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USA Healthcare Bill Passes!

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:
  • 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.
Important: Most of this doesn't kick in until 2014 - 2020.

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.




( 32 comments — Leave a comment )
Mar. 22nd, 2010 11:10 am (UTC)
Mar. 22nd, 2010 06:06 pm (UTC)
Thanks. I look forward to seeing the final itemized list.
Mar. 22nd, 2010 11:25 am (UTC)
Socialism begins in America
The "do-nothing" Republicans were trying to do what approximately 60% of Americans wanted them to do...defeat this horrible bill. Never in our Nations history have we been threatened or taxed for doing nothing. Don't buy health inusurance, pay a "penalty". Sounds like strong arming to me!! Watch our taxes go up, businesses lose money and fold, Medicare costs go up, insurance rates go up, and the Democrats get voted out of office in November. Obama bought the necessary votes he needed with more empty promises and lies to his fellow Democrats. Yep...this is "Change I can Believe In". And Chris, in the true manner of which the Liberals are conducting their business now...make sure as you screen this posting, you don't allow it to be printed because it is a dissenting voice.

Mar. 22nd, 2010 06:05 pm (UTC)
Re: Socialism begins in America
Hi Mark (which one, by the way?). First off, I wanted to reply to the nonsensical "liberals don't allow dissent" comment. In case you haven't been listening to the news during the past 10 years, it's the right wing that has shouted down dissent. I only screen anonymous comments because of all the spam. Calling Republicans "do-nothings" doesn't make me a liberal; it just shows I've been paying attention *g* The only reason the percentage against healthcare reform went up is due to fear-mongering, lies, and screaming from the right wing. If you look at those same polls, you'll see that most people support healthcare reform; they just don't like this or that - or else they've succumbed to fear and lies.

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.
Mar. 22nd, 2010 02:07 pm (UTC)
I'm happy to see this first hurdle cleared. It ain't perfect, but it's a start. I for one will benefit from the provision that insurance companies can no longer deny healthcare based on pre-existing conditions. But I know full well that they will find a way to ramp the premiums up to the max on those of us who have them.
Mar. 22nd, 2010 06:07 pm (UTC)
Yes indeed! I, too, am pretty excited about that provision, what with not being tenured faculty.
Mar. 22nd, 2010 02:09 pm (UTC)
Well damn, because starting July 1 I won't have any insurance. Oh, well.
Mar. 22nd, 2010 06:08 pm (UTC)
I don't know why it didn't just go into effect right away. I'm guessing it's due to conservative Democrats who hope to be out of office before we start seeing those benefits.

On the plus side, you might be able to get on your parents' plan sooner....
Mar. 22nd, 2010 03:05 pm (UTC)
Studies show these reforms will save great big gobs of money and reduce the deficit over time.

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.
Mar. 22nd, 2010 03:57 pm (UTC)

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.
(no title) - tully01 - Mar. 22nd, 2010 06:01 pm (UTC) - Expand
(no title) - piezocuttlefish - Mar. 22nd, 2010 06:19 pm (UTC) - Expand
(no title) - tully01 - Mar. 22nd, 2010 08:55 pm (UTC) - Expand
(no title) - piezocuttlefish - Mar. 22nd, 2010 11:19 pm (UTC) - Expand
incredibly insane - (Anonymous) - Apr. 7th, 2010 08:31 pm (UTC) - Expand
Re: incredibly insane - mckitterick - Apr. 7th, 2010 08:38 pm (UTC) - Expand
(no title) - mckitterick - Mar. 22nd, 2010 06:11 pm (UTC) - Expand
(no title) - tully01 - Mar. 22nd, 2010 08:22 pm (UTC) - Expand
(no title) - mckitterick - Mar. 22nd, 2010 09:07 pm (UTC) - Expand
(no title) - tully01 - Mar. 22nd, 2010 09:13 pm (UTC) - Expand
(no title) - mckitterick - Mar. 22nd, 2010 09:17 pm (UTC) - Expand
Mar. 22nd, 2010 05:08 pm (UTC)
Despite all the problems this is going to cause, this sounds like a hell of a good v1.0.
Mar. 22nd, 2010 06:12 pm (UTC)
More like an excellent 0.1 *g*

But change has to start somewhere, and as far as Alpha tests go, this looks better than most!
(Deleted comment)
Mar. 22nd, 2010 06:15 pm (UTC)
I read a recent medical study about modern miracles of medicine... only to realize that the researchers had only studied men. *sigh*

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.
(Deleted comment)
(no title) - mckitterick - Mar. 22nd, 2010 07:52 pm (UTC) - Expand
(no title) - jaylake - Mar. 22nd, 2010 08:57 pm (UTC) - Expand
(no title) - mckitterick - Mar. 22nd, 2010 09:10 pm (UTC) - Expand
(no title) - tully01 - Mar. 22nd, 2010 09:09 pm (UTC) - Expand
(no title) - piezocuttlefish - Mar. 22nd, 2010 08:58 pm (UTC) - Expand
Mar. 22nd, 2010 09:46 pm (UTC)
Hi Chris, sorry to post anonymously. As a receiver of public health and medicaid in the past I would like to speak from experience - I could not possibly have afforded health insurance at that time and fining me would not have been able to change that. As a participant in Medicaid I and my children were often treated like dirt by the providers who deigned to accept us. I currently pay out the nose for health insurance not because I can well afford it but to spare my kids from humiliation. I am waiting to see what happens, but I suspect the insurance companies will be the ones to benefit most from this.
Mar. 22nd, 2010 10:11 pm (UTC)
Gotta love a man who really does try to keep the campaign promises.
Mar. 22nd, 2010 10:15 pm (UTC)
True, that! And he seems to have been the only politician who tried to work with both parties.
( 32 comments — Leave a comment )

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