Wednesday, 24 March 2010

"This is a Big Fucking Deal"


So spake Vice-President Joe Biden into the ear of President Barack Obama at the event to celebrate the passing of the US healthcare reform bill, or HR 4872 and for once, this was not so much a gaff by the Veep but an accurate summation of what a profoundly important and amazing moment this is in American political history. And as compromised and battered as the bill is, the fact it has been passed, the fact it has made it through a partizan and hostile political landscape filled with smears, lies and ignorance, is one of the finest achievements by any President for some time.



The key elements of the bill are outlined here:

WITHIN THE FIRST YEAR OF ENACTMENT

*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

*Insurers will be barred from excluding children for coverage because of pre-existing conditions.

*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

*A tax credit becomes available for some small businesses to help provide coverage for workers.

*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011

*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.

*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.

*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

*Employers are required to disclose the value of health benefits on employees' W-2 tax forms.

*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.

*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.

*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.

*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.

*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

*State health insurance exchanges for small businesses and individuals open.

*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

*Health plans no longer can exclude people from coverage due to pre-existing conditions.

*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.

*Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.


In summary then, a great but by no means perfect piece of legislation for a nation desperately in need of healthcare reform, as the private sector proves once again that there are some things it should not be allowed within a million miles of, or indeed to be involved in at all.

Of course there are the deluded voices of dissent, who bandy round images of Obama as Hitler, or mis-readings of socialism, or willingly suckle from the teat of mis-information and lies (perhaps because, just because, a black man is President) that enables intransigence to a valuable piece of legislation that helps those most in need...


To them, I offer these words that I found at Dave's blog:

You didn't get mad when the Supreme Court stopped a legal recount and appointed a President.
You didn't get mad when Cheney allowed Energy company officials to dictate energy policy.
You didn't get mad when a covert CIA operative got outed.
You didn't get mad when the Patriot Act got passed.
You didn't get mad when we illegally invaded a country that posed no threat to us.
You didn't get mad when we spent over 600 billion(and counting) on said illegal war.
You didn't get mad when over 10 billion dollars just disappeared in Iraq.
You didn't get mad when you saw the Abu Grahib photos.
You didn't get mad when you found out we were torturing people.
You didn't get mad when the government was illegally wiretapping Americans.
You didn't get mad when we didn't catch Bin Laden.
You didn't get mad when you saw the horrible conditions at Walter Reed.
You didn't get mad when we let a major US city drown.
You didn't get mad when the deficit hit the trillion dollar mark.
You finally got mad when the government decided that people in America deserved the right to see a doctor if they are sick.

10 comments:

  1. The whole controversy does look bizarre from this continent. I suspect in a very few years not many Americans will be able to work out what the fuss was about in the first place.

    Also the word 'socialism' gets bandied about (a) without apparently a clue what it means and (b) with the belief that merely invoking the evil word concludes all argument to the speaker/writer's satisfaction.

    'That's socialism!'

    :-O

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  2. Of course, I still can't forgive Obama for nixing NASA's budget...the bastard.

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  3. The concluding bit is ace, really thought-provoking.

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  4. i wish more americans paid as much attention to what goes on in our country as all y'all do, sguar! xoxoxo

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  5. White Rabbit:

    Two good points, just I can't wait for the future, I hate seeing what some Americans are doing to there country.

    Darren:

    You and your space rockets...

    Claude:

    Well, thanks go to Dave for that bit of it.

    Savannah:

    So do I Savannah, so do I...

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  6. In Canada it was conservatives, for political expediency, delivered universal healthcare. They wanted to undermine the NDP. That was smart on their part.

    I don't understand how the American right thinks? Now they have to campaign for insurance companies dropping children with pre-existing conditions etc.

    Thank you for visiting my blog.

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  7. Indeed Ren, I can never understand that either and the fact we can't makes us on the right side (if you'll forgive the pun) of the wire.

    No worries about coming to see you, seems The Sentinel is away so feels safe for me to comment there.

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  8. The American right believe they have popular ideas. No amount of polls, will change them.

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  9. The American Right acts the way they do because they're selfish, immature bastards who hate poor people (even if the poor people are themselves).
    It'll be nice if this all dies down, but I suspect that it wont, especially when people are forced to buy insurance. Why we couldnt just expand Medicare or the VA coverage, I dont know (oh, yeah, that idiotic "socialism" meme - another way for the Right to say, "I dont want 'undeserving' people to get any of 'my' money").

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  10. Ren:

    And it is that entrenchment and intransigence that I find so deeply angering and offensive.

    Dave:

    Right on brother, right on!

    ReplyDelete

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