This item is full of the usual right-wing bullshit. For example:
"Government can't even run Medicaid or Medicare." Really? Government is doing a great job on both of these programs. Medicare's administrative costs are a fraction of those in the private health care industry. And it provides decent health care for some 40 million U.S. senior citizens, at a fraction of what Big Health Inc. charges.
"Wake up before we lose every single liberty that our forefathers fought and died for." Irrelevant moralizing. What liberty? To pay ever-increasing health care premiums? To find, just before an expensive operation, that our insurance doesn't cover it? To be refused coverage because we once had a disease that is now cured? If that;s liberty, I'll take government "control."
This is in response to Mr. Potter's Huffington Post remarks of late December.
I'm sorry Mr. Potter (how Christmassy is that statement?) but by your own admission this is a gift to the industry and you haven't made any convincing arguments that:
1. The bill can or will be fixed any time in the next 5 years through more legislation
2. That the Kennedy vision that you cite can be reconciled with this awful bill
Unfortunately your post is mostly (unsubstantiated) hope that things will improve and understandable but misguided emotionalism from the stories you've heard and the people you've met. If you regularly read HuffPo you will notice numerous, lengthy, well-reasoned posts about the unlikeliness of the improvements here like those we saw to landmark civil rights bills.
You of all people should know that the industry doesn't care, doesn't cave, and how it manipulates and the end-runs they'll do to avoid the weak enforcement mechanisms in this bill. Your post would have done a greater service if you exclusively talked about the ways they WILL do all those end-runs. At least that way we have a better chance at anticipating future battles and how this will play out.
And you stayed COMPLETELY away form the failure of the president and key congressional leaders to push for anything remotely close to the Kennedy vision/a bill that will FORCE the industry to compete against a powerful govt run option. Maybe you care more about quicker results than entrenched corporatism but some of us do worry about an unholy alliance. This bill will increase and entrench that industry power which makes your reference to their deep pockets and resources all that much more troubling. You say the corporatized system is broken/corrupt yet you advocate strengthening it.
>> progressives can't merely brush off their hands, move on to other issues and hope the stars will align again for "real" reform.
This is a little insulting. This was THE key issue among progressive volunteers I worked with and explains their rage. Besides, the so-called "kill the bill" folks have done nothing of the sort. They're saying either insist that certain things be fixed or walk away and START OVER with a congressional RECONCILIATION bill and a better chance to get a much stronger bill. No one's brushing off anything. No one's consulting an astrologer. Also, since you glibly put "real" in quotes, yes, this is not "real" reform by the standards YOU YOURSELF previously stated.
I understand your sense of urgency to save lives. Frankly, your post sounded a bit like you were burned out. Given that many aspects of this bill don't kick in until 2013 it's clear that this bill doesn't share that urgency. Perhaps a re-crafted bill could be more immediate. In fact, a serious expansion to Medicare or the VA system could be implemented FAR quicker than the current bill and save lives quicker and over timer in greater volume.
I'm also saying to you that the President has sold us out. I worked hundreds of hours to elect him but I won't be fooled. I'm sure you know the level of donations he's gotten from your former industry. Don't enable this bad behavior. Don't copy it. If another legislative go-round is necessary and happens it's especially important that people like you publicly push back against him, Reid and anyone else. He's already lied that he never supported the Public Option. He must not only be pressured by people like you, he must be forced to pressure people like Lieberman which he apparently didn't bother to do.
Please, your previous words were well-informed, insightful, strong and encouraging. Giving up now is not.
I greatly admire Mr. Potter for his guts in coming forward, and for his contribution to returning the health care debate to some level of sanity.
I do have a comment about his statement on MSNBC to the effect that it can be hard to get good numbers on medical loss ratios and the ability of insurers to fudge the numbers with accounting tricks. They may certainly try to do that, but if Congress enacts proper standards, it should be possible for even the most naive regulator to find the correct number.
I was able to get a back-of-the-envelope number simply by using publicly available Census Bureau tables. Although the data available to me was out of date -- from 2006 -- I was able to confirm the general belief that MLR averages 80% or less.
In 2006, according to the Census Bureau, total personal income was a little under eleven trillion dollars. After taxes, they had $9.63 trillion to spend. During the same year, total national expenditures on health care were 2.11 trillion dollars -- an amazing 22% of net personal income.
Now, although $2.11 trillion was spent on health care, only $1.97 trillion was spent on actual health care goods and services. The difference, about 140 billion dollars, is presumably the “net cost” incurred by non-health care providers (i.e., insurance companies, HMOs and similar gatekeepers). That figure includes any income not directly spent for health care, such as advertising, marketing, sales commissions, premium taxes, additions to reserves, and profit.
In 2006, $723.4 billion was spent on health insurance premiums. Deducting the $140 billion leaves $583.4 billion spent on health care providers, which works out to a loss ratio of 80.6 percent. Since the providers spent some of that money on their own advertising and marketing, and their profits, the actual amount spent on direct health care is probably quite a bit less. If the providers spent 90% of their income on health care, that would result in a real MLR of 72.5%.
I was a math major in college, but I'm a lawyer, not a statistician. The lesson is that if I could derive these numbers in half an hour using public information, regulators getting detailed figures from each company could easily do a more accurate job. The key is not to add, but to subtract!
I'm afraid I had great difficulty following your argument - and in the end was unsure what you were advocating. And, I didn't see the monthly premium factored in to the analysis. But, you seemed to be directing your aim in the wrong direction.
What was being discussed was "... an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs."
-- Requiring insurance companies to spend a minimum percentage of premium dollars on the healthcare of their policyholders means more premium dollars will go to pay for healthcare rather than to fatten the pockets of the already obscenely overpaid insurance executives and wall street fat-cats. Their multimillion dollar salaries + bonuses far exceed anything your average general practitioner earns - family doctors, internists and the like are underpaid which is why they are in short supply. I would much rather those who provide high quality care be better compensated, that costly but needed tests be provided, that critical life and limb saving surgeries and treatment be covered rather than go to those whose jobs it is to fatten their wallets and extract increased profits (from your premium dollars) rather than improving and providing healthcare.
I don't know where you'd rather your premium dollars go, but I want mine to go to the care providers, to treatment, to tests, and research and development.
I recently resigned from my independent "consulting" job as a medical consultant performing UR (utilization review) for a very large insurance company. My task was to decide if a medical diagnostic and or treatment request should be prospectively approved, denied, or modified based on the claim history and the use of clinical guidelines.
It became clear to me that my role (and that of my peers was not so independent) and too many of those who made these decisions without ever seeing the claimant used these guides as they were mandates and or standards of care. These decisions were then dictating care not delivered. This process and a statement from my "superior" re: the "% of my approvals" after more than 6 years led to my decision to resign and attempt to blow the whistle.
With health care reform, "evidence based medicine" in the form of guidelines will be used as a manner to decide what should be considered "medically necessary" and may be used in their literal "black and white" language, rather than as a "guide" and in consideration of the individual case in it's totality in context.
The 2009 ARRA has appropriated $1.2B from the DHHS to arrive at "comparative effectiveness research" which will produce more these guidelines for future use( i.e., recall mammogram controversy) when deciding what medical testing and care is "necessary"......
Too often, these guides are not applicable to the case based on the many variables these guides do not take into account. Thus, a provider and their patient need to make an informed and consented upon decision after reviewing these guides in context to the specific case.
It's important that any legislation includes the appropriate use of any guides and should never be used solely as a means to deny care of any type.
Pages