Point 1- Ends discrimination against people with pre-existing conditions.
Insurance companies are in business to make money. They have spent decades creating actuary tables that set rates based on the physical condition of a person. In companies with fewer than twenty five employees, employee rates and acceptability are determined by pre-existing conditions. Companies with more than 25 employees pay the same rate but are subject to the exclusion of a pre-existing condition if the employee has had a lapse in coverage. What this means is if someone worked for company A and health insurance through the company and they had a condition, say breast cancer, when they leave the company, if they do not get health insurance outside the company for a specific period of time (generally more than 90 days), the insurance company at company B where she starts her new job can opt to exclude the costs of breast cancer treatment. If she keeps health insurance coverage between employers, the new insurance company will cover it.
So here's the easy solution, if you lose your job and have a pre-existing condition, or for that matter even if you don't, continue your insurance either on an individual policy or through COBRA until you begin the new job. "Ending discrimination" is just wordplay saying if the employee screws up, it's okay, GOVCO is here to make those mean insurance companies cover you.
What this will mean is insurance companies are going to limit their clients to larger companies where they can spread the risk. It is too easy for them to lose money on small firms. In essence, this Obamacare point serves to penalize the small business man who desired to provide healthcare insurance for his employees. The result, thousands more uninsured employees.
Point 2- Prevents insurance companies from dropping coverage when people are sick and need it most.
Unless the insurance company can clearly demonstrate that:, 1. the condition was pre-existing, 2. The insured was aware of the condition, 3. The employ intentionally refused to make the insurance company ware when applying, few people would argue in favor of the insurance companies on this one. However, there needs to be a method of recourse for the insurance company if the above conditions exist. Otherwise, an applicant can say anything they want to get the insurance and then the insurance company is stuck with the bill.
Point 3- Caps out-of pocket expenses so people don't go broke when they get sick.
The bottom line is that employers determine how the money works when they take bids for coverage. The employer chooses the employee's copay and deductible from a myriad of options in order to fit their budget. The higher the deductible, the less expensive the insurance. If the employer is footing the bill for most of the cost, a higher deductible can make the difference between being able to offer insurance or not. By putting a ceiling on deductibles, two things will happen. First, employers will immediately switch to policies with much higher copays. In other words instead of one employee being stuck paying $10,000 deductible the year of their heart surgery, every family is out hundreds more per year in copays. The hardest hit is families.
Second, there will be some small business employers who will choose not to offer insurance due the prohibitive cost. SO once again, GOVCO trying to do good is uninsuring thousands with this action.
Point 4- Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
First of all, according to the CDC, flu shots range in effectiveness from "unmeasurable" to 90% depending on the year and how well they guess the formula. So the question begs to be asked, if we demand that insurers provide preventative treatment with a high level of success uncertainty for the flu, should we demand them to provide any preventative treatment as long as it falls within the same level of efficacy. For instance, the efficacy of Gardasil lies somewhere between 14-50%. Should insurers be required to administer this vaccine free as well. If so, where do you draw the line, acupuncture, hypnosis. If a product is proven to reduce costly illness, the insurance company is going to pay for it anyway to reduce the cure costs. If they aren't already paying for it, one must question the efficacy. Also, if those tests are disclosed as being an additional charge prior to the client signing up, that's part of the contract. If you don't like it, get your insurance somewhere else.
On another note, has anyone considered that by having clients pay for some preventative care insurance companies are keeping costs down. Rolling these costs into the policy will only raise the premium. Once again, this rate hike will result in small business cancelling their health insurance.
Ironically, medicaid only provides preventative services in 36 states. It is not a federal requirement. I guess the really poor don't need flu shots.
Point 5- Protects Medicare for seniors
Here's what the president says he will do "The President's plan will extend new protections for Medicare beneficiaries that improve quality, coordinate care and reduce beneficiary and program costs. These protections will extend the life of the Medicare Trust Fund to pay for care for future generations."
Here's what that means: The current government run health care system provides low quality care at high cost. In addition, the future of funding for medicare is uncertain. So we are going to fix it. By fixing the quality issue, we will ocntinue to be able to afford to provide it…maybe.
Don't gloss over this one. Here is government run health care admitting it is doing a poor job at providing health care while simultaneously claiming they are the best at providing health care. You have to be a rube to miss the irony.
Point 6- Creates a new insurance marketplace – the Exchange – that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices
There is already a market out there for individual insurance policies. You can even purchase "gap" insurance to cover you between jobs . Maybe they haven't looked around much but "The exchange" sounds a lot like ehealthinsurance. But that is a company. I'm sure the government is much better at running a website. Just check one of theirs out. Better yet, call them and see how long you are on hold.
Point 6-Provides new tax credits to help people buy insurance
What a bureaucratic mess! I'm assuming that this sliding scale is going to be some algorithm written by an MIT graduate taking into account the taxpayer's family status, cost of living index, salary, and living expenses. Tax credits sound nice. But remember, that is another way of saying government give away. And we all know where the government gets the money to give away. I'm not saying this idea doesn't have a utopian side to it. Imagine all those single mothers with limited wages working for companies that don't provide health insurance. Parade a few in front of congress and there won't be a dry eye, especially if little Timmy tells his story. But for every legitimate story, there are a dozen stories of abuses of the system. Maybe point 6A should be to establish an audit department. But that will never happen. After all, what politician wants to be a part of denying coverage to anyone for any reason once pandoras box is open.
Also, am I the only one that sees this as an extension of medicaid? Of course, medicaid wants you to liquidate everything before you can be covered. I'm sure that the tax credit will be available to all those Mercedes driving poor folks solely based on income. And let's face it, no one ever fudges that number.
Point 7- Offers a public health insurance option to provide the uninsured and those who can't find affordable coverage with a real choice.
"The President believes the public option must operate like any private insurance company – it must be self-sufficient and rely on the premiums it collects." This statement implies government efficiency. Remember the earlier point about improving the quality of medicare. Show me one efficiently run government program. The same people that believe the public "option" will be self-sufficient are the ones who vote in the "education" lottery based on the promise that all the lottery money will go toward improving education. How's that working out for you. I know in our district, 25% of the teachers were laid off and not one administrator. Thank goodness for the lottery.
You simply can't have an insurance company operate at break even if they must accept preexisting conditions and not charge a premium. Here's what is going to happen. As all these small employers with high risk employees stop offering insurance, they are the ones who will use the govco insurance. There is no way enough healthy people will be paying in the premiums to offset their cost. This department CANNOT break even. Remember, the goal is to provide insurance for those who can't afford insurance. Therefore, GOVCO rates must be lower than market. SO they are going to insure to sickest individuals and charge the lowest rates and give away preventative maintenance. People, they can't break even.
Point 8- Immediately offers new, low-cost coverage through a national "high risk" pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.
What this translates to is forcing existing companies to accept clients with pre-existing conditions on a rotating basis just like auto insurance. The result…you guessed it, higher premiums all around to compensate and more small business cancelling insurance.
Point 9- Won't add a dime to the deficit and is paid for upfront
The plan fully pays for this investment through health system savings and new revenue including a fee on insurance companies that sell very expensive plans. Let's read between the lines. If you don't increase the deficit and insurance costs a bucket of money, how do you pay for it. Raise taxes! First they are going to charge companies that have expensive plans. Well that's kind of vague isn't it. The fee does nothing but raise the cost of the policy even more!!! Add in a little supply and demand and those companies write even fewer policies generating less revenue for the system. Sooner or later, either the department will run at deficit, or our taxes go up to pay for it. Please don't be so ignorant and think you won't pay for it.
Point 10- Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality
I'm sorry, did I just read some companies mission statement. What the hell does this mean. "Delivery system reform" I guess that means how you get your medical care. I don't know where you get yours, but my doctors and hospitals are the most service oriented, quality controlled organizations I have run into outside the Hilton. The only thing that needs reform is the amount of freeloading Medicaid cases taking up space in the ER because they don't want to go to Walgreens next door and buy an aspirin. Did I mention they are carrying a Gucci bag and driving an Escalade. My personal favorite is the Medicaid patient who called 911 from CVS to get a ride to the ER because she didn't want to pay for chapstick. Because of government delivery system reforms, the ambulance was required to take her to the ER. The ER was required to admit her. And we are required to pay for it. This is the kind of efficiency I can't wait for more of.
Also, I love how the government's incentives have amped up the quality of education. Now students spend the whole school year practicing to take a test instead of learning because quality is measured on pass rate for the test. By Govco, determining the metric for quality, the patient is no longer the stakeholder. Bad idea bro.
Point 11-
Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system
This commission is focused on the lack of quality in Medicare! Don't get me wrong, I'm all for this. I appreciate the government admitting it doesn't have a clue what is wrong with there system, especially when they are about to enlarge it so much.
Point 12- Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.
Another way of saying this in English is that malpractice claims will be capped. Gee, do you think the insurance companies insuring all those doctors had anything to do with this one. Maybe the $27 million in campaign donations was well spent. What does this mean to Joe the plumber. First, his doctor can now buy a bigger house because he has to pay much less for insurance. Next when they amputate his arm instead of remove his kidney stone, GOVCO will have already determined the payout for that and he can take his ten grand and be on his way. But the good news is when his doctor adds a guest house, he can do the plumbing, or not.
Point 13- Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform
First of all, the first point is pretty minimal. 98% of large employers are already offering insurance. So legislating the other 2% into insuring only means a few more bankruptcies. Think about it, the only companies not investing in their employees are the ones on the brink of bankruptcy. What you are going to find is companies breaking onto smaller companies so they can ditch the rule.
The second part is just the ribbon on the package. Who can't afford it. If there is Medicaid for the indigent, Govco insurance for the low income, tax credits for the somewhat low income, and "the magic exchange for everyone else" shouldn't this just say everyone must be insured. Folks mark this as one of many freedoms that will disappear in the Obama administration. Think about it. The government is mandating that you spend your money yet again. If you want to ride the bus, you don't have to carry auto insurance. If you want to live with family, you don't have to pay property taxes , a mortgage, or even rent. In addition to taxes, you are now REQUIRED to part with your money.
So what is the fine going to be. If you walk into the ER without insurance, are they going to tack a parking ticket onto your bill. So now a guy who can't really afford health insurance, even though the geek at govco says he can if he sells everything he has, has to spend more money on fines making insurance farther out of reach. Now that's what I call reform, or in other words, sticking it to the little man.
