Change, especially of this caliber, is going to impact some of us more than others. And as lurking says - it is going to be us babyboomers. Andn it won't be anything new - we have been carrying and paying for the indigent all along. And don't get me wrong - I believe it is our duty to help those who can't help themselves. BUT let's be sure that it is being done equitably and thhat WE are being the care we deserve.

THANK YOU, thhank you for not talking politicsi here. It gives us a chance to roll out this blueprint and check the specs. And THEN if we see we are taking the load of enforcing this change, THEN we make noise! lol
peg

Thank you for sharing a positive experience with public insurance. Given the polemical nature of this reform, we often read of patient "horror stories" in socialized medical care. In reality, aren't these the minority of cases? I would think that with some sort of law of averages we would have an equal share of private insurance stories that are less than ideal. Every system has its flaws.

Laura

Lucky for you, my previous attempt at posting to this thread was intervened by gremlins who have taken up residence in my Mac. This is all I can remember:

Thanks to everyone who provided summary and op-ed links; right now I don't have the patience or the time to read the entire proposal. I found this good summary site to add: http://edlabor.house.gov/blog/2009/0...ices-act.shtml The actual bill is here too.

This reform, while completely necessary, concerns me. I'm concerned that there is no guiding philosophy for the change other than making it more affordable and providing coverage for all. In other words, if it's going to be this broad in scope, we should have a serious fundamental common belief about care, but do we?

Any sort of attempt at partial government control of what has long been private enterprise will be always fundamentally flawed. Any attempt to exercise a belief that all citizens, regardless of income or socio-economic status, are entitled to the same extraordinary level of health care will be tainted by the fact that there will always be a two tier system of coverage or service in this country reflective of our history and economic systems.

Why? Capitalism- this is not a bipartisan argument of any sort, just a fundamental fact that our economy runs on this belief, and health care has been a key player in this system. It also has to do with our collective psyche; the American belief in Manifest Destiny and the cultivation of the rugged individualist over the concern for society as a whole. It's the very same reason we have buses and subways, yet people choose hummers (with vanity tags, of course) and freeways. It's about wanting to believe we are somehow different than our neighbor, that we deserve better than the bus driver we pass every day on the road, but ultimately it's about the illusion of control. People want to believe that they are in control of their own health through choice and providing them with a costly, private health insurance has done just that.

So, instead of having a revolutionary reform of health care, we'll end up with a two tier or track system in the politician's attempt to, once again, make everyone happy. We'll have a substandard system of basic diagnostic tests, clinical diagnoses (think PD), drug coverage, and long term palliative care for those of us who do not have private insurance. We'll have a state of the art, sky is the limit, system for those of us who do have private insurance or who can afford to "buy" the best. In other words, I fear it will be a universal or codified version of the status quo. Maybe not, but I don't sense a revolution or coup d'état, I see it more as a street rumble.

Specifically, I wonder:

-Will specialists be given the latitude they need in making differential diagnoses? Can they order the same number and quality of tests for both public and private insured patients?

-Will health care providers be billed to cover all their actual costs?

-How does this bill affect the research community in providing new or innovative treatments for those who have need?

-What is the view of integrative or holistic health? Can a physician and patient work up a plan: supplements, yoga, therapist, etc. for those chronically ill (insert PD here) and receive some sort of coverage?

-What is the view on long term care of disabled, elderly, and mentally impaired people? Do we still pen them up in an inhumane fashion inside "homes" in order to pretend that they don't exist? Many families would choose to care for their loved one within a natural, familial environment if offered assistance in doing so.

-Does the reform not only provide for, but encourage house calls by doctors and nurses? Does it encourage new health care professionals to even offer this as a service?

-Does it ensure that Penny Patient does not have to wait one year for a confirming PET scan to learn she has PD while Charlie Capital waltzes in, plunks down $2000 and gets his scan the same day? Think to the future when neuroprotectives may be available- it may not make much of a difference now, but it will down the road.

-Are rural residents likely to receive any better health care? Appalachia is not a pretty site.

-How do we ensure people don't fall through the cracks?

Let's face it, there are always cracks.

-Laura

N.B. Always save your magnum (or minor) opus somewhere on your computer as you type.

Last night CNBC hosted a roundtable discussion with key stakeholders to discuss the challenges and possible solutions to the issues confounding us around finding more affordable care, assuring broader access to care and who will pay for it.

The hour-long special featured a one-minute clip from Michael J. Fox reminding policy makers to consider strategies to improved drug development costs/timeframes within these critical discussions.

http://www.cnbc.com/id/30582844

Debi

Outstanding message! thanks, paula

As reports come in from the workings of our new federal team I am beginning to get concerned. This completely affects how a new federal health care sytem will run. Here are some of them:

1. Obama promised the federal deficit would not increase if a national heathcare system were implemented, and in fact, that he would cut in half our federal deficit by the end of his first term. Here's the link where this is (go to page two):

http://www.whitehouse.gov/blog/pg2/?CategoryId=3

The OMB has now issued two reports stating that the federal deficit can only increase with a national health plan, that there will be no "savings" if the plan is implemented. The number thrown out was over 1.5trillion dollars over ten years, and that did not count "administrative expenses"-did anyone know the proposal calls for THIRTY ONE brand-new federal agencies to "administer" the plan? See point below on administrative costs...

2. Administrative costs of the proposal: here is a smattering of them:

First, the OMB's comment in their report: “We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal’s likely effects on spending for other federal programs.” ...so as I understand it, the 1.5 trillion does not incluse these costs, and they are huge.

The plan adds a new “Health Choices Commissioner” who would helm the new “Health Choices Administration” (Section 141 of the bill) – separate from the already existing Department of Health and Human Services, Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Veterans Health Administration, and the Indian Health Service.

Also proposed is the creation of a “Public Health Investment Fund” and a “Health Insurance Exchange Trust Fund.” The latter would create a “transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers.”

No matter that state insurance departments already operate such systems. This is simply federal redundancy.

The plan also creates a new “Bureau of Health Information” (not to be confused with the already existing National Center for Health Statistics) within the department of Health and Human Services. The BHI will be led by a new “Assistant Secretary for Health Information.” The new assistant secretary will coordinate with the recently-created “National Coordinator for Health Information Technology” – who is responsible for monitoring the $19.5 billion in the stimulus law to implement “a nationwide interoperable, privacy-protected health information technology infrastructure.” The federal government is so good at protecting its information that several of its own databases were recently hacked into, so this is worrisome.

The new Bureau of Health Information will house its own “Office of Civil Rights” and “Office of Minority Health.” The information czar will be required to collect health statistics in the “primary language” of ethnic minorities – and thus, the need for a new “language demonstration program” to showcase their efforts. The plan includes provisions to ensure “cultural and linguistics competence training” and establish “a youth public health program to expose and recruit high school students into public health careers.”

How does this improve core health care? Good question.

And there's more, if you can stomach it. The bill would add a new “Senior Advisor for Health Care Fraud” and require the Attorney General to appoint a “Senior Counsel for Health Care Fraud Enforcement.” There’s already a national Health Care Fraud and Abuse Control Program, but who’s counting?

To coordinate all the new bureaucrats, there would also be created a new “Health Care Program Integrity Coordinating Council” to “to coordinate strategic planning among federal agencies involved in health care integrity and oversight.”

Not too sure why it's in there, but hell, everything else is so why not, a new “Coordinated Environmental Public Health Network” to “build upon and coordinate among existing nvironmental and health data collection systems and create state environmental public health networks.”

Also new, a “National Health Care Workforce Commission” will be “tasked with reviewing health care workforce and projected workforce needs.” New funding will be available for a “demonstration program to improve immunization coverage”, I am not too sure what that means but sure hope it won't take away my current right to refuse the flu shot or any other vaccine for me or mine.

Who’ll be looking out for you? The House bill creates a “public plan ombudsman” and a “special health insurance exchange inspector general” to police spending and guard against waste, fraud, and abuse. Thank heavens, I was beginning to be worried, but with this ombudsman in place, I feel so much better.

3. Tax increase. We were also told income taxes would not be increased, yet Congress has come up with a plan to hit "wealthy" taxpayers with a surtax...now, you may not make the 280K a year to qualify as "wealthy" now, but just wait until "wealthy" gets redefined to be 200K, then 150K, then 100K, then 75K...you see where this is going....soon anyone making a decent salary will be classified as "wealthy" and subject to the additional tax. Truly wealthy people have options, like moving, and if enough of our big taxpayers change their residence, we are in deep doo-doo, regardless of whether we have national healthcare or not (they already have tons of money offshore, it would be easy for some of these folks to simply live outside the US for the requisit number of days in order to qualify for nonresident/domicile status). Something like 1% of the top filers are paying close to 40% of the income taxes already, if only a few of these folks leave, that's a big problem.

4. Option to keep existing plan. We have been told we will be able to keep our existing policies if we want them, yet a recent article in the Wall Street Journal - "Idea to Tax Insurers" "Gaining Traction" indicates otherwise...if insurance companies are taxed, my coverage is going to either be reduced or made more expensive, and thus my health care costs are now higher than they were...that's not what we were told this reform would do! Or worse, my insurance company eliminates my plan altogether, forcing me to choose the federal option, which I am pretty sure we will not want.

See my other post on the Tenth Amendment, where states are opting out of the federal plan.

Laura - Your post is right on. You did a great job of explaining the current situation without resorting to polarizing labels.

The challenge of this reform is rooted in our American psyche, individualism, and the belief that the more you make, the more you should be able to buy. Health insurance and thus access to health care became a "benefit" offered by employers, so those without the ability to work were shut out of the system from the get go. We forget that until recently that group included the vast majority of women, who were dependent upon an employed and employable husband to have access to health care.

And you are right when you say that instead of real reform we will get only a "codification of the status quo." The Washington Post yesterday had a story about how the "Heath Care Debate Focuses on a Satisfied Majority," writing:

"Although polls have consistently shown that just over half of Americans think the health-care system is in need of reform, a substantial majority say they are satisfied with their own insurance and care. Any hope of change will require their support, according to experts and advocates across the ideological spectrum."

The really scary thing is that most people don't understand, or want to believe, that they are one job loss away from no health care at all. There have been comments in this thread over the fear that reform will strip care from the elderly and the disabled. The fact is, the system already does imperil these folks.

It's a strange place that we live in that rewards you with security and peace of mind if you remain healthy, but puts you in jeopardy once you lose that health. If not the government, then who and how do we protect those most vulnerable in our population? The government does it now - the old and disabled are dumped on the Medicare system; the poor get Medicaid. Isn't it a shame that it is how we are currently treating our elderly, disabled and indigent that scares us away from real reform? That we are content right now that certain classes of people get second rate care when they somehow lose that American trait of being able to fend for themselves? It's ok unless it happens to me.

We already throw our vulnerable to the wolves. I believe we can do better as a citizenry - isn't that the American way?

Obama is targeting people who are currently satisfied with their insurance in his effort to sell his program. These are the points the White House is making to show why those who are insured now should want to see health reform. Read the whole article in the Washington Post:

* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
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The Associated Press calls these "consumer protections;" here's their story today.

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Sorry about the bad link in my first post. Try this one to see or print the actual document:

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

or go to http://thomas.loc.gov/home/thomas.html and there is a link to the bill on the home page.

Thanks for the other comments. Debi, did you happen to read this one with a headline that really grabs you: Who Will Tell Michael J. Fox He Needs to Die?"

http://spectator.org/archives/2009/0...chael-j-fox-he

I'm sure there will be lots of input into this before it's over!

Peggy

Provacative!