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It’s Here, It’s Queer: Our Perplexing Healthcare Package

March 22, 2010

Of course I mean “queer” in the original, archaic, Webster’s-approved sense of the word: Strange. Odd. Puzzling. The healthcare bill that nabbed a narrow victory last night in the House of Representatives is nobody’s idea of a coherent reform package. It’s a grotesque piece of work that resembles one of those loopy mythical hybrids:  a gryphon, perhaps, or a Donklephant. It goes to show you that sometimes a compromise can breed monsters.

Like the mythical gryphon, a grotesque hybrid

The new package, which will be stamped with President Obama’s seal of approval any day now, has something in it to offend everybody.  For the first time ever, it forces the American people to buy health insurance or face stiff penalties. Ditto for companies with 50 or more employees.  At the same time, it forces insurance companies to cover high-risk individuals whose costly health woes could sink a battleship. 

You have to agree there’s a lot of forcing here. I don’t know about you, but I don’t like to be forced. It’s what totalitarian governments do to earn their unsavory reputations.

Yes, it’s a grotesque creature, this new healthcare package. By compelling everyone to patronize private insurance companies, it seems to favor conservative interests. But then it turns that bias upside down by putting those insurance companies in a government-imposed stranglehold: not only must they insure the ill and infirm… they’re compelled to grant them carte blanche — no more lifetime caps on benefits. This part of the package is a leftist’s vision of nirvana.

Granted, the bill offers a few overdue public perks: it promises to extend Medicaid to the borderline-poor, and it offers partially subsidized health insurance for the struggling lower middle class. These benefits aren’t exactly free, of course: they’ll cost taxpayers an estimated $948 billion over the next ten years. But what’s an extra trillion 0r thereabouts to a nation already in hock up to its eyebrows?

People who hate the new package (and their numbers will be legion) will undoubtedly huff about the perils of compromise. They’ll assert that this certifiably weird program embodies the pitfalls of moderate thinking: by trying to please everybody, it pleases nobody.

But it just ain’t so. A truly moderate program would have offered a public option as well as a private option. Instead of forcing the uninsured to buy insurance and the insurance companies to insure them, it would have promoted freedom of choice. Two systems, side by side, existing in the spirit of friendly competition… each serving the needs of its customers.

Too simple, alas, and too much to ask for.

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40 Comments leave one →
  1. Dave Johnson permalink
    March 22, 2010 11:03 pm


    While I agree that the existing legislation is not pretty, I guess I’m in the glass half-full camp. For starters, the removal of pre-existing conditions is a huge change–one that represents a very moral and principled stand that everyone deserves the right to be covered. I’ve known too many friends particularly during this downturn that have committed the “mistake” of having coverage, being laid off and when they do find a new job are told that they can no longer be insured because of pre-existing conditions. This isn’t about affordable care–it’s about denial of coverage. There is no market-based way to eliminate pre-existing condition clauses–after all, who would WANT to insure people you KNOW are going to access healthcare? While the public option was one way to do this, another way is through the mandatory insurance coverage.

    Why is everyone so hung up on the insurance mandate? Most states require you to purchase car insurance when you buy a car. All banks require you to purchase home insurance when you apply for a mortgage. While these are not federal institutions (unless you count Fannie Mae and Freddie Mac), they are certainly requirements that we all accept as part of “doing business”. The insurance mandate can be viewed as an extension of a larger social contract–we are all in this together, through sickness and health. It is not significantly different from the fact that we ALL pay taxes to support schools, national defense, the highway system, and a myriad of other things–some or many of which as individuals we do not want to support nor need in our daily lives. Yet, the social contract is there to ensure that we, as a society, benefit as a whole.

    Lastly, my engineering background says that we need to become more adaptive and flexible when it comes to legislation, even legislation that affects 1/6 of the economy. Thus, we need to be able to look at what works and what doesn’t work and be able to change and adapt it to make it something that does work. This is probably one of the hardest things to do given our (human) innate fear of change and the particularly partisan rancor that exists in the US right now.

    So, I’m going to look at this Donklephant as a promising first step. One that we recognize the inherent value of covering every person and one that brings home the idea of a shared responsibility for the welfare of all.

  2. March 23, 2010 4:20 am

    There are a couple of good measures in this, but the overall pricetag for what this accomplishes is outrageous. This is like if your tire has gone flat — replacing the engine.

    To answer Dave Johnson, I think he need to look no further than Massachusetts as a model for insurance mandate. The rates in the state have shot up, while the average person has to wait an extra 10 days to see their doctor. What many people forget is that you don’t need health insurance to have health care, yet the state has not only mandated it, but also forced employers to pay a major portion of the cost, making most people think health care is suddenly cheap, and they go out to their doctor even more. Vicious cycle that is spiraling out of control… and a model for what this bill will do.

    • March 23, 2010 12:12 pm

      LOUDelf: I thought the mandates were excessive, too. Granted, nearly everyone needs insurance to be able to afford today’s exorbitant medical costs, particularly for hospital stays and other major treatments. But the very rich can get by without insurance, and illlegal immigrants (who definitely need it) probably won’t be forced to buy it. So yes, the new system is far from perfect. But if you think about it, even our old insurance system (especially the HMOs) added a nightmarish bureaucratic element to medical care.

      I’m concerned about the effect of the new mandates on smallish companies (50+ employees) that are now required to provide insurance for their employees. I wonder if salaries will suffer as a result.

      • March 24, 2010 4:59 pm

        “I’m concerned about the effect of the new mandates on smallish companies” — I’ve seen estimates that these mandates may require the hiring of over 16,000 IRS agents… not included in the pricetag of the bill. Add in the other additional costs, we will either see our healthcare costs further increase, or the quality decrease with this bill.

        Where I’m worried is that you don’t ram through this whopper of a bill with arm-twisting, threats, and process maneuvers just the make things “a little better” by the best estimates. The simple answer is to expand (or make unlimited) HSAs so people don’t feel they need insurance (they don’t) and allow them to shop for services. This will drive down insurance costs for those who pursue it, and cause providers to be more competitive with their costs as well. Once the consumer starts shopping, suppliers get competitive and either offer better services, better quality, better price or a combination of the three. That’s what we need, not people being forced to buy a product.

  3. March 23, 2010 9:41 am

    @LOUDelf, more like replacing the entire frame when the engine misfires…
    The Bill does some good, eliminating pre-existing conditions, forbidding insurance companies from dropping people mid-treatment, allowing parents to keep their children on their insurance plans until they’re 26, and some extra aid for seniors. That said, the mandate _has_ to go, at least unitil a public option is offered instead of fines. (and hopefully then too) Do those fines remind anyone else of Debtors’ prison? Car insurance is not the smae thing at all, nobody’s forcing people to buy the car.

    • March 23, 2010 12:15 pm

      TK: Hey, you’re pink again! I was hoping for a public option, too, instead of mandates. But of course, I’m no economist, so I really haven’t worked out all the implications. If we offered a public option, would companies stop offering health insurance as a benefit and simply tell their people to go on the public plan? It gets complicated…

      • March 23, 2010 12:55 pm

        I doubt companies would tell their employees to go public, and cancel any existing plans. (unless the mandate stayed after a public option) Free market and all that, the better companies would still offer better plans to attract employees.
        Say it loud, I’m pink and I’m miffed… Internet Explorer is the anti-christ of browsers.

      • December 25, 2012 11:00 pm

        Yes. Ins premium, dotcor visits, prescription drugs, contact lenses, and necessarily surgery or purchases are deductible. Over the counter drugs and unnecessarily surgery like boob jobs are not.You add them all up, substract any medical reimb and thats your medical tax deduction. but it is limited to 7.5% of your Adjusted Gross Income (which is your income adjustments), so if you make too much money you most likely cant take the benefit. If you want to save more money, add in you over the counter drugs.

    • March 24, 2010 5:00 pm

      Ha, good one. And probably more appropriate too.

      I agree, there are some (sorry, please read: SOME) good provisions in the bill.

  4. March 23, 2010 11:57 am

    Dave: Welcome to our corner of the “centrosphere.” I totally agree that we needed to cover everyone with pre-existing conditions, but I was hoping the now-discarded public option would patch that gaping hole. It’s funny… I’m no champion of corporate interests; in fact, I frequently rant about corporate misdeeds here at The New Moderate. But I still can’t see the justice in forcing insurance companies to foot the bill for patients with major health problems. (That’s what the public option was supposed to cover.)

    As long as the public option isn’t an option, the new healthcare package is better than nothing. And you’re absolutely right that a viable society is built upon a social contract that emphasizes shared responsibility — a happy medium between the leftist welfare state and the sometimes callous individualism espoused by conservatives.

    You’re a first-rate writer, by the way. (Are you sure you’re really an engineer?)

  5. valdobiade permalink
    March 23, 2010 1:44 pm

    LOUDelf wrote: “…but the overall pricetag for what this accomplishes is outrageous”

    It seems that the main opposition to the health care package is the “pricetag”. I don’t have information for how high is the Government US Defense price tag. Can somebody tell me? Spending in Afghanistan and Iraq is waste of money, what US gained from those wars?

    Also, I know that Obama says the deficit would be covered in 10 years, and when some were convinced about that, others went to oppose not because of the price tag, but because the new health care is “death panels”, “pull the plug on grannies”, “kills the babies” etc.

    It seems for me that all who opposed the health care overhaul, starting with city hall meetings and ending with Fox News Glenn Beck are just foaming at the mouth guys. They keep saying that the “majority” of Americans don’t want health care, but then why aren’t they satisfied that the majority of Americans want abortions?
    I mean, why are they calling now that “majority” is right, but when they are in minority they cry “don’t oppress the minority”? Isn’t that hypocritical?

    • March 23, 2010 2:39 pm

      Valdo: Of course it’s hypocritical, but radio and TV pundits do whatever they can to “spin” an issue to their advantage. Don’t tell me you actually expect them to be honest and unbiased!

  6. March 23, 2010 5:30 pm

    Valdo, the Republicans and teabaggers are so far from reason, truth, and intelligence at this point that they actually believe what they say, then they *exaggerate, and believe that. The vicious cycle of stupidity.


    • March 23, 2010 5:30 pm

      Huh, no more pink, Firefox for the win!

  7. Priscilla permalink
    March 23, 2010 6:11 pm

    Ok, first the disclaimer: I am not a Republican, nor have I ever attended a Tea Party rally. But, honestly, as a moderate in temperament and politics, I see far more moderation, fiscal and social responsibility, inclusion, dignity, and just plain common sense from those two groups than I do from my old friends, the liberals and left-leaners.

    The name-calling and bigotry (“teabaggers “, “racists”, “rednecks” etc.) that I hear and read comes mostly from the left side. I’m not saying that the right doesn’t have it mouthbreathers, but the ignorance and hatred of the left directed at anyone who dares to say that this law may be unconstitutional or may move us closer to financial ruin and loss of liberty is breathtaking – and I, for one, am disgusted by it. Partisan debate is part of a democracy and I would submit that there was only one bi-partisan side to the debate over this bill and it was the opposing side.

    A few points: I would like to hear of one example – just one – of a major national bill passed in the last 50 years that was passed without a single vote from the minority party. Give me one example of any law that mandates that private citizens buy a product from a corporation, under penalty of fine or imprisonment. I know that there is no such thing, and I agree with those who say that this insurance mandate is unconstitutional. Hell, the only other individual mandate of any sort that has ever existed in this country before this was the requirement to register for the draft.

    And, Dave, I think you make some very valid points, but I would submit that providing health insurance to all does not guarantee access to healthcare. Although I am not a proponent of single-payer, I would have MUCH rather seen a reasonable, cost effective public option that could have been introduced along with opening up interstate competition among health insurers, creating insurance exchanges and allowing people to keep their insurance when they switch jobs. It would be much better than this unholy alliance between the big insurance companies and the government which now controls them. They have essentially become the FreddieMac and FannieMaes of healthcare……and we all know how that story ends.

  8. valdobiade permalink
    March 23, 2010 8:06 pm

    Priscilla, you may be very observant when you point out that there was not even one vote from republicans, however this is not what shocked me.

    Many US Presidents tried to fix the health care. Most of them were democrats, and most republicans were against. What is shocking in the fact that there was not one republican vote? Does it make it the new health care law unconstitutional? I don’ t think so.

    Finally, when a president has more guts, you see rabid groups forming in town meeting, name calling (socialist, communist, Stalinist, Hitler, Nazism, etc. etc.)… That’s was frightening me, but I was more for democrats because I don’t like intimidation. I like intelligent discussions, not prayers, religious hymns and all that brouhaha.

    If it was so obvious that this health care is so unconstitutional, why republicans weren’t pressing only on this point? Why republicans needed stupid name-calling of the health care, like “death panels”, “pull the plug on grannies”, “kills the babies” etc…?

  9. March 23, 2010 10:09 pm

    @Priscilla, are you really trying to call Democrats on name calling? Those near-rioters spewing obscenities and slurs _were_ called teabaggers at the start, by _everyone_. They changed it because they were embarrassed. Raincheck, when you call people niggers and call the black president a “black dog” among other things on those signs, you _are_ a racist. I rarely use that word, (racist) I think it’s overused, and that overuse leads to a lack of seriousness in real racism. (Think, ” boy who cried wolf”) What was bi-partisan on the Republican side? NOT ONE OF THEM VOTED FOR IT! The Democrats, on the other hand, had ~20-30 people who voted against it, and the bill had 200+ REPUBLICAN amendments. What about the outright lies against the bill? (Deathcamps) Where’s the dignity there?

    It’s not perfect, it’s barely good, but at least it’s something. All the Republicans had to offer was delay and NO. The bill can be fixed over time with trial and error, if someone dies waiting because their insurance dropped them, or they couldn’t afford it anymore, that can’t be fixed. And why would the Republicans vote for it, “it will be his [Obama’s] Waterloo” they had nothing to gain and everything to lose. “I hope he fails.” The Republicans aren’t in this for the people.

    @valdobiade Actually, the _mandate_ is unconstitutional, (or at least it will be ruled as such) I think it was designed for a bill that had a public option, to stop uninsured people using the ER as their sole care provider and being unable to pay.

  10. Priscilla permalink
    March 24, 2010 1:20 am

    On the namecalling thing…’s a non-starter,really, because both sides do it – so all I’ll say is that if , in fact, you honestly believe that all of those thousands of folks protesting confiscatory taxes, mandated insurance, and the potential destruction of our healthcare delivery system were racists, then there really isn’t anything to argue about, is there? Every crowd has its unruly jerks, and I saw nothing to indicate that the protest was generally unruly, violent or racist in any way. If you saw otherwise, we see very differently.

    valdo, I totally agree with you that the Repubs put themselves in this position by not reforming healthcare when they had the chance in the 90’s…you seem to believe that they were “against” reform, I believe that they had other priorities, but the result is the same- they gave up their chance to make free market reforms that would solve the problems that led us to this place. I also agree somewhat with you TK, that by trying to make Obama’s gov’t takeover of healthcare his Waterloo, they gave up the chance to have some leverage over the bill. But I also believe that the Dems were never going to give them much leverage anyway, so they took their best shot at defeating very bad bill, and they got spanked.

    I agree with Rick that this bill is grotesque. I’m pretty sure that it will not improve healthCARE for anyone, it will merely increase the costs of healthINSURANCE and reduce access for everyone. And, yes there is that nasty little matter of the government forcing its citizens to buy something whether they want it or not.

    Anyway, we’re all in it now…and the Dems better hope that the Republicans are never again in the majority, because they have pretty much destroyed the concept of compromise and consensus in the ugly way they have passed this law. It may be a very long time before any of us see real statesmanship from either party….ugh.

    • March 24, 2010 10:01 am

      Priscilla, I know not _all_ of the tea partiers are closet tea baggers, just a startlingly large number of them. If they want to be taken seriously, they should remove the nut jobs from the group, and stop allowing them to _pay_ to join. You have as much credibility as you’re craziest member. This is why the Democrats are having so much trouble, but at least the Democrats’ crazies aren’t showing up at rallies with guns and racist signs, shouting profanity.

      The Bill is retarded, (literally, “delayed in development”) but it does some good. (See above post) It probably can be fixed. Or at least show people what needs to be included in the next bill.

      Why do you think the Democrats destroyed the concept of compromise? I repeat, 200 Republican amendments, dozens of Democrats who voted against it, NOT ONE Republican voted for it. How would you have suggested the Democrats compromise with “NO, SCRAP THE BILL!”? Cave entirely to the minority, and call it “compromise”? Majority rule is the most basic form of Democracy, and November will tell who the majority really is. Until then, I’m glad they’re not just trying to garner votes by avoiding tough decisions.

  11. valdobiade permalink
    March 24, 2010 12:41 pm

    Priscilla, below are some except showing the European reaction at the health care reform:
    “On Sunday evening the richest, most powerful country in the world, the USA, finally entered the 20th century. Yes, not the 21st century, but the 20th,” read an article published Monday on the popular French news website
    Europeans have long expressed dismay at the fact that millions of Americans have no health insurance, and tales of American suffering are always in the media.
    In Europe, voters demand that their governments offer good public services – including decent education and medical care – and regularly vote them out of office when they fail to deliver. Taxes may be slightly higher in Europe, but medical fees are heavily subsidized by governments and are drastically cheaper than they are in the U.S.

    Yes, the problem with the rich in the US is that they will pay higher taxes.. How many socialist or communist countries are there in Europe?
    Yes, the bill is “grotesque” due to US not being experienced at taking care of all American citizens.

  12. valdobiade permalink
    March 24, 2010 12:42 pm

    correction: “excerpts”, not “except”

  13. Priscilla permalink
    March 25, 2010 12:43 am

    TK, how do you know how many of the Tea Party activists are “closet teabaggers”?

    Some random facts about the healthcare bill : 1) it does not mandate coverage for pre-existing conditions for children under 26 (an oxymoron in its own right, btw) 2)it allows states to “opt out” of the individual mandate, provided they can meet the coverage requirements- which are not universal…I find this very weird. 3) it defines as Medicaid eligible, families of four with an income of $89,000.

    Bottom line: People will still be engaging in adverse selection. You must buy health insurance… or you must pay a fine. The government doesn’t care which you do. So, pay $8,000 to $12,000 or more for insurance, or pay an $875 fine and pay for your office visits out of pocket? If you have a bad accident or disease.. THEN you buy the policy because you can’t be turned down (guaranteed issue). So, this will still come to pass… private insurance will soon go out of business and then we’ll left be only the government, who we know does everything with the utmost efficiency.

  14. March 25, 2010 10:38 am

    Yes, everyone, the name-callers and bigots lurk on both sides of the political fence. The Democrats are usually more disdainful (due to their superior education and social status), which I still find to be one of life’s more puzzling ironies. (I always thought Democrats were supposed to stand up for the “little guy.”) The extreme right-wingers are equally abusive these days, but their behavior is based on fear (of a socialistic, nonwhite, non-Christian America). Moderates and mainstream Republicans are probably the least biased of anyone on the political spectrum.

    Priscilla: At first I thought the healthcare bill actually favored the insurance companies by compelling everyone to obtain private health insurance. When I actually read the terms of the bill, I saw that it worked both ways: yes, we have to patronize the insurance companies, but they’re also forced to insure high-risk customers and eliminate lifetime caps on payouts. So I can see how the new system might be a slippery slope to a single-payer public healthcare system: as you mentioned, it could eventually put the insurance companies out of business!

    Good grief… the new system is such a mishmash of conflicting ideas, more convoluted than the plot of a James Bond movie. I think Obama’s original plan was for competing private and public options, which would have made the most sense. Yes, the public option might have forced insurance companies to lower their premiums to some extent, but it wouldn’t have forced them to take on all those high-risk customers. And nobody would have been forced to pay for private insurance.

    By the way, I think that income figure of $89,000 for a family of four was the upper limit for partially government-subsidized insurance, not free Medicaid.

  15. valdobiade permalink
    March 25, 2010 1:00 pm

    Please explain the below excerpt. I do not understand why even if republicans cry “socialism” there cannot be.
    Still, the new law will undoubtedly expand the government’s influence. Sen. Judd Gregg, R-N.H., warned Tuesday it will lead to the “quasi-nationalization of the health industry.”

    Underline “quasi.” Democrats dropped their idea of a government insurance plan to compete with private carriers. So any “socialization” will be channeled through Wellpoint, UnitedHealthcare and other private insurance giants.

  16. valdobiade permalink
    March 25, 2010 1:07 pm

    I am sorry to copy-paste, but these excerpts make sense to me, however it is not “in line” with what Priscillia is afraid, and Rick may be in accord. Please try to “destroy” the below quote point by point, so I can understand better the antithesis between what has been done and the status-quo (before the new health care law). I may be still afraid about new health care law. Thank you!


    Government’s role in health care has been steadily growing since Medicare and Medicaid were established 45 years ago. Even if Republicans were to take control of Washington and repeal this bill, government would still be on track to pick up more than half the nation’s health care tab by 2012, according to a report last month from Medicare.

    “The Republican myth is that the government is for the first time going to take over the health care sector,” said economist Joe Antos of the business-oriented American Enterprise Institute. “The takeover was probably largely accomplished in 1965 with the creation of Medicare and Medicaid. Since the early days, Medicare has called the shots on a lot of policy issues that private insurance fell in line with.”

  17. Hallie permalink
    March 25, 2010 1:18 pm

    Thanks Pricilla. I always enjoy your posts.

  18. valdobiade permalink
    March 25, 2010 1:46 pm

    Hallie, I don’t know what you’re thanking for, but it seems that Priscilla is using reasoning to solidify her pessimism. We already know that this bill can be improved. Just continuing to badmouth the bill shows that there is still no cooperation from republican part.

  19. Priscilla permalink
    March 25, 2010 4:22 pm

    valdo, valdo, I am not sure how to take your last comment! I’m glad that you think I am using “reasoning”, but I am not really pessimistic (although I can certainly see how my recent comments might give that impression). And, well, I guess I am “badmouthing” the new law, but is that wrong if I think it is bad law?

    Unfortunately, it’s not a bill anymore, it is the law…..and once the House re-votes on the reconciliation “fixes” it will be a somewhat worse and even more complicated law, which will include the nationalization of the student loan industry. But yes, it can be changed…and that will almost certainly happen at some level. Ideally, I’d like to see the courts declare it unconsititutional, but even if they don’t there are other ways to modify it. I guess my fear can be summarized in the old saing “What starts out twisted, ends up twisted.”

    Yeah, Rick, I misspoke somewhat on that Medicaid thing. you’re right about the $89,000 being the subsidy ceiling. It’s sort of like partial Medicaid, I guess…..

  20. valdobiade permalink
    March 25, 2010 5:03 pm

    Prisci, I am not that educated in US Laws, but for what I know, any law can be altered through bills. The fact that repubs want it thrown out altogether is a sign of rabid behavior, not reasoning. That explain the fact that repubs did not attack the law only as unconstitutional, but as “death panels”, “pull the plug on gramma”, “kills the babies” and all that nonsense.

    You, on the other side, use reasoning to “foresee”, but what you see is only pessimism. As I told you before, the law seems twisted, or “grotesque” as Rick put it, however US is still in Neanderthal era regarding the level of taking health care for all American citizens. I hope that US of A will evolve in taking care of all citizens.

    From capitalism, societies went to communism then back to capitalism, but I don’t know any country with public health care going to exclusive private health care. Maybe you know one…

    • March 25, 2010 5:16 pm

      @ Priscilla, I’m not sure about your comment about…
      “mandatory coverage for under 26 year-olds”
      Where you talking about…
      “allowing parents to keep their children on their insurance plans until they’re 26”?

      Once again, (hopefully for the last time) We know the law isn’t perfect, or even very good, but it _could_ be, _eventually_ if the Republicans would just work with people, instead of egging on tea rallies. How long has it been since an entire party decided to _only_ block the other? How did that turn out?

      Rock Bottom Line: Something had to be done, and all the Republicans are doing is obstruction.

  21. valdobiade permalink
    March 25, 2010 5:19 pm

    Prisci, when a president had his first days counted as “he did nothing” in his fist 100 days, then he was wished to fail (see Rush), then “why is he doing nothing?” and so on and so forth… When finally he did something, you really expect thanks from the party that lost elections?
    Who counted what Bush did in his firsts 100 days? Who cared? He took a country that has a relatively good economy, and then abandoned the country on the verge of another Great Depression with bails and “golden parachutes” for the rich.
    I do love your reasoning, it is not “teabaggers” shouting (BTW Tea Party called themselves “teabaggers” until somebody told them about the slang)

  22. March 25, 2010 5:29 pm

    This just in:

    Republicans are blaming _Democrats_ for the violence!!! The violence perpetrated by Teabaggers, IE Rocks and bullets through windows and graffiti.
    Then they said the Democrats were Exploiting the violence in order to gain funding!!!!
    As if the Republicans weren’t making money off the teabaggers!? This is illustrating what we’re trying to say, THE REPUBLICANS LIE!!!

  23. Priscilla permalink
    March 27, 2010 12:36 am

    valdo, better study that US Constitution a little closer…once the Prez signs a “bill” that has been passed by both houses of Congress, it is a “law”. The only “alterations” that happen after that are by judicial interpretation, repeal, or by other laws that change the bad law….but those have to be passed by both houses and signed too.

    TK, amazingly, the current law does not require policies to cover children under 26 with pre-existing conditions, unless they were already covered…just like before. Apparently,the geniuses who wrote this thing forgot that little tidbit, which was supposed to be a central part of the reform….. the reconciliation fix added the provision that children under 26 can stay on their parents plan. I don’t know about you, but I don’t really consider a 26 year old a”child”….but, whatever, that is really neither here nor there.

    I wish you guys were right about this thing being so easy to fix…..but, alas, no such luck.

    • March 27, 2010 1:24 am

      I never said _easy_, I said it _can_ (and needs) to be fixed. Our government may be incapable of doing anything easily. (excepting screw-ups) I had also not know that children could be excluded from their parents health insurance. Oh well, if it were obvious, they would have done something, right… 😦 Maybe we should “encourage” the next group of “geniuses” to write a bill in “creative” and “interesting” ways. Anyone know where I can get a shark sized water tank and laser beam? I’m having an idea…

  24. Hallie permalink
    March 27, 2010 3:19 am

    Priscilla, they forgot the “kid’s coverage” part when writing the bill— but they didn’t forget to write themselves out of it…

    Valdo, the republicans introduced 35 amendments to the bill, trying to control costs and help improve the impact on the nation while it was in the senate this week. All but 2 where shot down by the dems.

    TK, what we need is: patients, people who work in the industry, ecomonists, insurance people, and a “few” politicians from each party to write the bill. Not a bunch of white house interns working for said politicians writing the bill.

    This law strikes close to home for me. I work in “inpatient” rehab— a valuable service, I think. We help patients gain strength after a debilitating illness (stroke, spinal cord injury, extended illness etc). We do intensive rehabilitation, teaching and training to help the patient adapt to his new illness/injury and we work with family and other medical resources in the community with the goal of returning the patient to his home.

    Unfortunately, in this new law, inpatient rehab funding in one of the benefits that is on the “Medicare cut” hit list. This is how it goes down in a hospital: once the patient is medically stable, he is discharged from the medical-surgical ward. Without us, if he is not strong enough to go home, he goes to a nursing home. Have you ever been to a nursing home? It’s not good. In a nursing home, there is one RN to 35 patients, the physician sees the patient once a week, and the patient gets 1-2 hours of therapy a day. In our unit (and thousands like us in the country) there is one RN to 4-6 patients, the physicians round daily, and the patient gets 3 to 6 hours of therapy a day. Plus there is an involved team of social workers, doctors, therapist, nurses etc all working on the patient’s case.

    So what, you say? Trust me, you wouldn’t say that if it was your father or mother with the stroke. You want the best for your loved one, and a nursing home ain’t it. This law, that helps the ~15% of people without insurance hurts the ~ 85% with insurance. And it does nothing to lower costs or deal with the crazy amount of red tape and bureaucracy- and that is the problem.

    A side note, from an insider prospective, there have been several studies that show 1 RN to 4 patients is the optimal number of nurses on a medical floor to ensure good patient outcome. The lower the nurse patient ratio, the less chance the patient’s have of suffering complications and return hospitalization. And in the long run, a lower nurse/patience ratio actually decreases costs by reducing later complications. Guess what happens when hospital funding is cut (as will happen in this law)? No, the CEO’s and administrators aren’t cut. The ancillary and nursing staff gets cut. Right now, Medicare labels certain “return visits” as preventable and refuses to pay, specifically: urinary tract infection and bedsores. This new law expands the definition of what is a “preventable” illness. So, with this law, funding gets cut, nursing and ancillary staff gets cut, complications increase, the hospital loses even more money, more staff cut, worse patient outcomes… it is a slippery slope.

    BTW, did you know that Medicare currently denies more claims than private insurance? So, we are going to fix the problem of “denied claims” by even more government?

    Also, the law is supposed to lower the use of ER (a very expensive way to take care of a “cold”) by offering insurance to all for preventative care. But, in Massachusetts the use of the ER actually went up when everyone had insurance… Why? Because, hey, I’m not paying for it…

    I’m not saying that cost and bureaucracy doesn’t need to be changed… what I am saying, is this law isn’t it.

  25. March 27, 2010 12:42 pm

    Thanks for the insider’s perspective, Hallie. It would be nice if the lawmakers actually consulted with medical practitioners before formulating their bills.

    I’ve heard about these people who use ERs as a substitute for ordinary doctor visits. But I thought ERs had triage nurses who could say, “Sorry, Bubba, this ER isn’t for treating migraines. Go see a doctor in the morning.” Maybe they need to be a little more strict about who they let inside.

  26. Hallie permalink
    March 27, 2010 1:28 pm

    Nope, the triage nurses say– “OK bubba, you need to wait while we treat this gun shot wound first,” but they can not refuse to treat anybody. And actually if you have a sudden migraine (worst headache ever), without a history of migraines, then the ER IS the place for you, (but I was just being technical ;o)).

    A better alternative to restricting who can be seen in an ER, which would no doubt lead to someone eventually being missed, would be to have more stand alone urgent care clinics (like the kind you find in Walgreens) that are staffed with Nurse Practitioners and Physician Assistants. You don’t need a highly paid Physician to diagnose an ear infection and prescribe an antibiotic. An NP or PA can do the same for much less. Also, there are government funded low income clinics who use a sliding scale for billing in many communities. It would be nice to increase support for these clinics.

  27. March 28, 2010 2:48 pm

    Hallie, I’m amazed that ERs are required to handle everyone who arrives at the door. I agree with you about those “urgent care” clinics. I went to one of those when I had appendicitis 20 years ago. (I had to wait about three hours for test results there, then transfer to the local hospital, which made me wait another six hours before they let me in for surgery. Meanwhile, my appendix had almost burst. But that’s another story.) Anyway, despite all that, I think alternative clinics are a good idea — assuming that sick people can find them. (Everyone knows where the nearest hospital is; on the other hand, they might not know about the local urgent-care clinic.)

    By the way, we’ve just set a New Moderate record for the number of comments on a single post. Thanks, everyone!

  28. valdobiade permalink
    March 29, 2010 1:39 pm

    Prisci, a law can be improved, interpreted, or repealed with another law. I know that. Even the Prohibition law that was inserted as an amendment in the Constitution, was repealed with another amendment. Nothing is written in stone when it comes to the US Laws. As I told you, the law can repealed when repubs can get the majority, then the government will pick up the tab anyway, only that “we the people” will pay for whatever big insurance monopoly would want to get in order to be bailed.

    Hallie, regarding the health care, repubs wanted to get their way or nothing. Their way, as before, was nothing.

    As for me, I will never understand why such a powerful country cannot have health care for ALL its citizens. I thought that is was included in the “pursuit of happiness” , but I think that happiness is not a right but a privilege given by the controlling class.

  29. valdobiade permalink
    March 29, 2010 2:06 pm

    On the other hand, I think that I know why US cannot provide health care for ALL US citizens: Not ALL citizens are productive, so the “unproductives” do not deserve health care.
    If ALL citizens would be productive, then we will be in Communism, only Communists provide health care for all citizens. Am I right?

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