Saturday, June 20, 2009

And For My Next Trick . . .

According to the New York Times the House has revealed a plan for sweeping health care reform in the United States.

But there are a few hitches.

They don't know how much it will cost.

They don't know how to fund it.

But other than that . . .
The draft bill would require all Americans to carry health insurance. Most employers would have to provide coverage to employees or pay a fee equivalent to 8 percent of their payroll.
Everyone must have health insurance or else what?

Then there is this goody:
The plan would also end many insurance company practices that deny coverage or charge higher premiums to sick people.
This is no problem. A handful of states already prohibit carriers from denying coverage (aka guaranteed issue) and/or charging a higher premium (known as community rating) for those with health problems.

Premiums in those states are 2x to 3x higher than comparable plans in states where carriers are free to medically underwrite coverage.
The 852-page House bill, as expected, is more expansive than the legislation taking shape in the Senate, where work on the issue bogged down this week after early cost estimates came in far higher than expected.
No one read the 1100 page stimulus bill. Wonder if anyone will read this one?

That's probably expecting too much, don't you think?
The proposal would expand Medicaid eligibility, increase Medicaid payments to primary care doctors and gradually close a gap in Medicare coverage of prescription drugs known as a doughnut hole.
If this were a car company, the design would look like a gas guzzling Hummer on steroids.

But wait! American car companies are not supposed to produce these kinds of car's any more. America wants smaller, fuel efficient "green" car's.
The bill would impose a new “tax on individuals without acceptable health care coverage.”
I can hardly wait to find out how "acceptable coverage" is defined.
The tax would be based on a person’s income and could not exceed the average cost of a basic health insurance policy.
Define "basic".
The House bill shows what Democrats mean when they speak of a “robust” public insurance plan.

Under the bill, the public plan would be run by the Department of Health and Human Services and would offer three or four policies, with different levels of benefits. The plan would initially use Medicare fee schedules, paying most doctors and hospitals at Medicare rates, plus about 5 percent. After three years, the health secretary could negotiate with doctors and hospitals.
American's turning 65 have a difficult time finding doc's willing to accept Medicare patients due to the low reimbursement. Anyone want to wager if folks under the "public plan" will encounter similar obstacles?
But the bill says, “There shall be no administrative or judicial review of a payment rate or methodology” used to pay health care providers in the public plan.
Sounds like no oversight to me. Isn't this what led to Fannie Mae & Freddie Mac crashing on the rocks?
The bill would limit what doctors could charge patients in the public insurance plan, just as Medicare limits what doctors can charge beneficiaries.
Wonder how the doc's feel about that?
The bill would require drug companies to finance improvements in the Medicare drug benefit. Drug companies would have to pay rebates to the government on drugs dispensed to low-income Medicare beneficiaries.
Gosh, this sounds an awful lot like cost shifting to the private sector.
The bill would expand Medicaid to cover millions of people with incomes below 133 percent of the poverty level ($14,400 for an individual, $29,330 for a family of four). The cost would be borne by the federal government.

The government would also offer subsidies to make insurance more affordable for people with incomes from 133 percent to 400 percent of the poverty level ($43,300 for an individual, $88,200 for a family of four).
I still have difficulty thinking of a family that earns $88,200 as poor. I guess it is something I will have to get over.
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