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I've Had Enough Of All The Bullshit And Disinformation About The Bill, Here It Is, READ IT!

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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:01 AM
Original message
I've Had Enough Of All The Bullshit And Disinformation About The Bill, Here It Is, READ IT!
Edited on Thu Mar-11-10 11:05 AM by Beetwasher
If you want to debate, argue, slam, promote blah blah blah, why don't you read it first (or at least this analysis)?

It seems a lot of people here have not read it, and yet they spout off about it anyway. Or, they are purposely pushing disinformation about it.

Here's the analysis. Obviously it will be subject to the reconciliation side car, which will only improve it. But the details of that are not available yet.

The Patient Protection and Affordable Care Act Section by Section Analysis

http://dpc.senate.gov/healthreformbill/healthbill49.pdf

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zipplewrath Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:06 AM
Response to Original message
1. Well, that's nice but...
Half of the argument is what much of this functionally means. The other half is what isn't in here.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:19 AM
Response to Reply #1
2. So?
It would still behoove one to read it before spouting off on it.
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zipplewrath Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:28 AM
Response to Reply #2
4. What makes you think we haven't? nt
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:29 AM
Response to Reply #4
6. I'm Omniscient
I know everything. Stop that, your palms will get hairy.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:19 AM
Response to Original message
3. I've read the bill and I don't agree with it.
It's riddled with loopholes. For instance, you have only to skim the very first paragraphs to find this:

Sec. 2718. Bringing down the cost of health care coverage. Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. The requirement to provide a refund expires on December 31, 2013, but the requirement to report percentages continues.

Notice how the requirement for insurance companies to refund the revenue for expenditures for non-claim costs exceeding 20% to the enrollees expires at the end of 2013. Now, this was a great provision to extract a price from the industry for failing to abide by the MLR. There is still the point that there is no agency in the federal gov't with the expertise to audit the books of the insurance industry adequately to detect manipulation of this. But, let's assume for the sake of this debate that they could be caught manipulating the numbers, why is the penalty for failing to meet the MLR only until the end of 2013? Is there some expectation that their efforts to avoid paying claims will end by then? The only thing after that is to report their percentages. The bill is full of this sort of thing which imposes a regulation with one hand and weakens it with the other.
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joeybee12 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:30 AM
Response to Reply #3
8. +1
And I would add, if Congress isn't even going to read the bill before voting on it, why should I???
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Maru Kitteh Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 12:31 AM
Response to Reply #8
56. Was it Rush or Glen Beck who sold you that line?
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Hekate Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:43 PM
Response to Reply #8
69. I think the USA PATRIOT Act was the exception rather than the rule, joey, & of course it was Repub
350 pages of unconstitutional crap came off some genius's shelf and was presented to Congress as a full-out emergency package while they were all quite literally shell-shocked from the events of 9-11, including the plane slamming into the Pentagon. (I have a friend who was working in DC that day, and it shook the town like an earthquake.)

Thanks to Bush's henchmen, Senators and Reps were given no time to read the damn thing, nor to have their staffs vet it. They had a few days, at best.

THIS bill, on the contrary, is no such animal. Anyone in Congress who by now has not had their staff read it in full and present an analysis, or by now has not personally given the various iterations of the bill the once-over, is simply not doing his or her job. They are misrepresenting the case -- they are lying. They've had a year.

Sorry, joeybee, this line is baloney.

Hekate

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sinkingfeeling Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:34 AM
Response to Reply #3
10. Isn't the time limitation due to the expected creation of exchanges that will mandate the MLR?
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berni_mccoy Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:39 AM
Original message
It's futile to argue with someone who is Single-Payer-Or-Die. They will find any
language in the bill and use it to make their case. They'll argue that there are no Immediate Benefits (an argument that Karl Rove used and got called b.s. on by Media Matters). They won't even support the Public Option because it's not Medicare For All.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:19 PM
Response to Original message
24. You have totally mischaracterized my stand. I am not single payer or die
I was very much in support of the House bill even with the weakness of the public option that made it into the final bill. I felt even this sliver of a PO would give us a foundation upon which we could expand.

I was also in support of the blended bill for the Senate that Reid wrote to combine the Senate HELP and Finance bills which contained a PO with an opt out for the states. Even when that was dropped and the Medicare expansion replaced it, I was hopeful it would give us the foundation we could build on which supporters keep telling us this bill is but which, in reality, it is not.

The House bill was not a good bill but it was, grudgingly, acceptable. There is not one provision from the House bill which got better in the Senate bill and most everything got worse.

I am sure it suits your purposes to characterize me as single payer or die but it is not truthful, in the least.
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timtom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:35 PM
Response to Reply #24
33. He's confusing you with me.
I am single-payer or die.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:51 PM
Response to Reply #33
37. Ah, thank you for the clarification. nt
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:51 AM
Response to Reply #10
19. But who will be verifying the private insurance companies do not exceed
the MLR.

In addition Wendell Potter said the MLR was 95% in the early 90's, now we are setting into law a profit of between 20% and 25% with the MLR of 75% and 80%.

:shrug:


http://www.examiner.com/x-19087-Special-Interests-Examiner~y2010m2d2-Amazing-secrets-of-the-Senate-healthcare-bill-revealed-using-middleschool-math

"...Let’s get right to it. Section 2718 of the Senate bill provides that...

Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. The requirement to provide a refund expires on December 31, 2013, but the requirement to report percentages continues.(1)


Talk about “refunds” to patients sounds good at first, but what the Senate is really saying here is that the Senate bill requires private insurers to spend only 75 to 80 percent of every premium dollar on actual health care. OK, so what does that mean?

Let’s put it another way: the Senate bill authorizes private insurers to consume 20 to 25 percent of every premium dollar on administrative costs.

But according to the Senate’s own data, ordinary Medicare's administrative costs are only 2%.(2) In other words, if we simply opened ordinary Medicare to uninsured Americans, 98 cents of every Medicare dollar would buy actual health care.


Believe it or not, the two little facts given above—that 20 to 25% figure, and that 2%— are enough to prove, without any other information, the colossal stupidity and shocking corruption of the so-called "Patient Protection and Affordable Care Act." ....."








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berni_mccoy Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:52 AM
Response to Reply #19
20. The OPM will, in conjunction with the local Exchange administrators.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 03:19 PM
Response to Reply #20
42. Would you cite the section of the bill and do you think there will be enough
staff to audit all their books and in addition enough knowledge to even know where to look.

:shrug:

And maybe you address the question/concerns in this link...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7894063&mesg_id=7894265

"Sec. 2718. Bringing down the cost of health care coverage. Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. The requirement to provide a refund expires on December 31, 2013, but the requirement to report percentages continues.

Notice how the requirement for insurance companies to refund the revenue for expenditures for non-claim costs exceeding 20% to the enrollees expires at the end of 2013. Now, this was a great provision to extract a price from the industry for failing to abide by the MLR. There is still the point that there is no agency in the federal gov't with the expertise to audit the books of the insurance industry adequately to detect manipulation of this. But, let's assume for the sake of this debate that they could be caught manipulating the numbers, why is the penalty for failing to meet the MLR only until the end of 2013? Is there some expectation that their efforts to avoid paying claims will end by then? The only thing after that is to report their percentages. The bill is full of this sort of thing which imposes a regulation with one hand and weakens it with the other."


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grantcart Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:34 PM
Response to Reply #42
67. The answers to your questions are here
http://journals.democraticunderground.com/grantcart/256

The OPM already is the gate keeper for health plans for federal employees

Here is how they do it for federal employees

http://www.opm.gov/insure/health/planinfo/index.asp
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:27 PM
Response to Reply #19
26. Add to this that I heard Potter talk on this after passage of the Senate bill
and he was asked by Lawrence O'Donnel if there was any agency or individual with the expertise to open the books of the insurance companies and detect manipulation of the numbers (fraud, in other words). He replied, "I don't think so. I don't know of any. Perhaps Jay Rockerfeller's group could come closer than most but..."
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 03:25 PM
Response to Reply #26
43. Found the interview ...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7302927&mesg_id=7304281

O'DONNELL: "Is there anyone currently employed in the U.S. government - at the IRS, or in the HHS - who knows how to enforce this; how to go into an insurance company and figure out what their real medical loss ratio is?"

POTTER: "No, I don't think so. At least I haven't come across them. One of the things I have learned over the last six months is that there is very, very little understanding in Washington about how commercial health insurance companies work, including on Capitol Hill. The exceptions are Sen. Rockefeller and his team..."


And here...

Who’s Enforcing The Medical Loss Ratio?
http://news.firedoglake.com/2009/12/23/whos-enforcing-the-medical-loss-ratio/

Thanks

:)




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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 08:26 PM
Response to Reply #43
50. Thank you for that! I heard that interview but have never had a copy of it! nt
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 08:55 PM
Response to Reply #50
51. You're welcome, I just posted it in the PV forum...
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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 09:52 PM
Response to Reply #43
52. Ohferchrissakes, every homeowners and auto policy in the country...
is underwritten by a company regulated by a state insurance department that digs into its books and knows all about loss ratios and reserves.

This is not nearly as mysterious as it sounds.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:59 PM
Response to Reply #52
53. Really? Wonder why so many abuses of it in health insurance, then?
They haven't been doing too well up until now.
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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 12:28 AM
Response to Reply #53
55. For one thing, there hasn't been a requirement to cap...
expenses in health insurance before, so it could hardly have been abused.

For another, most people talking about health insurers' expenses have absolutely no idea what they are talking about. Start with the commissions commonly paid to producers for small accounts. Then you got the rent, phone bills and other office costs. Know what they should be in either dollars or percentages of revenue? How do such expenses get charged off? (And how does Medicare get away with so little of them?)

"Medical loss ratio"? It's a loss ratio and they have their own way of reserving claims. If they have a cancer patient with an estimated million dollar course of therapy over the next two years, common insurance practice is to set up a reserve to make sure the claim gets paid and accounted for. It might go into this year's numbers, or might not, but the entire amount is reserved and set aside until the case is resolved.



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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 12:49 AM
Response to Reply #55
57. There are states who have MLR caps and it has not really brought costs down or stopped the abuses of
the industry. It hasn't stopped the bullshit denials of claims. Hey, I thought it sounded good, too. It was not I who told Lawrence O'Donnell there was no agency competent to detect the fraud. And it wasn't me who put out the report to the investors cheering this level as the one that could be manipulated.

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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 01:09 PM
Response to Reply #57
88. You might note that not all claims denials are bullshit, but, that's not...
the point, and it has nothing to do with expense caps.

The only point I made is that there are plenty of agencies out there experienced in auditing insurance books. Anyone who says there isn't is a liar or ignorant.

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dflprincess Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:15 AM
Response to Reply #55
81. Minnesota has caps on the nonprofits that operate in the state
and, a few years ago when they were finally audited, it was found that one of the had flat out lied to the state about meeting the caps.

It was also found that a lot of money was being spent on things like a condo for an executive and lavish entertainment. All the while charging premiums just as high as the for profits.

For those of you think including nonprofit options in the "exchange" will give the for profits any real competition - it was NON profits pulling these stunts.

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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 01:14 PM
Response to Reply #81
89. The key there is how it took so long to audit them. Regulated utilities, and...
insurance companies for some lines of business, have to open their books to justify any rate increases.

What's so hard for this country to understand about that? For some reason, we keep either decimating the regulatory agencies, or allowing them to be used as entries for jobs in the regulated industries.

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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:15 PM
Response to Reply #26
72. It took California years and they really didn't get a good look
The Insurance Companies involved opted to settle instead.
Many like my self did not benefit from the settlement, because of how long it took the state to act on our complaints.
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Mimosa Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 04:37 PM
Response to Reply #19
46. But Medicare is going broke
Slipslidingaway, you said:

"But according to the Senate’s own data, ordinary Medicare's administrative costs are only 2%.(2) In other words, if we simply opened ordinary Medicare to uninsured Americans, 98 cents of every Medicare dollar would buy actual health care."

Medicare is not adequately funded. That's another related issue, of course.

I can see where the bill as is opens the door to incremental change down the road. ;)
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 06:41 PM
Response to Reply #46
49. Couple of things, if Medicare is going broke when use money to partially
Edited on Thu Mar-11-10 06:42 PM by slipslidingaway
fund this bill and why not push for Medicare to negotiate drug prices.

:shrug:

The Obama HC plan said we could save up to 30 billion every year if we did this and that, went he went to DC, he would correct this. Instead all we heard about was the deal with Pharma?

An improved Medicare for All system would not only give Everyone access to care, it would also help the funding problems. Why mandate that people pay that for profits to private companies.

???






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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 12:01 AM
Response to Reply #46
54. The change it opens the door for down the road is privatization of Medicare
And if Medicare is going broke, why are we cutting $500 billion out of it?

I know the answer to this but I don't think many do.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:23 PM
Response to Reply #10
25. I think that is the idea but, in reading through the bill (not just a summary or analysis)
under the sections on the exchange, I can not find a requirement to refund the difference if they fail to meet the MLR. Now, I can't swear it's not there because this bill is huge and I'm certain there are law makers who will be voting who can't answer a lot of the questions about the details. What is ambiguous about this, though, is if the creation of the exchanges is the reason this provision is removed from this section, why does the provision of continuing to report remain there?
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TheKentuckian Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 03:35 PM
Response to Reply #10
44. The exchanges will start with less than 1% of the population and after ten years will
be under 5% by almost any estimate. The market effects of the exchanges is very overstated.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:08 PM
Response to Reply #3
71. I agree and have also read the bill
Edited on Fri Mar-12-10 11:45 PM by unapatriciated
The regulations and penalties on fraudulent claims regarding the insured and providers are very strict yet when it comes to the Insurance companies the only penalty (i could find) is not being able to sell in the exchange. And even that was not set in stone.

I would like to see strong regulations and penalties now regarding denial of claims instead of trying to fix it later.

California passed strong laws in the early 90's. The Insurance Companies did not adhere to those laws and many such as myself complained. It wasn't until 2008 that state took action regarding complaints.
http://www.hmohelp.ca.gov/aboutTheDMHC/itn/state_review_ins_pol.pdf

It wasn't until 2009 that they settled out of court. Unfortunately many like myself did not share in the settlement because of the long period before they actually addressed the problem.
1991-2005 was when my insurance company denied and delayed care for my son, that resulted in the loss of my home and unnecessary crippling of my son.
http://articles.latimes.com/2009/feb/11/business/fi-bluecross11

edited to fix links


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dflprincess Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 01:26 PM
Response to Reply #71
91. That's exactly what I noticed about any regulations or penalties
they're all directed at those buying the products (individual or employer based) and woe unto anyone who lies to get a subsidy. - Oversight of the insurance industry? Not so much.
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readmoreoften Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 08:58 PM
Response to Reply #3
93. +1
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Bobbie Jo Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:29 AM
Response to Original message
5. Telling.
By virtue of the apparent unrecs, it seems some either simply won't be bothered with going to the actual source, or don't find it necessary for others to do so.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:36 AM
Original message
Perhaps the unreccs are from some who have read the bill and seen it for what it is.
That would be me. I've read this bill, in its entirety, several times.
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Bobbie Jo Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:29 PM
Response to Original message
27. Oh I see.
Edited on Thu Mar-11-10 12:31 PM by Bobbie Jo
Then why wouldn't you want someone else to read it and form their own opinion?
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:35 PM
Response to Reply #27
34. I have no problem with anyone reading the bill. I have made that suggestion to many here
My urec is due to the antagonistic nature of the headline of the bill and the fact that what was posted is, in reality, an analysis of the bill and not the bill.

It is funny, though, that the OP is one I asked to show me the language from the bill to support a statement he made about the bill at one time and I was just accused of 'spreading bullshit, and never got a response that showed me where the language of the bill disputed my position.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:24 PM
Response to Reply #34
73. yes
I have read through this very lengthy bill and it reads like an Insurance Policy. The odds are with the House:banghead:
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cornermouse Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:46 AM
Response to Reply #5
17. Whatever.
2711. No lifetime caps - that's the first thing the insurance industry will start working to get rid of. My bet? It'll be done within a year if not sooner.
2712. No rescission - all they have to do is raise the premium beyond the person's ability to pay.
2713. Coverage of preventive care - don't look now, but I believe they've already found a way around this one. Bottom line will be that eventually you'll be paying for screening/preventive care, not them.

I'm not going to spend the rest of the day going down the list when I'm pretty sure you aren't going to read it.

You've already made up your mind.
So have I.

You believe you're right.
I believe you're wrong.

I believe I'm right.
You believe I'm wrong.

What now? Pretty much nothing.

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Bobbie Jo Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:32 PM
Response to Reply #17
30. What was that?
Edited on Thu Mar-11-10 12:35 PM by Bobbie Jo
Beside your usual spew.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:49 PM
Response to Reply #17
36. 2712. No rescission
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).

As I was once accused of being dishonest for ignoring section 2702 and 2742 which the poster claimed, somehow, mitigated this gaping loophole, I will now post 2702 for the readers to see for themselves if it, indeed, address this issue at all. I would welcome any help at all in finding section 2742 in this bill as I have searched it, extensively, and can not find it listed at all in the contents or in a scrolling of the entire bill. My belief, though, is if found it has nothing to do with closing the above loophole.

SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.

`(a) Guaranteed Issuance of Coverage in the Individual and Group Market- Subject to subsections (b) through (e), each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage.
`(b) Enrollment-
`(1) RESTRICTION- A health insurance issuer described in subsection (a) may restrict enrollment in coverage described in such subsection to open or special enrollment periods.
`(2) ESTABLISHMENT- A health insurance issuer described in subsection (a) shall, in accordance with the regulations promulgated under paragraph (3), establish special enrollment periods for qualifying events (under section 603 of the Employee Retirement Income Security Act of 1974).
`(3) REGULATIONS- The Secretary shall promulgate regulations with respect to enrollment periods under paragraphs (1) and (2).

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sinkingfeeling Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:30 AM
Response to Original message
7. Nice summary. There's lots of good stuff in there.
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joeybee12 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:33 AM
Response to Original message
9. I certainly hope you mean EVERYONE should read it, including those
who are cheering it on...or are you assuming that if you're against it you haven't read it, and if you're for it, you have to have read it?
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:36 AM
Response to Reply #9
12. I Think My OP Made It Pretty Clear, Or Did You Bother To Read THAT?
"If you want to debate, argue, slam, promote blah blah blah, why don't you read it first (or at least this analysis)?
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joeybee12 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:55 AM
Response to Reply #12
22. No, it's your attitude that caught my attention first...
and then i started reading your responses to those who don't like it, and that was clear you're a promoter. Sorry, sweetie, you're too transparent even when you try to hide your intentions.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:32 PM
Response to Reply #22
31. LOL! Attitude? Is That Code For Asshole? Yeah, I'm An Asshole, So What?
I make no bones about the fact that I support this legislation, not trying to hide anything. So what, cupcake? I'm still putting this out there for everyone to read so they're not talking out of their assess. I see too much of that.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:42 PM
Response to Reply #31
76. Than put out a link to the actual bill.
Some of us have read all of it not just the cliff notes.
There are far too many loopholes that give way to much wiggle room for the Insurance Industry.
When California passed legislation in the early 90's regarding pre-existing condition and The Fair Claims Practice Act.Tthe Insurance Industry found ways around it (or flat out ignored it).
It took years for the state to even address the issue and still many were never reimbursed for wrongful denials of coverage.

http://www.hmohelp.ca.gov/aboutTheDMHC/itn/state_review_ins_pol.pdf

http://articles.latimes.com/2009/feb/11/business/fi-bluecross11
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:46 AM
Response to Reply #76
84. It's A Good Thing Then That There Will Now Be Another Level Of Federal Enforcment
Edited on Sat Mar-13-10 12:47 AM by Beetwasher
to back up the state levels of enforcement.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:11 PM
Response to Reply #84
87. That's the problem
Edited on Sat Mar-13-10 12:18 PM by unapatriciated
There are no real penalties, if they wrongfully deny claims or coverage. The only penalty is being dropped from the exchange or provide coverage previously denied (I spent years on this merry-go-round).
The Insurance Companies in California wrongfully denied claims and flat out ignored the law in the early 90's and well into 2008 (and probably still doing it). It took until 2008 for California to actually act on the multitude of complaints regarding denials, reviews and the dropping of coverage altogether.
They settled out of court for a fraction of what the Ins. Co. stole from their insureds. California only went back to 2007 when settling, giving the Companies involved twelve years of illegal profits for wrongfully denying claims.

My fight started in 1991 with the first denial for my son's medical treatment. I spent years fighting reviews and denials that created critical interruptions in care causing the unnecessary crippling of my child and forced the sale of my home.

In 1993 after years of filing complaints with the state, I took my files to one of the leading attorneys in Insurance abuse (William Shernoff). After reviewing my files I was told they couldn't do anymore than what I was doing. In fact they praised my work in regards to detail and follow-up. The sad thing is the insurance companies wrote the rules and knew how to play the game better than the insured. They put you on the merry-go -round of denials and reviews. Keeping the monies in their pockets for as long as possible.
This (technically legal) practice resulted in emotional and financial hardships that in too many cases lead to unnecessary disabilities, deaths and financial ruin for the policy holders in California.

There are pages and pages (in this bill) of monetary penalties dealing with fraud in filing claims or "misrepresentation of material facts" (Ins. Co. love to use this in denying claims and canceling policies) when purchasing polices.
Pages and pages with penalties regarding medical care providers for fraud.
Not one penalty, zip, nada when it comes to the Insurance Companies.

Bottom line you can have many layers of regulations and agencies to enforce those regulations, but if there are no real penalties the Insurance Companies will abuse the system every time.
They play the odds on what keeps more money in their pocket, knowing in advance it's more profitable for them to do this.
We have seen this done time and time again, when are we going to learn from past mistakes in legislation and include stiff penalties for these practices.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 01:15 PM
Response to Reply #87
90. I forgot too add that the years of work in fighting my insurance co.
for the wrongful denial of claims and the merry-go-round of paper work resulted in the stealing of time from my family. Time I can never get back. My other children understood but it was still extremely hard on them and caused my marriage to fall apart.
I do not wish this on another family and is the main reason I object to the lack of penalties in regards to the Insurance Companies in this bill.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 08:58 PM
Response to Reply #90
94. That Will Now Be Illegal And Prosecutable By DOJ
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 10:37 PM
Response to Reply #94
98. please give me a link to that, I found it nowhere in the bill.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 10:41 PM
Response to Reply #98
99. Umm, Laws Don't Need To Specify That If You Break Them You Can Be Prosecuted
Edited on Sat Mar-13-10 10:43 PM by Beetwasher
It's self evident because it's FEDERAL LAW. Federal law is enforced by DOJ and Federal Courts. That's what they do. They enforce Federal Laws. That's how law works.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 10:53 PM
Response to Reply #99
100. like they did with this one?
:rofl:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=385x442526

I have been there and know all to well how they are prosecuted.
Like I said there are no real penalties and they will do exactly like the did in California.
But for some reason you believe in fairy tales.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 10:56 PM
Response to Reply #100
101. Well, Why Regulate Anything? People Are Going To Try To Get Away With Shit!
Edited on Sat Mar-13-10 10:58 PM by Beetwasher
And sometimes they succeed. By your idiotic logic, we shouldn't even have laws against murder, because some people get away with it.

I notice you're no longer pursuing the idiotic notion that a law has to specify that if broken you can be prosecuted. Good move.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-14-10 12:02 AM
Response to Reply #101
102. Your joking right
There are penalties for murder...It's called prison time. You don't get a pass when convicted. Pfizer got a pass and the Insurance Companies involved in wrongful denials got a twelve year pass in California.
What you fail to acknowledge is, if there are no real penalties attached to the regulations, there is no incentive to comply.
I did not concede to your circular logic. It took years for California to actually move on the Insurance Companies for "breaking the law" what makes you think it will be any different at the federal level?
By federal regulations Pfizer should have been barred from Medicare, didn't happen. By California regulations the offending Insurance companies should have been barred from selling plans in California, didn't happen.

They know they are ignoring the laws, but realize it is more profitable to pay the fine when and if they get caught. They already have a proven track record of doing just that. Where have you been that you have such trust that the Insurance Industry will do the right thing? Me thinks you work for one.

I notice you can't produce a link for penalties in this bill when, NOT IF, the Insurance Industry ignores the regulations.

Like I have said over and over again there are pages and pages in this bill with real penalties should an insured or health care provider file a fraudulently claim, but for some reason it wasn't necessary to include penalties if the insurance industry fraudulently denied or delayed care for an insured. Where is the protection for the policy holder? Yes you can dispute denials (just like California allowed) but that takes time and time is something that the critically ill do not have but the Insurance Companies do.

I'm not an idiot nor is my logic, I spent years fighting my Insurance Company for Wrongful denials of claims and delaying care. So I think I have a little more incite into the behavior of the Insurance Industry and what they will do to make as much profit as possible.
May I suggest you watch Sicko and if you have already seen you need to watch it again.

Talking to you brings back memories of fighting with the claims department when they denied or reviewed my son's medical bills.
I knew they were "breaking" California Law but they knew they had a time frame that allowed them to deny coverage legally while i filled out the same paper work over and over again. So I spent years on their merry-go-round.
I don't intend to spend one more minute on your little ride.


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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-14-10 09:29 AM
Response to Reply #102
103. Sucks For You, But That's The Idiotic Result Of Your "Logic", Despite Your Spin
Edited on Sun Mar-14-10 09:30 AM by Beetwasher
Courts decide your penalty when you break laws. Some laws have specific penalties written into them, others don't. You break a Federal Law, you can be prosecuted. That's how law works.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 08:56 PM
Response to Reply #87
92. You Break Federal Law You Can be prosecuted by DOJ
What's so hard to understand about that?
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LynneSin Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:36 AM
Response to Original message
11. Beet, I love you but how dare you ask for common sense with this gang
We thrive on reactionary knee-jerk. I mean I heard that the HCR will do NOTHING, I say NOTHING to cure my adult-onset ACNE so therefore we need to end this bill once and for all.

:eyes:
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:39 AM
Response to Reply #11
13. Just Call Me Beetwashquixote
Edited on Thu Mar-11-10 11:39 AM by Beetwasher
:hi: :loveya:
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LynneSin Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:45 AM
Response to Reply #13
16. Here you go - go crazy!
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:50 AM
Response to Reply #16
18. I'm Tiliting!
n/t
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Winterblues Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:54 AM
Response to Reply #16
21. That looks suspiciously like a terrorist to me, I say we attack
It doesn't seem to move to swiftly so should be an easy victory..:shrug:
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:01 AM
Response to Reply #11
78. not end it just fix some of the problems.
Edited on Sat Mar-13-10 12:01 AM by unapatriciated
I do not knee-jerk and have real concerns.
I have read the full bill not just the cliff notes.
I see some of the same problems as what California had regarding legislation that they passed in the early 90's.
It took years to get the companies to comply they settled out of court repaying only a small fraction on what they stole.
Without strong penalties, regulations have no teeth.
I spent over ten years fighting denials and reviews 1991-2005, and I see nothing in this legislation to penalize them for doing the same things that they did in California.

If we are going to give the insurance companies over 30 million new customers we better damn well have penalties for abuse.
You will find plenty of monetary penalties is this bill for fraud when it comes to the insured or the health care provider and zip when it comes to the Insurance Companies.
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Peacetrain Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:41 AM
Response to Original message
14. Thank you.. I hope people will take a second and read it..
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 01:33 PM
Response to Reply #14
41. A Second? You're Quick!
;)
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WilliamPitt Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 11:42 AM
Response to Original message
15. Why do you hate America?
Read it? Sheesh.

:P
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 01:32 PM
Response to Reply #15
40. Freedoms. Man, I Hate Those Things
I hate your freedoms. :evilgrin:
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Bluenorthwest Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:06 PM
Response to Original message
23. But that is not the bill. It is an analysis of that bill
Since the header is about disinformation, and claims this IS the bill, I will gladly split the hair. If you read this, you have not read the bill. It is that simple.
Reading the bill is a good idea, and those who promote it should do so. Have you?
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harun Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:30 PM
Response to Reply #23
28. Reading the actual bill is not that bad. I suggest people read the actual bill.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:31 PM
Response to Reply #23
29. I noticed that & decided not to quibble. Here's the posting of the bill I've been working off:
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:33 PM
Response to Reply #23
32. Umm, Did You Read My Post? I Make That Clear In The Post
Duh.

I've read the whole bill, but that may be too much for some people to digest.
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PVnRT Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 03:58 PM
Response to Reply #32
45. "Some people" = "anyone who disagrees with me"
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 05:05 PM
Response to Reply #45
48. No, It Means Some People Don't Have Time To Read A Bill Thousands Of Pages Long
Edited on Thu Mar-11-10 05:06 PM by Beetwasher
That's why I posted the analysis of the bill. Try to comprehend what you read.
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Fumesucker Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:42 PM
Response to Original message
35. California has basically thrown in the towel as far as regulating Anthem Blue Cross
The insurance company is too big and too powerful for California..

The enforcement mechanism for the private mandate is spelled out and I have no doubt that it will be strictly enforced by that most loved of all federal agencies the IRS..

The enforcement mechanisms for the insurance companies are far less clear and appear to mostly the states and yet the insurance companies have far more power than any mere individual.

When the least powerful are strictly regulated and the most powerful are loosely regulated it is a recipe for abuse by the most powerful.

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Politicub Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 12:54 PM
Response to Original message
38. I love this bill. Truly. It would be a huge leap forward for America.
Edited on Thu Mar-11-10 01:02 PM by Politicub
Some of the reforms are remarkable in their sweeping breadth of improving the system.

And for those complaining about mandates, I don't believe you've read the bill. Have you seen the fees?

$95 in 2014, $350 in 2015, $750 in 2016

And if you qualify, you get insurance subsidies or medicaid, which is being expanded.

The idea is, if you don't qualify for government assistance and you still use the emergency room system or forgo insurance until you are sick, you get penalized for it. I think that's fairer for everyone else who takes responsibility for their health care.

On edit: for the two people who have private messaged me telling me how much I must hate women, you are an idiot. I guess I need to clarify that I am not in favor of every section or every single sentence of this bill.

BUT ON BALANCE, it's a progressive piece of legislation. And I believe Bernie Sanders when he says it provides for a backdoor public option by way of the community health clinics. Once people have access to care that don't have it now, they will never allow this new right to be taken away from them.


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seabeckind Donating Member (406 posts) Send PM | Profile | Ignore Thu Mar-11-10 01:17 PM
Response to Reply #38
39. Let me begin by saying I haven't read "THE BILL"
Ok, glad I cleared that up. Oh, and I don't plan to.

The problem with this table above is that it once again squeezes the middle class. I have never been in the position of being poor enough to get assistance. I have also never been in the position of being rich enough that even $150 a month didn't hurt -- a lot. Instead I just sucked it up and put out the $150 a month.

Insurance would cost a family just starting out around $10k a year (yeah, with a bigas deductible). Even if they have 2 earners that $900 or so a month is going to really put a crimp in their finances.

They can shove that bill. I don't want to have to live on the promise that it'll be fixed someday.

And progressive? Maybe in figuring out a way to give more money to insurance companies.
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Politicub Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-11-10 05:04 PM
Response to Reply #39
47. Some people on DU must have ice in their veins
For the number of people this bill will help, I'm starting to wonder if people who oppose it outright know how selfish they appear to be. And please, spare me the purity tests.

Maybe I'm the only one who feels this way, but the practical side of me says let's get this passed to help people AND give the Dems a big accomplishment to tout this Fall.

Where do you get your numbers? Seriously - $10k/year?

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seabeckind Donating Member (406 posts) Send PM | Profile | Ignore Fri Mar-12-10 01:46 AM
Response to Reply #47
58. You're right, I'm probably very low
My insurance costs around $14000 a year, family plan. My employer kicks in 70%.

Maybe you're happy with the POS bill that doesn't cover EVERYONE but maybe you're the one with ice water who's willing to let 15 million do without.

This thing is just another giveaway to the insurance companies. Show me some real progress. Until then I stand with Dennis.
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:12 AM
Response to Reply #38
80. It's not the basic mandates that most of us have problems with.
It's the lack of regulations with penalties that would hold the Insurance Companies accountable for abuse.

And the various loopholes regarding premiums for pre-existing conditions and older age groups.

You can have all the regulations you want and if there are no real penalties the Insurance Companies will abuse the system. If you don't believe me ask California.

http://www.hmohelp.ca.gov/aboutTheDMHC/itn/state_review_ins_pol.pdf

http://articles.latimes.com/2009/feb/11/business/fi-bluecross11
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freddie mertz Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 08:11 AM
Response to Original message
59. The pdf you linked to is NOT the text of the bill. It's an "analysis".
Almost fooled us.
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livetohike Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 09:03 AM
Response to Reply #59
60. The OP states it is an analysis n/t
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freddie mertz Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:24 AM
Response to Reply #60
64. Yes, but OP also exhorts us to "READ THE BILL"...
Edited on Fri Mar-12-10 10:24 AM by freddie mertz
Then provides a link to a cleaned up analysis, prepared, I assume, by people who support the damed thing.

Where's the 2,000 page version the Pukes are always on about?

Anyone actually read THAT?
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:29 PM
Response to Reply #64
65. I Read That
Did you?
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Bluebear Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 09:06 AM
Response to Original message
61. What section analyzes the public option? Thanks. Obama said it must have one for him to sign it.
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readmoreoften Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 09:02 PM
Response to Reply #61
96. Pay that no mind. You have 1000+ pages of Newspeak to mush through, Bluebear.
Chop chop. Finish quickly and go about the business of praising the Democrats regardless of what they do.
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Stinky The Clown Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 09:11 AM
Response to Original message
62. I know someone who read it and defends it .......
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Name removed Donating Member (0 posts) Send PM | Profile | Ignore Fri Mar-12-10 10:30 PM
Response to Reply #62
66. Deleted message
Message removed by moderator. Click here to review the message board rules.
 
Stinky The Clown Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:56 PM
Response to Reply #66
70. Bullshit begets bullshit.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:35 PM
Response to Reply #70
74. You're The Expert!
n/t
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Stinky The Clown Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 11:57 PM
Response to Reply #74
77. I love the way your nose wrinkles when you get flustered
Kiss me, you fool!

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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:08 AM
Response to Reply #77
79. Buy Me Dinner First!
I'm not cheap date. But I am easy.
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Stinky The Clown Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:30 AM
Response to Reply #79
82. Sure
'roo okay?

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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 12:45 AM
Response to Reply #82
83. I Prefer Breast Milk Cheese
n/t
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deaniac21 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 09:28 AM
Response to Original message
63. I'm just proud of how open and transparent the process has
been. For once no backroom deals or payoffs to corporations.
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NuttyFluffers Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-12-10 10:39 PM
Response to Original message
68. already read it. deliberately convoluted into weak sauce.
why is it assumed only people who agree with you read it? what a pedantic assumption.
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Name removed Donating Member (0 posts) Send PM | Profile | Ignore Fri Mar-12-10 11:36 PM
Response to Reply #68
75. Deleted message
Message removed by moderator. Click here to review the message board rules.
 
NuttyFluffers Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 07:37 AM
Response to Reply #75
85. don't get amnesia on me, it's in your freakin' OP! or did you not read that?
"If you want to debate, argue, slam, promote blah blah blah, why don't you read it first (or at least this analysis)?

It seems a lot of people here have not read it, and yet they spout off about it anyway. Or, they are purposely pushing disinformation about it.

Here's the analysis."

quoted straight off of what you said. and instead of the actual bill, we get an analysis (that logic dictates you obviously favor).

oh, and this reply of yours -- thanks for proving you are pedantic. i'm done with you.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 09:01 PM
Response to Reply #85
95. LOL! Buy bye
Dont forget to write, cupcake.
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bread_and_roses Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 08:22 AM
Response to Original message
86. Is this the 1000+ pager? No, I don't have time to read it, nor should I bother
First of all, it shouldn't be that long. Second, of course I am going to rely on analysts and experts I trust to some degree to parse it out for me. Third, the entire farce is nothing but a shell game anyway, as has been amply demonstrated. This demand to "read the bill!" is utterly ridiculous.
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Mar-13-10 09:03 PM
Response to Reply #86
97. Yes, its utterly ridiculous to actually b informed!
That could be the most pathetic reply yet.
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bread_and_roses Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-14-10 09:38 AM
Response to Reply #97
104. no, it is utterly ridiculous to pretend one has expertise one hasn't
these bills are written in legalese. The probability of my being able to decipher them is pretty low. And I would bet the same of most here. They are also written to sneak in the maximum loopholes for the corporate pay-masters who's lobbyists seem to actually write most of them. And if the OP was about the "President's Bill" - whatever that's looking like these days - same applies.

Why would anyone bother to read the Bill when THIS "The Democrats' scam becomes more transparent" http://www.salon.com/news/opinion/glenn_greenwald/2010/03/12/democrats/index.html has been apparent for months, if not longer?
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Beetwasher Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-14-10 10:47 AM
Response to Reply #104
105. Some People Are Proud Of Their Ignorance
Go figure.

You don't know shit, refuse to educate yourself and your damn proud of it! You go, cupcake!
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unapatriciated Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Mar-15-10 11:23 AM
Response to Reply #104
106. you are correct, much like most Insurance policies.
I spent years reading my HC policy when fighting denials or reviews on my son's medical care.
I did read this bill and found many loopholes the insurance industry could use to deny care and stay within the regulations and little or no penalties when they didn't comply.
Yet there are pages and pages of penalties for the insured and the Health Care Providers should they file a fraudulent claim or 'misrepresent material facts' (this one is used quit often by the Ins. Co. to deny coverage).
But when they are wrong real people suffer, the Insurance Companies see no real penalty except for an occasional fine or they are forced to reinstate the policy (often too late).

http://www.youtube.com/watch?v=dT_2GjSkzHE
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