Universal Health Care...

[Balloon guy 158]

You mean like this:http://docs.google.com/Doc?docid=0AfKD_yOC...qMzc1&hl=en

There were some unintentionally funny lines there with regards to dentist and England.

So the answer is to keep moving in the wrong direction? I'd like to hear an explanation of that theory.

I am an expert on this theory, should mk fail to explain it's nuances, I will cover most of the salient points.

[mk 11]

So, your "except" is a little more than half of all policy decisions?OK.

Importantly, the 'except' doesn't apply to the discussion at hand.

[brvheart 1,752]

http://www.nytimes.com/2010/07/25/world/eu.../rXPHKg5Aa4HiAg

[Balloon guy 158]

http://www.nytimes.com/2010/07/25/world/eu.../rXPHKg5Aa4HiAg

So you want us to copy Europe?

[Jeepster80125 0]

from the article:The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment. Obamacare centralizes healthcare, which apparently sucks, according to the article. Isn't the end result of obamacare to have things like '150 entities known as primary care trusts' and stuff?I guess my question, isn't obamacare similar to what is currently sucking over there?

[CaneBrain 95]

I guess my question, isn't obamacare similar to what is currently sucking over there?

What's the difference between their suck and our pre-obama care suck?

[Jeepster80125 0]

What's the difference between their suck and our pre-obama care suck?

I'm not sure, but my more global point was that healthcare reform didn't do much to address those problems. Me using that word makes 'healthcare reform' a talking point, instead of taking a specific part, analyzing that, and figuring out a solution. Obamacare will just create jobs for politicians and their buddies. It rigs the system so that insurance companies will fail, but since they are too big to fail, they'll just be subsidized or moved into medicare and medicaid, because those two government entitlement programs have no problems.

[Jeepster80125 0]

This is an email blast from health insurance company Humana, to insurance producers. I didn't have time to read it all, but it could be interesting info, so I'm posting the whole thing. There are links in the article that I don't have time to reproduce now, I'd be happy to if anyone wants.New regulations standardize appeals processNew regulations announced last week by the Obama administration empower patients to appeal denied claims, while standardizing appeals processes that many states already require. The appeal regulations, released as an "interim final rule" from the Departments of Health and Human Services (HHS), Labor and the Treasury, outline a two-level process for questioning denied claims. First, patients appeal directly to the insurer, and then – if necessary – to an independent outside review panel. The panel's decision is binding, and health plans must pay the cost of external reviews. If an insurer's decision is overruled, the health plan must cover the claim in question. People can also use the same process to appeal rescissions (cases in which their policy is cancelled). Humana has offered third-party review of rescissions since 2008. The regulations take effect for plan years beginning on or after September 23. They do not apply to grandfathered plans – plans in existence before the health care reform law was enacted on March 23, 2010 – but the new rules do apply to self-funded plans, whose members will have "access to a federal external review program," according to an administration fact sheet. Self-funded group health plans must meet the new standards for external review for plan years on or after September 23, 2010. The administration says it will release additional guidance shortly on how such plans must comply.The administration predicts 41 million people in new employer and individual plans will benefit right away from the new rules. That number is expected to grow to 88 million by 2013. "The appeals rules today will extend important protections and simplify the system for consumers," said Labor Secretary Hilda Solis in a news release. "And they will ensure that consumers in new health plans have access to internal and external appeals processes that are clearly defined, impartial and designed to ensure that when health care is needed and covered, consumers get it." States are encouraged to adopt the new standards by July 2011, but for many, that simply means modifying existing appeal statutes. While 44 states currently provide some form of external appeal, the administration's fact sheet says "the laws governing these processes vary greatly and fail to cover millions of Americans. ... The rules issued today will end the patchwork of protections that apply to only some plans in some states, and simplify the system for consumers." During a transition period for policy years before July 1, 2011, insurers in states with existing external appeal processes are considered in compliance with the consumer protections. HHS will review state laws to determine if they meet the new standards.Here's what the administration's fact sheet says about internal appeals processes. Plans "must have an internal appeals process that:Allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage; Gives consumers detailed information about the grounds for the denial of claims or coverage;Requires plans to notify consumers about their right to appeal and instructs them on how to begin the appeals process; Ensures a full and fair review of the denial; and Provides consumers with an expedited appeals process in urgent cases."For external appeals, the regulations encourage states to adopt standards established by the National Association of Insurance Commissioners (NAIC), which call for many of the same protections. The NAIC standards also charge states with policing external reviewers. In connection with the new appeal regulations, the administration announced $30 million in grants to help states establish or strengthen consumer assistance offices, which are designed to help people with everything from selecting a plan to filing appeals.(Not to be used for implementation purposes. Humana's commercial health care reform implementation team is evaluating the HHS regulation. This is intended as an advisory only and does not constitute any legal or tax advice. Consult a legal or tax professional for guidance regarding this regulation.)The battle over medical-loss ratiosBeginning next year, health insurance companies must spend 85 percent of large group premium dollars and 80 percent of small group premium dollars on medical care – or pay a penalty to customers in the form of premium rebates. But what exactly counts as "medical care?" The reform law gives the National Association of Insurance Commissioners (NAIC) the job of defining what should be included in the definition. NAIC's decision will be just a recommendation – the Department of Health and Human Services gets the final say. It's a hot topic. The organization Health Care for America Now (HCAN) has accused the health insurance industry of trying to undermine the process of how these medical-loss ratios – or MLRs – will be calculated. An HCAN report says, "If insurers are successful at redefining medical care, they will continue ripping off Americans... They want to expand the definition of allowable medical expenses to include costs that are not directly related to the delivery of care and have not historically been classified as medical. They want to strengthen their ability to maximize profits and skirt incentives to reduce cost."Robert Zirkelbach of America's Health Insurance Plans called HCAN's rhetoric "a desperate attempt to distract attention away from the fact that these regulations could put at risk important services and benefits that improve the quality of care for millions of patients." Those benefits include disease management, quality improvement, and anti-fraud programs. State insurance commissioners and business have also weighed in, saying they are concerned that if the definition of medical care is too restrictive, the result could be larger premium increases and insurance companies pulling out of some markets. Read the concerns of some business groups here, and a letter from the Maine insurance commissioner here. Also, see graphics on health plan administrative costs here.Meanwhile, a report by Weiss Ratings says that large insurance companies are likely to be able to cope with the new MLR rules requiring a higher percentage of spending on medical care. It's small insurers that may not be able to. The report points out that if small insurers fail, that could mean less competition in the marketplace, which could result in higher premiums and less choice.NAIC is reportedly close to writing the draft recommendations, and may be ready to submit final recommendations to HHS within the next month.Old business re: reformOn July 21, 129 House Democrats introduced legislation, H.R. 5808, proposing to amend the health reform law to include a government-run health plan. California Rep. Lynn Woolsey is the bill's lead sponsor. H.R. 5808 would require that a public health insurance option be offered through the new health insurance exchanges, which are scheduled to begin operation in 2014. During the first three years, provider payments would be 5 percent higher than Medicare payment rates. The HHS secretary would have authority to adjust payments that are excessive or deficient, on a budget-neutral basis. At this point, however, the bill is not thought to have a very good chance of being passed.Regarding another reform battle – over the constitutionality of the individual mandate to buy insurance – the New York Times noted that although the Obama administration insisted during the reform debate that the individual mandate was not a tax, now, in court, they are defending the provision as an exercise of the government's "power to lay and collect taxes." Read the article about that change here. The promotional brochure sent out by the federal government in May touting the benefits of health reform to 40 million Medicare beneficiaries continues to be under attack from the GOP. Here is the recent Republican response, which claims the brochure is "filled with inaccuracies and omissions" and is "misleading," and says it "selectively provided information, and, in some instances, blatantly contradicted conclusions made by Medicare's chief actuary." Health and Human Services Secretary Kathleen Sebelius responded that the brochure is "an important beneficiary tool." In May, House Speaker Nancy Pelosi described the brochure as "really good" and as "an important part of an outreach campaign" to challenge myths about reform.The Center for Health Transformation's health-care reform wall chart is an amazing work of technical art. Catch a glimpse of it here.Pressure from the statesLast week, Congress approved an extension of unemployment insurance benefits. But the health-related provisions that used to be part of that bill – increased Medicaid contributions to the states and COBRA-benefit subsidies for individuals who have lost their jobs – were not included this time. This means individuals who have lost their jobs since June 1 will get no assistance in paying for COBRA benefits, which means many will not be able to stay on their former employers' policies. Individuals who lost their jobs before June 1 got subsidies worth 65 percent of the cost of their COBRA plan.Meanwhile, state governors and state lawmakers – already looking at big budget deficits because of their smaller revenue streams and an increased number of people who qualify for Medicaid and other state programs – are putting pressure on members of Congress. But there is no plan or timetable right now for taking up either the Medicaid-funding or the COBRA issue.The National Conference of State Legislatures is meeting this week in Louisville, and in a forum on health reform lawmakers expressed frustration over the situation they're in. One legislative staffer from California told the Louisville Courier-Journal that lawmakers there had hoped to balance a huge deficit by cutting some Medicaid services, but found out that was not allowed under the new health reform law. "Those options are no longer on the table for us," she said.Pressure from the docsLast week, the American Medical Association and 47 state medical groups sent insurance companies, including Humana, a letter objecting to the doctor-ranking methods used by some. The letter referred to a RAND study on physician cost profiling that said doctors were assigned to the wrong cost tier 22 percent of the time. "We have been talking for years about the unreliability of physician profiling," the letter said, "particularly in regards to the Rube Goldbergesque systems used to assess so-called physician efficiency. In light of all this new evidence, it is time to reassess the potential damage these error plagued reports can cause. Patients are being encouraged, and often incentivized, to leave longstanding relationships with physicians they trust, or see certain physicians and physician groups, based on information that RAND has shown to be incorrect..."The doctor groups asked insurers to subject their methods to outside review, and "to work with the AMA, and the physicians and state medical societies for each state... to formally reevaluate your physician rating program(s) and demonstrate that they are reliable, accurate and valid; drive quality improvement efforts; and address the concerns raised in RAND's research findings." Humana's view: Humana is already working closely with the National Quality Forum, the AMA and the AQA Alliance to determine the most important measures to track. We do not exclude doctors from our networks solely on the basis of the cost of care – our tools include both cost and quality measures, and do not have the limitations of the methodology described by RAND. Fighting fraudAttorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius are now in the process of leading seven regional health care fraud prevention summits. The first took place in Miami on July 16 and brought together federal, state and local law enforcement partners, beneficiaries, providers and other interested parties to discuss ways to eliminate fraud. Both Sebelius and Holder called the new health reform law "secretly one of the strongest health care anti-fraud bills in American history." Sebelius said, "For years, we tolerated health care fraud. We accepted that with any big enterprise, there was going to be some waste."She continued, "Those days are over. As we try to bring down skyrocketing costs across our health-care system, we can't afford to ignore the billions of dollars we lose to simple theft. At a time when families are struggling to make every dollar count, we must too."The reform law provides $350 million in new resources over the next 10 years to fight fraud in the health care system. It toughens sentencing for criminal activity, enhances screenings and enrollment requirements for providers and suppliers, encourages increased sharing of data across government agencies, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses. Read Sebelius' full remarks here.Health information technologyTwo weeks ago, the Department of Health and Human Services released the final regulations on what providers must do to qualify for help paying for the creation of electronic health records. These regulations are different from the initial rules, which were met seven months ago with heavy criticism from hospitals and doctors, who thought they were too stringent.This time, the rules offer greater flexibility. Doctors and hospitals have more latitude in determining a course for meeting and reporting certain objectives and how they demonstrate meaningful use. The final rule divides the objectives into two groups: a "core" group of required objectives and a "menu set" of procedures from which they may choose any five. In the 2009 stimulus package, the federal government included $27 billion over the next 10 years to reward doctors and hospitals for installing electronic health systems. Doctors can get up to $44,000 from Medicare and $63,750 from Medicaid. Hospitals will be eligible for at least $2 million from the federal government depending on their size and number of patient discharges. In 2015, the federal government will start reducing payments to hospitals and doctors that are not using electronic health records. According to HHS Secretary Kathleen Sebelius, only about 20 percent of hospitals and 10 percent of physicians have basic electronic health systems today. These systems are expected to improve health-care quality, reduce errors and lower costs.

[85suited 0]

A judge on Monday refused to dismiss the state of Virginia’s challenge to President Barack Obama’s landmark healthcare law, a setback that will force his administration to mount a lengthy legal defense of the overhaul effort.U.S. District Judge Henry Hudson refused to dismiss the state’s lawsuit which argues the law’s requirement that its residents have health insurance was unconstitutional, allowing the challenge to go forward.

[CaneBrain 95]

A judge on Monday refused to dismiss the state of Virginia’s challenge to President Barack Obama’s landmark healthcare law, a setback that will force his administration to mount a lengthy legal defense of the overhaul effort.U.S. District Judge Henry Hudson refused to dismiss the state’s lawsuit which argues the law’s requirement that its residents have health insurance was unconstitutional, allowing the challenge to go forward.

Not a huge surprise. This is a pretty big 10th amendment issue.

[85suited 0]

All eyes were on Missouri today. The Show Me voters were voting for or against the new federal health care law.Missouri showed Obamacare the door.FOX KC reported:Election officials are hoping the heat won’t keep people from getting out to vote. One of the hottest races in Missouri is Proposition C. It’s an issue that is getting a lot of attention across the country.All eyes will be on Missouri’s Proposition C results because it’s the first time voters in the country vote for or against the new federal health care law. Basically Proposition C would create a state law against federal mandates requiring people to buy health insurance.Missouri’s top U.S. Senate candidates are divided on the measure. If passed, it will will reject part of the new federal health care law. Republicans Roy Blunt and Chuck Purgason both support Proposition C. Democrat Robin Carnahan plans to vote against it.

and the results were: Proposition C Precincts Reporting 3354 of 3354 Yes 667,680 71.1% No 271,102 28.9% Total Votes 938,782I guess the people of Missouri aren't happy with OBAMACARE

[CaneBrain 95]

and the results were: Proposition C Precincts Reporting 3354 of 3354 Yes 667,680 71.1% No 271,102 28.9% Total Votes 938,782I guess the people of Missouri aren't happy with OBAMACARE

Too bad this is an empty gesture.That article should read: "if passed, this ultimately means nothing because of Federal pre-emption". I think everyone should have to take Con Law so people might not sound so dumb (not directed at you 85).

[Naked_Cowboy 0]

I mean, yes, the supremacy clause renders the direct result of the law null and void, but things like this are obviously a plus on the side of the states who are trying to take the federal government to court and challenge the constitutionality of obamacare in the first place.

[CaneBrain 95]

I mean, yes, the supremacy clause renders the direct result of the law null and void, but things like this are obviously a plus on the side of the states who are trying to take the federal government to court and challenge the constitutionality of obamacare in the first place.

I am not even willing to go that far. It shows public dissatisfaction with the law (and it is a crappy law)......but that is irrelevant to its constitutionality.It's certainly a negative for Obama generally but for the law itself, meh.

[Pot Odds RAC 23]

A judge on Monday refused to dismiss the state of Virginia’s challenge to President Barack Obama’s landmark healthcare law, a setback that will force his administration to mount a lengthy legal defense of the overhaul effort.U.S. District Judge Henry Hudson refused to dismiss the state’s lawsuit which argues the law’s requirement that its residents have health insurance was unconstitutional, allowing the challenge to go forward.

How irresponsible of an Administration to pass a law that they know will be subjected to costly legal battles.

[CaneBrain 95]

How irresponsible of an Administration to pass a law that they know will be subjected to costly legal battles.

I hope you feel the same way about AZ's immigration law then especially given that the law's main sponsor admitted he wrote the law anticipating a costly legal slog to the Supreme Court.

[Pot Odds RAC 23]

I hope you feel the same way about AZ's immigration law then especially given that the law's main sponsor admitted he wrote the law anticipating a costly legal slog to the Supreme Court.

My comment was 100% referencing your criticism of the AZ Law. I thought about quoting one of your posts but got lazy.

[CaneBrain 95]

My comment was 100% referencing your criticism of the AZ Law. I thought about quoting one of your posts but got lazy.

The difference is I dont think Obama and Co. thought about it becoming a massive legal battle......pretty sure they said to themselves 'who wouldnt want some healthcare reform'. Miscalculation!

[Jeepster80125 0]

I know I've posted this before, and I see a new story on cnn.http://money.cnn.com/2010/08/11/news/compa...in&hpt=SbinRegarding medical tourism, this specific example was from a smallish company with a partially self funded insurance product. With a fully insured program, the premiums are paid entirely by the employer, and the liability for claims is on the insurance carrier. Every person covered is put into a 'pool', where large single claims aren't an issue.With a partial fully self funded plan, that liability falls back onto the employer group. This type of program is good for large companies. Basically, a company takes on some liability for it's employees health. The premiums are much lower, but if there is a large claim, end stage liver disease for example, then the plan blows up and the company can't pay the claim. With this example, it seems that the company was willing to shoulder some of the potential liability for medical malpractice. No fully insured company like United or BlueCross/BlueShield would ever cover liability on care performed outside this country. So, we'll see an increase in medical tourism in smallish companies that are partially or fully self funded insurance-wise, but I don't think this will ever catch on at a large scale, because I don't think the med-mal liability issues could ever get agreed on by all parties. I'm not sure if this company made them sign a waiver of liability or anything.

[Jeepster80125 0]

http://www.flatheadbeacon.com/articles/art...stos_aid/19253/in part:Then she asked Baucus if the extended Medicare coverage could be repealed when a new presidential administration takes over, since she feared her grandchildren could suffer from asbestos sickness, making them the fourth generation in her family stricken with contamination.A staff member for Baucus told her the health care law has the power of statute, and would need to be repealed for the coverage to go away.Judy Matott asked Baucus if he would work to improve Libby’s image, and then asked him and Sebelius, “if either of you read the health care bill before it was passed and if not, that is the most despicable, irresponsible thing.”Baucus replied that if Libby residents assembled an economic development plan, he would do what he could to help, and he took credit for “essentially” writing the health care bill that passed the Senate.“I don’t think you want me to waste my time to read every page of the health care bill. You know why? It’s statutory language,” Baucus said. “We hire experts.”In response to Matott’s question and another from a woman asking if the health care law was Constitutional, Baucus gave a broad defense of the changes, comparing them to programs like Social Security and Medicare that were unpopular when passed but have proven beneficial to Americans over the long term.

[strategy 4]

At least five of the 34 House Democrats who voted against their party’s health care reform bill are highlighting their “no” votes in ads back home. By contrast, party officials in Washington can’t identify a single House member who’s running an ad boasting of a “yes” vote — despite the fact that 219 House Democrats voted in favor of final passage in March.One Democratic strategist said it would be “political malfeasance” to run such an ad now.Democrats have taken that advice to heart; it appears that no Democratic incumbent — in the House or in the Senate — has run a pro-reform TV ad since April, when Senate Majority Leader Harry Reid (D-Nev.) ran one.Most of the Democrats running ads highlighting their opposition to the law are in conservative-leaning districts and considered the most endangered. They’re using their vote against the overhaul as proof of their willingness to buck party leadership and their commitment to watching the nation’s debt.

srcI don't know where politico lies on the spectrum, but this is not unexpected anyway. you could reasonably spin this in either direction, but either way, this is pretty solid evidence of healthcare reform's failure.

[LongLiveYorke 38]

I don't know where politico lies on the spectrum, but this is not unexpected anyway. you could reasonably spin this in either direction, but either way, this is pretty solid evidence of healthcare reform's failure.

It is evidence of Democratic cowardice, but has little to do with health reform itself. The reason heath reform is very unpopular, even for people among whom it should be popular, is that Democrats refuse to verbally support it. I'm not sure why this is so. It would be easy to make a pretty convincing ad showing off the healthcare bill. If one voted for it, stand up and say why. Certainly one should be able to convincingly argue in favor of it if one voted for it.My ad would highlight the fact that insurance companies will no longer be able to drop people's insurance due to illness, will no longer be able to have annual compensation caps, will no longer be able to discriminate to whom they provide care, and other things like that. I would also discuss things like electronic medical records, which should make healthcare much more efficient.If a Democrat who voted for it can't support Obamacare in an ad, he deserves to lose his seat, imo.

[strategy 4]

It is evidence of Democratic cowardice, but has little to do with health reform itself. The reason heath reform is very unpopular, even for people among whom it should be popular, is that Democrats refuse to verbally support it. I'm not sure why this is so. It would be easy to make a pretty convincing ad showing off the healthcare bill. If one voted for it, stand up and say why. Certainly one should be able to convincingly argue in favor of it if one voted for it.My ad would highlight the fact that insurance companies will no longer be able to drop people's insurance due to illness, will no longer be able to have annual compensation caps, will no longer be able to discriminate to whom they provide care, and other things like that. I would also discuss things like electronic medical records, which should make healthcare much more efficient.If a Democrat who voted for it can't support Obamacare in an ad, he deserves to lose his seat, imo.

if the party who pushed it through has now, six months later, lost its unity on the issue, I think that makes the push a failure. I say this without commenting on the merits of the actual bill. the majority of dems who oppose it are probably on the "you caved to whiny middle america" side.

[LongLiveYorke 38]

if the party who pushed it through has now, six months later, lost its unity on the issue, I think that makes the push a failure.

Well, the push wasn't a failure because the bill passed and is on the books. It's unfortunate though non unexpected that the D's lost their spine on the issue, but that doesn't effect the law.

[strategy 4]

Well, the push wasn't a failure because the bill passed and is on the books. It's unfortunate though not unexpected that the D's lost their spine on the issue, but that doesn't effect the law.

note what happens and when:http://en.wikipedia.org/wiki/Patient_Prote...rdable_Care_Actit doesn't matter that it passed if the dems abandon the effort and repeal it before 2014. sure, there are some measures kicking in today, but the meat of it comes in 2014. I'm willing to agree that it's not a guaranteed failure (because the no-action outcome is to have it in place) but I see this as very, very bad news for the healthcare reform effort.basically, Obama has to win in 2012 or this is getting repealed before much of it is even attempted.