Canada's Health Care

[RM]

I've seen a few T.V. shows recently about different health care systems around the globe. I was wondering how satisfied the Canadians here are with your system. The good, bad, and ugly so to speak. Pros and cons, that sort of thing.

Just curious.

[Yuri]

Ron,
I've had the unfortunate opportunity to see the Canadian health care system from both sides. Recently from the inside-out with my illness as well as from the outside looking in through my 30+ years of employment as a medical microbiologist. I feel that both private and socialized medicine have good points as well as bad.
As for the Canadian system:

Pros - The benefit of socialized medicine is that you don't have to show your wallet every time you need medical assistance and that most needs are covered whether it might be a visit to the family doctor or a heart transplant. The financial impact is carried by the government (the citizens as a whole) but, of course, that is reflected in our personal taxation rate. Private health insurance can be purchased, often subsidized by one's employer, to cover items not covered by the government (ie. dental, supplemental drugs, optical, etc). The government health care system cannot turn anyone down for a pre-existing condition, extended use etc. There are no HMOs and everyone is entitled to see any doctor of their choosing and basically get as many 'second opinions' as they wish. Here you probably won't lose your house in a medical crisis nor be denied treatment at the hospital of your choosing because you can't pay.

Cons - As everything is publicly funded, all medical tests, procedures, physicians have their basic rates capped by the government. (yes, I know, doctors have ways to boost their income). When a hospital, institute or doctor gets the same basic rate of reimbursement for the same service or procedure rendered there is less incentive to be better than the next. Competition drives excellence. If competition were allowed, better hospitals could charge more in order to attract more experienced doctors, purchase better equipment and trial more 'approved' cutting edge & experimental procedures. That said, we have some great doctors and great facilities. But arguably outside of Toronto's 'Hospital for Sick Children' I have to wonder if we have a truly 'world renowned' facility in Canada. Understandably the U.S. has a greater population but still there are proportionately more universally recognized world renowned hospitals such as Boston's 'Brigham & Womans', Minnesota's 'Mayo Clinic' and Baltimore's 'Johns Hopkins', just to name a few. These are health care facilities that lead the way and not just implement what is currently accepted.

Most regions of Canada have an ongoing shortage of doctors, family physicians in particular. Many have been lured away to the U.S. by better prospects, modern facilities and higher income. Emergency rooms are overcrowded with some unacceptable wait times up to 14 hours post triage before receiving treatment. Some newer medications & procedures approved in the U.S. (and even in Canada) are simply not covered by the Canadian health care system. The choice then becomes the patient's - pay out of pocket to travel to the U.S. or elsewhere for treatment or stay ill and possibly die.

Some argue that a 'Two Tier' system should be implemented - where there is public health care for the masses and private (for profit) for those able and willing to pay. Of course many doctor's will gravitate to the better facilities and pay in the private field. Many Canadians fear that allowing a Two Tier system will eventually erode the public care and the U.S.system will dominate. For all intents and purposes a two tier system already exists to some degree as I know of no sports athlete or politician who ever had to stand in line for surgery or an MRI.

Hospitals in Canada are required by legislation to operate 'in the black'. Few are able to offer all the services requested by the community through government funding. As a result I've personally witnessed outdated and even broken equipment that continues to be used, essential but infrequently requested tests being diverted or canceled as well as a cutback in custodial services which may hasten the spread of MRSA, C.difficle or the common flu.

Ron, to answer your question, I'm generally satisfied but we could do so much better....

Anyways, that's my 2 cent take (not government funded) on our system. I'm sure some of my compatriots will disagree.

(I have yet to see Michael Moore's film on the subject)

[talbot10]

Ron,
Thanks for asking that question and
Yuri,
Thanks for taking the time in providing such a thoughtful and informative answer. I have wondered many times myself how the two systems stack up in the real world
Bill

[jj]

The financial impact is carried by the government (the citizens as a whole)

I'd add that it's also carried by big businesses (employer health tax) otherwise those personal income tax rates would be even higher.. I know, hard to imagine

I've spent a good chunk of the past 25 years attempting to correlate reductions in various cost mixes with reductions in quality of care and desired outcomes...many qualitative measures can be subjective by nature ...I think we're getting better but much work remains ahead

over the years, so many seminars, articles and other informative sources seem to be biased in one way or another...I think you've highlighted the main +/- issues thoughtfully, thoroughly and quite objectively, Yuri

[RM]

Yuri,

I echo Bill Hall's thanks for the reply. Very enlightening. I have a feeling a Universal Health Care proposal will soon find it's way back to the US Congress, and that is the root of my interest.

You mentioned that you were generally satisfied, but it could be much better. If you (or anyone) wish to offer your thoughts, I would like to hear your ideas for improvement.

Thanks again.

[jj]

outdated and even broken equipment that continues to be used

yes, just like our military

I understood there were increases in infection control funding ever since SARS however I'm surprised there were cutbacks in custodial services ...no cost savings, in even the slightest, can be justified at the risk of compromising a sanitary environment for ourselves and/or loved ones

I should've been captivated but never made it through this past Moore doc

[charlene]

I agree with yuri about things needing to be improved..hospital based infections are a huge problem..sanitary conditions need to be paramount with any and all who come into the facilities. period. much is done but more is needed. hospitals breed infection..much has to do with the architecture-many new hospitals around the world are going with one patient per room.
having seen first hand several hospitals in toronto and area in the last few years and been involved with mri/cat scans/ultrasounds/neurology/genetics/extended hospital stay and not receiving one bill even tho some appts.were along time coming, i must say that on the whole i'm very satisfied with things. 3wait times in ER were bad. all professionals were exemplary, compassionate, caring and generous with their time whether in person or on the phone.
there are those with horror stories tho..sadly.
insurance with employers helps cover dental and prescriptions..
oral surgery last week was 1700.00 and all but 200 was covered. prescription rinse was covered as well..
article; http://www.macleans.ca/science/health/article.jsp?content=20080709_57479_57479
and about hospital infections;http://www.macleans.ca/science/health/article.jsp?content=20080611_31411_31411

[jj]

all professionals were exemplary, compassionate, caring and generous with their time whether in person or on the phone

ahh, so refreshing to hear gratuitous words such as these...reminds me of why so many family members and friends chose this field in the first place, to whole-heartedly serve those in need of care

it's deflating to acknowledge many caregivers have lost their zest - there will always be some bad apples out there, then again, there are many bad apple patients out there too

[charlene]

James - you are so right about bad apple patients. Sitting in ER and waiting rooms for all kinds of different tests and doctors I saw some pretty bad behaviour yet never once did I see a nurse/clinician/doctor ever be anything but polite and helpful.
I sent all we came across in our travels within the health care system thankyou cards for being so compassionate and kind..

[jj]

I sent ...thankyou cards for being so compassionate and kind..

a very sweet touch,
hmm, doesn't sound like your mower doctor will be getting one;)

[BILLW]

Very nice touch Char - I'm sure they were quite pleased and surprised.

Very interesting discussion. I'm ONLY 55 and I'm wondering as I follow along here: when did my health expenses become the responsibility of others ? When I was a kid you went to the doctor and you paid on your way out. You took your prescription to the drugstore and paid cash after waiting 10 minutes. Done. When I say others some might say government but it's the same, no ?

Anyway when I talk to younger people at work I'm amazed at what the younger generation has been told that they are entitled to. I suppose if everyone agrees that it's worth the price in taxes, etc. that's one thing. But I don't see where people who would care to opt out have a choice.

Bill :)

[charlene]

Not everyone can afford medical care .. a prescription now and then may be do-able, perhaps some small bills can be paid..

People who earn minimum wage and are barely making a living can't afford huge legal bills if they are injured or develop some sort of disease.. Medical care here is for everyone and taxes pay for it as they also pay for education/police/fire etc.

Many people don't have kids and may wonder why they should have any taxes for schools etc. Well the children of today will be the ones paying taxes in the future to help pay for their old age pensions and health care etc..It is for all of society that education tax is charged to everyone..just as health care..

A healthy society (or as healthy as it can be) benefits all. When some marginilized members can't afford to pay and therefore do not seek medical help we as a people are diminished in our values as a caring, helpful, compassionate society. Our good health is paramount to being productive citizens, therefore being able to work and contribute in many ways, not just as tax payers..

Nobody here is turned away for health care and that includes visitors to this country and rarely are they charged anywhere near what their care costs.
When immigrants show up here they are given health care despite their work status. They may also receive dental benefits. This goes for those who claim refugee status for themselves and family and they are then housed and clothed and fed and given medical/dental care as well while their claims are reviewed. This can take up to 4 years with appeals!

If the medical care my family has received in the last several years was pay as you go we would not be able to pay. Paying health care by mortgaging the house etc. is not done here.. People will not lose their homes to pay for hospital stays/surgeries/cancer care etc. It's just not done.

One never knows when major medical issues of a physical or mental kind will arise and it gives me peace of mind knowing that when an emergency of any medical kind does arise I can immediately go to the hospital or clinic or doctor and know we will be looked after without the worry of a clerk at the desk asking us for payment which we may well not be able to pay...

[Sundown17]

Being both a health care employee and a health care user, I am the first to admit the US health care system needs a major overhaul...but we do have all of the above mentioned categories...private insurance (the kind that employer/employee each contribute or the uber rich pay out of pocket) government insurance (for the qualifying poor, disabled and anyone over 62) and pay as you go (for all the unfortunate people that do not fall under either of the former).

I work in an Intensive Care Unit at a non profit hospital in New Hampshire. The hospital will treat any and every patient that shows up regardless of their ability to pay. Yes, they will be billed and yeah, maybe even get some phone calls down the road looking for money, but they are never turned away even if they already have a large outstanding bill with us. The social workers work with them to figure out a way to get the bill paid, whether it be some government hand out or an agreed upon monthly payment that is doable on the person's income (I've seen as low as $35 a month on a multi thousand dollar bill, if that was all the person could afford to pay each month and as long as they made the $35 payment each month, no harassing phone calls).

Case in point, there was a patient that would be admitted, oh, probably every couple of months or so, to the ICU. He was basically a homeless, alcoholic, drug user. And when he got close to dying, he would call 911 and get an ambulance to take him to the Emergency Room. They would admit him, the ICU would fix him up and then send him home after a week with services to try to improve his living style that he would reject after about two weeks. And then the process would start all over. (Interestingly enough, whenever he was hospitalized, all kinds of family would show up, demanding this or that for him...which made us wonder...where were these people when he was alone drinking, injecting and smoking himself into illness?) Anyway, my point is that, I suspect that by the time he passed away, he had ran up a hospital care bill in the hundreds of thousands with his many admissions, which will never be paid. So in a sense we do already have a universal health care system...it's just not universally available.

Can anyone tell me...I had heard that in universal health care, if someone is habitually ill because of self-abuse or non-compliance (not taking their meds or engaging in activity that will make a diagnosed chronic illness worse) sooner or later they will be turned away from treatment by the doctor, hospital unless they pay for it themselves...is that true? The hospital I work at is not allowed to do that. So needless to say, we see the same patients over and over again because they don't/won't take their meds or care of themselves.

And not every hospital is non profit, but many are and some of them are the biggies that Yuri mentioned. My husband had open heart surgery at Brigham and Womens this past winter. We have wonderful private health insurance through his employer that we pay oh, around $200 a month for. The bill was over $100k, our out of pocket was less than $500. However I met a woman in the waiting room whose daughter was getting a heart transplant. She had no insurance, but the daughter was getting every bit the same high quality care that my husband was. The hospital had set up a cot for her so she didn't have to pay for a hotel room. And a nearby hospital was validating her daily parking so she could keep her car parked in their garage for the duration. Unfortunately this is more the exception than the rule and more available in the high health care cities like Boston.

Sorry, kinda went off on my little personal rant here. Didn't really address Ron's question...but I have been very interested in the replies.

Yes, we do have to do something to make sure affordable health care is available to everyone. But one way or another those that can pay for it, will, whether it be through private insurance or in higher taxes for property, purchases, income and those that can't pay, won't, because they don't/can't own property or work or afford spending sprees. Nothing is truly free. It's just a difference of seeing upclose and personal what it's costing you or have it hidden in taxes and fees. It will be interesting to see if the US does implement a more global health care system, how "smooth" the transition will be. Personally I see a big fat ugly mess with alot of fingers in the pot still trying to get rich from it and sadly alot of people still falling through the cracks because anything involving the government is not a simple line from point A to point B.

But then that's a whole 'nother rant...:P

Diane

[RM]

Nothing is truly free.
Diane

You guys are good. Very interesting perspectives. I think Kristofferson might disagree with your quoted statement. Didn't he proclaim that "nothin' ain't worth nothin', but it's free".

Just kidding.

Residing here in an illegal immigrant corridor in Arizona, one frequently hears the news that a pickup loaded with 18 illegals has overturned, and they have been transported by helicopter to nearby hospitals. There's a cost somewhere.

[Sundown17]

Actually Ron, if you think about it, I was paraphrasing Kris...nothing is free, honestly. lol

[charlene]

Like a flight simulator for hospitals
Aug 01, 2008 04:30 AM

Carol Goar

Summer jobs don't get much better than this.

A team of six students from different faculties at the University of Toronto has spent the past nine weeks developing Pulse Check, an online emergency room simulator – a glorified video game – that allows doctors, medical students and hospital managers to test changes in procedures, technology and staffing without putting patients' lives at risk.

They can see what works – and what backfires – as they attempt to shorten wait times, reduce overcrowding and improve patient care.

"Pilots don't learn how to fly in stormy weather. They do it in a flight simulator. This is the same idea," says medical student Kelly Emms, a member of the design team.

The project was the brainchild of Dr. Dante Morra, medical director of the Centre for Innovation in Complex Care at the University Health Network, and Dr. Brian Golden, chair of the Centre for Health Sector Strategy at the Rotman School of Management.

They recruited six top students – two industrial designers, an engineer, a doctor working toward his MBA, a social worker and a medical student – and told them to use their skills, their training and their imagination to turn the concept into a reality by the end of July.

None of the students knew each other at the outset. Some weren't even sure what a change simulator was. But they tackled their task with enthusiasm and a deadline-driven sense of urgency.

They began by figuring out what each person brought to the table and agreeing that, while there would be differences of opinion and approach, they wouldn't allow any conflict to become personal.

"Teamwork is hard. We did have arguments about how to do things, but there was no rivalry," Emms says. "And we had mentors. Dr. Morra was there every day."

A software company, ExperiencePoint, was also on hand to coach the students on game-creation. The firm specializes in computer simulations for business decision-making.

Once the project began, time flew. "It was nine weeks of craziness," Emms says. "I looked at my calendar and said: `Where did July go?'"

Yesterday, the students officially unveiled Pulse Check at Toronto General Hospital. Today, the team disbands.

But the friendships will last. The lessons in interdisciplinary co-operation will last. And the simulator will certainly last.

ExperiencePoint plans to sell it to health-care institutions around the world. The students won't get any royalties, but they're all fine with that. They didn't invent the game to make money.

There will be other paybacks. Next year, Pulse Check will be introduced into the third-year medical curriculum at the University of Toronto. The Mayo Clinic has expressed an interest. Word is spreading through the health-care community that innovative things are happening at the University Health Network.

As their last collective act, the students decided to showcase their creation. They were eager to let people try it, meet the virtual characters and see how each decision triggers a chain of consequences, some intended, some not.

A game takes about three hours. It begins with sirens wailing. A stroke patient almost dies waiting in the emergency room. The chief executive officer of the hospital comes onscreen and says: "You've been hired to this fix this."

Resources are limited. There are no empty beds or spare nurses. But there are 50 options, which can be tried in any combination.

The video is meant for teams of doctors, nurses, physiotherapists, hospital administrators and social workers. The objective is to come up with a strategy that speeds up admissions, provides high-quality care and wins the support of management, the medical staff and the board.

"Web-based simulations are an excellent educational tool," Golden says. "Students are able to grasp complicated concepts in a short amount of time."

They're also fun. Almost no one would say that about introducing change into a rigidly structured hospital. It is one of the hardest organizational challenges there is.

Pulse Check will make the job easier. But it is just a tool. Health-care leaders will have to supply the judgment and humanity.

[jj]

When I was a kid you went to the doctor and you paid on your way out


that's how it is with dental up here...unless you pay for a private plan or your employer chips in with the premiums deducted from your pay

"when I was a kid" (this would be my dad speaking, lol) he said his dad told the dentist to just fill any cavities WITHOUT any pre-freezing because it would be a cheaper billing ie. out of pocket expense for his dad...my jaws hurt whenever I think of him telling me that, yeow

regarding healthcare, I don't know how my chronically, financially struggling sis's (estranged, deadbeat husbands/dads) would have been able to raise all my neices and nephews if our system was a pay-as-you-play one

[Cathy]

I'm allergic to Novacaine. The one time I did have it, I blacked out for 20 minutes and scared the poor dentist and has assistant to death. I always went without when having any dental work done, because the alternatives didn't work too well.

Cathy

[RM]

Well, now that this thread is nearing 1.5 years of age, I'd thought I'd bring it up again. Any new perspectives, or thoughts on the dialogue the pundits here in the U.S. are spraying about ?

'Times are a changing'. There are many excellent posts in this thread that you may want to revisit.

[Auburn Annie]

Interesting - I missed this the first time around, I guess.

Bill W - when you were a boy (and Fred Flintstone and I went to grade school together so I'm no spring chicken either - doctors still made house calls!) if you sprained an ankle Mom wrapped an Ace bandage around it, and grandpa fixed up makeshift crutches for you. Office visits to a doctor were rare and cost $5-10 in a big city, less in a town (see below) so of course you could pay cash. Prescriptions rarely ran more than $2 or $3 because - frankly - there wasn't much beyond aspirin on the shelf and maybe penicillin, sulfa drugs and eyedrops for glaucoma available by way of prescription. The local pharmacist might compound something from materials at hand but for gut ache you took bismuth or coke syrup (my mother kept a bottle in the refrigerator for us as needed), tincture of iodine for cuts and scrapes, etc. You get the picture.

Surgery was put off if possible, a last resort not so much because of the complications and difficulty of the surgery itself but the high rate of postoperative infections that killed so many. There was little or nothing to offer for a bad hip beyond a cane. You can't have 21st century treatment for mid-20th century prices. See http://www.nytimes.com/2006/09/27/business/27leonhardt.html

From The 1950s: Medicine and Health

An Office Visit
The average family doctor was a busy man in his late forties. He worked about sixty hours a week and was on call twenty-four hours a day, seven days a week. If you were too ill to come to him, he would most likely agree to come to your home. Only one out of fourteen family doctors refused to make house calls in 1958. Otherwise, you went to the doctor's office between about 9 or 10 A.M. and 4:30 or 5 P.M. On a typical day most doctors treated an average of twenty-six patients in their offices (in addition to those in the hospital, whom the doctor visited before and after office hours). You would expect to wait between one and two hours in the office before seeing the doctor. Your doctor would be likely to work on a first-come, first-served basis, rather than by appointment.

The Patient's View
If you were an average patient in the 1950s, you visited your family doctor five times a year, and you would grudgingly admit that he earned the three dollars to four dollars he charged for an office visit (though you may have felt differently if you lived in a large city, where the cost was as high as fourteen dollars). You would have grumbled nonetheless about the impersonal quality of the care and would have felt that for as much as he charged, the doctor might have spent more time treating you. It seemed to many patients in the 1950s that their doctors showed insufficient interest in their welfare, asked too few questions, and rushed treatment in an effort to see as many patients as possible.

HOW MUCH DID DOCTORS MAKE?
In 1951 doctors' annual earnings for 1949 were reported by the Department of Commerce. The report calculated the average salary of a physician to be $11,058, but there was a wide range of earnings depending on specialty. By comparison, the median family income in 1949 was just under $3,400.

Neurological Surgeons $28,628
Pathologists 22,284
Gynecologists 19,283
Members of Partnerships 17,222
Full Specialists 15,014
Doctors Paid by Fee 11,858
Part Specialists 11,758
General Practitioners 8,835
Doctors on Salary 8,272
By 1958 the average earnings of family practitioners had risen to about $15,000, and specialist earnings had risen accordingly. The median family income had risen to $4,845.

(Median family income in 2006 was $58407 according to the 2009 Statistical Abstract.)


Table 2. Median compensation for physicians, 2005.

Specialty Less than two years in specialty/Over one year in specialty
Anesthesiology
$259,948 $321,686
Surgery: General
228,839 282,504
Obstetrics/gynecology: General
203,270 247,348
Psychiatry: General
173,922 180,000
Internal medicine: General
141,912 166,420
Pediatrics: General
132,953 161,331
Family practice (without obstetrics)
137,119 156,010
Footnotes:
(NOTE) Source: Medical Group Management Association, Physician Compensation and Production Report, 2005.

[RM]

Just pulling this back up.......are you folks in Canada paying any attention to the divisive issue of 'health care reform' under way here in the U.S.A. ?

It's quite entertaining and depressing to watch the process unfold.

[charlene]

oh yeah - it's all over the news here.- we can't avoid it..
"quite entertaining" as GL would say..
http://www.thestar.com/default
http://cnews.canoe.ca/CNEWS/World/2010/03/21/13307496-ap.html
http://www.cbc.ca/world/story/2010/03/21/us-healthcare-vote.html
http://www.theglobeandmail.com/news/world/democrats-predict-victory-in-landmark-health-care-vote/article1507245/

[timetraveler]

After having read Yuri's take on the Canadian system, it would explain why the general public here in America is in such a stir, what with the current debate going on in D.C. about how to fix the health care system here. For many people here, folks can't afford health care insurance. One of the things being proposed is slappng a tax on employers to pay for basic barebones policies. The only problem with that idea is that if such a thing happens, it's only going to increase the unemployment rate, as the employers reaction is going to be to put some of his employees on part time hours, making them eneligible for company insurance. In many cases, the worker would be terminated outright from their job, just so the employer can maintain their profits, which would be a cruel blow to what has been called "the working poor". I've heard folks here say that perhaps such people should try to get public assisstance & get Medicaide, however, if you make a certain income level, you're denied it. Simply put, the working poor are put in a Catch22 situation where they make too much to qualify for state assisstance, yet they still don't make enough to purchace basic health care insurance. One thing that I myself don't like about the whole mess is that one part of the current healthcare thing that they have in the current incarnation of the bill is that any person who doesn't have health insurance has to pay a fine, just because they don't have insurance. That's a hell of a thing to tell a family where they're getting ready to loose their home because the working adults have become unemployed through no fault of their own. 'Nuff said on that.

[RM]

oh yeah - it's all over the news here.- we can't avoid it..


Sorry about that.

[charlene]

Sorry about that.

;)

[podunklander]

yay it passed :clap:

[RM]

Although skeptical, I hope it works out.

What a week......

Uncle Jay will explain..... :

http://www.youtube.com/user/UncleJayExplains#p/a/u/0/q1gxn8uknd0

[charlene]

I hope it works too.

[Auburn Annie]

Okay, it's signed. For our Canadian friends - and many Americans who have lost track of what is and isn't included, here's a summary of the bill and the timeline of what goes into effect when. It ain't perfect, by far, but seeing as how we've been trying since 1912 to enact something close to this, it's major:

Health care bill summary and timeline

President Obama signed sweeping health care reform into law today. The Senate must now pass a package of changes that will reconcile the differences between Senate and House bills. If those changes are worked out, here is how health care reforms will affect you:

Within the first year

• Young adults will be able stay on their parents' insurance until their 27th birthday.

• Seniors will get a $250 rebate to help fill the "doughnut hole" in Medicare prescription drug coverage, which falls between the $2,700 initial limit and when catastrophic coverage kicks in at $6,154.

• Insurers will be barred from imposing exclusions on children with pre-existing conditions. Pools will cover those with pre-existing health conditions until health care coverage exchanges are operational.

• Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.

• Lifetime limits on benefits and restrictive annual limits will be prohibited. [no caps]

• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.

• A temporary reinsurance program will help offset costs of coverage for companies that provide early retiree health benefits for those ages 55 to 64.

• New plans will be required to implement an appeals process for coverage determinations and claims.

• Adoption tax credit and assistance exclusion will increase by $1,000. The bill makes the credit refundable and extends it through 2011.

• A 10 percent tax will be imposed on amounts paid for indoor tanning services on or after July 1.

• Businesses with fewer than 50 employees will get tax credits covering 35 percent of their health care premiums, increasing to 50 percent by 2014.

2011

• Medicare will provide free annual wellness visits and personalized prevention plans. New plans will be required to cover preventive services with no co-pay.

• States can offer home- and community-based services to the disabled through Medicaid rather than institutional care beginning October 1.

• A 50 percent discount will be provided on brand-name drugs for Prescription Drug Plan or Medicare Advantage enrollees. Additional discounts on brand-name and generic drugs will be phased in to completely close the "doughnut hole" by 2020.

• Additional tax for health savings account withdrawals before age 65 for nonqualified medical expenses will increase from 10 percent to 20 percent. Additional tax for Archer medical savings account withdrawals not used for qualified medical expenses will increase from 15 percent to 20 percent.

• A plan to provide a vehicle for small businesses to offer tax-free benefits will be created. This would ease the small employer's administrative burden of sponsoring a cafeteria plan.

• The Medicare payroll tax will increase from 1.45 percent to 2.35 percent for individuals earning more than $200,000 and married filing jointly above $250,000.

2013

• Health plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.

• Contributions to flexible savings accounts will be limited to $2,500 per year, indexed by the Consumer Price Index in subsequent years.

• The Employer Medicare Part D subsidy deduction will be eliminated. Employers will lose the tax deduction for subsidizing prescription drug plans for Medicare Part D-eligible retirees.

• There will be increases to the income threshold from 7.5 percent to 10 percent of adjusted gross income. Those older than 65 can claim the 7.5 percent deduction through 2016.

• The hospital insurance tax will increase 0.9 percentage points for those earning more than $200,000 ($250,000 for married filing jointly), and it includes net investment income.

• A 2.9 percent excise tax on the first sale of medical devices will be established. Excepted are eyeglasses, contact lenses, hearing aids or other items for individual use.

2014

• Citizens will be required to have acceptable coverage or pay a penalty of $95 in 2014, $325 in 2015, $695 (or up to 2.5 percent of income) in 2016. Families will pay half the amount for children, up to a cap of $2,250 per family. After 2016, penalties are indexed to Consumer Price Index.

• Workers who are exempt from individual responsibility for coverage but don't qualify for tax credits can take their employer contribution and join an exchange plan.

• Companies with 50 or more employees must offer coverage to employees or pay a $2,000 penalty per employee after their first 30 if at least one of their employees receives a tax credit. Waiting periods before insurance takes effect is limited to 90 days. Employers who offer coverage but whose employees receive tax credits will pay $3,000 for each worker receiving a tax credit.

• Insurers can no longer refuse to sell or renew policies because of an individual's health status. Health plans can no longer exclude coverage for pre-existing conditions. Insurers can't charge higher rates because of heath status, gender or other factors.

• Health plans will be prohibited from imposing annual limits on coverage.

• Health insurance exchanges will open in each state to individuals and small employers to comparison shop for standardized health packages.

• Credits will be available through exchanges for those whose income is above Medicaid eligibility and below 400 percent of poverty level who are not eligible for or offered other acceptable coverage.

• Medicaid eligibility will increase to 133 percent of poverty for all nonelderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.

• An annual health insurance provider fee will be imposed across the health insurance sector according to insurers' market share to companies whose total premiums exceed $25 million.

2018

• 2018 Taxing "Cadillac" plans: An excise tax will be imposed on high-cost, employer-provided health plans beyond $27,500 for family coverage and $10,200 for single coverage; it will increase to $30,950 for families and $11,850 for individuals, retirees and employees in high-risk professions

[RM]

Auburn Annie,

Thanks for the summary. You are one organized gal.

I can't wait for baseball to begin.

[charlene]

http://www.cnn.com/2010/POLITICS/03/23/health.care.timeline/index.html?hpt=T1
link to above timeline that Annie posted and the comments about it at:
http://politicalticker.blogs.cnn.com/2010/03/23/timeline-how-health-care-reform-will-affect-you/?fbid=mribGh2SmPE

always interesting to read what the regular folks have to say... it'squite the divisive policy from what i've been reading and seeing on the news....

Bring on the baseball !!

[timetraveler]

Okay, it's signed. For our Canadian friends - and many Americans who have lost track of what is and isn't included, here's a summary of the bill and the timeline of what goes into effect when. It ain't perfect, by far, but seeing as how we've been trying since 1912 to enact something close to this, it's major:

Health care bill summary and timeline

President Obama signed sweeping health care reform into law today. The Senate must now pass a package of changes that will reconcile the differences between Senate and House bills. If those changes are worked out, here is how health care reforms will affect you:

Within the first year

• Young adults will be able stay on their parents' insurance until their 27th birthday.

• Seniors will get a $250 rebate to help fill the "doughnut hole" in Medicare prescription drug coverage, which falls between the $2,700 initial limit and when catastrophic coverage kicks in at $6,154.

• Insurers will be barred from imposing exclusions on children with pre-existing conditions. Pools will cover those with pre-existing health conditions until health care coverage exchanges are operational.

• Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.

• Lifetime limits on benefits and restrictive annual limits will be prohibited. [no caps]

• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.

• A temporary reinsurance program will help offset costs of coverage for companies that provide early retiree health benefits for those ages 55 to 64.

• New plans will be required to implement an appeals process for coverage determinations and claims.

• Adoption tax credit and assistance exclusion will increase by $1,000. The bill makes the credit refundable and extends it through 2011.

• A 10 percent tax will be imposed on amounts paid for indoor tanning services on or after July 1.

• Businesses with fewer than 50 employees will get tax credits covering 35 percent of their health care premiums, increasing to 50 percent by 2014.

2011

• Medicare will provide free annual wellness visits and personalized prevention plans. New plans will be required to cover preventive services with no co-pay.

• States can offer home- and community-based services to the disabled through Medicaid rather than institutional care beginning October 1.

• A 50 percent discount will be provided on brand-name drugs for Prescription Drug Plan or Medicare Advantage enrollees. Additional discounts on brand-name and generic drugs will be phased in to completely close the "doughnut hole" by 2020.

• Additional tax for health savings account withdrawals before age 65 for nonqualified medical expenses will increase from 10 percent to 20 percent. Additional tax for Archer medical savings account withdrawals not used for qualified medical expenses will increase from 15 percent to 20 percent.

• A plan to provide a vehicle for small businesses to offer tax-free benefits will be created. This would ease the small employer's administrative burden of sponsoring a cafeteria plan.

• The Medicare payroll tax will increase from 1.45 percent to 2.35 percent for individuals earning more than $200,000 and married filing jointly above $250,000.

2013

• Health plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.

• Contributions to flexible savings accounts will be limited to $2,500 per year, indexed by the Consumer Price Index in subsequent years.

• The Employer Medicare Part D subsidy deduction will be eliminated. Employers will lose the tax deduction for subsidizing prescription drug plans for Medicare Part D-eligible retirees.

• There will be increases to the income threshold from 7.5 percent to 10 percent of adjusted gross income. Those older than 65 can claim the 7.5 percent deduction through 2016.

• The hospital insurance tax will increase 0.9 percentage points for those earning more than $200,000 ($250,000 for married filing jointly), and it includes net investment income.

• A 2.9 percent excise tax on the first sale of medical devices will be established. Excepted are eyeglasses, contact lenses, hearing aids or other items for individual use.

2014

• Citizens will be required to have acceptable coverage or pay a penalty of $95 in 2014, $325 in 2015, $695 (or up to 2.5 percent of income) in 2016. Families will pay half the amount for children, up to a cap of $2,250 per family. After 2016, penalties are indexed to Consumer Price Index.

• Workers who are exempt from individual responsibility for coverage but don't qualify for tax credits can take their employer contribution and join an exchange plan.

• Companies with 50 or more employees must offer coverage to employees or pay a $2,000 penalty per employee after their first 30 if at least one of their employees receives a tax credit. Waiting periods before insurance takes effect is limited to 90 days. Employers who offer coverage but whose employees receive tax credits will pay $3,000 for each worker receiving a tax credit.

• Insurers can no longer refuse to sell or renew policies because of an individual's health status. Health plans can no longer exclude coverage for pre-existing conditions. Insurers can't charge higher rates because of heath status, gender or other factors.

• Health plans will be prohibited from imposing annual limits on coverage.

• Health insurance exchanges will open in each state to individuals and small employers to comparison shop for standardized health packages.

• Credits will be available through exchanges for those whose income is above Medicaid eligibility and below 400 percent of poverty level who are not eligible for or offered other acceptable coverage.

• Medicaid eligibility will increase to 133 percent of poverty for all nonelderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.

• An annual health insurance provider fee will be imposed across the health insurance sector according to insurers' market share to companies whose total premiums exceed $25 million.

2018

• 2018 Taxing "Cadillac" plans: An excise tax will be imposed on high-cost, employer-provided health plans beyond $27,500 for family coverage and $10,200 for single coverage; it will increase to $30,950 for families and $11,850 for individuals, retirees and employees in high-risk professionsHmmm. Well, when explained in plain & easy to understand English, instead of the crazy gibberish that I've been hearing it all explained in, it's not such a frightening sounding thing. Still, the one thing that bothers me is the part that penalizes folks without insurance. I can't help but wonder if the government will be penalizing the homeless, or will the item that was designed to reconcile the differances in the new law adress such a situation.