The Baucus Health Plan Discussion

[WhiskeyGirl]

Will the Baucus health plan reduce healthcare costs for everyone?  What exactly are they reforming? 

Does it really matter if something is budget or deficit neutral if individual taxpayers will be paying more for everything healthcare related?

Employers paying higher payroll taxes? 

Are the budget and deficits being shifted to taxpayers?  A shifting of expenses for another government run entitlement program that benefits everyone except those that have to pay for it?

Is the government taking money out of your pocket anyway?


I read the outline linked here http://blogs.wsj.com/washwire/2009/09/08/baucuss-health-plan-targets-industry/

The proposal from Baucus looks like it could be a summary of HR3200.  It looks plain and simple, with details to be filled in later.  Who's filling in the blanks? 

Will it look like HR3200 when it's done?

I have listened to Kathleen Sebelius and others say the 'REFORM' will save every senior money. 

I disagree and here are some of the reasons why.

Part of the outline requires drug companies to give those with Part D coverage a 50% discount off the negotiated price of the drugs they need.  Who's negotiating the price of these drugs?  What is their track record?  Who pays rack rates for drugs?  Only Americans?

What good is a 50% discount if for example, the retail price is $50 a pill, the negotiated rate is $40 a pill, and the senior can't afford even $5 a pill?  In this example, just suppose the price for third world countries is like $1 a pill. 

Why do Americans pay more?  I believe it works the same for vaccines. 

Why shouldn't ALL Americans have access to the same fair price for medical goods, services, and drugs?

There seems to be an exception to this 50% discount.  The way I read it, if you pay more for Part B than the basic $96.40, you do not get the advantage of the 50% discount.  You get to pay full price.  Why are SOME excluded from the discount?

Some might suggest that those paying more than the basic Part B premium are wealthy. 

What kind of people fall in the wealthy category?   Hmmm...folks who have saved and invested their entire lives.  Maybe their investments are having a good year.  Should they pay more? 

In Wisconsin, there are some, like farmers (and other businesses) that sell the farm, or some land and have a large one time hit to their annual income, they pay a higher Part B premium for one year.  Now, under this proposal, they lose the drug discount. 

What if their entire lifetime of work is tied up in the farm and land or business?  That's their income, their life savings.  They've scrimped and saved to keep their income for a lifetime.  Should they pay more because they have a different savings than folks who worked for the government and get a pension? 

What if they're selling the land to pay the Medicare Part A deductibles?  Part B coinsurance?  

I haven't seen anyone address the HIGH out of pocket expenses seniors on Original Medicare have. 

Obama and others, want to eliminate the Medicare Advantage plan (I believe this is referred to as the 'fraud, waste, and abuse' or Medicare 'overpayments' by politicians) which in many cases, limits or may even cap out of pocket expenses for seniors and others.  In this Baucus outline, it looks like the same thing may happen.

Is the Baucus Health Plan just an outline of HR3200? 

Who's filling in the details?

Why don't ALL Americans have access to the same low prices for healthcare?  Drugs? 

[WhiskeyGirl]

Competition and the RIGHT to choose the coverage plan that suits your family, budget, and beliefs.

Where in the Baucus plan is competition?  I saw mandates for STATE health exchanges.  This was in HR3200 too. 

The federal government defines the plan benefits, rate structure, and all kinds of things.  What if someone wanted to save some money and take a high deductible for their family?  Gee, I only have three in my family and one is a child.  'My HSA includes one preventive care doctor visit a year, and gives me generous discounts for my prescription drugs, I think I can manage those everyday expenses out of my own pocket.  Why should I pay the insurance company to manage those things for me?  Maybe I can save thousands a year?'

Alternatively, someone may want to pay more for the benefit of having the insurance company manage their daily healthcare expenses and doctor visits.  Should they pay more for this service or convenience?

I believe the Baucus plan mandates benefits and FIXED out of pocket expenses.  Higher deductibles usually come with LOWER premiums. 

Why not encourage consumers to spend THEIR and THE PUBLIC dollars carefully?

There are also mandated rate structures.  Why?  Shouldn't all Americans have access to the same fair prices?  Pay based on the usage of their families?  In some plans, folks pay one rate for a family regardless of how many children the family has.  In other cases, folks pay based on family composition - the number of adults and the number of children.  Those with more children pay more.  Those with two adults pay more.  Those with one adult and one child pay for just one adult and one child.  Should all ratepayers subsidize the larger family?

The Baucus paper also had a section that seemed to suggest that ALL plans need to migrate to the government rate structure.   What if you like the structure you have?

Is it really meaningful that you keep your same doctor and your insurance if you like it and the government forces changes on both?  Will you still like your insurance when the government rating structure is implemented?

With increasing government interference in insurance, has competition and choice increased?  I believe there are states that have little or no choice for small groups and individuals due to government regulation.  Wisconsin still has choice.

Where is the competition and choice?  If someone wants a deluxe or robust plan should they pay more than someone who wants the basics with say a $5,000 deductible? 

In states with highly regulated rate structures and rules, is there more choice today than say twenty years ago?

What choices will Americans have when there is just one federal mandate?  Four levels of benefits?  That seems to me to be less choice than today.

What if someone wants a plan without maternity/reproductive coverage?  At some point, many people have no need for this benefit.  Same with mental health and nursing home. 

In the olden days, healthcare didn't cover maternity or reproductive expenses.  Pregnancy was not considered an illness or a disease.  Same with birth control, abortion, and impotency.  Mental illness and physical therapy  were also not covered or limited. 

Where is the choice?  Why aren't patients being held accountable for controlling healthcare costs?

At some point, the healthcare costs WILL bankrupt the nation.  How many years?  Twenty? 

Who decides how care is rationed?  Who gets care?

Why doesn't the plan focus on individual responsibility, individual needs, and individual decisions on how much healthcare is worth?

Should I pay more for someone who wants a Goldman $40,000 a year healthcare plan?  And, needs a subsidy for $39,500?

jmho

[WhiskeyGirl]

Another problem?  Tax credits for those at or under about 135% of the federal poverty level.

In some states, Medicaid benefits and programs are much more generous than in others.

California and my state of Wisconsin come to mind.

Here is an easy to read chart for Wisconsin - http://dhs.wisconsin.gov/MEDICAID/fpl/fpl.htm

In some cases, folks well above the FPL are eligible for Wisconsin Medicaid or other healthcare programs.  Should they get tax credits and Medicaid?  Another handout for those that qualify?

There is also a section on State High Risk Pools and making more money available. 

A few things come to mind -

Why would anyone need to continue a High Risk Pool with a government option?  Insurance reform? 

Some states like Wisconsin, do not limit the number of folks that may enter the state plan called HIRSP.  The plan is paid for by participants and taxes on insurance companies. 

In other states, like Illinois, the number of participants is limited, and there may be a waiting list.

Exactly what does the Baucus subsidy add to State High Risk Plans? 

Over the years, why haven't ALL states adopted a robust state high risk plan?

If the Baucus plan seems to shift things to state control, and 'guts' state ability to regulate, why is the government getting involved?

I wonder how many in Congress have had to deal with insurance companies that are regulated by the Federal Government?  Ever try to deal with a Part C or D plan?  It can take months!

Why would you give someone tax credits if they already get their healthcare free through Medicaid?

imho

[WhiskeyGirl]

If ALL Americans wanted healthcare reform in great numbers, why didn't they do it at the state level?  Some have, some have not.  California is almost bankrupt. 

Is it possible that they are concerned with how to pay for all this healthcare? 

Why isn't Congress and the White House concerned with all the expense?

Is it better that a whole nation is bankrupt, or a few individuals? 

I know folks without insurance who have lots of bills and they pay a little each month for the rest of their lives - they don't file bankruptcy.

Where in any of these bills does it address healthcare inflation due to care for illegal aliens?  When will these folks start paying for the care they receive?  If politicians keep talking about how much these folks cost taxpayers already, why aren't they doing something to eliminate this expense?  Why aren't these people being held accountable for their healthcare debts?

Why don't they ever ask poll questions like "Should immigration status be determined in the healthcare setting?"  "Should illegal aliens be stabilized/treated and immediately deported?"  "Should illegal aliens be fingerprinted and robust collection actions utilized?"

If insurance status and ability to pay is determined for citizens, why not immigration status?

Why doesn't anyone in the media ever 

How much do deluxe, robust, all inclusive plans cost? 

Do rich plans feel the effects of healthcare inflation more than plans that are more basic or with higher deductibles?

I keep seeing affordability limits of say 10-13% of income.  Something just screams that ANY robust government plan will ALWAYS cost more than 10-13% of income. 

Is the government shooting for a basic plan for everyone?

Or a robust, deluxe plan like the Goldman's enjoy for $40,000 per year?

Somehow, I image the government plan will have benefits that require annual premiums of $40,000.

How much of a robust plan are individuals willing to pay for?

States?  Future taxpayers?

Who's paying off the deficit when it comes due in the future?

Maybe tomorrows children want to determine their future?  Maybe they'll wonder why their parents and grandparents wasted all this money and STUCK them with the bill?

There should be a compassionate answer to the problem of healthcare.  I don't see it in any of these helter skelter holdup plans.  I just see debt, national destruction, fraud, waste, and abuse. 

imho

[WhiskeyGirl]

Why aren't their fee structures imposed on hospitals?  In my state beauticians have to post a fee menu.  Why not hospitals?

Why aren't hospital charges/fees controlled?

Something like - the difference between the highest and lowest charges for a service cannot be more than 10%.

It also doesn't address other incentives.  How many rebate schemes do providers participate in?  Do they send incentive checks (by any name) to large networks?  Plans?

Why don't providers charge fair prices? 

How much non-healthcare/service related expenses do healthcare providers have?  If you're asking this information of insurance companies, why not healthcare providers?

It seems that healthcare providers, especially large multi-hospital systems, get a green light.

In smaller areas, how can there be competition, if the majority of providers/facilities are owned/controlled by the same entity? 

Why are providers (other than doctors) falling between the reform/inflation cracks?