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.

It would be safe to say that everyone is in agreement that the health care crisis in America has to be addressed. From that point, however, it becomes a matter of opinion as to what needs to be done. It has to be realized that there are some very serious consequences ahead if the problem of a health care reform plan is not addressed.

For those that have no coverage at the moment they are aware of the happenings. If it continues the way it is going then there are going to be more and more children that are not receiving the medical care that is needed. There is no doubt that this is going to eventually lead to being where the children are in very poor health.

Then there are the cancer patients that have no health insurance. They really are not getting the opportunity to receive the treatment that could basically save their lives by catching the cancer in the early stages. The result of all of this is going to be an increase death rate most likely at a much younger age if some type of a health care reform plan is not put into effect.

Based on just these few factors alone there is no way of saying that coverage is not needed and even the coverage that is being supplied now has to be revamped so that it is accessible to everyone.

What has been put to paper so far by the Obama government  in respect to a health care reform plan which is of course under fire by the opposition covers many different issues. The basics of this are that the new health care reform plan would make sure that every individual has access to insurance. Which would in turn allow them to get the health care that they deserve

It would also mean that those that are paying for their health care through premiums it would be more affordable. There are many circumstances where an individual could obtain insurance through their place of employment, for example, but are just not able to afford the premium costs.

The other issue that would be addressed by the new health care reform plan is taking the Medicare system that is in place now and making it much stronger. These are the three major points of the reform that has been put before the senate.

These is just the basic shell of what needs to be done but the cost factors of course for all of these are phenomenal and the money has to be addressed as to covering the cost.

However one also has to take into account what the cost is going to be if something is not done by way of a health care reform plan. This also includes the financial cost as well considering the more that the individual workers’ health fails the less production is being done and this does no good for the economy either.

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.

So knowing this why in the world go ahead and even introduce such a bill then? Simply, because it is a starting point. Getting the bill passed is the first real step to getting everyone within the government to sit down and take some form of action, whether it be negative or position. It has got passed the point of being able to just “sit on the fence” or the “no comment” types of attitude towards healthcare reform.

When you stop to think about it up until now there has been no healthcare reform plan so nothing to oppose. This may sound harsh in painting a picture that the opposition is against health reform altogether. This is not the point which when no doubt they welcome a positive solution as well. The point is though that the opposition are looking at it strictly from the point of finances. In reality, this is the most important issue.

What President Obama seems to be trying to address is that the problem in not going to go away just because they are no funds to rectify it. He is determined that if  everyone will become of one mind that a solution must be found then it will be so. In other words there is no more running away from the problem. It’s time to address it and find the best solution possible. It may not be the one that everyone wants, but it is a start.

With the healthcare reform being such a hot topic of debate right now. Where does the ones that really count stand? Meaning the people of the United States, who stand to either gain or lose from healthcare reform. It would seem a little odd to think that one could lose from healthcare reform, but there are some very big Insurance Companies and employers that just aren’t sure they could withstand the crunch of a healthcare reform that could adversely affect them. Is it going to become a snowball effect where it would then affect jobs?

There is no doubt that all parties of the Government have a very hard and long road ahead of them when it comes to healthcare reform.

From this point on though it would seem that the thoughts now become divided. Of course it’s just a part of life for the two sides of government to disagree just about on everything. So just what is so different about the healthcare system now then in was two years ago? The answer to that question is twofold, meaning not much and then quite a bit.

What has changed?

Probably, for the first time an issue that has had any significance to it is the leader of the Country has taken a hard look at the issue and has taken a definite step forward towards healthcare reform. That’s not to say that past presidents have not given the health care crisis a hard look either however, it seems that it never got beyond the looking stage. At least President Obama looked, planned and took action. Getting it to the house to have it approved as a bill was a big hurdle that he and his party successfully completed.

Even if the bill in its present format is totally restructured which no doubt much of it will be progress has been made.

What has not changed?

The same old argument concerning healthcare reform still remains the same and comes down to money. Sure everyone wants healthcare but the big question is who is going to pay for it and where is the money going to come from? This has always been the big question and the ultimate brick wall that any thought of future plans gets blocked at.

So now what?

This three word question seems to be what the entire healthcare reform is hinging on. Something that is significant. however, is that President Obama seems intent on seeing this through and perhaps his relentless attitude is the very thing that will see healthcare reform become a reality. Albeit perhaps not to the extent or as picture perfect as he would like it to be. Then again, something is better than nothing but also a quick fix is not the answer either.

The conclusion is that it’s times for  both sides of the Government to work towards a plan in common rather than running in opposite directions because it would seem that this is what the opposition is expected to do.

What seemed to be a done deal. However, soon took a downward spiral with the  Democrats losing their position of the senate seat originally held by Senator Edward Kennedy.

It is obvious that President Obama has a one goal mandate when it comes to health care and is hoping that congress will join in the unity of this goal. Should they do this. However, just what would Congress healthcare reform decisions consist of?

It would seem that the means of reaching a solution to passing the bill would be the ideal gathering of the “the minds” referring to both sides of congress as well as the health care professionals. This would be to hash over the health reform bills to see what is needed and what will work. At least this is the feeling of the President.

Although for weeks there has not been any indication as to which way the Congress healthcare reform will continue to the next step, the President has declared that there is to be a television healthcare session slated for Feb 25th. Somewhat like a debate the President has asked the Republicans to attend a present their solutions for the soaring medical insurance costs in the USA and the lack of medical care for those who simply cannot afford it.

In the meantime, the powers of the senate are putting their heads together to devise a condensed version of the bill, which could be made law. The ultimate resolution would be that it would be able to fall into line with the budget bill.

There is no doubt the public as a whole is looking upon this with many wondering if the outcome is going to be merely a Band-Aid solution to the critically needed health care reform throughout the Country. This could come down to extended coverage for those that fall within the economically poor category using Medicaid, while those in the mid to average income would be eligible for supplementary health care help by way of purchasing the necessary insurance.

Although there are many details to this potentially new concept of easing the health care crisis it would still mean that coverage would be provided through the current employers that are presently doing so. In addition Companies could merge to buy Insurance plans. It would basically mean that everyone would be required to have medical coverage or face a fine.

President Obama is of the belief that with a publicly televised debate the people of America will get to hear both sides of Congress healthcare reform proposals and will then be able to make an informed stance on what to believe and support.

So now it would seem that at least the first hurdle of getting the bill for healthcare reform passed now means facing the bigger hurdle of getting it put into law or at least some part of it.

President Lyndon Johnson finally succeeded in major health legislation in 1965 by passing Medicare legislation to provide extended coverage to low-income families. While the program has been vastly revised in successive legislation, it remains a core part of American public policy today, and the social safety net was extended further in 1985 with passage of COBRA health care benefits for the unemployed (http://www.dol.gov/dol/topic/health-plans/cobra.htm).  In the past two decades, a number of major reform efforts have met strong opposition, including the Clinton health reform effort of 1993 and President Bush’s efforts to create medical savings accounts. While President Bush did not achieve universal success, his Medicare Prescription Drug, Improvement, and Modernization Act added a prescription drug benefit to Medicare for senior citizens.  Today’s healthcare reform debate has incorporated many of the ideas and lessons of this history, and now brings new perspectives on reform.

Health Policy Ideas Today

Health policy scholars are actively working on incorporating the latest research into modern health reform efforts.  The goal is to provide a framework for more cost effective quality care, working with hospitals, insurers and government officials to create consensus.  While there are a number of approaches to reform, major efforts to reduce the costs of health care relate to better statistical analysis and record keeping of treatment options. Currently, doctors are allowed to select a patient’s course of treatment according to insurance guidelines, although research has suggested that independent analysis should also play a role in determining which treatments are optimal.

Current Office of Management and Budget Peter Orszag has been a strong proponent of Independent Advisory Panels which provide objective, independent reviews of varying treatment options. For publicly based health services, incorporating the latest research into treatment plans is a core part of ensuring the most cost effective treatment available. The OMB is also working on tax reform issues related to providing incentives for medical professionals to deliver cost effective care and tax incentives for those who deliver effective plans (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/19/AR2009081902261.html).

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.

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.