Health Reform? Huh?

If you find yourself asking the above question, look no further.

Well, look further if you'd like, as I'm only posting my summary, but the info is pulled from both my school and the Kaiser Family Foundation (a great resource for impartial info- I recommend it over any news-media sources).

I'm going to outline what's up and then give my brief opinion of the situation for those who are interested. More extensive information will follow after my opinion. It should be a pretty good outline as to what's going on as of today. (Certain things might change if the reconciliation package passes the Senate- namely the removal of special preferences for specific states and a restriction on the proposed minor tax on really wild insurance policies.) Let's go!

What's going to happen change right now? These things will happen in the first year.

• People who are currently deemed "uninsurable" due to preexisting conditions will be able to enroll in a new federal insurance program that should be established in 90 days. This will serve to kind of get the ball rolling until such conditions are banned outright for adults in 2014.
• Children under 19 cannot be denied covered due to preexisting conditions. Parents will be able to continue covering their children on their plans up until the age of 26 (unless they are offered insurance through their employer). This helps give kids access.
• The Medicare Part D Coverage Gap (the giant "doughnut hole" in coverage for drugs for the elderly) will be halved, with 50% being covered (up from zero). This helps fix a huge cost issue in providing pharmaceuticals to the elderly. Fun fact: Want to know the quality of the legislation that made Part D coverage, passed in 2006, so awesome? The main proponent of the legislation and head of the committee on pharmaceuticals, Former Congressman Billy Tauzin (R-LA), quit Congress two days after it passed and then immediately started working for the PhRMA lobbying group. Insane.
• Small businesses (less than 25 employees/wages of less than $50,000) qualify for a tax credit of up to 35% of the costs of health insurance premiums for employees.
• No more lifetime caps on insurance coverage and restrictions will be placed on annual limits.
• Insurance companies not cancel coverage retroactively except in cases of fraud.
• Increased government oversight of insurance costs and overhead. Companies must report how much they spend on medical care against administrative costs.

Fast Facts

- Everyone will be mandated to have health insurance. To help with this, insurance subsidies will be available to individuals making $14,404 to $43,320 or families making $29,326 to $88,200. People below these ranges already qualify for coverage through Medicaid, or if old enough, Medicare. The subsidies would be given on a sliding scale. If you already possess insurance through an employer or group, nothing changes. You keep your insurance and continue as usual.

-If you do not purchase insurance, you will be fined. It is $95 dollars for an individual, starting in 2014, and increases to $325 in 2015, and $695 (or up to 2.5% of income) in 2016. For families, the maximum would be $2,085 in 2016, however, people can be exempt from this fine because of financial hardship or if they are Native American (and thus already provided with a degree of federal health insurance).

-Preventative health care visits, regular check ups, and many cancer screenings can no longer have a co-pay and will be free in some cases.

-The Medicare payroll tax of would be raised to 2.35% (from 1.45%) on individuals making more than $200,000 a year and couples making over $250,000.

-The reform is estimated to cost $940 billion dollars over the course of a decade. However, with all of the changes being made, the reform will actually decrease the federal budget deficit by $138 billion over the same decade. In addition, it is estimated to reduce the deficit by ~$1 trillion over the second decade.

My Thoughts?

Very briefly, I think that the bill will do much more good than harm. It extends coverage to people who need it while adding regulation and changes to the industry that will help make it more viable for the future and help the national economy (Health care is currently ~16% of the GDP and rising, that needs to change. In comparable countries it's less then 10%). I get frustrated with people who want something that is XYZ-more liberal or ABC-more conservative. To me, and I view this as being more practical, the question must be if this is the best step in the right direct that we can take at this moment? Does it lay the groundwork for things being better both now and in the future?

In my opinion, belief, and thoughts, it does. The reform does not murder Liberty or kill Freedom. The Constitution is still intact and well. We are not becoming a crazed totalitarian nation and this doesn't set us on that path, or close to it; such notions are nothing more than the rantings of those trying to make money or short-term political capital, preying on fear and appealing to the extremes.

Nothing will ever be perfect. Remember, the object is to form a more perfect Union. I think this qualifies as more perfect than what we have now.

Your thoughts?

P.S.- Want more info? About how this affects things in the industry? Here's some summary:

HOSPITALS: "The hospitals are ultimately the winners — one doesn’t increase spending on health care by nearly $1 trillion without some significant part of it flowing to hospitals," said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.

· Pros:

o Worried they might get hit hard by the health legislation, hospitals were the first industry to make a deal with President Barack Obama and the Senate Finance Committee last year. Hospital groups agreed to give up $155 billion in Medicare funding over the next decade. But they are expecting that to make more than that – at least $170 billion - by having to treat fewer uninsured patients.

o An individual insurance mandate and subsidies for low-income Americans to buy coverage means hospitals will have more paying customers.

o Hospitals got guarantees that cuts in federal Disproportionate Share payments that they receive for treating the uninsured wouldn't occur until the insurance expansion is in place. And even then, some of the funding will remain to help hospitals treat illegal immigrants and recipients of Medicaid, the state-federal program for the poor.

· Cons:

o Hospitals are slated to lose $155 billion in federal funding over a decade.

o A new independent commission would have broad authority over Medicare spending, though most of its powers don't kick in until 2018.

· Mixed

o The bill sharply expands Medicaid, which will reduce the number of uninsured patients. But Medicaid typically pays less than private insurers or Medicare.

INSURERS : In the short term, insurers will gain enrollment but the bill may cost them in the long run if health costs don't come under control," said Peter Kongstvedt, a McLean, Va.-based insurance industry consultant.

· Pros

o The individual health insurance mandate, along with subsidies for low-income Americans, will bring insurers tens of millions of new customers.

o The expansion of Medicaid will also provide new customers; many recipients will be covered by private managed care plans.

· Cons

o The bill calls for $132 billion in cuts to Medicare Advantage plans, the private health plans that cover one in five seniors (only one in ten seniors in Kansas).

o New taxes on the industry total $70 billion over 10 years, beginning in 2014.

o Insurers are facing a new requirement to spend 85 percent of their premium dollars on health care, potentially leaving less money for administration, marketing and profits.

o The so-called "Cadillac" tax on high-cost health plans is aimed at insurers, though it won't take effect until 2018.

o Lawmakers called for relatively low penalties -- just $95 in 2014 – for not buying insurance, which could encourage many healthy people to skip coverage.

PHARMACEUTICAL COMPANIES: "Pharma is one of the big winners," said Nancy Chockley, president of the National Institute for Health Care Management, a nonpartisan health policy research organization funded by Blue Cross and Blue Shield plans and government grants.

· Pros

o The drug industry will put up $84.8 billion to help fund the legislation. Part of that goes to making brand-name drugs more affordable for seniors who hit the Medicare coverage gap - the "doughnut hole." But pharmaceutical firms stand to make much more in return. With more Americans insured, more can buy brand-name drugs.

o Expensive biologic drugs would get 12 years of exclusivity protection from generics. Obama, AARP and the generic drug industry were calling for a 5- or 7-year limit. While biologic drugs are only a small portion of industry sales, they represent the fastest-growing segment of the market.

o The legislation, despite the pleas of some lawmakers, doesn't make it easier for Americans to buy less expensive drugs from abroad. Nor does it allow the government to negotiate lower drug prices for Medicare.

· Cons

o The industry will pay out $84.8 billion in new fees, rebates and discounts over the next decade.

DOCTORS : "Primary care doctors got a bump up in funding and overall doctors got a pass," said Gail Wilensky, a senior fellow at Project Hope and former head of the Medicare program.

· Pros

o Primary-care doctors and surgeons practicing in areas with a shortage of physicians get a 10 percent bonus payment from Medicare from 2011 to 2015. Medicaid will pay primary care doctors Medicare rates in 2013 and 2014, to coincide with the Medicaid expansion. Medicare typically pays at least 20 percent higher rates than Medicaid.

· Cons

o No significant medical liability changes are in any of the overhaul bills, though there is money for states to run pilot programs.

· Mixed

o The Medicaid expansion, to everyone under 133 percent of the federal poverty level ($29,326 for a family of four) means more patients have insurance, though at the lower Medicaid rates.

o The current Medicare physician payment formula that each year threatens to slash doctor payments was left untouched. But Congress traditionally steps in to nullify the cuts.

NURSING HOMES: Because most nursing home patients are covered by Medicare or Medicaid, reducing the number of uninsured doesn't really help the facilities. As a result, the industry doesn't see much gain in the overhaul.

· Pros

o The bill would establish the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary insurance program that would allow people to finance their long-term care in advance through payroll deductions. It would provide a cash benefit of about $50 a day for long-term care, including nursing homes, in the home and adult day care.

· Cons

Nursing homes would see their Medicare reimbursements cut by about $15 billion over the next decade. While Medicare comprises only about 13 percent of nursing home revenue, the industry relies on the money to offset low Medicaid reimbursement.

A Complex Situation - Part 1: Politics

UPDATE: I really am going to post parts 2/3. I promise. School has just swamped me and I'm not sure when I can sit down and devote the time I want to present everything clearly. Until then: why not leave or check out the comments?

NOTE: This discussion will need to be split into multiple blog posts. There's just too much information for a single one. The discussion will most likely be divided into the categories of Politics, Insurance Companies, and Philosophy. Don't worry; I'll cover everything that everyone commented about.

I think that my title pretty much defines the current state of health care. If you're just joining in on this little session, I highly recommend that you read the very different opinions and views expressed in the comments of this post as I'll be summarizing and referencing peoples thoughts here.

Looking at each person's response, the reason for debate/fighting/disagreement pretty much slapped me in the face. Out of the six of my friends that commented, each brought up different issues, concerns, and possible solutions. Now think about how we have 300+ million people in our country . Yikes. No wonder people are heated about things.

The common fact that everyone acknowledged: something needs to change. No one thinks that our status quo should be maintained. Health care needs to change.

So, I've decided to make the discussion more manageable by breaking it down into the subcategories of (I think) Politics, Health Insurance, and Philosophy. I'll try to pull points from each person into the category where it most fits for my discussion/presentation. Don't worry if you think I've missed something right now as I'll likely bring it up in one of the following posts. Where possible I'll link/cite facts that I've learned. Let's go!

First up: Politics.

-Caleb said the predominate issue is the "time in which to revamp" health care and that he thinks Democrats are trying to rush things through to bolster political power. Instead, the process should slow down because it is "affecting everyone...not just the deaf Democrats in power." He thinks "that Obama's tactic of "we must pass everything now, no questions asked" is dishonest and insulting."

-Tyler talked about how the US is behind Europe in health care standards and that if "legislation allows some Americans a higher quality of life, but is an imperfect plan, it is worth it." The final goal and objective should be to "improve quality of life." [Side note: the US ranks 37th in the WHO rankings from 2000 (most current) and yet we by far spend the most money]

-Kevin said the government shouldn't have access to medical records or "the right to determine, based on set criteria and yes/no symptom check sheets, whether or not an individual receives medical care." He also thinks the government should "slow down when developing a new system of health care" because it's often a flawed design and concept of an idea that leads to problems and failure. The role of government, and politicians, is to analyze the situation and revamp healthcare "for the fulfillment and benefit of the majority," because "legislation passed without adequate consideration for the people fails."

-Megh talked about how she thinks health care should be free and paid for through taxes because anyone can get sick at any time, but acknowledged that the US will likely never have this reform due to the financial stakes of large companies. She also linked an article that spoke of the need for Democrats to maintain their push for legislative reform despite the short-term implications it may toward re-election.

My Thoughts?

First, I take issue with the idea that the problems of healthcare reform are somehow the individual fault of either the Democrats, Republicans, or the Obama administration. In my opinion, if blame were to be assigned it would fall at the feet of Congress, both Left and Right alike.

As previously stated, most everyone agrees that the country seriously needs reform. Sadly, the big problem of passing/not passing any legislation is not because of the differing views of the political parties but instead the issue of politicking. Both parties have become so obsessed with winning and being correct that the legislative process has ceased to function. Democrats in Congress, feeling jilted from decades without full political power (holding both Congress and the Presidency), seem to occasionally feel the need to flex their power over the GOP and not compromise. This could be really bad if someone wanted to compromise. Republicans, upset about this and their lack of a cohesive party theme/identity, have essentially stuck their fingers in their ears, tucked their head, and hoped that Democratic failure=Republican success. You have one side attempting to enact some kind of payback and the opposing side trying to not do their job and hope that it leads to being re-elected.

This is no way to run a country.

Kevin said it best in his comment, explaining that we

"elected them [Congresspersons] to make decisions not necessarily based on their goals or ambitions but based on our [the citizens'] situation and needs. It is their job to view the current national and global situation from every possible angle. It is their job to make sense of things and then approach the problem with the goal of improving the lives of those they serve."

I think most everyone in the country would agree with that. We need less politicking, fighting, bickering, partisanship, and worrying about the next election and more cooperation and accomplishment. How does this play out in health care and with the reform that is being debated now?

Like most everything about health care: it's debatable. The current bill is HR 3590- Patient Protection and Affordable Care Act (that's the FULL TEXT- you won't read it). There are also quick summaries from the Democratic and Republican parties. As an overview, the bill would reform/regulate circumstances for physician malpractice, prevent insurance companies from denying coverage to anyone with a preexisting condition, expand health insurance coverage to the ~40-60 million uninsured Americans (I quote a range because we learned how about each year millions of people lose/gain coverage; it's a cycle), offer a federal pool for those without insurance to buy into, and require everyone to have health insurance (much like mandatory auto insurance). This would be paid for through taxes on individuals making more than $500,000 a year (actually repealing an old tax cut), people with really ornate health plans now (I refuse to use the name of a certain car brand), and through cutting/reworking existing programs and funds. It is estimated to cost ~$850 billion total over the next 10 years, but actually result in a ~$150 billion deficit reduction over that time.

Now most people see those things, having heard about them in the news, and go "Whoa, those are all the things the Democrats want. None of the Republicans want that." To that I reply: not exactly. Surprisingly, that reform is actually more of a centrist option. Many people who are far left or far right would prefer something different (a single-payer and completely private system, respectively but they'll be more of that later, under the Philosophy post). HR 3590 actually isn't that different than the current Massachusetts health care system, signed into law in 2006 by Republican then-governor Mitt Romney.

Now, I know that's a lot of information but sadly it's really just a quick overview of the current situation. Don't worry, I'll present a discussion/reasoning of the various different types of health care systems during the Philosophy post while going through more comments. The gist of all this? Congress, meaning both political parties, need to cut the crap, do their jobs (meaning make the necessary changes to fix the country), and stop worrying about their own job security.

Lastly, and this is more of a detail, I don't think Obama can be blamed for allegedly pushing reform through too quickly or- and I'm paraphrasing- for playing the urgency card too much, simply because he does not set the pace. (All of this assumes one thinks things are going too quickly.) The president's role is to set the agenda. A pillar of Obama's campaign message was health care reform; it makes sense to me that he would be calling for Congress to tackle such legislation (not to mention it makes up ~14-17% of our economy). The reform itself and its timing is an issue of Congress and their responsibility to write and pass.

Personally, I don't think that there is ever going to be a "right time" to work on health care reform or any big issue for that matter. Don't get me wrong, I want things to be well thought out and done right, but health care reform is not a new issue. FDR, Truman, Johnson, Nixon and Clinton have all attempted comprehensive health care reform. Only Johnson succeeded (partially) with the creation of Medicare and Medicaid. (Fun fact: FDR was going to propose socialized medicine until a certain country had to go crazy with that whole whacked-out-final-solution-socialism-world war thing. It's in this book which I've recommended before.) With the current political environment of every action being analyzed through the prism of the next election and everyone too worried to simply do the job they were hired for, I'd rather Obama make it a national issue (thereby doing his job) and try to get Congress to finish it.

Still with me? If so: more to come later.

Until next time.

*While I don't think it's a fair way to describe any of my readers, Glenn Beck is probably certifiably insane and terrible for our political process. Regardless of political views.

Health Care Reform: My Thoughts on "The Speech"

This evening (as most people know), President Obama addressed a joint session of Congress on Health Care, specifically:

• the current state of it in the U.S.
  
• his thoughts on why reform is needed
• what reform should accomplish
• what is/is not true about the rumors that have circulated about the proposed reform "bill."
  
  (I put "bill" in quotations because no official bill has yet been agreed upon. Four submitted, one more on the way)
  

A number of things stand out with this address, both in regard to his speech, and the nature of the event. While the President often addresses the nation, be it on prime time TV or otherwise, presidential speeches to joint sessions of Congress come few and far between. The last one given, to my knowledge (and excluding State of the Union/Inaugural Addresses), was given by President Bush after 9/11. I personally think this scarcity is because of how much time is spent applauding (if you're the party in power) and attempting to look as-defiant-as-one-can-while-sitting-during-a-joint-session-of-Congress (the minority party). The fact that Obama chose to hold such an address on health care stands as a testament its importance.

So, enough about the actual event, what about the speech? Overall, I found myself pleased with the speech. The President seemed to approach the entire debate head-on and systematically work through some problem issues. Could there have been more discussed? Of course. More details given? Without a doubt. From a practical stance, however, he seemed to cover the most important things as best as he could for the time being (it was only a 45 min speech, after all). I was specifically glad to hear Obama address the few following things (among many others, because my opinion obviously weighs heavily on both him and Congress):

• The current outrageous costs of health care when compared to nations similar to the U.S. Health care accounts for ~18% of our GDP , while the next closest country slides in at ~9% (That link is also just a good website to checkout for general health care facts).
  
  When compared, health rankings between the US and similar nations have no real statistical difference (measures include infant mortality, life span, cancer survival rates, etc). If there's no real different in that, and in patients' satisfaction with their physician, why does our cost so much more? For more information, this article summarizes things pretty well and pulls statistics from the CIA World Fact Book.
  
  
• The idea that an extreme change, to either the right (complete individual privatization) or the left (national single payer), can not be viewed as a feasible option right now. The health care system ties too tightly into the entirety of our economy and way-of-life that any major overhaul would simply be too detrimental .
  
  One of the most frustrating things to hear others talk about is how the US will have "socialized medicine." It's just not going to happen, and really, socialized medicine wouldn't actually be the end of the world (surprised, no?), we as a country just make terrible connections when we hear the world "Socialism" (You can thank the National Socialist German Workers Party for that, along with the Cold War. Oddly enough neither are true examples of socialism).
  
  I'm also glad he addressed other silly things like the idea of death panels and the fact that many in the GOP (and some on the left) are actively choosing to not work because it's a better political move. I'm sorry, I like to think that you were elected to work. I wish all in Congress would work so hard that there was no one the people could NOT reelect them rather than sitting-bored because you'd rather not make waves.
  
  
• His inclusion of Ted Kennedy's well-touted view that the health care debate should not be a political or partisan debate, but a moral debate. It's not often that I would prefer our Congress to debate moral issues, however the issue of health care strikes a different chord with me.
  
  I've always thought a person's ability to easily access adequate medical care when needed as something that just makes sense. I cannot understand why people are more than okay with protecting citizens and their safety by having military/police/firefighters/clean water/etc but then run scared when prompted to protect a persons general well being.
  
  It just does not compute for me. I think when people get sick they should be able to focus on getting well rather than even entertaining the idea that they might not go see the doctor because of access/cost.
  

I could go on for pages explaining all of my thoughts and comments about the speech and debate, but I'm not sure how many people have made it this far. If you really want to read more of my rambling ideas: click here.

If you missed the speech, NPR has a pretty good summary , or you can read the entire text here (it's a few clicks down, past an initial summary).

For a good website that just has interesting health care facts, check out the NCHC (National Coalition on Health Care- they were linked above too). I find the "Facts" tab at the top to be most interesting.

Sidenote: I wish my time stamp was accurate. Anyone know how to change that?

Lastly, what did you all think of the speech? Or how do you feel about the debate/reform? I'm happy to discuss or just see what other people think. Until next time.