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NOTE:  This was written before the Public Option was taken off the table.  Much of analysis covers the Exchanges still in place as of June, 2012.

The comments are as important and add to the analysis.  Please add updated information you may have to the new diary.  Because of an html glitch, I am not able to copy/paste into new diary.  Again, the comments below add info, so the glitch is a good thing.

Learn about the ACA  here..  

An Analysis of The House Bill called:  “America’s Affordable Health Choices Act of 2009”

Is below.  I thought, if we are fighting for the Public Option, we could read it.  It's not that long.  It's a short read.  However, the Public Option is so dependent on another Section, I was bummed to learn I had to read that, too.

So the PART I of the diary is an overview of The Health Insurance Exchange (HIE), which will probably be what each State offers, in my opinion.  Will the HIE and non-HIE premiums cost the same if the Bill passes?

In PART II the Public Option has been copied and pasted and commented on.  It's a short read folks.  I hope you will take this chance, this weekend to learn in greater detail what we are fighting for and to raise important questions for our Congress.

DISCLAIMER:  Diarist is not a professional health care or policy wonk.  Comments reflect questions raised and a desire to better understand.  The diary is an invitation to professionals here to help us all know what we are fighting for.  However, much effort was made to share the questions that came to mind when reading the Bill sections below.  My apologies for any hints of cynicism and/or snarks.

If you do have some suggestions and information, please include a clear reference to the section you are commenting on.  I will include your information in future updates.  Thank you.

“America’s Affordable Health Choices Act of 2009”

You can read the whole Bill here:
http://edlabor.house.gov/...

The Public Health Option is found on page 116.  

HOWEVER, what becomes immediately understood is that the Public Option is subject to the stipulations under Division A, Title II, Subtitle A or the  Health Insurance Exchange which are the rules for all insurance providers allowed to provide insurance within the Exchange.

So, in order to understand the Public Option, we need to understand the rules for The Health Insurance Exchange.

OK, I read it for you.  Each paragraph below is what I felt were the important points.  I also included the questions and ideas raised when reading this.  

I will say, however, that I did not find any language referring to our coverage.  Here is a list of important points in the Health Exchange:

The Bill seems more about who can play, who gets paid and how, and THE MANDATES rules including the Excise Taxes fining those who don't comply.  But I haven't read the rest yet, either.

PART I Health Insurance Exchange Overview - Commentary
 

I think this is sort of like the Congress’ basket of choices.  The Health Choices Commissioner is established under section 141 along with a Health Insurance Ombudsman.

Quite frankly, there is a huge bureaucracy created under this Bill that seems to duplicate what Medicare already does.  Obviously, there would need to be an exponential addition of human resources for newly included insureds.

However, both the Federal and State Insurance commissioners will oversee it.

Actually, States may create their own Health Insurance Exchanges either singularly, or in conjunction with other states, pgs. 111-114.

Health Insurance is mandated in the America’s Affordable Health Choices Act of 2009 for employers and employees, pg. 110.  Both individuals and employers will have to pay an Excise Tax, payable to the US Treasury, for non-compliance.

6.  The individual will pay 2.5% of adjusted income, not to exceed the annual average insurance premium.  The employer pays less.  Can't remember or find where I gleaned this so it may not be true.

7.  All individuals and employers without insurance are eligible for the Health Exchange beginning in 2013.  Those with insurance are not eligible until the first 3 years pass or after 2016, or so it seems.

8.  In 2016, larger employers and their employees become eligible for Health Exchange options, but not before, or so it seems.  This protects the Insurers interests for almost 7 years.

9.  On page 78, it appears an individual can be considered a non-traditional Medicaid eligible if there is no gap in coverage prior to applying, in order to cover a period between loss of coverage and the upcoming open enrollment for the Exchange between September and November (pg. 96) each year.  

10.  Once enrolled in the Health Exchange, you remain eligible for the exchange, p. 79.  Towards the end of page 90, item (III) gives the Commissioner an opening for determination re:  Medicaid/Exchange eligibility.

11.  The Employer size breakdown is outlined on page 80.  Under 10 employees, under 20 employees, and all other employers.  Not sure why they have these three categories.

12.  The Employer mandate is outlined on page 81.  On page 144 the Employer contribution states the employer will pay 72.5% of individual premiums and 65% of family premiums.  The employer pays the rest and it appears this amount will be taxed as income, although I am not sure on this.

13.  The Employer must give the employee 30 days to decide and then, if employee fails to choose, the Employer will auto enroll the employee.

14.  Insurance providers, including the Public Option, are called QHBP offering entities.  On page 84, it states that to qualify the QHBP must offer three plans:  Basic, Enhanced, and Premium for the area of operation.

15.  The Basic plan has the highest out-of-pocket expense, the Enhanced less out-of-pocket expense, and the Premium the least.

16.  This seems to be much like our current three tier programs.  Sadly, those in most need will be sacked with the most out-of-pocket expense again, or so it seems.

17.  On page 86 it is clear that no dental or vision is included in these plans.  Another FAIL in my opinion.  There will be a Premium-Plus option that includes dental and vision for those who can afford the premiums.  

18.  On page 87, there is a hint of some health care services that will require no co-pay in the Basic plan.

19.  On page 88, the Commissioner will review and negotiate the Insurer bids in the same manner that Medicare review is done, I think.

20.  The Federal Acquisition Regulation will not apply to QHBP contracts, pg. 89.

21.  All QHBP will be licensed within the state they operate under State law.  Will any States not authorize the Public Option?

22.  A QHBP can notify the Commissioner of a “capacity limitation”.  What will that mean?

23.  The Commissioner will require risk pooling.

24.  Contracts for outpatient services with covered entities will be defined in the Public Health Service Act, July 1, 2009, section 340(a)(4) and specified by the Commissioner.  I couldn’t find the specifics online.

However, if you go to www.thomas.gov and search for

“Public Health Service Act” 2009.  

You will get a list of awesome of health improvement coverage made this year.  You can be proud of some of the work our Congress has done!  I hope the 100+ list of health laws are funded.

Back to the Health Care bill.  

25.  HMO’s are included on page 91.  However, on pg. 92 the co-pay for going out-of-network has to be equal to the co-pay for going in- network.  This is a good change.

26.  Pg. 97 hints that the Health Exchange polices are NOT portable; however, if you move out of coverage area, the Commissioner can grant Special Enrollment into a new Exchange.  Other special enrollment criteria are here as well.

27.  We can be auto-enrolled and randomly assigned as well.  Pgs. 97-98.

28.  This is foggy and, quite frankly troubling because the Public Option is not mentioned.  Individuals not covered by an employer will pay “the plans directly”.  Page 99.  There is not mention of who to pay for the Public Option.

29.  We will communicate via an 1800 number and the Internet, pg. 99.  On pg. 100 there is an opening to outsource assistance.  Go privatization!

30.  Page 102 has language that could indicate an Schip sunset and a move to Medicaid.  I know my state keeps cutting back funding for Medicaid so this concerns me, but I don’t know much about Schip or Medicaid.  This is an important question to ask.  I hope I am wrong here.

31.  AFFORDABILITY CREDITS, pg. 106.  The Commissioner will coordinate.  However, the Treasury will hold our Public Option premiums.  Some details are on page 120.

32.  Adverse Selection.  Will be minimized, not rooted out.  Disappointing.  Pg. 107.

33.  A new Bureaucracy will be created.  Pages 107-109.  The Office of the Special Inspector General for the Health Insurance Exchange, headed by a Special Inspector General, appointed by the President with Senate approval.  The Office of the Special Inspector General shall terminate after 5 years of the enactment of this bill, and two years after it begins operating, pg. 109.
34.  APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS.
“There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).
 

OK, does anyone anticipate any problems here?  Here’s what I see as a potential problem.  We are running deep deficits, so what money is there that the “Treasury not otherwise appropriated”.  A good question to raise.

Page 109

35.  Trust Fund and Excise Taxes for the Americans who choose to not comply.  Ok.  I am quite liberal; however, WHAT IS WRONG with a system that FINES people who can't or choose not to join this HUGE social experiment?   If all is affordable, who in their right mind wouldn't comply?  I can't seem to muster any faith in a system that allows Health Care for Profit to continue.  But, maybe that's just me.

36.  Here you can read about the Health Insurance Exchange money matters:

37.  SEC. 207. HEALTH INSURANCE EXCHANGE TRUST FUND.
(a) ESTABLISHMENT OF HEALTH INSURANCE EX-
CHANGE TRUST FUND.—There is created within the
Treasury of the United States a trust fund to be known
as the ‘‘Health Insurance Exchange Trust Fund’’ (in this
section referred to as the ‘‘Trust Fund’’), consisting of
such amounts as may be appropriated or credited to the
Trust Fund under this section or any other provision of
law.
Can we demand protection of this Trust Fund so another President doesn't dip into it to finance another "off the books" war like Iraq?
38.  (b) PAYMENTS FROM TRUST FUND.—The Commis-
sioner shall pay from time to time from the Trust Fund
such amounts as the Commissioner determines are nec-
essary to make payments to operate the Health Insurance
Exchange, including payments under subtitle C (relating
to affordability credits).
Is this written in anticipation of costs that may not have to be considered if we just made it simple and had two plans:  The One You Have and Medicare for Uninsured

39.  (c) TRANSFERS TO TRUST FUND.—

(1) DEDICATED PAYMENTS.—There is hereby
appropriated to the Trust Fund amounts equivalent
to the following:

110

40.  (A) TAXES ON INDIVIDUALS NOT OBTAIN-
ING ACCEPTABLE COVERAGE
.—The amounts re
ceived in the Treasury under section 59B of the
Internal Revenue Code of 1986 (relating to re-
quirement of health insurance coverage for indi-
viduals).
Are they expecting a windfall?  I sure hope not because only the uninsured have to pay this.  
41.  (B) EMPLOYMENT TAXES ON EMPLOYERS
NOT PROVIDING ACCEPTABLE COVERAGE.—The
amounts received in the Treasury under section
3111(c) of the Internal Revenue Code of 1986
(relating to employers electing to not provide
health benefits).
42.  (C) EXCISE TAX ON FAILURES TO MEET
CERTAIN HEALTH COVERAGE REQUIRE-
MENTS.—The amounts received in the Treasury
under section 4980H(b) (relating to excise tax
with respect to failure to meet health coverage
participation requirements).
43.  (2) APPROPRIATIONS TO COVER GOVERNMENT
CONTRIBUTIONS.—There are hereby appropriated,
out of any moneys in the Treasury not otherwise ap-
propriated, to the Trust Fund, an amount equivalent
to the amount of payments made from the Trust
Fund under subsection (b) plus such amounts as are
necessary reduced by the amounts deposited under
paragraph (1).

44.  Most of the remaining Title II discusses how the States can set up and operate their own Health Insurance Exchanges.  Well, don’t they already have “pools”?  The big concern in the language is on page 113.

As one of the criteria for acceptance by the Commissioner “The State provides assurances..WILL NOT RESULT IN ANY NET INCREASE IN EXPENDITURES TO THE FEDERAL GOVERNMENT”.

45.  What does that mean, and as most States are near bankruptcy, do you want to be forced into a mandated State Exchange?  If a State runs an Exchange, will we be able to opt for the Federal Public Option.  It is just not clear in the Bill, to me anyway.  

PART II - THE PUBLIC OPTION

So, as you now read the Public Health Insurance Option, you will have some idea of what they mean when they refer to QHBP and Health Care Exchange compliance.

So, here is the Bill's Public Health Insurance Option.  It doesn't take all that long to read, guys!

Again, you can read the whole bill here:
http://edlabor.house.gov/...

Page 116:  Subtitle B—Public Health Insurance Option  

SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A
PUBLIC HEALTH INSURANCE OPTION AS AN
EXCHANGE-QUALIFIED HEALTH BENEFITS
PLAN.

(a) ESTABLISHMENT.—For years beginning with Y1,
the Secretary of Health and Human Services (in this sub-
title referred to as the ‘‘Secretary’’) shall provide for the  
offering of an Exchange-participating health benefits plan  
(in this division referred to as the ‘‘public health insurance
option’’) that ensures choice, competition, and stability of
affordable, high quality coverage throughout the United
States in accordance with this subtitle. In designing the
option, the Secretary’s primary responsibility is to create
a low-cost plan without comprimising quality or access to
care.

The program won't go into effect until 2013.
(b) OFFERING AS AN EXCHANGE-PARTICIPATING
HEALTH BENEFITS PLAN.—

(1) EXCLUSIVE TO THE EXCHANGE.—The pub-
lic health insurance option shall only be made avail-
able through the Health Insurance Exchange.


If you are insured at the time it goes into effect, you won't qualify for the Public Option, if I understand this correctly.
(2) ENSURING A LEVEL PLAYING FIELD.—Con-
sistent with this subtitle, the public health insurance  
option shall comply with requirements that are ap-  

 Pg. 117
plicable under this title to an Exchange-participating
health benefits plan, including requirements related
to benefits, benefit levels, provider networks, notices,
consumer protections, and cost sharing.

(3) PROVISION OF BENEFIT LEVELS.—The pub-
lic health insurance option—
(A) shall offer basic, enhanced, and pre-
mium plans; and

(B) may offer premium-plus plans.  

Remember, a Basic, Enhanced, and Premium program with no dental/vision.  Also, I found no language stating any regulation on how competitive or not competitive this program will be allowed to be.  It will still cost money so I remain concerned for so many of us who don't qualify for Medicaid, but can't afford health insurance either.  Lot's of details need to be learned.
(c) ADMINISTRATIVE CONTRACTING.—The Secretary
may enter into contracts for the purpose of performing
administrative functions (including functions described in
subsection (a)(4) of section 1874A of the Social Security
Act) with respect to the public health insurance option in
the same manner as the Secretary may enter into con-
tracts under subsection (a)(1) of such section. The Sec-
retary has the same authority with respect to the public
health insurance option as the Secretary has under sub-
sections (a)(1) and (b) of section 1874A of the Social Se-
curity Act with respect to title XVIII of such Act. Con-
tracts under this subsection shall not involve the transfer
of insurance risk to such entity.

Is this the open door to the furthur privatization of the Public Option.  If so, good grief~
(d) OMBUDSMAN.—The Secretary shall establish an
office of the ombudsman for the public health insurance
option which shall have duties with respect to the public  

Pg. 118
health insurance option similar to the duties of the Medi-
care Beneficiary Ombudsman under section 1808(c)(2) of
the Social Security Act.


Another Ombudsman!  That's two new Ombudsmen so far.
(e) DATA COLLECTION.—The Secretary shall collect
such data as may be required to establish premiums and
payment rates for the public health insurance option and
for other purposes under this subtitle, including to im-
prove quality and to reduce racial, ethnic, and other dis-
parities in health and health care.
I like the sound of this.  Hope it means affordable premiums and out of pockets.  Although, somewhere in the Bill I read of the familiar $5,000 for individual, $10,000 family out-of-pocket deductibles.  Maybe I misread it.
(f) TREATMENT OF PUBLIC HEALTH INSURANCE OPTION.—
With respect to the public health insurance option,
the Secretary shall be treated as a QHBP offering entity
offering an Exchange-participating health benefits plan.
This is good reason why I included an overview of the Exchange.
(g) ACCESS TO FEDERAL COURTS.—The provisions
of Medicare (and related provisions of title II of the Social
Security Act) relating to access of Medicare beneficiaries
to Federal courts for the enforcement of rights under
Medicare, including with respect to amounts in con-
troversy, shall apply to the public health insurance option
and individuals enrolled under such option under this title
in the same manner as such provisions apply to Medicare
and Medicare beneficiaries.
Recourse for those who have legal resources.  Good idea!
SEC. 222. PREMIUMS  AND  FINANCING.  

(a) ESTABLISHMENT OF PREMIUMS

Page 119

(1) IN GENERAL.—The Secretary shall establish
geographically-adjusted premium rates for the public
health insurance option in a manner—

Not a "One Price Fit's All".  Darn!

(

A) that complies with the premium rules
established by the Commissioner under section
113 for Exchange-participating health benefit
plans; and

(B) at a level sufficient to fully finance the
costs of—

(i) health benefits provided by the
public health insurance option; and

(ii) administrative costs related to op-
erating the public health insurance option.

Don't we already know that we Can't Afford Medical Care in the USA.  It's too expensive.  There needs to be some price gouging legislation!
(2) CONTINGENCY MARGIN.—In establishing
premium rates under paragraph (1), the Secretary
shall include an appropriate amount for a contin-
gency margin.
Anyone want to guess what this might actually mean?
(b) ACCOUNT.—

(1) ESTABLISHMENT.—There is established in
the Treasury of the United States an Account for
the receipts and disbursements attributable to the
operation of the public health insurance option, in-
cluding the start-up funding under paragraph (2).

Section 1854(g) of the Social Security Act shall
apply to receipts described in the previous sentence

Page 120
in the same manner as such section applies to pay
ments or premiums described in such section.

The same rules/regs for Medicare payments found here:
Sec. 1854. [42 U.S.C. 1395w–24] (a) Submission of Proposed Premiums, Bid Amounts,[347] and Related Information.—
http://www.ssa.gov/...
 
(2) START-UP FUNDING.—

(A) IN GENERAL.—In order to provide for
the establishment of the public health insurance
option there is hereby appropriated to the Sec-
retary, out of any funds in the Treasury not
otherwise appropriated, $2,000,000,000.
In
order to provide for initial claims reserves be
fore the collection of premiums, there is hereby
appropriated to the Secretary, out of any funds
in the Treasury not otherwise appropriated,
such sums as necessary to cover 90 days worth
of claims reserves based on projected enroll-
ment.

(B) AMORTIZATION OF START-UP FUND-
ING.—The Secretary shall provide for the re-
payment of the startup funding provided under
subparagraph (A) to the Treasury in an amor-
tized manner over the 10-year period beginning
with Y1.

(C) LIMITATION ON FUNDING.—Nothing in
this section shall be construed as authorizing
any additional appropriations to the Account,
other than such amounts as are otherwise pro-

Page 121
vided with respect to other Exchange-partici-
pating health benefits plans.

Rats.  Are special fund authorizations for just the Public Option Fund disallowed?  Is this to protect the private insurers from UNJUST competition?
SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES.  

(a) RATES ESTABLISHED BY SECRETARY.—

(1) IN GENERAL.—The Secretary shall establish
payment rates for the public health insurance option
for services and health care providers consistent with
this section and may change such payment rates in
accordance with section 224.

(2) INITIAL PAYMENT RULES.—

(A) IN GENERAL.—Except as provided in
subparagraph (B) and subsection (b)(1), during
Y1, Y2, and Y3, the Secretary shall base the
payment rates under this section for services
and providers described in paragraph (1) on the
payment rates for similar services and providers
under parts A and B of Medicare.

This changes around a bit further down the page.  However, there are many doctors who don't take Medicare patients in my area.  How about your area?  Keep reading.  This becomes quite interesting.  As I said in the beginning, a lot of the bill is about HOW people can play and how they will be paid!
(B) EXCEPTIONS.—

(i) PRACTITIONERS’ SERVICES.—Payment
rates for practitioners’ services other-
wise established under the fee schedule
under section 1848 of the Social Security
Act
shall be applied without regard to the
provisions under subsection (f) of such sec-
tion and the update under subsection

Page 122
(d)(4) under such section for a year as ap
plied under this paragraph shall be not less
than 1 percent.

Well, that clears things up a bit?  Ok, I am snarking.  Here is the SSA site where you can read about PAYMENT FOR PHYSICIANS' SERVICES, Sec. 1848. [42 U.S.C. 1395w–4] (a) Payment Based on Fee Schedule.—
https://www.socialsecurity.gov/...

And here's the original Social Security Act 1935.   Note that it is only  maybe 11 pages.  Back when Congress KEPT IT SIMPLE!
http://www.nationalcenter.org/...

(ii) ADJUSTMENTS.—The Secretary
may determine the extent to which Medi-
care adjustments applicable to base pay-
ment rates under parts A and B of Medi-
care shall apply under this subtitle.
WIGGLE ROOM!
(3) FOR NEW SERVICES.—The Secretary shall
modify payment rates described in paragraph (2) in
order to accommodate payments for services, such as
well-child visits, that are not otherwise covered
under Medicare.

(4) PRESCRIPTION DRUGS.—Payment rates
under this section for prescription drugs that are not
paid for under part A or part B of Medicare shall
be at rates negotiated by the Secretary.

You may be noticing that Medicare is being used as the foundation.  So why not just sign people up for Medicare!  

Again, if you go to www.thomas.gov and search for “Public Health Service Act” 2009,
you will find a list of awesome of health improvement coverage made this year.  You can be proud of some of the work our Congress has done!  I hope the 100+ list of health laws are funded. I am assuming these were passed for inclusion in covered services under the Reform Bill to fill in some of the egregious exclusions by the present insurers.  I am just guessing, however.

NOTICE that the Pharma Windfall here is that all the drugs covered under Medicare part A and/or part B will NOT BE NEGOTIATED.  BS!

OK, back to Doctor payments.  Remember I mentioned above some policy shifting.  Here it is:

(b) INCENTIVES FOR PARTICIPATING PROVIDERS.—

(1) INITIAL INCENTIVE PERIOD.—

(A) IN GENERAL.—The Secretary shall
provide, in the case of services described in sub-
paragraph (B) furnished during Y1, Y2, and
Y3, for payment rates that are 5 percent great-
er than the rates established under subsection  
(a).

That's nice!  So Docs will be paid 5% more to treat non-Medicare patients?  Maybe I am reading this wrong.  Otherwise, could the elderly have an even harder time finding a participating doctor?

Page 123
(B) SERVICES DESCRIBED.—The services
described in this subparagraph are items and
professional services, under the public health in-
surance option by a physician or other health
care practitioner who participates in both Medi-
care and the public health insurance option.

(C) SPECIAL RULES.—A pediatrician and
any other health care practitioner who is a type
of practitioner that does not typically partici-
pate in Medicare (as determined by the Sec-
retary) shall also be eligible for the increased
payment rates under subparagraph (A)
.
PLEASE add the following:  "IF the practitioner will also take Medicare patients for non-gerintological treatments".  Please!
(2) SUBSEQUENT PERIODS.— Beginning with
Y4 and for subsequent years, the Secretary shall
continue to use an administrative process to set such
rates in order to promote payment accuracy, to en-
sure adequate beneficiary access to providers, and to
promote affordablility and the efficient delivery of
medical care consistent with section 221(a). Such
rates shall not be set at levels expected to increase
overall medical costs under the option beyond what
would be expected if the process under subsection
(a)(2) and paragraph (1) of this subsection were
continued.
The Bill could use more cost-containment language!

Page 124

(3) ESTABLISHMENT OF A PROVIDER NET-
WORK.—Health care providers participating under
Medicare are participating providers in the public
health insurance option unless they opt out in a
process established by the Secretary.
THIS IS IMPORTANT.  A provider will earn 5% more treating non-Medicare patients.  The low percentage of doctors treating Medicare patients surely shouldn't be invited to opt out of being a Medicare doctor.  Can someone from AARP chime in here, please?
(c) ADMINISTRATIVE PROCESS FOR SETTING
RATES.
—Chapter 5 of title 5, United States Code shall
apply to the process for the initial establishment of pay-
ment rates under this section but not to the specific meth-
odology for establishing such rates or the calculation of
such rates
.
RED ALERT:  There doesn't appear to be a Chapter 5 of title 5, United States Code?  There are three (3) sections under Title 5:
http://frwebgate.access.gpo.gov/...

And there is a Title 5 Appendix that has a Section 5 here:
http://frwebgate.access.gpo.gov/...

ADMINISTRATIVE PROCESS FOR SETTING RATES is very important.  I think this refers to what premiums we will pay.  Are they going to surprise us?  I have some rumblings that the Public Option will cost 20% or so less than existing premiums.  That's a rumor.  

(d) CONSTRUCTION.—Nothing in this subtitle shall
be construed as limiting the Secretary’s authority to cor-
rect for payments that are excessive or deficient, taking
into account the provisions of section 221(a) and the
amounts paid for similar health care providers and serv-
ices under other Exchange-participating health benefits
plans.
LAWYER ALERT!  Does this sound like an open door to an end of the year bill?  Or maybe a refund, although that would probably shock us to death!  I don't see how provider fees can be similar nationwide.  Could some providers actually improve their profit margins?   And why the Secretary and not the Commissioner who runs the Exchange for which the Public Option is part and parcel, or so we hope?  This clause raises more questions than it answers, in my opinion.
(e) CONSTRUCTION.—Nothing in this subtitle shall be
construed as affecting the authority of the Secretary to
establish payment rates, including payments to provide for
the more efficient delivery of services, such as the initia-
tives provided for under section 224.

(f) LIMITATIONS ON REVIEW.—There shall be no ad-
ministrative or judicial review of a payment rate or meth-

Page 125
odology established under this section or under section
224.

That's a lot of power for just the Secretary.  And no review?  Curious.
SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIV-
ERY SYSTEM REFORM.   Page 125

(a) IN GENERAL.—For plan years beginning with Y1,
the Secretary may utilize innovative payment mechanisms
and policies to determine payments for items and services
under the public health insurance option. The payment
mechanisms and policies under this section may include
patient-centered medical home and other care manage-
ment payments, accountable care organizations, value-
based purchasing, bundling of services, differential pay-
ment rates, performance or utilization based payments,
partial capitation, and direct contracting with providers.

(b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.—
The Secretary shall design and implement the payment
mechanisms and policies under this section in a manner
that—

(1) seeks to—
(A) improve health outcomes;
(B) reduce health disparities (including ra-
cial, ethnic, and other disparities);  
(C) provide efficent and affordable care;
(D) address geographic variation in the
provision of health services; or

Page 126
(E) prevent or manage chronic illness; and
(2) promotes care that is integrated, patient-
centered, quality, and efficient.

There goes that $2,000,000,000 start up capital.  Ok, I get silly after working too hard.
(c) ENCOURAGING THE USE OF HIGH VALUE SERV-
ICES.—To the extent allowed by the benefit standards ap-
plied to all Exchange-participating health benefits plans,
the public health insurance option may modify cost shar-
ing and payment rates to encourage the use of services
that promote health and value.
Oh, more privatization.  I just wish I knew someone on the inside.  But good for jobs.  High paying?
(d) NON-UNIFORMITY PERMITTED.—Nothing in this
subtitle shall prevent the Secretary from varying payments
based on different payment structure models (such as ac
countable care organizations and medical homes) under
the public health insurance option for different geographic
areas.
Prices and payments will vary geographically.  I hope they give some incentive to serve the non-served areas so health care becomes available to rural America.
SEC. 225. PROVIDER PARTICIPATION.  Page 126

(a) IN GENERAL.—The Secretary shall establish con-
ditions of participation for health care providers under the
public health insurance option.

(b) LICENSURE OR CERTIFICATION.—The Secretary
shall not allow a health care provider to participate in the
public health insurance option unless such provider is ap-
propriately licensed or certified under State law.

Could some language be added to ban doctors who have lost their license in any State?  I can just see a doctor moving from state to state.
(c) PAYMENT TERMS FOR PROVIDERS.—

Page 127
(1) PHYSICIANS.—The Secretary shall provide
for the annual participation of physicians under the
public health insurance option, for which payment
may be made for services furnished during the year,
in one of 2 classes:

(A) PREFERRED PHYSICIANS.—Those phy-
sicians who agree to accept the payment rate
established under section 223 (without regard
to cost-sharing) as the payment in full.

(B) PARTICIPATING, NON-PREFERRED
PHYSICIANS.—Those physicians who agree not
to impose charges (in relation to the payment
rate described in section 223 for such physi-
cians) that exceed the ratio permitted under
section 1848(g)(2)(C) of the Social Security
Act.
You can read the fees here:
PAYMENT FOR PHYSICIANS' SERVICES
Sec. 1848. [42 U.S.C. 1395w–4] (a) Payment Based on Fee Schedule.—
http://www.ssa.gov/...
(2) OTHER PROVIDERS.—The Secretary shall
provide for the participation (on an annual or other
basis specified by the Secretary) of health care pro-
viders (other than physicians) under the public
health insurance option under which payment shall
only be available if the provider agrees to accept the
payment rate established under section 223 (without
regard to cost-sharing) as the payment in full.
Dare we dream?  Will there be preferred physicians happy with the Medicare payments, or with 5% above Medicare?  And no co-pays from us? Am I interpreting this correctly?
Page 128
(d) EXCLUSION OF CERTAIN PROVIDERS.—The Sec-
retary shall exclude from participation under the public
health insurance option a health care provider that is ex-
cluded from participation in a Federal health care pro-
gram (as defined in section 1128B(f) of the Social Secu-
rity Act).
http://www.ssa.gov/...
Excludes individuals and entities from participating on the basis of prior convictions for fraud, patient abuse, felony conviction relating to a controlled substance, etc. (Thanks to triv33 for this contribution)
SEC. 226. APPLICATION OF FRAUD AND ABUSE PROVI-
SIONS.  
Provisions of law (other than criminal law provisions)
identified by the Secretary by regulation, in consultation
with the Inspector General of the Department of Health
and Human Services, that impose sanctions with respect
to waste, fraud, and abuse under Medicare, such as the
False Claims Act (31 U.S.C. 3729 et seq.), shall also
apply to the public health.
End of Bill
Under the False Claims Act, 31 U.S.C. §§ 3729-3733, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim.
http://www.taf.org/...
You can read the law here:  http://www.taf.org/...

The entities providing insurance coverage are called "QHBP offering entities".  They include (found on page 12):

Employer Sponsored Group Plan as defined by section 733(a)(1)(d) of the Employee Retirement Income Security Act of 1974;

Health Insurance Coverage from Private Insurer;

Public Health Insurance Option via the Secretary of HHS (must follow the rules of the Health Insurance Exchange);

Non-Federal Governmental Plan (or State(s) Plan), as defined in the Public Health Service Act, section 2791(d).  (A quick read through the Health Exchange language indicates that a State or group of States may create their own Health Exchange under the approval of the Secretary of HHS); and

A Federal governmental plan as defined in the Public Health Service Act in section 2791(d), overseen by the appropriate Federal official.

 
"(F) DEPOSIT OF PENALTY COLLECTED.—
Any amount of penalty collected under this paragraph shall be deposited as miscellaneous receipts in the Treasury of the United States.’

I think the Excise Taxes (fines for non-participation) should go into the Public Option Trust for payment of health care services to others, not "miscellaneous receipts" that will be sucked Down the National Debt Drain.  I don't get this clause.

Done!  Don't you think we should familiarize ourselves with this MONSTER SIZED BILL?

FYI.  Here are some websites that we can use in the future as we try to solve another proposed legislative puzzle:

Cornell University Law School has a great search engine for free:
http://www.law.cornell.edu/

Social Security Law, etc.  You can search for a specific section, which is very helpful with the health care issue.
http://www.ssa.gov/

US Government Printing Office, a great resource!
http://www.gpoaccess.gov/...

Originally posted to War on Error on Sun Sep 06, 2009 at 09:53 AM PDT.

Also republished by Single Payer California and Jobs Wages and Community Investment Working Group.

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Comment Preferences

  •  Tip Jar (234+ / 0-)
    Recommended by:
    Renee, JekyllnHyde, Mimikatz, Sally in SF, ferg, SarahLee, noabsolutes, Blutodog, Coldblue Steele, wu ming, Sherri in TX, LynChi, Pescadero Bill, bellatrys, eeff, TX Unmuzzled, frisco, bumblebums, HeavyJ, RubDMC, Gustogirl, concernedamerican, bronte17, EricS, Cassandra77, mbayrob, understandinglife, CoolOnion, Mlle Orignalmale, Pithy Cherub, greengrrl, nargel, Miss Blue, bewert, bejammin075, Eddie C, pat bunny, ranger995, elmo, CalbraithRodgers, GN1927, grrr, alizard, dkmich, bwintx, Matt Esler, econlibVA, kfred, tomjones, moggie12, valadon, The Gryffin, pat208, Big Tex, rapala, nailbender, radarlady, 3goldens, NoMoreLies, greycat, town, SherwoodB, mjd in florida, Militarytracy, sap, Jersey Girl, Flint, basquebob, david78209, NeuvoLiberal, Annalize5, Buffalo Girl, ladybug53, Burned, kaliope, JanL, Ekaterin, Asinus Asinum Fricat, Showman, sideboth, gwilson, Nightprowlkitty, Pinko Elephant, myboo, vigilant meerkat, sherlyle, trentinca, buckstop, sabredance, NBBooks, triv33, 4Freedom, Rosaura, Libby Shaw, ER Doc, Dreaming of Better Days, kurt, PhilW, Hedwig, markthshark, Aaa T Tudeattack, tegrat, bigchin, One Pissed Off Liberal, xaxado, donnamarie, nipit, Loudoun County Dem, dmh44, bluetownship, vets74, LillithMc, greenchiledem, Steve In DC, HCKAD, jayden, second gen, Jack the R, pioneer111, leonard145b, A Person, keikekaze, stony, TomP, Empower Ink, Eireknight, lisastar, Hippokleides, LarsThorwald, Haplogroup V, Jeff Y, rubine, Seamus D, temptxan, S C B, cheforacle, echatwa, haruki, allie123, Mayfly, CupofTea, Mike Taylor, FudgeFighter, SciMathGuy, Pris from LA, J M F, MTmarilyn, aufklaerer, litoralis, greengemini, BigAlinWashSt, eyry, carolyn urban, An Affirming Flame, Notus, proud2Bliberal, weltshmertz, velvet blasphemy, mrchumchum, Bonsai66, platypus60, ZilV, The Liberty of Meat, Hot2na, Corneliusmingus, PoliticalJunkessa, Little Flower, ArthurPoet, fernan47, Nonconformist, reesespcs, northernlights, Laughter Shrapnel, loveendures, citisven, Leftcandid, NuttyProf, Lazar, ppl can fly, My Stupid Opinion, Jez, miss SPED, LaughingPlanet, bullyness, jethrock, GeeBee, TheWesternSun, CS in AZ, RJP9999, Eddie L, Benintn, Mariken, juturna, Kristina40, JRandomPoster, Johnny Q, chambersc, MsGrin, sidious666, Rockpopple, dmet, BrowniesAreGood, Colorado is the Shiznit, heart of a quince, annominous, Journalist Julia, bgblcklab1, ems97007, vahana, AuroraDawn, Moe Gamble, two moms in Az, brendams, Billdbq, Ms Bluezone, marleycat, Cinnamon Rollover, Escamillo, gater2112, dle2GA, gokinsmen, Yogurt721, MRA NY, RMForbes, COkdub, Liberal Mole, Daulphin, Anthony Page aka SecondComing, Willa Rogers, RatCitySqueaker, mikeVA, rahzayfon, CalliopeIrjaPearl, lightshine

    Poverty does not mean powerless. Unite!

    by War on Error on Sun Sep 06, 2009 at 09:53:54 AM PDT

    •  Anyone know what this means? (9+ / 0-)

      Closing tag (li) does not match last opening tag (strong).
      Closing tag (ol) does not match last opening tag (li).
      Closing tag (strong) does not match last opening tag (ol).

      I made some minor editing changes and now I can't republish.

      I wish dKos would change their program so that IF there is a problem, it would tell us why.

      Oh my!

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 10:59:05 AM PDT

      [ Parent ]

    •  THANKS KOSSERS! (21+ / 0-)

      Hope this helps lots of people better understand what Congress is trying to do.

      Also, once I can figure out the tag problem, I have some edits ready to publish.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 11:13:44 AM PDT

      [ Parent ]

      •  First there is reading the bill (2+ / 0-)
        Recommended by:
        SarahLee, weltshmertz

        then looking at its ammendment history, what passed, changed or was substituted and why someone wanted that included or not, then there is understanding the implications.

        To me it looks like pre existing conditions can no longer be excluded, there is a public option, doctors are encouraged to work in primary care and community health by student loan forgiveness, primary care includes dental and optometry, and we still have insurance companies and administrators involved in running the program but with somewhat less opportunity to overcharge, exclude coverage or act without independant supervision or regulation.

        Live Free or Die --- Investigate, Incarcerate

        by rktect on Sun Sep 06, 2009 at 06:00:14 PM PDT

        [ Parent ]

        •  And, yet, there are still rescission statements (0+ / 0-)

          Why?

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 09:24:17 PM PDT

          [ Parent ]

        •  The Public Option, especially if it is (0+ / 0-)

          "regulated" on a state basis, is going to be a real headache for providers.  It will just add another insurer, or group of insurers, to deal with.  If the congressional goobers just opened up Medicare to the under-65 crowd that problem (as well as many others) would be nonexistant.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Mon Sep 07, 2009 at 11:14:33 AM PDT

          [ Parent ]

    •  I know what the "appropriated" clause means (2+ / 0-)
      Recommended by:
      WisVoter, War on Error

      There are hereby appropriated,
      out of any moneys in the Treasury not otherwise ap-
      propriated, to the Trust Fund,

      This is actually very powerful.

      The "moneys in the Treasury" include the money from sale of US Treasury bills/bonds/notes etc.  It's the big wads of Federal Reserve Notes which the Fed gives the Treasury in exchange for said bills/bonds/notes.  There's lots of it.  Always.

      One of those clauses appears to guarantee that the treasury will cover all of some particular class of expenses (I'm a bit confused by what), no dollar limit.  "Such amounts as are necessary?"  That's pretty powerful!  Congress doesn't pass open-ended appropriations often.

      an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).

      -5.63, -8.10. Learn about Duverger's Law.

      by neroden on Sun Sep 06, 2009 at 02:37:25 PM PDT

      [ Parent ]

    •  Public Option folks need to read: (4+ / 0-)

      Bait and Switch: How the Public Option was sold

      Reply to Critics of Bait and Switch

      and

      Can the Public Option succeed where Prudential Failed

      From the last link:

      Jacob Hacker laid out his vision of what is now called "the public option" in papers published in 2001 and 2007. Hacker spelled out five criteria he believed the "option" had to meet:

        1. It had to be pre-populated with tens of millions of people;
        2. Only "option" enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
        3. The "option" and its subsidies had to be available to all non-elderly Americans (not just the uninsured and employees of small employers);
        4. The "option" had to be given authority to use Medicare’s provider reimbursement rates (which are typically 20 percent below the rates paid by insurance companies); and
        5. The insurance industry had to offer the same minimum level of benefits the "option" had to offer.

      Although I question some of the assumptions Hacker made in these papers, including his assumption that the "option" will inevitably enjoy Medicare’s low overhead costs, I have little doubt that an "option" which met Hacker’s five criteria would stand an excellent chance of surviving its start-up phase in most markets in the U.S. (I am ignoring here the question of whether an "option" as strong as Hacker’s original has a better chance of being enacted than a single-payer system does. Events of the last few months should disabuse the entire world of that myth.)

      But when the Democrats drafted legislation early in 2009 that included provisions creating an "option," they abandoned the first four of Hacker’s criteria and kept only the last one (the one requiring insurance companies and the "option" to cover the same benefits). Proponents of the "option," including Hacker, did not raise a fuss about this. Not surprisingly, the "option" provisions of the bills introduced in July – one by the Senate Health, Education, Labor and Pensions (HELP) Committee and the other by the chairs of the three House committees with jurisdiction over health care reform – were basically unchanged from those in the draft versions. The Congressional Budget Office estimates the HELP Committee’s "option" will insure approximately zero people and the "option" in the House bill (HR 3200) will insure roughly 10 million people.

    •  Missing important information (1+ / 0-)
      Recommended by:
      ppl can fly

      Granted I got this from the CBO not reading the bill

      http://fpc.state.gov/...

      Federal poverty
      level (FPL)
      Premium payment limit
      (as a percent of income)
      133% or less 1.5%
      150% 3.0%
      200% 5.0%
      250% 7.0%
      300% 9.0%
      350% 10.0%
      400% 11.0%

      •  Federal Poverty Level 2009 (0+ / 0-)

        The 2009 Poverty Guidelines for the
        48 Contiguous States and the District of Columbia
        Persons in family Poverty guideline
        1 $10,830
        2 14,570
        3 18,310
        4 22,050
        5 25,790
        6 29,530
        7 33,270
        8 37,010
        For families with more than 8 persons, add $3,740 for each additional person.

        http://aspe.hhs.gov/...

        Submitted January, 2009 by Mike Leavitt
        http://aspe.hhs.gov/...

        Poverty levels since 1982, a list of each year:
        http://aspe.hhs.gov/...

        How to calculate the percentages of poverty level:

        I have a chart showing percentage multiples [e.g., 125 percent, 150 percent, etc.] of last year’s poverty guidelines.  How can I get an updated version of that chart based on this year’s guidelines?

        The only way to get an update of a chart showing percentage multiples of the poverty guidelines is to contact the organization or office that prepared it.  While ASPE calculates the poverty guidelines each year, ASPE does not calculate or prepare any charts showing percentage multiples of the poverty guidelines even though such charts may indicate the HHS poverty guidelines as the source.

        In general, one can calculate various percentage multiples of the guidelines by taking the current guidelines and multiplying each number by 1.25 for 125 percent, 1.50 for 150 percent, etc.  Be aware, however, that the rounding rules for these calculations, as well as procedures for calculating monthly income, are determined by the federal, state, and local program offices that use the poverty guidelines for eligibility purposes.

        http://aspe.hhs.gov/...

        Thanks, topdog08.  This was top of my Find List this morning.

        As a team, dKos can take on projects like this even if we are amateurs.  If we are mistaken in any analysis, those in the know will chime in and help.

        Poverty does not mean powerless. Unite!

        by War on Error on Mon Sep 07, 2009 at 06:42:57 AM PDT

        [ Parent ]

    •  What a bunch of crap.. (0+ / 0-)

      Each state still gets to regulate.  That means the public option will be regulated by each state.. but then again, the regs of the public option  will be set nationally, as will any plan in the exchange.

      Can anyone say "dueling regulations"?  (Cue theme from 'Deliverance')

      This is crazy.  We have to open up health insurance nationally.  We get absolutely no portability like this!

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon Sep 07, 2009 at 12:22:08 AM PDT

      [ Parent ]

    •  Thank you for repeating this (0+ / 0-)

      In the upcoming days, it is VITAL that people read not only your analysis but also the bill itself.

      I still love you and I still call you George.

  •  There appears to be very little (28+ / 0-)

    to get enthusiastic about -- quite the opposite. :-(

    I want a do over.

    Single Payer Single Payer Single Payer Single Payer Single Payer Single Payer Single Payer

    by CalbraithRodgers on Sun Sep 06, 2009 at 10:25:22 AM PDT

  •  Great followup, WoE (23+ / 0-)

    Thanks for all your work. This one's hotlisted too.

    Let the great world spin for ever down the ringing grooves of change. - Tennyson

    by bumblebums on Sun Sep 06, 2009 at 10:40:47 AM PDT

  •  Thanks for all the info... (11+ / 0-)

    I will read this carefully and save it for future reference. It has concerned me that I know so little about the actual legislation I am supportive of!

    Love is the lasting legacy of our lives

    by princesspat on Sun Sep 06, 2009 at 10:48:20 AM PDT

  •  Rec'ed it. Thanks for doing this. (19+ / 0-)

    WE DEMS ARE ALL IN. TIME TO JUST LEGISLATE IT FOR THE GREATER GOOD, or WE ARE ALL OUT.

    by potatohead on Sun Sep 06, 2009 at 10:58:15 AM PDT

  •  Having said that, I want a do over. (21+ / 0-)

    Seriously,

    This has been just shotgunned full of holes.  What is there is helpful, but just tepid.

    As it stands right now, FAIL.

    It's gonna fail like the Bank Bill failed.  

    WE DEMS ARE ALL IN. TIME TO JUST LEGISLATE IT FOR THE GREATER GOOD, or WE ARE ALL OUT.

    by potatohead on Sun Sep 06, 2009 at 10:59:12 AM PDT

    •  And given that we had all of August (15+ / 0-)

      for the public to have a chance to get educated about the bill - everything totally derailed byt the thuggist idiots of FOX, shutting down ANY intelligent discussion of something so vital to "The General Welfare" of the country.

      This is bizarro land, truly.  

      •  The proponents of the bill (13+ / 0-)

        are not encouraging intelligent discussion any more than the opponents.

        The bill is crap. It is more of the same. It adds new layers of complexity and bullshit (which translate into expense and inefficiency)

      •  Exactly (2+ / 0-)
        Recommended by:
        fernan47, Johnny Q

         

        And where was Bulldog Rahm? Why wasn't he out there, telling demonstrable liars to shut the fuck up?

        Necessity is the mother of revolution...

        by o the umanity on Sun Sep 06, 2009 at 03:17:59 PM PDT

        [ Parent ]

        •  He's totally corporate. Progressives are the (5+ / 0-)

          only ones actually calling for meaningful reform.

          Depressing really.

          I think we need to take the fight to them.  Diaried that the other day too.

          Just announce primary challengers for every corporate Dem Senator, start up a donation pool, $10 a month, or a week, or something, and campaign on them right now.

          Let the bastards get a taste of the blood bath coming in the mid-terms, if they screw us on this.

          Stimulus was tepid.  Fail.

          Bank bill was tepid.  EPIC FAIL.  We are actually worse off in most cases!  Unbelievable.

          The way this is structured, a whole lot of people will get either junk coverage for the same dollars, or have to pay more for the coverage they have now, all of that being mandated, and be excluded from whatever Public Option ends up being legislated.

          TRULY EPIC FAIL.

          WE DEMS ARE ALL IN. TIME TO JUST LEGISLATE IT FOR THE GREATER GOOD, or WE ARE ALL OUT.

          by potatohead on Sun Sep 06, 2009 at 04:21:56 PM PDT

          [ Parent ]

    •  Yup (18+ / 0-)

      FYI slinker posted some great analysis back in June re: Chuck Schumer's (apparently, successful) plan to compromise with various Dem factions on the public option, resulting in the weakened plan described above.  Here are links to two great diaries on the topic of a public option "compromise":

      http://www.dailykos.com/...

      http://www.dailykos.com/...

      Senate is playing games; this has been going on for a while.  The devil is in the details here.  If the public option can be crafted to be only marginally more attractive than private insurance, as well as unavailable to most people, that coupled with mandates will equal a bonanza for the private insurance industry---a backdoor way of that industry achieving its goal of being compensated for more vigorous regulations with an influx of compelled new $$$$$ from Anericans.

      So they're going to make the debate all about no public option versus a public option, then declare victory and pacify the left with a weakened public option which works almost as well for private insurers as no public option.

      I love that this diarist chose to post this analysis; incredible service to this site.

    •  How many Americans are aware (23+ / 0-)

      that the public option and reform doesn't become effective until 2013, after the next presidential election?  I don't believe that's what most people voted for and I mean moderates, Independents and Democrats.  WTF?  They really need to go back to the drawing board and think about the needy Americans that trusted them and/or are keeping them in office to look after them and not their corporate donors.   The corporate money-grubbing "Blue Dogs" will be the 1st to lose their jobs.

      To Congress: "GO BIG" or go home

      by mjd in florida on Sun Sep 06, 2009 at 11:39:21 AM PDT

      [ Parent ]

      •  Ah, You caught this subtle move. (15+ / 0-)

        I would suspect that the new Congress will be able to derail anything that challenges the power of the insurers.

        How many will die needlessly before 2013

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 11:52:32 AM PDT

        [ Parent ]

        •  Thank you (3+ / 0-)
          Recommended by:
          SarahLee, mjd in florida, Johnny Q

          How many will die needlessly before 2013

          We don't have that long, people. We don't.

          Necessity is the mother of revolution...

          by o the umanity on Sun Sep 06, 2009 at 03:32:18 PM PDT

          [ Parent ]

          •  Seriously we don't. (4+ / 0-)

            My costs doubled in 4 years, and this last increase was 40 fucking percent.

            In another diary, I suggested a good metric for judging the reform was simple dollars.

            Average Americans pay HALF.  Average small to mid sized business pays HALF.

            We get a huge stimulus, and it rolls back the worst of the damage.

            At this rate, we will have to say a FOURTH to actually get reform.

            It's so frustrating to see that simply not discussed.

            I am rapidly becoming a militant Democrat, who is deffo anti-big business and anti-free market.

            We are getting screwed on this deal.

            WE DEMS ARE ALL IN. TIME TO JUST LEGISLATE IT FOR THE GREATER GOOD, or WE ARE ALL OUT.

            by potatohead on Sun Sep 06, 2009 at 04:17:43 PM PDT

            [ Parent ]

            •  Gandhi Break! (2+ / 0-)
              Recommended by:
              o the umanity, CupofTea

              Like a good sherbert, Gandhi quotes can clear our hearts and minds after partaking of a few rich diaries.  And, like a cold shower, can still the raging passions of the heart.

              Here are some of his many wise quotes.  I hope they help mellow you all out a bit as well as inspire you to continue to Fight the Good Fight!  

              Gandhi pointed out three possible responses to oppression and injustice.

              One he described as the coward's way: to accept the wrong or run away from it.

              The second option was to stand and fight by force of arms. Gandhi said this was better than acceptance or running away.

              But the third way, he said, was best of all and required the most courage to stand and fight solely by non-violent means.

              Gandhi said that the non-violent activist, like any soldier, had to be ready to die for the cause. The difference was that the non-violent activist, while willing to die, was never willing to kill.

              http://www.mkgandhi.org/...

              http://www.dailykos.com/...

              Please, don't lose you soul because the souless irritate you, K?

              Violence begets violence begets violence.  It's a lose/lose strategy.  If we still have the law, we can fix this.  We just have to stop being hoodwinked by Corporaticians.

              I think other countries would be on THE PEOPLE's side, if the Feds get too nasty.

              Poverty does not mean powerless. Unite!

              by War on Error on Sun Sep 06, 2009 at 04:24:02 PM PDT

              [ Parent ]

              •  We have to stop this minority (1+ / 0-)
                Recommended by:
                wsexson

                Corporaticians are the minority here, numbers-wise. The only majority they have is the campaign war chest provided to them by their saviors on K Street.

                Corporaticians have stolen the soul of this nation, and I am tired of bending over for them, because I am tired of being screwed by their corporate-favoring policies.

                I am not a corporation, and I cannot compete with one. And I shouldn't have to. And neither should you.

                Necessity is the mother of revolution...

                by o the umanity on Sun Sep 06, 2009 at 04:32:08 PM PDT

                [ Parent ]

              •  Militant doesn't equate to violent. (3+ / 0-)
                Recommended by:
                wsexson, mjd in florida, lurks a lot

                What it does equate to is being less than nice.

                This is completely warranted given where we are right now.

                Politics as usual gets us legislation as usual.

                What that means is Americans being given last consideration all the time.

                Taking this crap to them is long overdue.

                We need to be taking this ugly corporate world view, highlighting it, and the damage it's causing, and wrap it right around the neck of these corporate wanna be Democrats.

                The only difference between them and Republicans is they are sympathetic to social issues.

                That is simply not good enough.  It never was good enough, but I'll have to be honest and say I didn't realize it, until this issue.

                I thought there were Democrats and Progressive Democrats.  I thought we had some common ground, meaning we might not get the best progressive legislation.  Nobody cares about that.

                What I did not expect was to see these clowns perfectly willing to screw us like Republicans would.

                The current legislation is very highly likely to do that.

                And it's so goddammed Orwellian too.

                All we are hearing is how much it will cost us.  Hell yes it's going to cost something.  What did people think?

                Truth is, it will cost the very wealthy and corporations, if we are to get meaningful reform.  The American people and small to mid-sized business needs a break.

                Too much cost and risk has been pushed onto them, and it's time to push it back some.

                This is why we got the majority we did.

                What do we hear?

                Maybe, if everybody is really nice, we can let the Bush tax cuts expire.

                I'm sorry, but that's not good enough.

                Maybe if we are really nice, we might get some tepid reform years from now.

                Not good enough.

                The simulus was deemed too costly.  So, it gets watered down, and half of it is more TAX CUTS.  Result = we stop the damage, but we don't actually give one iota of relief to ordinary people.

                Bank bill has time delays and is filled with holes.  Result = not one bit of relief, and for a whole lot of people, a flat out regression in terms of bank regulation doing them any real good.

                We've dropped a ton of money on wars, financial bailouts, and other expensive things.  The framing on those is "must be done", "everybody sacrifice", or some other damn thing.

                On this issue, "deficit neutral", and "how much it will cost".  

                Are you fucking kidding me?

                I hear Tarp is paying back nicely.  Fine, we've got money to start health care with right?  

                We have a debt based system.  There is no improvment in the state of things without incurring debt.

                The key is to make sure that debt is tied to the building of things of value, so that we get paid back.

                That's stimulus.

                Health care done right will cost us some initial dollars.  We get that back in the form of greatly increased economic activity because our businesses can compete and their overhead costs go down.

                How much is enough?

                That's my question.  I don't think there is an answer to it either.  They want as much as we can bear, plus a little.

                "militant" is an expression.  

                I'm not willing to be nice anymore.  If we get another useless piece of major legislation, all we have worked for is going to get lost, unless we actually step up as Progressives and make it damn clear we are not a part of this crap.

                Will that divide the party?  Hell yes it will, and I'm fine with that.

                As far as I am concerned, they need to be treated just like we treat Republicans.

                We drag out their dirty laundry and air it in public.  We drag out their corporate dollars and hang those around their necks.  We post up Progressive people to challenge them, consume their resources, and pressure them to reconsider.

                We grant them no quarter basically.  

                In fact, I would start with a comparison of their voting records and those of Republicans.

                Republicans got us here.  Took them 30 years.  

                During that time, Progressive Democrats were the only ones not wanting to go here.  We have been building and building.

                We have the high ground.  We have the majority support of the people on most of the issues.  We need to start very clearly differentiating ourselves from corporate Democrats, or we will be lumped in with them, and that's not ok.

                A big-corporate Democrat is just a nice Republican.  

                Not fucking good enough, and it's high time we started saying exactly that.

                That's militant.  Not violent, just brutally honest.

                WE DEMS ARE ALL IN. TIME TO JUST LEGISLATE IT FOR THE GREATER GOOD, or WE ARE ALL OUT.

                by potatohead on Sun Sep 06, 2009 at 07:20:15 PM PDT

                [ Parent ]

      •  Exactly (5+ / 0-)

        I think it would be such a big mistake for congress to try to sell the American people a bag of goods and call it healthcare reform.  This is something which affects too many people and to which too many people will pay vigorous attention for these types of games.

        Congress needs to deliver the reform which was sold to the American people.  Great point!

  •  A CO-OP won't work (27+ / 0-)

     John King on CNN is pushing for a CO-OP, stating "Farmers Do It".  Well in our community "Farmers Did It".  Our CO-OP went broke 4 years ago and shut it's doors along with several others in Southwestern Oklahoma.  PO is the only way to go.

  •  I've got a critical analysis (13+ / 0-)

    Especially of the current drawbacks.  It's the way I explaining why the current one should be dumped in favor of Medicare for Anyone Who Wants It

    -Hope never cost Corporate America a dime

    by DWCG on Sun Sep 06, 2009 at 11:07:45 AM PDT

  •  Maybe I missed it somewhere... (2+ / 0-)
    Recommended by:
    sockpuppet, GN1927

    Which of the at least five bills out there is this one? Is this H.R. 3200, or something else?

    Reality has a well-known liberal bias.

    by allergywoman on Sun Sep 06, 2009 at 11:12:34 AM PDT

  •  What you've just done here (29+ / 0-)

    is so tremendously important, I wish I had more than one rec for you.

    We're not just fighting against no public option; we're fighting against a weak public option or a public option in name only, which, coupled with individual mandates, would gently herd most of the uninsured into purchasing private insurance products, while congresspeople get to grandstand and proclaim, "I'm fighting for the public option!!" not telling us that it is designed from the vantage point of a "fair playing field" for private insurers, not from the vantage point of what's best for average Americans or the necessity of controlling costs via a new, well-funded, muscular nonprofit competitor in the healthcare insurance industry.

    Funding limitations.  Negotiation limitations.  Restricted availability.

    We can do better than this.

    Thank you so so so very much for taking the focus here.  You've just done a tremendous service to HCR discussions here.

    •  This is what the Republicans desperately want to (9+ / 0-)

      .... strip out of the bill because they think it goes way too far.

      Please keep that in mind.

      The opposition to this bill is that this mild public option is actually radicalized socialism/commmunism/complete govt takeover of all medical care in the US

      So stripping it out, as the Republicans want the purity trolls such as the single payer people to do, works in their favor to validate what they've been claiming all along.  The Blue Dogs are compromised by Oil and DOD money. So are some of the most liberal members of Congress, not signing on to the pledge to keep it in the bill.

      Now this sh*t.

      Yes, they could have done better, they didn't, THEY WON'T,  and you just discovered you let the Republicans frame the issue for the past 3 months.

      "Toads of Glory, slugs of joy... as he trotted down the path before a dragon ate him"-Alex Hall/ Stop McClintock

      by AmericanRiverCanyon on Sun Sep 06, 2009 at 11:31:58 AM PDT

      [ Parent ]

      •  They absolutely can do better (4+ / 0-)
        Recommended by:
        wsexson, buckstop, Cassiodorus, AuroraDawn

        they were contemplating doing better, because I remember watching with total complete dismay as Schumer started granstanding on a weakened public option, spreading the meme that it is somehow imperative that the public option be perceived as "fair" to private insurers.

        They can certainly do better than this IMO, and I was never a unwilling to compromise from single payer.  I always liked the plan which POTUS sold on the campaign trail: strong public option (whomever doesn't want it doesn't have to buy it, end of story) coupled with no mandates for adults (under the logic that people actually won't have to be forced into buying a quality, affordable insurance product).  That's what was sold to the country, and that's what congress needs to deliver IMO.  Even from a purely political vantage point, this is the best thing to do IMO.

        •  He was definitely against mandates. (4+ / 0-)
          Recommended by:
          neroden, buckstop, xaxado, Johnny Q

          I remember that speech.

          Hey, are all of his speeches available somewhere to read.

          Next election, we have to have a way to record everything the Corporaticians say.

          I am upset.  Too many are suffering in America needlessly.

          And the Swedish get 5 paid weeks of vacation every year!

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 01:09:36 PM PDT

          [ Parent ]

          •  He's probably still against mandates (2+ / 0-)
            Recommended by:
            neroden, JanL

            personally, but he is a leader in the party, not the party.  He's not writing this legislation and he can't just railroad congress or make demands.  That failed during the Clinton years.

            The only solution that we have IMO is: just as in '07, '08, the progressive grassroots is going to have to step in here.  Your diary is a fine addition to that effort.

            •  So he's against them (0+ / 0-)

              the same way he was against Telecom immunity..."before he was for it."

              "What if everybody thought like you?" "Then I'd be a damn fool to think otherwise."-- Catch 22

              by Johnny Q on Sun Sep 06, 2009 at 02:46:47 PM PDT

              [ Parent ]

              •  I don't understand your point (1+ / 0-)
                Recommended by:
                eparrot

                I'm about fighting for real healthcare reform, which has been steadily watered down since at least May of this year by an assortment of characters in the Democratic caucuses in both houses.  I don't have time for gratuitous Obama-bashing.

  •  Medicare please. (26+ / 0-)

    Please, I would like to buy into medicare coverage for myself and my wife.  That's all.  I don't think I'll make it to 65 otherwise.  Srsly.  

    :: Hopeful even still ::

    by Rick Aucoin on Sun Sep 06, 2009 at 11:13:13 AM PDT

    •  READ please! (10+ / 0-)

      I just read this article by Matt Taibbi. It is the most coherent thing I have read explaining how we got into this mess.
      The take away is that we are all in deep trouble. Neither the right nor the left have influenced the debate, and the myriad of conflicting bills are so messed up that it is hard to imagine what a conference committee bill could have in it.
      The divide in the country is too great. It would take both sides to come together and kick out the entire Congress.
      I didn't vote for Obama, but for the good of the people and the country, I am on my knees praying to multiple deities that he find the wisdom to lead us out of this approaching cataclysm.

    •  The money quote IMHO from Taibbi... (17+ / 0-)

      In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.

      Everyone knows this, including the president. Last spring, when he met with Rep. Lynn Woolsey, the co-chair of the Congressional Progressive Caucus, Obama openly said so. "He said if he were starting from scratch, he would have a single-payer system," says Woolsey. "But he thought it wasn't possible, because it would disrupt the health care industry."

      Huh? This isn't a small point: The president and the Democrats decided not to press for the only plan that makes sense for everyone, in order to preserve an industry that is not only cruel and stupid and dysfunctional, but through its rank inefficiency has necessitated the very reforms now being debated. Even though the Democrats enjoy a political monopoly and could have started from a very strong bargaining position, they chose instead to concede at least half the battle before it even began.

      "...because it would disrupt the health care industry." Hmm. Well, as with people who choose to be tobacco farmers, tough shit. Let them choose to support themselves in a way that doesn't help them cause the suffering deaths of their fellow human beings. If they don't care about that, then they shouldn't expect any sympathy.

      </rant>

      Electing conservatives is like hiring a carpenter who thinks hammers are evil.

      by bwintx on Sun Sep 06, 2009 at 11:45:21 AM PDT

      [ Parent ]

      •  Correction (1+ / 0-)
        Recommended by:
        SarahLee

        "the suffering and deaths"...

        Electing conservatives is like hiring a carpenter who thinks hammers are evil.

        by bwintx on Sun Sep 06, 2009 at 11:46:19 AM PDT

        [ Parent ]

      •  Corporaticians have replaced Politicians! (5+ / 0-)
        Recommended by:
        poe, bwintx, 4Freedom, Johnny Q, AuroraDawn

        Isn't this what Taibbi is saying?

        It's what I am saying.

        And if the Supreme Court rules in favor of political corporate media productions like Hilliary the Movie, we will have little to no say on the Hill.

        Hell, what say do we have now?

        We are easy, we are simple.  We want health care.

        Here's my bill proposal:

        Medicare for All with a "Keep Your Private Plan if You want"
        The rules of Medicare apply to both.

        An freakin TWO LINE Bill.  How hard would that be?

        But no.  It isn't the insurers the Corporaticians are protecting.  It's the money, our money and our employers' money.

        We pay, they play.  It's totally out of hand, and this health care issue has pulled back the curtain.

        Sadly, it appears that Obama is just as infected as the rest.

        Why, because he needs the millions from the health care industry to run in 2012.  Although, I somehow suspect he might pass on that option.  Wouldn't you?

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 11:59:23 AM PDT

        [ Parent ]

        •  He's not (0+ / 0-)

          Sadly, it appears that Obama is just as infected as the rest.

          If he were, we wouldn't be talking about this because mandates plus no public option at all would be a done deal.  POTUS can't just write this legislation and command congress to pass it.  That failed during the Clinton years.  But POTUS is a leader in this party, not the party.  And what we're seeing here is the same faction which gave us a bipartisan AUMF and the repeal of Glass-Steagall at it again.  Same freaking people.  We fought back in November 2008 and we're fighting back again now, for the soul of this party.  Keep hope alive; we can do this.

        •  It certainly seems like we have entered.... (2+ / 0-)
          Recommended by:
          SarahLee, poe

          Aldous Huxley's Brave New World. With Senators who represent corporations instead of people.

          They may as well just change their little placards - Evan Bayh,  D - Wellpoint.

          I knew this bill wouldn't really go into effect until 2013. That's not a shock, which was one of the reasons I found the claim this was "going too fast" laughable. For many people whose lives depend on it, this isn't going nearly fast enough.

          I was for single-payer (and would still prefer the Medicare for all approach), but was willing to compromise for a robust public option. There doesn't seem to be anything terribly robust about this bill. Without major changes, I actually find much of this quite discouraging. I still prefer a public option over nothing, but this is a mess.

          Blackadder: They're upset, Sir, because they are so poor that they are forced to have children merely to provide a cheap alternative to turkey at Christmas.

          by AuroraDawn on Sun Sep 06, 2009 at 12:42:29 PM PDT

          [ Parent ]

        •  Started with the Powell Memo (0+ / 0-)

          and the birth of the Right Wing Noise Machine.

          Liberals and Democratic politicians then allowed themselves to be cowed by the right swing of the media - the nation did not change, but the media sell out did.  

          Problem is that the citizen activists lost their spines as well and started cowering, compromising to be "reality based" and pragmatic instead of sticking to principles.  That left politicians with a fear that if they also did not move right, they would not have support.

          As I wrote earlier in Jerome's diary:

          Within the political realm you sometimes risk dying because that still moves the cause forward.  Republicans manage to do this, but Dems not so much.  

          Democrats always seem to have a "right now and next election" strategy while Republicans have a "right now and all the future strategy."  

          LBJ had a "if you don't like this, I've got a bill you will really hate" negotiating strategy.  He wasn't perfect, especially with Vietnam, but he moved the nation forward anyway.

          If you are going to die (your bill and maybe your election chances) from an issue, it is best to die standing for the right thing (which may allow for rebirth) than to fall to your knees with a compromise that is not in the best interest of the nation - How you die for it matters.  

    •  Hope everyone reads this! n/t (0+ / 0-)
    •  Talibbi has been doing a good job (1+ / 0-)
      Recommended by:
      Johnny Q

      trying to bring sanity and reality to the discussion.  Not enough folks are listening.

  •  HR3200 (3+ / 0-)
    Recommended by:
    sockpuppet, 4Freedom, Johnny Q

    Who wrote this thing?
    I know it was Waxman's committee, but who ACTUALLY wrote this? I'm having a hard time imagining how such a mess could come out of supposedly competent people.

    •  it's actually well thought-out (6+ / 0-)

      And I assume it's the committee staff that does all the actual language.

      The problem is, if you start with our current system, and let people keep their current insurance, all the pieces need to work together to ensure it works economically.  Each piece depends on the others.

      Mandates require enforcement (the 2% tax).

      Personal mandates require subsidies for lower-income people.

      Preexisting condition and recission regulations force the mandates.

      Mandates require a public option to avoid a private insurance windfall.

      The public option needs lots of details to get right: who runs it, who's allowed to buy into it, how consumer prices are decided, how provider prices are decided.

      "At the end of the day, the public plan wins the game." Sen. Ben Nelson

      by ferg on Sun Sep 06, 2009 at 11:27:59 AM PDT

      [ Parent ]

      •  I hear you, ferg, and I understand the loop. (11+ / 0-)

        However, complexities cause problems.  It's how we got into this mess to begin with.

        It would be so much simpler to have what is called the PO just be a Medicare In Option.

        And the insurers get their damn windfall for another 7 years under the mandate.  

        Who is going to fight when the insurers start playing their games?  Will the patients still have to fight, pay or lose their credit while the fight goes on?  

        with the highest unemployement in 20+ years, who can afford the damn premiums anyway.

        The Corporaticians wrote this Bill, or copy and pasted the emails they received from the insurers, more than likely.

        A Single Payer Option, or Medicare In, wasn't on the table because it would cause the insurers too many headaches as in loss of revenues.

        If this Bill stands, the PEOPLE are not insured better health care.  It's just that plain and simple.

        Unless you can prove to me otherwise, which would be a huge hassle, I know.

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 11:42:41 AM PDT

        [ Parent ]

        •  agreed, Medicare-in would be far simpler (6+ / 0-)

          and far less things to go wrong (regulation enforcement, etc.)

          We'd need to convince people that an 8% payroll tax increase and a replacement of private insurance is a better solution.  And with the fear of change and total opposition from Republicans, that support isn't anywhere close to being there yet.

          And I don't know how to solve the 8% tax problem.

          "At the end of the day, the public plan wins the game." Sen. Ben Nelson

          by ferg on Sun Sep 06, 2009 at 11:51:10 AM PDT

          [ Parent ]

          •  Poll after Poll here demonstrate people are more (5+ / 0-)

            than willing to pass what they pay for premiums directly to Medicare.  We could call it Medicare P (for people, snark).  

            If the premium-in-return-for-health-care-model is truly workable, all Medicare would have to do is set up an account for the premiums to be received and services paid from.

            The insurers get to stay in place; however, it seems unconstitutional to me to force people to remain with private insurers until 2016 while other can, and there is a Medicare In or PO available.  What a nut cruncher insult to the people!

            Congress is a gathering of Corporaticians, not representatives of the people.  Politics has sunk to its lowest form of self-interest in our history.

            We are losing our democracy to the corporations.  I believe Mousilini (sp) called this fascism.  So, what Beck isn't smart enough to discern is that he is actually pulling back the curtain on our Corporate Controlled Country.  Bush Co burned whatever remnants of protection we had when he privatized practically the entire government.

            And WE are paying for our own demise.  Are we STUPID?

            Boycott the damn Insurers.  Tell you employer to give you the money he is paying the insurer.

            We have three years to starve these purveyors of Medicide.

            Poverty does not mean powerless. Unite!

            by War on Error on Sun Sep 06, 2009 at 12:07:35 PM PDT

            [ Parent ]

            •  the polls never give a cost (2+ / 0-)
              Recommended by:
              Sherri in TX, bullyness

              I've never seen a poll that says, "would you be willing to pay 8% more payroll for medicare-for-all".  It's easy to say you're willing to pay when there are no numbers attached.

              Given the California initiatives, I have zero confidence in voters willingness to pay for anything.  Many people answering "yes" to the current single payer polls think they'd pay something silly like a 1% increase in payroll taxes.

              "At the end of the day, the public plan wins the game." Sen. Ben Nelson

              by ferg on Sun Sep 06, 2009 at 12:23:35 PM PDT

              [ Parent ]

              •  8% payroll would be less than the (2+ / 0-)
                Recommended by:
                ferg, Sherri in TX

                costs of the premiums and annual co pays people with real health problems are presently forced to pay under our for profit Medicide system.

                The polls were for "money the same" provider change to Medicare.  

                Where are you getting the 8% payroll tax from.  They are already taking 30% out each week, and for what?

                Poverty does not mean powerless. Unite!

                by War on Error on Sun Sep 06, 2009 at 01:14:48 PM PDT

                [ Parent ]

                •  correct, but that needs to be sold (0+ / 0-)

                  You and I believe the 8% payroll would be less, but the Republican noise machine would say otherwise, and their argument would be much stronger than the current nonsense about death panels.

                  The 8% is from HR 676 finance analysis.  It's possible, of course, to raise other taxes to lower the payroll tax  (the current HR 676 does that), but the total amount is the same and I prefer the New Deal philosophy of everyone paying for their own health care like Social Security.

                  "At the end of the day, the public plan wins the game." Sen. Ben Nelson

                  by ferg on Sun Sep 06, 2009 at 01:30:41 PM PDT

                  [ Parent ]

              •  In Australia (2+ / 0-)
                Recommended by:
                wu ming, Johnny Q

                their single-payer plan costs 1.5% in payroll taxes.

                So it's not that silly.

                •  Australia uses the general fund (0+ / 0-)

                  From wikipedia

                  If the [payroll] levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%

                  It's possible to get the funding from other places (like income taxes), but the total cost remains about 8% of payroll.

                  "At the end of the day, the public plan wins the game." Sen. Ben Nelson

                  by ferg on Sun Sep 06, 2009 at 02:02:12 PM PDT

                  [ Parent ]

              •  exactly (0+ / 0-)

                I have seen so many polls tossed around stating all the overwhelming support for the PO and the like...I'd like to see how much people are willing to pay for this stuff asked as a followup question.

            •  Boycotting my insurer isn't an option... (2+ / 0-)
              Recommended by:
              ferg, barbwires

              if I want to keep breathing. It isn't a matter of stupidity. I pay them because I literally have no choice. The Neocons scream at town halls about their "choices" being taken away. They are the ones too foolish to realize that they already have no choice.

              Blackadder: They're upset, Sir, because they are so poor that they are forced to have children merely to provide a cheap alternative to turkey at Christmas.

              by AuroraDawn on Sun Sep 06, 2009 at 12:48:30 PM PDT

              [ Parent ]

          •  I don't think the 8% tax would be necessary (1+ / 0-)
            Recommended by:
            alizard

            if it was an optional opt in program to Medicare, Insurers make a lot of money off of medicare since 1998 when they started to privatize many of the administrative functions to insurers. They bid on it each year and usually the loser(s) take a nice stock hit. The winner(s) get a boost. That's why it's a little difficult for me to understand why they aren't doing it.

            Then later then can pass amendments to discontinue the privatization function provided we can completely kick year GOP out of Congress and find 60 votes in the senate that aren't owned by corporations. . That's if we are even able to hold on to it if this piece of regurgitated dog shit passes

            2013= 88,000- 404,000 dead depending on which study is correct.

            It really is time for a third party. These are the people that voted to go to war over 2974 dead (with 1.5-3 Million dollar govt payments to the families) yet cavalierly dismiss the 100s of thousands who have or will die between 2001 and 2013 and the money spent on the wars.

            If Obama was a true change agent , he would say, "I'll go to one term, to fight for real Health care reform". Chances are when it kicked in for a few years, he would be re-elected in 2012 or he could run again in 2016.

      •  2.5% up to the annual average policy price (0+ / 0-)

        Individuals who did not maintain acceptable health
        insurance coverage for themselves and their children would be required to pay an additional tax,
        prorated for the time the individual (or family) does not have coverage, equal to the lesser of (1)
        2.5 % of the taxpayer’s modified adjusted gross income10 (MAGI) over the amount of income
        required to file a tax return, or (2) the national average premium for applicable single or family
        coverage.

        Others would be exempt from the individual
        mandate, including nonresident aliens, individuals residing outside of the United States,

        individuals residing in possessions of the United States, those with qualified religious
        exemptions, those allowed to be a dependent for tax-filing purposes, and others granted an
        exemption by the Secretary.

        http://fpc.state.gov/...

        Pages 5-6  CBO

        Summary
        This report summarizes key provisions affecting private health insurance in H.R. 3200, America’s
        Affordable Health Choices Act of 2009, as ordered reported by House Committees on Education
        and Labor and on Ways and Means. Specifically, this report focuses on Division A (or I) of H.R.
        3200 from those committees.

        http://fpc.state.gov/...

        Intro.

        Poverty does not mean powerless. Unite!

        by War on Error on Mon Sep 07, 2009 at 06:49:31 AM PDT

        [ Parent ]

  •  we're screwed... again. n/t (2+ / 0-)
    Recommended by:
    sabredance, Johnny Q

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Sun Sep 06, 2009 at 11:27:16 AM PDT

  •  Excellent! QUICK SUMMARY (17+ / 0-)
    1.  Public option is an option ONLY available in the exchange program.
    1.  People who already have insurance which includes all with employer-based insurance ARE NOT ELIGIBLE for the public option and the exchange program.  Thus 160-180 million Americans are NOT eligible.
    1.  Exchange program won't start until 2013.
    1.  The trigger for the public option will occur in 2013 if certain criteria are not met.  The trigger if happens will happen the SAME TIME AS THE EXCHANGE IS SET UP WHICH IS 2013.
    1.  Only people allowed to participate in the exchange are the uninsured, self-employed, and the employees of small businesses.  People who already have insurance can't participate.

    Ben Nelson and Olympia Snowe support the trigger while House liberals support the public option automatically put into the exchange.  However BOTH go in affect the same year which is 2013.

    Obama 7/09: "Don't bet against us" (unless the Dems screw it up).

    by Drdemocrat on Sun Sep 06, 2009 at 11:28:23 AM PDT

    •  We don't have two parties anymore. (4+ / 0-)
      Recommended by:
      buckstop, 4Freedom, pkbarbiedoll, Johnny Q

      We have 100 Senate Corporaticians.  Shame on them all.  And far too many of them are frightening idealogues.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 12:09:01 PM PDT

      [ Parent ]

      •  Don't get discouraged (4+ / 0-)

        there are some very smart and powerful people who have many years of experience with these types of shenanigans.  The thought was that the left wouldn't pay attention to the details to this level, and that thought isn't irrational: before blogs, would this level of nitpicking advocacy on the grassroots level been possible?

        Thanks again for this diary, because you've done your part to put the focus back where it needs to be: the details of the public option.

        We all need to contact reps and senators and let them know that we're watching, and doing our analysis, and will not accept a public option in name only.  That would be bad for the country, as well as the party in 2010.

        •  Smart and powerful, yes. (2+ / 0-)
          Recommended by:
          GN1927, Johnny Q

          But what good is this if they aren't using these talents and privileges in the interest of the People?

          btw, thanks for all of your great comments.

          We have become mired in the WIN or LOSE mode and, all too often, over look the details of the argument we are having with ourselves (written with a chuckle and a groan).

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 01:18:01 PM PDT

          [ Parent ]

          •  LOL (0+ / 0-)

            what good is this if they aren't using these talents and privileges in the interest of the People?

            It's all about them.  And their ambitions, and their power.  They're better than the GOP, which is how they sleep at night.  But this same crew/Dem faction has delivered
            big
            fat
            packages of
            FAIL
            before, and are capable of doing it again.  It is what it is.  But I think that the progressive left, if organized, is more than capable of mounting a successful response, because we've done it before.

            btw, thanks for all of your great comments.

            No, thank you for this diary.

    •  This is Ridiculous. (1+ / 0-)
      Recommended by:
      alizard

      Ben Nelson and Olympia Snowe support the trigger while House liberals support the public option automatically put into the exchange.  However BOTH go in affect the same year which is 2013.

      Sunshine on my shoulders...

      by pkbarbiedoll on Sun Sep 06, 2009 at 12:52:49 PM PDT

      [ Parent ]

    •  Wait a minute..... (2+ / 0-)
      Recommended by:
      alizard, AvoMonster

      ....doesn't the entire thing start in 2013?  So it's not a trigger -- the entire mess starts in 2013.  

      Mandates without a strong enough bill to control costs.  That's just great.  I hated them when Hillary proposed them and I hate them now.  If you have irregular income, like waiters and waitresses and anyone self-employed, this is a nightmare.  Mandates with serious premium cost controls and a level of affordable health care is the only way to entertain mandates.  Affordable health care is not $5,000 deductibles that people don't have, and co--pays that keep them from seeking care.  

      The lower middle class will get screwed, again.  Individuals will get screwed, again.  The older you are, the more screwed you will be, again.  They will only be able to afford junk insurance that covers nothing with high deductibles and co-pays.  Not actual health insurance coverage.  

      Can anyone explain to me the rank stupidity of Democrats to leave this until 2013?  By then, there won't be a Democrat left in Congress, much less the White House.  Unless a bill gets passed and implemented so people can experience a lifting of their burdens, everyone is screwed.  Even the Republicans understood that:  Medicare Part D was passed.  It was a sucky bill but seniors by and large are happy enough because drugs that were never covered under Medicare were now covered.  There was some measurable relief before the next election. What idiots.  

      It's actually pretty simple:  affordable premiums with affordable deductibles and co-pays so people can afford to take their kids to the doctor for an ear infection before their fever is 104.  

      I don't see this in this bill.  

  •  Medicare for sale. Step right up. Get your red (5+ / 0-)

    hot Medicare.

    Going like hot cakes.  Better than sliced bread.

    To halt under fire is folly. To halt under fire and not fire back is suicide. Officers must set the example

    by 88kathy on Sun Sep 06, 2009 at 11:29:58 AM PDT

  •  I'm seeing on page 28 that dental and vision (10+ / 0-)

    is covered for anyone (they use the word "children") under the age of 21 in the Essential Benefits Package. It's a step in the right direction but why don't people realize that often the key to overall health is good dental health?

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 11:37:45 AM PDT

    •  Quick answer....$$$$$ (9+ / 0-)

      I remember a diary here recently where someone has to get emergency dental and a sprained ankle fixed in Sweden.

      Cost?  $200.

      When she returned to the US, the completion of the root canal prepared in Sweden cost $1,000.

      $1,000 and the tooth was already prepped in Sweden.

      How many people in America can really afford to pay for the occasional unexpected root canal or cap?

      Hell, most Americans are struggling to keep good tires on their car which cost about the same as a root canal.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 11:46:40 AM PDT

      [ Parent ]

      •  I know, but it's that old (2+ / 0-)
        Recommended by:
        GN1927, Brooke In Seattle

        "stitch in time" thing.  People put off needed dental care because it costs so much, which leads to even bigger problems with their general health which leads to bigger medical bills (that presumably are covered) but which would have been so much smaller or avoidable completely if they had just gotten dental care when they needed it.

        A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

        by marleycat on Sun Sep 06, 2009 at 11:53:20 AM PDT

        [ Parent ]

    •  That was a kick in the stomach. (1+ / 0-)
      Recommended by:
      barbwires

      Here's how it will work:  I will be mandated to buy insurance.  I'm self-employed and sometimes have enough money and sometimes not -- to pay exorbitant insurance rates.  I'm 59 years old -- my "affordable" coverage will be more than I can afford, but I will pay a fine if I don't buy it.  

      My cataracts from asthma medication over the last 25 years will not be covered.  So I will have to come up with the $8,800 to pay for cataract surgery out of pocket (because I am going blind) plus the premiums that I can only afford if I am forced to buy a policy with a $5,000 deductible and unaffordable co-pays.  

      All I've ever wanted is to be able to do what I do when I buy a car as a self-employed person:  I buy reasonably priced cars that give me excellent gas mileage to get me through the times when money is tight.  I buy either new, reasonably priced cars or late model used cars because if we don't have a car, we can't practice our business.    If I have to take out a car loan, I make sure the payments are low enough so I can afford them when business is slow.  I don't see anything in this analysis of the bill where I will be able to do that.  To afford premiums, I will be forced to buy a "junker".  

      For awhile I was thinking that any reform would help me:  if pre-existing conditions were dropped at least I could get insurance that I can't get now.  A PO would give me affordable coverage.  

      Now it's beginning to look worse than nothing.  That is a huge, huge thing for me to say.

      •  At age 61, I can't afford the premiums either. (0+ / 0-)

        What will they do, put IRS leans on our homes?

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 03:51:20 PM PDT

        [ Parent ]

        •  At age 54 (and 56 for hubby) it's tough for us, (0+ / 0-)

          too. So we've had to go into our state's high risk pool and bought the lowest premium plan available. The downside is that it's a high-deductible plan requiring an HSA.  We are hoping we all stay healthy. The real kicker for me is that we have to wait three years before any of this new stuff kicks in - but maybe that will give all of us time to hit the jackpot before we are mandated to buy insurance.  And just think how much closer we'll be to Medicare!

          A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

          by marleycat on Sun Sep 06, 2009 at 04:34:33 PM PDT

          [ Parent ]

          •  I will be there, Medicare that is. (1+ / 0-)
            Recommended by:
            marleycat

            I just hope they don't gut it.  I have the strangest crappy luck in  my life (with tons of miracles, too).

            It will be all my fault if Medicare is gutted when it is my turn to receive it!

            bwaaaaaaaahaaaaaaaaaa

            They can't take away a sense of humor, or can they?

            Poverty does not mean powerless. Unite!

            by War on Error on Sun Sep 06, 2009 at 05:35:07 PM PDT

            [ Parent ]

      •  You have not taken into account a few things: (0+ / 0-)
        1.  You don't know your subsidies.
        1.  If you get a plan with a lower deductible, you may not GAIN anything, with subsidies, but you might not be any farther back AND it would include whatever health problems you now have.

        The problem with analyzing things like this, piecemeal, is that we don't see the whole of the pie.

        The OTHER problem is that this won't be the final bill.  Could be worse, could be better.

        Personally, it would be far superior if they opened medicare for everyone or some other type of single payer but folks, you are DREAMING if you think that will happen.

        You think the shit has hit the fan over the PO?  Try Single Payer even if the CBO rated it better, the naysayers would have a frigging fit EVEN if it is cheaper, better, and if it could give us all the ability to balance a ball on our noses.

        If anyone thinks for a moment we can start over, that won't happen, either.  We either fight to make this better (which means understanding it in its whole, not piecemeal) or we fight against it, or we fight for it.

        But insisting we "start over" won't go anywhere.

        For those without insurance, this won't help for several years and I am a bit shocked to read through the comments that many didn't realize that the kick in date is 2013.  That was a focus of mine on the calls I made... start it earlier.

        Legislation is not easy to analyze and for me, I have to do it on paper so I can shift back and forth to sections.  The reason that attorneys and other legal beagles draft this stuff is because it is, eh-hem, law. Reading law takes practice.

        I really appreciate this diary and all the hard work that went into it but I must be honest and say that this isn't helpful to me, personally, as I cannot analyze things this way.  One thing that may be helpful to some (besides the links given by fem down thread), is to CALL Waxman's office and ask your questions.

        I can assure you that calling any republican office will not be helpful.

        866-338-1015 toll-free to Congress in D.C. USE it!

        by cany on Sun Sep 06, 2009 at 08:42:23 PM PDT

        [ Parent ]

        •  Ok, I have to admit I spent 3.5 years doing (0+ / 0-)

          nothing but reading/editing legal documents.

          And another few years working for a CPA firm.

          I did pour over the rest of the bill, but even this was almost too much to present in a diary.

          The two sections above do provide a good glimpse into the thinking on the Hill.

          And, you are correct, this will not be the final Bill; however, from all the talking heads, I doubt the final bill will be more robust to our favor than the above.

          This is sad.  WHAT could have persuaded those in the beginning of this process to take Single Payer off the table, and I take offense at the answer "reality".

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 08:59:10 PM PDT

          [ Parent ]

  •  Thank you so much (6+ / 0-)

    for all this hard work. Great job.

    It has been said that man is a rational animal. All my life I have been searching for evidence which could support this.--- Bertrand Russell

    by triv33 on Sun Sep 06, 2009 at 11:44:42 AM PDT

    •  You are welcome. Did you see your credit above? (3+ / 0-)
      Recommended by:
      triv33, 4Freedom, Johnny Q

      That is if it is still there.

      The hardest part of doing this diary was struggling with dKos HTML issues.

      So I have lost track of the edits I have tried to make.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 11:47:38 AM PDT

      [ Parent ]

      •  yes, (1+ / 0-)
        Recommended by:
        4Freedom

        and thanks, but, really, you didn't need to, it was the least I could do after all the work you put in to this. It was my small way of thanking you.

        It has been said that man is a rational animal. All my life I have been searching for evidence which could support this.--- Bertrand Russell

        by triv33 on Sun Sep 06, 2009 at 11:49:29 AM PDT

        [ Parent ]

  •  So I Can't Have the Public Option (6+ / 0-)

    Unless I quit my job, which provides it?

    The moral arc of the universe is long, but it bends towards justice. - Martin Luther King, Jr.

    by easong on Sun Sep 06, 2009 at 11:54:58 AM PDT

  •  I also see that if medical loss ratios are lower (1+ / 0-)
    Recommended by:
    GN1927

    than expected, there is a provision for rebates of premiums paid...? (p. 54)

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 11:55:23 AM PDT

    •  bwahsaaaaaaa. I saw that. and I chuckled (4+ / 0-)
      Recommended by:
      GN1927, 4Freedom, Johnny Q, marleycat

      rebates.  I'm not holding my breath.  It's just not going to happen, but maybe I am too cynical.

      Hey, marley, if you are reading the Bill, kudos!

      Please make some notes as you go along and post a diary with your findings.

      We all can do this.  As a matter of fact, if we wanted to, we could all volunteer to read 20 pages (less than 10 real pages because the lines are only 3 inches wide, the font is large, and the between line spacing is wide.

      So, if anyone else reading here wants to volunteer for a chunk, sign up below.

      Great work, Marleycat!

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 12:14:57 PM PDT

      [ Parent ]

      •  Thanks....I'm trying to slog through it. (1+ / 0-)
        Recommended by:
        4Freedom

        I have to admit, when I saw the rebates section I laughed, too.  We'll see.  

        A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

        by marleycat on Sun Sep 06, 2009 at 12:22:45 PM PDT

        [ Parent ]

        •  Thanks to both of you for reading the bill! (1+ / 0-)
          Recommended by:
          CupofTea

          It couldn't be more awkward or difficult for me to follow.

          Of course I have a zillion crises I'm dealing with in my business, so am distracted, but the wording is hard to track.

          •  Agree. The wording is difficult. nt (1+ / 0-)
            Recommended by:
            4Freedom

            A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

            by marleycat on Sun Sep 06, 2009 at 12:29:29 PM PDT

            [ Parent ]

          •  Here is Page 54 section being discussed here: (2+ / 0-)
            Recommended by:
            4Freedom, marleycat

            54
            ‘‘SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.

            ‘‘(a) IN GENERAL.—Each health insurance issuer
            that offers health insurance coverage in the small or large
            group market shall provide that for any plan year in which
            the coverage has a medical loss ratio below a level specified
            by the Secretary, the issuer shall provide in a manner
            specified by the Secretary for rebates to enrollees of pay-
            ment sufficient to meet such loss ratio.

            Such methodology
            shall be set at the highest level medical loss ratio possible
            that is designed to ensure adequate participation by
            issuers, competition in the health insurance market, and
            value for consumers so that their premiums are used for
            services.

            There are three groups: Small, Medium, and Large, sort of like fries.  I wonder why the medium sized group isn't mentioned?

            So, if I understand this correctly, the issuer must spend a certain percentage of premiums received on the enrollees medical care OR pay out the difference between the Secretary's mandated Loss Ratio and what they paid to the enrollees.  

            As there could be millions of enrollees, would each receive a prorated amount SHOULD such a rebate be required?

            Perhaps there could be an accumulated pool of REFUSED to pay for services gathered by the Secretary and the difference could be used to pay for these services in a pro rated manner.

            Rescission is STILL on the table.  See page 56.

            Poverty does not mean powerless. Unite!

            by War on Error on Sun Sep 06, 2009 at 12:40:30 PM PDT

            [ Parent ]

            •  Yeah, but at least they are (1+ / 0-)
              Recommended by:
              4Freedom

              putting a few safeguards in the bill in case an insurer decides to rescind.

              RESCISSION.—A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2).
              The Secretary, no later than July 1, 2010, shall issue guidance implementing this requirement, including procedures for independent, external third party review.

              Since preexisting conditions are not supposed to enter into an insurer's providing coverage, I am not sure what defines fraud - my worst fears are that the insurance companies will find some creative way to define it.

              A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

              by marleycat on Sun Sep 06, 2009 at 12:50:40 PM PDT

              [ Parent ]

  •  BRAVO, WoE! Hard work DOES get rewarded! (7+ / 0-)

    Kick ass diary! Congrats!

    The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?' - 1984

    by MinistryOfTruth on Sun Sep 06, 2009 at 12:02:57 PM PDT

  •  So does this mean (0+ / 0-)

    that employer premium payments will be taxed as income? Or am I reading this wrong?

    -9.75, -8.36 The arc of history is long, but it bends toward justice.

    by Laughter Shrapnel on Sun Sep 06, 2009 at 12:04:35 PM PDT

  •  This is why I don't get the fuss over the trigger (3+ / 0-)
    Recommended by:
    GN1927, Militarytracy, marleycat

    If the public option doesn't kick in until 2013, then it already has a trigger.

  •  There's this for the wing-nuts: (2+ / 0-)
    Recommended by:
    fiddlingnero, MinistryOfTruth

    (p. 143)

    SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
    Nothing in this subtitle shall allow Federal payments
    for affordability credits on behalf of individuals  who are not lawfully present in the United States.

    Just to make it absolutely clear to them....

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 12:35:33 PM PDT

  •  P. 147 Requires some kind of (0+ / 0-)

    contribution by the employer towards health insurance for part-time employees, based on the average number of weekly hours by the employee. Also, if an employer decreases an employee's pay by the amount they are contributing on the employee's behalf, that doesn't count as a contribution by the employer.  

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 12:44:10 PM PDT

    •  Under the mandate (1+ / 0-)
      Recommended by:
      marleycat

      The employer must contribute a prorated amount towards the part time employees mandated coverage.

      For instance if a full time employee's premium is $500/mo, the employer would have to contribute $250 for a half-time employee, and the employer would make up the difference (and hopefully qualify for some assistance from the Fed under affordability clauses in the Bill).

      The second part, sounds like the premium payments are paid by the employee that's why the employer can't deduct the amount from his gross income.

      However, it also hints that that amount might be taxed as income.

      Is this what you are reading into this, too?

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 01:28:57 PM PDT

      [ Parent ]

      •  Clarification: (0+ / 0-)

        my understanding is that employers would have to contribute a minimum of 72.5% of the total premium for individual coverage, and a minimum of 65% of the total premium for an employee electing family coverage, with the balance being paid by the employee.  These minimums apply to full-time employees. For part-time employees, the employer contribution would be related to the number of hours per week, but it isn't spelled out.

        I read the section on employers reducing wages to account for the portion they pay in premiums as a penalty for doing so.  In other words, if you do that, you will, in effect, not be providing "acceptable" health insurance coverage for your employee and are subject to penalties.

        I'm not sure the bill is clear on whether the employer portion of insurance premiums is taxable, but my sense is that it would be.

        A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

        by marleycat on Sun Sep 06, 2009 at 02:23:33 PM PDT

        [ Parent ]

        •  Honestly, my eyes are crossing and my brain (1+ / 0-)
          Recommended by:
          marleycat

          is a tangle.  I need some hours away from this.

          The example above, $500, could be viewed as the 72.5% or 65% paid for the full-time worker and the $250 the prorated amount for the half-time worker.

          I need to go play for a while.

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 02:37:15 PM PDT

          [ Parent ]

  •  no recs (1+ / 0-)
    Recommended by:
    lookit

    a lot of work, yes. You do have a number of errors. i won't quibble with your opinions, but you do have some analysis problems.

  •  Rec'd (1+ / 0-)
    Recommended by:
    RatCitySqueaker

    Even though a lot of this is too lawyer-speak for me, it's atleast a bill.  I want this one the Rec list for a while so I can come back to it once I have an idea of the specifics I want to look for.

    Flowers Bloom for my Ex - though Honeybees are pretty cool too.

    by Yoshi En Son on Sun Sep 06, 2009 at 12:48:37 PM PDT

  •  Civil penalties for employers not (0+ / 0-)

    providing coverage look a little stiffer than previously bandied about:

    (A) CIVIL PENALTIES.—In the case of
    any employer who fails (during any period with
    respect to which an election under section
    801(a) is in effect) to satisfy the health cov-
    erage participation requirements with respect to
    any employee, the Secretary may assess a civil
    penalty against the employer of $100 for each
    day in the period beginning on the date such
    failure first occurs and ending on the date such
    failure is corrected

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 12:57:06 PM PDT

  •  "The perfect is the enemy of the good" (0+ / 0-)

    Looking at this bill and seeing how much we've already compromised and knowing that some want us to compromise even more raises an important question.

    Is this bill the Perfect or the Good?  Because to my lying eyes, it looks like neither.

    "What if everybody thought like you?" "Then I'd be a damn fool to think otherwise."-- Catch 22

    by Johnny Q on Sun Sep 06, 2009 at 01:01:20 PM PDT

  •  Individual taxpayer penalties: (0+ / 0-)

    (p. 167) If an individual does not have acceptable health care coverage:

    TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
    (1) the taxpayer’s modified adjusted gross income for the taxable year, over
    (2) the amount of gross income specified in
    section 6012(a)(1) with respect to the taxpayer.
    (b) LIMITATIONS.—
    (1) TAX LIMITED TO AVERAGE PREMIUM.—
    (A) IN GENERAL.—The tax imposed
    under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 01:07:18 PM PDT

  •  I thought thre was more than one bill floating (0+ / 0-)

    around in congress. Or did I miss out on something?

    I was under the impression that there are three bills pending.

    "be a loyal plastic robot boy in a world that doesn't care" - Frank Zappa

    by Unbozo on Sun Sep 06, 2009 at 01:13:19 PM PDT

  •  Camel = Horse designed by a committee! (4+ / 0-)
    Recommended by:
    poe, alizard, AvoMonster, marleycat

    Manoman, that was NOT a short read!

    Like the old adage says, the devil's in the details. I hate reading laws - it reminds me of every nasty thing that's ever been said about law-making (aka sausage-making). Sometimes I suspect that Congressional laws are written by lawyers for the sole purpose of ensuring future employment for more lawyers.

    Really and truly, though, I'd like to see a much, much, much simpler plan - something that could be written in a few paragraphs and could be understood by regular non-attorney, non-policy-wonks people. Something like:

    "In 2010, American citizens aged 55 and up will be eligible to purchase Medicare, and may purchase Medicare through the regular Medicare enrollment process. Each year, eligibility to purchase Medicare through the same process will be extended (ages 45-54 in 2011, ages 35-44 in 2012, ages 25-34 in 2012, ages 19-24 in 2013, and all children ages 0-18 in 2014, at which time SCHIP will be discontinued."

    As for the cost:

    "The purchase price of Medicare will be 2.5% of the citizen's pre-deduction gross income for the year ending December 31 of the enrollment year."

    Nah. Too fucking simple.

    Thank you for plowing through some of the details for us. I've read parts of the bill, but since I'm not a lawyer, my brain simply decided that it was too damn complicated and went off to play FreeCell. :-)

    We no longer have Ted Kennedy to fight the Good Fight or Walter Cronkite to tell us about it. Each one of us must now wear a small bit of their mantles.

    by SciMathGuy on Sun Sep 06, 2009 at 01:17:09 PM PDT

    •  Way too simple and logical. nt (1+ / 0-)
      Recommended by:
      SciMathGuy

      A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

      by marleycat on Sun Sep 06, 2009 at 01:21:49 PM PDT

      [ Parent ]

    •  You mean like these bills? (4+ / 0-)
      Recommended by:
      wu ming, poe, SciMathGuy, marleycat

      Civil Rights Act of 1964 – 8 Pages
      http://www.archives.gov/...

      Medicare operates as a single-payer health care system. The Social Security Act of 1965 was passed by Congress in late-spring of 1965 and signed into law on July 30, 1965, by President Lyndon B. Johnson as amendments to Social Security legislation. At the bill-signing ceremony President Johnson enrolled former President Harry S. Truman as the first Medicare beneficiary and presented him with the first Medicare card.
      http://rotenochsen.wordpress.com/...

      Social Security Act 1935  maybe 11 pages.  
      http://www.nationalcenter.org/...

      Medicare operates as a single-payer health care system. The Social Security Act of 1965 was passed by Congress in late-spring of 1965 and signed into law on July 30, 1965, by President Lyndon B. Johnson as amendments to Social Security legislation. At the bill-signing ceremony President Johnson enrolled former President Harry S. Truman as the first Medicare beneficiary and presented him with the first Medicare card.
      http://rotenochsen.wordpress.com/...

      THE ENTIRE SOCIAL SECURITY ACT of 1935 was 11 Pages

      Where have we lost it, folks?

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 01:36:09 PM PDT

      [ Parent ]

      •  Thanks, War on Error! (1+ / 0-)
        Recommended by:
        poe

        Yeah! Like those! Even I could understand those. We have indeed lost it. I don't know where we lost it, either, but I'd bet it has something to do with having lobbyists for every damn special interest group in the world contribute to writing the laws. That's about the only thing worse than having lawyers writing the laws!

        We no longer have Ted Kennedy to fight the Good Fight or Walter Cronkite to tell us about it. Each one of us must now wear a small bit of their mantles.

        by SciMathGuy on Sun Sep 06, 2009 at 02:22:42 PM PDT

        [ Parent ]

  •  This is a great diary (2+ / 0-)
    Recommended by:
    alizard, RedlandsDem

    A bad bill is worse than no bill and adding transparency to the current health care reform process is an excellent way to make sure a good bill is passed.  Kudos WoE!

  •  Reduced business tax credits for providing (0+ / 0-)

    employee health coverage. (pages 188-189) For small businesses it can be up to 50% of the amount paid for insurance, and is phased out for every aggregate that the average compensation per employee is over $20,000. No tax credit is allowed for premiums paid for any employee making over $80,000 a year.

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 01:30:00 PM PDT

    •  Hmmm. I'm not a tax expert (0+ / 0-)

      but it looks like these tax credits are on top of the standard business deduction one can take for providing health insurance coverage to employees, but the deductions are reduced by the amount of the credit.

      A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

      by marleycat on Sun Sep 06, 2009 at 01:35:40 PM PDT

      [ Parent ]

    •  Well I hope they tax the crap out of the (1+ / 0-)
      Recommended by:
      marleycat

      premiums the Insurers receive to help pay for real health care.  Or would they be non-plussed, still pay the CEO millions, and short change the insureds even more?

      What a freaking mess.

      Hey, could you copy/paste the section you address in the comments so others can read easily, if you have the time?

      We can do a diary called Marley and WoE, under your dKoss name.

      Please feel free to copy paste this diary and use in your diary.  I can't copy/paste anyway because of some invisible codes I will never be able to find.

      A dKos glitch?  Or a tin foil had conspiracy to shut me down,

      Oh my!

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 01:41:04 PM PDT

      [ Parent ]

  •  Hey WoE, my take on this is different than yours (0+ / 0-)

    (A) TAXES ON INDIVIDUALS NOT OBTAIN-
    ING ACCEPTABLE COVERAGE.—The amounts re
    ceived in the Treasury under section 59B of the
    Internal Revenue Code of 1986 (relating to re-
    quirement of health insurance coverage for indi-
    viduals).

    I thhink this is more like a tax surcharge for those people who continue to buy junk insurance, so, it is more like a tariff that will make the junk insurance less affordable and therefore the good insurance more desirable, but I might be wrong.

    What's your take?

    The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?' - 1984

    by MinistryOfTruth on Sun Sep 06, 2009 at 01:32:28 PM PDT

    •  Somewhere in the beginning of the bill (1+ / 0-)
      Recommended by:
      MinistryOfTruth

      they talk about "acceptable" insurance, but they don't go into any detail about what constitutes "acceptable." At the moment, the taxes/penalties for not having acceptable coverage could well cover junk coverage.  (Sorry for jumping in on your question to WoE.)

      A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

      by marleycat on Sun Sep 06, 2009 at 01:40:02 PM PDT

      [ Parent ]

    •  That comment belongs under (1+ / 0-)
      Recommended by:
      MinistryOfTruth

      all three quotes. but I CANT edit

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 01:44:23 PM PDT

      [ Parent ]

    •  You could be right. (0+ / 0-)

      I am having a hard time understanding penalties.

      Wouldn't everyone want to sign on to good coverage at a reasonable rate?

      So those who don't sign on, will they be those who can't afford to for whatever reason?

      Ok, there will always be some who refuse to comply; however, rather than an automatic, IRS involved fine, couldn't some effort be made first to ascertain why a person doesn't sign on?

      This is a new social experiment.  All sides will need some time to reflect and comply, don't you think?

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 02:16:14 PM PDT

      [ Parent ]

  •  I'm reminded of Windows Vista (1+ / 0-)
    Recommended by:
    neroden

    An operating system, made by committee, that nobody can stand. Taibbi's article in Rolling Stone confirms my suspicion.

    Maybe we need Steve Jobs to write the health care bill.

    This ain't no party. This ain't no disco. This ain't no foolin' around!

    by Snud on Sun Sep 06, 2009 at 01:40:46 PM PDT

  •  p. 197. Here's where the republicans will (0+ / 0-)

    really step up the opposition:

    Subpart B—Surcharge on High Income Individuals
    SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
    (a) GENERAL RULE.—In the case of a taxpayer
    other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—
    (1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds$350,000 but does not exceed $500,000,
    (2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
    (3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 01:47:33 PM PDT

  •  Vision insurance is not that useful, for most (0+ / 0-)

    people expenses even without insurance are not that high and very predictable. And premiums are relatively high compared to coverage. Dental is more useful but maybe it could be included in the future.

    •  Dental is essential (2+ / 0-)
      Recommended by:
      esquimaux, War on Error

      And vision and hearing are too. Without early detection, a lot of conditions that could have been treated can end up being far more serious, and expensive. The body can't be looked at in parts. Every part of it has to be covered, for the whole to be as healthy as it can be. And the thing is that routing exams for dental, vision and hearing are relatively inexpensive, and easily included in an overall plan without costing much.

      "Those who stand for nothing fall for anything." - Alexander Hamilton

      by kovie on Sun Sep 06, 2009 at 03:56:17 PM PDT

      [ Parent ]

  •  There's a glaring error in your diary. (7+ / 0-)

    Medicare contracts out most of its administrative functions to private contractors, but Medicare retains rule-making, benefit-setting, and federal oversight, which is what we really need with the public option.

    I work full-time with the FDL team on health reform thanks to your donations.

    by slinkerwink on Sun Sep 06, 2009 at 01:58:44 PM PDT

    •  Thanks, slinkerwink. (3+ / 0-)
      Recommended by:
      GN1927, alizard, neroden

      Could you link this comment to the copy/pasted section you are referencing so I can take a look see and update when/if I am ever allowed to edit this diary?

      Thanks.  I really hope you, NYCeve and other professionals can help improve on this amateur effort.

      We really need to hear from CPAs and lawyers as well as doctors and other health care administrators as well.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 02:20:31 PM PDT

      [ Parent ]

    •  Could it be less expensive to stop outsourcing! (0+ / 0-)

      Somehow I sense the sub, sub, sub, sub, sub, contracting services isn't giving US, the ones who pay for all of this, the best bang for our buck.

      What do you think?  Wouldn't we all be better off with government jobs instead of the low paying, part-time jobs the companies on the government teet are giving us?

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 02:45:32 PM PDT

      [ Parent ]

  •  OK, folks, my eyes are about to fall out. (0+ / 0-)

    There's a lot of stuff on reforming Medicare and Medicaid which I am sure is useful, and the last section is on appropriations for Community Health Centers, medical professions education and loan repayments (my son is pre-med, so that looks promising), all of which I will read at a later time.  Right now I need to go do some gardening.....
    Hope my notes helped.

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Sun Sep 06, 2009 at 02:02:44 PM PDT

    •  Sheesh, after spending all that time reading (0+ / 0-)

      the bill, I just realized I hadn't rec'd the diary. So now I have, and now I'm going out to garden.

      A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

      by marleycat on Sun Sep 06, 2009 at 02:05:17 PM PDT

      [ Parent ]

      •  It is grueling to read this stuff, isn't it? (1+ / 0-)
        Recommended by:
        marleycat

        Thank you for your loving commitment to help others understand this particular bill.

        As I have said earlier, it may not be anything like the final product, but it gives us a window into what they are thinking, would you agree?

        Happy gardening!

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 02:22:10 PM PDT

        [ Parent ]

  •  Vision and dental (0+ / 0-)

    You don't need vision insurance. Just pay for your exam and your glasses.

    There are plenty of decent discount dental plans available. There are not delays with discount plans, much better deal for the patient.

    When I lost my dental insurance, I stopped making appointments for a couple of years. I had one of those nifty electric toothbrushes.

    Then I read about how poor dental health can be related to cardiac problems. I do have high blood pressure so I got myself back into a dental hygiene program.

    Maybe vision and dental programs are being thrown into the bill so they don't offend those practitioners, but come on, simplify this bill.

    Just start rolling people into Medicare, starting with the 60-65 set.

  •  So now we've gone from bashing (2+ / 0-)
    Recommended by:
    Militarytracy, cany

    the President for not supporting the Public Option, to bashing the Public Option that the President has not supported. So we now must defeat the President and the awful Public Option. So when the President supports the Public Option on Wednesday he's really betraying his progressive base. WTF?

    •  It's a real mess, isn't it! (1+ / 0-)
      Recommended by:
      fernan47

      I may have mentioned that I was prompted a month ago to do an analysis and sat back waiting for someone else to do it.

      No one did, that I could find anyway.

      So, I sucked it up and donated a couple of days hoping to learn for myself and then, when I saw was in the House version, I was impressed to dare to comment and share.

      The Bill is an insight into the mind of Congress, the most progressive branch I might add.

      It speaks for itself.   Do you like what it is saying?  Really, I do want to know what you think of what you have read about the Bill.  

      Thanks for commenting.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 02:50:29 PM PDT

      [ Parent ]

      •  I think you should have presented the (0+ / 0-)

        the facts of the bill and left your opinions, whether positive or negative, out of it. But, your intentions are noble.

        •  You are absolutely correct. (2+ / 0-)
          Recommended by:
          poe, fernan47

          However, sometimes someone has to dare to have an opinion to get the ball rolling.

          I tried madly to edit out some of my irrelevant thoughts but have been locked out of being able to repost with edits.  

          It has been stressful.  However, someone was kind enough to email me a copy so I am in the process of editing for a repost tomorrow to INCLUDE the wonderful information and insights others who are reading the bill have included in the comments above.

          Thereafter, I will continue to read this bill and post info and comments to help others, hopefully without cynicism and/or snark.

          It's difficult to turn off the dKos auto-communicate mode which can be so much fun.

          But, again, you are correct.  This is a serious subject and should be given that respect.  :? )

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 03:08:43 PM PDT

          [ Parent ]

      •  You will find many links (4+ / 0-)

        that could be helpful to you in the diary I posted some weeks back

        http://www.dailykos.com/...

        I talk about the role of the health insurance exchange, how the public option relates to the exchange, and other key aspects of the bill.

        I also recommend the following info sources (the fact sheets on HR3200 available for download at the House Ed/Labor committee blog are particularly good).

        http://www.whitehouse.gov/...  
        (debunks myths and conspiracy theories, includes FAQ page)

        http://www.healthreform.gov/ (reports and data, including http://www.healthreform.gov/... - state by state analysis)

        http://www.whitehouse.gov/...
        (how healthcare reform will protect consumers)

        http://edlabor.house.gov/...  (copy of AAHC House version, download fact sheets on public option, health insurance exchange, myths/facts and more)

        http://voices.washingtonpost.com/... Must-read description of the house bill (Ezra Klein)

        And a discussion of the corresponding senate bill (Ezra Klein)
        http://voices.washingtonpost.com/...

        http://www.thomas.gov  (search Congressional materials)

        http://healthcareforamericanow.org/...
        (summary of legislative process)
        Ezra Klein, "Healthcare Reform for Beginners," http://voices.washingtonpost.com/...

        Ezra Klein – "Health Insurance Exchanges: The Most Important,
        Undernoticed Part of Health Reform,"
        http://voices.washingtonpost.com/...

        Jacob Hacker, "The Case for Public Plan Choice," http://institute.ourfuture.org/...

        Igor Volsky, "Bending the Cost Curve with Health Reform"
        http://wonkroom.thinkprogress.org/...

        •  Thank you, Femlaw (0+ / 0-)

          This ought to keep us all busy for awhile.

          However, I am really interested in your opinions regarding this diary, especially any comments made that have missed the ball completely.

          I can't really launch forward without some specifics if I have missed the ball.

          If you do have a moment to read the diary and find section(s)/comments that miss the ball, could you please include either a copy/paste of the section(s)/comment so it is easy to see what section you are responding to.

          Thanks.

          As the opening of the diary suggests, I am really seeking input from professionals here, otherwise we are left with our own interpretations.

          Poverty does not mean powerless. Unite!

          by War on Error on Sun Sep 06, 2009 at 03:43:53 PM PDT

          [ Parent ]

        •  Ezra Klein is an apologist (2+ / 0-)
          Recommended by:
          ferg, Cassiodorus

          for corporatist Democrats and bipartisan fetishists. He's been simply awful on this topic and BTD has been demolishing and ridiculing him daily on TalkLeft. His entire shtick comes down to how progressives need to grow up and accept whatever establishment Dems offer them, because that's just how it works. Um, no.

          "Those who stand for nothing fall for anything." - Alexander Hamilton

          by kovie on Sun Sep 06, 2009 at 03:51:14 PM PDT

          [ Parent ]

          •  Read the House fact sheets then (1+ / 0-)
            Recommended by:
            taylormattd

            Or are those suspect too?

            Or go to HCAN.

            I don't really care - you will find the same basic information on the bill from all these sources and they are pretty consistent.  

            The basics of what are in the bill are important and there really aren't a lot of easily accessible and understandable explanations out there.

            Whether or not you agree with his policy recommendations, I doubt you will find anything actually inaccurate in his bill summaries.  They are an easy to read overview of the basic elements and how they work.

            •  Not objecting to those (0+ / 0-)

              I am objecting to Klein's mealy-mouthed DLCism, which is defeatist crap.

              He wants to be the next Michael Kinsley, without the snark. I.e. a "sensible liberal" that even conservatives can grow to like, because he isn't a crazy far-left DFH.

              Or the vaguely liberal version of David Broder. He speaks establishmentarian.

              "Those who stand for nothing fall for anything." - Alexander Hamilton

              by kovie on Sun Sep 06, 2009 at 04:59:15 PM PDT

              [ Parent ]

              •  Why do you throw words like defeatist (0+ / 0-)

                and apologist but you never get in to why a certain policy or set of policy choices is wrong?  Then you attach it to a group or set of perceived boogiemen to undermine the idea without addressing an idea on its merits?

            •  I am wondering why you don't share your (0+ / 0-)

              opinions?

              Poverty does not mean powerless. Unite!

              by War on Error on Sun Sep 06, 2009 at 05:32:03 PM PDT

              [ Parent ]

              •  On your post? (0+ / 0-)

                I'm not sure I can manage a really detailed point by point review tonight, I was just offering some sources that might be handy to readers in the quick info/summary category.

                Really the core issue, which you address above, is that the public option is structurally tied to the health insurance exchange.  The exchange is a very important mechanism by itself that is made stronger by the presence of a public plan.

                The exchange means the end of the individual insurance market in this country, thank god.  When folks talk about "getting the same deal as members of Congress," the exchange is the direct parallel to the FEHBP - it is a similar way of offering a choice of many plans.  And it allows for a much more highly regulated market than we currently have.  People buying on the exchange can buy a public or private plan, and they will get subsidized for both if their incomes fall within a certain range.    

                •  That's a description of what we are willing (0+ / 0-)

                  to compromise; however, honestly the Exchange insurers are the very same insurers presently monopolizing coverage in the states.

                  I am a Medicare for All proponent.  I can support a very strong affordable, robust Public Option if Congress refuses to even consider Medicare for All; but it makes me sad that our Democratic majority is being wasted on mediocre instead of perfect.

                  The states will control the Exchanges more than likely.

                  People with insurance don't get the Public Option until 2017.  We will be stuck with the MurderBySpreadsheet crowd for another 7 years, 6 at the least?  Many will suffer, Femlaw.

                  And many federal employees can't afford the FEHBP either.

                  The subsidies will have to be huge to get everyone covered without taking food off of their tables.  And is there a budget for that?

                  I just pray we don't get mandates AND an unfettered private insurance industry.  

                  The plan reviewed above, falls way short of the rosy picture you present, and we all wish was the end product.

                  Somehow, I don't think so, but I am open to being wrong.

                  I surely our Transparent President Obama lets us all read and munch on the product out of committee a few weeks before voting on it.  Because, somehow if we pass the wrong law, it will haunt us for quite a while.

                  Poverty does not mean powerless. Unite!

                  by War on Error on Sun Sep 06, 2009 at 08:52:42 PM PDT

                  [ Parent ]

        •  helpful, thanks! nt (0+ / 0-)

          People were tortured to get false confessions to fraudulently justify our invading Iraq

          by grrr on Mon Sep 07, 2009 at 04:13:18 PM PDT

          [ Parent ]

    •  Read Taibbi's article in RS (5+ / 0-)

      He presents a really solid case for how even the public option, as currently envisioned, and along with all the other provisions of the various bills being considered, is hardly reform. Basically, we'll all be forced to buy expensive crap insurance, or be locked into the expensive crap insurance that we already have. It's utterly depressing.

      "Those who stand for nothing fall for anything." - Alexander Hamilton

      by kovie on Sun Sep 06, 2009 at 03:53:21 PM PDT

      [ Parent ]

      •  Or worse, pay what little money we have (2+ / 0-)
        Recommended by:
        kovie, esquimaux

        for disposable capital, our toothpaste money, for a crappy policy that won't pay for anything until it's Emergency Room time, and then we can spend the rest of our lives paying for that, or go bankrupt if we haven't already done so.

        Mandates

        while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.

        http://www.rollingstone.com/...

        We won't even be able to figure out what they hell we are buying!

        Why can't Congress just throw in the towel and do what other countries do?

        They didn't give a crap when I lost everything because the banks "stopped lending"?  $60,000 worth of new purchase orders!  One a summer test order for a HUGE retail chain that would have been worth asy $250,000 for the upcoming year.  Gone!  House, gone!  Health insurance, gone!  

        Why should we care about the fate of the MurderBySpreadsheet industry?

        Poverty does not mean powerless. Unite!

        by War on Error on Sun Sep 06, 2009 at 04:15:08 PM PDT

        [ Parent ]

        •  Having worked for it myself (2+ / 0-)
          Recommended by:
          GN1927, NuttyProf

          There is no reason you should worry about it. The rank and file will find other jobs. The execs will find ways to keep their yachts, mansions and manservants. They always do.

          I was recently invited by an insurance exec friend to have dinner at the home of another insurance exec friend of his. Nice guy, friendly, hospitable, but he lived on acres of prime country real estate with horses, stables, woods, paths, gardens, etc. I'm sure he works hard and earns his pay. But man, if this is where our insurance and health care dollars are going in a country in which millions don't have health care and are just getting by, this isn't right. It just isn't. A person has the right to be rich and be well-compensated for their work. But not on the backs on the unfortunate.

          "Those who stand for nothing fall for anything." - Alexander Hamilton

          by kovie on Sun Sep 06, 2009 at 04:28:10 PM PDT

          [ Parent ]

          •  That is exactly where our health care dollars are (1+ / 0-)
            Recommended by:
            kovie

            And, as far as I can tell from reading this, it's not going to change.  Which only begs the question, what are the insurance companies so worried about?  This is a huge boon to them, they really lose nothing and gain a huge block of business, mostly from claim free, easy money, high profit accounts.

            I'd STFU if I were them and make sure it got passed ASAP.

            "The great thing in the world is not so much where we stand, as in what direction we are moving." Oliver Wendell Holmes

            by AvoMonster on Sun Sep 06, 2009 at 05:15:43 PM PDT

            [ Parent ]

            •  If Taibbi's take on these bills gets passed (1+ / 0-)
              Recommended by:
              scorpiorising

              Then that is exactly right. Even the best of them aren't that good, which is really the most underreported aspect of all this. Obama is right (even though he meant it in a different sense) that the PO isn't the whole deal. There are lots of other aspects, that are as bad if not worse. Like individual mandates w/o employer mandates, no price controls, no negotiated rates, etc. One giveaway after another, presented as "reform".

              "Those who stand for nothing fall for anything." - Alexander Hamilton

              by kovie on Sun Sep 06, 2009 at 05:48:22 PM PDT

              [ Parent ]

              •  btw, I just finished reading Taibbi's article. (1+ / 0-)
                Recommended by:
                kovie

                Amazing.

                Somehow I got the vibe via my tin foil hat and was inspired to read the above sections of the bill and report the findings here.

                I guess I didn't get it all that wrong.

                Poverty does not mean powerless. Unite!

                by War on Error on Sun Sep 06, 2009 at 06:37:03 PM PDT

                [ Parent ]

                •  Yeah but Matt's just an Obama = Bush hater (0+ / 0-)

                  So clearly he's got an agenda and can't be trusted! What do you mean the earth is round? You just hate flat earthers and want to destroy us!

                  "Those who stand for nothing fall for anything." - Alexander Hamilton

                  by kovie on Sun Sep 06, 2009 at 07:11:30 PM PDT

                  [ Parent ]

            •  IMO, the whole teabagger movement (1+ / 0-)
              Recommended by:
              VincaMajor

              is astroturf funded by Big Insurance, Big PHRMA, and Big Coal (climate change polluter giveaways of taxpayer money are next) in order to:

              • give progressives a 'bright shiny object' and knee-jerk us into supporting Democrats without examining the actual content of the legislation
              • give politicians cover for making the bill "bi-partisan" (as in sellout) in response to "public demand"

              I also believe that the people like Dick Armey and friends who are collecting this astroturf money are trying to build a movement whose ultimate goal is to mirror the 1930s German Brown Shirts.

              Looking for intelligent energy policy alternatives? Try here.

              by alizard on Sun Sep 06, 2009 at 06:48:06 PM PDT

              [ Parent ]

    •  Herding cats (0+ / 0-)

      You get scratched to death :)

      "People die. Strategies fail. Blame is laid. And we, as a nation, are made to look like assholes." - Brandon Friedman

      by Militarytracy on Sun Sep 06, 2009 at 03:55:58 PM PDT

      [ Parent ]

    •  We're examining the details (0+ / 0-)

      of proposed legislation.  I personally do not bash President Obama.  But I do think that progressives need to be extremely and intimately involved in the details of public option legislation.

      Disagree with you here.

    •  Yep. Our job is to shred everything. n/t (0+ / 0-)

      866-338-1015 toll-free to Congress in D.C. USE it!

      by cany on Sun Sep 06, 2009 at 07:55:21 PM PDT

      [ Parent ]

  •  Thank you for this! (0+ / 0-)

    I read through this quickly, and I will be reading this in greater detail, later, and then I will respond, in detail .... but not sure if I can till much later today, or maybe not till tomorrow, but I will respond and comment.

    Note 1: I am an IT professional who services the health care and insurance industry.

    Note 2: If someone is criticizing this, unless one puts SPECIFIC DETAILED SUBSTANTIVE REFERENCES, to PRECISE line items, with recommendations to fix this, then they are, as far as I am concerned, an ANTI-PUBLIC OPTION TROLL.

    ~we study the old to understand the new~from one thing know ten thousand~to see things truly one must see what is in the light and what lies hidden in shadow~

    by ArthurPoet on Sun Sep 06, 2009 at 03:47:10 PM PDT

    •  Hey, ArthurPoet, this will be great. (1+ / 0-)
      Recommended by:
      GN1927

      However, it sounds like you might have a great deal to offer so perhaps it would be easier for you to write your own diary clarifying the points in this diary that have missed the ball.

      ummm...are you calling me an Anti-PO Troll?  or those who criticized this diary without providing the specifics they were referring to?

      I am unsure.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 04:03:16 PM PDT

      [ Parent ]

      •  I calling those who criticized, in commments, (0+ / 0-)

        ... with comments merely saying "FAIL" but added ZERO depth, zero commentary, zero specifics.

        I am ABSOLUTELY NOT criticizing you for your efforts, Heavens NO! ... I have nothing but high praise and deep thanks for the work you have done, and are doing.

        I will work on a diary today and post later today or tomorrow.

        ~we study the old to understand the new~from one thing know ten thousand~to see things truly one must see what is in the light and what lies hidden in shadow~

        by ArthurPoet on Mon Sep 07, 2009 at 05:18:20 PM PDT

        [ Parent ]

        •  TYPO --> I *WAS* calling those who criticized, (0+ / 0-)

          ... without adding detailed specifics, "ANTI-PUBLIC OPTION TROLLS ... not you!

          You added numerous specifics.

          ~we study the old to understand the new~from one thing know ten thousand~to see things truly one must see what is in the light and what lies hidden in shadow~

          by ArthurPoet on Mon Sep 07, 2009 at 05:48:32 PM PDT

          [ Parent ]

        •  Oh, whew. Thanks. I wasn't sure (1+ / 0-)
          Recommended by:
          ArthurPoet

          Yeah, I was surprised by those who didn't pipe in and help clarify this huge issue.  Some are even in the KNOW big time.  Oh well.  It is a holiday weekend.  Well, we know what I did this weekend.  

          You might want to include this information in your diary, too.

          I just dropped this off at Fire Dog Lake:

          Health Insurance Reform? Not Until 2018! Say It Ain’t So.
          http://seminal.firedoglake.com/...

          Hey, thanks for the positive feedback.  You made my day!

          I look forward to your input/diary.  Let me know when you publish it, K?

          Poverty does not mean powerless. Unite!

          by War on Error on Mon Sep 07, 2009 at 06:11:07 PM PDT

          [ Parent ]

          •  And this like some immediate insurer gains! (1+ / 0-)
            Recommended by:
            ArthurPoet

            Here's a great examples of the WINDFALL

            The Commissioner would pay insurers additional amounts to cover the reduced cost-sharing provided to credit-eligible individuals.

            CRS report, page 15
            http://fpc.state.gov/...

            Within 90 days after enactment, H.R. 3200 would create a temporary reinsurance program, with funding not to exceed $10 billion, to assist participating employment-based plans with the cost of providing health benefits to eligible retirees who are 55 and older and their dependents. The Secretary would reimburse the plan for 80% of the portion of a claim above $15,000 and below $90,000 (adjusted annually for inflation).

            Amounts paid to the plan would be used to lower costs directly to participants in the form of premiums, co-payments, and other out-of-pocket costs, but could be not used to reduce the costs of an employer maintaining the plan.

            Page 7, Same CRS report link above

            So, the Secretary pays the insurer, starting in 90 days after the Bill is law, and THEN the insurer is trusted to pass that along to the insureds?  This will be interesting.  And the Bill doesn't go into effect for the public until 2013.  Hmmm.  

            This is beginning to sound as good as the Bank Credit Card Windfall Legislation.  For the banks, from the people.  

            Why not just put these age 55+ retired people onto Medicare?  Do you think the insurers can survive without them?

            Certain small businesses would be eligible for a 50% credit toward the cost of coverage.

            This credit would be phased out as average employee compensation increased from $20,000 to $40,000, then as the number of employees increased from 10 to 25.

            Employees would be counted if they received at least $5,000 in compensation, but the credit would not apply toward insurance for employees whose compensation exceeded $80,000. This credit would be treated as part of the general business credit and would not be refundable; it would be available only to a business with a tax liability.

            http://fpc.state.gov/...

            also Page 7, CRS sited above

            Fewer taxes into the Federal Budget?  But what does "certain" mean?  Well, this could help more people working for small business with small wages (too many Americans in my opinion) a chance to have insurance and, hey, maybe even health care.  

            Where's that 50% credit for individual FOLKS?  Effective in 6 months.  How many would $10Billion help?

            I'd love to see that, if Corporaticians in DC could find their hearts, feel their hearts, listen to their hearts, and act on those promptings (the heart being a metephor, of course).

            But no, most of the wording I have read this weekend reeks of industry input, so the Corporaticians are determined to keep the health insurers flush, and the campaign coffers fat.

            What a sad state for my old friend, Democracy.  How I miss her.

            Poverty does not mean powerless. Unite!

            by War on Error on Mon Sep 07, 2009 at 06:21:40 PM PDT

            [ Parent ]

            •  Thanks. I will read through .... (0+ / 0-)

              ... and just commented on your diary posted today, which I will also read through. This is a very busy time for me ... (no holiday weekend, lol) ... but/so, I have very limited time, but this is very important, and so I will try to make some time to put something together.

              ~we study the old to understand the new~from one thing know ten thousand~to see things truly one must see what is in the light and what lies hidden in shadow~

              by ArthurPoet on Mon Sep 07, 2009 at 06:41:11 PM PDT

              [ Parent ]

  •  Or one can just read (1+ / 0-)
    Recommended by:
    Annalize5

    Matt Taibbi's excellent and damning Rolling Stone article on the health care reform.

    In a word: clusterfuck.

    "Those who stand for nothing fall for anything." - Alexander Hamilton

    by kovie on Sun Sep 06, 2009 at 03:48:25 PM PDT

  •  Thanks for a lot of work (0+ / 0-)

    Will those ombudsmen have teeth is one  of my questions...

    Torture: An act... specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control.

    by MsGrin on Sun Sep 06, 2009 at 04:09:41 PM PDT

  •  Please stop using page numbers (2+ / 0-)
    Recommended by:
    GN1927, CupofTea

    to refer to sections of legislation. Use the section/subsection/paragraph header numbers. The pages can move around much more than the headers.

    If you recall, this was something that added to the confusion about the notorious RW emails about HR3200: it was hard to respond to any of their statements because they only provided page numbers apparently corresponding to some random printout, and the other available copies had completely different pagination.

    Greg Shenaut

    •  Well, the link to the bill is in the beginning (1+ / 0-)
      Recommended by:
      GN1927

      of the diary.

      I did wrestle with this for purposes here.  I will be updating when more input from professionals is received.  I will edit and include the items you suggest.  Thank you.  Point well taken!

      However, if you open the link above, it is quite easy to scroll to the page.

      Actually, I copy/pasted to Word so I could do a Search for.

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 04:18:49 PM PDT

      [ Parent ]

    •  Sadly, I can't edit this version. nt (0+ / 0-)

      Poverty does not mean powerless. Unite!

      by War on Error on Sun Sep 06, 2009 at 04:28:00 PM PDT

      [ Parent ]

  •  Here's what I want to know...where does this guy (2+ / 0-)
    Recommended by:
    vets74, BigAlinWashSt

    go to get signed up for "healthcare"?

    homeless man

  •  Exchanges = another gift to the same people who (1+ / 0-)
    Recommended by:
    splashoil

    fucked everything up in the first place (private health insurance co.s). Reminiscent of the bank bailouts, isn’t it?
    I say scrap this POS and try for a exclusively government administered, private-sector-free, TRUE PUBLIC OPTION!

  •  Thanks. It's overwhelming and (1+ / 0-)
    Recommended by:
    CupofTea

    confusing to try and wade through it.  That's probably one of the many reasons most of the media doesn't really try to report on it in much depth.  They're too lazy.  It's easier and more sensational to just show some nutjobs at a town hall.

  •  my god man (or woman), you are brave (0+ / 0-)

    thanks for wading through this - thing.  Obviously, there are questions.  I think we will have to wait for a final bill to render judgment, but thanks for your work!

  •  Nothing wrong (0+ / 0-)

    I have always been thinking Public Option proponents will somehow be disappointed because all bills call for a self sufficient unsubsidized  public insurance  - that means it will be pricey.

    Medicare - if you buy it when you lack the 10 years still cost around %400 or more.

    The only good thing about public option is that pre-existing disease are covered and no lifetime limits, etc.

    But things can evolve ---the thing is to have this approved then later in the future to make changes to adopt to the needs of people.

    Dont let the LIARS win. Stand up for TRUTH! Stand up for Health Care Reform!

    by timber on Mon Sep 07, 2009 at 04:37:35 AM PDT

  •  Don't like this journal (0+ / 0-)

    Too much opinion, too much levity.  I don't find this analysis at all helpful.  You did alot of writing - actually copying and pasting, thank you but no rec from me.

    Kent Conrad is chasing a white rabbit named Harvey (don't let him co-opt real reform).

    by noofsh on Mon Sep 07, 2009 at 05:57:24 AM PDT

  •  2013 (0+ / 0-)

    This BILL is never ever going to happen. Putting a 2013 start date is a joke. We are all being treated to a Kabuki puppet show.

    "It's better to die on your feet then live on your knees" E. Zapata

    by Blutodog on Mon Sep 07, 2009 at 06:47:45 AM PDT

  •  Anything is better than what's happening now. (0+ / 0-)

    Poverty is a death sentence, while we waste trillions on corporate bail-outs and doing wars so's to make them expensive.

    Second Round: the White House wakes up that Veterans Health Administration costs 1/2 to 1/3 what private care costs. And there's already civilian copy-cat ops that work just fine.

    This is a good bloody-their-noses First Round legal instrument.

    Rough draft for it, anyway.

    Angry White Males + Personality Disorder delusionals + sane Pro-Lifers =EQ= The GOPer Base

    by vets74 on Mon Sep 07, 2009 at 10:00:52 AM PDT

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