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Taken from http://www.defendyourhealthcare.us/

What the Pelosi Health-Care Bill Really Says
Here are some important passages in the 2,000 page legislation.
OPINION / NOVEMBER 7, 2009
By BETSY MCCAUGHEY

The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

(Here's a link to the entire 1,990 page bill in PDF format in case you want to see for yourself all the points Betsy McCaughey makes.)

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.

• 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.

• 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.

• 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, and ineligible for subsidies.

• 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.

Eviscerating Medicare:

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."

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."

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.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• 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.

• 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.

• 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."

Questionable Priorities:

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."

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.

• 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.

• 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."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

For the text of the bill with page numbers, see www.defendyourhealthcare.us.

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York state.

Last edited by kxmode on 10 Nov 2009, 1:54 pm, edited 1 time in total.

Autistic people usually get stuck with restriction but never seem to qualify for benefits. If this "health care" legislation becomes "law," I hope the people will fight it with every means available. Believe me when I say that I am no friend of the insurance cartel. However, this legislation will not transfer power from the insurance cartel to the people, it will only give the government more power at the expense of the people as well as maintain the insurance cartel's power over our health care.

Fantastic, sign me up! Seriously though, why are people under the illusion that the current insurance industry run system is working out just fine? My family already pays 18% of our income on premiums (not including co-pays which have just gone up again), we rarely see actual physicians - usually just NP's, and we are on a waiting list for a specialist for over 1 year now. We have no choice in plans or providers as they are dictated by our employer and insurance company. We are unable to independantly chose a different insurance provider because the cost would be closer to 40% of our income and we'd be denied anyway because my husband and my son have pre-existing conditions. My daughter might not qualify either because she is considered underweight (she was slightly premature). My only complaint with this bill is that I don't think it goes far enough. I would favor a Medicare-For-All system.

It won't be any better under a government controlled system. I hate the current system as much as you or anyone else, but I know that a more government controlled system would not be any better. A government bureaucracy takes a 5 minute job and turns it into a 1 hour one. There is very little that government can do that private citizens cannot do better and cheaper. I would prefer to get rid of both the insurance monopolies as well as the government control over the system. It would be better if everyone paid their doctors directly and cut out the parasites. If that were to happen, then medical providers would be forced to make care affordable or go out of business.

The "repugnicans" mistake corporatism for capitalism. Corporatism occurs when multi-billion dollar corporations use their financial and political power to get legislation passed that gives them unjust advantage over competitors. The insurance industry has managed to cut themselves out a quite a few fiefdoms. I cannot get together with a group of like minded folks to form an insurance pool nor can I buy insurance out of state without running afoul of some government rule. The insurance industry needs crushing as much as the government bureaucracy.

And an article from the liberal New Yorker...

Some Vaguely Heretical Thoughts on Health-Care Reform

With the publication of H.R. 3962, the House Democrats’ mammoth, 1,990-page proposal to restructure the health-care system (the outlines of which can be found in this detailed summary), decision time is fast approaching in the big reform debate. Paul Krugman, in his usual forthright style, says, “History is about to be made—and everyone has to decide which side they’re on.” Democrats and progressives can line up behind the reform legislation that House Speaker Nancy Pelosi put forward last week, or they can help to kill reform for another generation by aligning with hard-line conservatives.

As political analysis, there’s something to be said for Krugman’s Manichean view of the world. But Krugman is also an economist—a very good one—and the economics of what is proposed bear inspection. The President is on the verge of fulfilling his campaign pledge to extend health-care coverage to many of the uninsured. He is doing this, however, not by transforming the existing system of private insurance, which gave rise to many of the current problems, but by extending it. The White House has reached a deal with the big health insurers, such as Aetna and CIGNA. In return for the industry’s agreeing to cover people with preëxisting health conditions, and making various other more minor concessions, the government will force more than twenty million new customers into its arms.

I regard an expansion of the government safety net as ethically essential, economically justified, and long overdue. It is indefensible for a country as rich as the United States to fail to provide adequate health care for many of its citizens. In extending our health-care system, all we are doing is catching up with Otto Von Bismarck’s Germany, which recognized a hundred and twenty-five years ago that universal health and disability coverage, along with old age pensions and a system of public education, were essential elements of a modern society. Moreover, given the reluctance of “Blue Dog” Democrats, such as Nebraska Senator Ben Nelson, to support anything that smacks of big government, and President Obama’s determination to coöperate with moderate Republicans, the proposed reform may be the most that can be accomplished today. But we will be dealing with its consequences for decades to come, and I think it’s important to be clear about what the reform amounts to.

Let’s remind ourselves of the basics. There are two big (and linked) problems with the current health-care system. It excludes 46.3 million Americans, according to the Census Bureau, and it is inordinately expensive. The proposed reform purports to tackle both of these problems; in fact, it only addresses the first one in any systematic manner. The future cost savings that the Administration and its congressional allies are promising to deliver are based on wishful thinking and sleight of hand. Over time, the reform, as proposed, would almost certainly add substantially to the budget deficit, thereby worsening the long-term fiscal crisis that the country faces. Financing this measure alone wouldn’t break the U.S. Treasury. Other elements of the fiscal picture, such as the looming increases in interest payments on the national debt and an explosive growth in Medicare spending as the baby boomers retire—are far larger. But the numbers involved in health-care reform are still significant—perhaps one per cent of annual G.D.P.

The Pelosi bill, in particular, wouldn’t do much, if anything, to address the overall escalation in health-care costs, much of which is rooted in the nature of insurance, where individuals consume costly health services, and different people—the other members of their risk pool—pay for them. This is the “moral hazard” problem that the economist Kenneth Arrow identified as long ago as 1963. (For an easy-to-understand account of Arrow’s argument, see this riveting new book on market failure.) In the past twenty years, many ideas have been tried in the effort to restrict the growth of spending within a private insurance system, the most notable of which was the creation of H.M.O.s. Some have enjoyed temporary success. None have worked for long.

If you read through the briefing papers provided by the House Ways and Means Committee, the fiscal implications of the proposed reform are pretty obvious. Under the proposed legislation, people whose employers don’t offer health coverage will receive “affordability credits” that fall with income, tapering off at about eighty-five thousand dollars a year. A lower-middle-class family of four earning, say, forty-five thousand dollars a year would be entitled to a subsidy of, say, seventy-five hundred dollars a year, to enable them to buy a basic health insurance plan that would cost them, say, eleven thousand dollars a year on the proposed Health Insurance Exchange, These estimates are based on a table on page 3 of the summary document I referred to earlier, which says that families that earn between two hundred and two hundred and fifty per cent of the federal poverty level would have to pay a maximum of eight per cent of their income in insurance premiums. Some poorer families that couldn’t afford to buy coverage even with the generous new tax breaks and subsidies would become eligible for an expanded Medicaid program. Individuals and families that failed to obtain coverage despite these inducements would be subject to a fine of seven hundred and fifty dollars for each uninsured adult.

By any standards, the subsidies in the plan are big ones. For example, they dwarf the Earned Income Tax Credits for poor and middle-income working families, which have been steadily expanded since George H. W. Bush first introduced them. From an egalitarian perspective, the establishment of these generous subsidies would be an important moment in U.S. history. But two practical questions immediately arise. Who would police the new system, and how much would it cost?

The answer to the first question is the Internal Revenue Service. If you couldn’t prove to the I.R.S. that you hadn’t obtained coverage, it would add the seven-hundred-and-fifty-dollar fine to your tax bill. A healthy, single, self-employed person in his twenties would have the choice of buying an individual insurance plan for, say, five to six thousand dollars a year (considerably less than that if he were eligible for a subsidy) or paying the fine. Undoubtedly, some people will choose to pay the fine and go uninsured. According to a Congressional Budget Office analysis of Pelosi’s plan, in 2019 there would still be about eighteen million uninsured adults. (In percentage terms, the share of legal nonelderly Americans with health coverage would rise from about eighty-three per cent today to about ninety-six per cent.)

According to the C.B.O., in summary, many more people will, with government assistance, buy private insurance coverage (some twenty-one million) and many others (about fifteen million) will become newly eligible for Medicaid, which is wholly financed by the taxpayer. Surely, this will cost considerable sums of money and add to the deficit. Or will it? The Democrat-controlled C.B.O. says that the Pelosi plan will actually reduce the deficit by a hundred and four billion dollars between 2010 and 2019, thereby satisfying President Obama’s claim that the reform will be deficit neutral. Furthermore, the C.B.O. suggests that the legislation’s impact on the deficit will continue to be negative in the following decade, from 2019 to 2029. I wish I could believe these figures, but I don’t.

Two large items underpin the Administration’s math: five hundred and seventy-two billion dollars of tax increases over ten years, and roughly the same amount of cost savings on Medicare and other existing government health programs. Most of the revenue increase would come from levying a 5.4 per cent surcharge on Americans individuals who earn more than five hundred thousand dollars a year and joint filers that earn more than a million dollars. I am a big supporter of progressive taxation, but at some point it becomes politically unsustainable. If health-care reform goes through, and the Bush tax cuts expire in 2011, top earners will face a marginal tax rate of forty-five per cent at the federal level. Add in state and local taxes, plus Social Security and Medicare payments, and wealthy people in New York, say, would be facing tax rates of about sixty per cent. As sure as night follows day, this would generate more tax evasion and a political backlash. Without a doubt, the next Republican-controlled Congress would reverse the changes.

If it decides to forgo soaking the rich, the Administration could return to its earlier proposal, which was included in a Senate Finance Committee bill that Senator Max Baucus put forward, to tax firms that provide their employees with costly “Cadillac” health-care plans. “A policy such as this is probably the number one item that health economists across the ideological spectrum believe is likely to stem the explosion of health-care costs,” Christine Romer, the chair of the White House Council of Economic Advisers, said in a recent speech. But this idea wouldn’t work politically, either. To raise enough revenue, the tax on swanky insurance plans would have to be set as high as forty per cent. When labor unions, some of whose members enjoy coverage in these plans, learned about this punitive levy they objected loudly, prompting Pelosi to drop the idea, which, broadly speaking, amounts to taxing the upper middle class to provide benefits for the lower middle class.

What about the proposed cost savings? They, too, are questionable. Most of them consist of reductions in Medicare outlays, which, according to this C.B.O. analysis, would save four hundred and twenty-six billion dollars between 2010 and 2019 compared with current plans. Look a bit more closely, and you find that more than half of the Medicare savings (two hundred and twenty-nine billion dollars) come from cutting payments to providers of services under the regular program; most of the rest (a hundred and seventy billion dollars) come from changing the way payments are set in the Medicare Advantage program. Does anybody really believe that these savings will materialize? For decades now, Congress has been promising to reduce the growth of Medicare outlays, and yet every year they continue to go up. The reasons are straightforward: the population is aging; seniors are politically active; and health-care treatments, particularly for the aging, continue to evolve in complex and costly ways.

To be fair, contained in its reform plan, the White House does have a proposal to address these issues: the establishment of an Independent Medicare Advisory Council (IMAC), which would provide Congress each year with cost-saving recommendations. “By removing some of the political pressure around such reforms,” Romer said in the same speech, “the IMAC would make it easier for improvements to be made year after year.” This statement can only be described as wishful thinking. I hope it will be proved right, but Washington is replete with now-defunct independent bodies and commissions that toiled dutifully, did good work, and made little difference.

So what does it all add up to? The U.S. government is making a costly and open-ended commitment to help provide health coverage for the vast majority of its citizens. I support this commitment, and I think the federal government’s spending priorities should be altered to make it happen. But let’s not pretend that it isn’t a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won’t.

Many Democratic insiders know all this, or most of it. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration, like the Bush Administration before it (and many other Administrations before that) is creating a new entitlement program, which, once established, will be virtually impossible to rescind. At some point in the future, the fiscal consequences of the reform will have to be dealt with in a more meaningful way, but by then the principle of (near) universal coverage will be well established. Even a twenty-first-century Ronald Reagan will have great difficult overturning it.

That takes me back to where I began. Both in terms of the political calculus of the Democratic Party, and in terms of making the United States a more equitable society, expanding health-care coverage now and worrying later about its long-term consequences is an eminently defensible strategy. Putting on my amateur historian’s cap, I might even claim that some subterfuge is historically necessary to get great reforms enacted. But as an economics reporter and commentator, I feel obliged to put on my green eyeshade and count the dollars.

Plan Pelosi is a financial Black Hole into which the U.S. will sink. The only way out will be rationing of health care as occurs in Britain and Canada.

It will look at first as if it is working, but the long run prospects are grim.

ruveyn

Yes, yes, everyone knows that government run health insurance is a disaster.

That's why Canada and the UK both have infant mortality rates and under-5 mortality rates 25% lower than the United States. Canada's life expectancy at birth is 3 years longer than that in the United States.

Canada spends 9.8% of its GDP on health care (USD 3,463 per capita) of which 70% is government expenditure. The United States spends 15.2% of GDP (USD $6,347 per capita) of which 45% is government expenditure.

So, spending USD$400 less per capita, the Canadian government delivers to every single person resident in the country (including temporary foreign workers and foreign students), comprehensive health care, with a substantially lower child mortality rate and longer life expectancy.

The simple fact of the matter is that private insurers exist to accomplish two goals: to distribute the cost of health care across the widest possible base; and to extract profit from the throughput. Health insurers do not provide any economic value-added to the system, they only redistribute cost. This is a classic example of a function that is better performed by Government, because Government does not have a profit motive.

Clearly the mixed market healthcare system is working well for US residents.

Thoughts I can get organized enought to get out right now are to dump the current tax code, go with the Fair Tax so you get home with rather more of your earnings than you do now, and allow unimpeded competition across the country for private health plans.

This talk of "obscene" insurance profits?
http://www.google.com/hostednews/ap/article/ALeqM5iorq8FSpX_4LX_UG_xHQIjJY3SvgD9BI5VB00

This comes through the Associated Press, which ain't exactly those right wing talk radio guys.







What's that line about "Show me the money"?

Say, aren't the drug companies in favor of the government health plan?
http://www.msnbc.msn.com/id/31485134/ns/politics-white_house/


{and what kind of pocket change are they giving in campaign contributions - directly or indirectly ???????????????}

okay, the drug companies have $80 billion to "give away", but; how much did the insurance companies even make in total?

http://abcnews.go.com/Business/health-insurance-profits-worth-outrage/story?id=9036632




At that rate, it's going to take quite a few insurance companies to make enough money to match what the drug companies have to just play with.

now, this, in there
Ain't nessecarily what it seems:




Remember - drug companies have eighty billion dollars to pretty much give away, while insurance companies "Made Hundreds of Millions"


so, insurance companies are making "hundreds of millions"
and, drug companies are giving away eighty-thousand millions.

Rather Interesting, no?


NOTE: Profits and Profit Margins are NOT the same thing!
Profits are the total income, the gross income.
Profit Margins are what is left after all the operating expenses and taxes are paid, the net income.
be very aware of that difference when reading the news.

This reform will be a lateral move.

US healthcare system sucks now and it will suck after the reform too. The costs to the public will be the same too.

Too many powerful and wealthy people and organizations oppose the reform because they are the middle men between me and my doctor and they are the ones making the most money. These men will find a way to make the reform a failure, despite what this bill says and despite anything the government does or does not do.

We need to reform the tort law so the doctors can't be sued by patients unless the doctors were grossly negligent. There are inherent risks in medical procedures. If little Timmy died on the operating table it wasn't necessarily doctors that killed him. That would reduce doctor's operating costs because they wouldn't have to carry 10 million dollars of insurance coverage. And then we need to have a lightweight insurance structure, pereferably run by healthcare professionals, with little administrative overhead.

Basically, cut out lawyers, insurance brokers, and bureaucrats out of the healthcare system.

We have some of the most competent doctors in the world, and certainly the most well equipped hospitals in the world. And yet our heathcare system is "in trouble"? That's just sad.

You attribute the difference to medical care. This is a fallacy. Health outcomes are more dependent on eating and exercise habits and economic class. We have large underclass (mostly persons of color) who do not get adequate medical care. It is not surprising that infant mortality is greater among these people.

Bad eating habits and lack of exercise have more to do with morbidity associated with cardiovascular conditions than does medical care.

At the turn of the twentieth century, death from infectious diseases was cut in half but cleaning up the water supply and making waste disposal more hygienic. This had more to do with increasing life expectancy than any improvement in medical care.

Canada is bound to score higher in health outcome. Percentagewise, Canada, has fewer blacks than the U.S. That alone will account for some of the difference.

If people stopped smoking, ate right and exercised sufficiently the outcomes would improve independent of the quality and quantity of medical care.

ruveyn

ah, thaT reminds me of something.

Found somewhere and copied into something I e-mailed to a friend and copied from there to here.
Forget where I found it and too lazy to google for it right now.

That's a petty and racist thing to say, not to mention over-generalizing.

I would like to point out something that makes me fearful.

From "What the Pelosi Health-Care Bill Really Says" (more conservative leaning)

From "Some Vaguely Heretical Thoughts on Health-Care Reform" (more liberal leaning)


You have different people basically saying the same thing. Doesn't this at least alarm anyone?

Actually, the comparative statistics were drawn from the CIA world factbook, and are normalized.

As for health outcomes being more dependent upon eating and exercise habits and economic class, that may be a contributing factor for life expectancy, but it certainly isn't for infant and early childhood mortality. The largest contributors to infant mortality are the lack of availability and lack of quality of pre-natal and neo-natal care.

Bear in mind, as well, that health care spending includes spending on prevention. Government funded initiatives that encourage good nutrition and exercise choices are just as much part of health care spending as hospital bills.

Something about "CIA" and "fact" appearing together always amuses me.

It might be quite accurate and realistic after all: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5127a1.htm


And



I think US black population is about 12 to 13 percent.
Some Googling brings up Canada's black population just a bit over 2 percent.
http://www.blackhistorysociety.ca/Black%20Canada%20History.htm

If 12% of one population has a given situation
and
if only 2% of other population has a given situation
it will indeed impact the scores of both populations as a whole.

Significantly.