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December 21st, 2009
01:34 PM ET
Real-life effects of reform getting lost in the noiseBy Dr. Sanjay Gupta Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle. (Read the Senate health care legislation) I want to use this blog as a platform to try and address some of your specific questions and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million. So, let’s start here: Based on what you know about this bill, do you think you will be impacted? Has this affected your current plan, if, for example, you are working for a large corporation? What information is still lacking for you? Click here to see Dr. Gupta answering some of your health care reform questions. |
  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
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My health insurance premiums have increased from $150/month in 2001 to $850/month in 2009! A $700/month increase? I'm paying $8,400 more for health care in 2009 than I was in 2001, and I'm on the SAME PLAN now I was on in 2001. THE HEALTH INSURANCE COMPANIES ARE RIPPING OFF THE GENERAL PUBLIC. PERIOD! THANK YOU PRESIDENT OBAMA AND DEMOCRATS FOR GIVING US REFORM. It may not be perfect (yet), but it's a great start.
As a physician in the nation's capitol, I am personally appalled by this bill and the attack it has aganist doctors. As an anesthesiologist, I provide a necessary service to patients everyday undergoing surgery. I take on huge malpractice insurance because of the many possible complications that may arise from my work. However, no where in this bill is tort reform addressed. Why? BECAUSE LAWYERS WROTE THIS BILL. I hope the public does not for one second believe that the AMA speaks for all doctors–it most certainly does NOT. My specialty stands to lose big time on this bill, which will have a huge effect on the availability of anesthesiologists in the future. If you want surgery, you need anesthesia, and as a result of this bill, my profession will be irreparably damaged. And the intrusion of CRNAs (nurses who have training in anesthesia) will breed the false sense of security that these providers can handle the types of cases that are best suited for physicians. This bill will be extremely dangerous to the quality of surgical procedures and anesthesia performed in this country.
To the medicare provier,,, that experience you speak abot is the experience of every premium paying citizen of the USA. Over the years insurance has become more expensive, and more difficult to get a payout. Maybe the best health insurance reform woukld be to outlaw health insurance. Let people pay omn the barrel. Its worth a look, and a debate,, though it takes two for a debate,,, and the repubs just don;t want debate,,, they like the status quo. America has elected a super majority in the senate for this reson,,, repubs are helpless,,, and for that matter clueless,,,, they ran the congress for 6 years and did nothing but give money to the older medicare recipients, and allowed insurance companies to dump customers who were to cost intrusive. When you are ridged to an extreme,,, u get what u did not want,,, a democrat super majority.
I like so many have a few things to say about this topic. And I like so many others are also very emotional over this. I am not the lucky winner of a healthy body and have my share of medical issues and risks due to treatments. I am in favor of not dropping or preventing the enrollment of individuals into a health care plans because of current conditions, pre-existing conditions or possible future conditions.
I don't believe either the House or the Senate like their bill for the entirety of what it is. -Lets be honest, both bills look a bit like Frankenstein.
I don't believe it is right to tax the rich to fund the rest of the nations health care. -When did we become the nation where we punish those who are successful? I am not rich. I am very much a poor college student.
I don't believe it is conducive to tax the "medical device manufacturers" for their products. -How are you going to get much needed technology to the people if their costs go up?
What I do believe in are innovative thinkers who develop the simplest answer for a gamut of complex problems. I do believe there solutions that are more effective and much simpler than the one in which we have engaged ourselves in.
So lets take a moment to step back and look at the root of this issue, shall we. We have millions of uninsured Americans supposedly because they simply cannot find the means to pay for the costs. So now our real issue is cost. What if we simply devise a new method to help others find the funds and get their health care without the government stepping into this sector of our lives. Say, we all have been pretty upset about our current tax system and politicians using it for leverage in election times. I also can't see anyone enjoying the hours or money they spend to file their taxes every year. What if we simply reform our tax system to much clearer so everyone knows how much they are paying in taxes and cut EVERYONE'S cost for the essentials for living. There are actually such bills proposed in both the House and the Senate to reform the tax system to a much simpler national sales taxes that will get rid of the income tax and all taxes on businesses. This will both stimulate the economy and promote growth right here at home as well as provide better funding for our current federal programs (even those which are failing because of lack of funding), lower our deficit, pay for the costs of essentials as well as leave a little extra money for those 40 million uninsured American's to buy health care for their families.
My point is, why is there so much time and effort spent working towards something that no one will like in the end? Why are we not exploring all of our options? Why are we focusing on just one idea? Over 300 million people in this country, I can bet you a few of them have much better ideas than just this health care reform.
My issues are:
1. Why not allow interstate health purchasing without coverage mandates to drive costs down?
2. Why not do autoenrollment with an opt out to increase coverage rather than an individual mandate with questionable constitutionality? Studies have shown that autoenrollment works at a 80% plus success rate.
3. The CBO score is phony. No one believes the Medicare cuts will happen so this is a huge budget buster while we have a 1.4 trillion deficit and a 30 trillion unfunded liability in Medicare.
4. Private insurance will become more expensive with more mandates
5. Increased taxes will hurt the economy. A payroll tax increase is insane with 10% unemployment.
I may bring a different perspective than many others here as I am an insurance agent. Specifically, I specialize in insurance for seniors, and that means Medicaid. I see a lot of half facts, omissions, and outright errors in statements made by politicians, activists and media.
Insurance companies have been cast as the boogieman in this issue, but the truth is they are very tightly regulated, what we say and don't say is controlled, the presentations we use to sell products are regulated, the brochures we use have to be approved, in the case or medicare by the state and the CMS. Even are prices are approved by the state, and we have to actually show the regulators that they are justified. Yes there are some bad eggs out there, shoot there are bad eggs in the bunch that are trying to shove this through far faster than it should be. (Has anyone actually had time to read through let alone study and consider the final "Harry Reid" version of the bill yet?) But let's be careful not to trash the good with the bad ... please.
On the subject of preexisting conditions, this is not a desire of insurers to be evil, but a simple, standard, procedure found in any insurance called underwriting. The company simply ensures that they take on reasonable risks. Car insurers do it, (even in "no fault" states), home insurers do it, ship insurers do it, industry insurers do it, you name it, if it's insured underwriters have considered the risks. I do not know of a state that does not have a high risk pool for medical insurance. Many also have state sponsored programs to help middle to lower income people who could not otherwise afford insurance.
On the subject of the uninsured, many choose not to be insured for one reason or another, they don't feel it's important, or affordable, or are willing to assume the risk, or just plain figure the government will bail them out if they get really sick. Believe me, even in the Medicare market I see this every day.
Do we need health care reform? Yes, Is it being addressed correctly, I have to say no. From what I have seen and read, the base issues are not being addressed, but either ignored or glossed over, for instance, I see no addressing of tort reform. This is a huge factor in medical expenses, impacting every aspect of health care, from doctors fees, to nursing, to equipment. Yes we need to be able to address malpractice issues, but there also needs to be some controls. As it is the only ones getting rich are the lawyers.
Likewise some of the regulatory issues need to be addressed. This may not be an easy nut to crack, but the paperwork that is required to be filed and regulations to be followed is not only overwhelming but, at times, contradictory. Many times the regulatory paperwork associated with a policy is several times larger than the application itself. It is only worse for the medical industry.
Let's deal with health care, we CAN make it better, IF we take the time to look at it in a rational matter, get the politics out, and do it right. Anything less will border on criminal neglect.
Interesting point about healthcare reform which it does not address besides tort reform is the shortage of primary care docs.
By increasing the number of people with insurance which usually pays a little better than medicare/medicaid. And decreasing medicare/medicaid reimbursement, docs will stop taking medicare/medicaid patients and take the newly insured less complicated cases.
ok, what about those with adequate health insurance already, that ALSO have children with life limiting chronic health issues? I mean...really good coverage.....What is the TAX gonna be on our dollars for what is paid out (taxing the benefits), and what about the yearly cap? a YEARLY cap will be devastating for her life.
As an internal medicine doctor with 25 years of experience, I find myself somewhat skeptical of the government's latest efforts to "fix" healthcare. I realize that placing millions of people on medicaid or medicare is not likely to help the situation. Very few doctors accept medicaid, and not just because of the extremely poor reimbursement. Quite a few patients with medicare will tell you they have had difficulty finding a doctor that will take medicare patients. Again, not just because of the low reimbursement. It's my belief, and I may be wrong, that as more patients are placed on medicaid and medicare, as medicaid and medicare reimbursements drop even further, and as more and more doctors are hassled, sometimes unjustly, for "fraud" in the federal programs in an attempt to "eliminate waste and fraud," you will eventually end up with less doctors trying to provide care to more patients. Less young people will choose medicine as a career, a problem we already have in primary care. More experienced people will retire earlier or change professions. Your new "doctors" will more likely be nurse practitioners or physician's assistants rather than doctors. By virtue of my profession and experience, I may be in a unique position to judge the care provided by others. When I seek medical care myself, I want a doctor, and a very good one at that. I wish you all good health and good luck. God Bless!
I am very glad for this legislation. My wife will finally be able to see a regular physician, and not have to go to the ER if she needs to be seen for something a regular doctor could treat. She split her toe open a several months back – needed stitches, but it didn't hurt much or anything. She could have gone to a regular doctor, if she had insurance. She doesn't, so she went to the ER. Took the doc there less than 5 minutes to put in 3 stitches, which he said she did need. Bill was $900.00 – we can't pay it. Hospital charity – thus the taxpayers, will pay it. If we had been able to see a regular doctor, the bill would have been FAR lower. She works hard, but her employer doesn't cover her, and I am disabled. We don't go to the ER for every little thing. She and I were sick with the flu or something for a month recently, but we toughed it out. It would have been nice to have seen a regular doctor to get some cough medicine or something.
It is extremely rare that legislation of any sort gets passed that everyone is happy with. Heck, get 20 people together and try to agree on what toppings to order on an extra-large pizza without getting 1/4th this, 1/4th that, etc! Yes – there are problems with this legislation. There are things that will need to be fixed. I am sure that this will not be the last we will hear of this legislation. Amendments of all sorts will be proposed over the years – some good, some bad. But it is a step in the right direction.
After watching the Numbers Crunch segment, I fear for myself and my husband, and every other person in the States. Currently we only spend about 500.00-600.00 dollars on health care a year. Looks like if this bill passes, we will be FORCED to spend out of pocket an ADDITIONAL $13,000.00 ~ Excuse me, but that does NOT HELP US in the least!
$13,000.00 would be better spent for us in a savings account for our retirement in 20 years.
I am an American living in Puerto Vallarta Mexico. What I have found interesting here is that income tax is 7% (vs. 30-40% in the states) but yet they still have a public health care system where everyone has the right to quality health care. Then of course those who can afford it have access to private health care and private insurance, it is only government run for the people who can not afford it on their own.
Sure if you have a deviated septum that needs fixed you might have to go on a list, but if you have an accident and crush your nose you will get the surgery you need immediately, and if you say you have a deviated septum just so you get a nose job before your next class reunion then you will be on a very long list. If Mexico can find a solution on a 7% income tax, God knows the US can do it on their 30-40% income tax. I am so sick of the whining. Last year my US insurance premium increased 165% in one year and all I did was have an annual checkup the previous year that would have been cheaper than what I paid in premiums all year. I dropped my insurance because I could not afford it any more... now here I am in Mexico.
Bottomline is US needs Healthcare Reform, and has needed it for a long time.
I read a lot of comments about the provisions don't begin until 2014, and that US needs them now. All I can say is Clinton attempted to pass Healthcare Reform in 1994, and I don't know what the Republicans have attempted to do between Clinton and Obama. Anyway it seems like US is 20 years behind in Healthcare Reform. Was anyone held accountable for this?
It has been my experience that projects are rarely perfect on original release dates, so they need to go through a process of stepwise refinement to improve and enhance the system.
This is what will be needed for Healthcare Reform. It will not be perfect out of the gate, but over time if the US people communicate their needs and wishes to politicians then Healthcare Reform will improve over time.
I see this as being a long and arduous journey, but the US people need to continuously hound US politicians to improve US people's current situation.
I want to draw everyone's attention to Lori and her comments (Dec. 22, 5:24pm). Lori is an actual administrator in the Medicaid system and knows first-hand how screwed up the system is.
Notably, one of her concerns deals with veterans who also have medicare or medicaid. My father is a veteran and is receiving medicaid benefits. He had to undergo major surgery this past fall but he had to wait nearly 7 months to get it scheduled and had to navigate through a forest of red-tape. He was fortunate to have great administrative help to get him through the red-tape. I also want to say that he had fantastic surgeons at the VA Hospital – they were actually shared from right across the street at Duke Medical Center. We have the best physicians and medical technology in the world. However, I have grave concerns that this health care bill will create disincentive throughout the system. Doctors who have hundreds of thousands of dollars in student loan debt will be paid less, and manufacturers of medical technology and pharmaceutical companies, both of which spend billions in research, will be penalized with higher taxes. This coupled with waiting periods and inevitable rationing will destroy the care people receive. Worse yet is the impact that this healthcare legislation will have on businesses and individuals. The tax increases are going to be prohibit growth in our already struggling economy.
I question why people such as Lori, who actually understand the way the system works, were not called before the senate to give testimony as to the potential pitfalls of this legislation. Instead, we are being sold platitudes by Congress and its leaders. Majority leaders in the Senate miss no opportunity to jump in front of a camera to tell us how great this legislation is and how much it will help people. Yet, they have no personal knowledge of how it works or will work and do not even participate in these programs because they have their own insurance that will not be effected by the legislation.
Recall that the legislation was originally designed to afford coverage to approximately 46 million do not have healthcare (based upon 2007 census date). However, what is not addressed in this number is the fact that approximately 9 million of this number were not citizens (who under the new legislation will be covered); 6.4 million inaccurately reported; 4.3 million were eligible for Medicaid but did not sign up, 10 million made 300 times the poverty level in income but chose not to get insurance. That leaves, in reality, approximately 15 million that need coverage. That is approximately 4.8% of the country's population.
Isn't there a better, less expensive way to get healthcare coverage to such a small percentage of this country's population without tearing apart the system? Wouldn't it be more prudent to eliminate fraud, waste and inefficiency in the system and with this savings get coverage to these people? Wouldn't it be more prudent to actually spend time investigating the problem before proposing a mammoth piece of legislation that is so open-ended and so unpredictable that we really have no idea what will happen when the bills come due in 2014?
No doubt some change is needed. People like Lori, who work with and understand government run healthcare, should be leading the debate and should be the ones relied upon for their professional insight into what changes need to be made. Instead, we are being directed down a road with no map by Congressional leaders who have no stake in the outcome and will be unaffected if it ends in catastrophe since they won't be getting their healthcare from this system they have created.
This reminds me a lot of "let them eat cake" – the famous words attributed to Marie Antoinette just before the French Revolution. The significance of this statement, and corollary to our present quagmire, is that the Antoinette, being royalty, had no understanding of the plight of the French people during the bread shortage – she could not relate to it. I fear that those today in Congress have likewise no understanding of the nature of the problem and are simply patronizing the American people by telling us that they know what is best for us.
I am in favor of giving every member of Congress a first-hand understanding of what non-Congress member healthcare is like and voting every one of them out of office beginning in 2010. Vive la revolution.
I just wanted to point out to the people that are saying they are for this healthcare reform and this bill that I think they are forgetting that it is being passed by our US government who is already in great debt. People are forgetting that this is going to take money, and just "taxing the rich" isn't going to do much of anything. So where will the money come from? Do people really know how much healthcare cost? And I'm not talking about the insurance. If the goverment starts controlling the cost of healthcare, then the "quality" of this healthcare goes with it. So, if this actually passes, good luck getting an appointment and getting the quality health care you need.
We have no idea how it will impact us and the problem is we are being told how it will impact us before enough facts are permanent. It would make little sense for me to read a 2000 page piece of major legislation that this dynamic in nature.
So, we have the usual people who don't want government in their lives filling thier self fulfilling prophecy.
Dr. Gupta with all due respect we got here by asking how things affect us. How am I affected? Well, this plan isn't about just us. It is about over 30 million uninsured people who are going to get care whether we provide it in this bill or not. It is about a clearly broken healthcare system that need a major overhaul. I will know how it affects me if it is simply affordable and quality. Until then, I won't know.
Who is going to insure that the billions of dollars collected before any benefits of this plan are released realized are safely kept? Who is going to be held accountable when those tax dollars taken from us through surcharges and new taxes actually pay for any health insurance? Are we sure Pelosi or Reid will not spend those dollars during their last months in office? And if they do spend them, how do we hold them accountable and get the money put back in the health care pool?
The administration did a horrible job passing out our money to save the financial world without any clauses prohibiting bonuses being given out to executives of tax payer saved organizations! They just rushed that garbage through then had no accountability for giving our money to the rich. Face it folks, they are going to take our money and spend it on what ever the heck they want, and there is nothing you can do about it! Nothing! Closest thing to a dictatorship I have ever seen in this country! I recommend you tell your respective members of congress they will be fired if they take money from you and then spend it other than promised. Make these people accountable! It is the only chance we have. Once they dig into our pockets, we will never get our money back and receive no benefits for the spend!
Here is the issue at hand; the government is attempting to put in place health reform that is badly needed. I think that Obama and his administration could have educated the American people with the many forms of communication available (TV, Web, Mail). What people have to realize is yes we will have to pay into the reform somehow and yes there will be changes but it is up to us to make sure that we are asking to be educated about the health reform. No one knows what going on with the Health Reform Bill and that is what scares us the most.
Here is another issue is that during the 8 months of healthcare debate I have yet to see anyone else come up with an alternative to the current proposed health reform bill. There were some proposals but they were created as an afterthought.
What we as Americans have to remember is that over the course of 4 decades we have allowed millions of our loved ones to past because of a lack of access to healthcare. So for those citizens that have yet to know what hardship is or watch a family member slowly fade away let’s hope that those situations never find you. Because believe it or not, you’re fellow Americans have the unfortunate task of living through this every day without help. Americans need help now because it will never be the right time and it will never be perfect.
The rush to pass this legislation will likely result in increased costs and larger defecits. There are many good elements of both the House and Senate bills but when special interests are favored and deals are cut to buy votes we can expect that the Bold Goals envisioned to revamp health care by providing world class care for more at a lower cost will never be realized. The Senators who cut deals to get "benefits" for the states in exchange for their vote should be ashamed of themselves. One can only hope that when the House and Senate join in conference committee they will "get it right" and throw out elements of both bills that are not needed. We stand on the edge of magor change but will settle for a watered down solution if the Conference Committee does not do what they are called to do. Otherwise the legislation will increase taxes for all and will cause a longer period of no economic growth
I think a common thread of the concerns raised in all of the comments is that the American people have not been provided with any details of the legislation. This has been far from a transparent process. The question that should be asked is why is it not transparent?
I suspect that one answer to this question is because there is not a single legislator who can tell you the details and the true costs of the bill and whether it will indeed provide the coverage that is claimed.
A more conspiratorial answer is that they do not want you to know that it is nothing more than a veiled and deliberate act of creating socialized medicine – or at least the first giant step in that direction from which we cannot turn back. I hate to be a conspiracy theorist but the bill is actually only going to provide coverage to 4.5% of the populus, and even then it is acknowledged that it will not cover everyone. It certainly begs the question as to why we will drive ourselves into enormous debt and ridiculous taxation to cover such a small percentage.
I read the comments of everyone here who has contributed to this discussion. I am not cold-hearted. I think we can all agree that healthcare reform is necessary and for those of you without coverage, we need to find a way to get it to you. But it is imperative that we do it in a way that will not destroy our economy and it should be done in such a way that all parties are at the table and that we know exactly what we are doing before we do it. Rushing through legislation without knowing the consequences does not help anyone – not even those who have no coverage now – because if the consequences ruin the economy and destroy small business, there isn’t going to be anyone left to pay the bill.
We just rushed to borrow and spend $1 trillion to bail out financial institutions and did it in such a way that we have no control over how the money was spent and how it will ever be paid back. We simply cannot afford to do this again.
I'm retired early and am in the gap before medicare. I have a chronic arthritic decease which means little to me, but is an showstopper to most insurance companies. I recently relocated to a new state and was able to get an individual policy that excludes any treatment to my joints even due to injury. I feel the injury exclusion to be unfair but had to take the policy due to economics. Since I will have an existing policy in place, will the new rules require the company to cover me fully? If so, will they raise my rates to a level I cant afford?
1)-Why us government cannot control fraud and abuse by Doctors, Hospital, Pharmacies.
2)-Why us government, US congress want to cut Medicare benefits?
We paid Medicare insurance on every pay checks, we continue to pay every month when we retire but others did not pay and getting medical and medicaid?
If so many of us are against this costly life changing bill why haven't the "elected officials listened to their constituents?
Where's the Tort reform?
Oh wait, they put language in this bill that prevents any capping of lawyer fees. What a travesty.
The only ones benefitting from this bill is:
1) Insurers
2) Lawyers
Those that get screwed:
1) Taxpayer
Here's what they should have done.
1) Require insurers to standardize their coverages between themselves that meet specified guidelines.
2) Require all states to have a minimum of 3 insurers providing plans. If a state does not have the minimum then a public option would be available in that state to suppress costs.
3) Mandate insurers profits to never exceed 10%. Since insurance is mandated then they should not be free to have any greater profits.
4) Mandate hospitals to revamp their records to be electronic and record keeping costs never exceed 10% of their overall cost.
5) No pre-existing conditions may exclude anyone's coverage
6) Tort reform: All medical civil cases, both the suer and their lawyers may only collect from compensatory damages. Punitive damages go to the general fund for financing the public option.
7) Mandate that insurance to doctors may not exceed 10% of a doctor's income.
8) Mandate that the hospital is only liable to being sued in cases where an independent panel (community leaders) have determine that there is just cause. (None serving on that panel can be lawyers).
9) Merge all federal employees coverage to be the same as everyone else. No special sweet deals for congress and gov't employees anymore
10) Bite the bullet and define an upper limit for care. Fix a limit to n dollars a day. If it exceeds that then a patient has to pay the rest without anymore aid.
I believe that this bill (in whatever form that it comes in after conference) is despartely needed for those who are not insured. One could definitely argue that it will probably cost more that what the CBO has estimated. Additionally, no one really knows how this bill will work in the end. But in my opinion, this is a moral imperative as well as a healthcare imperative. Americans (and yes, I am a proud American) are too focused on 'what's in it for me" and not on those who really need it. The bill is definitely not perfect but it is a start to build upon down the road. Politically speaking, we as a country have been funding all kinds of initiatives that were questionable. The previous administration cut taxes without paying for them. The prescription drug bill was a boon for the pharmacuetical industry. None of this was paid for. Now, Republicans want to complain about a healthcare bill that the CBO says will reduce the deficit over the years. Whether that happens or not is to be seen but at least you can give the Democrats credit for trying to put in place change that is paid for all the while working for all Americans to reform healthcare. I hope this works out well for Americans and yes, there is a lot of work to do to make it better. But in the long run, I think the Republicans are on the wrong end of this moral arguement. It's easy for them to blow smoke about costs and government intrusion, while on TV. But, I bet Glen Beck, Mitch McConnell, Rush Limbaugh, and others won't dare go up to the person who lost their insurance because of a job loss or were denied because of a pre-existing condition, and complain that "this is socialism or it costs too much!" I suspect they would get something in return.....
I , for one, am disgusted by the Cornhusker Kickback. I consider it to be the single most corrupt political act in my lifetime. Moreover, the entire pretense for this "reform" was to control costs, but it does nothing to accomplish this. Through creative sleight-of-hand accounting, there is a suggestion that MCARE costs will go down. I am going to start looking for another career, as I don't think I will want to practice in the era of Obamacare.
It seems to me that the vast majority of people out there without a vested interest in the health insurance industry have very loudly demanded a public option over and over and over again. Yet our representatives seem to keep backing-down over and over and over again to the monster health insurance conglomerates.
WE THE PEOPLE DEMAND A PUBLIC HEALTHCARE OPTION!
READ OUR LIPS! NO EXCUSES! PUBLIC OPTION NOW!
its funny. ive been somewhat keeping up this conversation, and it seems that by and large, we are all saying the same thing. whether we are doctors, or lawyers, or EMTs or uninsured, we all agree that the system is broken, but we are about to replace it with an even more broken one.
read the thread, almost ALL of us are opposed to this. where were our elected leaders when we spoke about this? perhaps its more than the healthcare system that needs reform. we are all against it, yet it passed.
representative democracy?
may god help us all.
Congratulations, America. I cannot begin to express how proud I am to fight for a nation governed by the people for the.... wait wait wait. Apparently, this country has become so lazy that when they vote in officials because it's the cool thing to do, and manage to take the sovereign right of the people to govern themselves completely out of the equation..... even better, not even lift a finger about it... yes. Thank you for reminding me why I chose to defend this Nation. Apparently, I am an idealistic idiot who still believes in neighbors walking together and actually doing something about an issue. No.... let us just watch and see what happens on the media outlets. I'm not angry because this bill has passed. I am angry because this country allowed those idiotic fatheads to even vote on it. YOUR representation just screwed YOU. Hope your happy.
Its a sad day in America, that a bill such as this is so close to passing. The government is for all practical purposes is broke and the 2 trillion dollar projected cost of this bill is going to put the economy in worse shape, increase unemployment, small business will suffer (the major employer in USA), if you can believe that 2 trillion is the final cost. I could see the cost to triple that figure. The level of care we can expect to receive. Dr's have warned that long lines will form in waiting rooms and many may not live to get the treatment if the level of care gets to that of other countries that have social medicine. Each and every one of us need to call, write and email our senators and congressmen and tell them that if they vote yes to Obama care, they have lost your vote at reelection time. That is the only way we will be able to stop this terrible bill from happening. A health care bill should be debated for years, not weeks to make sure it is done right, not just something done. Write, call and email your representatives today, before it is to late.
With all due respect, I'm confused by the complaints by so many physicians about this bill. I'm sure tort reform is desperately needed in the U.S. I served on a jury for a frivolous malpractice suit. The plaintiff had no case at all. It was an expensive waste of time. Several of my family members are physicians, and I'm aware that Medicare reimbursements are low and that student loans are large. I believe everyone should receive fair pay for their services. Still, after all that, I've never met a poor doctor. I've never even met a doctor who is just doing OK. Every doctor I know is REALLY, REALLY RICH! Maybe expectations are a bit unrealistic?
I dont get it. Everybody seems to be afraid of the Government making heath care more affordable for poor people. And it's cost, Simply because they are challenging the very industry that will go up on your premiums anyway. Which will bankrupt this nation anyway. And when you or your family member really need the Insurance you've been paying for , they are going to find a way to drop you. That has been their pratice. And they will say it's the Governments fault. And you want to keep these Corparations in charge of you Health? As a nation we are the most ignorant, selfish, self centered people on the face of this planet. We learn nothing from history. This bill, even as it stands can be amended. Why do you think the Republican fault so hard to keep it from getting it to a vote. If the President signs it into law. It can be Amended. Before 2010 they can have most of what they origanally wanted in the bill in the first place. Through budgetery changes. It has to be a law first. Face it people, many Congressmen and Sinators are bought and paid for. Dispite that, there are some good things going to happen in this bill. if we give them time. I mean when they amend what needs to be amended to benefit the American People. It has to be a law first.
The only way this will work is if medical personnel get paid less and taxes are raised. One has to assume that the 31-45 million people, who presently can't afford health insurance, will be heavily subsidized with this new program. Some states are in trouble now. I doubt they can handle medicaid being expanded (more $$$). Besides, many doctors don't service Medicaid patients now, because many of these patients are only looking for ways to get drugs. I also heard that the government only gives the docs 15 bucks a visit for Medicaid patients. This is a fraction of what a private insured patient pays per visit. I hope this country's healthcare system doesn't go down in flames like we've experienced with the housing debacle.
This new bill will do very little to promote better health for Americans, but instead is mostly a political plan to promote future votes. As a nation, we should have first had the much needed national discussion to found consensus as to what actually is health versus just "medical services", and how do we quantitatively measure health (as is done in most other nations that provide national health care). Only then should we spend federal tax payer dollars to "buy" health. Cost effectiveness is the cornerstone of all responsible federal spending, but was conveniently left out of this new bill (that was probably crafted by the insurance and hospital network lobby).
Medicaid is our least cost effective current US system, followed closely by Medicare. VA medical services are the most cost effective, but our public is too self driven to accept this model for themselves. However, if we are to avoid government fiscal meltdown within one generation, it will take this VA rationing approach. Our current mode of spending for medical services is unsustainable. Yet, admitting this reality to the public would be political suicide.
Obama should have called for a very bare bones plan that covers all pre-existing diagnoses, and one that is self funded after a little start up cash. Premiums could have been structured based upon ability to pay, just like we pay income taxes. This could have been the start of real reform, and lessons learned retooled each year to better meet the needs of the public. Medicaid and eventually Medicare could have been folded into this highly cost effective new plan that promotes real health rather than "medical services".
A. Patient:
I am a critical care nurse. I know a lot of doctors too, and related to two specialists myself. Do you really think salaries in the 200-400k defines REALLY, REALLY RICH? – Especially given the fact that they have a MINIMUM of 11 years post high school, expensive, demanding education (15 years for specialists). In New York that barely affords you a three bedroom home.
Their education requirements puts them into their 30's before they start their wage earning careers, five or more years later than their professional counterparts. That's 5+ years less time paying off debt, saving for retirement, saving for kids college, etc. Some specialists I know make half a million, and some just over that, like cardiologists and neurosurgeons – and it is WELL EARNED money. But they are NOT millionaires, like John Edwards, who became a multi-millionaire off the health care system by suing doctors.
Perhaps we should just get rid of wealth altogether in this country? Maybe nobody should be allowed access to the American dream of EARNING and ACHIEVING wealth – because if doctors can't have access to that – whose career choices require more than any other – nobody should.
It's not a matter of perspective on wealth. It's a matter of perspective on value statements. The doctors I know are not asking to be multi-millionaires like John Edwards – but they are rightfully asking to keep the salaries that they have and currently do EARN. Who wants to face life and death decisions, weekends/nights/holidays, continuous education requirements, 300k+ a year in malpractice premiums, 200k+ in education debt, more education than any other career choice, etc. – yet not be allowed to make as much or more than a CEO, banker, real estate developer, a trial lawyer, etc. who have less than half the education and personal sacrifice requirements and little to no legal risks in their jobs?
Bottom line – We can make doctors NOT really, really rich....But then good luck in 20 to 30 years finding someone around wiling to make the huge personal sacrifices necessary to become skilled at removing your brain tumor, or intervening on your heart attack – procedures that bring them huge personal and professional risks.
Maybe someday America will not be the wealthiest nation, and our children will not grow up dreaming of how to earn and achieve that American dream of wealth they see around them. Maybe we will be more like other countries, with a much lower standard of living. Maybe then more people will be willing to spend 15 years of their post high school years working toward a career that requires life and death decisions, huge personal debt, nights/weekends/holidays, huge malpractice premiums and risk of personally, professionally, and emotionally devastating lawsuits despite your best efforts, and all for a salary similar to people whose sacrifices were less than half as demanding. I guess I can see it.
Why is taxing "Cadillac" plans going to make a difference at all? If not having health insurance is the problem Congress is trying to address, why are we punishing taxpaying, wage-earning citizens for just that, having health insurance? It's called socialized medicine for a reason.
Secondly, Health Insurance is not a synonym for Health Care! In many cases, they seem to be opposite eachother!
And something seemingly no one has touched on, Medical Device manufacturers will be assessed fees under BOTH the House and Senate bills? Medical Device manufacturers are not the problem! Without them, the consequences are obvious! no medical devices! This bill is unbelievable and although I am pro-life, Senator Bill Nelson apparently isn't! Just because not every American can afford the great medical care available within the country doesn't mean we have to end America's century long foothold on the greatest medical powerhouse in the world.
Lastly, I am one of the 40 million uninsured Americans. I can afford any coverage I want. However, I don't think Insurance is the best fit for me.
For years, I've paid for my health care out of pocket. Between my age (I'm over 50) and pre-existing conditions, any insurance I could get through my husband's work would not only cost more than what I pay for medical now, but would not cover most issues.
Paying for a required policy would probably cost us all the money we could barely afford – the few policies that would take me quote over $500 a month to as high as $845 a month. That would mean we couldn't afford co-payments at all, which would mean that we wouldn't be able to use the required health insurance and would no longer be able to pay out of pocket ourselves.
What this means is that some health insurance company will get $6000 or more a year for me that we can't afford, and won't have to pay out a dime because we won't have the money left over to pay for anything. It's nice to talk about tax rebates, but they come too late for anyone like me who will need the money during the year for medicine, copays, etc.
In cases like me, as far as I can see, the only ones who will benefit are the insurance companies.
Am I missing something?
This bill will affect every American in a negative way: Taxes, Government intervention in treatment, increases in private insurance rates which will result in MORE AMERICANS not being covered than before. Medicare will be affected and every improvement made by the establishing of Medicare Advantage will be no advantage to senior citizens if there are cutbacks to medicare payments to providers. The private health insurers (not that I feel sorry for a company which profits from ill health) will suffer which means their subscribers will suffer. Their employees will suffer and who is next to suffer? US
Providing guaranteed issue insurance to all Americans alone would have been a major step to having more Americans covered. Adjusting the rating system thereby providing insurance to untold millions would have provided the existing system with more claim dollars but the rest of the two thousand pages will decimate a system which has worked for decades. Perhaps our 'lawmakers' should concentrate on the laws which do not work and pass laws like the above AND add to it that no advertising can be done by either Pharmeceutal companies or Health Insurers – thereby adding Billions of dollars to the Claim pool to pay claims for the swelling number of people insured under a guaranteed system. We have never taken healthcare seriously enough to make changes – but changes take time and so does constructing laws to protect our poplulation. It cannot be accomplished inside of a few months – not without serious analysis for the long reaching affects on the nation as a whole. This bill is a disaster and if it is allowed to pass the complexion of the country and the purpose of government will be skewed to MORE government and less governed.
To add insult to injury, the people who created this disaster are not subject to living with the results. The Government that will burden us with this bill will have first class healthcare and security for the rest of their lives – while we suffer with their misjudgements, back room deals and 'behind the scenes bargaining' to get SOMETHING passed, whether WE THE PEOPLE want it or not. Perhaps the advisors from the healthcare industry should not have been a chairman (chair persons) who flew there on a private jet – but instead, those who work in this field every day such as underwriters, agents, claims processers – the Americans who are going to have to end up living with the bill. Not the elite who do not.
Ultimately, anything less than single payer is a failure. This progressive will never again vote for any candidate at any level who does not support single payer and is willing to fight for it. The US healthcare system is morally abhorrent, not to mention unimaginably inefficient. Universal public healthcare funded by a progressive tax, nothing less. Its time for the US to join the rest of the developed world in the 21st century.
I understand that we needed to OVERHAUL our healthcare system but did we have to rush it? Yes, its been a long time coming but Pres Obama has been in office only a year and we have had COMMISSION investigating the littlest of things ... hmmm, shall we say Troopergate or even WhiteWater ... for 2 to 3 times longer! Why couldn't this have been on a time table of 2 years or 3 just so that the public could weigh in with their opinions? Why couldn't we spend more time getting republicans involved and hear their side to it all? Why couldn't there be MORE reform to the insurance industry or the drug industry where Americans pay far more for everything than other countries? What fix will this make for medicare?
All of these are important factors and I believe the Democrats, my party of choice, are making this bill (both bills) rush through so that in Nov 2010 they can SCREAM look what I accomplished! And why, if every darn poll shows a VAST majority of Americans saying NO to either the bills themselves or to the rush factor of passing them are the DEmocrats and the president himself PUSHING it through so hard?
Are the American people ALL dumb and need to be lead around by these elected officials? Where is the transparency?
Will the elected officials have to pay HIGHER taxes on their "CADILLAC" plans or will we, the people who pay taxes, be subsidizing their plans as well?
The more I read about this bill, the more I hate it! I have been a democrat nearly all my life (age 66) and I am so very disappointed in the ridiculousness of both the Senate and House versions that I don't even think I want to vote anymore.....Democratic of Republican, or even as an independent.
I voted for Obama with great trepidation....hoping he could live up to his promises with so little background experience behind him. (I would never have voted for McCain and Obama was my only choice.....as I said, I have always believed in the Democrat's ideals). I now see what I suspected all along....that Obama is one naive man in thinking he could change how Washington operates. He had little to do with the versions of these bills of the House and Senate....leaving it all up to the Dems to construct a bill that reflected his promises during campaigning. ...and look at what they presented to him. He only wants to show he got a healthcare/insurance reform bill passed, and to hope that future amendments would be passed to correct the nonsense terms in these bills....regardless of what was in it. If he is stupid enough to approve this bill I will be totally disgusted with him.
We need to be sounding off to Obama, not here in this forum and certainly not to the deaf ears of the House and Senate. This whole thing is a sham and will destroy the quality of health care in this country. Not enough doctors to even support all the new patients that will now be insured (no, must be insured). I am a Medicare recipient and found it hard enough in last year just to find a primary care doctor in private practice who would accept new patients on Medicare. These doctors are reimbursed peanuts on their bills....just 20% of submitted bills to Medicare. No wonder there are few doctors who will accept it . And I read that Medicare reimbursements to doctors will be cut even further by another 4 or 5%.
I really doubt many Americans with or without health insurance at this time will benefit in any way by this ridiculous bill. I have never been so disgusted with the way politics works in this country. Obama....you should be ashamed of this and veto it as soon as it hits your desk....but thatwould admit defeat woudn't it? Do you have the guts to veto this bill?
It seems to me that most of the people making these comments are making wild statements about what will happen when the health care reform bill goes into effect. The truth is that no one knows exactly what will happen, partly because the final bill has not yet been written. The house and senate versions of the bill are different and must be merged together before the bill is in final form.
Additionally, I am incresingly alarmed by the many people who imply that our government or "big" government is an evil to be rejected no matter what. How do they think our highway system was built, medicare came into being and why we have clean water to drink?
Our form of government is not perfect, but it has worked well so far. My concern is the special interests like big businesses who unduly influence the members of Congress in order to get concessions for their industry. The banking industry and Wall Street are the real culprits for a lot of what is wrong in our world today, yet no one is railing against them.
Paging Dr. Gupta:when will you respond to the fears (Lack of knowledge) writers are raising?
1-For those of you who are still insisting no one is in favor of this bill, would you please read the comments by people who have been repeatedly injured by the private insurance companies.
2-For those of you still trying to make Obama a demon, would you please note that the tilt to the insurance companies has been Republican, private insurance companies, and the pharmaceutical industry protecting their own turf. Likewise with the failed effort to get reimportation of drugs from Canada and the like. Real helath insurance reform was killed before it even got out of the gate.
3- For those of you calling this bill a rush job...where have you been? These issues have been discussed for over 30 years. And invariably the AMA, Republicans, the pharmaceutical industry, and anyone who still enjoyed shouting "communism!!!!" sabotaged any reform.
4-Would you please stop quotting neighbors, distant friends with: " I heard...", "They say....". Folks, you gotta do your homework first. Do you really know what you are talking about?
5-For those of you who keep insisting the Federal governmant will run (very poorly) your health care, would youy please provide some facts? How do you know this? Where in either the House or Senate bill is this established or created? Are you aware there is a difference between national health care and national insurance?
6-Quick test: What does the Hill-Burton Act do? When did it go into effect? Name the hospitals that don't receive Hill-Burton funds? (There I've already given you hint)
7-You gotta do your homework first.
Patty Cake, you're missing a few things and unfortunately you are not alone.
First of all, any insurance you get through your husband's work is not based solely on YOUR age and YOUR pre-existing conditions...employer rates are based on the average risk profile of everyone in the group. If your husband works for a small company, there will likely be medical underwriting but unless everyone in the group is sicker than you, you'll actually get a lower rate than you could ever get on an individual basis, especially if his employer is paying part of the cost. You should also have an out-of-pocket max which you will really appreciate the year you end up with a hospital stay.
Second most of your $6000 does not go to the health insurer's bottom line...only about 3.5 % of it does. 80-85% of your premiums pays for part of someone else's medical and pharmacy costs. 14-15% pays for administrative costs and around 3% is paid in federal and state taxes. Yeah that's right folks, the government profits off premiums about as much as the companies doing all the work.
Health insurance is NOT the same thing as health care. Anybody who needs health care can get it...hospitals should not turn you away and it's illegal for any ER to turn you away even if you have no ability to pay. Insurance by definition is protection from risk. After taxes and administration expenses (including sales commissions) are paid, the remaining funds pay the claims for everyone who paid premiums and anything left is profit. Your $6000 doesn't even pay for ONE DAY in the hospital (average cost $10,000 per day and this doesn't include physician or radiology charges and this is AFTER the discount the health insurer negotiated on your behalf). It would only pay for 5 months of an injectable drug (average cost $1200 a MONTH). Believe me, I appreciated only having to pay $6000 of the $35,000 hospital bill when my perfectly healthy husband WITHOUT pre-existing conditions ended up in the hospital with a staph infection. You never know when you'll end up in the hospital. That's the point of insurance – to pool the funds of many to pay for the claims of the few.
We need as many low risk individuals as possible to keep the average rates down. This legislation removes the ability to entice these individuals to purchase insurance by no longer allowing discounts for healthy people (that alone could mean a 30% premium increase for a small business), no longer allowing gender rating, and significantly decreasing the ability to age rate. After all that, increase premiums an estimated 85% so everyone can have the "right" to only purchase insurance AFTER they get sick. So individual premium rates for young healthy males will double or triple. The "penalty" for not being insured is only $95 in year 1 and only goes up to $750 by year 3. What idiot wouldn't pay a fine versus paying 5 times as much for health insurance unless he actually needs a lot of health care that year? This means that insurance rates will be unaffordable for most.
Whoever made the comment about making profit off the ill, I agree. Someone needs to seriously do something about the double digit profit margins of hospitals, not to mention the multi-million incomes for hospital CEOs. I do think doctors deserve a high salary but don't think CEOs of hospitals should make such obscene profits off the ill.
My health insurer decreased admin expenses from about 21% to about 14.5% in the last 8 years (publicly available information). So the government wants to add 2% to health insurance premiums in additional federal taxes to make health insurers more efficient? Medicare has crappy benefits (why do you think we have a Med Supp market), underpays physicians, has rampant fraud and abuse, and zero customer service and is projected to be broke in less than 10 years. What does the government know about efficiency?
Why are supporters of the bill so happy about the projected $132 million savings to the federal budget? Isn't this bill supposed to cost $1 trillion? I may not have the exact figures but I certainly have the magnitude right.
Horse,
To your list.
1. Talk to the people currently being failed by the Medicare/Medicaid system. Most people with Medicare also carry a supplemental private policy so don't have a problem, but those who do not have a hard time finding a provider who will accept them because of the egregiously low reimbursement rates. Doctors close their practices to more than a few who have only government health insurance policies, leaving it hard for those to find a provider. That is even true with kids who have SCHIP.
2. Obama made the sleazy deal with the drug companies, not the republicans. Are you implying he was powerless to stop it?
3. We have not been talking about THESE BILLS for decades. You can't just write legislation that is several thousand pages long, scream that it's old news, and rush it through passage. These changes are a HUGE deal!! They should take a lot of time to figure out, not weeks or months. When the very congress members who have the responsibility to pass these laws have not actually read them in their entirety, something is very seriously wrong.
5. Proof the government is terrible at running businesses (this could be LONG). Here you have it:
a. Medicare has 38 trillion dollars in unfunded liabilities, sees 60-90 billion dollars in waste and fraud (our tax dollars) out the door each year. Clearly their administrative costs are too low if they are checking only 5% or less of their claims.
b. Medicare and Medicaid both pay providers less than what it costs for them to provide the care. The Centers for Medicare and Medicaid Services (CMS) itself reported that between 1992 and 2010, inflation to provide care has risen 54%, while reimbursements have only risen 11%. Practices cannot stay open with that model. No wonder 6 Massachusetts hospitals are going bankrupt and suing the state for underfunding. Currently, cardiology is scheduled to receive a fatal reimbursement blow from the government – CLOSING many out of hospital practices. People who currently go to a local cardiac clinic will no longer have that option. They are being pushed into hospital settings for that care – a setting that is more expensive, and could be an hour or more travel time. Closing those outlying facilities means failure of people to receive timely cardiac intervention when they need it emergently. Cutting Medicare reimbursements does not just affect those on Medicare.
Not only that.......Our politicians collect millions and millions of dollars from lobby groups every year. The American Medical Association has had to fork out millions lobbying congress each year to stop them from cutting Medicare reimbursements even further. Money well spent in health care? Congress does not seem real interested in changing that pattern, and why would they, they get to collect millions from those who lobby them. These are not the kinds of people I want running my health care system. I want them doing what they are supposed to do....regulate industry, not participate in it.
This list could go on and on, but I'll stop.
Hospitals are already making cuts to survive what we as employees
are told could be the demise of our jobs. Those employees are direct
health care professionals. I know personally, nurses who are filing bankruptcy due to low census days and many work more than 1 job.
Again I remind everyone...these are direct health care professionals.
Hospitals are preparing for major financial hits by decreasing the ability to give good care to very sick people with less staff. In addition to ? tort reform....who in their right mind will feel safe enough to work in medicine. If anyone has valid input please respond. I am a cancer nurse of 24 years and I must confess I am now beginning to worry....
Linda's comments point out the need to eliminate the profit motive in health care – which is why a public option is necessary. Corporations will do whatever they have to do to maintain a profit, including cutting back on staff in hospitals. It makes no difference to them that patient care is compromised. I too am a nurse by the way, but I changed professions years ago when I saw how corporate greed impacted how hospitals are run. Nurses and Doctors are caught in the middle, pressured to maintain quality health care without adequate resources. It is an untenable position to be in.
Many European countries recognize that it is morally incumbant upon a nation to provide quality health care for all citizens without the pressure to make a profit. Hence the nationalization of health care in those countries. Get it?
On 12/31/2008, I was diagnosed with papillary thyroid cancer. On January 4, 2009, I started COBRA. Surgery followed on 1/14//09 with two radioactive iodine treatments (March 2009 and 2010). COBRA ends the beginning of July 2010. I now am identified with pre-existing condition of a treatable curable cancer (test results were great!!). All my medical care has been at Emory University Hospital and Clinic in Atlanta. How will the health care reform help me post-COBRA. My insurance agent said currently I am uninsurable when COBRA runs out for perhaps 5-10 years.. I am currently self employed. I am 49 years of age and single. Not sure where to turn so I have insurance. Not sure how this reform with help me now vs. 2014. Your reponse is greatly appreciated.