HR 3200: The House version of reform
There are currently five or six different bills about healthcare reform pending in the U. S. House of Representatives and the Senate. Recently, an e-mail smear was circulated about HR 3200, one of the main bills in the House awaiting a vote. The e-mail warned about the rationing of health care and government takeovers of the smallest details of our lives.
The one I received surely sounds dire. Either our Legislators have completely lost their minds (which is what it sounds like), or this e-mail is full of nonsense. Given that I sometimes wonder if our legislators have lost their minds, I decided to find out which it was. So I read it carefully, along with the Bill itself.
This web site is my response, item by item, in case you, too, are wondering. It is my personal effort to fight the smears and spread the truth about reform.
I have followed the discussion on reform pretty closely, and I’ve been involved in the “system” for a long time, so I’m hoping I understand the issues that are being addressed in the Bill well enough to explain them here.
If you don’t support the Bill, that’s your right in our democracy, but you can’t make a reasonable decision if you don’t know what the Bill really says. And the e-mails you’re getting aren’t telling you what it really says.
Here is a link to the Bill, if you want to read it as we go along.
In my discussion here, the orange print is the e-mail author’s statements about the Bill. I’ve cut and pasted them directly from my e-mail.
The black print is my comments.
The blue print is quotes taken directly from the Bill itself, so that you can compare it with what the e-mail claims it says. The green are links to more information about health care. You will also find these links in the sidebar at the top of the page.
Personal examples illustrating the underlying reasoning behind the provisions in the Bill will be given in purple. If you already get the idea, you can skip these sections.
After I go through the e-mail, I will review some provisions in the Bill that he skips over. I’ll be adding them to a separate page on this website in a day or two.
To begin, the author of the e-mail smear states the following:
Reviewed, revised and adapted on July 29, 2009, by Liberty Counsel from the original authored by Peter Fleckenstein and posted on FreeRepublic.com and his blog.
And here he begins his concerns:
Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”!
Here is the actual quote from the Bill itself:
There will be ongoing monitoring of the entire plan to assess “the extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure.”
This quote is from a section about a Commission that will be organized to study the effects of the total health care plan on small businesses and the overall health care delivery system itself. If it is hurting small businesses and forcing them to opt out of the proposed system, they want to know, so that they can improve it. They want everyone buying into the main system, if possible. That will lower costs for everyone.
One of their concerns is that if some companies opt out and “self insure,” it will raise the cost for others in the “insurance exchange,” the place where everyone else gets their policies. They want to design this so that all employers will find benefits to join the exchange instead.
When businesses "self insure," that means that they create their own insurance plan. They pay for their employees’ health care directly from the company. They don’t pay premiums to a big insurance company. They do have to have plenty of money available to cover their employees, if someone gets really sick.
As a provider, I deal with several of these. Because they’re very small organizations, humans actually answer their phones! which I find quite refreshing. Some of them are good policies. Some are better than the big plans. Some are very inadequate, and are disappointments to their employees, who, however, have no choice in the matter.
This new Bill would give employees a choice. You will no longer have to remain with the policy your employer chooses for you, if you don’t want to.
Sec. 122, Pg. 29, Lines 4-16 – YOUR HEALTH CARE WILL BE RATIONED!
The Bill doesn’t say anything about rationing. This section of the Bill refers to what services must be covered in any policy, and what the cost-sharing responsibility (that’s you) will be. Cost sharing refers to the insured, not the insurer. He makes it sound like it’s the insurer who will be limited to spending certain amounts, i.e., rationing. Not so. What the Bill says is this:
1. There won’t be any cost to the insured for preventative services, things like mammograms, PSA tests, bone density tests, colonoscopies,etc. They want to require private insurance companies to provide these services with no co-pay so that you will be more likely to obtain them. It saves the whole system (and you) money in the long run (not to mention, saving people’s lives).
2. Cost sharing for the insured will be limited to $5000 a year per person, or $10,000 a year per family.
That means that no individual or family will have to pay more than that. That will increase slightly each year (by $100) to keep up with inflation.
IN OTHER WORDS, FOLKS, this is not about rationing. It’s about families being protected from having to go broke or file bankruptcy because of health care bills. Uncle Sam (if you let him) will be requiring the insurance companies to give you bang for your buck.
But that’s the catch in a democracy. You have to let him. (And to make those choices, you have to know the truth).
• Sec. 123, Pg. 30 – THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get.
There will be a committee made up of people from various health care contexts, including researchers and providers, that will be making recommendations to doctors about what treatments are most effective. They will NOT BE MAKING RECOMMENDATIONS TO INDIVIDUAL DOCTORS FOR INDIVIDUAL PATIENTS (as they do currently in some private Managed Care companies)!
Let me give you an example. When I had ovarian cancer, the recommended treatment was six chemo sessions, three weeks apart, with a combination of two particular chemicals. I was concerned that only six chemo treatments were recommended. It didn’t sound like much to me, when I had a very advanced stage cancer. Why was this the recommendation? Because this is what clinical trials in cancer centers all over the country found, over time, was most effective for the most people with my type of cancer. Because of that research, this is what treatment they must provide in all cancer centers around the country that are official approved "cancer centers", until they find something that works even better (so we’re already doing this with regard to cancer).
My family doctor from my childhood (the one who delivered me) (he was 95 at the time) was a bit troubled by this (every patient he’d ever had with ovarian cancer had died. Six treatments didn’t sound like much to him, either). His son ( a doctor, too) explained it to him. This is how medicine is done these days. Through research, from which “standards of care” are decided. In Dr. McQuarrie’s time, they had no choice. There was very little research. They had to make educated guesses and wing it. For most things today, we don’t have to do that.
It does mean that unproved treatments won’t be paid for, unless they are part of a clinical trial. But they already do that. That’s nothing new.
It will probably also mean things like this: people who have blood glucose levels that are rising might have to be told by their doctors that they can turn that around with diet and exercise. Doctors might have to explain and encourage life-style changes instead of just giving pills and scheduling another checkup in a month.
There’s an interesting book called The China Study (which is actually not mostly about China, it’s about nutrition and disease around the world) by Colin Campbell, M.D., a renowned nutrition researcher. He presents very convincing evidence that our diet causes most of our health problems. He told a colleague of his, "You know, your diabetes patients can get off their medication if they change their diets." His friend reportedly said to him, "What are you trying to do, ruin my business?! My diabetes patients come in once a month for a checkup!" And in this society of obesity, he has a lot of them, so he makes a lot of money from them.
This Bill is trying to change this kind of thing. The effort is to encourage prevention (HEALTH care), rather than allowing the present system of DISEASE care to continue. (It’s also trying to figure out how to pay doctors for success, rather than for seeing patients over and over again for chronic conditions that could actually be reversed or cured with a different approach).
(Note: drug companies, and in the current system, hospitals and doctors, make more money by continuing to let people be sick. If we don’t want to go bankrupt as a nation because of our health care system, we need to change that.)
• Sec. 142, Pg. 42 – The Health Choices Commissioner will choose your benefits for you. You have no choice!
This is another distortion. What this Bill will be requiring, again, is that insurance companies will be required to provide certain basic benefits, like mammograms, PSA tests, bone density tests, immunizations, etc. Whether you make use of those benefits is your choice. Nobody is going to drag you to them. This guarantees that you will have the choice of obtaining certain basic benefits that have been shown to be cost-effective and save lives.
• Sec. 152, Pg. 50-51 – HC will be provided to ALL NON-US citizens.
This doesn’t say a darned thing about Non-US citizens. This is what it actually says:
"Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services."
This is a protection against racism, gender bias, discrimination by age, ethnicity, whatever.
You who are worried that the elderly will not get as good a care as the young, read this! This protects them! Similarly, have any of you heard that women are not getting the same quality health care as men for heart disease? Doctors have not historically recognized heart disease symptoms in women because it was more common in men for years. That is changing now that women are in the work force and under more stress. Doctors need to become more alert to this.
A 44 year old friend of mine didn’t feel well at the office one hot day and went to Immediate Care. They gave her some Gatorade, and sent her home. She died that night of a heart attack. Would they have treated a man who had the same symptoms in the same way? This clause tries to protect people against this type of discrimination, whether intentional or not.
Also, millions of Non-US citizens will probably also be treated. We have millions of immigrants who are here legally, who are not yet citizens, who work and pay taxes, who will also be required to have insurance in this program, who will receive health care. Most of us descended from such folks.
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Sec. 163, Pg. 58-59 beginning at line 5 – Government will have real-time access to individual’s finances & a National ID health care card will be issued!
This is what it actually says:
" …enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;"
Even back in the 70s, at the community mental health centers, we got copies of people’s pay stubs to determine their level of payment. In those days, everyone (yes, EVERYONE) could get mental health care at the local mental health center, on a sliding fee scale. But yes, you can’t just go in and say, "I want to pay $5 a visit," when you make $100,000 a year. You have to provide evidence of income. We’ve been doing this for decades. It’s nothing new or terrible. What they mean about real-time access to a person’s finances is that they have to produce a pay stub from the last month or so, not five years ago.
This clause is also meant to reduce fraud. People have been known to use other people’s health insurance. Someone apparently used another person’s Medicare card for $250,000 surgery. This is not cool. It robs the system and makes it difficult to provide services to people who have a right to it. Because of those people who have robbed the system, a new law went into effect May 1st that when insurance is used, we have to get a photo ID for our records. If we don’t and we’re audited, we’re in trouble. Yes, it’s more regulation. But because of fraud.
When somebody comes for service, they have to produce proof of coverage, or agree to self pay. It’s nothing new.
Everyone who has health insurance has a health care ID card. It’s nothing new, either. Where has this guy Peter been, who allegedly wrote this e-mail?
The rest of that whole section is about streamlining paperwork to increase efficiency. A great idea. I hope they mean it.
• Sec. 163, Pg. 59, Lines 21-24 – Government will have direct access to your bank accounts for electronic funds transfer.
The Bill is primarily talking about electronic funds transfers to providers from third parties (insurance companies and Medicare and Medicaid). This whole section is about record keeping (by providers) and payment (to providers by health insurance companies) . At present, it is extremely inefficient. This is a move towards efficiency. Medicaid and Medicare already pay by electronic funds transfer. Social security also does it for beneficiaries. It’s handy, isn’t it? It saves you from having to go to the bank to deposit your check. It also saves a lot of paper and clerical time on the part of the people who send those checks.
When we submit Medicaid claims, if they go in before Friday, “checks” are cut the next Wednesday, and they are in our account, electronically, the next Friday. NO OTHER THIRD PARTY IS THAT EFFICIENT. If there is a glitch with Medicaid, we can e-mail the local liaison person, she will check on why the glitch happened, getting back to us by the next day, we fix it, resend the claim, and are paid the next week or two. Other companies typically take three to four weeks to pay us in the first place, if there are no glitches.
If there are glitches, heaven help us. We call, we try and get a human to help us, sometimes we get one, sometimes we don’t, we try and figure out where to write to if we don’t. Often we are told to rebill and when we do, weeks later we get a denial saying, “Sorry, this claim has already been processed.” We call again, and so forth. This can go on for months. Sometimes it takes months and months to get paid. I honestly believe that some companies set their systems up so that we’ll just give up.
The government programs are much more efficient. They actually pay for what they say they’ll pay for. Electronic payment is great. It helps everybody in the system. It saves paper, trees, administrative costs, etc., keeping costs down. Which keeps your premiums down.
• Sec. 164, Pg. 65 is a payoff subsidized plan for retirees and their families in unions & community organizations (ACORN).
Here’s what it really says (ACORN and community organizations are not mentioned–he just puts that in there to get your dander up.):
“Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the ‘‘reinsurance program’’) to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees.”
Yes, this is a government subsidy plan. Note that it says “temporary.” It’s for companies like Chrysler. You know, those companies that are going bankrupt, laying off thousands of people, closing their plants, etc. They are going broke because of their commitments, made 30-40 years ago, to their future retirees to provide them with health care.
They are having to pay HUGE health care costs for thousands of retirees (plus their current employees), and with health care costs going up so fast, they can’t afford it anymore. This is another government bailout to save those companies, to save jobs, to save the economy. None of these companies could have predicted how much health care costs would go up.
So yes, this is a government subsidy. It’s a subsidy to the companies that, for better or for worse, keep our economy humming. The alternative is to lay off thousands more people, close more plants, have more companies go bankrupt, or, increase the cost of automobiles a whole lot. Take your pick.
It is temporary because these companies are renegotiating their retirement packages and eliminating this perk, so in a few years, there won’t be any more retirees they’ll be paying health insurance for. They’ll all be on Medicare, or buying their own policies if they don’t qualify for Medicare.
Meanwhile, if we don’t want to help these companies, we can just buy Toyotas instead. They don’t have this problem because they didn’t make those commitments to pay their retirees’ health care. That’s one of the reasons they’re doing better financially.
• Sec. 201, Pg. 72, Lines 8-14 – Government is creating an HC Exchange to bring private plans under government control.
It does not say that it is doing this to bring private plans under government control. This is another distortion.
The purpose of this provision is to make a larger variety of health care plans available to everyone. Right now, there are strict limits on which policies people can access, much more strict than for auto insurance. We can buy auto insurance from any company in the US. Not so with health care. We have to buy within our state or within the state that our business is based in, or companies that are licensed in our state….etc.
Again, this is a protection for individuals, and small businesses. Here’s what it really says:
“(a) ESTABLISHMENT.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.”
Does that "bring private plans under control?" Probably, somewhat, because they will have more competition. This Bill is trying to preserve the free market for health care. They believe that more competition will bring costs down. They also believe that if EVERYONE buys into the system, it will bring costs down.
This plan allows for a public option for people who can’t afford the private insurance–which, I must remind you, has to pay for huge CEO salaries, TV ads, campaign financing, lobbying, nice little perks for their employees, and profits, in addition to health care for their consumers. Those who believe in health care for profit and want to pay for all of these extra costs will still have plenty of companies to choose from. Those who don’t, or who want to save some money, can buy the public option.
Sec. 203, Pg. 84 – Government mandates ALL benefit packages for private Health Care plans in the exchange.
What the bill says is that each insurance company has to offer a basic economical plan, which will typically have a higher cost share for the insured than a plan with more coverage. That’s how things work now. No change there.
If they offer the basic plan, then they can offer an enhanced plan, and if they offer an enhanced plan, they can offer a premium plan, and if they offer a premium plan, they can offer a premium plus plan. They can’t just offer a premium plus (expensive) plan without the more economical plans. That’s all it’s saying.
It is a protection for us, the people.
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Sec. 203, Pg. 85, Line 7 – Specifications of benefit levels for plans means that the government will define your HC plan and has the ability to ration your health care!
Again, this is not what this says. It is about giving the consumer the freedom to choose the level of coverage he or she wants. It is all about choice, not about the government deciding which plan you choose, or “having the ability to ration your health care. “
Private plans already ration your health care. Since Managed Care started about 15 years ago, they’ve been rationing it more than ever before .
We have fought hard as a nation to STOP the private companies from rationing in a way that costs people their lives. This Bill is an effort to improve care, not make it worse.
Sec. 205, Pg. 95, Lines 8-18 – The government will use groups (i.e., ACORN & AmeriCorps) to “inform and educate” (sign up) individuals for government plan. .
This is what it really says (Note: ACORN and Americorps are not in there. Again, he’s trying to get your dander up.)
“(1) OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.”
The section c referred to above says this:
“ENROLLMENT INFORMATION.—The Commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process, including before each open enrollment period. In carrying out the previous sentence, the Commissioner may work with other appropriate entities to facilitate such provision of information.”
In other words, there will be places where people can go to get information about how the new plan works and what is best for them–just as there is now to help Medicare recipients to choose a drug plan that is best for them.
It doesn’t say anything about “signing people up” for the public option.
The authors of this Bill are our legislators whose campaigns were paid for, in part, by the private insurance companies. They are very busy protecting those companies in this Bill. It is quite obvious. They’re not pushing the public option. They put it in because most of our citizens want a public option to bring costs down.
I
mean really, folks. Even on my own (Republican) senator’s web page, there was a paragraph something like the following: “I don’t support a public option because I don’t want some bureaucrat making health care decisions, rationing our health care or limiting the choice of doctors people can see.” I wrote to him, quoting the section, and asked him if he really believed that we did not have all of that right now with Managed Care. Those things have been HUGE problems with Managed Care (private insurance companies), and we’ve had to fight like dogs to get some of them changed a little bit. (He’s since taken the paragraph off of his website. It was clearly misleading nonsense and I’m sure he knew it.)
Sec. 205, Pg. 102, Lines 12-18 – Medicaid-eligible individuals will be automatically enrolled in Medicaid. No freedom to choose.
This, again, is a distortion. This is what it really says.
“ AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.”
Emphasis mine. Notice: they had the option of enrolling in a private plan and chose not to.
People who get sick who do not have money (that is, people who are eligible for Medicaid) and do not have insurance, cost everyone else a lot of money. Hospitals have to treat them anyway if they receive any federal funding, which most do. That means that other people (you and me) are charged more to cover the costs of the uninsured. This is an effort to fix that problem. Note: Medicaid is free to people who are eligible for it. The government will be paying for their health care, without charging them a premium–because they don’t have any money. They are just putting them on the books so that when they show up at the emergency room, the hospital will be able to bill for their care.
Sec. 223, Pg. 124, Lines 24-25 – No company can sue the government for price-fixing. No “administrative of judicial review” against a government monopoly.
There’s no government monopoly here. A government monopoly would be a single payer government plan. This is a Bill that preserves, for better or for worse (some people think for worse) your right to choose from a large variety of private plans OR a public option. There are hundreds of private health insurance companies in our country. That’s hardly a monopoly.
Sec. 225, Pg. 127, Lines 1-16 – Doctors – the government will tell YOU what you can make. “The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year.”
It doesn’t say anything about fees here, it just says doctors will be paid, period. However, in case you didn’t know, all third parties (government and private) have been telling us for years what they’ll pay us. This is nothing new.
What annoys me is that they don’t also “negotiate” lower payment schedules for drugs. It is discriminatory to limit what doctors can charge, but not limit what the drug companies can charge, and I hope that changes in this Bill. (Ah, I see, as I read on, that it does.)
Sec. 312, Pg. 145, Lines 15-17 – Employers MUST auto enroll employees into public option plan.
Not true. Above lines 15-17 it says this:
“(1) OFFERING OF COVERAGE.—The employer offers the coverage described in section 311(1) either through an Exchange-participating health benefits plan or other than through such a plan. Lines 15-17 say this:
(4) AUTO ENROLLMENT OF EMPLOYEES.—The employer provides for auto enrollment of the employee in accordance with subsection.(c)
Subsection (c) says this:
The requirement of this subsection with respect to an employer and an employee is that the employer automatically enroll such employee into the employment-based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium.”
It says the employer must provide coverage one way or another, not the public plan, unless they choose it. It also says (he forgets to mention that here) that the employer will not necessarily have to pay the full cost of the premium, if the business income does not make this possible. There are percentages outlined that are acceptable.
With regard to the employer enrolling an employee in any particular plan, it says this:
“OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.”
More choice for the employee than now. Not less. The employee can opt out of the public plan even if the employer or other employees choose it. He or she can opt out of ANY plan the employer chooses.
The way it is now, if an employer decides to change plans, which they have the option of doing annually, the employee has to go along. This usually means new networks, different doctors, different coverage, etc.
This bill will allow them not to have to change plans if they don’t want to.
It’s really disruptive when a patient’s coverage changes in the middle of their care. Everything has to be done all over again (we have to call the new company, find out what the coverage is, what the patient’s new co-pay will be, etc.) It’s a time waster. And often, the new policy doesn’t have the same coverage (that’s why they usually change. They find a cheaper plan. Cheaper usually means less coverage.) So suddenly, the patient in the middle of a course of treatment, who thought he/she knew what the cost was going to be, isn’t covered that well anymore. That will be changed.
Sec. 313, Pg. 149, Lines 16-23 – ANY employer with payroll $400,000 and above who does not provide public option pays 8% tax on all payroll.
First, nowhere does it say that the employer has to enroll employees in the public option. But they do have to provide something towards their employee’s insurance. If they don’t, they are asked to pay into the system @ the rate of 8% if the business makes over $400,000 a year.
If everyone pays into the system, it makes the average cost per person much lower. That’s why it’s critical for everyone to participate. They are trying to lower costs for everyone. People have to cooperate with this, or costs will not be lowered.
We (most of us) abide by the law that requires us to have auto insurance, because when everybody didn’t have it, it cost more for those of us who did, especially if there was an accident. We can also cooperate with each other to make health care work better and cost each individual less.
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Sec. 313, Pg. 150, Lines 9-13 – Businesses with payroll between $251,000 and $400,000 who do not provide public option pay 2-6% tax on all payroll.
Again, not true. Businesses with payroll between $251,000 and $400,000 will be taxed if they don’t provide some kind of insurance. It doesn’t have to be the public option.
Sec. 401.59B, Pg. 167, Lines 18-23 – ANY individual who does not have acceptable care, according to government, will be taxed 2.5% of income.
Correction: They will be taxed 2.5% over and above their modified gross income (whatever that means), not to exceed the amount of the average premium paid by someone else with their income in their region of the country. This means that if they don’t voluntarily choose a health care plan, the government will charge them anyway, an appropriate premium rate. Why? Because if they end up at the hospital, it’s only fair that they have paid into the system that is going to be taking care of them. Currently, when an uninsured person is treated at the hospital and can’t pay his or her bill, you and I pay, with higher charges on our bills. This is an effort to change this. Just as they made a law years ago that everybody had to have auto-insurance, because the people who didn’t were costing everyone else a lot of money. It’s the same issue.
Sec. 59B, Pg. 170, Line 1 – Any NONRESIDENT alien is exempt from individual taxes. (Americans will pay for their health care.) .
This is another lie. The term “Nonresident alien” is a person who is in the country temporarily, but legally, such as students whose families pay their way, teachers, trainees, or exchange students who are sponsored by organizations. Depending upon their Visa type, they are required to have insurance unless they clearly have the means to pay for their own health care (many students who come here are from wealthy families abroad).
They are not exempt from individual taxes. They are exempt from the 2.5% penalty tax described (in black) in the section above–i.e., enough to cover a health insurance premium–because they have provided evidence, in obtaining their visa, that they have insurance or the means to pay for health care. Links:
Sec. 431, Pg. 195, Lines 1-3 – Officers and employees of HC Administration (government) will have access to ALL Americans’ financial and personal records.
Again, this is distortion (have you noticed that every single one of these claims is a distortion or outright lie? I hope you’re getting the picture here.) (You should ask yourselves why people who send this nonsense around have to lie.)
What it says is that Americans who expect a reduction in the amount that they have to pay for health care (not ALL Americans, as he claims) have to show that they deserve such consideration, by handing over their tax returns, which can only be used for the purpose of determining whether they deserve the credit towards their health care.
We already do this. We do it for property tax reductions, Medicaid eligibility, etc.
Again, people can’t just go in and say, “I”m poor, I deserve to pay less.” They have to show evidence and meet certain criteria.
Sec. 441, Pg. 203, Lines 14-15 – “The tax imposed under this section shall not be treated as tax.” Yes, it says that.
But he didn’t finish the sentence. Here’s what it says:
“The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.’’
If people are poor, they’ll receive a credit (that is, a reduction in their premium) when determining what they owe. It will be calculated on their whole income, not their income minus the penalty tax. That is to their advantage. It means they get a larger credit.
Sec. 1121, Pg. 239, Lines 14-24 – The government will limit and reduce physician services for Medicaid. Seniors, low income and poor are the ones affected.
They will be studying which services provide value in terms of health care outcomes, and which do not, and trying to adjust to improve value. In other words, yes, they might be eliminating certain services, namely, the ones that aren’t doing any good.
This is different from when they cut programs in the 70s (more about that below). Then they cut them whether they worked or not. Here, they’re just trying to trim the ones that aren’t worth the money.
Sec. 1121, Pg. 241, Lines 6-8 – Doctors, it does not matter what specialty you have; you’ll all be paid the same. “Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”
The service categories they are talking about are, specifically, “evaluation and management,” and “preventative services.” This does not include things like surgery, which are special skills.
A few days after I broke my arm two years ago, I had to see a surgeon (or so I was told by the ER folks) to see if I was going to need surgery to set it properly. He charged me something close to $200 for a 10-15 minute evaluation, (he looked at my arm and saw that I could move it well, it wasn’t swollen anymore, it didn’t hurt as much). My family doctor would have only charged about $75 for the same service, but could have just as competently offered an opinion about whether I needed surgery (I didn’t). I wish I had figured that out beforehand, but hey, you’re told to see a surgeon, you see a surgeon.
This way of paying for services isn’t fair, i.e., paying a surgeon more just because he’s a surgeon, and paying a pediatrician or family practitioner less, just because he’s not a “specialist.” It’s making it extremely difficult for general practitioners and pediatricians to make a living. Here in our community, a pediatrician left several years ago, after the beginning of Managed Care, because he was struggling to make more than $40,000 a year. He wanted to spend more than 5 minutes with each patient. (When fees are lowered, you have to see more patients to pay the same bills….your bills don’t change, just your income does. So most doctors spend far less time with each patient than they used to). He moved to a salaried position in a big city.
This has become such a problem that students in medical schools are almost all going into specialties, not the general practices. We aren’t going to have any physicians in general practices (pediatricians and family practitioners, OBGYNs, geriatric specialists, etc. ) if we don’t do something to change this and balance things out. This is an effort toward that end.
As you’ll see below, surgeons will still get paid more for doing surgery, which is a more highly skilled and high risk (note: lawsuit vulnerable) venture.
Sec. 1122, Pg. 253, Lines 10-23 – The government “validates work relative value units” (sets value of doctor’s time), professional judgment, methods etc. (defining the value of humans).
This is what they actually say (it speaks to the issue just discussed above):
‘‘(ii) COMPONENTS AND ELEMENTS OF WORK.—The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and intra-service components of work.”
This is what they are talking about here: They are trying to adjust the present service codes (codes that we put into our claims to get paid properly) to more accurately reflect what the doctor actually puts into the service, in terms of time, energy, skill level, etc. Somebody who is on his or her feet for 8 hours doing complex and risky surgery (for which they pay a fortune in malpractice insurance) is going to get paid more than someone evaluating blood tests or looking down your throat. Makes sense to me. But when that surgeon is evaluating blood tests or looking down your throat, he or she going to be paid the same as other doctors, not the higher fee that surgeons can now charge. Surgeons will surely make less than they do now. Hopefully, pediatricians and general practitioners will earn more, so that we will continue to have some.
Sec. 1131, Pg. 265 – Government mandates and controls productivity for private HC industries. “Incorporating Productivity Improvements into Market Basket Updates that Do Not Already Incorporate Such Improvements.”
They’re talking about having one provider or group of providers that is doing something less expensively (and more successfully, with better outcomes), like the Mayo Clinic (where doctors have apparently developed an approach that is more cost-effective, with better patient outcomes), share those methods with other groups and regions around the country so that they can do likewise. One sector learning from another to improve care and decrease costs.
Terrible idea. Just terrible. 
What this is actually doing is encouraging innovation and creativity so that things work better and cost less, and promote the sharing of ideas about how to give the same or better quality care for less money.
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Sec. 1141, Pg. 268 – The government regulates rental and purchase of power-driven wheelchairs.
It’s about time. This is a frequently abused, costly and fraud-ridden service provided by Medicare. Someone reportedly actually managed to sell the very same chair to hundreds of people and get paid for it by Medicare before they were caught. (People never got the chair, obviously).
But actually, The Bill doesn’t say this. It is revising certain words in the former bill governing Medicare, and without reading that bill at the same time, it all sounds like gobbledegook. Impossible to tell what they’re talking about.
But for whatever it’s worth, my 91 year old quite feeble mother who is mostly wheel chair bound has a regular old (very old) wheel chair that she gets around in. The leg and arm movements that she has to do to get around are the only exercise she gets. I see a lot of people around who look a lot stronger and healthier than she is who are zipping around in their power-driven wheel chairs. They cost a lot more than a regular wheel chair (about five times as much), and the profit margins are obviously greater, or you wouldn’t see them being advertised all the time on TV.
These chairs were created and intended for people who can’t move a regular wheelchair. Many of the people who have them could use a regular wheel chair, and would quite possibly be better off if they got more exercise moving a wheel chair around with their own muscles.
My mother could probably qualify for one. She refuses to even ask because she believes that they are a waste of Medicare’s money. (We need more people who think like that).
Sec. 1145, Pg. 272 – Treatment of certain cancer hospitals: Cancer patients and their treatment are open to rationing!
(There’s that nasty word again. He likes that word “rationing”.)
The Bill doesn’t say that at all. What it says is that if one hospital is spending a whole lot more on cancer treatment than another hospital, per patient, without improved outcomes, the more expensive hospital is going to have to make adjustments.
They have learned, for example, that some hospitals in Florida do a whole bunch more CAT scans on their cancer patients with no better outcomes. Mind you, hospitals make money when they do those tests. They’re going to have to cut down to only what they need to provide treatment.
This doesn’t say anything about denying cancer patients treatment they need to get well, maintain or be comfortable. It means they’re going to be auditing treatment centers that are costing a lot more than other ones, without improving outcomes, find out why, and have them make adjustments to keep costs down.
Remember, in this “fee for service” system that we have, doing more makes you more money. But doing more doesn’t necessarily provide better outcomes. We’re trying to change that to save the system money. We’re also trying to figure out how to pay doctors for success, rather than for “more.”
Sec. 1151, Pg. 280 – The government will penalize hospitals for what government deems preventable readmissions (incentives for hospital to not treat and release).
It is obvious when reading the bill that there has been a problem with some hospitals having excess readmissions while others have not. Are they making mistakes, misdiagnosing, discharging people too soon? Who knows? They’re trying to cut down on that because it’s costly. They will identify the hospitals that have significantly higher rates of readmission, and find out why, so they can fix the problem.
• Sec. 1156, Pg. 317, Lines 13-20 – “PROHIBITION on physician ownership or Investment.” Government tells doctors what/how much they can own.
No it doesn’t. It tells them how much percentage they can own of the hospital they refer people to. Conflict of interest. If you own the hospital and are making money when people go to that hospital, you’re not as likely to make decisions based upon the needs of the patient. Example: say there are two hospitals in town, but one has a much better dialysis program than the other one. You need dialysis, but your doctor has part ownership in the other one, so he sends you to that one instead of the one with the best program. That’s what they’re talking about. Doctors have done this kind of thing for years, without patients knowing they have part ownership in the hospital.
• Sec. 1156, Pg. 317-318, Lines 21-25, 1-3 – “PROHIBITION on Expansion of Facility Capacity.” The government will mandate that hospitals cannot expand (“number of operating rooms or beds”).
This is related to the section above. It’s doctor’s investments in the hospitals they refer people to and work in.
• Sec. 1156, Pg. 321, Lines 2-13 – Hospitals have opportunity to apply for exception BUT community input required.
Again, this is related to physician’s financial interest in the hospital.
• Sec. 1162, Pg. 335-339, Lines 16-25 – outcome-based measures. Rationing.
Its not about rationing, it’s about quality control. Outcome has to do with whether the treatment worked or not. If it doesn’t work, do you want your doctor to give you that treatment? Or would you rather he or she give you a treatment that works better?
Sec. 1162, Pg. 341, Lines 3-9 – The government has authority to disqualify Medicare Advantage Plans (Part B), HMOs, etc. This will force people into a government plan.
First, the Bill doesn’t say anything about HMOs. He made that up.
Secondly, Disqualifying some Med Advantage plans won’t force you into a government plan. People can buy a better Med Advantage plan if they want to, or a traditional supplement. The Bill will be increasing the standards for Med Advantage plans and disqualifying the ones that don’t shape up (some do not provide good coverage and are costing Medicare a fortune, which I’ll explain below). Some of the changes they will be asking them to make are consistent with what they’re asking all insurance companies to make.
Other changes include requiring them to provide benefits that are more like what Medicare covers. There will, for example, be limits on out-of-pocket costs for the insured. And there will be limits to how much these plans have to pay for health care, as opposed to administrative costs. That is, they will have to provide good value for the people who buy them. What a concept.
They will be rating all of the plans and publishing those ratings, so that people will know which ones are good and which ones aren’t so good. But to understand why, you need to understand what a Med Advantage plan is.
The medigap (supplemental) plans are all private plans that pay some or all of what Medicare doesn’t pay. Med Advantage plans actually REPLACE Medicare altogether, but many people who buy them really don’t understand that. In fact, our e-mail author doesn’t understand it. He calls them Part B, when actually these policies replace both Medicare A and B. Suddenly, you don’t have Medicare anymore, not for the hospital, not for the doctor. You have private insurance for everything. But that might not be terribly obvious to you for reasons explained below.
When I qualified for Medicare just a few months ago, I had a hard time figuring out how a Med Advantage Plan was different from a Medicare Supplement. When an insurance company sends out advertisements for their Medicare Supplement plans, they typically send ads for both of these types of plans at the same time (and you get a whole bunch of them when you’re old enough for Medicare, without even asking). I finally found a very helpful website that explained the difference, the medicare advocacy site.
Here is my understanding:
Traditional Medicare Part A pays 80% of hospitalization. You get it automatically when you get Medicare, at no charge (you’ve been paying into it for years, with your FICA tax). Part B pays 80% of outpatient services. Traditionally, until 2003, Medicare folks who kept Part B (it is optional) paid their $96 dollars (or so) to the general Medicare fund that we all draw from when we’re sick (it is deducted from our social security check if we choose to keep it). The individual pays the other 20% of both hospital and outpatient care, or buys a private supplemental plan (often called Medigap plans) to pay all or part of the other 20% for both A and B.
These Medigap plans are standardized (read: simple for both consumers and providers to understand). There are only a certain number of types, all with letter codes, A through L, each letter code referring to exactly what coverage they provide (some have larger deductibles than others, etc.) You can choose how much coverage you want. There are simple charts that make it easy for consumers and providers to know exactly what the coverage is. You can see a chart here:
All companies that provide these plans provide exactly the same coverage for each plan. They charge differently, but provide the same coverage. ( They bank on having better customer service than their competitor, I guess.) For these supplements, we pay another premium. Mine is $93 month. So I pay a total of about $189 a month for my health care. $96 of that goes into the general Medicare fund, and $93 goes to the private company that provides my supplement.
Then in 2003 the congress allowed Med Advantage plans into the picture. These plans are provided by private companies, there is a huge variety, just like regular insurance plans (they can create their own combinations of benefits instead of having them standardized, which makes it much harder for both consumers and providers to know what is going to be covered), and very importantly, that $96 dollars that you pay to Medicare out of your social security check doesn’t go into the general Medicare fund, it goes to the private company from which you get your plan (in addition to whatever additional premium you pay the private company). Uncle Sam takes it out of your SS check, but sends it to the private company.
In addition to Uncle Sam sending your Part B payment to these companies, he also sends the company additional money. For some of these plans, the government sends them as much as $600 a month! This is draining the general Medicare fund, and it’s doing it more quickly than if you still had Medicare, because the private plans are not as cost-efficient. How can they be? They’re paying for all those perks, high CEO salaries, lobbying costs, campaign contributions, and profits.
Med-Advantage plans are a government giveaway to the private companies, which are making billions from these plans. (BILLIONS that should be going to HEALTH CARE, not to PROFIT.) That’s BILLIONS being drained from our Medicare fund to increase private profits!
But in reality, these plans do not provide more or better coverage than the original Medicare. They appear to on the surface. They might provide, for example, $100 for dental, which Medicare doesn’t cover, or for vision, which Medicare doesn’t cover. Some of them pay for some medications (but they have very large “doughnut holes” in that drug coverage. That is, they help you for a while, then you pay EVERYTHING for another few months, and then when you’ve spent thousands of dollars, they chip in again.) You do still have co-pays for doctor visits and medicines in most of the plans.
In fact, here’s what was confusing to me and why I looked into it. Part B Medicare pays 80% of a doctor visit. The individual pays the other 20%. That means if a doctor visit is $100, you pay $20 for your copay if you don’t have a supplemental plan. But doctors aren’t allowed $100 a visit for a regular visit. Medicare pays less. So out of curiosity, I called one of my doctor’s billing services and asked what Medicare paid for an office visit. “$83.” That means that my copay, if I didn’t have a supplement, would be $16.
But many Med Advantage plans proudly advertise that if you buy their plan, you will only have a $20 copay for a doctor visit. WHAT? if I buy their “advantage” plan, I’ll have a larger copay than if I have no plan at all! This makes no sense. If I buy a regular old medigap supplement plan, I have no copay at all. So how are these “med advantage plans” an advantage?
Well, they look like an advantage on the surface, because first-off, the premiums are lower than the supplement plans, say $45 a month instead of my $93. Some have no premiums at all. Some pay for some medications. They do the dental and vision bits. So it looks like a good deal on the surface. But many also pay doctors less than Medicare pays. So before you get one, you need to make sure that your doctor is in their “network” and accepts their LOWER THAN MEDICARE fee. Here we go again with networks (read: obstacles created for patient and provider alike, and reduced fees for providers. Good luck learning about what all the obstacles are in your policy).
And just wait until you end up in the hospital or a nursing home. Then you’re out of luck. Your Med Advantage Plan might pay for days 1-3, but it probably won’t pay for days 3-21 (which your regular Medicare and Supplement would have paid). It will pick up after day 21.
How many people stay in the hospital more than 21 days, and how is someone going to be able to afford the hundreds of dollars a day from day 3 to 21? Suddenly you have a several thousand dollar hospital bill, even if you’re only in the hospital for a week or ten days. And then, after that, there is the nursing home, which has a similar payment structure (pays the first few days, but not the next few weeks, and then chips in again if you’re still alive or still there), but you’re likely to be in the nursing home for a couple of months. So if you get really sick, like, have a stroke, you’re going to be paying a lot of money yourself. Thousands and thousands of dollars.
Not so with a traditional supplement plan. If you have original Medicare and a supplement, everything is paid for except the deductible you chose in the beginning (mine is $135 a year). EVERYTHING (up to 100 days, which, it turns out, is adequate for most serious illnesses). Suddenly my $93 a month is a really good deal. I’m paying less than $2400 total a year for anything less than total disaster requiring care for more than 100 days (for which we need long term care insurance). My costs will most likely never be more than that. Drugs, of course, are additional. Personally, I don’t do drugs, even the legal ones, unless absolutely necessary. If I have a health problem that is caused by my lifestyle, I change my lifestyle to address the problem. Then I don’t have all those side-effects to deal with (and I feel better, too–partly because I’m not adding to the drug company’s outrageous profits–they ARE the most profitable industry in America, no thanks to me–except, of course, that very, very expensive chemo they gave me when I had cancer. And I’m still here, so I’m glad they did.
So these Med Advantage plans turn out to be ok only if you don’t become seriously ill, and are really only an advantage for the insurance companies (just like Managed Care has improved things for no one except the managers). They are costing Medicare a fortune. It has ended up draining the general fund and fragmenting a system that wasn’t broke to begin with (you know, if it ain’t broke, don’t fix it). It was simply a giveaway to all those insurance companies that pay heavily into our legislators’ campaigns, whose CEOS probably thought they weren’t making enough profit from the regular supplements.
If our congressmen and women were truly into saving the country money instead of protecting the private insurance companies, they would eliminate these Med Advantage plans altogether (as Obama would like them to do). Instead, they are proposing spending money monitoring them so that they don’t keep ripping us off. It’s a waste.
My advice: Go buy a nice private supplemental (Medigap) plan (from the same company that sold you the Med Advantage plan, if you still trust them). Your $96 that is deducted from your Social Security will go into the Medicare pot and make the system stronger, and you’ll have better coverage as you get older. Much better.
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Sec. 1177, Pg. 354 – Government will RESTRICT enrollment of special needs people! “Extension of Authority of Special Needs Plans to Restrict Enrollment.”
The key word here is “extension”. Obviously, plans were already made to do this, and now they’ve extended the current benefits for from 2 to five years. In other words, they’ve maintained benefits for special needs for now.
Sec. 1233, Pg. 425, Lines 4-12 – Government mandates Advance (Death) Care Planning consultation. Think Senior Citizens and end of life. END-OF-LIFE COUNSELING. SOME IN THE ADMINISTRATION HAVE ALREADY DISCUSSED RATIONING HEALTH CARE FOR THE ELDERLY.
• Sec. 1233, Pg. 425, Lines 17-19 – Government WILL instruct and consult regarding living wills and durable powers of attorney. Mandatory end-of-life planning!
• Sec. 1233, Pg. 425-426, Lines 22-25, 1-3 – Government provides approved list of end-of- life resources, guiding you in death.
• Sec. 1233, Pg. 427, Lines 15-24 – Government mandates program for orders for life- sustaining treatment (i.e. end of life). The government has a say in how your life ends.
Actually, they are assuring the opposite, i.e., that health care providers provide life-sustaining services at all times, unless otherwise directed. Yes, health care practitioners (not the Government) are encouraged to talk to patients about what kind of end of life care they want, but there is no implication here that anyone push them towards just giving up. None.
It lays out in detail what people can specify in their living wills about end of life care. This is good. Some people want to keep taking their medications, but don’t want to be resuscitated if they’re brain dead. Some people want to be resuscitated if they’re not brain dead, even if they’re going to be paralyzed. Some people don’t. This bill gives people the ability to spell it out.
Without living wills, health care professionals must provide full medical treatment, whether the individual wants it or not. That’s why they’re pushing for living wills, i.e., because right now, they’re keeping a lot of people alive who wouldn’t want to be kept alive if they were still competent to make a choice.
(In a section that our e-mail guy doesn’t talk about, they establish many provisions to improve service and quality of life for the elderly, especially those in nursing homes, etc., who require ongoing care. You can see a list of these, when I’ve finished reading the Bill, elsewhere on this website.)
NOTE: They said on the news tonight–8/14/9–that this provision will be eliminated because of the distortions like this one and worse, that have been shouted from the rooftops by people who want to kill health care reform.
Sec. 1711, Pg. 764 – The government will require preventative services – including vaccinations (no choice).
This is under a section on coverage. The government will require that insurance companies cover these services. It isn’t forcing anyone to make use of that coverage if they don’t want to.
Sec. 1713, Pg. 768 – Government-determined Nurse Home Visitation Services (Hello union pay backs).
(Huh?) This is a section entitled OPTIONAL COVERAGE OF NURSE HOME VISITATION SERVICES.
The key word here is “optional.”
Years ago, if you needed any medical help to be covered by Medicare, you had to be in the hospital or nursing home. It was silly, because some things can be done as easily and much more cheaply at home. This provision expands home services, if you want them. It’s optional.
Sec. 1713, Pg. 768, Lines 3-5 – Nurse Home Visit Services – Service #1: “Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.” Compulsory ABORTIONS?
I do not cease to wonder at the imagination of this writer, and his ability to use those half a dozen catchwords that get people going emotionally. Rationing, mandates, ACORN, abortion, government control. He loves those words (because he knows they upset a lot of people). Funny that none of them are in this Bill.
This is a section about providing home-based services to at-risk families to reduce child abuse and neglect.
I used to work for an evaluation service for young children in a large city in the east. We evaluated one little girl, 18 months, who was a bit of a pistol, and challenging to her single Mom, who often acted very angrily around this child. She admitted that her kids didn’t listen, so yes, she sometimes spanked. She was 22, expecting her fifth child any day. We were worried that when the baby was born, the 18 month old would be at even greater risk because she was so demanding, and when a new baby comes, children, especially at that age, can have increased behavior problems. We decided on Friday to go to court on Monday and recommend placement for the 18 month old until the mother could get some help and get her kids under control. The situation was critical enough that this mother in this situation wasn’t going to participate in or respond to the available help in the community (there was no one visiting homes and making such help convenient and her baby was due any day). The child was killed on Sunday. Autopsy showed evidence of similar injuries to her liver in the past.
I’ve seen some tragedies where I work now, too. In each and every case, the folks at Child Protection Services were made aware by people in the community that a particular family was having a problem. In each case, they didn’t go in until a child was hurt or killed, or they could in some other way charge the parents with a crime of some sort. In each case, the parents were charged and the children were removed. But I thought to myself, “This is a community problem. The community knew this family was having a hard time. Why did Health and Welfare wait so long? Why didn’t they just go in and offer the family some help? “
This new agency is intended to fill a gap in social services, to offer help to families BEFORE tragedies happen, and prevent them.
Prevention is good, people. It saves a lot of suffering and quite a few lives. It helps kids grow up in happier homes. Such kids are less likely to get into trouble or have mental health problems later. Those things cost a whole lot more money later than they do when kids are little. Help the families now, while they need it.
Might there be some birth control advice in these at home visits when a mother is overwhelmed by several babies, one after another? Certainly (including abstinence). Would we rather have pregnancies prevented than have 18 month old babies killed by blows to their abdomen? I would.
Nothing is said here about abortion. Nobody is going to be forced to have an abortion. You know that, I know that, and the author of this e-mail knows that. He’s just trying to get your dander up so you’ll write your congress person and ask them to vote against reform. I sure am wondering what his vested interest is in preventing reform, especially since he has to keep lying about what the proposed reform is all about.
Sec. 1733, Pg. 788-798 – Government will set and mandate drug prices, therefore controlling which drugs are brought to market. (Goodbye innovation and private research.)
I’m not sure it says this (it’s not clear.) But you know what? It’s time to rein in the pharmaceutical companies. They could pay their salesmen a little less (many make about $300,000K a year–that’s more than a lot of doctors make), stop the TV ads (we’re the only country in the world that allows TV advertising by drug companies), lower their markups a bit (which can top 500,000% for some drugs–I’m not kidding, look it up. Xanax is more than that), pay their CEOs less (they make in the tens of millions a year, some $40,000,000 PER YEAR), pay fewer lobbying fees, campaign contributions, etc. Even after the costs of research and development are thrown in, drug companies are still the most profitable business in America and the world. (You can learn more about drug companies in the several links at the top of the page).
It’s about time our government tried to do something to control drug prices.
We could also try, as our first approach, encouraging and monitoring life-style changes for patients, rather than just giving them drugs. But the doctors are courted by the drug companies with not-so-subtle inducements to prescribe their drugs. See several of the links provided above.
Sec. 1744, Pg. 796-799 – Establishes PAYMENTS for graduate medical education. The government will now control your doctor’s education.
The government helps to pay for almost everybody’s education through Pell Grants, student loans, etc. They’ve been doing this since the GI bill after WW II. Would you rather have a more ignorant, less educated society? I wouldn’t. (Our e-mail guy might. It will make it easier for him to manipulate people with this nonsense, so they do what he wants them to do.)
Sec.1751, Pg. 800 – The government will decide which Health Care conditions will be paid. Say “RATION!”
Actually, here they’re talking about Medicaid not paying for certain “health care acquired” conditions. In other words, doctor or hospital error. Maybe they want the people who caused the condition to pay for the care. That would make sense.
Sec. 1759, Pg. 809 – Billing Agents, clearinghouses, or other alternate payees are required to register. The government takes over private payment systems too.
This is nothing new, it’s been true since the advent of electronic billing, which went into effect about eight years ago. They have to register with any company they send electronic claims to. Private companies and the government probably want to know who is connecting to their computer systems. Wouldn’t you like to know if someone were connecting to your computer system, and why?
It doesn’t mean the government is taking over private payment systems, anymore than it takes over your car when you register your car. It’s yours to use as you like, as long as you follow the rules and don’t hurt anybody. But they still want to know who it belongs to, in case anything goes wrong or the privilege is abused.
Sec. 1801, Pg. 819-823 – The Government will identify individuals “likely to be ineligible” for subsidies. Will access all personal financial information.
The government already has your financial information. It’s called your tax returns. They’re trying to avoid giving services away to people who have the means to pay for them. Another cost-saver.
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Sec. 4375, Pg. 828-832, Lines 12-16 – Government will impose a fee on ALL private health insurance plans, including self-insured, to pay for Trust Fund!
The Trust Fund in question will be used to research what methods and treatments are most cost-effective. The results of this research will benefit health insurance companies because it will keep costs down. They will benefit the most from it, financially. So they can pay for it. Seems fair to me. No individual company has the manpower or national perspective to be able to do this kind of research by themselves.
Sec. 440, Pg. 837-839 – The government will design and implement Home Visitation Program for families with young kids and families that are expecting children.
There is a long section here outlining what services will be provided, by whom, to prevent child abuse and neglect and maximize child development. The program is optional for families.
This is exactly the kind of thing Head Start has been doing for decades, with great results. It is a government program. It hasn’t taken over families or the world. It has helped and supported families to raise their kids, and their kids have done better all the way through high school, as a result of that investment in early childhood. There are fewer unwanted pregnancies for these kids who were in Head Start, fewer high school drop outs, fewer of these kids have drug problems and legal problems as teenagers.
There used to be some excellent early childhood programs, e.g., early identification programs (to identify developmental and mental health problems early when they can be much more easily and cheaply fixed), infant stimulation programs to help kids maximize their intellectual potential, therapeutic day cares, etc., that were killed in the 70s. On Reagan’s watch, some excellent and very cost-effective early childhood programs were simply eliminated. Mental health professionals predicted at the time that because of reduced funds and an end to so many programs for young children, 30 years later the prison population would increase dramatically.
And it has. We have the largest percentage of our population in prison than any nation in the world, 738/100,000 as compared with 107/100,000 in Canada right next door. This compares with an average of about 60/100,000 in Northern Europe, and about 100/100,000 in Western Europe (despite their greater population density). You have to wonder what they are doing differently than we are to keep crime down. (I know that in Northern Europe one thing they’re doing differently is investing in families and children, e.g., with more family leave time for parents, better day care, etc.)
Investing in early childhood is the best thing we can do to reduce costs of various sorts down the line.
His next criticism:
.Sec. 2201, Pg. 864 – The government will MANDATE the establishment of a National Health Service Corps.
o Sec. 2201 – “Fulfillment of Obligated Service Requirement”
o Sec. 2201, Pg. 864-875 – The NHS Corps is a program where Doctors perform mandatory HC for 2 years for partial loan repayment.
He really loves that word MANDATE, doesn’t he?
Even if a National Health Service Corps is mandated, nobody is mandated to participate in it. That’s voluntary. He said it’s mandatory for doctors. It’s not. Not only that, they’ve reduced the service to part time rather than full time, if a doctor wants to do the service. That means he or she can work part time for a salary and part time to repay loans. That means he doesn’t have to starve for two more years while repaying his loans.
So it amounts to this: if a medical student has opted to accept federal funding for his or her medical education, then (s)he can choose to pay part of it back with public service. They agree to do this when they accept the financial help to go to school. That’s where the “obligation” comes from. But they don’t have to accept financial help through this program in the first place if they don’t want to.
This is nothing new. When I taught school on the Navajo Reservation 40 years ago, there were several doctors at the public health hospitals serving the Navajos, giving 2 years of service to the country that paid for their medical training.
This also happens with teachers and nurses. It’s been happening for decades.
Is this a bad idea?
Sec. 2212, Pg. 875-891 – The government takes over the education of Medical students and Doctors through education and loans.
Shame on the government.
I don’t know about you, but I received part of my education from a government loan, which I paid back. What else is new? I went to grad school 35 years ago. I repeat: government loans and grants for education have been around since the GI bill after WWII. Does that mean we’re now all robots of the government?
What nonsense.
I think that one reason our legislators are helping doctors with medical school is to provide some incentive for becoming a doctor. For all the years in school, and all the money it costs, and all the years that we’re not earning while we’re being trained, it’s just not worth it anymore. It’s become way too complicated and stressful, and doesn’t provide an income anymore that justifies all the hassle and nonsense.
Sec. 2511, Pg. 992 – Government will establish school-based “health” clinics. Your children will be indoctrinated and your grandchildren may be aborted!
Gosh. I remember getting immunizations at school when I was a kid. Does that mean I was indoctrinated? He’s taking it a little far, don’t you think?
I’ll say more about this idea in a section below. He brings it up again.
There’s more…..but I’m getting tired. It’s always the same drill. Now he’s upset about a Public Health Workforce Corps.
Indian Reservations and other isolated or under-served areas of our country are served by Public Health Hospitals. This is because these communities don’t have the money or the expertise to set up their own hospitals (and they do live in our country and they do get sick). There is a shortage of health professionals in these communities, and especially health professionals from the populations that are served by these hospitals and clinics. This provision is an attempt to change those things. It includes helping professionals who go to these areas become acquainted with the languages and cultures of these areas, if they want to, which will make their work with these populations more effective. It also provides for training people from these communities to provide health care to their own communities.
On the Navajo Reservation 40 years ago, there was only one Navajo doctor out of a population of about 200,000 Navajos. That’s been changing a little bit insofar as more Navajos are going to college and into the various professions, which is a good thing. This Bill intends to help that trend along in health care because these populations still don’t have enough of their own people to provide treatment in their own communities. With a better understanding of their own culture than outsiders, they are sorely needed.
Here’s a good one:
Sec. 3121, Pg. 935, Lines 1-2 – The government will develop “Healthy People & National Public Health Performance Standards.” They will tell us what to eat?
The government already tells us what to eat. It’s called the dietary guidelines from the Department of Health and Human Services. ( They don’t, however, shove it down our throats. ) They’ve been putting out these quidelines since 1980 and revising them every five years. Actually, I thought that the guidelines I was taught in tenth grade (49 years ago) were provided by the government.
Since this Bill is putting a very strong emphasis on health and prevention, we might actually get dietary recommendations that are made by nutritionists and nutrition research instead of by the meat, dairy and sugar industries (as happened the last time the Department made their dietary recommendations–as described in the Appendix of The China Study by Colin Campbell. They did not have a single solitary nutritionist on the last committee, not one, according to Campbell.)
Anyway, I think in the Bill they are talking about the performance of Public Health, not the performance of the people they serve.
Sec. 3131, Pg. 942, Lines 22-25 – “Task Force on Community Preventive Services.” More government? Under the Offices of Surgeon General, Public Health Services, Minority Health and Women’s Health.
No, this isn’t more government. This is a task force made up of “stake holders” in a prevention effort, namely, consumers and patient groups, providers, federal agencies, and insurance companies. They already exist.
Next, he complains about having a core public health infrastructure, with a workforce, labs, information systems, etc. I’m not even going to bother quoting him on that one. You get the picture.
We already have a core public health infrastructure. This is just beefing it up for current problems, like pandemics, and also attempting to provide for better service to make us healthier, especially in under-served areas.
Sec. 399Z-1, Pg. 993 – School-Based Health Clinics will be integrated into the school environment. More government brainwashing in school.
What does he think the government is going to be “brainwashing” our kids about? Eating right? Exercising? Disease prevention?
Whatever the case, parental consent will be required for any kid to be involved in the clinic in any way and confidentiality will be maintained, just as it is in any clinic.
I suspect that one of their primary concerns is the huge increase, in recent years, in childhood obesity. If there were clinics at the schools available to these kids, perhaps health care professionals could help them learn how to normalize their weight and prevent a whole lot of illness and suffering down the line. Parents obviously are not doing this job adequately right now, and their kids and our health care system are going to suffer big time if we don’t get it under control.
Why not do something to try and turn this around?
Here’s one last little nugget:
Sec. 2521, Pg. 1000 – The government will establish a National Medical Device Registry. Will you be tracked?
The answer is yes! Why? To establish “safety and outcome data” on each device, to make sure that things like pace makers or breast implants don’t kill you. Personally, I would prefer that they establish this before they put it into my body, but I guess it’s good to follow-up afterwards, just in case. There do seem to be mishaps years later for some of these devices.
If there’s a tracking system, and problems develop for some people, at least they can let the other people with such a device know about the problem. I’d like that if it were me, wouldn’t you?
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My Personal Conclusion about HR 3200
Now that I’ve satisfied myself about the accuracy or lack thereof (mostly the latter) of this smear e-mail:
All in all, I don’t find this Bill scary. I find it more complicated than it needs to be (a single payer system would be infinitely less complicated and much cheaper). But in a democracy, everybody has a voice, and compromise is the name of the game. I see serious efforts here to meet the needs of consumers, providers, and private business. I see efforts to bring costs down, while improving care. I see a real desire to move in the direction of prevention, which is the only thing that will really save us significant amounts of money. I see efforts to provide people with plenty of choices, while at the same time making some rules that will protect us all.
You can’t expect private insurance companies to do all of this for us. They are in this business to make money. They make money from the current system. They aren’t going to make as much money in a reformed system. Protecting them instead of the public (that’s you), which is what you will be doing if you tell your congressman to vote against reform, is just going to keep making them richer and the rest of us poorer. That makes sense only if you work for an insurance company.
Think about it. Do you really think that the CEOs of these large companies, who average 10-12 million dollar salaries per year, care about saving you money, providing the care you need, or even saving your life? Check out some of the interviews that have been had with them by our legislators on the floor of the House or Senate in the past few weeks. They’ve been asked, “Doesn’t it bother you that people are dying because of your refusal to provide treatment?” When I happened to turn the TV on to one such interview, it was amazing how long the insurance representative paused. The question had to be repeated, he paused so long. Eventually, he said yes, it bothered him. But if it did, it hadn’t changed the policies of the company. They let people die, folks, while they stall and stall about whether they’re going to pay for a physician-recommended treatment. Not all of them, but a lot of them.
And even when a treatment is covered by their plan, they try and avoid paying for it. I have a friend who worked for several years for an insurance company. They were taught, “Find a way to deny the claim.” They’re in business to make money. It must be darned good business because new companies are being created frequently. We providers have to be extremely vigilant about which claims have not yet been paid so that we can follow-up, because sometimes, they just don’t pay. This has improved some in the past four or five years, but it’s been a HUGE problem with private companies, some more than others.
The government plans have rules. The rules are decided by committees of any number of people after studying the issues. Sometimes I disagree with their rules. But when they make a rule, they stick to it. If they say they’ll pay for something, they pay for it. You don’t have to work harder to get paid than you did providing the service.
The proposal in the Senate’s bill, instead of a public plan OPTION, is a “cooperative.” This approach will be very complicated to set up, and is bound to have higher administrative costs than a public option. Cooperatives can also limit the choice of doctors even moreso than most HMOs, because many of them hire and pay a salary to just a certain number of doctors, and those are the ones you will go to. I just had a family come in last week that has been in a co-op for several years. Their son only knew the doctor he had seen there. But their employer changed insurance companies, and so the family could no longer access that doctor–he works only for the co-op. They had to start all over with new providers.
Medicare is already set up and works very efficiently. Why spend all that money reinventing the wheel (in each of 50 states) for a system we don’t know will work? Why not just improve and expand one that we know does work? The main problem with Medicare is that it is insuring only the oldest citizens, who typically have a lot more health problems (and therefore cost the system more) . If we allow a more balanced population to buy into it, including younger and healthier people, the average cost to Medicare per person will come way down.
This will be especially true if we, as a society, start eating right and exercising more, and adopt my mother’s attitude: if you don’t really need it, don’t ask Medicare to provide it for you.
Please remember, bureaucrats in the government are either elected or appointed by people who are elected. We can throw them out if we don’t like them. We can’t throw out the bureaucrats of private insurance companies, unless we’re rich enough to own more than half of their stock. We’re stuck with them. And unless you buy your own health insurance rather than having it provided by your employer, you can’t just change companies. You have to stay with what your employer says you stay with.
Not so with this new Bill–you don’t have to stay with the one your employer chooses. If you don’t like the company or the policy, you’ll have the freedom to make your own choice. That, alone, will make the insurance companies provide better service than they do now, because they’ll have to work harder to keep you as a customer.
#1 by ageispanther on August 24th, 2009
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My concern would be public (federal) healthcare; we know how often the government actually CARES about it’s people (letting families in need live in squaler, and then jailing them on whims, denying basic health care at good hospitals if they have no insurance, blah blah), so really, the track record alone isn’t good….would this really change?
#2 by Pam on August 24th, 2009
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In my experience, it’s the states, not the feds, who are guilty of this. I see it in Child Protection all the time, and CPS is always a state and sometimes a county agency. The Bill discussed above has a provision for an agency that would be available to families for HELP, not just taking their kids.
Too often, the state programs are underfunded and supervised and staffed by people who don’t have the breadth of training and experience they need, or the time, to do the job right. For example, they often don’t seem to recognize the damage done to a two year old’s development when they remove them from the home for 6 months. They also often don’t seem to have the expertise to recognize a personality disorder when they see one, i.e., a parent who isn’t going to have the capacity or the motivation for change.
Around here, we’ve moved in the direction of less training, not more, allowing volunteer lay people from the community, with little more than common sense, making recommendations to the court about whether to remove kids. I had a case recently where the CASA worker (volunteer) was concerned that the father wasn’t showering every day. I mean, geesh! for that kind of nonsense, the two kids were out for six months (beginning with a temporarily dirty house).
And when kids DO need to be protected, they often are not. I had a case years ago where a 14 year old girl had been severely beaten by her stepfather. CPS knew it, they saw the bruises. He said he’d change, and they left. Personality disordered people don’t change, typically. Her father had to save his money for six months to go to court and get custody. CPS could have easily moved the kid to his house without him having to spend $10,000 in legal fees.
These programs need full time, well trained and experienced clinicians who have the necessary training, at least to supervise, but I’ve never seen it. Maybe in the wealthier states.
Federal programs tend to be more realistic, in their design, about what level of expertise is needed for any particular job, and they provide sufficient funds to make the work load livable and the training excellent. In Head Start, for example, they hire community people who don’t have a lot of training. But they hire enough of them, and provide them with enough training (and very good training), that they do a very good job.
Any hospital that receives federal funding has to treat people. In this Bill, there is a provision that they will have to provide the same care to anyone, regardless of issues unrelated to health care.
Honestly, in my experience, the Feds do a much better job than the states. I don’t fear them at all. I fear what is happening now, i.e., that people with less and less training are being hired to do these very difficult jobs.
Thanks for reading and commenting! Just got the site up today, and you’re my first reader!
Pam
#3 by Joe ward on September 7th, 2009
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Pam,
Sometimes, I guess, it takes seeing the real bad stuff to see through all of the lies and not be so shallow. I really love what you have done here. You rock.
Do you mind me linking to your site?
Thanks Joe Ward
#4 by Pam on September 7th, 2009
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Thanks for the compliment! Of course you can link to it. Make it go viral!
I’m going to have to learn how to upload links, as my webmaster is overwhelmed with work,,,,but meanwhile, I will go check yours out.
Pam
#5 by Colleen Thompson on September 12th, 2009
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“1. There won’t be any cost to the insured for preventative services, things like mammograms, PSA tests, bone density tests, colonoscopies,etc. They want to require private insurance companies to provide these services with no co-pay so that you will be more likely to obtain them. It saves the whole system (and you) money in the long run (not to mention, saving people’s lives).”
There’s been a lot of discussion about the cost of preventive care. The President earned a False from Politifact.com on this (see http://www.politifact.com/truth-o-meter/statements/2009/sep/09/barack-obama/obama-says-preventive-care-saves-money-it-doesnt/”
What I have not seen discussed is the moral or ethical side of preventive care. So what if it costs more for testing a large population so that a few can be saved? Isn’t that worth it?
Also, as science marches on, the candidate populations for a particular test can be more specific, which will lessen the overall cost.
Politifact.com is a great site, even though they seem to be overly strict when evaluating Obama’s statements as compared to others’.
#6 by Pam on September 12th, 2009
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Colleen, It’s an interesting article. Thanks for sending it.
I agree, early detection and prevention is a moral issue, not just a cost issue. It is odd that there hasn’t been much discussion about that.
Certainly tests for early detection are going to cost. I don’t have the stats to figure it all out myself, of course. For some things, e.g., mammograms, bone density tests, they certainly would appear to save money (and possibly also blood sugar tests, blood pressure checks, etc.). THey are cheap to do and treatment is expensive. Colonscopies are, of course, much more expensive. One costs $1800, I think, and my husband’s treatment (unsuccessful) for colon cancer cost about $150,000 over two plus years. For that amount, about 83 people could have a colonoscopy. That’s not very many. But one only needs one about every ten years, unless there is a family history.
There is an interesting assumption by one commentator that all prevention is a medical intervention, e.g., preventing heart disease by giving statins. Or preventing strokes by giving blood pressure medication. Or preventing osteoporosis by giving expensive medications.
I would have to say that some prevention is just life-style changes. Group education could be cheap and learning to manage weight and exercise doesn’t cost any more than a little education. It is just as effective for osteoporosis to lift weights and increase Vit. D and Calcium intake as it is to take Fosomax, etc., and without the side effects.
Other countries do prevention. In Japan, every single citizen has a complete physical every year. At those physicals they probably decide which tests to use for early detection. In any case, they spend a lot less than we do (their diet is also significantly better).
I will check out politicat more often. THanks for the comment and the tip.
#7 by High School on February 4th, 2010
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Thank you very much for that wonderful article
#8 by Pam on February 5th, 2010
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THanks for reading! It’s kinda become old news now, hasn’t it?
I hope they will restore the public option, but I’m not optimistic.
#9 by Pam on March 6th, 2010
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THanks. The problem is, it’s probably old news. I reviewed an analytical summary of the Senate Bill yesterday, and it’s pretty depressing. The public option is gone. They’ve raised the bar so that insurance companies will be LIMITED to charging 20% more for premiums than they actually spend on health care (for groups), and 25% for individual policies. This means that they can charge that much to cover administrative salaries, administrative nonsense, lobbying and campaign costs, and profits. Medicare administrative costs are under 5%.
The Senate Bill also allows insurance companies to charge older people more for their insurance, even if they’re healthy. Personally, I didn’t have any health problems from age 57 to age 65 when I went on Medicare. It’s not fair! If they’re going to charge some people more, then charge the people who don’t take care of their health. Maybe that will motivate them to do what they can to get well.
They also want to complicate the enrollment process for providers who want to accept Medicare, and charge providers $200 to apply! Fortunately, the AMA has protested this! What you might not know is that currently, each and every insurance company does their own criminal background check, their own call to our licensing board, etc. It can take months to get into a network (so that they can pay us less–that’s the only reason for networks).
I’ve proposed to Reid, Pelosi, and my unhelpful legislators that we create a National Register of providers that ALL third parties must use, so that only one entity is doing the background checks, and it’s all online for anyone to use. CAQH is already doing that, and we help them out by updating our info every three months. But most insurance companies don’t use it. WHy? delaying our getting into their networks benefits them.
The other thing I hope to God they are doing is standardizing billing. This month my first claim to Medicare was denied because I failed to omit the dashes from the patient’s social security number. Silly me entered it just as it is on the card (which all other companies accept). The details drive us nuts.
So please, folks, write to your legislators and ask for some repairs to the Senate Bill, and ask them to return the public option. Without it, this is just another giveaway to insurance companies.