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In case you missed the result of the vote, the health-care reform bill passed late Sunday night, and Obama promises to sign it ASAP. Obama makes some comments here (YouTube video).
Some of the main points as I understand them:
Summary: A few tweaks to existing rules rather than real reform. That is, we don't get the "Public Option," and we certainly aren't approaching single-payer. We don't get new competition in the health-insurance industry, because they retain state-based dominance rather than the kind of interstate competition one sees in other insurance types. Insurance companies will get richer, plus now they'll cite this law as a reason to raise rates. And it won't help anyone for years to come.
An LJ-friend gives 10 reasons for real healthcare reform. Great ideas, and what reasonable person would argue with this? Still, we won't see such an option as long as the Republican party is able to continue convincing people that enriching insurance companies is our patriotic duty. Oh, and the Repubs are screaming about how they'll make a big deal out this in November. I hope they do, because, seriously folks, what kind of whackadoo thinks this bill is a "Federal takeover" of any kind? If anything, it's a boondoggle for insurance companies.
In short, last night's passage of the bill is a win for Obama - and a loss for the do-nothing Republicans - and that's cool. It's a bunch of much-needed improvements to the current system. It will help a lot of people stay healthier without going broke. And those are all good things. So I applaud.
Chris
Some of the main points as I understand them:
- Everyone must have insurance; if you choose not to, you pay a $700 fine. Weird and nanny-ish, but is designed to encourage more healthy young folks to add their low costs to the insurance pools (and presumably help fund Federal expenses).
- If you're poor, you get to opt-in to Medicaid. Not sure if you can opt out while avoiding the fine.
- If you make a little more, the Feds help you buy insurance.
- If you're a company with 50 or more employees, you must provide health insurance to them or pay a fine.
- If you're an employee whose workplace doesn't provide insurance or if you don't have a job, state-limited, private insurance will become available through state-based "insurance exchanges."
- Insurance companies must cover young folks under their parents' plans even after they move out (until age 26). I presume this helps keep young people in the insurance pool without having to fine them.
- Insurance companies can no longer deny healthcare based on pre-existing conditions.
- Out-of-pocket Medicare drug expenses will gradually drop.
- Federal money cannot be spent on abortions except in special cases (and because of the subsidies, this means no insurance can cover it). Not sure why this was such a battle: Does current insurance cover abortion? And who gets so many abortions that they need insurance to cover it?
- New taxes on the super-rich and on healthcare plans worth more than many people earn in year will help pay for the reforms.
- Studies show these reforms will save great big gobs of money and reduce the deficit over time.
Summary: A few tweaks to existing rules rather than real reform. That is, we don't get the "Public Option," and we certainly aren't approaching single-payer. We don't get new competition in the health-insurance industry, because they retain state-based dominance rather than the kind of interstate competition one sees in other insurance types. Insurance companies will get richer, plus now they'll cite this law as a reason to raise rates. And it won't help anyone for years to come.
An LJ-friend gives 10 reasons for real healthcare reform. Great ideas, and what reasonable person would argue with this? Still, we won't see such an option as long as the Republican party is able to continue convincing people that enriching insurance companies is our patriotic duty. Oh, and the Repubs are screaming about how they'll make a big deal out this in November. I hope they do, because, seriously folks, what kind of whackadoo thinks this bill is a "Federal takeover" of any kind? If anything, it's a boondoggle for insurance companies.
In short, last night's passage of the bill is a win for Obama - and a loss for the do-nothing Republicans - and that's cool. It's a bunch of much-needed improvements to the current system. It will help a lot of people stay healthier without going broke. And those are all good things. So I applaud.
Chris
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http://www.nytimes.com/2010/03/22/your-money/health-insurance/22consumer.html?hp
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From: (Anonymous)
Socialism begins in America
Mark
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Re: Socialism begins in America
Okay, with that out of the way, I would love to hear what about this plan is against the goals of today's Republican Party? This reform is a huge boon to insurance companies, and the Republican Party is all about Big Money. The only way this would have looked even remotely like "socialism" is if the Public Option had survived or if we got Medicare for Everyone. Far from it.
So please enlighten me about why the right wing is against this - except that it's a victory for the Democratic Party and, specifically, for Obama. Because that's the only thing I can see.
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On the plus side, you might be able to get on your parents' plan sooner....
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Not any studies worth believing, and I've been analyzing legislative budgets for nearly twenty years. It will neither save money nor reduce deficits. Quite the opposite. CBO is prohibited from making estimates longer than ten years, and Congress understands the scoring rules as well as CBO does, and gamed the hell out of them. Fantasy in, fantasy out.
The preliminary "ten year score" has the first year as this year (2010) for four years of no benefit payouts but still all the taxes, but only six years of program costs. And the program costs themselves were gamed -- they counted the "Medicare savings" twice, for example, yet the separate bill to eliminate the bulk of them (the "doctor fix" bill) is already in process. And those purported "savings" are over half the cost of the bill.
The constitutionality of a tax/penalty on breathing-without-approved-insurance is suspect. Expect lawsuits. If it fails to pass muster with the Supremes (likely) add in another $12B a year or so in non-appearing revenue.
Nor does throwing new money into a system of relatively fixed supply make prices go DOWN. There are only so many doctors and nurses, and it takes years to train new ones. So prices will go UP. Capping prices will inevitably produce shortages. Someone somewhere better start pumping out a whole lotta new primary care docs and nurses, because we already have acute shortages of both.
Expanding Medicaid will produce its own set of problems. Only about half of all doctors will see Medicaid patients now, because the reimbursement rates don't cover actual expenses. And we have that doctor shortage that is not getting better. Also, the fed gov't only pays for part of Medicaid, so state gov'ts are going to get slammed with massive unfunded mandates in the expansion. Unlike the fed gov't, they can't print money to offset that.
Obama wanted this in the worst way, so that's the way we got it.
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I like to think that the agile insurance companies will, in the face of their revenues being cut, lobby for ways to cut their costs. As you mention, the supply of medical practitioners is insufficient to meet demand. I think this change will force an increase in available practitioners. The quickest way to do that is to increase the number of pathways one can receive a license to practice.
In most states, only DOs and MDs can prescribe. In some states, those with a Ph.D. in psychology or a Psy. D. and a postdoc program in psychopharmacology can prescribe psychotherapeutic drugs. This sort of specialisation may well catch on in other states and other disciplines. GPs will continue to be a one-stop shop, but if we add similar programs on to existing specialisations (physical therapy, for example), we can increase the supply of medical practitioners without shoving more people through med school.
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There's no magic wand for the MD/RN shortage -- though we could maybe swing the understandable motivation of fresh-graduated MD's to go into the high-paying specialties by forgiving their student debt if they go into primary care instead. The average MD leaves med school with over $200K in student loans, which is a humongous spur towards training for $400k/yr specialties rather than $100K/yr ones. And we should expand the number of training slots for primary-care residencies versus other specialties. We should be doing these things regardless of any other "reforms."
You won't find either of those things in the Senate or House bills, both of which actually contain massive funds cuts for residency/teaching hospitals in the Medicare "savings" calculus.
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Yeah. That's not a mistake you should make in polite company. :)
Hmm. What you said amounts to providing subsidies to a certain population. I think subsidising Family Care doctors is probably a little better than farm subsidies (mohair anyone), but subsidies seem like bad business in general. Better to tax the more lucrative specialties, no? Level the economic playing field a bit so that more people will naturally want to go into Family Medicine without costing the government money.
Funding cuts for residency/teaching hospitals: a step in the libertarian direction?
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The idea I stated adds more specialists to the pool.
Specialists in what? Maybe you should state it more clearly.
Letting a few psychologists have script authority in the states where they don't already is hardly going to have much impact on health care overall.
As for your taxation scheme, you should consider that when you tax something you get less of it, and when you subsidize it, you get more of it. We have an overall shortage of physicians in all fields that is particulary acute in the primary-care fields, and primary care is what we are going to need a hell of a lot more of fairly quickly. That doesn't mean we'll need fewer cardiologists or pulmonologists or endocrinologists. Changing the specialty mix while reducing the total number of physicians doesn't seem terribly helpful, but that would be the natural result of your proposal. We need more, not less.
Funding cuts for residency/teaching hospitals: a step in the libertarian direction?
No, a step in the bogus-government-accounting direction. Those cuts are reasonably certain to never actually happen, now that they've served their purpose in gaming the CBO scoring of the bills. Which is why they need to be added back into the price tag.
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From: (Anonymous)
incredibly insane
Just in case you missed it the "insurance companies" are guaranteed a 20% Profit margin, to be paid by the TAXPAYERS.
Do you know what the 'market' considers a decent 'profit' right now for these same companies?
Their margins are 5% or less.
Do you hear any of these companies Complaining?
I know most Americans have a very hard time with Math.
This is a direct result of "Progressive" education.
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Interestingly, I could have gotten insured on my own for less if I'd've been willing to use a simpler plan. Geez.
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But change has to start somewhere, and as far as Alpha tests go, this looks better than most!
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Having never undergone an abortion, I've no idea how much it costs. Nonetheless, this question might be phrased another way, "And who gets cancer so many times that they need insurance to cover it?" Once is enough. It's a medical proceedure -- a major medical proceedure. And chosing not to cover it causes even more medical issues. But then, chances are, pregnancy isn't covered either (not without an extra waver that costs more $) because pregnancy is a choice. Oh, btw, no abortion and no birth control for you. But hey, pregnancy is a choice on the part of the woman, right? And it's not ever dangerous or life-threatening. babies just pop right out the instant a woman decides to have one. like magic.
one day 'male' will no longer be the standard for health care. one day.
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Abortions performed at dedicated clinics are only a few hundred dollars. Cancer can cost that much per second of chemo - big difference. I sure as hell hope that this bill doesn't get so warped that pregnancy isn't covered by federal monies, or birth control... but wouldn't bet against it, the way the horse-trading is going.
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And check out Jay Lake's post that I linked in my follow-up; he speaks to the abortion issue better than I could in my sleepless state ;-)
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As for chemo, about $18,000 every other week at the nominal bill rate. Times twelve sessions.
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There is where I want to see some serious reform next.
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Abortion is a touchy one, but almost all elective abortions are first-trimester and that's fairly cheap, and constitutionally protected. Late-term procedures are done almost entirely for justifiable medical reasons, no matter what rants you hear from the pro-lifers.
You want to drive a pro-lifer totally nuts? Point out to them that the average pregnancy carries at least ten times the injury/death risk of even a late-term abortion procedure. Fact. They won't believe you, but it's fun watching their faces get all red and spittle-flecked.
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There are programs to cover abortions for low-income mothers-to-not-be (underfunded). Medicaid still pays for abortion in case of "life-endangering circumstances, rape, or incest", as mandated by federal law. That seems to limit the responsibilities of people to situations of elective sex without undue hardship. We definitely need more honest and pervasive sex ed, though. The body doesn't come with a user's manual, so it'd be nice if we could provide a good one.
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