Stuff You Should Know - President Obama's Health Care Plan: Soup to Nuts

Episode Date: September 22, 2009

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. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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Hey and welcome to the podcast. I'm Josh Clark. With me as always is Charles W. Chuck Bryant, the doctor, and with Charles W. Chuck 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 Rahm Emanuel combined. So we're glad to have you here, Molly. I'm sorry, I think I could take Rahm down.

But you could. He's a bulldog. Yeah, but... I'm pretty feisty. I've seen you, though. Have you seen her leg wrestle? No, but that's startling. I've been behind the, in front of her sights.

Sure. It's not a pleasant day. Yeah, I have too. Chuck, it isn't. Which is why we're scared of Molly, but we're glad she's here, right, Molly? I hope so. I hope you're glad I'm here. We're also glad you're here because much like the Necronomicon podcast, we intend to use

you as a shield just to get that out of the way. Let's talk about healthcare reform. Okay. 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.

We're not going to be discussing any of the politics. What we're going to do is simply present the proposals that are in play right now. Sure. And then part three is going to be criticisms, pros, cons, maybe other ideas for fixing the healthcare system. And then part four is what I'm excited about. Oh, yeah? 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. So let's talk about Obama's proposal. Is it even Obama's proposal? You know, Obama has made this a priority in his presidency. Big time. Big time, but he has not come down from on high with a massive plan for us all to react

to. You know who did do that? The Clintons did. That's right. The 90s. Moses. That was on the third tablet, I think. Right.

The healthcare tablet was dropped. Yeah, the Clintons actually wrote legislation and were peddling it around Capitol Hill in the 90s and it didn't work. 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 hubbub, but he came out with eight principles and then left it to Congress. That's five committees from Congress to create plans. And then in the week we're recording this, he came out and made this mega speech that's come up with all this attention. So now the week we're recording this, Obama's come back out with a speech and made it look like it's a little bit more of his plan, tried to wrestle control away from the media spin. He's saying what he wants in a plan, what he doesn't want, what he's open to compromise

about. But let's start. He's in campaign mode. He was. He's definitely back from vacation. Yeah. Yeah. So, should we talk about his eight proposals?

Yes. I mean, we're talking about a thousand pages or so of legislation right now, right? Well, we've got two bills on the table from four committees. Now, when he says there are four committees who've come up with bills, one of the bills is a tri-committee bill. So that's where that comes from. Okay. Three committees came up with one bill from the House, H.R.3200.

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 read a lot of that bill number. I'm just going to excuse myself. Let's just say you're quite, take over, Molly. I dream about H.R.3200. 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 the upcoming Senate Finance Committee bill. So by the time people hear this, that bill might be out. It's the trifecta. It's the one everyone's waiting for because it's a bipartisan committee. 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 that's the one everyone's waiting on, Beta Breath.

Yeah. Well, today, breaking news was that the chairman of that committee, Democrat Max Baucus, basically said, we're pushing through with this very soon. And it doesn't matter if I have Republican support or not. We're going to push it through and we'll have it up for review by the 21st of September. So, wow. That's the latest word. Yeah.

Yeah. I have dreams about Max now. Do you really? That's nice. So anyway, that's a personal note. So Obama says, 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 go in a circle while 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 loss or change. He wants to kill your grandparents.

Oh, wait. Sorry. No. He wants to improve quality care and patient safety. Right. And let's see. He wants to guarantee choice of doctors and coverage plans. Right?

Yes. And safeguard families from bankruptcies related to health expenses. How many is that one? I think that's seven. He wants to, the final one, he wants to shrink long-term cost increases in healthcare for businesses and the government. So those are pretty broad principles. No bold goals.

I think you'd be hard pressed to find someone who would disagree with these principles just in thought and theory. But then the Congress had the hard job of making them into bills. And we have that 1,000 pages of legislation as it stands right now, not including the Senate Finance Committee. I think we're up to about 1,600 pages. Wow, without the Senate Finance Committee's bill? Yeah.

And you read it all correct in Braille, which was, she taught herself Braille history. I had it translated and then read in. That's, I'm so impressed. So let's talk about how Congress did take these eight principles and turn them into healthcare as you were saying. Let's start with individuals. One of the big things is that everyone, both of the proposals that are out right now say that everyone has to have health insurance.

Yeah. It's an individual mandate and it's sort of barring an idea from car insurance. If we've all got to carry car insurance, then 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 going to come to your house and beat your kids in front of you. But the tax man will? Right.

Because I think the Senate bill says you pay $750 a year in tax penalties for not having insurance. And then the house plan is, I think, up to 2.5% of your adjusted income. Yes. Yeah. But no more than the lowest price plan. Right. Like they're not going to charge you more than you would have to pay in health insurance.

Right. I mean, if you can pay the premium in taxes, essentially you could just pay the premium to them. So what we took it is we're going to get some money, so you might as well hint, hint, go spend it on health care rather than funding the IRS. Right. But now most people already have health insurance. The majority of people get it from their employers and so that's pretty easy to meet

that requirement, right? But we don't want the employers to just chicken out. So employers have a mandate as well. Exactly. So now we have two mandates, employer and individual. And I heard actually the Senate finance is not going to have an employer mandate and that's why businesses are probably going to be a little more favorable for that one. Yeah.

But I said, you know, that's one of the theories of that's what killed Clinton's bills. You know, it's a job killer. Right. So, but that sounds kind of political. So let's just back off and say, you're an employer, you're 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. But you also, we already have Medicaid Medicare, so that covers automatically a certain percentage of Americans. Sure. But they're also expanding Medicaid, right? I think to 150% of our poverty level.

Yeah. That is the current Senate plan would be 150% above the federal poverty level and the House would do 133% of the federal poverty level. Right. And they're also planning on kind of cleaning house in those two systems, right, and making them more efficient and cheaper. Yes. Hopefully.

Well, we'll get to that when we start talking about how this is going to be paid for. But let's talk about subsidies for individuals. Let's say that, oh, I don't know, I make 350% income above the federal poverty level. That would be great. Well, I know. Dare to dream. Will I be eligible for subsidies? Yes.

Yes. Okay. Let's say if we're going with 150% above poverty level, from that to poverty level, you're covered by Medicaid. From 150% up to 400, is it you're eligible for subsidies on a sliding scale, Molly? Right. What they do is, obviously, if you make a little bit more money, if you're closer to that 400% level of the federal poverty level, you will pay a greater amount of the premium

than if you were just making 150% of the federal poverty level. So in the House Committee, for example, you get your subsidy, but you will pay, let's say you were at 350. You're going to be still paying 9% to 10% of your income toward the thing. But then you'll also get a subsidy to cover the rest of the premium. Got you. That makes sense. It's kind of like when I go to my shrink and I say, dude, I make $20,000 a year and

he doesn't charge me as much as the physician who comes in after me. Yeah. That's actually a really good point, Chuck, that there's a lot of key points in these proposals are already in effect in some ways, either de facto, like your shrink charging you on a sliding scale, or mandates about everyone having to have insurance, like the Massachusetts experiment, right? So this is kind of taking a lot of maybe good ideas and putting them together, good ideas being a very political way to put it, right?

What's the Massachusetts experiment? 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 it Massachusetts a success in terms of its health insurance?

You mean we? Oh yeah, you'll be there. So where's everybody going to get this insurance? There's an insurance marketplace that's being set up, right? Yeah, this is sort of the new big thing. So the insurance marketplace is sort of this attempt to have the general public get their insurance the same way that Congress people do. Because essentially when you become elected to Congress, you are presented with five plans

or not five, that's not, I mean, it's not a specific number, but basically you're 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, plain 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 plain language is a really big part of this. Right. 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 is covered. And in both of these bills, every plan that's in that marketplace will have a certain set of minimum benefits that will cover. Right, things that have to be covered, correct?

Things that have to be in there. And then there will be plans that are better than that in terms of maybe you want spa 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, we'll get into this obviously later too, but that's getting a little political as well with what can be covered and what's not, right? Right. But let's just for the time being, call 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 already have an existing one, it will

probably have about five years to meet these requirements as well. Right, but it won't change at first, right? No. They have about a five-year window. They'll be grandfathered in for several years, right? And you said in your article how healthcare reform works that these basic requirements will keep the marketplace from becoming like a dumping ground for shoddy policies, right? Right.

And you 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, you know. Crappy coverage? Yeah. That's one way to put it. I mean, the whole point of this plan, whether you have insurance or you don't have insurance, in Obama's point of view, is to strengthen health insurance for everyone. Right.

So obviously if you don't have a plan already, you're going to want 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. 2023 is already well underway, everybody, so don't wait any longer to level up your small business. And the way you can do that is by joining up with Stamps.com.

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Is it good? Dude. It's like, it's better than the army. Do you get spa days? You get massage, spa days, you get like mani-pedis paid for. You know, I have to give this. Because this is the first I've ever heard of spa days. I think there's a sushi clause.

You know, in Germany, spa days are included. Really? Yeah. Man. Universal health care. That's wonderful. Small businesses, you were saying that businesses are going to have a mandate to provide health insurance.

They're also going to be allowed to go to this insurance marketplace to select as well. Right. Employers are going to be subject to a pay or play requirement where if you don't provide health insurance for your employees, you're going to 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 like 95% of small businesses in the US will be exempt in his recent speech. Right. So, and the Senate and the House define 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 $250,000 a year, you wouldn't be considered a small business under this exemption. Right.

But, you know, that's probably going to be one of the things that's ironed out and reexamined pretty closely in the reconciliation of these two bills, but they would also be eligible to enter this marketplace and provide insurance to their employees with the help of subsidies. Oh, 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, in this marketplace, let's all pretend that we're in there right now.

Okay. Close your eyes. Close your eyes. This is nice. Do you see all these little logos? Like there's Etna's logo. There's Snoopy. Say hi to Snoopy.

Hi, Snoopy. Do you see this one? What is that? Like a screaming eagle with a bandaged head? What is that? That's the US of A. That is new. Or it would be if this thing gets passed.

That's the public option, right? Yes, the public option has been one of the more controversial parts of all these bills, correct? Yes. Okay. So, it's controversial. What's 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. Right. Because if you're competing against people, then you 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 so that it's a government-run option that will have lower rates probably. Now, obviously, right there, you're going to have some contention about what the rate should be because can a private insurer compete with a public insurer will have sort of the government stamp of approval that might make it impervious to any sort of attack or disaster. But the thinking is that similar to the way we provide Medicare and Medicaid for certain people, that we would have this option for people to get health insurance at a pretty affordable cost set by the government.

Right. 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 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. Right. It's really something to watch. That was something that in the speech Obama said he was willing to negotiate on. Right. 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 30 percent lower than most insurance

rates because that isn't fair to private insurers. It would have to be similar to private insurance likely, and it would also have to fund itself through premiums. Right. It would be self-sustaining. Yeah, because if you've got federal or injections of federal cash, you're not really competing with anything. Right.

And Obama said that he wouldn't back anything that added to the deficit. Is that correct? Yes. Right. So that's the public option. Everybody back away slowly. Back away. Well, you know, one thing that might be interesting to talk about is we always hear Obama saying

that if you like your health insurance, you can keep it. Right? Right. If you like your health insurance, you can keep it. That's terrible. That was awful. Do it as Clinton saying it. No.

Come on. Do it. If you like your health insurance, you can keep it. There. Much better. 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.

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? No. Why not? Because... Because you have the option through work, so you're immediately discounted? 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, if we were 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 employee. That could happen. But the thinking is, is that if everyone has to know sort of what their insurance costs versus what it costs in the marketplace, then that competitive spirit might keep insurance fair and honest. This can get really tricky. So well, let's talk about...let's talk some more about how insurance companies are going to be affected.

Just in addition to this possible competition from a public option, there are some mandates in this legislation, for example, that says you can't discriminate based on pre-existing conditions any longer. Right. So you used the example of that woman who's denied that, what was it? She was going to have a dolomastectomy, and then they found out she didn't declare a case of acne from her childhood, and thus they postponed the treatment and her breast cancer grew.

Right. And under this proposal, there's no more pre-existing condition denials in Parker. Right. And it doesn't cost you more. You can't be charged a higher premium because you have a pre-existing condition. They're going to do away with that completely? Yeah. For people who have insurance and for people who are trying to get insurance.

I think that's going in under this plan. So if you smoke 10 packs of cigarettes a day and you walk in there with an oxygen tank, they have to cover you for the same amount of money? Yeah. As far as I know. Well, the country. I know. That's awesome.

But there's also a mandate that there can no longer be caps on spending by insurance companies, and actually not only that, it's back on the consumer, there's now a cap on how much a consumer can pay out of pocket every year for their own health care, right? Because a lot of bankruptcies are driven by medical costs. We're thinking that if you can't go broke because you're sick, then we will decrease the number of bankruptcies and the damage we might be doing to our economy that way. Interesting. Definitely.

So that's insurance companies. That's also, again, we're just kind of hitting the high points here. We're talking about, as Molly said, 1,600 pages of legislation as it stands now. So let's talk about Medicaid and Medicare. Chuck mentioned this earlier about kind of cutting waste in the Medicaid and Medicare system. And that, actually, let's talk about how much this is going to cost. The OMB suggests it's going to be about a trillion dollars over 10 years for 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 30% of the services that are performed medically in this country are unnecessary. And that's overall, that's not just Medicare and Medicaid. Adding a third limb.

Yeah. Yeah. Potentially, or getting rid of that third limb that you wanted to keep. Yeah. You know? Yeah, you know what? Because both ways, buddy. I just blew my mind.

But to get rid of those costs right away and to also cut out some administrative costs, all this paper shuffling that a lot of people do could help as well. 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 how our whole health insurance system works. That's a $170 billion a year that goes to insurance companies for the exact same service that's provided to people by the government. So they would haul that and shuffle them over to Medicare standard?

Mm-hmm. Mm-hmm. No more advantage for you? Right. Right. Because it pays 14% more than regular Medicare for the same service. The exact same service. Interesting.

The people who would have just stayed with regular Medicare, we could have saved $170 billion a year. Right. But that's just that $170 billion. You can save another $600 billion just from cutting waste, right? And I think he's also talking about bundling services that leads to bundling services, correct? Yeah. That's a big deal.

It's sort of his testing ground for this, because as I said, this 30% 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 everyone who can't run a program. But they've done these studies where they compare areas that spend a lot of money on Medicare to just a little bit of money on Medicare. But 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 ailment that these lower spending people had over here. So what can we do to emulate those lower spending areas? That's where we get this idea of bundling that Josh was talking about. Right. So if a person goes into the hospital with a heart attack, instead of, you know, this doctor seeing him, then this doctor seeing him, then this doctor seeing him, and everyone

charging separately for all their tests. Fee for service. Fee for service. Then, you know, you go into the hospital as a Medicare patient and you are in there for your heart attack. Right. 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 more a matter of how you kind of pay your cable bill if you have your cable, your internet, and your phone all together. Sure. Fundling. You just pay one bill to the hospital for all that as opposed to paying for your cardiogram and, you know, the MRI scan they decide you need and blah, blah, blah. That kind of makes sense. Well, but it also leads to another kind of radical suggestion that's found in these proposals

is establishing what kind of care you should follow when somebody comes into for a heart attack. Like standardizing the heart attack. Right. Because how do you know how much 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 has a 98% success rate. So we're going to go with this one. Right. Well, I don't think they're going to throw out this one. I mean, they obviously they don't want treatments that don't work. Right. But I think it's more and obviously I think we're going to talk about rationed healthcare in the next podcast.

Sure. But this is where people start to get this idea, but let's say that there are three treatments for a heart attack. This one works. The first one works for 90% of the population. The second works for 5% of the population. And the other one also works for 5% of the population. Rather 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. Okay. That fits the 5% of the population. So it'd be kind of prioritizing more than standardizing. It'd be tearing up sort of what works. But I think Obama's been very clear that if your doctor thinks that he wants to still go with number three that has the 5% effectiveness rate, he can do that.

Okay. You should be on that panel. Are you on the panel? Okay, guys. We already talked about some forms of paying for this by cutting waste and getting rid of Medicare plus. Advantage. Advantage.

What are some other ideas for paying for this? Because Obama said he wasn't going to sign anything that added a cent to the deficit. And one complication with him just saying, I'm going to eliminate fraud and waste is those aren't scoreable measures according to the Congressional Budget Office. Right. You know, it's got to be something for them to say, yes, it provides, you know, 20 million dollars. It's going to be something the federal government can kind of, you know, point to as opposed

to this nebulous cutting cost thing. Right. Obama's been pretty clear that he would like to tax people who make more than $250,000 a year, change their tax deductions. And that I believe is what the House plan calls for. There's also the idea that we would tax the employer plans that are currently untaxed, the employer tax exemption. Oh, change, get rid of that all together?

Yeah, they wouldn't be exempt anymore. And there's the thinking, you know, this was something McCain brought up in the presidential campaign that Obama poo pooed, which is why it may not come back right away. You know, there's the idea of people shouldn't have to tax why it is essentially free for them now. Right. 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, but also if it's not just

this free perk that employers can hand out, they 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. Sure. So we can all look forward to raises?

Is that what you're saying? One thought behind this idea, but other people are like, no, that's a tax. I don't want it. Right. 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 except plans. And then, you know, still kind of rub some people the wrong way.

So the proposal has been floated just to tax the mega plans, the ones that do have spa days. Yeah, kind of like there's a CEO of Goldman Sachs. He's a plan that's $40,000 a year. You're kidding. And yeah, you always hear him brought up as like, you know, does he really need this tax-free $40,000 health insurance plan? Goldman Sachs takes a beating in here.

We mention them all the time. Kashkari. They bear the brunt. Yeah. So there's the thought that maybe we would tax either people who have those kind of plans or the insurance companies that offer those kinds of plans. But you know, there's this Time Magazine article that found that actually a lot of state employees have really good plans too.

I saw that. And 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 is a possible source of funding. Wow. 2023 is already well underway, everybody. So don't wait any longer to level up your small business. And the way you can do that is by joining up with stamps.com.

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The provision where any child born in the United States is automatically covered if they don't have insurance. Stuff like that. We're not going to cover any of the raucousness surrounding those in this one. As a matter of fact, I think we've reached the end of this one, guys. I think so. Molly, thank you very much for coming in. My pleasure.

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 teeth clenched shouting, you lie, you lie. That's going to be about myths, truths, and lies concerning healthcare reform and Obama's proposal. And there'll be criticism from the right and the left on the plan of that one, right, Chuck? What about the center?

The center is just kind of staying mute. And gooey? Yeah. Let's tune for that. It's part three in our special four-part healthcare suite series brought to you by HowStuffWorks.com. For more on this and thousands of other topics, visit HowStuffWorks.com. Want more HowStuffWorks? Check out our blogs on the HowStuffWorks.com homepage.

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