Healthcare reform. What does it all mean?

[MooseMom]

Hemodoc, Romona stated that she does not want to have to pay for the health care of illegals.  I pointed out that she already does everytime an illegal goes to the ER because he cannot go anywhere else for care.  As Bill pointed out, it is much more of a burden to taxpayers to treat people in the ER instead of allowing them access to primary/preventative care

Like you, I would be happy with a Swiss system that encourages market competition between companies that are non-profit, but this idea has been roundly defeated by those on the right side of the political spectrum.  I do not listen to Glen Beck...what do you think his view would be re introducing the Swiss system as the template for American health care?  A hypothetical question, to be sure, but I'd be eager to hear what you think his views would be.  I may be wrong, but I suspect that in his world, "not-for-profit" is synonymous with "socialist"...

I don't think, however, that we can/should entrust our health care to charity.

[Romona]

I guess I sound cruel saying that someone in this country illegally should be denied. If they are ill treat them and bill country of origin.
I hope all of this works. People do need health care.

[thegrammalady]

my biggest thing is i want coverage for the 20% that medicare doesn't cover, and i'm willing to pay for it. however as things stood i was unable to purchase a supplemental policy, as things stood all insurance agencies considered me uninsurable. as long as this changes, i'll be happy.

[Bill Peckham]

Email from Troy Zimmerman at the National Kidney Foundation.

=======================================================

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.)

...

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.

So if people are getting full insurance via this myriad of programs why do we need to still work for the extensions?

[Zach]

So if people are getting full insurance via this myriad of programs why do we need to still work for the extensions?

Go ask Troy.

 

[Hemodoc]

Dear MooseMom,

I am not trying to pick on you, but you simply don't represent well what you are saying about the conservative right in some of your comments.  Privately owned non-profits are not socialististic which instead implies either government control or government ownership depending on the political definition of your choice. Once again, the history of hospitals in America was that of non-profit, usually religious organization run corporations that was the back bone of developing the excellence in medical care that America is known for.  The for profit industry developed after the infusion of monies from the government during the 1960's and is to blame for many of the practices that many such as Bill have loathed.  The very nature of medical care in my mind is the greatest humanitarian intervention that one man can do for another that is in pain and suffering.  My personal view is that this should always be done as a viable non-profit venture.  The very nature of for profit organizations is the corporate bottom line which leads to less care to the patient.  As a physician and now as a patient, the business of medicine was always an issue that I placed well below the importance of treating the patient to the highest level possible, at least that was always my goal.

As far as Glenn Beck, he has very much a libertarian philosophy so I cannot speak for him, but libertarians advocate for the smallest effective government to prevent anarchy, but allow the maximal personal freedom which also entails personal responsibility.  Yet, if we must and will have universal health coverage, the least intrusive is privately owned non-profit medical corporations that compete among each other to provide the highest level of care.  In my mind, that is the least of all the evils.

Now, let me take issue with your statement that the non-profit idea was roundly defeated by the right wingers.  Since the right wing was not included in the health care debate, and a completely partisan bill was passed by rather dubious process, how can you say that the right excluded this as an option.  The health care bill as passed is completely left wing democratic law with minimal allowed input from the right.  The debate over health care passage was among the democrats for over a year, not the republicans with the super majority in congress and the senate.  Up until February, the Republicans could not even mount a filibuster.

If the president and congress wanted to give all Americans what they have as health care benefits, they have had that majority since the day that President Obama took office.  Yet they have specifically excluded themselves from this duty that we are all now under.  I just heard today that coverage for children's pre-existing conditions was not including in this sizable law meaning we will need further fixes to the health care law.  Bill can correct me if that is incorrect, but that is a report that I heard on Fox news today.

I spoke on the issue of the ER in response to your comment that docs are too busy to burden themselves checking for citizenship before treating patients in an ER setting. We have had EMTALA for nearly 30 years so this is not at all an issue to the treating doc. I have long understood that the bill for $100.00 for a single band aide in the hospitial was to cover the care of the indigent and those that could not pay, but yet the hospital was mandated to care for.  The artificially elevated costs of private health insurance was a hidden tax in insurance premiums that lead in part to the elevated cost of care in America.  However, the reports that I am hearing from Verizon is that health premium costs will go up substantially and benefits will be reduced since passage of this law.  If we are getting a massive infusion of Federal dollars to care for those that do not have coverage, why then is the private insurance costs now going up since they no longer have to also cover the costs of the uninsured?  Shouldn't the uncompensated Federal mandates of the last 3 decades now be offset so that health care premiums would go down?

Lastly, charity such as the MDA telethon, breast cancer research and many other charities have played an important role in advancing health care in America which offsets that of other nations who have not been as generous as Americans in general.  I had a patient with Myasthenia Gravis, which is a neuromuscular condition, who received a free wheelchair from the Jerry Lewis organization.  The Ronald McDonald foundation has provided amazing care for families of those undergoing cancer treatment.  Dialysis advocacy has likewise greatly benefit from charitable donations as well.  In fact, the history of charitable benefit to the health care of this nation has a long standing  benefit over hundreds of years.  The advent of government intervention into health care is only a few decades old and has yet to surpass the accomplishments of charity in health care in America.  It does have that opportunity before it right now and in such, I will simply hold my final judgement until they prove if they can keep all that they have promised.  That is a tall order without at the same time causing economic  collapse of our companies and ruining the last vestiges the best aspects of our health care system that came about by the historical benefit of charities and citizens who held personal accountability to provide health care for themselves and for their neighbors.

[Bill Peckham]

Medicare has helped fewer people than charity? Medicaid has helped fewer people than charity? The VA has helped fewer people than charity? Childrens health insurance has helped fewer people than charity?

Politics is a confusing business but it would be hard to watch the process for the last year and not understand that Senators like Baukus, Lincoln, Nelson, et al the so called blue dog democrats would have agreed to anything if six Republican senators or thirty house republicans would have agreed to a compromise. The reason Grassley couldn't reach a compromise with Baukus is that he couldn't guarantee a single republican would come along and one Senator alone is not politically viable.

Take just the weeks after Brown's victory in Jan - it was just two months ago. If you pay any attention to politics you know that if six R senators had come to the "moderate" Dems with a compromise package it would have been embraced. That didn't happen because the Republicans decided in January 2009 that their best hope would be if Obama was seen as a failure. Where is the accountability for their predictions that have already turned out to be not true: as soon as it passes the Dems will attempt to change the subject; it will be signed in the middle of the night; the more the American public know about the bill the less they'll like it. They made the frequent claim that CNN polling had 59% against the bill without explaining that they were conflating opposition from the right and the left - if you just listened to sources from the right, this week must have been very confusing.

I looked on the Fox News website and didn't see a story about kids not getting insurance - they already are largely covered through SCHIP, this existed before the Affordable Care Act was ever signed, so I don't know what that is reference to.

[MooseMom]

Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements.  I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees.  You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see.  I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism.  Anything that the current administration does is defined as "socialistic'' in their worldview.   There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill.  I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect.   There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative.  I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.

[Bill Peckham]

Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements.  I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees.  You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see.  I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism.  Anything that the current administration does is defined as "socialistic'' in their worldview.   There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill.  I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect.   There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative.  I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.

For instance the mandate and the exchanges are Republican ideas.

ETA a link (H/t Yglesias):
From Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:

But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.

[MooseMom]

pt 2.  Effective in September, insurers will no longer be allowed to exclude children because of pre-existing conditions.  For current policies, the pre-existing conditions exclusion must be rescinded.  This will not be the case for adult policyholders until 2014.  I am stunned that a man as obviously as intelligent as you get your news from Fox and Glen Beck.   You're just making stuff up!

If you are so impressed by the importance of charity in our healthcare system, why not rely solely on that virtue for your dialysis treatments?  Charity certainly helps certain groups or individuals at certain times, but certainly not enough for anyone to feel secure solely on that one revenue stream.

"Libertarian" is code for "As long as I've got mine, screw you."  Just about everyone on this forum is either on Medicare, will soon be on Medicare or is taking care of someone on Medicare because of their dependence on dialysis.  Medicare is about as "big government" as you can get.  You and I are the very ones about whom the healthy speak as being without "personal responsibility" because we are dependent upon the American taxpayer to subsidize our lifesaving treatments, and many of us cannot work because of illness. 
I know you are not picking on me because it is evident that you really haven't read a word I've written. 

[MooseMom]

For instance the mandate and the exchanges are Republican ideas.

Exactly, so please stop making stuff up, Hemodoc, and I'll stop picking on you.  This business of not allowing republicans to submit ideas or that the bill was completely partisan is a right old load of bollocks.  Certain Republican congresspeople have abdicated their role of "loyal opposition" and instead have taken up one of partisan politician.  Plus they just make up stuff...

[Hemodoc]

Bill, my reference to charity is that as the basis for our medical development over the first part of the last century and it is a good and rewarding history.  The history of government intervention is too young to see how it will be viewed historically.  If it continues to advance the ideals and effectiveness that was instilled in our institutions before the advent of government intrusion into American health care, then it shall likewise be held with as high a regard. The change from a predominantly private health care system to a government run system is a major change. If it leads to health care rationing and diminishing of our health care standards, will it be able to lay such a claim as the improvement of health care standards that was developed with our predominantly private system based originally on charity?

The ideals of altruistic medicine are something that I caught the tail end of during my medical training and was in many ways the predominant ethics of my military experience since we were freed from any economic constraints.  Our only admonition was to do what was right for the patient.  As I have noted at DSEN, we have a new medical ethics that is not at all pretty in its application.  DRG's were a big part of the development of the new medical ethics that supplanted the altruistic medical ethics that in my opinion was an extension of the charity established American health care industry from prior to the 1960's. We are finally seeing the end of this altruistic, charity derived medical ethics and it is now supplanted by population medicine where cost/QALY is the new standard.  I am not in the least diminishing the people that the VA, medicare, medicaid and other programs have to date helped, I am simply pointing out that we are now embarking on a new health care paradigm in America that goes away from our historical charity based foundations.  The impact that this will have in 5, 10, 15 or 20 or more years has yet to be written.

As far as the issue on childhood coverage, it was a quick mention by one commentator this morning, so I will likewise see if this shows up again in this discussion.

As far as politics, I do not have much trust in any of these folks whether Republican or Democrat.  I see that the Republicans have a new statement to rrepeal and replace.  What are they going to replace this with if they get the majority in November?  The history of the Republicans is that they almost never undo what the Democrats did in their years of strength.  Health care reform is here to stay.  Will it be to our betterment? As I continue to say in all my posts, I am going to sit back and see if they can keep their lofty promises. 

What I fear is that this will be a severe economic stress to our already stressed economy.  A little off topic is how the great depression occurred in the eyes of many by the banking policies which contracted the supply of money coupled with the expansion of taxes at the same time.  This double insult to our economy is what many analysts say caused the next 10 plus years of not only American economic collapse, but throughout the entire world.  Since the 2008 Wall Street collapse, the Federal Reserve has tightened the money supply.  We now have this huge increased tax burden of the health care upon us as well as several other programs that will significantly increase the tax burden upon all, not just the rich.  What will be the result of all of these increased burdens to our economy?  As far as time lines, it is now the equivalent of 1931 with the depression ripping away in 1932/1933.  By the time the health bill takes effect in 2013, we should have the effects on the economy whether good or bad.  Is this chicken little?  Is this crying wolf?  I actually hope that my opposition and fears are completely in error.  If so, you will have earned a convert.

I believe that we will know within months where we are headed if not one or two years since the corporations in America must now start to comply with this new law even though it does not come on line until 2013.  I believe that we are in the process of living through history again and not for the best.  If the Democrats have judged correctly, this will be an unjustified fear when we get to 2013.  If they are wrong, then increased unemployment rates and home foreclosures will be the topics at hand leading up to the November elections and beyond. Were there other ways that we could have improved access to care?  Well, that is really not a topic of debate anymore since we are already starting this brave new experiment.  All I am saying is, there are a whole lot of health related and economic related promises made by this administration with this law.  Well, I hope that they can deliver on these promises since there is much more at stake than just health care.  It is now in their court to deliver since he is my president as well.

[Hemodoc]

Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements.  I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees.  You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see.  I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism.  Anything that the current administration does is defined as "socialistic'' in their worldview.   There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill.  I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect.   There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative.  I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.

For instance the mandate and the exchanges are Republican ideas.

ETA a link (H/t Yglesias):
From Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:

But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.

Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats.  It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway.  There are many Republicans which opposed the exchanges as well.

[Bill Peckham]

What I fear is that this will be a severe economic stress to our already stressed economy.  A little off topic is how the great depression occurred in the eyes of many by the banking policies which contracted the supply of money coupled with the expansion of taxes at the same time.  This double insult to our economy is what many analysts say caused the next 10 plus years of not only American economic collapse, but throughout the entire world.  Since the 2008 Wall Street collapse, the Federal Reserve has tightened the money supply.  We now have this huge increased tax burden of the health care upon us as well as several other programs that will significantly increase the tax burden upon all, not just the rich.  What will be the result of all of these increased burdens to our economy?  As far as time lines, it is now the equivalent of 1931 with the depression ripping away in 1932/1933.  By the time the health bill takes effect in 2013, we should have the effects on the economy whether good or bad.  Is this chicken little?  Is this crying wolf?  I actually hope that my opposition and fears are completely in error.  If so, you will have earned a convert.
...

Just to clairify the Great Depression started in 1929 and was exacerbated in 1930 by the passage of the Smoot–Hawley Tariff Act. The response of the Fed in 2008 and on to contain what was nearlyt a depression was to massively inflate the money supply. There has been very little tightening - basically the repayment of TARP funds could be considered tightening, it took money out of circulation and returned it to the Fed - instead we are in a period of historic flood of money into the economy, that's Keynesian economic policy.

The economy has been growing for the last two quarters. If someone thought that another collapse was coming there is a lot of money to be made, just go short on the market. The DOW is up 27% since 1/1/09, maybe on Wall Street they don't know what's going on.

[Bill Peckham]

Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements.  I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees.  You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see.  I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism.  Anything that the current administration does is defined as "socialistic'' in their worldview.   There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill.  I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect.   There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative.  I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.

For instance the mandate and the exchanges are Republican ideas.

ETA a link (H/t Yglesias):
From Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:

But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.

Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats.  It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway.  There are many Republicans which opposed the exchanges as well.

From a September 2009 Kaiser Health article:
At least three comprehensive GOP bills have been introduced: one by Sen. Tom Coburn of Oklahoma, Sen. Richard Burr of North Carolina and Rep. Paul Ryan of Wisconsin; another by Rep. Tom Price of Georgia and a third by Rep. John Shadegg of Arizona.

All three bills have a few themes in common with their Democratic proposals. For example, they create health insurance exchanges to make it easier for the uninsured and small businesses to find affordable insurance, although the exchanges have less regulatory authority than do the proposals outlined by the Democrats.


The actual legislation is know as the Coburn/Ryan Bill

ETA: Here is a discussion during the election in 2008 with the Heritage Foundation saying a national exchange would be a bad idea - Obama should use state level exchanges. Well that's what happened.

[Hemodoc]

pt 2.  Effective in September, insurers will no longer be allowed to exclude children because of pre-existing conditions.  For current policies, the pre-existing conditions exclusion must be rescinded.  This will not be the case for adult policyholders until 2014.  I am stunned that a man as obviously as intelligent as you get your news from Fox and Glen Beck.   You're just making stuff up!

If you are so impressed by the importance of charity in our healthcare system, why not rely solely on that virtue for your dialysis treatments?  Charity certainly helps certain groups or individuals at certain times, but certainly not enough for anyone to feel secure solely on that one revenue stream.

"Libertarian" is code for "As long as I've got mine, screw you."  Just about everyone on this forum is either on Medicare, will soon be on Medicare or is taking care of someone on Medicare because of their dependence on dialysis.  Medicare is about as "big government" as you can get.  You and I are the very ones about whom the healthy speak as being without "personal responsibility" because we are dependent upon the American taxpayer to subsidize our lifesaving treatments, and many of us cannot work because of illness. 
I know you are not picking on me because it is evident that you really haven't read a word I've written.

Come come MooseMom, I stated my source, asked Bill if he had heard this, acknowledged it was only one commentator and that I would see if it comes up again.  By the way, there really is a reason why Fox is killing the others in the ratings.  And it is not the only source of my information as it is my habit to do my own research on many issues of interest to me.  My entire reason I even commented on this thread is because you have several times over badly misspoken on what the opposition to this law was on the right.  I understand I am pretty much a lone dissenter, but please allow me to speak our views clearly without propaganda distortions that you have placed several times.  I have in fact read every word that you speak, but you continue to misrepresent my views and those of the opposition.  Am I not allowed to correct you and state properly our opposition?

As far as the issue of dialysis payments, what would have happened to American dialysis if the government had not payed for it, but had established that it was no longer experimental and was standard of care instead?  We did this with EMTALA which has cost many more billions than the entire ESRD CMS program that provides care for every patient that enters the ER no matter there ability to pay or even what nation they are from.  Would the health care industry have sought out the most optimal and economical way of keeping people out of the hospital to lower costs instead of putting money in their pockets from the government by providing less and less care to the patient? If you compare how the American government program stacks up to the other developed nations, who will argue that we could have done a lot better job. The government and their payment incentives to dialysis providers is complicit with this historical lack of care compared to other nations.  How did it go so wrong here in America when so many other nations do better?  The government no doubt plays an important role in our lives, but I firmly believe it is a great error to place all of our trust in them alone.  History bears this out.

Actually, I was fortunate to have full coverage through my employer without any Medicare dollars when I started on dialysis.  There are actual success stories in the private sector as well.  In fact, about 85% of people were satisfied with their coverage before this law took place.  The ball is in the hands of the current administration to see where that number is in 5 to 20 years.  Must I remind you that you folks one this debate?  Let us at least respectfully display accurately what our opposition is all about with out your continued misrepresentations of my views.  Trust me, it is not at all I got mine, screw you.

[Hemodoc]

Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements.  I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees.  You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see.  I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism.  Anything that the current administration does is defined as "socialistic'' in their worldview.   There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill.  I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect.   There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative.  I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.

For instance the mandate and the exchanges are Republican ideas.

ETA a link (H/t Yglesias):
From Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:

But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.

Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats.  It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway.  There are many Republicans which opposed the exchanges as well.

From a September 2009 Kaiser Health article:
At least three comprehensive GOP bills have been introduced: one by Sen. Tom Coburn of Oklahoma, Sen. Richard Burr of North Carolina and Rep. Paul Ryan of Wisconsin; another by Rep. Tom Price of Georgia and a third by Rep. John Shadegg of Arizona.
All three bills have a few themes in common with their Democratic proposals. For example, they create health insurance exchanges to make it easier for the uninsured and small businesses to find affordable insurance, although the exchanges have less regulatory authority than do the proposals outlined by the Democrats.
The actual legislation is know as the Coburn/Ryan Bill

Bill,

As always, I have the greatest respect for your knowledge of the political process especially where health care issues come to which is far beyond my own dabbles into the political elements of health care.  In addition, I try to avoid confronting you on these issues since we have respectfully agreed to disagree with the greater importance of the agreement that we share for how to improve healthcare from the renal dialysis medical perspective. I am also not all beyond educating or correcting.  Once again, I would not have commented at all on this thread were it not for the gross misrepresentations by others of the reasons why I and others with my shared perspective were in opposition to this law as written. I believe that I have stated those aspects succinctly in the last few posts. My main forte is with the the medical aspects of optimal health care and not the political arena.  I will sign off this thread at this time and just hope that your optimism is correct and that my pessimism is incorrect since the time for debate is actually over.  It is now our new reality.

As always,

Most sincerely,

Peter

[Bill Peckham]

No worries. Remember we first met in person when I was in Spokane as an Obama delegate at the Washington State convention. You didn't hold it against me then either 

This legislation is pretty centrist - most of the concern I've heard expressed rely on bad actors at some point making decisions that are not politically viable. The idea of Medicare rationing care based on age isn't politically realistic, for instance, we all plan on being old some day.

2/3rds of the access expansion in this bill is through getting people into private insurance plans, 1/3 into Medicaid. Right now the coverage market is about 50/50 so this makes our national market more private, less government run. Math is bipartisan.

[Hemodoc]

No worries. Remember we first met in person when I was in Spokane as an Obama delegate at the Washington State convention. You didn't hold it against me then either 

This legislation is pretty centrist - most of the concern I've heard expressed rely on bad actors at some point making decisions that are not politically viable. The idea of Medicare rationing care based on age isn't politically realistic, for instance, we all plan on being old some day.

2/3rds of the access expansion in this bill is through getting people into private insurance plans, 1/3 into Medicaid. Right now the coverage market is about 50/50 so this makes our national market more private, less government run. Math is bipartisan.

I guess that is why some call us the odd couple of dialysis advocacy.

Cheers,

Peter

[MooseMom]

Hemodoc, I sincerely regret that the national discussion re health care reform has morphed into an "us vs them" monster.  I don't want to be regarded as "you folks" who "won".  Lastly (and this WILL be my final word on this), that 85% are "satisfied" with their current coverage is just not good enough for this great nation.  Fortunately, many Americans do NOT ascribe to the "I've got mine, so screw you" mentality and want everyone to have access to health care outside of the local ER.  I understand that your focus is on the medical aspect of legislation, and I am glad for that.  Perhaps my interest is more in the political aspect because 1, I am not a doctor and 2. how people think, and why they think the way they do, when it comes to great social issues is intellectually interesting to me.  Having lived in various countries with various health care systems, I am interested in how populations form their social values and then go about honoring them.  I am formed by my life experiences just as you are.

I think you and I are actually more in agreement than it may at first appear.  I understand your mistrust in government.  My mistrust is more aimed at Corporate America.

Sincerely,
MM

[Hemodoc]

Thank you MooseMom

[Bill Peckham]

http://www.mixx.com/stories/12564555/insurers_might_delay_covering_pre_existing_conditions_nytimes_com

Coverage Now for Sick Children? Check Fine Print
By ROBERT PEAR     

WASHINGTON — Just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.     
Mr. Obama, speaking at a health care rally in northern Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”     

The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan.     

To insurance companies, the language of the law is not so clear.     

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.     

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”     
Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.     

“The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.     

Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”     

The issue is one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance and brochures to educate the public. Their decisions will have major practical implications.     

Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy.     
 
The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.     

But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language  of insurance, the law does not include a “guaranteed issue” requirement before then.     

Consumer advocates worry that instead of refusing to cover treatment for a specific pre-existing condition, an insurer might simply deny coverage for the child or the family.     
 
“If you have a sick kid, the individual insurance market will continue to be a scary place,” said Karen L. Pollitz, a research professor at the Health Policy Institute at Georgetown University.     

Experts at the National Association of Insurance Commissioners share that concern.     

“I would like to see the kids covered,” said Sandy Praeger, the insurance commissioner of Kansas. “But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19.”     

A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.     

Starting in January 2014, health plans will be required to accept everyone who applies for coverage.     
Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools.     
 
Federal officials will need to write rules or guidance to address a number of concerns. The issues to be resolved include defining the “essential health benefits” that must be offered by all insurers; deciding which dependents are entitled to stay on their parents’ insurance; determining who qualifies for a “hardship exemption” from the requirement to have insurance; and deciding who is eligible for a new long-term care insurance program.     

As originally conceived, most of the new federal requirements would have taken effect at the same time, in three or four years. The requirements for people to carry insurance, for employers to offer it and for insurers to accept all applicants were tied together.     

But as criticism of their proposal grew, Democrats wanted to show that the legislation would produce immediate, tangible benefits. So they accelerated the ban on “pre-existing condition exclusions” for children.     

Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.     

In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.     

Seems to me insurers are looking to delay implementation via taking this to court. I can't say I've read the language in question (and it's not likely I'd understand it if I were to read it) but politically I'm not understanding the wisdom of picking this issue to dispute.

But then it was the announcement of 40% rate hikes after the Brown election that propelled the legislation forward in February, so I 'm not sure how strategic the insurance industry really is.