Unlike so many, I find myself being more impressed each time I delve into the new law. This is, ultimately, a piece of legislation that WILL achieve many stated and even unstated objectives:
1. It will extend the Medicare Part A trust fund for just long enough to allow BOTH sides to discuss meaningful reforms to make it truly sustainable.
2. It provides a real commitment to our nation's poor; and strengthens Medicaid at the same time. Here, too, there are opportunities for additional reforms, but this makes clear what our priorities are; and, importantly, demonstrates our national humanity and compassion for those less fortunate.
3. It dramatically reforms our understanding of and right to health insurance. We have never had a federal definition of health insurance and this begins that discussion in a meaningful way.
4. It is financially sustainable, as long as our elected officials do not undo the tax and revenue-generating items.
What do we need to wait for and hope for?
1. Tort reform and/or Malpractice reform. This should have been firmly part of this law, but will have to wait.
2. Sustainable Growth Rate legislative reform: This is universally recognized as necessary and putting it off, even for a few months, is a big disappointment.
3. Implementation of insurance regulation and insurance exchange regulation will be the first real tests of the success of the law.
4. Taking the Medicare savings and law changes as a first step; and not ignoring the very real legacy costs that we still have to address. AND working with the private (for-profit and not-for-profit) sector to develop a structure and process for improving the delivery of high-quality health care with consideration of cost.
5. Revisiting the notion of better patient education and not being scared off by hateful rhetoric. Discussions around end-of-life and compassionate care should not be politicized or used for pure political gain.
I remain very optimistic about this country and about seeing our elected officials, of both parties, come together around common goals and purposes. In the mean-time, I am proud of the many elected individuals (and their staffs) for having stood behind their promises and made this a reality.
Amelia - "We need to restore competition to the market place"
Competition is great for items like Lexis cars that you do not want eveyone to have. The market sets a reasonable price, and those who can afford them, get them. It is terrible for those items you want everyone to have.
In colonial times, fire departments were competitive companies. You signed up with a company, and got a medaillon which you put on your house. If the Penn Mutal fire dept arrived and your house had a Green Tree medaillon, they let it burn to the ground. Soon we had what we have today, a municipal socialized fire dept which everyone pays taxes to support.
Other advanced countries get better health care as measured by all 16 of the bottom line public health statistics, and they do it at HALF the cost per person. None of them have competitive free market health insurers. You can look at the history of health insurance in this country and see clearly that competition simple does not work in this case.
We can reform it but we need to go much further than the Dems even believe and the Pubs could stomach.
We need to restore competition to the market place. The first real step happened yesterday when the House voted to repeal of the exemption for health insurers to anti-trust laws. (I find it ironic that the Republicans - the champions of capitalism - didn't vote for this.)
The next step is to restore consumer influence on costs. I think that means requiring providers and insurers to publish the real cost of services. They do this in Singapore. Negotiated rates between providers and insurers leaves the consumer out of an ability to influence health care costs - consumers are only choosing based on premium, co-pays, and co-insurance. I would even suggest we do not allow insurers to negotiate rates with providers.
We need to remove the burden of providing heath insurance from business. Our business cannot compete on a global market while bearing the constantly increasing cost of health care. Go to The Kaiser Family Foundation web site for more information, but note the decreasing number of employers who offer health insurance and, particularly, the statistics regarding employer health insurance at small businesses, the jobs engine of our economy.
We need a public option to cover those who cannot afford health insurance and a mandate that everyone is required to have health insurance.
As long as insurers are allowed to negotiate rates with providers, Medicare, Medicaid, and any public option insurance run by the government should be allowed to negotiate rates, too. No, not allowed - required.
All this just food for thought. But, what the Dems propose and the nothing the Pubs propose is not enough to bring capitalism's advantages and constraints back into the health care industry.
The problem is that people are heatedly fighting public option out of ideology. Conservative leaders, who will always be able to afford health care, denounce pubilc option, then the followers repeat their words.
Even after an avalanche of propaganda and pathetic scare tactics, a solid majority of American people support public option. Every industrialized, 'civilized' nation (and a few that are not) have humane health care policies.
After the decimation of our economy in the nation of 'free-market' capilalism, the ideological arguemtns against public option are bankrupt. Rev. Bookburn - Radio Volta
We came together during WW2 for a common cause, and could do so again if we had the national will. Some things are just the right thing to do. We seem to be a religious nation - where is the outcry? Are we not so concerned about the health of the born as the unborn? Cut with the arguing, the discussions about socialism, and just agree it has to be done. Then figure it out. It won't be perfect and may require some sacrifice or adjustment by all of us.
I recently read J.R. Reid's book the Healing of America in which he compares the health care system in various countries. I seems clear to me that among the major industrialized countries we have the worse health care system for people. It is interesting that Germany's system was developed by Bismark who was an avid anti-tax leader. On the other hand, we have the best system from the perspective of the health care industry. It is all a matter of perspecive. Our political system needs money to support reelection and the policies that come out of congress reflect that fact.
I am a mathematician and the inability of smart people to face facts on "tort reform" is driving me nuts. These facts are clear. States with tort reform not only have no lower health costs, but the frequency of tests and treatments is similar to those states without tort reform. Trot reform , caps on malpractice suits, does not save money. If you go to page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, you will see much of the data.
Is there any way I can get people to face facts besides going to the Mall, pouring gasoline over myself, and lighting a match?
There may be no panacea, but there are some things than can & should be done in the US:
1) Tort reform is necessary - no other country has this problem, & other country's systems never had to deal with it.
2) Insurers must not be allowed to "cherry pick" the healthiest clients by denial of service, and must offer the same level of benefits at the same price for all.
3) Youths must be covered under parents policies up to age 26 at least, so long as they are in school
4) Everyone must buy in, and those without employment or otherwise indigent should be covered by Medicare/Medicade - these would provide the "government option".
5) Government should re-structure health insurers as "Non-profit", and control the outlandish CEO salaries & perks these companies pay.
6) Government should establish a universal health claim form and procedure codes that all insurers, hospitals, and physicians use to make & pay claims.
If the plans being debated do all these things, then universal coverage just might work here.
How to figure out 2 + 3
Suppose we had the problem of determining 2 + 3. We had been using 23 as the sum which seemed pretty reasonable, but it hadn't been working out so hot. The rest of the world has been using 5, and they've been getting pretty good results. They live longer than we do. Their babies weigh more at birth. And so on. AND they've been saving a bundle.
So we say we're gonna reform our 2 + 3 policy. We gonna consider every and all possibilities and pick out the best. I like 6; it works well for the product. Why not for the sum?
BUT wait a minute. We want a UNIQUELY AMERICAN solution. We will not consider 5. We won't even discuss 5. Our newspapers will delete 5 from their fonts. If you try to talk about 5, YOU WILL BE ARRESTED! We sure don't want to do what them damn ferriners do.