WhiteCoat

Insurance For All

While many legislators praise this vote as an historic event, it is a pyrrhic victory.

I went looking for the final text of the health care bill and performed several internet searches. Came up with lots of results. Noted that the number of hits to this blog increased substantially looking for health care bill highlights. During my searches, one result that came up persistently was here.

HR3200

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I don’t think that this is the final version of the bill, but I’m not sure. One thing that I did notice was that since HR3200 was introduced in the House, there have been more than 1000 changes to the bill. More than two thirds of the bill has changed and the word count from the bill has more than doubled. Only 22% of people voting on the site stated that they supported the bill. Is there any wonder why most Americans don’t like the bill? No one can figure out what it contains. I’d venture a guess that most members of Congress don’t know what it contains. There were deals being brokered and changes being made shortly before the bill was passed, and less than an hour after it was passed, it was amended again.

I think that the final wording in the bill is here, but I’m not sure. One summary of the contents of the bill (posted at 6:30 PM on the evening of the vote) can be found here.

The more commentary I read about the contents of the bill , the more worried I become.

No insurance companies can “deny coverage” for people for pre-existing conditions – effective 2014. Why the wait? What happens when, instead of “denying coverage” for people with pre-existing conditions, the insurance companies just hike the insurance premiums for those patients? Then those with pre-existing conditions end up with no coverage because they can’t afford the premiums. It is already happening.

When 16 million people are added to Medicaid ranks when the Medicaid system is already imploding due to lack of funding throughout the country, should we consider it a victory that those people now have “insurance” but little access to health care? When patients in Massachusetts received insurance but couldn’t find physicians to take care of them, the amount of emergency department usage increased. You know – that cheap inexpensive care.

Illegal immigrants are no longer eligible for Medicaid. Denying illegal immigrants health care insurance won’t keep them from becoming sick. Where will they go for health care? You guessed it – to the emergency department. Now instead of receiving a pittance for providing care, the hospitals will likely receive nothing for providing that care. Who will end up paying for care to the uninsured?

What happens when all the projected “savings” aren’t realized in the future and the feds start cutting benefits and cutting payments to providers even more? Your payments into the system won’t go down, but what you get out of it sure will. The only way to make up for the gargantuan health care deficits is for the government to pay out less than it takes in. How does that happen? Either increase taxes or decrease benefits. The bill already cuts Medicare spending by $500 billion and increases taxes on investments. Look for even more taxes and less benefits in the future.

Remember: Health care insurance does not equal health care access. Never has. Never will.

If you want to see how your representatives voted on the measure, the New York Times has a rundown on each elected official’s vote.

Don’t know if it was intentional or not, but the banner ad above the article listing everyone’s votes was for a job search company.

Foreshadowing for November?

Congressional Vote + Job Search

36 Responses to “Insurance For All”

  1. Ben says:

    http://www.opencongress.org/bill/111-h3590/show

    That is the bill that first passed the house today.

    http://www.opencongress.org/house_reconciliation

    And that is the amendment to the first bill to align it more with the views of the House that passed an hour later.

  2. Ben says:

    Also, about your point about the pre-existing clause only taking effect years later:

    EC. 1101. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.
    (a) In General- Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.

    (d) Eligible Individual- An individual shall be deemed to be an eligible individual for purposes of this section if such individual–

    (3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.

    You can read the rest of the section on the first bill I linked.

  3. Great post…and ughhhhhh! I too am anxious to see where this all heads after the November elections. In the meantime, ughhhhhh!

  4. DaveyNC says:

    The Law of Unintended Consequences is unleashed upon the land in a big way. Watch today as markets stagnate or even crash. Next, watch as unemployment spikes again. We need to get used to permanent unemployment rates in the 9-12% range instead of the 4-6% we have historically had. It just became to pricy for many companies to hire someone. The Lefties wanted a more European-style health care system and with it comes a more European-style economy.

    All you have to do is look at how the tax code has metastasized over the years to get an understanding of what will happen to this mess.

    • WarmSocks says:

      I really don’t see this healthcare bill making it expensive for employers to provide insurance for their employees. Just the opposite. According to the Kaiser Family Foundation’s survey of employers, the average annual premium paid by employers to provide health insurance to single employees was $4,824 in 2009. Family coverage was an average of $13,375 per employee. Now it will cost less money and eliminate the administrative hassle if employers just drop all health insurance plans and pay the government fine.

  5. DaveyNC says:

    Here, read a Lefty analysis of the bill. It’s a fail, by any measure. Link here: http://goo.gl/qzuE

    In response to Ben@2, from the link:

    “Myth 12: The bill will provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition.
    Fact: Access to the “high risk pool” is limited and the pool is underfunded. Only those who have been uninsured for more than six months will qualify for the high-risk pool. Only 0.7% of those without insurance now will get coverage, and the Centers for Medicare and Medicaid Services report estimates it will run out of funding by 2011 or 2012.”

  6. Matt says:

    Physicians who see themselves as independent professionals, ask not for whom the bell tolls.

  7. Jacqueline says:

    Great post…the map is quite interesting. Sad…sad day :(

  8. Max Kennerly says:

    The inadequate Medicaid funding is a problem and was a problem before the bill; other than that, though, what’s your objection to the bill?

    Do you really think that “denied coverage” is preferable to “expensive coverage?” What sense does that make?

    For most of America, the bill doesn’t change much. For people without employer-sponsored health care, it find imposes some basic regulatory controls on the hopelessly unfair and punitive private insurance market. What’s so wrong about that?

    • DaveyNC says:

      What’s wrong with it is that we are spending over $1,000,000,000,000.00 to make nothing change.

      • Matt says:

        Oh, something’s changing. This is a first step. The controls Max notes are true, and will have the effect of raising the price of insurance for all (“Dependents” up to age 26? We used to just call them freeloaders.)

        When that insurance cost inevitably rises, and we’re all paying more for our coverage directly out of our pocket, there will be a cry for cheaper insurance. The government will say “perhaps if we centralized all functions, and got rid of insurer overhead”, to which the people will reply that sounds good. It will sound even better when you’re not writing a monthly check for your premium, but instead it’s just a small percentage out of your paycheck. Don’t misunderstand me – it won’t be cheaper, you just won’t feel it as much. It’s the difference between your paycheck withholding now and if you had to write a check to the IRS every year – think you’d care more how your taxes were spent if it were the latter? You better believe it.

        Will costs be less? Of course not. Will physicians and patients have more control? Don’t be foolish. Will your taxes go up? Undoubtedly. Will the people do anything about it? Nope.

        This battle is over, folks. Government power does not recede, only increase. I don’t mean that in a black helicopters kind of way, but in the creeping growth of all bureaucracy way.

      • M Student says:

        “(”Dependents” up to age 26? We used to just call them freeloaders.)”

        Freeloader? I call myself a medical student. Oh well, potatoes potatos, tomatoes tomatos.

    • WhiteCoat says:

      One of the biggest reasons that coverage is “expensive” is that there is no transparency in the system. Create more of a free market model and the prices would decrease significantly.
      I don’t think that the controls imposed on the insurance market will have their intended effect — at all. If anything, insurers will benefit because of the mandate that everyone have insurance. What safeguards are placed on arbitrary denial of benefits?

      • Max Kennerly says:

        You’re right about the mandate being a benefit to insurance companies, but in exchange they get a lot of controls.

        Here’s some of the stuff that happens immediately (all taken from the detailed summary at http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm ):

        “Immediate Improvements. Implementing health insurance reform will take some time. However, many immediate reforms will take effect in 2010. The Patient Protection and Affordable Care Act will:
         Eliminate lifetime and unreasonable annual limits on benefits, with annual limits prohibited in 2014
         Prohibit rescissions of health insurance policies
         Provide assistance for those who are uninsured because of a pre-existing condition
         Prohibit pre-existing condition exclusions for children
         Require coverage of preventive services and immunizations
         Extend dependant coverage up to age 26
         Develop uniform coverage documents so consumers can make apples-to-apples comparisons when shopping for health insurance
         Cap insurance company non-medical, administrative expenditures
         Ensure consumers have access to an effective appeals process and provide consumer a place to turn for assistance navigating the appeals process and accessing their coverage
         Create a temporary re-insurance program to support coverage for early retirees
         Establish an internet portal to assist Americans in identifying coverage options
         Facilitate administrative simplification to lower health system costs”

        Down the road,

        “Health Insurance Market Reform. Beginning in 2014, more significant insurance reforms will be implemented. Across individual and small group health insurance markets in all states, new rules will end medical underwriting and pre-existing condition exclusions. Insurers will be prohibited from denying coverage or setting rates based on gender, health status, medical condition, claims experience, genetic information, evidence of domestic violence, or other health-related factors. Premiums will vary only by family structure, geography, actuarial value, tobacco use, participation in a health promotion program, and age (by not more than three to one).”

        That’s pretty big stuff. “Cap insurance company non-medical, administrative expenditures” is a huge one, since it forces the insurance company to thin down their coverage programs, stop arbitrarily denying everyone, and focus on the real coverage situations, of which there will be a lot fewer since the big exclusions (like pre-existing conditions) are gone.

      • Matt says:

        Stop with your “free market” nonsense. You’ve repeatedly said you can’t/won’t operate in the free market. You want all the upside, but none of the downside risk of the free market. You’re not going to get this. What’s more, other than a few plaintive cries online, your profession has made no step to go towards a more “free market” system. In fact, you guys routinely ask the government to take you further away from the free market.

        It’s ridiculous that you keep harping about it.

      • Matt says:

        The above comment is not a response to Max, but to WC.

  9. Dave says:

    I’m not sure any of us really know what’s going to happen with the bill but I agree with Max. Too many people in this country cannot get insurance even if they want it, or cant afford it if they can get it. The cost of medical care is too high for folks to afford if they dont have insurance. In the current system businesses basically fund health care, which doesn’t help the individual who’s been laid off. This needed to be fixed and hopefully the current bill will help do that.

    As far as funding and cost, look at the bigger issue. The only real ways to reduce our deficit is to do one of the below:
    Reduce social security, medicare and other entitlement programs (VA, etc)
    Get out of our involvement in foriegn wars
    Or, raise taxes.

    The answer we get from Congress (and the American people) is, “do none of the above”.

    There is money to be saved in the current system, which siphons off a lot of money in administrative cost. This doesn’t count the whole tier of administrative personnel whose only function is to deal with JCAH, or the tier of “quality managers” who are really only concerned with length of stay, not to mention the malpractice costs. And I’m not sure why drugs cost so much, medical devices cost so much, or some procedures are valued so highly over cognitive work. But probably nothing in the current bill will alter any of this.

    • WhiteCoat says:

      I agree with you on most of your thoughts, but you have bought into one of the fallacies that permeates throughout the health care reform debate: Insurance is equivalent to health care.
      Having insurance doesn’t mean that anyone will be able to obtain access to the system – especially if health care providers lose money every time they see someone who has that insurance. Fewer and fewer providers will accept the “insurance” that everyone is required to purchase until we’re in the same boat that we’re in right now – after spending trillions of dollars to get there.
      If the government really wants to provide health care to everyone, why not create regional hospitals that provide “government sponsored” care to everyone at no cost?
      Then the public would be after the government for quality issues and for failure to provide appropriate care. As the system stands now, the government can blame other entities when it cuts the payments to the point that those entities can no longer afford to provide care. The Golden Rule … he who has the gold makes the rules.

      • igloodoc says:

        WC… public funded hospitals are inevitable given what healthcare reform will do to Medicare/Medicaid.
        Physician reimbursement will under Medicare/Medicaid will be the first target of the “waste, abuse and fraud” cuts to funding. As we physicians proved… we rolled over to the 21% cut without a whimper. (I don’t remember even seeing one major news story on any network). But our munificent benefactor relented, and we are back in the no-cuts zone. (But then again, Stupack was a no, right?). The next rounds of “cost saving” cuts, after ours, will be those evil profit generating hospitals.
        Predictably Docs will opt out of the Medicare/Medicaid system. The hospitals, with their dinosaur-like administrations, will finally realize the paperwork/manpower savings of opting out and eventually will. This will create a crisis.
        The next Democratic congress(or maybe even Republican) will then swoop in with the single payer system with mandatory participation. We will then be a two tier system, with a large government run system of Docs/hospitals, and a small private system.
        This seems to be following the history of the Canadian single payer system …

      • Matt says:

        “Then the public would be after the government for quality issues and for failure to provide appropriate care”

        And the government will turn to the providers for that failure, with some byzantine sanction and review system. There will be no opportunity to present your case to a jury without a financial stake. At best you’ll get union style arbitration provisions. At worst, the government will have its own “judge” review, and will send you a letter advising you that it doesn’t put much merit in your view of the situation, and you’ve been fined/sanctioned/whatever.

        And of course, you’ll look to blame everyone but yourself. The fact will remain though, that while this healthcare takeover was coming down the pike for a year now, your profession has done little to stop it or offer alternatives. In fact, by bitching and moaning constantly about the shortcomings in the present situation, yet offering little in the way of constructive solutions, you’ve in fact helped to make the “reform” case. Not that you’ll ever acknowledge that, though.

  10. Dave says:

    Very good point. I’ve made the comment several times that doctors now are seeing medicaid patients at a loss and medicare patients at cost. The problem with a lot of socialized systems is that they are underfunded. It may be that a two-tierd system is the way to go.

    • Matt says:

      Problem for most physicians will be that they have no idea how to compete in the non-government tier. You’ve suckled at the teat so long, you have no idea how to market or price your services. What’s more, in the free market, you won’t rise or fall as a group, in the sense that now you all get paid the same regardless of skill.

      You’ll all be competing for a much smaller pool of private dollars, and the only winners will be those that know how to be successful businesspeople and quality physicians. I’d venture to say that’s a very small subset of physicians. Not because you’re dumb, but because you’ve not done it in so long, and there won’t be enough money for many of you to make it that way.

  11. Ed says:

    If this plan is supposed to be so wonderful and helpful, why have they made it in such a was that they do not participate?

    Just like social security. It is great for everyone else, but not them.

    Kinda like paying your taxes…..

    • Doc99 says:

      Social Security and Medicare go belly-up soon, since the revenue streams were diverted long ago. What makes anyone think that the revenue streams from new taxes will go toward Healthcare for the uninsured, especially given government’s long term history for raiding Peter to pay Potus?

    • hashmd says:

      Because they really have stated “Let them eat cake!”

      There is healthcare for Congress, then there is healthcare for the rest of us. THAT is the 2 tier system they really have developed.

      If any of our employers provided the benefit plan that Congress and POTUS gets, they’d be taxed for it for providing a “too rich” plan!!! Does the gov’t. get taxed for providing a too rich plan? Of course not.

      They are above the law. Until they have to live with what they have fashioned, they will not ever “get it right” (like somehow they know how to get it right).

    • SeaSpray says:

      Where did they come up with that figure? And if they do that ..how do they expect ins companies will be able to provide the same quality of insurance?

      We have good insurance and decent premiums. I don’t want to lose it or be forced to pay a fortune for it. It would be a hardship. And then increased taxes?

      Please tell me ..why is this new bill good for my family? I have pre-existing conditions. So ..does this now mean I am going to be paying much higher prices for my same insurance.

      I’m stunned. I have been following this from the beginning and yet I am in disbelief that we can now be harmed financially because of this debacle of a HC bill. My husband worked hard for his entire adult life. We chose a plan that has been excellent coverage for our family and now it could all be turned upside down. I know ..spread the wealth.

      This is a financial disaster for our economy over the long term and quality of care will be compromised.

      • Pattie, RN says:

        Yup—get another example of how working hard, delaying gratification, getting an education, choosing a viable career path, taking care of one’s health and limiting family size within a two-parent household are all “old school”. These steps used to be the path to a good life, knowing that illness and injury can hit anyone, anywhere, but these were still the rules to live by.

        Now, those of us who chose those pathways are the fools who get to pay for everyone else’s rotten choices. And spare me the sob stories—for every real, unpreventable tragedy out there, there are 50 more that are the result of stupidity and/or laziness. And I challenge anyone who works in health care or social services to dispute that ratio of bad luck -vs-self imposed burdens.

  12. Anonymous says:

    I can’t wait for the next election. I’m predicting democrats are going to get raped in the polls. Then we’ll see Obama become a lame duck president where he goes on a million rally speeches but no one cares because congress isn’t lock step behind him anymore.

    • Aaron says:

      That’s not how the news cycle works. What happens next is the Senate parliamentarian probably kills or strips most of the house amendments, but we have the health care bill that passed now more or less. Over the coming weeks the reality sinks in that health care is passed and other issues will dominate the 24-7 news, but the majority of Americans who wanted to do something about healthcare, even or maybe especially if it wasn’t this, know that the Obama administration passed the most paradigm changing legislation of the last several decades. The question now is whether he is one of the Roosevelt or is he a Lyndon Johnson (if the political system can even accept comparisons to the past).

  13. ERP says:

    I see the HCR as the first step. Lots of issues need to be ironed out over the next decade or more. Clearly, we could not continue what we were doing.
    Also, my understanding WC, is that the bill allows for Medicaid payments to Primary care MD’s (peds, fp and IM) to rise to Medicare rates. Not perfect but a start. That may help the newly “insured” get some access.

    • igloodoc says:

      I think that part is in the reconciliation in the senate, ERP. I think medicare is boosted 10% in underserved areas and medicaid rises as it is tied to the medicare dollar, again in underserved areas.

      I could be wrong. I could be Matt.

      • Matt says:

        Yeah, you could be wrong or right. But on this issue you’re fooling yourself if you think I’m wrong. When the costs start to hit, the “fix” ain’t going to be fixed no more. Your salary is cost cutting measure number one across the board.

        I may not know much medicine, but this political issue has drawn out pretty much as I expected.

  14. SeaSpray says:

    The health care system had to be fixed ..but why did they have to throw the good out?

    Why do they not address tort reform?

    Why couldn’t they open up state borders?

    Since when is it constitutional to mandate people purchase health ins or fine them if they don’t?

    I also heard that if people don’t get insurance, if they then become sick ..then they can sign up for insurance. Maybe it’s worth it to pay the penalty for no insurance and then just sign up when/if something happens?

    And are penalties one time or every year you’re not insured or don’t insure your employees?

    And how does it help small businesses to force them to insure or be fined? My hairdresser was telling me that the owner (of 2 shops) has more than 50 people on the payroll. he does not provide insurance. they are wondering if he will insure them or opt to pay the 2,000.00 penalty ..per employee… a minimum of 100,000.00 in penalty? Seriously ..how is this good for small businesses? It seems the logical thing to do would be to reduce the staff ..let some people go to come under the 50.

    Then 16,000.00 more IRS to follow up on these penalties, etc. ??

    This all seems so WRONG!

    Intrusive with a capital “I”!

    America ..land of the free .. not any more.

    How is this ultimately going to affect quality/availability of care, medical research, having state-of-the-art equipment as this bohemoth HC debacle becomes increasingly more of a financial burden?

    And the way they did this ..with corruption ..buy offs. How does giving away billions of dollars in buy offs for things that have *nothing* to do with medicine go to helping the sick patients and our healthcare system? So that we will be paying for these things for generations?

    Another friend was waiting to go into an appointment and she heard them having a financial meeting. She was past her appointment time and would have to leave for work and said she’d have to reschedule. The doctor came out, apologized and said that they were having a financial meeting about medical ins and they now have to pay 200.00 more per person and they will be getting a lower quality of ins.

    And how will this financially stressed employer/employee climate affect new hires?

    I also don’t understand how they could justify the cost of this bill when they worked with skewed numbers and they all knew it?

    And perhaps most mind boggling of all ..how in the world could any rational, intelligent human being (Never mind that they are our political leaders we trusted to do what was right) sign their name to *anything* if they don’t KNOW what is in the contract/bill and/or the long term consequences of said bill. ?? Pelosi actually said they wouldn’t know what was in the bill until they passed it. REALLY?

    Especially since it is 1/6 of our economy and will so profoundly effect our nation and her people.

    The majority of people are opposed to this bill.

    They did not listen. They did not care to find out the facts ..to rework through the problems in a bipartisan effort. Just wanted to pass it ..consequences be damned.

  15. Sid Schwab says:

    So much misinformation, Seaspray, including but not limited to the fabricated 16,000 IRS agents. You need better sources.

    http://www.washingtonmonthly.com/archives/individual/2010_04/023160.php

    As to “mandates:” http://knowyourgovernment.wordpress.com/2010/03/31/understanding-the-health-care-reform-mandate/

    For the rest of the misinformation, you chose not to answer my request that you comment on my blog, and I don’t want to waste time of the bloggers and commenters here. You know how to reach me, if you’d like answers to your questions.

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