Universal Health Coverage

[Shapley]

The New York Times quotes Dennis Kucinich as saying

“I believe health care is a civil right.”

A thought provoking statement

This bill does not address the 'right' to heatlh care, it merely established insurance as a mandate. In fact, it is all about insurance, and has little or nothing to do with health care at all. It takes the Fannie Mae/Freddie Mac approach to insurance, which is probably the inent. After Fannie Mae/Freddie Mac irreparably harmed the mortgage industry, the governemnt 'came to the rescue' and took over. Why create a public option when you can merely nationalize the private one?

A sad state of affairs.

[Giant Communist Robot]

I could be wrong, but I think that this comes from an historical perspective where people were denied access to health care based on considerations like race. I think access was the right, not health insurance. Kind of a "blur" in thinking, I expect.

[Haggis@wk]

I've lost my tricare coverage with this bill so I'm a little...upset. Please recall that Medicaid rejects more health care than any other insurance company. Plus I heard that the taxes, which begins 01/01/11 will be retroactive to 01/01/10. Welcome to Socialism.

[Shapley]

I've lost my tricare coverage with this bill so I'm a little...upset. Please recall that Medicaid rejects more health care than any other insurance company. Plus I heard that the taxes, which begins 01/01/11 will be retroactive to 01/01/10. Welcome to Socialism.

Once upon a time, we believed that 'no ex post facto law' prohibited retroactivity in all laws passed by Congress. That thinking has changed.

Notice, however, that the taxes bill will not come due until after 2010 election. Methinks that's why they delayed passage of the bill before now.

Since the House had to pass the Senate bill word-for-word in order not to have to face a reconciliation vote, and the Senate bill was passed last year, it is probable that the bill does date the tax increase to 1/1/10, which would have been retroactive even had the bill passed shortly after leaving the Senate. It would be my hope that the courts would reject retroactivity that far back, but there is precedent. The luxury-tax repeal passed by President Clinton in 1993 was retroactive all the way back to its passage. It is hard to imagine that any President or Congress could actually alter, retroactively, the doings of the President and/or Congress that preceded them, but such is the America of today.

[Mahlersfifth]

Yes Haggis.. Danny Williams. Had heart surgery in the US. SO did my American uncle who's surgery wasn't so good and he had to have it done twice and paid both times. My uncle wasn't so wealthy NOR celebrity-like as is Danny who is always controversial, kooky, wealthy and Premier of Newfoundland. Of course Danny could have had his surgery here in Ontario you know, and had his province reimburse my province for the pleasure but all in all I'd say it all worked out well. The man didn't get to jump the queue here (as all wealthy politicos can do) and instead paid hundreds of thousands for the privilege to have it done in the US which left a more deserving person to have received their surgery on time and for free because Danny went to the US. And Danny won't really be out of pocket too much, he is Premier of Newfoundland after all.

[Haggis@wk]

Yes Haggis.. Danny Williams. Had heart surgery in the US. SO did my American uncle who's surgery wasn't so good and he had to have it done twice and paid both times. My uncle wasn't so wealthy NOR celebrity-like as is Danny who is always controversial, kooky, wealthy and Premier of Newfoundland. Of course Danny could have had his surgery here in Ontario you know, and had his province reimburse my province for the pleasure but all in all I'd say it all worked out well. The man didn't get to jump the queue here (as all wealthy politicos can do) and instead paid hundreds of thousands for the privilege to have it done in the US which left a more deserving person to have received their surgery on time and for free because Danny went to the US. And Danny won't really be out of pocket too much, he is Premier of Newfoundland after all.

Of course the fact that open heart surgery is hideously painful for months following the surgery was just a minor plus

[Haggis@wk]

Exempted From Obamacare: Senior Staff Who Wrote the Bill

[piqaboo]

Yes Haggis.. Danny Williams. Had heart surgery in the US. SO did my American uncle who's surgery wasn't so good and he had to have it done twice and paid both times. My uncle wasn't so wealthy NOR celebrity-like as is Danny who is always controversial, kooky, wealthy and Premier of Newfoundland. Of course Danny could have had his surgery here in Ontario you know, and had his province reimburse my province for the pleasure but all in all I'd say it all worked out well. The man didn't get to jump the queue here (as all wealthy politicos can do) and instead paid hundreds of thousands for the privilege to have it done in the US which left a more deserving person to have received their surgery on time and for free because Danny went to the US. And Danny won't really be out of pocket too much, he is Premier of Newfoundland after all.

Of course the fact that open heart surgery is hideously painful for months following the surgery was just a minor plus

Are you implying that it would have hurt less if he'd had the surgery done in Canada?

[Haggis@wk]

Are you implying that it would have hurt less if he'd had the surgery done in Canada?

Just the opposite, according to the press, the only option he had in Canada was open heart surgery. That's when they crack your chest, break a lot of bones. Recovery from that is painful.

[Giant Communist Robot]

Some time ago I tried to make the point that the root cause of the cost of health care was not the insurance companies. Any large entity will have some inefficiencies but on the whole I think private enterprise is more efficient than government. My feeling is that in the future we will see less coverage and higher costs than we will like.

[Haggis@wk]

Arne Duncan manipulated school lists to favor powerful.

“Chicago Breaking News reported late last night that former Chicago schools chief and current Secretary of Education Arne Duncan manipulated a system to favor powerful political allies by placing their children in the schools of their choice. The discovery of a list, the existence of which had been long denied by the city, and its composition of mainly high-powered political figures calls into question the appeals system used to reconsider applications that had been denied by the top Chicago-area schools.”

Prediction: There’ll be special “lists” for powerful people who need kidney transplants, too.

[Haggis@wk]

Bloomberg’s survey asked over a thousand adults their opinions of the ObamaCare bill during and after its passage, and like almost every poll taken in the last several months, a majority of respondents opposed it. Moreover, a majority also consider it a government takeover of the American health-care system:

Americans remain skeptical about the health-care overhaul even after the U.S. House passed landmark legislation that promises to provide access to medical coverage for tens of millions of the uninsured.
At the same time, most say the government should play a role in ensuring everyone has access to affordable care, a Bloomberg National Poll shows. A majority also agree that health care is a private matter and consider the new rules approved by Congress to be a government takeover. …

While more than six of 10 respondents agree the government should play a role in ensuring Americans have health care, 53 percent say the plan amounts to a government-run system. Yet six of 10 also say individuals should be responsible for making sure their health-care needs are met.

Democrats have a tough road ahead with this bill. Most of its benefits don’t kick in for years, but the taxes and fees start almost immediately. The longer it takes for jobs to start getting created again, the more voters will link this to ObamaCare and the Democrats who insisted on passing it during a deep recession.

It also presents another problem for Democrats, which is that they will own every failure within the American health-care system from this point forward. Had Republicans successfully blocked ObamaCare, they would have owned them, but now it all falls on the Democrats. Every sob story now becomes either the fault of legislation that went too far or didn’t go far enough — and don’t think Democrats won’t use the latter to push ObamaCare into single-payer territory

[Haggis@wk]

JAMES TARANTO: The Obamaklatura.

“If you and Larry Summers both get sick and need a treatment that the Medicare Advisory Commission (dysphemistically known as the Death Panel) deems too expensive, what are the odds that you’ll find a way to get it anyway and he won’t? How about the other way around? In the Soviet Union, those privileged by political connections were called the nomenklatura. Here, we can call it the Obamaklatura.”

[Haggis@wk]

An M.D. in family practice passed along this letter she sent to her patients after Obamacare became law. She relates that, so far, "100% of those who have contacted me about it have supported me and accepted the new conditions."

March 23, 2010

My Dear Patient,

As you must know, Congress has just passed extensive legislation governing health care delivery and insurance systems. Whether you agree with what it does or not, we are all now subject to this law and its sweeping changes.

I have always conducted my medical practice with my patient’s best interests as my first priority. Although not legally obliged to do so, I have routinely provided you with a receipt that has all the codes necessary to bill your own health insurance company for any reimbursement to which you are entitled. Until now, that insurance company was a free enterprise despite the fact that it was heavily regulated by state and federal laws. Now the situation is quite different. Through the new law’s mandates, regulatory powers and reform, health insurance is and will be largely a government activity which will have an ever larger jurisdiction over how doctors practice, make clinical judgments and are paid.

The new law provides for about 150 new government agencies, many of which are designed to be ‘oversight’ bureaucracies which will have the right to decide what medical care is legal to provide through insurance. Among other things, they will have the right to review my medical care of you and read your medical record. Now, as soon as you submit our economic transaction to your insurance company for reimbursement, you have involved me in these regulations and put me in the jurisdiction of government for my activities, decisions and behavior as your doctor.

No one can have two masters. Either I can serve you as my patient or I can serve the government. Either I can continue to make your welfare and health my only concern, including the protection of your privacy and medical records, or I can abide by ever-increasing amounts of government regulations and dictates to my decisions. I can’t do both. I choose to continue to follow my conscience and practice medicine to serve you.

For this reason, I am responding to the situation created by this new law by exercising my right not to participate in any health insurance program. I will still provide you with the same medical services that I always have, but the interaction will be exclusively and privately between you and me. This means that I will provide you only with a receipt for the services you have paid for, but without the additional information that is required to submit your receipt for reimbursement to your health insurance company. That is the only way I can make sure there will be no conflict between following the law and serving you. Because the law is now in effect, so must these changes be to my practice.

Sincerely,

Linda Johnston, MD

I mentioned earlier that I am now paying my own doctor directly. My wife and I both use the same doctor and during her routine visit yesterday he commented that he is in talks to create a private pool with some of his former partners. Apparently, according to him, this kind of talk has been going on (quietly) all over the state (maybe the country?) He'll provide details later on but it seems like he and Dr. Johnston are of a same mind.

[jamiebk]

An M.D. in family practice passed along this letter she sent to her patients after Obamacare became law. She relates that, so far, "100% of those who have contacted me about it have supported me and accepted the new conditions."

Wait until they find out that they will be unable to use their Health Care Spending Account to pay the Doctors's bill. The HSA won't allow reimbursement from your account unless you submit proof that it was a medically related expense. You need a receipt with codes and Date of Service for that even if you don't submit it to your insurance company. I don't understand why the good doctor won't provide the servce code. I do understand that she doesn't want to "mess" with insurance. However, if I were a patient, I would want a reciept that clearly indicates what I paid for...regardless of whether I submitted it independently to my insurance or reimbursed myself through my HSA.

[Haggis@wk]

Wait until they find out that they will be unable to use their Health Care Spending Account to pay the Doctors's bill. The HSA won't allow reimbursement from your account unless you submit proof that it was a medically related expense. You need a receipt with codes and Date of Service for that even if you don't submit it to your insurance company. I don't understand why the good doctor won't provide the servce code. I do understand that she doesn't want to "mess" with insurance. However, if I were a patient, I would want a reciept that clearly indicates what I paid for...regardless of whether I submitted it independently to my insurance or reimbursed myself through my HSA.

I think you are seeing the phenomenon of doctors totally dropping off the grid. If they totally refuse to accept any insurance payments, even backhanded by a patient filing for reimbursement after the service (which still makes them accountable under the new HCR law) then they will have complete freedom to barter with private patients, similar to private medicine practices in Britain for decades and now permissible in Canada after outlawing it for decades.

This bill is terribly unpopular and if it can’t be repealed (please, God!) many Americans, doctors and patients alike, will find ways to thwart it.

I fully intend to ignore it and pay for my own healthcare. I’ll pay the penalty every year and if I get really sick (cancer, heart attack, etc.) I’ll sign up for the health care at that time and let you and other lawful Americans help pay for it. This law is going to create a very cynical America.

[Haggis@wk]

AT&T Inc. will take a $1 billion non-cash accounting charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers.
The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses. On Friday, 3M Co. said it will also take a charge of $85 million to $90 million.

Remember, this is companies doing the “decent” thing, not the “required” thing. This will not go on much longer, probably not past the middle of next year.

My old employer, UPS used to send “retirement reminder” to employees when they near 55. They want to hire younger workers as soon as they can to cut expensive salaries and to move the anticipated increase healthcare cost onto the retirement accounts and off the capital gains accounts.

I wonder who the first “respectable” company will be? The one that just says, “Sorry, too expensive to take the charge, we’ll just cut the healthcare cost to the older workers in line with the law."

The reductions to health care benefits for the older worker now gives those companies cover to do that and by the way, cut the retirees loose too and let them join the new “pools.”

[Haggis@wk]

Is the individual mandate unenforceable?

According to a report by Congress's Joint Committee on Taxation, the individual mandatel in Obamacare lacks any real enforcement mechanism:

The penalty applies to any period the individual does not maintain minimum essential coverage and is determined monthly. The penalty is assessed through the Code and accounted for as an additional amount of Federal tax owed. However, it is not subject to the enforcement provisions of subtitle F of the Code. The use of liens and seizures otherwise authorized for collection of taxes does not apply to the collection of this penalty. Non-compliance with the personal responsibility requirement to have health coverage is not subject to criminal or civil penalties under the Code and interest does not accrue for failure to pay such assessments in a timely manner.

This is probably, to echo the vice-president, a really REALLY B.F.D. Without effective enforcement of the individual mandate, and with proscriptions against denying coverage on preexisting conditions, you've got yourself the potential for a pretty big moral hazard.

Pass the bill to find out what is in it. Or what ain't.

[Shapley]

A mandate would be unconstitutional, but a 'voluntary mandate' probably wouldn't...

That is to say, they may be seeking to get around the constitutionality problem by saying it isn't really a mandate, and therefore is constitutional.

[Haggis@wk]

A mandate would be unconstitutional, but a 'voluntary mandate' probably wouldn't...

That is to say, they may be seeking to get around the constitutionality problem by saying it isn't really a mandate, and therefore is constitutional.

Then they have to give you medical care but you don't have to pay for it. I might get behind this after all