The Facts about the House Bill to Reform Health Care

Most people don't know what is in the House bill to reform health care, yet it is, I think, close to what the Obama administration originally envisioned. When the House and Senate bills are reconciled, how close will the final product be to the House bill?  Hard to tell, but I see it as a benchmark for progressive reform. While it’s not perfect, it represents a very good start. Over the next three years, as it’s fleshed out, details are filled in, and Medicare is reformed in ways that enhances the quality of care, eliminates hazardous waste and reins in costs, it could become an excellent plan.  But you can’t root for it if you don’t know what’s in it.

As I mentioned yesterday, the House Committee on Education and Labor has put together an interactive graphic to help people figure out how “America’s Affordable Health Choices Act,” HR3200 would affect them.  Again here’s the link. Click on it, and you can find out what the legislation would mean for you, whether you’re self-employed, uninsured, on Medicare, or have employer-based insurance. It also tells you how the bill would affect both large and small employers.

This bill addresses many of the problems that I wrote about in Money-Driven Medicine—and that you see in the film; waste, profiteering, a shortage of primary care doctors, and a system that rewards doctors for doing something—but not for listening to and talking to the patient.

HR 3200 aims to change the financial incentives in our system. Rather than paying physicians more if they see more patients, and order more tests and procedures, it offers bonuses for better outcomes.  The bill also addresses the high cost of care, protects patients from medical bankruptcy, makes primary care more accessible, and guarantees that no one will be denied insurance, or charged exorbitant premiums because of a pre-existing condition.  Here’s a quick overview.

Few realize that "America's Affordable Health Choices Act" promises:

 No more co-pays or deductibles for preventive care

 No more rate increases for pre-existing conditions, gender, or occupation

 No more coverage denials for pre-existing conditions

 An annual cap on your out-of-pocket expenses that should prevent medical bankruptcies.  (The cap will be based on your income, but no matter how much you earn, no one will be asked to pay more than $5,000 a year in out-of-pocket expenses –$10,000 a year for a family. This includes all co-pays and deductibles.)

 Guaranteed, affordable oral, hearing, and vision care for your kids

 Mental health care coverage for everyone

 More family doctors and nurses will enter the workforce, helping guarantee access

 More family doctors and nurses entering the workforce, helping to guarantee access.The bill raises fees for primary care, offers bonuses to those who provide primary care as well as loan-forgiveness for medical students who choose primary care.  It also raises pay for nursing school instructors. At present many qualified candidates would like to enter nursing school, but there are not enough teachers.

 No more lifetime limits on how much insurance companies will pay

 No reason to ever make a job or life decision again based on health care coverage

Under the bill you can:

 Keep your doctor, and your current plan, if you like them

 If you don’t have employer-based insurance and buy your own plan, you’ll be able to enjoy lower group rates because you’ll be part of a national pool

The Public Insurance Plan

 The bill also offers a high quality public health insurance option that would compete with private insurers. Yesterday, the New England Journal of Medicine published a new poll online showing that nearly three-quarters of all doctors support some form of a public insurance plan.

But no doctor would be forced to participate in the public insurance plan. And no patient would be forced to choose it.

The pollsters explain that doctors like the idea of a public plan because they like Medicare. Many observers expect that the public sector plan would be modeled on a new, improved Medicare. The House bill calls for Medicare reforms that would simultaneously reduce costs and lead to better care by rewarding health care providers for the quality, rather than the quantity of the care they provide.

In order to work out any wrinkles in the public insurance plan, the House bill proposes phasing it in. In the first year of health care reform the public option would available to the uninsured, the self-employed and small employers with less than 11 employees. In the second year, it will be open to those with 20 or fewer employees and over time, to larger employers.

For a more detailed, very clear, user-friendly look at the House bill, go to this website where you can click on specific topics such as: “Myths vs. Facts,” “The Health Insurance Exchange,” “Employers and Health Reform” and “Strengthening Medicare.”

 

21 thoughts on “The Facts about the House Bill to Reform Health Care

  1. I still say a big cost driver is poor quality and total inefficiency (in the delivery of care to the patient). I’ve heard Obama talk about improving quality and investing in electronic medical records (efficiency), but what specifics are being talked about to address the quality problems? Patients rights?

  2. The Public Option: Doctor Approved
    A new study just published in the NEJM, found that a majority of physicians support the creation of a public health care option.
    The Robert Wood Johnson Foundation study showed that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance.
    If the additional 10 percent of doctors who support an entirely public health system are included, then approximately three out of four physicians nationwide support inclusion of a public option.
    Only 27 percent support a private-only reform that would provide subsidies for low-income individuals to purchase private insurance.
    The researchers surveyed a nationally representative sample of 2,130 physicians across America. The president and CEO of the foundation said that “This survey reveals important information about the perspective of physicians on issues central to the health reform debate. Policy makers should listen to their doctors.”
    “We found that no matter how you sliced the data, physicians demonstrated majority support for a public health insurance option, regardless of their type of practice or where they live.”
    Among those physicians who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options (the AMA has opposed a public option).
    These results given a voice to individual physicians in the national discussion about health reform. They want reform. Most often we hear the opinions of special interest people (like on this website) rather than doctors themselves, but Americans want to hear the opinions of doctors like those who treat them. This study lets us hear the unfiltered views of physicians on key elements of health reform and should be useful for lawmakers.
    Source: The Huffington Post

  3. Gregory:
    Are you suggesting that physicians would be willing to accept current Medicare reimbursements, if there were no competitive private insurers?
    That would mean a sugnificant cut in pay.
    If so, I can see how that would help solve insurance affordability, particularly if hospitals and all other providers took similar cuts.
    Seems to me that medical care is a necessity that is priced as a lixury.
    The most effective way to lower insurance costs is to lower reimbursemenbts across the board.
    Don Levit

  4. I called my doctor to let her know that I ran out of the sample rx she gave me and if she wanted me to continue on the medicine to please call it in to the pharmacy. She sent me a bill for $20 for calling in the prescription! Is that legal???

  5. Addressing the comment by Don Levit regarding lowering physician fees:
    Lowering physician fees can have very little effect on overall health care costs. The key to lowering costs is to lower overutilization. It is not the fee paid to the physician that will make the difference, it is changing the physician’s practice of test ordering, referral, prescribing, etc.
    Lowering the physician’s fee by 20% can save $50 or so per encounter. Avoiding the unnecessary MRI, etc. can save $1,000 and more.

  6. Maggie, I clicked your link that explains how the plan would affect me. Unfortunately it lacks important details like what does, “quality affordable plan” mean, or how much “affordability credits” will be, or whether premiums through a “public plan” or “exchange” will be any more significantly affordable than private insurance is now. It also does not say how forcing insurance companies to cover pre-exisitng conditions will increase my insurance premium. It appears I’ll be in the this plan’s donut hole, and will end up either paying the fine for not purchasing insurance or be forced into yet another unaffordable insurance premium along with higher taxes to pay for other peoples healthcare subsidies. I can’t sign on to this bill.

  7. I don’t see how we,as Americans, can be forced to buy insurance, this is indentured servitude…unreasonable seizure. I’m starting to get confused myself about everything being said and proposed. Is Obama proposing that we all be mandated to purchase health insurance? From for-profit insurers? I still don’t know why the residents of MA put up with this, who’s fighting that aspect of this reform debate?

  8. I truly believe that these new bailout and healthcare plans are designed to make my head explode. That would silence at least one American’s concern and voice of opposition.
    Now on top of the announcement that charges for the existing Medicare plan will be raised, thereby reducing the SSN payment, Sen. Max Baucus (D-Montana) wants to reduce Medicare/Medicaid and force me to pay for more insurance as I enter retirement age.
    After paying the maximum SSN tax since 1974, being told I was paying for my “secure” future, he thinks this would be a fair arrangement.
    Before I will ever take any new plans seriously, I have one issue:
    “When you replace my retirement and healthcare options, will you and all the hundreds of thousands of Federal employees join me in the same exact new plan? Or will you continue to separate yourselves from the vast majority of hardworking Americans and continue to belong to your private ‘Cadillac’ plan, funded yet again by my tax dollars?”

  9. Lisa, are you against your state mandating the purchase of auto insurance? Isn’t it nice to know that if another driver causes a wreck to your car that there is a mechanism to pay for it. I’m not against mandated health insurance, just mandated health insurance that simply provides continued profits to insurers and a healthcare industry that charges at least twice what the rest of the industrialized world charges – at the expense of trapped premium payers and patients. Don’t mandate me into a corrupt and inefficient system so that lobby money will continue to flow to politicians.

  10. Peter: “just mandated health insurance that simply provides continued profits to insurers and a healthcare industry that charges at least twice what the rest of the industrialized world charges – at the expense of trapped premium payers and patients. Don’t mandate me into a corrupt and inefficient system so that lobby money will continue to flow to politicians.”
    I object to the same, but you can’t compare it to auto insurance. Owing a car and driving it down the road is a priviledge, I can certianly choose not to operate a motor vehicle and therefore would not be forced to purchase insurance.
    So, if you’re going to compare the two, then what you’re saying is, if I exercise my freedom to pursue life & liberty by the very acting of choosing to breathe, that is my priviledge, the price I pay for the priviledge of existing is to buy insurance? Get real.

  11. “…the price I pay for the priviledge of existing is to buy insurance? Get real.”
    Obviously Lisa you haven’t heard about the concept of shared responsibilty. Healthcare is not about if you need it, it’s about when you need it. Who do you expect to pay for your emergency room care if you don’t have the resources to yourself?

  12. Lisa, erobin, Don, Mary, Peter, Lisa, Etrigan, Peter– second comment
    Lisa–The House bill promotes quality by encouraging Medicare to begin “bundling payments” to docors and hopsitals–one lump sum they divvy up. This encourages collaboration because no one gets a bonus unless everyone collaborates.
    The bill also authorized Medicare to refuse to pay for preventable readmissions at hospitals that report a large number of readmissions.
    It would have Medicare pay bonuses to doctors who do a good job of managing chronic diseases.
    It also would pay for the time needed to take a patient througoh the entire
    shared-decision-making protocol.
    “Patients Rights” is reallly not something that can be legislated. Sure you draft a list of what should happen– patient should be treated with dignity. They have a right to safe, effective care . .
    But none of this will happen unless hospitals become less chaotic–if they were doing fewer tests and procedurs there would be more time to listen to patients–and fewer errors.
    Patients should have a right to end-of-life counseling but we saw how the conservatives–and the public– responded to that. . .
    Ultimately, patients win rights in one of two ways: attitudes change (and this can’t be legislated) or through malpractice lawsuits (charging unsafe hosptial conditions etc.)
    erobin–
    thanks for the links!
    Don–
    Medicare fees for many specialits’ services are very high. In certain cases the Medicare Payment Advisory Commission poitns out, Medicare is over-paying.
    Private insurers (they trad association) has privately told Medicare that if it will lead the way, they will follow Medicare cuts for certain very lucrative servcies that are performed too often on patients who don’t benefit.
    Private insurers just want Medicare to provide political cover.
    AT teh same time Medicare, and everyone else, will be raising fees for the preventive and primary servcies that do benefit patients.
    Mary–
    Yes, it’s perfectly legal.
    And the truth is, she deserves to be paid for her time.
    How long does it take to call the pharmacy? A few minutes. But first she has to listen to your phone message. Look up your birthdate if you didn’t give it to her. Write down your pharmacy’s number and call.
    Alternatively she could tell you she will write out the prescription adn you can come pick it up, and she’ll charge you only $5 for looking up the info and writing it.
    Is your time worth $15?
    In Manhattan most doctors tell you that if you want a refill you have to make an appointment, come in and pay for a full office visit.
    Insurers do not reimburse them for the time they spend on the phone with you and the pharmacy.
    They are only paid for time they spend with you in person.
    So I have to pay at least the $35 co-pay to get a prescription re-filled (assuming I have met the deductible)–and waste a couple hours of my time in the doctor’s waiting room.
    I would be delighted if someone called it in and sent me a $20 bill.
    Peter
    If you think about it for a second, how could anyone possibly tell you what your premiums will be when this plan is rolled out in 2013–or what your subsidy might be?.
    Do you know what interest rates are going to be in 2013? Do you know how much the nation, as a whole, will be spending on healthcare in 2013?
    Do you know what the car that you are driving now will be worth in 2013?
    Do you know what inflation will be over the next 3 1/2 years? 2% a year? 6% a year?
    Do you know what you will be earning in 2013?
    (Subsidies will depend on what you earn).
    Do you know if you’ll have a job in 2013?
    Any legislation passed now can only provide broad outlines.
    For example, the House bill says that a family of four earning less than $88,000 in today’s dollars will qualify for some subsidy.
    This tells you that if you now have joint income of $100,000, and expect your pay to stay the same or go up, you won’t get a subsidy.
    On the other hand, if you lose your job you will.
    We also know that, today, the average family plan costs about $13,500.
    If, in 2013, your employer is not providing insurance benefits, then you would have to pay the entire $13,500 (in today’s dollars)–assuming you want a good private sector plan and aren’t eligible for a subsidy.
    If your employer is still providing insurance then your premium will be about what it is now–plus healthcare inflation between now and then. (At the current rate–8% a year you could expect your premium to be over 25% higher–unless we have serious reforms, cutting the waste in the system.)
    On the other hand, between now and 2013, we may see reforms. Insurers may begin to cut back on how much they pay hospitals (see the recent guest post on how Medicare pays hospials.)
    Right now, private insurers are rewarding many hospitals for inefficiency–paying them 15% to 20% more than it should cost them ot care for patients–if they were providing the high quality care that the most efficient hospitals provide.
    Insurers may also cut back on how much they are willing to pay for tests that we don’t really need–and how much they are willing to pay for certain specialists’ services.
    See the post titled “Low Hanging Fruit”
    If they do that, by 2013 private insuers might b e able to offer good comprehensive family plans for less than over $13,000 in today’s dollars.
    Maybe they’ll even start netogatiing wiht drug makers for real discounts.
    Pharma doesn’t need to make 16% profit margins.
    If insurers get serious about reducing waste maybe
    they could put together good family plans that cost only $11,000 a year in today’s dollars.
    A public sector plan should cost about $1500 to less because its administrative costs aren’t as high.
    So maybe in 2013, you could find a very good public sector family plan for $9500.
    IF you’re earning $100,000 joint income, that’s about 10% of your income– which is what Europeans wind up paying for health insurance in countries where everyone has insurance. (If they spend more than that they get help from the government.)
    Finally, yes if people with pre-existing conditions are included in the insurance pool, your premiums will be higher than they are now–if you live in a state that lets insurers shun the sick.
    Google a state that has community rating and guaranteed issue and you’ll get an idea of how
    much higher.
    IN return for those higher premiums you’ll know that you, or your mother, or your child, will not be denied coverage–or charged exorbitant premiums– if they have the bad luck to be diagnosed with cancer.
    Finally if you don’t “sign on” with health care reform you can be certain of one thing: 9 years from now, your insurance premiums will be twice as high as they are now. (This is if health care inflation continues at the same level that it has been at for the last 10 years.)
    And it’s not at all likely that you will be earning twice what you earn now.
    So if you don’t “sign on” for reform, in 10 years you and our family may not have heath insurance. (Unless we make structural reforms that rein in spending, employers are going to be getting out of the health benefit busines in droves.
    The unknowns of what reform will cost you may make you anxious. But the alternative–no reform–is truly terrifying.
    Lisa–
    If you want to tell insurers that they cannot refuse to sell someone insurance because you are sick –or charge them exorbitant rates because of a pre-exisiting condition–then everyone has to buy insurance (a they do in other developed countries.)
    Othewise people would wait until they were sick, and then buy insurance, safe in the knowledge that the insurer would have to cover them and couldnt’ charge them more.
    That doesn’t mean you have to buy for-profit insurance. In Massachusetts, any of the insurers are non-profits.
    But Texas (where you live) is a much more conservative state–non-profits like Kaiser were
    driven out of the state when they tried to expand there.
    Obama would like to have a public sector option for everyone–nationwide.
    Right now, polls show that roughly 3/4 of physicians want that too.
    But when you ask the publc– only 40% to 50% seem to want a public plan.
    They’ve been scared by the conservatives.
    This is not the president’s fault. He –and many other people–have been very clear that it would be like Medicare for people under 65. And under the House bill it woudl incorporate Medicare reforms designed to improve quality and elminate waste.
    Etrigan–
    Actually federal employees and Congressmen pay part of the permiums–just as you pay part of the premium if you have employer-based insurance.
    IF they choose a cadillac plan, they pay higher premiums.
    But I agree that Medicare is getting expensive for many middle class seniors. A reader is working on a guest-post about this.
    I doubt that Baucus suggestions for Medicare will fly. PRogressives and the AARP etc will be dead-set against it.
    But Medicare does ahve to get serious about he paste–no more angioplasties becaue the patient wants a “quick fix” for his angina, nad doesn’t want to exercise, change his diet and take inexpensive medications. (The angioplasty is only a temporary fix.)
    No more MRIs for back pain becuase your brother-in-law had one.
    NO more routine PSA testing for average-risk men when we have NO medical evidence that it saves lives or lenghtens lives by one day.
    See the post titled “Low Hanging Fruit” for examples of all of the place where we Know that we waste money . .–and expose patients to unncessary risks.
    Peter–
    Good point about auto insurance. But you need to read the post about you is making money from healthcare inflation.
    Drug-makers are enjoying 16% provit margins.
    Fro profit insurers have 3% profit margins. They are barely profitable. Check out what has happened to their stock prices in recent years.
    Our insurance premiums are so much higher than in other countries because we use so much more care, and much of that care is over-priced.
    As a result the amount that for-profit insurers have been paying out in reimbursements to doctors hospitals and patients has been rising by 8% a year, year after year, for the past 10 years.
    They pass those spiraling reimbursements on to you,, the customers, which is why your premiums have skyrockets. But they have not been making huge profits– they’re scraping by at 3%.
    Why are the reimbursement that they pay out rising so rapidly?
    When compared to people in other countries, Americans undergo many, many more surgeries–and in recent years, the number of surgeries has climbed sharply. (Though we are no healhtier than we were.)
    Each year, we also undergo many many more tests, we are hugely over-medicated–and we pay more for drugs than anyone else in the world–when we are in the hospital, we undergo many more tests and procedures . .
    And, outcomes are no better than in other coutntries. Often they are worse.
    The overtreatment is a bigger problem in some parts of the U.S. than in others.
    We have more than two decades of research done by doctors at Dartmouth showing that at academic medical centers in some regions of the U.S. (NY, Mass., Southern California, parts of Texas) Medicare spends 50% more on very similar patients.
    The reserach adjusts for differences in the patients’ income, race, age, just how sick they are, etc.
    The research reveals that Medicare spends so much more at some academic medical centers because
    patients are over-treated. They see more specialists, spend more days in the hopsital, undergo more tests and treatmetns than
    they would at places like the Mayo Clinic (which costs Medicare much less).
    Yet outcomes are no better at the medical centers where patients receive the most aggressive, most intensive treatment. Often they are worse–because patients are being exposed to unncessary risks.

  13. I’m with Lisa in regards to mandated insurance.
    If the plans were more attractive, people would respond appropriately.
    It is obvious to me that health insurance is deemed important by the general public.
    Why else would 60% of the American people get their insurance from their employers, when the family premium is $13,000 a year?
    That’s way too much money to fork over to any third party, be it private insurance or a government-owned plan.
    Insurance premiums should be heavily skewed toward the investment side, toward individual reserves, toward the future when more of our claims will occur as we age.
    Pay-as-you-go won’t cut it, for it looks only to the current year, not the future.
    Don Levit

  14. Peter, do not put words in my mouth. I never said I expected anybody else to pay for my ER visit.
    My point is this focus on “insurance” reform, in my opinion, is becoming alarming to me, we have to work from the top down. My point is, how dare we put up with being ordered by law to purchase health care “insurance.” Who is assuming this will drive down costs and improve quality. Where’s all the MA residents chiming in here? I ALREADY fork over a large percentage of my paycheck to…who is it now United Healthcare? I get no benefit. I can’t afford to go to the doctor. I’m not using the service but I have to keep paying more to “share the risk” in case I need it. Forcing me to purchase the same thing, by law, is going to make everything all better? Massachusettes?
    I can’t keep up with all the updates and latest regarding healthcare reform anymore, I consider Maggie a trusted source and I can’t even keep up with her blogs sometimes when she’s on a roll. My overall impression is the patient/consumer is getting lost, again, in this debate. The crux of the problem isn’t who is paying the bill, it’s the cost. All these estimates of what it will cost per person, per family, there’s no way to pin that down. If we ever do improve quality and effciency those numbers should drop dramatically, and why can’t patients pay for services rendered? Why can’t we? Because it’s too expensive. You don’t “make it affordable” by forcing everybody to contribute.
    I board of “mostly” physicians to determine quality and clincial effectiveness? Where’s the patient on this board? The scientist? Why isn’t there equal representation from all stakeholders?

  15. “If you think about it for a second, how could anyone possibly tell you what your premiums will be when this plan is rolled out in 2013–or what your subsidy might be?.”
    Maggie, isn’t this the meat of the bill everyone is asking about? If politicians are writing the legislation wouldn’t they know what’s in the bill? Isn’t it the cost that we’re all fighting about? Why would anyone support a bill that’s going to cost them more if COST is what we’re all fighting about? If we knew the cost we’d have a better idea on whether to support it or not. Do you think the taxpayers of Massachusetts are enjoying their “Universal Coverage” insurance reform? Was that sold as a “trust us” bill as well?

  16. Peter–
    Peter–
    No–the “meat of the bill” is not about what it is going to cost you–or what it is going to cost me..
    The “meat of the bill” is about what it is going to mean for all of us– and
    more importantly –what healthcare is going to cost all of us –as a nation– going forward.
    Let me make it simple:
    with no bill, you can be certain that youor health care will cost you more next year, the year after and the year after that.
    The cost of care–what hospitals charge, what doctors charge, what drug-makers charge is going up every year.
    And the amount of care that insured people use– the number of tests they undergo, the number of treatments and procedures, the amount of medication they take–is going up every year.
    Doctors are running more tests on more patients. And those tests are leading to more procedures.
    Without reform legislation you can be absolutely certain that the cost of your health insurance will go up roughly 8% a year– next year, the year after and the year after.
    The amount that private insuers pay out in reimbursements has been going up 8% a year, every year, for the last ten years because prices are gong up and because the volulme of tests, treatments and drugs is
    increasing.
    Witiout heatlhcare reform, this will not change.
    This means that in 9 years, your premiums double–if you still have insurance.
    How can we stop that?
    Only if we persuade doctors, hospitals and patients that people really don’t need all of those tests, procedures and drugs–that (as more than two decades of Dartmouth reserach shows)
    1/3 of our heatlh care dollars are spent on unncessary, ineffective, often unproven tests and treatments as well as over-priced drugs and devices that, too often, are no better than the older drugs adn devices that are no better than the drugs and devices they are trying to replace–and often riskier.
    The House bill would let Medicare begin to eliminate some of the waste by paying doctors less for tests and treatmenst that we know provide little benefit to the patient–and raising co-pays for those tests and treatments.
    This would steer patients and physicians away from all of the unnecessary angioplasties and by-passes, the mammograms for average-risk women that the breast cancer coalition tells us often are doing more harm than good, the PSA tests that the American Cancer Society no longer recommends for average-risk men etc. etc. etc.
    (See the post titled “Low Hanging Fruit” as well as the one about mammograms with the phrase “double-edged” sword in the title.
    If Medicare begins to do this, private insurers are likely to follow suit IF they have to compete wtih a public plan that is able to offer lower premiums becaue it is incorporating Medicare’s reforms by steering doctors and patients away from ineffective unncessary treatments.
    Under the House bill (HR 3200) both Medicare and the public plan also would be able to negotiate with drug-makers for lower prices on drugs.
    Just how much money would we save if we stopped paying for unncessary tests, treatments and hospitalzation–and if we negotiated for discounts on drugs?
    Peter –There is absolutely no way to calculate this. To project how much we would save you would have to be a mind-reader–and able to guess how millions of patients would react when they found out the co-pay for a PSA test was now $50, and were told that this is because there is no medical evidence that PSA tests save lives–or even extend life by a single day.
    How would hundreds of urologists react when told that Medicare was cutting what it pays for PSA tests by 50%? (These by the way are hypothetical numbers).
    The American Society of Urologists is the only professonal group that still recommends routine PSA testing. (the major cancer societies and the Preventive Services Task Force don’t.)
    How many urologists woudl stop recommending the tests if they were going to be paid much less to administer–and their patients were asking questions about why the co-pays were so high?
    Can you suggest how to estimate the savings? And then estimate savings with many fewer bypasses, angioplasties, mammograms, hopsitalizations, etc.?
    In addition, under the house bill, Medicare would negotiate fees with doctors and hopsitals. It would raise fees for primary care docs but would probably try to hold most fees steady, and cut some for services that don’t benefit patients.
    The White House would like to have an indenpendent board of phsyciains have the power to set fees.
    Many docotrs and hospitals feel that the public plan should pay everyone more than Medicare pays.
    How will these negotiations work out?
    We don’t know.
    Why can’t the government negotiate fees first–before rolling out reform in 2013?
    Because doctors and hospitals won’t negotiate until they see how many patients are in teh public plan and whether they need those customers or whether they can afford to refuse to take the public plan.
    How many people will sign up for the public plan and how many will choose private sector insurance instead?
    It depends on how low the premiums are for the public plan and how successful the lobbyists are in persuading Amricans to be afraid of the public plan.
    Because the public plan will have lower administrative costs, if it sticks to Medicare’s payment schedule, the Commonweatlh fund estimates it will cost household about $2,250 less than a family plan with a private sector insurer (which now costs about $13,500)
    Just how low will the public plan premiums go depends on how much it manags to save by reducing the number of unncessary tests and treatments, and by negotiating with drug-makers.
    No one will negoatiate until they see how big the public plan is (how many people sign up) and how much clout it has as a result.
    Bottom line: we know that reform under the House bill will save money. We don’t know how much money.
    You ask: are the people in Mass. happy?
    In Massachusetts the low-income people who had no insurance and who now have health care and full or partial subsidy are happy that they and their children now have access to care.
    In other developed countries–where everyone has health coverage–people who are better off accept the fact that they have a social responsibility–a moral responsibility–to help pay for healthcare for people who otherwise could not afford it.
    They just wouldn’t be comfortable living in a society where some people don’t have healthcare.
    The people in Massachusetts who are least happy with the healthcare system there are people who earn too much to qualify for a subsidy and at the same time aren’t rich–say a couple earning $68,000 a year.
    Premiums are very high in Massachusetts because it MADE NO EFFORT TO REDUCE SPENDING AND UTLIZATION
    BEFORE ROLLING OUT REFORM.
    Massachusetts has teh most expensive care on the globe because there are more specialists in Mass. per capita, more hospital beds per capita, and the people of Mass. undergo more tests and treatments, are more likely to be hospitalized, take more drugs etc. than people in other parts of the country.
    Could premiums for that couple earning $68,000 be lower than they are in Mass–yes, if we bring down spending.
    Ultimately “reform ” is not about what I pay or what you pay–it is about reducing costs and enhancing value for all Americans.

  17. Yes .. this will make the USA a second-class nation, promoting debt, welfare dependence, and more political phonies.
    Congratulations.

  18. This is all well and fine but what does this do for the individual that is to young for Medicare and have to start drawing social security early because they are unemployed and do not have coverage?

  19. People, no one is being forced to buy this plan!! Let’s say.. that right now you pay about %10-12 of your income to medicaid. Don’t you realize that this bill OVER RIDES that?? THIS would be our new plan. Illegal Aliens would be dropped. Lowering costs there alone about %10 then couple that with the fact that hospitals are basicaly going to be charged for a patient with something preventable have to come back.. and not get paid for extra tests, meaning they are going to be forced to be better Doctors. So let’s review, 1. lower cost 2. not paying more than you are now
    3. Not being forced to use it
    4. More attentive Doctors
    Look at the swiss, they were one of the first to enact a plan like this.. They currently have the highest quality of life in the WORLD.
    Quit being scared by reports and articles released by Anti-Obama groups that are proven outright lies 2 days later. Last year I reported $12,000 income. a very bad year. I was working in Car sales, got laid off just before the Dealership went out of buisness. Woke up one morning with a horrible pain in my side, I could barely move.. Went to the ER, racked up about $5,000 in bills (Kidney stone, infected Kidney) I still havn’t paid it.So becasue of that, my credit score is lower, I can’t buy a cheap little $10,000 American car. Now if i was covered, I would have paid maybe about 300-400 dollars ( more than they got out of me so far), and been able to have gotten a car. Meaning I could travel further for work, paid more taxes, paid more into the healthcare system, paid my hospital bills, and probably been responcable for 1-2 more jobs. You people really, really, need to learn to take a look at the Nation as a Neighborhood, take care of each other, love your neighbor,
    Or you go ahead and trust the companies that have left us where we are, capitolism had free riehn for the last 200years, and look where the CEO’s left us. Something is wrong when a small gas station goes out of buisness, a oil company reports 10 billion in profits, the CEO get’s 10 million in pay alone, yet prices get raised…. go ahead, trust the companies if you want. I would rather have the guy I can vote out or have impeached in charge of my healthcare.