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Old 08-13-2009, 08:44 PM
motordavid's Avatar
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Current Federal Health Care Benefits...

The Basics of the FEHBP, which all of our elected geniuses and,
all of the giant group of Fed employees, fall under:

Key Features of the FEHBP
The FEHBP offers a wide range of plans with a variety of benefits. Although there are some adverse selection pressures in the system, these are surprisingly small considering the fact that the FEHBP by law is community rated (the same premium must be charged to everyone without regard to age and other risk factors) and that there are wide plan variations. The key features are:
1. A stable premium structure
Premiums and other enrollee costs have been kept well in check. For much of the FEHBP's recent history, premiums have risen no faster than those in the private sector; in many years, they have fallen below those of private plans and Medicare. As the Congressional Research Service (CRS) noted in 1989, the "rise in private sector premiums in the 1980s exceeds FEHBP's."3 Later studies have shown similar cost control. In fact, premiums have been quite flat. The average FEHBP plan premium rose 0.4 percent in 1996 and 2.4 percent in 1997. In 1995, the premium actually fell 3.3 percent.

2. Negotiated premiums in a competitive market
Unlike Medicare, the FEHBP does not pay fee-for-service providers according to a fee schedule and does not pay managed care plans according to a rigid formula. Instead, it invites plans to submit a package of benefits at a proposed premium, and then negotiates prices and benefits plan by plan. Each approved plan, along with competitors, is offered to federal workers and retirees. The FEHBP pays a percentage of the negotiated premium, up to a dollar limit.

3. Many competing private plans
The FEHBP plans include several offered by employee cooperatives and major unions. One reason these plans are popular is that they are organized by groups that actually represent enrollees rather than by health maintenance organizations (HMOs) or insurance companies that often perceive the enrollee as a passive buyer in an individual market. This feature could be particularly attractive in a reformed Medicare system. One might imagine, for example, plans offered through the American Association of Retired Persons, major unions, or even churches.

4. Information dissemination
The FEHBP has a comprehensive system of information distribution, complemented by a sophisticated system of information provided through consumer organizations, to help beneficiaries make choices. This could be a model for Medicare, which has been roundly criticized by the U.S. General Accounting Office (GAO) for its relatively poor information system.4

5. Negotiated service contracts
Negotiations on premiums and benefits are held between the Office of Personnel Management (OPM), which runs the FEHBP, and individual plans. For HMO and point-of-service (POS) plans, the OPM typically starts its negotiations based on the local market for these plans; it does not, as in the case of Medicare, apply a formula based on the local fee-for service market. In the case of fee-for-service and preferred provider organization (PPO) plans, the OPM negotiates a fixed profit per subscriber, usually between 0.5 percent and 0.75 percent of premium. Thus, plans make money through negotiated service contracts rather than traditional profits. Although these plans have to accept market risk, they must lodge revenue surpluses in special reserve accounts that can enable them to bid more competitively in future years. This variation of the normal market answers many of the concerns voiced against allowing competing private plans in Medicare.

6. Low overhead costs
The FEHBP indicates that a large national program for millions of people, with a wide variety of plans and benefits and careful negotiations between the government and the plans, can be run with a fraction of the staff now running Medicare. As Reischauer notes, the OPM "accomplished the task [of running the FEHBP] in 1996 with a staff of fewer than 150 full-time equivalent employees and a modest administrative budget of around $20 million."5

7. Less regulatory control
Those who choose plans in the FEHBP are not locked into a comprehensive government-standardized benefits package. There are no premium caps on private insurance plans. There is no Department of Defense-style system of competitive bidding to determine which private plans can or cannot compete for employees' dollars. There are no government boards or panels setting rigid standards for the quality of medical care or specifying the value of a doctor's labor in the delivery of medical services. Private insurance companies, competing for each consumer's dollars, bear the lion's share of administrative costs, and the role of government bureaucracy and regulation is comparatively small.

* * * * *

But, Congress, the Senate and select "others" have no
waiting period and the "gov't"/we as taxpayers, pay 75%
of their "premiums".

More Health Care Perks for Congress

And the Congressional perks don’t stop with the FEHBP. According to the article “Health care as good as Congress gets,” by John Barry, a staff writer for the St. Petersburg Times, “Members of Congress have their own pharmacy, right in the Capitol. They also have a team of doctors, technicians and nurses standing by in case something busts in a filibuster. They can get a physical exam, an X-ray or an electrocardiogram, without leaving work.”
Although members pay extra for these services - Representatives pay about $300 per month, and Senators about $600 - taxpayers end up kicking in another $2 million. That’s $2 million not being spent on those who need it.
House and Senate’s Health Care Legacy

Despite the services that members of Congress receive at the taxpayer’s expense, they’ve done little on behalf of those who cannot afford or cannot get health care. The Oakland Tribune article “Congress’ wild health care ride” (January 7, 2008) reports that Congress’ attention is instead focused on the financial well being of pharmaceutical and insurance companies.
To illustrate this point, the article states that, according to the Medicare Reform Act of 2004, Medicare is prohibited from negotiating with pharmaceutical companies for lower prices. However, not only is this negotiating power available to governments in other industrialized countries, it’s also similar to the power granted to the FEHBP, which itself is permitted to negotiate premiums and prices.
It's true that the U.S. Congress is talking up health care reform, but members of the House and Senate - both Republicans and Democrats alike - take millions of dollars in contributions from the health sector, which includes health providers, insurers, and pharmaceutical companies
In the meantime, millions of Americans are receiving inadequate health care, and millions more could lose their health insurance at any time. Those who’ve managed to maintain their insurance have seen their rates go up and their deductibles rise. Many end up medically bankrupt. Yet throughout all this upheaval, one thing has remained steady - the health care coverage afforded members of Congress. If they’ve proven nothing else, they’ve shown taxpayers that they know how to take care of themselves

Read more: http://public-healthcare-issues.suite101.com/article.cfm/health_care_for_the_us_congress#ixzz0O75FdnWA

And, a very good art. from the Oregonian, summing up some
of the points and expanding on others:

Just how good a health plan does Congress have? - Oregonlive.com

Our Mileage May Vary, Considerably... No wonder that Sentimental Ted, the Health Care Reform Figurehead/Genius, wants no part of
the New Deal for he and his fellow senators or, the Congress, or the Fed employees.

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Last edited by motordavid; 08-14-2009 at 07:42 AM.
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Old 08-14-2009, 05:49 AM
X5Flyboy's Avatar
Join Date: Jun 2005
Location: ID, and a world of my own
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thanks MD. A few years ago I asked a Senator from Idaho what he paid for his full coverage healthcare (dental, eye, major medical, etc) $356/month! I don't believe they have any "age" brackets or restricions due to weight or existing health either. Everyone at that townhall meeting agreed they were more than willing to accept what his plan was vs the garbage they presently foist off on us.

IMHO, this is a job better tackled in steps. the first of which is malpractice/tort reform. This can be done without ANY money fron us. Now I don't know what your malpractice insurance had cost, but a friend of my father was a thorasic surgeon. Never had any lawsuits of any kind brought against him in his entire career. He told me the last yea he practiced (a while ago now), he made $600k. Over $300k went to malpractice insurance.

I also understand the vast majority of lawsuits are caused by less than 10% of the doctors. Why is there no effort to get rid of the bad doctors? Or an effort to curb "extortion" lawsuits. Where is the judicial review to evaluate whether the lawsuit has merit? And don't get me started on the padded fees lawyers submit. Some jury awards are down right ridiculous. Tell me which is better..., a lower amount (that meets patient future care) or having the insurance company file bankruptcy and not get anything for years (this is where only the lawyers win). Thi one area of reform would not cost us taxpayers a cent, yet could lower overall healthcare costs. The only ones "losing" would be lawyers.
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Old 08-17-2009, 05:45 PM
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