Obama healthcare plan omits public option

**Prince** · 02-22-2010, 10:37 AM

Obama healthcare plan omits public option

The Obama healthcare plan, unveiled Monday, would rein in rate hikes, and includes an exchange where people can shop for coverage, but not a public option.

by Linda Feldmann Staff writer / February 22, 2010
Washington

President Obama unveiled Monday his own plan for comprehensive health insurance reform, based largely on legislation the Senate passed in December. In a bow to Republicans, the plan includes new GOP-backed provisions designed to crack down on waste, fraud, and abuse.

Despite hints leading up to Monday’s unveiling that Mr. Obama’s plan would include a "public option" – a government-run insurance plan designed to compete with private insurers – it does not. But his plan does set up an insurance marketplace, or "exchange," in which consumers can shop for coverage. The plan would also create new federal authority to rein in rate hikes deemed exorbitant, a hot issue following double-digit increases announced earlier this month by Anthem Blue Cross of California.

Like both the House and Senate versions, the plan includes a mandate that individuals purchase insurance, and bans insurers from excluding consumers with preexisting conditions.

The plan, posted on the White House web site, represents Obama’s opening bid in advance of a bipartisan healthcare summit on Thursday. In a conference call Monday morning, a senior administration official suggested Obama is prepared for Congress to use a legislative procedure called “reconciliation,” which requires only a majority of votes to gain passage – and not the 60 Senate votes needed to overcome a filibuster.

“The president believes the American people deserve an up or down vote on health care,” said Dan Pfeiffer, White House communications director. “This package is designed to provide us the flexibility to achieve that if the Republican Party decides to filibuster health reform.”

The White House plan would also:

• Eliminate the special provision in the Senate version that would have aided Nebraska on expanded Medicaid payments, and instead boost federal funding for expanded Medicaid in all states.

• Close the so-called “donut hole” in Medicare prescription drug coverage, which leaves seniors paying significant out of pocket expense.

• Increase the threshold for the excise tax on high-end insurance plans from $23,000 for a family plan to $27,500. The tax would begin in 2018 and apply to all healthcare plans.

The White House maintains its plan would reduce the budget deficit by $100 billion over the next 10 years, and about $1 trillion over the following decade. It also says its plan will help more than 31 million Americans afford health insurance who do not have it today, and make insurance more affordable to those who do have it. The plan includes a provision that allows low-income people who cannot afford health insurance to receive a waiver from the mandate.

On the sensitive issue of abortion, Obama’s plan keeps the Senate language, which is less restrictive than the House version. Obama has maintained from the start that the reform should not permit federal funding of abortions, though anti-abortion forces argue the Senate version would do that. The White House could lose crucial Democratic votes in the House if the Senate language stays.

Republicans were expected to react negatively to Obama’s overall proposal after calling on the administration to start from scratch. The Obama plan does not do that.

**ZECH** · 02-22-2010, 02:08 PM

While I think we need some type of reform, I wont buy this "ram it down their throats" approach they are using. I hope the repubs can get it defeated.
The public in general is very opposed to this. If it passes, expect a very different senate and house come Nov.

**ALBOB** · 02-22-2010, 04:41 PM

Despite hints leading up to Monday’s unveiling that Mr. Obama’s plan would include a "public option" – a government-run insurance plan designed to compete with private insurers – it does not. But his plan does set up an insurance marketplace, or "exchange," in which consumers can shop for coverage. The plan would also create new federal authority to rein in rate hikes deemed exorbitant, a hot issue following double-digit increases announced earlier this month by Anthem Blue Cross of California.

This is crap. If they create competition by allowing consumers to shop for coverage across state lines then that in itself will drive the prices down. Creating a new federal authority won't do anything but drive our taxes up.

Like both the House and Senate versions, the plan includes a mandate that individuals purchase insurance, and bans insurers from excluding consumers with preexisting conditions.

This part sucks too. Some lard ass eats nothing but Big Macs and Krispey Kreams all his life, get's diagnosed with Diabetes, goes to his insurance company demanding they write him a policy and they're not allowed to tell him to fuck off? Bullshit. And TELLING me I HAVE to buy health insurance? Screw you! The government has no business trying to do that.

**KelJu** · 02-22-2010, 04:45 PM

Originally Posted by ALBOB

Like both the House and Senate versions, the plan includes a mandate that individuals purchase insurance, and bans insurers from excluding consumers with preexisting conditions.

This part sucks too. Some lard ass eats nothing but Big Macs and Krispey Kreams all his life, get's diagnosed with Diabetes, goes to his insurance company demanding they write him a policy and they're not allowed to tell him to fuck off? Bullshit. And TELLING me I HAVE to buy health insurance? Screw you! The government has no business trying to do that.

One of two things will have to happen here. Either all people have to pay for health insurance, or hospitals should have the right to turn away a dying patient with no insurance.

Either way is fine by me.

**DOMS** · 02-22-2010, 05:03 PM

Another issue with this bill is that, as a health care provider, you're not allowed to check the citizenship status of a patient. In other words, Mexicans will flood across the border is even greater numbers to take advantage of free healthcare.

**Dark Geared God** · 02-22-2010, 05:08 PM

an exchange where people can shop for coverage, but not a public option.
Its a public option they just worded it diff they are still pushing the option. don' t be fooled..

**danzik17** · 02-22-2010, 05:55 PM

Originally Posted by ALBOB

This is crap. If they create competition by allowing consumers to shop for coverage across state lines then that in itself will drive the prices down. Creating a new federal authority won't do anything but drive our taxes up.

Not quite true on the competition part without having a regulation plan in place. Look at the credit card companies as a model for this. Originally, they all migrated to states where laws on interest rates were more favorable (no usury laws) and allowed them to charge people 25% interest.

I see a similar thing happening with across the lines healthcare unless we take preventative steps.

**bandaidwoman** · 02-22-2010, 06:24 PM

How much does President Obama expect us to pay for health care? | Physicians for a National Health Program

this is written from a physicians perspective

the devil is in the details

That said, let's look at what the President expects a family of four with an income of $66,000 to pay for health care. The premium contribution would be 9.5% of income, or $6270 for the basic plan with an actuarial value of 70%. If they wanted or needed a better plan, they would have to pay the full difference in the premium. At an actuarial value of 70%, they would also have to pay an average of 30% of all health care costs. This can vary considerably because of plan design in the form of deductibles, copayments, coinsurance, non-covered benefits, stop loss, out-of-network care exempt from stop loss, and other factors. If they either elected not to or were unable to pay the premium, they would have to pay a penalty of $1650, but then, of course, they would have no protection at all against potential health care costs.

By the way,this insurance exchange is going to be administered and doled out by private insurers, our tax money will finance private insurance market even further, and I thought only republicans believed in corporate welfare....
it's crap

**ALBOB2** · 02-22-2010, 07:06 PM

Originally Posted by danzik17

Not quite true on the competition part without having a regulation plan in place. Look at the credit card companies as a model for this. Originally, they all migrated to states where laws on interest rates were more favorable (no usury laws) and allowed them to charge people 25% interest.

I see a similar thing happening with across the lines healthcare unless we take preventative steps.

Credit card companies are only one example but, the VAST majority of product and service companies are kept in check with nothing more than pure competition. It's the capitolism that we're based on and it works IF the damn government stays out of the way and stops fucking it up. Don't like the interest your credit card company is charging? Go with a different company. It's called voting with your wallet and it works.

**danzik17** · 02-22-2010, 08:41 PM

Originally Posted by ALBOB2

Credit card companies are only one example but, the VAST majority of product and service companies are kept in check with nothing more than pure competition. It's the capitolism that we're based on and it works IF the damn government stays out of the way and stops fucking it up. Don't like the interest your credit card company is charging? Go with a different company. It's called voting with your wallet and it works.

In a perfect world, I would agree with you. But like credit card companies, there are only a few healthcare companies that own the vast majority of the market. Certainly qualifies as a trust since they seem to raise rates in sync in both areas.

Unfortunately, voting with your wallet doesn't go far when the other viable companies do the same thing. Going without health insurance isn't a smart option, therefore you have to choose one of them.

In any case it's still not going to make a significant dent in spending - it's the seniors on medicare. You old farts cost a shit ton to keep alive!

**Pirate!** · 02-22-2010, 09:04 PM

Trying to improve health care by regulating insurance is absurd. Insurance does not equal health care. Insurance is a business and contractual arrangement. Insurance is supposed to be for emergencies, as with your care and house.

The only people ever served by increased regulation are those seeking new government jobs.

**Dale Mabry** · 02-23-2010, 03:44 AM

Originally Posted by dg806

The public in general is very opposed to this. If it passes, expect a very different senate and house come Nov.

You should expect this anyway, the sheep are angry.

**bandaidwoman** · 02-23-2010, 07:28 AM

The health insurance market does not operate on free market principles. When demand for a service declines, most businesses lower their prices ( look at mcdonalds and other franchises offering dollar menus as demand is less). As demand for private insurance goes down ( people losing jobs and small companies no longer can afford employee health insurance as an overhead) they raise their prices. Look at Blue cross wellpoint raised individual premiums 39% despite windfall profits last year.

**Prince** · 02-23-2010, 08:44 AM

Originally Posted by bandaidwoman

The health insurance market does not operate on free market principles. When demand for a service declines, most businesses lower their prices ( look at mcdonalds and other franchises offering dollar menus as demand is less). As demand for private insurance goes down ( people losing jobs and small companies no longer can afford employee health insurance as an overhead) they raise their prices. Look at Blue cross wellpoint raised individual premiums 39% despite windfall profits last year.

well said.

**GearsMcGilf** · 02-23-2010, 10:02 AM

This doesn't mean that the answer is another $trillion govt program that will be mismanaged like medicare and medicade, and destroy the healthcare system. The answer is to break up the monopoly that the big insurance companies have on the industry and seperate private insurance from employers. If we could shop for health insurance the same way we shop for life insurance, then companies would have to compete for individual business and the cost would be forced down. As it stands now, they can raise their rates for any reason they want, or no reason at all, and the employer passes it onto the employees who can do fuck all about it.

Competition in the health insurance industry is almost nonexistent. The answer is free market competition, not more govt spending and mismanagement. Unfortunately, Obama and his cronies are still willing to protect the industry from competition, even when it means trillions more in wasteful spending.

**bandaidwoman** · 02-23-2010, 12:16 PM

Originally Posted by GearsMcGilf

This doesn't mean that the answer is another $trillion govt program that will be mismanaged like medicare and medicade, and destroy the healthcare system. The answer is to break up the monopoly that the big insurance companies have on the industry and seperate private insurance from employers. If we could shop for health insurance the same way we shop for life insurance, then companies would have to compete for individual business and the cost would be forced down. As it stands now, they can raise their rates for any reason they want, or no reason at all, and the employer passes it onto the employees who can do fuck all about it.

Competition in the health insurance industry is almost nonexistent. The answer is free market competition, not more govt spending and mismanagement. Unfortunately, Obama and his cronies are still willing to protect the industry from competition, even when it means trillions more in wasteful spending.

It is ideal but the health insurance market does not want the individual market. In order to maintain affordable premiums carriers must weed out potential buyers who are certain to incur substantial claims.
Insurance is about spreading risk and the best way to do that is en masse, with employers like myself are taking the sucker punch for the individuals. In a voluntary market it means they need to buy insurance before their known risks exceeds the premium.Most individuals won't do this, and then, if the health care reform does disallow prexisting, individuals may only purchase insurance once they come down with an illness. This dynamic, known as adverse selection, is at the root of much of the problems facing the individual market.

I'm not an acutarialist but I believe they have crunched the numbers to know that the individual market for health care claims is much more of a money losing option than the life insurance market.

**Dark Geared God** · 02-23-2010, 05:14 PM

Originally Posted by bandaidwoman

The health insurance market does not operate on free market principles. When demand for a service declines, most businesses lower their prices ( look at mcdonalds and other franchises offering dollar menus as demand is less). As demand for private insurance goes down ( people losing jobs and small companies no longer can afford employee health insurance as an overhead) they raise their prices. Look at Blue cross wellpoint raised individual premiums 39% despite windfall profits last year.

I think they are in bed with obama think about all of a sudden bang the prices jump when health care is dead ...come on its a set up. so the dems can go look see we did it for your own good

**GearsMcGilf** · 02-23-2010, 05:43 PM

Originally Posted by bandaidwoman

It is ideal but the health insurance market does not want the individual market. In order to maintain affordable premiums carriers must weed out potential buyers who are certain to incur substantial claims.
Insurance is about spreading risk and the best way to do that is en masse, with employers like myself are taking the sucker punch for the individuals. In a voluntary market it means they need to buy insurance before their known risks exceeds the premium.Most individuals won't do this, and then, if the health care reform does disallow prexisting, individuals may only purchase insurance once they come down with an illness. This dynamic, known as adverse selection, is at the root of much of the problems facing the individual market.

I'm not an acutarialist but I believe they have crunched the numbers to know that the individual market for health care claims is much more of a money losing option than the life insurance market.

If it were introduced to the individual market, I don't see why careful underwriting guidelines that are already being followed now couldn't weed out those who are uninsurable, as they do now.

With the Obama plan, as I understand it, insurance companies won't be able to disqualify people with pre-existing conditions or set a maximum lifetime limit of coverage (i.e. $1 million). That's a sure way to put private insurance companies out of business over the long run. That's sure not the answer.

As it stands now, I can't call an insurer, say in TN, AR, CA, AZ, etc and compare it with BCBS here locally and buy the most competitive policy, regardless of state lines. WTF sense does that make? That just wreaks of politicians in the pockets of big insurance. If I could shop like that, it would have to bring premiums down and ultimately the fees charged by docs and hospitals.

**Dale Mabry** · 02-23-2010, 06:14 PM

Originally Posted by GearsMcGilf

If it were introduced to the individual market, I don't see why careful underwriting guidelines that are already being followed now couldn't weed out those who are uninsurable, as they do now.

With the Obama plan, as I understand it, insurance companies won't be able to disqualify people with pre-existing conditions or set a maximum lifetime limit of coverage (i.e. $1 million). That's a sure way to put private insurance companies out of business over the long run. That's sure not the answer.

As it stands now, I can't call an insurer, say in TN, AR, CA, AZ, etc and compare it with BCBS here locally and buy the most competitive policy, regardless of state lines. WTF sense does that make? That just wreaks of politicians in the pockets of big insurance. If I could shop like that, it would have to bring premiums down and ultimately the fees charged by docs and hospitals.

Are you kidding? With the rate that this industry is consolidating through mergers and buyouts, in 3 years there's going to be 1 or 2 companies running everything. State to state competition will merely be adjustments in the standard of living, which is precisely why that will never happen.

**GearsMcGilf** · 02-23-2010, 08:11 PM

Originally Posted by Dale Mabry

Are you kidding? With the rate that this industry is consolidating through mergers and buyouts, in 3 years there's going to be 1 or 2 companies running everything. State to state competition will merely be adjustments in the standard of living, which is precisely why that will never happen.

Not if the same antitrust regulations are applied to them that are already applied to every other industry.

**pitman** · 02-23-2010, 08:14 PM

Originally Posted by DOMS

Another issue with this bill is that, as a health care provider, you're not allowed to check the citizenship status of a patient. In other words, Mexicans will flood across the border is even greater numbers to take advantage of free healthcare.

dont forget YOUR haiti peeps doms !!!

**Dark Geared God** · 02-23-2010, 08:27 PM

Originally Posted by GearsMcGilf

If it were introduced to the individual market, I don't see why careful underwriting guidelines that are already being followed now couldn't weed out those who are uninsurable, as they do now.

With the Obama plan, as I understand it, insurance companies won't be able to disqualify people with pre-existing conditions or set a maximum lifetime limit of coverage (i.e. $1 million). That's a sure way to put private insurance companies out of business over the long run. That's sure not the answer.

As it stands now, I can't call an insurer, say in TN, AR, CA, AZ, etc and compare it with BCBS here locally and buy the most competitive policy, regardless of state lines. WTF sense does that make? That just wreaks of politicians in the pockets of big insurance. If I could shop like that, it would have to bring premiums down and ultimately the fees charged by docs and hospitals.

I agree but you can take your car and house insurance from state to state...makes sense?WTF

**KelJu** · 02-23-2010, 08:48 PM

Ok, I have the only rational solution, but is is cold.

Deny any and all assistance to anyone terminal.
Kill all old people.
Kill all violent criminals.
Kill all mentally retarded people.
Sterilize anyone who is born with a dominant gene for an illness. If they get sick, kill them.
Kill anyone on disability.

Anyone left over gets free healthcare!

**DOMS** · 02-23-2010, 08:58 PM

Originally Posted by KelJu

Ok, I have the only rational solution, but is is cold.

Deny any and all assistance to anyone terminal.
Kill all old people.
Kill all violent criminals.
Kill all mentally retarded people.
Sterilize anyone who is born with a dominant gene for an illness. If they get sick, kill them.
Kill anyone on disability.

Anyone left over gets free healthcare!

Can we kill Mexicans, too?

**GearsMcGilf** · 02-23-2010, 09:14 PM

Originally Posted by DOMS

Can we kill Mexicans, too?

Yes, but just the ones that are here illegally.

**ALBOB** · 02-24-2010, 08:18 AM

Originally Posted by KelJu

Ok, I have the only rational solution, but is is cold.

Deny any and all assistance to anyone terminal.
Kill all old people.
Kill all violent criminals.
Kill all mentally retarded people.
Sterilize anyone who is born with a dominant gene for an illness. If they get sick, kill them.
Kill anyone on disability.

Anyone left over gets free healthcare!

Now THAT one I can support. The rest, not so much

I'm alive, therefore I'm terminal
I'm old
I've been told by my wife MANY times that I'm retarded
I have a long history of cancer and heart disease in my family
I'm collecting a V.A. disability from my time in the Air Force

NAH, I Think I'm gonna stick with just killing all the violent criminals.

**bandaidwoman** · 02-24-2010, 08:57 AM

Originally Posted by KelJu

Ok, I have the only rational solution, but is is cold.

Deny any and all assistance to anyone terminal.
Kill all old people.
Kill all violent criminals.
Kill all mentally retarded people.
Sterilize anyone who is born with a dominant gene for an illness. If they get sick, kill them.
Kill anyone on disability.

Anyone left over gets free healthcare!

single payer is the solution with free competition for secondary insurance.

as surgeon general everitt koop stated, by saving 400 billion a year in just paperwork alone, we could subsidize every citizen's health care.

It's insane that my four doc practice has 45 employees ( billers, coders, verifiers, two office managers, people just to do precerts, prior auths, etc. etc.) 6 check in check out people to verify insurance and their benefits ( where I can send labs to , quest, lab corp etc and where i can get a radilogical study, wellpoint hospitals or not etc.). 10 person telephone consoul to field phone calls not just from patients but from insurance companies etc.

It's insane and unsustainable.

**tucker01** · 02-24-2010, 09:06 AM

Originally Posted by KelJu

Ok, I have the only rational solution, but is is cold.

Deny any and all assistance to anyone terminal.
Kill all old people.
Kill all violent criminals.
Kill all mentally retarded people.
Sterilize anyone who is born with a dominant gene for an illness. If they get sick, kill them.
Kill anyone on disability.

Anyone left over gets free healthcare!

Should they have blond hair and blue eyes as well?

**Prince** · 02-24-2010, 09:23 AM

Originally Posted by KelJu

Deny any and all assistance to anyone terminal.
Kill all old people.

you very well be in these two situations, I bet you would then change your mind.

**bandaidwoman** · 02-24-2010, 09:50 AM

Kelju has a point in that most of the medicare expenses are spent during the last few months of a person's life and it may not have necessarily affected their outcome.( look at the dartmouth atlas study) Thus, should doctors like those in Denmark be able to judge when intensive efforts will be futile and deny extreme life sustainng measures even when the family demands it? Right now if a 95 year old with emphysema wants to be put on a ventilator to prolong his life maybe another 2 weeks I can't deny him or her.

At the same time, a end stage cancer patient may want everything done so they can live another three months so they can see their daughter give birth to their new grandson? Who am I to deny that patient those last precious three months?

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