What’s changing in health care? Stay tuned…

I just returned from Washington, D.C., after a week of intense training about the new health care law – what it is, and what it might mean for people in Northern New York, and the rest of the country.  The workshop was held jointly by NPR and the Kaiser Family Foundation (whose mission is to provide information about health care policy – and is NOT the same organization as Kaiser Permanente health insurance).

There’s been so much political wrangling over the health care law, it’s been hard for most people to understand what’s actually in it.  Turns out, the state of New York is a leader in getting ready to implement the law, which is scheduled to go into effect in January 2014.  Some states, such as Florida, are doing nothing to prepare.  Political insiders who spoke with us in Washington think these states are counting on the U.S. Supreme Court to strike it down, or for Mitt Romney to be elected president, and then repeal it.

In the coming months, I’m planning to report about what New York is doing, and what it will mean for people here.  One thing we learned was that for folks who have employee-sponsored health insurance, it’s not going to change much.  It’s the people on Medicaid, Medicare, and those with no insurance, who can expect some changes – new health care exchanges, and possibly a (subsidized) mandate to buy insurance.

But nearly everyone who spoke with our group of reporters in Washington about details of the law, also spoke with a caveat – no one really knows how the Supreme Court will rule.  The decision is expected sometime in June.

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25 Comments on “What’s changing in health care? Stay tuned…”

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  1. JDM says:

    “no one really knows how the Supreme Court will rule”

    Oh, I think Obama knows. I think Cuomo knows.

    They’re getting out in front of this because they know it’s going down.

  2. knuckleheadedliberal says:

    JDM are you saying the Republican appointed Supreme Court Justices have a pre-determined point of view?

  3. JDM says:

    khl: aren’t you aware that the Justices have already decided on this and are now preparing their written opinions?

    The Supreme court took a straw poll among themselves after the public hearings. They know what their peers are thinking.

    They will send letters back-and-forth to each other, but their minds are pretty much made up.

    The real question is “do you think Justice Kagan hasn’t told Obama the result of the straw poll?”

  4. PNElba says:

    I know that picture on the post is what we call a caduceus, but its actually not accurate. Please see:


  5. mervel says:

    How much is NYS currently paying to “get ready” to implement the new law? It looked like they had already subcontracted some huge contacts for experts to help the state help us.

  6. Larry says:

    If not much is going to change for people with employer-sponsored insurance then there’s really no point to this law, is there? Nobody wants to address the root cause of the problem: Doctors and medical institutions who charge outrageous, unnecessary and sometimes downright fraudulent fees and insurance companies who blindly pay the claims and then pass the costs on to insureds. The medical establishment and insurance companies in this country have a great scam going! We need to break the cycle that encourages unneeded, wasteful and unwarranted spending.

  7. knuckleheadedliberal says:

    I agree with Larry. We need to have a single-payer universal health care system in which the primary focus is on the medical needs of the patients and the players are paid fairly for their skills and education.

  8. Walker says:

    Larry, I’ve never had insurance that paid anything like the full amount– usually they pay something between 10% to maybe 75%, more commonly toward the low end, especially on hospital bills. The rest is just written off, meaning that the doctors and hospitals are overcharging by absurd amounts.

    Case in point: I’m looking at a bill I got a few years ago that shows total charges of $2915. BC/BS payed just over $700, I paid $158, the doctor wrote off $2031, based on his contract with the insurance company. Folks with no insurance would have been on the hook for the full amount.

    I’m not saying that insurance companies aren’t a serious part of the problem– they are. It’s generally conceded that they’re siphoning 20% off the top, and that’s not considering the doctors’ time and staffing costs dealing with them.

    But it’s absolutely cray what’s gone on in health care. The original 1929 Blue Cross/Blue Shield plan guaranteed teachers 21 days of hospital care for $6 a year! That was back when both hospitals and insurance companies were true non-profits.

  9. Kent Gregson says:

    I told my doctor that as a contractor I have to live or die on the amount of my estimate. I asked him why he could not tell me how much the blood test was going to cost. He said the system is not set up that way and there may be complications found along the way that would change the price. I said that when I do construction I always find complications, but I cannot change the price I said it would cost. To his credit the doctor admitted that his system was not fair. Medicine billing is totally open ended. There is no way to tell if you’ve already paid the total cost. Someone who you never met could send you a bill for services you didn’t know were rendered or wether they were actually rendered.

  10. knuckleheadedliberal says:

    Kent points out how our medical system has parted ways with the Free Enterprise System. The customer rarely has any knowledge about what a fair price should be for a service being provided. There is no price competition in the system, and in many cases the customer being treated is in pain or discomfort that prohibits them from making a rational decision. Sometimes the customer isn’t even conscious and sometimes the customer is in a life or death situation.

    Within the system that we have there is often no choice. Perhaps if you are very wealthy and can pay any bill out of pocket you have choice. If you are poor and don’t have health insurance you go to the Emergency Room and take what you can get. Even if you have a good health insurance plan your choice is limited by the providers within the system and by the tests and treatments the insurance company decides to cover.

    The system is set up to keep the customer ignorant of billing practices, best practices in treatment methods or even the relative skill of the providers.

    And all of that is thrown out the window if you live in a very rural area where you may not even have a doctor in your community.

  11. Walker says:

    Which is as good an argument for adopting a single-payer system as could possibly be devised!

  12. mervel says:

    It would be interesting to do so. Given the influence of the current medical lobby on both the Democrats and Republicans I doubt any sort of single payer system that did not really really pay out to this lobby would get passed. You can see their strength in how they manipulated this current bill, insurance companies will make MORE than they make now, Drug companies will also cash in, doctors look to be in the middle. If Obama can’t pull it off who will?

  13. mervel says:

    I think the first thing to do is start with medicare and medicaid. Just set much lower reimbursement schedules and re-do how they set reimbursements based on outcomes versus procedures. The government already has the power to really make a difference.

  14. Paul says:

    “Which is as good an argument for adopting a single-payer system as could possibly be devised!”

    According to NPR (and just about any source you check) a government run monopoly is as about as in efficient as you can get. Is HC an exception?

  15. Walker says:

    Paul, I don’t know what NPR source you’re referring to, but I think it’s likely that our current health system is far less efficient than even the worst government bureaucracies, so yes, I think it is decidedly an exception. The much-vaunted efficiencies of the marketplace clearly don’t apply in our current healthcare system. Why would you assume it is efficient? Look at our costs and outcomes in comparison with “inefficient” state-run systems in Canada and Europe.

  16. Pete Klein says:

    The best solution for all the health care problems in this country is for everyone to quit going to the doctor or the hospital. In short order, with no one to bleed for money, they will lower their prices.

  17. Larry says:

    I do not necessarily support a single payer system but I do believe we need to reintroduce sanity into a system that, for example, that allows providers to charge thousands for doctors who never meet the patient to “review” medical tests without that patient’s knowledge or agreement. They do so because they can. They need to be stopped.

  18. Paul says:

    “I think it’s likely that our current health system is far less efficient than even the worst government bureaucracies”


  19. Paul says:

    The reason our health care system is less efficient than it should be is that we have blended many “systems” together into a bureaucratic mess.

    Walker when you say “Canada or Europe” you are talking about many types of HC systems. I am sure that you understand that Canada and Germany for example have completely different HC systems.

  20. knuckleheadedliberal says:

    Paul: “According to NPR (and just about any source you check) a government run monopoly is as about as in efficient as you can get.”

    Huh? Is this one of those puzzels where you have to find the 6 things wrong with this statement?

  21. Paul says:

    Knuck, yes it is. But I do have a correction. I should have said PBS. Sorry for the error. Proceed with the puzzle. There must now be 5 left!

  22. Walker says:

    “I am sure that you understand that Canada and Germany for example have completely different HC systems.”

    Yes, Paul, I do understand that. Your point being?

  23. Paul says:

    my point? For example in Germany premiums are split between workers and employers and private insurance plans pay private doctors and hospitals. Hardly the single payer system that you suggest above?

  24. Walker says:

    Yes, Paul, Germany is the exception that proves the rule. They have universal health care not unlike the Obama plan, but it performs far less well than the French system:

    Germany has the world’s oldest universal health care system, dating back to Otto von Bismarck’s Social legislation in 1883. Currently the population is covered by a fairly comprehensive health insurance plan provided by statute. Certain groups of people (lifetime officials, self-employed persons, employees with high income) can opt out of the plan and switch to a private insurance contract. Previously, these groups could also choose to do without insurance, but this option was dropped in 2009. According to the World Health Organization, Germany’s health care system was 77% government-funded and 23% privately funded as of 2005. In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men).

    The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the “best overall health care” in the world. In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a figure much higher than the average spent by countries in Europe but less than in the US.

    Italy has had a public healthcare system since 1978. Healthcare spending in Italy accounted for more than 9.0% of the national GDP in 2008, slightly above the OECD countries’ average of 8.9%. However, Italy ranks as having the world’s 2nd best healthcare system, and the world’s 3rd best healthcare performance.

    The World Health Organization, in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study). The Commonwealth Fund ranked the United States last in the quality of health care among similar countries,[12] and notes U.S. care costs the most.


  25. Kent, The way medical billing works is that the government (Medicare & Medicaid) pay less than what it costs and private insurance companies negotiate lower rates. This leaves doctors and hospitals short of paying their bills so they make it up by charging the uninsured more. A kind of ‘redistribution of wealth’ but by private industry rather than government. The same thing happens with drugs. Ever seen those pill ads that say “Can’t afford your medication? Contact us at…” They sell the drugs at cut rates to the poor and make up the difference on the rest.

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