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奥巴马的健保改革真是拿“富人”开刀吗？
除了“富人”以外，谁不愿意拿“富人”开刀？
奥巴马和支持他的国会和媒体们每天向美国人民灌输的健保改革方案标题都是让“富人”给“穷人”保健买单。
这种马克思主义的阶级斗争哲学在今天的美国如此受到推崇，说明什么问题？
我认为除了说大部分美国人民是一群白痴以外没什么可以解释得更清楚的了。
相比之下，民主党可以说跟黑道老大一样，想怎么样就怎么样，看你们谁敢吭气儿？
奥巴马说，GIVE ME HEALTHCARE REFORM BILL NOW！怎么样，民主党国会议员们屁颠儿屁颠儿地紧忙活儿。巨额赤字算什么，这次是“富人”买单。
谁是“富人”？
按民主党国会的提案，家庭收入$350，000。00，个人收入在$280，000。00的都是“富人”。
这也算“富人”？笑话！
他们是高收入者，但决不是“富人”。 这些人承担着50%的联邦所得税负。把地方各种税加一起，他们收入的50%到60%，全部被政府拿走。这些人很多是小业主，是美国经济的支柱。
拿他们开刀会是什么后果？
很简单，一是破坏美国经济的大动脉，二是制造通货膨胀。在经济衰退的大环境下，增加小主的税负无疑是雪上加霜。业主要么裁员,关门，要么提高物价。裁员,关门就是增加失业，提高物价就会造成通货膨胀。
但问题还不在这里。
奥巴马所谓的保健改革最根本的是个人医疗保险由谁来买单的问题。
有医疗保险，是你的权力(RIGHT)还是你的责任(RESPONSIBILITY)，这才是关键。
奥巴马和他的民主党国会认为，每个人有权力有保险。那么请问，你有权力拥有的保险是你自己拿钱来买还是让别人掏腰包？
你不认为你个人的健康你个人不该负责吗？如果你愿意买保险，你不认为你该自己掏腰包吗？
我想，这个问题我们每个勤劳的华人都会说，自己的身体健康自己负责，自己的保险自己买。
很可惜，奥巴马和支持奥巴马的人不这么认为。他们认为个人的健康要别人负责，自己的保险要别人掏腰包。
你会说，反正我没那么多的收入，这事儿跟我没关系。
也许没直接的关系，间接的绝对有。当你的医生不接受你的保险，或你的病要等等再看因为看病的人太多的时候，当你无法选择你的医生的时候，您再说这事儿跟你没关系，那就是掩耳盗铃了。
再说，由政府管理的医疗保健事业有那个是成功的？ 政府照顾老弱病残的MEDICARE和MEDICAID已经破产了你知道吗？政府给退伍军人的保健也要破产了你知道吗？
有人拿加拿大的全民保险来跟美国个人保险来比，说美国落后，你听说加拿大政府自己都承认全民保险失败吗？ 你知道加拿大人有人生病要来美国人看吗？
当人把个人责任和权力混为一谈的时候，基本上就是胡搅蛮缠了。当政客利用人们贪婪懒惰的心理，打着公平的旗帜要劫富济贫的时候，正直的人民要问一个为什么，要怀疑政客们真实的目的。
很遗憾，大部分美国人民对政治麻木不仁了，不了解也不关心了。就像一个俄罗斯作者写的那样，美国人关心的是明星们的八卦，而对华盛顿在侵犯他们真正的自由权力根本不关心。
当有这么多好吃懒做的美国人和大量不纳税非法移民的存在，当政府惩罚有生产能力的人, 奖励没生产能力的人，这个社会是不会公平的，这个国家是不会有什么竞争力的，这个制度是要土崩瓦解的。
很可惜，世界最强大的国家美国正在朝这个方向走。
更可悲的是，NOBODY CARES。
By 鲁克
奥巴马及其民主党正在力推全民健保法案，不知道打算到美国看病的欧洲人如何想，据说这是美国历史上最大的医疗改革方案，至少要耗资一万五千亿。众议院议长佩洛西甚至骄傲地说，这将是一个“历史性及转变性的”时刻。
让每位美国民众拥有一份负担得起的优质健保，不论他们的收入多少及健康情况，一切都交给政府计划，让政府保障你一切的健康隐忧。
奥巴马确实够“伟大”，在他任内居然要把医疗保险变成美国公民的基本权利。我想天堂里的托马斯-杰弗逊也要懊悔，为什么当初不在《独立宣言》的生命权、自由权和追求幸福的权利，补上医疗保险权。这样两百年多前，美国人就可以拥有健康保障了。而且当时，美国政府没有这么大的财政压力，也不这如此巨额的花费，推行起来会方便很多。
奥巴马象所有政府领导人一样，认为自己政策是具有“前瞻性”的。他自以为这不仅防止了未来美国出现哀鸿遍野，改变了穷人就医无门的状况，而且他自以为果断推行“碳限额交易”新能源政策，不仅可以拯救动物，植物，昆虫以及看不见的微生物，而且可以让地球重新焕发“青”春，人类从此不再担心地球因为发烧发热而自杀。
而且从摇篮到坟墓，即使是穷人也都可以享受到政府免费供应的 “全民健保”，这是一块多么也好用的成人“纸尿布”啊，那么如此一来人们是不是就真的安全了呢？难道这一切都是天上掉的馅饼？政府免费赠送的午餐？
当然不是，一万五千亿谁来买单？奥巴马竞选时说给富人加税，不给中产家庭加税。他的确是给富人加税了，比如全民健保草案对年收入逾百万的人的所得税增加5.4%，对“所谓的富人”（年收入超过28万美元的人）也增加了所得税。
那么他是不是穷人期待的侠盗罗宾汉呢？除了对富人下手，他对穷人也没有闲下手，只不过把他们所得税换成其他形式的税费来盘剥穷人罢了。
年初，奥巴马和民主党掌控的国会通过了扩大SCHIP法案，大幅增加了烟草税，把香烟税增加到156%，让烟民平均每包香烟多付六毛二。而受烟草税影响最大的就是穷人。按照哈佛大学的经济学家Kip Viscusi说法，香烟税的承担对象主要是穷人，根据九十年代的调查，年收入一万元的比年收入五万以上的人在香烟税上多缴一倍的税。而且，奥巴马又在六月签署了反烟的法案，授权美国食品药物总局管制烟草行业，而这项计划，估计在十年内会给烟草行业增加五十亿的税费，这些税费最终恐怕还是由消费买单。
烟草税是所谓道德君子眼中的“原罪税”，但是即便提高了烟税，并没有证据说明，烟民会因此减少，而更多证据表明烟草黑市却因此繁荣，黑社会的暴力事件因此而增加。
还有一个原罪税就是给酒精类饮料税，奥巴马政府出台的草案包括了对酒类加税，而且计划十年内为政府征收六百二十亿的税收，甜饮料也在不例外，奥巴马计划十年内为政府增加五百二十亿的税收。但是，根据麻省理工以及全美经济研究所的经济学家调查，虽然这里没有明显的对个人加税，但是实行国民零售税的政策，冲击巨大的就是穷人，相当于加重了穷人的税负。根据Tax Foundation的2001年估算，联邦酒税相当于给盘剥了穷人家庭0.37%的收入，中产家庭0.12%的收入，而对于较高收入的家庭只相当于 0.02%。
（注:D. Feenberg, A. Mitrusi and J. Poterba, “Distributional Effects of Adopting a National Retail Sales Tax,” Tax Policy and the Economy 10 (1996).）
奥巴马的政策有的不是直接加税，但同样加重了中产阶级以及穷人生活的负担。由众议院通过旨在减少温室气体的奥巴马新能源计划将增加美国家庭的电费支出，根据国会预算局（CBO）的统计，平均每户家庭每年平均多支出一百七十五美金。
而对于中产阶级，那些年收入超过二十万美元的美国人，奥巴马还计划将他们的两项所得税税率分别提高至36%与39.6%，并限制部分可扣除项目的金额，例如取消因为慈善捐赠而抵税的情况。这项计划又将为联邦政府十年内征收到两千七百亿的税收。
加图学者Michael D. Tanner说，奥巴马的医改等于给每个美国人增加了相当于收入的2。5%的税。把所有由于医改法案造成的新税加起来，相当于给全美纳税人增加了5000多亿的税。
奥巴马说要让前总统布什实行的减税政策2010年期满后自动失效之外。而且，他另外计划提高资本利得税和公司税。经济学家斯维亚（John Silvia）指出，提高资本利得税和公司税，必然抑制外国资本流入美国，减缓经济成本及减少工作机会，“如果外国投资者预期我们的税率将会上升，他们在这个国家的投资，就不会像在预期不增税的情况下那么多。这不只对华尔街来说是个坏消息，对整个美国都是。”
奥巴马税富勒贫的政策，犹如胡佛总统的在世。上世纪，美国就是因为胡佛各类加税政策，造成美国投资锐减，民间百业凋零，资本大量涌入腐败的官僚体系，美国经济才从此一步一步滑向了经济大萧条。
by 标-尺-网
you got it!
民主党真虚伪!
http://www.freerepublic.com/focus/f-news/2295751/posts
NO, NO, No! Obama's so call "rich" people who make more than 250k a year are including many small business owners, prefessional, doctors and lawyers. They are the people who work hard and study hard.
Most of rich people I know, my friends, are not born in rich. they are the ones habitually working more than 60 hours a week. They go to school until they are close to 40 yrs old, got doctorate degree and getting paid well. They are the ones getting married late and having kids late because they have to sacrifice they personal life to be successful.
It's not fair to take their hard earned money and give to someone else. Unless you are the one that is waiting for the Free Meals.
http://www.freeourhealthcarenow.com/
Being a Canadian doesn't mean you understand the health care system there better than any of American, just like they are too many idiots American here too.
I know quiet a few canadian doctors who migrated to United States. They think universal health care system may work in Canada, but it sure will not work as well in America. For example, in Texas, 1/3 of population is black, 25% of population is hispanic, and who knows how many more illegals are here. Most of them are under-educated and heavily depend on governement support. In Cananda, people are better educated and not as lazy.
Our tax payers are paying for food stamps, wigs, medicaid and medicare of those people already, why should we pay more?
Can you please read the author's article more throughly? It's the author who mistakely critized Canada's medical system first. As a Canadian who knows more about our own system than some ignorant Americans, I feel like to tell the truth.
Leave us alone, and we'll leave you alone.
Our boarders are so close. Some of our people go to USA to get medical treatments and tons of American seniors have crossed the boarder to buy medicines in Canada. There are also Americans who don't have medical insurance coming here for treatments and we helped them.
Don't take me wrong. I actually like Mrs. Palin who is so funny and make me laugh so many times. If you think her so high, you must wish your children have her IQ and go to the same or simiar level of college she went, what's the name? North Idaho College? who knows where it is?
If you are a canadian, then mind your own business and leave us along. We people here know how to decide what we want or what we don't want at our home. The last thing we want is a lousy healthcare system like yours. If your system is so "good", your politicians or rich people wouldn't have come US for healthcare,period.
BTW, don't mock Sarah Palin like your loony liberal US friends here, they just love to hate Sarah, because Sarah scares the sh*t out of them. Is Sarah your nightmare too??? Yikes!!
If you are a canadian, then mind your own business and leave us along. We people here know how to decide what we want or what we don't want at our home. The last thing we want is a lousy healthcare system like yours. If your system is so "good", your politicians or rich people wouldn't have come US for healthcare,period.
BTW, don't mock Sarah Palin like your loony liberal US friends here, they just love to hate Sarah, because Sarah scares the sh*t out them. Do Sarah is your nightmare too??? Yikes!!
It's not true that the government to tell the patient when to see the doctors. You can see your family doctor any time and the family doctor refers you to see specialists if needed. Depending on the schdule of the specialists and surgeons, patients may have to go on a waiting list, but it's fair to everyone, only the ones in imediate life-critic conditions can get ahead on the list.
My friend with lung cancer got his chemo treatment pretty quick. Some cancer patients who can afford to pay private doctors go to USA or Europe to get quick treatments or treatments with advanced/newest technologies some of which are not availabe in Canada. I am not wrong to say that those patients must have some money because those special cancer centers in USA are very expensive and not every middle-class American can afford it. And lots of company medical insurance may not pay for this kind of treatment. But it's understandable to get better treatments if you have the money. The public medical system takes care of the basic medical needs of everybody, but not in the most advanced form.
If Canada were a 3-rd world contry, like you called it, and all 3rd-world contries were like Canada, what a wonderful world we would live in. No war, no hunger, no Wall street.
Yes, Canada is a third-world country, Hongkong is a small city and Russia is a tiny picture looked out from Sarah Palin's bedroom widnow. And God bless USA, ONLY USA.
这也是为什么我说美国人大部分是白痴的原因之一。
很遗憾，香港只是一个小城市，跟美国能比的只有美国。
奥巴马的公立方案将使私人保险非法化，只有白痴们像吸了大麻似的会拥护它
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT
When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.
It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage.
The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether."
What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.
The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.
With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed.
The public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.
Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives.
It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It's scary to think how many more breaches of liberty we'll come across in the final 1,002.
1. 雇主可以因为有全民保险而不给雇员提供好的private insurance。
2. 于是大家只有两个选择： 去公立医生那里，或者自己掏腰包。
3. 对大多数中产阶级来说，自己掏腰包还是负担不起，只好去公立医生。
4. 于是中产阶级和没有收入的或是低收入的junkie接受同样的公立医疗。
5. 公立医院和公立医生的医疗质量只会随时间而越来越差，因为你和低收入人群同样接受近于免费的医疗服务，那些提供服务的人会觉得你跟领救济差不多，既然是免费，给你差不多看看就行了，谈何质量。而且这些医生等于是给政府工作，懒散，低效，cut corners，各种问题都会出现。小病等三年，大病治不了。--我亲身经历过美国的私立保险制度，和另一国家地区的公立医疗制度，这么说吧，公立医疗系统中我见到的误诊病例和各种frustration真比私立系统多得多。很多人并不知道公立医疗怎么回事，就想当然的以为它好，支持它。不了解情况没有发言权。
not true. cancer patients from Canada who can't wait any longer for the government to tell them when to see doctor come to US to save their life. No just some people with money.
As a canadian, you should know the socialism practice in your country is the key factor that makes Canada a third-world country in a second-world country cloth.
All big canadian business are making money in the US, not in Canada.
very good point, thanks.
thanks.
another misunderstanding case. Poor people has Medicaid from the Ferderal government and no hospital can reject any patient in life-threatening situation.
I don't think you have any idea about US healthcare system. For the poor and elderly, the Federal government has Medicaid and Medicare program. Please get your facts streight.
The problem is,Obama is so ambitions to get everything done (health care bill, enviornmental bill, education, carbon trade, etc) , not only the so call "rich people" has to pay more, everybody eventally has to pay more too.
the result is, bigger government, poor people. Geeze, that is just like chinese government.
everybody knows why health care cost has increase so much over last a few years: illegal immigrant! They are flooding in every major or minor hospitals in the states while we flipping the bills. oh no, they are the potential voters, Obama will only help them to get more health care coverage.
老美一开始寄希望于一张黑色的脸和它所代表的朝气,把美国从经济政治内外交困的泥潭中拔出来,还没过6个月的蜜月期,他们就已经失望了.
奥巴马不是救世主,那些听到他当选时哭得乱期八糟的黑人,印尼人,韩国人,日本人都没有意识到这一点.
===
奥巴马当然也有道理:
1) "富人"赚钱多,也需要其他人的支撑...
2) 这些医药保险费比起打伊拉克的军费比,是很少的! 支持应无问题.
Oops, you just proved yourself a brainless liberal.
Get a reality check before spewing nonsense. moron.
对没钱看病人来说，可看病，比选医生更紧迫，更需要。
Noso：你如果也是小业主的话，那一定是不给雇员健保福利的那种。知道其它小业主为什么支持Obama？因为Obama带给他们降低健保支出的希望。
BO is nothing but a radical S.O.B.
"有医疗保险，是你的权力(RIGHT,here using entitlement may more accurate)还是你的责任(RESPONSIBILITY)，这才是关键。
exact my point. thanks.
Thank you for sharing your story with us.
agree with you!
intersting point, can you explain more in detail?
The problem with the health care system now is too much regulation. my husband is a cancel survivor and he is very against the new "health care reform". people need to wake up and stop this country from spinning out of control!
美国有句名言：“ when you are 20's and you ain't a democrat, you have no heart. But when you are 40's and you ain't a republican, you have no brain. "
The sad thing in the US is that too many people can only see today and cannot see tomorrow, too many people believe in theory (which sounds good) even though this theory does not work in real like (look at Medicare & Medicaid!).
很有意思的观察。
I have just one question for him:
who is going to pay for all this?
Before the U.S. Senate Committee on Commerce, Science and Transportation
June 24, 2009
Mr. Chairman, thank you for the opportunity to be here this afternoon.
My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick - all so they can satisfy their Wall Street investors.
I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand--or even to obtain--information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.
When I left my job as head of corporate communications for one of the country's largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry's charm offensive--which is the most visible part of duplicitous and well-financed PR and lobbying campaigns--may well shape reform in a way that benefits Wall Street far more than average Americans.
A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA's health care division was one of three industry executives who came here to assure members of Congress that they would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton's proposals, they said they enthusiastically supported several specific goals.
Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn't be here today.
Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.
The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ?benefit? ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.
To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later
To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.(1) The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.
They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether - leaving workers uninsured. The practice is known in the industry as ?purging. The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.
An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust's members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.
Purging through pricing games is not limited to letting go of an isolated number of unprofitable accounts. It is endemic in the industry. For instance, between 1996 and 1999, Aetna initiated a series of company acquisitions and became the nation's largest health insurer with 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to ?identify and dump unprofitable corporate accounts, as The Wall Street Journal reported in 2004.(2)
Armed with a stockpile of new information on policyholders, new management and a shift in strategy, in 2000, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna lost 8 million covered lives due to strategic and other factors.
While strategically initiating these cost hikes, insurers have professed to be the victims of rising health costs while taking no responsibility for their share of America's health care affordability crisis. Yet, all the while, health-plan operating margins have increased as sick people are forced to scramble for insurance.
Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer's premium dollars for care the year before.
It's little wonder that insurers try to hide information like that from its customers. Many people fall victim to these industry tactics, but the Houston employer might have known better - it was the Harris County Medical Society, the county doctors' association.
... A study conducted last year by Pricewaterhouse Coopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients.
There are many ways insurers keep their customers in the dark and purposely mislead them - especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage.
An estimated 25 million Americans are now underinsured for two principle reasons. First, the high deductible plans many of them have been forced to accept - like I was forced to accept at CIGNA - require them to pay more out of their own pockets for medical care, whether they can afford it or not. The trend toward these high-deductible plans alarms many health care experts and state insurance commissioners. As California Lieutenant Governor John Garamendi told the Associated Press in 2005 when he was serving as the state's insurance commissioner, the movement toward consumer-driven coverage will eventually result in a ?death spiral? for managed care plans. This will happen, he said, as consumer-driven plans ?cherry-pick? the youngest, healthiest and richest customers while forcing managed care plans to charge more to cover the sickest patients. The result, he predicted, will be more uninsured people.
In selling consumer-driven plans, insurers often try to persuade employers to go ?full replacement,? which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them.
Secondly, the number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance. The industry is insistent on being able to retain so-called ?benefit design flexibility so they can continue to market these kinds of often worthless policies. The big insurers have spent millions acquiring companies that specialize in what they call ?limited-benefit? plans. An example of such a plan is marketed by one of the big insurers under the name of Starbridge Select. Not only are the benefits extremely limited but the underwriting criteria established by the insurer essentially guarantee big profits. Pre-existing conditions are not covered during the first six months, and the employer must have an annual employee turnover rate of 70 percent or more, so most of the workers don't even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don't pay any of the premiums--the employees pay for everything. As Consumer Reports noted in May, many people who buy limited-benefit policies, which often provide little or no hospitalization, are misled by marketing materials and think they are buying more comprehensive care. In many cases it is not until they actually try to use the policies that they find out they will get little help from the insurer in paying the bills.
The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders--those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay--are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.
Thank you, Mr. Chairman, for beginning this conversation on transparency and for making this such a priority. S. 1050, your legislation to require insurance companies to be more honest and transparent in how they communicate with consumers, is essential. So, too, is S. 1278, the Consumers Choice Health Plan, which would create a strong public health insurance option as a benchmark in transparency and quality. Americans need and overwhelmingly support the option of obtaining coverage from a public plan. The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a ?government-run system. But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.
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1 Samuel Zuvekas and Joel Cohen, "Prescription Drugs And The Changing Concentration Of Health Care Expenditures," Health Affairs, 26 (1) (January/February 2007): 249-257.
2 "Behind Aetna's Turnaround: Small Steps to Pare Cost of Care," Wall Street Journal, August 13, 2004.
Thanks. FYI:
House Democrats on Tuesday rolled out a far-reaching $1.5 trillion plan that for the first time would make health care a right and a responsibility for all Americans, with medical providers, employers and the wealthiest picking up most of the tab.
The federal government would be responsible for ensuring that every person, regardless of income or the state of their health, has access to an affordable insurance plan. Individuals and employers would have new obligations to get coverage, or face hefty penalties.
Health care overhaul is President Barack Obama's top domestic priority, and his goal is to slow rising costs and provide coverage to nearly 50 million uninsured Americans.
Democratic leaders said they would push the measure through committee and toward a vote in the full House by month's end, while the pace of activity quickened on the other side of the Capitol.
Senate Majority Leader Harry Reid said he wanted floor debate to begin a week from Monday. Other officials said that timetable was likely to slip. Even so, it underscored a renewed sense of urgency.
The House legislation unveiled by Speaker Nancy Pelosi and other Democrats would slow the growth of Medicare and Medicaid payments to medical providers. From big hospitals to solo physician practices, providers also would be held to account for quality care, not just ordering up tests and procedures. Insurance companies would be prohibited from denying coverage to the sick. The industry also would face stiff competition from a new government plan designed along the lines of Medicare.
The liberal-leaning plan lacked figures on total costs, but a House Democratic aide said the total bill would add up to about $1.5 trillion over 10 years. The aide spoke on condition of anonymity to discuss the private calculations. Most of the bill's costs come in the last five years after the 2012 presidential election.
The legislation calls for a 5.4 percent tax increase on individuals making more than $1 million a year, with a gradual tax beginning at $280,000 for individuals. Employers who don't provide coverage would be hit with a penalty equal to 8 percent of workers' wages with an exemption for small businesses. Individuals who decline an offer of affordable coverage would pay 2.5 percent of their incomes as a penalty, up to the average cost of a health insurance plan.
With Obama pressing Congress to act on health care this summer, House leaders want to move their bill quickly through three committees and to a floor vote before the August congressional recess. But a group of moderate and conservative Democrats has withheld support, and no Republican votes are expected.
The House bill seemed unlikely to win broad backing in the Senate, where the Senate Health, Education, Labor and Pensions Committee was expected to finish its version of the legislation Wednesday in what was looking to be a party-line vote. Another panel, the Senate Finance Committee, was striving to unveil a bill by the end of the week.
Standing before a banner that read "Quality Affordable Care for the Middle Class," Pelosi, D-Calif., called the moment "historic and transformative." The bill would provide "stability and peace of mind" by braking costs and guaranteeing coverage, she said.
"We are going to accomplish what many people felt wouldn't happen in our lifetime," said House Energy and Commerce Committee Chairman Henry Waxman, D-Calif., one of the main sponsors. Obama, who issued a statement hailing the measure, plans to keep up the pressure on Congress by delivering remarks in the Rose Garden on Wednesday.
Speaking in Warren, Mich., where he was promoting new spending for community colleges, Obama anticipated a congressional confrontation over health care.
"There's going to be a major debate over the next three weeks," he said, deviating from his prepared text. "And don't be fooled by folks trying to scare you saying we can't change the health care system.We have no choice but to change the health care system because right now it's broken for too many Americans."
Separately, Obama spoke by telephone with Sen. Charles Grassley, the Iowa Republican viewed as critical to the fate of bipartisan negotiations in the Senate.
House Democrats said the income tax increase in their bill would apply only to the top 1.2 percent of households, those who earn about one-quarter of all income. The wealthiest 4 percent of small business owners would be among them. The tax would start at 1 percent for couples making $350,000 and individuals earning $280,000, ramp up to 1.5 percent above $500,000 of income, and jump to 5.4 percent for those earning above $1 million.
The tax would raise an estimated $544 billion over 10 years.
Business groups and the insurance industry immediately assailed the legislation. In a letter to lawmakers, major business organizations branded the 1,000-page bill a job-killer. Its coverage mandate would automatically raise the cost of hiring a new worker, they said.
"Exempting some micro-businesses will not prevent this provision from killing many jobs," the letter said. "Congress should allow market forces and employer autonomy to determine what benefits employers provide, rather than deciding by fiat."
The business groups also warned that the U.S. health care system could be damaged by adding a government-run insurance plan and a federal council that would make some decisions on benefits, as called for in the legislation. Thirty-one organizations signed the letter, including the U.S. Chamber of Commerce, the Business Roundtable representing top corporate CEOs and the National Retail Federation.
The House bill would change the way individuals and many employers get health insurance. It would set up a new national purchasing pool, called an exchange. The exchange would offer a menu of plans, with different levels of coverage. A government plan would be among the options, and the exchange would eventually be open to most employers. Insurers say that combination would drive many of them out of business since the public plan would be able to offer lower premiums to virtually all Americans.
But backers of a public plan ? including Obama ? say it would provide healthy competition for the insurance industry.
Under the House bill, the government would provide subsidies to make coverage more affordable for households with incomes up to four times the federal poverty level, or $88,000 for a family of four and $43,000 for an individual. Medicaid ? the federal-state health program for the poor ? would be expanded to individuals and families up to 133 percent of the poverty line. About 17 million people would remain uninsured ? about 6 percent of the population ? and half of them would be illegal immigrants.
The legislation also would improve the Medicare prescription drug benefit by gradually reducing a coverage gap known as the 'doughnut hole.'
The individual and employer coverage requirements would raise about $192 billion over 10 years, the Congressional Budget Office said.
Even before the bill was unveiled, the House Ways and Means Committee announced it would vote on the proposal beginning on Thursday. The panel is one of three that must act before the bill can go to the full House, probably later in the month.
Some House Democrats privately have expressed concern that they will be required to vote on higher taxes, only to learn later that the Senate does not intend to follow through with legislation of its own. That would leave rank-and-file House Democrats up for re-election next year in the uncomfortable position of having to explain their vote on a costly bill that never reached Obama's desk or became law.
by 2009 Associated Press.
您起码有一天没看报了吧，对了，我说的是英文报。: )
就您这破英文，免了吧。
受阶级斗争学说流毒不潜啊。我就不信你有机会话不想当资产阶级。
what a great quote! thanks!
thanks. : )
too bad, that's not my point.