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To: Neeka who wrote (13924)	10/26/2003 2:06:11 PM
From: LindyBill	Respond to of 793917

I alluded to my co-pay when talking about Health Care this morning. I pay $10 and that encourages me to use it more often. What co-pay is the right balance? I suspect right now it is $20. Look at this quote. "If you make people pay more for their health care," said Uwe Reinhardt, a health economist at Princeton, "all you are doing is rationing health care according to income Another Socialist Economics Professor at Princeton. Everything is "rationed" by ablility to pay. _________________________________________________ October 26, 2003 CO-PAYING THE PIPER Do Some Pay Too Little for Health Care? By DAVID E. ROSENBAUM - NEW YORK TIMES WASHINGTON — Consider what would happen if employers paid for their workers' car insurance and if that insurance covered routine maintenance. No doubt, the cars would spend a good deal more time in the shop, and the price of repairs and the cost of auto insurance would skyrocket. By the same token, some health policy experts say, Americans see doctors more often, have more procedures and take more medicine than they need because most, if not all, of the cost is covered by insurance. "When consumers don't have to pay any regard to price, they overconsume," said Kate Sullivan, director of health policy at the United States Chamber of Commerce. "You get more value for what you buy when you have a stake in it." But there would be another consequence if people's cars received more service: they would run a lot better and last a lot longer. This analogy may also apply to health care. "People who have affordable and good health insurance get good preventive care and treatment when they need it," said Christine Owens, a health policy specialist at the A.F.L.-C.I.O. "People who don't have good, affordable health care delay treatment and are in poorer health." The question of whether Americans should have to pay more of their health care expenses out of pocket has become a central one in labor negotiations and in the political debates here and in state capitals. More than 80,000 supermarket workers are now on strike in California and four other states over proposed cuts in their medical benefits. Transit workers in Los Angeles and garbage workers in Chicago also walked out this month over changes in their health insurance. Workers at Verizon and the Big Three automakers agreed to much smaller pay raises than they might have expected this year so that their contracts would retain health plans allowing them to pay little or nothing for comprehensive health coverage. In Congress, negotiators are struggling over what the elderly should pay if prescription drugs are covered under Medicare. They are considering charging people who are on Medicare for part of the cost of home visits by health aides. Faced with spiraling costs for Medicaid, the federal-state health insurance program for the poor, many states have begun requiring low-income adults and the parents of children covered by the State Children's Health Insurance Program to make co-payments when they receive medical treatment. "The public is more worried about their rising health care costs than they are about anything else — even about their mortgage payments or whether they will lose their savings in the stock market," said Drew Altman, president of the Kaiser Family Foundation, which conducts opinion polls about health matters. But many economists, liberals and conservatives alike, have concluded that health costs will continue to rise out of control unless patients are required to pay more out of pocket for the services they use. "As we've moved away from managed care as a cost-control device, we have no choice but to move to higher deductibles and co-pays," said John F. Holahan, director of the Health Policy Center at the Urban Institute, a research group in Washington. The latest Kaiser study shows that workers are dipping into their wallets more often these days to meet medical expenses. Since 2000, the average annual cost of insurance premiums has risen to $9,068 from $6,230 for family coverage, and the worker's average share is now $2,412, up from $1,619, an increase of nearly 50 percent. Co-payments (what patients pay out of pocket for each service) and deductibles (the annual amount people must pay before insurance kicks in) have also risen. What insured workers actually pay for health care varies widely. The average deductible is $275 for people in preferred-provider organizations, the most common type of health plan, but for workers in small companies, it is almost $500. Co-payments for doctor visits range from $5 to more than $25, depending on the plan. But in almost all cases, the expense is not so great that workers change their behavior — not enough, say, for most patients to ask doctors in advance what they charge. Jonathan Gruber, an economist at the Massachusetts Institute of Technology who was a deputy treasury secretary in the Clinton administration, argues that to limit overuse of health care, people should have to pay enough of the cost out of pocket that it pinches. Perhaps poor people should be exempt from cost sharing, he said, but "people with union contracts are affluent enough that they can afford some co-pays." Some economists disagree with Mr. Gruber. Market principles do not apply to health care, they say, because most people believe good health is priceless. "If you make people pay more for their health care," said Uwe Reinhardt, a health economist at Princeton, "all you are doing is rationing health care according to income. People like you and me would continue to get all we want, and those without means would have to do without." Some economists who are comfortable with the principle of making people pay more are not sure how much it would take to keep overall costs down, because all insurance plans would still cover catastrophic expenses. A large proportion of total costs are attributable to a relatively small number of people who are very sick, and their bills generally exceed the ceiling on catastrophic expenses. There is no conclusive evidence that people's health would deteriorate if they were charged more for care. Mr. Gruber said he was convinced that "the health gains" from generous health insurance "are not large enough to justify the additional costs in aggregate." But Mr. Reinhardt was skeptical and fell back on the auto insurance analogy. "When I was young and could not afford regular maintenance, my cars constantly broke down," he said. "Now my cars run forever." nytimes.com

To: Neeka who wrote (13924)	10/26/2003 2:55:03 PM
From: KLP	Read Replies (1) \| Respond to of 793917

Nancy Peloski is allowing the immigration laws to be broken ....People like her moan and groan about terrorists, but when it comes to actually trying to do something about the situation....nada. Here's a run down on who supports her.....Note the Top 10 in EACH list!!!!! opensecrets.org R E P R E S E N T A T I V E (D - CA) Nancy Pelosi 2003-2004 Total Receipts: $832,444 2003-2004 Total Spent: $600,178 Cash on Hand: $279,365 Debts: $0 Date of last report: September 30, 2003 First elected 1987 Next election 2004 HOW TO READ THIS CHART: This chart lists the top donors to this member of Congress during the current election cycle. The organizations themselves did not donate, rather the money came from the organization's PAC, its individual members or employees or owners, and those individuals' immediate families. Organization totals include subsidiaries and affiliates. Typically, members of Congress draw their contributions from two main sources: PACs and lobbyists who give because of the member's position on key congressional committees, and local companies, unions and other organizations from their home district. Challengers tend to rely more heavily on home-state donors, since most PACs put most of their dollars behind incumbents. NANCY PELOSI (D-CA) Top Contributors 1 E&J Gallo Winery $36,000 2 Akin, Gump et al $12,000 3 American Fedn of St/Cnty/Munic Employees $10,500 4 Chicago Board Options Exchange $10,000 4 Gap Inc $10,000 4 Machinists/Aerospace Workers Union $10,000 4 Sallie Mae $10,000 4 Service Employees International Union $10,000 9 MacKenzie Patterson Inc $8,000 9 State of California $8,000 11 JP Morgan Chase & Co $6,500 12 Credit Union National Assn $6,000 12 Holland & Knight $6,000 14 Air Line Pilots Assn $5,000 14 American Postal Workers Union $5,000 14 Bricklayers Union $5,000 14 Carpenters & Joiners Union $5,000 14 Copeland, Lowery & Jacquez $5,000 14 Deloitte Touche Tohmatsu $5,000 14 Intl Brotherhood of Electrical Workers $5,000 14 Laborers Union $5,000 14 Metropolitan Life $5,000 14 National Air Traffic Controllers Assn $5,000 14 National Assn of Realtors $5,000 14 National Cable & Telecommunications Assn $5,000 14 National Education Assn $5,000 14 Natl Assn Insurance & Financial Advisors $5,000 14 Operating Engineers Union $5,000 14 Plumbers/Pipefitters Union $5,000 14 Sheet Metal Workers Union $5,000 14 Teamsters Union $5,000 14 United Auto Workers $5,000 88888888888888888888888888888888 NANCY PELOSI (D-CA) Top Industries The top industries supporting Nancy Pelosi are: 1 Lobbyists $49,000 2 Retired $48,550 3 Misc Finance $48,000 4 Lawyers/Law Firms $40,000 5 Beer, Wine & Liquor $38,268 6 Transportation Unions $36,500 7 Building Trade Unions $35,500 8 Securities & Investment $34,500 9 Real Estate $34,050 10 TV/Movies/Music $31,500 11 Public Sector Unions $26,500 12 Industrial Unions $26,000 13 Insurance $22,250 14 Misc Unions $17,500 15 Commercial Banks $13,500 16 Health Professionals $13,250 17 Business Services $13,000 18 Computers/Internet $12,220 19 Non-Profit Institutions $12,000 20 Printing & Publishing $