On Health Care, It's Hurry Up and Wait

Many Proposed Reforms Wouldn't Take Effect Until 2013, Which Could Have Both Liberals and Conservatives Complaining

(CBS)  This story was written by CBSNews.com political reporter Stephanie Condon.

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Amid a days-long media blitz in which President Obama urged Congress to pass health care legislation this summer, a reporter queried the president at a televised, prime time news conference Wednesday night, asking, "Why the rush?"

"I'm rushed because I get letters every day from families that are being clobbered by health care costs. And they ask me, can you help?" Mr. Obama answered.

"So I've got a middle-aged couple that will write me and they say, 'Our daughter just found out she's got leukemia, and if I don't do something soon we just either are going to go bankrupt, or we're not going to be able to provide our daughter with the care that she needs.' And in a country like ours, that's not right. So that's part of my rush."

Indeed, the White House has worked hard to create a sense of urgency over health care legislation. But for many of the reforms being touted, Americans are being told to hurry up - and then wait. Significant provisions of the health care legislation under consideration, it turns out, will not go into effect until 2013.

Mr. Obama addressed this fact at an Ohio town hall on Thursday.

"Most of these changes would be phased in over several years," he said. "So it's not as if you're going to wake up tomorrow and suddenly the health care system is all changed completely. We are going to phase this in, in an intelligent, deliberate way."

While momentous changes certainly take time to implement, this means by 2010 -- and even 2012 -- Democrats may not be able to boast of reducing the number of uninsured. In fact, they may have to explain an increased number of uninsured, according to government estimates.

There would be reforms in place within a year of the bill's passage that could make serious changes in people's lives, such as prohibiting insurance companies from denying coverage to those with pre-existing conditions. But at the time of Mr. Obama's next election campaign, people will still be waiting for subsidies to help with crippling health care costs as well as the "public option" that the president says will keep private insurers in check.

Many have argued that the Mr. Obama's political capital rests on the passage of health care legislation. Yet with many of the most significant pieces of reform left on the drawing board for four more years even if the legislation is passed, the issue of health care reform could still prove to be problematic for Democrats in 2010 and 2012.

When Would Americans See Changes?

Most of the proposed changes intended to reduce the number of uninsured Americans and relieve some of the costs of health care are slated in the House legislation to take effect in 2013. These include the government-sponsored health insurance plan, or "public option," and the health insurance exchange -- the marketplace where individuals and small businesses will be able to find cheaper insurance plans.

The provisions slated to take effect in 2013 also include an expansion of Medicaid eligibility to those whose income is at or below 133 percent of the poverty line (or $29,300 for a family of four), and subsidies for those who fall between 133 percent and 400 percent of the poverty line. The mandate in the bill for all individuals to acquire health insurance and the mandate for all employers to either provide insurance or pay a price also takes effect in 2013.

A preliminary analysis (PDF) of the House bill from the Congressional Budget Office estimates that after the bill's enactment, the number of uninsured Americans would actually increase by two million to a total of 52 million by 2012. After the major reforms were implemented, that figure would drop to 27 million in 2013 and eventually to 17 million in 2017, the CBO estimates.

That four-year delay for implementation would likely not sit well with grassroots progressives who share the sense of urgency Mr. Obama has conveyed and have worked hard to support Democrats' reform efforts. The grassroots group MoveOn.org, which has five million members, considers health care reform its top issue.

"MoveOn members see this as an urgent crisis, and want it solved as fast as possible," said MoveOn's executive director Justin Ruben. "Health care costs are spiraling out of control, and the public plan is a critical piece of bringing costs down and making care affordable, and so are the subsidies. The bottom line is, the sooner health care reform begins making a difference in people's lives, the better... and the better it will be for politicians sticking their reputation on solving it."

While those sweeping changes would be implemented in 2013, others would go into effect more quickly. For instance, thanks to an amendment from Rep. Joe Courtney (D-Conn.), market reforms to prohibit insurance companies from denying coverage to those with pre-existing conditions will go into effect six months after the bill is passed -- rather than in 2013, as originally proposed.

"Will it make a difference for Americans not to be denied coverage because of pre-existing conditions? Absolutely," Ruben said.

Furthermore, within the first year of its enactment, the House legislation would prohibit rescissions, the abusive practice of health insurance companies rescinding existing health insurance policies as a way of avoiding costs. It would also boost Medicaid reimbursements for primary care and improve preventive health coverage in Medicare and Medicaid. On top of that, it would in 2010 increase funding for community health centers and expand training programs for primary care physicians and nurses.

In an interview, Courtney said the rollout of the major benefits is simply limited by what can practically happen in a given time frame.

"If I had my druthers, we would have it up and running as quickly as we could," he said. "There really is an honest-to-God logical challenge to setting up a new program that quickly. Once you get through this legislative sausage process, it's not going to kick in the next day."

He said the president and other Democrats will have to "deal with it head on" and explain why the changes take time.

"You try to visualize what (people) are going to be living through for three or four years... I'm sure people will be upset," Courtney said.

Courtney called the 2013 target an "outside date" and said the intent of the House Education and Labor Committee was to leave room for the Secretary of Health and Human Services -- who would be responsible for administering some of the major reforms -- to accelerate the process.

"I would imagine there would be political pressure to try and beat that date," he said.

A Potential GOP Talking Point

While Mr. Obama and congressional leaders may have to placate liberals on the delayed timeline, Republicans could easily use it against the Democrats, conservatives say, in the same way the GOP has railed against the incremental roll out of the $787 billion stimulus package.

"I'd like to ask my folks back in Ohio, where the unemployment rate is at 11.2 percent, whether they've been rescued by (the Democrats') economy," Rep. John Boehner said at a health care press conference Wednesday. "And if they try to fix our health care system like they've tried to rescue our economy, I think we're in really, really big trouble."

Bradley Blakeman, a Republican strategist who served in the Bush administration, said Mr. Obama has done himself a disservice by adopting the same kind of urgent tone in his health care rhetoric that he had when pushing the American Recovery and Reinvestment Act.

"Everything seems to be an emergency," Blakeman said. "He got his stimulus, 80 percent of which is unspent. He promised jobs would increase, and the money would be flying out the door. We know that none of that is coming to fruition, and yet the president put his prestige on the line. He's lost his credibility on emergency legislation."

But Ruben from MoveOn said it would be "the height of irony" for Republicans to criticize Democrats for the slow implementation of health reforms, after "using every tactic they can think of to delay" the process.
"I think MoveOn members and most Americans... understand problems can't be solved over night," he said. "The question they're going to be asking is, 'Is our government working hard to fix them?'"

Blakeman suggested that given the weak economy and high cost of reform, Republicans will be able to argue that the changes will bring about more harm than good. That point will be underscored, he said, if the Congress enacts an income surtax to pay for reforms in 2011, two years before the government plan takes effect, as the House has suggested.

"It's all about the economy, and that's what the president and the Democrats are missing," he said. "I think the American people are going to say, 'What did we buy here?'"

[Hal_Horvath]

The overwhelming majority of Republicans and Democrats support Health Care Insurance reform.

That's clearly likely, and it implies the main issue most people also place on top -- health care inflation -- must be addressed by reform also.

Fortunately, address health care inflation is doable in a market way by encouraging outcome-based payments. This would also appeal across the political spectrum.

Finally, the main issue of this article: 2013 is far too long to wait for substantive reform.

2010 would be better.

http://findingourdream.blogspot.com/2009/07/2013-could-be-lifetime-awaydo-simple.html

[hamiltongrad]

There is no true Health Care Crisis. everyone gets excellent and equal care, even if you are here as a non citizen on a green card, and need a pacemaker, you get one.

What this is all about is power.

In the UK, the monitors have limited restaurant portion sizes, as "unhealthy" eating adds to cost. Also rationing... Do we want that ? UK, going blind in both eyes. You have to wait, for one to go 100 % because all you need, really is one eye if you are old.

There are so many variables in medicine that there is rarely one answer that fits all people with the same condition. Some people need drugs, other surgery, others can have huge will power and go down another path. We are acting like the Gov't can sort all of this out. They can't . it is similar to the housing crash. Gov't decided it could interfer with the complex markiet forces to social engineer, and look what happened.

Gov't is not the answer. IT is the problem. What we need is LEGAL reforms first. Diabolical Attorneys are behind all this "reform" as they want more control, more lawsuits.

Actually for all the "smarts" President is coming off a bit naive, insular, and kind of uninformed, at times insulting with rather crude remarks that may be OK for acadmics who are never challenged, and all this adds up to a bit funny and scary.

Change we can believe in, OK. But what we GOT, was CHANGE in WHAT WE BELIEVE ?

[ampsanne]

I was sent an alarming e-mail today. The health bill contains a thing about people that are on Medicare. People on Medicare will have to meet with a consultant every 5 yrs. and if they are sickly their medications will be taken away from them, and then they want you to die. You will be given options on how you want to do it. Now if that don't scare the h3ll out of you I don't know what does. If this isn't some kind of Nazism I don't know what is. Fred Thomas interviewed
Betsy McCaughey and there is an audio that you can listen to to learn more about it on Fred Thomases website. Seniors you must hear this. And also even though you have health insurance eventually you will be forced to go along with the program. I urge you to listen to this interview. This health bill must not go through.

[Hal_Horvath]

Great piece by Condon here. Gets to a very consequential question: how soon for real reform?

My thoughts in response:

http://findingourdream.blogspot.com/2009/07/2013-could-be-lifetime-awaydo-simple.html

[lovegetpeace]

Folks,
This is what American's get for $3.6 Trillions a year from our current Private Health Care system:

America ranks #42 worst in Infant Mortality Rate in the modern world:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

America ranks #47 in Life Expectancy Rate in the modern world:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

America got the #1 Highest Healthcare Cost (over twice (2X) 2nd place Sweden) in the modern world:
http://dll.umaine.ed/ble/U.S.%20HCweb.pdf

Americans have the only Private Health Care system in the world. When you are ill or injured and especially in an emergency, nobody shops around for the clinic or hospital with the best value care. The fact is that there cannot be Competition when it comes to an emergency.

Half of all personal bankruptcies filed in the U.S. every year are because of medical issues.

As long as you have mega pharmaceutical and hospital profits that are based on prolonged treatment rather than quick cures, the incentive is not to cure things such as cancer and AIDS. There's far more money in slowly killing a person for a number of years while bleeding them, their families and their insurance dry, as opposed to curing them with a quick, one-time treatment.

In American, if you do not die from your illness, then you will die from the by-product (side-effects) of the prescriptions.

All Foreign Capitalists have a Huge Competition Advantage against all American's Capitalists because they never pay Private Health Insurance.

All Seniors have Socialized medicine (Medicare) in America. Sooner or later you will be a Senior whom will kill any Republican if they wish to take it away. All Children have Socialized medicine (CHIP) in America. All Military Veterans have Socialized medicine in America.

It for the folks like us in the Middle that cannot sleep with this Out-of-Control Health Care cost.

Like President Obama said, American are paying $6,000.00 more per year per person than the next most costly nation Sweden for similar results. Sweden is a very Socialist society.

What good is it to have the most advanced/high-tech Health Care in the world if nobody can afford it?

[lovegetpeace]

In 2008, our Private Health Care industry made $13 Billion in just Profits and raised our monthly Premiums an average of 17%.

I high respect and admire President Obama for taking on this Greed straight head-on.

[trapbreaking]

by McRoboCon - Republicon Congressional fascists will pay with their jobs for supporting more of the same in 2010 and 2012.

A democrat sits in the oval office. The democrats have a 60 seat filibuster proof senate and an overwhelming majority in the house. Why will republicans pay for it with their jobs? If the democrats wanted this budget busting boondoggle it would be law already.

.

[lovegetpeace]

As long as the cost of Health Care is out-of-control, the Public Option will come sooner or later.

Please be patience!

[sjc_1]

Two things that need to be changed in the health care proposal. One is no mandate for small business and individuals. Two is taxing health care insurance premiums provided by businesses to employees as ordinary income.

Many will not like the second point, but health insurance premiums paid for by the employer ARE compensation, just like salaries and wages. When you subsidize anything it distorts the market and makes health care even more expensive. When some of the money for health care comes out of your pocket, you tend to push back on prices and competition can begin.

[lovegetpeace]

In an Emergency, nobody ask "Let's shop around for the best Emergency Room and Hospital and then take me there for treatment" or when I have an illness "Let's shop around for the best doctor and I am going there".

Imagine an Ambulance asking you to which Hospital or Clinic they should take you. They take you to the nearest facility to treat you.

There is no and there cannot be Competition in any Health Care system.

[sjc_1]

An emergency is less than 1% of what goes on in a $2.5 trillion dollar mess. Get a grip and quit putting up red herrings to distract from the real issues. Health care is a bloated for profit greed pit in America and it is WAY over due to realize this and fix it.

[olyboy]

The pre-existing condition clause in the bill is akin to saying that someone should be allowed to buy fire insurance AFTER his house burns down. Do these people think that's fair and just? It will destroy private insurance.

[lovegetpeace]

The opposite is already killing Insurance Companies with a smaller and smaller pool. The smaller the pool, the Higher the premium per human.

For maximum pool, the government is the answer.

The Insurance industry competes each year to see who removes the most benefits and high risk clients from their database. The winners get high stock prices by Wall Streets.

[trapbreaking]

The long slide down has begun. Rasmussen polls today says that Obama's favorability rating has fallen below 50% - : "Overall, 49% of voters say they at least somewhat approve of the President's performance. Today marks the first time his overall approval rating has ever fallen below 50% among Likely Voters nationwide. Fifty-one percent (51%) disapprove.


The honeymoon is over Barack Hussein.

.

[lovegetpeace]

Folks,

This is what American's get for $3.6 Trillions a year from our current Private Health Care system:

America ranks #42 worst in Infant Mortality Rate in the modern world:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

America ranks #47 in Life Expectancy Rate in the modern world:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

America got the #1 Highest Healthcare Cost (over twice (2X) 2nd place Sweden) in the modern world:
http://dll.umaine.ed/ble/U.S.%20HCweb.pdf

Americans have the only Private Health Care system in the world. When you are ill or injured and especially in an

emergency, nobody shops around for the clinic or hospital with the best value care. The fact is that there cannot be

Competition when it comes to an emergency.

Half of all personal bankruptcies filed in the U.S. every day are because of medical issues.

As long as you have mega pharmaceutical and hospital profits that are based on prolonged treatment rather than quick

cures, the incentive is not to cure things such as cancer and AIDS. There's far more money in slowly killing a person for a

number of years while bleeding them, their families and their insurance dry, as opposed to curing them with a quick,

one-time treatment.

In American, if you do not die from your illness, then you will die from the by-product (side-effects) of the prescriptions.

All Foreign Capitalists have a Huge Competition Advantage against all American's Capitalists because they never pay

Private Health Insurance.

All Seniors have Socialized medicine (Medicare) in America. Sooner or later you will be a Senior whom will kill any

Republican if they wish to take it away. All Children have Socialized medicine (CHIP) in America. All Military Veterans

have Socialized medicine in America.

It for the folks like us in the Middle that cannot sleep with this Out-of-Control Health Care cost.

Like Obama said, American are paying $6,000.00 more per year per person than the next most costly nation Sweden for similar results. Sweden is a very Socialistic nation.

What good is it to have the most advanced/high-tech Health Care in the world if nobody can afford it?

[lovegetpeace]

Folks,

If you do not want Universal Health Care, then why will our Private Insurance industry not take over all the High Risk Americans over 65 already under MediCare and those under 11 under CHIP? Why conveniently leave all those Americans over 65 with MediCare and those under 11 udner CHIP to the Government? Please read the history of How these public insurance came to be.

[trapbreaking]

lovegetpeace - Are you saying that 116 Millions Americans do not work and contribute to society? What is your IQ level?
.................................................................

What is America's IQ level?

Rasmussen: -
53% Now Oppose Congressional Health Care Reform

Wednesday, July 22, 2009

The health care reform legislation working its way through Congress has lost support over the past month. The latest Rasmussen Reports national telephone survey shows that 44% of U.S. voters are at least somewhat in favor of the reform effort while 53% are at least somewhat opposed.

Gallup: Health Care: Less than half (41%) say a new law needs to be passed this year. About a quarter of Americans (24%) do not favor passing new healthcare legislation at all.

Here is the lastest shocker: Obama's rating falls below 50%

Rasmussen: Overall, 49% of voters say they at least somewhat approve of the President's performance. Today marks the first time his overall approval rating has ever fallen below 50% among Likely Voters nationwide. Fifty-one percent (51%) disapprove.

[lovegetpeace]

Folks,
81% of American whom are very lucky to have Private Health Insurance have HMOs.

HMOs instruct the Doctors what cheaper treatment to give you.

Beside this fact, per the phamaceutical industry commercials/ads on TV, Internet, Magazines and other media, Americans are instructing their Doctors which Drugs they want. The phamaceutical industry have found that these commercials/ads works perfect - goldmine.

In other words, Americans do not need Doctors. This is the reason Family Doctors are becoming Extinct and Hospital have filed record Bankruptcies since 2001.

[trapbreaking]

by lovegetpeace - - Folks, If Republicans succeed in stopping Health Care Reform this year,
...........................................

LOL! In the Oval office is a democrat. The Senate has a democrat veto proof 60 seats, the House is overwhelmingly democrat. To blame the GOP for the defeat would be a farce.

A majority of Americans don't want this budget busting boondoggle and even the democrats in congress can read the writing.

[lovegetpeace]

Folks,
81% of American whom are very lucky to have Private Health Insurance have HMOs.

HMOs instruct the Doctors what cheaper treatment to give you.

Beside this fact, per the phamaceutical industry commercials/ads on TV, Americans are instructing their Doctor which Drug they want.

In other words, Americans do not need Doctors. This is the reason Family Doctors are becoming Extinct and Hospital have filed record Bankruptcies since 2001.

[clancy49]

What everyone should understand is that this program is not social medicine. Read the bill carefully. This is the opportunity to get trillions from working taxpayers and spend millions for great profit just like the insurance companies. It will put the insurance companies out of business, but all those profits will go to government coffers to spend lavishly around the world and poor nations like Africa and for the Washington D.C. elite to live lavishly. Yes, our health care is horrible, but it is because of the greedy profiteers in insurance soon to be the government. The health care will not improve. If this President, administration, and Congress really wanted to improve health care there would only be two steps. 1. Protect Doctors from frivilous law suits, only bad doctors deserve malpractice suits. 2. Change Insurance and Pharmaceuticals from excessive greedy profit stockholder sharing dividend mongers to non profit. Then watch how quickly the American Health Care system returns to the great icon of humanity and medicine it used to be.

[lovegetpeace]

Amazing how our world only Private Health Care system is the only Free Market Private Enterprise that prices itself more out of the market each year.

[rhs648]

For some people the automotice industry, the cable industry, the cell phone industry, and the power industry price themselves poy of the market each year. There are plenty of industries pricing themselves out of the market.

[rhs648]

correction

For some people the automotive industry, the cable industry, the cell phone industry, and the power companies price themselves out of the market each year. There are plenty of industries pricing themselves out of the market.

[rhs648]

You guys who want to overhaul health care should realize that many Americans are very happy with the current system. Many of us have excellent health insurance plans that havbe taken care of our families for many years. When my father had $70,000 in bills for his open heart surgery, his insurance paid all but a $100 decuctible. When my step mother needed a heart valve replament operation, her insurance paid for most of her bills. It is experiences like these that both give us confidence in the health care system and make us want to keave things alone. 91% of the American people say they have health insurance according to a recent poll.

[lovegetpeace]

Hey rhs648,
Please provide the name, source and URL of your 'recent poll'.

[rhs648]

lovegetpeace - Fox news poll dated July 23 at http://www.foxnews.com/story/0,2933,534605,00.html

[thusspokezara]

Will doctors be forced to accept patients with Public Health Insurance? What good will do me to have insurance if a doctor won't see me?

[lovegetpeace]

Hey thussspokezara,
Doctors and Specialists already accept Seniors with Medicare, children with CHIP and Military Veterans with Public Health Insurance.