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Dec 2013 update to Obamacare

Dec 2013 update to Obamacare

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Published by Linda de Sosa
Summary of Obamacare updated, including several pages of suggestions to increase access without destroying our healthcare system.
Summary of Obamacare updated, including several pages of suggestions to increase access without destroying our healthcare system.

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Published by: Linda de Sosa on Dec 16, 2013
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Linda de Sosa, Houston TX
A Dissection of the Health Care Reform
I have updated this report with newer facts and figures to demonstrate that my predictions are already being proven correct. Linda de Sosa 12/16/2013 Original preface: Assuming many Americans have not had time to do research, I am compiling information from studies and government sources, adding questions to assess logic and ideas generated from many sources for solutions. 3/18/2010 3/20/2010 CBO report: http://cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf  3/23/2011 CBO report: http://cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12119/03-30-healthcarelegislation.pdf  3/2012 CBO report: http://cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf  
First, why do we need it?
Possibilities mentioned are a.
The US Healthcare system is not good b.
The US Healthcare system is good, but not enough people have access c.
The US Healthcare system is good, but healthcare or insurance costs too much
What is the quality of the US health care system?
Look at Infant mortality
 (percentage of infants not living to one year of age) The US rate is high, relative to other countries (6.8%) What are the causes? d.
Higher rate of very low birth weight infants in US (12.4%) and rising rapidly i.
Primarily teen mothers and mothers 40+ (Source: CDC study) ii.
For older mothers, directly related to higher multiple births (fertility treatments, not lack of health care) iii.
Younger mother analysis 1.
Mothers younger among American Indian, black, Mexicans, and Puerto Ricans 2.
Mothers younger in Alabama, Arizona, Arkansas, DC, Georgia, Louisiana, Mississippi, Nevada, New Mexico, Oklahoma, South Carolina, Tennessee, Texas. iv.
US infant preterm mortality rate is actually higher than other countries, indicating better health care e.
Decreases significantly if we could reduce low birth weight
 suggests improved access to prenatal care for teens and improved teen pregnancy prevention programs f.
Small rate variation due to US increased definition of live birth i.
Several countries do not consider a birth live unless it is over a certain weight or gestation week
 Norway, Czech Republic, France, Ireland, Netherlands, Poland ii.
Accounts for some, but not large amount of our lag g.
The top 3 causes of infant mortality (equally 43% of the cases) are congenital malformations, disorders leading to low birth weight and gestation, and sudden infant death syndrome.
Therefore, infant mortality does not indict health care quality itself.
Linda de Sosa, Houston TX
Look at average age at death in US
Not a valid measure of quality of health care i.
If you compare the death rate of a tribe of motorcyclists riding fast without helmets with a tribe that walks everywhere, which one would have a lower average age at death? Have we even discussed health care?
Average age at death is a function of life and habits, not health care
Stress, Obesity, smoking, bad nutrition, sedentary lifestyle
Look at innovation
50% of pharmaceutical patents come from US b.
Large percentage of Nobel prize winners in medicine (84%) c.
CT and MRI machine quantity relative to other countries d.
Where are the best medical centers in the world
 where do people go when they need help from all over the world? e.
Example of Von Hippel Lindau clinics (rare disease) i.
11 countries have clinics to treat ii.
10 countries have 13 clinics iii.
The US has 24 clinics, 3 in Houston alone.
Ignore UN comparative measures that are politically charged and based on invalid criteria
heavy deduction for “fairness” where a country would receive a higher score for 2 persons
dying since they had equal treatment versus one living. b.
High rating for Cuba with such a broken system outside the capital that they don’t even have bandages.
Do health insurance companies receive obscene profits?
The latest study showed they only received
2.2% profit
, down from 6%. That is substantially less than most industries. b.
Since the companies are public, the profits actually go to shareholders c.
Profits from others in the health industry are used for research and breakthroughs that can fuel future profits.
Rather than bemoan our health care system, we need to increase access
First, we need to understand the problem Here is an analysis of health insurance (Source: Census bureau 2008) Total people 301.4million Insured 255.1 84.6% Not Insured 46.3 15.4% Government Care 87.4 29.0% Medicare 43 Medicaid 42.6 Other (VA, government employees) 1.8 Private Health Care 201 66.7%
Linda de Sosa, Houston TX
Employee 176.3 58.5% Private Pay 24.7 8.2% Of the 46.3 million not covered, why? Make over $75,000 so assume voluntary 7.5 Eligible for Medicaid or CHIP for Children 14 Illegally in Country 9.5 Other 15.3 Of these, young invincibles 4.7 Therefore, those who are involuntarily uninsured are a segment of
15.3 million
 The uninsured are disproportionately in the South and West, American Indian, and Hispanic (30.7%). Even discounting the illegal proportion of Hispanics, a Hispanic cultural bias against insurance was indicated. In addition, the states with the highest percentage of involuntary uninsured are Texas, New Mexico, Louisiana, Florida, Arkansas, Arizona, Oklahoma, Mississippi, and Alabama. Analysis shows that the difference in state income per person was also a large indicator. In other words, these states have lower incomes per person and so fewer people can afford insurance. Therefore, these states would need more financial help if they are going to increase their percentage of people insured.
Conclusion: We have a great system, but we must increase access and lower costs. So, does the bill do this? How to evaluate any bill
Does it fix the problem or meet the need without injuring other parties? 2)
Is it Constitutional? 3)
Is it something the nation can afford?
Does it fix the problem?
The bill raises taxes. a.
Cost analysis below shows cost overruns. b.
Health care subsidies for poor c.
Those who choose not to get insured are penalized (or jailed!). [Update
 during the battle for passage, these were called penalties. During the judicial battle, these were called taxes] d.
Taxes high cost insurance plans in the future 2)
The bill penalizes seniors a.
There is a 21% decrease in payments to providers who accept Medicare b.
Currently, 50% of doctors do not accept Medicare alone because it reimburses 8% less than the cost - so that number will increase. [Update: headline 3/5/2011
 Opt-outs hit record in Texas] c.
Kelsey-Seybold Clinic, the largest private multispecialty physician group in Houston, does not accept Medicare without additional insurance. If this number decreases further, then either seniors will have to pay more, or their care will have to be rationed. d.
Lower Medicare Advantage subsidies - $131.9 billion over 10 years (page 13 CBO) e.
Holds future provider payments to less than inflation. The Senate CBO report states on page 19:

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