12
   

What do you think of Obama's health care plan?

 
 
Reply Thu 10 Sep, 2009 06:43 pm
Amid all the talk about the political process the policy itself is something comparatively neglected. I'd be interested in hearing other opinions about the plan Obama released. In case you haven't seen it here it is:

http://www.whitehouse.gov/issues/health_care/plan/

What do you think?
 
Robert Gentel
 
  1  
Reply Thu 10 Sep, 2009 06:59 pm
@Robert Gentel,
And, what do you think of Obama's speech?

The Sideshow Becomes the Center Ring

Quote:
According to a CNN flash poll [PDF], the president killed. Asked, "What was your overall reaction to President Obama's speech tonight -- very positive, somewhat positive, somewhat negative or very negative?" 77% of respondents answered that it was either very or somewhat positive, with the majority -- 56% -- calling their reaction "very positive."

But that isn't the only indication that the president's words had an impact. Where 60% said they thought Obama would move the country in the right direction before the speech, 70% thought so afterward -- a ten-point jump. He had even more success with opinions of his specific plan; 53% supported Obama's healthcare reforms before the speech and 67% favored them afterward.

75% believe that congress will pass most of his proposals and 72% felt the president was clear about what he wanted. Looking through this, there isn't a bad number in this poll. But Joe Wilson is getting a lot of the coverage.
Foofie
 
  1  
Reply Thu 10 Sep, 2009 07:14 pm
My concern is that it could turn out to be a cash cow for the governement. Sort of like bridges and roads that are only supposed to have tolls, until the construction is paid off, yet the toll booths remain forever.

Since the Democrats have a predilection to caring social programs, I am wondering if there will always be another social program that requires funding, and tweaking the government health care system could free up a few dollars? But then again, I am a cynic when it comes to the Democrats and my cynical belief that they are willing to make the government the proverbial policeman for social equality a la Robin Hood. Just my opinion.
0 Replies
 
Diest TKO
 
  1  
Reply Thu 10 Sep, 2009 07:17 pm
my most noteworthy thing is that Obama chose to not back down on the public option.

This was very important to me, and after Obama had made the wishy-washy-if-there-isn't-a-public-option statement a month ago, that's when I personally observed things unravel the most. This seemed to bring things back in focus for me.

Other than that, I'm pleased with firm language about pre-existing conditional care and preventative care.

T
K
O
Robert Gentel
 
  1  
Reply Thu 10 Sep, 2009 07:21 pm
@Diest TKO,
Diest TKO wrote:
my most noteworthy thing is that Obama chose to not back down on the public option.


This is actually the part I'm most interested in hearing thoughts about. I've got mixed feelings about it, by claiming that this won't cost a dime it's not the same public option that I think anyone had in mind.

I need to study more, but my impression is that it's closer to a co-op than a real public option.
0 Replies
 
dyslexia
 
  2  
Reply Thu 10 Sep, 2009 07:32 pm
I was pretty impressed with the second half of the speech; there were few/none specifics in the first part. In terms of cost I don't have a problem with impact on the fed budget, we need to pay for what we get I just want to be sure we get what we need. On the other hand I believe good medical care available to all (including illegal aliens) is very important and ranks even higher than good education for all.
ebrown p
 
  2  
Reply Thu 10 Sep, 2009 07:36 pm
@dyslexia,
Well Dys, I almost agree with you... 'cept I don't think there should be any illegal aliens.
0 Replies
 
rabel22
 
  1  
Reply Thu 10 Sep, 2009 11:18 pm
If they keep the public option I will be forced to admit that health insurance is moveing forward under the dems just as they promised. However I will wait to see what the final bill looks like after its passed. Look at what has happened to the so called bill which was supposed to regulate the banking industry. they , the banks, can still steal as blatently as they ever have. Its still big money that talks the loudest.
0 Replies
 
roger
 
  3  
Reply Fri 11 Sep, 2009 02:18 am
@Robert Gentel,
Mostly responding to the topic headers:

•Ends discrimination against people with pre-existing conditions.

•Limits premium discrimination based on gender and age.

•Prevents insurance companies from dropping coverage when people are sick and need it most.

Those are important goals. Keep in mind that they can only be acheived if insurance is mandatory. All the young, healthy and active people not engaged in dangerous activities are going to have to be dragged into the program, whether they like it or not, and they are going to have to pay substantially the same premium as transplant recipients, the old, and the chronically ill. The only other possibility is massive government subsidy.



•Caps out-of pocket expenses so people don’t go broke when they get sick.

Another fine goal. Again, it's going to be paid for by premiums from the lowest risk part of the population, and I am already hearing grumbles about having to support Medicare. Somebody is going to have to pay for it.

•Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.

Good idea. I never had such a problem when I had company sponsored health care, but someone must have run into it. Oddly, one of the ways we are going to pay for the whole shebang is to reduce "unnecessary" diagnostic tests. I have concerns about who is going to decide what is necessary. Personally, I vote for my doctor's opinion. I selected him for a number of reasons, and his professional judgement is one of those reasons.

•Protects Medicare for seniors. The President’s plan will extend new protections for Medicare beneficiaries that improve quality, coordinate care and reduce beneficiary and program costs.

I have no idea what "coordinate care" means. Otherwise, it's a vague statement, and the best care in the world is meaningless unless doctors and other providers are willing to accept new Medicare patients. At present rates of compensation, most do not.

•Eliminates the "donut-hole" gap in coverage for prescription drugs.

The donut hole exists for those who choose Medicare Part D. Part D is purchased from private insurance. The options are nearly endless. You can have a plan with no deductable and little or maybe no co-pay. It is very expensive. You can choose a policy with up to $295.00/year deductable and moderate co-pay for much less. There are all kinds of combinations, and they are priced accordingly. If every Part D plan is going to cover unlimited prescriptions, every plan is going to cost much, much more. Or again, there will have to be massive subsidies. I am not aware of just how much these plans are already subsidized, but I'm sure they are. My own total cost for drugs, premium, co-pay, and deductable are less than the absolute minimum known cost of prescriptions.


If You Don't Have Insurance
Quality, Affordable Choices for All Americans


•Creates a new insurance marketplace " the Exchange " that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices. The President’s plan allows Americans who have health insurance and like it to keep it. But for those who lose their jobs, change jobs or move, new high quality, affordable options will be available in the exchange. Beginning in 2013, the Exchange will give Americans without access to affordable insurance on the job, and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits, and quality.

Depending on how you define "high quality" and "affordable", I simply don't believe it.

•Provides new tax credits to help people buy insurance.

I think that means other people are going to see their taxes go up.


•Provides small businesses tax credits and affordable options for covering employees.

Again, it just might depend on what he means by "affordable". If small business indeed pay higher premiums for the same coverage for employees, this should be addressed.

Tax credits. Um, weren't we recently talking about removing the tax advantages of health insurance from both employers and employees to cover the costs of health care for everyone?

•Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.

Maybe I can comment on this at some other time. Maybe.

•Immediately offers new, low-cost coverage through a national "high risk" pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

Redundant. Our President and I both covered the essence of this in the first three topics.


•Won’t add a dime to the deficit and is paid for upfront.

First, this says "to the deficit". It does not say it won't add to total costs. Second, I just plain do not believe it.

•Requires additional cuts if savings are not realized. Under the plan, if the savings promised at the time of enactment don’t materialize, the President will be required to put forth additional savings to ensure that the plan does not add to the deficit.

As I read this, it means that cuts are going to be made to health care immediately, and if that doesn't do the trick, it will be cut, and cut again. That's possibly the most open ended statement I've ever heard, except for the guy that told me he would pay back the twenty I lent him when his pony came in. Needless to say, his pony did not come in.


•Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality. The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes.

Robert, if you understand that, I was you would explain it to me.


•Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.

Well, I think that explains what the doctors will do for a living, if they are driven out of business.



•Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.

This could be a good idea, depending on how it is implemented.

•Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.

Okay, it's like any other business tax. It will either be paid from price increases, or the unemployment numbers are going to take a hit. Clearly, "individuals who can afford it" means it will be mandatory participation, which I assumed from the first three topics, combined. Whether good or bad, that's how it will be.
chai2
 
  1  
Reply Fri 11 Sep, 2009 05:09 am
Roger, thank you for intelligently listing and commenting on all the thoughts that were running around in my head while reading Roberts link.
0 Replies
 
FreeDuck
 
  1  
Reply Fri 11 Sep, 2009 08:33 am
@Robert Gentel,
I don't think it's enough. I would have preferred single payer.
0 Replies
 
FreeDuck
 
  1  
Reply Fri 11 Sep, 2009 08:38 am
This:
Quote:
Beginning in 2013, the Exchange will give Americans without access to affordable insurance on the job, and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits, and quality.

If the mandates take effect before this I see it as a significant burden on people who do not have access to employer-sponsored insurance.
McGentrix
 
  1  
Reply Fri 11 Sep, 2009 08:40 am
@FreeDuck,
FreeDuck wrote:

This:
Quote:
Beginning in 2013, the Exchange will give Americans without access to affordable insurance on the job, and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits, and quality.

If the mandates take effect before this I see it as a significant burden on people who do not have access to employer-sponsored insurance.


It also gives the Obama administration the breathing room needed to get past the next election.
FreeDuck
 
  1  
Reply Fri 11 Sep, 2009 08:52 am
@McGentrix,
McGentrix wrote:

FreeDuck wrote:

This:
Quote:
Beginning in 2013, the Exchange will give Americans without access to affordable insurance on the job, and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits, and quality.

If the mandates take effect before this I see it as a significant burden on people who do not have access to employer-sponsored insurance.


It also gives the Obama administration the breathing room needed to get past the next election.

I'm not convinced it helps him. The people who are against a public option are not going to be voting Democrat, period. But people who want it might stay home.
0 Replies
 
ossobuco
 
  1  
Reply Fri 11 Sep, 2009 09:45 am
@roger,
That was a terrific breakdown by you there, Roger, thank you for doing that. I've one immediate comment on something towards the end -

roger wrote:

Mostly responding to the topic headers:

•Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality. The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes.

Robert, if you understand that, I was you would explain it to me.


A New Yorker article, typically long, that addresses some ideas on this -
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
I'm not going to quote pieces of it because the author develops his concepts over the course of the article. Plus, last time I quoted the first sentence, you mis-took it, Roger.

A short NYT opinion piece by Gawande et al that gives sort of clip view of possibilities for lowering medical costs is here -
http://www.nytimes.com/2009/08/13/opinion/13gawande.html?ref=global-home

The first article gives a thorough description of medical practices re ordering tests or surgeries in two communities in Texas, each with very similar economies, populations, and medical needs, and explores the reasons for the differences in expenses and discusses medical outcome statistics for the two places. Then it goes into what is offered in some existing systems that are both well regarded re medical expertise, medical outcomes, and expenses - that is, how some people solve making expenses smart with good outcomes.
Gawande et al don't insist on a cookie cutter solution from on high, but are offering examples for what can work.

The second article, is, as I said, merely a clip and not a fraction as interesting as the first.
ossobuco
 
  1  
Reply Fri 11 Sep, 2009 09:54 am
@ossobuco,
Ahhhh, omit the word "both" in front of well regarded - I meant to use two categories for the regard, not to say he was describing only two alternatives for smart practices.
0 Replies
 
Finn dAbuzz
 
  0  
Reply Fri 11 Sep, 2009 05:21 pm
Bookmark
0 Replies
 
Finn dAbuzz
 
  1  
Reply Fri 11 Sep, 2009 11:02 pm
@Diest TKO,
Diest TKO wrote:

my most noteworthy thing is that Obama chose to not back down on the public option.

This was very important to me, and after Obama had made the wishy-washy-if-there-isn't-a-public-option statement a month ago, that's when I personally observed things unravel the most. This seemed to bring things back in focus for me.

Other than that, I'm pleased with firm language about pre-existing conditional care and preventative care.

T
K
O


Why is the public option so very important to you?
Diest TKO
 
  2  
Reply Sat 12 Sep, 2009 12:01 am
@Finn dAbuzz,
I agree with the President that it will create competition in the private market and get cost down along with quality up.

I think his public-private school example and my public defender-private legal practice example illustrate that private industry can thrive with a non-profit competitor.

Without the public option, I still would be glad for the other two things, but I know a lot of uninsured people who would benefit from access to a public plan. I lived without insurance myself up until a year ago. I have a firend with cancer who is fighting his insurance company as hard as his tumor, and another friend who has been diagnosed HIV positive a month after getting laid off and losing his insurance.

T
K
O
0 Replies
 
Finn dAbuzz
 
  1  
Reply Sat 12 Sep, 2009 12:37 am
@roger,
roger wrote:

Mostly responding to the topic headers:

•Ends discrimination against people with pre-existing conditions.

•Limits premium discrimination based on gender and age.

•Prevents insurance companies from dropping coverage when people are sick and need it most.

Those are important goals. Keep in mind that they can only be acheived if insurance is mandatory. All the young, healthy and active people not engaged in dangerous activities are going to have to be dragged into the program, whether they like it or not, and they are going to have to pay substantially the same premium as transplant recipients, the old, and the chronically ill. The only other possibility is massive government subsidy.

I appreciate your choice of words roger.

They are "important" goals but why and for whom?

People have been conditioned to regard any and all "discrimination" as undesirable, unfair, and even immoral, but this is foolish. As you rightly point out, if we are to eliminate discrimination in terms of healthcare coverage based on age, gender, and medical history, then we must eliminate discrimination in terms of the cost for that coverage based on the same factors.

But, of course, this is not what Obama and the Democrats would have us believe.

Insurance is based on principles of risk spread and the law of large numbers, but has always distinguished between low risks and very high risks. This why young men under the age of 25 pay much more than the rest of us for car insurance.

While men in this age group are more likely than the rest of us to have accidents, it is not certain that they will and so although they may have to pay more than us for insurance, they remain insurable.

A person (young or old) who is not insured, but has just had an accident is not able to call an insurance agent and obtain coverage for his car that is retroactive to one minute before the accident.

It makes absolutely no sense to insure a known loss, unless the premium the company charges is some percentage higher than the cost of the loss and the expense required to process the claim. Why would anyone buy such "insurance?"

However to mandate that insurance companies cannot reject persons with pre-existing conditions comes close to mandating that they also provide a policy for a house that is on fire.

If, God forbid, you or I have cancer but we have no insurance, how can any health insurance company be expected to provide us with coverage at a cost that is less than the cost of the healthcare for our cancer?

The answer is they cannot, unless

a) They are allowed to charge everyone else a rate that is in no way based on our own health statistics, but geared to offset the cost of care for known cancer patients

b) The intent is to drive them out of business

"A" illustrates the intellectual dishonesty of the argument of the president and most Democrats.

Government mandates insurance companies take risks that are beyond a profitable model and then Government castigates these insurers for increasing their premiums.

Most people do not realize that insurers are not able to raise their prices without State approval. If insurance premiums rise, it is because the companies have made a compelling case to Government that an increase is necessary.

This is the cynical and disingenuous Kabuki dance in which Obama and the Democrats want to engage: Just about regulate the profit out of insurance and then cast the insurance companies as out of control bad guys.

Because of extreme regulation, insurance profit margins are very very thin. It is absolutely foolish to invest in any publicly traded insurance company that is subject to regulations.

Government controls insurance prices and mandates terms of coverage. Does anyone really think that the profitability of insurance companies is a major concern of Government regulators? Reluctant assent to increased premium is given only when regulators fear that an insurance market in their state will disappear.

Most Democrats and some Republicans prefer that Government pay for the losses of their citizens. In this way they can artificially keep costs down for the voters and punt the real financial implications to ensuing generations.

The state funded and run property insurance company in Florida is a perfect example. If you live in Florida, there is a much greater chance that your house will be damaged by a hurricane than if you live in Ohio, and yet Floridians want to pay the same premiums as folks in Ohio. Insurance companies can only spread the risk so far. Catastrophes that cost insurance companies billions of dollars happen regularly in Florida. They do not in Ohio. People in Florida should pay more for homeowners insurance than people in Ohio.

For political reasons, the state of Florida has established a state funded insurance pool to cover those citizens who do not want to, or cannot pay their fair premium.

What a great idea!

The state can do so because it doesn't demand profit, and it doesn't incur those ridiculous costs of executive shindigs in Boca Raton. Right? (Sound familiar as regards the "Public Option" for health insurance?)

Problem is that in subsidizing insurance for an enormous number of Floridian properties, the state's "insurance company" is one major hurricane away from total insolvency. The math of economics is not suspended because Government is involved.

So what will happen if a category 5 hurricane hits Florida? The state run "insurance company" will go bust and be unable to pay claims. What will they do then? Well, what they plan on doing is levying "assessments." Assessments against:

1) The insurance companies that do business in FL but never saw a dime of the premiums paid by the state's insureds
2) Out of state property owners - Snowbirds who have vacation residences in FL but don't vote there.
3) The citizens of Florida who have paid premiums to private insurance companies.

None of these assessments will be enough and so the ultimate bail-out source will be the federal Government.

There is a reason why Florida and other coastal states are pushing for a Federal Catastrophe Insurance fund --- subsidized by the citizens of Ohio, Michigan, Kentucky, Nevada, Arizona, etc etc etc.

Obama's health insurance plan is to drive private insurance companies out of business, and get the pesky constraints of economics out of way of pleasing voters, but just like the Florida Catastrophe Fund will, eventually, have to pay the piper, so will a Federal Health Insurance option.

BTW - what insurance company is able to cancel coverage once one of their policyholders becomes ill? This is a straw man.



•Caps out-of pocket expenses so people don’t go broke when they get sick.

Another fine goal. Again, it's going to be paid for by premiums from the lowest risk part of the population, and I am already hearing grumbles about having to support Medicare. Somebody is going to have to pay for it.

There is a tried and true principle known as "Having Skin in The Game." If you personally bear some measure of a risk you are more likely to mitigate that risk. The Obama plan will have those who do mitigate their risks by exercising, eating healthy and not smoking, paying for their fellow citizens who cannot be bothered.

Of course, this inherent inequity can be resolved by not requiring the fit to subsidize the unfit: Let the Government pick up the extra cost. Of course there is no way this can possibly happen without increasing the deficit.


•Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.

Good idea. I never had such a problem when I had company sponsored health care, but someone must have run into it. Oddly, one of the ways we are going to pay for the whole shebang is to reduce "unnecessary" diagnostic tests. I have concerns about who is going to decide what is necessary. Personally, I vote for my doctor's opinion. I selected him for a number of reasons, and his professional judgement is one of those reasons.

Another straw man Most private health insurance plans pay for preventive care, and the notion that preventive healthcare will save money over the long run sound logical but has not been proven.

Remember when HMOs came on the scene? Their marketing reps would always try to sell you on the fact that you could always visit your HMO doctor whenever you had an ache or the sniffles, because they knew that preventive care would save them money in the long run. What actually happened though? Whenever a virus hit town and you wanted to see your HMO doctor because of your sniffles, you were told that he or she was not seeing patients with minor symptoms and to call back if they got worse. Obviously the model didn't work.

Expensive superfluous tests will be brought under control when there is medical malpractice tort reform, and not before. The alternative is to have a bureaucrat decide what tests are valid = personal disasters.

Enough for tonight.




 

Related Topics

Obama '08? - Discussion by sozobe
Let's get rid of the Electoral College - Discussion by Robert Gentel
McCain's VP: - Discussion by Cycloptichorn
McCain is blowing his election chances. - Discussion by McGentrix
Food Stamp Turkeys - Discussion by H2O MAN
The 2008 Democrat Convention - Discussion by Lash
Snowdon is a dummy - Discussion by cicerone imposter
GAFFNEY: Whose side is Obama on? - Discussion by gungasnake
 
  1. Forums
  2. » What do you think of Obama's health care plan?
Copyright © 2019 MadLab, LLC :: Terms of Service :: Privacy Policy :: Page generated in 0.04 seconds on 06/20/2019 at 01:17:59