ACTION ALERT: Fight The Healthcare CEO Pocket Lining Act of 2009!

[WeDidIt]

That's pretty much what "healthcare reform" is sorting out to be.

You're going to be required to get insurance from a private healthcare insurance company and if you don't, you get fined.

There will be a "trigger" for a public option that will be so odious that a public option will be dead for all time.

The Insurance companies claim they'll keep costs down, but the entire purpose for the existance of any public corporation to to acquire profits for the shareholders, so they won't give a fuck.

So I say, what we have today is BETTER than what so-called Democrats are in the process of ramming down or collective throats.

[sandnsea]

1. How about just fight the trigger

and recognize that the only way to ever really have universal coverage will eventually be with some kind of mandate. I wish they hadn't put it in now, but since they did it gives us more leverage to fight for a full public option because that's the only way there is real choice.

That's how our democracy works. There is never a perfect bill introduced that the entire Congress lines up behind. You have to fight over every detail.

[dflprincess]

2. That's how our democracy doesn't work

Polls are showing a majority of the people want single payer - but a majority of "our" Congress has been bought by the insurance companies so what we want doesn't matter.

The only "reform" in this bill is that nearly everyone will be forced to contribute to the the health insurance companies with no guarantees that access to health care will actually improve. I agree with the OP, if this thing passes we'll be worse off than we are now and it will take another 20 years to get any real reform passed.

Universal coverage does not equal universal access.

[sandnsea]

11. Polls show a majority want universal health care

and believe the government has a roll in making it available. Universale health coverage does not necessarily equal single payer either.

I have subsidized insurance, it actually works fine.

[Ms. Toad]

3. First - I don't really care who administers the plan that

treats all applicants the same (accepts them all, and charges premiums based on relatively neutral characteristics such as age and community rating) and is subsidized for those who can't afford premiums witout subsidies.

Second can you please point me to the "trigger" in the Kennedy bill (or any other draft circulating or introduced)? I reviewed the Kennedy bill and I don't recall seeing a trigger.

Disclaimer: What I would really prefer is single payer. Short of that, I will support any plan that takes a substantial step in that direction - whether or not it includes a "public option" - by requiring access to health care without regard to health (i.e. no exclusion for pre-existing conditions) and affordability (premiums not tied to health status, with subsidies or free access for low income individuals). Accessible and affordable care is far more important to me than trashing health insurance companies (even though I am not terribly fond of insurance companies).

[dflprincess]

4. The insurance companies are in business to make money

share price and the bottom line are their only priorites. The officers of these companies will do anything they have to avoid losing the gravy train they've been riding, including everything possible to sabotage any public option. Allowing them in (while keeping single payer advocates out) is not reform.

Kennedy's bill is a big enough disappointment as it is currently written but it will be worthless once all the "compromises" (sell outs) are made. We are being had.

[Ms. Toad]

5. A public option that meets the criteria set out by

Dean and Obama can easily be satisfied by a plan which permits basing premiums on health status, which offers no subsidies for low income people, and which allows insurance companies to reject individuals based on their health, none of which would be permitted under Kennedy's draft bill.

I realize that insurance companies are in business to make money - and frankly, that is the lesser of two evils if the alternative is a public health option without the above guarantees which would allow private insurers to continue to cherry pick the cheaper customers and would doom the public option to failure

Single payer is obviously my preference, and I am disappointed (but not surprised) that Obama has declared it off the table. He has always been for mandatory insurance (although now he has apparently moved toward the Hillary version of requiring insurance for all rather than just for children. Given that is the reality, I prefer a Kennedy-like bill even if it has a trigger (which I do not believe it includes - but for the sake of argument...) over a plan that meets the public plan criteria supported by both Dean and Obama which can easily be written without making any significant change in access or affordability.

[dflprincess]

6. When single payer won't even be discussed

when the will of the people is being ignored, we can hardly expect that we're going to be given anything that even resembles reforms. Most the Democrats, including Obama, aren't ever pretending that they haven't been bought by the insurance companies.

[Ms. Toad]

8. Suit yourself - personally, I'm going to put my energy

into trying to get somewhere with what's on the table - as long as it is a significant step in the right direction, and Kennedy's proposal is.

[dflprincess]

9. By the time it goes to the floor for a vote Kennedy's proposal

(which sucks and is a major disappointment) will have been amended and watered down so much that even he he won't support it.

Besides, starting your bargaining with what you're willing to settle for isn't a good strategy. You start out asking for everything and make the other side compromise with you.

[Ms. Toad]

10. That's why I was so disappointed with Obama's and Dean's

starting points for a public option - both of which could have been satisfied by plans that would have been doomed to failure because they could be satisfied by a plan written to require the public option to accept all of the pain and none of the gain. If they started out requiring nothing - the most we would get was nothing, and probably far less.

Kennedy's plan is considerably more than nothing, it's now our job to make sure it isn't watered down too much. It isn't where I wanted to start - but less than a week ago I was pointing out how little Obama's and Dean's plans actually required and being told to stop being such a wet blanket - they were wonderful plans that would certainly include everything we hoped for. My how times change (except that there are still people complaining about Kennedy's plan who are simultaneously insisting we need a true public option - not realizing that Kennedy's plan goes far beyond the minimum threshold set by Obama and Dean.

[dflprincess]

12. Kennedy's plan is mainly reworked Romeny Care

after 40 years I expected him to come up with something better - and there is no way we can keep it from being made worse unless you can raise enough money to match the bribes the insurance companies pay. The polls are showing the majority of Americans want single payer and we're being ignored - I can't even get a straight answer out of Amy Klobuchar's office about her postion on this (though she does send out one of the best written non-response responses I've ever seen).

It's never been clearer that Congress does not represent us and it's time to change the national motto to "Money Talks".

[Ms. Toad]

13. It fixes some of the problems with Romney care.

Not all of them, and it isn't even close to Single Payer - but again - it is what we have to work with so I plan to keep pushing since I don't think we can afford to insist on Single Payer or nothing.

I set out minimum standards any bill had to meet to get my support as significant progress, and the plan meets those standards. There are other ways to meet it (Access + a subsidy for anyone low income or with chronic health problems, opening Medicare/Medicaid to anyone with chronic health problems (without fees)). I would be thrilled if something else came along that was better.

But for now, my bottom line is that I want significant changes in access and affordability - which are included in Kennedy's draft bill. When Kennedy's bill removes the provisions that are crucial to those, it will lose my support.

[Dragonfli]

14. You make some sense but miss a point that kills people

Coverage based on a profit model does not mean care.
Care sometimes is withheld (or in the case of my wife) delayed to the point where a breast cancer was allowed to metastasize into the lung wall DURING THE WAIT while the doctor had to fight the insurer because another surgeon was requested in case a skin graft was needed. (it was timed rather carefully by the doctor - stop chemo for just long enough to build up her system - then do the surgery before it could metastasize, the insurance company added 6 months to that - in that time the tumor grew three-fold(quite laterally) and metastasized, they KILLED HER to save the money on one specialist. The ironic part is they finally agreed with him, but the surgery was too late.

That is the role insurers play, can you give me an example besides denials that they bring to the table? What exactly do they do to earn the money and get the right to make decisions for doctors?

Insures deny care all the time, it is one of the ways they make money.
Another problem you are missing is that all of that profit drives up the cost beyond affordabilty.

Another thing you miss is that fining people that can't afford health care will not make them be able to afford it.
It is just a way to get them more clients.

The biggest part you miss is that we need health care, not insurance, let them insure property if they wish to make money and experiment with claim denials. The denials will hurt many financially, but may not actually kill people.

I hope you never have to learn the difference between health care and insurance the sad way as I did.
I also hope you never have to learn what it is like not to have the money even to get a basic policy with a $5,000 deductible and no prescription or actually get fined for it.

The proof of the failure of mandated insurance schemes is evident already in Mass. Poorer folk get insurance there they can't afford and can't afford even to use and yet they are required by law to buy this garbage. And if they can get the deductible together somehow there is no guarantee they will not get between them and the doctor with a denial.

It is snake oil plane and simple, if it isn't explain to me what it is (besides denials) the insurers actually provide regarding care?
Are they nurses in suit drag or something? Also can we really afford to supply obscene profits to a vestigal organization and supply health care?

[Ms. Toad]

15. I'm not missing the points

It just isn't a black and white issue for me as far as insurance v. public option is concerned. I fully understand the difference between care and insurance, and I have successfully waged several fights with the insurance company as to what is covered and what is not (with the aid of caring physicians). In fact, I have never lost one I decided was worth fighting to the end.

My problem with insurance fights has actually been with a few lemon doctors who have decided it is not in their best interests to advocate on behalf of their patients. I actually had one doctor call and scream at me because I insisted that she either (1) explain why it was appropriate to have child who had not yet finished growing be seen by an adult orthopedic surgeon for a fracture in or near the growth plate or (2) write a letter to the insurance company advocating for an exception to their plan to permit my daughter to be treated by a non-plan pediatric orthopedic surgeon (there were none in the plan). She refused (unless I paid her hourly rate to write the letter). We promptly fired her, and that is the only significant battle I have lost with the insurance company (I actually chose not to continue fighting that battle once we ascertained the fracture was not in the growth plate - which was impossible to tell from the ER x-rays available at the the time of the screaming phone call).

She is one of three physicians we have fired for similar reasons; I expect my physician to be an advocate for me (or my child), not a mouthpiece for the insurance company. On the other hand, I have had several excellent physicians who have been able to win exceptions to their policy for me without me even lifting a finger - probably the most significant was obtaining the right to use a non-forumlary medication off label which allowed me to remain out of the hospital rather than be hospitalized for two weeks (a denial for the same use of that drug was featured on an episode of ER - there they lost the battle with the insurance company, which was unfortunately typical without a strong doctor advocating for his patient).

I am not advocating insurance as the way to go - I don't think it is. Single payer is the option I would prefer. If we're stuck with an insurance model, though, I just don't think that administration by a public entity as opposed to an private one is the most important thing. It is far more important to build other safeguards into the system - because even if the public option is not a for-profit, it will still be administered with an eye to saving money to meet its budget, with some of the same results. So - I am not willing to reject a plan represents significant progress by requiring insurance companies to meet minimum standards (and there are standards in the bill - I didn't focus on them when I was skimming through it) and provides substantial assistance for those who cannot afford the price of the premium. (Kennedy's plan provides subsidies up to 500% of poverty, and requires insurance companies and public option plans to be on equal footing - both must accept all, both must cover the same conditions/treatments, neither can cap lifetime payouts).

But - if you don't want to have your care paid for through an insurance company, then pick the public option. I'm pretty sure it is not based on a trigger in Kennedy's plan - and because of the additional protections in Kennedy's plan over the Mass plan (which keep it from being a dumping ground for uninsurable people), the cost should be lower than in Mass.

[Dragonfli]

16. My own experience with profit care begs to differ.

A lesson that costs more than your "intellectual musings".

Why are we stuck with it as you claim?
What do they ACTUALLY bring to the table?
How can you save the same 30% you would by getting rid of this unnecessary evil?

You can tell me all day long how much these questions don't matter.
Find a spiritualist if you believe in that sort of thing and then explain it my wife.

It is precisely your callous attitude to the damage being done and that will be allowed to continue that allows this sort of crap to pass as reform when it is a really just a customer supplying mandate, nothing more.

It is easy to claim that those forced into buying a policy with high deductibles and crappy "coverage" will be affordable with a little help, truth is the levels they use to decide such things are well below subsistence and not a true poverty line (even with the added percentage). A plan available that can be afforded by buying less food would be as crappy as the plans they will mirror that are in Mass.

I only agree with you on one thing, a true public option would be a start and would eventually turn into a less cruel system if it were not for the fact that it has already been decided that if the insurance companies can't compete with it it will be modified to mirror the snake oil they sell.

Show me a public option that is not "modified" to help insurance companies and I will get on board and will do so without reservation.
Schumers criteria, if followed, would take a true public option off the table and you damn well know it.

You are mistaken about insurance company denials but I can understand that as I didn't realize what they can/will do for the sake of a bottom line until they did it to me.

They are little more, no, actually less than vultures.

[Ms. Toad]

17. I am not arguing against single payer

or for insurance companies. If there was a realistic chance of getting single payer I would be spending my energies there - but the people in charge of the committees and policy direction which will ultimately determine what is voted on are not willing to even entertain the idea.

My attitude is not callous; it is realistic. I want more, but I am not going to forego the chance to make real progress in the right direction because I can't have it all right now.

I have been arguing against all of the lofty statements praising the public option because the minimum requirements they (Obama and Dean) set could easily be satisfied by something I find completely unsatisfactory - a public option that would be an expensive dumping ground for all those who cannot afford or are denied insurance completely without a guarantee that there would be an income based subsidy.

Kennedy's plan has enough specifics and enough guarantees and restrictions on insurance companies that it is a significant step forward, and I will support it.

If there is a single payer plan that is specific enough to meet what I consider necessary for real change I will support that, as well. The only one currently introduced that I am aware of (Conyer's bill) that serves the entire country is pretty vague (so lots of room for error) and has two significant problems. First, pay can be capitation based (meaning the primary provider gets a pot of money to pay for all treatment including tests and specialist visits and gets some or all of what is left over at the end of the year). That provides a strong motivation to deny access to costly specialists and for costly diagnostic or treatment procedures. Second, prescriptions are limited to a formulary without any express mechanism by which physicians can obtain an exception to the formulary - meaning one size fits all medication without any exceptions. Those two problems (combined with its general vagueness) may be significant enough that I cannot support it - I haven't decided yet. From a personal perspective (as you should be able to appreciate from what follows), those two would knock it out for me, but I haven't decided whether from a policy perspective it goes far enough that I can support it.

With all due respect, you don't have a clue how non-intellectual my musings are. I have a daughter, now 18, who has been living with a chronic illness since she was 4 was who was recently diagnosed with a progressive illness for which there is no medical treatment and which will ultimately require a liver transplant. Some of the battles I have fought and won have been on her behalf in connection with the illness she has been living with since she was 4.

In the mean time, she is not well enough to work and may not be well enough to attend school full time - but not ill enough to qualify for SSI/SSD. She ages out of my policy, if she cannot carry a full time load in a little over a month. The expectation is that it will take around 18 years of getting progressively worse until she is sick enough that a transplant is less hazardous than living with the illness. The experimental medication she is now taking would cost (if we had to pay for it) around $55,000 a year. Once the study she is in is completed, we will be faced with trying to convince her insurance company to pay for the medication which may prevent the her body's continuous attack on her bile ducts from destroying her liver before a cure can be found.

She desperately in need of some relief NOW - and can't afford to trash a proposal that makes significant progress while waiting for the perfect proposal. Kennedy's proposal would guarantee access to and treatment for her condition at a cost considerably lower than the $14,000 a year that open enrollment in Ohio currently costs - whether it is administered by the public or the insurance company. If they are required to cover her - I will fight the insurance companies all day for her right to appropriate treatment.

What she can't afford is to pay $14,000 a year for insurance and still have insurance company battles about access to health care because we decided to stamp our feet and insist it must be single payer or nothing.

[Dragonfli]

18. She will get coverage then (I hope she does)

You do realize that she will still have to fight for every costly thing she needs and that you will not win all the battles.(I actually hope you will win each and every battle, but I know them better)

I suppose one way to beat her, my wife and all the people (that yes you are callous about - others daughters that will not have the money even with help to pay the huge deductibles on the bottom policies) is to divide and conquer. It is working well.

Sign on the bottom line as long as it helps your family (you seem to sincerely believe that it will - I have my doubts).

Blood is thicker in ones own family than in the families of others.

They have won then.
And your family will not be as covered as you imagine, I hope I am wrong but...

You are going to learn the same way I did unfortunately, but at least I understand why now and I do have a unique perspective on how much that drives you.

I would have signed anything to save my wife so I won't criticize you any more. I understand and wish you only the best of luck and care.

No point in discussing policy with you anymore, I know you will take anything they offer that will help even a little and understand that your heart leaves you no choice in the matter, such is the power of love, horrible that they use that against us.

[Ms. Toad]

19. I will NOT take anything they offer.

I have certain minimum criteria that a plan must meet in order to win my support. Kennedy's does, Conyers may, the 5 state single payer does not, Dean's peititon did not, nor did Obama's policy statement.

If you search DU you will find I argued just as vehemently against signing Dean's petition or jumping on Obama's bandwagon for a pubic health option because what they called for could easily be satisfied by a sham public option that did not address access and affordability. Such a plan would have resulted in the pubic option being a dumping ground for anyone who couldn't get covered elsewhere, would have failed miserably. That would have set back the possibility for real change at least a decade. I am not willing to support a public option plan that provides little more access than is currently available and no guarantees/restrictions that make it affordable and/or subsidized.

I may well end up supporting Conyers' single payer, even though the salary based on capitation and formulary restrictions (without a means for obtaining exception on a medical basis)are significant problems. If I do support it, both those restrictions work against my personal interests, but my personal interests are less important if the result overall provides more access and affordablity.

What we must have now is something which increases access to and affordability of care. My position is that each plan must be evaluated on its merits, not its name or whether it involves private insurance companies. I won't draw a line that tosses out a plan that provides access to care to all and increases affordability just because it allows insurance companies to continue to exist - in contrast - I will draw a line which tosses out some plans which call for a single payer or public option if the substance of those plans is not well designed to provide more access and more affordability.

I encourage you to read the bills that have been submitted or for which drafts are available, not just go on press reports, and to decide based on the merits of what is actually in the bill whether it is worth supporting. As long as we are ignorant there will be no meaningful change. The paltry handful of people who actually commented on the Kennedy bill, in contrast to the boatload of people who jumped on the Dean petition without understanding its shortcomings certainly suggests that ignorance is the biggest threat to real progress.

[Kansas Wyatt]

7. Democrats making sure that Jeb Bush is a solid contender for 2012.

Don't think so?

Just watch, because that is exactly what will happen if the Democrats KEEP ignoring the people. The people stay home, since the Democrats did NO better than the Republicans, and Jeb wins.

Besides, the Democrats have a habit of screwing themselves so hard, that it allows a Bush to waltz right on in.