Islandman

[Yuttie]

i like the new senate bill.....not holistic enough but a damn good bill none the less.

[Islandman]

I am a bit disapointed with some of the final concessions to get Leiberman and Nelson on board, particularly the killing the option to buy into Medicare from age 55.

Also I did not realise that for adults, the ban on refusing coverage due to pre-existing conditions will not come into effect until 2014. Was that always in the bill or is that a last minute change?

Maybe thats the best that could be done to get the 60 votes, but I don't think the Howard Dean wing will be happy. I hope the compromise talks between the House and Senate can bring it back a bit towards the House version.

[Yuttie]

its tricky to explain but basically they can't refuse to pay for "essential" services before 2014; whatever the hell that means, coorporate definition of essential greatly differs from mainstreet's definition.

They also adopted some of the Wyden languages which allows individuals who don't qualify for federal subsidizes to receive vouchers to purchase insurance in the exhange.

It has greater subsidizes and better consumer protections; more money is also given to the state for meidcaid payment to prevent squeezing the budgets any further.

Also companies are required to spend 85% of their profits on large firms and 80% with small firms.

more to come haven't gotten through deciphering the document as yet.

http://www.politico.com/static/PPM145_chris1.html

[Karl]

its tricky to explain but basically

Also companies are required to spend 85% of their profits on large firms and 80% with small firms.

[Yuttie]

insurers are required to spend 85% of the profits they make from lbeing contracted arge companies on actually health care and not "administrative cost". They normally do this for the most part but on the small man market they normally spend about 60% of their profits, that will now be boosted to 80%.

Here's another nugget, insurers that spike their rate before the exchange is established will be barred from entering the exchange.

[Karl]

insurers are required to spend 85% of the profits they make from lbeing contracted arge companies on actually health care and not "administrative cost". They normally do this for the most part but on the small man market they normally spend about 60% of their profits, that will now be boosted to 80%.

So they shall spend what %age of there profits?!

[Yuttie]

85% of the profits earn from the employer system and 80% of the profits from the individual market.

too seperate markets boss...think of it as Digicel having to reinvest 85% of the profits they generate in Jamaica back in Jamaica and 80% of the money earn in Haiti back in Haiti.

[Jawge]

Finals are over, good. Yuttie Ja earned 1.53 billion USD in off peak season and we still have high unemployment etc. etc,. Boss yuh have any idea what might cause this or the way to go forward?

[Yuttie]

how much was the expense?

[Jawge]

Not sure but I'm sure they wouldn't spend 6oo million to get 1500 million.
Also our dollar keeps declining and the workers' pay remain the same.

[Islandman]

Good article on the business case for health care reform. I don't think this argument was made often enough.

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From the NY Times

Without Health Reform, America's Innovation Gap Will Grow
by David Leonhardt
Wednesday, December 16, 2009


Greg Woock is the chief executive of Pinger, a fast-growing Silicon Valley company that makes iPhone applications. So Mr. Woock spends a fair amount of time interviewing job applicants. In almost every interview, he told me recently, the applicant asks about Pinger's health insurance plan.

Now think about that for a minute.

In the cradle of American innovation, workers are making career choices based on co-payments, pre-existing conditions and other minutiae of health insurance. They are not necessarily making decisions based on what would be best for their careers and, in turn, for the American economy -- that is, "where their skills match and where they can grow the most," as another Silicon Valley entrepreneur, Cyriac Roeding, says. Health insurance, Mr. Roeding adds, "is distorting the decision-making."

It is impossible to know how much economic damage these distortions are causing, but they clearly aren't good. Economic research suggests that more than 1.5 million workers who would otherwise have switched jobs fail to do so every year because of fears about health insurance. Some of them would have moved to companies where they could have contributed more, and others would have started their own businesses.

This link between insurance and innovation isn't relevant merely for the obvious reason that Congress is in the late stages of debating health reform. It is also relevant because the United States is suffering from an innovation deficit.

Even before the financial crisis, the decade that will end later this month was on pace to have the slowest economic growth of any since before World War II. The No. 1 reason, I'd argue, was our innovation deficit.

For most of this decade, the rate at which companies eliminated jobs was actually lower than in the 1990s (despite the stories you sometimes hear about the United States having entered a new era of economic instability). The problem was that companies weren't creating enough new jobs. The rate at which existing companies added jobs declined 14 percent from the end of the 1990s to 2007, according to the Labor Department. The rate at which start-up companies created jobs fell even more: 24 percent.

Given the consequences of the innovation deficit -- slower growth, fewer jobs, lower living standards -- you would want to look for every possible solution, wouldn't you?

You'd want to allow more talented immigrants to become citizens, so that the next Sergey Brin, Liz Claiborne or Andy Grove, immigrant entrepreneurs all, didn't end up starting their companies elsewhere. You would want to clean up the tangled corporate tax code. You would want to finance more basic research.

And you would want to make people feel confident that they could take risks -- start a new company or join a young one -- without worrying about whether they would still receive adequate medical care.

Congress is now close to passing a very promising health reform bill. Neither the bill that the House passed last month nor the bill being debated in the Senate is good enough yet. But they are close.

Ultimately, health reform will be judged by two yardsticks. The first will be whether it begins to shift medicine away from the corrosive fee-for-service system that leads to uneven results and soaring costs. The second will be whether people can easily buy insurance even if they don't work for a large company or qualify for Medicare or Medicaid.

Silicon Valley, with its network of venture capital backers, figures out a way to get most of its workers some kind of health insurance. But many other entrepreneurs have a harder time of it. Only 46 percent of companies with three to nine employees offer health insurance, down from 56 percent a decade ago, according to the Kaiser Family Foundation.

Why? The administrative costs of insurance are high when they aren't spread over a large group of workers. Insurers also know that the individuals and small companies who sign up for health plans tend to be the ones with the most medical problems, pushing premiums for such plans even higher.

So unless the government steps in to create a large pool of workers who can then buy insurance more cheaply, many small companies will go without it -- and some workers will find themselves tethered to the safety of a big company.

As Eric Schmidt, Google's chief executive, told me, "There clearly are people who choose to stay in their jobs due to the fact that they don't have insurance portability." Just consider the economic research showing that people married to someone with health insurance are more likely to work at small companies than people who aren't so lucky.

The path to a health bill that begins to solve both core problems -- access and cost -- is fairly clear, numerous health economists say. It involves combining the Senate provisions on cost and quality control (and, ideally, strengthening them) with the House provisions on insurance access. Ezra Klein, the blogger and health policy writer, refers to it as a "health care reform fantasy draft."

The House bill does a good job of creating affordable insurance plans for the uninsured but does little to attack fee-for-service medicine. As a result, medical costs are likely to stay high for everyone.

The Senate bill, by contrast, has the "essential elements of a successful, fiscally responsible reform strategy," according to a recent letter from 26 economists, including four Nobel Prize winners and two former directors of the Congressional Budget Office. But the Senate plan is too rough on the newly insured. It would force many of them to pay thousands of dollars a year out of pocket, on top of their premiums, for care.

"Take the Senate on cost control and the House on affordability," Jonathan Gruber of M.I.T. argues, "and you've the best possible bill."

And what if Congress -- distracted by hot-button issues like drug imports, government-financed abortions and the so-called public option -- produces something short of best? Should we then hope that it gives up and take another crack at health reform in, say, 2025?

Well, remember that this process was never going to be easy and was always going to be messy. But in the coming days and weeks, the choices before Congress will be straightforward: How can the bills still be improved? And once all the negotiating is over, will the final package seem likely to do more good than harm?

Last week, Medicare's chief actuary came out with a report that offered some useful guidance on that second question. The report became fodder for critics of the bills because it estimated that the current Senate plan would raise national health spending slightly. Without health reform, the country would spend $4.67 trillion on medical care in 2019. With it, we would spend $20 billion more, a total of $4.69 trillion.

If you dug into the report, however, you discovered the main reason for the projected increase. Vastly more people -- about 33 million -- would have insurance if the Senate plan passed. "There are more people insured, and more people getting treatment," the actuary, Rick Foster, said.

Yet health spending would rise by just 0.5 percent. The cost of insuring a given individual would be significantly reduced, in other words, and millions of people would no longer have to worry about whether they were insured.

Maybe one of those millions will end up starting the next great American company.

[Yuttie]

i like how they structrured the bill to give the Secretary of HHS the power to implement the pay for quality program nationwide based on the most successful pilot model at the state level. I also like the idea that an independent board can enforce those changes as well.

what to you think of the major investment in primary care, local health clinics, and at home physician visits? I'm telling you it's very good bill; they just need to fix the pharmaceutical aspect and make voucher program more open.

[Assasin]

Well well. While it is not perfect but I am glad they democrats are moving ahead.

It will result in growth in the economy and hopefully better healtchare.
It is needed at this time more than any stimilus package.

The republicans again are on the wrong side of history.

[Islandman]

I hope I will have some time to figure out the details of the bill later on, but I take your word for it that it is still good enough to be considered real health care reform.

If they can do something about Medicare/Medicaid fraud that would help a lot in payiing for this. I saw an estimate that more than 20% of medicare costs are due to fraudulent claims.

[Jawge]

You what's the beauty about this? It will work out; the senate, congress, President et al are just working within the confines of a system laid down some two hundred odd years ago? The question is this: how could thes men draw up a PLAN that functions over two hundred years? another word Vision.

Garvey was giving us Jakans some vision but we scoffed at him. In Ja our plight remains the same after 1838 and we don't ask why or how can this be? Check our system of govt. (the source code) and we will know why.

We need our own source code built from scratch; something set up to benefit Ja and all its citizens.