Obama's Health Care Plan

SUMG · June 16, 2009

So....we're told over and over how we must make sure that everyone in the US has health insurance. And that there are 46-50 million uninsured. Now, comes word from the non-partisan Congressional Budget Office, that the President's plan would cost over $1 trillion and would only have a net result of covering 16 million of the aforementioned 46 million.

Doesn't make much sense to me, to totally destroy the healthcare system.....and not even cover everyone (if that was such a disaster to begin with):

http://www.redstate.com/brianfaughnan/2009...obamacare-fail/

Edited June 16, 2009 by SUMG

FirefightnRick · June 17, 2009

Again, for our liberal friends who are concerned over reading the facts here from a conservative outlet so often, here is the formal letter of analysis on the subject to the Committee on Health, Education, Labor, and Pensions explaining how it is that the Affordable Health Choices Act, or the Kennedy-Dodd Bill as it has become to be known, will only reduce non-elderly uninsured people by 16 million by 2019 as reported by the Congressonal Budget Office and the Joint Committee on Taxation at a cost of $1 Trillion.

As it states, this analysis doesn't included the public option so I expect more to come. Still this is a rough start for this thing but I don't expect much of it to be raised during the upcoming OBama sales pitch on ABC?

We'll see.

Rick

Edited June 17, 2009 by FirefightnRick

UNTflyer · June 17, 2009

If true, this comes out to $62,500 per person. That's ridiculous.

Why don't we just do this... set a means test to determine who truly can't afford health insurance, and then let private insurance compete for their business, paid for by the government. Lowest bid wins. I still don't like paying for those who won't do for themselves, but it's a hell of a lot better than the alternative.

hickoryhouse · June 17, 2009

If true, this comes out to $62,500 per person. That's ridiculous.
Why don't we just do this... set a means test to determine who truly can't afford health insurance, and then let private insurance compete for their business, paid for by the government. Lowest bid wins. I still don't like paying for those who won't do for themselves, but it's a hell of a lot better than the alternative.

Look at that, a solution that can make both sides at least satisfied, the government gets to intervene and the market gets the nod as who should fix the problem! compromise, wow.

Harry · June 18, 2009

The first issue is you have to understand that the health care system here in the US is broken. If you don't understand that premise, and that health care costs in this current system are unsustainable then you don't understand our health care system. It may work for you, and if so I am glad to hear it. Second, if you think that private insurance is going to be able to solve these issues on their own you are wrong. They will cherry pick the best risk and leave the rest out there to show up at the emergency room where WE end up paying for it in the end anyway.

When you deal with people who are sick or have pre-existing conditions and can't get coverage you will understand. When you meet people who have been laid off in this economy, can't afford coverage and are scared to death of getting ill and going bankrupt you will understand. I don't disagree that the costs of this reform have to be addressed but stating that private insurance companies who are revenue and profit driven will solve the problems on their own is naive.

Harry · June 18, 2009

For those trying to figure out this health reform situation I think this is a fairly good summary:

http://www.cnn.com/2009/HEALTH/06/18/ep.he....reform.basics/

UNT90 · June 18, 2009

The first issue is you have to understand that the health care system here in the US is broken. If you don't understand that premise, and that health care costs in this current system are unsustainable then you don't understand our health care system. It may work for you, and if so I am glad to hear it. Second, if you think that private insurance is going to be able to solve these issues on their own you are wrong. They will cherry pick the best risk and leave the rest out there to show up at the emergency room where WE end up paying for it in the end anyway.
When you deal with people who are sick or have pre-existing conditions and can't get coverage you will understand. When you meet people who have been laid off in this economy, can't afford coverage and are scared to death of getting ill and going bankrupt you will understand. I don't disagree that the costs of this reform have to be addressed but stating that private insurance companies who are revenue and profit driven will solve the problems on their own is naive.

And to think that the Federal Government is the be all, end all, and will solve this problem is extremely naive. Any social problem that the Fed Government has ever attempted to solve, it has only made it much worse. Look at Education. Billions pumped into the Dept. of Ed. since it's inception, and the level of education continues to decrease each year. The only avenue that the federal government has ever pursued, and the only one it knows, is to throw money at the problem.

I definitley don't have the answer on this, but I know, without a doubt, that the federal government is not it.

greenminer · June 18, 2009

So, if I read this thread correctly, we're in agreement that our health system has to swing both ways in order to work and be balanced.

Thanks.

Harry · June 18, 2009

And to think that the Federal Government is the be all, end all, and will solve this problem is extremely naive. Any social problem that the Fed Government has ever attempted to solve, it has only made it much worse. Look at Education. Billions pumped into the Dept. of Ed. since it's inception, and the level of education continues to decrease each year. The only avenue that the federal government has ever pursued, and the only one it knows, is to throw money at the problem.
I definitley don't have the answer on this, but I know, without a doubt, that the federal government is not it.

90 I am skeptical about the government too. However, having spent a lot of my career on the insurance side I can tell you that they aren't the complete answer either. There are no easy answers to this problem. I have little patience for those who continue to shoot holes in attempts to reform but ignore the problem and offer no solutions.

keith · June 18, 2009

The first issue is you have to understand that the health care system here in the US is broken. If you don't understand that premise, and that health care costs in this current system are unsustainable then you don't understand our health care system. It may work for you, and if so I am glad to hear it. Second, if you think that private insurance is going to be able to solve these issues on their own you are wrong. They will cherry pick the best risk and leave the rest out there to show up at the emergency room where WE end up paying for it in the end anyway.
When you deal with people who are sick or have pre-existing conditions and can't get coverage you will understand. When you meet people who have been laid off in this economy, can't afford coverage and are scared to death of getting ill and going bankrupt you will understand. I don't disagree that the costs of this reform have to be addressed but stating that private insurance companies who are revenue and profit driven will solve the problems on their own is naive.

I appreciate that you are bringing your knowledge and experience in this arena to the board and that you patiently try to explain the various issues for us, but I disagree with your fundamental premise and I think for those attempting to make a case for health care reform, it is a dangerous place to start. Personally, when I hear discusions start this way it's like hearing Al Gore say, "the debate on global warming is over." This is a huge red flag IMHO.

Random thoughts and comments....

Arguably, the United States has the most advanced medical care, medical technology, medical treatment and procedures available in the world today. This just doesn't happen by itself, we enjoy this precisely because of our system. Broken systems do not produce these results.

If we say the *cost* of providing health care is the problem (not the cost of insurance), then what are we doing about that? I have seen nothing in Obama's plan that identifies the components that make up the cost of the acutal health care and attacking those. How much of our health care expenditures are defensive in nature (trying to avoid a law suit), how much is discretionary (face lifts, augmentation, life-style driven), how much is spent in the last year of life? We are over medicated and looking for a quick fix in a pill. Here's an idea. Take most of the prescription medicine and make it available over-the-counter. Now if someone wants that pill, they have to pay for it out of their own pocket. I bet you would see a dramatic drop in all the pills people are taking.

"can't afford coverage and are scared to death of getting ill and going bankrupt you will understand" I submit that this is not a health care issue. This is a fear thing, an emotional response, probably somewhat irrational and I would say sensationalized by the media. This speaks to the catastrophic health event and the let's assume the worst case scenario arguments. Do these happen? Yes, they do, but what are the odds that they will happen to you? We've all allowed the horror stories that get protrayed over and over again in the media to permeate our psyches. Perhaps our health care system is too good and people are "saved" here (only to become that catastrophic health care burden) when in other countries with less advanced health care, they would not have been saved.

"... stating that private insurance companies who are revenue and profit driven will solve the problems on their own is naive." Aren't hospitals and doctors also driven by a profit motive?

From the CNN article.... "Obama said he's already identified "hundreds of billions of dollars" worth of savings in the federal budget that could help finance health care reform, such as rooting out waste, fraud and abuse in Medicare and Medicaid. He's also proposed reducing tax deductions for high-income Americans." So if we have waste, fraud and abuse in Medicare and Medicaid (Federally managed programs), why will that not exist in the new programs? If this waste, fraud and abuse exists now, what is being done NOW to rectify it? Hundreds of billions of dollars???? If he is not going after that now then it is criminal.

Keith

Edited June 18, 2009 by keith

greenminer · June 18, 2009

Random thoughts and comments....
Arguably, the United States has the most advanced medical care, medical technology, medical treatment and procedures available in the world today. This just doesn't happen by itself, we enjoy this precisely because of our system. Broken systems do not produce these results.

Isn't the cause of this the same reason it is flawed? The private industry allows tons of money to flow and accelerate for these wonderful technologies and advancements, but they are also conveniently easily accessible for a select few, and nearly impossible for the "rest" to get a piece of.

I can already tell you are much more versed and educated than I am in this subject. Please consider this a humble devil's advocation

Edited June 18, 2009 by greenminer

Harry · June 18, 2009

Keith you make some valid points as always.

But you can't compare this crisis to the creator of the internet's global warming campaign. 69.5% of Americans say the health care system is "in crisis and needs a total overhaul" or "is seriously troubled and needs significant revisions." Only 2.1% say "It is one of the best systems in the world and doesn't need to be changed. I believe to start down the path of fixing the problem you have to admit that the health care system is broken. Does this impact all of us, heck no. I've been paying premiums for decades and knock on wood never been laid off or had any major health issues. Insurers have made a ton of money on me. But just because it hasn't impacted me personally, doesn't change the fact that I realize the system is broken.

You are correct, there are certain aspects of the system that work great, and we have some of the best technologies and medications in the free world. If you have money and your employer offers coverage you have access to the best care in the world bar none. There are certainly aspects of our current system that need to stay put and I agree with you on that. Call me a dreamer, but I believe you can fix the bad without eliminating the good. In the very least it is worth trying.

The rising cost of health care and insurance are one in the same to me. Insurers will always have to build a profit on top of the cost of providing medical benefits and I don't begrudge them that. It's just the amount of profit, associated bureaucracy and cherrypicking I have a problem with. And certainly the blame for the rising costs can be shared among all of us and that includes physicians, hospitals, medical device companies, pharmaceuticals, consumers and the list goes on. One thing that has to be addressed is the way doctors and hospitals are paid. The fact that we pay them on a fee for service basis is a major part of the problem. Providers should be paid on the quality of services they provide; not the quantity! Health and wellness should be a major component of the plan, although the savings from making lifestyle changes and excercise usually take time to affect costs (it doesn't happen overnight). It's not right that primary care physicians are paid sometime 1/5 or 1/6 of what specialists are paid when the work just as hard and are in many ways more important in terms of managing costs. It's not right that drug companies spend millions of dollars pushing high costs drugs to doctors. It's not right that you live a healthy lifestyle and eat right and you subsidize the guy in the next cube who is pounding ding dongs. It's not right that insurance companies are only providing wellness benefits to businesses that are performing well and leaves the struggling ones to fend for themselves. I could go on and on.

In terms of specifics on how they will cut costs, the details are still are being worked out but I see some good ideas. One is cutting Medicare and Medicaid payments and overpayments to insurance companies, drug companies, hospitals and providers. Both Republicans and Dems agree there are tons of waste and excess in those four areas alone. Emergency room care costs should go down because of Universal coverage. Right now we pay over $100 billion to hospitals that provide care to the uninsured.

The term rationing care is used as a weapon against reform but the reality is we have to start rationing some aspects of healthcare or the entire system will implode due to costs. If a 75 year old man needs a knee replacement the artificial knee should be based on his expected life span, say 20 years not the 100- year version that costs twice as much. If someone has a wart on their toe, they don't need a $1000 MRI, they just need a biopsy and a doctor to burn it off. If someone wants a cosmetic eye procedure, they should have to pay for it, not sneak it through under the guise of medical necessity. Plans should be designed where the consumer has some scratch in the game, not where they just pay a $10 copay and get $5000 worth of services! Sorry to get off track on this but I am really passionate about this stuff.

Many say that we can't afford to have government run our health care but I would submit to you that the private insurance industry has had many, many years to address and stymie the costs and has been very unsuccessful in doing so. In fact, while our healthcare costs are rising 9% in 2009 a year when many people are losing their jobs and coverage. From 2003 to 2007 the combined profits of the major health insurance companies increased by 170 percent. So just leaving it to the insurance companies to manage is like letting the wolf guard the hen house - it is not working and it will not solve the problem. Perhaps this could be addressed without government intervention (ie co-op plans) and I am open to that.

Since Congress is ultimately responsible for drafting the legislation that Obama will sign, it is safe to say that those details are still being hashed over and debated vigorously. I have seen some really good aspects in these draft bills like universal coverage and some bad things like paying a subsidy for a couple earning near 80K. This debate is a good thing, for too long we have swept this health care issue under the carpet and left it as a masive burden for future generations to bear. But it should be a debate, with both sides coming up with ideas and potential solutions not just hem hawing and standing by the status quo.

I agree with you that Medicaid and Medicare are not perfect and I do think that both of these programs will have to be addressed if any semblance of reform is being implemented. The fact is, private insurers base much of their reimbursement to providers off of the Medicare schedules so inequities in how Medicare pays for things affects the entire system. Medicare does very little in terms of reimbursing based on quality outcomes and that one area just has to be addressed if this system is truly going to be reformed.

I will disagree with you on one point, this crisis is not just something that is being drummed up and it is not just individual cases that are outliers. One of the major reasons a once great company like GM went under was due to the fact every car they built had an additional $1500 added to the cost because of health benefit costs. There are real people with real stories who are struggling to get their real healthcare needs covered. There are people stuck in jobs they do not want to do because of their fear that they will lose their coverage or won't be able to afford coverage if they move to another job or start their own business. We need to fix this problem now and not leave it for our kids and grandchilden to deal with.

Harry · June 18, 2009

For the record, the way SUMG posted this topic is innaccurate. This bill - which is really not a final bill but a first draft for congressional budgeting purposes - is not Obama's bill. It is a bill sponsored by senators Edward Kennedy and Christopher Dodd. There are multiple bills from both congressional Democrats and Republicans being considered by Obama and the administration.

June 18, 2009

Harry,

"Medicare does very little in terms of reimbursing based on quality outcomes and that one area just has to be addressed if this system is truly going to be reformed. "

This one sentence is where a business person needs to stay out of the Doctor's way. The day you start paying more for a positive outcome is the day you don't want to take you deathly ill child to the Doctor. Doctors will start passing off *really* sick patients and taking the easy fixable ones. They will send the patient to the county hospital or the teaching hospital with all resident doctors. You already see some cherry picking in the medical system and it has led to some unbalanced care. For instance, the notion of "Heart Hospitals." Sure, they make a lot of money, but they divert money making cases from other general hospitals. Now EKGs, MRIs, Bypasses, etc (which are highly paid by insured people) go to the "Heart Hospital" ... The county hospital gets the ER traumas and uninsured... One hospital is a star, the other is the "problem with the medical system."

Doctors won't purposely sandbag cases or purposely have bad outcomes. They *practice* medicine.

Harry · June 18, 2009

Harry,
"Medicare does very little in terms of reimbursing based on quality outcomes and that one area just has to be addressed if this system is truly going to be reformed. "
This one sentence is where a business person needs to stay out of the Doctor's way. The day you start paying more for a positive outcome is the day you don't want to take you deathly ill child to the Doctor. Doctors will start passing off *really* sick patients and taking the easy fixable ones. They will send the patient to the county hospital or the teaching hospital with all resident doctors. You already see some cherry picking in the medical system and it has led to some unbalanced care. For instance, the notion of "Heart Hospitals." Sure, they make a lot of money, but they divert money making cases from other general hospitals. Now EKGs, MRIs, Bypasses, etc (which are highly paid by insured people) go to the "Heart Hospital" ... The county hospital gets the ER traumas and uninsured... One hospital is a star, the other is the "problem with the medical system."
Doctors won't purposely sandbag cases or purposely have bad outcomes. They *practice* medicine.

Good point John. My point was more to address that physicians should be paid MORE for quality outcomes versus number of procedures. There should be an acuity factor or adjustment applied to take into account doctors who see the more complex patients or you will most definitely see cherry picking.

keith · June 19, 2009

Isn't the cause of this the same reason it is flawed? The private industry allows tons of money to flow and accelerate for these wonderful technologies and advancements, but they are also conveniently easily accessible for a select few, and nearly impossible for the "rest" to get a piece of.
I can already tell you are much more versed and educated than I am in this subject. Please consider this a humble devil's advocation

Interesting perspective. But I think this is just the way it works. Not everyone can afford the nicest houses or the most expensive cars. Is that fair? How far do we take this? I think ultimately the costs of the best and most advanced medical treatments do come down and becomes available to more and more people.

Keith

keith · June 19, 2009

OK...here are a few other ideas. Again this is based on the premise that the cost of providing heath care is too high and continues to rise out of control.

1) Tort reform. Cap settlements for medical malpractice.

2) The Federal government subsidizes (funds, guarantees, backs, etc.) malpractice insurance. This would remove a major contributor (the major contributor?) to the cost of health care. This would likely have to be done in conjunction with #1. There are a lot fewer doctors than there are uninsured right? Instead of covering 50 million people, cover 5 million (I have no idea how many there are) doctors. If you can take a big chunk out of the cost then the end product becomes more affordable.

3) The Federal govenment could establish price contols on medical procedures, prescription drugs, equipment, etc. setting standard (lower) rates. Pretty dramatic, but if we are really in dire straits.....

I'm really not a fan of 2 or 3, but I'm looking for options that are short of the significant expansion of the role of the Federal government that I think we are in for with the plans currently being discussed.

Keith

Edited June 19, 2009 by keith

FirefightnRick · June 19, 2009

I'm having a hard time believing this is another "Crisis" that we need to rush without pause to correct.

Yesterday, to the tune of roughly $500 to the taxpayers expense I made an EMS(95% of our calls) call to the place that prides themselves as "Doing the MOST GOOD" for an individual who called 911 and needed help immediately. He was 32 years old and built very lean like Jerry Rice, about 6 foot 1, around 175 pounds with muscles ripping from every inch of his body. The guy looked like he could be covering the defensive backfield of any pro football team in the country. His problem? He stubbed his middle toe on his left foot walking up and over the curb headed for the bread line and demanded to be taken to the hospital by ambulance, another expense to the taxpayer of roughly $1500. No telling what the hospital expense was, again at the producing taxpayer's expense? He is one of hundreds in our city every day who sit around in the shade, smoking their cigarettes and drinking their 5th's, text messaging each other on their cell phones waiting for the door to open for one of their two free meals of the day.

In the home, we make other similar EMS calls, same story. Only these people do work. They have to? Otherwise how are they feeding their 8 kids and paying for their 4 and 5 vehicles parked in the yard, many brand new with $2,000 plus worth of tires and rims or for their 72 inch HD television sets, stereos or for the iPhones and Blackberry's they have in their hands when we walk in? Yet when one is experiencing Braxton-Hicks Contractions, has a fainting spell or has had diarhea the past 10 hours they ALL know to call 911 and take the free ride downtown. I don't get it? There's no way in hell all of them have been denied health insurance?

My company was the second busiest engine company in the city last year with a little over 4,000 calls. There's 54 companies in the city and as a department we are averaging over 95,000 calls a year, with 95% of those EMS calls, so roughly a little over 90,000 EMS call per year. Now, of course there are ligitimate EMS calls and we must treat them all as such. But in reality and by my experience the majority of them are rarely true emergencies yet many of their stories will be used to legitimize this "Crisis". We are running on headaches, upset stomachs, difficulty breathing calls in which the patient claim they can't breath(probably due to an allergy) yet their O2 saturation reading will be above 90%. and on and on and on.

A larger city like Dallas, San Antonio and Houston are quadrupling our calls. Take all of this into account and do the math and you can see there is a huge waste of resources.

Personally, I don't know anyone who has been denied medical insurance. I know a lot of people who don't have it by choice though and I was one of them for several years after college. We know the 47-50 Million uninsured qoute is an unsubstantiated myth yet it is also being used to legitimize this "crisis". Just like it was a crisis that needed to be answered about the banks, so we rushed to spendulous our way out of that when it didn't need to happen. Pending rising unemployement was a "crisis" and if we spendulous it won't go over 8%, it's now 9.4%. It was a "crisis" and tragedy was sure to be around the corner if we didn't bail out GM and Chrysler, because if we didn't do it, who would? Then a Chinese company buys Hummer, Fiat buys Chrysler and now Roger Penske buy's GM's Saturn division and the money the taxpayers paid for both companies is gone and more than likely the problems that caused their demise still exists(ie... Unions recieved nearly 17% of the purchase).

Joe Biden said last week "We guessed wrong". This health care issue will account for roughly 17% of our national wealth. Are we willing to let these clowns who have quadrupled the national dept in a little over 8 months do it to us again by rushing in with another "Guess" with the chance that it could destroy the best healthcare system on the planet?

And when will the healthy debate begin with all of this? The democrats didn't enact reconciliation last month for nothing? They want to fast track this thing without any debate or input from the opposition of any kind. This is a power grab. Nothing more, nothing less. And I'm not buying that this isn't Oama's plan? Is that why he is allowing ABC to use the White House to produce a closed door infomercial without any opposition to sell this to the American public? I mean, is anyone else paying attention to the "Chicago Way" of how this administration works?

Rick

Edited June 19, 2009 by FirefightnRick

keith · June 19, 2009

Thanks Rick. There is nothing like a first-hand report from the front line to add perspective to the "crisis." I'm also very suspicious of political demagogues that say we must do "x" by "y" or some horrible thing will happen. We need open debate on this issue. This administration and congress have been pushing through legislation at warp speed. This one especially needs more scrutiny.

Keith

UNTflyer · June 19, 2009

Show me anyone, ANYONE, who is truly being denied health care because they can't afford it or don't have insurance, and I will agree to nationalized health care.

And I don't mean someone sitting around their house with a chronic ailment who was denied by a private doctor and whining to the local newspaper about it- there are clinics, programs, Medicare and Medicaid, etc. Unfortunately, when you're poor you have to do some legwork to get the help you need.

There is no health care "crisis" in this country. What we have is a crisis of the poor, the lazy, and those with money mismanagement issues.

SUMG · June 19, 2009

How the hospital program that Michelle Obama set up at that Chicago hospital she worked for---how they deal with the poor:

http://michellemalkin.com/2009/06/19/the-o...e2%80%99t-hear/

FirefightnRick · June 24, 2009

Carrol, in the Denver Post: U.S. health care is not inferior

The most annoying claim in America's health-care debate? Easy. It's the repeated charge that the U.S. gets inferior results despite spending much more on health care than other countries.
Often this claim will be followed with the superficially appalling news that U.S. health care is ranked 37th in overall performance by the World Health Organization.
Admittedly, the United States does spend more on health care, at nearly 16 percent of its gross national product, than any other country. Even relatively big-spending Switzerland, France and Germany devote only 11 to 12 percent of GDP on health care.
On the other hand, we're also wealthier than other countries. As people grow richer — here, in Europe and any place you care to name — they tend to devote more resources to their health. So in the natural course of affairs, we should be spending more than others, although probably not as much more as we do.
But what about the allegedly inferior results? Let's first dispose of that 37th place ranking......

Rick

Edited June 24, 2009 by FirefightnRick

keith · June 24, 2009

Military personnel have health care benefits as part of their service/employment in the armed forces of The United States. Health care could be as close as the nearest recruitment office if the uninsured were *really* interested.

Keith