Lamorinda Patch "Quick Quotes" On Healthcare Ruling

Eileen July 3, 2012 at 11:17 pm

..continuing... I don't know what the right answer is on the question of whether to cover everything or ration (and what? how?).
But, as I asserted before, the model I would construct to evaluate the options would likely be quite different from yours, Chris, in its shape and input assumptions. In past debates on similar subjects, you've indicated a different approach to valuing the, for lack of a better term, "net present value" of an immigrant with only a basic education, assuming - as I've understood you - that the children of such immigrants will be more of a drain than a "gain" overall, economically. I'm more optimistic on the NPV inputs, in that situation, probably because I'm only one generation removed from poorly-educated immigrant grandparents (on my Mom's side), whose kids and grandkids have built solid careers and are very much positively contributing to the US economy. I don't think that the timing of our immigration or our race/ethnicity has a bearing on this. It was simply a desire to achieve that drove the grandparents to immigrate that, in turn, drove the kids and grandkids to succeed in a variety of professions.

Eileen July 3, 2012 at 11:29 pm

All of that said, if I would prefer to move away from an "employer-based" HC insurance system to a system where any person - or family - could buy their own HC insurance that would allow the workers in the household to pursue whatever job/career opportunity they desired without considering the relative cost of HC coverage - or even whether it would be available at all.
In my and my husband's business careers - mostly on Wall Street - we've moved jobs often and worked through short periods of unemployment. Throughout, we would have welcomed the opportunity to choose independent HC insurance - that would have covered us no matter where we lived in the USA - so as to minimize the disruption in our personal health care (e.g., is my current OB/GYN on the new company's plan?) and allowed us to plan for our monthly HC insurance outlay. It's absurd that a John Doe, with whatever inherited conditions or concerns stemming from lifestyle choices might pay, for the same coverage: (1) a $300/mo premium co-pay and $10 co-pay for an Rx with Fortune 500 employer X; or, (2) a $600/mo premium co-pay and $40 co-pay for an Rx with 10,000 employee company Y;, or, (3) a $1,000/mo premium co-pay with no Rx coverage for a catastrophic plan s/he purchases individually while self-employed or working for a small co. The individual risk to the insurance co. is identical across all three employment options.

2nd Generation Moraga July 3, 2012 at 11:45 pm

Appologies to Cyndi Lauper: "I see your true colors
Shining through..."

X July 4, 2012 at 12:42 am

2nd - I was just blogging about her today. She's writing the lyrics and music for the new musical, "Kinky Boots", based on the UK movie with the same name.

Jason Schmidt July 4, 2012 at 12:07 pm

26% of Small Practices May Close, Survey Says
Medscape July 2, 2012 (Washington, DC) — One third of physicians in small group practices who responded to a recent survey expect their 2012 income to fall below what they earned last year. Financial pressures could have a devastating effect on physicians in practices of 10 or fewer participants: 26% surveyed said they might have to close their practice within the next 12 months. A total of 49% of small practice physicians reported cutting staff and services to reduce operating expenses. Despite such measures, 23% said they have used personal savings, and 20% have had to borrow money to cover expenses. "This poll is quite startling in the revelations about small practices, the healthcare lifelines to many communities," said Stephen Smith, CMO for MDLinx. "Physicians have had missiles raining in on their practices at an increasing pace—the economy, regulations, paperwork, insurance, lawsuits, etc." 56% reported that Medicare and Medicare payments provided 75% of their income, according to a review of survey responses conducted by Medscape Medical News. If the scheduled 27% reduction in Medicare payments takes effect next year, 61% said they would be forced to make additional cuts in services, and nearly 7% said they would have to close their practices. "The coming retraction this survey hints at," said Smith, "would mean longer drives to less-personal, higher-cost medical care for millions of Americans."

Fritz 'Congodog' Stoop July 4, 2012 at 02:08 pm

The Randian 'thin the herd' mentality works very well with caribou and colonies of fish. If we are ready to behave like lower case life forms, like beavers that simply walk away from their elderly and aid them on their return to the food chain, how then are we to identify ourselves as 'valuers' of life. Should we shed our superiority complex and admit we are simply animals that fight by any means necessary for the biggest territory, a space so big we may never see its boundary?
One graceful thing about the so-called 'lower case' animals is that they do not approach life with the goal af having any more than they actually need. The human struggle to distance one's self from the teeming undermasses may be a practical goal in their myopic view, but it does absolutely nothing but undervalue their own very existence. The wedge between the educated (technology) and the illiterate grows daily at an exponential rate. Fumbling in the dark about how to treat their maladies is a fool's errand. Preparing them for inclusion is time and effort better spent. The detritus of the electronic miasma is clogging and dulling the senses of the upper classes now. Unless unbridled irrelevant consumptive compulsion is removed from this equation, the finite world we live in will meet an ominous comeuppance and, ironically, the meek will once again inherit the earth. Resources are finite. If this society were a machine, it would already be discarded as broken.

Chris Nicholson July 4, 2012 at 05:35 pm

Eileen: Happy 4th. Should those with preexisting conditions be able to buy life insurance at the same rate as healthy people? Please reconcile your answer with your views on healthcare.
Big companies either self insure or buy pooled coverage even for those with Pre-existing conditions as a term of employment. This is not an insurance company conspiracy. Companies with yang healthy populations pay lower group premiums. The system is not blind to actuarial risk. The person with preexisting condition pricing a standalone policy will pay more because of selection bias. They are NOT an average risk, and the premium must reflect this if the insurance company is to survive. I agree that tax incentives for employer provider insurance should be dropped and insurance should be decoupled from employment. No also favor a rule where is you have continuous coverage, you can never be dropped (again, just like life insurance). I think the most efficient system would have everyone pay out of pocket for basic care, and the standard policy would look like a high deductible / catastrophic policy. We need to tighten the linkage between pricing of care and consumers. I fear the ACA pushes in the wrong direction.

Fritz 'Congodog' Stoop July 4, 2012 at 05:46 pm

How about, if you weigh more than your acceptable weight (based on height and bone structure) plus 20%, i.e., a 150 pounder could weigh 180, then you are ineligible for state assisted HC. The numbers of people responsible for the largest drain on the system are the obese. So incentivize them.
If you want a free lunch, from here on out its sprouts and tofu, baby. Just because Mitt was smart enough to get rich shipping thousands of jobs to China at the loss of 1000s Americans willing and able to work, they should suck it up and start technology companies. How'm I doin', Chris. The legislation to preclude the use of food stamps for junk food is also a step in the right direction, albeit small. Note: just back from RLP on the 4th of July and of the 2 or 3 families actually using the park, all the adults present (excluding moi) would not qualify for HC (see top). Why are there so many obese folks? Check this site: http://www.cdc.gov/obesity/data/adult.html/

Chris Nicholson July 4, 2012 at 06:03 pm

Thanks for the Independence Day patriotic pep talk.

Chris Nicholson July 4, 2012 at 06:17 pm

It is not true that obesity is the main source of HC expense, it is just one of the most (in theory) controllable. A rational system would charge people according to acuarial risk, including BMI, family history, etc.
I would not have the govt grant or deny coverage to anyone.

Born and Raised July 5, 2012 at 10:37 am

I come back after a day and the last posts are the most revealing. It seems that you have people that are labeled "liberals" because they don't agree with the people who are against Obamacare. The people who agree with Obamacare might not be liberals but are lumped in anyway because that's what it must be. Same party line crap that has us in the mess we're in now and with no way to make any compromise that might improve the bill.
By the way Vincent, I stand corrected. The USPS is cutting more offices and client confidence is dropping. It won't be long until they are nothing but letter carriers again. It seems they never got around to improving their technology and when they finally did the training program was a massive failure. I don't have all the answers and I don't think anyone does. Certainly not in the context of having a hold on the HCR bill. Experts in HC are still scratching their heads on what it will mean for everybody. Truth is, it's a done deal and we either deal with it or bring it back yelling and kicking to court which will inflame even more partisan rhetoric. To me it's like our school parcel taxes. I vote yes on every one of them even though I don't have kids but I think it's best for the community as a whole.

Chris Nicholson July 5, 2012 at 12:12 pm

B&R: People are individuals, but saying/assuming that "universal healthcare" is a "liberal" issue is not exactly controversial. The only opposition I heard from the left was that the ACA did not go far enough toward a single-payer system. I actually agree with that, in part. If what we want is efficient socialized medicine, no one starting with a clean sheet would come up with the ACA. For example. If you want to extract savings from the HC industry, you don't first (as Obama did) sell your soul to them in exchange for $100M+ to help pas the ACA (against a promise that the Feds will go easy on them). These pay offs are well documented, not conspiracy theories.
Here's a look at some of the nasties in the ACA sausage from PBS, the well-known puppet of the GOP: http://www.pbs.org/wgbh/pages/frontline/obamasdeal/

c5 July 5, 2012 at 12:43 pm

deborah, you need to click your heels together to get back into that time machine to a time when things were very different. in this day and age we have to compete in a global economy for jobs, companies, ideas, capital, the whole enchilada. if we tried to go back in time via disastrous taxes, we would become so uncompetitive we would quickly look just like greece...or spain...or italy...etc....
as for romney, i don't know if i will vote for him or not (i was an obama voter in 08) but to say that he hasn't worked hard and been successful is just plain wrong.

Amanda July 5, 2012 at 03:56 pm

I'm going with Congodog on the obesity thing again here. Don't forget costs of the prescription drug epidemic: http://rockcenter.msnbc.msn.com/_news/2012/07/05/12570381-prescription-drug-addiction-among-pregnant-women-becoming-monstrous-tidal-wave?lite

Deborah Lazaroff July 5, 2012 at 07:35 pm

Oh, excuse me, Vincent L, for taking a break from what is normally about 12 hours a day of jub-hunting (almost equal to the amount of time I have put in daily on every job I've worked-10 - 11 hours a day) to make some comments on something that is important to me. As far as not being able to find a job, you tell me Mr. Trickle-Down-Economy. I'm 54 years old and competing against much younger people in one of the worst economies ever. I'm working no less now to find a job than I did when I was employed. For me it's always been 8 am - 6 or 7 pm without a lunch break.

Deborah Lazaroff July 5, 2012 at 07:41 pm

c5, I never said that Mitt Romney never worked hard or became successful, although I question how much genuine labor is expended in buying companies, laying people off, and then re-selling the companies to make a profit. Obviously Romney was very successful at this, or he would still be working today. He hasn't had to do ANY real work for years since he left Bain, since all of his income is passive income from investments and dividends, both of which are taxed at a lower rate than federal income taxes from real labor. That's what the 1% live on--passive income. And that's what enables the Mittster to own as many homes and cars as he does.

Deborah Lazaroff July 5, 2012 at 07:49 pm

*facepalm* Vincent L, Chris Nicholson and Jason Schmidt do not seem to grasp the fact that Federal Income taxes are collected through payroll taxes. Payroll taxes are NOT a separate tax. As I stated before, the majority of federal income tax in the USA is collected through payroll taxes, which are taxes on real labor, not passive income like investments and dividends which are taxed at a much lower rate. And as far as the so-called 50% receiving ALL of their withheld money back as tax refunds, I'm ROFLMAO. Even people on unemployment have to pay taxes! Show me where it says that 50% of the American population receives ALL of their withheld federal income tax refunded--and Fox News and The Heritage Foundation don't count as objective sources. That's complete and utter bull****.

Deborah Lazaroff July 5, 2012 at 07:51 pm

99% of people who receive federal income tax refunds do NOT receive the entire amount withheld through their payroll taxes. They receive a refund for the amount they OVERPAID into the system.

Chris Nicholson July 5, 2012 at 08:21 pm

@Deborah: It is hard to find work out there. You're obviously bright, articulate, a good writer and highly opinionated. Maybe start a left-wing blog. Not kidding. Not a quick path to riches, but if you are willing to work 10 hours a day, I think you'd do better than $21k/year once you built a following. JD would prob even give you free distribution on Patch to prime the pump....

Deborah Lazaroff July 5, 2012 at 08:26 pm

Sorry, Chris Nicholson, but Born and Raised is right--unversal healthcare is NOT just a "Liberal issue"--especially in all the countries that have it. I would hardly call Germany or the UK "liberal" countries. Germany has one of the best healthare systems in the world, and they've had it since the 19th century. In fact, the very best healthcare systems in the world in Germany AND Japan--hardly two countries with ragingly liberal populaces. And how ironic it is that the Axis ended up wealthier and with better social services than the Allies! In fact, I question who won the war in the end--Europe, Asia and the former soviet union are all mass graveyards, and yet they certainly didn't suffer after the war, did they? In fact, not spending all their GDP on defense is what enabled both economies to thrive. And both have government-regulated, privately-administered health plans, which is the direction we should go in.
That said, I'm with Walter Cronkite. Like him, I'm proud to be a Liberal, and I don't believe there's anything shameful about considering what's best for the country as a whole, and wanting to ensure that the less fortunate have the equal opportunities guaranteed to ALL of us under the constituion--not just the rich and powerful.

Chris Nicholson July 5, 2012 at 08:38 pm

@Deborah: I think from context it was clear that I was speaking from a U.S. frame of reference. Germany has fully embraced the social welfare state (and, in contrast to France, is happy to pay for it) and their left-leaning major party is semi-reformed marxist.
I agree that a Socialist German would not view universal healthcare as a "liberal" priority. Not sure how that factoid advances the debate here in the USA.... To make sure I wasn't out of touch, I googled "liberal agenda." The firest hit confirms my perspective (BTW, google is smart enough to infer that I meant "u.s. liberal agenda." http://en.wikipedia.org/wiki/Modern_liberalism_in_the_United_States

Valerie Sloven July 5, 2012 at 11:36 pm

Almost every developed country in the world has embraced universal healthcare. In my opinion it is way past time for America to do the same.

Jason Schmidt July 6, 2012 at 01:22 am

Deborah: nearly 50% of the USA does NOT pay Federal Income Tax. Here it is explained very simply by CNN, hardly a biased source, just a few months back:
WHY NEARLY HALF OF US DON'T PAY INCOME TAX By Jeanne Sahadi @CNNMoney April 26, 2012 http://money.cnn.com/2012/04/26/pf/taxes/income-tax/index.htm Also, payroll taxes are broken into several separate taxes, they are not just one "tax". You have, in California: Federal withholding, State withholding, Social Security, Medicare, and you may also have deductions for state disability and some other items. Some people consider Social Security and Medicare to be "paying into a system" rather than a tax; either way these are not refunded, and you also have to pay double on these (yours and your employer's contribution) if you are self-employed.

2nd Generation Moraga July 6, 2012 at 01:50 pm

@CN: Thanks for the Frontline link. I watched it and the biggest point that I came away with was the absolute refusal of the GOP to support the process in any way. This documentary clearly illustrated that their primary agenda from day one was to NOT give the President any sort of "victory" - regardless if that meant saddling the American people with an inferior bill.
Imagine the solution that would have come about had the GOP actually participated and contributed in the process.

J.D. O'Connor (Editor) July 6, 2012 at 01:58 pm

@Deborah -- Our Patch Human Resources recruiter Chris Nicholson has correctly identified a potential outlet for what you're going through right now. I don't believe you're alone, judging from similar emails/contact from others in PatchLandia, and I would agree with Chris that you may want to put your experiences to "paper" if you will, here. I would be interested. I think others would be, too. It may add more time to your already busy day but...
And if that doesn't come to pass, we wish you the very best and hopes for a break in this very tough climate of ours.

KFrances July 6, 2012 at 03:22 pm

I agree that the bill should have either gone farther to single payer or not been passed at all. Right now it is Fascist Medicine.
It is VERY dangerous that an unelected board of 15 people (IPAB) will decide treatment - not your doctor. In general, the U.N. does not like the U.S. or Americans. The IMF/World Bank will be making the decisions.

John Bobincheck July 16, 2012 at 06:42 pm

For those who see it, please quote the part of this post that is racist.

John Bobincheck July 16, 2012 at 06:57 pm

1. If you already have insurance, the only way this impacts you is it will possibly lower your future rates. YOU CAN KEEP YOUR EXISTING COVERAGE.
This is probably going to be a false statement. In CA, pre-ACA compliant plans have already been phased out. If you check, you'll find out that the plan you are on today is most likely not the plan you were on 3 years ago. Those plans were made obsolete by carriers by increasing the costs. Additionally, the new ACA compliant plans are priced differently than the older "grandfathered" plans. The new plans are priced within a much narrower band vs. the older plans which allowed for much lower pricing for younger people. This results in a double whammy for the young. Not only will they be forced to buy insurance, the insurance they buy will be significantly more expensive. 2. If you couldn't qualify or didn't have insurance through your employer, now you can get it. Probably True: This is, in my opinion, one of the better outcomes that we may see from this legislation. 3. If you could get insurance, and simply decided its not in your best interest to have it - now you have to stop sponging off the rest of us - and you have to pay for it. Unfortunately, probably not true: Ca is a mandatory insurance state for auto insurance and yet, we buy uninsured motorist insurance -- there will be those who don't pay into the system.

John Bobincheck July 16, 2012 at 07:37 pm

DL,
Two of the three largest small group carriers in CA are non-profit (Kaiser and Blue Shield). The third, Anthem (Blue Cross), is a for profit company. I know that Blue Shield is already operating under the 80% Medical Loss Ratio and I believe Kaiser and Anthem are either very close or under it as well. To go one further, Blue Shield has been operating at a 2% profit for the last two years. Unless you understand how government run insurance is currently funded, please do not suggest that it costs less or is more efficient. One of the contributors to the increase in healthcare costs to those in private plans is the necessary cost shifting that occurs at the provider level for the public plans. I encourage you to discuss with any hospital administrator to learn more about the disparity in reimbursement rates.

Deborah Lazaroff July 17, 2012 at 04:13 pm

@J.D. - I've just discovered your comment after not being here for some time. I would indeed be interested! I believe you have access to my e-mail through my registration. Please do contact me with information on what this would entail. I look forward to hearing from you!