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Joined: 2/9/2008
Msg: 368
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A great day for AmericaPage 9 of 17    (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
The shortage of HC professionals is either a disingenuous and/or very cold argument to fight off care for those who fall through the gaps of health care.

As Rumsfeld noted not long ago..""As you know, you go to war with the army you have, not the army you might want or wish to have at a later time." Of course the people screaming the loudest now about denying health care to Americans, were complicit and silent when the fiscal and moral disasters of the previous administration's policies.

Can we not move into health care for Americans with the Doctors and nurses we have and not wish we had? I tend to believe the argument leans toward the cold side. There was the same coldness by the same people as millions of lives were destroyed thousands of miles away. There are people have little value to those who have it all. The threat of "poor blacks, hispanics and white trash" suddenly standing in the same line for basic health care appears to threaten the (I got mine) crowd. The answer from their argument appears to be that we need to allow the herd to be thinned out to the point the numbers are down enough where the physicians and nurses can handle the load. Lose your job and insurance...thinning needed. Be born with birth defects/pre-existing conditions, thin em Danno. Get to old or prematurely infirmed to work to buy or qualify for insurance, 60% of bankruptcies due to medical debt...not human basic human decency due you. We have shortages you know. Nothing personal. BTW..we reserve the right to price gouge in the ER since you don't have insurance..Nice house, mind if we take it?

Yes money is important, so important we can throw trillions at something that has the opposite to do with human welfare as we did during the 2 Oh Ohs, but now we cannot do something positive for human welfare since we now have this sudden awareness of fiscal responsibility. Let's not address waste, fraud, inefficiency and redundancy, price fixing, huge CEO bonuses, and other broken pieces of the current insurance and HC industries. The sick and injured poor are to blame and must be sacrificed.

I appreciate the patience of the Saints for those here who try to reason with facts against emotion, but if you look at the raucous crowds, the anger, the spitting and ugliness, this is not about facts or even human decency. This is something unspoken.

Getting back to Rummy...""I would not say that the future is necessarily less predictable than the past. I think the past was not predictable when it started."
Joined: 10/17/2005
Msg: 369
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A great day for America
Posted: 3/29/2010 6:22:35 AM
Like I said, there are plenty of empty buildings (used to be clinics) just waiting to be brought back to life.

There is also a surge among nurses to move upwards into nurse practitioner positions. This will greatly relieve the immediate need for MD's. They can handle well visits and routine check-ups that will be covered by the insurance. Well visits and routine check-ups cut down tremendously on ER visits since people are staying healthy or catching problems long before it escalates into an emergency situation.

In anticipation of a few of the hard heads in here (who are well-known for feigning stupidity) although I'm sure they know exactly what a nurse practitioner is, here is what a nurse practitioner is and how they work ...
What Is a Nurse Practitioner?

A nurse practitioner (NP) is a registered nurse (RN) who has completed advanced education (a minimum of a master's degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a broad range of health care services. They provide some of the same care provided by physicians and maintain close working relationships with physicians. An NP can serve as a patient's regular health care provider.

Nurse practitioners see patients of all ages. The core philosophy of the field is individualized care. Nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. This can mean fewer prescriptions and less expensive treatments. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

Because the profession is state regulated, care provided by NPs varies. A nurse practitioner's duties include the following:

* Collaborating with physicians and other health professionals as needed, including providing referrals
* Counseling and educating patients on health behaviors, self-care skills, and treatment options
* Diagnosing and treating acute illnesses, infections, and injuries
* Diagnosing, treating, and monitoring chronic diseases (e.g., diabetes, high blood pressure)
* Obtaining medical histories and conducting physical examinations
* Ordering, performing, and interpreting diagnostic studies (e.g., lab tests, x-rays, EKGs)
* Prescribing medications
* Prescribing physical therapy and other rehabilitation treatments
* Providing prenatal care and family planning services
* Providing well-child care, including screening and immunizations
* Providing health maintenance care for adults, including annual physicals

Nurse practitioners provide high-quality, cost-effective individualized care that is comparable to the health care provided by physicians, and NP services are often covered by insurance providers. NPs practice in all states. The institutions in which they work include the following:

* Community clinics and health centers
* Health departments
* Health maintenance organizations (HMOs)
* Home health care agencies
* Hospitals and hospital clinics
* Hospice centers
* Nurse practitioner offices
* Nursing homes
* Nursing schools
* Physician offices
* Private offices
* Public health departments
* School/college clinics
* Veterans Administration facilities
* Walk-in clinics

Most NPs specialize in a particular field of medical care, and there are as many types of NPs as there are medical specialties.

NPs and Women's Health

Women with serious conditions, especially those that require surgery, need the services of a physician. But when women have typical health care needs, an NP can serve as the primary health care provider.

Some nurse practitioners focus specifically on obstetrics and gynecology. They provide services that include the following:

* Care before and after menopause
* Contraceptive care
* Evaluation and treatment of common vaginal infections
* Health and wellness counseling
* Midwifery
* Physical exams, including Pap smears
* Pregnancy testing and care before, during, and after pregnancy
* Screening and referral for other health problems
* STD screening and follow-up

Licensure and Certification

To be licensed as a nurse practitioner, the candidate must first complete the education and training necessary to be a registered nurse (RN).

Requirements for a registered nurse include an associate degree in nursing (ADN), a bachelor of science degree in nursing (BSN), or completion of a diploma program, as well as direct patient care for acutely or chronically ill patients. Associate degree in nursing programs, which are offered by community and junior colleges, usually take 2–3 years. BSN programs are offered by colleges and universities and take 4–5 years and diploma programs are administered in hospitals and usually take 2–3 years. Depending on the program attended, the candidate may fulfill some NP requirements while completing the RN degree.

In most cases, state regulations require and professionals and employers in the field strongly recommend a master's degree as a minimal requirement for NPs. To become NPs, nurses with an ADN or diploma enter a bachelor of science to master's program. They may be able to find a staff nursing position and take advantage of tuition reimbursement programs to work toward a BSN.

Once registered nurse status is attained, the candidate must complete a state-approved advanced training program that usually specializes in a field such as family practice, internal medicine, or women's health. The degree can be granted by any of the following:

* Community college (grants an associate degree)
* Hospital-based program (grants a 3-year diploma)
* University, which grants a bachelor of science in nursing (BSN) degree; a master's of science in nursing (MSN) degree, which is the minimum degree required; or a doctorate in nursing

The variety of educational paths for NPs is a result of the history of the field. In 1965, the profession of nurse practitioner was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. Currently, educational options require a master's or doctorate to attain NP status.

After completing the education program, the candidate must be licensed by the state in which he or she plans to practice. The State Boards of Nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a nursing program and clinical experience. Because state board requirements differ, nurse practitioners may have to fulfill additional requirements, such as certification by the American Nurses Credentialing Center (ANCC) or a specialty nursing organization. The license period varies by state; some require biennial relicensing, others require triennial.

After receiving state licensing, a nurse practitioner can apply for national certification from the ANA or other professional nursing boards such as the American Academy of Nurse Practitioners (AANP). Some NPs pursue certification in a specialty. Several organizations oversee certification, including the following:

* American Association of Critical-Care Nurses
* Board of Certification for Emergency Nursing
* National Certification Board of Pediatric Nurse Practitioners and Nurses
* National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
* Oncology Nursing Certification Corporation

A women's health nurse must have experience in direct patient care, education, administration, and/or research. He or she must have graduated from an OB/GYN nurse practitioner program (1-year program that is accepted by the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties). The NP must also complete a required number of teaching and clinic hours in an OB/GYN setting. The National Association of Nurse

Practitioners in Women's Health (NPWH) oversees the accreditation of programs that prepare NPs in women's health.

As the above poster noted ...
The shortage of HC professionals is either a disingenuous and/or very cold argument to fight off care for those who fall through the gaps of health care.

There is really no excuse to repeat ignorant remarks related to not being prepared for the influx of new patients related to the HC bill. In the end, it was never designed to give immediate care to all 30+ million people who need benefits. Anyone who is capable of reading already knows that it will all grow gradually, so it is truly disingenuous to insinuate that we would not be ready for the influx in appropriate time frames.

It's just another excuse to beat up on the President and his policies, another excuse to deny those who need help the most. Those participating in such behavior need to step out of the box and look at themselves ... ask themselves if they would be proud to claim such behavior.

As we know, there will always be racists and bigots (and just your run-of-the-mill small-minded people) ... who are proud to be what they are, so obviously we do have to anticipate we will experience it in here as well.

So sad ...
Joined: 12/30/2006
Msg: 371
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A great day for America
Posted: 3/29/2010 6:41:50 AM

In case you weren't aware... that obligation, in general, ends at immediately life-saving/stabilizing care... NO ER anywhere in the US is obligated to do a pacemaker implantation on an ER/non-paying case... The extent of the obligation in the US, without insurance/cash/AMEX, would end at stabilizing him (that would be the "zaps" you mentioned)... The wait in ICU and the pacemaker implantation would not happen as it is not required to immediately save his life/stabilize him... Anymore than he would be given 6 months of chemo free-of-charge just by showing up in an ER with cancer...

You're passing on information third hand. Sorry, but that story doesn't ring true to someone who lives here.
Nor does it ring true to anyone in the U.S. who has taken the time to enlighten themselves on the topic (as opposed to just swallowing the right wing propaganda, fear and hate mongering)
And, as much as I try to avoid such arguments because they do little to advance any cause on POF, 3 pages ago someone stated:
The irony of those self-professed Christians who despise health care for the "least among us" is matched by the Creationists who believe in Darwinian survival of the richest when it comes to health care. Nearly everyone I know in the health care sector say that universal health care would save us tons of money via preventative care vs. the emergency room of last resort model of today.
and someone replied:
Lie and cheat? I get it your Christian thing... the only way?
Other religious beliefs are acceptable ... That is until the Dem's convert the nation to Islam.... Next year.. so we can all go on the Hajj.............
I would only like to add to that:

James 2-14: What doth it profit, my brethren, though a man say he hath faith, and have not works? can faith save him?
Jas 2:15 If a brother or sister be naked, and destitute of daily food,
Jas 2:16 And one of you say unto them, Depart in peace, be ye warmed and filled; notwithstanding ye give them not those things which are needful to the body;what doth it profit?
Jas 2:17 Even so faith, if it hath not works, is dead, being alone.

The moral objection exemption was put in the bill to address the beliefs of those who do NOT believe in medical care....PERIOD. NOT those who blindly follow the self proclaimed "conservative" cult (Republican...who have proven themselves to be ANYTHING BUT) by defending and preserving a blatant system of white collar crime. (Committed by the Insurance/financial sector) I DO hope that non-Christians can realize that TRUE Christians are NOT this hateful and eager to "deny the things which are needful to the body" basic health care. That aside...we come once again to the REAL problem which is WHY those who ARE opposed to this bill...ARE opposed.

Of the 34 Democrats who oppose the bill....their reasons ARE (as have been stated) that 1) Abortion is NOT included as part of "health care" (which makes it easier for me to support the legislation with a clear conscience) and 2) that illegal aliens are exempt from coverage.

Republicans reasons for opposing the legislation range from...1) screw the poor...let them eat cake; to 2) we want them to have health care...but we want the government to pay it to the existing Health Care Management Companies....and NOT to State run Management bureaus. I would imagine that the real cash will end up in the hands of the "Insurance companies"....which..ARE "Financial Institutions" (underwriters) Where the biggest source of fraud and waste lies is in the "health care management organizations".

So we keep getting really confused because we're unable to distinguish between the 2 supposedly separate entities. The Underwriters are one in the same; but the MANAGEMENT of these insurance monies is the point addressed in all right wing slants.

Thank you Cotter (Post # 368) for posting those points! LOL! I had them up once but they got lost in the shuffle somewhere!

Ya's statements like this:
Even with government provisions it takes time to build facilities and time to train Health Care Personal needed to staff those facilities, anywhere from 2 years for a nurse to 10 or more for physicians. No amount of laws or money can magically train medical personal, especially physicians.

Average time from start to finish for someone to become a physician is 10 + years(more if specialized), 6 yrs for a physician's assistant, 2-4 years for nurses, and 6 years for pharmacist ---Add to this list x-ray techs, lab techs, surgery techs and the list goes on.

So if by chance the US can get enough qualified individuals to be a physicians that means it will be around 2020 before we to put the doctors needed out there where shortages already exist, especially in the field of primary care.

Following are just snippets from just four of the numerous articles about the need for more physicians in our country, especially in primary care. An estimated 17,000 or so are needed for just our country's current shortage ...This does not even take in the shortage of other trained/degreed health care personal like nurses, lab personal, radiology and ??? or facilities that take time to train or build.
that truly baffle me. LOL! HOW can anyone say something like this....and then ACCUSE someone else of supporting "Death Panels".....If THIS statement does not REEK of "death panel" then I certainly don't know what does!!!! The underlying sentiment here is....we don't have enough doctors.... and it's too inconvenient (for them) to train more, so just let those without insurance die in the streets. They of course totally IGNORE the fact that....if "health care" IS reformed...then perhaps MORE talented people would see some REASON to enter into health care as a profession. It is our understanding that part of this bill is to address TORT reform; and along with that lowering the number of frivolous lawsuits, which would in return serve to lower the cost of malpractice insurance, thus.....making actually being a doctor more,000 as profitable as being an HMO/PPO CEO. I can hardly blame a talented young individual for declining to take on the expense of an additional 8 years of college and then have to spend upwards to 70% of my income buying malpractice insurance...when they could just as easily go to school for 4 years, become an insurance executive and earn MORE.

Keep posting all the "snippets" too ... that'll make the wish for Obama to fail come true ... NOT.
LOL! Cotter!!!! YOU just hit the nail right on it's proverbial little head!!!! I started out only marginally in favor of this legislation; but the more I've read here, and been prompted to read elsewhere....not only am I now TOTALLY sold that THIS IS a great day for America....but when I leave here today, I'm going to the Democratic Headquarters to not only switch my voting registration, but to VOLUNTEER to recruit other "recovering Republicans"!!!! LOL!

I stood up and CHEERED when I read this in the news yesterday!!!!
Fed up with waiting, President Barack Obama announced Saturday he would bypass a vacationing Senate and name 15 people to key administration jobs, wielding for the first time the blunt political tool known as the recess appointment.

The move immediately deepened the divide between the Democratic president and Republicans in the Senate following a long, bruising fight over health care. Obama revealed his decision by blistering Republicans, accusing them of holding up nominees for months solely to try to score a political advantage on him.

"I simply cannot allow partisan politics to stand in the way of the basic functioning of government," Obama said in a statement.
Whatever doubts I HAD about this man....have been removed. I'm certainly NOT saying that he's perfect, or that I agree with all his ideas....but dang!!! He STOOD UP to those worthless slobs!!!

Wouldn't it be nice if they made the fear mongering illegal?
It certainly has MY vote!!!!

This is easily, by far the stupidest reason I have ever seen to delay health care reform. Because you don't have enough doctors to start treating all these poor people who are going to come into the system. All those rich folks are going to have to share the time they spend with their doctor with some poor people who obviously do not deserve to see a doctor because they aren't rich.

Sometimes you just have to shake your head.
Yup, Elitism at it's finest!

While Nevada malpractice insurance rates are between middle to high in comparison with all other states, doctors of many types in Nevada---including general internists, pediatricians, and general practice doctors---earn a higher average salary than doctors in any other state. In 2009 one of the highest rates of insurance in Nevada is for OB/GYNs, who may pay between $85,000 for malpractice liability insurance per year up to $142,000 per year for a premium plan by a prominent insurance company. Although the average annual salary for such doctors is around $180,000 in 2009, malpractice insurance can still be a huge financial burden.

Florida has some of the highest rates of liability insurance. Moreover, the deviation between low and high averages varies in Florida more widely than in almost any other state. For instance, a doctor in internal medicine in Florida could expect to pay in excess of $56,000 per year for insurance as in 2009, in contrast with Minnesota's $4,000. General surgeons paid in between $90,000 per year and $175,000 per year or more. OB/GYNs once again could expect the highest rates, with liability coverage ranging from $100,000 to $200,000 per year.
SO, whether your were a doctor OR a patient...WHERE would YOU choose to work or be treated? AND, so that we're not comparing apples to oranges here:

According to the US Department of Labor, as of May 2008, the median annual salary in the United States for an Ob Gyn is $199,350. The average annual salary for an Ob Gyn who practices in a specialty hospital is just under $202,000.

Malpractice insurance premiums vary widely from state to state. Florida is the highest-premium state, with an average 2004 premium of more than $195,000, followed by Nevada, Michigan, the District of Columbia, Ohio, Massachusetts, West Virginia, Connecticut, Illinois and New York.

The 10 lowest-premium states are Oklahoma, at about $17,000 on average, and Nebraska, South Dakota, Minnesota, Indiana, Idaho, North Dakota, Wisconsin, Arkansas and South Carolina.

Many areas of the country, especially around major metropolitan areas, are experiencing large increases in the average costs of premiums. Between 2003 and 2004, Dade County in Florida, which includes the city of Miami, went from $249,000 to $277,000, an increase of about 11 percent.

In that same period, Cook County in Illinois, which includes Chicago , jumped about 67 percent from $138,000 to more than $230,000. Wayne County in Michigan , which includes Detroit, went up 18 percent, from almost $164,000 to nearly $194,000.

AMA reports:
Medical Student Debt
Student debt statistics

* $156,456 – According to the Association of American Medical Colleges (AAMC), the average educational debt of indebted graduates of the class of 2009.
Whipping out my calculator here....and Stafford Loan rates are 6.8%...which means that doctor is paying for the FIRST 10 years....almost $1,800. a month in loan payments, and IF he/she's practicing in an "average state" say $70K a year in malpractice insurance, that's $5864.98 a MONTH ...and another "average"....general surgeons earn about $150K per year....or $12,500 per month. That leaves them with a whopping $3,835. per month!!!! LOL! Poor doctors!!!! Let's see.....I had 2 years of Tech school, 5 yrs OJT...and as a journeyman pipefitter/plumber....I earned MORE than that! (a LOT more than that!) And we wonder WHY there's a shortage of doctors?

Aetna's Ron Williams - CEO Compensation
May 14, 2009 — 3:22pm ET | By Dan Bowman

Ron Williams - Aetna

Total Compensation: $24,300,112

Details: Williams earned $24,300,112 in total compensation for 2008, with more than half of that ($13,537,365) coming from option awards. He also received an additional $6,456,630 in stock awards to go along with his base salary of $1,091,764.

Personal use of a corporate aircraft and vehicle, as well as financial planning and 401(k) company matches added up to $101,487 for Williams.
He "earned" (and I use the term loosely!) $2,025,009.33....A MONTH!

And ANYONE can sit here and TYPE that "money is not important" when you're dealing with a sick loved one...... with a straight face???? OMG!!! You've GOT to be joking!!! Maybe these folks should call Ron Williams next time someone in their family needs a triple bypass!!!!
Joined: 2/9/2008
Msg: 372
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A great day for America
Posted: 3/29/2010 6:53:48 AM
Thank you Saint GrandmaBooBoo, and Saint Cotter for your continuing patience and diligence in providing factual information. Doubly saint-like for doing so with the realization that facts only confuse and enrage the opposition.

The Insurance Corporationadolfs have found a loophole to extend their death panels for kids for another 4 years. Compassionate conservatidolfism at it's finest.

PS..tea partyadolfs...Bushadolf actually killed, poisoned, tortured and maimed millions after his 9/11 Reichstag fire. Nothing comparable can be said about Obama.
Joined: 12/30/2006
Msg: 375
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A great day for America
Posted: 3/29/2010 8:10:33 AM
To restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


This Act may be cited as the `Health Insurance Industry Fair Competition Act'.


(a) Amendment to McCarran-Ferguson Act- Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the McCarran-Ferguson Act, is amended by adding at the end the following:

`(c) Nothing contained in this Act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance. For purposes of the preceding sentence, the term `antitrust laws' has the meaning given it in subsection (a) of the first section of the Clayton Act, except that such term includes section 5 of the Federal Trade Commission Act to the extent that such section 5 applies to unfair methods of competition.'.

(b) Related Provision- For purposes of section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to the extent such section applies to unfair methods of competition, section 3(c) of the McCarran-Ferguson Act shall apply with respect to the business of health insurance without regard to whether such business is carried on for profit, notwithstanding the definition of `Corporation' contained in section 4 of the Federal Trade Commission Act.

Passed the House of Representatives February 24, 2010.
And THIS what the Republicans ARE in an uproar about....removing the "anti-trust exemption" for their Insurance buds.

I highly recommend this video, which deals with the financial industry...of which INSURANCE COMPANIES and HEALTH MANAGEMENT COMPANIES are the MAJOR component.
Joined: 3/31/2008
Msg: 379
A great day for America
Posted: 3/29/2010 11:15:24 AM
Fact is that "good timely medical service" is as rare as the dodo in UHC countries. In most you have long waiting lines, doctor shortages and a lack of qualified family physicians.

In the US the further we've gone towards socialized medicine the harder it has been to get quality medical care unless you have the money and are willing to pay a premium to avail yourselves of concierge medical practices and/or pay out-of-pocket.

Fact is that private insurance companies base their reimbursement rates on what Medicare will pay. Blue Cross Blue Shield (for example) will pay a premium above Medicare, but they keep the rates close. So as Medicare has decreased payments the private insurance companies have as well.

This is why doctors limit Medicaid (lowest paid) the most, Medicare (medium) to usually less than 30 percent of revenues, and private insurance (highest paid) to the rest of the practice. However, with Medicaid payments now being less than a doctor's cost of providing service, it's becoming harder and harder for primary care physicians to make a living. The older ones are retiring or going into other fields where they can use their medical degree (I notice that more and more medical writers these days are physicians), and new medical school graduates are going into more highly paid specialties.

We had already started screwing up our medical system with socialized medicine way before this bill ever passed. The new legislation makes it worse, but we aren't sure yet how much worse.

Regardless, it stays the same. If you have money you'll get good timely medical care, and if you don't you won't.
Joined: 10/17/2005
Msg: 380
view profile
A great day for America
Posted: 3/29/2010 11:16:08 AM

The current physician shortage ...

It's just one piece of reality that is pointing out that just having more affordable care with insurance will not be guaranteeing people good Timely medical coverage.

In fact with the shortage getting worse, Timely medical care will most likely become a luxury...

If under best case scenarios enough capable people decide to or can be encouraged to educate themselves in the Medical field as physicians ...

This cannot be magically fixed over night with some bill, especially since physician shortage is also a worldwide problem as already pointed out by others.

Physician shortage and unavailability of good timely medical is just one of the vague reality aspects that most have not talked out to the general public that the bill cannot guarantee a fix for, especially immediately.

I see the fear mongering is going to continue in spite of the fact that it's already known that an "immediate" influx of 30+ million patients is not realistic.

It does make one wonder if these people have any idea what they sound like? Do they care that they aren't making any sense?

LMAO ... Run, chicken little, run ... tomorrow there will be 30+ million people lined up for health care at all your local clinics.

(I wonder if anyone has a left-over bomb shelter for each and every one of our resident chicken little's to hide in until this health care "crunch" passes? We wouldn't want them to get trampled in the lines.)

I guess some aren't getting it.

Reminder ...
There is really no excuse to repeat ignorant remarks related to not being prepared for the influx of new patients related to the HC bill. In the end, it was never designed to give immediate care to all 30+ million people who need benefits. Anyone who is capable of reading already knows that it will all grow gradually, so it is truly disingenuous to insinuate that we would not be ready for the influx in appropriate time frames.

It's just another excuse to beat up on the President and his policies, another excuse to deny those who need help the most. Those participating in such behavior need to step out of the box and look at themselves ... ask themselves if they would be proud to claim such behavior.
Joined: 12/30/2006
Msg: 381
view profile
A great day for America
Posted: 3/29/2010 11:18:50 AM

But just a few questions are if the costs will truly be affordable and where and how one will access that medical care in a timely manner, along with the true impact to our current trillions of dollars in national debt.
That's because there are apparently only a "few" who understand that the societal costs are not measured only by what is reported as "national debt". The "few" realize the costs associated with 60% of all personal bankruptcies being DIRECTLY attributed to medical bills by the non- or underinsured. The "few" recognize that bankruptcy of individuals lowers the standards of living by increasing the PRICES of everything...for ALL of us. The "few" realize that hospital emergency rooms are and have been becoming overly crowded unnecessarily who can go to ER and not be turned away for an ear infection (accompanied by a temperature of 103) but they CANNOT get a doctors appointment without either the CASH... or an insurance card. The "few" realize that an ounce of prevention is worth a pound of cure. The "few" realize that preventative medicine PREVENTS a vast majority of long term and extremely expensive hospitalizations in the LONG TERM. The "few" realize that approx. 20% of the premiums they pay currently are to absorb the costs of such cases (of the uninsured).

From Business dated March 29,2010

Although health reform likely will cause some initial disruption to the health insurance industry, the addition of millions of new plan members could prove advantageous to insurers ultimately, some industry experts say.

However, until that day comes, insurers will be forced to streamline their operations to maintain minimum medical loss ratios set by the legislation while also meeting state solvency requirements and posting a profit for shareholders.

Also of concern are the effects of two new excise taxes—one assessed on insurers based on market share and the other assessed on high-cost health insurance products called “Cadillac” plans.

Insurers and analysts are concerned that the rate bands established by the legislation will not allow the pricing flexibility necessary for insurers to continue to offer affordable yet profitable insurance plans.

Analysts also expect insurers to eventually exit the Medicare Advantage market in response to changes in the payment structure under the Patient Protection and Affordable Care Act. On the other hand, insurers are likely to expand into Medicaid, which will grow as a result of the legislation. Under Medicare Advantage, insurers contract with the government to provide benefits at least equal to those in the traditional Medicare program. Medicare Advantage critics say the premiums the government pays insurers are excessive.

About 10 million Medicare-eligible beneficiaries are enrolled in Medicare Advantage plans, which typically are preferred provider organizations.

Meanwhile, analysts and insurers were uncertain how new state insurance exchanges, from which individuals and small employers will be able to obtain coverage, will operate and reserved judgment until after final regulations are issued.

Based on analysts' initial assessments, the margins of for-profit and publicly traded health insurers could erode moderately to enable them to meet minimum medical loss ratios set by the legislation. The new law requires insurers underwriting individual and small-group coverage to spend at least 80% of their premium revenues on medical care, while insurers providing coverage to large groups must spend at least 85% on medical care.

A lot depends on how the medical loss ratio will be calculated, said Sally Rosen, managing senior financial analyst at A.M. Best Co. Inc. in Oldwick, N.J.

“It appears they have not clearly defined ‘loss ratio' in the legislation,” Ms. Rosen said. Some insurers include disease management and other health management services in their medical loss ratios, while others do not and incorporate them into their administrative costs. As a result, the latter companies appear to be spending more on administration, she explained.

“We'll be watching over the next four to six months to see how medical loss ratio is defined, what the reporting mechanisms will be, etc.,” said Joe Marinucci, a primary credit analyst at Standard & Poor's Corp. in New York.

The delay in assessment of two new excise taxes—one based on market share, using premiums to define market share; and the other on the costliest “Cadillac” health plans—to 2014 and 2018, respectively, is a “net credit positive” for insurers, said Steve Zaharuk, senior vp at Moody's Investors Service in New York.

However, it is uncertain how much of the new taxes insurers will be able to pass along to consumers but still keep their products affordable, he said.

Because the premium tax is based on fully insured products business—not on self-insured or administrative services-only business—it will hit some insurers harder than others, Mr. Zaharuk added.

For example, Bloomfield, Conn.-based CIGNA Corp., “which has a huge amount of ASO business, won't get taxed, whereas a company that has a lot of Medicaid business and receives premium payments from states and the federal government will be taxed,” he said.

However, insurers with a large share of Medicaid business will not be able to pass this added cost on to those customers because Medicaid enrollees don't pay premiums, Mr. Zaharuk pointed out. Instead, they will either have to absorb the cost or pass it on to other customers in higher premiums.

“Insurers will be passing on this tax to the private payers—individuals and small employers,” he said.

Immediately after the legislation passed the House, Washington-based health insurer trade group America's Health Insurance Plans issued a statement warning that the tax would be passed on to consumers.

The weak mandate included in the legislation—individuals who do not purchase insurance will be forced to pay the lesser of $695 or 2% of income—also could have a negative effect on insurers' ability to offer affordable coverage, Mr. Zaharuk said.

In its statement, AHIP predicted that the “weak” coverage requirement will encourage people to wait to purchase health insurance until they are sick.

“Insurers fear that in a couple of years they'll have a pool of very sick people and they'll have to keep increasing premiums, which will be very unpopular. But they have to meet solvency requirements. Eventually they may stop selling individual insurance,” Mr. Zaharuk said.

The health insurance industry is continuing to protest the narrow rate bands included in the legislation. At most, insurers can charge three times the lowest premium for individuals based on age and geography, but not on health status. They can, however, charge tobacco users 50% more for coverage.

“The new age rating requirements will cause premiums to increase for people under the age of 30 by more than 50%,” AHIP warned.

The Chicago-based Blue Cross & Blue Shield Assn. had been advocating a 5:1 ratio, according to a spokesman.

The revised funding scheme for Medicare Advantage in the legislation is likely to result in lower margins and moderately lower market penetration levels for health insurers over the next one to three years, according to analysts. Health insurers controlled 23% of the Medicare market in 2009 after a rather strong, three-year expansion, according to S&P.

Moody's Mr. Zaharuk and S&P's Mr. Marinucci said they see the Medicare Advantage market contracting in response to the revised payment structure, similar to the mass exodus of Medicare+Choice plans that came after the federal government's funding cuts at the beginning of the millennium.

A.M. Best's Ms. Rosen sees insurers cutting back on optional benefits such as chiropractic care and/or charging higher copayments and deductibles to Medicare Advantage plan members.

Because the legislation expands Medicaid eligibility in most states, analysts forecast that more insurers will enter that market, some by acquisition of carriers that already have strong footholds in the market, such as St. Louis-based Centene Corp., Virginia Beach, Va.-based Amerigroup Corp. and Long Beach, Calif.-based Molina Healthcare Inc.

For some insurers, this could be a profitable line of business, analysts say.

“Although Medicaid is low-margin business” an expansion under health reform “could attract healthier people, and higher-income individuals tend to be healthier,” said Ms. Rosen.

Medicaid business also could be profitable for insurers if they can better manage care, suggested Mr. Zaharuk.

For example, the most expensive claims under Medicaid have been related to low birth weight and premature babies, but if insurers provide prenatal care to pregnant women, this could reduce this cost significantly, thereby making this a more profitable line of business for insurers, he said.

While Medicaid is a low-margin business for the most part, it is also high-volume, which should eventually be a boon to insurers, said Tom Weakland, managing partner in the health care practice at Diamond Management & Technology Consultants Inc. in Chicago.

“I think in the near term—between now and 2014—I would expect profits, revenue, margins to go down for most insurers because of the Medicare Advantage cuts, because insurers can't sell policies with lifetime caps, because they can't exclude children with pre-existing conditions or drop adults when they're sick,” he said.

“Before 32 million people come into the system, insurers are going to have to do lots of things that affect their profitability. Insurers need to operate more efficiently, cut down infrastructure costs,” Mr. Weakland said.

“But, in the long term, if we put 20 million to 30 million more people in the system, even at slightly lower margins, that's additional revenue coming in and I think that would be a good thing for health insurers,” he said.

Gosh......."The revised funding scheme for Medicare Advantage in the legislation is likely to result in lower margins and moderately lower market penetration levels for health insurers over the next one to three years, according to analysts. Health insurers controlled 23% of the Medicare market in 2009 after a rather strong, three-year expansion, according to S&P." AND......"A.M. Best's Ms. Rosen sees insurers cutting back on optional benefits such as chiropractic care and/or charging higher copayments and deductibles to Medicare Advantage plan members." LOL! Now....I have one of those "Anthem Blue Cross/Blue Shield" Health Plans....but I don't get chiropractic care covered!!!

Let's repeat this: "Analysts also expect insurers to eventually exit the Medicare Advantage market in response to changes in the payment structure under the Patient Protection and Affordable Care Act. On the other hand, insurers are likely to expand into Medicaid, which will grow as a result of the legislation. Under Medicare Advantage, insurers contract with the government to provide benefits at least equal to those in the traditional Medicare program. Medicare Advantage critics say the premiums the government pays insurers are excessive.

About 10 million Medicare-eligible beneficiaries are enrolled in Medicare Advantage plans, which typically are preferred provider organizations."

While it's not happy news that those under the "Medicare Advantage"....who by the NO extra (only their $94 a month medicare is paid to BCBS to "manage seniors health plan"....where is the "profit" in "giving away" stuff like chiropractic visits??? My argument here is a common sense one....they're NOT (giving anything away)...SOMEWHERE....there is profit....or they wouldn't be DOING IT!!!!

Back (2 years ago) when I still believed in capitalism....I'd have said...YES, let it remain private.....just about anyone can handle money BETTER than the Federal Government! BUT...I've been PROVEN WRONG. ( I was actually awake during the whole AIG, mess) No doubt they COULD handle it better....but they've PROVEN that they WILL NOT. (handle it better) So be it! It NEEDS to be done...and they've certainly had AMPLE opportunity to do so. It's nothing more than another one of THEIR "bad risks"...they were counting on being able to milk the system a little longer and got caught in the slamming door. Too bad, So Sad! The Republicans had YEARS....decades in fact to come up with a workable Health Care "option" and REFUSED to do so.
Joined: 12/30/2006
Msg: 384
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A great day for America
Posted: 3/29/2010 2:46:21 PM

I suppose those of you who are complaining would do the same thing the teabaggers did to that man with Parkinson's..
OMG yes, was that not absolutely DISGUSTING? And still, as evil as those 2 men are....I don't wish upon THEM the same kind of stupid, hateful attitude that they had for that man....WHO...from the biography, had been an engineer in the nuclear field until his illness. Well...No, I DO wish that these men would have the "equal opportunity" to be treated so badly....but...not their children...should one of them ever get cancer.....THEN can you see that fat slob screaming in HIS childs face that there are NO handouts...that he/she has to WORK for everything they get....or the other moron throwing money that the mans face. Well, probably not in THIS life....but these 2 jerks WILL be judged with the SAME degree of mercy that they've shown to others...eventually.
the man.....and
the Teabag Party

I can remember as a younger person...going to my doctors office...and KNOWING that it was likely to be a 3 hr wait. I've gone to my orthopaedic surgeons office...and asked to reschedule for another time, because he'd been called to the hospital to perform an emergency surgery. I eliminated these "wait times" by having a GENERAL PRACTICIONER...who spends her time mostly doing preventative care. I've never waited over 5 minutes....BUT, if her caseload increases by 100 patients (in a town of 23,000...with dozens of other doctors) and I have to wait an hour to get in....ya know...that's FINE with me...and I'm not so arrogant or hateful that I think I "deserve" better care, or more attention simply because MY insurance company pays more. I am confident that if I were critically of her nurses would alert her. In fact, I was once actually sent to be admitted to the hospital when the nurse took my temperature in the waiting room because I was so ill. (It was ex-husband had all but carried me in).

This insistence that doctors and nurses are suddenly going to grow horns and become stupid just because of an increase in patient load is more fear mongering...and I suspect possibly even some other more serious and insidious issues. I think it's a real misnomer to judge EVERYONE to react to situations they don't care for as violently and with as much vehemence as the Teabaggers and their supporters do. Thankfully, most people in the world are not that intent on shoving their so called "values" down everyone else's throat that they'll deliberately sabotage the situation just to prove their misguided personal points. LOL! I hope we don't look at the Senate as an example of mature and rational behavior though...or that's what we WOULD do.
Joined: 10/17/2005
Msg: 385
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A great day for America
Posted: 3/29/2010 2:54:18 PM

Medical facilities/buildings will be the easiest part of this equation since so many have closed. Some closed due to the way the Federal government has already been reimbursing them, some due to inadequate staffing, and some due to both.
All mostly due to people who didn't have insurance and no more money to go to the doctor. I have no idea what the statement about the "Federal government" is all about but I'm sure the poster will find some twisted way to incorporate Obama into it.

Medical personal on the other hand will be different due to Educational time constraints on the medical personal shortage we already have.....10 years + for a Physician, 6 years + for an Nurse Practitioner, 2-4 for RNs, and the list goes on....
There is no shortage on medical personnel. There are plenty of doctors out there working in other jobs because they can't afford to open a practice on their own with all the costs involved and the high price of liability insurance.

There are plenty of nurses out there without jobs and many are already working on their advanced degrees. Such statements as above are truly nothing but "chicken little" fear mongering statements.

It is just that it is not likely going to be in a very timely method for some time to come in our country.
Hopefully it's not going to be life threatening when one have to wait, because untimely medical care will probably get worse before it gets better under the best governmental scenarios.
There will not be any problems with waiting, but if it makes a person feel better, I suppose they will keep repeating it until they're blue in the face. (LMAO, I can see it now, their heads buried in the sand, screaming at the top of their lungs how they have to wait for proper medical care, and while they have their heads in the sand, the others are getting treated and going home already.)

I suppose fear mongering could be sort of like someone on drugs ... they get high while participating and just have to keep getting their "fix" ... otherwise they're just not happy.
Joined: 12/30/2006
Msg: 387
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A great day for America
Posted: 3/29/2010 3:41:09 PM

The Freedomworks Man that threw dollars, Claims he is having major problems... Sleep and stuff.... poor guy...
Nwhaaaa, nwhaaaaa, nwhaaaaaa

Yeah, well IF he is indeed having remorse, you can almost bet that it's NOT because of his behavior to someone else...but because someone has pointed out to him that it COULD be HIS son/daughter/wife....who gets diagnosed with cancer and then has HIS coverage dropped...and if he's loosing's because he's afraid someone will recognize him when HE goes to to a UA agency to beg for help with those medical bills. I HOPE...that they REMEMBER his face!
Joined: 12/30/2006
Msg: 389
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A great day for America
Posted: 3/29/2010 5:13:42 PM

I know had this weak kneed, Soft hearted Liberal been there I would have Dumped his A$$.. ...No sick call...
Well, I'm afraid I'd have been cheering you on.....and asking God to forgive me later....but you're absolutely right... this Teabag bunch are about as evil as they come. The more I read about them and their schenannigans...they're certainly doing a mighty fine bang up job for the devil. And, I'm absolutely NOT trying to go off topic here...but the Teabag party....who for the most part CLAIM to be "Christians"....I don't think there is ONE real Christian among them. From everything I've seen and read...they much more closely resemble the Pharisees.

LOL! I did get a real kick out of their chant "NO Public Option"...when, it's SUPPOSED to be their basic Mantra......PUBLIC CHOICE. I mean REALLY.....fighting AGAINST removing the exemption that insurance companies have from "anti-trust laws"???? WOW!!! How incredibly stupid can anyone get?

Then the one demonstration where they all had the signs saying that Health Care was bad...people who wanted it (except THEMSELVES of course) were all heathens!!! LOL! They're carrying signs telling the uninsured they need to trust God....which ya know....I don't have a problem with personally....but they're screaming for "heathens" to do what THEY themselves seem incapable of doing...i.e. They're a bunch of hypocrites. And this screaming of communism, Nazism.....My goodness.....if ANYONE resembles a bunch of's the Teabaggers. One Teabagger interviewed said she was there to protest her lost rights!!!! When ask what that "right" was....she CLAIMED....LOL! now...get THIS.....her "lost right" was......the FREEDOM OF SPEECH!!!! LOL! WOW!!! She's at a public demonstration, screaming into a megaphone....and claiming that she has NO "freedom of speech"!

LOL! it really reminds me of my grandson (age 6) who announces to me that we hae NO FOOD in the house....LOL! I have 2 freezers full....and I just noticed that I needed to move some things to the pantry because my cabinet shelves were beginning to sag under the weight of all the food in them!!! LOL! What my grandson MEANT was....there was NO JUNK FOOD in the house. This is his little "protest" over me replacing the Little Debbie cakes with boxes of raisins, trail mix, granola bars

What the womanchild really meant was....that she keeps screaming nonsense and nobody takes her seriously....duhhhh, sounds like a 6 yr old mentality to me!
Joined: 2/9/2008
Msg: 390
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A great day for America
Posted: 3/29/2010 6:01:46 PM
Once again, I must sing your praises of common sense. You are a rare flower. Kind, gentle, sweet, and forgiving of the butchers of the earth and one another. It is difficult for most who have been sitting back, listening to the ugliness and viciousness to not respond in kind. I must, given my upbringing. When viciously attacked, for no good reason, my people defended themselves. We went through a period in US history, where response to the status quo was deemed unpatriotic at the least and against the status quo, worthy of treason if we did not love to kill Iraqis. The pendulum shifts, and now the Christian Militia deems the Cops and families to be the enemies.

This whole demonization of health care advocates as Nazis and Socialists, is no doubt the farthest reach of total BS that any party any where has tried to employ to make a non-issue, some sort of conspiracy.

Part of me wishes to reconcile the total insanity that has driven this nation into such divides and self-fulfilling prophesies of civil war....and the other half wishes to defend my kine and kin from what is apparently, another species of which there is no dialogue or reason.

To put it in perspective...the far right has fomented this divide, been brutal, vastly wrong about the real enemies to our continuation as a nation, been manipulated to vote against their own interests, and when all else failed, needed to find enemies within their own churches and neighborhoods to sate their fear of the real world.

Reality is coming folks. The empire and white rule is going...going...gone. Time to be humans, treat one another as such, and move into the future. Every belief system has a version of the Golden Rule. WTF is so difficult about that, and why does it have to be nuanced?
Joined: 10/17/2005
Msg: 391
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A great day for America
Posted: 3/29/2010 6:33:25 PM
Health-reform rally heckler says he's sorry and scared
Wednesday, March 24, 2010 12:19 PM
By Catherine Candisky
Columbus Dispatch

Chris Reichert has apologized for throwing dollars bills at a man with Parkinson's Disease during a health care rally last week.

The man who berated and tossed dollar bills at a man with Parkinson's disease during a health care protest last week says he is remorseful and scared.

"I snapped. I absolutely snapped and I can't explain it any other way," said Chris Reichert of Victorian Village, in a Dispatch interview.

In his first comments on an incident that went viral across the Internet and was repeatedly played on cable television news shows, Reichert said he is sorry about his confrontation with Robert A. Letcher, 60, of the North Side. Letcher, a former nuclear engineer who suffers from Parkinson's, was verbally attacked as he sat before anti-health care demonstrators in front of Rep. Mary Jo Kilroy's district office last week.

"He's got every right to do what he did and some may say I did too, but what I did was shameful," Reichert said. "I haven't slept since that day."

"I made a donation (to a local Parkinson's disease group) and that starts the healing process."

Earlier this week, Reichert, 40, denied any involvement in a confrontation featured in a Dispatch video that drew an emotional response from viewers across the country.

"I wanted this to go away, but it won't and I'm paying the consequences," Reichert said.

He said he's fearful for his family after reading comments about his actions on the Internet.

"I've been looking at the web sites," he said. "People are hunting for me."

The demonstration took place just days before the House voted on health-care reform legislation, drawing hundreds of supporters and opponents. Kilroy herself condemned the action, entering a link to the video into the Congressional Record. Ohio Democrats plan to use the incident to raise money.

When Letcher sat down in front of opponents and held a sign indicating that he had Parkinson's disease, an unidentified man berated him, saying, "If you're looking for a hand-out, you're on the wrong end of town."

Reichert then stepped from the crowd, bent down, pointed a finger in Letcher's face and as he tossed a pair of dollar bills yelled, "I'll pay for this guy. Here you go. Let's start a pot, I'll pay for you. I'll decide when to give you money. Here. Here's another one."

Organizers on both sides of the debate quickly condemned the actions of Reichert and the other man, who still has not been identified. Reichert, a registered Republican, said he is not politically active. He said he heard about the rally on the radio and a neighbor invited him to attend.

"That was my first time at any political rally and I'm never going to another one," Reichert said.

"I will never ever, ever go to another one."
I'll be sure to let Robert know that guy hasn't been sleeping and is ashamed of what he did. (Robert goes to the church I occasionally attend ... The First Unitarian Church here in Columbus. I thought he looked familiar ... I actually know him.)

Yeah, well IF he is indeed having remorse, you can almost bet that it's NOT because of his behavior to someone else...but because someone has pointed out to him that it COULD be HIS son/daughter/wife ...
If anything I think he's having remorse about being found out.

I don't believe for one minute he's all that sorry about what he did. For never having been to any kind of political rally before, he sure got awfully involved ... rather quickly.

It's people like him that made the victory all that much sweeter.
Joined: 2/9/2008
Msg: 392
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A great day for America
Posted: 3/30/2010 3:35:22 PM
Ya know..If the conservative French President thinks our health care debate sucks, we need to re-label it in defiance.
Freedom Insurance Corporate Death Panels
Freedom Medical Debt Home Foreclosures
Freedom Policy Cancelations

"Welcome to the club of states who don't turn their back on the sick and the poor," Sarkozy said, referring to the US health care overhaul signed by President Barack Obama last week.

From the European perspective, he said, "when we look at the American debate on reforming health care, it's difficult to believe".

"The very fact that there should have been such a violent debate simply on the fact that the poorest of Americans should not be left out in the streets without a cent to look after them... is something astonishing to us."

Then to hearty applause, he added: "If you come to France and something happens to you, you won't be asked for your credit card before you're rushed to the hospital."

"Obama is not a brown-skinned anti-war socialist who gives away free healthcare. You're thinking of Jesus." - John Fugelsang
Joined: 11/15/2006
Msg: 393
A great day for America
Posted: 3/30/2010 4:28:05 PM
"Welcome to the club of states who don't turn their back on the sick and the poor," Sarkozy said, referring to the US health care overhaul signed by President Barack Obama last week.

From the European perspective, he said, "when we look at the American debate on reforming health care, it's difficult to believe".

This is rich... Maybe the American right will finally see just how far right of "conservative" they actually are compared to the, oh, approximately 5.7 billion people in the rest of the world...

This... from Sarkozy, the arch-conservative... Sarkozy, the tax-cutter... Sarkozy, the 'term-limits' President... Sarkozy, the 'Law and Order' candidate... At least HE appears to have softened a bit in the last little while... had a little "epiphany" apparently... something about a failure of laissez-faire or somesuch...

I'm sure we'll hear something about "surrender monkeys" before too long... Or "How dare he speak. Who do they think they are? If it wasn't for us they would be speaking German."... The Germans have public healthcare too, BTW... And their Chancellor is a conservative... Her party's philosophy is to apply the principles of Christian Democracy and the "Christian understanding of humans and their responsibility toward God."... AND they have public healthcare (did I mention that before?)...


Christian democracy is a political ideology that seeks to apply Christian principles to public policy. It emerged in nineteenth-century Europe under the influence of conservatism and Catholic social teaching.
Joined: 12/30/2006
Msg: 397
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A great day for America
Posted: 3/31/2010 5:34:03 AM

At least look at the good side,

And on the IRONIC SIDE......

It's penned by one of the same ilk which brought us a 850 BILLION dollar handout to pay off the gambling debts of the finance industry (of which...Insurance companies are a major part).

It's ironic that....they (authors of "I do not like Healthcare") DID NOT see "too much drama" when "conservatives" were crying that a collapse of the banking industry would destroy life as we know it. (which actually...would be a GOOD thing). Ohhhhh No, they cried!!! It would close off credit, and raise interest rates, blah, blah, blah, blah, blah! Whine, whine, whine. LOL! and yet, over 1 year later....they STILL have NO problem whatsoever....that the financial industry is doing EXACTLY what the conservatives where saying would be disastrous!!! It's "not drama", "not stealing", "not immoral"...or anything else...that conservatives steal.....errrr, I mean "borrow" billions of dollars from the American public to pay gambling debts....or fund $2million dollar weekend get aways for Corporate execs...or to pay MILLIONS upon MILLIONS to inept conservative "money managers" in the form of they can keep finding new and better ways to steal..errrr...I mean borrow from taxpayers.

It's ironic that they don't like "this kind of hope" which has a MUCH better chance of staving off the millions of bankruptcies which are filed NOT due to overspending families, but due over 60% of the time to unexpected medical bills. Medical bills NOT of the "uninsured" most often (they're more likely to get help from charitable organizations) but of the so called "insured" who....even after paying thousands per year in insurance premiums....are canceled when they file a claim.

It's ironic that, those who don't like healthcare, but who do love bank bailouts because we have to keep "credit flowing"....are now finding that their credit lines have been reduced anyway, even if they've never had a late payment, and they have "healthy" income to debt ratios.

Indeed: I find it totally ironic that conservatives like helping out those who are irresponsible, immoral, incompetent, and dishonest....but vehemently oppose lifting one finger to help out the family who.....keeps their lights on, and their toilets flushing, and their restaurants and country clubs operating, and their schools open, and their homes from burning to the ground, and their private jets taking off and landing, and their caviar getting to the gourmet food shoppe, their floors sparkling clean, their lawns well manicured, their hair neatly trimmed, ...etc, etc, etc......The authors of "I Do Not Like Healthcare" will certainly be once again doing their whiny drama bit once again when there is a shortage of those to cater to THEM.....once they've all died......which is a bit "dramatic" but metaphorically......when they've all given up and realized that when health care costs eat up 80% of your simply cut your health care costs by reducing your working at all.

I find myself continually torn between "fixing" what's wrong....or just letting it follow through to it's logical outcome (a social revolution). One one hand, I think I'd like to see the masses shove the greed and corruption down the throats of these special interest Senators....and on the other, I'd like to gather up all the ignorant "poor" who are too stupid to fight fire with fire and SIMPLY refusing to play....and bang their silly heads together and ask them what the hell they've been waiting for!

There comes a time when it's more economically feasible to just burn it to the ground and start over than it is to try to fix everything that's wrong.....and I think that THIS is one of those times. Either we FIX it NOW....or the next step is...we burn it to the ground and start over. Senate (like all good slum lords) will keep milking the dilapidated property for every cent they can squeeze out of HUD...until it falls to the ground. After all...they don't make any easy money for something which commands "fair market value".
Joined: 3/31/2008
Msg: 398
A great day for America
Posted: 3/31/2010 12:19:41 PM

a) Any government involvement in healthcare is the end of life as we know it....when they are all covered by....wait for it......government healthcare are all government employees.....and your entire military. Seems there's no one in the " opt out" line that I can see anyway for any of them.

They are not covered by government health care plans. Those are Medicare, Medicaid, SCHIP, and the VA system. The Federal Employee Health Benefit Program is comprised of a multitude of private insurance plans from which government employees can pick. When I was on the Hill years ago, I was covered by one of the programs (BC/BS).

The plans that Members of Congress have are no different than those of employees in most large corporations. The only difference is that the premiums are paid for by tax dollars because they are government employees (just like their wages are covered by taxes).

Now if we don't want to have representatives in Congress we can always amend the constitution, but until that time, we have to pay them.
Joined: 2/9/2008
Msg: 400
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A great day for America
Posted: 3/31/2010 6:41:26 PM
Actually, I did once bust my ass. Broke my sacrum in half and fractured my coccyx in a fall while hiking, with no insurance. My chiropractor assured me that putting one's ass in a sling was not helpful or covered, and I recovered by benign neglect, not lifting and losing work. Under the new rules, I might have had better options for covering my ass at the time. Miller on the other hand, has never really busted his, relied upon luck and kissing Homeland inSecurty ass when he felt appropriate, relied on corporate sponsors and his brief SNL luck, to become a lazy-ass, pompous,penisheadish, cheap shot artist. He is no Mark Twain but he is an ass and is covered.
Joined: 12/9/2009
Msg: 401
A great day for America
Posted: 3/31/2010 6:43:59 PM

One thing still strikes me as a bit odd. All these politicians going around telling you that:

a) Any government involvement in healthcare is the end of life as we know it....when they are all covered by....wait for it......government healthcare are all government employees.....and your entire military. Seems there's no one in the " opt out" line that I can see anyway for any of them.
Are you saying they are stuck with their "government health care plan", that there is no way they can get out of it?

Less government is better government, brought to you by the same people that are working...for the government. On the other hand, defense industries are really great examples of all the good things government does, and have little problems getting more money than many other parts of society. Money given to various corporations is another great government idea.

Giving any money to an actual American citizen, or any type of reasonable benefit a total waste of time.
Oh I don't know, back when GWB gave the Americans Clinton's surplus, they all ran out and spent it. But you're right, that was a total waste.
Joined: 12/9/2009
Msg: 403
A great day for America
Posted: 3/31/2010 7:39:34 PM

Oh I don't know, back when GWB gave the Americans Clinton's surplus, they all ran out and spent it. But you're right, that was a total waste.

Either sarcasm is completely lost on you,
Actually I was being sarcastic by mentioning the huge gift of about $300 to $600 that people got back in 2001. I remember my mother got out her coupons and went grocery shopping and aside from having to buy milk and eggs occasionally, she ate on those groceries for 6 months.

But I also know folks who spent it on things like a new cell phone or couple of computer games.

or you're so eager to disagree with someone that you're not thinking through the posts that you read.
Sorry, didn't mean to sound "disagreeable".
Joined: 12/30/2006
Msg: 405
view profile
A great day for America
Posted: 4/1/2010 5:58:19 AM

But I also know folks who spent it on things like a new cell phone or couple of computer games.
But....HOW do you know this? I do you know that it was THAT EXACT $300 or $600 that they used to buy the cell phone or computer game? LOL! Actually.... I kinda remember buying a new digital camera with mine....BUT, as I have direct deposit....there's no REAL way to know whether it was MY personal income which paid for the camera....or the $600 from the government since I use the same bank account for all receivables...and hey...the dollar bills get mixed up in there. AND...for that do we know that I didn't use SOMEONE ELSE's dollar bills???? I mean, really...every once in a while....I see someone's name written on dollar bills...but I'd be really hard pressed to track them down....return THEIR dollar bill to them...and find out who got the ones that should have had my name on them! (lame argument)

Please feel free to correct me if these statements/citations are indeed factually wrong in any way.
No, not a thing wrong that I can see.

People just get really CONFUSED about their own insurance, or lack thereof. Almost 60% of Americans have "self-insured plans"....and most don't even know what it means.

What is a self-insured health plan?
A self-insured group health plan (or a 'self-funded' plan as it is also called) is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for each - out of pocket - as they are incurred instead of paying a fixed premium to an insurance carrier, which is known as a fully-insured plan.

Self-insured plans are set up by employers to pay the health claims of its employees. The employer sets aside funds for the health claims. The employer assumes the risk of providing the benefits and is obligated to pay all the claims. Sometimes self-insured plans are confused with fully insured plans because employers often hire an insurance company to pay the claims. If you do not know what kind of plan you have; ask your employer or plan administrator. Federal laws enforced by the US Department of Labor govern legitimate self-insured plans.

States are not allowed to regulate these plans. This means that state laws requiring specific benefits in health care plans do not apply to self-insured plans. Beware that some fraudulent health plans may be described or offered as "self-insured" when, in fact, they are operating without state or federal approval. If a health insurance policy seems too good to be true, be careful.

What kind of health plan do you have?
If you have health insurance through your employer, you can find what you need to know about the plan by reading your benefits handbook. Then, if you are still not sure, ask the people who work in your human resources or union benefits office.

Self-insured employer plans
Many people aren't sure whether the health plan they have through their employer is fully insured or self-insured. But if you work for a large company or government, there's a chance your health plan is self-insured.

These self-funded plans are not insurance. The employer pays employee health care costs from the employer's own pocket.

That's why these self-funded plans tend to work best for companies that are large enough to offer good coverage and pay large claims for expensive medical services. A self-insured plan may seem just like traditional insurance to you, but it does not always work the same way. And the differences can be important.

Of course, as long as claims are being paid you may not notice whether your employer is fully insured or self-funded.

MY "health insurance card" says Blue Cross/Blue Shield on it....and indeed, BCBS does carry the "stop loss" insurance policy (set at $50,000.00), HOWEVER, my company IS "self-insured", meaning that ANY covered medical expense is paid BY THE EMPLOYER....NOT the "insurance company". I.E. in my case, BCBS is a TPA (Third Party Administrator)....WHICH is ALL that OPM is.

Now, as to which TPA charges more to administer those anyone's guess. One thing we DO know however, is that.......OPM IS susceptible to state and federal AUDITS, where as other TPA's (acting as such, under ERSIA....are EXEMPT from the same) And, while we're being brutally honest here, YES, by allowing individual States to "administer" and "audit", and insert their own "state mandated" fees, most feel that this will increase healthcare costs....and ya know...that sounds about right.

Courts consider ERISA preemption

As more businesses move to self-insure, they commonly use national health plans as third-party administrators. Traditionally, courts had ruled that state laws relating to insurance payments, contracting and benefits were preempted by the federal ERISA law, but more recent decisions have weakened the so-called "ERISA shield." Here are some key federal court decisions regarding self-insured plans and ERISA preemption of state laws:

BUT, it's kinda like the little "economic talk" I had with my grandchildren last night. I told them I had some "Good news"...that we're getting a housekeeper!!!! The "bad news" was...that...we're giving up HD TV in their bedrooms and the family room, cutting the grocery budget by $200 per month by eliminating all "snack/junk foods", we're going to forgo vacation this year, as well as the pool membership and all weekend camping trips, etc.!!!!! Needless to say, they immediately decided to clean up their bedrooms!!!!

Now, one of the BIGGEST arguments we here about "state controls" is that they build in that pesky 20% "tax" or whatever they call fund the State Medicaid....or whatever the hell they say it's for.... FOR the UNinsured....they're STILL whining that that will remain in place....even when there AREN'T any "uninsured"! Another lame argument...but hey....we all know how to add.....few of us know when to subtract!

Likewise, I was reading an article yesterday in which a "business man" insisted that hiring a 51st worker would cost him over $100,000!!! He stated that he pays 60% of the premiums for his current 50 workers, but mysteriously....for some unstated reason.....adding the 51 worker would somehow preclude him from continuing the practice...thus costing him $100,000.....which is the fine of $695 per employee. The law ACTUALLY states, that any employer of over 50 people will be "fined" IF an employee files for a state subsidy....BUT then, only for THAT employee...NOT for all the workers who don't file for state subsidies. So, should he fail to offer the 51st employee health care...then his fine would be $695...NOT $100,000.+ He did not state what those premiums were that he paid 60% of....and I don't know....and in fact am not sure the sliding scales have yet been published, but if he's paying 60% of a $1,500 a month premium and expecting an employee who earns only $8 hr. to pick up the other $600 per month then yes, with a gross income of about $2,600 per month....the worker is going to definitely qualify for a subsidy.

None of the naysayers however are going to convince me that the intent...or LANGUAGE of this law is to FORCE either employers, or citizens to purchase $1,500 a month insurance policies. No, don't be ridiculous. It's written to provide BASIC health care....NO frills, such as 40-60% "disability" sick pay while you're in the hospital. (a common add on to those $1,500 mo. plans) It should certainly encourage employers however to offer a VARIETY of plans and deductibles.
Joined: 2/9/2008
Msg: 406
view profile
A great day for America
Posted: 4/1/2010 4:06:55 PM
Speaking of language, and irony. Teabonics illustrates the failing of the education system, critical thinking skills, along with the health care failure. Sure...we all have our typos...but you would think, that a bit more care would be taken for a poster.
Painfully funny in places.
Joined: 3/31/2008
Msg: 409
A great day for America
Posted: 4/3/2010 1:28:40 PM
/Please feel free to correct me if these statements/citations are indeed factually wrong in any way./

None of those statements are wrong, but federal government employees still aren't covered by government plans. They are covered by private plans that the government buys for its employees. And companies like IBM also have pharmacies, doctors and nurses on site in large sites. Sure, it's a perk paid for by the government, but if you're going to have government employees that's how they're going to get paid.

And the majority of highly paid (and educated) government employees could make a lot more money in the private sector. That group of people works for the government either out of patriotism or for the security that government employment brings (i.e., you make less money but it's a lot harder to get fired or downsized).
Joined: 12/30/2006
Msg: 411
view profile
A great day for America
Posted: 4/5/2010 3:15:59 AM
^^^^ Whewww, there for a second I thought they were going to try to pass this guy off as a journalist. (poor reading comprehension and all) Thankfully, he's just a former speechwriter....apparently under "another administration".
(The New Ledger) Benjamin Domenech, a former speechwriter and political appointee at the Department of Health and Human Services, is managing editor of Health Care News.

He lost credibility (with me) when he attempts to persuade the public that it's only Democratic staffers who are exempt. That may work well in speech-writing, but makes for poor journalism.

Secondly, you would think that anyone who actually worked in Health and Human services would have a better understanding of how health insurance works; but perhaps that's why he's a "Former" employee...or perhaps...rather than journalism, he's still writing persuasive speeches...trying to pass them off as journalism.

Here's what is so totally incoherent about his "rant": He states:
A major story during the course of the health care debate was whether members of Congress would commit to placing themselves in the same health care exchanges as average citizens, or whether they would hang on to their government plans - that’s why leadership chose to add this portion to the bill, serving as a guarantee that members would participate in the same health plans as the people. Here’s the relevant text:


(i) REQUIREMENT- Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are-

(I) created under this Act (or an amendment made by this Act); or

(II) offered through an Exchange established under this Act (or an amendment made by this Act).

But as with a lot of legislative matters, the devil is in the details - or in this case, the definitions. As anyone who’s worked on Capitol Hill knows, the personal office staff for a member is governed by different rules than those who work on committees and in the leadership offices.

It appears from the way this language is written that those staffers NOT in personal offices, such as those working and paid under the committee structure (such as those working for Chairman Henry Waxman) or those working on leadership staff (such as those working for Speaker Nancy Pelosi) would be exempt from these requirements (emphasis added).

Well, at least he's admitted that it's simply his personal perception of what he's read (and didn't quite understand).

First of all....EVERY American is "exempt" from purchasing insurance through the "Exchanges". EVERY American has the OPTION of KEEPING their current Health Care Plans. I also noted that of all the "definitions" he listed, he FAILED to list the definition of "EXCHANGES.

As Flyonthewall stated earlier:
The Federal Employee Health Benefit Program is comprised of a multitude of private insurance plans from which government employees can pick. When I was on the Hill years ago, I was covered by one of the programs (BC/BS).

A Washington Post columnist writes:
If I had to choose the most important aspect of health reform, it wouldn't be the public plan. Nor would it be the individual mandate, or the employer mandate, or the employer tax exclusion, or the Medicaid expansion. It wouldn't, in fact, be any of the issues that are dominating the political conversation.

Rather, it would be the Health Insurance Exchange. This idea goes by a lot of different names. Massachusetts has a variant called the Connector. Ted Kennedy's bill talked about Gateways. Ron Wyden and Bob Bennett's legislation calls for Health Help Agencies. The name is fundamentally unimportant. But the concept itself is the bridge between the health system we have and the health system we want.

The central problem facing health reformers is a simple one: America's health-care system is a mess. But a lot of people rely on it very heavily. But how do you merge the need for root-and-branch reform with the public's fear of rapid change?

The answer, put simply, is that you don't institute rapid change. You don't take what people have. But you give them the option to trade up to something better. As the theory goes, if the current system really is so inefficient, and your alternative really is so much better, then the lure of lower costs and better quality will persuade Americans to switch to the new system of their own accord.

This was a little-noticed wrinkle in President Obama's speech to the American Medical Association yesterday. Traditionally, reformers promise that if you like what you have, you'll be able to keep it. Obama echoed that vow. But he also said that "if you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange.” That is, in effect, the opposite promise: If you don't like what you have, you'll be able to change it.

The vehicle for that promise is the Health Insurance Exchange.

Imagine that you decided you didn't like your current health insurance and you wanted to change it. Your employer very likely doesn't offer any alternatives. If you do have a choice, it's almost certainly not between more than three different plans.

You could, of course, spit at your employer's offerings and go buy insurance on your own. But the individual insurance market is a scary place. You're on your own, so you have no bargaining power with insurers. Providers can simply refuse to sell you health insurance, or they can jack up your prices because of past illness. They can sell you a plan that's insufficient for your needs and that's thick with loopholes and technicalities. A favored trick, for instance, is to sell plans that don't cover any preexisting conditions: If you go to a doctor complaining of back pain, but it turns out you've felt back pain before, they don't have to cover any costs relating to the ailment.

The Health Insurance Exchange gives you another option. Unlike your employer, it will have a wide array of competing providers offering different plans with varying benefit levels, emphases and price tags. Unlike the individual market, insurers won't be able to discriminate based on your health history or your future risk. Plans will have to be certified as meeting a minimum level of comprehensiveness. Plans that routinely screw over members will lose customers to competing insurers.

The Health Insurance Exchange, combines the benefits of choice that are theoretically available on the individual market with the bargaining power and scale that's generally accessible only in large employers (and the exchange will, in theory, have more bargaining power than even the largest employers, as it will have a much larger base of customers). You also have a space to test out innovative ideas that might make the market better, like Sen. Jay Rockefeller's (D-W.Va.) insurance rating agency, or the public insurance option. You can standardize billing and payment methods and force the adoption of electronic medical records.

And what happens when you introduce productive competition, efficiencies of scale, more innovation and increased consumer power into a market as dysfunctional as the current situation for health insurance? In theory, you get lower prices and higher quality. And if the Health Insurance Exchange has lower prices and higher quality, more individuals will use it and more companies will buy into it. And if that happens, then the efficiencies of scale should increase, and so should the pace of innovation (as the rewards will be greater with more customers), and so the Health Insurance Exchange should further outpace the other markets, thereby attracting yet more customers, thereby further accelerating the virtuous cycle. Eventually, it could become the country's primary insurance market.

To be sure, the exchange faces considerable difficulties. At the beginning, it's likely to be limited to individuals, the self-employed, and small businesses. Otherwise, experts worry -- probably correctly -- that only businesses with sick and expensive workers will buy in, and the costs of the exchange will start high. Instead, the hope is to get it on stable footing and then progressively open it to new groups. Its success isn't a sure thing. It's a theory. But it's arguably the best one we've got.

EXCHANGES GIVE INDIVIDUALS and SMALL BUSINESSES the same bargaining clout that large businesses have. The insurance policies that will be available through EXCHANGES will BE through the same insurance companies that anyone is using now. It's NO different that what all these "Medicare Advantage" programs are NOW doing.


Medicare Advantage Plans
Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

* Medicare Health Maintenance Organization (HMOs)
* Preferred Provider Organizations (PPO)
* Private Fee-for-Service Plans
* Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

OR This, from the Kaiser Family Foundation

Consider Your Medicare Options

Nearly 45 million people are covered by the Medicare program. People with Medicare can get their coverage through original Medicare (the traditional fee-for-service program) or from Medicare private plans (the Medicare Advantage program). Today, more than ten million people with Medicare are enrolled in a Medicare private plan (HMO, PPO, PFFS, SNP, MSA). Most people with Medicare who have joined a Medicare private plan are in health maintenance organizations (HMOs), which have been available under Medicare since the mid-1980s.

To make an informed decision, you need to first understand how these health plans work and how they differ, then decide which option is best for you. Here is a brief description of each of the Medicare options.

Original Medicare

If you choose coverage under the traditional fee-for-service Medicare program, you can generally get care from any doctor or hospital you want and receive coverage for your care anywhere in the country. However, traditional Medicare has high cost-sharing requirements and does not currently cover the costs of certain services. To help pay for uncovered benefits and to help with Medicare's cost-sharing requirements, many people in the traditional Medicare program have supplemental insurance (see Health Insurance to Supplement Medicare).

Medicare Advantage

Medicare Health Maintenance Organizations (HMOs)
Medicare HMOs cover the same doctor and hospital services as the original Medicare program, but out-of-pocket costs for these services are usually different. HMOs appeal to some people with Medicare because they may provide additional benefits, such as eyeglasses, which are not covered by the traditional Medicare program. Medicare HMOs may charge a premium that you would need to pay in addition to the Part B monthly premium.

You should be aware that Medicare HMO enrollees generally can only use doctors, hospitals, and other providers in the HMO's network. For an additional fee, some HMOs offer point-of-service (POS) benefits that partially cover care received outside the network.

If you join a Medicare HMO, you will usually have to select a primary care doctor who is responsible for deciding when you should see a specialist and which specialist you should see.

Neither Medicare nor the HMO will pay for unauthorized visits to specialists in the plan, providers outside the HMO's network, or for non-emergency care outside the HMO's service area.

Medicare Preferred Provider Organizations (PPOs)
Medicare PPOs are private health plans, much like Medicare HMOs. HMOs and PPOs differ in two key ways:

1. Medicare PPOs cover some of the costs of your care if you use doctors and hospitals outside the network.
2. Medicare PPOs generally do not require that you see a primary care physician before going to a specialist.

Regional PPOs became available under Medicare in 2006. These plans are similar to local Medicare PPOs, but serve a larger geographic area (either a single state or multi-state area) and must offer the same premiums, benefits, and cost-sharing requirements to all beneficiaries in the region. Regional Medicare PPOs offer all Medicare benefits, including the prescription drug benefit, but unlike traditional Medicare, these plans have a single deductible for hospital and physician services and an annual out-of-pocket limit on cost sharing for benefits covered under Parts A and B of Medicare. Keep in mind that the out-of-pocket limit will vary depending on the plan you select. As with local PPOs, individuals who sign up for a regional PPO will typically pay more if they go to providers outside of the network.

Private Fee-for-Service (PFFS) Plans
Private fee-for-service plans cover Medicare benefits; most but not all PFFS plans cover prescription drugs. Unlike Medicare HMOs and PPOs, private fee-for-service plans do not have a formal network of doctors and hospitals, and not all doctors and hospitals are willing to provide health care services to members of a private fee-for-service plan. If you are considering enrolling in a private fee-for-service plan, make sure your doctors and hospital are willing to accept the private fee-for-service plan’s payments for services before you enroll. Also, be sure you understand a plan’s benefits and cost sharing requirements before you enroll because private fee-for-service plans decide how much enrollees pay for Medicare-covered services and may charge higher cost sharing for certain health care services than the original Medicare program. Private fee-for-service plans are not required to offer the Medicare drug benefit, but many do. If you enroll in a private fee-for-service plan without drug coverage, you can also enroll in a Medicare stand-alone prescription drug plan for your drug coverage.

Special Needs Plans (SNPs)
Special needs plans are private plans that provide Medicare benefits, including drug coverage, for beneficiaries with special needs. These include people who are eligible for both Medicare and Medicaid, those living in certain long-term care facilities (like a nursing home), and those with specific chronic or disabling conditions.

For additional information about Medicare Advantage plans, call 1-800-MEDICARE, or get information about Medicare options in your area on the Medicare Options Compare website.

Medicare Medical Savings Accounts (MSAs)
People on Medicare have access to a consumer-directed Medicare Advantage product called a Medicare Medical Savings Account (MSA). The MSA option has two parts. The first part is a Medicare Advantage health plan with a high deductible. The second part is a medical savings account into which Medicare deposits an annual amount that can be used to pay health care costs.

Here is how the Medicare MSAs and high deductible health plans work:

* Medicare makes an annual deposit into an interest-bearing account to help beneficiaries pay their health costs. The money in the account can be used to pay for most medical services, which are considered qualified medical expenses, including the deductible for the high deductible health plan. Beneficiaries may not contribute their own funds to the account.
* High deductible health plans cover all Medicare Part A and Part B benefits. They may also cover additional benefits at an extra cost but no plans offer supplemental benefits in 2009. There is no monthly premium for these plans, however, beneficiaries are still required to pay the Part B monthly premium.
* A beneficiary enrolled in this type of plan must meet an annual deductible (max $10,500 in 2009) before the plan will begin to pay for health care expenses. After the deductible is met, the plan is responsible for all Medicare-covered services other than prescription drugs.
* At the end of the year, if any amount of the deposit into the MSA account is unspent, it remains the property of the beneficiary and can be rolled over to cover costs incurred in the following year.
* MSA/high deductible health plans do not cover Part D prescription drugs. However, beneficiaries with this coverage may enroll in a stand-alone prescription drug plan (PDP). The funds in the MSA account cannot be used to pay Part D premiums, but can be used to pay for Part D co-payments, coinsurance and deductibles tax-free. However, funds withdrawn from an MSA account to pay for Part D drugs do not count toward the beneficiary’s true out-of-pocket costs.

Medicare Advantage and Prescription Drugs

All companies offering Medicare Advantage plans must offer prescription drug coverage in at least one of their plans. Medicare Advantage plans with drug coverage may vary in their premiums, deductibles, formularies and cost-sharing, depending on the type of Medicare Advantage plan you select. See the Medicare and Prescription Drug section for more information.

Know What You Want from a Medicare Plan

Whether original Medicare, a Medicare HMO, or another private Medicare plan is right for you will depend on your unique needs and circumstances. Think about what is most important to you when you are healthy and when you are sick. Here are some topics to consider:

Receiving care from the doctor and hospital of your choice
Under original Medicare, you can use whichever specialists and hospitals you choose, whenever you need, and without a referral from another doctor. Medicare private plan options could limit your ability to get care from the doctor or hospital of your choice, or there may be extra charges for out-of-network care. If provider choice is a priority, you should consider original Medicare with added protection from a Medicare supplemental insurance policy, sometimes known as Medigap, or from an employer-sponsored or union retiree health plan, if you are eligible (see Health Insurance to Supplement Medicare).

Getting coverage of additional benefits to reduce your medical costs

If you are on a tight budget and are willing to limit your choice of doctors and hospitals, you may be able to reduce your health care expenses and get coverage of additional benefits through a Medicare Advantage plan. It is important to review the scope and limits of additional benefits when choosing among available plans. It is also important to look at how much your out-of-pocket costs will be if you get sick. For example, some Medicare private plans charge a copay for each day of an inpatient hospital stay, while original Medicare charges only a deductible but no daily copays for the first 60 days of a hospital stay.

Maintaining health care coverage while away from home
Under original Medicare, you will be covered for care anywhere in the United States. While private plans must cover emergency care for members outside the plan area, most do not cover other health care services while away from home. For example, Medicare HMOs have more restrictive networks of doctors and hospitals that limit coverage away from home.

Keeping supplemental coverage from a former employer or union
If you are considering joining a Medicare private plan (either a Medicare Advantage plan or a stand-alone prescription drug plan), you should talk to your employer or former employer to be sure you won't lose valuable retiree health benefits if you sign up for a private plan. Many employers offer retiree health coverage as a supplement to traditional Medicare; some also offer coverage through Medicare HMOs and other private plan options.

Coordinating with Medicaid benefits
If your income and assets are quite modest, you may qualify for Medicaid benefits or other special programs that will help pay some of your health care costs. For those who qualify, Medicaid often pays for valuable benefits, such as nursing home care, and also pays Medicare's premiums. If you are already covered by Medicare and Medicaid, you should find out what you must pay to join a Medicare private plan and whether Medicaid will cover the plan’s copayments. Contact information for your state Medicaid office can be found in the Additional Resources section of this guide.

Changing your mind

The open enrollment period to switch Medicare Advantage plans is limited to the first three months of the year (January 1 - March 31st). For stand-alone prescription drug plans, the open enrollment period runs from November 15 through December 31 of each year. If you are also eligible for Medicaid, you can switch plans at anytime.

If you enroll in a Medicare private plan that later stops serving people with Medicare, you can always return to original Medicare, (the traditional fee-for-service program), or you can enroll in another Medicare Advantage plan.

Photo of a woman doing researchCompare Medicare Advantage Plans Offered Where You Live
You can keep your coverage through your Medicare private plan if the plan continues operating in your area from year to year. If you think you may want to change, the next step is to find out which plans are offered where you live. While original Medicare is available in all parts of the U.S., certain types of private plans may not be. In some areas of the U.S., people with Medicare have a limited choice of private plans available, while in other areas, there are multiple Medicare private plans from which to choose.

For a list of plans in your area and a copy of the Medicare handbook, Medicare & You, call Medicare at 1-800-MEDICARE or visit Medicare's website at For free help in understanding differences among Medicare plans, you can call your State Health Insurance Assistance Program (SHIP). Contact information for your state’s SHIP is found in the Medicare handbook and in this guide under Additional Resources.

You should consider four important factors before signing up for a plan:

1. Accessibility of doctors and hospitals
Can you continue to see the doctors you know and trust if you join a certain plan? Your doctor or specialist might be in one plan's network, but not in another's. Even if your doctor is in a plan’s network, he or she can leave that network at any time. What about your choice of hospital?
2. Extra benefits
The supplemental benefits offered by Medicare private plans vary widely and may change every year. If you want to join a plan because of the prescription drug benefit, make sure that the plan covers the drugs you need and you understand any limits that may apply.
3. Cost
How much are the monthly premiums and copayments associated with different health care services? Is there a deductible? How do the costs for various services differ from Original Medicare? Keep in mind that costs generally change each calendar year.
4. Quality and reputation
Not all Medicare private plans are the same. Review each plan's written information and try to talk to plan members about their experiences. For information on quality and performance, visit Medicare's website at

I absolutely amazes me that some people are still arguing that there "IS NO ADVANTAGE" to buying anything in large quantities! Geeeezzz, I figured everyone knew the REASON WalMart ( could sell things cheaper was because they were buying a gazillion at a time. The more units you buy...the cheaper the cost...PER UNIT. YES, the total bill is more...but the price PER UNIT drops.

It certainly didn't take a degree in rocket science to figure out when BC/BS offered my ex (at age 65) a very comparable insurance package (to my own BC/BS insurance...which my employer claims to cost them $1,500 per month)...for ONLY his $96.50 Medicare payment....AND a few benefits that straight Medicare doesn't cover. Naturally, they also tried to "upsell" him to more benefits...for more money, and I'm sure a lot of seniors choose those extra benefits; but the point is...they don't HAVE to.

NOWHERE in this new law does it state that low or moderate income people HAVE to purchase insurance plans that include vision, dental, income replacement, nursing home care, $0 deductible plans or any of those other FRILLS. Insurance companies make money on the FRILLS...not the BASIC HEALTH CARE. Of course they LOVE selling a dental and vision rider for an extra $2,000 per year! The average family of 4 spends LESS than $1,500 per year on those 2 things, so there's a $500 profit for each dental/vision rider they sell.

Look, it's SIMPLE. Insurance companies do NOT want to sell "individual" or "small policies". One, it creates too much paperwork, two, it requires that they hire more people to handle all the paperwork. Imagine you have 10,000 people in a county who have no insurance. Imagine that, an Exchange lumps these 10,000 people together and calls them "ABC Company"...and then acts as the TPA to purchase insurance for all the individuals in "ABC Company". ABC Company is now insured by BC/BS....they get a nice little blue and white BC/BS insurance card....with a nice little "group number" and plan code on it. BC/BS is now happy, because their bookkeeping now reflects NOT 100% risk because if 1 member gets sick there goes 100% of the profits and then some....but rather LESS risk, because NOT ALL of 10,000 people paying premiums is going to all get sick at the same time....and wipe out all the profit. I.E. 1 family paying $1,200 per year, vs. 10,000 families paying $1,200,000.00. You don't make a lot of money investing $1,200. You DO make a lot of money investing 1 million.
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