The true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.
Today, that bomb goes off.
Today, the Department of Health & Human Services issues the rules of what insurer expenditures will—and will not—qualify as a medical expense for purposes of meeting the requirement.
As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.
Here’s an example: For months, health insurance brokers and salespeople have been lobbying to have the commissions they earn for selling an insurer’s program to consumers be included as a ‘medical expense’ for purposes of the rules. HHS has, today, given them the official thumbs down, as well they should have. Selling me a health insurance policy is simply not the same as providing me with the medical care I am entitled to under the policy. Sales is clearly an overhead cost in any business and had HHS included this as a medical cost, it would have signaled that they are not at all serious about enforcing the concept of the medical loss ratio.
So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised?
Not a chance-and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it.
If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.
If you believe that the end of private, for-profit health insurance is some type of nefarious step towards a socialist society, then you might want to attend church this Sunday to mourn the loss of health insurers being able to worm out of covering the bills of a cancer patient because she forgot to write down on her application that she had skin acne for three months when she was a teenager.
Of course, those of you who fear the inevitable arrival of universal health care really shouldn’t be too fretful. There will always be a for-profit health insurance industry for those who want to pay for it. The only difference will be that those who cannot afford private coverage will also have an opportunity to get their families the medical care that they need.
Everyone wins-except the for-profit health insurers.
So now are you beginning to understand why the Republicans have been trying so damn hard to smear the ACA, and why, at the same time that health insurance companies were publicly supporting the bill, they were also secretly funneling millions of dollars to an anti-reform lobbying group in the hopes of sabotaging it?
They must have realized that President Obama, chess player extraordinaire, was positioning his pawns to put them in checkmate. And so he has.
Update: It looks like support for the Affordable Care Act is on the rise now that it has been held up by the Supreme Court. And the good news just keeps on coming.
Way to go President Obama! You have our backs and I promise to have your back come November. You make us proud.
ReplyDeleteI have his back. Go Obama 2012
DeleteI thought the "bomb" went off today, July 1st, but come to find out that article was written December 2, 2011 -- There are only 2 comments that are more recent than a month ago.
ReplyDeleteForbes! Holy shit (sorry Buddhists).
ReplyDeleteThis president really is Ninja. Wow, wow, wow. I will give what I can afford to this president.
Thank you, President Obama! No wonder the Republicans are having such a shit fit. The insurance company lobbyists are probably after all of them to get this thing stopped.
ReplyDeleteNow we all know why Mittens is saying he'll repeal Obamacare the first day he is in office. Americans are not going to want to give up their new insurance!!!!
Listended to a 'red' radio station in Anchorage, AK today and the announcer was spreading pure lies about what Obamacare is going to do to Americans. Sure are trying to scare the hell out of people and the majority of what was said was not true. Said the costs of medical care would going to increase, we are all going to be taxed immediately, all the kids had to 'have' shots to include HIV for babies even though they were not having sex!!! What crap!
People need to pay attention and obtain the facts as to Obamacare because the Repubs are going to continue lying about it until election time!!!
Ah, the magic HIV shot -- which does not exist -- for babies, for anyone! Just scare tactics.
DeleteAs for Romney becoming President of our country, rest easy. It isn't going to happen. He simply is not presidential material and everyone knows it now. The truth has come out.
Excellent catch. Thanks very much. Good news feels soooo good in the midst of all the wack.
ReplyDeleteIf President Obama wins re-election and ACA is fully implemented Sarah Palin's political obituary will be written with a permanent marker. Her aspirations to run in 2016 will be just for padding her bank account not anything serious. Her anyone but Obama, repeal ObamaCare and all the other ludicrous Palin statements will all be replayed right before her final asscension into the political history books.
ReplyDeleteadmittedly, I have been opposed, then when passed, indifferent to this bill because it mandates that people pay money to private for-profit corps who have fucked the people for decades. what you have posted here gryphen is making me take another look. I will need to look deeper, because of course this could just be another one of those "herding" tactics that makes something sound better than what it really is, but I will look further. thanks.
ReplyDeleteIt gets free loaders to pay what they owe instead of the rest of us fronting their bills with higher premiums, that's what it does.
DeleteIt's an important first step. My hope is that eventually this country will embrace universal single-payor healthcare. In the meantime, many wrongs are righted by this law. When the exchanges are in place in 2014, most people will be able to find a plan that they can afford. I am tired of the idiots who are whining that there's a "new tax" and I am equally tired of the idiots who are complaining that we did not get the "golden egg" of universal health care at this time. Obviously, since most Americans still wrongly believe that the very best health care in the world is only available in the US, time and refinements of the act will have to be brought in over time. At this point, Medicare functions quite well but it's been in place and morphing over the last twenty years at least. Quit complaining - we're finally on the right track with regard to health care protection.
DeleteThe more I learn, the more grateful I am for the Affordable Health Care Act. Love the right wing spin on it being a "Tax" and "mandate", and how our freedoms and liberty are being taken away.
ReplyDeleteWe tax cigarettes, alcohol, and fossil fuels heavily, we've been doing it for years. Why? To make unhealthy choices more expensive, and to help fund highway maintenance for the safety of all drivers.
Now that a Conservative leaning supreme court judge has ruled it's constitutional, he's not a nice person, just like President Obama (in their feeble estimations).
I LOVE his smile, ever the optimist. Looking at that picture just makes me feel that everything will be alright.
ReplyDeleteFor more information on AHCA click below. If you are a teabagger troll please ask one of your 5 year olds to read it to you.
ReplyDeletehttp://www.healthcare.gov/law/full
"...just like President Obama (in their feeble estimations)."
ReplyDeleteI hope you don't mind if I reword that a bit.
"Now that a Conservative leaning supreme court judge has ruled it's constitutional, he's not a nice person, just like President Obama, in the estimation of the feeble-minded."
There. That reads much better.
obama was against the mandate, before he was for the mandate
ReplyDeletepalin was a tool, before she was a dingbat
DeleteI joke! She's actually been both all along.
Thank God for ACA. I just donated to the president's re election campaign. I'm very ill and have not been able to acquire insurance beause of it. Now, I will be able to and get coverage for my husband too if we make it to 2014, but I am so glad I lived to see this happen. Justice Roberts is a brave soul who for once did not follow partisan politics. We must make sure Obama is reelected because the other side will move to destroy everything he has accomplished with ACA.
ReplyDeleteWhere's the like button?
ReplyDeleteThe Affordable Care Act will go down in history as the President's most important accomplishment. I told those Republican asshats that it would not be wise to nickname the act "ObamaCare", but they would not listen to me. In doing so, they have cemented his place in history. Their hatred and jealousy of this talented young man may yet have the effect of rendering their party irrelevant. Great strategy.
The best laid plans of mice and men often go awry.
I would also like to add that the choice of Kathleen Sebelius as Secretary of Health and Human Services was an excellent one. She is no friend of the big insurance companies, and has worked as hard as anyone to bring this legislation to law. It was not hard to notice that the Republican lawmakers never go after her, I think she would be happy to cut them down to size.
Obama/Biden 2012!
As a Canadian, I & others have posted for years that the US has to get rid of the 'for profit' insurers. That bean counters could decide whether you get treatment or not -- they looked at their bottom line profits & are beholden to their shareholders -- not you. AHA was the first step towards universal/single payer as it's a massive step from what you have to that but you're on the road!!
ReplyDeleteAs a Canadian, hear all the crap the Rethugs & anti-healthcare lobbyists have spewed for years about CDN & Europe systems -- the majority is BS. Expect the anti-healthcare ads to surface again -- this time without the moron FL Gov who was one of the biggest BS'ers about it under ads by 'Conservatives for Patient's Rights' (wiki page - interesting clicking on his wife's name to read his 'stock review' -- he's like Romney, very shifty attempting to hide things & avoid taxation) - As of March, 2009, Rick Scott had given about $5 million for a planned $20 million advertising campaign by CPR.
Canadians are not racing to the US for treatments. Some are sent there & it's paid for. Some treatments may not be available in Canada in that it's not something required often -- we don't have the population the US does. We may have to wait a bit for some treatments/specialist appts -- but so do you. The nightmare stories some talk about re waiting -- we have those in the country that are trying to push to get rid of our system & turn it into 'for profit'. Let's just call them what they are -- CDN rethugs!! Yea - let's change it to a failing expensive system!! Each Province has their own system. Like NH & MA has theirs. I visit another Province & require medical care - I'm covered.
I pay based on income calculated on my income tax submission. So, in that sense, we're 'mandated' to pay or you could say it's a tax! It's never been 'free' as many refer. I'll never lose my house for med bills; I pick my family dr & should I go to hospital emerg, I can go to any hospital -- not based on whether the dr/hosp is within the plan. Go to walk-in clinics instead of making appt with family dr. Dr decides/sets the tests/treatment/surgeries - no calls for insurer approvals.
The difference is, the cost is lower than yours, as the gov set costs as to what things are worth & payable to Drs/hosp. Hospitals are not 'for profit' with shareholders. Dr's offices - they're self-employed & bill gov for patient treatment.
Should I want additional, I can buy it from a 'for profit' or if I worked, most have additional insurance I can buy. Depending on policy, it would upgrade my hospital room, pay for glasses, have dental coverage.
There are a number of Canadians that read IM. If people had questions, I & I'm sure the others, would have no problem answering them as there is much misinformation said about healthcare. I laugh to hear the rethugs always refer to the European healthcare where it too is different in each country. It's like the Rethugs are afraid to refer to Canada in oh so many things. Guess they figure if they don't say or refer to Canada -- we don't exist north of the Lower 48 or they think we're part of the U.S. -- no thanks!!! Or we'll just go away!! Just don't fear 'universal' or 'single payer'!!!
A piece of trivia fact for you -- Kiefer Sutherland's grandfather, Tommy Douglas was the creator of the Canadian healthcare/medicare system. He was voted by the people in 2004 as the 'Greatest Canadian' - Born in Scotland in 1904 - he had died in 1986. Healthcare/medicare was created nationwide in 1966.
Thank you for sharing. My sister is navigating the Canadian system now from a small town in BC. The closest "big" town for cancer care for her is Kelowna. However, we have been meeting at the Coast (Vancouver area) since we have family in the vicinity, thus no hotel costs included for 3 weeks of radiation.
DeleteAs you mentioned above, she has additional insurance through her work that pays for glasses, dental coverage, and whatnot.
But she does not need to worry about losing her home, going broke, etc. just to get coverage for her cancer.
I, OTOH, must consider how my husband and I are going to handle his medical needs, particularly as his job may be going away and I am already on retirement. SS may not pick up the costs incurred in keeping him with us.
We have both worked out whole lives, paid our bills, paid taxes, given back to our communities - in other words, been productive citizens. But we could become financial burdens to society because of the health care system in the US.
Tommy Douglas is a hero in my eyes - and I believe that President Obama will also be remembered for finally helping ALL Americans out. The 1% don't need assistance, everyone else does.
Thanks for writing a great message about how the Canadian system works for all its citizens, not just the rich.
I pray for the day when we have universal health care coverage in the US. But it will take time. Insurance companies and medical associations have always had too much power in this country. But that is beginning to change. I think the ACA is the best beginning we could have given the ordeal that President Obama and the Democrats in Congress had to go through to get the law passed. Proof of what's hopeful about the law is the continuing lies and rage from the Republicans.
DeleteThank you, Anon @9:40 p.m. I have lived in Canada for over thirty years and am impressed by the universal coverage. Even served for a time on a local health council, made up of providers, consumers (like myself) and elected representatives. I was appointed, not through political pull, but because I applied and fit the criteria as a consumer advocate. Eye opening. Not one insurance representative was on the board - because they do not have standing in this model. Sure, there are private insurance carriers, like the one that covered me when I was working for a large company. (And they're just as bad as the American version. Trust me.) It offered extra benefits, like dental, prescription and eye exams/glasses. Basic health insurance is covered whether you're working or not. For those in low income brackets, there are grants for prescriptions and seniors are automatically covered. One thing I do not worry about: a catastrophic illness wiping me out financially. No worry either about pre-existing conditions. Abortions are covered as well. No big deal up here about that - yet. (Psst. Please don't tell the RWNJs about that.)
ReplyDeleteAnd as an American, I can still vote by absentee ballot. Obama/Biden 2012