If health care reform is killed, what happens?

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA).  Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works. Most voters would be utterly disgusted if Congress returns to the health care debate this fall. It was ugly the first time around; virtually no one wants to watch re-runs on C-Span.  In the months ahead, Americans hope that their elected representatives will do just three things: create jobs, create jobs, and create jobs.

Secondly, if conservatives somehow succeed in crippling the reform bill, we will find ourselves back in a world of laissez-faire health care where medical spending continues to spiral by 4.5% to 9% a year (just as it has for the past ten years), thanks to a combination of climbing prices and rising utilization.

Here, I’m not talking about how much insurance premiums rose: reimbursements that private insurers, Medicare and Medicaid paid out to hospitals, doctors and patients over the past ten years have been climbing by 4.5% to over 9% annually.

In some years, Medicare reimbursements were growing faster; in other years, payouts by private insurers levitated. Over the same span, Kaiser reports that premiums for a family plan rose by an average of 13.1% a year.

Without the Affordable Care Act (ACA), payouts for drugs, devices, hospital services and physicians’ services are expected to accelerate over the next ten years, rising by an average of more than 6% a year. Without reform, roughly one-third of our health care dollars will still be squandered on unnecessary treatments, redundant tests, over-priced products, preventable hospitalizations and avoidable medical errors.  Employers will continue to shift costs to employees (or just get out of the health benefits business altogether), and more and more Americans will find themselves priced out of the health care market.

Rather than joining the rest of the developed world by offering affordable, comprehensive care to all of our citizens, the U.S. will find itself becoming  part of the “developing world”– where only the very wealthy have access to good care.

I don’t believe that will happen.  We are on the path to reform. It will be a long, rocky road, but there is no turning back. The alternative is just too bleak.

The Liberal dream

That said, why am I even addressing the possibility that conservatives will form a death panel and pull the plug on the ACA?

Because some irrepressibly optimistic progressives have begun to suggest that if reform’s opponents prevail, the story might have a happy ending. And I am worried that these liberals may encourage other progressives to step back, and let conservatives have their way. After all, many on the Left found the Affordable Care Act disappointing—a half measure, not what they hoped Obama would deliver. Some are willing to let it slip away.

Just a few days ago, in a piece in AOLNews titled “Obamacare Critics: Be Careful What You Wish For,” New American Foundation fellow Micah Weinberg made the argument that a victory for the conservatives could  lead us to what some liberals still yearn for: a single-payer system.

If this round of reform fails … we’ll have to do something entirely different. But don’t hold your breath waiting for a system that relies even more heavily on the private market for health insurance.

In fact, the most likely thing that we will do is move toward a system like Medicare that is financed by the government. It turns out that Medicare is extremely popular among seniors of all political persuasions, even tea partying ones. After all, the thing the town hall screamers were the most upset about was the idea that the program would be changed to institute “death panels.” This was a vicious smear that could not have been further from the truth. But it shows just how little appetite there is for changing the Medicare program in any way, even among members of the conservative right.

So people of all political stripes love to love Medicare, and they love to hate insurance companies. It stands to reason, therefore, that if we have to start over, we’ll build on what is popular rather than heading even further in an unpopular direction.

Conservative Republicans are free to continue their quest to undermine health care reform. But they should be careful what they wish for, because through their actions they may be the very people who finally lead this country to … a single-payer health care system.

Employer-based insurance versus Medicare

What Weinberg forgets is that while seniors love Medicare, a great many  Americans under 65 love—or at least like—their employer-based insurance,  if for only one reason: their employer pays for it.

And when employers pick up most of the tab, this is good news for all taxpayers. When middle-class and low-income employees working at large companies have good insurance, we don’t have to worry about funding subsidies to help them buy coverage. (Granted, wages are lower because employers provide benefits—in that sense the employee pays for his health insurance.  But as I explain below, if single-payer replaced employer-based insurance, salaries would not automatically rise to equal the value of the lost perks.)

Typically, employers pay 85% of health insurance premiums according to the Kaiser Family Foundation. In addition, as this Kaiser Issue Brief points out, the average large-employer PPO plan is more generous than Medicare.

Even when you include Medicare’s relatively new prescription drug benefit, Kaiser observes, the average value of Medicare benefits in 2007 ($10,610) lagged the value of the typical plan offered by a large employer ($12, 160). “Medicare is less generous, on average, than the comparison employer plans because it has higher cost-sharing for inpatient care under Part A (particularly for relatively short hospital stays), no out-of-pocket limit on services provided under Part B, and less generous drug coverage under the standard Part D benefits …”

In 2010, for example, if a Medicare patient is hospitalized he must meet a deductible of $1,100 before Medicare kicks in to pay for the first 60 days of hospitalization.   If he remains in the hospital longer than 60 days, the patient faces a co-pay of $275 per day—up into day 90—and $550 per day for days 91 through 150. After 150 days, the patient is responsible for all hospital charges, and there is no cap on how much he will be asked to pay, out of pocket, in a given year. Medicare part B covers physicians’ services, but seniors must pay premiums of $110.50 to $353.60 per month (depending on income), and Medicare pays only 80% of the approved costs for these services.

As Kaiser explains: “individual Medicare also pays a smaller share of total costs associated with covered benefits, on average, than either the typical large employer PPO or the Federal Employee Health Benefit Plan’s standard option). In 2007, Medicare paid 74 percent of costs associated with covered benefits for an individual with average health care costs ($14,270), while the typical large employer PPO paid 85 percent of total costs.”

Indeed, when they turn 65, many Americans are surprised to discover that Medicare doesn’t reimburse for everything their employer-based insurance covered—routine eye exams, for example, are not included in the package. Many seniors are even more startled by co-pays and deductibles that can be hefty, particularly if they’re hospitalized.

To compare job-based insurance to Medicare, think of it this way:  60 percent of seniors lay out as much as $279 a month to pay for supplemental coverage such as MediGap in order to fill the cracks in Medicare. That’s $3,448 a year—just to bring Medicare up to the level of a good employer plan.

Make no mistake:  I’m not suggesting that seniors don’t like Medicare; They do. At least the 60% who have supplemental coverage (because either they or their former employer can afford it) are pretty content.

But younger Americans who are lucky enough to work for a large company where they have employer-based insurance are fond of their coverage, too.  They won’t want to give it up–especially if someone explains that insurance modeled on traditional Medicare would cover less, while costing them more.

Before dreaming of single-payer

If a single-payer plan set out to match the benefits that large employers now offer, it would cost taxpayers a bundle.

Granted, thanks to lower administrative costs, a public plan’s premiums should be at least 5 percent to 7 percent lower than premiums for a comparable private plan. (These numbers come from a Commonwealth Fund brief that offers a very positive assessment of how much a public plan could save.) When compared to a “public option,” that competes with private insurance, a single-payer plan should yield even greater savings because hospital  and doctors would be dealing with only one payer, slashing their paperwork and administrative costs.

But, over time, those administrative savings wouldn’t be enough to pay for the generous benefits that large companies offer. Don’t forget that the price of the services and products that hospitals, doctors, drug makers and device makers provide has been climbing by an average of nearly 5% to 11% a year, year after year, for two decades. The one-time savings in administrative costs (however big it is), won’t compensate for continuous, compounded increases in the underlying cost of medical products and services.

The only way that a single-payer system could afford the level of coverage that large employers offer is if we rein in runaway health care inflation by wringing some of the waste out of our system. And, assuming that we’re going to eliminate waste in an intelligent way, using a scalpel, not a meat cleaver, this will take time. The Affordable Care Act set out to change  how we reimburse  for care by moving away from fee-for-service, paying health care providers for value (better outcomes at a lower price), not volume.  This means persuading patients—and physicians—that more care is not necessarily better care.

Financial carrots and sticks also can encourage hospitals to take a closer look at the medical errors that, according to a recent study conducted by Millman, Inc. for the Society of Actuaries (SOA), added $19.5 billion to the nation’s health care bill in 2008. Not all errors are preventable, but many are. The most expensive error on the SOA list—pressure ulcers (a.k.a. bedsores) often can be avoided. Yet in 2008 374,964 ulcers, at a cost of $10,288 each, boosted the nation’s health care tab by $3.858 billion. (See the Institute for Health Care Improvement on prevention programs that have dramatically reduced the incidence of pressure ulcers in a number of hospitals.)

Who would make up for the dollars employers now pour into health care?

Keep in mind that if we switched to a single-payer system, large companies would no longer pay 85% of their employee’s premium. Low-income and middle income families who now have job-based insurance would qualify for subsidies, but taxpayers would have to foot the bill.  More affluent employees (individual earning over $43, 320 or a family of four taking home more than $88,200)–would not receive a government subsidy.

As noted, single-payer insurance would enjoy lower administrative costs, but even so, next year, comprehensive family coverage that is comparable to what large employers now offer would cost more than $10,000 (By then, a private plan that offers good coverage for a family will fetch close to $14,000)

But wait—if  employers no longer provided benefits, wouldn’t Congress insist that they raise wages-, or pay higher taxes into an insurance pool to help fund the cost of universal coverage? Yes, but it’s doubtful that either wage hikes or taxes would equal what employers now lay out for insurance.

First, what an employer now spends on premiums is tax deductible as a business expense. The value of that tax deduction varies, but let’s say that a company contributes $9,000 to each employee’s insurance premiums (this was the average contribution in 2007), and that, after taking the deduction, insurance costs the company $9,000 minus “X” (with X equaling the value of the tax write-off) per employee.)

If single-payer replaced employer-based insurance, would most employers be willing or able to raise each employee’s wages by $9,000—or contribute $9,000 to the pool? Probably not.  Employers would argue, not unreasonably, that in the past they were spending only $9,000 minus X, and they were hard-pressed to do that. They cannot afford more.

Secondly, when an employer invests in his own employees’ insurance, he buys something that is of value to his business: employee loyalty. His workers are less likely to move to a competitor if he offers generous insurance. This saves him the time and money that it takes to train new workers. Turnover is expensive. Under a single-payer system, if a business pays taxes into a national insurance pool, it gets nothing in return. This is another reason why employers would be reluctant to toss even “$9,000 minus X” into a pool that would fund universal coverage. Many in Congress would sympathize with their reasoning.

As for raising wages –- if the 1990s taught us anything about labor economics, it is that employers will not hike salaries for most workers unless they absolutely must. Even while earnings grew and productivity rose, in the 1990s the average worker did not see his wages climb. Corporations paid out dividends to shareholders, bought other companies, invested in their own business, bought back their stock and hiked executive salaries.  They did everything—except share higher profits with workers—until the final years of the decade. Even then, workers’ wages did not begin to catch up with the gains corporations and their investors enjoyed.

Today, with real unemployment well over 10 percent, businesses are not worried about losing workers. In the past two years, when companies such as GM or Dow Jones cut back on insurance benefits, they did not hand out raises.

Under a single-payer system, I am sure Congress would expect businesses to make a contribution to the pool that funds government subsidies, but you can be quite certain that employers would not wind up paying 85% of the cost of coverage—not even 85% of the cost for the 133 million employees that large companies now insure.

Who will pick up the difference? Tax-payers and more affluent Americans who don’t  qualify for government subsidies.

Why Medicare E (for Everyone) just isn’t affordable now

Do we want to try to drop the entire U.S. population into a single-payer system that resembles Medicare sometime over the next few years? No. Keep in mind that our entire health care system is broken.  Medicare, like other payers, squanders roughly one-third of its dollars on treatments and products that provide little or no benefit to the patient. Our for-profit medical-industrial complex is set up to maximize the amount we spend on drugs, hospitals, tests and procedures.  If we attempted to roll out a single-payer plan next year, the only way we could afford to cover everyone is if took an axe to the waste, rationing care, slashing physicians’ fees and closing hospitals. This is not rational reform.

As it stands, we’re planning on shepherding some 32 million uninsured Americans into what we euphemistically call our health care “system” in 2014. This is because we have no choice. Those Americans have been left out in the cold for too long. They need our help. And we have to start somewhere.

The good news is that the cost of covering the uninsured, along with the climbing cost of Medicare, will push policy-makers to start demanding value for our health care dollars. Already, Medicare has begun insisting on higher quality, lower cost, patient-centered care (refusing to pay for preventable hospital readmissions, for instance.)

Medicare director Don Berwick will be setting an example that private insurers will follow. As president of the Institute for Health Care Improvement (IHI), Berwick has had great success in showing hospitals, doctors and nurses that they can make their own work environment more efficient, and their work more satisfying  if they collaborate to provide better, safer care at a lower cost. Reform shouldn’t have to be imposed on caregivers. It can happen from the inside. Berwick understands this better than anyone. Between now and 2014, we can prepare for reform, but it will take more than three years to make the deep structural changes needed.

If Liberals want a public option, they should protect reform legislation

Congress is not going to pass a single-payer bill at this point in time. For one, legislators know that the vast majority of the 133 million employees who work at large companies where their employer pays 85% of premiums are quite attached to that perk. Why wouldn’t they want to hold onto it? On average, benefits are better than Medicare’s, and cost sharing is lower.

Why should the rest of us care whether those 133 million hang on to a sweet deal? Because society as a whole benefits as long as those corporations continue funding 85% of the cost of insurance for their workers–including millions of middle-income and low-income Americans. (Under the rules of employer-based insurance, all employees must receive the same deal.) And according to a Kaiser survey, despite the economic downturn, employers remain surprisingly committed to providing benefits: 95 percent of those with 50 or more employees offer insurance. Although they are increasing co-pays, only 2% say they are very likely to drop benefits. This gives us some breathing room, time to bring down health care inflation, before Americans  decide whether they want a single plan for everyone.

Make no mistake: I’m not disparaging the liberal dream. I’m just saying that it won’t happen in the next few years.

First, we need to realign the financial incentives in our health care system .The reform legislation lays out the blueprint for providing higher quality, more affordable care, but reform will be a process that takes place over time.

As I have suggested in the past, my guess is that sometime before 2014 a public option will be added to the current reform scheme. Under the new regulations, some for-profit insurers are bound to throw in the towel, and I suspect that we will need a public plan to take up the slack in the Exchanges. Ultimately, I expect that a public plan will be open to everyone. When reform legislation included that option beginning in 2014, legislators suggested that employees of large companies would be eligible to join a few years later. If a public plan manages to provide high quality coverage at a reasonable price, more and more families will pick the government plan.

This is the best route to a public health care: let Americans choose it.

But all of this will happen only if we press ahead with reform. Liberals must put their heads down, get behind the Affordable Care Act, and push—as hard as they can.

The alternative is not the status quo—it is something far worse. The situation is deteriorating as I write. Our health care system is heading for a wall. Without reform, even Medicare will run out of money, and you and I will just have to hope against hope that we and our loved ones don’t get sick.

Maggie Mahar is a fellow at The Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much. She blogs at Health Beat, where this post originally appeared.

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  • paul

    if the conservatives kill health care reform, we go back to the slow steady march into oblivion. if the liberals keep reform alive, we head in the same direction but at a brisk jog.

    …are those really the only two choices we have?

  • justin

    My that’s a long post.

    Healthcare delivery is not laissez-faire; health insurance and medicare/medicaid dictate prices to doctors and hospitals. Insurance companies are for profit and pay their executives milllions of dollars every year; they should be non-profits. If you want health care to cost less do the following:
    1. Tort reform
    2. Ration medications and treatments
    3. Stop direct to consumer pharmaceutical advertising.
    4. Make americans less fat and lazy
    5. Make americans responsible for part of the cost of their health care.
    6. Pray.
    7. Require advance directives/living will for all citizens.
    8. Require government sponsored TV advertisements regarding futility and cost of end of life care.
    9. If families disagree with medical personnel and want to keep the venilator running, get another medical opinion stating the patient has likelihood of living, or else family pays for the cost.3
    10. Require that uninsured individuals who receive EMTALA emergency care have to repay with volunteer work at the hospital or treating doctor’s office.
    11. Pray some more.

  • Muddy Waters

    Good points Justin. If only liberals could see beyond their economic blindness and happy-feely attitudes and into the future 10 years. Then, maybe they will see that Obamacare will destroy healthcare. But in the end, isn’t that what Obama had in mind from the start? One must demonstrate the futility in fixing healthcare before one can take it over entirely. No piece of legislation can make people care or take responsibility for their lives.

  • Med/Peds Doc

    After I read, “Here, I’m not talking about how much insurance premiums rose: reimbursements that private insurers, Medicare and Medicaid paid out to hospitals, doctors and patients over the past ten years have been climbing by 4.5% to over 9% annually,” I HAD TO STOP READING! No other factual statements in this post can be believed. If any docs reading this are getting 4.5-9% increases in reimbursement yearly for the past 10 years from Medicaid and Medicare, please speak up. Deafening silence follows….

  • imdoc

    If healthcare reform is killed, we will do what Americans have always done – become self reliant again. How can anyone responsibly advocate that a federal government which is effectively broke make more unfunded promises? We are, depending upon which source one reads, $80-100 trillion in debt. It should frighten everyone to think of putting substantially all our medical care dollars into the federal coffers and hope for the best. If anyone has a great idea about how we painlessly fund the entitlement programs which already exist, I am listening…

    • gzuckier

      Hey, being broke hasn’t stopped us from launching multitrillion dollar wars overseas with no forseeable end point; why would it stop us from giving poor kids checkups?

  • http://www.aneurysmsupport.com/ Mike

    “the majority of the public either favors the legislation or want to “wait and see” how well it works.”

    How could the author throw this out and still keep a straight face! This is the most despised piece of legislation that has ever been crammed down our throats. No one I know likes it. I stopped reading at this point because the author made it clear with this one unfounded statement that she has an agenda and would play loose with the fact when it suited her. To me, there was no point to read further.

    I do not know what the answer is for rising medical costs, but I know it is not this legislation.

  • http://wellescent.com/health_blog Wellescent Wellness Boards

    It is never a good thing to give up a fight when the other side is still fighting and with the Republicans having spent 7 times what the Democrats have on their messaging regarding health care reform, it is quite clear that Democrats needed and still need to advertise the health reforms far more. While the reforms are by no means perfect, they are certainly better than what existed, The only issue is that that they don’t do enough to fix the fundamental problems that exist with the health care system which make it cost too much.

    However, if the Republicans repeal the reforms or paralyze them, then there won’t even be this first step to work from.

  • SarahW

    ON the contrary, most Americans feel that legislation was ill considered before it was shoved through, removes liberty (a huge cost) and will reduce their own choices and make all of them more expensive.

    Repeal is what is needed, and it will be gutted and then repealed.

  • MSmith

    Latest AP poll (widely publicized) shows an even split on whether to repeal vs expand the law (37% each or so) with an addition 15% wanting to keep it the same and 10% wanting to scale it back. Do the math – Ms. Mahar’s statement is accurate.

    • MedPeds Doc

      We all know polls are biased so I bet I can find poll that says the opposite. I can assure you that Mrs. Mahar’s statements about reimbursement to MDs from Medicare and Medicaid rising 4.5%-9% per year for the past 10 years is remarkably inaccurate. No doubt reform is needed. The real shame is that we doctors are so caught up taking care of patients that we cannot drive reform. It is the patients and physicians who need to drive reform, not the insurance companies or government.

    • http://www.aneurysmsupport.com/ Mike

      Just keep whistling past the graveyard there Skippy. Did you not see what happened yesterday? A historical plus 60 seat pick up in the House. You lost the majority of governors, and you lost, at least, six Senate seats.

      Obama made this election about him when he announced his agenda is on the ballot. He got his rear handed to him. Your agenda is dead.

      • MSmith

        Just talking about the poll – wasn’t having an ideological debate. No amount of ranting can make that poll disappear. Truth sometimes gets in the way of the going narrative.

        • http://www.aneurysmsupport.com/ Mike

          AP, yeah right, there is an objective and fair source. Just in case you did not notice, that was sarcasm.

          By the way, a poll does not make something true.

  • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

    The new Congressional makeup does not have the 2/3 majority vote to kill this bill. It can prevent appropriations for it, creating a scenario where the law roles out and there is no way to fund it. It will not be a pretty scene for doctors, patients , or facilities delivering care

    • http://www.aneurysmsupport.com/ Mike

      True Doctor Reznick, yet the election could well persuade so former supporters to change their mind.

  • John Ryan

    “Fifty-nine percent (59%) of those who voted in today’s elections nationwide favor repeal of the national health care bill passed by congressional Democrats in March, including 48% who Strongly Favor it.” (http://www.rasmussenreports.com/public_content/politics/elections/election_2010/election_night/election_night_2010_exit_poll_results)

    • MSmith

      That’s fine, but if your talking about bias, Rasmussen had a demonstrably incorrect and irrefutable overestimation of Republican victories in this cycle by about 3-4 points based on the actual results Tuesday night:
      http://fivethirtyeight.blogs.nytimes.com/2010/11/02/live-blogging-election-night/
      Other exit polls (whose pre-election polling was more accurate) were more in line with the most recent polling on health care – about a 50/50 split on repeal with neither opinion achieving plurality.
      http://www.cnn.com/ELECTION/2010/results/polls/#val=USH00p3
      Also, these are polls of voters in an election when Republicans turnout was high and Democrats were crushed. Polls of registered voters (a clearer reflection of public sentiment) would be much different.

      • John Ryan

        I wasn’t the one who said ” No amount of ranting can make that poll disappear. Truth sometimes gets in the way of the going narrative.” Works both ways.

      • http://www.aneurysmsupport.com/ Mike

        True, Rasmussen missed big time this year. Moral of this, polls are not always accurate.

  • David Hager, M.D.

    The comments I quote below make sense to me. This is still all in vivo, real time experimentation. Health care numbers among the many new, perplexing problems inherent to 7 billion of us now running around on the planet.

    I see a lot of experts touting solutions with conviction. In my opinion, an issue’s number of experts is inversely proportional to what we actually know.

    We’ll probably eventually figure it out … but the solution may look pretty diffferent from our current concepts.

    http://www.kaiserhealthnews.org/Columns/2010/November/110310frakt.aspx

    “Let’s be honest. We really don’t know what’s going to control health care costs, long term. Today’s politically winning idea could be tomorrow’s platter of humble pie.

    “The history of health care cost control suggests that the chances of long-term success of any particular idea are low. This concept or that may be a political winner today, but that doesn’t make it a fiscal winner of tomorrow. Do you think you know how to control health care costs? Don’t bet on it.”

  • Brad Tangen

    Here in the U.S. 2 out of 3 that get cancer are still alive after 5 years versus 1 out of 2 of those under government managed healthcare. To pass this bill, for the first time in history a President sat down with the CBO to doctor the accounting numbers. This bill mandates FEWER choices of health care plans and makes plans more expensive with all the mandates. If we are to maintain our level of healthcare innovation this plan MUST be repealed or we will wind up with more people dying once they get a major illness. The low income uninsured can be given healthcare vouchers to buy a plan they can choose at far less cost than the Obamacare bill rather than having one imposed on them by the government. Specific consumer protections in Obamacare can be passed in separate bills if they’re needed but to gum up innovation the way Obamacare does is a damned shame. By the way, 58 percent want Obamacare repealed. Get out of your bubble. People’s lives are at stake here.

    • Catca

      Why do you assume the uninsured are low-income? They already get medicaid. What about the people who can’t get insurance because there are virtually NO restrictions on insurance underwriting??? Unless you want to defend United Healthcare for declining coverage to my 6 month old son this past August for being “too tall for his age” (he’s 98th percentile). That is an actual quote from the insurance denial letter. You talk about preventing death and peoples lives being at stake yet fail to recognize how many people have no access to the innovation you refer to. These people aren’t looking for a free ride – just the ability to pay a premium and have access to the system just as those who work for large employers do. What about another small business owner I know who paid $2,000 a month for insurance premiums and his son came down with leukemia. The insurance policy was up for renewal 2 months later and the insurance company dropped them. So he paid alot more than his fair share in terms of the amounts charged on premiums and then was dropped. That’s not insurance in substance by any stretch of the imagination. If he worked for a large employer, his coverage would have remained in tact. The reality is we have a 2 tier system in this country where the only access to real healthcare is if you work for a large employer or are very wealthy. If not, you’re out of luck. Is this the system you want to revert back to? I hope for your sake you never lose your large employer plan or if you are a small business person paying through the nose, I hope you have a reality check about just how good that coverage your paying for is. Since without healthcare reform you’re paying those premiums and if you make any claims other than regular checkups – you may be dropped. You are in substance self-insuring but still paying big premiums for the appearance of coverage.

  • PAULMD

    For those of us heavily involved in Medicare, the rest of this year is really about cash flow and solvency.

    The shackles of the Obama health reform LAW….

    combined with the promised fiscal austerity of the of the again empowered republitea party….

    equals all of the mandates on the healthcare system’s providers and less pay to boot!

    • http://Www.twitter.com/alicearobertson Alice

      Indeed, this is not up to par with other articles from this author. This is misinformation and false assumptions. Thank you to those who tried to straighten this article out. The responses are informative.

    • Catca

      Paul,

      I sincerely hope this doesn’t happen. Doctors perform amazing services and deserve to be paid well for what they do.

  • gzuckier

    Yes, conservatives will finally have a chance to torpedo this socialist bill, written in its final form by Bob Dole and Howard Baker.

    • http://www.aneurysmsupport.com/ Mike

      I have no idea if Bob Dole and Howard Baker support this or not. Even if they do it does not mean that all conservatives do, just as not all dims supported it.

  • PAULMD

    It is interesting to me that Obama Care is still often referred to as “Bill” when in fact it is The LAW of The Land.

    When I continue to read “bill” I wipe the sleep from my eyes and smile, for a moment thinking that it still ain’t over.

    My hope is that it is because it IS law, it will harden the resolve of those like me, that oppose it.

    • http://www.aneurysmsupport.com/ Mike

      “My hope is that it is because it IS law, it will harden the resolve of those like me, that oppose it.”

      I think it has Doctor Paul.

  • Catca

    May you never lose your large employer plan. If you ever do, you’ll find that you have few to NO choices in health care coverage. I left my large employer and started a business and can’t get private insurance even though I have no health conditions and qualify for super preferred rates on life insurance. Why? Because I had a c-section, just like 30-40% of the women in this country who’ve had kids. My son was turned down at the age of 6 months for being “too tall for his age”. What’s disappointing about this blog is it addresses repeal of healthcare reform but that’s not what the House Repubs are proposing. They are threatening to cut off funding for reform and replace it with nothing. The republicans admitted the system is broken and complained they were shut out of writing the reform legislation – a legitimate complaint. But then, how do they retain credibility if they cut off funding for reform and propose nothing in its place??? In fact, the health insurance program for kids that was passed under Clinton the last time we visited healthcare reform is now starting to get cut off by Repub state governors (I’m looking at you Arizona Gov Brewer). More and more Americans are unable to get insurance – middle class Americans. The poor get medicaid and the seniors get medicare, but those caught in the middle virtually have no access except through a large employer. I started a small business and may have to close it since I can’t get healthcare insurance. That means loss of jobs as well as loss of income to my vendors, etc. I can’t even negotiate a plan with healthcare providers like a large company self-insuring can because the rules are set up to only allow large group plans to do that. So large companies can negotiate to pay $35 for a well baby checkup but I can’t negotiate and have to pay $156 to subsidize the large employers????? Sorry, there is no rational or objective defense of the system as it stands. If the repubs want to fix the system and present a different reform bill – I’m listening. The Dem’s reform bill has some big flaws – no doubt. But to cut off funding and replace it with nothing is irresponsible and frankly immoral. Maybe it’s time the republicans change their name to the big business party.

    • John Ryan

      You are assuming that Obamacare will provide you with the equivalent of commercial insurance. There is no guarantee of that. What it will do is force you to pay for other people’s insurance, even if you are in good health. I don’t know what the Repubs will offer, most likely nothing will be done, since both sides are posturing defiantly. There is a way to get eveyone covered, but passing a bill using targeted favors and procedural tricks is a way to inflame the opposition. Making the insurance companies spend some of their huge profits to provide basic insurance doesn’t need a reform bill, it just takes some negotiating and likely foregoing some contributions by some of our legislators. And they need to be covered by the same health care pla. Then we can trust it.

      • http://Www.twitter.com/alicearobertson Alice

        If you go to the GMA site you will see Newt Gingrich discussing what he wants. I believe he unofficially reflects much of what the GOP has in mind. To sum it up he uses the German model where doctors and insurance have maintained private enterprise. They asked about regulating the insurance companies and he feels more competition, and allowing each citizen to choose their insurer means competition will be a type of watchdog. Then go over to the financial guru of GMA and hear her tips for getting insurance….tip….she does not recommend choosing the low premium or co pay……either do I. Unless, you are young and healthy (which my daughter was and she ran up a six figure bill this year) she said the deductibles could run higher than you will save. Much more on their site. And you can write to them with insurance questions and complaints.

        • Catca

          Alice,

          Thank you for your suggestion. I actually like the German model – my family is from Austria and I’ve used both the German and Austrian systems and have been very pleased with the care I received. I also lived in England for a few years and actually came back to the States to use our healthcare for any kind of procedure beyond a regular check up. The English system’s doctors were competent, but the technology available to them was way behind what was available in the U.S. As far as tips on what policy to buy, at this point I will be happy to even get a policy so I get negotiated discount rates for services. I’m completely serious, my son was 6 months old in August, and was declined for insurance for being “too tall for his age”. That was an actual quote from the denial letter issued by United Health Insurance. He’s 98th percentile so he’s tall, but not abnormally so. I was declined by 3 separate companies because I had a c-section in August. There are insurance companies that wouldn’t decline my son for being tall, but I can’t apply in just his name because the insurance companies stopped writing individual policies for children under 18 since they can no longer decline for pre-existing conditions. The Democrats asked them not to exit the market and proposed that they put in a reg that there would be annual enrollment for individual kids policies similar to what large cos do in order to help mitigate the risk that people won’t pay premiums and just get insurance when their child has an issue but the insurance companies rejected that and pulled out anyway. So, if Newt Gingrich is thinking about modeling after the German system, I’m definitely interested in that suggestion. But why aren’t the Repubs putting that forth. The contract with America thing they put out in September puts forward no suggestions other than to repeal or block funding. That’s what’s angering me with the Repubs. They acknowledge there are serious issues when out of power, but as soon as they get back in power (or at least a seat at the table – they don’t have the Senate or the Presidency so it’s not like they are in power again), they suddenly don’t put forward the proposals. I like much of what the Repubs suggested during the reform debate and was upset that the Democrats did the whole thing behind closed doors without involving republican legislators. But it’s very hard to take them seriously when they are simply taking a defiant position right now with cutting off funding for reform rather than putting forth constructive proposals to fix the problems in the system.

          • http://Www.twitter.com/alicearobertson Alice

            How frustrating! I have two friends who purchase their own insurance. One was a lawyer who quit practicing out of integrity, and her husband (a lawyer) prefers real estate these days. They adopted children with many needs from overseas. She purchased great insurance because of all the special needs (one child needs a monthly blood transfusion that is common in little girls from China). My other friend has a small business and an employee died from cancer within a year of hiring him. Their premiums went up for awhile, but both of my friends believe in the free market and are ruthless in their pursuits for the best policies. If I knew how to email you I would present your dilemma to them, and forward you their responses. There are avenues to fight these denials (most people know I have had two children with cancer, so insurance company denials are not new to me).

            I lived in the UK…met my husband there……so…government, socialistic type of care terrifies me.

            I highly recommend you email the Good Morning America insurance team. They claim they have helped many and encourage viewers to write. They often profile a case…..it is one way the media can actually do some good….it doesn’t make up for the slothful journalistic messes….but it gives us hope that there is something nice amidst all the garbage.

            I realize with so many anonymous posters here….that few want to expose themselves….but if there is any way I can help you…or email my friends please write to me at: arobert6@Juno.com. or click on the hyperlink to my name and it should take you somewhere that has my email address (someone here helped put up that gravitar…then they disappeared and I have no memory of how I did it, or how to change it).

      • Catca

        John,

        Right now I am paying for other people’s insurance under the current system. I have to self pay so I pay to subsidize large companies and insurers. They’ll pay $35 for a visit that I’ll have to pay 5x for because under the rules of the system I am barred from negotiating a plan to self insure as well. And they won’t accept me into their insurance plans even though I am willing to pay the premiums simply because I had a c-section? I am in perfect health! The bill that was passed is flawed and I agree it doesn’t do anything to control costs – but seriously, blocking funding rather than amending the bill to improve it brings us back to status quo which isn’t pretty. Will I get the equivalent of commercial insurance under the exchange plans in 2014? Probably not, but I should get enough to mitigate risk and have actual access to an equitable distribution of fees for services. That is a huge improvement over no reform.

        • John Ryan

          I certainly agree the present system is terrible. I look at it both ways, both as someone who gets increasingly restricted insurance benefits as a policy holder, and as a small business owner being squeezed to cover my employees. I am just saying that “any reform is better than nothing” does not take into account what kind of system may be put in motion by this bill. As the Medicaid patients I care for have found out, going to a overbooked, careless specialist or understaffed facility willing to take Medicaid because they live on volume creates a greater risk of error or other mishaps. And if government recreates or extends a Medicaid-type program, expect limits in meds, eligible procedures, limits in rehab time — all of which may cause you to pay with your health what you now pay with your wallet.

          • Alice

            The healthcare system may start to resemble the assembly line public school system? Wonder why there isn’t more outrage about that? Is it because those most disgusted pay out-of-pocket for private schools?

    • http://www.aneurysmsupport.com/ Mike

      So, why exactly will you have to close your business if you cannot get healthcare insurance? Granted, under Obamacare you are a criminal if you do not purchase some type of health care but I thought that “Dear Leader” was going to take care of that for you. How will closing your business solve your insurance problem? Do you intend to go back to work for a company that offers a healthcare plan? Sorry, your post is not making sense to me.

      As I have said before in other threads, I don’t know what the solution is but this law is not it, and neither is socialism. It simple does not work.

      • Catca

        Mike,

        It is rather obvious – I may have to close to work for a large corporation to get employer provided healthcare. I am making good money but I am completely prevented from mitigating healthcare risk with the way the system is set up. Why can a large employer negotiate rates and self-insure but a small employer cannot? If doctors negotiate with me, they’ll be sued for fraud. Does my post not make sense? Perhaps because the healthcare system makes no sense

        • http://www.aneurysmsupport.com/ Mike

          It is rather obvious Carla. The large employer is just that large. They have more members to distribute the risk among and will collect more premiums. I do not like many of the insurance practices either but they are a business and their shareholders and investors expect them to be profitable. Want to reduce insurance costs, make the companies more competitive, allow companies to sell out of state and take steps to make the healthcare industry a bit more efficient. For example, reduce the reams of redundant paperwork. How much could that one simple step save?

          • Catca

            Mike,

            Please explain to me how a 6 month old who has never been to the doctor for anything other than a well baby check up and immunizations can be declined for being “too tall for his age”. That is an actual quote from the denial letter. My son is 98th percentile so tall yes, but not abnormally so. How does that affect the insurance companies profit margin? Can you find any reason there would be even 1 penny paid out on any claim related to his height??? I’m sorry, you may not like the reality – but insurance companies are not operating ethically. And competition? You get declined and you go into a database for all the other insurance companies to see subjecting you to further scrutinization when you apply with someone else, making it harder to get insurance. The system is rigged against individuals. I’m tired of people constantly suggesting that the uninsured don’t want to pay premiums and are looking for a free ride. It is probably true of some people, but many are like me. Having access to healthcare should be considered a fundamental right. I don’t see a moral justification to say some people should be denied access because it affects profit margin. They are not denied with a large company. Republicans say small business is an engine for fueling growth, but if small business can’t get access to health insurance policies because of profit margins, they’ll close and those owners will get jobs with big companies for access to healthcare. It’s a bigger deal than paying a couple percent more in my income taxes. I don’t mean access to being kept on a ventilator with no hope of returning to consciousness for years on end or situations like that, but the right to pay an equitable share of costs. And Mike, explain to me about your large insurer and company comment. Yes, they have a larger pool to spread the risk. But why is it that the law allows them to negotiate rates beforehand to create a plan and self-insure. If I tried to do that as an individual, the doctors I negotiated with would be sued for fraud by the insurance companies because they all have the same clause in the contracts and if a doctor doesn’t accept that clause, they’ll go out of business. So, a large co or insurance company can negotiate to pay $3500 for a hip replacement should it ever be needed but I can’t negotiate to pay say $5,000 (as a discount from $10,000). I know for a fact doctors groups who’ve been sued for up front negotiations with patients. This has nothing to do with spreading risk across a large pool of people. The system is literally rigged in favor of large companies. A small employer should be free to negotiate, they may have more risk because they can’t spread it across a large pool, but they should be able to negotiate rates just like a large insurer or large company. And why do employees at large companies, who already have a favorable situation with health insurance, get a tax deduction for paying health insurance premiums but individuals do not? There are so many examples of an uneven playing field that have everything to do with bad public policy and nothing to do with a large companies ability to spread the risk. You act like the only issue is cost, but it’s not. Access is pretty big as well, and as much as large cos are complaining about cost, the problem is ten-fold for small companies. Your suggestions about allowing companies to sell across state lines is something the Repubs suggested during the debate while the reform bill was originally being drafted. I agree, I think that makes sense. The bill that was passed doesn’t have any cost control measures that I can see which is a big flaw. But why are the Repubs backing away from that now? They are just threatening to cut off funding for what was passed and aren’t bringing back their previous suggestions? That just takes a bad situation and makes it a lot worse.

          • http://www.aneurysmsupport.com/ Mike

            Catca

            As I said in this, or perhaps another thread, I do not like all the practices of insurance companies myself. Did you appeal the denial or ask the insurance company for an explanation?

            “Having access to healthcare should be considered a fundamental right.”

            It does not appear to me that anyone is denying you access to healthcare, they are just declining to pay it.

            “Republicans say small business is an engine for fueling growth, but if small business can’t get access to health insurance policies because of profit margins, they’ll close and those owners will get jobs with big companies for access to healthcare.”

            Perhaps small business owners should approach insurance companies as a group so they would have the same bargaining power as a large company.

            “If I tried to do that as an individual, the doctors I negotiated with would be sued for fraud by the insurance companies because they all have the same clause in the contracts and if a doctor doesn’t accept that clause, they’ll go out of business. So, a large co or insurance company can negotiate to pay $3500 for a hip replacement should it ever be needed but I can’t negotiate to pay say $5,000 (as a discount from $10,000). I know for a fact doctors groups who’ve been sued for up front negotiations with patients.”

            I do not think that is a law but a contractual agreement between the doctors in question and the insurance companies.

            “A small employer should be free to negotiate, they may have more risk because they can’t spread it across a large pool, but they should be able to negotiate rates just like a large insurer or large company.”

            To my knowledge they are, but I am not aware of anything compelling the insurance companies to negotiate with them. I agree, they likely won’t as they are interested in the big contracts. I am certain that in your own business you would be more interested in and put more effort into securing a big contract, with bigger returns than in a smaller one with smaller returns. I’m not saying that this is ethical, just that its the way it is.

            There are many practices by the insurance companies and healthcare providers that I do not like nor agree with. All I am saying the that socialized medicine, socialism, and this new “law” is not the answer. Socialized medicine and socialism in general do not work.

  • Alice

    I am rushed, but I wanted to post that I think the insurance companies are going to have to change….a bit (less profit, more coverage…if this passes)! I will write to you with the GMA site.

    http://abcnews.go.com/Health/wireStory?id=11937121
    States Group OKs Tough Health Insurance Rules

  • Alice

    This is the story I watched with Chris Cuomo. Some heartbreaking stories here…..I realize often the capitalists behave badly….it’s the downside to a good system with humans running it…..but the system works. I just struggle with how much regulation is enough to stiffle, yet let them remain profitable (and it’s with great apprehension I ever want the government involved).
    There are a ton of responses I lack time to read, but hopefully, somewhere within this is a tip or two (realizing most responses will be from hurting people). Since this story was reported we have the healthcare bill (I think I am being passive/aggressive not calling it a “law”….something inside me just can’t bring myself to typing that) …which means…..like the regulations on the banks…..they will find new ways to do business that often don’t help the consumer. There is no perfect way to do business……someone gains and someone gets hurt. It’s almost a game of odds. There is a website you can leave a question for Chris Cuomo and I, understand, they have a staff that works on this problem.

    http://abcnews.go.com/GMA/story?id=5257491&page=1

    Denied: Fighting For Insurance Coverage
    Big Response to GMA Gets Answers Story About Cigna Denying Insurance Benefits

    ****”The insurance companies know if they deny and deny claims that many of the claimants will never pursue their claims,” Grisham said. ******