Wednesday, November 18, 2009

The Health Care Bill is Too Important to Not Read

This week Harry Reid is promising to force a vote on the new 2070 page Health Care Bill. No one has seen it, no one has read it, including those Senators on both sides of the aisle who will be voting on it. Why the rush? Don't we have other issues that are maybe more important to focus on today?

In 1776 The Declaration of Independence was written was debated by committees and was presented to all the members on June 28th, it was left on the table for all to read until July 1st when it was debated by the full body, and with compromise was passed on July 2nd. This was the defining document of our nation, it was one page long.

In 1787 The United States Constitution was written, the Constitutional Convention began May 25th, the Constitution was written and approved to move forward September 17th. It wasn't fully ratified and put into action until September 13th 1788. This was a four page document, and it spelled out how we would run an entire country.

Why the rush to pass a 2,070 page bill that no one has seen? Why is this the single most important thing that we as a nation must focus upon. Are we not fighting two wars, and are teetering ever closer to a possible full blown World War with Iran moving into the mix? Do we not have, depending on whose numbers you study, between 10.2 and 22.6% unemployment with no relief in sight? Wouldn't it be better to focus on those issues rather than trying to completely dismantle and rebuild our health care system overnight when no one knows what the unintended consequences, no less the unintended consequences, will be?

These things we do know:

We learned yesterday what a government run health care will look like when we hear that women shouldn't get mammograms, or even do self-exams any more because the false results are "too costly" on our health care system and aren't worth the lives that those tests save. We will soon hear the same for prostate exams, and others.

We know that this bill will cost somewhere, depending upon whose math you see, between 900 billion and 3 trillion dollars.

We know that if you don't buy government "approved" health insurance that they project to cost a family around 15,000.00/year you will be fined, if you don't pay the fine, you will go to jail for up to five years.

Those things alone should give us pause and should make us demand that our legislators slow down, take their time, read it, digest it. Shouldn't they act like legislators are supposed to and fight it over line by line finding compromises, catching mistakes, coming up with something that will work, while cutting all the payoffs to special interests out?

I don't care if you are a Republican, Democrat, Independent, Libertarian, Green, or whatever, you need to contact your Senator and ask them to please slow down. Take their time, this is far too important for our own health and lives, for that of our parents, and our children to rush through.

This is a list of some of the things that have been found in it so far:

What the government will require you to do:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community health care workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."

These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

For the text of the bill with page numbers, see

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