So now that the Healthcare bill has been signed into law most people do not really know what it means. What is included in the bill and when will it begin?

Within the first year:

• 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 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 per cent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

In 2011:

• Medicare provides 10 per cent 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 IRS forms.
• An annual fee is imposed on pharmaceutical companies based on market share. The fee does not apply to companies with sales of $5 million or less.

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.

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 per cent from 7.5 per cent of income. The threshold remains at 7.5 per cent for the elderly through 2016.
• The Medicare payroll tax is raised to 2.35 per cent from 1.45 per cent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income at a rate of 3.8 per cent for that income group.
• A 2.9 per cent excise tax is imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

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 per cent 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.

In 2015:

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

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.

There is no doubt that all eyes are going to be on the Blair house meeting that is an opened televised meeting among the republicans and democrats. This will take place on February 25th and the public will be able to get a first hand at viewing of just where both parties stand on this subject and specifically the Obama Health Care plan.

President Obama has indicated that this is the next step in the process of creating a health care reform that will benefit everyone.

The opposition feel that the entire process should be started from the beginning. President Obama has two concepts that he has presented and neither one of these have been acceptable by the opposition. He is of the belief that the two concepts of the Obama Health Care plans could be merged and worked upon to come out with the solution. The democrats are of the belief that this process will take it to the next level.

The republicans, however, feel that the whole Obama Health Care plan should be started from the beginning and any work that has been done by the democrats to this point should be scrapped. President Obama feels that a lot of work has been put into this so far and there is some very viable ground work to work with.

Where the general public stands on their opinion right now in regard to the Obama Health Care proposals seems to be mixed and confused.

It is understandable why the public would be confused when there has been so much debate and flurry created over the health care reform issue. One of the biggest factors about the Obama Health Care bill is the cost factor. This is of concern to the people who now feel that every dollar is being stretched as it is. They perceive more cost being laid on them and that they feel they simply cannot carry the burden now. However, there are just as many that are of the mind that health care reform must be put into action.

Perhaps the Blair house meeting will give the general public more insight as to just where both parties stand and where the Obama Health Care plan is going to end up. It will allow them to make some judgment decisions as to which side they want to stand with.

The republicans are of the mind that they people are against the health care reform as it stands in any way that it is been presented by the democrats at this point. The democrats feel that if the public is more informed as to what is in the Obama Health Care proposals, and what it stands for that they may be more supportive.

There is little doubt that there may be some very interesting factors coming out of this televised meeting. In any event, it should have some effect on the public itself, even if there are no resolutions.

While the primary ideological debate over healthcare reform in America is centered on the Democratic and Republican parties, a number of independent libertarians have also been vocal in expressing their reservations to current legislative options. Although few libertarians have been elected to Congress, a number of leading health and policy scholars have taken a market-based approach which suggests that government healthcare may be counter-productive. The academic debate over the merits of health reform incorporates these varying perspectives, which come from scholars across a variety of disciplines.

Economics of Health Care

Free market economists have been modeling the role of government in health markets since the 1960s, and have aimed to model the influences of government entry, irrational consumer decisions and the role of competition in the market. At the core of the issue is the role of policy in shaping incentives: while liberal economists such as Cass Sunstein argue government should encourage certain types of health behavior , other libertarian scholars have argued that providing more choices and less regulation should be the focus on improving health outcomes.

Research on Health Reform

Two major economic scholars active in health research today are MIT’s Jonathan Gruber and Harvard’s Richard Thaler. Both economists take a free-market approach to the subject but are careful to evaluate potential market failures, externalities and unintended constraints which lead to sub-optimal outcomes. Therefore, while scholars such as Robert Barro of Harvard have argued that private insurance markets can solve healthcare reform issues, centrist research has taken a more nuanced approach to the issue.

In a 2008 report on behavioral economics, Thaler argues that research into why people fail to make rational savings decisions can shed light on sub-par health care practices as well.  One overlooked aspect, according to the paper, is the presentation of the options to consumers. While many consumers might agree that quality health care is important, the availability and presentation of choices is even more important. Providing consumers with a clear road map to selecting a plan, especially when they are not given one by their employer is crucially important. For uninsured families, therefore, providing coverage guidance should be a core part of the planning process. Gruber also argues in another paper that lessons from Massachusetts state health care reform can help policy makers better understand effective reform on a national level. In particular, his paper takes a deeper look at consumers budgets and how mandatory plans can encourage more investment in quality health care, including preventative options.

When the Congressional Budget Office released a report suggesting that healthcare reform legislation may not reduce the overall budget deficit , many policy makers and citizens raised a critical eye. A core part of the healthcare reform debate today relates to its role in lowering overall public spending on health expenses. Since the national US budget deficit is at an all-time adjusted high, structuring legislation to reduce long-run health expenses provides a means for more sustainable health policy. Expert Cost Estimates Today, aggregate healthcare expenses cost nearly 20% of the annual Gross Domestic Product, totaling over $2 trillion in spending, and over $7,000 for each citizen. More importantly, the rising trend in health care costs suggests that health expenditures are growing faster than either currency or wage inflation, making adjusted health expenses even higher in a down economy. The current debate in Congress relates to creating incentives for more affordable treatments, better preventative care and broader coverage for the uninsured (whose lack of coverage leads to adverse effects on the aggregate economy.) Over half of aggregate medical expenses are attributed to direct care in terms of hospital stays and direct medical coverage. Spending on preventative care, education and fitness, on the other hand, represents a much smaller portion of costs. As a result, the overall debate on healthcare reform expenses relates to policy conditions under which consumers and local organizations can make better health allocation decisions. Elements of Savings While there is no single panacea to lowering healthcare expenses, there are several approaches which are being actively incorporated into reform efforts. One of these savings elements relates to better medical technology, including electronic medical records, more efficient medical devices and improved communications between health providers. The theory is that with better information, health care professionals can make most efficient and cost effective decisions. By adjusting their decision making, doctors can lower unnecessary medical costs and help encourage faster recovery. Another aspect of savings includes streamlining and prioritizing existing coverage. By investing more in early education, regulating drug marketing costs and providing more effective public options for senior care, policy makers believe they can take steps to lower overall health expenses. Policy makers argue that creating a public regulator which oversees the pharmaceutical, private insurance and medical device industries can provide an effective way to reduce unnecessary costs and prioritize effective, necessary care options.

While healthcare reform in America remains the center of a contentious debate over economic planning, America’s neighbor to the north has integrated public health options for decades. Many policy analysts have analyzed Canada’s public health care plan as a blueprint to better understand the potential implications for Healthcare reform in America. We wanted to provide you some insight into Canadian healthcare, along with its options, costs and implications for international policy making.

Background to the Health Plans

The Canada Health act established a public healthcare option in the country funded by provincial taxes and a subsidized general premium rate scaled by income. The Ministry of Health issues each citizen a Care Card  which provides access to essential professional medical care options, while also allowing patients to invest in supplemental and premium private care. The Government negotiates prescription drug pricing, leading to lower wholesale and direct consumer costs, which lowers out of pocket expenses for many consumers.

Under the plan, the elderly and poor are offered subsidized treatment options which help to ensure complete coverage. The program also has a strong focus on preventative care with mandatory checkups and evaluations, along with a focus on delivering efficient care. Patients are encouraged to use their medical care wisely, and there are stringent limits on over-use or irresponsible personal choices that may lead to higher medical costs. The Canada Health Act went into law in 1984, following on provincial programs which established universal access to health care on a local level.

Costs and Options in Canada

According to the plan, nearly ¾ of essential health care costs are covered under the government’s plan. These expenses include treatment for disease, preventative care, pregnancy and disability costs, as well as support for low income families and the elderly. Citizens still pay a pro-rated monthly premium around $50 per month as well as supplemental costs for specialized care. As part of the plan, citizens pay for aspects of care including dentistry, vision care as well as the cost of certain prescriptions.

While many groups argue that the system under delivers care to those in need, the country’s vital health statistics rank remarkably well in areas ranging from life expectancy, infant mortality and overall healthcare efficiency. As a result, many policy makers in the United States have studied Canada’s health care system carefully with an aim of incorporating some of its most productive elements into our own national plan.