House Health Bill

is here, all 1,990 pages of it. I’m still trying to figure it out. But from the early details I’ve seen, it strikes me that the real news here is not the public option, but rather, the decision to expand Medicaid eligibility all the way up to 150% of poverty. That’s a significant increase from earlier versions, which went to 133%. Both versions also would make the program a truly income-based one for the first time.

More to come…

Related Topics: house health care bill, Congress, Health Care, Nancy Pelosi
  • Latest on Swampland

    From left: AP; ABACAUSA

    The Phony War: Obama and Romney Are Debating Character, Not Policy

    More than five months from Election Day, the back-and-forth about Mitt Romney’s record at Bain already feels played out. Unfortunately, there’s good reason to expect the campaign continues in this vein indefinitely. Neither Barack Obama nor Mitt Romney are terribly interested in dwelling on policy platforms. Romney’s plan to slash spending and keep taxes low on the wealthy isn’t especially popular, at least not at any level of detail beyond a blithe promise to shrink the deficit. Meanwhile, Obama’s signature first-term achievements, like health care, the stimulus and Wall Street reform, are all unpopular or tricky to sell. (The Dodd-Frank bill is the most popular of these, but hyping it means offending wealthy donors.) So what we’re getting instead is a superficial duel about character–and, worse, one that’s based on the largely false premise that the better man can better “manage” the economy back to health.

    Obama Administration Blocks Global Health Fund To Fight Disease In Developing NationsHuffPost Politics

    Audacity of Dope: Tales of a Toking Teenage Obama

    We knew Barack Obama smoked weed in high school because he wrote about it in his books. What we didn’t know, until Buzzfeed posted these choice nuggets (I’m so sorry) from David Maraniss’s new book on the President’s younger years, were the giggle-worthy details of his “Choom Gang” lifestyle, which are right out of a buddy stoner flick. Obama and his friends drove around the lush Hawaii countryside, hot-boxing their VW bus and re-upping with a long-haired pizza-tossing dealer named Ray, whom Obama thanked in his yearbook “for all the good times.”

  • grape_crush

    Overview materials are available from the House Committee on Education and Labor at this link, if you don’t have three or four free days to examine the bill.

    (…thanks once again, Steve Benen over at the WaMo…)

  • grape_crush

    Oh, and here’s the .pdf four-pager from the Education and Labor Committee site.

  • stuartzechman

    Well, it’s no moonshot.

    To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

    I’d love to know when the press corps stopped being able to tell readers the difference between the terms “reduce the cost” and “reduce the growth in spending“.
    .
    Was it when they couldn’t tell/say that Newt Gingrich was lying during his tenure as Speaker about the Republican plan to lower (cut) entitlement spending?
    .
    In the world given to Americans by the profession tasked with analyzing policy, reducing the increase in the price of apples from $2.00 this year/$2.25 next year downward to $2.00 this year/$2.10 next year is a great triumph of ingenuity and savings.
    .
    …and, if your family can’t afford $2.10 per apple, the government will borrow money from banks (it just lent money to) to make up for the reduction in taxes they will allow you to take on your return.
    .
    Nobody seems to be able to say that the same, similar or better quality apples cost $1 in every other rich country.
    .
    The political press corps does a superb job of informing the American people about circumstances, events and the ramifications of policy, and the Democrats we elect to Congress are not meek, unambitious souls, but warriors for the middle class!
    .
    Reduction in the growth of spending!
    .
    Public option with limited bargaining power available to a fraction of the general public!
    .
    Victory!
    .
    (I will continue reading the bill…)

  • pafro

    I thinks the real story is it’s so longgggg!!!! I mean it is longer than the last book I read:
    Were teh Wyld Thinks R.
    Why does it so long????
    Reed teh bil!!!
    /teabagger

  • stuartzechman

    Well, this is a short-term item, so it’s not that significant, but I hope that it doesn’t portend more stupidity and loophole-iness in the rest of it:

    21 TITLE I—IMMEDIATE REFORMS
    .
    22 SEC. 101. NATIONAL HIGH-RISK POOL PROGRAM.
    .
    (c) ELIGIBILITY.—For purposes of this section, the
    .
    12 term ‘‘eligible individual’’ means an individual—
    .
    9 (3) who has not had health insurance coverage
    .
    10 or coverage under an employment-based health plan
    .
    11 for at least the 6-month period immediately pre
    .
    12 ceding the date of the individual’s application for
    .
    13 high-risk pool coverage under this section.

    What is that about?
    .
    So if you’ve just lost your job, and you’re getting screwed by insurers, you don’t get access the “immediate reforms”?
    .
    Who does the thinking for these imbeciles?

  • grape_crush

    That must be the ’6-month-avoidance-of-illness’ provision, Stalwart…If you can just keep your cancer from progressing during that time period, then you can get coverage and keep your house!

  • kbanginmotown

    Thursday…no feeding….

  • stuartzechman

    Well…they say later that this is what they’re getting at:

    6 (f) PROTECTION AGAINST DUMPING RISKS BY INSURERS.—
    .
    8 (1) IN GENERAL.—The Secretary shall establish
    .
    9 criteria for determining whether health insurance
    .
    10 issuers and employment-based health plans have discouraged an individual from remaining enrolled in
    .
    12 prior coverage based on that individual’s health status.

    , but that won’t stop dumping, it will just kill the people who get dumped, because the government will say “No, no, no! Go back and litigate your employer/insurer! We’re not taking you!“, which is just as f*cked as it is now.
    .
    Either we help people who need help now, or we don’t. Creating a complex, temporary system designed not to do too much isn’t the meaning of the term “IMMEDIATE REFORMS”.
    .
    Can’t they do anything right?

  • kbanginmotown

    thx grape!

  • deconstructiva

    p. 23 – at least they got the no pre-exisitng exclusion periods thingy in there, whew.
    p. 28-31 – ending recission abuse – may end policies only for clear fraud but third-party review required if asked, sunshine on price gouging
    p. 41 – revising erisa to prohibit domestic violence as pre-existing
    KT, did you plan for a really long lunch to go thru this? Maybe order a cold salad or no-mayo deli sandwich? Instead of three-martini drinks, will two cosmos + LI iced tea work? Are you reading this solo or are Amy, Jay, and Kate reading pieces also?

  • grape_crush

    ..it will just kill the people who get dumped, because the government will say “No, no, no! Go back and litigate your employer/insurer! We’re not taking you!”..
    .
    I dunno if that dumping provision is even applicable…I’m more worried about this:

    the term ‘‘eligible individual” means an individual who has not had health insurance coverage or coverage under an employment-based health plan for at least the 6-month period immediately preceding the date of the individual’s application

    as it applied to people who just lost their jobs…either you don’t buy COBRA and hope nothing happens for six months or get price-gouged by COBRA until your eligibility expires and then hope nothing happens for six months.
    .
    Sad.

  • rustyreturns

    I believe that from my reading this part of the bill is simply a “temporary” fix until the “real” public option becomes available stuart.
    .
    Congress will set aside 5 BILLION dollars starting soon after this bill passes for people to be covered with “insurance” through a “risk pool” of benefits, again until the public option is put into place in 2012 or so.
    .
    This should squash all of the complaints about the other bills and such that were putting into place a “plan” that would begin taxing everyone for benefits, but they would not have access to those benefits until 2013 in the Baccus Bill.
    .
    I will be curious as to how the CBO will “score” this bill.
    .
    I have found these areas to be of interest as well.
    .

    (in this section referred to as the ‘‘pro2
    gram’’) to provide health benefits to eligible individuals
    3 during the period beginning on January 1, 2010, and, sub4
    ject to subsection (h)(3)(B), ending on the date on which
    5 the Health Insurance Exchange is established.
    .
    (A) may vary by age so long as the ratio
    10 of the highest such premium to the lowest such
    11 premium does not exceed the ratio of 2 to 1;
    .
    (A) the annual deductible for such benefits
    5 may not be higher than $1,500 for an indi6
    vidual or such higher amount for a family as
    7 determined by the Secretary;
    8 (B) there may not be annual or lifetime
    9 limits; and
    10 (C) the maximum cost-sharing with respect
    11 to an individual (or family) for a year shall not
    12 exceed $5,000 for an individual (or $10,000 for
    13 a family).
    14 (3) NO PREEXISTING CONDITION EXCLUSION
    15 PERIODS.—No preexisting condition exclusion period
    16 shall be imposed on coverage under the program.
    .
    ‘‘(a) IN GENERAL.—A group health plan and a health
    6 insurance issuer providing health insurance coverage in
    7 connection with a group health plan, may not impose an
    8 aggregate dollar lifetime limit with respect to benefits pay9
    able under the plan or coverage.
    .
    Wellness program grants
    3 shall be awarded to small employers (as defined by
    4 the Secretary) for any plan year in an amount equal
    5 to 50 percent of the costs paid or incurred by such
    6 employers in connection with a qualified wellness
    7 program during the plan year.

  • formerlyrainbow68

    Karen: I am not commenting on this particular article. I saw on another site on the internet that Time would have an article on Plouffe’s new book about Obama’s campaign. That sounded interesting to me, so I made a mental note to pick up the magazine when I take my kids to Barnes and Noble this weekend. I come to Time and the article appears to be availabe in its entirety! How is a well-written, interesting magazine going to survive if it keeps giving its product away for free??

  • stuartzechman

    Rustydog:
    .
    The people who wrote this are beyond tone deaf politically. There’s a section right after the $5 billion you mention, Rustydog, that actually enumerates the establishment of waiting lists for health care.
    .
    That’s right, long lines are right there in the law when this thing runs out of funds (presumably after all of that liver-transplant dumping they couldn’t avoid takes place).
    .
    Here you go, send this to your friends at Fox News:

    14 (1) IN GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.
    .
    22 (2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

    Brilliant.
    .
    So if they run out of cash, they don’t go back to congress, they put people’s treatment on hold.
    .
    Even if you’ve faithfully paid your premiums to the government, your benefits may summarily be reduced, and you will be told to get in line.
    .
    Immediate reform!
    .
    I can’t wait until I get to the language of the non-temporary stuff…

  • stuartzechman

    How will the NBC network survive if it keeps giving away “Meet The Press” for free each Sunday?

  • palininatowel

    Stuart, reading the provision about “insufficient funds” leads me to believe that the slogan for the 2010 program should be, “Get sick early, get sick often.” (This is a play on the old Chicago election mantra, “Vote early, vote often.”)
    .
    Best to come down with a serious illness early in the fiscal year if one is uninsured.

  • rustyreturns

    Perhaps this section will allow you to relax stuart. For folks such as yourself, I am sure this will rid you of any fears you may have now…
    ,

    “SEC. 305. OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS
    PLAN.
    IN GENERAL.—
    (1) OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (3) of such subsection, to in form and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such out reach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.

    . :D

  • freeinpa

    The 1990 pages can be broken down very simply:

    1) Not all people will be covered
    2) Everyone’s premiums will be higher
    3) Taxes will be higher
    4) Services will be cut

    The engine for growth of new jobs will be ways to defraud this system. Then one Obama campaign promise will be upheld.

  • rustyreturns

    Here is where the Government will ensure that the “Exchange” will not run out of funds, stuart. You should not fear for rationing and waiting for needed treatments.
    .
    The Government will simply tax the hell out of everyone who currently has insurance or if they refuse to buy insurance then penalize them for not buying said insurance.
    .
    This I am sure will cover the cost of any un-expected costs the CBO neglects to cost analyze.
    .

    (A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE.—The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).
    (B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE.—The amounts received in the Treasury under sections 3111(c) and 3221(c) of the Internal Revenue Code of 1986 (relating to employers elect12
    ing to not provide health benefits).
    (C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIRE MENTS.—The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage
    participation requirements).
    (2) APPROPRIATIONS TO COVER GOVERNMENT
    CONTRIBUTIONS.—There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust
    Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).

  • deconstructiva

    …NBC will survive by selling out to some cable company who thinks they can make a fortune (aka the Greater Fool Theory). It reminds me of the “Dharma & Greg” episode where Dharma opens a shop that sells …nothing, literally. And yet she draws a crowd where people hang out and do whatever. She loses money running the store but makes a profit by selling the lease to Starbucks.

  • deconstructiva

    Oh, screw it. Instead of reading 19900 pages, I’ll just let stuart and rusty hash it out and then read KT’s wise insights (and Amy’s deconstruction of the staying-out-of-abortion passages). I don’t know who’s going to read all those sections about separate Native American tribal rules, though.

  • stuartzechman

    OK here’s the good news:

    2 ‘‘(a) IN GENERAL
    .
    Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary (but not less than 85 percent), the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of the amount by which the issuer’s medical loss ratio is less than the level so specified.
    .
    10 ‘‘(b) IMPLEMENTATION.—The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate it based on the average medical loss ratio in a health insurance issuer’s book of business for the small and large group market. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans. In determining the medical loss ratio, the Secretary shall exclude State taxes and licensing or regulatory fees. Such methodology shall be designed and exceptions shall be established to ensure adequate participation by health insurance issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.

    That’s good (not great)!
    .
    In case you haven’t seen Sicko, “medical loss ratio” means the amount insurers collect in premiums to the amount paid out in claims.
    .
    So if AETNA collects $100 in premiums, and they pay out $60 in claims, they are said to have a “medical loss ratio” of 60 percent.
    .
    Health insurers are constantly attempting to reduce their medical loss ratio to zero. In their perfect world, they would have a medical loss ratio of 0 percent, and keep every dollar of premiums by paying out no claims whatsoever.
    .
    This bill does some weird stuff that empowers the Secretary of Health and Human Services to play favorites by monkeying around with setting a ratio for each health insurance company, but it also essentially forbids insurers from paying out less than 85 cents on each premium dollar in claims, which is on balance a good thing for people paying premiums.
    .
    …And the bad news:

    24 ‘‘(c) SUNSET.—Subsections (a) and (b) shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.’’.

    What?!?
    .
    What do you mean, morons?
    .
    So they’re saying that coverage offered through the exchange (in which the public option competes) won’t be subject to this same premium/claim payment guaranteed quality control at all.
    .
    Super.
    .
    Why the f*cking loophole?
    .
    Why do people who get their coverage through employers get to have insurance that is more likely to pay out claims to premium dollars?
    .
    Je-sus!
    .
    It looks like these geniuses are “incentivizing” participation in the exchange by doing away with the 85% medical loss ratio requirement for insurers who get in. Of course, that just means that insurers who get in are more likely to offer junk insurance that doesn’t pay claims through whatever loophole mechanisms they can find.
    .
    Incentives! Reform!
    .
    Who came up with that one?

  • stuartzechman

    We’d appreciate your help, though…
    .
    Take a section –any section– and really, really read it to find out what it does and means.
    .
    We can’t cover everything perfectly by ourselves, but we can do it all if everybody takes a small piece…
    .
    FACT CHECKERS OF THE UNIVERSE, UNITE!

  • rustyreturns

    The section in the bill that covers the policing and review of “Employer Contributions” will be as big or bigger than the current IRS. With all of the regulations which will be put on businesses, another IRS-like Government Agency will be put into place.
    .
    It gets more complicated the more I read. God help us all!!
    .
    b) ENFORCEMENT OF HEALTH COVERAGE PARTICI21
    PATION REQUIREMENTS.—Section 502 of such Act (29
    22 U.S.C. 1132) is amended—

  • rustyreturns

    Well the good news to the “Employer Contribution” requirement, is that it will not take effect until Dec 2012.
    .
    This will surely give all of the businesses in America the chance to out-source all of our jobs to foreign countries before the Government begins the process of beginning penalities for non-performance.
    .
    (b) EFFECTIVE DATE.—The amendments made by
    subsection (a) shall apply to periods beginning after De23 cember 31, 2012.

  • stuartzechman

    Mandatory participation by business is ridiculous and counter productive.
    .
    Nobody on the left wanted this, Rustydog.
    .
    We said “To hell with them. If they want to offer benefits, fine, if not, then fine. We’ll take wage increases (more $$ in our pockets) any day, as long as insurance companies are required by law to sell quality policies at a good rate to us –or we get Medicare & pay reasonable premiums to until we’re 65.
    .
    How are American businesses supposed to compete with other countries when they have this idiotic health care coverage cost that no other nations have? How are workers supposed to argue for more money when more money is going to their insurance every quarter?
    “.
    .
    This is another screwy centrist compromise.

  • formerlyrainbow68

    stuart: A world of difference and you know it.

  • stuartzechman

    Rustydog:
    .
    individuals with other cognitive impairments.
    .
    LOL
    .
    That covers people who get their information primarily from Fox News:
    .
    40 seconds in shows what they’re really watching for

  • stuartzechman

    Sorry, help me out: what do you mean?

  • stuartzechman

    The anti-rescission stuff is good, although not the best, and potentially open to abuse:

    9 ‘‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL THIRD-PARTY REVIEW IN CASES OF RESCISSION.
    .
    12 ‘‘(a) NOTICE AND REVIEW RIGHT.—If a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market, before such rescission may take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent, external third-party under procedures specified by the Secretary under section 2742(f).
    .
    20 ‘‘(b) INDEPENDENT DETERMINATION.—If the individual requests such review by an independent, external third-party of a rescission of health insurance coverage, the coverage shall remain in effect until such third party determines that the coverage may be rescinded under the guidance issued by the Secretary under section 2742(f).’’.

    The good news is that (maybe, depends on the meaning of “rescission taking effect”) prior to the interruption of claim payment or descent into hospital-ejection “uninsured” status, some other party must review the rescission order for “clear and convincing evidence” of fraudulent claim:

    18 ‘‘(f) RESCISSION.—A health insurance issuer may rescind individual health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2), under procedures that provide for independent, external third-party review.’’.

    The bad news?
    .
    For some crazy reason, the bill’s authors haven’t given the exact same protection to folks insured under employers’ group plan. It’s not that they don’t have protection against rescission, but they don’t have quite the opportunity for review and adjudication spelled out that the individuals have. I can’t figure out why.
    .
    Also, I can’t quite figure out what “third party” they’re talking about, and who’s paying for such arbitration services. If it’s the current third-party people who the insurers pay to go through claims looking for opportunities to rescind coverage, then how is the situation terribly different? How is this scheme supposed to work so that it’s different than the current system? Who will make these calls?
    .
    …And, the standard shouldn’t be “evidence of fraud”, it should be “evidence of fraudulent intent“.
    .
    It seems to me that there’s no difference being made between an unintentional failure to disclose something on a health insurance form, and an attempt to procure funds for a pretend condition. I’m not sure at this point that this anti-rescission language is actually different from how the industry currently operates.
    .
    So, bottom line: good, maybe.

  • pafro

    As if on cue, the Boner is complaining that he doesn’t read very well and will never be able to digest a bill this long.

  • stuartzechman

    OK, we might be good on this front:
    .
    For some crazy reason, the bill’s authors haven’t given the exact same protection to folks insured under employers’ group plan.
    .
    , because at the end of specifying that the “third party review” stuff is only for “CERTAIN CASES.—INDIVIDUAL MARKET.—”, they then go ahead and apply it to employer-based coverage:

    ‘‘The provisions of section 2746 shall apply to group health insurance coverage in the same manner as such provisions apply to individual health insurance coverage, except that any reference to section 2742(f) is deemed a reference to section 2712(f).’’.

    It just looks like they arbitrarily stopped enumerating group and individual sections separately at this point.
    .
    Sloppy statute, but good result.

  • formerlyrainbow68

    I was minding my own business moaning and groaning to Karen about how they need to stop giving away their magazine’s content on the website. I thought you were making fun of me by making the NBC remark. My bad?

  • stuartzechman

    Hey! Not bad!

    17 SEC. 104. SUNSHINE ON PRICE GOUGING BY HEALTH INSURANCE ISSUERS.
    .
    The Secretary of Health and Human Services, in conjunction with States, shall establish a process for the annual review of increases in premiums for health insurance coverage. Such process shall require health insurance issuers to submit a justification for any premium increases prior to implementation of the increase.

    Notice how it doesn’t actually say that HHS can prohibit an increase, nor does it require HHS to release the review to the public in a timely fashion, but that’s a start.
    .
    At lease government officials can’t plead ignorance.

  • stuartzechman

    I wasn’t making fun of you at all, but both NBC and Time operate on an advertiser-driven model, so that even if the magazine’s hard copy were literally dumped on every American’s door for free every month, the revenue model would be similar to the current situation.
    .
    The problem with these people going broke has to do with advertiser rates going down the toilet in a massive death-spiral of deflation (having to do with how silly and arbitrary they were in the first place), and piss-poor business strategy and management, not primarily subscription falloff.
    .
    Presumably, since Time doesn’t actually need to bear the cost of printing and distributing hard copy as the primary capital requirement of doing business, they should be in a phenomenal position to reap the benefits of putting out an online magazine with a hugely recognizable brand, and phasing away their print operation entirely.
    .
    They’re idiots though, so they’re failing.

  • arartteacher

    stuart do you think we should have single payer like some of the other countries around the world?

  • stuartzechman

    The simple answer is: Yes.
    .
    That said, I don’t care about the method, i.e. single-payer that we use to achieve the result, which is citizens’ guaranteed access to France-level (extremely high) quality health care for rich and poor alike at costs commensurate with the rest of the developed world, instead of the mediocre health care available to only some of us at twice what the rest of the rich world pays.
    .
    Japan, for example, doesn’t have a public option, nor a single-payer system. They have an entirely private (yet non-profit) system of health insurance providers, who pay prices for drugs, hospital treatments, laboratory tests and medical procedures whose prices are set by the government every two years.
    .
    Even though the Japanese don’t have a single-payer system, they pay less than twice what we do as a nation for health care, and they live longer, see their doctors three times as often, and are in better health than Americans.
    .
    I’ll take the result of Japan’s way of doing it over a single-payer system that fails.
    .
    I’ll also take that result over our stupid system that is failing, too.
    .
    Single-payer looks good to me because, unlike Japan, we already have Medicare in place, which should be the starting point for the government setting health care prices down to at least European levels, if not Japanese. I mean, where else are they going to sell their stuff…Zimbabwe? Until we set prices down to the levels that, say, Italy or France or Germany pay, we’re going to go broke no matter who is paying, single-payer or private market payer.
    .
    If we were to extend Medicare’s eligibility age downward, charge premiums (the same for every citizen) paid on tax returns for those under 65 and over 18, and provide subsidies in income-based cases, we would probably be a lot farther toward having a first-world health care system than we are today with this bill. We could then focus our attention on solving the health care cost bubble that our nation alone in the world is experiencing, probably with price controls exerted on (currently) very powerful corporate interests.
    .
    But, hey, whatever works, you know?

  • arartteacher

    I agree totally. I think that involving the health care industrie in any way is a step back though unless the government is putting some serious regulations on them to keep them from robbing us blind like they have been for years.What do you say when people say that government health care means rationed health care and all that mess. People say look at canada. I have talked to canadians and they say they go to the doctor when they need to.Im just not really sure what people are so afraid of.

  • apollyon07

    I completely agree with your point about “reducing the growth” of spending. This is such BS. Claiming “reducing the growth” of spending as a great victory would be like your boss telling you that he’s going to cut your pay by 10%, and then only cutting by 5% and expecting you to thank him for a raise.

  • carotexas1

    Stuart, good news for senior citizens and bad news for Pharma and maybe the President and Baucus the House left in closing the doughnut hole. This bill has the HHS Secretary negotiating drugs.

    John Aravosis at America blog posted this call from Nancy Pelosi.

    http://www.americablog.com/2009/10/live-blogging-blog-call-with-speaker.html

  • http://twitter.com/ktumulty Karen Tumulty
  • stuartzechman

    Yep, I’m getting there:

    DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS
    .
    ‘‘(8) PHASED-IN ELIMINATION OF COVERAGE
    GAP.—
    ‘‘(A) IN GENERAL.—For each year beginning with 2011, the Secretary shall consistent with this paragraph progressively increase the initial coverage limit (described in subsection (b)(3)) and decrease the annual out-of-pocket threshold from the amounts otherwise computed until, beginning in 2019, there is a continuation of coverage from the initial coverage limit for expenditures incurred through the total amount of expenditures at which benefits are available under paragraph (4).

    You’re right, it phases in the close of the doughnut hole, but I’m going over what Pelosi presumably is referring to:

    ‘‘(iii) the Secretary shall establish procedures, which may include a reconciliation process, to fully reimburse PDP sponsors with respect to prescription drug plans and MA organizations with respect to MA–PD plans for the reduction in beneficiary cost sharing associated with the application of subparagraph (A);
    .
    ‘‘(iv) the Secretary shall develop an estimate of the additional increased costs attributable to the application of this paragraph for increased drug utilization and financing and administrative costs and shall use such estimate to adjust payments to PDP sponsors with respect to prescription drug plans under this part and MA organizations with respect to MA–PD plans under part C; and
    .
    ‘‘(v) the Secretary shall establish procedures for retroactive reimbursement of part D eligible individuals who are covered under such a plan for costs which are incurred before the date of initial implemen12
    tation of subparagraph (A) and which would be reimbursed under such a plan if such implementation occurred as of Janu15
    ary 1, 2010.’’.

    .
    I’m not 100% certain that this means negotiate prices, i.e. set prices on behalf of all Medicare beneficiaries for prescription drugs.
    .
    It would be an incredible victory for the American people if I were able to find that specifically enumerated language, however.
    .
    I would vote for this bill just for that provision, if it’s really there..

  • stuartzechman

    KT:
    .
    It seems as if the big news about this bill isn’t the the public option, you’re right: it’s weak, maybe even weak enough to excise from the bill.
    .
    The big news seems to be the extension of Medicaid “Rebates” into Medicare, with all that implies about costs going down somewhat…but market transparency also falling through the floor, setting the stage for continued unsolvable cost catastrophe for Medicare (and therefore Social Security) into the bleak future.
    .
    The “Rebate” deal, whereby PhRMA keeps the retail price to insurers high, while paying back the government a rebate of varying amounts months after the retail price is paid, is a huge part of the reason why we have such high health care cost inflation in this country (even though the price growth came down a bit in 2007, according to HHS).
    .
    There will be some news to be found in hospital reimbursements, too, I’ll bet. Not good news for the cost of health care (or Medicare/Medicaid), if you know what I mean.
    .
    Thanks so much for putting this post up, btw.

  • messenia

    Has anyone seen an analysis of “Division C – Public Health and Workforce Development”?

    The text is so full of references to other legislation, it’s virtually impossible for a lay person to understand what it will mean in terms of increasing providers.

  • stuartzechman

    This is the law they seem to refer to most.
    .
    TITLE 42 – THE PUBLIC HEALTH AND WELFARE
    .
    They are mostly adding law to the ends of sentences in this thing, where a ton of health care legislation exists.

  • http://swampland.blogs.time.com/2009/10/29/medicaid-the-other-public-option/ Medicaid: The OTHER Public Option – Swampland – TIME.com

    [...] October 29, 2009 at 8:41 pm Submit a Comment • Trackback (0) As I noted earlier, the real surprise in the House health care bill wasn't the public plan–we had pretty much known for days that House [...]

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