Pending Health Care Reform

“October 7, 2009
Congress Breaks Obama Promise on Government Role in Health Care
by Dennis G. Smith

One of the reasons Americans are understandably wary of the current health care legislation moving through Congress is that the specifics of legislation do not match the rhetoric of the President. To defuse public suspicions, researchers at the Urban Institute recently published a study trying to persuade ordinary Americans that "[c]urrent national health reform proposals would not cause 'a government takeover of health care.'"[1]

However, what President Obama actually promised is that reform "will keep government out of health care decisions."[2] Like the definition of what constitutes a tax, whether the President is keeping his promise depends on how one defines the word takeover.

The Wrong Yardstick

The thrust of the Urban analysts" argument is that growing fears of a federal takeover of American health care are unfounded because the federal government will not own hospitals, nor will all the physicians in America be federal employees. Thus, they write, "Nothing in pending proposals would increase the proportion of care provided by publicly owned hospitals or by publicly employed physicians."[3] They contrast the Veterans Administration, which does own facilities and employs doctors, with Medicare, which reimburses private providers.

Curiously, they do not mention the government-run health care system that has operated under the Department of Health and Human Services (HHS) for more than 50 years: the Indian Health Service (IHS), which directly employs more than 15,000 individuals and operates hospitals, health centers, and other clinics. Per capita expenditures under the IHS are $2,349 per user, compared to the total U.S. population of $6,538.[4]

If per capita expenditures are the measure of efficiency, the IHS model would be the winner hands down. But poor access to health care is clearly an issue with the IHS, which may perhaps be the reason the report does not reference it as a means of showing how well government run health care can work.

Species Vary

It would also be wrong to conclude that the Veterans Administration or IHS models are the only forms of government-controlled health care.

The Urban analysts opine that the proposed government-run health insurance option, like that which is proposed in the House bill (H.R. 3200), will be just like any other private health plan. Of course, inasmuch as the federal authorities have never run anything remotely like a private insurance health plan, it is hard to imagine how such a public health insurance option will actually operate.

In the House bill, the "public option" is described in a mere seven and one-half pages of text, leaving considerable discretion and unprecedented power in the hands of the executive branch.[5] Section 221 specifies, "In designing the [public] option, the [HHS] Secretary"s primary responsibility is to create a low-cost plan without comprimising [sic] quality or access to care."[6] That leaves a lot of room for the exercise of government power and thus political--as opposed to private--decision making.

Concentrated Power

Under the House bill, for example, what are the limits of political power? Where is the line inappropriately crossed, say, when the congressionally created commissioner of the new Health Choices Administration and the HHS Secretary define health benefit coverage and the delivery system? At what point do these regulatory interventions insert themselves into the practice of medicine? For example, will there be:

A drug formulary?
Limitations on the number or types of drugs?
Limitations on the amount, duration, and scope of services?
Prior authorization?
Physician profiling?
Excluding physicians for ordering too many tests?
Different types of managed care?
HMOs?
Only one national HMO?
Selective contracting for any types of providers?
National coverage decisions on new technologies?
No one, including the Urban analysts, knows the answers to these questions based on the House legislative text alone. If any of these measures are adopted--all of which insert bureaucracy into the practice of medicine to some degree--then the size of the federal "takeover" is proportionate to the number of people in the government plan. Authors of the legislation apparently believe the number of people in the government plan will be large, because Section 223 essentially drafts every provider currently in the Medicare program.[7]

The Myth of "Negotiation"

Some proponents of the House bill insist that the government health plan will not use its leverage in the marketplace to muscle out private competition. This is perplexing. If the government plan is not "big enough" in terms of the number of covered lives, then it does not have sufficient market share to use leverage against doctors and hospitals. Without such leverage, it cannot lower costs.

For years, some Members of Congress have supported legislation to allow the HHS Secretary to "negotiate" prices of prescription drugs. Negotiation is a polite word for something very different: price fixing. Coercion is more accurate.

How does it work? The same way states--led by California--have done it for years in Medicaid: getting supplemental rebates from drug manufacturers. California threatens to limit access to a manufacturer"s products unless the manufacturer lowers its price. California then gets deeper discounts because the manufacturer cannot afford to forfeit the state"s business.

While it is true that physicians participating in the government health plan would not be direct employees of the federal government, their income will be increasingly dependent upon what federal officials decide to pay. The more people join the government plan, the more their physicians will depend on the federal government for their income. Federal funding will not just affect the market; it will become the market--doctors and hospitals will not be able to opt out or avoid it.

Just as California has used its leverage to force drug manufacturers to accept lower payments, so too would the federal government force doctors and hospitals to accept lower reimbursement. If reimbursement falls "too low," as the experience of state Medicaid programs show, beneficiary access to services is threatened. It is ironic that congressional proponents argue that the federal government is not a threat to access to care when Section 1121 of the bill proposes to "fix" the sustainable growth rate for physicians under Medicare at a cost of $228 billion.[8]

Obviously, no one, including the Urban analysts, can say how future events will unfold. Should the House bill become law, for example, after four years doctors and hospitals would be paid essentially what the federal government wants to pay: "The [HHS] Secretary shall continue to use an administrative process to set such rates in order to promote payment accuracy, to ensure adequate beneficiary access to providers, and to promote affordability and the efficient delivery of medical care."[9]

Drafting Doctors

The idea that doctors will somehow be free from government coercion is na�ve. Under Section 223 of the House bill, every medical professional currently in the Medicare program would be, in effect, "drafted" into the new government health plan.

How is requiring every current Medicare provider to join the public plan--unless the HHS Secretary agrees to let that provider out--not a government takeover?

More Dependency

CBO estimates that under current law, there will be 74 million people by 2019 who are served by Medicaid for at least some part of the year.[10] Assuming the State Children"s Health Insurance Program continues, another 7 million children will be covered if current enrollment stays the same. Another 60 million individuals will be served by Medicare.[11] Approximately 8 million will be served by both Medicare and Medicaid, leaving a net Medicare and Medicaid population of about 126 million people. CBO estimates another 11 million individuals will be added to Medicaid under H.R. 3200, and 30 million individuals will receive new government subsidies, bringing the total number of individuals receiving some form of government assistance for health care to about 174 million.

Again, the government market will be so large that doctors and hospitals will be forced to increase their government business, which will displace their private business. Yet the President has also warned, "Medicare costs are consuming our federal budget. ... Medicaid is overwhelming our state budgets."[12] The history of Medicare and Medicaid shows that government budgets control costs by cutting eligibility, cutting benefits, or coercing providers--which in turn limits access to health care.

Inevitable and Unprecedented

Under current law and assumptions, by 2019, the Medicare Trust Fund will have been depleted for two years; it will then no longer be able to pay its bills on time. Furthermore, the President has also vowed not to raise taxes on the middle class--a shaky promise in light of the transactions now occurring in the Senate Finance Committee--and to not increase the deficit by one dime. With the collision of all of these events, a government "takeover" in the form of greater government control over health care financing and the practice of medicine is inevitable.

Dennis G. Smith is Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation.



--------------------------------------------------------------------------------

[1]Stan Dorn and Stephen Zuckerman, "Current Health Reform Proposals: No Government Takeover of American Health Care," Urban Institute, September 2009, at http://www.urban.org/uploadedpdf/411952_current_health
_reform.pdf (September 23, 2009).

[2]Press release, "News Conference by the President," the White House, July 23, 2009, at http://www.whitehouse.gov/the_press_office/News-Conference
-by-the-President-July-22-2009/ (October 7, 2009).

[3]Dorn and Zuckerman, "Current Health Reform Proposals," p. 3.

[4]U.S. Department of Health and Human Services, Indian Health Service, "IHS Fact Sheet: Year 2009 Profile," at http://info.ihs.gov/Profile09.asp (September 23, 2009).

[5]America"s Affordable Health Choices Act of 2009, H.R. 3200, Subtitle B, 11th Cong., 1st Sess., Sections 221-226, pp. 116-128.

[6]Ibid., p. 116.

[7]Ibid., p. 124.

[8]See Dennis G. Smith, "The Baucus Health Bill: A Medicare Physician Payment Shell Game," Heritage Foundation WebMemo No. 2629, September 25, 2009, at http://www.heritage.org/Research/HealthCare/wm2629.cfm.

[9]America"s Affordable Health Choices Act of 2009, p. 123.

[10]Congressional Budget Office, "Spending and Enrollment Detail for CBO"s March 2009 Baseline: Medicaid," at http://www.cbo.gov/budget/factsheets/
2009b/medicaid.pdf (September 28, 2009).

[11]Congressional Budget Office, "CBO"s March 2009 Baseline: Medicare," March 24, 2009, at http://www.cbo.gov/budget/factsheets/2009b/medicare.pdf (September 28, 2009).

[12]Press release, "Remarks by the President at the Opening of the White House Forum on Health Reform," March 5, 2009, at http://www.whitehouse
.gov/the_press_office/Remarks-by-the-President-at-the-Opening-of-the-
White-House-Forum-on-Health-Reform/ (October 7, 2009).”

“CBO: Cost $829 billion+ and 25 million+ still left uninsured?

Even if you buy into the BS that its about helping the uninsured please tell me with these stats what's the point.”

“That sounds just like the fvcking National Redneck Association and the Assault Weapons Ban. They did their fvcking damdest to emasculate the bill, THEN THEY COMPLAINED THAT IT DIDN'T HAVE ANY TEETH.

Fvcking Scuz.

”

“YEah, those f'ing rednecks at the CBO!”

“LOL...Tilty hits the "usual lame reply" button and goes back to contemplating the next planet out past Saturn.”

“
The S-Word and Dr. Kevorkian's Accountant

Health care Rx from my socialist fire department

Thursday 15 October 2009
by: Greg Palast, t r u t h o u t | Op-Ed


Tell me where it hurts, Mr. President.

What's killing you, Barack, is what's killing us all: an evil germ called "Medical Loss Ratio."

"Medical Loss Ratio" [MLR] is the fancy term used by health insurance companies for their slice, their take-out, their pound of flesh, their gross - very gross - profit.

The "MLR" is the difference between what you pay an insurance company and what that insurer pays out to doctors, hospitals and pharmacists for your medical care.

I've totted it up from the raw stats: The "MLR," insurance companies' margins, is about to top - holy mama! - a quarter trillion dollars a year. That's $2.7 trillion over the next decade.

Until the 1990's, insurers skimmed only about a nickel on the dollar for their "service," Wendell Potter told me. Potter is the CIGNA insurance company PR man who came in from the cold to tell us about what goes down inside the health insurance gold mine. Today, Potter notes (and I've checked his accuracy), porky operators like AIG have kicked up their Loss Ratio by nearly 500 percent.

The industries' slice is growing to nearly a quarter of your insurance bill. All of it just paperwork and profiteering.

President Obama is never going to pull the insurance company piggies from a trough this big, especially when the industry has made room for Congressional snouts.

So what's the Rx? Easy: Kill the pigs and call the fire department.

The only solution to Loss Ratio piggery is to kill the pigs: eliminate health insurers from the health industry entirely.

We can't cure our ills, as our president has attempted, by attacking the problem ass-backwards. No, Mr. Obama, we don't need HEALTH INSURANCE for everyone, we need HEALTH CARE for everyone. There's a giant difference. Instead of concentrating on PAYMENT, we need to focus solely on providing the health SERVICE.

From my London days writing for The Guardian, I can tell you the British do NOT have national health insurance. They have a National Health Service.

The government builds hospitals, hires doctors and, when you need the service, you just go and get it. It's kind of like the fire department. When your house is on fire, you don't call your fire insurance company, you call THE FIRE DEPARTMENT. We care first about the service, not the payment.

The British government hires the doctors, like firemen, and Brits use them, like firemen, as they need them.

It works. My mother-in-law, a nurse, on a visit to England, was stunned at the speed, quality and absence of mad paperwork to fix her broken arm.

But, you might say, that's, that's SOCIALISM! Well, yes, it is. And I'm not afraid to use the S-word: Socialized Medicine. Just like America's Socialized Fire Departments. (Fun fact: socialized, i.e. publicly funded, fire departments were 'invented' by the revolutionary Ben Franklin.)

And Yes We Can get socialized medicine passed into law.

Really. It's simple: we sneak it in with the kids.

We can learn from Lyndon Johnson's sale of Socialist Medicare. Johnson knew that no one could argue that Granny do without a doctor. Can the "Pro-Life" Republicans now tell us that pregnant moms and children ages 0 to 3 should be denied care? Therefore, to the Medicare program for those 65-or-older, we simply add "Kiddie Care," for those from Negative 9 months through age 3.

But instead of the wallet-busting Medicare system, in which doctors and hospitals are paid for each suture, bag of blood and pat on the head, Kiddie Care will be provided by Kiddie Care Service salaried doctors.

How do we get doctors (who now AVERAGE $240,575 a year) to take well-paid, but not pig-paid, posts? We grab'm while they're young. We pay doctors the full cost of their medical education; and we treat them as humans during internship, not as in the current system where interns are treated as medi-slaves. In return for the public paying for their medical education, the public gets the young doctors' ten-year commitment to work for the health service at a reasonable salary.

That's not my invention. The free-education idea for staffing a national health service had long ago been proposed by that wily old dog Ted Kennedy. (Damn, we miss him.)

Once the first wave of three-year-olds are about to turn four and their families face having to buy them health insurance, these millions of parents will become an unstoppable army of lobbyists screaming for the extension of Kiddie Care to age four, then to age five, then to age six and so on. Get it?

Yes, Mr. Limbaugh, I am another bleeding heart trying to sneak socialized medicine into America. Yes, I am trying to rid us of the "free-market" insurers who are causing the bleeding. Health insurers are as useful to our health care system as a bicycle is useful to a goldfish.

Free-Market Fantasia

There ain't no such thing as a "free market" in medical care, as there is a free market in food. You can eat peanut butter instead of dining at Maxime's. But you can't tell the surgeon, "No thanks, I can't afford a new kidney this week - I'll just have a broken arm."

A free-market for-profit insurance system means that, when you need a new pancreas, your fate is left to an insurance company computer programmed by Franz Kafka, Dr. Kevorkian and his accountant. It's you versus the Medical Loss Ratio. Good luck.

In olden days, doctors would attach leeches to suck a patient's blood. Today, we have insurance companies' Medical Loss Ratio. Both can kill you. If Obama and America want to end this sickness in the body politic, start with Dr. Kennedy's sure-fire cure: a national health service for kids - and get rid of the bloodsuckers.

***

I Quit: A Personal Note

I learned of the Kiddie Care solution during my brief and ill-starred tenure at the Center for Hospital Administration Studies at the University of Chicago "Billings" Hospital. I couldn't make up that name. Years later, they hired Michelle Obama as their vice president for community affairs.

In my time, three decades ago, "Billings" handled the affairs of that poor community by shipping the uninsured, sometimes bleeding, to poor-folks hospitals. One wounded patient died on the poverty shuttle.

I quit, and swore that one day I'd write about it. I just did.



*********************


Forensic economist Greg Palast is author of the New York Times bestseller, "The Best Democracy Money Can Buy." His investigations for BBC TV and Democracy Now! can be seen by subscribing to Palast's reports at www.GregPalast.com. Hear Wendell Potter tell Greg Palast about health insurers' dirty secret here.

”

“http://www.youtube.com/watch?v=fT3_1rPkjRI&feature=player_embedded

Harry Reid admits Obamacare will cost 2 trillion dollars!

Wake up sheeple”

“You're out of your mind strat.

When Reid gave the 2 trillion dollar figure, he was talking about the total annual health care expenditure in the US, not what reform will cost.”

“http://www.nj.com/news/index.ssf/2009/10/holmdel_man_leaves_79-year-old.html

He must have been a Democrat.”

“When this ultimately passes their brains are going to squirt out of their ears like boiling hot play-doh.

Pay close attention to the reconciliation process.”

“October 15, 2009
The Baucus Medicaid Provisions: The Senate�s Massive Welfare Expansion
by Dennis G. Smith

One issue in the Baucus health care bill has not received the attention it deserves: Half of the reduction in the uninsured will result from the enrollment of millions of Americans in Medicaid.

Expanding Medicaid is not reform. Americans across the political spectrum who are being promised health reform will, if Congress gets its way, be stunned to find themselves in a welfare office applying for Medicaid and then searching desperately for doctors who will accept their Medicaid card.

Congress is proposing the single largest expansion of an entitlement program since Medicare and Medicaid were created in 1965. Medicaid does not have enough providers in the existing program; adding more people to a flawed system would only compound the problem.

90 Million People on Medicaid/SCHIP

Under the current baselines for Medicaid and the State Children's Health Insurance Program (SCHIP), there will be 76 million individuals served by these programs for at least some part of the year in 2019. Under the Senate Finance Committee proposal, the number on Medicaid/SCHIP will top 90 million.

The majority of these individuals will be young and healthy. Keeping them on welfare rolls will shift even more costs to individuals and families buying health insurance, as doctors and hospitals recoup their losses from Medicare/SCHIP by charging more to the privately insured. In effect, the congressional policy seems to be to expand dependency by discriminating against individuals based on their income.

Congress will also create new inequities among working families. Individuals covered through Medicaid, the new exchanges, and current employer coverage would be paying significantly different amounts for their health coverage.

Senate Finance Reverses Course

Under Senator Max Baucus's (D-MT) original proposal, the Congressional Budget Office (CBO) estimated that 11 million individuals would be added to Medicaid/SCHIP by 2019 at a federal cost of $287 billion.[1] After the Baucus plan was amended, CBO estimated that 14 million individuals would be added to Medicaid/SCHIP at a federal cost of $345 billion.[2]

CBO has not released its assumptions about the impact on Medicaid enrollment due to other factors such as "crowd out" (the substitution of public funds for private expenditures and loss of private coverage) and how employers will treat dependents in reaction to the employer provisions in the legislation. Thus, the increased Medicaid/SCHIP enrollment is likely understated, as has historically been the case.

Under the original Baucus plan, Medicaid eligibility was expanded to non-disabled adults (childless adults as well as parents of children on Medicaid) with income up to 133 percent of the federal poverty level (FPL).[3] However, individuals with income between 100 percent and 133 percent of the FPL would have also been eligible for the new subsidies and, beginning in 2014, could have chosen to receive coverage through the exchange rather than Medicaid. In effect, the maintenance-of-effort requirement on states would drop back to 100 percent of the FPL.[4]

SCHIP eligibility would have been increased to 250 percent FPL, but subsidies would have been provided through the exchange. States were given additional federal funding through enhanced match rates. But even with the additional federal funding, Medicaid expansion would cost states an estimated $37 billion.

In the committee's markup, states would be allowed to raise Medicaid eligibility above 133 percent FPL, and SCHIP is continued to 2019.[5] States could expand SCHIP eligibility to higher income levels and would receive new enhanced match rates. Current law benefits and cost-sharing limits would be continued. Until actual legislative language is available, it is unclear whether use of the exchange is a state choice or an individual choice or how SCHIP financing through 2019 will be provided.

Most disturbing, however, is why the Finance Committee reversed course and put more people into Medicaid and SCHIP rather than covering them through tax credits and allowing them to get private health insurance if they want it. In truth, the committee probably elected to expand Medicaid not because it is better but because it is cheaper--at least on paper.

Medicaid pays providers 20-25 percent less than does the private sector, forcing doctors and hospitals to subsidize Medicaid through lower rates. This deters providers from participating in the program, creating a lack of access that itself is a form of rationing. Of course, putting more people into Medicaid will ultimately make the access problem even worse.

In addition, the pharmaceutical manufacturers who thought they had cut a deal with the White House will find themselves paying additional rebates to Medicaid.

Even More Expansion?

As the Obama Administration negotiates the final legislative package behind closed doors with the House and Senate leadership, taxpayers can rest assured that final decisions on Medicaid will not be resolved until the last minute. If Congress needs to find additional "savings" for the overall legislative package, it may do so by expanding Medicaid even more, perhaps for persons with incomes up to 150 percent of FPL ($16,245 annually).

Although final decisions have not been made, states have already been warned by congressional staff of the potential to put millions more onto Medicaid beyond the current estimates. How much federal support will be available through enhanced match rates is also up in the air. The cynical exercise of pitting state against state in a formula fight should be a wake-up call to the governors. It is yet another indication that, as a matter of policy, the legislation is headed in the wrong direction.

Who "Belongs" on Medicaid?

Medicaid was originally created to provide access to health care for families on welfare. Its mission was expanded over time through federal mandates and state options. An expansion to all individuals below 150 percent FPL would introduce a new group of young, healthy individuals onto government dependency.

Individuals at 150 percent FPL includes millions who have never been considered "poor" or in need of government assistance. According to the Census Bureau, there are 6.4 million individuals age 18-24 years old living on their own. More than half have income below 150 percent FPL.[6] But the percentage of individuals age 25-34 below 150 percent FPL drops to 24.3 percent.

Do college students and part-time workers really belong on Medicaid? Putting them into Medicaid erodes the sound policy objective of stabilizing the insurance market that would have occurred if these young, healthy lives had been added into the private insurance pool. The health insurers who thought the young, healthy population would help stabilize costs for them will instead lose many of them to Medicaid.

Lost State Flexibility

The burden of expanding Medicaid will also fall on the states. The CBO estimates that the Finance Committee plan will cost states $33 billion over 10 years. Governor Phil Bredesen (D-TN) warns that costs are likely underestimated and could cost his state $3 billion.[7]

States also face an erosion of their authority to manage their Medicaid programs, as Congress is adding new federal mandates to cover certain benefits and conform their programs to federal standards. The true cost to taxpayers in the states will become apparent only over time.

Many state officials cannot afford their current Medicaid programs; they certainly cannot afford to add 14 million more individuals. Medicaid is already crowding out resources for other state and local priorities such as education, child welfare, public health, and investment in transportation systems and infrastructure. More money for Medicaid means less money for these other priorities.

Expanding Medicaid Is Not Reform

The Baucus bill will not lower the cost of health care as the American people were led to believe it would. Budget constraints are forcing more people into Medicaid, with the final number still unknown. Simply forcing more people into Medicaid is not reform. Expanding Medicaid will ultimately shift even more costs to providers and the private sector. It is a giant step backward from what was promised, and it comes at the cost of everything else.

In June, President Obama told Senate Democrats, "As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid."[8] Unfortunately, that is precisely what Congress is going to do with the Baucus bill.

Dennis G. Smith is Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation.



--------------------------------------------------------------------------------

[1]Congressional Budget Office, "Preliminary Analysis of the Insurance Coverage Specifications Provided by the Senate Finance Committee," September 15, 2009, at http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16
-Proposal_SFC_Chairman.pdf (October 15, 2009).

[2]Congressional Budget Office, "Preliminary Analysis of the Insurance Coverage Provisions Contained in the Amended Chairman's Mark," October 7, 2009, at http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-
Baucus_letter.pdf (October 15, 2009).

[3]The FPL is adjusted annually and is based on income and family size. In 2009, 133 percent FPL is $14,404 for an individual and $29,327 for a family of four.

[4]See Committee on Finance, U.S. Senate, "Chairman's Mark: America's Healthy Future Act of 2009," September 22, 2009, p. 42, at http://finance
.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_
Future_Act.pdf (October 15, 2009).

[5]See Committee on Finance, U.S. Senate, "Chairman's Mark: America's Healthy Future Act of 2009," (amended version) at http://www.finance
.senate.gov/sitepages/leg/LEG%202009/100209_Americas_Healthy_Future_Act
_AMENDED.pdf (October 15, 2009), pp. 50-52 and 54-58.

[6]U.S. Department of Commerce, U.S. Census Bureau, "Current Population Survey: POV01: Age and Sex of All People, Family Members and Unrelated Individuals Iterated by Income-to-Poverty Ratio and Race: 2008," at http://www.census.gov/hhes/www/cpstables/032009/pov/new01_150_01.htm (October 15, 2009).

[7]Andy Sher, "Bredesen Warns Cost to State Could Exceed $3 Billion," Chattanooga Times Free Press, October 14, 2009, at http://www.timesfreepress.com/news/2009/oct/14/bredesen-warns-cost
-state-could-exceed-3-billion/?local (October 15, 2009).

[8]Press release, "Remarks by the President before Meeting with Senate Democrats to Discuss Health Care," the White House, June 2, 2009, at http://www.whitehouse.gov/the_press_office/Remarks-by-the-President
-before-meeting-with-Senate-Democrats-to-discuss-health-care/ (October 15,”

“The most massive expansion of your 'welfare state' in the last quarter century was accomplished by George Duhbya Bush with his multi-multi-multi-billion-dollar giveaway to the drug industry.

Just in case you ferrrrrrgot.


Riddle me this, moonbat ----- Why didn't the Rebublicans stipulate that the prices for that MOUNTAIN of drugs be negotiated?

”

“The fruitcakes are going to shiit themselves when they realize this means them too, lol. They'll ride it right into the poor house all the while prattling on about what a great thing it is because the poor and the sick will now have "affordable" healthcare and the man isn't making his big profit. Tools.”

“There was an interesting comment made a few minutes ago on C-SPAN.

The health insurance companies were characterized as 'the dog in the manger' because their policies are too expensive for the working poor yet they vehemently oppose a public option that would otherwise insure them.

In Other Words, they don't insure these people anyway, so what's their beef? It looks like they just want them to go away and die.

”

“They're all drug cartels. The only difference is the legal drug companies get off with 99% tax free rather than the illegal 100%.”

“I bet that's it exactly; they want people to die. (Those insurance companies make millions on dead people.)

Does it ever embarrass certain people knowing that they have to resort to the "they must want people to die" or "racist" comments because they can't put forth an honest to goodness argument to support their view? F'n pathetic.”

“I wonder what television would do without all the drug company advertizing bucks. I'm still amazed how they spend so much more on advertizing than all the 'research' they keep lying about.

It must be Marketing research they're talking about....”

“Ad taxes are a big part of health care cost, but they have to keep some ad slots for election time, eh? Ad and Lobby taxes could top even the big mean gov in the drug biz.”

“OOOh Tilty turns on the EEEEVIL Drug Companies...>LOL. without them Tilty your "gerbil induced" life expectency would have dropped.”

“Senate proposals put premium on healthy living
Bills could put workers under pressure to lose weight, stop smoking

Gerry Broome / AP file



Get in shape or pay a price.

That's a message more Americans could hear if the health care reform bills passed by the Senate Finance and Health committees become law.

By more than doubling the maximum rewards and penalties that companies can apply to employees who flunk medical evaluations, the bills could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.
Story continues below ↓advertisement | your ad here

The initiative, largely eclipsed in the health care debate, builds on a trend that is already in play among some corporations and that more workers will see in the packages they bring home during this month's open enrollment. Some employers offer lower premiums to people who complete personal health assessments; others offer only limited benefit packages to smokers.

The current legislative effort takes the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and groups devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society, and the American Diabetes Association.

A colossal loophole?
President Obama and members of Congress have declared that they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The health insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems like diabetes, heart disease and stroke.

"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is in effect discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.

The legislation would make exceptions for people who have medical reasons for not meeting targets.

Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to "focus on wellness and prevention rather than just disease and treatment," said Business Roundtable president John J. Castellani.

BeniComp Group, an Indiana company that manages incentives for employers, says on its Web site that the programs can save employers money in a variety of ways. Medical screenings will catch problems early. Employers will shift costs to others. Some employees will "choose other health care options."

Douglas J. Short, BeniComp's chief executive, said the incentives he uses focus on outcomes, not conditions.

"I can't give you an incentive based on being a diabetic or not being a diabetic, but whether you're managing your blood glucose level — I can give you an incentive based on that," Short said.

National epidemic of obesity
The incentives could attack a national epidemic of obesity. They also cut to a philosophical core of the health care debate. Should health insurance be like auto insurance, in which good drivers earn discounts and reckless ones pay a price, thereby encouraging better habits? Or should it be a safety net in which the young and healthy support the old and sick with the understanding that youth and good health are transitory?

Under current regulation, incentives based on health factors can be no larger than 20 percent of the premium paid by employer and employee combined. The legislation passed by the Health and Finance committees would increase the limit to 30 percent, and it would give government officials the power to raise it to 50 percent.

A single employee whose annual premiums cost him and his employer the national average of $4,824 could have as much as $2,412 on the line. At least under the Health Committee bill, the stakes could be higher for people with family coverage. Families with premiums of $13,375 — the combined average for employer-sponsored coverage, according to a recent survey — could have $6,687.50 at risk.

An amendment passed unanimously by the Health Committee would allow insurers to use the same rewards and penalties in the market for individual insurance, though legislative language subsequently drafted by the committee's Democratic staff does not reflect that vote, Sen. Mike Enzi (Wyo.), for the committee's ranking Republican, has said. The bill drafted by the Senate Finance Committee would set up a trial program allowing insurers in 10 states to use wellness-based incentives for individuals.

America's Health Insurance Plans, an industry lobby, has argued that insurers should be allowed to consider participation in wellness programs when setting individual premiums.

Wellness incentives voluntary
Employers and other advocates of expanded wellness incentives say taking steps to get healthier would be voluntary. Sen. John Ensign, a Nevada Republican and lead sponsor of the Finance Committee's wellness provision, said his proposal "would guarantee that the incentive is strong enough for Americans to want to participate."

Wellness incentives have been spreading rapidly in the corporate world. Unlike the legislative proposals, which address incentives based on results, the corporate programs typically compensate employees based on effort alone — for example, enrolling in smoking cessation programs even if they fail to kick the habit, or undergoing detailed medical assessments regardless of the findings. But there are exceptions: The Safeway supermarket company allows certain employees to reduce their premiums by meeting standards for body mass and other measures. Safeway chief executive Steve Burd has framed it as an issue of personal responsibility.

Click for related content
Pelosi makes case for public health care option

Valeo, a supplier of auto parts, four years ago raised the deductible on an employee health plan to $2,200 from $200 for individual coverage and to $4,400 from $400 for family coverage. Then it gave employees the opportunity to reduce the deductible to its starting point by being nonsmokers and meeting goals for blood pressure, cholesterol, and body mass index, said Robert Wade, Valeo's director of human resources for North America.

"If they don't comply they end up being penalized, if you will, but we refer to it as a Healthy Rewards program," Wade said.

Workers who choose not to submit to yearly medical assessments have been offered a different health plan that carries higher premiums, Wade said.”

“LOL...already being bandied about in senior EMS circles..."How can med control issue "Cease care" orders to Units so that "special patients" will not even be transported without $$$$.”

“health care reform;
Colorado insurers say health care bill would lead to "system collapse"
Executives contend proposed penalties for opting out are too low.
By Jennifer Brown
The Denver Post
Posted: 10/19/2009 01:00:00 AM MDT


Colorado insurance executives, cautious supporters of health care reform throughout the past year, are now warning that current proposals could cause a "system collapse."

At issue are what insurance companies consider absurdly low penalties for people who choose not to buy health insurance.

Their concern: People will buy insurance only when they desperately need it, such as after they're diagnosed with cancer or heart disease.

Healthy people might choose to pay the penalty, now proposed at a few hundred dollars per year, because it is far less expensive than buying insurance.

Insurance companies, under that scenario, would end up spending more to treat patients than they would receive in premiums. Rates


"People would come in, pay premiums for a few months while they were getting their cancer treatments," said John Martie, president and general manager of Anthem Blue Cross Blue Shield of Colorado. "If enough people did that, the whole system would collapse.

"I would hope it wouldn't get that far. Ultimately, it would lead to rationing of care."

In the health care bill passed Tuesday by the Senate Finance Committee, adults who do not purchase health insurance would face an excise-tax penalty of $200 a year starting in 2014 and rising gradually to $750 in 2017.

The tax would be prorated if an individual has health insurance for part of a year.

The insurance industry incited an immediate and passionate backlash after saying the Senate bill would cause insurance premiums to increase.


Gov. Bill Ritter slammed insurance companies in a campaign e-mail last week, calling on America's Health Insurance Plans to retract its "misleading, fear-mongering statement" that said premiums would rise.

"The same folks who successfully derailed health care reform last time around are once again up to no good," Ritter said. "It's a self-serving, untrue, desperate effort by the insurance industry to protect its excessive profits — and one that cannot be taken seriously."

Reform advocates say it is farfetched to assume people who can't afford insurance — and might qualify for government subsidies — would opt to pay a penalty instead.

"They are assuming that people would game the system," said Denise de Percin, executive director of the Colorado Consumer Health Initiative.

"They are looking at the worst-case scenario. People aren't stupid — they are not going to pay a penalty and get nothing," de Percin said.

Supporters of the legislation from the Senate Finance Committee also point out that the proposed penalty is only a proposal. Congress likely will refine the legislation, aiming to strike the right balance between government subsidies and penalties for violating the insurance mandate.

But Ben Price, executive director of the Colorado Association of Health Plans, said the proposed penalty is way off the mark. It is so low, "we can't really call it a mandate," he said.

"Without a mechanism for enforcement, people will wait until they are sick to get coverage," Price said.

Premiums, he said, would "go up for individuals, small business, everyone. Congress needs to create a strong mandate in order to make an 'all-in' system work."

Executives still back reform

Colorado insurance executives said they still support reform and point out that they offered a year ago to stop rejecting patients with pre-existing health conditions if the government would require everyone to purchase insurance.

"We've been adamant all along that those penalties have to be higher than what premiums would cost," said Martie, who was in Washington two weeks ago lobbying Colorado lawmakers.”

“You fvcking imbeciles are killing people for your Party and their owners.”

“message from Tllt being ignored”

“You even COPIED that!”

“LMFAO@dUUd”

“WHOOPS...Tilty...death panel? Or just EMERGENCY MEASURE? You make the call.

http://www.sun-sentinel.com/news/nationworld/sfl-swine-flu-crisis-propublica-sboct18,0,2336680.story

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with poor prognoses from ventilators to treat those who have better chances of surviving. That decision would be made by the hospital.

The flu causes severe respiratory illnesses in a small percentage of cases, and patients who need ventilators and are deprived of them could die without the breathing assistance the machines provide.

Essentially if care gets overwhelmed RATIONING will exist. HMMMMMM....”

“Destruction Of Healthcare Delivery System Underway

By HERB DENENBERG, For The Bulletin
Sunday, October 18, 2009

If you want to understand why Aetna, Independence Blue Cross (Keystone), and other insurance companies are dropping some, though not all, of their Medicare Advantage policies, you have to understand the way these plans have been tainted by President Obama and the Democratic proposals for Obamacare in its various forms. Their proposals, not yet enacted, will destroy the greatest health care delivery system in the world if enacted. But what they have already done has started to do serious damage to our system, as exemplified by what is going on with Medicare Advantage. Medicare Advantage plans are popular and have many advantages for senior citizens. So, naturally, Mr. Obama wants to kill them.

The trade association America’s Health Insurance Plans (AHIP) describes Medicare Advantage plans as follows: “An increasing number of Medicare beneficiaries are choosing Medicare Advantage (MA) plans. Medicare Advantage plans offer a different approach to health care delivery than beneficiaries experience under fee-for-service Medicare. Instead of focusing almost exclusively on treating beneficiaries when they are sick, these plans also place a strong emphasis on preventive health care services that help to keep beneficiaries healthy, detect diseases at an early stage and avoid preventable illnesses. In addition, MA plans help reduce beneficiaries’ out-of-pocket costs by providing additional benefits not covered in the Medicare program and reducing cost-sharing for Medicare-covered benefits.” AHIP says about 10 million people are now enrolled in Medicare Advantage plans, accounting for 25 percent of the market.

Mr. Obama has proposed cutting the heart out of Medicare in general and Medicare Advantage plans in particular by trying to save about a half a trillion dollars to finance his government takeover of our health delivery system. This Obama proposal and its reasons are, of course, as phony as a three-and-a-half dollar bill, as everyone knows those savings have been talked about for decades, but never achieved. They are virtually inherent in a government system of health delivery and the fraud, waste, inefficiency and abuse it produces. If those savings from eliminating fraud, etc. are there, why haven’t they already realized them?

But the Obama Medicare and Medicare Advantage savings ploy is not only a phony idea, but also an immediately damaging one. Mr. Obama has demonized Medicare Advantage, virtually painting it as a fraud, involving government payments for no good purpose. This has probably raised concerns in the minds of Medicare Advantage providers, who may wonder about the future of this form of coverage. But there’s more. When you see the disgraceful performance of Mr. Obama and his leftist radical Congress who are in the process of acting more like junior dictators than legislators, you wonder why anyone would even want to be in the business of selling health insurance. Consider what Congress is doing:

• The Democratic Congress has been passing bills of astronomical cost and complexity without reading them

• The legislative process has frozen out the Republicans, so what should be a bipartisan process, as promised by Obama, is turning out to be hyper partisanship at its worst, Obama style

• These same Democrats have voted against giving the public 72 hours before a vote to read the bills. You’d think if Congress doesn’t want to read the bills, at least it would allow the public the right to do so, given Mr. Obama’s promise of transparency

• Then there’s the U.S. Senate Finance Committee, which just passed not a bill with legislative language, but a bill with “concepts.” This means no one knows what the bill will cost or what it will really mean once it is translated into legislative language. The Democratic Senate is, in a real sense, flying blind and is about to crash not only our health care delivery system, but our economy as well

• Finally, Mr. Obama and Congress are willing to ignore the Town Hall meetings, the Tea Parties and public opinion, which concertedly, repetitiously and loudly say, “Read the bills, let us read the bills and don’t wreck our present health care delivery system.”

I would think this would frighten much of the health insurance industry, and they may well want to start pruning or cutting back some of their coverage. But there’s one other striking development about the Medicare Advantage scenario. Mr. Obama seems to have a knack of doing exactly the opposite of the right thing. He’s never off just 20 or 30 degrees in one direction; he’s usually off 180 degrees, being totally, absolutely wrong. Consider his views on Medicare Advantage. He wants to cut their special funding which will effectively abolish them.

What makes this view bizarre is that Mr. Obama has been singing the praises of prevention and even claiming huge savings because he plans on introducing more prevention into the health care delivery system. Yet, the Medicare Advantage Plans already stresses prevention and the kind of case management of chronic illnesses that generates prevention of complications and disease. Medicare Advantage Plans have built in features that encourage preventive medicine. For example, they may feature comprehensive disease management for such medical problems as asthma, diabetes, and congestive heart failure. A spokesman of Aetna, Inc., Walt Cherniak, told me their plans may provide online tools for managing disease, access to nurses for medical management, and the monitoring of cases to make sure each patient gets the care they need. The Medicare Advantage plans also feature first dollar coverage so policyholders have no incentive to skip routine tests and monitoring. Like Aetna, Independence Blue Cross also has an impressive list of features to promote prevention.

These plans, therefore, follow Mr. Obama’s recommendation not only as to prevention, but also as to comprehensive coverage. By less reliance on deductibles, co-pays, and coinsurance, the Medicare Advantage policies do exactly what Mr. Obama says he wants, yet, at the same time, those are the plans singled out for phasing out by Mr. Obama.

There’s another important feature of Medicare Advantage plans that make sense. They transfer the handling of the policies to free enterprise, private insurers like Aetna, Inc. and Independence Blue Cross. They handle claims and other administrative matters. But this poses another contradiction. Mr. Obama said he wants to build on our existing insurance system and not abolish it or remake it in the form of a single-pay system. But his views on Medicare Advantage are taking us in the opposite direction of what he supposedly advocates, destroying a segment of the private insurance industry, rather than building on it and utilizing it.

Mr. Obama made one other move that will help kill the very kind of coverage he advocates. A spokesman for Independence Blue Cross, Ruth Stoolman, told me that one of the reasons the company dropped some of its Medicare Advantage policies was a high cut in reimbursement that was unprecedented. There were other reasons for the cutting of certain Medicare Advantage policies. For example, Ms. Stoolman said one discontinued plan had few members. That helped make it a candidate for elimination. Ms. Stoolman said still another factor was rising costs of the medical services provided by these plans.

Before going further, the situation of policyholders losing their present Medicare Advantage policies should be clarified:

• Every such policyholder should have received a letter from Medicare explaining what is happening and listing all other offering plans and their contact numbers

• The two companies mentioned above, Aetna Inc. and Independence Blue Cross (Keystone) offer other Medicare Advantage plans that might be options worth considering

• Any policyholder dropped from their Medicare Advantage policy can enroll in another plan without medical underwriting, consequently eliminating any problem of pre-existing conditions

• The open enrollment period will run until the end of the year, so policyholders will have ample time to consider their options

• The dropped plans discussed in this column are all Medicare Advantage plans and do not involve Medigap, the Medicare supplements other than Medicare Advantage

• There’s no reason to panic, as there are all kinds of alternatives for those whose plans are being discontinued

It should be noted that this is another example of the endless lies told byMr. Obama and the Democratic Congress to sell Obamacare. He endlessly promised everyone they could keep their coverage if they are happy with it. At the same time, he said he’d be taking steps to initiate a severe cutback or even an end for Medicare Advantage. But if you haven’t figured out by now that Mr. Obama’s a habitual liar, you haven’t been paying attention. Remember his promise of bipartisanship? It has instead has become a policy of Chicago thuggishness. Remember his policy of transparency? Now the public doesn’t even have a chance to read the bills before passage and the various bills will be put together behind closed doors. But if I would list all the Mr. Obama lies and broken promises, I would need not a column but a multi-volume encyclopedia.”

“Analysis: Courting doctors in health care battle

By DAVID ESPO (AP) – 13 hours ago

WASHINGTON — In the special interest war over health care, the White House and congressional Democrats have the nation's drug makers and hospitals generally on their side; the insurance industry, not so much.

Now the bill's supporters are making a play to lock in the American Medical Association, the organization that says it represents 250,000 doctors and medical students in every state and congressional district. The principal enticement, a $247 billion measure making its way to the Senate floor, aims to wipe out a scheduled 21 percent rate cut for doctors treating Medicare patients and replace it with a permanent, predictable system for future fee increases.

The AMA, firmly in favor of higher pay for doctors, began airing ads last week saying the increase would "protect seniors' access to quality care." In case lawmakers need any inducement to act, a late 2008 study by the Medicare Payment Advisory Commission, which advises Congress, found that nearly 30 percent of Medicare patients looking for a new primary care doctor had trouble finding one.

Yet the AMA won't yet pledge support for the major health care bill that is the chief objective of the White House and congressional Democrats, despite a request that several officials say was made at a meeting last week with Senate Majority Leader Harry Reid, D-Nev.

Nor does it seem eager to soft-pedal another of its own top priorities, legislation to restrict medical malpractice payments.

"We continue to press for significant medical liability reform because we know that is a very important contributor to unnecessary health care costs," Dr. J. James Rohack, president of the AMA, said in an interview in which he declined repeatedly to say whether the organization had been asked to back off.

Higher payments to doctors and curbs on medical malpractice awards "in my mind are separate issues. I can't speak for how other people are putting this whole thing together," he added.

Evidently not in the minds of Democrats. Several officials say that request, too, was conveyed to the AMA and other doctor groups in last week's session with Reid. Not coincidentally, any limitations in medical malpractice awards are anathema to trial lawyers, whom Democrats count as among their most reliable and generous campaign supporters.

The dance is one of many in the long-running health care debate, the issue that has consumed Congress, the administration and a vast constellation of outside groups for months.

Take the Senate Finance Committee, which last week approved a middle-of-the-road measure that may eventually prove a template for a compromise on an issue that has defied solution for decades. Sen. Olympia Snowe of Maine drew headlines when she became the first Republican to support White House-backed health care legislation.

But according to some of the bill's supporters, a vote that occurred with little fanfare several evenings earlier was crucial to the legislation's survival.

It pitted the drug makers and the White House on one side and most of the committee's Democrats on the other.

At issue was a plan by Sen. Bill Nelson, D-Fla., to sweeten drug benefits for certain Medicare beneficiaries — normally something all lawmakers can favor. In this case, Nelson proposed raising fees on drug companies by $106 billion over a decade to cover the costs. "Did PhRMA come to the table in the agreement with the White House with enough? A number of us feel that is not the case," he said of the industry.

But his approach happened to run afoul of a deal the industry made months ago with the White House and Sen. Max Baucus, D-Mont., the committee's chairman. Drug makers would cover $80 billion of the cost of the legislation over a decade, and the White House and Baucus would help shield them from attempts by other lawmakers to impose additional fees or taxes.

Left undisclosed for weeks was a critical codicil — that the industry would bankroll an expensive advertising campaign to promote the bill's passage, at a cost of $100 million or more.

Passage of Nelson's proposal "may well undermine our ability to pass comprehensive health care reform in this Congress and I think that would be a great tragedy," Sen. Tom Carper, D-Del., said shortly before the vote.

Baucus, too, spoke against Nelson's recommendation, although he added, "we have to find some other time and some other way to fill the doughnut hole," a reference to a gap in coverage under the Medicare prescription drug program.

Of Nelson, Baucus said, "I frankly wish the senator had decided not to push" for a vote.

Not only Baucus, but also the White House had urged Nelson to drop his amendment, according to Senate sources who spoke on condition of anonymity. On the vote, the chairman, Carper and Sen. Bob Menendez, D-N.J., joined all committee Republicans in opposing the plan, and it failed on a vote of 13-10.

The drug deal was secure, and so, too, the bill.

Special interest politics was also at play for the nation's hospitals. They, too, have a side deal with the White House and Baucus, and they also received a measure of protection in the bill that cleared the committee.

At the last minute, the chairman decided to shield them from any future cuts to be recommended by an independent commission charged with recommending savings in Medicare.

The insurance industry?

Reid made an unusual appearance at a Senate committee hearing recently to support repeal of 60-year-old antitrust laws that benefit insurance companies.

EDITOR'S NOTE _ David Espo is chief congressional correspondent for The Associated Press.”

“LOL...its getting hilarious. We had an idea floated for "standing orders" for how to evaluate patients for transport in case of a major "influenza" outbreak.

Any people here with extremely elderly or incapacitated family members?

Uh huh. Well apparently in a major disaster say you call 911 and EMS arrives, they eval your handicapped child (say on a ventilator or other respiratory support) or family member. They are in serious condition but it is determined that their "service need" exceeds their "value". The discussion is that the online medical control will issue orders to refuse transport.

One of the new voices from the Federal level mentioned we might be able to find a way to "medicate" the patients so they won't suffer too much in front of the family.”

“George Orwell couldn't have written it better...”

“Death Panel?”

“Not actually a panel more of a "standing order"....so there really won't be "anyone" to sue.”

“^^^The Axis of Stupid.^^^”

“Americas Corporations open their doors to their board meetings?

Isn't the bible the last say in Death Panels?
last edited: 10/21/09 11:06:24 AM”

“
Sheer Beauty


OH, to be a fly on the wall in their boardrooms when THIS shlt hit the fan! I guess if they say it doesn't affect them, they won't oppose it......


Dems go after antitrust exemption for insurers

WASHINGTON � Democrats launched a drive at both ends of the Capitol on Wednesday to strip the insurance industry of its decades-old exemption from federal antitrust laws, part of an increasingly bare-knuckled struggle over landmark health care legislation sought by President Barack Obama.

If enacted, the change would put an end to "price-fixing, bid-rigging and market allocation in the health and medical malpractice" insurance areas, said Sen. Patrick Leahy, D-Vt., chairman of the Senate Judiciary Committee. Leahy said he would seek a vote on the plan when the Senate debates health care legislation in the next few weeks.

Leahy made his comments at virtually the same time the House Judiciary Committee voted 20-9 to end an industry exemption that dates to 1945. Three Republicans supported the move.

Senior Democratic officials in the House said the leadership was inclined to incorporate the measure into the broader health care bill expected to be brought to the floor for a vote within a few weeks. No final decision has been made, they added.

In response, an industry official said Democrats were targeting a problem that does not exist.

The events coincided with a vote in the Senate to sidetrack legislation averting a 21 percent cut in Medicare payments for doctors in January and raising their fees by $247 billion over a decade. The 47-53 vote was 13 short of the 60 needed to advance the bill, reflecting concerns that the measure would have raised deficits. The result was a defeat for Democrats and an embarrassment for the American Medical Association, which had mounted a seven-figure advertising effort to assure passage of one of its top priorities.

Republicans grumbled that Senate Democrats timed the offensive on antitrust matters to obscure their defeat on the bill setting pay rates for doctors, a measure that GOP leader Mitch McConnell, R-Ky., called "the Senate's first vote on health care this year."

Even so, taken together, the threats to revoke long-standing antitrust protections reflect the fury Democrats have projected in response to recent insurance industry attempts to influence the shape of legislation. The events occurred less than a week after the insurers' trade association issued a report saying a measure in the Senate Finance Committee would produce sharp increases in premiums for millions of people who currently have insurance.

Democrats and the White House reacted angrily, attacking the study as flawed and politically motivated.

Responding to the day's developments, the industry said the legislation was based on a misperception of existing law. "We believe that health insurers have not been engaging in anticompetitive conduct and that McCarran-Ferguson does not provide a shield for such conduct," Karen Ignagni, president and CEO of American's Health Insurance Plans, wrote to Rep. John Conyers, the Michigan Democrat who chairs the Houses Judiciary Committee.

"Thus, the bills attempt to remedy a problem that does not exist," she wrote.

The McCarran-Ferguson Act of 1945 gives states authority to regulate the insurance industry for antitrust matters, and the companies are exempt from federal jurisdiction.

To buttress its case, industry officials circulated a paper from JPMorgan, the investment bank. "Ultimately, just using the terms antitrust and health insurers in the same sentence makes a great headline, but in practice given the narrow scope of the act, we doubt a repeal has meaningful implications for the publicly traded companies," it said.

The industry holds a large conference beginning on Thursday several blocks from the Capitol.

The White House had no reaction. Instead, aides pointed to Obama's statement last weekend that insurers are earning "profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing."

The developments came as Democrats struggled in both houses of Congress to enact Obama's call for legislation to expand health care to millions who lack insurance, provide greater consumer protections to millions more, and rein in the cost of medical care in general.

In the Senate, Reid, key committee chairmen and White House aides are at work crafting legislation the Senate can vote on later this fall.

The House is also on track for a vote this fall, although weeks of private negotiations among Democrats have yet to produce agreement on a bill.

Among the most controversial unresolved issues concerns proposals for the government to sell insurance in competition with private companies. The House bill is certain to include such a provision. Although the rank and file have yet to come to an agreement on key details, officials said the leadership was counting carefully to see if it had the votes to establish a system that would pay doctors 5 percent more than they receive for treating Medicare patients. Hospitals and other providers would be paid at Medicare rates, without the additional 5 percent, they said.

It is unclear what type of so-called "public option" will be incorporated into the Senate measure, where Democratic moderates are wary of the idea, even though public polling consistently shows its popularity.

Until recently, the insurance industry has played a noncommittal role as legislative proposals developed in both houses of Congress. AHIP announced months ago it supported comprehensive health care reform and Obama called on Ignagni to speak at a televised White House event designed to showcase widespread agreement that the time had come to change the current system.

Essentially, industry offered a trade. It agreed to abandon practices such as denying coverage on the basis of pre-existing medical conditions if the legislation required nearly universal coverage, a step that would give it access to millions of new customers. At the same time, it vigorously opposes any legislation that would allow the government to sell insurance.

The tone began to change when the Finance Committee voted to excuse an estimated two million lower income Americans from a requirement to purchase insurance, at the same time it greatly reduced the penalties for those who were still covered, but refused to buy coverage.




Screw the insurance comopanies AND screw the AMA's backdoor raid of the Treasury.

”

“Don't forget steroid ball too.”

“NPR's This American Life have been doing stories concerning healthcare. I'm generally so effing sick of the subject I can't stomach it any more but they have such a different take on it and offer stories and info no one else is going to give you. Ever hear how employer driven health insurance even got started? Fascinating.

I will never be for government run healthcare or insurance but I do see something needs to be changed with the drug companies, insurance companies and healthcare providers. The Maryland state price setting is one way but I'm not really big on price fixing.”

“NPR's take is very left wing. I listen to it all the time.”

“This American Life, while being carried by NPR, it is a completely separate production from, say, NPR's All Things considered. I'm not saying it isn't left leaning but that is the very reason I listen to it (and NPR news as well) so that I can gather facts from all sides and make up my own mind.”

“which is unlike, for example, reading the NY Times, where there are no facts to gather.”

“That;s the same reason I listen to it too. I was referring to All Things Considered. I don't recall hearing This American Life, but ....it's NPR.

HAving said that, I have made up my mind and I don't trust them one bit. We can't afford another trillion dollars over the next 10 years( for only 5 years of coverage). The dollar is tettering on the edge already. Coverage will deteriorate, beauracracy will bloat, services will be cut, and taxes will skyrocket.

The effeciency of the Post Office
the compasion of the IRS
the effectiveness of Katrina”

“House Dems want Medicare for everyone
By Mike Soraghan - 10/20/09 08:27 PM ET
Say hello to �Medicare Part E� � as in, �Medicare for Everyone.�

House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option.



The strategy could benefit Democrats struggling to bridge the gap between liberals in their party, who want the public option, and centrists, who are worried it would drive private insurers out of business.


While much of the public is foggy on what a public option actually is, people understand Medicare. It also would place the new public option within the rubric of a familiar system rather than something new and unknown.


The idea has bubbled up among House Democrats and leaders in the past week, most prominently in a caucus meeting last Thursday.


Rep. Mike Ross (D-Ark.) spoke out last week in favor of re-branding the public option as Medicare, startling many because he has loudly proclaimed his opposition to a public option.


Rep. Jim Oberstar (D-Minn.), the veteran chairman of the House Transportation Committee, also voiced his support, as did House Majority Whip James Clyburn (D-S.C.).


John Schadl, a spokesman for Oberstar, explained the congressman likes the idea because people are familiar with Medicare.


�One of his concerns is that people don�t know what a public option is. Medicare is a public option,� Schadl said. He said Oberstar started talking about �Medicare for Everyone� during August town hall meetings.


A notable incident last summer demonstrated the popularity of Medicare and the confusion over the public option when a man famously told Rep. Bob Inglis (R-S.C.), �Keep your government hands off my Medicare.�


Speaker Nancy Pelosi (D-Calif.) planned to unveil a proposal to her caucus Tuesday night that would include the public option favored by liberals in the healthcare bill Democrats want to bring to the floor, according to two House sources.


The plan, called the �robust� option or �Medicare Plus 5� in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November


Some Democrats say there�s no need to rename a legislative concept that�s gained steadily in support since being lambasted as a �government takeover� in August. A Washington Post-ABC poll published Tuesday showed 57 percent of the public supports the idea � up five points since August � while 40 percent opposes it.


�It keeps polling better and better as a public health insurance option,� said a senior Democratic aide. �I don�t think it�s changing.� Polling experts, however, have documented that many people don�t know what a public option is, and that small changes in language can cause poll results to vary widely. An August poll by Penn, Schoen and Berland Associates showed that only 37 percent of those polled correctly identified the public option from a list of three choices.


�Before this year, few people had ever heard of the term �public option,� � Ross said last week.


It�s not clear exactly how the new Medicare idea would work. Some want to expand Medicare itself to uninsured people under 65. Others want to simply rename what is now called the public health insurance option.


Oberstar, who supports a �single-payer� system that would be completely run by the government, doesn�t want a Medicare public option to be based on existing Medicare rates because he believe Minnesota is one of the states shortchanged by Medicare reimbursements.


Republicans mocked the idea of re-branding a plan they still consider a government takeover of healthcare.



�It didn�t matter what they called Crystal Pepsi; no one wanted to drink it,� said Michael Steel, spokesman for House Minority Leader John Boehner (R-Ohio). �No matter how the Democrats �re-brand� their government takeover of healthcare, the American people oppose it.�


Republicans also note that Medicare is already $37 trillion in the hole and is projected to go bankrupt by 2018. �Has anyone noticed that Medicare is completely broke?� said Andrew Biggs, a scholar at the American Enterprise Institute who worked in the White House on President George W. Bush�s plan to overhaul Social Security.


The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi has flatly stated that the House bill will include a public option.


In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn�t advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.


In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.


People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal �Medicare Part E.�


The idea of expanding Medicare while still keeping private insurance was proposed in 2007 by Johns Hopkins University Professors Gerard Anderson and Hugh Waters. They presented a paper at a forum of the Brookings Institution advocating �Medicare Part E(veryone),� and said their proposal would expand Medicare to ensure universal coverage while allowing people to stay on their employers� health plans.”

“I find the differing shows and productions NPR carries to be of different degrees of progressiveness. Just like about any media organization.

Personally I don't trust the government with one red cent of our tax money but at the same time I also see we can not carry on the way we are going. Now just what the solution is is the big question.”

“The conservative Richard Nixon proposed a plan similar to what today's progressives are seeking - way back in 1974: http://www.kaiserhealthnews.org/Stories/2009/September/03/nixon-proposal.aspx

The Republican Party has abandoned conservative principals and is now simply the defender of corporate profits.”

“Both parties have left their base values Violin and both pander to the corporate profits. Just ask Joe Biden (D-MBNA).”