[Vision2020] Health Insurance is NOT Health Care

[Andreas Schou]

On Fri, Sep 25, 2009 at 11:52 PM, Donovan Arnold <
donovanjarnold2008 at yahoo.com> wrote:

>
> Mr. Schou,
>
>
>
> As someone that lives in the health care profession, I can honestly say,
> based on your arguments that you are unawares of the reality of the industry
> and mainly are relying on arguments designed to persuade people to support a
> bill that will do nothing for people that need health care but look good on
> paper. Please review your claims, and the reality.
>
>
>
> The Claim:
>
>
>
> “You are wrong. The subsidy in the Baucus bill, which is by far the most
> conservative, is set at 300% of the poverty threshold, or around $33,000
> for an individual. The more reasonable subsidy level set in the House is
> around $44,000, or 400% of the poverty threshold.”
>
> The Reality:
>
>  The Baucus bill will not pass with any substantial health subsidize for
> those making 300% above the poverty line because it would add trillions more
> to the national debt. The median income in the United States is below 300%
> the national poverty line. Please sit down and do the math.
>
> A 300% rate would mean over 150 million people would qualify for a
> government subsidize as a single, married, or dependant. Even a $60 subsidy
> for each person a month, a drop in the bucket, would add an additional
> trillion dollars annually to the debt.
>
> In addition, there is nothing in the bill to prevent the insurance company
> from raising their premiums or deductibles to erase any gains a family makes
> with a government subsidy. You also have to look at the hidden costs of
> implementing this subsidy, the costs of families to file tax returns and
> hiring tax attorneys to get the subsidy back. Also, consider the reluctance
> of some people to bother with the hassle, or who may not see the subsidy
> anyway because they owe back taxes or have garnishments.
>
> The reality is that in order for this plan to be affordable it will only
> cover people in the 100-200% percent above poverty range because most of
> them are already covered, in part, by the taxpayer.
>

Donovan --

You're telling me, then, that you just invented a bill to object to rather
than object to the bill that exists. That's fine. However, the CBO's markup
of the Baucus bill with a 300% subsidy reads as follows:

"According to CBO and JCT’s assessment, enacting the Chairman’s proposal
would result in a net reduction in federal budget deficits of $49 billion
over the 2010–2019 period (see Table 1). The estimate includes a projected
net cost of $500 billion over 10 years for the proposed expansions in
insurance coverage. That net cost itself reflects a gross total of $774
billion in credits and subsidies provided through the exchanges, increased
net outlays for Medicaid and the Children’s Health Insurance Program (CHIP),
and tax credits for small employers; those costs are partly offset by $215
billion in revenues from the excise tax on high-premium insurance plans and
$59 billion in revenues from other sources.1 The net cost of the coverage
expansions would be more than offset by the combination of other spending
changes that CBO estimates would save $409 billion over the 10 years and
other tax provisions that JCT and CBO estimate would increase federal
revenues by $139 billion over the same period.2 In subsequent years, the
collective effect of those provisions would probably be continued reductions
in federal budget deficits."

Congress's nonpartisan research service thinks you're wrong.


> The Claim:
>
> “You are wrong. The bill tinkers with Medicare reimbursement rates (more
> for primary care, less for specialist care), rolls back reimbursement for
> Medicare Advantage to the Medicare reimbursement rate,. . . “
>
> The Reality:
>
>
>
> Most people on Medicare need specialists. I recall few times taking a
> client to see a general practice physician in my years transporting the
> elderly and disabled, they have always been specialist with few exceptions,
> like getting a referral to see a specialist. To cut the care they need in
> favor of seeing a physician they don’t is bad medicine and it will hurt the
> people that need to see a specialist.  More professions and physicians are
> moving to specialties.
>

One of the biggest problems in American health care is doctors moving away
from primary care and toward specialist care. There's a tremendous
undersupply of primary care in this country (which is why I have to wait
three months to see my physician) and nothing's currently being done about
it. The changes in the rates are relatively small. The number I'm looking at
proposes roughly an 8% increase in reimbursement rates for primary care.


> The Claims:
>
>
>
> “Medicare Advantage is a program that reimburses private insurers for
> medical care. It reimburses at 114% the rate that Medicare does. There is
> absolutely no reason for this to be the case.”
>
>  The Reality:
>
> There are very good reasons.
>

The purpose of Medicare Advantage was to compete with government-provided
Medicare and reduce costs. Instead, it increases costs by 14%. This is
crazy, and "but it provides better service than Medicare" is over the line.


> The Claim:
>
> “You are wrong. Illegal immigrants are ineligible to receive the subsidy.
> Insofar as they might be able to obtain health insurance through a health
> insurance exchange, they join the risk pool without subsidy, reducing
> insurance rates for everyone else. This is comparable to the way things work
> today; illegal immigrants will be no more able (but also no less able) to
> pay for health care health insurance than they are today.”
>
>
>
> The Reality:
>
>
>
> There is no requirement to provide proof of citizenship to get the health
> care subsidy. They will get it, the same as every other public service.
>

Again, Donovan, you are wrong. There's no up-front requirement to purchase
insurance through an exchange, which is fine, because the addition of
illegal immigrants would broaden the risk pool and cut emergency room costs.
However, the insurance subsidy is delivered as a tax credit, which means
that the illegal immigrant would have to have a fraudulent SSN in order to
use their taxes.


> The Claim:
>
> “You are wrong. The majority of the savings come from diluting the
> insurance pool in two ways. First, the individual mandate (which requires
> people to buy health insurance) adds healthy people to the health
> insurance pool.”
>
> The Reality:
>
>
>
> *Forcing people to buy something increases costs*. So it isn’t saving
> anything, it is just taking money from private working people and giving it
> to the insurance companies. It also has robbed me of my freedom of choice
> not to give my money to an insurance company and knocked me and about 50
> million others from 300% above the poverty to 200% above the poverty line.
> Most importantly, it misses the point of doing this in the first place,
> improving health care, not saving for insurance companies.
>

This just betrays a misunderstanding of how insurance works.


>
> The Claim:
>
> “Second, the insurance exchanges broaden the risk pools across several
> insurers.”
>
> The Reality:
>
> You can do this simply by allowing insurance companies to pool across state
> lines, much more cheaply, and quickly
>

This is the Republican idea, and this is why no one thinks you're a "liberal
Democrat" but you. This is exactly what the insurance companies have been
clamoring for for years. Here's why: insurers will have the choice of 50
regulatory schemes. When that happens, as has happened with the regulation
of credit cards and trusts, there's a regulatory "race to the bottom" to
capture as much of the industry as possible under the least restrictive
regulatory scheme.

If this happens, there will most likely be virtually *no* regulation of
health insurance in this country.


>  The Claim:
>
> “Third, a public option or co-op option would cram down insurance
> companies' profit margins by forcing them to compete with a nonprofit
> option.”
>
>
>
> Reality:
>
>
>
> Private options already do compete with nonprofit options. It hasn’t
> reduced the cost of insurance or health care. Nor has it improved health
> care. In addition, private company profits are only about 5 cents on the
> dollar, not a dramatic savings considering how much more you will spend in
> taxes covering the subsidies.
>

Government-run health care is both the cheapest and the most popular health
care in this country. Medicare has been experiencing only a 5.6% annual cost
increase; the average increase in the cost of private health care is 5.9%.

http://voices.washingtonpost.com/ezra-klein/medicarephigrowth.jpg


>
> From: Andreas Schou <ophite at gmail.com>
> Subject: Re: [Vision2020] Health Insurance is NOT Health Care
> To: "Donovan Arnold" <donovanjarnold2008 at yahoo.com>
> Cc: vision2020 at moscow.com, "NicholasGier" <NGIER at uidaho.edu>
> Date: Friday, September 25, 2009, 7:02 PM
>
>
>
>>
>>   First, if I lose my job after 4 months of work in the year, I will go
>> broke. Obama will force me to buy insurance, which consequentially will be
>> about $300 a month if I lose my job (those offered COBRA, know what I mean
>> first hand). His promise to help the poor, (those making less than $930 a
>> month) won’t apply to me because after 4 months of work, I will be over
>> $10,500 income mark to receive government assistance with insurance costs.
>> Who can afford $300 a month on $10,500 a year? Obama thinks everyone can.
>>
>
> Donovan --
>
> You are wrong. The subsidy in the Baucus bill, which is by far the most
> conservative, is set at 300% of the poverty threshold, or around $33,000 for
> an individual. The more reasonable subsidy level set in the House is around
> $44,000, or 400% of the poverty threshold.
>
>
>> Second, one way to pay for part of this horrible plan, Obama is going to
>> be making cuts to Medicare. This is horrible
>>
>
> You are wrong. The bill tinkers with Medicare reimbursement rates (more for
> primary care, less for specialist care), rolls back reimbursement for
> Medicare Advantage to the Medicare reimbursement rate, and establishes
> comparative effectiveness research boards. Though I doubt the "waste, fraud,
> and abuse" savings will be as high as they say it is, there are no Medicare
> "cuts."
>
> Yes, you tell me, but what about Medicare Advantage? Medicare Advantage is
> a program that reimburses private insurers for medical care. It reimburses
> at 114% the rate that Medicare does. There is absolutely no reason for this
> to be the case.
>
>
>>
>> Next, it would provide free medical care to anyone that could crawl,
>> climb, walk, roll or drive, legally or illegally, into the United States.
>>
>>
>
> You are wrong. Illegal immigrants are ineligible to receive the subsidy.
> Insofar as they might be able to obtain health insurance through a health
> insurance exchange, they join the risk pool without subsidy, reducing
> insurance rates for everyone else. This is comparable to the way things work
> today; illegal immigrants will be no more able (but also no less able) to
> pay for health care health insurance than they are today.
>
>
>>
>>
>> Another aspect of this bill will be an increase in your insurance
>> premiums. If *everyone *regardless of illness, injury, or ailment, is
>> allowed into your insurance co-op, then there will be more medical costs,
>> and more costs handed to you. The only way insurance companies could absorb
>> those costs would be to raise your premiums and deductibles.
>>
>
> You are wrong. The majority of the savings come from diluting the insurance
> pool in two ways. First, the individual mandate (which requires people to
> buy health insurance) adds healthy people to the health insurance pool.
> Second, the insurance exchanges broaden the risk pools across several
> insurers. Third, a public option or co-op option would cram down insurance
> companies' profit margins by forcing them to compete with a nonprofit
> option.
>
> Literally no point you made has any foundation, as per normal.
>
> -----Inline Attachment Follows-----
>
> =======================================================
> List services made available by First Step Internet,
> serving the communities of the Palouse since 1994.
>                http://www.fsr.net
>           mailto:Vision2020 at moscow.com<http://us.mc447.mail.yahoo.com/mc/compose?to=Vision2020@moscow.com>
> =======================================================
>
>
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://mailman.fsr.com/pipermail/vision2020/attachments/20090926/df049077/attachment-0001.html