graphic by twolf1
Jane and Scarecrow show that Max Baucus’ real plan is for the uninsured to be forced to buy junk insurance. They are referring to the minimum actuarial value of the plans that Baucus is talking about. He proposes a mandate that uninsured people get plans that will cover “less than 70%” of medical costs.
How would you feel about this insurance plan: a $500 deductible; a 50% co-pay, and a maximum of $4,200 out-of-pocket cost. Using a highly simplified model from the CBO, this plan has an actuarial value of about 66%. The premium for an individual would be $3,290 plus the administrative costs, which range from 7% to 30%. The high end is for individual and small firm policies, so let’s say 25%, for total premiums of at least $4,112.50.
Under this plan, if you had medical costs of $8,725, or more, you would get back more than you paid in, that is, your premiums plus your co-pay plus your deductible would equal your costs. If you had $5,000 in expenses, maybe the cost of falling and breaking an arm (you’d be amazed how hard it is to find the cost for a medical procedure), you’d be out your premium and $2,750, a total of $6,862.50 that year. That is going to be a real problem for someone making $35,000 per year.
I’d call that a pretty good definition of junk insurance. The key point in any insurance policy is whether people can pay the costs of their health care without wrecking their budget. I don’t really see how this insurance would help anyone who got seriously hurt and had to miss time off from work, with all the attendant costs, including drugs and drug co-pays, and whatever else the insurance company could wiggle out of paying.
The CBO explains that the price of insurance is the amount the company expects to pay out plus the administrative costs. See page 59 (page 85 of the .pdf) of this .pdf from the CBO. This chapter gives an excellent and straight-forward explanation of insurance pricing. The CBO used this material as the basis for evaluating proposed legislation. The amount the company expects to pay is summed up in the term “actuarial value.” This is from page 62 (page 85 of the .pdf).
One useful way to compare health insurance plans with different design features is by examining their actuarial value. That summary statistic measures the share of health care spending for a given population that would be covered by each plan and thus reflects both covered services and cost-sharing requirements (see Box 3-1).
Cost-sharing requirements are deductibles and co-pays. You calculate the actuarial value by taking a group of policy holders with different annual medical expenses and calculating the amount the insurance company would pay for each. CBO gives an example on page 65. This is a very simplified version, which assumes that there are five different policy-holders with five different annual expenditures, and calculates the actuarial value from that.
Another way to read their example is to assume that there are 5 quintiles, each of which averages the amount of total annual spending shown in the chart. The payment levels are $600, $1,000, $1,500, $3,700 and $18,200. I have no idea if this matches up with the real world, and we don’t have any real actuarial data, but I assume they wouldn’t just work with a stupid example, so I use it to see what it means for policy holders.
If you use that data as the actuarial distribution, it is easy to calculate that my example of junk insurance, $500 deductible, 50% co-pay and a maximum out-of-pocket of $4,200, has an actuarial value of about 66%, which makes it viable under Senator Baucus’ leaked whatever it is.
That should make exactly one group happy: Baucus’ insurance company constituency.
Related posts:
- Former Insurance Industry Exec: Baucus Plan a “Gift” to Insurance Companies
- Baucus Bill: Forcing Americans to Buy Junk Insurance They Can’t Afford to Use
- The Max Tax: Baucus Plan Fails to Control Growth of Insurance Premiums
- Your Junk Insurance is About to Get Worse, Courtesy of Max Baucus & Rahm Emanuel
- The Max Tax: Incenting Junk Insurance to Benefit Large Corporations
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How about Baucus and his family take the plan he is suggesting. This is the WORST thing that could possibly happen. My biggest nightmare is Obama signing something like this piece of shit bill that would bankrupt even more people for getting sick.
I agree with your criticism of the Baucus proposal.
Should I read into your comment the implication that the Baucus proposal is worse than the Senate HELP Committee bill and HR 3200?
Kip Sullivan
Why haven’t we heard from the Raucus Baucus Caucus, his vaunted Gang of Six, about this marvelous proposal? Or did they get the cocktail napkin wet with rings? Does anybody else support this, after a year of Max’s braying? Is this Max’s Last Stand, and is Max alone?
If this kind of work is what Senators get paid for — he’s been at this for more than a year — Americans need to grab their pitchforks. The Senate game is up; Max has given it away. They are do-nothing purchased corporatists.
Finally got around to reading Taibbi’s article in Rolling Stone. Everyone who hasn’t yet read it, it’s worth the time:
sorry the link won’t work, but its at the Rolling Stone Magazine page.
Why are we even paying attention to this plan the ones from the house are better. Co Opts are a gift to the insurance companies. And besides Baucus couldn’t even run his committee he just proves the old saying that Democrat’s when in power can’t govern. Folks like him in congress will give the Repuk’s control in 2010
“They are do-nothing purchased corporatists.” —-you are way too polite. Fucking whores is more like it(whoops, that’s an oxymoron).
The plan you described sounds pretty good to me! I pay $400 per month for a $1200 deductible- heavy co-pays- and a max out of pocket expense of $10k (If I remember properly). This is considered very good insurance. I believe I also have a $5mm limit on what the insurance plan will cover- after that I’m on my own.
At any rate, even if one thinks that the coverage you describe is “junk”, where is it written that people are “forced” to buy it? These are only minimum standards for a plan- not maximum, and people can buy as rich a plan as they care to.
I know hundreds of people who would love to have such “junk” insurance- and count me as one of em- particularly if I get help from the govt. to buy it.
Where is Kerry that wimp and the other Dem’s who are on this committee ???
I just fucking want to be able to buy into a good type of medicare.
Not one dime for private insurance.. not. one. dime.
Let’s burn Well Point, CIGNA, United, Blue Cross articles of incorporation in effigy on the capitol steps. Then let’s do it for real.
The Baucus/obama/snowe “reform” plan isnt about expanding health care and lowering cost, its about claiming political victory and handing the insurance cartel a truly historic payoff/ripoff to get it.In most cricumstances, when govt and capitalism collude like this we are getting ripped off, but the costs are better hidden. It must be an indication of how far removed the ruling class in washington and gated communities everywhere are from the middle class, and how deep and wide the class canyon has become if they couldnt see that this rip off isnt going to go over unnoticed like so many before it.
in decorating, it can be said, “less is more.” this seems to be the case the health insurance industry and its paid lackeys would also like you to believe. fine, let him get his measure out of committee and cover his as* until his next primary. his and kennedy’s health care plans will go to the floor, then conference and finally reconciliation.
no amount of campaign donations can overcome a majority of voters who come out to vote against baucus, conrad, the two nelsons and mary landrieu.
But dirty bloggers don’t have editors or cackleyators, just Cheetos and Red Bull. Very serious people, like Baucus, Alter and Friedman know what’s best for us. Be still.
The alternative is to let them live but restrict what they can charge, as the french do. They have the best health coverage in the world- of course they also restrict what docs, hospitals, and drug companies charge. It works great.
WHEN PEOPLE ARE ASKED IF THEY WANT THE “PUBLIC OPTION” 43% SAY YES
WHEN PEOPLE ARE ASKED IF THEY WANT THE “PUBLIC CHOICE” 77% SAY YES
WHAT WOULD HAPPEN IF THEY WERE ASKED IF THEY WANT A “MEDICARE CHOICE?”
Over 37 Trillion Reasons 0BAMA/AXELROD /GIBBS/ EMANUEL ARE WRONG
Support STRONGEST PUBLIC OPTION = Medicare for ALL WHO want it and OPT OUT for those who DON’T!
HEALTH CARE COSTS = $37 TRILLION / 10 YEARS
Calculations (see table): ($5+$2.4)/2*10 = $37 Trillion
HEALTH CARE COSTS = THE #1 THREAT TO OUR FUTURE!
$2.4Trillion spent in 2008, 17% of OUR GDP
$3.1Trillion by 2012
$4.3Trillion by 2016
$5.0Trillion by 2018
And we are worried about $600 Billion, less than 2% or 1.6%! GIVE ME A BREAK!
The $1.3 Trillion in savings from non-emergency use of the ER will be saved by the States and Cities and therefore reduce funding from the Federal Government!
__________________
[CURRENT 2008 Costs for 47 million uninsured= $87Billion =10 yr cost $870 Billion
2007 Medical uninsured bad debt=$25.4Billion, increased 9.5%/yr=10yr cost $433Billn
Adding $870 Billion+$443 Billion=$1.3 Trillion]
__________________
100,000,000 people to ??? people in Medicare can negotiate “FAIR PRICING” for Health Care Services! Stops the FOR-PROFIT GOUGING!
Make #1 MAY0 C1inic the N0RM instead of the Exception! #37 USA Cuba Care!
Create Incentive for ER Doctors to convert to Family Practice Doctors!
And adding salt to the wound, it’s still ’sickness insurance’, not health insurance.
Health insurance would incorporate features aimed at improving and enhancing ‘wellness’: discounted gym memberships, nutrition classes and/or counseling, and ’stop smoking’ programs and support. And ‘wellness insurance’ would also address mental health and stress reduction programs.
When did Baucus decide to put health insurance reform in a pair of cement shoes and push it off the nearest bridge?
It’s written into the bill that people are required to have insurance. If you don’t get something better from your employer, this is what you must purchase.
Requiring people to buy insurance without meaningful reform of the insurance industry or substantive pressure on their practices through competition with an option to purchase a public insurance program is a gold mine for the insurance companies. They get a guaranteed market and no pressures to hold the line on costs.
Im waiting to see if Obama actually explains how this turd is supposed to work, in detail. Not in misleading euphemisms and mistatements of truth like “the bill would give nearly universall coverage to millions who lack it”..not so. the bill would force people who cant afford health insurance to buy it anyway, and the REALLY sick thing is, these kinds of junk insurance polices are available all over the place right now for about $50-$100 dollar per month. after mandates and subsidies, dose anyone doubt the insurance industry will be getting probably, $500 – $1500 dollars per month for them…..nice “reform”
BAUCUS GIVES AWAY THE SHIP in Negotiated DEAL with BIG PHARMA!
Tauzin Representing Big Pharma said, “They wanted a big player … to negotiate with Democratic Senator Max Baucus, who heads the Senate Finance Committee, which has yet to present its version of health care legislation. Baucus is beholden to the health care industry, having raked in nearly $1.5 million in 2007-2008 from lobbies representing hospitals, insurers, pharmaceuticals and other health care interests.”
“Tauzin’s negotiations with Baucus went well for the drug companies, with the committee reportedly moving away from measures that would have allowed the government to negotiate drug prices, or allowed the importing of cheaper drugs from Canada or Europe.”
http://www.wsws.org/articles/2…..-a07.shtml
The White House reviewed and approved of the BAUCUS GIVEAWAY!
I presume that Baucus isn’t actually designing a plan but merely making some working assumptions so that his group can go about the business of finding a way to finance it. If so, it’s probably better to emphasize that part of his proposal.
HR 3200 sets up a minimum actuarial value of 70%. Baucus is lower, and by definition worse. It requires at least one plan with an 85% actuarial value, and one with 95%. The costs of these plans will be higher.
HR 3200 calls for higher subsidies. That is a major difference in its favor.
Baucus doesn’t make any statement about cost control. HR 3200 sets up the public option, which I believe will control costs, at least if it isn’t destroyed by the industry or the “level playing field” jerks.
“This is considered very good insurance” by whom?
Comments like this one make my Inner Barbarian chortle.
Yeah, well, our insurance co’s should be murdered.. If we want insurance like the French, that’s fantastic! But we better start from scratch, not work with the criminals we have.
The PUBLIC OPTION DEATH PANEL OF SIX – WHERE DOES THEIR LOOT ORIGINATE?
42.6% from Washington and New York!
56.40% from Washington, New York, Los Angeles, and Chicago!
[source: opensecrets.0rg]
CITY ________CITY’s T0P D0G__$L00T_% of Total
WASHINGTON ENZI 4,136,861 24.3%
NEW YORK SNOWE 2,845,333 18.3%
ALBUQUERQUE BINGAMAN 1,471,833 9.5%
LOS ANGELES BINGAMAN 991,777 6.4%
CHICAGO BINGAMAN 963,027 6.3%
SANTA FE BINGAMAN 900,091 6.1%
DES MOINES GRASSLEY 795,837 5.4%
PORTLAND SNOWE 638,378 4.4%
SAN FRANCISCO BAUCUS 475,000 3.3%
BILLINGS BAUCUS 377,021 2.6%
BOSTON SNOWE 344,532 2.4%
MISSOULA BAUCUS 299,926 2.1%
DENVER BINGAMAN 290,638 2.1%
BRIDGEPORT ENZI 213,379 1.5%
BANGOR SNOWE 205,320 1.5%
It is time for BAUCUS to be hauled up in front of the “USELESS Senate Ethics Committee” that has proved it “PROTECTS ITS OWN,” just to see if they have any power at all over corruption!
In 2004 the House Ethics Committee unanimously admonished DeLay for his actions related to a 2002 energy bill.
A Committee memo stated that DeLay “created the appearance that donors were being provided with special access to Representative DeLay regarding the then-pending energy legislation.”
NOW it is TIME for the SENATE ETHICS COMMITTEE to look at BAUCUS who “created the appearance that donors were being provided with special access to Senator BAUCUS regarding the NOW-pending Health Care legislation.”
___________________
BAUCUS stands out for FLY FISHING with the Industry Executives!
Like DeLay stood out for Golfing with the O1L Executives!
exactly! would anyone weep for the insurance industry if it went stone dead belly up and dissapeared from the earth?
Here’s the link to Matt Taibbi’s Rolling Stone article:
http://www.rollingstone.com
/politics/story/29988909
/sick_and_wrong/1
I think if you just clip and paste as a whole link, it should work.
Don’t disagree with what you say but please don’t shout. It’s hard on the eyes.
My ears are bleeding over here.
How about tossing everyone eligible for a public plan into medicare with parts B etc eligibility?
What the F… are we doing here???!!!
NOW it is TIME for the SENATE ETHICS COMMITTEE to look at BAUCUS who “created the appearance that donors were being provided with special access to Senator BAUCUS regarding the NOW-pending Health Care legislation.”
___________________
BAUCUS stands out for FLY FISHING with the Industry Executives!
Like DeLay stood out for Golfing with the O1L Executives!
========== ========== ========== ========== ========
Perhaps One of these Progressives could give BAUCUS a run for his 0ffice – Hopefully NOT his L00T!
Brian Schweitzer, Governor
John Schneeberger (Hamilton)
Frank Kromkowski (Helena)
Diane Kamp (Big Timber)
Paul Richards (Boulder)
Pete Talbot (Missoula)
Debbie Smith (Helena)
PAUL CLARK, TROUT CREEK
RON ERICKSON, MISSOULA
CHRISTINE KAUFMANN, HELENA
NORMA BIXBY, LAME DEER
MICHELE REINHART, MISSOULA
MIKE MENAHAN, HELENA
LARRY CYR, BUTTE
KENDALL VAN DYK, BILLINGS
It would seem to be crazy to NOT require people to buy insurance that meets some minimum standards if you are going to require companies or the govt. to insure anyone who applies. You need to keep people from skipping coverage until they get sick and THEN signing up- freeloading the system.
Seems quite logical to me!
START FROM THE PREMISE THAT ALL NEGOTIATED TERMS WITH REPUBLICANS ARE “OFF-THE-TABLE”
Yes! Republicans Now Support Medicare 100%!
BACK ON THE NEGOTIATING TABLE:
1. Single-Payer Medicare!
2. Buying Medicine in Bulk -keep COSTS DOWN+Re-importation of Drugs!
3. Bargaining with Hospitals and Other Service Providers
4. Remove all LOOPHOLES!
_________________
MEDICARE FOR ALL WHO WANT IT and ADD that ANYONE CAN OPT OUT TO BUY COMMERCIAL INSURANCE!
HR 676 – 50 pages of simple reading – Basically MEDICARE for ALL but let people Buy Insurance if they want!
FIGHT THE BUREAUCRACIES and NEW LOOPHOLES IN HR 3200+BAUCUS BILL!
HR 676 = No Loopholes + No NEW Bureaucracy! Maximum Cost Savings:
A Savings of $1.3 Trillion over 10 years from uninsured NOT using Emergency Rooms!
[CURRENT 2008 Costs for 47 million uninsured= $87Billion =10 yr cost $870Billion
2007 Medical uninsured bad debt=$25.4Billion, increased 9.5%/yr=10 yr cost of $433Billion
Adding $870Billion+$443Billion=$1.3Trillion]
Matt Tiabbi has three videos that make it clear the only useful option for Americans is HR 676 Single-Payer with an option for people to OPT OUT and Buy Insurance!
All other House and Senate Bills have LOOPHOLES+GIMMICKS that give Corporatists massive INCREASED PROFITS and will FURTHER DAMAGE AMERICA!
http://www.rollingstone.com/videos/player/29735557
http://www.rollingstone.com/videos/player/29735504
http://www.rollingstone.com/videos/player/29735535
S 703 – Single-Payer in Senate is still VIABLE just add option for people to OPT OUT and Buy Insurance!
And it’s on the table!
Thanks! Hope folks read it.
oilfieldguy go drill baby drill with that talk, the time to be still is over we need to stay aware and active!
I agree with eureka springs!
Us that have only a glimmer of hope left that this Obama experiment is still viable, we need a sign. If O signals to the nation that he, as the president, supports a public option for Insurance reform and is willing, finally to say so and basically tell Baucus and his band of lying jackass comedians to blow it out their pie holes, then we’re back on track..If not, we’re sunk.
Dude, post your own diary.
Insurance serves NO Purpose in Health Care Whatsoever!
Corporations Self-Insure!
306,000,000 in MEDICARE can demand PRICING ATTENTION and QUALITY IMPROVEMENTS!
Insurance Companies block our vision and our VOICES FROM BEING HEARD by the Hospitals, Doctors, Drug Companies, and other members of the Health Care establishment!
Remove this CURTAIN and BLOCKADE!
____________
End Socialism!
Keep your hands off my MEDICARE and my SOCIALISM SECURITY!
____________
STRONGEST PUBLIC OPTION = Medicare for ALL WHO WANT IT HR 676 and ADD an option to OPT OUT for those who want to BUY COMMERCIAL INSURANCE!
The public option would not be free. However, with the profit motive removed, no advertising and bargaining power (perhaps), the public option would be far cheaper than private insurance. This would force executives to give up multi-million dollar salaries and such to lower their premiums. Plus, they would actually have to play claims, where in some cases they have a 40% rejection rate. This is why we would like the public option to be a choice.
OK!
Shouting really gets old.
Er, that was snark. Sorry for the confusion. I’ll just quietly rub this knot on my head you just gave me.
Baucus: $4 Million from Health Care Industries!
#1 Lawyers/Law Firms $1,608,823
#3 Insurance $1,190,463
#4 Health Professionals $1,032,276
#5 Pharmaceuticals/Health Products $751,605
#6 Lobbyists $738,884
#8 Hospitals/Nursing Homes $570,491
#12 Health Services/HMOs $463,350
Jeff Bingaman Health Care Funding: $853,000
#2 HealthProfessionals $547,616
#11 Insurance $160,875
#17 Pharmaceuticals/Health Products $144,498
#1 Lawyers/LawFirms $1,210,098
#6 Lobbyists $271,979
#7 Securities&Investment $242,276
#9 Real Estate $202,191
#12 CommercialBanks $158,935
#16 BusinessServices $145,713
Kent Conrad Health Care Funding: $2,169,000
#2Insurance $828,787
#3HealthProfessionals $617,432
#6Lobbyists $425,236 – Not included
#13Hospitals/NursingHomes $277,766
#15Pharmaceuticals/Health Products $255,450
#19HealthServices/HMOs $189,715
Wall Street/Finance: $1,189,000
#4Securities &Investment $597,524
#8RealEstate $348,841
#16CommercialBanks $242,229
#1Lawyers/Law Firms $1,038,407
Depends on what kind of system you’re trying to build, rw.
If you’re trying to build a system that encourages health care, that’s one thing. If you’re trying to build a system that games the financing of the delivery of health care, that’s quite another.
Insurance companies are *not* in the health care business. They are in the finance business. There’s no sin in that, but let’s not confuse one with the other.
Let me see if I understand what you’re saying:
1) You, personally, would be better off with this insurance than what you have
2) If people don’t think it covers enough, they can just pay more for better insurance
What about the people who will be forced to buy insurance and won’t be able to use it because they can’t make the co-pays? How do they wind up better off?
The point, as peterr says, is that people have to buy this, and naturally they will go to the cheaper policies, the junk policies. When they get hurt or really sick, they will learn just how little it does for them. It isn’t even clear those policies will leave them solvent. It is particularly troubling that the young will be the primary buyers of junk policies. They will be turned off forever.
Bill MAHER SHOW:
Moyers said, “I think the reason for that is that the Democratic Party like the Republican Party has become DEEPLY influenced by Corporate Money.
I think Rahm Emanuel, who is a clever politician, understands that money for 0BAMA’S reelection will come primarily from the Health Industry, Drug Industry, and Wall Street.
So he is a Corporate Democrat who is determined that there won’t be something in this legislation that will turn off these powerful interests.”
We are BEING S0LD D0WN THE R1VER!
Copy and paste for Video:
http://www.youtube.com/watch?v…..edded#t=41
and i especialy agree with jacksonandrew, and thaks for the good info
New around these parts?
BIG BAD SOCIALISM??
Socialism is economic organization by equitable access to resources for all individuals and an equitable method of compensation.
Progressivism advocates progress, improvement, or reform against the STATUS QUO.
Conservatism advocates the preservation of the STATUS QUO and opposing ANY changes.
The ultimate Conservative is a Libertarian since they want the Status Quo in their DREAMS of some world that never existed and they believe “cause and effect” does not exist so have no conscious or guilt!
VAMP1RE Capitalism is great for the Wall Street and Corporate VAMP1RES but the rest of us are running low on BL00D!
________________________
PROUD TO BE A LIBERAL:
Definition of LIBERAL: In 1690, John Locke defined Modern liberal thought writing, “no one ought to harm another in his life, health, liberty, or possessions.” A belief in the dignity and worth of individuals.
Liberalism holds that the only legitimate form of government is one that respects the liberty of its citizens, with open and fair elections, where all citizens have equal rights by law.
Socialism is economic organization by equitable access to resources for all individuals and an equitable method of compensation.
Locke, Paine, Jefferson, Madison, Franklin, Washington, and even Adam Smith (hijacked by the right) should be required reading in schools again.
Misuse of the term will NOT end with the continuous L1ES from the Right!
Our President must embrace the label LIBERAL and be proud of what it STANDS FOR: The dignity and worth of ALL individuals!
easy big boy
Time for FIRE in FIRE DOG LAKE!
YES NEW!
Cover your EARS then!
Rethug: “The great thing about “welfare voters” is that they are self-perpetuating.”
Answer: Are you talking about Wall Street?
They are the only recipients of WELFARE with $23.7 Trillion so far!
That is $237,000 per family in America given to Wall Street!
Corporate Welfare to the CR00KS!
_________________
THE WELFARE STATE WE MUST UNDERSTAND!
$13 Trillion =BL00D+ SWEAT+ TEARS OF ALL AMERICAN WOMEN AND MEN WORKING TOGETHER for ONE YEAR (Add up all their VALUES)
Wall St WELFARE STARTED UNDER BUSH = $23.7 TRILLION = 2 Years LOST
Jane
(can’t get the reply button to work)
As I understand the discussion, the poor will continue to be covered by medicaid and there will be help available for those up to $70k income or so.
Who would be the people who couldn’t afford the copays?
Even medicare has copays and deductibles.
Here’s a link where you can write your own diary: http://seminal.firedoglake.com/diary/post
Congress should kill off insurance companies as we know them.. I don’t see any other reasonable way to deal with these fraudulent teabagger hiring leaches.
Please don’t dominate the rap, jack, if you’ve got nothing new to say.
If you please, don’t back up the track; this train’s got to run today.
I spent a little time on the mountain, I spent a little time on the hill.
I heard someone say “Better run away”, others say “better stand still”.
Now I don’t know, but I been told it’s hard to run with the weight of gold.
Other hand I have heard it said, it’s just as hard with the weight of lead.
You sure know how to make folks warm to the logic of your position, friend.
When I enter somewhere new, filled with people that don’t know me, I take a little time to get the feel of the place. Shouting at everyone may get attention, but it tends to turn folks off.
Me, in my current situation.
OK bro, just worrying about the FDL image! I thought we were talking about CEO’s!
Welcome to the lake. We are primarily a group of activists and like to discuss the issues and get differing points of views from others. On some blogs, no one talks to each other and it’s just a neverending series of cut-n-pasters. Your input and views are valuable.
That is just you!
I am a bit different and isn’t that what makes for a democracy!
Back off.
Thanks! We must get the facts out about Baucus and what he is doing to Health Care!
I don’t do that!
But if you impoverish yourself by paying for your medical care out-of-pocket, and then also pay the new uninsured fines when they catch you without “insurance,” you will be eligible for MedicAid!
See how easy that was?
Somehow ‘universal single payer health care’ has morphed into ‘a public option’ which has morphed into ‘let’s figure out a way to give even more millions of dollars to the health care industry.’
Even Reagan agreed that Health Care is “A RIGHT for ALL regardless of income!”
The Socialist LEADER Reagan signed Bill saying, “Inpatient care provided must be at an equal level for ALL patients, Regardless of Ability to pay.”
23 Years ago Reagan signed (1986) law making Health Care a “RIGHT” for ALL PEOPLE IN AMERICA, including visitors and a1iens, the EMTALA!
Of course, some days you will sit for 8 hours to get your chest cold looked at and it costs all of us $1.3 Trillion every ten years because the ER is the most expensive health care in America!
If Obama ushered in a historic sweeping health insurance reform for ALL AMERICANS
the Republican party could be utterly discredited for DECADES.
___________________
Voters will reward Democrats with political loyalty (for DECADES) like Depression-era voters did in gratitude for the New Deal and Social Security.
It will lead Republicans to the “Party of DEAD” for DECADES if 0BAMA Passes a Strong Public Option Bill!
They KNOW IT and are F1GTHING like a Cornered/Angry L1ON!
Isn’t that gross? Since it’s such a Catch-22, they should call it “YossarianCare.”
Yeah, who needs a house.. if they can just have medicaid..)
that would be me.
Perhaps you didn’t understand the point of the broken arm example. The cost to an individual making around making $35K would be nearly 20% of income. In what world is that reasonable?
If a health insurance mandate without a public option is made law, profits for the private insurance companies will go up and democrats in office will go down.
Sanders vs. Sessions on CNN: Sessions says we don’t want teh government running our health care. Sanders says so you want to disband the VA?? Sessions says oh, no, let’s get together to solve the probems rather than scrapping the whole system. Sanders did good: fiery, forceful.
OT? and REALLY disturbing: Earlier CNN was reporting with punditry (that I didn’t listen to …) that Obama’s “Whites” polling numbers are falling. This is the problem with all this racism. It’s working, if only by subversion. It’s got to be countered. Appeasement is disastrous!
If I interpret JacksonAndrew, the “Illness Maintenance” companies are blood sucking parasites who care only for consumers and not patients. Also in many cases they do not provide quality health care. It is more profitable to keep people ill. But Neo-con Shock Doctrine policy, by Council of Foreign Relations, American Enterprise Institute, Goldman Sachs and the 30,000 dee cee corporate lobbyists, to destroy democracy is right on schedule.
I love that. When I was in the Army, I used that name as the basis for a nickname.
I told ya that speech today would rile up the crackers. He was signifyin’ and they hate that!
It’s really a rip off. The mortgage for me and Chris’ house is about $1400 per month; my portion of the health insurance premium for the 2 of us is $680 per month; my employer is picking up about $800 per month and that is going to go down next year.
So I’m paying for half of another house per year, and getting NOTHING for it.
Lucky me, that situation will soon be mandated.
The outrage should be universal.
Like nobody knew that till he showed up with his cut and paste.
Sell at a loss; make it up in volume! LOL!
I’m sure when Obama accepts a few more resignations from the black Marxist Truthers his Administration is populated with, his white-approval numbers will start to soar!
/Rahm
An Amazing $573 Mi11ion to Repub1icans in CONGRESS from BIG PHARMA+1nsurance+Hea1th Care Providers!
BIG PHARMA Funding FUNDING ALONE to Republicans = $llO MILLION
[0pensecrets.0rg]
When I was in the Army I lived Catch-22!
Mandate without public option is the end of the democratic party. It’s a trap. It’s insanity.
People will be required to PAY for a system worse than the one they have now.
And then the repubs can say “see, the evil dems took away your health care freedom. That was their plan all along. Let freedom ring!”
Where is the broken arm example? And where did you get the 50% copay you use in your post? From Baucus?
Exactly! Collusion among Insurance Companies will continue in a different form:
Instead of diving up the States (You take Arizona and I get Colorado) it will change to only PRICE FIXING. That is why their is almost NO competition.
With a TRIGGER then they will PRICE FIX for Five Years, then behave well to avoid the TRIGGER, and then Collude and Price Fix again.
Strongest Public Option = HR 676 (50 simple pages) of basically Medicare for all + Add an OPT OUT for those who want to Pay Commercial Insurance Companies (they can buy in later for a FAIR PRICE).
Mod note: please be respectful to the author and to other commenters and do not try to dominate the conversation.
Here’s a reality-based plan. Why don’t all the conservatives who hate taxes, etc. be allowed to OPT-out of *some* taxes ~ you have to pay for roads and police because you cannot opt out of the services ~ so if you don’t like the public option you get a tax reduction but you don’t get public option health coverage. And you don’t get unemployment or Medicaid or whatever …
I know, I know, but it would wake some people up … maybe ….
$37 Trillion over the next ten years to Health Care Industries!
The important numbers are:
1. US ranks 37th, on PAR with CUBA and below Chile and Costa Rica
2. US pays 134% over the median other rated countries pay
3. We live shorter lives
4. We are less Healthy
5. We have a higher rate of Infant mortality
6. Medicare has a 3.1% Administrative Cost while Insurance Companies range from 20% to 30% or 650% to 1,000% Higher
7. Our services are geared towards making MONEY NOT HELPING PATIENTS STAY WELL OR GET WELL
Exactly!
Buying back in would be COSTLY!
Please take a careful look at the post. Baucus sets the bar for the actuarial value of acceptable plans at under 70%. I worked out an example that meets the test. I apply it to a broken arm.
Everyone wants to talk about this stuff in the abstract, forgetting that it will have real world impact. I think it helps to have concrete examples.
This is a good rundown of what’s wrong with the Baucus plan, masaccio. Add to all this that the insurance companies expect to keep at least 20 percent of their premiums, and you have a recipe for inefficiency.
yup
I think this is a key distinction. Are you purchasing insurance now? Or are you uninsured now because you can’t afford it or don’t think it’s worth it?
1. If you don’t get insurance through an employer, but you do buy insurance today on the individual market, then the bill could help you, as rw notes. The reason is that the mandate creates a larger shared risk pool, so (in theory) the costs are averaged over a larger group, and the average cost can be less than what some individuals pay now. And the subsidies could help even more for those who are eligible.
2. But the effect on the currently uninsured is very different. For the first time, they are required to purchase a product they weren’t required to purchase before. And for some, perhaps most of these, the value of that insurance to them could be less than what they are forced to pay, especially if the subsidies are low and as the co-pays/deductibles/total yearly out-of-pocket exposure get higher. masaccio’s case applies primarily to this second group.
Ignore at will. Thread hijack complete.
For the “Reply” button to work, you have to have Javascript enabled, at least within the firedoglake.com domain. If you have Firefox running NoScript, that last clause makes sense, otherwise, just enable Javascript and it should work.
You are confused about the nature of the trigger. Rahmbo will have his finger on the trigger, watching to see if the health insurance industry donates to republicans. If they do…boom.
Just my opinion though.
What you say is true, at least if you can count on the government to enforce the new rules. What if you can’t? It’s a fair question, given how little they’ve enforced the rules until now on any part of the financial
sectorindustry. The public option, assuming it’s a good one, would be one way of keeping insurance companies honest that doesn’t depend on Congress’s continuing to fund an enforcement regime, and the President’s desire to use that regime.It really does help. And the other thing that drives me nuts are the lifetime caps. I have a stack of EOB [explanation of benefits] that I’m looking at for Chris’s recent foray into healthcare nightmare.
After 2 weeksw of total discomfort, he gets in to see his primary doc, who walks him straight over to the ER for CAT scans etc. Diagnosis; diverticulitis.
In terms of actual treatment, he saw 2 doctors for about 15 minutes each, was run through the CAT machine, then on a gurney ( in the hallway – no rooms available) for about 4 hours with an IV drip. Total bill? $7,500+.
Four frikking hours, $7,500. That’s insane. But the worst part is the cap. We’ll get marked for $7500, when they’ll (CIGNA) actually pay out about $3700.
Your million dollar cap is worth about $500,000 and at these prices, and they’re expected increase, your coverage becomes less and less meaningful or effective.
You put your finger on the issue I thought we would disagree about: Your belief that the tiny little “option” in HR 3200 will cut costs. Is that accurate? Are you saying that the “option” provisions in the current version of HR 3200 (the original version and the version that passed the House Ways and Means and Ed and Labor committees)will create an “option” that will actually survive and force the insurance industry to lower its premiums?
If that’s what you’re saying, could you tell me why you think that?
The fact is the “option” in HR 3200 is no better than the “option” in the Senate HELP Committee bill, which you did not cite, presumably because you agree with me that it will accomplish nothing (except perhaps to embarrass all of us who believe government can provide health insurance a lot more efficiently than the insurance industry can when the government is allowed to do that without selling insurance, which is what the “option” will do). I’m about to post a comment documenting this fact on the PNHP blog. I’d be glad to discuss this further here if you have some questions about my statement that the HR 3200 “option” is just as pathetic as the HELP Committee “option.”
If you’re wrong — if the “option” in HR 3200 is just a little bauble that will do nothing to cut costs and might even fail to survive — then all the promises in HR 3200 (that the coverage will be better than the Baucus proposal, and the subsidies will be higher than the Baucus proposal) mean nothing.
If there is no cost containment in either HR 3200 or the Baucus proposal, then why should we care that the authors of 3200 make bigger boasts about their coverage and their subsidies than Baucus makes? In that event, shouldn’t we be demanding that both Baucus and the authors of HR 3200 stop pedalling snake oil? Why direct our anger at Baucus’s proposal only?
Kip
Actually, even you are too polite. In the wild west, a guy like Baucus would have been strung up by the towns people. Considering his position in the Senate and the oath he took, this is a treasonous act.
The “trigger” will never never never be pulled. That’s the beauty of the trigger trick. Things will change, smoke will flow, mirrors will float, and oh gosh golly we just can’t “force” thinkgs like we said we would, for all the reasons that the lobbyists and the corporations are being coddled now. Triggers are a game. We will always be losing.
Yes that is the IDEA!
My broken arm would have cost double with insurance (and 5k or more deductible). I could not afford half that to begin with.
And I skipped appointments to save costs, didn’t consider possible treatments / surgery… kept basic ex-rays to a minimum (less than Dr wanted).. and received no physical therapy.
Had I paid for insurance first.. i would certainly be homeless today.
The oath he took, at least officially, was to preserve and defend the Constitution. How do you think he violated that oath?
Max should be required to enforce this law he is pushing. He will probably have hundreds of thousands of middle class, especially younger, citizens to arrest each month when they decide not to buy this crap and have a life instead.
Actually, the examples are completely necessary: in the abstract it’s all supposed to work so well and the fairy tales are lovely … when real people’s health and money are in play, not so much, huh.
Excellent Point Oilfieldguy.
We are paying attention to Baucus’ plan because he is the front man for the White House.
I’m pretty sure you are right about the impact on the currently uninsured. As to the individual market, the CBO says this:
If individuals can buy through the exchange, then the administrative costs would drop, and their premiums would be lower. I think HR 3200 permits that. If so, the source of the premium drop is probably the lower administrative costs.
I’m working on the public option issue, and will post more later.
The way I am seeing HR 3200 work is that WITH the mandate, the risk becomes spread amongst all the carriers. The Carriers get to keep their employer pool, but MUST play in the Exchange.
Now come all these new people in the Exchange, some where around 30 milllion? Regardless of the actual number, it will be big. So in this exchange portion, the Carriers have one of 2 options; compete and lower costs, or continually churn over customers to the PO/Exchange over time.
The actuaries are shitting bricks about this, because it’s true that Carrier margins will decline. And that’s exactly what they don’t want, yet what makes sense to make healthcare affordable.
It’s fine to make 20-30% on financial or speculative investments, but is it fine to speculate on your individual life/healthcare outcome?
This is why the PO is the “Solomon’s Baby” of healthcare. Single payer is the right way to go; the PO is the political way, the “ok we’ve made a concession” way to go.
Jane’s made that abundantly clear.
I stand by what I wrote. This is not about trying to get republican votes or even providing a great bill. It is about keeping the health insurance lobby in bed with corporate dems and away from funding republicans and attack ads.
The trigger is a threat to the industry to behave for the benefit of the Democratic power structure, all orchestrated by Rahm Emmanuel.
What’s to stop them from just applying that cost savings to their profit margin, instead of passing it on to the consumer?
That is just not right. Not right at all. It makes me so sad for you.
If you were in Denver you could live at my house. You’d love the food! You’d improve the music around here too!
Don’t depend on electoral politics to solve this. Max isn’t up for re election until 2014. The world could end by then. Movements is where it is at. Join the “Mad as Hell Docs” as they make their way from Portland, Oregon to D.C. This is the modern day equivalent of the 1894 march to Washington of Coxey’s Army of the unemployed. They were going to D.C. to demand that the government create money not the bankers. They were part of the “Greenbacks” movements that figured out that we the people shouldn’t be borrowing money from the bankers and being charged interest.
If you are living in the “now”, working for the next election is a bunch of b.s. Now is the time for action
Oh I am fine, happy and in my wonderful home. because I didn’t try to buy insurance… and the kindness of many friends.
The point is, under Baucus Plan (especially if mandated) I would have been totally screwed.
Single payer is the right way to go; the PO is the political way, the “ok we’ve made a concession” way to go.
It’s also the path of least resistance among the electorate, I think. One thing I was struck by at the town hall I attended was how many people genuinely liked the insurance they had, and were resistant to giving it up. When it’s your health and life involved, and something’s working for you, you’ll be a lot less likely to want to give it up without knowing what you’re giving it up for, and how that’s going to work out. The PO gives people a choice, which several of the people at the town hall who liked their insurance nevertheless thought was a splendid idea.
You have to regulate the rates they can charge, just like car insurance, or it won’t work.
Anyone think that the health insurance companies would be happy being told they can’t raise their rates 10 or 20 percent every year?
I totally agree! No free lunch department: If I were to return to Canada, I would pay an additional $4,000 a year in income tax, in effect to cover me in the province of Ontario.
In the US, I am so fortunate as to have a state health plan that costs me $171 a month. It’s a Cadillac! A $200 deductible and a small co-pay. Includes prescriptions with low co-pay. I would be in real difficulty if I had to pay $400 a month!!
I’ve been distressed and screaming about this aspect of the insurance reform bill for a long time because I’m concerned about what’s going to happen to the people who are living from paycheck to paycheck struggling to remain current on their home mortgages and credit card debt payments. Those who are employed, but not covered by employer provided insurance, will no doubt find their employers deducting the cost of their insurance from their paychecks and suddenly find themselves in bankruptcy court. The self employed who cannot afford the insurance probably won’t pay it triggering massive non-compliance.
This brings up the following question: What are the penalties and how will they be enforced? I can foresee people losing their homes and possessions behind this.
And if our congress critters get the bright idea to criminalize non-compliance, I can see a whole lot of torches and pitchforks lighting up the night skies around Congress and the White House.
The last thing we need is more people in prison.
Sounds like just more Money for Corproate coffers for virtually no cost to them!! Oh well Blue Dogs could care less about the Middle Class… nothing we already DON’T know about them…
Me.
Those of us who aren’t poor but aren’t rich either.
The middle class and the ‘working poor’.
I just want to emphasize that this isn’t a rhetorical question – I’m wondering.
What state? Sounds like a winner.
Whew! Good. Glad you’re happy and ok. ;]
I found your comment to be true from the last townhall I was at; DeGette’s, last Thursday here in Denver.
FGS. Isn’t health of a population as important as the education of a population, which has largely been paid by the public for decades? The rest of the developed world thinks so. Morality, aside.
WA!
They wind up being forced to pay money they don’t have for nothing because even when sick they can’t go to the doctor. Why can’t people understand that folks without jobs have NO money to purchase anything.
I gave two questions for you.
(1)You’re assuming (a) “option” insurance will be available throughout the country and (b) that it will be cheaper. Why do you make either assumption? Can you point me to a single document that describes how the Department of Health and Human Services will succeed in making health insurance for the non-elderly available for sale in even one state, much less all 50, and, when it has done that, how low the “option” premiums will be vis a vis those of the insurance industry?
(2)Why do you assume that creating more tax-financed customers for the insurance industry — you called it “spreading the risk among all the carriers” — will lower costs for either the insurance industry or the “option”? If covering the 50 million uninsured was a surefire way to lower costs, the insurance industry would have done it long ago without hectoring from the government.
Kip
“I have altered the deal, pray I don’t alter it any further”
Summary:
Baucus’ plan = force uninsured to buy junk insurance
Baucus’ plan = uninsured people get plans coving “less than 70%” of medical costs.
Baucus’ plan = $500 deductible; a 50% co-pay, and max of $4,200 out-of-pocket cost
Baucus’ plan = model by CBO has an actuarial value of about 66%
Baucus’ plan = Individual Premium $3,290 plus administrative costs, from 7% to 30%
Baucus’ plan = one group happy = Baucus’ insurance company constituency.
They’re talking fines of up to 2.5 percent of your income. (Not sure if that’s gross income or net income, but the amount – and the idea, if we’re supposed to buy crappy insurance – is certainly gross enough. If it’s cheaper than the insurance, a lot of us will choose that route.)
Nice video. I like the guy who’s on the state insurance program but doesn’t like the government competing with private insurance.
If covering the 50 million uninsured was a surefire way to lower costs, the insurance industry would have done it long ago without hectoring from the government
The insurance companies will get another windfall if americans are forced by purchase insurance. Unless/Until the insurance industry is heavily regulated they will never do anthing to lower costs. They would increase costs in perpetuity until there was no one left to afford it.
A great quote illustrating how things go when the power arrangement is asymmetrical.
I have personal experience with the system. I am very disappointed in medical doctors who put up with this. Medical care is corporate medical care. Goldman Sachs own pharmaceuticals and health insurance companies and tells doctors what medications are allowed. Try to get alternate or experimental treatments and health care professionals have to control themselves from laughing at you.
1) That would be the actual “law” we’re talking about. Not a suggestion, but an actual “law.” And in that law, the PO says it will take premiums and be subject to the same regulations as the other for-profit Carriers; and there’s the rub. The non-profit PO doesn’t require the same 20-30% profit margins that the private carriers do; that instantly equals cheaper.
2) The carriers do not want to add risk; they only want to add profit. They’re CORPORATIONS fercryingoutloud, and don’t want to have to actually pay monies out. This is the nut of the compromise; the PO says “dear Insurance company – we know you love your profits – we’ll even help you keep some. So what you gotta do is take some more risk, and pay some more monies out, but dont worry; we’ll subsidize your premiums.”
Like the teabaggers say “Read the bill! Read the Bill!”
Wait, you mean the insurance company applies to your lifetime cap what they were initially billed and not what they actually paid to the hospital for the service? That’s insane.
Ok, I’ll look for your comment on whether the “option” in HR 3200 can save can cut costs. When you do post that comment, could you post information about the affordability of health insurance under HR 3200 and compare that with the coverage and subsidies in the Baucus proposal?
Given the higher cost of HR 3200 (a trillion dollars over a decade vs maybe $850 billion for the Baucus proposal), I have no doubt that, on paper, the coverage and subsidies in HR 3200 look better than those in the Baucus proposal. The issue is whether we should believe advocates of HR 3200 who claim (more often implicitly than explicitly) that HR 3200’s method of paying for its better coverage/subsidies is more credible and more politically feasible than Baucus’s method.
Kip
i see net profit margins listed as 3.9% for “accident and health insurance” industry
http://biz.yahoo.com/p/sum_qpmd.html
what am i missing?
did they know that hr 676 (single payer bill) would mean no copays, no deductibles and no coinsurance for all medically necessary healthcare?
i wouldn’t want to give us good insurance either (and i’ve had some very good insurance) unless it was for something even better. but i’ve had some success even with republicans wrt single payer (none of them were in the top 1% income though).
Yep. They have to send you an annual statement. Read it and weep.
The margins KellyCDenver refers to are what health insurance companies term a “medical loss ratio”. That is the percentage of the premiums they collect that they get to keep, instead of being sent on to some doctors or hospitals. Calculating it is supposed to be something of a black art. Some explanation here, mixed in with some other subjects, unfortunately. I don’t know how the margins in the chart you linked are calculated.
I would guess the vast majority of those people have never used that insurance for anything more than routine healthcare. Those of us who have insurance and have to use it because of a chronic condition and have been denied treatment time and time and time again know how “great” our insurance really is.
Hate to say it folks, but unless Obama does something fast, our own party will tank Healthcare reform for the Republicans. He needs to take back the reins of this out of control bunch of losers in Congress, and charge ahead with decent, fair and effective reform.
I mean, really, is this the best that a leader of the Democratic caucus can come up with? No wonder the polling numbers are dropping like frickin’ anchors. The problem is, Obama is taking the major hit here, which is potentially going to kill all of us in 2010.
Time to get really, REALLY nasty.
Look at your link you provided – who’s at the top? REIT Healthcare facilities.
This seems more about preventing people from seeking equal or better care at a better price in other countries. I bet other industries with they could do that. Instead of the public option, we get no option at all.
The facts you cite are not correct. I won’t attempt here to review all the problems with your assessment. I’ll note just the most obvious and more important fact you got wrong: Insurance companies do not make 20-30% profits. Their profits are more like 2-5%. You were probably thinking of their ADMINISTRATIVE costs (expenditures on things like advertising, lobbying, management salaries, telling docs how to practice medicine, and profit), which are on the order of about 20-30% of expenditures or revenues.
But the “option” will also have very high administrative costs compared with Medicare (the federal agency to which “option” advocates constantly compare the “option”). The “option” will have to hire a sales force,it will have to advertise, it will have to develop a reserve fund, and it will probably also have to play the “managed care” game (for example, hire bureaucrats to approve hospitalizations and second-guess prescriptions ordered by doctors, and negotiate contracts with “networks” of providers so it can limit choice just like Aetna et al. do).
Could you point me to a paper or document describing how high the admin costs of the “option” will be compared with those of the average insurance company the “option” will be competing with? If you can’t, upon what basis do you claim the “option” will be able to set its premiums below those of the insurers it will compete with?
Can you point me to a document that discusses how the Secretary of DHHS is supposed to create the “options” all over America per HR 3200? Will we see “option” offices in all cities in America with more than, say, 50,000 people? Will we see ads for the “option” in local newspapers and on TV? If none of this is going to happen, where will the “option’s” customers come from? Do we really expect that if the “exchange” or “exchanges” run a Website, and somewhere on the Website people can click on “public health insurance,” that’ll recruit the critical mass of customers in each state it will take for the “option” to survive in that state?
I know that my questions asking you for documentation are rhetorical. I know full well the documents I’m asking for don’t exist. Is it not appalling that at this late hour in the “option” campaign, and in the debate about how to solve the health care crisis, that the questions I’m raising have not been answered and documented by “option” advocates?
Kip
MAN you are cynical – and yet, I find your hypothesis strangely compelling…
Bottom line for me: I am prepared to be pleasantly surprised on Wednesday, and also at the outcome of whatever conference committee ends up happening. But I don’t really expect to see real solutions out of this process, and the consequences of that will be devastating. Imagine a dysfunctional health insurance program that touches every single American, that is owned by the Democrats and which is denigrated by every Republican running for office in the entire nation. Catastrophic. And, if that’s what we get (i.e., mandate without strong public option) we’ll deserve every bit of the grief that results.
that’s not insurance. you were claiming 20-30% profit margins for insurance and i respectfully submit you are wrong about that.
oh, such a funny. Obama gave them the reins, and they are producing a plan very much to the liking of the insurance and pharma CEO’s with whom he has been meeting.
Hate to say it, but this is the plan that your candidate has for the country – mandated junk insurance for everyone, whether they want it or not, and huge guaranteed profits for the insurance cartel.
those of you who love the Democratic Party so much, that you would never vote for any other, should at least try to prevent your lover from doing something this stupid, because lots of people will be in the mood to punish those who are punishing them with a multi-thousand dollar annual unfunded mandate.
(enforced by everyone’s favorite govt agency, the IRS.)
It’s crony capitalism at its best, and really isn’t this the only legitimate role for government in the eyes of the GOP and the Blue Dogs? I mean you can’t raise taxes on any individual or corporation regardless of the merit because that means you are engaged in income redistribution , which is no longer morally acceptable even if it is lawful. You can’t run a single payer system that offers huge health cost savings and the promise of improved health outcomes because that’s socialism even if you charge a premium. You can’t even offer a public insurance plan as an option complete with premiums and a separate and thus premium consuming private administration because government sponsored competition is de facto illegitimate competition.
So since you can’t raise taxes for any reason and you can’t sponsor competition even in oligopolistic scenarios like the health care sector, what can you do? Apparently it’s okay to play mission impossible in Afghanistan, but is it going to be okay to replenish the FDIC’s coffers by tapping the financial industry’s shoulder and demanding that they pay the bill? Of course not, that would be unfair to our might captains of industry. This is yet another tab for the taxpayer and if and when the taxpayer gets angry then you just lower their taxes because, after all, the Blue Dogs and Obama have endorsed and validated this race to the bottom.
I doubt they did, but even if they knew that’s how it was supposed to work out, they’d have probably wanted to wait and see. Can’t say I blame them, either. Bureaucracies will follow the rules, as long as they’re clear. However, if they’re not or the rules make no sense, things don’t go so well. There’s also the potential problem of underfunding for the agency involved, etc.
Health Affairs Web Exclusive, May 14, 2009, gives us numbers.
Key Findings
■Physicians, on average, spent 142.3 hours per year interacting with health plans, or 3.0 hours per week and 2.7 physician work weeks per year. Primary care physicians spent significantly more time (164.9 hours per year) than medical specialists (123.7 hours) or surgical specialists (100.3 hours).
■Nursing staff spent an additional 23 weeks per year per physician interacting with health plans, while clerical staff spent 44 weeks and senior administrators spent 2.6 weeks doing so.
■Compared with other interactions, physicians, on average, spent more time dealing with formularies (78.2 hours for primary care doctors, for example), and the least on submitting or reviewing health plan quality data (1.9 hours annually for all physicians).
■Converted into dollars, practices spent an average of $68,274 per physician per year interacting with health plans; primary care practices spent $64,859 annually per physician, nearly one-third of the income, plus benefits, of the typical primary care physician.
The authors further note that “the estimated $31 billion in costs physician practices incur in their interactions with health plans comprises 6.9 percent of all U.S. expenditures for physicians and clinical services. That is six times the amount the federal government spends annually on the Children’s Health Insurance Program (CHIP).”
kip,
i have a question about the issue of claims denials. we’ve been reading about how high they are in CA. do you have any estimate of how much money private insurance companies save by denying claims? the reason i ask is that i expect a po would not do that (a very good thing!) but then that might add to po costs compared with the private insurance corps.
thanks.
The number KCD is referring to is the medical loss ratio. Typically it’s in the 20-30 percent range. That means that for every dollar that are paid in premiums, 70 to 80 cents ends up in the hands of health care providers. The equivalent cost of Medicare is less than three percent.
I totally disagree. What you describe is the present corrupt system. Hire bureaucrats to overturn medical decisions. Would these bureaucrats have to have a high school degree? You left something out in your comment, doctors and their patients. We do not need no stinkin’ bureaucrats, advertisers, lobbyists, second-guessers or other parasites murdering us as happens now. Funny, you called “patients”, “customers”, which says a lot about your commitment to “reform”.
The magic of the marketplace? Social conscience? Fierce governmental regulation?
If you think the status quo is fine, then that’s what you think.
If you think the Health Insurance companies make way too much money, and take it out of the economy at the point of the employers, where all our jobs are leaving the country, and it’s also junk insurance if you’re self employed, that’s what I think. I do not expect to reconcile those points of view with you.
We’re at a I said/you said point in the debate and it’s not meaningful to go further.
Personally, I’ve never had an insurance policy that was better than 676 could be, and would have probably been in favor of such a plan at any point in the last thirty years. I understand the reluctance of people who are happy with what they do have, however. I’ve been around entirely too many government programs that didn’t turn out like they were supposed to.
In other words, my question could have been rhetorical after all.
Health Care REIT (Real Estate Investment Trust) facilities are not part of the health insurance complex?
You’re joking, right?
I want single payer, or at least real public option, so I can get health insurance that I can at least halfway trust to do what it says it will do and be there when I need it. Yes, I could sign up through my employer, but my choices are limited (bad, worse, and limited-service-locations) and the informational material is about as clear as coal. (Mud would be an improvement.)
Hi Selise,
I recall a single study done maybe eight years ago on a slightly different issue. The issue studied in that paper was the percent of services ordered by physicians (or it might have been percent of hospitalizations ordered by physicians) that were vetoed by insurance companies BEFORE the services were rendered. Which means no claim was ever filed. Obviously, that’s a different issue from the one you described — what percent of CLAIMS do insurers refuse to pay.
The paper reported that a small percent of services were flat out denied by the insurer or insurers studied, but a larger proportion were amended. For example, a request to do a procedure in a hospital was approved but only if it was done in a clinic. A drug in a certain category was approved but only if it was another brand or a generic.
I don’t think I’ve ever seen a study on the issue you raise.
The question you’re raising is a lot like the one I raised in my last comment here, namely, Why won’t the “option” have to pay for lots of bureaucrats to play the managed care game, which will drive up its administrative costs? If the “option” doesn’t play the managed care game –if it doesn’t restrict patient choice of provider, if it doesn’t use drug formularies that pay for Prozac but not Zoloft, if it doesn’t hire bureaucrats to veto doctor decisions to hospitalize patients or give them 20 physical rehab sessions instead of 10 — if the “option” doesn’t play all those games, its MEDICAL costs will rise, possibly by so much that it will force the “option’s” premiums to rise way above those of the insurance companies it competes with. This will happen not only because managed care tactics do have a depressing effect on medical-service utilization rates, but because of “adverse selection” as well. What that means is that when an insurance company gets a reputation for being kinder and gentler to its insured customers, sicker people tend to gravitate to that insurance company, which drives up its medical costs and ultimately its premiums.
Of course, if the “option” does decide it has to play the managed care game — and it hires a million bureaucrats to play all those games — it will have higher admin costs.
Kip
Some of the biggest property owners in the country are insurance companies. They do real estate investments in order to make money. More money.
Why does it have to do those? If it goes the Medicare route, the mechanisms are mostly set up and can be copied. Yes, they’d have to hire people, but they wouldn’t be re-inventing the wheel, and they wouldn’t need a zillion people who do nothing but sit around and deny claims. On paper, with pens, because I have yet to meet an insurance company that understands computers in any context other than mainframe-IT and, maybe, a website that can’t be used by customers.
You nailed it, my friend. Precisely because “option” advocates are proposing to stick a publicly-run insurance company in the middle of the “present corrupt system,” I predict the “option” will either have to function like the insurance companies that dominate that system, or it will gets it rear end kicked by the insurance companies. I believe that when you dump a dolphin into a tank full of sharks, the dophin either begins to act like a shark or it gets destroyed.
Kip
For starters, please read at least page 5 of this letter from CBO to Congressman Rangel:
CBO says the number is subject to a high degree of uncertainty. There is good reason to believe this estimate is low.
not joking. from wikipedia:
don’t think that’s insurance.
i would be very happy to be wrong. just don’t think i am.
Waaah waaahh, call the waaaahmbulance! Those sick people are to blame for the high prices! Have they no respect for capitalism? Something should be done with them, because they are hurting the profits of the high net worth individuals!
I know. There are 8 Giant REITs. They also are the major underwriters for Private MOrtgage insurance. To say they are not part of the health insurance complex is to willfully not understand how the whole thing works.
Shame on selise. She did great work on FISA and congressional procedure, but to in any way defend the frikking nasty healthcare insurance companies is beneath her previous work.
And btw, Kip is an obvious tool; Kip provides no alternative plan. Kip likes how it is, unless he shows otherwise.
Oh my God, Kip Sullivan on this blog! I used to represent stars…movie stars like Emma Thompson and Alan Arkin. You are a star in health care. And if we have a revolution, your name will be bigger than theirs. And they will be pleased.
See my response to Selise and Frank re why the “option” will be under great pressure to adopt managed care tactics.
What do you mean, “If it goes the Medicare route…”? Neither HR 3200 nor the Senate HELP bill, nor any of the prominent “option” advocates, are proposing merely to have Medicare start selling health insurance to the non-elderly. All “option” advocates are proposing starting an insurance program from scratch. HR 3200 and the HELP bill make that very clear. Both bills authorize the Secretary of DHHS to hire dozens, maybe hundreds, of corporations (most will no doubt be insurance companies) to create the “option” programs in all 50 states. Under the HELP bill, these corporations are called “contracting administrators.” They don’t have a name under HR 3200, but the qualifications they have to have to get contracts from the Secretary are identical to those described in the HELP bill.
“Option” advocates are constantly comparing the “option” to Medicare. They should stop doing that. The “option” isn’t going to be part of Medicare, and it isn’t going to look like Medicare. It’s going to be created by private-sector corporations, most of which will be insurance companies because they have the expertise to create insurance companies all over the country. It’s going to be a balkanized program, not a single uniform public health insurance program like Medicare.
Kip
So that’s why they talk so funny. /s
Hugs to you mm.
That would send everyone out of the insurance market, I think. Of course, the fine might be in addition to either denial of service when you need it… or huge pay-as-you go charges…and then a compulsory membership in a bad and expensive plan. It would be triggered by getting caught, likely a health care emergency. The penalty might be in addition to all this.
i agree with everything you wrote. and indeed i’ve read (uwe reinhardt iirc) that under funding can sometimes be a little bit of a problem with single payer systems.
however, the one thing something like hr 676 has going for it (vs po) is that since everyone is in the same program our gov officials, including the bureaucrats, would have an incentive not to eff it up if their families depended on it too. so i’d expect (and this is just my wild guess) that underfunding, etc would be more of a problem for po than for sp.
no way do i trust anyone in gov right now. therefore aligning our incentives is imo an important feature which hr 676 has but pos do not (unless all fed gov employees and their families had to be on the po — that was actually my contribution to scarecrow’s list of features for a ‘robust’ po).
Hi mm- thanks- I got a laugh, because I actually agree.
KellyCDenver- Kip is not a tool. I know you have a good heart, but you are casting aspersions where none are due.
Lie lie lie lie lie! There is no such provision in HR 3200
Point to the section where it says that.
I’ve read that CBO letter. The CBO gave one reason and one reason only for its highly uncertain estimate: HR 3200 authorizes the “option” to use Medicare’s rates plus 5%, which will translate into rates roughly 15% below the insurance industry’s rates.
Now I have a question for you: Can you tell me where in the CBO letter the CBO explained how the “option” is going to force providers to take “option”-insured patients at those rates? Can you tell me where in HR 3200 it says providers must accept any “option”-insured patient who walks in their doors? Can you tell me where in HR 3200 the bill guarantees a huge opening-day customer base? If HR 3200 did either of those things — it either forced all providers to take all “option” enrollees, or it created a huge enrollee base on day one the way the law creating Medicare did for Medicare — then I would agree that the “option’s” premiums would be below average. But HR 3200 does neither.
Giving the “option” the authority to pay providers below-average rates without giving the “option” the authority to force providers to accept “option” enrollees, or giving it a huge enrollee base prior to opening for business, is like giving someone a pair of scissors with one blade.
Kip
thank you.
Sec 223(c). Could you point out to me the section in HR 3200 where it says the Secretary of DHHS is authorized to hire public employees?
Kip
I’ll happily agree when I see a Kip point of view that is progressive, rather than just knocking down the points of progressive legislation.
If Kip is all pro single payer, well hell yeah! Love to Kip!
i have never defended the private health insurance industry. i hate them. i want them gone.
my disagreement with you is over the amount of profit the health insurance companies have. how does high profits in REITs affect the amount of profit insurance companies get that the po would not? i honestly don’t see it.
KellyC- let me make sure I got your intent correct.
If Kip is all pro single payer, then that changes your previously articulated view? Is that what you meant? (sorry, my brain is a bit fried- been dealing with undergrads- seriously- no reflection on you!)
For a possible health care model to study, I would suggest Canada. If I had the money I would go there now to get medical treatments that are forbidden to me here.
Kip -Section 201 governs the creation of the Exchange, not your 223 which governs payments.
Dearest Montanamaven,You are a gentlewoman and a scholar. Thank you for your kind words. When the revolution is over, let’s have a big single-payer party and let’s make sure we do the boogaloo together.
Kip
lol. you might want to take a look at this. i think you will enjoy it. *g*
Yes indeed. If Kip is mad that we don’t have single payer, and the the PO is bullshit, then I am fine with that.
If Kip thinks status quo is OK, I’m totally against that.
The Public Option is indeed the compromise down from single payer. And I hate that. I want single payer and I wish like hell they would have called it the “Competitive America” act. Because that would have been true.
I view the PO as the “foot in the door” legislation that only barely BEGINS to deal with the healthcare insurance company profits, driving them downward. That is the bottom line for me. It has to all start and stop somewhere.
What a piss-poor analogy. Indeed it’s not even based on very good biology (which argues diversification of niches would occur when organisms from different species are in competition- if you converge you are MORE likely to go extinct).
Dolphins and sharks both eat fish. But they obtain them in different ways. Sharks are solitary or uncoordinated group hunters, while dolphins are socialists, driving schools of fish into collective traps. The reason sharks and dolphins occupy the same sea is because they are differently adapted (as are various sharks species BTW).
Presumably the public options major concern would be those desiring health care- not making profits for investors. Thus they are very different adaptations. If every option eventually converged to the same system then we’d simply be arguing over nothing. But the reality is that the Health Care models in different Industrial nations are vastly different than the US…the Netherlands, Switzerland, Canada, Britain, Sweden, and France are all different than ours in cost and service and totality of coverage. They’ve had these systems for more than 50 years…they have not “converged” on the US private corporate model at all.
OK!
I am an IDIOT! I should have googled kip’s name.
Sorry there kipster; I have had too many run ins with the tea baggers and whatever else in the health care debates in real life, and arguing with a single payer advocate is the last thing I ever wanted to do.
Too busy being on defense is no excuse, and I apologize. I really do.
Kelly
You asked me where in HR 3200 the Secretary is authorized to hire corporations to set up the “options.” I hit the wrong key in my last reply: It’s 221(c), not 223(c).
221(c) is entitled “administrative contracting.” This section authorizes the Secretary to contract with companies that qualify as “medicare administrative contractors” under another federal statute. Most of the corporations that hold MAC contracts today are insurance companies. Section 3106 in the Senate HELP bill is even clearer about this: Private-sector corporations will set up, and may run, the “options” in the HELP Committee bill.
I repeat my question for you: Can you show me where in HR 3200 the Secretary is instructed to hire public employees to run create the “option”? Can you find such a provision in the HELP bill?
If the Secretary is only authorized to contract with corporations to create the “options,” and no where is the Secretary authorized to hire public employees, we have only one conclusion to draw: Private-sector corporations will set up, and maybe run, the “option.”
You began this thread urging me to read the bill. I urge you to do likewise. These damn bills are very hard on the eyes and the brain, but it is possible to decipher them. Let’s discuss what’s actually in these bills, not what you’ve heard from Health Care for America Now or Howard Dean about what’s in these bills. To hear them tell it, the “option” is just like Medicare. Nothing could be further from the truth.
Kip
my pov is that a good po could be the “foot in the door” but a bad po would be a disaster. we’d have the damn mandates AND the well would be poisoned for single payer with the voting public (if a bad po taught us that the gov is incapable of running public insurance).
that is why i am very interested in understanding the assumptions that are being made re the pos now being considered in legislation. i don’t want a bad po — imo that would be the worst thing that could happen.
No need to apologize, but thank you much anyway.
KellyC-
Well, I’d be getting beyond my knowledge to comment on the precise emotions Kip has.
But, he is indeed an advocate for single payer. And has been for quite some time.
He has written several articles for the PNHP blog (posted by Andrew Coates). http://pnhp.org/ is (to quote) Physicians for a National Health Program is a non-profit research and education organization of 17,000 physicians, medical students and health professionals who support single-payer national health insurance.
edited- just saw your most recent comment KellyC- I knew you had a good heart! It’s hard to keep track of who’s who or what’s what in all this mess, I know that!
if i’m wrong about the insurance profits there will be another apology on this thread – mine.
When you’re swimming in a tank full of sharks, no one cares what your “major concern” is. You could be a saint and you will be eaten.
Sharks do attack lone dolphins, but groups of dolphins likewise attack sharks. There is at least one case claimed where dolphins protected humans from sharks. SAVE THE DOLPHINS!
Hang on though – 223(c) says Chapter 5 of USC Title 5 says:
(c) Administrative Process for Setting Rates.—
Chapter 5 of title 5, United States Code shall apply to the process for the initial establishment of payment rates under this section but not to the specific methodology for establishing such rates or the calculation of such rates.
That’s public employees dominant in the process, no?
To finish here, I am really sorry to have diatribed against Kip Sullivan. I really am. I have learned a lesson, and shall keep to it.
What I should have said way upstairs, is what I’ll finish with;
I just can’t stand what we’re having to do to provide care for me and my husbands parents to get them into assisted living. We don’t have enough money, and somehow, we have too much.
The insurance game in the middle of this is beyond exasperating; those companies are profiting, while my folks surely are not. They’re declining, and the road from today to medicaid is fraught with pitfalls and perils that are not for the faint hearted.
There surely is a better and more humane way to provide what folks need, than how we do it today.
Humbly (yeah, now yer humble, you dingbat!)
Kelly
Feel better, Kelly.
Remember, public policy is best described by mathematical equations. Always been that way.
Just some stirring going on. It’s hard to resist.
Assisted living is another issue. They
should be covered under medicade.
this is a personal issue for many of us so passion runs high.
learning more is all good though and i’ll try to track down more info re profit margins. thanks for the conversation!
One minor note, not against Kip, because single payer is the promised land, but just a word of caution. When a giant corporation says that its profits only run 2-5% of revenue, they’re playing games with the truth.
I was an internal auditor for a major corporation for a time, and they have more ways to talk poor than you can believe. They have so many ways to benefit themselves and hide/squirrel away money for themselves for later. That 2-5% is just for the suckers who think they own the business because they have a few hundred shares of common stock.
I think there is a lot of misunderstanding of Kip Sullivan’s position. He is very much not for keeping things the same. He is critiquing Obamacare and the PO from a more single payer perspective.
In regard to the quote above, I should note that Howard Dean does this a lot too where he equates the PO to single payer which it emphatically isn’t.
The whole idea is that if the PO was kind of or sort of like Medicare then why not combine the two? And if you were going to combine the two, then why not just extend this across the board into something like Medicare for All where you would get simplification and cost savings that an orphan PO is never going to deliver?
And the ‘retirement communities’ (which are really specialized apartment and condo complexes) should be regulated. Otherwise, because they’re for-profit operations, they’ll raise their charges 10 percent or more – every year.
good point. do you have an estimate? even if it was double the official numbers, it would still not be anything like 20-30 percent.
here’s steffie woolhandler’s testimony (my bold):
Reagan the GREAT SOCIALIST!
Reagan Signed into Law 1986 PROGRAM that MAKES HEALTH CARE A “RIGHT” FOR EVERYONE that says, “Inpatient care provided must be at an equal level for ALL patients, Regardless of Ability to pay. Hospitals may not discharge patients prior to stabilization if patient’s insurance is canceled or discontinues payment during course of stay.”
Obligations of Health Care Providers under EMTALA.
- – - – - – - – - – - – - – - – - – -
0BAMA must Beat that with the STRONGEST PUBLIC OPTION:
Simply modify the Medicare Bill using Reconciliation and add the following clauses:
[Note: An existing Bill like Medicare can be modified by simple majority in Senate]
i. Automatic Coverage for all persons 0-25 and 65 Years and older.
ii. Automatic Optional Coverage for 25 to 64 group unless they OPT OUT and Buy from a Commercial Insurance Company!
iii. Consolidate into Medicare other current programs: Medicaid, Children, FED Gov.
That SIMPLE: THE END!
__________ __________ _
Benefits:
1. Savings of $1.3 Trillion/10 years from uninsured NOT using Emergency Rooms!
2. No NEW BUREAUCRACY LIKE the other BILLS! In fact removes several of them!
3. Can Be Done by 2010!
4. 3-4% Admin Fees vs 30% Admin Fees by Insurance Cos (600%-1,000% Higher)
5. No NEW L00PHOLES for Corporations to EXPLOIT!
6. Amend current law so done with Reconciliation!
7. 100,000,000+ people in Medicare=negotiate “FAIR Health Care Pricing” Services!
Say hello to Adam Schiff’s office when they drop by. They like the figures.
By way of clarification: they like the fact that there are figures like these. Whether they like the figures themselves, I don’t know.