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Thursday Night Open Thread

Now that the health care bill is passed, what does it do?

This is an open thread, all topics welcome.

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    Republicans have their problems too (5.00 / 1) (#10)
    by mmc9431 on Fri Mar 26, 2010 at 06:03:07 AM EST
    Democrats aren't the only ones that may suffer in November. Bennet in Utah is in big trouble too. When a conservative from Utah with a 98% rating from the NRA isn't hard core enough, who is? The tea baggers and Club for growth are pounding all Republicans that don't tow their line.

    This may be the salvation for the Democrats. The hate and violence encouraged by the hard line right could alienate a lot of moderates across the country.

    I have always wondered (none / 0) (#14)
    by Peter G on Fri Mar 26, 2010 at 08:40:32 AM EST
    whether that expression is "tow the line" (as in, pull along behind by means of a nautical rope), or "toe the line" (as in, put the front edge of your lower extremities on the chalk mark).  I haven't bothered to do any research on it, however.  Any thoughts from the interesting "TL community" on this?

    Parent
    It's "toe the line" (none / 0) (#15)
    by andgarden on Fri Mar 26, 2010 at 08:58:43 AM EST
    I know this because it was a question on a British quiz show a few years ago. . .

    Parent
    the rorschach kid (5.00 / 1) (#16)
    by Capt Howdy on Fri Mar 26, 2010 at 09:11:54 AM EST
    it seems how you see Marcelas Owens depends on what you bring with you.
    how great would it be if we lived in a world where people could look at this brave smart little kid and see him for exactly what he is, a brave smart little kid.
    instead of a "new, dubious poster boy for Demcare." as Malkin put it, "Desperate Dems cling to human kiddie shield," Malkin wrote that Marcelas "admits he doesn't understand the complexities of health insurance reform and doesn't 'think it's anyone's fault' that his mom passed away.
    honest to god.  how petty and pathetic is that.
    or Limpbaugh,  "Your mom would have still died, anyway".
    I have even read how evil and underhanded it was for the president to send out one of his "workers", as Marcelas called them, to buy him a tie just like the presidents.  do these people have a sole?  its a serious question.
    for me, after days of reading about sick evil people acting out like spoiled children, watching this video of this amazing kid talking about the president using his first name like he was his pal took the whole foul stinking pathetic world we live in and put a big ole smiley face on it.

    No Pre-existing Coverage Exclusions for Children?? (none / 0) (#1)
    by Dan the Man on Thu Mar 25, 2010 at 10:15:36 PM EST
    One of the pdfs says:


    No Pre-existing Coverage Exclusions for Children. Prohibits health insurers from excluding coverage of pre-existing conditions for children. Effective six months after enactment, applies to all employer plans and new plans in the individual market.

    But the Democrats have already said that is not quite correct.


    Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday.


    But (5.00 / 1) (#2)
    by TeresaInSnow2 on Thu Mar 25, 2010 at 10:40:48 PM EST
    they make Romneycare, the Republican Heritage Foundation written bill sound so good !!!  Don't spoil their fun.

    I definitely object to their use of the word "free" (free preventive care, etc).  Trust me, none of this is going to be be free in any way, shape or form.

    Parent

    HHS is apparently going to write regs (5.00 / 1) (#3)
    by andgarden on Thu Mar 25, 2010 at 11:04:54 PM EST
    to clarify. But my guess is that they may have to go through the whole NPRM process, and that could take a while.

    Parent
    "Clarify" my sweet Aunt Fanny (5.00 / 1) (#11)
    by lambert on Fri Mar 26, 2010 at 06:32:32 AM EST
    No doubt, no doubt. I'm with Bruce Dixon:

    Supposedly, insurers can't refuse to insure anybody, or jack prices on the basis of pre-existing conditions, and can't revoke policies when people get sick enough to actually use them. But so many loopholes and end runs have been written into the legislation that these and other widely ballyhooed provisions to safeguard the interests of patients are in fact meaningless. The ban on pre-existing conditions for example is negated by allowing insurers to offer "wellness" discounts. The older, the fatter, the less physically fit and the already sick need not apply for these discounts, and the fit will lose them when they gain a few pounds.

    Of course, loopholes are exactly what we should expect, since Liz Fowler, a Wellpoint VP on secondment to Max Baucus's staff, drafted the Senate bill.

    And though I've had my disagreements with FDL on the so-called "public option," this summary is cogent:

    The bill does not empower a regulatory body to keep people from being dropped when they're sick.
    There are already many states that have laws on the books prohibiting people from being dropped when they're sick, but without an enforcement mechanism, there is little to hold the insurance companies in check.

    The "internal appeals process" is in the hands of the insurance companies themselves, and the "external" one is up to each state.
    Ensuring that consumers have access to "internal appeals" simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an "external appeals process," as there is neither funding nor a regulatory mechanism for enforcement at the federal level.

    So, the Senate PDFs are so much propaganda. I can't imagine why anybody would regard them as authoritative statements of "the immediate benefits," since (a) the benefits depend on regulations not yet written, and (b) the regulations deoend on enforcement powers that do not exist.

    * * *

    I do understand why career "progressives," looking ahead to 2010, need to catapult the propaganda for HCR (High Corporate Returns), but those of us whose lives are actually going to be affected by the bills need to think a little more carefully about our values and interests before allowing the bus to be driven over us.

    Parent

    The shoddy foundation under this sham (none / 0) (#18)
    by Ellie on Fri Mar 26, 2010 at 09:45:41 AM EST
    The bill does not empower a regulatory body to keep people from being dropped when they're sick.

    Corporations routinely misbehave with impunity, knowing it can take years for a small-fish to get justice.

    Even with a solid support system, anyone who's had to deal with a longterm illness (whether as a patient or caregiver) knows how tiring additional red tape can be. That's just the best-case scenario.

    Now why would I even doubt that big insurance companies will prefer to offload this stress onto the insured rather than acting compassionately in this regard?

    Parent

    Yes... (none / 0) (#17)
    by MileHi Hawkeye on Fri Mar 26, 2010 at 09:38:06 AM EST
    ...working out the practical details of the legislation has begun.  The NAIC National meeting started yesterday and we'll be working all weekend at crafting policy.  


    Parent
    As you suggest,, MileHi (none / 0) (#26)
    by christinep on Fri Mar 26, 2010 at 12:48:08 PM EST
    working out the details has begun. Usually, the details of major legislation follow in regulations promulgated by the responsible Department/Agency. In this case, Sec Sebelius and her HHS staff have primary responsibility. For the details, the APA and govt process will provide significant opportunity to comment on proposed regulations to implement the Act.

    Parent
    We're working in concert... (5.00 / 1) (#28)
    by MileHi Hawkeye on Fri Mar 26, 2010 at 02:06:39 PM EST
    ...with HHS to figure out what's what and how all the nuts and bolts fit together.  That's the fun part for me--actually influencing public policy.  

    Parent
    Same topic (5.00 / 1) (#8)
    by Makarov on Fri Mar 26, 2010 at 02:43:27 AM EST
    different source, with some interesting quotes:

    http://www.kaiserhealthnews.org/Stories/2010/March/24/sick-kids-coverage.aspx

    America's Health Insurance Plans, the main insurance lobbying group, says through a spokesman that it interprets the new law as not requiring insurers to cover all child applicants this year....

    Randy Kammer, a vice president for Blue Cross and Blue Shield of Florida, the largest health insurer in that state, said she interprets the law as allowing insurers to reject coverage for children in some cases until 2014.




    Parent
    HCR: Effect of Prescription Drug Tax (none / 0) (#4)
    by Dan the Man on Thu Mar 25, 2010 at 11:39:06 PM EST
    Link


    The new health care law will make it more expensive for companies to offer prescription drug coverage for retirees because companies will receive smaller tax deductions for those benefits in the future.
    As many as 1.5 million to 2 million retirees could lose the prescription drug benefits their former employers provide because of the tax changes.


    Passage of HCR produces (none / 0) (#5)
    by andgarden on Fri Mar 26, 2010 at 12:32:02 AM EST
    a substantial bounce for Democrats across the board in R2K polling. Given the general political and economic environment, I do not believe that Democrats can coast to victory in November on this alone. On the contrary, they must continue to deliver.

    It may well be that a genuine threat of the nuclear option is required to prevent catastrophic Democratic losses. But they will never be convinced of this (and that is closely related to the reason why they are in such trouble to begin with).

    While (none / 0) (#9)
    by Ga6thDem on Fri Mar 26, 2010 at 05:40:32 AM EST
    there may have been a bounce, R2K's record has not been good.

    Unfortunately the inside the beltway types seem to think that this will be enough for November. IMO it's not.

    Parent

    "Bounce"? Dead cat bounce (none / 0) (#12)
    by lambert on Fri Mar 26, 2010 at 06:35:36 AM EST
    Of course, if the bill were really good, the Dems wouldn't have put off real implementation until 2014 -- one election past Obama's career transition to TV host, and too close to the next mid-terms to affect anything.

    Parent
    Implementation process (none / 0) (#27)
    by christinep on Fri Mar 26, 2010 at 12:54:51 PM EST
    My experience in the federal govt employ is that the implementation process--such as regulation drafting, notice of proposal(s) in the Federal Register, publication of final regulations--may account for a good portion of time leading to 2014. Secretary Sebelius will begin the process of "filling in the regulatory details" that occurs after enactment of major federal legislation. The exchange process coupled with mandates, subsidization, and compliance process would be expected to be defined more specifically in regulatory form. That does take a bit of time since most big Acts set the structure and requirements, but are not self-implementing in the details.

    Parent
    That was quick (none / 0) (#19)
    by CST on Fri Mar 26, 2010 at 10:15:59 AM EST
    Also Gallup says plurality now favor bill.

    I've been saying for a long time, once this thing passes public opinion will shift - it doesn't hurt that the opposition has gone completely bonkers.  I think a lot of people were getting fairly fed up with the process and are just glad it's done.

    Agree that Dems need to keep moving forward though.  This can't be the only thing they've done all year.

    Parent

    A bounce for Obama but not (none / 0) (#21)
    by Cream City on Fri Mar 26, 2010 at 10:47:32 AM EST
    for Dems in Congress, with midterm elections coming:

    For congressional Democrats, 32% call their efforts on health care excellent or good; 33% poor.

    And even for Obama, this may be ephemeral as the pushback by businesses keeps coming -- like the major businesses coming out to say that they just will cut prescription coverage for pensioners, etc.

    Parent

    the most illuminating (5.00 / 1) (#23)
    by CST on Fri Mar 26, 2010 at 10:59:35 AM EST
    thing about this poll (to me) is:

    "A solid majority of seniors oppose the bill; a solid majority of those younger than 40 favor it."

    Lets face it, younger americans made out the best in this bill.  Between the new 26 rule, the student loan package, and the fact that young people are the largest group of uninsured - that's who got the most.

    Older Americans probably are more worried about cuts in Medicare - and the shrinking/closing of the donut hole really hasn't been prominently touted.

    But he did deliver to his base.  Which is actually kind of interesting as a political tactic since it is pretty rare to cater policy to the young - I wonder if this will help keep young people engaged.

    Parent

    still better for Dems (none / 0) (#22)
    by CST on Fri Mar 26, 2010 at 10:52:29 AM EST
    than republicans with only 26% good, 34% poor.

    Clearly not something Dems can rest on yet for midterms, just pointing out that I don't think it will be the "death of dems" like many were predicting.

    The one thing I will say is that it looks like HHS is gonna come out swinging.  One problem with this bill is that it leaves a lot up to HHS so if Republicans regain control they can really $crew with it.  The good thing about that now though is with Obama in office - he's gonna want to make it as effective as possible - since this is kind of his baby now.

    Parent

    Lets put away the Political Theater! (none / 0) (#6)
    by Gerald USN Ret on Fri Mar 26, 2010 at 12:37:21 AM EST
    First off realize that the insurance companies are not spending their own money providing Doctors, Hospitals, Medicine, and Vare of any kind.

    They only re-distribute the money that comes to them from employers, or private citizens, or the US Government itself which gets it from the same sources.

    So if there is a new benefit or a relaxing or dismantling of some requirement that everyone hates, then someone will still have to pay for it, and it will not be the insurance companies.

    The arguments against and the bad mouthing against the insurance companies are just Political Theater.

    If you want the insurance Companies to pay out more money for more people, and more treatments, then just give them more money.  It is as simple as that.
    Remember also that they make more profit the more money they distribute, just like any other business, so more money into the health industry will mean more profit for the insurance companies.

    Where the bill falls short (none / 0) (#7)
    by suzieg on Fri Mar 26, 2010 at 01:23:52 AM EST
    http://www.counterpunch.com/demoro03252010.html

    -The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for other moderate income working people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gohttp://www.counterpunch.com/demoro03252010.htmluging, care denials, and other abuses.

    -Inadequate healthcare cost controls for individuals and families. 1. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, an idea also dropped from the bill. 2. There is no standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer provided plans. 3. An illusory limit on out-of-pocket medical expenses. But even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.

    -No meaningful restrictions on claims denials insurers don't want to pay for. Proponents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.

    -Significant loopholes in the much touted insurance reforms: 1. Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions. 2. Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will likely set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states. 3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees. 4. Insurers may continue to rescind policies, drop coverage, for "fraud or intentional misrepresentation" - the main pretext insurance companies now use.

    --Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.

    --Erosion of women's reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.

    --A windfall for pharmaceutical giants. Through a deal with the White House, the administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.

    Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.

    Thanks, "progressives"! (none / 0) (#13)
    by lambert on Fri Mar 26, 2010 at 06:37:01 AM EST
    +1000:
    Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need

    Which is the source of the problem. They just made things worse (for us, though better for themselves).

    Parent
    Arms deal with Russia (none / 0) (#20)
    by CST on Fri Mar 26, 2010 at 10:34:51 AM EST
    made today, cuts number of deployed warheads by about 1/3.  That's about 700-1000 fewer nuclear warheads per country.

    Also included - language that might make it more difficult to put in "defensive" missles in the future.

    Good News (none / 0) (#25)
    by squeaky on Fri Mar 26, 2010 at 12:25:13 PM EST
    Considering the clash that happened over Russian support of Iranian Nuclear plant with SOS Clinton.  

    Parent
    North Korea ... (none / 0) (#24)
    by desertswine on Fri Mar 26, 2010 at 11:19:39 AM EST
    has apparently sunk a South Korean warship.

    Make way under the bus (none / 0) (#29)
    by DancingOpossum on Fri Mar 26, 2010 at 03:18:21 PM EST
    Make some room for Greenpeace:

    A proposal has been put forth at the International Whaling Commission (IWC) that would not only reinstate commercial whaling around the world, it would legitimize Japan's "scientific" slaughter in the Southern Ocean Whale Sanctuary. Nearly 25 years of protection for the whales could be tossed out the window if this proposal passes at the next IWC meeting in June 2010.

    Shockingly, the Obama administration's representatives at the IWC actually support the deal to reinstate commercial whaling and are urging other nations to do the same. The delegates say that their directive comes directly from President Obama himself.

    http://www.distantocean.com/2010/03/theres-an-ahab-in-the-white-house.html

    Greenpeace supported Obama largely on the promise of his support for the whaling moratorium. Oops.

    Obama seems to have a real vicious streak to him. What on earth did Greenpeace do to deserve this treatment? It's not like they agitated for a public option in HCR or anything. Or should we ask, what shiny object are the Japanese dangling in front of Obama to get him to swing their way and turn his back on yet another campaign promise?

    Meanwhile, whales and people will continue to die on his Nobel Peace Prize watch. (And mountains. I'm not forgetting West Virginia, punished by a wave of MTR for daring to vote against him in the primary.) I am so furious I don't have words for it anymore.

    Lifting the moratorium (none / 0) (#30)
    by Socraticsilence on Fri Mar 26, 2010 at 04:36:43 PM EST
    and imposing quota's would likely reduce the actual number of whales killed but you know it wouldn't be as symbolically satisfying as the ban and the fact that the Japanese currently loophole it.

    Parent
    So lifting the moratorium would .... (none / 0) (#31)
    by Yman on Fri Mar 26, 2010 at 07:26:43 PM EST
    ... be a good thing, in that it would reduce the number of whales killed?  Really?  How?  The draft plan has no quotas, and the only ones arguing the number would mysteriously decline are the proponents of whaling.

    Shocker.

    BTW - At least he's not breaking yet another campaign promise.  Oh, wait ...

    ... During the presidential race, then-Senator Obama gave this response to a Greenpeace questionnaire dated March 16, 2008: "As president, I will ensure that the U.S. provides leadership in enforcing international wildlife protection agreements, including strengthening the international moratorium on commercial whaling. Allowing Japan to continue commercial whaling is unacceptable.


    Parent