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For some time now, the knee-jerk reaction of "liberals" (meaning, sundry fans/supporters/allies of the President and the Democratic Party) to the GOP's irrational, dishonest and hypocritical opposition to and criticism of the Affordable Care Act, has been to point out that the GOP has no "plan" of its own and to ask them, rhetorically, to articulate one. Meaning, the GOP has no idea how to accomplish, and has articulated no measurable concrete proposal for accomplishing, the three main goals of health care reform: (1) insure the uninsured, (2) bring costs down by reducing uninsured medical risk, and (3) end or curtail the more egregious consumer abuses perpetrated by insurers. How do you accomplish (1), (2) and (3) in a way that is more conservative, more "market-based," than the ACA, not to mention do it in a way that will not cost anyone anything?

My reaction to that has always been to point out that the GOP has no answer and no such "plan" because it doesn't actually want to accomplish (1), (2) or (3). Its goal is, and has always been, to keep the insurance, biotech and pharmaceutical industries profitable.  The only way to do that in the face of ever-increasing demand for medical services -- the only commodity for which supply can never exceed demand -- is to serve fewer people, i.e., depress demand by pricing people out of the market. Rather than try to bring more people into the health care system, which would cost insurers, providers, manufacturers and already-insured consumers money no matter how you slice it, the GOP's goal is to keep people out of the system and serve only those who can already afford its exorbitant costs.

The best the GOP can usually do is trot out broad, vague, 35,000-foot-high-level abstractions like "patient-centered health care system" and "common-sense free-market solutions," which sound nice when spoken to David Gregory over and over again but don't tell us much in the way of actual policy, let alone actual legislation. Ask them to get more specific and they recite the same boilerplate proposals over and over again, which are only slightly less rhetorical and abstract: "tort reform," "sell insurance across state lines," "health savings accounts" and, of course, "tax credits."

None of these have actually worked where and to the extent they've been tried, and the first two can't really be accomplished by federal legislation anyway since they're the purview of state courts and insurance commissioners, respectively.  Mainly, though, the common thread in these "proposals" to the extent they have any meaning at all is that they would benefit providers, manufacturers, insurers, and people who already have health insurance, can already afford it and don't really need to use it. None of these things, even if it could be put into actual practice as actual policy by federal legislation, would get a single uninsured person insured, make insurance affordable for anyone who can't already afford it, or give anyone peace of mind who doesn't already have it that their insurance will be there when they need it and that medical costs will not break them.

Which brings us to the latest Republican attempt to prove that they do, in fact, have an actual "plan" that is an actual alternative to "Obamacare." Follow me below the fold to see what a "patient-centered health care system" would look like after President Cruz signs it into law in 2017.

Now, finally, the GOP has a "plan" of its own that goes a bit further beyond rhetorical abstractions. As reported and described by the National Journal:

A trio of Senate Republicans on Monday introduced their plan to replace Obamacare with a new system that is built largely around making individuals responsible for a higher portion of their health care costs.

...

In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.

Most people don't recognize how much their employer contributes to their health care plan and don't see the costs the insurance company covers: If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."

Reading the National Journal report and others, I think that's a pretty fair assessment of the plan's "essence." My sense of it is this: Have consumers (i.e., patients) pay more, and have employers and insurers pay less, thus the system becomes more "patient-centered." Eliminate regulations and consumer protections, leave it up to consumers to protect themselves, thus creating a more "patient-centered" system.

The theory seems to be that if you give consumers more "skin in the game," they'll make better choices about whether, when, where and how to spend their health-care dollar, and the cumulative effect thereof will be to bring costs down. Setting aside the wishful-thinking aspects of this theory, it should at least be pointed out that most consumers are not physicians, medical experts or insurance actuaries. One of the reasons why we have commercial regulation and consumer protection in the first place is that we don't expect people to become experts on everything they might think about buying. For all the braying we hear from the Right about the "nanny state," and the "government telling you what's best for you" and what-not, the fact is that sometimes we do need experts to help us make good choices and prevent us from making bad ones. But I'm not here to launch into a consumer-advocacy dissertation.

What concerns me about this "plan" is that at its core, its "essence" is to require people to take greater risks with their health. Again, the plan is to make people shoulder more of the actual costs of their own medical care, relying less on their employers and insurers to cover them. The purpose of that is to make people more aware and conscious of what their care actually costs, so they'll "be smarter consumers" and "make better choices" in the marketplace. Meaning, and I really can't think of any other meaning, we want people to think twice about seeking medical care when they get sick or injured. We want people to have to decide whether they really, really feel they really, really need treatment and whether it's really, really worth the money before they call a doctor or go to the ER.

I do have to applaud the GOP for coming up with a "plan" that really is an ideological alternative to the right of the ACA. I always understood that the underlying goal of health-care reform was to reduce risk for patients, to give people peace of mind that they can get treated when they get sick or injured and that it won't bankrupt them in the process. Indeed, one of the rationales behind the individual mandate and minimum-coverage regulations in the ACA (you know, the ones that "forced" insurers to "cancel" all those plans that people "liked") is that we don't want people to take risks with their health, and we won't allow people to take risks with their health anymore because when they lose, we all lose. This "plan" that the GOP has come up with does the precise opposite. In encourages, if not outright compels, people to take chances with their physical well-being.

I honestly can't think of another meaning or rationale for the "skin in the game" aspect of the GOP's "plan." The ACA's goal [whether it can or will accomplish same being an open and separate question] is and has been to relieve people of the burdens and risks associated with medical care and its costs; to shift some of those risks and burdens from patients to insurers, employers, providers, manufacturers and government -- all of which are in a better position to bear them than any individual consumer. The goal of the GOP plan appears to be the precise opposite, viz., make individual consumers take greater risks and bear more of that burden, while making insurers, employers, providers, manufacturers, and government bear less of it.

I guess that's what they mean by a "patient-centered health care system."

Originally posted to GrafZeppelin127 on Tue Jan 28, 2014 at 07:39 AM PST.

Also republished by Community Spotlight.

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Comment Preferences

  •  You put the patient in the center (19+ / 0-)

    surrounded by hungry sharks, circling ever closer to nibble away at the patient, soon followed by large greedy bites.

    People currently running a circular firing squad tend to think this way.

    There's no such thing as a Free Information Kit. There is, however, advertising.

    by lotac on Tue Jan 28, 2014 at 07:43:44 AM PST

    •  That's how every other industry (1+ / 0-)
      Recommended by:
      caul

      is structured.

      I'm living in America, and in America you're on your own. America's not a country. It's just a business.

      by CFAmick on Tue Jan 28, 2014 at 10:45:25 AM PST

      [ Parent ]

    •  The GOP plan is Jaws II (8+ / 0-)

      "just when you thought it was safe to go back to the doctor..."

      Bullseye, GrafZeppelin. There can be no other reading of this than "health care is too good for you (and you know who you are.)  Behave and you might get a little bit, someday".
       The black heart of every ideological stance of this increasingly devolving political party is division and cruelty.
      None of the modern gop 'visions' for America include rising up in any way. They cheer the death of the space program, plummeting college graduation rates, and the American Dream while fomenting the most overt racism and sexism seen on the public stage in decades. They actively seek to cut access to democracy and the society at large to more and more parts of the population, they hobble science, technology, and progress of all kinds.
      It's bullying, when stripped of its increasingly negligible trappings. All of their paper mache arguments need to be deconstructed as concisely as this one.

      Last full month in which the average daily temperature did not exceed twentieth-century norms: 2/1985 - Harper's Index, 2/2013

      by kamarvt on Tue Jan 28, 2014 at 01:37:26 PM PST

      [ Parent ]

  •  Still leaves out millions. (9+ / 0-)

    The current ACA, as adjudicated by the Supreme Court, already leaves out millions of people.

    The R plan leaves out millions more.

    Either way, we should be able to cover everyone like most civilized countries do.

    "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

    by Brooke In Seattle on Tue Jan 28, 2014 at 07:48:24 AM PST

    •  Maybe, but not intentionally. (14+ / 0-)

      There's a difference between a plan that "leaves [people] out" by failing, neglecting, or being unable to cover them, and one that purposefully excludes them.

      We should be able to cover everyone like most civilized countries do; in fact we are able to cover everyone like most civilized countries do. We just don't have the will or the desire to do it. As long as Americans value money more than people, we will continue to care for our money first and our people second.

      •  Except that the current plan does purposefully (0+ / 0-)

        exclude them thanks to the SCrOTUS allowing states to opt out of the Medicaid expansion.

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Tue Jan 28, 2014 at 06:48:01 PM PST

        [ Parent ]

        •  No, the "current plan" does not purposefully (4+ / 0-)

          exclude them. It is not designed to exclude them nor is it intended to exclude them.  At most, it leaves open the possibility that they will be excluded, which is not the same as a purposeful exclusion. The states that refuse to expand Medicaid are the ones that purposefully exclude them. Place the blame where it belongs.

          •  Florida and Texas do not have a state income tax (0+ / 0-)

            If someone gets $1,000 worth of expansion Medicaid care in New York State the federal government would pay $900 and New York State $100.

            The State of New York would then get about $60 of that $1,000 back in personal and corporate income tax, making the net cost to New York of $40.

            In Florida and Texas that Medicaid care might only cost $850 since medical and other costs are cheaper  than in New York. The cost to the federal government would be $765 and the upfront cost to Florida or Texas $85.

            Only about $5 of that $85 would come back via state corporate income taxation, so the net cost of Medicaid expansion care would be $80 per $1,000 of New York State level care.

            The PPACA would have Florida and Texas state governments paying twice the net cost of New York State for expansion Medicaid care items. This is a non-starter in Austin and Tallahassee.

            Also, since providing Medicaid in Florida and Texas is so much cheaper for the federal government (about 15% less), many in Florida and Texas want state Medicaid expansion co-shares waived for lower provider cost states.

          •  Well I definitely place the blame on the SCrOTUS (1+ / 0-)
            Recommended by:
            caul

            which is exactly where it belongs.

            You have watched Faux News, now lose 2d10 SAN.

            by Throw The Bums Out on Wed Jan 29, 2014 at 07:50:11 AM PST

            [ Parent ]

            •  States don't have a choice (1+ / 0-)
              Recommended by:
              Throw The Bums Out

              regarding participation when it comes to special education.

              In 1975, the Education for All Handicapped Children Act (EHA) Public Law 94-142 established the right of children with disabilities to receive a free, appropriate public education and provided funds to enable state and local education agencies to comply with the new requirements. The act stated that its purpose was fourfold:
              To assure that all children with disabilities receive a free appropriate public education emphasizing special education and related services designed to meet their unique needs
              To protect the rights of children with disabilities and their parents
              To help state and local education agencies provide for the education of all children with disabilities
              To assess and assure the effectiveness of efforts to educate all children with disabilities [8]

              In 1986 EHA was reauthorized as PL 99-457, additionally covering infants and toddlers below age 3 with disabilities, and providing for associated Individual Family Service Plans (IFSP), prepared documents to ensure individualized special service delivery to families of respective infants and toddlers.

              http://en.wikipedia.org/...

              I don't see where states have a choice with respect to medical care. The 1960(?) case (New York...?) SCOTUS relied on was rendered obsolete by the 1975 and 1986 laws and subsequent court actions.

  •  Let's examine these: (8+ / 0-)
    "tort reform," "sell insurance across state lines," "health savings accounts" and, of course, "tax credits."
    Tort Reform---Does Texas have the tort reform that goes the farthest?  What has been the result?--Lower insurance premiums to doctors and lower bills to patients, or just higher profits for the insurers?  How about protection to the patients harmed by bad doctors?

    Insurance Sold Across State Lines---Which state had the worst insurance on the market before the ACA, and which state has the weakest state insurance regulator?  No matter how cheap, how would this crappy insurance work for folks in other states?

    Health Savings Accounts---Just a vehicle to enrich the few insurance companies that offer policies that comply with the requirements, but has anyone here actually used an HSA?  How did it work out?

    Income Tax Credits---Well, first one needs a high enough income to be pay taxes and therefore make use of the tax credits.  How many Americans only wish they made enough income to pay enough tax to fully utilize the suggested tax credits?

    If anyone has any solid info on these four points, please post it.

    •  GA tried, no out of state ins company wanted to (10+ / 0-)

      play, Tort reform changed NOTHING

      you have to pay fed taxes to use tax credits

      ditto, health savings accounts, you need some thousands of dollars around to "save"

      they have no ideas that work

      "The poor can never be made to suffer enough." Jimmy Breslin

      by merrywidow on Tue Jan 28, 2014 at 08:03:09 AM PST

      [ Parent ]

    •  "Tort reform" means limiting the liability of (9+ / 0-)

      providers and manufacturers for the harm that they cause. You can't really do "tort reform" by federal legislation because torts are creatures of state law. Medical malpractice and products liability are state-created common-law torts; Congress has no authority over state courts.

      "Selling insurance across state lines" is a way of allowing insurers to avoid regulation and taxes, and find a state haven from which they can sell the least coverage at the highest prices with the weakest consumer protections. This can't be done by federal legislation either because each state has its own insurance department and insurance commissioner, and it's up to them to determine if they'll allow out-of-state policies to be sold within their jurisdiction.  Congress can't compel them to do that.

      It's also not a great idea to buy insurance across state lines if the state where you live has materially different risks than the state from which you buy your policy. If you live in Connecticut, where there's a significant risk of Lyme disease, you don't want to buy a policy from Wyoming, where there is zero risk of Lyme disease and an insurer would therefore not cover it.

      The others are designed to help those who already have, and can already afford, coverage. HSA's and tax credits would do nothing to insure the uninsured or make insurance affordable to anyone who can't already afford it.

      •  One possible tort reform would be to use the (0+ / 0-)

        Same approach as the Federal Government's TriCare tort system.

        One of its big advantages for ordinary people, is that it accommodates smaller claims, rather than the current system where lawyers will not take a claim because it is too small.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Tue Jan 28, 2014 at 08:55:30 AM PST

        [ Parent ]

      •  Tort reform pays for all economic loss (0+ / 0-)

        Can't work again (economic loss) - million plus in many case

        Need a second $50,000 operation to fix the first (economic loss) - paid in full

        Need 10 $35,000 operations to fix cosmetic damage - paid in full

        Generally only non-economic damages are limited, i.e. for "pain and suffering".

        non-economic losses such as loss of enjoyment of sex, missing an episode of the Sopranos while having the second operation done, spending thousands of hours trying to win the lawsuit, and "pain and suffering"  (which normally is money to pay the lawyer)  - $250,000 maximum

        Doctors do things like surgery that lawyers can't.

        No lawyer is going to deliver a baby in Charlotte, North Carolina if one of the best tort lawyers in the USA scares all the obstetricians in the Charlotte area to set up shop in South Carolina.

        So until lawyers can replace doctors, the doctors can and will put their foot down and any state that wants their citizens to have medical care provided by doctors had better put a damper on non-economic loss claims.

        •  The statement that (0+ / 0-)

          "Tort reform pays for all economic loss" doesn't make sense.

          "Tort reform" doesn't "pay for" anything. "Tort reform" is an abstract concept; it doesn't have money of its own.

          What you might have meant to say, which if so would be more accurate, is:

          The specific tort reform proposal made by [person/group] in [state/Congress] in [year], as described in [publication] on [date], would require providers and manufacturers who are adjudicated liable for medical malpractice or product liability to pay for all economic loss suffered by the plaintiff. That proposal, which was [introduced/passed] in [year] in [state/Congress], would only limit non-economic damages.
          As a general matter, "tort reform" means limiting the tort liability of tort defendants, or limiting the ability of tort plaintiffs to bring claims. (Of course it could also mean the opposite, but I doubt Republicans and their fans mean the opposite when they recite the phrase, "tort reform."). The precise nature and extent of those limitations, and their rationale, depends on the specific context and content of the specific proposal being made at a specific time and place by a specific legislator or group of legislators in a specific jurisdiction.

          Pointing out that "tort reform" means limiting what providers and manufacturers would have to pay for the harm they cause, or limiting the ability of patients to bring legal claims against them, is not to argue one way or another whether this would be a good thing or a bad thing, whether it should or should not be done, or why. It is simply what the phrase means.

          •  I left out something (0+ / 0-)

            MALPRACTICE INSURANCE under "tort reform pays for all economic losses."

            My apologies to one and all for the lack of three words.

            •  As I pointed out, I was sure that was what you (0+ / 0-)

              meant, with the caveat that you're referring to some unspecified proposal for "tort reform" that was actually made at some particular time and place by some particular person or group, not to "tort reform" definitionally.

              In other words, "tort reform" would not necessarily require malpractice insurance to pay for all economic losses. It could do that, but it won't necessarily do that. "Tort reform" could just as easily, just as likely, place significant limits on economic-loss damages. It could even go so far as to eliminate medical-malpractice tort claims or damages altogether. Or it could expand liability and eliminate existing limits on economic and/or non-economic damages.

              My only point is that it cannot be said that "tort reform" by definition means that providers, manufacturers or their insurers must "pay for all economic losses" caused by their negligence or malfeasance. "Tort reform" means that the ability of individuals to bring claims against and recover damages from tortfeasors will change. Exactly how and to what extent it will change depends on the specific proposal being made by the specific person or group proposing it at that specific time.

    •  I had an HSA (9+ / 0-)

      I hated it. It made me cry several times, because money wasn't where it was supposed to be, or couldn't get to where it needed to be, in time to pick up a prescription or other expensive expense.

      HSA primarily benefits banks and wall street, because they collect lucrative fees from them. The only reason they're financially viable is because of the tax incentive - otherwise, they actually would cost MORE than a normal health insurance plan.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Tue Jan 28, 2014 at 08:34:40 AM PST

      [ Parent ]

      •  They're Shit, Pure Shit (3+ / 0-)
        Recommended by:
        Calamity Jean, OhioNatureMom, caul

        My anger at that pile of shit banker gift knows no bounds.  How the fuck am I supposed to know how much out of pocket I'm due to spend next year?  Meanwhile, the out of pocket that may show up is not deductible until it's over 5% of gross income.  WOW!!!

        Can't some asshole give me a tax card for medical that provides a IRS statement instead of me putting dollars up front?

        •  There are two types of medical financial accounts (0+ / 0-)

          1. health savings account (HSA)
          2. flexible spending account (FSA)

          A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).[1][2] The funds contributed to an account are not subject to federal income tax at the time of deposit.

          Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

          http://en.wikipedia.org/...

          "How the fuck am I supposed to know how much out of pocket I'm due to spend next year? "

          You are confusing a FSA with an HSA.

    •  Re: tort reform, we don't even need (3+ / 0-)
      Recommended by:
      AnnCetera, OhioNatureMom, caul

      to compare states. There is no explosion of medical malpractice lawsuits -- the number of lawsuits per capita and the average cost per lawsuit have both been decreasing steadily since 2001, in almost every state. Malpractice insurance has gotten more expensive anyway. That's entirely on the insurers.

      •  It has gotten more expensive since (0+ / 0-)

        it can take five years to settle a malpractice suit and interest rates are near all-time lows.

        In 2001 the malpractice insurer might have gotten an 8% return on the money set aside to pay claims.

        In 2014 the malpractice insurer might be getting 3.5% return on the money set aside to pay claims.

        To make up for say five years of 4.5% less interest income each year, the malpractice insurer must charge 22.5% more in premiums.

    •  Texas Tort Reform... (6+ / 0-)

      ...has definitely lowered malpractice premiums for doctors.  However, there has been no overall reduction in health care expenditures, with health care cost increases since tort reform being at or above the national average.

      Bottom line is that based on our experience in Texas, tort reform does not achieve savings in the health care system.

      Political Compass: -6.75, -3.08

      by TexasTom on Tue Jan 28, 2014 at 01:28:38 PM PST

      [ Parent ]

  •  Yes! I want to choose whether to get cancer (11+ / 0-)

    treatment or not, depending on my budget concerns.

    "The poor can never be made to suffer enough." Jimmy Breslin

    by merrywidow on Tue Jan 28, 2014 at 08:01:30 AM PST

    •  the first question to ask after an accident; (11+ / 0-)

      Does this injury look expensive to you?

      The whole thing is beyond ludicrous. The abominable pretense that one's health is subject to the same cost-benefit analysis as a shampoo buy is obscene.
      Should I be cutting deals in the ambulance for a quickie suture job, an inflatable cast, and a bottle of Tylenol if it saves me the thousands I will be charged the minute the cart wheels through the door of the ER? Seems like a good idea, but what if I have internal bleeding? I'd be out a lot more if that's the case...gee, if I didn't have this concussion it would be easier to make these large financial decisions.

      Yup. It'd be funny if it wasn't both monstrous and true.

      Last full month in which the average daily temperature did not exceed twentieth-century norms: 2/1985 - Harper's Index, 2/2013

      by kamarvt on Tue Jan 28, 2014 at 01:47:31 PM PST

      [ Parent ]

      •  So much of that "competition" and "better (7+ / 0-)

        choices" is set up with the fiction that people have choice available to them.  Many areas of the country have one provider.  Many people seeking attention aren't fully aware of their state, so decisions they make are not going to be made with full awareness - they hurt, or they're woozy or they have a temperature of 104 degrees - they need fixing and it's Republicans who want to insert at this point someone to verify whether the person has funds and is insured.  Democrats want to keep decisions between a patient and a doctor, not with a financial decision-maker go-between.

        •  Information is not available (4+ / 0-)
          Recommended by:
          NoMoreLies, caul, ColoTim, kamarvt

          Competition presumes you can evaluate the relative benefits and costs of the competing providers of services. What, exactly, are you supposed to base your assessment on, the list of "Best Doctors in America" in the US Airways inflight magazine?

          If you're buying a car, or a house or a toaster oven, there are standardized measures on which you can evaluate whether the one you're considering is a good value. What are the analogous measures for health care? The most you can find out about a doctor, for instance, in most places is what Medical School they attended and whether they're board certified. That doesn't tell you much.

          Real life example: work colleague is being treated, at 30 years old, for aggressive breast cancer. She goes to Johns Hopkins, assuming the quality of care will be the best (and they're covered under our insurance). They tell her the chemo will make her infertile, and when she started experiencing pregnancy symptoms during the post-chemo radiation treatment, they sent her to a psychiatrist for her obvious "phantom pregnancy." That "phantom pregnancy" is now 12 years old and her younger sister is 4. None of the doctors at Johns Hopkins bothered to run a basic pregnancy test on her.

          A government that denies gay men the right to bridal registry is a fascist state - Margaret Cho

          by CPT Doom on Wed Jan 29, 2014 at 07:29:05 AM PST

          [ Parent ]

          •  You can find out much more (0+ / 0-)

            Doctors, like cameras, get reviewed on the Internet.

            The most you can find out about a doctor, for instance, in most places is what Medical School they attended and whether they're board certified. That doesn't tell you much.
          •  You can ask for an estimate under Florida law (1+ / 0-)
            Recommended by:
            ColoTim
            BILL OF RIGHTS AND RESPONSIBILITIES
            ** MEMORIAL HOSPITAL
            Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients.  You may request a copy of the full text of this law from your health care provider or health care facility.  A summary of your rights and responsibilities follows:

            A patient has the right to:
              Be treated with courtesy and respect, with appreciation of his/her individual dignity, and with protection of his/her need for privacy.
              A prompt and reasonable response to questions and requests.
            Know who is providing medical services and who is responsible for his/her care.
            .....
             Be given, upon request, full information and necessary counseling on the availability of known financial resources for his/her care.

            A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.

            Receive upon request, prior to treatment, a reasonable estimate of charges for medical care.

            http://www.smh.com/...
            •  That works if you then have time and ability (1+ / 0-)
              Recommended by:
              ichibon

              to make the informed choice about treatment, and you have choices for who the provider is and what they charge.  In Republican world, they always have choice and can make informed decisions that will always lead to a successful outcome.  In Real World, I don't think that is often the case.  And quite honestly, I don't want to be arguing over every detail of my bill as to whether something is customary and necessary.  I don't know those things, I don't know how much it should cost and I don't want a bean counter making a decision about what care I should receive (even if they're just looking over the doctor's shoulder).

              •  Under the PPACA (0+ / 0-)

                WHEN GETTING EMERGENCY CARE insurers have the responsibility of making sure you only have to pay for the contracted deductible and co-pays and maximum out-of-pocket listed in your plan and limited by your household income.

                [How that is supposed to work in the real world I don't know.]

                If not getting emergency care, the theory is you have time to shop.

      •  eBay Dialysis Treatment? (3+ / 0-)
        Recommended by:
        OhioNatureMom, caul, ichibon

        Put a bid in or click buy it now.

  •  You know who really doesn't appreciate how much (11+ / 0-)

    health care costs? Senators.

    Maybe they should try it just for themselves to start.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Tue Jan 28, 2014 at 08:07:48 AM PST

  •  Sad thing is they probably believe this s**** (11+ / 0-)

    They're delusional.

    Republicans can be good at making money for themselves or for their business (Romney for example). But republicans are, in general, totally incompetent when it comes to economics. Their theories have been proven wrong, time and time and time again. What they have is ideology.

    They have no place in governing anything at the state or national level. They have no clue.

    Yes, they're in the pocket of big money interests. But I'm convinced they're ALSO incompetent, profoundly incompetent. And not only in economics, but also in foreign policy (they don't understand other cultures), in environment, you name it.

    WHO in this party is knowledgeable in anything other than business ?

    I would be curious to see if ANY health care economist will agree with this plan. Not a FAUX health care economist; a REAL one, who's respected by his peers….

  •  I guess that's what they mean by a... (1+ / 0-)
    Recommended by:
    scott jones

    I guess that's what they mean by a "patient-centered targeted health care system."

  •  Diary does not describe the Republican Plan (0+ / 0-)

    For those interested in what was actually proposed see the actual proposal

    At senate.gov The Patient Choice, Affordability, Responsibility, and Empowerment Act A Legislative Proposal

    I have not read the proposal yet, so I don't have comments on the proposal itself.

    Insight as to how some Republicans will present this approach and compare it to ACA can be seen at a Forbes article Senate Republicans Develop The Most Credible Plan Yet To 'Repeal And Replace' Obamacare

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Tue Jan 28, 2014 at 08:47:59 AM PST

    •  I'm confused. You say you haven't read it, (2+ / 0-)
      Recommended by:
      kamarvt, caul

      but you insist that the diary "does not describe the Republican Plan." This seems to imply that the diary's description of the plan, to the extent the diary attempts or purports to describe it, is inaccurate. If you haven't read the plan, what is the basis for that determination?

      In what way is the diary's description of the plan, to the extent it contains any such description, inaccurate? What is the basis for that determination?

      Is the National Journal's characterization of the plan, as quoted in the diary, inaccurate? If so, in what way? What is the basis for that determination?

      Is the National Journal's description of the plan, as set forth in the linked article, inaccurate? If so, in what way? What is the basis for that determination?

      If your comment did not mean to imply that the diary's description of the plan, to the extent it contains any such description, was incorrect, what then did you mean to imply?

      The diary neither attempts nor purports to describe the Republican Plan. It's an assessment, not a description.

      •  It is quite obvious that the diary does not (0+ / 0-)

        describe the plan even to those who have not read it. If one only read the diary, and one was asked to summarize the proposal, there would be little one could say.

        The diary does not cover even the proposal's basics, pre existing conditions, what subsidies and to who if any, etc.

        Prior to making my comment, I had read other's analysis of the plan, and much was omitted in this diary.  I generally refrain from forming my own views about proposals until after I read the proposal.

        I have since read the proposals 8 pages. My earlier statement that the diary does not inform the reader as to what the proposal says in summary is valid.

        .

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Tue Jan 28, 2014 at 09:52:07 AM PST

        [ Parent ]

        •  Is this assessment unfair or inaccurate: (2+ / 0-)
          Recommended by:
          DBoon, caul
          A trio of Senate Republicans on Monday introduced their plan to replace Obamacare with a new system that is built largely around making individuals responsible for a higher portion of their health care costs.

          ...

          In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.

          If so, in what way? What is the basis of that assessment?

          What specific statements in the diary are unfair or inaccurate assessments of the proposal, or of this aspect of the proposal? In what way? What is the basis of that assessment?

          Be specific, please; more specific than blanket statements that various unspecified things were not mentioned. Complaining that things were not said does not by itself undermine what was said, unless it can be shown that some specific omission bears materially on the assessment. If you can demonstrate that any specific thing that was omitted invalidates the assessment, please do so by identifying that thing and explaining why it is important, and how it negates or invalidates the characterization quoted above.

          Thank you.

          •  For unknown reasons you believe the diary fully (0+ / 0-)

            describes a proposal.  This belief is so outlandish that I don't know of anything I can write to help you see the obvious.

            To know what an 8 page proposal says, read it.

            The most important way to protect the environment is not to have more than one child.

            by nextstep on Tue Jan 28, 2014 at 10:42:13 AM PST

            [ Parent ]

            •  For unknown reasons you believe that the statement (1+ / 0-)
              Recommended by:
              caul
              The diary neither attempts nor purports to describe the Republican Plan. It's an assessment, not a description.
              ...indicates that I "believe the diary fully describes a proposal."

              Not sure where we can go with that. If you don't know or understand the difference between a description and an assessment, I can't really help you.

              Since you haven't attempted to answer any of my questions, I guess we're done.

        •  Moreover, it's not my job as a diarist (2+ / 0-)
          Recommended by:
          ahumbleopinion, caul

          to spell out all the details of the proposal. As you've pointed out, there are plenty of places people can go to read and learn about it, in whatever degree of detail they wish.

          The diary is my assessment of the proposal, based on what I have seen, heard and read about it, including what its proponents have said and written. The diary does not purport to be anything more or less than that, nor is it required to be anything more or less than that. If you disagree with that assessment or think it's unfair, fine. Let's have that debate. If you'd like to write a diary spelling out (and, if you wish, defending) every particular detail of the proposal, please do so and I'll be glad to read it.

          But let's not pretend that I had some sort of obligation to spell out and explain every last detail of the proposal before offering readers my assessment of it.

          •  So you agree with my statement (0+ / 0-)

            "Diary does not describe the Republican Plan"

            I never wrote that you had an obligation to provide a detailed summary of the proposal.  I provided a link to the actual proposal, so those who may be interested could read it.

            Why do you have a problem with my providing a link to the actual 8 page proposal ?

            Is it not obvious that the actual proposal is the actual proposal?

            The most important way to protect the environment is not to have more than one child.

            by nextstep on Tue Jan 28, 2014 at 10:51:47 AM PST

            [ Parent ]

            •  I agree with your statement that the (2+ / 0-)
              Recommended by:
              DBoon, caul

              "diary does not describe the Republican plan" to the extent it means that the diary does not describe the Republican plan. As I have said repeatedly, the diary is an assessment of that plan, not a description.

              My initial response/question was whether you meant to merely point out what the diary does not do -- an odd thing to point out just for the sake of pointing it out -- or to challenge the assessment by implying that it was invalid because (a.) it did not fully describe the plan before offering an assessment thereof, or (b.) the omitted details would, if provided, invalidate the assessment.

              All you really needed to say was that you meant to do the former, not the latter. If that's in fact what you intended. The former just struck me as an odd complaint in the absence of any requirement to the contrary, or any substantive rebuttal of the assessment.

              I have no problem whatsoever with your linking to the actual proposal or anyone else's assessment thereof, and I neither said nor implied that I did. It's the reader's job to determine the validity of my assessment, or anyone else's, including that of the proposal's authors.

  •  Typical Republican Plan (4+ / 0-)

    This again is a typical Republican plan which places all of the burden on the consumer and none of it on the business interests which the Republicans represent.  Economics actually is a balance of supply and demand but Republicans only look  at demand, which is the consumer, and places all the burden on them.  

    The main reason for the high cost in this field are the numerous market restraints and distortions created through the business community to reduce supply and increase costs or somehow else distort the market to make it more profitable for these businesses to operate.  The severe market restraints exercised through the AMA and excessive salaries generated for medical doctors in this country are legend but nobody ever talks about doing anything about it.  Pharmaceutical companies exploit patent laws which provide them with the leverage to demand twenty times the actual costs of medication.  The Constitution says that Congress can create patents to ultimately benefit society but does not say how these laws should be written for any individual industry in order to accomplish this objective. Insurance companies are motivated to deny coverage and severely decrease price transparency in order to drive up costs.  Hospitals gouge people without insurance or who have been denied coverage by their insurance by charging three to five times the market rate.  The list goes on and on.  

    These are the primary items which must be addressed to reduce costs but of course the Republicans will never address any of them since they themselves represent those people causing the problem and thus are quite content on trying to perpetuate a system that continues to generate high prices and high costs.  

  •  The one, sure, certain Republican "alternative" (6+ / 0-)

    to intelligent, sensible, and affordable HEALTH INSURANCE - which ultimately pays for HEALTH CARE - is, and always has been, simply:  "If you can't afford to PAY - through the nose at the highest gouges possible - for serious illness or injury, then DIE OFF, and get to hell out of the way of profit making Insurance Companies."

    The is NO OTHER; and never will be, regardless of flowery language and high-falutin' phraseology.

  •  GOP: 'don't get sick, but if you do DIE QUICKLY (8+ / 0-)

    Alan Grayson summed it up perfectly years ago.

    His candor may have helped cause his electoral defeat, but he's back and I sincerely hope he continues to be the tell-it-like-it-is thorn in the ass of the GOP that the Dems REALLY need someone in Congress to be...

    Anthony Weiner eventually proved to be self-destructive, but while he was in congress, his moments of blasting the Republicans on the floor and calling out their hypocrisy were priceless, and legendary.

    Rep. Weiner blasts GOP on 9/11 First Responders bill

    America's LAST HOPE: vote the GOP OUT in 2014 elections. MAKE them LOSE the House Majority and reduce their numbers in the Senate. Democrats move America forward - Republicans take us backward and are KILLING OUR NATION!

    by dagnome on Tue Jan 28, 2014 at 09:55:22 AM PST

  •  isn't that (3+ / 0-)
    Recommended by:
    kayak58, OhioNatureMom, caul

    what's in effect now, making the user pay more and more while the profit centers have less exposure to financial risk.

    I'll take the ACA, thanks. It's not perfect, but it is a step toward what might eventually, if we all live long enough or our children do, toward a decent, comprehensive, affordable-for-all healthcare system in these United States.

    You know, sort of like what other developed countries have already had for years now.

    Great Questions of Western Philosophy: How much wood would a woodchuck chuck if a woodchuck could chuck wood?

    by Mnemosyne on Tue Jan 28, 2014 at 12:07:57 PM PST

    •  As I told someone else, (4+ / 0-)
      Recommended by:
      DBoon, mmacdDE, OhioNatureMom, caul

      that will not happen until, as a nation, we would rather take care of our people than take care of our money.  

      •  our response to climate change is telling (2+ / 0-)
        Recommended by:
        OhioNatureMom, caul

        about where we are and whether or not we care to change clearly destructive but profitable behaviors unless and until forced. The deadline for that little bit of business keeps moving up, and we are actually hastening its arrival each year. Societally, I think this will dwarf the accumulating human damage of a pay to play health care system within a few decades, at most.

        Last full month in which the average daily temperature did not exceed twentieth-century norms: 2/1985 - Harper's Index, 2/2013

        by kamarvt on Tue Jan 28, 2014 at 01:55:39 PM PST

        [ Parent ]

  •  republican health insurance plan (2+ / 0-)
    Recommended by:
    OhioNatureMom, caul

    they should just call their new idea for health insurance a plan to die for which is exactly what they are hoping for so they can continue to live in their own nirvana.  i don't know how many you have had the opportunity to engage people( and i use that word sarcastically ) who are as idealogically challenged as republicans are.  it is impossible to have a reasonable conversation with people who are evil and crazy.  there is no idea they can propose that can have any meaningful benefit except for their  parasitic sucklings that help them remain alive .  i don't want to get into pointing out the petty details of their failed proposals.  i just wish i could wave my hand and make them go away to a place where they can eat their own.  

  •  Uh... I read the GOP plan (0+ / 0-)

    It is actually backhandedly better than the ACA. It is essentially the ACA with the handwavium replaced by cruelty.
    The fundamental problem with health care in America is cost - we can provide much better care if it wasn't so damn expensive.
    The fatal flaw of the ACA is that it hides costs behind tax subsidies, it does not address those costs. The Republican plan shifts the "burden" of those costs from employers to the working class. This is "better" because it will fail more visibly. The public - the voting public - will be forced to see how expensive health delivery is and demand actual reform - single payer. Of course, the GOP doesn't see this. (or perhaps it does - the plutocrats win by shifting costs to the working class, but they also win under single payer - at least as long as we have regressive taxation)

  •  All Republican economics (2+ / 0-)
    Recommended by:
    OhioNatureMom, caul

    are based around the consumer having perfect information and all the time in the world to figure these things out.
       So it shouldn't be a surprise that their "reforms" are also based upon these fictional concepts.

    None are so hopelessly enslaved, as those who falsely believe they are free. The truth has been kept from the depth of their minds by masters who rule them with lies. -Johann von Goethe

    by gjohnsit on Tue Jan 28, 2014 at 01:48:54 PM PST

  •  Obamacare (i.e., Romneycare, Dolecare, etc.) (4+ / 0-)

    IS the GOP's idea.  So, really, they're only failing to come up with ANOTHER GOP health plan, one that isn't tainted by being approved by Obama and Democrats.

    It's too easy to forget this.  Obamacare was their idea.  They love Obamacare, just not Obama.  If Obama said he loved peanut butter, they'd boycott it as Obama Butter.

  •  The insurance industry has an interest (0+ / 0-)

    in bringing down the growth in healthcare costs, because the system we had pre-ACA was rapidly becoming unsustainable. There is only so much money out there that can be milked out of either consumers or employers. And as these get priced out of the insurance market, their only alternative is to "trade down" to no insurance or less complete insurance, and roll the dice that they will get by with fewer or no doctor visits, procedures and prescriptions.  If they do need ER care that's a cost to the system and no revenue is coming in from these patients.

    Rapid growth in healthcare costs didn't hit industry profits right away but in the long run it is bound to.

  •  The USA has already experimented with this (4+ / 0-)

    via all the uninsured and under insured.

    It works very badly for all concerned, because patients defer preventive care, and necessary care, racking up much worse health outcomes which cost more to address when they surface as emergencies.

    Public health suffers,  productivity suffers, and increasing healthcare costs drag down the economy.

    We know what works --- Universal Affordable Healthcare.  And insurance can be, but need not be part of that  equation.

    •  Indeed... (2+ / 0-)
      Recommended by:
      OhioNatureMom, caul

      One should not confuse health care with health insurance. The insurance industry, as it relates to health care, is providing virtually no value added, to my eyes.

      Single payer is the way to go. Hopefully, the slow-motion thumbscrews for health insurance that were inserted into the ACA will help hasten the public opinion toward a single payer plan.

      Soon, all it will take is a comparison between Medicare, and health care provided by for-profit entities; in cost, outcomes, and simplicity, the Medicare model will win.

      "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

      by AnnCetera on Tue Jan 28, 2014 at 05:40:42 PM PST

      [ Parent ]

  •  The need to 'sensatize' consumers to the high cost (2+ / 0-)
    Recommended by:
    OhioNatureMom, SingleVoter

    of their medical care, and have them shoulder more of the cost, assumes that their employers have been spending the employer portion in a wasteful, irrational way.  That is a really big 'fuck you' to all the private HR reps and small business executives who have been shouldering the financial and decision making burden all this time.  It is telling them they have been making bad decisions and wasting money.  And the GOP solution is to shift the burden from  professional HR people who are trained to make these decisions, to the individual.  And each individual is up against the big insurers.  Yeah, that seems like a perfect 'out of the frying pan, into the fire' analogy.  

    Way to go GOP!   After 4 years of dithering about health care you come up with a total loser idea.

    To write a Republican Party talking point on a policy issue, any policy issue, all you need is: a noun, a verb, and 'Obamacare'.

    by MARTinNJ on Wed Jan 29, 2014 at 05:51:26 AM PST

    •  By state law insurers (and many employers) (0+ / 0-)

      often have to pay the asking price of all drugs approved by the FDA that are prescribed and medically necessary in the eyes of the doctor.

      If I say cheap drug has an intolerable (and hard to verify) side effect listed in an old PDR (such as making me too sleepy to drive safely or causing me to lose interest in the sack) I can probably get the doctor to prescribe the Brand Name drug I have seen advertised.

      Employers and insurers don't have much control.

      If my neighbor gets a heart attack Local Hospital owned by greedy Republican businessmen is the only choice.

  •  GOP's idea: (0+ / 0-)

    Warning! Conservative comments are not welcome in this venue unless they agree with the mostly liberal commenters here.

  •  Republican plan fails the Norquist test (0+ / 0-)

    It taxes 35% of the employer-paid  premium. It is a tax increase. The hypocrites will find some way to disguise the facts, but you can't paint a turd.

    it is a Republican Tax Increase!

    •  This is the pledge (0+ / 0-)
      Taxpayer Protection Pledge
      I, ________, pledge to the taxpayers of the state of _________, and to the American people that I will:
      ONE, oppose any and all efforts to increase the marginal income tax rates for individuals and/or businesses; and
      TWO, oppose any net reduction or elimination of deductions and credits, unless matched dollar for dollar by further reducing tax rates.
      http://s3.amazonaws.com/...

      1. It is not an increase in the rates
      2. It is not an elimination of a deduction or credit

      It is an elimination of an exemption from taxation of an employer provided benefit.

    •  The Norquist Pledge (0+ / 0-)

      doesn't prohibit all possible tax increases.

      Double the federal gas tax and Grover will only bitch when he has to refill his tank.

  •  The HSA was meant to pre-fund high deductible (0+ / 0-)

    health insurance.

    The deductible for all health insurance (insurance Republicans love and also insurance Democrats love)should be pre-funded.

    The bronze deductibles are high for most people and the silver plan deductibles are high for many people.

    If you don't have even $200 to spare you probably shouldn't be buying a $2,000 deductible silver plan.

    If you have only $100 to spare as a deductible, you probably should place this deductible with the insurer who should refund it (or forward it to you next insurer) if not used to pay claims.

    If you can't spare $100 (or $2,000) you should be buying FIRST-DOLLAR insurance. You get $X of care, you swipe your insurance card through an electronic reader (and $X gets transferred to your doctor's bank account from your insurer's bank account) and you walk out the door. About half of all Kossacks need FIRST-DOLLAR health insurance.

  •  Merely a flesh wound.... (0+ / 0-)

    I don't need any medical care for that arm just lopped off...now I have "skin in the game"

  •  I personally don't like deductible insurance (0+ / 0-)

    I think pre-funded matching co-insurance should be used.

    You might have $2,000 to invest as a matching co-insurance funding amount.

    The insurer might initially pay on say a 3-to-1 ratio.

    A $200 medical bill would have the insurer paying $150 and you $50 from your $2,000 premium reducing co-insurance investment.

    This is patient "skin" in the game but "skin" that the insurer will protect well since the insurer's "skin" is also in the game.

    You premium would be based on your $2,000 prefunding amount. Your premium would be less than those with no prefunding amount getting FIRST-DOLLAR (insurer pays 100% every time) coverage.

    Once the matching co-pay prefunding is used up, the insurer would pay 100% instead of say 75% with a 3-to-1 co-pay match.

    Insurer "skin" needs to always be in the game in my opinion.

  •  I see the potential of people falling (0+ / 0-)

    through an increased number of loopholes.

    The PPACA already has low-income people like me in Florida falling through without coverage of any kind (and unable to access cheap care in Mexico as I could the day Obama first took office)

  •  What is needed is a better ability of insurers (0+ / 0-)

    and government to manage costs .

    Perhaps the FDA should not be able to review a drug until insurers covering 50 million people have a pricing agreement in place that covers the drug.

    Perhaps prospective medical students should have to sign a fee-limiting agreement with the federal government such as never charging more than 79% of current Medicare fees.

  •  A lot depends on the details (0+ / 0-)
    Under our plan, families earning up to $71,000, or 300 percent of the federal poverty level, will get a tax credit to purchase the insurance of their choosing.
    http://www.hatch.senate.gov/...

    Is there any tax credits for single people (like Single Voter)and couples not normally loved by the GOP?

  •  I looked for a bill (0+ / 0-)

    at Thomas under Senator Hatch and Senator Burr, but I could not find a bill.

  •  to get more skin in the game (0+ / 0-)

    most people need to be saggy and baggy.  

    Unfortunately, most of us can not afford to feed elephants.

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