Santorum, from the clips I've seen, didn't a pretty good job of making the case that Obamacare is largely Romneycare applied to the Federal level. (Many of us never questioned that, but oh well.)

Obamacare is, in the current Republican narrative, a massive takeover of health care, tyranny, socialism, etc. So my question is, why did the heritage foundation come up with individual mandate? Is their secret agenda socialist tyranny?

And why up until recently did so many Republicans support a mandate and tout Romneycare as a "market-based" alternative to "govt run health care"?

Seriously, what has changed for so many R's to have done a complete 180 on this? Heck, I'd settle for one of them just *admitting* they've done a 180....

Anytime you hear Republicans (and I am one) refer to a "market-based" solution, that is code for "a big government program managed by Republicans/conservatives". Sometimes that is acceptable for the party bosses, and sometimes it isn't.

Also, you will never get any of them to admit they are doing a 180. That is because they are only halfway through doing a 360.

The individual mandate is a good thing, and one of the best features of Obamacare. If you are going to require coverage of pre-existing conditions, then it is an absolutely mandatory feature.

The individual mandate is being challenged, not because it is the worst part of Obamacare but because it is the easiest part of the bill to attack constitutionally. If it were properly presented as what it really is, a tax, then it would sail through constitutionally. But of course, that would expose rather blatantly that Obama was lying through his teeth when he made the campaign promise not to raise taxes on anyone making less than $250,000.

To me the worst possible outcome would be if the supreme court decided that the mandate was unconstitutional but allowed the rest of the bill to stand. The truly bad parts are the rest of the bill--the vast majority of the rest of the bill. Obamacare without the mandate creates an environment where the private insuarnce industry becomes economically unfeasible pretty quickly. Once that happens, you have the socialist's dream--a single-payer system for everyone. At that point, my solution will be to become a medical tourist, complete with French health insurance policy to pay for it. I've already started the process of obtaining the policy. I guess that is an idicator of how much faith I have in Obamacare to deliver.

What Romney needs to do is a visual where he has two stacks of paper--one 100 pages on which is written the Romneycare bill, and the other 2200 pages on which is written the Obamacare bill. "This {pointing to the Romneycare bill} is clearly not that {pointing to the Obamacare bill}." Why he doesn't make that distinction is beyond me to comprehend.

There are probably 100 pages of good stuff in Obamacare--mostly the 100 pagers that were taken from Romneycare. There are 2100 pages of bad stuff-the rest. Somebody needs to make that point. The Health Choices Commission, the Independent Payment Advisory Boad, the Council on Comparative Outcomes (which was actually part of the "stimulus" rather than Obamacare) are the really bad parts. Yes, they are the real "death panels" that will take your health care decisions away from you and your doctor and put them in the hands of unaccountable bureaucrats--and there will be not one thing you can do about it. And if you think insurance companies like to deny claims to maximize profits, that's nothing compared to the way an unaccountable bureaucrat will deny claims to make budget. As soon as cutting costs becomes a paramount goal, access to quality medical care will disappear in the US. Don't take my word for it, CBO has already made the point. Where? Why, the reports where "CBO said Obamacare will reduce the federal deficit," that's where.

Obamacare basically combines the worst of our present system (tying health insurance to employment) with the worst of a single-payer (like Canada) or single-provider (like UK) system. Our system is not great. Neither are thiers. The much sound-byted WHO study where the US finished 37th (not the "37th best" health care by the way, that's not what the study measured, contrary to the sound byte) is instructive. It was weighted to give far more importance to universal access and equality than to health care quality--as several observers have noted, their factors were set up so that a system where everybody got terrible care would score higher than a system where some people got good care and some got terrible care. Given that bias, Canada and UK should have finished way, way ahead of us. In fact, UK finished 19th and Canada 30th. And both do similarly badly, or worse, up until the present when measured agianst truly quality systems. In two recent rankings comparing Canada with 29 Euroepan countries, Canada finished 30th--and UK 18th. Cosnsitency, but not of a good sort.

The best health care system in the WHO study was France. Today most observers would rate it slightly below the new number 1, Holland. Both, along with Germany, Switzerland, Belgium, Austria, and Luxembourg, all of which are typically ranked in the top ten worldwide systems, follow a very different model, the so-called Bismarck private insurance system. The Heritage model was based on this approach, the Dutch version IIRC. Universal private insurance, with some base level guaranteed by the government and market-based supplements above that. In France, for example, 99+% of the population is covered by the basic government guaranteed program (the exceptions being people in transition who haven't gotten into the system yet), and 90% also purchase free market supplements. Note that the percentage of French people who buy supplemental insurance is higher than the percentage of Americans who buy any health insurance. Their sytem has substantially less direct government involvement than ours did pre-Obamacare. Basically the government functions like an employer does here--collect payroll taxes (deductions) to fund it, then make premium payments to the insurance company selected by each individual.

Of course, this approach was not actively discussed in the run-up to Obamacare. To me, this signifies that the true goal was something other than world-class health care. You may infer a different reason. Perhaps I am being too skeptical. But I don't think so.

I would also point out that the individual mandate for insurance, insofar as I have seen it within romneycare is primarily for catastrophic coverage and not for routine exams. Iow, as I understand it, going to the doc-in-a-box for a cold or physical and paying out of pocket while protecting the country from needing to fork over 7 figures for an accident or cancer or the like is legal under romneycare, but illegal under Obamacare. I could be wrong, not having looked closely at romneycare, but that is what I understand.

And yes... Call it a tax or merely quadruple Medicaid premiums and it passes constitutional muster

FTR, I don't believe there is an actual war on Christianity... But I DO believe that certain other religions and movements that are being granted freedoms and preferences not given to others. Bigotry is bigotry, and reverse bigotry doesn't make it better, but worse. IMO, LOTS of groups claiming to seek tolerance are incredibly intolerent of dissenting opinions.

(01-27-2012 02:10 PM)Hambone10 Wrote:  I would also point out that the individual mandate for insurance, insofar as I have seen it within romneycare is primarily for catastrophic coverage and not for routine exams. Iow, as I understand it, going to the doc-in-a-box for a cold or physical and paying out of pocket while protecting the country from needing to fork over 7 figures for an accident or cancer or the like is legal under romneycare, but illegal under Obamacare. I could be wrong, not having looked closely at romneycare, but that is what I understand.

This is not correct.

Here is the minimal coverage required under Massachusetts Law: https://www.mahealthconnector.org/portal...ements.pdf

As you can see, the constraints basically define plans as needing to follow a PPO, HMO or traditional FFS model with limits on the deductible ($2000 max) and out of pocket ($5000 max) and requiring that any high co-payments (over $100) apply toward the deductible. In addition, basically all standard aspects of medical care must be included in the coverage.

Quote:MCC-compliant plans must provide coverage for a broad range of medical services.
There must be some level of coverage for:

• Ambulatory patient services, including outpatient day surgery and related anesthesia
• Diagnostic imaging and screening procedures, including x-rays
• Emergency services
• Hospitalization, including at a minimum, inpatient acute care services which are generally provided by an acute care hospital for covered benefits in accordance with the member's subscriber certificate or plan description
• Maternity and newborn care
• Medical/surgical care, including preventative and primary care
• Mental health and substance abuse services
• Prescription drugs
• Radiation therapy and chemotherapy
  

There are limits on what a subscriber will pay for in-network services:

• Annual deductibles cannot be more than $2,000 for an individual and $4,000 for a family for services received in-network
• For plans with up-front deductibles or co-insurance on core services, there is an annual maximum on out-of-pocket spending of no more than $5,000 for an individual and $10,000 for a family for services received in-network
• The out-of-pocket maximum must include all co-payments over $100, co-insurance and deductibles for in-network services, but does not include prescription drugs
• For plans that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family
• Doctor visits for preventive care must be provided prior to the deductible
  

There can be no limits or caps on:

• Prescription drug benefits
• The total amount paid for a particular illness or for benefits in a single year
• Certain services, such as a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges
  

The broad range of medical services must be available to all people covered by the plan. For example, if a plan covers dependents, it must include maternity services for the pregnant daughter of the subscriber.

If after reviewing the plan benefit summary, you do not know whether the plan meets MCC, contact your employer or your insurer.

Thank you for the correction. I will look more closely

(01-27-2012 06:03 PM)texd Wrote:  Here is the minimal coverage required under Massachusetts Law: https://www.mahealthconnector.org/portal...ements.pdf
As you can see, the constraints basically define plans as needing to follow a PPO, HMO or traditional FFS model with limits on the deductible ($2000 max) and out of pocket ($5000 max) and requiring that any high co-payments (over $100) apply toward the deductible. In addition, basically all standard aspects of medical care must be included in the coverage.

Quote:MCC-compliant plans must provide coverage for a broad range of medical services.
There must be some level of coverage for:

• Ambulatory patient services, including outpatient day surgery and related anesthesia
• Diagnostic imaging and screening procedures, including x-rays
• Emergency services
• Hospitalization, including at a minimum, inpatient acute care services which are generally provided by an acute care hospital for covered benefits in accordance with the member's subscriber certificate or plan description
• Maternity and newborn care
• Medical/surgical care, including preventative and primary care
• Mental health and substance abuse services
• Prescription drugs
• Radiation therapy and chemotherapy
  

There are limits on what a subscriber will pay for in-network services:

• Annual deductibles cannot be more than $2,000 for an individual and $4,000 for a family for services received in-network
• For plans with up-front deductibles or co-insurance on core services, there is an annual maximum on out-of-pocket spending of no more than $5,000 for an individual and $10,000 for a family for services received in-network
• The out-of-pocket maximum must include all co-payments over $100, co-insurance and deductibles for in-network services, but does not include prescription drugs
• For plans that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family
• Doctor visits for preventive care must be provided prior to the deductible
  

There can be no limits or caps on:

• Prescription drug benefits
• The total amount paid for a particular illness or for benefits in a single year
• Certain services, such as a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges
  

The broad range of medical services must be available to all people covered by the plan. For example, if a plan covers dependents, it must include maternity services for the pregnant daughter of the subscriber.

If after reviewing the plan benefit summary, you do not know whether the plan meets MCC, contact your employer or your insurer.

My gut feel reading this is that these standards are way too restrictive.