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President Obama's Health Care Plan: Soup to Nuts · Stuff You Should Know

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Speaker 1: Brought to you by the reinvented two thousand twelve camera.
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Speaker 1: It's ready. Are you welcome to Stuff you Should Know
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Speaker 1: from House Stuff Works dot Com. Hey, and welcome to
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Speaker 1: the podcast. I'm Josh Clark. With me, as always is
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Speaker 1: Charles W. Chuck Bryant, Doctor. And with Charles W. Chuck
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Speaker 1: Bryant is Molly Edmonds of Stuff Mom Never Told You Fame,
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Speaker 1: one of our sister podcasts, and Molly has also been
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Speaker 1: doing more research into healthcare reform than me, Chuck and
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Speaker 1: Ram Emanuel Combine. So we're glad to have you here. Molly.
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Speaker 1: I think I could take down but you could. He's
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Speaker 1: a bulldog. Yeah, but I've seen you. Have you seen
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Speaker 1: her leg wrestle? No, but startling. I've been behind me
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Speaker 1: in front of her sights. Sure, I'm not a pleasant day. Yeah,
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Speaker 1: I have to chuck it, which is why we're scared
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Speaker 1: of Molly. But we're glad she's here, right Maum, I hope,
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Speaker 1: So I hope you're glad I'm here. We're also glad
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Speaker 1: you're here because, like the Necronomicon podcast, we intend to
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Speaker 1: use you as a shield. Just to get that out
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Speaker 1: of the way, let's talk about healthcare form. All right.
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Speaker 1: I want to also say that we are not going
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Speaker 1: to be discussing any of the politics in this one.
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Speaker 1: This is part two, you lie. Except for that part. Um,
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Speaker 1: We're not going to be discussing any of the politics.
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Speaker 1: What we're gonna do is simply present, uh, the proposals
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Speaker 1: that are in play right now. And then Part three
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Speaker 1: is going to be criticisms, pros cons maybe other ideas
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Speaker 1: for fixing the health care system. And then part four
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Speaker 1: is what I'm excited about, myths and truths. Yes, yeah,
1:37
Speaker 1: we're going to be talking about just outright lies, things
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Speaker 1: that are kind of on the fence, and things that
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Speaker 1: actually are true but are discussing. Um, so let's talk
1:46
Speaker 1: about Obama's proposal. Is it even Obama's proposal? You know,
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Speaker 1: Obama has made this a priority in his presidency, but
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Speaker 1: big time, but he has not come down from on
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Speaker 1: high with a massive plan for us all to reactive.
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Speaker 1: You know who did do that? The Clintons. The Clintons did,
2:02
Speaker 1: that's right, and Moses Moses. Uh, that was on the
2:05
Speaker 1: third tablet right yea, Um there tablet was dropped. Yeah,
2:09
Speaker 1: the Clintons actually wrote legislation and we're peddling it around
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Speaker 1: Capitol Hill in the nineties and it didn't work. That
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Speaker 1: that plan didn't work, So clearly Obama learned from his predecessors, right, right,
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Speaker 1: So Obama has laid out eight principles. This is what
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Speaker 1: he did early on. I think this has gotten lost
2:25
Speaker 1: in all the hubbu but he came out with a
2:27
Speaker 1: principles UM and then left it to Congress as five
2:30
Speaker 1: companies from Congress to create plans. And then in the
2:33
Speaker 1: week we're recording this, he came out and made this
2:35
Speaker 1: mega speech that's come up with you know, all this attention.
2:38
Speaker 1: So now the week we're recording this, Obama has come
2:40
Speaker 1: back out with the speech and made it made it
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Speaker 1: look like it's a little bit more of his plan,
2:43
Speaker 1: tried to wrestle control away from you know, the media spin.
2:46
Speaker 1: He's saying what he wants in a plan, what he
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Speaker 1: doesn't want, what he's open to compromise about. UM. But
2:51
Speaker 1: let's start in campaign mode. He was he's definitely back
2:54
Speaker 1: from vacation. Yeah, yeah, So should we talk about his
2:58
Speaker 1: A proposals. Let's let's say, I mean, what we're talking
3:01
Speaker 1: about A thousand pages pages are so of legislation right now, right,
3:06
Speaker 1: we got we got two bills on the table from
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Speaker 1: four committees. And when he says there are four committees
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Speaker 1: who have come up with bills, one of the bills
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Speaker 1: is a try committee bill, so that's where that comes from.
3:16
Speaker 1: Three committees came up with one bill um from the
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Speaker 1: House HR three two zero zero, and then the Senate
3:21
Speaker 1: has a bill. I have to point this out. I'm sorry,
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Speaker 1: Molly didn't even look at her notes to writt along
3:25
Speaker 1: that bill number. I'm just gonna excuse myself to dream
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Speaker 1: about HR three two zero zero. I bet you do.
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Speaker 1: At this point she didn't look at her notes again.
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Speaker 1: And you know what I have anxiety dreams about is
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Speaker 1: the upcoming Senate Finance Committee bills. So by the time
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Speaker 1: people hear this, that bill might become might be out.
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Speaker 1: It's the trifecta. It's the one everyone's waiting for because
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Speaker 1: it's a bipartisan committee. Um being the Senate Finance Committee,
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Speaker 1: they have to say how they're going to pay for it,
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Speaker 1: which the other bills were not as on the hook for.
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Speaker 1: So you know that's the one everyone's waiting on. Beta breath. Yeah. Actually,
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Speaker 1: I saw today breaking news was that the chairman of
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Speaker 1: that commit. The Democrat Max Bacchus basically said, we're pushing
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Speaker 1: through with this very soon, and it doesn't matter if
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Speaker 1: I have Republican sport or not. We're gonna push it
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Speaker 1: through and we'll have it for a review by the
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Speaker 1: twenty one September. So wow, that's the latest word. Yeah,
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Speaker 1: I have dreams about Max. Now do you really that's nice?
4:18
Speaker 1: So um, anyway, that's a personal note. So Obama says,
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Speaker 1: here the here are the eight things that he saw
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Speaker 1: that he wanted in the plan. Okay, he wanted to
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Speaker 1: assure affordable, quality health coverage for all Americans. You guys
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Speaker 1: want to I'll do one, yeah, yeah, I'll go next.
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Speaker 1: He wants to remove obstacles to coverage for people with
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Speaker 1: pre existing conditions. He wants to invest in prevention and wellness.
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Speaker 1: He wants to maintain coverage in the event of job
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Speaker 1: loss or change. He wants to kill your grandparents. Oh,
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Speaker 1: I'm sorry. Now. He wants to improve quality care and
4:50
Speaker 1: patient safety. Right uh? And uh, let's see. He wants
4:54
Speaker 1: to guarantee choice of doctors and coverage plans, right yes,
4:58
Speaker 1: and safeguard families from bankruptcies related to health expenses. I
5:02
Speaker 1: think that's seven. He wants to the final one he
5:04
Speaker 1: wants to shrink long term cost increases in healthcare for
5:08
Speaker 1: businesses and the government. So those are pretty um broad principles.
5:13
Speaker 1: I think you'd be hard pressed to find someone who
5:16
Speaker 1: would disagree with these principles just it's got and theory.
5:20
Speaker 1: But then the Congress had the hard job of making
5:22
Speaker 1: them into bills. So we have that thousand pages of
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Speaker 1: legislation as it stands right now, not including the Senate
5:29
Speaker 1: Finance committment, without the Senate Finance correct in Brail, which
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Speaker 1: was she taught herself, had translated and then read in.
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Speaker 1: So so let's talk about how Congress did take these
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Speaker 1: eight principles and turn them into healthcare. As you were saying, um,
5:47
Speaker 1: let's start with individuals. One of the big things is
5:50
Speaker 1: that everyone, Both of both of the proposals that are
5:53
Speaker 1: out right now say that everyone has to have health insurance. Yeah,
5:57
Speaker 1: it's an individual mandate, and you know it's it's sort
6:00
Speaker 1: of borrowing an idea from car insurance. If we've all
6:02
Speaker 1: got to carry car insurance, then you know, what's what's
6:04
Speaker 1: health insurance in addition to that? Right, So if you
6:07
Speaker 1: don't have health insurance. You don't have to stormtroopers aren't
6:11
Speaker 1: going to come to your house and beat your kids
6:12
Speaker 1: in front of you. But the tax man, well right, yeah,
6:15
Speaker 1: because I think the Senate bill says you pay seven
6:19
Speaker 1: fifty dollars a year in tax penalties for not having insurance.
6:23
Speaker 1: And then the house plan is I think up to
6:26
Speaker 1: two point five percent of your adjusted income. Yeah, but
6:32
Speaker 1: no more than the lowest price plan. Right, Like, they're
6:36
Speaker 1: not going to charge you more than you would have
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Speaker 1: to pay your health insurance, right, I mean, if you
6:39
Speaker 1: if you can pay the premium and taxes, essentially you
6:42
Speaker 1: could just pay the premium. Well that's the way I
6:44
Speaker 1: took it is we're going to get some money, so
6:46
Speaker 1: you might as well, hint, hint, to go spending on
6:48
Speaker 1: healthcare ether than funding the I R S. Right, But
6:51
Speaker 1: now most people already have health insurance. The majority people
6:54
Speaker 1: get it from their employers, and so that's pretty easy
6:56
Speaker 1: to to meet that requirement, right, But we don't want
6:59
Speaker 1: the employer to just chicken out, So employers have a
7:02
Speaker 1: mandate as well, exactly. So now we have to mandates
7:05
Speaker 1: employer and individual. And I heard actually the Senate Finance
7:09
Speaker 1: is not going to have an employee an employer mandate,
7:12
Speaker 1: and that's why businesses are probably gonna be a little
7:14
Speaker 1: more favorable that I said. You know, that's one of
7:16
Speaker 1: the theories that that's what killed Clinton's bills. You know,
7:18
Speaker 1: it's a job killer, right, So um, but that that
7:21
Speaker 1: sounds kind of political. So let's just back off and
7:24
Speaker 1: say you're an employer, you're in an individual, You've got
7:27
Speaker 1: this mandate. What if you can't afford it? Well, there's subsidies. Yes, Well,
7:31
Speaker 1: not only subsidies. I mean, if you are going to
7:33
Speaker 1: mandate that everybody has to have health insurance, you have
7:36
Speaker 1: to make exemptions for certain people. Um, but you also
7:40
Speaker 1: we already have Medicaid Medicare, so that covers automatically a
7:44
Speaker 1: certain percentage of Americans. But they're also expanding Medicaid, right,
7:48
Speaker 1: I think two power Yeah, that is the current Senate
7:52
Speaker 1: plan would be a hundred about the federal power level,
7:55
Speaker 1: and the House would do a hundred of the federal
7:58
Speaker 1: powery level. Right. And they're also planning on kind of
8:00
Speaker 1: cleaning house in those two systems, right and making them
8:03
Speaker 1: more efficient and cheaper. Yes, hopefully. Yeah, Well we'll get
8:08
Speaker 1: to that when we start talking about how this is
8:09
Speaker 1: going to be paid for? UM. But let's talk about
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Speaker 1: subsidies for individuals. UM. Let's say that, Oh, I don't know,
8:18
Speaker 1: I make three hundred and fifty percent income above the
8:22
Speaker 1: federal poverty level. Right, Well, I know they're to dream.
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Speaker 1: Will will I be eligible for subsidies? Yes? Yes, Okay,
8:32
Speaker 1: So I think it goes from Uh, let's say if
8:35
Speaker 1: we're going with a hundred and fifty percent above poverty level. Uh.
8:39
Speaker 1: From that to poverty level you're covered by medicaid. From
8:42
Speaker 1: a hundred up to what is it? Uh, you're eligible
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Speaker 1: for subsidies on a sliding scale only. Right. What they
8:50
Speaker 1: do is, obviously, if you make a little bit more money,
8:52
Speaker 1: if you're closer to that level of the federal poverty level,
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Speaker 1: you will pay a greater amount of the premium than
8:58
Speaker 1: if you were just making a hundred five of the
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Speaker 1: federal pobby level. So in the House Committee, for example,
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Speaker 1: you get your subsidy, but you will pay Let's say
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Speaker 1: you were at three fifty, You're gonna people still paying
9:09
Speaker 1: your income toward the thing, and but then you also
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Speaker 1: get a subsidy to cover the rest of the premium.
9:17
Speaker 1: Kind Of like when I go to my shrink and
9:19
Speaker 1: I say, dude, I make a year and he doesn't
9:21
Speaker 1: charge me as much as the physician. It comesn't after me. Yeah,
9:25
Speaker 1: that's actually a really good point, Chuck, that there's a
9:27
Speaker 1: lot of um, a lot of key points in these
9:30
Speaker 1: proposals are already in effect in some ways either um
9:35
Speaker 1: de facto like your your shrink charging you on a
9:39
Speaker 1: sliding scale, or you know, um mandates about everyone having
9:43
Speaker 1: to have insurance like that the Massachusetts experiment. Right, So
9:47
Speaker 1: this is kind of taking a lot of maybe good
9:49
Speaker 1: ideas and putting them together, a good ideas being a
9:53
Speaker 1: very political way to put it. Right, what's the Massachusetts
9:56
Speaker 1: experiment where everyone has to have insurance? I don't think
9:59
Speaker 1: I knew that? Yeah, wow, Yes, And you know, that's
10:02
Speaker 1: probably a good thing for you guys to discuss in
10:03
Speaker 1: the next podcast, because I mean, is the Massachusetts a
10:06
Speaker 1: success in terms of its health insurance? So, um, where
10:12
Speaker 1: is everybody going to get this insurance? There's an insurance
10:14
Speaker 1: marketplace that's being set up, right, Yeah, this is sort
10:17
Speaker 1: of the new big thing. Um. So the insurance marketplace
10:19
Speaker 1: is sort of this attempt to have the general public
10:23
Speaker 1: get their insurance the same way that Congress people do, right,
10:26
Speaker 1: because essentially, when you become elected to Congress, you are
10:29
Speaker 1: presented with five plans. Are not not five, that's not
10:33
Speaker 1: I mean it's not a specific number. But basically you're
10:35
Speaker 1: offered all these plans that tell you exactly how much
10:37
Speaker 1: it's going to cost and what benefits are provided. And
10:40
Speaker 1: it's very easy to use. Yeah, I think plain language
10:43
Speaker 1: is one of the provisions in at least the House
10:46
Speaker 1: Bill Transparency Plan language. Yeah, like you have to say
10:50
Speaker 1: this is what's covered, and this is what's not covered,
10:53
Speaker 1: and this is what you get for what you pay for. Right. Like,
10:56
Speaker 1: plain language is a really big part of this. So
10:59
Speaker 1: if you're trying to fulfill your individual mandate, you will
11:02
Speaker 1: look at all these plans and say, well, I want
11:03
Speaker 1: this one because I know it costs this much and
11:05
Speaker 1: I know that this, this, and this and is covered.
11:08
Speaker 1: And in both of these bills, every plan that's in
11:11
Speaker 1: that marketplace will will have a certain set of minimum
11:15
Speaker 1: benefits that it wills that have to be in there,
11:19
Speaker 1: and then there will be plans that are better than
11:21
Speaker 1: that in terms of maybe you want you know, spaw
11:24
Speaker 1: days covered or something like that you can pay to
11:26
Speaker 1: get that extra. But let's say you just want to
11:28
Speaker 1: be able to go get you know, a mammogram under
11:31
Speaker 1: your health insurance plan. That's probably closer to what's going
11:34
Speaker 1: to be considered an essential benefit that has to be
11:36
Speaker 1: in the plan, right and it gets will get into
11:38
Speaker 1: this obviously latter two. But that's getting a little political
11:40
Speaker 1: as well, with what can be covered and what's not right. Right,
11:42
Speaker 1: But let's just for the time being called the minimum benefits,
11:45
Speaker 1: because what we're what these proposals give the government license
11:50
Speaker 1: to do, is to define what these minimum standards of
11:54
Speaker 1: health insurance are, and eventually all health insurance plans, if
11:57
Speaker 1: you are have an existing one, it will I have
12:00
Speaker 1: about five years to meet these requirements as well, right,
12:03
Speaker 1: but it won't change it first. Right now, they have
12:05
Speaker 1: about a five year window grandfathered in for several years. Right.
12:09
Speaker 1: And you staid in your article how healthcare reform works that, um,
12:13
Speaker 1: these basic requirements will keep the marketplace from becoming like
12:17
Speaker 1: a dumping ground for shoddy policies, right right, You know,
12:21
Speaker 1: we don't want anyone in the marketplace who already maybe
12:23
Speaker 1: doesn't have a job or can't afford regular insurance to
12:26
Speaker 1: just be stuck with sort of um crappy coverage. I mean,
12:31
Speaker 1: the whole point of this plan, whether you have insurance
12:33
Speaker 1: or you don't have insurance. And Obama's point of view
12:35
Speaker 1: is to strength and health insurance for everyone. Right, So obviously,
12:39
Speaker 1: if you don't have a plan already, you're gonna want
12:41
Speaker 1: sort of that basic care. But you also want to
12:43
Speaker 1: make sure that the people who already have insurance are
12:45
Speaker 1: being protected in the same way, right, right, right? Do
12:47
Speaker 1: you know what insurance everyone should have? What motion picture
12:50
Speaker 1: health and welfare? Is it good? It's like it's better
12:53
Speaker 1: than the army. Did you get Spada? You get massage,
12:57
Speaker 1: spa days, you get like Manny Petties paid for it. Actually,
13:00
Speaker 1: because this is the first I've ever heard of spot date,
13:02
Speaker 1: I think there's a sushi clause. You know, in Germany,
13:06
Speaker 1: spots are included universal health care. That's wonderful. Um, small businesses,
13:13
Speaker 1: you were saying that that businesses are going to have
13:15
Speaker 1: a mandate to provide health insurance. Uh, they're also going
13:19
Speaker 1: to be allowed to, um, go to this insurance marketplace
13:22
Speaker 1: to select as well. Right, employers are going to be
13:25
Speaker 1: subject to a payer play requirement where if you don't
13:29
Speaker 1: provide health insurance for your employees. You're gonna have to
13:31
Speaker 1: pay into a fund for all your employees who don't
13:34
Speaker 1: have health insurance. Now, this would probably be a job
13:37
Speaker 1: killer if it were to be applied to small businesses.
13:39
Speaker 1: So small businesses will be exempt from this requirement, right.
13:42
Speaker 1: I think Obama said small businesses in the US will
13:45
Speaker 1: be exempted his recent speech, right, So, um, and and
13:49
Speaker 1: the Senate and the House to find small businesses differently
13:52
Speaker 1: in their current plan. They might look at how many
13:54
Speaker 1: employees you have. They might look at your you know,
13:57
Speaker 1: income per year. I think if you make more than
13:59
Speaker 1: two dollars a year, you wouldn't be considered a small
14:02
Speaker 1: business under this exemption. Um. But you know, that's that's
14:05
Speaker 1: probably gonna be one of the things that's ironed out
14:07
Speaker 1: and re examine pretty closely in the reconciliation of these
14:10
Speaker 1: two bills. But um, they would also be eligible to
14:14
Speaker 1: enter this marketplace and provide insurance to their employees with
14:18
Speaker 1: the help of subsidies. Okay, And like people, those employers
14:22
Speaker 1: that decide I'm not doing this, they are going to
14:25
Speaker 1: have to pay, and that money will be contributed to
14:28
Speaker 1: the insurance marketplace, right right, So either way, it's provide,
14:32
Speaker 1: like you said, pay your play. Um. So in this marketplace,
14:36
Speaker 1: let's all pretend that we're in there right now. Okay, closure, closure,
14:39
Speaker 1: This is nice. Do you see all these little logos,
14:42
Speaker 1: like there's Etna's logo, there's Snoopy, say hi to Snoopy.
14:46
Speaker 1: Um do you see this one? What is that? Like
14:48
Speaker 1: a screaming eagle with a bandaged head with the us
14:52
Speaker 1: of a that is new or it would be if
14:55
Speaker 1: this thing gets past. That's the public option, right, yes,
14:58
Speaker 1: the public option has in one of the more controversial
15:01
Speaker 1: parts of all these bills. Correct, yes, okay, so it's controversial.
15:07
Speaker 1: What's what's what does it entail? What's going on here?
15:09
Speaker 1: So the point of having this marketplace is one way
15:12
Speaker 1: that Obama thinks we can keep our insurance companies honest
15:15
Speaker 1: and competitive, because if you're competing against people, then you
15:18
Speaker 1: will provide good service for good value. Makes sense? Makes sense? Now,
15:23
Speaker 1: Obama thinks that one way to ensure that this happens
15:25
Speaker 1: is to also introduce this public health insurance option. Um.
15:28
Speaker 1: So that it's a government run option that will have
15:32
Speaker 1: lower rates probably. Um Now, obviously right there, you're going
15:35
Speaker 1: to have some contention about what the rate should be
15:37
Speaker 1: because kind of private ensure compete with UM. You know,
15:41
Speaker 1: a public ensure will have sort of the government um
15:45
Speaker 1: stamp of approval that might make it impervious to any
15:48
Speaker 1: sort of attack or disaster. UM. But the thinking is
15:52
Speaker 1: is that, you know, similar to the way we provide
15:54
Speaker 1: Medicare and Medicaid for certain people, that we would have
15:57
Speaker 1: this option for people to UM get health insurance at
16:01
Speaker 1: a pretty pretty affordable cost set by the government. But
16:04
Speaker 1: we don't know what cost that would be yet, So
16:07
Speaker 1: you really can't get into an argument about whether insurers
16:09
Speaker 1: could compete. Are the financials not really set on this yet. No,
16:12
Speaker 1: And you know, if you've been following the news, this
16:14
Speaker 1: is probably the thing you see that, oh it's been dropped.
16:16
Speaker 1: Oh it hasn't been dropped. We might have a co
16:18
Speaker 1: op instead. UM. It's really something to watch. That was
16:21
Speaker 1: something that in the speech Obama said he was willing
16:24
Speaker 1: to negotiate on, so it's still to come. He has
16:27
Speaker 1: said so far though, that it wouldn't be just another Medicare.
16:31
Speaker 1: We wouldn't just have Medicare rates which are about lower
16:34
Speaker 1: than most insurance rates, because that isn't fair to private insurers.
16:37
Speaker 1: It would have to be UM similar to private insurance likely,
16:41
Speaker 1: and it would also UM have to fund itself through premiums.
16:44
Speaker 1: It would be self sustaining because I mean, if you've
16:47
Speaker 1: got federal or injections of federal cash, you're not really
16:50
Speaker 1: competing with anything, right, Yeah, And I think Obama said
16:53
Speaker 1: that he wouldn't back anything to added to the deficit.
16:55
Speaker 1: Is that correct? So that's the public option. Everybody back
17:00
Speaker 1: away slowly. Well, you know one thing that might be
17:03
Speaker 1: interesting to talk about is we always hear Obamas saying
17:06
Speaker 1: that if you like your health insurance, you can keep it,
17:08
Speaker 1: right right, If you like your health insurance, you can
17:10
Speaker 1: keep it. The thing is it is Clinton saying no,
17:15
Speaker 1: if you like your health insurance, you can keep it
17:17
Speaker 1: there much better. But the thing is, let's think about
17:20
Speaker 1: the people who don't like their health insurance and might
17:23
Speaker 1: be thinking, oh, man, a public option sounds pretty good.
17:25
Speaker 1: That's an excellent point because you never hear that mentioned. Um,
17:28
Speaker 1: you know, you can't really opt out of your employer
17:31
Speaker 1: based health insurance because you don't like it and just
17:33
Speaker 1: get into a cheaper public option. You can't. Why not?
17:37
Speaker 1: Because because you have the option through work so you're
17:41
Speaker 1: immediately discounted. Because yes, but if right now the insurance
17:44
Speaker 1: marketplace will only be open to those people who don't
17:47
Speaker 1: have insurance through their employer at first, but I mean,
17:50
Speaker 1: I don't if we're still five years away from a marketplace.
17:53
Speaker 1: I think we'd be at least five years after that
17:55
Speaker 1: away from allowing everyone in. So right now, you have
17:58
Speaker 1: to stick with your employer based health insurance unless your
18:01
Speaker 1: employer drops. You know, that's something that people are saying.
18:04
Speaker 1: You know, if there's some cheap plan and employers figure
18:06
Speaker 1: it's cheaper just to pay the fee than to cover
18:08
Speaker 1: their employees, that could happen. But um, the thinking is
18:13
Speaker 1: is that if if everyone has to know sort of
18:15
Speaker 1: what their insurance cost versus what it costs in the marketplace,
18:19
Speaker 1: then that competitive spirit might keep insurance fair and honest.
18:22
Speaker 1: This canna get really tricky, so well, let's talk about
18:25
Speaker 1: Let's talk some more about how insurance companies are going
18:28
Speaker 1: to be effected. Just in addition to this possible competition
18:32
Speaker 1: from a public option, there are some mandates in this legislation,
18:37
Speaker 1: for example, that says you can't discriminate based on pre
18:41
Speaker 1: existing conditions any longer. Obama likes to use that. Um.
18:45
Speaker 1: The example of that woman who's denied that what wasn't
18:48
Speaker 1: she was going to have a mastectomy, and then they
18:51
Speaker 1: found out she didn't declare a case of acne from
18:53
Speaker 1: her childhood, and thus they postponed the treatment on her
18:56
Speaker 1: breast cancer grow right and and under under this proposal,
19:00
Speaker 1: there's no more pre existing condition to niles and right
19:03
Speaker 1: or and it, and it doesn't cost you more. You
19:04
Speaker 1: can't be charged a higher premium because you have a
19:06
Speaker 1: pre existing because they're gonna do with that completely for
19:09
Speaker 1: people who have insurance and for people who are trying
19:12
Speaker 1: to get insurance, like that's going man under this plan.
19:14
Speaker 1: So if you smoke tin packs of cigarettes today and
19:16
Speaker 1: you walk in there with an oxygen tank, they have
19:19
Speaker 1: to cover you, Yeah, for the same amount of money. Yeah,
19:22
Speaker 1: as far as I know about the country, that's awesome. UM.
19:27
Speaker 1: There's also a mandate that, um, there can no longer
19:30
Speaker 1: be caps on spending my insurance companies. And actually not
19:35
Speaker 1: only that, the the the it's back on the consumer.
19:39
Speaker 1: There's now a cap on how much a consumer can
19:42
Speaker 1: pay out a pocket every year for their own healthcare.
19:47
Speaker 1: Right because a lot of bankruptcies are driven by medical costs.
19:50
Speaker 1: We're thinking that you know, if if there's if you
19:52
Speaker 1: can't go broke because you're sick, then we will decrease
19:55
Speaker 1: the number of bankruptcies. Damage right, the damage we might
19:59
Speaker 1: be doing to our economy that way interesting definitely. Um
20:01
Speaker 1: there then, so that's insurance companies. That's also again we're
20:05
Speaker 1: just kind of hitting the high points here. We're talking about,
20:08
Speaker 1: as Molly said, sixteen hundred pages of legislation as the
20:10
Speaker 1: stands now. UM, So let's talk about UM Medicaid and Medicare.
20:15
Speaker 1: Chuck mentioned this earlier about UM kind of cutting waste
20:19
Speaker 1: in the Medicaid and Medicare system. Uh, and that actually,
20:23
Speaker 1: let's talk about how much is this going to cost?
20:25
Speaker 1: The OMB suggests it's going to be about a trillion
20:29
Speaker 1: dollars over ten years for these these proposals for Obama's plan.
20:33
Speaker 1: Obama is saying that two thirds of this can be
20:36
Speaker 1: paid for right off the bat, just by cutting waste
20:39
Speaker 1: with Medicare and Medicaid. What is he talking about, Well,
20:43
Speaker 1: there's an estimate that about of the services that are
20:47
Speaker 1: performed medically in this country are unnecessary. And that's overall,
20:50
Speaker 1: that's not just Medicare, Medicaid adding a third limb, yeah, potentially,
20:55
Speaker 1: or getting rid of that third limb that you wanted
20:57
Speaker 1: to keep. Yeah, you know, either waste buddy, just blew
21:02
Speaker 1: my mind. But to get rid of those costs right away, um,
21:07
Speaker 1: and to also cut out some administrative costs all this
21:10
Speaker 1: paper shuffling that a lot of people do, could um,
21:13
Speaker 1: could help as well. The big the big name you
21:15
Speaker 1: always hear in association to this is Medicare advantage, which
21:18
Speaker 1: is a private program within the public program, which you know,
21:21
Speaker 1: I don't know if that makes much sense, but it's
21:23
Speaker 1: probably indicative of power whole health insurance system works. Um.
21:27
Speaker 1: That's a hundand seventy billion a year that goes to
21:30
Speaker 1: insurance companies for the exact same service that's provided to
21:34
Speaker 1: people by the government. So they would cauld that and
21:36
Speaker 1: shuffle them over to Medicare standard. No more advantage for you, right, right,
21:41
Speaker 1: because it pays four more than regular Medicare for the
21:44
Speaker 1: same exact same service. The people who would have just
21:48
Speaker 1: stayed with regular Medicare, we could have saved a hundred
21:50
Speaker 1: seventy billion year, right, But that's just that hundred seventy billion.
21:53
Speaker 1: He's saying you can save another six billion just from
21:56
Speaker 1: cutting waste, right. Uh, And I think he's all so
22:00
Speaker 1: talking about bundling services that leads to bundling services, correct,
22:04
Speaker 1: And that's a big deal. It's started his testing ground
22:07
Speaker 1: for this because, as I said, this thirty percent waste
22:09
Speaker 1: is endemic in the system. It's not just Medicare. It's
22:12
Speaker 1: not just the government that can't run a program. It's
22:14
Speaker 1: it's everyone who can't run a program. But they've done
22:16
Speaker 1: these studies, um where they compare areas that spend a
22:19
Speaker 1: lot of money on Medicare to just a little bit
22:21
Speaker 1: of money on Medicare, and the people who have less
22:24
Speaker 1: spent on them live longer and are healthier. The people
22:28
Speaker 1: who have more doctors visits, more time in the hospital
22:31
Speaker 1: are the ones that are more likely to die from
22:33
Speaker 1: the exact same ailement that these lower spending people had
22:35
Speaker 1: over here. So what can we do to emulate those
22:38
Speaker 1: lower spending areas? Um, that's where we get this idea
22:41
Speaker 1: of bundling that Josh was talking about. So if a
22:44
Speaker 1: person goes into the hospital with a heart attack, instead
22:46
Speaker 1: of you know, this doctor seeing him, then this doctor
22:49
Speaker 1: see him, then this doctor see m and everyone charging
22:52
Speaker 1: separately for all their tests for service be for service.
22:56
Speaker 1: Then you know, you go into the hospital as a
22:57
Speaker 1: Medicare patient and you are in there for your heart attack,
23:01
Speaker 1: and all the treatment that you get relates to your
23:03
Speaker 1: heart attack. Your doctors need to work together to figure
23:06
Speaker 1: out the best course of treatment. And so it's it's
23:09
Speaker 1: more a matter of how you kind of pay your
23:10
Speaker 1: cable bill if you have your cable, your internet in
23:12
Speaker 1: your phone altogether, Um, you just bundling. You just pay
23:16
Speaker 1: one bill to the hospital for all that as opposed
23:18
Speaker 1: to paying for your cardiogram and you know the m
23:22
Speaker 1: R I scan they decides you need it and blah
23:23
Speaker 1: blah blah. That kind of makes sense well, but it
23:26
Speaker 1: also leads to another kind of um radical suggestion that's
23:32
Speaker 1: found in these proposals is establishing what kind of care
23:37
Speaker 1: you should follow when somebody comes into UH for a
23:41
Speaker 1: heart attack, right, because how do you know how much
23:45
Speaker 1: it should cost unless you know what procedures you have
23:49
Speaker 1: to follow and how much those procedures should cost. So
23:52
Speaker 1: to do that, they're setting up a panel that reviews
23:55
Speaker 1: the effectiveness of methods of treatment and says this doesn't work,
23:59
Speaker 1: this is success rate, So we're gonna go with this one, right, Well,
24:04
Speaker 1: I don't think they're going to throw out this one.
24:06
Speaker 1: I mean they obviously they don't want treatments that don't work.
24:09
Speaker 1: But I think it's more And obviously I think we're
24:11
Speaker 1: going to talk about rational healthcare in the next podcast.
24:14
Speaker 1: But this is where people start to this idea. But
24:16
Speaker 1: let's say that there are three treatments for a heart attack.
24:20
Speaker 1: This one works, the first one works of population, the
24:23
Speaker 1: second works for five percent of the population, and the
24:25
Speaker 1: other one also works for five percent of population. Rather
24:28
Speaker 1: than doing all three, do you have a greater chance
24:30
Speaker 1: of starting with this one? Right? And if that doesn't work,
24:33
Speaker 1: then go to one. It's the population, Yeah, be tearing
24:38
Speaker 1: up sort of what works. But I think Obama has
24:41
Speaker 1: been very clear that if your doctor thinks that he
24:44
Speaker 1: wants to still go with number three that has the
24:46
Speaker 1: five percent effectiveness rate, he can do that. Okay, you
24:50
Speaker 1: should be on that panel. Are you on the pannel? Okay, guys,
24:53
Speaker 1: we already talked about some forms of paying for this
24:56
Speaker 1: by cutting waste and getting rid of Medicare plus advantage advantage, Um,
25:01
Speaker 1: what are some other ideas for paying for this? Because
25:04
Speaker 1: you know, Obama said he wasn't gonna sign anything that
25:06
Speaker 1: edit is sent to the deficit. And you know, one
25:09
Speaker 1: complication with him just saying I'm going to eliminate fraud
25:11
Speaker 1: and waste is those aren't scoreable measures according to the
25:14
Speaker 1: Congressional Budget Office. You know, it's got to be something
25:17
Speaker 1: for them to say, yes, it provides you know, twenty
25:19
Speaker 1: million dollars. It's gonna be something the federal government can
25:22
Speaker 1: kind of you know, point to as opposed to this
25:24
Speaker 1: nebulous cutting cost thing. Um. Obama has been pretty clear
25:27
Speaker 1: that he would like to tax people who make more
25:29
Speaker 1: than two dollars a year change their tax deductions, and
25:33
Speaker 1: that I believe is what the House Plan calls for. Um.
25:37
Speaker 1: There's also the idea that we would tax the employer
25:40
Speaker 1: plans that are currently on tax the employer tax um
25:44
Speaker 1: exemption to get rid of that all together. Yeah, they
25:47
Speaker 1: wouldn't be exempt anymore. And there's the thinking, you know,
25:50
Speaker 1: this was something that Kine brought up in the presidential
25:52
Speaker 1: campaign that Obama poo pooed, which is why it may
25:54
Speaker 1: not come back right away. Um. You know, there's the
25:58
Speaker 1: idea of people shouldn't have to tax. Why is essentially
26:00
Speaker 1: free for them now. But I mean, on the one hand,
26:04
Speaker 1: it would be kind of an invisible tax because as
26:06
Speaker 1: we say, you already don't know how much your health
26:08
Speaker 1: insurance costs um. But also if it's if it's not
26:12
Speaker 1: just this free perk that employers can hand out, they
26:15
Speaker 1: might be more likely to increase your wages, is one thought.
26:19
Speaker 1: I mean, right now, a lot of employers can say,
26:21
Speaker 1: this is your salary, but look at this great health
26:23
Speaker 1: care plan you don't have to pay for. Whereas when
26:26
Speaker 1: that becomes an actual cost to a person, then you
26:29
Speaker 1: would weigh that a little bit in more in relation
26:31
Speaker 1: to the money in your pocket, so we can all
26:33
Speaker 1: look forward to raises it's cost. I mean, that's just
26:36
Speaker 1: one thought behind behind this idea. But other people are like, no,
26:39
Speaker 1: that's a tax. I don't want it. So then another
26:42
Speaker 1: proposal is to flip that tax and tax the insurance
26:44
Speaker 1: companies that offer the plans because they're obviously putting a
26:48
Speaker 1: pretty penny in their pocket for these tax accept plans,
26:51
Speaker 1: and then you know, still kind of rub some people
26:53
Speaker 1: a wrong ways. The proposal has been floated just to
26:56
Speaker 1: tax um the mega plans, the ones that to have
26:59
Speaker 1: spa days. Yeah, kind of like there's the CEO of
27:01
Speaker 1: Golden Sax. He's a planet's forty dollars a year, You're kidding,
27:05
Speaker 1: And yeah, you always hear him brought up is like,
27:07
Speaker 1: you know, does he really need this tax free health
27:11
Speaker 1: insurance plans? Golman texts beating in here. We mentioned them
27:14
Speaker 1: all the time. They bear the brunt. Ye. So there's
27:17
Speaker 1: the thought that maybe we would at tax either people
27:19
Speaker 1: who have those kind of plans or the insurance companies
27:22
Speaker 1: that offer those kinds of plans. Um. But you know,
27:25
Speaker 1: there's this Time magazine article that found that actually a
27:27
Speaker 1: lot of state employees have really good plans too. But
27:30
Speaker 1: I think that what people are trying to get at
27:33
Speaker 1: is that there's money in these employer tax exemptions that
27:36
Speaker 1: we're going to have to look at it. It is
27:38
Speaker 1: a possible source of funding. So that's the high points.
27:42
Speaker 1: There's some other ones like oh, I don't know, um
27:45
Speaker 1: Medicaid paying for family planning services right at the donut hole,
27:50
Speaker 1: which we sever the provision where any child born in
27:56
Speaker 1: the United States is automatically covered if they don't have insurance.
28:00
Speaker 1: Stuff like that, Uh, we're not going to cover any
28:03
Speaker 1: of the raucousness surrounding those and this one. As a
28:07
Speaker 1: matter of fact, I think we've reached the end of
28:09
Speaker 1: this one. Guys, Um, Molly, thank you very much for
28:12
Speaker 1: coming in. We'll see you in the next one, and
28:15
Speaker 1: you'll want to tune in for part three, especially if
28:17
Speaker 1: you wake up in the middle of the night with
28:19
Speaker 1: your keep clenched shouting you lie, you lie. That's going
28:23
Speaker 1: to be about midst truths and lies concerning healthcare reform
28:28
Speaker 1: and Obama's proposal, and they'll be criticism from the right
28:32
Speaker 1: and the left on the on the plane of that one. Right, Chuck,
28:34
Speaker 1: what about the center? The center is just staying mute
28:38
Speaker 1: and yeah, okay, So stay tuned for that. That's part
28:42
Speaker 1: three in our special four part Healthcare Suite series, brought
28:45
Speaker 1: to you by how stuff works dot com. For more
28:52
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