Some Key Points in President Obama's Health Care Proposal

The White House has released President Obama's proposed health care plan. Big Tent Democrat has the White House recap and some preliminary thoughts. I add mine below, from the various pages of the White House release.

The President’s Proposal builds off of the legislation that passed the Senate and improves on it by bridging key differences between the House and the Senate as well as by incorporating Republican provisions that strengthen the proposal.

The overview says it changes the Senate-passed bill and "reflects policies from the House-passed bill and the President’s priorities." Among the key changes it touts: It ends discrimination on pre-existing conditions and closes the Medicare "donut hole" gap in coverage. It increases the excise tax threshhold "from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans." For singles, it is $10,500. (Why are singles always discriminated against?) [More...]

The Act will include an additional 0.9 percentage point Hospital Insurance tax for households with incomes exceeding $200,000 for singles and $250,000 for married couples filing jointly. In addition, it would add a 2.9 percent tax for such high-income households to unearned income including interest, dividends, annuities, royalties and rents (excluding income from active participation in S corporations).

What about the public option? The section on "the Role of Public Programs" begins here. Nothing there. But, in the section called Title I. Quality, Affordable Health Care, it says:

For Americans with insurance coverage who like what they have, they can keep it. Nothing in this act or anywhere in the bill forces anyone to change the insurance they have, period.

Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market – the same insurance market that every member of Congress will be required to use for their insurance. The insurance Exchange will pool buying power and give Americans new affordable choices of private insurance plans that have to compete for their business based on cost and quality. Small business owners will not only be able to choose insurance coverage through this exchange, but will receive a new tax credit to help offset the cost of covering their employees.

On Social Security:

Protect the Social Security Trust Funds.

The President’s Proposal provides that, if necessary, funds will be transferred to the Social Security Trust Funds to ensure that they are held harmless by the Proposal.

There's also a section on "Improving Access to Innovative Medical Therapies:"

The Act promotes innovation and saves consumers money. It ends anti-competitive behavior by drug companies that keep effective and affordable generic drugs off the market. It extends drug discounts to hospitals and communities that serve low-income patients. And it creates a pathway for the creation of generic versions of biological drugs so that doctors and patients have access to effective and lower cost alternatives.

How long will it take to "create a pathway" for generic biological drugs? What about the people who need them now and whose insurance companies won't pay? Will they be provided the non-generic one?

One other promise I'll have to read the fine print on:

[It gives] consumers new power to appeal insurance company decisions that deny doctor ordered treatments covered by insurance.

What about treatments the insurance companies refuse to cover?

I'll say one thing for Obama's proposal: It's in plain English. It does a much better job of explaining the provisions than either the House or Senate bill did. It will be interesting to see if the descriptions match the fine print of whatever bill we end up with.

As for substance, I'll let the experts weigh in. One question I have is how much Republicans will water it down, and how many compromises Democrats will allow in order to get their vote, if needed?

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    On the penalty (5.00 / 1) (#7)
    by andgarden on Mon Feb 22, 2010 at 10:26:32 AM EST
    The President's Proposal adopts the Senate approach but lowers the flat dollar assessments, and raises the percent of income assessment that individuals pay if they choose not to become insured. Specifically, it lowers the flat dollar amounts from $495 to $325 in 2015 and $750 to $695 in 2016. Subsequent years are indexed to $695 rather than $750, so the flat dollar amounts in later years are lower than the Senate bill as well. The President's Proposal raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years - the same percent of income as in the House bill, which makes the assessment more progressive. For ease of administration, the President's Proposal changes the payment exemption from the Senate policy (individuals with income below the poverty threshold) to individuals with income below the tax filing threshold (the House policy). In other words, a married couple with income below $18,700 will not have to pay the assessment. The President's Proposal also adopts the Senate's "hardship" exemption.
    It strikes me that this also raises more revenue than the Senate bill.

    I'm sick of all the mental algebra (5.00 / 1) (#9)
    by katiebird on Mon Feb 22, 2010 at 11:29:43 AM EST
    I'm sick of all the mental algebra required to translate tables based on "families of four" to my family of two -- how hard would it be to put add an appendix with tables for more varied family sizes & incomes?

    Maybe it's selfish of me but, I want to know How Much it will COST me -- and what I'll get.

    The way they write these proposals it's really difficult to tell.

    Although (I guess) this one's a slight improvement since I don't have to hunt all over for the poverty tables.

    Heh (none / 0) (#12)
    by cawaltz on Mon Feb 22, 2010 at 11:37:48 AM EST
    I have a family of six so I am right there with ya. At least with the poverty level tables they are nice enough to tell me add $8,000 per extra person.

    Spreadsheet calcs here... (none / 0) (#15)
    by NealB on Mon Feb 22, 2010 at 02:04:15 PM EST
    Thank you (none / 0) (#18)
    by cawaltz on Mon Feb 22, 2010 at 03:35:30 PM EST
    From a financial standpoint it looks like the maximum for our household will be about $100 more than what we pay now. That isn't godawful since we have a fairly affordable $200 a month now. (depending on what deductibles look like)Especially since it extends coverage by 7 years on the kids and we would no longer be have to worry that the mole removal my daughter underwent as a teen would preclude her from coverage.

    I'm still concerned about the 15,000 this plan doesn't cover, I still think that non union folk may fall into that excise bucket, and I still think there are alot of details and regulatory mechanisms missing.

    Not as godawful as I imagined though.


    Wow Great! (none / 0) (#19)
    by katiebird on Mon Feb 22, 2010 at 03:44:32 PM EST
    Do the subsidies bring the premiums down to those levels?

    I'm not sure (none / 0) (#24)
    by cawaltz on Mon Feb 22, 2010 at 04:13:09 PM EST
    The maximum allowable though for our family size and household income (approx.) is about $300 a month on the table. We are between the 150 and 200% mark. His plan misses some details so it hard to tell if that is the amount post subsidy or not. It also doesn't define what acceptable deductible and co pay levels are which is concerning. $300 a month for health insurance is decent coverage for someone with a co pay less so if after $300, you are expected to cough up another thousand when being seen(which would actually work out to another hundred per month having to be saved to meet deductible). I'm still doing reading.

    To be clear (none / 0) (#1)
    by Big Tent Democrat on Mon Feb 22, 2010 at 10:19:32 AM EST
    My quote was from the President's release, not Ezra's analysis.

    I have not read Ezra's analysis.

    I would also add (none / 0) (#2)
    by Big Tent Democrat on Mon Feb 22, 2010 at 10:20:32 AM EST
    that this is not a bill, so the "plain language" you like will not be a part of the President's bill as he has not presented a bill, per se, just a plain English proposal.

    thank's I'll fix both (none / 0) (#3)
    by Jeralyn on Mon Feb 22, 2010 at 10:21:28 AM EST
    Here's a very good change (none / 0) (#4)
    by andgarden on Mon Feb 22, 2010 at 10:22:43 AM EST
    The Senate bill includes a "grandfather" policy that allows people who like their current coverage, to keep it. Within months of legislation being enacted, it requires plans to cover adult dependents up to age 26, prohibits rescissions, mandates that plans have a stronger appeals process, and requires State insurance authorities to conduct annual rate review, backed up by the oversight of the HHS Secretary.

    How is that enforceable? (5.00 / 0) (#5)
    by Big Tent Democrat on Mon Feb 22, 2010 at 10:24:46 AM EST
    I mean you can "keep it" if you can pay the rate increases.

    Employer plans (none / 0) (#6)
    by andgarden on Mon Feb 22, 2010 at 10:25:38 AM EST
    would have been largely exempted from the new provisions. This appears to change that.

    And you can 'keep it' only if your insurer .. (none / 0) (#31)
    by RonK Seattle on Mon Feb 22, 2010 at 08:39:18 PM EST
    ... continues to offer it. No guarantees on that, enforceable or otherwise.

    Still, most insurance customers will be able to keep what they have, more or less, for the time being.


    dependent coverage to age 26 (none / 0) (#32)
    by steamboat on Mon Feb 22, 2010 at 09:56:38 PM EST
    But I have read that one version of dependent coverage only applied to newly insured dependents, as opposed to currently covered dependents. Which is it in the current proposal I wonder?

    dependent coverage to age 26 (none / 0) (#33)
    by steamboat on Mon Feb 22, 2010 at 09:57:57 PM EST
    But I have read that one version of dependent coverage only applied to newly insured dependents, as opposed to currently covered dependents. Which is it in the current proposal I wonder?

    When does all of this start? (none / 0) (#8)
    by ding7777 on Mon Feb 22, 2010 at 11:10:39 AM EST
    In 2018, about 35% of the Baby Boomers (the ones supposedly causing this crisis) will already be on Medicare

    pandering (none / 0) (#10)
    by diogenes on Mon Feb 22, 2010 at 11:34:58 AM EST
    The donut hole elimination and increase in limits for the excise tax are pure pandering for a decade which will be filled with massive deficits (soon to be higher) until we turn into Greece and then have to have the IMF sort out our finances.

    heh (none / 0) (#11)
    by andgarden on Mon Feb 22, 2010 at 11:35:37 AM EST
    Better buy Swiss Francs!

    Greece - another economic debacle brought to you (none / 0) (#25)
    by DFLer on Mon Feb 22, 2010 at 04:29:16 PM EST
    by the good folks at Goldman Sachs

    Discriminated? (none / 0) (#13)
    by Abdul Abulbul Amir on Mon Feb 22, 2010 at 12:41:08 PM EST

    ...from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans." For singles, it is $10,500. (Why are singles always discriminated against?)

    What discrimination?  A family plan to cover six people will pay the tax at less than $5,000 a head, where the tax does not hit a single until $10,500.  

    That is hardly discrimination against singles, more like the other way around.

    You assume (none / 0) (#14)
    by jbindc on Mon Feb 22, 2010 at 01:54:49 PM EST
    That all "families" are large.  A "family plan" could be 2 people, in which case, the tax will hit at almost $14,000, as opposed to $10,500 if you had two umarried people living together.

    The average family (none / 0) (#16)
    by Abdul Abulbul Amir on Mon Feb 22, 2010 at 03:04:27 PM EST

    The average family is larger than two persons.

    Average family size (none / 0) (#17)
    by jbindc on Mon Feb 22, 2010 at 03:17:43 PM EST
    3.2 persons - average household size 2.61

    US Census Bureau

    The point is - you can't make an assumption about 6 people in a family.  Compared to smaller (or rather, "average") families, single people DO pay more per person.


    your math is a little off (none / 0) (#20)
    by CST on Mon Feb 22, 2010 at 03:44:59 PM EST
    compared to the average family size of 3.2 people, the excise tax hits single people a bit less than families, as 27,000/3 < 10,000.

    Household demos include single people.

    However, I think this brings up a good point that it's a bit ubsurd to lump "families" into one group with a fixed cap.  Since that cap is the same if you are 2 people or 6 people.  There should be some margin of difference.


    Yeah (none / 0) (#22)
    by jbindc on Mon Feb 22, 2010 at 04:05:28 PM EST
    My math was based on families of 2 - i.e. married couples with no children or "old people" children as a co-worker of mine called hers.

    Theoretically, you could have a married couple in their 40's (not that old and still working) who have adult children with their own jobs or married (so as not to be included in the "up to 26 years of age" clause), who would have $27,000 / 2 = $13,500.

    But yes, the point is, as you so succinctly put it, it's hard to lump families together when they could run from 2 to say, 20 (as in the Duggars's case).


    The point remains (none / 0) (#21)
    by Abdul Abulbul Amir on Mon Feb 22, 2010 at 03:46:03 PM EST

    Even for the average family sixe the tax kicks in at a lower per person number tham for singles.

    BTW, the average household is not useful as it includes simgles.

    No matter how you slice it those with larger famlies are more likely to be hit with the tax than singles.  That does not disadvantage singles in any way.


    In the Sunday edition of the San francisco (none / 0) (#23)
    by hairspray on Mon Feb 22, 2010 at 04:07:30 PM EST
    Chronicle, written by Carolyn Lockhead, she  states that rising health care costs are due to the fact that 4 major cartels have developed in the health care field which pulls 2.3 trillion out of the economy each year.  They are: physician groups, hospital corporations, insurers  and medical equipment manufacturers.  Each blames the other for the rises, but each guards, protects and inflates its own revenue.  They fight each other for control.  And of course they fight the reformers.  After reading this essay, I fail to see how any of the solutions being proposed make any real change to the corrupt dynamic in place.

    Hairspray, do you have (none / 0) (#26)
    by Zorba on Mon Feb 22, 2010 at 04:34:46 PM EST
    a link for that essay?  I would love to read it.  I am surprised that she didn't include the large pharmaceutical companies (if she didn't), since the rising cost of prescription drugs also play a part in the increases in health care costs.  Speaking from my own perspective, my prescription drugs (those not available yet in generic form) have been rising a lot every year, as has the amount that I pay which is not covered by my health insurance policy.

    The articles will not be available (none / 0) (#28)
    by ding7777 on Mon Feb 22, 2010 at 06:23:17 PM EST
    online until Tuesday (link)

    Thanks! n/t (none / 0) (#29)
    by Zorba on Mon Feb 22, 2010 at 06:48:21 PM EST
    Thanks (none / 0) (#35)
    by hairspray on Tue Feb 23, 2010 at 12:21:51 AM EST
    See below (none / 0) (#34)
    by hairspray on Tue Feb 23, 2010 at 12:21:19 AM EST
    Private Practice physician groups.......... (none / 0) (#27)
    by samsguy18 on Mon Feb 22, 2010 at 05:10:42 PM EST
    Cherry pick !!!! The chronically ill... the poor... the uninsured are stabilized at these centers and quickly transfered to county hospitals or academic centers. This ongoing practice if not addressed will cripple those institutions who do open their doors to our vulnerable citizens.

    The President's Proposal... (none / 0) (#30)
    by lambert on Mon Feb 22, 2010 at 08:29:23 PM EST
    .... is a big nothingburger -- heavily focused on eliminating "millions" of dollars in "waste, fraud, and abuse" in Medicare, while offering no visible enforcement mechanism for reining in the insurance companies. It's also full of Republican talking points. I'm shocked.

    Yes, I'm shocked too... (none / 0) (#36)
    by weltec2 on Tue Feb 23, 2010 at 08:25:28 PM EST

    Here's the San Francisco Chronicle article (none / 0) (#37)
    by mcl on Wed Feb 24, 2010 at 10:30:59 AM EST
    I'll post it in short blocks. Part 1:

    "Soaring costs laid to growing power of medical cartels"

    Feb. 21 2010, San Francisco Chronicle
    Carolyn Lochhead and Victoria Colliver

    The planned spike in health insurance rates by Anthem Blue Cross in California is just the tip of a Titanic-size iceberg of exorbitant price increases, secret pricing and consolidation not only by insurers - but by the hospitals, doctors and medical devicemakers that send the bills to the insurers.

    Insurers, who strike deals with providers, pass the bills on to patients, businesses and governments. The nation is fast being bankrupted by a medical money machine that costs $2.5 trillion a year and takes more than $1 of every $6 that Americans earn.

    "It's an insider's game in health care," said Jeffrey Lerner, president and chief executive of the ECRI Institute, a nonprofit that researches medical practices.

    Anthem, a subsidiary of WellPoint Inc., has come under state and federal scrutiny for its plan to raise rates by as much as 39 percent for many of its 700,000 California members who buy individual coverage. The company blames the increases on healthy individual policyholders who have dropped out of the market, creating a pool of sicker people.

    The company said it will delay the rate hikes until May 1 to allow a state review. Hearings are planned in Sacramento and Washington, and Health and Human Services Secretary Kathleen Sebelius issued a report Thursday that found double-digit premium hikes in California and a half-dozen other states.

    While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.

    Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.

    Many industry insiders are afraid to speak on the record for fear of antagonizing the medical groups they rely on for their survival. Contracting practices are draped in secrecy. Prices are almost impossible to obtain because of "confidentiality agreements" among hospitals, physician groups, insurers and devicemakers who do not want their markups exposed to competition or public scrutiny.

    Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.

    "But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200," Bernstein said. "It's ridiculous. There's no open competition."

    With doctors and hospitals sprinkled in every congressional district and wielding their clout, a year of health reform in Congress has overlooked some of the biggest cost drivers in American medicine.

    "While the talk surrounding health reform has been about problems with the health insurance market, and I don't want to suggest that's entirely misplaced, I think market power on the part of providers, doctors and hospitals is a bigger issue," said Martin Gaynor, an economist at Carnegie Mellon University.

    part 2 of the same article (none / 0) (#38)
    by mcl on Wed Feb 24, 2010 at 10:31:49 AM EST
    (not available online, I transcribed this from the print edition)

    Jerry Flanagan, health care policy director for Consumer Watchdog in Santa Monica, said the heath care system is "in a tug-of-war between warring tribes ... over who has market dominance over price." Flanagan doesn't think the insurance industry is losing the battle.

    Consumers have almost no control over costs, no ability to shop and little incentive to do so because most patients neither buy their own insurance nor pay their medical bills directly. But they foot the bill in skyrocketing premiums, deductibles and co-pays.

    Individuals who buy their own insurance instead of getting it through their employer are at an especially steep disadvantage. They do not get the giant tax break Congress grants only to employers. Nor do they get the discounts that providers negotiate, often confidentially, for large insurers.

    What has received far less scrutiny is the collusion operating underneath this system. The regional "networks" that hospitals and their allied physicians form to negotiate with insurers often exclude competitors and lock in exorbitant prices that are passed on as premiums.

    Keith Smith, an anesthesiologist and co-founder of the Oklahoma Surgery Center in Oklahoma City, posts his surgery center's prices online, a rarity in the industry. But he points to the "preferred provider organizations," or PPOs, that he contends have morphed into medical cartels that make deals with insurers to monopolize care in their region.

    "My prices at my facility are most of the time 70 percent to 80 percent less than the same procedure across town at a not-for-profit hospital," Smith said. "Yet Blue Cross and any number of insurance companies are not the least bit interested in contracting with me. And we're not fly-by-night. We've been in business 13 years and have the top physicians in the city. All I know is something smells."

    Don Crane, chief executive of the California Association of Physician Groups, which represents medical groups reimbursed by managed-care policies, blamed much of providers' high costs on the fee-for-service system, which he says encourages doctors and hospitals to spend more, and on paltry reimbursement rates from government programs.

    But a report last month by Massachusetts Attorney General Martha Coakley found extensive evidence of anti-competitive behavior among providers, including huge price disparities that bear no relation to anything except market power. Special pricing pacts and other forms of collusive behavior were "pervasive," the report said.

    The report said large provider networks that dominate local territories exercise leverage over insurers who need to offer their services.

    Insurers leap on this argument, blaming rising provider charges, which were up about 6 percent last year, for higher premiums. But they do little to fight them. Exempt from antitrust laws, insurers have been rapidly consolidating and often dominate local regions, giving them power to pass on price increases to consumers and businesses.

    Democratic Rep. John Garamendi of Walnut Grove (Sacramento County), a former state insurance commissioner, said provider groups "can dominate the market to the extent of dictating prices" in a local area. "We simply do not have a market system in many parts of the nation and California."

    Critics say even large price increases by providers cannot justify the double-digit increases that Anthem planned.

    "It's hard for me to make the leap from something that's a few percent over inflation to something that is many multiples over inflation," said Marian Mulkey, senior program officer for the California HealthCare Foundation, an independent philanthropy group based in Oakland.


    Current HCR bill addresses NONE of these issues (none / 0) (#39)
    by mcl on Wed Feb 24, 2010 at 11:02:42 AM EST
    Moreover, none of the claims made about what this bill does are factually correct.

    Let's blow through the smoke and mirrors and see what this bill actually does:

    [1] This bill does not end discrimination due to pre-existing conditions. Instead, it allows insurers to throw people paying enrolees off the insurance rolls by permitting insurers to dump people for "fraud." And what's one of the definitions of fraud?  Not disclosing to the insurer that you have pre-existing condition...even if you were unaware of it.

    Presto!  Change-o!  You come down with some illness, and the insurance company doctor determines you had it but never notified your insurer. Whoops!  You're dumped from the insurance rolls!  Say hello to discrimination on the basis of pre-existing conditions, just under another name.

    [2] The senate HCR bill "expands" Medicaid in name only. What it actually does is to dump 15 million more people onto state-funded Medicaid at the very time all the states are slashing their Medicaid outlays in every way possible. This is another scam -- a classic con game of 3-card monte. Claim the federal government will expand Medicaid, then dump the uninsurable sick people onto state Medicaid programs which are getting slashed right and left. Give lip service to increased federal funding of medicaid, while actually declaring a budget freeze (as Obama has just done).  Net result? Instead of uninsurable sick people blowing the roof off the federal deficit, they'll merely blow the roof off individual state deficits. Naturally, states are prevented by law from running continuing deficits so they'll be forced to shut down their Medicaid programs. Presto! Change-o!  Like homeless people rousted by the police and moved from one jurisdiction to another, those 15 million uninsurable new sick people will get magically removed from the federal rolls and dumped onto the state Medicaid rolls...except the states will dump 'em 'cause they don't have the money to pay for it. End result: same situation we've got now. The senate HCR bill is a scam, nothing more.

    "Facing relentless fiscal pressure and exploding demand for government health care, virtually every state is making or considering substantial cuts in Medicaid, even as Democrats push to add 15 million people to the rolls."

    Source: New York Times article States Consider Medicaid Cuts As Use Grows, 18 February 2010.

    [3] Proponent after proponent of the senate HCR bill has claimed that this bill does not force individuals to buy health care, and they're lying. With a threshold for the excise tax of $10,500 per year, even the lowliest Wal*Mart employee will be forced to pay the excise tax because they can't afford the health insurance. So the senate HCR "reform" bill won't provide health care for most of the 43 million uninsured people...but it will reduce their income. This HCR bill is the most punitively repressive legislation ever introduced in American history -- it is, in fact, a fine for being poor.

    Never before in American history has the full power of the U.S. government been used to fine people for the crime of being poor. That's unprecedented.

    But wait...it gets better!

    [4] The Congressional Budget Office has run the numbers and concluded that the "cadillac tax" (misnamed because the so-called "cadillac HCR plans" are merely plans which offer decent reasonable health benefits) will crush 1 out of 5 families earning between $50,000 and $75,000 per year by larding on an extra tax on their health insurance.

    "The Senate's health benefits excise tax would impact 27% of families and 22% of individual plans by 2019 according to the Joint Committee on Taxation," Courtney said, "and those numbers would just increase."

    Senate Plan To Tax Health Plans Is Bad Policy

    [5] The language in the HCR bill is lying outright when it claims "The Act promotes innovation and saves consumers money. It ends anti-competitive behavior by drug companies that keep effective and affordable generic drugs off the market. It extends drug discounts to hospitals and communities that serve low-income patients. And it creates a pathway for the creation of generic versions of biological drugs so that doctors and patients have access to effective and lower cost alternatives."

    This language lies because the primary cause of the skyrocketing medical costs is the network of collusive anti-competitive cartels linking doctors and hospitals and insurers and medical devicemakers in a dense mafia-like web of secret non-disclosure agreements (medical omerta) and sweetheart special deals (hospitals are contractually prevented from using lower-cost drugs or lower-cost doctors or lower-cost tests, insurers are contractually prevented from using lower-cost hospitals and doctors, and so on).

    So each of the examples above is invalid because the generic cheaper drugs will never get used, since the hospitals and doctors will be contractually prevented from using them. Likewise, hospitals that serve low-income communities won't be able to take advantage of those drug discounts, because those hospitals will also be contractually prevented from using lower-cost alternative medicines by the sweetheart contracts locking them into monopolistic cartels of big pharma drug makers. Finally, the "pathway for the creation of generic biological drugs" will go unused because the drug companies will merely change one molecule in the drug and then re-patent the new version, at the same time requiring their captive doctors and hospitals to use the new patented high-cost drug and contractually preventing them from using the lower-cost generic version. This already happens, so it's nothing new or exotic.

    None of the features of the HCR bill eliminate the anti-competitive monopolistic cartels and secret price lock-in contracts discussed in the San Francisco Chronicle article. On the contrary: the current HCR bill will greatly worsen the current monopolistic web of cartels because it will force all Americans to buy insurance from these anti-competitive cartels, creating a helpless captive market.

    Prediction: as sky-high as the price increases in health care have been so far, if this HCR bill goes through, you ain't seen nothin' yet. Forget about Anthem's puny 39% per year premium increases. With a captive market of helpless victims forced at the point of the government bayonet to buy insurance from these cartels, you'll see 390% yearly premium increases, 3900% increases, 39,000% yearly premium increases. With the government threatening prison and fines for anyone who refusing the pay these corrupt medical cartels, the sky's the limit. Cost will take off like the space shuttle headed to Arcturus.