If you can't answer these three questions about the bill then you don't know jacks**t about it.

[grantcart]

For the record I can't find definitive answers to these questions despite hours of research so I fall into the "Don't Know Jack Shit Group". I suspect the whole country is in the same position.

People who support the bill without being able to cite with authority the answers to these three questions are supporting without knowing the facts. The burden at this point is not on the critics, not on Dr. Dean but on the administration and congressional leaders to be clear about what is being offered.

It is possible that this is a good bill, but without the answer to these three questions no one can make an intelligent informed decision.

1) What is the MLR (medical loss ratio) of the plan?

The establishes the amount of money that the insurance companies keep and that they have to pay out to actual providers. The original House bill had 85%, Rockefeller ammendment made it 90%. This would be a devestating blow to insurance companies. Here is what the CBO says:

CBO says that a high MLR - even without the public option would transform health care in America into a de facto government run program. .

(Medicare MLR is 97%, current private care 65% so a 90% MLR would put us very close to a government run health care system

A proposal to require health insurers to provide rebates to their enrollees to the extent that their medical loss ratios are less than 90 percent would effectively force insurers to achieve a high medical loss ratio. Combining this requirement with the other provisions of the PPACA would greatly restrict flexibility related to the sale and purchase of health insurance. In CBO’s view, this further expansion of the federal government’s role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget.

2)Is there a sunset provision for the MLR?

Some very intelligent wonks have noted that the final House version of the bill appears to have inserted a sunset provision.

http://www.opencongress.org/articles/view/1357-The-Most-Important-Health-Care-Reform-Provision-You-ve-Never-Heard-Of

Is it a sunsine provision? is it a mistake?

Obviously a high MLR would be great but if it is only going to last until 2013 then its pretty useless.



3) Will the OPM control the prices for plans going into the exchange?

Let's say that the answer to 1) and 2) is "The MLR is 90% and there is no sunset provision". Then we are halfway to a great bill, even without the Public Option.

However the Public Option was there for a reason - to serve as a break for prices. With a high MLR insurance companies would no longer have an incentive to decline procedures, they would have an incentive to pay out on every claim and now over spend because with higher revenues they will now make higher profits.

The Office or Personnel Management serves as the Human Resource clearing house for all Federal and Postal employees. They are the gateway for the health insurance providers (Blue Cross, Concordia, Aetna and Kaiser) that have been approved for the exchange that federal employees use to chose their health plans (FEHB).

If OPM approves the plans in a similar way then providers would have to get prices and coverage approved by OPM, and they do a pretty good job. Federal Employees have different companies to choose from and can chose individual or family and low, medium and high options.



A bill that has a high MLR with no sunset clause and OPM in charge of approving plan rates WOULD be a huge reform.


Does this bill have those provisions? As far as I can tell no one can answer definitively. All of these things have been discussed but they don't seem to be promoting them NOW.

Until I know for sure the answers to these three questions I think it is impossible to support this bill.

But you shouldn't ask me because I can't answer the questions and therefore I know JACKSHIT about the bill.

[cali]

1. excellent post.

I would also like to know what are the mechanism for enforcement re Insurance companies, what is the budget for enforcement and who are the enforcers.

[grantcart]

3. Also good questions

more good questions would be what is the acual level of subsidies being proposed.

But before all of those questions should be answered we need to know the basic archeticture of the plan.

[dgibby]

44. I want to know about the annual cap loophole.

Is it still in the bill? What's an "unreasonable" amt? Who decides?

[timeforpeace]

2. Then it must be time to vote on it.

[David Zephyr]

5. Ain't that the truth?

Funny and tragic at the same time.

[GreenPartyVoter]

9. *snarf*

[tabasco]

59. Damn.

I thought you might have been swept up.

[flyarm]

4. isn't it sad and pathetic that It will effect your health and health care and you don't know

Jack shit about a health care bill that will directly effect your life and the lives of all Americans ..and we are being told by our White House to support what you don't know jack shit about and neither do most Americans..is this the way we are supposed to run a democratically elected republic..just buck up and support what ever shit they throw at us??????????

I refuse to support anything blindly..no matter what party throws shit at us and tells us to support!

[Cant trust em]

6. Some people are asking you to not support it for the same reason.

Most people don't know what they're talking about. I'm one of them. I don't have enough time to get too deep into detail. Most people just go on instincts.

[grantcart]

11. The burden on explaining it in a clear fashion are the people that are writing it

This is not too much detail this, IMHO, is the ball game. It is as important a question as whether or not there is a Public Option.

[Cant trust em]

17. I agree. My problem is that a lot of the reading I do is at work.

I can only pay about half the amount of attention I need to. I usually save the ones where policy details are involved for when I get home. That way I can give them the attention they deserve.

[closeupready]

32. Evidencing the case that corruption is part of the equation here IS the confusing language of HCR

Clearly, as I pointed out numerous times yesterday, there are so many loopholes in the Senate version that it does not improve, in any way, many of the objectionable practices which were on display in Michael Moore's film "Sicko", and yet, institutionalizes the role of the private health insurance carriers. If you believe corruption is the reason why consumers are going to be put at a disadvantage post-legislation, then the fact that the language of the bill itself is confusing and obscure serves the interests of those who want to pass legislation which, again, is clearly detrimental to the American people.

[closeupready]

10. Bush was able to shove through countless pieces of legislation using similar means.

You know, how they pushed through the Patriot Act and TARP. Sad that he's taking his cues from a Republican president.

[grantcart]

25. I think the President and Congressional leaders should be criticized for

confusing the message and leaving us confused but nobody is "pushing" anything through its anybody's question whether it will pass and most people feel that they should have had a higher profile and pushed harder.

[NJmaverick]

13. You shouldn't support something you don't know or understand, just as you shouldn't be against

something you don't know or understand. I think we all should make every effort to have informed positions.

[girl gone mad]

64. But you should definitely oppose something when no one who supports it can explain it to you..

in any clear and reasonable manner. Better to stick with the evil you know than risk getting stuck with a far worse evil.

[flyarm]

78. exactly!..but the problem is , the White House and congress do not want you to know what is being

planned..that is why they have made it so confusing to everyone!

I talked to my hubby's Union leader and they will not endorse anything that they don't know what is proposed in a clear , precise manner! And that is the case here..no one knows what is in the bill..But Harry Reid and a few others!

So how can anyone support responsibily what they don't know what the jack shit they are supporting???????

[David Zephyr]

7. K&R. Pass this along to friends and family.

Get the truth out while we still can.

[HughMoran]

69. Zipper head - find out the answer before you do

You didn't even read the post, did you?

[hfojvt]

8. that makes sense to me

but you seem to let critics off the hook. It's apparently okay for them to be dead set against it and to burn with rage against any of the fools and liars and charlatans (and dittocrats) who aupport the bill, even though neither group really knows jack about it. Which means it might actuall be a decent bill and Weiner not be a liar or coward or sell out.

[grantcart]

12. I definitely let critics off the hook. The responsibility of getting the key points of the bill

known to the public are the people who are writing it.


These are key features. I want to support the bill but I am not going along with a bill that does not meet the President's stated goals, including controlling cost and prices.

[alc]

46. I agree completly

I've had pdfs of every version of the bills. And I've tried to find the response to every critic's argument I see. When I can't find the response I see if someone else has a response that is backed up by the bill. There have been a number of loopholes (or mistakes) in different versions of the bills, and I haven't seen many "supporters" point them out. We need to have this bill looked at very critically and if we can use the text of the bill to show that they are wrong that's good. If we can't use the text of the bill to show that critics are wrong, then we aren't getting what we think.

[laughingliberal]

67. Here's my problem with that

I know enough of what is horrible about this to know it is a contract on America. None of the people coming out in vigorous support has said anything that comes close to mitigating the damage of it. The most bandied about talking point for those pushing it on us is the "covers 30 million new people." The parts of the bill they use to support that statistic do not support it. If they have some magical thing buried in there that would, actually, do that there is no doubt they'd be out there in front with it. They aren't lacking for media access.

[Zodiak]

14. I'd like to add a few more if you don't mind, Grantcart

1. What effect will being allowed to sell insurance policies across state lines have on "cost control"? There is so previous little real cost control in this bill as-is, so how do we not know that the least regulatory state will effectively remove all price controls?

2. What will be "minimal coverage" as outlined many times in the bill. What does "minimum coverage" mean in terms of copays, deductibles, and limits on services?

3. Since the HHS Secretary has most of the regulatory power of oversight in this bill, how can we guarantee that a Republican or a DLCer will take office and NOT put an industry insider with conflicts of interest in that position? It certainly has been a pattern lately for BOTH parties.

None of these questions are part of this debate, and their conspicuous absence leads me to believe that the answers to all of these questions are not encouraging.

And yes, I heard about the sunset clause. Like all of the issues I mention above, it's not being addressed.

[grantcart]

20. good questions

Your number 1 will be largely answered if the OPM is in chage of authorizing plans, they aren't going to allow funny business on plans in the exchange.

Your number 3 seems to be answered in that the power of the HHS Secretary only flows in one direction - against the insurance companies.

For example on the MLR at 85% the HHS Sec has the power to move it higher than 85% but not lower.


But don't trust me because I know JS about it.

[Zodiak]

61. I read a lot about HHS Sec. having appeal power, as well

I just really fear putting so much power in a political position. So much damage has been done by "regulators" who took en entirely hands-off approach.

Is the OPM in charge of ALL insurance policies, or only those on the exchange? When I read through the bill, it seemed that most of the regulatory power of the OPM was reserved for the exchange?

Since the exchange will have a very stringent requirement list, I do not want the rest of America subject to insurance policies sold over state lines, especially corporate America, which loves to move offices according to least resistance.

And no, I really don't know JS about it, either, but I SOOOOO want to. I am learning as I go, and I am frankly very busy at work lately.

But I have a LOT of questions that are unanswered, and the lack of answers fuels a lot of suspicion. Admittedly, I am fairly cynical because of a long history of watching pigs-in-a-poke sold to the American people, sometimes even with good intentions.

[Richardo]

15. This may be my favorite post of the whole HC folderol.

:patriot:

[grantcart]

24. Thanks Richardo

[lapfog_1]

16. In regards to the so-called MLR.

Think about this for a moment.

What the bill says is that the insurance companies have a FIXED MARGIN, but not a fixed profit. In effect, they now have a COST PLUS AWARD FEE contract. Whatever their "costs" are, they get to keep 15% or 10% of the money. There is NO INCENTIVE to keep costs in check. In fact, to increase their profits, what do they need to do? INCREASE COSTS!!!

I used to run government contracts for NASA. The absolute WORST contracts (for the taxpayer) were the cost+ contracts. And, btw, one of the largest contracts I dealt with was cost+7% (to Computer Sciences Corporation for about 200 contractors and their equipment). They are worse than no-bid contracts. Basically, to make money, the contractor is encouraged to spend as much money on stuff as possible and then claim it all is "required" to meet the SOW. Why do you think Lockheed, possibly the largest government contractor in the US, is now interested in getting into health care insurance.

In addition, there is every incentive to cost shift. Something isn't very profitable for the insurance company to manage (usually very small cost items that have more cost associated with handling the paperwork than the actual item) and they move that to a "100% co-pay" status (not covered by insurance). Things like small ticket medicines ($20 a month prescription).

[Zodiak]

18. I used to work in insurance

These tricks you outline are common and most likely well-known to the industry.

Plus a whole lot more tricks you didn't mention (and neither does the bill).

[lapfog_1]

23. Oh trust me, I've seen them all.

I just mentioned the easy ones to explain.

I was a SEB (Source Evaluation Board) member for years and years.

Moving the health care insurance industry to the status of government contractor (which is what the subsidies essentially do, only with an "exchange" rather than a RFP/bid process) AND including a "cost+" provision with that contractor status is possibly the worst aspect of this bill.

It will do nothing to contain costs. There is every incentive to increase costs. And there is a mandate for people to buy the insurance. We will have the very worst aspects of both the "free market" system and "socialized market" systems in place. No competition and an incentive to INCREASE costs.

This will cost a bloody fortune, and more and more people will be forced into the "subsidized" portion of the population.

And to pay for it, there is this "wonderful" tax on "Cadillac" health insurance policies... you might be led to believe that this is a tax on corporate executives... but it's really a regressive tax on union workers. Workers who over the years have negotiated hard to get those benefits for union members.

[grantcart]

21. Exactly why the question of OPM is so critical

IF the OPM is in charge of fixing prices and coverage then the insurance companies would be boxed in on both gross margin and price.


Also the HHS secretary would have the power to increase the MLR but not decrease it.


The MLR provision is attractive on the surface but without price control is worthless, in place of a public option supervision by the OPM could be even better and would be worth supporting the bill.


But then again I don't know if the OPM is going to be the gatekeeper of the plans.

[lapfog_1]

27. Even IF the OPM is exercising some sort of power to institute

price controls... all that creates is incentive to "game the system", i.e. figure out what are the "higher cost" items that the OPM allows, and make sure that more and more patients get that item. For example, the insurance industry will lobby the doctors now to "always make sure, get an MRI done". The doctors, many of whom have a stake in the labs that perform these expensive medical procedures, and the equipment manufacturers that make these devices, will HAPPILY go along with this new "best practice" medicine. So everyone with a tummy ache gets an MRI. Why? Because it's increases the cost!! and therefore increases the PROFITS for insurance company. If the OPM (which isn't equipped today to do any of this) steps in and says "Hey, that was an unnecessary test!" then the GOP rushes to the microphones with the now LEGITIMATE claim that the government is rationing care and coming between you and your doctor. Death panels!

The insurance industry OVERNIGHT will flip... and all those "claim denied" assholes will become "hey, you needed THIS also now" because we provided an incentive for them to do so.

Anyone that thinks this won't happen is naive.

Kill this bill, pass something else via reconciliation.

We can't afford this health care.

[grantcart]

35. Saying that OPM isn't equipped today to do any of this

completely undermines whatever claims you make about being an insurance inside expert. I meet with thousands of federal employees a year who are using FEHB and there are no complaints about OPM's job at all.

OPM has for decades been the gatekeeper for the millions of federal employees. They layout plan providers and they are tough as hell. Why do you think that reformers keep saying that we should get what federal employees get.

But this issue is easily proved.

Here is OPM's website link to find out what plans you would get as a federal employee.

Insert your zip code into the search engine and you can see what plans are approved for federal employees in your area.

http://www.opm.gov/insure/health/search/plansearch.aspx

OPM is proven and operational. If they are in control of the plans then it would be a huge step forward.

[lapfog_1]

42. I never claimed to be an "insurance inside expert"

however, I am an expert on federal government contracts, having been a contracting officer for the federal government.

And you make my point. The OPM manages PLANS not procedures. They are not equipped to review the individual insurance claims of millions of americans (30+ million in this bill).

So, what they would price fix is the premiums, right? So its a cost+ contract based on premiums. But underlying medical costs are what set the premiums. If the costs rise, then the premiums must also rise. And in a cost+award fee world, that increases profits. Not margins. Profits. So there is every incentive in the world for the the insurance industry to encourage increasing medical expenses. And thereby present a united monopolistic (a status that the insurance industry will continue to enjoy) front to whomever in placed in charge of determining premiums.

Besides, I haven't seen any analysis of the current Senate bill that places them in charge of fixing premium prices. No where does that exist. If it was proposed that the government assert price controls over premiums (as opposed to asserting fixing profit margins, as you correctly pointed out with the MLR provision), I'm sure the Republicans would be taking to the the microphones in droves, screaming about government control of private industry, unconstitutional, etc etc)... and I just haven't heard this argument from them.

If you have it on good authority that the OPM will be doing price controls via cost fixing, please point me to the analysis of the now marked up (and gutted) Reid bill.

Sure, it could be inserted in conference. But I don't trust the Democratic party anymore to fight for real health care reform (actually, health care INSURANCE reform).

[grantcart]

45. I don't have it on any authority that the OPM will be doing anything

That is the reason that I said it was a key question and I placed myself in the "I know jackshit" about this bill despite the fact that I work full time with federal employees about their benefits.

You are mixing two different points and both are important.

The first is the basic archetecture.

I submit that MLR at 90% and an effective gatekeeper on plans like the OPM would prove to be a big improvement and with no preexisting conditions and subsidies would be a big step forward.


The question of enforcement is another question. It should be considered seperately. You are right that insurance companies are very capable of "gaming the system" but this enforcement can be dealt with easily if their is the political will.


One point is that under the proposed legislation the SSH has significant enforcement powers, including increasing the MLR. This is a big club.

Everyone has heard of 'frivilous lawsuits'. There used to be a penalty against insurance companies for 'frivilous denials of claims'. If an insurance company denied a claim without substantive issues then they could be assessed a penalty at a rate 10 times the claim.

There was a time in American where insurance companies didn't dare to conduct trivial denial of claims, and of all of the problems this would be the easiest to solve, again, if there was the political will to do so.

[lapfog_1]

49. However, a much better deterent against "gaming the system"

moves, and the insurance industry greed as a whole, would be a robust Public Option, or failing that, gradually expanding Medicare.

[grantcart]

58. agreed

[andym]

29. Very good point-- need an MLR CAP and an absolute CAP

They need a percentage MLR of 90% AND an absolute cash limit of maximum differential between cost of services and everything else ("overhead" + profits) per year. That would help encourage them to negotiate with the Hosptitals, and Medical groups. How much should that be? Not sure.

[grantcart]

38. go to this link and see what I am saying about OPM

http://www.opm.gov/insure/health/search/plansearch.aspx

put in your zip code and click through

[NJmaverick]

19. This is one of the best posts I have seen for some time

you are correct the MLR is very important. With the loss of the Public Option this is the only cost controlling measure currently in the bill (although other things could potentially be added).

[grantcart]

22. Thank you

But technically the MLR is only a "margin controlling" measure and would actually push insurers to increase claim payout to justify higher prices.

This is what makes the question about OPM so important.

[NJmaverick]

28. My understanding from what I have read is that the insurance exchanges would be run by state

insurance commissions. Still you make an excellent point about the cost margins not encouraging efficiency.

[girl gone mad]

65. The exchange will be national, but individual states can choose..

to operate their own exchanges, though they will still be required to follow the Federal rules.

[Parker CA]

26. Grantcart, thank you for this excellent post. Now, where to find the real answers...?

[grantcart]

39. I was waitng for you Parker

[walldude]

30. My friend the worst thing about this isn't that we can't figure it out

it's that they don't know whats in the bill either. Do you think they are any different? Most of them don't bother to read the bill.

I swear that the whole point of voting was to have someone represent me in the government, so I could keep working and have my free time with my family, not so I would have to do their fucking job for them and know everything that is in every bill.

Maybe when I'm done doing their job they could come out on the road with me for a week or two so they can do my job. I'd love to see some of these whiners work 4 or 5 18 hour days in a row then tell me how hard it is to read all those bills.

[grantcart]

68. talk about watching them make sausage

[HuckleB]

31. K & R for good thought and honesty!!!!

[unblock]

33. hey! less substance, more vitriol!

where do you get off trying to dig into the actual merits of the bill?

:hi:

i'm actually encouraged (though i remain highly skeptical) by the notion of a high mlr. that said, while it's a recipe for higher payouts, it's also a recipe for higher premiums.

[Nicholas D Wolfwood]

34. It's 85% in the Senate bill.

Page 204 of HR 3590 (http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf)
1 (3) in the case of a plan that provides health
2 insurance coverage offered by a health insurance
3 issuer, that has a medical loss ratio of at least 85
4 percent.

So far as I can tell, there is no sunset. So far as I can tell, it is not regulated by OPM, but I don't understand why they would do so. They are charged strictly to be essentially the government's HR department, so it wouldn't be under their jurisdiction in the first place.

[grantcart]

36. The Rockefeller ammendment is supposed to make it 90%

OPM is not in relation to the MLR but the plans that would be accepted.

[Nicholas D Wolfwood]

37. Gotcha.

Well, it's in the bill. Haven't seen it stripped out yet.

As for the sunset, I did a search for the terms of the sunset that seems to be in the House bill, and it's not there.

[ThomWV]

40. Your argument fails in the first sentence of its defense

Right in the beginning you give this citation "MLR is 97%, current private care 65% so a 90% MLR would put us very close to a government run health care system" If I told you my name is Thom and I weigh 97 pounds but another guy's name is Bill and he weighs 65 pounds, but when he gains weight to equal mine his name will automatically change to Thom. Just because private insurance companies move their "MLR" to something closer to 97% doesn't for a second make them Government Run.

The rest of the argument builds on the first, and so it fails.

Sorry.

[grantcart]

47. You must not have read the OP

1) The OP advocates no 'argument'

2) The OP identifies 3 important questions. If you disagree with that assumption you will be the first on the thread to do so and everyone else on the thread is wrong.

3) The CBO states clearly that it would make it a 'defacto' government run plan.

4) I also said that doesn't make it a good plan as the price controls would also be needed.

5) Every progressive expert on the subject considers a 90% MLR to be a good thing if price controls also exist. I challenge you to find one person on this earth who thinks that a 90% MLR with effective price controls would not be a huge positive change for the American people. I have a very attractive bridge to sell to that person.

[McCamy Taylor]

41. This would not fix things. They would just charge higher premiums across the board---

Which is currently legal under the no anti-trust oversight of the insurance industry laws that we have now.

There's just one problem: The formula Obama and others want to use to determine an appropriate level of administrative overhead allows health insurers to directly benefit as premiums rise — a very perverse incentive to lower costs. Put another way, as long as premiums increase at a rate higher than general inflation, Obama's plan would allow health insurers to continue reaping greater profits while spending more on salaries, marketing and office buildings with each passing year.

The issue can be arcane, but it's crucial to understanding a major health insurance industry justification for setting administrative costs: the "medical-loss ratio," the percent of premium dollars insurers spend on medical expenses. According to regulators in Oregon and some in other parts of the country, this method is flawed and should be re-examined.

snip

Currently, as in most states, administrative costs are allowed to increase at the same staggering rate as premiums, which have gone up more than 10 percent annually for the past decade not because there are more visits to the hospital, but because those visits have become on average more expensive.

http://miller-mccune.com/health/obama-plan-to-cap-health-insurance-overhead-flawed-1459

So, no a law that sets a fixed profit loss margin does not get us home free. It just provides a massive incentive for the insurers to consolidate (as they are doing) raise rates (as they are doing) and lobby against Leahy's repeal of the anti-trust exemption.

[grantcart]

43. That is why the question of OPM being the gatekeeper for plans

They have been doing this for decades.

It has been discussed as part of the plan.

Not familiar with OPM's work go here:

http://www.opm.gov/insure/health/search/plansearch.aspx

Plans of this quality operating at 90% MLR with subsidies would be a great step forward.

Is that what we are getting? No one knows.

[McCamy Taylor]

60. If the plans double their premiums (which they legally can do) 10% profit will be twice as much.

I have seen no language anywhere to suggest that the Senate has capped rates. Instead they are allowing "nationwide plans" which will allow the insurers to offer less---for the same high sums--- without any state insurance regulation.

[BlueIdaho]

48. Great Post!

Unfortunately we can't know - Reid has secreted the actual Senate bill in his holy underwear until he has his 60 votes. The provisions you've outlined would go a long way toward helping me sleep at night.

[jgraz]

50. Except the MLR as written is a disaster for consumers.

Do you know how you keep paying bloated CEO bonuses on a 10% profit margin? YOU RAISE PREMIUMS.

A 90% MLR will place HUGE pressure on private insurance to jack up rates as high as the market will bear. And since people will be given a choice of buying their shit or going to jail, that's pretty fucking high.

[grantcart]

56. Totally agree that is why the question of who the gatekeeper on the plans are

some mentioned OPM - they do an excellent job.

[NYC_SKP]

51. I know JACK SHIT about the this Bill.

and I'm in good company.

So, which ones among our esteemed journalists is digging for the answers???

:shrug:

[truedelphi]

52. Absolutely excellently written OP grantcart

I like how despite your need to be expressive, your remained honest.

No, most of us do not know Jack____ about this bill.

And I tried to read some of the actual bill - but let's face it - more than likely in another six months some provision will come to light that spells out how every time an American with an M or a J in their name uses the program, the head of the top insurance companies gets another two million bucks. (So much for obama's promise of transperency! Made again and again last campaign season.)

Again thank you for this.

I found this part really frightening (I guess you did to or you wouldn't have bothered to post this:)-
But there’s a twist to all of this. The version of the bill that was passed by the House last weekend includes the provision, but also includes some curious, new “sunset” language. The sunset language states that the new minimum medical loss ratio requirements “shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.”

In other words, in 2013, when most of the bill takes effect, the medical loss ratio language would be null and void. There would be no more profit control, just the market competition that is provided by whatever form of the public option is included in the bill. Read the sunset language in context here.

[grantcart]

57. informed observers think it may be a simple error

a critical question though

[grahamhgreen]

53. 1) How much jail time can be imposed on the CEO and BoD if they violate the MLR?

[grahamhgreen]

54. Just the fact that the bill is riddled with obfuscatory and arcane terminology proves the bill is

meant to be confusing, confusing enough to create an easy to game system, just like the financial services modernization act.

We did not need to know what a credit default swap or a CDO was to know it was bad policy that would lead to disaster.

We don't need to know what a wire game is or a false Samaritan to know a con game - a classic bait and switch in this case - when I see one.

[pattmarty]

55. One very important thing you left out is the "minimum" or barebones.....

.......plans that will be the plans the poor and working class will have to buy. High deductibles and copays rumored to be as bad as 60-40. You will have people forced to buy insurance that they will in fact be unable to use because of high deductibles and high copays. This will do absolutely nothing to lower people forced into bankruptcy because of insufficient coverages. The Senate also took out the anti trust provision. If it looks like shit and smells like shit, then it must be ..........

[sabrina 1]

72. I've read that too. That the poor will have what is the equivalent

liability insurance on a car. Nowhere near enough to cover fixing it, so they usually get scrapped leaving the owner with no car.

Considering that the poor will be paying what for them will be far more than they can afford, but when they get sick, will not be able to afford the co-pays, I have a question also.

As things stand now, people with no insurance can go to the ER if they have a medical crisis. It is NOT free, as many on the right continue to falsely claim. The bills come later and are usually pretty exorbitant. But lives have been saved because of the law that forbids turning down people for lack of insurance.

My question is, and I haven't yet found an answer. Will the poor who will now be forced to have coverage, still be able to go to the ER if the cost of the treatment they need isn't covered by their premiums and they cannot afford the co-pays? Has this even been discussed?

What made me wonder about this was when Obama mentioned that the uninsured go to the ER and that 'this puts a burden on the rest of us'. Does that mean that he wants this bill to make it possible for hospitals to refuse treatment from now on? Sounded that way to me, which would be okay if the premiums covered life-saving care. But what if they don't? As you pointed out, there will be huge co-pays which the working poor will not be able to afford.

I would really like someone to answer this question. But who can we ask? I can't find an answer. But I do know that if it ends the requirement to treat people regardless of their insurance coverage, people are going to die.

[pattmarty]

73. My guess at this stage of the "bill" is they will still go to the emergency..............

..............room and their (shitty) insurance will pay a part of the bill. As far as "follow up", I would guess again that they will not be able to go to "their" doctor because of the copay situation. Look at every doctor/dentist office you go to now, they have signs posted all over stating that you must pay "up front" any fees not covered by insurance. My belief now is that we will never ever have a "European" style of coverage where an individual will either pay nothing at time of service or a very minimum fee. I think the ONE thing that virtually no one can argue, is how powerful the insurance companies are. If we let this shit bill pass now, we will never be able to "fix it" as a lot of the liberal Dems are saying. The Dems put themselves in a very precarious position either passing a piece of crap (which eventually everybody will realize as the case) and calling it a "victory" or scrapping the bill and go for more of a regulatory regime against the insurance companies. The Dems are in a "lose-lose" position in my opinion and it's their own goddamn fault.

[sabrina 1]

82. Thanks for your response. You are probably right.

So, essentially, the claim that '30 million Americans will now be covered' is deception, nothing will change for the sick working poor as far as getting care, except that they will have even more bills to pay, this time to Private Insurance, with the IRS as the collection agency should they fail to do so.

I have seen those signs when I went to the doctor with a family member a few months ago. I remember thinking, 'but what if you can't pay up front'? I was told that people who can't pay, are told to go to the emergency room. If the co-pays are as high as some people are claiming for this 'coverage', I imagine they will be told the same thing by their doctors.

[Journeyman]

62. Wow -- a reasoned approach on DU. . .

been awhile since I read one like that.

I can't say if what you argue is valid or not -- I too know Jack Shit about the bill -- but there's a considerable amount to ponder.

Thanks for this post, grantcart. I'll be looking for further posts from you.

[grantcart]

66. well its critical we pool our ignorance!!

[pipi_k]

63. Huh. I never knew jackshit about it...ever.

And I'll be the first to admit it.

[grantcart]

70. As John Stewart would say this classifies as a "Clusterf%^&k"

[bertman]

71. ". . . I can't answer the questions and therefore I know JACKSHIT about the bill."

And therein lies the crux of the problem with this piece of legislation. It is everything and nothing. It morphs from one thing into another overnight. This is a high-stakes shell game that the American people are supposed to support because "this may be our last chance at healthcare reform". I call "Bullshit" on this whole process. When the process is Bullshit, the results are usually Bullshit.

We DO NOT have to have a bill right now. We have to have a GOOD bill or NO bill. The polls are telling us that the American people see through this whole charade. If the Democrats are willing to kill the bill as it stands now and come up with something decent that's fine with me. But having these artificial deadlines and acting like this all must be done in the next week or two weeks or two months is just a ploy to scare people into accepting something that smells like Jack Shit. Or worse.

[eridani]

74. Great. The guy who can't afford the battery for his defibrillator dies anyway--

-but he will get a REBATE on his premium a year later. This is a really stupid sort of regulation. What if they had dealt with the CA energy "crisis" that way? Grandma dies because her respirator shuts down during a "brownout," but she gets a rebate next year after the government shows that Enron/Reliant have been price gouging. Jeebus! Regulation is putting utilities and health care under strict price control, period.

[blueworld]

75. Excellent post, but also not knowing jackshit, I do have some questions

Does a high MLR include procedures and prescriptions as determined by the health insurance companies themselves? I foresee endless maneuvering (think credit swaps). If the cost of prescription drugs in the US is always high & can't be negotiated down, then they can maintain a higher MLR simply by recommending more prescriptions, right?

If the cost of MRI's and certain other diagnostic tests are also high, that again would disguise the actual payout, right? In other words, I'm suspicious that they can avoid rebates & maintain a higher MLR simply because other aspects of the healthcare system are already rigged in their favor.

I worked in all these industries for decades; I've seen many of their books, their internal memos, their schemes & their distribution plans. We all look to maximize profits, & the system is gamed for them from the start, which is why I believe only a clean, actual competitor will generate any real, actual cost savings. I don't believe it can be legislated.

I realize there's no perfect bill possible, but I cringe at what's currently being offered without a robust public option, which is the only feature I believe will even make future improvements possible.

[grantcart]

92. I had the same worries but several insurance knowledgeable people

say that it is very difficult to manipulate the MLR because the line is very clear - payments to care providers for services.

[BzaDem]

76. I am happy that there are reasonable people here still open to supporting this

even after the blow of losing the public option and buy-in.

I believe the MLR is 85% for the large group market and 80% for the small group/individual markets. (http://tpmdc.talkingpointsmemo.com/2009/12/abortion-compromise-reached-nelson-to-issue-statement-shortly.php)

As for a sunset, I also do not know yet.

For question 3, I do believe the OPM will be negotiating plans that are allowed onto the OPM plan. That means they will be able to negotiate for the lowest price possible (and tell insurers to take a hike if they try to charge unreasonable rates). I am not positive about exactly how the negotiation works, but this seems consistent with the above link and everything I have heard about the OPM plan.

In addition, the above link says that insurers who "jack up their rates" will be barred from participating in the exchange altogether (even outside of the OPM plan in the exchange). I'm not sure what "jack up their rates" means operationally.

[bongobobtherealone]

80. you are

correct about the 85/80 at least at the moment. I've been trying to read the bill and I must say, it's takes a lot of effort to read. I think we need to have a law that states anyone that has ever been a lawyer can't write bills BC 95% of what I've read is legal mumbo jumbo~

[grantcart]

81. It appears that the MLR cap and OPM are in the bill

I know that the HHS Sec can increase the MLR.

[AuntPatsy]

77. Excellent Op, I am assuming that was their intention from the beginning...

keep us guessing and in the dark so that we remain unsure, how can one make good decisions, thoughtful, decisions, life changing decisions without ever knowing all the facts..

I have a strong feeling that not even those in washington that will vote on this HCR bill have even had more than a peek at it's contents and what bothers me even more, I don't think they want to take the time to read through it all..

I love how laws and or bills are made and passed simply on bipartisan bickering and for the most part those voting have no real idea what they are voting for...

welcome to american politics...

Show me the money, all else pales in comparison when attempting to push more bs on american citizens....

[Deja Q]

79. I D K

Therefore I D K JS A I. :D

[Kurt_and_Hunter]

83. Compromise bill MLR seems to be 75%-80% (depending on some factor I forget)

[grantcart]

90. Just saw in the bill its 80 to 85 depending on large or small markets

(by sheer luck this is what I predicted some time ago)

[LWolf]

84. Sure I do.

Know Jack Shit.

Even though I can't answer your very pertinent questions.

I know that mandated private insurance is a step back, not forward.

[grantcart]

89. All single payer systems are mandated so are all single payer systems

a step back, including highly regulated ones like Switzerland and the Netherlands that mandate insurance control it like a public utility and are single payer systems?

[LWolf]

93. All single payer systems

are not mandated private insurance.

[bvar22]

85. What I DO know about this (Senate) Bill is that....

...Mega-Billions (a TRILLION?) of our Tax Dollars will be MANDATED into the private For Profit sector.

That 20%+ of these tax dollars will NOT go toward Health Care, but to the profits of Private Corporations.

That almost no one will be happy when they open their NEW Health Care Package and find a Big Bill from the For Profit Corporations that will NOW be using the IRS as their private collection agency.
They WILL blame the Democrats...and rightly so.

They Republican Party will be brought back from the DEAD and given credibility for OPPOSING this bill.

That the Democratic Party will have presided over possibly the largest transfer of Public Wealth into the pockets of the private sector in history.

That the seeds for the Privatization (and destruction) of Medicare are planted in this bill.
($500 Billion Dollar defunding to pay for "private" Health Insurance).

What more do I need to know?
:shrug:

[grantcart]

86. If the MLR rate is 90% that would mean that their total operating margin

would be only 10% and that they would have to be all of their direct and indirect non claim expenses from this and what ever is left over would be their profit.


You are completely uninformed on the actual facts of the bill but entitled to be outraged.

We shouldn't have to be guessing about this.

Unfortunately the "facts" that you put forth are not based in reality.

[bvar22]

87. So you will disagree ....

...about the amount of cream (OUR Tax Dollars.."subsidies") the For Profits will be skimming off the top.
What about some of the other points?

I also have NO FAITH in our current politicians' ability to produce bullet proof "regulation" or effective "oversight" to ensure that the % these cold blooded corporations rake off the top stays within the guidelines.

If you could point to ONE instance in the last 30 years where the Democratic Party (or the Republicans) has enforced "regulation" on ANY of the major Corporations operating under their aegis, please point that out.

Isn't it against the LAW to operate a PO Box in the Bahamas to evade paying US Taxes?

Here is what happens when our Democrats promise they are going to "regulate" Corporations:

"Look at the bill the House of Representatives recently passed to reform accounting and financial disclosure in the wake of Enron.

Despite everything we learned about the gang from Houston, the bill does not close the revolving door between accountants and their clients, nor will it prohibit accounting firms from making millions by selling consulting services to the same companies they audit.

Critics now call it the "Ken Lay Protection Act." And what happened the other day when the Senate voted on regulating energy derivatives, those mischievous devices Enron used to manipulate prices and gouge customers?

Why, Senator Phil Gramm of Texas, that old and faithful friend of Enron, managed to scuttle it.

Then there's the new farm bill that will give more than $50 billion in new subsidies to the richest and largest farms in America.

And the new energy bill that takes your tax dollars and transfers them to the richest energy companies in the country.

Remember our recent story about how Enron used stock options to avoid paying taxes in four out of the last five years?

Well, even as we talk, the White House and business lobbies, with Democratic Senator Joe Lieberman as their point man, are working to block reform of stock options.

Yes, the rich declared class war and won.

All that's left is for politics to divide up the spoils.

http://www.pbs.org/now/commentary/moyers7.html

[grantcart]

88. There are two different sets of questions

1) What is in the bill


and


2) How enforcement can work


You now admit that everything you said about what is in the bill is in error but that doesn't matter because the US never enforces any laws against the corporations.


When I signed up for the cable service I use to type this message to you I used Adelphia and Congressman Cunningham was my congressman.

The top three officers of Adelphia are in jail and the President is almost certain to die in jail, Adelphia was taken away from them and sold to Time Warner. You know what happened to Cunningham. These are examples that are from my own zip code and relevent to typing on this computer.


If you want to have an intelligent conversation based on facts then you need to stay on point.

1) The first question is what is actually in the bill.

2) Is it better?

3) Is it sufficiently better to sacrifice long term goals.

If it is a good bill then the question of enforcement would become a critical one, but we are not there yet. Its obvious that you don't care about 1,2 or 3 above.

If we get to the question of the bill becoming worthwhile then enforcement becomes relevent.

[Shagbark Hickory]

91. Cliff's notes please.......

[AVID]

94. k

[Cleita]

95. Nobody knows yet because the final bill is still in flux. n/t

[uponit7771]

96. Kicked and thank you for thi