The below is from Betsy McCaughey’s column in the November 7 online edition of the Wall Street Journal. My comments are in (green):
What the government will require you to do:
• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there’s no grace period. You’ll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit. (So much for keeping your current health insurance as promised by President Obama.)
• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you’ll be legally required to pay for it. That’s like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.
On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.
(Who can afford up to 20% of their income taken away before taxes? I sure as hell can’t! I have things to pay for – like food, a mortgage, utilities, and other insurance for the car and house. President Obama did promise that this health care plan would be deficit neutral – it will be – the government will not be taking out loans to cover the costs of the program, they’ll be taking them out of your pocket!)
• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill. (Choice? What choice?)
• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement. (Well, duh!! Illegal immigrants usually don’t file income taxes!!)
• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less. (Nothing like not knowing what your costs are going to be. Job killer for sure!)
In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.
• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what’s called a "medical home." (Is that the old folks home on the edge of town?)
The medical home is this decade’s version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis." (Bureaucratic control of shoving the level of care down your throat – another promise by President Obama that falls by the wayside!)
A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority. (Government controlled gatekeepers, ready to deny you coverage at the earliest opportunity.)
• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients. (Cost savings at the expense of potentially inferior care.)
• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida. (The doctors will get shortchanged here – the standard of living is not the same in all regions of the country.)
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care. (Reduced care for our senior citizens.)
• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services." (Government telling doctors how to practice medicine.)
While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.
• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program." (No required qualifications? No accountability!! With your healthcare dollars!! Can you say ACORN? I knew you could…)
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services. (Let’s make sure that “qualified people” are served by the program… How many times has fraud been uncovered in Medicaid, Medicare, and Social Security that relates to unqualified people receiving benefits?)
• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services. (So you can land in this country, legally or illegally, presumably (hopefully!) pay into the system, not learn the language of the country, and still have a translator at no charge. Something is not right here.)
• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities." (If this isn’t a form of reverse discrimination, I don’t know what else could be.)
• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance. (Starting the cradle to the grave cycle.)
This is only the beginning of the findings of what the House passed Saturday night. I believe it was rushed through to prevent the critics of the Bill from dissecting it like its predecessor HR3200. And even then, it was a very close vote.
And then there is this little jewel that asks a very good question:
I can only hope that our Senators will see that this legislation does not offer choice to the American people, but instead takes away choice and replaces it with shackles.