HR3200 - The Health Care Bill
Since there’s so much discussion going on about this bill, I thought I’d take a look at all 1,017 pages and see if anything seems particularly disturbing. The bill’s short title is “America’s Affordable Health Choices Act of 2009.” A promising start, at least. It goes on to assure the reader that “everyone” will have health insurance that will “meet such standards…as the Commissioner may establish…” A few pages later, there’s a “Secretary” involved with copayments. There’s also cost sharing, so this affordable health choice won’t cost you more than $5,000 for individuals and $10,000 for families every year. If you’re part of this health care plan, you won’t have to worry about whether you can afford the cost sharing, since the bill will “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….” It appears that the government will be looking at your finances and making sure you’re paying by “electronic funds transfers, in order to allow automated reconciliation with the related health care payment…”
There will be a new health insurance exchange trust fund, which gets its money from taxes on individuals who choose not to have health care coverage, employment taxes on employers not providing acceptable coverage, excise taxes on failures to meet “certain health coverage requirements” and various appropriations. The earlier-mentioned Commissioner decides the “geographically-adjusted premium rates for the public health insurance…” but for items and services, “the Secretary shall establish payment rates…for services and health care providers…” That includes what doctors will be paid. The bill spends another 100+ pages amending tax law so that some employers, individuals without insurance and “high income individuals” all get to pay more taxes. Medicare and Medicaid get “improvements” that take up 215 pages.
Many pages of seemingly unrelated paragraphs that span the entire field of medical care, then there’s an item in the section titled “Program Integrity” that is worth mentioning. “Enhanced penalties for individuals excluded from program participation.” Who would be excluded? After further reading, I conclude that this applies to doctors. The following will keep any doctor from working on his or her own, outside the government plan. An excluded individual who “orders or prescribes an item or service, including without limitation home health care, diagnostic and clinical lab tests, prescription drugs, durable medical equipment, ambulance services, physical or occupational therapy, or any other item or service” gets fined $50,000 for each order or prescription. Looks like it’s go to a doctor that the government approved (meaning a doctor that agrees to accept only what the government pays) or none at all.
The section on “advanced care planning” with its mandatory consultation to explain things like durable power of attorney and orders regarding life sustaining treatment sounds like a lot of authority to give the government. Those are about as personal as any decisions could be, and now health care would make sure that everyone had such orders out there in advance. Less cost if all the patients who want to die without some type of treatment get to do so. The rest of the bill has too many subjects to pick one out in particular, to the point where I am not sure whether one thousand pages worth of five hundred different topics can do any single one of them successfully. At least it specifies how health care quality will be measured, by the same group that will be running the health care. Perfect.
There will be a new health insurance exchange trust fund, which gets its money from taxes on individuals who choose not to have health care coverage, employment taxes on employers not providing acceptable coverage, excise taxes on failures to meet “certain health coverage requirements” and various appropriations. The earlier-mentioned Commissioner decides the “geographically-adjusted premium rates for the public health insurance…” but for items and services, “the Secretary shall establish payment rates…for services and health care providers…” That includes what doctors will be paid. The bill spends another 100+ pages amending tax law so that some employers, individuals without insurance and “high income individuals” all get to pay more taxes. Medicare and Medicaid get “improvements” that take up 215 pages.
Many pages of seemingly unrelated paragraphs that span the entire field of medical care, then there’s an item in the section titled “Program Integrity” that is worth mentioning. “Enhanced penalties for individuals excluded from program participation.” Who would be excluded? After further reading, I conclude that this applies to doctors. The following will keep any doctor from working on his or her own, outside the government plan. An excluded individual who “orders or prescribes an item or service, including without limitation home health care, diagnostic and clinical lab tests, prescription drugs, durable medical equipment, ambulance services, physical or occupational therapy, or any other item or service” gets fined $50,000 for each order or prescription. Looks like it’s go to a doctor that the government approved (meaning a doctor that agrees to accept only what the government pays) or none at all.
The section on “advanced care planning” with its mandatory consultation to explain things like durable power of attorney and orders regarding life sustaining treatment sounds like a lot of authority to give the government. Those are about as personal as any decisions could be, and now health care would make sure that everyone had such orders out there in advance. Less cost if all the patients who want to die without some type of treatment get to do so. The rest of the bill has too many subjects to pick one out in particular, to the point where I am not sure whether one thousand pages worth of five hundred different topics can do any single one of them successfully. At least it specifies how health care quality will be measured, by the same group that will be running the health care. Perfect.
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