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Sei'taer
08-14-2009, 09:22 AM
Ok. Since it's been brought up a couple of times, I want to talk about it. Healthcare reform, insurance reform, government insurance reform, whatever it's being called today.

I've been doing a lot of reading on it (I'm 620 pages in) (I don't know how in the F SP and Sini and you other lawyerly types read this shit all the time. I have a whole new respect for you. Actually, the reading isn't that hard it's the understanding). So here's what I've found and hears what I understand, and I'm going to make suggestions for solutions I think will help.

I want to be constructive, so even if I think it, I'm not going to talk about this person or that person being stupid. This is about the bill from the House only (no one else has a bill). So, here we go.

Opting out.

This is one of the things that i'm really concerned about, because I will want to opt out.

Here's is what it says:

page 167-68 section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:

(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—

(1) the taxpayer’s modified adjusted gross income for the taxable year, over

(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .

My thoughts are this (and feel free to tell me if I am interpreting it incorrectly, like I said, my lawyer speak is not good). Anyone caught without acceptable coverage (I'll catch this next), who is not in the government plan, will be charged a special tax. This apparently will be enforced by the IRS, since they control tax codes. So, if you keep private insurance, but it doesn't meet the minimum required by the gov't you will be penalized, on top of what you already pay in taxes to pay for the public healthcare system.

Acceptable Coverage:

pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:

(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .

(b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services . . .

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services . . .

(9) Maternity care.

(10) Well baby and well child care . . .

(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

(3) MINIMUM ACTUARIAL VALUE.—

(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

Ok, if you say, want to pay for general services out of pocket, and keep coverage for catastrophic things, you can't do that. You will end up paying the extra tax talked about above. This section is very clear on exactly what type of coverage you must carry. By saying that this is acceptable coverage, and only this, there is no room to wiggle at all on private insurance. Also, it doesn't appear that you can buy a supplemental type insurance to go along with public insurance unless it meets all these qualifications.

Automatic Enrollment:

page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:

(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

And, page 145, section 312:

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

You're in. No matter what. You're employer has to, by law, automatically enroll you.

Now, the parts that are really scary to me. I have a much bigger problem with these than I do with the rest.


pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES.

(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—

(i) taxpayer identity information with respect to such taxpayer,

(ii) the filing status of such taxpayer,

(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),

(iv) the number of dependents of the taxpayer,

(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and

(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.

And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:

(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.

This bill opens up all tax information to federal officials. It doesn't really limit who. Looks like any federal official who decides he needs some information on you can get it. Employers are also required to report whatever the gov't says it needs regarding your particular information. I think I'm correct in saying that there are limits, but in part (v) the secratary has the power to bypass those limits whenever he sees fit. In other words, they can open your tax records, medical records, school records, bank records, etc. anytime they please and there are no limits on who they can give this information to.



Rationing


pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:

(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

and, under “Definitions”:

(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .

and:

(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

and:

(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .

(C) the measures of readmissions

The Gov't decides what is an applicable medical condition. they also decide who can be re-admitted to the hospital. It's some type of statistical formula that they use and when enough people have been discharged for the same thing, then you can be readmitted, but not before that. It also says that there will be no judicial reviews on this issue. The decision of the gov't is final.


Ok, I'm getting a headache. I have more, but I don't want to do it right now. Let's move on to solutions.

My first solution would be Tort reform. Doctors, nurses, specialists, etc. carry hundreds of thousands, even millions in some cases, of dollars of insurance from lawsuits.

Secondly, I would like insurance companies to be allowed to sell across state lines. It seems silly to me that people in NJ have to pay so much more for insurance than I do. It seems to me that if someone from NJ wants to buy blue cross of TN then they should be able to do it. Big corporations are allowed to do it. ERISA allows them to take their coverage to any state in the union. All of us should have that option, not just the big companies. So, we need to drop the law that forbids the sale of insurance across state lines.

Third, give a tax break to individuals who buy their own insurance. Don't punish them for their ability to take strain off of the the medicaid/medicare rolls. If people were given a break on taxes as they got older so they could buy insurance themselves, they wouldn't have to use medicare and it would ease some of the pressure so that people who aren't able to do it will be able to keep reliable care with medicare. It will also help people who are disabled get on the medicare rolls a little easier because it won't be so crammed up. It may take a little adjusting over time, but I think it would work.

Fourth, give individuals who have insurance a tax break. If you don't have insurance, you don't get the break. It entices people to keep insurance up to date. It also reduces the strain on doctors and hospitals who are not getting paid for services by people who don't have insurance.

Ok, I better get to work. I think this is a good start though.

Gilshalos Sedai
08-14-2009, 10:06 AM
Yeah, but Sei... you make sense. Government's not supposed to make sense.


A co-worker took advantage of the bosses' absence and printed out the whole bill. She and her husband plan to look at it over the weekend. Bryan and I get it after they're done. It took two reams of paper, at least.

Sei'taer
08-14-2009, 10:18 AM
Yeah, but Sei... you make sense. Government's not supposed to make sense.


A co-worker took advantage of the bosses' absence and printed out the whole bill. She and her husband plan to look at it over the weekend. Bryan and I get it after they're done. It took two reams of paper, at least.

I've been reading it online. Maybe thats why it gives me a headache.

Gilshalos Sedai
08-14-2009, 10:23 AM
Yeah, it couldn't possibly be the legalese or the political doublespeak.

Sei'taer
08-14-2009, 10:32 AM
Yeah, it couldn't possibly be the legalese or the political doublespeak.

No...not at all lol

StrangePackage
08-14-2009, 10:36 AM
You know, a one page bill that says "We now have single payer health care with private health care providers" would be a lot simpler and probably work much better.

Too bad that idea was taken off the table forever ago.

JSUCamel
08-14-2009, 10:47 AM
First of all, could you link to this bill, so we can read the whole thing (instead of the out-of-context bits that you decided to quote)?

Thanks.

Anyone caught without acceptable coverage (I'll catch this next), who is not in the government plan, will be charged a special tax. This apparently will be enforced by the IRS, since they control tax codes. So, if you keep private insurance, but it doesn't meet the minimum required by the gov't you will be penalized, on top of what you already pay in taxes to pay for the public healthcare system.


The bolded part is your mistake. There's nothing in that section that says "acceptable coverage" is the government plan. This isn't anything different than the way car insurance works in many states -- you MUST have coverage, otherwise you get fined a shitload of money.

I'm not a health care specialist, but I do know that nearly every single plan I've looked at for private insurance covers all of those things listed under "Acceptable Care".

And you keep conveniently ignoring the fact that Obama has said many times that existing health care plans won't be affected -- so you don't have to "opt out". It's an opt-in proposal, not an opt-out.

Ok, if you say, want to pay for general services out of pocket, and keep coverage for catastrophic things, you can't do that. You will end up paying the extra tax talked about above. This section is very clear on exactly what type of coverage you must carry. By saying that this is acceptable coverage, and only this, there is no room to wiggle at all on private insurance.

Again, this is no different than car insurance is for many states. It's not "this and ONLY this", it's "At the minimum, it must cover these things". There's a huge difference. You can have as much coverage as you want, so long as it hits all of these points.

And let me ask you, why would you want health coverage that doesn't cover hospitalizations, prescriptions, maternity care, emergency care, professional care, etc? Do you really think you're invincible? It's the ones that DO think they're invincible that wind up in the ER without insurance.

Also, it doesn't appear that you can buy a supplemental type insurance to go along with public insurance unless it meets all these qualifications.

It doesn't mention this specifically, but it doesn't say anywhere in that quote that you can't get other insurance. In fact, nowhere in anything you've quoted does it say that you have to be on the government plan; it's just listing standards that the plans have to meet -- kinda like how you have to meet certain standards to graduate high school (what, you can't take a public option?) or to buy alcohol (what, any teen on the street can't just buy a beer? How dare they!).

You're in. No matter what. You're employer has to, by law, automatically enroll you.

There are a few different health care proposals floating around, and since I can only respond to what you've quoted (which are out of context), I can't really respond to this, except to say that I'm pretty sure the auto-enrollment means that all employers that make X dollars per year have to auto-enroll you in A HEALTHCARE PLAN. It doesn't say it has to be a government one.

The Medicare/Medicaid one is for eligible individuals, and you and I are not eligible, so this doesn't affect you at all.

Also, if you read this section again, at the top it says "Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:". From what I understand, the behind-the-scenes of the health industry is what's going to change. Instead of a health insurance company from NJ being the only major health provider for NJ, they're going to compete in an exchange marketplace for coverage. In other words, employers get an option in a competing marketplace of health insurance carriers. I'm not entirely sure how exchanges like this work, but this is how Congress gets their health insurance and it's how oil and other commodities get exchanged around the world.

Your benefits won't change, nor will your situation. What will happen is that employers will get to pick from a variety of competing carriers instead of just one or two major ones. That's my understanding of it, anyway.

This bill opens up all tax information to federal officials. It doesn't really limit who.

It limits it to the Health Commission and its offices. But this information isn't any different than those any college student gives when filing for financial aid or when you file for a loan (I've had to give similar info when filing for loans, etc). I don't see what the problem is here.


Employers are also required to report whatever the gov't says it needs regarding your particular information. I think I'm correct in saying that there are limits, but in part (v) the secratary has the power to bypass those limits whenever he sees fit. In other words, they can open your tax records, medical records, school records, bank records, etc. anytime they please and there are no limits on who they can give this information to.

I don't see anything in here that refers to medical records, bank records, school records, or anything else. It says specifically that the Health Choices Commissioner, Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of Treasury, as applicable, will be furnished with "such information as the Commissioner may require to ascertain compliance with the requirements of this section."

This section, of course, being "DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES". They don't need anything but tax information from the previous tax year (as already spelled out in this section).

The Gov't decides what is an applicable medical condition. they also decide who can be re-admitted to the hospital. It's some type of statistical formula that they use and when enough people have been discharged for the same thing, then you can be readmitted, but not before that. It also says that there will be no judicial reviews on this issue. The decision of the gov't is final.

Again, you've cut out sections and edited it out-of-context so we can't view the whole thing. A link to the whole bill would be great. There is clearly a section that defines what "applicable conditions" are, but you've edited that out, so I can't really properly respond to this.

This section is intended, I believe, to restrict people from abusing the health care system (on a whim, for attention, because they're lonely, for pain killers, etc), but since I can't read the rest of the bill, I can't really properly respond.

...solutions...

I agree with your solutions.

All I really want out of a health care plan is a sort of Bill of Rights for Healthcare.

I want it explicitly stated in a legal fashion that says that I have the right to healthcare, that my pre-existing condition won't cause me to be denied coverage, and that if I need care, I'll get it.

I'm in a situation right now where if I can't find a job in the next year, I'm dead.

And that's just not fair. I'm a hard-working, responsible individual. I'm not a drug addict, I'm not homeless, I'm not on welfare -- I'm just like you. But because health insurance companies have decided that I'm uninsurable (how is that better than the Secretary of Health deciding this?), then I'm fucked.

Reform is definitely necessary, and I don't understand why so many people are upset about the government regulating it. I just can't wrap my head around it. Nothing you've posted has in any way appeared to me that the government has some nefarious plan to wipe out private health insurance carriers, and nothing you've posted has in any way convinced me that the government regulating health care is a bad idea. All I'm seeing, not just from you, but from most opponents to the plans, is extrapolation of what might happen in the future if this is passed, and quite frankly, it's not enough of a negative to outweigh the positives in my mind.

Gilshalos Sedai
08-14-2009, 10:57 AM
HR 3200 (http://energycommerce.house.gov/Press_111/20090714/aahca.pdf)


There is no way in hell I'm copying pasting this sucker here. A co-worker just printed it out and it took up 2.5 reams of paper.

Davian93
08-14-2009, 11:15 AM
HR 3200 (http://energycommerce.house.gov/Press_111/20090714/aahca.pdf)


There is no way in hell I'm copying pasting this sucker here. A co-worker just printed it out and it took up 2.5 reams of paper.

Anything that long HAS to be good...just agree with it...or sign it (if you are a Congressperson)

JSUCamel
08-14-2009, 11:37 AM
What is this mysterious Health Insurance Exchange?

(a) ESTABLISHMENT.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.

Notice the word "option" at the end of the definition. A public insurance option. Not mandatory -- optional. But in case that's not enough, there's this section:

(a) ACCESS TO COVERAGE.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

As you can see, you're eligible to do the Exchange, unless you're part of another qualified plan or other acceptable coverage.

But wait, what's this "acceptable coverage" nonsense? I mean, does that mean the government will say "Our plan is the only acceptable plan, and you're stuck with us!"? No, of course not.

(2) ACCEPTABLE COVERAGE.—For purposes of this division, the term ‘‘acceptable coverage’’ means any of the following:
(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan.
(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in sub-section (b) of such section).
(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act.
(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE). - Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Commissioner in coordination with the Secretary of Treasury to be not less than a level specified by the Commissioner and Secretary of Veteran’s Affairs, in coordination with the Secretary of Treasury, based on the individual’s priority for services as provided under section 1705(a) of such title.
(G) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordina- 20
tion with the Secretary of the Treasury, recognizes for purposes of this paragraph.

As you can see, if you meet any of the above criteria -- including already having a group health plan through you're employer (in case you're drowsy from falling asleep at work, I'll spell it out for you -- THIS MEANS YOU. That's right, the coverage you have is acceptable coverage and you don't have to do the government plan if you don't want to!). It also covers Medicare and Medicaid recipients, as well as the armed forces and veterans. They're all considered acceptable coverage.

(B) EMPLOYEE CHOICE.—Any employee offered Exchange-participating health benefits plans by the employer of such employee under subparagraph (A) may choose coverage under any such plan. That choice includes, with respect to family coverage, coverage of the dependents of such employee.

Ah, choice. What a wonderful provision.

I could go on, but since this is one of three proposed bills, I'm not gonna waste any more time reading this. I'll rehash this when it gets down to one bill and then I'll read it and get back to you.

Just to be clear, ST, I understand where you're coming from because I certainly share some of your concerns, but I just disagree with your interpretations. I think you're being overly paranoid about what the government intends to do and that you're either overlooking or ignoring some of the language that should relieve/ease your fears.

Gilshalos Sedai
08-14-2009, 12:05 PM
I think Sei's problem is, if you're fortunate to be able to pay cash, you're going to get smacked by the IRS on April 15 for not being on ANY plan. At least with the requirement for car insurance, you're only in trouble if you get a ticket or have an accident.

JSUCamel
08-14-2009, 12:20 PM
I think Sei's problem is, if you're fortunate to be able to pay cash, you're going to get smacked by the IRS on April 15 for not being on ANY plan. At least with the requirement for car insurance, you're only in trouble if you get a ticket or have an accident.

True, but isn't the whole "tax the wealthy" thing what everyone wants?

Gilshalos Sedai
08-14-2009, 12:30 PM
No.

JSUCamel
08-14-2009, 12:34 PM
No.

Wouldn't have known that from the thread last week, where Sini and I were the only ones challenging that idea.

Sinistrum
08-14-2009, 12:39 PM
And you keep conveniently ignoring the fact that Obama has said many times that existing health care plans won't be affected

Oh, Obama said it so it must be true...

Gilshalos Sedai
08-14-2009, 12:40 PM
I think Ozy and Sei argreed with you two.


I just didn't want the middle class taxed more.

JSUCamel
08-14-2009, 12:43 PM
Oh, Obama said it so it must be true...

Ah, but it's also in all three of the proposed bills that I've read. So unless they're going to conveniently remove that part to satisfy your cynicism, you're just being a douche.

Gilshalos Sedai
08-14-2009, 12:46 PM
What about the limits on terminally or chronically ill that are supposed to be in there.


(I'm waiting on the hard copy to find them, I hate reading on a monitor.)

JSUCamel
08-14-2009, 12:57 PM
What about the limits on terminally or chronically ill that are supposed to be in there.


(I'm waiting on the hard copy to find them, I hate reading on a monitor.)

This is all I could find on a quick scan through.

INITIATIVE FOR END OF LIFE CARE.-
(1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)) is amended by adding at the end the following new paragraphs:
‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—
‘‘(A) IN GENERAL.—For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
‘‘(B) PROPOSED SET OF MEASURES.—The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’’.
(c) INCLUSION OF INFORMATION IN MEDICARE & YOU HANDBOOK.—
(1) MEDICARE & YOU HANDBOOK.—
(A) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including—
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.—The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

There was also this:

(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;

That last was under the "reporting" section on how the Health Commission is supposed to report things to the government.

Sinistrum
08-14-2009, 01:00 PM
Ah, but it's also in all three of the proposed bills that I've read. So unless they're going to conveniently remove that part to satisfy your cynicism, you're just being a douche.

Why? Because I doubt the word of a politican? And you do know how bills get passed right? There is plenty of opportunity to take a hatchet to this bill and chop out or include stuff. Its only just gotten out of committee in the House.

Zaela Sedai
08-14-2009, 05:49 PM
Secondly, I would like insurance companies to be allowed to sell across state lines. It seems silly to me that people in NJ have to pay so much more for insurance than I do. It seems to me that if someone from NJ wants to buy blue cross of TN then they should be able to do it. Big corporations are allowed to do it. ERISA allows them to take their coverage to any state in the union. All of us should have that option, not just the big companies. So, we need to drop the law that forbids the sale of insurance across state lines.

I think I can give you the "why" on this one Taer.

The reason smaller companies don't buy across state lines is because they are generally Fully Insured, meaning the Insurance Company pays there medical bills. Because of this the Insurance companies need to follow specific state mandates. NJ has a SHITTON of state mandates, TN barely has any, so because of this, it costs the insurance company much more to insure a company sitused in NJ then it does in TN, and consequently, the coverage costs much more.

The larger companies however, they are self funded. Because they are self funded they do not have to follow any state regulations. They must follow federal mandates, but there aren't as many of those. (Although there is a huge Mental Health Parity/Substance Use Disorders change coming through on 10/3 as well as a Hearing Aids Coverage mandate) Because they 1. pay the medical bills them selves and only pay the insurances companies as a paper pusher and 2. they don't have to follow state regulations, they can shop around and have it cost less. However, they do run the risk of shelling out for Nancy's cancer treatment and Bobby's transplant, but in the long run its cheaper than paying monthly premiums for everyone. Cause if you don't ever go to the doctor they don't pay much of anything.


Not sure if that clarifies anything for you, and its all i can offer for insight as an insider... I do not agree with complete government reform though. Let Private and Public compete, thats fine, but I want a choice.

Sei'taer
08-17-2009, 08:34 AM
I realize this is all kind of moot now, because Obama and Sebelius have started to change their definitions of what they want in this bill, but I still wanted to post this. So, here it is.

------------------------

First, I meant to post the link, but I was being rushed at work. You'd think that since I didn't have anything to do they'd leave me alone.

The bolded part is your mistake. There's nothing in that section that says "acceptable coverage" is the government plan. This isn't anything different than the way car insurance works in many states -- you MUST have coverage, otherwise you get fined a shitload of money.

I'm not a health care specialist, but I do know that nearly every single plan I've looked at for private insurance covers all of those things listed under "Acceptable Care".

And you keep conveniently ignoring the fact that Obama has said many times that existing health care plans won't be affected -- so you don't have to "opt out". It's an opt-in proposal, not an opt-out.

It's an opt-out proposal, according to this:

page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:

(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

And, page 145, section 312:

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

The employer is responsible for autoenrollment. If you don't want it, you must opt out or you will be automatically enrolled by your employer through autoenrollment. the only way you can opt out, legally, is to meet what the government says is acceptable coverage. to be fair, it's not clearly defined and I just picked the part out of the 3 or 4 passages I found that I thought was talking about acceptable coverage. You found some others that also explain it. thats mainly why i posted this. I want to talk about it and about my interpretation of what it says and then weigh it against what other people say the interpretation is. I don't speak this language very well. In my defense though, I don't think the bureaucrats do either.


As you can see, if you meet any of the above criteria -- including already having a group health plan through you're employer (in case you're drowsy from falling asleep at work, I'll spell it out for you -- THIS MEANS YOU. That's right, the coverage you have is acceptable coverage and you don't have to do the government plan if you don't want to!). It also covers Medicare and Medicaid recipients, as well as the armed forces and veterans. They're all considered acceptable coverage.

One problem though. This clause/section/whatever:

(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in sub-section (b) of such section).

Grandfathered means that you can have exactly what you have. As soon as something changes, then it is no longer grandfathered. We get into a lot of stuff at work over grandfather issues. If you have a shed that was built in 1950 that is too close to the property line, then you are free to leave it there. When you decide to tear it down, you have to move it to a legal location. If a storm blows through and destroys it, then it can be replaced, but it must be replaced in a legal location. If your insurance changes, in some way, then it is no longer grandfathered. You must meet whatever the gov't terms as acceptable coverage from then on.

Not sure if that clarifies anything for you, and its all i can offer for insight as an insider... I do not agree with complete government reform though. Let Private and Public compete, thats fine, but I want a choice.

I understand it, but I don't like it. I think that if I want coverage for everything, all the way up to chiropractic, then I should have the option to buy NJ insurance. If I want to buy catastrophic only, then I should have that choice. I should be able to make my insurance fit my needs, the same whay I do with car insurance. The state says, "this is what you need at the minimum, but it may not cover everything if you have an accident" and you can go from there, basically designing your insurance plan around what the minimum coverage has to be. The minimum coverage has to be a reasonable too. I think the minimum in NJ is unreasonable. Thats the kind of thing that drive prices up for everyone else.

And Camel. I know things need to be fixed. I want them to be fixed. They are bad for a lot of people. There are ways to fix it that make a lot more sense then just throwing it in our governments lap. Government is inefficient as hell. Government also doesn't have to make a profit, so they are allowed to be inefficient.

Anyway, like I said earlier, this is all a moot point until we see whats going to happen after the fall break.

Ivhon
08-17-2009, 10:30 AM
I realize this is all kind of moot now, because Obama and Sebelius have started to change their definitions of what they want in this bill, but I still wanted to post this. So, here it is.

------------------------

First, I meant to post the link, but I was being rushed at work. You'd think that since I didn't have anything to do they'd leave me alone.



It's an opt-out proposal, according to this:



The employer is responsible for autoenrollment. If you don't want it, you must opt out or you will be automatically enrolled by your employer through autoenrollment. the only way you can opt out, legally, is to meet what the government says is acceptable coverage. to be fair, it's not clearly defined and I just picked the part out of the 3 or 4 passages I found that I thought was talking about acceptable coverage. You found some others that also explain it. thats mainly why i posted this. I want to talk about it and about my interpretation of what it says and then weigh it against what other people say the interpretation is. I don't speak this language very well. In my defense though, I don't think the bureaucrats do either.




One problem though. This clause/section/whatever:



Grandfathered means that you can have exactly what you have. As soon as something changes, then it is no longer grandfathered. We get into a lot of stuff at work over grandfather issues. If you have a shed that was built in 1950 that is too close to the property line, then you are free to leave it there. When you decide to tear it down, you have to move it to a legal location. If a storm blows through and destroys it, then it can be replaced, but it must be replaced in a legal location. If your insurance changes, in some way, then it is no longer grandfathered. You must meet whatever the gov't terms as acceptable coverage from then on.



I understand it, but I don't like it. I think that if I want coverage for everything, all the way up to chiropractic, then I should have the option to buy NJ insurance. If I want to buy catastrophic only, then I should have that choice. I should be able to make my insurance fit my needs, the same whay I do with car insurance. The state says, "this is what you need at the minimum, but it may not cover everything if you have an accident" and you can go from there, basically designing your insurance plan around what the minimum coverage has to be. The minimum coverage has to be a reasonable too. I think the minimum in NJ is unreasonable. Thats the kind of thing that drive prices up for everyone else.

And Camel. I know things need to be fixed. I want them to be fixed. They are bad for a lot of people. There are ways to fix it that make a lot more sense then just throwing it in our governments lap. Government is inefficient as hell. Government also doesn't have to make a profit, so they are allowed to be inefficient.

Anyway, like I said earlier, this is all a moot point until we see whats going to happen after the fall break.

Im avoiding the debate as much as possible. However, what little I remember was that BC/BS was pretty efficient when it was not-for-profit. Then the insurance companies came in and cherrypicked it all to hell.

I really don't understand the idea that we MUST save the private insurance companies. They are precisely the problem. The only way they can have record profits during this recession is the combination of horrendous rate increases and not paying on claims.

Sure the government is inefficient, but I just dont buy the idea that it is always inefficient - except at killing foreigners - to the point that the government CANNOT provide a better service than the private sector. The private sector, in this case, is taking increasingly HUGE amounts of money and NOT providing the service.

Basically, I guess, the ideological stance seems to fail in this case. No ideology is correct 100% of the time, and in the case of insurance and health care the private sector is doing a DIS-service, which to me is worse than just inefficient service.

The only real answer that I have heard is to make health-care/insurance not for profit. My health (and yours) should not be secondary to a shareholder report.

Sei'taer
08-17-2009, 10:36 AM
I've been reading about not for profit co-ops this morning and so far, I think the idea has merit. I really don't have any in-depth opinions on it yet, but so far it seems ok.

JSUCamel
08-17-2009, 11:07 AM
Sure the government is inefficient, but I just dont buy the idea that it is always inefficient - except at killing foreigners - to the point that the government CANNOT provide a better service than the private sector.

This is the #1 argument that I'm hearing from the opponents of the health care reform proposals. Sei'taer is probably the only person I've talked to yet that actually has thought it through and is making intelligent arguments against the current set of proposals. Everyone else seems to fall back on parroting Beck or O'Reilly or Olbermann's and can't actually tell me WHY having the government get involved is a bad thing.

My brother, for instance, is one of these idiots.

Brother: "The government shouldn't get involved in our health care!"
Me: "Why not?"
Brother: "They're gonna fuck it up!"
Me: "How?"
Brother: "They can't run anything!"
Me: "Why do you say that?"
Brother: "Everyone knows that!"
Me: "I don't. Why do you think they can't run anything?"
Brother: "They'll just waste money like they always do!"
Me: "Oh really?"
Brother: "And they never do the job the right way!"
Me: "What do you mean?"
Brother: "Whatever, the government shouldn't regulate our health care. We'll turn into Canada, and everyone knows Canada's health care system sucks. People have to wait three months for EMERGENCY X-rays!!"
Me: "Where did you hear that?"
Brother: "What?"
Me: "Where did you hear that Canadians wait 3 months for an emergency X-ray? If they break their leg, they have to wait three months to get a scan?"
Brother: "Everyone knows this."

At this point, our Canadian cousins who happen to visiting this particular weekend are simultaneously horrified at his ignorance and amused by how far off he is.

Me: "I don't know this. Where did you hear it?"
Brother: "What, are you going to challenge my sources every time I bring up a good point?"
Me: "It's not a good point -- that's why I want to know your source. Is it a credible source, or are you just quoting Glenn Beck or Bill O'Reilly? How about we ask the real experts right now?"

Our Canadian cousins explain that they quite enjoy their healthcare system, that they have a few gripes with it, mainly with prices for medicines and such, but overall, they get the health care that they need and when they need it.

Brother: "But you have to wait months to see a doctor for a regular visit!"
Me: "Do you remember the last time you went to the dentist?"
Brother: "Sure."
Me: "What was the last thing you did when you left?"
Brother: "I said thanks and left."
Me: "You didn't make an appointment for next time?"
Brother: "Well, yeah."
Me: "And when's that appointment?"
Brother: "Uh.. December."
Me: "So six months from then?"
Brother: "..."

This becomes a prime point for me to interject that, thanks to government regulation, I'm alive. The FAA regulated my flight from Atlanta to Chicago to visit, the FDA made sure that the medicine I take every day isn't, you know, poison or something. Government regulation makes sure that the car I drive has airbags that work, the USGS makes sure that the fancy GPS system I used to find the fastest way from Chicago to Atlanta actually works, the Department of Labor makes sure that when I lose my job, I'm not gonna starve on the street while I look for a new job.

Sure, there are programs that are inefficient (Medicare and NASA immediately come to mind), but there are a TON of agencies and regulatory commissions out there that make sure that every single thing that you use every day is safe, that what you eat is safe, that what you drive is safe, that the cities you visit are safe. The reason most of us are alive, that we have these 80 year life spans (as opposed to 40, 50 year lifespans 100 years ago, or whatever they were), is in large part due to government regulation.

You cannot convince me that "government regulation is bad" without any supporting arguments. You may at some point be able to convince me that THIS PARTICULAR PLAN is a bad idea, because it does A, B and C and in this example it was shown that A didn't work, and in that example it was shown that B didn't work, and unless X occurs, then C will turn out like Y did.... but nobody's doing that. They're decrying government intervention -- why? Because Glenn Beck said so?

Sei'taer has made some excellent points regarding the current proposals and wording that could be interpreted in ways that aren't to our greatest advantage. I happen to disagree with his view, but he is absolutely making an intelligent argument.

Don't let this go to your head, ST, but if everyone was like you with respect to arguing for their side of things, this country would be running a lot better. Right now, the loudest voices tend to be the idiots -- on all sides, liberal, conservative, centrist -- and the smartest ones, for whatever reason, are sitting on the sidelines.

Davian93
08-17-2009, 11:22 AM
Without a public option, any healthcare reform is worthless.

Obama seems like he is gonna give in on the public option and that will be a damn shame.

Stupid conservatives in the pocket of the insurance companies are screwing us again...not surprised one bit.

JSUCamel
08-17-2009, 11:34 AM
Without a public option, any healthcare reform is worthless.

I agree with this because no health insurance carrier will voluntarily cover people like me -- over time, I'm a losing proposition.

Davian93
08-17-2009, 11:39 AM
I agree with this because no health insurance carrier will voluntarily cover people like me -- over time, I'm a losing proposition.

Exactly, my fiancee is in the same boat. Without the VA (she's a vet too), she'd be screwed...and possibly dead.

My injuries are considered "preexisting conditions" and thus, without the VA, I wouldn't be covered for something major. Minor appointments they dont care so much but any big $$ item and I guarantee they'd tell me to go F@*@# myself.

We need a public option and we need nationalized healthcare. Our country needs to stop bending over for the Insurance Industry.

JSUCamel
08-17-2009, 11:42 AM
We need a public option and we need nationalized healthcare. Our country needs to stop bending over for the Insurance Industry.

One thing I do agree with ST about is that we shouldn't rush into this. Ideally, we'd have something in place by next year. (Because, uh, that's when my COBRA runs out. Incidentally, that's another government law that has made sure I'm alive -- in mandates that health insurance carriers continue to cover me for 18 months after losing coverage through a job).

Based on what I've read on two of the three proposed bills, I actually kinda like what they're proposing. There are a few items here and there that I've noticed that I'm not too keen about, but overall, I like most of the plans.

Sinistrum
08-17-2009, 11:50 AM
I really don't understand the idea that we MUST save the private insurance companies.

*Parrots the same arguments made about the wisedom of the car company bail outs*

Its really for the same reasons. They've got powerful lobbyists and everyone always seems to crap themselves at the idea of a major company going down and the job losses that go along with that.

GonzoTheGreat
08-17-2009, 12:05 PM
*Parrots the same arguments made about the wisedom of the car company bail outs*

Its really for the same reasons. They've got powerful lobbyists and everyone always seems to crap themselves at the idea of a major company going down and the job losses that go along with that.Now, that may make some sense in the case of car companies. But with health insurance?

Let's see:
-A government system would be run from your own country, so it would employ primarily US citizens.
-If the government system is just as inefficient as the private companies, then it would need at least as many employees, thus keeping at least as many people in jobs. If the government wages would be lower, on average, this would mean more jobs, not less.
-If the government system is more efficient (as some claim it will be), then that would mean having fewer people work in this branch, admittedly. But it would also mean having an improved health system, which in turn would benefit the entire US economy.

The thing about the lobbyists I can't counter, obviously, because it is the simple truth.

Sei'taer
08-17-2009, 12:11 PM
My only problem with the regulations Camel is talking about is that they are regulations. They are mandated by the gov't but not run by the gov't.

Here's how I look at it. Obama has brought this up a few times in speeches. Last time was in CO. Fedex, UPS, Postal Service. All are in competition with each other. Who has better service, makes a profit, has fair prices for customers, and has better customer service? One of these three is talking about shutting down around 100 of its facilities nationwide and cutting delivery days from 6 to 5 because it is losing money and can't compete because it is being run badly and more and more people are opting not to use them. They also depend on their competitor to provide services for them that they cannot provide on their own, due to bureaucratic issues that can't be changed without a complete shut down and restructuring and even the it's only given a 50/50 chance of being able to keep up with competition.

Gilshalos Sedai
08-17-2009, 12:24 PM
For every VA or USDA you get the Post Office and Amtrak.


I'm neither for nor against public run health care. I do know the VA is the only reason my father is alive and my mother isn't bankrupt caring for him. But he can't get most of his pill through the VA because they're newly invented. He has to use my mother's private insurance to pay for VERY costly meds.

And under a public health care system, I doubt anyone would have found my hypothyroidism.

But despite my misgivings, I do know there's a lot of people like Camel that need it and aren't getting it.

Sei'taer
08-17-2009, 01:08 PM
The VA, I don't know anything about. It's for veterans, I'm not one. It is something that was promised to them for their service. Fine with me and I'm happy we had the foresight to take care of our soldiers when they need it.

The USDA, on the other hand is a regulatory office. They don't run the food supply industry. The food industry runs itself and has to follow the mandate regulations of the USDA. Same with the FDA, FCC, etc. I have no problem with that (not much of one anyway).

My problem is that the gov't would never put the USDA in charge of our food supply. The USDA wouldn't know how to do that. They are a regulatory authority only. It would be like telling me to go build a bridge. I know how to do it, but I can't weld, work concrete, or run any of the equipment that would be used in building it. It would be incredibly inefficient because I would have to do things several times to get it right and end up throwing a lot of money away on mistakes that someone who knew how to do these things wouldn't make. I can tell someone all day how to fillet gauge a weld, but damned if I can do the weld myself.

Gilshalos Sedai
08-17-2009, 01:11 PM
So, you'd rather a board to more efficiently regulate the insurance agencies that we DO have?

Sei'taer
08-17-2009, 01:33 PM
So, you'd rather a board to more efficiently regulate the insurance agencies that we DO have?

No...that's not what I said at all. You can't compare The USDA to the Postal service. One is a regulatory authority (an inspection department, to be really basic about it) and the other is not.

JSUCamel
08-17-2009, 01:35 PM
So, you'd rather a board to more efficiently regulate the insurance agencies that we DO have?

I'd be okay with that, actually.

All I really want is for a mandate that everyone must be able to get affordable coverage, pre-existing condition or no, from health insurance carriers in law somewhere. Call it a sort of a Health Care Bill of Rights, if you will.

Right now, there's nothing to keep the insurance companies from dumping me to the mud when my COBRA extension runs out.

To be honest, I'm not picky. Public option, regulatory law, kindness of their hearts (not holding my breath), whatever.. I just want to know that I'm gonna be able to get the health care I need at an affordable price.

Sei'taer
08-17-2009, 02:00 PM
I'd be okay with that, actually.

All I really want is for a mandate that everyone must be able to get affordable coverage, pre-existing condition or no, from health insurance carriers in law somewhere. Call it a sort of a Health Care Bill of Rights, if you will.

Right now, there's nothing to keep the insurance companies from dumping me to the mud when my COBRA extension runs out.

To be honest, I'm not picky. Public option, regulatory law, kindness of their hearts (not holding my breath), whatever.. I just want to know that I'm gonna be able to get the health care I need at an affordable price.

We almost have that with HIPAA. Unfortunately, it doesn't go quite far enough and it's also not well enforced because there is no real punishment for not following the rule. From what I understand, it's about like getting a parking ticket.

Sinistrum
08-17-2009, 02:05 PM
Let's see:
-A government system would be run from your own country, so it would employ primarily US citizens.
-If the government system is just as inefficient as the private companies, then it would need at least as many employees, thus keeping at least as many people in jobs. If the government wages would be lower, on average, this would mean more jobs, not less.
-If the government system is more efficient (as some claim it will be), then that would mean having fewer people work in this branch, admittedly. But it would also mean having an improved health system, which in turn would benefit the entire US economy.

Well all of these points could be turned around against the car companies too. After all its not like people are going to stop buying or driving cars, right? They'd just buy them from other sources who would have room to expand rapidly with the old guard out of the way. But that's sort of besides the point of this thread.

JSUCamel
08-17-2009, 03:12 PM
We almost have that with HIPAA. Unfortunately, it doesn't go quite far enough and it's also not well enforced because there is no real punishment for not following the rule. From what I understand, it's about like getting a parking ticket.

As I understand it, HIPAA has more to do with privacy laws than regulating who gets covered. Even so, "almost" won't sound too good next to my obituary.

Neilbert
08-17-2009, 03:21 PM
(1) the taxpayer’s modified adjusted gross income for the taxable year, over

Oh, hello regressive taxation.

Sei'taer
08-17-2009, 03:25 PM
As I understand it, HIPAA has more to do with privacy laws than regulating who gets covered. Even so, "almost" won't sound too good next to my obituary.

It also goes into coverage. I'm not on a computer right now but when I get on one I'll post what I'm talking about. I was just using it as an example of how our gov't talks about fixing things and then, either makes a situation worse, doesn't follow through on enforcement, or makes it so convoluted and hard to understand there are so many loopholes it might as well have never been done in the first place.

It might be good for you to be up on the HIPAA rules so when you do find a full time job you know how to push for this.

Neilbert
08-17-2009, 03:32 PM
No...that's not what I said at all. You can't compare The USDA to the Postal service. One is a regulatory authority (an inspection department, to be really basic about it) and the other is not.

Correct me if I'm wrong, but isn't the Postal Service required by law to deliver mail wherever? While the other two can just drop unprofitable routes or outsource them to the Postal Service?

Gilshalos Sedai
08-17-2009, 03:36 PM
You are correct.


However, like the auto workers, they're paying full retirement to 40 year olds because they put in their 20 years.

Sei'taer
08-17-2009, 04:00 PM
As I understand it, HIPAA has more to do with privacy laws than regulating who gets covered. Even so, "almost" won't sound too good next to my obituary.

Here's the HIPAA part I was talking about.

Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.

Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[1] However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[2] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[3] A "significant break" in coverage is defined as any 63 day period without any creditable coverage.[4]

Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans such as dental or vision plans that are offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.

However, an alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Unfortunately, since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans such as dental to apply towards exclusion periods of the new plan that does include those coverages.

Someone who is in the insurance industry probably knows more about it than I do. There's a lot of info on HIPAA.org (http://www.hipaa.org/)

Also, while I was looking for that, I found this (http://www.bloomberg.com/apps/news?pid=20601087&sid=aXM9gjEVUW68&refer=home). I don't know if the drugs you need are on there, but I figured I would post it. It's worth a shot anyway.

Davian93
08-17-2009, 04:11 PM
A government system would be run from your own country, so it would employ primarily US citizens.


They would all be US Citizens as that is a basic requirement for being a federal employee.

JSUCamel
08-17-2009, 04:19 PM
Here's the HIPAA part I was talking about.

Ah yes. That part basically says that they have to cover me after 12-18 months. That's at least a year where I basically have to hope that nothing comes up relating to my pre-existing condition, and given my pre-existing condition, that's a super scary thought.

I'm not entirely sure whether my meds would be affected under that situation, but it would certainly cover visits to my transplant team and any related medical costs (such as biopsies, etc).

Sei'taer
08-17-2009, 04:28 PM
Ah yes. That part basically says that they have to cover me after 12-18 months. That's at least a year where I basically have to hope that nothing comes up relating to my pre-existing condition, and given my pre-existing condition, that's a super scary thought.

I'm not entirely sure whether my meds would be affected under that situation, but it would certainly cover visits to my transplant team and any related medical costs (such as biopsies, etc).

That's why I said they almost made it. Too much wiggle room in there though.

tworiverswoman
08-17-2009, 06:25 PM
(1) the taxpayer’s modified adjusted gross income for the taxable year, over
Oh, hello regressive taxation.I didn't follow your thinking on this. Can you expand on what you meant?

Also why you only bolded the word "gross?"


Elsewhere -- the "grandfathered" part bothers me, too - because the health care plans I'm familiar with change EVERY YEAR - at least a little bit. Small tweaks in coverage and so forth. New technology that changes things and so forth. Which means my existing health care plans would be accepted for only one year, then tossed out and made to "conform."

Camel, I really appreciate the remarks you made applauding some of the government agencies and popping the myth that a government run agency cannot, by its very nature, do a good job. My next-door-neighbor is similar in attitude to your brother, and also has an aversion toward Obama that rivals any of you Bush haters from the last few years. And I can't quite call him "prejudiced" because he doesn't really think of Obama as black. (Again, remember where I live. Obama went to school here and has family here.) Frankly, I think Steve would be even WORSE if it were someone like ... oh, say, Al Franken.

Steve firmly believes that Obama plans to "slip the needle" to old people to get rid of them, and to ration health care and all the other things I've heard and read that can be tossed out the window by any THINKING person.

This bothers me most because I have always known my friend to be a very logical and rational man, with a good sense of humor and a laid-back attitude toward most things. And he couldn't understand the HATRED people felt toward Bush - and now doesn't see that he's the mirror image of those people he didn't understand. :(

JSUCamel
08-18-2009, 12:54 AM
I had an epiphany tonight, regarding the public health insurance option.

Right now, I have two options:

1) Get a full time job
2) Marry someone who has health insurance and switch to family coverage.

The second option is clearly not going to happen anytime soon. There's not anyone I'm even remotely interested in right now, much less willing to marry. The first option is really tough with the economy.

Big deal, right?

The problem that I'm having right now job-wise is that I can get part-time and temp contract jobs out the wazoo. In fact, there are so many available in Chicago that I'm (over)qualified for, that I could easily make the equivalent of what I was making at my last full time job with Tam.

So why don't I do that?

Because I can't afford to also cover my health costs. Contract and part-time work, by definition, don't come with benefits. The clock is ticking on COBRA and I can barely afford to pay the payments right now ($450/month for my COBRA payment.. that's half my rent, more than all my utilities combined... more than the food I eat in a month). There's no way I'd be able to pay out of pocket for that 4-hour ER stay for a kidney stone.

Basically what I'm saying is that the primary reason that I haven't just gone full-time freelance web development is because of the health insurance thing. A public health option would make that doable.

All I can really hope is that a public health insurance option is worth it.

Davian93
08-18-2009, 03:45 AM
You could move to VT or Mass...both have public state run health insurance which (in VT's case) is fairly affordable from what I understand. Mass requires people to have health insurance and thus requires that people have access to affordable health care.

Yes we are all evil Socialists in New England.


Why is the desire for affordable health care such an evil idea to Conservatives (who seem to be either super rich and thus can pay for it themselves or are on Welfare/Medicare and don't need no damn govment ruining their healthcare!!!

GonzoTheGreat
08-18-2009, 04:38 AM
Well all of these points could be turned around against the car companies too. After all its not like people are going to stop buying or driving cars, right? They'd just buy them from other sources who would have room to expand rapidly with the old guard out of the way. But that's sort of besides the point of this thread.Apart from the fact that you could, in theory at least, buy cars that were made elsewhere. On the other hand, for someone living in Nebraska, it wouldn't be useful to have health insurance that is valid only in South Korea, even if the paperwork was duly sent to him where he lives.

Sei'taer
08-18-2009, 08:47 AM
Steve firmly believes that Obama plans to "slip the needle" to old people to get rid of them, and to ration health care and all the other things I've heard and read that can be tossed out the window by any THINKING person.


I was talking to a friend of mine last night and showing him this thread. He had a perfectly plausible reason for the call of "rationing" even though neither of us thinks it would happen. After he explained it, I can see why people believe there will be rationing. Here's his explanation, with the names changed to match people here.

Ok, we'll take Camel and I as examples. I am healthy as a horse, go to the doc once a year for my physical, rarely use my prescription plan because I'm not on any type of drug that has to be refilled monthly, nor do I have to have doctor visits to get checked on the use of these drugs and whether they are working or not. So, my yearly bill out of pocket $20 worth of co-pay, $200 from the insurance.

Camel, on the other hand, has had a very significant transplant operation, has to take meds all the time to keep himself healthy, has to have regular check-ups to keep up with his transplant and the problems that can arise from that. His yearly out of pocket is probably in the thousands, as well as the pay out from the insurance company.

Now, if things get bad with healthcare and we start running out of money, who are they going to take healthcare away from? Not me, obviously, because that $200 a year isn't going to help much. Camel, though, uses a lot. So if they start looking for savings, they are going to look to Camel first, since he obviously uses a lot they can make some cuts in his care and see big savings immediately.

Of course, this all depends on the money being spent in the first place and requires that the healthcare is having money problems and is looking for the easiest and quickest way to cut costs.

All in all, it's an effective scare tactic, especially with the older people who spend a lot of money on healthcare. I had a good time talking about it last night. He's a paramedic in Memphis so this is going to change his situation regardless of which way it goes.

Davian93
08-18-2009, 08:57 AM
Rationing already occurs on a daily basis...its simply done by insurance companies who are out to make a profit. I think a gov't run plan would cut down on rationing if nothing else. There would be more controls on it.

Zanguini
08-18-2009, 09:05 AM
First question you are asked when you enter a hospital, is not what are your symptoms, nor how are you feeling, nor can I help you, but it is 'Do you have insurance.'

Davian93
08-18-2009, 09:07 AM
First question you are asked when you enter a hospital, is not what are your symptoms, nor how are you feeling, nor can I help you, but it is 'Do you have insurance.'

And if you answer "No" you get treated like crap...trust me, I know. We had that happen a few months ago with my fiancee as she doesn't have civilian insurance and we had an emergency. We were treated like crap...completely different than when she used to work and had insurance...Bastards.

JSUCamel
08-18-2009, 12:43 PM
Now, if things get bad with healthcare and we start running out of money, who are they going to take healthcare away from? Not me, obviously, because that $200 a year isn't going to help much. Camel, though, uses a lot. So if they start looking for savings, they are going to look to Camel first, since he obviously uses a lot they can make some cuts in his care and see big savings immediately.

I would ask: how is this different than the current system? It's already rationed and I've been deemed uninsurable. The only reason I'm getting any coverage at all is because the government (who is supposed to be the bad guy in this scenario) has mandated that I have to be given a chance to find new coverage within 18 months, and that new coverage would also be mandated by law (protecting coverage of pre-existing conditions).

Health care is already rationed. The way I see it, worst case scenario, we're back at the status quo. We know the status quo isn't working, so our only option is to change it. It might make it better, or it might not change anything at all.

All in all, it's an effective scare tactic, especially with the older people who spend a lot of money on healthcare. I had a good time talking about it last night. He's a paramedic in Memphis so this is going to change his situation regardless of which way it goes.

And that's all it is: a scare tactic.

Sei'taer
08-18-2009, 04:22 PM
And that's all it is: a scare tactic.

Not really, the reason it works so well is because it already happens. People who are already worried about it don't trust the gov't to do the right thing. They see it in the public healthcare systems of other countries and they worry that it will happen here.

It's like that old saying that "the funniest jokes have an element of truth in them (George Burns? Bob Hope? Dunno, might have been Shakespeare)" The best way to scare someone is to stick an element of truth in the scare. It all goes back to the trust factor. Do you trust the gov't or not?

GonzoTheGreat
08-18-2009, 04:33 PM
Let me put it differently: don't they have the guts to take a risk?

JSUCamel
08-18-2009, 04:50 PM
They see it in the public healthcare systems of other countries and they worry that it will happen here.

IT ALREADY HAPPENS HERE. I'm living proof. I have been DENIED private insurance. I have been DENIED the possibility of getting health care. The ONLY REASON I get health care is BECAUSE THE GOVERNMENT MANDATED IT.

If the government DID NOT get involved, then I WOULD BE DEAD. The opponents of these plans don't seem to get that.

I didn't choose this. I didn't drink hardly at all before my transplant. I didn't ask for it. I didn't take drugs. I didn't commit any crimes. I didn't call up my doctor and volunteer for this. I didn't stab myself in the liver until it failed.

I exercised regularly. I ate healthy food. I worked hard at my jobs and in my classes. I paid my taxes. I paid my car insurance, my health insurance. I gave blood as often as I could.

I didn't ask for this.

But this happened to me. And I live in fear that the day will come when I can't get my medicine, and I'm going to die, because some idiots can't get it into their heads that people deserve the right to live.

I'm not asking for welfare. I'm not asking for you to pay for everything. I'm willing to pay a premium -- a fair, affordable premium. All I ask in return is that I get the same medical treatment benefits that you do.

Businesses won't think like that. They have to think about the bottom line. People have to get paid, support their families. There has to be a profit margin, or they can't continue their work. So they cut corners, they cut losses, they fire lazy workers, they get rid of clients that don't pay up.

The government, on the other hand, has a duty to protect and defend the rights of its citizens. It nearly always operates at a loss, because it can't cut corners, it can't cut losses. Those very losses are the ones that the businesses won't cover. People like me, who are honest citizens who just need a leg up sometimes. The government tries to look out for people like me, and sometimes they ask you to chip in.

But then you sit back, with your beer and big screen TVs, and you say "Why should I? Why should I, a hard working individual, give up any of my money to help someone I don't even know?"

But you do know them. You know me. You know Pops, a government worker who has to have medical attention because of his blood sugar levels. You know people at work who lose limbs in construction accidents. You know people who have a child with mental defects so that they can never live on their own and always have to be taken care of. You know people who have worked hard all their lives, but something unfortunate, something bad, something beyond their control happens to them and they can't do it on their own.

And you still sit there and act all indignant that the government wants you to help.

Apparently, people like you will never understand why this is so important until you're actually in my shoes. And despite this attitude, I hope you're never in my shoes.

Sei'taer
08-18-2009, 05:30 PM
You're right. I'm for a reform of the healthcare system, but the system that I am reading about I am absolutely not for. I also have a vested interest in this...not just you, or Pops, or anyone else for that matter. I am all for gtetting something set up to help people like you. I am also for choice. I don't for a second believe that I will have that choice beyond the first year of this program. I can't believe that people who are so willing to fight like hell for the choice of having an abortion, or legalizing drugs are so willing to give up the same choice about their healthcare...and give it up to an entity that has shown time and again that it can't manage itself, much less make things good for everyone else. I'm worried that my daughter will be put on the back burner, because, unlike you, she will never be able to contribute to society in any way, shape or form. She will be a drain on society for her entire life and I am NOT willing to place that drain on anyone else because someone decided that I am not good enough or capable of taking care of her. WOuld I like some help? Absolutely, but not to the detriment of the rest of the country. It is not my place to take what is not mine. It is my place to take care of her to the best of my ability and maybe get a little leniency from someone once in a while, just like you need. What's so hard to understand about that?

I don't get this entitlement thing. I'm entitled to free care for her because she was born with a handicap? That's plain old bullshit. I'm entitled to getting the care for her that I can pay for and a little reform in the private healthcare system will do that. Once I turn her sovereignty over to the state, then I have failed to take care of mine. Maybe thats a foriegn concept to a lot of people but it's perfectly logical to me. I made her, she is my responsibility and for these motherfucking bullshit 13 to 15 years of life that she is going to have I'll be goddamned if anyone is going to tell me how, when, where and why I am should let her go or how, when, where and why I should take care of her. It's my choice. My choice. My fucking choice. Not yours, not the governments, not the state of TN or AL and not the worlds. It's MINE. She can't make a choice on her own. She doesn't have that ability, so she needs to depend on someone who loves her and knows her to stand up and make decisions for her. Not some fucker trying to make budget, in the government or in the insurance industry.

If our system sucks so bad, why do people from other countries come here to get healthcare? Why do people from Canada run down to the states for a surgery and pay out of pocket for them? Why is private healthcare in Canada making a comeback? Why is private healthcare so popular in the UK? Why do people in New Zealand buy healthcare after the age of 70 when they have free healthcare? Is it possible, that while public healthcare is good for some people, when you reach a certain age, or have a certain type of illness, they are not capable of helping you? I think that makes it useless in the long run.

I don't know why you felt the need to jump down my throat when we were having a perfectly logical discussion about healthcare, like should be going on in town hall meetings, but the unions or the tea party people have to come in and fuck it up. I think a logical discussion goes a lot farther than yelling and screaming and rushing to judgement. I like debate, Camel...you know that. I look forward to hearing your POV on things because it is usually so different from mine. And as I've gotten older, i do take what we talk about to heart and listen more than I talk. I hate doing what I just did because it hurts my feelings and makes me feel like I am losing a friend because we don't agree over something that we both need in a bad way. It's a stupid way to have a discussion. On my part as well as yours. I'll regret posting it, I'm sure. But I'm going to anyway, because like I said at the beginning. I also have a vested interest in this debate...as much as you do.

Davian93
08-18-2009, 05:35 PM
Regulate it like car insurance is regulated in Massachusetts. You MUST have it and it MUST be affordable. Private companies still offer it but they must insure anyone willing to pay a fair premium.

It would work.

Gov't healthcare can work.

JSUCamel
08-18-2009, 06:12 PM
I don't get this entitlement thing. I'm entitled to free care for her because she was born with a handicap?

I don't know where you're getting this entitlement thing. Who's asking for free healthcare? I'm not asking for free healthcare. I'm not asking for a handout. There's nothing I've read anywhere that indicates that this public option is free. In fact, as I understand it, you'd be paying a premium just like with a regular one. I'm perfectly willing to pay a premium. What I'm not willing to do is accept that I can't get my medicine because I'm uninsurable.

I am also for choice. I don't for a second believe that I will have that choice beyond the first year of this program.

You want a choice, do you? Let me ask you this. What choice do you have now? You can stick with your employer's plan or... or what? Get a private plan? Good luck with that. There isn't a private plan out there that will cover your daughter.

I want a choice, too. But I don't have one. I literally don't have a choice. There is nobody out there who will voluntarily cover me at all.

she is my responsibility and for these motherfucking bullshit 13 to 15 years of life that she is going to have I'll be goddamned if anyone is going to tell me how, when, where and why I am should let her go or how, when, where and why I should take care of her.

Again, I haven't seen anything that indicates that anyone other than you and your doctor are going to be able to choose what treatment your daughter gets. I don't see anything anywhere in any plan or proposal that has been published that says that anyone but you (and your wife) get to decide this kind of thing. Are you talking about Palin's "death panel"? That's not what "end-of-life" consulting is. If you believe that death panel crap, then you're not nearly as smart as I thought you were.

If our system sucks so bad, why do people from other countries come here to get healthcare? Why do people from Canada run down to the states for a surgery and pay out of pocket for them? Why is private healthcare in Canada making a comeback? Why is private healthcare so popular in the UK? Why do people in New Zealand buy healthcare after the age of 70 when they have free healthcare?

Some of that is false (or rather, inaccurate) information, but I'll give it a shot. We've been talking about "health care reform" when what we're really arguing about is "health insurance reform". People from all over the world come to the US for health care because we have the best doctors, the best medicine, the best technology. They pay for it out of pocket because they can't get it as good where they're from -- this has nothing to do with health insurance, whether this procedure gets covered or not.

To put it a different way, our HEALTH CARE SYSTEM doesn't (totally) suck, but our HEALTH INSURANCE SYSTEM sucks major ass.

I hate doing what I just did because it hurts my feelings and makes me feel like I am losing a friend because we don't agree over something that we both need in a bad way.

If you think that I'm not going to be your friend because of this thread, then you don't really know me as well as you should. This is a very touchy subject for everyone. If I came across as jumping down your throat or whatever... well, it's because I'm scared. The current system has given me the finger, and I want change, and I want it before I die. I don't want to be that guy who dies of thirst in the desert when that mirage in the distance isn't really a mirage, it's the real thing, but he gave up before he got there.

Most of all, I'm frustrated and angered by the sheer irrationality of the opposition to reform. People who insist that the government can't run anything on its own. Why not? What about all those alphabet agencies we mentioned earlier? The FAA, the USDA, the FDA, the CDC, the USGS... they're all government agencies that have done just fine. Nobody seems to be able to tell me why a government agency can't do something right. All they do is point out how they don't trust the government.

Well, why the hell not? The government makes sure you have the basics: food, water, shelter. It makes sure you have roads to drive on, clean air, clean water, power for appliances and electronics. It makes sure you don't get mugged on your way to work, that a woman can walk down the street by herself and not cower in fear at every sound for fear of being raped, that your buildings are up to code and even that your Cheerios really do help lower cholesterol. In the vast majority of cases, the government looks out for you.

Sometimes it's inefficient, sometimes it's corrupt, sometimes it's unpleasant, but it works. Do you really think we're the greatest country on earth DESPITE our government?

Do you really think the government is out to get you? Out to kill your daughter?

Then perhaps you really do need to move to another country.

ST, I don't want you to take these personally. You're the only one really engaging this argument, so I tend to be talking to you. I'm just making my case. I'm trying to understand yours, but I just can't make your fears make sense to me.

Maybe I'm naive.
Maybe I'm too trusting.
Who knows..

JSUCamel
08-19-2009, 02:23 AM
http://images.theweek.com/dir_27/the_week_13998_27.jpg

This is what I see in my mind when people talk about how they want "choice" and how they don't want the government "running things poorly" and how they want to "make [their] own decisions".

Gilshalos Sedai
08-19-2009, 08:30 AM
Camel, you are making a very sound argument. But I can also see Sei's POV. Both of you, for different reasons, are on the edge here and have an incredibly huge stake in the debate.


I do have a question, Camel for the immediate future since this legislation won't be enacted more than likely before your COBRA runs out, why can't you get on Medicare? Especially now that you're unemployed? (I don't honestly know anything about Medicare.)

Davian93
08-19-2009, 08:43 AM
Camel, you are making a very sound argument. But I can also see Sei's POV. Both of you, for different reasons, are on the edge here and have an incredibly huge stake in the debate.


I do have a question, Camel for the immediate future since this legislation won't be enacted more than likely before your COBRA runs out, why can't you get on Medicare? Especially now that you're unemployed? (I don't honestly know anything about Medicare.)

He probably makes just enough through his part time jobs and still has COBRA so he can "afford" not to be on Medicare...according to Uncle Sam.

Sei'taer
08-19-2009, 08:50 AM
You want a choice, do you? Let me ask you this. What choice do you have now? You can stick with your employer's plan or... or what? Get a private plan? Good luck with that. There isn't a private plan out there that will cover your daughter.

I have a private plan. I got it 2 years ago. I went here (http://www.rettsyndrome.org/) and made a plea for help after my daughter was denied medicare and medicaid, and denied full social security because she is not "fully disabled." This for a little girl who can't talk, walk, eat on her own, feeds herself with her hands, but is not capable of holding a fork or spoon, much less getting it to her mouth, can hold a cup, has seizures without the proper meds, and has a deformed ribcage and spine that hampers her breathing and makes her susceptible to pneumonia. I also, because of my plea, was able to get an anonymous donor to pay for the trips and hotel rooms in ATL every 3 months so she can get the care she needs from one of the 2 Rett specialists on the eastern half of the US. So, yeah, I understand that your scared, I am too. My daughter was already denied coverage by...guess who? Our public healthcare plan. I have no faith that she will be covered under the new plan. I also don't know what I will have to pay for her meds without my insurance and my secondary insurance. Apparently public healthcare doesn't cover prescriptions. If this does pass, my only hope is that prices drop enough that I don't have to pay the $3900 a month out of pocket for her meds.

Again, I haven't seen anything that indicates that anyone other than you and your doctor are going to be able to choose what treatment your daughter gets. I don't see anything anywhere in any plan or proposal that has been published that says that anyone but you (and your wife) get to decide this kind of thing. Are you talking about Palin's "death panel"? That's not what "end-of-life" consulting is. If you believe that death panel crap, then you're not nearly as smart as I thought you were.

No, I'm not talking about death panels. My daughters life span, if she doesn't die from a seizure, is only about 15 years tops. I've been through the death panel and it wasn't mandated by the government. What I'm talking about is that my daughter has already been denied coverage by the government. If she gets denied again, or gets accepted on the basis that she use treatments that are already proven not to work, and my grandfathered insurance gets un-grandfathered, she's fucked. Where does that leave her? As dead as you'd be.

To put it a different way, our HEALTH CARE SYSTEM doesn't (totally) suck, but our HEALTH INSURANCE SYSTEM sucks major ass.

No shit. Did you ever here the quote, "Don't just do something, stand there!" I think we are in the "Just doing something mode." And while we're on that subject. If I remember right, the dems have a supermajority in both houses. It can't be filibustered. If this is so great and so important, why not just pass it? If it needed to be rushed so nobody could get a chance to really look at then it was all there to be done. It could have been done with no problem. Oh, thats right, the republicans are standing in the way, right? Yeah, the people who can't stop a damn thing from going through are stopping it cold....how?

If you think that I'm not going to be your friend because of this thread, then you don't really know me as well as you should. This is a very touchy subject for everyone. If I came across as jumping down your throat or whatever... well, it's because I'm scared. The current system has given me the finger, and I want change, and I want it before I die. I don't want to be that guy who dies of thirst in the desert when that mirage in the distance isn't really a mirage, it's the real thing, but he gave up before he got there.

No, I don't believe that. My daughter (and me) have been given the finger too. But from the other side of the coin.

Most of all, I'm frustrated and angered by the sheer irrationality of the opposition to reform. People who insist that the government can't run anything on its own. Why not? What about all those alphabet agencies we mentioned earlier? The FAA, the USDA, the FDA, the CDC, the USGS... they're all government agencies that have done just fine. Nobody seems to be able to tell me why a government agency can't do something right. All they do is point out how they don't trust the government.

I'll try to make this plain, like I pointed out to Gil. These agancies run inspection departments. They don't run the industry. Our federal roads are maintained by the states, with money from the feds, but they are built by private contractors. I don't trust the gov't because I work for them. I see how they operate, I see what they are willing to spend money on, and I see how much they are willing to throw at stuff that makes no sense at all. The FAA mandates rules and regulations, and enforces those regulations, USDA does the same thing, so does the FCC. FCC doesn't run the radio stations, the USDA doesn't run the food industry, and the FAA doesn't run the airline industry.


I have to go to a prebid meeting this morning sso I need to go. Needless to say, I'm as scared as you are Camel, but for different reasons I suppose.

Gilshalos Sedai
08-19-2009, 08:56 AM
Uh... if your daugther was already denied by the government... what guarentee does Camel have? What are the provisions for chronic or incurable conditions?

Davian93
08-19-2009, 08:58 AM
I don't trust the gov't because I work for them. I see how they operate, I see what they are willing to spend money on, and I see how much they are willing to throw at stuff that makes no sense at all.

He makes a good point there. Though if we could simply regulate the insurance side of things enforcing mandatory insurance and affordable premiums (hell, subsidize the premiums with gov't funds if need be) that would answer both of your issues with our current situation.

Gilshalos Sedai
08-19-2009, 09:12 AM
Yeah, if the government turns you down, then where do you go?

Sei'taer
08-19-2009, 10:44 AM
Uh... if your daugther was already denied by the government... what guarentee does Camel have? What are the provisions for chronic or incurable conditions?

I don't know. And thats what scares me.

Gilshalos Sedai
08-19-2009, 10:47 AM
Considering I have one of those, too, it also terrifies me.

JSUCamel
08-19-2009, 11:30 AM
I have a private plan. I got it 2 years ago. I went here and made a plea for help after my daughter was denied medicare and medicaid, and denied full social security because she is not "fully disabled." This for a little girl who can't talk, walk, eat on her own, feeds herself with her hands, but is not capable of holding a fork or spoon, much less getting it to her mouth, can hold a cup, has seizures without the proper meds, and has a deformed ribcage and spine that hampers her breathing and makes her susceptible to pneumonia. I also, because of my plea, was able to get an anonymous donor to pay for the trips and hotel rooms in ATL every 3 months so she can get the care she needs from one of the 2 Rett specialists on the eastern half of the US.

That's awesome. Really, it is. But that approach doesn't work for everyone. You got lucky, really lucky. There's no "anonymous donor" waiting out there to give me $10000/year to make sure I get to visit my doctor to make sure my liver still, you know, works. There just aren't enough philanthropists to make that work on a large scale.

So, yeah, I understand that your scared, I am too. My daughter was already denied coverage by...guess who? Our public healthcare plan.

You mean the plan you get through work? or Medicare? or what? I thought the whole point of this proposal was to create a "public healthcare plan" because one doesn't exist. I'm not sure what you're referring to here. Clarify, please?

According to all three bills that I've read, the proposed plans will cover preexisting conditions such as Rett Syndrome as well as organ transplants.

Apparently public healthcare doesn't cover prescriptions.

I have no idea where you got this from. I'll look at the bills again and see if I can find anything to ease your mind about this, but medical prescriptions are one of the most important parts of health insurance... I can't imagine it wouldn't be covered. If that's true, then... I can't support a bill where that's true.

If this does pass, my only hope is that prices drop enough that I don't have to pay the $3900 a month out of pocket for her meds.

Agreed. Now we're talking about health CARE reform, where costs are just prohibitively expensive. I was talking to Frenzy about this last night. My transplant cost nearly half a million dollars, all told. This isn't exact, but it's close. The bill broke down something like this:

Hospital stay: $100,000
Pharmacy: $40,000
Radiology: $100,000
Doctors fees: $160,000
Administrative fees: $25,000
Other fees: $35,000

Some of these fees are just ridiculously high. Six figures for a few cat scans and MRIs? My yearly salary for three weeks worth of medicine? (granted, it was a shit load of medicine).

This is the kind of problem HEALTH CARE REFORM should be focusing on. What sucks is that 99% of the debate is focusing on the insurance side of things, which is still fucked up, but the root of the problem at the insurance level is the costs at the health-care level.

If I remember right, the dems have a supermajority in both houses. It can't be filibustered. If this is so great and so important, why not just pass it? If it needed to be rushed so nobody could get a chance to really look at then it was all there to be done.

I don't see why it needs to be rushed. I don't think it should be rushed. I think any halfway intelligent person, Democrats and Republicans included, would want to take their time to make sure it's a good bill. It's clearly not being ramrodded through Congress -- so the argument that they want to pass it without reading it is a faulty one -- or else it would have already been passed.

The reason it hasn't been past is very simple: it's a very complex issue and a very complex bill. You've read it, or at least looked at it: it's over 1000 pages. That takes time to dissect and fix the crap that's in it. I'll be the first to admit there are crap items in there that need to go (for instance, I'm with you on that tax-the-people-who-opt-out thing).

I'm not pushing for THESE bills to be passed RIGHT NOW. I'm pushing for SOMETHING to change, and right now, 99% of the opposition is screaming "THE GOVERNMENT CAN'T RUN ANYTHING!" and that's just not a constructive attitude. Fortunately, and I may be naive to think this, but I think our Congressmen are being much more intelligent about this than the masses of America. And I'm confident that when this plan finally does pass, it's going to be a better system than what we've already got.

I'll try to make this plain, like I pointed out to Gil. These agencies run inspection departments. They don't run the industry.

This is very true. As I said before, I'd be perfectly happy with a Bill of Rights, if you will, saying that I'm guaranteed health coverage no matter what conditions I may or may not have. I don't need a public government option -- I just need my medicine.

Camel for the immediate future since this legislation won't be enacted more than likely before your COBRA runs out, why can't you get on Medicare?

Dav's right. I make too much money each year. Funnily enough (or not, if you're boring), I don't even qualify for Disability, despite the fact that I'm Profoundly Deaf.

Davian93
08-19-2009, 11:38 AM
Dav's right. I make too much money each year. Funnily enough (or not, if you're boring), I don't even qualify for Disability, despite the fact that I'm Profoundly Deaf.

Gotta love it. One of the downsides to any type of social welfare is that to qualify you have to be completely and utterly broker or massively in debt. Thus there is no motivation for someone to work hard to get off such aid. They can bust their butt 18 hours a day all for the joy of not getting any assistance. In the end, they end up with basically the same level of living as the would have gotten on the public dole.

Gilshalos Sedai
08-19-2009, 11:39 AM
That one is truly fucked up, Camel.

JSUCamel
08-19-2009, 11:40 AM
That one is truly fucked up, Camel.

I agree. Their reasoning is that I still able to perform work, with or without reasonable accommodation.

I think I could convince some state somewhere to let me qualify, but I'd have to jump through so many hoops.. it's really not worth it.

Gilshalos Sedai
08-19-2009, 11:55 AM
That makes about as much sense as Bryan being exluded from most law enforcement because he's colorblind.


Despite being totally able to overcome it.

Davian93
08-19-2009, 12:27 PM
That makes about as much sense as Bryan being exluded from most law enforcement because he's colorblind.


Despite being totally able to overcome it.

How did they let him in the Army? I thought that was one of the requirements for military service...or maybe it was just certain MOS.

Gilshalos Sedai
08-19-2009, 12:43 PM
Certain MOS. That's why he was communications, not Infantry.

Davian93
08-19-2009, 12:47 PM
Certain MOS. That's why he was communications, not Infantry.

Yeah, I guess it would be hard to see that Commie wearing red if one cannot distinguish the color red from the rest of the visible light spectrum....thus making it quite difficult to put a bullet in his head.

JSUCamel
08-19-2009, 12:55 PM
Yeah, I guess it would be hard to see that Commie wearing red if one cannot distinguish the color red from the rest of the visible light spectrum....thus making it quite difficult to put a bullet in his head.

Because, you know.. Commies wear bright red in combat.

Gilshalos Sedai
08-19-2009, 01:03 PM
It's also a really dumb test. It's hard for even a person with 100% color vision to take, especially if you're not 20/20.

Davian93
08-19-2009, 01:03 PM
Because, you know.. Commies wear bright red in combat.

Hey, I didn't write the cadence....

Sei'taer
08-19-2009, 04:30 PM
You mean the plan you get through work? or Medicare? or what? I thought the whole point of this proposal was to create a "public healthcare plan" because one doesn't exist. I'm not sure what you're referring to here. Clarify, please?



Yes, she was denied medicare and medicaid. She was denied 3 times. Then she was denied after I hired one of those companies that will get you medicare, or you don't have to pay them. I don't remember the exact quote for her denial, but it basically came down to her sustainability and life expectancy. Also, the fact that she was denied social security didn't help either. All of it played together. If I can, I'll try to find the papers and put it on here. I thought I was over it, then all of this came up.

JSUCamel
08-19-2009, 04:33 PM
Yes, she was denied medicare and medicaid. She was denied 3 times. Then she was denied after I hired one of those companies that will get you medicare, or you don't have to pay them. I don't remember the exact quote for her denial, but it basically came down to her sustainability and life expectancy. Also, the fact that she was denied social security didn't help either. All of it played together. If I can, I'll try to find the papers and put it on here. I thought I was over it, then all of this came up.

Yikes. Have you looked into the high-risk insurance pools? I don't know if TN has one, but I know IL has one. It's for people who are otherwise uninsurable.. usually limited to a certain number of participants (I believe IL's is something like 10,000 people).

I'm sure you've looked everywhere, just offering some ideas that I've run into while trying to develop plans B, C, D, E and F, in case the shit hits the fan.

Davian93
08-19-2009, 05:14 PM
Have you looked into suing the Fed. gov't? (directed to Taer)

That's complete Bullshite!

Sinistrum
08-19-2009, 08:11 PM
They can only sue the government if the government has allowed suit. I don't remember off the top of my head if suits are allowed based upon denial of medicaid/medicare coverage. Sovereign Immunity is kind of a bitch like that. And just think, we can have our entire health care system subject to sort of thing.

Sei'taer
08-19-2009, 10:15 PM
Have you looked into suing the Fed. gov't? (directed to Taer)

That's complete Bullshite!

Yes, she was denied medicare and medicaid. She was denied 3 times. Then she was denied after I hired one of those companies that will get you medicare, or you don't have to pay them. I don't remember the exact quote for her denial, but it basically came down to her sustainability and life expectancy. Also, the fact that she was denied social security didn't help either. All of it played together. If I can, I'll try to find the papers and put it on here. I thought I was over it, then all of this came up.

These were lawyer types...

You can only ask for covereage to be extended to you. You can't sue for coverage.

Davian93
08-20-2009, 06:58 AM
These were lawyer types...

You can only ask for covereage to be extended to you. You can't sue for coverage.

Ahh...sorry I missed that part. Well, I read it but didn't comprehend I suppose.

Zanguini
08-20-2009, 08:23 AM
I passed my color blind test but i failed my depth perception test. The only thing i couldnt be was a pilot. They gave me a choice between a lot of things that they needed and I chose weather. Though it was a close toss up between that and ATC, and R&D.

Davian93
08-20-2009, 09:54 AM
I passed my color blind test but i failed my depth perception test. The only thing i couldnt be was a pilot. They gave me a choice between a lot of things that they needed and I chose weather. Though it was a close toss up between that and ATC, and R&D.

R & D would have been a fun choice (if its Research/Development and not something else). I worked as a civilian for AFMC and all the AF guys that worked in the office absolutely loved their jobs. Though it was so far from real military that they were basically civilians that wore BDU's or flight suits. Got to work with a bunch of fighter pilots too as a result of that and fighter pilots are honestly the coolest military people to ever hang around with.

Zanguini
08-20-2009, 03:43 PM
Pilots are asses.

GonzoTheGreat
08-20-2009, 03:49 PM
Yeah, asses, aces, more or less the same thing.

Davian93
08-20-2009, 04:40 PM
Pilots are asses.

Not when you don't work for them...when you're a civilian, they're pretty cool.

Birgitte
08-21-2009, 06:20 PM
Pilots are asses.


No offense, Sare. ;)

JSUCamel
08-22-2009, 02:05 PM
http://www.seattlepi.com/dayart/20090722/Cartoon20090722.jpg

http://www.seattlepi.com/dayart/20090822/525horsey20090822.jpg

http://www.seattlepi.com/dayart/20090816/cartoon20090816.jpg

Belazamon
08-22-2009, 03:19 PM
Congress Deadlocked Over How Not To Provide Health Care (http://www.theonion.com/content/news/congress_deadlocked_over_how_to)