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Augusta panel weighs in on health care overhaul

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Moving toward health care reform could mean some short-term pain, higher premiums and frustration when an estimated 32 million previously uninsured people crash the system, an expert panel of Augusta hospital CEOs and physician leaders said during a discussion at The Augusta Chronicle.

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Dr. LaToya Jackson examines Willie Bussey, 86, at Belle Terrace Downtown Health Center. The clinic serves Medicare patients, such as Bussey, and those with other plans or no insurance.   Zach Boyden-Holmes/Staff
Zach Boyden-Holmes/Staff
Dr. LaToya Jackson examines Willie Bussey, 86, at Belle Terrace Downtown Health Center. The clinic serves Medicare patients, such as Bussey, and those with other plans or no insurance.

In the long term, though, it could mean greater gains in health for the population through better preventive care and a system that rewards quality over volume, they said.

Although reform often has been miscast as government-run or socialist medicine, future changes could lead to greater consumer information and more competition as more integration takes place among providers.

Even outside the Affordable Care Act passed this year, other reforms pushing electronic medical records and more objective data reporting will have an impact. Though some of the new health care reform law provisions -- such as requiring plans to cover preventive services including mammograms without a co-pay or deductible -- have already gone into effect, others will phase in up to 2014. Many on the panel predicted both short-term and long-term consequences.

For instance, the law allows, beginning in Oct. 1, 2012, for value-based purchasing that requires hospitals to publicly report a lot of new performance data and gives incentives for improving performance.

"In the long run, if this is a successful reform, patients are going to see improved quality as hospitals compete on measurables that they haven't been seeing yet," said Dr. Ricardo Azziz, the president of the Medical College of Georgia and the CEO of MCG Health System. "We are going to basically see better health overall as people have more access to preventive care and the overall health of the population improves.

"But in the short run, obviously they are not going to see that. They are going to see mostly the burden and not the benefit."

In the short term, for instance, premiums might go up, particularly for those with rich benefits. Better consumer information in the future should lead providers to compete in new ways, said C. Shayne George, the CEO of Doctors Hospital.

"I think you are going to have to define the value that you are going to bring," he said. "How do you differentiate yourself from another facility? We're all going to be measured on a lot of the same things. There's going to be a more educated consumer, potentially. So, they can just go to the Web site and compare and make those choices. I'm sure physicians will be a part of that process, too, when physicians come into the system and their piece of the continuum is measured as well."

Measuring success

The new law allows for physicians and hospitals to group together starting in 2012 to form accountable care organizations that would be paid for managing the health of enrolled patients, although the actual details of what those plans will look like has not been defined. Such arrangements could help in putting an emphasis on preventive care, promoting quality of care over volume of visits and changing the way the payment process sometimes drives care, said Dr. Jacqueline Fincher, of McDuffie Medical Associates, and the governor-elect of the Georgia chapter of the American College of Physicians.

"Even just a 10-year time frame could make a huge difference, because then physicians are not being paid just to move people through and work on a volume basis, they're actually being measured in terms of quality, of how well you've taken care of that patient as measured and benchmarked against your peers," she said.

It might be that hospitals will directly employ many of their physicians, as some already are starting to do, said Dr. Phillip Kennedy, the CEO of Center for Primary Care and the president of the Primary Care Association LLC.

"I think we are going to continue to see employment of physicians at a rate that we haven't seen probably in 15 to 20 years. You're already seeing it now," he said. New physicians are seeking employment directly with hospitals because of the uncertainty, which also has made some established practices more leery of adding partners, Kennedy said.

Even with new physician-hospital arrangements, the influx of new patients could change the way care is accessed, said Jim Davis, the CEO of University Hospital.

"Patients, when they walk in, may not see a doctor," he said. "They may see a dietitian, they may see a nurse practitioner or a (physician assistant)."

Hospitals also will be held accountable for ensuring good outcomes, such as making sure a patient is not readmitted within a certain amount of time after they leave, Davis said.

Meeting the needs

Republican leaders, flush with victory from Tuesday's election, have vowed to take down the health reform law. Although panelists said there are parts of it they are uncomfortable with, none expect that to happen, at least in the short term. For one thing, taking out parts of the law, such as the mandate to purchase health insurance or for most larger employers to provide it, could trip up providers such as hospitals who agreed to $155 billion in cuts for the promise of near-universal coverage.

"If you blow up the individual mandates and employer mandates, everything just falls apart," said Jim Cruickshank, the CEO of Trinity Hospital of Augusta.

Getting those 30 million or so new people covered could be tricky, he said.

"Where are we going to get the primary care and specialists to take care of this large (population)?" Cruickshank said. "It's like opening the floodgates."

The short-term solution could be federally qualified health centers, which get federal funding to help provide care for low-income and uninsured patients, he said. Belle Terrace Downtown Health Center in Augusta is one of these clinics and provides care for the uninsured in addition to insured patients such as 86-year-old Willie Edward Bussey, who has Medicare. The clinic is "more convenient" than going through a physician office, he said. Bussey was in for an after-hospital checkup after getting admitted twice in October within five days. Those kinds of re-admissions within a certain time frame likely will not be reimbursed in the future.

"They barely pay for it now, really," said Dr. LaToya Jackson, the lead physician for the clinic.

Still, she said she believes health reform will benefit her patients, particularly the uninsured, who have trouble getting some screening tests.

"Colonoscopies are very hard for me to get for people," Jackson said.

Medicare cuts, costs

Even with health care reform begun, the most pressing concern for physicians is a 23 percent cut in Medicare payments looming Dec. 1, followed by a 6.5 percent cut Jan. 1.

The big cuts resulted from Congress continually putting off the cuts over the years, which caused the amount to keep snowballing, said Dr. Phillip Kennedy, the CEO of Center for Primary Care and the president of the Primary Care Association LLC. And that could hit home for Medicare patients immediately, he said.

"That's one of the things patients may ask me. If I have a relationship with you, certainly that's not going to affect us," Kennedy said. "But that is certainly going to affect my ability to take on new Medicare patients. If I'm just seeing people at a loss, then I can't sustain that."

Medicare was already a tough payer to sustain, said Dr. Jacqueline W. Fincher, of McDuffie Medical Associates and the governor-elect of the Georgia chapter of the American College of Physicians.

"We found in our practice if we allowed our practice to get more than 50 percent Medicare, if we went above that threshold, we started going in the red," she said.

-- Tom Corwin, staff writer

BACKGROUND:

President Obama signed into law a landmark health care reform bill March 23 that would bring near-universal coverage to a nation in which tens of millions of people are uninsured. The plan's provisions would be phased in over four years, and it is expected to expand coverage to about 95 percent of eligible Americans.

POLITICAL DEVELOPMENTS:

- An exit poll Tuesday showed 53 percent of voting seniors said the health care law should be repealed.

- On Wednesday, Obama defended the legislation as "the right thing to do."

- On Thursday, congressional Republicans vowed to force repeated votes on the repeal of the overhaul.

WHAT'S NEXT IN WASHINGTON: Obama has ruled out accepting a repeal of the health care measure but said he would be open to reasonable changes in the legislation. He contends most voters would not want to repeal provisions such as eliminating a coverage gap in Medicare prescription drugs for seniors.

-- From wire reports

Timeline of key provisions

The Affordable Care Act would be phased in over time. Republican leaders have vowed to repeal the bill.

2010

- Tax credit for health insurance for small businesses

- $250 Medicare Part D rebate for those who hit the doughnut hole and pay out of pocket

- No co-pays or deductibles for preventive care such as colonoscopies

- Eliminate lifetime limits on coverage

2011

- 50 percent discount on brand-name drugs for Medicare Part D

- Rebates from large employer plans that do not spend 85 percent on actual health care services, 80 percent for individual plans

- Allow states to generally use Medicaid dollars for home and community-based services for the disabled

2012

- Allow for Accountable Care Organizations, potentially groups of physicians and hospitals that manage care of patients to improve quality and reduce hospital admissions

- Begin Value-Based Purchasing, to require public hospital data and provide incentives to improve care

2013

- Increased Medicaid payments for primary care physicians

- Pilot programs to bundle payments for all providers (physicians, hospitals, etc.) per episode of care provided

2014

- Creation of Health Insurance Exchanges for those not offered insurance by an employer

- Mandate for most to buy health insurance

- Elimination of annual limits on coverage

- Elimination of denials for pre-existing conditions

- Increase of small-business health insurance tax credit

Comments (39) Add comment
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faithson
5265
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faithson 11/07/10 - 01:34 am
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please note that 53% of

please note that 53% of senior voters polled is less than 30% of the total electorate. Significant, but by no means a reason to throw the baby out with the bathwater.

dickworth1
954
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dickworth1 11/07/10 - 03:39 am
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please note that this health
Unpublished

please note that this health care is going to cost working people a ton of
money to cover scumbags that will not work or will not buy insurance offered by their employer if they do work. Far too long, people are giving welfare, food stamps and aid for their utiities, rent, and other essentials,
where is the incinitive to work? Most people understand that the folks that work pay for these services, so those in favor of the government
taking care of you remember it is not free. Repeal the government, not just healthcare!

carcraft
27101
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carcraft 11/07/10 - 06:21 am
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Please note that entry level

Please note that entry level jobs at places like McDonalds and others are being granted waivers from part of this monstorsity because young entry level workers are generally healthier and don't require 80-85% of the money being spent on health care. I had to laugh because AARP a big supporter is having trouble meeting it's increases in health insurance because of Obama care...I also noted there were a lot of I thinks, etc, in short speculation by panel members. It is also interesting that 1/3 of the deadlines for implimentation have not been meet!

johnston.cliff
2
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johnston.cliff 11/07/10 - 07:27 am
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Please note that for the

Please note that for the system to work, total socialization, under government control, must take place. Moving to the mandates of "everyone must buy health insurance" and "hospitals and doctors may form companies" (i.e., one size fits all) will only work if everyone joins in and the government has total control of the medical services industry. About 50% of doctors who have invested their income well and can afford to, will be leaving the system if it stays as it is. The government estimate of 32 million new people in the program, already short on physicians, will be a "temporary short term pain"?
This socialization of the medical system is insanity.
For the sake of the country, it's imperative that obamacare is dismantled and defunded as soon as possible.

scoobynews
3896
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scoobynews 11/07/10 - 08:59 pm
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I sat through a meeting about

I sat through a meeting about open enrollment and my blood just boiled. Increased premiums, increased co-pays, increased medicine cost, long term no longer will be covered by my employer if I want it I have to pay for all of it, increase, increase, increase..... Yet I still have be in line with a mother of 4 kids using her EBT card while I pay for my mine. I know several people who will not pay for health care that is offered to them through their jobs because it is too expensive. I make the choice to pay my portion of everything my job does not cover because it is my responsiblity to pay for my family's well being not the governments. I chose to have one child not three more I can afford. If American citizens would stop thinking everyone owes them a hand out and get off their butts to work we would not have these problems. If women would stop having baby after baby that they can't mother or afford. Why should I have to pay for other people's bad choices such as drinking too much, over eating, and smoking? As I tell my students all the time - NOTHING is free. Someone has to pay and it will be the working class. We will pay dearly for all those unfortunates that are mostly able bodied people who could work if they would choose to do so. I can not tell you how angry it will make me to know what kind people I will be providing healthcare for - the single mom with 4 kids who has the money to hit the clubs on the weekend yet can't pay her hospital bills for the births of those children, the meth lab technician that burns himself, the overweight woman that rides on one of those mobile shopping carts filling it with twinkies and here is a laugh diet Coke. Call me uncompassionate or whatever but I am tired of paying for other's poor judgement and choices. Yet they have NO compassion for those of us paying for them to receive EBT or medicaid. When they stop making stupid choices and care about the money that comes out of my pocket that goes to help support them then I will do the same as for now I have my own family to take care of and find it a struggle with increased premiums, co pays, and deductables that I have to PAY.

chascush
0
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chascush 11/07/10 - 08:32 am
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faithson, ‘please note that

faithson, ‘please note that 53% of senior voters polled is less than 30% of the total electorate. Significant, but by no means a reason to throw the baby out with the bathwater.’
So screw the seniors you have paid into the system for 50+ years TO COVER THE FREELOADERS?
I have an idea why not just drop black people off the health coverage after all they are only about 13% of the total electorate. Have about drop health coverage for Hispanics they are only about 15% of the electorate? No reason to throw the baby out with bathwater, right faithson .

chascush
0
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chascush 11/07/10 - 08:44 am
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scoobynews, ‘I can not tell

scoobynews, ‘I can not tell you how angry it will make me to know what kind people I will be providing healthcare for - the single mom with 4 kids who has the money to hit the clubs on the weekend yet can't pay her hospital bills for the births of those children, the meth lab technician that burns himself, the overweight woman that rides on one of those mobile shopping carts filling it with twinkies and here is a laugh diet Coke.’
I afraid we are already paying for most of the ones you mention. Now we will start paying the rest of the deadbeats. Many, many young people choose not to have health insurance because they are young and healthy and if they paid for health coverage they couldn’t afford the new car with fancy mag wheels.
How about some PERSONAL RESPONSIBILITY but that is a dirty word for the liberals.

josan43
0
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josan43 11/07/10 - 09:15 am
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I agree with the statement we

I agree with the statement we have tooo many free loaders. I think a flat co-pay of $13.00 per visit to doctors or hospitals, or for prescriptions would help cover the costs. And have AFDC recepients work at the public building, grounds for 4 hours a day. Cleaning, sweeping, picking up trash, washing windows to be able to receive the checks, soon they would want to earn more and get another job.
Parents who do not pay for the care of their own children, DB Moms and Dads should have to walk the highways picking up trash or in a lunch room washing dishes. do something to earn the needs for the families.

rj1960j10
14
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rj1960j10 11/07/10 - 09:21 am
0
0
My premiums, co pays and

My premiums, co pays and deductables are all going up. I have not used my medical for years, why not give me credit for that. Instead I have to pay for the free loaders that do not work.

corgimom
34196
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corgimom 11/07/10 - 10:24 am
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On Nov 1 I was in California.

On Nov 1 I was in California. I was at the grocery store, buying groceries for my two grandchildren. I was buying eggs, fruit, yogurt, meat, soup, vegetables, etc. I paid for it all myself.

I saw people with buggies piled high with junk food. Ice cream, Popsicles, snack cakes, candy, and not a nutritious food in sight- and then they paid for it with an EBT card. I'm not talking one box of cookies. I'm talking the entire buggy was full of junk food.

And THAT is what is wrong with America today.

carcraft
27101
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carcraft 11/07/10 - 10:45 am
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If this health care bill was

If this health care bill was so popular among the citizens and only 56% of the seniors opposed it why did no Democrates run on having passed it? Sanford Bishop and Patty Murry did and Patty Murry came close to losing in Washington a very liberal Democratic state! This law is not at all popular and Ted Kennedy's old seat went to a Republican to stop the bill. The bill was passed by reconcilliation so there are a lot of problems with it. I do not believe it will pass constitutional muster! NO Obama hasn't raised your taxes but he might as well have because your health care premiums are doing the same as a tax increase would, providing governmant mandated health care to those who won't provide it for them selves!

Techfan
6461
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Techfan 11/07/10 - 10:47 am
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The "freeloaders' as y'all

The "freeloaders' as y'all like to call them, already have Medicaid. 53% of seniors oppose it? They are already covered by Medicare.

carcraft
27101
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carcraft 11/07/10 - 10:49 am
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Scoobynews, you also forgot

Scoobynews, you also forgot the gang bangers, drug addicts and petty criminals that get shot, beat up andin car wrecks all the time. They come into the hospital all tated up, money for tatoos etc, with an attitude but no money or attitude for responsibility and health insurance!

Techfan
6461
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Techfan 11/07/10 - 10:55 am
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scooby: I've been sitting in

scooby: I've been sitting in those meetings for the past decade. Never have they told us premiums or copays where decreasing or that we would receive more coverage. Three years ago, we had an almost 30% increase in premiums in that one year alone, and all totaled around 150% for the decade (a bit more than the national average of 131% increase over the decade).

Techfan
6461
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Techfan 11/07/10 - 11:03 am
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car: Yes McD's and others got

car: Yes McD's and others got a temporary waiver for their "insurance", if you can call what Mcd's offers "insurance". 2 plans: 1-$14 a week for a plan that maxes out at $2,000 of coverage, 2-$32 a week for a plan that maxes out at $10,000. They are so generous.

carcraft
27101
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carcraft 11/07/10 - 11:24 am
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Tech, the point is that the

Tech, the point is that the clowns that wrote this bill think that one size fits all..The reason McD's got the waiver is even at the very limited coverage people use less that 80% of the cost of the plan for health care . These are entry level workers or retirees with other forms of health care. When I started working I had NO insurance and didn't need any really...I didn't get health insurance until I started college and had lapses between my college years. My First major health care expense was the birth of my first child and my wife and I payed for it because we both worked full time while going to school but had no health care insurance!

grouse
1635
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grouse 11/07/10 - 12:36 pm
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The thing that caught me eye
Unpublished

The thing that caught me eye about this panel of experts was that no one from the insurance companies was represented and therefore couldn't be questioned about profits, etc...

faithson
5265
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faithson 11/07/10 - 12:43 pm
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Something like 28% of black

Something like 28% of black young men do not have jobs. A man who does not 'learn' how to work will forever be a burden on the whole society. We had better find ways to put these unemployed youth to work, no matter the toil expected of them. This health care issue pales in comparison to what will become of us if we don't find some way to put this younger generation to work. A compulsory system of some kind is called for. To many young people growing up without a work ethic will be our undoing, as is so appropriately expressed in our Juvenal justice system.

Little Lamb
46998
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Little Lamb 11/07/10 - 12:44 pm
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Come on, Grouse. You keep

Come on, Grouse. You keep harping on health insurance companies’ profits, but say nothing about insurance companies in general. Do you think it is wrong for life insurance companies, auto insurance companies, homeowner insurance companies, business insurance companies, personal insurance companies, etc. to make profits? What is so special about health insurance companies?

Little Lamb
46998
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Little Lamb 11/07/10 - 12:47 pm
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0
Yeah, I can see the world

Yeah, I can see the world according to Grouse, now. If my house burns down, the government can give me another one. If I am mugged on the street, I tell the government and they re-imburse me for my cash and my medical bill. If I have a wreck, the government gives me a new car from government motors. If someone sues my business because I made a defective product, the government pays them.

Who is the government? You and I, grouse.

Techfan
6461
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Techfan 11/07/10 - 12:52 pm
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I haven't seen a lot of

I haven't seen a lot of retirees at Mcd's, maybe greeters at Wal Mart.

Little Lamb
46998
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Little Lamb 11/07/10 - 01:02 pm
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Faithson wrote: Something

Faithson wrote:

Something like 28% of black young men do not have jobs. . . . We had better find ways to put these unemployed youth to work, no matter the toil expected of them. . . . A compulsory system of some kind is called for.

Yeah, forced labor of black young men in the 18th and 19th centuries really worked out well.

ameliaf
0
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ameliaf 11/07/10 - 02:23 pm
0
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There has been a little

There has been a little confusion on the part of some of my fellow seniors about the new health care law.

Remember that senior who held up a sign at a Tea Party rally? It said "Keep the Guvmint out of my Medicare!"

Just one of those alzheimer's moments.

ameliaf
0
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ameliaf 11/07/10 - 02:31 pm
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One of the best things that

One of the best things that could happen to our ability to get the best health care at the best cost will be the ability to get comparative data on how well doctors and hospitals perform. If I needed a major operation, I would love to be able to look up which hospitals had the most experience, the least screw-ups, the best outcomes, and to compare costs. Same for doctors - what do different doctors charge for an annual physical? What do different labs charge for that blood work I have done every six months? What do Docs A, B, and C charge for the colonoscopy the doctor said it was time for.

Rather than just go to whatever doctor or hospital my doctor recommends, I have no problem doing a little research. I just have a hard time getting the info. Some specialists offices won't tell you unless you bring the doctors referral/script to their office so they can see exactly what the doctor wanted, or insist they won't know until the specialist talks to the doctor and the specialist won't talk to the doctor unless the appointment is scheduled.

Some insurers have done a little on this. Aetna is one. I don't know about others.

We can't bring consumer pressure on prices into the market place unless we have information. The new health law is, evidently, going to help that process along.

gaspringwater
3
Points
gaspringwater 11/07/10 - 03:14 pm
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Republicans made gains and

Republicans made gains and took the House in the in the election and there’s no doubt Boehner & Co. will provoke a new round of intense squabbling about changing health care. But the Senate and the White House are still Democratically controlled and health care repeal is not their agenda.

A recent Harvard analysis of 17 opinion polls found 41 percent of Americans favored repealing most of the major parts of the bill; 31 percent wanted some changes that would increase the government’s involvement in health care; and 18 percent wanted the law put in place as is.

http://www.statesman.com/blogs/content/shared-gen/blogs/austin/health/en...

And the inconvenient reality, Americans pay more for healthcare than any other country and the cost and the number of people who can't afford it are ever increasing.

dani
12
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dani 11/07/10 - 05:30 pm
0
0
Please note that the much

Please note that the much ballyhooed do-nut hole is $1,700.00 plus out-of-pocket expense. After you reach the "hole" you "might" be eligible for a one time $250.00 rebate check.

themaninthemirror
0
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themaninthemirror 11/07/10 - 06:33 pm
0
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josan43, your 8:15 a.m.

josan43, your 8:15 a.m. posting hit the nail on the head. I agree with you completely. There are many people receiving government benefits who are perfectly capable of doing something to justify those benefits. The reason they keep getting them is they do not have to do anything other than show up and apply for them. If they had to do some work to keep the benefits, they would quickly drop off the rolls. We have too many bleeding heart liberals in government.

corgimom
34196
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corgimom 11/07/10 - 07:38 pm
0
0
themanin- what do you propose

themanin- what do you propose that people do with their small children while they work, and how are they supposed to get to their workplace?

Take a long look at Richmond County and the bus system- and see where the buses don't go. Look at Burke County and the rest of the CSRA. How would they get there?

scoobynews
3896
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scoobynews 11/07/10 - 09:15 pm
0
0
Corgimom we usually see

Corgimom we usually see pretty eye to eye on issues but your statement - " what do you propose that people do with their small children while they work, and how are they supposed to get to their workplace?" The same thing I have to do with mine put them in daycare. I pay $90 a week for my son to attend day care while I work. I guess I am so angry about this because I have watched too many people I know from when I was in school pop out babies and then sit on their tails drawing a check. I teach way too many students whose parents are beating the system. I have several kids who qualify for "free" or "reduced" lunch yet I KNOW the neighborhoods the live in are very expensive to buy OR rent a house in. Another good answer would be stop having all those babies you can't care for. I just saw an article about woman having babies and none married. Each of those women will get WIC (I supposedly made too much money to get it yet I was supporting myself and my husband who was layed off during that time), EBT, a free paid for birth with room and board for mother and child at the hospital of their choice. It makes one just plain sick to keep paying and paying for folks who can't keep their legs closed long enough to stop having baby after baby to even think about going to get a real job. The only job they seem to know is how to have more babies.

TrulyWorried
15386
Points
TrulyWorried 11/07/10 - 09:28 pm
0
0
University has their 'in

University has their 'in house' doctors now from what I heard and you will be treated by one of those if you are admitted. Has anyone else heard the same?

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