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September 25, 2009

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John Kyl's mother didn't need maternity care, either.

He sprang fully formed from Ayn Rand's forehead.

No fair winning the thread on the first post.

that is great -- i've actually emailed it to others

I'm not sure I agree. Isn't his point that adding coverage to his policy that he couldn't possibly use can drive up his costs? Similarly, there's no reason to add testicular cancer coverage into the policy for a woman.

Your diabetes example is weak because it's something that we all COULD have, which is the point of insurance. Kyl has zero chance of becoming pregnant, so making him pay for that coverage seems questionable.

Now, it seems to me that customizing plans for each individual insurance customer based on what diseases they could possibly have is much more likely to drive up costs than being more broad with a policy and covering a larger group of people.

It's an interesting question - -though I don't think his opposition was "let's kill this so we can include a more robust and specialized guarantee".

If you customize your insurance coverage perfectly, it is indistinguishable from paying for everything yourself (except for paying the insurance company its rake off).

free lunch

you beat me to it

they don't even know what insurance is and they are supposed to be making policy

sheesh

this Wonk Room link has the goods. Money quote:

Kyl’s amendment would prohibit the government from defining which benefits should be included in a standard benefit package and would permit health insurance companies to design policies that exclude higher-cost beneficiaries. Currently, “it is difficult and costly for women to find health insurance that covers maternity care” in the individual health insurance market. According to a survey conducted by the National Women’s Law Center, the vast majority of individual market health insurance policies “do not cover maternity care at all. A limited number of insurers sell separate maternity coverage for an additional fee known as a ‘rider,’ but this supplemental coverage is often expensive and limited in scope.”

I think we could all listen to the debate and find something that sounds sketchy. in this exchange:

Grassley: It gets back to something that President Obama was speaking about on the Sunday talk shows, trying to say that it’s not true that the penalty for not getting insurance is a tax, referring to the individual mandate.

The mark before us makes it pretty clear that the penalty is a tax, it looks like the tax is now up to about $2,000 dollars a year, so Mr. Barthold, isn’t the penalty here an excise tax and won't it affect people making under $250,000 dollars a year?

Barthold: Senator Grassley, the penalty proposed in the Chairman’s mark, is as you observed, it's structured as a penalty excise tax, we have other penalty excise taxes in the internal revenue code. We have not separately analyzed - we’ve worked in conjunction with Mr. Elmendorf and his colleagues at the Congressional Budget Office, in terms of the overall effects of what sort of people might purchase insurance through the exchange, who would not have insurance provided by their employer, and where the individual mandate or the employer free rider penalty would arise.

We have not done a combined distribution analyses across income to specifically answer your question but to the extent that yes we think that some people would be subject to the penalty excise tax when everything shakes out we would expect that some would have incomes less than $200,000 dollars.

Baucus: Let me just say on that point, that’s an interesting question. This is really a penalty that’s being collected by the Internal Revenue Service, it could be collected by another body, another entity, another agency perhaps HHS. HHS could set up a whole other apparatus, maybe the HELP bill has something similar I don’t know, and that leads to all kinds of complications, they don’t have the data, they're not as efficient.

But somebody’s going to have to collect the penalty to the degree that the penalty is paid. In the modification, too, we’ve reduced the penalty significantly, we’ve cut it in half, so it’s much smaller than it otherwise was.

But somebody’s going to have to collect it to the degree that there is one, and that it is committed to determination, or at least it’s my determination so far, that the better, more efficient is through the IRS which is set up to collect these kinds of penalties, so it’s really a penalty that we’re talking about here just the IRS it's not HHS is collecting the penalty

I would say Baucus seems to be dancing a bit. But that is how discussions go. Drawing a correlation between it and Baucus basic desire to raise taxes on the middle class may not be fair, or maybe it is.

Sorry, my previous post quote was from here

I would say Baucus seems to be dancing a bit. But that is how discussions go. Drawing a correlation between it and Baucus basic desire to raise taxes on the middle class may not be fair, or maybe it is.

Marty, I couldn't help but notice that your comment does not contain a declarative sentence explaining what Baucus said that was sketchy. Is there a reason why you prefer not to make clear arguments using declarative sentences?

I really don't understand what point you're trying to make. If your point is "people who refuse to get insurance will be penalized with a fine and that's really a tax", well, everyone needs insurance. People who don't get any insurance are saving themselves money by passing on the cost to the rest of us. They're taxing us right now since statistically, some of them are absolutely going to need expensive care that the rest of us will have to pay for. Forcing people to pay their own way rather than mooching off of everyone else doesn't seem like a problem to me, but perhaps you're in favor of the moochers.

Under Kyl's logic, I'm not sick ergo I don't need health care coverage. It's completely asinine. Sure Kyl might not need maternity coverage, but what about his wife? Or his sister? Or - as Stabenow pointed out - his mother?

The idea that if you, personally, right now, aren't suffering financially from an an ailment isn't just selfish and short-sighted. It flies in the face of the concept of insurance.

Kyl's position is at best an "I've got mine" glibertarian non-policy and at worst an anti-insurance mindset entirely.

If we're not covering maternity needs - something every person born into the next generation can claim advantage from - what the hell is insurance supposed to cover?

Fuck Kyl.

I'm not sure I agree. Isn't his point that adding coverage to his policy that he couldn't possibly use can drive up his costs? Similarly, there's no reason to add testicular cancer coverage into the policy for a woman.

....

it seems to me that customizing plans for each individual insurance customer based on what diseases they could possibly have is much more likely to drive up costs than being more broad with a policy and covering a larger group of people.

Doesn't this conflict with your previous point, and Kyl's?

Maternity coverage illustrates one of the big problems with our system. Of course you can't get an individual policy for maternity coverage, because no one would buy such a policy who wasn't at least somewhat likely to get pregnant. It's an excellent candidate for a "death spiral." That means the market is not going to provide it unless compelled to.

So should we not have maternity insurance? That doesn't seem right.

Kyl's conception of insurance would be something quite different to what health insurance actually is.

Health insurance - I'm talking about the current US system of employment-based insurance with private insurers - is a socialist system. That is: it says that it is to the benefit both of individuals and to us all collectively to split the costs of insuring against a very wide range of risks across a wide range of people, many of whom will not be susceptible to particular types of risks (pregnancy; prostate cancer; knee replacements) either ever or in the near future. We don't differentiate pricing based on risk even though a naive or overly-individualistic approach might suggest it.

This particular piece of socialism, while imperfect and non-universal, is extremely popular and successful for the people who are part of it. Kyl probably finds the fact that people like this actually-existing socialist health insurance system discomforting, as well he should since his affiliation is with a political party that supposedly opposes socialism in any form.

But the fact is, actually-existing socialism of this type works well and is very popular across the developed world, including in the US. In order to avoid offending the delicate sensibilities of Americans, it's tied to employment here and nobody even calls those kinds of policies "social democratic" even though they are, albeit imperfectly.

Socialism socialism socialism! Booga booga!

I used to suspect that all the perverse incentives in the health insurance system, and all the depraved tricks they pull to deny coverage to people who need it... are really just a reflection of the insurance-takers' willingness to dodge the old "do unto others" rule. I'm a bit reminded of that now.

Sure, I won't need maternity care. But since I can't take credit for that myself (it was an accident of birth), it would be wrong of me not to chip in - I reckon I'd probably want it too, if nature made me that way.

"Doesn't this conflict with your previous point, and Kyl's?"

Yes, sorry, I probably could have been more clear. I just thought there was some misrepresentation of what Kyl was proposing.

I think too much customization would nullify his earlier claims about costs. But I also think that he point isn't THAT outlandish, and that the counterarguments along the lines of "I'm not sick yet" are weak. He's not arguing that it shouldn't cover issues he doesn't have, he's arguing that it shouldn't cover issues it's impossible to ever have.

For example, I wouldn't particularly object to broad male/female splits in plans that cover issues specific to each sex. I don't see how that would really save money, but it doesn't strike me as unreasonable either.

Seriously:

If John Kyl was insured as an individual, is there a mandate that the coverage would or must include language stipulating that he is covered for maternity care.

Family coverage is another matter.

Are single females covered automatically for testicular and prostate cancer?

A few males suffer from breast cancer, which throws a spaniard into the works.

Not seriously: Is John Kyl complaining that he is paying for maternity coverage (he's maybe paying for 28% of his coverage under the FED Health plan; the taxpayers pay the rest, which by the way is the way it should be) and he may damned well go out and get pregnant just to get his money's worth?

If you die of disease A, should your survivors receive a refund for the premiums paid in for the diseases covered that you didn't die of?

It seems unfortunate to pay for coverage and testing for say, diabetes, and then be unfortunate enough not to contract it and have it kill you.

What a waste.

I think this really illustrates how ridiculous our thinking about health insurance has become.

If you view health insurance as true "insurance" then Kyl is right- there's no reason for anyone to want to be included in an insured group that's covered for something that have a zero percent risk of contracting. It would be like me buying boat insurance when I haven't got a boat.

In fact, much of our debate about health insurance would vanish entirely if we truly wanted health "insurance." Getting cut off because you got sick? That's fine for real insurance, its how it works. Easily becoming uninsurable because your specific risk is too high or you're already sick? That's basic insurance 101- no one will sell you fire insurance if your home is already alight.

The fact is that we treat health insurance, and think of health insurance, like a subscription to a gym. At the gym, you pay your dues, and attend as much as you require. With health insurance, you pay your dues, you get as much medical care as you require.

Its never going to happen, but if everyone just admitted that, we could probably just create a single payer system and be done with it all.

OK, so you make an argument that is so painfully, deliberately dumb that your opponents either have to spend all of their time walking the discussion back to square one, or else just throw up their arms and retire to the bar in despair.

Guess what happens then?

You win.

"which throws a spaniard into the works."

My name is Inigo Montoya . . .

Isn't his point that adding coverage to his policy that he couldn't possibly use can drive up his costs?

Here's the thing I don't understand about Kyl's comments- adding maternity costs to his insurance shouldn't rate his rates at all- it's a zero-probability event.
The only reason to charge someone money to insure something that cannot occur is if you are gouging them.

Thullen, to address your serious point. It is true that women will not get testicular or prostate cancer (which are much more costly to treat than maternity care and delivery). However, the counterargument, and I have seen this in print from an insurance company executive, is that becoming pregnant is a choice (obviously not always) and the others are illnesses which were not voluntary.

Of course Kyl's argument is similar to people who don't have children saying they should don't pay taxes that go toward schools because they don't utilize them.

A large portion of the conservatives in this country do not have a concept of what the phrase common welfare means, even though it is used in their Holy Grail, the Constitution. Unless they see some sort of benefit received personally from some expenditure of theirs, it is unnecessary.

However, they would scream the loudest if all roads became toll roads, or if there was suddenly a surcharge on all airfares to fund the FAA, etc.

Kyl's comment, from a purely selfish perspective, makes all the sense in the world. From the perspective of those who look beyond themselves, it is ludicrous.

Kyl's comment, from a purely selfish perspective, makes all the sense in the world. From the perspective of those who look beyond themselves, it is ludicrous.

I'd go further and say it's an unwise way to look at things even from a purely selfish perspective if you really think about it. What kind of world do people want to live in, anyway? Conservatives seem to want to lead the race to the bottom.

Clearly, GOPers need to be given the full spectrum of diseases/disorders/conditions that one could possible have, and which require medical treatment.

It's the only way they'll every figure out "why" the heath coverage is "needed".

I hope Sen Kyl enjoys his new cancer-diabetes-male pregnancy.

A large portion of the conservatives in this country do not have a concept of what the phrase common welfare means, even though it is used in their Holy Grail, the Constitution. Unless they see some sort of benefit received personally from some expenditure of theirs, it is unnecessary.

True dat. They live in a fee for service world.

But of course, when they want it available, it damned well better be available.

Unless of course they voted against it.

There are over 300M people living here now. By 2050, it'll be over 400M. It's a give and take world, and will only be more so.

"I'll take care of myself, you take care of yourself" just isn't going to scale. Norquist's "leave me alone" mandate will increasingly be a recipe for national suicide.

My own snark on Kyl's proclamation is that he's been marinating in all of this winger "Obama is a tyrant and must be opposed" rhetoric, he fell asleep last night while watching "Macbeth", and now he's somehow decided that he must save the nation by becoming a man Of No Woman Born.

I think he hoped that after he made his declaration Obama would appear, sword in hand, to say "Lay on, JonKyl,
And damn'd be him that first cries, 'Hold, enough!'"

russell: "I'll take care of myself, you take care of yourself" just isn't going to scale."

And what's the cost scale going to be? How much is it going to cost this coming decade to finance it?

Morally I believe we need to cover more people, without excluding medical pre-conditions, for as long as they need care.

But I'd like to know how much that will cost, to see if I can afford to keep drinking Jack Daniels or have to switch to bottles of Miller Lite.

How much are these changes going to raise premiums for those who are insured now. How much will it raise taxes over the next decade? How will it effect Medicare? Are services going to be trimmed as a result? Will there be longer lines, less treatments?

And will any of the proposals not under consideration even reduce health care costs a penny on the dollar?

You guys keep criticizing the Republicans for not having an alternate plan, but you don't have an honest cost analysis for the plans you're offering now. It's the just the old 'trust me' routine.

patrick says: "The fact is that we treat health insurance, and think of health insurance, like a subscription to a gym. At the gym, you pay your dues, and attend as much as you require. With health insurance, you pay your dues, you get as much medical care as you require."

Most gyms don't work that way. They have various layers of membership, depending on usage and age. In some, members are signed up for two visits a week, and pay less (Bally's, in California offers that). Some only pay for pool access, and not the gym. Others pay for optional services, like lockers and towels (the YMCA charges for that), and special classes like Karate, for which members are required to buy additional insurance.

And of course, the biggest difference between gym club membership, and the proposed national health insurance plan is that none of the gym club members are forced to pay a penalty tax if they don't want to join.

No, the biggest difference between gym club membership and and the proposed national health insurance plan is that if you don't go to the gym you might get slightly fatter whereas if you don't have health insurance you might go without vital medications or treatment and suffer and die. Or, on-topic, go without pre- and post-natal care and perhaps have your infant suffer and die.

Isn't that a fine start for an American citizen? Through no fault of their own, by the lottery of birth, some infants shall be denied the care we know how to provide, care that we have people willing to provide, that we have built buildings to provide such care in, care that we have researched and manufactured instruments to assist with; care provided based on the knowledge that doctors and nurses and mothers and babies have lived and worked and died to discover over the last few centuries, around the world.

But we must deny that care in some cases, here in America - though it may soften the blow if I let you know that most of the American babies who will be denied that care will have black or brown skin, or if white will be of very low class - because we must establish the Market Price For Healthcare, which is an object of religious reverence to a small & obscure sect who have now convinced a larger crowd that it is vital for their salvation that this object remain sacrosanct.

Of course, we must respect the wishes of this small cult no matter what the cost to the rest of us is, because we must not offend their religion. It is an acceptable price to pay that American babies should die despite our hospitals and nursing schools and medical schools and high technology. After all, this religion is very important.

And what's the cost scale going to be?

Health care in this country *already* costs more than we can afford.

We pay more, for less, than any other OECD nation. Let's look at what they do and figure it out.

Seriously, this is a problem that has already been solved, several times, in several different ways, by countries that have far fewer resources to bring to the table.

We're just being stupid. Stupid as in block-headed, obtuse, mulish, willfully ignorant, obdurate.

Our mind is set on driving over the cliff, and nothing will dissuade us from it.

Stupid like that.

Money's at issue, but not in the way you fear.

Morally I believe we need to cover more people, without excluding medical pre-conditions, for as long as they need care.

Great. Then let's just f**king do it, OK?

"Our mind is set on driving us over the cliff, and nothing will dissuade us from it."

Say you're riding shotgun in a car with a guy, any old Republican in the House of Reps, who has decided to play chicken as he drives, for his own obscure sadistic reasons.

The car happens to be pulling a trailer containing containing 120 million Americans, some who don't like the ride and some who think they do.

He punches the accelerator and heads straight for the cliff.

He takes a look over at you to see how you're reacting.

The normal reaction would be flopsweat, begging, some crying, maybe trying to explain how irrational the driver's actions seem, you might wet your pants .etc.

The more you do that, the more maniacally the driver laughs and the harder he steps on the gas.

But what if you decided the only way to save the day and the millions apparently being towed to their doom (with you meeting doom first right there in the front seat), that you would call the driver's bluff and reach over with one foot and stomp on top of his foot on the accelerator, and you don't let up.

Then you laugh manically and stare the driver down. "Let's do it." "Are we both having fun now?"

I think the driver, at some point, as you both see oblivion up ahead, pales and starts begging YOU to let up. "Please, I was just trying to make a point."

"Me too, except you've just experienced what it's like to f--- with someone who is crazier than you are, you cowardly dumbsh-t."

Whoops, too late. Free fall.

If I follow Kyl's logic correctly, there shouldn't be coverage for brain injury, either, since he obviously doesn't have one to be injured.

Better yet, there's a chase car with assorted lunatics/a-sholes in the so-called media filming the run-away car AND cheering the sadistic driver on.

You need to take the wheel away from the sadistic driver too and manuever behind the car filled with lunatics and push them ahead of you.

They go over the cliff first, for once in their worthless lives, silent.

I'll bet Mr. Kyl claims to be "pro-life" - it'd be interesting to hear how he justifies denying maternity care to those denied abortions...

Kimberly Young of Ohio (see Washington Monthly) meets her death panel.

If John Kyl was insured as an individual, is there a mandate that the coverage would or must include language stipulating that he is covered for maternity care.

There should be. Kyl, and others of the "Men can't get pregnant, so why should they pay?" school ignore one very important fact.

When a woman gets pregnant, there is normally a man involved in the process. Doesn't he bear some responsibility for the costs? I think it's wrong to claim that, because the woman bears the physical burden of pregnancy and childbirth, she must also bear the entire financial burden. That burden should certainly be shared.

In fact, if we are going to exempt some people from paying for maternity insurance on grounds that they will never have a child, there are many more women who should be exempt than men. A man of Kyl's age might well father a child. A woman of that age will not bear one.


Jay Jerome--

Do you have health insurance? Are you enjoying the 12-15% annual increases in premiums and and accompanying reductions of coverage? How's that bottle of Jack Daniels looking as your "basic" health care costs go up by hundreds of dollars a year without even seeing a doctor?

Need serious dental work? If so, that bottle of Jack Daniels is certainly cheaper, and it'll come in handy for killing the pain and augmenting the liquid diet you'll be reduced to.

I don't mean to get personal, but how old are you? Do you have insurance now? You may or may not want to answer, but so far I have found that people with the most "concerns" about reform are not struggling with the current situation, either because they're young and healthy and ignorant of what older and/or sicker people are dealing with, or because they have some sort of lavish coverage from a high-end job or the government.

And Kyl is an idiot. I took an informal poll at my small company, asking people if they wanted to see coverage reduced or sicker people tossed out of the pool. No one wanted those things, for a very simple reason: They understand that they'd be next on the chopping block. No one in our company *resents* mandatory coverage for our young co-workers starting a family, or our older co-workers with serious health problems. Hell, if we wanted to reduce our premiums we could toss out the owner, who was diagnosed with lymphoma. But then, he would die, the company would fold and we wouldn't have jobs, let alone insurance.

"When a woman gets pregnant, there is normally a man involved in the process. Doesn't he bear some responsibility for the costs?"

Thing is, it's usually a specific man involved in the process. So, why the hell should some guy who's carefully NOT getting women pregnant, or already paying for the health insurance of the only woman he stands any chance of getting pregnant, be paying for the pregnancy coverage of random women he's got nothing to do with?

So, why the hell should some guy who's carefully NOT getting women pregnant, or already paying for the health insurance of the only woman he stands any chance of getting pregnant, be paying for the pregnancy coverage of random women he's got nothing to do with?

Again, why the Hell should some guy who's carefully NOT getting type 2 diabetes, and already paying for the insurance of any dependents who might get type 2 diabetes, be paying for the type 2 diabetes coverage of random people he has nothing to do with?

When a woman gets pregnant, there is normally a man involved in the process. Doesn't he bear some responsibility for the costs?

Not unless the pregnant woman will allow him to.

Allow the principle that the man has to pay for the pregnancy costs, and you bring in the spectre of the man controlling the woman's pregnancy.

Once the baby is born, the man has financial obligations towards his daughter or son which the law ought not to allow him to evade (unless his knowing this child exists will constitute a danger to child or mother).

But during the pregnancy, it's the woman's decision whether or not she wants to tell him she's pregnant. It's nobody else's business if she chooses not to, and as the man has absolutely no legal right to make any decision for her about her pregnancy, he ought to have no legal obligation to share the costs of the pregnancy.

It's not appropriate, if you care to be thought enlightened, to forever try to make someone's reasoned views to look stupid. One of the problems in our approach to health insurance is treating expected events in the same way as unexpected events. The former should be viewed as prepaid coverage and the latter as insurance. Maternity costs for a normal pregnancy and delivery and routine dental procedures fall in the category of prepaid coverage, not insurance. These really should be treated in a different way from a condition like diabetes which should be covered by insurance (and the insurance coverage for diabetes might need some kind of additional premium if the insured's behavioral pattern indicates a much higher risk than the average person).

At the time of my daughter's pregnancy with her second child, she had insurance coverage for herself and her child, but no maternity coverage. That pregnancy resulted in a delivery that was two months premature and the expenses were significant. She and her husband had to pay the customary expenses related to the pregnancy, but the abnormal medical expenses for my daughter prior to the birth and the additional hospital and other medical expenses for the baby were covered.

I see no reason whatever for a requirement that health insurance cover maternity medical costs since most of these events are either planned or should be known to be very likely.

Senator Kyl knows exactly what he is talking about and he is exactly on the mark. What is stupid is to think that an insurance company should include in an individual's coverage an event that has an almost absolute likelihood of occurring and be expected not to charge an additional fee. What is even more stupid is to act like this is insurance and have all policyholders or taxpayers share the fee.

Good Ole Boy: It's not appropriate, if you care to be thought enlightened, to forever try to make someone's reasoned views to look stupid.

But as Senator Kyl clearly has no reasoned views on health insurance, this hardly applies: he is stupid.

Maternity costs for a normal pregnancy and delivery and routine dental procedures fall in the category of prepaid coverage, not insurance.

Yeah, because if a woman gets unexpectedly pregnant, she can always have an abortion - in which case, health insurance costs should cover those costs. I didn't know you were so fervently pro-abortion, GOB.

'Yeah, because if a woman gets unexpectedly pregnant, she can always have an abortion - in which case, health insurance costs should cover those costs. I didn't know you were so fervently pro-abortion, GOB.'

No need to make stupid inferences.

What I said is what I meant.

GoodOleBoy: What is stupid is to think that an insurance company should include in an individual's coverage an event that has an almost absolute likelihood of occurring and be expected not to charge an additional fee."

Or a high likelihood of occurring. So that two-pack a day smokers and heroine users should be required to pay a risk primium or be entered into a special risk pool (which is what some of the European nations with universal care provisions require).

'Yeah, because if a woman gets unexpectedly pregnant'

I do understand that this does still happen in England when the girls get drunk out of their minds and cannot even remember who they have been with or what they might have done. Maybe a 'public option' is in order.

'So that two-pack a day smokers and heroine users should be required to pay a risk primium or be entered into a special risk pool'

More candidates for the 'public option'.

The 'public option' could be used to cover all the stupid people who do all the stupid things that they may even have a difficult time remembering that they did.

Grover G's question above should apply to Brett and GOB as well. Do you guys [assumption on my part] have any bleeping idea what you are talking about?

Sure, let's not pay for routine prenatal and maternity care.
Let's not pay for routine physicals, preventive care or diagnostic tests either. My doc wants me to have a colonoscopy every three years? Oops, out of my pocket.

Not only is this not moral, in the absolute world of Brett and GOB its also not practical and definitely not cost effective.

No, I don't have a cite, but ANY problem detected earlier is cheaper to treat.

Of course, in their Galt world, Kyl and Brett might say the cheapest way of all is to diagnose something only after its untreatable, death being the least costly alternative of all.


Oh, and GOB: If your daughter and son-in-law couldn't have afforded to pay for their maternity and prenatal care, or had not been insured for the problem that ensued, do you think you might not have a grandchild now?

'Let's not pay for routine physicals'

I don't ever recall this being covered in any health insurance plan I ever had, and not by Medicare now.

'If your daughter and son-in-law couldn't have afforded to pay for their maternity and prenatal care, or had not been insured for the problem that ensued, do you think you might not have a grandchild now?'

I would have the grandchild now without question.

EFGoldman, are you having some trouble with the distinction between, "X should not be paid for", and "Requiring X to be paid for is not insurance"?

You want to argue for a social welfare program, CALL IT a social welfare program. "Insurance" is something else.

"..., but ANY problem detected earlier is cheaper to treat."
[...]
"Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive.

"For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
[...]

Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs

GoodOleBoy, I'm not sure I understand your point. Your daughter and son-in-law didn't have maternity coverage, so they paid, what, about $8-10K out of pocket? When for a few dollars more a month they could have paid a quarter of that or less?

That pregnancy resulted in a delivery that was two months premature and the expenses were significant. She and her husband had to pay the customary expenses related to the pregnancy, but the abnormal medical expenses for my daughter prior to the birth and the additional hospital and other medical expenses for the baby were covered.

I see no reason whatever for a requirement that health insurance cover maternity medical costs since most of these events are either planned or should be known to be very likely.

Hmm... funny thing. Your grandchild's premature birth entailed enormous expense compared to a non-premature birth, and the insurer was forced to pay them. What an unfortunate outcome. It almost seems like the insurer ought to try to avoid that.

Nah, covering such expenses would be an irresponsible waste of money, wouldn't it? It's plainly better for everyone to just roll the dice and hope the house wins. It's probably cheaper, and it's not being as frugal as possible in that case could cause any harm nearly as grave as the least increase in insurance premiums.

I do understand that this does still happen in England when the girls get drunk out of their minds and cannot even remember who they have been with or what they might have done.

Careful there, chum. Aside from the dubious proposition that some American college girls don't do exactly that on an almost weekly basis, Texas (Whoooooooo!) has the fifth-highest teen pregnancy rate in the United States. Only Nevada, Arizona, Mississippi and New Mexico have it worse.

Boy, you sure lash out when you get your feelings hurt, huh?

You want to argue for a social welfare program, CALL IT a social welfare program. "Insurance" is something else.

Sorry, but no. The majority of people in the US receive healthcare through health insurance that operates in exactly the way you are describing as "social welfare". I agree that "insurance" is a bit of a misnomer, but that is what the actually-existing employment-based programs are called, and they operate in exactly that risk-spreading fashion, with indifference to the risk profile or differing needs of individual participants.

You can't redefine "health insurance" to only mean exactly what you want it to mean, when it already has a different, widely-understood meaning that includes things you would like to exclude. It doesn't matter if your definition better fits the pure definition of "insurance", because that's not what people mean when they talk about "health insurance".

GOB:
I do understand that [unexpected pregnancy] does still happen in England when the girls get drunk out of their minds and cannot even remember who they have been with or what they might have done. Maybe a 'public option' is in order.

You know, all the implications you packed into this would be hilarious if they weren't so ridiculous and insulting.

I grew up in the rural Midwest. Unexpected pregnancy was (and I've no cause to doubt remains) rife, despite the distinct absence of a wanton and inebriated British partygirl demographic. I guess all that good 'ole personal responsibility and unwavering old-fashioned American morality you (condescendingly) allude to must have somehow just up and missed the area where I lived... right?

Thank you, Jacob, for being clearer than I was.

And GOB, yes, my (employer-based) insurance absolutely covers my annual physical, diagnostics and other preventive services (like flu shots and tetanus shots).

And my [different employer, different provider] employer insurance absolutely covered maternity, prenatal and postnatal care for my wife and daughter twenty-eight years ago.

Back to the future, I say.

GOB, your argument is that a planned pregnancy can be saved up for. True. A woman could decide not to have a baby until she's saved up for the costs of pre-natal care, childbirth, post-natal care, assuming nothing goes wrong.

In which case, a woman who gets accidentally pregnant before she's saved up for the costs you feel she should pay for herself, will need to have an abortion: that's cheaper. Far from being a "stupid inference", GOB, it's a straightforward consequence: You are arguing that pregnant women who haven't got enough money to pay the "routine" costs of having a baby, ought to have an abortion instead.

Of course, in the US, that is pretty much what happens right now anyway, thanks to the pro-abortion anti-maternity policies of the dominant right-wing ideology of the past 30 years:

Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion. Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion. 2008 stats

And according to Planned Parenthood, consistently, women who come to their clinics seeking an abortion list economic need as one of their reasons for deciding to terminate the pregnancy. So yes, GOB: you are making a pro-abortion argument, when you argue that health insurance ought not to cover pre-natal/childbirth/post-natal care, because a woman ought to have enough saved to pay for that before she decides to have a baby.

I do understand that this does still happen in England when the girls get drunk out of their minds and cannot even remember who they have been with or what they might have done.

In the US, in 2005, the number of abortions per 1,000 women aged 15-44 was 19.4. In England, in 2004-2006, the number of abortions per 1,000 women aged 15-44 was 17.8. cite

I consider 17.4 to be way too high a figure: while all women in the UK can have free contraception on the NHS, it seems clear that not enough of them are making use of that access. But trying to get into a statistics war about abortion and unexpected pregnancies and infant mortality, GOB, is not a war an American can win with a European. We do better, on all counts.

How about: "Kyl shouldn't win that argument and any baseline should include maternity benefits and there should be a baseline".

I like that argument best.

However,

When a woman gets pregnant, there is normally a man involved in the process. Doesn't he bear some responsibility for the costs? I think it's wrong to claim that, because the woman bears the physical burden of pregnancy and childbirth, she must also bear the entire financial burden. That burden should certainly be shared

This argument is absurd. Married people with family insurance would have that as baseline, single women have the responsibility and rights for reproductive decisions and their insurance would necessarily have to take into account that possibility.

Brett:

Different insurance programs work different ways. Life insurance will be collected on if you continue the policy. Property and casualty claims are relatively rare. Health insurance is in the middle. What is covered does affect the costs but defining what is covered does not make it a social welfare program.

I personally think that replacing insurance with a universal social welfare program would be cheaper in the long run, would work better and would be better for everyone other than the set that contains GE Medical, United HealthCare and overpaid surgeons. I'm willing to live with the fact that we will continue to let health insurers get a cut for no good reason, but I am not willing to let them sell insurance and rescind it after the fact. I am not willing to let them cut benefits. I am not willing to let them contract to be the ERISA administrators for lousy insurance provided by self-insured companies. It is no more social welfare to expect insurance companies to provide proper benefits than it is to expect companies to sell safe food and products.

I have to agree with Marty, we need a baseline and Kyl's complaint is about something that anyone with any compassion would consider part of the baseline. I hope his attack on this coverage works like Arnie's attack on nurses in California -- a chance for average folks to really realize how completely indifferent the GOP is to the concerns of those who need insurance.

efgoldman says "Sure, let's not pay for routine prenatal and maternity care."

There's already a government program that does that, doncha know? It's called Medicade, which already provides 45% of the pregnancy-related care in this country, the majority to poor Americans, and cross-Mexican-border illegals -- your tax dollars at work.

And under the Baucus proposals pregnancy ISN'T covered -- unless a higher premium is paid to cover it.

By the way, how many of you arguing in favor of the Democratic bill have even READ the damn thing?

How about the Congressional Budget Office evaluation of it?

We need to change the name of this blog to ObiSockPuppet

Jesurgislac says:
"But trying to get into a statistics war about abortion and unexpected pregnancies and infant mortality, GOB, is not a war an American can win with a European. We do better, on all counts."

How do you do on surgeries in general? Coronary bypass? Angioplasties? How about cancer death rates? And stroke death rates?

How about Wait-Times for surgeries in OCED countries?

"Waiting times for elective (non-urgent) surgery are a main health policy concern in approximately half of OECD countries. Mean waiting times for elective surgical procedures are above three months in several countries and maximum waiting times can stretch into years. They generate dissatisfaction for the patients and among the general public."

That from an OECD report in Jul-2003. And wait times haven't improved since then, and from the bitching online in England and elsewhere about it, I'm guessing it's gotten worse.

"Sure, let's not pay for routine prenatal and maternity care."

Ok, let's pay for it one time, and then charge mothers a tax for each additional child born.

We can call it the W.C. Fields 'Drat-A-Brat' Tax, or the 'Go-way Ya Bother Me Kid' Penalty. Or the Rug-Rat Excise Tax.

And of course I'd be willing to cover birth control devices under the insurance benefits to encourage restraint ...

I'd be more impressed by the waiting-list argument if I hadn't twice in the past five years, once while on a truly amazing Cadillac plan, spent more than six months zonked out on painkillers between the decision that I required surgery to function and the first time all the necessary moving pieces could be coordinated at my good ol' American hospital.

Meanwhile, Kyl's certainty that maternity care is not relevant to his life raises the possibility that he was hatched.

*I* haven't seen his birth certificate — have you?

Marty

This argument is absurd. Married people with family insurance would have that as baseline, single women have the responsibility and rights for reproductive decisions and their insurance would necessarily have to take into account that possibility.

Do you honestly think that men have no responsibility for pregnancy?

Brett

Thing is, it's usually a specific man involved in the process. So, why the hell should some guy who's carefully NOT getting women pregnant, or already paying for the health insurance of the only woman he stands any chance of getting pregnant, be paying for the pregnancy coverage of random women he's got nothing to do with?

If your random guy is paying for maternity coverage for the only woman he's going to get pregnant then how does the mandate hurt him?

It won't cause total costs of pregnancies to rise. So Jack pays for maternity insurance for himself and Jill, instead of just for Jill. But since the number of people paying has roughly doubled the cost of the insurance should be halved. In other words, the actuarially correct total premium for a couple is the same, no matter the name(s) on the policy.

As for the careful guy, what happens if he gets careless? And what about the careful people who don't ride motorcycles, or drink a lot, or overeat, etc.? We all make lifestyle choices. Some have more risk than others. are you suggesting that insurance companies should inquire into all that, and monitor it?

Jes,

I'm not sure I understand your concern. I suppose if a pregnant woman did not want to make a claim against the father's policy that would be OK.

"And under the Baucus proposals pregnancy ISN'T covered -- unless a higher premium is paid to cover it."

Who says they like the Baucus proposal?

"By the way, how many of you arguing in favor of the Democratic bill have even READ the damn thing?"

I've read a good bit of it, and the entire summary. What's your point?

"How about the Congressional Budget Office evaluation of it?"

What about it? The CBO has confirmed that it's deficit-neutral.

Okay, I've answered your questions. How about you answer mine: Are you currently insured?

"It's called Medicade, which already provides 45% of the pregnancy-related care in this country, the majority to poor Americans, and cross-Mexican-border illegals -- your tax dollars at work."

Actually it's called Medicaid and it would be much preferable to have poor people insured, and insured legally, than depending on Medicaid. Wouldn't you agree?

I think that a system that serves everyone but people have to wait for nonurgent surgeries is better than one like we have where large numbers of people get no health care at all until it is an emergency and then have to wait in emergency rooms sometimes for days for their emergency care the cost of which bankrupts them...

People in places like Canada bitch about their systems but they are in absolutely no hurry to become more like us.

"...but they are in absolutely no hurry to become more like us."
Perhaps not, but some of them don't mind taking advantage of US health care when they can't get what they need in Canada.

Various hospitals in US in cities bordering Canada have tied up with Canadian Health care agencies to provide care not otherwise available in Canada.

Patients in Canada, especially requiring medical attention for heart, imaging tests, bariatric or other similar services tend to prefer medical facilities in US rather than in Canada. Even Canada too tends to rely on support from facilities in US rather than building its own systems.

Various patients surveyed appeared happy over the medical treatment facilities available for, now a days, common ailments as angioplasty, leukemia, cancer, bone marrow transplant etc. The bills have been taken care of by Canadian health Care.
[...]

Canadians prefer US health care over its own

I, too, would be happier about U.S. medical care if I had the Canadian government paying for it.

Canadians can afford to come here for procedures. Americans go to Pakistan to be able to afford the same procedures.

1. Panama
2. Brazil
3. Malaysia
4. Costa Rica
5. India

Top 5 Medical Tourism Destinations: Medical tourism can mean attractive opportunities for foreign patients and investors

grover asks again:"Are you currently insured?"

I've recently addressed that on prior posts... know how to do an archive search?

Russel states re: Baucus Bill: "The CBO has confirmed that it's deficit-neutral."

You know, Russell, these health care issues are important to the future of the nation, and it doesn't reflect well on you to distort the discussion with simple-minded expedient reductions of fact, just to make a point.

In fact, the CBO report to Baucus clearly states the following important caveats regarding what is only a preliminary analysis:


• First, while we understand that specifications provided to CBO were intended to be consistent with the Chairman’s published mark document, CBO and JCT have not reviewed that document to determine whether it conforms in all respects to those specifications.
• Second, CBO has not yet completed its review of legislative language that would translate those specifications into law; review of that language could have a significant effect on the analysis. In particular, this analysis reflects an assumption that sufficient reporting and enforcement provisions will be included to implement the specified policies in an effective manner. More generally, as CBO’s and JCT’s understanding of the specifications improves, that could also affect our future estimates.
• Third, we have sought to model all of the specifications and to capture their principal effects on federal spending, but we have not taken into account all of the proposal’s effects on spending for other federal programs or estimated the federal government’s administrative costs for oversight and implementation that would be subject to future appropriations.
• Fourth, the budgetary information shown in the tables reflects many of the major cash flows that would affect the federal budget as a result of implementing the specified policies and provides a preliminary assessment of the net effects on the federal budget deficit (subject to the caveats listed above). Some cash flows (such as risk adjustment payments) would appear in the budget but would net to zero and thus would not affect the deficit; CBO and JCT have not yet estimated all of those cash flows.


"I've recently addressed that on prior posts... know how to do an archive search?"

Sorry I haven't clung to your every word. I'm not spending an hour on it. I'll take it as a "no."

"Russel states re: Baucus Bill:"

No, that was me. The CBO declared HR 3200 to be deficit neutral. Are you talking about the Baucus proposal? If so, why are you asking if I've read something that basically hasn't been done?

Arizona does not mandate maternity coverage.

Courtesy one of those quote sites, let's pick a plan, say $1000 deductible, 20 percent co-insurance, $25 co-pay, no maternity except complications.

For the same policy a 29-year-old man pays $146 per month, a 29-year-old woman pays $198 per month.

In Oregon, with mandated maternity coverage, for comparable plans a man and woman pay the same, $180.

Now consider that a maternity rider costs between $100 and $300 per month.

So in Oregon, the insurance for the male goes up somewhat, but there is parity between male and female premiums. In Arizona, the cost for a young female who wants maternity coverage is double, possibly triple what the male pays. And that's assuming that an affordable plan even offers maternity riders, which many don't. In addition, coverage is often inadequate and requires one- to two-year waiting periods.

Check out this comment from a recent online article on health insurance:

"My 28 year old healthy, single daughter was quoted around $200 per month. from Anthem until she asked about maternity coverage, which jumped the price to over $700 per month. That was with a $5000 per year. deductible. That's over eight grand a year, approximately 25 percent of her annual salary. That is completely unacceptable."

Now, maybe that's the way you think it should be. It seems *more* than discriminatory to me.


Now let's say these two kids get married and want a family plan:

For comparable plans they would pay $176 in Arizona and $222 in Oregon.

So again, whereas in Arizona the penalty for maternity coverage would be at least $100 a month, if a rider is available, in Oregon the difference is $46 across the board. In Oregon, you can get a high-deductible plan with decent co-insurance and maternity coverage for as little as $123 a month. In Arizona, unless you sacrifice office-visit co-pays, it's about the same or a little less.

Of course, this is an estimate and differences may be based on other factors. But a young couple looking for maternity coverage would obviously be better off in Oregon, which mandates maternity care, than in Arizona. The question is, are other Oregonians content to pay higher premiums across the board? That's assuming, of course, that maternity coverage contributes to higher premiums, which I think is a safe assumption. Other mandates and factors contribute as well.

But here's the thing: In Arizona, if you're a young couple who isn't planning to have children right away, you can save money on a policy. BUT if you accidentally get pregnant, you will not be able to get coverage and you are stuck with a minimum of $7K worth of hospital bills (March of Dimes estimate), unless you can negotiate it down. If you plan to get pregnant and want coverage, you *may* be able to get it but the cost will be at least $1200 a year (probably more) and the coverage will be slim, leaving you with about $4000-7000 in costs anyway. Have you saved any money?

I would think that living in Oregon would be a much better idea, except that Uncle Jay won't invite you over to dinner because he resents paying more on his own policy to ensure your own coverage.

But what would Uncle Jay be paying for health care if maternity coverage wasn't mandated? What would the cost-shifting for unpaid maternity bills look like?

Correction: in Arizona, my young couple would have to buy a maternity rider, so their premiums would increase by at least $100 a month. So whereas in Oregon they can get insurance with maternity coverage for $222 a month, in Arizona they'd have to pay much more--the difference being they can save money in Arizona by forgoing maternity coverage.

I think I said the same thing twice. Sorry! :-p

I'm not sure I understand your concern.

I'm concerned that if a man has a legal obligation to provide financial help with pregnancy, he may use that obligation as leverage to control the pregnancy - either to force her to have an abortion when she doesn't want one, or to deny her an abortion when she does want one,

We need to change the name of this blog to ObiSockPuppet

What's this "we" business? I don't see you listed among the site owners and contributors.

This is the Internet. Start your own blog. It's free.

DNFTT

Jes,

I see. Of course, even without considering the possibility of legislation, the fact that the expenses would be paid by insurance, rather than out of the father's pocket, would mitigate this.

In any case, I don't see why opposition to an abortion, at least, would be financially motivated. In the case of a long-term relationship, it seems to me that covering maternity expenses would lead to a better situation.

"Kyl shouldn't win that argument and any baseline should include maternity benefits and there should be a baseline".

Hear hear.

Look, the basic question here is: what kind of a thing is health insurance?

If it's just another fungible commodity, like potatoes, or oil changes, or shoelaces, then it should be provided by private vendors in a plain old open market. We probably need some basic regulation to make sure that nobody's getting egregiously ripped off, and we probably need some help in the form of tax breaks or direct transfer payments to make sure that folks who simply can't afford it have some path to getting it.

If it's not like potatoes, or oil changes, or shoelaces, but is instead something more like highways, or trash collection, or postal delivery, or access to potable water -- if it's a basic requirement for living a something-less-than-stunted life in the actual culture and economy that we all live in -- then perhaps something else is needed.

Kyl doesn't want to pay for maternity insurance because he's not going to get pregnant. The flip side of that is that women will want to opt out of coverage for testicular or prostate cancer, or for any of the many other unique and colorful ways in which male bodies are prone to breaking down.

I don't care if Kyl gets a maternity rider or not. What I do care about is the Kyl doesn't have the option of not paying for every big or little thing that doesn't apply to him.

The reason for that is because then the cost shifts to the folks who are more likely to need those kinds of care.

As Grover's example makes clear, some of those folks won't be able to afford it, and so they won't get it.

And as Thullen's comment makes clear, the result of that will be that lovely young people with the full potential of their lives just coming into flower will die from the god-damned flu.

The flu.

If we're going to nickel and dime it, let's quit horsing around. Put it in the private sector, offer some help to folks who can't afford to buy it otherwise, and we'll all take our chances. People will continue to die, suffer, go bankrupt, and otherwise endure hair-raising calamity due to completely preventible illnesses, but at least we'll be clear about what we consider our obligation to one another to be.

If we don't want to live in that kind of society, then we need to quit screwing around worrying about every 10 or 15 or 50 bucks that's being confiscated from us by force of arms at great cost to our personal liberty, and just f**king pony up.

Why? So that everyone can go to the damned doctor when they need to. Everyone. Even folks smoke, who forget to take their meds, who eat Twinkies for breakfast, or who sky-dive or bungie-jump for kicks.

Even people who get pregnant.

Everyone. Cause we all, every one of us, is walking around with some kind of genetic time-bomb waiting to go off, we all have some bad habit or other, we all have our stupid distracted days when we are relatively more likely to step in front of a bus or fall down an open manhole.

Everyone.

Yeah, if Kyl has to get maternity care, it will cost him some incremental amount more for health insurance than it might otherwise have done. And paying for his prostate operation, and maybe his Viagra, is going to cost some woman some incremental amount more than she would otherwise have to pay. Healthy young people are going to get the short end of the stick right up until they aren't healthy young people anymore, at which time some other healthy young person will bail their sorry @sses out.

That's how it works when people decide to get each other's back. If we don't want to do that, we should just shut up about the whole thing and hope our luck holds out.

So go look your neighbor in the eye and decide which way you want to roll, cause that is the choice that's on the table.

And for the record, the reason why Kyl in particular is pissing me off is that he has *excellent* medical coverage -- about as good as anyone is likely to have -- and part of the cost of his coverage is being paid now, today, by some poor slob who is trying to decide whether to go to the doctor or pay his rent.

So yeah, he has his little academic point, but screw him. He's not facing any real dilemna about what coverage he might or might not need, he's all set, courtesy of you and me.

Hoo boy.

One to put my most irritating pedantic asshatery hat on the Constitution does NOT talk about the 'common welfare', instead it uses the word 'general welfare'. Easy mistake since the preamble reads "provide for the common defence, promote the general Welfare" but maybe one you don't want to make when accusing your opponents of not having read the Constitution.

Two. The answer to these questions is "Yes" and "Yes"
"If John Kyl was insured as an individual, is there a mandate that the coverage would or must include language stipulating that he is covered for maternity care.

Family coverage is another matter.

Are single females covered automatically for testicular and prostate cancer?"

There are no provisions in HR3200 that would allow coverage or cost to vary between men and women either on an individual or family plan. Which makes the question moot. If you get injured or sick and your treatment falls in the equivalent of Medicare's 'normal and necessary care' you get covered. There will be no need for a chromosome test to see whether you get your XY coverage or your XX coverage.

Plus this whole discussion shows why it is stupid to provide health care on an insurance model to start with. People are going to have babies, people are going to get shot, people are going to be born with genetic predispositions or even near guarantees of developing certain medical conditions. Hiring people to assess this risk for every given individual is just a waste of resources. Get sick, see a doctor. Something most of the rest of the developed world figure out decades ago.

Plus this whole discussion shows why it is stupid to provide health care on an insurance model to start with. People are going to have babies, people are going to get shot, people are going to be born with genetic predispositions or even near guarantees of developing certain medical conditions. Hiring people to assess this risk for every given individual is just a waste of resources

So Kyl's paying for it ANYWAY, whether maternity is part of his coverage or not...

I notice Kyl didn't object to having coverage for getting shot.

I guess when you serve on U.S. House of Representative Death Palins, you want to cover all eventualities for yourself.

I'm beginning to see what worries HIM.

The "people are going to get shot" mention by gwangung reminds me of two stories side-by-side in yesterday's Denver Post.

The first was about city and state funding cuts to homeless elderly programs. The second was about our Democratic Senator trying to increase funding for target ranges on public lands for our beleaguered sportsmen and gun enthusiasts.

I believe a rational, money-saving approach would be to allow the folks who need target practice to fan out at night through Denver's parks, alleys, and low-lying areas under bridges to use the homeless elderly for target practice.

You would save the taxpayer money on both ends, cut out the bureaucratic middlemen who get in the way of bringing cruelty directly to those who deserve it, and there would be more lentils for the rest of us.

For John Thullen ...

Thanks for the "a spaniard in the works" spoonerism -- my big smile of the day ....

The book is well worth reading -- if you can find a copy. I read mine regularly.

http://www.amazon.com/Spaniard-Works-John-Lennon/dp/1568492995

And what's the cost scale going to be?

Are you stupid? We pay more than any other country as a percentage of GDP for health care. To cover, adequately, 2/3rds of our population.

We rank 37th for all this spending. And one-third of us have jack...

Call us when your head isn't so far up your butt you feel it necessary to say incredibly retarded things in your post...

Let's not pay for routine physicals
==========
I don't ever recall this being covered in any health insurance plan I ever had, and not by Medicare now.

If we're going to be anecdotal, a routine physical at reasonable intervals has been covered by every plan I've had. Now that I'm over 50, the plan would cover an annual physical; as I find them unpleasant and I have no symptoms, I go every other year.

Grover quotes this:
"My 28 year old healthy, single daughter was quoted around $200 per month. from Anthem until she asked about maternity coverage, which jumped the price to over $700 per month. That was with a $5000 per year. deductible. That's over eight grand a year, approximately 25 percent of her annual salary. That is completely unacceptable."

And adds this:
"Now, maybe that's the way you think it should be. It seems *more* than discriminatory to me."

I'm sure that even though those insurance coverage numbers you quoted above seem unrealistic, you did due diligence and checked them out after you read them to verify their authenticity, and didn't merely repeat them blindly to support a partisan view, because even a cursory check of health insurers in Arizona would have indicated they must have been exaggerated.

BlueCross BlueShield of Arizona, for instance, shows rates only slightly higher than those at Kaiser-Permanente, in Oregon (the state you chose for examples you presented in your reply) for policies offering maternity coverage. At Kaiser-Permanente the most expensive premiums for a healthy 28 year old woman, including maternity coverage, is $248 a month, with no yearly deductible. And though maternity coverage is mandated in Oregon, they include a $300 a day inpatient maternity care co-payment ($1,500 max per admittance) - so that other members in the Kaiser plan aren't fully footing the bill for another Oregonian baby spewed into the state.

Similarly, for Blue Shield's BlueSecure Plus plan in Arizona the inpatient member co-pay is $250 a day, for a max of three co-pays per admission - but the policy must be in force for 12 months before the delivery occurs (to keep women from scamming the system, and only signing up after they're pregnant).

Nevertheless, thinking it over in the light of your reasoned arguments, Grover, I'm coming round to your point of view. All of us, every American, young and old, should willingly bear additional expenses and higher premiums to cover maternity costs, any and all of them. This blanket coverage, without extra premiums, should also include infertile woman taking medications that significantly increase the chance of multiple births: triplets, quadruplets, quintuplets, and any other higher-order multiples that advanced fertility techniques enable. And of course we should also include maternity benefits for older woman who want to become pregnant in their 50s and 60s, even if the fertility drugs they take to accomplish it produce higher incidences of birth defects. We are the world, after all, and responsible for all happenstances within it, and therefore should be willing to pay higher premiums to prove our heart is in the right place.

Therefore, in the same spirit of heart-felt accommodation, any and all procedures or surgeries which improve the overall well-being and self-esteem of those covered under the new healthcare initiative should be included at a flat-rate premium, including breast implants, nose jobs, fanny-lifts, tummy-tucks, botox injections, penis enlargements, vagina tightening, and all transsexual treatments and surgeries.

And so what if that adds more to the overall health care burden, who cares - the majority of those expenses will be paid for by Senior Citizens on Medicare, from the cornucopia of savings the Prez promises we'll realize after we do a little belt-tightening on that program. And in the overall scheme of things in Progressive America whose medical care is more important? Great Grandma and her arthritic joints and bed-sore back, or that 28 year old single Sex-In-The-City wannabe described above, who's too lazy or stupid or drunk or coked-up to take birth control precautions, and wants the rest of us to hedge her health insurance bet and ameliorate her maternity ward tab if she gets knocked up some night?

Like the rest of you, I’ll take door number two.

This blanket coverage, without extra premiums, should also include infertile woman taking medications that significantly increase the chance of multiple births: triplets, quadruplets, quintuplets, and any other higher-order multiples that advanced fertility techniques enable.

You realize that fertility treatments are not generally covered by medical insurance and that there are NO proposals to do so currently before Congress right?

And of course we should also include maternity benefits for older woman who want to become pregnant in their 50s and 60s, even if the fertility drugs they take to accomplish it produce higher incidences of birth defects.

Why should we do that? We don't do that now. I mean, Medicare covers 60 year old women right now and does not spend significant amounts of money on maternity care. Do you think some new insurance policy might alter the fundamental nature of human biology?

You appear to be deeply confused as to the difference between maternity and fertility benefits. The two are...quite different. Even though they both involve pregnancy.

Look, if you want to construct an elaborate fantasy health care insurance proposal and assume that it is radically different from any real insurance proposal on the table and then assume that human biology magically changes, then I can guess you can prove that your fictional health care insurance proposal is a really bad idea. I'm not sure why anyone should care. At all.

Jay, you can Google "maternity rider costs" and find plenty of confirmation that maternity riders are expensive and offer very limited coverage.

The Arizona BlueSecure Plus plan you mention costs our 29-year-old woman a whopping $593 per month--and that's for an HMO plan. So yes, they're certainly making sure that no one else gets "stuck" with the cost of that baby! The cheapest maternity coverage I could find for zip code 85003 at ehealthinsurance.com was $286 for an HMO plan at HealthNet.

I was comparing PPO plans, generally $1000-2500 deductibles, 20% co-insurance and unlimited $25-30 office visit co-pays, which gives you CHOICE, which is what we all want, right? There is no PPO plan at that site for 85003 which includes maternity benefits.

My point was to find out for myself if mandatory maternity coverage increased premiums for similar plans. I think that's the case, but those increases for young parents are very small compared to either sacrificing choice for coverage, or paying a lot more money for a PPO plan, as seems to be the case in Arizona. Of course that means everyone else pays higher premiums too. But if maternity coverage is unaffordable for many young people, and we end up with a bunch of unpaid hospital bills, what does that do to health care costs? I don't have an immediate answer, but it's very possible that what one might save by "picking and choosing" who gets maternity coverage might be a wash compared with the higher costs for your local care.

As for the rest of your post, I think Turbulence responded well to that. You haven't responded to any of my other points about Baucus or the CBO reports or even whether you yourself pay for health insurance.

Actually, though, Turbulence is wrong about infertility treatments, I believe. Nine states currently mandate coverage for this, and fifteen mandate that coverage be offered.

But of course there are qualifiers to all these mandates, to the extent that Jay's wildest socialistic dreams are unlikely to come true.

I'm not sure I agree. Isn't his point that adding coverage to his policy that he couldn't possibly use can drive up his costs?

If so, it's a stupid one. How much would you expect to pay for coverage against being injured during the Thirty Years War?

Sorry to post so much, but I keep learning more. The problem with an HMO maternity plan is that most HMOs will require you to sign the baby up for the plan within thirty days, and the premiums can be much higher than standard coverage (because there's no deductible, etc.) So you have to be careful about what your HMO will charge if they cover the birth.

including breast implants, nose jobs, fanny-lifts, tummy-tucks, botox injections, penis enlargements, vagina tightening, and all transsexual treatments and surgeries.

Anyone spot the odd one out that might possibly be not considered unnecessary by anyone with a brain and a conscience?

"I really don't understand what point you're trying to make. If your point is "people who refuse to get insurance will be penalized with a fine and that's really a tax", well, everyone needs insurance."

My point was that, in the Finance Committee there are over 500 amendnets being disussed and if you take one discussion out of the whole and say (from the post)"

"This exchange really gets at the deeper divide between the parties on these issues. The GOP, institutionally, doesn't really care if you have health coverage or not."

Then I can go find a statement or conversation and create an equally irrational conclusion on the other side. I can also conclude that it isn't just the "conservatives" using fear tactics to make their points, Publius does a nice job here.

Marty: Then I can go find a statement or conversation and create an equally irrational conclusion on the other side.

What, the Republicans are making rational comments about healthcare now?

Marty, what is irrational about saying that the party which institutionally opposes everyone having access to healthcare, doesn't care if people have healthcare or not?

And if you're not scared that you live in a country where you can die of a treatable disease because your insurance company decided it would cut into their profits too much for them to pay for your healthcare costs, well... you're either very brave or very stupid. But the people who point this out are not scaremongering: that would be the Republicans who try to claim that the NHS has "death panels" and that Obama wants to kill your grandmother.

sanbikinoraion, Jay Jerome is trolling. DNFTT.

"Marty, what is irrational about saying that the party which institutionally opposes everyone having access to healthcare, doesn't care if people have healthcare or not?"

There are many Republicans, in power(Olympia Snowe and others) who expicitly want this type of HCR to succeed. Many others want HCR at a different scale.

I would hope that every provision and amendment in this process is thoroughly discussed. This back and forth is not "an example" of Republicans as whole not wanting HCR. And constantly saying things like

And if you're not scared that you live in a country where you can die of a treatable disease because your insurance company decided it would cut into their profits too much for them to pay for your healthcare costs, well... you're either very brave or very stupid

is fearmongering as sure as death panels is.

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