Tuesday, September 22, 2009

Let's start discussilng the details

Now that everyone has gotten his anger off his chest about the Healthcare Reform, it seems to me we ought to start discussing real details. For example instead of denying or affirming that a "death panel" is proposed in the Reform act, let's discuss what a "death panel" might look like and when it would be appropriate and whether it is something that should be included in a package paid for by public tax money. The same should be done with premarital counseling, elective plastic surgery, breast enhancements, hearing aids, etc. The list is surprisingly short. Most of us have compared insurance policies during open enrollment with an employer. So we're not talking about a 1,000 page document.

I think we ought to talk about actual pay to doctors, hospitals, independent therapists. The discussion to this point is so general and non-specific that almost any plan might qualify. That may be the intention of President Obama and it may be a good strategy but it isn't one I particularly like. Give me some details just like I get from Blue Cross, Kaiser, and Pacificare.


  1. I keep wondering when Social Security, Medicare and Medicaid were fixed to move on to fixing all of healthcare. I must have missed all of those memos....

    An actuarial table of services provided based on age and other health factors (my understanding is this is what the UK has) makes sense for the government option assuming the government option is meant to be the cheaper\minimum option that all Americans are required to pay into if not covered under a more comprehensive\free market option. I heard the Senate Finance committee last night (get to watch c-span in the hotel) discussing prices for the government option, but to your point I have not heard anyone discussing what the governement option would cover or if they would have different rates for different ages or health habits (which of course would seem logical but sometimes politics and lobbyists get in the way of logic).

  2. What I think is telling is that part of the funding will come from "savings" earned by reducing payments the government currently pays to insurers to provide Medicare Advantage. When those payments are reduced, plan benefits are necessarily going to be reduced. But when one insurance carrier sent letters to each of their policy members alerting them of this fact, Senator Baucus called Medicare CMS to tell the insurance company to stop it. And Medicare has told the insurance plan such letters were not allowed. The powers that be do not like Medicare Advantage: one of my friends read the book that came with the Medicare enrollment process and found that it said if you chose a Medicare Advantage plan, and stayed on it for more than 1 year, you would not be able to switch back to regular Medicare! If the terms of the Advantage plans change significantly, then the regular Medicare plus a better Medigap policy might be better. But I'll bet the government would decide what provisions were not to be allowed in these policies as well. He who pays the bills calls the shots. I have wondered if the government can solve the Medicare funding problem by having everyone on a national-type system: then they can reduce benefits to everyone so the Medicare enrollees don't think they are alone in reduced coverage/choices. Another funding proposal is to tax insurers who offer more expensive policies that cover more options, which will raise premiums. I just turned 65 and compared Medicare A & B to my old insurance. We currently pay $465/month for a family policy. It is aces and spades better than Part A/B combined, which is why you need to buy a Medigap policy. Our insurance company said if we rejected coverage of Medicare, our company would only be able to give us the same coverage as Medicare A/B! Since I don't know what the government is going to be up to with the Medicgap and Advantage programs, we are keeping our retiree health benefits and paying the extra Medicare premium for the benefit!

    How many doctors do you know who will not accept new patients if they are on Medicare? How many doctors do you think might retire completely if we get the new health system? How can we afford it if we have such a huge deficit? The 1000 plus page house bill does not appear to cover details very well. It is broad language, but is so big because it is double spaced so the legislators can write stuff in/out in conference. The generalities are worrisome, and without specifics, could be very worrisome. Ach--I will cut this long story short!

  3. I'm just pleased as punch that I have now seen a blog entry and two comments in a row where everyone is frustrated, but no one insulted another person. I've seen conversation between friends turn ugly over this. Yay for civil dialogue without inflammatory language.

  4. Add a couple of facebook comments that were equally well-mannered. I am also impressed. I know I won't be voting for anyone next November who has the manners of a toddler throwing a tantrum or has done nothing constructive to make this world or this country a better place to live. A big thanks to you who contribute to civil discourse and progressive planning.

  5. I hope I can write an observation or two about the healthcare issue you raised in a recent blog. I don't intend to be argumentative or insulting, just following up on what you wrote.

    I have been following the Senate Finance Committee's deliberations this week on CSPAN. Watching and hearing (something I sometimes, well, really often times miss) the hearing is much more confusing than reading some commentator's evaluation of what has been going on. My mind is not so far gone that I cannot reach conclusions without being prompted by someone in the media who doesn't have any better ability than I do to sift through the dialogue.

    My frustration level is significant as I watch first hand the machinations of partisanship in a body we trust with our future. Yesterday I watched our Senators debate the issue of the "donut hole" in Medicare part D, the drug plan. Having been caught in that donut hole I have some personal experience in what the Senators were discussing (maybe cussing rather than discussing would be more appropriate). Without getting too specific (something the Senators also seem to avoid) I wonder why the donut hole was part of the original legislation in the first place. It seems to me that people who consume costly medications quickly in order to preserve life and reasonably good health, and enter the donut hole are precisely the ones who need help with the cost of medication. I suspect that you and Caroline can identify with this concept.

    A general observation about the hearings will suffice. I am alarmed at the nit picking, partisanship, political theater evidenced in the hearings. And that observation relates to all parties, not just one side or the other. This demonstration of the way our government operates is disturbing to me.


  6. Thanks for letting me move your comment to this thread. It represents a side of the discussion which is all too often ignored. I certainly agree with your observation of the machinations of the legislative branch of our federal government and probably the state governments as well. Having worked with private corporations all my life where a good portion of the board of directors' time was spent attempting to be more effective, I find the legislature appalling. They seem to be looking for ways to get nothing done at all and blame it on the opposition. If the play "1776" is at all accurate history, this behavior of the legislature is not new and, in fact, may have been purposefully designed that way.

    I contend that for something as important as national Healthcare reform, both parties have an obligation to put together something that is simple, straightforward and presentable to normal people such as you and me. If insurance companies can do it, why not the most powerful government in the world?