HCR ruminations

Although the Senate still must adopt the House-passed reconciliation bill to seal the deal, the President has signed health care reform into law. To suggest it was a long, hard fight would be to wildly underestimate the complications -- in language, in egos and in timing -- the Democrats in both houses of Congress overcame. It wasn't pretty, but it got done.

What is "it," exactly? What does it do, and where does it leave us? Finally, is it good, or bad?

First, the bill is H.R. 3590, the Patient Protection and Affordable Care Act. It's accompanied by H.R.4872, the Health Care and Education Affordability Reconciliation Act of 2010, a.k.a. the "reconciliation bill," which the Senate is considering as this is written. The health care/insurance bill is 906 pages in its final form. The reconciliation bill is 2310 pages. No, I haven't read them.

Second, let's distinguish between health "care" and health "insurance." Basically, we're talking about reforming the health insurance market/industry in the U.S. By definition, that also means improving the availability, quality and cost of health care. In my book, that's a good thing.

There are good things in the bill. According to CBS News:

• The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
• Closes the Medicare prescription drug "donut hole" by 2020.
• Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs.
• Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level and want to purchase their own health insurance on an exchange are eligible for subsidies.
• Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
• Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.

There's bad stuff, too. For example, some of this is going to take way too fucking long. 2020? 2014? Also, there's no public option and/or no mechanism to buy into Medicare. For the un- or self-employed (I am about to become the latter...), very little will change immediately. The individual coverage mandate also is problematic, along with fines and excise taxes on so-called "Cadillac" plans.

In my case, for example, I have decent health insurance through my employer. That will end soon as I'm leaving that job. In the near-term, if I want insurance (I do...), I must purchase it on the open market and/or under COBRA. Until the exchanges are created and until the mandate kicks in, I remain at the insurance companies' mercy.

(Interesting factoid, for those who don't know and perhaps buy into Rethuglican shrieks of how Dems have manipulated the system and rammed this legislation through the process by using reconciliation. COBRA stands for "Consolidated Omnibus Reconciliation Act of 1985." Reconciliation itself is a Congressional procedure, adopted via the Congressional Budget Act of 1974. It basically is the process by which Congress does its fine-tuning of the federal budget. It's not unlike an individual sitting down at a kitchen table to balance his/her personal budget and deciding where to cut and where to expand expenditures and income. To suggest it's some rare, unused procedure hidden in the Congressional rulebook is deceitful at best.)

There's a lot not to like in the bill(s). Mainly, though, the result is a compromise, one continuing the status quo of commercial insurance and private health care providers for the time being. It's a far cry from the ways in which most, if not all, other industrialized countries deal with these challenges.

However, it's a start. It's a start toward ending ever-escalating health insurance premiums. It's a start toward preventing corporate bureaucrats from deciding who lives and dies. It's a start toward equalizing the disparities in health care between the elites and the underprivileged. It's a beginning of the trend away from employer-provided health insurance and toward universal coverage (the status quo makes little sense).

Given the realities of our political system, the legislation is something of a miracle, actually. It's not the end of reform. It's the beginning.

DCr