Fee-for-Service (FFS) Plans (non-PPO)
Fee-for-Service (FFS) Plans with a Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
HMO Plans Offering a Point of Service (POS)
Consumer-Driven Health Plans (CDHP)
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
High Deductible Health Plan (HDHP)
A High Deductible Health Plan is a health insurance plan in which the enrollee plays a deductible of at least $1,150 (Self Only coverage) or $2,300 (family coverage)
Last night's Colbert Report had segment on GOP delay tactics with quotes from Olympia Snowe and Pat Roberts...
Olympia Snowe:
"...I do believe that the American people are rightfully entitled to see exactly what we are doing, what we are legislating, words matter..."
Good to know, but how come your staff is so good at evading any and all questions?
Pat Roberts:
"The thing I'm trying to point out is, we would at least have 72 hours for the people the providers have hired to keep up with all the legislation that we pass around here, and the regulation we pass around here, to say, "Hey, wait a minute, have you considered this?"
Good to know someone's got the providers and lobbyists' back.
And good to know they pass so much legislation and regulation that the lobbyists can't keep up... what exactly is he referring to?
(Kid's are stupid. Even worse are the adults that believe the bullshit from Glenn Beck, et. al. - from the diries - promoted by Gerald Weinand)
Below is a transcript of Jon's explanation of the video's origin. Followed by the actual clip; the school video portion begins at the 3:30 mark in the video - but it's worth watching all of it!
[It was] One school in NJ, Obama had nothing to do with it. It occurred during Black History Month just after the inauguration. It was part of a program saluting other presidents as well, and parents were notified of the lyrics beforehand. And there were no complaints before the show, during the show, or after the show. - Jon Stewart on The Daily Show
And that's why Jon Stewart is the "Most Trusted Name in News" today.
AKA: Kay's cure-all for the masochistic insomniac.
Did you know that it's illegal for an advertiser to make false, deceptive or unfair claims when trying to sell you toothpaste? Did you know that's it's not illegal to make false, deceptive or unfair claims when trying to sell you a political message?
I'll use this ad, First Maine Yes On 1 Ad, to analyze how the truth in advertising laws might pertain to the claims made.
If Stand for Marriage Maine was selling you toothpaste with this degree of deceptive practice, there's a good chance they could face charges of fraud, and you could always change toothpastes. However, when selling politics that could affect the lives of thousands who have no other recourse under the law, it is perfectly legal.
According to the FTC, advertisers are to follow three rules under the Federal Trade Commission Act. - Advertising must be truthful and non-deceptive.
- Advertisers must have evidence to back up their claims.
- Advertisers cannot be unfair.
What makes an Ad deceptive?
According to the FTC's Deception Policy Statement, an ad is deceptive if it contains or omits any information that:
- is likely to mislead a person acting in a reasonable manner.
- is "material." meaning information important to the decision making process.
The FTC determines an ad is deceptive using a few steps and tests. First, addressing the "reasonable consumer" clause by looking at the ad in context. All words, phrases and pictures are taken to together to determine what is being conveyed to the consumer.
The FTC considers both "express" and "implied" claims to be pertinent. And under the law, advertisers must have evidence to support any claims made, whether they are express or implied.
The FTC considers what the ad does not say. Any failure to include information that leaves a consumer with a mis-impression is deemed deceptive.
The FTC considers whether any such claims are "material" - meaning that they are important to the decision making process.
The FTC looks at whether there is sufficient evidence to support claims made in the ad.
Political speech is not held to these standards. It is deemed to be necessary to a healthy democracy that the broadest interpretation of the right to free speech should be applied to political speech. I agree, but I'd prefer that the allowed latitude stop short of perpetrating fraud.
Just yesterday, Harvard Medical School released a study that shows nearly 45,000 people in the United States die each year because they don't have health insurance. [1]
With new reports coming out every day about insurance companies trying to increase their profits by dropping patients after they get seriously ill and classifying cesarean sections and experiencing domestic violence as "pre-existing conditions," these devastating numbers are bound to grow unless we act. [2]
Thanks to all of you who took action this week to raise the issue of domestic violence as a "pre-existing condition" in eight states and Washington, DC. You emailed and called, and people are taking notice. Below are just a few of the things you made happen this week:
1. Rep. Diane Watson (D-CA), a member of Rep. Kucinich's Subcommitee on Domestic Policy, submitted questions and a written statement on the issue. Rep. Watson wrote:
I was especially horrified to learn that in 8 states and the District of Columbia, insurance companies include domestic violence as a pre-existing condition. With 20 to 35 percent of emergency room visits made by women a result of domestic violence, I can see how this morally appalling practice makes sense for insurance companies trying to spend as little as possible. What I cannot understand is how we can consent to such practices continuing.
She included the following questions to insurance executives:
Q: How do you justify denying coverage to victims of such crimes when they need them the most, and then indefinitely thereafter?
Q: Without being legally obligated to do so would you commit today to permanently stopping this discriminatory practice?
2. First Lady Michelle Obama mentioned the issue of domestic violence as a "pre-existing condition" in her speech on women and health care today.
3. MSNBC shows "Countdown with Keith Olbermann" and "Dr. Nancy" both raised the issue on their shows this week.
4. The insurance commissioner in Mississippi demanded that classifying domestic violence as a "pre-existing condition" immediately be made illegal in his state.
Today I called the DC offices of Rep. Michaud, and Sen. Collins to ask a few questions.
First I asked each if they believed access to health to be a right of all Americans.
From Rep. Michaud's office: I spoke to a nice young man named Josh, who was the congressman's intern.
He gave me a fairly long-winded answer that was non-responsive to the actual question. I asked if he had political aspirations, and he said yes. I told him he was a making a good start. He agreed to ask the congressman to get back to me on that question.
From Sen. Susan Collins' Office: I spoke to a young woman named Alex, who when I asked about her job, said "I answer phones and stuff." I asked if she had a job title and she said no. So I asked to speak to someone who could answer questions regarding health care reform. She said she could help me. I was less than confident in veracity of that claim, but chose to keep that fact to myself.
So I asked my first question: is health care access a right? The response was that the senator "has no official stance on that issue." Suddenly, I had much more faith that Alex could answer all my questions - as long as I didn't expect any actual substance and/or relevance in the answers.
This study found that medical bills accounted for 62% of all bankruptcies in 2007. Additionally, the study found that of all medical bankruptcies, more than 3/4 -- 77.9% -- were people who had health insurance coverage.
The administration's logic versus the industry smear machine.
The health care "debate" is rife with the rhetoric of fear. It's punctuated by emotionally charged lies, mis-directions, and obfuscations. One thing it is not is a debate. There is no room in debate for "they who are the most terrifying win." A debate is about logic, and well-reasoned and persuasive argument and rebuttal. But mostly, it should be about truth. Philosophies can vary, but the truth should remain the truth. That's why we do need a "fairness doctrine."
Perhaps not the same one that the FCC deemed as having a "chilling effect" on political speech, as opposed to enabling it, about 20 years back. I see no realistic method of achieving the old goals of advising ahead of time those with an interest in the speech and allowing a rebuttal for every instance of political speech broadcast on any medium. This would indeed have a chilling effect on political speech, as well as being a logistical nightmare.
I ask only that we hold political speech the same standards we impose on all other forms of broadcast and print media news -- an obligation to tell the truth. No slander, no libel, and no lies. No more passing off unverifiable rumor as news using the "some people say" or "question mark" dodges. All public officials should be held to the highest standard of honesty in their discourse. They should be required to have evidence to back any and all claims, and this evidence should be readily available to the public.
If you want to say that "this amounts to a government takeover of health care," you need to prove it, and explain why it's a bad thing for the American people. If want to say that "single payer systems are rife with problems, such as rationing and the unavailability of the latest medical technologies," prove it. Not with anecdotal evidence, but with an honest assessment and due diligence.
If you want to say that "this would lead to a collapse of the private insurance industry," prove it. And while you're at it, tell the American people the truth about the private coverage you're defending. Explain the Medical Loss Ratio, and how it induces the rationing of care. Tell the American people what exactly these companies add to the value of the economy. Tell them how H. Edward Hanway makes more in a one day than the average American worker makes all year, and his primary responsibility is making sure Cigna is not spending "too much" money on health care. Then explain why this not a conflict of interest between company and consumer.
Reading the text of the America's Affordable Health Choices Act of 2009
An Example
For (at least the hope of) clarity, this is one of the easiest examples I could find.
The quest to find the definition of "Acceptable Coverage"
1. Establishing the requirement:
Sec. 401.(a) Amending Internal Revenue Code of 1986, Part VIII (Subpart A)(Sec. 59B)(d)
12 ''(d) ACCEPTABLE COVERAGE REQUIREMENT.-
13 ''(1) IN GENERAL.-The requirements of this
14 subsection are met with respect to any individual for
15 any period if such individual (and each qualifying
16 child of such individual) is covered by acceptable
17 coverage at all times during such period.
18 ''(2) ACCEPTABLE COVERAGE.-For purposes
19 of this section, the term 'acceptable coverage' means
20 any of the following:
2. Naming the requirement:
Sec. 401.(a) Amending Internal Revenue Code of 1986, Part VIII (Subpart A)(Sec. 59B)(d)(2)(A)
21 ''(A) QUALIFIED HEALTH BENEFITS PLAN
22 COVERAGE.-Coverage under a qualified health
23 benefits plan (as defined in section 100(c) of
24 the America's Affordable Health Choices Act of
25 2009).
3. Defining the requirement:
a. Off we go to section 101(c)
3 (1) ACCEPTABLE COVERAGE.-The term ''ac-
4 ceptable coverage'' has the meaning given such term
5 in section 202(d)(2).
b. Off we go to section 202(d)(2)
6 (2) ACCEPTABLE COVERAGE.-For purposes of
7 this division, the term ''acceptable coverage'' means
8 any of the following:
9 (A) QUALIFIED HEALTH BENEFITS PLAN
10 COVERAGE.-Coverage under a qualified health
11 benefits plan.
What did we learn so far? There's a requirement for "acceptable coverage" which can be satisfied by something called a "Qualified Health Benefit Plan." However, not knowing what a "Qualified Health Benefit Plan" is makes this knowledge somewhat less than helpful.
We have also learned why this thing is 1000 pages long... anyone notice that we're going in circles.
Where:
Qualified Health Benefits Plan = QHBP
Accceptable coverage = AC
This is simply as I can say it:
We require AC - where AC is defined as having a QHBP - where QHBP is defined as having coverage under a QHBP
Under Sec. 401. of the so-called "America's Affordable Health Choices Act of 2009'' we will have no choice. That is no choice but to involuntarily finance this disaster. This section amends the Internal Revenue Code of 1986 to apply a 2.5% of Adjusted Gross Income (AGI) tax on any individual not covered by "acceptable coverage." They have a list of what constitutes "acceptable coverage," which, for most of us, includes buying a benefit plan from the bill's so-called "exchange," by keeping your current insurance if this coverage deemed "acceptable," or by qualifying for Medicare and/or Medicaid. This tax can be doubled if the uninsured taxpayer has a "qualifying child" dependent without "acceptable coverage."
This amounts to about $1,125.00 per year for the approximate U.S. median income for an individual and $2,250.00 per year for those at a median income with an uninsured qualifying child. This tax is NOT reducible by tax credits of any kind. Nor does this tax buy you any insurance coverage, it merely punishes you until you give in.
Further, it seems to say that insurers will be required to issue "proof of coverage" papers to each person they cover. Which will be required for tax purposes to show proof of coverage. Any one besides me starting to feel like an automobile?
This a travesty of epic proportions! Our representatives have the nerve to tell us they won't give us a single payer system, and in many cases not even a strong public option. Why? Because it will tank the private insurance industry with unfair competition. You gotta be kidding me. They have no compunction whatsoever to force us to become customers so they can save "free market" competition?
*Note: this document is nearly impossible to read with any clarity because of the constant referencing to other sections, sub-paragraphs, etc. for definitions and related provisions. This is excessive to the point where without a system of hyperlinks to the various references many paragraphs are essentially meaningless without tracking them all down manually. The real pisser is they include both page and line numbers, but don't use either for references. I did my best.
I received this email from "The Pen," a netroots activist group.
OK, we just got it a big new batch of the "Single Payer Health Care" caps, so if you had requested one already yours will go out tomorrow first class. And if you haven't, here is a direct link to a page where you can get yours. Whatever you can afford is good enough for us. We just want to get the message out.
Folks, we really need to have a talk. When you hear lunatic talk out there (mostly trial balloons really) like Congress doesn't even think it can pass a weak joke of a public option, there is only one reason. None of us are doing enough to speak out. We need more people to call their members of Congress. We need more people out there wearing their "Single Payer Health Care" caps. It's just that simple, we MUST speak out to win.
Again, here is the link to our phone lobby page on HR 676
"Of all the preposterous assumptions of humanity, nothing exceeds the criticisms made on the habits of the poor by the well-housed, well-warmed, and well-fed." -- Herman Melville
You know those emails you sometimes get? The ones wrapping political views in cute or inspirational stories? For example, the grasshopper and the ant story - but instead of the original ending, it ends with the do-nothing grasshopper warm and fed, and the hard working ant out in the cold. All because of taxes on the ant and welfare for the grasshopper. Just enough truth in there to make you think.
Ever notice the content is overwhelmingly conservative in nature? I can actually remember the one, out of hundreds, liberal themed email I've gotten in the last year. It attacked country singer Toby Keith for, if I recall correctly, being racist and supporting "lynching." All because of some "tongue in cheek" song lyrics about the merits of "eye-for-an-eye" justice. Thing is, it was patently false unless you really wanted to see something to complain about, and therefore, it was ultimately ineffective as rhetoric.
The health care reform debate of late has me thinking a lot about perceptions. It seems to me that so very many of us want the same things, but our perceptions lead us down different paths. I am fond of telling people who disagree on any subject, and use their disagreement to pass judgment, that all points of view are equally valid -- Einstein proved this conclusively. And so he did, but it occurs to me lately that those perceptions, to be truly valid, must be based in truth. Too often they are not.
This not the fault of the point of view, nor of the person viewing life through it, but rather the fault of an acceptance of disingenuous rhetoric. I say disingenuous, rather than untrue or false, because the rhetoric I speak of is never entirely untrue, but instead, cleverly designed to lead one to false conclusions. To my mind a much more dangerous ploy.
In the current climate of the health care reform debate, it seems like all our questions are motivated by fear. Undoubtedly, this is an effect that some with a vested interest in maintaining the status quo are working to achieve. They seem to be quite good at their jobs. At this time, however, I would like to ask you to imagine what it might be like when we implement needed reforms. Instead of asking what might reform do to us, imagine asking what reform will do for us.
I'm a frequent correspondent with my congressional representatives, and I've long known that it's common practice among members of congress to lump such correspondence into categories and send out canned position papers as a reply to such inquiries. Recently, I conducted an experiment to see what would happen if one had questions about the content of the position paper. In my first attempt, I used the same channel as the original inquiry - the congress member's web site email form. I had wondered if, and truth be told fully expected, that I would get a copy of the exact same position paper. I was right.
This led me to ask the question: Why do lobby's and lobbyists command the level of influence they do. Is it solely a matter of campaign money and revolving door accessibility? Or is it, perhaps, something deeper?
Thank you for sending a copy of the position paper you sent me last time I asked questions regarding health care reform. What, exactly, do I have to do to get my questions taken seriously?
I spent a great deal of time and effort to engage your office in a serious debate on an issue that closely affects me and my family. To have my thoughts simply lumped in a category and sent a canned reply is unacceptable. I deserve better. My family deserves better. The American people deserve better.
So please, let me know what it takes to get your attention. Do I have to register as a lobbyist? Start a PAC and contribute to your warchest?
Don't you see - this is exactly why you are so out of touch with the people of Maine and the American people. Your world begins and ends inside the beltway.
Note: This was an expected development, but still somehow very disappointing.
I'd like to talk to you, once again, about health care reform. I have decided to include each of you in all my future correspondence, and I would welcome any reply that each of you care to make.
Do you believe the following words to be true?
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just Powers from the consent of the governed, - That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness."
- Declaration of Independence
I believe they are not true. Though written and signed by men of great courage and foresight, they still failed. At that time, they failed include more than 50% of the population.
I believe these words have slowly become more accurate over the years. Today they include most of the population, but not all... so these words are indeed more accurate, but ultimately they are still not true. We have failed to fully realize what Lincoln called "our Grand Experiment." By which he meant a true representative democracy, or as he put it "a government of the people, by the people, and for the people."
Why point this out? What does it have to do with health care reform? Everything. Like it or not, and most don't like it, the insurance industry is a form of government. A government accountable, not to the people, but only to profit.
I'd like to talk to you, once again about health care reform. I have decided to include each of you in all my future correspondence, and I would welcome any reply that each of you care to make.
At this time, I'd like to ask a very specific question: Do you believe health care to be a fundamental right of all Americans?
Some interesting and excellent ideas on how truth and "framing" are not mutually exclusive properties, and how language can make your message resonate with people, and therefore all the more powerful.
Sen. Snowe, you recently took a walk in Bangor, and talked with some people about health care. First, a sincere thank you for making yourself available. It means a lot to us.
I found myself intrigued by the Bangor Daily News coverage of the event. Here is an excerpt of a conversation with Dr. Kathryn Bourgoin:
"The senator, as cool as anyone could be on a 90-degree day, agreed that Medicare has worked well for the nation's seniors. "But, I'm not as confident that government can run an entire system," Snowe said." - Snowe talks health care on Bangor walk; The Bangor Daily News, August 20, 2009, By Eric Russell.
Interesting perspective, to say the least, since you seem to have the utmost confidence that, with a little reform, the private sector can run an entire system just fine. How is that even possible? It defies all logic.
Please.... please... PLEASE, take off your ideological blinders that tell you the "free market" works best in any situation, and look at the evidence.
Medicare has a long, successful track record, as you have admitted, an overhead of 4%, and the person running it makes $150,000 a year.
The private sector insurance companies, on the other hand, have an average of 30% overhead, and an average CEO salary in excess of $10,000,0001. These companies preside over the most expensive system in the world, we pay 50% more for our health care than the next closest industrialized country, and we pay that premium for a quality of service that ranks 37th in the world, and dead last among the top 19 industrialized nations2.
Great Britain has government run health care, and spends just 6% of it's GDP on health care. The United States spends 17% of the GDP of the largest economy on the planet, yet the WHO ranks Great Britain's system 18th in the world compared to 37th for United States2.
Afraid of rationing? Try getting into an emergency room in any U.S. city, on any given evening. In his book, Sick: The Untold Story of America's Health Care Crisis - and the People Who Pay the Price, Jonathan Cohn tells the story of a 55 year old Boston woman with heart disease. One evening at 4:35pm, following her collapse and a 911 call, the responding ambulance was turned away, due to over-crowding, from the emergency room of the closest hospital [within 5 minutes] equipped to deal with her condition. She was re-routed to another nearby hospital whose trauma team did not have the means to perform the life saving procedure she required. By 7:03pm that evening, she had died.
Why the crowding, and hence the rationing? Because the under-insured and uninsured have no choice but to go to emergency rooms for any treatment they need. You see, to have a regular primary care physician and office visits, they pretty much insist on having insurance and/or immediate payment. While emergency rooms cannot, by law, refuse emergency treatment. So these people literally have to wait until a condition becomes an emergency!
Why is this true? Put simply, so H. Edward Hanway (Cigna) can retire with a $73 million golden parachute1, and Ronald Williams (Aetna) can make $18.6 million a year1. What do we get for paying this exorbitant compensation? They develop better and better ways to raise premiums, deny claims, exclude the sick from coverage, and purge customers who actually, you know, use the insurance to get health care (the audacity!). Also known as making a profit in a free market, but yeah, Senator, big government is the problem.
Senator, what exactly, considering the above, makes you so confident in the private insurers? Your reform? Your oft-touted SHOP Act doesn't even ban discriminatory practices such as pre-existing conditions. Fostering competition? Your bill fails there too, Senator, a co-op for shopping? No matter how many co-ops you form, there are still only 8 major players, and they don't need your co-op as badly as you need them... According the economics I studied, that still leaves them in the driver's seat on pricing.
What makes me so sure? Because some states, like Maine, already have consumer protection laws that these companies don't want to deal with... so they just don't offer insurance here. What's your plan on that?
Seriously, what is your plan? Since the Finance Committee is keeping the details of their plan under wraps (somewhat understandably, I admit) during negotiations, we really don't know anything but the broad strokes. According to the Washington Post, It will cover an estimated 94% of Americans -- eventually. Here's an interesting quote from article: "The Finance Committee coalition is seeking compromise on some of the most complex issues facing Congress [such as]... ...who and how many should be allowed to remain uninsured."
Yet, even as you sit your taxpayer sponsored; all visits, screenings, and procedures 100% covered; socialized health insured "persons" around your conference table deciding whom to exclude, Some of you people have the nerve, the unmitigated gall, to call the provisions of H.R. 3200, Sec. 1233 monstrous, evil, and/or dangerous? You have the temerity to lie about bureaucrats making life-critical decisions they have no business making? It's becoming very easy to see where you get your material.
Congress needs to come to grip a certain fact: Only a non-profit, low overhead organization is going to fix this. So, tell us Senator, what's wrong with Medicare for everyone again?
By the way, I have an idea. How about we leave members of congress, and all the congressional support staff serving congress as a whole, uninsured? The co-ops are your idea, how about you buy your insurance there?
1. Source: AFL-CIO, 2009 Executive Pay Watch 2. Source: World Health Organization, World Health Report
Note: fortunately, it's a well established fact that the terms "persons" and "asses" are interchangeable when discussing members of congress.
DIRIGO BLUE is available as an