Henry Raymond

Fairfax News => Political Issues/Comments => Topic started by: Henry on April 03, 2011, 08:24:23 PM

Title: Help Me Understand
Post by: Henry on April 03, 2011, 08:24:23 PM: The new healthcare bill. I am 77 years old with my primary insurance being Medicare. I do have catastrophic care from IBM that I pay for that kicks in after I pay $4,000 out of pocket. I have prescription Insurance from Merk Medco and Eye Care from IBM.

I know this seems selfish, but will this new healthcare bill doi anything for me.

Can anyone net out in a few sentances just what is the New Healthcare Bill??
Title: Re: Help Me Understand
Post by: Chris Santee on April 04, 2011, 06:46:47 AM: Here's a start from Northwest Medical's C.E.O. Jill Bowen:
http://www.samessenger.com/node/1196 (http://www.samessenger.com/node/1196)
Title: Re: Help Me Understand
Post by: Chris Santee on April 04, 2011, 09:56:21 AM: since you mention IBM:

Major Vermont employers voice opposition to proposed healthcare plan
by Angela Chagnon
The Senate Health & Welfare committee held a hearing Wednesday night to hear from Vermont's business community about H.202, the health care reform bill recently passed by the House. They got an earful. The state's largest private employer, IBM, and a burlington business often referred to when discussing Vermont's economic future, Dealer.com, expressed detailed opposition to the bill.

"The healthcare reform Vermont proposes has to be fully vetted and have a very high probability of success," remarked John O'Kane, IBM's Manager of Government Programs for Vermont. "We cannot ask Vermonters and employers to be 'test subjects' for a 'grand experiment'."

"IBM strongly opposes H.202," he stated emphatically. "The bill's failure to respect multi-state employer exemptions under ERISA threatens our ability to offer uniform benefits to all our U.S. employees."

O'Kane said that IBM was "disappointed that significant large employer concerns about maintaining existing health benefits design and funding flexibility were not incorporated in prior legislative action on this bill." He remarked that asking IBM to trust that the proposed healthcare plan would lower healthcare costs and "achieve better health outcomes for employers like IBM than we can accomplish for ourselves" was a "significant risk" for IBM to take.

"IBM strongly supports healthcare reform," O'Kane continued. He outlined the need to make changes to bring costs down and deal with coverage for the uninsured. "However, effectively dismantling employer provided healthcare benefits just doesn't make sense, and that is what this bill proposes."

O'Kane's testimony included several suggested changes and additions to the bill, mostly about protecting ERISA and preventing large companies from being double-taxed via H.202's proposed payroll tax. Also submitted in the testimony were several questions regarding the plan's financial aspects and what the healthcare plan will consist of for individuals and providers.

In summary, O'Kane requested legislators to "clarify that Vermont will respect all ERISA exemptions to that employers offering health insurance will be able to continue doing so and have the flexibility to meet employee needs in and outside of any one state."

He went on to say that the only way for companies to "exist and provide jobs" was to "maintain competitive costs."

"Adding significant taxes to these companies will not make Vermont employers more competitive in the global economy," said O'Kane. "Bringing health care costs down will."

Lastly, O'Kane advised against rushing the bill through. "Complete top to bottom system transformation at an accelerated pace is daunting and carries great risk."

After O'Kane finished, two company officials from Dealer.com in South Burlington also testified - Kristen Halpin, Chief Talent Officer and Mike Lane, Chief Operating Officer.

After outlining the amount of business Dealer.com brings to Vermont and how the company ensures that its employees' healthcare needs are well taken care of, Halpin said that their business practice was to hire companies that "want to know the rules, be able to explain why they are doing the things they are doing, and should know how the resources are allocated." She said that she was not able to answer those questions about H.202.

"If I go to one of my customers and say, 'I have an idea', take concepts and put it toward them, and basically say, 'it's going to potentially cost something' -- I can't sell them that, because I can't articulate what that looks like," remarked Lane. "My board is not going to let me build that product or invest in that unless I can actually answer these questions, and show a model that's actually going to work and succeed. We're afraid that going down the road we are right now, we're just setting up for failure. And there's too much risk involved in this that's failed too many times before for us to just fall into the same kind of thing."

"We can't give our customers products that are half developed, because they won't take it," Halpin reiterated. "We're not saying we can't do this, what we're saying is let's sit back and answer questions just like we do with our customers."

"We're providing so many jobs for Vermonters, that we want to be sure we can maintain that," continued Halpin. "So we're just asking that you help us answer these questions before we take such a large step because it can be very beneficial to do it right."

Halpin concluded: "We're trying so hard to keep our business here. We could easily say, 'Wow, we've got a hundred resumes from California overnight, we can fill all our jobs.' But we don't. We're making extra effort to do everything we can to hire in Vermont and bring people here."
Title: Re: Help Me Understand
Post by: Chris Santee on April 04, 2011, 02:00:08 PM: according to GeorgeTill (D-Jericho) who took a poll among Vermont's licensed physicians:

28.4% of respondents say they are likely to stop practicing in Vermont should a “single payer” system be initiated.
Title: Re: Help Me Understand
Post by: Thor on April 04, 2011, 03:57:46 PM: Henry,

It would appear after reading through some of this info that this Health Care bill is not going to be beneficial to you or any of us that have health care, like what we got, pay for it ourselves and don't want changes. But, Shummy and his cronies want to make this happen. The points that John O'Kane from IBM pointed out are on the mark, but I am sure no one from the Senate Health and Welfare Committee took any notes on it.

Chris,

Did the Dem from Jericho make any further points after he got that information about 28% of the physicians stopping their practices here if the single payer system is implemented? He probably thinks it is okay if they stop practicing / leave the state, as you don't really need that many doctors in a socialist society. People can wait a long time to see the doctor, when they don't have to work because the gov't is giving them everything!
Title: Re: Help Me Understand
Post by: Chris Santee on April 04, 2011, 04:07:20 PM: www.georgetill.com (http://www.georgetill.com)
Title: Re: Help Me Understand
Post by: Thor on April 04, 2011, 04:44:25 PM: Chris,

Have you gone to that website and read any of the Health Care Bill input? It is nothing but smoke and mirrors, rainbows and unicorns. I don't know who this Dr. Hsiao is, but he certainly provided a significant amount of input into this thing. Hell, according to him, this bill will save Vermont $50 million in its first year. But the folks who attended that Senate Health & Welfare Committee hearing the other night could not make such claims.... wonder why? Perhaps they didn't want to say something and possibly be held to it. (Typical politician) Anyway. I think they should scrap the entire idea. They would probably be able to see that too, if they could just pry their heads out of their asses long enough to look around.
Title: Re: Help Me Understand
Post by: j_gluck on April 04, 2011, 09:21:24 PM: Dr. Hsiao was hired by the Legislature to develop three options for universal healthcare coverage for VT. He presented his report in January and will continue to work with the Legislature and Shumlin administration as they move forward. Here is his information page at the Harvard School of Public Health - http://www.hsph.harvard.edu/faculty/william-hsiao/ (http://www.hsph.harvard.edu/faculty/william-hsiao/)

He is an economist who studies the economics and health proficiency of healthcare systems in the US and around the world.
Title: Re: Help Me Understand
Post by: j_gluck on April 04, 2011, 09:30:31 PM: For another point of view, please go to the Physicians for a National Health Program website - http://www.pnhp.org/ (http://www.pnhp.org/)

Just to clarify - the numbers in this quote from their website are national, not Vermont-only numbers.

Quote
The U.S. spends twice as much as other industrialized nations on health care, $8,160 per capita. Yet our system performs poorly in comparison and still leaves 50.7 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

Our current system is broken and leaves many un- or under-insured. Vermont can be a leader in this effort to join the rest of the industrialized world in implementing a single-payer system.
Title: Re: Help Me Understand
Post by: Thor on April 05, 2011, 05:06:30 AM: The bureaucracy and paperwork issue is a direct reflection of the gov'ts involvement. Further gov't involvement in anything is going to add to the bureaucracy, not fix it. When they go to this system here in VT, they are going to wind up with a worse situation than they currently have, because any large businesses will move to another state, and the smaller businesses are going to close up shop. And when the doctors start leaving the state, and we cannot keep even the young, motivated health care people here, the situation will become worse again. And ultimately, it will work out, because only those with socialist beliefs will stay here and continue to pay into the system, in the hopes and beliefs that this will work here... even though it has not worked anywhere else with any success.
Title: Re: Help Me Understand
Post by: msm on April 05, 2011, 06:33:05 AM: Thor,

You hit the nail on the head man ---- Well said --- Looks like the State Run-It-My Way boys will drive all business out of the state -- then what ?? Raise veggies and sell firewood ?

These planned changes will only drive more young professionals from the state --- I sad state of affairs ...

Mike M
Title: Re: Help Me Understand
Post by: msm on April 05, 2011, 06:50:09 AM: I missed an important point, the State Administrators should be consulting the leadership at IBM and Dealer.com. Seek theri input on how to bring additional business into the state. From my perspective, Dealer.com is type of industry, technical professions , leading edge, environmentally-friendly business. The State needs to better understand how to entice this type of business into the state .. These job have a positive trickle down affect on local economies and tend the spawn additional smaller businesses in the same field. Ripping health care benefits apart and demanding additional payments from your leading employers is sure means of losing these important tax revenue sources. When the leave -- they are gone forever ---

The State of VT has the oldest average population in the country .. Why ? Anti-Business is WHY !! This new Healthcare plan will yield more business losses , more young people leaving and no one left ( except for out-state second home owners ) to pay the bills.

Gary Gilbert what are your thoughts on these Healthcare changes ? Let the residents of Fairfax and Georgia know your thoughts and how you approach the complex hreal world issue.

Mike McNall -- BFA Class of '77
Title: Re: Help Me Understand
Post by: Thor on April 05, 2011, 07:20:14 AM: Mike,

All these folks claiming that this health bill will make things so much better.... I would like to know what they are basing it off of? Have they ever seen this in action, or are they basing this off of what they are being told? They could make a short trip down to Mass, and see how Romney Care failed there and is costing the state exponentially higher bills than what they had before they "fixed it". I have lived in the UK, I have lived in Germany and I have traveled to many countries where this system is supposed to work or "be better". But it isn't, the people there talk about how good we have it here in the states.

I had the chance to talk to a young med student this past weekend. She doesn't want to leave VT, but she is probably going to. With Shummy and his comrades setting pay schedules for the medical industry, some of these young kids are worried they won't make enough to be able to afford to live here and pay back their student loans. But perhaps Shummy has a plan for that as well. Maybe he will forgive all their college debt if they promise to stay here.... oooops, then the colleges will leave. Damn the mess we get in when we try to keep "giving sh_t away".
Title: Re: Help Me Understand
Post by: Gary Gilbert on April 05, 2011, 08:37:11 AM: H 202 is a cautious step to combat the rapid rise of health care cost for Vermonters and not the great leap that some have suggested. Education cost increases have received a great deal of attention over the last few years. Voters hate to see their educational property tax bill. It is visible and immediate. They know it is going to come out of their pockets even if they pay based on income. They know each time they send money to schools; they just don’t know how much of that increase is caused by health care costs.

Health care costs are not as evident as education costs. But have a broader societal impact. They drive increases in every service and product offered in Vermont. But health care costs are often shared with an employer and the employee may not be aware of the total cost for their coverage. I have heard from an employer whose cost for a health benefit package is greater than their profits for the year. This business owner is acutely aware of the costs and how much they are increasing.

Let me put this in perspective. In the six years for 2004-2010 education spending saw an average annual growth of 4.87% with a total growth of 33%. This was not good. During the same period the cost of Medicaid revenues saw an average annual growth of 8.43% with a total growth of 62%. Not only is this twice the rate of education increases, but it is also a significant cause of that increase. A projected total health spending increase of one million dollars a day cannot continue and we need to take steps to counter that growth. The question is whether it is possible to direct more of that cost toward care by applying less to administrative overhead.

H 202 is a move in that direction. It constructs a process that will be very transparent to the public. There are multiple checkpoints and places where legislative action would be required before the next successive step could be taken. It is your legislative body that will ask and determine answers to the important questions before each step. They will need to understand what will be in a benefits package, the cost of that package and a financing plan. This would be followed by enacting a Green Mountain Care budget. Public input will be sought at each step. It is important to remember that health insurance companies do not provide health care. They manage the flow of dollars between the provider and the client at a cost to the client. A single pipeline for multiple payers could effectively reduce this off the top cost and allow more of our health care dollars to be used for services instead of paperwork.

The bill is now in the Senate Health Committee where they are taking testimony. Businesses and different categories of doctors are divided, health care advocates support some kind of change, and insurance brokers oppose it. As the bill now exists, subject to change, it makes no changes to Medicaid/medicare, Military ins., or companies that self-insure.
Gary
Title: Re: Help Me Understand
Post by: Thor on April 05, 2011, 11:26:56 AM: Not sure that H202 is how I would define a "cautious first step". To me, something way more incremental might answer that mail. Maybe try it out in a particular region, a particular city, first to see how it goes on a smaller scale, before it is implemented full scale statewide and we find out it isn't working the way it was anticipated. If it is implemented full scale and we find out the unthought of details are detrimental to the system, what will happen? Nope, nothing cautious about that...
Title: Re: Help Me Understand
Post by: Chris Santee on April 05, 2011, 03:43:08 PM: from Vermont State Auditor Tom Salmon to the Fairfax News:

H.202: Please hit the Pause Button
The Latin root of the word auditor is auditus: “a listening, a hearing.”
I have aggressively listened and sought understanding of Vermont’s healthcare bill H.202:
1. I attended Dr Hsiao’s first public hearing in 2010, in Room 11 of the Statehouse when he declared the difficulty.

2. I attended his January 19, 2011, presentation in the House chamber and reviewed his materials.

3. I have reviewed H.202, which is now in the Vermont Senate’s hands.

4. I have listened to medical professionals and reviewed the Joint Fiscal Office projections (scary in the coming years).

5. I have discussed the matter with insiders who call the process a “train wreck” because “providers are mobile” and “subsidized clients will have to accept basic care with lower service levels --- or will the state have to fund a silver and gold plan too?”

6. I have listened to lawyers who ask about the Constitution and the “privileges and immunities” clause that could draw, logically, unhealthy people here. “Let’s go to Vermont for that surgery I’ve put off.” Please note the bill already confirms we have a shortage of doctors.

7. I have read op-eds and listened to radio interviews of thoughtful, informed professionals who have deep concerns that we are moving too fast. Representative Browning articulated her concerns very well, and voted “nay.”

8. This bill misleads the public by presenting a stated purpose that includes “setting forth a strategic plan”, when in reality it demands great energy and resources (millions of dollars) across state government far exceeding scope and possibility.

9. One week ago I participated on a health care panel in Rutland. I said very little except to voice my concerns as an auditor; the impact to the financial statements, bond rating and future liability of the state are unknowns. It was a civil and thoughtful discourse among the audience, legislators, healthcare professionals, insurance salespeople, etc. The unanswered questions were too numerous to document. Cross-border, ERISA and residency concerns just to name a few.

New information on all fronts would lead responsible leaders to push the pause button and gather more information before proceeding. The financial incentives and promises of administrative savings are no longer realistic, given all the amendments arising. Furthermore, past audits by our office have indicated that Vermont lacks a proven track record of strategic planning, performance measurement and implementing reform.

Much has changed since Dr.. Hsiao has visited Room 11: A well intended idea has met its unfeasibility. Why not work within the operational reality to construct a feasible plan without all the hype and history making? In the auditor’s office we live by the creed: “A quality process leads to a quality product.” In a March 2010 letter to Congressman Welch last year, I sought to convey the same message. President Obama had a chance to really fix Medicaid and Medicare but he punted. Now Vermont is on track to repeat the same type of mistake.

This bill is a political solution attempting to solve a complex financial problem. Medicaid keeps Joint Fiscal’s Steve Klein up at night because leaders have lacked the courage to address the real problems.

Vermont has some other large problems, too. With unfunded pension and OPEB (other post-employment benefits) responsibilities, increased income sensitivity payments, declining income tax revenues, federal ARRA money going away, and infrastructure and demographic challenges, it is time for leaders to lead and financial people to be heard. I hope people will hear what I am saying. I have testified on sensitive matters from the Bennington “sick” building, to pre-kindergarten, to the unemployment fund. The fiscal impact of this commitment of resources is unknown without a better formulated strategy in advance. Vermonters can handle the truth.

Thomas M. Salmon CPA is the Vermont State Auditor. He lives in Saint Johnsbury.
Title: Re: Help Me Understand
Post by: Loctavious on April 05, 2011, 04:27:21 PM: Chris,
Would you mind commenting on strictly the rhetoric side of this 'discussion'? You're a known republican who offers mild to no rhetoric and if you do, provides factual evidence to support your view. You refrain from 'offering' energized and grossly inflated terms, name-calling, and the typical and offensive partisan rhetoric (possibly due to the fact it polarizes even further the differing opinions and actually serves to prevent either side from seeking any middle ground or possibility of seeing the others point of view).
I feel that perhaps your presentation of how such charged rhetoric, name-calling, and poorly thought out adjectives ( or perhaps it's a lack emotional intelligence) to describe issues, is counter productive to what some folks hope to achieve when they themselves opine about these issues - which is to offer their view on how said issue will affect them adversely.
ALSO - I'm pretty sure Henry wouldn't condone language which is meant to offend, name-call, or otherwise belittle another's point of view - especially profanity - as he states on the top of the page of the forums.

Thanks bud.

Loct
Title: Re: Help Me Understand
Post by: rod anode on April 06, 2011, 03:25:42 AM: loc.you must have been in mensa
Title: Re: Help Me Understand
Post by: mkr on April 06, 2011, 08:01:22 AM: Loct, I believe Chris is just passing on the info from Tom Salmon up above and not his words.
Title: Re: Help Me Understand
Post by: cedarman on April 06, 2011, 08:49:24 AM: Health INSURANCE reform is NOT HealthCare reform. It seems to me that politicians focus on the "administrative costs". Yes, there can be some savings in that area, but we won't see significant savings in healthcare cost until we start looking at WHY cost of care is climbing so much faster than inflation.

Is the overall increase due to more people seeking healthcare due to an aging population, or is cost climbing so fast due to rapid increases in the cost of procedures and medications?

Are the costs of materials required for diagnosis/treatment climbing rapidly due to a lack of supply or due to suffocating government regulations?
Title: Re: Help Me Understand
Post by: Chris Santee on April 06, 2011, 09:02:17 AM: Thanks, Coach, always a pleasure to hear from you, you say the sweetest things.

Yes, mkr, some of my posts are from me and some were submitted to the Fairfax News, I try to identify all.
(I don't want to be like the Republican legislator who read someone else's speech on the floor, I'll refrain from blasting him).
Or did I just do that ?

Henry, sorry I didn't keep it to a sentence or two, that's tough.
In my humble opinion, I believe it's going to cost you more in cash, co-pays and you may have to find a new doctor, maybe in a new town. You'll have to wait longer for an appointment and more and more of your coverage will be denied as the program gets more and more expensive.

J_Gluck, thanks for explaining who the doctor is and providing the links, but you can say Harvard, Harvard, Harvard all you like.
There are others at Harvard who disagree.
You mention "He is an economist who studies the economics and health proficiency of healthcare systems in the US and around the world." 100% Correct, but this is a first time experiment in the US and I'm not really interested in being one of his guinea pigs in his study, I'm a human being, and I happen to need healthcare (My primary has already informed me that we won't be together much longer).

Gary, thanks for (I'm having some problems posting here)
Title: Re: Help Me Understand
Post by: Stand Alone Defense on April 06, 2011, 09:10:08 AM: Thanks for your input Chris, and also well said I agree with you 100% on this issue!! I got your back buddy!!
Title: Re: Help Me Understand
Post by: Chris Santee on April 06, 2011, 09:12:51 AM: The problem may have been posting at the same time as cedarman.
Or maybe your site is just tired of hearing from me.
:-)

Gary, thanks for commenting, I believe communication is very important and I appreciate both you and Carolyn posting here.
But, (you knew that was coming) I don't think it's a cautious step that sends 28% of our doctors packing.

Or does it ??????????????
The D from Jericho, who I admired for honesty admitted to Anson Tebbets, that some people taking the poll may not have been docs afterall. Darn, lost the link from WCAX.

Mike, I agree about Dealer.com and IBM, what they have to say worries me and we should listen to them. How's Tampa liking Manny ? I hope your storms are over for a nicer spring.

Thor, yes I saw through the smoke and mirrors and don't agree with Till, but I was surprised he admitted 28% would leave the state before he admitted they might not be doctors (I'll get that link now).

Then, I'm going to enjoy some of this sunshine, I hope you all do too.
Title: Re: Help Me Understand
Post by: Chris Santee on April 06, 2011, 09:38:13 AM: Here's the link from WCAX:
http://www.wcax.com/Global/story.asp?S=14390288 (http://www.wcax.com/Global/story.asp?S=14390288)

It's chiily out today, but very sunny, enjoy !

I've got some selectboard stuff to follow up on. I was interested in a speed bump by Gaming Weasel's house to slow down the kids at the covered bridge, but if they get in an accident, it would be my fault for putting the speed bump in.
Not the kid's fault for driving 60MPH through the covered bridge, no, it would be my fault.
So a bump is out (sorry for any confusion here Lena6) but a deputy might be in.

Don't Speed on Maple Street !!!
Title: Re: Help Me Understand
Post by: Loctavious on April 07, 2011, 03:08:35 PM: No seriosuly - chris - i wasn't being facetious or sarcastic - I legitmately meant what i said about your approach NOT being as charged and partisanly-riling ( that is not a word but perhaps it may become one) as others - no joke. Or maybe it's because i know and respect you that i don't take it to heart - regardless, i'm sure you'll agree the rhetoric gets us no closer to the middle - which is where real progress is made.
Title: Re: Help Me Understand
Post by: mirjo on April 08, 2011, 02:08:50 PM: Quote
i'm sure you'll agree the rhetoric gets us no closer to the middle - which is where real progress is made.

Agreed. It's where the answer lies. I think most people agree something needs to be done. I think the concept of a single payer system run by the government makes people's hair stand on end, with the exception of yours Henry ;-), because the government time and again has proven itself to be a bogged down, inefficient behemoth, fraught with partisan infighting and grandstanding. (especially Washington) Our local folks at the state level really want to do the right thing, but knowing what the right thing is, is not an easy question to answer and not an easy task to undertake.

We hear a lot about administrative costs. A LOT. What we don't hear about (and I think it was mentioned here somewhere...) is why health care costs so much in the first place. Why do MRI's cost $3000? How are those costs calculated? Cost of machine/energy use/personnel to run, what other factors figure in to that number? Are the older models less energy efficient? Do the newer models which take less time and therefore "see more patients/day" make more money for the hospital overall? Does the radiologist need to charge $400-500 to read it? And then does the specialist who ordered it need to charge that much again? These questions I've never had answered, but have always wondered. Whenever I've had an MRI, two docs have charged for reading it. If the Radiologist is the expert, why is the other guy charging for his concurring?

I'm not a numbers cruncher, nor a member of Mensa, but it seems logical to me that if Health Care Reform is the issue at hand, then maybe the entire scope of the issue should be dissected. It seems like maybe Health Care reform and Insurance reform are getting confused (also mentioned, I believe). I think there is a problem with both, but I also think they are kind of two separate, but related things.

For years, hospitals (pushed by ins co) have been moving away from inpatient stays to more procedures that are "day surgeries." Clinical Pathways were implemented years ago as a means of tracking patients on expected outcomes for specific surgeries and only those who deviate from the anticipated path stay longer (they ultimately cost more and generate more paperwork and make the numbers look bad) Bypass patients are only expected to stay about 3-5 days. The plan of care is very routine and the outcomes and deviations are very predictable in most cases. This is just one example.

It seems like this trend toward saving money for the insurance company and getting people out of the hospital faster (which is better in many cases, though not all) didn't lead to any real reform in health care or in saving money any money, since insurance and costs have continued to increase phenomenally. There is so much more to this than single payer vs what already exists.

Everyone who has great insurance coverage that they don't want to mess with I say you're lucky. I will also say that not everyone is sitting in that boat with you. I think there is a happy medium somewhere, but those in charge need to look and listen carefully. As any good carpenter will tell you: Measure twice, cut once.