Health care reform – the road ahead

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
Winston Churchill, 1942.

One way or another I'm gonna find ya
I'm gonna getcha getcha getcha getcha.
Blondie.

In the original Senate version of the Health Care reform bill we find this clause …

Subtitle D: Improvements to Medicaid Services - (Sec. 2301) Requires Medicaid coverage of: (1) freestanding birth center services …

Yes, there are a lot of funny bits in this sausage. We don’t know the half of ‘em, but I do know my family will pay for them. Now that the bill done (for now) I can say that the wingnuts were right about some things; my team’s “$250,000 and above” slogan was nonsense. “One way or another” upper 30th percentile “tax-equivalents” [1] will go up.

I’m good with paying for this; I expected to pay for it when I campaigned for Barack Obama. Altruism aside, there are tangible personal benefits for my family:

• We’re no longer lashed to my employer. Since I expect to be an involuntary entrepreneur within 8 years this is rather good.
• Not all of our children are equally suited to life in the post-modern world. This bill increases the probability that they will, at least, receive health care after my warrantee expires.
• Now my insurance provider doesn’t have to be demonic to survive
• America is less likely to turn into Haiti of the North. I really don’t like broken glass topped walls.

What’s next? We’ve been stuck in the headlights for a generation, but now we’re moving. We might be charging towards the oncoming truck, but even that may be an improvement on standing still. At least with motion comes opportunity.

The question isn’t where we need to go. We’ve known that for at least thirty years. We’re going to the same place as everyone else on earth – good enough care for everyone and luxurious care for those with money. The question is how we get there.

Until now the American people have been completely unwilling to think about health care cost. It would have been nice if we could have cut costs before increasing access, it would have been nice if we’d come up with a reform plan that made it easier to cut costs, it would be nice if we weren’t charging towards the right fender of that oncoming truck. Nice – but not going to happen in a world where the GOP has gone mad.

Now, however, we’ll all be, at last, considering costs and value. It won’t be pretty, but if it were pretty it wouldn’t be real.

That’s progress.

See also:

Post-passage commentary

• Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles (worth a scan, really)
• Best health care reform commentary (all the things I don’t need to say)
• Health insurance companies only the demonic survive (Just before passage, but fits here. Now insurance companies can explore non-demonic options.)
• How the Health Care Overhaul Could Affect You - Graphic - NYTimes.com (try it – it’s great)

Older general discussions that are still relevant

• Discovering medical prices and the problem with paying cash
• Health insurance we're defeated by a complexity attack
• The hidden insurance problem they can play the game better than we can
• Gawande and NEJM cost of care roundtable

The future: “pretty good care”, aka “good enough care” – where we’re going

• Health care reform – lessons from Quebec (pretty good care)
• Healthcare Reform The One Slide Presentation
• Staggering towards health care access

[1] Federal “Taxes” rarely include anything so obvious as a rate increase. Tax equivalents include

• actions that shift services burdens to the states – which either reduce state services or increase state or local taxes
• unfunded federal state or local mandates of all varieties including regulatory or reporting burdens
• means testing that remove tax breaks (the AMT is the mother of means testing)
• elimination of tax dodging programs such as the Flex plan we enroll in (I’ll be glad to see that evil scam die)
• user fees
• service taxes (such as the 10% tanning tax – which, amusingly, is aimed squarely at the Tea Party demographic of less educated paleskins).