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Tuesday, December 22, 2009

Health Care Reform: What happens next

When all is said and done with the likely passage of the health care bill, more was said than done. Everyone probably watched one of their favorite parts disappear. Whether you really wanted a public option plan, were really hoping for some serious efforts to reduce Medicare spending, or really wanted a death panel to go after grandpa and perhaps your strange uncle, it's not happening.

What will happen is that in 2013 or 2014, it will be a law for everyone to have health insurance. Insurance companies will no longer deny anyone, not provide care for a pre-existing condition, or not give you whatever plan you want. Basically, that's it and it's a good thing. People should not be denied access to health care based on their employment status. Insurance companies actually don't like having to build up elaborate systems to deny people and would prefer that everyone join the party (and pay their premium to join that party).

There will be a period of adjustment as we come to terms with this notion of the individual mandate or the idea that we all have to carry health insurance just like we need auto insurance. This adjustment will come with the realization that there is a direct connection between everyone buying insurance and the affordability of insurance. The young, beautiful, and healthy need to pay now in order to have insurance when they are old, sick, and need cosmetic surgery (which will not be taxed by the way. Instead indoor tanning salons will be taxed to help pay for this. No, I couldn't make this stuff up if I tried). Just like we get a taxes for Medicare taken out of our pay check in order to enjoy it when we're older.

For those who were fans of the Public Option plan, you all know that I think you are wrong. However, the Public Plan really died in the House bill when it required negotiation with health care providers instead of jamming Medicare rates down their throats. With that clause, the Congressional Budget Office analysis ruled that the Public Plan will cost more then the average private insurance plan. As a result, policy wonks breathed a sigh of relief over their fears of accidentally writing about the "Pubic" Plan since spell check will never catch that.

The idea of 55 year olds being able to buy into Medicare would have never worked. Medicare would cost $800/month and it would not cover routine doctor visits nor would have an out of pocket maximum which would limit the most you would ever have to pay (a common feature of private insurance plans). The only Boomers who would pay that are those who cannot get other insurance, would use thousands of dollars of services per month, and the result would be skyrocketing premiums. That is called the insurance death cycle (not to be confused with death panels).

For those who still worried about costs and how we'll pay for this, that question will be answered in 5 years when the bills start to come. Health care policy has always addressed access first and cost second. Massachusetts is looking at cost control as we speak with global payments and Accountable Care Organizations. Medicare has produced the DRG system and other changes in the past to address the solvency of the program and will do so again. Cost containment will be part 2 of health care reform.

Now that the debate is wrapping up, enjoy the holiday season, sit back, relax and play the Have sex with, Marry, or Throw Off the Cliff game with Joe Lieberman, Ben Nelson, and Sarah Palin (My answer is Palin, Lieberman, Nelson). We'll have an individual mandate and no one will be denied health insurance. Disaster didn't happen and a government bureaucrat won't ever get between you and your doctor. Unless, of course, you're talking about an abortion with your doctor and in that case all three branches of government will be lined up outside of your uterus.


Elliott said...

Todd- You crack me up. Do you think the issue of an individual mandate will go to the supreme court, and will the 5 conservative justices declare it unconstitutional?

Elliott said...

And one more thing. Sarah is bad news, stay away from her.

Deadhedge said...

Hi Elliot,
I could see the liberal judges hating the individual mandate due to affordability concerns. However, we have mandates around auto insurance and paying Medicare taxes so I don't see how this would be unconstitutional.

With Sarah, the game is all about forced choices. How would you play it?

Thanks for reading.

babbler said...

I was surfing the blogs and came across your intelligent and thoughtful post. We slugs are a curious type....I wonder if health care reform applies to mollusks as well as humans? I am worried about being taxed to warm my belly at the indoor tanning salon. This really chaps my mantle! I am going to look at this thing out of one optic tentacle for the time being.
In the meantime, I shall contine to hope for the best and wish you kids a Merry Christmas and a high water content in the new year.
Mrs. Slug in Oregon

Ben said...

Marry, as in wake up to every morning for the rest of your life? Lieberman? I guess I haven't seen enough of Nelson to make an informed choice about marrying him, but I might go Nelson, Palin, and Lieberman (because I really do want to throw him off a cliff). I bet she'd fix me bacon and eggs.

Ben said...

Any chance for single payer happening ever?

Deadhedge said...

@ Babbler, thanks for visiting. I never thought of health reform from a slug's perspective.

@ Ben, Marry Palin? You would probably have to read Going Rogue and her bacon can't be that good. Lieberman's got character and character does go a long way.

With single payer, the closest that I could see would be a system where the government contracts with all of insurance companies to provide uniform benefits, prices, and administration. This is like the Federal Employees benefit or Medicare Advantage. We have too much history with insurance companies and they do a lot of the insurance administration better than the government could.

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