Healthcare Reform 101...a Personal Primer

President Obama is "going to the mattresses" tonight when he addresses Congress on behalf of Healthcare Reform. What is contained in Healthcare Reform? Let's make it simple:

• Requirement that all Americans have insurance and provide government subsidies for those who cannot afford it. The only reason this is here is because otherwise people would apply only when they become sick. If insurance can't discriminate for health risk, then everyone needs to carry to be fair to everyone.
• A bar to insurance companies from refusing coverage for pre-existing conditions; imposing lifetime caps on coverage; or dropping people when they get sick.
• Health care providers have already agreed to lower costs, and drug companies will lower costs on prescription drugs for seniors.
• No discrimination of health insurance prices except by family, geography and age. Allowed discrimination is limited.
• No forced dropping of health insurance by insurance providers, unless there is proof of fraud. The current practice by companies is the first time a person becomes seriously ill the insurance company tried to find a minor oversight on the application and then drop the policy due to falsified information.
• There are a set of hospital administration goals designed to prevent the insurance company from delaying and help the hospitals get payments easier and let the patient know the costs beforehand when possible.
• A public insurance option. Basically a not for profit insurance that will keep other insurance companies from charging too much of a profit overhead via competition.
• A health insurance exchange. Successful in other countries when presenting private insurance options to the public.
• Health care council that will control the government programs and make recommendations for major changes directly to a secretary under the president.
• Current reform discussions include requiring insurance companies to cover routine checkups and preventative care—mammograms, colonoscopies, etc.—in order to avoid chronic illnesses or treat them early, which will save money for patients as well as insurance companies.
• Insurance companies will also be forced to limit how much they can charge for out-of-pocket expenses.

One of the more controversial points in Healthcare reform is the government-sponsored insurance plan; the so-called "public option." The essence of the plan is to offer more affordable coverage for those who cannot afford the rates of major insurance providers. However, no one will be forced into such a plan. As President Obama stated, “…if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.” And the government option would likely follow in the footsteps of and take on some of the positive aspects of Medicaid and Medicare, which are also government-sponsored programs that have worked sufficiently since their inceptions.

We need to pass Healthcare Reform.

It's really telling that the majority of those who oppose it already have access to healthcare and already have insurance or the financial resources that will pay for their healthcare needs. They just don't want everyone else to have access to what they take for granted.

In full disclosure, let me tell you right from the beginning...I'm biased.

I'm alive today because of good healthcare and the insurance to pay for it. I have had two major health challenges in my life and without access to extra tests, extra consultations, great doctor referrals and insurance that paid the bills; I would be dead.

At 19 years old, I had a tumor of the thymus gland that had wrapped itself around my esophagus, lay between my lungs and near my heart. Several doctors said it was "inoperable" and that I had 9 months to a year to live. That was 27 years ago last month. We found the best thoracic surgeon in Washington, DC, who put together the best medical team he needed and they not only successfully removed the tumor; my parents took me home a week later without having to pay ANYTHING because our insurance covered EVERYTHING.

6 years ago, as most people know I had weight-loss surgery because I had ballooned to a morbidly obese weight of over 300 pounds. The weight alone was taking years off my life, but the accompanying co-morbidity issues (diabetes, blood clots, pulmonary disease, heart failure) that were sure to follow was enough to convince me to take a chance on yet another life-saving medical procedure. Again, I had great doctors, excellent care, an amazing result and NO OUT OF POCKET expenses for the surgery and aftercare because I was completely covered by INSURANCE.

In the course of the last two weeks, my mother had to have emergency spinal surgery or risk the loss of the use of her leg. The surgery was performed by a top doctor at a world renowned hospital and in 6 days she was home, set up with her at home physical therapy routine. I spoke to her today and she's doing her exercises with her physical therapist with a new piece of machinery that her doctor ordered for her to use to speed her recovery along. Do you have any idea how much this kind of care would have cost without adequate insurance? Our family would be bankrupt...any family would.

It is not unreasonable to think that everyone deserves these kinds of blessed results when it comes to healthcare...and to not see it is selfish, short-sighted and shows a lack of caring and understanding.

I've said it before, but it bears repeating on this day: I believe that everyone is entitled to healthcare coverage, I believe that there should be fair competition between those who will provide it and I believe that providing healthcare to all is a fundamental need that is the moral imperative of this generation.

Listen to the President tonight, form your own opinion...but at least know the facts:

Today we are spending over $2 trillion a year on health care—almost 50 percent more per person than the next most costly nation. Yet, for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren’t any healthier…healthcare is the single most important thing we can do for America and Americans. Those are the facts.