Frequently Asked Questions About Reform Proposals in HR3200
Will seniors be denied care just because they are old?
No, there is a provision in the Bill that requires caregivers to provide the same treatments regardless of age, gender, race, or any other factor unrelated to health care. It will assure seniors the right to any treatment that a younger person would be able to receive for the same condition. It will also assure that women receive the same treatment that men do, for example, for symptoms of a heart attack. Often, women have gotten less than adequate care because physicians, historically, have viewed heart attacks as more of a male problem and fail to recognize the symptoms in women.
They have discovered some areas where money is being wasted, like, some Cancer Centers giving more tests (a CAT scan costs about $1800), without better outcomes. Some hospitals having too many readmissions, perhaps because of errors. They want to fix that problem. Those are places things can be cut, but without affecting treatment outcomes. Your benefits won’t be cut.
If we don’t reform health care, however, in about 8 years, they will be forced to start cutting benefits, because the system will go broke.
Are they requiring caregivers to force seniors to decide how they want to die?
No. There was a provision in the Bill, which was voluntary, that would encourage providers to help seniors communicate their wants while they are still able, if something should happen to them that they would not be able to make treatment decisions. It’s called a Living Will. These are used routinely already in hospitals, nursing homes and assisted living facilities, but usually only after a life-threatening incident. Sometimes, after such an incident, individuals are no longer able to communicate their wishes, so, even if they would not want it, we have to provide every lifesaving treatment possible. This provision encourages them to make decisions while they are still healthy, so this won’t happen.
Will health care be rationed?
Your health care is rationed now much more than it will be under reform, and it will get worse if there is no reform. Rationing of health care by private companies has been worse in the last 15 years than ever before. Notice, it hasn’t lowered costs (nor has lowering provider fees lowered costs). As things are now, your insurance company can simply terminate you if they don’t want to pay for your care anymore. Further, they can refuse to cover even a proven treatment, or hem and haw so long that the patient dies. Under reform, they won’t be able to do those things anymore.
Insurance companies ration how many tests they will pay for, e.g., how often they’ll pay for a mammogram, a colonoscopy, a bone density test, etc. That will probably continue under both the private and the public plans, but the good news is, they’ll have to pay 100% for preventative care (namely, those tests that find problems early and save lives). In the past, private companies did not have to cover them at all. Medicare already does.
There are limits to everything. You don’t need and won’t be able to have, for example, a colonoscopy every year, unless a previous test shows you to be at super high risk. You won’t be able to have elective surgery, unless you want to pay for it yourself. You might not be able to have knee surgery if studies show that physical therapy is as beneficial (unless you want to pay for it yourself).
In that sense, there will be rationing. But far less than we’ve had under the private plans in the past. “Standards of care” will be recommended on the basis of research. However, there are always exceptions to the rule, and physicians are always allowed to discuss exceptions for approval. Hopefully, insurers will be more responsive to doctor recommendations than they have been in the past.
Is the government going to take over my bank account?
No, they’re going to allow you to pay your health care bills electronically (by automatic withdrawal), if you want to, just like you do other bills.
They’re also asking insurance companies to start paying providers electronically, by making electronic deposits to providers’ bank accounts. This saves tons of paper, time and money. Medicare and Medicaid (and Social Security) already do this. Imagine the trees that it saves, not to mention the clerical time, because they won’t have to stuff millions of envelops.
No, even if your employer signs all of his or her employees up for a public plan, you have 30 days to “opt out,” and get your own plan in HR 3200. Although this is not the final Bill, this provision will probably be in any final bill.
Isn’t Obama just trying to ruin private insurance companies with this health care reform, so that he can force us into socialized medicine?
No, he’s trying to rein them in. Insurance company CEOs (of the several largest companies) make huge salaries, $10,000,000 to $12,000,000 a YEAR (plus, they own a lot of the company stock worth a whole lot more than that), while treatment is denied, and provider fees are lowered to the point that many doctors are struggling financially and there’s a 30% shortage of general practitioners and pediatricians in many communities. Companies also pay huge lobbying fees (to try and influence congress), huge campaign contributions (for the same reason), and they make very healthy profits. There is a lot of administrative waste in the private plans. They spend about 12-15% of their money on administration, whereas Medicare spends about 3%.
Obama would like insurance companies to trim their perks and administrative costs, so that they can lower your premiums and also spend a higher percentage of their money on health care. Wouldn’t you like that, too? Personally, I’m not into paying higher premiums and co-pays so that their CEOs can make ten million a year, and use their profits to try and control our legislators. That makes me mad. MAD! In my opinion, health care for profit wasn’t a good idea. It has corrupted the system and raised costs.
But the public plan can negotiate with doctors for lower fees, so won’t the private plans be at a huge disadvantage?
It’s a myth that private plans don’t “negotiate” for lower provider fees (actually, neither negotiate, they just tell us what they’ll pay us, and we sign on the bottom line, or we don’t get their patients–because we’re not “in network.”)
Medicare pays psychologists just about 4% less than Blue Cross and Blue Shield (that’s about $3-$5 a session–not something most providers will quibble over, especially since Medicare pays electronically, directly into our accounts, getting our money to us quickly. They also automatically bill the secondary insurance electronically, saving us time. Private insurance companies could easily do both of these things, which would save them a lot of paper, clerical time, and thus, money.
Medicare pays significantly MORE than several other large companies–over 20% more than United Health Care.
Medicaid pays very low, about 30% less than Medicare, and $10 less than United Health Care. However, many private companies have been coming down the pike the last couple of years offering us contracts for almost 10% less than Medicaid. (Personally, I tell them “no thanks”. It’s less than the usual and customary fee of 25 years ago).
Private insurance is only at a disadvantage because they want to keep outrageously high CEO salaries, money to influence congress, and good healthy profits.
Here’s just some of the CEO salaries for last year, for some major companies:
Ron Williams, …..AETNA Total compensation: $24,300,112.00
H. Edward Hanway, …..CIGNA Total Compensation: $12,236,740.00
Angela Braly, …..WELLPOINT Total Compensation: $9,844,212.00
Dale Wolf, …..COVENTRY HEALTH CARE Total Comp: $9,047,469.00
Ron Williams, …..AETNA Total compensation: $24,300,112.00
H. Edward Hanway, …..CIGNA Total Compensation: $12,236,740.00
Angela Braly, …..WELLPOINT Total Compensation: $9,844,212.00
Dale Wolf, …..COVENTRY HEALTH CARE Total Comp: $9,047,469.00
I think they could trim those a bit and not even notice.
We don’t have the money to keep doing things as we are. If we continue as we are, your health care costs will continue to go up faster than your salary, and your benefits will most likely be reduced as a way for you or your employer to pay for health care.
Changing the tax codes for the wealthy, people who make more than $250,000 a year, back to what they were before Bush gave them a tax break they didn’t need and didn’t even ask for (“a solution for which there was no problem” as one journalist put it), will pay for 2/3 of the program. Prevention, getting rid of waste, having incentives for doctors to cure rather than monitor chronic conditions forever (such as diabetes), and expecting everyone to buy into the system are all features that are expected to cover the other third.
Yes. Drug companies have agreed to work with the plan. Gaps in coverage for the elderly will be closed, saving some people several thousand dollars a year, and prices will be negotiated for the elderly (If you’d like to see them negotiated for everyone, write your congressperson and tell him or her!).
I hope that generic drugs that HAVE BEEN AVAILABLE INTERNATIONALLY FOR YEARS, but not in this country, will NOW be sold in this country, saving ALL of us money. Personally, I’m supposed to take a drug that costs about $300 a month here. The generic is not available. I found out online that I could get it generically from other countries for $56.
I find that outrageous, i.e., that drug companies continue to charge such high prices when a generic could be made available. I wrote my senator and told him so. He said, “We can’t tell drug companies what to charge. That would be interfering with their right to a free market.” I wrote him back and asked, “What about my right to a free market. You’ve been telling doctors what we can charge for years.” (He didn’t write back).
(If you also think this is outrageous that they don’t have to sell us the generics that are available, please, complain to your congresspersons and senators and let’s get it changed.)
And if you buy into the idea that drug companies need their profits for research, think again. They are the most profitable industry in the country (possibly the world) AFTER the cost of research and development, and some of their CEOs make $40,000,000 a YEAR. They can trim their profits and their salaries.
Everyone knows that federal bureaucracies are inefficient, costly, and invade our privacy. Wouldn’t it be better, instead of having a government-run public option, to turn the matter over to the states?
I’ve worked for six federally funded programs during my career, in four different states. They have been the best jobs of my life. They have been well designed, enlightened, cutting edge, they provided enough money for competent staffing, training and supervision, they encouraged innovation, and although they had carefully designed structures, the structures were there for guidance and for the protection of the privacy of the public, not for asking us to do the impossible and squelching creativity or professional competence.
One of those jobs was with an interdisciplinary team of professionals evaluating developmentally delayed children up to the age of six. We were not very well paid. Our team of very well trained professionals did comprehensive evaluations, including home and preschool visits out in Appalachia, for about $500 per child, while the local Children’s Hospital did less thorough, in-house evals for about $3000 per child–this was back in the mid-70s. But the job was so interesting and so satisfying (because we saw such good results) that we didn’t care about the pay. It was enough. When the program was eliminated with Reagan’s many cuts, the psychiatrist commented about what a shame it was. She said, “They actually let us do a good job.” In many programs, it’s very hard to do a good job because there is too much work and too little time.
Consider, also, Head Start. It is federally funded. Head Start workers are not paid very high wages. But they do a great job, the program is so well designed, the staff training excellent, and they are able to incorporate enough features into their program to actually make it work. If they were to eliminate, for example, parent training or home visits, it would not be nearly as effective. Research shows that Head Start kids do better all the way through high school. That saves us bunches of money in the juvenile justice system.
I’ve had several other jobs in federally funded programs which were equally well-designed and effective.
I’ve also worked with state funded programs in three different states. In my experience, they are less well designed, much bulkier with rules and structure (much of which is redundant and/or doesn’t make much sense), require a lot more paperwork, allow less room for “doing a good job,” and for innovation and creativity. They are typically not funded well enough to allow for hiring enough competent people to do the job. Thus, in my experience, they ask for the impossible from their workers (way too great a work load), and waste a lot of money insofar as less competent people take longer to get at the crux of a problem and find a good solution.
This has not always been the case in the state programs I’ve worked with, of course. But it often has. The personnel of these programs are well-intentioned and hardworking people. But they don’t have the training and support (and cutting-edge ideas) to be as consistently successful as the federal programs, in my experience.
The federal government has enough resources to hire the best experts in the country to design their programs. Many states seem to have more difficulty with this, perhaps because they don’t have the resources to pay the best experts for design and training.
Just considering Medicare and Medicaid, the first being federal, and the second being state-run (but with some federal funding), Medicare seems to me, as a provider, to be more reasonable and efficient.
Medicaid (in Idaho, at least) requires psychologists to have a physician supervisor. They don’t care if it’s a dermatologist (who knows little or nothing about mental health), as long as it’s a physician. Medicare gave up this requirement over 25 years ago. There is also a provision by Medicaid in Idaho saying that solo providers are not acceptable. This means that we have to form a “clinic” of at least three people: the physician (who doesn’t have to be in the same building), and two others, who do have to be in the same building. This means that if you want to be a Medicaid provider, you might have to move your office.
As a Medicaid provider, if I get a self-referred patient, I have to send them off to their Primary Care Physician to get a “referral,” even though they are self-referred and I have already seen them. I have 30 days to get this “referral.” It is not sufficient to just notify the PCP that they have sought services. Incidentally, PCPs NEVER refuse to make the “referral.” Why would they do that, and risk liability if something were to happen to the patient that would have been prevented if they had been allowed mental health services? The “referral” is paperwork busy work, both for me and for the physician.
Then I have to send the patient to the “supervisor” of the “clinic”, because he or she has to meet each patient before signing the treatment plan. In my case, I had never met the supervisor who signed my treatment plans, in the more than two years I was in the “clinic”, but we had to have that “supervisor.” (And it was apparently ok with Medicaid that the “supervisor” had never met us). Not once did the supervisor question the treatment or refuse to sign the plan. It is more paperwork busy work, and it is redundant, because the primary care physician already knows the patient much better than a supervisor can in one visit.
So, calculate the waste: In order to see me, the patient has to have two physician appointments, at a cost of something like $40 each. If I change my treatment plan (which I’m supposed to do if I change my approach in treatment, and at least once a year), then I have to send the child back to the “supervisor”. Multiply this nonsense by 130,000 kids on the Medicaid rolls in Idaho, and right there, we are wasting $10,400,000 a year. Since children are only a quarter of the Medicaid population, if you multiply that by four, we’re wasting $45,600,000 a year on unnecessary and redundant services.
Now, to be honest, sometimes the PCP doesn’t require the patient to come in for the “referral” if they have been in recently and the doctor knows the patient well. So perhaps we are only wasting about $40,000,000 a year (on this particular requirement).
Psychologists are trained and licensed to do the work that we do. We know significantly more about our profession than a medical doctor does. Why require these physician stamps of approval that cost us tens of millions of dollars? No other third party, public or private, requires this kind of nonsense. Medicare figured out a long decades ago that such requirements wasted money and were discriminatory. This is just one example of how Medicare is more enlightened, more efficient, and less wasteful.
These and other experiences are why I, personally, would prefer a federally run public plan, rather than turning a public or nonprofit option over to the states. In addition, if we turned the nonprofit option over to the states, 50 groups of people would each be redesigning the wheel. With one federal program, just one group of people would be doing that work. In fact, they could simply clone Medicare, or let people buy into the program that already exists.
What would be cheaper? Having fifty groups designing plans, or one group designing a plan