WSJ - you won’t be able to “keep your health-care plan”

[Anonymous]

It is my right to try everything I want to save my life and I never want a doctor to decide that my care has ended. That is a scary slope that England is now going through with breast cancer patients. It's all fine to say that certain care should be stopped until it is you or your family. I have great insurance that I pay or as does 85% of the country. Why would we want to put ourselves in a situation where we even have to think about rationing for a bunch of people who mainly refuse to buy insurance? If you are productive, there is no upside to you. This board also mainly has a bunch of younger people who have no problem with the idea of sub par care because most people who need the most medical intervention are older.

[Anonymous]

I am not aware of a plan on the table right now which would eliminate the right of a patient to privately contract with a physician - as long as you pay out of pocket. It's not rationing care, it's rationing payment. Big difference.

But yes, sometimes your physician will tell you that treatment is through. Not rationing, but ethics. When further treatment is unethical and futile many docs will refuse to do additional surgeries, etc. . . .

[Anonymous]

No no no-this is not ethics. As it stands now-doctors will tell you if they think something will work and you decide whether you want to go on. This is important because you are in control. Obama has already said openly that there need to be changes in care and gave examples that we should move to pain management rather than surgery for some-this is a soft way of saying euthanasia. It's awful. I really hate how he uses marketing terms that sound okay and goes over the head of a lot of people and he knows this but the reality is that if you are over 65 you are going to walk into a world where doctors will say "no hip replacement or heart valve replacement for you." Again..many people on his board are young and maybe even think "hey 65 is pretty old and maybe you shouldn't receive that sort of care" you will change your mind when 65 doesn't seem so old.

[jsteele]

Anonymous wrote:No no no-this is not ethics. As it stands now-doctors will tell you if they think something will work and you decide whether you want to go on. This is important because you are in control. Obama has already said openly that there need to be changes in care and gave examples that we should move to pain management rather than surgery for some-this is a soft way of saying euthanasia. It's awful. I really hate how he uses marketing terms that sound okay and goes over the head of a lot of people and he knows this but the reality is that if you are over 65 you are going to walk into a world where doctors will say "no hip replacement or heart valve replacement for you." Again..many people on his board are young and maybe even think "hey 65 is pretty old and maybe you shouldn't receive that sort of care" you will change your mind when 65 doesn't seem so old.

Please cite at least one credible source that supports your position that doctors will not be allowed to mention or offer the same medical alternatives they provide today. Again, posts like this are simply aimed at scaring the uninformed and have no basis in reality.

[Anonymous]

We will still be allowed to offer the care. But you will have to pay out of pocket. Nothing wrong with that! My taxes do not have to pay for your futile care.

And yes, we do already say no sometimes. I have refused to do unnecessary surgery whenever the risks are clearly greater than the benefits. And so have my colleagues. In the gray area where it's not so clear, or when the benefits clearly outweight the risks, it's your choice.

[Anonymous]

Ah not accurate on being able to pay out of pocket-the buracracy will prevent that as it does in England and Canada. But for the sake of argument --so you are saying if you are not rich and able to pay for that knee replacement when you are old that you should suffer when you may have had good insurance that would have covered that previously? Is that what you are saying because futile encompasses a lot of things. Of course taxes should pay for abortions that many people in the country have ethical questions against? Cuts both ways. Goes back to majority of the country has good insurance that they like and they are about to give that up for people like you who don' think their life is valued much after a certain age and for the many many people with cancer who are looking to extend their life..guess that doesn't matter as long as we include people who refuse to buy insurance and illegals. That's wonderful. I am someone who would be able to travel outside the country for better treatment but I really feel fo the middleclass who don't deserve this and many of whom don't understand what is about to happen to them.

[jsteele]

Anonymous wrote:Ah not accurate on being able to pay out of pocket-the buracracy will prevent that as it does in England and Canada. But for the sake of argument --so you are saying if you are not rich and able to pay for that knee replacement when you are old that you should suffer when you may have had good insurance that would have covered that previously? Is that what you are saying because futile encompasses a lot of things. Of course taxes should pay for abortions that many people in the country have ethical questions against? Cuts both ways. Goes back to majority of the country has good insurance that they like and they are about to give that up for people like you who don' think their life is valued much after a certain age and for the many many people with cancer who are looking to extend their life..guess that doesn't matter as long as we include people who refuse to buy insurance and illegals. That's wonderful. I am someone who would be able to travel outside the country for better treatment but I really feel fo the middleclass who don't deserve this and many of whom don't understand what is about to happen to them.

I'll give you points for having a vivid imagination, but this forum is for discussing politics, not creative writing. Repeating the same rant over and over is not going to make anything you have to say true. None of this has any basis in fact, which is exactly why you are unable to cite any sources. Can you even substantiate that people with good insurances would lose them? Let alone the rest of your fantasies. It should be easy to debate health care reform on its merits without resorting to base falsehoods.

[Anonymous]

Getting abusive doesn't change the reality.

I have already stated Obama doesn't have to do anything for private healthcare to go away with the upcoming changes he proposes, in terms of saying you lose your healthcare. It is fact that when the government controls majority of the healthcare dollars ( and anyone who understand the most basic finance knows that he who controls the dollars, controls everything) your service will be compromised. He has already talked openly about 'rationing" and saying that maybe drugs would be better than surgery is a death sentence for many people..he said this on several interviews including talking his recent abc Informercial that no contrarian debate on but I will let that go for another topic.

As for how people will lose care with their insurers is easy. Many people work for small companies where there are under 100 people and they have insurance there. Obama is already talking about higher taxes on those people who own the companies and also on higher corporate taxes. Many of those companies will say hmm I will pay the tax the government hits me with for not giving healthcare and those people will be driven to the public option.

Larger companies may also decide that it would be cheaper to push employees to the public option. The public option will be a large medicare and medicaid combined into one and anyone who has dealt with either knows it's not great and this option will be like medicare on steriods oh and it will have millions and millions coming into it at the same time. At the same time we have a limited number of doctors and we are continually trying to cut their profits so there will be a braindrain and why not? If you are the smartest in your class why would you want to deal with this but again millions and millions more instantly insured and same doctors??? Of course care will be compromised--anyone should see this? The private insurers will be in a bind because they don't have the unlimited resource of the federal goverment to fund and fed employees get ready because this public option will be you soon..I have family that works at hhs and this is the eventual hope--the whole "insurance bank is a scam that will go away". yup..and most at hhs aren't making millions to buy ancillary insurance. I am in a position to buy ancillary insurance so this "rant" as you call it Jeff is not about me, it's about the majority of people on DCUM who are not going to be in a position to buy private insurance and those rates will be high because they will have to be so if you think insurance is expensive now..look at what it will be

Within ten years, the privates will be out and then the real fun begins because there will be no other recourse and you will be SIL if you don't like your care. The fact that Obama already talks pretty openly about "end of life" care is sort of scary in the sense that you the person may not be able to choose what you want for your care. There is somthing very very scary about knowing that you will not be able to decide. I know people who were told that the odds were not great that they could hang on and they did some for five years and some still going but you know five years is a million when you are that person. Imagine Patrick Swayze--this kind of care would say..ah you are screwed and let's give you some "comfort" drugs. Instead he has outlived many with pancreatic cancer and I am sure he is so grateful for each extra month. That is his choice. He has paid and been productive. Why should his care be compromised when a majority of the uninsured choose to be unisinsured.

I also hear the reason for doing this is to keep people from using emergency rooms as doctor's offices. Do you really think that will stop? It will be impossibly long to get a doctor's appointment with all the people and those same people who don't take the time or have the pride to insure themselves and not suck the system will be using the "free" stuff like candy. Love that one of the plans being pssed around allows illegals to be on the plan and hmmm doesn't anyone think that is strange? Remember that over 40% of our country already doesn't pay income taxes.

So where I am lying Jeff?? Tell me how this new plan will be good for me? Sell me on it and remember I am a tax paying proud American.

[Anonymous]

Nicely put.

[Anonymous]

Sounds like a lot of assumptions, speculations and even more doom and gloom.
And BTW I have dealt with Medicaid and it was more than fine. They covered everything and I never had any problems. We now have a family plan through my husband's job that we pay almost $600 per month for. I can't tell the difference.

[jsteele]

Anonymous wrote:
So where I am lying Jeff?? Tell me how this new plan will be good for me? Sell me on it and remember I am a tax paying proud American.

What you are lying about:

1) First, there is currently no agreed upon plan, yet you continue to make assumptions of what will be in future plans that you present as fact;
2) you repeatedly state that it will not be possible to privately pay for services that are available today.

The healthcare reform bills are currently in committee. The Senate committee has not even released a draft. The House version is still in flux. Various revenue ideas have been floated, but none have been agreed to. So, at this point it is impossible to say what taxes, if any, will be imposed, much less the result of those taxes.

You have repeatedly stated that currently insured individuals will lose their insurance. First, you said this was because of the repeal of ERISA. Now, you are suddenly blaming it on taxes and not even mentioning ERISA.

Here are facts:

1) we don't know what, if any taxes, will be included;
2) we don't know the amount of penalties companies will pay for not providing insurance;
3) we don't know the cost of the public option;
4) we don't know what will be offered in the public option.

Without knowing any of that information, it is impossible to say something like "Many of those companies will say hmm I will pay the tax the government hits me with for not giving healthcare and those people will be driven to the public option." What if the tax is higher than the insurance cost? Then, your theory is likely to be wrong.

It is not true to say that healthcare reform will cause people who are currently happy with their insurance to lose it. You can only offer your opinion that under certain scenarios, that might happen. Yet, you present it as fact.

Similarly, there has been no discussion of legislation that will outlaw the private delivery of medical services. Your contention that out-of-pocket payment for medical treatment is prevented in Canada and England is wrong. I don't know whether you are lying or uninformed, but either way, you are not telling the truth. Similarly, you are not telling the truth when you say that healthcare reform in the US will prevent out-of-pocket payment for medical treatment (given that there is no support for such legislation in Congress).

There is a certain dishonestly to your entire approach to this debate when you continually say "Obama will do such and such" or "Obama talked about such and such" and proceed to attack that as if words go from his mouth directly to law. You completely ignore the sausage-making process that is taking place in Congress. Why not debate the Congressional bills rather than out-of-context remarks from Obama?

Why you should support healthcare reform:

1) Because reducing medical costs for everyone will benefit you;
2) Because when our citizens are healthier, the entire country is better off.
3) Because a lot of our fellow citizens are one medical emergency away from bankruptcy, and that shouldn't be the case;
4) Because the "rationing" you fear is already taking place with faceless insurance company bureaucrats who are paid not to pay for our services making the decisions. I have experienced within my immediate family what it is like to have the insurance company refuse to cover procedures.
5) Because lower health costs will help make American companies more competitive internationally.
6) and, because a failure to reform the current system will lead to even more Americans losing access to necessary healthcare.

[Anonymous]

PP --

What we do know about the public plan is that it will pay providers based on Medicare rates (this was proposed in both the HELP and Tri Committee bills). So, it will do nothing to improve quality (which in this case means 'bang for buck') or to address the 'paying for volume' issue that the current Medicare program faces. Instead, it will simply "shift the curve" (as Elmendorf has stated). By focusing solely on this type of policy change, Congress and the President are not addressing the root of the matter. Until we're actually discussing the structural changes that could happen, its not real reform.

Just a gripe here, but I don't accept the premise that medical costs are too high, because doing so necessarily implies that we have somehow reached the pinnacle of medical innovation. If we were to examine 1950s medical care at today's prices, then we'd see that cost has gone down. Same thing even for 80s or 90s care. Innovation is expensive, but I'm willing to pay for it to make ensure that my grandkids might be closer to or have cures for diseases and conditions that are deadly today. Because other countries are economic free-riders and have put in place strong price controls, American prices have had to compensate by increasing even higher beyond inflation and income growth. If health reform "has" to happen today, and as the liberal dems have envisioned, then I guess i'm glad its 2009, and we're not still treating the humors with blood letting.

[Anonymous]

Anonymous wrote:Ah not accurate on being able to pay out of pocket-the buracracy will prevent that as it does in England and Canada. But for the sake of argument --so you are saying if you are not rich and able to pay for that knee replacement when you are old that you should suffer when you may have had good insurance that would have covered that previously?

I don't believe that is what is being proposed here. But even if it is:

I would be OK living in a society that provided basic health care for all, including the poor, but you couldn't, even on your own, get your knees replaced. Vaccinations and antibiotics and preventive care for all trumps knee replacements for old people who let themselves get fat and ruined their knees. And I will soon be old and I'm overweight. I'll give up that knee if I must.

[jsteele]

Anonymous wrote:PP --

What we do know about the public plan is that it will pay providers based on Medicare rates (this was proposed in both the HELP and Tri Committee bills). So, it will do nothing to improve quality (which in this case means 'bang for buck') or to address the 'paying for volume' issue that the current Medicare program faces. Instead, it will simply "shift the curve" (as Elmendorf has stated). By focusing solely on this type of policy change, Congress and the President are not addressing the root of the matter. Until we're actually discussing the structural changes that could happen, its not real reform.

You may be happy to hear that the agreement just arrived at between Waxman and the Blue Dogs no longer links the rates paid by the public option to Medicare rates. Rather, they will be negotiated by the Health and Human Services secretary. Also, that is similar to what was in the Senate HELP committee bill, so I think you were mistaken about that above (though the whole thing is very complicated).

Also, I'm not sure why you believe that anyone is "focusing solely on this type of policy change". There are a huge number of other things included in these bills. The public option is only one part -- albeit a very controversial part -- of the proposed reforms.

[Anonymous]

00:10 here

By "this type of policy change" I meant focusing on cost solely, as opposed to outcomes based payments. I realize that is a long way off as the research methodologies for developing those outcomes measures aren't quite there yet. Point being, just narrowly focusing on cost isn't going to get the job done to actually improving our medical system.

Yes, there are lots of other provisions in the bills, but they are largely driven by an ideology focused on a single-payer system, and then turning dials where available to find ways to pay for it.

We'll see where E&C ends up with their markup. At least there won't be a floor vote until September so Members can actually read the bill. I'm more optimistic to see what comes out of the SFC for a more thoughtful approach to policy.