[O/E] Five freedoms you would lose under Obamacare

[Surlethe]

CNN op/ed

NEW YORK (Fortune) -- In promoting his health-care agenda, President Obama has repeatedly reassured Americans that they can keep their existing health plans -- and that the benefits and access they prize will be enhanced through reform.

A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy's Health committee, contradict the President's assurances. To be sure, it isn't easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

If you prize choosing your own cardiologist or urologist under your company's Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests -- you may be shocked to learn that you could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution.

In short, the Obama platform would mandate extremely full, expensive, and highly subsidized coverage -- including a lot of benefits people would never pay for with their own money -- but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can't have. It's a revolution, all right, but in the wrong direction.

Let's explore the five freedoms that Americans would lose under Obamacare:

1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn't even know what's in their plans and what they're required to pay for, directly or indirectly, until after the bills become law.

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.

Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage. So if a 20-year-old who costs just $800 a year to insure is forced to pay $2,500, a 62-year-old who costs $7,500 would pay no more than $5,000.

Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that's understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet. That's hardly a formula for lower costs. It's as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.

3. Freedom to choose high-deductible coverage

The bills threaten to eliminate the one part of the market truly driven by consumers spending their own money. That's what makes a market, and health care needs more of it, not less.

Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It's worth diving into the weeds -- the territory where most pundits and politicians don't seem to have ventured.

The legislation divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don't have real insurance. Those are the GEs (GE, Fortune 500) and Time Warners (TWX, Fortune 500) and most other big companies.

The House bill states that employees covered by ERISA plans are "grandfathered." Under ERISA, the plans can do pretty much what they want -- they're exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.

But read on.

The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the "qualified" policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we've already discussed. So for Americans in large corporations, "keeping your own plan" has a strict deadline. In five years, like it or not, you'll get dumped into the exchange. As we'll see, it could happen a lot earlier.

The outlook is worse for the second group. It encompasses employees who aren't under ERISA but get actual insurance either on their own or through small businesses. After the legislation passes, all insurers that offer a wide range of plans to these employees will be forced to offer only "qualified" plans to new customers, via the exchanges.

The employees who got their coverage before the law goes into effect can keep their plans, but once again, there's a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it's likely that millions of employees will lose their plans in 12 months.

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they're healthy and switching to fee-for-service when they become seriously ill. "That would kill fee-for-service in a hurry," says Goodman.

In reality, the flexible, employer-based plans that now dominate the landscape, and that Americans so cherish, could disappear far faster than the 5 year "grace period" that's barely being discussed.

Companies would have the option of paying an 8% payroll tax into a fund that pays for coverage for Americans who aren't covered by their employers. It won't happen right away -- large companies must wait a couple of years before they opt out. But it will happen, since it's likely that the tax will rise a lot more slowly than corporate health-care costs, especially since they'll be lobbying Washington to keep the tax under control in the righteous name of job creation.

The best solution is to move to a let-freedom-ring regime of high deductibles, no community rating, no standard benefits, and cross-state shopping for bargains (another market-based reform that's strictly taboo in the bills). I'll propose my own solution in another piece soon on Fortune.com. For now, we suffer with a flawed health-care system, but we still have our Five Freedoms. Call them the Five Endangered Freedoms.

Any thoughts? I'd prefer to just skip straight to a single-payer system instead of this halfway clusterfuck. The article, I'm pretty sure, is exaggerating, but the basic theme of this health care "reform" seems to be adding layers and layers to an already-complicated system instead of simply cleaning house and putting in place a national insurance policy.

[Stark]

I'll lose the freedom to pay my real costs?

NO WONDER POOR PEOPLE HATE IT LOL!

The conservative bobbleheads nodding along to this are pretty funny.

It's amusing to look around Australia and see all these freedoms we've lost. Doctors have no freedom of choice!

[Darth Wong]

1. Freedom to choose what's in your plan

How many Americans currently get to actually choose what's in their health insurance plan, unless they're rich?

2. Freedom to be rewarded for healthy living, or pay your real costs

Uh, that's called "being uninsured". The whole point of insurance is risk pooling so that you don't pay your real health-care costs. Risk pooling does, by nature, smooth over inconsistencies in the population.

3. Freedom to choose high-deductible coverage

And that's called "being poorly insured".

4. Freedom to keep your existing plan

Provided you can afford it, and you don't get laid off from a job which provides benefits, and you don't experience "recission", and you don't actually use your policy enough that you run into your lifetime benefit caps ...

In any case, he's complaining that if they outlaw certain kinds of insurance plans (like those high-deductible ones), then people who have those plans can't keep them (leaving aside all the ways they can already lose them under the existing "system"). That falls into the "no shit, Einstein" category of blindingly obvious statements, and is really just a repetition of his earlier points.

5. Freedom to choose your doctors

I like the way he complains that the system would set up groups like HMOs. Uh, don't a lot of Americans already get care through an HMO? Is he just saying that if you're lucky enough to belong to the group which is too elite for HMOs, then you shouldn't be forced to live like the HMO people? If it's so horrible to get health-care under HMO conditions, then why is it tolerable that millions of Americans use HMOs right now? Or is it just tolerable because the writer himself doesn't use one, and doesn't want to be forced to live like the people who do?

[Serafina]

1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn't even know what's in their plans and what they're required to pay for, directly or indirectly, until after the bills become law.

So, it will increase the quality of your insurance. Implying that it raises health care expenses is, well, stupid - of course costs increase if people pay for stuff they were not able to pay for before. This does not mean that the system gets less efficient - it just expands.

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.

Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage. So if a 20-year-old who costs just $800 a year to insure is forced to pay $2,500, a 62-year-old who costs $7,500 would pay no more than $5,000.

Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that's understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet. That's hardly a formula for lower costs. It's as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.

Well, insurances (and thats what we are talking about) HAVE to do this to work. If everyone was paying for what he gets, there would be no need for an insurance at all.
Claiming that this is a BAD thing for an insurance to do is just plain stupid.

3. Freedom to choose high-deductible coverage

The bills threaten to eliminate the one part of the market truly driven by consumers spending their own money. That's what makes a market, and health care needs more of it, not less.

Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."

Ok, so, currently, some people take insurances that only pay for expensive stuff. Everything else, they pay out of their own pockets.
The new system "forces" people to take insurances that are not stripped-down. This is going to eleminate a certain branch from the insurance industry.
Well, he actually seems to have a point here - but does not seem to be a big loss.

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It's worth diving into the weeds -- the territory where most pundits and politicians don't seem to have ventured.

The legislation divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don't have real insurance. Those are the GEs (GE, Fortune 500) and Time Warners (TWX, Fortune 500) and most other big companies.

The House bill states that employees covered by ERISA plans are "grandfathered." Under ERISA, the plans can do pretty much what they want -- they're exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.

But read on.

The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the "qualified" policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we've already discussed. So for Americans in large corporations, "keeping your own plan" has a strict deadline. In five years, like it or not, you'll get dumped into the exchange. As we'll see, it could happen a lot earlier.

The outlook is worse for the second group. It encompasses employees who aren't under ERISA but get actual insurance either on their own or through small businesses. After the legislation passes, all insurers that offer a wide range of plans to these employees will be forced to offer only "qualified" plans to new customers, via the exchanges.

The employees who got their coverage before the law goes into effect can keep their plans, but once again, there's a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it's likely that millions of employees will lose their plans in 12 months.

It seems that everyone that has no or insufficient insurance will be "forced" to get an real insurance - OH NOES!!
Isn't that kinda the whole point of the reform? Getting everyone an insurance, one that actually pays for medial expenses?
How can it possibly do that if people are allowed to retain their own, retared insuances and even get NEW retarded insurances?

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they're healthy and switching to fee-for-service when they become seriously ill. "That would kill fee-for-service in a hurry," says Goodman.

Well, we have a system with these "medical homes" in Germany. It works. It works great, because my doctor actully knows which specialists are good (and specialised in my problem), something which i can not know (because i did not study medicine).
Yes, it can be a problem if cost-efficiency force doctors to deny care and rerouting to specialists. But is does not automatically happen

Any thoughts? I'd prefer to just skip straight to a single-payer system instead of this halfway clusterfuck. The article, I'm pretty sure, is exaggerating, but the basic theme of this health care "reform" seems to be adding layers and layers to an already-complicated system instead of simply cleaning house and putting in place a national insurance policy.

You are propably right - the planed reformed seems to be too complicated. Of course, thats what you get if you HAVE to appease free-market wankers, while trying to put up something that will reduce the free market - to protect the human right of physical integrity.

[Aaron]

The bleating about "I need to be able to choose my doctor!" is both pathetic and amusing. WTF qualifies the average person to decide if their doc is good or terrible anyways? I choose my doc based on whether he's taking new patients and if I get along with him and no more, I don't know enough about medicine to tell if he's selling me a line of BS or not and I doubt the average Yank is any different!

As for specialists, unless I personally know the specialist in the field I need to see I tell the doc to get me in whoever he can.

The plan itself (assuming this article is in any way accurate) is pretty fucked up though, I thought the idea was to simplify things not turn health care into auto insurance.

[Darth Wong]

I thought the idea was to simplify things not turn health care into auto insurance.

Health care in the US is already like auto insurance. Pretty much anything except for a drastic top-to-bottom overhaul of the system would result in something that looks ridiculously complicated and annoying to a Canadian. Most Americans don't realize what a mess their current system is because they never bother to read the fine print on their insurance policies. As far as they're concerned, the "health care system" in America boils down to whatever they personally have, and even for that, it's just the summary because they never read anything more than that.

[Superboy]

I don't really know much about the details of how American health care works, but I was a especially confused about this:

The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Do any private plans currently allow you to get MRIs and other scans whenever you feel like it? Doesn't it already take a doctor saying that there is a good reason for it before you're insurance will cover it?

[Gaidin]

How many Americans currently get to actually choose what's in their health insurance plan, unless they're rich?

I know for sure the only reason I'm insured at all is because my work covers it. Nobody will touch me with a ten foot pole thanks to my condition. Choice? What choice? I want this 'choice' they speak of in the article.

[Darth Wong]

I don't really know much about the details of how American health care works, but I was a especially confused about this:

The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Do any private plans currently allow you to get MRIs and other scans whenever you feel like it? Doesn't it already take a doctor saying that there is a good reason for it before you're insurance will cover it?

There is no such thing as an insurance company which allows you to self-diagnose, choose your own treatments, and reimburse you without questions. The reason he says this bullshit is that one woman from Canada who's running around screaming about how awful the Canadian system is because it didn't let her do precisely that. All of the American right-wing politicians are making her into a celebrity for exposing the flaws of socialized medicine, even though there are zero insurance companies out there which would do that. In fact, since the woman in question has a bad health history, she would most likely have been denied coverage entirely because of her pre-existing condition.

[General Zod]

I don't really know much about the details of how American health care works, but I was a especially confused about this:

The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Do any private plans currently allow you to get MRIs and other scans whenever you feel like it? Doesn't it already take a doctor saying that there is a good reason for it before you're insurance will cover it?

It really depends on the plan you have. If your plan is shit then you can expect a lot of red-tape. If it's medium to average then you can still expect to shell out co-pays even if your Doctor thinks it's necessary.

[Superboy]

The reason he says this bullshit is that one woman from Canada who's running around screaming about how awful the Canadian system is because it didn't let her do precisely that.

Out of curiousity, what's the woman's name? I wouldn't mind reading up on that.

I don't understand how some of these things even become talking points. The author of this op ed is bemoaning the loss of things that the american system never had to begin with.

Another question; why won't the new health care plan allow people to choose their own doctors? Not that it's really a major fault with the plan, but as a Canadian I've always been able to choose my doctor and I'm curious why any system would prevent that.

[Darth Wong]

The reason he says this bullshit is that one woman from Canada who's running around screaming about how awful the Canadian system is because it didn't let her do precisely that.

Out of curiousity, what's the woman's name? I wouldn't mind reading up on that.

Shona Holmes. She claimed that she was given a six month wait time on life-saving surgery due to Canada's horrible health care system, but she has no proof that it was actually required to save her life, and her medical records are protected for privacy reasons, which is convenient for her whirlwind publicity tour. She subsequently amended that figure to three months, which makes me wonder how much of this story she's making up as she goes along. It's certainly made her a superstar on the American political circuit, and she got on TV as a result. Maybe she'll go on speaking tours.

http://www.theglobeandmail.com/news/nat ... le1235958/

BTW, the Globe and Mail is actually a conservative newspaper, at least by Canadian standards. This is not what some might refer to as a "liberal newspaper". The Globe and Mail has long been the financial news reporting bastion of Canada. It's our equivalent to the Wall Street Journal.

I don't understand how some of these things even become talking points. The author of this op ed is bemoaning the loss of things that the american system never had to begin with.

Another question; why won't the new health care plan allow people to choose their own doctors? Not that it's really a major fault with the plan, but as a Canadian I've always been able to choose my doctor and I'm curious why any system would prevent that.

They think Canadians can't choose our own doctors. As far as I can tell, the average American thinks that in order to get health care, a Canadian must fill out a government form to apply for it first. They honestly don't realize that we just phone up the doctor and ask for an appointment, just like anyone else does.

[Superboy]

Thanks for the link. I can't help but think the best way to convince people that socialized healthcare is a good idea would be to simply educate them about it.

In regards to that woman claiming she spent 6 months waiting for a life-saving surgery: are there any available numbers on exactly how many people die while waiting for a life-saving procedure? I tried searching around for any statistics regarding waiting lists, but it's hard to come across any hard numbers.

[Darth Wong]

Thanks for the link. I can't help but think the best way to convince people that socialized healthcare is a good idea would be to simply educate them about it.

In regards to that woman claiming she spent 6 months waiting for a life-saving surgery: are there any available numbers on exactly how many people die while waiting for a life-saving procedure? I tried searching around for any statistics regarding waiting lists, but it's hard to come across any hard numbers.

Medical privacy laws make it difficult to collect that kind of information. That's one of the things that makes Shona Holmes' story so suspicious: she has not a shred of evidence to actually support her story, and she's already changed her story once since going public with it. Saying it was a six month delay and then later saying it was a three month delay ... which was it? How do you confuse six months with three months?

In any case, Canadians don't all get the same wait time. The wait time you get depends on the severity of your need. I waited six months to get my hernia repaired at the Shouldice clinic, but the guy sharing my room got his surgery booked the day after he came in for his consultation, because his case was far more serious than mine. This is how a triage system works, for fuck's sake. Very few people should actually die while waiting for life-saving care, because if you're close to death, you get moved to the front of the line.

[Darth Holbytlan]

1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

In other words, they're banning shit plans that don't actually cover anything.

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26.

Notice how he criticizes the bill for problems in state health care programs, but doesn't actually point out anything wrong with the Senate version. Oh wait, paying for those druggies to get off of drugs is a terrible waste of money; everyone knows that they aren't really people, anyway. Neither are starving grad students; just ask any professor.

That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn't even know what's in their plans and what they're required to pay for, directly or indirectly, until after the bills become law.

Depends on the nature of the experts, wouldn't it? Given that he doesn't criticize the make up of the board, I'm guessing that it's filled with medical experts or something else equally horrible.

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Don't these people know how insurance is supposed to work? You hand money to the insurance company. When you get sick, they hand part of it back to you, and pocket the rest. If you have the gall to need all of your money back, you get dropped because you didn't mention that time you stubbed your toe 3 years ago. Or they can just raise the rates of all your coworkers—they should have taken better care of your health, after all.

Pooling funds? What's that?

3. Freedom to choose high-deductible coverage

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."

You mean they might eliminate my employer forced provided HSA? They'll prevent me from paying for all my own medical care. Can't have that.

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise.

Right, they'll be forced to get good plans.

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they're healthy and switching to fee-for-service when they become seriously ill. "That would kill fee-for-service in a hurry," says Goodman.

So the author just thinks only HMOs can compete when they have to cover everyone. This sounds pretty dubious to me, but I'll admit I don't know the details of the differences in costs to HMO providers vs others for different ages. Even if there is a difference, I suspect that enough people hate HMOs to be willing to pay a premium for other coverage.

[Superboy]

This is how a triage system works, for fuck's sake. Very few people should actually die while waiting for life-saving care, because if you're close to death, you get moved to the front of the line

That's what always struck me as weird about the long-waiting-times argument that republicans are so fond of. The very nature of the triage system means that if you have to wait a long time for treatment, it's almost always because there are other people who need to be treated more urgently. The fact that republicans take issue with this seems to be a blatant confession that they believe they should be treated before those who can't afford it even if they don't need treatment as urgently. The selfishness doesn't surprise me, but the transparent way they argue about it on a national stage does.

[Darth Wong]

This is how a triage system works, for fuck's sake. Very few people should actually die while waiting for life-saving care, because if you're close to death, you get moved to the front of the line

That's what always struck me as weird about the long-waiting-times argument that republicans are so fond of. The very nature of the triage system means that if you have to wait a long time for treatment, it's almost always because there are other people who need to be treated more urgently. The fact that republicans take issue with this seems to be a blatant confession that they believe they should be treated before those who can't afford it even if they don't need treatment as urgently. The selfishness doesn't surprise me, but the transparent way they argue about it on a national stage does.

That's why they're pushing this Shona Holmes story so hard. She is peddling a story where she was put on a six month waiting list for life-saving surgery, when in fact every doctor she consulted said it was not life-threatening. She kept shopping around until she found a doctor willing to agree with her self-diagnosis and charge her $100,000 for her surgery (she is currently suing the province for this money; I hope she loses), and now she's being touted to support the "socialized health care will kill you" story. It's unvarnished bullshit.

[Themightytom]

Medical privacy laws make it difficult to collect that kind of information. That's one of the things that makes Shona Holmes' story so suspicious: she has not a shred of evidence to actually support her story, and she's already changed her story once since going public with it. Saying it was a six month delay and then later saying it was a three month delay ... which was it? How do you confuse six months with three months?

.

Emergency room congestion at LEAST would be reduced if people could get issues checked out before they become an emergency. Ie: follow ups on surgeries, asessment of suspicious symptoms We had a kid at the shelter who had a HORRIBLE rash going on, so I called one of our board members who is a doctor and son of a bitch if it wasn't LYME disease. The kid has had it for almost a month. he would have been in line with frigging ORGAN failure. Then there's issues about disease transmission. if someones getting checked out regularly, they get caught with say tuberculosis, BEFORE they spread it around, or mono, or various flus...

Also, health insurance for substance abusers would save us ZOUNDS of money being poured into an inneffectual penal system its really awkward when a crackhead wants to stop but can't get into a medical detox program and can either risk unmonitored detox symptoms or live in an emergency room.


Whats with this terminology "Freedoms we would give up"? its more like "Hypothetical situations that have about as much practical application as "Anyone can be president!"

[SCRawl]

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

Others have done a good enough job of pointing out the weak points in this article, but this actually struck me as absurd: hair transplants are required to be part of the default minimum coverage? What on earth is the justification for that? I'm, er, rather seriously follicularly challenged, and there's no way for me to justify that my medical insurance plan ought to cover something like this. I mean, I can maybe see wigs for cancer patients, but not surgery to correct male pattern baldness. What's next, pectoral implants for guys who don't want to go to the gym?

[Themightytom]

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

Others have done a good enough job of pointing out the weak points in this article, but this actually struck me as absurd: hair transplants are required to be part of the default minimum coverage? What on earth is the justification for that? I'm, er, rather seriously follicularly challenged, and there's no way for me to justify that my medical insurance plan ought to cover something like this. I mean, I can maybe see wigs for cancer patients, but not surgery to correct male pattern baldness. What's next, pectoral implants for guys who don't want to go to the gym?

OO! maybe we can add optional breast implants for women in the army because it gives them confidence! Like in Brazil.
I'm thinking Obama isn't REALLY trimming the fat as much as he says he is

[Lord MJ]

I think even if you eliminate all the FUD about Socialized Medicine, people will oppose it.

Most of the fears of waiting list, not being to choose your own doctor, etc are not the real reason people in the US oppose Socialized Medicine.

The problem people have is "Why should the upwardly mobile be taxed to pay for handouts? Why should I have to pay for someone else's care? People that support a Public Health system are selfish and expect the upwardly mobile to pay their hard earned cash for their care, etc, etc."

[Darth Wong]

I'm not so sure about that. The Americans I've tangled with in other venues have a disturbing tendency to completely believe all of the preposterous lies being told about the Canadian system, no matter how absurd they may be. I think it's entirely possible that they really do think that all of these terrors are realistic outcomes of socialized medicine.

And really, why wouldn't they believe all of this bullshit? It's being reported by their news organizations, who have developed a wonderful little dodge for journalistic ethics: simply have a guest speaker say all these things, and then the accuracy of those statements is no longer your responsibility, even though they're being stated in your so-called news show!

[Stark]

I think even if you eliminate all the FUD about Socialized Medicine, people will oppose it.

Most of the fears of waiting list, not being to choose your own doctor, etc are not the real reason people in the US oppose Socialized Medicine.

The problem people have is "Why should the upwardly mobile be taxed to pay for handouts? Why should I have to pay for someone else's care? People that support a Public Health system are selfish and expect the upwardly mobile to pay their hard earned cash for their care, etc, etc."

The phrase I heard often in the 90s was 'penalising success'. Now, at the time AU had some pretty crazy business taxes, such that small businesses trying to expand had a hard time, but this was used in reference to the whole 'If I make lots of money why should i pay more tax' thing.

[ThomasP]

If it's so horrible to get health-care under HMO conditions, then why is it tolerable that millions of Americans use HMOs right now? Or is it just tolerable because the writer himself doesn't use one, and doesn't want to be forced to live like the people who do?

An e-acquaintance, who's strongly American-style Libertarian (which will become obvious), was raging about this plan just this week.

According to him, it boils down to the latter case. He's got a good job and good insurance, so of course he doesn't see the need for any change. Paraphrasing, "how is reducing options and rationing care going to help anything, just to provide coverage to the minority that can't afford it?"

He actually conceded that basic care, things like the flu or emergency services, would be handled better by a universal public system; the kicker was that he might have to wait a few months for something non-life threatening like shoulder surgery.

So, basically, his argument comes down to screw everybody that's not in my position, I gots mine and want to keep it that way.

[Covenant]

I had to pick my Dentist from a list, so I did some research and found a place right near me that has the best quality and care of any place I've been to yet. And it's cheap as all fuck on my worthless shittyass Aetna discount card. That's a restrictive system, and I did fine--all Obamacare would do to me in particular is give me more insurance for less cost, so boo-hoo.