Monday, August 17, 2009

Health care bill is still bad, even without 'public option'

The latest news over the weekend is that President Barack Obama may be willing to drop the 'public option' from the health care bills currently in Congress.

The House version, HR 3200, is the only one really available to review because the Senate has yet to publish any of their voted-on versions.

The hope by some is that elimination of the 'public option' would make every day Americans (who are opposed to government takeover of the medical industry) less resistant to the bill. However, there is still much to dislike in HR 3200 and plenty of reasons for this bill to be soundly defeated.

One of the arguments that routinely get mentioned is that nothing in the bill takes over a single hospital or a single doctor. But you don't need to physically come in and take ownership of a hospital to be able to control what goes on in that facility.

Whenever government can dictate what you do, how you do it, what you charge for it and tax you or fine you for non-compliance, government has 'taken over.' And that's what this bill would do.

HR 3200 mandates that individuals must obtain insurance or be taxed. So if you're a healthy young person who'd rather save money for purchasing a house than pay several hundred dollars a month for insurance - too bad. Government knows what is best for you and if you try to make that decision on your own, you will have to pay government for the freedom of making such a decision.

Interestingly a large number of the "46 million uninsured" are young people who have access to insurance but choose to forgo it in order to set their own priorities with their funds. That's why the 'buy insurance or be taxed' provision is in the bill.

But don't believe just my words, read the bill. It says so in Section 401, Tax on individuals without acceptable health care coverage. From the bill:

"(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of:

(1) the taxpayer’s modified adjusted gross income for the taxable year ...

(2) the amount of gross income specified in section 6012(a)(1)...”

Note, too, that if you're without insurance for "any time during the year," you become subject to the tax. So if you've decided not to purchase COBRA coverage for the time between leaving one job and when your insurance kicks in for your new job, you get taxed - even if it's just for a week.

How many people routinely make such a decision, especially if they're healthy?

The bill also gives government the ability to determine what type of coverage you have. It's section 122 (b) which dictates the minimum services to be covered, including maternity and well-baby care. Now, that may be great for a young couple who wants to have kids, but what about older individuals or those who cannot have children? Why should their insurance be required to provide that service - and why should they be required to pay for something they won't ever use?

This section also requires a 70% actuarial value of the benefits. While this may be a rather technical requirement to most, it means that the current option of choosing to pay for routine services like doctor visits, but carrying insurance for major illnesses or injuries is illegal once the bill is law.

Then there is the entire Title IV Quality, Subtitle A Comparative Effectiveness Research section 1401. Under the provisions of this section, government sets up a new bureaucracy (including board members who get per diem payments as well as travel reimbursements and staff to carry out the terms of the bill) to determine what treatments will be approved.

Included is the authority to use data from electronic medical records for determining the comparative effectiveness of treatments. I wonder, because I do not know, if they can access such records without our permission. The bill does give the newly established research center the authority to obtain data from any agency or department of government and from other sources.

This section also allows the government to determine national priorities for research. I can only wonder how many lobbyists various disease foundations will have to hire to get their disease on the national priority list? And will the national priorities end up like Oregon? In that state, they rank treatments

"for various diseases and conditions, currently from 1 to 680, in order of priority. The health care dollars available determine which priorities are met. As program costs have grown, the list of covered procedures has become shorter.

In 2009, the state will pay only for the first 503 procedures. It won't pay to remove ear wax, treat vocal cord paralysis, or repair deformities of one's upper body and limbs. It will fund therapy for conduct disorder (age 18 and under), selective mutism in childhood (a prolonged refusal to talk in social situations where talking is normal), pathological gambling, and mild depression and other mood disorders.

Reordering Priorities. Surprisingly, between 2002 and 2009 there was a fairly radical reordering of the plain language priorities. A great many life-saving procedures that ranked high in 2002 have been relegated to a much lower position in 2009, while procedures that are only tangentially related to life and death have climbed to the top. (While extensive code lists define actual treatment, most people must rely on the plain language to judge list adequacy.)

For example, medical treatment for Type I diabetes, which ranked second in 2002, was demoted to 10th place in 2009. Oddly, given that not providing treatment for Type I diabetes is a death sentence, it has been placed behind spending on smoking cessation, sterilization and drug abuse treatment. And this is not an isolated case."

In Oregon in 2002, appendicitis ranked 12th for treatment priorities but in 2009, it dropped to 84th, behind treatment for asthma (11th), lactose intolerance (13th) and abortion (41st).

While the Oregon priorities are for treatments, will the federal government's priority list for research experience similar changes? We don't know - that question hasn't been answered by any Congressional representatives, yet.

Another aspect of the comparative effectiveness research section is the 'oversight' the government will exert. Under the current terms of the bill, the government will decide if independent research on medical issues is 'credible' and 'consistent' with the government standards (which the center will also establish). They can 'recommend' the research methodologies. What happens if you don't take their recommendation on methodologies? Will your research be determined 'credible' if you'd not done it the way they say you should?

Government also gets to set rates. According to Sec. 223, Payment rates for items and services, the government gets to 'correct' payments that are excessive or deficient. This also means they get to determine the definition of 'excessive' and 'deficient.'

(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.

(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.

Even without the public option, this bill takes over our health care system by dictating what is covered, how much is paid for it, what treatments are better than others and whether or not you should get such treatments.

It uses the force of government, through taxation and the Internal Revenue Service, to penalize for non-compliance, which, in effect, makes the government the decision-maker for your health care needs and wants.

Oh, sure, you get to decide which doctor to use, they claim, hoping that you'll see that 'choice' as sufficient liberty when it comes to your health. But your relationship with that practitioner is dictated from beginning to end, so it's really not much of a choice, is it?

We cannot be dissuaded on the opposition to the bill simply because one aspect might be removed. The entire bill is bad and we must be vigilant in pointing out and opposing all the other aspects that result in a government take over of the industry.

And no - the insurance companies have not paid me for this opinion.

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