Supreme Court Lets Affordable Health Care Act Stand….Implications for ME/CFS

June 28, 2012

Posted by Cort Johnson

In a surprise, Chief Justice John Roberts joined the four liberal members of the Supreme Court to uphold most provisions of the Affordable Health Care Act including the individual health care mandate.

The implications of the Supreme Court’s decision are substantial for people with chronic illnesses, in general, and for people with chronic fatigue syndrome who often have with low incomes and difficulty purchasing health care.  NBC News called the decision “a major victory for millions of Americans who either can’t purchase health insurance or have chronic illnesses.”

With studies suggesting that ME/CFS costs the average family about $20,000 a year in lost wages, and with a recent CDC study findings that on direct medical costs averaging almost $6,000 annually, a significant portion of which is paid out of pocket, this is a community that could use some financial relief at the doctors office.

Republican presidential candidate Mitt Romney and other Republicans have vowed to repeal the bill in its entirety. Now that the most parts of the bill have passed muster at the Supreme Court the fate of the bill may be determined by the outcome of the upcoming election.

Pre-existing Illnesses

One of the most significant aspects of the Affordable Health Care Act is its clause preventing companies from restricting or barring coverage because of a pre-existing health condition.  Prior to the enactment of the bill insurance companies could refuse to sell a policy, or charge several times more for it or exclude specific conditions from coverage. Under this bill insurance companies will not be allowed to jack up rates or exclude coverage for conditions when you become ill – a situation which drove many to bankruptcy or left them unable to afford insurance coverage.

Remarkably it appears that ‘most’ insurance companies won’t even be able to charge more for people with pre-existing conditions.  The government website states

“Under the Affordable Care Act, in 2014, most health insurers will no longer carve out needed benefits, charge higher premiums, put lifetime limits on coverage of key benefits, or deny coverage due to a person’s pre-existing condition”

The desire to cover pre-existing conditions drove the most controversial aspect the Bill, the individual mandate, which requires all Americans who can afford to, to have insurance so that the premiums for healthy people will help pay the costs of those who become  ill.

The Uninsured

The law is designed to greatly reduce the number of people without health insurance – a problem afflicting many with ME/CFS.  Estimates suggest that as many as 30 million people who do not now have health insurance will have it by 2014  Federal subsidies (which tap out at $44,000 a family) will enable millions of lower-income Americans who could not otherwise afford health insurance to have it.

Tax Credits Assist the Less Well Off

  • Lower-income people will be eligible for Medicaid in states that provide that option. (Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid.) The court’s decision to refuse to compel states which refuse to expand Medicaid eligibility to people with lower incomes to give up their already existing Medicaid funds may blunt the laws reach in some areas.  A Department of Health and Human Services (DHHS) report found that a low-income family could save up to $14,900 a year using tax credits.
  • Middle-class - Tax credits for those earning  between 100% and 400% (@ $43,000) of the poverty line will be available to assist in buying insurance coverage. A Department of Health and Human Services (DHHS) report found that tax credits may help middle-class families save as much as $2,300 a year.

Insurance Exchanges

People buying individual policies and small businesses will be able to use ‘insurance exchanges’ to shop for policies. These exchanges will offer the same choice of health plans as congressmen or women currently have. Thus far 14 states, including California, Colorado and West Virginia, have already authorized  the creation of these “exchanges”.  They are due to be enacted by Jan 1st, 2014. Find about more about insurance exchanges here.  Check out a map on your state’s progress in producing them.

The Already Insured

Companies with greater than 50 employees will be required to offer insurance or pay a penalty.  If workers aren’t satisfied with the options a company offers they are free to use the money the employer might have contributed to their insurance and use it to shop on the Insurance Exchanges. 

It’s not clear the effect the law will have on premiums. A  DHHS report stated that ‘all businesses’ will ‘likely see’reduced health care premiums of $2,000 per family by 2019.

Others

  • Ending Lifetime Limits – the end of lifetime limits on health care will help those most severely stricken from sliding into bankruptcy and/or losing medical care.
  • Honest Mistakes No Longer Cause for Insurance Withdrawl – for years insurance companies have found ways to deny coverage if they can find small mistakes in applications. Under the Affordable Care Act they will no longer be able to do that.
  • Premium Payments Must Primarily go to Health Care Not Administrative Overhead and Marketing –  a certain portion of your insurance payments are required to go to health care not administration or marketing or a portion of your fee will be rebated. In his comment on the Supreme Court decision President Obama stated that in Oct of this year 13 million people will receive insurance company rebates because their insurance company spent more in administrative and marketing costs than allowed.
  • Medicare - Medicare recipients will keep getting discounts on prescription drugs to close a gap in coverage known as the “doughnut hole.

Improved and More Efficient Health Care

 The bill provides a variety of means designed to make health care more efficient and effective. These include improvements to physician and hospital quality care reporting, development of outcome measures, a National Health Care strategy based on health care quality and testing a variety of models to improve health care delivery.

More Emphasis on Understanding and Treating Pain – Some of the less talked changes could have implications for people with ME/CFS.  Section 4305, for instance,  requires increased attention on treating chronic pain.  Some of the requirements, which include the creation of a Pain Consortium to provide annual recommendations to the Director of the NIH,  and the creation of an Inter-agency Pain Research Coordinating Committee tasked with identifying critical gaps in pain research and treatment, have already begun to be carried out.
Other programs include
  • A Value-based Purchasing Program – will provide hospitals financial incentives to increase their quality of care  by providing more money to better performing hospitals.  Hospitals will be required to publicly report a variety of performance results for heart attacks, infections, surgical care, pneumonia, etc. The government site reports “for the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.” This program will begin in October of this year. 
  • Reduced Billing Costs – the law standardizes billing and requires health plans to begin adopting and implementing rules for the electronic exchange of health information. The govt site states “Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care.” This program will come into effect Oct, 2012.
  • More Free Preventative Health Care – by Jan 1st 2013 insurance providers will be required to provide more free preventative health care services such as check ups and mammograms.
  • ‘Bundling’ to Save Money - The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment ;plan called “bundling,” hospitals, doctors, and providers are paid a flat rate care rather than using  the current system where each service or test  is billed separately to Medicare.

Jan 1st, 2014

If the bill is not repealed, on Jan 1st, 2014 – just 18 months from now – most of the major changes (individual mandate, creation of Insurance Exchanges, Medicaid eligibility for low-income patients, tax credits for the middle class, etc.) will kick in. Click here for a timeline.

After that a few more changes are in store. For instance, by Jan 1st, 2015 physician payments will begin to be tied to the quality of health care they provide.

As more information becomes available on the Affordable Health Care Law’s effect on people with chronic illnesses such as ME/CFS we’ll report on it.

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70 comments

{ 70 comments… read them below or add one }

Sallysblooms June 28, 2012 at 2:02 pm

Very bad for all concerned. Not just people with CFS. Disaster. Only hope is election time.

Esther12 June 28, 2012 at 2:51 pm

Thanks Cort.

While treatment options for CFS are so limited, these reforms probably won't lead to much direct improvement in the way people's CFS is treated… but it should make it easier for those with CFS to have the coverage needed in case other medical problems emerge.

WillowJ June 28, 2012 at 3:28 pm

Many needed reforms were included in the PPAHCA, but there was also a lot of baggage included which reinforces many of the things about our current structure which aren't working (and adds some new things which I think will cause further, faster failure). We could devise a better reform. American Medical Association has a suggestion (dated 2008) which I support.
http://www.ama-assn.org/resources/doc/washington/ama-proposal-health-reform-2008.pdf

floydguy June 28, 2012 at 3:57 pm

I am not touching this one except to say that US healthcare costs are unsustainable with or without Obamacare. Either way the healthcare system is more like dealing with the DMV than Amazon or Apple. The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company. Republicans seem to be okay with this as they've not made much of an effort to change it themselves. Republicans aren't providing much balance on this issue. They appear to want a consolidation of power in healthcare as much as the Dems – just as long as it's "privatized"…economic statism is not just for the left!

Sallysblooms June 28, 2012 at 3:59 pm

Nothing more than a gigatic tax that Obama said it WASN'T. OOOPS. ha. Guess we all know now. This has never worked anywhere.

Merry June 28, 2012 at 4:17 pm

Great news for the country and for me personally. I've been doing without medical care for several years now. And it makes me sad that anyone in the ME/CFS community would fight against access to health care for the millions of uninsured and under-insured.

CJB June 28, 2012 at 4:19 pm

Great article, Cort.

If the more fundamental aspects are left intact, it will help a lot of folks I know and love. It's a far cry from what I wanted and I don't think anyone was 100% comfortable with it, but it was the best that could be accomplished at the time. Some of the provisions included really common-sense strategies that will reduce costs and improve outcomes. Those are seldom talked about, but are probably among the more important.

It needs to be built upon and improved, I agree. And we'll really only know what impact it will have with some experience.

I like it when at least one of the Supreme's behaves in an unpredictable way. Gives me hope. WTG Chief Justice Roberts. The Sunday Morning talking heads are going to be fun to watch this weekend.

WillowJ June 28, 2012 at 4:30 pm
Merry

Great news for the country and for me personally. I've been doing without medical care for several years now. And it makes me sad that anyone in the ME/CFS community would fight against access to health care for the millions of uninsured and under-insured.

I don't think anybody said that, Merry. Certainly not me. Cheers.

ggingues June 28, 2012 at 5:12 pm
WillowJ

I don't think anybody said that, Merry. Certainly not me. Cheers.

I agree, I think it is horrible news for the country and it will not stand. Obama is finished, he has awakened a sleeping giant, good by Dems. He has killed his party, an overreach by gov't. Unfortunately it will just crash our economy much sooner than expected, if allowed to stand. Just about everything the gov't does is unsustainable and just distorts markets.

The things that the gov't subsidizes heavily, rise above inflation every year, look at education and health care. Typical inflation is about 3%, and the aforementioned industries rise about double of 3% if not more, year after year.

They are also behind the housing bubble, which we have not recovered from, and will not for years to come. If people want more massive meddling in our economy by the feds, than get ready for a massive implosion also.

GG

PS Hope I can keep donating monthly to this website and other worthy CFS causes. (The working poor).

Bob June 28, 2012 at 6:09 pm

Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise. I imagined that most people would have @Merry's perspective on the issue. Anyway, I'm not expressing a view, because I don't know enough details, and I'm not a US citizen, so it doesn't affect me.

Sallysblooms June 28, 2012 at 6:12 pm

Very few American's want this mess. We have had freedom. This would not pass now if it were done again. It was a joke, NO one read it first.

liquid sky June 28, 2012 at 6:31 pm
Merry

Great news for the country and for me personally. I've been doing without medical care for several years now. And it makes me sad that anyone in the ME/CFS community would fight against access to health care for the millions of uninsured and under-insured.

I am so glad that this will help you gain access to medical care, Merry. There are some really nice and sensible provisions in this law. Looking at the list of provisions provided by Cort, I can't see anything that is not an improvement.
Making the insurance companies spend a percentage of your premiums on direct healthcare rather than administrative or advertising expenses is a good start. I have worked in healthcare all my working life and I have always thought that it should be non-profit. Not there yet.

Last week I went to a specialist and was waiting in line to pay my copay. The lady in front of me was charged 50 cents for her copay. I thought that was crazy as I have to pay $30.00 for mine and pay for insurance. Then I thought later that I was being unfair. Maybe that was all she could pay, so who was I to judge? I like the idea that everyone pays something. Some are freeloading when they could afford insurance, but don't and the cost is payed by those with insurance in higher costs for services. No one is above a medical emergency and we shouldn't expect others to pick up the costs. This bill helps most everyone afford insurance.

Bob June 28, 2012 at 6:37 pm
Merry

Great news for … me personally. I've been doing without medical care for several years now. …

Great to hear it's good news for you personally Merry. :) I'm really pleased to hear that.

Sorry to hear the bill doesn't suit everyone.

Bob June 28, 2012 at 6:44 pm

In the UK we get 100% free healthcare (except for regular dentistry), paid for by taxes.
I think most people really appreciate our NHS, and despite the negative things you probably hear about it on this forum (including from me), I think it does a brilliant job with most medical issues.
But it does often let us down, as it doesn't have the resources to be perfect.
It tends to serve acute and emergency problems very well, but neglects many chronic problems like CFS/ME and depression.

Sushi June 28, 2012 at 6:45 pm
Bob

Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise. I imagined that most people would have @Merry's perspective on the issue. Anyway, I'm not expressing a view, because I don't know enough details, and I'm not a US citizen, so it doesn't affect me.

Hi Bob,

I think quite a few of the US citizens on the forum are going to avoid posting on this thread as it could turn easily turn into a political debate. Just to say that the yays and nays here may not statistically reflect opinions.

Sushi

Cort June 28, 2012 at 6:48 pm
jenbooks

Hi Koan I see your point. I wanted to protect people from a hard fall if there would be one (it may be that the results pan out! Or at least partially). When I heard that news I became anxious that so many people put themselves on the line so early (including the wonderful Hillary Johnson).

But I didn't confirm it–ie I did not ask which scientists where and when and may I speak with them? I just am not in a position to do that…I don't feel so anyway.

I'm sorry it's causing you anxiety (the rumor). I guess it's ramping up the "what if" that you speak of in regards to buddhist practice. The anxiety from "how come" and "what if"…uggggg….

The problem is there's no really good answer except a time machine to undo the moment one fell ill, by whatever means….

To say Roberts disappointed conservatives is an understatements….he certainly has guts :).. Personally I see the law as being very helpful and was happy to see it passed.

Cort June 28, 2012 at 6:50 pm

It would be lovely if the law continues to be tweaked to maximize efficiency and reward innovation. From what commentators said it does accomplish its goal of getting most Americans covered and there's quite a bit left to do on cutting costs.

CJB June 28, 2012 at 6:50 pm
Sallysblooms

Very few American's want this mess. We have had freedom. This would not pass now if it were done again. It was a joke, NO one read it first.

I'm afraid very few Americans understand what's in the bill. There's been a well-financed misinformation campaign.

I disagree that it was a joke. It was the product of a decades-long effort to provide healthcare to every American. And now the Supreme Court has ruled it's constitutional.

There's still a lot of work to be done.

Hope123 June 28, 2012 at 7:07 pm

As a CFS patient and former healthcare worker, the bill is not perfect but then few things are. As the saying goes, "Don't let the perfect be the enemy of the good." I support it and am glad it passed.

I have family in Canada and friends in Europe who have lived in the US. When I first became ill, one of the first things everyone was concerned about was how I would continue to get healthcare if I no longer had a job and whether I would be bankrupt by medical costs. (50% of bankruptcies in the US are related to medical illness) My Canadian relatives have endured cancer and serious strokes but no one became bankrupt and from what I could see, their care did not suffer. A friend offered to help me pay for care but I was lucky to have worked for an employer who covered my healthcare for an extended period initially and then to have enough money to buy the same-level insurance under COBRA until I was approved for Medicare.

Patients I have had in the past and many people on this forum aren't so lucky. If they're not covered by spousal/ parental insurance, aren't financially well-off enough, can't work enough to get insurance benefits, or their employer doesn't offer insurance, they're hung out to dry unless and until they get approved by Medicare. Approval as we know can take years and is not guaranteed. We see this on the forum regularly. It's true insurance doesn't cover many things people with CFS may want to get tested for or for particular treatments but insurance does pay for RULING OUT other illnesses that can cause your symptoms. AND that is very important. How many times have people here said "you might want to get checked out for such and such"? Besides which, having CFS doesn't protect you from other medical conditions.

It's interesting to read some interviews of people on the street as some express that they are against it but with further details from the reporter or some more contemplation,their answer becomes less certain and some adopt a more "let's wait and see" attitude.

Cort June 28, 2012 at 7:13 pm
Esther12

Thanks Cort.

While treatment options for CFS are so limited, these reforms probably won't lead to much direct improvement in the way people's CFS is treated… but it should make it easier for those with CFS to have the coverage needed in case other medical problems emerge.

Yes…We'll see what the ultimate consequences of the bill are for the health care system over time (if it isn't repealed) but I think it has to help those who can't get covered because of pre-existing coverages or who faced increases in fees because of CFS. I pay 25% more for insurance because of CFS and I'm perfectly healthy otherwise. I imagine people who are really sick have a horrid time of it. It will also help people with ME/CFS with low incomes get insurance coverage….and relieve some of the burden that insurance coverage creates for people with more money…

I don't see how it could effect the greatest need – producing adequate treatments and more research – but it's not designed to do that kind of thing either.

HowToEscape? June 28, 2012 at 7:14 pm
Sallysblooms

Very bad for all concerned. Not just people with CFS. Disaster. Only hope is election time.

How?

I claim no special expertise on the subject, but I don't see it changing the essential mess our system is in one way or another. It won't make medicine itself any better or reverse current trends; that wasn't its goal. It should make the purchasing of medical services less chaotic – you can keep the same insurance after you change jobs etc. Making at least the buying end (for most people that means 'insurance') less of a mess has been on presidential agendas since Eisenhower.

Before the bill, the biggest medical consumers, by far, were the retired, mostly via Medicare/'caid
After the bill…. the biggest medical consumers, by far, were the retired, mostly via Medicare/'caid

It does appear that the average person will be able to spend a little less time navigating the insurance jungle and a little more dealing with health issues, but the larger issue of doctors having to waste much of their efforts dealing with insurance and thus being forced to become employees in a hospital or group practice, and the issue of diseases without an effective constituency being ignored (that's us) are untouched; these are not part of the political debate/circus show.

Esther12 June 28, 2012 at 7:16 pm
Cort

.he certainly has guts :)

A lot of the analysis I have been reading have been emphasising this as a clever political play by Roberts to set a new precedent restraining Congress's use of the Commerce clause, and a cautious move to avoid political over-reach by the court. We're coming up to an election which is going to be defined by the unlimited private spending unleashed by the court's Citizen's United decision, and a lot of American's are not going to like the lowering of tone this will lead too – striking down key aspects of legislation passed by Congress would have been another risky move for a relatively new Chief Justice. I don't think Roberts wanted to give Democrats room to run against the court.

Also Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity… "Hold on, I didn't think I was reading a thread about this?!"

ggingues

They are also behind the housing bubble, which we have not recovered from, and will not for years to come..

The US housing bubble was a prime example of markets in action. Some on the right have tried to claim it was the result of Freddie Mac and Fannie Mae… but if you look at the figures, and see where the money was coming from, this is just not an argument that makes sense. Booms and busts are an inevitable part of market economies, they always have been and always will be. Some like to pretend that markets are always rational, but this is just an article of faith, and not a claim supported by the evidence. Under Greenspan, the Fed did decide that it should not be the governments job to try to spot and deflate bubbles… but that was the government doing too little rather than too much.

Cort June 28, 2012 at 7:17 pm
Hope123

As a CFS patient and former healthcare worker, the bill is not perfect but then few things are. As the saying goes, "Don't let the perfect be the enemy of the good." I support it and am glad it passed.

I have family in Canada and friends in Europe who have lived in the US. When I first became ill, one of the first things everyone was concerned about was how I would continue to get healthcare if I no longer had a job and whether I would be bankrupt by medical costs. (50% of bankruptcies in the US are related to medical illness) My Canadian relatives have endured cancer and serious strokes but no one became bankrupt and from what I could see, their care did not suffer. A friend offered to help me pay for care but I was lucky to have worked for an employer who covered my healthcare for an extended period initially and then to have enough money to buy the same-level insurance under COBRA until I was approved for Medicare.

Patients I have had in the past and many people on this forum aren't so lucky. If they're not covered by spousal/ parental insurance, aren't financially well-off enough, can't work enough to get insurance benefits, or their employer doesn't offer insurance, they're hung out to dry unless and until they get approved by Medicare. Approval as we know can take years and is not guaranteed. We see this on the forum regularly. It's true insurance doesn't cover many things people with CFS may want to get tested for or for particular treatments but insurance does pay for RULING OUT other illnesses that can cause your symptoms. AND that is very important. How many times have people here said "you might want to get checked out for such and such"? Besides which, having CFS doesn't protect you from other medical conditions.

It's interesting to read some interviews of people on the street as some express that they are against it but with further details from the reporter or some more contemplation,their answer becomes less certain and some adopt a more "let's wait and see" attitude.

Some time ago I read that medical problems were the greatest single factor contributing to individual bankruptcies….These weren't people that spent recklessly,. they just happened to come down with an illness, probably lost their job, ultimately couldn't afford their insurance and eventually went bankrupt – sad, sad stories. I was on Cobra for awhile – it was VERY expensive – really not a good alternative for me..

Cort June 28, 2012 at 7:18 pm

Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity… "Hold on, I didn't think I was reading a thread about this?!"
[/quote]
I just saw that – its the weirdest thing….We have a system that is supposed to intermix comments from the blog and the Forums…..it seems to be have troubles. I believe that was a comment from the blog.

Esther12 June 28, 2012 at 7:26 pm

I've noticed it happen a few times. I think it has happened to Mark too. Maybe something to do with being moderators? I've not pointed it out previously, as I thought you may have just copied + pasted something in error, but it does seem like something odd is happening instead.

HowToEscape? June 28, 2012 at 7:36 pm

And obviously I should have typed

"Before the bill, the biggest medical consumers, by far, were the retired, mostly via Medicare/’caid
After the bill… the biggest medical consumers, by far, will be the retired, mostly via Medicare/’caid

I believe it does address and may fix a fair amount of the craziness in the current system of health _insurance_, but that's a different animal than medicine.

It does not address the fact that most people will consume more health $ in their last 12 months than in their 1st 21 years. Nobody is willing to deal with that. Would you rather have a better health foundation built in your 1st 21 years or extra medical attention in your last 12 months? Dunno about you (OP), but I'd rather have had a chance at avoiding this disease instead of the free power scooter and Medicare paid triple bypass when I'm 70.

mellster June 28, 2012 at 7:38 pm
Esther12

A lot of the analysis I have been reading have been emphasising this as a clever political play by Roberts to set a new precedent restraining Congress's use of the Commerce clause, and a cautious move to avoid political over-reach by the court. We're coming up to an election which is going to be defined by the unlimited private spending unleashed by the court's Citizen's United decision, and a lot of American's are not going to like the lowering of tone this will lead too – striking down key aspects of legislation passed by Congress would have been another risky move for a relatively new Chief Justice. I don't think Roberts wanted to give Democrats room to run against the court.

Also Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity… "Hold on, I didn't think I was reading a thread about this?!"

The US housing bubble was a prime example of markets in action. Some on the right have tried to claim it was the result of Freddie Mac and Fannie Mae… but if you look at the figures, and see where the money was coming from, this is just not an argument that makes sense. Booms and busts are an inevitable part of market economies, they always have been and always will be. Some like to pretend that markets are always rational, but this is just an article of faith, and not a claim supported by the evidence. Under Greenspan, the Fed did decide that it should not be the governments job to try to spot and deflate bubbles… but that was the government doing too little rather than too much.

What? Greenspan actively inflated the bubble with artificially low interest rates, and Turbo Timmy and Bernanke made it even worse. This has nothing to do with left vs right and fannie and freddie have a lot to do with it. Furthermore the law has been broken so many times and the rule of law has been abandoned making this bascially a lawless society (for some). fannie and freddie plus all the other bailouts were the biggest fraud in taxpayer history, if the rule of law had been applied, three quarters of the banks would not exist anymore, quite a few high rollers would spend their life in jail (deservedly so), the bad debt would have been cleared by now with small savers and most of the middle class being protected by their account insurance (up to 100K/250K), inflation would be non-existent and the US would be on the path to becoming debt free again with manufacturing and other service sectors that matter leading and the financial services that produce nothing being curbed, admittedly though after a few hard years. Unfortunately it is much worse now, people are getting fed up with their savings rate of .33 % (should be cat least 10 x) and are gambling and riverboating on houses and what not with cheap credit again, partying like it's 1999 all over again. This is not a matter of regulations which are driven by special interest anyways and are mostly useless, it is about enforcing the law. That being said, I always thought free basic healthcare for everybody was a noble goal to have and trying to achieve. But much easier to talk then to implement ;) I might support free baisc healthcare for everyone, but I definitely do not support homeownership for everyone..

HowToEscape? June 28, 2012 at 7:46 pm
floydguy

I am not touching this one except to say that US healthcare costs are unsustainable with or without Obamacare. Either way the healthcare system is more like dealing with the DMV than Amazon or Apple. The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company. Republicans seem to be okay with this as they've not made much of an effort to change it themselves. Republicans aren't providing much balance on this issue. They appear to want a consolidation of power in healthcare as much as the Dems – just as long as it's "privatized"…economic statism is not just for the left!

"The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company."

There's the biggest root. The insurance model was well intentioned – who has the spare change for a heart attack, or dealing with a major medical event plan that *surprise* doesn't happen to cover your major event and its aftermath (or those of half of the other suckers who bought that policy).
But buyer and seller are now disconnected, with the insurance maze in between. Unintended consequences have exploded.

Esther12 June 28, 2012 at 8:11 pm
mellster

What? Greenspan actively inflated the bubble with artificially low interest rates, and Turbo Timmy and Bernanke made it even worse. This has nothing to do with left vs right and fannie and freddie have a lot to do with it. Furthermore the law has been broken so many times and the rule of law has been abandoned making this bascially a lawless society (for some). fannie and freddie plus all the other bailouts were the biggest fraud in taxpayer history, if the rule of law had been applied, three quarters of the banks would not exist anymore, quite a few high rollers would spend their life in jail (deservedly so), the bad debt would have been cleared by now with small savers and most of the middle class being protected by their account insurance (up to 100K/250K), inflation would be non-existent and the US would be on the path to becoming debt free again with manufacturing and other service sectors that matter leading and the financial services that produce nothing being curbed, admittedly though after a few hard years. Unfortunately it is much worse now, people are getting fed up with their savings rate of .33 % (should be cat least 10 x) and are gambling and riverboating on houses and what not with cheap credit again, partying like it's 1999 all over again. This is not a matter of regulations which are driven by special interest anyways and are mostly useless, it is about enforcing the law. That being said, I always thought free basic healthcare for everybody was a noble goal to have and trying to achieve. But much easier to talk then to implement ;) I might support free baisc healthcare for everyone, but I definitely do not support homeownership for everyone..

A lot of that is just ways in which government is not perfect. Or course it is not. And neither are the markets. Neither ever have been, or ever will be. It's pretty clear that the key change which led to the housing bubble was the rise of complex derivatives which led to investors being unable to make meaningful judgements about the risks they were taking – this was market driven, with the government's failure being it's lack of intervention.

Greenspan didn't act to inflate the bubble, but he did decide that it was not the government's role to try to predict and deflate bubbles, instead believing interest rates should be used simply to smooth the business cycle and soften recessions – this was based on unrealistic assumption about the rationality of markets.

There is always a long-term danger of moral hazard when the government intervenes in the way that it has, and this does require regulatory changes, but in the short term, the US banking system was verging on the edge of collapse, and the models I've seen trying to estimate the harm this would have done have all led to pretty catastrophic results. It might not seem it now, but the Bush and Obama administration responses to the banking crises were pretty good considering how quickly they needed to act. I think that a lot of people didn't really understand how serious the problems being faced four years ago were – it was a 1929 style disaster, and we've been relatively lucky in the levels of suffering we've had to, so far, endure. There are still a lot more dominoes which could fall and change that luck (the Euro? China?).

Snow Leopard June 28, 2012 at 8:18 pm

There are some major positives as well as negatives in this bill (as usual for American politics).

I am a big fan of the consumer protections for example – insurance companies moving the goal posts and denying coverage to those who need it most. Changing the incentives for how medicine is practised (quality not quantity) etc.

I don't like how the US system pressures employers to provide coverage, because this means that there is less competition and choice compared to if the individual chose the insurer (like in Australia). Likewise I don't like how most insurance companies do not give you a free choice of which doctors you can see. Eg if you are insured with Kaiser Permanente, you can only basically go to Kaiser hospitals and medical practitioners. Again, this reduces the accountability of those services since there is no competition.

My sister lived in the USA for over 10 years, guess which medical/health system she prefers between the USA and Australian systems?

Do not be blinded by contemporary ideology.

CJB June 28, 2012 at 8:23 pm
Sallysblooms

Sadly so true. Too many do not bothers to really understand the implications this has. This is not free. There is no way to pay for all of this. We see what happened to other countries. People that move here can't believe this happened. People come here whenever they possibly can. No waits of 9 months for heart surgery, etc. It happens daily, so many coming for care. Hopefully this will be changed.

People who understand what's in the bill are able to talk about different provisions and don't just whitewash the entire effort. I'm afraid your statements don't match the facts. We spend the most and have among the poorest outcomes.

What do you mean by, "this is not free"?

What do you mean by, "there is no way to pay for all of this."

What do you mean when you say "we see what happened to other countries"

What do you mean when you say "people come here whenever they possibly can"

etc.

I've heard these statements for years now coming from certain media outlets and media personalities, but they are easily refuted. We don't need more hysteria surrounding these issues. Especially as a patient community. We need less fear-based hate rhetoric and more cool-headed, thoughtful, results-based progress.

I don't know all of the implications this bill will have, but I have already benefitted and Merry will benefit. It has been scored by the budget office to cut costs versus doing nothing. The right to life, liberty and the pursuit of happiness do not exist if you are sick and can't afford care. I think healthcare should be a right and this bill doesn't get close to that, so I'm not happy with it either, but it isn't stealing anyone's freedom (the Supremes just made that decision today), the independent Budget Office says it will save money so I don't know what your argument about paying for it means, other countries spend less money and get better outcomes.

I'm not saying you don't understand what's in the bill. But what you're saying doesn't show that you do. It doesn't address what's actually in the bill.

I'm only responding to this post because you used my post out of context and I wanted to clarify.

mellster June 28, 2012 at 8:31 pm

Greenspan didn't act to inflate the bubble, but he did decide that it was not the government's role to try to predict and deflate bubbles, instead believing interest rates should be used simply to smooth the business cyicle and soften recessions – this was based on unrealistic assumption about the rationality of markets.

What? The (unconstitutional) fed committed felonious fraud by counterfeiting the currency and creating money out of thin air to depress the interest rates! And worse they gave it to special interest groups. Everybody else debasing their currency by printing it would go straight to jail.

I think that a lot of people didn't really understand how serious the problems being faced four years ago were – it was a 1929 style disaster, and we've been relatively lucky in the levels of suffering we've had to, so far, endure.

That is not true – you cannot spend more money than you take in, you cannot argue with math. In fact acting on the crisis in that way made it much worse. It may have smoothened out things in the short term for people in debt while destroying the value of others who had the foresight to save and/or sound businesses, but in the long run it destroys the poor and middle class via inflation. Countries that clear their bad debt and default where necessary and employ austerity (for everybody, not just the poor and middle class) and say no to bailouts like Estonia or any other countries that favor balanced budgets have long recovered and prosper again. The only place where the government had to act and where it didn't is to prosecute and jail all the people involved in fraudulent loans and selling junk derivatives as AAA (knowing that they were junk which is fraud) as well as seize assets of fraudulent companies and redistribute to their customers what was stolen.

Snow Leopard June 28, 2012 at 8:42 pm

Guys, it is probably a good idea to take the discussion about the financial system and monetary policy elsewhere.

ggingues June 28, 2012 at 8:57 pm
Cort

To say Roberts disappointed conservatives is an understatements….he certainly has guts :).. Personally I see the law as being very helpful and was happy to see it passed.

Yes, it passed with only Democrats votes. Now to see if it stands, Nov. 2012 will be the ultimate judge.

GG

PS I feel bad that everyone that does not have insurance, has less access. but my impression of Drs iin this area that treat CFS, do not take insurance. So I don't think this will be a major help to most patients. We really need to get more Drs educated on CFS and some real treatments, otherwise it's not very helpful for the CFS community. Hope I am wrong in this regard.

WillowJ June 28, 2012 at 9:02 pm
Bob

Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise.

Again, there were good and necessary things included in this bill. The question is, is the total package a rational way to do those things, or should we scrap it and do those things in another way (because of the dangerous things in the bill; things that are not mentioned in the "this is the good the bill will do" conversations… and because the bill fails to reform several things in the structure of how health insurance and care is structured and paid for, which drives up the cost and drives down quality)?

For those who want to know what the objections might be, one big danger to us is the Comparative Effectiveness panel: an unelected 19-member panel. Via this panel of bureaucrats, it's highly possible that all insurances everywhere will come to cover only CBT/GET for ME/CFS. (More standard diseases also will have issues; not all patients are going to respond well to the 'gold standard' treatment and may need something different, which may no longer be covered)

(currently anything is covered which is FDA approved and which your doctor can convince your insurance company is medically necessary for you [usually not a problem with most companies, though there are a couple of 'bad apple' companies where either the independent doctor has trouble, or the HMO doctors are trained to be ineffective/cheap], unless your policy has specific exclusions [for example, standard exclusions include naturopathic care, experimental treatments, and some inexcusable exclusions like limits on "mental" health coverage]; for Medicare/Medicaid there may be a specific list of what is covered and what is not, I'm not sure about that).

Objections not specific to our community can be found at sites such as (this is not a blanket endorsement of all these sites and everything on them or in the articles cited):
http://www.heritage.org/issues/health-care
http://www.ncpa.org/healthcare/
http://www.cato.org/
http://www.ama-assn.org/ama1/pub/upload/mm/478/admincosts.pdf

No problem if anyone disagrees–I always assume everyone came by their position in a rational and compassionate manner–and I am not looking for a debate (will probably not post in this thread anymore). Just offering information for those who might be curious or want to know how 'the other side' reached their seemingly inexplicable conclusions. ;)

Doogle June 28, 2012 at 9:04 pm

I'm proud to say I support the healthcare bill. The government probably will not implement it as efficiently as everyone would like, but in my opinion it's a great major step forward to improve health care access in this country. I will not vote for a candidate that is determined to undo it.

ggingues June 28, 2012 at 9:16 pm
CJB

People who understand what's in the bill are able to talk about different provisions and don't just whitewash the entire effort. I'm afraid your statements don't match the facts. We spend the most and have among the poorest outcomes.

What do you mean by, "this is not free"?

What do you mean by, "there is no way to pay for all of this."

What do you mean when you say "we see what happened to other countries"

What do you mean when you say "people come here whenever they possibly can"

etc.

I've heard these statements for years now coming from certain media outlets and media personalities, but they are easily refuted. We don't need more hysteria surrounding these issues. Especially as a patient community. We need less fear-based hate rhetoric and more cool-headed, thoughtful, results-based progress.

I don't know all of the implications this bill will have, but I have already benefitted and Merry will benefit. It has been scored by the budget office to cut costs versus doing nothing. The right to life, liberty and the pursuit of happiness do not exist if you are sick and can't afford care. I think healthcare should be a right and this bill doesn't get close to that, so I'm not happy with it either, but it isn't stealing anyone's freedom (the Supremes just made that decision today), the independent Budget Office says it will save money so I don't know what your argument about paying for it means, other countries spend less money and get better outcomes.

I'm not saying you don't understand what's in the bill. But what you're saying doesn't show that you do. It doesn't address what's actually in the bill.

I'm only responding to this post because you used my post out of context and I wanted to clarify.

Where's the hate you speak of? Wow, health care should be a right, looks like you are living in the wrong country, definetly not what our founding fathers had in mind.

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.

My understanding is that scoring by the CBO is done the way politicians want it done, both sides do it, so its not a really good measuring stick, unless the expectations/models used are accurate, and we know people change their behaviour based on costs. Like politicians think they can keep raising taxes on cigarettes etc.., and they will just collect more money, but people change there behaviors, or find a way around these things, so less money comes and it just gets compounded.

CJB June 28, 2012 at 9:25 pm
WillowJ

Again, there were good and necessary things included in this bill. The question is, is the total package a rational way to do those things, or should we scrap it and do those things in another way (because of the dangerous things in the bill; things that are not mentioned in the "this is the good the bill will do" conversations… and because the bill fails to reform several things in the structure of how health insurance and care is structured and paid for, which drives up the cost and drives down quality)?

For those who want to know what the objections might be, one big danger to us is the Comparative Effectiveness panel: an unelected 19-member panel. Via this panel of bureaucrats, it's highly possible that all insurances everywhere will come to cover only CBT/GET for ME/CFS. (More standard diseases also will have issues; not all patients are going to respond well to the 'gold standard' treatment and may need something different, which may no longer be covered)

(currently anything is covered which is FDA approved and which your doctor can convince your insurance company is medically necessary for you [usually not a problem with most companies, though there are a couple of 'bad apple' companies where either the independent doctor has trouble, or the HMO doctors are trained to be ineffective/cheap], unless your policy has specific exclusions [for example, standard exclusions include naturopathic care, experimental treatments, and some inexcusable exclusions like limits on "mental" health coverage]; for Medicare/Medicaid there may be a specific list of what is covered and what is not, I'm not sure about that).

Objections not specific to our community can be found at sites such as (this is not a blanket endorsement of all these sites and everything on them or in the articles cited):
http://www.heritage.org/issues/health-care
http://www.ncpa.org/healthcare/
http://www.cato.org/
http://www.ama-assn.org/ama1/pub/upload/mm/478/admincosts.pdf

No problem if anyone disagrees–I always assume everyone came by their position in a rational and compassionate manner–and I am not looking for a debate (will probably not post in this thread anymore). Just offering information for those who might be curious or want to know how 'the other side' reached their seemingly inexplicable conclusions. ;)

I'm only going to respond to the one issue you raise of the Comparative Effectiveness panel and its mandate:

The Council will not recommend clinical guidelines for payment, coverage or treatment. The Council will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities. It will also provide input on priorities for the $400 million fund in the Recovery Act that the Secretary will allocate to advance this type of research

I disagree that it's highly probable this panel will cause insurance companies to only offer CBT/GET for a CFS diagnosis. As I understand its function, it is looking at what works and what doesn't and making recommendations on treatment options based on their findings. It makes tremendous sense. Under their mandate, CBT and GET wouldn't get recommended because they're ineffective. As we've seen with our experience with CFSAC, the powers are strictly limited by law.

Any body with authority can abuse it, but I think this argument against Obamacare is particularly misrepresenting the realities. I'm afraid at least two of your links for objections to the bill are strictly political, the Cato Institute is well known to me.

And as you say, I assume you came to your position in a ration and compassionate manner and I hold it with respect.
.

CJB June 28, 2012 at 9:29 pm
ggingues

Where's the hate you speak of? Wow, health care should be a right, looks like you are living in the wrong country, definetly not what our founding fathers had in mind.

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.

My understanding is that scoring by the CBO is done the way politicians want it done, both sides do it, so its not a really good measuring stick, unless the expectations/models used are accurate, and we know people change their behaviour based on costs. Like politicians think they can keep raising taxes on cigarettes etc.., and they will just collect more money, but people change there behaviors, or find a way around these things, so less money comes and it just gets compounded.

Hate rhetoric referring to certain media personalities in particular.

I'm definitely living in the right country.

Both sides agree to use the CBO numbers.

CJB June 28, 2012 at 9:54 pm
ggingues

Where's the hate you speak of? Wow, health care should be a right, looks like you are living in the wrong country, definetly not what our founding fathers had in mind.

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.

My understanding is that scoring by the CBO is done the way politicians want it done, both sides do it, so its not a really good measuring stick, unless the expectations/models used are accurate, and we know people change their behaviour based on costs. Like politicians think they can keep raising taxes on cigarettes etc.., and they will just collect more money, but people change there behaviors, or find a way around these things, so less money comes and it just gets compounded.

From Thom Hartmann:

I mean, it's time to wake up to the fact that there are very real human values that are part of a successful experience of life, liberty and the pursuit of happiness.

When Thomas Jefferson wrote those words into the Declaration of Independence,we were the first nation in the history of the world to have the word happiness in our founding document.

And consider it for a minute. You cannot have life if you don't have a social safety net, if you don't have a national healthcare program, if you don't have, if you don't know that whatever happens whether you have a job or whether you don't, whether you're born into a rich family or a poor family, no matter what, you can't have life if you don't have access to those things.

You can't have liberty if you don't have those things. As Franklin Roosevelt said so famously in 1936, in June of 1936, he said, "a necessitous man is not a free man". You're not free if you're homeless. You're not free if you're sick and you can't pay for it. You're not free if you're jobless.

And the pursuit of happiness? How can we pursue happiness when we're constantly concerned about survival. That is a pure dysfunction. If we want to get back to life, liberty and the pursuit of happiness in the United States, we need to be seriously looking at the way they've done it in other countries that actually works.

Cort June 29, 2012 at 4:13 am
ggingues

Yes, it passed with only Democrats votes. Now to see if it stands, Nov. 2012 will be the ultimate judge.

GG

PS I feel bad that everyone that does not have insurance, has less access. but my impression of Drs iin this area that treat CFS, do not take insurance. So I don't think this will be a major help to most patients. We really need to get more Drs educated on CFS and some real treatments, otherwise it's not very helpful for the CFS community. Hope I am wrong in this regard.

That's a good point. I don't think most do. (Dr. Peterson is a standout in that he actually takes Medicare!) but I don't think that means patients can't get reimbursed by insurance; I think it means they have to give the doctors bills to their insurance companies directly. Does anybody know? Its been a long time since I saw a doctor for ME/CFS…

Nielk June 29, 2012 at 4:16 am
Cort

That's a good point. I don't think most do. (Dr. Peterson is a standout in that he actually takes Medicare!) but I don't think that means patients can't get reimbursed by insurance; I think it means they have to give the doctors bills to their insurance companies directly. Does anybody know? Its been a long time since I saw a doctor for ME/CFS…

Drs. Enlander and Natelson in New York accept Medicare too.

Esther12 June 29, 2012 at 4:41 am
Snow Leopard

Guys, it is probably a good idea to take the discussion about the financial system and monetary policy elsewhere.

Darn it.

SOC June 29, 2012 at 6:19 am
Cort

That's a good point. I don't think most do. (Dr. Peterson is a standout in that he actually takes Medicare!) but I don't think that means patients can't get reimbursed by insurance; I think it means they have to give the doctors bills to their insurance companies directly. Does anybody know? Its been a long time since I saw a doctor for ME/CFS…

Yes, that is correct.

Drs that "don't take insurance" simply don't bill directly to the insurance. The patient has to pay up front, submit the bills to their insurance company and get reimbursed directly by the insurance company. It does not mean the insurance company doesn't pay. The resources necessary for a clinic to bill directly to insurance are very high. It is expensive to the clinic in terms of manpower and paperwork and therefore adds to the cost of services from the clinic. It also takes quite a long time for a relatively new clinic to get the paperwork in place to be able to bill insurance directly, which is one reason some of our ME/CFS doctors don't have that capability (yet).

This can be very difficult for patients without a good cash flow because you have to have enough money to pay the bills up front. Even if you get reimbursed later, you are without several thousand dollars for many months. If you don't have that kind of cash to play with, you don't get to see the doctor you need.

This kind of arrangement is not a problem for well-to-do Texas Tea-Partiers, since they have money to throw around, and they don't care about the rest of us middle-class schmucks who either can't work because of our illness, or have to try to survive in this conservative-created middle-class economic crisis while paying for, say, :whistle: the medical bills (including supplements and expensive not-covered-by-insurance off-label meds) for multiple family members with ME/CFS.

mellster June 29, 2012 at 8:52 am

My experience with MDs that don't bill the insurance companies directly but rather present you with a superbill to submit is that the insurance covers 10%-20% max. of the bill, and that is if you're lucky. While theoretically the MDs have not opted out of insurance, practically they have, and there is only one reason for it, and that is that they make more money, and even more important, they get their money faster (cash-flow!) because they don't have to wait for the insurance companies to approve.

Ema June 29, 2012 at 9:55 am
mellster

My experience with MDs that don't bill the insurance companies directly but rather present you with a superbill to submit is that the insurance covers 10%-20% max. of the bill, and that is if you're lucky.

My experience is similar but I find the reimbursement rate is generally less than 10%.

I have been able to negotiate cash discounts often with doctors and labs that have saved me a lot of money. The amount they bill insurance is usually at least three times higher than what they will accept as payment in full. It's a pain to call and deal with the billing office but totally worth it in most cases as the savings can be significant.

SOC June 29, 2012 at 9:58 am
mellster

My experience with MDs that don't bill the insurance companies directly but rather present you with a superbill to submit is that the insurance covers 10%-20% max. of the bill, and that is if you're lucky. While theoretically the MDs have not opted out of insurance, practically they have, and there is only one reason for it, and that is that they make more money, and even more important, they get their money faster (cash-flow!) because they don't have to wait for the insurance companies to approve.

I don't disagree with this overall. :) My experience, however, is that insurance has paid no less (so far) than 80% of the bill. I suppose that depends on your insurance company. The whole medical industry is terribly inconsistent.

user9876 June 29, 2012 at 9:58 am
ggingues

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.
.

It doesn't follow that universal healthcare increases costs. I believe that the US spends around 17% of GDP on healthcare which is just about the highest in the world. This compares with 9.6% for the UK in 2010 of which I believe 8% is spent on the NHS and 1.6% on private provision.

Sushi June 29, 2012 at 10:04 am

With Medicare, I don't think you can send them the bill yourself if the doctor doesn't accept Medicare. Seems to work differently from private insurance. :(

Sushi

user9876 June 29, 2012 at 12:56 pm
Sallysblooms

Talking to doctors will really help everyone understand. This will not help anyone. We have seen what happens to other countries.

I think health care in the UK is very good, although getting worse due to recent budget cuts and reorganisations.

If anyone is really interested in comparisons there is a lot of data on:

http://www.oecd.org/document/30/0,3746,en_2649_37407_12968734_1_1_1_37407,00.html

jimells June 29, 2012 at 1:35 pm

As a famous baseball player said, it's hard to make predictions, especially about the future. But I'm not optimistic about the results of the new law. Extremely poor people who live in states governed by actual human beings will likely benefit from Medicaid coverage. I certainly hope that includes Merry. But I live in Maine, where the foot-in-mouth governor just rammed through a law to dump FORTY THOUSAND people off Medicaid. It's not likely his handlers will allow him to change his mind and accept the new program. He's too busy cutting the state income tax rate for the highest earners.

We can be assured that the insurance companies will benefit. This law is for them, not us. The fact that some working class people might benefit is a happy accident. It's important to remember that the US, like most of the world, is a subsidiary of the FIRE sector – Finance, Insurance, Real Estate. We exist to serve them. Until the FIRE sector completely wrecks the economy (shouldn't be many more years) no substantial structural changes will happen. They will just keep piling bricks on a foundation of sand.

I have never seen or heard any discussion of just what the premiums will be. That is remarkable. Presently we have no idea whether or not working people will be able to actually pay for these policies. I predict many will not. So not only will they continue to not have real access to the medical industry, they will be assessed penalty 'taxes' for being poor. As usual.

How many of the new Medicaid patients will be able to find a doctor that will accept Medicaid? I have see no discussions of this. In Maine, most Medicaid patients are dumped into an HMO-type plan. They literally have to get permission to change providers. Fortunately I have Medicaid due to disability, so I don't have these restrictions. My biggest problem is that I can not see out-of-state providers, so I will never have the oppurtunity to see a real CFS specialist.

Someone mentioned the fact that insurance companies prefer to sell insurance through employers, and really stick it to individual policy holders. There is a simple reason for that: one has to be relatively healthy to keep a job; these are the customers the insurance companies want.

The last time I bought individual insurance in Maine, there was only one company, Anthem, selling those policies. All the others dropped their customers, including me. I have seen nothing that suggests this will change, just a lot of blather about 'insurance exchanges', in other words, a web site listing phone numbers to call and wait on hold for hours.

As always, the devil is in the details, and in the bureaucrats that interpret the regulations that no one can understand, and whether those bureaucrats expect to leave 'public service' for a cushy job in the insurance industry. God I hate being so cynical all the time. There really is bliss in ignorance.

Sallysblooms June 29, 2012 at 1:39 pm

There really is bliss in ignorance.

It doesn't last long if people are not informed. That is how all of this began.

CJB June 29, 2012 at 2:47 pm

Part of the act was to fund a website with information and facts about the plan. A good place to start for information.

http://www.healthcare.gov/

Ema June 29, 2012 at 2:57 pm
SOC

I don't disagree with this overall. :) My experience, however, is that insurance has paid no less (so far) than 80% of the bill. I suppose that depends on your insurance company. The whole medical industry is terribly inconsistent.

It might also depend on how you look at it…My insurance was *meant* to pay 80% out of network. But that was only 80% of what they considered reasonable and customary and not 80% of the actual bill. So in actuality that 80% coverage ended up being about 10% of the total charge.

But of course, as you say, experiences vary as widely as the policies.

It's a racket any way you slice it.

HowToEscape? June 29, 2012 at 4:28 pm
Sushi
Bob

Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise. I imagined that most people would have @Merry's perspective on the issue. Anyway, I'm not expressing a view, because I don't know enough details, and I'm not a US citizen, so it doesn't affect me.

Hi Bob,

I think quite a few of the US citizens on the forum are going to avoid posting on this thread as it could turn easily turn into a political debate. Just to say that the yays and nays here may not statistically reflect opinions.

Sushi

Amen. I did post in this thread … and would like to hit undo on that. Politics gets, err, odorous.

Victronix June 29, 2012 at 9:26 pm
user9876
ggingues

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.
.

It doesn't follow that universal healthcare increases costs. I believe that the US spends around 17% of GDP on healthcare which is just about the highest in the world. This compares with 9.6% for the UK in 2010 of which I believe 8% is spent on the NHS and 1.6% on private provision.

Excellent point.

The only real reason we don't have universal healthcare is that our politicians have to raise fantastically large sums of money, increasingly so every year, and creating a bill did nothing for the profits of those who fund their campaigns — big HMOs, big Pharma, etc. — is basically impossible for the Democrats or the Republicans because their jobs depend on giveaways to their funders.

That's why I vote Green Party, which takes no corporate donations. The Green US presidential candidate is Dr. Jill Stein, a Harvard-trained physician and a leading advocate for single-payer Medicare for All who twice ran against Romney in Massachusetts

Here's what she had to say about the Supreme Court decision on her website:

Stein noted that "Obamacare is based on Romneycare, and as with so much else, Obama implemented a Republican scheme to impose mandates that are a regressive tax on working people. The Roberts Court may call it constitutional, but the mandate is still bad news for our suffering millions. Romneycare has meant that the working poor have seen a health cost increase ten times that of the wealthy. As a physician, I've seen Romneycare in action in my home state of Massachusetts. Forty percent of the people who need health coverage find that it's still too expensive for them. And a quarter of the people who seek payments get denied by their private insurers. It has failed to control costs, and as a result they are raising co-pays and attacking public employee health plans. It's a fiscal and administrative nightmare which has gutted public services in Massachusetts. Schemes developed by health industry lobbyists to enrich themselves will never take care of our real needs.”
http://www.jillstein.org/romneycare_and_obamacare

When Jill debated Romney during the Mass Governor's race, the Boston Globe described her as "the only adult in the room." — http://www.c-spanvideo.org/program/173128-1

SOC June 29, 2012 at 9:54 pm
Ema

It might also depend on how you look at it…My insurance was *meant* to pay 80% out of network. But that was only 80% of what they considered reasonable and customary and not 80% of the actual bill. So in actuality that 80% coverage ended up being about 10% of the total charge.

But of course, as you say, experiences vary as widely as the policies.

It's a racket any way you slice it.

A racket indeed. :rolleyes:

I suppose I'm either fortunate in my insurance or in my choice of physicians. I'm also not in an HMO, which may be beneficial in this case.

However you slice it, though, the medical industry is making money hand over fist and patients are suffering for it.

Valentijn June 30, 2012 at 5:56 am
Sallysblooms

Talking to doctors will really help everyone understand. This will not help anyone. We have seen what happens to other countries.

I live in one of those "other countries", and things are quite good here. My insurance after getting sick now costs half of what it did in the US prior to getting sick. It's a very similar situation to Obamacare – there are private insurers that are required to offer certain services. No one can opt out, people that can't afford it are covered, etc.

I'm not sure what horrible things you think are happening in Europe and elsewhere. Waiting times here to see doctors about the same, as is appointment length. All doctor visits and prescribed meds are fully covered. There's a "deductible" of something like 100 euros for the entire year, except it's actually in the form of a refund if it isn't used. No one takes out their checkbook or debit card in a doctor's office, or a drug store, or a hospital. It's an amazing and safe feeling.

The money to pay for the system comes from all the lucky, currently healthy people, who are also forced to pay into the plan. Then one day they'll be the old sick people, and younger folks will be helping keep their rates low.

So what, exactly, is bad about any of this?

Bob June 30, 2012 at 6:12 am

I don't think that many people in the UK would swap our system for anything else either, and definitely not for the US system.
Sure, it's not perfect, and we complain about it a lot, but overall it really does look after us from birth to death when we really need it.
Personally, I think it's the best thing about our country, and I hold it in very high regard.
Yes, CFS patients are neglected, but I think that's more of a social-care issue and a political corruption issue rather than a health care issue.

Esther12 June 30, 2012 at 6:25 am
Bob

I think that's more of a social-care issue and a political corruption issue rather than a health care issue.

I don't think that the two can be separated so easily. The problems CFS has faced in the UK are a prime example of a more state driven, rather than consumer driven, approach to healthcare. The current US reforms are relatively minor, and don't move the US to anything like the UK model for healthcare, but I do think that the way in which CFS has been treated are a fine example of the problems which can be caused by the UK approach to healthcare, even if they were far from inevitable are could have been easily avoided by a more reasonable approach to patients.

Bob June 30, 2012 at 6:44 am
Esther12

I don't think that the two can be separated so easily. The problems CFS has faced in the UK are a prime example of a more state driven, rather than consumer driven, approach to healthcare. The current US reforms are relatively minor, and don't move the US to anything like the UK model for healthcare, but I do think that the way in which CFS has been treated are a fine example of the problems which can be caused by the UK approach to healthcare, even if they were far from inevitable are could have been easily avoided by a more reasonable approach to patients.

I don't agree. I think a state-driven approach has created a world-class first-rate health care system, at relative low cost, and the UK government set up the NHS in the first place. Not that I'm saying there isn't room for improvement.

I think that the neglect of CFS/ME comes down to two things: resources and corruption…
The corruption re ME/CFS is seen in the US system as well, where ME/CFS isn't properly recognised nationally, and it also seems to be similar throughout many of the health care systems of the world, because a lack of knowledge and ignorance allows the corrupting influences to gain a foothold.
As for resources, I don't think that's easily solved. They have issues re insurance and access to healthcare in the US.
I don't see how you can get a proper consumer-driven health care system. Are there any? Consumers only win when there is proper competitive market, which I doubt you could ever get in a health care market, just as you don't in utility companies, and rail companies.

Esther12 June 30, 2012 at 6:51 am

Most European countries have a mixed system of private insurance and government involvement.

I think that there is a big cultural difference in the UK, where many doctors and patients see their relationships as the benevolent doctor being kindly willing to provide some free treatment, rather than that of a professional being paid to provide a service. The sort of mistreatment seen by many CFS patients in the UK is less likely to occur when patients themselves have more power.

There are different problems which can occur in a more consumer driven approach to healthcare, but fact that CFS seems to have been treated particularly badly in the UK, and the nature of the UK healthcare system, does seem very likely to be related to me.

Bob June 30, 2012 at 7:56 am
Esther12

Most European countries have a mixed system of private insurance and government involvement.

I think that there is a big cultural difference in the UK, where many doctors and patients see their relationships as the benevolent doctor being kindly willing to provide some free treatment, rather than that of a professional being paid to provide a service. The sort of mistreatment seen by many CFS patients in the UK is less likely to occur when patients themselves have more power.

There are different problems which can occur in a more consumer driven approach to healthcare, but fact that CFS seems to have been treated particularly badly in the UK, and the nature of the UK healthcare system, does seem very likely to be related to me.

I can't remember the details, but I think the new NHS bill is supposed to give us freedom to choose our doctors, and gives doctors the freedom to chose service providers. So maybe that will address some of those concerns, if the new system works at all. But I can't help feeling it will be a total disaster.

I agree with what you say about the patient-doctor relationship in the UK. We are often stuck with one doctor (who can dictate our health care) who we see as an authority figure, and who we don't like to argue with in case we upset them and they turn against us. This means that it's an unbalanced relationship, giving the doctor too much power.

I noticed the contrast with the private sector, recently, when my cat had an emergency. I knew she had a stomach problem, relating to fur balls, but I didn't know exactly what the problem was. I went to a vet who couldn't diagnose the problem but wanted me to pay £500 for an investigation into cancer, which I new was highly unlikely to be related to her issues, so I declined the cancer investigation, thinking it was a rip-off. I went back to the vet a second time and they still couldn't diagnose her. So I suddenly realised that unlike the NHS, I could chose another vet! Wow! That's amazing, I thought! I have a choice! How refreshing! (I don't know why I had thought otherwise… I just got confused because it was health care!) So I went to a second vet, but the outcome was exactly the same, and he also wanted me to pay loads for a cancer investigation. Neither of them could offer my cat an endoscopy, for whatever reason I couldn't understand, which I thought would be a simple procedure. Luckily, after years of ME, I don't trust health-care providers any more, so I trusted my own instincts, and observations, more than the vets'. I wouldn't have done so a few years ago. So, feeling a little defeated, and very worried, I finally went to one more vet. "Oh, she might have stomach inflammation", the vet said. "Treat her with this medicine." And guess what… The cat was better in three days.

So that's my only experience of private health care! (Apart from dentists.) The individual vets were useless, but I could shop around.

But I don't think private health care for people works in the same way. It equates to a monopoly, and the system seems to be rigged against the consumer, and the costs are enormous.

Unfortunately, I don't know anything about the European systems, so we might be able to learn something from them. But I still believe that the UK system is one of the best in the world, and one of the cheapest in developed countries. So personally, I think it's a case of "the grass is always greener on the other side", and that each system has pros and cons.

Lou June 30, 2012 at 9:16 am
Valentijn

I live in one of those "other countries", and things are quite good here. My insurance after getting sick now costs half of what it did in the US prior to getting sick. It's a very similar situation to Obamacare – there are private insurers that are required to offer certain services. No one can opt out, people that can't afford it are covered, etc.

I'm not sure what horrible things you think are happening in Europe and elsewhere. Waiting times here to see doctors about the same, as is appointment length. All doctor visits and prescribed meds are fully covered. There's a "deductible" of something like 100 euros for the entire year, except it's actually in the form of a refund if it isn't used. No one takes out their checkbook or debit card in a doctor's office, or a drug store, or a hospital. It's an amazing and safe feeling.

The money to pay for the system comes from all the lucky, currently healthy people, who are also forced to pay into the plan. Then one day they'll be the old sick people, and younger folks will be helping keep their rates low.

So what, exactly, is bad about any of this?

Unlikely you'll get an answer, you're messing up the mess argument.

Esther12 June 30, 2012 at 9:28 am
Bob

So personally, I think it's a case of "the grass is always greener on the other side", and that each system has pros and cons.

Yeah – I think that the UK system is, overall, definitely better than the US system. I was just pointing out what I see as one of the problems with it. It's also possible for people to slip in to being proud of the way their country does things, and over-look the problems that there are with it.

jimells June 30, 2012 at 9:41 am

In theory, U.S. patients can choose their providers, but in practice, well, it frequently doesn't happen. In rural areas there are few providers to choose from, and the number seems to be shrinking, especially for dental care.

I don't know how it is in other areas, but where I live, trying to see a new provider is like applying for a job. I'm not kidding. If the doctor sees something they don't like in one's file (chronic pain, narcotics prescriptions, etc.), that person doesn't get in. According to the Americans With Disabilities Act, this sort of blatant discrimination is illegal, but there is no one to enforce it, so they get away with it.

And it literally takes months to be 'approved'. First they send a fax to the old provider for records. Then they wait for the records. And wait. And wait. When one calls to find out what the delay is, one will be told, "Well, you can't expect us to inconvienence the old provider by bugging them." I offered to send copies from my own files. Nope. The records *Must* come directly from the previous provider. The Medicaid people offered to send records from *their* files. That too was unacceptable. After waiting several months, what arrived was so incomplete as to be useless. At that point, they finally allowed me to bring in records from my own files.

Anyway, after nine years of getting sicker and sicker, I still don't have a diagnosis. My own personal story hardly seems like a ringing endorsement of the U.S. model of the 'free market'. Apparently the U.S. model works for some people, maybe even a few people on this forum, but they are few and far between.

ggingues June 30, 2012 at 5:42 pm
Nielk
Cort

That's a good point. I don't think most do. (Dr. Peterson is a standout in that he actually takes Medicare!) but I don't think that means patients can't get reimbursed by insurance; I think it means they have to give the doctors bills to their insurance companies directly. Does anybody know? Its been a long time since I saw a doctor for ME/CFS…

Drs. Enlander and Natelson in New York accept Medicare too.

Good to hear that a few CFS drs take Medicare.

GG

Sallysblooms June 30, 2012 at 6:27 pm

Would be nice to be able to take down this banner.

Sparrow June 30, 2012 at 7:44 pm

I have to admit that I was a little appalled to hear some of the stuff that people were informally spreading around about healthcare in other countries. Seemed like a pretty disgusting (and TOTALLY misleading) scare tactic. There are tons of countries that have made government involvement in health care work great, and sustain it just fine.

I am Canadian. I have great quality healthcare. I get all the tests, doctor's appointment, specialist referrals, etc. that I need. Cancer, or childbirth, or other recognized health conditions won't cost me a penny. No worries, no additional stress, no bankruptcy from medical bills. Having a pre-existing condition doesn't matter at all. Nobody is denied coverage, and nobody is going broke trying to pay for insurance. Nobody is dying because they can't get access to tests or top notch care.

I myself have needed a number of MRI's, appointments with top specialists, etc., and have been seen promptly and been given everything they had to give me. Many doctors still struggle here with how to approach ME in particular, but that seems to be true around the world. Our wait times are very reasonable, particularly when you take into consideration that the most urgent needs take precedence. That's totally fine with me. If you're actively bleeding from the head, I am happy for you to go first. :) When I've had problems that needed more urgent answers (e.g. sudden hearing loss, or signs of a possible tumor), I've gotten the appropriate testing right away.

Much of the rest of the world is very confused about how someone could be opposed to your new healthcare bill, and sees it as a long overdue step in the right direction. I feel like there are a lot of active misinformation campaigns that go on in the U.S., designed to sway people over to the views that would most benefit a small group of wealthy and influential individuals, at the cost of what would truly be best for other people. I hope that if anyone has questions about what healthcare is really like in other countries, they will be able to find someone here to ask. Because everyone I know here thinks it's great, including several people who moved here from the U.S. and love it.

Hope123 July 5, 2012 at 11:15 pm

I also wanted to add that I worked briefly in healthcare in a two systems in the US where everyone I saw was covered by insurance already. So payment was mostly a non-issue for most patients. On my side, I merely marked the diagnosis, time spent, procedures done, etc. electronically and sent them off into the system. I had no staff who needed to call multiple insurance companies, most of my decisions were not questioned, and the rare times it was, I got to speak to an expert MD who at least understood where I was coming from rather than lower-level personnel or even worse, a clerk with no medical training at all. [It happens.]

I imagine this is the norm for most MDs working outside the US in countries with a national health insurance system. It definitely makes it easier for the clinicians and I can see how paperwork dealing with multiple insurance companies can drive up cost.

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