Healthcare reform. What does it all mean?

[billybags]

I live in the UK and I have been taking a little interest in Obama's Health care Reform. Can you tell me in simple terms what it means and why so many people seem to be against it and don't want it. To me it sounds like it will help a lot of people who can not afford insurance for health care, have I got it wrong?

[MooseMom]

The conflicts are generally more philosophical than anything.  Just about everyone agrees that the current system does not serve the American people very well.  Those who are against the reforms feel that they are symbolic of government intrusion into the patient/doctor relationship and of a growth in the power of a centralized Government.  Of course, Medicare is beloved here, much like the NHS is to the people of the UK, so government is already very much involved in the healthcare of many Americans.  The cost is also an issue; our federal deficit is growing, and detractors fear that the cost of this bill will only add to it.  The real bugbear is the soaring cost of medical care, and who pays for it, whether it be an individual, a corporation or the Government will quickly become irrelevant if costs are not contained.  The US is a vast country; it is not small and containable like the UK where a central government can easily dole out funds to local health authorities based on need.  For the US to do that, a large bureaucracy will need to be created, and that only adds to the fear of "Big Government".  But we have large bureaucracies for just about everything else, anyway.     What the net result of this new legislation will be still remains to be seen; we won't know for perhaps another decade just how things will pan out.  But we do know that within a few months, insurance companies will no longer be able to use the "pre-existing condition" card to drop children from coverage.  The same protection for adults will happen in 2014.  It will be easier to move your coverage from one job to another, which is a huge improvement in the current job market.    I'm sure you will get many more replies here, but it is not a simple matter!  I personally would like to see a single payer system because I do not think it is economically wise to force businesses to offer insurance; it's a huge cost to small businesses that are the engine of our economy.  Historically, businesses offered health insurance as an incentive to workers, and I think that that original purpose is obsolete

[paul.karen]

Well Stated MM.

There are many other factors as well as to why so many didnt want healthcare to be put n place in the manner it was. 

[Jean]

I agree, PK. It is not so much what was passed as the way it was done. We watched the debates, nearly all day and the arguing and bickering were terrible. And, all of those people outside protesting, and have been protesting, and were completely ignored. The whole deal was, we are going to do this, whether you people like it or not.Between Obama and Pelosi, they just lied and lied. There are many things about this bill that I really think stink, but it is a done deal now. We will see what happens.

[billybags]

MooseMom, Thanks for explaining this to me, I got a bit more of an in site into it. It is not straight forward is it. I agree a single payer system sounds good and ok it would take a long while to filter through, but at least it would be fairer to every one..

Jean your government sounds a lot like ours, they all lie through their teeth. We also have the EU to deal with, we got pushed into that also. We go to the election in May and to be quite honest none of the parties are worth a vote.They are all in it for what they can get out of it..

Thanks for your reply's.

[MooseMom]

In the end, we as a nation debated this issue, we elected congresspeople to represent us, those congresspeople voted accordingly for/against the health bill, the majority won, and that's how our country works.  I don't know if it is fair to quibble about the process just because you may not like the outcome.  There are a lot of people who hate this bill because they believe it does not go far enough, and they probably feel ignored, too.  People who said that this bill would establish "death panels" lied along with many others who just made stuff up to frighten people; these are often the same people who use words like "liberty" and "freedom" to gloss over inequity.

It has taken decades and decades to pass a healthcare bill that really is not that particularly strong, so it is hardly true that anything has been rammed down our throats.  Much in the bill won't even come to pass until 2014.  Some things that WILL change soon, though are:  Prohibit NEW INSURANCE PLANS from dropping coverage for children due to pre-existing conditions, establish high risk pools for people with catastrophic illness, Prohibit NEW INSURANCE PLANS from kicking people off INDIVIDUAL policies (lots of fine print there), no more lifetime limits on all plans, tax credits for small businesses to help them purchase coverage, NEW PLANS will cover preventative care, everyone shall have better access to appeals processes in NEW PLANS, premium rebates for people whose insurance companies are paying too much in admin costs (read: CEO salaries).  Not a lot is going to change soon for people who already have employer based insurance plans.  But there are some good things here.

[paul.karen]

The truth is they passed a healthcare plan written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, to be signed by a president who hasn't read it and who smokes, with funding administered by a treasury chief who didn't pay his t...axe......s, all to be overseen by a surgeon general who is obese, and financed by a country that's broke.

There are some great things in this bill for sure.  And there are many things in this bill that are big unknowns.

But if we look at the track record of what the government runs like medicare-the post ofice-social security-welfare programs they are all going bankrupt.  They all are WAY OVER BUDGET by billions of dollars.  Hell we pay $20,000 for a $20 toilet seat when it goes through congress.
We are going to cover an additional 32 million people with the same if not less doctors and nurses.  People who work will end up picking up much of the fees for people who ccant afford insurance.

I dont know one person sho is against reform for our medical system.
But when pelosi and Obama BUY VOTES for billions of dollars then something isnt right. 

It is done and all we can do now is wait and see.  And lets remember republicans didnt hold this up for a year.  It was the Dermocrats themselvs who couldnt get it done until the payoffs were dolled out.  Which we the taxpayers end up paying for.

[MooseMom]

I just also want to explain that unlike in the UK, access to health care in the US is for the most part tied to your job.  The vast majority of us get our insurance through our employer/spouse's employer.  Like most people, we do not tend to try to solve problems until they become an emergency, and once the economy tanked and so many people lost their jobs, the emergency was upon us.  The matter became quite urgent, and that is one reason why it probably feels like this legislation was passed so quickly.  We left it til the last minute.  I am hoping that one result of this new bill will be more "portable" insurance because as things are now, too many people feel they cannot move or change jobs without risking their access to health care, and this is fundamentally un-American.  We are held captive by our system; it deprives us of the freedom to move about or to look for more fulfilling employment if that is our choice.  My husband's employer offers good insurance (for now), but I don't have a choice in which company his employer insures with.  Since I have CKD, that's one whopper of a pre-existing condition, and I am therefore uninsurable should I choose to buy an individual plan.  I doubt that any single person on this forum would be able to find an insurance company to underwrite his/her dialysis costs if he/she were to try to buy an individual plan.  But in the US, dialysis costs are mostly paid for by Medicare, a government run, single payer entity.  Ironic, isn't it!?  Corporate insurance companies will underwrite those costs for only 30 months because after that, we no longer contribute positively to their bottom line.

[MooseMom]

Yes, the "Louisiana Purchase", et al were offensive, and that's why they were stricken from the final bill, thank goodness!

[BigSky]

We are going to cover an additional 32 million people with the same if not less doctors and nurses.  People who work will end up picking up much of the fees for people who ccant afford insurance.
 

Uninsured will not be covered until 2019 I believe.

Also some things to keep in mind are that as a nation we always pay for the less fortunate.

This has been necessary thing by government to build this nation. 

Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.

Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history.  Without it we would still be some backwater third world country.

 

[paul.karen]

I dont mind helping the down and out and the less fortunate.

I do however very much mind raising other peoples children through my hard earned monies.  Paying people to live off the system when they could be contributing to society.
To many people feel entitled and that the government owes them something.

Then again maybe im the stupid one?  Maybe since i qualify for disability i should quit my job and work the system like so many other people are doing.

Im all for supporting our vets and handicapped people.  But to support the drug dealer driving in his nice car collecting SSI, or a crack mother having another baby so she doesn't get kicked off welfare this is what i dont agree with.

Oh and i also dont want my money going to anyone who is here illegally.  But i dont get a say in any of that.

[Meinuk]

Also some things to keep in mind are that as a nation we always pay for the less fortunate.

This has been necessary thing by government to build this nation. 

Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.

Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history.

BigSky, I have to say, on those points, I agree with you. (I just wanted to be able to type the words... BigSky, I agree with you )

Somewhere along the way, we went from being a nation united to being a nation of individual rights.  We need to find a happy medium in order to survive.  The partisan politics on both sides have been odious to me for some time now, but I have learned to live with it and try not to buy into the hype from either side. It is not easy with so many people being so polarized, but I have learned that there are people I love who are just to the right of Atilla the Hun, and people who I love who are so far to the left of left that Mao himself would call her a lefty.  These are people who have a lot of anger at the system for whatever reason, but they are still people with families, responsibilities, dreams and ambitions; politics alone should never define anyone.

The truth is, all of this is just a start.  And as long as all of the vitriol keeps flying the only people who will profit will be the attorneys who file the litigation.

I just hope that one day in the future, people won't have to make the choice between feeding their family, paying the rent or going to the doctor.  It is when they put off going to the doctor that catastrophe happens (like kidney failure)  Medical care should not be a luxury in the land of the free.

 Ok, I am jumping back out of the political threads... (if only we could fix health care without politics... sigh....)

[MooseMom]

Unfortunately, we have not yet devised the perfect system that will weed out the scammers from those truly in need.  We all want to help those who need a helping hand while not at the same time supporting the drug dealer with the fancy car.  A lot of taxpayers' money is spent in tracking down and eliminating fraud, but fraud still exists.  But that doesn't mean that we should never help anyone.   Just because someone may feel entitled or may think the government owes them something doesn't mean that they will get it.  There is nothing in the new bill that would guarantee coverage to those who are here illegally.  What I want from this bill is for it to give people who are uninsured because they cannot afford their own private plan due to pre-existing conditions the opportunity to buy for themselves an insurance policy that will give them access to care. As things are now, profit making concerns are depriving us of our freedom of choice.  We fool ourselves if we really believe that we are passing healthcare for the "less fortunate"; we should pass it for ALL of us because we never know when someone on some board somewhere will define you and me as "the less fortunate".  We have ESRD; we ARE the "less fortunate" already.

[Poppylicious]

I just hope that one day in the future, people won't have to make the choice between feeding their family, paying the rent or going to the doctor.

Is that what happens now?  See, as a very simple person it was this which really stood out for me.  Everything else was gobbledy-gook.  I can't understand why anybody would want to deprive anybody else of being able to see a GP and get medical care.  I realise that's a terribly simplistic view of it, but that's the crux of the whole situation from where I'm reading. 

I've been reading some of the comments on the Facebook group 'I bet we can find 1,000,000+ people who disapprove of the Health Care Bill' and also some of the comments on the BBC Have Your Say (international) site and I've found some of it difficult to stomach.  It makes me sad (for many reasons).  It also makes me realise that in many respects your culture and way of life is alien to me despite the fact that I 'know' so much about the USA from a lifetime spent devouring American books, tellybox shows, music and films.

Ok, I am jumping back out of the political threads...

As am I ... 

[ahamner]

But in the US, dialysis costs are mostly paid for by Medicare, a government run, single payer entity.  Ironic, isn't it!?  Corporate insurance companies will underwrite those costs for only 30 months because after that, we no longer contribute positively to their bottom line.

I was under the impression that Medicare pays for dialysis treatments for CKD patients regardless of age except that the government mandates that it is secondary to any private insurance someone may have for the first 30 months of treatment.  If you have no other insurance, Medicare will pay 80% of the cost immediately.  So, I thought it was Medicare that wouldn't pay for the first 30 months of treatments to save the government money.  Dialysis providers usually absorb (write off) the costs which are unreimbursed by Medicare if the patient cannot afford to pay the rest of the costs. 

In the case of a kidney transplant, my understanding is Medicare will only pay for the first 36 months of required drugs after transplant and then you are on your own for the cost of the drugs after that and thus you will need private insurance if you manage to live that long.

In my case Medicare never paid for any of my dialysis treatments for the nine months I was on dialysis nor did they pay any of the costs of my transplant operation and hospital stay.  My post transplant medications and lab tests have also been paid by my private insurance. 

It has always puzzled me what logical reason Medicare has to limit payment for required medications for transplant patients to 36 months.  I have talked to people who let their transplants fail because they couldn't afford the drugs to prevent rejection and had to go back on dialysis (which costs more but then Medicare will pay again).

When I reach 65 years old in two years, I will be required to sign up for Medicare. However I will continue to need private insurance since Medicare only pays 80% of the allowed costs and I will be responsible for the rest.  So I will have to begin paying a monthly premium for Medicare Part B ($100 plus monthly) in addition to the premiums I now pay for the private insurance to maintain the coverage I have now.

Hopefully, the health care reform bill won't result in my private insurance being required to adopt the Medicare rules.

[paris]

Uninsured will not be covered until 2019 I believe.

Also some things to keep in mind are that as a nation we always pay for the less fortunate.

This has been necessary thing by government to build this nation. 

Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.

Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history.  Without it we would still be some backwater third world country.

I agree with Big Sky, too.       Well said.

I also don't think that because I am on disability, that I am living off the system.  I worked for a long time paying into S.S. and I am so grateful that now I can "withdraw" some of what I have put into it.

[Rerun]

Ahamner, your private insurance must pay 100% right now?

[ahamner]

Ahamner, your private insurance must pay 100% right now?

Yes it pays 100% of allowable charges, except for small co-pays.

[Bill Peckham]

Between now and 2014 A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014 not 2019, for those who can't afford insurance now you should have access to coverage by 2014. For people with a Tx and no access to coverage you should have access through state high risk pools in 2011

For people with low income and who reside in the vast majority of states (Medicaid is a state administered program with rules differing from state to state) this bill is huge improvement. This bill will establish income eligibility for Medicaid at 133 percent of poverty irrespective of family status.

Today access to Medicaid depends both on the state where you live and your family status. For adults who are not parents, in 43 states you can be penniless and you’re ineligible for Medicare. Period. No review. No appeal. No kids/no coverage in 43 states. This bill does away with that and allows low income single adults access to Meidcaid based on need. This is huge for some people on dialysis and or living with a transplant and in itself nearly meets the need created by the lack of immunosuppressant drug coverage.

But there is more. Today, if you have kids the Medicaid Average income eligibility standard is 69 percent of poverty. In some states, it’s as low as 25 percent of poverty. Think about that - in half the states if you have kids and make 70% of the poverty level you are not eligible for Medicaid. That goes to 133% in all states, with the bill.

If you make more than 133% of the poverty level for your family size you can buy into the exchanges starting in 2014. Check out the Kaiser Family Foundation's premium calculator  to figure out your cost in the exchange. The question I can't answer is will the base policy in the exchange cover the basic immunosuppressant drugs someone would need post transplant? With the reconciliation bill that the Senate has yet to vote on the base plan is better than the one already voted into law sent to the President's desk for signing in the Senate Bill. After reconciliation the base plan will be pretty good but I do not yet have the definitive link on what the base plan will cover. I'd bet immunosuppressant are covered but ... still looking for a link.

ETA: 2014 is when the Medicaid changes go into effect too.
http://docs.house.gov/energycommerce/AFFORDABILITY.pdf

 

[murf]

Billbags, you are very brave indeed. Recently, I asked for some kind American to explain their health system and provoked a raging argument on this site that lasted two weeks. I will be looking with interest at what develops here.

[BigSky]

I dont mind helping the down and out and the less fortunate.

I do however very much mind raising other peoples children through my hard earned monies.  Paying people to live off the system when they could be contributing to society.
To many people feel entitled and that the government owes them something.

Then again maybe im the stupid one?  Maybe since i qualify for disability i should quit my job and work the system like so many other people are doing.

Im all for supporting our vets and handicapped people.  But to support the drug dealer driving in his nice car collecting SSI, or a crack mother having another baby so she doesn't get kicked off welfare this is what i dont agree with.

Oh and i also dont want my money going to anyone who is here illegally.  But i dont get a say in any of that.

There does need to be some changes with the system.

Anyone convicted of a drug offense while on SSI should be banned from every receiving it.  Among other things I also think earned income credit should be done away and that money applied to the costs of this bill. 

[Bill Peckham]

I live in the UK and I have been taking a little interest in Obama's Health care Reform. Can you tell me in simple terms what it means and why so many people seem to be against it and don't want it. To me it sounds like it will help a lot of people who can not afford insurance for health care, have I got it wrong?

It represents a fundamental shift in the nature of health care from being the responsibility of each individual to organize their access - the idea is you get health insurance through work, or you buy it on your own - to the government making sure you have organized your health care access.

But as far as actual impact we're talking about changing how 940 BILLION is spent over 10 years on a healthcare sector that will cost something like 40 TRILLION or more over that same period.

To put this in dollar terms that our minds can comprehend (I can't really comprehend a billion dollars let alone a trillion) it's as if you are saying that over next 10 years you'll spend $90 differently, out of $4,000.

[Rerun]

You have to answer this:

Is Health Care a "Right" or a "Privilege"?

If it is a "right" than the government pays for it.  If it is a Privilege than you pay for it if you can afford it.

[BigSky]

You have to answer this:

Is Health Care a "Right" or a "Privilege"?

If it is a "right" than the government pays for it.  If it is a Privilege than you pay for it if you can afford it.

Health care is a Right.

The Declaration lays out several unalienable rights, one of them being Life.  Of which Republicans should have been behind reforming health care while they were in power because the Declarations Right to Life is one of the views that give when it comes to being against abortion.

That is why Roe v Wade is so flawed. It violates that principal of the Declaration.

[Hemodoc]

The proof will be in the pudding.  There are major aspects that should cause all to sit back and take notice of the huge tax increases as well as the number of IRS agents hired should also tell us something.  I simply do not have the confidence in our government to run anything, especially health care given the outcomes of CMS compared to other developed nations with CKD issues.  Just call me skeptical, I will wait and see what they finally deliver.  However, before we see what they will deliver 4 years down the road, we will see what happens with our economy long before it takes effect.  We may find everyone has access to health care, but our jobs have gone oversees. So, we will all just have to wait and see what we face. I will remain skeptical until they deliver what they promise without imploding our economy.  I am not sure that they can deliver all that they have promised.  Remaining skeptical in Idaho.