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.