Democratic Health Care Reform Plan Unveiled

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  • November 12, 2008
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Senate Finance Committee Chairman Max Baucus published his plan for health care reform on Nov. 12, and it bears striking resemblance to President-elect Barack Obama’s plan. The message is the same: universal coverage, hopefully reduce health care costs, and potentially  improve quality care.

Universal Care
To achieve universal coverage, Senator Baucus’ plan promotes a shared responsibility between individuals, employers, and the government. Individuals would be responsible to have insurance, mid- to large-sized employers would be required to offer a section 125 plan to employees or contribute to a nationwide insurance pool called the “Health Insurance Exchange,” and the government would continue to offer public programs at federal and state levels.

The new Exchange program, Baucus said, would eventually provide coverage to the 46 million Americans currently without health insurance.

“Those who already have health coverage could keep what they have. But for those who need affordable, guaranteed coverage, the Exchange would be a marketplace where Americans could easily compare and purchase the plans of their choice,” Baucus said.

Until then, the Baucus plan would make health care immediately available to Americans aged 55 to 64 years through a Medicare buy-in, and it would phase out the current two-year waiting period for individuals with disabilities. The plan would also expand Medicaid to cover all impoverished Americans.

Reduce Costs
Once everyone has coverage, health care costs will go down, reasons Baucus. “Requiring all Americans to have health insurance will help end the shifting costs from the uninsured to the insured,” Baucus said.

Reducing costs also means weeding out waste, eliminating overpayments, and designing a financial system that works for everyone. And like Obama, the Baucus plan would support additional funding for health information technology (IT).

“Health IT is needed for quality reporting and improvement and to give providers ready access to better evidence and other clinical decision-support tools,” Baucus said. Both Baucus and Obama have said they see health IT as a long-term solution for lowering spending.

The Baucus plan would also invest more to detect and eliminate fraud, waste and abuse in public programs, and overpayments to private insurers. Payments and incentives to providers would be made more transparent, “careful” reform of medical malpractice laws would be considered, and tax code reform would be explored.

Improve Quality Care
To cover the uninsured and reduce health care spending, Baucus said “the perverse incentives fostered by current payment systems” must also be addressed. This is where physician participation plays a part in the “shared responsibility.”

To right this alleged wrong, the plan would focus payment incentives on quality and value. “Increasing the supply and availability of primary care practitioners by improving the value placed on their work is a necessary step toward meaningful reform,” Baucus said. He goes on to say, “Fixing the unstable and unsustainable Medicare physician payment formula is a necessary step” in realigning payment incentives for quality care.

The American Medical Association released a statement Nov. 12 applauding Chairman Baucus on his commitment to health care reform.

You can read the Baucus “Call to Action” health reform 2009 plan in its entirety on the Finance Committee Web site. Sens. Obama and Joe Biden’s plan is also available online.

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No Responses to “Democratic Health Care Reform Plan Unveiled”

  1. Laurie says:

    if the government handles healthcare would coders be out of a job?

  2. Nadene says:

    We also need to help Medicare patients who are not allowed to see their own doctors because they
    no longer see these patients because of the Medicare payments. How can they get to see docs on a regular basis if they can only go to the ER (emergency rooms) or the centers (Quick fix medical
    places) for the continued care. There is no follow up for them. This upsets me that we do not take better care of them. Why can’t they get the same coverage senators and congressmen have?

  3. Belinda says:

    To Laurie, I would like to say I am a bit concerned about this as well as Medicare A and B are now communicating w/each other, and all the Coding scrubbers and CAC applications out there I do believe our job may do a slight change into more of an audit/validate role so therefore the need would decrease.

  4. matthew olubusade says:

    i have read it and i said it is time to let all Americans have insurance and kudos to the Democrats and especially President Barak Obama.

  5. Debra Seyfried says:

    Socialized medicine is a two-edged sword. It comes with a price-tag, namely higher taxes. It doesn’t increase care providers, it in fact, decreases them due to even lower payments. That will equate to lowering expenses and loss of jobs. We need to be balanced and realize that we are responsible for our own fiscal health as well as physical health. There will be no quick fix, and no easy fix either. Democrat or Republican.

  6. LeeAnn says:

    This is a very sensitive issue for me. I have a twenty year old daughter with a couple of chronic medical conditions. She is currently a full time student so she is covered under my insurance. But starting the first of the year, she will no longer be covered. She makes just enough not to qualify for Medicaid, which unless you are pretty much jobless you don’t qualify. Cobra coverage will cost $500-600 per month which is the same as the Indiana insurance pool that they have. That is a joke because it is way to expensive for anyone to afford. We don’t want her insurance to lapse while she is looking for a full time job after graduation because then pre-existing issues will come in. I see two section of the population that are desparate for a change in healthcare, one being newly graduated college kids who are looking for full time employment and can’t afford or get coverage and those that are in the Medicare gap. Something has to be done. I am sure it will be too late for my daughter though. Does anyone have any suggestions for getting her covered?

  7. T says:

    I know things with change with universal health care but there are other countries participating in this program. Maybe we should check with some of the coders in other countries to determine if our jobs will be in jeopardy. Also, I think our constant involvement with the payer will shift and we will be involved in gather date on the quality of care. (Isn’t that what it is all about?) This is material that is stressed while obtaining your RHIT.

  8. T says:

    sorry typo I meant to write gathering data

  9. Cathy says:

    Socialized medicine is definitely a two-edged sword. I received medical care in military hospitals and clinics for 14 years. The care was not high quality and sometimes was not even available. I remember when the one of the largest military hospitals in the USA (Ft Campbell, Ky) did not even have an ENT. Investigate the health care in countries that have socialized medicine. You will find that the quality is way below our American system. Sometimes, I think that Americans are addicted to complaining. Our system is not perfect, but it is the best in the world. I do hope that young people just graduating from college and those in the Medicare gap can be provided for at a reasonable cost. I have a daughter who graduated in May 2008 and still does not have adequate coverage. She works for a small non-profit business that cannot afford to offer a good plan. So, I do see some problems. However, I do not believe that the federal government can solve the problems.

  10. Kay says:

    Socialized medicine – as everyone likes to call it, does not have to be taboo. I lived in London for several years and found that government subsidized health care was a god send. People were healthier, thinner, more active and sought out care when needed. They did not wait until they were in dire straights before going to hospital. Emergency rooms were not filled with children with ear infections and bad colds. The emergency rooms were used the way they were intended, for emergencies. I think it will be a hpayy day when there is insurance coverage for everyone.
    And no, coders, you will not be out of a job. Coding for procedures is not going away. There still needs to be a way to report care activities to the payer whether that payer is the government or commerical.

  11. Carol says:

    First, I do not believe coders will be out of a job. I believe everyone’s job will change as new legislation is enacted and those with a solid background in coding, reimbursement, and compliance will be more in demand than they are now. You have change in any industry. Adapt or you will be left behind.
    We all recognize the current system is not sustainable as is and something must change. As an employer, it is very costly to provide health insurance to employees and their families and many employers are having to cut back on benefits because of double digit increases in insurance costs every year. As a physician practice, it is difficult to continue to provide even COL pay increases and benefits to providers and staff when reimbursement cuts are constantly hanging out there and patients can’t even afford to pay their copays and deductibles. The system is going to change and whether we have a Democrat or Republican Congress, our government is going to be involved. My understanding is that the US is the only wealthy industrialized nation that does not provide some type of universal health care. I hope those making decisions are looking at other countries systems to see what works and what doesn’t.

  12. Kat says:

    Regarding socialized medicine affecting our jobs, yes, I do believe it will. First of all, if we keep our jobs, we will be government employees and so will our docs. I wonder how that will affect our salaries, especially if the docs are taking a pay cut.
    Secondly, the quality of healthcare will suffer. Why is it that people from other countries that currently have socialized medicine come to the US for their treatment? Because we have the best healthcare system in the world. I agree that the insurance system is “broken,” but I tend to think there must be a better way to fix it, and the person with that solution has yet to come forward…
    Lastly, I am wondering how our country is going to pay to integrate the socialization of medicine. Raise my taxes and “spread the wealth around?” I give that a big thumbs down.
    As always, thank goodness we live in a Democracy where we can all express our views…so far.

  13. Judy Etzler, CPC says:

    The universal health plan that is being proposed isn’t socialized medicine. When we use the phrase socialized medicine we are saying that all the medical providers, facilities and clinics – everyone is an employee of the federal government. The Veteran’s Administration is a good example of socialized medicine. What we are headed for isn’t socialized medicine it is simple a reform of our medical payment system to include all of us who need medical care. For our medical providers it is medical care and business as usual – no one of them goes to work for the government and the clinics and hospitals do not become government owned. Only the payment system changes.
    My personal preference is for a one payer insurance company. Fold everyone into a single payer and watch insurance premiums drop. Most insurance companies are for profit companies and we all know tht having may different insurance compnies with so many different rules slows down payment.
    Laurie, As more people get health care coders will have more work. It is the change to ICD-10 that will rock our world. ICD-10 is more comprehensive to computer interpretation and computer assisted coding. If we finally back ICD-10 up with SNOMED computers will do the coding and we will move on to other back up positions. As Carol says in her post above “Adapt or you will be left behind”, a saying that rings of Darwinian evolution.

  14. Joanne Kent says:

    Judy’s and Carols comments are very accurate in my opinion. Some terms like “socialized” have become very emotionally laden–and especially lately, have been used to incite a lot of fear. Whether this is due to the right wing political climate of the last 8 years or not, I agree that we need to redefine our current system and realize that it’s how a system is utilized and implemented that results in poor managemnt or coverage, not necessarily that the system itself has no element of merit at all. A change from the current system doesnt mean it’s socialist or even communist just because it’s different or focuses on the patient rather than the provider’s pay scale. The proposed plan actually addresses the aspect of equitable provider compensation. We’ve just survived 8 years of fear tacticts let’s not scare ourselves into thinking there’ll be no place for us in what we all hope will be an improved system.

  15. Kat says:

    In response to Joanne Kent’s comments, maybe you would prefer the term “nationalized medicine?”
    Maybe that would be more of a warm and fuzzy term for you.
    Some of us have valid concerns because we actually know people that live in countries in which the government mandates healthcare for everyone. And according to the patients in the other countries, this system does not focus on the patient, as you stated. I have been told by several people that the quality of the healthcare itself and the wait times for urgently needed care are far from being focused on the patient.
    As far as the job of the coder in other countries with this type of healthcare system, I don’t know. And this translates into “fear of the unknown.”
    So please don’t trivialize the concerns of those of us who are concerned about these changes.
    I also think that the terms “right wing political climate,” “8 years of fear tactics” and “communist” probably belong in a chatroom far from here.

  16. Joanne Kent says:

    To Kat: perhaps you’re right about some things but we don’t live or operate in a vacuum, the climate in which we operate may indeed effect how we view health care change, especially if all the outcomes can’t be clearly predicted. If your politcal sense was offended–that was not my intent, sorry, but my perhaps eager intent was to emphasize a more hopeful approach, and not to have any progress inhibited by emotionally charged adjectives like the ones often used in our society right now. As far as wait times and patient focused care are concerned– other countries have their flaws, but some are actually more family focused than we are right now. I haven’t seen recently documented proof that the quality is universally poor or less than ours, and wait times here can be brutal as well. I must say your use of the word “trivialize” is suprising–that’s a button pusher too and perhaps the kind of thing I was talking about. You know it woud not be reasonable to trivialize any views here. Thanks for responding.

  17. Kat says:

    To Joanne:
    I hear what you are saying.
    I do have high hopes that whatever changes are made to the healthcare system are positive as far as quality of care and utilization of coders’ skills.
    And after all, we coders are all in this together, right?

  18. Judy Etzler, CPC says:

    I’m glad that we are having this discussion because it is going to happen on a national level soon. I look forward to health care for every one and will do my part to facilitate. In this discussion please remember to help others to understand that what we will propose is only a medical payment care issue not a change in who owns our providers, clinics or facilities. We use medical terminology correctly let’s understand the terminology as we discuss this issue.
    Kat – Yes as coders we are all in this together, you are right.

  19. Guy says:

    Subject: History and Socialism
    Could this scenario play out in the US? Of course it could.
    Long ago (year 2000) and far away in a distant country called Germany, the people wanted change, so they gave power to the Social Democratic Party (SDP) because the SDP promised to take from the rich and give to the middle class and poor.
    True to their word, they raised taxes on the rich businesses and people and cut taxes on the middle class and the poor. They increased entitlements to the poor, and everybody was happy, right? (WRONG!).
    The first thing German citizens noticed was the price of basic commodities increased and contributions to their retirement plans decreased. The companies explained that they had to remain competitive in a world economy. The second thing that occurred was the unemployment rate increased. Slowly at first, as companies explained their funds for expansion and research and development were gone.
    Millions of average people that had invested in German businesses saw the value of their investments decrease because company profits either diminished or disappeared.
    Billions of Euros (Dollars) that the rich had donated to various charities were no longer available and the Government had to make up the shortfall.
    After 2 years, the prices on basic foodstuffs had risen by 25% and everything had a price increase. People began to realize that the tax breaks from the government did not cover the price increases. In an attempt to slow rising prices, the German Chancellor (President) made a secret deal with Saddam Hussein to supply oil to Germany at a preferred price. (Remember the oil for food scandal). But even that could not slow the tide. People on fixed incomes were especially hit hard. My mother-in-law had to receive financial help from her children just to survive.
    Germany, a country that had one of the strongest economies in the world, a country that imported workers from other countries, now had an internal unemployment rate of over 8%. Hundreds of thousands of small businesses failed, including 2 of my wife’s cousins, one that employed 17 people and one that employed 10 people. And still the unemployment rate rose.
    Mercedes-Benz, for the first time in their history, closed 2 plants in Germany and moved them to China. They said to take advantage of the Chinese market, but how many Communist countries do you know where the people can afford to buy a Mercedes? The German people knew better.
    I visited my in-laws in 2004, which is where quite a bit of this information comes from. The rest came from research and the Internet. While I was visiting in Germany, the unemployment rate was 10.7%. Their real spending money had decreased by 25 to 30 percent. Their economy, which at one time was the envy of Europe, was in a shambles. ALL THIS TIME THE GERMAN MEDIA KEPT APPROVING OF THE WAY THE ECONOMY WAS PERFORMING.
    In 2005, the Germans finally threw Gerhard Schroeder and his party out of office. It was estimated by some German economists that it will take 34 years to recover from the damage Schroeder’s policies had caused .
    Similar occurrences were taking place in France (under Chirac) where unemployment rose to 11.4% and there were riots in the streets. The French people finally threw him out of office, too.
    A famous man once said “People that do not learn from history are doomed to repeat it.”
    If you do not believe me, do your own research. If you have any questions, ask me.
    I am sure that I can trot out 15 economists to prove his plan can work, but let me remind you of what President Harry Truman said: ‘If you take 360 economists and place them in a room, they will all face in a different direction.’
    I am a concerned citizen worried about this country and the direction it is taking toward socialism. Socialism has failed in every democratic country that it was tried. Remember the old saying “be careful of what you wish for, you may get it.’ I URGE, NO, I PLEAD WITH YOU TO PASS THIS ON. I WOULD LIKE EVERYONE IN THE USA TO READ THIS AND MAKE UP THEIR OWN MIND.

  20. Kat says:

    To Guy:
    Thank you and God Bless the USA.

  21. Kat says:

    To Guy,
    Thank you.
    Well put.

  22. Sherry Salinas says:

    I think they are rushing in the department of healthcare reform. If they honestly take a good look where the money is going to that the people on Medicare give monthly then I think that would be a turning point for health care in itself. Each Medicare patient pays roughly 96.80 a month if not more. If half of those americans do not get the tests and medical care they need and medicare pays next to nothing. Where is all of this money going to? If you look at the costs that Medicare and Medicaid actually do not pay and leave the majority for the third party payers; then people wonder why health insurance deductibles are so high. Secondly, you have physicians that recieve a bonus at the end of each fiscal year per patient for keeping that patient’s health care costs very low under that cap. If you times by how many physicians are receiving thousands and thousands of dollars per year by keeping the health care costs down along with the quality of care so low then I would in turn think a great suggestion is to take a good part of those monies and put it into a sufficient fund for other americans that do not have health care.
    And take notice how Senate Finance Committee Max Baucus state that at least for the first two years
    that only people ranging from 55 yrs of age to 64 yrs of age would be covered on medicare. Is this so medicare can earn more money and spend less for health care coverage? If someone can be smart enough to think of a great health reform plan than the term “reform” would be meant for everyone and not just for a certain age group. I say, show us all what medicare and medicaid actually pay for health care costs compared to the third party payers. In addition, if this is to cover all americans then I would imagine age discrimination falls along these lines because you would have to be 55 or older to to be eligible for the program.
    The bottom line is that they are saying they want afforable healthcare for all those 46 million americans that are not covered. Moreover, if you are introducing a viable health plan be sure it includes everyone that needs health care insurance along with the committment of “Exceptional Quality Care” as well.

  23. Erin Settles says:

    Nationalized healthcare is not a lovely as it sounds. If it was people from Canada and Europe would not be comming to America to surgeries and other life saving procedures done. America’s healthcare system is the best because its NOT nationalized. Let me put it this way, if you live in Canda and lets say you need a specific type of heart surgery and your number 41 on the list and they are only going to do 40 that year, your out of luck, and there is no guarentee that you will be on the top of the list the next year. Long story short you may die before you get your procedure done. But in the USA you are put on a transplant list based on your need and the severity of you diesease, hence if you will die without it your at the top if you can live comfortably for a couple years your towards the middle of the end. Another point I would like to make people who have insurance and are going bankrupt due to medical bills are doing so because they didnt research there plan coverage before signing up for the insurance plan they picked. The cheapest plan is not always the best plan to pick. The more you pay for the plan the better the coverage. You wouldn’t buy a care without taking it to a machanic for a full system check, so why would you but a health plan without doing the research. I am a single working mother who has private healthcare that I pay a pretty penny for, but I dont have mounting healthcare bills when my son has severe asthma and I have diabetes. In the end you get what you pay or vote for.

  24. LeeAnn says:

    I disagree with the statement that “people who have insurance and are going bankrupt due to medical bills are doing so because they didn’t research their plan coverage before signing up”. Many people cannot choose their insurance plan, what their employer offers is what they get. Sure the employer may offer more than one plan, but to get the “good” plan some people have to pay as much as half of their income and there is no way that they can. If given the choice of food for their kids or a better insurance policy, people are going to choose their kids. Then when something happens medically they are stuck with the bill. I have a daughter with many health issues plus two other children. I also have the best insurance that I can afford. However at one time last year, I was making payments on 15 different medical bills. Even if you just pay $10 per month on each (which most of them won’t alllow) that is $150.00 / month. Most want at least $35/month which makes the total $525/month. I am very happy for you that you don’t have mounting healthcare bills,
    but that is not the case for everyone.

  25. Lisa says:

    Applause to Guy. People are going to get that change. And they won’t know what hit them. I think a bunch of ill-informed people are headed to a rude awakening. Be careful what you wish for indeed.

  26. Sue says:

    Applause to Guy as well. First of all people need to look closely at the so called 46 million Americans without healthcare. How many are illegal. How many make over 75,000 per year and choose not to have health insurance. I think that the senators and congressman as well as all government employees should be required to have the exact same insurance that they think would be great for the rest of us. Also free healthcare will not be any good if there are not enough doctors to treat patients. Doctors need to make a certain amount of money to stay in practice. If the reimbursements go much lower doctors will close their practices and/ or stop taking medicare and medicaid. People often forget that free healthcare is not really free at all. Somebody is paying the price for it.

  27. Judy Etzler, CPC says:

    Nationalized helathcare is NOT SOCIALIZED MEDICINE!!! Please understand the difference. England and Canada have SOCIALIZED. What we are proposing is NATIONALIZED. There is a huge difference in terms.
    Non profit hospital emergency departments treat the indigent now for free. We all pay for it when we get our medical bills or taxes. We all pay the price for it now and everyday.

  28. Karen says:

    It takes more than improving health insurance to improve quality of care. There are so many healthcare providers in today’s world, who do not considered the emotional status, and physical status of a client. They are concerned only portion of the body. Many of the healthcare providers are at their place of work for a paycheck. When not treating the whole body, healing prccess is delayed. Therefore, we need to considered the type of care that our present healthcare providers are doing in this ugly world.

  29. Janet Hawkins says:

    Anytime the government handles anything it results in more jobs because the government has yet to figure out how to rum themselves let alone huge medical programs. When did you last call Medicare or Medicaid in your state and try to get help. I am not so concerned about being out of a job but I do agree that it may become more audit focused. Socialized medicine is indeed a two edge sword. The price is lesser quality care to the patient and higher taxes to the public. I appreciate the drive to solve the problem of the need for health care but just the thought of Washington DC handling this makes me shudder.

  30. Sherry Steigerwald says:

    Sorry, I’ve read most of your comments concerning this hot-bed issue. I am strongly opposed to socialized medicine and more Gov. involvment for me, is not the answer. The Gov. plans in place are workable if only we could stop the abusers. Those who cheat on applications to get medicaid, those who bill for procedures not done, those that stay on public assistance longer than necessary are the takers from those who are really in need. Medicare costs for our seniors has and is still rising at an alarming rate. It is true our elderly are choosing between food and scripts, doctors or rent and are purchasing unsafe animal food in order to afford medical care. And the abusers are still out there unconsciously continuing to take, robbing from the truly needy. We need more auditors, more investigators to prevent abusers from continuing to do so and see to it that the truly needy have their needs met without having to sacrifice their dignity, homes or other necessary survivial amenities.
    More money for inforcement of existing laws and less goverment interference in our healthcare could lower costs while continuing to provide the best medical care in the world.

  31. Anthony Peters says:

    I an interested in a coding career and signing up for the schooling. I own my own floor restoration business, but times are hard. I am a father of 2 boys 13 and 3, and I want to be able to pay my bills and feed my family. It’s pretty scary right now. I’ve put the last 10 years of my life into this business, and it seems like all things have failed. I just want to know if i’m making a secure and proper decision. i am a hard worker and enjoy work. I find it very rewarding to work hard.
    Thank You
    Anthony Peters

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