Monday, March 22, 2010

Health Care Passes: What now?

Well everything and nothing. The world moved under our feet and yet we won't feel anything right away. But some random thoughts.

No more sniffles in the Emergency Room. If you're kid is sick you take him to your doctor, or to Bernie Sander's newly funded Community Health Centers. 15 million people, including for the first time working poor singles, will be added to Medicaid, if you need to see a doctor you make an appointment, or walk in.

Near elimination of cost shifting due to non-reimbursed care. Currently hospitals are squeezed from both ends, on the one side having to negotiate with insurers to lower costs, on the other side providing care that they know they will never be able to collect for, and in the middle the uninsured or underinsured who get the resultant cost-shifting, and if they have assets can end up losing them all. Over time this should just level out, a medical procedure will cost what it does, whether you are publicly or privately insured. And among other things this will revolutionize charitable hospitals including the Catholic and Jewish systems. In my town both main hospitals are run by the Sisters of Providence who have a sterling record of writing off care to those who can't afford to pay, in turn sucking down huge amounts of money from the various parishes that support them, now those donated funds can go other directions.

No more collection jars on the store counter for poor Lexi or some other child who can't afford a needed operation. No more TV features of some struggling family facing destitution because Dad maxed out his lifetime limit on his insurance and Mom is still sick, no more stories about how in the richest country on earth people could still be dying because they simply couldn't afford the care anymore.

Things you would never have thought of. Nowadays people have medical riders on their car insurance in case of traumatic injury. Probably no longer necessary except perhaps for long term care. Same with AFLAC and other suppliers of supplemental insurance, with no annual or lifetime limits why carry a cancer policy?

Transformation of the labor/employer power balance. Practically every major labor struggle over the last twenty years has revolved around health care coverage with employers implicitly or explicitly threatening to just drop it altogether if they don't get the wage or cost-sharing concessions they want. Now in a lot of cases they won't be able to drop coverage even if they want to or have to pay a per employee subsidy to the Exchange to help pay for individual coverage.

These are just random thoughts on the morning after. But we haven't begun to think through all the ramifications of this.

Sunday, March 21, 2010

Jeez, its been a month

since I checked in here. And close to that at Angry Bear. But I am still around and still thinking about stuff but not with enough intensity to actually get a coherent piece together. But a hint of things to come.

Today is the day for Health Care Reform. It is a big day for me, for a variety of reasons I would never get insured through the individual market under the rules operating today, and the market for jobs with such coverage from the employer being kind of bleak in my field (property research and development). But it is a bigger day for the country, this will be transformative in ways that go far beyond simple health outcomes.

One example is the breaking of the handcuffs that keep people stuck with their employers. I had a co-worker who was independently wealthy, he had parlayed a successful career in commercial real estate into shrewd investing into what I surmised was a pretty comfortable portfolio. His hobby was to go on cruises and his dream was to organize a cruise travel agency which would allow him to organize and lead cruise groups, which if it were up to Jim would have meant him being out at sea all the time. Instead he was stuck working along side me at a demanding and often frustrating mid-level customer service job issuing building permits and explaining zoning regulations. Why? Because he had some medical conditions that would have made buying insurance literally impossible. If this bill had been in place ten years ago who knows how many thousands of cruise miles he might have under his belt (literally, Jim loved to eat, and cruising is the right place for that).

And this country is full of people like Jim, entrepreneurs and artists and free-lance writers who would love to strike out on their own but who have to take a boring job simply because they, or more often perhaps their children, need access to health care. The bill being enacted today doesn't break this bond between job and health coverage, people will still be attracted to jobs with "bennies", but the knowledge that losing a job doesn't mean losing access to health care outright will be extra-ordinarily liberating.

Up to today a lot of my Health Care blogging has been focused on defending the current bills from attacks from both the Left and the Right in a situation where the opposition from both sides has been arguing from bills that mostly existed only in their own imaginations, or the bill they thought would emerge from negotiations. And this combined with the fact that the bills were in fact always changing and not always for the better, made it difficult to pin down exactly what this new Health Care system would look like. Well hopefully starting tomorrow all that back and forth and change will be stabilized by two pieces of enacted legislation. At which point I expect to present a series of posts laying out not what the bills might do but what the law will do in terms of access, affordability and cost control. After I take my own advice and "Read the Bill".

On another front we are fast approaching what I semi-jokingly call "The Bestest Day of the Year", the release of the Annual Report of the Trustees of Social Security. This year is much more critical than years past because of a combination of a bad job situation that really is hurting Social Security combined with the existence of the President's Entitlements Commission. People who have always hated Social Security on principle are gearing up for one last run at killing it or transforming it beyond recognition. So in response I am planning another series of tutorials on various aspects of its financing.

I can't promise daily posts, but hopefully it won't be a month, I wouldn't be surprised in people aren't purging me out of their blogrolls as I type. Arrivederchi.