The healthcare debate has lawmakers at odds, and if you are wondering why Congress can’t seem to get a hold on the issue of medical insurance the simple answer is: it’s not easy. A large part of the healthcare debate is spending, and lawmakers must predict how much money the country’s health system will need in the future.

As said in an article by The New England Journal of Medicine, no one can accurately predict what health care expenditures will be 10 years from now, because they will depend on many factors, every one of which is unpredictable. For instance, what health problems will the country face in 2020? No one knows what the incidence of heart disease, cancer, and other major objects of health care spending will be 10 years from now. The prevalence of obesity may continue to increase or reverse its course. New infectious diseases may appear and become widespread. Equally important, and equally difficult to predict, are advances in medicine, or in economic terms, changes in medical technology. New drugs, new devices, new imaging techniques, and new surgical procedures have had a huge impact on health care expenditures in the past and probably will in the future as well.

And then there is the cost of medical advancements. Some advancements are proven to be cost effective while others are seen as wasteful. But how can Congressional leaders know exactly which interventions to invest in?

Healthcare spending becomes a matter of how much a life is worth. It’s a difficult principle to quantify and even more challenging for lawmakers to govern. So as lawmakers struggle to come to common ground on how to make health insurance more affordable, remember, it’s no easy fix.

Healthcare reform is a very controversial issue. Many people are opposed to the tactics and approach being used by Democrats. One of the main points of contention is the inclusion of a mandate, which requires all individuals over a certain income level to buy health insurance. While supporters consider it a necessary evil in order to expand affordable health coverage to all (since consumers would no longer be able to take advantage of the system by waiting to buy coverage until they get sick, health insurance companies would have no choice but to approve people with pre-existing conditions), Republicans consider it an infringement upon states’ rights.

Several state legislatures have fought back against that provision. Virginia is planning to pass a law that would allow the state to opt out of the individual mandate, by not allowing any entity to require its citizens to buy health insurance. Florida is among the other 32 states–mostly Republican-led–that have considered such a measure, whether through the state government or public referendums.

These laws are likely to cause the issue to reach the Supreme Court. President Obama, who specialized in constitutional law himself, has dismissed concerns that the mandate may be unconstitutional. However, some conservative legal scholars believe that the purchase of an individual health insurance plan does not qualify as interstate commerce that the federal government can regulate.

A new type of medical insurance will soon be available to workers in Portland, Ore. Here is how it works: Participating health insurance plans will offer free health care for certain illnesses such as diabetes or depression. Sounds to good to be true, and maybe it is. There are selected treatments that will cost you pretty big. The insurers have singled out selected treatments that are often overused, including knee replacements, hysterectomies, and heart bypass surgery.

The new insurance is an attempt to control medical spending that continues to rise and impact health insurance premiums.

“We’re trying to make people better consumers,” says John Worcester, head of benefits at Evraz Oregon Steel, the sole employer to sign up since the plans began coming on the market earlier this year.

Workers who choose the option over a more traditional plan next year could see their costs drop sharply if they have one of six chronic conditions but might pay hundreds more in deductibles and co-payments if they need a hip replacement or a heart stent.

Those who support the new plan feel it will improve health and reduce medical costs. However, critics warn the plan will limit access to certain medical services. People who are advised to have one of the overused treatments will be discouraged from them due to the high costs. The plan could have an adverse affect of hurting individuals instead of helping them.

Medical imaging tests are an innovation that have helped many people catch diseases before they spread and improve their health. However, they have caused health insurance rates to skyrocket over the past two years.

There are several factors responsible for the 20% increase:

• Investment in expensive new machines, such as digital mammography machines
• More imaging tests being performed in hospitals, instead of cheaper freestanding clinics, which are up to twice as expensive
• An increase in the number of tests performed by doctors
• Hospitals substituting tests with higher reimbursement rates (e.g. CT scans) for ones with lower reimbursement (e.g. X-rays)
• Hospitals increasing prices for the same treatments

Health insurance companies often require pre-authorization before paying for medical imaging, but they often pay high rates when it is approved.  They pay significantly higher amounts to hospitals that perform digital mammograms as opposed to standard film mammograms, even though the former have not yet proven to be more effective. Doing so encourages hospitals to encourage such tests, even when it may be wasteful.

The cost is then passed onto patients through their health insurance plans.

Some Republicans are trying to figure out why the media is pushing Obama’s deadline for passing the healthcare bill.

In an article on conservative website FOX News, critics say journalist are falling for Obama deadline to pass healthcare by March 18th.

Republicans say President Obama has been fighting and losing the health care reform battle since he first took office. In fact, his only major legislative victory was the passage of the $787 billion stimulus bill. After that, the American people were more afraid of his passes than they had been of Bill Clinton’s. Voters wouldn’t let him pass anything and it showed. His popularity dropped. The Democratic Congress’s popularity dropped even further and health care reform went from blockbuster to disaster flick.

But, the fact that journalists are pushing the March 18th deadline may be an indication of their support for the health bill. Perhaps it is a way of expressing hope for passage of Obama’s plan. And while Republicans feel Americans are not backing healthcare reform this probably isn’t the case. Many Americans have been mislead by opposition and are confused about Obama’s plan for affordable medical insurance, but they are not against it.

Those without good health insurance want the President to fix the system and those with healthcare want to keep their good health insurance and pay cheaper rates. The truth is most Americans want a healthcare industry that doesn’t cherry pick who it ensures. Generally speaking, people want a healthcare system that cares for the sick, eliminates special interest and money hungry health insurance executives.

So when the president — and the media — and the uninsured tell us health care reform must happen right now, it’s fair to wonder why many Congressional leaders– have not answered.

New Massachusetts Senator Scott Brown has largely stayed under the radar since his election in January, although the impact of his win has reached far and wide. With 41 seats in the Senate, Republicans can now use the filibuster. The Obama administration has now resorted to pushing for budget reconciliation to avoid that and pass affordable health insurance reforms.

Brown thinks that wouldn’t be a smart move. He sees his victory as a message America is sending to Washington: kill the current bill. Whether or not the newly proposed changes (which include a handful of Republican proposals) are any more appealing to him than the bill he previously ran against is unknown, but the process by which they would become law appears somewhat unseemly. According to Brown, his state will be especially hurt, largely because there has already been Massachusetts health insurance reform–they’ll be subsidizing other states that didn’t take those steps, when it should be each state’s individual decision. Like many GOP politicians, he believes that Democrats will face massive losses in the fall elections if they go it alone and ignore their wishes.

President Obama has said that healthcare reform can’t wait, and that he is willing to be a one-term president in order to achieve the goals that he feels have been neglected by previous administrations. Do congressional Democrats have the same lack of self-preservation?

Student loan reform may work its way into the healthcare bill. President Obama has proposed student loan reforms, which would slash subsidies the government gives loan companies like Sallie Mae, would save the government billions of dollars — a critical point given the health care debate has largely come down to arguments over cost savings.

Republicans and Conservative Democrats have expressed concern over the costs of the health bill. Some Democrat leaders who are on the fence about the bill are waiting to see how much money the bill will save businesses, insured, and the government. Leaders are now putting together a compromise version that should make health insurance more affordable. However, details on cost savings are still being worked out.

If President Obama is able to provide medical insurance to millions of Americans and at the same time pass student loan reform, it could give Democrats a clear political victory to pass reforms that would help the uninsured and also thousands of students across the country who last week protested rising higher education costs.

Did you know that many health insurance companies don’t bother to look into the details of many reimbursements? While the number of health insurance plans denying claims and leaving patients with the whole cost is more widely publicized, the other side of the coin is insurers who fail to catch obvious waste.

Some experts state that a health insurer may not bother to look into claims under $100,000. That means that thousands of dollars can fall through the cracks, and those numbers can add up. A woman with Georgia health insurance used one IV bag during a two-hour emergency room visit, yet her insurance company was charged $4,000 for 41 bags. The insurance company initially paid the amount in full!

Why do hospitals overcharge? Sometimes it’s a simple billing error. Quite frankly, many do it because they can. Most Americans have health insurance, and health insurance providers tend to ignore small expenses. Meanwhile, public health insurance provides lower reimbursement rates. They increase the sticker price less severely for uninsured patients, though they are still affected.

As an informed consumer, you should report potentially wasteful medical expenses, in order to save yourself money on health insurance rates in the future. Beware that they can be hidden in the bill statements.

The health industry is taking more heat today. Health and Human Services Secretary Kathleen Sebelius called them out, telling executives they need to choose between short-term profits and a “sustainable health insurance market.”

Sebelius told members of America’s Health Insurance Plans (AHIP) to consider what customers were going through. “Can you blame them for thinking the system’s broken when their health insurance – which is supposed to protect them from exorbitant health costs – still forces them to pay thousands of dollars out of their pocket each year?”

White House officials have been mounting pressure on insurers in recent weeks. They are calling for medical insurance executives to release details on skyrocketing premium increases. Officials want to know where the money is going and how much of it is actually covering medical costs.

Sebelius says health insurers are working against Obama’s healthcare overhaul. Insurers have millions of dollars set aside to launch ads against health care reform legislation. “You can choose to continue your opposition to reform,” she said. “If you do and reform goes down in defeat, we know what will happen. By next March, premiums will be taking an even bigger bite out of Americans’ wages.”

President Obama has been working to rally support from Americans, and it’s working. Thousands gathered in downtown Washington to support his plan for healthcare reform.

About 5,000 people traveled from different parts of the country to participate in the march. Protesters criticized the health insurance industry and addressed increasing premiums. President Obama is citing such increases as the reason healthcare reform is desperately needed.

The rally comes at a time when Republicans warn that Americans don’t want Obama’s health bill to pass. Republican strategists have said that if Obama overhauls the system, Democrats will pay the consequences in the upcoming November midterm elections.

President Obama says he doesn’t know how the move will play out politically but that Americans are waiting for lawmakers to finish what he started, end a year of legislative struggle and enact legislation ushering in near-universal medical insurance coverage for the first time in the country’s history.

White House officials expect to pass the health bill by March 17th.