Healthcare reform. What does it all mean?

[Bill Peckham]

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.

That's a Constitutional argument I hadn't considered but I think you can also make the point in terms of efficiencies but most importantly just having a country that you want to live in - like you said in an earlier post the whole point is to do things, I'd add the internet or the postal system or the national parks - that make this such a great place to live. It would be better if access to health care was a right, so why not make it a right.

And Peter the proof is in the eating not actually in the pudding. You'll need links for the number of IRS agent point.

ETA If you're interested in the revenue aka tax elements of the post reconciliation bill they're here:
http://docs.house.gov/energycommerce/REVENUE.pdf

[billybags]

Whoops Murf, What have I started? I don't think I will ever understand the American system.

[MooseMom]

As I was listening to Congressman Stupak the other day, along with others who are pro-life, I couldn't help but wonder about how the health bill will affect those women who need prenatal care and do not have adequate insurance.  It seems odd to me that there are many, many good and thoughtful people in this country who fight hard for the lives of the unborn WHILE THEY ARE STILL UNBORN yet do not seem to understand the role of good prenatal care.  And if those babies are born with disabilities and their parents don't have access to adequate insurance, well, they don't seem to matter anymore.  It seems that too many are willing to fight for their lives but not for their health.  If you are truly pro-life, then you need to think long and hard about your stand on helping everyone have access to affordable healthcare.

[Hemodoc]

Dear MooseMom,

Having signed hundreds of WIC forms for Medicaid patients who not only get free prenatal care but also nutritional supplements, your comments simply do not have merit since those too poor to purchase their own health insurance already have access to health care in this at risk group.

I have looked at how other nations have done health care reform and America's current solution does not come close to some that actually did a good job doing this.  In addition, I have seen the hand of the FDA in pharmaceutical price increases which are the largest segment of our rising health care costs, yet big Pharma made a sweet heart deal in our health care reform so pharmaceutical costs are not addressed except to limit Canadian imports and generics.  It is business as usual for health care reform as far as big pharma is concerned, and may actually be better.  Much more can be said about big unions and all of the special deals with all of the different states.  This law will not apply to all citizens equally. Is that fair?

So, please do not interject humanitarian issues as a substitute for real political and economic issues that the majority of American people objected to.  America is the biggest giving nation in the world in part due to our economic status.  Many such as myself give large parts of our income to charity, so just because many oppose this version of health reform, it does not in the least impinge upon our own personal humanitarian efforts.  Protecting the innocent unborn child in the womb is the greatest of these humanitarian efforts. Likewise, affordable health care for all people is in the same light, but I do not in the least believe that we achieved true health care reform with what just passed in Washington DC.  Providing or not providing humanitarian health care needs is not why so many in America have objected to the political dealings in the health care deal.  Let's talk apples to apples please.

[MooseMom]

Dear Hemodoc, unfortunately, there are many people in this country who do not qualify for Medicaid or Medicare that still are underinsured and do not get the prenatal care they need or else do not have coverage for a newborn with lifelong developmental or physical disability.  These are the middle class people who have lost their jobs or whose employers no longer provide health insurance.  Much of the opposition to health care reform in this country comes from some perception that such reform is only for the "poor" and is nothing more than a benefits package, that it benefits "them" and costs "us".  I do not see access to prenatal care and insurance for children as a "humanitarian issue".  The majority of Americans do not object to prohibiting Corporate America from invalidating their policies due to "pre-existing" conditions or keeping kids on their policies until 26, or the temporary creation of high risk pools or no more aggregate limits.  Yes, let's do talk apples to apples and quit equating humanitary actions with giving all Americans the opportunity to have access to affordable health care. I don't know what health insurance reform has to do with America's status as a charitable nation.  "Reform" and "charity" are faaaaaar from synonymous in this discussion, and that you imply differently is quite disturbing.  It's the "us" versus "them" undertone that is disconcerting.
 
Very few laws apply to all citizens equally.  That's why ESRD victims get special provisions re Medicare.

OK, you can have the last word because I will not enter into further discussion on this.  It feels inappropriate. I really do not enjoy arguing with people who, at least on some level, share the same illness, fear and anxiety thatI do.   None of us need any more aggravation in our lives, especially from people who already have so much on their plates.   

[Hemodoc]

Dear MooseMom,

I am afraid that you don't understand in the least the opposition to this specific health care package.  Sorry you don't want to debate your own comments but so be it.  I do believe that you are in error about those with disabilities since the ADA covers a wide variety of disabilities not the least of which is CKD issues.  I worked for nearly two years with autistic children before going to medical school and their incenter treatment was covered through special education mandates of the school district.  There are many levels of help to those disadvantaged in our nation already, but that is not what the opposition to health care reform was all about.

If people think that we have done a good job with this package, then go and look at how other nations have done health care reform without disrupting many aspects of our entire nation as this law has the potential.  Many have gone before us, but it does not appear to me that America borrowed from the best ideas of the other nations.  The uproar in this nation was and is over the special interest deals that made up much of this package.  By the way, a law that does not apply equally to all of its citizens is not constitutional.

In any case, charity is one of the most profound markers of humanitarian societies and America ranks highest in this regard. Take a look at this PBS show on health care reform around the world.  You have now seen the American version of health care reform, ask if we did better or worse than the others around the world.  As I mentioned to Bill, they have made many promises both health care wise and economic wise with this law that I do not believe that they will deliver.  Many do not at all share the optimism that the current congress got this bill right.  I suspect that after the next election round in November, we will then enter into a Value Added Tax debate to finance this law that is by many analysts underfunded and will increase dramatically government spending and borrowing, the economics that they have sited simply do not add up to provide health care to all and reduce the budget deficits.  In such, i am quite willing to simply come back to this debate a year from now and see what we are facing. I suspect as do others that a VAT is next coming down the pike.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Will the new law create jobs or will more go oversees?  Will comparative effectiveness research lead to higher standards or to truncated standards set arbitrarily by $/QALY?  In other words, the bar is now set at $100,000 per added QALY with dialysis per year now rated at $96,000/QALY.  The ESRD program is felt by many to be a failure and is used as the measuring stick of maximum medical benefit or medical failure in some eyes but this is not set in stone.  This is the average cost analysis and those that are the sickest dialysis patients are set at nearly $500,000/QALY and many articles have already stated that they should not receive that benefit, it should be denied.  If anyone is interested in what we shall see coming down the road, then all you have to do is look at the commentary of the NICE in the UK where medical decisions are based on politics and not by the doctors that desire new and effective treatments available in other nations but denied to those in the UK.  Many examples of this are available for anyone that wishes to look. 

This is not the end of the health care debate, it is in many ways just the start.  The difference will be all American patients trying to move CMS to do that what is right and not just the dialysis population.  I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion.  Once again, just call me skeptical.  I will simply wait to see how well they deliver on their promises but I will not hold my breath.  I truly do not believe that they can or will deliver what they are promising on all fronts.  Time will tell.

[MooseMom]

OK.  First off, I will tell you that I have an autistic child, and that I have lived in the UK and have received medical care in that country, in the US and in France.  I can tell you that there is absolutely no way that an autistic child in the state of Illinois where I live has the same access to medical, educational, recreational, residential and occupational opportunities as an autistic child in the UK.  That is why my son lives there and not here in the US.  You can quote any statistic you want, but I've lived it.

I saw the Frontline episode of which you speak, and I do not think that any of the healthcare systems seen in those countries featured would be politically viable here.  I am not sure I understood your post; are you advocating the inclusion of various elements seen in these countries' healthcare systems? I certainly would agree with you in such a case, but Americans would rail against anything smacking of the NHS in the UK (I don't think Americans really understand "socialized medicine" vs "single payer" vs "universal coverage") or the mandate to have insurance in Japan (which we are seeing here) or the non-profit "sickness funds" seen in Germany (No profit???  That's Communism!!!).  What exactly do you want to see, Hemodoc?  I agree with you that this healthcare reform bill is woeful as I would prefer to see employers freed from having to provide health care insurance (that's anti-business in my mind) and also see the profit-making incentive removed from the whole equation. The entire system should be scrapped and should be rebuilt using ideas like you've illustrated via Frontline, but oh wait...you've said that it must be done without "disrupting many aspects of our nation".  Is that even possible? Have a single payer system and free employers from this huge financial burden, and you won't see so many jobs go overseas where health care costs are low or are subsidized.  The NHS worked brilliantly for me and I wouldn't mind seeing it recreated here.  Why don't you do me the favor of spelling out EXACTLY the nature of the opposition to the new bill, and while you are at it, outline EXACTLY the special interest deals that have you so incensed.  You and I might actually be more in agreement than you think.

I still don't understand the line you are trying to draw tying charity with health care reform.  So I'm a bit thick; sorry.

[MooseMom]

I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion.  .

Who has placed the road blocks to optimal dialysis, and why?  What is the exact nature of these roadblocks?

Is there anything in the new bill with which you agree?

I would be most interested in your picture of the ideal American healthcare system that you think most citizens would support.

[Bill Peckham]

I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion.  .

Who has placed the road blocks to optimal dialysis, and why?  What is the exact nature of these roadblocks?

Is there anything in the new bill with which you agree?

I would be most interested in your picture of the ideal American healthcare system that you think most citizens would support.

I think the answer is those who profit. Profit driven medicine has done a disservice to dialyzors and is bankrupting the country. This bill allows the medical profession the opportunity to do what they went to school to do - help people. I think this quote from Dr. Gawande is spot on:
“We as a nation—and in particular those of us in medicine—now have work to do to defend and deliver on this promise and to address the legitimate concerns about costs while making health care better for everyone. But that is the remarkable thing. We have finally been given the work to do.”

I saw that quote on Maggie Mahar's blog:

Medical Professionals Must Lead: This is Your Revolution--Atul Gawande                                 

Writing on the New Yorker’s “News Desk” today, Boston surgeon Atul Gawande laid out the challenge that health care reform poses for hospital administrators, physicians, nurses and every other professional in our health care system. (By professionals, I mean people who realize that they must put the interests of a sick person ahead of their own interests. I have met pharmacists, lab workers, home health care workers and many others who take this responsibility seriously. In many cases, this is why they chose the job.)
Gawande writes: “What made the passage of health reform historic is that, after almost a century of effort to reverse this, hope has arrived.

“We as a nation—and in particular those of us in medicine—now have work to do to defend and deliver on this promise and to address the legitimate concerns about costs while making health care better for everyone. But that is the remarkable thing. We have finally been given the work to do.”

Yes, this legislation gives medical professionals an opportunity to take the power back from the for-profit corporations that now, to a very large degree, run health care in this country. Today, even nonprofit insurers and hospitals are affected by for-profits. They must compete with them, and thus, in many cases, they have begun to imitate them.

But health care professionals can help only if they understand that reform is all about rewarding  patient-centered, evidence-based medicine. Medicine should not be profit-driven. Those who think of medicine as a “business,” like any other, will be out of luck.

[MooseMom]

So, Bill, you are saying that we dialysis patients don't get as much dialysis as we may need because it bites into corporate profit margins?  But isn't making profit the American way?  Or is that just on Ferenginar?     Dialysis is an expensive proposition.  Who should pay for it?  Who should pay for us here on IHD?  Answer that simple question, Hemodoc, instead of darkening the waters with statements about Charitable America and special interests.  Going back to the Frontline piece, out of the five capitalist democracies that were featured, not a single one based their health care system on profit.  What has been rammed down our throats is this idea that we should entrust our access to healthcare to Corporate balance sheets.  If you want to rail against special interests, let's start there. 

Thank you, Bill, for your post.

[Bill Peckham]

The bill that the President signed into law yesterday addresses the profit in the provision of health care insurance and it provides tools to evaluate the value of medicine, the comparative value. Health care isn't directly changed, however, there are plenty of pilots and studies. But to get from there to a take over of medicine you have to assume the new data will be used to achieve these unlikely outcomes.

I've actually called for comparative effectiveness research in an official capacity - I served on a panel that CMS put together to look at developing Quality Measures for dialysis in the area of Fluid Weight Management. It was an interesting process on a topic I am specifically very interested in and think is important but there is not a lot of data to base decisions on - comparative effectiveness research is critically important because I think there are devices and approaches that are available today that would improve the provision of dialysis as measured by the standard mortality rate and/or the standard hospitalization rate.

However, it is not enough that my gut tells me one device or approach is supperior to another, you have to have data. Comparative effectiveness research provides data. The objective is not obscured in the 2,400 page bill. CMS's objective is to reimburse efficient and clinically outstanding care.

One part of this bill that I haven't heard any mention of is that preventive care is reimbursed @ 100%, not even the standard 80%. And things like a yearly physical are reimbursed through Medicare. The CBO gave no credit for these preventive measures saving money, but I think that is paying doctors to keep people well and should save money.

[Hemodoc]

Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.

As far as workable systems, privately owned nonprofit healthcare competing among each other as in Switzerland is a very interesting proposition since I have seen how well a nonprofit can run when it is run well.  My experience with Kaiser was over all positive with some issues I simply learned how to get around like in any system.  On the other hand, my experience in the last 6 months with Group Health up here in Idaho which is affiliated with Kaiser has been very negative.  Switzerland has only non profit medical groups and that is the right place to start as well as keeping them privately owned and not government owned.  It keeps market place solutions in place as well as real patient choice.  What we have in this bill is no where near what they accomplished in Switzerland from what I can see.

As far as docs taking charge, we have one more 600 pound gorilla in the exam room now that the government has stepped in.  Private practice is nearly a dead form of medical care, so the docs have long since lost their power to lead in so many ways.  I agree that docs need to take the lead and that has been my main theme at DSEN with optimal dialysis and nephrologists.  Unfortunately, the old fashioned doc who places the patient first is becoming a dinosaur and is headed for extinction.  I have written about the new medical ethics at DSEN and they are nearly uniformly accepted by the younger generation of docs who are schooled in rationing their resources especially from those in the ER and basing decisions on utilization of the population instead of what is best for the individual before you in the exam room.  It is a completely different philosophy of practice that removes the doctor as the patient advocate. 

Once old fashioned docs like me die off, then the patient advocate doc will become quite rare indeed.  So, I echo your sentiments that the docs should lead, but now it will be the politicians that will be making coverage decisions and taking the lead.  They will make their decisions based on population needs, not individual needs.  The new medical ethics have now been politicized.  I know personally from my years protecting patients from early discharge and recommended less costly treatments as well as those that now advocate for me with my renal disease how important it is to have doctors in charge of medical care.  Today docs are rated on how well they manage groups of patients which means the individual is often at the mercy of how much the docs has already spent on other patients ahead of him.  The way they did it in our group was to simply publish your ranking on specific issue such as antibiotics, CT scans, etc.  What happens is that the mean keeps dropping every time they report since you don't want to be in the highest 10% who receive reprimands without looking at the individual cases and their merits for each.  Treating the population is much different than treating the individual.  But that is the new way to do medicine.

We will now use CER as the measuring stick at a central CMS site instead of individual decision making in the exam room.  Primary care will likely be the big winner with rightly placed attention to preventative medicine and specialty care will be the loser with expensive breakthrough treatments less easily adopted. Unfortunately, preventative measures have failed in so many instances due to individual health choices and lifestyles.  There is a limit to how far preventative care can go, important but limited. The health care may be great if you stay healthy, but I will wait to see how the chronically ill fair under this.  As I said before, I remain skeptical that they can keep all of their promises without imploding our economy at the same time.  That is not a spring board for debate, just where I am looking for future developments.  Once again, time will tell.  Still skeptical.

[MooseMom]

Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.

I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has.  That was not only what he campaigned on, but that's what he was saying up until the final vote last week.  Why do you think that is not what we ended up with?  Looking at the FEHBP, I don't see anything there that most Americans would not gladly have.  In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why.  Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices.  But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has?  If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy?  Not the Federal Government, surely.

[Bill Peckham]

Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.

I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has.  That was not only what he campaigned on, but that's what he was saying up until the final vote last week.  Why do you think that is not what we ended up with?  Looking at the FEHBP, I don't see anything there that most Americans would not gladly have.  In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why.  Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices.  But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has?  If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy?  Not the Federal Government, surely.

http://www.a-s-t.org/files/pdf/public_policy/BCHRU_March24.pdf

The bill would require the federal Office of Personnel Management, which currently administers the Federal Employees Health Benefit Program, to contract with private health insurers to offer at least two nationwide plans, one of which must be non-profit, through the exchanges. OPM would be responsible for negotiating with insurers and ensuring that the plans meet minimum standards, just as it does for FEHBP. FEHBP would remain a separate program with its own risk pool.

[Hemodoc]

Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.

I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has.  That was not only what he campaigned on, but that's what he was saying up until the final vote last week.  Why do you think that is not what we ended up with?  Looking at the FEHBP, I don't see anything there that most Americans would not gladly have.  In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why.  Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices.  But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has?  If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy?  Not the Federal Government, surely.

Dear MooseMom,

Yes, who will be paying is exactly the question at the heart of those that opposed what is now the law of the land.  I see that the Senate took quick action on reconciliation.  A year from now if they tack a Value Added Tax on to everything every American buys, you will have your answer on who will pay.  Welcome to the new United States of Europe.  I believe we have actually come full circle on why the majority of American's opposed this law and it had nothing to do with the separate abortion issue although some did object on that issue.  Abortion was not what this battle was about.

Once again, I remain quite skeptical especially about the economic aspects of this new law as promised in the debates over the last week.  But our opposition unfortunately did not secure an affordable health reform, so it will be time to pay the piper so to speak.  I believe in January 2011, the issue will be the VAT.  Only a guess and it is not my original supposition, but I simply do not see the financial promises made in the last week every coming together to lower the deficit.  The solution will have to be added taxes.  The VAT will most likely be the next contested battle over health care reform.  I don't see the state opposition mounting to something that will be overturned by the Supreme Court, but you never know.  Not much more to say about that, only time will tell.  Still skeptical in Idaho.

[MooseMom]

But Hemodoc, you didn't answer my question.  If you got what you want, which is FEHBP for all, the question still remains...who subsidizes that 75%?  Do you think the American people would accept having the OPM negotiating with insurance companies like they do for current federal employees (as pointed out by Bill)   Isn't that more "big government intervention"?  As for VAT, well, I lived in the UK and survived with VAT, and if you had a VAT here, it wouldn't by definition make us "European".  That's the sort of rhetoric that takes people's attention away from the real issues at hand.  In the UK, there are many things that are not subject to VAT such as food (that you buy in supermarkets, not the food you eat in restaurants), children's clothing, newspapers, equipment for the disabled..all of these things are zero rated but taxed pretty highly in the US.  There are other goods that have a lower VAT, too.  Of course, the problem here would be that states would squawk because they have their own tax rates whereas in the UK, there's not an Essex sales tax, for example.    Of course the issue here was never really abortion, but there are people who, again, want to merely avert our attention.  I'm really interested in your ideas on who would pay for the subsidized premiums payable to insurance companies that participate in FEHBP if what was available to Federal employees were made available to all of us.  I'm sorry if I didn't follow your post, but I don't believe you answered that question.  You said that, yes, that was the question...I know that, but what are your ideas regarding the answer?  In our present volatile political climate, what do you think the people would accept as the answer?

[Hemodoc]

Dear MooseMom,

I already answered what system I believe has done the best and that is the one in Switzerland.

Who will pay?  That is quite simply you and me and everyone else.

[MooseMom]

Dear MooseMom,
I already answered what system I believe has done the best and that is the one in Switzerland.

The Swiss have mandated universal coverage.  That seems to be a real sticking point here in the US; how would you go about convincing Americans that mandatory insurance does not impinge upon "liberty and freedom"?  And insurance companies in Switzerland are not allowed to make profit on basic care provisions; do you think that would fly here in the US?  Switzerland also does not have employer-based insurance plans like we do here in the US, so how would you go about taking employer provided plans out of the equation?  I personally agree that either the Swiss system or the expansion of FEHBP would be very nice, but then you'd get into major upheaval which you stated you wanted to avoid.  If you were president, how would you present the Swiss template to Americans?  How would you make it politically palatable to the Glen Becks and Congressman Boehners of the world?

[Hemodoc]

Dear MooseMom,

I have aqlready answered who I thought did the best job in their countries health care reform.  That I believe is the Swiss.  The issue is not should we improve our system but how.  We now have mandated health insurance for all with IRS penalties to those who don't comply, not sure what point you are trying to make. The reason that I like the Swiss model is it is based on market competition among the insurance companies who are all non profit.  The advent of for profit health care in America is actually a new issue in the last generation or so.  I remember clearly the stories of I believe Humana coming on board with a for profit company.  The history of American medicine is that of nonprofit hospitals and groups that depended on charity.  I worked for 11 years at Kaiser which had more money available to the patient than the for profit companies we competed against.  The NHS in the UK looked at how well Kaiser accomplished the job of taking care of patients at the same level of payment per patient with Kaiser able to deliver much more than the NHS.

I have no problem with a shared burden for all to carry when it comes to the responsibility of our health care.  However, time will tell if Glenn Beck is correct on how this bill will affect Americans.  I believe he is correct on how it will effect our economy in the long run. I usually watch his program every day and his main focus is on the historical aspects and how they affected people in the past and he extrapolates that to the future.  Once again, ask me these questions in 5 or 10 years.

As far as the politics, my view is that there is simply too much corruption on both sides of the aisle so I will pass on answering the political issues without having an honest group of people representing us.  We have long since left the provisions of a republic which is rule by law.  The founders deliberately rejected rule by the majority otherwise called democracy because of the history of democracy which always leads overtime to dictatorship.

[Romona]

How far are things going to get before it is declared "Unconstitutional" to force someone to purchase a policy. I don't know if people are going to worry about paying a fine if they are in danger of losing their home. What is the role of the individual states? As things are now the each state offers different levels in services for such things as education. Using autism as an example, things can vary from county to county with in a state. I live in Pennsylvania which offers a low cost health insurance for children. There are also low cost plans for adults through the state, but very long waiting lists. How low cost these plans actually are, I don't know. For a family on a low income it might seem like a fortune. I personally don't have a problem with tax dollars used for people that truely need it. I do have a problem with people abusing the system. I don't want to pay for the health care of people that aren't here legally. I have sympathy for their plight, whatever they suffered to want to leave their country. Come to the U.S. the way our ancestors did, the legal way. What is going to stop employers from downsizing so they won't have to offer an employer plan? Kind of rambling, but my opinion.

[MooseMom]

Romona, no one wants their tax dollars going to people who are here illegally, but if such a person shows up with his kid at the ER, what would you have a doctor do?  It puts doctors in an untenable position if you make them establish a patient's legal status before giving treatment.  And employers are already downsizing, and have done for years, to avoid having to pay for their employees' expensive health care.  That's why so many jobs leave the US, and that's why I personally would like to see single payer and allow businesses to come out from under this particular cost of trade.

Hemodoc, we long ago stopped being a democracy.  We are ruled by Corporate America.  Profits come first.

[BigSky]

Its highly doubtful it would be ruled unconstitutional to make people buy plans as precedence shows that mandatory insurance is not unconstitutional.

The medical community loses millions of dollars a year because people cannot pay their bills.  60% of all bankruptcies are the result of medical bills. 

Take that into account with the numerous accounts that are past due that are sent to collections.  Now if everyone has medical coverage, its very reasonable that costs would go down because the medical community is not losing millions of dollars a year and thus would not have to raise prices to cover that loss.

If one drives its mandatory they have auto insurance.

Now if one seeks medical care they must have health insurance.

And EVERYONE seeks medical care at one time or another in their life.

Under the bill abortions are not covered  nor are illegals.

[Hemodoc]

Dear MooseMom,

No one in America is denied treatment in any ER do to economic status or citizenship.  It is regulated under legislation called EMTALA and it has very hefty fines that all docs take great care to comply with.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

[Bill Peckham]

Dear MooseMom,

No one in America is denied treatment in any ER do to economic status or citizenship.  It is regulated under legislation called EMTALA and it has very hefty fines that all docs take great care to comply with.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

People across the south are being relegated to the emergency room for dialysis because they are illegal and/or do not have insurance. The ER is not the appropriate venue for routine health care. After the Affordable Care Act at least those with citizenship will be able to get routine health care outside the ERs which should take a tremendous burden off of them - not that worried parents won't still show up with kids sniffling but people generally will begin to look to community clinics and their own physicians for ongoing care.

[okarol]

Email from Troy Zimmerman at the National Kidney Foundation.

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An Update on Health Care Reform
Health Care Reform Update

With Senate approval of health care reform on March 25, 2010, we wanted to highlight some of the provisions contained in the underlying bill and in the corrections bill (or "reconciliation bill"). (The legislation signed by President Obama on March 23, 2010 was the underlying health reform bill and identical to what the Senate passed on December 24, 2009; the corrections bill made changes to the underlying bill, under agreement with House and Senate leaders.)

The National Kidney Foundation (NKF) did not advocate for or against a specific health care reform bill throughout the process. However, we signed various letters of support on specific provisions (such as eliminating lifetime benefit caps) that were coordinate by coalitions and organizations. We believe that the legislation will benefit Americans with kidney disease or at risk of developing it. Here are some of the well-known features of the health care reform package that should have a positive impact on the population we serve.

1- Enhanced access to health insurance for individuals who are identified as having pre-existing medical conditions (including living organ donors) and who have been barred from coverage, or who could only obtain health insurance with premiums they cannot afford.

2- Elimination of annual and lifetime caps on the cost of services that health insurance will cover. (This could ensure continued access to care and to all treatment options for individuals who have been on dialysis for several years and received two or more kidney transplants.)

3- Reduction in out of pocket expenses for Medicare beneficiaries who have prescription drug coverage through Part D, by closing the "coverage gap" or "donut hole" by 2020, beginning next year.

4- Health insurance premium assistance for individuals or families earning less than 400% of Federal Poverty Level (approximately $88,000 a year for a family of four).

5- An estimated 31 million fewer Americans will be uninsured by 2019 than what would have occurred without reform, resulting in 94% of non-elderly having coverage (this estimate excludes unauthorized immigrants).

6- Prevention services expanded to include coverage of annual wellness visits.

7- Most coinsurance requirements for Medicare prevention services and wellness programs are eliminated.

8- Medicare Accountable Care Organizations created to better coordinate care.

Many of you monitored our efforts to expand Medicare coverage of immunosuppressive drugs for kidney recipients. NKF pursued a concerted effort, with many other organizations representing transplant candidates, recipients, and health care professionals, to leverage the health care reform movement in order to obtain relief from the 36 month limitation on Medicare coverage of the medications needed to prevent transplant rejection. The initiative bore fruit when a provision to expand Medicare coverage for these expensive immunosuppressive medications was included in the health care reform bill approved on the floor of the U. S. House of Representatives in November, 2009. However, the immunosuppressive provision was not contained in the Senate passed bill in December, nor was it included in the "corrections" or reconciliation package that the Senate approved on March 25, 2010. Nonetheless, we are optimistic this is only a temporary setback, as evidenced by the House support in November.

We are committed to pursue every opportunity, whether this year or next, to achieve this extension of Medicare coverage for transplant medications. The gradual expansion of Medicare benefits for transplant recipients over the last 25 years gives us further confidence that we will be able to claim victory in the near future. We hope we can count on every member of the NKF Board of Directors and our professional and patient advocates in our efforts to meet this challenge.

We will monitor the implementation of the health reform provisions to make sure that individuals with kidney disease or at risk of developing it will achieve the maximum benefit from these positive developments. If you have any questions about the legislation, please contact Dolph Chianchiano dolphc@kidney.org or Troy Zimmerman troyz@kidney.org
Thank you.