Wednesday, September 16, 2009

Compromise is not always a good thing

The much anticipated Senate “Gang of Six” bill was put forth today by Montana Senator Max Baucus. Follow the Link to the PDF . I took most of the day to read it and I must say I am not happy. This is not the plan we were promised during the election. If this is what passes for reform than we are pretty much boned.
There is no public option in the bill, there is a provision for cooperatives but no public option. We were promised in writing.
“Specifically, the Obama plan will: (1) establish a new public
insurance program, available to Americans who neither qualify for Medicaid or SCHIP
nor have access to insurance through their employers, as well as to small businesses that
want to offer insurance to their employees; “ from the Obama plan PDF page2
There is a tax placed on the reciprocation of drugs.
The Chairman‘s Mark would increase the rebate for non-innovator, multiple source drugs to 13 percent of AMP. Page 53
The Chairman‘s Mark would impose a fee on any person that manufactures or imports prescription drugs for sale in the United States. Page 217
What we were promised during the campaign.
Drug reimportation. The second-fastest growing type of health expenses is
prescription drugs.46 Pharmaceutical companies should profit when their research
and development results in a groundbreaking new drug. But some companies are
exploiting Americans by dramatically overcharging U.S. consumers. These
companies are selling the exact same drugs in Europe and Canada but charging
Americans a 67 percent premium.47 Obama will allow Americans to buy their
medicines from other developed countries if the drugs are safe and prices are
lower outside the U.S. from page 10.
Looks like the drug dealers made a pretty good compromise. Protectionist policies continue and now they will have a captive audience.
The worst part of the bill in my opinion.
Beginning in 2013, all U.S. citizens and legal residents would be required to purchase coverage …. “ page 31
The mandate with a fine. $750 per year. For the poor, 100 to 300% of the poverty level. However, the maximum penalty amount a family above 300 percent of FPL would pay is $3,800.
The mandate was supposed to come later and only after lower premiums failed to get everyone to purchase coverage. The trigger was supposed to be for the mandate not the public option.
The details are still sorely lacking but the general tenor of the bill is full of loopholes and grandfathering. The fees tend to kick in in 2010 and any benefits tend to begin in 2013.
Hospitals that have physician ownership and a provider agreement in operation on November 1, 2009 and that met other specified requirements would be exempt from this self-referral ban. Page 177 for example.
And the big one Pre existing conditions. This for many the point of reform. What we were promised :
“Guaranteed eligibility. No American will be turned away FROM ANY
INSURANCE PLAN because of illness or pre-existing conditions. “
What we get under Baucus:
Within a year of enactment, any uninsured individual who has been denied health care coverage due to a pre-existing condition can enroll in a high-risk pool. Page 5
If you have cancer or other progressive type disease you might be dead in 6 months or bankrupt.
The rules for the small group market would be the same as those for the individual market, except that they would be phased in over a period of up to five years beginning January 1, 2013, as determined by each state with approval from the Secretary. Page 6 so the pre existing thing may not go away until 2018?
The ambiguities in the bill are going to lead to more government takeover nonsense but I am not going to be specific as the lunatic fringe on the right doesn’t need my help.
We are being sold out to the corporate masters in this bill. Will The President make good on his promises? We await his response. Bear in mind that the Missouri compromise preserved slavery for 40 odd years.

Thursday, September 3, 2009

Town Hall

Spent a pleasant Wednesday afternoon. at a Town Hall meeting on health care reform. The event was sponsored by California Congressman Mike Thompson. The sun was shining for a change and by the time I pulled the last hill into Redwood Acres I was a bit on the sweaty side.

There was quite a line when I arrived about an hour before the scheduled start time. Most of the signs were pro-reform, actually the greatest number of signs were for some kind of single payer system but the congressmen made sure everyone knew that single payer was not even on the table when he began his remarks. This was not received warmly. There were no outrageous or even witty signs for either position. 10 people pushing Michael Moore’s film, “Sicko” on one side and Reform Health care on the other created a little levity in line when it was pointed out that they had misspelled Helth care. A quick laugh and a felt pen, problem solved. Signs were not allowed in the building but I did not see any of the radical posters prevalent at other Town Halls.

In fact the entire proceeding was pretty civil. One individual could not let a particularly odd speaker get his message out and was removed. Representative Thompson made a concerted effort that everyone have their chance be heard for about an hour and a half. In order to let as many people speak as possible demonstrations were discouraged so gauging the crowd’s position was sometimes difficult. I would put it at about a 60 40 split, single payer /pro reform being the 60. The other forty were a combination of concerned about the government taking over healthcare with a smaller percentage of, “healthcare violates the constitution “ way out types. One was wearing a , “Comrade Obama” bumper sticker on his T-shirt but there was not a lot of that type hyperbole. I went mostly to listen as for me the battle was lost when our fearless leader took single payer off the table with, “If we were starting from scratch of course single payer is better but we are not starting from scratch.”

The crowd chatted amiably waiting for the start. I spent a few minutes correcting a Reagan lover on the subject of deficits and selling arms to terrorists but all very polite. When Rep. Thompson began he laid out a few items then went right to questions. He stressed that we were not getting single payer socialized medicine and that the Government was not taking over health care. He gave his support to the public option again explaining that the public option was a premium supported alternative to private insurance and would not replace private insurance. He stressed that the reform would be paid for up front. As questions were raised he stated over and over that those happy with their Insurance could keep what they had.

The crowd laughed off the Republican woman that tried to bring up, “Death Panels” in the form of quality life year projections and the one nut yelling socialism periodically was met with derision. Of course it wouldn’t be Humboldt county without at least one person brining up legalizing cannabis. Tonight it was a young Marine that was discharged for using pot to treat his PTSD. His position was dismissed with laughter and Thompson made a bit of an ass of himself about it. There was also the obligatory protect the fetus cult member. I am sorry to say that all the house bills have the same defect in that none will cover the reproductive health of women.

Many people had nightmare stories about denied care, bankrupting deductibles and co-payments, and getting preexisting conditioned almost to death. A few had complaints about government care either the VA or military medicine but most were about insurance companies. Everyone on it was thrilled with Medicare. Mike was explaining to one individual that wanted the government completely out of health care that when it was put to a vote not one representative could be found to vote for the repeal of Medicare.

I am glad my Rep supports a public option. I am glad that my local community can have a productive dialog without the fringe hijacking the venue. That being said I am not confident that what I am hearing will go very far to solving the problems in our health care reimbursement system.