Health (Care Reform bill) provisions begin phasing in Thursday - a great over-view article

[JohnWxy]

http://www.usatoday.com/news/health/2010-09-22-healthlaw22_ST_N.htm?csp=obinsite

Several key consumer protections under the nation's new health law begin taking effect Thursday — six months after its enactment.
Insurers can no longer set a dollar limit on the amount of care they'll provide over a person's lifetime or deny coverage to sick children. Young adults can stay on their parents' health plans until age 26. And consumers get greater rights to appeal insurers' decisions.

"It's really putting in place long overdue consumer protections," Health Secretary Kathleen Sebelius said in an interview with USA TODAY. "It's getting rid of some of the worst rules of the industry that prevented people from getting covered at all or, at a time they needed coverage the most, limited the coverage they had."

Many people, however, will have to wait until Jan. 1 for the changes to help them. That's because most of the new provisions apply to insurance policies that begin on or after Thursday. Many plans operate on a calendar year, and this fall will begin enrollment for next year.


http://www.usatoday.com/news/health/2010-09-22-healthlaw22_ST_N.htm?csp=obinsite#chart">What's Changing

[Cleita]

1. What good is it if there are no caps on premiums and

deductibles. Most ordinary working class people won't be able to afford the coverage regardless.

[JohnWxy]

2. WHat you are describing is what would have happened without Obama and Dems stepping in.

Health insurance premiums were going up so fast that in a few years we would have seen employers dropping group plans and employees not beinga able to afford those that were kept by employers. We would have seen the number of uninsured people explode in the coming years to 30% of the population. That's an untenable situation.

So many people going to emergency rooms for care things would have ground to a halt. We pay for the care of those who can't pay for care at emergency rooms. Governments local, state and federal reimburse hospitals for uncompensated care ($35 Billion in 2004). Those who still could afford insurance would see the share of their premiums due to increased costs of uncompensated care go from the currwent 8.6% to over 10%, contributing to the repid increase in premiums. Of course, caring for people in emergency rooms is the most expensive way to go. It's better to have them covered and getting real health care at doctors offices (instead of emergency health care).

Without taking some action the health care system in the U.S. was headed for disaster. If that would have happened quick disaster relief would have been required ... such as lettinig people of any age into Medicare. A solution many feel would be superior to trying to salvage the for profit medical insurance industry. They have a point. And if this doesn't work that may be what will have to be done.

[Cleita]

3. Sorry, but it's still headed for disaster if they

don't put Medicare out on the market as a choice to buy into in the exchange. The competition with Medicare will force the insurance companies to be less greedy, or even go out of the health care business altogether, which would be a win, win IMHO. People need a real choice in their health care especially with the mandates.

[JohnWxy]

4. Obama felt something had to be done but that the Health care industry

would not tolerate what you just described, short of a crash in the health insurance industry.

So Obams tried a compromise approach. We'll see if it works. Much can be done to negotiate with insurers to keep their skimmed amounts down and with a rationalized system, to work on the cost of professional services. IT's a compromise. We'll just have to see if it can be made to work.

[Cleita]

5. Since it hasn't worked in other states and countries that

the same approach has been tried in, why would it magically work for us?

[JohnWxy]

6. Just trying to be a "good soldier". However, France has regulated private insurers and they have

a profit margin of about 4%. About one fifth what our insurers take - pre regulation(in the Health Car Bill is a provision stating the insurers must pay out at least 85% of their revenues for claims. It's a far cry from 96% but it is a start).

But of course, there is more to this than just regulating insurance companies 'cut' (please, don't ask me what they DO for that cut). There is the revolution in how medical care is provided, measured and compensated. We want to go to pay-for-results as opposed to pay-for-quantity of procedures and tests. You have to have a real system in place to 'pull this off'.

I'm hoping it will work out. If it doesn't, changes will have to be made.

[Cleita]

8. France does not allow insurers to cover basic

health care. The government covers and pays 80% of basic health care and you can buy insurance for the 20% copay and any other bells and whistles you might want. The government also regulates those insurers so that the abuses we see here can't be perpetrated there. Those who can't afford insurance or copays get the 20% covered by the government so that 99% of Frenchmen are covered. People always bring up France as a successful model of privatization but it's not true. As a matter-of-fact if you look at the plans of most European countries, even the ones like the Netherlands or Germany who seem to operate successfully with private insurance and still cover most of their citizens, you will find that basic health care is a right for every citizen and that the governments heavily regulate their insurers, often making basic health care non-profit so the same abuses we see here aren't an issue in those countries.

[JohnWxy]

18. Thanks for your input. I didn't know the government takes care of basic care in France.

[pnwmom]

10. Actually, a private system has been working in Switzerland.

It was one of the models that made people think it might work for us.

http://en.wikipedia.org/wiki/Healthcare_in_Switzerland

Healthcare in Switzerland is regulated by the Federal Health Insurance Act of 1994. Health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).

SNIP
Health insurance covers the costs of medical treatment and hospitalisation of the insured. However, the insured person pays part of the cost of treatment. This is done (a) by means of an annual excess (or deductible, called the franchise), which ranges from CHF 300 to a maximum of CHF 2,500 as chosen by the insured person (premiums are adjusted accordingly) and (b) by a charge of 10% of the costs over and above the excess up to a stop-loss amount of CHF 700.

Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Federal Act. It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.<1>

SNIP

Regulations require "a 25-year-old and an 80-year-old individual pay a given insurer the same premium for the same type of policy..Overall, then, the Swiss health system is a variant of the highly government-regulated social insurance systems of Europe..that rely on ostensibly private, nonprofit health insurers that also are subject to uniform fee schedules and myriad government regulations."<2>

The insured pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, then the government gives the insured a cash subsidy to pay for any additional premium.<1>

The universal compulsory coverage provides for treatment in case of illness or accident (unless another accident insurance provides the cover) and pregnancy. Health insurance covers the costs of medical treatment and hospitalisation of the insured. However, the insured person pays part of the cost of treatment.

SNIP

[Cleita]

12. From your post.

They are not allowed to make a profit off this basic insurance. The insured pays up to 8% of their personal income and the government subsidizes it afterwards. In other words it's highly regulated and your post says it's a variant of the highly government-regulated systems of Europe because it's standardized coverage across the country and the insurance companies have to follow the rules. Non-profit and highly regulated are the key phrases here. Our system has nothing of those safeguards.

[pnwmom]

14. Our plan is highly regulated, and many of the insurers are non-profit.

Obviously, our plan isn't an exact replica of Switzerland's, but it is incorrect to imply, as you did, that no plan in the world has successfully used private insurers. Or that we couldn't start with Obama's plan and work out the kinks till we ended up with a better, but still privately based plan.

[Cleita]

15. Our insurers will never allow a plan like Switzerland's

or Germany's or France's that allow more private insurers than other more government run programs like in Britain or Canada. Has this past year not taught you anything? THEY WILL NEVER ALLOW IT. They don't want any regulation, not even the milquetoast stuff that did pass in the bill. You might want to read this article on the Swiss system.

http://www.pnhp.org/news/2010/september/understanding-the-swiss-watch-function-of-switzerlands-health-system

Understanding The 'Swiss Watch' Function Of Switzerland's Health System

Note from PNHP: This interview makes it clear that in the Swiss system, which is based on private health insurance, the government nevertheless plays a big role. The minister said, when asked who set drug prices in the Swiss system: "I set the prices for drugs."

More at link.

[pnwmom]

16. I believe this year was about calling their bluff.

They say they want to do this and they can do it -- more successfully than a public option. Then let them prove it. If they don't succeed, then on to plan B -- the public option. Or plan C -- Medicare for all.

[pnwmom]

7. Who says there are no caps? n/t

[Cleita]

9. If you read the USA article it outlines what it covers and

doesn't cover and there is no cap on premiums. Nothing is said about how high deductibles can go either. If you can find it anywhere, please post.

[pnwmom]

11. Insurers will be subject to caps that limit how much they can vary premiums

according to age, rather than pre-existing health conditions. And general hikes have to be justified and approved, just as they are now. Some have already been disapproved.

[Cleita]

13. Really, now or in the future because right now the

insurers are on a feeding frenzy of raising premiums indiscriminately. I know. I work in a doctor's office and patients are increasingly complaining about this and it isn't one or two patients but about three out of five.

[pnwmom]

17. They have always been raising premiums but this year they're sending letters

out to your patients falsely blaming rate hikes on Obama's health care plan. However, their increases must be justified and approved by the government and some have already been forced to roll back their planned rate hikes.

OTOH, they can't triple a small business's premiums because one of its employees got cancer. And individual premiums (as opposed to general rate hikes) can only rise with age, and that rise is capped.