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

Fran

Former desparate mom
I know that there will be a help to those on medicare who max out of their prescription medicare supplement plan and go into "the doughnut hole". My mom maxed out by July of last year. Her prescriptions per month were almost 1 1/2 times her monthly income. She had to pay out of pocket for 6 months until Jan. 1st. It's the only thing I know about the plan and it's a good thing in my humble opinion. If she didn't have help from credit cards and family she would have had to go without medications or pay her utilities.
 

Mom2oddson

Active Member
I grew up with Navy Medical care. It was great for serious stuff like cancer or emergency surgeries. But for regular care it stunk. Never got a choice on what doctor you saw, never saw the same one more that 2-3 times total. Never had a say in your own health care.

I loved it when I got to go to the private sector in health care. If I had a doctor that wouldn't listen to me, I got to fire him and find one that would. I hope this new plan doesn't take me back to the old way of medical care.
 

flutterby

Fly away!
Terry, there isn't a government plan and a private plan. There is no public option.

Either your employer provides insurance, you are on medicare or on medicaid, or you buy your own plan through whichever insurance company you choose. There will be caps on premiums and there will be federal subsidies for those that can't afford to purchase health insurance.

This might be helpful.

http://www.politifact.com/truth-o-m...8/top-10-facts-know-about-health-care-reform/

I would like to say that this issue has divided our country and not brought out the best in people. Regardless of how we label ourselves, we are all American. We must work together, not against each other and find mutual ground.

I have watched too many friends' posts on FB deteriorate where the debate was no longer debate, but hateful, hurtful, spiteful, words and name calling. It saddens me deeply. We are better than that. Or we should be.

Off my soapbox.
 

DammitJanet

Well-Known Member
The one thing that Im not happy about is this didnt address my problem. The LCP and Medicare issue. So Im still out of luck with my therapist. It was so close before this health care reform went on the table.
 

Marguerite

Active Member
OK, I'm beginning my post before I've read everybody's, I'll go bck and read (and add to this) as I go.

Janet, Tony's "boss" - talk to your taxation department about this, because it now is going to have a bigger impact on Tony's expenses. Maybe all you want to know from your tax office is - how does this new scheme affect Tony's tax? What can he claim? And then just mention/describe the boss. If your tax office is anything like ours, this will prick up their ears if boss is doing anything underhand, and they will be watching for him and may even decide to do an audit.
With the Aussie tax office (ATO) - they have a consult line, we can ring and pick their brains about all sorts of things. The person you talk to is an ATO employee of course, but also a tax payer who also wants to beat the system, but legally. They are very helpful but also very down on people knowingly trying to rort the system.

The 80% cover in some cases and 100% in others - we have something similar, I wouldn't mindbetting your incoming system has been modelled at least in part on ours.

Your private insurance companies - they will need to be regulated, supervised, watched, hounded and made to toe the line and not rip people off. I did hear tat they will no longer be allowed to drop people who "make too many claims" - after all, that is why people take out insurance, to cover them in the event of them NEEDING to make claims. In Australia, we can't be dropped unless we are claiming fraudulently. I know there have been frequent periods when our own personal health insurance company (yes, husband & I also carry private health insurance on top of the state-based public cover) would have loved to have dropped me, we hd claimed more tan we'd paid into it, over a number of years.

Another point you may not have realised - insurance premiums should go down, when there is a state-based health scheme. Our private health insurance used to cover GP visits, specialist visits as well as hospitalisations. Now it no longer has to cover any doctor visits and we only have to pay for hospital (which our insurance mostly covers) if we choose to go to a private hospital, or be admitted as a private patient. If we are admitted as public patients (which we can always choose) we get the same level of care, guaranteed. But the waiting list is often a lot longer. However, if it's an emergency such as a burst appendix or car accident, you have the choice on admission and generally people go public - you're going to get admitted anyway, going private just gives you the chance of a private room instead of having to share. Personally, I like the company.

I haven't had a chance to go digging into the new US plans, I know they can't be all like the Aussie scheme because of cultural differences. Our scheme is very much more Big Brother in what they can do to check up on you; if you do the right thing you have nothing to fear, but in Australia it's very hard to do the wrong thing and get away with it for long.

When our public health system first came in, it was ripe for exploitation by unscrupulous service providers and insurance companies. But a lot has been learned and I strongly suspect your people have been talking to our people about just how to avoid these problems.

It won't be perfect. But it's got to be better. Also, they will need to keep tweaking it to make it work better. There will be problems. It will take time. But hopefully once it's in place, you will see benefits fairly soon.

Our scheme is funded through an increase in taxation - above a certain (poverty line) level of income, there is about 1% levy (I think it might be 1.5% now). When you're already paying 40c in the dollar, what's another cent or two? Above a certain (rich) level I think the percentage is higher, unless you take out private health insurance (which pays for the fun stuff like specs, dental, physiotherapy, etc). Mental health - not a problem, psychiatrists are doctors too. But only recently were we able to claim for psychologist and only under certain conditions. Otherwise we had to have private insurance, or fork out (and then claim it back on tax).

Trinity, in Australia we always have the option of getting the job done privately if we can't accept the waiting time for the public scheme. But we always need a doctor's referral, and part of the Big Broter in our system monitors doctors who order too many "unnecessary" tests. So if a panel of doctors would not agree that your MRI is needed, your doctor would be in trouble (if he routinely over-prescribes or over-orders). But if it's genuinely needed - no problem.
With my breast cancer, I could have chosen to go public (and not pay a cent) but there was an unknown waiting time before I could have had my surgery. I am privately insured so I chose the private hospital route which got me my surgery within a fortnight. My brother, on the other hand, is stuck with the Queensland public health system and it's HUGE waiting times at public hospitals, and had to wait 18 months for urgent prostate surgery. Mind you, he could have complained louder and got attention sooner. Queensland is bad for this, mainly because their hospitals are not able to cope. Our national government is on the point of taking over all the states who until now have jurisdiction over actually providing the health services, even though the federal government foots the bill.
My breast cancer surgery - if I'd waited for the public hospital, I probably would have had my surgery in about 8 weeks instead of 2. NSW is not so bad as Queensland.

So for the US - administration is going to take time to set up and get it right. It won't happen overnight because you're a bigger country with more states and a previously different system which needs help to transition.

I wish you all well and hope that this is going to work out better overall for you. When you experience problems, you need to do two things:

1) Let the authorities know, loudly, so they can take the problems into account with their necessary tweaking; and

2) Never forget the alternative.

Marg
 

flutterby

Fly away!
Marg, there is no public option for us so in reality we won't see our premiums go down. Employer based health insurance premiums shouldn't go up as quickly as they have been and those that have to buy insurance on their own may actually see an increase because their plans will now have to cover more than what it did previously.
 

muttmeister

Well-Known Member
Well, I'm glad they finally passed SOMETHING although it is so watered down I wonder if it will do any good for anybody. At least it is a first step.

I have to admit that, although I do read the paper, I have stopped watching the news on TV. This is mainly to prevent me from getting mad and having a stroke as the health insurance I have now is not something I want to use because it would bankrupt me if I had a big bill, even with insurance. I get so mad with all of the politics that I want to move to a small island somewhere and rely on the local witch doctor. The antis have put out so many lies that even the people who are for reform are scared and the pros have made so many promises that Jesus Christ himself couldn't keep them all. I'm personally sick of the whole thing (but hopefully not sick enough to need a doctor because I can't afford one).
 

busywend

Well-Known Member
I hate the divide, too. It is not something this generation has really experienced and it is scary. It seems there are so many people getting extreme. I hope it is passion.
This should help millions of Americans. That is a good thing. If I have to pay a little more, I am OK with that.

I believe the # of pages is around 2300. And it does take quite a few pages of outlines and defining terms before you actually get to the meat of the reform.

It will takes years for most of us to see any changes, but I do believe the cost of health care in general will be reduced due to greater regulation.

Keeping my fingers crossed!
 

busywend

Well-Known Member
by the way - thank you all for keeping this post a discussion without many strong opinions that might cause it to get locked. I really appreciate it. It is cool that we can discuss it rationally.
 

hearts and roses

Mind Reader
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.

I have to agree, Loth. I would have liked to have seen an emphasis placed on prohibiting pharmaceuticals from running commercials and making 'behind closed doors' with physicians to push their drugs. I would have liked to have seen a cap on how much insurance companies can charge their policy holders for premiums as well as how much insurance companies can charge doctors and hospitals for their premiums.

I don't presume to know everything about this, but I am glad that it passed. In one of my classes we're covering social welfare programs and we've been going over this in class non-stop. One thing that I have found particularly interesting is that history does repeat itself, so I am hopeful. A large majority were against FDR when he pushed for the SSI; People were against Pres Johnson when he pushed for Medicaid and also Medicare expansions and don't forget that under his administration, the Civil Rights Act was passed and people didn't like that either....and now this. I have hope. I truly have hope and I hope that once the bugs are worked out, this will be good for our country. It's time for a little unity.
 

Marguerite

Active Member
The experience we've had in Australia has been very bumpy. In the early days our national health system was a huge financial drain on the country and also subject to being abused by various health professionals who saw it as a way to make a lot of money, fast. That was in the mid-70s.

Since then, there has been a lot of improvement with computerised systems, databases, the internet - all working together so information is cross-checked and those ripping off the system now WILL get caught, if not now then later, when the information percolates trough to officials.

It's a bit like athletes competing at Olympic levels, who have to give samples all the time and those samples are now kept. If at some future stage tests improve and old samples get re-tested to see if way back when, Athlete A was using a performance enhancing substance which was illegal at that time but not able to be tested for then - they will be found out.

The way our system works now is still not perfect, but it is improving all the time. And the amount our government spends on health care per head, is still way down. We're a smaller country, population-wise. This should make it more difficult for us to administer, we don't have economies of scale to help us. But our system is currently the best it has ever been, in terms of services provided as well as scrutiny of providers to minimise abuse of the system.

I'm also impressed with everybody's careful discussion of this issue as apolitically as possible. I think it's too important to share ideas and information, to spoil with political point-scoring.

We've been watching this issue closely from Australia and hoping that something can be done, somehow, to improve your health system. Not sure if Johnson would have been able to put anything workable in place back then - you are a BIG country. But now, you can pick our brains, plus the brains of other countries with similar systems, take what will work, discard the rubbish, learn from our mistakes in our country - and maybe come up with something that will work best for your people in your country.

Well done, everybody!

Marg
 

DammitJanet

Well-Known Member
One thing I did read was a funny one liner somewhere. It said something to the effect of: even with all of this reform, it will still cost approximately the same thing to treat a cold or fix a bum knee...lol.
 

Hound dog

Nana's are Beautiful
I'm also impressed this didn't become a huge argument. I think most people agree the current way things are isn't working well. I think the main disagreement is on how to fix it. I'm not one for big political arguments though. I figure everyone is entitled to their opinion and don't necessarily feel it's my job to make them agree with mine. lol Depending on where you are in life, and what you're dealing with, you're going to see things differently. Just how it is.

However, I think with something this huge, the issue should have been taken directly to the people for a vote. Maybe it would've ended up the same way, but I think more people would have felt they were being listened to that way.
 

Marguerite

Active Member
Often with something this big, there is scope somewhere for consumer input. Maybe talk to your congressman? I don't know what the channels would be for you, but I do know that with medical research the standard of practice is to have an Ethics Committee that the research has to answer to, and there generally is scope to have members of the public on Ethics Committees.

So maybe you can have input from members of the public in there somewhere after all?

Marg
 

hearts and roses

Mind Reader
Often with something this big, there is scope somewhere for consumer input. Maybe talk to your congressman? I don't know what the channels would be for you, but I do know that with medical research the standard of practice is to have an Ethics Committee that the research has to answer to, and there generally is scope to have members of the public on Ethics Committees. So maybe you can have input from members of the public in there somewhere after all?
Marg

For those who choose to be involved in the political process, they absolutely can call their congress-person, state representatives, etc. You can write, email or call if you feel the need. Also, at some point, I feel that we need to trust that those we elected into any office at any level will vote the way his/her constituents would like them to.

As you stated in your earlier post, Marg, our country population-wise, is HUGE. Therefore, it is difficult to vote on something so large as a healthcare reform bill which may (or may not) effect large and small groups of our population. For example, I have four siblings. While my sister (also in CT) and I enjoy a very nice (comparably) health insurance plan, my oldest sister in a poor part sticks-like area of WV has NO insurance at all and she hasn't qualified for state insurance (well, I think she has, but she won't apply). My brother in NY has decent health insurance through his union but he pays through the nose for it. And my other sister in PA has insurance through her union and she is happy with it to date. We all worry about our oldest sister. She has been the loudest cheerleader for the health reform bill because niether of her adult sons with families of their own have health insurance either - they will all benefit from this somehow. By the time I may benefit from it, perhaps all the bugs will have been worked out!
 

SRL

Active Member
Another point you may not have realised - insurance premiums should go down, when there is a state-based health scheme. Our private health insurance used to cover GP visits, specialist visits as well as hospitalisations. Now it no longer has to cover any doctor visits and we only have to pay for hospital (which our insurance mostly covers) if we choose to go to a private hospital, or be admitted as a private patient. If we are admitted as public patients (which we can always choose) we get the same level of care, guaranteed. But the waiting list is often a lot longer. However, if it's an emergency such as a burst appendix or car accident, you have the choice on admission and generally people go public - you're going to get admitted anyway, going private just gives you the chance of a private room instead of having to share. Personally, I like the company.

I sincerely believe that we need improvements to our healthcare in the US, especially to make coverage available to everyone. But I am not happy with the process, or the outcome of this bill.

1) To have a major social bill of this kind be passed by only partisan support (and with the last of those limping over the line as they were bought off by deals) is guaranteed to cause major problems. There's already numerous legal challenges that the bill isn't constitutional, and there is a very strong possibility that when the power shifts to the Republicans it will be repealed. in my opinion, it would have been far better had this been a bipartisan effort to fix the problem areas instead of partisan effort to overhaul it all. This past decade has seen the rise of what may be the most dysfunctional, least approved of congress in history. Had this been a bipartisan effort, future congresses would have been much more likely to be willing to work with it to try and work any bugs out.

2) Costs. No one truly has any idea of what this bill will cost, when you take into account the unknown price of the deals made to buy votes together with the deceptive accounting that was done to make it appear cost effective.
http://online.wsj.com/article/SB10001424052748703775504575136133814210008.html?mod=rss_opinion_main

http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html?ref=opinion

I don't believe for a moment that this bill will keep costs down. The US government isn't exactly known for efficiency or cost containments. I believe it will increase the national debt and result in tax increases for the upper and middle classes, plus pass the costs along to future generations. The money has to come from somewhere so they're either going to have to borrow it, print it, or tax it out of someone. I don't believe for a moment that money will be generated from reduced costs or budget reductions.

3) Medicaid, the largest governement run healthcare program, is in serious trouble because it is inefficient, often doesn't pay providers enough to justify their services, and it often doesn't pay them on time. States, pharmacies, and doctors are limiting number of patients and/or considering pulling out if they haven't already.

And I don't know about your states, but people who are on the state run programs here have very limited choices and long waiting lists...and it won't get any better because we're $5+ billion in debt, with no relief in sight. Politicians here simply can't live within their means and sometime it's got to catch up with the citizens.
 

DammitJanet

Well-Known Member
SRL...that is one of my fears, that they are going to start this thing out and start paying for it but then even by 2014 when most of it is supposed to go into effect, it will have been negated. If they start cutting medicare now but then say they are going to start giving health insurance in 2014...ehhh...not too ok in my book.

But it looks like Medicaid is going to increase fast right from the beginning? Or I may be reading it wrong on the dates. I know CHIPS is going to start soon. I know they say that Medicaid is going to now cover all the poor instead of only the chosen brackets now. Thats going to increase Medicaid by a whole lot.
 

Nancy

Well-Known Member
No one can be turned down for pre-existing conditions from any insurance company under this plan. If you are high risk you have the option of buying into a high risk plan. We were turned down by many insurance companies because of pre-existing conditions, none of which have ever cost our insurnace company a dime. We finally found coverage but it cost $36,000 a year. They did it because they could. We couldn't afford not to be covered. And yet they have forced us into a $10,000 deductible per person, thus making sure they would probably never have to pay out a dime.

Personally I am very grateful this passed and only wish it contained the public option, but baby steps. I do believe quality health care is our right, not a privilege for those who can afford it.

The scare tactics that have been used are really quite astonishing. When the sky doesn't fall in six months I will be anxious to see the response.

No one is forced to change their insurance if they are happy with it.

Nancy
 

DammitJanet

Well-Known Member
Nancy, have you read this thing to figure out how it will effect you guys? I wondered about you when I read it. Isnt your husband considered self employed? Or does he work for a firm that would consider offering insurance to get the tax bonuses?

I think as of immediately pre-existing can get insurance from the hi risk insurance bank. Might look into that one. Have no idea what that is.
 

Nancy

Well-Known Member
Janet, it will actually help him in his business. He is self employed and runs a small business and he does offer health insurance to his employees. He will now get a tax credit for doing what he has been doing all along for 25 years. This will be a big help to small businesses.

Personally we were really hoping for the public option so we could buy into it. husband's pre-existing condition is a kidney condition he got from having nephritis as a teen. It has never ever caused him a problem and hopefully never will. It is watched closely every six months. Why should he have been denied coverage for over 45 years because of something that happened so long ago which never cost them a dime. We could have paid for several kidney transplants out of pocket from the premiums we have paid over the years. And gosh forbid if any of us who got therapy for ourselves or our kids tried to get insurance. That's a huge red flag and would probably disallow all of our kids from finding afforable coverage after they left their parents policy.

We will be looking into the high risk bank when the details come out. Funny thing is late last year when all the talk was coming out on insurance companies and the health care plan, we called our insurance company and told them we wanted to drop the kids from our policy as we could no longer afford it. Wouldn't you know that they changed our rate from $36,000 to $13,000 with no change in covereage because they said our plan was now discontinued and we could fit into a different plan because we were grandfathered. I believe in my heart that they were trying to cover up their excessive pricing before it came out. They have now increased it to $17,000 a year in the past 6 months so it is gradually going back up. I am not a fan aof private for profit insurance campanies. Did you know that all health insurance companies use to be not for profit? Not a shining example of the free enterprise system.

One of the arguments that some of the states are using to sue (which will not hold up but looks good for future elections) is that no one should be forced to buy health insurance. Are we not forced to carry auto insurance?

Nancy
 
Top