Healthcare Reform - Reject or Perfect?

Healthcare Reform - Reject or Perfect?

What is the state of U.S. health care now that the dust has settled following the healthcare reform battle of 2009 and early 2010? The opposing sides have vastly contrary views regarding this matter mostly formed to uphold their point of view. Nobody received everything they wanted during this process. Most received some acceptable compromises and some disappointments. Hand wringing over the process has been rampant on both sides.

I would like to offer a more sober and clear eyed examination of the state of our healthcare system. I will begin with a summary of the evolution and resulting state of U.S. health care prior to this reform bill's passage. Then I will give my synopsis of how the bill began, evolved, and finished during the 14 month battle. Finally I will give my views on the positives and negatives of this new law as well as the changes and additions I would like to see implemented to improve it. Health care is too vital to our country to allow to remain stagnant and unresponsive to our needs.

How did our health care system get to this point? For most of our history there were no high tech diagnostic machines or high cost prescription drugs. People were treated with common therapies and either recovered relatively quickly or died if the illness was serious enough. Medical bills were not onerous for the most part. Therefore health care insurance was not necessary.

Some life insurance companies started to offer healthcare insurance plans in the 1930s and 1940s. Non-profit companies such as Blue Cross Blue Shield also formed to provide healthcare insurance. Companies first began offering plans during the World War II years because of government imposed wage freezes. These companies used the plans to recruit and retain workers in lieu of higher wages. These plans grew in popularity after the war due to their success in attracting employees.

These plans were fee for service plans until the 1980s when health care costs began exploding. Company health care plans quickly and steadily moved to managed care plans to control costs. Ever since costs have continued to rapidly spiral out of control with benefits being curtailed and premiums rising. The vast majority of people in the United States now receive their health care insurance through company sponsored plans. Government sponsored plans such as Medicare cover individuals over 65 and SCHIP covers poor children. Approximately 50 million Americans have no health care insurance at all.

Now we turn to the debate over the HealthCare Reform bill that occurred during 2009-2010 and the resulting law that Congress passed and the President signed. The House of Representatives and the Senate began introducing health care reform bills early in 2009 after President Obama's inauguration. He had vowed during the presidential campaign to make health care reform a priority and convinced the Democratic leadership in Congress to proceed promptly.

The Republicans initially decided to have some dialogue about making some minor changes to the health care system but were intent on leaving the bulk of the system intact. Eventually special interest groups worked behind the scenes to derail the entire effort. They enlisted a group of followers to attend congressional Town Hall meetings regarding the proposed healthcare reform bills. These followers bombarded the representatives with accusations and catcalls ruining the informational purposes of the meetings. The Republicans saw the potential political damage of going against the wishes of this group and ceased negotiations with the Democrats. They also saw the potential political gain of these attacks and attached themselves to this opposition group. They proceeded to oppose every action the Democrats tried from that point on. The Democrats needed 60 votes for cloture every time the Republicans filibustered a significant action attempted by the Democrats. This allowed the bill to be watered down each time by Senators seeking special advatages for their constituents in exchange for their vote.

Finally on March 23, 2010 President Obama was able to sign the Healthcare Reform bill that was passed and reconciled by both houses. Several key provisions have already taken effect. Insurance companies are now barred from dropping coverage to individuals when they get sick or injured. Young adults are able to remain on their parents health insurance plan until they reach the age of 26. The medicare drug benefit gap that has proven to be very expensive to seniors has been eased with an annual $250 rebate. This gap will eventually be eliminated. Small businesses have been given a tax credit to provide their employees with health care insurance. The rest of the provisions of this bill will be implemented on a rolling basis through 2018. The most important and controversial aspects will be introduced in 2014.

The biggest of these is the opening of state health insurance exchanges for individuals and small businesses. Most people will be required to obtain health care insurance or be forced to pay a tax. Individuals with income up to 133% of the federal poverty line will qualify for Medicaid coverage. Those with incomes up to 400% of this poverty line are eligible for tax credits. Health care insurance companies will no longer be allowed to refuse coverage to persons who have pre-existing conditions. These are the major aspects of the new Healthcare Reform law.

Now that we have examined our health care history and status, allow me to elucidate my views on how we should proceed to improve on this historic Healthcare Reform law. This entire process was one of compromise and no one is totally happy with the result. The Republicans are intent on repealing the bill after the November 2010 election through new legislation. This is a bit unrealistic at least in the short term due to the inevitable President Obama veto. They are also pursuing legal action with appeals in many state courts around the country. The most prevalent appeal they are making is that the law is unconstitutional because it forces individuals to purchase health care insurance. They also argue that the states should not be forced to create and run these state health care insurance exchanges. The United States Supreme Court will probably be the ultimate arbiter of the individual mandate aspect of the law.

I personally feel that the law can survive no matter which way this issue is decided though costs will escalate if it is struck down. I also feel it should be upheld as constitutional. We mandate automobile drivers to have insurance if they drive. Why not mandate health care insurance? Why should taxpayers foot the bill for those who roll the dice and refuse to insure themselves? Young healthy individuals could purchase a "bare bones" policy which would cover doctors visits and hospitalization costs with higher deductibles and higher out of pocket expenses. This way the taxpayer is not left footing the bill and the individual is able to purchase a less expensive policy that matches his lower risk of illness and injury. We require those that work to pay for social security and other social safety net programs. Why not also require them to pay for health care insurance as part of our shared social compact?

I feel the state health care insurance exchanges will be the most important aspect of the new reform law. They are the compromise that Congress reached when they realized that they did not have the votes to pass a true public option. These exchanges will be the vehicles used to ensure that every United States citizen has health care coverage. Each state exchange will have the power of numbers to keep rates low and give individuals quality low cost health care coverage.

I believe that every American citizen has a right to have access to affordable health care. The 9th amendment in the United States Constitution states " The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people". Therefore in my view, a right to affordable health care is essential and thus one of the rights not originally enumerated in the Constitution which the 9th amendment refers to. We can already see this in effect in the following de facto manner. Most hospitals refuse to withhold treatment to people who are indigent and cannot pay for it. Public hospitals are required to treat these individuals by law. I am not stating that people have a right to free health care. The right to affordable health care comes with the responsibility to obtain and pay for it if they have the economic means to do so. Those individuals with incomes around and below the poverty line will be given assistance to obtain health care insurance. The state run health care insurance exchanges are a good first step towards ensuring coverage for all individuals.

I feel they are only a start on providing this insurance. Much more work needs to be done. The opportunities for innovations and changes to these exchanges will present themselves as the exchanges are rolled out in 2014 and begin to mature. Lower costs should develop through streamlined systems and lessened paperwork. Proposed preventative health care measures should also lower costs in the long run and make these plans very attractive. For too long our health care system has incentivized medical procedures to maximize profits. We now have the opportunity to convert the system into one of rewarding quality of health care in terms of wellness, successful medical outcomes, and patient satisfaction.

Companies will be watching all of these developments very closely. They are by nature attracted to lower costs and higher quality. I would not be surprised to see many companies gradually begin to drop their company sponsored health care insurance plans and simply pay the tax to the U.S. government to provide health care insurance to their employees. We could see a large growth in these exchanges as a result. This growth should accelerate if these exchanges continue lowering costs while keeping quality high. Some state health care exchanges will be more successful than others due to size and competency. Mergers of some state exchanges are another change that I believe would help the overall system. I hope legislators would consider this option when and if the necessity develops. These mergers could help solve some state exchange problems and also create greater economies of scale. We see this employed in the business world every day so why not with these health care insurance exchanges as well. This could lead to purchasing health care insurance across state lines which is an issue that Republicans have advocated for. I also believe we need serious medical malpractice tort reform to lower costs. This is another Republican issue who's time has come and deserves serious consideration. Medical malpractice lawsuits are out of control and this must be corrected.

These are the major changes that I would like to see our new health care reform system take in the next few years. Medical professionals, administrators, and politicians must constantly examine how this new health care system is working. Successful innovations should be adopted nationwide. Processes that do not work correctly should be changed or phased out. Vigilance and innovation are necessary to allow this new health care system to work correctly. I am hopeful these steps will be taken so we can develop the fairer and more efficient health care system we deserve and need. Health care is now the largest part of our economy and growing. The prosperity and quality of life of all Americans is at stake here. We need to get together and make our health care system work. Failure is not an option

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Comments 100 comments

GJFALCONE 6 years ago

HOW DOES THE USA COMPARE TO OTHER MAJOR INDUSTRIALIZED NATIONS THROUGHOUT THE WORLD REGARDING HEALTHCARE SYSTEMS? ISN'T IT TRUE THE MAJORITY OF NATIONS HAVE HEALTHCARE PAID FOR AS WE HAVE, FOR EXAMPLE, NATIONAL DEFENCE PAID FOR? DO YOU THINK THE HEALTHCARE LOBBY WAS PARTLY RESPOSIBLE FOR WRITING THE PRESENT LAW COMPLETE WITH LOOPHOLES TO UNDERMINE, FOR EXAMPLE, PRE-EXISTING CONDITIONS FOR CHILDREN BY SIMPLY NOT OFFERING THAT POLICY ANY LONGER? SO THE 50 MILLION PEOPLE THAT HAD NO COVERAGE PRIOR TO THE LAW ARE NOW COVERED?

THX MR.SCHNEIDER OF PARSIPPANY NJ.


HSchneider 6 years ago from Parsippany, New Jersey Author

The USA is tops in regards to the level of high tech medical procedures available. Our medical research is second to none. We lag badly in health care delivery. I saw the rating the other day and I think we are about 20th in delivery. Having health care insurance be dependent on having a job or being rich is crazy. The healthcare lobby was monumental in helping craft this healthcare bill. You are quite right. They tried their best to kill it. Then they watered it down with loopholes when they couldn't kill it. The government needs to bring the hammer down on those companies rejecting children for pre-existing conditions. I went through the roof when I heard about it. The media should also shine the light on them. They should get on board or get out of the business. The 50 million are not covered yet. That will come in 2014 when the state exchanges are fully formed and in effect. Why so long? There again is the health care lobbyists efforts. As I wrote, this law is a start but there is a huge amount of work to do. It needs to be cleaned up or else it will not cover Americans as it should. Thanks for the great comments.


marisan profile image

marisan 6 years ago from Brazil

HSchneider Hello, very interesting your hubs, and his explanation to the subject knowledge is very clear from reading this important hub, I'm your fan, I see you ever engaged in fine causes. Now I had an overview of the health systems of their country.

I await your other hubs

Hugs

Marilúcia


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you very much for your kind comments Marilucia. Health care is very important for all of us in the world. How is the health care system for you in Brazil?


OpinionDuck profile image

OpinionDuck 6 years ago

HS

While this hub is interesting and informative it is in my opinion out of focus. It is not even a reform bill as much as it is a medicare type instrument for the population.

The real focus should be on the quality of medical care and not the quantity of people that are insured.

We keep hearing that the US has the best medical system in the world. If that is true than I pity the rest of the world. The fact is that without a comparison to the rest of the world, healthcare in the US is pathetic.

I have written about this in my hubs and it is too lengthy to comment on it here in detail.

It starts with the inept FDA, the Health Insurance Companies, the Drug companies, the hospitals and the medical professionals. The all contribute to the pathetic healthcare in this country.

For example, when was the last significant medical cure in this country. It was in the 1950s when the Polio Vaccine took out Polio. This by the way was before the FDA was given the responsibility to oversee the drug companies. It was also before we had the large insurance companies practicing medicine without a license. It was also before we had thousands of patented and expensive drugs. It was also before we had hundred of medical specialists.

There is much more but these factors contribute to the pathetic medical care in this country.


HSchneider 6 years ago from Parsippany, New Jersey Author

I agree with many of your points. The FDA is woefully underfunded. They are also usually staffed by people from the health care sector who have contributed to the problem anyhow. The Bush Administration made it its candy store. The health care insurance companies are horrible. If I had all the power in the world, I would eliminate them. Unfortunately they are so entrenched in the system that there power is incredible. I believe these insurance companies have skewed the entire system making doctors and hospitals order unnecessary procedures simply for the money. I think the doctors and hospitals would do much better without insurance intermediaries. I have very cautious hope for the new law. I am wary though. I'll read your Hubs on this subject. Thanks for your comments.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

The Healthcare Reform Bill is flawed and as times goes on we should expect Congress to revamp the bill. President Obama said many statements regarding what's in the bill that is being exposed as untruthful. Many of our representatives in congress both Republican and Democrat did not even read the bill before casting their votes. One congressman said that the bill was too complicated to read.Maybe congressional staff should be relieved of their duties to help the congressman


HSchneider 6 years ago from Parsippany, New Jersey Author

I agree that the plan is flawed as many political compromises are. I feel we needed a start on a system that is less haphazard than the one we have now. Too many people are being left out in the old system. The health insurance companies have too much power and hopefully the exchanges will begin to loosen their stranglehold. Hopefully Congress will remain vigilant and make this reform better. Thanks for your input Jon. I appreciate it.


EmgeeOnline profile image

EmgeeOnline 6 years ago

Hey HSchneider,

Great, informative hub. I agree with you on many of your points and would also like to see this law continue to develop and get better. What I think alot of people don't understand is how powerful the insurance lobby is and that if this bill didn't get put into law, we again would be without any changes and that wouldn't be good for our citizens or the country. As I pointed out the hub that I wrote about Healthcare, anytime any of our Presidents tried to change the healthcare system, it was met by very powerful opposition to keep the cash cow industry going. Without this change, again nothing would have been done for who knows how long.

As imperfect as this bill is, it is without a doubt a step in the right direction. What bothers me is how much disinformation was put out there to scare people who follow politics through commercials and soundbites.

I recently got a letter from my provider saying that since I have been on that policy before the healthcare law was put into action, I can KEEP MY SAME COVERAGE WITHOUT CHANGE. I WOULD BE GRANDFATHERED IN. Hmm, didn't Obama say this same thing while FOX and the Republicans were saying how that isn't true, we wouldn't be able to keep our same policy?

It would have been better if the changes would have happened sooner so that all the nonsense tactics could be easily disproved; but I realize... this is politics. I feel that once the law is in place and our American citizens get coverage, we will see a change in attitude. Think of the same "socialist" fear debate when Social Security and Medicare was going through it's growing pains. Can you imagine trying to take that away from our Seniors now?


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you Emgee. I quite agree with you that the forces against this bill were enormous just like they were in 1993. The health insurance companies are powerful and they will fight tooth and nail to keep their ox from being gored. These companies do whatever they can to cut costs by denying coverage while raising rates with impunity. As you said this new law was necessary even with all its flaws. The paperwork and excessive profit the insurance companies have drives costs up enormously. These new state exchanges will be a great experiment which I believe will be the first step towards a system that will benefit all Americans.


Jillian Barclay profile image

Jillian Barclay 6 years ago from California, USA

Excellent hub! To the point and fact based! This should be required reading for anyone prior to their ranting and raving about how horrible the health care bill is.


JON EWALL profile image

JON EWALL 6 years ago from usa

HUBBERS

''These companies do whatever they can to cut costs by denying coverage while raising rates with impunity.''

COMMENTS TO THE ARTICLE

The US Government is the largest healthcare insurance provider in the world. They manage medicare,medicaid, the va (veterans administration ) and ships ( for children ).

The US GOVERMENT denying services is 8.5% and is #1

Etna is #2 at 6.0% denial

Obama is chastising the insurance companies for denying insurance coverage when it's our government leading the world.

Both Democrat and Republican members of Congress agree that the denial of pre existing conditions need to be fixed.Despite what the Obama congress is saying about the insurance companies,note that their profit margins are between 2% and 4%. That is not a lot considering that the government taxes company profits.

President Obama and the Democrat leadership don't get it either.

Obama remarked that we need every one to pay for insurance (that

increases the insured pool )so that the cost comes down. Right

on, there is an income -cost formula based on the size of the pool.

With 9.7% unemployment and 14.9 million out of work, the paying pool goes down and insurance cost goes up. Result higher premiums to paying customers, sometimes necessary for insurance companies to

stay in business. In 2006 unemployment was 4.6%, last year of a Republican controlled congress.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you very much Jillian. I appreciate your comments especially because of your wide ranging experience in the health care industry. You know first hand what the problems are.


HSchneider 6 years ago from Parsippany, New Jersey Author

Jon, You are quite right about the rejection rates. My hope is that this system evolves from one where doctors order unnecessary tests and procedures just to earn income into one where they get paid more based on wellness and income. I know this may sound like pie in the sky thinking but it is what the Obama Administration has been saying and I am hopeful. Finally when people are out of work they will get tax credits or medicaid depending on the person's fiscal condition.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

The added unemployed to medicaid is breaking the states and they (the states ) are cutting services and still going broke.A single payer government system is not what the majority of people want. The government's record to doing anything with taxpayer money will be another disaster

''unnecessary tests and procedures just to earn income''

Ask your doctor what he pays for medical malpractice insurance than you will have a better understanding why the doctors order more testing. Tort reform was omitted from the Health care Bill.


Deni Edwards profile image

Deni Edwards 6 years ago from california

Your hub is excellent! I read all the healthcare bills and your information is extremely accurate. Fine job!

I find that many people believe the same thing that you do: "I would not be surprised to see many companies gradually begin to drop their company sponsored health care insurance plans and simply pay the tax to the U.S. government to provide health care insurance to their employees. "

Sometimes I am naïve and foolish, always thinking the best of people. I can't comprehend an employer that willingly offers health insurance prior to this legislation would do this. It just doesn't make sense, and I hope it doesn't happen.

Once again, extremely accurate and well-written.


HSchneider 6 years ago from Parsippany, New Jersey Author

Jon, Tort reform was not in the bill and I do agree that it should be added in another bill. It is out of control. The Democrats were not going to tackle this last year with everything else going on. Maybe a Republican House will.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you Deni. I appreciate your comments. Let's see how things evolve. I may be crazy but I'm hoping people will do the right thing and this reform will work out. The bill is far from perfect. That which doesn't work should be fixed. The Obama administration and Congress need to watch each step of this and adjust.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

''Tort reform was not in the bill '',it was discussed as it (tort) effects the cost of insurance to both the health provider, insurance companies and the customers.

Congress didn't do nothing to stop unemployment which also increases the cost of insurance to the customers.

Please , no excuses for congress, PRESIDENT BARAK OBAMA and their arrogance and irresponsibility to the desires of the people.


HSchneider 6 years ago from Parsippany, New Jersey Author

Congress tried to curb unemployment with the stimulus package. It kept unemployment from being worse. It should have had less pork and more infrastructure and alternative energy spending. The cause of the high unemployment though was the irresponsible lack of oversight on the markets. Bush was an absentee President and he filled all the regulatory posts with industry cronies. I'm not excusing the Reublican Congress of 2001-2006, I'm blaming them and Bush. The Obama administration policies are mostly correct and will turn things around. It takes a lot of time to clean up the Bush and Delay catastrophe.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

‘’Congress TRIED to curb unemployment with the stimulus package. It kept unemployment from being worse’’ WRONG

‘’Reublican Congress of 2001-2006, I'm blaming them and Bush.’’ WRONG

With due respect for your opinion, let’s face the facts.

Under George W. Bush and the Republican Congress unemployment was 4.6%.The Democrats under the leadership of Pelosi and Reid took control of Congress in 2007. The recession started in Dec2007 and supposedly ended in June of 2009.Unemployment in Jan 2007 was 4.6% and today it is 9.7% under almost 4 years of a Democrat controlled Congress. The economy has not gotten much better but worst.

The stimulus spending has not provided the stimulus to decrease unemployment as promised, that’s a FACT. The present Barak Obama administration and Democrat Congress has not been truthful with the American people. The mainstream media has remained silent to the facts leading up to the recession.

The Healthcare Reform bill (2600 pages ) is a product of President Barak Obama and the Democrats in Congress. The Democrat leadership pushed the bill thru congress with members not even reading or debating the bill as required by constitutional rules. The Speaker of the House Pelosi said ‘’ we must pass the bill to find out what’s in it ‘’.

Something is drastically wrong in Congress and Washington. The country don’t need to be represented by politicians, either Republican or Democrat, who forget the oath of office that they pledged to keep.


HSchneider 6 years ago from Parsippany, New Jersey Author

Jon, I have tried to be reasonable with you in our debate. I read your Hub critiquing the Healthcare Reform Bill. Beyond tort reform and purchasing insurance across state lines, which I also advocate for, what would you do to make our healthcare system fairer and more efficient? You seem to enjoy sniping at all politicians. But what are your remedies? The same with the economy as a whole. Maybe a Hub on these subjects would be in order with positive ideas and not just naysaying. i would look forward to reading it.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

YOU SAID ''I'm not excusing the Republican Congress of 2001-2006, I'm blaming them and Bush.'' ''You seem to enjoy sniping at all politicians.''

wow! who is calling the kettle black?


HSchneider 6 years ago from Parsippany, New Jersey Author

Jon, It is true I am blaming them for our current economic problems but I am also trying to offer possible solutions in this Hub and others. How about we both get past the blame game. I've stated in this Hub where I wish we would proceed with healthcare reform. I have agreed with you on tort reform and purchasing insurance across state lines. What else would you do to reform health care? I am truly interested in hearing your ideas. I would like to hear positive ideas from anyone and from all political stripes. Thank you.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

THE SOLUTION IS SIMPLE,just start over with 100% bipartisanship. That didn't this time. The polls indicated that 65%+ of the people were against the present bill.


HSchneider 6 years ago from Parsippany, New Jersey Author

OK Jon, I get it. We fundamentally disagree. I feel we can improve on what was passed and you feel it's worthless and we need to start over.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

Disaghreement is what makes the world go around.Debates are sometimes nesesarry to a good solution. There were no productive debates in approving the Healthcare bill.On another subject, check this out.

A program worth NOT MISSING about the TAX debate.

video.foxnews.com/v/4359620/beck-taxing-times


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

''Congress tried to curb unemployment with the stimulus package. It kept unemployment from being worse''.WRONG

President Barak Obama told the American public that they can see where all the TARP( STIMULUS) money is being spent at Recovery.gov

The press investigated and found that there were $ millions going to districts that didn’t even exist. Today 10/6/10 the media reported that $162 billion of Tarp money can’t be accounted for by the administration.

Government mismanagement, fraud or just corruption when it comes to the government having control of the peoples money.

JOBS ???? WHERE ???


HSchneider 6 years ago from Parsippany, New Jersey Author

Jon, I guess you are one of those conspiracy theorists. I agree that less pork should have been in the bill. Were some $ misspent or was fraud perpetrated? In a bill this size that's inevitable no matter how diligent one is. If millions went to fraud out of 700 billion then that's not a bad percentage. None should go to fraud but there are always greedy people. Now why don't you write a Hub on this subject and I'll debate you there on it. I'm discussing health care reform here and we obviously differ. I believe government can help and you believe government should be out of everything. Fair enough. We disagree. I'm also not going to read your Fox Glenn Beck site on taxes. Anything Beck says or airs is a fraud and thus not worth my time. I'll watch Fox but not Beck.


JON EWALL profile image

JON EWALL 6 years ago from usa

HSchneider

''not going to read your Fox Glenn Beck''

Believe me it won't hurt you, it will help you get pass the propaganda. You have an open mind and I enjoyed our little debate.

PEACE DON'T FORGET TO VOTE IN NOV.

Remember that Pelosi and Reid have been in control of Congress since 2007, almost 4 years now.Oh I forgot that Obama was their too.


HSchneider 6 years ago from Parsippany, New Jersey Author

I enjoyed the debate also Jon and I most certainly will be voting in November. Take care.


Freeway Flyer profile image

Freeway Flyer 6 years ago

The economic "prosperity" of the early 2000's was largely an illusion based on low interest rates and easy credit. The economy today is the result of the bubble popping, and we are fortunate that things are not even worse. But that's another story.

As you said, most Americans, when push comes to shove, would argue that a person in need has a right to health care. Few would turn an uninsured person away at the emergency room door. So if we accept the premise that health care is a right, then we should try to deliver that care as efficiently as possible. Clearly, this is not happening with the "hodgepodge" of a "system" that has evolved over several decades. When the emergency room becomes the primary care facility, we all pay higher costs.

Thanks for writing a hub that tries to offer constructive solutions instead of simply pointing out what is wrong. A balanced, non-partisan analysis is refreshing these days. I've written some similar stuff on my blog about health care, and I will touch it up and post it on hubpages soon.


HSchneider 6 years ago from Parsippany, New Jersey Author

I look forward to reading that Hub on healthcare. You encapsulated well the way I feel about this subject in your middle paragraph. I tried to look at this subject from many sides and I am glad that came through. This new law needs to be given a chance and improved where necessary.


dharris74 profile image

dharris74 6 years ago from if (WIDGETBOX) WIDGETBOX.renderWidget('6953ebb6-33d0-4f42-ab95-0fd8e7d00fbe');Get the My Triond Articles widget and many other great free widgets at Widgetbox! Not seeing a widget? (More info)

A very informative look at the healthcare situation. I am glad to see that you are well-informed on this matter. Most people argue about and don't really know what they are arguing about. I too wish the bill had gone farther, but I am very proud that we finally have the framework for ensuring those who are currently without healthcare coverage and cant afford it.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you. I believe in researching my subjects thoroughly first. Knowledge is power. You are quite right that it is important we have some form of healthcare reform out there for now. These state health care exchanges will be the key to the whole plan. Unfortunately the political compromises put them off until 2014.


James A Watkins profile image

James A Watkins 6 years ago from Chicago

Actually, the linkage between health care and employment was mostly a sop to labor unions, who knew only large unionized employers could afford it and therefore health care insurance would attract workers to unionized workplaces. The federal tax code discriminates against people who buy their own health insurance, and has since 1943, by making you pay with after-tax dollars unless you get your insurance through your employer.

Health care insurance should never have been linked with our jobs. After all, few have complaints about the homeowners insurance, car insurance, or life insurance industries. Hundreds of companies can compete for your business across state lines and that system works great. You buy the insurance yourself, you have the freedom to buy as little or as much as you want.

HMOs were created by Congress through legislation. Medicare and Medicaid have been a disaster. They should be privatized and given to Visa/MasterCard to administer. Have you ever wondered why fraud in the two Medis runs 10-15% but credit card fraud runs less than 1%?

Medicare and Medicaid were supposed to cost the taxpayers $4B a year. Fraud and waste alone in these programs run about $100B every year.The cost for Medicare and Medicaid is now over $600B per annum, with unfunded future liabilities of $80,000,000,000,000. That is how successful the government has been so far, in managing just a portion of America's health care. So what does the Left say? We need more, much more!

We need tort reform to eliminate most malpractice suits. Doctors practice—there are no guaranteed outcomes. There should be no suing doctors unless they are willfully negligent with malice and forethought. The cost of malpractice insurance is astronomical today.

The government sets the prices for half of all health care spending in America today. There are more than a million prices set by the government for medical care in the United States. Some prices are set too high, resulting in a surplus of those services; some are set too low, resulting in a shortage of those services. That is what happens when the state interferes with the free market.

There are 2,000 health care benefits that are mandated by the government that drive insurance costs up by an estimated 35 percent.

9.7 million of the uninsured are illegal aliens. 14 million people qualify for government programs, but haven't bothered to sign up. 18 million Americans are working and making enough to buy insurance through their employers but choose not to (half of those make over $75,000 a year; the other half make over $50,000).

The true number of poor without health insurance because they can't afford it is 8 million people, but they still get medical treatment. It is against federal law to deny them treatment at any hospital in the United States.

Don't we all notice the price of technology steadily comes down unless it is medical technology? That's because the government doesn't set the prices of computers, cell phones, and plasma television sets. In most commodities consumers exercise value judgment about the dollars they spend; and this causes goods and services to become better and cheaper.

Health care is currently one of the few industries not properly influenced by market dynamics. The essence of the problem is that the consumers (the patients) are not the buyers. They do not possess the financial leverage, which consumers have in almost every other sector of our economy, because they do not pay the bills.

Health care has been wrongly insulated from competition that brings about higher productivity and lower cost. When there is a commercial market in health care, prices react much as they do in any industry. The lesson of nearly four hundred years of free market capitalism is clear: We should expect to get more choices of higher quality and falling prices if the government will stay out of health care.

A big problem with Medicaid is that it is jointly funded by the states and the federal government. The feds set the minimum requirements for the program, but the sky is the limit for states—they decide what coverages to provide. This means a state politician can promise anything to the people of his state, knowing the federal government is required to foot half the bill. Obviously, this is a formula for states to try and outdo each other and expand what is covered.

Fraud and waste run rampant. The New York Times reports that Medicaid is "so huge, so complex and so lightly policed, that it is easily exploited." Since our entire system of health care in America is only 60 times larger than Medicaid maybe we should put that same bureaucracy in charge of the whole enchilada. What harm could it do?

Americans on Medicare and Medicaid are constantly subjected to unnecessary tests (which are invasive, painful and dangerous) and unneeded surgeries. And the results in patients lives are often undesirable. This is not the fault of greedy doctors as social liberals would have you believe. It is primarily because the government will pay for any test or surgery ordered, and to do as many as possible reduces the odds of a doctor facing a malpractice suit.

The only way the government can control health care costs is to ration care. It can try to reduce salaries for doctors and nurses, but this leads to the loss of talented people, who may choose other lines of work instead of medicine. Government can slash what it will pay for medicine and procedures, but this will reduce capital investment in research and development—the one area of health care in America where we unquestionably lead the world today—because we still have a semblance of a free market system that rewards innovation.

The effort to repeal Obamacare is supported by those who believe that to grant government control over health care in America is to accept a huge loss of individual liberty—the freedom to make our own decisions about our health care. Socialized health care gives government the power to decide who lives and who dies.

The fear is that this power may one day be wielded to reward or punish citizens according to their political views, as it has been historically in every Socialist country.


LRCBlogger profile image

LRCBlogger 6 years ago

Great hub, our opinions are very much the same. I agree with you on tort reform. I didn't like how the Dems sort of swept it under the rug as being a very small portion of the cost. While frivolous lawsuits are a small portion, the very expensive insurance that Doctors pay is a very large reason why the costs continue to rocket.

I also think we need a public option to keep the for profit insurance companies "honest" in their pricing. Competition would benefit the American people.

Republicans calling for 'repeal and replace' are really just calling for 'repeal and forget about it'


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you for commenting James. I agree with a few of your points. Healthcare should never have been attached to employment. It is a system that has evolved since World War II as I wrote and it is antiquated and unfair. I also agree that it is unfair for the employed to receive their insurance pre tax and those who have to purchase it individually after tax. I am currently unemployed and it is quite a burden. Tort reform is absolutely eseential to cost control. I feel purchasing across state lines would be helpful also. I of course differ from you as far as the efficacy of the government running the programs. Yes there is often a lot of fraud but I feel that this requires much stricter oversight. I know this is a point we fundamentally disagree about. Your Via/Mastercard idea is one I have never heard about and frankly I must ponder that one for awhile before issuing a view on it. It is interesting though. One of my points is that new ideas are needed so I like that. I feel thises new state exchanges should be great incubators for implementing this plan and coming up with new ideas on how to provide health care. Who knows, maybe it will evolve your way. I know you feel there is no way that will happen and this will evolve into a massive fraud ridden and wasteful system but I have higher hopes for it. There will be fits and starts but with proper vigilance from adminstrators, legislators, and most importantly citizens, this system can work and create a fairer and more efficient system. I like and expected you would think thoughtfully and thoroughly about this subject and I appreciate your sharing your views.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thanks LRC. I think you are right and I agree with your comments. I hope that everyone listens to everyone's input from both the left, right, and center. We need to make this work so all ideas should be debated. Those who just want it repealed and have nothing else to offer, I dismiss that as political posturing. If they have something better to offer, then I'm all ears.


Paulette305 profile image

Paulette305 6 years ago

Mr. Schneider: This is a great hub. The Republicans found a judge that is questioning whether the Healthcare Reform Bill is legal or not. If one aspect of the bill is found to be unconstitutional the entire bill can be tossed. This is the wealthy Republicans, once again thinking only about them self and not about America as a whole. These Republicans are behaving like spoilt little children who are having a temper tantrum because someone else won.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you Paulette. I agree that the Republican court challenges are a threat to the bill. My hope is that the appeals will be eventually quashed. I do hope that if part or parts are ultimately struck down, the bill will still survive. There is too much good in it to allow it to go down. The Supreme Court will be the ultimate arbiter. The Republicans are just pandering to their far right for votes this election.


DTR0005 profile image

DTR0005 6 years ago from Midwest

Wow... this is a very honest, level-headed, and fact-filled piece. Health care has been my war horse for a number of years now. I do enjoy your work.


HSchneider 6 years ago from Parsippany, New Jersey Author

Thank you DTR. This issue is vital to our country. We are way behind the rest of the developed world in this area. Health insurance should not be based on the fact that you are employed or not. It's ridiculous and we need all ideas we can use to improve it. I believe the new Healthcare Reform Law is a flawed but decent first step.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

SOME TIME AGO YOU SAID

''Young adults are able to remain on their parents health insurance plan until they reach the age of 26.''

Here's a exerpt from an article I came across in our local newspaper. For what it's worth to your beliefs.

Healthcare ‘’added mandates mean higher costs’’

Consequences of the new federal Healthcare Reform bill that some insurers are having trouble complying with the law’s tough requirements. The provision requiring insurers to keep children on their parents Healthcare plans until age 26, for example.

Curiously, one of those troubled groups is a New York affiliate of the Service Employees International (SEIU )Union, which had been one of the most ardent and vocal supporters of the new law. SEIU officials enjoyed near-constant access to the White House throughout the 18-month healthcare debate.

The union local 1199SEIU United Healthcare workers east, represents about 30,000 low-wage home-based healthcare workers. A letter was sent to members on Oct.22 informing them that, partly because of the passage of Obamcare, it was forced to drop coverage for some 6,000 children. Mitra Behroozi wrote, ‘’ our limited resources are already stretched as far as possible’’, ‘’ and meeting this new requirement would be financially impossible.’’

The union later restated its storyline. Other insurers are saying otherwise, acknowledging the obvious: if a law adds mandates, costs don’t drop. They rise.


HSchneider 5 years ago from Parsippany, New Jersey Author

Health insurance companies simply have to charge the parents and the companies whatever the extra cost is to add this 18 to 26 year old to the plan. They well know how much to charge and how to squeeze as much profit out of them as they can. 18 to 26 year olds are relatively small risks since they are healthier than the rest of the population. My bet is that the insurance companies are gouging these companies and parents. Employer based health insurance is unfair and should be eliminated. I wish health insurance companies were eliminated and replaced by competing government health exchanges. Non profit based exchanges. That way the American public will be served and not these companies profits.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

Something like medicaid and medicare non profits?

A record one-in-six Americans is now enrolled in some type of anti-poverty program. USA Today notes more than 50 million Americans are on Medicaid, up 17 percent since the recession began; more than 40 million people get food stamps -- up 50 percent; nearly 10 million

people receive unemployment insurance -- nearly quadruple the 2007 number; more than 4.4 million Americans are on welfare an 18 % increase.

As you might expect, the cost of the federal programs has swelled as well. Medicaid's cost is up 36 percent to $273 billion; jobless benefits have risen from $43 billion to $160 billion; food stamps have gone up 80 percent to $70 billion, and welfare is up nearly

25 percent, to $22 billion.


HSchneider 5 years ago from Parsippany, New Jersey Author

I guess you would like to eliminate these programs. Let everyone go without any health care or assistance of any kind. Survival of the fittest. That is not the America I wish to live in. Yes, these programs need reforming. The entire healthcare system needs to be automated and eliminate this costly and wasteful expense. The private sector would simply create huge profits for themselves and tinier payouts on claims. But your right, eliminate these programs. One for all, and all for me.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

I received notices from my insurance carriers this week. Premiums will increase 20% and deductibles will be higher. Didn't president Barak Obama promise that healthcare cost will be lower? Incompetence or just another lie.

Another phase of the Healthcare Reform bill went into effect on 9/23/10. Insurance companies are now required to pay for yearly check ups as required by the new law. Previously the mandated preventive care check ups were paid by the individual. Hence insurance companies will now incur addition expenses and eventually PREMIUMS WILL GO UP.

Some 60% of the people do not want the healthcare reform bill passed in its present form.The US has the best health care system in the world. It’s not about

health care, it's about controlling insurance cost and government control of healthcare. Last year some 33,000 Canadians came to the US for treatment.

15 MILLION OUT OF WORK reduces the insurance pool, naturally those who can pay will pay more.


HSchneider 5 years ago from Parsippany, New Jersey Author

You know the the entirety of the plan does not go into effect until 2014 when the state exchange pools are up and running. Thus the crooked health insurance companies are going to jack up rates every year to get every drop of profit they can until then. I wish this plan could have been put into effect much faster but special interests and the Tea Party were successful in watering it down. Free preventative check-ups will diagnose problems earlier and bring down costs in the long run. If you wish to complain about your rates, complain to your insurance carrier. They are the culprits.


Neil Sperling profile image

Neil Sperling 5 years ago from Port Dover Ontario Canada

Interesting debate - In Canada we have Government Insurance PLUS many people have additional insurance as the Government does not cover all.

Our system is under review as it is one HUGE tax burden..... and much of the reason is what James said above..... no competition in health technology etc.

I see another huge angle to the total problem. Starts with too much wealth in the hands of too few.... Some of the wealthiest people virtually control pharmaceutical companies and the same people control the insurance industries. They also control much of the manufacturing, media and energy companies.

They (the illusive they) love to see the left and right extremists fight each other, that way they can play with the market to make sure they capitalize the most from both left and right philosophies.

Until the majority of the working middle class start working together on issues rather than fight each other for left or right politics, we will remain in a mess.

To me is health care reform is just one more cog in the wheel where "they" keep us fighting each other for their own gain and control.

The rich get richer - the poor get poorer and the working middle class disappears.


HSchneider 5 years ago from Parsippany, New Jersey Author

Thank you Neil for adding your viewpoint from Canada which has an almost total National Healthcare program. I agree that the right and left fight heavily over this issue and most others also. The corporations are always masterful in using their large caches of money and lobbyists to pit each side against each other and thus getting what they want. They contribute heavily to both sides. I also agree that added competition is needed. I believe that our new Healthcare plan with its 50 state run insurance exchanges could facilitate this. I would like to see them eventually form into regional exchanges to use their economies of scale more effectively. I don't know if it will work. The status quo didn't. I feel employer based healthcare is inherently unfair. The point you made about many Canadians needing to supplement their insurance is also true of the U.S.'s medicare program for the elderly. Most supplement this with an outside plan. My mother does so. I appreciate your comments.


judydcash 5 years ago

Neil's right- the 2 sides argue & fight, and then 'compromise' back & forth on a never-ending pendulum, while greedy pigs use their influen$e to fatten their bellies.

I don't have much hope that things will change enough, we tend to pass laws that do minimal change, then push things out into the farther future. We do this with every problem (environmental, health care & financial problems...) so it always in the end takes the PEOPLE (that silent Majority, Neil, we are a big part of the lack of progress too) getting FED UP and bringing hue & cry (Civil rights, women's vote) to finally push us over the tipping point.

I'm referring to healthcare, but also to the fact that we can't afford to pay for all of this now, and if/when things pick up again would the vast majority tolerate funding a wasteful system? Only if it doesn't seemingly affect us!

Sound pessimistic? Or realistic- it's human nature to put off the really big things, and we as a huge republic can only make REAL CHANGE if a sea-change of attitude takes place!

Thanks,

judy

ps- I believe that individual responsibility is as important in health care as collective taking care - but education is what needs to happen and I'm glad for this HUB-forum! Nice work to bring it together HS.

pps- I just was in a health care survey/focus group recently, wow, if you could have heard the comments there! None of the ladies were Tea Party people, but those conservative points resonated with over half the group!


HSchneider 5 years ago from Parsippany, New Jersey Author

I agree with you that many issues tend to get pushed back farther and farther until the problem becomes critical. That is true with this Healthcare Reform bill because the main points such as the state run exchanges don't start until 2014. I know a lot of people complain about this bill but no one is giving it a chance. I believe this is mostly due to Republican right wing misinformation. Also the bill as written is supposed to be paid for. Whether that turns out to be the case, we will have to see. I am a little skeptical of that myself. Thanks for your insightful comments.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

ALL OF THE ABOVE forget one important player in healthcare. Open your eyes and realize that the Government IS PLAYING AN IMPORTANT ROLE IN THE COST( REGULATIONS ) of providing healthcare. The insurance industry is working on a 3% to 4%profit margin. Profit is what's left after paying government taxes, overhead costs and claim payments. REMEMBER THAT 35% of the profit goes to the US Treasury ( the people).In 2011 a provision of the Healthcare bill kicks in. Insurance companies will be required to spend 85% of their premiums on paying claims, that leaves them with 15% for overhead and profit. Insurance companies will raising premiums so as not to go out of business.

The question remains ‘’ who will or should be paying for the poor ‘’.


HSchneider 5 years ago from Parsippany, New Jersey Author

Insurance companies will be raising premiums because that is what they do. They will also find ways to cut out on paying claims and raising what their customers pay out of pocket. These companies only care about their bottom line. Not their customers.


Neil Sperling profile image

Neil Sperling 5 years ago from Port Dover Ontario Canada

I agree with HSchneider - the insurance companies will raise their premiums and find more ways to NOT pay out.

Pharmaceutical companies and companies that manufacture equipment for the health care industry milk the system for huge dollars. Admin costs in health care are way out of line. The same billionaires own the majority of stocks in both insurance and pharmacy.(not to mention the manufacturing of health care goods)

To top it off Preventative health is not even considered a benefit and pharmaceutical companies lobby for controls on home remedies.... It is all sick.

So much greed and power tripping. There would be fewer poor if greed and power tripping was governed. And that is not a left side comment - as I see it the extreme left and extreme right both end up benefiting the same few people. Extremism is the major problem, from health care to taxes to economics in general.


HSchneider 5 years ago from Parsippany, New Jersey Author

I see that our center right vs center left dichotomy of ideas can be fruitful in developing common sense solutions. Your points are well taken. All parts of the healthcare system try to milk every ounce of profit they can. Administrative costs are outrageous and need to be streamlined by both automation and eliminating these middlemen. I could not agree with you more about extremism on both sides. No good ever comes from it. They both take good ideas and stretch them out of shape to suit their own ideologies. Then the people suffer. I long for the day where constructive thought and compromise was the rule instead of the exception in Congress.


Neil Sperling profile image

Neil Sperling 5 years ago from Port Dover Ontario Canada

LOL - trouble is common sense does not seem to get listened too!

Cheers to the middle road - Cheers to the Working Middle Class (what's left of it)


HSchneider 5 years ago from Parsippany, New Jersey Author

No, it doesn't seem to get listened to. But I still hold out hope. The Obama Administration and the Republicans have compromised some here in the U.S. in the past couple of weeks. I am not crazy about their Tax Bill but they both compromised. Now it looks like the START Treaty will get passed and Don't Ask Don't Tell will be repealed. You see, hope still springs eternal.


Neil Sperling profile image

Neil Sperling 5 years ago from Port Dover Ontario Canada

Hope is worth hanging onto


HSchneider 5 years ago from Parsippany, New Jersey Author

Amen Neil.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

Just a reminder of what was said before.

The US Government is the largest healthcare insurance provider in the world. They manage medicare,medicaid, the va (veterans administration ) and ships ( for children ).

The US GOVERMENT denying services is 8.5% and is #1

Etna is #2 at 6.0% denial

Obama is chastising the insurance companies for denying insurance coverage when it's our government leading the world.

DO YOU REALLY BELIEVE THAT THE US GOVERNMENT knows how to run the healthcare industry?


HSchneider 5 years ago from Parsippany, New Jersey Author

I believe they would do it better and more humanely than any of the profit driven Healthcare Insurance companies. But the new Healthcare Reform law leaves this duty in the insurance company hands. So I guess the question is moot for now. In 2014 and beyond we will see who does it better. The insurance companies or the state run exchanges.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA

Dear HSchneider,

I am sorry, but I have to comment! As I stated previously, I believe that your article is fact-based and you are more well-informed than most. I am a fan of your articles!

Jon Ewall is ONLY correct when he speaks about denial rates. But, he does not understand what a claims denial is. It is not denial of services. It is a denial of the claim and the manner in which it has been filled out and submitted. If one line on the claim form is incorrect (name, ID number, diagnosis code, even the address the claim is sent to), then the claim is denied and that is what makes up claims denial statistics.

Private insurers usually deny a service BEFORE a claim is even sent to them. Their denials come in the form (most often) of authorization denials. Doctors will request a treatment, hospitalization, test or medication and the private insurer will refuse to approve the authorization or referral request. Those denials of requested care never get to the claims stage.

Medicare (straight Medicare, not Medicare Advantage) does not require pre-authorization, so all services that are performed are sent to them directly, with no middleman (Utilization Management).

There is a great opinion posted on this very subject that I find extremely enlightening. The author has his facts straight. If you are interested, link to: http://dailykos.com/story/2009/10/6/05110/6076.

Mr. Ewall might find that it explains his misinterpretation of the term 'claims denials'.

Again, I am sorry for commenting about this, but Mr. Ewall tries to influence opinion while being completely misinformed. I have worked in every aspect of health care and when I see someone so mixed-up, I just cannot stop myself.


HSchneider 5 years ago from Parsippany, New Jersey Author

There is no need to apologize Jillian. I appreciate your comments and your elucidation on this subject. Your experience and knowledge in all aspects of this industry make your opinion very valuable to me. Your common sense views on all subjects adds to this. I suspect that Jon is a person that feels that government can only mess up and make a process inefficient and that private industry is always preferable. I believe that when dealing with such a critical life altering segment of business, our government should have a leading role. For profit companies overwhelming mission is to generate profits. This of course leads to large claim denials. My preference would be to eliminate these middlemen but they have become so entrenched that this outcome is unlikely at any time in the near future. I appreciate your shining a light on how they deal with claims. It is true that medicare turns down some claims and procedures but their main goal is not for profit. Government is inefficient so they must be strictly monitored. But these healthcare insurance companies should be also. Thank you again for your enlightening comments.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

I would like to respond to a reply by Jillian Barclay referring to my statement ‘’The US GOVERNMENT denying services is 8.5% and is #1

Etna is #2 at 6.0% denial ‘’

JB said ‘’But, he does not understand what a claims denial is. It is not denial of services. Mr. Ewall might find that it explains his misinterpretation of the term 'claims denials'.’

My statement refers to ‘’service’’, not claims.

JB said ‘’great opinion posted ,link to http://dailykos.com/story/2009/10/6/05110/6076.but Mr. Ewall tries to influence opinion while being completely misinformed.’’

The link did not open, the article was not there to be read. My reply was not intended to influence opinion but to only report a fact.

There are certain SERVICES and TEST that Medicare does not approve for payment. When a service or test is performed and Medicare will not approve, a private supplement insurance in most cases will also deny payment. The patient will end up paying 100% of the bill for the SERVICE or test.

JB said ‘’Medicare (straight Medicare, not Medicare Advantage) does not require pre-authorization, so all services that are performed are sent to them directly, with no middleman’’

Medicare patients are notified prior to certain services being performed that Medicare may not pay for the service. The patient is required to sign for the service and acknowledge that the patient will be required to pay prior to service .

The Medicare booklet has a list of SERVICES that Medicare will not make payment .

One must not confuse the difference between a Government insurer and a private For Profit insurer. Private insurers paying out more money than they receive in premiums go out of business. Government agencies turn to Congress and the Taxpayers for more funding otherwise they too would be out of business. Let’s not forget that Government mandates and regulations force insurers (private market ) to raise prices to comply with the law.

In the state of Arizona Medicaid patients are being denied needed organ transplants. The Medicaid program funded by the State and Federal government is in the red.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA

Suggest Mr. Ewall cut and paste the link (minus the period at the end) into his google browser. The article shows up and explains denials, denials for what and the denial codes attached. He can also find the article by entering the phrase, Medicare denial rates into his google browser. The article shows on the first page at the bottom of the page.

Again, you cannot debate when people don't do the actual research. Much has been written on the subject and many articles, including CMS (Medicare) itself, explain why the results are skewed.


JON EWALL profile image

JON EWALL 5 years ago from usa

Jillian Barclay

You said ‘’Jon Ewall is ONLY CORRECT when he speaks about denial rates. But, he does not understand what a claims denial is.’’

There is a difference between a service denial and a claim denial as I stated. Your example refers to denial of payments for service or billing errors. Check out this site.

Medicare’s Refusal of Medical Claims Continues to Outpace Private Rate

By Mary Theroux

Thursday December 17, 2009 at 2:55:18 PM PST


teamrn profile image

teamrn 5 years ago from Chicago

Should I make a new hub to comment on your well-written article? I do take issue with a few of your assumptions and so I'll address them line by line and I'll use quotations to QUOTE your text.

How did our health care system get to this point? Yep, how did we get to the point where items related to healthcare (HC) like treatment, research, meds etc, is approaching 20% of our nation's GDP when in other countries it is much lower 5-10%?

Looking at those other countries there's a different model, a universal healthcare coverage system. where everyone is covered, But, it's not free like many think.

One may think we sought to adopt that same model, That's a thought; but food for a different article, altogether.

Seems like the more salient point is that because of the R&D, the innovation, the entrepreneurship our system was riding on an even keel; until those expenses started to cost. And when they cost, those costs spiraled and spiraled out of control until we got to the point we're at now. So how do we prevent those costs from continuing their upward rise?

Cut R & D? Do we honestly want that? Do we honestly want to be a country that settles for mediocrity in developing new medications and treatments? Or do we want to be that country that is able to get Congresswoman Giffords to the OR in 38 minutes and out of the hospital to rehab in less than 3 weeks. I think we-or at least me-want the later. Another conundrum. We want our system to cost less.

At the same time, we want to be the country where others come from around the world to know that they're going to get the best medical care.

Do we want the high infant mortality we have? No, We need to have that innovation and R&D to find out WHY it's so high. In the same token, do we want the single mother of 5 children who has breast cancer to have access to have health care coverage? OF COURSE WE DO. We have rigorous disagreements about HOW to accomplish this. Not a soul alive wants to see her or her children suffer; but I've been accused of wanting just that because I don't agree with the current initiative.

After WWII, employers started to offer health insurance as a benefit to attract employees. Great, because the woman couldn't be denied health insurance-it was group insurance. However, once she could no longer work and COBRA benefits had run out (if she could afford them), shopping for insurance was next to impossible with cancer.

So, it was proposed that we cover everyone. The humane thing to do. However, to do this, we as a country would need to make certain changes to what we expect from our health care system. We would need to cut that R & D budget, we'd need to decrease the benefits we offer already and the services we already promised.

I'll start with decreasing the benefits we already offer. Currently, if an individual needs an MRI every month and the procedure is deemed medically necessary, it will be covered. Common sense dictates that that might not be true when that same system is trying to cut costs/trying care for more people on a decreased budget. Decreased? Why? Because it has a fixed amount of dollars and it is trying to insure more people.

I see only one way around this conundrum; and that is to raise taxes. After all, to offer more, you cut the fat, but it's also likely, very likely that there must be more dollars going into the HC system than go out. Otherwise we lose quality.

"The Republicans initially decided to have some dialogue about making some minor changes to the health care system but were intent on leaving the bulk of the system intact. " Unfortunately, Republican minority DID have ideas but were shut out of discussion, They offered proposals at the bipartisan healthcare summit like tort reform and the ability to shop for insurance across state lines, but were met with "...The election is over..." I interpreted that to mean, 'it's my way or the highway.'

We all need to give up something to have something and many proposed that caps on malpractice awards be set. That would be a good step, right. Unfortunately,, the trial lawyers would be dealt a blow on that one and they were one of the largest contributors to the President's campaign. I sense a "you scratch my back, I'll scratch yours..."

"They [Republicans] proceeded to oppose every action the Democrats tried from that point on. " I disagree.

Republicans offered solutions, like the ability to purchase insurance across state lines. After all that would increase competition and keep costs down. That was voted down. They wanted unemployed individuals and small business to be able to pool together as a group to buy health insurance. THey want states to decide for themselves what reforms would work in their STATES.

These are just a few of the proposals offered by the Republican minority, not accepted by the majority. http://www.gop.gov/solutions/healthcare

"Young adults are able to remain on their parents health insurance plan until they reach the age of 26." A key provision; another one where common sense doesn't prevail and says HOW can you offer more and spend less? Also, young adults who may be going to college graduate BY 22, AND in most cases are covered by employer sponsored insurance by 24, assuming that the college grad applies him/herself and looks hard for a job.

Offering insurance coverage until 26 gives NO incentive for the child to 'get out on his own' and get a job. What happened to personal responsibility? This is one more mail in the coffin of caring for you from cradle to grave/nanny state. 'Don't worry, if YOU won't care for YOU, the government will care for YOU instead. Your parents aren't even responsible for YOU. Uncle Sam is. How much longer before Uncle Same OWNS you?

The provision of obtaining health insurance or paying the tax flies right in the face of "I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes." Serendipitously gotten around by the use of 'penalty!'

Differences of opinion are what make this country great and a healthy dose of debate make it even greater. Our founding fathers had duels to settle their disagreements, thank goodness we're beyond that, but occasionally rancor emerges.

Now, my views. "This entire process was one of compromise and no one is totally happy with the result. " I don't see that the Republicans compromised, because they weren't usually allowed at the TABLE. Remember the statement at the 2010 BIPARTISAN summit, "The election is over." ?

As far as Constitutionality on mandating that everyone purchase healthcare insurance like we must have driver's insurance. The mandatory (?) driver's insurance is a STATE right. The Constitutionality of this provision has been challenged under the Commerce Clause of Article 1 Section 8 clause 3 of The Constitution. I'll quote it here, you decide if it applies, . The commerce cause grants Congress that right “To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes”.

Hmmmmm. The several states. Remember, back then North America didn't have the same number of states and people now purchase their car insurance across state lines. Why is it okay to purchase car insurance across state lines, but not health insurance? I don't feel the argument will hold up quite frankly. If I, John Q. Public can shoot this hole through an argument, I can imagine the brilliant trial lawyers eloquence speech and arguments.

Enough of a lengthy response, but a few of my differences with the Health Care bill; also, we're paying taxes on the bill, but with the exception of a few groups, most Americans won't see benefits until 2014. More expense. Most important, children with pre-existing medical conditions were covered right away.


HSchneider 5 years ago from Parsippany, New Jersey Author

Thank you for commenting Teamrn. I appreciate both your praise and criticism. I will attempt to address your issues. I agree with you that much of the explosion in health care costs is due to innovation and R&D. I don't wish to limit any of that and I don't believe this bill will. There is nothing in it which deters the drug companies or other medical corporations from innovating or limiting their profits. I don't believe we need to cut R&D to cover everyone. Some benefits will be cut especially since way too many procedures and tests are ordered. Taxes will be increased. I have no doubt of that. I believe there should be different levels of plans offered from which to choose from. Your age, health, and income status will influence your choice. I disagree with you that the GOP was serious especially after the Town Hall meetings of the summer of 2009. The opposition was organized and sponsored by Far Right groups and deterred and scared off GOP leaders. Senate GOP Minority Leader McConnell continually states his objective is to just say no to Obama to beat him in 2012. I do agree with you that serious Tort Reform needs to be implemented along with Healthcare Insurance competition across states. There is no reason that it cannot be negotiated to be added on to this bill and I am all for it. I said so in this Hub. I also disagree with you on the provision for children to remain on their parents plans until they hit 26. The "no incentive to look for a job" would only be true for a small minority. It reminds me of the argument against extended unemployment benefits because it encourages one to not seek work. It's a total crock. Jobs are often difficult to get out of school and there needs to be some safety net. Besides, I have much more confidence in parents pushing their children to get out there and get a job than you do. As for your argument against the mandate, it is not a tax. It is a requirement to pay a minimum for health care insurance. Is it fair if we pick up their tab if they cannot pay? Also, if you want insurance across the states, then "The Commerce Clause" would apply. I also wish all the benefits and plans were starting this year instead of 2014. Unfortunately that was one of many compromises the Democrats had to make to get even this scaled back plan passed. Finally, I simply feel that our archaic and unfair healthcare delivery system must be changed. Why is it a requirement to be employed to get affordable health care? I don't believe it is but I do agree the present plan is flawed. I hope it is amended as needed as time goes by and made stronger. This includes your proposals for Tort Reform and insurance across states. I look forward to reading more from you and also debating you on the issue. Could there be a Hub on this in the future from you? I hope so.


teamrn profile image

teamrn 5 years ago from Chicago

HSchneider, yes I'll do a hub in more general terms. This HC reform bill has taken on such a highly charged tone that some (not you) take it too personally. There's logic in the things you say. But a few things I disagree with (NO A PREPOSITION IS A WORD YOU DON'T END A SENTENCE WITH!!)

Glad we're both in agreement on the need for tort reform. The POTUS said in his St of hte Union speech that that was on his agenda. I'm anxious to see what he does.

As to my 22 year old niece staying on her parents HC plan until she's 26, that's wrong. Even if she is unable to find gainful employment in her chosen field (I'm just choosing her b/c she happens to be 22), she should be able to find SOME work in 4 years. If not, she'll bankrupt her parents. And if the government provides HC, she'll bankrupt it.

Allowing her to stay on her parents plan is EVERY incentive for her parents not to teach her to be self-reliant. I love her to death, but there comes a time when we all have to spread our wings and fly. That's the hard ass/tough love attitude, but if people know they can ALWAYS count on bleeding hearts, eventually they'll stop relying on themselves. Human nature 101.

"Some benefits will be cut especially since way too many procedures and tests are ordered." I agree, far too many procedures are done and often in the name of practicing defensive medicine. So, there are benefits that will be cut. My point, I can do w/ one less CBC this year, but when you offer more to more people and offer it for less (that in and of itself is suspect) and by the way, you propose to insure millions more (offering those increased benefits to more) the numbers just don't add up.

The CBO released one set of figures, the bill would lower the deficit by $138 Billion. Imagine the hype that one got. Then noted health care economist wrote in the New York Times this op-ed:

http://www.nytimes.com/2010/03/21/opinion/21holtz-... "the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out." That's another reason that I'm not inclined to believe that the HC bill will be saving $$.

"As for your argument against the mandate, it is not a tax. It is a requirement to pay a minimum for health care insurance. Is it fair if we pick up their tab if they cannot pay? " Tax, penalty, whatever, it is something that must be paid. There are many on fixed incomes, myself included who face a nearly 4% cut in SS benefits in several years, that to penalize/tax/throw the book at me is wrong. Especially for someone who ran on championing the 'little guy.'

IMHO, the government has no business being involved in healthcare above or beyond what is stated in the Constitution. Powers not specifically granted to the Congress in he Constitution, shall belong to the states. I haven't seen anything in the Constitution saying that Congress shall have power over healthcare. I think Ben and Jeff and George saw a big problem with that, The VA is but one example of government involvement in HC.

You speak of something not being fair; LIFE ISN'T FAIR. Should the US of An attempt to solve every unfairness in this world? Only in a utopian society can fairness truly be addressed. Inequities BUILT into a system: NOW THAT IS DIFFERENT than the unfairness that life hands us. Getting a bit too philosophical for this post, though.

This is becoming longer than I wanted. In the next few days, I'll put together a separate hub on this. Sort of a "point counter point!"


HSchneider 5 years ago from Parsippany, New Jersey Author

I think we both have a different view on the Constitution as well as a different philosophical view on life. I also want people to stand up for themselves but having your whole life ruined when you lose your job because of the loss of affordable healthcare is simply unacceptable to me. I am going through it now. Luckily I can afford it but most people can't. As for the Constitution, we have had for years numerous social programs which have not been ruled unconstitutional such as social security, unemployment benefits, medicare, medicaid, etc. The Constitution has some elasticity. I wrote a Hub on this. The conservatives would and will file challenges against these if they think they can win. They currently have a conservative Supreme Court so we will see. The 9th amendment gives broader interpretation into the Constitution than most people think. The founding fathers knew they did not have all the wisdom in the world and had not enumerated all the rights that may be. They also knew that new conditions would arise over time that would have to be dealt with. I believe that providing a minimal of affordable health care to all is one of these newer basic rights due to the astronomical costs. Finally, I disagree with the way they are dealing with SS benefits. I believe they should raise the income threshold that SS can be taxed on. It is an easy fix that would take into account inflation over the last several years. Thank you for commenting again and I appreciate the vigorous debate. I look forward to reading and commenting on your Hubs.


teamrn profile image

teamrn 5 years ago from Chicago

H, I started another response, then I had to go out. I'm going to Hub something, but it'll be a while;; have so many ideas! Lots of food for thought and good debate topics Annie


HSchneider 5 years ago from Parsippany, New Jersey Author

Annie, I look forward to reading your many ideas in your Hub. I also look forward to both agreeing and disagreeing with you and debating about it. That is the only real place people can learn and come up with good new ideas.


American View profile image

American View 5 years ago from Plano, Texas

HS,

No question repeal it. I have read all 1500 pages, its scary. Hows this for an Idea. Let me know what you think

http://hubpages.com/politics/New-Idea-for-Health-C


HSchneider 5 years ago from Parsippany, New Jersey Author

I actually liked your Hub and I would love to see your Healthcare Plan implemented, American View. Unfortunately both political sides would rally against it especially after the healthcare reform debates of 2009. I do not feel we should repeal the reform plan passed in 2010. It was too hard fought for and nothing else would be put in its place. I would absolutely wish to see your excellent ideas incorporated into it. My belief is that it is absolutely unfair that one can only receive affordable healthcare if they are employed. I consider this to be un-American and unconstitutional. Your plan would take care of this main concern and I applaud you for it. I just don't see it being taken up anytime soon. Again I would like the new law evolve into what you are calling for. Thank you for your comments and your insightful Hub.


kimh039 profile image

kimh039 5 years ago

It looks like we agree that employer based health insurance seems un-American, and that the outrageous law suits need to be addressed. Hind sight is 20/20 of course, but it seems reform is about 100 years too little, too late. I see it as just the beginning of a very long process. The court in Cincinnati this week determined it is constitutional, so I'm thinking we'll be looking at more reform. Thanks for the good info and insights HSchneider.


HSchneider 5 years ago from Parsippany, New Jersey Author

Thank you KimH039. We do agree on most points relating to health insurance. We also agree that reform has come much too late to this process. President Nixon was ready to push and sign a healthcare bill that makes our current one seem timid. Unfortunately the Democrats would not accept a smaller victory back then. We should have a one payer system to get all the waste out of the system and return sanity to it. Unfortunately the insurance companies are too entrenched. At least these new state exchanges will be a good start. I hope the Supreme Court upholds this plan and the individual mandate. I am scared though because of the political makeup of the court. We will see.


kimh039 profile image

kimh039 5 years ago

next agenda: politician reform:)


HSchneider 5 years ago from Parsippany, New Jersey Author

Absolutely, but good luck with that. I am working on an election finance Hub. Money corrupts the entire process.


JON EWALL profile image

JON EWALL 5 years ago from usa

HSchneider

Obama said that Healthcare cost would go down if the Healthcare reform bill was passed. Barack Obama said that unions would not be exempt from the new law. Obama said that government paid abortions are not in the law. All of the above was a Obama lie, none of the above is true.

The Stimulus package passed in 2009 included $19 billion for electronic health records mostly to be an incentive for Medicare providers. Speaker Pelosi’s statement ‘’ we must pass the bill to find out what’s in it ‘’ apparently is true. The Obama administration is adding more information as time goes forward.

Check your insurance premiums, ours went up 25% in 2010 , 25% in 2011 and now we have received a notice that premiums will rise another 25% with higher deductibles.

The Republican controlled House of Representatives recently has voted to appeal Obamacare.

The first regulations are set to go into effect in Oct. 2012.


HSchneider 5 years ago from Parsippany, New Jersey Author

Jon, Two points. The first is that the bulk of the rules for this law go into effect in 2014. That leads to my second point. The corporations and insurance companies are taking advantage of loopholes and the time gap now because the Republicans and conservative Democrats watered the bill down and delayed it until 2014. They are ripping off America now when they still have the chance. The state run exchanges will end that in 2014. They should have converted to a single payer system but that did not have the votes unfortunately. The healthcare insurance companies are the bane of our existence. Also if the courts rule that the healthcare mandate that you must obtain healthcare insurance is unconstitutional, then costs will soar dramatically. It will probably destroy the whole law because of the dramatic added costs.


arb profile image

arb 4 years ago from oregon

Enjoyed your hub very much. Well written and provacative. That I agree with you has little bearing on my like of it. By the way, I wrote a similar hub called America the Beautiful.Amazing how great minds think so similarly. Be well


HSchneider 4 years ago from Parsippany, New Jersey Author

Thank you very much, Arb. I will check out your Hub.


HSchneider 4 years ago from Parsippany, New Jersey Author

Today was a victory for Affordable Healthcare for the American people. The Democrats must hold on to this victory in November or else the Republicans, who are beholden to big moneyed corporate interests, will try to repeal it. The fight is not over but today is a promising and encouraging day.


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HSchneider 4 years ago from Parsippany, New Jersey Author

Thank you Pharmd950. I am glad you liked it.


Aunt Jimi profile image

Aunt Jimi 3 years ago from The reddest of the Red states!

Agree that we have a rudimentary healthcare reform that is about to take place and a great deal needs still to be done to make it work as it should. I do think that defense remains the largest expenditure in our economy, and it is so colossal it is destabilizing the rest of the economy. These wars that would seem to be for the purpose of lowering the world's population are a luxury we can't afford.


HSchneider 3 years ago from Parsippany, New Jersey Author

Our defense expenditures and military complex do indeed need to be cut back dramatically. Hopefully President Obama will do this after the final drawdown from Afghanistan in 2014. These wars have been a terrible drain on our national budget. Thank you for your comments, Aunt Jimi.


HSchneider 2 years ago from Parsippany, New Jersey Author

The final sign ups for the new Affordable Healthcare Act insurance are 8 million for this initial period. 35% of these new enrollees are 35 years of age or less. This is the demographic most desired by insurers because they are the most healthy and will file far fewer claims. Therefore the Congressional Budget Office estimates that premiums for next year and 10 years out will be sharply lower than forecasted. They are forecasting that this has caused them to lower their budget projections on the federal budget by 100 billion dollars over the next 10 years. 3 million uninsured have also been insured with the expanded Medicaid program. Million of under 26 year olds are now insured under their parents' programs. Sounds to me that this new law has been an undeniable success and will only expand upon this progress. Do not believe any of the lies the Republicans and Koch Brothers sponsored groups spew against this law. It is working and the proof is in the numbers. These numbers will include the expanded life spans and quality of lives that the poor will experience in the coming years.


RachaelOhalloran profile image

RachaelOhalloran 2 years ago from United States

Healthcare insurance is a very slippery slope in our house because we have 1 sickie, 1 wellie and both are senior citizens with medium to high income that makes us unqualified for a lot of other programs.

One of us is in the donut hole, one is not. Whatever one of us doesn't qualify for, or still have insurance benefits for - then the other does (medications). So we end up getting doctors to write scripts so we can switch the prescriptions back and forth between us so we at least have the medication in the house.

One has severe health issues, one has mild. One has exhausted all 100 hospital day allowable annual benefits for this year and it is only April! If a hospitalization is required from here on, it is self pay.

We pay $245 a month for my husband's insurance in addition to Medicare $96 and for my plan I pay $139 plus $96 Medicare. Medicare comes right out of our checks so we don't even see it. But we have to pay the monthly premium for insurance. My husband is high risk due to his stroke in 1999 and disability status.

Obamacare has done nothing for us in to hospitalization days. However, Obama's silver lining is - if all 100 hospital days are used up and one has now become self pay, one can always go to a nursing home or rehab as inpatient and use those 90 inpatient days for a rather small copay of $100 per day for 10 days (!!!) and then no copays for the other 80 days.

Not too many doctors are willing to 1) come to a nursing home 2) come to treat a patient who belongs in a hospital and 3) approve of the whole venture for fear of being sued for defrauding insurance companies.

We are in the process of moving from one state to another and fortunately the insurance situation is better in the new state than in our present state. The good part about moving mid-year is that the donut hole we are in now in California will be non-existent for several months in our new state because we are getting new insurance as new residents and everything resets to zero to start fresh.

With that said, I can't say insurance in California has been a good ride. They say Obamacare gave a lot to seniors (altho we didn't see much of it in our house due to income level and high risk health status) and the actual Affordable Healthcare Act did nothing for my 30's somethings children ( I have 5).

They have insurance thru their workplaces (or spouse's workplaces) and for all the tooting and rooting the gov't did about Obamacare plan, I feel it was a bust for the majority of Americans because they are already covered on a plan (work, Medicare supplement, etc.).

The kicker is that I work in healthcare. I see first hand how seniors can't afford the high copays for services and esp medications, so they do without them while in donut hole - bec the $$ tag is so high, whereas with insurance, the price has a different schedule of fees to follow.

When Mrs. M looks at her monthly prescription and sees that the insurance company paid $101 for her prescription and her copay was $30, imagine her surprise when she is in the donut hole a few months later and that same prescription she expected to cost her $131 (copay and ins price), now costs her over $500. Not fair.

There are too many seniors who are doing without because insurance has stopped paying and the donut hole price is inflated from the insurance schedule price and it has only gotten worse since 2011 or so

Our demographics just for some FYI are: I first got on Social Security at age 66. I'm 68 now still work part time as a home hospice RN. My hubby is totally disabled from a stroke in 1999, off disability and now on reg Social Security and is 74 y/o.

He used all his 100 days per year of hospitalization already and is in medication donut hole where we pay full price for his meds until we reach $4500 cash outlay, then we go back on insurance for the remainder of the year at "discounted prescription rates." which is about 30% of cost. It is terrible.

Sorry to go on so much, but with people tooting how great Obamacare is, I wanted to share how it is not so great for us.

The move to our new state will be free monthly premiums for insurance, no hospitalization limit of days and low or no copays for our medications. In fact I am here in the new state now to establish residency and the new insurance is phenomenal. I don't understand the differences from state to state in cost - who gets that money?? and I don't understand if one state can afford to give free or almost free premium insurance to seniors why can't all states do that?

Thanks for reading! LOL


RachaelOhalloran profile image

RachaelOhalloran 2 years ago from United States

If your hub is still up in one year, I'd like to come back and give you some highlights about the changes we experience in our new state as compared to California.

If the coming year is $$$ anything like this last 1 1/2 months since I've been here establishing residency, then I will be ecstatic.

I pay nothing for a monthly premium, nothing for copay medications up to Tier 4, then it is $20, nothing for primary doctor visits and $10 for my specialists, nothing for diabetic supplies and only $50 for ER which is waived if admitted. They have Urgent Care centers here which we didn't have in my area of CA and they are free - they use them when doctor offices are closed for the day or in place of ER visits for everyday ailments that can be taken care of (antibiotics, broken limbs to cast, Xrays, medication adjustments, etc.)

The First 5 inpatient days is $50 a day (ours was $100) and after that nothing for 100 days per year. If you are a hardship or have renal disease, the 100 days is waived, no limit on hospitalization days. My hubby qualifies for the waiver here but not in CA

Now that might all change with each year as insurance companies change their benefits each year, but even if they do, the savings of premiums and medication copays alone is big for us.

We are selling our house in CA and I just bought a house here, my hubby is coming in about a month- as soon as he gets clearance to travel from his docs and as soon as my 2 sons can do the move for the rest of the furniture and bring my hubby.

So it will be an interesting transition.

Thank you.


HSchneider 2 years ago from Parsippany, New Jersey Author

That sounds like a tremendous healthcare situation you are now in, Rachael. Good for you. I intend on staying on HubPages especially since this was the first writing site I ever joined. It's like home to me. I am sure this Hub will be up a year from now and I look forward to reading about the changes you have experienced in your new state and how it has progressed.


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Thank you or your comments, John. I have no suggestions regarding safeguarding my system. I am having problems also.


HSchneider 17 months ago from Parsippany, New Jersey Author

The Supreme Court has now upheld this critical ACA law a second time. This time about some shoddy wording, the first time constitutionally. This time by 6-3. Now the Republicans must totally repeal this after 2016 to destroy it which will put them in the path of the wrath of the American people. That would be foolish and inhumane.

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