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Re: Health care reform in the United States Via Wiki (wall of text)
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Health care reform in the United States in 2010 was enacted nationally and most recently in two bills: the Patient Protection and Affordable Care Act which became law on March 23, 2010[1][2] and was shortly thereafter amended by the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) (which became law on March 30). Reuters and CNN summarized the March 2010 reforms and the year in which they take effect.[3][4]
History of national reform efforts
Main article: History of health care reform in the United States
Here is a summary of reform achievements at the national level in the United States. For failed efforts, State based efforts, native tribes services and more details generally, see the main article History of health care reform in the United States.
* 1965 President Lyndon Johnson enacted legislation which introduced Medicare, covering both hospital and general medical insurance for senior citizens paid for by a Federal employment tax over the working life of the retiree, and Medicaid permitted the Federal government to partially fund a program for the poor, with the program managed and co-financed by the individual states.[5][6]
* 1985 The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.[7]
* 1997 The State Children's Health Insurance Program, or SCHIP, was established by the federal government in 1997 to provide health insurance to children in families at or below 200 percent of the federal poverty line.[8]
* 2010 The Patient Protection and Affordable Care Act is enacted by President Barack Obama, providing for the phased introduction over four years of a comprehensive system of mandated health insurance with reforms designed to eliminate "some of the worst practices of the insurance companies" — pre-condition screening and premium loadings, policy rescinds on technicalities when illness seems imminent, lifetime and annual coverage caps. It also sets a minimum ratio of direct health care spending to premium income, and creates price competition bolstered by the creation of three standard insurance coverage levels to enable like-for-like comparisons by consumers, and a web based health insurance exchange where consumers can compare prices and purchase plans. The system preserves private insurance and private health care providers and provides more subsidies to enable the poor to buy insurance.
[edit] Key reform drivers for the 2010 reforms
Just before the passage of the bill, President Obama gave a speech at a rally in Pennsylvania in which he outlined the key elements of his reforms and why he felt it was imperative for Congress to vote for the legislation.[9]
[edit] Extend coverage through insurance mandate
The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL),[10] subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be on sliding scale from 2% to 9.8% of income,[11][12] providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research. The new law mandates that by 2014, people must have adequate insurance coverage or else pay a fine. It is estimated will reduce the number of the uninsured from 19% of all residents in 2010 to 8% by 2016.[13] To achieve this the new law provides subsidies to encourage smaller employers to buy coverage for their workers and makes it easier to qualify for Medicaid. For those not on a government program such as Medicare or who do not get employer sponsored insurance, direct subsidies will help those on lower incomes to purchase insurance through a new on-line exchange, an internet State run market place, where there will be like-for-like price transparency of insurance company offerings. This is expected to improve price competition between insurers. The 8% figure of uninsured are expected to be mostly illegal immigrants (5%), who are not eligible for subsidies, and the remaining 3% will be those who exercise their freedom not to be insured and who opt instead to pay the fine.[13][14]
The new law aims to offset the cost of the insurance subsidies from savings to be made by reducing the problem of the medically uninsured. Approximately $43 billion was spent annually (in 2008) supporting a minimal level of health care services for the uninsured[15] and the average family was reckoned to be paying an additional $1,000 per year in insurance premiums to cover the uninsured.[16] The subsidies will most likely go to benefit the poorest and sickest (i.e. those who have the most difficulty in getting insurance currently) and who are most likely already in receipt of subsidies of one form or another (through uncompensated care schemes or by the higher costs levied on those with insurance). Making insurance mandatory rather than voluntary will tend to bring younger, healthier people into the insurance pool at a relatively low incremental cost which should reduce costs for everybody else in the pool.[17]
The new law should also improve the health of the nation by increasing insurance coverage. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States associated with lack of insurance.[18][19] More broadly, a 1997 analysis estimated the number of people in the United States—insured and uninsured—who die per year because of lack of medical care was nearly 100,000.[20]
[edit] Guaranteed issue, community rating, individual mandate
Starting in 2014, the law will prohibit insurers denying coverage to sicker applicants, or imposing special conditions such as higher cost sharing, higher premiums, setting black-out periods, and rescinding policies for minor errors in the insurance application. This requirement is called guaranteed issue with community rating. Health care expenditures are highly concentrated with the most expensive 5% of the population accounting for half of aggregate health care spending, whereas the bottom 50% of spenders account for only 3%, which means that insurers' gains to be had from avoiding the sick greatly outweigh any possible gains from managing their care. As a consequence, insurers resources have been devoted to such avoidance at a direct cost to effective care management which is against the interests of the insured.[15] Instead of providing health security, the health insurance industry had, since the 1970s began to compete not on service and price but by becoming good risk differentiators, seeking to insure only those with good or normal health profiles and excluding those considered to be or to become unhealthy and therefore less profitable. According to a study from Cambridge Hospital, Harvard Law School and Ohio University, 62% of all 2007 personal bankruptcies in the United States were due to an inability to pay medical costs.[21] Many of these people forced into bankruptcy had medical insurance but the effect of caps, exclusions, and inability to fund or continue COBRA coverage was behind many of these bankruptcies. Medical impoverishment is almost unheard of in wealthy countries other than the US either because the state covers everyone or everyone is obliged by law to have insurance.[22]
Also starting in 2014, the law will require people who do not have health insurance which meets a nationally approved minimum standard to pay a tax penalty. This type of tax incentive to be insured has been called a Health insurance mandate. This method of gaining near universal coverage and achieving community rating is used in Massachusetts law and is a feature of health care law in many other countries. The law in 2014 requires all insurers to accept all applicants without personal medical underwriting and all applicants must be accepted for coverage without the imposition of special coverage rules for cost sharing and without the loading of premiums for pre-existing conditions. State-run internet based exchanges begin operations, providing a market place for small businesses and private individuals without health insurance to buy coverage on a group basis. These exchanges will be similar to others already in existence such as the Massachusetts Connector and that operating for Federal employees. Premiums in the exchange can only vary according to age, geographic region, coverage type (individual or family), or tobacco use.[23] The exchanges are expected to sharpen price competition by showing prices from each competing insurer in the exchange for like-for-like policies.
[edit] Make health insurance more effective
By forcing insurers to cover more of a person's health care costs by excluding lifetime and annual caps, cover first dollar costs for screenings and immunizations and preventing exclusions for necessary care. Ensure that no more than 15% of insurance premiums were swallowed up in insurance company overheads. Some insurance or health benefit schemes were considered wholly inadequate.[24]
[edit] Reduce the deficit
Reducing the deficit was another driver in health care reform. The reform legislation that passed was estimated by the Congressional Budget Office to reduce the deficit by $143 billion over 10 years.[25] However, the CBO numbers are the subject of some debate. [26]
[edit] Eliminate overpayment in Medicare Advantage
Medicare Advantage plans are offered by private insurers and provide benefits over and above coverage in Medicare Parts A and B and receive funding from the Medicare fund for taking on Part A and B coverage. However, under a revised contract made during the previous Bush presidency, Medicare was overpaying the private insurers. MedPAC estimated the overpayment as being approximately $12 billion a year.[27] This meant that the average person in traditional Medicare was paying $90 a year as a subsidy to private insurers for which they received zero benefit and eliminating this overpayment would save $177 billion over ten years.[28]
[edit] Political positions of the main parties
The main political opposition to the passing of health care reform legislation in 2010 came from the Republican party and not a single Republican in the House or Senate voted in favor of the bill.[29] This opposition was broadly based on objections to rises in taxation, especially of the so-called "Cadillac insurance plans" and the corollary increase in government spending on affordability subsidies. The GOP also objected to a new Health Insurance Rate Authority that would determine whether rate increases were "unreasonable" and to enforced rebates or premium reductions, and to any proposal that might have allowed government funds to subsidize abortion.[30] The opposition declared the law to be a "government takeover of health care". One version of an original draft prepared in the House of Representatives did call for a "public option" (a public insurer as one extra choice for consumers, competing against private insurers). Some Republicans have contested the constitutionality of the clause in the final legislation requiring people to purchase insurance. Both the government and the insurance industry have argued that this is a necessary prerequisite to achieve universality and equity for other insurance payers and to prevent people buying insurance only in time of need. The government argues that this is covered under the Commerce Clause, whereas detractors argue that this is wrong. As of 2010, this matter is still before the courts. Mitt Romney has said that the new law does not resemble the Massachussetts health care plan and did not support it. Past Republican figures such as Richard Nixon as well as some writers for the conservative think tank Heritage Foundation have supported a mandate, but no longer do.[31] The same is true of the concept of the insurance exchanges which the bill sets up, with some Republicans and the Heritage Foundation once supported.[32]
The GOP's official current position as represented by the House majority is that the Affordable Care Act should simply be repealed and the House voted for this in the first main session in January 2011. Since the Republicans last presented a bill in the House on health care reform in 2009, no new policy initiatives have been launched. However prominent republicans have criticized democrat attempts at reform. Betsy McCaughey, a health care analyst who came to political prominence after she helped defeat the Clinton health care plan of 1993,[33][34][35] "got the ball rolling" in July and August 2009 when she called the bill "a vicious assault on elderly people" that will "cut your life short".[36] McCaughey was joined in spreading the idea by other pundits and conservative media that had had helped defeat the Clinton era legislation, including The Washington Times and The American Spectator.[33] According to The New York Times, McCaughey also falsely claimed that presidential advisor Dr. Ezekiel Emanuel thought that the disabled should not be entitled to medical care, which helped inspire Palin's warnings about "death panels".[37][38][39] Both McCaughey and Palin's remarks about what Palin called an alleged 'death panel' were based on opinions about Ezekiel Emanuel[40][41][42][43][44] and previous page 425 legislation.[42][43][45][46]
Emanuel is an opponent of legalization of doctor-assisted suicide or euthanasia.[47] FactCheck.org said, "We agree that Emanuel’s meaning is being twisted. In one article, he was talking about a philosophical trend, and in another, he was writing about how to make the most ethical choices when forced to choose which patients get organ transplants or vaccines when supplies are limited."[38][48] An article on Time.com said that Emanuel "was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources ... 'My quotes were just being taken out of context.'"[49] Regarding page 425 of a health care bill, Congressman Earl Blumenauer (who sponsored the legislation) said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing".[50] Page 425 of this legislation is similar to end-of-life counseling that became law when George W. Bush was president.[51]
On the other side, Obama gave, in his State of the Union Address held just before the final passage of the bill, his reasons for taking on the issue of health care. He said it was because of the stories that he had heard from Americans with pre-existing conditions whose lives depend on getting insurance coverage; stories of patients being denied coverage, and of families with insurance who are just one illness away from financial ruin. He said that the approach being taken would protect every American from the worst practices of the insurance industry. He said it would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. He claimed that if they did nothing, millions of Americans would lose their health care this year and the deficit would grow. He said that premiums would increase and patients would be denied the care they need, and that small business owners would continue to drop coverage altogether. He said he would not walk away from those Americans, and he urged others in Congress not to do so either. He claimed that doctors and nurses in the health care system, who know the system best, consider this (legislation) a vast improvement over the status quo. He challenged anyone, from either party, with a better plan that would bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, to let him know, because he was eager to see it.[52]
[edit] Public policy debate
Main article: Health care reform debate in the United States
See also: Health care reforms proposed during the Obama administration and Public opinion on health care reform in the United States
[edit] Abortion
A lot of the political debate centered on the prevention of the Federal funding of abortion. In the legislation that was finally passed the existing law on the preservation of the principle of no Federal funding for abortion (except in cases of rape, incest, or to preserve the life of the mother) was preserved.[53] The law requires people to pay for that element of coverage with a separate check to create a specific fund which is not subsidized and which is used to fund these services. State insurance commissioners are charged with policing this “segregation of funds”. Whether insurers in the exchanges can offer abortion coverage at all was left as a matter for individual States to decide. The default is that insurers will be allowed to offer abortion coverage as they do now unless a State passes legislation to the contrary.
[edit] Lobbying
According to Obama, America's health insurance industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other proposed legislation.[54] There are six registered health care lobbyists for every member of Congress.[55] The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Committee on Finance that drafted Senate health care legislation is Senator Max Baucus (D-MT).[56] A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT), in 2009.[57]
America's Health Insurance Plans, a lobby group funded by American private health insurance companies published its plans for health care reform in December 2008.[58] The key elements called for co-ordinated national strategy for health care with insurance regulation set in a national framework but enforced by the states.[58] It also called for a personal health care mandate requiring every American to have health insurance or face penalties. This, it said, was a necessary pre-requisite for guaranteed issue policies to prevent insurers from having to pre-screen applicants and set limits on coverage for pre-existing conditions, otherwise healthy people would put off buying insurance until they get sick.[58] It also called for the establishment of body to reform the payment system (including a shift from fee-for-service to fee-for-quality-outcomes), and a body to undertake Comparative effectiveness research because it admitted that the current system was not effective at providing value for money or even best practice and computerization and standardization of health care records and claims processing.[58] Most of the issues which AHIP called for in its plans have been implemented by the Obama administration and Congress in the reform process with the exception of a completely national framework for health care insurance regulation. Though the bill does place certain national rules for insurance to qualify as being "coverage" acceptable within the meaning of the individual mandate, states have retained the power under the reforms to regulate the industry and this was not put in a national framework.
[edit] Possible future reforms
The Patient Protection and Affordable Health Care Act 2010 contained provisions which allows the Centers for Medicare and Medicaid Services (CMS) to undertake pilot projects which, if they are successful could be implemented in future.
[edit] Universal health care
See also: Universal health care#United States
The universal health care proposal pending in Congress is called the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act.") The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,[59] probably because of the 40% cost savings associated with universal preventative care[60] and elimination of insurance company overhead costs.
[edit] Balancing doctor supply and demand
The Medicare Graduate Medical Education program regulates the supply of medical doctors in the U.S. By adjusting the reimbursement rates to establish more income equality among the medical professions, the effective cost of medical care can be lowered.
[edit] Bundled payments
A key project is one that could radically change the way the medical profession is paid for services under Medicare and Medicaid. The current system, which is also the prime system used by medical insurers is known as "fee for service" because the medical practitioner is paid only for the performance of medical procedures which, it is argued means that doctors have a perverse incentive to do more tests (which generates more income) which may not be in the patients' best long term interest. The current system encourages medical interventions such as surgeries and prescribed medicines (all of which carry some risk for the patient but increase revenues for the medical care industry) and does not reward other activities such as encouraging behavioral changes such as modifying dietary habits and quitting smoking, or follow-ups regarding prescribed regimes which could have better outcomes for the patient at a lower cost. The current fee-for-service system also rewards bad hospitals for bad service. Some[who?] have noted that the best hospitals have fewer re-admission rates than others, which benefits patients, but some of the worst hospitals have high re-admission rates which is bad for patients but is perversely rewarded under the fee-for-service system.
Projects at CMS are examining the possibility of rewarding health care providers through a process known as "bundled payments"[61] by which local doctors and hospitals in an area would be paid not on a fee for service basis but on a capitation system linked to outcomes. The areas with the best outcomes would get more. This system, it is argued, makes medical practitioners much more concerned to focus on activities that deliver real health benefits at a lower cost to the system by removing the perversities inherent in the fee-for-service system.
Though aimed as a model for health care funded by CMS, if the project is successful it is thought that the model could be followed by the commercial health insurance industry also.
[edit] 2010 Patient Protection and Affordable Care Act details
Main articles: Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
Key provisions of the health-care legislation passed in March 2010 are:[3]
[edit] Within one year of enactment (2010–2011)
* Insurance companies barred from dropping people from coverage when they get sick, ending the practice of rescission. Lifetime coverage limits eliminated and annual limits restricted.
* Young adults able to stay on their parents' health plans until age 26. Many health plans previously dropped dependents from coverage when they turned 19 or finished college.
* Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new program for high risk pools that will expire once new insurance exchanges begin operating in 2014.
* Insurance companies cannot deny group or new (non-grandfathered) individual coverage to children under age 19 due to a pre-existing condition.[62]
* 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 plan beneficiaries who fall into the Medicare Part D coverage gap (the so-called "doughnut hole") will get a $250 rebate. The new law eventually closes that gap completely. (The old law required the sick person to pay 100% of their own annual medicine costs after $2,700 was spent in the coverage year and did not start again until after $6,154 was spent).
* A tax credit becomes available for some small businesses to help provide coverage for workers.
* A 10% tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.
[edit] Effective during 2011
* Medicare provides 10% bonus payments to primary care physicians and general surgeons.
* Medicare will cover the full cost of annual wellness visits and personalized prevention plan services for beneficiaries. New health plans will be required to cover preventive services with little or no direct 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 tax forms.
* An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.
[edit] Effective as of 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, begins tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.
* Companies will be required to issue 1099 forms to any vendor of services or rental property to which the business has paid more than $600. Form 1099 is also sent to the IRS. Under the existing law, businesses issued the Form 1099 only to individuals who provided services or property to a business. The health care law included the same form be issued to corporations as well, and that the form be issued to individuals and corporations that provide property to the business.[63][64] Only business related payments are reportable, personal payments not.[65] There are a number of exceptions. For example: payments for merchandise, telephone, freight, storage, payments of rent to real estate agents are excepted.[65] The health care bill mandate aims to collect lost revenue from companies that under-report on their tax returns. The provision is expected to raise $17 billion over 10 years.[66]
[edit] Effective as of 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% from 7.5% of income. The threshold remains at 7.5% for the elderly through 2016.
* The Federal Insurance Contributions Act tax (FICA) is raised to 2.35% from 1.45% for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
* A 2.9% 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.
[edit] Effective as of 2014
Main article: Patient Protection and Affordable Care Act#Effective by January 1, 2014
* State health insurance exchanges for small businesses and individuals open.
* Individuals with income up to 133% of the federal poverty level qualify for Medicaid coverage.
* Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
* Premium cap for maximum "out-of-pocket" pay will be established for people with incomes up to 400 percent of FPL.[67][10] Section 1401 of PPACA explains that the subsidy will be provided as an advancable, refundable tax credit[68] and gives a formula for its calculation.[69] Refundable tax credit is a way to provide government benefit to people even with no tax liability[70] (example: Child Tax Credit). According to White House and Congressional Budget Office figures, the maximum share of income that enrollees would have to pay for the "silver" healthcare plan would vary depending on their income relative to the federal poverty level, as follows:[71][11] for families with income 133–150% of FPL will be 4-4.7% of income, for families with income of 150–200% of FPL will be 4.7-6.5% of income, for families with income 200–250% of FPL will be 6.5-8.4% of income, for families with income 250-300% of FPL will be 8.4-10.2% of income, for families with income from 300 to 400% of FPL will be 10.2% of income. In 2016,the federal poverty level is projected to equal about $11,800 for a single person and about $24,000 for family of four.[71] See Subsidy Calculator for specific dollar amount.[72]
* Most people required to obtain health insurance coverage or pay a tax if they don't.
* 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.
[edit] Effective 2015
* Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.
[edit] Effective 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.
[edit] Legal challenges
Main article: Patient Protection and Affordable Care Act: Legal challenges
As Congressional approval neared, opponents of health care reform shifted from parliamentary and procedural opposition to challenge the constitutionality of the legislation. The Virginia General Assembly passed the Virginia Health Care Freedom Act before Congress completed action on its bill. Governor Robert F. McDonnell signed that law on March 24, prior to House approval of the reconciliation bill.[73] The Virginia law prohibits any individual from being required to purchase health insurance. On March 17, 2010, Virginia Attorney General Ken Cuccinelli sent House Speaker Nancy Pelosi a letter threatening constitutional challenge to the enactment of the bill if the House used a self-implementing rule and deemed the bill, which had begun in the Senate, to pass.[74] On March 23, 2010, Cuccinelli filed Commonwealth v. Sebelius in the Federal District Court for the Eastern District of Virginia challenging the Constitutionality of the insurance requirement.[75] Also on March 23, 2010, the Attorney General of Florida, together with the States of South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington, Idaho and South Dakota filed a joint law suit in a Florida district court also challenging the new law.[76]
Some Constitutional law professors and commentators in the press have opined that the lawsuits and state laws are unlikely to succeed.[77][78][79][80] However, other Constitutional law professors and other legal experts maintain that the health insurance mandate (the requirement that individuals purchase insurance, or face a penalty) is, in fact, unconstitutional.[81][82]
On August 2, 2010, District Court Judge Henry Hudson, presiding over Virginia's lawsuit challenging the Obama administration's health care reform package, denied the Justice Department's attempt to have that lawsuit dismissed, stating that Virginia's case raises Constitutional issues - mainly whether Congress has the right under the Commerce Clause to regulate and tax a person's decision not to participate in interstate commerce.[83]
On December 13, 2010, U.S. District Judge Henry E. Hudson struck down part of the health care law. "In his 42-page opinion, Hudson concluded that requiring most people to get insurance or pay a fine - as the law mandates starting in 2014 - is an unprecedented expansion of federal power and cannot be justified under Congress's authority to regulate interstate commerce." .[84][85]
Re: Health care reform in the United States Via Wiki (wall of text)
BarackObama
I am willing to work with anyone—Democrat or Republican, governor or member of Congress—to make #HCR even better and more affordable. about 4 hours ago via HootSuite Retweeted by sebastianbach and 100+ others
Re: Health care reform in the United States Via Wiki (wall of text)
The original concept of Health Care Reform was brilliant and could've been revolutionary.
Senators/Congressman-women scared for their jobs, insurance ("big business") scared for their bottom line turned it into the clusterfuck of the beginning of this decade.
Sad, it could've really been something, and people like myself are still stuck without health care because they keep pulling their dicks up there.
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Re: Health care reform in the United States Via Wiki (wall of text)
The mandate's unconstitutional, but the bill dies without it. Obviously no one would buy insurance if they couldn't turn you away for pre-existing conditions. The only way the insurance industry stays afloat is with the mandate, if pre-existing conditions aren't a basis for exclusion.
I don't really believe in positive rights anyway, but the system's certainly fucked.
