Obama's health plan takes shape

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Barack Obama's health plan takes shape

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If Congress were to take a vote on a health reform bill today, Democrats and Republicans would find a surprising level of agreement-so much so that the broad outlines of a consensus plan already are taking shape.

Sick or healthy, rich or poor, all Americans would be guaranteed access to health insurance.

In fact, they'd probably be required to purchase it-perhaps through mandates in the law that would include stiff tax penalties for anyone who tried to opt out.

Newly created insurance marketplaces would make finding a plan as easy as shopping for cheap airfare. People could keep their coverage, even if they switched jobs. And they might be able to choose between private insurers and a government-backed plan.

But here's the catch-none of this would come free, with the wealthiest Americans likely to face higher taxes to help pay for coverage for all.

It's hard to believe that only three months ago, health care advocates worried that President Barack Obama would drop the health reform issue from his first-year agenda. Now, with an August deadline to pass a bill, a compromise that once seemed unimaginable is considered quite possible, both sides say.

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herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical.

I still think single payer should be seriously discussed.

elkpark

14,633 Posts

I still think single payer should be seriously discussed.

I agree completely, but that's obviously not going to happen -- I believe the best we're going to get is the "public option" model, and even that is not a done deal. :o

funnypharm

34 Posts

Specializes in ACLS.

Looks like we will be getting that 25% VAT (value added tax) sooner than we thought. Every time a commodity moves it will be taxed. The problem is that Countries that have a VAT don't have the IRS. Also, they do not have 30% of their country with or close to Metabolic Syndrome aka Obese. We will be crushed by this. We are not the Skinny Swiss or the super healthy Japanese. We will need at least a 25% VAT just to touch this.

Nurses will also take an estimated 25% pay cut as well. (You do the math):down:

Here is an example of what universal health care would be like if it was the restaurant business.

[YOUTUBE]http://www.youtube.com/watch?v=gHWAu3irXNg[/YOUTUBE]

GCTMT

335 Posts

Specializes in LTC.

I didn't like the mandate idea. Especially without a public option. Agree with elkpark and herring.

Two months left.

lindarn

1,982 Posts

This scenario sounds more like what we have already, with huge co pays, paperwork to get things approved. This a bunch of anti single payer baloney propaganda. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.
Looks like we will be getting that 25% VAT (value added tax) sooner than we thought. Every time a commodity moves it will be taxed. The problem is that Countries that have a VAT don't have the IRS. Also, they do not have 30% of their country with or close to Metabolic Syndrome aka Obese. We will be crushed by this. We are not the Skinny Swiss or the super healthy Japanese. We will need at least a 25% VAT just to touch this.

Nurses will also take an estimated 25% pay cut as well. (You do the math):down:

Here is an example of what universal health care would be like if it was the restaurant business.

gHWAu3irXNg

Your impression of what UHC is like is incorrect.

Home Health Columnist / Guide

NRSKarenRN, BSN, RN

10 Articles; 18,227 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion.

from deloitte center for health solutions:

health care reform memo: may 4, 2009.

what’s ahead for the next 100 days? the pace of health reform and its attention in the media will increase…

june - july 2009: legislation may be reported by various key committees of the house and senate and will be finalized, as will the work of special task forces designated in the stimulus package:

  • five major committees continue work toward reform bills: senate health, education, labor and pensions, senate finance, house energy and commerce, house ways and means, and house education and labor.
  • 20 member health information technology policy committee under guidance of the office of the national coordinator (onc) director david blumenthal and special assistant john glaser makes recommendations about electronic health record (ehr) rollout—definition of meaningful use, incremental vs. aggressive rollout of program, certification commission for healthcare information technology (cchit) certification criteria and more.
  • 15 member council on comparative effectiveness research led by agency for healthcare research and quality (ahrq) director carolyn clancy makes recommendations about infrastructure and timing for the development of the national comparative effectiveness program.

most likely after the august recess, differences between the house and senate health reform bills will need to be resolved in a joint conference committee. the committees will likely address the issues presented by:

  • a new public plan


  • the development of a new public plan to insure 25-40 million uninsured and under-insured americans, as well as employees whose companies elect to “pay” rather than play.
  • individual mandate
    required levels of coverage (basic benefits) applicable to all americans.
  • comparative effectiveness
    a public repository of information that medicare and other public plans will follow to make coverage decisions about which interventions (drugs, diagnostic tests, surgical options) are appropriate based on side-by-side comparisons of efficacy, effectiveness and possibly cost differentials. a possible by-product of the effort will be the development of a national formulary upon which prescription drug coverage for medicare is based.
  • medicare reforms
    elimination of the “donut” hole in part d coverage; use of means testing for traditional medicare premiums paid by seniors based on their income; allowance for medicare to contract directly with pharmaceutical companies; reduced premiums and increased compliance requirements for medicare advantage plans; and others.
  • expansion of primary care
    mechanisms including expansion of the national service corps; expansion of “medical home” demonstration projects; increased funding for community health centers and other mechanisms to strengthen primary care. likely funding cuts to acute and specialist provider payments will be recommended.

now is the time to write your federal congresspersons to tell them your concerns about which aspects to include in healthcare legislation.

GCTMT

335 Posts

Specializes in LTC.

Here's an update. It looks like there's going to a mandate, they're calling it a "soft mandate".:chuckle

allnurses Guide

herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical.

Thousands plan to be in the streets all summer in support os a single payer system:

'Single-Payer' Supporters Challenge Democrats

When President Obama convened a town-hall meeting in Rio Rancho, N.M., last month, he wanted to talk about credit card reform. But many in the crowd had a different agenda.

"So many people go bankrupt using their credit cards to pay for health care," the first questioner said to applause. "Why have they taken single-payer off the plate?"

The "single-payer" activists had struck again. As Obama and congressional Democrats work to hammer out landmark health-care legislation, they face increasingly noisy protests from those on the left who complain that a national program like those in Europe has been excluded from the debate.

The White House and Democratic leaders have made clear there is no chance that Congress will adopt a single-payer approach -- named for the idea that a single government-backed insurance plan would pay for all Americans' medical costs -- because it is too radical a change. ...

http://www.washingtonpost.com/wp-dyn/content/story/2009/06/05/ST2009060504116.html

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

22 Articles; 9,986 Posts

Specializes in LTC, assisted living, med-surg, psych.

This is very, very disappointing. I had expected better from President Obama and the Democrats, and while I know they're up against an almost impossible-to-defeat insurance juggernaut, I hate to see them knuckle under without even putting up a fight.

I'm afraid that mandating that people carry health insurance will only make things WORSE, not better. Where's the incentive to make insurance affordable? Where's the encouragement to make plans more uniform and cut down on some of the paperwork? And where, oh where, is the rule that says insurance companies can no longer "cherry-pick" and deny people coverage for pre-existing conditions?

I don't see any of that being dealt with in any meaningful way here. This, in fact, sounds to me like the worst of all possible worlds---no real change in the way health care is paid for, PLUS higher taxes and fewer jobs. Phooey.

blue note

179 Posts

this is very, very disappointing. i had expected better from president obama and the democrats, and while i know they're up against an almost impossible-to-defeat insurance juggernaut, i hate to see them knuckle under without even putting up a fight.

i hear ya! i'm a die-hard liberal, but yeah, it's very sad to see that too many dems can be bought and paid for by the big insurance companies as well. it's why baucus first shut out single-payer advocates from the discussion, but i also take it as a good sign that he has been forced to reverse his position due to feedback from his constituents in montana. we need to make this happen for every politician who doesn't at least consider single-payer as a viable option.

i'm afraid that mandating that people carry health insurance will only make things worse, not better. where's the incentive to make insurance affordable? where's the encouragement to make plans more uniform and cut down on some of the paperwork? and where, oh where, is the rule that says insurance companies can no longer "cherry-pick" and deny people coverage for pre-existing conditions?
the insurance companies claim they won't deny coverage for pre-existing conditions but without any price controls, it is entirely meaningless! i mean, they can set the price at $5000 a month and still claim they are not denying coverage, right? but unless you're oprah or bill gates, fat lot of good that will do ya!

i used to think that if the mandate came with a public option, it might be an improvement, but i think i've changed my mind after watching bill moyers journal where two single-payer advocate doctors explained why it was not a good idea. from the transcript of that interview:

bill moyers: there aren't any details. but he seems to be advocating a public option that would compete with the private insurance-driven sector, as a way of lowering the cost. what do you think about it? is that- am i reading his plan correctly?

dr. david himmelstein: well, most of the cost savings he's talking about are really illusory, i think. and my research group has done most of the research work on administrative costs in health care. and the administrative costs he's talking about saving are a tiny fraction of the potential savings under single-payer. 'cause hospitals have to keep their bureaucracy, if you're dealing with hundreds of different plans. and doctors have to keep the bureaucracy in our office. you don't actually get the streamlining that you get from having one payer that has one set of rules and can pay lump sum budgets to hospitals. but more than that, we're worried that the public plan actually becomes a dumping ground for the unprofitable patients. as it's happening in medicare.

bill moyers: what do you mean? how would that happen?

dr. david himmelstein: well, the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. so, you put your signup office on the second floor of a walkup building. and people who can't navigate stairs are the expensive people.

dr. sidney wolfe: get rid of the heart failure patients.

dr. david himmelstein: or you have your signup dinners in a rural area at night, where only relatively healthy people are able to drive and stay up that late. so, there's a whole science to how you sign up selectively healthier patients. and the insurance industry spends millions and millions of dollars on that. and would continue to as they've done under medicare. selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.

and there's really, despite regulations in medicare that says you can't do that, that's continued to happen. and it means that every time a patient signs up with a private plan under medicare, we pay 15 percent more than we would pay if that same patient were in the medicare program.

i also have to throw this bit in:

dr. sidney wolfe: over the last 30 plus years there have been maybe two and a half, three times more doctors and nurses. pretty much in proportion with the growth in population. there are 30 times, 3-0 times more health administrators. these people are not doctors. they're not nurses. they're not pharmacists. they're not providing care. many of them are being paid to deny care. so, they are fighting with the doctors, with the hospitals to see how few bills can be paid. that's how the insurance industry thrives by denying care, paying as little out as it can, getting the healthiest patients, and yet getting reimbursed as though these patients were sicker than they really are.

so, it's a system that is guaranteed to waste a lot of money. and what we've said is that the amount of money that's just being wasted in one year is enough to pay for more than enough of the premiums for those that are uninsured and the people that are underinsured. so, it's not a matter of bringing more money. i mean, the industry is now saying, "we could save $2 trillion over the next ten years. let us. trust us. we will lower our costs and everything." the amount that can be saved over the next ten years by just eliminating the health insurance industry is $4 trillion, in one fell swoop.

half-baked measures that appease the insurance companies would be a disaster for reform and a set back for future reform because conservatives would latch on to any failures as evidence that the "free market" is the only answer. no matter how much money the health insurance industry throws into politicians' coffers, they are still answerable to the voters - getting that message across to baucus was a start but single-payer advocates need to keep the pressure on every decision maker.
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