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Advocates crow as Blue Shield yanks rate hike

By Josh Richman
Wednesday, March 16th, 2011 at 5:34 pm in Assembly, Dave Jones, George Miller, healthcare reform, Pete Stark, U.S. House.

Sacramento and Washington are abuzz over Blue Shield of California’s announcement today that it’s withdrawing its plan for a May 1 increase in health insurance rates for individual policyholders.

Blue ShieldIt would’ve been the third such rate hike since October; the three hikes combined would have raised rates by as much as 87 percent for some of its 200,000 policyholders, according to the California Department of Insurance. San Francisco-based Blue Shield has said rising health care costs forced the previous rate hikes; it said it lost $27 million on individual policies last year and expects more such losses this year. The cancelled increase will save members about $35 million to $40 million in added premiums.

Health-care affordability advocates say federal and state health-care reform laws are responsible for the insurer backing down.

“This latest withdrawal by Blue Shield shows that scrutiny matters. The new spotlight on rising health insurance rates, placed by the new federal health law and aggressive implementation at the state level, is having an impact of saving consumers money,” Health Access California Executive Director Anthony Wright said in a news release.

But while the Department of Managed Health Care and the California Department of Insurance now have the authority to review whether or not proposed rate increases are excessive, unjustified or unfairly discriminatory, neither department has the authority to reject such an increase.

“This is the third insurer that has withdrawn or reduced rates as a result of additional scrutiny and requests that they justify those rates. New federal and state laws now make these rate hikes public, but we need to take the next step, to pass the rate regulation bill now pending in the California legislature,” he said. “Blue Shield says they want a focus on the medical costs driving health care costs – but that’s what rate review and regulation would help do.”

And that’s what California Insurance Commissioner Dave Jones says he’s intent on doing. He wants to bring California in line with the 20 states in which insurance regulators have authority not only to review rate hikes but to reject the excessive ones; he has sponsored AB 52, carried by Assemblyman Mike Feuer, D-Los Angeles, to give that authority to his office and the DMHC. (Actually, the bill right now just declares the Legislature’s intent to make such a change, but I hear it’ll be amended in the next few days so that it would actually do the deed.)

Dave JonesJones issued a news release today saying he appreciates Blue Shield’s support of the federal Patient Protection and Affordable Care Act enacted last year, and of the health benefits exchange California is moving to enact under it by 2014. The law lets the Insurance Commissioner recommend which insurers will be allowed to sell insurance in this exchange, and “Blue Shield’s decision to refrain from a third rate increase is certainly consistent with their desire to participate,” Jones said.

“But one of the missing pieces of the federal healthcare reform is the authority to reject excessive rate hikes,” he added. “Today’s news is a welcome development and certainly a relief for several hundred thousand of Blue Shield policyholders in California, but it reminds us all that insurance companies hold all the cards when it comes to setting rates. Blue Shield policyholders still had to pay the first two rate increases. Those with health insurance are at the mercy of insurance company decisions to raise rates multiple times each year. That’s why we need to pass Assembly Bill 52.”

Feuer issued a statement today too, saying “(f)amilies and businesses should not have to depend on the whim of an insurance company to halt a major rate increase. Without a robust rate approval process in place, Californians will continue to experience these outrageous increases.”

Members of Congress were quick to weigh in on today’s developments as well.

Rep. George Miller, D-Martinez, the House Education and the Workforce Committee’s ranking Democrat, issued a statement calling Blue Shield’s withdrawal of its premium increase “good news for Californians who faced losing their insurance because of this rate hike. While California families are still suffering from the recession, they shouldn’t also have to worry about yet another hit to their pocketbooks.”

And Rep. Pete Stark, D-Fremont, the Ways and Means Health Subcommittee’s ranking Democrat, said Blue Shield is putting its money where its mouth is. “As one of the few insurers that has worked collaboratively toward health care reform, today’s actions show that its not just talk – they’re willing to put their money behind their words. I commend them for taking this action. While other insurers may be less willing to make moves like this voluntarily, the good news is that the tools enacted in the new health reform law will force them to be more honest and forthcoming.”

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  • Elwood

    Isn’t that nice?

    Georgie Porgie and Senile Stark are never at a loss for dimmiecrat talking points.

    I’m a little worried,though.

    Neither one of them mentioned working families.

  • John W

    Keeping in mind that, unlike Anthem Blue Cross, California Blue Shield is nonprofit (i.e., no shareholders), how can they go from needing repeated high double digit increases to being able to go with zero increase? Uncontrolled growth in underlying health care costs drives insurance rates, not the other way around. But this recent Blue Shield situation seems bizarre.

  • Jay

    If you want to free up billions of dollars for businesses because they will NOT have to cover employees anymore (this will produce significant job growth) is to go to a single payer.

    We do NOT need a middle man (insurance companies) taking profit out of the system. Instead the money should go directly to the medical professionals and institutions that provide you the care you need.

    In addition, it will significantly REDUCE cost for everyone that has insurance because it will have everyone in the system using a small amount of people’s paycheck. No more paying for people to use expensive emergency room visits. Now they will able to get help from a doctor before there problem gets bad.

    Lastly, it’s just the ‘humane’ thing to do.

  • EWard

    Single payer system means Government run healthcare.

    Here are some parts of Obamacare bill HB3200.

    Provides insurance to all non-U.S. residents, even if they are here illegally.

    The plan will be subsidized (by the govt) for all union members, union retirees and for community organizations (such as Acorn),

    The tax imposed under this section will not be treated as a tax????

    Doctors will all be paid the same regardless of specialty, and the government will set all doctors’ fees.

    Cancer hospitals will ration care according to the patient’s age.

    The government mandates advance-care planning consultations. Those on Social Security will be required to attend and “end-of-life planning” seminar every five years.

    The government will specify which doctors can write an end-of-life order.

    This bill will not apply to members of Congress.

    This is not a humane plan but all about giving the control to Big Government.

  • John W

    EWard,

    There can be honest differences of opinion about health care policy and what you like to call “ObamaCare.” But virtually none of the statements you made about the bill is true — from the first statement about insurance for illegal residents to the last about not applying to members of Congress. As the saying goes, you’re entitled to your own opionions, but not to your own facts.

  • Tom Benigno

    I was at a meeting today, one of the quests said “Quote now that the baby Boomer’s will be retiring they will want all the health care they can get”.

  • Josh Richman

    Re #4 and #5: John’s absolutely right that Eward’s statements are as wrong as the day is long; I just haven’t had enough time until now to back it up with the real facts.

    As the language tends to match exactly, I’ll assume Eward got these talking points from the viral e-mail based on the observations of former Texas judge David Kithil, pretty strongly debunked a few months ago by the Washington Post – as acknowledged by Kithil himself. But for everyone’s edification, let’s go point by point:

    “Provides insurance to all non-U.S. residents, even if they are here illegally.” False. There’s a generic nondiscrimination clause, which says insurers may not discriminate with regard to “personal characteristics extraneous to the provision of high quality health care or related services.” It says nothing about “non-US citizens” or immigrants, legal or otherwise. In fact, the legislation specifically states that undocumented aliens will not be eligible for credits to help them buy health insurance.

    “The plan will be subsidized (by the govt) for all union members, union retirees and for community organizations (such as Acorn),” False. Again, per PolitiFact, Section 164 creates a temporary reinsurance program to help employers or employee associations pay for coverage for workers ages 55 to 64. It does not mention labor unions or community organizer groups, though presumably they could qualify for subsidies like any other employee association that previously offered health insurance. The section’s point, however, is to offer subsidies to employer-based insurance programs, not unions or community organizers.

    “The tax imposed under this section will not be treated as a tax????” False; check pages 730-733, dealing only with the excise tax on high-cost, employee-sponsored health coverage. “The cost of applicable employer sponsored coverage shall be determined under rules similar to the rules of section 4980B(f)(4), except that in determining such cost, any portion of the cost of such coverage which is attributable to the tax imposed under this section shall not be taken into account and the amount of such cost shall be calculated separately for self-only coverage and other coverage.”

    “Doctors will all be paid the same regardless of specialty, and the government will set all doctors’ fees.” False. How could that even be possible, when it’ll still be insurance companies – not the government – deciding what physicians are paid based on services provided?

    “Cancer hospitals will ration care according to the patient’s age.” False. Section 3138, on page 321, essentially says the government has the power to study the costs of pay¬ments to cancer hospitals, and if it finds they’re charging more for the same services as general hospitals due to higher specialty drug costs and so forth, it can adjust pay¬ments to reflect those costs. Basically, it means the government would under some circumstances be willing to pay more of the cost for patients going to a cancer hospital.

    “The government mandates advance-care planning consultations. Those on Social Security will be required to attend and ‘end-of-life planning’ seminar every five years.” False. Not in the bill at all, nor is it what the Administration’s recent rule-making achieves.

    “The government will specify which doctors can write an end-of-life order.” False. I can’t find the phrase “end-of-life” anywhere in the bill, nor anything resembling this provision.

    “This bill will not apply to members of Congress.” Maybe that’s because Congress already has a government-subsidized health care plan from which no one can be excluded or penalized for pre-existing conditions, regardless of age, and in which dependents are covered up to age 26, whether they’re students or not, and even if they have a pre-existing condition. Most of the GOP House freshman joined that plan without complaint, by the way, even as they moved to repeal the Affordable Care Act.

  • John W

    Josh, kudos for fleshing out the specifics. Regarding the “members of Congress” part, they would obtain coverage through the “ObamaCare” exchanges (private insurance companies) when established in 2014 rather than through the current Federal Employee Health Plan. Even if that weren’t true, they would be no different than any other person who is covered through an employer-sponsored group health plan – the Federal Employee Health Plan in their case. Except for the fact that employees in that program have more private insurers and plan options to choose from, it’s much like any typical large employer plan. Employees pay roughly one quarter of the premium, deductibles, co-pays etc. In some respects, it is not as generous as the better private employer plans, in that, unless things have changed from the past, dental and vision coverage are available as options but not employer-paid. To their credit, a small number of Tea Party GOP members have walked the talk and opted out of the Federal employee plan, rather than be accused of being hypocrites for opposing “ObamaCare” while treating themselves to government-paid coverage. On the other hand, there was another new GOP member, a physician no less, who whined about the fact that, as a new enrollee, he had to wait the standard 30 days for his coverage to kick in.

  • EWard

    Josh Richman

    This is the language in Obamacare regarding illegal aliens….
    “Reading the actual summary of the health care reform law makes it very clear that illegal immigrants are not covered under Obamacare. Senator Harry Reid, House Minority Leader Nancy Pelosi, and Presiden Obama have stated countless times that illegal aliens are not covered under the health care reform law. Then why does the question persist? The answer has to do with H.R. 3200.”

    “H.R. 3200, the Precursor to the Patient Protection and Affordable Care Act of 2009
    The Congressional Research Service says that under H.R. 3200, a health insurance exchange would begin in 2013. It would offer both private and public options. There are no restrictions on citizenship. This means that whether a citizen or non-citizen, legal or illegal, permanent or temporary, that individual will be covered under the government health insurance exchanges. H.R. 3200 does not require individuals to show proof of citizenship when applying for an exchange, either.”

    Tax in Obamacare….12/13/10 Federal Judge Henry Hudson ruled against the Obama Admin. on 3 essential points…
    a. Individuals who do not actively participate in commerce–that is, who do not voluntarily purchase health insurance–cannot be said to be participating in commerce under the US Constitution’s Commerce Clause, and there is no Supreme Court precedent providing otherwise

    b. The Necessary and Proper Clause of the Constitution cannot be used as a backdoor means to enforce a statue that is not otherwise constitutional under Congress’s enumerated powers.

    c. There is a differnce between a tax and penalty, there is much Supreme Court precedent in this regard, and the penalty provision in Obamacare is not a tax but a penalty and therefore, is unconstitutional for it is applied to individuals who choose not to purchase health care.

    Doctors’ Fees….You cite the Washington Post. What you fail to mention is their claim was rebutted both by the WSJ and Obama himself. The “President’s own past prediction that his HC plan would eventually lead to a government-run “single-payer” health care system.”

    “Under Obamacare, govt. control is pervasive: Govt. defines what health ins. is. Govt. defines what “minimum essential coverage is. Govt. forces everyone to buy one of four varieties of high, low-value health ins. Congress establishes 159 govt. agencies to run the new hc system. The govt. grants new powers to the Secty of Health and Human Services. Why do you think she has granted waivers to companies about to dump the hc plans of their employees? How can you say this is not leading to Big Government HC?

    Cancer Hospitals – Ration Care
    Donald Berwick is the head of Medicare and Medicaid. Days after his appt. the Susan G. Komen for the Cure Foundation and the Ovarian Cancer Alliance warned for the first-time in history, FDA approved anti-cancer drugs might not be covered by Medicare.

    On Dec. 16 2010 the FDA revoked the use of Avastin for the treatment of late stage breast cancer.

    End of Life – Christianity Today 1/6/11

    “On New Year’s Day, the government implemented new Medicare fee policies for physicians including a “voluntary end-of-life care” provision that would reimburse doctors for advising patients on end-of-life care. The following Tuesday, the Obama administration announced the revised regulations would remove the provision, effectively halting renewed controversy almost before it began.”

    “The controversy threatened to re-ignite shortly after a memo from the office of Rep. Earl Blumenauer (D-Oregon) became public. (Blumenauer wrote the original end-of-life provision.) The memo celebrated the inclusion of the end-of-life provision in the Medicare regulations, which were released November 29 with little scrutiny. “The longer this goes unnoticed, the better our chances of keeping it,” according to the memo. The memo advised proponents to keep the inclusion “quiet” in order to avoid “the ‘death panel’ myth.”

    “The proposed new Medicare rules released last July did not include the end-of-life provision. However, the provision was included in the policies as released November 29. “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically,” an administration official said Tuesday.”

    Congress & Obama Care
    The HC coverage of Congress is paid by the taxpayers. If Obamacare is so great, why have over 1,000 waivers been granted to companies to exempt them temporarily from the bill?

  • EWard

    Obamacare Tax Hikes – Source National Review/Kiplinger Letter/National Taxpayers Union

    1. 10% tax on indoor tanning services
    2. Eliminate tax deduction for those employers who provide Medicare prescription drug coverage
    3. Increase HSA penalties by 50% to 20%
    4. Cap employer contributions to tax-free FSAs at $2,500. As of now, the “limit” is determined by your business
    5. Prohibit HSA funds from being used to purchase over-the-counter drugs
    6. Medicare surtax for individuals making $200,000 and families earning $250,000 as well as a 3.8% Medicare tax on investment income for these taxpayers
    7. You will have to spend 10% of your income on medical expenses before making itemized deductions. Currently, the starting point is 7.5%
    8. Employer mandate…All businesses with more than 50 employees will have to offer approved health plans or pay a tax of $2,000 per employee
    9. A Cadillac tax will charge high-value plans ($10,200 for individuals and $27,500 for families) a 40% excise tax
    10. Individual mandate…Everyone must purchase health insurance or pay a fee. According to National Review, it starts in 2014 at $95 or 1% of gross income, whichever is greater, and maxes out in 2016 at the greater of $695 or 2.5% of income

  • John W

    Re #10

    Josh already covered what is in the law on the books. Your list of tax items is far more truthful than your original claims about what was in the law. Nobody, especially not Obama, ever said expanding coverage to 30 million people would be free. He only said that, unlike Bush’s prescription drug program, it would be paid for and not add to the deficit. If you don’t like the idea of doing something to expand coverage and reform the individual health insurance market, then you won’t like any of the taxes. Fair ’nuff! I understand and agree with the rationale for several of the tax items you listed. I won’t go through it item-by-item but will point out that the Cadillac tax is good health care policy, not just a source of revenue to pay for the law. Cadillac plans are those that have no co-pays, no deductibles, no cost-sharing “skin in the game” by the person(s) who benefit. They lead to “what the hell, why not” over-use of the health care system and drive up global health care costs for all of us. The biggest mistake we ever made in health care policy was to exempt employer paid health care from taxable income. It’s a major reason why our health care spending as a percent of GDP is double every other country’s, including those with universal, single payer coverage. The tax exemptibility also disproportionately benefits people in higher tax brackets and subsidizes things like $15,000 “executive physicals.” Regarding HSA’s or FSA’s and over-the-counter drugs, do you really think the government should help people buy aspirin or Sudafed? If people don’t want to pay the tanning tax, they don’t have to go to the tanning salons. They’ll live longer and save the rest of us from paying for their melanoma treatments later in life.

  • Josh Richman

    Re: #9

    The language you cut and pasted makes my point: HR 3200 didn’t become law; HR 3590 did, and there’s nothing in the law that “provides insurance to all non-U.S. residents, even if they are here illegally.”

    Judge Hudson’s Dec. 13 ruling has nothing whatsoever to do with the nonexistent tax provision you cited the first time; rather, he found that the law’s individual mandate provision of the law exceeded Congress’ powers under the U.S. Constitution’s Commerce Clause. His judgement is currently being appealed to the 4th U.S. Circuit Court of Appeals, and almost certainly will then go to the U.S. Supreme Court.

    I didn’t cite the Washington Post in refuting your fallacious claim that “doctors will all be paid the same regardless of specialty, and the government will set all doctors’ fees.” It’s just simply not in the law. And maybe the President does hope that this law is a first step toward eventual consideration of a single-payer system, but no such provision exists in this law; also, single-payer advocates were sorely disappointed with this law, which they saw as a massive giveaway to the for-profit insurance industry – hardly socialized medicine. Government has regulated insurance for decades; this bill reformed how it’s done.

    The government’s move on Avastin has nothing whatsoever to do with any kind of rationing. Avastin remains approved for a half dozen forms of cancer, including colon, lung, kidney and brain cancer, but the FDA in December moved to pull the accelerated approval it had given the drug for use against breast cancer in 2008 because its manufacturer couldn’t produce evidence that the drug slowed breast cancer as much as it had previously claimed. Per the FDA, “The agency is making this recommendation after reviewing the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or ‘holes’) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.”

    As I indicated before, the Obama Administration – in a rule-making procedure unrelated to the Affordable Care Act – decided late last year to allow Medicare reimbursements for those who choose to consult their physicians about end-of-life care; no such consultations were to be required of anybody. In rescinding that amendment in January, Centers for Medicare & Medicaid Services Administrator Donald Berwick and HHS Secretary Kathleen Sebelius wrote, “While we believe that we acted within our authority in including voluntary advance care planning as an additional specified element of the new annual wellness visit in the final rule, it has become apparent that we did not have an opportunity to consider prior to the issuance of the final rule the wide range of views on this subject held by a broad range of stakeholders (including members of Congress and those who were involved with this provision during the debate on the Affordable Care Act).” And do you know what end-of-life consultations are, anyway? Are you against people making informed decisions about how they want to live and die, things such as palliative and hospice care, living wills, and so on? Even Betsy McCaughey, the former New York lieutenant governor who was one of the prime sources of that odious “death panels” lie, acknowledges “Medicare should reimburse physicians for counseling patients on the medical decisions they may face.”

    And finally, I’m not sure what your point is about Congress’ health plan. Here’s the latest on the waivers you mentioned; the Administration says they’re meant as a means of flexibility – so that employers and unions don’t bear extreme costs from the law’s requirements that they phase out annual dollar limits on coverage of essential health benefits – until the state health exchanges come into play in 2014.

  • Josh Richman

    Re: #10…

    There’s no disputing most of these, although there’s plenty of explaining:

    1.Here’s the IRS explainer on the indoor tanning services excise tax. And here’s one rationale for it.

    2. So, you’re against “government health care,” yet you’d prefer that employers not only get a government subsidy for retirees’ prescription drug benefits but ALSO keep deducting that subsidy from their taxes?

    3. Health Savings Accounts let you set aside money, for which you can then claim a tax deduction, to pay for whatever health care costs you expect to incur; that money can be carried along from year to year. HSAs often are offered as an alternative to a more traditional health insurance plan. The penalty to which you refer is meant to disencourage you from taking money out of your HSA for some purpose other than that, just the same way you pay a penalty for early withdrawals of the money you put into a 401k.

    4.) Flexible Spending Accounts let you contribute money from your salary before taxes are withheld and then use it to be reimbursed for out-of-pocket health care and dependent care expenses; the money can’t be rolled over from year to year – you forfeit whatever’s left in it when the year ends – so it’s important that you don’t over-withhold. FSAs often are offered in addition to a more traditional health insurance plan. The new law will limit Flexible Spending Accounts (FSAs) contributions to $2,500 starting in 2013, down from $5,000 today, but this doesn’t apply to HSAs.

    5. Starting January 1 of this year, over-the-counter drugs are no longer considered eligible medical expenses. However, if you get a doctor’s prescription for over-the-counter drugs then you can still use your HSA to pay for the items tax-free and penalty-free with your HSA. The rule against buying over-the-counter drugs with you HSA does not apply to non-drug over-the-counter items such as bandages or contact lenses cleaner. Read more about it here.

    6. Yes, that’s true – the nation’s wealthiest residents will be asked to pay a little more to support Medicare.

    7. Yes, the adjusted gross income threshold for claiming the itemized deduction for medical expenses is increased from 7.5 percent to 10 percent, although people 65 and older would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.

    8. Time magazine had a good rundown on the employer mandate, which already has been the law of the land in Hawaii since 1974, in Massachusetts since 2007 and in San Francisco since 2008. “In both states, the mandate has successfully lowered the rate of the uninsured far below the national average, without substantially adversely affecting businesses.”

    9. Beginning in 2018, insurers issuing unusually expensive, or “Cadillac,” employer health plans will be subject to a 40 percent excise tax on premium amounts exceeding $10,200 for single coverage and $27,500 for families. Per this excellent Kaiser Health News explainer, “The goal is twofold: to generate revenue to help pay for covering the uninsured; and to make the most expensive plans — which some argue encourage overuse of medical care — less attractive.”

    10. Yes, the Affordable Care Act imposes an individual mandate that everyone must buy health insurance or pay a fee. Supporters’ rationale is that the bill already bars insurers from excluding people due to pre-existing conditions – an idea that’s very popular with the American public – and without an individual mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage; you’d then get a feedback loop in which higher premiums would lead to more people dropping coverage. This is the provision at issue in many of the still-pending lawsuits challenging the law’s constitutionality; so far, three federal judges have upheld the law as constitutional while two have deemed it unconstitutional, and appeals are in progress.

  • EWard

    Josh

    Let me answer the claims about single payer aka Government run health care, rationing, waivers and doctors fees.

    My family pays $14,000+ a year for HC. This doesn’t include prescriptions or co-payments. These are out of pocket expenses for us.

    Obamacare mandates businesses with 50 or more employees to offer approved HC plans or pay a fine of $2,000 per employee.

    As a business owner with 50 employees, is it cheaper for me to pay the fines and drop the HC coverage of my workers? Or will I pay the $700,000 for 50 employees?

    Obamacare incentivizes businesses to drop the HC plans of their employees and thus employees are forced into exchanges. The exchanges are a precursor to Government run HC. There is a big difference between coverage and care.

    Why do you think over 1,000 waivers have been granted for 1 year by the HHS to a numbers of companies, organizations, and unions? Without the waivers, the companies would drop their HC plans. For example, McDonald’s told regulators that it would be “economically prohibitive” for its insurance carrier to continue cover its 30,000 hourly workers unless it received a waiver that 80% of premiums for such minimal plans be spent on medicare care.

    McDonald’s has its waiver for 115,000 workers, not just 30,000. Jack in the Box has a waiver. The largest waiver, for 351,000 people, is for the United Federation of Teachers Welfare Fund.

    Union benefit funds have received about 166 waivers. This means that 860,000 union members are exempt from Obamacare temporarily.

    If you access the HHS website, it takes about 6 clicks to reach the waiver’s list. What happened to transparency?

    Voters do not want government control HC. Obamacare requires 15,000 to 18,000 additional IRS agents to implement it. How does this give anyone quality health coverage?

    Over the next 10 years, Obamacare will take 500 billion from Medicare. Medicare recipients will receive higher premiums while doctors, nurses, and hospitals will earn less. The 500 billion will fund Medicaid patients.

    Baby boomers sacrificed for Medicaid patients. Boomers have paid for Medicare their entire working life. In Dec. 2010, Medicare doctors faced a 20% deduction in fees and another 6.5% deduction in Jan. 2011. This is rationing.

    Your comments about Avastin are misleading. “No cancer drug has ever been taken off the market based solely on “overall survivability,” says Sally Pipes, president and CEO of the Pacific Research Institute. Calculations of a drug’s effectiveness have been based on tumor response and progression-free survival rates, added Pipes.

    Stats on Avastin
    -In the manufacturer’s critical phase III study, tumors shrank in nearly 50% of patients receiving the medicine.
    -Patients who received Avastin in conjunction with chemotherapy lived nearly twice as long as would otherwise be expected without their disease worsening.
    -For some patients Avastin regime translantes into years of additional life.

    More govt rationing coming…
    -Medicare coverage for Provenge, a drug for advanced prostate cancer, is also in jeopardy.

    End-0f-Life Planning Before It Was Deleted

    Let me get this straight. You believe it’s normal for the end-of-life planning provision to be added without any public discussion or forum? Gee, I wonder why the public would get upset about that? Are you kidding me?

    Even Dr. Berwick talks about rationing. “The decision is not whether or not we will ration care-the decision is will we ration care with our eyes open.”

    Josh, do you want your Health Care rationed? What about your parents or friends? It’s unbelievable anyone would believe this is okay.

    Obamacare is an entitlement. If Social Security and Medicare are broke how can we afford this? More importantly, it will eventually force Americans into one system with bureaucrats such as Dr. Berwick making life and death decisions for us.

    Legal/Illegal Residents-Obamacare
    Source: Sen. Coburn’s office 8/2/10

    Legal residents are required to obtain the mandated HC coverage.

    Legal residents that have lived here less than 5 years and incomes 133% below the Federal poverty level cannot enroll in Medicaid. Instead, they can get highly subsidized insurance in an health ins. exchange. In other words, if Medicaid Ins. is lower quality, the legal resident with less than 5 years will have access to higher quality coverage than a US citizen with the same income.

    Undocumented aliens are not subject to the mandates or fines. They cannot buy into the exchange or enroll in Medicaid. However, hospital emergency rooms cannot deny them care.

  • Tom Benigno

    Many of us that are over 65 or even 75 that are still alive paid dearly for our coverage over the years. Now when those who are 55 to 62 say they paid and deserve more, they are right.
    Although soon there won’t be that many contributors to Social Security or Medicare that will be able to serve those new retirees. As it is now there are only one out of three people working and paying into the Social Security,and that is a major issue.
    If Blue Shield Blue Cross say they will not raise
    premiums,look out.

  • John W

    Re #15

    Your point about contributors to SS and Medicare is correct. I just started on Medicare, so I’ve doodled with the numbers. Median wage today is about $40k. Medicare payroll tax is 2.9% for employee and employer combined, which adds up to $1,160 per year. Many of us have paid way, way more than that over the years, but that’s the average. Based on those numbers, when the ratio of workers to Medicare enrollees falls to 2.3:1, there would be $2,668 into the Medicare Part A trust fund for each Medicare enrollee. Average Medicare costs today are roughly $11k per enrollee, with 20% of enrollees accounting for 80% of the costs. So you can see the problem. What’s worse is that medical costs are rising faster than average wages, so the gap will widen. It gets even worse. The payroll tax is just for Medicare Part A (Hospitalization). When the trust fund IOU’s are exhausted in a few years, Medicare Part A is not allowed to pay out more than it receives in payroll taxes. So something will have to give big time. Unless those of us on Medicare want to receive third world health care, we are going to have to pay far more than we do currently for the care receive. My Medicare Part B, supplemental plan, and Prescription Drug premiums add up to just $282 per month, compared to $528 I was paying Kaiser before going on Medicare. So, I probably should be paying something more like the Kaiser premium for Medicare, even though my lifetime Medicare payroll taxes total more than $120k. Then there is Part B (physician services), which is 25% paid by Part B premiums, some by co-pays and deductibles and the rest by general tax revenues. Same for Part D (prescription drugs). Then there’s Medicaid, funded with general tax revenue. Social Security is easy. When the SS trust fund IOU’s have been exhausted about 2037, SS taxes will cover about 75-80% of promised benefits. They can just cut the benefit amount across the board, raise the eligibility age, means test or whatever; but it all amounts to the same thing — cutting directly or indirectly by 20-25%. Both Democrats and Republicans need to rise above politics as ususal and get serious about this.

  • John W

    Re: #14 EWard

    “Obamacare incentivizes businesses to drop the HC plans of their employees and thus employees are forced into exchanges.” That’s one way of looking at it. Another is that employees will have a place to go to get insurance when their employers dump coverage, which many will do with or without Obamacare. And they’ll have more choices than just the one or two plans that an employer typically offers.

    Waivers — relax, they are all temporary and designed to avoid unnecessary disruption leading up to full implementation in 2014 — assuming the Repubs don’t ditch the whole thing in 2013.

    “If you access the HHS website, it takes about 6 clicks to reach the waiver’s list.” Big deal. It takes me six clicks to get the NCAA basketball scores.

    “Obamacare requires 15,000 to 18,000 additional IRS agents.” Total fiction made up by the Repubs. Check it out on Factcheck.org.

    “Obamacare will take $500 billion from Medicare.” Yes, and by reducing Medicare spending by that much, the life of the trust fund has been extended by several years. The reductions are (a) from reducing the special subsidy for Medicare Advantage private insurers, which paid those insurers more per patient than traditional Medicare costs; (b) from reducing wasteful over-charges for durable medicare equipment; (c) from reducing Medicare fraud and (d) by reducing payments to hospitals, since they will be saving money due to more people being covered, resulting in the hospitals having to provide less uncompensated care. All sounds good to me.

    “Boomers have paid for Medicare their entire working life.” Well, unless you have paid Medicare Part A payroll taxes on about $10 million in lifetime earnings, the taxes probably will not cover the cost of the hospitalization services you are likely to require during your Medicare lifetime. Also, those taxes only cover Part A. You’ve paid nothing through payroll taxes for Part B (physician services) and Part D (prescription drugs).

    “Doctors faced a 20% reduction in fees.” First, it didn’t happen. Second, due to statutory requirements, this has been coming up every year for many years, and then they pass a temporary “doc fix” to avoid it. It’s totally screwed up but has absolutely nothing to do with Obamacare.

    All your comments about Avastin etc. Josh was correct in his explanation on this, but you obviously are sticking to your own interpretation of things. As for Sally Pipes and the PRI, who do you think funds their so-called “free market” health care policy research? They won’t disclose the information (no transparency here), but it is generally known that much of the money comes from Big Pharma.

    End of life planning. Come on now. This has nothing to do with death panels, assisted suicide or anything like that. This was simply so that, if a patient wanted counseling about palliative care, hospice etc. from his or her physician, the doctor could get paid for it. Right now, docs can’t take the time to do it, because there is no way to get reimbursed for the time it takes to do it.