Do you support the Obama Healthcare Plan?

The government wrecks everything it touches. We already have two good examples of what happens when the government runs healthcare: The VA system and Medicare.

The VA System is notorious for poor service. Rationing is very much a reality in that system with many Vets experiencing long wait times and sub-standard care. And remember that disgusting VA hospital that came to light in the Bush Administration. The government made a promise to military vets and they have done a very poor job of keeping it.

Medicare is an economic disaster that represents a humungus unfunded liability which is going to wreak havoc on our economy and particularly young people who will be forced to pay it. It also practices rationing of a sort. Reimbursement rates to healthcare providers are artificially low dictates and many of them therefore refuse to accept Medicare patients. Defactgo rationing.

The Government is already in charge of a substantial portion of our healthcare and they are doing a miserable job of it. They should fix what they are already doing before we entrust them with any more control over 1/6th of our economy.

Beyond that, I have no interest in rationing medical care to my parents and grand parents in order to provide care to the un-insured. Rationing often amounts to denying care. Denying our elderly care is essentially the same as killing them and I don't believe that it is appropriate for our government to decide who gets to live and who gets denied care and is effectively killed by our own government. The government made a promise to our elderly and they should damn well keep it. My parents and grandparents paid into Medicare all of their working lives via payroll deductions and it is wrong for Obama to kill them.

Something like 25% of the uninsured are illegal immigrants or their children. Here is an idea that is a lot cheaper than the $1.3 trillion dollars Obama plans to spend giving insurance to illegal aliens: send them home!

There are a lot of things that could be done to improve our healthcare system like tort reform and allowing interstate competition and allowing consumers to buy ala-carte insurance policies without the expensive mandates required in many states. But Obamacare is the wrong answer.

...because there are things that I like in the plan, and things that I don't. Plus, I'm still reading the blasted thing.

There is a difference, however, between the way the VA is set up and what is being proposed in the new healtcare plan. The VA represents care that is both provided and funded by the government. The doctors and nurses are government employees, and a government plan pays for the services. The staff to patient ratio is very high, the program is underfunded, and there is no competitive pressure to encourage any sort of efficiency. Its a bad model. The plan being proposed in the House doesn't work this way.

In the proposed plan, private providers still compete for payment. What seems to bug people the most is the government's public option. In the industry (and remember, I work as a technology analyst for a MAJOR clearinghouse for medical billing), we call this a "payer." I work directly with several hundred private payers, and honestly, Tricare/Champus (the government run plan that is the payer for military personnel and vets) is probably the most stable and efficient payer that I deal with.

I agree that Medicare costs too much (though I would suggest that the main reason for this is Medicare FRAUD by providers) but similar to my comments above, as a functioning payer Medicare is extremely efficient. Their payment floor is one of the lowest in the industry (14 days), and they always lead the industry in the successful implementation of new changes in the technology, standards and transaction sets. In terms of practical operations, Medicare is comparable to most of the large private payers and superior to many of them.

Its not really rationing, because there are plenty of public and providers that DO accept Medicare. What your talking about really isn't rationing, because Medicare WILL pay for most procedures. And in fact, the relatively few procedures which they won't pay for are also typically refused by the vast majority of private payers. In fact, the private payers usually have MORE exclusions than Medicare.

An interesting point to insert here is that one of the main reasons that healthcare costs are so burdensome on the uninsured is that ALL of the payers engage in the practice of artificially depressing their payment rates. They can do this because groups have a greater bargaining power than individuals. The providers (hospitals, doctors, clinics, etc.) are thus forced to accept beneath cost reimbursement rates from these insurance groups. In turn, they shift the loss onto the bills of the uninsured patient (what we call, "self-pays"). So, the self-pays are actually paying an artificially INCREASED cost, far above what a covered patient pays. In many cases, the industry does this because they don't actually expect the self-pay patient to pay the bill. They just wait for the default and then write-off and/or sell the debt. In many cases, these procedures are inflated SO much that the loss actually eaten by the provider really isn't much of a loss at all.

This is why I actually support a public-option plan. Eliminating the majority of uninsured patients would provide a stabilizing influence on the industry's pricing model, which when you actually see the numbers side-by-side looks pretty out-of-whack.

Are they, really? Its easy to focus on the problems with Medicare (and I agree, there are problems) is that its operations are relatively transparent. But the private payers have their own problems, too. For example, most (and I'd almost say ALL) of the private payers are built around a denial of service business model. Without getting too technical, the private payers apply an extraordinary maze of conditions to their billing requirements that make it extraordinarily difficult qualify for a payment. Any tiny error on a claim renders the entire claim invalid. Their sole focus is to delay payments (allowing them to gain interest on the held funds) and when possible to deny.

For example, the private payers were very resistant to the idea of paperless billing. This seems rather strange, of course, since electronic claims processing is infinitely more efficient than manual paper processing, not to mention the base cost reduction from eliminating paper supplies and printing. The REASON the private payers hated paperless billing (and there are still a few hold outs on this, despite a federal mandate that has been in place for a couple of years now), is that paperless billing eliminates the need to use SNAIL MAIL to communicate a rejection to a provider. The industry standard used to be to check a claim until you find the FIRST error. Then you stop processing and return the claim to the provider (at least two weeks to receive, revise and re-submit). The payer then re-processes the claim and checks until they find the SECOND error. Wash and repeat. It used to take many months to see the final distribution of funds associated with most claims.

The private insurance companies are NOT on the sides of their customers. In fact, those companies only make money if they DON'T PAY as many claims as possible. Now granted, there's (usually) nothing ILLEGAL about this. Customers are thus seen as "the enemy" by most private payers, and treated as such (only after you make a claim, of course). Personally, I really think its a DIRTY industry, and one of the reasons that I like MY job is that as a clearinghouse, my company's whole purpose is to help our customers (the providers) navigate the maze and ensure that the payers issue the fastest and most complete reimbursement to the providers.

I really think this is a spurious charge. For one, you don't HAVE to go with the public option payer. If you want better care in your elderly years than everyone else, you can PAY for it (just like now). Secondly, there's nothing actually in the bill that would suggest that end-of-life care would be denied based on cost. In fact, the bill actually increases the end-of-life care options when compared to the current Medicare system.

This is a false claim that has been recently circulating the internet in the form of a chain letter. In fact, section 246 of the bill states very plainly...

SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

This is a perfect example of the MANY bald faced lies (and I don't think that YOU'RE lying jack, but once again you're been suckered in by conservative sources that are lying to you) that are being passed around about this legislation. There are a LOT of people who have a vested financial interest in seeing ANY reform effort fail, and if you follow healthcare politics closely (like I do), then you shouldn't be suprised or particularly impressed by the current smear campaign. This is business as usual in the insurance industry, which historically has virulently opposed EVERY major effort to reform its practices.

TTFN,
Blackout
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Party of Fear vs. Party of Hate
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Check out Progressive PRIDE, a Gay-Straight Alliance for the ProU community.

I agree that Medicare costs too much (though I would suggest that the main reason for this is Medicare FRAUD by providers) but similar to my comments above, as a functioning payer Medicare is extremely efficient.

The unfundated mandate that is Medicare threatens to consume the majority of the entire Federal Government budget beginning in a few years and getting progressively worse for several decades. It is a disaster without doubt the single biggest problem and challenge facing our government.

If fraud is the problem, shouldn't the absolute focus of any healthcare reform coming down the pike be to first get a handle on this fraud and stop it?

Are private insurers subject to equally pervasive fraud problems? If not, what are they doing differently?

You seem to agree that the government is doing a miserable job with the VA System and at least to the extent that they are unable or unwilling to control massive fraud are doing an incompetent job of running Medicare. Until they show a willingness and the ability to fix these problems, why would we trust them with an even larger slice of our healthcare sector?

If Medicare is fraud-ridden and therefore incredibly expensive, wasteful and threatening to bankrupt us, is there any reason to believe that a vastly expanded government run insurance program won't also by rife with fraud (see my comments about illegal aliens above)?

It is hard to honestly favor or oppose something as difficult to nail down as 1000+ pages of reform that hasn't solidified into a final proposal. The recess of congress has given us a chance to look at the present form of the proposal.

Some intentions of this bill are hard to oppose:
1)Universal health coverage.
2)Reducing the cost of health care.
3)Improving health outcomes.

The mess that we face presently is obviously far from ideal. The question is does this 'solution' bring us closer to an ideal, or take us further away?

Some of the provisions of this bill are likely to increase the cost of private coverage:
No denial for preexisting illness.
No waiting period for coverage to take effect.
No denial of renewal
All of these are practiced by insurance companies to reduce costs. Higher costs = Higher premiums.

There is also a provision which requires a rebate to customers if total income exceeds payout by more than the 'allowable profit'. As 'fair' as that may seem it might also eliminate any incentive to reduce costs. This type profit limitation coupled with a 'public option' seems aimed at eventually eliminating most private providers. Competition in this sector has been ineffective at keeping prices down, but reducing and perhaps even eliminating competition and profit incentive for cost control may result in a less efficient bureaucracy in it's place.

As proposed this bill seems to ADD administrative overhead, not reduce it. VA, Medicare, Medicaid are all left intact. Public option coverage is added, but individuals have to apply, and are taxed if they are not covered for any portion of the year if their income exceeds 400% of the poverty level. I admit that I have read only the broad strokes of this, and the mechanics of how a day laborer that hasn't bothered to apply for coverage will actually be dealt with are a mystery to me. I just keep seeing more paperwork, and thus more paper pushing jobs in government as I read. I project, but only time will tell, that these multiple overlapping government health care systems will eventually be unified into a 'single payer' in the name of efficiency.

Many of the elements could improve the present system and even make the market more efficient:
Standards of essential benefits. That allow consumers to compare coverage each plan provides in a standardized format.
Timely payment requirements.
Electronic paperwork and payment requirements.
If the consequence of this bill, unintended or otherwise, is to eliminate private insurers none of that will matter.

Elephants in the room that are ignored:
Tort Reform. It costs over $200,000/MD/Year to allow our current 'lottery by lawsuit' system to aim at doctors.

America leads the world in doctors per patient, medical innovation, Cutting edge equipment per patient, and development of new drugs. The top end of our current system is the best in the world, that excellence is the Baby we have to prevent throwing out with the dirty bath water that represents the inefficiencies in our current system.

"It is only by risking our persons from one hour to another that we live at all. And often enough our faith beforehand in an uncertified result is the only thing that makes the result come true."
- William James

but I voted "no" for a variety of reasons.

1) I don't trust the government. I don't ever see our current government doing things which will actually benefit those at the very bottom of the heap; we hear lots of promises, but in the end, the poorest Americans keep getting the shaft. I doubt we'll ever have a healthcare plan which actually takes care of the health of all Americans, including the homebums, the junkies, the vagrants, the unemployed, teenage mommas, people with criminal records...these people matter to me, but they don't seem to matter much to "our" government. Whenever I'm in a relationship with an individual which is one-sided, I tend to get out of that relationship, so I feel the same way with our government; fuck 'um. They take my taxes and pay for cops to fuck with me and my friends....

2) I don't trust Western medicine either. I don't know if Obama's new plan would cover midwives, nautropaths, herbalists, massage therapists and other healthcare practicioners I'd actually go see, but I kinda doubt it. I think I'll stick with working out trades with these practioners and seeing them instead.

Love ya,
Carrot

As someone who has been denied insurance by every carrier, I am a supporter of offering government funded health coverage to those who are uninsured. I am not poor (or wealthy), but I cannot afford $300 a month because I had to go on Nebraska's CHIP program for "high-risk" people. I've already spent hundreds of thousands in medical and insurance bills in my 28 years from a disease, but after my Cobra ran out, I had NOWHERE to turn and was forced onto the CHIP program.

No matter what, the insurance companies need to be put into check immediately. I was even denied from one company because of an anti-depressant I was using (not from my disease!). To think that we can go on like this is like turning a blind eye to the people who need help the most.

Did they (and by ‘they’ I mean the mysterious people who take care of the site) perform some sort of restore of the site recently? I noticed my comment here, and all the comments made after mine, disappeared a few days ago, as did my vote in the poll. Sounds like political censorship, methinks. Just kidding.

The jist of what I said was I am against Obama's healthcare plan, it's too expensive and ungainly, and there are better ideas for reform out there (some may be suprised to hear that- gasp- the "party of no" actually is offering alternatives to Obama's healthcare plan).

This is a topic I live with everyday. As a "federally recognized" Native American in the USA, I get free healthcare according to treaties laid down years ago from my ancesters. It's not much though. Literally, the remody for ailments from the common cold to cancer is, "I'm going to perscribe you some ibuprophen." I have relatives that have literally died in the waiting room because the administrative nurses did not think them sick enough. Believe me this plan is not a good move in any way at all. Ask any Native American (keyword: federally recognized)