Examiner.com¹

Senate Democrats have ceded two key components of President Obama’s health care reform proposals: The proposed Medicare buy-in for those ages 55-64 and a public option.

Democrats had wanted to see Medicare expanded so that people aged 55 and over can buy in to the government-run plan, which currently covers senior citizens aged 65 or older. A public insurance option would have offered competition to high priced private insurers and allowed citizens to purchase low-cost policies through government markets.

These components of the bill were apparently dropped in a cave-in to Republicans, centrist Democrats, and Joe Lieberman (I-CT). Sen. Lieberman, a crucial vote if the bill is to garner 60 votes, threatened to join Republicans in a filibuster of the bill if it includes either the Medicare buy-in or a public option. On CBS’s Face the Nation, Lieberman said that in order to get 60 votes in the Senate, “You got to take out the Medicare buy-in. You got to forget about the public option. You probably have to take out the Class Act.” According to The New York Times, “Mr. Lieberman is also insisting that he will not vote for a fallback public option that would create a government-run program if the legislation otherwise fails to accomplish its goals. The Class Act is a reference to a proposed long-term care insurance program that was included in the bill.”  Lieberman’s other condition is eliminating a government insurance program focused on home health care for the disabled.

According to Reuters, when asked whether Democrats had truly dropped both the Medicare buy-in and the public option provisions, Senator Max Baucus (D-) said, “It’s looking like that’s the case.”

Some Senate Democrats attempted to rationalize the concessions by suggesting that the passage of any bill is better than no bill at all. According to Bloomberg News, Sen. Evan Bayh (D-IN) said, “The general consensus was that…we shouldn’t make the perfect the enemy of the good and in order to get all the insurance reforms accomplished and a number of other good things in the bill.” Dropping the Medicare expansion “would be necessary to get the 60 votes.”

“This bill, without public option, without Medicare buy-in, is a giant step forward toward transforming American health care,” said Senator Tom Harkin (D-IA). “That’s reality, there is enough good stuff in that bill that we should move ahead with it.” Harkin, currently replacing Sen. Ted Kennedy as chairman of the Senate Health, Education and Labor Committee, had once been one of the public option’s most staunch defenders.

“At some point you have to switch from the sentiment, the emotion of the words, to the facts,” said Sen. Jay Rockefeller (D-WV) . “And then you’ve got to decide, ‘If I didn’t get what I want, in the form that I wanted it, am I willing to cashier 31 million Americans? I want a bill.’”

Even Sen. Roland Burris (D-IL), who threatened to filibuster any bill that does not include a public option, appeared to cave-in. “I know how difficult it has been to get this far. My colleagues may have forged a compromise bill that can achieve the 60 votes that will be needed for its passage but until this bill addresses cost, competition and accountability in a meaningful way, it will not win my vote,” he said, according to The Hill.

In lieu of a public option, the bill would have the Office of Public Management (OPM) oversee private insurers who accept clients under federal subsidies. Jacob S. Hacker, a professor of political science at Yale University and an expert on U.S. health and social policy, claims that a robust public option is essential for any meaningful health care reform. In The New Republic he writes:

Offering one or a few national plans under the auspices of the OPM won’t provide what a public plan can–the choice of a broad, transparent, accountable, and affordable plan that doesn’t deny needed care, restrains the growth of premiums over time, and serves as a benchmark for private plans. Indeed, because Blue Cross and Blue Shield (BCBS) is the most likely national non-profit to take advantage of this new opening, and because the Blues dominate most states, the plan perversely amounts to trying to increase competition and choice by encouraging Blue Cross and Blue Shield to compete against, you guessed it, Blue Cross and Blue Shield. That’s competition?

It is unclear exactly what Democrats are referring to that will remain in the bill constituting significant health care reform besides a ban of insurance companies denying coverage due to pre-existing conditions. The bill would include mandatory private sector insurance, which would be a profit windfall for big insurance and pharmaceutical companies on the backs of millions of the poorest Americans who currently cannot afford coverage.

Any bill that might pass Congress at this point will be a flawed compromise, one that will deeply disappoint the Democratic base and one that will leave unaddressed major flaws in the health system. Perhaps no bill at all may be a better choice at this point.
 

For more info:

http://www.politico.com/news/stories/1009/28788.html

http://www.cbsnews.com/htdocs/pdf/FTN_121309.pdf?tag=cbsnewsTwoColUpperPromoArea

http://prescriptions.blogs.nytimes.com/2009/12/14/health-fight-echoes-the-stimulus-battle/

http://www.reuters.com/article/idUSTRE5B83TG20091215

http://www.bloomberg.com/apps/news?pid=20601087&sid=aBkmi3m1MRvA&pos=9

http://iowaindependent.com/19748/harkin-strong-public-option-will-pass-by-christmas

http://thehill.com/homenews/senate/72187-reid-gives-in-to-centrists-on-healthcare-senators-say

http://thehill.com/blogs/blog-briefing-room/news/72209-sen-burris-hints-at-shift-from-public-option-threats 

Share on Facebook

1. ((http://www.examiner.com/x-23316-Madison-Independent-Examiner~y2009m12d15-Senate-drops-public-option-Medicare-buyin-from-health-bill [↩]

WASHINGTON, D.C. (AP) –¹  The House has opened debate on President Barack Obama’s landmark health care overhaul that would extend insurance to tens of millions of Americans and enact dramatic changes to the country’s medical system.

Unfortunatly not dramatic enough.  I am sure there will be lots of add-on that will weaken the bill even more. 

President Barack Obama is traveling to Capitol Hill on Saturday to try to close the sale on his signature health care overhaul, facing a make-or-break vote in the House certain to be seen as a test of his presidency.

Everything is seen as a  “test of his presidency” – the guy can’t take a breath without it being called a test of his presidency and without it making people question his ability to get the job done.

Obama scheduled a late-morning visit with House Democrats convening a rare Saturday session on legislation to remake the U.S. health care system, extending coverage to tens of millions now uninsured and banning insurance company practices such as denial of coverage based on pre-existing medical problems.

The pre-existing condition thing has always been the most stupid think I have ever seen – you allow companies to deny those who need the care more then anybody else, iven if the pre-existing conditions aren’t as expesnive to treat or if they are birth defects that the person and his/her family had no choice over.That’s where the German in me comes out kicking and screaming.  Children, Pregnant women, people with disabilities, and the elderly should ALWAYS be covered – and so should ever person that is working or seeking employment .

Late Friday, House Democrats cleared an abortion-related impasse blocking a vote and officials expressed optimism they had finally lined up the support needed to pass Obama’s signature issue.

Under the arrangement, Democratic Reps. Bart Stupak of Michigan, Brad Ellsworth of Indiana and other abortion opponents were promised an opportunity to insert tougher restrictions into the legislation during debate on the House floor.

F*** this.  Same bullshit as usual.

Share on Facebook

1. Vote Expected Today On Health Care Bill – WBOC-TV 16, Delmarvas News Leader, FOX 21 -. [↩]

 The Chairman‘s Mark would establish Federal rating, issue, renewability, and pre-existing condition rules for the individual market. Issuers in the individual market could vary premiums based only on the following characteristics: tobacco use, age, and family composition. Specifically, premiums could vary no more than the ratio specified for each characteristic: 

•  Tobacco use – 1.5:1  (meaning 1.5 dollars for every dollar spent by another person – a 150% variance)
• Age – 5:1 (500%)
• Family composition: 
  •  Single – 1:1 (100%) 
  • Adult with child – 1.8:1 (180%)
  • Two adults – 2:1 (200%)
  • Family – 3:1 (300%)

 

Taking together all permissible risk factors, premiums within a family category could not vary by more than a 7.5:1 composite ratio. 

 

  

 

 So let’s see – a 20-ish year old person would have to pay – oh, let’s say $200. If that person smoked, he/she would have to pay $300.

If that person – for some reason – was say 70 years old instead of 20, he/she would have to pay up to $1,000 for the same coverage and up to $1,500 if he or she smokes.

Someone better find that “fountain of youth” quickly.

Also, premiums “within a family category” could vary by 750%!!!!  Meaning, a family of non-smokers that has two kids and the parents are in their twenties or early thirties may pay $600, while a family where the parents are a bit older may pay as much as $7,500 for that same coverage.  Of course, since the age variance doens’t specify age limits – would some insurers go up the 500% for someone as young as 45, becuase they deem them as old, or someone has to be 63 or 55 or 95 or what?

Share on Facebook

“caps would be placed on patients’ yearly health care costs”

So once that “cap” is in place and a patient’s health care bill goes up and above the cap – will they just tell the cancer to dissapear?  What will happen with people that have serious illnesses that go above that cap?  I think what is meant is a cap on out-of pocket expenses- but I will need to check on that – until then – forget it for now.

UPDATE – OK, here it is:

 All plans must provide preventive and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that at least meet minimum standards set by Federal and state laws. In addition, plans could charge no cost-sharing (e.g., deductibles, copayments) for preventive care services, except in cases where value-based insurance design 

 is used. Plans could also not include lifetime limits on coverage or annual limits on any benefits. Any insurer that rates on tobacco use must also provide coverage for comprehensive tobacco cessation programs including counseling and pharmacotherapy (prescription and non-prescription). The provisions in this paragraph would all be within the actuarial value of the appropriate benefit level.

Ok, I understand that.  I am a bit shaky on this one here:

 Definition of Levels. 

 For those between 100-200 percent of FPL, the benefit will include an out-of-pocket limit equal to one-third of the HSA current law limit. For those between 200-300 percent of FPL, the benefit will include an out-of-pocket limit equal to one-half of the HSA current law limit. 

 The bronze benefit package, which would represent minimum creditable coverage (MCC), would be equal to the actuarial value of 65 percent with an out-of-pocket limit up to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010) indexed to the per capita growth in premiums for the insured market as determined by the Secretary of HHS. The silver benefit package would have an actuarial value of 70 percent with the out-of-pocket limits for MCC. The gold benefit package would have an actuarial value of 80 percent with the out-of-pocket limits for MCC. The platinum benefit package would have an actuarial value of 90 percent with the out-of-pocket limits for MCC. A separate ―young invincible‖ policy would be available for those 25 years or younger. This plan would be a catastrophic only policy in which the catastrophic coverage level would be set at the HSA current law limit, but prevention benefits would be exempt from the deductible.

Care to explain? My German brain just isn’t making sense of it.

Just FYI —

Some info I found on the web:

• bone-marrow transplants cost around $260000
• average cost of one round of chemotherapy is $150,000
• $2,187 average monthly health care cost for prostate cancer
• $7,616 average monthly health care cost for pancreatic cancer
•  $41,000 health care costs per premature born child during their first year of life
• a minimum of $5000 cleft lip surgery and/or cleft palate repair
• $39,891 average cost to Medicaid for INITIAL lung cancer treatment
• $41,134 average cost to Medicaid for INITIAL prostate cancer treatment
• $20,964 average cost to Medicaid for INITIAL breast cancer treatment
• Avastin for the treatment of recurrent breast cancer costs about $55,000 a year for a Medicare patient
• minimum estimated cost for a regular delivery in a hospital $7800
• $4306 median annual medical cost for children with ADD/ADHD
• average heart bypass-procedure cost $20673 not nclkuding follow up treatment, medication, etc.
• caring for an individual with autism can cost more than $3 million in their lifetime
• $13243 average annual healthcare cost for a person with diabetes 
• $28436 average annual healthcare cost for chronically homeless individuals
• $33007 average annual healthcare cost for someone older than 65 with Alzheimer’s Disease or another form of dementia

Share on Facebook