Who would have been affected by the "advent of the valuable aspects" yet?

Unless you just changed jobs and were not denied coverage because of pre-existing condition hardly anyone has experienced the benfit.

Sure some college kids can stay on the parent's policy longer. Or some unemployed and uncovered can join a pool but if you are unemployed and can't make mortgage, an item that you can't afford but could live without is no effect.

If one can't afford $1,200 a month since one is unemployed but one still can't afford $400 a month either.

For America to compete in the world she needs a healthy and educated workforce.

Anyone not pushing to improve American worker's health or education is not a patriot

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On August 1 Arkansas started the Pre-existing Insurance Plan. http://chiparkansas.org/
I wonder how many have obtained insurance through the site.

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The criminal ponzi schemers are still in charge.

Didn't anyone else read today - the top few in our halls of congress are worth 1.2 billion.

Democrats just raised the highest prices in the world another trillion. The percentage of our health care costs in terms of GDP (also by far the highest in the world) will continue to rise. And we are still the only developed nation who leaves millions with no hope of care.

There is an illness in America when conversation cannot make room in any corner for common good or common sense. The Koch's and the baggers only excuse so much. I'm still marveling from afar at the excuses Democrats make.

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imjustsaying: My wife is on it and it eats our lunch to the tune of about $900 a month. Being self-employed, I pay for own plan and that went up about 30% because I had the gall to turn 55. I was hoping the health care bill would do something to lower or at least slow the increases for people who are in the same boat I'm in, but my guess is I'll be paying more to fund the 30 million who can't afford care. Hell at this rate, I'll be joining them before I'm 60.

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Demos had a majority in the House, held POTUS and had a simple, one vote majority in the Senate. Yet, a few of their own provided the poison pills to kill meaningful healthcare insurance reform. If the public OPTION had been insisted upon and fought for then reform would be heralded. Instead they let the Lincolns in the Senate dance with Republicans and add 130 poison pills to an otherwise good plan so that today there is no real reform.
Perhaps there's not very much to celebrate.

imjustsaying, did you ever check the fees for Ark's CHIP? After being canceled due to a chronic condition several years ago I made an effort and discovered I could not afford CHIP. That's the tragic underbelly of such programs. By the time a person is uninsurable they are often too broke to afford an expensive plan like CHIP.

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It's doubtful and likely much too late for "The One" to have learned that you don't play nice with Republicans and seek their 'cooperation' on any major measure.

What Hillary said about "The One" is now all too apparent, "he's made some speeches."

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I don’t get it, unless Americans believe they should get their healthcare “free,” and of course there’s no such thing as “free” healthcare or “free” anything else.

I read all the raving here about universal healthcare abroad and how it’s there for all. Well, it ain’t free, folks.

Germany? Germany REQUIRES people making less than $70K a year to have health insurance which is operated by more than 200 competing insurance companies. The system is funded by income tax.

Netherlands? Everyone living or working there is REQUIRED to purchase health insurance. Insurers are required to offer a government-mandated standard package and provide coverage to all. The government gives subsidies to companies that take on high-risk clients with chronic illnesses and severe disabilities.

France? The main sources of funding for “healthcare for all” are payroll and income taxes. And co-payments and extra billing.

Canada? Its universal healthcare is funded through general taxation, and any supplemental insurance is paid out-of-pocket. Many Canadians purchase insurance to supplement a government program they think is lacking in many services.

Italy? Funding for its “healthcare for all” comes from a mix of income taxes, local taxes, and co-payments.

I could go on with Spain, Australia, Sweden, etc., but you get the drift. There’s no such thing as “free” healthcare, and America would not be the first or only country to REQUIRE insurance.

Medicare/single payer for all in America? Would love to see it, but it's not gonna happen in our lifetime, friends, so we best get over it. Something is better than nothing. Oh, yes it is.

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What a teabagging straw man tactic Durango makes. I guess it's OK to be an Act Max for the Democrats.

I've never seen on person on this blog suggest anything is or could be free.

And you just made a fine case for how so many countries in so many ways do a far superior job than we.

To take that case and cheer for the fact we will never do right, not even close, is a perfect example of the illness I mentioned below.

You who buy something now are and have been paying far more than enough to assure both you and all those who cannot afford it get the care needed. In fact using any of the countries and their methods Durango listed as an example... it is clear most of you should have also ended up paying less overall (perhaps increased taxes, less directly to privateers and pharma - but less overall) while we went to some sort of single payer or tri care system.

The conversation in America is sick... in nearly all corners it simply despises common sense or common good while cheering divisive and costly stupidity... as long as it's your team who does it.

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Yeah, right. Want to see what the aginners are doing? Seven states suing the government to overturn the act have their hands out for subsidies from the program.

http://news.yahoo.com/s/ap/us_health_playi…

Now for the corporations lining up for their share which btw includes those those Koch boys:

http://www.washingtonmonthly.com/archives/…

Shameless hypocrites.

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Yeah, right. Want to see what the aginners are doing? Seven states suing the government to overturn the act have their hands out for subsidies from the program.

http://news.yahoo.com/s/ap/us_health_playi…

Now for the corporations lining up for their share which btw includes those those Koch boys:

http://www.washingtonmonthly.com/archives/…

Shameless hypocrites.

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All I need to know if the Affordable Care Act is good is to identify the people who are against it. So based on who is fighting so hard to repeal it, I must conclude that it’s GREAT.

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We all should remember there is 2000 pages in this bill. One part, have one idea which, states that on 1/1/2014, an employer that provides health insurance to employees shall issue a voucher to each employee stating the value or cost of the health insurance provided. The employee then has an option to go to the state insurance exchange (another provision) and purchase their insurance, and pocket the difference if any. Of course, then the value of the vovcher becomes taxable income for the employee and he must pay income tax and SS. It could be though that the company just give an houly wage increase, pay the gov fine for not providing insurance and be out of the insurance business. There seems to be a lot of back doors here that in the end will eliminate the "legacy cost" that is spoken so much of in large business. We got it, time will tell if we live that long. To read more google health care vouchers

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Getting rid of that damn "donut hole", it is a major win. The $250 check helped but that was the same day I paid $330 for two scripts. Drug prices have been allowed to go up so fast that in year #1, I hit the "donut hole" in September. This year, with only one script addition and one existing going generic, I was in the "hole" in late April. Just came out the other side. As a retired state employee, we were forced to drop the state coverage which had similar tiers of coverage and no "hole" and go into the Bush "wonder".

That is one major correction to the existing healthcare issues before the bill passed. I know seniors who basically take their meds until they hit the hole and then wait to restart in January. Not the way to a healthy country and remember that the highest costs are in the last 30 days of life.

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Eureka, if I’m an Act Max for the Democrats, then you’re a John Boozman Republican. Truth is, I’ve actually thought so for a long time, now.

In fact, I’m not at all sure you weren’t HenryS. But enough of the name-calling you instigated.

A couple of questions for you, Eureka: Did you read Ernie Dumas’ column in the Arkansas Times a few weeks ago? You did? Then tell me, Eureka, which of the “Obamacare” benefits/advantages Dumas described would you so freely forfeit, all just to have things your way — as in nothing? Tell us why it is that you prefer an empty glass to a glass half filled.

I'll close on this note, Eureka: When you have a fourth of the knowledge that Dumas has about the health insurance reform legislation and the rules and regs being written to implement it, I might take you a bit more seriously.

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More straw, Durango. You keep looking anywhere accept the bottom lines I keep repeating. Most expensive just went up for the worst care from infant mortality to life expectancy in the developed world.

All the 'good' Ernie praises would be included and better if we just went to any of the countries models you listed or that I propose. So you and Ernie have fun spending way to much money to keep way to many without care at all.

You have fun cheerleading Democrats into victory, America into solvency, business into competitiveness, or your way through the pearly gates with a bag over your head with that one. It is you who seem to be cheering for another team. Oh wait... thank Goddess I am no longer a Democrat.

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My friend Durango, somehow your feathers were ruffled to the extent that you never addressed ES's argument.

His argument is COSTS. I'm glad you listed the intelligent plans the Swedes and Germans have. They are so UNlike ours it's not even funny.

Some of the cost-drivers of American healthcare have some brakes put on them. Others don't.

I attended a fine lecture in Rogers, AR by Hershey Garner, Md and Dr Robert Leflar, proff of public health. Together they likely know much more than Ernie.

Cost drivers for many items will be contained, namely physician's fees. But the BIG cost driver mentioned above was not touched...medications. And tell us who or what mechanism will be in place to regulate what insurers are allowed to charge?

Two big drivers, insurance profits and pharmaceuticals are unchecked. This makes no mention of other fees, like technology charges for services.

Just learned from a friend who's been living in Nepal for the past 7 years and does a occasional forays into Europe that the $44 inhaler I use daily sells for $2 in Nepal and about $4 in Europe. His wife uses the identical inhaler.

Just as local Mds discovered they can charge more for "tests" under Medicare rules there will be more tests under Affordable...Act, that is, until for-profit companies close the loop and mass confusion ensues between Medicare providers and A..A providers.

As mentioned, there were 130 poison pills included in the coming health care debacle.

The good side of the story is it's a beginning. Amendments can be added after Republics take over long enough to destroy everything and then real, long-term re-building America can begin. But first my money says we will have big collapse.

Others no longer need American banking services.

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eLwood describes precisely my own reason for finding all too little to celebrate in this legislation: "Demos had a majority in the House, held POTUS and had a simple, one vote majority in the Senate. Yet, a few of their own provided the poison pills to kill meaningful healthcare insurance reform. If the public OPTION had been insisted upon and fought for then reform would be heralded. Instead they let the Lincolns in the Senate dance with Republicans and add 130 poison pills to an otherwise good plan so that today there is no real reform.

Perhaps there's not very much to celebrate."

And so for the first time in my life, in the coming election, I intend to cast a vote for the third-party candidate. I know (and have used) all the arguments against doing that: I'll be helping elect the Republican I don't want in office; I'll be throwing away my vote; we need to reform the system we have from within by electing change-minded Democrats, etc.

The Democratic party no longer has my automatic allegiance. I'm very tired of being told things are going to change, that I count and that the hopes I have for real change count, and then being served up a stale dish of same old, same old.

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Well eLwood, some of my colleagues no longer accept Medicare as their offices have determined the costs of seeing those patients exceeds the revenue they can expect to receive. Driving those costs down is not likely to increase access to care, but place additional barriers. Access to care is going to be a burden for all of us. Add in 30,000,000 uninsured who receive care just as us baby boomers start to get sick and the current crop of docs are going to be swamped even as NPs and PAs pick up much of the routine care. Cut reimbursement and you may find the older docs like me walk away instead of working part time until 70. The younger docs have far more "balanced" lifestyles than us old farts and as a group adopt considerably less onerous work schedules. Current medical schools classes are more than half women which is great, but the problem is that female medical graduates work far few years than their male counterparts. Medical schools could turn out more doctors, but figure that is 10 to 15 years away at best.

None of that is to say anything except...........a manpower shortage is looming.


We, the country, screwed the pooch on healthcare reform.

There were four major cost centers that should be been reigned in:
Physcian owned diagnostic testing - MRI and CT primarily
Gross profiteering by Pharma - no excuse for Congress banning reimports!
Gross profiteering and cherry picking by insurance companies.
Costs generated by a medico-legal system unmatched anywhere in the world.

Had Congress seriously addressed those issues, we'd all be getting better care for less money.

They didn't.

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I'm in 100% agreement with you today Ol Doc. We've had 28 years of free-market government mostly by lawyers. I wish to thank you for your input. It's good to hear from professionals on the front lines.

Just as free-market gub-mint has had poor vision regarding the nation's infrastructure needs it's only matched by poor vision regarding the infrastructure that keeps us alive, medical professionals. However we must admit that for years your exclusive profession sought to limit its numbers. Now we're dumbed down enough that too many would-be APNs and RNs cannot pass the course work. One woman who owns a massage school where very basic anatomy is taught told me most of her new students struggle to pass what was considered easy 12 years ago. However, her new students are skilled with Iphone usage.

My pulmonologist must limit the number of Medicare patients seen, otherwise would need to close his doors. Fortunately he is co-owner of the testing center two floors below his office so that affords him the luxury of seeing a few of us old pharts.

In all fairness he has required lung function tests on me only 2x in 4 years. Is that too often to determine if my meds need adjusting? The test last year surprised everyone, including Md, to the extent that I would miss the incinerator by the predicted time. I've pre-chosen DNR.

Again, thank you for your post.
.

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Think things are bad now? Try this, from today's Salon. Michael Lind's stunning and sobering look into our future.

"How Caesarism came to America: Can we reform Congress in time to save democracy?"

http://www.salon.com/news/politics/us_sena…

"By the fourth decade of the 21st century, the new system was in place. Caesarism had come to America. Congress, with its own consent, had been relegated to the status of a marginal debating society. Most laws were mere enabling acts, delegating the executive branch the power to fill in the details. In practice the American Constitution of checks and balances among separate branches of government had been replaced by a new system of plebiscitary presidentialism -- a system of elective dictatorship, with free elections for the dictator every four years. Real power lay with the executive branch, not with the speaker of the House or the Senate majority leader."

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“The good side of the story is it's a beginning.”

► Precisely, eLwood. And that is where I’m coming from. For the life of me, I can’t figure why Eureka misses that crucial point. The needed amendments can be made whether or not the fool Republicans take over.

“. . I intend to cast a vote for the third-party candidate. I know . . . I'll be helping elect the Republican I don't want in office; I'll be throwing away my vote; we need to reform the system we have from within by electing change-minded Democrats, etc.”

► Yes, you will; yes, you will; and yes, we do, William D.

“. . some of my colleagues no longer accept Medicare as their offices have determined the costs of seeing those patients exceeds the revenue they can expect to receive.”

► So very true, olddoc. I hear it almost every month from friends who’ve just become eligible for Medicare or who are about to. The remainder of your post is absolutely spot-on. You’ve often brought to mind my own physician of 35 years who retired last year. I’ll never find another one like him.

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We don't expect free health care In the USA but, We should expect that paying twice as much as any other country in the world that we would at least have coverage. Forty Six million are not covered & we need more bang for our buck. If we had single payer coverage with what we are paying now we should have the best coverage in the world . We don't ---why?

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Hackett, you may not expect free healthcare, but you might be surprised by the millions in this country who do, not realizing that it's got to be paid for somehow; by taxes as in some of the countries listed above, or co-pays, or extra billings, whatever.

Can you imagine the outcry if you announced tonight that income taxes or sales taxes or property taxes or add-on taxes of some sort were going to be implemented or raised X% to pay for universal healthcare? Think about that one.

True that 46 million are not covered right now. Repeal the new law, and two years from now there'll be 49 million not covered. And two years after that, 51 million not covered. I can remember just a few years ago when "only" 37 million had no insurance.

Yet, people like Eureka want to repeal what we’ve just won. Guess he missed the Teddy Kennedy performance back in ’71 when Kennedy fought fang and claw the health plan Nixon introduced. It was a damned good plan.

It would have (1) guaranteed basic coverage, (2) required employers to provide insurance for employees, (3) handed out federal subsidies for the poor, (4) coordinated insurance for the self-employed, (5) created rural health clinics, and (6) would have established a network of state committees to set health insurance industry standards. His plan would have covered almost all Americans.

As I’ve posted before, Kennedy later came to regret his opposition to Nixon’s plan and called it a missed opportunity. One of his biggest political mistakes, he said. “We should have jumped on that,” he told the Boston Globe a few months before he died.

Then, of course, there was the Medicare catastrophic legislation that passed and was signed into law by Reagan, circa 1989. It offered all kinds of new benefits, including prescription drugs. But the AARP of all people raised hell, saying it would increase their taxes (see what I said above about raising taxes) and they kept on hammering away until the catastrophic act was repealed the next year.

Now, after having gone two decades without prescription drug coverage that the catastrophic act would have provided, Medicare Part D comes along with drug coverage. So, what’s happening? Lots of old people are now raising hell about Part D and the donut hole, and their out-of-pocket drug costs.

Too bad the 1989 legislation was repealed. They and eventually most of us on this blog would have been a lot better off with the 1989 legislation.

But, we never learn, do we? So, yeah, let’s go the Eureka route; let’s repeal Obamacare. Let’s start all over. Let’s “get it right this time.” Rather than build on what we’ve just gained, let’s just go back to zero with the health insurance boys in total control and wait another twenty or thirty years. You know, to get it right. Makes all kinds of sense doesn’t it?

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Durango My point was with double the expenditure of any other industrial nation we should have healthcare for everybody. There should not be a raise in costs or more taxes if we already pay twice as much as others. Instead a reallocation of costs spread among all the people & corporations & a single payer health care that covers all. I know it is a simple plan & almost impossible.

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Hackett, I don’t disagree that there’s enough healthcare dollars already in circulation to pay for universal care without raising taxes. We just don’t have the gumption or will needed to end our foolish ways and spend those dollars wisely. We’re so friggin’ wasteful. And lazy.

Forget the high premiums most of us are already paying and look at Medicare fraud and waste, for example. Everybody talks about it; but nobody does anything meaningful about it.

Some of the most recent figures I’ve seen were for 2007 when $835 million in fraudulent Medicare payments were identified and the government recovered only $55 million, or about 7%. I recently read that last year $36 billion (yes, with a B) in Medicare “overpayments” were made. “Overpayments” can be anything from flagrant scams to innocent billing errors, but there’s a heckuv lot of the former going on.

The problem, imo, is that hospitals, docs, and other providers/vendors are paid first and answer questions later, if asked, but in the overwhelming majority of cases, there’s little or no “asking.” Add to that the fact that Medicare’s private contractors who have actually identified fraud are notorious for sitting on the cases for months on end when they oughta be referring them to law enforcement.

To Grassley’s credit, he’s been raising hell about the impotence of Medicare’s fraud busters, and says we’re not getting our money’s worth. I could not agree more. Obama, too, has set a high priority on doing something about fraud and abuse, saying the wasted and stolen Medicare dollars could do much to offset the cost of universal health care.

We’ll see what Grassley and the president come up with, but color me very pessimistic about any success with curbing fraud and waste, since as I said at the beginning of this post, we don’t seem to have the will or sense to actually do it. Which brings us back to raising taxes which nobody wants to do. It’s a pretty vicious and stupid circle, don’t you think?

And we haven’t even talked about fraud and waste in Medicaid. I’d get on a rant about that this morning, too, but I won’t because my eyes are beginning to glass over and I suspect yours are, too.

So, I’ll quit by saying that were I king there’d be no fraud and abuse in the current government programs and one way or the other, we’d have a single payer system.

But, as king, I wouldn’t kill Obamacare before getting my own system operating. You know, like Eureka would. I’d build off what’s already provided by Obamacare. How sad for the country that I ain’t king.

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