Obama's Blueprint on Healthcare

[au2004ece 30]

I've been challenge by ruinred to read Obama's Blueprint for America and cite where I disagree.

http://www.barackobama.com/pdf/ObamaBlueprintForChange.pdf

Subsidies: Individuals and families who do not qualify for Medicaid or SCHIP but still need

financial assistance will receive an income-related federal subsidy to buy into the new public

plan or purchase a private health care plan.

This is what I was talking about when I mentioned that some would be FORCED to pay for the healthcare of others. These subsidies will come from taxpayer money. When the government provides subsidies to a group, they only increase the group's dependence on government. For children this is fine, but when individual adults are included in the subsidies, I see a problem. There is no mention that the subsidies will be provided for only X amount of time while the individual again becomes self-sufficient, therefore I see no incentive for an individual to again become self-sufficient. Why are these people ENTITLED to health insurance at the expense of others?

(2) National Health Insurance Exchange: The Obama plan will create a National Health Insurance

Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a

watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on how healthy you are. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

The part that says "Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on how healthy you are. The Exchange will require that all the plans offered are at least as generous as the new public plan" is what troubles me.

The government should not tell insurers they must insure everyone who applies. The government should not regulate prices ("fair and stable" premiums). Read that again ("Insurers would have to charge fair and stable prices"). This means that the government will be setting what prices are fair and what stable prices mean. So, the government will be setting prices. This sounds a lot like the government taking over the entire healthcare industry to me. (This is a place I see Socialism in Obama's plan) It sounds like the real goal of these proposals is to run the private insurers out of business (little chance for profits) so that everyone must then participate in the government plan.

But, that's not the only problem here. The government will be telling all insurance companies that all plans they offer must be as "generous" as the plan offered by the government. Why? Shouldn't a company be able to offer any plan they like. If somebody buys it, then it is a needed plan. Why can't the insurance companies offer lower cost, catastrophic only coverage if somebody will buy it?

(3) Employer Contribution: Employers that do not offer or make a meaningful contribution to the cost of

quality health coverage for their employees will be required to contribute a percentage of payroll toward the

costs of the national plan. Small employers that meet certain revenue thresholds will be exempt.

Employers should not be forced to offer health insurance or pay more taxes. This should be a choice for the employer.

(1) Reducing Costs of Catastrophic Illnesses for Employers and Their Employees. Catastrophic

health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan

would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold

if they guarantee such savings are used to reduce the cost of workers’ premiums.

This is describing more government subsidies for healthcare. Why do this? Let the companies charge enough in premiums so that they can cover the costs.

and making the health workforce more diverse.

Sounds like more affirmative action. Affirmative action in healthcare hiring will cause a decrease in quality, because the standard for being hired will shift from qualifications based on skill to qualifications based on race.

Reform Medical Malpractice: Obama will strengthen antitrust laws to prevent insurers from

overcharging physicians for their malpractice insurance

Haha. According to Obama, the insurance companies that charge a lot for malpractice insurance are the problem, not the number of lawsuits.

His plan will force insurers to pay out a reasonable share of their premiums for patient

care instead of keeping exorbitant amounts for profits and administration.

So, under Obama's plan the government will set the amount of profit that a healthcare insurance company can make. Why don't we start setting a cap on profits for car insurance companies, or restaurants, or hotels, or whatever? Creating profit ceilings is another method of taking control of the entire system and forcing more people into the government plan when the restrictions become so much that a company cannot operate with a profit.

These are a few of the area where I find that I have disagreements. I disagree with the premise that this is a situation where the government acts, but if the government is going to act I would prefer they act in a less destructive manner.

[Auburn85 436]

yeah, the employers part i don't get

on page 3 the piece states: "Rising costs are also a burden to employers, especially small businesses, which are increasingly unable to provide health insurance coverage for their employees and remain competitive."

then, on page 4-5 it states: " Employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality healthcare coverage for their employees will be required to contribute a percentage of payroll towards the cost of the national plan."

what will be considered a meaningful contribution? Couldn't find much detail in this plan, just alot of on the surface talk.

meaningful contribution... is he wanting a healthcare tax put on businesses according to size and profit? meaning tax businesses like individuals by placing business income in different tax brackets?

[pensacola tiger 0]

au2004ace.......very well said. There was no name calling or pettiness. You responded well to the ideas in the plan with wich you disagree. I agree with every point you made. But even if I didn't I would still think it was a well thoughtout, intelligent response.

[au2004ece 30]

au2004ace.......very well said. There was no name calling or pettiness. You responded well to the ideas in the plan with wich you disagree. I agree with every point you made. But even if I didn't I would still think it was a well thoughtout, intelligent response.

Thanks. But now I'm left with an empty feeling. I thought TitanTiger or RuinRed would be able to at least provide an argument about why my concerns were not valid. Now I can only think that supporters of this plan know the items I have pointed out will have destructive effects on healthcare and yet still wish to have Obama make this plan a reality.

[MDM4AU 337]

au2004ace.......very well said. There was no name calling or pettiness. You responded well to the ideas in the plan with wich you disagree. I agree with every point you made. But even if I didn't I would still think it was a well thoughtout, intelligent response.

Thanks. But now I'm left with an empty feeling. I thought TitanTiger or RuinRed would be able to at least provide an argument about why my concerns were not valid. Now I can only think that supporters of this plan know the items I have pointed out will have destructive effects on healthcare and yet still wish to have Obama make this plan a reality.

So, since Titan calls you out on the socialist thing, he's automatically supposed to be an Obama supporter and disagree with you on everything. You're either for him completely or against him completely....is that it?

[RunInRed 18,089]

au2004ace.......very well said. There was no name calling or pettiness. You responded well to the ideas in the plan with wich you disagree. I agree with every point you made. But even if I didn't I would still think it was a well thoughtout, intelligent response.

Thanks. But now I'm left with an empty feeling. I thought TitanTiger or RuinRed would be able to at least provide an argument about why my concerns were not valid. Now I can only think that supporters of this plan know the items I have pointed out will have destructive effects on healthcare and yet still wish to have Obama make this plan a reality.

I agree...good post. Sorry, I have not had a chance to craft a meaningful response yet...but it's coming...

[TitanTiger 21,040]

Patience, grasshopper. It's not like you posted a question asking me my favorite ice cream flavor.

As I see it, it comes down to whether you see healthcare as a privilege in the same class as the having a nice car, a flat screen TV, a house in a gated community and so on or whether you see it as a basic human right such as food, clothing and shelter. When you see that the #1 cause of bankruptcy in this country is due to medical bills, you question whether we're on the right course. I'll come at this from two angles:

1. Employing the cliche of "What Would Jesus Do," and trying to imagine His answer to the privilege or right question, I have a very hard time making a case that He would say, "good healthcare is a privilege for those who can afford it."

2. I can't see how anyone could believe that getting everyone to have decent health insurance isn't a worthy and noble goal to shoot for.

So, the question, if you think along those lines, is how do you achieve that? I don't like the model of Britain and Canada because the quality of care seems to go down and taxes are astronomical to pay for it. So, I'm open to ideas on how to make good healthcare available to everyone while avoiding rationed care and exorbitant taxes. That likely will involve some form of government intervention and might involve some degree of subsidy for the poor. I don't have a problem as long as my aforementioned caveats are kept in mind and under control.

Reform Medical Malpractice: Obama will strengthen antitrust laws to prevent insurers from

overcharging physicians for their malpractice insurance.

Haha. According to Obama, the insurance companies that charge a lot for malpractice insurance are the problem, not the number of lawsuits.

Actually both are a problem. Insurance companies have been jacking up malpractice insurance premiums in ways that do not even come close to corresponding to payouts from lawsuits. But you'll also find that the major reason for increased health care costs the last 15 years isn't lawsuits. From the conservative Cato Institute:

• The first, and by far the largest excess cost, is due to the current overuse of medical resources by patients. Overuse is the rational response of consumers who do not have to pay the entire cost of the medical services they use. The causes of those excess costs are Medicaid, Medicare, and tax laws that provide incentives for individuals to have their employers purchase their medical care in the form of private health insurance.

http://www.cato.org/pubs/pas/pa211.html

Also from PriceWaterHouseCoopers:'

Higher utilization of services accounted for 43% of the increase, fueled by factors such as increased consumer demand, new and more intensive medical treatments and defensive medicine, as well as aging and unhealthy lifestyles. Price increases in excess of inflation accounted for 30% of the increase and were impacted by movement among purchasers to broader-access health plans, provider consolidation, increased costs of labor and higher priced technologies.

http://www.ahipbelieves.com/press-releases...owth-slows.html

So, 73% of the increases in health care costs come from thing that have nothing to do with malpractice and lawsuit payouts have not increased anywhere near the rate that the insurance companies have increased malpractice premiums to make up for less growth in their investment portfolios.

In a nutshell, there's my take. I see healthcare as more of a basic need than a luxury, so it doesn't really compare to things like restaurants and hotels. As such, I think it's a worthwhile goal for a society as affluent as ours to at least get all children (who can't be held responsible for their parents bad decisions or laziness) covered under a good healthcare plan. If we can get everyone covered and not ration care or break the bank in taxes, then that's a good goal too. We shouldn't settle for the quick and simple answers given by either extreme of this debate.

[RunInRed 18,089]

Let me just open by giving some basic observations of the plan:

His plan is centered around a new regulatory agency called the National Health Insurance Exchange, which is both responsible for regulating the insurance industry (more on this in a moment) and administering the new public insurance program Obama's plan creates. Simply put, I view his plan as much more of a regulatory agency than I do some "socialistic government healthcare initiative" and I think that's a big area where we see things differently.

Obama's plan does not set the public and private plans in competition with each other, as some others have proposed. Rather, the best way to think of it is as a two-track plan. The first track extends the new public program to the self-employed, small businesses, and the uninsured. In other words, the public plan is open to those who are currently disadvantaged in the insurance market -- it is not a new insurance market unto itself. That said, if it proves popular and effective, it would be trivial to expand it in the future, letting all businesses, or all individuals, buy in.

The second track (and where I think most of us would likely fall into) is a restructured insurance market. Participating insurers -- and as of yet, it's not clear to me whether insurers have to participate, or whether their participation would be optional -- will have to offer minimum benefits, spend a certain portion of their budget on patient care (rather than profits and advertising), be barred from discriminating on health history, and be forced to justify large premium increases. Employers will have to either pay into this market, or pay into the national plan. This approach makes a whole lot of sense to me and would begin to address the ridicuous healthcare cost problems.

From there, Obama has a lot of the normal additions of preventive health care, electronic medical records, chronic disease management, etc. A notable omission is any sort of mandate for adults: This is a plan that would make universal coverage affordable and feasible yet still allow those who do not want insurance to opt out. Hardly socialistic in my opinion.

One thing also not to be missed as its relatively buried in the proposal: transparency on cost and quality. Extremely insightful, on the mark in terms of need, and probably has the greatest potential for positively impacting our health care system in the long-run.

So why do we need universal healthcare and how do we pay for it you ask?

Surprisingly, we already spend more than enough money on health care to finance comprehensive universal health coverage...the latest statistics I saw (and you'd have to google) says the U.S. spends somewhere in the neighborhood of over $6,000 per person in the U.S. per year - two to three times the amount spent in other countries that insure everyone. And we still have ever increasing cost, an unstainable system, and individuals who simply can no longer afford any coverage. In basic principle, I think the current approach is not only not working but that is putting many people on a path of financial destruction. I personally believe that by correcting the inefficient way we finance health care we can both save lives and money.

Bottom line...I believe in "a more perfect union" and I want some one who in office who is committed to addressing this problem. Obama has put forth a plan that may have flaws but definitely begins the conversation and seems to be a reasonable approach.

Okay..now onto some of your specific concerns....

Subsidies: Individuals and families who do not qualify for Medicaid or SCHIP but still need

financial assistance will receive an income-related federal subsidy to buy into the new public

plan or purchase a private health care plan.

This is what I was talking about when I mentioned that some would be FORCED to pay for the healthcare of others. These subsidies will come from taxpayer money. When the government provides subsidies to a group, they only increase the group's dependence on government. For children this is fine, but when individual adults are included in the subsidies, I see a problem. There is no mention that the subsidies will be provided for only X amount of time while the individual again becomes self-sufficient, therefore I see no incentive for an individual to again become self-sufficient. Why are these people ENTITLED to health insurance at the expense of others?

At Titan pointed out, it is about priorities. Do you feel we ought to try to present affordable healthcare to all or do you want to just let every body fend for themselves? My argument is that we have tried the later approach and it is not working - cost are astronomical, people can not afford coverage, businesses are struggling to meet the benefits bar (healthcare article from Starbucks' CEO), and medicare at its current pace is unstainable.

My position is that I want to do some thing to bring down cost for all. This does not mean "free government healthcare for all." In fact, I am not looking for a handout but I do think that with a slight change in priorities, the public and private sectors can solve this problem together.

Does it mean that there could have to be some subsidies for the poor? Yes. I think even McCain said the other day that the affluent should pay higher deductibles, (same concept). So how do you pay for this? Rolling back the tax cut on the wealthy (those making over 250k) to the levels they were at in the 90s (35% to 39%) and ending a war that cost $300M+/day would be a decent place to start.

What I also think you are missing is that we are already incurring the cost of providing healthcare to "the poor" under the cloak of higher costs - who do you think picks up the tab when someone is rushed into an ER with no insurance coverage?

(2) National Health Insurance Exchange: The Obama plan will create a National Health Insurance

Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a

watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on how healthy you are. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

The part that says "Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on how healthy you are. The Exchange will require that all the plans offered are at least as generous as the new public plan" is what troubles me.

The government should not tell insurers they must insure everyone who applies. The government should not regulate prices ("fair and stable" premiums). Read that again ("Insurers would have to charge fair and stable prices"). This means that the government will be setting what prices are fair and what stable prices mean. So, the government will be setting prices. This sounds a lot like the government taking over the entire healthcare industry to me. (This is a place I see Socialism in Obama's plan) It sounds like the real goal of these proposals is to run the private insurers out of business (little chance for profits) so that everyone must then participate in the government plan.

But, that's not the only problem here. The government will be telling all insurance companies that all plans they offer must be as "generous" as the plan offered by the government. Why? Shouldn't a company be able to offer any plan they like. If somebody buys it, then it is a needed plan. Why can't the insurance companies offer lower cost, catastrophic only coverage if somebody will buy it?

Well, in an ideal world, insurance companies would act in manner that would not require regulation. But just like letting a kid run wild in a candy shop unattended, trouble results. I'm not sure you are accepting the situation this country faces. The current policies and practices of insurance companies have left families in bankruptcy, have prevented those from getting the medicines and treatments they need, and have burdened our economy with costs that are becoming unaffordable - and not just to the poor. Look, we regulate our financial markets, the airline industry, the oil industry and on and on. Rules that protect the citizens of this country are not socialistic ideals - it's a government that is working for the people.

(3) Employer Contribution: Employers that do not offer or make a meaningful contribution to the cost of

quality health coverage for their employees will be required to contribute a percentage of payroll toward the

costs of the national plan. Small employers that meet certain revenue thresholds will be exempt.

Employers should not be forced to offer health insurance or pay more taxes. This should be a choice for the employer.

Again, we have the problems of employers who are not doing the right thing and employees are getting hosed as a result. I would like to know more in terms of what he means by "meaningful" but I think the basic idea is right. Also note that he says small employers would be exempt.

This again comes back to my point that when people don't have affordable insurance, every one else pays. So on the flip side, why should I have to absorb the cost of higher insurance because a large employer chooses not to provide healthcare to their employees?

It's about bringing everyone inline and creating a system that works for all. You can't just tackle insurance companies - you have to look at all inputs and employers are a key factor.

(1) Reducing Costs of Catastrophic Illnesses for Employers and Their Employees. Catastrophic

health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan

would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold

if they guarantee such savings are used to reduce the cost of workers’ premiums.

This is describing more government subsidies for healthcare. Why do this? Let the companies charge enough in premiums so that they can cover the costs.

And what happens when you can no longer afford the premium? What happens when you end up in bankruptcy because you had a catastrophic illness? Just a second ago you were griping about employers having to contribute and now you are griping because the plan wants to help employers cover catastrophic costs.