Note: From 2006-2012, I was an editor and contributor to BlogHer.com. Because of changes in ownership, the content I created is no longer visible on the site. I have been retrieving some of the work that I did on the site that got the most response and republishing it here.

This particular blog post was part of a 2009 BlogHer collaboration with the Sunlight Foundation to stimulate informed discussion on what would become the Affordable Care Act.  Sunlight had created a tool, OpenCongress.org, that allowed one to read the full text of proposed legislation and annotate it paragraph by paragraph with comments and questions. One could track the progress of the bill by adding a widget to a personal blog or website.

This was one of several blog posts I wrote on particular aspects of the act. I also wrote about how the bill would address the need for more health care professionals, and how it treated medical malpractice. Other members of the staff also researched the bill and posted from their respective beats. For the most part, the discussion, while passionate, was informed and civil.

We now talk about projects like this as examples of community engagement.I don’t think that term was in use then. I remain proud of the work we did on that project and I still return to the lessons we learned from it. I only wish we had done more of it. Here, the text of the first post is reproduced, with comments. You can see a rendering of the original page at the Internet Archive.

Forget the Spin Doctors. Let’s have a real conversation about health care reform.

August 11, 2009 by Kim Pearson in News & Politics

Pres. Obama focused on proposed protections for people with pre-existing conditions, and other consumer protections, at a town hall meeting in Portsmouth, NH today:

Under the reform we’re proposing, insurance companies will be
prohibited from denying coverage because of a person’s medical history.
Period. (Applause.) They will not be able to drop your coverage if you
get sick. (Applause.) They will not be able to water down your coverage
when you need it. (Applause.) Your health insurance should be there for
you when it counts — not just when you’re paying premiums, but when
you actually get sick. And it will be when we pass this plan.
(Applause.)

 Trudy Lieberman, who has been tracking press coverage of the health care debate at the Columbia Journalism Review for more than a year, says when Congress returns in the fall, journalists ought to pay close attention to just how many of those consumer protections survive lobbying pressures and backroom negotiations. On pre-existing conditions, for example, Lieberman warns us to watch for:

Lobbyists inserting language that limits insurers’ risks, like the restrictions in the HIPAA law that still make it difficult for sick people to obtain coverage. President Obama has been silent on the question of age rating, which serves as a proxy for using health as a factor in charging higher rates. Older people are likely to present more health risks and cost the insurers money. 

 The welfare of elderly and disabled patients under the proposed reforms has been a big topic of conversation ever since former Alaska Gov. Sarah Palin posted a Facebook note claiming that under the proposed law, her disabled son’s health care would be determined by a “death panel.” That claim was quckly and roundly rebutted. (see Politifact and the Associated Press for details.)  However, she also expressed a general mistrust of the so-called public option – a proposed government insurance plan for those who can’t get private insurance. Megan McArdle is one of the people who worries about the potential unintended consequences:

Once the government gets into the business of providing our health
care, the government gets into the business of deciding whose life
matters, and how much.  It gets into the business of deciding what we
“really” want, where what we really want can never be a second
chocolate eclair that might make us a size fourteen and raise the cost
of treating us.

Economist Brad DeLong says McArdle doesn’t know what she’s talking about. He pleads:

Could we persuade the Atlantic to replace Megan McArdle with
somebody like David Cutler, Atul Gewande, or Ezekiel Emmanuel who
actually knows and can write about health care for the duration of the
health care debate?

 DeLong also points us this piece by Sounthern Bealle, who took particular exception to Gov. Palin’s Facebook note:

You have no idea what it’s like to be called into a sterile conference
room with a hospital administrator you’ve never met before and be told
that your mother’s insurance policy will only pay for 30 days in ICU.
You can’t imagine what it’s like to be advised that you need to “make
some decisions,” like whether your mother should be released “HTD”
which is hospital parlance for “home to die,” or if you want to pay out
of pocket to keep her in the ICU another week. And when you ask how
much that would cost you are given a number so impossibly large that
you realize there really are no decisions to make. The decision has
been made for you. “Living will” or no, it doesn’t matter. The bank
account and the insurance policy have trumped any legal document.

 Under the proposed reforms, insurance companies wouldn’t be able to cap coverage. The proposal would also pay for Medicare recipients to have a consultation with their doctors about end-of-life care. It also encourages living wills.

One of the biggest sticking point in the health care debate, of course, is the proposed “public option” — the proposed govenment-sponsored plan for those who don’t have private insurance and don’t qualify for Medicaid or Medicare. Conservative critics such as the Heritage Foundation insist that the result would be a “massive erosion of private health insurance.” Rather than a federal pool, Heritage suggests there ought to be state-level “health insurance exchange[s]: in which companies can voluntarily participate:

In a truly competitive market based on
real consumer choice and genuine competition, the suppliers of goods
and services would operate on a level playing field and government
would be confined to making and enforcing rules to protect consumers
from fraud and misleading advertising, establishing minimum standards
for health and safety, and enforcing contracts.

An exchange could facilitate that process.

Critics say the Heritage Foundation proposal wouldn’t help contain costs or significantly reduced the ranks of the uninsured.

What questions do you have about health care reform? 

Related:

• Jane Hamsher, thinks that Democrats could have done a better job of organizing support.
• Slate’s Timothy Noah likes the Demcratic proposal.
• Moveon has an ad campaign rebutting “lies” about haalth care reform.
• Politicact debunks the claim that abortions would get funding  under the new proposal.
• Salon presents evidence that Dr. Ezekiel Emmanuel, one of Pres. Obama’s health care policy advisor, isn’t the dangerous nut he’s been made out to be.

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Comments: 23

Why not call a spade a spade

Southerngirl August 12, 2009 – 1:11pm

Health Reform Frustration

cooper August 12, 2009 – 4:32pm

I strongly disagree

NOfreelunch August 15, 2009 – 1:35pm

Racism isn’t always obvious

siditty August 17, 2009 – 6:20am

And until Glenn Beck says “Obama’s policies aren’t working for me or even working in general because he’s a black man” or makes any suggestion that his disagreement with the President is racial, I still maintain that you calling him or even implying he is a racist just by the virtue of you apparently being some self-appointed mind-reading racism expert is again judgmental, divisive and just plain all kinds of wrong.

Racism extends beyond the obvious, especially in this day and age, which is why with people like you, racism will continue, it goes beyond burning a cross in someone’s yard and dragging them behind a truck.

Glenn Beck is under the impression that health care reform was “reparations” and “to settle old racial scores”. Last I checked, health care reform was for ALL races of people, and contrary to Beck’s belief, which I assume you believe since you are here defending what Beck is saying is that you are under the impression black people are looking for a free ride and will do anything to get it, or that we don’t work or pay taxes, so this isn’t a concern for black people, just another hand out, which to me is racist, ignorant, and inaccurate.

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My apologies

NOfreelunch August 18, 2009 – 2:25pm

First off, sorry to invoke the Glenn Beck name again after Kim requesting the opposite.

But I would be remiss without saying that I’m sorry to dianaelee and siditty, in that I had no idea that Glenn Beck had called the President a racist. (Insert joke about “where have I been” or me “living under a rock” here.) The times that I have listened to Beck on my car radio I thought had been frequent enough that I was comfortable he never said anything even approaching racist. All I’ve ever heard from him are conservative rants, mostly about the economy, health care and the like, on which I have to say I did agree with him the majority of the time.

Notice how in my last post I said “UNTIL Beck…suggests his disagreement with the President is racial” that I thought it was dead wrong to call him so, though. As it turns out, Beck did exactly the same thing that made me so mad in this thread: accusations of racism based solely on a political belief, stereotype, assumption or quick judgment. Beck can suspect the President is “racist” until the cows come home, but who does he think he is that he knows what is in the President’s heart? He’s not a mind reader. Therefore he must give the President the respect to keep his mouth shut about things he only suspects based on superficialities. He’s making an assumption based on his own belief, one that he cannot prove and about which he’s jumping to the worst and most offensive possible conclusion.

You’ve both pointed out that racism is not overt like it was in the past. I realize that. But in a way, that makes accusations of racism from both sides even more vicious, dangerous and divisive. Whether it comes from someone like Glenn Beck or it comes from people who view a mass quantity of conservative thinkers racist just by the virtue of their conservative beliefs, it’s so wrong and unfair. It just adds to the hostility in an already volitile political situation.

Siddity, you said in your response to me that because I was defending Glenn Beck that I was “under the impression black people are looking for a free ride and will
do anything to get it, or that we don’t work or pay taxes, so this
isn’t a concern for black people, just another hand out.” In reality, nothing could be further from the truth about how I feel. I only defended him because I thought he was being attacked as a bigot just because he is conservative. Siddity and theprisonerswife, from what I’ve read here we have no chance in hell on agreeing about health care policy, although siddity I respect the fact that you have based you views on the knowledge and experience you have with the situation. But I would like to make a plea for all liberals/progessives to not be judgmental in assuming so many conservatives are racist (or homophobic or any other type of bigoted). It’s become a stereotype that’s just been reiterated by your side one too many times for me to stand, and I reacted strongly. As a white person who has always been one to verbally lambast anyone who is being prejudiced against any minority, being called a racist is to me one of the worst insults there is, and it really hurts. There are so many people like me out there who have respect for people of every race, religion, gender and sexual preference–we just have a different view on what boils down to me to be primarily economic and foreign policy. I wish this was the Utopian “post racial society” that so many others would. Maybe you think I’m some sort of racist liar, and if you do there’s nothing I can do to change that. But I’m writing from my heart here and I hope that’s coming across.  

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Let’s keep Glenn Beck out of this, please

Kim Pearson August 17, 2009 – 6:26am

 His comment about Obama hating white people was so silly, even his managers at FOX disavowed it. 

I don’t pretend to discern his psychology or motives, but I do think that the effect of his remarks and approach to issues is racially divisive, intellectually deficient (because I have never seen him consider competing explanations for the limited data that he uses to support his assertions) and generally unhelpful. I know people at FOX who are real journalists and professionals, and I am embarrassed for them that Beck (and others like him) share their airtime. 

KimBlogHer Contributing Editor|Professor Kim|

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The Race Card Has Not Been Played

siditty August 17, 2009 – 6:13am

I am in awe over how any time race is even mentioned, it is a “card” used to trump any and everything.  The whole “race card” is a buzz word used by racists to keep people from accepting or admitting that for some of these people racism exists.  From the teabaggers upset about Obama bailing out big companies (even though Bush did this before Obama even got into office) from the birther movement, to this healthcare discussion that only offers dissent instead of real options; I don’t see how the race card is used.  

 This president has been nothing but transparent, we are completely aware of what this HR 3200 is, as public option as it is available for anyone to read.  

 You call this plan “tired socialism” that marginalizes health care in other countries?  How is this, despite the scare tactics Canada, the UK, as well as many other countries have managed to provide great care and still give people the option of using private insurance. You keep assuming this is socialized, as if this would be the only option, private healthcare will still exist.  The problem with private healthcare now is it isn’t accessible to those with pre-existing conditions, to those who make too much money to qualify for medicaid, but not enough to pay for COBRA when they get laid off, or when the company they own or work for doesn’t provide decent coverage.  There are bare bones insurance policies out there that exclude everything under the sun, including pregnancy and prenatal care.  

 Under a private plan you don’t have choices.  You go out of your network and see how much choice you have and how much your insurance company is willing to pay.  You have a choice of doctors on an approved list, you don’t get to choose ANY doctor.   Trust me with your current insurance plan, you don’t have as much choice as you think, and I want to add, there is nothing in this single payer option plan that states you will not have a choice in doctors.  

 You say people come to the United States for care, but you forget many other people go to other countries for their treatment because our treatment is unaffordable. I have known people to go to Mexico to get their hernia operations because without insurance here in America it is simply unaffordable.  My brother who has narcolepsy can not afford his medication and often gets it from either Canada or India because in those countries, the same exact medication is significantly cheaper.  

 You are concerned about people waiting.  Ask the family of Nataline Sarkisyan why she had to wait for a transplant because her insurance company refused to pay for it.  She died waiting.  Tell me how easy and quick it is to appeal a denial on a claim.  I can tell you as a former claims manager for a healthcare company, the one Nataline Sarkisyan died waiting on, that it can be very time consuming and if you are dying of cancer, you sometimes don’t have that much time.

 What countries are “below the level of excellence”?  I have yet to see this answer from you or anyone else opposing this.  It is frustrating to hear the same accusations over and over with no evidence to back it up.  

I come from healthcare my first jobs out of college were in insurance. I wrote and priced group insurance policies as an underwriter, reviewed claims as a claims manager, I have even worked as an insurance analyst, I know healthcare, and what you think you have, is completely different than what you have.

 I doubt you have as much choice as you think you do and that your insurance is paying for random tests to give you a piece of mind. The bottom line is healthcare prices have been driven up and the only folks profiting are those in the healthcare and insurance industries, while working people suffer. Believe it or not in America you can get subpar treatment, even with insurance.

Siditty

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Regardless of whether it passes or not…

LucindaA August 12, 2009 – 9:05pm

There are a few things I feel I want to point out.

We all have choices.  No one is required to take the health insurance provided through your job.  Any healthy individual can buy individual insurance.  Most choose not to because that would be foolish due to the cost.

I am self-employed.  I pay for my own insurance.  I have a pre-exisiting that does not allow me to switch insurance companies.  I am the poster child for this big reform.  

And yet…I don’t want the government creating a health care insurance plan.  We have one in Oregon.  It’s called the Oregon Health Plan.  It handles Medicare among other things.  Since OHP was developed, Medicare quality has dropped massively in our state.   Our state’s budget is out of control paying for this thing.  And still many who qualify for it can’t be bothered to apply.  They would rather go to the ER for basic health care costing everyone even more money.  

President Obama’s vague answers to detailed questions concerns me greatly.  The lobbying concerns me greatly.  I am very worried about what the coming months will bring.

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Some of this is  due to the

cooper August 13, 2009 – 10:28am

Some of this is  due to the fact that the insurance industry is not held to federal law – anti trust or regulation – and states make their own rules regarding insurance. As with education which is not nationally controlled, some areas of this country have very poor standards and outcomes outcomes, the same is true for the health insurance industry.

I agree we need more answers, but I also think there are certain things that could be run very well by the federal government, as there are many smaller programs that should be left totally to the individual or the separate states. Education and health care are two things that the folks in D.C. should have the balls to actually do what is right, not what is more likely to get them more campaign contributions.

cooper

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Lucinda, Medicare is a

siditty August 17, 2009 – 6:24am

Lucinda,

Medicare is a perfect example of healthcare gone wrong. During the Bush Administration to cut down on costs and fraud, it was determined Medicare Part D, prescription coverage be privatized, I worked for two companies that handled this, it was still full of fraud and cost more money because all the insurance companies were trying to get a piece of the pie and it didn’t cost any less than when it was in government control.  

He isn’t vague, you can read the bill for yourself to see exactly what is going on.  

Siditty

WSJ: End of life provision likely to be dropped

Kim Pearson August 13, 2009 – 12:07pm

 The cost of caring for patients who are near death accounts for a big
piece of the government’s medical spending. But a furor over a
provision for government-paid counseling to plan for end-of-life care
is steering lawmakers away from the issue. (More)

That’s unfortunate

LucindaA August 13, 2009 – 12:48pm

It’s one part of the bill I actually agree with.  We are all going to die and end-of-life care can be daunting.  Navigating hospice, medicaid, and the multitude of available procedures is tough and a little advice and counseling would help a lot of people deal with this stuff rather than avoid any planning until it’s too late.  Having an end-of-life care plan is no different than having a birthing plan in my opinion. 

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Any real reform needs to address this more effectively

Kim Pearson August 17, 2009 – 11:04am

 If I remember correctly, about half of the lifetime health care expenditure for each person takes place in the last six months of life. We can’t begin to calculate the cost in patient longevity and quality of life, no to mention patient and family emotional and financial resources, because too few of us have planned properly.

It may make sense to ensure that Medicare and Medicaid will pay for these kinds of consultations. Now my question is whether it’s true that the bill would require that health care providers submit proof that the consultation has happened? And do we buy the argument that having this kind of consult every five years will make elderly patients feel coerced into accepting euthanasia? Do we know other countries that do this, and is there any evidence to support critics’ claims in that regard? I’m not aware of any.

KimBlogHer Contributing Editor|Professor Kim|

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Editors of Femisex.comThis

Femisex August 13, 2009 – 10:13pm

Editors of Femisex.com

This is a complex issue and one of our editors spent years as a health care provider who billed insurance and dealt with the rigors of running a private practice.

Obma is giving us sound bites about misrepresentations but he has given plenty himself.

The plan out now is deeply flawed.  Medicare can not sustain the millions Obama would throw into this deeply dysfunctional system. Governors of both parties understand this and are revolting.

 A public option is absolutely a way to eventually rid American of private insurance. Key word, eventually–10 years out.

And without private insurance there can be no functional Medicare or Medicaid/Medical as we know it.   The double Ms are propped up by the better payments private insurance pays out.  Medicaid pays so little that no MDs can afford to take on those patients.  I challenge you to call your private MD and ask if she/he takes Medicaid patients. The answer will likely be no, unless you go to a public clinic or hospital for your care. Each day more and more MDs are refusing to take new Medicare pts as well, esp. in larger cities. It just pays too little.

 Hospitals are heavily subsidized to take on Medicaid patients.  Medicare pays much less than private ins.  Without private insurance, your hospital would quickly succumb to budget defeat.  The state of Mass. is currently suing the govt. because the load of underfunded public patients has reached a tipping point and hospitals are bleeding RED.

With is plan, Obama is consigning millions of middle class Americans to a future of sub-standard care if his plan goes through.  When budgets run dry, when private insurance can no longer keep pace with artificially low premiums set by the government a complete breakdown will ensue. 

 And of course, the cornerstone of Obama’s plan is ramped up care rationing.  To bring millions under the gvt pay for it system will require serious cuts. That is a Duh! 

 That does not mean cuts are not necessary, but it is deeply dishonest for Mr. Obama to suggest that the only pain American will feel is “not paying for things that dont’ make them healthier.” 

Combine this with the fact that for young women, giving the government more access to our reproductive health is not a good idea. A very very bad idea, as a matter fact.

It is essential to insure those who are not.  It is essential to cut costs.   There are good ideas out there.  The most rational, and least disrupting to this country and its economy is to implement cost cutting on medicare now.  If Obama’s proposed bend the curve down methods DO work–and history has shown us that is unlikely without tort reform and pay for procedure changes–and Medicare cost saving are realized then we can move forward. 

If costs are not cut, we have potentially salvaged this nation from unprecedented debt accumulation that would have occurred with a dive in see what happens later approach. In medicine, clinical trials always start with a small group to test safety. This is a must do approach for reform.   

For the millions w/out ins. we can start to tax health benefits.  This incentivizes cost savings on a nationwide level and allows us to give  private insurance plans to those without coverage.

To streamline the incredible hassle of medical billing, we can standardize re-reimbursement forms across all ins. companies.  And we can open up state lines so that Blue Cross of one state can compete with Blue Cross of another.  This all makes   good sense and Obama knows this.  But he is stuck; he promised not to raise taxes on the middle class.  He knows that eventually this will have to happen–taxing our health care benefits, but he doesn’t want to the be meanie who did so.   I challenge Mr. Obama to be brave enough to tell us the hard truth about what it will cost us to ins. the uninsured.  And I warn the uninsured–Medicaid is no good deal.  And if this goes through that is what you will get, not the private insurance you deserve.

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“And without private

siditty August 17, 2009 – 6:35am

“And without private insurance there can be no functional Medicare or Medicaid/Medical as we know it.   The double Ms are propped up by the better payments private insurance pays out.  Medicaid pays so little that no MDs can afford to take on those patients.”How so? Explain this to me. “With is plan, Obama is consigning millions of middle class Americans to a future of sub-standard care if his plan goes through”Again explain how this will happen and why does it not happen in other countries?” And of course, the cornerstone of Obama’s plan is ramped up care rationing.  To bring millions under the gvt pay for it system will require serious cuts. That is a Duh! “Do you seriously think your insurance company doesn’t do it now? They do trust me. What is considered experimental on many insurance policies, is common wide used practices in hospitals. Ask someone who has chemotherapy about rationing of treatment and having to decide what route to take based upon what their insurance is willing to pay. “For the millions w/out ins. we can start to tax health benefits.  This incentivizes cost savings on a nationwide level and allows us to give  private insurance plans to those without coverage.”What private insurers will take those with a pre-existing condition. You trust private industry too much, I worked in private industry and don’t. It scares the heck out of me they get away with what they currently do. “To streamline the incredible hassle of medical billing, we can standardize re-reimbursement forms across all ins. companies. “Been there, done that, and it doesn’t work, it has been tried, and it won’t work because not all policies work the same exact way and the standardized form would not be able to account for any and every nuance in policies. There is no huge master policies but millions of small policies. “And we can open up state lines so that Blue Cross of one state can compete with Blue Cross of another.”They don’t compete with each other because they work together. I have Blue Cross Blue Shield of New Jersey, I live in Texas, I use a Texas network to access my insurance, Blue Cross isn’t the only player out there, and depending upon your state, because most states have their own insurances boards what Blue Cross Blue Shield does in one state, they can’t do in another. You seem to think this policy is going after folks on medicaid, and it isn’t. It goes after people who can’t qualify for medicaid, but can’t pay for COBRA, or can’t afford or receive individual policies due to pre-existing conditions. It goes after the working people.

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Editors of Femisex.comHi

Femisex August 17, 2009 – 7:13am

Editors of Femisex.com

Hi siditty-

Your post, as written, was a bit hard to follow, but I seem to understand that you think we don’t want reform.  Not true.  You ask:

“What private insurers will take those with a pre-existing condition/”

We fully support legislation that gets rid of the pre-existing conditions clause.

Re rationing, we know rationing occurs now, but as we outline in our post today, the rationing will get much worse under public plan–10 years out. 

We also explain in greater detail the mechanics of how the public plan will undermine the entire private insurance industry.   I hope you will read this!

 Of course, if you have your heart set on single payer system, then you will not care if private ins. goes the way of record albums.  But at least we ought to outline how that will come about for the plurality.

Standardizing forms will require legislation to mandate this.  We have not tried this with any heart, only fitful isolated attempts.   That is a concession Mr. Obama could easily win from the ins. companies if he put muscle into this.

 Opening up the insurance companies across state lines will also require legislative changes, so it is not reasonable to suggest that has not worked.  In fact, is is now prohibited for those who live in one state to go out of state to get coverage in many many cases.

all best,

FS

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If you were to get rid of

siditty August 17, 2009 – 7:56am

IIf you were to get rid of the pre-existing condition clause, that will drive up the cost of insurance, will it not.  A policy with no pre-existing conditions is significantly higher than a policy without. I can say in my experience as an underwriter, it was a rare thing to see a policy without pre-existing conditions because the cost was so great.

After reading your article, I fail to see how rationing with get worse with the article you provided. It just says rationing will get worse, without providing specifics as to how this will occur.  I understand how a group that advises on medicare issues with cause a shortage.  The biggest issues with medicare itself are fraud and bureaucracy. The lunacy of the “donut hole” still baffles most people, most policy makers even.  His cost savings as stated in the article you linked would come from that fact that pharmaceutical companies, like in most other places in the world, would be forced to be cheaper because health costs would be driven down by this plan.   Does it not concern you that the same drug in Mexico, Canada, the UK, India, Switzerland, and countless other countries is significantly more expensive here in America simply because the companies simply charge so much because they can?  

The article also insinuates that those with private insurance pay for those with medicaid, which is only partially true, there is an assumption all those without insurance are poor and on public assistance, when the reality is, many of those who do not have insurance are those who have been dropped or premiums are so high they can’t afford it.  

 I would also like to see where in the plan it is modeled after medicaid pricing.  If you could show me where that is I would appreciate it.  

She is right, small business owners and companies like Wal Mart who offer horrible insurance to their employees will embrace and love this plan, but so will their employees who can’t afford the premiums or whose insurance is severely lacking.  

In terms of Kaiser Permanente type hospital systems, the majority of hospitals in major cities anyway are like that, it is rare to find a stand alone hospital that is not affiliated with some massive network of other hospitals.  

Private insurance dollars don’t prop up people.  They are the reason healthcare is so high.   They negotiate rates with the healthcare providers, and so far I don’t trust them or the providers to be concerned about the people in general, but rather they have self interests at play.  

The article also goes to the notion that people will be forced on the public plan. It is optional.  

The plan will help the majority and not a minority.  The fact is that even those of us with insurance suffer.  The majority of people in this country has health insurance and for those unlucky enough to become seriously ill, these are the people who suffer when having to decide what they can and cannot afford because their insurance has not and will not pay for things to help keep them alive.  

I also want someone to explain why CIGNA and other companies still manage to thrive globally even in countries with socialized health care systems. Insurance companies do very well in other parts of the world outside of America.  I do not think this system will eliminate insurance companies, it will however get them to review and reorganize how they are run here in America.  

The system as it stands now, insurance across state lines does not always work.  It can be very costly. It is not illegal for anyone with private insurance to end up in the hospital in another state and get treatment.  That would be denying people coverage. Much like if you get sick in the foreign country, the hospital in most countries would still take you, they might charge you, but they will not deny you service, even in countries with socialized health care.

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Editors of

Femisex August 17, 2009 – 1:00pm

Editors of Femisex.com

Siditty your mind is made up and facts will not change things for you.   You want a single payer, period.

  Ok, I get that now.  But the plurality of the nation must agree for this to occur or we will be bitterly, and i do mean bitterly divided.  The minority should not rule the majority or democracy breaks down.

We could go back and forth on the fact that public option will force folks out of their private ins., but that is not something you wish to admit.  Bipartisan institutes agree on this issue, with the projections of actual numbers only differing. (that is largely a function of short term outlooks vs. long term outlooks.)

You also say: “Private insurance dollars don’t prop up people.”  There is absolutely no serious disagreement on this issue for those in the know about hospital budgets–that is administrators all know that Medicaid payments would not allow for a functoining hospital–period.

  But again, you are intent on single payer, so I now understand you viewpoints. 

 For those that do not want single payer, there is another answer to covering the those w/out ins.: tax our health care benefits.  All those folks flooding into the system will allow the pre-existing clause to work and work well. 

I won’t engage you on portablity of coverage issues, again no use to go back and forth on something that is not legally permitted as we now stand.  You have opted to overlook that fact. 

Our best to you!

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Don’t stop talking

Kim Pearson August 17, 2009 – 2:23pm

Femisex and  Siddity – although you are not convincing each other, you are educating me, and for that, I am grateful.

Femisex, your point about legislation being needed to standardize billing forms is well-taken. I have heard that point made by senior administration officials as well. It will be interesting to see whether this is a provision in the legislation. If I recall correctly, it requires an exception to the antitrust act, right?

Here’s my suggestion. If you haven’t done so, already, how about using the link widget in this post to mark up the bill at OpenCongress.org, as Nancy Watzman has suggested?

And I have questions for each of you.

Siddity, where do you think that analysts who say the public option will kill private insurance are going wrong in their reasoning? I do see that you are predicting that insurers will change their practices in order to compete. Is there anything else?

Femisex, the suggestion of taxing health benefits has been floated, but it;s politically risky for Obama to go there, since he promised not to do that during the campaign. Do you think he ought to spend his political capital here? And would the GOP take advantage of the flip-flop in 2010.

Finally, what do you (and others) think of the proposed surtax on high wage earners? 

KimBlogHer Contributing Editor|Professor Kim|

Editors of Femisex.comhiya

Femisex August 17, 2009 – 8:31pm

Editors of Femisex.com

hiya Kim–

Femisex, the suggestion of taxing health benefits has been floated, but it;s politically risky for Obama to go there, since he promised not to do that during the campaign. Do you think he ought to spend his political capital here? And would the GOP take advantage of the flip-flop in 2010.

FemiSex responds:  Hmmm, do I care about Obama’s career of the millions who need insurance?  That is a very easy answer. 

 Obama is disingenuous–to say the least!– in saying his reforms will not mean taxing HC benes.  His Cost Savings are pie in the sky projections, but taxing health benes is something Americans can bank on now and it will not kick the can down the road to financial ruin.  Pay as we go, as it were.  McCain had the honesty to say that this is the only way we have to pay for the millions who can’t afford coverage.  He reminds me of Dole, a terrible campaigner but a reasonable fellow. 

Yes, McCain suffered for his honesty.  Obama Knows his reforms will increase taxes down the line–no way to do this without taxing the middle class eventually, but why tell the truth when you can make stuff up or tax those vanishing millionaires. It is dangerous to count on a very very few to pay for the very very many –dangerous for fiscal as well as moral reasons. 

If our taxes are on the line, it will incentivize each of us to use HC more wisely.  McCain ran on this idea; Obama thumped him for it just as he thumped HRC on mandates which he also understood would be  needed to get younger folks into the system.  Obama now wants mandates and claims, post election to have seen the light on this now.

HC Taxes would allow middle class Americans to keep private ins. and allow help for those who can’t afford ins. to gain it.  I believe Mr. Obama had the trust of the people to tell us that taxes would be needed to pay for his reforms.  Esp. after the CBO shot down his claims on price tags. If only he used that op to come clean.  But he has evaded an honest answer on this issue and his capital is already floundering.

  Americans are a skeptical bunch for the most part and we know a dog and pony show when we see one. My opinion and what I hear a lot from the public: only the far left has faith in what he says about HC at this point.  If I were his advisor, I’d tell him to come clean, risk a single term, and fess up.  My guess.  If he got rid of public option and got behind taxes on HC benes the economists would get behind him and cheer. The far right and far left would yell and the center would come together. 

It may be too late for the center to trust him these day, but I don’t think so.  And if the centered his plans and let go of his clear desire for single payer system, we all might get something done.  I’d remind Obama that he carried 28 state in 2009, no where near a mandate of past elections where the vote came in at 40 states for one candidate. 

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