Get ready for prime time with health-care primer

Sen. Max Baucus, President Obama, Sen. Christopher Dodd
REUTERS/Kevin Lamarque
President Obama speaks about health care during a June meeting with Senate Democrats, including Sens. Max Baucus, left, and Christopher Dodd, right.

What is President Obama’s prescription for health-care reform? We should have a better idea after he addresses a prime-time joint session of Congress tonight.

“One virtue of the speech is that the president will have a chance to lay out very clearly where we should go and where we should not,” White House political adviser David Axelrod said Sunday in a National Public Radio report.

Though Obama gave a general outline of his principles early on, he left a lot of the details to Congress. And now he’s trying to get the reform effort back on track after a summer of stormy town-hall meetings. If you don’t have time to read the thousands of pages of health-care-reform legislation, the following is a primer to help you navigate the current events and issues.

The biggest development during the Labor Day weekend is that Senate Finance Committee Chairman Max Baucus, D-Mont., has been circulating an 18-page “Framework for Comprehensive Health Reform” to the “Bipartisan Six” committee members trying to negotiate a compromise. Kaiser Health News has a PDF of the document. A lot of attention is focused on Baucus because his committee controls the purse strings of any health-reform legislation.

To help pay for the reform, the framework suggests imposing annual fees on these industries: health-insurance providers ($6 billion), the medical-device industry ($4 billion), pharmaceutical manufacturers ($2.3 billion) and clinical laboratories ($750 million).

“Like the versions of overhaul approved by three House committees and the Senate Health, Education, Labor and Pensions (HELP) Committee, the Baucus proposal would bar insurers from denying insurance coverage to individuals because of preexisting medical conditions or dropping coverage when policyholders become sick,” Congressional Quarterly Politics reports.

And, CQ Politics says, “The framework also would establish a system of consumer-owned insurance cooperatives in lieu of a government-run ‘public plan,’ and would expand Medicaid to millions more Americans.”

How legislation addresses key issues
The Los Angeles Times offers a solid comparison of the competing legislation by looking at six key issues in the reform debate: rising insurance costs, insuring the uninsured, protecting the insured, improving the quality of care, changes in Medicare, and the total cost of legislation. In each category, the newspaper sums up the proposals, the costs, and the arguments for and against. 

Here’s the section on protecting the insured:

House: Forbid insurance companies from refusing coverage on the basis of preexisting conditions. Outlaw annual or lifetime caps on benefits.

Senate: Same.

Cost: A ban on preexisting-condition exclusions would cost insurers some, but if coupled with a mandate requiring everyone to buy insurance, insurers would probably gain financially.

Argument for: Insurers often use preexisting conditions as a reason to deny coverage, making the purchase of a plan on the open market difficult.

Argument against: Without adequate protection for insurers, people would buy coverage only when they are seriously ill, some fear.

The Washington Post also answers eight pressing questions including:

• “If I don’t have health insurance now, how will reform affect me?”

• “If I currently have health insurance, how will reform affect me?”

• “I keep hearing about plans to create a ‘public option’ or health insurance cooperatives. How would those work?”

The Post gives an effective snapshot of what the current bills (except for the Baucus framework) have in common:

• Require every American to carry insurance, with discounts for people who cannot afford it and penalties for people who refuse to buy coverage.

• Require most employers to contribute to the cost of employee coverage or pay into a health fund, while small firms would be exempt or receive tax credits to reduce the price.

• Expand the Medicaid health program for the poor.

• Provide insurance discounts for people earning less than 400 percent of the federal poverty level, or about $73,000 for a family of three.

• Impose new restrictions on insurance practices, such as prohibiting the denial of coverage because of preexisting conditions.

• Create a new marketplace, dubbed an “exchange” or “gateway,” for individuals and small businesses to comparison-shop for insurance.

Experts still worried about impact on needier Americans
A Kaiser Health News exclusive takes a hard look at how some Americans may not get the relief they need.

“Concern about the legislation’s cost has overshadowed a major worry among some policy experts: Whether the Democrats’ plans would protect low- and moderate-income earners from excess financial burdens, as backers have promised,” Kaiser reports.

“Under the House proposal, people receiving government subsidies could still end up spending 20 percent or more of their annual incomes on premiums, deductibles and co-insurance, according to estimates prepared by the House Committee on Ways and Means and obtained by Kaiser Health News. That financial load could grow substantially if the proposal’s financing — $1 trillion over a decade — is pared back as congressional leaders come under pressure to reduce the legislation’s costs.”

Kaiser quotes Elisabeth Arenales, director of the health care program at the Colorado Center on Law & Policy, a nonprofit favoring expanded health care coverage that has studied low earners’ health cost burdens: “What we see every day is that families and individuals who have high co-payments or high out-of-pocket expenses that they have to satisfy are virtually in the same situation as people who don’t have insurance. They delay or don’t seek care. Most of the conversation (in Washington) is focusing on premium costs and not out of pocket expenses.”

How individual buyers are affected
Kaiser and the Washington Post collaborate on an analysis of how the legislation will affect people who buy their own insurance. They offer examples of different families who are already dealing with a variety of difficulties that reform could address: the uninsured, sharp premium increases because of age and other issues, high out-of-pocket costs and out-of-network fees, and pre-existing conditions.

“Still, the proposals, which come with an estimated trillion-dollar price tag over 10 years, wouldn’t solve all the problems faced by the millions of people who buy their own coverage,” the story notes. “Some could still face big out-of-pocket expenses. Others would earn too much to qualify for a subsidy. Premiums would probably continue to rise.”

A look at medical devices and why health care is expensive
If you’ve ever wondered why health care is so expensive, listen to this National Public Radio report about medical devices from an operating room in San Diego. The reporter describes the scene as a heart surgeon goes through a number of $2,000 stents before finding the right size for a patient’s artery.

At one point, she confides to listeners: “It feels bizarre to stand here not as the patient and not as the doctor but as a sort of accountant.”

“In this single operating room, doctors might go through a dozen stents in a day. The rolling metal shelves are stacked with boxes of stents, with what amounts to piles of money.”

The reporter doesn’t say where those stents are produced, but a Minnesotan can’t help but wonder if some were made here by Boston Scientific, a member of the medical-technology hub in the Twin Cities area.

“Harvard economist Ken Rogoff says that some materials you see in hospitals, like bandages, have been around long enough to become ordinary and cheap. ‘But the kind of fine scalpels used in heart surgery are really pretty new, and there are lots of different varieties,’ he says. ‘The market is still sorting itself out.’ “

The NPR reporter concludes: “We don’t get to know scalpels and stents the way we know calculators. We don’t really understand just how perfect they need to be. And we tend to accept that marginally better medical technologies are worth the cost.

“Because we’ll pay for the new, better stent, manufacturers are constantly trying to make a new, better stent. Americans have been incredible innovators in medical technology. We benefit from that. The world benefits from that. We also pay for it. A lot.”

Obama’s speech to Congress is scheduled to begin at 7 (CDT) tonight. Most major TV and radio networks will broadcast the speech.

Casey Selix, a news editor and staff writer for, can be reached at cselix[at]minnpost[dot]com.

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Comments (5)

  1. Submitted by Tim Nelson on 09/09/2009 - 10:14 am.

    Yesterday I learned that Congress wants to fine an individual $750 for not having health insurance. I was thinking that the fine would be indexed by income, basically from zero. In that scenario, I expected to pay a fine between $0 and $200.

    I needed a plan B, so I slept on it last night.

    Congress is regulating things like pre-existing conditions, and dropping people, which is fine by me. So, if percentage of coverage, and how much you have to pay yourself are still on the table, I think I can find a completely useless policy to buy.

    Lets say the insurance company pays out 5% of any claim, and that the first $100,000 is not covered either, I think an insurance company might be able to offer this policy for under $5 per month.

    This adds up to $60, which is a little more than I would like to pay, but I should be able to avoid the fine.

  2. Submitted by Joe Johnson on 09/09/2009 - 01:53 pm.

    Tim – I work around the IRS with a high frequency and I wouldn’t worry about the government being able to enforce a $60 penalty on you. They have enough issues finding $600,000 let alone $60.

  3. Submitted by dan buechler on 09/09/2009 - 03:27 pm.

    Watching PBS Newshour last night one got the feeling that there was an incredible amount of movement tuesday. Your reporting on the stents was a real good read.

  4. Submitted by Bernice Vetsch on 09/09/2009 - 03:40 pm.

    1) Have these surgeons ever considered measuring the affected artery?

    2) Did anyone see the new report from California (CalNurses?) on a study of how many denials the big insurance companies make? I didn’t get them all written down, but a few biggies are:

    United HealthCare – 39-40%

    Blue Cross/Blue Shield – 28%

    Cigna – 33%

    Pretty efficient way to increase profits, isn’t it? Just Say No. (Reminder: The top 10 insurers increased their profits by 428 percent in the years 2001 to 2007, by just this kind of “cost reduction.”)

    I hope someone has brought this report to the president’s attention.

  5. Submitted by dan buechler on 09/09/2009 - 04:50 pm.

    Watching a stent being placed on youtube is simply amazing. We take so much for granted. You should include or direct a clip.

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