"Henry J. Waternoose: James, this company has been in my family for three generations. I would do anything to keep it from going under.
Sulley: So would I, sir.
Henry J. Waternoose: Say, I could use your help with something.
Sulley: Anything, sir.
Henry J. Waternoose: You see, we've recently hired some new recruits, and frankly, they're... um...
Sulley: Inexperienced?
Henry J. Waternoose: Oh, they stink!
Sulley: Uh-huh.
Henry J. Waternoose: I thought you could drop by the simulator tomorrow and give them a little scare demonstration, show them what it takes to be our top scarer.
Sulley: I'll start with the old Waternoose Jump-and-Growl. [Jumps and growls]
Henry J. Waternoose: [Startled] Oh! Ha ha! That's my boy.
- memorable quote from the movie "Monsters, Inc."
Am I scared about health care reform yet? Have the monsters done their jobs? Do I really understand what is in the health care reform bill, H.R.3200 America's Affordable Health Choices Act of 2009.
It's purpose is...
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. as introduced. It sets forth provisions governing health insurance plans and issuers, including:
(1) exempting grandfathered health insurance coverage from requirements of this Act;
(2) prohibiting preexisting condition exclusions;
(3) providing for guaranteed coverage to all individuals and employers and automatic renewal of coverage;
(4) prohibiting premium variances, except for reasons of age, area, or family enrollment; and
(5) prohibiting rescission of health insurance coverage without clear and convincing evidence of fraud. Requires qualified health benefits plans to provide essential benefits. Prohibits an essential benefits package from imposing any annual or lifetime coverage limits. Lists required covered services, including hospitalization, prescription drugs, mental health services, preventive services, maternity care, and children's dental, vision, and hearing services and equipment. Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family. Establishes the Health Choices Administration as an independent agency to be headed by a Health Choices Commissioner. Establishes the Health Insurance Exchange within the Health Choices Administration in order to provide individuals and employers access to health insurance coverage choices, including a public health insurance option.
Requires the Commissioner to:
(1) contract with entities to offer health benefit plans through the Exchange to eligible individuals; and
(2) establish a risk-pooling mechanism for Exchange-participating health plans. Provides for an affordability premium credit and an affordability cost-sharing credit for low-income individuals and families participating in the Exchange. Requires employers to offer health benefits coverage to employees and make specified contributions towards such coverage or make contributions to the Exchange for employees obtaining coverage through the Exchange. Exempts businesses with payrolls below $250,000 from such requirement.
Amends the Internal Revenue Code to impose a tax on:
(1) an individual without coverage under a health benefits plan; and
(2) an employer that fails to satisfy health coverage participation requirements for an employee.
Imposes a surtax on individual modified adjusted gross income exceeding $350,000.
Amends title XVIII (Medicare) of the Social Security Act to revise provisions relating to payment, coverage, and access, including to:
(1) reduce payments to hospitals to account for excess re admissions;
(2) limit cost-sharing for Medicare Advantage beneficiaries;
(3) reduce the coverage gap under Medicare Part D (Voluntary Prescription Drug Benefit Program);
(4) provide for increased payment for primary health care services; and
(5) prohibit cost-sharing for covered preventive services.
Requires the Secretary of Health and Human Services (HHS) to provide for the development of quality measures for the delivery of health care services in the United States. Establishes a Center for Comparative Effectiveness Research within the Agency for Health care Research and Quality, financed by a tax on accident and health insurance policies, to conduct and support health care services effectiveness research. Sets forth provisions to reduce health care fraud.
Amends title XIX (Medicaid) of the Social Security Act to:
(1) expand Medicaid eligibility for low-income individuals and families;
(2) require coverage of additional preventive services; and
(3) increase payments for primary care services.
Sets forth provisions relating to the health workforce, including:
(1) addressing health care workforce needs through loan repayment and training;
(2) establishing the Public Health Workforce Corps;
(3) addressing health care workforce diversity; and
(4) establishing the Advisory Committee on Health Workforce Evaluation and Assessment.
Sets forth provisions to:
(1) provide for prevention and wellness activities;
(2) establish the Center for Quality Improvement;
(3) establish the position of the Assistant Secretary for Health Information;
(4) revise the 340B drug discount program (a program limiting the cost of covered outpatient drugs to certain federal grantees);
(5) establish a school-based health care program; and
(6) establish a national medical device registry.
Erm... not as complicated as I thought.
So... looks like a pretty good bill. It provides insurance companies with a captive (i.e., every American) market so they can continue to rake in the profits, and it provides Americans with coverage that is affordable, sustainable and without pre-existing condition loopholes. I like the Center for Quality Improvement/wellness provisions that recognize the importance of preventative health care. I also like the government run insurance/health care plan to give Blue Cross/Kaiser some competition and make sure low income and desperately poor people are covered.
The bottom line is that catastrophic health problems caused by accidents, disease, etc., can be addressed making everyone healthier.
Now, how do I think this beast will grow? My advanced age and California location permit me to use experience as my guide.
Three big questions: 1) Should the government provide health care? I mean is this really something that I want my taxes to pay for, just like defense, infrastructure, energy, communications.... I see a pattern here. Me and my family already pay for social security, medicare, roads, waterways, phone and electric lines, military bases, things or projects that span the entire nation and benefit everyone; 2) Does the government do a good job with these responsibilities; and 3) Could/would private corporations do a better job? My responses are yes, yes and no.
I've lived through the Enron energy rape of California. The state still feels the repercussions of this debacle. Letting "for profit" corporations provide what utility companies provide was a mistake and has plunged this state into bankruptcy. That's right. Enron and those who supported the cracked brain idea of letting the fox into the chicken coop of public utilities without proper oversight began California's economic decline. Private companies will manipulate the "market" and increase profits. That is the nature of the beast. Insurance companies are part of this herd. Maybe the alpha males of this breed.
The federal government via HR 3200 is skating on thin ice with the health care industry. In a sense, the feds want to create a viable health care utility company - allowing reasonable profits but not at the expense of the consumer. The crafty herd of health care corporations see dwindling profits and are fighting tooth and nail to kill this bill. The millions they are pouring into attack ads could be better spent finding new products, services and markets to support and enhance a national health care system. In other words, innovate instead of enervate. So, my big complaint with the bill is that it delivers a captive market (ala Californians during the energy crisis) to corporations. The only thing in this bill that saves consumers from the ravages of corporate greed is the government-run insurance plan. Without this plan, we are screwed.
Okay, okay, Mr. bored websurfer who has stumbled on my lonely blog, I agree. What has the energy industry have to do with health care? I use them to illustrate the nature of the beast. They are not utilities. They exist to make profits.
A more appropriate example would be the homeowner insurance companies who abandoned California right after the Northridge earthquake (and Florida, after the latest hurricane). Yup. We went to renew our homeowner insurance in 1995, a year after this catastrophe and ... we were cancelled even though we did not file any claims or do anything but pay our premiums on time. Republic Ins. no longer sold homeowner insurance in California. So, what to do? The state had to come up with a government insurance plan from a pool of willing companies who would not sell direct but would sell via the state so that losses could be spread out evenly. That's right, the state of California had to fill the void with an adequate plan at a reasonable cost.
So, I predict that this bill will pass with a government-run insurance option. After a short time, the health care industry will manipulate markets, abandon clients when the chips are down, go off shore, whatever they need to do to maintain their current profit margin. Millions of Americans will be left in the lurch by the corporations. The federal government will step in with a single payer, Medicare-type plan for all. More neighborhood clinics will sprout up. Big hospitals will shrink, change, or go away. The doctor and nurse shortage will decline. Americans will be healthier. People will not have to worry about high policy premiums and/or choices about losing their homes or paying for catastrophic health care costs. Mental health statistics for Americans will improve. Businesses will be able to phase out crippling health care benefits and be able to compete with other nations that have national health care. Health care as a utility will evolve, along with all of the growing pains associated with growth. The insurance and pharmaceutical industries will find ways to expand into new products, services and markets. Will this process be painful and filled with controversy. Yup. Do I want it? Yes.
So, why not simply jump to a single payer plan right now? As many progressive pundits point out, America is owned by the corporations and no one wants to stampede this skittish herd. We need to pick off what we can to survive - create a win/win wherever possible and hope for the best.
