patrick.net

Health care plan has hearty list of taxes
By Star-Ledger Wire Services
March 25, 2010, 9:00AM

The new health care reform law is chock-full of new taxes and tax increases that will affect many individuals and businesses, but it will be years before most of these hikes take a bite out of your -- or your company’s -- wallet. The law also has tax breaks to help both individuals and small businesses pay for insurance.

Figuring out exactly what the new law’s impact will be on your finances will be tricky, not only because many of the effective dates are delayed, but also because the law signed by President Obama will most likely change very soon: After passing the Senate bill on March 21, the House also approved a package of modifications that the Senate plans to pass before the end of the month.

Take a look at what’s coming down the road, starting with provisions that take effect first:

bull; A new 10 percent excise tax on indoor tanning services that takes effect for services provided after June 30, 2010.

• Giving small firms tax credits as incentives to provide coverage, starting this year. Employers with 10 or fewer workers and average annual wages of less than $25,000 can receive a credit of up to 35 percent of their health premium costs each year through 2013. The credit is phased out for firms larger than that and disappears completely if a company has more than 25 employees or average annual wages of $50,000 or more. Beginning in 2014, small firms that sign up with one of the health exchanges to be created can receive a credit of up to 50 percent of their costs.

• A requirement that businesses include the value of the health care benefits they provide to employees on W-2s, beginning with W-2s for 2011.

• Elimination, after this year, of a deduction employers now take for providing Medicare Part D prescription drug coverage to their retirees to the extent that the federal government subsidizes the coverage. This will not take effect until 2013.

• Doubling the penalty for nonqualified distributions from health savings accounts, to 20 percent, beginning in 2011.

• A limit on the amount that employees can contribute to health care flexible spending accounts to $2,500 a year. Under the House package of changes, the cap won’t take effect until 2013.

• A ban on using funds from flexible spending accounts, health reimbursement arrangements or health savings accounts for the cost of over-the-counter medications, starting in 2011.

• Imposing a 0.9 percent Medicare surtax on wages of single taxpayers earning more than $200,000 a year and couples earning over $250,000, starting in 2013. In addition, the House’s package of modifications would levy a special 3.8 percent Medicare tax on the unearned income of those taxpayers. The House defines unearned income as interest, dividends, capital gains, annuities, royalties and rents. Tax-exempt interest would not be included, nor would income from retirement accounts.

• A hike in the 7.5 percent floor on itemized deductions for medical expenses to 10 percent, beginning in 2013. But taxpayers age 65 and over are exempt from the cutback through 2016.

• A new 40 percent excise tax, beginning in 2013, on high-cost health plans, defined as those providing coverage in excess of $8,500 for individuals and $23,000 for families. The House’s package of modifications includes higher threshold amounts and an initial effective date of 2018.

• A new tax on individuals who don’t obtain adequate health coverage by 2014. The tax is be phased in over three years, starting at the greater of $95, or 0.5 percent of income, in 2014, and rising to the greater of $750, or 2 percent of income, in 2016. The House passed companion measure would modify this provision so that a person without coverage in 2014 would pay the greater of $95, or 1 percent of income, and in 2016 would pay the greater of $695, or 2.5 percent of income.

• Providing a refundable tax credit, once the individual mandate takes effect in 2014, to help low-income folks purchase coverage. To be eligible, a person’s household income must be between 100 percent and 400 percent of the federal poverty level, generally around $11,000 to $44,000 for singles and $22,000 to $88,000 for families.

• A nondeductible fee charged to businesses with 50 or more employees if the firms fail to offer adequate coverage. The fee will equal $750 times the number of workers in the firm, and is slated to go into effect in 2014. The House’s package of modifications would increase that fee to $2,000 times the number of employees, though it would not count the first 30 workers in that calculation.

-- Kiplinger

and?

elliemae says

and?

I'm just thrilled! I especially like: A requirement that businesses include the value of the health care benefits they provide to employees on W-2s, beginning with W-2s for 2011.

Taxable "wages" going up?

and? still waiting for something interesting.

elliemae says

and? still waiting for something interesting.

This exchange reminds me of the Simpson's episode where the doctor tries to explain to Homer that he has life threatening heart disease in increasingly simple terms. To which Homer retorts, "Huh?", "Could you dumb it down a little?" , "Put it in layman's terms, doc!"...so on.

AH, quite informative OP! Thanks for posting.

I wouldn't expect it to get much traction out of the locals though. If they can't swoop in with the AM talk radio dismissal, they aren't interested. After all, anyone that disagrees with the neo-liberal Obamacare legislation hates poor people, is racist, and learned everything he knows about economics from Leviticus. There couldn't possibly be any legitimate criticisms of an Obama bill.

CBOEtrader says

This exchange reminds me of the Simpson’s episode where the doctor tries to explain to Homer that he has life threatening heart disease in increasingly simple terms. To which Homer retorts, “Huh?”, “Could you dumb it down a little?” , “Put it in layman’s terms, doc!”…so on.
AH, quite informative OP! Thanks for posting.
I wouldn’t expect it to get much traction out of the locals though. If they can’t swoop in with the AM talk radio dismissal, they aren’t interested. After all, anyone that disagrees with the neo-liberal Obamacare legislation hates poor people, is racist, and learned everything he knows about economics from Leviticus. There couldn’t possibly be any legitimate criticisms of an Obama bill.

First off--that is a hilarious scene. A similar one that I laugh at every time it's on is the Cape Fear episode where the FBI puts them in witness protection and tries to explain his new identity to Homer. "I think he's talking to you...."

And re the rest of your post--on the contrary. I'm on record here stating that the bill is far from ideal in my opinion. I suspect my criticisms differ from yours though.

Just trying to understand your point, CBO. CBOEtrader says

After all, anyone that disagrees with the neo-liberal Obamacare legislation hates poor people, is racist, and learned everything he knows about economics from Leviticus. There couldn’t possibly be any legitimate criticisms of an Obama bill.

Is the bill the end-all, be-all? I don't know, I haven't read it yet. Is it a step in the right direction? Absolutely? Do I need someone to pick & choose the information that the bill contains and print it here? No.

Here's to hoping that stuff like this can stop with healthcare reform:

http://consumerist.com/2010/03/insurance-covers-meds-if-your-kid-is-clumsy-but-if-hes-autistic-he-owes-24000.html

"Nine-year old Nico owes $24,000. If he was just clumsy, he wouldn't, but because he's autistic, he's got to cough it up, according to the insurance company—and the collections agency that keeps calling him every day....

"My little boy was written a prescription for Occupational Therapy by his pediatrician for dyspraxia and hypotonia.
My insurance approved the prescription.

After 2 years, they revoked their approval because he has autism and backcharged me $24,000...

...f*** my insurance for them helping a neurotypical child that has issues with clumsiness, but not helping out a child with an autism diagnosis. It gives me the rage."

Quoting the Simpsons and implying that I lack the intelligence to understand Adhomo's post doesn't help make your point - if you have one. Other than "Obama bad," neither does he, from what I can tell.

elliemae says

Quoting the Simpsons and implying that I lack the intelligence to understand Adhomo’s post doesn’t help make your point

I do not think you are stupid. You are eloquent in communication, and also funny.

I think that you are being intentionally dense so as to hand-wavingly dismiss the very valid criticisms of the OP. The OP goes through and systematically explains why every democrat talking point is either misleading or outright wrong. Your only response is ,"And?" What? I thought you were an idealist, someone that cares for others. This bill is, yet again, a way for the politically well-connected to grab power, at the expense of the US taxpayer. It is a piece of junk, and all you can respond with is ,"And?"

In this comment: "After all, anyone that disagrees with the neo-liberal Obamacare legislation hates poor people, is racist, and learned everything he knows about economics from Leviticus. There couldn’t possibly be any legitimate criticisms of an Obama bill. "
...I was merely trying to rephrase the partisan-braindead criticisms of any opposition viewpoint to this bill that I have read over and over again on this site. You are a repeat offender of this brand of logic.

In your attempts to point out the Republican propoganda and lie machine, the Democratic supporters have forgotten to keep an eye on their own leaders. It is sickening, and very scary, quite frankly.

tatupu70 says

A similar one that I laugh at every time it’s on is the Cape Fear episode where the FBI puts them in witness protection and tries to explain his new identity to Homer. “I think he’s talking to you….”

Best line ever.

*CBOEtrader hi-fives Tat*

CBOEtrader says

elliemae says

Quoting the Simpsons and implying that I lack the intelligence to understand Adhomo’s post doesn’t help make your point

I do not think you are stupid. You are eloquent in communication, and also funny.
I think that you are being intentionally dense so as to hand-wavingly dismiss the very valid criticisms of the OP. The OP goes through and systematically explains why every democrat talking point is either misleading or outright wrong. Your only response is ,”And?” What? I thought you were an idealist, someone that cares for others. This bill is, yet again, a way for the politically well-connected to grab power, at the expense of the US taxpayer. It is a piece of junk, and all you can respond with is ,”And?”
In this comment: “After all, anyone that disagrees with the neo-liberal Obamacare legislation hates poor people, is racist, and learned everything he knows about economics from Leviticus. There couldn’t possibly be any legitimate criticisms of an Obama bill. ”
…I was merely trying to rephrase the partisan-braindead criticisms of any opposition viewpoint to this bill that I have read over and over again on this site. You are a repeat offender of this brand of logic.
In your attempts to point out the Republican propoganda and lie machine, the Democratic supporters have forgotten to keep an eye on their own leaders. It is sickening, and very scary, quite frankly.

Adhom, abe & the like are rabid anti-dentites. They have picked & chosen parts of the bill and posted it here in an attempt to display their outrage at the bill. But nothing that was said is new, it's only the parts that they choose to present to make whatever point they're trying to make. Their message is convoluted because of their constant personal attacks on people in this forum and their selective presentation.

So, no, I didn't understand his point. I've been waiting for an original thought, and all I ever get is "death panels" and "higher taxes."

CBOEtrader says

There couldn’t possibly be any legitimate criticisms of an Obama bill. ”

Sure there can. Just haven't heard it yet. They're not here to present valid criticisms, they're here to say rude & nasty stuff about other posters and present themselves as victims of the system. Yet when we ask for something substantial, they can't provide it.

Simply stated, there's no exchange of ideas. Just hit & run attacks. Now you're joining them.

Thank you.

elliemae says

they’re here to say rude & nasty stuff about other posters

Kettle meet black.

RayAmerica says

Kettle meet black.

Once again your command of the english language is lacking. I'd expect nothing less.

elliemae says

Once again your command of the english language is lacking. I’d expect nothing less.

Another fine example by Ms. Mean. It's comical how you whine about others being "rude & nasty" when you could write a book. How do you spell H Y P O C R I T E ?

elliemae says

I’ve been waiting for an original thought, and all I ever get is “death panels” and “higher taxes.”

Did you read the OP? It was the best criticism of the bill I've read so far. The entire OP was completely original. It was very clearly not a basic republican propoganda piece. In fact, some of the points turn free-market ideology on its head.

It is prudent and accurate to point out the higher taxes. Higher taxes can only be justified in creating more value for the average american than the taxes we will be paying for said value. It is the responsibility of those pushing for the new legislation to prove this point. Instead all we get is emotion baiting sob stories.

"Death panels", is a democratic propoganda phrase used to pooh-pooh the FACT that we will be forced to ration care in some way. Since it won't be done via cost of service and wealth of the served, how will it be done? Again, it is a very prudent discussion that no democrat seems willing to have.

elliemae says

CBOEtrader says
There couldn’t possibly be any legitimate criticisms of an Obama bill. ”
Sure there can. Just haven’t heard it yet.

Would it help if I copied and pasted some of the better points from the OP for you?

elliemae says

Just hit & run attacks. Now you’re joining them.

It seems you are posting out of anger. I apologize if I upset you. I was trying to resort to the tactics that I see you and Nomo using constantly, moreso so that you could see how rediculous they sound. Clearly, I have hit a chord with you.

I see you, Nomo, and other democrat leaning types escalating every discussion to namecalling nonsense. Do you feel that calling someone a brainwashed AM radio junkie will result in open discussion? Just an observation, but perhaps if you should respect others first, if you want them to respect you in return.

If The Insurance companies are crapping themselves. Then This bill just may have some teeth.
But I haven't heard to much from them as of yet so I think that this bill may just be a big poop sandwich for the people and a steak dinner for the insurance companies.

I'm sure the Health insurance Companies have Lawyer McLoophole Larry working a ton of OT this year

CBOEtrader says

Did you read the OP? It was the best criticism of the bill I’ve read so far. The entire OP was completely original. It was very clearly not a basic republican propoganda piece. In fact, some of the points turn free-market ideology on its head.

Yes, I read it. It was a link. Then the OP replied with regurgitated information from another article, only this time he didn't provide a link. I'd dare say cutting & pasting is completely unoriginal. CBOEtrader says

Would it help if I copied and pasted some of the better points from the OP for you?

No, that wouldn't be necessary, and certainly wouldn't be "original." I am fully capable of reading.

CBOEtrader says

I was trying to resort to the tactics that I see you and Nomo using constantly, moreso so that you could see how rediculous they sound. Clearly, I have hit a chord with you.

CBOEtrader says

Just an observation, but perhaps if you should respect others first, if you want them to respect you in return.

Respect is something that is earned - and that goal has not been accomplished thus far. But please, do go on, telling me how "rediculous" it sounds when you attempt to resort to the tactics of others. Don't attack me personally, I don't know you and I don't appreciate your comments.

CBOEtrader says

“Death panels”, is a democratic propoganda phrase used to pooh-pooh the FACT that we will be forced to ration care in some way. Since it won’t be done via cost of service and wealth of the served, how will it be done? Again, it is a very prudent discussion that no democrat seems willing to have.

Actually, "death panels" seems to have been coined to describe that payment will be provided to practitioners to discuss end-of-life issues with patients. Currently, insurers don't pay for this service and the discussion must be crammed into a regular visit. For those patients who have end-of-life questions such as feeding tube vs none, IV hydration vs none, Full resuscitation vs limited measures vs none, etc, these discussions must be crammed into a regular MD visit. Either that, or the MD refers to a hospice, which has a vested interest in the outcome (such as a getting the patient onto service in order to start receiveing $140+/- per day). Of course, not every hospice will encourage the patient to sign on - but they employ professional sales people with no medical experience who work on commission.

The language that was decried as "death panels" was payment for an MD visit for the purpose of discussing end-of-life issues. I've assisted many people as they completed Advanced Directives - and some of them chose to have all treatments possible no matter the cost. Others chose to be a DNR. Physicians should receive payment to review a patient's medical condition and discuss end-of-life issues without having to find a code that will pay for the visit.

CBOEtrader says

I apologize if I upset you.

Your apology is accepted. Please don't assume that you can attack me personally.

elliemae says

Don’t attack me personally, I don’t know you and I don’t appreciate your comments.

That is the modus operandi of others on this board. I get no joy out of intellectually bullying anonymous interweb inhabitants. When did I ever attack you, or anyone else personally? Forget it, discussing this is probably not productive.

elliemae says

Yes, I read it. It was a link...
I am fully capable of reading.

Ok, then you agre that ,"This bill does not bring down costs and leaves out
nearly every key cost control measure--• Public Option ($25-$110 billion)
• Medicare buy-in
• Drug reimportation ($19 billion)
• Medicare drug price negotiation ($300 billion)
• Shorter pathway to generic biologics ($71
billion)"

Furthermore...

"The bill ignored proven ways to cut health care
costs and still leaves 24 million people uninsured,
all while slightly raising total annual costs."

and...

"12. The bill will provide immediate access to insurance for Americans who are uninsured because of a
pre-existing condition.? NO, access to the “high risk pool” is limited and the pool is underfunded. It will cover few people, and will run out of money in 2011 or 2012. Only those who have been uninsured for more than six months will qualify for the high risk pool. Only 0.7% of those without insurance now will get coverage, and the CMS report estimates it will run out of funding by 2011 or 2012."

and...

"The bill does not empower a regulatory body to
keep people from being dropped when they’re
sick.
There are already many states that have laws on the
books prohibiting people from being dropped when
they’re sick, but without an enforcement mechanism,
there is little to hold the insurance companies in check."

and...

"This bill does not limit insurance company rate
hikes. Private insurers continue to be exempt from
anti-trust laws, and are free to raise rates without
fear of competition in many areas of the country."

and...

"Bernie Sanders’ provision in the Senate bill does
not start until 2017, and does not cover the
Department of Labor, so no, it doesn’t create a
pathway for single payer."

and...

"Most people with medical bankruptcies already
have insurance, and out-of-pocket expenses will
continue to be a burden on the middle class.
• In 2009, 1.5 million Americans declared
bankruptcy
• Of those, 62% were medically related
• Three-quarters of those had health insurance
• The Obama bill leaves 24 million without
insurance
• The maximum yearly out-of-pocket limit for a
family will be $11,900 (PDF) on top of
premiums
• A family with serious medical problems that
last for a few years could easily be financially
crushed by medical costs"

Now for the retort.

elliemae says

and?

Indeed.

CBOEtrader says

“Death panels”, is a democratic propoganda phrase used to pooh-pooh the FACT that we will be forced to ration care in some way. Since it won’t be done via cost of service and wealth of the served, how will it be done? Again, it is a very prudent discussion that no democrat seems willing to have.

That is most certainly NOT a fact, even if you capitalize it.

tatupu70 says

CBOEtrader says

“Death panels”, is a democratic propoganda phrase used to pooh-pooh the FACT that we will be forced to ration care in some way. Since it won’t be done via cost of service and wealth of the served, how will it be done? Again, it is a very prudent discussion that no democrat seems willing to have.

That is most certainly NOT a fact, even if you capitalize it.

I am confused by this. Are you really suggesting that we don't have to ration healthcare? Is healthcare is unlimited? Does healthcare not require resources, of which the world has a limited supply?

You are generally very rational. Did you misread my post?

CBOEtrader says

I am confused by this. Are you really suggesting that we don’t have to ration healthcare? Is healthcare is unlimited? Does healthcare not require resources, of which the world has a limited supply?

No, I agree health care is not unlimited. But, we are not necessarily maxed out currently, and the bill won't necessarily mean more healthcare will be dispensed (not sure if you can use the word healthcare in the context, but...). It should change the way it is dispensed--less ER, more Drs. office--and that could necessitate a shift in the types of Drs. we require as a country, but I just don't see it as a foregone conclusion that we will have to "ration" care.

And it may well turn out that we are short of resources--in the short term--but I still find it hard to believe that there would be any rationing. Drs/nurses might work longer hours, nurse practitioners might take on more responsibility, etc. I never cease to be surprised at the creativity of Americans under adverse conditions.

CBOEtrader says

tatupu70 says

CBOEtrader says

“Death panels”, is a democratic propoganda phrase used to pooh-pooh the FACT that we will be forced to ration care in some way. Since it won’t be done via cost of service and wealth of the served, how will it be done? Again, it is a very prudent discussion that no democrat seems willing to have.

That is most certainly NOT a fact, even if you capitalize it.

I am confused by this. Are you really suggesting that we don’t have to ration healthcare? Is healthcare is unlimited? Does healthcare not require resources, of which the world has a limited supply?
You are generally very rational. Did you misread my post?

Healthcare has been rationed due to payment issues in the past. From what I understand, this bill is stepping in the right direction of changing that.

CBOEtrader says

When did I ever attack you, or anyone else personally? Forget it, discussing this is probably not productive.

elliemae says

CBOEtrader says
I was trying to resort to the tactics that I see you and Nomo using constantly, moreso so that you could see how rediculous they sound. Clearly, I have hit a chord with you.

The problem that I have is that you don't believe that it's productive to discuss this issue - you want to pick & choose which talking points you'd like to quote. How is it possible to have a productive conversation when people only choose to discuss certain issues?

CBOEtrader says

Ok, then you agre...

The only thing with which I "agree" (I'm assuming that you meant that, and that your typos are a result of a lack of spell-check and not a reflection of your intellect) is that Healthcare should never be an option. We should choose not the republican way, nor the democratic way, nor the libertarian way, nor the conservative way, nor the liberal way... ad nauseum... to address the lack of delivery of healthcare in this country.

I suffered through a conversation between my boss and a man who was ex-military & then worked in a civil service desk job - he's over 300 pounds and draws a disability pension from the civil service job - with excellent healthcare coverage. My boss and this man agreed that if healthcare reform were to pass, then everyone would go to the doctor and the system would be broke.

If everyone had access to healthcare, our ER's would be less crowded and would be back to serving emergencies. Additionally, if everyone had access to healthcare, many conditions would be caught and treated long before they cost the system hundreds of thousands of dollars.

Healthcare should never be an option. I honestly don't give a shit how we accomplish this goal.

If everyone had access to healthcare, our ER’s would be less crowded and would be back to serving emergencies. Additionally, if everyone had access to healthcare, many conditions would be caught and treated long before they cost the system hundreds of thousands of dollars.

I'm not sure that the facts support that assertion. Many (most?) of the ER patients are legit emergencies from accidents, shootings, heart attacks, etc. who would come to the ER no matter whether they had coverage or not. What percentage of ER visits would have been prevented with universal access to healthcare? I'm sure there would be "some", but at what financial cost? Some savings in ER versus massively increased costs in regular treatments?

Regarding your claim of hundreds of thousands of dollars being saved by providing regular medical treatment, since that particular claim is purely economic, I'll reply in economic terms - those who don't receive regular medical care likely die well before those who receive regular medical treatment, saving money in overall lifetime medical costs. For example, it's well established that our social security and medicare system would be even deeper in debt if not for smokers. Smokers tend to die on average, shortly after retirement, saving the govt a TON of money in both SS payments not made and medicare services not provided. So from an economic perspective, I believe you're mistaken. The moral argument is a different issue.

Regarding the questions I asked about percentages of ER patients,

http://freakonomics.blogs.nytimes.com/2010/03/11/emergency-room-myths/

E.R. care represents less than 3 percent of healthcare spending, only 12 percent of E.R. visits are non-urgent, and the majority of E.R. patients are insured U.S. citizens, not uninsured, illegal immigrants. Meisel and Pines also point out that E.R. visits don’t necessarily cost more than primary care visits: “In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.”

ZippyDDoodah says

I’m sure there would be “some”, but at what financial cost? Some savings in ER versus massively increased costs in regular treatments?

lol--you are trying to dispute someone else's claim with nothing but your opinion. "massively increased costs"? really?

ZippyDDoodah says

Regarding your claim of hundreds of thousands of dollars being saved by providing regular medical treatment, since that particular claim is purely economic, I’ll reply in economic terms - those who don’t receive regular medical care likely die well before those who receive regular medical treatment, saving money in overall lifetime medical costs. For example, it’s well established that our social security and medicare system would be even deeper in debt if not for smokers. Smokers tend to die on average, shortly after retirement, saving the govt a TON of money in both SS payments not made and medicare services not provided. So from an economic perspective, I believe you’re mistaken

Again--really? How much do we spend trying to keep these smokers alive? On cancer treatment? How much productivity is lost to smokers being in the hospital and dead? I don't have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

don’t have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

http://www.usatoday.com/news/opinion/columnists/freeman/ncjf49.htm

From the article:

Harvard economist Kip Viscusi ran the numbers on smoking, even before the big payday for the government known as the tobacco settlement. Said Viscusi in a 1997 interview for the PBS program TechnoPolitics, "Because it's risky, [smoking] has adverse health effects that increase medical care costs of people when they are younger. But, in addition, smoking kills people," says Viscusi. "And smokers tend to die after they have contributed to Social Security and Medicare, but before they've collected all of their Social Security pension and Medicare benefits. As a result, there is a cost savings at the end of smokers' lives, and a cost increase earlier. But, on balance, the cost savings offsets the cost increase, so that smokers offer a net financial gain to the government…society saves almost $30 billion a year in Social Security benefits and Medicare benefits that would otherwise have had to be paid out, had smokers lived."

tatupu70 says

I don’t have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

Actually, smokers are a net win in purely financial terms compared to non-smokers, for exactly the reason Zippy said. Yes a lot is spent on treatments. But everybody needs treatment for something eventually unless they're lucky enough to just have a sudden fatal heart attack out of the blue, or die in an accident. See this for example

Conclusions: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

That's not even counting pension expenses. Fewer lost days of productive work might make up for part of that, but I doubt it's even close.

I have a friend that went to grad school for public policy. The joke there was that the government should be giving away free cigarettes, not taxing them. But of course it's a joke since public policy for the security and welfare of citizens.

So if we were to completely socialize medicine and at the same time remove seat-belts, remove taxes on cigarettes (put them back in GI rations) and alcohol, ban sunscreen, sell more twinkies, etc... we would have more to show for it in the end? gotta love the bean-counters!

Smoke 'em if you got 'em
Need a light?

All joking aside, this OP spreadsheet is merely to educate and balance the propaganda from those who say "This is what CHANGE looks like." I say THIS IS what "change" looks like. LOOK at it. I doubt many of you will like what you see, or at least will be very dissappointed with many of the "changes" let alone the consequences of the "change".

We need change, the right kind of change. Unfortunately this bill isn't it.

Prediction: there are going to be an awful lot of layoffs by small businesses that have employees numbered slightly above 50. Also, 43% of Drs. recently polled claim they are considering leaving the medical profession as a direct result of the passage of Obamacare. Obama is being proactive regarding all this bad news. He's INCREASING the IRS by 16,500 in order to help offset these losses of jobs.

AdHominem says

We need change, the right kind of change. Unfortunately this bill isn’t it.

Now, there's a statement of substance.

I hope the bill is a step in the right direction. I haven't made it all the way through - and do believe that it could have been much simpler.

I go nuts dealing with insurance auths, rules & regs. I explain these things to patients and they can't wrap their heads around it - it doesn't make sense to them. Hell, it barely makes sense to me. Try explaining to someone who needs a piece of specialty equipment that their insurance doesn't pay for it - and, if they want it, they'll have to pay for it out of their pocket. Co-payments for specialty equipment can climb quickly, resale value is nil...

Take a power wheelchair, for instance. A patient who is unable to propel a wheelchair qualifies for a power chair at a cost of around $6,000. There's a $1,000 co-payment (and equipment companies accept monthly payments for the customer's share). However, the resale value on the equipment is about $700 or so. Most people can't afford to pay $700 at once, so the Medicare system pays for a new chair for the next person when a used chair would easily fit their needs. What a load of crap.

There is no rhyme or reason to the system as it is now. True healthcare reform will take years to work out. But at least it's hope. Those people who haven't been able to afford medications in the donut hole see light at the end of the tunnel - all they have to do is hang on for a few years...

elliemae says

I go nuts dealing with insurance auths, rules & regs. I explain these things to patients and they can’t wrap their heads around it - it doesn’t make sense to them. Hell, it barely makes sense to me.

I agree ellie and your complaints about the system are valid and need to be addressed. Every administration in the past 100 years has worked to get more people insured (to please their campaign contributors in the insurance, pharma and medical industries). They have us all convinced that WE NEED HEALTH INSURANCE! And more than likely just to prove their point they will drive up costs even more. They have even passed laws giving tax breaks to employers who buy insurance for their employees and yet strangely they do not offer the same tax breaks to individuals.

But the question is who/what is the cause of this problem? The way I see it insurance companies get away with it because they are essentially entirely unaccountable for their behavior. Employers (or the government through taxpayers) foot the insurance bill for the vast majority of those insured. Therefore the "consumer" has little or no say in the negotiation of the contract so the negotiation naturally is skewed in favor of the insurer (or most powerful special interest lobby) and against the patient. Then on the other end since people are insulated from the true cost of medication, services, etc... there is little or no incentive for the individual to keep expenses down because their copay is $25 (or zero for Medicaid) either way.

elliemae says

Take a power wheelchair, for instance.

I agree it is ridiculous the choices these plans make. That is a classic example of the outcome of Federal programs. Fraud, waste and abuse.

elliemae says

There is no rhyme or reason to the system as it is now.

Here I disagree. There is a rhyme and a reason. Or put it another way there is a pattern here. With each passing year, and each piece of legislation there are winners and losers. Corporations rarely lose, big pharma grows bigger, medical costs keep rising, and insurance companies continue to grow in power and profits too. Oh, and government grows as well, adding more burdens for the taxpayer. Oh, and we have given entitlements to health care for many different groups of people, and now it seems we are entitling health insurance to everyone as well. So many thousands more people will get "health insurance" who didn't have it. The powers that be have to justify their power grabs by throwing us a carrot. There is definitely a rhyme and reason, the government and the larger corporations get more powerful. That is big business in America empowered by the Federal Reserve and powerful banksters and corporatists. Democrats and Republicans both serve these same special interests. Every cry for more government intervention plays right into their hands. The only way to reign them in is to take back the control of our currency.

"If the American people ever allow private banks to control the issue of their currency, first by inflation, then by deflation, the banks and corporations that will grow up around them will deprive the people of all property until their children wake up homeless on the continent their Fathers conquered...I believe that banking institutions are more dangerous to our liberties than standing armies... The issuing power should be taken from the banks and restored to the people, to whom it properly belongs." Thomas Jefferson

Zlxr says

I meant Drs. couldn’t bill for phony visits because they need the patient to validate that they visited.

Ya know when you sign in at the desk? That verifies that you've been there. MD's are required to keep that to prove that you were there. Ya know when they photocopy your ID? ditto. The problem isn't that docs bill for phony visits, although some docs add extra diagnoses to make an end run around the insurance company rules as to how often you can visit for the same problem. The patient usually has these diagnoses, but the doc is forced to use it as the reason for the visit.

There are still equipment companies that call and then mail stuff to patients, charging Medicare for the item. This happens often. Also, I see hospices sign people onto service even though they're not declining and don't need any care. Altho legal, it's not super ethical. The hard-sell marketing practice of hospices should be looked at carefully, but I guess that CMS has more to do with its time. So they're paying millions to hospices whose goal is to make money, not help people. That irks me, because I see it every day.

I've enjoyed some of the comments on this thread; the Freakonomics emergency room data is something I'll look into more. But I digress, I have uncovered the REAL reason for ObamaCare. He is trying to make himself more attractive to women (I challenge the Tea Partiers to top that one!). Women with the strongest masculinity preferences tended to hail from the countries with higher disease and mortality rates and some of the poorest scores on the health-care index... Women with the weakest masculinity preferences of all lived in Belgium, a country considered to have one of the best publicly funded health-care systems in Europe (alongside Denmark and the Netherlands in the health-care index).
And where does the U.S. stand in the masculinity ranking? The answer is fifth out of the 30 countries in the study, one of the highest. This is, after all, the home of James Dean and Clint Eastwood. And where does America stand in the health index ranking? Twentieth of 30 countries, one of the least healthy.

EBGuy says

I’ve enjoyed some of the comments on this thread; the Freakonomics emergency room data is something I’ll look into more. But I digress, I have uncovered the REAL reason for ObamaCare. He is trying to make himself more attractive to women (I challenge the Tea Partiers to top that one!). Women with the strongest masculinity preferences tended to hail from the countries with higher disease and mortality rates and some of the poorest scores on the health-care index… Women with the weakest masculinity preferences of all lived in Belgium, a country considered to have one of the best publicly funded health-care systems in Europe (alongside Denmark and the Netherlands in the health-care index).
And where does the U.S. stand in the masculinity ranking? The answer is fifth out of the 30 countries in the study, one of the highest. This is, after all, the home of James Dean and Clint Eastwood. And where does America stand in the health index ranking? Twentieth of 30 countries, one of the least healthy.

Um, yeah, really? What does this have to do with anything discussed in this thread? Are "masculine" men somehow more superior to men who are viewed as "less masculine?" You do understand that the gender adjective "masculine" is a culturally-based and culturally defined term, don't you? In ancient Egypt "masculine" men wore long hair, shaved all body hair, wore make up, and wore skirts. "Masculine" men in some tribes in Africa stretch their earlobes down to their shoulders and wear large discs in the holes.

So, under whose definition of "masculine" are we operating? And what does this cultural phenomenon have to do with the health care debate?

With subsidized housing, food stamps and now free health care, millions more dependents will be heading toward America..."Home of the Free" - get it, Free? Hahaha - we're dumb. We voted this upon ourselves.

Let's get this straight, 32 million more dependents and the same number of Doctors. That would result in: (1) better quality health care, (2) the same quality health care, (3) worse quality health care?

In case you can't handle the truth I'll help you - it will equally lower the quality of health care for all - comrade. Well, except for those few in the Political class - since the health care program is for the peons, not the Political class - after all they are better than us, right?

"Some animals are more equal than others" has already become true.

Honest Abe says

Let’s get this straight, 32 million more dependents and the same number of Doctors. That would result in: (1) better quality health care, (2) the same quality health care, (3) worse quality health care?

I'm not sure why this is so complicated to figure out for people like yourself. Many of the additional covered do not need immediate care, they just need a yearly checkup maybe so small problems don't become big ones. I expect a company with an increased number of customers and money, would hire more doctors. Probably they'll have to do some simple requests by PHONE which is more efficient, instead of trying to get everyone to come into the office because that means more billable hours. I've been angry with my previous HMO a couple of times when I want to ask the doctor something simple over the phone and they tell us no you need to come in. In the short-term there'll probably be increased involvement of nurse and other "non-MD" professionals. The system will cope.

You're joking, right? "The system will cope" - haha, the system will be flooded - and why not, its FREE. Every scratch, every cut, everything that most people would take care of themselves will now get "proper" medical attention, after all, its free !! Comrade, common sense says that a dramatic increase in the load will simply overload the system and as a result the system will provide an equally lower quality of care for all.

Vicente says

In the short-term there’ll probably be increased involvement of nurse and other “non-MD” professionals.

This is a great idea. Unfortunately there would be huge liability for having a simple checkup conducted by anything less than a fully trained doctor. Also, the AMA would cry foul. They want to keep their monopoly on health care, and can't do that if we have nurses and med students doling out low cost, basic care.

Vicente says

Many of the additional covered do not need immediate care, they just need a yearly checkup maybe so small problems don’t become big ones.

This might lower costs, but it has yet to be empirically proven. Besides, this only works if people actually want to see a doctor regularly, and put in effort to take care of themselves. Many of the "additional covered" do not want to go to a yearly checkup. They prefer the simplicity and efficiency of having free access (well, free to them anyways) to the ER any time they need to see a doctor. Here is a casestudy detailing a complete lack of interest in a free clinic program in alabama, which was an attempt to keep low income citizens from overcrowding the much more expensive ER.

"To effect a genuine reduction in ER crowding, HealthPlus had to attract 3000 patients. After two years, it succeeded in attracting only 500 individuals to sign up for the program, and of these, far fewer kept their follow-up appointments at participating clinics."

http://mises.org/daily/1133

Also, many people in general will not take doctor's orders to change their lifestyle either, which is a far bigger determinant of lifelong health than regular checkups. Our populations' low health scores, as compared to the rest of the western world, are partially a natural result of leading the world in obesity, for instance.

And if you are mistaken about this? Are you going to be back here apologizing and saying "ZOMG MY HMO DIDN'T COLLAPSE!" or will you just switch to some new tack? You seem convinced that it's a zero sum game and there's only so many units of health care to go around like a mineral, and are terrorized that someone is about to hornswoggle you out of your rightful share.

Vicente says

And if you are mistaken about this? Are you going to be back here apologizing and saying “ZOMG MY HMO DIDN’T COLLAPSE!” or will you just switch to some new tack? You seem convinced that it’s a zero sum game and there’s only so many units of health care to go around like a mineral, and are terrorized that someone is about to hornswoggle you out of your rightful share.

We will be forced to ration care somehow. That process is not one that I have heard addressed by either side, besides some moronic pundits throwing around "death panel" and "grandma killer" type phrases. Seriously though, how will rationing be decided? This is kind of important.

I would love to have an I-told-you-so follow up on this bill in two years time. How do we decide who wins? More importantly, what are we betting? Honor? Bragging rights?

Maybe HMO will do to doctors what most in America live with now. "Work more for less!" Whattya gonna do about it, we'll just SWAT the AMA really hard and modify visa rules so we can bring in cheaper doctors from somewhere else in the world! We have rationing right now. I remember like 5 years ago when my brother had a hernia and struggled mightily to get it treated in a timely fashion. Was there a hue & cry about rationing then? It's always existed! Even as a child watching MASH and other medical shows I learned the word "triage" which is a French word popularized after WWI for the prioritization of those needing medical treatment.

Soon enough, we'll find out!