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Would health care reform help you?

A special guest post by Barbara O’Brien of The Mahablog.


Many obstacles and stumbling blocks remain in the way of health care reform. After all we’ve been through, the House still may not pass the Senate bill, and/or the budgetary aspects of the bill may not get through the Senate reconciliation process.  Almost anybody could derail the thing in the next few weeks.

But just for fun, let’s look at what conventional wisdom says will be in the final bill and see if there is anything in it that will be an immediate benefit to people with mesothelioma and other asbestos-related disease.

It is likely that the final bill will provide additional funding for state high-risk insurance pools. Currently more than 30 states run such pools, which are nonprofit, state-sponsored health insurance plans for people who can’t buy insurance because of pre-existing conditions. The biggest problem with such pools is that, often, the insurance they offer is too expensive for many who might need it. Both the Senate and House bills provide $5 billion in subsidies for state high-risk pools to make the insurance more affordable.

Under the Senate bill, beginning in 2014, private companies would no longer be able to deny coverage to adults with pre-existing conditions, nor could they charge higher premiums for people with pre-existing conditions. Until then, the state high-risk pools could provide some help.

Closing the Medicare Part D coverage gap — also called the “doughnut hole” — is another potential provision that could help some patients with asbestos-related disease. The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and Medicare’s “catastrophic coverage” threshold.

For example, in 2009 Medicare Part D paid at least 75 percent of what patients paid for prescription drugs up to $2,700. After that, patients must pay for all of their prescription medications until what they have paid exceeds $6,154. At that point, the catastrophic coverage takes over, and Medicare pays for all but 5 percent of the patient’s drug bills. The final health care reform bill probably will provide for paying at least 50 percent of out-of-pocket costs in the doughnut hole.

You may have heard the bills include budget cuts to the Medicare program, and this has been a big concern to many people. Proponents of the bill insist that savings can be found to pay for the cuts, and that people who depend on Medicare won’t face reduced services. But this is a complex issue that I want to address in a later post.

The long-term provisions probably will include many other provisions that would benefit patients with asbestos-related disease, including increased funding for medical research. Although there are many complaints about the bill coming from all parts of the political spectrum, on the whole it would be a huge benefit to many people.

— Barbara O’Brien

Posted by on 03/10 at 04:28 PM
  1. The real problem--the meta problem--is that “insurance” is the wrong mechanism for providing health care. And it is the wrong metaphor for thinking about health care provision.

    Health care is not like auto repair, which you may or may not need. Everyone needs health care. So the whole risk/payout analysis is completely wrongheaded. Health care providers cant count on a population of “good drivers” who never “get in an accident.” And illness is not an accident, and there is no liable party to sue for damages.

    Posted by  on  03/10  at  10:10 PM
  2. So people with pre-existing conditions need to wait 4 years for this to kick in???

    I agree with Tony, we should not be providing health insurance. We should be providing lifetime health care as a fundamental right in the wealthiest country in the world. Just like education and social security should be part of the social contract.

    Posted by  on  03/11  at  01:45 PM
  3. Thanks Barabara and Michael. All the evidence I’ve seen is that it’s a good bill, relatively speaking given the realities of the Senate.

    Posted by Pete  on  03/11  at  02:24 PM
  4. Well, wait a minute.  Most of what we call health care is insurable - it’s not like education, food, or shelter.  The need for health care differs by individual, is not in the control of the individual, and, although it’s not predictable as to individuals, accurate actuarial projections for populations can be made.  Therefore, insurance is a perfectly reasonable way to pay for health care.  It’s not the only way, or even the best way, but for most of the money spent on health care, health insurance is not a “metaphor,” it’s genuine insurance.

    There are some aspects of health care that don’t fit well in the insurance model:  routine check-ups and provision of birth control, to name two.  For most people, what we call insurance for these is more a matter of employer subsidy.  But this is a small fraction of health care costs, and most of the money spent on health care really does result from insurable risk.

    Posted by  on  03/11  at  06:51 PM
  5. Insurance is first and foremost a social mechanism for sharing the risks of uncertain loss. So whatever we deliver will by definition be insurance.

    I counter-demonstrated (in favor of healthcare) Monday alongside a retired life and health actuary. I have 20 years in property and casualty insurance myself.

    In addition to healthcare, we need a disaster pool for hurricanes and earthquakes to augment flood insurance.

    You can call it pizza for all I care, but the key is sharing risk, not divvying it up into little bits. There are huge workers compensation pools that could be brought into the funding as well but they belong to trade associations and are - yet another tired metaphor - cash cows.

    The insurance industry isn’t as big as people think. Look at credit default swaps for goodness sake. The private insurance industry depends on investment capital and there are plenty of places safer to put your money than credit default swaps that somebody is pretending aren’t insurance or bonds.

    Let me also remind everybody that the Chinese government is one of the world’s largest reinsurers. A former president of Hartford Steam Boiler used to have a framed letter that accompanied a payment for a power loss in Jacksonville complaining that partial payment was going to (something like) “running dog capitalist military” forces that had rescued the hospital with ship’s capacity for a time.

    That happened over thirty years ago. The Chinese government may be even bigger now, don’tcha think? The point is that governments are part of the solution. Insurors don’t understand their own business to the extent that they are inadequate and don’t appreciate the fact. The hurt they lay on the American public is compensation for their own shortcomings.

    Posted by Bob Calder  on  03/11  at  07:40 PM
  6. Wow. A day after this post, which uses mesothelioma as an example, Merlin Olsen dies of mesothelioma.

    Coincidence? I think not.

    Posted by Jason B.  on  03/11  at  09:33 PM
  7. After reading this post I also surf on Merlin Olsen dies of mesothelioma. Found it more over tragic and shocking.

    Posted by Vibration plates  on  03/11  at  11:26 PM
  8. Would health care reform help you?

    Not really.  The proposals in the bill that would have helped me have already been thrown out.  Thus, i, and many others like me, will just have to wait out our next couple of years for the full Medicare to kick in.

    Posted by  on  03/12  at  06:27 PM
  9. Barbara,

    Are you saying the subsidies to the state pool plans will begin this year?  Are you sure this is starting this year, not 2013 or 2014 (depending upon the House or Senate bill being signed by Obama)?

    I ask because I have yet to see anything that benefits people start in the year of the passage of this bill.  Still, my disgust about this bill remains because even here, it is simply a subsidy to the insurance company that is still willing to cover you.  This plan at best is the Democratic Party’s version of the Medicare Part B debacle that has no cost containment and represents a giveaway to the privateers who lord it over the people of our nation, particularly those of us with pre-existing conditions that are rather severe.

    Right now, I continue to agree with Dennis Kucinich (D-OH) that this bill is a hoax, a giveaway to insurers and an abject failure on the part of the leadership of the Democratic Party to the insurance companies and Big Pharma.  I see no future for Medicare for All unless you push for Medicare for All.  Reid, Pelosi and Obama need to go to negotiation school.  If they wanted a compromise, they have to begin with Medicare for All, which is the best argument for reform in the first place. 

    Just imagine a debate between Anthony Weiner or Alan Grayson against anyone who is not in favor of Medicare for All where the actual plans are debated--not some nonsense about being “realistic” or “political considerations.” And the reason political considerations are nonsense is that when you argue with your best arguments first, and realize that Medicare for All does not have to be “explained,” you quickly see it is the insurance companies and Big Pharma who have to start arguing the Byzantine compromises, not you.  Then, you get much better legislation than this monstrosity that will only cause people to hate a “government” solution, which plays perfectly into the hands of Republicans, private insurers and Big Pharma.

    Posted by Mitchell Freedman  on  03/13  at  10:43 AM
  10. The painful rhetoric about “do-overs” is all about delaying universal healthcare the citizens of this nation desperately need.

    The neo-conservative tactic with climate change and the tactic with education reform is all about giving their backers time to position themselves and not about improving anything for anybody save themselves.

    If you are serious about having a rational conversation, you HAVE to let the paranoia go. Big Pharma, Big Insurance, and Big Energy are just players in the game whose influence should be clearly labeled. What would you think if every time Pelosi came on TV to talk about healthcare, some text identified her as having got less than 5% of her contributions from insurance and the Fox-chosen Republican of the day with text indicating his health donations way over 40%? Now that’s transparency. The only thing better than that would be an application that could automatically goose Roger Ailes every time he ordered his famously incompetent graphics department to put up wrong text.

    Posted by Bob Calder  on  03/13  at  12:33 PM
  11. I have slowly become a subscriber to the “just pass the bill” camp. Contains multiple disappointments and I am concerned about the rate of enactment, but, my god, if you can’t turn the fear of pre-existing condition denial (which crosses ideological lines) into a winning story…

    Posted by  on  03/13  at  07:30 PM
  12. have slowly become a subscriber to the “just pass the bill” camp. Contains multiple disappointments and I am concerned about the rate of enactment, but, my god, if you can’t turn the fear of pre-existing condition

    Posted by Cheap Evening Dresses  on  04/12  at  08:00 AM





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