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Landmark Health Insurance Bill Passes House 1698

Posted by timothy
from the put-off-that-angioplasty-for-a-while dept.
theodp writes "A hastily-crafted amendment imposing tough new restrictions on abortion coverage in insurance policies helped pave the way for the House to approve the Democrats' bill to overhaul the nation's health insurance system. 'It provides coverage for 96 percent of Americans,' said Rep. John Dingell. Rep. Candice Miller disagreed, calling the legislation 'a jobs-killing, tax-hiking, deficit-exploding' bill. The 1,990-page, $1.2 trillion legislation passed by a vote of 220-215 and moves on for Senate debate, which is expected to begin in several days." Update — 11/08 at 13:45 GMT by SS: Changed vote totals above to reflect the actual bill vote. The 240-194 number was for the abortion restrictions amendment.
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Landmark Health Insurance Bill Passes House

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  • What's in it? (Score:5, Insightful)

    by serps (517783) on Sunday November 08, 2009 @09:04AM (#30020854) Homepage

    Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history.

    I'm not from the US, but isn't that the main bit of you guys' healthcare system that's most in need of fixing?

    In my country, pre-existing conditions just mean that you can't claim anything for 12 months after joining. It doesn't affect premiums or anything, and no health insurance provider can reject your application.

    So, I guess, welcome to the 20th century!

    • Re:What's in it? (Score:4, Interesting)

      by Igarden2 (916096) on Sunday November 08, 2009 @09:23AM (#30020948)
      Dude, get a clue !!! The bill has no provision that the recipient of health care be a legal resident. Regardless of protestations to the contrary, unwelcome aliens will take full advantage of the U.S. taxpayers. The bill does nothing to streamline the payment process which now sucks up a huge amount of premiums. The bill does not limit the insurance companies from denying coverage for any damned thing. True, they can't deny selling you a policy, but that policy can have lots of loopholes to deny specific conditions. There is no mention of tort reform. That alone is the main reason that many doctors and hospitals are going out of business in my state. This nightmare does not really improve our health care system. There are so many other provisions that could have been enacted to make the system better. Do you see any limitations on Big Pharma in this bill? Neither do I. I am in favor of an improved health system. This bill is not even close to an improvement.
      • Re:What's in it? (Score:5, Informative)

        by Igarden2 (916096) on Sunday November 08, 2009 @09:43AM (#30021076)
        I forgot to mention the ultimate hypocrisy in this bill. Every member of the legislature is exempt from the bill. They have their own luxury system that is fully paid for by the taxpayers for life.
        • Re:What's in it? (Score:5, Insightful)

          by Anpheus (908711) on Sunday November 08, 2009 @12:23PM (#30022536)

          Actually, the health insurance exchanges are very similar to the federal health plans. All federal employees are given a choice of option and able to pick what benefits they consider most affordable. Everyone in federal government gets these options.

          In addition, the government, being so large, has been able to negotiate terms like bans on "pre-existing conditions" out of many of the contracts, for the benefit of all federal employees.

          So, basically, this health insurance bill gives we, the people, the same health insurance options they have. That all federal employees have. And it gives us their protections, and potentially a public option in states where the local monopoly or duopoly has control of the market.

          How horrible.

      • by gordonb (720772) on Sunday November 08, 2009 @10:00AM (#30021228)
        You will pay for the health care of illegal aliens - period.

        Let me repeat that. Whether they come to the ER without coverage or are enrolled in a government subsidized insurance program, you will pay. At least, in the latter case, they will contribute something and, perhaps, get some earlier care that will avoid expensive hospitalizations.

        The bone-headed reflexive anti-immigrant nonsense that passes for debate in the US just saddens me. We really need to upgrade our educational system.
      • Re:What's in it? (Score:5, Insightful)

        by MrKaos (858439) on Sunday November 08, 2009 @10:11AM (#30021348) Journal

        Regardless of protestations to the contrary, unwelcome aliens will take full advantage of the U.S. taxpayers.

        Isn't that what U.S citizen do to Canada now? and wasn't America built on immigrant labor?

        The bill does not limit the insurance companies from denying coverage for any damned thing.

        Seems to me insurance company profits would be better spent on just providing health care.

        What happened to the nice America that looked after all her children?

        • Re:What's in it? (Score:4, Insightful)

          by commodore64_love (1445365) on Sunday November 08, 2009 @11:06AM (#30021836) Journal

          >>>Isn't that what U.S citizen do to Canada now?

          Uh... no. Canadian hospitals ask for ID, and if you wave a US license the hospital will refuse to serve you. The only exception is in cases of emergency (like a car accident), in which case the American will be handed a bill.

          >>>wasn't America built on immigrant labor?

          LEGAL immigrant labor. Illegals that were rejected at Ellis Island were sent back home. We have the right to control who enters our land, just the same as you can stop me from walking into your living room.

    • Re:What's in it? (Score:4, Interesting)

      by Trailer Trash (60756) on Sunday November 08, 2009 @09:55AM (#30021172) Homepage
      The issue is that many people won't buy health insurance until they need it. That fundamentally breaks the model because insurance depends on having a pool of healthy people paying but not costing anything. The legislation kind of makes up for that by forcing everybody to buy health insurance (with threats of jail or heavy fines if they don't), but ultimately that will screw poor people who don't have money to buy it.
      • Re: (Score:3, Insightful)

        by fredjh (1602699)

        Yes... and then that gets back to pre-existing conditions.

        You don't get in a car accident and THEN buy insurance expecting them to cover it. You're supposed to have insurance BEFORE something happens.

        All this (requiring insurers to cover pre-existing conditions) does is encourage people to wait.

        • Re:What's in it? (Score:5, Insightful)

          by Eskarel (565631) on Sunday November 08, 2009 @12:09PM (#30022402)

          The problem with that is that in the US system, if you're unemployed, unless you're also independently wealthy, you almost certainly will not be able to afford to maintain your insurance premiums. Self insurance is insanely expensive, most employed people wouldn't be able to cover it.

          This means that if John Smith is covered by his parents till hi finishes college, gets a job works hard and pays his premiums for 20 years, and then gets cancer and can't work(and therefor can't continue to make his insurance payments) he's screwed. If he passes that time limit and they're allowed to call it a pre-existing condition no HMO will cover him.

          It's one thing to say you can't get in a car accident and then get insurance to cover it, that's perfectly fair. It's another to say that because you lost your job, or your husband or wife lost their job through no fault of their own that you're not going to be covered even if you paid premiums your whole life.

          There are some pretty easy ways to solve patients rorting the system anyway. You can either make coverage mandatory and pay for it with taxes(which is what we do for our public health insurance here in Australia) or you can put a waiting period for hospital cover(which is what we do on our private insurance).

          The US pays an absolutely extraordinary amount for health insurance, far more per capita than pretty much any other nation in the world. Which is pretty damned impressive when you consider how many people in the country are uninsured. If you took all that money that everyone is paying, and pumped it into a public system, like the one which pretty much every western nation in the world other than the US has and runs reasonably successfully, you could have a top notch system with great coverage for everyone without anyone paying one dime extra. You could probably distribute the costs better and get some better efficiency and offer a great system and cut the expenditures it costs an awful lot to run an HMO after all, not even counting profits.

          That won't happen of course since the US is so desperately afraid of actually letting their government do anything actually productive with their tax dollars like actually offering halfway decent public services and would much rather pay for guns or bailing out wall street millionaires, but at the least this new system might not screw over people who just have bad luck.

    • Re:What's in it? (Score:4, Interesting)

      by WindBourne (631190) on Sunday November 08, 2009 @10:41AM (#30021616) Journal
      The interesting thing is that it really will fix nothing. All this did was offer up some competition to Insurance (not necessarily a bad thing), but will fund the indigent, which is mostly Illegal aliens here.

      What is really sad is that it had NOTHING TO LOWER COSTS. We are in need of tort reform (how much money is paid out for lawsuits); costs of the docs eduction; costs of the drugs; costs of the hospital; etc.

      What is amazing is that the neo-cons passed a monster drug bill to help buy old votes. Part of it required the feds to pay TOP DOLLARS for the drugs. Here is the American gov who passed a bill that would make the US federal gov the single largest buyers of drugs in the world, and the neo-cons forbid negotiations for LOWEST PRICE. This is expected to costs something like 400 BILLION dollars, instead of 50 BILLION over the ten years that it was looked at. This is a nice and easy 350 billion dollars to be save. So, did the dems include that in this bill? Nope. They are leaving us at paying the TOP DOLLARS for this.

      I swear, The only thing worse than a GD democrat is an elected republican. The republicans are about pure greed and corrupt. The dems are stupid. America is in serious trouble.
      • Re:What's in it? (Score:5, Informative)

        by internic (453511) on Sunday November 08, 2009 @12:25PM (#30022568)

        All this did was offer up some competition to Insurance (not necessarily a bad thing), but will fund the indigent, which is mostly Illegal aliens here.

        On what basis are you concluding that? A quick look suggests that a good estimate of the poor (by official poverty line) in the US is 39 million, while the illegal immigrant population may be something around 11 million. That says that at the most about a quarter of the poor are illegal immigrants, and that's assuming that all illegal immigrants are poor (which isn't strictly true, though I don't know how far off it is). In any case, the bill bars illegal immigrants [factcheck.org] from getting aid in buying health insurance, although it remains to be seen how that would be enforced.

        What is really sad is that it had NOTHING TO LOWER COSTS. We are in need of tort reform (how much money is paid out for lawsuits); costs of the docs eduction; costs of the drugs; costs of the hospital; etc.

        While the situation with malpractice suits may be unreasonable, it's probably not a major contributor to health care costs [factcheck.org]. It sounds plausible on the surface that it would be, but apparently the total expenditure on malpractice insurance is less than $7 billion per year, which is totally dwarfed by total healthcare spending (something like $2.5 trillion). The cost of doctors practicing defensive medicine is, of course, harder to pin down, but it sounds like most studies still peg it as small. In any case, the CBO is estimating the savings on healthcare spending from malpractice award caps at 0.5%. I think this gets talked about a lot by politicians because it sounds plausible, there are some legitimate problems with malpractice suits, and, most importantly, people making malpractice claims are a convenient scapegoat since most of us won't ever be one or probably even know one.

        In terms of the other costs I agree, though. We pay an absurd amount for drugs and a lot more for medical procedures than most other developed democracies. I'm not certain of all of the reasons for that, but the most likely major reason is that in most of those places the government collectively bargins with providers on behalf of all citizens, setting prices for drugs and medical procedures (even in many countries where insurance is still provided by private companies, like Japan and Germany). You can certainly debate the merits of such a system, but its one indisputable advantage is cheap prices.

        ...neo-cons forbid negotiations for LOWEST PRICE. This is expected to costs something like 400 BILLION dollars, instead of 50 BILLION over the ten years that it was looked at. This is a nice and easy 350 billion dollars to be save. So, did the dems include that in this bill? Nope. They are leaving us at paying the TOP DOLLARS for this.

        I don't know what the will was among the Democrats to change the rules on drug purchasing by the government, but I'm sure that even those who supported it would not have lobbied for inclusion in this bill only because this bill had uncertain prospects in the first place, so adding something else potentially controversial probably would have killed it. It's bad strategy. If they want to make that change, it should come in a different bill.

      • Re:What's in it? (Score:4, Insightful)

        by RiotingPacifist (1228016) on Sunday November 08, 2009 @01:07PM (#30023030)

        Why are bills so big and all encompassing?

        Somebody should demand they be split up and be resubmitted as individual patches!

      • Re:What's in it? (Score:5, Interesting)

        by Rick17JJ (744063) on Sunday November 08, 2009 @01:50PM (#30023454)
        My medical insurance has recently gone up to $995 per month, now that I have just recently reached the age of 55. That is almost $12,000 per year that I am paying for medical insurance, just for myself. That is with a $1,250 deductible and no dental coverage.

        I once tried to switch to a less expensive plan, but Blue Cross Blue Shield of Arizona would not let me switch. I have never had any significant health problems, other than being somewhat overweight and having very slight high blood pressure. It was only during the last year, that I finally needed to start taking a mild diuretic to lower my slightly high blood pressure. I am a non-smoker in good health who walks 45 minutes per day, wears my seatbelt, and does not eat junk food. Despite that, I need to pay 1/3 of my net take home income (after taxes) on Medical insurance. How much would I have to pay if I had more significant health problems?

        I would like to see more willingness for Congress to ignore the lobbyists, and work on the causes of it being so expensive such as tort reform, big pharma, and the insurance industry.

        Is this bill going to make my insurance less expensive, or perhaps subsidise my insurance?

        Our government is already spending way more than it collects for taxes, so is this something which our country can afford without having to inflate our money supply more or borrow even money from China and elsewhere? I seem to recall Nancy Pelosi claiming that they had found some way to pay for it all. I have not really been following the news closely enough to know about those details.
  • by betterunixthanunix (980855) on Sunday November 08, 2009 @09:04AM (#30020858)
    Maybe the US will finally join the rest of the industrialized world in actually providing medical care to its citizens, instead of taking the, "find your own care" attitude.
    • by ColdWetDog (752185) on Sunday November 08, 2009 @09:49AM (#30021116) Homepage

      Maybe the US will finally join the rest of the industrialized world in actually providing medical care to its citizens, instead of taking the, "find your own care" attitude.

      Not bloody likely. At least, not with this bill.

      But thank you for the kind thoughts. Check in again a a decade or so, maybe we will have managed to drop to third world status by then and even Congress will realize that something drastic needs to be done.

    • by nanoakron (234907) on Sunday November 08, 2009 @10:07AM (#30021306)

      Doesn't sound like they will.

      So this new bill leaves 4% uncovered - that's 4% of nearly 300 million people!

      Whereas the healthcare systems of all other civilised nations leave no-one uncovered. Not even the tramps in the street.

      NB UK NHS user here - Our system has its faults, but at least one of those isn't "Sorry, we can't give you that treatment because you can't afford it...so just hurry up and die."

      -Nano.

  • by BBCWatcher (900486) on Sunday November 08, 2009 @09:08AM (#30020874)
    The final vote was a lot closer: 220 to 215. Which seems like a mid-20th century vote total. It really is quite remarkable that, in 2009, in the United States, there's still widespread debate and disagreement over the proposition that health care should not be rationed on the basis of ability to pay.
    • Re: (Score:3, Insightful)

      The final vote was a lot closer: 220 to 215. Which seems like a mid-20th century vote total. It really is quite remarkable that, in 2009, in the United States, there's still widespread debate and disagreement over the proposition that health care should not be rationed on the basis of ability to pay.

      The reason that deciding who gets healthcare on the basis of ability to pay is that what when demand for medical services goes up, the best way to get more providers of medical services is to increase what they get paid. Under this law, how will they increase the number of medical providers?

    • Re: (Score:3, Insightful)

      by jcr (53032)

      It really is quite remarkable that, in 2009, in the United States, there's still widespread debate and disagreement over the proposition that health care should not be rationed on the basis of ability to pay.

      Yes, quite remarkable given the obvious failure of rationing by congestion, as you see in the UK and Canada.

      -jcr

    • by AlpineR (32307) <wagnerr@umich.edu> on Sunday November 08, 2009 @10:07AM (#30021308) Homepage

      The close vote is intentional. The leaders realize that this is a once in a generation opportunity to reform healthcare, so they're going to push that reform as far as they can. They could propose some really minor changes that everybody agrees with. They could propose some really radical changes that almost nobody agrees with. Or they could push the biggest change they could get without failing.

      As for the party split, the Constitution does not entitle all political parties to equal happiness. In a time when reality has a liberal bias, the wishes of the electorate are reflected in the composition of the legislative bodies. Aside from their role in achieving a majority of votes in Congress, the Republicans are no more entitled to appeasement than are the Greens, Libertarians, or Communists.

  • by Timex (11710) * <smithadminNO@SPAMgmail.com> on Sunday November 08, 2009 @09:09AM (#30020878) Journal

    Let's see... Buy insurance, or go to jail. It sounds like Massachusetts.

    How would this get paid for, I wonder? It's written by the same people that brought you "Cash for Clunkers" and the "Stimulus Package", and we know what came of THEM.

    The Senate isn't expecting to make a vote on their version until next year. Hopefully it will die a horrible death. This bill has no business at ALL being the Law of the Land.

    • by Teckla (630646) on Sunday November 08, 2009 @09:42AM (#30021074)

      How would this get paid for, I wonder? It's written by the same people that brought you "Cash for Clunkers" and the "Stimulus Package", and we know what came of THEM.

      When it comes to this recession, the first stimulus package happened on George W. Bush's watch.

      Also, Ronald Reagan passed a massive stimulus package as well. When inflation is factored in, it was larger than Obama's stimulus.

      Even factoring in the Obama stimulus package, the vast majority of U.S. debt was accrued under the watch of Republican presidents.

      Let's try to stay grounded in reality and realize that both dominant political parties in the U.S. spend too much. There is plenty of blame to go around. Partisan bickering is blinding Americans to the fact that the real problem is that the government is even allowed to spend money it doesn't have.

  • Oh sweet (Score:3, Insightful)

    by JimboFBX (1097277) on Sunday November 08, 2009 @09:24AM (#30020958)
    So surely this bill, which makes it illegal to charge more for being a woman, also makes it illegal to charge more for being a man with car insurance and life insurance. Right? I mean, god forbid the democrats come up with a good idea and poorly execute it or create unfair exceptions that favor special interest groups that voted them in like they always do. So who read more than 100 of the 1,990 pages of this thing before voting? How do you even summarize something so simply in a matter of a few paragraphs, then someone manage to bloat that to 1,990 pages? Obviously there is a LOT more to this bill than what has hit the press releases.

    Well, countdown until this article gets over a 1,000 comments and only the top few become the ones actually read...
  • by Jah-Wren Ryel (80510) on Sunday November 08, 2009 @09:25AM (#30020964)

    I'm of the opinion that even the current system of private coverage is fundamentally a violation of doctor-patient confidentiality. You've got these insurance companies just itching to monetize any piece of data they can get from their paying customers, such that the half-assed nature of HIPAA really provides no assurance that your medical information won't be used in one way or another that is ultimately against your well-being.

    The only way to be sure your information (any info, not just medical records) won't be systematically abused is to make sure it isn't entered into a file or a database in the first place. Unfortunately, there seems to be a real focus on doing just the opposite with these healthcare changes - some sort of magical computer worshipping cargo cult thing where too many people think that if they can just get all our personal info into a database it will be the best thing since sliced bread. I'm tired of sacrificing privacy for the promise of increased efficiency and convenience and I am doubly tired of those promises failing to pan out in the long run. But that's exactly what I expect is going to happen here too.

    • by TheGavster (774657) on Sunday November 08, 2009 @10:43AM (#30021642) Homepage

      Fuck privacy between you and your health insurer. You have no expectation that your history of leaving open flames unattended be kept from your home insurer, or that your history of reckless driving be kept from your car insurer. If you have an expectation to bill $10K/month in healthcare expenses, I as a fellow premium-payer would expect you to kick a bit more in the pot than I do, since you are certain to pull more out.

  • 1.2T = 120B per year (Score:5, Informative)

    by volt4ire (1131825) on Sunday November 08, 2009 @09:40AM (#30021060) Homepage
    Let's be clear: 1.2 Billion is the cost for 10 years, not 1 single upfront cost (like bailouts or emergency war funding supplementals)
  • by TheMonkeyhouse (1271112) on Sunday November 08, 2009 @09:42AM (#30021070)
    so health care reform bill has passed it first step - actually a move forward even if you dont like the bill, everyone (except the fat insurance companies) admitted that things had to change, and so this is a start. however, the amendment restricting abortion coverage is HUGE step backwards and another reminder just how much the lunatic Religious Right has taken hold in the US. Hopefully this does not force people into coat hangers and whiskey again. so close, but yet so far still to come.
  • by Danathar (267989) on Sunday November 08, 2009 @09:54AM (#30021160) Journal

    Just my prediction, but I think it will be taken to court and ruled unconstitutional (since the court is still majority conservative)

  • Unconstitutional (Score:3, Insightful)

    by Coolhand2120 (1001761) on Sunday November 08, 2009 @10:05AM (#30021292)
    Can anyone show me where in the U.S. Constitution it says the government can force you to buy health insurance? On this basis alone this bill should never have come to fruition. We have this thing call enumerated powers in our Constitution and nowhere does it say the government can compel anyone to buy health insurance just because they are alive.
    • by forkazoo (138186) <(wrosecrans) (at) (gmail.com)> on Sunday November 08, 2009 @12:33PM (#30022638) Homepage

      Can anyone show me where in the U.S. Constitution it says the government can force you to buy health insurance? On this basis alone this bill should never have come to fruition. We have this thing call enumerated powers in our Constitution and nowhere does it say the government can compel anyone to buy health insurance just because they are alive.

      Huzzah! If the government taxes me and provides a service, I'm okay with that. (Single Payer.)

      If the government says I must buy some service from a private company, then I am living in Gilliam's Brazil, and people should be shot.

      The insurance companies have no right to exist, and no right to my money. People say that increasing pool size will bring down costs, but the insurance companies will just pocket the savings. There is no reason to believe that they would reduce cost to consumers because you remove the key defining force of the market. Business must entice buyers to the market with valuable goods and services. Once you make purchasing mandatory, businesses no longer have to compete with the competetive market force of 'Fuck You.'

      • by quacking duck (607555) on Sunday November 08, 2009 @04:13PM (#30024600)

        Huzzah! If the government taxes me and provides a service, I'm okay with that. (Single Payer.)

        If the government says I must buy some service from a private company, then I am living in Gilliam's Brazil, and people should be shot.

        The insurance companies have no right to exist, and no right to my money. People say that increasing pool size will bring down costs, but the insurance companies will just pocket the savings. There is no reason to believe that they would reduce cost to consumers because you remove the key defining force of the market. Business must entice buyers to the market with valuable goods and services. Once you make purchasing mandatory, businesses no longer have to compete with the competetive market force of 'Fuck You.'

        I agree with the sentiment, but I'm pretty sure you're already forced to buy a service from a private company.

        Own a car? The liability part of car insurance required by law. And though some Canadian provinces manage auto insurance, I doubt your state does, forcing you to use a private company.

  • by jonwil (467024) on Sunday November 08, 2009 @10:56AM (#30021746)

    This is how I would fix the problems:
    1.Eliminate company health plans (the providers of these plans have little to no incentive to offer any actual benefits to the employees as the companies cant change to someone better due to lock-in contracts and the huge costs of changing, nor can the employees generally switch without paying a lot more)

    2.Give every citizen a certain amount of tax-free money they can use to buy health insurance. i.e. the first $x of their health insurance costs are tax free. This makes up for the loss of company health plans (which are generally tax free)

    3.Make it super-easy for people to switch to another health provider anytime they choose without penalty (i.e. if they switch to a similar plan from a different provider, the new provider cant suddenly deny coverage for all your pre-existing conditions just because you switched providers)

    4.All health care providers must charge the same amount for the same treatment no matter who is paying. If a hospital charges $2000 for a procedure to one person, they must charge the same $2000 to everyone who gets the procedure (no matter if its the government via medicare, a large health plan, a small insurance company, an individual paying out of pocket or whatever else). Obviously they can increase the price anytime they want but again they need to charge the same new price to everyone

    5.Take away all incentives for doctors and hospitals and others to order "unnecessary" tests (including a reform of medical malpractice law so that lawyers cant argue "I sue the hospital for $$$$$ for failing to carry out when carrying out would have saved my clients life/heart/kidney/good looks/whatever")

    6.Remove any laws and red tape that make it harder to start up a health fund. Making it easier to run one (and reducing the administrative costs) may encourage new players into the market who offer better value much the same as what companies like Jet Blue did for air travel)

    7.Remove any rules/laws/etc that in any way restrict what health insurance companies are allowed to offer coverage for. If an insurance company wants to offer coverage for prescription glasses (for example), they should be allowed to do so.

    8.Low income earners and the poor (who cant afford health insurance) would get subsidized cover. Not government run cover but money from the government paid to the individual to cover part or all of their health insurance costs

    9.Health insurance companies would be banned from doing deals with specific hospitals or doctors (i.e. "you will only get coverage if you go to OUR hospital"). Further to this, companies that own health insurers would be prohibited from owning any operation involved in the provision of health care (e.g. hospitals, drug companies, medical equipment makers etc). Also, Health insurance companies would be banned from dictating treatment terms to doctors (i.e. if you want us to give coverage for this heart operation, you will do it the way we specify)

    and 10.Health insurance companies would be required to disclose upfront how much they will pay on a given treatment before the treatment is carried out and they must pay up. No more cases of saying one thing before you go into hospital and then changing their mind and denying payment AFTER the patient has racked up the big medical bills.

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