Here’s what is going to happen. From Reuters:
(Thanks to Josh P for showing this to me)
Here is what to expect if the bill becomes law:
WITHIN THE FIRST YEAR OF ENACTMENT
*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.
*Insurers will be barred from excluding children for coverage because of pre-existing conditions.
*Young adults will be able to stay on their parents’ health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
*Medicare drug beneficiaries who fall into the “doughnut hole” coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
*A tax credit becomes available for some small businesses to help provide coverage for workers.
*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.
WHAT HAPPENS IN 2011
*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
*Employers are required to disclose the value of health benefits on employees’ W-2 tax forms.
*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.
WHAT HAPPENS IN 2012
*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form “accountable care organizations” to improve quality and efficiency of care.
*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.
WHAT HAPPENS IN 2013
*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.
WHAT HAPPENS IN 2014
*State health insurance exchanges for small businesses and individuals open.
*Most people will be required to obtain health insurance coverage or pay a fine if they don’t. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
*Health plans no longer can exclude people from coverage due to pre-existing conditions.
*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren’t counted for the fine.
*Health insurance companies begin paying a fee based on their market share.
WHAT HAPPENS IN 2015
*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.
WHAT HAPPENS IN 2018
*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions. (Reporting by Donna Smith; Editing by David Alexander and Eric Beech
My girlfriend was running the other day. And daydreaming. So she fell and scraped up her elbow and hands. She bragged to me that she didn’t cry, but, to a twenty-five year old male, that doesn’t strike me as too impressive. As I’ve heard over the past few days how painful her scrapes are, I’ve reflected on just why women seem to be such wimps about physical pain. Here’s my probably false, but fairly plausible evolutionary explanation.
There is a biological basis for women’s wimpery. The part of their brains that process emotions are more intimately connected to the parts of their brains that process physical pain. This keeps them from being able to psychologically “distance” themselves from their pain – from putting it out of their minds in the way men commonly do. The reason for this neurological fact about women provides them with an evolutionary advantage: empathy. One’s ability to empathize with the needs and feelings of others is often fostered by reflecting on one’s own feelings. The more pain you feel then, the more likely you are to reflect on it, and the more you reflect on it, the more you understand what it’s like when you see others in similar discomforts, and so the more likely you are to care when you see their pain. This might at first seem like an evolutionary disadvantage, but it’s not. While empathizing may lead you to put yourself in a hazardous situation – say, to help save the life of another – it is also quite helpful in the evolutionary game of pass-on-the-genes. Here’s why. Imagine a cro-magnon mother who has no empathy for others. She would certainly be self-sufficient, and wouldn’t find herself in those hazardous situations that empathy might lead into. But she won’t be very good at passing on her genes. This is because, in order for your genes to make their way successfully into future generations, you have to mate, and your children have to live. A lack of empathy would hinder both – especially the second. If you can’t empathize, you won’t be very caring, as I said. If you’re not very caring though, you’ll probably make a poor mother, especially if you live in a hostile environment where infant mortality is high. The unsympathetic cro-magnon mother has a much higher chance of losing her child to malnutrition, mishandling, or general neglect because she just doesn’t care enough. If her child dies, so do her genes. In this way, females with more empathic brain structures are selected for by evolution. Which leaves us, after thousands of generations, with the empathic brain structures that make girls such wimps.
But I’m sure that’s all bs.
I’ve unintentionally assembled this story in my head. Someone with some american history knowledge tell me if I’ve got it.
Why our lives are sucked dry of meaning and pleasure by a 40-hour work week:
1. America is formed in reaction to what is seen as excessive government interference into economic, religious, and private life.
2. America is built in a land of plenty, where the threat of starvation or homelessness is absolutely minima.
3 America structures itself to minimize government interference in these areas, giving it the role of referee – making sure that everyone plays by fair rules (e.g. no monopolies, etc.)
4. With the life of the economy securely in the hands of the population, the possibility of prosperity is seemingly available to anyone with a good idea and a will to work hard. This is the American Dream.
5. Under the American Dream, since most people find themselves in the middle or lower-class, the psychology goes: I don’t have a whole lot, but I could have a whole lot if I worked really hard, so I will work as much as I can.
6. With the economy structured and maintained purely by people with this philosophy, the amount of work performed is extended far beyond what is required to meet the basic needs of life because, with the combination of plentiful resources and the dream of prosperity, work is no longer about meeting one’s needs, but rather is about climbing an economic ladder.
7. The average American, now, is in the historically bizarre situation of having plenty of food and reliable shelter, but still working as if faced with the threat of starvation. Most citizens never realize this – that the average person through history has not seen any need to work far more than what is required to meet their physical needs.
8. This bizarre situation is self perpetuating. For example, consider: in a free (i.e. non-government-run) market, pharmaceutical companies exist, as all other companies, in order to make money for their investors (in other economies, pharmaceuticals are developed, tested, and distributed by a government agency with little strong financial interest). In a society where the threat of death by disease is extremely low, and life expectancy is very high (ours) pharmaceutical companies need a way of generating revenue other than actual need for its products, where, in a society where pharmaceuticals were developed and distributed by the government, that agency would simply have its funding cut, so that the funds could be redirected. Instead, in America, the companies are given the freedom to promote their products commercially, by sending the message that citizens are constantly in danger of infection, disease, etc. This acts as an atom in the carrot hung in front of the worker’s face, giving a (very thin) motivation to continue working when needs are met.
9. So, the cycle continues: though there’s no need to work so much, the sense of need is constantly kept alive by a free market, that thrives not on the basis of its ability to meet real human needs, but to manufacture the perpetual sense of need, and offer a never-ending stream of items that simultaneously generate and meet these needs.
10. The result: Americans spend the majority of their waking hours (that is, most of their conscious lives) working, even though they could get by on far less, and spend more time playing, simply at the cost of giving up many of the items they don’t really want or need.
– If you work a forty-hour week, you get, on average, about three hours of free time a day. That’s three hours, only 1/8 of your time, to spend on the things you enjoy and the people you love.
– Studies have confirmed and reconfirmed that, once a person makes enough money to meet their basic needs and have just a little (a few thousand dollars a year) left over, their happiness levels out. One’s happiness, then, does not increase with wealth, but rather ceases to increase, regardless of affluence, once one has enough to eat, clothe themselves, have shelter, etc.