Bear Mountain Bull

Health Care Bill Explained

61 Comments

1. I’ve been reading various things on it–but I admit, this is far worse than I knew. I even wrote AARP on that one bullet–asking them about the rationing in the bill. They denied there was rationing, but it seems to me they lied.

   Comment by Maria — 7/26/2009 @ 11:23 am

2. In the immortal words of Yosemite Sam: “Yeah, dem’s fightin’ words!”

   Comment by Max Power — 7/26/2009 @ 11:48 am

3. This has a kind of final solution feel to it. Boomers are a demographic problem but, no Boomers, no problem.

   On the bright side, the Democrats among the Boomers will still be allowed to vote.

   Comment by Fred — 7/26/2009 @ 12:28 pm

4. Sounds to me like they’re following Daschle’s outline/plan to a ‘T’. Scary stuff indeed — especially for us boomers. We’ll just get sent off to pasture. And you’re right — the faster we can get rid of the boomers, the longer SocSec and Medicare can limp along…

   It could be taken to an extreme — they could do some of the health care ‘rationing’ along party lines.

   Comment by BMB — 7/26/2009 @ 3:30 pm

5. What bothers me, once again, is that there really is no focus on improving health care. It’s all about getting people insured–and how to force everyone to participate and how to force employers and individuals to pay up. There’s no discussion on alternative plans (like the one posted a week or so ago where you pay into a doctor’s office each month–and you get whatever care you need.) There’s no discussion on making health care more accessible–like allowing pharmacists or more nurse practicioners handle lower-grade prescriptions like antibiotics. There’s not talk about making the system more efficient. Just a hard, hard sell that insurance is the ONLY thing and instead of it being catastrophic insurance, it’s vanilla insurance. That’s it. Nothing else.

   Comment by Maria — 7/26/2009 @ 3:53 pm

6. Quick – scare up a story about a recently dead or dying celebrity! Avert your eyes, people!

   Thanks for the links, BMB.

   Comment by David — 7/26/2009 @ 4:23 pm

7. Sure thing David. I’m just glad that Mr. Fleckstein was willing to provide us with the Cliffs notes.

   Comment by BMB — 7/26/2009 @ 4:42 pm

8. Yep, me too. Let’s be honest – I had no intention of reading the whole thing myself.

   Comment by David — 7/26/2009 @ 7:29 pm

9. The Congress people don’t even read it. That’s the real crime.

   Comment by Maria — 7/26/2009 @ 7:46 pm

10. I was waiting for someone to point that out Yes, it’s criminal.

    Comment by David — 7/26/2009 @ 8:03 pm

11. Why should they care? It’s not their health system. They don’t have to live under the rules/laws they’re voting on.

    Comment by BMB — 7/26/2009 @ 8:29 pm

12. Nope, they have special health care and insurance just for them. Guess maybe if they had to live under the rules we do, they might just pay more attention.

    Comment by Maria — 7/27/2009 @ 11:02 am

13. Byrd and Kennedy should be the first to be forced
    join.

    Comment by Rod — 7/27/2009 @ 11:31 am

14. I’m sure they’d be thrilled to receive the ‘end of life’ counseling.

    Comment by BMB — 7/27/2009 @ 12:28 pm

15. I would like to clarify what the following section of the healthcare bill really says:

    SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED

    (c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-
    (1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
    (2) ANNUAL LIMITATION-
    (A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
    (B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
    (C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.
    (3) MINIMUM ACTUARIAL VALUE-
    (A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
    (B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

    Is this section saying that the basic plan will have a $5000 deductible for individual and a $10,000 deductible for family? And that the plan will pay 70% after the deductible is met?

    Comment by David Beaird — 7/28/2009 @ 2:11 pm

16. Hmm. It kinda sounds that way, doesn’t it? Outside of “preventive services” at least. And note those amounts will be increased each year, corresponding to the CPI.

    I’ll be honest — I haven’t read the bill, and can’t say that I’m very knowledgeable on the gory details. ‘Gory’ being the key word there…

    Comment by BMB — 7/28/2009 @ 2:23 pm

17. The problem (if interpretation is correct) is that catastrophic care is far more expensive than preventive. But then I suppose it depends on what is considered prevention. Diabetes care? You are preventing worse illness by getting insulin, right?

    5K deductible. That would be in line with coverage that was for catastrophic care. Of course, most people wanting health insurance probably aren’t thinking their deductible will be that high.

    See, that’s the problem. They didn’t even write the thing in English. Congress isn’t reading it and the American people have in their head a definition of “health insurance” that has nothing to do with this bill.

    Comment by Maria — 7/28/2009 @ 3:34 pm

18. It’s “BIG BROTHER” come to life!!!!!

    Comment by AB — 8/4/2009 @ 12:49 pm

19. I don’t remember where I read it this morning, but someone said something about Obama & Co. wanting to “stick the needle” in anyone over 39 years of age. Not that far off the mark, from what I’ve seen.

    Comment by BMB — 8/4/2009 @ 2:19 pm

20. Oh, yeah, the insurance industry doesn’t control our care NOW? And doctors decisions aren’t reversed?

    So, we’re supposed to keep the insurance industry alive without ‘competition’? Why??? We’re rationed now, we have people shut out because of “pre-existing conditions”, retroactive denial of claims…PERFECT,right?No rationing, right?

    Please. The scare tactics about the Canadian system are just that, too…they fall down exactly where our non-system falls down.

    But Medicare works. Just fund it! I kissed the ground when I became eligible for Medicare after several years of pretending I lived in a state that I had moved out of (using my brother’s address) because I was afraid I couldn’t get a new policy.

    All we focus on in this country is the “business” of the health care industry, not actual healthcare and people’s needs.

    UGH! I don’t like Obama’s plan because it enhances the role of the insurance industry way more than that industry deserves!~

    Comment by GRL — 8/5/2009 @ 12:10 am

21. GRL — I’ve been advocating trying to push insurance out of the picture for some time now, believing that our reliance on the use of insurance is stifling competition. Of course, my ideas will never see the light of day.

    Comment by BMB — 8/5/2009 @ 6:35 am

22. Huh? There’s something missing – all those Americans who die or live with crippling illnesses with no treatment and no access to healthcare right now. That’s a great outcome that we have had for decades.

    Comment by David Stein — 8/5/2009 @ 11:08 pm

23. We already have gov’t systems in place for those people — if those systems are broken, then fine, let’s fix ‘em. But for the rest of us, our over-reliance on health insurance is driving up costs for everyone by discouraging competition and keeping pricing structures in the dark shadows.

    Comment by BMB — 8/6/2009 @ 6:47 am

24. Okay, Mr. Fleckstein’s “Cliff’s Notes” are definately skewed, I agree its not a great bill, as its just creating another insurance company basically, what is wrong with the health plan every single other industrialized nation has, but I wish someone would actually make “Cliff’s Notes” of the Bill that aren’t skewed to one side or the other… seriously, read the comment, then go read the section of the bill he cites, if this was a book report, he’d get a “D” for accuracy, but an “A” for spinning…

    Comment by LLA — 8/7/2009 @ 9:10 am

25. In this debate, if you want a supposed ‘objective’ view, I’m afraid you’ll have to read the entire bill yourself. If you think he’s skewing the facts, feel free to take it up with him. The link to his blog is in the post.

    Comment by BMB — 8/7/2009 @ 9:29 am

26. I went through EVERY SINGLE claim this cuckoo (Peter Fleckstein) is making…every single one, and went through the actual Health Care Bill line by line according to his claims. Let me tell you people, this is propaganda of the simplest and most grotesque kind. If you’re a hammer, everything looks like nail, right? Every claim he makes (at the top of this page) is ABSOLUTELY skewed INTERPRETATION of the bill, and has nothing to do with the actual language of the bill. Just to cite one small example of how this so-called “analysis” is skewed: He claims the government will issue a “Health Care ID Card”. Oh my god! Run everyone, run!!!! Don’t be stupid people…what do you do when you go the doctor now, just tell them you name? Duh! Obviously you need an insurance card. Are you really so worried about the ‘big brother” government. Gimme a break, you think the insurance company hasn’t sold your address, phone numbers, and other private info already in the last 20 years?

    Bottom line, people, is that we need CHOICE in health care. CHOICE. You like your ridiculous high premiums and exclusions for pre-existing conditions?…don’t worry, you get to keep that bullcrap plan…you can stay ‘grandfathered” in it if you want.

    Comment by Mr. Unbiased — 8/9/2009 @ 7:28 pm

27. Well, except that, no, I don’t show an insurance card now and yes, I give them my name. And if you go through the bill, there is absolutely no guarantee that your premiums won’t be high–see commenter number 15 above. This is an assumption made by many people–they assume low premiums–in fact they assume lower premiums than they currently pay, but there is nothing in the bill that provides for that.

    Sure, there’s the threat/promise of “helping” people with premiums if they fall below some magic line, but be careful of where you think that line is. No one thinks they are rich–but Congress sets the line for who pays what taxes. A lot of people are assuming this bill will help them–lower premiums and make health care affordable. But…be careful of assuming that this plan is going to be affordable.

    And…why is it you say you don’t have a choice now? Sure, you can’t choose to pay a lower premium. But, well, what makes you so certain your premium will be lower with the government plan. What if you fall into the bracket where it’s actually higher?

    Comment by Maria — 8/9/2009 @ 7:50 pm

28. And keep in mind, I have nothing against improving health care (I’m all for it). I have nothing against lowering costs. I have nothing against finding ways to treat people with pre-existing conditions. I just don’t think this plan or national insurance, is it.

    Comment by Maria — 8/9/2009 @ 7:55 pm

29. Thanks for this list, I think it’s great — however I’m a bit skeptical about the whole thing. I looked up a single item:

    Pg 30 Sec 123
    THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get

    and read the section in the bill, and came away with a very different impression then the one supplied here. The way it’s phrased on your list, it makes it sound like some shadowy government body is sitting around, sifting through everyone’s health records, and deciding whether or not you get the treatment that might save your life. If you actually read Sec 123, you see that it describes the formation of a Health Benefits Committee — the group that decides what plans are available and what treatments are in the different plans. How is this in ANY WAY different than insurance companies today? In fact, it’s far better: Part of the mandate of the Health Benefits Committee is that it be comprised of a wide variety of practitioners, including experts in people with disabilities, children, etc. Additionally, all this info is public, so I get to see exactly who is making the decisions and what they’re deciding about my plan, a considerable improvement over the god-knows-what happens at my current health insurance company.

    I’m a little curious to know if anyone else looked up any of the other items here to see how valid they were, but after just one I’m not sure I’m going to spend my time on it.

    But again, thanks much for the list, it’s great to have a starting point for this whole debate.

    Comment by eric — 8/10/2009 @ 10:41 am

30. Eric, nothing wrong with a little skepticism. It’s not our list, it’s Mr. Fleckstein’s list.

    As with investing, when it comes to this health care plan there are numerous opinions out there, and many of them have their own agendas. It pays to do your own homework. We can only hope that our legislators will read the entire bill before voting on it…

    Comment by BMB — 8/10/2009 @ 10:54 am

31. I thought a number of the items on the list were…well, they were highlighted in the worst possible interpretation. I think that “leaning” the facts to frighten people ultimately isn’t a good way to go because then any valid points get overlooked.

    And I think Eric’s interpretation is fair except for the part about what is different today with insurance companies. Here is the key for today’s plans: In order to sell a plan to a company, insurance companies have to be competitive–they have to at least make a show of covering more at a lower cost. If someone doesn’t get the care they think they have–the person/company can sue.

    Throw a government committee in there — if THAT committee doesn’t cover it, guess what? No one HAS to. That happens to some extent today with medicare–if medicare doesn’t cover it, insurance companies use it as an excuse to not cover it. Ergo, you start letting a government body decide on various plans, you don’t have competition, you have a stifling of competition.

    You also have the problem of offering a particular item–that everyone offers–at a set rate. This means there is not any reason for a doctor or an insurance to offer it at a lower rate and they can’t charge more for it. It’s a form of price controls, which, while a lot of people think is good in health care, actually isn’t all that great. When the price of something is driven too low, people stop selling it and the lines to get it are suddenly a lot longer–and then you start having “rationing” either by design or just by accident. It’s already happening with today’s medicare. Some doctors don’t accept it–they feel they can’t stay above water with the low pay. Some doctors will no longer do certain procedures–the cost of carrying malpractice insurance is too high for certain procedures (this is especially true in premie births).

    It’s the case of one of my friends in the UK. She can get her kidney stones treated because there is national health insurance. It took 3 weeks to get it diagnosed due to waiting for an appt. It took about 8 weeks to get it treated after it was diagnosed. She was on a waiting list. Her cost was low–but her pain wasn’t so great.

    Comment by Maria — 8/10/2009 @ 11:40 am

32. We’d better be careful how much we talk about the health care plan, or we’ll get ‘flagged’ by the White House. Their snitches are on patrol.

    Comment by BMB — 8/10/2009 @ 12:19 pm

33. Please watch this Bill Moyers interview with someone who worked for CIGNA Health Insurance company for 15 years. It’s an intelligent discussion about some of the issues we all face as Americans regarding our health care. http://www.pbs.org/moyers/journal/07102009/watch2.html.
    Here’s the transcript if you’d rather read it. http://www.pbs.org/moyers/journal/07102009/transcript2.html

    Comment by Elizabeth — 8/10/2009 @ 3:18 pm

34. That’s a very one-sided article and it doesn’t specify why he thinks this government plan is good (ie, what will the deductible be? What will the premiums be?) He said he realized that people didn’t have health insurance–but having health insurance does not equal “Can afford care.”

    So really the article says, “We have a problem.” Yes. I think we’ve all agreed improvements are needed. And while he seemed to think a government run insurance program would solve it, I’m afraid he did not address the issue of just what it would cost.

    Comment by Maria — 8/10/2009 @ 3:29 pm

35. In addition, Michael Moore is in the entertainment industry. Talk about leaning the facts…

    Comment by Maria — 8/10/2009 @ 3:33 pm

36. Not only should we keep the gov’t out of the insurance business, we should get the insurance companies out of the insurance business. We can afford to pay for cell phones galore, iPods, plasma TVs, and a boatload of people just went out and bought new cars in the last few weeks. But no one is willing to write a check for their health care. That’s the way to start bringing costs down.

    You buy insurance on your house in case it burns down, but insurance doesn’t pay for a new front door or to mow your grass. It should be the same for health care.

    Let’s get those WalMart clinics going where people can go to have their blood pressure taken, cholesterol checked, and have simple blood tests done at a reasonable price — maybe see a doctor or nurse pract. if they’ve got a cold or something. Then we’d start seeing costs come down.

    Comment by BMB — 8/10/2009 @ 3:33 pm

37. Please…please go to a legitimate site to read the REAL proposed bills! This site is manufactured, perhaps by insurance company employees – who knows?…. to make you think it’s okay to read someone else’s condensed versions that are NOT accurate! I really mean NOT ACCURATE! Please, Americans, questions why this site wants to give you falsified claims…. why would this site do this? Do they want you to think for yourself? I think NOT! We need reform – please give constructive ideas to your representatives…. not emotionally charged and ill informed ideas …. read the real proposals … don’t let others pander to fears!

    Comment by Elizabeth — 8/11/2009 @ 7:09 pm

38. We linked to the bill above — here is the link again. If people want the ‘real’ thing, I suggest they read the legislation itself — that’s as ‘legitimate’ as you can get.

    We aren’t ‘manufacturing’ anything. If you ever bothered to read the original post, you would discover that the claims are those of Mr. Fleckstein, not of BMB. If you want to argue with him, you’d have better luck doing so at his site. And if you’d bother to read what BMB has been saying, you’d find that he’s recommending getting insurance out of the picture — hardly what an insurance company employee would suggest. Get a grip Liz.

    Do we need some change? Yup, it would be nice. But that doesn’t mean that the current proposals are the right ones.

    Comment by BMB — 8/11/2009 @ 7:43 pm

39. If your idea of a legit site was the one you posted yesterday with quotes from Michael Moore, I’d suggest that you take your own advice. Go read the bill. Spend some time at legit sites.

    Comment by Maria — 8/11/2009 @ 7:53 pm

40. Does the U.S. House of Representatives count as a legit site?

    Here is the healthcare bill (HR 3200) direct link from DC, in its 1012 page glory.

    http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

    Comment by Henry — 8/11/2009 @ 10:11 pm

41. “Health Care Bill Explained”? I don’t think we’ve travelled any closer to that goal here. BMB, please stop deflecting the many legitimate criticisms of the original posting by repeating that it is not the original work of this site but of Peter Fleckstein. We all see that. Your introduction to the quoted piece insinuates that it will clarify the “confusion between what the gov’t is saying they’re doing with health care and what they’re really planning to do…” You haven’t objected when folks respond with positive comments to Fleckstein; you accept the cheers because you know that you are now partially responsible for the content you posted, quote or not. The criticisms of the Fleckstein piece and of some similar comments posted here are accurate and important. Mostly they arise from partial readings of the bill text. For instance, the section that describes the cost of the government option plan is reprinted in a comment, but to get a full understanding of what that option would cost you, you would need to read further to where the bill outlines credits provided to low-income families and individuals (FYI, families earning less than 400% of the poverty level qualify for credits to be applied towards that $5000 annual deductible and premiums). Another confusion from partial reading: the misrepresentation that there is no discussion of alternative cost-saving measures. In fact, hundreds of pages are devoted to supporting various community-based health networks (for things like prevention and treatment from nurse practitioners). Confusingly structured, yes, but can we really fault Congress for writing a bill as bills are written? They have a logic and a structure designed for a specific purpose, and that purpose is to mesh with the legal and political institutions of the people who must execute the bill in the various executive administrations. The purpose is not to be accessible to laypeople. Other folks in government, most importantly the President should be doing the explaining, which he is doing quite well, if you give him a chance by reading his full-text addresses and visiting the handy Whitehouse website on healthcare instead of cruising blogs. Another mistake I’m seeing here is folks confusing the setting of minimum standards in healthcare with complete bureaucratic control. While there are legitimate concerns regarding the ripple effect of setting even the lowest of standards, they are hugely overblown on this and many other sites. The last and worst “mistake” made in the Fleckstein piece and, consequently on this blog which knowingly reposted it and “moderated” related comments, is plain old lying. It is impossible to imagine that even the most distracted reader could confuse what is in the bill with some of the lies written by Mr. Fleckstein above concerning illegal immigrants. In fact, the bill explicitly states (although it doesn’t have to, considering there are no contradictory passages in the new legislation) that current laws pertaining to residency will remain in effect and determine access to the rights and privileges described in the bill. And then there’s the end-of-life care issue. I have grudgingly accepted that, if you haven’t taken the few minutes necessary to discover those rumors about the government encouraging euthanasia are false, nothing I or anyone else writes or says will sway you. This bill is certainly intimidating, but I don’t feel rushed. For how many months have different versions of this bill been available at opencongress.org? No, the outrage and distrust with which we all seem to be consumed was manufactured far too late in the game for it to be considered sincere. You CAN take this bill on in a comprehensive way in just a few hours. You are all intelligent enough to determine which parts are legalese and which contain substantive directives, you just need to wade in and keep going. Then skip the hour or two blog-cruising and write an email to your representative outlining the points you like and dislike. Tell them their job is on the line with this one and mean it! Most urgently, please, please do not buy into the distrust and anger. Our system is flawed but it works if you work it. Bad ideas don’t need to be shouted at and angrily torn down; they wither away when better ones are thoughtfully issued.

    Comment by Ryan — 8/12/2009 @ 11:51 am

42. Ryan, this blog has posted whatever comments come in–whether they agreed with Fleck or didn’t. Anyone that wanted to post on why this bill is a good and great thing has certainly been welcome to post. I haven’t seen many such posts; Brad has probably posted some of the most interesting posts when it comes to: What problem are we trying to solve.

    So I’d have to ask you: you seem to be for the bill. Why? What’s so great about it? And if you like it, how do you propose the measures in it be paid for?

    Maybe you don’t think rationing will happen (although there is evidence from other countries with universal health care that it does happen) but what are your thoughts on why it won’t?

    Maybe you think the illegal immigration thing is a lie–but keep in mind that today hospitals are required to give care to anyone that goes into the ER–thus illegal immigrants are covered. So…this bill would not change that (and I don’t happen to think that it should, but those that don’t want illegals to have coverage…) you can see why people get the idea that illegals will have coverage. They are entitled to their opinion on the subject.

    Comment by Maria — 8/12/2009 @ 12:09 pm

43. You can rest assured that we have contacted our representatives with our thoughts. You can also be assured that we are not ‘angry’. We are willing to let the ’system’ work, as you say, flawed though it may be. We have our single votes, just like the rest. And we may not be thrilled with whatever the results are, but that isn’t anything new.

    Comment by BMB — 8/12/2009 @ 12:17 pm

44. I am sad to see that the original posting took the wording in the bill and twisted it so grossly that it looks evil. All of the conclusions and commentary I looked up are both incendiary and false. Hopefully the truly independent-minded folk see this for what it is and ignore the smoke these people are trying to blow.

    Comment by Mike — 8/12/2009 @ 8:02 pm

45. @Mike. I see more than smoke here.

    Would you care to offer your alternative interpretations to the sections Mr. Fleckstein specifically listed on specific pages of the House 3200 Bill and why we should not be concerned about this bill’s broad and vague language?

    When I read the 1017 page bill side-by-side with Fleckstein’s interpretation, common-sense indicates he raises valid concerns that the proposed law could be interpreted and realize undesirable consequences for us all in the future.

    This bill comes to us, “the taxpaying people,” by the same Congress that recently brought us the growing Afghan war, TARP, GM bailout, AIG bailout, stimulus, and still can’t offer solutions on the govt. programs already broken like social security.

    Why doesn’t Congress first win the Afghan war, pay off some debt, and make 3 of their businesses: the Post Office, GM, and Amtrak profitable then we’ll consider their ideas on the healthcare process afterwards?

    Comment by Henry — 8/12/2009 @ 11:12 pm

46. @Henry. Now there are some good ideas.

    Comment by Maria — 8/13/2009 @ 9:10 am

47. Love to, Henry. Let’s start with the first one:

    Fleckstein says:
    Pg 22 of the HC Bill
    MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!

    The bill actually says:
    Page 21
    SEC. 113. INSURANCE RATING RULES.
    2 (a) IN GENERAL.—The premium rate charged for an
    3 insured qualified health benefits plan may not vary except
    4 as follows:
    5 (1) LIMITED AGE VARIATION PERMITTED.—By
    6 age (within such age categories as the Commissioner
    7 shall specify) so long as the ratio of the highest such
    8 premium to the lowest such premium does not ex
    9 ceed the ratio of 2 to 1.
    10 (2) BY AREA.—By premium rating area (as
    11 permitted by State insurance regulators or, in the
    12 case of Exchange-participating health benefits plans,
    13 as specified by the Commissioner in consultation
    14 with such regulators).
    15 (3) BY FAMILY ENROLLMENT.—By family en
    16 rollment (such as variations within categories and
    17 compositions of families) so long as the ratio of the
    18 premium for family enrollment (or enrollments) to
    19 the premium for individual enrollment is uniform, as
    20 specified under State law and consistent with rules
    21 of the Commissioner.
    22 (b) STUDY AND REPORTS.—
    23 (1) STUDY.—The Commissioner, in coordina
    24 tion with the Secretary of Health and Human Serv
    25 ices and the Secretary of Labor, shall conduct a
    26 study of the large group insured and self-insured

    Page 22
    1 employer health care markets. Such study shall ex
    2 amine the following:
    3 (A) The types of employers by key charac
    4 teristics, including size, that purchase insured
    5 products versus those that self-insure.
    6 (B) The similarities and differences be
    7 tween typical insured and self-insured health
    8 plans.
    9 (C) The financial solvency and capital re
    10 serve levels of employers that self-insure by em
    11 ployer size.
    12 (D) The risk of self-insured employers not
    13 being able to pay obligations or otherwise be
    14 coming financially insolvent.
    15 (E) The extent to which rating rules are
    16 likely to cause adverse selection in the large
    17 group market or to encourage small and mid
    18 size employers to self-insure
    19 (2) REPORTS.—Not later than 18 months after
    20 the date of the enactment of this Act, the Commis
    21 sioner shall submit to Congress and the applicable
    22 agencies a report on the study conducted under
    23 paragraph (1). Such report shall include any rec
    24 ommendations the Commissioner deems appropriate
    25 to ensure that the law does not provide incentives
    Page 23
    •HR 3200 IH
    1 for small and mid-size employers to self-insure or
    2 create adverse selection in the risk pools of large
    3 group insurers and self-insured employers. Not later
    4 than 18 months after the first day of Y1, the Com
    5 missioner shall submit to Congress and the applica
    6 ble agencies an updated report on such study, in
    7 cluding updates on such recommendations.

    Now, of course nowhere in there does it use the word audit. And I recognize that the conspiracy folks who can see through walls will say “But wait, the Government says they will verify solvency and risk of becoming insolvent. This must mean a big, mean, nasty audit!” Do ya think there might be other ways to verify, like, say, self-reporting or financial analysis? Dun and Bradstreet has been doing this kind of analysis for years, and does it without audits.
    But we really know this isn’t about what the bill says. It’s about stopping that scary Obama. So no matter what the facts, the right wing will continue to yell and scream the same distortions, trying to create enough noise that nothing can get done. Sort of like how we never got around to finishing Afghanistan when we had the chance, verifying the WMDs before getting in the Iraq money hole, let finances run wild that made TARP and the AIG bailout necessary, propped up GM by using tax breaks to encourage people to buy SUVs, and drug our feet on fixing social security because the pure conservatives have hated the program since its inception. Truly sad.

    Comment by Mike — 8/13/2009 @ 9:10 am

48. Hmm. “Examine” and audit are pretty much the same thing, but quibbling over exact words isn’t going to sway anyone. Self reporting? Yeah, that worked very well for the financials and Enron didn’t it?

    Listen Mike, if you followed this blog at all, you’d know the opinions of TARP and GM aren’t high around here. (Both of which have continued to get money from both administrations–obama and bush.) This isn’t about democrats against republicans. Get past “supporting my team regardless of what they push.” It’s all about ideas. I don’t happen to believe Universal health insurance is a good idea, I don’t care whether it’s obama pushing it or not. You will notice that we’ve been talking about the bill–not obama.

    I happen to believe that regardless of whether the word “rationing” appears in the bill, that such bills lead to rationing and less quality. I base this on conversation and articles from people that live in countries that have it. There are some things about universal insurance that I like–for one, other countries have access to more drugs without a prescription, allergy medicine, birth control, antibiotics, etc. Other countries have different care facilities available. I am not against everything in the plan–but I think there are better ways to go about it. I think health care in this country can be improved without such a plan–by focusing in on solving the individual problems that need to be solved. By focusing in on problems one at a time–not by shoveling a huge, expensive plan–with no way to pay for it–down into the country.

    The right wing can yell and distort. Turns out we can see through that too. Or the left. I’m not against the plan because of distortions. I’m against the plan because I don’t want to pay for it. I don’t like many of the ideas. Don’t think that “if you just read it, you’d be for it.” I think there are better ways to solve the problems facing us and we can start by looking at the programs we already have and improving them and fixing them.

    Comment by Maria — 8/13/2009 @ 9:46 am

49. If you are involved in business, you realize audit has a VERY distinct meaning. It is very expensive for a company. The word was specifically chosen by Fleckstein because it is a scare word and causes people to stop thinking and start yelling. Since “Examine” was not in my post, I do not know how to respond to your question.
    As far as rationing goes, it is a pretty huge leap to assume it will happen. If you have specific ideas for alternatives, I am sure they would be welcome. The idea of approaching this problem piecemeal sounds good, but so many factors of the equation are interrelated that addressing one before the others inevitable leads to gridlock and we are back where we started.

    Comment by Mike — 8/13/2009 @ 10:30 am

50. “Examine” is the word used in the bill — from your post, page 22, lines 1-2.

    Comment by BMB — 8/13/2009 @ 10:34 am

51. Yes, audit has a specific meaning, but the word “examine” does not exclude an audit. I’m not scared by the word audit and I don’t recall yelling about it.

    Rationing to me, is not a huge leap to make, especially in a country that is already short health care providers. If it is a huge leap for you, that’s fine. You’re entitled to have your opinion. You may not like attacking the problem piecemeal either, but I happen to think it will save money and lead to far better solutions.

    I’ve listed a number of ideas that could be tried (in other posts.) I’m all for more nurse practioners, but I don’t think we need this huge bill to get that. I’m all for someone/anyone/from any party looking into malpractice insurance and lowering the cost so that doctors can do their job. I’m all for making medicines more available. Again, many, many steps can be taken to improve our healthcare system. I am not for this bill; I am not for burdening the American people with paying for this bill, but I am for improving the system.

    Comment by Maria — 8/13/2009 @ 10:41 am

52. Just some thoughts from someone who considers himself “neutral”:

    As far as where I’m coming from my broad opinion is this — I think we need to do something about health care. I think that there are ample data to support the idea that we’re not getting our money’s worth and it’s only going to get worse. I think the current process is untenable. I think that the “Right” does a tremendous disservice by preventing conversation about the topic, which leads to the “Left” trying to ram something through before all the shouting kills it all together. In my world we’d spend a lot of time figuring out how to do this best and then do it.

    On the subject of this particular original post, I put it in the category of a spam email used to scare people. If you put on your prism that’s dedicated to seeing malevolence, then you can read EVERY law in the world as giving the government the potential to do evil things. I know you will all scoff but that’s what the legal system is for. You can’t write a law that can’t be misapplied in absence of court interpretation. Some of the items on this list are downright bull and some are very loose interpretations. I don’t necessarily think we have a good bill, but making wild claims about it doesn’t help.

    Comment by Brad — 8/13/2009 @ 11:06 am

53. I agree Brad that leaning too far into scare tactics actually hurts more than it solves. It takes away from the discussion and also eliminates the possibility of discussing things like, ‘What is to prevent rationing?” which is a very real and legitimate concern–and the bill does nothing to relieve that worry. Just saying that the word rationing isn’t in there, doesn’t take away the concern or the evidence of rationing in other countries.

    Same thing with some of the other concerns–illegal immigration. Just stating it baldly in the post sure didn’t help anyone get clarification–but…from what I’ve read, there is nothing in the bill that keeps illegals from having coverage (and personally I’m not against them getting emergency care–but the bill leaves it open and it’s a valid concern). People are certainly entitled to know whether or not it covers them or not and how much.

    And yes, I have said all along that I think that while you can interpret the bill as done above, I think it was overdone. I also agree that going too far in either direction does a disservice. I will say that it generated a lot more discussion than I expected. I for one went and read many parts of the bill. I still don’t like it for reasons stated elsewhere, but it forced me to read it.

    Comment by Maria — 8/13/2009 @ 12:39 pm

54. Your reading assignments are never complete — there are different versions in the House and Senate. And I think there may be multiple versions in each…

    Comment by BMB — 8/13/2009 @ 12:44 pm

55. Yeah, there are like 5 of them out there.

    Comment by Maria — 8/13/2009 @ 12:47 pm

56. You think there’s any chance we could trade 5 incoherent ones for one good one?

    Comment by Brad — 8/13/2009 @ 1:50 pm

57. I’ll go 5-for-1 on incoherent Congress-people.

    Comment by BMB — 8/13/2009 @ 1:57 pm

58. @Mike. Thank you for the dialogue on the bill. I suppose it comes down to what the word “examine” means in a legal context. Both sides are corrupt.

    What about Mr. Emanuel and his time as a LEADER on the BOD at Freddie Mac from 2000-2002?

    http://www.businessandmedia.org/articles/2008/20081106133228.aspx

    And, Mr. Emanual’s nomination of Mr. Whitacre to GM as the current chairman of the Board who helped him during the SBC & AT&T mergers?

    http://www.gm.com/corporate/about/board.jsp

    To take an equal “shot” at the right, here Mr. Akerson on the board at GM is tied into that Bush private equity group known as the Carlyle Group. Oh. And, Mr. Akerson’s past, just like Emanual’s, is in the upper echelons of these telecom companies during the Worldcom merger scandals. Anyone remember Worldcom’s fraud which at the time was the largest before this TARP era broke those records?

    http://www.nytimes.com/2002/11/12/technology/12TELE.html
    http://www.businessweek.com/1997/41/b3548001.htm

    Total corruption by the left and right.

    These same corrupt people from Worldcom and Freddie, are now running GM and advocating this healthcare proposal. So, no, I don’t trust any of them!

    Comment by Henry — 8/13/2009 @ 4:47 pm

59. And, equal time for all. Here are links to the White House’s blog with the text of the email sent by the White House today in response to HR 3200’s critics:

    http://www.whitehouse.gov/blog/The-Return-of-the-Viral-Email/

    http://www.whitehouse.gov/realitycheck/

    http://www.healthreform.gov/

    “This is isn’t about politics. This is about people’s lives. This about people’s businesses. This about our future.” President Barack Obama.

    Comment by Henry — 8/13/2009 @ 6:47 pm

60. Pg 145 Line 15-17
    An Employer MUST auto enroll employees into public opt plan. NO CHOICE

    Pg 146 Lines 22-25
    Employers MUST pay for HC for part time employees AND their families.

    Wait what? Lie again. Lie better.

    Comment by big baby jesus — 8/16/2009 @ 12:11 pm

61. Ok gang. This topic has been talked to death, so comments on this thread are going to be closed.

    Thanks for all the input.

    Comment by BMB — 8/16/2009 @ 12:50 pm

RSS feed for comments on this post.

Sorry, the comment form is closed at this time.