health care insurance reform

Health care reform for the 46 million uninsured Americans.

In America we have Medicare for the elderly, Medicaid for lower income Americans, SCHIP for children, and COBRA for the temporarily unemployed. The main argument we hear for reform is that 46 million Americans do not have insurance. Who are these 46 Million, and why don't they have access to Medicare, Medicaid, SCHIP or Cobra?

For the record, according to the latest figures from the Census Bureau, 45.6 million Americans currently lack health insurance. This is actually down slightly from the 47 million that were uninsured in 2006. However, those numbers don't tell the whole story.

For example, roughly one quarter of those counted as uninsured -- 12 million people -- are eligible for Medicaid and the State Children's Health Insurance Program (S-CHIP), but haven't enrolled. This includes 64 percent of all uninsured children, and 29 percent of parents with children. Since these people would be enrolled in those programs automatically if they went to the hospital for care, calling them uninsured is really a smokescreen.

Another 10 million uninsured "Americans" are, at least technically, not Americans. Approximately 5.6 million are illegal immigrants, and another 4.4 million are legal immigrants but not citizens.

Nor are the uninsured necessarily poor. A new study by June O'Neill, former director of the Congressional Budget Office, found that 43 percent of the uninsured have incomes higher than 250 percent of the poverty level ($55,125 for a family of four). And slightly more than a third have incomes in excess of $66,000. A second study, by Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford, concluded that nearly three-quarters of the uninsured could afford coverage but chose not to purchase it.
And most of the uninsured are young and in good health. According to the CBO, roughly 60 percent are under the age of 35, and fully 86 percent report that they are in good or excellent health.

Finally, when we hear about 45 million Americans without health insurance, it conjures up the notion that all of those are born without health insurance, die without health insurance, and are never insured in between. The reality is that most people without health insurance are uninsured for a relatively short period of time. Only about 30 percent of the uninsured remain so for more than a year, approximately 16 percent for two years, and less than 2.5 percent for three years or longer. About half are uninsured for six months or less. Notably, because health insurance is too often tied to employment, the working poor who cycle in and out of the job market also cycle in and out of health insurance.

It seems those in true need of health insurance are the 10 million illegal immigrants and people who can't afford COBRA when they have lost their jobs, correct? The remaining groups either qualify for Medicaid or SCHIP, or choose not to purchase insurance.

Health care reform for those with insurance.

In this health care reform debate, when we hear the horror stories they are usually about people who were denied treatment, or dropped by insurance companies, or those who can't get coverage because of preexisting conditions. These stories are not about the 46 million who don't have health insurance. These are stories about the nightmares of people with insurance.

So, when the Obama Administration talks about health care reform, they really talking about creating government competition to private insurance companies. Right?

In an interview with ABC News after the town hall Lahn said he was not satisfied with the President’s response.

“I’m not trying to incite any uproar. I just want an answer. The American people deserve an answer," he said. "We have a Medicare/Medicaid, Social Security is bankrupting our country and we’re supposed to put more faith in the federal government? If you cant ride a bike don’t hop on the motorcycle, you know?”

Lahn said he got the same old talking points from the President.

I think this is why health care reform has become so confusing to people - the message originally pushed for the reason for reform was the 46 M uninsured. But the issue isn't providing coverage to those 46 million without insurance - because they do have access to coverage, but opt out one way or another (except for illegals). The main issue is people being denied care (or going broke) by their private insurance carriers.



Is it fair to say that the real problems are expensive private health insurance, insurance companies that deny care, outlandish lawsuits which increase costs, and expensive drug prices? I've noticed the administration has shifted slightly and is now calling it health care insurance reform. Doesn't this really boil down to a battle with the private insurance companies?

Obama wrote an op-ed today discussing his four step plan.

Affordable coverage for all Americans

"First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job."

Reform, cost controls, cut hundreds of billions from Medicare and Medicaid

"Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits."

Make Medicare more efficient

"Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies."

Mandate insurance companies

"Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable."

If the Government creates a government run public insurance plan, with the intent of providing low cost insurance affordable to all Americans, it will conceivably drive down costs in private companies to make them more competitive. Also, if the government mandates that insurance companies can't refuse a patient for a preexisting conditions, and must cover all illnesses (which they should) they could possibly lose major profits, perhaps even go broke? Would this lead to private insurance companies going out of business or requiring government bailouts?

"We will put an end to these practices. Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick.

Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies. There’s no reason that we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. It makes sense, it saves lives and it can also save money. "

And if we do get Health Care insurance reform, making insurance affordable to all Americans, why would we continue with Medicare, Medicaid, SCHIP and COBRA?

That wouldn't make sense to me. Why would we continue government subsidized, tax funded, federal and state programs to cover individual groups of Americans when the Government wants to create a Health Care Insurance Plan that would make health care affordable to all Americans?

This especially doesn't make sense in the cases of Medicare and Medicaid. The programs are going broke, and with Medicaid being funded in part by the states, many who are struggling, it doesn't make sense that they would continue that program. If Medicare is paid in part by payroll taxes, why wouldn't the government just roll those taxes over to the new Government Health Care Insurance Program, and do away with Medicare?

I am also confused when they talk about health care insurance that is affordable to all Americans, but costs a trillion dollars over ten years. If it is affordable to all Americans, why does it still cost a trillion dollars? What is that money for, exactly? Wouldn't it be more realistic to say that Americans will have access to insurance they can afford because someone else will be paying for it, for them? This doesn't really feel like reform, it just feels like someone is picking up the bill for uninsured Americans.

If you ask me, I think these reasons are why people are so frustrated and suspicious. What the Obama Administration is saying just doesn't make sense. I think the people screaming "keep your hands off my Medicare" see the writing on the wall. And if Obama intends to cut hundreds of billions of dollars in Medicare inefficiencies, it doesn't sound like a very *sound* program. How does he intend to cut? Obama ripped McCain for proposing cuts in Medicare, but now supports the idea.

"Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits."

Why is there so much waste, and how do they intend to fix the problems? Part of the cost of Medicare is attributable to fraud, which cost taxpayers over $60 billion in 2008. "The Government Accountability Office lists Medicare as a "high-risk" government program in need of reform, in part because of its vulnerability to fraud and partly because of its long-term financial problems."

I think those who are worried about losing their current insurance plans and doctors can see where the mandates and cost cutting can lead.

I feel like the Administration is dancing around their true Health Care plans, and in doing so, are muddling their message. They are trying to sugar coat/hide where the outcomes of the reform will lead. That's what people are picking up. I also think that is why people are worried about the so called *death panels*.

Like all industries, businesses look for ways to cut costs. Obama has talked about the rationale of operating on terminal patients, and even said perhaps sometimes pain pills are the solution. That's why people are worried. It's about cost cutting. The worry is that those sent to offer end of life counseling might be driven by the need to ensure those costs cuts are met. That seems a perfectly legitimate concern. Why do you think insurance companies deny care? Why do we think the government would be any different? Look what they do to the schools, in order to cut costs - school programs, classes, lunches, books, etc.

I think the Administration needs to be upfront and honest about their intentions (especially when so many of them have been videotaped saying they want single payer health care), plans, method to fund, and explain what their reform means down the road, because what they are proposing just doesn't make sense. And people can see that. Which is why approval is dropping.

Also, Obama does not support tort reform, and his administration has made a secret $80 Billion deal with PhRMA - two of the reasons health care in America is so expensive. Each year, $30 billion is awarded to victims of medical malpractice. That drives up our costs.

I agree that there is a need for insurance reform. Dropping people who get sick, people who have been paying for their insurance for years, is wrong. I think we need tort reform. I think if we are to have a government health care insurance plan, we need to do away with Medicare and Medicaid. I think it is wrong that Americans can become bankrupt if they get sick. I think pharmaceutical drugs are way too expensive.

I don't think the confusion, outrage and suspicion is based on misinformation being spread by any group - I think it boils down to the information being provided by the White House just doesn't make sense and isn't clear or developed thoroughly. I think we need an honest debate on where this reform will lead, and what it means in new taxes, and for Medicare, and for the future of private insurance. So far, we haven't heard any straight honest answers.

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If I understand the problems, and the intentions correctly (and who knows, I could be way off), I think if they were explained honestly, and clearly, and we knew what this means for the long haul, there would be a lot more people on board. The lack of information, and the feeling that things aren't adding up is what opens up the door for all kinds of misinformation to flood in. That is the problem I have with this debate. There is a feeling that the truth, the whole truth and nothing but the truth is not being told.

I think most people agree that lowering insurance costs would be a good thing. I also think everyone would agree that insurance companies should not be allowed to deny you coverage, or drop you if you get sick. I also think that most people would agree that drug prices are too high, and we should have tort reform. But these two issues are not even part of the current plans. How does Obama propose reform on skyrocketing health care costs without lowering drug prices (except for seniors) and tort reform? But because there is so much that doesn't make sense, or hasn't been communicated, people prefer to maintain the status quo. And in this economy, and with a trillion dollar price tag, and no clear vision, can you blame them?

I have no doubt that there are some groups who are against reform, but I think there a lots of people who are just confused about what this reform is, exactly. And yes, there have been some wingnuts out there protesting, but most people are honestly upset. People know how to add, but something here just isn't adding up...

Am I completely off my rocker, or does this just seem fishy?