Not to be political...but the elephant in the care reform

Discussion in 'The Watercooler' started by DammitJanet, Mar 23, 2010.

  1. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Now that we have it...what do we think? What do we actually understand? What is it? LOL.

    I went and read up on a few things and THINK I may understand a few basics of it.

    Some of it sounds okay. Some I am worried about. Some I think some folks are attempting to scare us to death over.

    It appears that as of the bill being signed into law, that kids up to age 26 can stay on parents insurance (under certain conditions Im sure). That sounds like a good thing.

    CHIP has been extended until age 24 I think. (Maybe that is to get everyone through college?)

    I am very worried about the Medicare Advantage issue. From what I understand, it is going to be removed. I think? That would be bad. Medicare alone only pays 80%. Medicare Advantage is a program people can choose and pay for instead of simply Medicare and it pays 100%. Its run by insurance companies. This is supposed to save money and help pay for this health care reform. A worry for me. Its supposed to start immediately. I dont know if seniors can buy into the new plans when they come out in 2014 either...but even then...that is 4 years away!

    I also havent seen a thing in this package about mental health care. Nothing. Must go searching again.
  2. klmno

    klmno Active Member

    I don't know much about it. I hope it does something for mental health- now that difficult child is "cured", I think I'm going to need some treatment real soon. LOL! But, who knows what the impact will be on us- our state decided to pass a law against it so now they plan to fight the fed government. (This is the same state government that can't find enough money to run the state so they have lay offs and possible furloughs for others but the senate wouldn't take a pay cut or work beyond their deadline without getting extra pay.)
  3. TerryJ2

    TerryJ2 Well-Known Member

    What do we actually understand? What is it? LOL.

    That's exactly what I said to difficult child yesterday. For all of his obstinacy and quirkiness, he loves to talk politics in the a.m.
    I told him that many of the people who voted for the bill hadn't even read it, and those who had, have their pet projects, so would vote for it because it may contain one or two things they like. (That's actually true of many bills.) Or, they may like the general, overall idea, but again, may not understand all of the details and implications.

    He was shocked. (Hey, when husband was on city council, there were 2 members who never read anything until the day the vote was called. Several didn't know what eminent domain was, and 2 people thought they could vote against Roe vs Wade. One wanted to spend the entire contingency fund (designed for hurricanes and other disasters) on a new kids' sports arena. I am not making this up. Why would it be diff on a higher level?)

    Yes, some know exactly what it going on. Mostly, lawyers who can speed read.

    That's very hard to explain to a kid, much less an adult.

    The bill is thousands of pps long.

    Much of it will be "explained" by its real-life interpretation by "competing" ins companies, by doctors, and by --cough, cough, cough--lawyers.

    I have to admit, it bothers me when every single company turns down people with-pre-existing conditions. It defeats the purpose of ins, in my humble opinion.
    MAYBE, maybe that will help some people who really need it.

    But so many doctors locally are quitting, and so many already don't take Medicare ... so, only time will tell.
  4. TerryJ2

    TerryJ2 Well-Known Member

    Klmno, my state is suing, too. Very interesting stuff.
  5. klmno

    klmno Active Member

    Yeah- doing something to solve the problem about those with pre-existing conditions having access to insurance and adequate treatment is huge to me. If it solves that problem plus makes insurance affordable, it has accomplished a lot in my book. Now they just need to focus on having access to adequate treatment- there are way too many quacks in the mental health prof, in my humble opinion, because their board doesn't care about anything except whether or not a therapist had sex with a client.
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    It will cover mental health care. So that will be good.

    Tony will have to buy health insurance because he is either considered self employed or his employer is too small to be under this plan. I have a huge bone of contention with his employer and had hoped this bill would force his employer to have to actually own up to the fact that he "employs" these people. Sigh...guess not. For what its worth, I will say why I have this bone of contention. Employer...Mr the Sub contractor. He carries the workmans comp, he gets the jobs, he tells ALL the men where the jobs are, when to be there and what time to meet at the store to catch the ride in the vans HE provides to the jobs. He even provides the larger tools such as Hilti guns, lasers and what not. Sure the guys have their own screwguns, hand tools and some have electrical chords but Mr X does have some of those too.

    Now Mr X, decides it is cheaper to pay these men on a 1099 because that way he doesnt have to do any payroll taxes! This is baloney. If they were true Subs, they would be deciding when to do the jobs, they would be finding the work themselves and be providing all their own tools. They would also be providing their own workmens comp. They arent subs...they are employees. Heck...he also charges them a fee to ride the van each day plus I know for a fact he takes mileage and depreciation on his taxes! Meanwhile, the "employees" have to pay their own taxes at the same base pay as if they worked for a regular employer but they pay more in the end because they are paying the full amount of SS tax. Plus they get no Unemployment taxes paid in. Can you tell it irks me? LOL. Its also the only way anyone does business around here!
  7. Hound dog

    Hound dog Nana's are Beautiful

    I am soooooooo not commenting. Except to say I have major issues with a govt who can't even manage their welfare system (let alone most of their other systhems) thinking they can manage healthcare for the entire country.
  8. trinityroyal

    trinityroyal Well-Known Member

    I have been following this situation with great interest, as I live in a country that currently has so-called "universal" health care. From what I have read, a lot of the arguments in favour of a government-run health care plan have used the Canadian health care system as an exemplar. I hope that they have learned from Canada's mistakes and don't duplicate them.

    Some of the things that have taken place over the last 20-odd years:

    1) De-listing of services. Items that used to be included under the government health coverage are now excluded and must be paid for out of pocket. These include: vision care, physiotherapy, chiropractic, podiatry, a lot of dermatology and so many other items. If your employer provides health insurance, some of these items might be covered, but otherwise you have to pay.
    2) Medication. Has never been included in the government health plan. Either your employer's health plan covers prescription costs, or you pay out of pocket.
    3) Dentistry. Same as drug plans. The gov doesn't touch it.

    I could go on and on, but I'll stop there. The one other issue that is really difficult is that, if an item IS included in the government roster, you are forbidden by law from seeking the treatment privately. So, if you need an MRI, which is covered, and the waiting list is 4 months, you're not allowed to go to a private MRI provider. Even if the delay could cause significant health problems.

    Regardless of where you sit on the political spectrum, it's of concern. Interesting that in Canada, there's a movement to allow privatization of health care, at the same time that the U.S. is moving more toward public provision.

  9. TerryJ2

    TerryJ2 Well-Known Member

    there are way too many quacks in the mental health prof, in my humble opinion, because their board doesn't care about anything except whether or not a therapist had sex with a client.

    There's nothing the govn't can do about that. It's the old boy network. Sick, sick, sick.
  10. Shari

    Shari IsItFridayYet?

    What's up with a 10% levy on indoor tanning in a health care reform bill????

    Among other WTH items.
  11. TerryJ2

    TerryJ2 Well-Known Member

    Interesting, Trinity!

    I don't know whether "our" plan forbids using both plans. IOW, if I use the gov't plan for an OBGYN, can I pay privately for dentistry? Would the govn't know? If they found out, would I have to pay them back? Or would they drop me from the plan. Except ... they are not allowed to drop anyone.

  12. trinityroyal

    trinityroyal Well-Known Member

    Exactly. Everyone is going to have to understand the fine details of the health care plan, and what they can and can't do, and how it differs from what they could or could not do before.

    With OHIP (the Ontario Health Insurance Plan), everyone who is registered as a citizen of the province is eligible for coverage, and entitled to receive whatever health care is covered under the provincial plan. The trouble is that so many things are not covered under the plan, and then people have to scramble around to find treatment and determine how to pay for it. Employer health plans tend to offer coverage for the services that are not included in the Provincial health plan, such as vision care, prescription drugs, dentistry, physio, chiropractic, etc. So for most people, between OHIP (or other provinces' equivalent) and employer health plans, they are well covered.

    Where the difficulties come up are situations such as:

    1) I need treatment that's not included in the health plan.
    For example, there was a story in the newspaper about a man who is being treated with Avastin for malignant brain tumours. But, because Avastin is not approved by the province to treat brain tumours, he must pay out of pocket something luke $7000 for each treatment.

    2) I need a diagnostic test that is included, but there's a long waiting list.
    For example, if I need an MRI the waiting list is 4 months or so, and there are no privately operated MRI clinics allowed in the province. If I have the money, I can nip across the border to Buffalo and get the tests done there with no waiting, but not everyone can afford the travel costs or the medical costs to do that. In fact, "medical tourism" is a booming business with tons of Canadians travelling to the U.S. to receive better quality health care that we have access to up here.

    I think there are advantages and disadvantages to both private and public health care. It's really a matter of whose running the show and how they're doing so.
  13. Marcie Mac

    Marcie Mac Just Plain Ole Tired

    Am so glad this finally passed - and believe bugs as they come up will be worked out. With the carriers not being able to say no on pre existing conditions, Danny can finally get health care. He recently went to the ER for a Kidney Stone (which had already passed). 4 hours, a pain pill and a cat scan and the bill was almost 12,000 with more bills by everyone who laid a hand on him comming in. And I wont worry so much about a possible lay off and not being able to get insurance due to high BiPolar (BP) pre existing

  14. TerryJ2

    TerryJ2 Well-Known Member

    Marcie, I think it's only the govn't plan that cannot say no to pre existing conditions. But I could be wrong.

    Wow. A CT scan for a kidney stone? I thought they used ultrasound to detect them, and high speed ultrasounds to break them up. But what do I know.
  15. Lothlorien

    Lothlorien Active Member Staff Member

    Personally, I think they should have gone after Heatlthcare reform, rather than takeover. I think deregulating the insurance companies would have brought competition and made it cheaper. I also think they should have passed a law making the insurance companies drop the term or use of pre-existing conditions as an excuse to not cover someone or gouge them with ridiculously high fees, while not covering anything that was pre-existent.
  16. DDD

    DDD Well-Known Member

    I don't think anyone really understands all the ramifications so the "anti" people hang on to one or two items to criticize and the "pro" people choose a few items to tout. Crazy.

    I imagine that FDR's people got similar flack when Social Security was passed. Is SS perfect? Of course not.
    on the other hand over the long run it sure has helped alot of people.

    I hope history repeats itself. DDD
  17. Marcie Mac

    Marcie Mac Just Plain Ole Tired

    Terry, maybe it was a ultrasound - I could have sworn he said Cat Scan because they wanted to see if there was a blockage- but whatever it was, 12,000 and counting? I have to read the bill because I could have swon on the news when they were discussing it that no insurance company could refuse coverage due to pre existing.
  18. Shari

    Shari IsItFridayYet?

    I think I heard it that way too, Marcie. But I could be wrong.

    How many pages is that thing supposed to be? like, 42000 or something? Who knows what's in it.
  19. KTMom91

    KTMom91 Well-Known Member

    I see both good and bad to this. On one hand, Hubby and I have tried several times to get health insurance on our own, only to be told that 1) I'm more than 100 pounds overweight...and I'm not THAT heavy...and would have to lose that weight and keep it off for over 6 months; 2) Hubby was also overweight, needed to lose the weight, etc.; and 3) Miss KT would have to be medication-free for more than TWO years. So, we've gone several times in our ten-year marriage without insurance, though I've been able to get Miss KT on Medi-Cal. I'm pleased that they can't refuse you for pre-existing conditions.

    I wonder how much input/autonomy individual states will have on providing care, and how long wait time will increase for treatment. Time will tell, though, and I'm willing to see how it plays out.
  20. Hound dog

    Hound dog Nana's are Beautiful

    Loth, I agree. It's the takeover part that most scares me. And it's certainly not like our govt has a reputation for running things well. There are a wide variety of ways reform could have been done much more effectively without the govt sticking their noses into it. And since social security funds are running out........well, that sort of speaks for itself.

    Govt took over GM. mother in law lost her good insurance, although via the govt she was just supposed to get a different scaled down version of her old insurance thru them. Now what she has is insurance that is "supposed" to be from GM, but it isn't........they stuck a new label on it and it's medicare. Believe me, sister in law and I've had enough arguments with them to find out. New version GM insurance refused to pay mother in law's nursing home fees because she can't be rehabed. Medicare, you can't claim it because her "new" insurance is medicare under a hidden behind different name. So had to pay all fees out of pocket until her money ran out (took 4 months by the way) and now she has to drop "GM" insurance to qualify for medicaid. That is what govt does when they stick their noses into areas they have no business sticking their noses into. They turn it into an even bigger mess than it was before. If govt hadn't "saved" GM, mother in law would've used medicare......a vast majority of her bills would've been paid......without all the confusion......until her money ran out from deductibles and she had to transfer to medicaid. For the insurance co's the govt signed on for was win/win.