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Though there's no overt ban on incandescent bulbs, there are definite steps in that direction. As of 2009 (I think) as a result of legislation enacted in 2007, ceiling fans have to adhere to energy efficiency standards. In particular, fans with medium base light fixtures must ship with CFLs, even though CFLs aren't suitable for use in ceiling fans (as they are not vibration tolerant and are not generally dimmable). While a pain, you can still install incandescent bulbs and use your "free" CFLs where they are more suitable. More onerous is the requirement that fans with candelabra base fixtures be equipped with a disabling device restricting the light kit power draw to 190W. These fans typically ship with 40W bulbs, but unlike the medium base fixtures, you can't simply replace them with a suitable bulb because the fan will detect when too much power is being drawn and automatically dim the lights for you. This leaves consumers in quite a bind. A 52" ceiling fan is suitable for a specific size room. 190W of incandescent light simply is not sufficient to light a room of that size. The first instinct is to install CFLs for these fixtures, but there are problems there too. As we all know CFLs are more expensive than their incandescent counterparts. Energy savings and longer life are supposed to offset that cost. However, CFLs with candelabra base are not easy to find and dimmable ones are almost impossible to find and are hugely expensive - well beyond what you can expect to recover in energy savings and longer life. I found one and only one source, online, at a price of around $25 each, and only sold in lots of a dozen. That's $300 (plus shipping) for light bulbs - or over 300% of the cost of the fan itself. The final insult is that the government-mandated device that limits the current to the light fixture also causes CFL bulbs - even dimmable bulbs - to flicker. I'm just grateful that I learned this before shelling out $300+ for bulbs that I would have been useless. Fortunately, I was able to disable the limiting device in my fan. This is probably beyond most people, however, who will end up being forced to just buy lamps...
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I don't think this is quite accurate. I'm certain, for example, that the range of allowable expenses for both HSAs and FSAs has been significantly narrowed, although I don't know exactly when all changes become effective (I'll find out in October when I am again required to elect my FSA contributions). Eventually (by 2014), you won't be able to use funds from these accounts on anything but actual medical care (deductibles or uncovered services) or RX drugs. Most of what people currently use these dollars for - OTC meds, contact lens solutions, equipment and supplies such as thermometers, band-aids, all will be ineligible for FSA or HSA spending. While everything else you wrote is strictly true, it is significantly incomplete. It is important to know for example that the health care law as passed DOES eventually outlaw the type of high-deductible plans that HSAs are required to be paired with. So even if existing HSAs are allowed to continue to exist after the law fully takes effect (which is an open question at the moment since it's left by the law at the sole discretion of whomever happens to be the secretary of HHS at the time), there will be few penalty-free ways to use the funds they contain, because the only health plans you'll be allowed (and required) to buy will have strict limits on deductibles, and will have no deductibles on the preventative care that make up the majority of most people's health care spending. Not to say that those services will be "free" per se, you'll just be paying for them in the form of higher premiums instead of out of pocket. The catch is that you can use your HSA funds for OOP expenses, but NOT for premiums. To understand all of this you also need to understand that the little "catch" that allows the president to keep saying "if you like the plan you have you can keep it" is the fact that most health plans exist for only a year. When you renew your health plan at the end of every year, you are actually enrolling in a brand new health plan every time. The law says that only new plans are subject to its mandates, so if you like your existing plan you can indeed keep it for as long as it exists. The problem is that it won't exist past New Years Eve. When you re-enroll you will find out that you are actually signing up for a new plan, and that new plan will be subject to all the restrictions the new law imposes. At least that's what the law says must happen. It is sufficiently complicated, and leaves so very much up to the individual discretion of Kathleen Sebelius, that there's really no way at all to predict what will actually happen. It is a virtual guarantee, however, that you will not be keeping the high-deductible plan with which your HSA is coupled for very much longer.
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I'm kind of wondering what one thing has to do with the other. All the FDIC did was collect money from banks to fund a mechanism by which depositors could be protected if a bank fails. All banks were treated the same. The senate bill, on the other hand, gives the executive branch unlimited and unilateral authority to decide which failing institutions will survive and which will not, with the survivors being bailed out by taxpayer funds. It introduces moral hazard that the FDIC didn't. Only depositors were protected by FDIC. The senate bill protects shareholders and creditors. And unlike TARP, congress has no say over the expenditures. Worst of all, the concentration of power in the executive branch opens up the possibility that politically favored institutions - such as donors to the party of the current president - might expect better treatment than their less generous counterparts. And if you don't think our illustrious president would countenance such graft, look at the administration engineered bankruptcy of GM, in which they engaged in exactly that sort of graft, right out in the open, not even trying to hide it. I see this blog is moving from the realm of financial matters into partisan activism as did the health blog. Very disappointing frankly. If there's anything the American consumer could use more impartial information and advice on it is financial matters.
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You're absolutely right that banning preexisting condition exclusions cannot work without the individual mandate. But you seem a little confused on the problem with the individual mandate itself. Yes, we don't like the individual mandate. But that's not the half of it. The individual mandate is blatantly unconstitutional, and cannot survive the inevitable constitutional challenge. If the existing legislation is enacted, it will immediately be challenged, and the individual mandate will be struck down. But what is worse is that the ban on preexisting condition exclusions may very well survive. If that happens, the only way any health insurer could possibly avoid immediate insolvency would be to close the door on ALL new applicants. (Assuming they are even allowed to do that - no one knows for sure because as you are well aware, no one has seen the legislation).
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I just thought I'd point out, since someone has to, that it isn't health care reform that is jeopardized by the election result in MA. It is specifically the partisan version of reform that the democrats have basically been trying to shove down the throats of a 3-1 opposed electorate for the past several months. Strip out only the unconstitutional elements of what the Senate passed, and Scott Brown notwithstanding you'll easily pick up enough republicans to break a filibuster. Strip out even 75% of what is not in fact reform, and thrown in maybe half of the bare minimum of what would be required to call it actual reform, and you'd get at least half the republican caucus - although you could well lose as many or more democrats. It is one thing to be political. It is inappropriate, but we've come to expect it here. It is another thing entirely to be political while misinforming your readership in order to make your particular political argument appear more persuasive than it actually is. It is a fact, verified by the CBO and no longer disputed by anyone, that the plan Obama has been pushing will increase costs for all, and that is after over a trillion-with-a-t net deficit increase from the government's contribution. And that is with benefits not kicking in until three years after tax and other cost increases.
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McCarthy is right about one thing. The public option was probably the single biggest problem with the bill, but it by no means represents all or even most of the damage that could be done. One of the biggest risks I see right now is the combination of the ban on preexisting existing exclusions and the individual mandate. Banning preexisting condition exclusions pretty much kills all health insurance for once and for all, because there is no reason for anyone to carry health insurance and pay premiums all the time if they have the option of waiting til they're sick, buying insurance just long enough to get treated, and then dropping it. That's pretty much common sense, and is where the individual mandate comes in. The problem is that the individual mandate is as clearly unconstitutional as anything you could imagine, and will almost certainly be struck down by the courts. Leaving us with about a month's worth of insurance companies taking in $0 and paying for all health care for everyone, until they rather quickly cease to exist. Oops.
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All existing health insurance - every policy currently sold by anyone - will be illegal under either of the bills currently under consideration. The government will set standards for what must be covered and what can be covered (something, along with selling insurance, that the constitution strictly prohibits it from doing by the way) and no existing health plan meets the criteria being discussed right now. As such, your insurer will not be prevented from canceling your coverage as you state, indeed they will be FORCED to cancel it and replace it with something else. Also note - and you will never convince me that the Consumer's Union does not already know this - that it is already illegal for insurance companies to cancel your insurance because you get sick. Undisputed as of right now are that premiums for coverage comparable to what most people have now will be higher; that coverage comparable to what most people have now will be inadequate to meet government mandates therefore the only plans available for purchase would be even more expensive than the inflated cost of our existing plans; and the reimbursement rates which will be forced down by the public option will result in fewer available doctors, with by some estimates as many as 30 million additional insureds needing services. And since there are fewer than 30M uninsured legal residents in this country, some of those who we will be subsidizing, and competing with for access to services, will necessarily be illegal aliens. There is no conceivable reason, other than political, to support this bill. It is certainly not supportable on the grounds of consumer advocacy, as consumers will be the biggest losers if this goes through.
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I'm pretty sure that the Google product in question actually uses GPS. Which would explain why it has all the features you'd expect from GPS, but also makes it unlikely in the extreme that it would ever contribute to the death of GPS.
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Personally, I think it's a stupid idea. But if it becomes law, I won't be turning it down.
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Sorry, Mr. McCarthy, but you are 100% wrong about this. In the current version of HR3400, there is exactly one restriction on availability of benefits to undocumented aliens. They are not eligible for "affordability credits", which is the mechanism by which those who can't afford insurance are given some money by the government to go out and buy some. For starters, as Mr. Wilson mentioned, there had been a lack of enforcement in the bill on this provision. In other words, the law says that illegal immigrants can't get affordability credits, but the government was not going to be checking to see whether those to whom it was providing the payments were legally in the US or not. The immediate reconsideration and adoption of a repeatedly defeated republican amendment to close this loophole would seem to be a tacit admission that Wilson was indeed correct. Beyond that, however, note that the rest of the bill is covered by a blanket anti-discrimination statement that prohibits discrimination against anyone, including illegal immigrants, other than in cases where it is expressly permitted. One of the implications of this is that even if illegal immigrants are denied access to affordability credits, they will still be able to buy into the public option (if it survives) with their own money. And mere membership in the public option, even if you pay your own premiums, involves a number of benefits out of the taxpayer's largess, including reimbursement rates for providers that will be imposed rather than negotiated (like what is done in Medicare, and as proponents of the public option have openly admitted they would do), and of course the fact that the public option will be able to operate at no profit, or even at a loss, with the balance being picked up by the taxpayer. I can get behind a lot of criticism of Joe Wilson. His outburst was unbecoming a member of congress -- at least a Republican member of congress (Democrats have behaved as badly and worse towards Bush during similar addresses in the past). However, as crude as it was, the cold hard fact is that Wilson's criticism was accurate. What president Obama said to trigger the outburst was not the truth, and he surely knew it at the time.
Toggle Commented Sep 14, 2009 on Who lies? at Consumer Reports Health Blog
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I got some kind of error posting this, and am not sure if it went through. If it did, please forgive the duplicate entry. Hibryd: By the way, about that Commonwealth Fund study you cited, there are some things in the fine print that alter the interpretation of the findings slightly. First, regarding overall satisfaction, the two relevant statistics cited, percent rating coverage "fair to poor" and percent reporting a negative experience, both break in Medicare's favor but not by enough to say that they have "much much" higher satisfaction. They also cite as relevant some things, such as percent reporting that their doctors don't take their insurance. Fewer Medicare recipients than privately insured report such a situation. But Medicare wields certain powers that private insurers do not, and that President Obama's "public option" will not if he's to keep his promise of competition on an equal footing, such as dictated as opposed to negotiated reimbursement rates and participation levels. Also, perhaps paradoxically, Medicare's lower rate of reported billing problems is actually a sign of another problem in the system that is fostered rather than mitigated by government involvement, and that is fraud. Medicare is far less discriminating than private insurers over who they pay and who they don't -- something which coincidentally should serve to further reduce their overhead costs relative to private insurers. One result is that recipients experience fewer problems with billing, but another is that far more fraudulent claims end up getting paid. And this actually highlights what could be one of the very biggest problems with the system overall, and one that any public option would expand beyond measure, and that is the isolation of the patient from the cost of their care. A lot of unnecessary care is delivered in the form of defensive medicine resulting from the counterproductive malpractice situation, but a lot is also delivered because the recipient doesn't have to worry directly about the cost. The one and only effective mitigation of this problem that has ever been proposed or enacted has been the combination of high-deductible catastrophic health coverage with health savings accounts (HSAs). The coverage protects you against potentially ruinous expenses, and the HSA, funded by the difference in premium between a normal plan and the cost of the catastrophic plan, and perhaps with an employer or government match to subsidize, allows people to cover their routine expenses. The fact that you keep whatever you don't spend allows patients to be affected by the choices they make, which makes it much more difficult for providers to get away with overcharging or providing unnecessary care. Ironically, this type of plan is one to which the current house bill, HR3200, is most hostile. If you're not familiar, HR3200 would outlaw any private plans that aren't traded in the newly conceived "exchange" model and only plans meeting certain government criteria would be allowed in the exchange. The bill includes a grandfather clause that would allow plans already in existence before the exchange opens to continue operating, though without accepting new members, at least until the grandfathered plans terms have expired, which is typically the end of the calendar year. High-deductible plans with HSAs, however, are specifically excluded from being eligible for the grandfather clause. So this is a good example of the proposed reform not just ignoring a major problem, but making it worse. Tony
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Hibryd: "Tony - I should also mention that I'm not saying Medicare is a perfect system...." I understand that. But you ARE asserting that it is better that current private options for the non-elderly, and the evidence simply doesn't support that, and that is despite the fact that Medicare is not on an equal footing with private insurance. Indeed, the Medicare model would necessarily collapse without private coverage for those not yet eligible for Medicare, because Medicare generally pays providers less than the market value for care, and in some cases less than it actually costs the providers to provide the care. The difference is made up by overcharging privately covered patients. "What, exactly, would be your solution?" Basically, I would focus on implementing targeted changes to address specific problems. There are enough that all claim to agree on to keep us busy for a while. Portability is a biggie. Current lack of portability is actually directly attributable to government policy. Large employers can get large group rates and tax advantages that individuals cannot. Other organizations can get group rates as well, but not the tax advantages. John McCain had the best answer to this problem, which was to change the tax deduction for employer plans into a tax credit for everyone. Ironic how it was misrepresented by Obama as being a proposal to tax health benefits, and how he's suggesting doing exactly that, except without the offsetting tax credit. Health IT is another one that everyone says they favor, but nothing ever seems to get done. It seems obviously to me that a complete, top-down overhaul of the entire system as is being proposed would be a dumb mistake, even if it was done thoughtfully over a period of years as a project of such scope would seem to warrant, with input from all sides and most of the details being filled in by subject matter experts. Instead they're trying to do it in a huge rush, with almost all the contributors being politicians from a single party who not only have a political agenda but don't know anything about health care. On top of that, some of the biggest known problems in the existing system are either ignored (medical malpractice), or even made worse (limited availability of resources such as doctors and nurses due to non-negotiated reimbursement rates for care) by all the proposals currently considered to have a chance of passage. And that is without mentioning the basic unconstitutionality of the federal government providing health insurance, whether exclusively or in competition with private insurance, which is made no more constitutional by the fact that we're already doing it with Medicare and Medicaid. "You know it has to be a government program, because no private entity will cover your mother-in-law" The very existence of Medicare Advantage belies this statement. In any case, I'm not talking about getting rid of or otherwise significantly changing Medicare, nor is anyone else. The debate here is whether it makes sense to expand its model to the general population, and the answer is that it it would not be possible, even if it was desirable (which it is not) because of its heavy reliance on subsidization not just from the government but from the inflated costs paid by the privately insured and the fee-for-service people. By the way, I'm enjoying the spirited debate, although I am starting to feel like it's a little pointless, because I doubt many people are reading anything we're saying. Tony
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Hibryd: All I can say is that for my money, Heritage, which is a conservative organization but that backs up their assertions with research and data, is a more reliable source than Paul Krugman. You said: "Heritage's main point is that per-person costs are lower for private plans than Medicare, but they provide absolutely no reason, whatsoever, why that figure should count instead of a percentage-based number." It seems fairly obvious why that should be the case. Most administrative costs are incurred on a per person, not a per-dollar-spent basis. The validity of Heritage's analysis is based on the fact, undisputed as far as I know, that if you take a number of healthy people equal to the current number of participants and enroll them in Medicare, doubling the total number of participants you would necessarily double or nearly double the administrative cost, but would spend nowhere near double the amount of money on care.
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Hybrid: "Medicare has a fraction of the overhead and *much* higher patient satisfaction levels than private plans." I don't know about satisfaction levels, although private plan satisfaction is sufficiently high that even 100% satisfaction in Medicare couldn't reasonably be referred to as "*much* higher". As far as overhead costs, I've heard that one repeated often. It's been debunked, as far as I'm aware, by the Heritage Foundation, though I imagine there are others. The only way to get a result favoring Medicare is to (1) measure the percentage on a cost basis rather than per patient; and (2) include as overhead for private coverage not just actual overhead, but the entire difference between premiums and claims paid. Each of these skews the numbers in favor of Medicare relative to reality. The first because Medicare covers seniors and seniors require more care on average allowing for overhead costs to be diluted - IE medicare spends $100 overhead on a patient using $1000 care, looks like only 10%, while private insurance spends $20 overhead on a patient only using $100 care, looks like 5%. And the second for the obvious reason, because you're counting expenses incurred by both programs as overhead for private plans, but not for Medicare, and also counting expenses for services not provided by Medicare as overhead for private plans. Under the apples to oranges comparison, Medicare wins. If you remove the easier to correct for error above, number (1), resulting in an "apples to pears" comparison if you will (a pear is more like an apple than an orange), private care wins, consistently and by a fair amount, even though their overhead rate includes expenses either that Medicare does not incur, or that it incurs but that aren't included in the overhead calculations. A true apples to apples comparison makes private insurance even more efficient relative to Medicare. Full analysis can be found here: http://www.heritage.org/research/healthcare/wm2505.cfm
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Doris: Thanks for your response. This is one of the most popular misconceptions I'm aware of. Private companies cannot deny coverage at will. An insurance policy is a contract between insured and insurer, and is backed up by contracts with providers. If you're policy states that certain care is covered, then the insurance company cannot deny coverage. If they do, they can be sued - something which is not true of Medicare and would not be true of a public plan like the one President Obama favors.
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