A Couple More Things About The Health Care Bill

Tuesday, 23 March 2010, 15:07 | Category : Healthcare, Politics
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We keep hearing that this bill shouldn’t have been passed because “a majority of Americans oppose it”. But, like all statistics, you have to understand what the responses really said. CNN’s poll released Monday, had it like this:

Based on what you
have read or heard about that legislation, do you generally favor it or generally oppose it?

Favor 39%
Oppose 59%
No opinion 2%

Sounds bad. But the next question was:

(IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is
too liberal, or because you think it is not liberal enough?

Favor 39%
Oppose, too liberal 43%
Oppose, not liberal enough 13%
No opinion 5%

That may explain the USA Today poll from today:

A good thing the bill passed 49%
A bad thing it passed 40%

It looks like the 13% mostly were satisfied, and came home to join the 39%.

Senate Health Care Reform Plan (H.R. 3590)

Thursday, 18 March 2010, 8:23 | Category : Healthcare, Politics
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Just to make it easier to follow my posts, here they are in order:

Part 1

Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

Part 8

Part 9

Part 10

Part 11

Wrap-Up

Senate Health Care Reform Plan (H.R. 3590), The Wrap-Up

Wednesday, 17 March 2010, 20:25 | Category : Healthcare, Politics
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So, I’ve finished reading the bill. Did I miss some things? Certainly. Did I miss something important? Probably. No surprise, it’s a massive bill. Often the language repeats, the same qualifications and requirements applying to different situations. But I have a much better grasp of what the Senate Democrats were trying to accomplish. I tried, for the most part, to keep my opinions out of what I wrote earlier. So, if you hung with me this far, and don’t want my opinions, you have my permission to stop reading now. Here’s what I think:

First, you have to understand that this bill doesn’t begin to resemble the “Federal takeover of health care” that the Republicans, Tea Party, and assorted other right-wing elements would have you believe. Many of the things it does are fix things that you and I hear friends, coworkers, and ourselves complaining about constantly. Does it fix them the best way possible? Maybe not. What’s the best way for you, and the best way for me, are likely different things. But it would make many parts of our health care system better, or more bearable. Does it save money? Maybe. Maybe not. It depends on things like efficiency improvements, and cutting some subsidies, and increasing some taxes. But by standardizing things like application and reimbursement forms, and forcing policies to be explained in plain language, and forcing insurance companies and healthcare provides to provide performance reports in common formats, it simplifies the process of getting and using healthcare and insurance. It means people with pre-existing conditions can get decent coverage and keep it. I know many people think people with pre-existing conditions are simply doing things to themselves that affects their health, but there’s so much more to it, and that’s such a callous attitude.

Yes, the Secretary of HHS has a great deal of discretionary power in this bill. The status quo isn’t going to change on its on, and that means someone somewhere has to do the pushing and pulling.

Most of all, my impression is that this bill could so easily have been much better, and could have addressed many of the objections of its opponent, if the Republicans had not decided to arrange themselves in lockstep opposition to anything and everything the Democrats tried to do, and simply say “no” over and over, like a 5-year-old who won’t eat his broccoli. And I don’t buy the “they wouldn’t allow any of our ideas on the table” argument. These guys have been doing this a long time – they know how to reach across and work with the other side. It could have been so much more. But it should be passed. It’s not a great bill, it may not even be a very good bill, but it’s good enough.

Senate Health Care Reform Plan (H.R. 3590), Part the Eleventh

Wednesday, 17 March 2010, 19:55 | Category : Healthcare, Politics
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Picking up at page 2005 – simple cafeteria plans for small businesses are established. I have to admit, I don’t grasp the significance of this, there must be something in existing laws that makes this difficult. Moving on to Title X, the act prohibits the imposition of lifetime or annual dollar limits on coverage. And our national paranoia about any form of gun control asserts itself – the act prohibits the collection of any information related to ‘‘(A) the presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property of an individual; or ‘‘(B) the lawful use, possession, or storage of a firearm or ammunition by an individual.”; and the presence or ownership of guns or ammunition cannot be used to increase insurance premiums. Amazing.

States can choose to outlaw any abortion coverage plans offered through the exchanges if they enact a state law prohibiting those services. No insurance plan can be forced to offer coverage for abortion services. If a plan does offer this coverage, the enrollee must pay for this coverage by a separate payment from their normal premium payment; if by payroll deduction, there must be two deductions; the insurance company must keep the payments for premiums covering abortion services in an account separate from their general account, and the payments for the services must come from these respective accounts.

If you’re interested (and I highly doubt that this survives the House), the infamous Ben Nelson payoff for Nebraska is on page 2129.

The act establishes a fund for states to assist pregnant and parenting teens and women, for things such as pregnancy/parenting student services centers established by colleges and universities or improving services offered to victims of domestic violence.

The act extends Medicare coverage to individuals exposed to and suffering from specific effects from certain environmental hazards (think mesothelioma and other cancers). And it will modernize the information technology used for Medicaid and Medicare.

The last hundred or so pages wind it down with sections about assisting the creation of collaborative community-based health centers for low-income patients, better access to dialysis and diabetes care, creating “centers of excellence” for treatment of depression. and enhancing the treatment for congenital heart disease and breast cancer.

Oh, and it creates a task force to “assess access to health care for beneficiaries of Federal health care systems in Alaska; and ‘‘(2) develop a strategy for the Federal Government to improve delivery of health care to Federal beneficiaries in the State of Alaska.” And it funds demonstration projects for states “for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations”.

The End.

Senate Health Care Reform Plan (H.R. 3590), Part the Tenth

Tuesday, 16 March 2010, 15:37 | Category : Healthcare, Politics
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Starting around page 1760, there is an act within an act – the Elder Justice Act, which has the goal of preventing, detecting, and treating abuse of the elderly. I certainly don’t make light of it, but I’m not going to delve into that part of the act. This is followed by a section on “Improving Access to Innovative Medical Therapies”. This seems to be all about “biosimilar biological products”. If I’m understanding the wording, it makes it easier to get follow-on drugs to market. But I may have it completely wrong.

Title VIII establishes a voluntary insurance program to aid people with “functional limitations” who want to continue living in their communities. The insurance would cover the costs of assistance, equipment, and home care. If I understand what the act is saying, you would have to be enrolled for up to 5 years before receiving assistance, so maybe this is like a long-term care policy. For tax purposes, it is treated “in the same manner as a qualified long-term care insurance contract for qualified long-term care services.”

Now we get to one of the things that gives heartburn to the House of Representatives – Title IX. This is the “Cadillac tax” on employer-sponsored insurance plans that offer “excess benefits”. The excess is determined by the cost to the employer of the insurance, which must be reported on the employee’s W-2. Initially, the bar is set at $8500 for individuals and $23,000 for family coverage, and would increase according to the cost of living each year. The amounts would be higher for employees in high-risk occupations or “employed to repair or install electrical or telecommunications lines”. High-cost states get an additional bump. I have heard that the House wants this taken, but it’s part of the funding source in the Senate plan. There is also a provision wherein manufacturers of medical equipment would pay a yearly fee to the government, according to a formula that I didn’t even try to understand, and there’s a fee paid by insurance providers that I also didn’t try to understand. And there’s a half-percent hospital insurance tax (Medicare) on those making over $200,000 a year. And, a 5 percent tax on elective cosmetic procedures, and a 10 percent tax on tanning booth services.