September 22, 2009 • 29 mins
In this special episode of Stuff You Should know, the second in a four-part series, Josh and Chuck -- and a special guest -- discuss President Obama's proposed health care plan in detail.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to Stuff you Should Know
from House Stuff Works dot Com. Hey, and welcome to
the podcast. I'm Josh Clark. With me, as always is
Charles W. Chuck Bryant, Doctor. And with Charles W. Chuck
(00:23):
Bryant is Molly Edmonds of Stuff Mom Never Told You Fame,
one of our sister podcasts, and Molly has also been
doing more research into healthcare reform than me, Chuck and
Ram Emanuel Combine. So we're glad to have you here. Molly.
I think I could take down but you could. He's
a bulldog. Yeah, but I've seen you. Have you seen
(00:44):
her leg wrestle? No, but startling. I've been behind me
in front of her sights. Sure, I'm not a pleasant day. Yeah,
I have to chuck it, which is why we're scared
of Molly. But we're glad she's here, right Maum, I hope,
So I hope you're glad I'm here. We're also glad
you're here because, like the Necronomicon podcast, we intend to
use you as a shield. Just to get that out
(01:04):
of the way, let's talk about healthcare form. All right.
I want to also say that we are not going
to be discussing any of the politics in this one.
This is part two, you lie. Except for that part. Um,
We're not going to be discussing any of the politics.
What we're gonna do is simply present, uh, the proposals
that are in play right now. And then Part three
(01:26):
is going to be criticisms, pros cons maybe other ideas
for fixing the health care system. And then part four
is what I'm excited about, myths and truths. Yes, yeah,
we're going to be talking about just outright lies, things
that are kind of on the fence, and things that
actually are true but are discussing. Um, so let's talk
about Obama's proposal. Is it even Obama's proposal? You know,
(01:50):
Obama has made this a priority in his presidency, but
big time, but he has not come down from on
high with a massive plan for us all to reactive.
You know who did do that? The Clintons. The Clintons did,
that's right, and Moses Moses. Uh, that was on the
third tablet right yea, Um there tablet was dropped. Yeah,
the Clintons actually wrote legislation and we're peddling it around
(02:13):
Capitol Hill in the nineties and it didn't work. That
that plan didn't work, So clearly Obama learned from his predecessors, right, right,
So Obama has laid out eight principles. This is what
he did early on. I think this has gotten lost
in all the hubbu but he came out with a
principles UM and then left it to Congress as five
companies from Congress to create plans. And then in the
(02:33):
week we're recording this, he came out and made this
mega speech that's come up with you know, all this attention.
So now the week we're recording this, Obama has come
back out with the speech and made it made it
look like it's a little bit more of his plan,
tried to wrestle control away from you know, the media spin.
He's saying what he wants in a plan, what he
doesn't want, what he's open to compromise about. UM. But
let's start in campaign mode. He was he's definitely back
(02:54):
from vacation. Yeah, yeah, So should we talk about his
A proposals. Let's let's say, I mean, what we're talking
about A thousand pages pages are so of legislation right now, right,
we got we got two bills on the table from
four committees. And when he says there are four committees
who have come up with bills, one of the bills
is a try committee bill, so that's where that comes from.
(03:16):
Three committees came up with one bill um from the
House HR three two zero zero, and then the Senate
has a bill. I have to point this out. I'm sorry,
Molly didn't even look at her notes to writt along
that bill number. I'm just gonna excuse myself to dream
about HR three two zero zero. I bet you do.
At this point she didn't look at her notes again.
And you know what I have anxiety dreams about is
(03:37):
the upcoming Senate Finance Committee bills. So by the time
people hear this, that bill might become might be out.
It's the trifecta. It's the one everyone's waiting for because
it's a bipartisan committee. Um being the Senate Finance Committee,
they have to say how they're going to pay for it,
which the other bills were not as on the hook for.
So you know that's the one everyone's waiting on. Beta breath. Yeah. Actually,
I saw today breaking news was that the chairman of
(03:59):
that commit. The Democrat Max Bacchus basically said, we're pushing
through with this very soon, and it doesn't matter if
I have Republican sport or not. We're gonna push it
through and we'll have it for a review by the
twenty one September. So wow, that's the latest word. Yeah,
I have dreams about Max. Now do you really that's nice?
So um, anyway, that's a personal note. So Obama says,
(04:23):
here the here are the eight things that he saw
that he wanted in the plan. Okay, he wanted to
assure affordable, quality health coverage for all Americans. You guys
want to I'll do one, yeah, yeah, I'll go next.
He wants to remove obstacles to coverage for people with
pre existing conditions. He wants to invest in prevention and wellness.
He wants to maintain coverage in the event of job
(04:44):
loss or change. He wants to kill your grandparents. Oh,
I'm sorry. Now. He wants to improve quality care and
patient safety. Right uh? And uh, let's see. He wants
to guarantee choice of doctors and coverage plans, right yes,
and safeguard families from bankruptcies related to health expenses. I
think that's seven. He wants to the final one he
(05:04):
wants to shrink long term cost increases in healthcare for
businesses and the government. So those are pretty um broad principles.
I think you'd be hard pressed to find someone who
would disagree with these principles just it's got and theory.
But then the Congress had the hard job of making
them into bills. So we have that thousand pages of
(05:26):
legislation as it stands right now, not including the Senate
Finance committment, without the Senate Finance correct in Brail, which
was she taught herself, had translated and then read in.
So so let's talk about how Congress did take these
eight principles and turn them into healthcare. As you were saying, um,
(05:47):
let's start with individuals. One of the big things is
that everyone, Both of both of the proposals that are
out right now say that everyone has to have health insurance. Yeah,
it's an individual mandate, and you know it's it's sort
of borrowing an idea from car insurance. If we've all
got to carry car insurance, then you know, what's what's
health insurance in addition to that? Right, So if you
don't have health insurance. You don't have to stormtroopers aren't
(06:11):
going to come to your house and beat your kids
in front of you. But the tax man, well right, yeah,
because I think the Senate bill says you pay seven
fifty dollars a year in tax penalties for not having insurance.
And then the house plan is I think up to
two point five percent of your adjusted income. Yeah, but
(06:32):
no more than the lowest price plan. Right, Like, they're
not going to charge you more than you would have
to pay your health insurance, right, I mean, if you
if you can pay the premium and taxes, essentially you
could just pay the premium. Well that's the way I
took it is we're going to get some money, so
you might as well, hint, hint, to go spending on
healthcare ether than funding the I R S. Right, But
now most people already have health insurance. The majority people
(06:54):
get it from their employers, and so that's pretty easy
to to meet that requirement, right, But we don't want
the employer to just chicken out, So employers have a
mandate as well, exactly. So now we have to mandates
employer and individual. And I heard actually the Senate Finance
is not going to have an employee an employer mandate,
and that's why businesses are probably gonna be a little
more favorable that I said. You know, that's one of
(07:16):
the theories that that's what killed Clinton's bills. You know,
it's a job killer, right, So um, but that that
sounds kind of political. So let's just back off and
say you're an employer, you're in an individual, You've got
this mandate. What if you can't afford it? Well, there's subsidies. Yes, Well,
not only subsidies. I mean, if you are going to
mandate that everybody has to have health insurance, you have
to make exemptions for certain people. Um, but you also
(07:40):
we already have Medicaid Medicare, so that covers automatically a
certain percentage of Americans. But they're also expanding Medicaid, right,
I think two power Yeah, that is the current Senate
plan would be a hundred about the federal power level,
and the House would do a hundred of the federal
powery level. Right. And they're also planning on kind of
cleaning house in those two systems, right and making them
(08:03):
more efficient and cheaper. Yes, hopefully. Yeah, Well we'll get
to that when we start talking about how this is
going to be paid for? UM. But let's talk about
subsidies for individuals. UM. Let's say that, Oh, I don't know,
I make three hundred and fifty percent income above the
federal poverty level. Right, Well, I know they're to dream.
(08:27):
Will will I be eligible for subsidies? Yes? Yes, Okay,
So I think it goes from Uh, let's say if
we're going with a hundred and fifty percent above poverty level. Uh.
From that to poverty level you're covered by medicaid. From
a hundred up to what is it? Uh, you're eligible
(08:47):
for subsidies on a sliding scale only. Right. What they
do is, obviously, if you make a little bit more money,
if you're closer to that level of the federal poverty level,
you will pay a greater amount of the premium than
if you were just making a hundred five of the
federal pobby level. So in the House Committee, for example,
you get your subsidy, but you will pay Let's say
you were at three fifty, You're gonna people still paying
(09:09):
your income toward the thing, and but then you also
get a subsidy to cover the rest of the premium.
Kind Of like when I go to my shrink and
I say, dude, I make a year and he doesn't
charge me as much as the physician. It comesn't after me. Yeah,
that's actually a really good point, Chuck, that there's a
lot of um, a lot of key points in these
(09:30):
proposals are already in effect in some ways either um
de facto like your your shrink charging you on a
sliding scale, or you know, um mandates about everyone having
to have insurance like that the Massachusetts experiment. Right, So
this is kind of taking a lot of maybe good
ideas and putting them together, a good ideas being a
(09:53):
very political way to put it. Right, what's the Massachusetts
experiment where everyone has to have insurance? I don't think
I knew that? Yeah, wow, Yes, And you know, that's
probably a good thing for you guys to discuss in
the next podcast, because I mean, is the Massachusetts a
success in terms of its health insurance? So, um, where
is everybody going to get this insurance? There's an insurance
(10:14):
marketplace that's being set up, right, Yeah, this is sort
of the new big thing. Um. So the insurance marketplace
is sort of this attempt to have the general public
get their insurance the same way that Congress people do, right,
because essentially, when you become elected to Congress, you are
presented with five plans. Are not not five, that's not
I mean it's not a specific number. But basically you're
(10:35):
offered all these plans that tell you exactly how much
it's going to cost and what benefits are provided. And
it's very easy to use. Yeah, I think plain language
is one of the provisions in at least the House
Bill Transparency Plan language. Yeah, like you have to say
this is what's covered, and this is what's not covered,
and this is what you get for what you pay for. Right. Like,
(10:56):
plain language is a really big part of this. So
if you're trying to fulfill your individual mandate, you will
look at all these plans and say, well, I want
this one because I know it costs this much and
I know that this, this, and this and is covered.
And in both of these bills, every plan that's in
that marketplace will will have a certain set of minimum
benefits that it wills that have to be in there,
(11:19):
and then there will be plans that are better than
that in terms of maybe you want you know, spaw
days covered or something like that you can pay to
get that extra. But let's say you just want to
be able to go get you know, a mammogram under
your health insurance plan. That's probably closer to what's going
to be considered an essential benefit that has to be
in the plan, right and it gets will get into
this obviously latter two. But that's getting a little political
(11:40):
as well, with what can be covered and what's not right. Right,
But let's just for the time being called the minimum benefits,
because what we're what these proposals give the government license
to do, is to define what these minimum standards of
health insurance are, and eventually all health insurance plans, if
you are have an existing one, it will I have
(12:00):
about five years to meet these requirements as well, right,
but it won't change it first. Right now, they have
about a five year window grandfathered in for several years. Right.
And you staid in your article how healthcare reform works that, um,
these basic requirements will keep the marketplace from becoming like
a dumping ground for shoddy policies, right right, You know,
(12:21):
we don't want anyone in the marketplace who already maybe
doesn't have a job or can't afford regular insurance to
just be stuck with sort of um crappy coverage. I mean,
the whole point of this plan, whether you have insurance
or you don't have insurance. And Obama's point of view
is to strength and health insurance for everyone. Right, So obviously,
if you don't have a plan already, you're gonna want
(12:41):
sort of that basic care. But you also want to
make sure that the people who already have insurance are
being protected in the same way, right, right, right? Do
you know what insurance everyone should have? What motion picture
health and welfare? Is it good? It's like it's better
than the army. Did you get Spada? You get massage,
spa days, you get like Manny Petties paid for it. Actually,
because this is the first I've ever heard of spot date,
(13:02):
I think there's a sushi clause. You know, in Germany,
spots are included universal health care. That's wonderful. Um, small businesses,
you were saying that that businesses are going to have
a mandate to provide health insurance. Uh, they're also going
to be allowed to, um, go to this insurance marketplace
to select as well. Right, employers are going to be
(13:25):
subject to a payer play requirement where if you don't
provide health insurance for your employees. You're gonna have to
pay into a fund for all your employees who don't
have health insurance. Now, this would probably be a job
killer if it were to be applied to small businesses.
So small businesses will be exempt from this requirement, right.
I think Obama said small businesses in the US will
be exempted his recent speech, right, So, um, and and
(13:49):
the Senate and the House to find small businesses differently
in their current plan. They might look at how many
employees you have. They might look at your you know,
income per year. I think if you make more than
two dollars a year, you wouldn't be considered a small
business under this exemption. Um. But you know, that's that's
probably gonna be one of the things that's ironed out
and re examine pretty closely in the reconciliation of these
(14:10):
two bills. But um, they would also be eligible to
enter this marketplace and provide insurance to their employees with
the help of subsidies. Okay, And like people, those employers
that decide I'm not doing this, they are going to
have to pay, and that money will be contributed to
the insurance marketplace, right right, So either way, it's provide,
(14:32):
like you said, pay your play. Um. So in this marketplace,
let's all pretend that we're in there right now. Okay, closure, closure,
This is nice. Do you see all these little logos,
like there's Etna's logo, there's Snoopy, say hi to Snoopy.
Um do you see this one? What is that? Like
a screaming eagle with a bandaged head with the us
of a that is new or it would be if
(14:55):
this thing gets past. That's the public option, right, yes,
the public option has in one of the more controversial
parts of all these bills. Correct, yes, okay, so it's controversial.
What's what's what does it entail? What's going on here?
So the point of having this marketplace is one way
that Obama thinks we can keep our insurance companies honest
and competitive, because if you're competing against people, then you
(15:18):
will provide good service for good value. Makes sense? Makes sense? Now,
Obama thinks that one way to ensure that this happens
is to also introduce this public health insurance option. Um.
So that it's a government run option that will have
lower rates probably. Um Now, obviously right there, you're going
to have some contention about what the rate should be
because kind of private ensure compete with UM. You know,
(15:41):
a public ensure will have sort of the government um
stamp of approval that might make it impervious to any
sort of attack or disaster. UM. But the thinking is
is that, you know, similar to the way we provide
Medicare and Medicaid for certain people, that we would have
this option for people to UM get health insurance at
(16:01):
a pretty pretty affordable cost set by the government. But
we don't know what cost that would be yet, So
you really can't get into an argument about whether insurers
could compete. Are the financials not really set on this yet. No,
And you know, if you've been following the news, this
is probably the thing you see that, oh it's been dropped.
Oh it hasn't been dropped. We might have a co
op instead. UM. It's really something to watch. That was
(16:21):
something that in the speech Obama said he was willing
to negotiate on, so it's still to come. He has
said so far though, that it wouldn't be just another Medicare.
We wouldn't just have Medicare rates which are about lower
than most insurance rates, because that isn't fair to private insurers.
It would have to be UM similar to private insurance likely,
and it would also UM have to fund itself through premiums.
(16:44):
It would be self sustaining because I mean, if you've
got federal or injections of federal cash, you're not really
competing with anything, right, Yeah, And I think Obama said
that he wouldn't back anything to added to the deficit.
Is that correct? So that's the public option. Everybody back
away slowly. Well, you know one thing that might be
interesting to talk about is we always hear Obamas saying
(17:06):
that if you like your health insurance, you can keep it,
right right, If you like your health insurance, you can
keep it. The thing is it is Clinton saying no,
if you like your health insurance, you can keep it
there much better. But the thing is, let's think about
the people who don't like their health insurance and might
be thinking, oh, man, a public option sounds pretty good.
That's an excellent point because you never hear that mentioned. Um,
(17:28):
you know, you can't really opt out of your employer
based health insurance because you don't like it and just
get into a cheaper public option. You can't. Why not?
Because because you have the option through work so you're
immediately discounted. Because yes, but if right now the insurance
marketplace will only be open to those people who don't
have insurance through their employer at first, but I mean,
(17:50):
I don't if we're still five years away from a marketplace.
I think we'd be at least five years after that
away from allowing everyone in. So right now, you have
to stick with your employer based health insurance unless your
employer drops. You know, that's something that people are saying.
You know, if there's some cheap plan and employers figure
it's cheaper just to pay the fee than to cover
their employees, that could happen. But um, the thinking is
(18:13):
is that if if everyone has to know sort of
what their insurance cost versus what it costs in the marketplace,
then that competitive spirit might keep insurance fair and honest.
This canna get really tricky, so well, let's talk about
Let's talk some more about how insurance companies are going
to be effected. Just in addition to this possible competition
from a public option, there are some mandates in this legislation,
(18:37):
for example, that says you can't discriminate based on pre
existing conditions any longer. Obama likes to use that. Um.
The example of that woman who's denied that what wasn't
she was going to have a mastectomy, and then they
found out she didn't declare a case of acne from
her childhood, and thus they postponed the treatment on her
breast cancer grow right and and under under this proposal,
(19:00):
there's no more pre existing condition to niles and right
or and it, and it doesn't cost you more. You
can't be charged a higher premium because you have a
pre existing because they're gonna do with that completely for
people who have insurance and for people who are trying
to get insurance, like that's going man under this plan.
So if you smoke tin packs of cigarettes today and
you walk in there with an oxygen tank, they have
to cover you, Yeah, for the same amount of money. Yeah,
(19:22):
as far as I know about the country, that's awesome. UM.
There's also a mandate that, um, there can no longer
be caps on spending my insurance companies. And actually not
only that, the the the it's back on the consumer.
There's now a cap on how much a consumer can
pay out a pocket every year for their own healthcare.
(19:47):
Right because a lot of bankruptcies are driven by medical costs.
We're thinking that you know, if if there's if you
can't go broke because you're sick, then we will decrease
the number of bankruptcies. Damage right, the damage we might
be doing to our economy that way interesting definitely. Um
there then, so that's insurance companies. That's also again we're
just kind of hitting the high points here. We're talking about,
(20:08):
as Molly said, sixteen hundred pages of legislation as the
stands now. UM, So let's talk about UM Medicaid and Medicare.
Chuck mentioned this earlier about UM kind of cutting waste
in the Medicaid and Medicare system. Uh, and that actually,
let's talk about how much is this going to cost?
The OMB suggests it's going to be about a trillion
(20:29):
dollars over ten years for these these proposals for Obama's plan.
Obama is saying that two thirds of this can be
paid for right off the bat, just by cutting waste
with Medicare and Medicaid. What is he talking about, Well,
there's an estimate that about of the services that are
performed medically in this country are unnecessary. And that's overall,
(20:50):
that's not just Medicare, Medicaid adding a third limb, yeah, potentially,
or getting rid of that third limb that you wanted
to keep. Yeah, you know, either waste buddy, just blew
my mind. But to get rid of those costs right away, um,
and to also cut out some administrative costs all this
paper shuffling that a lot of people do, could um,
(21:13):
could help as well. The big the big name you
always hear in association to this is Medicare advantage, which
is a private program within the public program, which you know,
I don't know if that makes much sense, but it's
probably indicative of power whole health insurance system works. Um.
That's a hundand seventy billion a year that goes to
insurance companies for the exact same service that's provided to
(21:34):
people by the government. So they would cauld that and
shuffle them over to Medicare standard. No more advantage for you, right, right,
because it pays four more than regular Medicare for the
same exact same service. The people who would have just
stayed with regular Medicare, we could have saved a hundred
seventy billion year, right, But that's just that hundred seventy billion.
He's saying you can save another six billion just from
(21:56):
cutting waste, right. Uh, And I think he's all so
talking about bundling services that leads to bundling services, correct,
And that's a big deal. It's started his testing ground
for this because, as I said, this thirty percent waste
is endemic in the system. It's not just Medicare. It's
not just the government that can't run a program. It's
it's everyone who can't run a program. But they've done
(22:16):
these studies, um where they compare areas that spend a
lot of money on Medicare to just a little bit
of money on Medicare, and the people who have less
spent on them live longer and are healthier. The people
who have more doctors visits, more time in the hospital
are the ones that are more likely to die from
the exact same ailement that these lower spending people had
over here. So what can we do to emulate those
(22:38):
lower spending areas? Um, that's where we get this idea
of bundling that Josh was talking about. So if a
person goes into the hospital with a heart attack, instead
of you know, this doctor seeing him, then this doctor
see him, then this doctor see m and everyone charging
separately for all their tests for service be for service.
Then you know, you go into the hospital as a
Medicare patient and you are in there for your heart attack,
(23:01):
and all the treatment that you get relates to your
heart attack. Your doctors need to work together to figure
out the best course of treatment. And so it's it's
more a matter of how you kind of pay your
cable bill if you have your cable, your internet in
your phone altogether, Um, you just bundling. You just pay
one bill to the hospital for all that as opposed
to paying for your cardiogram and you know the m
(23:22):
R I scan they decides you need it and blah
blah blah. That kind of makes sense well, but it
also leads to another kind of um radical suggestion that's
found in these proposals is establishing what kind of care
you should follow when somebody comes into UH for a
heart attack, right, because how do you know how much
(23:45):
it should cost unless you know what procedures you have
to follow and how much those procedures should cost. So
to do that, they're setting up a panel that reviews
the effectiveness of methods of treatment and says this doesn't work,
this is success rate, So we're gonna go with this one, right, Well,
I don't think they're going to throw out this one.
(24:06):
I mean they obviously they don't want treatments that don't work.
But I think it's more And obviously I think we're
going to talk about rational healthcare in the next podcast.
But this is where people start to this idea. But
let's say that there are three treatments for a heart attack.
This one works, the first one works of population, the
second works for five percent of the population, and the
other one also works for five percent of population. Rather
(24:28):
than doing all three, do you have a greater chance
of starting with this one? Right? And if that doesn't work,
then go to one. It's the population, Yeah, be tearing
up sort of what works. But I think Obama has
been very clear that if your doctor thinks that he
wants to still go with number three that has the
five percent effectiveness rate, he can do that. Okay, you
(24:50):
should be on that panel. Are you on the pannel? Okay, guys,
we already talked about some forms of paying for this
by cutting waste and getting rid of Medicare plus advantage advantage, Um,
what are some other ideas for paying for this? Because
you know, Obama said he wasn't gonna sign anything that
edit is sent to the deficit. And you know, one
complication with him just saying I'm going to eliminate fraud
(25:11):
and waste is those aren't scoreable measures according to the
Congressional Budget Office. You know, it's got to be something
for them to say, yes, it provides you know, twenty
million dollars. It's gonna be something the federal government can
kind of you know, point to as opposed to this
nebulous cutting cost thing. Um. Obama has been pretty clear
that he would like to tax people who make more
than two dollars a year change their tax deductions, and
(25:33):
that I believe is what the House Plan calls for. Um.
There's also the idea that we would tax the employer
plans that are currently on tax the employer tax um
exemption to get rid of that all together. Yeah, they
wouldn't be exempt anymore. And there's the thinking, you know,
this was something that Kine brought up in the presidential
campaign that Obama poo pooed, which is why it may
(25:54):
not come back right away. Um. You know, there's the
idea of people shouldn't have to tax. Why is essentially
free for them now. But I mean, on the one hand,
it would be kind of an invisible tax because as
we say, you already don't know how much your health
insurance costs um. But also if it's if it's not
just this free perk that employers can hand out, they
(26:15):
might be more likely to increase your wages, is one thought.
I mean, right now, a lot of employers can say,
this is your salary, but look at this great health
care plan you don't have to pay for. Whereas when
that becomes an actual cost to a person, then you
would weigh that a little bit in more in relation
to the money in your pocket, so we can all
look forward to raises it's cost. I mean, that's just
(26:36):
one thought behind behind this idea. But other people are like, no,
that's a tax. I don't want it. So then another
proposal is to flip that tax and tax the insurance
companies that offer the plans because they're obviously putting a
pretty penny in their pocket for these tax accept plans,
and then you know, still kind of rub some people
a wrong ways. The proposal has been floated just to
tax um the mega plans, the ones that to have
(26:59):
spa days. Yeah, kind of like there's the CEO of
Golden Sax. He's a planet's forty dollars a year, You're kidding,
And yeah, you always hear him brought up is like,
you know, does he really need this tax free health
insurance plans? Golman texts beating in here. We mentioned them
all the time. They bear the brunt. Ye. So there's
the thought that maybe we would at tax either people
(27:19):
who have those kind of plans or the insurance companies
that offer those kinds of plans. Um. But you know,
there's this Time magazine article that found that actually a
lot of state employees have really good plans too. But
I think that what people are trying to get at
is that there's money in these employer tax exemptions that
we're going to have to look at it. It is
a possible source of funding. So that's the high points.
(27:42):
There's some other ones like oh, I don't know, um
Medicaid paying for family planning services right at the donut hole,
which we sever the provision where any child born in
the United States is automatically covered if they don't have insurance.
Stuff like that, Uh, we're not going to cover any
(28:03):
of the raucousness surrounding those and this one. As a
matter of fact, I think we've reached the end of
this one. Guys, Um, Molly, thank you very much for
coming in. We'll see you in the next one, and
you'll want to tune in for part three, especially if
you wake up in the middle of the night with
your keep clenched shouting you lie, you lie. That's going
to be about midst truths and lies concerning healthcare reform
(28:28):
and Obama's proposal, and they'll be criticism from the right
and the left on the on the plane of that one. Right, Chuck,
what about the center? The center is just staying mute
and yeah, okay, So stay tuned for that. That's part
three in our special four part Healthcare Suite series, brought
to you by how stuff works dot com. For more
(28:52):
on this and thousands of other topics, is it how
stuff works dot Com. Want more how stuff Works, check
out our blogs on the house stuff Works to come
home page, brought to you by the reinvented two thousand
twelve camera. It's ready, are you
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to Stuff you Should Know
from House Stuff Works dot Com. Hey, and welcome to
the podcast. I'm Josh Clark. With me, as always is
Charles W. Chuck Bryant, Doctor. And with Charles W. Chuck
(00:23):
Bryant is Molly Edmonds of Stuff Mom Never Told You Fame,
one of our sister podcasts, and Molly has also been
doing more research into healthcare reform than me, Chuck and
Ram Emanuel Combine. So we're glad to have you here. Molly.
I think I could take down but you could. He's
a bulldog. Yeah, but I've seen you. Have you seen
(00:44):
her leg wrestle? No, but startling. I've been behind me
in front of her sights. Sure, I'm not a pleasant day. Yeah,
I have to chuck it, which is why we're scared
of Molly. But we're glad she's here, right Maum, I hope,
So I hope you're glad I'm here. We're also glad
you're here because, like the Necronomicon podcast, we intend to
use you as a shield. Just to get that out
(01:04):
of the way, let's talk about healthcare form. All right.
I want to also say that we are not going
to be discussing any of the politics in this one.
This is part two, you lie. Except for that part. Um,
We're not going to be discussing any of the politics.
What we're gonna do is simply present, uh, the proposals
that are in play right now. And then Part three
(01:26):
is going to be criticisms, pros cons maybe other ideas
for fixing the health care system. And then part four
is what I'm excited about, myths and truths. Yes, yeah,
we're going to be talking about just outright lies, things
that are kind of on the fence, and things that
actually are true but are discussing. Um, so let's talk
about Obama's proposal. Is it even Obama's proposal? You know,
(01:50):
Obama has made this a priority in his presidency, but
big time, but he has not come down from on
high with a massive plan for us all to reactive.
You know who did do that? The Clintons. The Clintons did,
that's right, and Moses Moses. Uh, that was on the
third tablet right yea, Um there tablet was dropped. Yeah,
the Clintons actually wrote legislation and we're peddling it around
(02:13):
Capitol Hill in the nineties and it didn't work. That
that plan didn't work, So clearly Obama learned from his predecessors, right, right,
So Obama has laid out eight principles. This is what
he did early on. I think this has gotten lost
in all the hubbu but he came out with a
principles UM and then left it to Congress as five
companies from Congress to create plans. And then in the
(02:33):
week we're recording this, he came out and made this
mega speech that's come up with you know, all this attention.
So now the week we're recording this, Obama has come
back out with the speech and made it made it
look like it's a little bit more of his plan,
tried to wrestle control away from you know, the media spin.
He's saying what he wants in a plan, what he
doesn't want, what he's open to compromise about. UM. But
let's start in campaign mode. He was he's definitely back
(02:54):
from vacation. Yeah, yeah, So should we talk about his
A proposals. Let's let's say, I mean, what we're talking
about A thousand pages pages are so of legislation right now, right,
we got we got two bills on the table from
four committees. And when he says there are four committees
who have come up with bills, one of the bills
is a try committee bill, so that's where that comes from.
(03:16):
Three committees came up with one bill um from the
House HR three two zero zero, and then the Senate
has a bill. I have to point this out. I'm sorry,
Molly didn't even look at her notes to writt along
that bill number. I'm just gonna excuse myself to dream
about HR three two zero zero. I bet you do.
At this point she didn't look at her notes again.
And you know what I have anxiety dreams about is
(03:37):
the upcoming Senate Finance Committee bills. So by the time
people hear this, that bill might become might be out.
It's the trifecta. It's the one everyone's waiting for because
it's a bipartisan committee. Um being the Senate Finance Committee,
they have to say how they're going to pay for it,
which the other bills were not as on the hook for.
So you know that's the one everyone's waiting on. Beta breath. Yeah. Actually,
I saw today breaking news was that the chairman of
(03:59):
that commit. The Democrat Max Bacchus basically said, we're pushing
through with this very soon, and it doesn't matter if
I have Republican sport or not. We're gonna push it
through and we'll have it for a review by the
twenty one September. So wow, that's the latest word. Yeah,
I have dreams about Max. Now do you really that's nice?
So um, anyway, that's a personal note. So Obama says,
(04:23):
here the here are the eight things that he saw
that he wanted in the plan. Okay, he wanted to
assure affordable, quality health coverage for all Americans. You guys
want to I'll do one, yeah, yeah, I'll go next.
He wants to remove obstacles to coverage for people with
pre existing conditions. He wants to invest in prevention and wellness.
He wants to maintain coverage in the event of job
(04:44):
loss or change. He wants to kill your grandparents. Oh,
I'm sorry. Now. He wants to improve quality care and
patient safety. Right uh? And uh, let's see. He wants
to guarantee choice of doctors and coverage plans, right yes,
and safeguard families from bankruptcies related to health expenses. I
think that's seven. He wants to the final one he
(05:04):
wants to shrink long term cost increases in healthcare for
businesses and the government. So those are pretty um broad principles.
I think you'd be hard pressed to find someone who
would disagree with these principles just it's got and theory.
But then the Congress had the hard job of making
them into bills. So we have that thousand pages of
(05:26):
legislation as it stands right now, not including the Senate
Finance committment, without the Senate Finance correct in Brail, which
was she taught herself, had translated and then read in.
So so let's talk about how Congress did take these
eight principles and turn them into healthcare. As you were saying, um,
(05:47):
let's start with individuals. One of the big things is
that everyone, Both of both of the proposals that are
out right now say that everyone has to have health insurance. Yeah,
it's an individual mandate, and you know it's it's sort
of borrowing an idea from car insurance. If we've all
got to carry car insurance, then you know, what's what's
health insurance in addition to that? Right, So if you
don't have health insurance. You don't have to stormtroopers aren't
(06:11):
going to come to your house and beat your kids
in front of you. But the tax man, well right, yeah,
because I think the Senate bill says you pay seven
fifty dollars a year in tax penalties for not having insurance.
And then the house plan is I think up to
two point five percent of your adjusted income. Yeah, but
(06:32):
no more than the lowest price plan. Right, Like, they're
not going to charge you more than you would have
to pay your health insurance, right, I mean, if you
if you can pay the premium and taxes, essentially you
could just pay the premium. Well that's the way I
took it is we're going to get some money, so
you might as well, hint, hint, to go spending on
healthcare ether than funding the I R S. Right, But
now most people already have health insurance. The majority people
(06:54):
get it from their employers, and so that's pretty easy
to to meet that requirement, right, But we don't want
the employer to just chicken out, So employers have a
mandate as well, exactly. So now we have to mandates
employer and individual. And I heard actually the Senate Finance
is not going to have an employee an employer mandate,
and that's why businesses are probably gonna be a little
more favorable that I said. You know, that's one of
(07:16):
the theories that that's what killed Clinton's bills. You know,
it's a job killer, right, So um, but that that
sounds kind of political. So let's just back off and
say you're an employer, you're in an individual, You've got
this mandate. What if you can't afford it? Well, there's subsidies. Yes, Well,
not only subsidies. I mean, if you are going to
mandate that everybody has to have health insurance, you have
to make exemptions for certain people. Um, but you also
(07:40):
we already have Medicaid Medicare, so that covers automatically a
certain percentage of Americans. But they're also expanding Medicaid, right,
I think two power Yeah, that is the current Senate
plan would be a hundred about the federal power level,
and the House would do a hundred of the federal
powery level. Right. And they're also planning on kind of
cleaning house in those two systems, right and making them
(08:03):
more efficient and cheaper. Yes, hopefully. Yeah, Well we'll get
to that when we start talking about how this is
going to be paid for? UM. But let's talk about
subsidies for individuals. UM. Let's say that, Oh, I don't know,
I make three hundred and fifty percent income above the
federal poverty level. Right, Well, I know they're to dream.
(08:27):
Will will I be eligible for subsidies? Yes? Yes, Okay,
So I think it goes from Uh, let's say if
we're going with a hundred and fifty percent above poverty level. Uh.
From that to poverty level you're covered by medicaid. From
a hundred up to what is it? Uh, you're eligible
(08:47):
for subsidies on a sliding scale only. Right. What they
do is, obviously, if you make a little bit more money,
if you're closer to that level of the federal poverty level,
you will pay a greater amount of the premium than
if you were just making a hundred five of the
federal pobby level. So in the House Committee, for example,
you get your subsidy, but you will pay Let's say
you were at three fifty, You're gonna people still paying
(09:09):
your income toward the thing, and but then you also
get a subsidy to cover the rest of the premium.
Kind Of like when I go to my shrink and
I say, dude, I make a year and he doesn't
charge me as much as the physician. It comesn't after me. Yeah,
that's actually a really good point, Chuck, that there's a
lot of um, a lot of key points in these
(09:30):
proposals are already in effect in some ways either um
de facto like your your shrink charging you on a
sliding scale, or you know, um mandates about everyone having
to have insurance like that the Massachusetts experiment. Right, So
this is kind of taking a lot of maybe good
ideas and putting them together, a good ideas being a
(09:53):
very political way to put it. Right, what's the Massachusetts
experiment where everyone has to have insurance? I don't think
I knew that? Yeah, wow, Yes, And you know, that's
probably a good thing for you guys to discuss in
the next podcast, because I mean, is the Massachusetts a
success in terms of its health insurance? So, um, where
is everybody going to get this insurance? There's an insurance
(10:14):
marketplace that's being set up, right, Yeah, this is sort
of the new big thing. Um. So the insurance marketplace
is sort of this attempt to have the general public
get their insurance the same way that Congress people do, right,
because essentially, when you become elected to Congress, you are
presented with five plans. Are not not five, that's not
I mean it's not a specific number. But basically you're
(10:35):
offered all these plans that tell you exactly how much
it's going to cost and what benefits are provided. And
it's very easy to use. Yeah, I think plain language
is one of the provisions in at least the House
Bill Transparency Plan language. Yeah, like you have to say
this is what's covered, and this is what's not covered,
and this is what you get for what you pay for. Right. Like,
(10:56):
plain language is a really big part of this. So
if you're trying to fulfill your individual mandate, you will
look at all these plans and say, well, I want
this one because I know it costs this much and
I know that this, this, and this and is covered.
And in both of these bills, every plan that's in
that marketplace will will have a certain set of minimum
benefits that it wills that have to be in there,
(11:19):
and then there will be plans that are better than
that in terms of maybe you want you know, spaw
days covered or something like that you can pay to
get that extra. But let's say you just want to
be able to go get you know, a mammogram under
your health insurance plan. That's probably closer to what's going
to be considered an essential benefit that has to be
in the plan, right and it gets will get into
this obviously latter two. But that's getting a little political
(11:40):
as well, with what can be covered and what's not right. Right,
But let's just for the time being called the minimum benefits,
because what we're what these proposals give the government license
to do, is to define what these minimum standards of
health insurance are, and eventually all health insurance plans, if
you are have an existing one, it will I have
(12:00):
about five years to meet these requirements as well, right,
but it won't change it first. Right now, they have
about a five year window grandfathered in for several years. Right.
And you staid in your article how healthcare reform works that, um,
these basic requirements will keep the marketplace from becoming like
a dumping ground for shoddy policies, right right, You know,
(12:21):
we don't want anyone in the marketplace who already maybe
doesn't have a job or can't afford regular insurance to
just be stuck with sort of um crappy coverage. I mean,
the whole point of this plan, whether you have insurance
or you don't have insurance. And Obama's point of view
is to strength and health insurance for everyone. Right, So obviously,
if you don't have a plan already, you're gonna want
(12:41):
sort of that basic care. But you also want to
make sure that the people who already have insurance are
being protected in the same way, right, right, right? Do
you know what insurance everyone should have? What motion picture
health and welfare? Is it good? It's like it's better
than the army. Did you get Spada? You get massage,
spa days, you get like Manny Petties paid for it. Actually,
because this is the first I've ever heard of spot date,
(13:02):
I think there's a sushi clause. You know, in Germany,
spots are included universal health care. That's wonderful. Um, small businesses,
you were saying that that businesses are going to have
a mandate to provide health insurance. Uh, they're also going
to be allowed to, um, go to this insurance marketplace
to select as well. Right, employers are going to be
(13:25):
subject to a payer play requirement where if you don't
provide health insurance for your employees. You're gonna have to
pay into a fund for all your employees who don't
have health insurance. Now, this would probably be a job
killer if it were to be applied to small businesses.
So small businesses will be exempt from this requirement, right.
I think Obama said small businesses in the US will
be exempted his recent speech, right, So, um, and and
(13:49):
the Senate and the House to find small businesses differently
in their current plan. They might look at how many
employees you have. They might look at your you know,
income per year. I think if you make more than
two dollars a year, you wouldn't be considered a small
business under this exemption. Um. But you know, that's that's
probably gonna be one of the things that's ironed out
and re examine pretty closely in the reconciliation of these
(14:10):
two bills. But um, they would also be eligible to
enter this marketplace and provide insurance to their employees with
the help of subsidies. Okay, And like people, those employers
that decide I'm not doing this, they are going to
have to pay, and that money will be contributed to
the insurance marketplace, right right, So either way, it's provide,
(14:32):
like you said, pay your play. Um. So in this marketplace,
let's all pretend that we're in there right now. Okay, closure, closure,
This is nice. Do you see all these little logos,
like there's Etna's logo, there's Snoopy, say hi to Snoopy.
Um do you see this one? What is that? Like
a screaming eagle with a bandaged head with the us
of a that is new or it would be if
(14:55):
this thing gets past. That's the public option, right, yes,
the public option has in one of the more controversial
parts of all these bills. Correct, yes, okay, so it's controversial.
What's what's what does it entail? What's going on here?
So the point of having this marketplace is one way
that Obama thinks we can keep our insurance companies honest
and competitive, because if you're competing against people, then you
(15:18):
will provide good service for good value. Makes sense? Makes sense? Now,
Obama thinks that one way to ensure that this happens
is to also introduce this public health insurance option. Um.
So that it's a government run option that will have
lower rates probably. Um Now, obviously right there, you're going
to have some contention about what the rate should be
because kind of private ensure compete with UM. You know,
(15:41):
a public ensure will have sort of the government um
stamp of approval that might make it impervious to any
sort of attack or disaster. UM. But the thinking is
is that, you know, similar to the way we provide
Medicare and Medicaid for certain people, that we would have
this option for people to UM get health insurance at
(16:01):
a pretty pretty affordable cost set by the government. But
we don't know what cost that would be yet, So
you really can't get into an argument about whether insurers
could compete. Are the financials not really set on this yet. No,
And you know, if you've been following the news, this
is probably the thing you see that, oh it's been dropped.
Oh it hasn't been dropped. We might have a co
op instead. UM. It's really something to watch. That was
(16:21):
something that in the speech Obama said he was willing
to negotiate on, so it's still to come. He has
said so far though, that it wouldn't be just another Medicare.
We wouldn't just have Medicare rates which are about lower
than most insurance rates, because that isn't fair to private insurers.
It would have to be UM similar to private insurance likely,
and it would also UM have to fund itself through premiums.
(16:44):
It would be self sustaining because I mean, if you've
got federal or injections of federal cash, you're not really
competing with anything, right, Yeah, And I think Obama said
that he wouldn't back anything to added to the deficit.
Is that correct? So that's the public option. Everybody back
away slowly. Well, you know one thing that might be
interesting to talk about is we always hear Obamas saying
(17:06):
that if you like your health insurance, you can keep it,
right right, If you like your health insurance, you can
keep it. The thing is it is Clinton saying no,
if you like your health insurance, you can keep it
there much better. But the thing is, let's think about
the people who don't like their health insurance and might
be thinking, oh, man, a public option sounds pretty good.
That's an excellent point because you never hear that mentioned. Um,
(17:28):
you know, you can't really opt out of your employer
based health insurance because you don't like it and just
get into a cheaper public option. You can't. Why not?
Because because you have the option through work so you're
immediately discounted. Because yes, but if right now the insurance
marketplace will only be open to those people who don't
have insurance through their employer at first, but I mean,
(17:50):
I don't if we're still five years away from a marketplace.
I think we'd be at least five years after that
away from allowing everyone in. So right now, you have
to stick with your employer based health insurance unless your
employer drops. You know, that's something that people are saying.
You know, if there's some cheap plan and employers figure
it's cheaper just to pay the fee than to cover
their employees, that could happen. But um, the thinking is
(18:13):
is that if if everyone has to know sort of
what their insurance cost versus what it costs in the marketplace,
then that competitive spirit might keep insurance fair and honest.
This canna get really tricky, so well, let's talk about
Let's talk some more about how insurance companies are going
to be effected. Just in addition to this possible competition
from a public option, there are some mandates in this legislation,
(18:37):
for example, that says you can't discriminate based on pre
existing conditions any longer. Obama likes to use that. Um.
The example of that woman who's denied that what wasn't
she was going to have a mastectomy, and then they
found out she didn't declare a case of acne from
her childhood, and thus they postponed the treatment on her
breast cancer grow right and and under under this proposal,
(19:00):
there's no more pre existing condition to niles and right
or and it, and it doesn't cost you more. You
can't be charged a higher premium because you have a
pre existing because they're gonna do with that completely for
people who have insurance and for people who are trying
to get insurance, like that's going man under this plan.
So if you smoke tin packs of cigarettes today and
you walk in there with an oxygen tank, they have
to cover you, Yeah, for the same amount of money. Yeah,
(19:22):
as far as I know about the country, that's awesome. UM.
There's also a mandate that, um, there can no longer
be caps on spending my insurance companies. And actually not
only that, the the the it's back on the consumer.
There's now a cap on how much a consumer can
pay out a pocket every year for their own healthcare.
(19:47):
Right because a lot of bankruptcies are driven by medical costs.
We're thinking that you know, if if there's if you
can't go broke because you're sick, then we will decrease
the number of bankruptcies. Damage right, the damage we might
be doing to our economy that way interesting definitely. Um
there then, so that's insurance companies. That's also again we're
just kind of hitting the high points here. We're talking about,
(20:08):
as Molly said, sixteen hundred pages of legislation as the
stands now. UM, So let's talk about UM Medicaid and Medicare.
Chuck mentioned this earlier about UM kind of cutting waste
in the Medicaid and Medicare system. Uh, and that actually,
let's talk about how much is this going to cost?
The OMB suggests it's going to be about a trillion
(20:29):
dollars over ten years for these these proposals for Obama's plan.
Obama is saying that two thirds of this can be
paid for right off the bat, just by cutting waste
with Medicare and Medicaid. What is he talking about, Well,
there's an estimate that about of the services that are
performed medically in this country are unnecessary. And that's overall,
(20:50):
that's not just Medicare, Medicaid adding a third limb, yeah, potentially,
or getting rid of that third limb that you wanted
to keep. Yeah, you know, either waste buddy, just blew
my mind. But to get rid of those costs right away, um,
and to also cut out some administrative costs all this
paper shuffling that a lot of people do, could um,
(21:13):
could help as well. The big the big name you
always hear in association to this is Medicare advantage, which
is a private program within the public program, which you know,
I don't know if that makes much sense, but it's
probably indicative of power whole health insurance system works. Um.
That's a hundand seventy billion a year that goes to
insurance companies for the exact same service that's provided to
(21:34):
people by the government. So they would cauld that and
shuffle them over to Medicare standard. No more advantage for you, right, right,
because it pays four more than regular Medicare for the
same exact same service. The people who would have just
stayed with regular Medicare, we could have saved a hundred
seventy billion year, right, But that's just that hundred seventy billion.
He's saying you can save another six billion just from
(21:56):
cutting waste, right. Uh, And I think he's all so
talking about bundling services that leads to bundling services, correct,
And that's a big deal. It's started his testing ground
for this because, as I said, this thirty percent waste
is endemic in the system. It's not just Medicare. It's
not just the government that can't run a program. It's
it's everyone who can't run a program. But they've done
(22:16):
these studies, um where they compare areas that spend a
lot of money on Medicare to just a little bit
of money on Medicare, and the people who have less
spent on them live longer and are healthier. The people
who have more doctors visits, more time in the hospital
are the ones that are more likely to die from
the exact same ailement that these lower spending people had
over here. So what can we do to emulate those
(22:38):
lower spending areas? Um, that's where we get this idea
of bundling that Josh was talking about. So if a
person goes into the hospital with a heart attack, instead
of you know, this doctor seeing him, then this doctor
see him, then this doctor see m and everyone charging
separately for all their tests for service be for service.
Then you know, you go into the hospital as a
Medicare patient and you are in there for your heart attack,
(23:01):
and all the treatment that you get relates to your
heart attack. Your doctors need to work together to figure
out the best course of treatment. And so it's it's
more a matter of how you kind of pay your
cable bill if you have your cable, your internet in
your phone altogether, Um, you just bundling. You just pay
one bill to the hospital for all that as opposed
to paying for your cardiogram and you know the m
(23:22):
R I scan they decides you need it and blah
blah blah. That kind of makes sense well, but it
also leads to another kind of um radical suggestion that's
found in these proposals is establishing what kind of care
you should follow when somebody comes into UH for a
heart attack, right, because how do you know how much
(23:45):
it should cost unless you know what procedures you have
to follow and how much those procedures should cost. So
to do that, they're setting up a panel that reviews
the effectiveness of methods of treatment and says this doesn't work,
this is success rate, So we're gonna go with this one, right, Well,
I don't think they're going to throw out this one.
(24:06):
I mean they obviously they don't want treatments that don't work.
But I think it's more And obviously I think we're
going to talk about rational healthcare in the next podcast.
But this is where people start to this idea. But
let's say that there are three treatments for a heart attack.
This one works, the first one works of population, the
second works for five percent of the population, and the
other one also works for five percent of population. Rather
(24:28):
than doing all three, do you have a greater chance
of starting with this one? Right? And if that doesn't work,
then go to one. It's the population, Yeah, be tearing
up sort of what works. But I think Obama has
been very clear that if your doctor thinks that he
wants to still go with number three that has the
five percent effectiveness rate, he can do that. Okay, you
(24:50):
should be on that panel. Are you on the pannel? Okay, guys,
we already talked about some forms of paying for this
by cutting waste and getting rid of Medicare plus advantage advantage, Um,
what are some other ideas for paying for this? Because
you know, Obama said he wasn't gonna sign anything that
edit is sent to the deficit. And you know, one
complication with him just saying I'm going to eliminate fraud
(25:11):
and waste is those aren't scoreable measures according to the
Congressional Budget Office. You know, it's got to be something
for them to say, yes, it provides you know, twenty
million dollars. It's gonna be something the federal government can
kind of you know, point to as opposed to this
nebulous cutting cost thing. Um. Obama has been pretty clear
that he would like to tax people who make more
than two dollars a year change their tax deductions, and
(25:33):
that I believe is what the House Plan calls for. Um.
There's also the idea that we would tax the employer
plans that are currently on tax the employer tax um
exemption to get rid of that all together. Yeah, they
wouldn't be exempt anymore. And there's the thinking, you know,
this was something that Kine brought up in the presidential
campaign that Obama poo pooed, which is why it may
(25:54):
not come back right away. Um. You know, there's the
idea of people shouldn't have to tax. Why is essentially
free for them now. But I mean, on the one hand,
it would be kind of an invisible tax because as
we say, you already don't know how much your health
insurance costs um. But also if it's if it's not
just this free perk that employers can hand out, they
(26:15):
might be more likely to increase your wages, is one thought.
I mean, right now, a lot of employers can say,
this is your salary, but look at this great health
care plan you don't have to pay for. Whereas when
that becomes an actual cost to a person, then you
would weigh that a little bit in more in relation
to the money in your pocket, so we can all
look forward to raises it's cost. I mean, that's just
(26:36):
one thought behind behind this idea. But other people are like, no,
that's a tax. I don't want it. So then another
proposal is to flip that tax and tax the insurance
companies that offer the plans because they're obviously putting a
pretty penny in their pocket for these tax accept plans,
and then you know, still kind of rub some people
a wrong ways. The proposal has been floated just to
tax um the mega plans, the ones that to have
(26:59):
spa days. Yeah, kind of like there's the CEO of
Golden Sax. He's a planet's forty dollars a year, You're kidding,
And yeah, you always hear him brought up is like,
you know, does he really need this tax free health
insurance plans? Golman texts beating in here. We mentioned them
all the time. They bear the brunt. Ye. So there's
the thought that maybe we would at tax either people
(27:19):
who have those kind of plans or the insurance companies
that offer those kinds of plans. Um. But you know,
there's this Time magazine article that found that actually a
lot of state employees have really good plans too. But
I think that what people are trying to get at
is that there's money in these employer tax exemptions that
we're going to have to look at it. It is
a possible source of funding. So that's the high points.
(27:42):
There's some other ones like oh, I don't know, um
Medicaid paying for family planning services right at the donut hole,
which we sever the provision where any child born in
the United States is automatically covered if they don't have insurance.
Stuff like that, Uh, we're not going to cover any
(28:03):
of the raucousness surrounding those and this one. As a
matter of fact, I think we've reached the end of
this one. Guys, Um, Molly, thank you very much for
coming in. We'll see you in the next one, and
you'll want to tune in for part three, especially if
you wake up in the middle of the night with
your keep clenched shouting you lie, you lie. That's going
to be about midst truths and lies concerning healthcare reform
(28:28):
and Obama's proposal, and they'll be criticism from the right
and the left on the on the plane of that one. Right, Chuck,
what about the center? The center is just staying mute
and yeah, okay, So stay tuned for that. That's part
three in our special four part Healthcare Suite series, brought
to you by how stuff works dot com. For more
(28:52):
on this and thousands of other topics, is it how
stuff works dot Com. Want more how stuff Works, check
out our blogs on the house stuff Works to come
home page, brought to you by the reinvented two thousand
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