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Tuesday, March 23, 2010

Welcome To Bronzeworld

"Bronze" is the level of insurance that the Senate bill subsidizes.

Here is a WaPo calculator that helps you figure out your 2014 deal. Note that if this bill causes more employers to drop insurance, which it will, a lot of moderate income families are going to find themselves in Bronzeworld. Play with the calculator.

Note that it is a pretty good deal if you are healthy and low income, but for low-to-moderate income families with significant ongoing medical bills, many will be worse off than now - they will pay higher percentages of their income for medical bills than they now do.

This is why this bill is so sickening. So many of these people are going to realize that this is a cruel joke. Obviously we don't have 2009 stats yet, but I think median family income in the US will be in the 48-49K range. Anyway, take a look at the WaPo calculator and then guess what's going to happen to these people:
Rucker's wife has insurance, but the couple couldn't afford to put him on the policy. Now, he's excited he may also have coverage because of health care reform.

(Another example from the article).
"I worry day to day, honestly," he said. "I pray to make sure my child or my wife don't' get sick because, if they go to the hospital, we are looking at a couple of thousand (dollars in bills)."

Hah. In Bronzeworld, with 27%-30% copays, you are most certainly going to be facing a couple of thousand in bills every year. Don't think this will solve the medical bankruptcy syndrome!!! It won't. The ugly truth is that for many, insurance coverage and total out of pocket will grow under this bill. It's almost as if it were designed to prevent moderate income people from accessing medical care.

I can feel the mortgage defaults piling up already. I'm so depressed I want to suck my thumb under the bed for a week.

We need medical reform, but any medical reform has to make Medicare and Medicaid pay more for basic services as well as doing something for families who have chronically high medical bills. The biggest part of cost-shifting is coming from Medicare and Medicaid, not the uninsured.

Has anyone - anyone at all - figured out what this would do to a moderate income family with one person with moderate to severe diabetes? Anyone? Any chronic illness? Try insulin and testing costs on a 30% copay, and get back to me. Unless the regulators try to fix this by mandating (if they can, there's another range of lawsuits for you) first-dollar coverage for stuff that people have to have to maintain their health, we just condemned a huge number of people to a life of medical poverty.

I can't stand the gloating; this has turned into pure politics with no heart and no compassion.

God, I hate to post this. I tried to bold parts of it, but it all needs to be in bold. Are we there yet?

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed. That whenever any form of government becomes destructive to these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness. Prudence, indeed, will dictate that governments long established should not be changed for light and transient causes; and accordingly all experience hath shown that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security.

M_O_M, here's an article about some of the immediate measures implemented. There's some big goodies in here for seniors, plus it bans rescission. Those will mean something to some people--the question is what effect the taxes, penalties, and premium hikes will have, and whether they will outweigh the goodies politically.

Personally, I'm very worried about being able to keep my policy. We can't afford a full insurance plan that meets all the mandates in my state. We've got a catastrophic care plan with a very nice preventative care rider that is more affordable (and truthfully, gives us more of what we need than a traditional plan--we've got better dental and vision than the local Fortune 500 companies). I assume it won't meet the new mandates. I'm not sure how we'll afford an extra few hundred a month for the mandated coverage.
Neil - most of this bill's impact cannot be assessed very accurately, because there is a huge round of regulations to be written. And all the numerous commissions, etc.

The doughnut hole for the seniors is one thing - the first part is a $250 extra - but if doctor's payments are cut further that's not going to help them much.

I am concerned too - in theory this should be great for me, but in practice, none of my medical bills will be covered, and I'll be force to buy an astronomically expensive policy. I want a catastrophic - I'll pay all the regular bills on my own.

My concern is that many families will be forced to drop coverage in order to pay for medical bills.

The more coverage you mandate, the higher the premiums. It does get to the point that people can't afford to be insured.

An HSA with a high-deductible plan which kicks in with a good share percentage would work out a lot better for most people. Also it is cheaper and cuts administration.
Bulldog: Yes. We are there.

But also, we are the new guards.
CryingBulldog - My bulldog mix wants to meet you. She is charming, loves to take long walks if it is not raining, likes to snack on golf balls and the odd rock, and has a somewhat territorial approach to life. Loves to snuggle. Her personal credo is "Don't tread on me!"

"A long train of abuses and usurpations...." We're close.

I think 12 states have already filed suit? This is turning into such a weird boondoggle.
M_O_M, I'm guessing that eventually we'll all be driven to cash clinics for day-to-day stuff, and we'll muddle through as long as the government allows cash hospitals to open up. If not, there's going to be a lot of medical tourism. And, of course, we'll have to pay our poll tax every year without fail.

In the end, we'll muddle through and fix things, but right now is economically and demographically the time to be muddling anything at all.

How will HSAs be treated under the new regime? I have about $15K in one (mostly company funded) that just vested. Retire medical coverage just vested as well...but I think that will be gone ASAP (non-contract...can be dropped anytime, and will be...soon).
The only way to reduce costs is to stop the tort industry from bleeding the medical system. Less than half of the money paid out goes to compensate vicetims; the rest goes into the legal process. The only ones who benefit are the lawyers.

If this is placed squarely before the American people, they--we--will favor a fix. If they learn that forty percent or more of what they spend, and what their employer spends, and what the government spends, goes to liability insurance, they will support reform.
I have a nephew-in-law who is a medical fraud investigator. He has his own company and works under contract to insurance companies. He's not cheap. They hire him because he saves them money.

Medicare and Medicaid put no effort into policing fraud and waste. They say there this bill has provisions for stopping fraud and waste.

Why didn't they just do that as a starter? It would be a bipartisan winner. My read is that this is not about affordable care or access. It's about a new layer of government bureaus and regs.

May we throw as many of these bums out in November as possible.
What will this do to specialists? Those of us with oddball medical problems already get totally screwed in finding medical care at any price. Finding someone to help is the hard part.

I suspect this bill will crap all over specialists, which means that it effectively bans me from receiving medical care.
MoM,thank you for your coverage of this issue.It is a subject of vital interest to all Americans.I will not comment on the bill because I lapse into a vituperative rage when I try to.FUBAR will have to do.

"This is turning into such a weird boondoggle."

A new word will need to exist for those with children present.

I suggest clusterboondoggle.

Based on my very limited knowledge of the massive health care bill, it seems likely that I will be paying the tax penalty to remain uninsured. In that sense, it seems like a win for me personally.

Congress Just Offered Me Cheap Catastrophic Health Insurance

My girlfriend remains optimistic, but I think that's mostly out of necessity. The thought that her astronomically high health care costs could actually go up because of this bill is not a place she wishes her mind to go.
Neil, here's the shape of the future: speakeasy clinics. Congress just passed a "reform" that is going to work about as well as Prohibition, and the people are going to work around it the same way, if we don't manage to get it repealed first.

MOM, will you put in a good word for me with SuperDoc when it comes time to seek treatment at the SuperDoc Speakeasy?
Hah! Wonder what the secret knock will be?

Wife and I were discussing tonight what we need to take care of in the next six months. I'm pretty sure we'll be losing dental and vision. Fortunately, the baby will have arrived shortly before, so we shouldn't have to worry about any changes for that...
John, that's not even funny, because it looks like that's about where it will be.

One of the things that most people don't know is that most prescriptions are stored in electronic databases as a matter of law. By now all may be. In any case, the speakeasy doc will need to have his patients fill prescriptions out of the country or he may be sanctioned.

Right now there is nothing in this bill that prevents doctors from opting out of government and private insurance (not that there will be much of distinction). But there could well be increased FDA and DEA harassment over off-label uses of drugs.

If you guys want to know the secret knock, poor SuperDoc can't stand to turn away patients who are sick. So basically if you ever bring one who can't pay and pay for that person, you wind up in his "person who must always be seen" file.
Soviet - HSA's will be limited, but still there. The legislation is not hugely clear, but it looks like a 2.5K limit annually (based on recollection). I'll start posting some of precis soon; have patience.
I commented to a coworker today that this bill will expand two-way trade between the US and Canada: black-market cigarettes going north and black-market prescription drugs going south.

After all, if you are practicing in a speakeasy, it's not much of a step farther to breaking other laws. Then comes the payoffs to keep the speakeasy from being raided, and pretty soon you're at the Casablanca stage: "I'm shocked, shocked to discover illegal health care being provided in this establishment!" "Excuse me sir, here are your test results ..."
Stagflationary Mark: I've heard the term "goat rodeo" used as a family friendly version of the old "Charlie Foxtrot".

MoM: I'm holding out for your analysis of the bill. It's bound to be the best.

Speakeasy clinics: they'll be right next door to the speakeasy boutiques where they sell my unprovably lead-free baby booties and all the other non-compliant products for children 12 and under, including (gasp) loose-fitting cotton flannel pajamas. Down the street is Exhale, the club where people go to emit carbon dioxide without coming under government scrutiny. Across the street is the gun shop, and next door to that is the grocery store where you can get produce that was grown in secret backyard gardens without the benefit of federal inspection.

Speakeasy Street is gonna get pretty damn crowded pretty fast. Maybe we can all hide there and come out after everyone who's left outside has regulated themselves to death, and start a new government.
Vote Republican. Not only nationally, but locally. The State officials will be in charge of redistricting in 2011, which will affect the 2012 elections.

I want the #$^#$^#^ Democratic party to be less prevalent than the Greens.

By all means, encourage the tea party Republicans, we need true fiscal conservatives as much as possible... but work to throw every PoS Democrat you can out of office.

We can yet rid of this piece of crap. Yes We Can.

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