For those who haven’t had a chance to read the particulars of the new health care reform law, here it is in several formats. (Thanks to Don, Erin and Diane for the links.)

First, a CliffNotes version from the folks who brought you the whole thing. Second, a handy plug-in that explains exactly how you’ll fare, no matter what your circumstances. (There’s no law that says you can’t try several different scenarios.). Third, a more robust analysis by a staunchly non-partisan organization. And finally, a spotlight on a section overlooked by most media, i.e., changes in the way we will care for people when they need it most. 

1. Here’s a write-down of each section of the entire law, as passed. It’s short and fairly easy to understand.
http://dpc.senate.gov/healthreformbill/healthbill63.pdfv

2. The Washington Post has a cool interactive site. Fill in a couple of particulars (male, 57, NY, employer-provided insurance) and it will call up all the elements of the law that will pertain to your situation.
http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/

3. The Kaiser Family Foundation is a leader in health care information. Here is their summary of coverage provisions in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.
http://www.kff.org/healthreform/8023.cfm

4. The blog Cab Drollery cites an interesting opinion piece in the Los AngelesTimes, which outlines some of the benefits seniors will reap related to changes in Medicare that promote more home-based, long-term care. The plan is to move away from the nursing-home model to group- and home-based models for care. I bet many seniors will appreciate this.
http://cabdrollery.blogspot.com/2010/03/whats-in-it-for-me.html
 
Hope v. Anger 03/25/2010
 
Thanks, Bill Campbell of The Tome of the Unknown Writer, for sharing this.
 
 
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Kevin Pho, M.D., has a surprising take on the health care reform bill, as passed by the House Sunday night:

http://www.kevinmd.com/blog/2010/03/health-reform-conservatives-happy.html
 
Kevin and numerous guest bloggers (including this one) have written extensively about this legislation on KevinMD.com, read by almost 30,000 people daily. In addition to publishing his medical blog, this primary care physician maintains a lively Facebook page and Twitter voice, and contributes often to the editorial pages of USA Today. 
 
 
What will health care reform mean to you and your family?

Here's a section-by-section analysis of the bill, to date: http://dpc.senate.gov/healthreformbill/healthbill63.pdf

What does the health care reform bill do for seniors?

Here’s a timely video sent to Birds readers by the office of Senate Majority Leader Harry Reid: 
 
"Listen to Me!" 03/24/2010
 
Let’s suppose you live in a city with a 35% (!) unemployment rate and you lose your job. 

And let’s suppose your region isn’t the only one suffering from extraordinarily high unemployment. Unemployment is rampant, but unevenly distributed. You just happen to live in one of the worst places.

To help people like yourself, Congressman Smith from another state is sponsoring the New Jobs for America Bill  (NJAB) to stimulate job growth and provide benefits to the unemployed until the economy picks up.  

Would you expect your own Congressperson to vote YES on the NJAB? Or would you be happier if he or she said, “Hell, no, we don’t want no stinking new jobs in our area,” then votes NO and proposes his own We Don’t Want Your Stinking Jobs Bill?
 
Well, about 100 members of the House of Representatives did exactly that in the health care reform arena, voting against help for those without insurance, in spite of constituencies with 1-in-3, 1-in-4 and 1-in-5 uninsured. Most were from districts in Florida, Texas and California, as well as other parts of the south and west. Almost all were Republican. 

To add to the craziness, minutes after the bill was signed into law, Virginia, Idaho, Florida, South Carolina, Nebraska, Texas, Utah, Pennsylvania, Washington, Alabama, Michigan, and South Dakota filed lawsuits against the federal government to prevent it from providing health insurance to large numbers of their uninsured. What? 

Remember what John Boehner (Rep, 0H-8) said just before the vote about how important it was to listen to and represent the needs of one’s constituents, not just vote the party line?  He told them he was listening to them, probably in reference to the Tea Party slogan, "Listen to Me!"

To be fair, Boehner doesn’t have an unusually high number of uninsured in his district --only 12.40% -- but he did receive $2,728,844 in campaign contributions from the health care industry.  Which constituency was he listening to when he voted NO? 

Boehner isn’t the only one beholden to the industry, however. There are plenty sitting on both sides of the aisle.

(On the other hand, Charles Rangel (Dem, NY-15), from a district with 18.20% uninsured,  accepted $3,867,249 in contributions, but voted YES. Go figure.) 

Why would voters keep returning people to Congress to vote against their best interests? Does this make any sense? 

Here are a few names from the list of NO voters representing districts with high percentages of uninsured. You might recognize he name of a few who have been in Congress for many years.  

Joseph Barton                     TX-6                23.20% uninsured
Roy Blunt                              MO-7              19.50%
Lincoln Diaz-Balat               Fl-21               31.30%
Mario Diaz-Balat                 FL-25              31.30%
Kay Granger                        TX-12              25.70%
Ron Paul (!)                          TX-14              24.00%
John Mica                             FL-7                20.70%
Connie Mack                        FL-14              26.10%
Darrell Issa                           CA-49              21.90%
Charles Young                      FL-10              22.70%
Pete Sessions                     TX-32               35.70%
John Deal                             GA-9                 23.20
Virginia Brown-Waite          FL-5                 24.80%
Michael Conaway                TX-11               27.00%
Mary Bono Mack                  CA-45              24.10%

And the list goes on.

For a complete look at how members voted, how much they received in campaign contributions from the industry, and how many in their district are uninsured, see:
http://www.washingtonpost.com/wp-srv/special/politics/votes/house/finalhealthcare/ 
 
 
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In case you missed this in the NYT
Republican lawmakers stir up the 'tea party' crowd

By Dana Milbank
The Washington Post, Monday, March 22, 2010; A01

The Democrats were blamed for many horrible things -- tyranny! socialism! corruption! -- as they marched toward Sunday night's passage of health-care legislation, but nobody ever accused them of making health reform look easy.

It all began 14 long months ago, when Ted Kennedy was still alive and everybody, Republicans and Democrats alike, seemed to agree that the nation's health-care system needed change. Then came the town hall meetings, the death panels, the granny killing, the images of Nazi concentration camps, the Cornhusker Kickback, the Louisiana Purchase, Joe Wilson's "You lie!" moment, the middle-of-the-night and Christmas Eve votes, the Massachusetts special election, the Stupak Amendment, the Slaughter Plan, the filibusters, the supermajorities, the deeming and passing.

It was one of the ugliest and strangest periods the American legislative process has ever experienced. And Sunday was no different. The day's debate on the House floor was in its early moments when two men, one smelling strongly of alcohol, stood up in the public gallery and interrupted the debate with shouts of "Kill the bill!" and "The people said no!" As the Capitol Police led the demonstrators from the chamber, Republicans cheered -- for the hecklers.

Rep. Barney Frank (D-Mass.), who for the second day in a row had homophobic epithets hurled at him by demonstrators, called his Republican colleagues "clowns" for this display. But the circus was just beginning.

As lawmakers debated their way to a vote on the legislation, dozens of GOP lawmakers walked from the chamber, crossed the Speaker's Lobby, stepped out onto the members-only House balcony -- and proceeded to incite an unruly crowd.

Thousands of conservative "tea party" activists had massed on the south side of the Capitol, pushing to within about 50 feet of the building. Some Democrats worried aloud about the risk of violence, and police tried to keep the crowd away from the building.

But rather than calm the demonstrators, Republican congressmen whipped the masses into a frenzy. There on the House balcony, the GOP lawmakers' legislative dissent and the tea-party protest merged into one. Some lawmakers waved handwritten signs and led the crowd in chants of "Kill the bill." A few waved the yellow "Don't Tread on Me" flag of the tea-party movement. Still others fired up the demonstrators with campaign-style signs mocking House Speaker Nancy Pelosi.

Click "Read More" for the rest of the piece.
 
 
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Two hundred and nineteen thank yous, with special thanks to Speaker Nancy Pelosi, Rep. Steny Hoyer and many other champions of health care reform. On the Senate side, belated thank yous to the late Sen. Edward Kennedy and Senate Majority Leader Harry Reid and his staff, who answered so many of our questions. Of course, we thank Pres. Barack Obama for his vision and tenacity. 

Please thank all the bloggers who kept the topic alive and facts flowing over the past year, especially Kevin, Ronni, Saul, George, Darlene, Jan, Steve, Bill, Ann, Kathleen, Jacqui, Mary, Nancy and Diane.    

And, thanks to all who wrote or added to the health care reform discussion on this blog.

We know this is only the beginning of a rocky, winding and uneven path toward meaningful health care reform, but, it's a start. Now, the real work begins.

Thank you! Thank you! Thank you!
 
 
The New York Times
March 7, 2010
Editorial

If Reform Fails

As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation.

Are they really satisfied with the status quo? And is the status quo really sustainable?

Here are some basic facts Americans need to know as Congress decides whether to approve comprehensive reform or continue with what we have:

HOW REFORM WOULD WORK: Let’s be clear, the changes Mr. Obama and Democratic leaders in Congress are proposing are significant. But, despite what the critics charge, this is not a government takeover. And the program is not only fully paid for, it should actually reduce the deficit over the next two decades.

Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.

The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.

46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.

The Congressional Budget Office projects 54 million uninsured people in 2019; the actuary for the federal government’s Centers for Medicare and Medicaid Services projects 57 million.

It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.

The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.

BUT I HAVE INSURANCE: While most Americans have insurance, many pay exorbitant rates because they have no bargaining power with insurers.

That includes many of the tens of millions who buy their own insurance — the unemployed, the self-employed, and those whose employers do not offer insurance. The recently announced plan by Anthem Blue Cross in California to raise annual premiums by 35 to 39 percent for nearly a quarter of its individual subscribers is a chilling harbinger of what is to come if reform fails.

There are another 48 million people who work in relatively small firms that often cannot get the better rates of large-group coverage. All of these groups should be able to get a better deal if they can buy their insurance through new, competitive exchanges.

If current trends continue, the number of underinsured Americans — those who have coverage too skimpy to pay substantial medical bills or protect them from high out-of-pocket spending — will also rise from an estimated 25 million in 2007 to 35 million in 2011, according to the Commonwealth Fund, a respected research organization.

That will increase the risk that this group will forgo needed care and will expose many more of them to potential bankruptcy if they cannot pay huge medical bills. Some 72 million adults currently have medical debt or problems paying their bills even though most of them have insurance. Reform would help them by setting minimum standards of coverage and providing subsidies to tens of millions of low- and middle-income people to help pay their premiums.

BUT I LIKE MY INSURANCE: Most Americans get their insurance through large companies, with large group bargaining power. While they complain about premiums and paperwork, most seem satisfied with their coverage.

For them the real fear is what happens if they lose their jobs or decide to change jobs. Will they be shut out of coverage because of a pre-existing condition or forced to pay high rates to buy their own insurance?

For this group, the real advantage of reform is security. If they get laid off, decide to be self-employed or switch to a smaller employer that offers no insurance, they will still be guaranteed coverage — even if they are a cancer survivor or have heart trouble or any other pre-existing condition. And they will be able to buy insurance on the exchanges.

I’M JUST WORRIED ABOUT COSTS: You should be. The cost of medical care is rising far faster than wages or inflation. And despite all of the talk about reform “bending the curve,” no one is yet sure how to do that.

Many reforms that people instinctively believe should cut costs — computerization of medical records, paying doctors for quality not quantity of services, and prevention programs to promote healthy living and head off costly illnesses — cannot yet be shown to lower costs.

Pending reform legislation, specifically the Senate bill, would launch an array of pilot projects to test reforms in delivering and paying for care. It would also create a special board to accelerate the adoption of anything that seemed to work. That seems a reasonable way to go and a lot better than standing by as costs continue to spiral out of control. The Republicans’ proposals — including their call to cap malpractice awards — would make only a small dent in the problem.

WHAT ABOUT THE DEFICIT?: Republican critics of health care reform have done an especially good job of frightening Americans with their talk of bankrupting the Treasury. The truth of the matter is that the pending reform legislation has been designed to generate enough revenue and savings to more than offset the substantial cost of expanding Medicaid and providing subsidies to the middle class.

The Congressional Budget Office estimated that the Senate bill would reduce deficits over the first 10 years by $132 billion and even more in the second decade.

What critics certainly do not talk about is what happens to the deficit if Medicare costs continue their relentless rise. That is something that should keep Americans up at night.

The pending reforms would cut the growth in Medicare spending per beneficiary in half — from 4 percent a year to 2 percent — by demanding productivity savings from Medicare providers and cutting unjustified subsidies to the private plans in Medicare.

There is some skepticism that Congress will stick to its guns if health care providers say they cannot survive on the reduced rations. But Congress has stood by most previous Medicare cuts (physicians excepted) and should have its spine stiffened by new pay-go rules requiring that any Medicare increases be offset by other savings or taxes.

If reform is defeated, it seems likely that most of the proposed experiments designed to cut costs — first within Medicare and then throughout the rest of the health care system — will die as well. The legislation needs to be passed to establish a structure to force continuing improvement over the years. That is the best chance of restraining soaring medical costs that threaten the solvency of families, businesses and the federal government.

Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

This editorial is a part of a comprehensive examination of the debate over health care reform. You can read all of these editorials at: nytimes.com/edhealthcare2009.


 
 
 
This is why we need newspapers.

It takes a news operation the size of the New York Times to give a reporter like Robert Pear the time he needs to do this kind of reporting:

In House, Many Spoke With One Voice: Lobbyists’
The New York Times
November 15, 2009

As many of you know, the Congressional Record publishes transcripts of every floor debate and vote that takes place in both the Senate and House of Representatives. Every morning at 11, you can go online to http://www.gpoaccess.gov/crecord/  to read a transcript of the previous day’s proceedings. It’s free, searchable and downloadable.  

In addition to taped testimony, speakers are permitted to submit written testimony to clarify or add to their argument. Some do this, or rather, let their staffs do it for them. 

I can only guess, but I imagine Pear was looking for evidence that the unprecedented amount of money spent by health care industries to ward off a negative impact to their business, paid off, at least in terms of The Affordable Health Care for America Act [H.R. 3962].

Not that lobbyist don’t feed members with talking points related to every single bill that comes up for a vote, but this one was special. It spells out policies that will affect one-sixth of the nation’s economy, almost 100 percent of the population, and will direct our access to health care for many years to come.

Remarkably, forty-two House members –- 22 Republicans and 20 Democrats ---gave almost the exact same testimony, in support of their opinion, for OR against. Their thoughts –  and the words that expressed them – were provided at great expense by Genentech, a subsidiary of the Swiss drug giant Roche. 

You may recall Joe Wilson, the little-known Congressman from South Carolina who made his debut as a man who unable to keep his thoughts to himself, the night President Obama spelled out his health care reform message, before a special session of Congress. It seems that Joe sometimes allows others to do his thinking for him:

From the Times:

In separate statements using language suggested by the lobbyists, Representatives Blaine Luetkemeyer of Missouri and Joe Wilson of South Carolina, both Republicans, said: “One of the reasons I have long supported the U.S. biotechnology industry is that it is a homegrown success story that has been an engine of job creation in this country. Unfortunately, many of the largest companies that would seek to enter the biosimilar market have made their money by outsourcing their research to foreign countries like India.”

 
You’re not going to find a story like this on CNN or even CBS. It’s about words, and has no visual appeal. Furthermore, only a word person would spend the time hunting for similarities in text, and checking them against the text sent out by the lobbyists. And, only a newspaper would publish it, because print journalists understand the value and the power of the written word. 
 
 
from  today's The Greenfield (MA) Recorder:

A role in better health
Reforms go beyond cost and care


We’ve heard how health-care reform will or will not work, what it will or will not cost and how it will or will not impact us as individuals. We’ve also heard from people who sincerely believe we should simply leave it alone.

But, few talk about whether reform will improve health, particularly public health.

Considering how much we spend on health insurance, gyms, organic food and vitamins, we should be a very healthy nation. Apparently, there’s room for improvement:

1. We have the highest rate of preventable deaths among (19) industrialized nations.

2. We came in 37th on the World Health Report 2000 for overall health.

3. More than half of U.S. adults are overweight.

4. Almost 2 million a year die in the U.S. from chronic, treatable diseases.

According to Assistant Secretary for Health Howard K. Koh, all five health-care reform bills before Congress contain components that “absolutely” will improve those numbers. Koh was Massachusetts health commissioner from 1997-2003. Today he is America’s top doc, overseeing the U.S. Public Health Service, the CDC, Surgeon General’s office and many related agencies.

Reform will bring quality, affordable care to most Americans, with the operative term “affordable,” since everyone will pay toward their care.

Right now, millions of Americans cannot get coverage at any cost and 14,000 more lose their insurance every day, Koh said in a recent interview. “When Americans go without health insurance, they suffer,” he added.

According to Koh, one in six Americans with employer- sponsored insurance coverage in 2006 lost it by 2008, leaving many children and adults without preventive care, immunizations, basic dental services and prescription medicine. “When sick, (the uninsured) are more likely to experience poorer health outcomes” than the insured.

Insured or not, low-income Americans — including racial and ethnic minorities as well as people living in rural areas — are less likely to receive preventive care than others.

“We are the only advanced democracy that allows this hardship on millions of its people,” according to Koh.

Once insured under reform, there will be little financial reason for anyone to go without basic health care. We will be leveling the field, reducing health disparities, in terms of access to care.

As shocking as it may seem, with reform, millions will have the opportunity to see primary-care physicians — and even dentists — for the first time. Children and adults who previously saw doctors only in emergency rooms will be screened for and, if necessary, treated for chronic diseases. And, they will be called back for check-ups.

“We’re developing a wellness care system that protects health, promotes healthy behaviors and strengthens community prevention,” Koh said.

“A national report recently found that 100,000 lives could be saved each year by investing in five basic preventive services that are available through a doctor’s office,” Koh said. “We can’t eliminate all disease, but … we can reduce chronic disease by ensuring Americans have the care they need to prevent and treat these diseases so that if they do get sick and need care, they have the best possible chance of getting better.”

To accomplish this, the 2009 Recovery Act already has pumped millions into the health-care infrastructure to build work force. Reform measures will expand on that base. Big investments in medical training should boost resources in underserved areas — such as rural New England — which otherwise might not attract enough health-care workers to make reform work.

Of course, reform really begins with each one of us. Whether health-care reform succeeds or fails, individuals will share some responsibility with physicians, hospitals and drug companies.

It won’t be painless, or easy. There are no quick fixes. And, no one will chase us around to “make us” healthy.

If we haven’t already done so, we should start to build our own healthy lives based on knowledge, responsibility and respect. It’s time to make healthy choices, as in “yes” to salads, “no” to cigarettes and binge drinking, etc. We must vaccinate our kids, encourage loved ones to exercise, make sure our young people get enough sleep and our elders are seen by doctors when they need to. We should wash our hands, flu season or not. If sick, stay out of the workplace.

In other words, we need to get our collective act together to start taking proactive responsibility for our health, because the Band-Aid approach to health care is coming to a very expensive end.

But, whatever it takes should be worth the effort, making a big difference in the lives of our children and grandchildren, by making a big difference in public health.

When it comes to closing the gap on health disparities, Koh said, “we should remember that this isn’t a partisan issue. It’s a moral issue.”

_____________________
Greenfield resident Paula Hartman Cohen writes about health care and other issues for The Recorder publications, Harvard Public Health Review, Dartmouth Medicine Magazine, and KevinMD.com, among other media. She blogs at www.birdsonawireblog.com.