"After last year's sweeping healthcare reform law drew more than 30 lawsuits challenging its constitutionality, it seemed just a matter of time before the measure had a day of reckoning at the Supreme Court. On Monday, the court announced that day would come next year, in advance of the presidential election, when it has agreed to hear appeals on five of those lawsuits and to consider at least four separate legal issues. Two of them concern the limits of congressional power, a hot-button issue for those who fear that the new law endangers personal liberty. But as several lower courts have found, the measure fits within the constitutional boundaries already laid out by the courts."
Source: http://www.latimes.com/news/opinion/opinionla/la-ed-health-20111116,0,4240404.story

Here we go again. Now the Supreme Court wants to take up the debate over the constitutionality of the individual mandate which is an essential part of the Patient Protection and Affordable Care Act also knows as health care reform or "Obamacare". Of course the whole debate, stirred up by the Tea party movement, is beating around the bush failing to see the real issue here.

The real issue is NOT the individual mandate, but the fact that health care would still be not saving costs because the government has failed to pass mechanisms and powers that lower the cost of health care. Right now, the government is literally betting all its money on bulk purchase and special deals made with the health care industry that promised to save $2 trillion. But, just because the bill is not perfect yet does not mean that we need to repeal it. What bothers me the most about this attitude coming from the extreme pro-single payer left and the extreme right is that none of them have ever lived in a system with an individual mandate.

The most important thing is to have this bill as a foot in the door. We will build on this new system and who knows, by the end of the decade it might be a completely revamped system. But, nothing will happen when we keep demanding an absolutely ideal health care system in form of single payer or everybody paying out-of-pocket (which is an insane idea). Our first priority should be to provide health care for all. ". It doesn't matter if a cat is black or white, so long as it catches mice." - Deng Xiaoping.

A decision on the constitutionality of the Affordable Care Act will be done in mid 2012.

By Susan Jaffe
"Q. Does the health care reform law require insurers to offer dental coverage?

A. No. The law doesn't require insurers to cover dental care for adults, but there's a good chance that could change when the state insurance exchanges begin operating in 2014. [...]

Although adult dental care is not among some examples of benefits the law says must be covered, consumer advocates say it appears that the U.S. Department of Health and Human Services could include it in the regulations that will detail what essential benefits must be provided."

In other words, bad news. I'm disappointed that the government completely underestimates the life-saving importance of dental coverage. Diseases in the mouth that are not treated can cause serious heart diseases. However:

"The law treats children differently from adults when it comes to dental care. Health care plans sold in the exchanges must include dental coverage for children. The age limit will be set in the regulations."
Source: http://www.aarp.org/health/health-care-reform/info-12-2010/hcr_explained_dental_coverage.html

This is the typical attitude towards dental care. People assume it is something only minors need to put their teeth in the right order. That's simply not true. Every person needs to go to dental check-ups at least twice a year.

The separation of health, dental and eye care is one of the biggest scams of the private health insurance industry. The health of a person depends on the regular and cooperation of all those fields. That's why universal health care systems do not distinguish between the two. All get their money from a single fund through rates, premiums or taxes.

If the United States wants to work towards the goal of universal health care, the HHS must require insurers to provide health, dental and visual in a single, comprehensive health plan or better, set up a single payer health-care system that funds all three. I want to thank Ms. Jaffe for doing a great job of informing the public about this. For most people (including myself) it is nearly impossible to find out what kind of services will be guaranteed under the new law.

By Don McCanne, MD

“Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues,” by Timothy Stoltzfus Jost, should be read in full (44 pages) by everyone who cares about the future of our health care system. The Executive Summary alone is not adequate to understand the implications of the issues he discusses. Every page requires attentive reading since each is covered with red flags, far too many to cover in a qotd commentary.

It is an especially important report for those who believe that the health insurance exchange model is a satisfactory compromise for moving forward, while dismissing further efforts to create a public national health program. It is also important for single payer advocates (improved Medicare for all) since it is important to understand the red flags raised by this report, and be able to debate them with others.

Many of the issues listed would disappear under a single payer system. For instance, in spite of the measures in the law, adverse selection (concentrating high-cost patients in health plans) cannot be eliminated by the insurance exchanges, yet it would disappear in a single universal risk pool. That is especially important since adverse selection has destroyed previous insurance exchanges in numerous states.

Read more: http://californiaonecare.org/don-mccanne-md-policy-issues-for-the-health-insurance-exchanges/

Dr. John Geyman, Professor Emeritus of Family Medicine at the University of Washington School of Medicine in Seattle writes in The Huffington Post that the new Patient Protection and Affordable Act of 2010 (PPACA) won’t do enough to tame exploding healthcare costs. His essay breaks down the flaws in the complicated law in bullet points that are easy to understand. For example PPACA has:

• No price controls. Wall Street has already factored in rapid expansion of markets for drugs, medical devices and other services in a system of expanded access.

• No bulk purchasing. The PPACA has prohibited the government from negotiating the prices of prescription drugs and retains a ban on importation of drugs from Canada and other countries.

• Lack of control over perverse incentives that drive increased volume of services. These in turn are driven by retention of fee-for-service (FFS) reimbursement that encourages physicians and other providers to offer more services than are medically appropriate or necessary.

• No effective mechanism to rein in marginal or ineffective technologies. Coverage policies for new drugs and medical devices are still lax and not subject to rigorous evidence-based criteria for either efficacy or cost-effectiveness.

Click here to read the rest of Dr. Geyman’s article:
http://www.huffingtonpost.com/john-geyman/hijacked-stolen-health-ca_b_638630.html

Source: www.californiaoncecare.org

Short, he hits the nail on the head. In fact we shouldn't even call it Health Care Reform. For me, HCR died the day the public option was dropped. As long as the government doesn't have an active role in health care like Canada, European countries and even Hong Kong, the costs for health care will continue to rise. The special deals in this bill don't serve anyone than the health care lobby and big pharma companies.

I still hope that they can rescue the Federal Health Exchange. It would change a lot compared to State Exchanges.

• State Health Exchanges like the Massachusetts Health Connector above would handicap new health insurance companies. New health insurance companies usually are unkown. They would be chained to a State Exchange with little chance to break out to other state exchanges while established insurance companies would have the money and possibility
• In contrast, a new health insurance company who is listed in a single Federal Health Exchange could get attention from potential customers across the whole country. This also means that we would have a much greater choice through a Federal exchange than through 50 state exchanges, not to mention that it would cost millions to run 50 state exchanges compared to a single Federal Exchange.

We would benefit from new, more honest and more efficient competitors. I also think that this would get rid off this feeling that we are forced to buy insurance from the ones that used to abuse us.

According to the media and Senate Democrats, the public option has been dropped in favor of a quasi public option. This option would be based on nonprofit private health insurance companies but "heavily" regulated by the Office of Personnel Management.

What many people forget is the fact that the House bill would also have established Basic Health (the Senate's quasi public option) by requiring private insurance to offer basic health care along with the public option:

"An analysis by the CBO found that, for a basic health plan from an "exchange" created in the bill, premiums for a single person would be $5,300 by 2016, while a family of four would see a $15,000 premium. People making less than 400% of the income threshold for the federal poverty level would receive subsidies from the government to help offset that cost."
http://online.wsj.com/article/BT-CO-20091102-715403.html

Washington Post defines the subsidies in the House Health care bill:

"The House bill has subsidies up to 400 percent of poverty, which is equal to $43,320 for an individual and $88,200 for a family of four. At the bottom end -- 133 percent if income, as below that, you're eligible for Medicaid -- the subsidies limit your health premiums to 1.5 percent of income. At the top end -- 400 percent -- it's no more than 11 percent of income."
http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html

Shortly said: "Basic Health" has already been in healthcare reform legislature passed by the House of Representatives. Thus the public option has been replaced by something that has already been in the bill. That means the PUBLIC OPTION IS DEAD.

The Senate has not only dropped the option, Senate Democrats even have the courage to lie to us!

Hi,

Now, that the Senate bill has been introduced to us I realize what began as a HUGE, optimistic plan for Health Care Reform has been cut step by step over the last months.

+Our robust public option that competes with private insurers
-Now it is a weak public option that will have higher premiums

+We had the choice to CHOOSE between public and private insurance
-Now the public option is restricted to 2% of the population

+The Kucinch Amendment should grant states the right to create a single-payer system
-The vote has been postponed

+People 350% above the poverty line should get government-run health insurance
-People 133% above the poverty line can get government-run health insurance

+Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
-Limits annual out-of-pocket expenses to $8,500 for an individual and $23,000 for a family.

+People will be covered until 2013 when the health exchange is running from New Year 2010.
-People will be covered until 2014 when the health exchange is running from somewhere in 2010. This means, millions of patients will lose coverage after the Senate bill has been passed.


The only solution is real government-run health care that will run more efficiently and in favor of the patient, not the insurance CEOs.

Based on:

America's Affordable Health Choices Act of 2009
and
Senate Health Bill

I am NOT happy with health care reform. This bill shows why I am a strong supporter for completely government-run universal health care. Not Health Care Reform, real government-run health care where the government:

1. employs the doctors and nurses
2. can provide a comprehensive range of services
3. shapes its services around the needs and preferences of individual patients, their families and their carers
4. responds to the different needs of different populations
5. works continuously to improve the quality of services and to minimize errors
6. uses public funds for healthcare devoted solely to patients
7. works with others to ensure a seamless service for patients
8. helps to keep people healthy and work to reduce health inequalities
9. respects the confidentiality of individual patients and provide open access to information about services, treatment and performance

(based on NHS England)

So that it:

1. meets the needs of everyone
2. be free at the point of delivery
3. it be based on clinical need, not ability to pay

Read more at: http://www.huffingtonpost.com/2009/10/29/history-in-the-making-rea_n_338438.html