits. You only have to pay $1000 and the $500 is covered by your insured. Then the next visit is covered and so on for that year.

One stop to the ER for a sprained ankle 8 years ago cost me $750. Then throw on top the crutches and walking boot extra $500. Then the return visit and x-rays.... $400. See two visits $1650. I only had a $500 deductible back then.

Here is another side note. Most accidents happen at a home or someone property or an auto accident. Most home owners policies have a $1,000 med pay on it (or more). Now if you fall at someones home. You can get $1000 from the home owners policy and that is your deductible. Nothing out of your pocket.

Now if you have PIP coverage on an auto....again you can get your deductible paid for by another carrier (auto or home owners).


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## swift (Jun 4, 2004)

Chuck Smith pre-existing conditions are not as big a problem as the jokers that go to the ER (Expensive Room) with non emergent issues like a sprained ankle.

Healthcare reform needs to start with patient education and responsibility. Patients need to know what is appropriate for Clinic vs. ER or Primary care vs. going to a Specialist. And so on. Then insurance companies NEED to pay the bill.

Then as stated above TORT reform needs to be upfront and taken serious. For years Liquor companies couldn't advertise on TV but TORT lawyers do it all the time trolling for lawsuits to file. IF a person needs to be informed that they were wronged it probably wasn't that big a deal in the first place.

Govt sponsored insurance would be a good option if they were mandated to be on level ground with private insurers. AND govt sponsored insurance should not be allowed to legislate to the medical providers as Medicare/Medicaid does not. A healthcare regulatory board should be formed to see that things are being done with medical and fiscal responsibility by the medical providers. Having the folks that write the checks be the regulatory office as well is CRAZY.

Just a few ideas.


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## Chuck Smith (Feb 22, 2005)

Swift......nice jab at me....


> Chuck Smith pre-existing conditions are not as big a problem as the jokers that go to the ER (Expensive Room) with non emergent issues like a sprained ankle.


But i thought it was broken and could not walk. My meta tarsal was pulled out of joint by my ligament. The ER doctor and x-ray tech could not believe I did not break my foot from how I told them it happened.

Anyway....I agree on the Tort reform. Also what needs to be looked at is prescription drug reform. You and I have stated it before in other threads. But it takes a company millions and millions of dollars to get a drug approved and to market. Then they have a 10 year patent on it so no other drugs or generics can get introduced in 10 years. Plus most companies now make the generic themselves and hold it on the shelf.

But pre existing conditions to me is a big deal. Because a person on diabetic medication ($400 for my dad pre-insurance) a month plus doctor visits. Would pay the same amount as a health person of that age. That is not fair. Yes the bill states nothing about medications but medications will be included for people.

I also agree on people being educated. Like I mentioned above about the insurance most people don't know about this. They are also afraid to turn in medical claims because it will hurt friendships. But people that is why you have insurance. The home owners premium won't go up unless they turn in many claims.


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## swift (Jun 4, 2004)

I read my post and it did sound like a jab. It wasn't meant to be aimed at you. I noticed you needed a cam walker boot and crutches. I always use the sprained ankle as an example along with the earache and sore throat.


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## Chuck Smith (Feb 22, 2005)

Swift....don't worry about it I do have thick skin. :beer:

But I agree it is the people who go to the ER for every little thing that goes wrong. One they know they can get immediate attention. Plus immediate medications.

But before a bill is introduced at all they need reform...reform....reform.

This is like putting air into a tire with a leak. It does not make any sense. First you should fix the leak....then introduce the "new" air.


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## swift (Jun 4, 2004)

To me ruling out pre-existing conditions is like a car insurance company putting a rider on saying they wont cover deer collisions in ND because they occur more often than other states.

If I have insurance and become diabetic the insurance will cover me the same as you not having diabetes. BUT pre-existing condition riders won't cover a new participant with diabetes.

I have taken care of teenagers that at age 2 or 3 a Doctor put in their chart the diagnosis of Asthma. Insurance companies put riders on now (10 to 15 years later) that exclude treatments and medications for respiratory disease based on their "preexisting condition". That is just wrong.

I also find it amusing in the article above that age descrimination is written into the policy. Personally I believe that the elderly have earned the right for me to cover some of their expense. Afterall they have supplied me with the freedom I have and likely the profession I chose by being good taxpaying citizens their whole life. The mentality that the elderly are a burden to the system is reprehensible in my eyes. I can only hope that in 40 years I can look back and think I was as good a person and citizen as by 85 year old grandfather was.


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## swift (Jun 4, 2004)

> This is like putting air into a tire with a leak. It does not make any sense. First you should fix the leak....then introduce the "new" air.


Excellent analogy


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## Chuck Smith (Feb 22, 2005)

Swift.....I am not saying don't cover them.

But if they are under the "state or Federal" run health insurance if they are diabetic they should have to pay more than a person who is healthy upon sign up. But if they become diabetic after a while then that is fine.

What I am getting at is if a person who has a pre-existing condition has to pay X amount more because of that condition and the required care for that condition. In this bill everyone is on the same page except for age. Which is wrong.

Just like in auto insurance.....if a person who has DUI's, speeding tickets, careless driving tickets, at fault accidents, etc has to pay more in premium because of "PRE-Existing" circumstances/conditions than someone who does not have these things on their record.


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## Bobm (Aug 26, 2003)

--------------------------------------------------------------------------------

Read this carefully Obamas national heathcare is going to be a disaster if it gets done

June 09, 2009, 0:00 a.m.

Health-Care Bill Is the Ball Game
More competition, not less. More market discipline, not less.

By Mona Charen

You might suppose that President Obama has his hands full running two wars, administering General Motors, "rescuing" the banking system, attempting to empower unions over management, hushing up whispers about hypocrisy regarding Guantanamo detainees, managing the mortgage crisis, imposing "clean energy" on the nation, handling nuclear North Korea and nearly nuclear Iran, "stimulating" the economy, reviving the "peace process" between Palestinians and Israelis, inaugurating a new relationship with Russia and with the Muslim world, and reversing the rise of the world's oceans, but no, he has one more agenda item - overhauling U.S. health care.

The administration is hoping that a health bill will be voted on by early August, which may be overly optimistic but still means that this summer will be dominated by the health-care debate. Its outcome will determine the overall success or failure of Obama's effort to torque America toward the European model of statism. It isn't just that the health-care sector accounts for 17 percent of the U.S. economy. It is also the case that, if enacted, a nationalized health service - no matter how crushingly expensive or bureaucratic - will vitiate arguments about the proper scope of government. All future pleas for reducing the size of the state will run into the accusation that the small-government advocate is eager to take antibiotics from the mouth of a child or insulin from a diabetic.

Whereas the Clinton administration advertised the overhaul of American health care primarily as a means of covering the uninsured, President Obama is making the bolder claim that revamping health care is a way to save money. *Really? Medicare is already the program that ate the government, scheduled to go into bankruptcy itself in 2019. As the trustees' report put it, "While Medicare's annual costs were 3.2 percent of Gross Domestic Product (GDP) in 2008, or about three quarters of Social Security's, they are projected to surpass Social Security expenditures in 2028 and reach 11.4 percent of GDP in 2083."

Or consider the Massachusetts health-care reform introduced by Gov. Mitt Romney. Like every other government health-care program, Romney's has vastly exceeded cost projections. 
Initially projected at $125 million per year, the program actually cost taxpayers $133 million in 2007, $647 million in 2008, and $869 million in 2009, and could top $1.1 billion next year.*

"Health-care costs," President Obama intoned as he kicked off a summit on the subject, are "causing a bankruptcy every 30 seconds." Cord Blomquist on Openmarket.org observed that in 2008, a big year for bankruptcies, there were a total of 1.1 million bankruptcies. Adding up Obama's numbers - 120 bankruptcies per hour times 24 hours in a day and 365 days in a year equals 1,051,200 bankruptcies per year - would suggest that only 100,000 of those were for non-medical expenses. Does that make sense in the midst of a collapsing housing market? The study Obama based his numbers on was flawed in other ways as well, as ABC's Gary Langer noted on the ABC News website.

Beware of politicians bearing statistics. But what is even more galling than misleading (or outright false) statistics is to watch politicians rail about the expense of health insurance without once acknowledging their own role in jacking up the price. Health care is expensive, of course - though it also delivers value by improving the quality and length of life.

But our jerry-built system has made buying insurance much more expensive than it should be. *State mandates require insurance companies to cover a variety of specialized medical services (usually at the behest of lobbyists for the relevant service providers) including: in vitro fertilization, marriage therapy, smoking-cessation classes, hormone-replacement therapy, chiropractor visits, and so on. That makes it impossible for companies to offer cheap, no-frills, high-deductible plans for the young and healthy.* As Sally Pipes notes in The Top Ten Myths of American Health Care, *there were only 252 mandates in force 30 years ago. Today there are 1,901, an average of 38 per state.*

Government involvement in the health-care system, through mandates, has reduced competition (such as forbidding shopping for insurance across state lines). A skewed tax deduction that permits only employers and not employees to deduct the cost of health coverage has made health care more expensive than it ought to be. Yet President Obama proposes that a hair of the dog - vastly more government involvement - will bring down costs and improve quality. :eyeroll:

*If he follows the lead of Great Britain, Canada, or other countries whose systems he admires, he can definitely bring down costs. He can do it the way they have, by rationing care.*

But Americans should bear in mind this summer that when the president promises to get health-care costs under control he is really promising less care. There is a better way. More competition, not less. More market discipline, not less. This will affect every American for generations to come. The stakes could hardly be higher.

- Mona Charen is a nationally syndicated columnist. © 2009 Creators Syndicate, Inc.

--------------------------------------------------------------------------------

National Review Online - http://article.nationalreview.com/?q=M2 ... M4ZmQ5NjQ=


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## southdakbearfan (Oct 11, 2004)

I'm sorry to rain on O'bama's parade, but this is a frickin joke. The country does need health care reform, not the gov't taking over health care.

Medicare - broke in the near future
Social Security - broke in the near future
The Federal Budget - broke, the idiots just keep writing bigger checks.
Sensing a pattern here?

Those that say you will be able to keep your own health care, forget it, the gov't will be running it all, and rationing it out after a bunch of them get ousted for raising taxes dramatically to pay for it.

Reform drug research and drug pattening, install some semblance of price regulation. Kick the darn illegals out and quit giving them healthcare, and forget about this stupid utopian idea. That should be what is being pushed, not this crap.


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## Bowstring (Nov 27, 2006)

add to the above,

Amtrak big money loser, increasing the deficit year over year.
US Postal Service big money loser, increasing the deficit year over year.


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## Bobm (Aug 26, 2003)

price regulation never works as intended


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## R y a n (Apr 4, 2005)

I thank you all for a very civil discussion on the different and varied merits of this upcoming legislation.

I believe the following may address some of what has been discussed in these threads over the past few days...

Here is a bit of background into the details on the legislation being hashed out, including input from my local 10 term incumbent US Representative here in WA who is a well respected, major contributor to the details of the plan. His name is Congressman Jim McDermott, and he is an experienced medical doctor and child psychiatrist. Yesterday he was at the White House discussing health care reform with President Barack Obama and members of the House Ways and Means Committe (on which McDermott sits).

It's not the first time McDermott has been at the White House recently to talk health care. *In late April McDermott was selected* by the House Progressive Caucus, of which he's a member, to talk directly to Obama about *why it's so important to have a public option* in order to make health care reform meaningful.

McDermott has said that the "public option" is the major lynchpin in having solid sustainable legislation. He is far from the only person telling President Obama this, and *it sounds like the president's been listening*. Just as important is whether most of Congress is listening (and can be convinced).

Here is at video on the public option and McDermott's take on it, from recent talks on the Hill...






http://voices.washingtonpost.com/ezra-k ... nne_3.html

http://www.huffingtonpost.com/2009/06/0 ... 10390.html


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## Bobm (Aug 26, 2003)

everyone should watch Ryans wonderful video so they can fully understand the folly of these socialist utopian fools

bragging about the "successful" bankrupt medicaid

bragging about competition in one breath then dictating what their 
" competition" must cover pre existing conditions

Pre existing conditions eliminate the meaning of insurance there is no risk they already exist

WOuldnt my life be great if I could pass laws forcing the competition I have in my industry to follow expensive unsupportable dictates I make that would drive them out of the industry or out of business entirely

then I could raise my prices drop my quaility and keep no inventory , my customers could wait until I got good and damn ready to to send them equipment. What are they gooing to do about it I am the only player in town at that point?

Lastly the idea that any 10 term politician deserves respect makes me want to puke, gee whiz they have the own health care system, we pay for it ,OH and they have their own retirement system, we pay for it.
these criminals should be limitied to one 6 year term period

No suprise our great "champion of civil discourse or else" leftist loves them

Once last thing note how the far left has changed its name to "Progressive from "liberals". They should just be honest about it and change it to Communists another group of govt "progressives" that favor competition :eyeroll:

Kind of like "globull warming" is no "climate change" I guess with the long term cooling cycle we are in even they couldn't handle the "heat"

didn't it snow the other day in ND whens the last time that happened on this date?

I really am starting to believe that this country is going to go thru a armed rebellion something I never ever thought would happen


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## swift (Jun 4, 2004)

> Just like in auto insurance.....if a person who has DUI's, speeding tickets, careless driving tickets, at fault accidents, etc has to pay more in premium because of "PRE-Existing" circumstances/conditions than someone who does not have these things on their record.


Chuck the difference in this comparison is the folks above made a decision to break the law. Through their own fault they are at risk. With health related conditions there are very few people that choose to have the illness they have. I know about eating habits and destructive behaviors like alcohol use playing a factor soooo lets say we compromise....

Everyone starts out with the same premium. You work out keep your BP low, lipids down, and maintain a healthy lifestyle you would earn credits in the form of a partial refund. That way we reward those that take care of themselves but don't penalize the people that have conditions that are not lifestyle related like asthma and Type I diabetes, cancers and so on. We really aren't thinking that much differently. If only the politicians could look at what's best and not just political gain.


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## swift (Jun 4, 2004)

Somehow those quotes got reversed up above.


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## R y a n (Apr 4, 2005)

swift said:


> Somehow those quotes got reversed up above.


fixed


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## Chuck Smith (Feb 22, 2005)

> Everyone starts out with the same premium. You work out keep your BP low, lipids down, and maintain a healthy lifestyle you would earn credits in the form of a partial refund. That way we reward those that take care of themselves but don't penalize the people that have conditions that are not lifestyle related like asthma and Type I diabetes, cancers and so on. We really aren't thinking that much differently. If only the politicians could look at what's best and not just political gain.


I agree yet disagree. I still don't see how a healthy person has to pay the same premiums of an unhealthy person. But the credit or what ever would be a decent idea. But the credit idea is pretty much the same as not starting at the same price.

As an example....only example using low $$ amounts...

3 people identical in every way.....male, age, size, etc. Except pre existing conditions.

They all start at $10 premium. Through questioning and testing some info...

#1 is Diabetic type I, has high blood pressure, and high cholesteral. All pre existing. So they charge an extra $5 for diabetic, $2 for high blood pressure, and $3 for the cholesteral. So his premium would be $20.

#2 has asthma and that is it. So they add an extra $3. His total premium is #13

#3 is healthy and has no pre-existing conditions. $10 premium

Like i stated I am not saying that the people with pre-existing coverages don't get insurance. But they should have to pay more.

With the auto insurance you are correct those people did make the choice. But it was an example of how it should work. To let you know that is how insurance works now. They look at the risk and come up with a premium.

In the way they are wanting it passed that will not look at the risk. I mean why would you want to take care of yourself if no money was out of your pocket. Why would you be cautious with what you eat, your activity level, overall health. If you were on that bubble where you could be diagnoised of high BP, High Cholesteral, etc. some people will look at it as why should I work at getting healthier if i don't have to pay more for insurance. I will just maintain my lifestyle with out any financial consequences.

You have to realize why our nation is so unhealthy.....we as a society are lazy. I will admit I am apart of that problem too. Something I don't put much effort in. Think of it this way....I am feeling a little tired today so I won't go for that walk, run, bike ride, etc. and just sleep in. The next day....well I had a long day so I am going to have a few cocktails ....I wake up a little groggy and skip that work out again......the next day......heck I was on the phone all night with my old college buddy catching up.....I will sleep in an extra hour and just skip that work out......see the pattern. I have fallen in and out of it many times. So hitting the pocket book will make people not skip.

I read something in a paper or heard on tv about how men will lose more weight and keep it off if there was some sort of financial gain. If there is not they will lose less weight if working out or will gain it back after they loose it. Something to think about.


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## seabass (Sep 26, 2002)

Chuck Smith said:


> > In the way they are wanting it passed that will not look at the risk. I mean why would you want to take care of yourself if no money was out of your pocket. Why would you be cautious with what you eat, your activity level, overall health. If you were on that bubble where you could be diagnoised of high BP, High Cholesteral, etc. some people will look at it as why should I work at getting healthier if i don't have to pay more for insurance. I will just maintain my lifestyle with out any financial consequences.


Chuck, you first gave examples of how people with pre-existing conditions should pay more (which I disagree with), but your final statement above describes how people with lifestyle-related conditions should pay more (which I can agree with).

I disagree that people with pre-existing conditions should pay more because that to me is the whole point of insurance. Many of these conditions are genetic and I do not think that any insurace company should be profiling people based on genetics. Many genetic-related diseases (i.e. non life-style related) now have "genetic markers" associated with them which means that a battery of simple lab tests could in theory tell an insurance company what diseases you may be predisposed to getting... add a statistician in there and they will try to predict when you will die based on your lab tests in comparision with mortality rates of others with similar results.

I don't like that thought and to me it is just the logical extension of what you are arguing for above. If insurance companies get their hands on our DNA, trust me there will be a huge disparity in what people pay.

I personally hope that every penny I pay into my insurance company each month is a penny that will never be spent on me again. I hope that money never has to be used to pay for any medical-related bills of my own, but instead helps pay for medical bills of someone less fortunate.


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## TK33 (Aug 12, 2008)

I agree with most of what seabass said. The govt and healthcare industries have a hard enough time figuring out what is right in front of their faces let alone trying to make predictions or educated guesses.

The lifestyle issue is being oversimplified. People who work in transportation and service industies are more prone to be overweight, have cardiac issues, prostate issues, cancer, diabetes, and tend to have more fatigue and joint problems. Some of these are avoidable but some come with the territory of their occupation. The problem here is these are still high demand jobs that are vital to our economy and running the costs up on these occupations will not help the economy in any way.


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## seabass (Sep 26, 2002)

TK33 said:


> I agree with most of what seabass said. The govt and healthcare industries have a hard enough time figuring out what is right in front of their faces let alone trying to make predictions or educated guesses.
> 
> The lifestyle issue is being oversimplified. People who work in transportation and service industies are more prone to be overweight, have cardiac issues, prostate issues, cancer, diabetes, and tend to have more fatigue and joint problems. Some of these are avoidable but some come with the territory of their occupation. The problem here is these are still high demand jobs that are vital to our economy and running the costs up on these occupations will not help the economy in any way.


I agree. The life-style related issue I actually meant was smoking... which is a no-brainer anymore. But then again I thought I read somewhere that smokers aren't even that big of a drain because they die earlier, thus do not require the medical care associated with old age. I could be way off on that though.


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## Chuck Smith (Feb 22, 2005)

Here is what is wrong....

And what I don't think people are seeing with this. Lets me break it down (again numbers are nothing accurate.) This is the system that people are saying not to charge for pre existing conditions..

You have 100 people. 50 male 50 female. All same age. 5 are diabetic. 1 has cancer. They all pay in a year premium $2000. Then they are covered. $200,000 in the "insurance Kitty" so to speak.

One person with an pre-existing illness will rack up $100,000 in medical bills in a year and co-pay on medications. (They pay some for medications but the "Kitty" pays the co-pay).

Then 10 women have baby's. That is with out complications roughly $7700 per child. 
http://www.associatedcontent.com/articl ... ancy_.html
Now that is $77,000 more out of the insurance kitty.

Now lets say a person becomes ill and gets cancer..... $100,000 more money out of the kitty.
http://www.winningcancer.com/txt/costs- ... reatments/

So in my example 12 people out of 100 and the premium paid in is less than the amount needed for coverage. $77,000

Just to pay for the 12 people 100 where is the extra $77,000 going to come from?????

Let alone the regular care for the other 88 people who get sick, flu shots, heart meds, high BP meds, High cholesteral meds, diabetic supplys, diabetic meds, sprained ankles, regular doctor visits, broken arms, broken fingers, back pain, neck pain, etc.

I will tell you where the extra $$ will come from. Taxes. Then the next year premium increases. Now if you charge the other people with pre-existing conditions a little more like $3000. The people who are diabetic.....extra

I think pre-existing and lifestyle should place in effect on premiums. Just like they do now when you buy insurance.


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## seabass (Sep 26, 2002)

So do you want the one person to cover the difference? I think the bottom line is that you are using numbers that do not jive with reality. What if it was one person out of 1,000 instead of 100. Not to mention that the insurance company makes interest on the premiums collected.

I didn't have to take a physical or talk about any pre-existing conditions with my current provider, and they seem to be doing okay as a company. If you allow the insurance company to discriminate, it's not going to be an extra dollar here and there for someone with diabetes... I imagine it will be a slippery slope and they will charge big bucks to those people. So not only does a person with a pre-exising disease have to cope with said disease, they have to work that much harder to have enough $$ to pay the premiums! I don't think so.


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## Chuck Smith (Feb 22, 2005)

5% of all americans have diabetes. 18.2 million and you take the census population of 304,000,000 in the US. Again this is Legal US Citizens. $174 billion and divide that with 18.2 million.

That would be about $9500 per patient. These numbers were not involved in my example....the $9500 per person. So that is an added $47,500 on that total. (if you look at the link for a patient with diabetes it costs more like $11,000)

http://www.diabetes.org/diabetes-statis ... -in-us.jsp

In 2005 about .6% of the population has cancer or was diagnosis with cancer. (500,000 + died) (google search % People in US with Cancer) So saying 1 out of 100 gets cancer or has cancer is pretty accurate.

So my numbers jive pretty well.

No what I am saying make the people with pre-existing cover all of there payments. But they need to pay more than a healthy person. *how else are you going to cover all the costs with out some discrimination.*

What I typed in bold is the Million $ question.


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## seabass (Sep 26, 2002)

But the $100,000 a year number you cited... you said that someone with a pre-existing condition will rack up ~100,000 dollars, approximately half of the $200,000 "insurance kitty." Does that number jive? I just don't know where all the numbers come from. What you basically are saying is that each pre-exising condition person out of 99 non-pre-exisiting persons consumes half of the insurance kitty. Is that really right?

Anyway Chuck, I've high-jacked this thread enough. I've got your point.


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## Chuck Smith (Feb 22, 2005)

Now I have not even figured in nursing home care for elderly, care for people who are mentally ill, physical handicaps, medical care for children, etc.

Again where is all this $$$ going to come from to care for all these people?? If everyone is paying the same amount in age brackets.


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## Chuck Smith (Feb 22, 2005)

Here is another one....look at the cost of wheel chairs...

http://www.quickie-wheelchairs.com/?gcl ... DAodBi64eg

Here is some back ground on myself. I have a handicap brother. He has cerebral palsy. I have an aunt, grandmother, and father that are all diabetic. I have had a grandmother pass away after battling lung cancer and other complications with it. Two grandfathers each have heart attacks. Grandmother with diabetes now going through liver complications, heart complications, etc. She alone racked up over $100,000 in medical bills in a year.

So I have seen the costs of these things and I know that by providing "cheap" insurance which is what this bill is trying to do will not cover all the costs associated unless tort reform of some sort happens.

Like I have mentioned earlier on in the post. Why try to implement a new program in a broken system. It is like putting air in a tire with a leak. First you need to fix the tire.


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## Chuck Smith (Feb 22, 2005)

> But the $100,000 a year number you cited... you said that someone with a pre-existing condition will rack up ~100,000 dollars, approximately half of the $200,000 "insurance kitty." Does that number jive? I just don't know where all the numbers come from. What you basically are saying is that each pre-exising condition person out of 99 non-pre-exisiting persons consumes half of the insurance kitty. Is that really right?


A guy has heart disease, high bp, cholesteral issues, etc has heart attack or stroke. Needs nursing home care for a year, medications, surgeries, ambulance ride to the ER, doctor visits, testing, etc.

So yes one pre-existing condition of some sort can rack up $100,000 in a hurry.


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## seabass (Sep 26, 2002)

Last post on the topic for me... I am very well aware that someone can rack up $100,000 in a year (my wife did last year, but thats another story). But I thought you were using $100,000 as a _relative_ number to $200,000. Because in your example you have one person consuming half of the insurance kitty of 99 other people. Is that correct? So let's forget the numbers all together. Is it really true that one pre-exising condition person consumes half of the entire insurance kitty (to continue the phrasing) of 99 other people? THAT is the point I'm trying to emphasize.


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## Chuck Smith (Feb 22, 2005)

One thing this bill and all of the health care bills I have heard talked about is wanting to lower the cost of insurance for people. Then requiring people to have insurance.

Now lets just use the price of $2000 per person and the population census of 304,000,000. That is $608 Billion in premium. Pre-existing diabetics take up $174 billion. That is 5 % of the population. Then now you add in the .6% of americans fighting cancer. With a cost of $100,000 average per patient. That is 1.8 million (rounded down) people taking up $180 billion.

Now roughly $350 billion out of $608 is spent on 6% of the population. So over 1/2 is gone. So the rest of the 94% of the population has to work with less than 1/2 of the money allocated for health care. That is not taking into consideration of any other pre-existing health issues other than diabetes.

Now add in pregnancies, nursing home care, disability care (wheel chairs, walkers, etc.), broken bones, check ups, flu shots, medications, etc. The rest of the money will be gone in a hurry.


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## R y a n (Apr 4, 2005)

I feel your pain Seabass....

Getting this back on track... yesterday I posted a reply that Seattle Congressman Jim McDermott, and his staff, believe that "if there isn't a public option, you're not going to have real health care reform."

Here's why, via *Ezra Klein at the Washington Post:*

(This should make everyone take pause at the true motivations behind the "information" being pushed out attacking these proposals. Be careful where you get your "sources" from! 



> The private insurance market is a mess.
> 
> It's supposed to cover the sick and instead competes to insure the well. It employs platoons of adjusters whose sole job is to get out of paying for needed health care services that members thought were covered.
> Moreover, public insurance is simply more efficient. Medicare holds costs down better than private health insurance. The substantially public systems employed by every other industrialized nation cost less and cover more than the American model. So the question became how to marry the policy need for public insurance with the political need to preserve the status quo.
> ...


_*Now*_ comes *the news* that the American Medical Association-*which Klein points out* has "opposed all public plans proposed by all presidents in all contexts"-will not support health care reform that involves a public plan, and has told Congress as much in the following language:



> The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.


_Which_, again *returning to Klein,* is what the AMA has been saying _forever_.



> The AMA represents the interests - *which it tends to define as the profits* - of doctors.
> 
> *That gives it a slightly different perspective on the American health-care system. *
> 
> ...


Obama's going to be addressing the AMA on Monday in Chicago. Will he take them on the way he took on the auto-makers in Detroit in a speech during his presidential campaign? The way he took on the Muslims and Jews of the Middle East on his recent trip to Cairo, telling them to speak honestly about the truth of their conflict and the limited possible solutions? The way he took on unhelpful exploiters of America's racial tensions in his famous speech in Philadelphia?

We'll see.

Until then, please enjoy, once again *via Klein*, a pre-presidential Ronald Reagan telling Americans in 1961 why health care reform is a sneaky form of socialism.






Ohhhh by the way.... wanna make a guess who paid him to do this? 8)

*The AMA.*

Zingggg....

Puts alot into perspective now doesn't it? IMO, after learning this, the AMA's credibility went right out the door. It should give everyone pause to consider this perspective.

It makes perfect sense.

source(s):

http://voices.washingtonpost.com/ezra-k ... nne_3.html

http://www.nytimes.com/2009/06/11/us/po ... ealth.html

http://voices.washingtonpost.com/ezra-k ... assoc.html


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## R y a n (Apr 4, 2005)

Here's another great article on the very same point(s) written by the New Yorker magazine...

http://www.newyorker.com/reporting/2009 ... ande?yrail

Interesting read. (It's 8 pages, so make sure you click "next" thru all of them)

Quite simply, the AMA doesn't oppose health care reform, the AMA opposes doctors taking a pay cut.

Something to chew on...

ohhh and one last thing....

Do you know how Medicare keeps costs down? _They_ decide what rates are appropriate for various procedures and that's what they pay. Doctors can, of course, opt out which makes finding a doctor or simply staying with the one you have more and more difficult.

And doctors say that the reimbursements they receive from Medicare increasingly don't cover their costs. *Do you know how they bridge that gap?* They negotiate HIGHER rates with private insurance carriers.

It really isn't surprising that the AMA is opposing the idea of reform. Under a single policy, like Medicare, they're likely to make A LOT less than they do now and they're going to fight that tooth and nail. Private insurance is the only money train they have since most of us couldn't afford to pay cash at the rates they want.

So, the challenge here is not ONLY getting a single payer policy passed. Rather, it's enacting sweeping changes in a medical industrial complex that will mean lower payments and smaller paychecks in exchange for a cost effective and sustainable system.

Wanna guess what the AMA prefers?

Getting these changes past that cabal will be interesting. I hope it can happen but the power in this case does not lie with the patient, it lies with the doctors and insurers who can afford to pay to play in Washington.


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## Bowstring (Nov 27, 2006)

Chuck Smith said:


> Now I have not even figured in nursing home care for elderly, care for people who are mentally ill, physical handicaps, medical care for children, etc.
> 
> Again where is all this $$$ going to come from to care for all these people?? If everyone is paying the same amount in age brackets.


China of course! This entitlement will add to the national debt like no other entitlement out there and will be funded by selling more treasuries to China and other countries. :eyeroll:


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## TK33 (Aug 12, 2008)

I have heard from people who work at both Fargo hospitals that their biggest problem is malpractice insurance and the second biggest problem is people not paying their bill. There are of course two sides to people not paying their bill. I went in once for a knee issue and noticed an arm sling on my bill  . It reminded me of when I brought one of my diesels to the shop and they told me I needed new spark plugs :lol:

In theory the providers think they will be ahead by getting more money in and thus those of us who pay our bills (correct bills anyway) will have our medical and prescription costs lowered. I don't buy it, especially with the government involved. Look at food costs, corn is down and ethanol is in the tank but food costs haven't dropped. :roll: :x Government is involved there too, it is also an essential of life.


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## Chuck Smith (Feb 22, 2005)

Like Tk33 stated.

It does no good to revamp the health insurance industry (make some public and Goverment involved and rest private) when prices of services won't go down.

Like I have stated. Putting air into a flat tire. Trying to fix one and not the other.

The thing about insurance rates.....they will drop and be more affordable if they don't have to pay as much to the hospitals for services. What they are doing is putting the horse before the cart. Tort reform first and then adjust the insurance industry.

------------------- a little off topic ---------------------------

This is how insurance companies work. If they are an A rated company or A+ rated company they spend every $$ they collect in premium out every year. A 1 to 1 ratio. Every dollar in and every dollar out.

Now the $$ out is paid in claims, office staff, operating costs, and investing. Also insurance companies can't boost great profits. They have to invest profits in re-insurance, study programs, etc.

So if they pay less in claims they have to invest or drop rates. Why do you think rates fluctuate. (except medical because they keep paying more and more and more in.)


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## TK33 (Aug 12, 2008)

Correct me if I am wrong chuck but that is on profits only right?

They can still overpay execs, board members, and pick up the tab on ludacris retreats or vacations right?


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## Chuck Smith (Feb 22, 2005)

> Correct me if I am wrong chuck but that is on profits only right?
> 
> They can still overpay execs, board members, and pick up the tab on ludacris retreats or vacations right?


The answer is yes and no.

This industry is very tightly regulated. But yes they still can pay bonuses, profit sharing, and contingencies. (All are structured...like if you hit a quota you get a %, you sell so many policies you get $$ off a trip, etc.) But all of this is under a watchful eye of big brother. But only a certain % of profit can be paid in bonuses, retreats, etc. The rest needs to be invested or given away to studies and stuff like that. They can only show X amount of profit a year. Now what those numbers are I have no idea. I am just an agent for many insurance companies. I am not on any boards or stuff like that. But I do know how things work.

They are not like the banking industry with the frivilous spending, retreats, etc. The banking industry was not regulated. The insurance is tightly regulated.

One thing I read last night in my local paper is that Obama is willing to do tort reform. He is even facing opposition from his fellow dems on this. Because many dems are high paid lawyers and that will hurt them. I just think he needs to do that first before an over haul is needed. Because if you do tort reform it will swing the prices down to an affordable level. Then if it does not self-right itself then do a complete over haul.


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