Saturday, December 18, 2010

A Review of "Obamacare"

As is typical of groundbreaking laws, the Affordable Care Act has quite a few critics; as you may have noticed.  And it's funny to contrast the attacks by those on the right, who imagine it to be a socialist takeover of the entire healthcare industry, compared with those on the left, who don't think it did a damn thing because it didn't include a Public Option that most folks wouldn't have used.

And all this made sense back before it was passed, because there was no real bill to discuss, as everything was influx and up for negotiations.  Yet, here we are a good eight months after the law was passed, yet these people still seem to think it's either a dastardly government takeover or a dastardly handout to the insurance industry; depending upon their ideology. 

And I'm like, huh?  If we're going to discuss the law, could we at least discuss the actual law, rather than what you were told about the law before it passed?  Because I see conservatives ranting every day about how Obama has made healthcare worse and more expensive, yet cite no examples of how the law does either of these things.  And there are those on the left who still insist it did nothing, while refusing to talk about rescission, pre-existing conditions, endless rate hikes, and other bad things that have been dealt with.

And for as much as I definitely score the leftwing critics as being infinitely closer to reality than the conspiracy theorist whackjobs on the right, I'd prefer that both sides at least discuss the actual law they're attempting to dismiss.  And so I decided to go through the Wikipedia page of the Affordable Care Act and highlight the important changes that have already been implemented.  Enjoy!

Effective Immediately

A non-profit Patient-Centered Outcomes Research Institute is established, independent from government, to undertake comparative effectiveness research.

Creation of task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.

Effective June 21, 2010

Adults with pre-existing conditions will be eligible to join a temporary high-risk pool, which will be superseded by the health care exchange in 2014.

Effective September 23, 2010

Insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays in new policies issued.

Dependents (children) will be permitted to remain on their parents' insurance plan until their 26th birthday.

Insurers are prohibited from excluding pre-existing medical conditions (except in grandfathered individual health insurance plans) for children under the age of 19.

Insurers are prohibited from charging co-payments or deductibles for Level A or Level B preventive care and medical screenings on all new insurance plans.

Individuals affected by the Medicare Part D coverage gap will receive a $250 rebate, and 50% of the gap will be eliminated in 2011. The gap will be eliminated by 2020.

Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014.

Insurers are prohibited from dropping policyholders when they get sick.

Insurers are required to reveal details about administrative and executive expenditures.

Insurers are required to implement an appeals process for coverage determination and claims on all new plans.

Medicare is expanded to small, rural hospitals and facilities.

And again, those are all the changes that have already been implemented.  I dare anyone to look through this list and tell me this stuff isn't important.  That these are Republican ideas.  That we'd have been better off without these things.  Go ahead, I dare you.

The reality is that many of these directly cure complaints liberals had about insurers.  Yet, now that Obama has ended these problems, we're to imagine they weren't problems at all.  Or maybe we're supposed to think insurers can still rescind policies and deny coverage to children born with birth defects, and as if the appeals process for claims isn't a good thing.  And we're removing the "doughnut hole" Bush gave us in his prescription drug plan.  And we expanded Medicare.  Does this really count for nothing?  Really?

Better than the Public Option

And why do they discredit all these things?  Because we lost the Public Option.  Yet...the Public Option we "lost" wasn't the Public Option people envisioned.  The one being debated wasn't some backdoor single-payer that would allow you to dump your shitty employer-paid insurance.  It would have been yet another option for those who are forced to use the Insurance Exchanges we're setting up.  It was for people who lacked insurance, not people who wanted another option than their current insurance. 

And seeing as how the Affordable Care Act also includes strong incentives for small businesses to provide insurance to their employees, as well as forcing larger companies to cover their employees, the Public Option would be even more unnecessary than it is already.  Especially as the government now gets to set the minimum standard for health insurance, as well as dictating what the rates will be and how much of the premium must go towards healthcare.  By contrast, the Public Option was pretty small potatoes.

And so that's why Obama's so frustrated with people on the left attacking him over this law, because we got most of what we wanted, and the Public Option was only a minor part of the deal.  If you look over these things we've gotten and will get in the next few years, you'll realize that the insurers have been muzzled by government regulations and the crappy insurance of the past will soon be over.  We won. 

So again, I defy anyone to look over this list and tell me it does nothing, or isn't reflective of liberalism.  And this is just the beginning, with the big things happening in 2014.  The reality is that Obama has changed healthcare as we know it, and it's a damn good change.

1 comment:

Davis X. Machina said...

Constant references to the bully pulpit remind me to remind you that the best poli-sci we've got can't find much of an effect, if it has an effect at all. Even for 'great communicators'...

On Deaf Ears: The Limits of the Bully Pulpit, George C. Edwards, Yale University Press, 2006