"PUBLIC HEALTH INSURANCE OPTION.—The term ‘‘public health insurance option’’ means
the public health insurance option as provided under subtitle B of title II.
I think Senator Specter has it mostly right. The town hall sessions with screaming people are not representative of the people of the country. (click here) His town hall sessions were completely shameful. There were people there that acted as if they were persistent enough the Senator would have to speak the words they wanted to hear. It was a beautiful moment when after being brow beaten by a participant in the town hall session he stated, "I won't sign a health care reform bill that adds one dollar to the deficit." The brow beater expected a groveling explanation after his fit, what he got was sanity. Didn't expect that.
I mentioned yesterday the particulars of 'cost sharing' in that an individual's maximum would be $5000.00 and a family's maximum would be $10,000.00. I should have listed the definition that appears on page 8, lines 11 and 12 and 9, lines 1 through 3.
COST-SHARING.—The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services.
So that is the limit on any 'fees' a health insurance company can apply to an insurance policy. It is important to address cost sharing because it limits today and in the future the extent a subscriber will have to pay. It makes it reliable. Cost sharing is necessary to contain the price of health insurance, but, also to deter abuse. So, these are additions to the cost of the health insurance coverage itself, such as deducibles and copayments no different than most policies that are employer based today. The primary differences are the limits on cost and the lack of cost of preventive care. Most folks won't notice any changes in their coverage or costs except for the lack of charges on preventive care and new limits on their copay or deductible responsiblity. Most folks will want to keep their current coverage, but, with greater assurances that costs will not increase in the future.
I wanted to be sure I mentioned that and didn't gloss over it. I think it is important for Americans to realize their legislators are making definitive moves to construct a health insurance reform that is realistic and not idealistic. The 'tone' among the 'angry' in the country is that this is 'another' big Democratic spending bill.
You know, they are trying to 'sterotype' the legislation as a big spending program that will cause all kinds of problems to the country's deficit. That is not the case. The bill sets limits on what insurance companies can expect from their members in the way of 'out of pocket' expenses. But, the bill also holds accountable Americans to carry their own weight in subscription fees and copays, etc. up to the limit the law allows.
The legislation for Health Care Reform is not a give away program, however, it will take care of people and allow for expenses beyond the 'preventive medicine' that is to be without cost. It allows for reasonable cost sharing of services that are needed if diagnosis require same. The legislation is no joke and should be taken seriously. We need this in this country to 'STABLIZE' a grossly unstable industry that robs people of their right to treatment to enhance their profitability. This bill will require health insurance corporations to treat their members with respect and not as if they were chattel.
With that reality comes the understanding, at least from my perspective, as to why there needs to be a public option. We don't want health insurance companies forming cartels and acting in unison against the citizens of the USA so to effect increased profits. A Public Option hinders such exploitation and keeps costs reasonable.Changing the subject just a bit is the 'idea' of portability of health insurance coverage. No. I don't see that any health insurance company should have a corner on the market. As things stand now, each state has their own companies that provide coverage to people. That is not a bad idea. The differences will become more homogenous with the passage of federal laws, but, there is no reason for any one company to hold the entire market in one state while conducting business in all fifty. That will remove competition. Not only that, but, if everyone bought health insurance from a South Carolina company it would reek havoc with economies on other states where companies would be closing their doors and laying off workers. The entire delivery system would be bogged down by only a few insurance carriers. I do not believe in cross border insurance reform. I don't believe portability is a good idea. It will slow down care and damage economies. Just for the record.
I also wanted to mention this 'thing' the press has against Hillary speaking her mind while in Africa. I thought she was great. It was a demanding schedule, but, I simply loved her remarks about the 2000 Election in the USA. Is there anyone besides Walker Bush and Jeb that can state it was a fair election? I mean really. The Secretary of State of Florida, what's her name, disenfranchised thousands of black voters before the elections. She did it deliberately to effect the vote in favor of Walker Bush. Somebody had to say it. I loved the moment Hillary took to 'example' the way a democracy can be derailed by corruption at the highest levels of government. I love that Al Franken is a Senator, too. You know what I mean?After realizing there are now limits to copays and deductibles and all that mess the government has taken the 'cost' of membership seriously and doesn't leave it to chance. Page 21, beginning with line 1 there are "Insurance Rating Rules" that will help the health insurance companies ask fair market prices for their services.
On page 24, beginning with line 4 the government states that in order to be called a health insurance company there has to be a sufficient provider network. As example, with a health insurance company named Great West, the nearest primary care physician might be seventy miles away. That's ridiculous and places undo expense on the insured to find an 'in network' primary care physician. Well, that mess is going to stop or the consumer has the right to find other insurance even with pre-existing conditions.
On Page 24, line 17 the bill starts to address an understanding of establishing 'value' and 'lower premiums.' It is based upon a medical loss ratio that insures the company is meeting expectation of its subscribers while providing for reasonable costs to their members in the way of subscription costs. There will be entities within the government to assist in that reality. If it is found the insurance company is charging too much for their actual loss by its enrollees there might have to be an annual rebate of costs. Imagine that, a healthier group of enrollees that didn't occur the costs the company anticipated and actually provided a lucrative bottom line for the year. Well, those savings would be passed on. That's how I read that one. So much for exploiting the American consumer based on their wellness. It keeps a check on costs in the face of better health of the insured. Contains costs to consumers.
See the costs to Americans isn't going to be served 'straight up.' The bill provides a 'dynamic' of cost to care. It is a very fluid bill whereby people that are well actually will be rewarded in their premiums. It's interesting. The bill is a living dynamic. There are no hard and fast costs here EXCEPT where maximums will apply. This bill is not an easy spread sheet kind of thing. There are a lot of aspects to it that are as dynamic as their subscribers. It's pretty cool stuff.
It's nearly 11:00 PM my time, so I think I'll end it for tonight and pick up again somewhere around page 35 if there is anything significant to note.
Until tomorrow.
