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Health Care Bills Discussion (On The Actual Proposed Bills)
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kmguru's Avatar kmguru
Moderator (9,976 posts)
Old 11-08-09, 02:49 PM
 #21
Reply With Quote   kmguru is offline
The wellness Program as proposed in the bill is too little and therefore would not provide much benefit. Besides, the way we use the Prescription Drugs is not to cure anything because you have to be on for Life...so how we are going to be well?

The top 40 drugs are (think about the Helth Care industry supporting these drugs...)

1. Lipitor
2. Toprol XL
3. Norvasc
4. Synthroid
5. Lexapro
6. Nexium
7. Singulair
8. Prevacid
9. Ambien
10. Zoloft
11. Advair Diskus
12. Zyrtec
13. Effexor XR
14. Fosamax
15. Plavix
16. Protonix
17. Vytorin
18. Zocor
19. Diovan
20. Lotrel
21. Levaquin
22. Premarin Tabs
23. Zetia
24. Wellbutrin XL
25. Klor-Con
26. Diovan HCT
27. Crestor
28. Avandia
29. Actos
30. Altace
31. Celebrex
32. Viagra
33. Levoxyl
34. Coreg
35. Yasmin
36. Nasonex
37. Seroquel
38. Tricor
39. Lantus
40. Flomax
madanthonywayne's Avatar madanthonywayne
Illegitimi non carborundum (9,727 posts)
Old 11-13-09, 12:09 AM
 #22
Reply With Quote   madanthonywayne is offline
An article in the Wall Street Journal points out that the plan passed by the house would cause the cost of health care to increase rather than decrease and cause the author to lose his insurance and use the money he now uses to pay for insurance to pay the fine imposed for not having it.

The problem is that the "qualified plans" called for in the bill are quite comprehensive and therefore expensive plans. This guy, being self employed, chooses to buy only a very basic plan that covers only hospitalization and he uses the thousands of dollars he saves on premiums to pay for any other costs he incurs. Such plans would not qualify under the house bill, so it would force many to pay for not having insurance rather than paying for a basic plan.

I'm a registered Democrat living in New York City, and I buy my own health insurance. But now, having seen the health-care reform bill that passed the House, I'm preparing for life without health insurance. And unless I'm the only person covered under the Empire Blue Cross/Blue Shield "Tradition Plus" plan, a lot of other people will end up just like me, uninsured.

I will gain one thing, though—an annual fine for losing my insurance. The exact amount of that fine isn't clear yet, but so far it looks like I'll be paying about the same amount—$2,000 a year—for having no insurance as I do now for having it.

Let's get specific. What is the "Tradition Plus" plan that I've purchased each year since moving to New York in 2006? It's a hospitalization plan. If an accident or illness puts me in the hospital, all my hospital expenses are covered. Why is it so affordable? Because it covers only hospital expenses. Any fees from a physician who is not a hospital employee (i.e., who bills the patient privately) I would pay out of pocket.

Before I come to the big question—why will I lose this insurance plan if anything like the House bill becomes law?—I want to address a smaller one. Why do I choose the Empire "Tradition Plus" plan instead of a comprehensive HMO-type plan that covers physician fees, prescriptions, etc.? Because, unlike other states, New York already mandates two things that the current federal health-care reform will mandate. The first mandate prohibits insurers from denying coverage because of a pre-existing medical condition. The second mandate prohibits insurers from denying coverage, or determining prices, based on age. The result is that HMO plans in the state are now very expensive. The price of Empire's basic, least expensive HMO plan is more than $13,000 a year for an individual, more than $26,000 a year for a married couple, and more than $39,000 a year for a family with children. Empire is a reputable firm and those prices are typical of what's available to New York City residents. Upstate New Yorkers pay slightly less.

The only less expensive alternative is the "Tradition Plus" plan. That's why I buy it. The money I save by not buying the basic HMO plan—roughly $11,000 a year—I can draw on to pay for any doctor visits I choose to make.

The House health-care reform bill hinges on what it calls a "qualified" health-care plan. Individuals will be required by law either to buy a plan that meets the criteria of a qualified health-care plan or pay a fine. What are those criteria? They're the basic components of a comprehensive HMO-type plan, which means that Empire's "Tradition Plus" will not qualify because it covers only hospital costs. In other words, if President Obama signs into law the kind of health-care reform bill that is currently on the table, I will have only two choices: buy an expensive qualified plan or pay a fine for being uninsured.

And there is nothing in any of the pending health-care legislation that will make the cost of a qualified plan significantly lower than it is in New York now. On the contrary, once the health-insurance mandates that already exist in New York become the law of the land, insurance premiums everywhere else will rise as they did here. What I can't figure out is why Congress would want to prohibit someone like me from keeping an affordable hospitalization plan. It works for me and it works for the hospital. I guess that's the problem. It's simple, it's easy to understand, and it works.

I realize that we who buy our own health insurance are a fairly small percentage of the market, but there are millions of us. Millions more may have an employer-based plan today, but not tomorrow. So, as I prepare for the winter of my disinsurance, at least I'm not alone.


iceaura
Registered Senior User (10,455 posts)
Old 11-13-09, 03:47 AM
 #23
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Let's lead off by saying that I think these US government plans are doomed, dead on arrival, unworkable failures of conception. That is, I agree with madanthony's author's essential conclusions.

The only option that has a chance is socialized insurance, and everybody who has been paying attention knows this.

But:
Originally Posted by author
What I can't figure out is why Congress would want to prohibit someone like me from keeping an affordable hospitalization plan. It works for me and it works for the hospital. I guess that's the problem. It's simple, it's easy to understand, and it works.
Well, no, it doesn't work.

It doesn't cover the costs of medical care for serious illness, and it doesn't cover the costs of prevention. Joe there is counting on not getting sick. If he does get sick, the cost burden will first bankrupt him, and then fall on others. And any buildup of costs from his likely failures to keep up with prevention and early detection routines will contribute to the total cost of the system, regardless of who pays.

Plans like that are why 75% of the medical cost driven bankruptcies in the US involve people who had insurance, and why emergency rooms are going under in a swamp of crises that should have been routine doctor visits months earlier.

Originally Posted by author
The result is that HMO plans in the state are now very expensive. The price of Empire's basic, least expensive HMO plan is more than $13,000 a year for an individual, more than $26,000 a year for a married couple, and more than $39,000 a year for a family with children. Empire is a reputable firm and those prices are typical of what's available to New York City residents
So all that free market stuff doesn't keep the costs down? We are not shocked.

In France, in Paris, coverage much better than Empire's "basic" plan costs the citizens less than a third of those numbers.

But Joe there is worried about losing the horseshit plan he has (ask anyone who has landed in the hospital for sudden emergency what percentage of such costs Joe will probably be paying, according to that description. And that's the stuff Joe thinks he has covered!). That's how bad this system is - guys like Joe are worried about losing insurance like that.
madanthonywayne's Avatar madanthonywayne
Illegitimi non carborundum (9,727 posts)
Old 11-14-09, 11:48 AM
 #24
Reply With Quote   madanthonywayne is offline
Originally Posted by iceaura
But Joe there is worried about losing the horseshit plan he has (ask anyone who has landed in the hospital for sudden emergency what percentage of such costs Joe will probably be paying, according to that description. And that's the stuff Joe thinks he has covered!). That's how bad this system is - guys like Joe are worried about losing insurance like that.
Hospital costs are the ones that can really kill you. When my son broke his femur he was in traction in the hospital for a few weeks. The doctor's bills were a few thousand dollars. The Hospital bill was over $300,000.

Furthermore, he's clearly better off with the plan he has now than paying the same amount of money in fines and having no coverage whatsoever.
joepistole's Avatar joepistole
Honor, Courage, Commitment (5,922 posts)
Old 11-14-09, 02:47 PM
 #25
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As Ice pointed out, these watered down plans do not cover the risk. Should the insured suffer a seriouss illness, his plan will not pay his expenses. Will the insured be able to pay those expenses, likely not. So who pays for those services, the hospital directly. But since the hospital does not have a local printing press where they can create money to pay their bills those costs have to be passed on to those who do have good insurance and can afford to pay our bills...driving up healthcare costs. That is why everyone is required to carry an insurance policy sufficient enough to cover potential expenses.
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