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Harrison 11-07-2009 06:54 PM

Affordable Health Care for America Act (H.R. Full Version)
Those of you following a proposed trillion-dollar healthcare overhaul know that this behemoth legislation is being debated at this very moment. The 1990 page bill can be found here (and other places).

An op-ed letter in a major US Newspaper recently quoted the prescient wisdom of James Madison, in relation to this particular “healthcare bill monstrosity,” which is 19.6 pounds printed:
“…It will be of little avail to the people that the laws are made by men of their own choice if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man who knows what the law is today can guess what it will be tomorrow…”
Jane Sasseen’s article in Business Week seems to echo this concern in another way, going so far as to call this pricey reform a “Tax Hike by Any Other Name.” She raises some good points in the article – like how the middle class will end up footing much of the financial burden for this change. Also in this article, Jane mentions how device-makers may be forced to pony up more bucks - $120 billion over the next decade. And it is anyones guess how that translates back to us patients. In the meantime, more and more people are receiving ortho implants, so maybe Uncle Sam is raiding the treasure chest!?

Please answer the one-question poll herein. And offer your comment regarding this complicated, but well-intentioned bill.

rhatzy 11-08-2009 10:27 AM

Madison, Jefferson and the rest were brilliant men who understood government but also most important human nature and their writings and views are still relevant today. It's a shame that most of our politicians more than likely have never read any of their works, especially the consitution. These great founders of our country warned of us people like Pelosi, Obama, Reid and the rest of the ilk.


Jack 11-16-2009 09:07 PM

From a NC newspaper, article on health cuts This is medicaid but an example of how government handles healthcare.

I especially took interest in this quote--"Another new Medicaid restriction targets radiological tests, such as ultrasounds, CT scans and MRIs. Starting this month, before a Medicaid recipient can get one of these tests, the test will have to be approved by a private management company that has a contract with the state."---Is there a Radiologist in the house? tconner around?

Harrison 11-20-2009 07:16 PM

Jack, thx for posting this lovely tidbit of information... :uhoh: But thx, everyone, for voting too. If you have not yet, pls do!

ans 11-22-2009 07:19 AM

I certainly hope that docs get reimbursed more than Medicare rates. I wonder how they'd fare under a public plan. I know the rates are killing me.

2cool4U 11-23-2009 01:20 AM

Medicare rates are lower than private insurers in my region, often by a substantial amount. Medicaid rates are even lower still, less than half Medicare for many imaging studies. Beyond that, there's free care available to those without any coverage, which varies by region and hospital.

The AMA thinks any decrease in per person reimbursement to physicians will be offset by having a greater number of patients covered by insurance. I'm not sure anyone knows what will happen to total physician payments. But net income is likely to decrease simply because most physicians will see increases in their income tax. If reimbursements should happen to fall and taxes increase, I predict a rise in physician retirements. Not en masse, just a gradual shift, especially if retirement funds continue to recover.

I predict longer waits for medical care in that scenario. The only sound advice I can give is to know the issues and vote in local, state and nation elections accordingly.


LBP 12-11-2009 02:27 AM

OMG, anyone and everyone who has or is fighting for insurance to cover ADR should be fighting hard to get this heath care reform bill passed hopefully with a public option.

I pratically lost a decade of my life, career and credit ruined all because private employer provided health care insurance screwed me and my life by refusing to cover my surgery.

1) as long as health insurance is tied to our employment, we have no real choice. When you apply for a job you cant exactly ask what insurance plan they have. You don't get that info until they are making an offer of employment or after you've accepted employment. Therefore, we are at the mercy of our employers to determine the quality of insurance options. Furthermore, national insurance companies should offer the same plans to anyone in the nation. The only regional plans should be smaller regional companies. All markets in all areas of the country should have real choice.

2) Insurance companies are raising premiums, raising co-pays, and covering less, and fighting us by denying and delaying payment on claims while pocketing their profits in risky hedge funds and pay their execs tons of money. I have had to fight for 8 mos to get a physical therapy claim paid. Ridiculous. Just fighting the games played by private insurance companies. someone else may pay out of pocket or just give up and not get the treatment they need. Who says we are not already getting compromised health care because of this terrible existing system of insurance taking our money to cover less and less. What a joke.

3) Quality of PT has drastically declined in the last 5-10 years because insurance will not cover basic PT techniques. NOw a days you are barely touched by a PT but instead left to aides who just record in a chart what exercises you've done. That's not great physical therapy!

4) Democrats are actually trying to even the playing field for patients. Republicans are obstructionists not because they believe its in our best interst but because they think it's in their best political interests. They will keep saying anything they can think of even if it's a patent lie and they hope that you will drink their brand of kool aide if they say it often enough.

5) People need real choice and we need real competition to keep prices down.

6) I'm on Medicare now, and yes the reimbursements are low but I received better health care now than when I had an hmo and ppo when I was sitll working. Now that I'm on Medicare, I have all sorts of plan options to choose from. I never had these choices when I was working. When I was stuck with UHC, they refused to cover my surgery, and I couldn't buy an individual plan without having a pre-existing condition. So how is our current system worth keeping?

7) one thing we want to make sure is in the final bill is the FEHB policy for federal employees which states that once the FDA approves a drug or device, private ins cannot claim it is still "experiental and/or investigational" We want are drs not insurance companies in charge of our health care decisions.

Wake up people, call your congressmen and women to make them vote for meaningful health care reform. Lower premiums, more coverage, lower co-pays, lower prescription costs, and less profits to the CEOs of the healthcare industry.

Jack 12-11-2009 10:29 PM

I hate to throw water on your post but have you actually read even the high points of this proposed legislation? To think the Federal government will pay for disc replacement for all who want it is a pipe dream. Generally the payers of even Medicare for such procedures as this are with the supplemental insurance that Medicare recipients pay for through the private sector.

Who do you think will pay for this? Under our current plan, if a Medicare person is poor, for example and is over 65 years of age and qualifies for Medicare and Medicaid, they end up on Medicaid and paid for by the states that pick up most of the tab for Medicaid. Can California or New York states pay for this?

Eighty percent of all healthcare costs in the USA that require some type of healthcare are related to lifestyle to a certain extent such as overweight, sedentary lifestyle, drinks, smokes, etc. If an overweight person wants knee replacement should the get a new knee or a diet and pain meds (narcotics). Which do you think the Fed is going to push for in a condition that requires TDR, narcotics or a new disc? To think the government can dictate Medicaid rates for re-imbursement is a pipe dream.

Just look at the scam politics on costs. Taxes for the "first ten years" but they will only be paying for the last seven. Those ten trillion dollars only pays for 7 years. Think about the next ten years. If you take all the money for the top 5% of tax payers, who pay for most all the taxes, there would still not be enough money.

What program has the Fed undertook that actually cost less? I don’t know of any.

I could go on but knowledge is key. We all need to discuss this openly, like Obama said during his campaign. He said all this behind closed door stuff like that is going on now, would not be done. He said it would all be on C-Span so we could see all the wheelin and dealin like offering 100 million to the state of Louisiana if the senator from there would change her vote.

Harrison 12-12-2009 07:39 PM

Our small poll -- reflective of American Polls
LBP, you raise some really outstanding points, born from your painful experiences. And you argue very convincingly in your eight arguments. Jack also raises some good points in terms of the beast that is being “rammed” through the system – will it serve our interests? Will it address your concerns? Pay for new enabling medical solutions like ADR?

I don’t see how. Look at Medicare’s growing costs and ever-shrinking reimbursements. If that’s any indication (by symbol or as a benchmark for a future system) then we are addressing the wrong list of problems. I fear we already have a grossly bureaucratic health care system. Perhaps its reflective of our bloated, overloaded, unaccountable political system, which is why we need to start from scratch. That means NOT adding band aids on top of band aids…more layers of new committees…new policies on top of old ones, etc.

You may recall some of the chats we had about this in the past. I can’t seem to find the meaty topics, but Liz mentioned this wonderful PBS documentary – have you seen this: Sick Around the World - PBS documentary? The other countries figured out how to make things work – by doing careful analysis of systems around the world. It would seem the more successful ones started by comprehensive analysis and built completely NEW systems. I believe we are destined for failure unless we do that same.

OK, a bit of a rant….

Jack, I don’t fully agree with your points about lifestyle being such a major cost factor or “burden.” (BTW: I am in good health: not overweight and don’t smoke.) Sure, life choices are a big factor; but I think it is a bit over-emphasized and to some degree inaccurate. For example, it is argued that 1/3 of this country has one or more “chronic” diseases, which may not relate to smoking or weight. For example, think of the number of diabetic, asthmatic or “auto-immune” patients there are in this country – and all the doctors’ visits and meds prescribed to these patients.

Closer to “our” domain, think about the costs (and pains) with these grim patients' statistics (annual):
  • 80,000+ infected prosthetics requiring revision surgery;
  • 100,000+ deaths from nosocomial infections; of which 20,000 may be MRSA;
  • 500,000 deaths stemming from biofilm-related infections;
  • 1.9 million + hospital acquired infections!
These numbers were drawn from the CDC, NIH and CRID. But I had to really hunt to find and authenticate them for currency and accuracy. My point is that these numbers are just the tip of the iceberg and reflect a whole, different universe of chronic issues that are both under-reported and expensive in both human and economic terms.

So, back to the problem: what is the problem with healthcare?! Or list of problems? The person that determines & prioritizes the list is the leader of healthcare in America. And Obama, the healthcare president, has deferred this “list” to the House and Senate, knowing that other countries already solved this massive problem. Ironically, just this week, he received a peace prize in a country that has (forgive the expression) kick-*** healthcare.

Perhaps we are now living metaphorically in the book “Lord of the Flies.” I know that’s blunt, but if we don’t get our act together and focus on our budget issues – we’ll see trouble like we’ve not seen in generations. I’ll leave with one of my favorite quotes (stolen from Edison and morphed by Steve case):

"Vision without (the ability of) execution is a hallucination."

LBP 12-16-2009 11:50 PM


I've gained 40-50lbs because my employer provided insurance refused to pay for a necessary back surgery and I had to live 8 years in chronic pain, unable to do any meaningful exercise and daily activities to maintain my prior weight. Just because you're skinny doesn't mean you can't be an alcoholic, drug addict, ridden with various cancers etc! Besides, not all of us have the same metabolism. If you want to address obesity issues, then help keep daily gym classes in school, increase after school sports programs alive, make the school lunch programs more healthy, create incentives with employers or health insurance companies to get a discount for gym memberships.

Stop pointing fingers at the poor and sick. You should be pointing fingers at filthy rich insurance execs and hedge fund managers. They are taking our money without any quality of service in return.

I am exhasted from fighting my insurance company to even address an appeal on a claim. I sent the appeal via certified mail and they have delayed and avoided a decision claiming they cannot find my appeal and yet they will do nothing about the substance of my appeal after repeated calls to remind them I have an appeal outstanding. After months of no progress, I've had medicare file 2 separate complaints because my appeal has been outstanding since the first week of JULY!!!! You can bet that I will never stay with Blue Cross ever again. They are a nightmare. They fraudulently denied PT claims, with an explanation that I exceeded my annual benefits which was patently false becuase I had unlimited PT benefits. What they should have said was that my treater failed to use proper medicare codes. Yet once I convinced my treater of the real problem, the corrected claims were denied as "duplicates" Are you kidding me!!! I am single with one medicare insurance plan. There is no question from the insurance companies prospective that they should have instructed my treater why it was really denied and how to fix the probem, yet they do everything in their power to dely and deny and hope to utterly confuse the problem so that the treaters think the patients owe them money when it's the ins co that owes them money! I can complain to medicare until I am blue in the face but my individual complaints are not likely going to get Blue Cross kicked out of the Medicare Advantage program and there's no fine levied against the insurance company for such disgusting pratices. Where is the accountability for insurance companies? NONE so we need real health care and healthcare insurance reform.

If you can't have meaningful choice of changing insurance plans/insurance companies, or a public option, you are screwed, and if the government doesn't start restricting the costs insurance companies can charge us and regulate with checks and balances for what they can deny, you are doubly screwed.

When I was accepted on Medicare, I had the choice to select Aetna's Medicare plan because that was the only plan likely to cover ADR. ADR is like any new technology, the costs drop over time and it's really not any more costly than fusion.

Even with Medicare based insurance, I cannot believe the jumps in out of pocket costs from last year to this coming year. CT scan copays from 100 to $200. Steroid injecitons the same jump. This year I hit the infamous donut hole re prescriptions by August! But at least my generics were still covered. Next year, I don't even get generics covered once I hit the donut whole. I was paying $90/week in co pays for PT. I've had to not get certain treatments due to prohibitive costs and all it's accomplishing is a delay in returning to the workforce and getting off of Medicare. How is that good for our economy?

Jack I'd like to know what profile of persons you think are the only one's worthy of health care...the one's that don't need it? And who made you God to make such sweeping stereotypical judgments?

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