ObamaCare's Ever-Rising Price Tag

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by masquerade, Jun 3, 2010.

  1. masquerade
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    masquerade positivity

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    White House Senior Adviser David Axelrod argued earlier this year that health-care reform would become more popular after it passed, boosting Democrats in the midterm elections. "We have to go out and sell it," he told the National Journal, adding in an interview in Newsweek that "people [will] see the benefits that accrue to them."

    That's not quite how it has worked out. ObamaCare is becoming more, not less, unpopular. The Rasmussen poll reported the week after health reform's passage in March that 55% of likely voters supported its repeal while 42% did not. A Rasmussen poll last month showed that 56% backed repeal; 39% did not.


    For starters, Mr. Foster estimated Americans would pay $120 billion in fines for not having adequate insurance coverage and that 14 million people would lose their coverage as rising costs led companies to dump it. Those effects are not in keeping with Mr. Obama's promises that if people liked the health insurance they had they could keep it, and that the reforms would provide universal coverage.

    Finding it hard to cover costs under the bill's formulas, according to Mr. Foster's analysis, doctors would refuse new patients and one out of every six hospitals and nursing homes could start operating in the red. And while Medicaid would cover 16 million more people, there might not be enough doctors to treat them.


    That's not the end of the bad news. October will see the first round of Medicare cuts. Up to half of seniors will lose their Medicare Advantage coverage (a program that allows seniors to receive additional services through a private health plan), or at least some of their benefits under this program. Watch for the administration to try to keep companies from notifying their customers of benefit cuts or premium increases before the election. Meanwhile, the Daily Caller website reported yesterday that the administration has missed deadlines for issuing four sets of regulations specified by the bill and lacks a master time-line for the other required regulations.

    The entire article
     
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  2. Old Rocks
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    Old Rocks Diamond Member

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    OK. Let's just go straight to a Canadian system. That way, we would save nearly fifty per cent. And cover everybody.

    See, better care, less cost, everybody covered. Now who is against that? And why are they against that?
     
  3. RevRabbiJCG
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    RevRabbiJCG RevRabbiJCG

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    According to the latest reports Canada's universal healthcare has rising costs and that folks have started paying for visits that were once free. Listen, just because one nation has a healthcare system the whole world envys, doesn't mean we should have it too.
     
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  4. Meister
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    Meister VIP Member Supporting Member

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    Your a silly ass, roxie. Their healthcare system is not running too well these days, and are seeing huge deficits...that is with something like 33 million people. Now look at our 300 million. Stop dropping the acid and get back to reality. :cuckoo:
     
  5. jeffrockit
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    jeffrockit Senior Member

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    10 reasons why that would be a big mistake:
    Hoover Institution - Hoover Digest - Here’s a Second Opinion
     
  6. WillowTree
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    WillowTree Diamond Member

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    cause big wig canadians have been known to come here for their care, isn't that a clue?
     
  7. saveliberty
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    saveliberty Diamond Member

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    It is going to be a great day when the Democrats hand the keys to healthcare back. Then we can put out a bill that has tort reform, interstate purchasing and more fraud enforcement.
     
  8. Gatekeeper
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    Gatekeeper Senior Member

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    From what I see happening to the wife and I from this 'reform'

    Our monthly cost for a plan is now about $1024/mo. $12,288/year. It mysteriously went UP about 7 months ago by $250/mo.

    Co-Pays for medicine mysteriously going up from $10 for 95% of them to $25 and $50. WTF?

    Flexpay, pretaxed monies using a debit card for co-pays and meds, that too on Jan 1,2011 is being CUT BACK, lowered! More cost for the consumer who is already paying through the nose to these greedy corps, and no end in sight for these mysterious increases.

    There is a lot happening in the background, are companies jacking rates and modifying their plans to cover some projected losses or what? This is insanity, we are getting screwed royally by this administrations incompetent plan that was shoved up our collective butts without lube.

    We have been had America, royally, and not even a friggen kiss or a squeeze. Who are these people in Washington D.C. that have BS'd the masses with their mountain of bovine crap? When does it end?

    Signed, Pi$$ed off citizen
     
  9. Greenbeard
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    Greenbeard Gold Member

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    There are a few points to be made here.

    1. Most of the $120 billion in fines estimated in the CMS Actuary report is paid by employers who don't offer coverage and have employees getting public subsidies to buy insurance in the exchanges. It's true that the CMS Actuary's estimates of penalty payments are higher than the CBO's estimates--that's because he thinks the relatively low levels the penalties were set at aren't high enough to encourage people to get insurance. Or at least not as many people as the CBO calculated would be encouraged to get insurance.
    2. While this isn't particularly desirable from a public health viewpoint, it should be noted (since this thread is called "ObamaCare's Ever-Rising Price Tag") that this may actually help the finances of the program. The CBO cost estimates that dominated the headlines during the debate assumed only $69 billion in revenue from individual and employer penalties through 2019, not $120 billion. But if more people are going to forgo exchange subsidies and instead pay the government, the math changes a bit.
    3. The "14 million would lose their employer-sponsored coverage" isn't useful without some sort of benchmark: the CMS Actuary report estimates that without reform, 13 million would lose employer-sponsored coverage (so in his estimate, the number of people in employer-sponsored plans would be only 1 million lower under reform than otherwise). However, the difference is that reform offers those people a place to go: a new, transparent individual marketplace, the health insurance exchanges.
    4. It's worth considering why the CMS Actuary thinks people will lose coverage. The short answer is: in many cases it may actually be to their benefit. As he writes in the report:
      Employer-sponsored health insurance has traditionally been the largest source of coverage in the U.S., and we anticipate that it would continue to be so under the PPACA. By 2019, an estimated 13 million workers and family members would become newly covered as a result of additional employers offering health coverage, a greater proportion of workers enrolling in employer plans, and an extension of dependent coverage up to age 26. However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries would find it to their--and their employees'--advantage to end their plans, thereby allowing their workers to qualify for heavily subsidized coverage through the Exchanges. Somewhat similarly, many part-time workers could obtain coverage more inexpensively through the Exchanges or by enrolling in the expanded Medicaid program.
    5. The "if you like your coverage, you can keep it" pledge doesn't mean your employer won't drop coverage if it becomes too expensive. This has been taken to mean so many things that it obviously doesn't but the President has been fairly clear (blogs.abcnews.com/politicalpunch/2009/06/what-does-the-presidents-promise-youll-be-able-to-keep-your-health-care-plan-period-really-mean.html) on what it means:
      “When I say if you have your plan and you like it,…or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform,” the President said.​

    This I believe refers to patients with public insurance, primarily Medicaid recipients. This is part of the reason the law contains a two-year increase in Medicaid's primary care reimbursement rates (bumping them to Medicare levels). But access is going to be an issue we'll have to keep paying attention to.

    Workforce issues are absolutely important. The new law contains workforce development provisions, particularly to increase the number of primary care physicians but certainly that's going to have to be an ongoing effort.


    I'm just going to pull from an in-depth summary (dpc.senate.gov/healthreformbill/healthbill96.pdf) for this because I don't see any benefit to quoting the actual legislative language.

    I would assume from your name--perhaps wrongly--that you would favor an approach to liability reform that encourages individual states to determine for themselves what liability reforms work best for them. An approach sort of like the one in the new law:

    Sec. 10607. State demonstration programs to evaluate alternatives to current medical tort litigation. Authorizes grants to States to test alternatives to civil tort litigation. These models would be required to emphasize patient safety, the disclosure of health care errors, and the early resolution of disputes. Patients would be able to opt-out of these alternatives at any time. The Secretary of HHS would be required to conduct an evaluation to determine the effectiveness of the alternatives.​

    If you'd like to try offering plans that can be sold across state lines, you're in luck.

    Sec. 1334. Multi-State Plans. As added by Section 10104, requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program.​

    But perhaps you don't like the federal oversight of those plans. You're in luck again! There's another option that puts states in the driver's seat and encourages them to allow interstate sales of insurance between them:

    Sec. 1333. Provisions relating to offering of plans in more than one State. By July 1, 2013, requires the Secretary, in consultation with NAIC, to issue regulations for interstate health care choice compacts, which can be entered into beginning in 2016. Under such compacts, qualified health plans could be offered in all participating States, but insurers would still be subject to the consumer protection laws of the purchaser’s State. Insurers would be required to be licensed in all participating States (or comply as if they were licensed), and to clearly notify consumers that a policy may not be subject to all the laws and regulations of the purchaser’s State. Requires States to enact a law to enter into compacts and Secretarial approval, but only if the Secretary determines that the compact will provide coverage that is at least as comprehensive and affordable, to at least a comparable number of residents, as this title would provide; and that it will not increase the Federal deficit or weaken enforcement of State consumer protection laws.​

    And how about that fraud enforcement?

    Subtitle E – Medicare, Medicaid, and CHIP Program Integrity Provisions

    Sec. 6401. Provider screening and other enrollment requirements under Medicare,
    Medicaid, and CHIP.


    Provider Screening. Requires that the Secretary, in consultation with the HHS Office of Inspector General (HHS OIG), establish procedures for screening providers and suppliers participating in Medicare, Medicaid, and CHIP. The Secretary would be required to determine the level of screening according to the risk of fraud, waste, and abuse with respect to each category of provider or supplier. At a minimum, all providers and suppliers would be subject to licensure checks. The Secretary would have the authority to impose additional screening measures based on risk, including fingerprinting, criminal background checks, multi-State data base inquiries, and random or unannounced site visits. An application fee of $200 for individual practitioners and $500 for institutional providers and suppliers would be imposed to cover the costs of screening each time they re-verify their enrollment (every five years). Section 10603 removes the enrollment fee for physicians.

    Disclosure Requirements. Providers and suppliers enrolling or re-enrolling in Medicare, Medicaid, or CHIP would be subject to new disclosure requirements. Applicants would be required to disclose current or previous affiliations with any provider or supplier that has uncollected debt, has had their payments suspended, has been excluded from participating in a Federal health care program, or has had their billing privileges revoked. The Secretary would be authorized to deny enrollment in these programs if these affiliations pose an undue risk to a program.

    Compliance Programs. By a date determined by the Secretary, certain providers and suppliers would be required to establish a compliance program. The requirements for the compliance program would be developed by the Secretary and the HHS OIG.

    Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.

    Integrated Data Repository. Requires CMS to include in the integrated data repository (IDR) claims and payment data from the following programs: Medicare (Parts A, B, C, and D), Medicaid, CHIP, health-related programs administered by the Departments of Veterans Affairs (VA) and Defense (DOD), the Social Security Administration, and the Indian Health Service (IHS).

    Access to Data. The Secretary would be required to enter into data-sharing agreements with the Commissioner of Social Security, the Secretaries of the VA and DOD, and the Director of the IHS to help identity fraud, waste, and abuse. The Committee Bill would grant the HHS OIG and the Department of Justice (DOJ) access to the IDR for the purposes of conducting law enforcement and oversight activities consistent with applicable privacy, security, and disclosure laws.

    Overpayments. Requires that overpayments be reported and returned within 60 days from the date the overpayment was identified or by the date a corresponding cost report was due, whichever is later.

    National Provider Identifier. Requires the Secretary to issue a regulation mandating that all Medicare, Medicaid, and CHIP providers include their NPI on enrollment applications.

    Medicaid Management Information System. Authorizes the Secretary to withhold the Federal matching payment to States for medical assistance expenditures when the State does not report enrollee encounter data in a timely manner to the State’s Medicaid Management Information System (MMIS).

    Permissive Exclusions. Subjects providers and suppliers to exclusion for providing false information on any application to enroll or participate in a Federal health care program.

    Civil Monetary Penalties. Expands the use of Civil Monetary Penalties (CMPs) to excluded individuals who order or prescribe an item or service, make false statements on applications or contracts to participate in a Federal health care program, or who know of an overpayment and do not return the overpayment. Each violation would be subject to CMPs of up to $50,000.

    Testimonial Subpoena Authority. The Secretary would be able to issue subpoenas and require the attendance and testimony of witnesses and the production of any other evidence that relates to matters under investigation or in question by the Secretary.

    Surety Bonds. Requires that the Secretary take into account the volume of billing for a DME supplier or home health agency when determining the size of the surety bond. The Secretary would have the authority to impose this requirement on other providers and suppliers considered to be at risk by the Secretary.

    Payment Suspensions. Authorizes the Secretary to suspend payments to a provider or supplier pending a fraud investigation. As amended by Section 1304 of the Reconciliation Act, allows a 90-day period of enhanced oversight and withholding of payment in cases where the HHS Secretary identifies a significant risk of fraud among DME suppliers.

    Health Care Fraud and Abuse Control Account. As amended by Section 1301 of the Reconciliation Act, increases Health Care Fraud and Abuse Control (HCFAC) funding by $350 million over the next decade. The provision would also permanently apply the CPI-U adjustment to HCFAC and Medicare Integrity Program (MIP) funding.

    Medicare and Medicaid Integrity Programs. Requires Medicare and Medicaid Integrity Program contractors to provide the Secretary and the HHS OIG with performance statistics, including the number and amount of overpayments recovered, the number of fraud referrals, and the return on investment for such activities.

    Sec. 6403. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank. Requires the Secretary to maintain a national health care fraud and abuse data collection program for reporting certain adverse actions taken against health care providers, suppliers, and practitioners, and submit information on the actions to the National Practitioner Data Bank (NPDB). The Secretary would also be required to establish a process to terminate the Healthcare Integrity and Protection Databank (HIPDB) and ensure that the information formerly collected in the HIPDB is transferred to the NPDB.

    Sec. 6404. Maximum period for submission of Medicare claims reduced to not more than 12 months. Beginning January 2010, the maximum period for submission of Medicare claims would be reduced to not more than 12 months.

    Sec. 6405. Physicians who order items or services required to be Medicare enrolled physicians or eligible professionals. Requires durable medical equipment (DME) or home health services to be ordered by a Medicare eligible professional or physician enrolled in the Medicare program. The Secretary would have the authority to extend these requirements to other Medicare items and services to reduce fraud, waste, and abuse. Section 10604 clarifies that only physicians enrolled in the Medicare program may order home health services under Medicare Part A and Part B.

    Sec. 6406. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse. Beginning January 1, 2010, the Secretary would have the authority to disenroll, for no more than one year, a Medicare enrolled physician or supplier that fails to maintain and provide access to written orders or requests for payment for DME, certification for home health services, or referrals for other items and services. The provision would also extend the HHS OIG’s permissive exclusion authority to include individuals or entities that order, refer, or certify the need for health care services that fail to provide adequate documentation to verify payment.

    Sec. 6407. Face-to-face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare. Requires physicians to have a face-to-face encounter with the individual prior to issuing a certification for home health services or DME. The Secretary would be authorized to apply the face-to-face encounter requirement to other items and services based upon a finding that doing so would reduce the risk of fraud, waste, and abuse. Section 10605 clarifies that the face-to-face encounter required prior to certification for home health services may be performed by a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant.

    Sec. 6408. Enhanced penalties. Subjects persons who fail to grant HHS OIG timely access to documents, for the purpose of audits, investigations, evaluations, or other statutory functions, to CMPs of $15,000 for each day of failure. Also, persons who knowingly make, use, or cause to be made or used any false statement to a Federal health care program would be subject to a CMP of $50,000 for each violation. The violations that could be subject to the imposition of sanctions and CMPs by the Secretary would include Medicare Advantage (MA) or Part D plans that: (1) enroll individuals in a MA or Part D plan without their consent, (2) transfer an individual from one plan to another for the purpose of earning a commission, (3) fail to comply with marketing requirements and CMS guidance, or (4) employ or contract with an individual or entity that commits a violation. Penalties for MA and Part D plans that misrepresent or falsify information would be increased to up to three times the amount claimed by a plan or plan sponsor based on the misrepresentation or falsified information.

    Sec. 6409. Medicare self-referral disclosure protocol. Within six months of enactment, the Secretary, in cooperation with the HHS OIG, would be required to establish a self-referral disclosure protocol to enable health care providers and suppliers to disclose actual or potential violations of the physician self-referral law.

    Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program. Requires the Secretary to expand the number of areas to be included in round two of the competitive bidding program from 79 of the largest metropolitan statistical areas (MSAs) to 100 of the largest MSAs, and to use competitively bid prices in all areas by 2016.

    Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program. Requires States to establish contracts with one or more Recovery Audit Contractors (RACs). These State RAC contracts would be established to identify underpayments and overpayments and to recoup overpayments made for services provided under State Medicaid plans as well as State plan waivers. The Secretary would also be required to expand the RAC program to Medicare Parts C and D.

    Subtitle F – Additional Medicaid Program Integrity Provisions

    Sec. 6501. Termination of provider participation under Medicaid if terminated under Medicare or other State plan. Requires States to terminate individuals or entities from their Medicaid programs if the individuals or entities were terminated from Medicare or another State’s Medicaid program.

    Sec. 6502. Medicaid exclusion from participation relating to certain ownership, control, and management affiliations. Requires Medicaid agencies to exclude individuals or entities from participating in Medicaid for a specified period of time if the entity or individual owns, controls, or manages an entity that: (1) has failed to repay overpayments during the period as determined by the Secretary; (2) is suspended, excluded, or terminated from participation in any Medicaid program; or (3) is affiliated with an individual or entity that has been suspended, excluded, or terminated from Medicaid participation.

    Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid. Requires any agents, clearinghouses, or other alternate payees that submit claims on behalf of health care providers to register with the State and the Secretary in a form and manner specified by the Secretary.

    Sec. 6504. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse. Requires States and Medicaid managed care entities to submit data elements from MMIS as determined necessary by the Secretary for program integrity, program oversight, and administration.

    Sec. 6505. Prohibition on payments to institutions or entities located outside of the United States. Prohibits States from making any payments for items or services provided under a Medicaid State plan or waiver to any financial institution or entity located outside of the United States.

    Sec. 6506. Overpayments. Extends the period for States to repay overpayments to one year when a final determination of the amount of the overpayment has not been determined due to an ongoing judicial or administrative process. When overpayments due to fraud are pending, State repayments of the Federal portion would not be due until 30 days after the date of the final judgment.

    Sec. 6507. Mandatory State use of national correct coding initiative. Requires States to make their MMIS methodologies compatible with Medicare’s national correct coding initiative (NCCI) that promotes correct coding and controls improper coding.

    Sec. 6508. General effective date. Requires States to implement fraud, waste, and abuse programs before January 1, 2011.

    Subtitle G—Additional Program Integrity Provisions

    Sec. 6601. Prohibition on false statements and representations. Employees and agents of multiple employer welfare arrangements (MEWAs) will be subject to criminal penalties if they provide false statements in marketing materials regarding a plan’s financial solvency, benefits, or regulatory status.

    Sec. 6602. Clarifying definition.

    Sec. 6603. Development of model uniform report form. To facilitate consistent reporting by private health plans of suspected cases of fraud and abuse, a model uniform reporting form will be developed by the National Association of Insurance Commissioners, under the direction of the HHS Secretary.

    Sec. 6604. Applicability of State law to combat fraud and abuse. The Department of Labor will adopt regulatory standards and/or issue orders to prevent fraudulent MEWAs from escaping liability for their actions under State law by claiming that State law enforcement is preempted by Federal law.

    Sec. 6605. Enabling the Department of Labor to issue administrative summary cease and desist orders and summary seizures orders against plans in financially hazardous condition. The Department of Labor is authorized to issue “cease and desist” orders to temporarily shut down operations of plans conducting fraudulent activities or posing a serious threat to the public, until hearings can be completed. If it appears that a plan is in a financially hazardous condition, the agency may seize the plan’s assets.

    Sec. 6606. MEWA plan registration with the Department of Labor. MEWAs will be required to file their Federal registration forms, and thereby be subject to government verification of their legitimacy, before enrolling anyone.

    Sec. 6607. Permitting evidentiary privilege and confidential communications. Permits the Department of Labor to allow confidential communication among public officials relating to investigation of fraud and abuse.​

    And from the reconciliation bill:

    Subtitle D – Reducing Fraud, Waste, and Abuse

    Sec. 1301. Community mental health centers. Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse.

    Sec. 1302. Medicare prepayment medical review limitations. Streamlines procedures to conduct Medicare prepayment reviews to facilitate additional reviews designed to reduce fraud and abuse.

    Sec. 1303. Funding to fight fraud, waste and abuse. Increases funding for the Health Care Fraud and Abuse Control Fund by $250 million over the next decade. Indexes funds to fight Medicaid fraud based on the increase in the Consumer Price Index.

    Sec. 1304. 90-day period of enhanced oversight for initial claims of DME suppliers. Allows a 90-day period of enhanced oversight and withholding of payment in cases where the HHS Secretary identifies a significant risk of fraud among DME suppliers.​

    What are the additional provisions you want to implement when you get the keys back?
     
  10. Meister
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    Meister VIP Member Supporting Member

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    Greenbeard, your posts are too long and I bet no one will read your entire posts :eusa_whistle: (just a heads up).
    But I think your saying we are on the path to UHC, and this I will agree with.

    PS....all those sections just looks like more bureaucracy. Why hasn't there been a fund for fighting waste and fraud already in place?
     
    Last edited: Jun 20, 2010

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