What’s in the Health Care bill

For a useful summary of the provisions of our new national health care system, see  A look at the health care overhaul bill – washingtonpost.com.  Here are some highlights:

COST: $940 billion over 10 years, according to the Congressional Budget Office.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent. . . .

EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.

SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

This seems like we’ll be spending an awful lot of money for not all that much. We go from 83% of Americans with health insurance to 95%, a gain of 12%? More people will be getting government money. Does a family of four making $88,200 really need a subsidy? Isn’t that a really good salary? (Most college professors don’t make anywhere near that, and yet they do OK.) I’m curious what percentage of Americans will go on at least a partial dole. Quite a lot, I’d think.

And it doesn’t go into effect until 2014! So why all the urgency in the rhetoric and in the push to get this passed?

Other thoughts about what this bill would do?

Passing Health Care without voting for it

Our Democratic leaders are resolved to pass the health care reform bill no matter what.  Even if it doesn’t have the votes.  Here is the latest strategy:

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

Instead, Pelosi (D-Calif.) would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers “deem” the health-care bill to be passed.

The tactic — known as a “self-executing rule” or a “deem and pass” — has been commonly used, although never to pass legislation as momentous as the $875 billion health-care bill. It is one of three options that Pelosi said she is considering for a late-week House vote, but she added that she prefers it because it would politically protect lawmakers who are reluctant to publicly support the measure.

“It's more insider and process-oriented than most people want to know,” the speaker said in a roundtable discussion with bloggers Monday. “But I like it,” she said, “because people don't have to vote on the Senate bill.”

via House may try to pass Senate health-care bill without voting on it – washingtonpost.com.

Organ harvest in ER

In a bid to get more organs to transplant, the federal government is funding a program to remove organs in emergency rooms as soon as the heart stops beating.  Nevermind about brain death.  The sooner hearts, lungs, and livers are removed, the better they work, so it’s good to harvest them while the body is still warm.  This, however, raises ethical concerns:

In the hope of expanding a controversial form of organ donation into emergency rooms around the United States, a federally funded project has begun trying to obtain kidneys, livers and possibly other body parts from car-accident victims, heart-attack fatalities and other urgent-care patients.

Using a $321,000 grant from the Department of Health and Human Services, the emergency departments at the University of Pittsburgh Medical Center-Presbyterian Hospital and Allegheny General Hospital in Pittsburgh have started rapidly identifying donors among patients whom doctors are unable to save and taking steps to preserve their organs so a transplant team can rush to try to retrieve them.

Obtaining organs from emergency room patients has long been considered off-limits in the United States because of ethical and logistical concerns. This pilot project aims to investigate whether it is feasible and, if so, to encourage other hospitals nationwide to follow. So far, neither hospital has yet gotten any usable organs.

“This is about helping people who have declared themselves to be donors, but die in a place where donation is currently not possible,” said Clifton W. Callaway, an associate professor of emergency medicine at the University of Pittsburgh who is leading the project. “It’s also about helping the large number of people awaiting transplants who could die waiting because of the shortage of organs.”

Critics say the program represents a troubling attempt to bring a questionable form of organ procurement into an even more ethically dicey situation: the tumultuous environment of an ER, where more than ever it raises the specter of doctors preying on dying patients for their organs.

“There’s a fine line between methods that are pioneering and methods that are predatory,” said Leslie M. Whetstine, a bioethicist at Walsh University in Ohio. “This seems to me to be in the latter category. It’s ghoulish.”

For decades, most hearts, lungs, kidneys, livers and other organs obtained for transplants in the United States have come from patients who have been pronounced dead in a hospital after a complete cessation of brain activity, known as brain death, was carefully determined.

But because thousands of people die each year waiting for organ transplants, the federal government has begun promoting an alternative that involves surgeons taking organs, within minutes, from patients whose hearts have stopped beating but who have not been declared brain-dead. The faster organs are retrieved, the better the chances they will be useable.

Although increasingly common, the practice remains controversial because of questions about whether organ preservation and removal might begin before patients are technically dead, and because of fears that doctors might not do everything possible to save patients and may even hasten their deaths, to increase the chance of obtaining organs.

In the United States, the practice, known as “donation after cardiac death,” or DCD, is being done only on patients in the intensive-care unit or other parts of the hospital for whom the possibility of death has been long anticipated, and there has been time to methodically assess their condition and make sure family members are comfortable with the decision. Each hospital can decide whether and how to perform the procedure.

In 2008, the Children’s Hospital in Colorado sparked intense debate with a federally funded DCD pilot project that involved taking hearts from babies 75 seconds after they were removed from life support. After an intensive review, the hospital restarted the program about two months ago but required that surgeons wait two minutes.

via Project to get transplant organs from ER patients raises ethics questions – washingtonpost.com.

Would universal health care lower the abortion rate?

Catholic journalist T. J. Reid makes a challenging connection for us pro-lifers:

Increasing health-care coverage is one of the most powerful tools for reducing the number of abortions — a fact proved by years of experience in other industrialized nations. All the other advanced, free-market democracies provide health-care coverage for everybody. And all of them have lower rates of abortion than does the United States.

This is not a coincidence. There’s a direct connection between greater health coverage and lower abortion rates. To oppose expanded coverage in the name of restricting abortion gets things exactly backward. It’s like saying you won’t fix the broken furnace in a schoolhouse because you're against pneumonia. Nonsense! Fixing the furnace will reduce the rate of pneumonia. In the same way, expanding health-care coverage will reduce the rate of abortion.

At least, that’s the lesson from every other rich democracy.

The latest United Nations comparative statistics, available at http://data.un.org, demonstrate the point clearly. The U.N. data measure the number of abortions for women ages 15 to 44. They show that Canada, for example, has 15.2 abortions per 1,000 women; Denmark, 14.3; Germany, 7.8; Japan, 12.3; Britain, 17.0; and the United States, 20.8. When it comes to abortion rates in the developed world, we’re No. 1.

No one could argue that Germans, Japanese, Brits or Canadians have more respect for life or deeper religious convictions than Americans do. So why do they have fewer abortions?

One key reason seems to be that all those countries provide health care for everybody at a reasonable cost. That has a profound effect on women contemplating what to do about an unwanted pregnancy.

via T.R. Reid – Universal health care tends to cut the abortion rate – washingtonpost.com.

How would you answer this?   If you don’t accept this explanation, how would you account for the USA having the highest abortion rate?   If the connection the author posits is real, shouldn’t pro-lifers support some version of universal health care, even it means sacrificing some of our lesser principles?

UPDATE: Michael New answers the article.

Destroying the Senate

The “Christian Science Monitor,” not a conservative publication, has a piece by Mark Sappenfield entitled Reconciliation: why healthcare reform ‘nuclear option’ is deadly. It discusses the tactic of evading the filibuster rules so as to pass the Health Care Reform bill with a bare majority, rather than needing 60 votes. The author is referring to a “Face the Nation” appearance by centrist Republican Lindsey Graham and centrist Democrat Evan Bayh:

To many senators, including Graham, these procedures are not roadblocks to effective governance, they are the building blocks of it. The Senate is generally the last word in American legislative politics partly because it is seen as being more collegial and collaborative than its congressional cousin – and these seemingly arcane rules are the reason it is so, some would argue.

What is the significance of requiring a bill to win 60 votes or face a filibuster, after all? It is, at least on one level, an inducement to find compromise – to cross the aisle, to build coalitions.

To Graham, using reconciliation to pass healthcare reform circumvents the very mandate for consensus-building that makes the Senate unique.

Of course, reconciliation has been used before by both parties. But Graham noted that other cases involved at least some cross-party consensus. In this case, not a single Senate Republican voted for the healthcare reform bill.

If Senate Democrats used reconciliation to make changes to their healthcare bill, Republicans would pull out every stop to bring work in the Senate to a halt between now and the November elections, both Graham and Senator Bayh conceded.

Analogies

I love analogies.  Here is one from Charles Krauthammer on a conundrum in the health care reform bill:

Obama was reduced to suggesting that his health-care reform was indeed popular because when you ask people about individual items (for example, eliminating exclusions for preexisting conditions or capping individual out-of-pocket payments), they are in favor.

Yet mystifyingly they oppose the whole package. How can that be?

Allow me to demystify. Imagine a bill granting every American a free federally delivered ice cream every Sunday morning. Provision 2: steak on Monday, also home delivered. Provision 3: a dozen red roses every Tuesday. You get the idea. Would each individual provision be popular in the polls? Of course.

However (life is a vale of howevers) suppose these provisions were bundled into a bill that also spelled out how the goodies are to be paid for and managed — say, half a trillion dollars in new taxes, half a trillion in Medicare cuts (cuts not to keep Medicare solvent but to pay for the ice cream, steak and flowers), 118 new boards and commissions to administer the bounty-giving, and government regulation dictating, for example, how your steak is to be cooked. How do you think this would poll?

Perhaps something like 3 to 1 against, which is what the latest CNN poll shows is the citizenry’s feeling about the current Democratic health-care bills.

What are some other analogies that might help us understand current issues?

(This is not a thread about the health care bill, as such. Challenge the aptness of Krauthammer’s analogy, if you wish, but what I’d like to see are more analogies.)