The lead article in today’s New York Times, “Health Care Law Will Let States Tailor Benefits,” describes a major policy reversal by the Obama administration regarding the implementation of the Affordable Care Act. The federal government will let the states define the essential elements of a benefit package within broad categories set by the administration. This reversal means there is, in effect, no minimum standard of coverage.

While the Affordable Care Act does delineate areas of coverage, such as preventative care, emergency services, doctor services, maternal care and prescription drugs, this decision will give the states broad leeway regarding the components required in each field. As a result, the impact of the Affordable Care Act will be much greater in states such as New York than, say, Alabama.

It is important to note that this structure is similar to the way Medicaid and the Children’s Health Insurance Program (CHIP) works, but the idea of elemental coverage is inherent in the concept of national health insurance. In fact, this decision may be more political than policy-oriented; one of the main criticisms of Republican Presidential candidates involves the effort by the Affordable Care Act to impose a rigid, bureaucratic, one-size-fits-all system upon the states.

There is bound to be some reaction to this decision by the Democratic base, and it may represent just one more example of the President caving in to pressure by Republicans.

The lead article in today’s New York Times, “Justices to Hear Health Care Case as Race Heats Up,” will bring the debate over President’s Obama signature achievement, “The Patient Protection and Affordable Care Act,” to a climax right in the middle of the Presidential campaign.

This development ensures that the health care debate will remain one of the front and center issues in the campaign, perhaps eclipsing the economy as the primary concern of voters. That result carries peril for both sides in the debate, threatening to energize the bases of either one Party or the other depending on which way the Supreme Court rules.

The Supreme Court scheduled more than five hours of debate on the issue compared to the usual one. Two hours are devoted to the individual mandate, one hour to whether it can be severed from the rest of the law, and three hours on related matters. These matters include the expansion of Medicare as a condition for state participation in the program as well as an abstruse legal issue, the “Anti-Injunction Act.”

As is typical of legal arguments, this Act could throw the whole process into confusion and delay a ruling until 2015. The Act prevents lawsuits designed to prevent the collection of a tax, and thus, a lawsuit could not be filed until the first “tax” is collected — in other words, when the first mandate is applied.

The final ruling could have a major effect on the future course of our government and the type of society we bequeath to our children. One hopes it involves care for our fellow man and a more compassionate society.

The lead article in today’s New York Times, “Supreme Court is Asked to Rule on Health Care,” is a gutsy move by the administration to avoid delay and expedite a ruling on the Affordable Care Act after the 11th circuit court held the individual mandate unconstitutional.

Opponents of the ACA have seized on the individual mandate as a focus of their efforts to repeal the law, not because they were opposed to the individual mandate at the time of legislative approval, but because they will do anything to roll back President Obama’s signature achievement.

Taking the rising healthcare costs as a given, the ACA is most noteworthy, in my opinion, because it covers so many formerly uninsured people. I am more than willing to pay a higher premium for the sake of the vulnerable who either can’t afford insurance or were prohibited due to pre-existing conditions from getting any.

In yesterday’s action asking for expedited review by the Supreme Court, the Justice Department noted that other landmark legislation had been challenged in court such as the Civil Rights Act and Social Security Act. In fact, the current suit really represents nothing other than sour grapes from Republicans who lost the legislative battle to stop enactment.

The lead article in today’s New York Times, “Health Insurers Push Premiums Sharply Higher,” documents an effort by the healthcare industry to “get prepared” before President Obama’s Affordable Care Act is fully implemented in 2014.

Insurance companies have enjoyed three years of record profits and, according to consumer advocates, there is no reason to see the frequently double-digit percentage increase in premiums. However, after President Obama’s act goes into effect, companies will have to justify increases of more than 10 percent, plus the increased competition in itself will make it more difficult to raise rates.

Insurance companies do have some other mitigating circumstances. They must now cover children up to age 26 on their parents’ policies and offer certain preventative tests, such as mammograms, with no co-pay. But I do think they need to be reined in regarding these premiums that have doubled since 2001.

New York State already has legislation in place to do something about this for smaller businesses, and its Insurance Department should exercise its authority. Thanks to the sterling record of the Cuomo administration so far, I have little doubt that this will eventually occur.

As the saying goes on MSNBC, healthcare is a necessity for everyone, and it is unfair for corporate greed to play such a prominent role in this field. The New York Times does us a great service by leading with this article today.

The lead article in today’s New York Times, “Medicare Claims Showing Overuse for CT Scanning,” gives a good example of the way oversight can improve medical practices under the new healthcare bill. According to federal researchers, a significant number of hospitals are conducting two CT scans of patients on the same day. The major concern in this occurrence involves unnecessary exposure to radiation when a more measured approach can be pursued instead. CT scans expose patients to approximately 300 times as much radiation as a chest x-ray so doing them twice (700x) involves a major risk.

At major teaching hospitals this practice of double scans is less than one percent — the main concern appears to be community hospitals in rural areas. While the double scans, one often involving the use of iodine as a follow up, are primarily ordered by doctors, hospitals still can implement quality protocols to prevent them from occurring on the same day. And the savings for Medicare can be significant.

While there is no evidence that the double tests are being used to generate additional revenue, they certainly due contribute to our spiraling healthcare costs when other methods can be pursued instead. And given that the health of the patient is our ultimate goal, one hopes that this article in The New York Times will serve a useful purpose.

The lead article in today’s New York Times, “Medicare Plan for Payments Irks Hospitals,” describes a predictable chaffing at the bit by hospitals regarding new requirements to make them more efficient and ensure a higher quality of care. President Obama’s healthcare plan will use a new statistic, “Medicare spending per beneficiary,” to determine payment rates, giving a higher percentage to hospitals with the best and most efficient treatment of patients.

The contention raised concerns a provision to track spending on patients for up to 90 days after they leave the hospital. Hospitals claims they have little-to-no control over this time period, and it is unfair for them to be held accountable for it. The reason for the inclusion of this parameter is to encourage better coordination between hospitals and physicians.

In my opinion, the important thing is to establish any sort of payment formula, and it can always be adjusted subsequent to application, if necessary. I’m pretty sure that hospitals would find some other reason to object to this general requirement because, in effect, they don’t like it in the first place.

The idea of giving hospitals “performance scores” is a good one because it makes some attempt to hold off runaway healthcare costs. Again, the important thing is we’re doing something; the details can always be refined.

The lead article in today’s New York Times, “Health Insurers Profit as Many Postpone Care,” makes me glad the Democrats finally passed national health insurance. The nation’s major insurance companies are raising premiums substantially faster than the rate of inflation despite record profits and a decision by many consumers to forego medical treatments they believe are unnecessary.

Many wonder whether the rapid increase in premiums is based on a fear by many insurance companies about the launch of President Obama’s healthcare act, primarily slated to kick in around 2014 or 2015. One of the most expensive provisions, a requirement to cover people despite potentially expensive pre-existing conditions, may be unpredictable in its effect on private insurance companies.

Still today, many people still suffer from high deductibles; 10 percent of people with employer-based coverage are hit with a yearly deductible of $2,000, and, in these uncertain economic times, that is making them think twice about elective procedures, using brand versus generic drugs and even preventive tests such as a mammography or colonoscopy.

Insurers are claiming that they expect patient demand for procedures to increase again later in the year, but noone knows that for sure, and meanwhile these predatory companies are rolling in cash and increasing rates by double digits to boot.

The lead article in today’s New York Times, “As Vowed, House Votes to Repeal Health Care Law,” describes fulfillment of a campaign promise by Republicans but, in reality, demonstrates their fundamental opposition to government intervention on behalf of the poor and suffering.

The article relates background on the 245-to-189 vote, and the Democrats showed surprising unity with all but three voting against the legislation (the turncoats were Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas).

The Republicans supposed support of certain planks of the health care bill rings hollow as they’ve never passed health care legislation when they were in power. Of course, the Democrats immediately trumpeted these planks including the prohibition against discrimination based on pre-existing conditions, the ability for children to stay on their parents’ plan until age 26 and the expansion of care to 30 million new people.

The passage of the repeal, of course, is symbolic only as the Senate will not even introduce the legislation, and President Obama would veto it in any case. It does, however, represent an attempt by Republicans to take the offense after the assassination attempt against Gabrielle Giffords. The article notes that this will be followed by very real attempts to limit federal spending.

The lead article in today’s New York Times, “Short of Repeal, G.O.P. will Chip at Health Law,” demonstrates a major character flaw in the Republican Party, they don’t know when to quit. The legislative battle over health care has been waged and won by the Democrats. The Republicans should be gracious in defeat and give the new law a chance to work and let Americans evaluate the results.

Instead, they can’t admit defeat and will work to dismantle the law in every way they know how. This includes preventing money for enforcement, going after specific provisions — such as requiring businesses to pay a tax penalty if they don’t offer insurance to their employees — limiting support of the I.R.S. meant to ensure compliance with the law, and much more.

Of course, the Republicans are ignoring popular provisions of the law such as prohibiting discrimination by insurance companies based on pre-existing conditions, keeping children on their parents’ policies until age 26, removing caps on lifetime benefits and the removal of co-pays for preventative health services. Republicans are also threatening to hold investigations about the new law if they gain the gavel by taking over the House.

This is not the way our politics is supposed to work and brings the meaning of obstructionism to a whole new level. The Republicans had their chance to work with the Democrats to shape the healthcare legislation but they chose not to. They should take their lumps and give the legislation a fair chance to succeed.

The lead article in today’s New York Times, “Health Care Overhaul Becomes the Law of the Land; In the Process, Pushing Back at Inequality,” is a news analysis on the broader themes of healthcare legislation. It looks at the bill’s attack on ecomomic inequality and compares it to the trends since Ronald Reagan took power, that is increasing inequality between the rich and the poor.

The article notes that since the 1970′s, the tax rates of the rich have plumetted while their incomes have grown significantly more than anyone else. The healthcare bill, officially known as the Patient Protection and Affordable Care Act, works in the opposite direction. It assists families with incomes under $88,000 to buy insurance while drawing a large part of its funding from those earning $250,000 a year or more.

In doing so, the article notes, this bill has officially signified the end of the “age of Reagan.” That is a good thing, in my opinion, because the United States is not about a class-based society, and it has always been best for our self-image when a rising tide lifts all boats, not leaving major groups of people behind.

Of course, much of the above observations are symbolic. There will be no sudden wrenching of our society, and the sky will not fall as some Republicans would have us believe. This healthcare legislation is more about hope than anything else and a vision for the future.