Wednesday, March 24, 2010

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.


  1. Very good summation Kirk. I understand that the official 2009 poverty guidelines will be in effect until next week. I don't have my calculator handy either but these numbers are ambiguous anyway.

    I look at it as a step forward and backward simultaneously. Two of your Ohio congressman are under attack for voting toward the bill. And John Boehner seems to enjoy lighting the fire under the whackos.

  2. thank you for making this whole mess much clearer.
    this may seem like an odd question, but how the hell is all this going to be administrated? effectively? especially on the state level?

    i don't have health insurance. can't afford it OR the fine. and i don't use conventional medicine anyway. so throw me in jail. that way i'll get housing, food, AND healthcare all at once.

  3. Glad you liked the summation, Tag. The post was running kind of long so I left out a lot of stuff I wanted to say about the opposition. I may do that in a future post if it doesn't die down. The Republican Party is beginning to resemble La Cosa Nostra.

    This is regulation, not socialism. And I'm not sure the insurance companies won't gouge people anyway, seeing as there's no rule to actually stop them. So, we'll see.

  4. @standing--Don't thank me, thank the Cleveland Plain Dealer. I was just riffing off them. As to how it's going to be administered, remember, no new federal insurance entity is actually being created, so I imagine the Department of Health and Human Services will just be enforcing the various regulations, but I'm not sure. From your comment, I assume you're into alternative medicine. I kind of doubt that will be covered, unless you can convince some insurance company that it will save them money. Remember, they're not going anywhere.

    Your comment about jail reminds me of the Charlie Chaplin movie MODERN TIMES. During the Great Depression, Chaplin's enjoying himself behind bars, and is disappointed when the police decides he's innocent after all.

  5. @standing--Me again! Just noticed the "especially on the state level" (I read these comment much too fast). I'm worried about that, too. Here in Ohio, I don't think the state government can afford a Xerox machine for all the new paperwork.

  6. Waaahhh. This popped up as I am on my way to have a medical procedure that scares me, which I detest, which is known to be really risky for me but there's no other choice, and for which I pay one hell of a lot of money each time it is needed. We're in such a hell of a mess, I wonder if anything can possibly ease us out of it. I'm middle class, nowhere near poverty level and uninsured - flying without a net right now. Please offer me something I can buy! Kirk, it pleased me to see my Rep. Dina Titus on your sidebar. Her office used a letter from me when they solicited constituents to write and tell their health care burdens.

  7. Kirk, how about Bob Dylan's MODERN TIMES? One of my firm favorites.

  8. the states don't have the money or staffing to do this. HHS is already behind the eight ball in enforcing existing regulations.
    and i'm really surprised the insurance companies haven't gotten into the alternative medicine market. probably not enough money in it for them, just like there's no money in preventative care or educating folks to take care of themselves.

  9. @Limes--I didn't mean to be a downer. After all, I did say I'm GLAD it passed. Sorry about your health, which you've hinted about from time to time on your own blog. I don't know why we have to wait until 2014 for all this to take effect. It could be repealed by then! As far the costs go, I think, the idea is that the insurance companies will have so much extra moolah due to the mandates, there will be no reason for them to raise rates, and everything will get cheaper. Hope Obama and Co. are right about that. If not, progressive politics will be doomed until the 22nd century. I hope your procedure goes well. Again, I didn't mean to bum you out.

    Can't say I'm familiar with the Bob Dylan song, but for you, Les, I'll make an attempt to seek it out.

  10. @standing--Stay on the soapbox all you want, at least until you run out of room.

    Man, these comments are coming fast and furious. I'm actually working up a sweat answering them!

  11. Many Insurance providers do cover some alternative medicine usually at with exorbitant premiums and minimal coverage. Some companies are starting to smarten up about prevention. One company Amerigroup emphasizes it but plans differ from state to state and they only cover medicaid eligibles in most places. Unfortunately since the board ousted the founder of the company 3 years ago they have moved more toward proven bottom-line solutions.

  12. Modern Times is a wonderful, change from his usual genre, Dylan album, Kirk. In 2006, I went to a concert thinking I was going to a Bob Dylan concert and he has tremendous meaning to me, so I was a happy cookie. At this concert, he did NO Bob Dylan stuff, but unveiled Modern Times. My date and I LOVED it! The man was over 60 years old and STILL changing it up.

    You weren't a downer, Kirk. It's just the topic of the ages. And I'm not "ill". Actually, to be honest, I'm as healthy as a horse, and in the best condition of my life. Except that I have a couple of worrisome "condtions" that sometimes tap me on the shoulder to remind me that nothing is guaranteed us. No worries - I worked today and I'll work tomorrow and I'll work to understand health care reform and I'll work to get myself insured.

  13. I'm glad to hear that, Les. You had me worried there.

    I've never been to a Bob Dylan concert, but I've read in a lot of different places that Dylan never sings the same song the same way when performing live, that he always uses different arraingements or something. I also read an interview where Dylan denies this. He claims people are just sitting in section of the audience each time, and that's why they sound different. I wonder...

  14. That should be "different section of the audience"

    I wonder if I make the same typos twice.

  15. Well, if any one of us could map the labyrinth that is Dylan's good mind, it would be remarkable. I've only seen him live the one time and it was wonderful, even if it wasn't what I expected. The concert date was on a special date in my world and I felt transported back to my mis-spent youth, even though Dylan surprised us all by presenting music we'd never heard before.


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