Report Provides State-By-State Look at the Impact to Residents, Businesses and State Government if Health Reform Fails

Out-of-Pocket Health Care Costs Could Increase More Than 35 Percent in Every State by 2019
Researchers from the Urban Institute used the Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system is not reformed. The health reform failure report shows that under the worst-case scenario, within 10 years:

The number of people without insurance would increase by more than 30 percent in 29 states.
In every state, the number of uninsured would increase by at least 10 percent.
Businesses would see their premiums increase—more than doubling in 27 states.
Even in the best case scenario, employers in 46 states would see premiums increase by more than 60 percent.
Every state would see a smaller share of its population getting health care through their job.
Half of the states would see the number of people with ESI fall by more than 10 percent.
Every state would see spending for Medicaid/Children’s Health Insurance Program (CHIP) rise by more than 75 percent.
The amount of uncompensated care in the health system would more than double in 45 states

Yes this is all very terrible!  However what would be considerably worse and what is also much more likely to occur is in fact the dollar being debased or devalued.  As we keep saying and screaming, STOP SPENDING!

What difference will having great health insurance make if you have no food?  The level of poverty in the United States is getting ready to explode, regardless of health care reform.

The basic economic facts are simple.  We cannot spend another dollar that we don’t have, as the only reason that the United States economy is afloat now is because other countries allow us to be.  China and other Asian countries that are developing are sending their economic resources here to make sure we have enough money to buy their gadgets.  When they realize the foolishness of such an errand which it seems they have, they are going to pull the plug on their treasury purchases.  This will hasten our free fall.

The truth is that the US needs to do more than reform health care, we need economic reform, but it is apparent that neither will happen and the status quo is seemingly prevailing.  Be prepared is the last words of encouragement I can offer.

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USA Today, your newspaper for the obvious has now figured out the most amazing thing.  Not amazingly new or suprising new, but amazing because they were able to use deduction.  Besides their normal printing of the date, USA Today has now began to state obvious facts and present them as news.  With figures from the GAO in hand it was announced today that Medicaid is actually wasting money.  This shocking to nobody story has uncovered the fact that Americans on Medicaid often use the plan to pay for their addicitons to opiates and euprhoia and mood altering drugs. 

WASHINGTON — As Congress debates the government’s role in health care, a report out Wednesday finds that state and federal officials failed to detect millions of dollars in Medicaid prescription drug abuse.An audit of the government program in five large states found about 65,000 instances of beneficiaries improperly obtaining potentially addictive drugs at a cost of about $65 million during 2006 and 2007 — including thousands of prescriptions written for dead patients or by people posing as doctors.

The report, by the Government Accountability Office (GAO), represents “an enormous opportunity to save money,” says Sen. Tom Carper, D-Del., who has scheduled a hearing Wednesday on the findings.

When bills for the doctors’ visits are added, along with the potential for Medicaid fraud in states not reviewed by the GAO audit, Carper said: “We’re talking hundreds of millions of dollars.”

SENATE PANEL: Place ‘public option’ on respirator

That could be good news for President Obama, who argues that a massive expansion of health care coverage can be funded by squeezing waste out of the current system. But as Obama continues to press for a government-run health insurance plan, the GAO report also reveals shortcomings in how the government manages Medicaid. The program for low-income and disabled Americans, run jointly by states and the federal government, underwrote more than $23 billion in drug costs last year.

The GAO audit focused on 10 types of frequently abused prescription drugs — painkillers and mood-altering medications. Abuse of such medications is “second only to marijuana,” Joseph Rannazzisi of the Drug Enforcement Administration says in prepared testimony for the hearing.

Medicaid Pain

A well-known example is the death of pop star Michael Jackson, which was ruled a homicide in August after revelations that the singer had pressed his personal physician to prescribe powerful sedatives to help him sleep.

The states targeted by the GAO — California, Illinois, New York, North Carolina and Texas — accounted for 40% of Medicaid’s prescription drug payments in fiscal years 2006 and 2007. They are not fully taking advantage of federal databases or technology that could spot fraud, the report said.

The GAO found:

• About 65,000 cases where Medicaid beneficiaries visited six or more doctors and up to 46 different pharmacies to acquire prescriptions — a practice known as “doctor-shopping” that allows purchasers to exceed the legal limit of drugs.

• Sixty-five doctors or pharmacists writing or filling prescriptions after being banned from Medicaid, some for illegally selling such drugs.

• About 1,800 prescriptions written for dead patients and 1,200 prescriptions “written” by dead physicians.

States are working to prevent Medicaid prescription abuse but there are “significant issues that must be addressed,” Ann Kohler, director of the National Association of State Medicaid Directors, says in testimony prepared for the hearing. One obstacle she identified: tight state budgets that are slowing needed information-technology improvements.

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Ron Paul: We Need True Competition in Medical Care

By tmartin • September 24, 2009

I have been a supporter of Ron Paul in nearly everyone of his ventures and believe that unless his basic economic principles are acted upon, we are truly facing an economic collapse.  On the other hand, I have seen the suffering of humanity up close and I would disagree with his number one assertion because in fact though he is right when he references our countries founding principles both morally and economically, I cannot imagine Dr. Ron Paul turning away the needy.  As a primary care physician who I am certain has seen more up close suffering then me as a health insurance broker his arguments are based on science and reason which of course eliminate humanity.  At the end of the day though, which is quickly coming, it won’t matter what health care legislation is undertaken as the United States will be broke, flat broke, and then there will be millions more uninsured and uncared for.

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What’s the issue?

The leading health reform bills in Congress would impose a national individual mandate requiring most Americans to have health insurance. New standards would be set to determine “acceptable” minimum coverage and spell out how much people needed to contribute out of their own pockets. Coverage could be obtained in various ways, including through employers, through government health programs, or through new federal or state health insurance exchanges. Subsidies
would make coverage more affordable for low and moderate-income people, and insurance market reforms would make coverage more reliable. Penalties, most likely in the form of a tax, would be imposed on individuals who had not obtained coverage or who were not exempted from the requirement for various reasons.

For supporters, including President Barack Obama — who explicitly endorsed the individual mandate in a speech to a joint session of Congress on September 9, 2009 — the individual mandate is an essential part of national health reform. Requiring everyone to have or to contribute toward health insurance is viewed as central to reducing the number of uninsured people. Health insurers also regard an individual mandate as a critical element of a package of reforms that would require them to abandon some practices and meet new requirements.

Opponents of an individual mandate object for different reasons. Some who are or lean libertarian consider the proposal a coercive move by government. Others object to the fact that the mandate would force many people to spend a sizable portion of their incomes on health insurance — perhaps for coverage that is not especially generous.  Still others consider an individual mandate unenforceable.

As described below, a number of technical aspects of a mandate would be critical to determining how well it would either accomplish supporters’ goals for coverage or feed opponents’ fears about the cost burden that will be imposed on many.

What’s the background?

This is not the first time an individual mandate has been proposed at the national level in the United States. The concept was put forward in 1993 as part of the Health Security Act, the national health reform legislation proposed by then- President Bill Clinton. It was also the centerpiece of alternative reform proposals, such as that proposed by Rep. Jim Cooper, then representing Tennessee’s 4th District.

The concept died with the collapse of health reform efforts in 1994, but it surfaced again during the 2008 presidential campaign, when it was a subject of debate among Democratic candidates. Then–New York Senator Hillary Clinton proposed an individual mandate as part of her plan.   Then-candidate Obama proposed a mandate requiring parents to make certain their children were covered, but said an individual mandate was not part of his initial plan. However, he said an individual mandate could be considered following implementation of major health reform if it were deemed necessary to expand coverage.

In 2006, Massachusetts became the first state in the nation to require all residents age 18 and older to have health insurance. The state also enacted several other measures to expand coverage in other ways and to facilitate compliance with the mandate.

The mandate, which took effect in 2007, includes these key provisions:
• Residents must confirm on their state income tax forms that they have insurance, unless their incomes, or other factors including access to employer coverage, are such that they are deemed unable to obtain “affordable” coverage.   The affordability levels are set each year by a newly created, independent, quasi-governmental agency called the Commonwealth Health Insurance Connector. Hardship waivers are also available for people who arguably have access to affordable coverage but can’t afford it for particular reasons.
• The Connector also serves as an intermediary, helping individuals and small businesses acquire health coverage. The coverage must meet certain benefit standards that, among other things, specify the types of benefits that must be included in policies. Through the Connector, individuals, depending on their income level, can qualify for state-subsidized health coverage or purchase private health insurance products certified as providing high-quality health coverage. These offerings include new low-cost plans for 18-to-26-year-olds, with lower benefits, cost sharing, and benefit maximums as low as $50,000.
• Individuals who are subject to the requirement but do not comply must pay penalties equivalent to a portion of the costs of health insurance.  In 2009, the maximum penalty is $624 for 18-to-26 year-olds and $1,068 for those age
27 and older.

The Massachusetts law has other features, including a requirement that employers with 11 or more workers either contribute to employees’ health insurance or pay a penalty. It is widely agreed that the individual mandate has been a
key reason that the uninsurance rate among non elderly Massachusetts adults has fallen from 7 percent in 2007 to an estimated 2.6 percent, according to an Urban Institute study conducted for the Massachusetts Division of Health Care Finance and Policy. In part, the mandate appears to  have prompted more workers eligible for employer coverage to enroll in the coverage offered to them.

A number of other states, including California, Maryland, Maine, and Washington, have also considered individual mandates but not adopted them. And several European countries have also enacted individual mandates, often in the context of major health reforms. Switzerland adopted an individual mandate in 1996. Strict penalties enforced by the Swiss cantons, or provinces, are imposed on those who do not purchase health insurance for infants within three months of birth or after moving to Switzerland. The Swiss mandate has helped achieve a 99 percent compliance rate.

The Netherlands in 2006 mandated that individuals purchase health insurance or face a penalty of 130 percent of premiums. Early reports from the first year of implementation suggest that 98.9 percent of residents enrolled in health insurance.

What’s proposed?

An individual mandate is a key component of all three major legislative health reform proposals now under consideration in Congress. But at the same time, a mandate is only one part of complex reform plans in which the various pieces are to a large extent interdependent. “In 2006, Massachusetts became the first state in the nation to require all residents 18 and older to have health insurance.”

For example, if policymakers decide there should be an individual mandate, they must also decide what type or amount of coverage people must have. Another issue is whether an individual mandate applies to adults only or also to children — and who can be exempted from the requirement for religious or other reasons. What’s more, since not everyone will be able to afford the full costs of coverage, policymakers must decide what, if any, financial or other assistance will be available to help people buy it. There are also questions about what the penalties for not obtaining coverage will be, as well as the method of enforcement. If penalties are imposed through the tax system, for example, people who don’t file taxes could in effect escape the requirement.

Each of the leading congressional proposals addresses these questions in somewhat different ways, as described below.

The House bill

As this brief is being published, the majority in the House of Representatives is finalizing its version of the House bill, the America’s Affordable Health Choices Act of 2009 (HR 3200). Three different versions were approved by three House committees during the summer of 2009. All versions of the Tri-Committee bill, as it is known, would have an individual mandate — a requirement that individuals and their dependents have so-called acceptable coverage. This would include coverage under Medicare, Medicaid, military health insurance, or the Veterans Health Administration; an employment-based plan; a new public health insurance plan, as set forth in the bill; or any other “qualified health benefits plan” that includes at least an “essential benefits package.” The legislation lists broad categories of benefits that would have to be included, such as physician and hospital services, but the specifics would be determined by the secretary of health and human services (HHS).

The House bill includes a number of measures designed to help people obtain coverage. Large employers would be required to offer coverage (see Health Policy Brief, “Shared Responsibility,” August 13, 2009). New tax credits would go to small, low-wage businesses to help them pay for workers’  coverage.

The bill would also provide Medicaid coverage to anyone with incomes under 133 percent of the federal poverty level, which in 2009 is equal to $14,404 for an individual and $29,327 for a family of four. (For more, plus a table showing incomes at different multiples of the federal poverty level, see Health Policy Brief, “Coverage for Low-Income People,” July 24, 2009.) The bill would also provide subsidies for those with incomes too high to receive Medicaid but under 400 percent of the federal poverty level (in 2009, this is $43,420 for an individual and $88,200 for a family of four). These subsidies would help people purchasing private health insurance coverage or the new public option through the proposed new national Health Insurance Exchange.  Employers would also be required to offer coverage to their employees or pay a penalty. If the employment-based insurance costs workers more

EXHIBIT 1
Key Features of Individual Mandate Proposals
Provision House bill Senate HELP Committee bill Senate Finance Committee bill Exemptions Those demonstrating financial hardship; Native Americans; those with religious objections (e.g., Christian Science).  Same as House bill, except Native Americans would only be exempt if states don’t establish a separate exchange for them. Also, if coverage is unaffordable because lowest premium available exceeds 12.5% of income.  Those without coverage for fewer than  90 days.  Same as House bill. Also, if coverage is unaffordable because lowest premium available exceeds 10% of income.  Penalties Maximum is 2.5% tax on income, not to exceed average national premium for basic coverage.  $750 annual tax penalty. Annual tax penalty of $750 for individuals at 100%–300% of federal poverty level ($1,500 maximum per family); $950 ($1,900 per family) for those with higher incomes.  health pol ic y br i e f indi v idual r e spons ibi l it y than 12 percent of their income in the second year of the mandate, they could qualify for tax credits to buy coverage through the exchange instead.

The bill’s marketplace reforms and consumer protection provisions would also make it easier for individuals to obtain coverage. For example, insurance companies could not reject applicants because of their pre-existing health conditions.  Limits would be placed on how much companies could vary the premiums charged to policy holders based on age, family size, and location.

Certain people could claim and obtain exemptions from the mandate — for example, on religious grounds or financial hardship — and Native Americans would be automatically exempt.  People could also claim and obtain exemptions because insurance was unaffordable, although the legislation is silent on specifics of how this exemption would work.

For everyone else who could not prove having “acceptable coverage,” there would be penalties.  These would consist of a 2.5 percent income surtax, not to exceed the cost of the average national premium for individual or family basic coverage.

To facilitate enforcement of the mandate, all entities that provided “acceptable” coverage to any individual or family would have to report that information annually to the U.S. Treasury Department. This is similar to current law requiring companies to file W-2 forms with the IRS indicating how much they have paid to employees in wages, salaries, and any taxable benefits.

The Senate HELP Committee bill

In July 2009, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Affordable Health Choices Act. This proposed legislation would also require all individuals to have health insurance described as “minimum qualifying health coverage.” The HHS secretary would determine what constitutes this coverage, but the bill says that basic benefits would be covered, such as physician and hospital services as well as services for mental health and substance abuse.
As with the House bill, exceptions would be allowed. People for whom minimum qualifying health coverage was not deemed affordable, or who were suffering financial hardship, would not have to comply. Coverage would be considered
unaffordable if it cost more than 12.5 percent of the individual’s adjusted gross income; definitions of what constitutes financial hardship would be drawn up by the HHS secretary with input from a newly created Medical Advisory Council. Also initially exempted would be people in states that are not “participating” in a new national Health Insurance Exchange, or “gateway,” or that had not yet established their own state exchange. Native Americans would be exempted from the mandate, as would those who were without coverage for any reason for fewer than 90 days.

Those subject to the mandate, but who neglected to comply, would have to pay a tax penalty. The  legislation doesn’t offer a detailed description of how this penalty would be determined but says that it could be no more than $750 a year.

Like the House bill, the HELP Committee bill includes measures to encourage people to obtain coverage and, in many instances, to make it more affordable for them. It would require employers to provide coverage to their employees or pay a penalty.  And it would also offer subsidies for individuals and families with incomes up to 400 percent of the federal poverty level for plans purchased through the new national gateway or state gateways.
The HELP Committee bill would also make it easier to obtain coverage by providing consumer protection measures limiting how much health insurance premiums could vary based on age, location, family size, and tobacco use. It would also forbid variations in pricing because of sex, type of employment, or past medical claims.

The Senate Finance Committee bill As of publication of this brief, this bill is being finalized by the committee. It includes a “personal responsibility requirement” for obtaining health insurance, either on one’s own or through an employer or government program. Language in the proposal would allow the mandate to be waived in a state if it meets certain coverage levels and achieves certain cost containment goals.

As in the House and Senate HELP Committee bills, the individual mandate in the Finance Committee bill would work in tandem with other provisions to spread coverage. Medicaid would be expanded to anyone with income under 133 percent of the federal poverty level. Tax credits would encourage small, low-wage businesses to provide coverage, while other incentives would encourage large employers to offer coverage as well.

For other people who are uninsured, coverage could be purchased through national or state health insurance exchanges. The draft unveiled by Senate Finance Committee chairman Max Baucus (D-MT) would establish four types of health plans that insurers could offer, with benefit levels ranging from low to high. These plans would have to provide at least a basic set of services, with no limit on annual or lifetime benefits. There would be no copays or other cost sharing for most preventive care. In addition to the four plan types, adults ages 18–25 could purchase a plan that would cost less and cover only catastrophic health expenses, with cost sharing for preventive care.  Other rules similar to those in the House bill would also make it easier to get and keep private health insurance coverage. Insurers offering coverage in the individual market could not impose pre-existing condition restrictions. Coverage would have to be offered to all interested buyers; coverage could not be rescinded after the policy holder became ill. Companies could raise premiums only up to certain limits because of a member’s age, tobacco use, family size, or location.  Subsidies: To help ensure that individuals can afford to comply with the mandate, the Senate Finance Committee bill also provides subsidies.  These so-called affordability credits, or tax credits, would go to people with low and moderate incomes who did not have employment-based coverage and who bought insurance through an exchange. The credits would be refundable, so that those who didn’t owe taxes would still get assistance; they would also be “advanceable,” so that people could obtain them at the time coverage was purchased rather than after the fact.  Starting in 2013, the tax credits would be available on a sliding-scale basis to offset the cost of premiums for individuals and families with incomes of 134–300 percent of the federal poverty
level. People with the lowest incomes would be eligible for the largest credits, based on the percentage of income that the cost of insurance represents, from 2 percent up to 12 percent. As of 2014, the credits would also be available to people with incomes of 100–133 percent of poverty, so that they could opt out of Medicaid coverage and into private health coverage if they chose.  In addition to tax credits, subsidies to defray out-of-pocket expenses would be available for those with incomes of 100–300 percent of poverty.  Out-of-pocket spending for those with incomes of 200–300 percent of poverty would also be limited and subsidized. In 2010, individuals and families in that category would have to pay no more than $3,987 out of pocket for individuals, or $7,973 for families.   The draft Finance Committee bill contains penalties for those who do not comply with the individual mandate. With some exceptions, most people who do not have health coverage would pay an excise tax starting in 2013, based on their income. For taxpayers with incomes of 100–300 percent of the federal poverty level, the penalty could be no more than $750 for individuals and $1,500 for families. For taxpayers with incomes above 300 percent of the federal poverty level, penalties would be capped at $950 for individuals and $1,900 for families.   The mandate would be waived for individuals under certain circumstances. These include situations in which the lowest-cost plan exceeded 10 percent of an individual’s or a family’s income or when an individual’s or family’s income was below 100 percent of the federal poverty level. Also exempt would be people with certain religious beliefs, undocumented workers, or people experiencing some level of financial hardship.

What’s the argument?

In favor of an individual mandate: Supporters make two primary sets of arguments in favor of requiring most Americans to have health insurance.  One set of arguments is primarily economic and market-oriented; the other is primarily ethical and moral.

In the first category, supporters argue that an individual mandate is key to having America’s hybrid public-private system of health coverage function as effectively as possible. Health insurance markets work best, they say, when everyone is insured. This is because the risk of high medical expenses for a relative few is spread among a large and diverse group of healthy people. These healthier individuals pay premiums regularly and may or may not be filing claims, in contrast to sicker enrollees who are filing claims regularly. In effect, premium dollars are shared across the healthy and sick alike. This is considered fair because, no mat-
“Refundable and ‘advanceable’ affordability credits would help people with low and moderate incomes.”  health pol ic y br i e f indi v idual r e spons ibi l it y ter what one’s health status is at a given moment, many if not most people will ultimately need some form of medical treatment.

Free riding and adverse selection: In the absence of a requirement to buy coverage, some healthy people tend not to buy it, believing that they won’t need it if they are not sick. This is a phenomenon known as “free riding.” Because many of these people become ill and are treated anyway, the costs of their care are often shifted to insured populations in the form of higher premiums.  By contrast, the sick may be more inclined to try to obtain coverage because of greater confidence that they’ll use it — a phenomenon known as “adverse selection.” Both of these phenomena can conspire to force insurers to raise premiums drastically or cancel coverage. That’s because, with primarily sick people enrolled, insurers would need to charge exorbitant premiums to cover costs. Otherwise, an insurer would end up paying so much in the way of claims that it would eventually become insolvent.

These are not theoretical propositions; both phenomena have actually occurred. As evidence of at least some population of “free riders,” some analysts point to the fact that according to the Census Bureau’s Current Population Survey, about 9.1 million people in households with incomes of $75,000 or more did not have coverage during 2007. Presumably many of them could have afforded insurance, although the coverage may not have been especially generous and may have cost a sizable share of their incomes. Similarly, there have been documented instances in which adverse selection was leading to “death spirals,” forcing health insurers to close entire books of business.

An individual mandate would eliminate these problems of adverse selection and free riding, supporters say. With nearly everybody, sick and healthy alike, in the health insurance “pool,” insurers could also eliminate practices that many find reprehensible. These include “rescissions,”  cancellations of coverage after enrollees submit claims for illness; “medical underwriting” that leads to dramatically higher premiums for sicker individuals; or specific exemptions written into some insurance policies that exclude coverage for treatment of “pre-existing” medical conditions.

In fact, the leading health insurance trade group, America’s Health Insurance Plans (AHIP), has told both Congress and the White House that it will agree to new regulations barring these practices if the legislation also includes an individual mandate. That way, people couldn’t wait until they got sick to sign up for coverage.  Not only would such changes be desirable from the standpoint of creating a functional insurance market, supporters argue; they are also required by social justice and moral fairness.   Supporters further contend that an individual mandate would be reasonable because it would be accompanied by resources that would help individuals comply with it. Health insurance exchanges would make it easy for people to shop for coverage. Subsidies would be provided to millions to make coverage more affordable.
Medicaid would be expanded to cover more low income people who don’t currently qualify for the program. Under a simulation of these latter two measures — subsidies and Medicaid expansion — modeled by researchers from the Urban Institute, approximately three-quarters of the nation’s uninsured people would be covered.  Finally, supporters expect that the individual mandate would affect only a minority of Americans who currently lack health insurance. Nearly three in five Americans under age 65 are already covered by employment-based health insurance; senior citizens and the disabled already have Medicare; and, as noted above, Medicaid expansion would cover many of the remaining uninsured people. Arguably, the group most affected by the individual mandate would be uninsured people with incomes higher than four times the federal poverty level (in 2009, about $88,000 for a family of four), who would receive no subsidies for coverage. The Urban Institute analysis shows that this group numbers fewer than 10 percent of the uninsured, or about 4 million people.

Against an individual mandate: A key argument against the requirement is that it would be an infringement by government on personal freedom and further extend the hand of government into health coverage and care. “Mandates have no place in a free society,” Rep. Mike Burgess (R-TX), a member of the House Energy and Commerce Committee, said after voting against HR 3200 in committee.  Other opponents of an individual mandate say it’s simply unreasonable to compel people to buy insurance that they clearly consider unnecessary or less important than other things they want.   “Insurers could eliminate practices that many find reprehensible, including cancelling coverage after enrollees submit claims for illness.”
Just because a mandate has succeeded in Massachusetts, many add, doesn’t mean that it would fly in other states with different political cultures or approaches to health reform.

Still others say that, in combination with other provisions of health reform, the mandate would be overly burdensome on many people. There are concerns that the subsidies proposed in various bills still won’t be enough to make mandated health coverage affordable for many people. Thus, millions of people could be compelled to purchase coverage with inadequate or no assistance from government to buy it. What’s more, requiring some moderate-income people to spend as much as 12 percent of their incomes on health coverage, as the bills under consideration would do, is simply unfair, these opponents of a mandate contend.  Others worry that when the required benefit package was ultimately established, it’s likely the benefits would be generous and the cost of the package high. Furthermore, opponents argue that even if the mandate were initially linked to a basic, low-cost plan, there would be constant pressure to expand the scope of benefits.

There are also questions about how an individual mandate for a minimum benefit package would be implemented, since health care costs and utilization vary widely across the country.   Opponents say it would not be fair to require the same amount of insurance nationwide when the cost is not the same. If states make these determinations, one could require less coverage than another, as is the case with optional Medicaid benefits, which can vary from state to state.

Questioning the need for a mandate: Some experts don’t necessarily oppose an individual mandate, but they question the need for it, depending on other provisions of health reform legislation. If insurance in a reformed system represented a “good buy” for people, they say, a mandate would not be necessary, because most people would elect to buy coverage. Whether or not insurance was such a good buy, with reasonable costs for good benefits, would depend on many other rules set forth in health reform — for example, how much insurers could charge different groups of people based on their age, or whether or not young adults could buy just catastrophic plans. One way to proceed, these experts say, would be to reform health insurance first, then wait to see if enough people enrolled so that a mandate wasn’t necessary.

Other experts who are skeptical of a mandate point to inherent tensions that could make it politically difficult to maintain and administer. In Massachusetts, for example, there are those who want a mandate, rich subsidies, and low required  benefits, and on the other side, those who want a mandate, a generous benefit package, and a willingness to exempt more people from the mandate.  These kinds of trade-offs might not be easy to resolve, and they could make an individual mandate extremely hard to maintain over the long haul.

Finally, some outright opponents of a mandate voice skepticism that it could be enforced. Auto insurance is mandatory in 47 states, although it is enforced only through license renewal and registrations, not through the tax code as an individual health insurance mandate would be. Still, the median number of uninsured drivers in those states is 12 percent.

What’s next?

As this brief is published, the fate of health reform legislation is unclear — as is the fate of the individual mandate proposal. House Democrats are finalizing their version of HR 3200 that is understood to contain an individual mandate. As noted, the Senate Finance Committee bill contains an individual mandate, as does the Senate HELP Committee bill. These two bills will be blended into a  final bill to be taken up by the Senate.

If legislation containing an individual mandate passes one or both houses of Congress, but in different bills, a conference committee will be appointed to craft a final compromise. It’s probable that a mandate would be included in that  compromise, called a “conference report.” However, many other provisions affecting the mandate could change, including the size and scope of the affordability credit and the penalties for noncompliance.  The conference report would then have to be passed by both houses of Congress and signed into law by the president. In short, whatever emerges from the process may in fact be different from the proposals discussed in this brief.   “There are  concerns that the mandate would be overly burdensome or that subsidies wouldn’t make coverage affordable.”

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The public option in my viewpoint is the single silliest notion, since giving out cash for broken down cars.   It is a gimmick.  Its not a solution.  Many people fall victim to the thought process that it is actually a Universal health care option when in fact it is just another version of the ridiculous Medicare Advantage plan.  This is the plan that is helps bankrupt the country while giving no real benefits to seniors but enriching health insurance companies like Humana and brokers like me.  The public option will be another drain on resources but it will in reality not even expand medical insurance, and when it does it would do so at an astronomical cost.  As we have said so often the only option is a Universal option.  Of course if the economy is able to maintain that option which it is doubtful it is assumed that Medicare and Medicaid would be combined.  This is basic economics and is called economies of scale.  It makes no sense to offer the same program using three different companies for different age groups.

The article below is an opinion piece from the Health Affairs Blog and is certainly well meaning and very factual even if the conclusion reeks of desperation.  Mr Balto, don’t beat around the bush just ask for what you want.  We know what you want and it is called Universal Coverage or Socialized Medicine.

by David Balto

The biggest flashpoint in the ongoing debate over the future of the U.S. health system is whether Congress should change the balance of power that now favors the private health insurance industry. Opponents of the idea argue that a public health insurance plan competing with private insurers would lead to inferior health care, harm providers, and drive the multibillion dollar for-profit health plans out of the market. Fears of Armageddon are without merit and inconsistent with reality.

The U.S. has a health care crisis created by the private insurance companies that some are so worried about protecting.  Health care costs are out of control, threatening the viability of American businesses and the hopes of millions of American families. More than 47 million Americans are uninsured, and according to Consumer Reports, as many as 70 million more have insurance that doesn’t really protect them.  In the past six years alone, health insurance premiums have increased by more than 87 percent, rising four times faster than the average American’s wages, according to a Kaiser Family Foundation report.  American families in the lowest income group spend 20 percent of household income on health insurance.  Health care costs are a substantial cause of three of five personal bankruptcies.

The Broken Health Insurance Market

While opponents of a public insurance plan proclaim their fealty to consumer choice and honest competition, any who dare to take the economic temperature of the existing health insurance marketplace would find few markets so clearly lacking in them. Health insurance markets are extraordinarily consolidated at the state and local level, according to the American Medical Association. In 39 states two insurers control at least 50 percent of the market, and in nine states a single firm controls at least 75 percent of the market, the AMA found. In 2007 the group reported that almost 95 percent of more than 300 metropolitan areas are highly concentrated.

What has been the result of this lack of competition?  Rapidly increasing premiums, declining service and escalating profits.  As noted above, health insurance premiums have almost doubled in the past seven years, while the number of uninsured has escalated. Without significant reform, this situation will only worsen:  premiums are expected to rise to nearly a quarter of the median family’s income by 2020.

Consumers have suffered while the for-profit insurers have had record profits.    From 2000 to 2007, the 10 largest publicly-traded health insurance companies increased their profits 428 percent, from $2.4 billion to $12.9 billion annually. In addition to profit, the seven largest for-profit insurers boosted their earnings per share by repurchasing $52.4 billion of their own stock from 2003 to 2008—money that could have been spent on improving the health care system or cutting premium rates. These profit margins have come directly out of customers’ pockets in the form of escalating premiums and worsening service. The Congressional Budget Office found that overhead and profit account for 11 percent, on average, of private insurer’s premium revenue.

Moreover, one cannot expect that normal market forces will “correct” the problems in these markets.  In a competitive market, one could expect that entry would occur when dominant firms exercise their market power.  But in health insurance there has been little or no meaningful entry in the past decade into markets that are highly concentrated.  The entry barriers to these markets are substantial:  employers are reluctant to switch plans and information is not transparent making it difficult to compare plan offerings.  The time and cost to switch plans is substantial.  Moreover, dominant insurers make entry all but impossible by locking up providers through most favored nations arrangements or all products clauses that make it difficult for them to facilitate entry by making a more attractive deal with a new entrant.

We cannot hope that antitrust enforcement will correct these problems.  Unfortunately during the Bush Administration there were no federal antitrust or consumer protection actions against health insurers.  None.  During the eight years of regulatory neglect there were almost 400 mergers and the DOJ required only minor restructuring of two mergers.  Certainly there can be efforts to reverse this regulatory neglect in the Obama Administration, but any antitrust action could correct harm in only a single market and would take several years and a substantial dedication of resources.

Moreover, health insurance markets lack the essential elements of a competitive market: choice and transparency.  This is because of the lack of meaningful consumer protection regulation.  The lack of transparency is crucial   Health insurance products are complex and terms are not uniform, making it extremely difficult at best for consumers to meaningfully compare their options. Insurers make special efforts to prevent transparency and information. As Wendell Potter, a former insurance executive, testified before the Senate Commerce Committee, “Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand—or even to obtain—information we need.”

The degree of ongoing harm to consumers is substantial.  In testimony before the Senate Commerce Committee, Consumers’ Union characterized the insurance system as plagued by “a swamp of financial shenanigans”—including a lack of transparency, conflicts of interest, and deceptive practices—and called on regulators and enforcers to step up actions to “prevent egregious consumer ripoffs.” To combat this conduct, State Attorneys General, Insurance Commissioners, and private parties have brought over 50 cases securing potentially over $1 billion in damages and fines since 2000.  Insurers have been found liable or settled charges for a wide variety of fraudulent and deceptive conduct including: utilizing falsified data to calculate reimbursements, refusing to pay for visits to providers erroneously listed as in-network; wrongfully denying claims for sick patients; failing to pay reimbursements in a timely manner; overcharging customers for premiums; refusing to cover emergency treatment; failing to provide notice of rate increases; ignoring customer complaints; and various other similar methods of denying needed care while maximizing profit. There are countless complaints by hospitals and physicians that preapproval provisions prevent them from providing adequate and safe care.

This record of countless enforcement actions is all the more remarkable when one considers that self-insured plans – which make up almost half the health insurance industry – are not subject to state regulation and have limited liability in the courts. Even under employer-sponsored plans, insurers regularly employ an arsenal of tools on behalf of employers to deny coverage and shift medical costs to consumers.

No other industry has such a comprehensive record of violating consumer protections. Take the recent scandal involving Ingenix, the UnitedHealth Group Inc. subsidiary that for years ran a database that has been discredited. New York state investigators found that health insurers, including Aetna Inc., Cigna Corp. and WellPoint Inc., contributed to and made use of a system that consistently low-balled reimbursement calculations for out-of-network care by doctors and hospitals. Families paid the difference. A California investigation revealed a common practice in which multiple insurers retroactively canceled policies of patients who developed costly illnesses. The insurers based these many of these decisions on thin allegations that consumers had provided incomplete medical information on their original applications.

The Need for a Public Plan

The lack of competition and record of egregious deceptive practices demonstrates the need for a public plan.  A public plan offers the promise of being able to enter these markets currently controlled by monopoly or oligopoly for-profit insurers.  The entry of the public plan, based on a nonprofit model and with greater efficiency and lower costs, will disrupt the cozy life of these dominant insurers.  This will force down premiums in a fashion that antitrust enforcement will never achieve.

A public plan will be the type of competitive “maverick” in the market that offers the potential to restore competition. Unlike the current for-profit insurers, a public plan does not have the need or incentive to raise and protect its profit margins.  Nor does it have any incentive to flout or manipulate regulations.  Its concerns are not profit, but the public health.

Moreover, a public plan will set a model of consumer protection compliance, not abuse.  With a public plan, the rival insurers will not be able to compete down the level of consumer protections or engage in collusive practices to harm consumers, such as the Ingenix example.  Rather, the public plan will serve as a model of consumer protection compliance.  The marketplace will then compel rival insurers to meet those standards or face the potential loss of consumers.  As President Obama put it, the check of a public plan would keep health insurers “honest.”

Overall, competition from a public plan would force insurers to respond to market forces, reducing prices and improving consumer protections.  Those who survive the competitive battle will be those with reasonable premiums and superior customer service.  As the Urban Institute puts it, “Incentives for them to innovate in the areas of cost containment and service delivery will be enhanced by the presence of a well-run and effective public plan.”

The Misplaced Criticism of the Public Plan

Health insurers decry the emergence of the public plan.  That is not surprising.  No competitor likes competition, especially when they are able to exercise market power, avoid regulation, and reap supracompetitive profits.  To counter competition, the opponents suggest that competition with the public plan will ultimately lead to the demise of the private health insurance market.  Their arguments are inconsistent with the economic realities of these markets.

The public plan opponents argue that Americans normally don’t respond to lack of competition by creating a government-run entity, such as a grocery store or a gas station. But those aren’t oligopoly markets with high entry barriers in which prices and profits have escalated rapidly.  Besides, health care is a different kind of marketplace. As a society we have an obligation to make sure people have access to affordable health care.  Moreover, grocery and gas station businesses are essentially transparent, unlike the health insurance business, whose customers do not know what their premium dollars will get them. The primary goal of for-profit insurance companies is to make money for their shareholders. Because they have successfully shielded their coverage rules and policies from public inspection by labeling them trade secrets, they can use egregious practices to deny coverage with inadequate accountability.

The opponents also suggest that the public plan will drive its rivals from the market, perhaps through predatory conduct.  This claim is simply inconsistent with the strong position of these powerful dominant health insurers.  The major health for-profit health insurers – United, Aetna, Cigna, Wellpoint, Humana, and others — have tremendous financial reserves.  In addition, as publicly traded companies they can call on the market for even greater financial support.  The nonprofit Blue Cross firms, which dominate dozens of markets, have tremendous financial reserves.   Simply, these firms are not about to be driven from the market by the emergence of a public plan.

Insurance companies complain that the proposed public health insurance plan will have unfair advantages and drive them from the market. These claims bear little relation to market realities. These firms are well-funded, sophisticated, and endowed with tremendous financial and human resources. As a former federal antitrust enforcement official, I know that they complain for the reason every competitor complains when a new rival arises – competitors never like competition.

Opponents of a public plan suggest that a plan will become too powerful and will exercise concentrated buying power that will hurt the quality of care.  Unlike for-profit firms, a public plan has no incentive to cut corners and prevent providers from giving their patients quality evidence-based care, because its ultimate goal is public health, not private profit. Nor does it have any interest in sideswiping regulations and shortchanging consumers.  Free market proponents argue that private health insurers should be lightly regulated to give Americans the best value. We have seen the results of that sort of regulatory neglect in many industries in the past eight years; the harm to all Americans, businesses and the overall economy could not be more profound.

Lawmakers from both sides of the aisle in Congress should recognize that there is no way to achieve meaningful health reform that does not include substantial structural and regulatory changes.  Initiating health care reform in the existing environment will not work without a component, such as a public health insurance plan, that revives genuine competition by offering Americans a meaningful choice and setting benchmarks on costs, service and consumer protection.  Incremental reforms without this essential component will be smothered by dominant health insurers that have decades of experience manipulating the market.

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From USA Today Opinion Blog

As a Florida health insurance broker, we see everyday the mess that is Medicare.  The program itself is fine actually, the problem is the private insurance companies that were allowed to crawl in and make these Medicare advantage plans wasteful.  Medicare is of course by everyone’s definition going bankrupt, and the two most identifiable culprits are the Medicare Prescription Plan or as I call it, “George Bush loves Big Phara,” and the private health insurance companies that have stolen our tax payer dollars to provide literally useless services.   Medicare pays 80% of your health care costs and the other 20% is paid by your secondary.  Why?  I have no idea.  The government could easily provide the same type of coverage with Medicare with the other 20%.  If there is a network issue the Medicare administration could just pay a small fee for access to the Blue Cross network in remote areas for instance.

In the end, as I always say none of this matters because Medicare is going bankrupt and so is Medicaid, and then our government unless we can be fiscally responsible which as anyone can see from the current and previous administration is not on the agenda.

Private medical insurers couldn’t compete, so now they get a subsidy.

The private form of Medicare known as Medicare Advantage is enormously popular with seniors, and no wonder. Private Medicare plans offer extras such as vision care, dental benefits and even health club memberships that may cost more or not be available at all in the traditional fee-for-service Medicare that most seniors use.

It’s hardly surprising that almost a quarter of Medicare’s 45 million beneficiaries have signed up. It’s a sweet deal, underwritten by working Americans who subsidize those gold-plated private plans. Taxpayers help pay an additional $1,138 per beneficiary every year above the cost of fee-for-service Medicare to give Medicare Advantage beneficiaries all those extras. Even Medicare beneficiaries themselves kick in — they pay about $43 a year in additional premiums to help subsidize Medicare Advantage members.

It gets worse. The inflated costs of Medicare Advantage are hastening the bankruptcy of the overall Medicare system by an estimated year and a half. Worst of all: Private Medicare was originally sold as a way to use the efficiency of private business to provide better service and add benefits more cheaply than the government could. Some Medicare HMOs do that, but many private plans don’t. Overall, private Medicare plans cost an indefensible 14% more than traditional Medicare.

Bottom line? Like it or not — and at the outset we were optimists about Advantage — its promise has failed. Far from improving Medicare, it has turned into a wasteful taxpayer handout to uncompetitive insurers. Enjoying the largesse are companies such as Humana, for which Medicare Advantage is a profitable and growing enterprise. We asked both Humana and the industry’s trade organization, America’s Health Insurance Plans, to defend this system in an opposing view. They declined.

If there’s anything in the medical system that’s ripe for cutbacks, it’s the wasteful subsidies in Medicare Advantage, which is projected to spend some $1.6 trillion over the next 10 years. A subsidy phase-down being considered in the Senate would save about $113 billion. That tiny fraction of the total would pay more than 10% of the cost of health reform.

But the iron rule of government benefits is that once they’re handed out, they’re difficult or impossible to take away, no matter how wasteful or unjustified they are. That’s what’s happening here. Seniors, stirred up by Republicans who want to block health reform and by insurance companies intent on keeping their subsidies, are complaining bitterly about losing benefits.

President Obama didn’t help by promising that people who like their health coverage can keep it. That’s not the case for Medicare Advantage, where Obama favors trimming subsidies. While the most efficient plans would survive, some uncompetitive plans would go out of business, and others would have to drop benefits or charge more.

And that’s as it should be. Seniors deserve to have options, but with Medicare going broke, those who want extras should bear the cost themselves. Cutting wasteful subsidies is exactly the right way to help pay for overhauling the health care system. If private companies can out-compete government-run health care, let them do it — without taxpayer handouts.

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After reading the latest issue of Business Week I am still amazed by the amount of qualified economists that still have no idea how serious of a situation we are in financially.  I don’t know if they are afraid of creating global panic which would result in a more expedient global depression, or if they are just really in the dark.  If any economist from the previous eras from 1900-1960 were to look at the situation today in the world market, and then gauge the effects of globalization occurring at uneven paces, they would be truly awed by the way we are reacting to the current crises.

Instead of fixing the basic economic issues, we are instead creating larger deficits and larger debts which are going to end up having to be paid back.  How?  There is only two ways out, one of course would be to inflate our way out of debt which will be great for the United States but terrible for Americans.  If the currency were to inflate on the scope necessary to write off our debts it would make us unable to afford anything except the basic necessities of life, and even that would be difficult.  As the United States has become a global superpower we have exported our entire manufacturing sector to foreign nations who can do it for less money.  This would mean that we would need to import everything as our manufacturing is so antiquated here in this country that it would take us years to restart this sector.

The other way of course is to simply default on our debt.  Which is actually quite common when you think about.  The IMF is actually in the business of country mortgages.  With the usual situation however, the IMF and some powerful US corporations go into a country and open up everything to foreign ownership from public utilities to the local gas station.  In the long run, seemingly this is good for the host nation, though in the short run the pain is not quantifiable as the main ingredient in IMF participation is the elimination of basic social programs.  The other drawback to the IMF, is that the invading companies will inevitably pollute and mindlessly ruin the local economy and environment.  This is inescapable, and many of the corporations that are guilty of these sins are companies that inspire trust and have our best politicians happily accepting donations.

This is not about Republican or Democrat, there is actually no visible difference as we have seen.  Barack Obama is trying to reform health care by adding some pitiful program that will end up hurting the economy more than helping our needy citizens that are dying without health care.  Much like Bush Medicare Prescription bill of 2003, which is of course the worst piece of legislation I have ever seen,  I am certain that the health care reform bill if it is passed will more than likely, worse.  Without a public option what is the point?  But even the public option is ridiculous!  Unless we get a universal plan there is no relief to be had by adding another excuse to sign up more people with Blue Cross.    But really none of this matters.  How could it?  It is but a drop in our loan-deficit bucket. What’s a trillion dollars, when you are fighting needless wars in two countries and have troops in unnecessary places all over the world.
Really, the end of this scenario will mean rampant inflation and the dollar becoming useless and a return to the gold standard.  Lest anyone think the gold standard was not a good way to value currency, lets remember that gold is close to $1000 and many experts are expecting it to reach $2000 as the dollar keeps losing value.  The gold standard was discarded in favor of the dollar, which of course is great for the United States but terrible for other countries.  It wouldn’t be terrible save for the fact that we are irresponsible and have taken on way too much consumer debt, which of course is not our major problem.  It is instead the government debt used to pay for the entitlement programs which are bankrupting the nation.  It might be too late to save the dollar and I actually opened up my very own gold account in order to start “investing” in the future global currency.  All it takes for us to lose the dollar is China’s current request to open the dollar standard to a basket of currencies including their own yuan which is much better positioned to be the world’s currency.  But again this is not fair to other countries as should China start pursuing an economic policy like ours then we would be the ones asking for the gold standard.  Thus gold which has been the most stable asset in world history is the only fair denomination for global currencies to be hedged against.

I still believe health reform is a necessity and universal health care is one of the only ways to fix our system, but health care is only one of our problems the other ones will need to be solved by fiscal discipline and better use of our entitlement programs.  There is no reason to include private corporations in public utilities.  Similarly there is no reason to bother passing health care legislation if the dollar is devalued.

Sure Mr. Bernanke, the Economy is Fine!

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I suppose if you are reading this blog you are at least familiar with the fact that Massachusetts passed a health reform bill with the help of a Republican governor who just ran for President but lost during the primaries due to his Mormon beliefs in heretic serpents.  Or something like that.  I don’t know which sentence seems more unlikely now if I didn’t know what actually happened, health reform or serpents.   When I heard about this magnificent piece of news I was shocked as I couldn’t ever imagine this occurring.  More significantly it gave me hope for the rest of the country.  As this happened in 2006, it should have had time to become a model for the rest of the country.  If you are not familiar with the reform that was passed in the ole MA in 2006 you might be surprised to learn that it actually helped cover nearly the entire population of Massachussets citizens.  More importantly, in this state where cigarettes are nearly $8 a carton and everything is more expensive than in Florida they were able to cover the entire populace with health plans that were also better than what we are forced to give out in Florida.

In 2006 health care costs were rising, but they didn’t seem to me anyways looking as if they would become our country’s only business.  How does the Massachussets model work?  By mandating coverage for everyone.  If you don’t get it you are forced to pay a state penalty and are covered by the states backup plan.  If you can’t afford it you are put on the state subsidy list.  Everything seemed impossibly greater then I could have ever imagined.  But where is our Star health reform bill today?

After bottoming out on alcohol and pain killers Health Reform Bill was just a shadow of his former star self.  Used to dating models and actresses, now he was married to a pill bottle.

That is silly.  What is happening in Massachusetts right now is that nobody fixed the main issue first.  Which is COST CONTROL.  As I have said many times here before, without health care cost control, you can pass any bill you want to and it won’t change the fact the economy is becoming a giant health insurance company.  No more American Government, instead the we will have an Aetna Government. 

The numbers from Massachusetts show the real pain of reform without change.  According to the Kaiser Family Foundation, insurance premiums have jumped 78% over the past 8 years while wages have barely budged above 15%.  Which means that 37% of the residents of Massachusetts can’t even afford to pay their copays and deductibles. 

As you go further with this information and add in the employer pain of paying these health insurance costs you are looking at what is most certainly the most silly situation in the world.  How are we letting health insurance companies and the health field in general threaten our entire way of life?  Why would we let these companies dictate any of the legislation that is passed for anything, anywhere!  We don’t have the best medicine in the world, we have the best medical care for just some people and the rest all 50 million of them have the worst medical care in the world.  The people that can afford these ridiculous prices will be happy to keep paying them, rather than lower their standard of care to allow access to care for millions of others.

I support the Massachusetts model, I support just about anything that lets us take control of our economy away from not just these health companies but from any company whether it is a Wall Street power broker or a crooked Washington lobbyist.  No person, no company should have any effect on the laws for a whole country.  This is ludicrous.

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With the news today coming out that the most recent gallup poll stunningly uncovered the fact that Americans want the best health care but don’t want to pay for it, came shock and disbelief albeit only from people that were stranded on a desert. 

“The poll of 3,026 adults, surveyed Friday through Sunday, has a margin of error of +/—2 percentage points. Some questions, asked of half the sample, have an error margin of +/—3 points.  By 56%-33%, those surveyed endorse the idea of enacting major health care changes this year. Just one in four say it’s not important to them.   When it comes to financing the costs, six of 10 favor the idea of requiring employers to provide health insurance for their workers or pay a fee instead. Increasing income taxes on upper-income Americans, an approach backed by House Ways and Means Chairman Charles Rangel, D-N.Y., is endorsed by 58%. Just over half support taxing sugary soft drinks.  By 53%-43%, though, those surveyed oppose taxing health care benefits above a certain level — Senate Finance Chairman Max Baucus, D-Mont., had floated that idea — and even more are against cutting Medicare costs, a provision of House and Senate plans.” from the USA Today Gallup poll.

The fact that this survey was actually paid for by a public company was more shocking to me,” said Captain Obvious of Iknewit, Florida.  Perhaps the greatest idea came from the Gallup poll writers themselves when they decided to go home for the day and stop asking silly questions.

This reminded me of a terrific book I read called the “Shock Doctrine” by Naomi Klien, a truly thought provoking book, quite the opposite of a Gallup poll.  Her book is based on historical facts and statistics that were used by the Chicago School of Economics to shock nations into globalization.  This allowed US companies to go into these poor, often battered companies and buy everything from the workers to their public utilities.  The reason why many of these countries were so poor was because they were often “spoiled” by social programs they couldn’t afford.  The IMF and the large corporations would then only loan money to remake the countries if the politicians would agree to open up global trade (which allowed the international companies to go in and buy everything that was attached) and repeal any and all social programs.  Largely, these countries of course suffered immensely worse then before the IMF had gone into the countries and after 5-10 years the local currency etc. would start to gain traction and the economy were modernized into a model of capitalism. 

The parallel between these countries (mostly Latin American and Middle Eastern) and our country today is that we are on the precipice of a truly awful economic decline and polls like the one by Gallup confirm that we as Americans want everything but won’t sacrifice anything to get it.    Of course the politicians will still promise and deliver these programs to us without regard to cost or anything else as long as they are elected time and again.  And the ugly truth of the book (which is pointedly liberal) is that we going to need to be shocked out of these habits in order to “reset” the economy.  All social programs and anything else that causes deficits and debt will have to be abandoned and then started all over again. 

As the most productive nation on earth, this future can certainly be avoided by making good decisions like Socialized HealthCare but cuts will have to be made elsewhere!   But just like after all the recessions that Greenspan avoided by messing with the interest rates (which is causing a larger, more impending crash which will combine all the past recessions as bills from these prior mistakes have never been absorbed, just deferred) and like we are doing again, now by avoiding the current recession and spending money that just doesn’t even exist, this final bill is going to come due.  And it is coming due. And when other countries wake up and stop financing our debts, as they wake up to the notion that is impossible for us to pay them back. When? I have no idea.  But the first part of it is happening already as the dollar continues to decline and China is slowing  its ridiculous purchase of our treasuries.   I am willing to give up my job for the good of this country and if we all do something painful it can help defray some of the pain that is coming, what are you willing to do?

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Health Technology is going to make your laundry list of medications and private Viagra stash pretty well known in order to save administrative costs on health care.  Don’t worry no ones laughing that you waited this long to take propecia.

I am not going to be that outspoken on this issue as there is 0 chance of someone dying from it.  However, in actuality it could save lives by giving critical care physicians and hospitals instant access to your medical records which will be housed at Central Processing.  Or as we at East Coast Health Insurance call it, Blue Cross Blue Shield: The Association. 

Our in house writer Meghan McCartan provides this interesting introspection on health insurance technology invading your house.  Maybe in fact, to save your stinking life. 

Health Insurance,Technology, and the National Debate

Spent any time listening to the health care debate recently? It seems almost impossible to avoid, and the partisan fighting on either side of the aisle can make for a difficult time in understanding the issues.

President Obama has tried to lay out his plans to show how they will benefit all Americans, and while some of the details of the funding and budgeting remain fuzzy, the reforms are fairly comprehensive. A stop in July in Ohio gave the President the stage to speak in a town-hall type meeting.

There, he explained that his reforms were not proposed only for those Americans (over 45 million) who were without health insurance; instead, he maintained that he was working to try to hold insurers to a higher standard for whom they will cover. Out-of-pocket expenses are a huge issue across the board and both the President and the Democratic Party at large are emphasizing the need to cap these expenses for those already insured under a plan. An additional key point the President makes is the importance of making it illegal to deny coverage for pre-existing conditions, making it more feasible for those with illnesses from diabetes to cancer to obtain health insurance to help manage the costs of their care. As it stands, such a diagnosis can almost immediately bankrupt those who do not carry the appropriate levels of coverage (or who do not have insurance at all).

In an economy in which small business (and larger business, as well) are being hit harder and harder in their bottom line by employee health-care costs, both sides agree to the need for reform. Interestingly, the fact that President Obama chose to lay out many of the specifics of his plan in Cleveland provided a background for a case study in success, focused on the Cleveland Clinic.

The Cleveland Clinic is recognized nationally as one of the best providers of care at the lowest-per-patient cost. During his remarks in July, President Obama praised the high quality of care doctors and nurses provided, at their own discretion, and called for those types of reforms to become national so that the quality of care could be determined by health care providers (as opposed to insurance companies). The highly trained staff at the Cleveland Clinic is empowered to make on-the-spot health care decisions for their patients without elaborate insurance company involvement.

This quality of care is made possible in part due to the technology employed by the Cleveland Clinic, allowing for better patient record-keeping and more accurate test monitoring. Repeat tests, or duplicative tests, almost never take place due to a speedy and accurate technology backbone that accurately and efficiently monitors patients’ procedures, health, and ongoing treatments. Fewer tests means lower expenses. This focus on technology will likely be an ongoing segment of the health care debate. Better care with a cost-effective bottom line is the goal both sides are seeking.

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