My Take On the Health Reform Bill

I spent a week reading through the massive (1017 pages-pdf warning) Health Reform Bill, HR3200, and I’ve noted areas of personal interest. This post will not be exhaustive (sorry; that would be impossible), but it will list (1) things that I thought the Bill did a good job with, (2) areas of personal concern and (3) areas that I don’t know what to make of. Before closing the post, I’d also like to (4) address areas where people have been flipping out followed by (5) some personal general concerns and hopes looking forward.

(1) Parts I Liked
I thought the goal of the bill is to be applauded. The government is seeking to reform the entire way we do health in the United States, not so much the way health procedures are covered. The Bill is comprehensive: touching everything from employer plan selections through what happens in the hospital and the doctor’s office. There is a focus on reviews and input from different levels (doctors, patients, pharmaceuticals, etc.) and even ways to establish ease of access to that information and wellness in general.

So I applauded that: there is no automatic enrollment into the public plan;  employers aren’t allowed to improperly steer employees to the public plan; there is a tax on certain non-insured individuals; there are some audits to discover non-compliance with any standards that the government comes up with (based on the health panel’s recommendations, current science, statistics, etc.); preventative services are covered and are not part of the deductible costs;  the government ensures information is disseminated to the public; and there will be websites available where this information can be accessed.

Some of these websites will consist of Nursing Home Comparisons or a way to shop for health coverage from the Health Exchange Network. One of the more helpful tools in the bill, specifically for doctors, is that in exchange for up to half of their tuition costs the doctors serve part time for a couple of years as part of the National Health program. This sort of thing will make the benefits of university hospitals available in more places than just University Hospitals.

The benefit from all of this mean that no child that is born in the states or her territories is born without some sort of coverage; that doctors will ideally have access at their fingertips to the nation’s leading science and opinions regarding specific diseases; and that consumers will have more choices as part of their personal health care.

(2) Parts I Didn’t Like
There is a big section on quality improvement predicated on following best practices, which are established by a panel and disseminated by the Secretary of Health to Hospitals, doctors and health care professionals. I think this needs some thinking out. I’m already facing something like this with my own insurance company where they keep requesting that my four year old daughter gets a spirometry test for her asthma while my doctors keep saying that they don’t do those sorts of tests until a kid is six. Of course, the Best Practices comes from doctors, but what’s important from my example is that it establishes that things vary per individual (although they admit differences with ethnic groups). I don’t think my daughter will even be able to do the test when she’s six since her growth curve is extremely slow.

Sometimes you can’t prescribe one brand of medication or procedure that works for most people—in others it just won’t work. So even though it might be good that the doctors have access to some major procedures that are helpful, it won’t do anyone any good if the National Best Practices are stipulated as consisting of those procedures at every level. Of course, the Health Care Bill doesn’t say that that will be the case but it was enough of an area of concern that I thought I should mention it.

I was also concerned with the policy fee for health insurance or self insurance. I don’t know why the need for the fee unless it is to bolster the funds available for the public plan (like a backdoor way to ensure the moneys are there without increasing taxes) but it seems to be a potential problem area especially when it comes to employers—and I’ll mention some of that in my closing thoughts (5).

I though the language about Family Planning was upsetting but understandable in terms of the established law. What does make me nervous is that the if there are fees and taxes being charged on individuals to support these services listed, could that mean that wmight also be paying for family planning that culminates in abortion? I’d like some clarification here but I think the Bill purposefully leaves the issue open. Should that be a health reform issue or should this fall under another category unless specifically concerned with the mother’s health?

The section on end of life services is helpful in informing people what they should have ready as they get older (in regards to wills and advance directives and so forth) but it concern me that the language was nebulous enough to allow for end of life services of the euthanasia kind. Now the bill doesn’t say anything like that—re-read what I just said “The Bill Does Not Endorse Euthanasia”—what it does do is open a door that can allow Euthanasia to fit nicely within its borders.

The last section that I really didn’t like is the costs for the basic coverage: 5000 for individuals and 10,000 for family. That strikes me as incredibly high deductible for a plan that is supposed to be helping out those who can’t afford health coverage. Now, of course preventative services are covered, but really that’s not that part that makes us broke.

(3) Parts That I Totally Don’t Understand.
The mention of the Secretary of Defense in the bill—that totally threw me for a spin and I keep thinking it’s a typo; the tax on non-insured people which I could understand and applaud (above) but I’m not sure if it is very helpful for the people who need it; how they will go about making sure that quality measurements work; and how will the doctors consult based on patient’s beliefs.

(4) Areas That People Need To Stop, Drop, and Breathe.
Health Care Rationing? No, people, the government is not ensuring that people don’t have access to services. The bill states that they will have levels of coverage (just like we have now with private health insurance) where there may be more or less out of pocket costs depending on the level of coverage. That shouldn’t surprise us since the government isn’t implementing a national health insurance plan, they’re trying to reform the entire health industry while still maintaining the coverage that’s currently out there.

Illegal Aliens Rewarded? There’s this myth about illegal aliens being exempt from individual taxes and getting free coverage is being overplayed. Other non-payers of this specific individual tax (not any tax) are dependents, individuals residing outside of the US (in US possession or territory), and individuals who are part of a specific religious group. This specific group in the bill are not illegal aliens, they are non-resident aliens (for example, non-citizens who are legally in the country with a visa but have not been in the country long enough to be considered a resident alien) and fall under a specific tax bracket specified by the IRS. The Bill explicitly states that there will be no federal payments made to undocumented aliens.

Mercy Killing? Third there’s this bit about the bill mandating mercy killing. Not true, the Bill states no such thing and really tries to define end of life services under the category of a consultation with a doctor, if it hasn’t been done within five years. It is trying to ease the final days but, as I said above, I think it leaves a door open to allow for certain provisions to fall underneath that consultation purview.

(5) Closing Concerns and Hopes.
One: I know how employers work. They offer three tiers of insurance that are the most affordable options they could get which allowed several attractive levels of coverage for their employees and the employees would choose between them. What I can see happening, even though the Reform Bill seems to make offering the plan to employees predicated on participating in the Health Care Exchange Program (which sounded like everyone will eventually participate in anyway), is that Employers offer the Public Plan as an affordable option against high premium options and we wind up “freely” choosing that public option. Of course, the bill stipulates that they will periodically check on some companies for improper steering, but is this really improper steering when companies do this sort of thing now?

Two: I hope that the legislators read through this thing and really implement needed changes. This is a major change in the way we do Health in the US and to rush through and sign something into Law without properly addressing all these areas could be catastrophic.

Three: I would like it if more people actually read the bill instead of listening to the left and right media. There’s a lot of stuff being said pro and con in regards to the bill and it’s getting the air of hysteria: from one side it feels like the car salesman pushing you to buy and from the other side it feels like the guy on the corner who is holding up a sign while looking upwards expecting the end of the world.

Four: I have concerns about the precedent we’re establishing—across the board. We have to be careful as we move forward not to lay the groundwork for wrong practices. The way the media has been broaching the subject; the way the town halls have gotten heated; the way the administration has been advertising; the way the polarizing talk is being implemented; the way the bill uses certain language; the way people obfuscate what the language of the bill states for their own purposes: it is all disconcerting.

18 thoughts on “My Take On the Health Reform Bill”

  1. Rey, it’s great to see that you approach this with such objectivity and disdain for the media. I , too, like to get all the info before I start making harsh and radical statements…I’ll be the first to tell you, I do NOT think Obama is perfect, but I also do NOT see any mal-intent in this administration(like there was in the last one…Karl Rove(slimiest slimebag), Dick Cheney(ewww, almost as slimy))…Everything that is being done seems to be for the good of the American people, unlike and unrestricted free market, which seems to lean towards the insurance companies, hospital executives, and pharmaceutical companies.

  2. I still don’t understand why we can’t buy into the plan that Gov. employees have. And if this new plan is so good, why the Gov. employees are exempt from using this new plan.

  3. Abortion has been passed off as health-care before, so unless there’s something specific that says it can’t be covered you can be sure people will push to get it covered. That’s why there’s so much resistance to leaving it open. The Hyde Amendment currently precludes this, but the Hyde Amendment will no longer be in effect if this bill passes, because it will replace all current law on publicly-funded heath insurance. In effect, this bill undoes the Hyde Amendment.

  4. Thanks for that Jeremy.

    B13: I need to do more research on that government plan. I’ve heard that charge before but it confuses me. I know HR3200 had a public option, but that’s all it seemed to be: an option. So technically, I wouldn’t have to be on that plan either. But inversely, you couldn’t be on the plan I choose because it was formulated by my employer in conjunction with the insurance company. Your statement raises a point that the public officials have a public plan that the public won’t have access to and that I’m trying to get information on because the bill, although it explains that there are three tiers in the public option, it doesn’t specify exactly what the highest tier looks like.

  5. This has nothing to do with the comments but I needed to house this here. I’ve heard a lot of statistics of people who support reform and those who don’t and those statistics vary by political slant. It’s expected, but it was interesting enough that I want to record some of this:

    About the Statistics:
    Mixed ResultsGallup Polls results: Results are based on telephone interviews with 2,017 national adults, aged 18 and older, conducted July 24-25, 2009.
    Majority NegativeRassmusen Reports: This national telephone survey of 1,000 Likely Voters was conducted by Rasmussen Reports August 7-8, 2009.
    Majority PositiveCNN Report: Interviews with 1,136 adult Americans, including an oversample
    of African-Americans, conducted by telephone by Opinion
    Research Corporation on July 31-August 3, 2009.
    Majority Opposed to HR3200 specifically–OpenCongress:Registered Users=564 in favor / 2629 opposed

  6. I appreciate your work here. I do question why, even though you say twice euthanasia is not in the bill, you chose to perpetuate the lie that it’s in there. If it’s not there, why bring it up?

  7. Xulon, the Bill does not support euthanasia but it also doesn’t deny it as part of end of life consultation. It tries to draw a circle but it was done in a way that left the matter open so that if we do get to that point, the Bill allows for it. The family planning clause language is similar without endorsing abortion it seems to allow for a consultation that would include it.

    Kathy: as to point 1, I see that potentially happening more because of how employers function than what the bill or the reform looks like. There’s provisions in there that are supposed to stop employers from that sort of thing but even so, I don’t trust bosses. As to point 2, that’s a good point regarding military care and it sucks you had to go through that. I have a friend who fought in ‘Nam who, though he gets effectively free care, gets very poor care for his condition (he’s a victim of Agent Orange). Also, the Bill specifically states that undocumented aliens will not be covered.

    I just want everyone to know that there are parts of the bill I like and parts I don’t like. I would like the government to refine it if they’re going to go ahead and do it (I mean, they will).

  8. Rey
    That’s why I think that keeping insurance privatized is important for the health of our country, for financial and freedom reasons. Opening up more private choice options for individuals is a better fix all around. There is always room for improvement, even in the private world, but the thing that matters is keeping our freedom to choose our own personal path in tact. My fear is that gov. intervention will eventually erode that freedom. It has done so historically in most things the gov. has wiggled their fingers into. I don’t really care whether one is Dem. or Rep. I’m an Independent. I like sensible solutions and gov. intervention is not sensible in most things.

    Rey, a final point. Somehow and sometime, we, as individuals must get over the idea that anyone owes us anything in this sinful, fallen world. In my earlier days, it was a privilege to have health care offered by an employer to an employee. It was used as an incentive to get the very best employees to work for you. It was not a right – it was a gift.

    Now, everyone demands it like it is their right to have it. Simply, none of us have the right to demand that the gov. selfishly take care of us, esp. when it causes an unfair balance of taxation….where a few pay for everything and most pay for nothing.

    Health care is something we must plan for – just like a house payment or a car payment. We are responsible for our personal lives – not the gov. and not our employer. In that way, it is the false ideology of the American people that really needs to be addressed. This is the root cause of the whole issue – entitlement. Somebody owes us something (especially the things we think they owe us….)

    Further, God intended for those in need to be taken care of by the church. The question is: do we do this? Each individual Christian has to answer this for themselves honestly. I somehow doubt that the early Christians relied on the gov. for anything. Instead, they worked hard – as we should work hard to provide for our needs. All of our true needs are covered by our Heavenly Father, aren’t they? Somehow, needs and wants are all mixed up in this generation. This is the eternal perspective that needs to develop within the Christian community. We can’t expect the secular world to understand this, but Christians should.

  9. I’m curious, Rey—did you see any language in the bill that suggested portable health care and/or that made pricing transparent?

    To the former, health care at the moment runs basically through employer subsidy; if you’re not employed, it suddenly becomes a lot more expensive. I would think, too, that portable health insurance would drive down costs (or drive up the uninsured) since insurance companies would no longer be able to rely on care costs being built into the price. (Employer subsidies aren’t seen by most who are covered; so my total cost is only a fraction of the real cost. This kind of price hiding makes it easier to charge more while simultaneously making it harder to get my own coverage.)

    To the latter, it’s nearly impossible to get any kind of information about what procedures cost, even on average. I understand, of course, that it’s difficult to predict the cost of a procedure, but I would favor a more parts+labor breakdown with prior estimates for non-emergency. While the human body isn’t a car, many procedures are fairly routine these days. It shouldn’t be difficult for us to produce the numbers that say, “If you need a knee replacement at 64, this is on average what it costs for someone in your demographic.”

    The other issue with opaque pricing is that if no one knows how much it really costs, then cost control methods are a lot harder to implement (in fact, our possibilities really start to collapse toward gov’t mandates instead of better efficiencies, et c.).

    Dunno, just a few thoughts. I don’t think we’re going to see real reform until the insurance and health industries are required to be more transparent in their practices. Making some kind of coverage mandate or funding a public coverage program won’t fix these problems.

  10. Mem, there was language about seemingly portable health care specifically in the form of the Health Exchange program although it didn’t seem to have language that ensured that the insurance you have in X company will carry over (at least in the short term). It sounded like companies would become part of the Exchange, eventually incorporating most of them into the Exchange but that the Exchange isn’t immediately available to individuals. You can find that info on Page 74 of HR3200. Title II Health Insurance Exchange.

    That portion explicates that the process will be transparent but it doesn’t explicate that since elsewhere it speaks about companies submitting costs to the Secretary which would include the actual cost of the procedure plus any prices or discounts negotiated by the companies. So the bill seems to know of an “actual cost” of a procedure and yet the language was obscured with the additions you mentioned. This is somewhat mentioned on pages 67 and 68 but it is specific to retirees in that section.

    The Bill may very well mention those costs elsewhere but it didn’t jump out at me in that reading and thus can’t find it.

  11. Last questions, more on the opinion: do you think the bill as you’ve read it incorporates lessons that we should’ve learned from our current system (both the failures and successes)? And do you think that it answers the moral responsibilities we have given our collective wealth and the needs of the people?

  12. I think one important lesson we need to remember through this thought process is this: our freedom to choose must be protected at all costs. Freedom, once eroded, rarely returns.

    When our government starts dictating how health care should be delivered, it interferes with the process of freedom of enterprise….and that of the freedom of the individual. Our founding Constitution did not guarantee the right to health care, nor should it. The Dec. of Independence does however stress the belief that the individual should function within our governmental structure as free individuals, endowed by our Creator with certain unalienable rights – life, liberty and the pursuit of happiness. It states next that government was established to protect these things. Our country was founded on the principle that less governmental involvement is better than too much. Thus, we should not be put in the position to become captive to a governmental-regulated system in most things. Free enterprise allows freedom of choice to flourish.

    I love this line in the Dec. of Independence: We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. —That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. :)

  13. Mem, short answers: (1) sort of but needs to go further and (2) not really and potentially harmful.

    I think the Health Reform bill addresses some necessary issues but I don’t think it addresses the bulk of the issues. For example, let’s say that the public option is employed and the Bill launches as is: how will they stop the skyrocketing costs? Will Big Pharm have a cap on drugs? Will lawsuit awards against doctors be capped? Will doctors still have to pay a high amount for liability insurance? Are deductibles still a major problem with health costs?

    So I don’t think that the House Bill (I’m currently reading the Senate Bill) incorporates all of what we’ve learned about the system as it stands. I’m not even sure that the Bill address our corporate moral responsibility since the deductibles are still high. It extends coverage (morally good); it broadens how long something is covered (which is good); and it tries to remove preventative procedures from the deductible requirement (which is very good)–but people’s problems isn’t so much the preventative: it’s the problems they have now.

    I would like to see an incentive program for gym membership. A tax on unhealthy foods also applied to the corporate level. An incentive program for whole grains, insecticide free food, organic milk, etc.

  14. @ Kathy…

    I see your point (but not really). So you’d be okay with insurance companies starting to charge whatever amount they feel? You wouldn’t want the government to step in and take control, protecting us, the consumer?

    I understand that less government is good in some ways, but when a basic thing like healthcare is almost impossible to afford (especially if you just lost your job, can’t find one, are disabled, have a pre-exsisting medical condition, etc) it takes away from what America really is…the land of the free (I don’t see being at the mercy of insurance companies as being free to pursue that happiness that you talk about). Hell…I have a full time job and I can barely afford the coverage I’ve got now (and i’m a healthy 27 year-old!)

    Oh and I’ve had several people tell me that the reason they don’t agree with the reform is because they don’t want to pay for everyone elses bills (since according to them everyone that needs help is a low-life, lazy bum). We’re not talking about the government providing everyone hummers and flat screen tvs people, we’re talking about freakin’ health insurance… why are people so angry about this? I just don’t get it. I’d hate to see one of them lose their job and get sick… I guess they wouldn’t want any help from anyone

  15. Jessica — had you asked a little more nicely, I would have responded in agreement with you. I also agree that insurance reform is necessary. I just don’t think we need a total overhaul of the health care system.

    Our health care system isn’t broken. It just needs tweeking. It’s a wonderful system where free people can choose their health care and physicians instead of having it mandated to them. Some of us believe we need to fix some of the broken things in the existing system….instead of replacing it with a gov. run system, where choices will be severely limited.

    We already know that the gov. can’t run anything for long without it going broke. The post office is one example…..Medicare will be financially broken in 10 years. How long do you think a huge health care system will last with all of this bureaucracy and trillions of $$ indebtedness to the Chinese? Just think about that for a minute. Just how long do you think the Chinese are going to wait to be repaid? They are a force to be reckoned with.

    The irony of this situation is that your generation will have to live with your demands long after I am gone — and that sucks for you. I give you 30 years and you will remember my words a little differently.

    It’s too bad you don’t understand the immense value of your freedom. It was won at a huge cost. My father paid a huge price for your freedom – he suffered in Korea, WWII, Vietnam twice, Grenada and Cuba…..just to let you believe that America owes you more than you deserve.

    You see, Jessica, freedom is not normal in this world. In fact, it is rare in this world. America is unique because we treasure the right of the individual. Why on earth do you want to throw this away? So you can feel entitled to free health insurance? Which by the way, is not free. Someone has to pay for it. Oh that’s right — you want me to pay for it!

    And yes, I am tired of your generation thinking that it’s your right to have the gov. provide for all of your needs. Where do you draw the line, Jessica? Who chooses what the gov. should and should not pay for? The latest lobby group? The biggest environmental group? You? Our budget is already drained from the plethora of pork that is in every bill passed in Congress today. Less government, Jessica, is better for all of us. Politicians on both sides need to start understanding the concept of LIMITING government if you want your future to remain free.

    Health care is not a right. It is something you work hard for and budget for — just like buying that TV you want. There is no difference. It is your choice to either buy that TV or buy health insurance….and be grateful that you had the choice to buy good health insurance for yourself and your loved ones.

    We make the choice to live within our means so that we can afford good insurance. Sadly, your generation doesn’t like to pay for things like this. Your generation would rather go out and buy the latest IPhone, go to a 15.00 movie every week, buy a Caramel Mocha Latte Grande at Starbucks everyday instead of budgeting for important things like health care. The little things add up.

    I have 2 girls your age. I know your generation well. There is value in understanding the concept of freedom and what it means to your future, Jessica. To use your vernacular, it’s your freekin’ future we are talking about. Do you want to remain a free young woman or do you want someone telling you what you can and can’t do in the future? That’s what we are talking about.

    Finally, none of us want the truly indigent to suffer. I’m tired of others painting conservatives as uncompassionate when we give more per capita to social programs, charities and welfare organizations than others do…..check out the stats.

    The fact is: There are already a plethora of gov. run health care programs for those in true need. In addition, almost every hospital has an indigent care program for the truly needy. It is a fallacy that those in true need cannot get health care. Instead, we need to better learn how to point them to existing programs.

    We, as Americans, are a compassionate people. I think all would agree that we must care for the truly needy. We must not, however, enable selfish people to ruin the most amazing country on the planet. We must stop assuming that things like health care are rights instead of items we work hard to possess. We should fix the bugs in the system now without dismantling it so that it doesn’t exist ever again.

    Sadly, part of the problem is the lack of education – the ignorance of the average American. Jessica, I know you won’t like what I have said….but just as your mother might say, I’m saying these things for your good, not for your misfortune. I want you to have a rich, full life — full of freedom and joy. I don’t want you to live in bondage. Your desire for a handout is creating a life of slavery for you, your children, and future generations. You can take those words to the bank.

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