Health care reform, Pros and cons?

Kelly - posted on 02/03/2010

Mary Elizabeth, that is kind of my point. You are trying to find a doc who will take medicare, and they can't afford to because the government doesn't pay for the costs. The doctors have to eat it, or pass it on to insurance companies. How many charity cases should they realistically be forced to accept? Why do you think this would get any better with a public option?

Laura, as far as debating what is on the table, what I said last night IS what is on the table. The reality here in the US is that the govt. run healthcare (medicare / medicaid) doesn't pay total cost. The proposal would pay medicare rate plus 10% which still falls short. Other than the so-called "doctors" that Obama trotted out on the WH lawn, many have been outspoken against the proposed bill, and for more than just reimbursement rates.

OB/GYN's, and other specialized doctors like surgeons, are being run under with overhead costs, largely malpractice insurance. Obviously, people are more apt to try to sue when something goes wrong during delivery, or a loved one dies in surgery whether it truely was malpractice or not. Those costs of course are passed on to patients, which is probably one of the main reason Sara's friend can't find PI that covers maternity for under $400 a month, and why its hard to find an OB/GYN that participates in medicare. Allowing the US government to control more of the healthcare industry is simply not the answer. There is a reason why government healthcare has failed for 70 + years. People as a whole are not going to swallow the b.s. being fed to them by politicians that don't care about the future.

http://online.wsj.com/article/SB12457138...
http://online.wsj.com/article/SB10001424...

Couple of articles that have bearing on the conversation.........

ME - posted on 02/03/2010

Just because you qualify for state funded health insurance does NOT mean that you can be seen by a doctor...I only thought it was difficult to find good docs when I had BC/BS, now, none of the ones who accept my ins. are accepting new clients, and NO ONE takes it for children...I will have to travel 45 miles through constantly grid-locked traffic (about an hour and a half drive one way) into the city of Chicago to get a doctor for my babies...offering it to people with no incentive for docs to accept is sort of pointless...Of course, we could have kept our BC/CS if we could have afforded to pay 500$/month for it, plus the co-pays, deductibles, prescription costs, and 10-20% that was left uncovered...clearly that isn't possible with no income...

As to hospitals not turning away the uninsured...that is true, and then they follow you around with multi-thousand dollar bills for the rest of your life, or until you can pay them back, destroying your credit...that works out real well for us folks who are currently down on our luck...

Isobel - posted on 02/03/2010

I believe you may be preaching to the choir...I think all we'll hear from the right for a while is the chirping of crickets... ;P

Sara - posted on 02/03/2010

Kelly--My friend/co-worker is healthy. She told met hat she has been unable to find a plan for less than $400/month for herself that would also inlcude maternity/well child check ups, since she and her husband want to try and have children soon, as they are both in their early 30's. Perhaps things are different in different states as far as plans available and the cost of them.

Isobel - posted on 02/02/2010

If we're just going to debate nonsense and silly predictions, instead of what's actually on the table and what's been said here...have a good night.

Kelly - posted on 02/02/2010

I agree with Linda that government takeover ( which is what public option is) will lead to decreased quality and higher costs. She is absolutely right about the reimbursement rates (medicare reimburses hospitals at 71% and private practitioners at 81% approx) which is part of what causes premiums to be as high as they are now. If a public option was instituted, the govt. would pay a proposed medicare rate plus 10% which is still less than actual cost. Public option would also destroy the private insurance market forcing more people onto the public so called "option". Why would businesses NOT drop their insurance coverage when they could get Washington to pick up part of the tab, and all of the administrative headaches? Once the private insurance market is gone, thats it. No more competition, and hundreds of thousands more people out of work to boot.

And you wouldn't have availability of doctors either. Many would be forced to shut their doors, or join consolidated medical groups. Financial penalties would be placed on primary care docs who refer to specialists. Surgeons and their equipment are where the big money is spent, and the govt. plan would be to reduce those costs by limiting their use. Many more people would be seeing physician's assistants instead of actual doctors too. So basically, its not as simple as "pass it now and work out the kinks later". Once this is passed, there will be no choice. The decisions made would be irreversible.

Linda - posted on 02/02/2010

Lack of universal coverage is not the same as lack of universal access. No hospital turns away the uninsured.

But, yes, I would like to see reforms made that address (truly) costs, rather than distorting them and just relocating them to a taxation problem rather than a premium problem.

What you are talking about with BCBS is an example of the free market at work -- BCBS screwed their doctors, and many dropped off their plans. My doctor doesn't take new patients under BCBS, because reimbursement rates are so low and even more difficult to get than normal. Luckily for me, since my family just got switched, they do grandfather existing patients!

But your mention of 30 million people -- I know from the workplace that some of those are voluntarily uninsured (young, healthy, don't find the premiums worthwhile to pay), and for the others, I'd rather have a more competitive free market answer than government takeover -- which will lead (yes, in my opinion) to increased costs not less, and decreased quality.

Kelly - posted on 02/02/2010

I know I have been gone for a while so I will be back-tracking, but there are a couple of things I want to touch on....... The first is a comment you made Laura about the 2 moms whose husbands were laid off..... part of the "unemployment package" is state run healthcare. Many people qualify instantly when they qualify for unemployment benefits. Granted, each state is a little different so some people might have different experiences than me or people I know personally, but generally if they qualify for unemployment pay, any children are automatically covered for a year, and pregnancy would definately be covered.

Sara, as far as your friend goes, I am not understanding why she cannot get reasonable health insurance. My husband is now considered a contractor, and we pay for our own insurance. I wanted a plan that covered 100% well baby check-ups for our 3 month old and 3 year old, and general coverage for myself and my husband. Yearly checkups are covered 100% and any other office visits have a $25 co-pay. For our family of 4 we pay $420 a month. That to me is quite affordable. My brother, a single guy that happens to be a stunt coordinator / crash dummy, pays under $100 a month for his private health insurance. How is it that your friend who I assume is healthy since you are using her as an example of a non pre-existing condition or poor person, cannot find a plan?

As far as comparing Canada to the US, its comparing apples to oranges. The point I was trying to make earlier was not that Canada's system wouldn't work in the US, it was that Govt. controlled healthcare wouldn't work in the US. If the majority of Canadians are happy with their Govt. run plan, good for them. I too have known or talked to many Europeans and Canadians that are not happy....... We could go back and forth forever on the horror stories in any country, so there really is no point of bringing any stories up here, all it does is disentigrate into he said / she said.

The GOP has offered up many ideas on how to make healthcare better without raising taxes, debt or costs.
http://gopleader.gov/UploadedFiles/Summa...

Simple PDF from the gop.gov website outlining their ideas, and showing the differences between those ideas and what is in Pelosi's nightmare of a health bill.

ME - posted on 02/02/2010

"The problem is, I think we have superior healthcare to nearly any other country you can name. The statistics where we fall down the list on rankings is when coverage is included -- but as far as quality of healthcare, we are tops or near top in nearly every case."



Just for the sake of argument...this "statistic" is the only one that matters to those of us without insurance for ourselves and our children! A public option would have solved this problem for around 30 million people (give or take a couple million). That's 30 million human beings...how is the answer to this question NOT obvious to EVERYONE!!! WE NEED A PUBLIC OPTION!!!! And yes, I held this position for YEARS before my husband lost his job and our insurance...



Speaking of availability of docs...When I had Blue Cross/BS PPO, Ins...(for the last 6 years)...I had a terrible time finding gp's, ob's, and and pediatricians under (what should have been) some GREAT ins. coverage...Not that there weren't any...but there certainly wasn't a large pool of qualified individuals to choose from...I had 1 choice of pediatrician(luckily, I loved her), and 3 for OBs...for a GP I had to drive about 30 min outside of DENVER, CO to find one I liked...because the only one offered by my insur. in a MAJOR CITY was a d-bag! I don't see how a public option could possibly make this worse!



I am of the opinion that there was enough good stuff in this bill that passing it, and ironing out the problems as we go, was the ONLY option by which we could be potentially saving the lives of the uninsured; obviously, that should be the most important issue in HEALTH reform...

Sara - posted on 02/02/2010

I think part of the problem has been that they haven't really been open in the proceedings for this bill, and trying to read it is like trying to read a stereo manuel. They haven't gone out and sold the bill to the people and haven't really been specific about what is contained in the bill and how it would help/change healthcare in this country. That, combined with the campaigns of misinformation sponsored by drug companies and others whose best political interests are served to defeat healthcare reform, has just lead to a HUGE mess. That's my take on the whole situation, anyway.

Isobel - posted on 02/02/2010

Name me a country (or state) that does not have a shortage of GPs? That's not a problem with the medical system (other than the fact that all the specialists get paid more) and the shortage of gynos (everywhere) is because of sky high insurance rates.

You are right...it is extremely complex...but there is lots of time to tweek. I say start with the obvious...fine tune the gears as you go.

Linda - posted on 02/02/2010

Understood, Laura. And I have to admit, I do use my perception of Canada's and UK's system to know I don't want that system here - fairly or unfairly so. Statistics and figures can be made to say anything, and anecdotal evidence is just that. But my version of common sense lends me to believe some things over others, so when I hear about Massachusetts universal coverage, but also their critical shortage of family physicians, that part of my brain goes, aha, see, there you go, because it supports my position. It is a complex issue, and any action may have unforeseen consequences. I'm not devaluing the real stories of hardship -- I'm just saying "fixing" those may spread greater pain to many others.

Isobel - posted on 02/02/2010

I'm sorry Linda...there have been many posts here in the past that spread MANY lies and propaganda about our system...it just appeared that you were headed down the same path. When discussing America's healthcare system, it's best to talk about AMERICA'S health care system. I have learned that the hard way ;)

Sara - posted on 02/02/2010

I was just talking this morning with a colleague here at work who is completing her PhD in April. She is an optometrist, her husband is an attorney who specializes in insurance law and after she has completed her PhD she will have no insurance. She can pay $400/month to get on her husband's insurance (his company does not offer insurance for spouses, yet they deal with insurance every day...go figure) or she can pay even more to get COBRA. So, it's not just the poor here in the US that can't get affordable health insurance or even people with pre-existing conditions. I have many friends who are Optometrists as well and they are considered self-employed and they pay out their butts every month for health insurance. So something clearly needs to be done to get affordable health insurance to everybody, 'cause it's not just low income folks that need it. And the alternatives that Republican's have offered to the bill don't address this, as a public option would have. I hope for a single payer system, but I doubt it will ever happen in the US..

Linda - posted on 02/02/2010

Uhh, I've made three posts. I didn't think any were attack'y in nature, at all.

And yes, I did see one where you said not for America -- but I am new to this topic, so if you've said it multiple, multiple times, I haven't seen all those entries, true. I do appreciate your understanding that it would not be a preferable system here, and wish some of our government officials shared that knowledge!

I am aware of the two-tier system (UK has that as well), but I don't find that desirable either -- although the likely result of a single payer system.

And as far as who has recommended it for us, I believe some of current politicians have, and if it wasn't for the wonderful voters of MA, we'd be well on our way! (MY opinion, not yours!)

Isobel - posted on 02/02/2010

I don't think saying off-handedly once that he liked single payer systems is necessarily being very much on record that he wants one for America...Countries that have them are very happy with them, but they evolved differently from America. Your country, my friend, is an entirely different animal.

What you may not realize is that in the last couple of years...Canada has a two tiered system, so now the wealthy can go to a private clinic and pay extra for faster service (I think this should alleviate any burden on your system :) )

FOR THE LOVE OF GOD!!! Who has recommended it for you??? How many times do I have to say...NOT for America!

I have read all of your posts carefully, asked reasonable questions, and conceded points where you have made good ones. You, however, seem to be on the attack mode.

Linda - posted on 02/02/2010

Who is not recommending government run healthcare? President Obama is very much on record saying he hopes ultimately for a single payer system, and if the current proposals passed, it is a step more in that direction than away from it.

As far as happy/unhappy Canadians, I think Paul Krugman learned watch the audience when he asked the question how many were happy -- expecting a majority show of hands, and instead got none. Fine, you trot out your friends, I trot out mine -- I point to Canadians coming across the border for treatment, you point to .. whatever it is you want to point to. It's your system, you're welcome to have the system you want -- but I am welcome to not want it here in America! (And I decidedly do not!)

As far as your paying more for less -- that's exactly what I think of Obamacare! It would be paying more for less!

In the words of Heinlein, TANSTAFL -- There ain't no such thing as a free lunch!

Isobel - posted on 02/02/2010

He's not recommending Gov't run health care....and anecdotal is right. I have been working very hard here not to just start singing the praises of my system and to keep the topic where it belongs...if you insist on continuing to put other systems down you will be inundated with responses to prove you wrong.

And we have two American members of this group who have debated on the topic of healthcare before...both of whose husbands were laid off (one needs to get her son an operation so that he can walk, and the other is due any time now)...neither of them can get any help because of pre-existing conditions.

Explain to me please...how paying more for less makes sense (assuming of course, that you are not one of the ones that already has theirs)

Linda - posted on 02/02/2010

Kelly, thank you for making my points better than I can myself! :)

The problem is, I think we have superior healthcare to nearly any other country you can name. The statistics where we fall down the list on rankings is when coverage is included -- but as far as quality of healthcare, we are tops or near top in nearly every case.

Our survivability and mortality rates among our uninsured are about equal to Britain's insured.

So, government provided healthcare will NOT enhance quality.

What I would like to see are solutions that provide true cost reforms, but preserve the quality of our system. There is no provable way that government run healthcare does that, and many counter examples.

As far as what we spend as a nation on our health as a percentage of GDP - I ask you, isn't spending for a quality system to a certain extent a good thing? One thing that drives up our costs are the multiplicity of high-tech equipment. Well, okay, but if my child needs an MRI for something, I don't want to wait two months -- I like a system with many (albeit costly) MRI machines around, so I can get him scheduled quickly. One thing we have to face as a nation is that quality healthcare is going to carry a high price tag -- and then do what we can to manage within that system but without reducing our quality.

Thank you, also, Kelly for pointing out that insurance companies, despite being demonized during the political season on healthcare, make a paltry 2-3% bottom line -- far, far behind many other industries! They are not "raping America" as is commonly portrayed!

By the way, I disagree that Canada's system "works for them". I know many disgruntled Canadians (anecdotal, I know), plus look how many sessions their parliament is struggling with costs in health care and how to reduce (which means taking away benefits from their population).

Isobel - posted on 02/02/2010

well...the government already has the poor (medicare?), they also already have the old (medicaid?)...so subsidizing the high risk (as Linda Webb suggested) is simply lumping the sick onto the pile as well.

Obama has already said that they are working on Tort Reform... what other reforms has the GOP recommended?

I believe that you are correct about the pharmaceutical companies...they have FAR too much power in your country and should be a large part of the reform.

I, for one, have never heard anybody suggest that Canada's system would work in America...it wouldn't. The only comments I have EVER made in regards to Canada's system is to correct the lies that certain groups in the US have spread about our system.

Kelly - posted on 02/02/2010

I don't think Linda was saying put the poor, sick and old in the hands of the government..... she said govt. SUBSIDIZING for high risk pools, and the expansion of them. Currently 33 states have some type of high risk pool insurance, and most of them are privately run, not run by the state government. If all states offered pools, and the additional costs were subsidized for those who couldn't afford the added expense, it would go a long way to helping people like Alisa. State laws cap rates, usually between 125-150 percent of the base individual market rate........ That is not unreasonable considering high risk people with pre-existing conditions are going to the doctor and requiring more medical treatment than the average healthy individual. This would not bankrupt the country, or the individual.

The other points she made, have been made by others on this forum (including myself) as well as the GOP. Why no one is listening to alternatives to government run healthcare is beyond me........ the point I think Linda is trying to make (and by all means Linda, correct me if I am wrong) is the same point I will reiterate. Healthcare needs to be reformed, but it doesn't necessarily have to be under government control. The saying "there is more than one way to skin a cat" is a perfect analogy here. There are many options for reform, and before we rush to pass a beast of a bill, we need to be responsible enough to completely examine all options. Just because Canada's system works for them, doesn't mean the US government should control our healthcare.

*and for the record, insurance companies don't make huge profits. The most profitable sector of healthcare is drug companies, but Obama isn't pushing them since they have shown support for his healthcare bill.....*

Isobel - posted on 02/02/2010

The only problem I see with that is...putting all the poor sick and old people in the hands of the government while leaving all the normal people out in the private sector will TRULY bankrupt your country and is EXACTLY what the insurance companies want. Profits will go through the roof (and so will your taxes).

Insurance DOES cost less if you don't do drugs, smoke, drink, skydive, etc)

Linda - posted on 02/02/2010

Here's the true health care reform I'd like to see:

Refundable tax credits for each family, so they can get insurance through their work or in the private market, whichever suits them best, and have the same tax treatment. Another advantage to this: begins the process of decoupling jobs from insurance, which should not be linked.

Tort reform to truly reduce costs and stop some of the costs inherent in defensive medicine.

Creation of neighborhood or statewide pools that are subsidized for the high risk market. (Here's where government support can really be of value!)

Insurance pricing/incentives for controllable behavior and choices. (My life insurance costs less if I don't smoke, why shouldn't my health insurance?)

Insurance models that increase patient knowledge of costs and encourage comparative shopping for medical services. Amazing what having a little skin in the game will make a person with a headache go, do I really need that MRI (and if the headache is bad enough, the answer will be yes),

Alisa - posted on 01/12/2010

Amie, you are so right. Anything passing will give us a road to follow toward additional benefits being added later. And strangely enough, my husband is Canadian. He was born in Markham and grew up in Vancouver after 6th grade. His parents now live in St. Catharines. And I use them quite often in my responses to Republicans spouting lies about Canadian healthcare for which they know nothing about. As much as Canadian healthcare my have it's flaws, our system has so many more.
Thank you so much for your comments. It means a lot that someone with some sense is listening. I still have Republicans tell me that I must be lying about my story because that "really" doesn't happen to people. Really? Really? It does!!!! And boy will they be in for a rude awakening when it happens to them. I bet most of them will be screaming for Medicare for Everyone when that happens.
All I want is a public option, that's all I'm asking for, and it looks like that won't be a part of the bill. I'm holding out hope till the end. But, as long as something passes, it'll be better than nothing.

Thanks again!!!!!

Amie - posted on 01/12/2010

Alisa your story saddens me. =( I can't imagine living that way. I don't think it's right or just. I don't believe medical care is a privilege. I'm also Canadian though so have known no other way. Our government passed UHC is the sixties.



My biggest peeve about the misconceptions is that a good majority of people think we are being taxed to high heaven JUST for health care. We're not. Only 9% of our income taxes paid go towards health care. Our system is complex though, we also pay GST and PST (for certain things). But we also have a lot of social programs that our money is used for. In total though out of all our tax dollars that my husband and I pay $3,600 go towards health care. For a family of 6 that's not bad for an entire year. We also have extended benefits, which are something else, through my husband's work. It covers our dental, eye, prescriptions, etc. For my husband and myself 80% of that stuff is covered. The rest is out of pocket. Our kids are 100% covered. (but I'll be honest. I haven't looked into if that's because of our coverage or because our province has it set up that dental, eye, prescription, etc. is free for youth under 18.) Which isn't much in the end since we get our check ups done once a year. Preventative care drives costs down! I truly fail to see why this is a hard concept to grasp.



Interesting story. When I was 19 my doctor (during my yearly physical) found pre-cancerous cells (which are different from abnormal cells but they test for those too). I got treatment, it was gone within the 1st year. I was tested every 6 months after that for a period of 2 years. It hasn't come back in any form. I still get my yearly physical but all is right in my world. If I had been in the states and couldn't afford coverage I hate to think what would have happened if I had not been getting my yearly physicals. It might not have been caught before it was full blown cancer, it might not have been caught until my life was nearly over, I don't know. But it is a reality for many people. They don't have preventative care so they wait for reactive care. Which then costs a whole lot more because of the procedures, the tests and the medications.



I hope reform is passed. Something needs to be done. It doesn't have to be perfect, it just needs to be something put in place so you (americans) can use it as building blocks to get to a "perfect" system that works for your country. As it stands, it's not working for too many people.

Alisa - posted on 01/12/2010

I read through it constantly and continue to see more good things and more bad things. I write about it on my examiner page as often as I can, but most just don't want to discuss the facts of the actual bill, they only want to discuss the lies brought forth from both sides about what they "think" is in the bill. It's very frustrating.

My bottom line is this. I am one of those with a pre-existing condition. It's not life threatening, it's not cancer or anything of the sort. It's something we have to watch and treat, but not a huge expense. $2800 a year for a CT scan and 1 prescription per month. So, overall not a huge expense for the insurance company. BUT, they denied me healthcare when my husband lost his job in '05. When he found a new job I was covered and Great West Healthcare was awesome. BUT, he changed jobs recently and CIGNA refused to cover me, despite being covered by GWH. Finally, after having no coverage for 9 months, they agreed to cover me but for $1200 a month. JUST FOR ME. We pay a total of $1600 a month for me and my 2 sons. My husband's HC is paid for by his company. Ultimately, I am being gouged by CIGNA, extorted really, and they WON'T even cover the pre-existing condition they're gouging me for. It's ridiculous. I am paying a fortune for something they won't cover. It should be criminal.
And you're right, there's nothing in the new bill that requires these companies to offer us coverage at a "reasonable" price if we have pre-existing conditions. They can still charge me $1200 or $12,000 a month, and if I can't pay it I'll be fined for not having the insurance coverage.
So, I think the government must be required to provide a public option for me to buy into as an option if this is the situation I'll be faced with. It's the right thing to do. The gov't shouldn't be able to require us to have something if they're not offering an equal option.
But for others like me, this bill, in any form MUST be passed. Most of the things passed by our government aren't fabulous at first, but grow and expand as needs of the people grow and expand. So I can only hope that this happens once it is passed. We are crazy not to offer a public option. And everyone I know is willing to pay for it. I don't want FREE healthcare, I just want an option of healthcare that won't financially ruin my family. We are not able to save any money, pay down our debts or our mortgage because we pay so much for insurance and then still pay $20,000 per year on top of that for additional medical expenses (co-pays, and items the insurance co. won't cover. We have a ppo, so we still have to pay between 20-50% of everything we have done).
Some form of healthcare reform must be passed for the good of all of us. And believe me, when you or someone in your immediate family is denied, you'll wish you had a public option as well.
Just my 2 cents.

Amie - posted on 01/05/2010

The section about enrolling in medicaid is for NON-elderly people that make below 133% of the poverty level. Assistance will be given to states to help cover the costs of those patients.

The way I am reading now about insurance (not just the public option but all insurance) is that what coverage/policy a person has before the bill in enacted they may keep. They will not have to conform to the new laws if your coverage is "grandfathered" through nor will they be eligible for tax credits. Since it will still be a market open after the bill is enacted people are free to choose which health plan they want with who BUT it will be mandatory all citizens have (at least) a minimum benefit health insurance with penalties given to those who do not have any insurance.

Pre-existing conditions will be wiped. Though I have yet to see any language that suggests companies can not charge through the nose to people who need insurance and have some type of pre-existing condition. I think that needs to be done. Especially with the BS insurance companies come up with. (case in point, abused women are a pre-existing condition pfftt)

Investment in Community Health centers will help with expanding health care access in areas that need it most.

Medicare as it stands reimburses based on quantity of care rather than quality. The bill includes a number of proposals to move away from this to so that quality care is given and help drive down costs for those on medicare. (Instead of doctors being paid for performing multiple tests and screenings which may not have anything to do with a patients condition)

Co-pays and deductibles will be eliminated for recommended preventative care. Including preventative care for women, providing people with information to lead healthy lives, improve education on disease prevention, and invest in a national disease prevention and public health strategy. Also including emergency services, hospitalization, physician services, outpatient services, maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, and mental health and substance abuse services.

Drug discount program will be expanded so that patients at children's hospitals, cancer hospitals, rural hospitals and under served areas will have access to lower cost drugs.


Still reading... I'll post more as I come across interesting points. =)

Amie - posted on 01/04/2010

Ok I found this funny. I'm not done reading either of these but the Democrats and Republicans have both put forth their own summaries on the bill. Lord help me... it's like children who try to tell you different versions of the same story. pfftt....

Anyway...

Democrats summary can be found here:
http://dpc.senate.gov/dpcdoc-sen_health_...

Republicans summary can be found here:
http://rpc.senate.gov/public/_files/L28H...


The Democrats one has the full text of the bill included. The republican one is from December 2nd but is the most current I can find of that party putting forth a summary. I'll keep looking though.

Kelley - posted on 01/03/2010

Seems as though there's alot to lose in these pages. Free health care, not so, mandatory health ins. without a whole of specifis....unless you count limitations and penalties as specifics.

It really bugs me that the emphasis is more on prohibiting or limiting factors rather than the services being offered.

Seems to be more details for grants monies.



I'm also aware that they've said all the details aren't in yet, but that should be presented to us before such a push for a huge $$$ bill.