I happened upon this article yesterday, and found it very interesting:

http://online.wsj.com/article/SB1000142 ... st_Popular

This is one point that really concerns me:

"...when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars."

So they are saying, I'm not even allowed to choose to not have insurance! They are basically making it law that you must have health insurance! Sorry, but I have a serious problem with that.

They are also converting Medicare to an HMO-based system, which will end up costing people even more money. For example, if you visit an allergist once a year, you would now be required to FIRST visit your primary car to get PERMISSION to go to their allergist...costing an extra co-payment, extra time, etc...when before they just went straight to their allergist. How is that cutting costs?

If they do this with Medicare, are they going to eventually do away with a PPO model for everyone else, forcing us all to do everything through our primary care doctor? I've been on an HMO...royal pain! My daughter had to make annual visits to the audiologist (she is hearing impaired, and needed new tests every year for her qualifications for services at school). When on an HMO, I had to take an extra day off of work to take her to the primary doctor for him to simply look her over so he could send the info to the insurance to allow us to go to the audiologist. This is someone with a documented problem that required regular attention by the specialist! I paid an extra co-pay, and my insurance had to pay for an extra office visit.

Here is something that is even scarier than that: "The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider." This tells me that these people will not be getting the best care!

I am all for there being health available to those who cannot afford it. I'm also for regulating costs, so that they cannot be outside of reasonable means. I do have problems with being told I will not have a choice in my health care options, and I shouldn't be penalized by my government if I choose not to purchase insurance!

Yup, they've been talking about this since the beginning. It's a carrot & stick tactic, the way they figure it, most people will opt to pay a lil bit more to get insurance rather than pay so much & get nothing. It's really more of a tax than a fine, it's not like speeding where you get a ticket for breaking the law.

The reason why they want to do it is because usually young people don't buy health insurance, because usually they're healthy, they don't really need it, they think they're invincible, often they don't work for places where its affordable, and it simply costs less to pay cash for health care (unless they need a surgery or something bad happens).

Old people, however, use the most in terms of health care treatments- so they cost the most to insure. So the way they see it, if you can coerce all the young people to get insurance, they will end up paying for all the old people who need it. And then, if a young person does end up needing expensive medical care (say they get cancer or something), they're not left in debt for the rest of their lives to pay for it. Since it would keep people from ruining their finances on medical debt, they'd be free to spend money on other things and thus help the economy (or so the idea goes).

Whereas now, if a young person has no health insurance, gets cancer, and racks up a million in medical care debt, they declare bankruptcy, their cars & home get repo'd, all of which end up costing the economy a good deal.



It's cutting costs because general practicians are extremely cheap compared to specialists. If you make everyone go to a GP for a doctor's note, then you run the chance that the GP will be able to take care of them without a specialist, or say "well, you don't actually need this." Both of which saves a ton of money. Specialists can be extremely expensive compared to GP's depending on what the speciality is.

So lets say you have allergies, they hope your GP will just go "well, here's an RX for some antihistamines, take this and if that's enough then you'll be fine, if you need more than that i'll write you a note so you can see an allergist."

The bigger problem is going to be RX coverage. Medicare right now isn't the best for prescriptions. One of my friends is on disability, which means he got auto-enrolled in medicare. They basically have a long list of "average" dosages and that's the most they'll give you. He gets migraines, and they only authorize enough of his prescription to treat 4 headaches per month. So if he gets a 5th migraine attack in a month? He has no drugs left to treat it.

I've had mixed results with HMO's and PPO's. My last HMO was actually decent as far as access to specialists went, and the drug plan was fairly cheap. Basically they had a tier plan where you paid $5 for each 30 day supply of a generic drug, $15 for something more expensive, $35/month for a name brand drug. Since I only used generics I was only spending like $40 a month for drugs under that HMO.

Then I switched to a PPO. Their drug plan was an equation. They took the cost of the drugs and made you pay a percentage of that. My drug costs went from $40 a month to $400 a month just because now I was paying a %. Same exact drugs, pharmacy, and dosages. That's almost as much as I spend a month on rent!

I think public health care and reform of the current system is really just passed one stepping stone by the support of the House of Reps. I think it's tricky and it is going to take some time to work things out to where it is extraordinarily functional.

I've never heard until reading that article that people can be fined for not having insurance. This seems ridiculous. What if someone simply cannot afford it? The government can't get blood out of a turnip, by fining someone who is economically struggling to the point where it is simply an expense that they cannot afford- what will fines do? Ruin credit through wage garnishments order by federal courts? Take your income tax return?

Shady business.

I do support this type of reform, but I try to look at it realistically. It's not something that is going to be perfect upon it's roll out. It's probably going to take decades to tweak it so that it is more efficient for everyone.

Basically it is a middle class tax. "Buy our policies or we'll fine you." If you're below middle class, you get a credit from the feds that you then use to buy a policy from the exchange. If you're poor (by whatever standards they come up with) it doesn't cost you much, in some cases nothing at all.

But i wouldn't expect all middle class families to afford buying policies easily, if someone is stretched thin now in that demographic (like your family with 2.6 kids where 1.6 of them are in college and the other 1.0 is about to finish high school), they're going to have it worse under this system because the middle class, especially young middle class, is basically what's paying for the whole program. Worse is relative though, it would be much cheaper for say, someone needing to buy insurance with a preexisting health condition (which, btw, includes as it is right now- being female and capable of reproduction), or someone who has no insurance whose kid is about to need a heart transplant.

I'd be more concerned though, over the Stupak amendment. The senate is surely going to pass the bill as it is with the Stupak amendment intact, which means under the program only the wealthy will be able to afford reproductive rights health care (abortions) since it removes that coverage from basically all the policies you can buy in the exchange. Who knows what else they'll start to exclude coverage of based on religious/morality objections later; std care, certain kinds of contraceptives (I would almost count on an eventual targeting of the morning after pill). The message is pretty clear to me though: "give us the power to control how health care works, and we'll strip away anything our powerful conservative factions demand so they don't feel like their tax dollars are subsidizing your sinful lifestyles." I can only begin to wonder what kind of crazy health care restrictions could be implemented if the republicans regain control of congress, or worse congress and the president's mansion.

We've always been told that if we need anyone in the family to go to a specialist that we need a referral from the PCP, there's nothing new about that one.

"Basically it is a middle class tax. "Buy our policies or we'll fine you." If you're below middle class, you get a credit from the feds that you then use to buy a policy from the exchange."

That's part of what bugs me! How much more tax are they going to take from us middle class? We are the ones who, as a whole, work the hardest, yet percentage-wise to our income, we are paying the most in taxes! Yes, rich are paying more in actual dollars, but with all the loopholes they have, the percentage of their income is actually lower. The poor are not paying any taxes...at the end of the year they basically get all they paid in back, plus some due to the earned income credit. Why do we always get punished for working hard and not coming from families with money?

You are also right about many families not being able to afford it. For my family income, it is predicted $15,000 premiums and $5,300 out of pocket per year. So, if my employer covers the required 72%, I'm still paying $350/month and $5,300 out of pocket (I'm sure that is deductibles). That is a lot!!! My current policy is about the same per month my portion, but my deductible is only $250 per person per year, and co-pays are $20/visit! Even with a family of 5, you can see I don't pay close to that out of pocket! Even if I am allowed to keep my current private option, how is the government option more affordable? If folks cannot afford what I'm paying for now, how will they afford that kind of public option plan?

As for being forced to go to a GP for everything first...yes, I can understand how for some problems, the GP may be able to resolve it in the first visit. However, people with verified issues will not be able to go to their specialists without going through a GP. All insurance needs to find a way to make this simpler! We have computers! Can't it be noted...this person has this condition and is from this point on permitted to go to this specialist at any time without first seeking approval from the GP! My GP said years ago there wasn't anything they could do for my allergies, and told me I needed to see an allergist for that, especially since my allergies were complicated by my asthma. I have to visit the allergist once a year during a particular season to get inhalers and another asthma medicine which has been found to also control allergies. Even on the PPO, I already have to jump through hoops to get my meds, because my PPO does not cover the medicine to be used for allergies (which so many doctors are doing). My allergist has to fax in a letter to the insurance that I am an asthma suffer (every time...they should have this on file by now), so they can clear the pharmacy to fill the prescription. I am guessing that this is because of the cost of the medicine to the insurance (the medicine is SINGULAR). If my PPO is that picky, I can only image how difficult it would be on a government HMO!!

"The message is pretty clear to me though: 'give us the power to control how health care works, and we'll strip away anything our powerful conservative factions demand so they don't feel like their tax dollars are subsidizing your sinful lifestyles.'"

This is what scares me the most! I definitely do not want the government deciding what procedures I'm going to be permitted to get. It will start with thinks like abortions, and then turn into the very thing that has already been rumored, but the White House swears is not true...denial of procedures on elderly and such that could help extend their lives, simply because they are already old or potentially terminal! I'm not going to simply be put on some meds to make my "last days" more comfortable when there is a procedure that could help me live another 10+ years! I am not going to be denied treatment because of my age or ailment! God will determine how long I live on this earth, and if God gave doctors knowledge that can extend my life, than that is His will! Our government is not God, and has no place saying who can and cannot get what treatments!

Only because I haven't seen anyone link it yet, here is the actual healthcare bill as it was submitted last week.

~spidey

-- Sun Nov 08, 2009 8:55 pm --



In the actual bill you will not simply be taxed "thousands of dollars". To be specific, the bill reads:


And acceptable healthcare coverage is pretty much anything from employer-supplied coverage, to Medicaid. It doesn't sound like it will be all that hard to find coverage you can afford, so there should be no reason not to have it.

To me, this is fair. If you basically go out of your way to avoid having health coverage, you should have to contribute extra to the taxpool since that's where the money will come from when you wind up in the hospital (provided you're not rolling in money - but then why would you not have insurance?).

~spidey

If I am reading this right; how much you'd get fined... er taxed, would depend on how much taxable income your household has. For some families as its described above would amount to thousands of dollars. Less than what it would cost to get insurance, to be sure.

And my argument is that if you make so much money that a 2.5% tax on your AGI would equate to "thousands of dollars" why would you not be carrying coverage?
A 2.5% tax equal to $2000 (i.e. "thousands") would mean you make $80000/year and you mean to say you can't afford to buy health coverage?

Edited to add:
Of course, I see your point if your insurance winds up being $350/month in which case you are paying twice your fine in coverage costs so you may opt NOT to carry coverage (which is still an option - you don't HAVE to carry coverage so long as you are ok with paying the additional tax).

Edited to add:

~spidey, who is hitting submit waaay to early...lol

-- Sun Nov 08, 2009 9:22 pm --

Just found this tidbit as well


Looks like so long as you have put in for a waiver stating that you don't make enough money to afford coverage, you won't have to pay the tax.

~spidey, who is plodding through the 1,990 pages of this bill still...

Well, I can only speculate here- myself with all my medical problems I can't imagine ever going without health insurance of some kind. But I can see why some people might think they don't need it; a lot of people in this world simply think "it won't happen to them" and that they won't need insurance.

Think about car insurance, there are still some states where it's not required. I lived in one state where it was optional, and you wouldn't believe how many people refused to buy car insurance thinking "hey, I am a safe driver- why would I need this?"

Health insurance is seen the same way to a lot of people. If their money is stretched thin, and they've always been really healthy (never needed to use a hospital, never had any surgeries, no major medical problems) and are young, they might get in that "this is just going to waste me money" mindset. And truthfully, they're right- you don't need insurance until you need insurance, the problem is if you wait until you need it, you've waited too long.

So if you have a typical mid to lower upper SEC American family with 2.6 kids, typical as in living beyond their means (house with a big mortgage, or possibly even a 2nd or 3rd mortgage on top of it, 4.6 cars so no one has to car pool, cable TV, steady stream of replacing consumer goods- tvs, computers, cell phones with the latest & greatest....), putting all 2.6 kids threw private college at 40 grand each per year... then I could see them not having the $10-15 grand it would cost to get the whole family health insurance, despite a household income of 100+ grand per year. Under this type of scenario, unless they opt to change their living conditions the tax might make more financial sense to them than getting health insurance. It's not that a family like that can't afford insurance, its that they don't want to. You remember that commercial ~3 years ago with a guy riding a lawn mower around talking about how "great" his lifestyle is, how he's in the country club, has a giant house, new cars, an inground pool- and then after the whole commercial he says at the end "and how am I paying for it? I am in debt up to my eye balls!" That's more what I have in mind here.


Edit; here's the ad: http://www.youtube.com/watch?v=hn5EP9StlVA

Everyone in the restaurant industry working double shifts for less than minimum wage found this hillarious. So Did the temps at the warehouse I used to work at, and... basically everyone not privileged enough to have a degree. work graveyard shift at a fast food joint for a night, and then tell me how hard the middle class work.


Try sitting at home, HOPING you get better on rest and over the counter meds, fearing that you'll be paying some hospital bill for the rest of your life if you don't. And knowing each day you rest is a day lighter that paycheck is going to be, no paid days off in the lower class job force. That is fear, that is what noone should face, just so the privileged class can have less 'hoops' to jump through. Don't worry real viable health care will not happen, not when we care only about ourselves.

When you pay over $10,000 in payroll tax, based on the IRS guidelines for deductions, and then have the IRS tell you they want several thousand more from you at the end of the year? Then, we get to sit back and watch the government squander our money away as if it were nothing, with no real benefits to us tax payers! Many of us middle class don't get refunds at the end of the year, we get bills!!!

Let me also share with you that many of us are exempt employees, which means that our companies can work the crap out of us and not have to compensate us for it! I just got through working 4 straight weeks without a single day off, and none of those days were a simple 8-5 kind of day...working evenings, strange night hours, etc. I didnt' get any extra pay. I don't get any extra days off in replacement of the extra days I worked. Because we are a 24-7 shop, we have a "graveyard" shift...15 straight hours for 7 days straight when it our turn....6 p.m to 9 a.m...very stressful hours because if you screw up, and a customer's reports are late, you have hell to pay! In my company, you are the ONLY person work the shift, and it all falls on you! You have 100 systems to keep moving, and there have been many times that more than half those servers have just stopped, and you are frantically trying to get them all moving again as to not delay the customer's product!!! Not all degrees put one into cushy jobs...most don't. IT for example, can be a very high stress, long hour job depending on where you end up working (like me, and several others I know). ER and hospital doctors and nurses have terrible jobs, often working 20 hours or more in one day!

And I'm not saying that we shouldn't have a public options health care, I'm saying that it shouldn't be forced on us to buy into the governments policy! That is illegal, and it is unconstitutional! BTW...I have sat at home HOPING that I would get better because my insurance company has jacked up the co-pays, as well as the drug companies jacking up the cost of the meds! My inhaler, which I need very regularly, went from being $7 (that was total cost, not after insurance) to $40 (after insurance, because total cost is over $100). My other prescription is also $40. Neither is that cost for the amount of meds I used to get either, so they are required to be filled more often. I can't afford $80 every two weeks for these things, so I have been doing without! AND I HAVE INSURANCE! However, I can't afford the $250 deductible right now, especially if that means on top of that I have to find $80 to get 2-weeks worth of meds! And here is the kicker...you want to know why my inhaler went from $7 to total cost of over $100? Because the global warming people said that the propellant was hurting the ozone, so they had to use a different propellant and put it in a different type of pump! How dumb is that, when I am breathing the med AND the propellant into my lungs, not spraying it out in the air!!! So now, many of us asthma sufferers go without, because we cannot afford the new price, and we are risking our lives by doing so...but what can we do! I try to do my best with OTC.

I think the biggest fear regarding this health care bill is the knowledge that government always tends to "grow" itself -- and not always effectively. That's the nature of the beast.

Universal public education was a great idea -- for an educated society would be better able to improve its standard of living. But our public education system in many areas of our nation is in a shambles, and it's doubtful that the children emerging from it are benefitting much. Teachers unions are in control in many places, to the extent that "bad" teachers cannot be fired from their jobs. In addition, school taxes make up a staggering portion of the typical homeowner's tax bill.

I admit that health care in the U.S. is a pressing dilemma. But I can't see the government attempting to solve it without the government's solution eventually coming back to bite us on the ass.

-- Nephele

If that were true you could make the same argument for states that force you to carry vehicle insurance.



And this is the broken part of the healthcare system that this bill is attempting to repair. IF it goes into effect and works like it is supposed to, your medical costs should go down. I am hopeful, but like Nephele has said, it will most likely fall apart in the end due to the fact that the government doesn't want to step on anyone's toes and go whole hog into a well-controlled system. They are trying too hard (imho) to please and I think they need to start pissing people (read: drug companies, private insureres) off a little more.

~spidey

Who the government SHOULD be going after is the drug companies and providers for jacking up prices, NOT the people requiring the care. Unfortunately, they are in it together, in reality. Look at the new H1N1 vaccine...a fast-tracked, untested vaccine that is require in two doses and is being pushed by our own government! This is not the first time, and the the last time this was done with the "swine" flu vaccine, many HEALTHY people who got the shot ended up with permanent health issues directly related to the vaccine! Gardasil...same thing. Fast tracked, not well tested, being pushed on the people. What is worse, if the government takes control of the health care system, in the future, you are going to be told that if you get sick from say H1N1, and you did NOT get the vaccine as your government advised you to, they will not cover you! Think it is way off...just wait! Once the government gets control of health care, they are basically in control of your whole life, as your life depends on how healthy you are! They will be able to force you to get vaccines that could end up causing you more problems by telling you they will not cover you if you don't get it. They can have the right to determine if you get a life-saving treatment, or you are just given meds to make you passing comfortable. I personally do not like the idea of the government having this kind of control over my life! People are just blindly giving up more and more rights...believing what their government tells them is in their best interests, which many of us know that the government is not truly concerned with....the best interests of the people! Otherwise, this is something we would be allowed to vote on!!! No taxation without representation! Yes, that is supposed to mean that we have representatives vote in our proxy on Capitol Hill. Problem is, due to the lack of term limits, it is very difficult to vote a person out when they are no longer representing your interests. Anyone who tries to run against them is at a disadvantage from the get go due to funds and name recognition. The way to the any office is based on how much money you can spend! So, the only way we can represent ourselves is by direct vote on the issues.

And forcing car insurance is different that forcing health insurance. You can choose whether or not you drive. If you do drive, you are putting yourself behind the wheel of a potential deadly weapon, and what you are really getting is proof that you can pay for another's injuries and damage if you operate your vehicle incorrectly. If you don't drive, you don't get the insurance. You can choose to walk, ride a bike, use public transporation. I have a friend in CA who does not own a car. She lives fairly close to work and uses those very options to get to work. She isn't required to get car insurance, because she does not have a car. It is her choice.

We will not have a choice but to buy into the government system. Why? Many employers are already saying that they will drop private coverage and have employees opt into the government option if it passes, because it will be cheaper on the employer. We will not have a choice, because the luxury of private insurance will be too high...will only be for the elite rich! The poor will get free health care, the middle-class will be fined if they don't pay whatever price the government sets, and the upper-class will have their private care!

Personally, for the most part, I think insurance is a big scam. You pay out outrageous amounts in the event something MAY happen, and you don't get any kind of refund if you do not use the policy at all that year. You may get some kind of a discount at renewal, but that discount for some reason is always less than the amount the insurance is being jacked up that year. Perfect driving records, and our car insurance has gone up every renewal...this last time $50/month! Why?