Show your wisdom, place your bets now on the US health care

[sunnyside]

So it looks like getting the bill through is a sure thing. Now in the past we've discussed hypothetical outcomes of the bill in various forms, but soon, (or maybe not so soon but eventually) it will come into reality.

So this is more about making your predictions, and maybe some day we can dig this out.

Anyway some metric type things to measure against:

Insure 32 million more Americans (out of 46.6 million currently uninsured)

Extend medicare by a decade. Current projections indicate that, at current tax levels and benifits, medicare would run out in 2017 (was 2019 when the economy was a little better). Since they do a lot of trending with this, we could possibly start seeing changes in the trends if it's working without taxes having to go up or benifits going down.

Save 1.3 trillion dollars. That's supposed to start delivering pretty quickly. This might be a little hard to pin down as it's based on saving vs where health care costs were supposed to go, but still, we've got projections to compare against. And savings vs massive extra expenditures will be fairly obvious.

Then there are other aspects that we could compare numbers for, such as average wait times for procedures and higher tech equipment.

Or the number of doctors compared to the number of patients.

And then wether existing health plans will stay in existance. (Well, obviously they'll be forced to change to remain legal, but will they simply add the required clauses and not jack up the prices or degrade benifits.)


Myself, I'm betting that we'll see people covered( though I expect the 14.6 billion people who still aren't going to be covered are going to be surprised), and possibly channel money to extend medicare. But it isn't going to save money at all, it's going to cost tons. While I give them credit for at least adding in some extra taxes to cover things, I don't think it's going to be enough. Wait times will go up if not the doctor/patient ratio, but not by a bunch as long as the government funds keep flowing into private insurance companies.

I also have a hunch that some people are going to start seeing some pain in health plans.

[Sionnach Glic]

I lost track of the reforms quite a while ago, when the Democrats started making concession after concession to the Republicans, so I'm not all that sure exactly what is being passed.

Though according to Reuters:

FACTBOX-US healthcare bill would provide immediate benefits
Fri Mar 19, 2010 6:46pm EDT

WASHINGTON, March 19 (Reuters) - The U.S. House of Representatives is heading for a Sunday vote on a sweeping overhaul of the $2.5 trillion U.S. healthcare system.

Regulatory News | Bonds

House Democrats are confident they can overcome solid Republican opposition and pass the bill. Leaders are using a two-step process where the House approves Senate-passed legislation and then votes for a separate package of changes to satisfy concerns of House Democrats. The Senate is expected to approve those changes as well and President Barack Obama plans to sign the bill into law.

Here is what to expect if the bill becomes law:

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. (Reporting by Donna Smith; Editing by David Alexander and Eric Beech)

It's a bit of a mixed bag, and far from what would be ideal. But at least it's moving in the right direction, though with more of a drunken stumble than a step.

[Aaron]

Myself, I'm betting that we'll see people covered( though I expect the 14.6 billion people who still aren't going to be covered are going to be surprised), and possibly channel money to extend medicare. But it isn't going to save money at all, it's going to cost tons. While I give them credit for at least adding in some extra taxes to cover things, I don't think it's going to be enough. Wait times will go up if not the doctor/patient ratio, but not by a bunch as long as the government funds keep flowing into private insurance companies.

I also have a hunch that some people are going to start seeing some pain in health plans.

This.

While I am fond of our system, I have long given up hope of the US being able to implement anything effective or in a competent manner. Especially since Obama can't even reign in his own party.

[Tyyr]

This isn't healthcare reform. There's exactly dick in this bill that tries to deal with healthcare costs which are the core problem. It's health insurance... well reform is probably not the right word but it's a health insurance bill.

*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.

...HAHAHAHAHAHAHA!! I love our government. A $3,554 gap in coverage that they try to fix with a $250 rebate.

*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.

Tax credits... really? For people who already get most of their taxes refunded? Wow, thanks Washington.

[Aaron]

This isn't healthcare reform. There's exactly dick in this bill that tries to deal with healthcare costs which are the core problem. It's health insurance... well reform is probably not the right word but it's a health insurance bill.

Yeah, a friend of mine called it "insurance rules changing."

[Mikey]

That's exactly what it is. True reform has to be taken out of the equation in order to get through at all, to the point at which a passable bill was to be only a band-aid.

[Deepcrush]

It sucks but we have to start somewhere. Truth is I don't think anyone would do well their first time around for a system like this. The best thing would be for the USA to accept and be willing to spend the next twenty years working it out.

[Mark]

What I don't understand is this. In Hawaii, it is state law that EVERY full time employee WILL be provided health care by their employer if they work 20 hours or more for four weeks. Anyone that doesn't have medical insurance can apply for Med Quest, which is the state insurance.

This whole thing could be settled by making that a Federal Law. That way, every American that has a full time job will have health ins from work, and with a minimal tax, can pay to provide money for the fed ins for those that can't, or in case they end up needing it later.

I mean, you've got a good chunk of people that are disabled but WANT to work. The government invests say $40,000 in fixing them, and they go back to work, paying taxes until they retire. The government makes money.

[sunnyside]

What I don't understand is this. In Hawaii, it is state law that EVERY full time employee WILL be provided health care by their employer if they work 20 hours or more for four weeks. Anyone that doesn't have medical insurance can apply for Med Quest, which is the state insurance.

This whole thing could be settled by making that a Federal Law. That way, every American that has a full time job will have health ins from work, and with a minimal tax, can pay to provide money for the fed ins for those that can't, or in case they end up needing it later.

I mean, you've got a good chunk of people that are disabled but WANT to work. The government invests say $40,000 in fixing them, and they go back to work, paying taxes until they retire. The government makes money.

Hmmm. Maybe you need to clarify how that works. Hawaii has a lower unisured rate, but it still has one and it isn't the lowest in the US, it's still about 1 in 10 among the under 65 crowd.

[Mikey]

Anyway, I can't see that flying in the entire U.S. While the idea of laissez-faire capitalism is strictly an unattainable ideal, the idea of that much regulation of required expenses won't fly.

[BigJKU316]

The whole idea of not allowing exclusion for pre-existing conditions is silly. At that point you are not buying insurance, you are simply paying a little so others can pay a lot.

There is nothing that stops me from having a dirt cheap plan that gives minimal coverage and then finding out I have cancer, buying the best plan I can and driving everyone's premiums through the roof. By definition if you can buy it after the fact it is not insurance anymore.

[Monroe]

*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.

...HAHAHAHAHAHAHA!! I love our government. A $3,554 gap in coverage that they try to fix with a $250 rebate.

My understanding was the 250 is for the previous year for those who just missed it. They are closing the hole in the future.

[sunnyside]

The whole idea of not allowing exclusion for pre-existing conditions is silly. At that point you are not buying insurance, you are simply paying a little so others can pay a lot.

There is nothing that stops me from having a dirt cheap plan that gives minimal coverage and then finding out I have cancer, buying the best plan I can and driving everyone's premiums through the roof. By definition if you can buy it after the fact it is not insurance anymore.

On notes like that I think a lot depends on wording. But there is plenty of room if things like that aren't restricted to really wreck healthcare in a manner that almost no one likes. My hope is that's patched, or we'd have heard more on it. Perhapse they're required to insure you despite pre-existing conditions, but only under their "basic" coverage.

[Tyyr]

Insurance premiums are going to go up, period. There's no way you can mandate that the insurance companies can't turn people away and not have them climb. Even if you don't game the system like that they're going to climb.

[Monroe]

Insurance premiums are going to go up, period. There's no way you can mandate that the insurance companies can't turn people away and not have them climb. Even if you don't game the system like that they're going to climb.

Aye there's nothing in the bill that says they can't go up. And if Corporate America and their allies the Republicans are smart they will make premiums sky rocket and then cry that its the bill's fault.