I read this article in the paper today. I am doing some research on the bill. Has anyone heard of this act? Has anyone researched and has some pro's or con's. I would love to know if you do!
Hillary Clinton talks about healthcare reform in terms of "American values, American families and American jobs."
Barack Obama talks about healthcare as a "right for everyone, not a privilege for the few."
John McCain talks about making insurance more affordable "by fostering competition and innovation."
Uwe Reinhardt talks about outrages.
The Princeton economics professor tells of a hospital patient charged ,000 for a night in the intensive care unit and 1 for stockings that run at a drugstore. He tells of a father who sought treatment for his son's infected eye and got billed ,200.
"Is this what America stands for?" he asked. But it wasn't really a question.
"This is not what this country stands for, this is not what my boy [a Marine who served in Iraq and Afghanistan] fought for," Reinhardt told editorial writers from around the country at the University of Maryland's Knight Center for Specialized Journalists.
For anyone who's paid a hospital bill lately, been faced with insurance premiums almost doubling, or agonized over how to afford medical treatment on a tight budget, healthcare reform isn't an abstract policy debate. And the presidential hopefuls, both Democratic and Republican, are acknowledging that it's an issue that could sway voters in November -- as well it should.
In the current healthcare system, spending per capita has increased about 4.5 percent a year for about four decades, much faster than the 2 percent annual growth of per-capita gross domestic product, Reinhardt explained.
"While we as a nation can afford this spending, the lower middle class can no longer afford it," he said.
And increased spending doesn't necessarily buy increased quality of care. A Dartmouth Medical School analysis of Medicare, which covers older Americans, found vast disparities in payments -- but they varied based on geography rather than on how sick the patients were, or how good the treatment.
Yet payment structures, for government-subsidized and private insurance, reward use of expensive tests and specialized treatment whether or not they're the best options.
"Physicians and the public don't have good information about quality care," said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which promotes healthcare improvements.
She advocated providing "evidence-based national guidelines for what works and what doesn't."
For instance, there's evidence that giving a patient an antibiotic an hour before surgery reduces the chance of infection, while administering it either earlier or later is less effective. But that kind of standard is available "only for a fraction of the care we provide," she told the Knight Center fellows last week.
Sen. Ron Wyden, an Oregon Democrat, said the climate is more receptive for adopting a national plan to revamp health insurance -- many Republicans now recognize that fixing the system will require covering everyone, and more Democrats recognize that government can't do it without involving private insurers.
He's trying to sell his colleagues on S 334, the Healthy Americans Act. It would, among other things, require all Americans to buy health insurance but make sure they can afford it.
Under the bill, employers would either turn premium subsidies into higher wages or contribute to a pool to help individuals or lower-income families buy insurance. Government would assist those below the poverty line. Insurance firms wouldn't be able to cover only healthy people but could offer discounts to encourage healthful behavior.
On Dec. 7, Wyden and co-sponsor Bob Bennett, R-Utah, announced that they were up to a bipartisan 13 backers, including Republicans Trent Lott of Mississippi and Lamar Alexander of Tennessee, Democrat Debbie Stabenow of Michigan and independent Joe Lieberman of Connecticut.
"There's a real chance that this may be the time the waters part," Wyden said. But he's realistic: "I never underestimate the capacity of the United States government to take something that's doable and somehow unravel it all."
Reinhardt said that Americans who most likely would benefit from "a progressively financed, universal health insurance scheme" either don't vote or "vote for candidates promising them that one day they, too, will be billionaires, as long as they keep taxes and government spending low."
If 2008 isn't the time to stop following false logic, when will be?
The Healthy Americans Act
For more on S 334, go to:
www.wyden.senate.gov/issues/Legislation/Healthy_Americans_Ac t.cfm
www.bennett.senate.gov/healthyamericans
Star-Telegram editorial writer. 817-390-7867I plan on doing some additional research on this. From the little that I've read it sounds more reasonable than having a national healthcare plan which would only band-aid an already wounded system of insurance and healthcare. It also keeps health insurance with the private sector and not run by the government. Don't have any opinions yet but do have some ideas. Lindy I always find it odd that Americans trust the private sector more than their democratically elected government. Isn't the government for the people by the people (and made up of Americans)? I would rather have a representative of me accountable for my health insurance than some guy just out to make a buck who I never voted for. Private sector corporations are LEGALLY OBLIGATED to maximise profit (IE---a corporate medical research company will NEVER find a cure for anything because that would decrease profit, something they are legally prohibited from doing. Also, a private insurance company will deny as many claims as it thinks it can get away with). You can vote out a government that isn't living up to it;s obligations. You can't do that with a CEO!
Unless one lives in the U.S. under the watchful eye of the government, works in the private sector, votes, follows the political scene closely, and understands that the politicians and the government are all flawed, will never understand our disregard for government involvement in our lives, including our health. I much prefer my health insurance be administered by the private sector than the government. Unfortunately, because I have Medicare I have to abide by the government rules. Fortunately, I also have private insurance. It's saved me many times over.
The Healthy Americans Act will give a certain amount of personal responsibility to the individual and rightly it should. The government is not set up to take care of every single person in the U.S. It's set-up to represent every single person in the U.S. By setting this act in motion it is representing and not personally taking care of each person, only the people who truly can't take care of themselves.
It also takes to task the insurance industry for selectively covering individuals. There will be no pre-exist for individuals but there will be heavy case management and each and every treatment will have to be pre-approved which will put an extreme strain on health providers.
One of my great concerns with this act: If one has private insurance, does it mean that you'll be rolled over to the new plan or can you continue with your present plan? I for one don't want to change my insurance.
There will be many internal problems with providers, facilities, and patient's lack of understanding the process. I think it will be a very confusing process for individuals. I do want to read more about it and do some research. I've read the links that you posted Mary B. and thanks. Lindy
I understand what you're saying.
If it weren't for cost shifting the medical treatment centers would be out of business and don't forget for a moment that hospital, clinics, urgent care, PT, OT and DME are businesses. They need to make money to survive. There is a whole twisted game that is played out between hospitals and the federal government regarding contracts, charges, reimbursements, and cost shifting. It makes the savings and loan and mortgage brokers look like sheer amateurs. In many ways it works and in many ways it doesn't. It's good for some and not good for others.
I've worked both in nursing, hospital administration and in the private sector health insurance industry and none of these entities are without fault. The government run health insurance program won't be much different than what's happening with Medicare/Medicaid. The system is flawed and broken and all our representatives do is band-aid it. It's going to take the private sector stepping in and saying I can effectively run the Health American Act and prove it, and then the private sector can be held ACCOUNTABLE for the results. You can't hold the federal government accountable except with your vote. Apathy runs rampant in our voting community but then that's another whole thread. Lindy
My husband is self-employed (not by choice - his job was exported to Pakistan). We are currently living with COBRA insurance and the cost is killing us. We have tried everything we can to purchase our own individual insurance, but no one will insure us because of our preexisting conditions. We are willing to PAY for insurance, but no one will insure us. Oh, there is "high risk" insurance out there, but it would cost more than our mortgage.
We chose the least expensive option available to us in the COBRA plans offered by my husband's former employer. Last year we paid more than ,000 in insurance premiums. In addition, we had to cover the first ,000 in medical costs. Over ,000 and that was the only option available to us. Guess what - we just got a notice that the cost for our insurance premium is going up beginning next month - we will be paying ,664 more next year!
My husband has tried to get a permanent position which would provide benefits, but the industry he is in prefers to hire consultants, in part because of the high cost of benefits!
Medical costs and insurance costs are out of control and we need to do something now. The question is what?
LinB you are exactly right. That is how it works. We as individuals can have more influence on a company than a huge bureaucracy.If I'm reading the Healthy Americans Act, then the above mentioned family will be covered by entitlements and subsidies because they fall below the poverty level for a family of 4. There will be fewer people who fall between the cracks if this act passes.
A working family who can't afford health insurance presently will be able to have health insurance with this plan. The biggest majority of noncovered individuals are the "working poor". I hate to use that term but it's one the government uses readily to describe families where both mom and dad are working, make a little too much money for Medicaid, and are left with no health coverage because premiums are astronomical. See Hillhoney's post above. This shouldn't happen in the richest country in the world. The children don't qualify for the state program because their parents income is a little higher than allowable.
There is one part of this act I find disturbing and that it gives the "health police" more power. I don't care if someone smokes. I feel it's their health and money. It's their right to destroy their health. With this plan employers and employees will be rewarded for good health practices. Will that mean in the future that people that have bad health practices will be penalized in some way? I'm not sure that I find that having the insurance company sitting in my house telling me that I can't smoke, drink, or practice unsafe sex is what I want from my insurance company. Smokers have been penalized for a long time when it comes to health insurance premiums.
The actuaries will love it. They'll state that claims cost will be reduced, health benefit dollars going to providers will be reduced, everyone will be healthy, or not. I don't smoke, drink, or practice unsafe sex and even if I did, I don't want some clerk on a phone from the insurance company lecturing me. Managed healthcare only works up to a certain point and I think that point will be reached sooner than later if this act passes. I would hope they'll be modification to the language and moderation for managed healthcare. Lindy
And if they are going to penalize people who smoke and drink, will they also penalize people who dine at McDonalds and never exercise? Or don't follow doctor's orders (prescriptions, etc)?JasmineRain, I'm not a doomsday type of person but I see it coming. Lindy
Hmm, good point Lindy. I will have to look more into that part. [QUOTE=JasmineRain]There isn't an answer for every segment of the population unless it's national health plan coverage and I don 't see that happening in the U.S. anytime soon. Look at the costs to implement and keep a program like this running. They're astronomical. Our friend to the north has a population roughly the same as California and there are finanacial problems within Canada's Medicare program.
The bottom line is as residents of the U.S. are we willing to give up our private insurance for a national health plan coverage that will only offer certain drugs, the need for pre authorization for each and every treatment, and longer waits for medical treatment - including surgeries? We don't have enough doctors, nurses or hospitals to treat each and every person in the U.S. The nursing shortage is critical at the present. How will national health insurance affect nurses, working conditions, income, and their unions? I'm just trying to be realistic about the situation and am looking at it from a financial and coverage point of view.
I'm all for national health insurance if there's enough money, doctors, nurses, hospitals, health careworkers, and I don't have to pay more in taxes than I'm already paying. Also, like Lori, I don't want to have to give up my private health insurance. We spent years planning and budgeting for our retirement so that we'd be financially stable and that included having the best health insurance we could afford.
I think it's more reasonable that the families who are working and can't afford health insurance premiums be covered and that's exactly what the Healthy Americans Act will do. The homeless and the poverty level will be taken care of by the government - the same as it's been in the past. If the homeless qualify for Medicaid then they've got health insurance coverage. At this point in time I don't think it matters who or where the coverage comes from as long as those segments of the population have coverage and I'm not so sure that they would care as long as they had coverage.
There will always be a small part of society that won't be covered and that will probably be because they've chosen not to be covered, they haven't applied for Medicaid for various personal reasons. It's impossible to force coverage on everyone. The federal government tried that with part D (prescription coverage) for the elderly and it's backfired on the government. After 3 years the government is still struggling to meet it's goals for part D. Ask any pharmacist and they'll tell you the horror stories concerning part D because they're on the frontline.
None of us have the answers but there may be hope with the Healthy Americans Act. Will I like it personally? No, not if I have to give up my present health insurance and pay more taxes. But I will like it if the option is to cover all working families, at reasonable costs, without an increase in taxes, and if they don't withhold drugs and treatment due to cost containment.
"the need for pre authorization for each and every treatment"
maryblooms You said you had great insurance coverage. I assume you got it through your job or your husbands job.
I know for a fact the you can not buy any medical insurance for any price once you have been dx'd with RA in the USA. The only policy I can buy on my own is is from my states high risk pool (00 per month). I would lose my eligibility for that pool if I go uninsured for 30 days.
Health Insurance should not be a 'for profit' thing, because the chronically ill can't get coverage. The whole nation should share the risk. If everybody paid some, we could have health care for everyone. Out of every health care dollar spent, we waste at least 25 cents on administration. Administration was the thing that keep joonie from getting the care she needed FOR MONTHS!
Healthy Americans Act - What do you thinkmaryblooms You said you had great insurance
coverage. I assume you got it through your job or your husbands job.
I know for a fact the you can not buy any medical insurance for any
price once you have been dx'd with RA in the USA. The only policy I can
buy on my own is is from my states high risk pool (00 per month). I
would lose my eligibility for that pool if I go uninsured for 30 days.
Health Insurance should not be a 'for profit' thing, because the
chronically ill can't get coverage. The whole nation should share the risk.
If everybody paid some, we could have health care for everyone. Out of
every health care dollar spent, we waste at least 25 cents on
administration. Administration was the thing that keep joonie from
getting the care she needed FOR MONTHS!
I am a great saver but not a good investor. I don't have 30K a year for my expected life span with 15k going for medical care. I'm not at all sure I could live on 15K in 5 years time....there would not be more income but for sure we can all count on higher prices.
Lorster you make it sound like it is under his control to keep his job...but is really not under his control. He will only have a job as long as his employer thinks he is making a profit off your husbands labor.
I have seen so many talented programmer's tossed into the street because an east Indian worker appeared to be the more profitable employee. Some of them have managed, others have failed dismally- losing their homes and families.
I find our new world a terrifying place.
We've had 3 open developer spots for over 2 months... can't find people to take the jobs! ,000+, medical/dental/vision (costs about 0/month), 401K with 3% matching, stock plan, tuition reimbursement... [QUOTE=marian]I am stuck in a job I hate because of health
insurance. I have lived like a church mouse my whole life and saved as
much as I could 15% of gross in a 401k because I was afraid RA would
force me out of the work force early.
I am a great saver but not a good investor. I don't have 30K a year for
my expected life span with 15k going for medical care. I'm not at all sure
I could live on 15K in 5 years time....there would not be more income but
for sure we can all count on higher prices.
Lorster you make it sound like it is under his control to keep his
job...but is really not under his control. He will only have a job as long as
his employer thinks he is making a profit off your husbands labor.
I have seen so many talented programmer's tossed into the street
because an east Indian worker appeared to be the more profitable
employee. Some of them have managed, others have failed dismally-
losing their homes and families.
I find our new world a terrifying place.
[/QUOTE]Gimpy, it's common practice that many treatments have to be pre-authorized, such as xrays, mris. ct scans, certain labs, all surgeries-both major and minor, 2nd opinions, referrals to specialists, many prescription drugs, laser treatment of psoriasis, almost any elective procedure. Many of us have insurance plans that use preauthorization as a cost containment feature. Your diagnoses have to match the treatment plans of the referring doctor.
Here's an example. This happened to someone I know: The insurancve company wouldn't approve Celebrex because the insurance clerk toldthe insured that Celebrex and Ibuprofen were the same drug and that they should take Ibu. and Celebrex wouldn't be approved. First off, the clerk was dead wrong and now the insured will have to fight this decision with an appeal. The appeal will require a letter of medical necessity from the doctor and probably a copy of the last office notes. It's an insane system that's inplace and I don't think it will change. It doesn't matter if it's a federally run program or a program with the private sector, cost containment saves money. Teaching wellness and prevention saves money in the long run but cost containment saves money in the short run and that's what the actuaries are looking at.
Consider yourself lucky that your waits are minimal and that you're happy waiting. The U.S. doesn't have the hospitals, doctors, nurses, or supporting medical providers and facilities to insure that every man, woman, and child in the U.S. receive care and treatment. You can't get an appointment with a specialist within a reasonable time. The hospit al in the area where I live has 3 brand new floors and they can't open them because of the nursing shortage. When I had my knee replaced 2 of my nurses were from Canada. They obtained their licenses in AZ. and are working as traveling nurses in the state. My internist is Canadian and so is the dermatologist that I saw last year.
I don't understand Canadian politics anymore than you understand U.S. politics and it's even more confusing when you have healthcare wrapped up in the politics of both countries.
The Healthy American Act sounds pretty wonderful but where are the hospital beds, doctors, nurses, and support persons that will be needed to be inplace when this Act is up and running. It takes at least 10 years to train a physician, 4 years for nurses training, many years from an idea of a hospital to an actual functioning building. People are not choosing nursing as a viable profession any longer. Doctors are in short supply all over the U.S. Except for plastic surgeons in LA.
This is what I did in my past life. I was head of research and development for a large health ins. co. for 5 years. All these issues that we've been discussing were on the table 20 years ago and they're still being discussed.
No action has taken place in the last twenty years to make sure there is an infrastructure in place to initiate and administer the Healthy Americans Act or a national insurance plan. Lindy
“It has been very, very difficult,” Schwarzenegger said of his nearly yearlong campaign to create a program for providing health coverage for most of California's uninsured. “There are so many entities out there fighting this process.”.
His visit to Kaiser's medical center on Zion Avenue in San Diego came two days after the Assembly passed legislation that would provide health insurance for 3.6 million of the 5.1 million Californians who are uninsured. Kaiser, a large health maintenance organization, is among the bill's supporters.
Money to subsidize residents who couldn't afford premiums would come from the federal government, employer contributions, a 4 percent fee on hospitals, individuals, county and other funds, and a tobacco tax increase.
The Assembly approved the legislation on a party-line vote, with Democrats providing all the votes needed.
The bill's outlook in the state Senate is uncertain.
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Senate President Pro Tempore Don Perata, D-Oakland, has expressed doubts about funding for the .5 billion program, saying he will not allow a Senate vote on the plan until the governor assures him that a budget deficit estimated at up to billion will not result in devastating cuts.Sen. Denise Ducheny, D-San Diego, raised similar worries in an interview yesterday afternoon.
“The biggest concerns overall have been the questions of financing the package,” she said. “It's not clear where all the new monies will come from.”
Ducheny also has reservations about the bill's mandate for most Californians to buy health insurance.
“How do you tell somebody that you're required by law to buy health insurance but you could be homeless if it's the difference between paying your rent and paying your insurance?” she said.
If the plan passes the Senate and is signed by Schwarzenegger, voters must approve the package of tax increases needed to finance it.
Assembly Speaker Fabian Núñez, D-Los Angeles, appeared at the San Diego hospital shortly before the governor arrived. He said the Assembly vote breathed new life into the reform effort which, at times, has been near death.
“We are a hop, skip and a jump away from making sure California has the best health care in the country,” he said.
Schwarzenegger has won some support among his business allies, and Núñez has gained some labor union backing for the reforms.
Joining the two state leaders at the San Diego hospital were regional heads of Service Employees International Union and the United Domestic Workers as well as representatives of the San Diego Regional Chamber of Commerce and the San Diego North Chamber of Commerce.
Danny Curtin, director of the California Conference of Carpenters, said legislative and voter approval of the bill would ripple across the country. “This will change the nature of the medical care delivery system in California. This will change America. It's historic.”
Others appearing alongside the governor at the hospital were less enthusiastic.
“We are going to take a look at the effects of” the Assembly bill, said Scott Alevy, vice president for public policy with the San Diego Regional Chamber. “It's still early.”
The proposal would require most residents to have health insurance, set up a program to cover low-income residents, force insurers to accept any resident who applies for coverage regardless of medical history, and increase Medi-Cal reimbursement rates to doctors and hospitals.
Perata has said he is opposed to relying on the tobacco tax proposal, in part because he fears it would trigger a massive campaign by the tobacco industry that would defeat the entire proposal.
Schwarzenegger said he is bracing for a battle with tobacco companies. “I think they might not like it,” he said.
In addition to tobacco industry opposition, Blue Cross of California, the state's leading private insurer, is also likely to spend millions of dollars to oppose the ballot measure. Blue Cross says that requiring insurers to cover all who want it regardless of pre-existing conditions would increase premiums for current policyholders.
The proposed ballot measure is likely to face strong resistance from some businesses opposed to employer fees along with opposition from some elements of the medical community.
Among the bill's supporters are two of the state's leading health insurers, Health Net and Blue Shield.