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  #1 (permalink)  
Old 11-07-2009, 05:05 PM
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So upset - medical insurance increase for 2010 :(

I currently pay $973 for medical insurance for JUST me (no husband or kids!)

And I just got a notice that it is being raised to $1,138 in January.

What in the world are people supposed to do?

I'm 62 so I have three more years until I can get Medicare.

This really sucks.
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Old 11-07-2009, 05:44 PM
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Ouch! Is that per month? If so, that's almost what ours is for a family of four. If we had to pay it (dh's company does) it would be our highest bill. Twice our mortgage. That's completely ridiculous for only one person.

My mom was looking into buying insurance, she's 53 with a history of cancer and the premiums were more than she made per month. Even one with a $10,000 deductible was several hundred dollars.
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Old 11-07-2009, 05:48 PM
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Yikes - can I ask what your deductible is? That's just a little less than what we pay for our family of four w/a $600 deductible, and then 80/20 until we've paid $1,600 out of pocket (per person... if two meet their $600's the whole fam is at the 80/20.... if two meet the $1,600, the whole fam is at 100%). DH's employer picks up 60% of our premium.
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Old 11-07-2009, 06:02 PM
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Hmm. I don't know. I suppose if we had a public health care option that would help, wouldn't it? Sorry if you're screwed. So are a lot of people.
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Old 11-07-2009, 06:36 PM
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Hmm. I don't know. I suppose if we had a public health care option that would help, wouldn't it?
You're kidding, right?
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Old 11-07-2009, 06:41 PM
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Unhappy

Wow that is alot and I thank God everyday that my parents have excellent coverage from my dads city job for it not with all my moms medical and now my dads medical problems it would be so so hard, this is not fair and I sincerely feel sorry for you again its not fair. Peace. Catherine
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Old 11-07-2009, 06:44 PM
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Originally Posted by ILUVLUCY420 View Post
Wow that is alot and I thank God everyday that my parents have excellent coverage from my dads city job for it not with all my moms medical and now my dads medical problems it would be so so hard, this is not fair and I sincerely feel sorry for you again its not fair. Peace. Catherine
I agree. And we do need reform.

Just not a public option.
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Old 11-07-2009, 07:07 PM
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I agree. And we do need reform.

Just not a public option.
A public option means that people who canbot afford coverage as described above could turn to the government for Medicare. I cannot understand why anyone is against that. 45,000 people die in this country every single year because they have no insurance.

Can you explain your opposition?
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Old 11-07-2009, 07:29 PM
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I agree. And we do need reform.

Just not a public option.
Yes, WE need reform....but, YOU don't need a public option. There are those that do.

In fact, we already have a public option...it is called Medicare.
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Old 11-07-2009, 07:34 PM
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The insurance companies know a public option will hold them to the fire to keep costs and profits low, which will help keep healthcare costs low. So, they are paying off the majority of the Republicans and one particular Senator from Connecticut to try to scare people with silly arguments to defeat the public option concept. Pretty simple really. The Republican party is quite adept at getting people to vote against their interests.

It is akin to getting people in red states to vote for those who want to reduce taxes. Even though red states get more back in Federal dollars per dollar invested than blue states. Mississippi gets back $2 in federal spending for every dollar it pays in federal taxes. Alaska $1.84; Louisiana: $1.78. North Dakota $1.68, Alabama $1.66, Tennessee $1.27, Idaho $1.21 and Arizona $1.19.

And, quite sadly, the common anchor to keep those pretty red states in line is abortion. It is a game. A financial game. And, abortion is just part of the game. Abortion will NEVER be against the law in the US. NEVER. But, time and time again it is used as a lure to get votes for other matters. Matters that are against abortion voters general interests. I find it quite sad. The racists I could care less about. But, the abortion people and the generally Christian religious voters being told who to vote for by their congregation leaders are being used as pawns is a disappointment.

Last edited by nightowlrn; 11-07-2009 at 07:46 PM.
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Old 11-07-2009, 07:52 PM
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I do not for one minute believe that moving to a public option will save us money in the long run. The government is notorious for underestimating by many times over the amount their programs will cost.

Name one government program that has gotten SMALLER over time.

I do not believe that government should get into the business of 'selling' citizens things in an arena where they are competing with private industry.

I believe that the hidden agenda is to ultimately end up with a system where every man, woman, and child is on the public dole. If there is a public option that is cheap, why would employers continue to offer insurance as a benefit to their employees? I foresee employers giving employees little raises to cover the cost of the public option and dropping them from the private system altogether. Then those individuals are STUCK with the public plan whether they like it or not. I believe that over time, that 'affordable' public option will only be supported by large, large, large increases in taxes as more and more people are part of the pool.

The reason employers are in the business of insuring employees goes back to the days when unions were beginning, as well as WWII, when there were government-imposed wage freezes and the only way companies could one-up each other and be attractive to potential employees was to offer benefits, which was allowed. To keep up with their competition, more and more businesses had to offer things like pensions and insurance. That worked when America wasn't competing against nations like China and there was cash to go around. Now that the marketplace is global, businesses don't necessarily have the cash to pony up all those goodies.

Personally, I live in an area of the country where unions - other than for teachers - really don't exist much. I've never been in a situation where we had cradle-to-grave safety nets. I don't think the government should be in the business of taking over what is currently a private sector industry because I don't think it will serve us well in the long run. They simply do NOT do a good job managing much of ANYTHING, and I am not ready to put them in charge of 1/6th of the economy.

Reform? Yes. Something that will bring costs down? Yes. But governmental competition against the private sector? Not their job. Not now, not ever.

I hope Pelosi and her bill go down in flames.
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Old 11-07-2009, 08:06 PM
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Well said nightwolrn.
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Old 11-07-2009, 08:31 PM
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$1,138 a month????

That's within a couple hundred of what I bring home a month, working a 40 hour a week job.

That is outrageous!
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Old 11-07-2009, 08:35 PM
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Her option is to let everything go and be on welfare. Then she can be taunted by the likes of many on this board for her inability to support herself and her poor financial planning. Or, she can just go to emergency rooms and know people who have no understanding of the horrors of health care costs will be paying for her care one way or another.
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Old 11-07-2009, 08:37 PM
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It's going to pass. A nasty amendment has been tacked on to make the GOP happy. (They're always happiest when sniffing panties)

Much of the arguments are just repeats of the arguments made by the GOP against Medicare. Ronald Reagan even made an album of the talking points. The GOP lied then; they're lying now. What's new?
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Old 11-07-2009, 09:01 PM
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It's going to pass. A nasty amendment has been tacked on to make the GOP happy. (They're always happiest when sniffing panties)
And this is the point at which you lose all credibility. That's pretty pathetic.
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Old 11-07-2009, 09:25 PM
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It's going to pass. A nasty amendment has been tacked on to make the GOP happy. (They're always happiest when sniffing panties)
I believe that was put in to appease some of the more conservative dems. The GOP isn't going be happy with anything this administration puts out. I'm all for bi-partisanship but there's no point in continuing to water down everything to appease them.
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Old 11-07-2009, 09:44 PM
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I believe that was put in to appease some of the more conservative dems. The GOP isn't going be happy with anything this administration puts out. I'm all for bi-partisanship but there's no point in continuing to water down everything to appease them.

I'm a bit confused as to what you mean here. I appreciate your knowledge of what's really going on (you're absolutely correct in that nothing has been added to appease the GOP - it's all an attempt to bring blue dogs onboard), but your statement about bi-partisanship seems to be in contrast to the first part of your post.

If it was bi-partisan they *would* have been trying to appease the GOP... but they've totally shut the GOP out, and have, as you indicated in the first part of your post, spent an inordinate amount of time trying to get fiscally conservative democrats in line.

I'm just scratching my head at the timing of this. It wasn't remotely part of Obama's campaign platform - at least not as a predominant plank. He campaigned on getting us out of the middle east and getting the economy back on track. To date, despite the fact that the economy seems like a runaway train even after his stimulus bills, he's focusing on what will ultimately cost taxpayers more than any other federal program ever has.

I just. don't. get. it.
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Old 11-07-2009, 09:44 PM
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We need reform, but when will people realize that the cost of the actual medical procedures, doctor appoitments & prescript costs are the real problem not insurance? That's what the gov. needs to try to fix.
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Old 11-07-2009, 10:01 PM
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We need reform, but when will people realize that the cost of the actual medical procedures, doctor appoitments & prescript costs are the real problem not insurance? That's what the gov. needs to try to fix.
Judy
Judy, I'm not really sure what you are saying - are you indicating that perhaps the problem isn't just insurance, per se, but the actual costs of the things we're having done, medically?

If so... while I don't have the answers, that has crossed my mind. I know that locally, an office visit is $80. That seems like a lot for a 15 - 20 minute appointment.

But then when I think about how many workers are involved in that visit who need paid, I come up with:
1) The person who answered the phone and scheduled my appt.
2) The person who checked me in
3) The nurse who weighed me, checked my pb, and took my temp
4) The chart-puller
5) The Dr.
6) The insurance filer
7) The cleaning service that is paid to clean the building at the end of the day

None of that takes into account the overhead of the building, the utilities, the insurance for the facilities, the insurance for the physicians, the x-ray machines and the MRI machines and the surgery rooms and the magazine subscriptions and the shot nurses and... dang, there are a lot of expenses associated with my 15-minute appointment and maintaining a facility capable of fixing whatever ails me.

I don't know what medical practices could do without or if they are padded in unnecessary ways. I do know that physician friends and relatives indicate that the government rate for reimbursements don't come close to covering their expenses. If EVERYBODY starts having their medical costs reimbursed at those rates, the rural hospitals I've always used will have to shut their doors. They're already struggling to make ends meet.
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Old 11-07-2009, 10:04 PM
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I
I'm just scratching my head at the timing of this. It wasn't remotely part of Obama's campaign platform - at least not as a predominant plank.
Healthcare reform was a HUGE portion of the Obama platfom. Perhaps you didn't notice for some reason.

Tell me then, what do you believe were the three "predominent" themes of his campaign and those of Senator McCaine's campaign then?
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Old 11-07-2009, 10:10 PM
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Healthcare reform was a HUGE portion of the Obama platfom. Perhaps you didn't notice for some reason.
I noticed a lot of talk about job corps and the war and the economy.
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Old 11-07-2009, 10:20 PM
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I noticed a lot of talk about job corps and the war and the economy.
Priorities: health care for all, ending the war in Iraq and addressing where the real problem was (Afganistan). Issues related to the economy came after our awareness the economy was on the brink of disaster.

Again, perhaps you didn't notice for some reason.

And, just so you are ready -- if healthcare reform is successful, the next issue to be addressed will be be energy. We were able address education already in bits and pieces the stimulus bills.
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Old 11-07-2009, 10:31 PM
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I'm just glad we get to vote him out in three years. If last Tuesday was any indication, things are about to swing back in the 'right' direction.
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Old 11-07-2009, 10:37 PM
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Time will tell
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Old 11-07-2009, 10:47 PM
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Back to the OP's issue...

KellyJef, I know you have mentioned your situation before. Can you refresh my memory about where you are, work-wise, etc?

I think that one of the downfalls with the employer-based system is portability, and I may be remembering incorrectly, but didn't you switch jobs semi-recently? While I don't want the government taking over, I've also never been a fan of the fact that employers are expected to offer health care as a 'benefit' to their workers. I think that's part of what has driven prices up. Large unionized companies set a standard that really isn't realistic, IMHO, and ultimately that drives the prices of their products up so high that... well, look at all those highly-unionized blue states.

My BIL has always had insurance that I can't even fathom. Their kids cost them $7, total. All pre-natal care, delivery... everything except the $7 it cost to have a tv in SIL's room. I also can't imagine how much his employer paid in premiums... and yet, in their world, companies that didn't offer the moon like that wouldn't get the best workers. The ante kept being upped, and the result was that their products were priced out of the marketplace for many Americans, and then sales slumped when our energy costs went up and people couldn't afford new cars, and the auto industry needed bailed out.

If employers had never been part of the equation, I think the private sector system we'd have would be unrecognizable to us...and much more affordable. When *we* don't see the bills for our premiums and employers are compelled to accept the exorbitant premiums or lose valuable employees, they bite the bullet every time. I think if we were paying for our own insurance the insurance companies - and the medical industry - would be more motivated to keep costs down.
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Old 11-07-2009, 11:42 PM
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I'm a bit confused as to what you mean here. I appreciate your knowledge of what's really going on (you're absolutely correct in that nothing has been added to appease the GOP - it's all an attempt to bring blue dogs onboard), but your statement about bi-partisanship seems to be in contrast to the first part of your post.

If it was bi-partisan they *would* have been trying to appease the GOP... but they've totally shut the GOP out, and have, as you indicated in the first part of your post, spent an inordinate amount of time trying to get fiscally conservative democrats in line.
I can understand making concessions to the blue dogs, we need their votes and they're willing to work at this. The GOP is a different story though. Changes have been made to try to garner GOP support, but it doesn't seem that they're willing to give an inch, so really, why keep trying? It's time for the dems to "sack up"and put through something that's really going to help average people.

I like to see debate on an issue, and don't want to see things rushed. But the longer this drags on the more convoluted the bill will become. Eventually it will just become a few changes in regulation and maybe a tax break or credit that really isn't going to make much of a difference to those that need help.

Keeping the status quo would be the most beneficial for me. I have a 100% company paid PPO. It's 90/10 and our ded. is 200 per person / 600 per family. We have it good (as far as insurance) a public option would likely put that in jeopardy, but it's not just about me and my family. There are a lot of people who need help and they need it now. When the biggest chunk of a person's pay is going toward medical cost or people are trying to decide whether to purchase food or medication, there's a serious problem.

I understand the GOP reluctance to work with the administration. When Bush was in office, I was usually distrustful of most of the things his administration did, not able to look at it with an open mind. I'm sure there were times that I didn't need to be, but when you don't trust someone, everything they do is suspect until proven otherwise.

If there was more give and take from the GOP, I could see hashing it out and coming up with a compromise. But it seems that the focus is on the negative and simply want to blast anything liberals may come up with. They've agreed on a few points, like Ins. companies not being able to exclude people for pre-existing conditions, but otherwise they're digging in their heels. Where as the dems have continued to to water down the bills to make some head way. It's not working and the dems are just continuing to be the woefully ineffective party that they are unfortunately. If they're not going to get support either way, it's time to find their balls and put through some real changes.
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Old 11-08-2009, 12:31 AM
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I'm just glad we get to vote him out in three years. If last Tuesday was any indication, things are about to swing back in the 'right' direction.
I'm hoping so too!
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Old 11-08-2009, 12:56 AM
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Red face

Well while I feel sadly for Kellyjef that medical premium payment is costly and not fair, I still will hold out hope that Potus Obama will make healthcare more afforable for all and I am not happy that we have 3 years left until we vote him out, I had hoped this would not turn to politics but it did all I know is I sincerely wish we were like foreign countrys who afford their citizens free healthcare that for all Americans especially the sick and elderly and babies and all in general a sincerely wonderful gift. Again no matter what you ever was voted in this year would have been dealing with the same problems and honestly do you really think things would have been any different it would not and thats a fact. Peace. Catherine
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Old 11-08-2009, 06:28 AM
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I'm just hoping I can get my Medicaid turned back on - we lost it briefly when hubby got a job finally but then he lost the job (sigh). We hadn't had health insurance at all for nearly four years prior to that because he worked contract/temp jobs. Not sure about the new reforms, but that Medicaid was the best health insurance I'd had since I was a little kid and my mom worked for a school district. I'm really desperate to get it reinstated before winter hits and I get sick like I almost always do.
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Old 11-08-2009, 07:01 AM
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Here's what I don't get. The same people champing at the bit for Medicare to kick in are the same ones who are against a public option. Please explain!
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Old 11-08-2009, 07:17 AM
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There is not doubt that we need some changes, but this current health care reform is not it!! If you think for one minute it is going to be cheaper you are highly mistaken. My personal opinion is that if you put a cap on how much a doctor can be sued, rates would go lower.
Here are just a few points in the health care reform... be very careful what you wish for!
Page 22: Mandates audits of all employers that self-insure!
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.
• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
• Page 58: Every person will be issued a National ID Healthcard.
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
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Old 11-08-2009, 07:50 AM
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Here are just a few points in the health care reform... be very careful what you wish for! ....
Did you actually look at the bill, or just pull those "points" from someone's blog? If you look at the pages cited, there are no such statements, other than the one regarding an agency that will decide what is and isn't covered by the plans. It doesn't state that the agency will decide what treatments you can and can't have!

People, do yourselves a favor and look at the bill for yourself. Don't trust so-called quotes from other sources.
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Old 11-08-2009, 09:07 AM
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A quick google reveals that the "points" about the bill were indeed taken from a blog or email. Here are the counterpoints, if you don't want to read the bill for yourself:

"Page 22: Mandates audits of all employers that self-insure!"
TRUTH: This is not an "audit," it's a study. Moreover, the bill states (pp. 22-23) that the report will "include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers." This is almost directly the opposite of the email's claim.

"Page 29: Admission: your health care will be rationed!"
TRUTH: Page 29 continues to define the "essential benefits package" and discusses limits on what Americans will have to spend on health care under this minimum standard. In no way does this section stipulate the rationing of care.

"Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)"
TRUTH: Page 30 begins to describe the Health Benefits Advisory Committee which establishes certain minimum standards for health insurance plans. In no way does this committee deny treatments and benefits to Americans with health insurance.

"Page 42: The 'Health Choices Commissioner' will decide health benefits for you. You will have no choice. None."
TRUTH: Page 42 begins to describe the Health Choices Commissioner' s duties. The idea that this person will decide what benefits Americans receive is patently false, given that most Americans will keep their current plans under reform, and Americans within the exchange will have the choice of purchasing many different kinds of health plans. Rather, the Commissioner will establish minimum standards to protect Americans.

"Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services."
TRUTH: Pages 50-51 contain a provision stating that discrimination will not be allowed in the provision of health care services. Nowhere does the bill state that non-US citizens will be provided free health care services. The bill prohibits federal dollars from being used for undocumented immigrants.

"Page 58: Every person will be issued a National ID Healthcard."
TRUTH: Page 58, in the context of a discussion of administrative standards, mentions that "determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility...may include utilization of a machine-readable health plan beneficiary identification card." In no way does the bill state that such a card would be national, or that it would be issued to every person, or that it would, in fact, be used at all.

"Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer."
TRUTH: Page 59 continues the discussion of administrative standards, and authorizes electronic transfers of money within the government. In no way does this provision grant the government access to individual bank accounts.
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Old 11-08-2009, 10:42 AM
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I heard that if you read the bill backwards it says Obama is the Massiah and a whole bunch of other stuff.
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Old 11-08-2009, 12:02 PM
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Originally Posted by wowitsdark View Post

KellyJef, I know you have mentioned your situation before. Can you refresh my memory about where you are, work-wise, etc?

My situation is this:

I lost my job in 2001 after 36 years when my company closed its doors with absolutely no warning (I actually worked in Human Resources so I was privy to a lot of confidential information and supposedly we were only going to have a major layoff -- not a closure).

Due to some serious, chronic health problems at the time I lost my job, I was only able to find periodic work as a temp from then on. I have had to pay for private, direct pay for my health insurance for the last 8-9 years. Originally, I was paying about $350 a month and it has gone up every year to the point where it will be $1,138 in 2010.

About a year ago, I found a permanent, part-time job that allows me enough flexibility that I am able to work around my health issues. But because it's part-time, I am not entitled to any benefits. Between my salary and my small pension, I can pay my medical premium -- and I am very grateful that I can. BUT that is only because my DH's social security takes care of the rest of our bills.

I just wish that I had retiree medical benefits from my company (like soooo many people have). I have to admit that I am very jealous of my MIL who worked for the school system: she has the best retiree medical coverage. She pays $5 for prescriptions and then gets $6 reimbursed!! That's just nuts.

DH is disabled and gets medical care from the VA.
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Old 11-08-2009, 01:27 PM
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I heard that if you read the bill backwards it says Obama is the Massiah and a whole bunch of other stuff.
lol Thanks for the chuckle!
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Old 11-08-2009, 01:45 PM
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My situation is this:

I lost my job in 2001 after 36 years when my company closed its doors with absolutely no warning (I actually worked in Human Resources so I was privy to a lot of confidential information and supposedly we were only going to have a major layoff -- not a closure).

Due to some serious, chronic health problems at the time I lost my job, I was only able to find periodic work as a temp from then on. I have had to pay for private, direct pay for my health insurance for the last 8-9 years. Originally, I was paying about $350 a month and it has gone up every year to the point where it will be $1,138 in 2010.

About a year ago, I found a permanent, part-time job that allows me enough flexibility that I am able to work around my health issues. But because it's part-time, I am not entitled to any benefits. Between my salary and my small pension, I can pay my medical premium -- and I am very grateful that I can. BUT that is only because my DH's social security takes care of the rest of our bills.

I just wish that I had retiree medical benefits from my company (like soooo many people have). I have to admit that I am very jealous of my MIL who worked for the school system: she has the best retiree medical coverage. She pays $5 for prescriptions and then gets $6 reimbursed!! That's just nuts.

DH is disabled and gets medical care from the VA.
I'm really sorry, KellyJeff. You're the perfect example of why some sort of reform is needed.

And I hear you about the 'that's nuts' w/school systems. Our retirees from that system have benefits like that as well, and they love it... but our district is in really, really dire straits right now, cutting programs for students right and left because the budget has to cover benefits for former employees. That's partly why I don't like the thought of a government takeover. I see what it's doing to other necessary things to provide such hefty benefits for employees who sometimes just put in 20 years and were fully vested.

I was visiting with my mom about this last night, and she mentioned not having any health insurance at all until they were done having kids. She said medical care was so cheap because there really weren't nearly so many things a physician could or would do. Yes, they could deliver your baby... but they didn't do home visits afterward, didn't do all the various tests immediately after birth, etc..

We do have such advanced capabilities... but they come at a very, very high cost.
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Old 11-08-2009, 03:13 PM
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I'm just glad we get to vote him out in three years. If last Tuesday was any indication, things are about to swing back in the 'right' direction.
More than 80% of the American people support the public option. Obama is still viewed favorably by more than 50% of registered voters.

Good luck replacing Obama with someone like Palin or Huckabee.
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Old 11-08-2009, 04:51 PM
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More than 80% of the American people support the public option. Obama is still viewed favorably by more than 50% of registered voters.

Good luck replacing Obama with someone like Palin or Huckabee.
Watch MSNBC much? Me thinks so if those are the stats you have to share.
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Old 11-08-2009, 06:41 PM
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Why do those who support Medicare not support the public option?
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Old 11-08-2009, 07:44 PM
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Why do those who support Medicare not support the public option?
Medicare and Medicaid are not administrated properly in this country.
If someone, anyone, could provide a good working model of how a public option shoud work---I could be convinced to get behind a public option.
I worked for the private company who administered the claims for Medicare....it was a sham. The paid for things that were questionable, but denied IMPORTANT things. For example---would pay for an ingrown toenail removal, but denied the ambulance ride to the MDs office. Why use an ambulance to transport? Bed bound patient on oxygen...

When our country can operate an insurance company (Medicare/Medicaid) and show that they know how to do it---then, I think we should discuss public option for healthcare.
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Old 11-08-2009, 08:45 PM
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Medicare and Medicaid are not administrated properly in this country. (blah blah blah).
I worked for CMS, not some claim company. I am one of the ones who interpreted rules and regs. I find it a great program. (with the exception of Part D -- talk about scammers) I could have thrown a few attorneys against the wall because of the whining they are hired to do for medical facilities, but overall the program is run very well considering the ever increasing numbers of very ill seniors. There are scammers out there, but deciding to catch them is often a cost analysis exercise. If catchng them costs more than just paying the claim, then not much effort is going to go into $$ to prosecute scammers.

--- An ingrown toe nail becomes infected and leads to potential amputation. Of course we want to take care of something cheap and easy rather than wait until it is going to cost 20K, a foot, and all the therapy after. Podiatry is of great importance to our elders due to decreased sensation for many reasons.

--- Medicare doesn't pay for non-emergency ambulance service generally. There has to be bright lines and this is one of them. Medicare doesn't pay for the convenience of a patient or a doctor. It does pay if a person cannot get out of bed without help, is not able to walk, and cannot sit in a wheelchair.

I don't know the specifics of your scenarios, but I don't want false information out on the board.

And - Medicaid is a state run program and every state differs. Medicare and Medicaid are in no way comparable. Medicare is an entitlement program and Medicaid is needs based.

ETA -- if you were in Montana and involved in Medicare Advantage --- let's just say that program was brought to us by the sam bunch who also brought us that fine boondogle Part D.

Last edited by nightowlrn; 11-08-2009 at 09:06 PM.
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Old 11-08-2009, 08:46 PM
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When our country can operate an insurance company (Medicare/Medicaid) and show that they know how to do it---then, I think we should discuss public option for healthcare.
So we should abolish Medicare? What do those who depend on it now do in the meantime?
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Old 11-08-2009, 08:52 PM
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--- An ingrown toe nail becomes infected and leads to potential amputation. Of course we want to take care of something cheap and easy rather than wait until it is going to cost 20K, a foot, and all the therapy after. Podiatry is of great importance to our elders due to decreased sensation for many reasons.

--- Medicare doesn't pay for non-emergency ambulance service generally. There has to be bright lines and this is one of them. Medicare doesn't pay for the convenience of a patient or a doctor. It does pay if a person cannot get out of bed without help, is not able to walk, and cannot sit in a wheelchair.

I don't know the specifics of your scenarios, but I don't want false information out on the board.

And - Medicaid is a state run program and every state differs. Medicare and Medicaid are in no way comparable. Medicare is an entitlement program and Medicaid is needs based.
Thanks for the insider information. I was skeptical of the anecdotal evidence.
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Old 11-08-2009, 10:16 PM
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I worked for CMS, not some claim company. I am one of the ones who interpreted rules and regs. I find it a great program. (with the exception of Part D -- talk about scammers) I could have thrown a few attorneys against the wall because of the whining they are hired to do for medical facilities, but overall the program is run very well considering the ever increasing numbers of very ill seniors. There are scammers out there, but deciding to catch them is often a cost analysis exercise. If catchng them costs more than just paying the claim, then not much effort is going to go into $$ to prosecute scammers.

--- An ingrown toe nail becomes infected and leads to potential amputation. Of course we want to take care of something cheap and easy rather than wait until it is going to cost 20K, a foot, and all the therapy after. Podiatry is of great importance to our elders due to decreased sensation for many reasons.

--- Medicare doesn't pay for non-emergency ambulance service generally. There has to be bright lines and this is one of them. Medicare doesn't pay for the convenience of a patient or a doctor. It does pay if a person cannot get out of bed without help, is not able to walk, and cannot sit in a wheelchair.

I don't know the specifics of your scenarios, but I don't want false information out on the board.

And - Medicaid is a state run program and every state differs. Medicare and Medicaid are in no way comparable. Medicare is an entitlement program and Medicaid is needs based.

ETA -- if you were in Montana and involved in Medicare Advantage --- let's just say that program was brought to us by the sam bunch who also brought us that fine boondogle Part D.
Actually, no, I worked for MT Blue Cross/Blue Shield prior to them losing the contract with CMS. FYI: We interpreted the same rules and regs you did. We weren't a bill processing center. We actually took calls from beneficiaries and providers---you know, worked in the trenches.
We disagree, but you don't have to be condescending. I saw things there that made me realize that while it (Medicare) is a good program there are areas for improvement.
The amounts paid for some CPT codes, but not others made me wonder.
When administration of oxygen during an ALS ambulance run is paid, but the code for supplies (oxygen and IV tubing) is "disallowed"? Doesn't make a lot of sense. Further, I found it disconcerting that (at the time) Medicare would not provide pre-authorization for procedures, thus if someone had a surgery and Medicare decided it wasn't necessary AFTER the fact---then the person ended up being charged. Also, at the time, Medicare (CMS) did not require medical notes to pay bills--it was based solely on Diagnosis codes and CPT codes. So, you saw a lot of MDs upcoding. They knew what CPT codes paid the highest.
There's a room for improvement.
1) Utilization review (which could help to make sure that all conserative measures had been tried, or if not there was a medical rationale for not...)
2) providing pre-authorization
3) requiring chart notes to substantiate all medical treatment.

Things may have changed--and I hope they have. But don't kid yourself--you may have actually worked for the Fed. Govt (CMS), but I did too (all my letters, voicemail message ID'd me as BC/BS of Montana FOR Centers for Medicare & Medicaid Services).
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Old 11-08-2009, 11:56 PM
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So we should abolish Medicare? What do those who depend on it now do in the meantime?
At this point, I don't know how you abolish it.

But I think if it had never been instituted, the free market would have helped keep medical costs down.

I think that is true of private insurers, as well. If we had never come to rely on insurance, never come to expect deep-pocketed employers to pick up that tab for us, etc., I think that medical care would be much more affordable.

As it is right now, medical care costs what it costs for many reasons. One of those reasons is because of the astronomical insurance costs physicians must pay just to be able to cover their own tushes. Check out the info here showing what OBGYN's pay in premiums just to be able to deliver babies. It states that in '04, it cost $270,000 in Dade County, FL. If an OBGYN had 270 pregnant patients, each of them would need to be charged $1,000 JUST to cover her Dr.'s malpractice insurance premiums! That's before the doctor even did a single procedure on the patient!

Hospitals and clinics must carry the overhead of the personnel involved with filing insurance claims. They have to have specialists dealing with Medicare and Medicaid. And those programs come with their own bureaucracies. In a thousand ways, the whole insurance scenario carries with it so many expenses that I think were insurance - government *or* private - stripped away, we'd see a dramatic decrease in what we'd need to pay out of pocket for hospitals and clinics to make a go of it.

CAN we get away from it at this point? I don't know how. And that's why I don't want us creating an even deeper obligation to this monster of a situation by going public option. Once we put our toe across the threshold, my gut tells me that within 20 years every one of us will have no choice but to use the public option. I think there is an agenda and that those who seek to institute the plans that are out there *today* ultimately want complete government take-over of the health care system, and this is just their first step.

Last edited by wowitsdark; 11-09-2009 at 12:10 AM.
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Old 11-09-2009, 07:54 AM
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At this point, I don't know how you abolish it.
You just abolish it. That's how.

Then, retired people will be in the same place as the rest of the folks in this country who can't afford to pay for private insurance. So what? No one who is against the public option seems to care about what those folks do about medical care.
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Old 11-09-2009, 08:45 AM
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"Not sure about the new reforms, but that Medicaid was the best health insurance I'd had" Im curious... The best because you didnt pay a penny for it and there are no co pays...
Well who wouldnt like that... If you went out and got a job, then there would be co pays and you would have to pay something for insurance....
THIS is why health care needs reform....
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Old 11-09-2009, 08:51 AM
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"Not sure about the new reforms, but that Medicaid was the best health insurance I'd had" Im curious... The best because you didnt pay a penny for it and there are no co pays...
Well who wouldnt like that... If you went out and got a job, then there would be co pays and you would have to pay something for insurance....
THIS is why health care needs reform....
Yeah, who do those lazy SOBs think they are? Get a job! What, you're disabled? Too bad! You have a job, but it doesn't offer health insurance? Too bad! You're elderly? Too bad! Every man for himself. Where do you think you are, a developed country? What would Jesus do? He'd say, "Too bad!"
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Old 11-09-2009, 09:00 AM
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You just abolish it. That's how.

Then, retired people will be in the same place as the rest of the folks in this country who can't afford to pay for private insurance. So what? No one who is against the public option seems to care about what those folks do about medical care.
That's quite an assumption. Just because we do not like THAT option does not mean we don't care.

Our seniors, by and large, lived much of their adult lives under the current system, with the expectation that Medicare would be there for them when they got to this phase in life. While it's not the scenario I would've preferred to see us do in the first place, now that it's here it wouldn't be ethical or moral to rip that away from people who planned with the expectation that it would be there. They've been taxed for it, like social security.

But for those in their earning years, I think the game is an entirely different one.
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Old 11-09-2009, 09:01 AM
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Yeah, who do those lazy SOBs think they are? Get a job! What, you're disabled? Too bad! You have a job, but it doesn't offer health insurance? Too bad! You're elderly? Too bad! Every man for himself. Where do you think you are, a developed country? What would Jesus do? He'd say, "Too bad!"
Okay, I'm sorry - I know this response was not to me, but it's impossible to reason with someone who can only hurl unfounded insults about the motives of those who don't care for a particular system and have a sanctimonious attitude about who 'cares' more. Give me a break. Get over yourself.
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Old 11-09-2009, 09:22 AM
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"I'm just hoping I can get my Medicaid turned back on - we lost it briefly when hubby got a job finally but then he lost the job (sigh). We hadn't had health insurance at all for nearly four years prior to that because he worked contract/temp jobs. Not sure about the new reforms, but that Medicaid was the best health insurance I'd had since I was a little kid and my mom worked for a school district. I'm really desperate to get it reinstated before winter hits and I get sick like I almost always do. " My post was in response to this poster... she does not mention that she is disabled or unable to work. If you look, her profile shows that she is 35 and a HOME MAKER... Yes in that case, get out and get a job....
Oh an dit also states she has 6 pets.... Maybe the amount of money spent on pet food could go to insurance... Well why do that when Medicaid is free?? We would all love to have insurance with no co pays, and not pay for it.. However most of us have too much pride in ourselves then to milk the system...
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Old 11-09-2009, 09:23 AM
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Okay, I'm sorry - I know this response was not to me.
Right. So get over yourself.
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Old 11-09-2009, 09:29 AM
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Right. So get over yourself.
I'm not the one claiming to care more, love more, and do more for my fellow man than others here.

I just believe that the system that attempts to 'save' the most people is not always the one that will create the most stability. Long term, instability will hurt the very people we were attempting to help, and I believe moving to a government-run system will create more instability than we have now.

You can't build stability on a foundation of fiscal irresponsibility, and I have yet to see the government get any awards for their financial acumen.
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Old 11-09-2009, 12:19 PM
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Not necessarily a statement of the above discussions, but my mom (and dad before he died last year), needed frequent contact with their Medicare adv program over the phone..For me, a 40+ college grad nurse, I often found the system hard to maneuver and get answers or clarifications.I did many appeals for them because of incorrect information and lack of payment..I don't know how the elderly without asistance from a child of other, are able to do this on their own..It's difficult just getting through the prompts (for someone who has no hearing difficulties).
As for insurance costs in general- my son had an ear infection over the summer-common for him as he's at our lake cottage..Because his ped office would not prescribe over the phone without seeing him, we ended up in the ER-only place to go in a small town..It cost over $500+ for insurance cost for a ten minute eval by a PA..Ear drops and antibiotic prescribed-the usual for my son. It would never be anywhere near this at the dr office..
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Old 11-09-2009, 12:40 PM
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I'm not the one claiming to care more, love more, and do more for my fellow man than others here.
I certainly don't claim to love more or do more. It seems to me that I and a lot of other people who support the public option care more than those who don't. What's your proposal for insuring the uncovered if you think the current proposal is no good?
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Old 11-09-2009, 06:29 PM
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