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Supreme Court Lets Affordable Health Care Act Stand....Implications for ME/CFS



In a surprise, Chief Justice John Roberts joined the four liberal members of the Supreme Court to uphold most provisions of the Affordable Health Care Act including the individual health care mandate.

The implications of the Supreme Court's decision are substantial for people with chronic illnesses, in general, and for people with chronic fatigue syndrome who often have with low incomes and difficulty purchasing health care. NBC News called the decision "a major victory for millions of Americans who either can’t purchase health insurance or have chronic illnesses."

With studies suggesting that ME/CFS costs the average family about $20,000 a year in lost wages, and with a recent CDC study findings that on direct medical costs averaging almost $6,000 annually, a significant portion of which is paid out of pocket, this is a community that could use some financial relief at the doctors office.

Republican presidential candidate Mitt Romney and other Republicans have vowed to repeal the bill in its entirety. Now that the most parts of the bill have passed muster at the Supreme Court the fate of the bill may be determined by the outcome of the upcoming election.

Pre-existing Illnesses

One of the most significant aspects of the Affordable Health Care Act is its clause preventing companies from restricting or barring coverage because of a pre-existing health condition. Prior to the enactment of the bill insurance companies could refuse to sell a policy, or charge several times more for it or exclude specific conditions from coverage. Under this bill insurance companies will not be allowed to jack up rates or exclude coverage for conditions when you become ill - a situation which drove many to bankruptcy or left them unable to afford insurance coverage.

Remarkably it appears that 'most' insurance companies won't even be able to charge more for people with pre-existing conditions. The government website states

"Under the Affordable Care Act, in 2014, most health insurers will no longer carve out needed benefits, charge higher premiums, put lifetime limits on coverage of key benefits, or deny coverage due to a person’s pre-existing condition"​

The desire to cover pre-existing conditions drove the most controversial aspect the Bill, the individual mandate, which requires all Americans who can afford to, to have insurance so that the premiums for healthy people will help pay the costs of those who become ill.

The Uninsured

The law is designed to greatly reduce the number of people without health insurance - a problem afflicting many with ME/CFS. Estimates suggest that as many as 30 million people who do not now have health insurance will have it by 2014 Federal subsidies (which tap out at $44,000 a family) will enable millions of lower-income Americans who could not otherwise afford health insurance to have it.

Tax Credits Assist the Less Well Off
  • Lower-income people will be eligible for Medicaid in states that provide that option. (Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid.) The court's decision to refuse to compel states which refuse to expand Medicaid eligibility to people with lower incomes to give up their already existing Medicaid funds may blunt the laws reach in some areas. A Department of Health and Human Services (DHHS) report found that a low-income family could save up to $14,900 a year using tax credits.
  • Middle-class - Tax credits for those earning between 100% and 400% (@ $43,000) of the poverty line will be available to assist in buying insurance coverage. A Department of Health and Human Services (DHHS) report found that tax credits may help middle-class families save as much as $2,300 a year.
Insurance Exchanges

People buying individual policies and small businesses will be able to use 'insurance exchanges' to shop for policies. These exchanges will offer the same choice of health plans as congressmen or women currently have. Thus far 14 states, including California, Colorado and West Virginia, have already authorized the creation of these "exchanges". They are due to be enacted by Jan 1st, 2014. Find about more about insurance exchanges here. Check out a map on your state's progress in producing them.

The Already Insured

Companies with greater than 50 employees will be required to offer insurance or pay a penalty. If workers aren't satisfied with the options a company offers they are free to use the money the employer might have contributed to their insurance and use it to shop on the Insurance Exchanges.

It's not clear the effect the law will have on premiums. A DHHS report stated that 'all businesses' will 'likely see'reduced health care premiums of $2,000 per family by 2019.

Others
  • Ending Lifetime Limits - the end of lifetime limits on health care will help those most severely stricken from sliding into bankruptcy and/or losing medical care.
  • Honest Mistakes No Longer Cause for Insurance Withdrawl - for years insurance companies have found ways to deny coverage if they can find small mistakes in applications. Under the Affordable Care Act they will no longer be able to do that.
  • Premium Payments Must Primarily go to Health Care Not Administrative Overhead and Marketing - a certain portion of your insurance payments are required to go to health care not administration or marketing or a portion of your fee will be rebated. In his comment on the Supreme Court decision President Obama stated that in Oct of this year 13 million people will receive insurance company rebates because their insurance company spent more in administrative and marketing costs than allowed.
  • Medicare - Medicare recipients will keep getting discounts on prescription drugs to close a gap in coverage known as the "doughnut hole.
Improved and More Efficient Health Care

The bill provides a variety of means designed to make health care more efficient and effective. These include improvements to physician and hospital quality care reporting, development of outcome measures, a National Health Care strategy based on health care quality and testing a variety of models to improve health care delivery.


More Emphasis on Understanding and Treating Pain - Some of the less talked changes could have implications for people with ME/CFS. Section 4305, for instance, requires increased attention on treating chronic pain. Some of the requirements, which include the creation of a Pain Consortium to provide annual recommendations to the Director of the NIH, and the creation of an Inter-agency Pain Research Coordinating Committee tasked with identifying critical gaps in pain research and treatment, have already begun to be carried out.

Other programs include
  • A Value-based Purchasing Program - will provide hospitals financial incentives to increase their quality of care by providing more money to better performing hospitals. Hospitals will be required to publicly report a variety of performance results for heart attacks, infections, surgical care, pneumonia, etc. The government site reports "for the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide." This program will begin in October of this year.
  • Reduced Billing Costs - the law standardizes billing and requires health plans to begin adopting and implementing rules for the electronic exchange of health information. The govt site states "Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care." This program will come into effect Oct, 2012.
  • More Free Preventative Health Care - by Jan 1st 2013 insurance providers will be required to provide more free preventative health care services such as check ups and mammograms.
  • 'Bundling' to Save Money - The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment ;plan called “bundling,” hospitals, doctors, and providers are paid a flat rate care rather than using the current system where each service or test is billed separately to Medicare.
Jan 1st, 2014

If the bill is not repealed, on Jan 1st, 2014 - just 18 months from now - most of the major changes (individual mandate, creation of Insurance Exchanges, Medicaid eligibility for low-income patients, tax credits for the middle class, etc.) will kick in. Click here for a timeline.

After that a few more changes are in store. For instance, by Jan 1st, 2015 physician payments will begin to be tied to the quality of health care they provide.

As more information becomes available on the Affordable Health Care Law's effect on people with chronic illnesses such as ME/CFS we'll report on it.
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Thanks Cort.

While treatment options for CFS are so limited, these reforms probably won't lead to much direct improvement in the way people's CFS is treated... but it should make it easier for those with CFS to have the coverage needed in case other medical problems emerge.

Yes...We'll see what the ultimate consequences of the bill are for the health care system over time (if it isn't repealed) but I think it has to help those who can't get covered because of pre-existing coverages or who faced increases in fees because of CFS. I pay 25% more for insurance because of CFS and I'm perfectly healthy otherwise. I imagine people who are really sick have a horrid time of it. It will also help people with ME/CFS with low incomes get insurance coverage....and relieve some of the burden that insurance coverage creates for people with more money...

I don't see how it could effect the greatest need - producing adequate treatments and more research - but it's not designed to do that kind of thing either.
 
Very bad for all concerned. Not just people with CFS. Disaster. Only hope is election time.
How?

I claim no special expertise on the subject, but I don't see it changing the essential mess our system is in one way or another. It won't make medicine itself any better or reverse current trends; that wasn't its goal. It should make the purchasing of medical services less chaotic - you can keep the same insurance after you change jobs etc. Making at least the buying end (for most people that means 'insurance') less of a mess has been on presidential agendas since Eisenhower.

Before the bill, the biggest medical consumers, by far, were the retired, mostly via Medicare/'caid
After the bill.... the biggest medical consumers, by far, were the retired, mostly via Medicare/'caid

It does appear that the average person will be able to spend a little less time navigating the insurance jungle and a little more dealing with health issues, but the larger issue of doctors having to waste much of their efforts dealing with insurance and thus being forced to become employees in a hospital or group practice, and the issue of diseases without an effective constituency being ignored (that's us) are untouched; these are not part of the political debate/circus show.
 
.he certainly has guts :)

A lot of the analysis I have been reading have been emphasising this as a clever political play by Roberts to set a new precedent restraining Congress's use of the Commerce clause, and a cautious move to avoid political over-reach by the court. We're coming up to an election which is going to be defined by the unlimited private spending unleashed by the court's Citizen's United decision, and a lot of American's are not going to like the lowering of tone this will lead too - striking down key aspects of legislation passed by Congress would have been another risky move for a relatively new Chief Justice. I don't think Roberts wanted to give Democrats room to run against the court.

Also Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity... "Hold on, I didn't think I was reading a thread about this?!"

They are also behind the housing bubble, which we have not recovered from, and will not for years to come..

The US housing bubble was a prime example of markets in action. Some on the right have tried to claim it was the result of Freddie Mac and Fannie Mae... but if you look at the figures, and see where the money was coming from, this is just not an argument that makes sense. Booms and busts are an inevitable part of market economies, they always have been and always will be. Some like to pretend that markets are always rational, but this is just an article of faith, and not a claim supported by the evidence. Under Greenspan, the Fed did decide that it should not be the governments job to try to spot and deflate bubbles... but that was the government doing too little rather than too much.
 
As a CFS patient and former healthcare worker, the bill is not perfect but then few things are. As the saying goes, "Don't let the perfect be the enemy of the good." I support it and am glad it passed.

I have family in Canada and friends in Europe who have lived in the US. When I first became ill, one of the first things everyone was concerned about was how I would continue to get healthcare if I no longer had a job and whether I would be bankrupt by medical costs. (50% of bankruptcies in the US are related to medical illness) My Canadian relatives have endured cancer and serious strokes but no one became bankrupt and from what I could see, their care did not suffer. A friend offered to help me pay for care but I was lucky to have worked for an employer who covered my healthcare for an extended period initially and then to have enough money to buy the same-level insurance under COBRA until I was approved for Medicare.

Patients I have had in the past and many people on this forum aren't so lucky. If they're not covered by spousal/ parental insurance, aren't financially well-off enough, can't work enough to get insurance benefits, or their employer doesn't offer insurance, they're hung out to dry unless and until they get approved by Medicare. Approval as we know can take years and is not guaranteed. We see this on the forum regularly. It's true insurance doesn't cover many things people with CFS may want to get tested for or for particular treatments but insurance does pay for RULING OUT other illnesses that can cause your symptoms. AND that is very important. How many times have people here said "you might want to get checked out for such and such"? Besides which, having CFS doesn't protect you from other medical conditions.

It's interesting to read some interviews of people on the street as some express that they are against it but with further details from the reporter or some more contemplation,their answer becomes less certain and some adopt a more "let's wait and see" attitude.
Some time ago I read that medical problems were the greatest single factor contributing to individual bankruptcies....These weren't people that spent recklessly,. they just happened to come down with an illness, probably lost their job, ultimately couldn't afford their insurance and eventually went bankrupt - sad, sad stories. I was on Cobra for awhile - it was VERY expensive - really not a good alternative for me..
 
Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity... "Hold on, I didn't think I was reading a thread about this?!"
[/quote]
I just saw that - its the weirdest thing....We have a system that is supposed to intermix comments from the blog and the Forums.....it seems to be have troubles. I believe that was a comment from the blog.
 
I've noticed it happen a few times. I think it has happened to Mark too. Maybe something to do with being moderators? I've not pointed it out previously, as I thought you may have just copied + pasted something in error, but it does seem like something odd is happening instead.
 
And obviously I should have typed

"Before the bill, the biggest medical consumers, by far, were the retired, mostly via Medicare/’caid
After the bill... the biggest medical consumers, by far, will be the retired, mostly via Medicare/’caid

I believe it does address and may fix a fair amount of the craziness in the current system of health _insurance_, but that's a different animal than medicine.

It does not address the fact that most people will consume more health $ in their last 12 months than in their 1st 21 years. Nobody is willing to deal with that. Would you rather have a better health foundation built in your 1st 21 years or extra medical attention in your last 12 months? Dunno about you (OP), but I'd rather have had a chance at avoiding this disease instead of the free power scooter and Medicare paid triple bypass when I'm 70.
 
A lot of the analysis I have been reading have been emphasising this as a clever political play by Roberts to set a new precedent restraining Congress's use of the Commerce clause, and a cautious move to avoid political over-reach by the court. We're coming up to an election which is going to be defined by the unlimited private spending unleashed by the court's Citizen's United decision, and a lot of American's are not going to like the lowering of tone this will lead too - striking down key aspects of legislation passed by Congress would have been another risky move for a relatively new Chief Justice. I don't think Roberts wanted to give Democrats room to run against the court.

Also Cort: Your posts often seem to feature quotes from old threads, like the Jenbrooks one above. What's going on? They often lead to moments of me questioning my own sanity... "Hold on, I didn't think I was reading a thread about this?!"



The US housing bubble was a prime example of markets in action. Some on the right have tried to claim it was the result of Freddie Mac and Fannie Mae... but if you look at the figures, and see where the money was coming from, this is just not an argument that makes sense. Booms and busts are an inevitable part of market economies, they always have been and always will be. Some like to pretend that markets are always rational, but this is just an article of faith, and not a claim supported by the evidence. Under Greenspan, the Fed did decide that it should not be the governments job to try to spot and deflate bubbles... but that was the government doing too little rather than too much.

What? Greenspan actively inflated the bubble with artificially low interest rates, and Turbo Timmy and Bernanke made it even worse. This has nothing to do with left vs right and fannie and freddie have a lot to do with it. Furthermore the law has been broken so many times and the rule of law has been abandoned making this bascially a lawless society (for some). fannie and freddie plus all the other bailouts were the biggest fraud in taxpayer history, if the rule of law had been applied, three quarters of the banks would not exist anymore, quite a few high rollers would spend their life in jail (deservedly so), the bad debt would have been cleared by now with small savers and most of the middle class being protected by their account insurance (up to 100K/250K), inflation would be non-existent and the US would be on the path to becoming debt free again with manufacturing and other service sectors that matter leading and the financial services that produce nothing being curbed, admittedly though after a few hard years. Unfortunately it is much worse now, people are getting fed up with their savings rate of .33 % (should be cat least 10 x) and are gambling and riverboating on houses and what not with cheap credit again, partying like it's 1999 all over again. This is not a matter of regulations which are driven by special interest anyways and are mostly useless, it is about enforcing the law. That being said, I always thought free basic healthcare for everybody was a noble goal to have and trying to achieve. But much easier to talk then to implement ;) I might support free baisc healthcare for everyone, but I definitely do not support homeownership for everyone..
 
I am not touching this one except to say that US healthcare costs are unsustainable with or without Obamacare. Either way the healthcare system is more like dealing with the DMV than Amazon or Apple. The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company. Republicans seem to be okay with this as they've not made much of an effort to change it themselves. Republicans aren't providing much balance on this issue. They appear to want a consolidation of power in healthcare as much as the Dems - just as long as it's "privatized"...economic statism is not just for the left!
"The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company."

There's the biggest root. The insurance model was well intentioned - who has the spare change for a heart attack, or dealing with a major medical event plan that *surprise* doesn't happen to cover your major event and its aftermath (or those of half of the other suckers who bought that policy).
But buyer and seller are now disconnected, with the insurance maze in between. Unintended consequences have exploded.
 
What? Greenspan actively inflated the bubble with artificially low interest rates, and Turbo Timmy and Bernanke made it even worse. This has nothing to do with left vs right and fannie and freddie have a lot to do with it. Furthermore the law has been broken so many times and the rule of law has been abandoned making this bascially a lawless society (for some). fannie and freddie plus all the other bailouts were the biggest fraud in taxpayer history, if the rule of law had been applied, three quarters of the banks would not exist anymore, quite a few high rollers would spend their life in jail (deservedly so), the bad debt would have been cleared by now with small savers and most of the middle class being protected by their account insurance (up to 100K/250K), inflation would be non-existent and the US would be on the path to becoming debt free again with manufacturing and other service sectors that matter leading and the financial services that produce nothing being curbed, admittedly though after a few hard years. Unfortunately it is much worse now, people are getting fed up with their savings rate of .33 % (should be cat least 10 x) and are gambling and riverboating on houses and what not with cheap credit again, partying like it's 1999 all over again. This is not a matter of regulations which are driven by special interest anyways and are mostly useless, it is about enforcing the law. That being said, I always thought free basic healthcare for everybody was a noble goal to have and trying to achieve. But much easier to talk then to implement ;) I might support free baisc healthcare for everyone, but I definitely do not support homeownership for everyone..

A lot of that is just ways in which government is not perfect. Or course it is not. And neither are the markets. Neither ever have been, or ever will be. It's pretty clear that the key change which led to the housing bubble was the rise of complex derivatives which led to investors being unable to make meaningful judgements about the risks they were taking - this was market driven, with the government's failure being it's lack of intervention.

Greenspan didn't act to inflate the bubble, but he did decide that it was not the government's role to try to predict and deflate bubbles, instead believing interest rates should be used simply to smooth the business cycle and soften recessions - this was based on unrealistic assumption about the rationality of markets.

There is always a long-term danger of moral hazard when the government intervenes in the way that it has, and this does require regulatory changes, but in the short term, the US banking system was verging on the edge of collapse, and the models I've seen trying to estimate the harm this would have done have all led to pretty catastrophic results. It might not seem it now, but the Bush and Obama administration responses to the banking crises were pretty good considering how quickly they needed to act. I think that a lot of people didn't really understand how serious the problems being faced four years ago were - it was a 1929 style disaster, and we've been relatively lucky in the levels of suffering we've had to, so far, endure. There are still a lot more dominoes which could fall and change that luck (the Euro? China?).
 
There are some major positives as well as negatives in this bill (as usual for American politics).

I am a big fan of the consumer protections for example - insurance companies moving the goal posts and denying coverage to those who need it most. Changing the incentives for how medicine is practised (quality not quantity) etc.

I don't like how the US system pressures employers to provide coverage, because this means that there is less competition and choice compared to if the individual chose the insurer (like in Australia). Likewise I don't like how most insurance companies do not give you a free choice of which doctors you can see. Eg if you are insured with Kaiser Permanente, you can only basically go to Kaiser hospitals and medical practitioners. Again, this reduces the accountability of those services since there is no competition.

My sister lived in the USA for over 10 years, guess which medical/health system she prefers between the USA and Australian systems?

Do not be blinded by contemporary ideology.
 
Sadly so true. Too many do not bothers to really understand the implications this has. This is not free. There is no way to pay for all of this. We see what happened to other countries. People that move here can't believe this happened. People come here whenever they possibly can. No waits of 9 months for heart surgery, etc. It happens daily, so many coming for care. Hopefully this will be changed.

People who understand what's in the bill are able to talk about different provisions and don't just whitewash the entire effort. I'm afraid your statements don't match the facts. We spend the most and have among the poorest outcomes.

What do you mean by, "this is not free"?

What do you mean by, "there is no way to pay for all of this."

What do you mean when you say "we see what happened to other countries"

What do you mean when you say "people come here whenever they possibly can"

etc.

I've heard these statements for years now coming from certain media outlets and media personalities, but they are easily refuted. We don't need more hysteria surrounding these issues. Especially as a patient community. We need less fear-based hate rhetoric and more cool-headed, thoughtful, results-based progress.

I don't know all of the implications this bill will have, but I have already benefitted and Merry will benefit. It has been scored by the budget office to cut costs versus doing nothing. The right to life, liberty and the pursuit of happiness do not exist if you are sick and can't afford care. I think healthcare should be a right and this bill doesn't get close to that, so I'm not happy with it either, but it isn't stealing anyone's freedom (the Supremes just made that decision today), the independent Budget Office says it will save money so I don't know what your argument about paying for it means, other countries spend less money and get better outcomes.

I'm not saying you don't understand what's in the bill. But what you're saying doesn't show that you do. It doesn't address what's actually in the bill.

I'm only responding to this post because you used my post out of context and I wanted to clarify.
 
Greenspan didn't act to inflate the bubble, but he did decide that it was not the government's role to try to predict and deflate bubbles, instead believing interest rates should be used simply to smooth the business cyicle and soften recessions - this was based on unrealistic assumption about the rationality of markets.
What? The (unconstitutional) fed committed felonious fraud by counterfeiting the currency and creating money out of thin air to depress the interest rates! And worse they gave it to special interest groups. Everybody else debasing their currency by printing it would go straight to jail.
I think that a lot of people didn't really understand how serious the problems being faced four years ago were - it was a 1929 style disaster, and we've been relatively lucky in the levels of suffering we've had to, so far, endure.
That is not true - you cannot spend more money than you take in, you cannot argue with math. In fact acting on the crisis in that way made it much worse. It may have smoothened out things in the short term for people in debt while destroying the value of others who had the foresight to save and/or sound businesses, but in the long run it destroys the poor and middle class via inflation. Countries that clear their bad debt and default where necessary and employ austerity (for everybody, not just the poor and middle class) and say no to bailouts like Estonia or any other countries that favor balanced budgets have long recovered and prosper again. The only place where the government had to act and where it didn't is to prosecute and jail all the people involved in fraudulent loans and selling junk derivatives as AAA (knowing that they were junk which is fraud) as well as seize assets of fraudulent companies and redistribute to their customers what was stolen.
 
To say Roberts disappointed conservatives is an understatements....he certainly has guts :).. Personally I see the law as being very helpful and was happy to see it passed.

Yes, it passed with only Democrats votes. Now to see if it stands, Nov. 2012 will be the ultimate judge.

GG

PS I feel bad that everyone that does not have insurance, has less access. but my impression of Drs iin this area that treat CFS, do not take insurance. So I don't think this will be a major help to most patients. We really need to get more Drs educated on CFS and some real treatments, otherwise it's not very helpful for the CFS community. Hope I am wrong in this regard.
 
Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise.

Again, there were good and necessary things included in this bill. The question is, is the total package a rational way to do those things, or should we scrap it and do those things in another way (because of the dangerous things in the bill; things that are not mentioned in the "this is the good the bill will do" conversations... and because the bill fails to reform several things in the structure of how health insurance and care is structured and paid for, which drives up the cost and drives down quality)?

For those who want to know what the objections might be, one big danger to us is the Comparative Effectiveness panel: an unelected 19-member panel. Via this panel of bureaucrats, it's highly possible that all insurances everywhere will come to cover only CBT/GET for ME/CFS. (More standard diseases also will have issues; not all patients are going to respond well to the 'gold standard' treatment and may need something different, which may no longer be covered)

(currently anything is covered which is FDA approved and which your doctor can convince your insurance company is medically necessary for you [usually not a problem with most companies, though there are a couple of 'bad apple' companies where either the independent doctor has trouble, or the HMO doctors are trained to be ineffective/cheap], unless your policy has specific exclusions [for example, standard exclusions include naturopathic care, experimental treatments, and some inexcusable exclusions like limits on "mental" health coverage]; for Medicare/Medicaid there may be a specific list of what is covered and what is not, I'm not sure about that).

Objections not specific to our community can be found at sites such as (this is not a blanket endorsement of all these sites and everything on them or in the articles cited):
http://www.heritage.org/issues/health-care
http://www.ncpa.org/healthcare/
http://www.cato.org/
http://www.ama-assn.org/ama1/pub/upload/mm/478/admincosts.pdf

No problem if anyone disagrees--I always assume everyone came by their position in a rational and compassionate manner--and I am not looking for a debate (will probably not post in this thread anymore). Just offering information for those who might be curious or want to know how 'the other side' reached their seemingly inexplicable conclusions. ;)
 
People who understand what's in the bill are able to talk about different provisions and don't just whitewash the entire effort. I'm afraid your statements don't match the facts. We spend the most and have among the poorest outcomes.

What do you mean by, "this is not free"?

What do you mean by, "there is no way to pay for all of this."

What do you mean when you say "we see what happened to other countries"

What do you mean when you say "people come here whenever they possibly can"

etc.

I've heard these statements for years now coming from certain media outlets and media personalities, but they are easily refuted. We don't need more hysteria surrounding these issues. Especially as a patient community. We need less fear-based hate rhetoric and more cool-headed, thoughtful, results-based progress.

I don't know all of the implications this bill will have, but I have already benefitted and Merry will benefit. It has been scored by the budget office to cut costs versus doing nothing. The right to life, liberty and the pursuit of happiness do not exist if you are sick and can't afford care. I think healthcare should be a right and this bill doesn't get close to that, so I'm not happy with it either, but it isn't stealing anyone's freedom (the Supremes just made that decision today), the independent Budget Office says it will save money so I don't know what your argument about paying for it means, other countries spend less money and get better outcomes.

I'm not saying you don't understand what's in the bill. But what you're saying doesn't show that you do. It doesn't address what's actually in the bill.

I'm only responding to this post because you used my post out of context and I wanted to clarify.

Where's the hate you speak of? Wow, health care should be a right, looks like you are living in the wrong country, definetly not what our founding fathers had in mind.

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.

My understanding is that scoring by the CBO is done the way politicians want it done, both sides do it, so its not a really good measuring stick, unless the expectations/models used are accurate, and we know people change their behaviour based on costs. Like politicians think they can keep raising taxes on cigarettes etc.., and they will just collect more money, but people change there behaviors, or find a way around these things, so less money comes and it just gets compounded.
 
Again, there were good and necessary things included in this bill. The question is, is the total package a rational way to do those things, or should we scrap it and do those things in another way (because of the dangerous things in the bill; things that are not mentioned in the "this is the good the bill will do" conversations... and because the bill fails to reform several things in the structure of how health insurance and care is structured and paid for, which drives up the cost and drives down quality)?

For those who want to know what the objections might be, one big danger to us is the Comparative Effectiveness panel: an unelected 19-member panel. Via this panel of bureaucrats, it's highly possible that all insurances everywhere will come to cover only CBT/GET for ME/CFS. (More standard diseases also will have issues; not all patients are going to respond well to the 'gold standard' treatment and may need something different, which may no longer be covered)

(currently anything is covered which is FDA approved and which your doctor can convince your insurance company is medically necessary for you [usually not a problem with most companies, though there are a couple of 'bad apple' companies where either the independent doctor has trouble, or the HMO doctors are trained to be ineffective/cheap], unless your policy has specific exclusions [for example, standard exclusions include naturopathic care, experimental treatments, and some inexcusable exclusions like limits on "mental" health coverage]; for Medicare/Medicaid there may be a specific list of what is covered and what is not, I'm not sure about that).

Objections not specific to our community can be found at sites such as (this is not a blanket endorsement of all these sites and everything on them or in the articles cited):
http://www.heritage.org/issues/health-care
http://www.ncpa.org/healthcare/
http://www.cato.org/
http://www.ama-assn.org/ama1/pub/upload/mm/478/admincosts.pdf

No problem if anyone disagrees--I always assume everyone came by their position in a rational and compassionate manner--and I am not looking for a debate (will probably not post in this thread anymore). Just offering information for those who might be curious or want to know how 'the other side' reached their seemingly inexplicable conclusions. ;)

I'm only going to respond to the one issue you raise of the Comparative Effectiveness panel and its mandate:


The Council will not recommend clinical guidelines for payment, coverage or treatment. The Council will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities. It will also provide input on priorities for the $400 million fund in the Recovery Act that the Secretary will allocate to advance this type of research

I disagree that it's highly probable this panel will cause insurance companies to only offer CBT/GET for a CFS diagnosis. As I understand its function, it is looking at what works and what doesn't and making recommendations on treatment options based on their findings. It makes tremendous sense. Under their mandate, CBT and GET wouldn't get recommended because they're ineffective. As we've seen with our experience with CFSAC, the powers are strictly limited by law.

Any body with authority can abuse it, but I think this argument against Obamacare is particularly misrepresenting the realities. I'm afraid at least two of your links for objections to the bill are strictly political, the Cato Institute is well known to me.

And as you say, I assume you came to your position in a ration and compassionate manner and I hold it with respect.
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Where's the hate you speak of? Wow, health care should be a right, looks like you are living in the wrong country, definetly not what our founding fathers had in mind.

I would like everyone to have medical treatment as needed, but reality sets in. We have 16 Trillion in debt and 1 trillion PLUS added every year lately, and no end in sight. Our politicians don't want to reform Social Security and/or Medicare etc, so the problem is just going to be exacerbated and the people will suffer, not the politicians.

My understanding is that scoring by the CBO is done the way politicians want it done, both sides do it, so its not a really good measuring stick, unless the expectations/models used are accurate, and we know people change their behaviour based on costs. Like politicians think they can keep raising taxes on cigarettes etc.., and they will just collect more money, but people change there behaviors, or find a way around these things, so less money comes and it just gets compounded.

Hate rhetoric referring to certain media personalities in particular.

I'm definitely living in the right country.

Both sides agree to use the CBO numbers.