The Truth: You can't keep the plan you had

Sticker shock often follows cancellation notice for those with individual health care policies

MIAMI — Dean Griffin liked the health insurance he purchased for himself and his wife three years ago and thought he’d be able to keep the plan even after the federal Affordable Care Act took effect.

But the 64-year-old recently received a letter notifying him the plan was being canceled because it didn’t cover certain benefits required under the law.

The Griffins, who live near Philadelphia on the Delaware border, pay $770 monthly for their soon-to-be-terminated health care plan with a $2,500 deductible. The cheapest plan they found on their state insurance exchange was a so-called bronze plan charging a $1,275 monthly premium with deductibles totaling $12,700. It covers only providers in Pennsylvania, so the couple wouldn’t be able to see the doctors in Delaware whom they’ve used for more than a decade.

“We’re buying insurance that we will never use and can’t possibly ever benefit from. We’re basically passing on a benefit to other people who are not otherwise able to buy basic insurance,” said Griffin, who is retired from running an information technology company.

The Griffins are among millions of people nationwide who buy individual insurance policies and are receiving notices that those policies are being discontinued because they don’t meet the higher benefit requirements of the new law.

They can buy different policies directly from insurers for 2014 or sign up for plans on state insurance exchanges. While lower-income people could see lower costs because of government subsidies, many in the middle class may get rude awakenings when they access the websites and realize they’ll have to pay significantly more.

Those not eligible for subsidies generally receive more comprehensive coverage than they had under their soon-to-be-canceled policies, but they’ll have to pay a lot more.

Because of the higher cost, the Griffins are considering paying the federal penalty — about $100 or 1 percent of income next year — rather than buying health insurance. They say they are healthy and don’t typically run up large health care costs. Dean Griffin said that will be cheaper because it’s unlikely they will get past the nearly $13,000 deductible for the coverage to kick in.

Individual health insurance policies are being canceled because the Affordable Care Act requires plans to cover certain benefits, such as maternity care, hospital visits and mental illness. The law also caps annual out-of-pocket costs consumers will pay each year.

In the past, consumers could get relatively inexpensive, bare-bones coverage, but those plans will no longer be available. Many consumers are frustrated by what they call forced upgrades as they’re pushed into plans with coverage options they don’t necessarily want. [...]

The article goes on to give more examples, from people in lower income brackets than the Griffins, who are also loosing the plans they had, and will now have to pay more.

I've been given a 90 day notice that my insurance plan is being canceled.

Health care reform, done properly, should offer us more choices of things we want and need, not choices made by bureaucrats that are shoved down our throats. I want the health care I had, not somebody elses decisions.

The problem with the ACA right from the beginning was that there was no significant bipartisan input. Reform was needed, but it was too one-sided, and this is the result.

Two interesting comments under the article:

UCanKeepthechange
11/3/2013 10:11 AM PST
The WH is attempting to blame cancelled policies on insurance companies. However, the truth is that it is due to the ACA.

The so called grandfathering in of existing policies was dishonest. If the cost to the consumer of a policy went up a single dollar ($1) since the law passed in 2010, it was DISQUALIFIED from the grandfather clause.

When the law passed in 2010, the administration already knew the following:

80%+ of individual market policies would not conform to ACA and would be eliminated by law
65% of policies for small businesses and their employees would not conform to ACA and would be eliminated by law
45% of policies for large businesses and their employees would not conform to ACA and would be eliminated by law.

So, when you hear the administration's talking heads blaming insurance, understand that it is simply another lie. This one is all on Obamacare.

Salverda
11/2/2013 7:10 PM PDT
Don't be deceived, by the latest straw-man argument, into thinking that insurance companies are some how sabotaging Obamacare. Think for a minute: Who wants the "individual mandate" forcing every American to become a costumer of the insurance industry? And: Why would insurance companies want to infuriate half of their current customers by canceling their existing policies, without having the law on their side? The insurance companies know that they won't loose their clients, they will just be "transferred" or "channeled" into more expensive plans that call for higher premiums and larger deductibles. The complicit insurance companies are in cahoots with Obama on Obamacare; Why aren't they speaking up right now while Obama falsely accuses them of canceling policies, and charges them with selling "inadequate" and "unsatisfactory" "bad-apple insurance" products to their costumers? They keep quiet and just take it, because they are colluding with Obama, open your eyes! Sure there were coverages (no coverage caps, pre-existing conditions, 26 year old "child" dependents) that the insurance industry was reluctant to offer, at first. Their costumers would not have stood for the increased costs of these extravagant, and even unnecessary, services. However, under Obamacare they have found a way to get us to pony up, and now, they view these services in a different light. Their clients will be forced by law, to pay for these things, and they have been "allowed" to charge us for them. To the insurance industry, it is as if all of their costumers have been upgraded into their highest cost Cadillac plans. And they are lapping it up, taking full advantage of the situation.

     

The changing face of healthcare

I recently came across this article, which is aimed at American physicians:

Getting ready for emerging care models

Like it or not change is coming to healthcare. The government, employer groups and other purchasers of healthcare are demanding higher quality and lower costs in the delivery of healthcare. The Affordable Care Act of 2010 started this evolution and whatever you call it -- value-based purchasing, accountable care, patient-centered healthcare, etc. -- it is taking root and starting to grow rapidly.

[...]

To get an idea of what you should be thinking about, let’s look to a healthcare market where these “new” healthcare delivery models are the norm and have been in place for years. One such market is in the Netherlands, where 90 percent of demand for care is generated in the primary care setting and providers (private) are paid a lump sum based on conditions and work in integrated care networks.

In the Netherlands today, 99 percent of physicians use a computer, 97 percent are Internet-enabled, 90 percent store all types of health records electronically, 84 percent receive lab results electronically, and 26 percent exchange data electronically with other providers – all benchmarks that the United States aims to achieve in the next 3-5 years. The international standards used in the Netherlands are consistent with U.S. conventions, as HL7 and ICD-9 are used in healthcare and ICD-10 is being adopted. Also, as in the United States, Holland does not have a dedicated health ID number or “smart card” for patients that some European countries have adopted but which are not relevant in this country. In these respects, the Dutch market is extremely similar to the U.S. market. This market is where our own company history started, and where our care collaboration and disease management solutions have matured.

Here is what you need and why
To participate in a value-based delivery model you must be willing and able to coordinate and collaborate on patient care with other ambulatory providers; the goal is to render the right amount of preventive care, avoiding health complications and resulting in better patient care with lower attendant costs. Once this mind shift has taken root -- a very different and, for some, a difficult way of thinking -- you need the basic tools and capabilities to engage in care coordination. These tools must:

Enable you to store patient information electronically. This does not have to be the typical full-blown EMR that legacy vendors have been marketing. These EMRs were developed in the fee-for-service model to optimize billing and reimbursement and resemble digital renditions of paper records. Not to mention they are expensive to acquire and maintain even when they may be subsidized by the ACO. Instead, you need a platform that is designed for the new delivery model focused on optimizing patient care, with a workflow that fits your practice pattern. For more on this see the 2010 PCAST Report titled "Realizing The Full Potential of Healthcare Information Technology to Improve Healthcare."

Enable patient-centric care, including making sure that patients receive reminders for preventive services through multiple channels based on their personal profile.

Support the care team network, allowing all providers, physicians, facilities, etc., involved in treating particular patients to share relevant information through collaborative and coordinated care.

Manage patients proactively.

Be able to generate electronic referrals.

Be a cloud-based solution. Cloud-based solutions require little or no local IT support and investment. This is really important for the average physician practice. Also the pricing level and payment structure with predictable cash flow more closely matches the size of the practice.

To distill down these capabilities into specific tool sets means you should expect to have the following: an EHR; a care collaboration/coordination solution; and the ability to exchange electronic referrals. The key in selecting the right solutions for your practice is to pick one with the right workflow for your practice. The solution(s) must be cloud-based so you can avoid the costly hassle of purchasing and supporting local software installations, which is expensive and not your core competency. If you do not have these capabilities you either might not be a candidate to participate in an ACO, clinically integrated care delivery network or PCMH, or the ACO will force you to use their solutions.

You should expect the ACO to provide other required solution capabilities such as clinical decision support (CDS), analytics, population health tools, health information exchange platform (HIE); reporting tools, etc. These are expensive solutions tailored for a large organization to manage and support. [...]

It goes on to describe the current inefficient, entrenched ways of doing things, and how they are going to be forced to rapidly change, as has happened in many other industries (It has an embedded link to an article in Forbes).


Also see:

Have Smart Phones to do Medical Work
     

Have Smart Phones to do Medical Work

And save us lots of time and money, too:

Visit NBCNews.com for breaking news, world news, and news about the economy

The doctor being interviewed talks about waste in the medical industry, and suggests that a third of all drugs prescribed are unnecessary or even harmful.

He demonstrates how a Smart Phone can be used to replace many costly and time consuming tests that waste time and money. Yet I wonder how far he will succeed with this medical phone apps technology? It would cut into the profit margins of those who are heavily invested in the old way of doing things.

 http://www.nbcnews.com/id/21134540/vp/50582822#50582822  

Rawanda Healthcare: Lessons for us all?

Rwanda's Historic Health Recovery: What the U.S. Might Learn

[...] Over the last ten years, Rwanda's health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda's economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

The rest of the world, wealthy countries and well as poor, can learn from Rwanda's rapid rise.

[...]

Rwanda achieves exceptional results not from how much money they spend on health, but from how they spend it. A recent article in BMJ, led by Farmer, examined World Health Organization data and sought to identify why Rwanda developed so rapidly, and to clarify the lessons for other countries. Rather than a single cause, the authors identified a series of interconnected factors that contributed to the country's turnaround.

First and foremost, credit belongs to the government of Rwanda's centralized planning. In 2000, the Rwandan government created a plan, called Vision 2020, to develop economically into a middle-income country over the next two decades. Dr. Agnes Binagwaho, Rwanda's Minister of Health, explained that "health is a key pillar of our development" and that without improving health, they will never alleviate the country's poverty.

[...]

While the specific context of Rwanda cannot be replicated, Dr. Farmer contends that Rwanda's focus on evidence-based policy, central planning, health systems, and equitable access to care should be heeded both by countries looking rebuild their health system and those with strong systems already in place. "In our commitment to understanding complexity," said Farmer, "we need to not forget that there are generalizable lessons to delivering care that are not acceptable to ignore."

While the United States still exceeds Rwanda in most traditional health metrics (such as life expectancy), and its hospitals and medical care surpass those in Rwanda, U.S. health outcomes still falter because too many patients fall through the cracks. The U.S. health system relies too heavily on doctors and hospitals to provide care. A growing body of research suggests that more frequent health care use and higher costs may lead to poorer health.

Farmer believes that, if the United States extended health care into the community like Rwanda, care for chronic diseases would markedly improve while costs would over time drop. Indeed, community-based pilots in the United States have proven effective in settings from inner-city Boston to rural Mississippi. [...]

There is much more in the full article. Lots of food for thought.
     

Truely Bipartisan Health Care Reform

Unlike Obamacare, the Wyden-Ryan plan is truely a bipartisan effort, that does not dump any grandma's off a cliff. From Senator Wyden's website:

Bipartisan Health Options

U.S. Senator Ron Wyden (D-OR) and U.S. Representative Paul Ryan (R-WI) introduced a new proposal that represents a major advance in the effort to build a more secure future for the millions of seniors who rely on Medicare.

The new report from Sen. Wyden and Rep. Ryan, titled “Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future,” outlines a detailed proposal to offer expanded health care choices for older Americans while preserving a traditional Medicare plan as an option. The report also proposes to give Americans under 65 more power and freedom to purchase insurance products they can carry with them into retirement.

[...]

Why do you say Wyden-Ryan won’t “end Medicare as we know it?”  Won’t allowing seniors to choose private health plans be a major change?

First of all, the hallmark of Medicare is not its structure but its guarantee that every American will have high quality health benefits as they get older.  And, as has been mentioned before, “Medicare as we know it” will end in 2022 if nothing is done to change its current course.  Wyden-Ryan takes action to ensure the Guarantee is preserved.

Contrary to what many believe, every Medicare beneficiary does not currently get their Medicare from the government-administered Medicare insurance plan.  Many seniors are already getting their Medicare from private health insurance plans.  In Oregon, for example, 56 percent of seniors currently get all or some of their health coverage from a private plan. (15 percent of Oregon seniors purchase private Medigap policies to supplement their traditional Medicare, while 41 percent of Oregon's Medicare beneficiaries are enrolled in private health insurance plans through Medicare Advantage.)Wyden-Ryan would allow seniors to continue to choose between the traditional government-administrated Medicare option and privately administered plans.  But instead of maintaining separate programs, Wyden would make those private plans more robust and accountable by forcing them to – for the first time – compete directly with traditional Medicare.

Every private plan that participates in the program would be required to offer health benefits that are AT LEAST as comprehensive as those offered by traditional Medicare and premium support payments would be pegged to the actual cost of health care in a given area, determined by an annual competitive bidding process.  Therefore, every senior – whether they get their health insurance from a private plan or the government – will be guaranteed to have the high quality health benefits that has long been Medicare’s promise.

How will Wyden-Ryan ensure that private insurance companies don’t take advantage of seniors?

All participating private plans will be required to offer benefits that are at least as comprehensive as traditional Medicare, with such standards enforced by the Centers for Medicare and Medicaid Services.  Any plan that is found taking advantage of seniors or providing inadequate care will be kicked out of the system. Cherry picking healthier seniors will be made unprofitable by robust risk-adjustment, and the Medicare Exchange where plans will seek to offer coverage to seniors, will be policed by the federal government.

It is worth noting that the Medigap law Senator Wyden authored to regulate the private market for Medicare’s supplemental insurance market has been protecting seniors from unscrupulous insurance practices for more than two decades.

How will Wyden-Ryan guarantee that health care will be affordable for all seniors? Isn’t it just a voucher?

A voucher suggests giving seniors a fixed amount of money indexed by a set rate of growth that may/may not have anything to do with the actual growth of health insurance costs.  Vouchers would not guarantee that seniors could afford health coverage.  (This is what the last year’s House Republican Budget did.)

Wyden-Ryan does not give seniors vouchers.  Instead Wyden-Ryan would guarantee that seniors can afford their health insurance premiums by giving seniors premium support payments, the amount of which will be determined by the actual cost of insurance premiums each year.

It would do this through a competitive bidding process in which private insurance plans, wanting to cover Medicare beneficiaries, would submit their benefit packages and the amount they will charge in premiums for the upcoming year.  The amount seniors receive in premium support will be determined by either the cost of traditional Medicare premiums or the second cheapest private plan available on the exchange (whichever is cheaper.)  This process will take place each year, so if health care costs – and therefore insurance premiums -- grow dramatically from one year to the next, so will the premiums support payments that seniors get to pay for them – thus ensuring that every senior can afford their health insurance premiums.

And again, every private plan in the Medicare exchange will be required to offer benefits that are at least as comprehensive as those offered by traditional Medicare. [...]

It's not a "Radical Plan to Kill Medicare". It actually builds on the Medicare options that already exist, in a way that will both control costs and offer more choices. And it's a plan we can actually afford!

It's definitely worth reading the whole thing. It's pretty much the same Medicare plan that Paul Ryan is advocating on his website.

In an interview for Human Events, Ryan explains the history of bipartisan support for the reforms he's advocating.

   

Milton Friedman's Cure for Health Care Costs

How to Cure Health Care

[...] The high cost and inequitable character of our medical care system are the direct result of our steady movement toward reliance on third-party payment. A cure requires reversing course, reprivatizing medical care by eliminating most third-party payment, and restoring the role of insurance to providing protection against major medical catastrophes.

The ideal way to do that would be to reverse past actions: repeal the tax exemption of employer-provided medical care; terminate Medicare and Medicaid; deregulate most insurance; and restrict the role of the government, preferably state and local rather than federal, to financing care for the hard cases. However, the vested interests that have grown up around the existing system, and the tyranny of the status quo, clearly make that solution not feasible politically. Yet it is worth stating the ideal as a guide to judging whether proposed incremental changes are in the right direction.

Most changes made in the final decade of the twentieth century were in the wrong direction. Despite rejection of the sweeping socialization of medicine proposed by Hillary Clinton, subsequent incremental changes have expanded the role of government, increased regulation of medical practice, and further constrained the terms of medical insurance, thereby raising its cost and increasing the fraction of individuals who choose or are forced to go without insurance.

There is one exception, which, though minor in current scope, is pregnant of future possibilities. The Kassebaum-Kennedy Bill, passed in 1996 after lengthy and acrimonious debate, included a narrowly limited four-year pilot program authorizing medical savings accounts. A medical savings account enables individuals to deposit tax-free funds in an account usable only for medical expense, provided they have a high-deductible insurance policy that limits the maximum out-of-pocket expense. As noted earlier, it eliminates third-party payment except for major medical expenses and is thus a movement very much in the right direction. By extending tax exemption to all medical expenses whether paid by the employer or not, it eliminates the present bias in favor of employer-provided medical care. That too is a move in the right direction. However, the extension of tax exemption increases the bias in favor of medical care compared to other household expenditures. This effect would tend to increase the implicit government subsidy for medical care, which would be a step in the wrong direction.

Before this pilot project, a number of large companies (e.g., Quaker Oats, Forbes, Golden Rule Insurance Company) had offered their employees the choice of a medical savings account instead of the usual low-deductible employer-provided insurance policy. In each case, the employer purchased a high-deductible major medical insurance policy for the employee and deposited a stated sum, generally about half of the deductible, in a medical savings account for the employee. That sum could be used by the employee for medical care. Any part not used during the year was the property of the employee and had to be included in taxable income. Despite the loss of the tax exemption, this alternative has generally been very popular with both employers and employees. It has reduced costs for the employer and empowered the employee, eliminating much third-party payment.

Medical savings accounts offer one way to resolve the growing financial and administrative problems of Medicare and Medicaid. It seems clear from private experience that a program along these lines would be less expensive and bureaucratic than the current system and more satisfactory to the participants. In effect, it would be a way to voucherize Medicare and Medicaid. It would enable participants to spend their own money on themselves for routine medical care and medical problems, rather than having to go through HMOs and insurance companies, while at the same time providing protection against medical catastrophes.

A more radical reform would, first, end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance (i.e., a major medical policy with a high deductible). Second, it would end tax exemption of employer-provided medical care. And, third, it would remove the restrictive regulations that are now imposed on medical insurance—hard to justify with universal catastrophic insurance.

This reform would solve the problem of the currently medically uninsured, eliminate most of the bureaucratic structure, free medical practitioners from an increasingly heavy burden of paperwork and regulation, and lead many employers and employees to convert employer-provided medical care into a higher cash wage. The taxpayer would save money because total government costs would plummet. The family would be relieved of one of its major concerns—the possibility of being impoverished by a major medical catastrophe—and most could readily finance the remaining medical costs. Families would once again have an incentive to monitor the providers of medical care and to establish the kind of personal relations with them that were once customary. The demonstrated efficiency of private enterprise would have a chance to improve the quality and lower the cost of medical care. The first question asked of a patient entering a hospital might once again become "What’s wrong?" not "What’s your insurance?"

I appreciate that he acknowledged that the vested interests of the status quo will make radical reform impossible. So he goes on to describe what can be done "realistically". THAT is worth aiming for.
     

Medicare's future, for those under age 55

People like me:

What no one is telling you about Medicare

[...] Cuts are inevitable. The real battle is over who bears the cost.

This spring the House passed a budget resolution designed by Paul Ryan (R-Wis.) that radically overhauls Medicare. The plan is unlikely to become law in its present form, but the ideas behind it will play a pivotal role in shaping Medicare reform.

Here's how the system would work: If you are younger than 55 today, your Medicare insurance would be replaced with a fixed voucher, or what Ryan calls "premium support," which you'd use to buy a private health insurance plan. In 2022 a typical 65-year-old would get about $8,000. Plans would have to take all comers, regardless of their health, and would charge the same price to people of the same age. Your premium support would go up as you got older or sicker. Low-income seniors would get extra cash.

You get skin in the game...

Premium support attempts to fight what economists call the moral hazard problem. If your insurance picks up a lot of your medical bills, you don't have much incentive to be a picky consumer. Your doctor prescribes, you comply. Even if there might be a cheaper way to get better results.

"Medicare has inherent in it inflationary pressures that push costs up very high, very rapidly," says Jim Capretta, a former George W. Bush administration budget official now at a think tank called the Ethics and Public Policy Center.

Ryan's approach would force you to make choices about what to do with your $8,000. You could pay a lot on top of that to get a generous plan or buy a cheap one that lets you see doctors within an HMO network and leaves you with a high deductible.

How much would that system reduce the cost of care? The answer is hotly contested. Some people would spend less but might also forgo care they really needed, says Juliette Cubanski, a Medicare policy analyst at the Kaiser Family Foundation.

Gail Wilensky, who ran the Medicare system during the George H.W. Bush administration, thinks a market dynamic will help a lot, but cautions that much spending is concentrated on the very sick, whose costs have blown past any reasonable deductible. "The serious spenders are always going to be using someone else's money," she says.

Shifting to private plans also has costs: Insurers have to charge enough to pay for administration and marketing while clearing a profit. The CBO, which concedes a lot of uncertainty about how vouchers would change the market, believes total costs would go up. It estimates that private plans will be so expensive that in 2022 a typical 65-year-old would spend twice as much to get the same benefits Medicare provides. That's an extra $6,240 to you.

...but a shrinking benefit.

The voucher is also a tool to cap government spending on health care. In 2022, once the feds send you $8,000, they're done paying for the year. "What we do in Medicare today is say, 'We're going to set in motion an open-ended entitlement, and the government's going to subsidize whatever it takes to provide that package,'" says Capretta. "The Ryan budget says, 'Why don't we build a budget that sets a level of taxation that we can afford, and here's the level of entitlement spending that will fit within that?'"

The idea of imposing a limit isn't inherently conservative or liberal. Most other rich countries, with their universal insurance, set a health care budget; the reform law signed by President Obama last year tries to cap spending too. But Ryan's cap is remarkably austere.

Social Security checks to rise 3.6%

The value of his voucher would grow at the level of inflation, which is almost always less than the growth of the economy. But no industrial country keeps health spending growth below GDP growth.

"It's implausible to think costs would inflate at that level," says Boston University health economist Austin Frakt. If so, then over time premium support would buy you less and less insurance -- and less and less care.

There are countless ways to moderate the severity of the Ryan plan. Wilensky suggests a cap that grows a little faster than GDP, for instance. What's most important about the proposal, though, is not the specific growth target; it's the philosophical stake in the ground planted about how much of the cost of paying for health care should be shared collectively, through taxes, and how much should be a responsibility for you, the individual, to bear. The Ryan plan says clearly: more on you. [...]

Hmmm. I do believe that costs have gotten so far out of control, because once the "government" is paying, instead of an individual, then nobody cares about the costs or questions what is being charged and why. But if it goes too far the other way, then people under 55 might be getting a lot less, even though they payed into Medicare the same as people over 55.

Is there a happy medium, a balance, somewhere? One will have to be found, because it sure can't continue like it is; unsustainable.

It's quite a long article. From PART 2:

Medicare: How much more will they cut?

For all the chatter about how politicians have to buckle down and get serious about reining in Medicare, you might have missed this development: Last year's health reform bill cut $500 billion out of two big Medicare programs over a decade, while increasing the number of high-income retirees who have to pay larger Part B premiums.

"It's as if that never happened," says Jonathan Oberlander, a professor of health policy at the University of North Carolina.

To be sure, health reform wasn't a let's-shrink-the-government project. The reason Democrats got their hands grimy and made cuts to the program was to help pay for a new health care entitlement, making it easier for Americans under 65 to buy their own insurance. Still, the new law shows that liberal lawmakers will slice into Medicare if needed, and offers a glimpse into how they'll try to do it.

The central idea behind the maze of cost-control provisions health reform establishes: Focus on trimming fat before reducing benefits. One approach is to reduce the power of providers to drive spending. When your doctor says you need this test or that surgery, you tend to take his word for it, even if you have hefty out-of-pocket costs. Hospitals, meanwhile, have consolidated in recent decades, giving them considerable price-setting power.

Results: There's substantial evidence that doctors at times over-treat, and you overpay for just about everything. "For a long hospital stay we pay $18,000, vs. $4,000 or $5,000 in Germany or Japan," says Gerard Anderson, director of the Center.

[...]

In coming months one idea you'll hear debated a lot is imposing a numerical cap on future government spending or revenue -- say, 21% of GDP or even 18%.

No matter what the specific numbers proposed are, growing health care costs are on a path to push the size of government well beyond those limits. If that happens, Medicare would go from long-term challenge to immediate crisis. Big changes would have to happen fast. Budget hawks ought to be specific about what those changes will be.

All you can know for sure now: This country, not just the government, but each of us as individuals -- is facing a monster of a doctor's bill, and there's no easy way to get around paying it.

Yikes.
     

Why Repealing ObamaCare is Unlikely

At least, not directly. So what CAN be done? Take a look:

What Republicans can — and can’t — do about ObamaCare

[...] The new Republican House majority will undoubtedly schedule a quick vote on repealing the health care law, perhaps as early as January. It will pass the House quite easily; not only will every Republican vote for repeal, but there are still a dozen Democrats in the House who voted no last March.

But that is as far as repeal is likely to go. The Democrats remain in control of the Senate, and Harry Reid, returning in triumph, is unlikely to even schedule a vote.

Repealing ObamaCare is just not going to happen while Obama is in office.

Some Republicans may be willing to take their symbolic victory in the House and call it a day. They shouldn’t. There are many things they can do short of repeal that can begin the step-by-step dismantling of ObamaCare.

At the low end of the scale, Republicans should use their new investigatory powers to hold hearings and force officials like HHS Secretary Kathleen Sebelius to testify about the law. For example, since the law passed we have learned that health care spending will go up, not down as promised, and that millions of Americans will not be able to keep the insurance they have today. What does Sebelius think of that? [...]

The second half of the article goes into what could happen, and what is likely to happen, and why.

Thankfully, much of the worst aspects of Obamacare can be dismantled. Other aspects can be modified. The Republicans may now get a chance to give many of the GOP's good ideas a fair hearing.

Eventually, some sort of bipartisan solution will be hammered together. That is what should have happened in the first place. This long slog ahead of us to sort it all out, has been unnecessary and an incredible waste of time and resources. The uncertainty it has created for potential employers has been devastating to job creation and the economy. I think most of the voters resent it. I know I do.
     

The Government's Mill Stone for Our Necks

Don't let them tie it onto us:

ObamaCare: A Tangled Knot Around America's Throat

Bureaucratic Web: Those who wondered what was in the health care overhaul bill now have a chance to look inside. What they see is a snarl of lines, arrows and geometric shapes that will do nothing to improve medical care.

Republican Sen. Sam Brownback of Kansas, GOP Rep. Kevin Brady of Texas and the minority staff of the Joint Economic Committee have provided a priceless public service by creating a flow chart (below) of the federal health care system that is being created by the Patient Protection and Affordable Care Act.


The chart displays, in words we can't improve, "a bewildering array of new government agencies, regulations and mandates."

At the center of the new federal health care universe is the secretary of Health and Human Services, who has been granted supernational powers. Radiating from that hub are the lesser celestial objects, such as Congress in the upper right corner, the president in the upper left, and doctors in the lower left.

Patients can be found near the bottom right corner. Remember them? They were supposed to be what the health care overhaul was all about. But they've been nudged, as almost an afterthought, to the fringe of this expanding universe.

Between patients and the secretary of Health and Human Services sit galaxies of red tape, taxes, regulations, federal programs, state agencies, mandates — and thousands of bureaucrats.

But the HHS secretary does not treat patients. Doctors do. And the expanse between them, according to this chart, is vast. They are separated by a government that is growing deeper, wider and more labyrinthine, an administrative state that will ration, dilute and ineffectively manage health care. [...]

Read the rest; it's even worse than the chart!

Remember in November, so we can REPEAL and REPLACE this garbage.


Also see:

Why Obamacare is a "healthcare bridge to nowhere" that can't be "tweaked"     

How does our health care spending compare to other countries?

Follow the link to see the large graphic with graphs; it's too big to post on my blog:

Health Care Spending: U.S. vs. Abroad
     

Why Obamacare is a "healthcare bridge to nowhere" that can't be "tweaked"

REPEAL
Why and how Obamacare must be undone

In the days since the enactment of their health care plan, Democrats in Washington have been desperately seeking to lodge the new program in the pantheon of American public-policy achievements. House Democratic whip James Clyburn compared the bill to the Civil Rights Act of 1964. Vice President Biden argued it vindicates a century of health reform efforts by Democrats and Republicans alike. House speaker Nancy Pelosi said “health insurance reform will stand alongside Social Security and Medicare in the annals of American history.”

Even putting aside the fact that Social Security and Medicare are going broke and taking the rest of the government with them, these frantic forced analogies are preposterous. The new law is a ghastly mess, which began as a badly misguided technocratic pipe dream and was then degraded into ruinous incoherence by the madcap process of its enactment.

The appeals to history are understandable, however, because the Democrats know that the law is also exceedingly vulnerable to a wholesale repeal effort: Its major provisions do not take effect for four years, yet in the interim it is likely to begin wreaking havoc with the health care sector—raising insurance premiums, health care costs, and public anxieties. If those major provisions do take effect, moreover, the true costs of the program will soon become clear, and its unsustainable structure will grow painfully obvious. So, to protect it from an angry public and from Republicans armed with alternatives, the new law must be made to seem thoroughly established and utterly irrevocable—a fact on the ground that must be lived with; tweaked, if necessary, at the edges, but at its core politically untouchable.

But it is no such thing. Obamacare starts life strikingly unpopular and looks likely to grow more so as we get to know it in the coming months and years. The entire House of Representatives, two-thirds of the Senate, and the president will be up for election before the law’s most significant provisions become fully active. The American public is concerned about spending, deficits, debt, taxes, and overactive government to an extent seldom seen in American history. The excesses of the plan seem likely to make the case for alternative gradual and incremental reforms only stronger.

And the repeal of Obamacare is essential to any meaningful effort to bring down health care costs, provide greater stability and security of coverage to more Americans, and address our entitlement crisis. Both the program’s original design and its contorted final form make repairs at the edges unworkable. The only solution is to repeal it and pursue genuine health care reform in its stead.



From Bad to Worse

To see why nothing short of repeal could suffice, we should begin at the core of our health care dilemma. [...]

The rest is an in-depth look at the different approaches to healthcare reform, how and why we ended up with the current bill, and why it is a "healthcare bridge to nowhere" which cannot succeed. And thus HAS to be repealed, and yes, replaced, with genuine SUSTAINABLE reform.

If only that had been done from the beginning. What a waste this all has been. And what a struggle we have ahead to clean up this mess.


Also see: "Obamacare is not going to happen"

     

Who adds passengers to a sinking boat?

The Democrat controlled US senate, apparently:

Senators Strike Health Deal

WASHINGTON -- Senior Senate Democrats reached tentative agreement Tuesday night to abandon the government-run insurance plan in their health-overhaul bill and to expand Medicare coverage to some people ages 55 to 64, clearing the most significant hurdle so far in getting a bill that can pass Congress.

[...]

Sen. John Barrasso (R., Wyo.) said expanding Medicare "is putting more people in a boat that's already sinking."

The American Medical Association said it opposes expanding Medicare because doctors face steep pay cuts under the program and many Medicare patients are struggling to find a doctor. Hospitals also said expanding Medicare and Medicaid is a bad idea.

"We want coverage -- in the worst way -- expanded, but both of these means are problematic for hospitals and physicians," said Chip Kahn, president of the Federation of American Hospitals, which lobbies on behalf of for-profit hospitals. "It's going to make it difficult to make it work."

After more than a week of debate on the Senate floor, Mr. Reid was working hard to unify his 60-member caucus, which includes 58 Democrats and two independents. A handful of moderate Democrats as well as Sen. Joseph Lieberman, the Connecticut independent, signaled concerns with the government-run plan, threatening to derail the broader bill. [...]

How can they even talk about expanding a failing program, without fixing the program first? Unless it's their intention to create even more chaos when Medicare fails. Are they deliberately creating an even larger crisis, so they can then claim "emergency" powers and push through something even worse?

     

The Free Market CAN Fix Health Care

Yes, Mr. President: A Free Market Can Fix Health Care

In March 2009, President Barack Obama said, "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way." This paper explains how letting workers control their health care dollars and tearing down regulatory barriers to competition would control costs, expand choice, improve health care quality, and make health coverage more secure.

First, Congress should give Medicare enrollees a voucher and the freedom to choose any health plan on the market. Vouchers would be means-tested, would contain Medicare spending, and are the only way to protect seniors from government rationing.

Second, to give workers control over their health care dollars, Congress should reform the tax treatment of health care with "large" health savings accounts. Large HSAs would reduce the number of uninsured Americans, would free workers to purchase secure health coverage from any source, and would effectively give workers a $9.7 trillion tax cut without increasing the federal budget deficit.

Third, Congress should break up state monopolies on insurance and clinician licensing. Allowing consumers to purchase health insurance licensed by other states could cover one-third of the uninsured without any new taxes or government subsidies.

Finally, Congress should reform Medicaid and the State Children's Health Insurance Program the way it reformed welfare in 1996. Block-granting those programs would reduce the deficit and encourage states to target resources to the truly needy.

The great advantage of a free market is that innovation and more prudent decisionmaking means that fewer patients will fall through the cracks. [...]

Precisely! The current healthcare system is hamstrug with government regulations that prohibit the free market from working. The free market hasn't failed healthcare; it hasn't had a free hand to work.

The part of the article I've quoted here is just the beginning. If you follow the link, there is a PDF file with the entire policy analysis in detail.

All this could be done without creating TRILLIONS of dollars of debt, and without creating new government programs that can't be sustained.
     

The "Public Option"; what it really means

The Public Option Deception

[...] more than one critic has wondered aloud why Democrats don’t just give up on the public option – which is opposed by every Republican – in order to reach a more bipartisan outcome. What exactly is so important about the public option anyway? And why do Democrats in particular seem so wedded to the idea?

There is a simple answer to these questions, but it’s an answer you’ve likely not heard from any institution in the mainstream media. The truth is that the public plan is a carefully devised scheme, a sneaky strategy, to deceive American voters. It’s a political marketing ploy designed to move the nation to a single-payer system – like the one in Canada – over the next decade. The public option is the Trojan horse. On the outside it’s all about “choice and competition”, but once it has been dragged within the walls of American medicine it’s true nature will become evident. By that time, it’ll be too late.

You want proof? We’ve got plenty. [...]

And there is plenty of proof. But what good is it, if people don't hear about it?

The latest strategy the Dems are considering, to push it through, is to change the name, to Medicare for everyone, because "Medicare" is a familiar word that doesn't scare people. The Dems don't care what the name of their Trojan Horse is, as long as they can sneak it in.

     

Health Care: How to do it right

The following article from Shawn Tully at CNNMoney.com, looks at REAL health care reform, by diagnosing the problems correctly, and then removing the obstacles:

Designing the ideal health care system
One Fortune editor explores the ups and down of Obamacare - and poses his own solution.

NEW YORK (Fortune) -- --This is the first installment in a series of health care columns by Fortune editor at large Shawn Tully.

Let's dream for a moment: Imagine that our nation could start with a clean slate and invent the best possible health care system to replace the current wobbly machine -- one that everybody agrees needs fixing.

Let's design a market-based, consumer-driven plan based on the belief that the same free-flowing forces that bring us the world's finest groceries, cars, and private mail delivery can also deliver high-quality health care at bargain prices.

In that world, put simply, the best way to spread coverage to the maximum number of Americans is to make it as affordable as possible, not by disguising the true cost through lavish subsidies, but by allowing the market to bring the benefits of real competition and consumer choice.

That will have two tremendous benefits. First, millions of Americans who lack insurance would buy it for the most basic of reasons -- they can afford it. And second, people who now have coverage would get to keep far more of their future incomes, instead of sacrificing their raises to soaring health care premiums.

So how do we get there?

The solution is to attack both sides of the problem -- inflated demand created by a system that encourages consumers to overuse and waste medical services, and restricted supply that pushes up the prices of those MRI exams, dialysis treatments, and physician visits.

These issues don't exist because the laws of supply and demand won't work in medicine, a misperception that's gained a shocking degree of credence. Once unshackled, they always work. But the market is blocked from working by a web of laws, regulations, and monopolistic restrictions. The solution isn't to add to them, as the Obama plan dictates, but to eliminate as may of these barriers as possible.

Hence, the goal is to put the consumer in charge by freeing Americans to spend their own money on health care, shop for the best prices, and keep what they don't spend. That's the way markets are supposed to behave. [...]

It goes on to show point by point, why this would be far superior to, and much less costly than, the Obama plan. The government does have an important role to play, but it's not the one they are reaching for currently. If they would simply do their part, and not overreach, we would all benefit. Read the whole thing, it's as clear as a bell, your must-read for the day.

There ARE viable alternatives that would work much better and cost much less than what the government is pushing on us. We need a Win/Win situation, not a situation that only benefits government expansion. We need a sustainable system that works efficiently. And we can have that by removing barriers in the current system, and keeping government in it's proper role.

Also see: True Health Care Reform: Reduce the "Wedge"
     

Big Business and Democrats unite for a very profitable Socialist Power-Grab

Pat has already beat me to the things I wanted to post about, so I refer you to his links:

Why Big Pharma and Big Insurance want Obama-style health-care reform:
"No one hates capitalism more than capitalists"

How the Democrats have been steering us towards this for decades:
The Plantation Party has been planning socialized healthcare for over 60 years

More "staged" Town Hall events, with pre-arranged questioners planted in the audience:
Obamugabe's Potemkin townhall

I would love to see the revolt of 1816 repeat itself:
Townhall protesters are not "unAmerican"

The protesters are scoring points, because many people agree with their concerns:
Krauthammer is wrong about the townhall protesters
     

True Health Care Reform: Reduce the "Wedge"

What is the "wedge"? It's one of the crucial things that makes health care costs so high. Read on. From Arthur Laffer at the WSJ:

How to Fix the Health-Care ‘Wedge’

[...] The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase. Mr. Obama’s health-care plan does nothing to address the gap between the price paid and the price received. Instead, it’s like a negative tax: Costs rise and people demand more than they need.

[...]

The bottom line is that when the government spends money on health care, the patient does not. The patient is then separated from the transaction in the sense that costs are no longer his concern. And when the patient doesn’t care about costs, only those who want higher costs—like doctors and drug companies—care.

Thus, health-care reform should be based on policies that diminish the health-care wedge rather than increase it. Mr. Obama’s reform principles—a public health-insurance option, mandated minimum coverage, mandated coverage of pre-existing conditions, and required purchase of health insurance—only increase the size of the wedge and thus health-care costs.

[...]

The president’s camp is quick to claim that his critics have not offered a viable alternative and would prefer to do nothing. But that argument couldn’t be further from the truth.

Rather than expanding the role of government in the health-care market, Congress should implement a patient-centered approach to health-care reform. A patient-centered approach focuses on the patient-doctor relationship and empowers the patient and the doctor to make effective and economical choices.

A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.

By empowering patients and doctors to manage health-care decisions, a patient-centered health-care reform will control costs, improve health outcomes, and improve the overall efficiency of the health-care system.

Congress needs to focus on reform that promotes what Americans want most: immediate, measurable ways to make health care more accessible and affordable without jeopardizing quality, individual choice, or personalized care. [...]

Mr. Laffer maintains that Obama's solutions won't work, because he has failed to diagnose the problems correctly. Read the whole thing. We need to fix our existing system, not scrap it for an even larger system that suffers from the same systemic problems, and that will also become unsustainable.
     

American Healthcare; could it be that it is so expensive, because it's the Best?

Ten reasons why American health-care is more expensive - and better (source: Hoover Digest at Stamford)

They are compelling reasons. Can anyone doubt that GOOD medical care does cost more? That's not to say there aren't things we can do to lower costs, but even so, quality usually costs more. Much of what we take for granted isn't even available to others. Even the poorer among us in the USA often get what they need. The assertion that without Obamacare, "poor sick people will die in the streets" is false.

There is room for reform, for sure. The Health Care Industry does not have our best interests in mind, any more than the government does. We are really going to have to insist on reforms that serve OUR interests, building on what's good about the current system, not destroying it.
     

Obamacare is in trouble, and rightly so

I think Peggy Noonan understands why, and explains it perfectly:

Common Sense May Sink ObamaCare
It turns out the president misjudged the nation’s mood.

[...] I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.

The final bill, with all its complexities, will probably be huge, a thousand pages or so. Americans don’t fear the devil’s in the details, they fear hell is. Do they want the same people running health care who gave us the Department of Motor Vehicles, the post office and the invasion of Iraq?

Let me throw forward three other things that I suspect lessen , or will lessen, support for full health-care reform, two of them not quantifiable. [...]

It's worth reading the whole thing, it makes a great deal of sense to me. And if that's not enough, look at some of the details of Obamacare, and how it's likely to affect you:


5 freedoms you'd lose in health care reform
If you read the fine print in the Congressional plans, you'll find that a lot of cherished aspects of the current system would disappear.

[...] A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy's Health committee, contradict the President's assurances. To be sure, it isn't easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

If you prize choosing your own cardiologist or urologist under your company's Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests -- you may be shocked to learn that you could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution.

In short, the Obama platform would mandate extremely full, expensive, and highly subsidized coverage -- including a lot of benefits people would never pay for with their own money -- but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can't have. It's a revolution, all right, but in the wrong direction.

Let's explore the five freedoms that Americans would lose under Obamacare:

Read the whole thing. Yikes! Please, lets kill this thing, before it goes any further. Let's improve the current system, not destroy it and replace it with an unsustainable, inefficient government program that limits our choices and tells us what to do, at great cost to us.
     

Obamacare: more government making more problems AND needless, unsustainable expense

Here is a government monster that needs to be killed before it's turned loose:

Inside the monstrous Obamacare bureaucracy



Many people seem to think we just need to get insurance for everyone, but not only is More Health Insurance is Not the Answer, it's actually part of the problem. Too many third parties and bureaucracy actually create administrative costs that are driving up the price of health care. Obamacare would simply expand and feed that problem. We need to simplify insurance and health care billing and bring prices back in touch with reality, using the free market and consumers choice.


Related Links:

Health Care Costs; why the high prices?

Lowering Health Care Costs for Everyone

A National Health Care Preview, and a lesson from Natasha Richardson's experience