Healthcare Is Too Important
I came across the following articles that I found interesting and Good read:
Healthcare Is Too Important to Be Put in the Hands of the Government
Jul 19 ’09 (Updated Sep 28 ’09)
The Bottom Line The healthcare bills that are working their way through Congress may end up giving government the right to decide who lives and who dies.
I hate to bother everyone with politics, but this is possibly the most serious political issue that we will face in our lifetime.
Right now, there are healthcare bills going through the House and Senate that will affect EVERYONE. They will affect the quality of medical care we all receive, the choices we will have for treatment and providers, the availability of jobs and the amount that we and generations to come will pay in taxes.
Some things I wish to point out are:
1) This bill is being rushed through Congress. The President initially wanted it passed this summer (and I’d like to think his intentions are good) but it is not a bad thing for bills to take time. At the very least, bills should take enough time so that all those voting on it have time to READ it. Ideally they should have enough time to read it more than once, understand it, study it and consider the long-term and short-term ramifications of it. Since this is still a representative democracy, it would be even better if their constituents had time to give them input.
UPDATE: The Senate and House have delayed the vote, but it could come up at any time. (The Senate is currently working through a few hundred amendments.) Lawmakers are trying to negate criticism of specific sections by pointing out that the bills aren’t finished. I might find this a reasonable argument if not for the fact that both the Senate and House had intended to bring the (unresolved) bills to a vote in August and postponed the vote only after a sizeable public outcry from both liberals and conservatives.
Washington State legislators have had forums assuring people of what the bills will/won’t do. I’ve pointed out to them that what they have said is in direct conflict with what is written. When I cite sections, they dismiss my concerns with an “oh that won’t be in the final bill” and “if you are really concerned about THAT then talk to your legislator and keep an eye on it.” The Senate and House bills total more than 1700 pages–that’s a lot to keep an eye on.
And I have to ask: If we can’t trust that any provision we currently see written in the bill is real then how can they so blythely assure us that all these things that they claim (especially the things that aren’t backed up by any actual language in the bill) will be realized in the final bill?
2) The House bill mandates that EVERYONE buy health insurance. And that health insurance MUST conform to government guidelines. If you do not buy the government-guideline health insurance you and/or your employer will be penalized severely at tax time.
The Senate Kennedy bill doesn’t mandate coverage (not in so many words)–but the CBO notes that the bill includes a provision to penalize people that don’t have coverage and concludes that it is the intent of the bill to also mandate coverage.
3) The government is anticipating that enough INDIVIDUALS and employers will not obey to allow the government to raise $200 BILLION in PENALTIES. The government needs this money to help fund this healthcare program, which experts estimate will initially cost more than a trillion dollars. Another $500 billion in funding will be taken from the budget for Medicare/ Medicaid. The rest will come from an increase in taxes.
($150 billion of the $500B is to come from Medicare Advantage.)
Pls note that the $500 billion cut to Medicare comes at a time when the ageing Baby Boomers are starting to need Medicare. Yes, there are abuses in Medicare, but just cutting funding will not automatically fix the abuses. The net result will be a lot more people counting on Medicare and significantly less money available per person than there is today.
4) If you buy your own insurance, your current health insurance plan probably does not conform to the government guidelines proscribed in the House bill–BUT individual health insurance plans existing before the law goes into effect will not have to meet the new insurance standards.
BE AWARE that this does NOT mean your current insurance coverage is guaranteed to remain untouched. If your plan were to change, it would no longer be excluded and you might have to switch to a government-conforming plan. Under the House bill a raise in rates or change in copayment might be considered enough of a change to negate the exclusion. If other people want to buy into your plan–they can’t. Since the number of people in the plan will dwindle, the rates will have to increase.
5) If you get your insurance through your employer, your plan WILL change. A group/employer’s health insurance plan is also grandfathered in–but only TEMPORARILY. In the House bill there is a 5-year grace period (see p. 17 of the draft) in which the employer has time to transition to a plan conforming to the government guidelines, after that penalties begin.
6) In a company where the current employees have a really good health benefits plan that doesn’t conform to government guidelines (and is temporarily grandfathered in), new hires will not be eligible for the same plan.
7) ALL employers will be forced to offer health insurance to their employees (both fulltime and parttime), paying a large percentage of the premiums. According to the House bill, employers who don’t provide coverage would be hit with a penalty equal to 8 percent of worker’s wages. There are subsidies available to some VERY small businesses, but the qualifying criteria (in both House and Senate bills) is complicated.
The Wall Street Journal has pointed out that even businesses with between 5-10 people might NOT qualify for the subsidies and has stated that small businesses will be hit especially hard.
I’ve seen news articles that say that small businesses with an annual payroll of $250,000 or less will be exempt, but I haven’t confirmed that in the actual text of the bills. (Some folks say the exclusion could go to businesses making $500k or even $750k–but according to the Senate bill the exemption will only last 3 years and require a lot of paperwork).
However, imagine this: if this is true and you are a small business with a payroll slightly over this amount, this could be enough incentive to layoff employees or possibly convert some positions to outsourcing so that you will gain the exclusion. If you were just under this amount, it’s a good reason to give smaller raises and stop hiring. This is NOT a good message to send businesses during a recession.
Update: some critics speculate that although the 8 percent penalty sounds hefty–it might actually be cheaper and easier for the employer to pay this instead of upgrading the company health insurance to conform to the new guidelines. Employees who are currently happy with their company’s group health plan, might end up losing it and having to buy the public option plan. If you are unsure as to whether this might happen to you, try to find out how much your health insurance is costing your employer, then calculate how much 8 percent of your pay is.
The CBO reasons that employers who don’t already provide health insurance are likely to pass any additional costs forced on them back on to the employees in the form of wage cuts and fewer job openings, especially for those who make close to minimum wage.
9) Update: I’ve seen many news articles that say that senators and congressmen will be able to keep their current health coverage, which they get through a federal package (FEHBP) and is supposed to be superior to the public option that many of the rest of us will end up on. (They might be referring to p.38 or p. 114 of the Senate plan– BAI09A84.pdf) I would feel more optimistic about this Public Option if the lawmakers were willing to go on it too, but so far they have fought tooth and nail against it and defeated measures mandating that legislators who vote for this universal healthcare plan give up their federal health coverage. Course they could just allow everyone access to the FEHBP, it seems a lot cheaper than mandating that each state set up a bureaucracy to administer and oversee an insurance program.
10) Update: The CBO believes that the Healthcare bills are likely to result in fewer people seeking employment (resulting in less tax revenue). If health insurance isn’t tied to employment, older people may opt for early retirement (especially if they can qualify for subsidized coverage). Younger people might opt to enter the workforce later since they can be carried on their parent’s plan till they are 27 and if they don’t earn money they can qualify for subsidized coverage. And some workers may opt to work fewer hours if they find that a slight increase in wages means they will get less in subsidies.
Right now when there is high unemployment people may not find a reduced work force to be a thing of concern, but these patterns of behavior persist when jobs are plentiful and labor is hard to come by. These subsidies are meant to assist folks who are struggling, but they can also be taken advantage of by people who have money in the bank (or wealthy parents) and have realized that they can get somebody else to pay for their health insurance. How will you feel when you see your tax dollars going to pay for health insurance for your neighbor’s kid, who could get a job but would rather play videos all day?
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Do not take my word for all this. Don’t just listen to the assurances that the politicians are giving (they could be mistaken or lying). Look at what the bills themselves are saying–AND KEEP LOOKING. There is more than one version of each bill. The bills will get merged at some point, but details change as a bill works its way through Congress. Don’t forget what happened recently to the Cap and Tax bill where Waxman added a 310-page amendment at 4am on the day of the vote–so PAY ATTENTION.
And don’t just read what the bills say, THINK about the logical outcome.
Some people might read through the bills and think, “well, it’s great, I fall into the category that will be subsidized.” Then ask youself this, “What if the bill passes then is amended, so that you are no longer in the group that is subsidized, but in the group that will be penalized thousands of dollars?”
If you don’t care only because you believe that someone else will be paying the tab–think harder. When has the government’s expectation of the cost of a project ever been accurate? Things ALWAYS cost more than expected. The current plan is already expected to cost more than a TRILLION DOLLARS. An easy way to bring down the cost is to toss out the subsidies.
Free money is an illusion. It has to come from somewhere. The government plans to bleed as much as it can out of high-income taxpayers, but it may not be able to get as much as it expects. With the downturn in the economy, revenues will be lower. The need for money will drive the government to grab it from wherever it can. Odds are taxes will increase for many more people, and the government won’t be able to give as much in subsidies as they currently promise. (Do you think that Social Security (FICA) started out by taking as big a chunk of the paycheck as it currently does?)
What if you don’t qualify for a subsidy and the government plan costs more than your current health plan? Or what if your employer has to do an across the board paycut or layoff some people in order to cover the increased healthcare costs?
Or what if it’s cheaper for your employer to pay the fine rather than provide healthcare? If your employer decides to stop providing you with health insurance, they pay the 8 percent TO THE GOVERNMENT–NOT TO YOU. You will have to pay for your own health insurance (probably buying the Public Option–you know the one that our lawmakers don’t want to get stuck with?). If you don’t qualify for a full subsidy, it will be like getting a paycut.
Also, if your employer is currently paying for your health insurance–that is pretax dollars. If your employer stops providing you with health insurance but is nice enough to give you more money to help defray the added cost–that will count as a pay increase which will increase the amount of taxes you pay AND you won’t be keeping any of that money because you will have to spend it on health insurance. (The CBO specifically mentions that this will help government revenue.)
What if you are used to the convenience of a PPO, but the new plan is more of an HMO and limits your choice of physicians? In the current bills, young healthy people don’t have the option of just buying inexpensive catastrophic coverage–they have to buy the same bloated plan because they need to pay for the people who aren’t as healthy.
Why do you want to put yourself in the position of reducing your freedom of choice? If you don’t like the government-guideline healthcare plan–TOO BAD–you will still be forced to buy it or pay thousands of dollars in fines.
If you feel the bill is unconstitutional and refuse to get government-guideline health insurance and then refuse to pay the fine, it’s like not paying your income tax. You open yourself up to larger fines and possible jailtime.
Update: I’ve been looking into the medical profession, to see feedback from doctors. Some doctors are in favor of the reform. One of these that I spoke to hadn’t read the bills, hadn’t ever dealt with Medicare–just knew that there were problems with the system and the bills promise to fix them. More sites and comments that I’ve read indicate that easily 2/3 of doctors oppose these bills. Many say that they will change professions, move to another country or retire early if the bill passes. I’ve seen postings from educators that say they’ve seen preMed college students change their major or hold off on applying for med school until they know whether this bill will pass.
I doubt whether all the doctors who talk about quitting will do so if the bill passes. They will instead linger in their jobs, reluctant to quit, but full of frustration and anger. I’m not saying that they would deliberately do anything unethical, but doctors are human. In dealing with any human I’ve found that I do not get their best effort when they are discontented with their job. In this recent demonizing of doctors, people often forget what a difficult job it is. Even something as simple as a headache can have a myriad of possible diagnoses, ranging from dehydration to the early signs of meningitis to an aneurysm. Doctors have to make these potentially life-death diagnoses all the time. I’d like to make it easier for them to work, not harder.
What if the nationalized system drives the private insurance carriers out of business, then fails because it is just too expensive? This could result in either no insurance to help defray the costs or rationing.
Many believe that the inevitable result of this healthcare bill will be a severe rationing of healthcare.
Rationing will mean that some government bureaucrat (not your doctor) will decide which tests and treatments you will have access to. In Canada rationing occurs in an ingenious way. Canadians that have been interviewed on TV say that no one is ever denied treatment–it’s just that sick people have to wait years and years and YEARS to get it.
Pls look into the healthcare bills NOW before they become laws.
If you want to maintain your freedom of choice when it comes to healthcare, please ask your legislators to vote against it.
UPDATE (9/10/09): I listened to President Obama’s speech last night. It was a great speech. It mentioned a lot of good ideas and reassured people about several items that have been heatedly discussed. I don’t want to bore people any more than I already have by going into everything he talked about, but I wish to make some key points:
1) President Obama is NOT the one writing the bill or adding amendments–the senators and representatives are. The current legislation (any of the 4 versions that are out of committtee) doesn’t match what the president talked about. The easiest thing might be for them to start over from scratch using the president’s speech as a blueprint.
2) The president has promised not to sign a bill that adds to the deficit. The current bills add from $239B to a trillion dollars to the deficit in the first 10 years (and that’s NOT including administrative costs, which haven’t been calculated yet). The president has further promised not to take any money from Medicare. The plan has been to offset the expense by taking $500 billion from Medicare, without it we should revise the estmates to adding $739B and $1.5 trillion to the deficit. If that money doesn’t come from Medicare it will come from somewhere else–we just don’t yet know where that will be.
(Some experts have maintained that the plan to cut $500B from Medicare is still in effect. The president would be keeping his word by using a bit of wordplay in that the money wouldn’t be cut from Medicare, but from the reimbursements that Medicare gives the healthcare professionals. Many doctors say that this would give them incentive to retire early.)
3) The president has promised to add a trigger that if the plan starts to cost more, that they will “cut spending” to prevent it from adding to the deficit. Lawmakers have had this provision before and when push comes to shove they’ve usually waived it and spent the money anyway. If they don’t–then think about it. The majority of the spending will be on claims, with a little on personnel to process those claims. If they cut the amount of money available for claims, it will mean that not everyone who wants medical treatment will be covered for it. They will then have to figure out what treatments will get covered and what won’t. THIS is what we mean by RATIONING.
I don’t expect rationing to happen immediately, but with all my heart I believe it to be inevitable. And I believe it is likely to become widescale after this new system becomes entrenched and it’s too late to go back to what we had.
Those who think that the government’s involvement means that no one will be denied coverage for anything are naive. It’s a nice idea, but it’s not feasible. It might work for a little while, but it’s not sustainable.
And I’ve lately started to wonder what effect these changes will have on the overall character of our society. As the burden for paying for healthcare gets shifted from the individual to society as a whole, then will it change how we will start to look at those among us who are sickly, fat, handicapped, old…and those who make risky choices that could land them in the hospital?
Will we stop shrugging and saying “it’s a free country” and start judging and saying “no, when YOU make bad choices, you become a BURDEN on all of us, so we can’t let you make those choices any more”?
4) The president talked about being more efficient and cutting waste in healthcare and I believe I know what he is talking about. A few of our state legislators in Washington State are part of the national healthcare effort and were summoned to DC to give input on the legislation (and they say they still have an inside track to help shape the final bills). One thing they have cited as an example of inefficiency and waste in our healthcare system is the way that different doctors have different ways of treating the same illness. They feel it’s more efficient for the government to identify the most effective treatments and pay only for those–and to NOT cover the other treatments. They feel the same way about medications–that the government should identify and cover only the “most effective” ones. They feel this approach will force doctors to be more efficient. At a glance this may sound good, but it ignores the fact that physiologies differ. Treatments that work on most people might not work on you. The drug that works on everyone else might work on you too, but might have unpleasant side effects, where a less common drug might work better.
Earlier this summer the president talked about efficiencies and treatment, mentioning how instead of subjecting a patient to a surgery that may or may not help, that just taking a pill to treat the symptoms might be better. The patient saves money and is spared the pain of surgery and the insurance carrier (in this case the government) saves money too. That is an okay option–but I want the patient and doctor to make that decision based on what is best for the patient. I don’t want the government to be influencing this decision.
My current insurance plan gives my doctor the flexibility to decide what treatment to use. If I end up on a government plan, I hope I can keep the same doctor and that she still has the same flexibility. Until we see the final legislation, we have no idea what we will or won’t get.
A sad truth to bear in mind is that it might take years for us to know for sure exactly what this government healthcare plan will be because a lot of the details will be left up to the people in charge (like the Secretary of HHS or some committee) and they will make changes as they see fit. Once they have the authority to control our healthcare, the rest is just details.
(Update 9/21/09)
I haven’t had time to read the Baucus bill, but those who have don’t like it. www.dickmorris.com has some analysis of it. It sounds like it will make things expensive for the healthy, and this going after “cadillac” plans will hurt the middle class, like firefighters who have these better plans.
(Update 9/24/09)
Some House lawmakers are pushing to delay the vote 72-hours after the bill is finalized. This is a good idea as it will give the public (those that are paying attention) the chance to drop everything and download and skim the final bill. It will also allow speed-reading congressmen the opportunity to go through it and it might give the CBO the chance to figure out how much it will cost.
The senate intends to not make the final bill available, they plan to have a translation written in non-legal available–which doesn’t sound too bad, except every once in awhile when they do this, the non-legal version has mistakes. In a 700-page bill, I’d be surprised if there were no mistakes, hopefully they won’t be on crucial clauses.
Bear in mind that even these are NOT FINAL. At some point the bills have to be combined into ONE that wil go before the president. I hope that bill has a chance to be studied in detail by the CBO (INCLUDING administrative costs), so that the president can know if the bill he is signing will add one dime or more to the deficit, so that we don’t have to wait 5- 20 years for the trigger clause to be activated and cause rationing or possibly ignored and add to our debt.
Here are some links that I think will be helpful:
(epinions has a bug that thought a few of the URLs–the ones for the House bills–were too long, so I had to add returns to break up the character strings in order to post the review–sorry, just paste the sections together)
http://keithhennessey.com/2009/06/09/house-health-bill/
http://www.dickmorris.com/blog/2009/09/21/obamacare-losing-everyone/#more-638
The Kennedy bill:
http://help.senate.gov/BAI09A84_xml.pdf.
the Baucus senate bill:
finance.senate.gov/healthreform2009/finalwhitepaper.pdf
House bill HR3200:
http://energycom
merce.
house.gov/Press_111/
20090714/aahca.pdf
earlier House draft that I used to write parts of this opinion:
http://waysandmeans.
house.gov/media/pdf
/111/hrdraft.pdf
CBO’s review of draft of Kennedy senate bill:
(NOT including administrative costs, the Senate plan will add a trillion dollars to the deficit)
http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf
CBO’s report on HR3200
(NOT including administrative costs, the heathcare plan will cost a trillion and add $239 billion to the deficit in the first 10 years and a trillion the next)
http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf
CBO’s report on the effect of these changes on labor markets
http://www.cbo.gov/ftpdocs/104xx/doc10435/07-13-HealthCareAndLaborMarkets.pdf
(The CBO reports are a lot easier to read than the bills–and shorter)
