(WXYZ) - We met accountant Leroy Gates at Lafayette Coney Island.
He was enjoying a day off. I was on a mission to clear the air on health care:
Stephen Clark: So you’ve got health care?
Leroy Gates: Yes I do.
Stephen Clark: Are you happy with the system?
Leroy Gates: Very happy. I’m a military retiree so I have Tricare. It’s an excellent program and I haven’t had any real significant increases in seven or eight years.
And that opinion puts Leroy squarely in the center of what most Americans think about the health care debate.
A recent ABC News/USA Today poll shows 80 percent of Americans are satisfied with the quality of health care they get. Roughly 60 percent say they’re satisfied with the cost of their health care.
Yet, as happy as most people seem to be about it, even Leroy Gates agrees that something’s got to be done.
Stephen Clark: Are you eager to see Congress and the President change the system?
Leroy Gates: Well, I’d like to see them change the system, yes, for the better.
Stephen Clark: Obviously the big talk these days is fixing the system. First question: Is the system broken?
Renee Courtney: Yes, I would say the system currently the way it is, people have limited access to care. And then the people who do have access to care, sometimes its inaccessible related to the price.
Stephen Clark: So do you think the health care system here in America needs to be fixed?
Ali Alhalmi: Yes, that would be fixed, yes.
So that’s where Congress finds itself today, trying to fix something that most people agree is working fine, but still is broken.
Which explains why we keep hearing this question:
Stephen Clark: The question is, can I keep my….
Rep. John Dingell: The answer to that question is yes. And I want to make it very clear. The answer is yes. Every American, if they like their plan, will be able to keep it.
Rep. Mike Rogers: It will change and here’s how they do it….
Republican Congressman Mike Rogers says you can keep your plan, but when congress gets through with it, it won’t look like the plan you have now.
Rep Mike Rogers: Until 2013, you can keep the insurance you have. No problem. But once the Federal Government Exchange opens, which is the government-run plan, plus anyone who wants to compete in America has to go through government mandates in the Exchange, your plan has to comply with the Federal Government Exchange. So the plan you have today is not going to be the plan that goes through the final exchange. It can’t. It’s just impossible.
Congressman Dingell concedes that point. But assures us under health care reform, our current plans will be the same, but better.
Rep. John Dingell: First of all, remember that I said the government standards are going to be floors rather than ceilings. And with the exception, insurance companies are going to be able to do whatever they want to do as long as they treat recipients fairly. But understand something more Stephen; this is really very important. We want the recipient of these plans to have choice.
So what’s next?
The House has merged its three proposals to come up with the so-called Final Version.
Thursday, Speaker of the House Nancy Pelosi said she hopes to get it onto the House floor for debate next week.
The Senate has also come up with its final plan.
So let’s look at the things they both will include, that will give us an indication of what is likely to be in the combined plan.
First – The Cost.The Senate bill is estimated at $829 billion over 10 years.
The measure in the House is $894 billion, although a separate $200 billion bill will be introduced to increase Medicare payments to doctors.
How Will We Pay For It?The Senate wants a tax on the so-called Cadillac insurance plans. Also, fees on insurance companies, drug makers and medical device manufacturers.
The House wants to place a 5.4 percent surtax on individuals making $500,000 or more. It also wants cuts in Medicaid and Medicare, as well as a tax on medical device manufacturers.
What About Businesses?Under the Senate plan, they don’t have to offer insurance, but companies with more than 50 full-time workers would pay a fee if the government has to subsidize coverage for employees.
The House measure requires employers to provide coverage or pay a penalty. Small businesses – those with less than $500,000 annual payrolls – are exempt.
What Are The Requirements On Individuals?The Senate says almost everyone must get insurance as long as it costs no more than 8 percent of their income. Those who can afford it but don’t buy it will be fined.
The House also requires coverage, but allows for hardship waivers. There’s a tax penalty of 2.5 percent of income for those who go uninsured.
Finally – The Public Option.Under the Senate plan, the government would negotiate rates with doctors and hospitals. Individual states would be able to opt out.
The House version also calls for negotiated rates, but there’s no opting out.
