Baucus Plan Looks Promising
Sep 16th, 2009 | 26 responses
Obviously at this point with the need to reconcile the various proposals we do not know what the final form will be for the Baucus proposal (America’s Healthy Future Act). But from the details contained in his announcement and outlined in this press release my preliminary reaction is positive. It looks to be a balanced approach which works to solve the current problems without creating a massive new program.
For those who missed the statement, the basic plan contains the following details (per the press release)
- Insurance coverage would be mandatory for everyone. I realize that for some it is controversial to have the government require you to get coverage, but as has been pointed out, those who do not have coverage rely on the idea that if an emergency arises they can get care anyway. It’s not fair for them to rely on this guarantee and just as it is proper to require basic auto insurance, I think it is fair to require basic health insurance.
- In order to help with this process, insurance companies would be prohibited from dropping coverage if you get sick and there would also e a ban on denying coverage due to a pre-existing condition. Some variations in rates would be allowed to take into account health status but the companies could not price people out of the market
- Insurance companies would not be allowed to place limits on annual or lifetime coverage, so you would not have to worry about suddenly having coverage end due to a major illness.
- Tax breaks would be offered to both small employers and individuals to assist in paying for coverage. Those who could still not afford coverage would also receive direct subsidies to assist in paying for coverage.
- Small businesses and self employed individuals could enter into cooperatives that would allow them to obtain the same package pricing that larger businesses can get.
There would also be reforms to Medicare to provide for wellness coverage and preventative care. Those below 133% of the poverty line would be able to join Medicaid regardless of age and there would be increased federal funding to the states to assist with payment for this expansion.
There would also be reforms to the way Medicare pays for treatment with the long term goal being improvements in the delivery system and reduction in waste.
As I said this is just a starting point but I think it is a good starting point. I’m sure there will be a lot of debate in the coming weeks and months but this just might be a plan that I could get behind (not that my view means much of course).
More details can be found either at the press release or the full text can be read online.
opinions powered by SendLove.to
26 Responses to “Baucus Plan Looks Promising”
If this were passed tomorrow, it would make a lot of people's lives better by providing better access. And that's certainly a good argument for passing it.
But it won't fix the fundamental problem of exploding health care costs. To be honest, the weak a** public-options in the other bills won't do that either. I think down the road — since we're too insane to dismantle the insurance industry and go with Medicare for all — we'll see the government move in and effectively nationalize the health insurance industry. Lots of regulations, subsidies and cost controls. We'll get all the upsides of a single-payer Medicare for all type plan, with all the downsides of rich insurance company CEOs skimming tax money off the top.
Yup, thats the real issue that has to be addressed, so far none of the democratic plans have adequately addressed that.
Nor have any GOP plans adequately addressed that. The cost of health care is highly complex. The low hanging fruit, as I've pointed out repeatedly, is the obscene waste of a for-profit intermediary between me and my doctor.
Medicare, I'll remind you, pays 19% less for doctors and 25% less for hospitals, plus costs 3.3% overhead, v.s. 16.7% MINIMUM (it's the insurance industry's own assessment). Leonidas, that's a 37% savings without any change in the actual services of doctors and hospitals. Tell me what GOP plan comes close to saving 1/3.
Medicare is also basically bankrupt. Using medicare as an example does not really make a good argument for public healthcare, actually it makes a very good argument to oppose it.
Medicare is no more bankrupt as private insurance. That myth is based on “unfunded obligations” which private insurance has in spades. Plus, how fundamentally dishonest is to say it is a financially sound model that gets to drop patients at age 65, avoiding the most costly period in a person's life.
Medicare is going bankrupt because its funding isn't increasing to keep up with the cost of health care across the board not because it's an inefficient program.
Put more simply, if the cost of hospital Tylenol goes up, both Medicare and private insurers need more money to pay for that Tylenol. Insurers pay for it by raising premiums or dropping sick customers. Medicare will need to pay for it by raising taxes or reducing benefits. But as it stands, Medicare customers and the taxpayer will get that Tylenol to a sick grandma for 20% cheaper than an insurance company will.
But right now private insurers are having to pick up the slack of underpaying medicare which drives private insurance costs up.
Also here is a piece on medicare overhead, definately some things worthy of consideration.
http://www.thehealthcareblog.com/the_health_car…
Also this piece on doctors choosing to opt out of medicare
http://www.nytimes.com/2009/04/02/business/reti…
Medicare in its current form is unsustainable; honest people know so and say so, and have said so for ages. Even Obama has said reform is essential (though nobody sane believes his commitment to it).
Don't forget Medicaid. While on the road today between Michigan and Indiana I got to listen to the latest description of how well things are going in Michigan, where only 64 per cent of providers (not the 99.99% that some might claim, for example) accept Medicaid. This has actually been known for years:
“Physician participation in the Michigan Medicaid program dwindled from 88 percent in 1999 to 64 percent in 2005, the last year physicians were surveyed, according to the medical society.”
http://www.wilx.com/news/headlines/44645077.html
That's another myth Leonidas. It is not possible or legal for the cost of one patient to be shifted to another. Even if that was possible, it's just crappy negotiation. You're saying the negotiators you're paying ultra top dollar to allow you to be charged for another patient's care?
97% of doctors take new Medicare patients, same as private insurers. Nearly all hospitals and clinics take Medicare patients. These are tiresome excuses for keeping insurance company fat cats fat. I personally know doctors who have opted out of Medicare. They've opted out of every PPO, and finally stopped taking ANY third party payment. That however, is NOT the norm.
“so far none of the democratic plans have adequately addressed that.”
On the plus side, the Baucus bill and announcing the intention to proceed with it is Baucus's contribution to the attempt begun by Obama to bring order to the Dem silliness and to resume “progress” toward some kind of eventual plan and eventual legislation. On the minus side is that this bill apparently continues the same gimmickry that the House dopes' bill and Obama's own list of objectives features, which is to “pay” partially for this expansion of federal health care by simply taking $500 B or some other big amount from Medicare — without any kind of reconciliation of the loss to Medicare, which already is failing even without being looted like that. As for any non-profit co-op, it means government (federal) support of some kind, most likely, and could well be a public option but just renamed.
“right now private insurers are having to pick up the slack of underpaying medicare which drives private insurance costs up”
Of course. Cost-shifting has long been known to be happening, as well as underpayment by Medicare (and Medicaid), which results in losses (which are made up by what else, cost-shifting for recovery). What will happen if we have even more underpayment later (which is what many short-sighted or class-envy-ridden people want more of, with government health care, when not more naive or ignorant “magic” cost savings) and there's less (or no more) chance to recoup at least some of the losses in some way?
First, let me commend ChrisWWW and GD for sticking to their guns and arguing for a single payer system. Whether one agrees or not (I don't), it is at least an honest argument.
The proposals coming from Congress are neither fish nor fowl. They seek to impose mandates on individuals, but are extremely weak on cost containment. The Baucus option, for example, claims to control insurance premiums while capping them at $21,000 annually for family coverage. That's about 50% higher than average family coverage costs today. It also claims to attack fraud and waste in Medicare, but is very non-specific in its approach, as it is with health care cost containment generally. It continues to allow for insurance company pricing increases based on pre-existing conditions, age and family size. It continues the costly multi-regulatory scheme of state-by-state regulation of the industry; it is built on a tax credit scheme, rather than a service provision scheme. Whoever labelled this an “insurance company enrichment and enhancement plan” had it about right. This is legislation designed to be “gamed” by the insurance companies.
Congress is simply unwilling to take on the entrenched interests to bring about real reform, whether those interests are the trial lawyers, the AMA, the insurance industry, unions, the AHA, medical device manufacturers, or the drug industry. Until we get legalized bribery (special interest influence) out of our system, meaningful reform appears destined to either fail or be so watered down as to be ineffectual.
Look, you guys hate Medicare and all government involvement. News flash: the insurance industry doesn't WANT the 65+ yo patients that Medicare covers. I haven't seen any credible evidence that significant “cost shifting” is taking place. Instead, efficient hospitals make money on Medicare, while poorly managed ones lose. That, my friends, is THEIR problem, not mine.
Insurance companies don't add anything meaningful to the health care system. They aren't really providing “insurance” because they manage to drop you whenever you actually get sick, and for the same reason they aren't providing effective cost-sharing. All they've managed to do well is take money from healthy people who don't go to the doctor and give that money to their fat cat CEOs.
Seriously, other than knee-jerk (and very selective) fear of socialism, what is the case for keeping health insurance companies?
“[P]hysician and other professional health care services providers who faced decreased revenues due to Medicaid/TennCare payment reductions would increase revenues from other health care payment sources, that is, shift costs to the non-Medicare non-Medicaid population…”
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?…
“Consumers and Employers Paying Almost $90 Billion Due to Under-Payments to Hospitals and Physicians by Medicare and Medicaid” [2008]
http://www.ahip.org/content/pressrelease.aspx?d…
http://www.bcbs.com/news/bluetvradio/cost-shift…
[California]
http://www.cfcepolicy.org/NR/rdonlyres/46C2B526…
[Vermont]
http://www.vtreform.com/d/volume3/20070131_THE_…
[Wisconsin]
http://www.wha.org/newsCenter/pdf/nr6-30-08pric…
[Maryland]
http://www.hcfo.net/pdf/chang.pdf
Et cetera
I see. So DLS, in your view, the insurance industry pays $1.35 for a $1 band-aid because Medicare gets it for $.85. And you want to further empower these fools? They are your ideal model of businessmen? Pitiful. Thanks, but no thanks. You go ahead and go with the cost plus 35% guys. I'll go with the one who negotiates the price DOWN.
Didn't we start a long time ago talking about REDUCING health care cost? Apparently, now we're debating how to keep costs high to suit the insurance industry.
DLS, thanks for the links. Do you even READ them? I sure got a good laugh. First, the WI report talks about “Medicare/Medicaid” but all its data is Medicaid (which probably should increase provider reimbursement rates). Several of the other links similarly lumped all government programs, yet failed to show specific problems with Medicare rates. The biggest laugh is how “cost shifting” was documented. They took the total paid, then set the cost-shifting rate as, and I quote, “we calculate cost shift by holding total provider reimbursement constant, but redistributng the source of payment. Medicare paid $48.9 billion less.. than if all payers paid equivalent rates.” So the inability of insurance companies to negotiate better rates is the fault of those who do?
That's clever indeed. Let's see. WalMart is selling $4 prescriptions. My local pharmacy charges over $20. So WalMart is “cost-shifting” massively, and the ACTUAL cost of those drugs should be $12. Because if someone can get a better deal, they're “cost shifting” to those who don't.
“They are your ideal model of businessmen? Pitiful.”
No, it's not my ideal at all, nor do I consider Medicare and Medicaid ideal government programs.
“DLS, thanks for the links. Do you even READ them?”
Yep. The emphasis on Medicaid is not misplaced; that program is more notorious than Medicare.
“So the inability of insurance companies to negotiate better rates is the fault of those who do?”
You're assuming that lower rates should be demanded and negotiated by the insurers, when in fact the problem is that the government programs are underpaying.
Nobody has successfully answered, What happens when current underpayments become more widespread, the rule rather than (for now) still amounting to an exception? Note that reducing Medicare payments not only is a hot current issue, but there are expressions of desires for (threats of) more to come.
“Apparently, now we're debating how to keep costs high to suit the insurance industry.”
Actually, no — the problem is that of underpayment, something for which I'm not exactly agitating against, as a rule, when it comes to a government program, or government spending of any kind.
Even you conceded the Medicaid case, kinda sorta:
“probably should increase provider reimbursement rates”
Cram-downs on the providers after a federal takeover of health care isn't the easy or painless thing that cram-downs on lenders and GM-Chrysler bond holders were (for most other than those who suffered at the time).
And unfortunately there haven't been any serious Republican plans.
Added: Damn, GD, I should learn to read the other comments before making mine!
The NYTimes seems to disagree with you.
Also
http://stanford.wellsphere.com/healthcare-indus…
http://www.physicianspractice.com/index/fuseact…
No we are talking about doctors and hospitals getting shafted by the government and those holding private policies making up for it in the private market.
And Santa will visit your home this Christmas
Max Baucus is bought and paid for by the health insurance industry. Their stock rose today in response to their success.
So, the right-leaning commenters here DO both complain that Medicare is too expensive AND that it's too cheap. That makes no sense at all. There is NO PRIVATE PLAN for the elderly. The private insurers DO NOT WANT high risk patients. You guys are apparently against ANY solution. There is ZERO in the Ryan plan or ANY OTHER to treat the elderly, who are increasing in numbers, and who are the cause of the claims that Medicare is bankrupt or will be soon. These circular arguments defy solution.
Medicare for all? Too expensive and too cheap. Serious discussion of cost controls through limits on end of life care? “DEATH PANELS!”
Well, I give up. Every other modern nation will continue to do better than we do at caring for our citizens' health and the right wingers and their sheep-like minions will shoot down every possible solution until they are all bankrupted by the very system they angrily and vociferously defend against ANY reform. Oh, except the rich. They'll be fine, and they just happen to include the executives of the insurance industry which the right apparently exists to protect.
Good luck with that. By the time your insurance rates double (in under 10 years, half of Americans will pay half their total income) and your employers all drop health benefits, I'll be on Medicare. Have fun feathering the nests of the rich and greedy on the backs of the sick and injured, and your families.