Medical Center

I'll be honest, the passage of the health care reform bill took me by surprise. It wasn't just that it passed, but that it passed this week. For some reason, I thought they would be arguing about it for another couple of months. It's not like I haven't been paying attention. I wrote about health care back in June , expressing my disappointment that a single payer system wasn't even considered, and that the alternative, a public option, looked like it might be dropped because it was considered too "divisive". When the option was indeed dropped, the whole health care debate began to seem like background noise. I tried to pay attention, but one can only listen to "We must not let the perfect become the enemy of the good" or "They want to shove government health care down our throats" so many times until it begins to sounds like, "Don't let a perfect enemy shove government throats down our good health care." So I gradually tuned out, until this week, when, lo and behold, it passed.

But what passed exactly? Here are some highlights of the bill, culled from the Cleveland Plain Dealer, along with my comments.

Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

So far, so good.

Beginning in 2014, almost everyone is required to be insured or pay a fine.

This is the part I don't quite get. I thought the reason there are so many uninsured is because they couldn't afford it. They can all of a sudden? But wait, help is on the way.

Expands federal-state insurance program for the poor [Medicaid] to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.

Now, are they saying 133 percent of $29,327, or are they saying the poverty level is something else, and the $29,327 is the 133 percent of that something else? Whatever the amount, a childless adult is going to have to divide it by four. Everyone better bone up on their math by 2014.

Tax subsidies for purchasing insurance available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

More math. Maybe they should add a pocket calculator subsidy.

Insurers barred from placing lifetime dollar limits on policies or from denying coverage to children with pre-existing existence medical problems.

I just so happen to know some parents of a child with pre-existing conditions. I haven't talked to them about any of this yet, but I can't help but think they're happy.

In 2014, insurers barred from denying coverage to anyone with pre-existing conditions or charging them more, or from charging more for a woman.

Until I read the above sentence, I had no idea that one's gender could be considered a pre-existing condition. Bars may offer Ladies Nights but not hospitals? Maybe Chastity Bono was just trying to save money.

Beginning in 2008, taxes health care plans costing at least $20,200 for individuals and $27,500 for families. Increased Medical payroll tax on investment income and wages for individuals making more than $200,000, or married couples above $250,000.

Taxes. The number one reason people bitch about big government. Well, look at it this way, those of you of the bitching persuasion, no tax is as expensive as the spot that may one day show up on your X-ray.

Gradually closes "doughnut hole" coverage gap in the Medicare prescription drug benefit that hits seniors who have spent $2,830. When it is eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.

Seniors, don't throw away those pocket calculators just yet.

Beginning in 2014, small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools.

And what exactly are state-based purchasing pools? Will they have actual addresses? Will they advertise? Will they be in the phone book? Will they be found online? One thing we don't need is word-of-mouth insurance.

Those of you from countries with national health insurance have probably read all the above and thought, "Wouldn't it just be simpler if the government payed for everything? Sure, you'd pay more in taxes, but you'd offset that with what you'd save on doctor's bills." Well, those of you from other countries, it's like this, any U.S. health care reform has to meet the approval of the middle-of-the-roaders, who decide everything in this country. What you consider national health insurance they consider Stalinism with a stethoscope. I'm sure the middle-of-the-roaders in your own countries would disagree. Maybe some day we'll have a middle-of-the-roaders cultural exchange. Just make sure your middle-of-the-roaders get a check-up before coming here.

For all my misgivings, I'm glad health care reform passed. Not ecstatic, as I would be were it single payer, but glad. It's better than what we had before. I don't know about the perfect being the enemy of the good, but the mediocre should at least be the enemy of the unconscionable.