Coastie

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http://www.investors.com/NewsAndAnalysis/capitalhill.htm


If some reports are to be believed, the Democrats will pass the Senate health care bill with some reconciliation changes later today. Thus, it is worthwhile to take a comprehensive look at the freedoms we will lose.

Of course, the bill is supposed to provide us with security. But it will result in skyrocketing insurance costs and physicians leaving the field in droves, making it harder to afford and find medical care. We may be about to live Benjamin Franklin’s adage, “People willing to trade their freedom for temporary security deserve neither and will lose both.”

The sections described below are taken from HR 3590 as agreed to by the Senate and from the reconciliation bill as displayed by the Rules Committee.

1. You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)

2. You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).

3. You would like to pay less in premiums by buying insurance with lifetime or annual limits on coverage? Tough. Health insurers will no longer be able to offer such policies, even if that is what customers prefer. (Section 2711).

4. Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).

5. You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).

6. You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.
You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).

7. Do you want a plan with lots of cost-sharing and low premiums? Well, the best you can do is a “Bronze plan,” which has benefits that provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided under the plan. Anything lower than that, tough. (Section 1302 (d)(1)(A))

8. You are an employer in the small-group insurance market and you’d like to offer policies with deductibles higher than $2,000 for individuals and $4,000 for families? Tough. (Section 1302 (c) (2) (A).

9. If you are a large employer (defined as at least 101 employees) and you do not want to provide health insurance to your employee, then you will pay a $750 fine per employee (It could be $2,000 to $3,000 under the reconciliation changes). Think you know how to better spend that money? Tough. (Section 1513).
10. You are an employer who offers health flexible spending arrangements and your employees want to deduct more than $2,500 from their salaries for it? Sorry, can’t do that. (Section 9005 (i)).

11. If you are a physician and you don’t want the government looking over your shoulder? Tough. The Secretary of Health and Human Services is authorized to use your claims data to issue you reports that measure the resources you use, provide information on the quality of care you provide, and compare the resources you use to those used by other physicians. Of course, this will all be just for informational purposes. It’s not like the government will ever use it to intervene in your practice and patients’ care. Of course not. (Section 3003 (i))

12. If you are a physician and you want to own your own hospital, you must be an owner and have a “Medicare provider agreement” by Feb. 1, 2010. (Dec. 31, 2010 in the reconciliation changes.) If you didn’t have those by then, you are out of luck. (Section 6001 (i) (1) (A)).

13. If you are a physician owner and you want to expand your hospital? Well, you can’t (Section 6001 (i) (1) (B). Unless, it is located in a country where, over the last five years, population growth has been 150% of what it has been in the state (Section 6601 (i) (3) ( E)). And then you cannot increase your capacity by more than 200% (Section 6001 (i) (3) (C)).

14. You are a health insurer and you want to raise premiums to meet costs? Well, if that increase is deemed “unreasonable” by the Secretary of Health and Human Services it will be subject to review and can be denied. (Section 1003)

15. The government will extract a fee of $2.3 billion annually from the pharmaceutical industry. If you are a pharmaceutical company what you will pay depends on the ratio of the number of brand-name drugs you sell to the total number of brand-name drugs sold in the U.S. So, if you sell 10% of the brand-name drugs in the U.S., what you pay will be 10% multiplied by $2.3 billion, or $230,000,000. (Under reconciliation, it starts at $2.55 billion, jumps to $3 billion in 2012, then to $3.5 billion in 2017 and $4.2 billion in 2018, before settling at $2.8 billion in 2019 (Section 1404)). Think you, as a pharmaceutical executive, know how to better use that money, say for research and development? Tough. (Section 9008 (b)).


16. The government will extract a fee of $2 billion annually from medical device makers. If you are a medical device maker what you will pay depends on your share of medical device sales in the U.S. So, if you sell 10% of the medical devices in the U.S., what you pay will be 10% multiplied by $2 billion, or $200,000,000. Think you, as a medical device maker, know how to better use that money, say for R&D? Tough. (Section 9009 (b)).
The reconciliation package turns that into a 2.9% excise tax for medical device makers. Think you, as a medical device maker, know how to better use that money, say for research and development? Tough. (Section 1405).

17. The government will extract a fee of $6.7 billion annually from insurance companies. If you are an insurer, what you will pay depends on your share of net premiums plus 200% of your administrative costs. So, if your net premiums and administrative costs are equal to 10% of the total, you will pay 10% of $6.7 billion, or $670,000,000. In the reconciliation bill, the fee will start at $8 billion in 2014, $11.3 billion in 2015, $1.9 billion in 2017, and $14.3 billion in 2018 (Section 1406).Think you, as an insurance executive, know how to better spend that money? Tough.(Section 9010 (b) (1) (A and B).)

18. If an insurance company board or its stockholders think the CEO is worth more than $500,000 in deferred compensation? Tough.(Section 9014).

19. You will have to pay an additional 0.5% payroll tax on any dollar you make over $250,000 if you file a joint return and $200,000 if you file an individual return. What? You think you know how to spend the money you earned better than the government? Tough. (Section 9015).
That amount will rise to a 3.8% tax if reconciliation passes. It will also apply to investment income, estates, and trusts. You think you know how to spend the money you earned better than the government? Like you need to ask. (Section 1402).

20. If you go for cosmetic surgery, you will pay an additional 5% tax on the cost of the procedure. Think you know how to spend that money you earned better than the government? Tough. (Section 9017).
 

geogil

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God Bless America. :mad::mad::mad::mad:
 

japhy

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a lot of these "restrictions" aren't anything but bs. if you know anything about medical regulation you would understand that there are already an insane amount of restrictions on physician ownership of hospital, hospital expansion and the like. when it comes to medicare, these regs have been around for decades. go back and read them.

as far as the quality care stuff, that already happens! its been going on for years. its called the medicare database. so scary... how do you think much of our academic research gets done.

and the things they are providing for are a pretty basic floor.

yawn...
 

Chloroform4Life

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I am obviously anti-making less money, but I wonder if this bill would mean more insured customers, which may balance out the potential cut in pay. Sorry for the run-on sentence.
 

Jeff05

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I am obviously anti-making less money, but I wonder if this bill would mean more insured customers, which may balance out the potential cut in pay. Sorry for the run-on sentence.
35 out of 47 million are going straight to medicaid, so that doesn't help insurance companies. whoever will sign up for actual insurance - will be likely use the system (hey i'm paying for it, might as well use it), so their premiums will not go into the profit column.

since NOTHING has been done about the underlying reason why americans are the fattest and sickest people in the first world - costs will now continue to spiral out of control.

this law is nothing more than another massive, unaffordable entitlement program paid for by the people who will ultimately NOT benefit from it (see in european countries people pay a lot, but at least get the services they pay for. here the people who pay for this program - high earners, medicare recipients with supplemental insurances, providers of healthcare will not benefit, at all).
 

powermd

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35 out of 47 million are going straight to medicaid, so that doesn't help insurance companies. whoever will sign up for actual insurance - will be likely use the system (hey i'm paying for it, might as well use it), so their premiums will not go into the profit column.

since NOTHING has been done about the underlying reason why americans are the fattest and sickest people in the first world - costs will now continue to spiral out of control.

this law is nothing more than another massive, unaffordable entitlement program paid for by the people who will ultimately NOT benefit from it (see in european countries people pay a lot, but at least get the services they pay for. here the people who pay for this program - high earners, medicare recipients with supplemental insurances, providers of healthcare will not benefit, at all).
I agree this bill sucks, and represents an enormous missed opportunity. I can't blame the Dems any more than the Republicans for squandering 8 straight years to get healthcare right (among other glaring issues).
 

Coastie

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This bill isn't a missed opportunity: Dems got exactly what they wanted, and the last thing this bill was truly about is healthcare.

It's about consolidating gov't power, and in the process, taking away freedoms from the American people: period.
 

Impromptu

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this law is nothing more than another massive, unaffordable entitlement program paid for by the people who will ultimately NOT benefit from it
If there is so much money being thrown around, how do I get some of it? (Besides being a politician, politician's family or friend, or politician's donor).
 

lidocaineallerg

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So I take it based on the closure of a previous thread that my question about application of local anesthetic on a patient with a proven lidocaine sensitivity, which may have educated others here (and which was academic in nature), was inappropriate, but this discussion is not. Based on this my only conclusion as a patient is that in my circumstance some of you may actually have killed me out of lack of an answer, or trying things you weren't sure were right. Great forum you have here, folks. I hope your self-satisfaction and comfort with ignorance keeps you warm at night.
 

Gimlet

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So I take it based on the closure of a previous thread that my question about application of local anesthetic on a patient with a proven lidocaine sensitivity, which may have educated others here (and which was academic in nature), was inappropriate, but this discussion is not. Based on this my only conclusion as a patient is that in my circumstance some of you may actually have killed me out of lack of an answer, or trying things you weren't sure were right. Great forum you have here, folks. I hope your self-satisfaction and comfort with ignorance keeps you warm at night.
Sorry you didn't find what you were looking for here. Unfortunately for patients in your situation, SDN is not for medical advice. It is a forum for medical students and doctors to discuss medicine and other topics germane to our lives, such as the one in this thread.

Although your question may have provided some stimulating discussion, the medical liability climate in the US precludes us from putting SDN at risk by continuing that train of thought.

Have a nice night and good luck finding the answers you're looking for.

Sorry you felt a need to lash out at us. Don't let the door hit yer ass on the way out!
 

Depakote

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So I take it based on the closure of a previous thread that my question about application of local anesthetic on a patient with a proven lidocaine sensitivity, which may have educated others here (and which was academic in nature), was inappropriate, but this discussion is not. Based on this my only conclusion as a patient is that in my circumstance some of you may actually have killed me out of lack of an answer, or trying things you weren't sure were right. Great forum you have here, folks. I hope your self-satisfaction and comfort with ignorance keeps you warm at night.
SDN is a resource for healthcare professionals to discuss various aspects of their education and practice. It is not the appropriate forum for the lay public to seek answers best provided by their healthcare provider.
 

Lonestar

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lol. thats funny narcotized.

But on the positive side, I will now have an added incentive to pay off my loans as quickly as possible and start a side business. sorry to all those still in the training trenches. 4-5 yrs from now, its gonna be fun.
 

Pooh & Annie

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This bill isn't a missed opportunity: Dems got exactly what they wanted, and the last thing this bill was truly about is healthcare.

It's about consolidating gov't power, and in the process, taking away freedoms from the American people: period.
wow dude. I think your mess are expired or something.
 

digitlnoize

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1. You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)
Seems to me that that $750 annual penalty will be a hell of a lot cheaper than getting an insurance policy. And with no exclusions on pre-existing conditions, what's preventing me from just paying the fine and picking up insurance if I need it?

2. You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).
This has been my problem with "universal health care" (at least in america) since Day One. Frankly, it's enough to make me want to find a new country. For real.

4. Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).
Look! It's the OPPOSITE of what we should be doing. I think that all pcp office visits and routine care should be paid in cash. This would lower costs, make people take care of their own health, and get the insurance company out of our way, while lowering paperwork and improving patient care.

5. You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).
I actually like this one. Believe it or not, some of us (all of us?) are actually IN SCHOOL until we're 26. It'd be nice if we had actual insurance during that time. This is very good for medical (and other professional) students.

I was actually one of those "slacker" kids myself. I worked 2 35-hour/week (just enough so they didn't have to give me benefits) jobs from 18-22, then a full-time job with benefits from 22-25. I went back to school (to go to med school) at 25 and lost all my coverage. Fortunately, I was able to find my own, not too expensive policy through one of my professional music organizations (I encourage everyone to become a "songwriter" and join BMI. It's free, and there are some good "benefits".)

My point is, that not all of us doctors are self-sufficient at age 26, and penalizing someone's health because they took the road less traveled is a bad thing to do, IMO. Lack of health insurance was a major impediment to my return to school. Preventing people from returning to higher education despite screwing up in their youth is NOT what we need to do.

6. You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.
You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).
Holy crap. I didn't even know this. Wow. Worst thing ever.
 

countingdays

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I think for the first time in this country's history a significant number of people are having those same thoughts. Never did I think I would. It's unlikely I would act on it, but just me even wondering what other countries are better amazes me.
The beauty of the United States SHOULD BE that different states can try different approaches, the best approach will become evident, and other states will follow the leader to better policy. Instead we have more and more federal control with less and less ability to demonstrate the failure of tax, spend, and regulate policy over free market libertarianism.

Our government is becoming exactly the intrusive obstruction to freedom that the Constitution was written to prevent. It seems that the only way to salvage our failing republic would be to have a strictly constructionist supreme court that would reverse the federal power grabs and return us to being a country of the people. Barring that, Article V conventions are the only way I know of for people to reclaim our stolen power and freedom. People are very unhappy with the course of the country, so successful Article V conventions are becoming plausible.


Alexander Hamilton:
"on the application of the legislatures of two thirds of the States [which at present amount to nine], to call a convention for proposing amendments, which shall be valid, to all intents and purposes, as part of the Constitution, when ratified by the legislatures of three fourths of the States, or by conventions in three fourths thereof." The words of this article are peremptory. The Congress "shall call a convention." Nothing in this particular is left to the discretion of that body. And of consequence, all the declamation about the disinclination to a change vanishes in air. Nor however difficult it may be supposed to unite two thirds or three fourths of the State legislatures, in amendments which may affect local interests, can there be any room to apprehend any such difficulty in a union on points which are merely relative to the general liberty or security of the people. We may safely rely on the disposition of the State legislatures to erect barriers against the encroachments of the national authority."

Abraham Lincoln:
"This country, with its institutions, belongs to the people who inhabit it. Whenever they shall grow weary of the existing Government, they can exercise their constitutional right of amending it or their revolutionary right to dismember or overthrow it.

Dwight D. Eisenhower:
"Through their state legislatures and without regard to the federal government, the people can demand a convention to propose amendments that can and will reverse any trends they see as fatal to true representative government."
 
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