“Gray Matters” Moves from Newsday to Time Goes By

Health Care Reform (Again)

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category_bug_politics.gif The health care reform drum beat in Congress moves forward at the pace and feel of a dirge. Now Senator Majority Leader Harry Reid says there may not be a vote on the Senate bill until 2010. House Leader Nancy Pelosi expects a vote on the merged House bill this week or next weekend or sometime, depending the source you read. But until the Senate votes, there can be no work on a final bill for the entire Congress.

As the bills now stand, here are some key points from one or another or both. None of this is guaranteed as there is no way to tell what the final bill will contain:

In the Senate version, the public option would apply only to people whose employers do not provide coverage and who cannot buy private coverage for whatever reason. States would be allowed to opt out of the public option.

In the House version, according to reports prior to the vote, the public option is stronger and does not allow states to opt out. It also forbids the federal government from bailing out the private option.

That last item represents doom for any public option because in either the House or Senate version, the pool of public option participants too small to successfully spread the risk. Is it possible that among all 535 members of Congress, their thousands of aides and me, I am the only one who has noticed that failure of the public option is built in? Or am I naïve to think it isn't being planned that way?

There had been a provision in the House bill that would allow individual states to create single-payer systems if they chose to, but it was stripped out.

The House bill expands Medicaid to more people, and provides for a 5.4 percent income tax surcharge for singles earning $500,000 or more and couples earning $1 million and above to help pay for the bill.

The House bill also provides more generous subsidies to families buying coverage from exchanges and – good news for elders - it lowers the cost of prescription drugs for Medicare beneficiaries by authorizing CMS to negotiate drug prices with pharmaceutical companies. The Senate bill only reduces the doughnut hole a bit.

There are hints this week that the execrable trigger option, the brainchild of Maine Senator Olympia Snowe may be back on the table. If it is passed in place of any version of a public option, a public option will never go into effect.

These items don't begin to explain the bills in any detail which, anyway, seems a waste of good brain cells to try to do since there is no way to know what the final bill from the two houses of Congress will contain.

What is evident overall, as we have discussed, is that aside from preventing private insurers from rejecting insurance applicants for most pre-existing conditions, the bills generously preserve the status quo for private insurers, even guaranteeing tens of millions of new customers, in one of the bills, by mandating purchase of insurance and limiting the number of people eligible for a public option.

That's what millions of lobbying dollars buys; billions for private companies and minimal help for everyone else.

Having spent the entire summer deeply embedded in following the progress of health care reform, I am terribly disappointed in what we now have before us. The only thing that could improve my mood about health care reform would be a knight in shining armor riding in with a single-payer system and magically persuading Congress and the president to see the light.

However, since that will not happen...

There is no choice but to support what we've got. If some kind of health care reform is not passed by this 111th Congress, there won't be another chance for 15 or 20 years. And in the interim, health care costs will skyrocket leaving millions more than now unable to afford coverage or treatment.

It is better to pass even as weak a bill as we will apparently get and have something to work with – to amend, tweak, change and fix (even the best bill would need some of that) – than to face the collapse of Medicare in a few years and perhaps the entire health care system.

What worries me most about Senator Reid's retreat on a Senate vote before early 2010 (remember that the Senate already missed a promised August vote) is that the mid-term election campaign will be gearing up and senators facing voters next year will be a volatile bunch as they try to please all the people in their states all the time.

So keep writing and calling your representatives in Congress. Tell them what parts of the bills you like and what you don't like. Let them know that their vote will affect your vote in the mid-term election next year.

The PBS series Life (Part 2), hosted by my friend Bob Lipstyte, is continuing on television and online. This week it's about dating - the second time around. Here's a clip:

You can watch the full episode here.

At The Elder Storytelling Place today, Johna Ferguson: Looking Backwards


I urge everyone here to please make a phone call to speak to your House of Representive Congress person and/or your Senator. Here is the main number for Congress – the Senate and House – in Washington, DC. 202 225-3121

CSPAN will cover the House vote so if we know when it will occur, we can watch it.

I am finally able to switch from COBRA to Medicare and am prepping for that now. But first, I am filling all my prescriptions with a 3 month supply as I fear the donut hole until the new bill passes with a 50% dicount during the donut hole.

We have the power to make a difference.

I just heard on CNN that one of the items that may hang up a Saturday vote on the House health reform bill is that some representatives want to be sure no federal funds that go to people who would receive subsidies to purchase health coverage would pay for abortions.

As far as I know, abortion is still legal in the U.S. so I don't see how funds can be denied for a legal medical procedure.

Am I missing something?

After wrestling with what to do about our insurance when we went onto Medicare last year, we were just notified by the company from which my husband retired that our current Advantage plan won't be there as one of the options. So we have to figure it out all over again. The option the company wants him to choose would run almost $400 a month (the last one wasn't cheap) with Medicare Part B on top of it. They are offering a $500 deductible covering whatever Medicare won't pay. So more complicated and more cost for the patients. I wasn't surprised as the insurance companies are gearing up to figure out some way to keep their high profits. Covering those they had forced out before isn't going to cut into their profits but everybody else's cost.

We are thinking about going on straight Medicare which isn't ideal (with it only covering 80% of whatever went wrong). Last year I had one mammogram and one finger being stitched. Pretty much that premium then is for disasters which could happen to any of us anytime.

I so much wish we would go to a single payer for all people in this country. People have been so easily frightened of even the public option that that seems unlikely.

Single payer is the only way I can see for good coverage from the poor to the rich. When everyone has the same thing there will be more motivation in keeping it good and reasonable in costs.

Paying for abortion is a big hang up and an amendment being considered is that no public monies will be used pay for it. That isn't good enough for the foes of abortion; they want to have an amendment that private insurance that gets any funding from the government won't pay for it either. The mean spirited radicals also want to deny coverage to Illegals, even if they pay for the premiums out of their own pocket.

Both bills are riddled with so many bad things I am not sure if the whole complicated mess is even worth fighting for. I think everyone should bury their legislators with a demand for the single payer system and scrap all this convoluted reform that will do nothing to bring down the cost of insurance.

I suspect the House version of the bill really does have some advantages for Medicare recipients. Harold Meyerson of the Washington Post has explained and I post about it here.

Whether the exchanges survive (and do anyone looking for a choice any good) depends on whether they can be expanded. Curiously, I think the current Senate version is a little better on that -- by the time most of us have gone on, this one might make real choices available to most people.

Yes -- anti-abortion nuts are trying to derail the bill in the House. On this I do trust Nancy Pelosi -- not to do the right thing because I do believe she doesn't have the votes, but to work parliamentary magic and not let them stop it. This is what she's good at and she's of an age and class to be vigorously pro-choice.

I've been researching long term care recently, my child bride is now the sole breadwinner in the family (I retired 10 years ago) and she intends to retire in about three years. So we'll need LT Care at that point.
Apparently it's economically advantageous to get LT Care early, so your premiums are lower.
BUT- how can you compare premiums and conditions without talking to dozens of insurance peddlers?
A national insurance exchange would make comparing policies feasible
We are really sailing on a "Ship of Fools"

Allowing states to develop their own single payer system would be a plausible solution. Ohio already has a non-profit health management firm that's doing an amazing job. They and other states could pattern their system after it.

For Rain: Sounds like your husband's company is his worst enemy...Go to just plain Medicare plus a supplement like United Health Care through AARP...Plan F is the cadillac according my local senior advisor. Then enter his medications into the Part D plan & shop for the best price...

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